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<1>
Accession Number
607461990
Title
Koroner arter cerrahisi uygulanan hastalarda kullanilan drenaj tupu
tiplerinin ve uygulanma yerlerinin ameliyat sonrasi donemde agri ve
efuzyon uzerine etkisi.
Source
Medical Journal of Bakirkoy. 11 (4) (pp 154-158), 2015. Date of
Publication: 2015.
Author
Belhan Z.; Karabulut E.H.; Ariturk C.; Okten E.M.; Toraman F.; Gormez S.;
Orhan P.
Institution
(Belhan) Acibadem Saglik Grubu, Turkey
(Karabulut, Ariturk, Okten) Acibadem Saglik Grubu, Kalp ve Damar
Cerrahisi, Turkey
(Toraman, Gormez) IstanbulTurkey
(Orhan) Acibadem Saglik Grubu, Bodrum Hastanesi Kalp ve Damar Cerrahisi,
Mugla, Turkey
Publisher
Yerkure Tanitim ve Yayincilik Hizmetleri A.S. (E-mail:
info@balkanmedicaljournal.org)
Abstract
Effect of different types of drain to postoperative effusion and pain on
patients who underwent coronary artery bypass grafting Objective: The
study was done to determine the effect of different types of drain to
postoperative effusion and pain on patients who enderwent coronary artery
bypass grafting (CABG). Material(s) and Method(s): 50 patients data
were evaluated prospectively. Standart drain was placed into 7-8th
intercostal area (Group 1). L drain was placed into pleural area (Group
2). Demographic data, drainage amounts were written from hospital
documents. Postoperative phericardial and pleural effusion was determined
by echocardiography and chest x-ray. Verbal Rating Scale was used to
dedicate pain score. Data were analyzed by T test. Result(s): Groups
demographic data were similar. Drainage was 652.0+/-328.3 ml (Group 1),
620.0 +/- 169.5 ml (p=0.04) in Group 2. Pain score before taking of drain
was 2.0+/-2.6 (Group 1), 1.0+/-1.6 (p=0.01) in Group 2, after taking of
drain was 4.7+/-3.0 (Group 1), 2.1+/-2.0 (p=0.05) in Group 2. Fifteen day
mean phericardial effusion was 0.2+/-0.4 cm (Group 1), 0.1+/-0.3 (p=0.05)
in Group 2. There was no difference between other parameters.
 Conclusion(s): Using both types of drain seems to be safe but L drain
is more comfortable because of less pain.

<2>
Accession Number
626249115
Title
Effect of electroencephalography-guided anesthetic administration on
postoperative delirium among older adults undergoing major surgery the
engages randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 321 (5) (pp 473-483),
2019. Date of Publication: 05 Feb 2019.
Author
Wildes T.S.; Mickle A.M.; Abdallah A.B.; Maybrier H.R.; Oberhaus J.;
Budelier T.P.; Kronzer A.; McKinnon S.L.; Park D.; Torres B.A.; Graetz
T.J.; Emmert D.A.; Palanca B.J.; Goswami S.; Jordan K.; Lin N.; Fritz
B.A.; Stevens T.W.; Jacobsohn E.; Schmitt E.M.; Inouye S.K.; Stark S.;
Lenze E.J.; Avidan M.S.
Institution
(Wildes, Mickle, Abdallah, Maybrier, Oberhaus, Budelier, Kronzer,
McKinnon, Park, Torres, Graetz, Emmert, Palanca, Goswami, Jordan, Fritz,
Stevens, Avidan) Department of Anesthesiology, Washington University,
School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, United States
(Lin) Department of Mathematics, Washington University, School of
Medicine, St Louis, MO, United States
(Jacobsohn) Department of Anesthesiology, University of Manitoba,
Winnipeg, Canada
(Schmitt, Inouye) Department of Medicine, Beth Israel-Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Stark) Department of Occupational Therapy, Washington University, School
of Medicine, St Louis, MO, United States
(Lenze) Department of Psychiatry, Washington University, School of
Medicine, St Louis, MO, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Intraoperative electroencephalogram (EEG) waveform suppression,
often suggesting excessive general anesthesia, has been associated with
postoperative delirium. OBJECTIVE To assess whether EEG-guided anesthetic
administration decreases the incidence of postoperative delirium. DESIGN,
SETTING, AND PARTICIPANTS Randomized clinical trial of 1232 adults
aged60years and older undergoing major surgery and receiving general
anesthesia at Barnes-Jewish Hospital in St Louis. Recruitmentwas from
January 2015 toMay 2018, with follow-up until July 2018. INTERVENTIONS
Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery
and positive vs negative recent fall history) to receive EEG-guided
anesthetic administration (n = 614) or usual anesthetic care (n = 618).
MAIN OUTCOMES AND MEASURES The primary outcomewas incident delirium during
postoperative days 1 through 5. Intraoperative measures included
anesthetic concentration, EEG suppression, and hypotension. Adverse events
included undesirable intraoperative movement, intraoperative awareness
with recall, postoperative nausea and vomiting, medical complications, and
death. RESULTS Of the 1232 randomized patients (median age, 69 years
[range, 60to 95]; 563women [45.7%]), 1213 (98.5%)were assessed for the
primary outcome. Delirium during postoperative days 1 to 5 occurred in 157
of 604patients (26.0%)in the guided group and 140 of 609 patients
(23.0%)in the usual care group (difference, 3.0%[95%CI, -2.0%to 8.0%]; P =
.22). Median end-tidal volatile anesthetic concentrationwas significantly
lower in the guided group than the usual care group (0.69 vs0.80minimum
alveolar concentration; difference, -0.11 [95%CI, -0.13 to -0.10), and
median cumulative time with EEGsuppressionwas significantly less (7 vs 13
minutes; difference, -6.0[95%CI, -9.9 to -2.1]). Therewas no significant
difference between groups in the median cumulative time with mean arterial
pressure below60mmHg (7 vs 7 minutes; difference,0.0[95%CI, -1.7 to 1.7]).
Undesirablemovement occurred in 137 patients (22.3%) in the guided and 95
(15.4%) in the usual care group.Nopatients reported intraoperative
awareness. Postoperative nausea and vomitingwas reported in 48 patients
(7.8%) in the guided and 55 patients (8.9%) in the usual care group.
Serious adverse eventswere reported in 124 patients (20.2%) in the guided
and 130 (21.0%)in the usual care group. Within 30 days of surgery, 4
patients (0.65%) in the guided group and 19 (3.07%) in the usual care
group died. CONCLUSIONS AND RELEVANCE Among older adults undergoing major
surgery, EEG-guided anesthetic administration, compared with usual care,
did not decrease the incidence of postoperative delirium. This finding
does not support the use of EEG-guided anesthetic administration for this
indication. Copyright © 2019 American Medical Association.

<3>
Accession Number
626035453
Title
Silent cerebral infarction and cognitive function following TAVI: An
observational two-centre UK comparison of the first-generation CoreValve
and second-generation Lotus valve.
Source
BMJ Open. 9 (1) (no pagination), 2019. Article Number: e022329. Date of
Publication: 01 Jan 2019.
Author
Musa T.A.; Uddin A.; Loveday C.; Dobson L.E.; Igra M.; Richards F.;
Swoboda P.P.; Singh A.; Garg P.; Foley J.R.J.; Fent G.J.; Goddard A.J.P.;
Malkin C.; Plein S.; Blackman D.J.; McCann G.P.; Greenwood J.P.
Institution
(Musa, Uddin, Dobson, Richards, Swoboda, Garg, Foley, Fent, Plein,
Greenwood) Multidisciplinary Cardiovascular Research Centre, Division of
Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic
Medicine, University of Leeds, Leeds, United Kingdom
(Loveday) Cognitive Science Research Unit, University of Westminster,
London, United Kingdom
(Igra, Goddard, Malkin, Plein, Blackman, Greenwood) Interventional
Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary,
Leeds, United Kingdom
(Singh, McCann) Department of Cardiovascular Sciences, BHF Cardiovascular
Research Centre, University of Leicester, Leicester, United Kingdom
(Singh, McCann) National Institute of Health Research (NIHR),
Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester,
United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To compare the incidence of silent cerebral infarction and
impact on cognitive function following transcatheter aortic valve
implantation (TAVI) with the first-generation CoreValve (Medtronic,
Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston
Scientific, Natick Massachusetts, USA). Design A prospective observational
study comprising a 1.5 T cerebral MRI scan, performed preoperatively and
immediately following TAVI, and neurocognitive assessments performed at
baseline, 30 days and 1 year follow-up. Setting University hospitals of
Leeds and Leicester, UK. Patients 66 (80.6+/-8.0 years, 47% male) patients
with high-risk severe symptomatic aortic stenosis recruited between April
2012 and May 2015. Main outcome measures Incidence of new cerebral
microinfarction and objective decline in neurocognitive performance.
Results All underwent cerebral MRI at baseline and immediately following
TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments
at baseline, 30 days and 1 year. There was a significantly greater
incidence of new cerebral microinfarction observed following the Lotus
TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts
per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean
volume of infarcted cerebral tissue per patient was equivalent following
the two prostheses (p=0.166). More patients suffered new anterior (14
(48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%),
p=0.005) lesions following Lotus. Lotus was associated with a decline in
verbal memory and psychomotor speed at 30 days. However, performance
longitudinally at 1 year was preserved in all neurocognitive domains.
Conclusions There was a higher incidence of silent cerebral
microinfarction and a greater number of lesions per patient following
Lotus compared with CoreValve. However, there was no objective decline in
neurocognitive function discernible at 1 year following TAVI with either
prosthesis. Copyright © Author(s) (or their employer(s)) 2019.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<4>
Accession Number
623698247
Title
Sodium Nitrite-Mediated Cardioprotection in Primary Percutaneous Coronary
Intervention for ST-Segment Elevation Myocardial Infarction: A
Cost-Effectiveness Analysis.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 24 (2) (pp
113-119), 2019. Date of Publication: 01 Mar 2019.
Author
Jones D.A.; Whittaker P.; Rathod K.S.; Richards A.J.; Andiapen M.;
Antoniou S.; Mathur A.; Ahluwalia A.
Institution
(Jones, Rathod, Mathur, Ahluwalia) Barts NIHR Biomedical Research Centre,
Barts and The London Medical School, Queen Mary University, London, United
Kingdom
(Jones, Rathod, Richards, Andiapen, Antoniou, Mathur, Ahluwalia) Barts
Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London,
United Kingdom
(Jones, Whittaker) Department of Health Policy, London School of Economics
and Political Science, London, United Kingdom
(Whittaker) Department of Emergency Medicine, Cardiovascular Research
Institute, Wayne State University, Detroit, MI, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objectives: In the follow-up of patients in a trial of intracoronary
sodium nitrite given during primary percutaneous coronary intervention
(PCI) after acute myocardial infarction (AMI), we found a reduction in the
incidence of major adverse cardiac events (MACEs). Specifically, MACE
rates were 5.2% versus 25.0% with placebo at 3 years (P =.013). Such MACE
reductions should also be associated with economic benefit. Thus, we
assessed the cost utility of sodium nitrite therapy versus standard
primary PCI only. Methods and Results: We developed a model to
simulate costs and quality-adjusted life years (QALYs) over the first 36
months after ST-Segment Elevation Myocardial Infarction (STEMI). Decision
tree analysis was used to assess different potential cardiovascular
outcomes after STEMI for patients in both treatment groups. Model inputs
were derived from the NITRITE-AMI study. Cost of comparative treatments
and follow-up in relation to cardiovascular events was calculated from the
United Kingdom National Health Service perspective. Higher procedural
costs for nitrite treatment were offset by lower costs for repeat
revascularization, myocardial infarction, and hospitalization for heart
failure compared to primary PCI plus placebo. Nitrite treatment was
associated with higher utility values (0.91 +/- 0.19 vs 0.82 +/- 0.30, P
=.041). The calculated incremental cost-effectiveness ratio of 2177 per
QALY indicates a cost-effective strategy. Furthermore, positive results
were maintained when input parameters varied, indicating the robustness of
our model. In fact, based on the difference in utility values, the cost of
nitrite could increase by 4-fold (2006 per vial) and remain
cost-effective. Conclusion(s): This first analysis of sodium nitrite
as a cardioprotective treatment demonstrates cost-effectiveness. Although
more comparative analysis and assessment of longer follow-up times are
required, our data indicate the considerable potential of nitrite-mediated
cardioprotection. Copyright © The Author(s) 2018.

<5>
Accession Number
626419169
Title
Effect of Intravenous Acetaminophen vs Placebo Combined with Propofol or
Dexmedetomidine on Postoperative Delirium among Older Patients Following
Cardiac Surgery: The DEXACET Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 321 (7) (pp 686-696),
2019. Date of Publication: 19 Feb 2019.
Author
Subramaniam B.; Shankar P.; Shaefi S.; Mueller A.; O'Gara B.;
Banner-Goodspeed V.; Gallagher J.; Gasangwa D.; Patxot M.; Packiasabapathy
S.; Mathur P.; Eikermann M.; Talmor D.; Marcantonio E.R.
Institution
(Subramaniam, Shankar, Shaefi, Mueller, O'Gara, Banner-Goodspeed,
Gasangwa, Patxot, Packiasabapathy, Mathur, Eikermann, Talmor) Department
of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, 375 Longwood Ave, W/MS-414,
Boston, MA 02215, United States
(Gallagher, Marcantonio) Department of Medicine, Division of Gerontology,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Postoperative delirium is common following cardiac surgery and
may be affected by choice of analgesic and sedative. Objective(s): To
evaluate the effect of postoperative intravenous (IV) acetaminophen
(paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on
postoperative delirium among older patients undergoing cardiac surgery.
 Design, Setting, and Participant(s): Randomized, placebo-controlled,
factorial clinical trial among 120 patients aged 60 years or older
undergoing on-pump coronary artery bypass graft (CABG) surgery or combined
CABG/valve surgeries at a US center. Enrollment was September 2015 to
April 2018, with follow-up ending in April 2019. Intervention(s):
Patients were randomized to 1 of 4 groups receiving postoperative
analgesia with IV acetaminophen or placebo every 6 hours for 48 hours and
postoperative sedation with dexmedetomidine or propofol starting at chest
closure and continued for up to 6 hours (acetaminophen and
dexmedetomidine: n = 29; placebo and dexmedetomidine: n = 30;
acetaminophen and propofol: n = 31; placebo and propofol: n = 30).
 Main Outcomes and Measures: The primary outcome was incidence of
postoperative in-hospital delirium by the Confusion Assessment Method.
Secondary outcomes included delirium duration, cognitive decline,
breakthrough analgesia within the first 48 hours, and ICU and hospital
length of stay. Result(s): Among 121 patients randomized (median age,
69 years; 19 women [15.8%]), 120 completed the trial. Patients treated
with IV acetaminophen had a significant reduction in delirium (10% vs 28%
placebo; difference, -18% [95% CI, -32% to -5%]; P =.01; HR, 2.8 [95% CI,
1.1-7.8]). Patients receiving dexmedetomidine vs propofol had no
significant difference in delirium (17% vs 21%; difference, -4% [95% CI,
-18% to 10%]; P =.54; HR, 0.8 [95% CI, 0.4-1.9]). There were significant
differences favoring acetaminophen vs placebo for 3 prespecified secondary
outcomes: delirium duration (median, 1 vs 2 days; difference, -1 [95% CI,
-2 to 0]), ICU length of stay (median, 29.5 vs 46.7 hours; difference,
-16.7 [95% CI, -20.3 to -0.8]), and breakthrough analgesia (median, 322.5
vs 405.3g morphine equivalents; difference, -83 [95% CI, -154 to -14]).
For dexmedetomidine vs propofol, only breakthrough analgesia was
significantly different (median, 328.8 vs 397.5g; difference, -69 [95% CI,
-155 to -4]; P =.04). Fourteen patients in both the
placebo-dexmedetomidine and acetaminophen-propofol groups (46% and 45%)
and 7 in the acetaminophen-dexmedetomidine and placebo-propofol groups
(24% and 23%) had hypotension. Conclusions and Relevance: Among older
patients undergoing cardiac surgery, postoperative scheduled IV
acetaminophen, combined with IV propofol or dexmedetomidine, reduced
in-hospital delirium vs placebo. Additional research, including comparison
of IV vs oral acetaminophen and other potentially opioid-sparing
analgesics, on the incidence of postoperative delirium is warranted. Trial
Registration: ClinicalTrials.gov Identifier: NCT02546765. Copyright
© 2019 American Medical Association. All rights reserved.

<6>
Accession Number
626231183
Title
Liberal transfusion strategy to prevent mortality and anaemia-associated,
ischaemic events in elderly non-cardiac surgical patients - The study
design of the LIBERAL-Trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 101. Date of
Publication: 04 Feb 2019.
Author
Meybohm P.; Lindau S.; Treskatsch S.; Francis R.; Spies C.; Velten M.;
Wittmann M.; Gueresir E.; Stoppe C.; Kowark A.; Coburn M.; Selleng S.;
Baschin M.; Jenichen G.; Meersch M.; Ermert T.; Zarbock A.; Kranke P.;
Kredel M.; Helf A.; Laufenberg-Feldmann R.; Ferner M.; Wittenmeier E.;
Gurtler K.-H.; Kienbaum P.; De Abreu M.G.; Sander M.; Bauer M.; Seyfried
T.; Gruenewald M.; Choorapoikayil S.; Mueller M.M.; Seifried E.; Brosteanu
O.; Bogatsch H.; Hasenclever D.; Zacharowski K.; Baron D.; Grottke O.;
Hill A.; Van Waesberghe J.; Ziemann S.; Tingart M.; Van Essen J.; Spring
O.; Pirzer R.; Jaschinski U.; Heller A.R.; Ertmer M.; Falk E.; Pickerodt
P.; Schiemann A.; Schmidt K.; Tafelski S.; Trauzeddel R.-F.; Perka C.;
Ehrentraut H.; Fingehut L.; Hopf A.; Guttenthaler V.; Neumann C.;
Osberghaus I.; Schuss P.; Winkler A.; Kohlhof H.; Wirtz D.C.; Kalb R.;
Hinterberg J.; Schafer M.; Koch T.; Piekarski F.; Tanner L.; Berg K.;
Wiedenbeck C.; Maushagen I.; Zeisset D.; Fuellenbach C.; Westphal S.;
Pfeiffer S.; Schnitzbauer A.; Marzi I.; Becker A.; Ghanaati S.;
Schmitz-Rixen T.; Brixner V.; Geisen C.; Herrmann E.; Edinger F.; Koch C.;
Kunzemann C.; Leicht D.; Markmann M.; Ruhrmann S.; Schneck E.; Schulte D.;
Grundling M.; Brenig I.; Gerber M.; Selleng K.; Wodrig S.; Bloos F.; Bloos
P.; Haucke A.; Knuhr-Kohlberg K.; Kolanos S.; Schwope K.; Thomas D.;
Buchholz C.; Heller B.; Renner J.; Schulz-Ruhtenberg N.; Elke G.; Fischer
S.; Hofbauer S.; Straub P.; Zimmer S.; Kullmar M.; Rosenow N.; Massoth C.;
Weiss R.; Bitzinger D.; Pfister K.; Guzman I.; Kranke E.-M.; Roewer N.;
Woeckel A.; Helmer P.
Institution
(Meybohm, Lindau, Choorapoikayil, Zacharowski) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
(Treskatsch, Francis, Spies) Department of Anesthesiology, Operative
Intensive Care Medicine, Berlin Institute of Health, Charite -
Universitatsmedizin Berlin, Freie Universitat Berlin, Humboldt-Universitat
zu Berlin, Campus Charite Mitte, Campus Virchow Klinikum, Berlin, Charite,
Germany
(Velten, Wittmann) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Gueresir) Department of Neurosurgery, University Hospital Bonn, Bonn,
Germany
(Stoppe) Department of Intensive Care Medicine, RWTH University Aachen,
Pauwelstrasse 30, Aachen 52074, Germany
(Kowark, Coburn) Department of Anesthesiology, RWTH University Aachen,
Pauwelstrasse 30, Aachen 52074, Germany
(Selleng, Baschin, Jenichen) Department of Anesthesiology, University
Hospital Greifswald, Greifswald, Germany
(Meersch, Ermert, Zarbock) Department of Anaesthesiology, Intensive Care
and Pain Therapy, University Hospital Munster, Munster, Germany
(Kranke, Kredel, Helf) Department of Anaesthesia and Critical Care,
University Hospital of Wurzburg, Wuerzburg, Germany
(Laufenberg-Feldmann, Ferner, Wittenmeier) Department of Anaesthesiology,
Intensive Care Medicine, University Hospital Mainz, Main, Germany
(Gurtler) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Augsburg, Augsburg, Germany
(Kienbaum) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Dusseldorf, Dusseldorf, Germany
(De Abreu) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Dresden, Dresden, Germany
(Sander) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Giessen-Marburg, Giessen, Germany
(Bauer) Department of Anaesthesiology, Intensive Care Medicine, University
Hospital Jena, Jena, Germany
(Seyfried) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Regensburg, Regensburg, Germany
(Gruenewald) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Mueller, Seifried) Institute for Transfusion Medicine and
Immunohaematology Frankfurt/ Main, German Red Cross Blood Transfusion
Service Baden-Wuerttemberg - Hessen, Frankfurt, Germany
(Brosteanu, Bogatsch) Clinical Trial Centre Leipzig, University Leipzig,
Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Leipzig, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative anaemia leads to impaired oxygen supply with a
risk of vital organ ischaemia. In healthy and fit individuals, anaemia can
be compensated by several mechanisms. Elderly patients, however, have less
compensatory mechanisms because of multiple co-morbidities and age-related
decline of functional reserves. The purpose of the study is to evaluate
whether elderly surgical patients may benefit from a liberal red blood
cell (RBC) transfusion strategy compared to a restrictive transfusion
strategy. Method(s): The LIBERAL Trial is a prospective, randomized,
multicentre, controlled clinical phase IV trial randomising 2470 elderly
(>= 70 years) patients undergoing intermediate- or high-risk non-cardiac
surgery. Registered patients will be randomised only if Haemoglobin (Hb)
reaches <=9 g/dl during surgery or within 3 days after surgery either to
the LIBERAL group (transfusion of a single RBC unit when Hb <= 9 g/dl with
a target range for the post-transfusion Hb level of 9-10.5 g/dl) or the
RESTRICTIVE group (transfusion of a single RBC unit when Hb <= 7.5 g/dl
with a target range for the post-transfusion Hb level of 7.5-9 g/dl). The
intervention per patient will be followed until hospital discharge or up
to 30 days after surgery, whichever occurs first. The primary efficacy
outcome is defined as a composite of all-cause mortality, acute myocardial
infarction, acute ischaemic stroke, acute kidney injury (stage III), acute
mesenteric ischaemia and acute peripheral vascular ischaemia within 90
days after surgery. Infections requiring iv antibiotics with
re-hospitalisation are assessed as important secondary endpoint. The
primary endpoint will be analysed by logistic regression adjusting for
age, cancer surgery (y/n), type of surgery (intermediate- or high-risk),
and incorporating centres as random effect. Discussion(s): The
LIBERAL-Trial will evaluate whether a liberal transfusion strategy reduces
the occurrence of major adverse events after non-cardiac surgery in the
geriatric population compared to a restrictive strategy within 90 days
after surgery. Trial registration: ClinicalTrials.gov (identifier:
NCT03369210). Copyright © 2019 The Author(s).

<7>
Accession Number
626182708
Title
Genome-wide association study of myocardial infarction, atrial
fibrillation, acute stroke, acute kidney injury and delirium after cardiac
surgery - A sub-analysis of the RIPHeart-Study.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 1002. Date of Publication: 24 Jan 2019.
Author
Westphal S.; Stoppe C.; Gruenewald M.; Bein B.; Renner J.; Cremer J.;
Coburn M.; Schaelte G.; Boening A.; Niemann B.; Kletzin F.; Roesner J.;
Strouhal U.; Reyher C.; Laufenberg-Feldmann R.; Ferner M.; Brandes I.F.;
Bauer M.; Kortgen A.; Stehr S.N.; Wittmann M.; Baumgarten G.; Struck R.;
Meyer-Treschan T.; Kienbaum P.; Heringlake M.; Schoen J.; Sander M.;
Treskatsch S.; Smul T.; Wolwender E.; Schilling T.; Degenhardt F.; Franke
A.; Mucha S.; Tittmann L.; Kohlhaas M.; Fuernau G.; Brosteanu O.;
Hasenclever D.; Zacharowski K.; Meybohm P.; Stevanovic A.; Rossaint R.;
Felzen M.; Goetzenich A.; Moormann T.; Chalk K.; Knuefermann P.; Boehm O.;
Hoeft A.; Winterhalter M.; Iken S.; Weber C.; Wiedenbeck C.; Schwarzmann
G.; Pense K.; Fichtlscherer A.Z.S.; Goerlach G.; Wollbrueck M.; Boening
U.; Weigand M.; Strauchmann J.; August K.; Morsbach K.U.; Paxian M.;
Reinhard K.; Scholz J.; Broch O.; Francksen H.; Albrecht M.; Kuhr B.;
Heinze H.; Paarmann H.; Sievers H.-H.; Klotz S.; Hachenberg T.; Werner C.;
Mauff S.; Alms A.; Bergt S.; Roewer N.
Institution
(Westphal, Strouhal, Reyher, Kohlhaas, Zacharowski, Meybohm) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Frankfurt, Germany
(Stoppe, Coburn, Schaelte) Department of Anaesthesiology, Medical Faculty,
RWTH Aachen, University Aachen, Aachen, Germany
(Bein) Department of Anaesthesiology, Intensive Care Medicine, Emergency
Medicine and Pain Therapy, Asklepios Klinik St. Georg, Hamburg, Germany
(Gruenewald, Bein, Renner) Department of Anaesthesiology and Intensive
Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel,
Germany
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Boening, Niemann) Department of Cardiovascular Surgery, University of
Giessen, Giessen, Germany
(Sander) Department of Anaesthesiology and Intensive Care, University of
Giessen, Giessen, Germany
(Kletzin) Clinic of Anaesthesiology and Intensive Care Medicine,
University Hospital Rostock, Rostock, Germany
(Roesner) Department of Anaesthesiology and Intensive Care, Suedstadt
Hospital Rostock, Rostock, Germany
(Laufenberg-Feldmann, Ferner) Department of Anesthesiology, Medical Center
of Johannes Gutenberg-University, Mainz, Germany
(Brandes) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Goettingen, Goettingen, Germany
(Bauer) Department of Anaesthesiology and Intensive Care, Klinikum Region
Hannover, Hannover, Germany
(Kortgen) Department of Anaesthesiology and Intensive Care Medicine,
Center for Sepsis Control and Care, Jena University Hospital, Jena,
Germany
(Stehr) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Leipzig, Leipzig, Germany
(Wittmann, Struck) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Baumgarten) Department of Anaesthesiology and Intensive Care Medicine,
Johanniter Hospital Bonn, Bonn, Germany
(Meyer-Treschan, Kienbaum) Department of Anaesthesiology and Intensive
Care Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
(Heringlake) Department of Anaesthesiology and Intensive Care Medicine,
University Luebeck, Luebeck, Germany
(Schoen) Department of Anaesthesiology and Intensive Care Medicine,
Hospital Neuruppin, Neuruppin, Germany
(Treskatsch) Department of Anaesthesiology and Intensive Care Medicine,
Charite-Universitatsmedizin Berlin, Campus Charite Mitte, Berlin, Germany
(Smul, Wolwender, Schilling) Department of Anaesthesiology, University
Hospital Wuerzburg, Wuerzburg, Germany
(Degenhardt, Franke, Mucha, Tittmann) Institute of Clinical Molecular
Biology, Kiel University, University Hospital Schleswig-Holstein, Campus
Kiel, Kiel, Germany
(Fuernau) University Heart Center Luebeck, Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), University Hospital
Schleswig-Holstein, Luebeck, Luebeck, Germany
(Brosteanu) Clinical Trial Centre, University Leipzig, Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Leipzig, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of our study was the identification of genetic
variants associated with postoperative complications after cardiac
surgery. Method(s): We conducted a prospective, double-blind,
multicenter, randomized trial (RIPHeart). We performed a genome-wide
association study (GWAS) in 1170 patients of both genders (871 males, 299
females) from the RIPHeart-Study cohort. Patients undergoing non-emergent
cardiac surgery were included. Primary endpoint comprises a binary
composite complication rate covering atrial fibrillation, delirium,
non-fatal myocardial infarction, acute renal failure and/or any new stroke
until hospital discharge with a maximum of fourteen days after surgery.
 Result(s): A total of 547,644 genotyped markers were available for
analysis. Following quality control and adjustment for clinical covariate,
one SNP reached genome-wide significance (PHLPP2, rs78064607, p = 3.77 x
10-8) and 139 (adjusted for all other outcomes) SNPs showed
promising association with p < 1 x 10-5 from the GWAS.
 Conclusion(s): We identified several potential loci, in particular
PHLPP2, BBS9, RyR2, DUSP4 and HSPA8, associated with new-onset of atrial
fibrillation, delirium, myocardial infarction, acute kidney injury and
stroke after cardiac surgery. Copyright © 2019 The Author(s).

<8>
Accession Number
621948971
Title
The use of viscoelastic haemostatic assays in non-cardiac surgical
settings: A systematic review and meta-analysis.
Source
Blood Transfusion. 16 (3) (pp 235-243), 2018. Date of Publication: 2018.
Author
Franchini M.; Mengoli C.; Cruciani M.; Marietta M.; Marano G.; Vaglio S.;
Pupella S.; Veropalumbo E.; Masiello F.; Liumbruno G.M.
Institution
(Franchini, Mengoli, Marano, Vaglio, Pupella, Veropalumbo, Masiello,
Liumbruno) Italian National Blood Centre, National Institute of Health,
Rome, Italy
(Franchini) Department of Haematology and Transfusion Medicine, Carlo Poma
Hospital, Strada Lago Paiolo 1, Mantua 46100, Italy
(Cruciani) Infection Control Committee, AULSS9 Scaligera, Verona, Italy
(Marietta) Department of Oncology, Hematology and Respiratory Diseases,
University Hospital, Modena, Italy
(Vaglio) Department of Clinical and Molecular Medicine, La Sapienza
University of Rome, Rome, Italy
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Background: Thrombelastography (TEG) and rotational thromboelastometry
(ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the
elastic properties of clotting blood. The aim of this systematic review
and meta-analysis was to evaluate the usefulness of these tests in
bleeding patients outside the cardiac surgical setting. Material(s)
and Method(s): We searched the Cochrane Library, MEDLINE, EMBASE and
SCOPUS. We also searched clinical trial registries for ongoing and
unpublished studies, and checked reference lists to identify additional
studies. Result(s): We found 4 randomised controlled trials (RCTs)
that met our inclusion criteria with a total of 229 participants. The
sample size was small (from 28 to 111 patients) and the follow-up periods
very heterogenous (from 4 weeks to 3 years). Pooled data from the 3 trials
reporting on mortality (199 participants) do not show any effect of the
use of TEG on mortality as compared to standard monitoring (based on the
average treatment effect from a fixed-effects model): Risk Ratio (RR)
0.71; 95% Confidence Interval (CI): 0.43 to 1.16. Likewise, the use of VHA
does not reduce the need for red blood cells (mean difference -0.64; 95%
CI: -1.51 to 0.23), platelet concentrates (mean difference -1.12; 95% CI:
-3.25 to 1.02), and fresh frozen plasma (mean difference -0.91; 95% CI:
-2.02 to 0.19) transfusion. The evidence on mortality and other outcomes
was uncertain (very low-certainty evidence, down-graded due to risk of
biases, imprecision, and inconsistency). Conclusion(s): Overall, the
certainty of the evidence provided by the trials was too low for us to be
certain of the benefits and harms of viscoelastic haemostatic assay in
non-cardiac surgical settings. More, larger, and better-designed RCTs
should be carried out in this area. Copyright © SIMTI Servizi
Srl.

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

<10>
Accession Number
624123323
Title
Impact of a Nurse Intervention to Improve Sleep Quality in Intensive Care
Units: Results From a Randomized Controlled Trial.
Source
Dimensions of critical care nursing : DCCN. 37 (6) (pp 310-317), 2018.
Date of Publication: 01 Nov 2018.
Author
Diaz-Alonso J.; Smith-Plaza A.M.; Suarez-Mier B.; Lana A.
Institution
(Diaz-Alonso) Julian Diaz-Alonso, RN, is a registered nurse specialized in
critical care and with extensive formation in emergencies at the Intensive
Care Unit, Asturias Central University Hospital, Oviedo, Spain. He is
currently a PhD candidate at the University of Oviedo. Andrea M.
Smith-Plaza, RN, is a registered nurse specialized in family and community
health at the Preventive Medicine and Public Health Department, School of
Medicine and Health Sciences, Oviedo, Spain. She is also junior researcher
in the Department of Medicine at the University of Oviedo. Belen
Suarez-Mier, RN, is a senior clinical researcher and a preventive medicine
nurse at the Preventive Medicine Unit, Asturias Central University
Hospital, Oviedo, Spain. Furthermore, she is a nursing assistant professor
at the University of Oviedo. Alberto Lana, PhD, is senior researcher at
the University of Oviedo. He has extensively published on several health
related topics, including nursing practice
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients of adult intensive care units (ICUs) often suffer
from a lack of sleep. Reducing anxiety by promoting adaptation to the ICU
prior to admission may be an appropriate way to increase sleep quality.
 OBJECTIVE(S): The aim of this study was to evaluate the impact on
sleep quality of a brief nurse intervention. METHOD(S): This was a
pilot randomized controlled trial in Spain. Forty patients admitted in
hospital for valve cardiac surgery were randomly allocated to (1) control
group (n = 20), receiving usual care, and to (2) experimental group (EG, n
= 20), receiving a nurse intervention the day before surgery and admission
in the ICU. The intervention was based on Roy Adaptation Model. A trained
nurse anticipated the stressful stimulus to patients in order to develop
functional adaptive behaviors. A set of photographs and videos was used to
illustrate the environment and assistance in the ICU. Sleep quality in the
ICU was measured with the Richards-Campbell Sleep Questionnaire and usual
sleep quality with the Pittsburgh Sleep Quality Index. RESULT(S):
After the intervention, sleep quality was lower in the EG compared with
the control group (-4 points in Richards-Campbell Sleep Questionnaire, P =
.69). Adjustment for main confounders led this reduction to -1.9 points (P
= .87) among patients in EG. Stratified analyses shown a positive impact
for people who usually slept well (+5.2 points, P = .77), but negative for
those who had previous poor sleep quality (-20.0 points, P = .24).
 CONCLUSION(S): A nurse intervention prior to ICU admission did not
increase patients' sleep quality. In addition, the intervention could have
incremented anxiety over the patients who used to sleep poorly at their
homes.

<11>
Accession Number
626495922
Title
Rationale and design of the CONSIDER AF study: Impact of sleep-disordered
breathing on atrial fibrillation and perioperative complications in
patients undergoing coronary artery bypass grafting surgery.
Source
Somnologie. (no pagination), 2019. Date of Publication: 2019.
Author
Tafelmeier M.; Knapp M.; Lebek S.; Floerchinger B.; Camboni D.; Wittmann
S.; Creutzenberg M.; Zeman F.; Schmid C.; Maier L.S.; Wagner S.; Arzt M.
Institution
(Tafelmeier, Knapp, Lebek, Maier, Wagner, Arzt) Department of Internal
Medicine II (Cardiology, Pneumology, and Intensive Care), University
Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg 93053,
Germany
(Floerchinger, Camboni, Schmid) Department of Cardiothoracic Surgery,
University Medical Center Regensburg, Regensburg, Germany
(Wittmann, Creutzenberg) Department of Anesthesiology, University Medical
Center Regensburg, Regensburg, Germany
(Zeman) Center for Clinical Studies, University Medical Center Regensburg,
Regensburg, Germany
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: The objectives of the CONSIDER AF (NCT02877745) observational
study are to evaluate the impact of sleep-disordered breathing (SDB) on
the rate of major adverse cardiac and cerebrovascular events in patients
undergoing elective coronary artery bypass grafting (CABG) surgery. In
addition, explorative analyses will allow specification of subgroups of
patients with SDB with the highest risk for peri- and postoperative
complications. Method(s): CONSIDER AF is a single-center study in
patients with and without SDB undergoing elective CABG. The presence and
type of SDB are assessed the night prior to CABG using portable SDB
monitoring. SDB is defined as an apnea-hypopnea index >=15/h. Biomaterials
(atrial myocardium and blood cells) are systematically sampled. New-onset
atrial fibrillation and peri- and postoperative complications are
prospectively evaluated during the hospital stay and over a period of 2
years. The relationship between postoperative complications and SDB or
covariables associated with postoperative complications in univariable
analyses are determined by multivariable logistic regression. Moreover,
length of hospital stay and time spent in the intensive/intermediate care
unit (ICU/IMC) of patients with and without SDB are analyzed. The
harvested biomaterials are analyzed for novel signaling events and
biomarkers. Discussion(s): The prospective observational CONSIDER AF
study is needed to identify specific risks, including SDB, and risk
populations in cardiac surgery. In addition, CONSIDER AF has the potential
to generate the rationale for hypotheses regarding peri- and postoperative
management of patients with SDB to be tested in future randomized clinical
trials. Based on this knowledge, the peri- and postoperative management of
patients with SDB may be optimized. Copyright © 2019, The
Author(s).

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

<13>
Accession Number
625413756
Title
Editor's presentation.
Source
European Journal of Preventive Cardiology. 26 (1) (pp 3-5), 2019. Date of
Publication: 01 Jan 2019.
Author
Piepoli M.F.
Institution
(Piepoli) Heart Failure Unit, Cardiology, G da Saliceto Hospital, Romagna,
Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<14>
Accession Number
623175250
Title
Meta-analysis of efficacy and safety of dual antiplatelet therapy versus
aspirin monotherapy after coronary artery bypass grafting.
Source
European Journal of Preventive Cardiology. 26 (2) (pp 215-218), 2019. Date
of Publication: 01 Jan 2019.
Author
Khan S.U.; Talluri S.; Rahman H.; Lekkala M.; Khan M.S.; Riaz H.; Shah H.;
Kaluski E.; Sattur S.
Institution
(Khan, Talluri, Rahman, Lekkala, Shah, Kaluski, Sattur) Guthrie Clinic,
Robert Packer Hospital, United States
(Khan) Cook County Hospital, United States
(Riaz) Cleveland Clinic, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

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

<16>
Accession Number
622684080
Title
Factors associated with non-participation in and dropout from cardiac
rehabilitation programmes: a systematic review of prospective cohort
studies.
Source
European Journal of Cardiovascular Nursing. 18 (1) (pp 38-47), 2019. Date
of Publication: 01 Jan 2019.
Author
Resurreccion D.M.; Moreno-Peral P.; Gomez-Herranz M.; Rubio-Valera M.;
Pastor L.; Caldas de Almeida J.M.; Motrico E.
Institution
(Resurreccion, Motrico) Departamento de Psicologia, Universidad Loyola
Andalucia, Spain
(Moreno-Peral, Motrico) SAMSERAP Group, Primary Care Prevention and Health
Promotion Research Network (RedIAPP), Spain
(Moreno-Peral) SAMSERAP Group, Instituto de Investigacion Biomedica de
Malaga (IBIMA), Spain
(Gomez-Herranz) Departamento de psicologia experimental, Universidad de
Sevilla, Spain
(Rubio-Valera) Research and Development Unit, Institut de Recerca Sant
Joan de Deu, Spain
(Rubio-Valera) Grupo PRISMA, Centro de Investigacion Biomedica en Red
Epidemiologia y Salud Publica, Spain
(Pastor) Unidad Clinica de Cardiologia, Hospital Nuestra Senora de Valme,
Spain
(Caldas de Almeida) Mental Health Department, Universidade Nova de Lisboa,
Portugal
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although evidence exists for the efficacy of cardiac
rehabilitation programmes to reduce morbidity and mortality among patients
with cardiovascular disease, cardiac rehabilitation programmes are
underused. We aimed systematically to review the evidence from prospective
cohort studies on factors associated with non-participation in and/or
dropping out from cardiac rehabilitation programmes. Method(s):
MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for
relevant publications from inception to February 2018. Search terms
included (a) coronary heart disease and other cardiac conditions; (b)
cardiac rehabilitation and secondary prevention; and (c) non-participation
in and/or dropout. Databases were searched following the PRISMA statement.
Study selection, data extraction and the assessment of study quality were
performed in duplicate. Result(s): We selected 43 studies with a
total of 63,425 patients from 10 different countries that met the
inclusion criteria. Factors associated with non-participation in and
dropout from cardiac rehabilitation were grouped into six broad
categories: intrapersonal factors, clinical factors, interpersonal
factors, logistical factors, cardiac rehabilitation programme factors and
health system factors. We found that clinical factors, logistical factors
and health system factors were the main factors assessed for
non-participation in cardiac rehabilitation. We also found differences
between the factors associated with non-participation and dropout.
 Conclusion(s): Several factors were determinant for non-participation
in and dropout from cardiac rehabilitation. These findings could be useful
to clinicians and policymakers for developing interventions aimed at
improving participation and completion of cardiac rehabilitation, such as
E-health or home-based delivery programmes. Trial Registration:
International Prospective Register of Systematic Reviews (PROSPERO)
identifier: CRD42016032973. Copyright © The European Society of
Cardiology 2018.

<17>
Accession Number
2001564218
Title
Impact of Short-Term Complications on Mortality and Quality of Life After
Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Interventions. 12 (4) (pp 362-369), 2019. Date of
Publication: 25 February 2019.
Author
Arnold S.V.; Zhang Y.; Baron S.J.; McAndrew T.C.; Alu M.C.; Kodali S.K.;
Kapadia S.; Thourani V.H.; Miller D.C.; Mack M.J.; Leon M.B.; Cohen D.J.
Institution
(Arnold, Baron, Cohen) Saint Luke's Mid America Heart Institute and
University of Missouri-Kansas City, Kansas City, MO, United States
(Zhang, McAndrew, Alu, Kodali, Leon) Columbia-Presbyterian Hospital, New
York, NY, United States
(Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United States
(Thourani) Medstar Washington Hospital Center/Georgetown University,
Washington, DC, United States
(Miller) Stanford University Medical School, Stanford, CA, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to examine the independent
association of short-term complications of transcatheter aortic valve
replacement (TAVR) with survival and quality of life at 1 year.
 Background(s): Prior studies have examined the mortality and cost
implications of various complications of TAVR. However, many of these
complications may primarily affect patients' quality of life after TAVR,
which has not been previously studied. Method(s): Among patients at
intermediate or high surgical risk who underwent TAVR as part of the
PARTNER (Placement of Aortic Transcatheter Valve) 2 studies and survived
30 days, the association between complications within the 30 days after
TAVR and mortality and quality of life at 1 year was examined. Quality of
life was assessed using the Kansas City Cardiomyopathy Questionnaire and
the Short-Form 12. Complications assessed included major and minor stroke,
life-threatening and major bleeding, vascular injury, stage 3 acute kidney
injury, new pacemaker implantation, and mild and moderate or severe
paravalvular leak (PVL). Multivariable models that included all
complications as well as baseline clinical factors were used to examine
the independent association of each complication with outcomes.
 Result(s): Among 3,763 TAVR patients, major stroke and stage 3 acute
kidney injury were associated with markedly increased risk for 1-year
mortality, with adjusted hazard ratios of 5.4 (95% confidence interval
[CI]: 3.1 to 9.5) and 4.9 (95% CI: 2.7 to 8.8), respectively, as well as
poorer quality of life among survivors (reductions in 1-year Kansas City
Cardiomyopathy Questionnaire overall summary score of 15.1 points [95% CI:
24.8 to 5.3 points] and 14.7 points [95% CI: 25.6 to 3.8 points],
respectively). Moderate or severe PVL, life-threatening bleeding, and
major bleeding were each associated with a more modest increase in
mortality and decrement in quality of life, whereas mild PVL was
associated with a small decrease in quality of life. After adjusting for
baseline characteristics and other complications, need for a new
pacemaker, minor stroke, and vascular injury were not independently
associated with poor outcomes. Conclusion(s): Among patients
undergoing TAVR, similar events are associated with increased mortality
and impaired quality of life at 1 year. These results suggest that despite
considerable progress, efforts to further reduce stroke, acute kidney
injury, bleeding, and moderate or severe PVL are likely to yield important
clinical benefits and remain key targets for device iteration and
procedural improvement. Copyright © 2019 American College of
Cardiology Foundation

<18>
Accession Number
624513084
Title
Effect of Cricoid Pressure Compared with a Sham Procedure in the Rapid
Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial.
Source
JAMA Surgery. 154 (1) (pp 9-17), 2019. Date of Publication: January 2019.
Author
Birenbaum A.; Hajage D.; Roche S.; Ntouba A.; Eurin M.; Cuvillon P.; Rohn
A.; Compere V.; Benhamou D.; Biais M.; Menut R.; Benachi S.; Lenfant F.;
Riou B.
Institution
(Birenbaum, Roche) Department of Anesthesiology and Critical Care, Hopital
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France
(Hajage) Sorbonne Universite, Department of Biostatistics Public Health
and Medical Information, Hopital Pitie-Salpetriere, Assistance
Publique-Hopitaux de Paris, Paris, France
(Ntouba) Universite Jules Verne, Department of Anesthesiology and Critical
Care, CHI Amiens-Picardie, Amiens, France
(Eurin) Department of Anesthesiology and Critical Care, Hopital Beaujon,
Assistance Publique-Hopitaux de Paris, Clichy, France
(Cuvillon) Universite de Montpellier, Department of Anesthesiology and
Critical Care, Hopital Caremeau, Nimes, France
(Rohn) Department of Anesthesiology and Critical Care, Centre Hospitalier
Universitaire Regional de Lille, Lille, France
(Compere) Universite de Haute-Normandie, Department of Anesthesiology and
Critical Care, Hopital, Rouen, France
(Benhamou) Universite Paris-Sud, Department of Anesthesiology and Critical
Care, Hopital Bicetre, Assistance Publique-Hopitaux de Paris, Le
Kremlin-Bicetre, France
(Biais) Universite Victor Segalen, Department of Anesthesiology and
Critical Care, Hopital Pellegrin, Bordeaux, France
(Menut) Universite Toulouse 3-Paul Sabatier, Department of Anesthesiology
and Intensive Care, University Hospital of Toulouse, Toulouse, France
(Benachi) Department of Anesthesiology and Critical Care, Hopital
Avicenne, Assistance Publique-Hopitaux de Paris, Bobigny, France
(Lenfant) Department of Anesthesiology, Centre Hospitalier Simone Veil,
Cannes, France
(Riou) Sorbonne Universite, UMR Inserm, Institut Hospitalo-universitaire
ICAN, Department of Emergency Medicine and Surgery, Hopital
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Paris, France
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The use of cricoid pressure (Sellick maneuver) during rapid
sequence induction (RSI) of anesthesia remains controversial in the
absence of a large randomized trial. Objective(s): To test the
hypothesis that the incidence of pulmonary aspiration is not increased
when cricoid pressure is not performed. Design, Setting, and
Participant(s): Randomized, double-blind, noninferiority trial conducted
in 10 academic centers. Patients undergoing anesthesia with RSI were
enrolled from February 2014 until February 2017 and followed up for 28
days or until hospital discharge (last follow-up, February 8, 2017).
 Intervention(s): Patients were assigned to a cricoid pressure
(Sellick group) or a sham procedure group. Main Outcomes and
Measures: Primary end point was the incidence of pulmonary aspiration (at
the glottis level during laryngoscopy or by tracheal aspiration after
intubation). It was hypothesized that the sham procedure would not be
inferior to the cricoid pressure. The secondary end points were related to
pulmonary aspiration, difficult tracheal intubation, and traumatic
complications owing to the tracheal intubation or cricoid pressure.
 Result(s): Of 3472 patients randomized, mean (SD) age was 51 (19)
years and 1777 (51%) were men. The primary end point, pulmonary
aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9
patients (0.5%) in the sham group. The upper limit of the 1-sided 95% CI
of relative risk was 2.00, exceeding 1.50, failing to demonstrate
noninferiority (P =.14). The risk difference was -0.06% (2-sided 95% CI,
-0.57 to 0.42) in the intent-to-treat population and -0.06% (2-sided 95%
CI, -0.56 to 0.43) in the per protocol population. Secondary end points
were not significantly different among the 2 groups (pneumonia, length of
stay, and mortality), although the comparison of the Cormack and Lehane
grade (Grades 3 and 4, 10% vs 5%; P <.001) and the longer intubation time
(Intubation time >30 seconds, 47% vs 40%; P <.001) suggest an increased
difficulty of tracheal intubation in the Sellick group. Conclusions
and Relevance: This large randomized clinical trial performed in patients
undergoing anesthesia with RSI failed to demonstrate the noninferiority of
the sham procedure in preventing pulmonary aspiration. Further studies are
required in pregnant women and outside the operating room. Trial
Registration: ClinicalTrials.gov Identifier: NCT02080754. Copyright
© 2018 American Medical Association. All rights reserved.

<19>
Accession Number
620696844
Title
Peri-operative management of patients with type-2 diabetes mellitus
undergoing non-cardiac surgery using liraglutide,
glucose-insulin-potassium infusion or intravenous insulin bolus regimens:
a randomised controlled trial.
Source
Anaesthesia. 73 (3) (pp 332-339), 2018. Date of Publication: March 2018.
Author
Polderman J.A.W.; van Steen S.C.J.; Thiel B.; Godfried M.B.; Houweling
P.L.; Hollmann M.W.; DeVries J.H.; Preckel B.; Hermanides J.
Institution
(Polderman, Hollmann, Preckel, Hermanides) Department of Anaesthesiology,
Academic Medical Centre Amsterdam, Amsterdam, Netherlands
(van Steen, DeVries) Department of Endocrinology, Academic Medical Centre
Amsterdam, Amsterdam, Netherlands
(Thiel, Godfried) Department of Anaesthesiology, Onze Lieve Vrouwe
Gasthuis, Amsterdam, Netherlands
(Houweling) Department of Anaesthesiology, Diakonessenhuis, Utrecht,
Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
In this open-label multicentre randomised controlled trial, we
investigated three peri-operative treatment strategies to lower glucose
and reduce the need for rescue insulin in patients aged 18-75 years with
type-2 diabetes mellitus undergoing non-cardiac surgery. Patients were
randomly allocated using a web-based randomisation program to
premedication with liraglutide (liraglutide group),
glucose-insulin-potassium infusion (insulin infusion group) or insulin
bolus regimen (insulin bolus group), targeting a glucose < 8.0
mmol.l-1. The primary outcome was the between group difference
in median glucose levels 1 h after surgery. We analysed 150 patients
(liraglutide group n = 44, insulin infusion group n = 53, insulin bolus
group n = 53) according to the intention-to-treat principle. Median (IQR
[range]) plasma glucose 1 h postoperatively was lower in the liraglutide
group compared with the insulin infusion and insulin bolus groups (6.6
(5.6-7.7 [4.2-13.5]) mmol.l-1 vs. 7.5 (6.4-8.3 [3.9-16.6])
mmol.l-1 (p = 0.026) and 7.6 (6.4-8.9 [4.7-13.2])
mmol.l-1) p = 0.006, respectively). The incidence of
hypoglycaemia and postoperative complications did not differ between the
groups. Six patients had pre-operative nausea in the liraglutide group, of
which two had severe nausea, compared with no patients in the insulin
infusion and insulin bolus groups (p = 0.007). The pre-operative
administration of liraglutide stabilised peri-operative plasma glucose
levels and reduced peri-operative insulin requirements, at the expense of
increased pre-operative nausea rates. Copyright © 2017 The
Association of Anaesthetists of Great Britain and Ireland

<20>
Accession Number
618803469
Title
Nitrous oxide-based vs. nitrous oxide-free general anaesthesia and
accidental awareness in surgical patients: an abridged Cochrane systematic
review.
Source
Anaesthesia. 73 (3) (pp 365-374), 2018. Date of Publication: March 2018.
Author
Hounsome J.; Greenhalgh J.; Schofield-Robinson O.J.; Lewis S.R.; Cook
T.M.; Smith A.F.
Institution
(Hounsome) Liverpool Reviews and Implementation Group, University of
Liverpool, Liverpool, United Kingdom
(Greenhalgh) Liverpool Reviews and Implementation Group, University of
Liverpool, Liverpool, United Kingdom
(Schofield-Robinson, Lewis) Patient Safety Research Unit, Department of
Anaesthesia, Royal Lancaster Infirmary, Lancaster, United Kingdom
(Cook) Royal United Hospital Bath NHS Foundation Trust, Bath, United
Kingdom
(Cook) School of Clinical Sciences, University of Bristol, Bristol, United
Kingdom
(Smith) Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster,
United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Accidental awareness during general anaesthesia can arise from a failure
to deliver sufficient anaesthetic agent, or from a patient's resistance to
an expected sufficient dose of such an agent. Awareness is 'explicit' if
the patient is subsequently able to recall the event. We conducted a
systematic review into the effect of nitrous oxide used as part of a
general anaesthetic on the risk of accidental awareness in people over the
age of five years undergoing general anaesthesia for surgery. We included
15 randomised controlled trials, 14 of which, representing a total of 3439
participants, were included in our primary analysis of the frequency of
accidental awareness events. The awareness incidence rate was rare within
these studies, and all were considered underpowered with respect to this
outcome. The risk of bias across all studies was judged to be high, and
76% of studies failed adequately to conceal participant allocation. We
considered the available evidence to be of very poor quality. There were a
total of three accidental awareness events reported in two studies, one of
which reported that the awareness was the result of a kink in a propofol
intravenous line. There were insufficient data to conduct a meta- or
sub-group analysis and there was insufficient evidence to draw
outcome-related conclusions. We can, however, recommend that future
studies focus on potentially high-risk groups such as obstetric or cardiac
surgery patients, or those receiving neuromuscular blocking drugs or total
intravenous anaesthesia. Copyright © 2017 The Association of
Anaesthetists of Great Britain and Ireland

<21>
Accession Number
619323234
Title
The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in
paediatric cardiac surgery: a prospective, randomised trial.
Source
Anaesthesia. 73 (2) (pp 205-215), 2018. Date of Publication: Februaryy
2018.
Author
Oh H.-W.; Lee J.-H.; Kim H.-C.; Kim E.-H.; Song I.-K.; Kim H.-S.; Kim
J.-T.
Institution
(Oh) Department of Anaesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
(Lee, Kim, Kim, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, Dongsan Medical
Centre, Keimyung University College of Medicine, Daegu, South Korea
(Song) Department of Anaesthesiology and Pain Medicine, Asan Medical
Centre, University of Ulsan College of Medicine, Seoul, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We have evaluated the effect of a colloid solution on acute kidney injury
in paediatric cardiac surgery. A total of 195 patients were ramdomly
divided into an hydroxyethyl starch group and a control group. In the
starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte) was
used as the primary fluid for volume resuscitation but was limited to 30
ml.kg-1. In the control group, only crystalloid fluid was used
during the peri-operative period. The incidence of acute kidney injury,
peri-operative transfusion, clinical outcomes and laboratory data were
compared. The incidence of acute kidney injury determined by Paediatric
Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute
Kidney Injury Network (AKIN) criteria were no different between the two
groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using
pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no
differences in clinical outcomes such as mortality, major adverse events,
intensive care unit stay or duration of mechanical ventilation. Clotting
time as measured using rotational thromboelastometry (ROTEM) was
prolonged, and clot firmness after 10 min and maximal clot firmness were
shorter in the starch group compared with the control group after sternal
closure. There was no difference in transfusion between the two groups.
Patients with acute kidney injury had worse clinical courses than those
without acute kidney injury. We conclude that intra-operative use of 6%
hydroxyethyl starch 130/0.4 up to 30 ml.kg-1 was not associated
with postoperative acute kidney injury in paediatric cardiac
patients. Copyright © 2017 The Association of Anaesthetists of
Great Britain and Ireland

<22>
Accession Number
626417445
Title
Practical considerations for cangrelor use in patients with acute coronary
syndromes.
Source
European Heart Journal: Acute Cardiovascular Care. 8 (1) (pp 39-44), 2019.
Date of Publication: 01 Feb 2019.
Author
Leonardi S.; Bhatt D.L.
Institution
(Leonardi) Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Cangrelor, the first and currently only available intravenous
P2Y<inf>12</inf> receptor antagonist, has been approved and is now being
used in patients with coronary artery disease requiring percutaneous
coronary intervention. The rationale for cangrelor use is most robust in
patients requiring an immediate, profound, and predictable level of
P2Y<inf>12</inf> inhibition - especially in patients with acute coronary
syndromes. Herein we summarize the drug development program and reflect on
practical considerations for clinicians on cangrelor use in the acute
setting surrounding percutaneous coronary intervention, including
selection of patients, concomitant administration of glycoprotein IIb/IIIa
inhibitors and transition strategies from intravenous to oral
P2Y<inf>12</inf> receptor antagonists. Copyright © The European
Society of Cardiology 2017.

<23>
Accession Number
626416399
Title
The Ross procedure versus prosthetic and homograft aortic valve
replacement: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 55 (2) (pp 247-255), 2019.
Date of Publication: 01 Feb 2019.
Author
McClure G.R.; Belley-Cote E.P.; Um K.; Gupta S.; Bouhout I.; Lortie H.;
Alraddadi H.; Alsagheir A.; McIntyre W.F.; Dorobantu D.-M.; Bossard M.;
Kim K.; Stoica S.; Eikelboom J.; Ouzounian M.; Chu M.W.A.; Parry D.;
El-Hamamsy I.; Whitlock R.P.
Institution
(McClure, Um) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(McClure, Gupta, Alsagheir, McIntyre, Kim, Whitlock) Department of
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton,
ON, Canada
(Belley-Cote, McIntyre, Eikelboom) Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Bossard, Eikelboom, Whitlock) Population Health Research
Institute, 237 Barton St. E, Hamilton, ON L8L 2X2, Canada
(Gupta, Alraddadi, Alsagheir, Parry, Whitlock) Division of Cardiac
Surgery, McMaster University, Hamilton, ON, Canada
(Bouhout, El-Hamamsy) Division of Cardiac Surgery, Montreal Heart
Institute, Universite de Montreal, Montreal, QC, Canada
(Lortie) Department of Medicine, Universite de Sherbrooke, Sherbrooke, QC,
Canada
(Dorobantu, Stoica) Bristol Heart Institute, University Hospitals Bristol
NHS Foundation Trust, Bristol, United Kingdom
(Dorobantu) Department of Cardiology, 'Prof. Dr. CC Iliescu' Institute for
Cardiovascular Diseases, Bucharest, Romania
(Bossard) Division of Cardiology, Heart Center, Luzerner Kantonsspital,
Luzern, Switzerland
(Ouzounian) Division of Cardiac Surgery, Peter Munk Cardiac Centre,
University of Toronto, Toronto, ON, Canada
(Chu) Division of Cardiac Surgery, Western University, London, ON, Canada
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Young adults undergoing aortic valve replacement (AVR) have
decreased life expectancy compared to matched controls. The Ross procedure
aims to improve valve lifespan while avoiding anticoagulation. We prepared
a systematic review and meta-analysis to assess the Ross procedure
compared to conventional AVR. METHOD(S): We searched MEDLINE, EMBASE
and Cochrane CENTRAL for studies evaluating the Ross procedure versus any
conventional AVR in adult patients. We performed screening, full-text
assessment, risk of bias evaluation and data collection independently and
in duplicate. We evaluated the risk of bias with the ROBINS-I and Cochrane
tools and quality of evidence with the GRADE framework. We pooled data
using the random- and fixed-effects models. RESULT(S): Thirteen
observational studies and 2 randomized controlled trials (RCTs) were
identified (n = 5346). No observational study was rated as having low risk
of bias. The Ross procedure was associated with decreased late mortality
in observational and RCT data [mean length of follow-up 2.6 years,
relative risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84, I2 = 58%,
very low quality]. The RCT estimate of effect was similar (mean length of
follow-up 8.8 years, RR 0.33, 95% CI 0.11-0.96, I2 = 66%, very low
quality). No difference was observed in mortality <30 days after surgery.
All-site reintervention was similar between groups in cohorts and
significantly reduced by the Ross procedure in RCTs (RR 1.41, 95% CI
0.89-2.24, I2 = 55%, very low quality and RR 0.41, 95% CI 0.22-0.78, I2 =
68%, high quality, respectively). CONCLUSION(S): Observational data,
with residual confounding, and RCT data suggest a late survival benefit
with the Ross procedure with no increased risk of reintervention when
compared to conventional AVR. Considering the quality of available
evidence and limited followup, additional high-quality randomized studies
are required to strengthen these findings. Copyright © The
Author(s) 2018. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<24>
Accession Number
626416143
Title
Clinical performance of a three-dimensional saddle-shaped, rigid ring for
mitral valve repair.
Source
European Journal of Cardio-thoracic Surgery. 55 (2) (pp 217-223), 2019.
Date of Publication: 01 Feb 2019.
Author
Doll N.; Sheytanov V.; Labrousse L.; Chu M.W.A.; Stefano P.; Mokracek A.;
Baron O.; Li S.; Gunzinger R.
Institution
(Doll, Sheytanov) Department of Cardiac Surgery, Sana Herzchirurgie
Stuttgart GmbH, Herdweg 2, Stuttgart 70174, Germany
(Labrousse) Department of Cardiac and Vascular Surgery, University
Hospital of Bordeaux, Bordeaux, France
(Chu) Division of Cardiac Surgery, Department of Surgery, Western
University, London Health Sciences Centre, London, ON, Canada
(Stefano) Department of Cardiac Surgery, Careggi University Hospital,
Florence, Italy
(Mokracek) Department of Cardiac Surgery, Czech Budejovice Hospital,
Budejovice, Czech Republic
(Baron) Department of Thoracic and Cardiovascular Surgery, North Laennec
Hospital, Nantes, France
(Li) Department of Biostatistics, Medtronic, Mounds View, MN, United
States
(Gunzinger) Department of Cardiovascular Surgery, German Heart Center
Munich, Munich, Germany
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The Profile 3D annuloplasty ring is a complete, rigid,
saddle-shaped ring indicated for reconstruction and/or remodelling of the
pathological mitral valve (MV) in patients with mitral insufficiency.
 METHOD(S): This prospective, non-randomized, observational,
postmarket release study characterized the patient population for which
the study ring was chosen for MV repair, assessed the relief from MV
dysfunction and determined the level of mitral regurgitation (MR) at
follow-up (6-12 months postimplant). RESULT(S): Between February 2013
and July 2015, 151 patients were enrolled at 7 centres; data were excluded
for 3 patients. The mean age of the remaining 148 patients was 63.8 +/-
12.3 years, and 85 patients (57.4%) were men. Ischaemic cardiomyopathy was
present in 15 patients (10.1%) and dilated cardiomyopathy in 12 patients
(8.1%). MR was severe in 86 of 145 patients with available data (59.3%).
Implantation was successful in 141 of 147 attempted procedures. Two deaths
(n = 148, 1.4%) occurred within 30 days, and 1 death (0.7%) occurred >30
days after implant. Analysis of patients with data from both visits (n =
111) demonstrated that MR was none or mild in 94.5% of patients, moderate
in 3.6% and moderate to severe in 1.8% at follow-up. Nearly all (104 of
109, 95.4%) patients were in New York Heart Association Class I/II. Among
patients with ischaemic cardiomyopathy or dilated cardiomyopathy
preoperatively, 16 of 19 patients with available data (84.2%) had no or
mild MR at follow-up. CONCLUSION(S): MV repair using the Profile 3D
annuloplasty ring is a safe and effective treatment for MR. Further
investigation is warranted to determine whether patients with ischaemic
cardiomyopathy or dilated cardiomyopathy derive unique benefit from this
saddleshaped ring. Copyright © The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
626415887
Title
A systemic review and meta-analysis: Bentall versus David procedure in
acute type A aortic dissection.
Source
European Journal of Cardio-thoracic Surgery. 55 (2) (pp 201-209), 2019.
Date of Publication: 01 Feb 2019.
Author
Mosbahi S.; Stak D.; Gravestock I.; Burgstaller J.M.; Steurer J.; Eckstein
F.; Ferrari E.; Berdajs D.A.
Institution
(Mosbahi) Department of General Surgery, County Hospital Freiburg,
Freiburg, Germany
(Stak) Department of Cardiac Surgery, Triemli City Hospital, Zurich,
Switzerland
(Gravestock, Burgstaller, Steurer) Horten Center for Patient-Oriented
Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
(Eckstein, Ferrari, Berdajs) Department of Cardiac Surgery, University
Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
(Ferrari) Department of Cardiac Surgery, Cardiocentro Ticcino, Lugano,
Switzerland
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This systemic review of the literature and meta-analysis examined the
current state of the evidence in long-term outcomes for and/or against
aortic valve reimplantation (RAV) versus composite valve graft (CVG)
intervention in patients with an acute type A dissection. Descriptive
statistics were used to summarize the baseline characteristics of patients
across studies. A random-effects metaregression was performed across study
arms with logit-transformed proportions weighted by the study size for
each of these outcomes. The results are presented as odds ratios with the
RAV procedure as compared to the CVG procedure, including 95% confidence
intervals (CIs) and P-values. Further outcomes are summarized with
medians, interquartile ranges and the range and number of patients at
risk. A total of 27 retrospective studies that included a combined 3058
patients were analysed. In-hospital mortality was in favour of the RAV
procedure, which was 2% vs 8% for the CVG procedure. Survival rate at
midterm was 98.8% (95% CI 91.7-100%) for RAV and 81.3% (CI 78.5-83.9%) for
CVG. Freedom from valve-related reintervention was 100% (CI 93.7-100%) for
RAV and 94.6% (CI 86.7-99.1%) for CVG. For an acute type A aortic
dissection in the mid-term period, RAV provides a superior outcome over
CVG, both in terms of aortic-valve-related reintervention and survival
rate. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<26>
Accession Number
2001528803
Title
Protective effect of remote ischemic pre-conditioning on patients
undergoing cardiac bypass valve replacement surgery: A randomized
controlled trial.
Source
Experimental and Therapeutic Medicine. 17 (3) (no pagination), 2019. Date
of Publication: 2019.
Author
Jin X.; Wang L.; Li L.; Zhao X.
Institution
(Jin, Wang, Li, Zhao) Department of Anesthesiology, The First Affiliated
Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Remote ischemic pre-conditioning (RIPC) may have a protective effect on
myocardial injury associated with cardiac bypass surgery (CPB). The
objective of the present study was to investigate the effect of RIPC on
ischemia/reperfusion (I/R) injury and to assess the underlying mechanisms.
A total of 241 patients who underwent valve replacement were randomly
assigned to receive either RIPC (n=121) or control group (n=120). The
primary endpoint was peri-operative myocardial injury (PMI), which was
determined by serum Highly sensitive cardiac troponin T (hsTnT). The
secondary endpoint was the blood gas indexes, acute lung injury and length
of intensive care unit stay, length of hospital stay and major adverse
cardiovascular events. The results indicated that in comparison with
control group, RIPC treatment reduced the levels of hsTnT at 6 and 24 h
post-CPB (P<0.001), as well as the alveolar-arterial oxygen pressure
difference and respiratory index after CPB. Furthermore, RIPC reduced the
incidence of acute lung injury by 15.3% (54.1% in the control group vs.
41.3% in the RIPC group, P=0.053). It was indicated that RIPC provided
myocardial and pulmonary protection during CPB. In addition, the length of
the intensive care unit and hospital stay was reduced by RIPC. Mechanistic
investigation revealed a reduced content of soluble intercellular adhesion
molecule-1, endothelin-1 and malondialdehyde, as well as elevated levels
of nitric oxide in the RIPC group compared with those in the control
group. This indicated that RIPC protected against I/R injury associated
with CPB through reducing the inflammatory response and oxidative damage,
as well as improving pulmonary vascular tension. In conclusion, RIPC
reduced myocardial and pulmonary injury associated with CPB. This
protective effect may be associated with the inhibition of the
inflammatory response and oxidative injury. The present study proved the
efficiency of this approach in reducing ischemia/reperfusion injury
associated with cardiac surgery. Clinical trial registry no.
ChiCTR1800015393. Copyright © 2019, Spandidos Publications. All
rights reserved.

<27>
Accession Number
2001528786
Title
One-year clinical outcome of angiography, fractional flow reserve and
instantaneous wave-free ratio guided percutaneous coronary intervention: A
prisma-compliant meta-analysis.
Source
Experimental and Therapeutic Medicine. 17 (3) (no pagination), 2019. Date
of Publication: 2019.
Author
Baumann S.; Mueller K.S.E.; Hetjens S.; Eder F.; Schaefer A.C.; Becher T.;
Borggrefe M.; Akin I.; Lossnitzer D.
Institution
(Baumann, Mueller, Eder, Schaefer, Borggrefe, Akin, Losnitzer) First
Department of Medicine-Cardiology, University Medical Centre Mannheim,
University of Heidelberg, Germany
(Hetjens) Medical Faculty Mannheim, Department of Medical Statistics,
University of Heidelberg, Germany
(Becher) DZHK (German Centre for Cardiovascular Research), Partner Site
Heidelberg/Mannheim, Mannheim D-68167, Germany
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
The present study aimed to compare the clinical outcome of patients with
coronary artery disease (CAD) who underwent a revascularization using
conventional coronary angiography or a physiologically guided
revascularization with Fractional Flow Reserve (FFR). Furthermore,
outcomes in FFR guided percutaneous coronary intervention (PCI) and
instantaneous wave-free ratio (iFR) guided PCI were compared. The analysis
was performed for reported outcomes at a 1-year follow-up. After searching
PubMed, EMBASE, and Web of Science for suitable publications, a total of
15, 880 subjects were included. Comparing angiography guided and FFR
guided PCI showed no significant difference in major adverse cardiac
events [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.59-1.04;
P=0.09; I2=73%], death from any cause (OR, 0.74; 95% CI, 0.46-1.18;
P=0.20; I2=74%), myocardial infarction (OR, 0.93; 95% CI, 0.81-1.07;
P=0.31; I2=0%) or unplanned revascularization (OR, 0.71; 95% CI,
0.41-1.23; P=0.22; I2=79%). In addition, no significant difference could
be found between iFR and FFR guided PCI for major adverse cardiac events
(OR, 0.97; 95% CI; 0.76-1.23; P=0.81; I2=0%), death from any cause (OR,
0.66; 95% CI, 0.40-1.11; P=0.12; I2=0%), myocardial infarction (OR, 0.83;
95% CI, 0.56-1.24; P=0.37) or unplanned revascularization (OR, 1.16; 95%
CI, 0.85-1.58; P=0.34; I2=16%). Overall, there was a tendency towards
better outcomes of FFR in all four clinical endpoints compared with
angiography guiding of PCI, and furthermore iFR showed no significant
inferiority when compared to FFR in said clinical endpoints. When
conducting a network meta-analysis, the results confirmed a
non-inferiority of iFR compared to angiography guided
revascularization. Copyright © 2019, Spandidos Publications. All
rights reserved.

<28>
Accession Number
626231365
Title
Comparison of transcatheter aortic valve implantation with other
approaches to treat aortic valve stenosis: A systematic review and
meta-analysis.
Source
Systematic Reviews. 8 (1) (no pagination), 2019. Article Number: 44. Date
of Publication: 05 Feb 2019.
Author
Wagner G.; Steiner S.; Gartlehner G.; Arfsten H.; Wildner B.; Mayr H.;
Moertl D.
Institution
(Wagner, Gartlehner) Department for Evidence-based Medicine and Clinical
Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Strase 30, Krems
3500, Austria
(Steiner) Division of Interventional Angiology, University Hospital
Leipzig, Liebigstrase 20, Haus 4, Leipzig 04103, Germany
(Gartlehner) RTI International, PO Box 12194, 3040 East Cornwallis Road,
Research Triangle Park, NC 27709-2194, United States
(Arfsten) Department of Medicine II, Division of Cardiology, Medical
University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
(Wildner) University Library-Information Retrieval Office, Medical
University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
(Mayr, Moertl) Department of Internal Medicine 3, University Hospital St.
Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1,
St. Poelten 3100, Austria
(Mayr, Moertl) Institute for Research of Ischaemic Cardiac Disease and
Rhythmology, Karl Landsteiner Society, Dunant-Platz 1, St. Poelten 3100,
Austria
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVI) is an
alternative treatment for patients with symptomatic severe aortic stenosis
ineligible for surgical aortic valve replacement (SAVR) or at increased
perioperative risk. Due to continually emerging evidence, we performed a
systematic review and meta-analysis comparing benefits and harms of TAVI,
SAVR, medical therapy, and balloon aortic valvuloplasty. Method(s):
We searched MEDLINE, Embase, and Cochrane CENTRAL from 2002 to June 6,
2017. We dually screened abstracts and full-text articles for randomized
controlled trials (RCTs) and propensity score-matched observational
studies. Two investigators independently rated the risk of bias of
included studies and determined the certainty of evidence using GRADE
(Grading of Recommendations Assessment, Development and Evaluation). If
data permitted, we performed meta-analyses using random- and fixed-effects
models. Result(s): Out of 7755 citations, we included six RCTs (5862
patients) and 13 observational studies (6376 patients). In meta-analyses,
patients treated with SAVR or TAVI had similar risks for mortality at 30
days (relative risk [RR] 1.05; 95% confidence interval [CI] 0.82 to 1.33)
and 1 year (RR 1.02; 95% CI 0.93 to 1.13). TAVI had significantly lower
risks for major bleeding but increased risks for major vascular
complications, moderate or severe paravalvular aortic regurgitation, and
new pacemaker implantation compared to SAVR. Comparing TAVI to medical
therapy, mortality did not differ at 30 days but was significantly reduced
at 1 year (RR 0.51; 95% CI 0.34 to 0.77). Conclusion(s): Given
similar mortality risks but different patterns of adverse events, the
choice between TAVI and SAVR remains an individual one. Copyright
© 2019 The Author(s).

<29>
Accession Number
626177969
Title
Bilateral versus single internal-thoracic-artery grafts at 10 years.
Source
New England Journal of Medicine. 380 (5) (pp 437-446), 2019. Date of
Publication: 31 Jan 2019.
Author
Taggart D.P.; Benedetto U.; Gerry S.; Altman D.G.; Gray A.M.; Lees B.;
Gaudino M.; Zamvar V.; Bochenek A.; Buxton B.; Choong C.; Clark S.; Deja
M.; Desai J.; Hasan R.; Jasinski M.; O'Keefe P.; Moraes F.; Pepper J.;
Seevanayagam S.; Sudarshan C.; Trivedi U.; Wos S.; Puskas J.; Flather M.
Institution
(Taggart, Gerry, Altman, Lees) Nuffield Department of Surgical Sciences,
John Radcliffe Hospital, Centre for Statistics in Medicine, Botnar
Research Centre, United Kingdom
(Gray) Health Economics Research Centre, Nuffield Department of Population
Health, University of Oxford, Oxford, United Kingdom
(Benedetto) School of Clinical Sciences, University of Bristol, Bristol
Royal Infirmary, Bristol, United Kingdom
(Zamvar) Department of Cardiac Surgery, Royal Infirmary of Edinburgh,
Edinburgh, United Kingdom
(Choong, Sudarshan) Royal Papworth Hospital, Cambridge, United Kingdom
(Clark) Department of Cardiac Surgery, Freeman Hospital, Newcastle, United
Kingdom
(Desai, Pepper) Department of Cardiac Surgery, King's College Hospital,
Royal Brompton Hospital and Imperial College London, London, United
Kingdom
(Hasan) Department of Cardiac Surgery, Royal Infirmary, Manchester, United
Kingdom
(O'Keefe) Department of Cardiac Surgery, University Hospital of Wales,
Cardiff, United Kingdom
(Trivedi) Department of Cardiac Surgery, Royal Sussex County, Brighton,
United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norfolk and
Norwich University Hospital, Norwich NR4 7TJ, United Kingdom
(Gaudino, Puskas) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York Presbyterian Hospital, Mount Sinai St. Luke's, New
York, United States
(Bochenek) Center for Cardiovascular Research and Development, American
Heart of Poland, Poland
(Deja, Wos) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Jasinski) Department of Cardiac and Thoracic Surgery, Wroclaw Medical
University, Wroclaw, Poland
(Buxton, Seevanayagam) Department of Cardiac Surgery, Austin Health,
Melbourne, VIC, Australia
(Moraes) Heart Institute of Pernambuco, Recife, Brazil
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Multiple arterial grafts may result in longer survival than
single arterial grafts after coronary-artery bypass grafting (CABG)
surgery. We evaluated the use of bilateral internal-thoracic-artery grafts
for CABG. METHODS We randomly assigned patients scheduled for CABG to
undergo bilateral or single internal-thoracic-artery grafting. Additional
arterial or vein grafts were used as indicated. The primary outcome was
death from any cause at 10 years. The composite of death from any cause,
myocardial infarction, or stroke was a secondary outcome. RESULTS A total
of 1548 patients were randomly assigned to undergo bilateral
internal-thoracic-artery grafting (the bilateral-graft group) and 1554 to
undergo single internal-thoracic-artery grafting (the single-graft group).
In the bilateral-graft group, 13.9% of the patients received only a single
internal-thoracic-artery graft, and in the single-graft group, 21.8% of
the patients also received a radial-artery graft. Vital status was not
known for 2.3% of the patients at 10 years. In the intention-to-treat
analysis at 10 years, there were 315 deaths (20.3% of the patients) in the
bilateral-graft group and 329 deaths (21.2%) in the single-graft group
(hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.12; P=0.62).
Regarding the composite outcome of death, myocardial infarction, or
stroke, there were 385 patients (24.9%) with an event in the
bilateral-graft group and 425 patients (27.3%) with an event in the
single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03). CONCLUSIONS
Among patients who were scheduled for CABG and had been randomly assigned
to undergo bilateral or single internal-thoracic-artery grafting, there
was no significant between-group difference in the rate of death from any
cause at 10 years in the intention-to-treat analysis. Further studies are
needed to determine whether multiple arterial grafts provide better
outcomes than a single internal-thoracic-artery graft. Copyright
© 2019 Massachusetts Medical Society.

<30>
Accession Number
626177967
Title
Partial oral versus intravenous antibiotic treatment of endocarditis.
Source
New England Journal of Medicine. 380 (5) (pp 415-424), 2019. Date of
Publication: 31 Jan 2019.
Author
Iversen K.; Ihlemann N.; Gill S.U.; Madsen T.; Elming H.; Jensen K.T.;
Bruun N.E.; Hofsten D.E.; Fursted K.; Christensen J.J.; Schultz M.; Klein
C.F.; Fosboll E.L.; Rosenvinge F.; Schonheyder H.C.; Kober L.;
TorpPedersen C.; HelwegLarsen J.; Tonder N.; Moser C.; Bundgaard H.
Institution
(Ihlemann, Hofsten, Fosboll, Kober, Bundgaard) Department of Cardiology B
2141, Heart Center, Rigshospitalet, Copenhagen University Hospital,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Iversen, Schultz, Klein) Department of Cardiology, Herlev-Gentofte
University Hospital, Denmark
(HelwegLarsen, Tonder, Moser) Departments of Infectious Diseases and
Clinical Microbiology Rigshospitalet, Department of Cardiology, Hill-erod
Hospital, Denmark
(Christensen) Department of Clinical Microbiology, Slagelse Hospital and
Institute of Clinical Medicine, University of Copenhagen, Copenhagen,
Denmark
(Gill, Rosenvinge) Departments of Cardiology, Clinical Microbiology,
Odense University Hospital, Odense, Denmark
(Madsen, TorpPedersen) Departments of Cardiology, Cardiology and
Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
(Schonheyder) Department of Clinical Microbiology, Aalborg University
Hospital, Aalborg University, Denmark
(TorpPedersen) Department of Health Science and Technology, Aalborg
University, Aalborg, Denmark
(Elming) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Jensen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Bruun) Department of Cardiology, University Hospital of Copenhagen,
Gentofte, Denmark
(Fursted) Department of Bacteria, Parasites and Fungi, Statens Serum
Institut, Copenhagen, Denmark
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Patients with infective endocarditis on the left side of the
heart are typically treated with intravenous antibiotic agents for up to 6
weeks. Whether a shift from intravenous to oral antibiotics once the
patient is in stable condition would result in efficacy and safety similar
to those with continued intravenous treatment is unknown. METHODS In a
randomized, noninferiority, multicenter trial, we assigned 400 adults in
stable condition who had endocarditis on the left side of the heart caused
by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or
coagulase-negative staphylococci and who were being treated with
intravenous antibiotics to continue intravenous treatment (199 patients)
or to switch to oral antibiotic treatment (201 patients). In all patients,
antibiotic treatment was administered intravenously for at least 10 days.
If feasible, patients in the orally treated group were discharged to
outpatient treatment. The primary outcome was a composite of all-cause
mortality, unplanned cardiac surgery, embolic events, or relapse of
bacteremia with the primary pathogen, from the time of randomization until
6 months after antibiotic treatment was completed. RESULTS After
randomization, antibiotic treatment was completed after a median of 19
days (interquartile range, 14 to 25) in the intravenously treated group
and 17 days (interquartile range, 14 to 25) in the orally treated group
(P=0.48). The primary composite outcome occurred in 24 patients (12.1%) in
the intravenously treated group and in 18 (9.0%) in the orally treated
group (between-group difference, 3.1 percentage points; 95% confidence
interval, -3.4 to 9.6; P=0.40), which met noninferiority criteria.
CONCLUSIONS In patients with endocarditis on the left side of the heart
who were in stable condition, changing to oral antibiotic treatment was
noninferior to continued intravenous antibiotic treatment. Copyright
© 2018 Massachusetts Medical Society.

<31>
Accession Number
2001551502
Title
Rationale and design of a multicenter randomized trial to compare the
graft patency between no-touch vein harvesting technique and conventional
approach in coronary artery bypass graft surgery.
Source
American Heart Journal. 210 (pp 75-80), 2019. Date of Publication: April
2019.
Author
Wang X.; Tian M.; Zheng Z.; Gao H.; Wang Y.; Wang L.; Hu S.
Institution
(Wang, Tian, Zheng, Gao, Wang, Hu) Department of Surgery, National Center
for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing, China
(Wang) Medical Research & Biometrics Center, National Center for
Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical
Sciences & Peking Union Medical College, Beijing, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Vein graft failure is a crucial challenge in coronary artery
bypass graft (CABG) surgery. Previous studies have suggested a patency
benefit of the No-Touch vein harvesting technique, but only with small
sample sizes. Material(s) and Method(s): This study is a prospective,
multicenter randomized clinical trial with a large sample size, aiming to
investigate the efficacy of the No-Touch technique compared with the
conventional approach. All patients requiring isolated CABG with left
internal mammary artery plus at least one saphenous vein graft will be
considered for entry into the study. Two thousand cases (1000 in each arm)
will be enrolled over 1 to 2 years in 7 hospitals in China. Participants
will be randomized in equal proportions between two surgical strategies:
the No-Touch or conventional technique. The primary endpoint is graft
vessel occlusion at 3 months after CABG surgery by CT coronary
angiography. Secondary outcomes are major adverse cardiac or
cerebrovascular events at 3 and 12 months post-operation and graft vessel
occlusion at 1 year. Discussion(s): This study will define the role
of the No-Touch vein harvesting technique in CABG surgery and provide
strong evidence to answer whether this technique could reduce vein graft
occlusion. Copyright © 2018

<32>
Accession Number
2000737452
Title
An updated meta-analysis of TAVR in patients at intermediate risk for
SAVR.
Source
Cardiovascular Revascularization Medicine. 20 (1) (pp 57-69), 2019. Date
of Publication: January 2019.
Author
Lazkani M.; Singh N.; Howe C.; Patel N.; Colon M.J.; Tasset M.; Amabile
O.; Morris M.; Fang H.K.; Pershad A.
Institution
(Lazkani, Patel, Colon, Tasset, Amabile, Morris, Fang, Pershad) University
of Arizona, Banner University Medical Center - Phoenix, United States
(Singh, Howe) University of Arizona, Banner University Medical Center,
Tuscon, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
approved for use in patients with severe aortic stenosis at intermediate,
high and extreme surgical risk. This meta-analysis was performed to assess
the safety and efficacy of TAVR compared to surgical aortic valve
replacement (SAVR) in intermediate risk patients. Method(s): We
searched PubMed, EMBASE, Web of science, and the Cochrane Central Register
of Controlled Trials databases for studies comparing TAVR versus SAVR in
patients at intermediate surgical risk, with a mean Society of Thoracic
Surgeon score of 3-8% or a mean logistic European risk score of 10-20%.
The primary endpoint was to assess the efficacy of TAVR compared to SAVR,
defined as all-cause and cardiovascular mortality at 30-days, 1-year, and
>=2 years of follow-up. Secondary endpoints were the safety profile,
comprising of cerebrovascular events, myocardial infarctions, permanent
pacemaker placement, new onset atrial fibrillation, aortic regurgitation,
vascular complications, major bleeding and acute kidney injury.
 Result(s): This is the largest and most contemporary meta-analysis of
5647 intermediate risk patients in eleven studies published to date. There
were no statistically significant differences in all-cause and cardiac
mortality at 30 days, 1- year and >2-years of follow up. Acute kidney
injury and atrial fibrillation occurred more frequently in patients
treated with SAVR and permanent pacemaker implantation and aortic
insufficiency were more frequent in patients treated with TAVR.
 Conclusion(s): This meta-analysis suggests that for intermediate risk
patients with severe aortic stenosis, TAVR has similar efficacy as SAVR
but with a different adverse event profile. Copyright © 2018
Elsevier Inc.

<33>
Accession Number
2001057948
Title
A randomized trial comparing two stent sizing strategies in coronary
bifurcation treatment with bioresorbable vascular scaffolds - The Absorb
Bifurcation Coronary (ABC) trial.
Source
Cardiovascular Revascularization Medicine. 20 (1) (pp 43-49), 2019. Date
of Publication: January 2019.
Author
Rampat R.; Mayo T.; Hildick-Smith D.; Cockburn J.
Institution
(Rampat, Hildick-Smith, Cockburn) Sussex Cardiac Centre, Brighton and
Sussex University Hospitals BN2 5BE, United Kingdom
(Rampat, Mayo) Brighton and Sussex Medical School BN1 9PX, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Limited information is available on the use of Bioresorbable
Vascular Scaffold (BVS) in bifurcations involving significant side
branches. When treating bifurcation disease with metal stents, the
recommendation is to choose a stent diameter based on the distal main
vessel diameter. Whether this sizing strategy is applicable to BVS is
currently unknown. Method(s): We randomised 37 patients undergoing
elective PCI for 'false' bifurcation disease (Medina 0,1,0; 1,0,0; 1,1,0)
to receive BVS based either on proximal or distal reference diameters.
Optical Frequency Domain Imaging (OFDI) measurements were performed pre
BVS insertion to obtain proximal and distal reference diameters and post
implantation. BVS size was chosen according to the proximal or distal
reference diameter as per randomisation. Implantation was performed using
the PSP technique tailored to bifurcation stenting. OFDI was repeated post
implantation to confirm satisfactory expansion and apposition.
 Result(s): Baseline demographics between the two groups were similar.
Patients were aged 62.8 +/- 3.3 years; 76% were male. Mean side branch
diameter was 2.24 +/- 0.13 mm. TIMI III flow in the main vessel was
achieved in all cases. Side branch occlusion occurred in 1 case (2.7%). In
the distal-sizing arm, there was a greater incidence of significant
malapposition (>300 mum) at the proximal end of the scaffold on OCT (2.3%
versus 0.8%, p 0.023). The incidence of distal edge dissections was
numerically greater in the proximal-sizing group but this was not
statistically significant (31.3% vs 11.8%, p 0.17). Conclusion(s):
Both proximal and distal sizing strategies have similar procedural
complication rates when using the ABSORB BVS to treat coronary
bifurcations. However a proximal sizing strategy is associated with less
malapposition and may be preferable. Copyright © 2018 Elsevier
Inc.

<34>
Accession Number
2001580984
Title
Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegia
solutions in pediatric patients undergoing open heart surgery: A
prospective randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (3) (pp 1182-1192.e1),
2019. Date of Publication: March 2019.
Author
Talwar S.; Chatterjee S.; Sreenivas V.; Makhija N.; Kapoor P.M.; Choudhary
S.K.; Airan B.
Institution
(Talwar, Chatterjee, Choudhary, Airan) Department of Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Sreenivas) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India
(Makhija, Kapoor) Department of Cardiac Anesthesiology, All India
Institute of Medical Sciences, New Delhi, India
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: We conducted a prospective randomized controlled trial to
compare del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK)
cardioplegia solution in pediatric patients undergoing intracardiac
tetralogy of Fallot repair. Method(s): One hundred consecutive
patients 12 years of age or younger, undergoing intracardiac repair of
tetralogy of Fallot were randomized into DN (n = 50) and HTK (n = 50)
groups. Cardioplegia strategy consisted of a single dose of DN (20 mL/kg)
or HTK (6 mL/kg/min for 6 minutes). Primary outcome was cardiac index
(CI). Secondary outcomes were ventricular arrhythmias post cross-clamp
release, time to peripheral rewarming, duration of mechanical ventilation,
inotropic score, intensive care unit and hospital stay, and serum levels
of troponin-I, interleukin-6, and tumor necrosis factor-alpha.
Ultrastructural changes in the myocardium were assessed. Result(s):
CI was significantly higher in the DN group compared with the HTK group at
6 (P =.005) and 24 hours (P <.001) after surgery. It was on an average
0.44 L/min/m2 higher in the DN group at any time point (P
=.004). Time for complete cessation of electrical activity was longer in
the HTK group (P =.01) and more patients in the HTK group had ventricular
arrhythmias post cross-clamp release (P =.03). Duration of mechanical
ventilation (P =.006), intensive care unit stay (P =.05), and hospital
stay (P <.001) were lower in the DN group. Patients in the DN group had
lower troponin I levels 24 hours after cardiopulmonary bypass (P <.001).
Electron microscopic studies showed more myocardial edema (P =.02) and
myofibrillar disarray (P =.04) in the HTK group along with lower glycogen
stores (P =.04). DN cardioplegia was more cost-effective than HTK
cardioplegia (P <.001). Conclusion(s): DN cardioplegia was associated
with better preservation of CI, less duration of mechanical ventilation,
shorter intensive care unit and hospital stays, lower inotropic scores,
and less release of troponin-I. Electron microscopy showed less myocardial
edema and better preservation of the myofibrillar architecture and
glycogen stores in the DN group. Copyright © 2018

<35>
Accession Number
626477014
Title
Replacing PT-INR monitoring of warfarin with Fiix-NR in clinical practice
reduces thromboembolism without increasing bleeding despite reduced number
of dose adjustments.
Source
Blood. Conference: 60th Annual Meeting of the American Society of
Hematology, ASH 2018. United States. 132 (Suppl. 1) (no pagination), 2018.
Date of Publication: November 2018.
Author
Oskarsdottir A.R.; Gudmundsdottir B.R.; Onundarson P.T.
Institution
(Oskarsdottir, Gudmundsdottir, Onundarson) Hematology Laboratory,
Landspitali University Hospital, Reykjavik, Iceland
Publisher
American Society of Hematology
Abstract
Background: Traditional prothrombin time (PT) based international
normalized ratio (INR) is often highly variable. Often this is caused by
rapid factor VII reductions due to its short (4 hour) halflife. Thus,
factor VII variation is an important confounder during vitamin K
antagonist (VKA) dosing. Furthermore, prior studies have demonstrated that
factor VII reductions only minimally influence the antithrombotic effect
and bleeding risk of VKA, the clinical effect depending mainly on
controlled reduction of factors II and X. Therefore, ignoring the
influence of FVII during VKA monitoring has the potential to simplify
management and outcome. The Fiix prothrombin time (Fiix-PT) is a new
modified PT that is only affected by reduced factors II and X. The Fiix-PT
is not affected by variations in factor VII. Hence, the Fiix normalized
ratio (Fiix- NR) fluctuates less than the standard standard PT-INR. In the
double-blind randomized clinical Fiix-trial, published in 2015, monitoring
of warfarin with with Fiix-PT (Fiix-NR) was compared to standard high
time-in-range PT-INR monitoring. Fiix-NR monitoring led to improved
time-inrange, reduced testing frequency, reduced dose-adjustment need and
a 50% reduction in thromboembolism (TE). Bleeding did not increase and it
occurred at a low rate in both trial arms. Subsequently starting on July
1st 2015 we replaced the PT-INR with Fiix-NR in our
anticoagulation monitoring practice. Aim(s): We compared
anticoagulation outcome and dosing frequency during 12 months prior to
switching from PT-INR based management (Pre-Fiix monitoring period) and
during 12 months following switch to Fiix-NR monitoring (Fiix monitoring
period). Method(s): This is a retrospective before and after study
involving unselected patients managed at a single anticoagulation
management service at the Landspitali University Hospital in Reykjavik,
Iceland. All patients on warfarin during two consecutive twelve month
periods were analysed irrespective of indication or anticoagulation target
range. Pre-Fiix patients analysis was based on events occuring during
months -12 to -1 before replacing the PT with Fiix PT and the Fiix
patients 'outcome was analysed during months +4 to +15. Three transitional
months were excluded. All patients were dosed by specialized staff using
the DAWN anticoagulation software. Hospital chart diagnostic codes were
reviewed for occurrence of TE or major bleeding (MB) during the two
separate monitoring periods.Surrogate assessments included the number of
tests, testing intervals and dose adjustment frequencies and will be
analyzed later. Result(s): During the Pre-Fiix period 2,345 patients
were managed with PT-INR for 1,984 patient years (0.85 years/patient) and
during the Fiix period 1,909 patients were managed with Fiix-NR for 1,643
patient years (0.86 y/pt). Indications for warfarin were identical during
both periods (atrial fibrillation 57%, venous thromboembolism 26%,
prosthetic heart valves 5% and other 12%). The INR target range during
both periods was 2.0-3.0 in 92% and 2.5-3.5 in 6%. Clinical outcome with
respect to TE and MB is shown in the figure. Overall the point estimates
were suggestive of a 34-52% reduction of TE with Fiix-NR monitoring
whereas major bleeding was similar. The reduction in untoward events in
the Fiix group was statistically significant for composite new TE (OR
0.63;0.41-0.97) and total stroke (ischemic and hemorrhagic, OR 0.57;CI
0.33-0.98), mainly driven by reduced cerebral infarction. Intracranial
bleeding occurred in 0.76% in the Pre-Fiix group and in 0.37% in the Fiix
montoring group (n.s., OR 0.51;0.19-1.32). The median time-within-
Target-range (TTR, Rosendaal method) was similar in both groups (75 vs
76%, respectively), despite dose adjustment frequency being reduced by 18%
in the Fiix monitoring group (OR 0.82;CI 0.79-0.85, p <0.0001).
 Conclusion(s): These results are in agreement with the results of the
Fiix-trial and show that ignoring factor VII during VKA monitoring is safe
and leads to reduction in thromboembolism without increasing bleeding.
Although TTR was identical in both groups, the dose adjustment need was
reduced possibly indicating that less anticoagulation variability in the
Fiix-NR group explains reduced thromboembolism. (Figure presented).

<36>
Accession Number
626476897
Title
Restrictive versus liberal red blood cell transfusion for cardiac surgery:
A systematic review and meta-analysis of randomized controlled trials.
Source
Blood. Conference: 60th Annual Meeting of the American Society of
Hematology, ASH 2018. United States. 132 (Suppl. 1) (no pagination), 2018.
Date of Publication: November 2018.
Author
Kheiri B.; Abdalla A.; Osman M.; Haykal T.; Chintalapati S.; Cranford J.;
Ahmed S.; Hassan M.; Bachuwa G.; Bhatt D.L.
Institution
(Kheiri, Abdalla, Osman, Haykal, Chintalapati, Cranford, Ahmed, Hassan,
Bachuwa) Hurley Medical Center, Michigan State University, Flint, MI,
United States
(Bhatt) Birgham and Womens Hospital, Boston, MA, United States
Publisher
American Society of Hematology
Abstract
Introduction:Patients undergoing cardiac surgery are among the most common
recipients of allogenic red blood cell (RBC) transfusions. However,
whether restrictive RBC transfusion strategies for cardiac surgery achieve
a similar clinical outcome in comparison with liberal strategies remains
unclear. Method(s):We searched PubMed, Embase, the Cochrane
Collaboration Central Register of Controlled Trials, and conference
proceedings from inception to December 2017 for all randomized trials
(RCTs). The primary outcome was mortality. Secondary outcomes were stroke,
respiratory morbidity, renal morbidity, infections, myocardial infarction
(MI), cardiac arrhythmia, gut morbidity, reoperation, intensive care unit
(ICU) length of stay (hours), and hospital length of stay (days). We
calculated the risk ratios (RR) and weighted mean difference (MD) for the
clinical outcomes using a random-effects model. Result(s):We included
9 RCTs with a total of 9,005 patients. There was no significant difference
in mortality between groups (RR 1.03; 95% CI 0.74- 1.45; P=0.86). In
addition, there were no significant differences between groups in the
clinical outcomes of infections (RR 1.09; 95% CI 0.94-1.26; P=0.26),
stroke (RR 0.98; 95% CI 0.72-1.35; P=0.91), respiratory morbidity (RR
1.05; 95% CI 0.89-1.24; P=0.58), renal morbidity (RR 1.02; 95% CI
0.94-1.09; P=0.68), myocardial infarction (RR 1.00; 95% CI 0.80-1.24;
P=0.99), cardiac arrhythmia (RR 1.05; 95% CI 0.88-1.26; P=0.56),
gastrointestinal morbidity (RR 1.93; 95% CI 0.81-4.63; P=0.14), or
reoperation (RR 0.90; 95% CI 0.67-1.20; P=0.46). There was a significant
difference in the intensive care unit length of stay (hours) (MD 4.29; 95%
CI: 2.19-6.39, P<0.01) favoring the liberal group. However, there was no
significant difference in the hospital length of stay (days) (MD 0.15; 95%
CI -0.18-0.48; P=0.38). Conclusion(s):This meta-analysis showed that
restrictive strategies for RBC transfusion are as safe as liberal
strategies in patients undergoing cardiac surgery. Key points: Restrictive
strategies for red blood cell transfusion are as safe as liberal
approaches in patients undergoing cardiac surgery. Longer duration of stay
in the intensive care unit is more common in patients managed with a
restrictive transfusion approach. However, the overall hospital length of
stay appeared to be similar between both groups. Further studies are
needed to ascertain threshold triggers for RBC transfusion. (Table
presented).

<37>
Accession Number
626476822
Title
Adverse neurological performance with critical congenital heart diseases
mainly from prenatal injury not cardiac surgery: Current evidence based on
a meta-analysis of functional magnetic resonance imaging.
Source
Journal of the Hong Kong College of Cardiology. Conference: 24th Annual
Scientific Congress of Hong Kong College of Cardiology. Hong Kong. 24 (1)
(pp 51), 2016. Date of Publication: April 2016.
Author
Li Y.F.; Hua Y.M.; Wang C.; Mu D.Z.; Zhou K.Y.
Institution
(Li, Hua, Wang, Mu, Zhou) Department of Pediatric Cardiovascular Disease,
West China Second University Hospital, Sichuan University, China
Publisher
Medcom Limited
Abstract
Objective: No consensus has been reached regarding whether congenital
heart disease (CHD) related brain injury is caused by cardiac surgery or
prenatal injury of CHD. We performed this meta-analysis to identify the
likely cause of adverse neurological performance in CHD patients.
 Method(s): Literature search was done in December 2013 and records
were retrieved from PubMed, Embase, the Cochrane Library and WHO trails
center without language restriction. Studies applying functional magnetic
resonance imaging (fMRI) evaluation of brain function before and after
surgery were included. The preoperative and postoperative fMRI results
were extracted, and meta-analysis was performed using Revman 5.1.1and
STATA 11.0, according to the guidelines from the Cochrane review group and
the MOOSE guidance. Result(s): A total of 937 citations were yielded
from electronic search. Fulltexts were retrieved for 16 articles and the
following studies were eligible for inclusion: 6 studies (n=327 cases)
with fMRI analysis before surgery and 3 studies (n=36 cases) with
completing perioperative fMRI analysis. The overall average diffusivity of
CHD cases was significant higher with a summarized Std. Mean Difference of
1.39 (95% CI=0.70, 2.08), and the fractional anisotropy was lower in CHD
cases with a summarized Std. Mean Difference of-1.34 (95% CI=-1.64,
-1.04). NAA/Cho and Lac/Cho were recorded in CHD cases with significant
differences compared to healthy ones. In postoperative near term,
significant change in NAA/Cr and NAA/Cho were found. However, the
difference was not found in follow up. Conclusion(s): The
meta-analysis demonstrated the delay in neurological development in
newborns with congenital heart disease, and cardiac surgery might lead to
mild brain injuries postoperatively, but recovery of fMRI evaluation has
been identified during the follow-up.

<38>
Accession Number
626476489
Title
24th Annual Scientific Congress of Hong Kong College of Cardiology.
Source
Journal of the Hong Kong College of Cardiology. Conference: 24th Annual
Scientific Congress of Hong Kong College of Cardiology. Hong Kong. 24 (1)
(no pagination), 2016. Date of Publication: April 2016.
Author
Anonymous
Publisher
Medcom Limited
Abstract
The proceedings contain 68 papers. The topics discussed include:
arrhythmia in severe fever with thrombocytopenia syndrome; reaching an
unreachable left main coronary ostium in a patient with dilated aortic
root; shock as prominent early manifestation of Kawasaki disease in
children; adverse neurological performance with critical congenital heart
diseases mainly from prenatal injury not cardiac surgery: current evidence
based on a meta-analysis of functional magnetic resonance imaging;
analysis of the clinical value of selective coronary angiography in
children with coronary lesions caused by Kawasaki disease (a report of six
cases); recurrent hemoptysis of pulmonary vascular anomalies in children -
a series of 11 cases treated with catheter-based therapy; the meta
analysis of infective endocarditis in Chinese children; and early and
midterm follow-up of vascular endothelial function in children with
surgical repair for coarctation of aorta.

<39>
Accession Number
626476323
Title
Analysis of the clinical value of selective coronary angiography in
children with coronary lesions caused by kawasaki disease (a report of six
cases).
Source
Journal of the Hong Kong College of Cardiology. Conference: 24th Annual
Scientific Congress of Hong Kong College of Cardiology. Hong Kong. 24 (1)
(pp 51), 2016. Date of Publication: April 2016.
Author
Hu L.; Li Y.F.; Zhang Z.W.; Xie Z.F.; Zeng G.H.
Institution
(Hu, Li, Zhang, Xie, Zeng) Guangdong Cardiovascular Institute, China
Publisher
Medcom Limited
Abstract
Objective: To analyze the clinical value of selective coronary angiography
(SCAG) to the coronary lesions caused by Kawasaki disease (KD) in
children, and explore the significance of SCAG to the interventional
therapy. Method(s): 6 children are in the age of 2-14 years old, the
median age was 7.5 years old; all of them have a clear history of KD.
Transthoracic echocardiography (TTE) showed them had coronary artery
lesions more or less, including heart failure and myocardial infarction of
2 cases. Six cases were examined by SCAG, according to the results, 2
cases proceeded intravascular ultrasound (IVUS), another 2 cases underwent
percutaneous balloon angioplasty, and another child received coronary
artery stent implantation. Result(s): SCAG results showed that 6
cases had different degree of coronary artery lesions. Case 1 got coronary
artery dilatation but no aneurysm formation, and there was no clinical
symptom, such as chest pain, so that no interventional therapy taken; 2
cases had coronary artery aneurysm without obvious stenosis, both of them
underwent IVUS evaluation of the coronary artery wall, but without further
intervention; 3 cases showed coronary artery aneurysms combined with
stenosis, and two of them took percutaneous balloon angioplasty, the
stenosis totally or partially relieved; the rest one got percutaneous
coronary artery stent implantation. PAEDIATRIC CARDIOLOGY I Adverse
Neurological Performance with Critical Congenital Heart Diseases mainly
from Prenatal Injury not Cardiac Surgery: Current Evidence based on a
Meta-analysis of Functional Magnetic Resonance Imaging YF Li, YM Hua, C
Wang, DZ Mu, KY Zhou Department of Pediatric Cardiovascular Disease, West
China Second University Hospital, Sichuan University, China Objective: No
consensus has been reached regarding whether congenital heart disease
(CHD) related brain injury is caused by cardiac surgery or prenatal injury
of CHD. We performed this meta-analysis to identify the likely cause of
adverse neurological performance in CHD patients. Method(s):
Literature search was done in December 2013 and records were retrieved
from PubMed, Embase, the Cochrane Library and WHO trails center without
language restriction. Studies applying functional magnetic resonance
imaging (fMRI) evaluation of brain function before and after surgery were
included. The preoperative and postoperative fMRI results were extracted,
and meta-analysis was performed using Revman 5.1.1and STATA 11.0,
according to the guidelines from the Cochrane review group and the MOOSE
guidance. Result(s): A total of 937 citations were yielded from
electronic search. Fulltexts were retrieved for 16 articles and the
following studies were eligible for inclusion: 6 studies (n=327 cases)
with fMRI analysis before surgery and 3 studies (n=36 cases) with
completing perioperative fMRI analysis. The overall average diffusivity of
CHD cases was significant higher with a summarized Std. Mean Difference of
1.39 (95% CI=0.70, 2.08), and the fractional anisotropy was lower in CHD
cases with a summarized Std. Mean Difference of-1.34 (95% CI=-1.64,
-1.04). NAA/Cho and Lac/Cho were recorded in CHD cases with significant
differences compared to healthy ones. In postoperative near term,
significant change in NAA/Cr and NAA/Cho were found. However, the
difference was not found in follow up. Conclusion(s): The
meta-analysis demonstrated the delay in neurological development in
newborns with congenital heart disease, and cardiac surgery might lead to
mild brain injuries postoperatively, but recovery of fMRI evaluation has
been identified during the follow-up. Conclusion(s): Selective
angiography of coronary artery lesions is a safe, effective, accurate way
to estimate coronary artery lesions in KD children, .

<40>
Accession Number
626483121
Title
Evaluation of Antibiotic Prophylaxis in Rhinoplasty: A Systematic Review
and Meta-analysis.
Source
JAMA facial plastic surgery. 21 (1) (pp 12-17), 2019. Date of Publication:
01 Jan 2019.
Author
Nuyen B.; Kandathil C.K.; Laimi K.; Rudy S.F.; Most S.P.; Saltychev M.
Institution
(Nuyen, Kandathil, Rudy, Most) Division of Facial Plastic and
Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery,
Stanford University School of Medicine, Stanford, CA, United States
(Laimi, Saltychev) Department of Physical and Rehabilitation Medicine,
Turku University Hospital, University of Turku, Turku, Finland
Publisher
NLM (Medline)
Abstract
Importance: Although antibiotic prophylaxis following rhinoplasty is
widespread, the evidence on antibiotic prophylaxis effectiveness and the
superiority of particular administration regimens is controversial. To
date, a meta-analysis on the topic has not been performed.
 Objective(s): To systematically review the association between use of
preventive antibiotics and postoperative complications in patients
undergoing rhinoplasty and quantify the review through meta-analysis.
 Data Sources: MEDLINE, Embase, CINAHL, Central (Cochrane Controlled
Register of Trials), Scopus, and Web of Science were searched with
prospectively designed search phrases on February 16, 2018. All databases
were searched from database inception. Key search terms included
rhinoplasty, nasal valve repair, and antibacterial agent. Study Selection:
Randomized clinical trials (RCTs) with adults (>=18 years) undergoing
rhinoplasty and including systemic antibiotic medications administered in
the absence of other reasons for use of an antibiotic (eg, localized or
systemic infection), without restrictions on language or the time of
publication, were included in the study. Interventions of interest were
classified into 3 types: (1) single-dose systemic antibiotic administered
within 24 hours before the first incision, (2) multidose systemic
antibiotic treatment started within 24 hours before the first incision and
continuing after the operation, and (3) systemic antibiotic therapy
(single dose or multidose) started within 24 hours after the first
incision. The following comparisons were made: for the interventions of
type 1, no antibiotic; for the interventions of types 2 or 3, no
antibiotic or an intervention of type 1. Data Extraction and Synthesis:
Data extraction was compliant with PRISMA guidelines and Cochrane Handbook
for Systematic Reviews of Interventions. Two independent reviewers
assessed the relevance of the remaining records at abstract and full-text
stages. Meta-analysis pooled with random-effects model. Main Outcomes
and Measures: Difference in infectious complication rate between groups.
 Result(s): A total of 262 records were identified; of these, only 5
RCTs fulfilled predetermined population, intervention, comparison, and
outcome criteria. The pooled study sample consisted of 589 participants.
No significant differences in outcome of preventive antibiotic therapy
given either preoperatively or postoperatively were found, with a pooled
risk ratio of 0.92 (95% CI, 0.35-2.43; P=.86). Conclusions and
Relevance: This study appears to be the first Cochrane-protocol systematic
review and meta-analysis investigating preventive antibiotics in
rhinoplasty. This study's results suggest that pooled evidence from the 5
RCTs does not support the use of preventive antibiotic therapy in
rhinoplasty.1.

<41>
Accession Number
626485308
Title
Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular
Injury and Oxidative Stress in Cardiovascular Surgery.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (1) (pp
10-17), 2019. Date of Publication: 20 Feb 2019.
Author
Ulugol H.; Aksu U.; Kocyigit M.; Kilercik M.; Karduz G.; Okten M.; Toraman
F.
Institution
(Ulugol, Kocyigit, Toraman) Department of Anesthesiology and Reanimation,
Acibadem University, School of Medicine, Istanbul, Turkey
(Aksu, Karduz) Department of Biology, Science Faculty, Istanbul
University, Istanbul, Turkey
(Kilercik) Department of Clinical Laboratory, Acibadem Kadikoy Hospital,
Istanbul, Turkey
(Okten) Department of Cardiovascular Surgery, Acibadem University, School
of Medicine, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: The purpose of this study was to evaluate the effect of different
cardioplegic solutions on endothelial integrity and oxidative stress in
cardiovascular surgery. METHOD(S): In this randomized prospective
study, after ethics approval and informed consent, 60 surgical patients
were included. Patients undergoing coronary bypass surgery were randomized
into two groups as warm blood cardioplegia (n = 30) and cold crystalloid
cardioplegia (n = 30) following the cross-clamping. Measurements were
performed at three time points: before induction of anesthesia (T1), at
admission to intensive care unit (ICU) (T2) and at the 24th postoperative
hour (T3). Besides biochemical routine hemodynamic monitoring, patients
were assessed for the sialic acid (SA), ischemic-modified albumin (IMA),
advanced oxide protein products (AOPPs), total thiol (SH), and free
hemoglobin (fHb) level. RESULT(S): Neither crystalloid nor blood
cardioplegia led to significant changes in the AOPPs, T-SH, and SA level
(p >0.05). Crystalloid cardioplegia, however, increased IMA level compared
to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb
levels were transiently increased in both groups at the second-time point
(p <0.001). fHb level was lower in the crystalloid group compared to that
in the other group (p <0.05) at T2. CONCLUSION(S): Cardioplegia type
creates similar effects on glycocalyx integrity. However, myocardial
protection could be provided with warm blood cardioplegia.

<42>
[Use Link to view the full text]
Accession Number
626484353
Title
Cost-Effectiveness of Mitral Valve Repair Versus Replacement for Severe
Ischemic Mitral Regurgitation: A Randomized Clinical Trial From the
Cardiothoracic Surgical Trials Network.
Source
Circulation. Cardiovascular quality and outcomes. 11 (11) (pp 13), 2018.
Date of Publication: 14 Nov 2018.
Author
Ferket B.S.; Ailawadi G.A.; Gelijns A.C.G.; Acker M.A.A.; Hohmann S.F.;
Chang H.L.; Bouchard, D.B.; Meltzer D.O.; Michler R.E.M.; Moquete E.G.;
Voisine P.V.; Mullen J.C.M.; Lala A.L.; Mack M.J.M.; Gillinov A.M.G.;
Thourani V.H.; Miller M.A.; Gammie J.S.G.; Parides M.K.P.; Bagiella E.B.;
Smith R.L.S.; Smith P.K.S.; Hung J.W.H.; Gupta L.N.G.; Rose E.A.R.; O'Gara
P.T.O.; Moskowitz A.J.M.; Cardiothoracic Surgical Trials Network (CTSN)
Investigators
Publisher
NLM (Medline)
Abstract
BACKGROUND: The CTSN (Cardiothoracic Surgical Trials Network) recently
reported no difference in left ventricular end-systolic volume index or in
survival at 2 years between patients with severe ischemic mitral
regurgitation (MR) randomized to mitral valve repair or replacement.
However, replacement provided more durable correction of MR and fewer
cardiovascular readmissions. Yet, costeffectiveness outcomes have not been
addressed. METHODS AND RESULTS: We conducted a cost-effectiveness analysis
of the surgical treatment of ischemic MR based on the CTSN trial (n=126
for repair; n=125 for replacement). Patient-level data on readmissions,
survival, qualityof- life, and US hospital costs were used to estimate
costs and quality-adjusted life years per patient over the trial duration
and a 10-year time horizon. We performed microsimulation for extrapolation
of outcomes beyond the 2 years of trial data. Bootstrap and deterministic
sensitivity analyses were done to address parameter uncertainty.
In-hospital cost estimates were $78 216 for replacement versus $72 761 for
repair (difference: $5455; 95% uncertainty interval [UI]: -7784-21 193)
while 2-year costs were $97 427 versus $96 261 (difference: $1166; 95% UI:
-16 253-17 172), respectively. Quality-adjusted life years at 2 years were
1.18 for replacement versus 1.23 for repair (difference: -0.05; 95% UI:
-0.17 to 0.07). Over 5 and 10 years, the benefits of reduction in
cardiovascular readmission rates with replacement increased, and survival
minimally improved compared with repair. At 5 years, cumulative costs and
quality-adjusted life years showed no difference on average, but by 10
years, there was a small, uncertain benefit for replacement: $118 023
versus $119 837 (difference: -$1814; 95% UI: -27 144 to 22 602) and
qualityadjusted life years: 4.06 versus 3.97 (difference: 0.09; 95% UI:
-0.87 to 1.08). After 10 years, the incremental cost-effectiveness of
replacement continued to improve. CONCLUSION(S): Our
cost-effectiveness analysis predicts potential savings in cost and gains
in quality-adjusted survival at 10 years when mitral valve replacement is
compared with repair for severe ischemic MR. These projected benefits,
however, were small and subject to variability. Efforts to further
delineate predictors of long-term outcomes in patients with severe
ischemic MR are needed to optimize surgical decisions for individual
patients, which should yield more cost-effective care. CLINICAL TRIAL
REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT00807040. Copyright 2018 American Heart Association, Inc.

<43>
Accession Number
626474510
Title
Pretreatment with glucose-insulin-potassium improves ventricular
performances after coronary artery bypass surgery: a randomized controlled
trial.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2019. Date
of Publication: 2019.
Author
Licker M.; Reynaud T.; Garofano N.; Sologashvili T.; Diaper J.;
Ellenberger C.
Institution
(Licker, Reynaud, Garofano, Diaper, Ellenberger) Department of
Anaesthesiology, Pharmacology and Intensive Care, University Hospital of
Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1211, Switzerland
(Licker) Faculty of Medicine, University of Geneva, Geneva, Switzerland
(Sologashvili) Division of Cardiovascular Surgery, University Hospital of
Geneva, Geneva, Switzerland
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Heart failure is the main cause of poor outcome following open heart
surgery and experimental studies have demonstrated that
glucose-insulin-potassium (GIK) infusion exerts cardioprotective effects
by reducing myocardial ischemia-reperfusion injuries. This randomized
controlled trial was designed to assess the effects of GIK on left
ventricular function in moderate-to-high risk patients undergoing on-pump
isolated coronary artery bypass surgery (CABGS), or combined with aortic
valve replacement. The primary outcomes were the effects of GIK on two-
and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF),
and on transmitral flow propagation velocity (Vp), that occurred between
the pre- and post-CPB periods. GIK administration was associated with
favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp
changes over the study periods. In GIK pretreated patients (N = 54), 2-D
and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD]
+ 3.5%, 95% confidence interval [95% CI] - 0.2 to 7.1%, MD + 4.0%, 95% CI
0.6-7.4%, and MD + 22.2%, 95% CI 16.0-28.4%, respectively). In contrast,
in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased
after CPB (MD - 7.5% [- 11.6 to - 3.4%], MD - 12.0% [- 15.2 to - 8.8%] and
MD - 21.3% [- 25.7 to - 16.9%], respectively). In conclusion, the
administration of GIK resulted in better preservation of systolic and
diastolic ventricular function in the early period following weaning from
CPB. Copyright © 2019, Springer Nature B.V.

<44>
Accession Number
626473153
Title
Intraoperative reduction of vasopressors using processed
electroencephalographic monitoring in patients undergoing elective cardiac
surgery: a randomized clinical trial.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2019. Date
of Publication: 2019.
Author
Sponholz C.; Schuwirth C.; Koenig L.; Hoyer H.; Coldewey S.M.; Schelenz
C.; Doenst T.; Kortgen A.; Bauer M.
Institution
(Sponholz, Schuwirth, Koenig, Coldewey, Schelenz, Kortgen, Bauer)
Department of Anesthesiology and Intensive Care Medicine, Jena University
Hospital, Jena, Germany
(Hoyer) Institute of Medical Statistics, Computer Sciences and Data
Sciences, Jena University Hospital, Jena, Germany
(Coldewey) ZIK Septomics Research Centre, Jena University Hospital,
Friedrich Schiller University Jena, Jena, Germany
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Jena, Germany
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Intraoperative vasopressor and fluid application are common strategies
against hypotension. Use of processed electroencephalographic monitoring
(pEEG) may reduce vasopressor application, a known risk factor for organ
dysfunction, in elective cardiac surgery patients. Randomized
single-centre clinical trial at Jena University Hospital. Adult patients
operated on cardiopulmonary bypass or off-pump coronary artery bypass
grafting were randomised to receive anesthesia with visible or blinded
pEEG using NarcotrendTM. In blinded-Narcotrend (NT) depth of anesthesia
was extrapolated from clinical signs, hemodynamic response and anesthetic
concentration, supplemented by target indices between 37 and 64 in the
visible-NT group. Intraoperative norepinephrine requirement (primary
endpoint), fluid balance, extubation time, delirium occurrence and adverse
events were evaluated. Patients of the intent-to-treat population
(visible-NT: n = 123, blinded-NT: n = 122) had similar patient and
procedural characteristics. Adjusted for type of surgery intraoperative
Norepinephrine application was significantly reduced in visible-NT (n =
120, robust mean of cumulative dose 4.71 micro g/kg bodyweight)
compared to blinded-NT patients (n = 119, 6.14 micro g/kg bodyweight)
(adjusted robust mean difference 1.71 (95% CI 0.33-3.10) micro g/kg
bodyweight). Although reduction in patients operated on cardiopulmonary
bypass was higher the interaction was not significant in post-hoc subgroup
analysis. Intraoperative fluid balance was similar among both groups and
strata. Extubation time was non-significantly lower in visible than in
blinded-NT group. Overall postoperative delirium risk was 16.4% without
differences among the groups. Adverse events-sudden movement/coughing,
perspiration or hypertension-occurred more often with visible-NT, while
one blinded-NT patient experienced intraoperative awareness. Titration of
depth of anesthesia in elective cardiac surgery patients using pEEG allows
to reduce application of norepinephrine. Copyright © 2019,
Springer Nature B.V.

<45>
Accession Number
625955648
Title
Automated oxygen administration versus conventional oxygen therapy after
major abdominal or thoracic surgery: Study protocol for an international
multicentre randomised controlled study.
Source
BMJ Open. 9 (1) (no pagination), 2019. Date of Publication: 01 Jan 2019.
Author
L'Her E.; Jaber S.; Verzilli D.; Jacob C.; Huiban B.; Futier E.; Kerforne
T.; Pateau V.; Bouchard P.-A.; Gouillou M.; Nowak E.; Lellouche F.
Institution
(L'Her) Medical Intensive Care, CHRU de Brest-La Cavale Blanche, Brest,
France
(L'Her, Pateau) LATIM INSERM UMR 1101, FHU Techsan, Universite de Bretagne
Occidentale, Brest, France
(Jaber, Verzilli) Intensive Care Unit, Department of Anesthesiology B DAR
B CHU de Montpellier, Universite Montpellier 1, Montpellier, France
(Jacob, Huiban) Anesthesiology Department, CHRU de Brest-La Cavale
Blanche, Brest, France
(Futier) Anesthesiology Department, Hopital Estaing, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Kerforne) Anesthesiology Department, CHU de Poitiers, Poitiers Cedex,
France
(Pateau) RandD, Oxynov Inc, Technopole Brest Iroise, Plouzane, France
(Bouchard, Lellouche) Research Laboratory, Centre de Recherche de
l'Institut de Cardiologie et de Pneumologie de Quebec, Quebec, France
(Gouillou, Nowak) Centre d'Investigation Clinique CIC INSERM 1412, CHRU de
Brest-La Cavale Blanche, Brest, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Hypoxemia and hyperoxia may occur after surgery with
potential related complications. The FreeO 2 PostOp trial is a
prospective, multicentre, randomised controlled trial that evaluates the
clinical impact of automated O 2 administration versus conventional O 2
therapy after major abdominal or thoracic surgeries. The study is powered
to demonstrate benefits of automated oxygen titration and weaning in term
of oxygenation, which is an important surrogate for complications after
such interventions. Methods and analysis After extubation, patients are
randomly assigned to the Standard (manual O 2 administration) or FreeO 2
group (automated closed-loop O 2 administration). Stratification is
performed for the study centre and a medical history of chronic
obstructive pulmonary disease (COPD). Primary outcome is the percentage of
time spent in the target zone of oxygen saturation, during a 3-day time
frame. In both groups, patients will benefit from continuous oximetry
recordings. The target zone of oxygen saturation is SpO 2 =88%-92% for
patients with COPD and 92%-96% for patients without COPD. Secondary
outcomes are the nursing workload assessed by the number of manual O 2
flow adjustments, the time spent with severe desaturation (SpO 2 <85%) and
hyperoxia area (SpO 2 >98%), the time spent in a hyperoxia area (SpO 2
>98%), the VO 2, the duration of oxygen administration during
hospitalisation, the frequency of use of mechanical ventilation (invasive
or non-invasive), the duration of the postrecovery room stay, the
hospitalisation length of stay and the survival rate. Ethics and
dissemination The FreeO 2 PostOp study is conducted in accordance with the
declaration of Helsinki and was registered on 11 September 2015
(http://www.clinicaltrials.gov). First patient inclusion was performed on
14 January 2016. The results of the study will be presented at academic
conferences and submitted to peer-reviewed journals. Trial registration
number NCT02546830. Copyright © © Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<46>
Accession Number
625936803
Title
Different suturing techniques in thoracic incision: Protocol for a
feasibility randomised controlled trial.
Source
BMJ Open. 9 (1) (no pagination), 2019. Article Number: e021645. Date of
Publication: 01 Jan 2019.
Author
Liu Z.; Liu X.; He L.; Yu X.; Wang L.; Wang R.; He Y.; Hao X.; Tang Z.; Su
Y.; Shu M.
Institution
(Liu, Liu, He, Yu, Wang, Wang, He, Hao, Tang, Shu) Department of
Aesthetic, Plastic and Maxillofacial Surgery, First Affiliated Hospital of
Xi'an Jiaotong University, Xi'an, Shaanxi, China
(Liu, Su) Department of Plastic Surgery, Xijing Hospital, Fourth Military
Medical University, Xi'an, Shaanxi, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Based on the principles of the ideal skin closure technique,
we previously described a suture technique (wedge-shaped excision and
modified buried vertical mattress suture (WE-MBVMS)) that could provide
excellent outcomes for the most demanding surfaces. However, adequate
clinical comparative evidence supporting improved outcomes is lacking.
Thus, the purpose of this protocol is to establish the feasibility of
conducting a fully randomised controlled trial (RCT) comparing the
clinical effectiveness of WE-MBVMS with a buried intradermal suture (BIS)
in closing thoracic incision. Methods and analysis: This study is a
feasibility RCT of WE-MBVMS and BIS in patients undergoing surgery for
costal cartilage harvesting. Seventy-eight participants are expected to
participate in the study and will be randomised in a ratio of 1:1 to
WE-MBVMS or BIS. Trial feasibility will be assessed by the number of
participants assessed for eligibility, recruitment rates, reasons for
ineligibility or non-participation, time for interventions, withdrawal and
retention at all follow-up points (3, 6 and 12 months), follow-up rates
and reasons for withdrawing from the trial. In addition, clinical data
regarding the cosmetic results of scars will be collected to inform the
sample size for a fully powered RCT. Ethics and dissemination: This study
has been approved by The First Affiliated Hospital of Xi'an Jiaotong
University Institutional Review Board (XJTU1AF2017LSK-120). The findings
will be published in peer-reviewed journals. Copyright © 2019
Author(s).

<47>
Accession Number
626235830
Title
Frailty in patients undergoing transcatheter aortic valve implantation: A
protocol for a systematic review.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e024163. Date of
Publication: 01 Feb 2019.
Author
Li Z.; Dawson E.; Moodie J.; Martin J.; Bagur R.; Cheng D.; Kiaii B.;
John-Baptiste A.
Institution
(Li, Martin, Bagur, John-Baptiste) Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Centre for Medical
Evidence, Decision Integrity and Clinical Impact (MEDICI), Western
University, London, ON, Canada
(Li, Dawson, Moodie, Martin, Cheng, John-Baptiste) Department of
Anesthesia and Perioperative Medicine, Western University, London, ON,
Canada
(Li, Martin, Bagur, Cheng, Kiaii, John-Baptiste) Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Bagur) Division of Cardiology, Department of Medicine, Western
University, London, ON, Canada
(Cheng) Division of Critical Care Medicine, Department of Medicine,
Western University, London, ON, Canada
(Kiaii) Division of Cardiac Surgery, Department of Surgery, Western
University, London, ON, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
London, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Aortic stenosis is a significant cause of morbidity and
mortality in older patients. The advent of transcatheter aortic valve
implantation (TAVI) offers an alternative to surgical aortic valve
replacement for patients with severe symptomatic aortic stenosis who are
at high or intermediate risk of adverse events. Existing evidence
highlights the importance of frailty as a predictor of poor outcomes
post-TAVI. The objective of this study is to review the operationalisation
of frailty instruments for TAVI recipients and determine clinical outcomes
and the change in quality of life in frail patients undergoing TAVI.
Methods and analysis Methods are reported according to the Preferred
Reporting Items for Systematic Review and Meta-Analysis Protocols 2015
checklist. We will search relevant databases to identify published,
completed but unpublished and ongoing studies. We will include studies of
patients with aortic stenosis, diagnosed as frail and who underwent a TAVI
procedure that report mortality, clinical outcomes or health-related
quality of life. Retrospective or prospective cohort studies, randomised
controlled trials and non-randomised controlled trials will be eligible
for inclusion. Two researchers will independently screen articles for
inclusion, with disagreements resolved by a third reviewer. One researcher
will extract data with audit by a second researcher. The risk of bias in
studies will be evaluated using the Quality in Prognosis Studies tool.
Meta-Analysis of mortality, survival curve and the change in quality of
life will be performed if appropriate. Subgroup analysis, sensitivity
analysis and meta-regression will be performed if necessary. Ethics and
dissemination Due to the nature of this study, no ethical issues are
foreseen. We will disseminate the results of our systematic review through
a peer-reviewed journal. Trial registration number
CRD42018090597. Copyright © Author(s) (or their employer(s))
2019.

<48>
Accession Number
626235807
Title
Improving neurodevelopmental outcomes in children with congenital heart
disease: Protocol for a randomised controlled trial of working memory
training.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e023304. Date of
Publication: 01 Feb 2019.
Author
Calderon J.; Bellinger D.C.; Hartigan C.; Lord A.; Stopp C.; Wypij D.;
Newburger J.W.
Institution
(Calderon) Boston Children's Hospital, Department of Psychiatry, Boston,
MA, United States
(Calderon, Bellinger) Department of Psychiatry, Harvard Medical School,
Boston, MA, United States
(Hartigan, Lord, Stopp, Wypij, Newburger) Department of Cardiology, Boston
Children's Hospital, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Newburger) Department of Pediatrics, Harvard Medical School, Boston, MA,
United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Executive function (EF) impairments are among the most
prevalent neurodevelopmental morbidities in youth with congenital heart
disease (CHD). To date, no studies have investigated the efficacy of
cognitive interventions to improve EF outcomes in children with CHD.
Methods and analysis This is a single-centre, single-blinded, two-Arm
randomised controlled trial to test the efficacy of Cogmed Working Memory
Training (Cogmed) versus standard of care in children with CHD after
open-heart surgery in infancy. Participants will consist of 100 children
with CHD aged 7-12 years who underwent open-heart surgery before the age
of 12 months. Participants are randomly allocated to either an
intervention group including training on the home-based Cogmed
intervention for a duration of approximately 5 weeks or a control group
who receive the standard of care. We will evaluate the efficacy of Cogmed
at post-Treatment and 3 months after completion of the intervention.
Baseline, post-Treatment and 3-month follow-up assessments will include
specific measures of EF, cognitive and social functioning, and attention
deficit hyperactivity disorder (ADHD) symptoms. The primary outcome of
this study is the change in standardised mean score on the List Sorting
Working Memory test from the National Institutes of Health Toolbox for the
Assessment of Neurological and Behavioral Function. Secondary outcomes
include measures of social skills, inhibitory control, cognitive
flexibility and behavioural EF as well as ADHD symptoms as measured by the
Behavior Rating Inventory of Executive Function, Second Edition, and the
Conners Third Edition. The efficacy of the intervention will be evaluated
by comparing within-subject differences (baseline to post-Treatment,
baseline to 3-month follow-up) between the two groups using an
intention-To-Treat analysis. Ethics and dissemination This study has
received Institutional Review Board (IRB) approval from Boston's
Children's Hospital IRB (P00022440) and the Human Protection Agency from
the US Department of Defense. Trial registration number NCT03023644;
Pre-results. Copyright © Author(s) (or their employer(s)) 2019.

<49>
Accession Number
626283949
Title
Effects of traditional Chinese exercise on cardiac rehabilitation after
percutaneous coronary intervention: Study protocol for network
meta-analysis of randomised controlled trials.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e023096. Date of
Publication: 2019.
Author
Luo C.; Wen J.; Sun W.; Li T.; Yu X.; Zhang T.; Zhou X.; Wu W.; Li R.
Institution
(Luo, Zhou, Wu, Li) Department of Cardiovascular Disease, First Affiliated
Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
(Wen, Sun, Li, Zhang) Guangzhou University of Chinese Medicine, Guangzhou,
China
(Yu) Department of Rehabilitation Center, First Affiliated Hospital of
Guangzhou, University of Chinese Medicine, Guangzhou, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Coronary heart disease (CHD) is the most common cause of
death worldwide. Percutaneous coronary intervention (PCI) has been shown
to reduce mortality in patients with CHD. However, there are still
recurrences of cardiovascular events after PCI. Cardiac rehabilitation
(CR) in patients with established CHD is associated with reductions in
cardiovascular mortality and hospital admissions, as well as improved
quality of life. More and more clinical trials suggest that traditional
Chinese exercise (TCE) plays a positive role in patients post-PCI. The
primary purposes of the current study are to conduct a network
meta-analysis of randomised trials to determine the effects of TCE in
patients after PCI, and to separately compare the effects of tai chi,
baduanjin and yijinjing on CR after PCI. Methods and analysis Studies will
be retrieved from the following databases: PubMed, Embase, Cochrane
Library, Chinese National Knowledge Infrastructure, Wanfang Data, Chinese
BioMedical Database and Chinese Science and Technology Periodicals
Database, from inception to December 2018. We will include randomised
controlled trials that are related to the effects of TCE therapies in
patients after PCI. The primary outcomes will be all-cause mortality,
revascularisations, health-related quality of life and hospitalisations.
Two reviewers will independently select eligible articles. For each
included article, two reviewers will independently extract the data and
assess the risk of bias by using the Cochrane risk of bias tool. Bayesian
network meta-analyses will be conducted to pool all treatment effects. The
ranking probabilities for the optimal intervention of various treatments
(tai chi, baduanjin or yijinjing) will be estimated by the mean ranks and
surface under the cumulative ranking curve. The Grading of Recommendations
Assessment, Development and Evaluation System will be used to assess the
quality of evidence. Ethics and dissemination The results will be
disseminated through peer-reviewed publications. They will provide
consolidated evidence to inform clinicians on the potential functions of
TCE in CR, and to provide reliable evidence for the application of TCE.
Trial registration number CRD42018088415. Copyright © Author(s)
(or their employer(s)) 2019. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<50>
Accession Number
626076643
Title
Multicentre, open-label, randomised controlled clinical trial to assess
the efficacy and safety of appropriate target values for lipid management
in patients who have mild-to-moderate stenotic lesions with high-risk
plaques in coronary arteries: Study protocol.
Source
BMJ Open. 9 (1) (no pagination), 2019. Article Number: e022843. Date of
Publication: 01 Jan 2019.
Author
Matsuda M.; Kada A.; Saito A.M.; Hasegawa K.
Institution
(Matsuda) Institute for Clinical Research, National Hospital Organization
Kure Medical Center, Kure, Japan
(Matsuda, Kada, Saito) Clinical Research Center, National Hospital
Organization Nagoya Medical Center, Nagoya, Japan
(Hasegawa) Division of Translational Research, National Hospital
Organization Kyoto Medical Center, Kyoto, Japan
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction To detect patients at high risk of developing myocardial
infarction, plaque characteristics as well as the degree of stenosis in
coronary arteries should be evaluated. However, unstable plaque or severe
calcification detected via coronary artery CT (CACT) is not reflected in
risk stratification according to current guidelines. It is hypothesised
that patients with high-risk findings on CACT (even those without proven
history of coronary artery diseases; CAD) should be strictly managed to
lower their low-density lipoprotein cholesterol (LDL-C) levels to targets
of secondary prevention. Currently, however, there is no evidence based on
prospective randomised intervention studies to prove this hypothesis.
Methods and analysis Patients with mild-to-moderate stenotic lesions with
positive remodelling or severe calcification, but without any history of
CAD, will be randomly allocated to group A (reduce LDL-C to <120~160 mg/dL
according to the primary prevention criteria based on the Japan
Atherosclerosis Society (JAS) Guideline for Prevention of Atherosclerotic
Cardiovascular Diseases 2017) and group B (reduce LDL-C to <70 mg/dL
according to the secondary prevention criteria for high risk based on the
JAS Guideline). They will be strictly managed to achieve the LDL-C
targets. We will follow-up and evaluate the composite endpoints consisting
of major cardiovascular events (death from CAD, non-fatal myocardial
infarction, operation for coronary revascularisation and stroke) and
stenosis progression or new stenosis development for 3 years. Ethics and
dissemination The study was approved by the National Hospital Organization
Central Research Ethics Committee. The results of this study are scheduled
to be published within 2 years after study completion via conference
presentation or journal publication. Copyright © 2018 Author(s)
(or their employer(s)).

<51>
Accession Number
623656274
Title
De novo NAD+ biosynthetic impairment in acute kidney injury in
humans.
Source
Nature Medicine. 24 (9) (pp 1351-1359), 2018. Date of Publication: 01 Sep
2018.
Author
Poyan Mehr A.; Tran M.T.; Ralto K.M.; Leaf D.E.; Washco V.; Messmer J.;
Lerner A.; Kher A.; Kim S.H.; Khoury C.C.; Herzig S.J.; Trovato M.E.;
Simon-Tillaux N.; Lynch M.R.; Thadhani R.I.; Clish C.B.; Khabbaz K.R.;
Rhee E.P.; Waikar S.S.; Berg A.H.; Parikh S.M.
Institution
(Poyan Mehr, Tran, Ralto, Washco, Messmer, Kher, Kim, Simon-Tillaux,
Lynch, Parikh) Division of Nephrology and Department of Medicine, Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
United States
(Ralto) Division of Pulmonary and Critical Care and Department of
Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA, United States
(Ralto) Division of Pulmonary and Critical Care, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, United States
(Leaf, Waikar) Division of Renal Medicine and Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
United States
(Lerner) Department of Anesthesia and Critical Care, Beth Israel Deaconess
Medical Center and Harvard Medical School, Boston, MA, United States
(Khoury, Thadhani, Rhee) Division of Nephrology and Department of
Medicine, Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
(Herzig) Division of General Medicine and Primary Care Medicine and
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard
Medical School, Boston, MA, United States
(Trovato, Khabbaz) Cardiovascular Institute and Department of Surgery,
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston,
MA, United States
(Clish, Rhee) Broad Institute of Harvard and MIT, Cambridge, MA, United
States
(Rhee) Endocrine Unit and Department of Medicine, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, United States
(Berg) Division of Clinical Chemistry and Department of Pathology, Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
United States
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Nicotinamide adenine dinucleotide (NAD+) extends longevity in
experimental organisms, raising interest in its impact on human health. De
novo NAD+ biosynthesis from tryptophan is evolutionarily
conserved yet considered supplanted among higher species by biosynthesis
from nicotinamide (NAM). Here we show that a bottleneck enzyme in de novo
biosynthesis, quinolinate phosphoribosyltransferase (QPRT), defends renal
NAD+ and mediates resistance to acute kidney injury (AKI).
Following murine AKI, renal NAD+ fell, quinolinate rose, and
QPRT declined. QPRT+/- mice exhibited higher quinolinate, lower
NAD+, and higher AKI susceptibility. Metabolomics suggested an
elevated urinary quinolinate/tryptophan ratio (uQ/T) as an indicator of
reduced QPRT. Elevated uQ/T predicted AKI and other adverse outcomes in
critically ill patients. A phase 1 placebo-controlled study of oral NAM
demonstrated a dose-related increase in circulating NAD+
metabolites. NAM was well tolerated and was associated with less AKI.
Therefore, impaired NAD+ biosynthesis may be a feature of
high-risk hospitalizations for which NAD+ augmentation could be
beneficial. Copyright © 2018, The Author(s).

<52>
Accession Number
621375589
Title
Long-term effect of exercise training in patients after transcatheter
aortic valve implantation: Follow-up of the SPORT:TAVI randomised pilot
study.
Source
European Journal of Preventive Cardiology. 25 (8) (pp 794-801), 2018. Date
of Publication: 01 May 2018.
Author
Pressler A.; Forschner L.; Hummel J.; Haller B.; Christle J.W.; Halle M.
Institution
(Pressler, Forschner, Hummel, Christle, Halle) Department of Prevention,
Rehabilitation and Sports Medicine, Technische Universitat Munchen,
Germany
(Haller) Institute for Medical Statistics and Epidemiology, Technische
Universitat Munchen, Germany
(Christle) Department of Medicine, Stanford University, United States
(Halle) DZHK (German Center for Cardiovascular Research), partner site
Munich Heart Alliance, Germany
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Increased exercise capacity favourably influences clinical
outcomes after transcatheter aortic valve implantation. In our SPORT:TAVI
randomised pilot trial, eight weeks of endurance and resistance training
(training group, TG) shortly after transcatheter aortic valve implantation
resulted in significantly improved exercise capacity, muscular strength
and quality of life compared to usual care (UC). However, the long-term
clinical benefits of such an intervention are unknown. Design(s): A
randomised controlled trial. Method(s): SPORT:TAVI participants
underwent reassessment of trial endpoints 24 +/- 6 months after baseline:
maximal oxygen uptake (VO<inf>2</inf>peak) and anaerobic threshold
(VO<inf>2</inf>AT) were assessed with cardiopulmonary exercise testing,
muscular strength with one-repetition maximum testing, quality of life
with the Kansas City cardiomyopathy and medical outcomes study 12-item
short-form health survey questionnaires, and prosthetic aortic valve
function with echocardiography. Result(s): Of 27 original
participants (TG 13; UC 14; age 81 +/- 6 years), more patients had died
during follow-up in UC (n = 5) than in TG (n = 2; P = 0.165); three
further patients (TG 1; UC 2) were unavailable for other reasons. In the
remaining patients (TG 10; UC 7), a significant between-group difference
in favour of TG was observed for change in VO<inf>2</inf>AT from baseline
(2.7 ml/min/kg (95% confidence interval 0.8-4.6); P = 0.008), but not for
change in VO<inf>2</inf>peak (2.1 ml/min/kg (-1.1-5.4); P = 0.178).
Changes in muscular strength and quality of life did not differ between
groups over time. Overall, prosthetic valve function remained intact in
both groups. Conclusion(s): Eight weeks of exercise training shortly
after transcatheter aortic valve implantation resulted in preserved
long-term improvements in VO<inf>2</inf>AT, but not VO<inf>2</inf>peak,
muscular strength or quality of life compared to usual care. The findings
emphasise the importance of ongoing exercise interventions following
transcatheter aortic valve implantation to maintain initial improvements
long term. Clinical Trial Registration (original trial):
Clinicaltrials.gov NCT01935297. Copyright © 2018, © The
European Society of Cardiology 2018.

<53>
Accession Number
621304862
Title
Metabolic syndrome and the risk of adverse cardiovascular events after an
acute coronary syndrome.
Source
European Journal of Preventive Cardiology. 25 (8) (pp 830-838), 2018. Date
of Publication: 01 May 2018.
Author
Cavallari I.; Cannon C.P.; Braunwald E.; Goodrich E.L.; Im K.A.; Lukas
M.A.; O'Donoghue M.L.
Institution
(Cavallari, Cannon, Braunwald, Goodrich, Im, O'Donoghue) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
United States
(Cavallari) Department of Cardiovascular Science, Campus Bio-Medico
University of Rome, Italy
(Lukas) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Philadelphia, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The incremental prognostic value of assessing the metabolic
syndrome has been disputed. Little is known regarding its prognostic value
in patients after an acute coronary syndrome. Design and methods: The
presence of metabolic syndrome (2005 International Diabetes Federation)
was assessed at baseline in SOLID-TIMI 52, a trial of patients within 30
days of acute coronary syndrome (median follow-up 2.5 years). The primary
endpoint was major coronary events (coronary heart disease death,
myocardial infarction or urgent coronary revascularization).
 Result(s): At baseline, 61.6% (n = 7537) of patients met the
definition of metabolic syndrome, 34.7% (n = 4247) had diabetes and 29.3%
had both (n = 3584). The presence of metabolic syndrome was associated
with increased risk of major coronary events (adjusted hazard ratio
(adjHR) 1.29, p < 0.0001) and recurrent myocardial infarction (adjHR 1.30,
p < 0.0001). Of the individual components of the definition, only diabetes
(adjHR 1.48, p < 0.0001) or impaired fasting glucose (adjHR 1.21, p =
0.002) and hypertension (adjHR 1.46, p < 0.0001) were associated with the
risk of major coronary events. In patients without diabetes, metabolic
syndrome was numerically but not significantly associated with the risk of
major coronary events (adjHR 1.13, p = 0.06). Conversely, diabetes was a
strong independent predictor of major coronary events in the absence of
metabolic syndrome (adjHR 1.57, p < 0.0001). The presence of both diabetes
and metabolic syndrome identified patients at highest risk of adverse
outcomes but the incremental value of metabolic syndrome was not
significant relative to diabetes alone (adjHR 1.07, p = 0.54).
 Conclusion(s): After acute coronary syndrome, diabetes is a strong
and independent predictor of adverse outcomes. Assessment of the metabolic
syndrome provides only marginal incremental value once the presence or
absence of diabetes is established. Copyright © 2018, © The
European Society of Cardiology 2018.

<54>
Accession Number
624224548
Title
Zero-Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and
Improves the Respiratory Function in Infants After Cardiopulmonary Bypass:
A Randomized Controlled Trial.
Source
Artificial Organs. 43 (2) (pp 167-172), 2019. Date of Publication:
Februaryy 2019.
Author
Gholampour Dehaki M.; Niknam S.; Azarfarin R.; Bakhshandeh H.; Mahdavi M.
Institution
(Gholampour Dehaki, Niknam, Azarfarin, Bakhshandeh, Mahdavi) Rajaie
Cardiovascular, Medical & Research Center-Perfusion, Tehran Province,
Tehran, Iran, Islamic Republic of
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and
infants to avoid exceeding hemodilution; however, transfusion-related
inflammation affects post-CPB outcomes in infant open-heart surgery.
Procalcitonin, a newly detected inflammatory moderator and a sensitive
parameter for predicting pulmonary dysfunction secondary to CPB, rises
after CPB. We hypothesized that the hemofiltration of priming blood before
CPB might decrease inflammatory mediators in the blood and post-CPB
inflammatory replications, thereby improving the respiratory function
after CPB in infants. Sixty infants with a weight below 10 kg were divided
randomly into two equal groups of CPB with the zero-balance
ultrafiltration (Z-BUF) of priming blood and CPB without it. The
procalcitonin level was measured before anesthesia, after admission to the
intensive care unit (ICU), and 24 h afterward. The respiratory index and
pulmonary compliance were measured after anesthesia, at the end of CPB,
and 2 h after admission to the ICU. Additionally, time to extubation was
recorded. The Z-BUF of priming blood maintained electrolytes within a
physiologic level, and procalcitonin had a slighter rise in the Z-BUF
Group at 24 h after admission to the ICU (P = 0.05). The respiratory index
was decreased in the Z-BUF Group, but the difference with the control
group did not reach statistical significance (P > 0.05). The change in
pulmonary compliance was significantly increased in the cyanotic patients
in the intervention group, but there was no significant difference between
the two groups. The time to extubation and the ICU stay were shorter in
the Z-BUF Group (P < 0.05). A positive correlation was found between the
peak procalcitonin concentration and the time to extubation directly and
pulmonary compliance reversely. These results suggest that the Z-BUF of
priming blood may have some beneficial clinical effects such as improved
respiratory function and attenuated procalcitonin. Copyright ©
2018 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<55>
Accession Number
2001537578
Title
Uniportal Lung Cancer Surgery: State of the Evidence.
Source
Annals of Thoracic Surgery. 107 (3) (pp 962-972), 2019. Date of
Publication: March 2019.
Author
Sihoe A.D.L.
Institution
(Sihoe) Department of Surgery, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Hong Kong, Hong Kong
(Sihoe) Division of Thoracic Surgery, The University of Hong Kong Shenzhen
Hospital, Shenzhen, China
(Sihoe) Department of Thoracic Surgery, Tongji University Shanghai
Pulmonary Hospital, Shanghai, China
Publisher
Elsevier USA
Abstract
Background: Uniportal video-assisted thoracic surgery (VATS) has generated
much attention in recent years, but questions remain regarding the
adequacy of evidence to support its use in lung cancer surgery. This
review aims to explore what the currently published literature suggests
the role of the uniportal approach may be and to critically appraise that
literature. Method(s): A systematic review was conducted using the
Ovid Medline database to identify articles related to uniportal VATS.
Articles were selected for review on the basis of ability to provide
original clinical data on the role of uniportal VATS for lung cancer
surgery. Result(s): The literature search revealed that only some
publications on uniportal VATS provided original clinical data. Twenty-two
articles were selected for review, including 9 case series and 13
comparative studies. No concerns about the safety of the uniportal VATS
were noted. Some but not all comparative studies provided data suggesting
that uniportal VATS may hold advantages over multiportal VATS in some
simple clinical outcomes (such as reduced lengths of stay and
postoperative pain). However, the quantity and quality of evidence thus
far are limited. Conclusion(s): It remains premature to declare
superiority for uniportal VATS in lung cancer surgery. A higher level of
evidence is needed, especially in investigating objective benefits and
treatment efficacy of the single-incision approach. Copyright ©
2019 The Society of Thoracic Surgeons

<56>
Accession Number
626461039
Title
Fibrinogen concentrate Vs. Cryoprecipitate for acquired hypofibrinogenemia
in cardiac surgery-the fibres study.
Source
Blood. Conference: 60th Annual Meeting of the American Society of
Hematology, ASH 2018. United States. 132 (Suppl. 1) (no pagination), 2018.
Date of Publication: November 2018.
Author
Carroll J.; Karkouti K.
Institution
(Carroll) Toronto General Hospital, Toronto, Canada
(Karkouti) University Health Network, Toronto General Hospital, Toronto,
Canada
Publisher
American Society of Hematology
Abstract
Introduction: Cardiac surgery involving cardiopulmonary bypass (CPB) is
associated with coagulopathy and excessive bleeding. This often requires
the transfusion of large volumes of allogeneic blood products and is
linked to an increased risk of adverse outcomes. A primary cause of
coagulopathy is acquired hypofibrinogenemia; when fibrinogen levels drop
below 1.5-2 mg/L, fibrinogen supplementation is required to maintain
hemostasis. The FIBrinogen REplenishment in Surgery (FIBRES) study aims to
compare the standard intervention, cryoprecipitate, with a new highly
purified, double virus-inactivated human fibrinogen concentrate.
 Method(s): The FIBRES study (NCT03037424) is a pragmatic,
multicenter, active-control, randomized, single-blinded, non-inferiority
phase 3 trial in adult patients undergoing cardiac surgery with CPB. The
study will enroll patients with clinically significant bleeding associated
with acquired hypofibrinogenemia. Patients for whom fibrinogen
supplementation is ordered within 24 hours of surgery will be randomized
to receive fibrinogen concentrate (4 g; Fibryga; Octapharma) or
cryoprecipitate (10 units; dose equivalent to 4 g fibrinogen concentrate)
(Figure 1). All randomized patients will receive fibrinogen
supplementation as clinically indicated. Owing to the emergency nature of
the clinical setting, patient consent at the point of randomization will
be waived, with written informed consent obtained within 24-48 hours
thereafter. The primary outcome is total allogeneic blood products (red
blood cells, plasma, platelets) administered within the first 24 hours of
surgery. Secondary outcomes include blood product use within 7 days,
incidence of major bleeding within 24 hours, fibrinogen levels, and
adverse events (AEs) and serious AEs within 28 days. Enrolment of 1,200
patients will provide >90% power to demonstrate non-inferiority, assuming
a 20% non-inferiority margin, =550 patients per group, and an approximate
10% drop-out rate. One pre-planned interim analysis will be conducted
after data are available for 600 evaluable patients with the option to
stop early for futility or overwhelming efficacy. The pragmatic design and
treatment algorithm align with standard practice, aiding adherence and
generalizability. Result(s): To date, 530 patients have been treated
across 11 sites. An IDMEAC review of safety has been performed every 100
patients enrolled, with the recommendation to continue as planned each
time. The study is expected to complete in late 2018, with results
available in early 2019. Conclusion(s): The FIBRES study is the
largest randomized study to date of fibrinogen concentrate versus
cryoprecipitate in adult cardiac surgical patients, an under-studied yet
high-risk population. Non-inferiority of the new fibrinogen concentrate
would support its use for patients developing acquired hypofibrinogenemia
during cardiac surgery. Results from the FIBRES study are likely to
improve care for cardiac surgical patients experiencing significant
bleeding.

<57>
Accession Number
626440952
Title
Why does a point of care guided transfusion algorithm not improve blood
loss and transfusion practice in patients undergoing high-risk cardiac
surgery? A prospective randomized controlled pilot study.
Source
BMC anesthesiology. 19 (1) (pp 24), 2019. Date of Publication: 18 Feb
2019.
Author
Lehmann F.; Rau J.; Malcolm B.; Sander M.; von Heymann C.; Moormann T.;
Geyer T.; Balzer F.; Wernecke K.D.; Kaufner L.
Institution
(Lehmann, Geyer, Balzer, Kaufner) Department of Anaesthesiology and
Intensive Care Medicine, Charite - Universitatsmedizin Berlin, Campus
Virchow-Klinikum and Campus Charite Mitte, Berlin, Germany
(Rau) Division of Medical Biotechnology, Paul-Ehrlich-Institut, Federal
Institute for Vaccines and Biomedicines, Langen, Hessen, Germany
(Malcolm) Department of Internal Medicine, Hegau-Bodensee-Klinikum,
Singen, Baden-Wurttemberg, Germany
(Sander) Department of Anaesthesiology, Intensive Care Medicine and Pain
therapy, University Hospital Giesen UKGM, Justus-Liebig-University
Giessen, Giessen, Hessen, Germany
(von Heymann) Department of Anaesthesia, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain,
Berlin, Germany
(Moormann) Department of Anaesthesiology and Intensive Care Medicine,
Martin-Luther-Krankenhaus, Berlin, Germany
(Wernecke) CRO SOSTANA GmbH and Charite - Universitatsmedizin Berlin,
Berlin, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Adult cardiac surgery is often complicated by elevated blood
losses that account for elevated transfusion requirements. Perioperative
bleeding and transfusion of blood products are major risk factors for
morbidity and mortality. Timely diagnostic and goal-directed therapies aim
at the reduction of bleeding and need for allogeneic transfusions.
 METHOD(S): Single-centre, prospective, randomized trial assessing
blood loss and transfusion requirements of 26 adult patients undergoing
elective cardiac surgery at high risk for perioperative bleeding. Primary
endpoint was blood loss at 24h postoperatively. Random assignment to
intra- and postoperative haemostatic management following either an
algorithm based on conventional coagulation assays (conventional group:
platelet count, aPTT, PT, fibrinogen) or based on point-of-care
(PoC-group) monitoring, i.e. activated rotational thromboelastometry
(ROTEM) combined with multiple aggregometry (Multiplate). Differences
between groups were analysed using nonparametric tests for independent
samples. RESULT(S): The study was terminated after interim analysis
(n =26). Chest tube drainage volume was 360ml (IQR 229-599ml) in the
conventional group, and 380ml (IQR 310-590ml) in the PoC-group (p =0.767)
after 24h. Basic patient characteristics, results of PoC coagulation
assays, and transfusion requirements of red blood cells and fresh frozen
plasma did not differ between groups. Coagulation results were comparable.
Platelets were transfused in the PoC group only. CONCLUSION(S): Blood
loss via chest tube drainage and transfusion amounts were not different
comparing PoC- and central lab-driven transfusion algorithms in subjects
that underwent high-risk cardiac surgery. Routine PoC coagulation
diagnostics do not seem to be beneficial when actual blood loss is low.
High risk procedures might not suffice as a sole risk factor for increased
blood loss. TRIAL REGISTRATION: NCT01402739 , Date of registration July
26, 2011.

<58>
Accession Number
2001598863
Title
Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting
in Unprotected Left Main Coronary Artery Stenosis.
Source
American Journal of the Medical Sciences. 357 (3) (pp 230-241), 2019. Date
of Publication: March 2019.
Author
Wang Z.; Zhan B.; Bao H.; Huang X.; Wu Y.; Liang Q.; Zhang W.; Jiang L.;
Cheng X.
Institution
(Wang, Zhan, Bao, Huang, Wu, Jiang, Cheng) Department of Cardiovascular
Medicine, Second Affiliated Hospital of Nanchang University, Nanchang,
Jiangxi, China
(Liang) Jiangxi Key Laboratory of Molecular Medicine, Second Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi, China
(Zhang) Department of Pharmacy, Second Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
Publisher
Elsevier B.V.
Abstract
Background: The present study performed a meta-analysis of randomized and
prospective trials to compare the outcomes of percutaneous coronary
intervention (PCI) with stents versus coronary artery bypass graft surgery
(CABG) for unprotected left main coronary artery (UPLM) stenosis.
 Method(s): The Cochrane Library, PubMed and EMBASE databases were
systematically searched until July 2017. The Newcastle-Ottawa scale was
used for quality assessment. Result(s): A total of 19 studies with
16,900 participants were included. Pooled analysis showed no significant
differences in all-cause mortality (odds ratio [OR] 0.94; 95% CI
0.74-1.20) and cardiac death (OR 1.04; 95% CI 0.74-1.47). However,
subgroup analysis showed that PCI was associated with a low all-cause
mortality rate at 30-day follow up (OR 0.48; 95% CI 0.26-0.89). The stroke
rate in PCI was lower in short-term follow up (OR 0.45; 95% CI 0.23-0.88)
and long-term follow up (OR 0.36; 95% CI 0.27-0.47). On the other hand,
PCI was associated with higher risk of myocardial infarction (OR 1.59; 95%
CI 1.34-1.88), repeat revascularization (OR 2.47; 95% CI 1.80-3.37) and
target vessel revascularization (OR 2.10; 95% CI 1.72-2.57) compared to
CABG in the pooled analysis. Conclusion(s): The current evidence
suggests that the risk of stroke was significantly reduced in PCI compared
to that in CABG. Therefore, PCI is the preferred treatment for patients
with a high risk of stroke. Additionally, in short-term follow up, PCI was
reported to be safe and effective for UPLM patients compared to CABG.
However, CABG caused fewer complications long term. Copyright ©
2019 Southern Society for Clinical Investigation

<59>
[Use Link to view the full text]
Accession Number
626465839
Title
Outcomes of patients with and without baseline lipid-lowering therapy
undergoing revascularization for left main coronary artery disease:
Analysis from the EXCEL trial.
Source
Coronary Artery Disease. 30 (2) (pp 143-149), 2019. Date of Publication:
01 Mar 2019.
Author
Chen S.; Redfors B.; Liu Y.; Vrolix M.; Macaya C.; Ben-Yehuda O.;
Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Chen, Redfors, Liu, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, Columbia University Medical Center,
1700 Broadway, New York, NY 10019, United States
(Ben-Yehuda, Stone) Division of Cardiology, NewYork-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden
(Vrolix) Ziekenhuis Oost Limburg, Genk, Belgium
(Macaya) Hospital Clinico de San Carlos, Madrid, Spain
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives There is a paucity of data on the effect of baseline
lipid-lowering therapy (LLT) in patients undergoing revascularization for
left main (LM) coronary artery disease (CAD). We compared outcomes for
patients with LMCAD randomized to percutaneous coronary intervention (PCI)
or coronary artery bypass grafting (CABG) according to the presence of
baseline LLT in the EXCEL trial. Patients and methods The EXCEL trial
randomized 1905 patients with LMCAD and SYNTAX scores up to 32 to PCI with
everolimus-eluting stents versus CABG. Patients were categorized according
to whether they were medically treated with LLT at baseline, and their
outcomes were examined using multivariable Cox proportional hazards
regression. The primary endpoint was a composite of death, stroke, or
myocardial infarction at 3 years. Results Among 1901 patients with known
baseline LLT status, 1331 (70.0%) were medically treated with LLT at
baseline. There were no significant differences between the PCI and CABG
groups in the 3-year rates of the primary endpoint in patients with versus
without baseline LLT (P interaction =0.62). Among patients with baseline
LLT, the 3-year rate of ischemia-driven revascularization was higher after
PCI compared with CABG (13.7 vs. 5.3%; adjusted hazard ratio=2.97; 95%
confidence interval: 1.95-4.55; P<0.0001), in contrast to patients without
baseline LLT (9.8 vs. 12.1%; adjusted hazard ratio=0.79; 95% confidence
interval: 0.47-1.33; P=0.39) (P interaction =0.0003). Conclusion In the
EXCEL trial, 3-year major adverse event rates after PCI versus CABG for
LMCAD were similar and consistent in patients with and without LLT at
baseline; however, revascularization during follow-up was more common
after PCI compared with CABG in patients with baseline LLT, but not in
those without baseline LLT. Copyright © 2019 Wolters Kluwer
Health, Inc.

<60>
Accession Number
626462179
Title
Radial artery versus right internal thoracic artery versus saphenous vein
as the second conduit for coronary artery bypass surgery: A network
meta-analysis of clinical outcomes.
Source
Journal of the American Heart Association. 8 (2) (no pagination), 2019.
Article Number: e010839. Date of Publication: 01 Jan 2019.
Author
Gaudino M.; Lorusso R.; Rahouma M.; Abouarab A.; Tam D.Y.; Spadaccio C.;
Saint-Hilary G.; Leonard J.; Iannaccone M.; D'Ascenzo F.; Di Franco A.;
Soletti G.; Kamel M.K.; Lau C.; Girardi L.N.; Schwann T.A.; Benedetto U.;
Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Rahouma, Abouarab, Leonard, Di Franco, Soletti, Kamel, Lau,
Girardi) Department of Cardio-Thoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Lorusso) Department of Cardio-Thoracic Surgery, Heart & Vascular Centre,
Maastricht University Medical Hospital and CARIM (Cardiovascular Research
Institute Maastricht), Maastricht, Netherlands
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Canada
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Spadaccio) Institute of Cardiovascular and Medical Sciences, University
of Glasgow, United Kingdom
(Saint-Hilary) Department of Matematical Sciences, Politecnico di Torino,
Turin, Italy
(Iannaccone, D'Ascenzo) Department of Cardiology, Citta della Scienza e
della Salute, University of Turin, Italy
(Schwann) University of Toledo Medical Center, Toledo, OH, United States
(Benedetto) School of Clinical Sciences, Bristol Heart Institute,
University of Bristol, United Kingdom
(Taggart) University of Oxford, United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background There remains uncertainty regarding the second-best conduit
after the internal thoracic artery in coronary artery bypass grafting. Few
studies directly compared the clinical results of the radial artery (RA),
right internal thoracic artery (RITA), and saphenous vein (SV). No network
meta-analysis has compared these 3 strategies. Methods and Results
andEMBASEwere searched for adjusted observational studies and randomized
controlled trials comparing theRA,SV, and/orRITAas the second conduit for
coronary artery bypass grafting. The primary end point was all-cause
long-term mortality. Secondary end points were operative mortality,
perioperative stroke, perioperative myocardial infarction, and deep
sternal wound infection (DSWI). Pairwise and network meta-analyses were
performed. A total of 149902 patients (4 randomized, 31 observational
studies) were included (RA, 16201, SV, 112018, RITA,21683). AtNMA, the use
ofSVwas associated with higher long-term mortality compared with
theRA(incidence rate ratio, 1.23; 95%CI, 1.12-1.34) andRITA(incidence rate
ratio, 1.26; 95%CI, 1.17-1.35). The risk ofDSWIforSVwas similar toRAbut
lower thanRITA(odds ratio, 0.71; 95%CI, 0.55-0.91). There were no
differences for any outcome betweenRITAandRA, althoughDSWItrended higher
withRITA(odds ratio, 1.39; 95%CI, 0.92-2.1). The risk ofDSWIin bilateral
internal thoracic artery studies was higher when the skeletonization
technique was not used. Conclusions The use of theRAor theRITAis
associated with a similar and statistically significant long-term clinical
benefit compared with theSV. There are no differences in operative risk or
complications between the 2 arterial conduits, butDSWIremains a concern
with bilateralITAwhen skeletonization is not used. Copyright ©
2019 The Authors. Published on behalf of the American Heart Association,
Inc., by Wiley.

<61>
Accession Number
2001616708
Title
Isolated adult congenital uni-leaflet severe mitral valve stenosis, a case
report, and review of literature.
Source
Journal of Cardiology Cases. (no pagination), 2019. Date of Publication:
2019.
Author
Naeim H.A.; Taha E.A.; Taha R.A.; Alatawi F.O.; Amodi O.; Abuelatta R.
Institution
(Naeim, Alatawi, Amodi, Abuelatta) Madina Cardiac Centre, Saudi Arabia
(Taha, Taha) Faculty of Medicine, Banha University, Egypt
(Alatawi) Taiba University, Saudi Arabia
(Naeim) Al-Azhar university, Egypt
Publisher
Elsevier Ltd
Abstract
Reported cases of uni-leaflet mitral valve (MV) were related to the
absence or dysplasia of the posterior mitral leaflet with ample anterior
mitral leaflet. We present here a new entity of uni-leaflet MV where the
MV appears as a membrane-like structure with a single slit-like orifice at
its lateral part with no commissures. Case report: Continuous Doppler flow
revealed a mean pressure gradient of 19 mmHg across the mitral valve
indicating severe mitral stenosis. In 3D images from the left atrial view,
the MV appeared like a membrane with a single orifice in its lateral part
toward the left atrial appendage, the area of this orifice by 3D was 0.52
cm2, there were no commissures or even any residual lines at
the site where commissures should be. The diagnosis of congenital severe
mitral stenosis due to acommissural MV was confirmed. During surgery, the
surgical appearance of the MV confirmed our diagnosis by 3D.
 Conclusion(s): Isolated congenital severe mitral stenosis presenting
in adulthood is rare, uni-leaflet MV as a cause is only reported in a few
cases. MV replacement is usually indicated due to the abnormal anatomy of
MV leaflets and the subvalvular apparatus. <Learning objectives: How to
diagnose uni-leaflet congenital mitral stenosis and how to differentiate
it from other causes of congenital mitral stenosis.> Copyright ©
2019 Japanese College of Cardiology

<62>
Accession Number
2001610580
Title
Off-pump coronary surgery: An updated systematic review and meta-analysis.
Source
Cirugia Cardiovascular. (no pagination), 2019. Date of Publication: 2019.
Author
Tena M.A.; Urso S.; Martinez-Comendador J.M.; Bellot R.; Gutierrez E.M.;
Gonzalez J.M.; Sadaba R.; Meca J.; Rios L.; Abad C.; Portela F.
Institution
(Tena, Urso, Bellot, Rios, Abad, Portela) Servicio de Cirugia Cardiaca,
Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Las Palmas,
Spain
(Martinez-Comendador, Gutierrez) Servicio de Cirugia Cardiaca, Hospital
Universitario de Leon, Leon, Spain
(Gonzalez) Unidad de Investigacion, Hospital Universitario Dr. Negrin, Las
Palmas de Gran Canaria, Las Palmas, Spain
(Sadaba) Servicio de Cirugia Cardiaca, Complejo Hospitalario de Navarra,
Pamplona, Navarra, Spain
(Meca) Servicio de Cirugia Cardiaca, Hospital La Paz, Madrid, Spain
Publisher
Elsevier Doyma
Abstract
Introduction and objectives: After 30 years, off-pump coronary artery
bypass grafting benefits are still controversial when compared with the
on-pump technique. For this reason, a meta-analysis is presented that
compares the early and long-term results of the 2 surgical strategies.
 Method(s): A search was made of PubMed, EMBASE, and the Cochrane
library database for clinical trials up to December 2017 for randomised
clinical trials investigating off-pump versus on-pump coronary surgery
with sample size of >= 100 patients. Result(s): A total of 34
clinical trials, with a total of 16,435 patients and 9643 examined grafts
were included in this meta-analysis. Off-pump surgery achieved similar
30-day and 1-year mortality compared with on-pump surgery. The off-pump
technique significantly decreased the risk of 30-day stroke (RR 0.73; 95%
CI; 0.57-0.94; p=0.015), but it increases 1-year repeat revascularization
risk (RR 1.52; 95% CI; 1.18-1.96; p=0.001), 5-year mortality risk (RR=
1.15; 95% CI; 1.03-1.29; p=0.012) and it is associated with worse graft
patency (RR 0.97; 95% CI; 0.94-0.99; p=0.007) compared with on-pump
surgery. Conclusion(s): Off-pump coronary surgery may provide better
short-term neurological results compared with the on-pump technique, at
the expense of a worse graft patency, increased risk of 1-year repeat
revascularisation, and of 5-years mortality. Copyright © 2019
Sociedad Espanola de Cirugia Toracica-Cardiovascular

<63>
Accession Number
624234772
Title
Effects of comprehensive cardiac rehabilitation on functional capacity in
a middle-income country: a randomised controlled trial.
Source
Heart. 105 (5) (pp 406-413), 2019. Date of Publication: 01 Mar 2019.
Author
Da Silva Chaves G.S.; De Melo Ghisi G.L.; Grace S.L.; Oh P.; Ribeiro A.L.;
Britto R.R.
Institution
(Da Silva Chaves, Britto) Physical Therapy Department, Federal University
of Minas Gerais, Belo Horizonte 31270-901, Brazil
(De Melo Ghisi, Grace, Oh) Cardiovascular Prevention and Rehabilitation
Program, University Health Network, University of Toronto, Toronto, ON,
Canada
(De Melo Ghisi, Grace) School of Kinesiology and Health Science, Faculty
of Health, York University, Toronto, ON, Canada
(Ribeiro) Hospital das Clinicas, Division of Cardiology and Cardiovascular
Surgery, School of Medicine, Universidade Federal de Minas Gerais, Minas
Gerais, Brazil
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Despite the growing epidemic of cardiovascular diseases in
middle-income countries, there is insufficient evidence about cardiac
rehabilitation (CR) in these countries. Thus, the effects of comprehensive
CR on functional capacity and risk factors were investigated in Brazil, to
test the hypothesis that it results in better outcomes than exercise-only
or no CR. Methods Single-blinded, randomised controlled trial with three
parallel arms: comprehensive CR (exercise+education) versus exercise-only
CR versus wait-list control. Eligible coronary patients were randomised in
blocks of four with 1:1:1 concealed allocation. Participants randomised to
exercise-only CR received 36 exercise classes; comprehensive CR group also
received 24 educational sessions. The primary outcome was incremental
shuttle walk test (ISWT) distance; secondary outcomes were cardiovascular
risk factors. All outcomes were assessed at baseline and 6 months later.
Analysis of covariance was performed on the basis of intention-to-treat
(ITT) and per-protocol. Results 115 (88.5%) patients were randomised; 93
(80.9%) were retained. There were improvements in ISWT distance from
pretest to post-test with comprehensive (from 358.4+/-132.6 to
464.8+/-121.6 m; mean change=106.4; p<0.001) and exercise-only (from
391.5+/-118.8 to 488.1+/-106.3 m; mean change=96.5, p<0.001) CR, with
significantly greater functional capacity with comprehensive CR versus
control (ITT: mean difference=75.6+/-30.7 m, 95% CI 1.4 to 150.2). There
were also reductions in systolic blood pressure with comprehensive CR
(ITT: reduction of 6.2+/-17.8 mm Hg, p=0.04). There were no significant
differences for other outcomes. Conclusion Results showed clinically
significant improvements in functional capacity and blood pressure with
CR, and significantly greater functional capacity with comprehensive CR
compared with usual care. Trial registration number NCT02575976;
Results. Copyright © 2019 Author(s) (or their employer(s)).
Re-use permitted under CC BY-NC.

<64>
Accession Number
626370946
Title
A model-based cost-effectiveness analysis of Patient Blood Management.
Source
Blood Transfusion. 17 (1) (pp 16-26), 2019. Date of Publication:
January-February 2019.
Author
Kleineruschkamp A.; Meybohm P.; Straub N.; Zacharowski K.; Choorapoikayil
S.
Institution
(Kleineruschkamp, Meybohm, Zacharowski, Choorapoikayil) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Theodor Stern Kai 7, Frankfurt 60590, Germany
(Straub) Institute of Market Research, Statistics and Prognosis, Munich,
Germany
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Background. Patient blood management (PBM) is a multidisciplinary concept
focused on the management of anaemia, minimisation of iatrogenic blood
loss and rational use of allogeneic blood products. The aims of this study
were: (i) to analyse post-operative outcome in patients with liberal vs
restrictive exposure to allogeneic blood products and (ii) to evaluate the
cost-effectiveness of PBM in patients undergoing surgery. Materials and
methods. A systematic literature review and meta-analysis were performed
to compare post-operative complications in predominantly non-transfused
patients (restrictive transfusion group) and patients who received one to
three units of red blood cells (liberal transfusion group). Outcome
measures included sepsis with/without pneumonia, acute renal failure,
acute myocardial infarction and acute stroke. In a second step, a health
economic model was developed to calculate cost-effectiveness of PBM
(PBM-arm vs control-arm) for simulated cohorts of 10,000 cardiac and
non-cardiac surgical patients based on the results of the meta-analysis
and costs. Results. Out of 478 search results, 22 studies were analysed in
the meta-analysis. The pooled relative risk of any complication in the
restrictive transfusion group was 0.43 for non-cardiac and 0.34 for
cardiac surgical patients. In the simulation model, PBM was related to
reduced complications (1,768 vs 1,245) and complication-related deaths
(411 vs 304) compared to standard care. PBM-related costs of therapy
exceeded costs of the control arm by 150 per patient. However, total
costs, including hospitalisation, were higher in the control-arm for both
non-cardiac ( 2,885.11) and cardiac surgery patients ( 1,760.69). The
incremental cost-effectiveness ratio including hospitalisation showed
savings of 30,458 (non-cardiac and cardiac surgery patients) for
preventing one complication and 128,023 (non-cardiac and cardiac surgery
patients) for prevention of one complication-related death in the PBM-arm.
Discussion. Our results indicate that PBM may be associated with fewer
adverse clinical outcomes compared to control management and may, thereby,
be cost-effective. Copyright © SIMTIPRO Srl

<65>
Accession Number
626370610
Title
Congress of neurological surgeons systematic review and evidence-based
guidelines on the evaluation and treatment of patients with thoracolumbar
spine trauma: Novel surgical strategies.
Source
Clinical Neurosurgery. 84 (1) (pp E59-E62), 2019. Date of Publication: 01
Jan 2019.
Author
Chi J.H.; Eichholz K.M.; Anderson P.A.; Arnold P.M.; Dailey A.T.; Dhall
S.S.; Harrop J.S.; Hoh D.J.; Qureshi S.; Rabb C.H.; Raksin P.B.; Kaiser
M.G.; O'Toole J.E.
Institution
(Chi) Department of Neurosurgery, Harvard Medical School, Brigham and
Women's Hospital, Boston, MA, United States
(Eichholz) St. Louis Minimally Invasive Spine Center, St. Louis, MO,
United States
(Anderson) Department of Orthopedics and Rehabilitation, University of
Wisconsin, Madison, WI, United States
(Arnold) Department of Neurosurgery, University of Kansas, School of
Medicine, Kansas City, KS, United States
(Dailey, Rabb) Department of Neurosurgery, University of Utah, Salt Lake
City, UT, United States
(Dhall) Department of Neurological Surgery, University of California, San
Francisco, San Francisco, CA, United States
(Harrop) Departments of Neurological Surgery and Orthopedic Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Hoh) Lillian S. Wells Department of Neurological Surgery, University of
Florida, Gainesville, FL, United States
(Qureshi) Department of Orthopaedic Surgery, Weill Cornell Medical
College, New York, NY, United States
(Raksin) Division of Neurosurgery, John H. Stroger Jr Hospital of Cook
County, Rush University Medical Center, Chicago, IL, United States
(Kaiser) Department of Neurosurgery, Columbia University, New York, NY,
United States
(O'Toole) Department of Neurological Surgery, Rush University Medical
Center, Chicago, IL, United States
Publisher
Oxford University Press
Abstract
BACKGROUND: Treatment of thoracolumbar burst fractures has traditionally
involved spinal instrumentation with fusion performed with standard open
surgical techniques. Novel surgical strategies, including instrumentation
without fusion and percutaneous instrumentation alone, have been
considered less invasive and more efficient treatments. OBJECTIVE(S):
To review the current literature and determine the role of fusion in
instrumented fixation, as well as the role of percutaneous
instrumentation, in the treatment of patients with thoracolumbar burst
fractures. METHOD(S): The task force members identified search
terms/parameters and a medical librarian implemented the literature
search, consistent with the literature search protocol (see Appendix I),
using the National Library of Medicine PubMed database and the Cochrane
Library for the period from January 1, 1946 to March 31, 2015.
 RESULT(S): A total of 906 articles were identified and 38 were
selected for full-text review. Of these articles, 12 articles met criteria
for inclusion in this systematic review. CONCLUSION(S): There is
grade A evidence for the omission of fusion in instrumented fixation for
thoracolumbar burst fractures. There is grade B evidence that percutaneous
instrumentation is as effective as open instrumentation for thoracolumbar
burst fractures. RECOMMENDATIONS: QUESTION: Does the addition of
arthrodesis to instrumented fixation improve outcomes in patients with
thoracic and lumbar burst fractures? RECOMMENDATION: It is recommended
that in the surgical treatment of patients with thoracolumbar burst
fractures, surgeons should understand that the addition of arthrodesis to
instrumented stabilization has not been shown to impact clinical or
radiological outcomes, and adds to increased blood loss and operative
time. Strength of Recommendation: Grade A QUESTION: How does the use of
minimally invasive techniques (including percutaneous instrumentation)
affect outcomes in patients undergoing surgery for thoracic and lumbar
fractures compared to conventional open techniques? RECOMMENDATION:
Stabilization using both open and percutaneous pedicle screwsmay be
considered in the treatment of thoracolumbar burst fractures as the
evidence suggests equivalent clinical outcomes. Copyright © 2018
by the Congress of Neurological Surgeons.

<66>
Accession Number
2001580530
Title
Interval From Initiation of Prasugrel to Coronary Angiography in Patients
With Non-ST-Segment Elevation Myocardial Infarction.
Source
Journal of the American College of Cardiology. 73 (8) (pp 906-914), 2019.
Date of Publication: 5 March 2019.
Author
Silvain J.; Rakowski T.; Lattuca B.; Liu Z.; Bolognese L.; Goldstein P.;
Hamm C.; Tanguay J.-F.; ten Berg J.; Widimsky P.; Miller D.; Portal J.-J.;
Collet J.-P.; Vicaut E.; Montalescot G.; Dudek D.
Institution
(Silvain, Lattuca, Collet, Montalescot) Sorbonne University, ACTION Study
Group, INSERM UMRS 1166, ICAN, Institut de Cardiologie, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Rakowski, Dudek) Institute of Cardiology, Jagiellonian University Medical
College, Krakow, Poland
(Lattuca) Service de Cardiologie, Centre Hospitalier Universitaire Nimes,
ACTION Study Group, Universite Montpellier, Montpellier, France
(Liu) Department of Cardiology, Peking Union Medical College Hospital,
Beijing, China
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera, Arezzo, Italy
(Goldstein) SAMU and Emergency Department, Lille University Hospital,
Lille, France
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim and Medical Clinic
I, University of Giessen, Giessen, Germany
(Tanguay) Montreal Heart Institute, Montreal University, Montreal, Quebec,
Canada
(ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Widimsky) Third Medical Faculty of Charles University and University
Hospital Royal Vineyards, Prague, Czech Republic
(Miller) Eli Lilly and Company, Indianapolis, Indiana, India
(Portal, Vicaut) Methodology and Statistical Unit, Centre Hospitalier
Universitaire Lariboisiere (ACTION Study Group, AP-HP, Universite Paris
7), Paris, France
Publisher
Elsevier USA
Abstract
Background: In the ACCOAST (A Comparison of Prasugrel at PCI or Time of
Diagnosis of Non-ST Elevation Myocardial Infarction) trial, the prasugrel
pre-treatment strategy versus placebo was associated with excess bleeding
complications and no improved ischemic outcome in non-ST-segment elevation
myocardial infarction (MI). Whether patients with the longest
pre-treatment duration had an ischemic benefit is unknown.
 Objective(s): This pre-specified analysis of the ACCOAST trial aimed
to assess the effect of pre-treatment duration with prasugrel (time from
randomization to angiography) on outcomes. Method(s): Within the
4,033 patients randomized in the ACCOAST trial, pre-treatment duration was
available in 4,001 patients (99.2%). The population of the trial was
divided into quartiles of pre-treatment duration (0.1 to 2.5 h, 2.5 to 3.9
h, 3.9 to 13.6 h, and >13.6 h) with an evaluation of the primary efficacy
endpoint of cardiovascular death, MI, stroke, urgent revascularization or
glycoprotein IIb/IIIa inhibitor bailout use. Secondary efficacy outcomes
including cardiovascular death, MI, or stroke; all-cause death; stent
thrombosis and safety outcomes (all coronary artery bypass graft [CABG] or
non-CABG TIMI [Thrombolysis In Myocardial Infarction] major bleeding) were
also evaluated at 7 days. Result(s): The primary efficacy outcome of
cardiovascular death, MI, stroke, urgent revascularization or glycoprotein
IIb/IIIa inhibitor bailout use did not differ between the quartiles of
pre-treatment duration in the trial population (p = 0.17 for interaction).
None of the secondary efficacy outcomes were found to be dependent on
pre-treatment duration. The safety outcome of all CABG or non-CABG TIMI
major bleeding did not differ between the quartiles of pre-treatment
duration (p = 0.37 for interaction). Conclusion(s): In non-ST-segment
elevation MI patients, the excess risk of bleeding and the absence of
ischemic benefit were consistent across the quartiles of increasing
duration of prasugrel pre-treatment. (A Comparison of Prasugrel at PCI or
Time of Diagnosis of Non-ST Elevation Myocardial Infarction [ACCOAST];
NCT01015287) Copyright © 2019 American College of Cardiology
Foundation

<67>
Accession Number
621531340
Title
Does high body mass index have any impact on survival of patients
undergoing oesophagectomy for oesophageal cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 693-695),
2018. Date of Publication: 01 Apr 2018.
Author
Deng H.-Y.; Qin C.-L.; Qiu X.-M.; Zhou Q.
Institution
(Deng, Qin, Qiu, Zhou) Lung Cancer Center, West China Hospital, Sichuan
University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does high body mass index
(BMI) have any impact on survival of patients undergoing oesophagectomy
for oesophageal cancer?' A total of 232 papers were found using the
reported search, of which 8 papers represented the best evidence to answer
the clinical question, which included 1 meta-analysis and 7 cohort
studies. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. One meta-analysis and 4 cohort studies provided the
evidence that high BMI was significantly correlated with a better survival
of oesophageal cancer patients undergoing oesophagectomy, while the other
3 cohort studies found that high BMI had no impact on the survival of
those patients. We conclude that patients with high BMI may have a better
prognosis than those with normal BMI undergoing oesophagectomy for
oesophageal cancer. Copyright © The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<68>
Accession Number
622501256
Title
Role of the tricuspid regurgitation after mitraclip and transcatheter
aortic valve implantation: A systematic review and meta-Analysis.
Source
European Heart Journal Cardiovascular Imaging. 19 (6) (pp 654-659), 2018.
Date of Publication: 01 Jun 2018.
Author
Pavasini R.; Ruggerini S.; Grapsa J.; Biscaglia S.; Tumscitz C.; Serenelli
M.; Boriani G.; Squeri A.; Campo G.
Institution
(Pavasini, Biscaglia, Tumscitz, Serenelli, Campo) Cardiology Unit, Azienda
Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
(Ruggerini, Boriani) Division of Cardiology, Department of Diagnostics,
University of Modena and Reggio Emilia, Policlinico d Modena, Italy
(Grapsa) Heart and Vascular Institute, Cleaveland Clinic, Cleaveland,
United States
(Squeri) Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research,
Cotignola, Italy
(Campo) Maria Cecilia Hospital, GVM Care and Research, E.S.: Health
Science Foundation, Cotignola, Italy
Publisher
Oxford University Press
Abstract
Aims Treatment of tricuspid regurgitation (TR) is common after surgery for
mitral and/or aortic valves. The prognostic role of moderate to severe TR
in patients undergoing mitraclip or transcatheter aortic valve
implantation (TAVI) is not well-defined. Thus, the aim of this article is
to perform a systematic review and meta-Analysis of articles valuing the
prognostic role of TR for patients undergoing mitraclip and TAVI. Methods
and results Articles were searched in Pubmed, Cochrane Library, Google
Scholar and Biomed Central in September 2016. Inclusion criteria:
observational or randomized clinical trials with data on the prognostic
role of TR in patients undergoing mitraclip or TAVI. Primary outcome was
all-cause mortality expressed as hazard ratio (HR). Six articles fulfilled
inclusion criteria, three were on mitraclip and three on TAVI. A total of
2329 patients were analysed (mean age was 78.38 (3.09), 63% male): 1328
treated with TAVI and 1001 with mitraclip. The HR for all-cause mortality
of moderate to severe TR was 2.0 (95% CI 1.57-2.55, I 2 = 0%). Data were
confirmed also after subgroup analysis for mitraclip vs. TAVI. None of the
factor considered in meta-regression analyses was affecting the primary
outcome. Conclusions The current meta-Analysis suggests that the presence
of moderate to severe TR in patients undergoing mitraclip or TAVI might be
a major determinant of all-cause mortality. New studies are needed to
confirm it and to plan possible intervention in order to reduce its
impact. Copyright © The Author 2017.

<69>
Accession Number
624573416
Title
A prospective, single-center, randomized study to assess whether automated
coregistration of optical coherence tomography with angiography can reduce
geographic miss.
Source
Catheterization and Cardiovascular Interventions. 93 (3) (pp 411-418),
2019. Date of Publication: 15 Feb 2019.
Author
Koyama K.; Fujino A.; Maehara A.; Yamamoto M.H.; Alexandru D.; Jennings
J.; Krug P.; Santiago L.M.; Murray M.; Bongiovanni L.; Lee T.; Kim S.-Y.;
Wang X.; Lin Y.; Matsumura M.; Ali Z.A.; Sosa F.; Haag E.; Mintz G.S.;
Shlofmitz R.A.
Institution
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Ali) Division of
Cardiology, Department of Medicine, Columbia University Medical Center,
New York, NY, United States
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Matsumura, Ali,
Mintz) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Alexandru, Jennings, Krug, Santiago, Murray, Bongiovanni, Haag,
Shlofmitz) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Wang) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Lin) Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangzhou, China
(Sosa) Abbott Vascular, Santa Clara, CA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We sought to evaluate whether automated coregistration of
optical coherence tomography (OCT) with angiography reduces geographic
miss (GM) during coronary stenting. Background(s): Previous
intravascular ultrasound or OCT studies have showed that residual disease
at the stent edge or stent edge dissection was associated with stent
thrombosis or edge restenosis. This has been termed GM. Method(s):
Two hundred de novo coronary lesions were randomized in a 1:1 ratio to
OCT-guided percutaneous coronary intervention (PCI) with versus without
automated coregistration of OCT with angiography. GM, the primary
endpoint, was defined as angiographic >=type B dissection or diameter
stenosis >50% or OCT minimum lumen area <4.0 mm2 with
significant residual disease or dissection (dissection flap >60degree)
within 5 mm from the stent edge. Result(s): The prevalence of GM was
not different comparing OCT-guided PCI with versus without automated
coregistration (27.6% vs 34.0%, P = 0.33). However, there was a trend
toward a reduced prevalence of significant distal stent edge dissection in
lesions with automated coregistration (11.1% vs 20.8%, P = 0.07). The
discrepancy in the distance between planned versus actual implanted stent
location with automated coregistration was significantly shorter than
without coregistration (1.9 +/- 1.6 mm vs 2.6 +/- 2.7 mm, P = 0.03),
especially the prevalence of >=5 mm discrepancy that was less frequent
with automated coregistration. Conclusion(s): Automated
coregistration of OCT with angiography did not reduce the primary endpoint
of GM after stent implantation. Copyright © 2018 Wiley
Periodicals, Inc.

<70>
[Use Link to view the full text]
Accession Number
625892372
Title
Percutaneous coronary intervention or coronary artery bypass graft in left
main coronary artery disease: a comprehensive meta-analysis of adjusted
observational studies and randomized controlled trials.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 19 (10) (pp
554-563), 2018. Date of Publication: 01 Oct 2018.
Author
Bertaina M.; De Filippo O.; Iannaccone M.; Colombo A.; Stone G.; Serruys
P.; Mancone M.; Omede P.; Conrotto F.; Pennone M.; Kimura T.; Kawamoto H.;
Zoccai G.B.; Sheiban I.; Templin C.; Benedetto U.; Cavalcante R.; D'Amico
M.; Gaudino M.; Moretti C.; Gaita F.; D'Ascenzo F.
Institution
(Bertaina, De Filippo, Iannaccone, Omede, Conrotto, Pennone, D'Amico,
Moretti, Gaita, D'Ascenzo) Division of Cardiology, Molinette Hospital,
Citta Della Salute e della Scienza, Turin, Italy
(Colombo, Kawamoto) Interventional Cardiology, Cardio-Thoracic-Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Stone) Cardiovascular Research and Education Columbia University Medical
Center, Presbyterian Hospital, NY, United States
(Serruys, Cavalcante) Department of Interventional Cardiology, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mancone) Department of Cardiovascular, Respiratory, Nephrology,
Anesthesiology and Geriatric Sciences, University 'La Sapienza' of Rome,
Rome, Italy
(Kimura) Department of Cardiovascular Medicine, Kyoto University, Japan
(Zoccai) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Latina, Italy
(Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli,
Italy
(Sheiban) Cardiology Department, Pederzoli Hospital, Verona, Italy
(Templin) University Heart Center, Department of Cardiology, University
Hospital Zurich, Zurich, Switzerland
(Benedetto, Gaudino) Bristol Heart Institute, University of Bristol,
School of Clinical Sciences, Bristol, United Kingdom
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Treatment of patients with ULMCA (unprotected left main
coronary artery disease) with percutaneous coronary intervention (PCI) has
been compared with coronary artery bypass graft (CABG), without conclusive
results. METHOD(S): All randomized controlled trials (RCTs) and
observational studies with multivariate analysis comparing PCI and CABG
for ULMCA were included. Major cardiovascular events (MACEs, composite of
all-cause death, MI, definite or probable ST, target vessel
revascularization and stroke) were the primary end points, whereas its
single components were the secondary ones, along with stent thrombosis,
graft occlusion and in-hospital death and stroke. Subgroup analyses were
performed according to Syntax score. RESULT(S): Six RCTs (4717
patients) and 20 observational studies with multivariate adjustment (14
597 patients) were included. After 5 (3-5.5) years, MACE rate was higher
for PCI [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07-1.14],
without difference in death, whereas more relevant risk of MI was because
of observational studies. Coronary stenting increased risk of
revascularization (OR 1.52; 95% CI 1.34-1.72). At meta-regression,
performance of PCI was improved by use of intra-coronary imaging and
worsened by first generation stents, whereas two arterial grafts increased
benefit of CABG. For patients with Syntax score less than 22, MACE rates
did not differ, whereas for higher values, CABG reduced MACE because of
lower risk of revascularization. Incidence of graft occlusion was 3.24%
(2.25-4.23), whereas 2.13% (1.28-2.98: all CI 95%) of patients experienced
stent thrombosis. CONCLUSION(S): Surgical revascularization reduces
risk of revascularization for ULMCA patients, especially for those with
Syntax score greater than 22, with a higher risk of in-hospital death.
Intra-coronary imaging and use of arterial grafts improved performance of
revascularization strategies.

<71>
Accession Number
626436439
Title
Change in frequency of arthroplasty surgery in rheumatoid arthritis: A
13-year population health study.
Source
Arthritis and Rheumatology. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2018. United States. 70 (Supplement 9) (pp
2406), 2018. Date of Publication: September 2018.
Author
Hanly J.G.; Lethbridge L.; Skedgel C.
Institution
(Hanly) Division of Rheumatology, Department of Medicine and Department of
Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie
University, Halifax, NS, Canada
(Lethbridge) Nova Scotia Health Authority, Halifax, NS, Canada
(Skedgel) Dalhousie University, Halifax, NS, Canada
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: Improvement in the medical management of rheumatoid
arthritis (RA) over the past two decades may have reduced the need for
arthroplasty surgery but the literature to date has reported inconsistent
findings. The objective of our study was to compare the annual frequency
of hip, knee and other arthroplasty surgery in a prevalent cohort of RA
cases and matched controls over 13 years. Method(s): A retrospective
cohort study was performed utilizing administrative healthcare data from
approximately 1 million people with access to universal healthcare between
1997 and 2010. RA cases were identified using a previously validated RA
case definition in the same dataset (1). Each case was matched by age and
sex to 4 randomly selected controls. The annual frequency of
arthroplasties in cases and controls was compared. In addition the
frequency of coronary artery interventions (bypass grafting, angioplasty
and stenting) was used as an additional control. Data included physician
billings, hospital discharges and patient registry information using ICD-9
and ICD-10. Statistical analysis used least squares regression t-tests and
2-proportion z-tests. Result(s): The number (prevalence) of RA cases
per year increased from 3,913 (0.42%) to 4,911 (0.52%) over the study. The
mean (SD) age changed from 56.7 (15.9) to 60.1 (14.9) years and the
proportion of females from 70.8% to 73.9%. In both the first and last
years of the study the frequency of all arthroplasty procedures was higher
in cases than controls (p< 0.001) (Table). Over time there was a gradual
and significant reduction in arthroplasty surgery in RA cases by 51.9%
(p<0.001). This was in contrast to controls in whom the frequency of
procedures increased by 31.9% (p=0.002) with the exception of hip
arthroplasty. For the latter procedure, the frequency decreased by 63% in
RA cases (p<0.001) and 35% in controls (p=0.617). In contrast to
arthroplasty procedures the frequency of cardiac procedures, which was
higher in RA cases in both the first (p=0.013) and final (p=0.003) years
of observation, increased in both cases and controls over time although
this did not reach statistical significance in either. Conclusion(s):
There was a striking reduction in arthroplasty surgery in RA cases over 13
years of observation. Lack of similar changes in controls and sustained
rates of cardiac procedures over the same time suggests that this was not
due to limited surgical access for RA patients. Earlier diagnosis and
improved medical treatment of RA are potentially responsible.

<72>
Accession Number
626435809
Title
Comparative risk of atrial fibrillation and cardiovascular events between
TNF-inhibitors and ustekinumab in patients with psoriasis and psoriatic
arthritis: A population-based multi-database study.
Source
Arthritis and Rheumatology. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2018. United States. 70 (Supplement 9) (pp
1789-1790), 2018. Date of Publication: September 2018.
Author
Lee M.; Desai R.J.; Jin Y.; Brill G.; Ogdie A.; Kim S.C.
Institution
(Lee, Brill, Kim) Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Desai) Division of Pharmacoepidemiology and Pharmacoeconimics, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Jin) Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Ogdie) Medicine/Rheumatology and Epidemiology, University of
Pennsylvania, Philadelphia, PA, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: Cardiovascular disease is a major comorbidity in
patients with psoriasis (PsO) and psoriatic arthritis (PsA). Increasing
evidence suggests a potential reduction in the risk of cardiovascular
(CV)events with biological diseasemodifying antirheumatic drugs
(bDMARDs)treatment, mainly including tumor necrosis factor inhibitors
(TNFi) with the more recent focus on atrial fibrillation (AF). However,
the comparative CV risk with different bDMARDs has not been adequately
studied in this patient population. Method(s): Using two large US
commercial insurance databases, Optum Clinformatics and MarketScan, we
identified patients with PsO or PsA diagnosis initiating ustekinumab or
TNFi (i.e., adalimumab, etanercept, infliximab, certolizumab, and
golimumab) from September 25, 2009 to September 30, 2015. The primary
outcome was incident AF and the secondary outcome was a composite CV event
including myocardial infarction, stroke, and coronary revascularization.
Patients were followed until the first occurrence of the following events:
1) outcomes, 2) death, 3) plan disenrollment, 4) switching or 5)
discontinuing treatment. To account for potential confounding, we
estimated propensity score (PS) as the predicted probability of receiving
ustekinumab conditioning on 62 covariates including demographic and
clinical factors in each database. We used weighting based on PS fine
stratification with 50 strata to control for confounding. The adjusted
hazard ratio (HR) of each outcome was estimated using a weighted Cox
proportional hazards regression model. We performed all the analyses
separately in each of the databases and then combined the HR by a
random-effects metaanalysis. Result(s): We identified 60,028 (15,470
in Optum and 44,558 in MarketScan) adult patients with PsO or PsA and no
prior AF. The mean age of the cohort was 47.2 +/- 12.7, and 51% were
female. 81% had diagnosis for PsO while 46% had PsA, and 27% had both PsO
and PsA. After PS stratification, covariates were well balanced between
the two groups. As presented in Table 1, 60 incident AF occurred in 9,071
ustekinumab initiators while 323 incident AF did in 50,957 TNF inhibitor
initiators (IR=4.7 and 5.0 cases per 1,000 person-year, respectively).
MACE occurred in 74 patients among ustekinumab initiators, and 421 of
patients initiated TNF inhibitors (IR=6.2 and 6.1 cases per 1,000
person-year, respectively). The combined HR for AF among the ustekinumab
initiators compared to those initiated TNFi was 1.15 (95% CI 0.70-1.89),
and for MACE, the HR was 1.14 (95% CI 0.89-1.46). Conclusion(s): In
this large cohort study of 60,028 patientswith PsO or PsA, we found no
substantially different risk of AF or CVD after initiation of ustekinumab
or TNFi. However, a possible small effect cannot be ruled out warranting
further studies with a longer follow-up. (Table Presented) .

<73>
Accession Number
626434445
Title
Radionuclide radiocardiopulmonography in evaluation of the
cardioprotective effectiveness of hypoxic preconditioning.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
31st Annual Congress of the European Association of Nuclear Medicine, EANM
2018. Germany. 45 (Supplement 1) (pp S378), 2018. Date of Publication:
October 2018.
Author
Vesnina Z.V.; Krivonogov N.G.; Arsenjeva Y.A.; Lishmanov Y.B.
Institution
(Vesnina, Krivonogov, Arsenjeva, Lishmanov) Cardiology Research Institute,
Tomsk NRMC, Tomsk, Russian Federation
Publisher
Springer Berlin Heidelberg
Abstract
Aim: Using radiocardiopulmonography to evaluate the car-dioprotective
effectiveness of hypoxic preconditioning (HPC) during myocardial
revascularization under extracorporeal circulation (EC). Material(s)
and Method(s): Sixty three patients (mean age 52.8 +/- 1.4 years) who
underwent coronary bypass surgery (CABG) under EC condition were examined.
All pts had chronic heart failure of NYHA class I-III. Patients were
randomized into 2 groups: 33 patients with HPC, conducted during CABG
(study group) and 30 patients made up a comparison group. Patients of both
groups were comparable in clinical and intra-operative data. The
precondition was performed in single-cycle 10-minute hypoxemia followed by
the 5-min period of reoxy-genation before global ischemia.
Radiocardiopulmonography with 99m-pertechnetate was performed before and
6-8 days after surgery with the calculation of the parameters of
cardio-pulmonary hemodynamics. Result(s): In the examined patients
before CABG we observed the decrease of the mean values of the cardiac
minute output (MO), cardiac index (SI), stroke index (SI) and circulation
efciency ratio (CER) as a consequence of the decrease in pumping function
of the heart, as well as an increase in the circulation time blood in the
lungs (T<inf>PUL</inf>) due to its both arterial and venous components,
which indicates the formation of pulmonary hypertension and venous
congestion of the left heart. In the postoperative period a positive
statistically significant change in most parameters of cardiopulmonary
hemodynamics occurred as a result of successful myocardial
re-vascularization in patients of both groups: an increase of MO, SI, CER,
half-emptying period of the left ventricle and a decrease of
T<inf>PUL</inf>. It should be noted that in the patients of the main
group, the positive dynamics of these parameters was statistically more
pronounced. Also, in contrast to the comparison group, the arterial
component of circulation in the lungs and the half-emptying period of the
right ventricle significantly decreased in patients with HPC, what
indicates a reduction in pulmonary hypertension and a regression of right
ventricular failure. On the 2nd day after operation creatine-kinaze (CK)
and CK-MB in the blood were increased in patients of both groups. Wherein
the mean level of CK-MB was significantly higher (by 33%) in the
comparison group relative to the main group (p = 0.046825), and the
relative index (RI = CPC-MB/CPC x 100) in the main group did not exceed
6%. This indicates that HPC increases the heart's tolerance to the effects
of "ischemia-reperfusion." Conclusion(s): Hypoxic preconditioning has
cardioprotective activity in patients undergoing open-heart surgery under
EC.

<74>
Accession Number
626433354
Title
Safety and tolerability of regadenoson pharmacological stress for
pre-operative evaluation of patients scheduled to undergo medium to
high-risk non-cardiac surgery: A randomized controlled study with
dipyridamole/preliminary results.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
31st Annual Congress of the European Association of Nuclear Medicine, EANM
2018. Germany. 45 (Supplement 1) (pp S366-S367), 2018. Date of
Publication: October 2018.
Author
Stavrou P.Z.; Polytarchou K.; Giannopoulou C.; Pantos K.; Mourouzis I.;
Papachristou M.; Datseris I.; Manolis A.S.
Institution
(Stavrou, Polytarchou, Giannopoulou, Papachristou, Datseris) Evagelismos
General Hospital of Athens, Athens, Greece
(Stavrou, Polytarchou, Pantos, Mourouzis, Manolis) Athens University
School of Medicine, Athens, Greece
Publisher
Springer Berlin Heidelberg
Abstract
Introduction: Regadenoson is a pharmacologic stress agent used in
myocardial perfusion imaging. It is a selective A2A ad-enosine receptor
agonist with a short half-life, high afinity for A2A receptors and low to
no afinity for the other adenosine receptors (A1, A2B and A3), which are
responsible for its adverse reactions. Regadenoson's main advantages are
its brief protocol of administration and its ability to be administered in
patients with asthma or chronic obstructive pulmonary disease (COPD) of
moderate severity. A disadvantage is the higher cost of this
pharmaceutical agent in comparison with the cheaper dipyrid-amole. The
purpose of this study is the assessment of regade-noson's safety and
tolerability, in comparison with dipyridamo-le, in a specific patient
group. Patients and Methods: This an ongoing randomized controlled
study of patients scheduled for medium-to high-risk non-cardiac surgery
who have at least 1 coronary risk factor and are undergoing pre-operative
evaluation with myocardial scintigraphy using pharmacological stress
agents. Patients are randomized into two groups, patients receiving
Regadenoson (study group) and patients stressed with Dipyridamole (control
group). Result(s): 73 patients have been recruited thus far. 35
patients (aged 70.5+/-10.2 years, 20 males) have been randomized to
pharmacologic stress with Regad-enoson, and 38 patients (aged 69.5+/-10.1
years, 26 males) to Dipyridamole (p for age >0.05). Patients with known
coronary artery disease were 11 (31.4%) in the Regadenoson group and 14
(36.8%) in the Dipyridamole group (p>0.05). Gastrointestinal discomfort
(25.7% vs 5.3%, p=0.015) and headache (14.3% vs 23.7%, p>0.05) were the 2
most frequent adverse reactions in the first group, while headache (23.7%
vs 14.3%, p>0.05) and dizziness (18.4% vs 11.4%, p>0.05), were the most
frequent ones in the second group. Aminophylline was administered to 7
patients in each group (p>0.05). After injection of Regadenoson, heart
rate increased by 29.4+/-9.0% and after Dipyridamole infusion by
15.6+/-8.3% (p<0.001). S-T depression in the ECG recording was observed in
6 (17.1%) patients in the first group (0.5-1 mm), and in 2 (5.3%, p>0.05)
in the second group (0.5-3 mm). No patient (0%) from the Regadenoson group
developed atrio-ventricular (AV) conduction abnormalities, while first
degree AV block was observed in 4 (10.5%) patients from the Dipyridamole
group (p=0.048). Conclusion(s): Regadenoson seems to be as safe and
tolerable as Dipyridamole, regarding adverse reactions, but with less AV
conduction abnormalities and faster resolution of symptoms due to its
shorter half-life.

<75>
Accession Number
626053671
Title
Antiplatelet Therapy versus Anticoagulation after Surgical Bioprosthetic
Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Thrombosis and Haemostasis. 119 (2) (pp 328-339), 2019. Date of
Publication: 2019.
Author
An K.R.; Belley-Cote E.P.; Um K.J.; Gupta S.; McClure G.R.; Jaffer I.H.;
Pandey A.; Spence J.; Van Der Wall S.J.; Eikelboom J.W.; Whitlock R.P.
Institution
(An, Um, McClure) Michael G. DeGroote School of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Gupta, Jaffer, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote) Division of Cardiology, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Jaffer, Eikelboom, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Gupta, Jaffer, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Pandey) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(Van Der Wall) Department of Thrombosis and Hemostasis, Leiden University
Medical Centre, Leiden University, Leiden, Netherlands
(Eikelboom) Division of Hematology and Thromboembolism, McMaster
University, Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular, Stroke Research Institute, 237
Barton Street East, Hamilton, ON L8L 2X2, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The optimal antithrombotic therapy after surgical bioprosthetic
aortic valve replacement (BAVR) is uncertain. We conducted a systematic
review and meta-analysis of observational studies and randomized
controlled trials (RCTs) comparing antiplatelet therapy and
anticoagulation in patients with surgical BAVR. Methods We searched
Cochrane CENTRAL, MEDLINE and EMBASE from inception to 3 November 2017 for
studies evaluating antiplatelet therapy versus anticoagulation early after
surgical BAVR. We performed title and abstract screening, full-text
review, risk of bias evaluation and data collection independently and in
duplicate. We evaluated overall quality of evidence using the Grading of
Recommendations Assessment, Development and Evaluation framework, and
pooled data using a random effects model. Results We identified 2 RCTs (n
= 397) and 5 observational studies (n = 2,012) meeting our eligibility
criteria. The mean follow-up for all outcomes was 3 months in RCTs, and 10
months for observational studies. Antiplatelet compared with anticoagulant
therapy demonstrated a trend towards fewer major bleeds in RCTs (relative
risk [RR], 0.34; 95% confidence interval [CI], 0.11-1.04, p = 0.06, I
2 = 0%, low quality evidence), and significantly fewer major
bleeds in observational studies (RR, 0.34; 95% CI, 0.20-0.58, p <= 0.0001,
I 2 = 0%, very low quality evidence), but stroke,
thromboembolism and mortality did not show a significant difference in
either RCTs or observational studies. Conclusion Antiplatelet therapy
demonstrated reduced bleeding risk with no negative effects on stroke,
thromboembolism or mortality compared with anticoagulation therapy after
surgical BAVR. Our confidence in the results is reduced by the low quality
of the available evidence. Copyright © 2019 Georg Thieme Verlag
KG Stuttgart New York.

<76>
Accession Number
2000778461
Title
Palliative Care for Patients With Advanced Heart Disease.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 833-843),
2019. Date of Publication: March 2019.
Author
Klinedinst R.; Kornfield Z.N.; Hadler R.A.
Institution
(Klinedinst) Division of Palliative Care, Department of Medicine, Hospital
of the University of Pennsylvania, Philadelphia, PA, United States
(Kornfield, Hadler) Department of Anesthesiology and Critical Care,
Hospital of the University of Pennsylvania, Philadelphia, PA, United
States
Publisher
W.B. Saunders
Abstract
Over the past 2 decades, the discipline of palliative care has evolved and
expanded such that it is now the standard of care for a variety of acute
and chronic processes. Although there are recommendations encouraging
incorporation of palliative care into the routine management of patients
with chronic cardiac processes, such as congestive heart failure,
implementation has been challenging, and nowhere more so than in the
cardiac surgical population. However, as the boundaries of surgical care
have expanded to include progressively more complex cases, increasing
attention has been given to the integration of palliative care into their
management. In this review article, the authors describe the existing
evidence for palliative care team involvement in patients with
non-operative and surgical cardiac diseases and examine future directions
for growth in this field. Copyright © 2018 Elsevier Inc.

<77>
Accession Number
625852777
Title
Post-transplant diabetes mellitus in patients with solid organ
transplants.
Source
Nature Reviews Endocrinology. 15 (3) (pp 172-188), 2019. Date of
Publication: 01 Mar 2019.
Author
Jenssen T.; Hartmann A.
Institution
(Jenssen, Hartmann) Department of Transplantation Medicine, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Jenssen, Hartmann) Institute of Clinical Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Solid organ transplantation (SOT) is a life-saving procedure and an
established treatment for patients with end-stage organ failure. However,
transplantation is also accompanied by associated cardiovascular risk
factors, of which post-transplant diabetes mellitus (PTDM) is one of the
most important. PTDM develops in 10-20% of patients with kidney
transplants and in 20-40% of patients who have undergone other SOT. PTDM
increases mortality, which is best documented in patients who have
received kidney and heart transplants. PTDM results from predisposing
factors (similar to type 2 diabetes mellitus) but also as a result of
specific post-transplant risk factors. Although PTDM has many
characteristics in common with type 2 diabetes mellitus, the prevention
and treatment of the two disorders are often different. Over the past 20
years, the lifespan of patients who have undergone SOT has increased, and
PTDM becomes more common over the lifespan of these patients. Accordingly,
PTDM becomes an important condition not only to be aware of but also to
treat. This Review presents the current knowledge on PTDM in patients
receiving kidney, heart, liver and lung transplants. This information is
not only for transplant health providers but also for endocrinologists and
others who will meet these patients in their clinics. Copyright ©
2018, Springer Nature Limited.

<78>
Accession Number
2001149356
Title
Intravenous and Inhaled Milrinone in Adult Cardiac Surgery Patients: A
Pairwise and Network Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 663-673),
2019. Date of Publication: March 2019.
Author
Rong L.Q.; Rahouma M.; Abouarab A.; Di Franco A.; Calautti N.M.;
Fitzgerald M.M.; Arisha M.J.; Ibrahim D.A.; Girardi L.N.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Calautti, Fitzgerald, Arisha, Ibrahim, Pryor) Department of
Anesthesiology, Weill Cornell Medicine, New York, NY, United States
(Rahouma, Abouarab, Di Franco, Girardi, Gaudino) Department of
Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
Publisher
W.B. Saunders
Abstract
Objective: To summarize the evidence on the hemodynamic,
echocardiographic, and clinical effects of inhaled and intravenous
milrinone (iMil and IvMil) in adult cardiac surgery patients.
 Design(s): Systematic review, pairwise and network meta-analysis.
 Setting(s): Multi-institutional. Participant(s): Adult cardiac
surgery patients. Intervention(s): Comparison between iMil and IvMil
versus other agents or placebo. Measurements and Main Results: The
primary endpoints were mean pulmonary artery pressure (MPAP) and
peripheral vascular resistance (PVR). Secondary endpoints included the
following: (1) mean arterial pressure, heart rate, and cardiac index (CI);
(2) echocardiographic data; and (3) clinical outcomes. Random model,
leave-one-out-analysis, and meta-regression were used. Thirty studies (6
iMil and 24 IvMil) were included for a total of 1,438 patients (194 iMil
and 521 IvMil). IvMil was associated with a lower MPAP, lower PVR, and
higher CI compared to placebo (standardized mean difference [SMD] = -0.22
[95% CI = -0.48 to 0.05], SMD = -0.49 [95% CI = -0.71 to -0.27], and SMD =
0.94 [95% CI = 0.51 to 1.37]). No difference in any outcome was found
between iMil and placebo. At network meta-analysis, significantly lower
PVR and shorter hospital length of stay were found for IvMil compared to
iMil (SMD = -0.82 [95% CI = -1.53 to -0.10] and SMD = -0.50 [95% CI =
-0.95 to -0.05], respectively). Conclusion(s): These results support
the clinical use of IvMil in cardiac surgery patients. No evidence at
present supports the adoption of iMil. Copyright © 2018 Elsevier
Inc.

<79>
Accession Number
2000972670
Title
Effects of Nicorandil Versus Nitroglycerin on Arterial Oxygenation During
Two-Lung Ventilation and One-Lung Ventilation in Patients With Risk
Factors for Myocardial Ischemia: A Prospective, Randomized, Double-Blind
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 702-709),
2019. Date of Publication: March 2019.
Author
Murakami C.; Kawano H.; Kinoshita M.; Kondo A.; Inoue M.
Institution
(Murakami, Kawano, Kinoshita, Kondo, Inoue) Department of Anesthesiology,
Tokushima Prefectural Central Hospital, Tokushima, Japan
Publisher
W.B. Saunders
Abstract
Objectives: To compare the effects of nicorandil and nitroglycerin on
arterial oxygenation during two-lung ventilation (TLV) and one-lung
ventilation (OLV) in patients with risk factors for myocardial ischemia.
 Design(s): A prospective, randomized, double-blind study.
 Setting(s): A tertiary care hospital. Participant(s): Fifty-six
patients scheduled for elective video-assisted thoracic surgery were
assigned randomly to either the nicorandil group or the nitroglycerin
group. Intervention(s): Patients in the nicorandil group received a
bolus dose of nicorandil, 0.08 mg/kg during induction of anesthesia,
followed by a continuous infusion at a rate of 0.08 mg/kg/h. Patients in
the nitroglycerin group received a continuous infusion of nitroglycerin at
a rate of 1 micro g/kg/min from the induction of anesthesia.
 Measurements and Main Results: Arterial blood gas analysis was
performed at the following points: before induction of anesthesia; during
TLV; at 5, 10, 20, and 30 minutes after the initiation of OLV.
PaO<inf>2</inf> at TLV (479.7 +/- 57.1 v 408.2 +/- 70.9 mmHg, p < 0.001);
and at 5 minutes (344.8 +/- 85.1 v 282.6 +/- 85.8 mmHg, p = 0.012), 20
minutes (215.7 +/- 103.0 v 158.2 +/- 74.5 mmHg, p = 0.027), and 30 minutes
(198.8 +/- 103.5 v 147.5 +/- 64.1 mmHg, p = 0.039) after OLV was
significantly higher in the nicorandil group than in the nitroglycerin
group. Conclusion(s): This study demonstrated that oxygenation during
TLV and OLV was significantly higher in patients receiving nicorandil than
in those receiving nitroglycerin. Copyright © 2018 Elsevier Inc.

<80>
Accession Number
2001528394
Title
Modified ultrafiltration in coronary artery bypass grafting: A randomized,
double-blinded, controlled clinical trial.
Source
Iranian Red Crescent Medical Journal. 20 (5) (no pagination), 2018.
Article Number: e66187. Date of Publication: 01 May 2018.
Author
Tabaei A.S.; Mortazian M.; Yaghoubi A.; Manesh S.A.; Totonchi Z.;
Baharestani B.; Mehrabanian M.; Pazoki-Toroudi H.; Kaveh H.; Toloueitabar
Y.; Ghanbari A.; Gorjipour F.
Institution
(Tabaei, Yaghoubi, Gorjipour, Totonchi, Baharestani, Kaveh, Toloueitabar,
Ghanbari) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mortazian) Department of Cardiology, AJA University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Manesh) Department of Radiology, Qom University of Medical Sciences and
Health Services, Qom, Iran, Islamic Republic of
(Mehrabanian) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Pazoki-Toroudi, Gorjipour) Physiology Research Center, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Modified Ultrafiltration (MUF) has been used in
Cardiopulmonary Bypass (CPB) operations to prevent hemodilution and remove
pro-inflammatory cytokines. It has been studied in pediatric operation
settings. However, evidence exists regarding its application in adults'
Coronary Artery Bypass Grafting (CABG) operation. Objective(s): The
present study investigated MUF and its effects on inflammatory cytokine
response, hemodilution and rotational thromboelastometry outcomes in
adults' CABG operation. Method(s): In a randomized controlled trial,
56 elective CABG patients that had referred to the Rajaie Cardiovascular
Medical and Research Center (Tehran, Iran) during year 2017 were randomly
assigned to two groups, including control and MUF groups. Preoperative and
postoperative clinical parameters were recorded. Serum level of
inflammatory cytokines after clamp removal, after Cardiopulmonary Bypass
(CPB) (MUF in the MUF group) and 24 hours after Intensive Care Unit (ICU)
entrance, and Rotational Thrombo-elastometry (ROTEM) indices,
pre-operation, and post-operation, were measured. Result(s): The two
groups were similar in clinical perioperative parameters, including
hemodynamics, transfusions, ROTEM indices, mechanical ventilation and CPB
time, and ICU stay. The levels of inflammatory mediators were
significantly increased after CPB in both groups. Interleukin (IL)-6,-8
and-10 measures were equal between the two groups in all trial measurement
points. The MUF group demonstrated a significantly lower level of Tumor
Necrosis Factor (TNF)-alpha compared with the control group after CPB
(1.55 +/- 0.29 versus 1.77 +/- 0.35 log10 pg/mL, respectively; P = 0.031).
Hemoglobin (9.55 +/- 0.96 versus 8.29 +/- 0.57 g/dl, P < 0.001) and
hematocrit % (29.96 +/- 3.23 and 24.72 +/- 1.62, P < 0.001) levels were
significantly higher in the MUF group compared with the control, after
CPB. Conclusion(s): Modified Ultrafiltration eliminates extra liquids
and TNF-alpha from circulation in adults CABG operation, without affecting
the hemostatic indices and improves hemoglobin level. It does not remove
anti-inflammatory cytokine IL-10 from circulation. Copyright ©
2018, Author(s).

<81>
Accession Number
2001485458
Title
Pregnant woman with valvular bioprosthesis insufficiency attended at a
hospital in the Western Amazon.
Source
European Journal of Obstetrics Gynecology and Reproductive Biology.
Conference: 26th EBCOG European Congress of Obstetrics and Gynaecology.
France. 234 (pp e223), 2019. Date of Publication: March 2019.
Author
Cunha M.A.P.; Da Conceicao Simoes M.; Baratella B.M.
Institution
(Cunha, Da Conceicao Simoes, Baratella) Hospital De Base Dr. Ary Pinheiro,
Porto Velho-Ro, Brazil
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Mitral valve stenosis has peculiarities when it affects
patients during pregnancy due to the physiological changes inherent to
this period associated with the increase in blood volume and the
appearance of the placental arteriovenous fistula, which causes the
cardiovascular system to undergo important hemodynamic overload - increase
in heart rate and cardiac output, and high rate of oxygen consumption.
These women may present hemodynamic instability as the volume overload
becomes poorly tolerated due to fixed valve obstruction. These changes
that begin mainly between the 6th and 8th weeks of pregnancy progress
gradually and reach their peak around the 30th week. Objective(s): To
report a case of mitral stenosis in a pregnant woman and to review the
literature on maternal repercussions during pregnancy. Method(s): The
present study uses a bibliographical reference, in order to seek
information about mitral stenosis during pregnancy and its maternal
repercussions during pregnancy. Discussion and conclusions: Discussion: R.
F. B., 35 years old, G2PN1A0, 27 weeks pregnant, with sequela of rheumatic
fever cardiopathy, with a history of mitral and aortic valve replacement
at 16 years of age, with a biological prosthesis. She remained
asymptomatic until the fifth month of gestation, when she started dyspnoea
and orthopnea, and was admitted to the obstetric center at high risk of
Rondonia, where there was pulmonary congestion without peripheral edema or
associated jugular swelling. The echocardiogram presents mitral and aortic
bioprostheses with moderate degree insufficiency, moderate tricuspid
insufficiency and pulmonary arterial hypertension. Clinical management
associated with corticotherapy for fetal pulmonary maturation was
performed, and it was subsequently submitted to cesarean section with a 34
weeks pregnant, with no further complications in the immediate
postoperative period. Conclusion(s): Cardiopathy is a serious
disease, but when concomitant with pregnancy it has an even darker
prognosis. Copyright © 2018

<82>
Accession Number
626389708
Title
Statins for the Primary Prevention of Coronary Heart Disease.
Source
BioMed Research International. 2019 (no pagination), 2019. Article Number:
4870350. Date of Publication: 2019.
Author
Li M.; Wang X.; Li X.; Chen H.; Hu Y.; Zhang X.; Tang X.; Miao Y.; Tian
G.; Shang H.
Institution
(Li, Wang, Li, Chen, Hu, Zhang, Tang, Tian, Shang) Key Laboratory of
Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen
Hospital, Beijing University of Chinese Medicine, Beijing, China
(Miao) First Teaching Hospital of Tianjin University of Traditional
Chinese Medicine, Tianjin, China
(Shang) Institute of Integration of Traditional Chinese and Western
Medicine, Guangzhou Medical University, Guangzhou, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Object. The purpose of this study was to fully assess the role of statins
in the primary prevention of coronary heart disease (CHD). Methods. We
searched six databases (PubMed, the Cochrane Library, Web of Science,
China National Knowledge Infrastructure, Wanfang Database, and Chinese
Scientific Journal Database) to identify relevant randomized controlled
trials (RCTs) from inception to 31 October 2017. Two review authors
independently assessed the methodological quality and analysed the data
using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95%
CI) were pooled using fixed/random-effects models. Funnel plots and Begg's
test were conducted to assess publication bias. The quality of the
evidence was evaluated using the Grading of Recommendations Assessment,
Development and Evaluation (GRADE) approach. Results. Sixteen RCTs with
69159 participants were included in this review. Statins can effectively
decrease the occurrence of angina (RR=0.70, 95% CI: 0.580.85,
I2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI:
0.510.69, I2 =14%), fatal MI (RR=0.49, 95% CI: 0.240.98,
I2 =0%), any MI (RR=0.53, 95% CI: 0.420.67, I2 =0%),
any coronary heart events (RR=0.73, 95% CI: 0.680.78, I2=0%),
coronary revascularization (RR=0.66, 95% CI: 0.550.78, I2 =
0%), and any cardiovascular events (RR=0.77, 95% CI: 0.7282, I2
= 0%). However, based on the current evidence, there were no significant
differences in CHD deaths (RR=0.82, 95% CI: 0.661.02, I2=0%)
and all-cause mortality (RR=0.88, 95% CI: 0.76 1.01, I2 =58%)
between the two groups. Additionally, statins were more likely to result
in diabetes (RR=1.21, 95% CI: 1.051.39, I2 =0%). There was no
evidence of publication biases, and the quality of the evidence was
considered moderate. Conclusion. Statins seemed to be beneficial for the
primary prevention of CHDs but have no effect on CHD death and all-cause
mortality. Copyright © 2019 Min Li et al.

<83>
Accession Number
2001594465
Title
Association of intraoperative circulating-brain injury biomarker and
neurodevelopmental outcomes at 1 year among neonates who have undergone
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Graham E.M.; Martin R.H.; Atz A.M.; Hamlin-Smith K.; Kavarana M.N.;
Bradley S.M.; Alsoufi B.; Mahle W.T.; Everett A.D.
Institution
(Graham, Atz) Division of Pediatric Cardiology, Department of Pediatrics,
Medical University of South Carolina, Charleston, SC, United States
(Martin) Department of Public Health Sciences, Medical University of South
Carolina, Charleston, SC, United States
(Hamlin-Smith) Department of Pediatrics, Medical University of South
Carolina, Charleston, SC, United States
(Kavarana, Bradley) Department of Cardiothoracic Surgery, Medical
University of South Carolina, Charleston, SC, United States
(Alsoufi) Department of Cardiothoracic Surgery, Children's Healthcare of
Atlanta and Emory University, Atlanta, Ga, United States
(Mahle) Division of Pediatric Cardiology, Department of Pediatrics,
Children's Healthcare of Atlanta and Emory University, Atlanta, Ga, United
States
(Everett) Division of Cardiology, Department of Pediatrics, Johns Hopkins
University, Baltimore, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Neurodevelopmental disability is the most significant
complication for survivors of infant surgery for congenital heart disease.
In this study we sought to determine if perioperative circulating brain
injury biomarker levels are associated with neurodevelopmental outcomes at
12 months. Method(s): A secondary analysis of a randomized controlled
trial of neonates who underwent cardiac surgery was performed. Glial
fibrillary acidic protein (GFAP) was measured: (1) before skin incision;
(2) immediately after bypass; (3) 4 and (4) 24 hours postoperatively.
Linear regression models were used to determine an association with the
highest levels of GFAP and Bayley Scales of Infant and Toddler Development
third edition (BSID) composite scores. Result(s): There were 97
subjects who had cardiac surgery at a mean age of 9 +/- 6 days and
completed a BSID at 12.5 +/- 0.6 months of age. Median (25th-75th
percentile) levels of GFAP were 0.01 (0.01-0.02), 0.85 (0.40-1.55), 0.07
(0.05-0.11), and 0.03 (0.02-0.04) ng/mL at the 4 time points,
respectively. In univariate analysis GFAP was negatively associated with
cognitive, language, and motor composite scores. GFAP levels immediately
after bypass differed between institutions; 1.57 (0.92-2.48) versus 0.77
(0.36-1.21) ng/mL (P = .01). After adjusting for center and potential
confounders, GFAP was independently associated with BSID motor score (P =
.04). Conclusion(s): Higher GFAP levels at the time of neonatal
cardiac operations were independently associated with decreased BSID motor
scores at 12 months. GFAP might serve as a diagnostic means to acutely
identify perioperative brain-specific injury and serve as a benchmark of
therapeutic efficacy for investigational treatments, discriminate
center-specific effects, and provide early prognostic information for
intervention. Copyright © 2019 The American Association for
Thoracic Surgery

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