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<1>
Accession Number
2001457680
Title
Meta-Analysis of the Role of Cangrelor for Patients Undergoing
Percutaneous Coronary Intervention.
Source
American Journal of Cardiology. 123 (7) (pp 1069-1075), 2019. Date of
Publication: 1 April 2019.
Author
Majmundar M.; Kansara T.; Jain A.; Mithawala P.; Desai R.; Shah P.; Doshi
R.
Institution
(Majmundar, Kansara) Department of Internal Medicine, Metropolitan
Hospital Center, New York Medical College, New York, NY, United States
(Jain) Department of Internal Medicine, Saint Luke's Hospital,
Chesterfield, MO, United States
(Shah) Department of Internal Medicine, S.B.K.S. Medical College,
Sumandeep Vidyapeeth University, Vadodara, India
(Mithawala) Department of Pharmacy, Presbyterian College School of
Pharmacy, Clinton, SC, United States
(Desai) Department of Cardiology, Atlanta VA Medical Center, Decatur,
Georgia, Georgia
(Shah) Department of Cardiology, Phoebe Putney Memorial Hospital, Albany,
Georgia, Georgia
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Inhibition of the P2Y12 receptor by an oral P2Y12 inhibitor with loading
doses along with Cyclooxygenase-1 inhibition by aspirin is considered a
first-line treatment strategy in patients with the acute coronary syndrome
and patients undergoing percutaneous coronary intervention (PCI).
Limitations associated with oral P2Y12 receptor inhibitors include a
requirement for in vivo conversion (thienopyridines), delayed onset of
action, suboptimal inhibition, irreversible inhibition (thienopyridines),
and delayed offset. In the acute setting, therapy with potent platelet
inhibitors that have a fast onset and offset is desirable to attenuate
thrombotic complications. Cangrelor, an intravenous agent, is an adenosine
triphosphate analog, selectively and explicitly blocking P2Y12
receptor-mediated platelet activation. Cangrelor has been studied in a
series of CHAMPION trials. A patient-level, meta-analysis of all 3 phase
III trials (24,910 patients), demonstrated that cangrelor significantly
reduced the rate of the composite outcome of death, myocardial infarction,
ischemia-driven revascularization, or stent thrombosis at 48 hours and 30
days compared with clopidogrel, with no significant increase in major
bleeding. It is approved for clinical use in patients undergoing PCI to
reduce the risk of myocardial infarction, repeat revascularization, and
stent thrombosis in patients who have not been treated with a P2Y12
platelet inhibitor and are not being given a
GPII<inf>b</inf>III<inf>a</inf> inhibitor. In conclusion, patients unable
to take oral medications undergoing emergent/urgent PCI and those who had
recent PCI with drug eluting stent in need for urgent cardiac or
noncardiac surgery are potential candidates for cangrelor.<br/>Copyright
&#xa9; 2019 Elsevier Ltd

<2>
Accession Number
625162541
Title
Ezetimibe for the prevention of cardiovascular disease and all-cause
mortality events.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD012502. Date of Publication: 19 Nov 2018.
Author
Zhan S.; Tang M.; Liu F.; Xia P.; Shu M.; Wu X.
Institution
(Zhan, Tang, Liu, Xia) First Affiliated Hospital of Third Military Medical
University (Army Medical University), Pharmacy Department, 30 Gaotanyan
Street, Chongqing, Shapingba District 400038, China
(Shu) First Affiliated Hospital of Third Military Medical University (Army
Medical University), Cardiovascular Department, Chongqing, China
(Wu) Third Military Medical University (Army Medical University),
Department of Health Statistics, College of Preventive Medicine,
Chongqing, China
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Cardiovascular disease (CVD) remains an important cause of
mortality and morbidity, and high levels of blood cholesterol are thought
to be the major modifiable risk factors for CVD. The use of statins is the
preferred treatment strategy for the prevention of CVD, but some people at
high-risk for CVD are intolerant to statin therapy or unable to achieve
their treatment goals with the maximal recommended doses of statin.
Ezetimibe is a selective cholesterol absorption inhibitor, whether it has
a positive effect on CVD events remains uncertain. Results from clinical
studies are inconsistent and a thorough evaluation of its efficacy and
safety for the prevention of CVD and mortality is necessary.
<br/>Objective(s): To assess the efficacy and safety of ezetimibe for the
prevention of CVD and all-cause mortality. <br/>Search Method(s): We
searched the CENTRAL, MEDLINE, Embase and Web of Science on 27 June 2018,
and two clinical trial registry platforms on 11 July 2018. We checked
reference lists from primary studies and review articles for additional
studies. No language restrictions were applied. <br/>Selection Criteria:
We included randomised controlled trials (RCTs) that compared ezetimibe
versus placebo or ezetimibe plus other lipid-modifying drugs versus other
lipid-modifying drugs alone in adults, with or without CVD, and which had
a follow-up of at least 12 months. <br/>Data Collection and Analysis: Two
review authors independently selected studies for inclusion, extracted
data, assessed risk of bias and contacted trialists to obtain missing
data. We performed statistical analyses according to the Cochrane Handbook
for Systematic Reviews of Interventions and used the GRADE to assess the
quality of evidence. <br/>Main Result(s): We included 26 RCTs randomising
23,499 participants. All included studies assessed effects of ezetimibe
plus other lipid-modifying drugs compared with other lipid-modifying drugs
alone or plus placebo. Our findings were driven by the largest study
(IMPROVE-IT), which had weights ranging from 41.5% to 98.4% in the
different meta-analyses. Ezetimibe with statins probably reduces the risk
of major adverse cardiovascular events compared with statins alone (risk
ratio (RR) 0.94, 95% confidence interval (CI) 0.90 to 0.98; a decrease
from 284/1000 to 267/1000, 95% CI 256 to 278; 21,727 participants; 10
studies; moderate-quality evidence). Trials reporting all-cause mortality
used ezetimibe with statin or fenofibrate and found they have little or no
effect on this outcome (RR 0.98, 95% CI 0.91 to 1.05; 21,222 participants;
8 studies; high-quality evidence). Adding ezetimibe to statins probably
reduces the risk of non-fatal myocardial infarction (MI) (RR 0.88, 95% CI
0.81 to 0.95; a decrease from 105/1000 to 92/1000, 95% CI 85 to 100;
21,145 participants; 6 studies; moderate-quality evidence) and non-fatal
stroke (RR 0.83, 95% CI 0.71 to 0.97; a decrease 32/1000 to 27/1000, 95%
CI 23 to 31; 21,205 participants; 6 studies; moderate-quality evidence).
Trials reporting cardiovascular mortality added ezetimibe to statin or
fenofibrate, probably having little or no effect on this outcome (RR 1.00,
95% CI 0.89 to 1.12; 19457 participants; 6 studies; moderate-quality
evidence). The need for coronary revascularisation might be reduced by
adding ezetimibe to statin (RR 0.94, 95% CI 0.89 to 0.99; a decrease from
196/1000 to 184/1000, 95% 175 to 194; 21,323 participants; 7 studies);
however, no difference in coronary revascularisation rate was observed
when a sensitivity analysis was limited to studies with a low risk of
bias. In terms of safety, adding ezetimibe to statins may make little or
no difference in the risk of hepatopathy (RR 1.14, 95% CI 0.96 to 1.35;
20,687 participants; 4 studies; low-quality evidence). It is uncertain
whether ezetimibe increase or decrease the risk of myopathy (RR 1.31, 95%
CI 0.72 to 2.38; 20,581 participants; 3 studies; very low-quality
evidence) and rhabdomyolysis, given the wide CIs and low event rate.
Little or no difference in the risk of cancer, gallbladder-related disease
and discontinuation due to adverse events were observed between treatment
groups. For serum lipids, adding ezetimibe to statin or fenofibrate might
further reduce the low-density lipoprotein cholesterol (LDL-C), total
cholesterol and triglyceride levels and likely increase the high-density
lipoprotein cholesterol levels; however, substantial heterogeneity was
detected in most analyses. None of the included studies reported on
health-related quality of life. Authors' conclusions: Moderate- to
high-quality evidence suggests that ezetimibe has modest beneficial
effects on the risk of CVD endpoints, primarily driven by a reduction in
non-fatal MI and non-fatal stroke, but it has little or no effect on
clinical fatal endpoints. The cardiovascular benefit of ezetimibe might
involve the reduction of LDL-C, total cholesterol and triglycerides. There
is insufficient evidence to determine whether ezetimibe increases the risk
of adverse events due to the low and very low quality of the evidence. The
evidence for beneficial effects was mainly obtained from individuals with
established atherosclerotic cardiovascular disease (ASCVD, predominantly
with acute coronary syndrome) administered ezetimibe plus statins.
However, there is limited evidence regarding the role of ezetimibe in
primary prevention and the effects of ezetimibe monotherapy in the
prevention of CVD, and these topics thus requires further
investigation.<br/>Copyright &#xa9; 2018 The Cochrane Collaboration.

<3>
Accession Number
624633588
Title
Acute exercise is not cardioprotective and may induce apoptotic signalling
in heart surgery: A randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (1) (pp 95-101), 2018.
Date of Publication: 01 Jul 2018.
Author
Smenes B.T.; Baekkerud F.H.; Slagsvold K.H.; Hassel E.; Wohlwend M.; Pinho
M.; Hoydal M.; Wisloff U.; Rognmo O.; Wahba A.
Institution
(Smenes, Baekkerud, Hassel, Wohlwend, Wisloff, Rognmo, Wahba) Department
of Circulation and Medical Imaging, K.G. Jebsen Center of Exercise in
Medicine, Norwegian University of Science and Technology, Trondheim,
Norway
(Slagsvold, Wahba) Department of Cardiothoracic Surgery, St. Olav's
University Hospital, Norwegian University of Science and Technology,
Prinsesse Kristinas gate 3, Trondheim 7006, Norway
(Hassel) Clinic of Thoracic and Occupational Medicine, St. Olav's
University Hospital, Trondheim, Norway
(Pinho, Hoydal) Group of Molecular and Cellular Cardiology, Department of
Circulation and Medical Imaging, Norwegian University of Science and
Technology, Trondheim, Norway
(Wisloff) School of Human Movement and Nutrition Sciences, University of
Queensland, Australia
Publisher
Oxford University Press
Abstract
OBJECTIVES: During open-heart surgery, the myocardium experiences
ischaemia-reperfusion injury. A single bout of moderate, 30-min exercise
induces preconditioning and protects the heart from ischaemia-reperfusion
injury in rats, but this has never been investigated in humans. We aimed
to investigate whether 1 bout of moderate exercise 24 h prior to surgery
protects against mitochondrial and cardiac damage. <br/>METHOD(S):
Patients scheduled for elective coronary artery bypass were eligible for
this pilot study. Twenty were included and randomized to the treadmill
exercise group (the EX group, n = 10) 24 h preoperatively or to standard
presurgical procedures (control n = 10). Right atrial (RA) and left
ventricular (LV) biopsies were collected immediately before and as long as
possible after aortic cross-clamping to assess the primary outcome of
mitochondrial respiration by respirometry, in addition to reactive oxygen
species production by fluorometry and apoptotic transcripts. Cardiac
troponin T and creatine kinase myocardial brain were measured in plasma at
arrival, before surgery and 6 and 24 h postoperatively. <br/>RESULT(S):
Mitochondrial respiration was lower in the EX group after surgery in the
LV (Complex I -22%, P < 0.05 and maximal -23%, P < 0.05) and the right
atrium (Complex I -25%, P < 0.05). Transcript level of the
apoptosis-related marker caspase 3 was increased 1.5-fold in the LV prior
to surgery in the EX group when compared with the control group, P < 0.05.
Cardiac troponin T was 45% higher in the EX group than in the control
group 6 h postoperatively (P = 0.03), although not significant when
corrected for aortic cross-clamping time. <br/>CONCLUSION(S): Results
indicate that exercise did not precondition the heart against
surgery-related damage. Exercise may render the myocardium and
mitochondria more vulnerable to perioperative damage. Clinical trials
registration number: NCT00218985
(https://clinicaltrials.gov/ct2/show/NCT00218985).<br/>Copyright &#xa9;
2018 Oxford University Press. All rights reserved.

<4>
Accession Number
626643755
Title
Remote ischaemic preconditioning ameliorates sinus rhythm restoration rate
through Cox maze radiofrequency procedure associated with inflammation
reaction reduction.
Source
Basic Research in Cardiology. 114 (3) (no pagination), 2019. Article
Number: 14. Date of Publication: 01 May 2019.
Author
Jiang Q.; Xiang B.; Wang H.; Huang K.; Kong H.; Hu S.
Institution
(Jiang, Xiang, Wang, Huang) Department of Cardiac Surgery, Sichuan
Provincial People's Hospital, Affiliated Hospital of University of
Electronic Science and Technology, #32, Western Section 2, 1st Ring Road,
Chengdu 610072, China
(Kong) Department of Heart Failure, Sichuan Provincial People's Hospital,
Affiliated Hospital of University of Electronic Science and Technology,
#32, Western Section 2, 1st Ring Road, Chengdu 610072, China
(Hu) Department of Cardiac Surgery, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing 100037, China
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Remote ischaemic preconditioning (RIPC) as adjuvant to selective heart
surgery attenuates cardiac injury and atrial fibrillation (AF) occurrence.
We investigated its effect on sinus rhythm (SR) restoration rate in
permanent AF patients undergoing Cox maze (CM) radiofrequency ablation
with concomitant mitral valve surgery. From May 2013 to May 2017, 206
patients with rheumatic valve disease concomitant with permanent AF were
randomized to receive prosthesis valve replacement and CM radiofrequency
ablation procedure with (n = 104) or without (n = 102) RIPC (intermittent
arm ischaemia through three cycles of 5-min inflation, followed by 5-min
deflation of a blood pressure cuff). The primary end point of the study
was freedom from cumulative AF without using antiarrhythmic drugs 1 year
after operation; the secondary end points included inflammation reaction
index over 48 h postoperatively and clinical outcomes. Baseline
characteristics and preoperative data did not differ between groups. The
SR restoration rates were significantly higher in the RIPC group, 85.6%,
83.7%, and 82.7%, than those in the control group, 72.5%, 70.6%, and
69.6%, at discharge, 6 months and 12 months, respectively, after the
radiofrequency ablation procedure (P < 0.05). The serum concentration of
high sensitivity C-reactive protein and neutrophil-lymphocyte ratio were
significantly decreased at 12 h, 24 h, and 48 h postoperatively in the
RIPC group compared to those in the control group (P < 0.05). RIPC induced
by brief ischaemia and reperfusion of the arm ameliorated SR restoration
rate in patients with permanent AF through CM radiofrequency ablation
procedure and was associated with reduction of postoperative systemic
inflammation reaction index.<br/>Copyright &#xa9; 2019, Springer-Verlag
GmbH Germany, part of Springer Nature.

<5>
Accession Number
626237712
Title
Intraoperative use of dexmedetomidine for the prevention of emergence
agitation and postoperative delirium in thoracic surgery: a
randomized-controlled trial.
Source
Canadian Journal of Anesthesia. 66 (4) (pp 371-379), 2019. Date of
Publication: 15 Apr 2019.
Author
Kim J.A.; Ahn H.J.; Yang M.; Lee S.H.; Jeong H.; Seong B.G.
Institution
(Kim, Ahn, Yang, Lee, Jeong, Seong) Department of Anesthesiology and Pain
Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul 135-710, South Korea
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: We investigated whether preventive use of dexmedetomidine during
surgery was effective for reducing emergence agitation and postoperative
delirium. <br/>Method(s): In this double-blind randomized-controlled
trial, 143 patients undergoing thoracoscopic lung resection surgery were
randomly assigned to the dexmedetomidine-sevoflurane (DEX-Sevo, n = 73) or
sevoflurane (Sevo, n = 70) groups. Dexmedetomidine or saline
administration was started after inducing anesthesia and continued until
the end of surgery at a fixed dose (0.5
micro&#32;g.kg^-1.hr^-1). The primary endpoint was the
incidence of delirium up until the end of postoperative day 3. Emergence
agitation and postoperative delirium were measured with the Riker sedation
agitation scale and the confusion assessment method, respectively. The
secondary endpoints were serum cytokine and catecholamine levels.
<br/>Result(s): The DEX-Sevo group showed less frequent emergence
agitation than the Sevo group (13% vs 35%, respectively; relative risk,
0.38; 95% confidence interval [CI], 0.18 to 0.79; P = 0.011) but the
incidence of delirium after discharge from the postanesthesia care unit
was not different (25% vs 25%, DEX-Sevo vs Sevo). Both pro- and
anti-inflammatory cytokines were lower in the DEX-Sevo group than in the
Sevo group. Nevertheless, the interleukin (IL)6/IL10 ratio (median
difference, 5.8; 95% CI,1.8 to 10.0; P = 0.012) and IL8/IL10 ratio (median
difference, 0.8; 95% CI, 0.2 to 1.3; P = 0.007) were higher in the
DEX-Sevo group than in the Sevo group, indicating a pro-inflammatory
cytokine balance in the DEX-Sevo group. Norepinephrine and epinephrine
levels were lower in the DEX-Sevo group than in the Sevo group (both, P <
0.001). <br/>Conclusion(s): Intraoperative dexmedetomidine reduced
emergence agitation but not postoperative delirium in patients undergoing
thoracic surgery. Dexmedetomidine seemed to affect emergence agitation
through catecholamines, but not through an anti-inflammatory action. Trial
registration Clinical Research Information Service (KCT 0001877);
registered 7 April, 2016.<br/>Copyright &#xa9; 2019, Canadian
Anesthesiologists' Society.

<6>
Accession Number
626602653
Title
Impact of renin-angiotensin system inhibitors continuation versus
discontinuation on outcome after major surgery: Protocol of a multicenter
randomized, controlled trial (STOP-or-NOT trial) 11 Medical and Health
Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 160. Date of
Publication: 05 Mar 2019.
Author
Legrand M.; Futier E.; Leone M.; Deniau B.; Mebazaa A.; Plaud B.; Coriat
P.; Rossignol P.; Vicaut E.; Gayat E.
Institution
(Legrand, Deniau, Mebazaa, Plaud, Gayat) AP-HP, GH St-Louis-Lariboisiere,
Department of Anesthesiology and Critical Care and Burn Unit, St-Louis
Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
(Legrand, Deniau, Mebazaa, Plaud, Gayat) University Paris Diderot, Paris,
France
(Legrand, Deniau, Mebazaa, Plaud, Gayat) UMR INSERM 942, Institut National
de la Sante et de la Recherche Medicale (INSERM), Lariboisiere Hospital,
Paris, France
(Legrand, Mebazaa, Rossignol, Gayat) F-CRIN INI-CRCT Network, Nancy,
France
(Futier) Departement de Medecine Perioperatoire, Anesthesie Reanimation
Hopital Estaing, CHU Clermont-Ferrand and Universite Clermont Auvergne,
CNRS, Inserm, Clermont-Ferrand, France
(Leone) Service d'Anesthesie et de Reanimation, Hopital Nord, Aix
Marseille Universite, APHM, Marseille, France
(Coriat) Departement d'Anesthesie-Reanimation, La Pite-Salpetriere,
Universite Paris Descartes, Paris, France
(Rossignol) Inserm, Centre d'Investigations Cliniques-Plurithematique
14-33, Inserm U1116, CHRU Nancy, Universite de Lorraine, Nancy, France
(Vicaut) Unite de Recherche Clinique, GH St-Louis-Lariboisere-Fernand
Widal, Universite Paris Diderot, Paris, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Chronic treatment of hypertension or heart failure very often
includes an angiotensin-converting enzyme inhibitors (ACE-Is) or
angiotensin receptor blockers (ARBs) as renin-angiotensin system
inhibitors (RASi) treatments. To stop or not to stop these medications
before major surgery remains an unresolved issue. The lack of evidence
leads to conflicting guidelines with respect to RASi management before
major surgery. The purpose of this study is to evaluate the impact of a
strategy of RASi continuation or discontinuation on perioperative
complications in patients undergoing major non-cardiac surgery.
<br/>Method(s): This is a multicenter, open-labeled randomized controlled
trial in > 30 French centers. In the experimental group, RASi will be
continued while the treatment will be stopped 48 h before the surgery in
the control arm. The primary endpoint is a composite endpoint of major
complications after surgery. An endpoint adjudication committee will
review clinical data and adjudicate efficacy endpoints while blinded to
the assigned study drug group. Main analysis will be by intention-to-treat
comparing the composite outcome measure at 28 days in the two groups. A
total of 2222 patients are planned to detect an absolute complications
difference of 5%. <br/>Discussion(s): The results of the trial should
provide robust evidence to anesthesiologists and surgeons regarding
management of RASi before major non-cardiac surgery. Trial registration:
ClinicalTrials.gov, NCT03374449. Registered on 11 December
2017.<br/>Copyright &#xa9; 2019 The Author(s).

<7>
Accession Number
626501638
Title
Tropheryma whipplei Endocarditis: Case presentation and review of the
literature.
Source
Open Forum Infectious Diseases. 6 (1) (no pagination), 2019. Date of
Publication: 01 Jan 2019.
Author
McGee M.; Brienesse S.; Chong B.; Levendel A.; Lai K.
Institution
(McGee, Brienesse, Chong, Lai) John Hunter Hospital, Cardiology
Department, Lookout Road, New Lambton, NSW 2305, Australia
(McGee, Brienesse, Lai) University of Newcastle, Newcastle, NSW, Australia
(Levendel) Tamworth Rural Referral Hospital, Tamworth, NSW, Australia
Publisher
Oxford University Press (E-mail: info@idsociety.org)
Abstract
Whipple's disease is a rare infective condition, classically presenting
with gastrointestinal manifestations. It is increasingly recognized as an
important cause of culture-negative endocarditis. We present a case of
Whipple's endocarditis presenting with heart failure. A literature review
identified 44 publications documenting 169 patients with Whipple's
endocarditis. The average age was 57.1 years. There is a clear sex
predominance, with 85% of cases being male. Presenting symptoms were
primarily articular involvement (52%) and heart failure (41%). In the
majority of cases, the diagnosis was made on examination of valvular
tissue. Preexisting valvular abnormalities were reported in 21%. The
aortic valve was most commonly involved, and multiple valves were involved
in 64% and 23% of cases, respectively. Antibiotic therapy was widely
varied and included a ceftriaxone, trimethoprim, and sulfamethoxazole
combination. The average follow-up was 20 months, and mortality was
approximately 24%. Physician awareness is paramount in the diagnosis and
management of this rare condition.<br/>Copyright &#xa9; 2018 The
Author(s). Published by Oxford University Press on behalf of Infectious
Diseases Society of America.

<8>
Accession Number
626573873
Title
Current status of coronary atherectomy.
Source
Cardiovascular Innovations and Applications. 3 (2) (pp 203-214), 2018.
Date of Publication: 2018.
Author
Mahmoud A.A.; Mahmoud A.N.; Elgendy A.Y.; Anderson R.D.
Institution
(Mahmoud, Mahmoud, Elgendy, Anderson) Division of Cardiovascular Medicine,
Department of Medicine, University of Florida, 1600 S.W. Archer Rd., P.O.
Box 100277, Gainesville, FL 32610-0277, United States
Publisher
Compuscript Ltd (E-mail: m.staunton@compuscript.com)
Abstract
There are several techniques for performing coronary atherosclerotic
plaque modification, known as atherectomy. Historically, clinical trials
show mostly equivalence between various coronary atherectomy techniques,
balloon angioplasty, and percutaneous coronary stenting. In the last
several years the use of a given atherectomy technique has been mostly as
a means of facilitating stent delivery in vessels that are heavily
calcified. No clinical trials have shown superiority of any atherectomy
method over more standard techniques of percutaneous coronary
intervention. This review begins with a discussion of directional
atherectomy, which is no longer available. The rotational atherectomy
technique and its clinical trial data are presented. Orbital atherectomy
is then discussed in detail, including the relevant clinical trials.
Finally, laser atherectomy techniques are reviewed, and the pertinent
trial data are presented. Lastly, future directions are
detailed.<br/>Copyright &#xa9; 2018 Cardiovascular Innovations and
Applications.

<9>
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.<br/>Copyright &#xa9; 2017 The
Association of Anaesthetists of Great Britain and Ireland

<10>
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.<br/>Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<11>
Accession Number
620600431
Title
Noninvasive cardiac testing vs clinical evaluation alone in acute chest
pain: A secondary analysis of the ROMICAT-II randomized clinical trial.
Source
JAMA Internal Medicine. 178 (2) (pp 212-219), 2018. Date of Publication:
February 2018.
Author
Reinhardt S.W.; Lin C.-J.; Novak E.; Brown D.L.
Institution
(Reinhardt) Department of Internal Medicine, Washington University School
of Medicine, St Louis, MO, United States
(Lin, Novak, Brown) Cardiovascular Division, Washington University School
of Medicine, Campus Box 8086, 660 S Euclid Ave, St Louis, MO 63110, United
States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: The incremental benefit of noninvasive testing in addition to
clinical evaluation (history, physical examination, an electrocardiogram
[ECG], and biomarker assessment) vs clinical evaluation alone for patients
who present to the emergency department (ED) with acute chest pain is
unknown. <br/>OBJECTIVE(S): To examine differences in outcomes with
clinical evaluation and noninvasive testing (coronary computed tomographic
angiography [CCTA] or stress testing) vs clinical evaluation alone.
DESIGN, SETTING, AND PARTICIPANTS: This study was a retrospective analysis
of data from the randomized multicenter Rule Out Myocardial
Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial.
Data for 1000 patients who presented with chest pain to the EDs at 9
hospitals in the United States were evaluated. INTERVENTIONS: Clinical
evaluation plus noninvasive testing (CCTA or stress test) vs clinical
evaluation alone. MAIN OUTCOMES AND MEASURES: Primary outcomewas length of
stay (LOS). Secondary outcomes included hospital admission, direct ED
discharge, downstream testing, rates of invasive coronary angiography,
revascularization, major adverse cardiac events (MACE), repeated ED visit
or hospitalization for recurrent chest pain at 28 days, and cost. Safety
end points were missed acute coronary syndrome (ACS) and cumulative
radiation exposure during the index visit and follow-up period.
<br/>RESULT(S): Of the 1000 patients randomized, 118 patients (12%) (mean
[SD] age, 53.2 [7.8]; 49 [42%] were female) did not undergo noninvasive
testing, whereas 882 (88%) (mean [SD] age, 54.4 [8.14] years; 419 [48%]
were female) received CCTA or stress testing. There was no difference in
baseline characteristics or clinical presentation between groups. Patients
who underwent clinical evaluation alone experienced a shorter LOS (20.3 vs
27.9 hours; P < .001), lower rates of diagnostic testing (P < .001) and
angiography (2%vs 11%; P < .001), lower median costs ($2261.50 vs
$2584.30; P = .009), and less cumulative radiation exposure (0 vs 9.9 mSv;
P < .001) during the 28-day study period. Lack of testing was associated
with a lower rate of diagnosis of ACS (0% vs 9%; P < .001) and less
coronary angiography and percutaneous coronary intervention (PCI) during
the index visit (0% vs 10%; P < .001, and 0% vs 4%; P = .02,
respectively). There was no difference in rates of PCI (2%vs 5%; P = .15),
coronary artery bypass surgery (0% vs 1%; P = .61), return ED visits (5.8%
vs 2.8%; P = .08), or MACE (2%vs 1%; P = .24) in the 28-day follow-up
period. CONCLUSIONS AND RELEVANCE: In patients presenting to the ED with
acute chest pain, negative biomarkers, and a nonischemic ECG result,
noninvasive testing with CCTA or stress testing leads to longer LOS, more
downstream testing, more radiation exposure, and greater cost without an
improvement in clinical outcomes.<br/>Copyright &#xa9; 2017 American
Medical Association. All rights reserved.

<12>
Accession Number
621208986
Title
Lung ultrasound compared with chest X-ray in diagnosing postoperative
pulmonary complications following cardiothoracic surgery: a prospective
observational study.
Source
Anaesthesia. 73 (8) (pp 946-954), 2018. Date of Publication: August 2018.
Author
Touw H.R.; Parlevliet K.L.; Beerepoot M.; Schober P.; Vonk A.; Twisk J.W.;
Elbers P.W.; Boer C.; Tuinman P.R.
Institution
(Touw, Parlevliet, Beerepoot, Elbers, Tuinman) Department of Intensive
Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and
Immunity Institute, VU University Medical Center Amsterdam, Netherlands
(Touw, Schober, Boer) Department of Anaesthesiology, Amsterdam
Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU
University Medical Center Amsterdam, Netherlands
(Vonk) Department of Cardiothoracic Surgery, Amsterdam Cardiovascular
Sciences, Amsterdam Infection and Immunity Institute, VU University
Medical Center Amsterdam, Netherlands
(Twisk) Department of Epidemiology and Biostatistics, Amsterdam
Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU
University Medical Center Amsterdam, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Postoperative pulmonary complications are common after cardiothoracic
surgery and are associated with adverse outcomes. The ability to detect
postoperative pulmonary complications using chest X-rays is limited, and
this technique requires radiation exposure. Little is known about the
diagnostic accuracy of lung ultrasound for the detection of postoperative
pulmonary complications after cardiothoracic surgery, and we therefore
aimed to compare lung ultrasound with chest X-ray to detect postoperative
pulmonary complications in this group of patients. We performed this
prospective, observational, single-centre study in a tertiary intensive
care unit treating adult patients who had undergone cardiothoracic
surgery. We recorded chest X-ray findings upon admission and on
postoperative days 2 and 3, as well as rates of postoperative pulmonary
complications and clinically-relevant postoperative pulmonary
complications that required therapy according to the treating physician as
part of their standard clinical practice. Lung ultrasound was performed by
an independent researcher at the time of chest X-ray. We compared lung
ultrasound with chest X-ray for the detection of postoperative pulmonary
complications and clinically-relevant postoperative pulmonary
complications. We also assessed inter-observer agreement for lung
ultrasound, and the time to perform both imaging techniques. Subgroup
analyses were performed to compare the time to detection of
clinically-relevant postoperative pulmonary complications by both
modalities. We recruited a total of 177 patients in whom both lung
ultrasound and chest X-ray imaging were performed. Lung ultrasound
identified 159 (90%) postoperative pulmonary complications on the day of
admission compared with 107 (61%) identified with chest X-ray (p < 0.001).
Lung ultrasound identified 11 out of 17 patients (65%) and chest X-ray 7
out of 17 patients (41%) with clinically-relevant postoperative pulmonary
complications (p < 0.001). The clinically-relevant postoperative pulmonary
complications were detected earlier using lung ultrasound compared with
chest X-ray (p = 0.024). Overall inter-observer agreement for lung
ultrasound was excellent (kappa = 0.907, p < 0.001). Following
cardiothoracic surgery, lung ultrasound detected more postoperative
pulmonary complications and clinically-relevant postoperative pulmonary
complications than chest X-ray, and at an earlier time-point. Our results
suggest lung ultrasound may be used as the primary imaging technique to
search for postoperative pulmonary complications after cardiothoracic
surgery, and will enhance bedside decision making.<br/>Copyright &#xa9;
2018 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf
of Association of Anaesthetists of Great Britain and Ireland

<13>
Accession Number
623128217
Title
Pharmacological interventions for protecting renal function after cardiac
surgery: a Bayesian network meta-analysis of comparative effectiveness.
Source
Anaesthesia. 73 (8) (pp 1019-1031), 2018. Date of Publication: August
2018.
Author
Kim W.H.; Hur M.; Park S.-K.; Jung D.E.; Kang P.; Yoo S.; Bahk J.-H.
Institution
(Kim, Hur, Park, Jung, Kang, Yoo, Bahk) Department of Anesthesiology and
Pain Medicine, Seoul National University Hospital, Seoul, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
Many drugs have been investigated as potentially protective of renal
function after cardiac surgery. However, their comparative effectiveness
has not been established. We performed an arm-based hierarchical Bayesian
network meta-analysis including 95 randomised controlled trials with
28,833 participants, which allowed us to compare some agents not
previously compared directly. Renal outcomes, including: the incidence of
postoperative renal dysfunction and haemodialysis; serum creatinine level
at 24 hours postoperatively; all-cause mortality; and length of hospital
and ICU stay, were compared. Exploratory meta-regression was conducted for
potential effect modifiers. A random effects model was selected according
to the evaluation of model fit by deviance information criteria. Atrial
natriuretic peptide (odds ratio (95%CrI) 0.28 (0.17-0.48);
moderate-quality evidence), B-type natriuretic peptide, dexmedetomidine,
levosimendan and N-acetyl cysteine significantly decreased the rate of
postoperative renal dysfunction compared with placebo. Atrial natriuretic
peptide (OR (95%CrI) 0.24 (0.10-0.58); low-quality evidence), B-type
natriuretic peptide, and dexamethasone significantly decreased the need
for haemodialysis. Levosimendan significantly decreased mortality, OR
(95%CrI) 0.49 (0.27-0.91); low-quality evidence). The benefit of atrial
natriuretic peptide was still apparent when baseline renal function was
normal. None of the potential effect modifiers were significantly
correlated with our renal outcomes. Atrial natriuretic peptide was ranked
best regarding renal dysfunction, haemodialysis and length of hospital
stay. Levosimendan was ranked best regarding mortality and ICU stay.
However, our results should be interpreted cautiously given the
assumptions made about transitivity and consistency.<br/>Copyright &#xa9;
2018 The Association of Anaesthetists of Great Britain and Ireland

<14>
Accession Number
620544679
Title
Videolaryngoscopy vs. Macintosh laryngoscopy for double-lumen tube
intubation in thoracic surgery: a systematic review and meta-analysis.
Source
Anaesthesia. 73 (8) (pp 997-1007), 2018. Date of Publication: August 2018.
Author
Liu T.T.; Li L.; Wan L.; Zhang C.H.; Yao W.L.
Institution
(Liu, Wan, Zhang, Yao) Department of Anaesthesiology, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
(Li) Department of Physiology, Hubei University of Chinese Medicine,
Wuhan, China
Publisher
Blackwell Publishing Ltd
Abstract
Double-lumen intubation is more difficult than single-lumen tracheal
intubation. Videolaryngoscopes have many advantages in airway management.
However, the advantages of videolaryngoscopy for intubation with a
double-lumen tube remain controversial compared with traditional Macintosh
laryngoscopy. In this study, we searched MEDLINE, Embase, Cochrane Library
and the Web of Science for randomised controlled trials comparing
videolaryngoscopy with Macintosh laryngoscopy for double-lumen tube
intubation. We found that videolaryngoscopy provided a higher success rate
at first attempt for double-lumen tube intubation, with an odds ratio
(95%CI) of 2.77 (1.92-4.00) (12 studies, 1215 patients, moderate-quality
evidence, p < 0.00001), as well as a lower incidence of oral, mucosal or
dental injuries during double-lumen tube intubation, odds ratio (95%CI)
0.36 (0.15-0.85) (11 studies, 1145 patients, low-quality evidence, p =
0.02), and for postoperative sore throat, odds ratio (95%CI) 0.54
(0.36-0.81) (7 studies, 561 patients, moderate-quality evidence, p =
0.003), compared with Macintosh laryngoscopy. There were no significant
differences in intubation time, with a standardised mean difference
(95%CI) of -0.10 (-0.62 to 0.42) (14 studies, 1310 patients, very
low-quality evidence, p = 0.71); and the incidence of postoperative voice
change, odds ratio (95%CI) 0.53 (0.21-1.31) (7 studies, 535 patients,
low-quality evidence, p = 0.17). Videolaryngoscopy led to a higher
incidence of malpositioned double-lumen tube, with an odds ratio (95%CI)
of 2.23 (1.10-4.52) (six studies, 487 patients, moderate-quality evidence,
p = 0.03).<br/>Copyright &#xa9; 2018 The Association of Anaesthetists of
Great Britain and Ireland

<15>
Accession Number
621585628
Title
Antithrombotic therapy in patients receiving saphenous vein coronary
artery bypass grafts: A protocol for a systematic review and network
metaanalysis.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019555. Date of
Publication: 2018.
Author
Solo K.; Martin J.; Lavi S.; Kabali C.; John-Baptiste A.; Nevis I.F.;
Choudhury T.; Mamas M.A.; Bagur R.
Institution
(Solo, Martin, John-Baptiste, Bagur) Department of Epidemiology and
Biostatistics, Schulich School of Medicine and Dentistry, Western
University, London, ON, Canada
(Martin, John-Baptiste) Department of Anesthesia and Perioperative
Medicine, Centre for Medical Evidence, Decision Integrity and Clinical
Impact (MEDICI), Western University, London, ON, Canada
(Lavi, Choudhury, Bagur) Division of Cardiology, London Health Sciences
Centre, London, ON, Canada
(Kabali) Epidemiology Division, University of Toronto, Dalla Lana School
of Public Health, Toronto, ON, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
London, ON, Canada
(Nevis) Health Quality Ontario, London, ON, Canada
(Mamas, Bagur) Keele Cardiovascular Research Group, Institute for Applied
Clinical Science, Centre for Prognosis Research, Institute of Primary Care
and Health Sciences, University of Keele, Keele, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: The current evidence for the prevention of saphenous vein
graft failure (SVGF) after coronary artery bypass graft (CABG) surgery
consists of direct head-tohead comparison of treatments (including
placebo) in randomised-controlled trials (RCTs) and observational studies.
However, summarising the evidence using traditional pairwise meta-analyses
does not allow the inclusion of data from treatments that have not been
compared head to head. Exclusion of such comparisons could impact the
precision of pooled estimates in a metaanalysis. Hence, to address the
challenge of whether aspirin alone or in addition to another
antithrombotic agent is a more effective regimen to improve SVG patency, a
network meta-analysis (NMA) is necessary. The objectives of this study are
to synthesise the available evidence on antithrombotic agents (or their
combination) and estimate the treatment effects among direct and indirect
treatment comparisons on SVGF and major adverse cardiovascular events, and
to generate a treatment ranking according to their efficacy and safety
outcomes. <br/>Method(s): We will perform a systematic review of RCTs
evaluating antithrombotic agents in patients undergoing CABG. A
comprehensive English literature search will be conducted using electronic
databases and grey literature resources to identify published and
unpublished articles. Two individuals will independently and in duplicate
screen potential studies, assess the eligibility of potential studies and
extract data. Risk of bias and quality of evidence will also be evaluated
independently and in duplicate. We will investigate the data to ensure its
suitability for NMA, including adequacy of the outcome data and
transitivity of treatment effects. We plan to estimate the pooled direct,
indirect and the mixed effects for all antithrombotic agents using a NMA.
Ethics and dissemination: Due to the nature of the study, there are no
ethical concerns nor informed consent required. We anticipate that this
NMA will be the first to simultaneously assess the relative effects of
multiple antithrombotic agents in patients undergoing CABG. The results of
this NMA will inform clinicians, patients and guideline developers the
best available evidence on comparative effects benefits of antithrombotic
agents after CABG while considering the side effect profile to support
future clinical decision-making. We will disseminate the results of our
systematic review and NMA through a peerreviewed journal.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2018. All rights reserved.

<16>
Accession Number
622656967
Title
Trimetazidine in the Prevention of Tissue Ischemic Conditions.
Source
Angiology. 70 (4) (pp 291-298), 2019. Date of Publication: 01 Apr 2019.
Author
Kallistratos M.S.; Poulimenos L.E.; Giannitsi S.; Tsinivizov P.; Manolis
A.J.
Institution
(Kallistratos, Poulimenos, Giannitsi, Tsinivizov, Manolis) Cardiology
Department, Asklepieion General Hospital, Athens, Greece
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Trimetazidine (TMZ) is a metabolic agent with significant anti-ischemic
properties. By inhibiting the terminal enzyme in the beta-oxidation
pathway, it shifts the energy substrate metabolism, enhancing glucose
metabolism. Thus, it maintains the required energy production with less
oxygen consumption, an effect necessary in cases of myocardi.
Trimetazidine was recently reaccredited as add-on therapy for symptomatic
treatment in patients with stable angina, not adequately controlled or
intolerant to first-line therapy. Trimetazidine was included in the
European Society of Cardioloy 2013 guidelines for the management of stable
coronary artery disease. Although TMZ has been used in cardiology for >40
years, only a few studies have assessed its effects in patients with acute
ischemic conditions. This review summarizes the current literature
regarding the addition of TMZ in patients with acute ischemic conditions
(acute myocardial infarction, ST-segment elevation myocardial infarction,
non-ST-segment elevation myocardial infarction, percutaneous coronary
intervention, and coronary artery bypass grafting). There is growing
evidence from recent studies that the addition of TMZ in patients with
such conditions is beneficial in terms of myocardial damage and major
cardiac events as well as decreasing reperfusion injury and
contrast-induced nephropathy.<br/>Copyright &#xa9; The Author(s) 2018.

<17>
Accession Number
2001225026
Title
A Review of Coronary Artery Bypass Grafting in the Indigenous Australian
Population.
Source
Heart Lung and Circulation. 28 (4) (pp 530-538), 2019. Date of
Publication: April 2019.
Author
Wiemers P.D.; Fraser J.F.; Marney L.; Yadav S.; Tam R.
Institution
(Wiemers, Marney, Yadav, Tam) Department of Cardiothoracic Surgery, The
Townsville Hospital, Townsville, Australia
(Wiemers, Fraser) University of Queensland School of Medicine, Brisbane,
Qld, Australia
(Fraser) Critical Care Research Group, The Prince Charles Hospital,
Brisbane, Qld, Australia
(Tam) James Cook University, College of Medicine and Dentistry,
Townsville, Qld, Australia
(Wiemers) Royal Brisbane & Women's Hospital Herston, Brisbane, Qld,
Australia
Publisher
Elsevier Ltd
Abstract
Introduction: Indigenous Australians experience poorer health outcomes
than non-Indigenous Australians. Ischaemic heart disease is a leading
contributor to the mortality gap which exists between Indigenous and
non-Indigenous Australians. <br/>Method(s): We reviewed the literature in
regards to Indigenous Australians undergoing coronary artery bypass
grafting (CABG) for management of ischaemic heart disease. <br/>Result(s):
Younger patients with higher rates of preventable risk factors constitute
the Indigenous Australian CABG population. Indigenous Australian females
are over-represented in series to date. High rates of left ventricular
dysfunction are seen in the Indigenous CABG cohorts potentially reflecting
barriers to medical care or the influence of high rates of diabetes
observed in the Indigenous Australian population. The distribution of
coronary artery disease appears to differ between Indigenous Australian
and non-Indigenous CABG cohorts likely reflecting a difference in the
referral patterns of the two population groups with diabetes again likely
influencing management decisions. Reduced utilisation of arterial conduits
in Indigenous Australian cohorts has been identified in a number of
series. This is of particular concern given the younger age structure of
the Indigenous Australian cohorts. Indigenous Australian patients suffer
excess morbidity and mortality in the longer term after undergoing CABG.
Ventricular dysfunction and excess comorbidities in the Indigenous
Australian CABG population appear largely responsible for this.
<br/>Conclusion(s): Excess morbidity and mortality endured by Indigenous
Australians in the longer term following CABG appears largely contributed
to by higher rates of ventricular dysfunction and comorbidities in the
Indigenous Australian CABG population. Maximising internal mammary artery
use and continued focus on strategies to reduce the impact of diabetes,
renal impairment and heart failure in the Indigenous Australian population
is essential to reduce the mortality gap experienced by Indigenous
Australians secondary to ischaemic heart disease.<br/>Copyright &#xa9;
2018

<18>
Accession Number
626713204
Title
Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Systematic
Review of Clinical Outcomes from the Past two Decades.
Source
Innovations (Philadelphia, Pa.). 14 (1) (pp 5-16), 2019. Date of
Publication: 01 Feb 2019.
Author
Gobolos L.; Ramahi J.; Obeso A.; Bartel T.; Hogan M.; Traina M.; Edris A.;
Hasan F.; Banna M.E.; Tuzcu E.M.; Bonatti J.
Institution
(Gobolos, Ramahi, Obeso, Bonatti) Department of Cardiac Surgery, Heart and
Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
(Bartel, Traina, Edris, Hasan, Banna, Tuzcu) Department of Cardiology,
Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab
Emirates
(Hogan) Departments of Anaesthesia, Intensive Care, Cleveland Clinic, Abu
Dhabi, United Arab Emirates
Publisher
NLM (Medline)
Abstract
Robotic totally endoscopic coronary artery bypass grafting (TECAB) was
introduced in 1998 and has over a period of two decades gradually emerged
from single-vessel revascularization to multivessel bypass grafting.
Dedicated centers have continuously evolved and further developed this
minimally invasive method of coronary bypass surgery. A literature review
was conducted to assess intra- and postoperative outcomes of TECAB. PubMed
returned 19 comprehensive articles on TECAB. Investigation was focused on
perioperative outcome parameters, i.e.: operative time, conversion to
larger incision, revision for bleeding, atrial fibrillation, stroke, acute
renal failure, and mortality. Outcome from the analysis of 2,397 reported
cases showed an average operative time of 291 +/- 57 minutes (range 112 to
1,050), conversion rate to larger incisions at 11.5%, and perioperative
mortality at 0.8%. Pooled data demonstrated 4.2% operative revision rate
due to postoperative hemorrhage, 1.0% stroke incidence, 1.6% acute renal
failure, and 13.3% de novo atrial fibrillation. The mean length of
hospital stay measured 5.8 +/- 1.7 days. Conversion rates and operative
times decreased over time. According to data in the literature, coronary
bypass surgery carried out in completely endoscopic fashion utilizing
robotic assistance can require relatively extensive operative times and
conversion rates are somewhat higher than in other robotic cardiac
surgery. However, major postoperative events lie in an acceptable range.
TECAB remains the surgical revascularization method with the least tissue
trauma and represents an opportunity for coronary artery bypass grafting
via port access. Rates of major complications are at least similar to
conventional surgical access procedures.

<19>
Accession Number
626701386
Title
Transcatheter versus surgical intervention: lessons from trials of
coronary revascularisation.
Source
Heart (British Cardiac Society). 105 (Supplement 2) (pp s44-s49), 2019.
Date of Publication: 01 Mar 2019.
Author
Gunn J.; Taggart D.P.
Institution
(Gunn) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
In this paper, a cardiac surgeon and an interventional cardiologist draw
lessons from the trials of percutaneous coronary intervention/coronary
artery bypass graft surgery (PCI/CABG) for the transcatheter aortic valve
implantation/surgical aortic valve replacement (TAVI/SAVR) era. Both PCI
and CABG are effective treatments, but do the trials ask the right
questions? They dwell on the 'either/or' decision for selected patients
suitable for both treatments, but provide little guidance for the majority
of 'real world' patients with comorbidities precluding CABG, or complex
coronary heart disease precluding PCI. The control group must be
meaningful and relevant. The pace of technological and therapeutic change
causes trials to date rapidly. Procedures often do not reflect everyday
practice, such as performing multivessel PCI, copious stenting and full
arterial grafting. Composite endpoints such as major adverse
cardiovascular and cerebrovascular events (MACCE) provide statistical
significance but little insight into patient-orientated needs. There is a
variety of temporal, safety, symptomatic and prognostic endpoints,
provoking debate over their relative and absolute magnitude and
importance; and there are issues of interpretation and inappropriate
extrapolation. Trial interpretation, crystallised in the Kaplan-Meier
curve, focuses on the relative benefit of one treatment over another, but
deserves careful scrutiny. Subgroup analysis tends to exceed its role in
dealing with issues such as poor left ventricular function, diabetes,
multivessel disease and proximal left anterior descending coronary artery
stenosis. Meta-analysis is controversial and guidelines date rapidly,
lacking robust evidence in some domains, yet assuming considerable
importance. Measures of frailty, physiological measures of blood flow,
'real world' activity levels, and predictions of benefit rarely feature.
The multidisciplinary Heart Team meeting, now integral to study design, is
challenging to deliver in practice. The PCI/CABG trials, and the issues
arising from them, provide salutary lessons in the TAVI/SAVR
era.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2019. No
commercial re-use. See rights and permissions. Published by BMJ.

<20>
Accession Number
626701322
Title
Results of mechanical versus tissue AVR: caution in young patients with
tissue AVR.
Source
Heart (British Cardiac Society). 105 (Supplement 2) (pp s34-s37), 2019.
Date of Publication: 01 Mar 2019.
Author
Briffa N.P.
Publisher
NLM (Medline)
Abstract
The first aortic valve prosthesis, implanted more than 50 years ago, was a
mechanical prosthesis (ball-and-cage design). Over the ensuing decades,
tissue prostheses and new mechanical designs were introduced to mitigate
the need for anticoagulation with its associated side effects. Tissue and
mechanical heart valve prostheses were compared in two head-to-head
randomised control trials. Both of these confirmed that mechanical
prostheses were durable but patients suffered anticoagulant-related
bleeds. Patients who received a tissue prosthesis were more likely to
suffer prosthetic dysfunction and require reoperation. This trend was
stronger in younger patients. Since the publication of those two trials,
several large retrospective studies using data from meta-analyses of
published papers or registries have failed to show a survival advantage of
either prostheses when implanted in the aortic position in younger
patients. This equipoise has been reflected in the heart valve disease
guidelines published by European and US societies. In recent years, the
primacy of patient choice, the rapid increase in life expectancy of
populations, the increased incidence of atrial fibrillation with
requirement for anticoagulation, the advent of transcatheter techniques to
treat degenerating tissue valves as well as advances in anticoagulant
therapy and in new tissue and to a lesser extent mechanical prosthetic
design continue to influence choice of aortic valve prosthesis in younger
patients undergoing aortic valve replacement.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2019. No commercial re-use. See rights
and permissions. Published by BMJ.

<21>
Accession Number
626700752
Title
Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients
after Cardiac Surgery.
Source
The Thoracic and cardiovascular surgeon. 67 (2) (pp 107-116), 2019. Date
of Publication: 01 Mar 2019.
Author
Yamashita K.; Hu N.; Ranjan R.; Selzman C.H.; Dosdall D.J.
Institution
(Yamashita, Ranjan, Selzman, Dosdall) Nora Eccles Harrison Cardiovascular
Research and Training Institute, University of Utah, Salt Lake City, UT,
United States
(Yamashita, Ranjan, Dosdall) Division of Cardiovascular Medicine,
Department of Internal Medicine, University of Utah, Salt Lake City, UT,
United States
(Hu) Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,
United States
(Hu) Division of Epidemiology, Department of Internal Medicine, University
of Utah, Salt Lake City, UT, United States
(Selzman, Dosdall) Division of Cardiothoracic Surgery, Department of
Surgery, University of Utah, Salt Lake City, UT, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common
arrhythmia following cardiac surgery and is associated with increased
health-care costs, complications, and mortality. The etiology of POAF is
incompletely understood and its prediction remains suboptimal. Using data
from published studies, we performed a systemic review and meta-analysis
to identify preoperative clinical risk factors associated with patients at
increased risk of POAF. <br/>METHOD(S): A systematic search of PubMed,
MEDLINE, and EMBASE databases was performed. <br/>RESULT(S): Twenty-four
studies that reported univariate analysis results regarding POAF risk
factors, published from 2001 to May 2017, were included in this
meta-analysis with a total number of 36,834 subjects. Eighteen studies
were performed in the United States and Europe and 16 studies were
prospective cohort studies. The standardized mean difference (SMD) between
POAF and non-POAF groups was significantly different (reported as [SMD:
95% confidence interval, CI]) for age (0.55: 0.47-0.63), left atrial
diameter (0.45: 0.15-0.75), and left ventricular ejection fraction (0.30:
0.14-0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI])
demonstrated that heart failure (1.56: 1.31-1.96), chronic obstructive
pulmonary disease (1.36: 1.13-1.64), hypertension (1.29: 1.12-1.48), and
myocardial infarction (1.18: 1.05-1.34) were significant predictors of
POAF incidence, while diabetes was marginally significant (1.06:
1.00-1.13). <br/>CONCLUSION(S): The present analysis suggested that older
age and history of heart failure were significant risk factors for POAF
consistently whether the included studies were prospective or
retrospective datasets.<br/>Copyright Georg Thieme Verlag KG Stuttgart .
New York.

<22>
Accession Number
626718725
Title
Severe infections due to Francisella tularensis ssp. holarctica in solid
organ transplant recipient: report of two cases and review of literature.
Source
BMC infectious diseases. 19 (1) (pp 238), 2019. Date of Publication: 08
Mar 2019.
Author
Bahuaud O.; Le Brun C.; Chalopin T.; Lacasse M.; Le Marec J.; Pantaleon
C.; Nicolas C.; Barbier L.; Bernard L.; Lemaignen A.
Institution
(Bahuaud, Chalopin, Lacasse, Le Marec, Bernard, Lemaignen) Department of
Internal Medicine and Infectious Diseases, University Hospital of Tours,
Hospital Bretonneau, boulevard Tonnelle, Tours Cedex 9 37044, France
(Bahuaud, Chalopin, Lacasse, Le Marec, Barbier, Bernard, Lemaignen)
Francois Rabelais University, Tours, France
(Le Brun) Department of Bacteriology, University Hospital of Tours, Tours,
France
(Pantaleon) Department of Cardiology, University Hospital of Tours, Tours,
France
(Nicolas) Department of Hepatology, University Hospital of Tours, Tours,
France
(Barbier) Department of Digestive Surgery, Hepatobiliary Surgery and Liver
Transplantation, University Hospital of Tours, Tours, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Tularemia is a rare zoonotic infection caused by bacterium
Francisella tularensis. It has been well described in immunocompetent
patients but poorly described in immunocompromised patients notably in
solid organ transplant recipients. CASE PRESENTATIONS: We report here two
cases of tularemia in solid organ transplant recipients including first
case after heart transplant. We also carried out an exhaustive review of
literature describing characteristics of this infection in solid organ
transplant recipients.

<23>
Accession Number
2001675387
Title
High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A
meta-analysis.
Source
Journal of Clinical Anesthesia. 57 (pp 57-62), 2019. Date of Publication:
November 2019.
Author
Rong L.Q.; Kamel M.K.; Rahouma M.; Naik A.; Mehta K.; Abouarab A.A.; Di
Franco A.; Demetres M.; Mustapich T.L.; Fitzgerald M.M.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Mustapich, Fitzgerald, Pryor) Department of Anesthesiology, Weill
Cornell Medicine/New York Presbyterian, NY, NY, United States
(Kamel, Rahouma, Naik, Mehta, Abouarab, Di Franco, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, NY,
NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective. We performed a systematic comparison of high-dose and
low-dose opioid anesthesia in cardiac surgery. <br/>Design(s): Systematic
review and meta-analysis of randomized controlled trials (RCTs).
<br/>Setting(s): Operating room. <br/>Patient(s): 1400 adult patients
undergoing cardiac surgery using general anesthesia. <br/>Intervention(s):
All RCTs comparing the effects of various doses of intravenous opioids
(morphine, fentanyl, sufentanil, and remifentanil) during adult cardiac
surgery using general anesthesia published until May 2018 (full-text
English articles reporting data from human subjects) were included.
Measurements: Primary outcome was intensive care unit (ICU) length of stay
(LOS). Secondary outcomes were ventilation time, use of vasopressors,
perioperative myocardial infarction, perioperative stroke, and hospital
LOS. <br/>Main Result(s): Eighteen articles were included (1400 patients).
There was no difference in ICU LOS between studies using high or low dose
of opioids (both short-acting and long-acting) (standard mean difference
[SMD]-0.02, 95%CI: -0.15-0.11, P = 0.74). Similarly, there was no
difference in secondary outcomes of ventilation time (SMD-0.27, 95%CI:
-0.63-0.09, P = 0.14), use of vasopressors (OR 0.61, 95%CI: 0.29-1.30, P =
0.20), myocardial infarction (risk difference 0.00, 95% CI: -0.02-0.03, P
= 0.70), stroke (RD 0.00, 95% CI: -0.01-0.01, P = 0.92) and hospital LOS
(SMD 0.03, 95% CI: -0.26-0.33, P = 0.84). At meta-regression, there was no
effect of age, gender, or type of opioid on the difference between groups.
<br/>Conclusion(s): Our data suggest that low-dose opioids, both short
acting and long acting, are safe and effective to use in adult cardiac
surgery patients, independent of the clinical characteristics of the
patients and the type of opioid used. In view of the current opioid
epidemic, low-dose opioid anesthesia should be considered for cardiac
surgery patients.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<24>
Accession Number
2001676494
Title
In-hospital physiotherapy improves physical activity level after lung
cancer surgery: a randomized controlled trial.
Source
Physiotherapy (United Kingdom). (no pagination), 2019. Date of
Publication: 2019.
Author
Jonsson M.; Hurtig-Wennlof A.; Ahlsson A.; Vidlund M.; Cao Y.; Westerdahl
E.
Institution
(Jonsson, Westerdahl) Department of Physiotherapy, Faculty of Medicine and
Health, Orebro University, Orebro SE-70182, Sweden
(Hurtig-Wennlof) School of Health Sciences, Department of Medical
Diagnostics, Faculty of Medicine and Health, Orebro University, Orebro
SE-70182, Sweden
(Ahlsson) Cardiovascular Division, Karolinska University Hospital,
Stockholm SE-17176, Sweden
(Vidlund) Department of Vascular and Cardiothoracic Surgery, Faculty of
Medicine and Health, Orebro University, Orebro SE-70182, Sweden
(Cao) Unit of Biostatistics, Institute of Environmental Medicine,
Karolinska Institutet, Stockholm SE-17177, Sweden
(Cao) Clinical Epidemiology and Biostatistics, School of Medical Sciences,
Orebro University, Orebro SE-70182, Sweden
Publisher
Elsevier Ltd
Abstract
Objectives: Patients undergoing lung cancer surgery are routinely offered
physiotherapy. Despite its routine use, effects on postoperative physical
recovery have yet not been demonstrated. The aim of this study was to
investigate whether physiotherapy could improve postoperative in-hospital
physical activity level and physical capacity. <br/>Design(s):
Single-blind randomized controlled trial. <br/>Setting(s): Thoracic
surgery department at a University Hospital. <br/>Participant(s): Patients
undergoing elective thoracic surgery (n = 94) for confirmed or suspected
lung cancer were assessed during hospital stay. <br/>Intervention(s):
Daily physiotherapy, consisting of mobilization, ambulation, shoulder
exercises and breathing exercises. The control group received no
physiotherapy treatment. <br/>Outcome(s): In-hospital physical activity
assessed with the Actigraph GT3X+ accelerometer, six-minute walk test,
spirometry and dyspnea scores. <br/>Result(s): The treatment group reached
significantly more accelerometer counts (2010 (1508) vs 1629 (1146), mean
difference 495 [95% CI 44 to 1109]), and steps per hour (49 (47) vs 37
(34), mean difference 14 [95% CI 3 to 30]), compared to the control group,
during the first three postoperative days. No significant differences in
six-minute walk test (percent of preoperative 71% vs 79%, P = 0.13),
spirometry (FEV1 percent of preoperative 69% vs 69%, P = 0.83) or dyspnoea
(M-MRC 2 vs 2, P = 0.74) between the groups were found.
<br/>Conclusion(s): Patients receiving in-hospital physiotherapy showed
increased level of physical activity during the first days after lung
cancer surgery, compared to an untreated control group. However, no
effects on the six-minute walk test or spirometric values were found. The
clinical importance of an increased physical activity level during the
early postoperative period needs to be further evaluated. Clinical Trial
Registration number: NCT01961700.<br/>Copyright &#xa9; 2018 The Authors

<25>
Accession Number
2001593954
Title
Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST
Guideline and Expert Panel Report.
Source
Chest. 155 (3) (pp 565-586), 2019. Date of Publication: March 2019.
Author
Klinger J.R.; Elliott C.G.; Levine D.J.; Bossone E.; Duvall L.; Fagan K.;
Frantsve-Hawley J.; Kawut S.M.; Ryan J.J.; Rosenzweig E.B.; Sederstrom N.;
Steen V.D.; Badesch D.B.
Institution
(Klinger) Brown University, Providence, RI, United States
(Elliott) Intermountain Healthcare and the University of Utah School of
Medicine, Murray, UT, United States
(Levine) University of Texas Health Science Center at San Antonio, San
Antonio, TX, United States
(Bossone) A. Cardarelli Hospital, Naples, Italy
(Duvall) OhioHealth/The Ohio State University, Columbus, OH, United States
(Fagan) University of South Alabama, Mobile, AL, United States
(Frantsve-Hawley) CHEST, Glenview, IL, United States
(Kawut) Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, United States
(Ryan) University of Utah, Salt Lake City, UT, United States
(Rosenzweig) Columbia University Medical Center, New York, NY, United
States
(Sederstrom) Children's Hospitals and Clinics of Minnesota, Minneapolis,
MN, United States
(Steen) Georgetown University Medical Center, Washington, DC, United
States
(Badesch) University of Colorado School of Medicine, Aurora, CO, United
States
Publisher
Elsevier Inc
Abstract
Background: Pulmonary arterial hypertension (PAH) carries a poor prognosis
if not promptly diagnosed and appropriately treated. The development and
approval of 14 medications over the last several decades have led to a
rapidly evolving approach to therapy, and have necessitated periodic
updating of evidence-based treatment guidelines. This guideline statement,
which now includes a visual algorithm to enhance its clinical utility,
represents the fourth iteration of the American College of Chest
Physicians Guideline and Expert Panel Report on Pharmacotherapy for PAH.
<br/>Method(s): The guideline panel conducted an updated systematic review
to identify studies published after those included in the 2014 guideline.
A systematic literature search was conducted using MEDLINE via PubMed and
the Cochrane Library. The quality of the body of evidence was assessed for
each critical or important outcome of interest using the Grading of
Recommendations Assessment, Development and Evaluation approach. Graded
recommendations and ungraded consensus-based statements were developed and
voted on using a modified Delphi technique to achieve consensus.
<br/>Result(s): Two new recommendations on combination therapy and two
ungraded consensus-based statements on palliative care were developed. An
evidence-based and consensus-driven treatment algorithm was created to
guide the clinician through an organized approach to management, and to
direct readers to the appropriate area of the document for more detailed
information. <br/>Conclusion(s): Therapeutic options for the patient with
PAH continue to expand through basic discovery, translational science, and
clinical trials. Optimal use of new treatment options requires prompt
evaluation at an expert center, utilization of current evidence-based
guidelines, and collaborative care using sound clinical
judgment.<br/>Copyright &#xa9; 2019 American College of Chest Physicians

<26>
Accession Number
624533683
Title
A prospective, observational study of cerebrovascular autoregulation and
its association with delirium following cardiac surgery.
Source
Anaesthesia. 74 (1) (pp 33-44), 2019. Date of Publication: January 2019.
Author
Chan B.; Aneman A.
Institution
(Chan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
(Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
Publisher
Blackwell Publishing Ltd
Abstract
This aim of this prospective observational cohort study was to evaluate
any association between postoperatively impaired cerebrovascular
autoregulation and the onset of delirium following cardiac surgery.
Previous studies have shown that impaired intra-operative cerebrovascular
autoregulation during cardiopulmonary bypass is associated with delirium.
However, postoperative changes in cerebrovascular autoregulation and its
association with delirium have not been investigated. One-hundred and
eight consecutive adult cardiac surgical patients without baseline
cognitive dysfunction or aphasia were included in the study.
Cerebrovascular autoregulation was assessed by the Pearson correlation
between near-infrared spectroscopy-derived cerebral tissue oxygen
saturation and mean arterial pressure to derive the tissue oximetry index.
Cerebrovascular autoregulation was monitored for a minimum of 90 min on
postoperative day 0 and postoperative day 1. Delirium was assessed
throughout intensive care unit admission using the confusion assessment
method for the intensive care unit. We observed delirium in 24 of the 108
patients studied. The mean (SD) tissue oximetry index was higher in
delirious patients on postoperative day 0 compared with non-delirious
patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on
postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All
patients showed improvement in tissue oximetry index on postoperative day
1 compared with postoperative day 0. Logistic regression analysis
demonstrated tissue oximetry index on postoperative day 0 to be
independently associated with delirium; odds ratio 1.05 (95%CI 1.01-1.10),
p = 0.043. In conclusion, we found an association between impaired
cerebrovascular autoregulation, measured by near-infrared spectroscopy,
and delirium in the early postoperative period.<br/>Copyright &#xa9; 2018
Association of Anaesthetists

<27>
Accession Number
619197728
Title
Clinical outcomes of coronary occlusion following transcatheter aortic
valve replacement: A systematic review.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 229-236), 2018. Date
of Publication: March 2018.
Author
Akinseye O.A.; Jha S.K.; Ibebuogu U.N.
Institution
(Akinseye, Jha, Ibebuogu) Division of Cardiovascular Diseases, Department
of Medicine, University of Tennessee Health Science Center, Memphis, TN,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Coronary occlusion (CO) is a rare but serious complication
following transcatheter aortic valve replacement (TAVR) with limited
published data. We sought to evaluate the immediate and short-term
outcomes of CO complicating TAVR. <br/>Method(s): Studies, including case
reports, case series and original articles published from 2002 to 2016
describing CO following TAVR were identified with a systematic electronic
search using the PRISMA Statement. Only studies reporting data on
demographic and procedural characteristics, management and follow up
outcomes were analyzed. <br/>Result(s): A total of 40 publications
describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean
age was 83 +/- 7 years and most (81%) were females. The mean logistic
EuroSCORE and STS score was 23.5 +/- 14.6% and 9.1 +/- 3.2% respectively.
TAVR access site was transfemoral in 73% and a balloon expandable valve
was used in 78%. Among those with LCA occlusion, the mean LCA ostium
height was 10.1 +/- 1.8 mm while the mean RCA ostium height was 10.4 +/-
2.0 mm among those with RCA occlusion. CO frequently involved the left
main coronary artery (80%) and the most common mechanism was displacement
of native valve leaflet (60%), and most cases occurred within 1-hour
post-implantation (88%). Percutaneous coronary intervention was attempted
in 82 patients and successful in 89%. Procedural death was 10.4%. CO
following TAVR in native aortic valve stenosis was associated with a
30-day mortality rate of 35.3%. <br/>Conclusion(s): CO following TAVR is
associated with a high procedural and 30-day mortality rate despite
aggressive resuscitative measures including percutaneous coronary
intervention.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<28>
Accession Number
617920749
Title
Comparison of outcomes in new-generation versus early-generation heart
valve in transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 186-191), 2018. Date
of Publication: March 2018.
Author
Ando T.; Takagi H.; Telila T.; Afonso L.
Institution
(Ando, Telila, Afonso) Detroit Medical Center/Wayne State University,
Division of Cardiology, Detroit, United States
(Takagi) Shizuoka Medical Center, Division of Cardiovascular Surgery,
Shizuoka, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: New-generation (NG) valves for transcatheter aortic valve
implantation (TAVI) has recently been widely used in real-world practice,
yet its comparative outcomes with early-generation (EG) valves remain
under-explored. <br/>Method(s): An electronic literature search using
PUBMED and EMBASE was conducted from inception to April 2017 for
matched-cohort studies. Articles that compared the outcomes of NG vs. EG
valves post TAVI with at least one of the following clinical outcome
reported were included: all-cause mortality, major or life-threatening
bleeding, major vascular complications (MVC), significant (more than
moderate) paravalvular regurgitation (PVR), cerebrovascular events,
significant (stage 2 or 3) acute kidney injury (AKI) and new permanent
pacemaker implantation (PPI) that occurred either in-hospital or within
30-days. <br/>Result(s): A total of 6 observational matched-cohort studies
with 585 and 647 patients included in NG and EG valves, respectively, were
included. EG valves were associated with a lower incidence of major or
life-threatening bleeding (5.7% vs. 15.7%, p < 0.00001), significant
paravalvular regurgitation (5.3% vs. 14.4%, p = 0.001), and significant
AKI (4.4% vs. 7.5, p = 0.03). All-cause mortality (3.5% vs. 5.0, p =
0.43), cerebrovascular events (3.4% vs. 2.3%, p = 0.34) and new PPI (11.0%
vs. 14.6%, p = 0.52) were similar between the two groups. NG demonstrated
lower tendency of MVC (2.5% vs. 7.2, p = 0.09) compared to EG valves.
<br/>Conclusion(s): NG demonstrated lower rates of significant AKI,
significant PVR and major or life-threatening bleeding while all-cause
mortality, new PPI, and cerebrovascular events remained similar compared
to EG valves.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<29>
Accession Number
623735451
Title
A randomised trial of serratus anterior plane block for analgesia after
thoracoscopic surgery.
Source
Anaesthesia. 73 (10) (pp 1260-1264), 2018. Date of Publication: October
2018.
Author
Park M.H.; Kim J.A.; Ahn H.J.; Yang M.K.; Son H.J.; Seong B.G.
Institution
(Park, Ahn, Yang, Seong) Department of Anesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
(Kim, Son) Department of Anesthesiology and Pain Medicine, Kangwon
National University School of Graduate Medicine, Chuncheon, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We evaluated the effect of pre-operative serratus anterior plane block on
postoperative pain and opioid consumption after thoracoscopic surgery. We
randomly allocated 89 participants to block with 30 ml ropivacaine 0.375%
(n = 44), or no block without placebo or sham procedure (n = 45). We
analysed results from 42 participants in each group. Serratus anterior
plane block reduced mean (SD) remifentanil dose during surgery, 0.12
(0.06) mg.h^-1 vs. 0.16 (0.06) mg.h^-1, p = 0.016, and
reduced mean (SD) fentanyl consumption in the first 24 postoperative
hours, 3.8 (1.9) mug.kg^-1 vs. 5.7 (1.6) mug.kg^-1, p
= 0.000004. Block also reduced the worst median (IQR [range]) pain scores
reported in the first 24 postoperative hours: 6 (5-7 [3-10]) vs. 7 (6-7
[3-10]), p = 0.027. Block decreased dissatisfaction with pain management,
categorised as 'highly unsatisfactory', 'unsatisfactory', 'neutral',
'satisfactory' or 'highly satisfactory': 1/2/21/18/0 vs. 1/14/15/11/1, p =
0.0038. There were no differences in the rates of nausea, vomiting,
dizziness or length of hospital stay. Serratus anterior plane block may be
used to reduce pain and opioid use after thoracoscopic lung
surgery.<br/>Copyright &#xa9; 2018 Association of Anaesthetists

<30>
Accession Number
622056132
Title
Is MRI equivalent to CT in the guidance of TAVR? A pilot study.
Source
European Radiology. 28 (11) (pp 4625-4634), 2018. Date of Publication: 01
Nov 2018.
Author
Mayr A.; Klug G.; Reinstadler S.J.; Feistritzer H.-J.; Reindl M.; Kremser
C.; Kranewitter C.; Bonaros N.; Friedrich G.; Feuchtner G.; Metzler B.
Institution
(Mayr, Kremser, Kranewitter, Feuchtner) University Clinic of Radiology,
Medical University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Klug, Reinstadler, Feistritzer, Reindl, Friedrich, Metzler) University
Clinic of Internal Medicine III, Cardiology and Angiology, Medical
University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Bonaros) University Clinic of Cardiac Surgery, Medical University of
Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To compare a comprehensive cardiovascular magnetic resonance
imaging (MRI) protocol with contrast-enhanced computed tomography
angiography (CTA) for guidance in transcatheter aortic valve replacement
(TAVR) evaluation. <br/>Methods and Results: Non-contrast
three-dimensional (3D) 'whole heart' MRI imaging for aortic annulus sizing
and measurements of coronary ostia heights, contrast-enhanced MRI
angiography (MRA) for evaluation of transfemoral routes as well as
aortoiliofemoral-CTA were performed in 16 patients referred for evaluation
of TAVR. Aortic annulus measurements by MRI and CTA showed a very strong
correlation (r=0.956, p<0.0001; effective annulus area for MRI 430+/-74
vs. 428+/-78 mm² for CTA, p=0.629). Regarding decision for
valve size there was complete consistency between MRI and CTA. Moreover,
vessel luminal diameters and angulations of aortoiliofemoral access as
measured by MRA and CTA showed overall very strong correlations (r= 0.819
to 0.996, all p<0.001), the agreement of minimal vessel diameter between
the two modalities revealed a bias of 0.02 mm (upper and lower limit of
agreement: 1.02 mm and -0.98 mm). <br/>Conclusion(s): In patients referred
for TAVR, MRI measurements of aortic annulus and minimal aortoiliofemoral
diameters showed good to excellent agreement. Decisions based on MRI
measurements regrading prosthesis sizing and transfemoral access would not
have modified TAVR-strategy as compared to a CTA-based choice. Key Points:
* 'Whole heart' MRI and CTA measurements of aortic annulus correlate very
strongly. * MRI- and CTA-based prostheses sizing are in excellent
agreement. * MRA and CTA equally guide TAVR access strategy.<br/>Copyright
&#xa9; 2018, European Society of Radiology.

<31>
Accession Number
622035440
Title
Modeling statin-induced reductions of cardiovascular events in primary
prevention: A VOYAGER meta-analysis.
Source
Cardiology (Switzerland). 140 (1) (pp 30-34), 2018. Date of Publication:
01 Jun 2018.
Author
Karlson B.W.; Nicholls S.J.; Lundman P.; Barter P.J.; Palmer M.K.
Institution
(Karlson) AstraZeneca Gothenburg, Pepparedsleden 1, Molndal SE-43183,
Sweden
(Karlson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA, Australia
(Lundman) Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
(Barter) University of New South Wales, Sydney, NSW, Australia
(Palmer) Manchester Metropolitan University, School of Healthcare Science,
Manchester, United Kingdom
Publisher
S. Karger AG
Abstract
Objective: We used individual patient data from the VOYAGER database to
estimate cardiovascular (CV) risk reduction with commonly used
high-intensity statins. <br/>Method(s): In patients with known
atherosclerotic CV disease (ASCVD) treated with high-intensity statin
therapy (n = 6,735), the predicted risk reduction was estimated using the
Cholesterol Treatment Trialists' Collaboration meta-analysis, which
determined risk reduction per 38.7 mg/dL statin-mediated reduction in
low-density lipoprotein cholesterol. <br/>Result(s): The greatest
reductions in risk were seen in major vascular events (estimated rate
ratios ranged from 0.55 with rosuvastatin [RSV] 40 mg to 0.60 with
atorvastatin [ATV] 40 mg) and coronary heart disease death (estimated rate
ratios ranged from 0.58 with RSV 40 mg to 0.64 with ATV 40 mg).
<br/>Conclusion(s): Our results show that, in individuals without clinical
ASCVD, statin therapy has the potential to reduce the frequency of CV
events.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel. All rights
reserved.

<32>
Accession Number
2001054350
Title
Comparison of International Guidelines for Assessment of Suspected Stable
Angina: Insights From the PROMISE and SCOT-HEART.
Source
JACC: Cardiovascular Imaging. 11 (9) (pp 1301-1310), 2018. Date of
Publication: September 2018.
Author
Adamson P.D.; Newby D.E.; Hill C.L.; Coles A.; Douglas P.S.; Fordyce C.B.
Institution
(Adamson, Newby) British Heart Foundation Centre for Cardiovascular
Science, University of Edinburgh, Edinburgh, United Kingdom
(Hill, Coles, Douglas) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, North Carolina, United States
(Fordyce) Division of Cardiology, University of British Columbia,
Vancouver, British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to compare the performance of major
guidelines for the assessment of stable chest pain including risk-based
(American College of Cardiology/American Heart Association and European
Society of Cardiology) and symptom-focused (National Institute for Health
and Care Excellence) strategies. <br/>Background(s): Although noninvasive
testing is not recommended in low-risk individuals with stable chest pain,
guidelines recommend differing approaches to defining low-risk patients.
<br/>Method(s): Patient-level data were obtained from the PROMISE
(Prospective Multicenter Imaging Study for Evaluation of Chest Pain) and
SCOT-HEART (Scottish Computed Tomography of the Heart) trials. Pre-test
probability was determined and patients dichotomized into low-risk and
intermediate-high-risk groups according to each guideline's definitions.
The primary endpoint was obstructive coronary artery disease on coronary
computed tomography angiography. Secondary endpoints were coronary
revascularization at 90 days and cardiovascular death or nonfatal
myocardial infarction up to 3 years. <br/>Result(s): In total, 13,773
patients were included of whom 6,160 had coronary computed tomography
angiography. The proportions of patients identified as low risk by the
American College of Cardiology/American Heart Association, European
Society of Cardiology, and National Institute for Health and Care
Excellence guidelines, respectively, were 2.5%, 2.5%, and 10.0% within
PROMISE, and 14.0%, 19.8%, and 38.4% within SCOT-HEART. All guidelines
identified lower rates of obstructive coronary artery disease in low-
versus intermediate-high-risk patients with a negative predictive value of
>=0.90. Compared with low-risk groups, all intermediate-high-risk groups
had greater risks of coronary revascularization (odds ratio [OR]: 2.2 to
24.1) and clinical outcomes (OR: 1.84 to 5.8). <br/>Conclusion(s):
Compared with risk-based guidelines, symptom-focused assessment identifies
a larger group of low-risk chest pain patients potentially deriving
limited benefit from noninvasive testing. (Scottish Computed Tomography of
the Heart Trial [SCOT-HEART]; NCT01149590; Prospective Multicenter Imaging
Study for Evaluation of Chest Pain [PROMISE]; NCT01174550)<br/>Copyright
&#xa9; 2018 The Authors

<33>
Accession Number
618878302
Title
Electrocardiographic changes after successful recanalization of a chronic
total coronary occlusion. A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 221-228), 2018. Date
of Publication: March 2018.
Author
van Dongen I.M.; Elias J.; Meijborg V.M.F.; De Bakker J.M.T.; Limpens J.;
Conrath C.E.; Henriques J.P.S.
Institution
(van Dongen, Elias, Meijborg, De Bakker, Conrath, Henriques) Department of
Cardiology, Academic Medical Center Amsterdam, Netherlands
(Limpens) Medical Library, Academic Medical Center Amsterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Observational studies suggest that in patients with a CTO
successful recanalization is associated with better clinical outcome. This
could be related to a reduction in the occurrence of arrhythmias, which
may result from modifications of the hibernating myocardium in a CTO
region. <br/>Methods and Results: We aimed to evaluate the effect of CTO
PCI on electrophysiological parameters, and conducted a systematic review
and meta-analysis according to the PRISMA guidelines. MEDLINE and EMBASE
were searched. Titles and abstracts identified by the search strategy were
independently screened by two investigators. Data were extracted and used
for meta-analyses where possible. In total, eight studies incorporating
467 patients were included in this review, evaluating the effect of
successful CTO PCI on various ECG parameters. Three studies showed a
significant decrease in mean QT dispersion of 17.46 ms [95% CI
10.62-24.30] after successful CTO PCI. QTc dispersion also decreased
significantly, with a mean decrease of 18.74 ms [95% CI 11.53-25.94]. In
one trial a significant decrease in Tp-e interval in leads V2 and V5, and
a significant decrease in Tp-e/QT ratio in leads V2 and V5 post-CTO PCI
were observed. <br/>Conclusion(s): This first systematic review and
meta-analysis suggests that successful CTO PCI is associated with an
immediate decrease in ECG parameters that reflect heterogeneity in
depolarization and repolarization, which could lead to a reduction in the
risk for ventricular arrhythmias and sudden cardiac death. We raise the
hypothesis that hibernating myocardium in a CTO region may not be as
deeply "in sleep" as one would assume.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<34>
Accession Number
623175183
Title
Study Design of the Graft Patency After FFR-Guided Versus
Angiography-Guided CABG Trial (GRAFFITI).
Source
Journal of Cardiovascular Translational Research. 11 (4) (pp 269-273),
2018. Date of Publication: 01 Aug 2018.
Author
Toth G.G.; De Bruyne B.; Kala P.; Ribichini F.L.; Casselman F.; Ramos R.;
Piroth Z.; Fournier S.; Van Mieghem C.; Penicka M.; Mates M.; Van Praet
F.; Degriek I.; Barbato E.
Institution
(Toth) Department of Cardiology, University Heart Center Graz, Medical
University of Graz, Graz, Austria
(Toth, De Bruyne, Casselman, Fournier, Van Mieghem, Penicka, Van Praet,
Degriek, Barbato) Cardiovascular Research Center Aalst, OLV Clinic, OLV
Hospital, Moorselbaan, 164, Aalst B-9300, Belgium
(Kala) Department of Cardiology and Internal Medicine, University Hospital
Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
(Ribichini) Division of Cardiology, Department of Medicine, University of
Verona, Verona, Italy
(Ramos) Hospital Santa Marta - Centro Hospitalar Lisboa Central, Lisbon,
Portugal
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
(Mates) Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Clinical benefit of invasive functionally guided revascularization has
been mostly investigated and proven for percutaneous coronary
intervention. It has never been prospectively evaluated whether a
systematic fractional flow reserve (FFR) assessment is also beneficial in
guiding coronary artery bypass graft surgery (CABG). The objective of the
GRAft patency after FFR-guided versus angiography-guIded CABG (GRAFFITI)
trial was to compare an FFR-guided revascularization strategy to the
traditional angiography-guided revascularization strategy for patients
undergoing CABG. Patients were enrolled with significantly diseased left
anterior descending or left main stem and at least one major coronary
artery with angiographically intermediate stenosis (30-90% diameter
stenosis) that was assessed by FFR. Thereafter, while the FFR values were
kept concealed, cardiac surgeons decided their intended procedural
strategy based on the coronary angiography alone. At this point, patients
underwent 1:1 randomization to either an FFR-guided or an
angiography-guided CABG strategy. In case the patient was randomized to
angiography-guided arm, cardiac surgeons kept their intended procedural
strategy, i.e., CABG was guided solely on the basis of the coronary
angiography. In case the patient was randomized to the FFR-guided arm, FFR
values were disclosed to the surgeons who revised the surgical protocol
according to the functional significance of each coronary stenosis. The
primary endpoint of the trial was the rate of graft occlusion at 12
months, assessed by coronary computed tomography or coronary angiography.
The secondary endpoints were (1) length of postoperative hospital stay;
(2) changes in surgical strategy depending upon FFR results (in FFR-guided
group only); and (3) rate of major adverse cardiac and cerebrovascular
events, i.e., composite of death, myocardial infarction, stroke, and any
revascularization during the follow-up period. This study is the first
prospective randomized trial investigating potential clinical benefits,
associated with FFR-guided surgical revascularization. Trial registration:
NCT01810224.<br/>Copyright &#xa9; 2018, Springer Science+Business Media,
LLC, part of Springer Nature.

<35>
Accession Number
625415470
Title
Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve
Regurgitation: A Systematic Review.
Source
Cardiology (Switzerland). 141 (3) (pp 132-140), 2019. Date of Publication:
01 Feb 2019.
Author
Jiang J.; Liu X.; He Y.; Xu Q.; Zhu Q.; Jaiswal S.; Wang L.; Hu P.; Gao
F.; Sun Y.; Liu C.; Lin X.; Liang J.; Ren K.; Wang J.
Institution
(Jiang, Liu, He, Xu, Zhu, Jaiswal, Wang, Hu, Gao, Liu, Lin, Liang, Ren,
Wang) Department of Cardiology, Second Affiliated Hospital, Zhejiang
University, School of Medicine, Hangzhou, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangdong,
China
Publisher
S. Karger AG
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a recent and
an effective treatment option for high- or extreme-surgical-risk patients
with symptomatic severe aortic stenosis. However, pure severe native
aortic valve regurgitation (NAVR) without aortic stenosis remains a
contraindication to TAVR. The aim of our systemic review analysis was to
evaluate TAVR in patients with pure NAVR. <br/>Method(s): We searched the
published articles in the PubMed and Web of Science databases (2002-2017)
using the Boolean operators for studies of NAVR patients undergoing TAVR.
Reference lists of all returned articles were searched recursively for
other relevant citations. Pooled estimates were calculated using a
random-effects meta-analysis. <br/>Result(s): Finally, a total of 10
studies were included in this analysis. The CoreValve was more frequently
used with a lower rate of device success and a higher rate of residual
aortic regurgitation. The new-generation transcatheter heart valves (THVs)
performed a significantly higher rate with less residual aortic
regurgitation and a success rate close to 100%. The 30-day all-cause
mortality rates ranged from 0 to 30% with an estimate summary rate of 9%
(95% CI: 5-15%; I² = 33%). Cerebrovascular events, major or
life-threatening bleeding, major vascular complications, acute kidney
disease, and new permanent pacemaker implantation occurred similarly in
both the new- and old-generation THV devices. <br/>Conclusion(s): Aortic
regurgitation remains a challenging pathology for TAVR. TAVR is a feasible
and reasonable option for carefully selected patients with pure aortic
regurgitation.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel.

<36>
Accession Number
2001576781
Title
Effects of preoperative administration of fibrinogen concentrate in
cardiac surgery khalaf-adeli et al effects of the preoperative
administration of a fibrinogen concentrate on bleeding and transfusion
requirements in cardiac surgery.
Source
Iranian Heart Journal. 20 (1) (pp 39-44), 2019. Date of Publication: 2019.
Author
Khalaf-Adeli E.; Babaee T.; Ghadrdoost B.; Baghizadeh F.; Alavi S.M.
Institution
(Khalaf-Adeli) Blood Transfusion Research Center, High Institute for
Research and Education in Transfusion Medicine, Tehran, Iran, Islamic
Republic of
(Babaee, Ghadrdoost, Baghizadeh, Alavi) Rajaie Cardiovascular, Medical,
and Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Taleghani Educational Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, IR Iran.
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: Contact of blood with the cardiopulmonary bypass (CPB) circuit
during cardiac surgery induces acquired multifactorial coagulopathy, which
results in an increased risk of bleeding and transfusion requirements. In
this study, we investigated the effects of the preoperative administration
of fibrinogen concentrates on bleeding and transfusion requirements in
cardiac surgery. <br/>Method(s): Seventy-eight patients scheduled for
elective coronary artery bypass graft (CABG) or valvular surgery were
included in this clinical trial between March 2017 and November 2017. The
patients were randomly assigned to fibrinogen and control groups. In the
fibrinogen group, the patients received 2 g of fibrinogen dissolved in 100
mL of normal saline over a 15-minute period 30 minutes after the induction
of anesthesia. In the control group, the patients received the same volume
of normal saline during the same period of time. The evaluation of the
coagulation system was performed via thromboelastometry (Rotem device).
Postoperative bleeding was recorded as the overall mediastinal drainage or
the other drainage at the surgical site during a 24-hour period after
surgery. The volumes of transfused packed red blood cells, fresh frozen
plasma (FFP), and platelet concentrates were recorded. <br/>Result(s): The
value of Fibtem-MCF did not show any significant difference between the
groups (12.4+/-4 vs 11.7+/-4 0.46; P=0.46). The mean volume of bleeding
was significantly lower in the fibrinogen group than in the control group
(168+/-12 vs 344+/-37; P=0.001). The mean volume of the platelet
concentrate used was significantly lower in the fibrinogen group than in
the control group (P<0.05). However, there was no significant difference
in terms of RBCs and FFP consumption between the groups.
<br/>Conclusion(s): It appears that although preoperative supplementation
with fibrinogen has no effect on transfusion with RBCs and FFP, it results
in a reduction in postoperative blood loss and platelet concentrate
requirement during cardiac surgery. (Iranian Heart Journal 2019;
20(1):39-44).<br/>Copyright &#xa9; 2019, Iranian Heart Association. All
rights reserved.

<37>
Accession Number
625728440
Title
Vasopressin therapy in cardiac surgery.
Source
Journal of Cardiac Surgery. 34 (1) (pp 20-27), 2019. Date of Publication:
January 2019.
Author
Kunkes J.H.; Baker W.L.; Hammond J.A.; Gluck J.
Institution
(Kunkes, Hammond, Gluck) Hartford Hospital, Hartford, CT, United States
(Kunkes, Hammond, Gluck) University of Connecticut School of Medicine,
Farmington, CT, United States
(Baker) University of Connecticut School of Pharmacy, Storrs, CT, United
States
(Hammond, Gluck) Heart and Vascular Institute, Hartford Healthcare,
Hartford, CT, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Arginine vasopressin (AVP) is a naturally occurring peptide
with diverse effects mediated through selective V1 and V2 receptors. About
10% of patients undergoing cardiopulmonary bypass develop postoperative
vasodilatory shock requiring high-dose catecholamines. We sought to
examine the role of AVP therapy in cardiac surgery. <br/>Method(s): A
search of Medline was conducted through September 2018 using key words and
medical subject headings (MeSH) relating to AVP, copeptin, and cardiac
surgery. A systematic review was performed on articles as they pertained
to AVP for use as a vasopressor after cardiovascular surgery complicated
by vasodilatory shock. <br/>Result(s): A relative or absolute deficiency
of Arginine vasopressin is associated with vasodilatory shock after
cardiopulmonary bypass. Physiologic replacement with exogenous Arginine
vasopressin results in significant increases in systemic vascular
resistance and mean arterial pressure with decreased requirements of
catecholamines. At doses of <0.1 U/min Arginine vasopressin is safe with
very few adverse effects. <br/>Conclusion(s): Post-cardiopulmonary bypass
vasodilatory shock is largely due to a relative deficiency of Arginine
vasopressin. Exogenous administration of low-dose Arginine vasopressin
alone or in combination with traditional catecholamines is a safe and
effective way to manage this type of vasodilatory shock.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<38>
Accession Number
624575453
Title
Comparative pharmacokinetics of tacrolimus in de novo pediatric transplant
recipients randomized to receive immediate- or prolonged-release
tacrolimus.
Source
Pediatric Transplantation. 22 (8) (no pagination), 2018. Article Number:
e13289. Date of Publication: December 2018.
Author
Vondrak K.; Dhawan A.; Parisi F.; Grenda R.; Debray D.; Marks S.D.; Webb
N.J.A.; Lachaux A.; Kazeem G.; Undre N.
Institution
(Vondrak) Department of Pediatrics, University Hospital Motol, Second
School of Medicine, Charles University, Prague, Czech Republic
(Dhawan) Paediatric Liver GI and Nutrition Center, King's College
Hospital, London, United Kingdom
(Parisi) Department of Pediatric Cardiology and Cardiac Surgery, Thoracic
Transplant Unit, Osp Pediatrico Bambino Gesu, Rome, Italy
(Grenda) Department of Nephrology and Kidney Transplantation, The
Children's Memorial Health Institute, Warsaw, Poland
(Debray) Pediatric Hepatology Unit, APHP-Hopital Universitaire
Necker-Enfants Malades, Paris, France
(Marks) Department of Paediatric Nephrology, Great Ormond Street Hospital
for Children, NHS Foundation Trust, London, United Kingdom
(Webb) Department of Paediatric Nephrology, Royal Manchester Children's
Hospital, Manchester University Foundation Trust, Manchester, United
Kingdom
(Lachaux) Service d'Hepatologie Pediatrique, Universite Lyon 1 et Hospices
Civils de Lyon, HFME, Bron Cedex, France
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kazeem) BENKAZ Consulting Ltd, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Phase 2, parallel-group, multicenter, open-label, 4-week study, comparing
PK of PR-T vs IR-T in de novo pediatric patients undergoing primary
kidney, liver, or heart transplantation. Patients randomized 1:1 to
receive once daily, PR-T-, or twice-daily, IR-T-based regimens; dose
adjustments permitted after Day 1. Twenty-four-hour PK profiles collected
on Days 1, 7, and 28. Primary endpoint: tacrolimus AUC<inf>24</inf>.
Secondary end points included tacrolimus C<inf>24</inf> and
C<inf>max</inf>. Endpoints compared between PR-T and IR-T on Days 1, 7,
and 28. Predefined similarity interval for CIs of LSM ratios: 80%-125%. PK
analysis set comprised 33 patients (PR-T, n = 15; IR-T, n = 18). Overall,
AUC<inf>24</inf> and C<inf>max</inf> were lower on Day 1 vs 7 and 28.
Geometric LSM ratios of PR-T:IR-T on Days 1, 7, and 28 were 66.3%, 92.5%,
99.9%, respectively, for AUC<inf>24</inf>; 66.3%, 82.2%, 90.9% for
C<inf>24</inf>; and 77.3%, 120.3%, 92.2% for C<inf>max</inf>.
AUC<inf>24</inf> 90% CI within predefined similarity interval on Day 28;
other 90% CIs fell outside. Linear relationship was similar between
AUC<inf>24</inf> and C<inf>24</inf>, and between tacrolimus formulations,
suggesting that the same therapeutic drug monitoring method can be used
with both formulations in de novo pediatric allograft
recipients.<br/>Copyright &#xa9; 2018 The Authors. Pediatric
Transplantation published by Wiley Periodicals, Inc

<39>
[Use Link to view the full text]
Accession Number
624867438
Title
Infectious endocarditis in the case of cirrhosis: Where do we stand?.
Source
European Journal of Gastroenterology and Hepatology. 30 (12) (pp
1406-1410), 2018. Date of Publication: 01 Dec 2018.
Author
Allaire M.; Ollivier-Hourmand I.; Garioud A.; Heng R.; Dao T.; Cadranel
J.-F.D.
Institution
(Allaire, Ollivier-Hourmand, Dao) Department of Hepato-Gastroenterology,
CHU Cote de Nacre, Caen, France
(Allaire) Inserm-U1149, CRI, Paris, France
(Garioud, Heng, Cadranel) Department of Hepato-Gastroenterology, GHPSO,
Hopital Laennec BP 72, Creil 60109, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Bacterial infections are common in the case of cirrhosis and represent a
major cause of morbidity and mortality. The most frequent infections are
spontaneous bacterial peritonitis, urinary tract infection, and pneumonia,
but few data on infectious endocarditis are available. Infectious
endocarditis is a rare event, and diagnosis can be made at all stages of
Child-Pugh classification. In the case of cirrhosis, the clinical features
and bacterial ecology are similar to that of the general population (two
males/one female, preferential location on the aortic and mitral valves,
history of heart disease, majority of Gram-positive bacteria), but
in-hospital mortality is higher. The Child-Pugh score and a history of
decompensation have been identified as independent predictive factors for
in-hospital mortality and a Child-Pugh score more than C10 was associated
with a higher risk of death. Less frequent use of aminoglycosides,
rifampin, and cardiac surgery has been described in cirrhotic patients,
probably because of potential toxicity. Nevertheless, as they are a
cornerstone of therapy, prospective studies on the impact of these
therapeutics are warranted to improve outcome in this population of
patients.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc. All rights
reserved.

<40>
Accession Number
625806118
Title
Additional filtering of blood from a cell salvage device is not likely to
show important additional benefits in outcome in cardiac surgery.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
de Vries A.J.; Vermeijden W.J.; van Pelt L.J.; van den Heuvel E.R.; van
Oeveren W.
Institution
(de Vries) Department of Anesthesiology, University Medical Center
Groningen, Groningen, Netherlands
(Vermeijden) Department of Critical Care, Medisch Spectrum Twente,
Enschede, Netherlands
(van Pelt) Department of Laboratory Medicine, University Medical Center
Groningen, Groningen, Netherlands
(van den Heuvel) Department of Mathematics & Computer Science, Eindhoven
University of Technology, Eindhoven, Netherlands
(van Oeveren) Haemoscan b.v, Groningen, Netherlands
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Several authors and manufacturers of cell salvage devices
recommend additional filtering of processed blood before transfusion.
There is no evidence to support this practice. Therefore, we compared the
clinical outcome and biochemical effects of cell salvage with or without
additional filtering. STUDY DESIGN AND METHODS: The patients, scheduled
for coronary artery bypass grafting, valve replacement, or combined
procedures were part of our randomized multicenter factorial study of cell
salvage and filter use on transfusion requirements (ISRCTN 58333401). They
were randomized to intraoperative cell salvage or cell salvage plus
additional WBC depletion filter. We compared the occurrence of major
adverse events (combined death/stroke/myocardial infarction) as primary
outcome and minor adverse events (renal function disturbances, infections,
delirium), ventilation time, and length of stay in the intensive care unit
and hospital. We also measured biochemical markers of organ injury and
inflammation. <br/>RESULT(S): One hundred eighty-nine patients had cell
salvage, and 175 patients had cell salvage plus filter and completed the
study. Demographic data, surgical procedures, and amount of salvaged blood
were not different between the groups. There was no difference in the
primary outcome with a risk of 6.3% (95% confidence interval [CI],
3.34-11.25) in the cell salvage plus filter group versus 5.8% (95% CI,
3.09-10.45) in the cell salvage group, a relative risk of 1.08 (95% CI,
0.48- 2.43]. There were no differences in minor adverse events and
biochemical markers between the groups. <br/>CONCLUSION(S): The routine
use of an additional filter for transfusion of salvaged blood is unlikely
to show important additional benefits.<br/>Copyright &#xa9; 2019 AABB

<41>
Accession Number
625353670
Title
Dopamine in critically ill patients with cardiac dysfunction: A systematic
review with meta-analysis and trial sequential analysis.
Source
Acta Anaesthesiologica Scandinavica. 63 (4) (pp 424-437), 2019. Date of
Publication: April 2019.
Author
Hiemstra B.; Koster G.; Wetterslev J.; Gluud C.; Jakobsen J.C.; Scheeren
T.W.L.; Keus F.; van der Horst I.C.C.
Institution
(Hiemstra, Koster, Keus, van der Horst) Department of Critical Care,
University of Groningen, University Medical Center Groningen, Groningen,
Netherlands
(Wetterslev, Gluud, Jakobsen) The Copenhagen Trial Unit (CTU), Centre for
Clinical Intervention Research, Copenhagen, Denmark
(Jakobsen) Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
(Scheeren) Department of Anesthesiology, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Dopamine has been used in patients with cardiac dysfunction
for more than five decades. Yet, no systematic review has assessed the
effects of dopamine in critically ill patients with cardiac dysfunction.
<br/>Method(s): This systematic review was conducted following The
Cochrane Handbook for Systematic Reviews of Interventions. We searched for
trials including patients with observed cardiac dysfunction published
until 19 April 2018. Risk of bias was evaluated and Trial Sequential
Analyses were conducted. The primary outcome was all-cause mortality at
longest follow-up. Secondary outcomes were serious adverse events,
myocardial infarction, arrhythmias, and renal replacement therapy. We used
GRADE to assess the certainty of the evidence. <br/>Result(s): We
identified 17 trials randomising 1218 participants. All trials were at
high risk of bias and only one trial used placebo. Dopamine compared with
any control treatment was not significantly associated with relative risk
of mortality (60/457 [13%] vs 90/581 [15%]; RR 0.91; 95% confidence
interval 0.68-1.21) or any other patient-centred outcomes. Trial
Sequential Analyses of all outcomes showed that there was insufficient
information to confirm or reject our anticipated intervention effects.
There were also no statistically significant associations for any of the
outcomes in subgroup analyses by type of comparator (inactive compared to
potentially active), dopamine dose (low compared to moderate dose), or
setting (cardiac surgery compared to heart failure). <br/>Conclusion(s):
Evidence for dopamine in critically ill patients with cardiac dysfunction
is sparse, of low quality, and inconclusive. The use of dopamine for
cardiac dysfunction can neither be recommended nor refuted.<br/>Copyright
&#xa9; 2018 The Authors. Acta Anaesthesiologica Scandinavica published by
John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica
Foundation.

<42>
Accession Number
625422278
Title
Remote ischaemic preconditioning increases serum extracellular vesicle
concentrations with altered micro-RNA signature in CABG patients.
Source
Acta Anaesthesiologica Scandinavica. 63 (4) (pp 483-492), 2019. Date of
Publication: April 2019.
Author
Frey U.H.; Klaassen M.; Ochsenfarth C.; Murke F.; Thielmann M.; Kottenberg
E.; Kleinbongard P.; Klenke S.; Engler A.; Heusch G.; Giebel B.; Peters J.
Institution
(Frey, Klaassen, Ochsenfarth, Kottenberg, Klenke, Engler, Peters) Klinik
fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Essen,
Universitat Duisburg-Essen, Essen, Germany
(Frey, Ochsenfarth) Klinik fur Anasthesiologie, operative Intensivmedizin,
Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitatsklinikum
der Ruhr-Universitat Bochum, Bochum, Germany
(Murke, Giebel) Institut fur Transfusionsmedizin, Universitatsklinikum,
Universitat Duisburg-Essen, Essen, Germany
(Thielmann) Klinik fur Thorax- und kardiovaskulare Chirurgie,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Essen, Germany
(Kleinbongard, Heusch) Institut fur Pathophysiologie, Westdeutsches Herz-
und Gefaszentrum, Universitatsklinikum Essen, Universitat Duisburg-Essen,
Essen, Germany
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Remote ischaemic preconditioning (RIPC) can attenuate
myocardial ischaemia/reperfusion injury but its underlying mechanisms
remain largely unknown. Recently, extracellular vesicles (EVs) containing
microRNAs (miRNAs) were shown to mediate distant intercellular
communication that may be involved in cardioprotection. We tested the
hypothesis that RIPC in anaesthetized patients undergoing coronary artery
bypass (CABG) surgery results in the release of EVs from the
ischaemic/reperfused arm into the blood stream harbouring cardioprotective
miRNAs. <br/>Method(s): In 58 patients randomised to RIPC (three 5/5
minutes episodes of left arm ischaemia/reperfusion by suprasystolic blood
pressure cuff inflations/deflations) or Sham, a subprotocol comprising of
parallel right radial artery and regional (left subclavian) venous blood
sampling before (awake) and 5 and 60 minutes after RIPC/Sham during
isoflurane/sufentanil anaesthesia could be completed. EVs were extracted
by polymer-based precipitation methods, their concentrations measured, and
their miRNA signature analysed. <br/>Result(s): Five minutes after RIPC,
regional venous EV concentrations downstream from the cuff increased and
arterial concentrations increased after 60 minutes (fold change [fc]:
RIPC: 1.33 +/- 0.5, Sham: 0.91 +/- 0.31; P = 0.003 for interaction).
Already 5 minutes after RIPC, expression of 26 miRNAs (threshold fc: 3.0,
P < 0.05) isolated from EVs including the cardioprotective miR-21 had
increased. RIPC also decreased postoperative Troponin I concentrations
(AUC RIPC: 336 ng/mL x 72 hours +/- 306 vs Sham: 713 +/- 1013; P = 0.041).
<br/>Conclusion(s): Remote ischaemic preconditioning increases serum EV
concentrations, most likely by early EV release from the patients' left
(RIPC) arm, alters their miRNA signature, and is associated with
myocardial protection. Thus, an increased EV concentration with an altered
miR-signature may mediate the RIPC effect.<br/>Copyright &#xa9; 2018 The
Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley &
Sons Ltd

<43>
[Use Link to view the full text]
Accession Number
626695880
Title
Therapeutic Challenges in Patients With Noncardioembolic Acute Ischemic
Stroke in Need of Double Antiplatelet Therapy for Coronary Artery Disease.
Source
American journal of therapeutics. 26 (2) (pp e213-e221), 2019. Date of
Publication: 01 Mar 2019.
Author
Oana Darabont R.; Stoicescu C.; Tiu C.
Institution
(Oana Darabont, Stoicescu) Discipline of Internal Medicine and Cardiology,
University Emergency Hospital Bucharest, University of Medicine and
Pharmacy "Carol Davila, Bucharest, Romania
(Tiu) Discipline of Neurology, University Emergency Hospital Bucharest,
University of Medicine and Pharmacy "Carol Davila, Bucharest, Romania
Publisher
NLM (Medline)
Abstract
BACKGROUND: The risk of ischemic stroke (IS) is significant within 6-12
months from the myocardial revascularization for an acute cardiac event.
Consequently, we can expect to have patients with an acute IS occurring
right in the time frame of dual antiplatelet therapy (DAPT) imposed by the
coronary heart disease (CHD). AREAS OF UNCERTAINTY: Until present, there
are no evidence-based guidelines for the management of patients with acute
IS in need of DAPT for ischemic heart disease. The aim of this article was
to go through the available data and to depict the appropriate therapeutic
strategy for this category of patients. DATA SOURCES: We have performed a
systematic review of the literature through June 2018, using
Medline/PubMed database. THERAPEUTIC ADVANCES: DAPT (aspirin and only
clopidogrel among all P2Y12 inhibitors) might be maintained or initiated
for CHD in patients with minor acute stroke and high-risk transient
ischemic attack patient with IS attributable to an important intracranial
stenosis, as long as this drug combination proved to be safe for them in
the prevention of stroke recurrence. In patients with IS receiving
thrombolysis, with increased size of infarction or high National Institute
of Health Stroke Score (NIHSS), the risk of hemorrhagic transformation
under DAPT must be weighed against the risk of stent thrombosis in the
coronary arteries, which, on its turn, depends on the clinical form for
which myocardial revascularization was performed, the time interval from
the complexity of a certain interventional procedure. <br/>CONCLUSION(S):
In the acute phase of an IS, maintenance or initiation of DAPT therapy
imposed by CHD relies, on one hand, on the risk of hemorrhagic
transformation of the brain injury and, on the other hand, on the risk of
stent thrombosis in the coronary arteries. The management of these
patients must be carried on by a vascular team, on an individualized
basis.

<44>
Accession Number
626688164
Title
Paraplegia prevention in aortic aneurysm repair by thoracoabdominal
staging with 'minimally invasive staged segmental artery coil
embolisation' (MIS2ACE): trial protocol for a randomised controlled
multicentre trial.
Source
BMJ open. 9 (3) (pp e025488), 2019. Date of Publication: 04 Mar 2019.
Author
Petroff D.; Czerny M.; Kolbel T.; Melissano G.; Lonn L.; Haunschild J.;
von Aspern K.; Neuhaus P.; Pelz J.; Epstein D.M.; Romo-Aviles N.;
Piotrowski K.; Etz C.D.
Institution
(Petroff, Neuhaus, Piotrowski) Clinical Trial Centre, University of
Leipzig, Leipzig, Germany
(Czerny) Department of Cardiovascular Surgery, Universitats-Herzzentrum
Freiburg Bad Krozingen GmbH, Bad Krozingen, Germany
(Czerny) Department of Cardiovascular Surgery, Albert-Ludwigs-Universitat
Freiburg Medizinische Fakultat, Freiburg, Germany
(Kolbel) Department of Vascular Medicine, University Heart Center Hamburg,
Hamburg, Germany
(Melissano) Division of Vascular Surgery, Universita Vita Salute San
Raffaele, Milano, Italy
(Lonn) Department of (Interventional) Radiology, Rigshospitalet, Denmark
(Haunschild, von Aspern, Etz) Department of Cardiac Surgery, University
Heart Center Leipzig, Leipzig, Germany
(Pelz) Department of Neurology, Universitatsklinikum Leipzig, Leipzig,
Germany
(Epstein) Economia Aplicada, Universidad de Granada - Campus de Cartuja,
Granada, Spain
(Romo-Aviles) Department of Social Anthropology, University of Granada,
Granada, Spain
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Spinal cord injury (SCI) including permanent paraplegia
constitutes a common complication after repair of thoracoabdominal aortic
aneurysms. The staged-repair concept promises to provide protection by
inducing arteriogenesis so that the collateral network can provide a
robust blood supply to the spinal cord after intervention. Minimally
invasive staged segmental artery coil embolisation (MIS2ACE) has been
proved recently to be a feasible enhanced approach to staged repair.
METHODS AND ANALYSIS: This randomised controlled trial uses a multicentre,
multinational, parallel group design, where 500 patients will be
randomised in a 1:1 ratio to standard aneurysm repair or to MIS2ACE in 1-3
sessions followed by repair. Before randomisation, physicians document
whether open or endovascular repair is planned. The primary endpoint is
successful aneurysm repair without substantial SCI 30 days after aneurysm
repair. Secondary endpoints include any form of SCI, mortality (up to
1year), length of stay in the intensive care unit, costs and
quality-adjusted life years. A generalised linear mixed model will be used
with the logit link function and randomisation arm, mode of repair (open
or endovascular repair), the Crawford type and the European System for
Cardiac Operative Risk Evaluation (euroSCORE) II as fixed effects and the
centre as a random effect. Safety endpoints include kidney failure,
respiratory failure and embolic events (also from debris). A qualitative
study will explore patient perceptions. ETHICS AND DISSEMINATION: This
trial has been approved by the lead Ethics Committee from the University
of Leipzig (435/17-ek) and will be reviewed by each of the Ethics
Committees at the trial sites. A dedicated project is coordinating
communication and dissemination of the trial. TRIAL REGISTRATION NUMBER:
NCT03434314.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2019.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<45>
Accession Number
626566803
Title
Epidural analgesia for adults undergoing cardiac surgery with or without
cardiopulmonary bypass.
Source
Cochrane Database of Systematic Reviews. 2019 (3) (no pagination), 2019.
Article Number: CD006715. Date of Publication: 01 Mar 2019.
Author
Guay J.; Kopp S.
Institution
(Guay) Department of Anesthesiology, Faculty of Medicine, University of
Sherbrooke, Sherbrooke, Canada
(Guay) Teaching and Research Unit, Health Sciences, University of Quebec
in Abitibi-Temiscamingue, Rouyn-Noranda, Canada
(Guay) Department of Anesthesiology and Critical Care, Faculty of
Medicine, Laval University, Quebec City, Canada
(Kopp) Department of Anesthesiology and Perioperative Medicine, Mayo
Clinic College of Medicine, Rochester, MN, United States
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background General anaesthesia combined with epidural analgesia may have a
beneficial effect on clinical outcomes. However, use of epidural analgesia
for cardiac surgery is controversial due to a theoretical increased risk
of epidural haematoma associated with systemic heparinization. This review
was published in 2013, and it was updated in 2019. Objectives To determine
the impact of perioperative epidural analgesia in adults undergoing
cardiac surgery, with or without cardiopulmonary bypass, on perioperative
mortality and cardiac, pulmonary, or neurological morbidity. Search
methods We searched CENTRAL, MEDLINE, and Embase in November 2018, and two
trial registers up to February 2019, together with references and relevant
conference abstracts. Selection criteria We included all randomized
controlled trials (RCTs) including adults undergoing any type of cardiac
surgery under general anaesthesia and comparing epidural analgesia versus
another modality of postoperative pain treatment. The primary outcome was
mortality. Data collection and analysis We used standard methodological
procedures as expected by Cochrane. Main results We included 69 trials
with 4860 participants: 2404 given epidural analgesia and 2456 receiving
comparators (systemic analgesia, peripheral nerve block, intrapleural
analgesia, or wound infiltration). The mean (or median) age of
participants varied between 43.5 years and 74.6 years. Surgeries performed
were coronary artery bypass grafting or valvular procedures and surgeries
for congenital heart disease. We judged that no trials were at low risk of
bias for all domains, and that all trials were at unclear/high risk of
bias for blinding of participants and personnel taking care of study
participants. Epidural analgesia versus systemic analgesia Trials show
there may be no difference in mortality at 0 to 30 days (risk difference
(RD) 0.00, 95% confidence interval (CI) -0.01 to 0.01; 38 trials with 3418
participants; low-quality evidence), and there may be a reduction in
myocardial infarction at 0 to 30 days (RD -0.01, 95% CI -0.02 to 0.00; 26
trials with 2713 participants; low-quality evidence). Epidural analgesia
may reduce the risk of 0 to 30 days respiratory depression (RD -0.03, 95%
CI -0.05 to -0.01; 21 trials with 1736 participants; low-quality
evidence). There is probably little or no difference in risk of pneumonia
at 0 to 30 days (RD -0.03, 95% CI -0.07 to 0.01; 10 trials with 1107
participants; moderate-quality evidence), and epidural analgesia probably
reduces the risk of atrial fibrillation or atrial flutter at 0 to 2 weeks
(RD -0.06, 95% CI -0.10 to -0.01; 18 trials with 2431 participants;
moderate-quality evidence). There may be no difference in cerebrovascular
accidents at 0 to 30 days (RD -0.00, 95% CI -0.01 to 0.01; 18 trials with
2232 participants; very low-quality evidence), and none of the included
trials reported any epidural haematoma events at 0 to 30 days (53 trials
with 3982 participants; low-quality evidence). Epidural analgesia probably
reduces the duration of tracheal intubation by the equivalent of 2.4 hours
(standardized mean difference (SMD) -0.78, 95% CI -1.01 to -0.55; 40
trials with 3353 participants; moderate-quality evidence). Epidural
analgesia reduces pain at rest and on movement up to 72 hours after
surgery. At six to eight hours, researchers noted a reduction in pain,
equivalent to a reduction of 1 point on a 0 to 10 pain scale (SMD -1.35,
95% CI -1.98 to -0.72; 10 trials with 502 participants; moderate-quality
evidence). Epidural analgesia may increase risk of hypotension (RD 0.21,
95% CI 0.09 to 0.33; 17 trials with 870 participants; low-quality
evidence) but may make little or no difference in the need for infusion of
inotropics or vasopressors (RD 0.00, 95% CI -0.06 to 0.07; 23 trials with
1821 participants; low-quality evidence). Epidural analgesia versus other
comparators Fewer studies compared epidural analgesia versus peripheral
nerve blocks (four studies), intrapleural analgesia (one study), and wound
infiltration (one study). Investigators provided no data for pulmonary
complications, atrial fibrillation or flutter, or for any of the
comparisons. When reported, other outcomes for these comparisons
(mortality, myocardial infarction, neurological complications, duration of
tracheal intubation, pain, and haemodynamic support) were uncertain due to
the small numbers of trials and participants. Authors' conclusions
Compared with systemic analgesia, epidural analgesia may reduce the risk
of myocardial infarction, respiratory depression, and atrial
fibrillation/atrial flutter, as well as the duration of tracheal
intubation and pain, in adults undergoing cardiac surgery. Theremay be
little or no difference in mortality, pneumonia, and epidural haematoma,
and effects on cerebrovascular accident are uncertain. Evidence is
insufficient to show the effects of epidural analgesia compared with
peripheral nerve blocks, intrapleural analgesia, or wound
infiltration.<br/>Copyright &#xa9; 2019 The Cochrane Collaboration.
Published by John Wiley and Sons, Ltd.

<46>
Accession Number
2001672743
Title
Danon disease: Gender differences in presentation and outcomes.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Brambatti M.; Caspi O.; Maolo A.; Koshi E.; Greenberg B.; Taylor M.R.G.;
Adler E.D.
Institution
(Brambatti, Caspi, Maolo, Koshi, Greenberg, Adler) Division of Cardiology,
University of California San Diego, San Diego, CA, United States
(Taylor) Cardiovascular Institute and Adult Medical Genetics Program,
University of Colorado Denver, CO, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Danon disease (DD) is a rare X-linked autophagic vacuolar
myopathy, characterized by high penetrance and severe cardiomyopathy.
Because of its rarity, the natural history (NH) is uncertain.
<br/>Objective(s): We aimed to describe disease variability and outcomes
through a systematic review of all published DD cases. <br/>Method(s):
Among 83 manuscripts in MEDLINE and EMBASE on DD cases published until
October 2017, we identified 146 patients with positive genetic testing for
DD or positive muscle biopsy in a relative of a genetically diagnosed
proband. <br/>Result(s): 56 females and 90 males were identified. 92.5% of
patients had cardiac abnormalities. Females presented with either
hypertrophic cardiomyopathy (HCM, 70.3%) or dilated cardiomyopathy (DCM,
29.3%) whereas males presented with HCM 96.2% of the time. The composite
outcome of death, heart transplant or ventricular assist devices occurred
equally in both sexes (32% of females and 37% of males, p = 0.60) but
later in females (median age 38 years) than in males (median age 21 years,
p < 0.001). Whereas women present with isolated cardiac disease 73% of the
time, in males DD was frequently multisystemic and presented as a triad of
cognitive impairment, skeletal myopathy, and HCM in 42% of patients.
<br/>Conclusion(s): In this first systematic review of DD, we confirmed
the severe morbidity and mortality associated with disease in both sexes.
Women presented with both HCM and DCM and generally with isolated cardiac
disease, whereas in men DD usually presented as HCM and was frequently
multi-systemic. Further prospective NH studies will be required to confirm
these findings.<br/>Copyright &#xa9; 2019 Elsevier B.V.

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

<48>
Accession Number
603966210
Title
The Preventive Effects of Posterior Pericardiotomy with Intrapericardial
Tube on the Development of Pericardial Effusion, Atrial Fibrillation, and
Acute Kidney Injury after Coronary Artery Surgery: A Prospective,
Randomized, Controlled Trial.
Source
Thoracic and Cardiovascular Surgeon. 64 (3) (pp 217-224), 2016. Date of
Publication: 01 Apr 2016.
Author
Kaya M.; Utkusavas A.; Erkanli K.; Guler S.; Kyaruzi M.; Birant A.;
Karacalilar M.; Akkus M.; Bakir I.
Institution
(Kaya, Erkanli, Guler, Kyaruzi, Karacalilar, Bakir) Department of
Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Utkusavas) Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
(Birant) Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Akkus) Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Pericardial effusion (PE), atrial fibrillation (AF), and acute
kidney injury (AKI) are commonly found after coronary artery surgery.
These adverse events may also be interwoven in the postoperative period.
In this prospective study, we investigated whether posterior
pericardiotomy (PP) with intrapericardial tube positioned along the right
atrium (pericardial space intervention) is effective in the prevention of
these adverse events. Methods The patients were randomly distributed to
the study and control groups. The study group consisted of patients with
pericardial space intervention, whereas the control group consisted of
patients without pericardial space interventions. In all patients, a
straight tube was placed in the anterior mediastinum and an angled tube
was placed into the left hemithorax. Results A total of 210 patients were
studied: 107 in the control group and 103 in the study group.
Statistically significant results were obtained in the amount of PE,
cardiac tamponade, AF (p = 0.019), and AKI during the postoperative
period, in favor of the study group. Length of hospital stay was
significantly shorter in the study group (6.11 +/- 2.31, p = 0.009).
Conclusion The PP with intrapericardial tube approach is safe, easy, and
effective in the prevention of PE, cardiac tamponade, and AF. The use of
this approach may reduce the risk of developing AKI during the
postoperative period. Besides, this technique also reduces the length of
hospital stay.<br/>Copyright &#xa9; 2016 Georg Thieme Verlag KG.

<49>
Accession Number
626519353
Title
The effect of hyperoxia on mortality in critically ill patients: A
systematic review and meta analysis.
Source
BMC Pulmonary Medicine. 19 (1) (no pagination), 2019. Article Number:
0810. Date of Publication: 26 Feb 2019.
Author
Ni Y.-N.; Wang Y.-M.; Liang B.-M.; Liang Z.-A.
Institution
(Ni, Liang, Liang) Department of Respiratory and Critical Care, West China
School of Medicine and West China Hospital, Sichuan University, No.37
Guoxue Alley, Chengdu 610041, China
(Wang) Department of Respiratory Medicine, Sichuan Second Hospital of
Traditional Chinese Medicine, Chengdu, Sichuan 610031, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Studies investigating the role of hyperoxia in critically ill
patients have reported conflicting results. We did this analysis to reveal
the effect of hyperoxia in the patients admitted to the intensive care
unit (ICU). <br/>Method(s): Electronic databases were searched for all the
studies exploring the role of hyperoxia in adult patients admitted to ICU.
The primary outcome was mortality. Random-effect model was used for
quantitative synthesis of the adjusted odds ratio (aOR). <br/>Result(s):
We identified 24 trials in our final analysis. Statistical heterogeneity
was found between hyperoxia and normoxia groups in patients with
mechanical ventilation (I² = 92%, P < 0.01), cardiac
arrest(I² = 63%, P = 0.01), traumatic brain injury
(I² = 85%, P < 0.01) and post cardiac surgery (I² =
80%, P = 0.03). Compared with normoxia, hyperoxia was associated with
higher mortality in overall patients (OR 1.22, 95% CI 1.12~1.33), as well
as in the subgroups of cardiac arrest (OR 1.30, 95% CI 1.08~1.57) and
extracorporeal life support (ELS) (OR 1.44, 95% CI 1.03~2.02).
<br/>Conclusion(s): Hyperoxia would lead to higher mortality in critically
ill patients especially in the patients with cardiac arrest and
ELS.<br/>Copyright &#xa9; 2019 The Author(s).

<50>
Accession Number
624425119
Title
Normothermic versus hypothermic cardiopulmonary bypass in low-risk
paediatric heart surgery: A randomised controlled trial.
Source
Heart. 105 (6) (pp 455-464), 2019. Date of Publication: 01 Mar 2019.
Author
Caputo M.; Pike K.; Baos S.; Sheehan K.; Selway K.; Ellis L.; Stoica S.;
Parry A.; Clayton G.; Culliford L.; Angelini G.D.; Pandey R.; Rogers C.A.
Institution
(Caputo, Sheehan, Selway, Stoica, Parry, Pandey) Bristol Royal Hospital
for Children, University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Pike, Baos, Ellis, Clayton, Culliford, Rogers) Clinical Trials and
Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol,
United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To compare normothermic (35degreeC-36degreeC) versus hypothermic
(28degreeC) cardiopulmonary bypass (CPB) in paediatric patients undergoing
open heart surgery to test the hypothesis that normothermic CPB perfusion
maintains the functional integrity of major organ systems leading to
faster recovery. Methods Two single-centre, randomised controlled trials
(known as Thermic-1 and Thermic-2, respectively) were carried out to
compare the effectiveness and acceptability of normothermic versus
hypothermic CPB in children with congenital heart disease undergoing open
heart surgery. In both studies, the co-primary clinical outcomes were
duration of inotropic support, intubation time and postoperative hospital
stay. Results In total, 200 participants were recruited; 59 to the
Thermic-1 study and 141 to the Thermic-2 study. 98 patients received
normothermic CPB and 102 patients received hypothermic CPB. There were no
significant differences between the treatment groups for any of the
co-primary outcomes: Inotrope duration HR=1.01, 95% CI (0.72 to 1.41);
intubation time HR=1.14, 95% CI (0.86 to 1.51); postoperative hospital
stay HR=1.06, 95% CI (0.80 to 1.40). Differences favouring normothermia
were found in urea nitrogen at 2 days geometric mean ratio (GMR)=0.86 95%
CI (0.77 to 0.97); serum creatinine at 3 days GMR=0.89, 95% CI (0.81 to
0.98); urinary albumin at 48 hours GMR=0.32, 95% CI (0.14 to 0.74) and
neutrophil gelatinase-associated lipocalin at 4 hours GMR=0.47, 95% CI
(0.22 to 1.02), but not at other postoperative time points. Conclusions
Normothermic CPB is as safe and effective as hypothermic CPB and can be
routinely adopted as a perfusion strategy in low-risk infants and children
undergoing open heart surgery. Trial registration number
ISRCTN93129502.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019.

<51>
Accession Number
2001577057
Title
Heparin initiation before and after femoral arterial access in primary
percutaneous coronary intervention: Side effects and angiographic success
rates.
Source
Iranian Heart Journal. 19 (4) (pp 18-25), 2018. Date of Publication: 2018.
Author
Mehr A.Z.; Sanati H.R.; Shakerian F.; Firouzi A.; Kiani R.; Zameni M.A.
Institution
(Mehr, Sanati, Shakerian, Firouzi, Kiani) Cardiovascular Intervention
Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Zameni) Rajaie Cardiovascular, Medical, and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: Percutaneous coronary intervention (PCI) with the addition of
potent antithrombotic medications is the best therapy recommended for
ST-elevation myocardial infarction (STEMI). The prehospital administration
of heparin is commonly prescribed in the absence of conclusive data
supporting its administration time. We aimed to study the side effects of
heparin administration, especially hematoma formation at the arterial
access site, between patients who received it before and after femoral
arterial access in PCI. <br/>Method(s): This prospectively randomized
clinical trial studied 128 patients who were diagnosed with STEMI and
candidated for primary PCI at Rajaie Cardiovascular, Medical, and Research
Center. Ninety-six patients who fulfilled the inclusion criteria were
enrolled and randomly allocated to 2 groups according to a random table.
The first group received heparin before the establishment of the femoral
arterial access in the catheterization laboratory or in the ambulance (as
soon as possible), while the second group received intravenous heparin
after arterial access insertion for primary PCI. The systemic side effects
of heparin and its angiographic appearances were compared between the 2
groups. <br/>Result(s): The administration of unfractionated heparin
before femoral arterial access in primary PCI had no more hematoma
formation than did heparin injection after femoral arterial access
(P=0.03). The study was unable to make any judgments regarding the
angiographic thrombus burden before primary PCI according to the time of
heparin injection because of the low volume of the patients; nonetheless,
there was no significant difference between the 2 groups concerning
thrombus burden. <br/>Conclusion(s): Heparin therapy before femoral
arterial access in primary PCI had no deleterious effect on hematoma
formation.<br/>Copyright &#xa9; 2018, Iranian Heart Association. All
rights reserved.

<52>
Accession Number
2001576965
Title
Which suction method is preferable for patients after cardiac surgery:
Open or closed endotracheal suction system?.
Source
Iranian Heart Journal. 19 (3) (pp 51-59), 2018. Date of Publication: 2018.
Author
Alavi S.M.; Babaei T.; Shaverdian S.; Norouzi Z.; Ghadrdoost B.;
Ziyaeifard M.; Bakhshandeh H.
Institution
(Alavi, Babaei, Shaverdian, Norouzi, Ghadrdoost, Ziyaeifard) Rajaie
Cardiovascular, Medical, and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Bakhshandeh) Cardiovascular Intervention Research Center, Rajaie
Cardiovascular, Medical, and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: There are 2 different methods of suctioning the airway: the
open tracheal suction system (OTSS) and the closed tracheal suction system
(CTSS). The aim of this study was to compare the efficacy of the OTSS and
the CTSS in maintaining the stability of hemodynamic and oxygen parameters
in patients after cardiac surgery. <br/>Method(s): This randomized
controlled clinical trial was conducted on 60 patients who were under
mechanical ventilation after cardiac surgery. The study population was
randomly divided into the OTSS and CTSS groups. All the patients were at
least 18 years old and hemodynamically stable. Hemodynamic parameters such
as systolic and diastolic blood pressures were measured. Oxygen parameters
such as the saturation percentage of arterial blood oxygen
(SpO<inf>2</inf>) and the oxygen pressure of arterial blood
(PaO<inf>2</inf>) were measured before, immediately, and also 3 and 5
minutes after suction. All the parameters were compared between the 2
groups. <br/>Result(s): The mean heart rate, the mean systolic blood
pressure, and the mean arterial blood pressure showed a higher increase in
the OTSS group (P<0.05), whereas the mean PaO<inf>2</inf> and
SpO<inf>2</inf> were higher in the CTSS group (P<0.05).
<br/>Conclusion(s): The CTSS caused fewer disturbances in the hemodynamic
and oxygen parameters in comparison with the OTSS in our study population.
Therefore, disturbances in the aforementioned parameters can be avoided by
using the CTSS in patients undergoing cardiac surgery.<br/>Copyright
&#xa9; 2018, Iranian Heart Association. All rights reserved.

<53>
Accession Number
2001085516
Title
Calculation Algorithm Reduces Protamine Doses Without Increasing Blood
Loss or the Transfusion Rate in Cardiac Surgery: Results of a Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 985-992),
2019. Date of Publication: April 2019.
Author
Kjellberg G.; Holm M.; Fux T.; Lindvall G.; van der Linden J.
Institution
(Kjellberg) Department of Thoracic Surgery and Anesthesia, Academic
Hospital, Uppsala, Sweden
(Kjellberg, Holm, Fux, Lindvall, van der Linden) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Holm) Division of Perioperative Medicine and Intensive Care, Karolinska
University Hospital, Huddinge, Sweden
(Fux, Lindvall, van der Linden) Division of Perioperative Medicine and
Intensive Care, Section Cardiothoracic Surgery and Anesthesiology,
Karolinska University Hospital, Stockholm, Sweden
Publisher
W.B. Saunders
Abstract
Objectives: The aim of the study was to investigate whether the HeProCalc
algorithm affects heparin and protamine dosage, postoperative blood loss,
and transfusion rate. <br/>Design(s): Randomized controlled trial.
<br/>Setting(s): University hospital. <br/>Participant(s): The study
comprised 210 cardiac surgery patients undergoing cardiac surgery with
cardiopulmonary bypass. Twenty patients were excluded because of
re-exploration for localized surgical bleeding (n = 9), violation of
protocol (n = 2), aprotinin use (n = 3 and nadir body temperature
<32degreeC (n = 6). <br/>Intervention(s): Study participants were randomly
assigned to either traditional heparin and protamine dosage based on body
weight only (control group) or dosage based on the HeProCalc algorithm
(intervention group). <br/>Measurements and Main Results: The initial
median heparin dose was 32,500 IU (interquartile range [IQR]
30,000-35,000) in the intervention group compared with 35,000 IU (IQR
30,000-37,500) (p = 0.025) in the control group. The total heparin dose in
the intervention group was 40,000 IU (IQR 32,500-47,500) compared with
42,500 IU (IQR 35,000-50,000) in the control group (p = 0.685). The total
protamine dose was 210 mg (IQR 190-240) in the intervention group compared
with 350 mg (IQR 300-380) (p < 0.001) in the control group. The ratio of
total protamine to initial dose of heparin in the intervention group was
0.62 compared with 1.0 (p < 0.001). The amount of chest tube bleeding
after 12 postoperative hours was 320 mL (IQR 250-460) in the intervention
group compared with 350 mL (IQR 250-450) (p = 0.754) in the control group.
Neither the transfusion rate nor postoperative blood loss differed
significantly between the 2 groups. <br/>Conclusion(s): Use of the
HeProCalc algorithm reduced protamine dosage and the protamine/heparin
ratio after cardiopulmonary bypass compared with conventional dosage based
on weight without significant effect on postoperative blood loss or the
transfusion rate.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<54>
Accession Number
2001135853
Title
Comparing Combined Short-Axis and Long-Axis Ultrasound-Guided Central
Venous Catheterization With Conventional Short-Axis Out-of-Plane
Approaches.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 1029-1034),
2019. Date of Publication: April 2019.
Author
Takeshita J.; Nishiyama K.; Fukumoto A.; Shime N.
Institution
(Takeshita) Department of Intensive Care Medicine, Osaka Prefectural
Hospital Organization, Osaka Women's and Children's Hospital, Izumi,
Osaka, Japan
(Nishiyama) Department of Emergency and Critical Care Medicine, National
Hospital Organization, Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
(Fukumoto) Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital,
Yamashina-ku, Kyoto, Japan
(Shime) Department of Emergency and Critical Care Medicine, Institute of
Biomedical and Health Sciences, Hiroshima University, Minami-ku,
Hiroshima, Japan
Publisher
W.B. Saunders
Abstract
Objective: Visualizing the needle tip using the short-axis out-of-plane
(SA-OOP) ultrasound-guided central venous catheterization approach is
difficult and results in posterior wall puncture (PWP). To improve needle
tip visualization in the long-axis view, combining the SA-OOP and the
long-axis in-plane approaches has been suggested. The authors, who
previously reported on the utility of this technique using a manikin
model, examined the feasibility of this novel method (referred to as the
combined short-axis and long-axis [CSLA] approach) and compared the CSLA
approach with the SA-OOP approach in humans for the present study.
<br/>Design(s): Prospective observational study. <br/>Setting(s): Single
institution, Rakuwakai Otowa Hospital. <br/>Participant(s): Patients
undergoing cardiac or vascular surgeries. <br/>Intervention(s): The CSLA
and SA-OOP approaches were used for ultrasound-guided right jugular venous
puncture. The puncturing procedures were determined arbitrarily
preoperatively without consideration of the patient's neck anatomy and
were based on the operator's preference without randomization.
<br/>Measurements and Main Results: The study comprised 100 patients.
Successful guidewire insertion without PWP was performed in 48 patients
(96%) in the CSLA approach group and 33 (66%) in the SA-OOP approach
group; the rate was significantly higher in the CSLA approach group (p =
0.0001). The procedural durations were 27.5 (range 17.0-122.0) seconds in
the CSLA approach group and 25.0 (range 15.0-158.0) seconds in the SA-OOP
approach group (p = 0.19). <br/>Conclusion(s): This study showed that the
CSLA approach to ultrasound-guided central venous catheterization might
help prevent PWP.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<55>
Accession Number
2001137367
Title
Perioperative Right Ventricular Pressure Monitoring in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 1090-1104),
2019. Date of Publication: April 2019.
Author
Raymond M.; Gronlykke L.; Couture E.J.; Desjardins G.; Cogan J.; Cloutier
J.; Lamarche Y.; L'Allier P.L.; Ravn H.B.; Couture P.; Deschamps A.;
Chamberland M.-E.; Ayoub C.; Lebon J.-S.; Julien M.; Taillefer J.; Rochon
A.; Denault A.Y.
Institution
(Raymond, Desjardins, Cogan, Couture, Deschamps, Chamberland, Ayoub,
Lebon, Julien, Taillefer, Rochon) Department of Anesthesiology, Montreal
Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
(Gronlykke, Ravn) Department of Cardiothoracic Anaesthesia,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Couture) Intensive Care Program, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada
(Cloutier) Department of Anesthesiology, Saint John Regional Hospital,
Saint John, New Brunswick, Canada
(Lamarche) Department of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada
(L'Allier) Department of Cardiology, Montreal Heart Institute, Universite
de Montreal, Montreal, Quebec, Canada
(Denault) Department of Anesthesiology and Cardiac Surgical Intensive Care
Department, Montreal Heart Institute, Universite de Montreal, Montreal,
Quebec, Canada
Publisher
W.B. Saunders
Abstract
Right ventricular (RV) dysfunction is a cause of increased morbidity and
mortality in both cardiac surgery and noncardiac surgery and in the
intensive care unit. Early diagnosis of this condition still poses a
challenge. The diagnosis of RV dysfunction traditionally is based on a
combination of echocardiography, hemodynamic measurements, and clinical
symptoms. This review describes the method of using RV pressure waveform
analysis to diagnose and grade the severity of RV dysfunction. The authors
describe the technique, optimal use, and pitfalls of this method, which
has been used at the Montreal Heart Institute since 2002, and review the
current literature on this method. The RV pressure waveform is obtained
using a pulmonary artery catheter with the capability of measuring RV
pressure by connecting a pressure transducer to the pacemaker port. The
authors describe how RV pressure waveform analysis can facilitate the
diagnosis of systolic and diastolic RV dysfunction, the evaluation of
RV-arterial coupling, and help diagnose RV outflow tract obstruction. RV
pressure waveform analysis also can be used to guide pharmacologic
treatment and fluid resuscitation strategies for RV
dysfunction.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<56>
Accession Number
605676644
Title
Erratum to: The preventive effects of posterior pericardiotomy with
intrapericardial tube on the development of pericardial effusion, atrial
fibrillation, and acute kidney injury after coronary artery surgery: A
prospective, randomized, controlled trial (Thoracic and Cardiovascular
Surgeon (2015) DOI: 10.1055/s-0035-1548737).
Source
Thoracic and Cardiovascular Surgeon. 64 (3) (pp E1-E2), 2016. Date of
Publication: 2016.
Author
Kaya M.; Savas A.U.; Erkanli K.; Guler S.; Kyaruzi M.; Birant A.;
Karacalilar M.; Akkus M.; Bakir I.
Institution
(Kaya, Erkanli, Guler, Kyaruzi, Karacalilar, Bakir) Department of
Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Mehmet Akif Ersoy
GKDC Egitim Hastanesi Halkali Kucukcekmece, Istanbul 34000, Turkey
(Savas) Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Birant) Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Akkus) Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
It has been brought to the Editor's attention that Table 2 in the above
publication contains an error in measurement units. The amount of
pericardial effusion by echocardiography is measured in mm, not in mL.
Article published eFirst on April 14, 2015. DOI of the original article:
10.1055/s-0035-1548737.<br/>Copyright &#xa9; 2016 Georg Thieme Verlag KG
Stuttgart - New York.

<57>
Accession Number
2001599107
Title
The effects of low-volume high-intensity interval versus moderate
intensity continuous training on heart rate variability, and hemodynamic
and echocardiography indices in men after coronary artery bypass grafting:
A randomized clinical trial study.
Source
ARYA Atherosclerosis. 14 (6) (pp 260-271), 2018. Date of Publication:
2018.
Author
Ghardashi-Afousi A.; Holisaz M.T.; Shirvani H.; Pishgoo B.
Institution
(Ghardashi-Afousi) Department of Exercise Physiology, School of Physical
Education and Exercise Sciences, University of Tehran AND Exercise
Physiology Research Center, Life Style Institute, Baqiyatallah University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Holisaz) Department of Physical Medicine and Rehabilitation, School of
Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Shirvani) Exercise Physiology Research Center, Life Style Institute,
Baqiyatallah University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Pishgoo) Atherosclerosis Research Center, School of Medicine,
Baqiyatallah University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: Heart rate variability (HRV) declines after coronary artery
bypass grafting (CABG). The purpose of this study was to evaluate the
effect of low-volume high-intensity interval training (LV-HIIT) and
moderate-intensity continuous training (MICT) on HRV as well as,
hemodynamic and echocardiography indices. <br/>METHOD(S): Forty-two men
after CABG (55.12 +/- 3.97 years) were randomly assigned into LVHIIT,
MICT, and control (CTL) groups. The exercise training in LV-HIIT consisted
of 2-minute interval at 85-95 percent of maximal heart rate (HRmax),
2-minute interval at 50% of HRmax and 40-minute interval at 70% of HRmax
in MICT for three sessions in a week, for 6-weeks. HRV parameters were
evaluated by 24-hour Holter electrocardiography (ECG) recording, and
echocardiography parameters at baseline and end of intervention were
measured in all 3 groups. <br/>RESULT(S): At the end of the intervention,
left ventricular ejection fraction (LVEF) significantly increased in
LV-HIIT group (58.53 +/- 7.26 percent) compared with MICT (52.26 +/- 7.91
percent) and CTL (49.68 +/- 7.27 percent) groups (P < 0.001). Furthermore,
mean R-R interval, root mean square successive difference (RMSSD) of R-R
interval, and standard deviation of R-R interval (SDRR) in LV-HIIT group
considerably increased compared with MICT group (P < 0.001).
High-frequency power (HF) significantly increased in LV-HIIT and MICT
groups compared with CTL group (P < 0.001). On the other hand, low
frequency (LF) and LF/HF ratio significantly decreased in LV-HIIT group in
comparison with MICT group (P < 0.010). <br/>CONCLUSION(S): These results
suggest that LV-HIIT has a greater effect on improvement of cardiac
autonomic activities by increasing R-R interval, SDRR, RMSSD, and HF, and
decreasing LF and LF/HF ratio in patients after CABG.<br/>Copyright &#xa9;
2018, Isfahan University of Medical Sciences(IUMS). All rights reserved

<58>
Accession Number
626668069
Title
Cardioplegia in paediatric cardiac surgery: A systematic review of
randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (1) (pp 144-150),
2019. Date of Publication: 01 Jan 2019.
Author
Drury N.E.; Yim I.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.;
Jones T.J.
Institution
(Drury, Yim, Patel, Oswald, Stickley, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Steelhouse Lane,
Birmingham B4 6NH, United Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
OBJECTIVES: Cardioplegia is the primary method for myocardial protection
during cardiac surgery. We conducted a systematic review of randomized
controlled trials of cardioplegia in children to evaluate the current
evidence base. <br/>METHOD(S): We searched MEDLINE, CENTRAL and LILACS and
manually screened retrieved references and systematic reviews to identify
all randomized controlled trials comparing cardioplegia solutions or
additives in children undergoing cardiac surgery published in any
language; secondary publications and those reporting inseparable adult
data were excluded. Two or more reviewers independently screened studies
for eligibility and extracted data; the Cochrane Risk of Bias tool was
used to assess for potential biases. <br/>RESULT(S): We identified 26
trials randomizing 1596 children undergoing surgery; all were
single-centre, Phase II trials, recruiting few patients (median 48,
interquartile range 30-99). The most frequent comparison was blood versus
crystalloid in 10 (38.5%) trials, and the most common end points were
biomarkers of myocardial injury (17, 65.4%), inotrope requirements (15,
57.7%) and length of stay in the intensive care unit (11, 42.3%). However,
the heterogeneity of patients, interventions and reported outcome measures
prohibited metaanalysis. Overall risk of bias was high in 3 (11.5%)
trials, unclear in 23 (88.5%) and low in none. <br/>CONCLUSION(S): The
current literature on cardioplegia in children contains no late phase
trials. The small size, inconsistent use of end points and low quality of
reported trials provide a limited evidence base to inform practice. A core
outcome set of clinically important, standardized, validated end points
for assessing myocardial protection in children should be developed to
facilitate the conduct of highquality, multicentre trials.<br/>Copyright
&#xa9; The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<59>
Accession Number
626667961
Title
Simulation training for lobectomy: A review of current literature and
future directions.
Source
European Journal of Cardio-thoracic Surgery. 55 (3) (pp 386-394), 2019.
Date of Publication: 01 Mar 2019.
Author
Nashaat A.; Sidhu H.S.; Yatham S.; Al-Azzawi M.; Preece R.
Institution
(Nashaat, Sidhu, Yatham) St George's University of London, London, United
Kingdom
(Al-Azzawi) Department of Trauma and Orthopaedics, Royal Victoria
Hospital, Belfast, United Kingdom
(Preece) Department of Vascular Surgery, St George's University Hospital,
London SW17 0QT, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
With growing work-time restrictions and public expectations, the
Halstedian educational model of 'see one, do one, teach one' is unfit for
the modern training of thoracic residents. With the cardiothoracic
surgical workforce set to decline by 50% over the next 10 years, new
models are desperately needed to help trainees bypass the early
error-prone phase of the lobectomy learning curve. In this review, we
detail the development and validation of numerous simulators designed to
teach trainees an array of skills ranging from basic technical skills to
more complex non-technical skills. Given the recent increases in minimally
invasive lobectomies, we critique both open and thoracoscopic simulators.
We elucidate that whilst there are a growing number of thoracic simulators
of varying fidelity available, fundamentally, there is currently a
significant lack of well-designed trials validating various simulators for
teaching lobectomy despite an awareness of their potential to improve
surgical education. Furthermore, there is a void in the simulation
training of non-technical skills within thoracic surgery. Encouragingly,
there is a definite awareness of the ability of simulation to aid with the
training of future thoracic surgical trainees.<br/>Copyright &#xa9; 2018.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<60>
Accession Number
626667032
Title
Can definitive chemoradiotherapy be an alternative to surgery for
early-stage oesophageal cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (1) (pp 37-40), 2019.
Date of Publication: 01 Jan 2019.
Author
Deng H.-Y.; Li G.; Luo J.; Alai G.
Institution
(Deng, Li, Luo, Alai) Lung Cancer Center, West China Hospital, Sichuan
University, Chengdu, China
(Deng) Department of Thoracic Surgery, West China Hospital, Sichuan
University, No. 37 Guoxue Alley, Chengdu 610041, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Can definitive
chemoradiotherapy (CRT) be an alternative to surgery for early-stage
oesophageal cancer? A total of 622 papers were found using the reported
search, of which 5 cohort studies represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. Three cohort studies with very
limited sample size reported that definitive CRT yielded comparable
overall survival to surgery, whereas the other 2 studies with large sample
size reported that definitive CRT yielded worse survival than surgery. Two
of the cohort studies also reported that definitive CRT was associated
with significantly higher rates of recurrence than surgery. The available
evidence, while both scarce and of poor quality, suggests that definitive
CRT for early-stage oesophageal cancer resulted in worse overall survival
and more recurrence when compared to surgery. Therefore, we would
recommend that surgery still remains the standard treatment for patients
with early-stage oesophageal cancer, whereas definitive CRT could be an
alternative to surgery for patients unfit for surgery, although with
slightly inferior outcomes.<br/>Copyright &#xa9; The Author(s) 2018.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<61>
Accession Number
2001092706
Title
Hydroxocobalamin for the Treatment of Vasoplegia: A Review of Current
Literature and Considerations for Use.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 894-901),
2019. Date of Publication: April 2019.
Author
Shapeton A.D.; Mahmood F.; Ortoleva J.P.
Institution
(Shapeton, Mahmood, Ortoleva) Department of Anesthesia, Critical Care and
Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United
States
Publisher
W.B. Saunders

<62>
Accession Number
626552432
Title
Early nasal high-flow versus Venturi mask oxygen therapy after lung
resection: A randomized trial.
Source
Critical Care. 23 (1) (no pagination), 2019. Article Number: 68. Date of
Publication: 28 Feb 2019.
Author
Pennisi M.A.; Bello G.; Congedo M.T.; Montini L.; Nachira D.; Ferretti
G.M.; Meacci E.; Gualtieri E.; De Pascale G.; Grieco D.L.; Margaritora S.;
Antonelli M.
Institution
(Pennisi, Bello, Montini, Gualtieri, De Pascale, Grieco, Antonelli)
Dipartimento Delle Scienze dell'Emergenza, Anestesiologiche e della
Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e
Tossicologia Clinica, Fondazione Policlinico Universitario A. Gemelli
IRCCS, Rome, Italy
(Pennisi, Bello, Montini, Gualtieri, De Pascale, Grieco, Antonelli)
Istituto di Anestesia e Rianimazione, Universita Cattolica Del Sacro
Cuore, Rome, Italy
(Congedo, Nachira, Ferretti, Meacci, Margaritora) Dipartimento Delle
Scienze Cardiovascolari e Toraciche, UOC di Chirurgia Toracica, Fondazione
Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
(Congedo, Nachira, Ferretti, Meacci, Margaritora) Istituto di Patologia
Speciale Chirurgica, Universita Cattolica Del Sacro Cuore, Rome, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Data on high-flow nasal oxygen after thoracic surgery are
limited and confined to the comparison with low-flow oxygen. Different
from low-flow oxygen, Venturi masks provide higher gas flow at a
predetermined fraction of inspired oxygen (FiO<inf>2</inf>). We conducted
a randomized trial to determine whether preemptive high-flow nasal oxygen
reduces the incidence of postoperative hypoxemia after lung resection, as
compared to Venturi mask oxygen therapy. <br/>Method(s): In this
single-center, randomized trial conducted in a teaching hospital in Italy,
consecutive adult patients undergoing thoracotomic lung resection, who
were not on long-term oxygen therapy, were randomly assigned to receive
high-flow nasal or Venturi mask oxygen after extubation continuously for
two postoperative days. The primary outcome was the incidence of
postoperative hypoxemia (i.e., ratio of the partial pressure of arterial
oxygen to FiO<inf>2</inf> (PaO<inf>2</inf>/FiO<inf>2</inf>) lower than 300
mmHg) within four postoperative days. <br/>Result(s): Between September
2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed
(47 in high-flow group and 48 in Venturi mask group). In both groups, 38
patients (81% in the high-flow group and 79% in the Venturi mask group)
developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for
the high-flow group of 1.11 [95% confidence interval (CI) 0.41-3] (p =
0.84). No inter-group differences were found in the degree of dyspnea nor
in the proportion of patients needing oxygen therapy after treatment
discontinuation (OR 1.34 [95% CI 0.60-3]), experiencing pulmonary
complications (OR 1.29 [95% CI 0.51-3.25]) or requiring ventilatory
support (OR 0.67 [95% CI 0.11-4.18]). Post hoc analyses revealed that
PaO<inf>2</inf>/FiO<inf>2</inf> during the study was not different between
groups (p = 0.92), but patients receiving high-flow nasal oxygen had lower
arterial pressure of carbon dioxide, with a mean inter-group difference of
2 mmHg [95% CI 0.5-3.4] (p = 0.009), and were burdened by a lower risk of
postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06-0.54], p =
0.002). <br/>Conclusion(s): When compared to Venturi mask after
thoracotomic lung resection, preemptive high-flow nasal oxygen did not
reduce the incidence of postoperative hypoxemia nor improved other
analyzed outcomes. Further adequately powered investigations in this
setting are warranted to establish whether high-flow nasal oxygen may
yield clinical benefit on carbon dioxide clearance.<br/>Copyright &#xa9;
2019 The Author(s).

<63>
Accession Number
626663144
Title
Effects of blood storage age on immune, coagulation, and nitric oxide
parameters in transfused patients undergoing cardiac surgery.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
Spinella P.C.; Sniecinski R.M.; Trachtenberg F.; Inglis H.C.; Ranganathan
G.; Heitman J.W.; Szlam F.; Danesh A.; Stone M.; Keating S.M.; Levy J.H.;
Assmann S.F.; Steiner M.E.; Doctor A.; Norris P.J.
Institution
(Spinella, Doctor) Department of Pediatrics, Washington University School
of Medicine in St. Louis, Saint Louis, United States
(Sniecinski, Szlam) Department of Anesthesiology, Emory University School
of Medicine, Atlanta, Georgia
(Trachtenberg, Ranganathan, Assmann) New England Research Institutes,
Watertown, United States
(Inglis, Heitman, Danesh, Stone, Keating, Norris) Vitalant Research
Institute, San Francisco, United States
(Levy) Department of Anesthesiology and Critical Care, Duke University
School of Medicine, Durham, United States
(Steiner) Department of Hematology and Pediatrics, University of
Minnesota, Minneapolis, United States
(Norris) Department of Laboratory Medicine, University of California, San
Francisco, United States
(Norris) Department of Medicine, University of California, San Francisco,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Retrospective studies suggested that storage age of RBCs is
associated with inflammation and thromboembolism. The Red Cell Storage
Duration Study (RECESS) trial randomized subjects undergoing complex
cardiac surgery to receive RBCs stored for shorter versus longer periods,
and no difference was seen in the primary outcome of change in multiple
organ dysfunction score. STUDY DESIGN AND METHODS: In the current study,
90 subjects from the RECESS trial were studied intensively using a range
of hemostasis, immunologic, and nitric oxide parameters. Samples were
collected before transfusion and on Days 2, 6, 28, and 180 after
transfusion. <br/>RESULT(S): Of 71 parameters tested, only 4 showed a
significant difference after transfusion between study arms: CD8+ T-cell
interferon-gamma secretion and the concentration of extracellular vesicles
bearing the B-cell marker CD19 were higher, and plasma endothelial growth
factor levels were lower in recipients of fresh versus aged RBCs. Plasma
interleukin-6 was higher at Day 2 and lower at Days 6 and 28 in recipients
of fresh versus aged RBCs. Multiple parameters showed significant
modulation after surgery and transfusion. Most analytes that changed after
surgery did not differ based on transfusion status. Several extracellular
vesicle markers, including two associated with platelets (CD41a and
CD62P), decreased in transfused patients more than in those who underwent
surgery without transfusion. <br/>CONCLUSION(S): Transfusion of fresh
versus aged RBCs does not result in substantial changes in hemostasis,
immune, or nitric oxide parameters. It is possible that transfusion
modulates the level of platelet-derived extracellular vesicles, which will
require study of patients randomly assigned to receipt of transfusion to
define.<br/>Copyright &#xa9; 2019 AABB

<64>
Accession Number
626662994
Title
Time course of the survival advantage of transcatheter over surgical
aortic valve replacement: Interplay between sex and patient risk profile.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Ueshima D.; Masiero G.; Schiavo A.; Badawy M.R.A.; Fraccaro C.; Napodano
M.; Brener S.J.; Tarantini G.
Institution
(Ueshima, Masiero, Schiavo, Badawy, Fraccaro, Napodano, Tarantini)
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
Medical School, Padua, Italy
(Badawy) Department of Cardiology, Faculty of Medicine, Minia University,
Minya, Egypt
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, New York, NY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of this study was to explore the time course of
survival advantage of TAVR over SAVR as function of the patients' risk and
sex. <br/>Background(s): Women have been reported to have better survival
than men undergoing transcatheter aortic valve replacement (TAVR).
However, scant data on the sex-based survival benefit of TAVR over
surgical aortic valve replacement (SAVR) are available. <br/>Method(s): A
systematic review of studies reporting clinical outcomes of men and women
undergoing TAVR or SAVR was performed. Studies were divided into two
groups according to average patient's risk score and the interplay of
surgical risk and sex on outcomes were analyzed. <br/>Result(s): Eight
studies involving 6,596 women and 7,204 men patients were extracted.
Unlike mens, women patients had survival advantage from TAVR over SAVR
that became substantial at 1 year from index procedure and persisted at
2-year of follow-up. Moreover, this sex-based TAVR survival advantage was
mainly observed in higher surgical risk patients. Men showed a
significantly lower rate of residual paravalvular leak after SAVR.
<br/>Conclusion(s): Women patients had a selective mortality benefit from
TAVR compared to SAVR. This sex-based TAVR benefit was mainly observed in
high surgical risk patients beyond 1 year from procedure.<br/>Copyright
&#xa9; 2019 Wiley Periodicals, Inc.

<65>
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.<br/>Copyright &#xa9; 2019 Min Li et al.

<66>
Accession Number
2001626817
Title
The Effect of Cardiac Rehabilitation on Health-Related Quality of Life in
Patients With Coronary Artery Disease: A Meta-analysis.
Source
Canadian Journal of Cardiology. 35 (3) (pp 352-364), 2019. Date of
Publication: March 2019.
Author
Francis T.; Kabboul N.; Rac V.; Mitsakakis N.; Pechlivanoglou P.; Bielecki
J.; Alter D.; Krahn M.
Institution
(Francis, Kabboul, Rac, Mitsakakis, Bielecki, Krahn) Toronto Health
Economics and Technology Assessment (THETA) Collaborative, Toronto General
Hospital Research Institute, University Health Network, Toronto, Ontario,
Canada
(Rac, Mitsakakis, Krahn) Institute of Health Policy, Management and
Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
(Pechlivanoglou) Child Health Evaluative Sciences, The Hospital for Sick
Children, Toronto, Ontario, Canada
(Alter, Krahn) Faculty of Medicine, University of Toronto, Toronto,
Ontario, Canada
(Alter) Toronto Rehabilitation Institute (TRI), University Health Network,
Toronto, Ontario, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The clinical effectiveness of cardiac rehabilitation (CR) on
health-related quality of life (HRQOL) is an area that has not been
consistently explored. The objective of this systematic review was to
evaluate the effectiveness of providing any core component of CR on HRQOL
domains. <br/>Method(s): We performed a meta-analysis and meta-regression
of randomized controlled trials (RCTs) on the core components of CR. RCTs
included adult patients with diagnosed coronary artery disease via
angiography, myocardial infarction, angina, or who had undergone coronary
revascularization. The Cochrane Library, MEDLINE, EMBASE, CINAHL,
SCI-EXPANDED, Psych INFO, and Web of Science were searched from inception
to April 27, 2017. Outcomes included overall, physical, emotional, and
social HRQOL. Outcomes were reported as standardized mean change (SMC)
with 95% confidence intervals (CIs). Effect size changes of 0.2, 0.5, and
0.8 SD units reflect a small, moderate, and large effect, respectively.
<br/>Result(s): Forty-nine reports of 41 RCTs with 11,747 patients were
included. Summary effect sizes were: overall HRQOL SMC, 0.28 (95% CI,
0.05-0.50), physical HRQOL SMC, 0.47 (95% CI, 0.13-0.81), emotional HRQOL
SMC, 0.37 (95% CI, -0.02 to 0.77), and social HRQOL SMC, 0.13 (95% CI,
-0.06 to 0.32). Meta-regression revealed type of CR intervention and year
of publication as positive statistically significant treatment effect
modifiers. <br/>Conclusion(s): Receiving CR was shown to improve HRQOL,
with exercise-, nonexercise-, and psychological-based interventions
playing a vital role. Although these improvements in HRQOL were modest
they still reflect an incremental benefit compared with receiving usual
care.<br/>Copyright &#xa9; 2018 Canadian Cardiovascular Society

<67>
Accession Number
623274683
Title
Fish oil supplementation does not affect cognitive outcomes in cardiac
surgery patients in the omega-3 fatty acids for prevention of
post-operative atrial fibrillation (OPERA) trial.
Source
Journal of Nutrition. 148 (3) (pp 472-479), 2018. Date of Publication: 01
Mar 2018.
Author
Jackson J.C.; Mozaffarian D.; Graves A.J.; Brown N.J.; Marchioli R.; Kiehl
A.L.; Ely E.W.
Institution
(Jackson, Kiehl, Ely) Department of Medicine, Divisions of Allergy,
Pulmonary and Critical Care Medicine, Nashville, TN, United States
(Graves) Division of Urologic Surgery, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Brown) Division of Pharmacology, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Jackson) Department of Psychiatry, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Jackson, Kiehl, Ely) Center for Health Services Research, Vanderbilt
University School of Medicine, Nashville, TN, United States
(Jackson) Research Service, Department of Veterans Affairs Medical Center,
Tennessee Valley Healthcare System, Nashville, TN, United States
(Jackson, Ely) Geriatric Research Education and Clinical Center (GRECC),
Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare
System, Nashville, TN, United States
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, United States
(Marchioli) Therapeutic Science and Strategy Unit (TSSU), Quintiles,Milan,
Italy
Publisher
Oxford University Press
Abstract
Background: Cognitive decline has been reported following cardiac surgery,
leading to great interest in interventions to minimize its occurrence.
Long-chain n-3 (omega-3) polyunsaturated fatty acids (PUFAs) have been
associated with less cognitive decline in observational studies, yet no
trials have tested the effects of n-3 PUFAs on cognitive decline after
surgery. <br/>Objective(s):We sought to determine whether perioperative
n-3 PUFA supplementation reduces postoperative cognitive decline in
patients postcardiac surgery. <br/>Method(s): The study comprised a
randomized, double-blind, placebo-controlled, multicenter, clinical trial
conducted on cardiac surgery recipients at 9 tertiary care medical centers
across the United States. Patients were randomly assigned to receive fish
oil (1-g capsules containing >=840 mg n-3 PUFAs as ethyl esters) or
placebo, with preoperative loading of 8-10 g over 2-5 d followed
postoperatively by 2 g/d until hospital discharge or postoperative day 10,
whichever came first. Global cognition was assessed using in-person
testing over 30 d with the Repeatable Battery for the Assessment of
Neuropsychological Status (RBANS) (primary outcome), Mini-Mental State
Exam (secondary outcome), and Trails A and B (secondary outcome) tests.
All end pointswere prespecified. Statistical methodswere employed,
including descriptive statistics, logistic regression, and various
sensitivity analyses. <br/>Result(s): A total of 320 US patients were
enrolled in the Omega-3 Fatty Acids for Prevention of Post-Operative
Atrial Fibrillation (OPERA) Cognitive Trial (OCT), a substudy of OPERA.
The median age was 62 y (IQR 53, 70 y). No differences in global cognition
were observed between placebo and fish oil groups at day 30 (P = 0.32) for
the primary outcome, a composite neuropsychological RBANS score. The
population demonstrated resolution of initial 4-d cognitive decline back
to baseline function by 30 d on the RBANS. <br/>Conclusion(s):
Perioperative supplementation with n-3 PUFAs in cardiac surgical patients
did not influence cognition <=30 d after discharge. Modern anesthetic,
surgical, and postoperative care may be mitigating previously observed
long-term declines in cognitive function following cardiac surgery. This
trial was registered at clinicaltrials.gov as NCT00970489. J Nutr
2018;148:472-479.<br/>Copyright &#xa9;2018 American Society for Nutrition.

<68>
Accession Number
626538998
Title
Rationale and design of PASSAT - Patients' satisfaction with local or
general anaesthesia in video-assisted thoracoscopic surgery: Study
protocol for a randomised controlled trial with a non-randomised side arm.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 149. Date of
Publication: 27 Feb 2019.
Author
Galetin T.; Bretzke P.; Lopez-Pastorini A.; Schieren M.; Koryllos A.;
Kosse N.; Schnell J.; Defosse J.M.; Wappler F.; Stoelben E.
Institution
(Galetin, Lopez-Pastorini, Koryllos, Stoelben) University Witten/Herdecke,
Department of Thoracic Surgery, Alfred-Herrhausen-Str. 50, Witten D-58448,
Germany
(Schieren, Defosse, Wappler) University Witten/Herdecke, Department of
Anaesthesiology and Intensive Care Medicine, Alfred-Herrhausen-Str. 50,
Witten D-58448, Germany
(Galetin, Lopez-Pastorini, Koryllos, Kosse, Schnell, Stoelben) University
Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic
Surgery, Ostmerheimer Str. 200, Cologne D-51109, Germany
(Schieren, Defosse, Wappler) University Witten/Herdecke, Medical Centre
Cologne-Merheim, Department of Anaesthesiology and Intensive Care
Medicine, Ostmerheimer Str. 200, Cologne D-51109, Germany
(Bretzke) Sana IT Services GmbH, Burger Strase 211, Remscheid 42859,
Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Although general anaesthesia (GA) with one-lung ventilation is
the current standard of care, minor thoracoscopic surgery, i.e. treatment
of pleural effusions, biopsies and small peripheral pulmonary wedge
resections, can also be performed using local anaesthesia (LA),
analgosedation and spontaneous breathing. Whilst the feasibility and
safety of LA have been demonstrated, its impact on patient satisfaction
remains unclear. Most studies evaluating patient satisfaction lack control
groups or do not meet psychometric criteria. We report the design of the
PASSAT trial (PAtientS' SATisfaction in thoracic surgery - general vs.
local anaesthesia), a randomised controlled trial with a non-randomised
side arm. <br/>Method(s): Patients presenting for minor thoracoscopic
surgery and physical eligibility for GA and LA are randomised to surgery
under GA (control group) or LA (intervention group). Those who refuse to
be randomised are asked to attend the study on the basis of their own
choice of anaesthesia (preference arm) and will be analysed separately.
The primary endpoint is patient satisfaction according to a
psychometrically validated questionnaire; secondary endpoints are
complication rates, capnometry, actual costs and cost effectiveness. The
study ends after inclusion of 54 patients in each of the two randomised
study groups. <br/>Discussion(s): The PASSAT study is the first randomised
controlled trial to systematically assess patients' satisfaction depending
on LA or GA. The study follows an interdisciplinary approach, and its
results may also be applicable to other surgical disciplines. It is also
the first cost study based on randomised samples. Comparison of the
randomised and the non-randomised groups may contribute to satisfaction
research. Trial registration: German Clinical Trials Register,
DRKS00013661. Registered on 23 March 2018.<br/>Copyright &#xa9; 2019 The
Author(s).

<69>
Accession Number
626629807
Title
The use of Povidone iodine in the anticipation and management of prolonged
postoperative air-leak.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2018. France. 52 (Supplement 62) (no
pagination), 2018. Date of Publication: September 2018.
Author
Saidane A.; Abid W.; Safta Y.B.; Daloul S.; Moussa M.B.; Boudaya M.-S.
Institution
(Saidane) Charles Nicolle Hospital, Pneumology Department, Tunis, Tunisia
(Abid, Safta, Daloul, Moussa, Boudaya) Charles Nicolle Hospital, Thoracic
Surgery Department, Tunis, Tunisia
Publisher
European Respiratory Society
Abstract
Background: Prolonged Air leak (PAL) is defined as air leak lasting beyond
the fifth post-operative day. It is a very common situation after lung
resections and is generally associated with a worse outcome with a more
complicated postoperative course (prolonged hospitalization, increased
costs ). <br/>Method(s): It is a randomized, double-blind, prospective
study .220 patients with a mean age of 61years, who underwent thoracic
surgery in our department, were included. A spirometry was performed to
measure the FEV1 (Forced Expiratory Volume). Each patient was subjected
for the instillation of 25 ml of Povidone iodine in the chest tube.
<br/>Result(s): Of these patients, 12% presented air leak in the first
post-operative day. After injecting povidone iodine as a sclerosant agent,
61.5% of these patients didn't present any air leak (AL) in the 2 first
post-operative days (61.5% versus 38.5%). It has also reduced the chest
drain time (3 days versus 7.5 days). Many risk factors of PAL may
influence the chest drain time such us : the low FEV1 (13 days versus 6
days), the kind of the surgical procedure performed (3.5 days after a
surgery of a pneumothorax versus 7 days after lobectomy or bilobectomy
with p= 0.02), the performance of upper lobectomy (18 days versus 8 days),
the presence of pleural adhesions (5 days versus 3 days) and the number of
chest tubes used (2 days using one chest tube versus 5 days using 2 or 3
chest tubes). <br/>Conclusion(s): Prolonged air leak is a serious
postoperative complication after lung resections. In this study, Chemical
pleurodesis using Povidone iodine as a sclerosant agent has been proved to
be an effective and safe method for early management of this complication.

<70>
Accession Number
626627234
Title
The effect of airway pressure release ventilation on circulation and
respiration in postoperation of cardiac surgery patients.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2018. France. 52 (Supplement 62) (no
pagination), 2018. Date of Publication: September 2018.
Author
Ge H.
Institution
(Ge) Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
Hangzhou, China
Publisher
European Respiratory Society
Abstract
Introduction: The purpose of this study was to investigate the effects of
airway pressure release ventilation (APRV) on hemodynamic and respiration
in post-operation of cardiac surgery patients. <br/>Method(s): Thirty-nine
patients who were 18 years age or older post-operation of cardiopulmonary
bypass patients, between November 2016 and February 2017, were
prospectively enrolled, randomized divided into two groups, 19 patients
with PCV and 20 patients with APRV. PCV group continued to conventional
setting. APRV group was set with a PEEPHigh according to the plateau
pressure; Time at PHigh (THigh) was set about > 90% respiratory cycle.
Parameters were adjusted based on the oxygenation, PaCO2 and mean blood
pressure. After a 5-minute stabilization period, hemodynamics and
respiratory parameters had been continuously observed until 3days.
<br/>Result(s): APRV result in better PaO2/FiO2 (340+/-97 vs. 301+/-82,
p<0.05). Lactate was decreased in APRV group (4.23+/-2.67 vs. 6.76+/-3.43,
p<0.01). In addition, Chest radiograph score (CRS) revealed less lung
injury in APRV mode (0.4+/-0.7 vs. 1.2+/-0.7, p<0.01). And the APRV group
presented a higher CI (3.1+/-0.7 vs. 2.8+/-0.8, p<0.05) SI (35.4+/-9.2vs.
33.1+/-9.7, p<0.05) compared with PCV group.

<71>
Accession Number
626626505
Title
Electrical impedance tomography in evaluating the effects of noninvasive
ventilation in the postoperative cardiac surgery: Randomized controlled
clinical trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2018. France. 52 (Supplement 62) (no
pagination), 2018. Date of Publication: September 2018.
Author
De Novaes A.; De Andrade A.D.; Campos S.; Modolo N.; Goncalves C.; Morais
C.; Rattes C.; Leite W.; Lima W.; Brandao D.C.
Institution
(De Novaes, De Andrade, Campos, Modolo, Goncalves, Morais, Rattes, Leite,
Lima, Brandao) 1Universidade Federal de Pernambuco UFPE, Recife, Brazil
Universidade Federal de PernambucoUFPE, Recife, Brazil Universidade
Federal de PernambucoUFPE, Recife, Brazil Universidade estadual paulista
Julio de Mesquita Filho, Botucatu, Brazil Universidade de Sao Paulo USP,
Recife, Brazil
Publisher
European Respiratory Society
Abstract
Introduction: Noninvasive ventilation has been widely used to prevent
pulmonary complications after cardiac surgery. Electrical Impedance
Tomography(EIT) has been highlighted as a tool to monitor the distribution
of regional pulmonary ventilation. However, there are few studies
available on the use of this tool in evaluating the effects of noninvasive
ventilation(NIV). <br/>Objective(s): To compare the effects of noninvasive
ventilation with oxygen therapy(OT) on pulmonary aeration and ventilation
in patients in the immediate postoperative period of cardiac surgery;
Hypothesis: the use of noninvasive ventilation in patients in the
postoperative period of cardiac surgery results in greater ventilation and
greater aeration during and after intervention compared to the control
group. <br/>Method(s): Patients were randomized into two groups: NIV and
OT (control). The evaluation was performed through EIT. of this
improvement after intervention. There was also a greater variation of
global impedance (ventilation) change during intervention (7,96 vs. 4,17,
p value 0,03). <br/>Conclusion(s): There was increased global aeration and
ventilation during noninvasive ventilation in patients in postoperative
cardiac surgery, but there was no maintenance of aeration improvement
after its interruption. Grants: FACEPE, CNPq and CAPES.

<72>
[Use Link to view the full text]
Accession Number
626633445
Title
Meta-analysis of impact of liver disease on mortality after transcatheter
aortic valve implantation.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 20 (4) (pp 237-244),
2019. Date of Publication: 01 Apr 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
AIMS: To evaluate whether liver disease is associated with increased
mortality after transcatheter aortic valve implantation (TAVI) and whether
TAVI is associated with decreased mortality compared to surgical aortic
valve replacement (SAVR) in patients with liver disease, we performed
meta-analyses of currently available studies. <br/>METHOD(S): Studies
reporting mortality in TAVI patients with liver disease versus those
without liver disease and mortality after TAVI versus SAVR in patients
with liver disease were eligible to be included. A relative risk (RR) or
hazard ratio of mortality for TAVI patients with versus without liver
disease and mortality for TAVI versus SAVR in patients with liver disease
was extracted from each individual study. Study-specific estimates were
combined in the random-effects model. <br/>RESULT(S): We identified nine
studies of TAVI patients with versus without liver disease and four
studies of TAVI versus SAVR in patients with liver cirrhosis. Pooled
analyses demonstrated no association of liver disease with early
(in-hospital/30-day) mortality (P = 0.28), but a statistically significant
association of liver disease with increases mid-term (1-2-year) mortality
(hazard ratio 1.87, P < 0.00001) in TAVI patients, and no statistically
significant difference in in-hospital mortality between TAVI and SAVR in
patients with cirrhosis (RR 0.60, P = 0.12). <br/>CONCLUSION(S): There may
be no impact of liver disease on early mortality in TAVI patients,
negative impact of liver disease on mid-term mortality in TAVI patients,
and no difference in in-hospital mortality between TAVI and SAVR in
patients with liver cirrhosis.

<73>
Accession Number
626637225
Title
Preinterventional hydrocortisone sustains the endothelial glycocalyx in
cardiac surgery.
Source
Clinical hemorheology and microcirculation. 71 (1) (pp 59-70), 2019. Date
of Publication: 2019.
Author
Brettner F.; Chappell D.; Nebelsiek T.; Hauer D.; Schelling G.; Becker
B.F.; Rehm M.; Weis F.
Institution
(Brettner, Chappell, Nebelsiek, Hauer, Schelling, Rehm) Department of
Anaesthesiology, University Hospital of Munich, LMU Munich, Munich,
Germany
(Brettner, Becker) Walter-Brendel Centre of Experimental Medicine,
Ludwig-Maximilians-University Munich, Martinsried, Germany
(Weis) Department of Anaesthesiology and Intensive Care Medicine,
Furstenfeldbruck, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients undergoing cardiac surgery commonly develop systemic
inflammation associated with tissue edema, which impairs outcome. One main
pathomechanism leading to the edema is the deterioration of the
endothelial glycocalyx, a key component of the vascular barrier. In animal
models hydrocortisone has proved to be protective for the glycocalyx.
<br/>OBJECTIVE(S): This trial evaluates the effect of hydrocortisone on
glycocalyx integrity in patients undergoing cardiac surgery with
cardiopulmonary bypass. <br/>METHOD(S): In a prospective, randomized
interventional pilot trial, 30 patients received either hydrocortisone
(100 mg over 10 min) or placebo (saline control) before surgery. Plasma
concentrations of glycocalyx constituents (syndecan-1, heparan sulfate)
and various clinical parameters (respiratory and renal function,
inflammatory markers, use of vasopressors, length of stay at the intensive
care unit) were measured. Primary endpoint was a significant difference of
glycocalyx constituents in plasma. Comparisons were made with Friedman's
and Wilcoxon tests (paired data), or the Kruskal-Wallis and Mann-Whitney U
tests (unpaired data). Holm-Bonferroni method was used for post-hoc
corrections. <br/>RESULT(S): Heparan sulfate and syndecan-1 increased
significantly during and after cardiac surgery with cardiopulmonary bypass
in both groups. Whereas the maximum increase of heparan sulfate was
12.3-fold in the control vs. 3.8-fold in the pretreated group (p < 0.05),
syndecan-1 values showed no significant difference between the groups
(maximal increase 3-fold). The inflammatory markers C-reactive protein and
interleukin-6 were also higher in the control than in the hydrocortisone
group, but there was no difference in patient mortality (zero), or in any
clinical parameters. <br/>CONCLUSION(S): Pretreatment with hydrocortisone
ameliorated shedding of heparan sulfate, a major constituent of the
endothelial glycocalyx, in patients undergoing cardiac surgery with
cardiopulmonary bypass, but had no relevant influence on various clinical
parameters or patient mortality. The relatively small number of patients
in this pilot study probably precluded detection of positive outcome
differences.

<74>
Accession Number
626640414
Title
Effect of methylprednisolone on acute kidney injury in patients undergoing
cardiac surgery with a cardiopulmonary bypass pump: a randomized
controlled trial.
Source
CMAJ : Canadian Medical Association journal = journal de l'Association
medicale canadienne. 191 (9) (pp E247-E256), 2019. Date of Publication: 04
Mar 2019.
Author
Garg A.X.; Chan M.T.V.; Cuerden M.S.; Devereaux P.J.; Abbasi S.H.;
Hildebrand A.; Lamontagne F.; Lamy A.; Noiseux N.; Parikh C.R.; Perkovic
V.; Quantz M.; Rochon A.; Royse A.; Sessler D.I.; Shah P.J.; Sontrop J.M.;
Tagarakis G.I.; Teoh K.H.; Vincent J.; Walsh M.; Yared J.-P.; Yusuf S.;
Whitlock R.P.
Institution
(Garg, Chan, Cuerden, Devereaux, Abbasi, Hildebrand, Lamontagne, Lamy,
Noiseux, Parikh, Perkovic, Quantz, Rochon, Royse, Sessler, Shah, Sontrop,
Tagarakis, Teoh, Vincent, Walsh, Yared, Yusuf, Whitlock) Division of
Nephrology (Garg, Cuerden, Sontrop), Department of Medicine, London Health
Sciences Centre, London, Ont.; Department of Anaesthesia and Intensive
Care (Chan), The Chinese University of Hong Kong, Hong Kong Special
Administrative Region, China; Departments of Health Research Methods,
Evidence, and Impact, and Medicine (Devereaux, Walsh), McMaster
University, Hamilton, Ont.; Tehran Heart Center (Abbasi), Tehran
University of Medical Sciences, Tehran, Iran; Division of Nephrology
(Hildebrand), Department of Medicine, University of Alberta, Edmonton,
Alta.; Departement de medecine (Lamontagne), Faculte de medecine et des
sciences de la sante, Universite de Sherbrooke, Sherbrooke, Que.;
Department of Surgery (Lamy) McMaster University, Hamilton, Ont.;
Department of Cardiac Surgery (Noiseux), Universite de Montreal, Montreal,
Que.; Division of Nephrology, Johns Hopkins School of Medicine (Parikh),
Baltimore, Md.; The George Institute for Global Health (Perkovic), Sydney,
Australia; Division of Cardiac Surgery (Quantz), London Health Sciences
Centre, University Hospital, London, Ont.; Montreal Heart Institute
(Rochon), Universite de Montreal, Montreal, Que.; Department of Surgery
(Royse), University of Melbourne, Melbourne, Australia; Department of
Outcomes Research (Sessler), Cleveland Clinic, Cleveland, Ohio; Department
of Cardiac Surgery (Shah), Princess Alexandra Hospital, Brisbane,
Australia; Department of Cardiovascular and Thoracic Surgery (Tagarakis),
Aristotle University of Thessaloniki, Thessaloniki, Greece; Division of
Cardiac Surgery (Teoh), Southlake Regional Health Centre, Newmarket, Ont.;
Population Health Research Institute (Vincent, Whitlock), Hamilton, Ont.;
Department of Cardiothoracic Anesthesiology (Yared), Cleveland Clinic,
Cleveland, Ohio; Division of Cardiology (Yusuf), Department of Medicine,
McMaster University, Hamilton, Ont
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative corticosteroid use may reduce acute kidney
injury. We sought to test whether methylprednisolone reduces the risk of
acute kidney injury after cardiac surgery. <br/>METHOD(S): We conducted a
prespecified substudy of a randomized controlled trial involving patients
undergoing cardiac surgery with cardiopulmonary bypass (2007-2014);
patients were recruited from 79 centres in 18 countries. Eligibility
criteria included a moderate-to-high risk of perioperative death based on
a preoperative score of 6 or greater on the European System for Cardiac
Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned
(1:1) to receive intravenous methylprednisolone (250 mg at anesthetic
induction and 250 mg at initiation of cardiopulmonary bypass) or placebo.
Patients, caregivers, data collectors and outcome adjudicators were
unaware of the assigned intervention. The primary outcome was
postoperative acute kidney injury, defined as an increase in the serum
creatinine concentration (from the preoperative value) of 0.3 mg/dL or
greater (>= 26.5 mumol/L) or 50% or greater in the 14-day period after
surgery, or use of dialysis within 30 days after surgery. <br/>RESULT(S):
Acute kidney injury occurred in 1479/3647 patients (40.6%) in the
methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo
group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11).
Results were consistent across several definitions of acute kidney injury
and in patients with preoperative chronic kidney disease. INTERPRETATION:
Intraoperative corticosteroid use did not reduce the risk of acute kidney
injury in patients with a moderate-to-high risk of perioperative death who
had cardiac surgery with cardiopulmonary bypass. Our results do not
support the prophylactic use of steroids during cardiopulmonary bypass
surgery. Trial registration: ClinicalTrials.gov, no.
NCT00427388.<br/>Copyright &#xa9; 2019 Joule Inc. or its licensors.

<75>
Accession Number
626614832
Title
Two-Year Outcomes after Transcatheter Aortic Valve Replacement with
Mechanical vs Self-expanding Valves: The REPRISE III Randomized Clinical
Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Reardon M.J.; Feldman T.E.; Meduri C.U.; Makkar R.R.; O'Hair D.; Linke A.;
Kereiakes D.J.; Waksman R.; Babliaros V.; Stoler R.C.; Mishkel G.J.; Rizik
D.G.; Iyer V.S.; Gleason T.G.; Tchetche D.; Rovin J.D.; Lhermusier T.;
Carrie D.; Hodson R.W.; Allocco D.J.; Meredith I.T.
Institution
(Reardon) Department of Cardiovascular Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Feldman) Evanston Hospital Cardiology Division, Northshore University
Health System, Evanston, IL, United States
(Meduri) Piedmont Heart Institute, Atlanta, GA, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(O'Hair) Aurora St Luke's Medical Center, Milwaukee, WI, United States
(Linke) Heart Center Dresde, Dresden University Hospital, Dresden, Germany
(Kereiakes) Lindner Research Center, Christ Hospital Heart and Vascular
Center, Cincinnati, OH, United States
(Waksman) Washington Hospital Center, Washington, DC, United States
(Babliaros) Emory University, Emory University Hospital, Atlanta, GA,
United States
(Stoler) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Mishkel) St John's Hospital, Springfield, IL, United States
(Rizik) HonorHealth, Scottsdale-Lincoln Health Network, Scottsdale, AZ,
United States
(Iyer) Gates Vascular Institute, University at Buffalo, Buffalo, NY,
United States
(Gleason) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Tchetche) Department of Internal Medicine/Cardiology, Herzzentrum
Dresden, Technische Universitat Dresden, Dresden, Germany
(Rovin) Morton Plant Mease Healthcare System, Clearwater, FL, United
States
(Lhermusier, Carrie) Clinique Pasteur, Toulouse, France
(Hodson) Providence St Vincent Medical Center, Portland, OR, United States
(Allocco, Meredith) Boston Scientific Corp, Marlborough, MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: To our knowledge, REPRISE III is the first large randomized
comparison of 2 different transcatheter aortic valve replacement
platforms: the mechanically expanded Lotus valve (Boston Scientific) and
self-expanding CoreValve (Medtronic). <br/>Objective(s): To evaluate
outcomes of Lotus vs CoreValve after 2 years. <br/>Design, Setting, and
Participant(s): A total of 912 patients with high/extreme risk and severe,
symptomatic aortic stenosis enrolled between September 22, 2014, and
December 24, 2015, were randomized 2:1 to receive Lotus (607 [66.6%]) or
CoreValve (305 [33.4%] at 55 centers in North America, Europe, and
Australia. The first 2-year visit occurred on October 17, 2016, and the
last was conducted on April 12, 2018. Clinical and echocardiographic
assessments are complete through 2 years and will continue annually
through 5 years. <br/>Main Outcomes and Measures: All-cause mortality and
all-cause mortality or disabling stroke at 2 years. Other clinical factors
included overall stroke, disabling stroke, repeated procedures,
rehospitalization, valve thrombosis, and pacemaker implantation.
Echocardiographic analyses included effective orifice area, mean gradient,
and paravalvular leaks (PVLs). <br/>Result(s): Of 912 participants, the
mean (SD) age was 82.8 (7.3) years, 465 (51%) were women, and the mean
(SD) Society of Thoracic Surgeons predicted risk of mortality was 6.8%
(4.0%). At 2 years, all-cause death was 21.3% with Lotus vs 22.5% with
CoreValve (hazard ratio [HR], 0.94; 95% CI, 0.69-1.26; P =.67) and
all-cause mortality or disabling stroke was 22.8% with Lotus and 27.0%
with CoreValve (HR, 0.81; 95% CI, 0.61-1.07; P =.14). Overall stroke was
8.4% vs 11.4% (HR, 0.75; 95% CI, 0.48-1.17; P =.21); disabling stroke was
more frequent with CoreValve vs Lotus (4.7% Lotus vs 8.6% CoreValve; HR,
0.53; 95% CI, 0.31-0.93; P =.02). More Lotus patients received a new
permanent pacemaker (41.7% vs 26.1%; HR, 1.87; 95% CI, 1.41-2.49; P <.01)
or had a valve thrombosis (3.0% vs 0.0%; P <.01) compared with CoreValve.
More patients who received CoreValve experienced a repeated procedure
(0.6% Lotus vs 2.9% CoreValve; HR, 0.19; 95% CI, 0.05-0.70; P <.01), valve
migration (0.0% vs 0.7%; P =.05), or embolization (0.0% vs 2.0%; P <.01)
than Lotus. Valve areas remained significantly larger and the mean
gradient was lower with CoreValve than Lotus (valve area, mean [SD]:
Lotus, 1.53 [0.49] cm² vs CoreValve, 1.76 [0.51]
cm²; P <.01; valve gradient, mean [SD]: Lotus, 13.0 [6.7] mm Hg
vs 8.1 [3.7] mm Hg; P <.01). Moderate or greater PVL was more frequent
with CoreValve (0.3% Lotus vs 3.8% CoreValve; P <.01) at 2 years. Larger
improvements in New York Heart Association (NYHA) functional class were
observed with Lotus compared with CoreValve (improved by >=1 NYHA class:
Lotus, 338 of 402 [84.1%] vs CoreValve, 143 of 189 [75.7%]; P =.01;
improved by >=2 NYHA classes: 122 of 402 [37.3%] vs 65 of 305 [21.3%]).
<br/>Conclusions and Relevance: After 2 years, all-cause mortality rates,
mortality or disabling stroke were similar between Lotus and CoreValve.
Disabling stroke, functional class, valve migration, and PVL favored the
Lotus arm whereas valve hemodynamics, thrombosis, and new pacemaker
implantation favored the CoreValve arm. Trial Registration:
clinicaltrials.gov Identifier: NCT02202434..<br/>Copyright &#xa9; 2019
American Chemical Society. All rights reserved.

<76>
Accession Number
625422931
Title
Impact of Patient and Lesion Characteristics on Drug-Coated Balloon
Angioplasty in the Femoropopliteal Artery: A Pooled Analysis of Four
Randomized Controlled Multicenter Trials.
Source
CardioVascular and Interventional Radiology. 42 (4) (pp 495-504), 2019.
Date of Publication: 15 Apr 2019.
Author
Albrecht T.; Ukrow A.; Werk M.; Tepe G.; Zeller T.; Meyer D.-R.; Kutschera
M.; Speck U.; Waliszewski M.
Institution
(Albrecht, Ukrow) Department of Radiology and Interventional Therapy,
Vivantes Klinikum Neukolln, Berlin, Germany
(Werk) Department of Radiology, Martin-Luther-Hospital, Berlin, Germany
(Tepe) Department of Radiology, RoMed Klinikum Rosenheim, Rosenheim,
Germany
(Zeller) Department of Angiology, Herzzentrum Bad Krozingen, Bad
Krozingen, Germany
(Meyer) Department of Diagnostic and Interventional Radiology, Hubertus
Hospital, Berlin, Germany
(Kutschera, Speck) Experimental Radiology, Department of Radiology,
Charite, Berlin, Germany
(Waliszewski) Medical Scientific Affairs, B.Braun Melsungen AG, Berlin,
Germany
(Waliszewski) Department of Internal Medicine and Cardiology, Charite -
Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
(Albrecht) Institut fur Radiologie und Interventionelle Therapie, Vivantes
Klinikum Neukolln, Rudower Str. 48, Berlin 12351, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objectives: The principal objective of this pooled analysis was to
investigate various patient and lesion characteristics on late lumen loss
(LLL) after drug-coated balloon (DCB) angioplasty. <br/>Background(s):
Four randomized controlled trials (THUNDER, FEMPAC, PACIFIER, CONSEQUENT)
were pooled to investigate the influence of various patient and lesion
characteristics on DCB angioplasty and on plain old balloon angioplasty
(POBA) in patients with femoropopliteal artery disease. <br/>Method(s):
Angiographic data from 355 patients were pooled to assess the impact of
patient (demographics, cardiovascular risk factors, cardiovascular
co-morbidities, Rutherford stages) and lesion-/procedure-related
(location, occlusion, length, restenosis, calcification, subintimal
crossing, post-dilatation, dissection, stenting) characteristics on LLL.
Linear regression models were utilized with LLL as the dependent variable
to determine the predictive value of cardiovascular and
lesion-/procedure-related factors. <br/>Result(s): Observational
statistics revealed that LLL was lower in the DCB group as compared to
POBA independent of all tested patient variables. LLL after DCB was also
independent of most lesion and procedural characteristics except for
lesion length and bailout stenting. LLL increased with lesion length in
both treatment groups. Bailout stenting did not improve LLL in the DCB
group but did so in the POBA group (0.74 +/- 1.07 mm vs. 1.22 +/- 1.36 mm,
p = 0.043). <br/>Conclusion(s): DCB was superior to POBA for all tested
patient subgroups and lesion subgroups. Our results suggest that all
patients and lesions benefit to a similar degree from the use of DCB.
DCB-PTA should therefore be preferred to POBA in all patients with
steno-occlusive femoropopliteal lesions.<br/>Copyright &#xa9; 2018,
Springer Science+Business Media, LLC, part of Springer Nature and the
Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

<77>
Accession Number
626537657
Title
Percutaneous closure of the patent ductus arteriosus: opportunities moving
forward.
Source
Congenital Heart Disease. 14 (1) (pp 95-99), 2019. Date of Publication:
January/Februaryy 2019.
Author
Mitchell C.C.; Rivera B.K.; Cooper J.N.; Smith C.V.; Berman D.P.;
Slaughter J.L.; Backes C.H.
Institution
(Mitchell, Rivera, Slaughter, Backes) Center for Perinatal Research, The
Research Institute at Nationwide Children's Hospital, Columbus, OH, United
States
(Cooper) Center for Surgical Outcomes Research, The Research Institute at
Nationwide Children's Hospital, Columbus, OH, United States
(Smith) Center for Integrated Brain Research, Seattle Children's Research
Institute, University of Washington School of Medicine, Seattle, WA,
United States
(Cooper, Berman, Slaughter, Backes) Department of Pediatrics, The Ohio
State University Wexner Medical Center, Columbus, OH, United States
(Berman, Backes) The Heart Center at Nationwide Children's Hospital,
Columbus, OH, United States
Publisher
Blackwell Publishing Ltd
Abstract
The optimal treatment method for infants with a patent ductus arteriosus
(PDA) necessitating closure remains a subject of controversy and debate.
While the risks associated with surgical PDA ligation are well described,
the available evidence base for alternative management strategies during
infancy, including percutaneous closure or conservative (nonintervention)
management, are not well explored. Among infants, the goals of this review
are to: (a) use rigorous systematic review methodology to assess the
quality and quantity of published reports on percutaneous closure vs
surgical ligation; (b) compare outcomes of percutaneous closure vs
conservative management; and (c) based on recommendations from the
International PDA symposium, to elucidate needs and opportunities for
future research and interdisciplinary collaboration. The available
evidence base, as well as on broad consensus reached at the International
PDA Symposium, suggests that a contemporary, pragmatic clinical trial
comparing PDA treatment strategies is warranted. Additionally, quality
assurance safeguards are necessary in the implementation of newer PDA
closure devices. Finally, to determine best approaches to treatment for
infants with PDA, tools for consistent data collection and reporting
across centers and disciplines are needed to minimize heterogeneity and
permit pooled analysis.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<78>
[Use Link to view the full text]
Accession Number
623904071
Title
Meta-analysis of death and myocardial infarction in the DEFINE-FLAIR and
iFR-SWEDEHEART trials.
Source
Circulation. 136 (24) (pp 2389-2391), 2017. Date of Publication: December
2017.
Author
Berry C.; McClure J.D.; Oldroyd K.G.
Institution
(Berry, McClure) British Heart Foundation Glasgow Cardiovascular Research
Centre, Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Scotland, United Kingdom
(Berry, Oldroyd) West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Clydebank, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<79>
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.<br/>Copyright &#xa9; The European
Society of Cardiology 2017.

<80>
Accession Number
626512976
Title
Restrictive versus liberal red blood cell transfusion for cardiac surgery:
a systematic review and meta-analysis of randomized controlled trials.
Source
Journal of Thrombosis and Thrombolysis. 47 (2) (pp 179-185), 2019. Date of
Publication: 15 Feb 2019.
Author
Kheiri B.; Abdalla A.; Osman M.; Haykal T.; Chintalapati S.; Cranford J.;
Sotzen J.; Gwinn M.; Ahmed S.; Hassan M.; Bachuwa G.; Bhatt D.L.
Institution
(Kheiri, Haykal, Chintalapati, Cranford, Sotzen, Ahmed, Hassan, Bachuwa)
Department of Internal Medicine, Hurley Medical Center/Michigan State
University, Flint, MI 48503, United States
(Abdalla) Division of Hematology & Oncology, Ascension St. John Hospital,
Grosse Pointe Woods, MI 48236, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV 26506, United States
(Gwinn) Michigan State University-College of Human Medicine, Flint, MI
48502, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, 75 Francis Street, Boston, MA 02115, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Patients undergoing cardiac surgery are among the most common recipients
of allogeneic 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. We searched electronic databases from inception to December 2017
for randomized controlled trials (RCTs). We calculated the risk ratios
(RRs) and weighted-mean difference (MD) using a random-effects model. We
included 9 RCTs with a total of 9005 patients. There was no significant
difference in mortality between groups [RR 1.03; 95% confidence interval
(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 (h) (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 to 0.48; P = 0.38).
In conclusion, this meta-analysis showed that restrictive strategies for
RBC transfusion are as safe as liberal strategies in patients undergoing
cardiac surgery with regards to short-term clinical
outcomes.<br/>Copyright &#xa9; 2018, Springer Science+Business Media, LLC,
part of Springer Nature.

<81>
Accession Number
626567785
Title
Music-based interventions for aphasia could act through a motor-speech
mechanism: a systematic review and case-control analysis of published
individual participant data.
Source
Aphasiology. 33 (4) (pp 466-497), 2019. Date of Publication: 03 Apr 2019.
Author
Zumbansen A.; Tremblay P.
Institution
(Zumbansen) Jewish General Hospital, McGill University, Montreal, QC,
Canada
(Tremblay) Departement de readaptation, Faculte de medecine, Centre de
recherche CERVO, Universite Laval, Quebec, QC, Canada
Publisher
Routledge (E-mail: info@tandf.co.uk)
Abstract
Background: Melodic Intonation Therapy, a music-based intervention for the
recovery of oral language production in aphasia, has been shown to be
particularly effective in patients with Broca's aphasia compared to other
aphasia subtypes. It has been suggested that this therapy might improve
language output by acting on motor-speech deficits often associated with
Broca's aphasia. In this article, we examine the relevance of a
motor-speech mechanism for music-based interventions designed to improve
verbal expression in patients with any type of aphasia. <br/>Aim(s): To
test the association between the presence of motor-speech disorders (MSDs)
and improvement with music-based protocols targeting verbal expression in
participants with aphasia. Methods and procedures: We conducted a
systematic review of publications reporting language production outcomes
following a music-based intervention in participants with aphasia and
performed a case-control analysis on extracted individual participant data
(IPD). The databases PubMed, MEDLINE (1800 to 9 March 2018), and PsycINFO
(1806 to March 2018) were screened, followed with cross-referencing. We
recorded data at the level of study and, when possible, at the IPD level.
When not explicitly reported, we applied a series of heuristics to infer
the presence/absence of an MSD in participants. Binomial logistic
regressions were performed to ascertain the effects of the presence of an
MSD, aphasia severity, treatment duration (in weeks), and treatment
intensity (hours/week) on the likelihood that participants would show a
speech or a language improvement following intervention. Outcomes &
Results: Forty original articles were included in this review. Twenty-two
reported sufficient details to be included in our IPD analysis, for a
total sample of 105 participants. Most interventions included some sort of
singing as their primary music-based facilitation technique for language
production. For speech improvement, statistically significant predictor
variables were the presence of an MSD and treatment intensity. For
language improvement, statistically significant predictor variables were
the presence of an MSD, treatment intensity, and duration. Severity of
aphasia was not associated with the likelihood of speech or language
improvement. <br/>Conclusion(s): Music-based interventions for language
production in aphasia may act via a motor-speech mechanism. We suggest
that music and singing-based therapies might be further investigated as
treatment options for patients with MSDs, whether associated with aphasia
or not.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Informa UK Limited, trading
as Taylor & Francis Group.

<82>
Accession Number
624326601
Title
Rivaroxaban versus Warfarin in Patients with Mechanical Heart Valve:
Rationale and Design of the RIWA Study.
Source
Drugs in R and D. 18 (4) (pp 303-308), 2018. Date of Publication: 01 Dec
2018.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Filho J.A.L.; Schonhofen I.S.; Camara
E.J.N.; Roever L.; Cardoso H.E.D.P.; Akrami K.M.
Institution
(Duraes, Filho, Schonhofen, Cardoso) General Hospital Roberto Santos,
Salvador, Bahia, Brazil
(Duraes, de Souza Lima Bitar, Camara) Federal University of Bahia, Medical
School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, BA 40025-010, Brazil
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
(Akrami) Division of Infectious Disease, Department of Medicine,
University of California, San Diego, San Diego, CA, United States
Publisher
Springer International Publishing
Abstract
Introduction: Mechanical heart valves (MHV) are extremely durable, but
they require permanent use of anticoagulation to prevent thromboembolic
events. The only approved therapeutic options are vitamin K antagonists
(VKAs), such as warfarin. As a drug class, clinical management is
difficult, therefore new alternatives need to be evaluated.
<br/>Method(s): RIWA is a phase II/III, prospective, open-label,
randomized, pilot study designed to investigate oral rivaroxaban 15 mg
twice daily compared with dose-adjusted warfarin for the prevention of
stroke (ischemic or hemorrhagic) and systemic embolism in patients with
MHV, from August 2018 to December 2019. Patients will undergo
transesophageal echocardiography at the beginning and the end of the study
(follow-up time 90 days). On an explanatory basis, all events will be
analyzed, including stroke, peripheral systemic embolism, valve
thrombosis, significant bleeding and death. <br/>Discussion(s): Warfarin
and similar VKAs are standard therapy for patients with an MHV. Even with
the appropriate use of therapy, the incidence of thromboembolic events is
high at 1-4% per year. Furthermore, bleeding risk is significant, ranging
from 2 to 9% per year. The new frontier to be overcome in relation to use
of the new oral anticoagulants is undoubtedly in patients with MHV. A
significant portion of people with MHV worldwide will benefit if
noninferiority of these new agents is confirmed. Trial Registration:
ClinicalTrials.gov identifier: NCT03566303. Recruitment Status:
Recruiting. First Posted: 25 June 2018. Last Update Posted: 25 June
2018.<br/>Copyright &#xa9; 2018, The Author(s).

<83>
Accession Number
624586004
Title
Effect of intraoperative dexmedetomidine on renal function after
cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a
randomized, placebo-controlled trial.
Source
International Journal of Hyperthermia. (no pagination), 2018. Date of
Publication: 2018.
Author
Song Y.; Kim D.-H.; Kwon T.D.; Han D.W.; Baik S.H.; Jung H.H.; Kim J.Y.
Institution
(Song, Kim, Kwon, Han, Jung, Kim) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Kim, Kwon, Han, Kim) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Baik) Department of Surgery, Yonsei University College of Medicine,
Seoul, South Korea
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal
chemotherapy (HIPEC) predispose to postoperative renal dysfunction.
Dexmedetomidine is an alpha<inf>2</inf> adrenoreceptor agonist, which has
renoprotective effects after cardiac surgery. <br/>Objective(s): To assess
the effect of dexmedetomidine on renal function after CRS and HIPEC.
Materials: Thirty-eight patients undergoing CRS and HIPEC were randomized
to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1
mug/kg over 20 min followed by infusion at 0.5 mug/kg/h) or 0.9% sodium
chloride (control group, n = 19) during surgery. Creatinine clearance
(CrCl) was assessed daily until postoperative day 7. Urine neutrophil
gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1
were measured for 24 h after surgery. <br/>Result(s): There was no
difference in the lowest CrCl value during the first 7 days
postoperatively, but the % change from baseline to the lowest value was
lower in the dexmedetomidine group than in the control group (p =.037).
Urine NGAL and KIM-1 levels were increased over time in both groups, but
the increases were significantly less in the dexmedetomidine group (p
=.018 and 0.038, respectively). In the dexmedetomidine group, the length
of intensive care unit stay was shorter (p =.034). <br/>Conclusion(s):
Intraoperative dexmedetomidine infusion did not improve renal function in
terms of serum Cr-related indices following CRS and HIPEC. However, as the
decrease in CrCl was attenuated and early tubular-injury markers were
lower in the dexmedetomidine group, dexmedetomidine may have protective
effects against early tubular injury in CRS and HIPEC. Clinical Trials
Registry:http://clinicaltrials.gov (NCT02641938).<br/>Copyright &#xa9;
2018, &#xa9; 2018 The Author(s). Published by Informa UK Limited, trading
as Taylor & Francis Group.

<84>
Accession Number
625597144
Title
Comparison of the Efficacy of Oral versus Intravascular Magnesium in the
Prevention of Hypomagnesemia and Arrhythmia after CABG.
Source
Brazilian journal of cardiovascular surgery. 33 (5) (pp 448-453), 2018.
Date of Publication: 01 Sep 2018.
Author
Jannati M.; Shahbazi S.; Eshaghi L.
Institution
(Jannati) Cardiovascular Surgery Ward, Faghihi Hospital, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shahbazi) Department of Anesthesiology, Shiraz Anesthesiology and
Critical and Care Research Center, Nemazee Hospital, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Eshaghi) Department of Anesthesiology, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Cardiac arrhythmias are a common challenge following open-heart
surgeries. Hypomagnesemia is believed to be correlated with this
condition. Prophylactic intravenous magnesium supplementation has been
practiced for a long time in patients undergoing CABG. This study was
designed in an attempt to compare the efficacy of oral versus intravenous
routes in the prevention of hypomagnesemia and arrhythmia. <br/>METHOD(S):
In this interventional clinical study, 82 patients were randomly assigned
to 2 groups. All patients were evaluated for baseline serum magnesium
level and arrhythmias. One group received 1,600 mg of oral magnesium
hydroxide through nasogastric (NG) tube prior to surgery, while the other
group received 2 g of magnesium sulfate during the induction of
anesthesia. The serum magnesium level was monitored for 48 hours after the
operation. The difference in preoperative hypomagnesemia was
non-significant (Sig: 0.576). <br/>RESULT(S): During the operation, the
serum magnesium level peaked around 4 mg/dL, and no hypomagnesemia was
detected in any patient. Although the curve of oral group declined
parallel and below that of intravenous (IV) group, no significant
differences were detected during postoperative monitoring. In addition, a
prevalence of arrhythmia of 13.9% and 6.5% was noticed in IV and oral
groups, respectively (OR: 0.428). <br/>CONCLUSION(S): Providing 1,600 mg
of oral magnesium supplement to patients is as effective as 2,000 mg of
magnesium sulfate IV in preventing hypomagnesemia and arrhythmia after
CABG. Thus, the authors introduce this treatment regimen as a promising
and cost-effective method.

<85>
Accession Number
2001561031
Title
Interventions to promote patient utilization of cardiac rehabilitation:
Cochrane systematic review and meta-analysis.
Source
Journal of Clinical Medicine. 8 (2) (no pagination), 2019. Article Number:
189. Date of Publication: 2019.
Author
de Araujo Pio C.S.; Chaves G.; Davies P.; Taylor R.; Grace S.
Institution
(de Araujo Pio, Grace) School of Kinesiology and Health Science, York
University, 4700 Keele St, Toronto, ON M3J 1P3, Canada
(Chaves) Department of Physical Therapy, Federal University of Minas
Gerais, Av. Pres. Antonio Carlos, 6627-Pampulha, Belo Horizonte, MG
31270-901, Brazil
(Davies) School of Social and Community Medicine, University of Bristol,
Queens Road, Bristol BS8 1QU, United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
(Grace) Toronto Rehabilitation Institute, University Health Network,
University of Toronto, 399 Bathurst St, Toronto, ON M5T 2S8, Canada
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Too few patients utilize cardiac rehabilitation (CR), despite its
benefits. The Cochrane review assessing the effectiveness of interventions
to increase CR utilization (enrolment, adherence, and completion) was
updated. A search was performed through July 2018 of the Cochrane and
MEDLINE (Medical Literature Analysis and Retrieval System Online)
databases, among other sources. Randomized controlled trials in adults
with myocardial infarction, angina, revascularization, or heart failure
were included. Interventions had to aim to increase utilization of
comprehensive phase II CR. Two authors independently performed all stages
of citation processing. Following the random-effects meta-analysis,
meta-regression was undertaken to explore the impact of pre-specified
factors. Twenty-six trials with 5299 participants were included (35.8%
women). Low-quality evidence showed an effect of interventions in
increasing enrolment (risk ratio (RR) = 1.27, 95% confidence interval (CI)
= 1.13-1.42). Meta-regression analyses suggested that the intervention
deliverer (nurse or allied healthcare provider, p = 0.02) and delivery
format (face-to-face, p = 0.01) were influential in increasing enrolment.
There was low-quality evidence that interventions to increase adherence
were effective (standardized mean difference (SMD) = 0.38, 95% CI =
0.20-0.55), particularly where remotely-offered (SMD = 0.56, 95% CI =
0.36-0.76). There was moderate-quality evidence that interventions to
increase program completion were effective (RR = 1.13, 95% CI =
1.02-1.25). There are effective interventions to increase CR utilization,
but more research is needed to establish specific, implementable materials
and protocols, particularly for completion.<br/>Copyright &#xa9; 2019 by
the authors. Licensee MDPI, Basel, Switzerland.

<86>
Accession Number
2001648019
Title
Perioperative Quality Initiative consensus statement on postoperative
blood pressure, risk and outcomes for elective surgery.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
McEvoy M.D.; Gupta R.; Koepke E.J.; Feldheiser A.; Michard F.; Levett D.;
Thacker J.K.M.; Hamilton M.; Grocott M.P.W.; Mythen M.G.; Miller T.E.;
Edwards M.R.; Ackland G.L.; Brudney C.S.; Cecconi M.; Ince C.; Irwin M.G.;
Lacey J.; Pinsky M.R.; Sanders R.; Hughes F.; Bader A.; Thompson A.; Hoeft
A.; Williams D.; Shaw A.D.; Sessler D.I.; Aronson S.; Berry C.; Gan T.J.;
Kellum J.; Plumb J.; Bloomstone J.; Koepke E.
Institution
(McEvoy, McEvoy, Shaw) Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, TN, United States
(Gupta) Department of Anesthesiology, Stony Brook School of Medicine,
Stony Brook, NY, United States
(Koepke, Miller, Thompson, Williams, Aronson, Koepke) Department of
Anesthesiology, Duke University Medical Center, Durham, NC, United States
(Thacker) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Feldheiser) Department of Anesthesiology and Operative Intensive Care
Medicine, Charite Universitatsmedizin, Berlin, Germany
(Michard) MiCo Sarl, Lausanne, Switzerland
(Levett) Department of Perioperative Medicine and Critical Care,
Southampton University Hospital NHS Foundation Trust, Southampton, United
Kingdom
(Hamilton) Department of Intensive Care Medicine and Anaesthesia, St.
George's Hospital and Medical School NHS Foundation Trust, London, United
Kingdom
(Grocott, Edwards) Critical Care Research Group, NIHR Biomedical Research
Centre, University Hospital Southampton NHS Foundation Trust/University of
Southampton, Southampton, United Kingdom
(Grocott, Edwards) Department of Anaesthesia, University Hospital
Southampton NHS Foundation Trust/University of Southampton, Southampton,
United Kingdom
(Mythen) UCL/UCLH National Institute of Health Research Biomedical
Research Centre, London, United Kingdom
(Grocott, Edwards) Respiratory and Critical Care Research Area, NIHR
Biomedical Research Centre, University Hospital Southampton, NHS
Foundation Trust, Southampton, United Kingdom
(Ackland) Translational Medicine & Therapeutics, William Harvey Research
Institute, Barts and The London School of Medicine and Dentistry, Queen
Mary University of London, John Vane Science Centre, Charterhouse Square,
London, United Kingdom
(Brudney) Department of Anesthesiology, University of Manitoba, Canada
(Cecconi) Department of Intensive Care Medicine, St George's Healthcare
NHS Trust and St George's University of London, United Kingdom
(Ince) Department of Intensive Care, University Medical Center Rotterdam,
Rotterdam, Netherlands
(Irwin) Department of Anaesthesiology, University of Hong Kong, Hong Kong
(Lacey, Hughes) University College London Hospitals NHS Trust, London,
United Kingdom
(Pinsky) Department of Critical Care Medicine, University of Pittsburgh,
Pittsburgh, PA, United States
(Sanders) Department of Anesthesiology, University of Wisconsin School of
Medicine and Public Health, Madison, WI, United States
(Bader) Department of Anesthesiology, Brigham and Women's Hospital,
Boston, MA, United States
(Hoeft) Department of Anaesthesiology and Intensive Care, University
Hospital Bonn, Bonn, Germany
(Sessler) Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
(Berry) Royal Devon and Exeter NHS Foundation Trust, Exeter, United
Kingdom
(Gupta, Gan) Department of Anesthesiology, Stony Brook University School
of Medicine, Stony Brook, NY, United States
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Levett, Plumb) University Hospital Southampton, NHS Foundation Trust,
Southampton, United Kingdom
(Bloomstone) University of Arizona College of Medicine-Phoenix, Phoenix,
AZ, United States
(Thacker) Department of Surgery, Division of Advanced Oncologic and GI
Surgery, Duke University Medical Center, Durham, NC, United States
(Feldheiser) Department of Anesthesiology and Operative Intensive Care
Medicine, Charite - Universitatsmedizin Berlin, Berlin, Germany
(Michard) MiCo, Denens, Switzerland
(Hamilton) Department of Anaesthesia & Critical Care Medicine, St.
George's Hospital and Medical School, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Postoperative hypotension and hypertension are frequent events
associated with increased risk of adverse outcomes. However, proper
assessment and management is often poorly understood. As a part of the
PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed
a consensus document addressing this topic. The target population includes
adult, non-cardiac surgical patients in the postoperative phase outside of
the ICU. <br/>Method(s): A modified Delphi technique was used, evaluating
papers published in MEDLINE examining postoperative blood pressure
monitoring, management, and outcomes. Practice recommendations were
developed in line with National Institute for Health and Care Excellence
guidelines. <br/>Result(s): Consensus recommendations were that (i) there
is evidence of harm associated with postoperative systolic arterial
pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the
threshold at which harm occurs may be higher than a systolic arterial
pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely
define the level of postoperative hypertension above which harm will
occur; (iv) a greater frequency of postoperative blood pressure
measurement is likely to identify risk of harm and clinical deterioration
earlier; and (v) there is evidence of harm from withholding beta-blockers,
angiotensin receptor blockers, and angiotensin-converting enzyme
inhibitors in the postoperative period. <br/>Conclusion(s): Despite
evidence of associations with postoperative hypotension or hypertension
with worse postoperative outcome, further research is needed to define the
optimal levels at which intervention is beneficial, to identify the best
methods and timing of postoperative blood pressure measurement, and to
refine the management of long-term antihypertensive treatment in the
postoperative phase.<br/>Copyright &#xa9; 2019 British Journal of
Anaesthesia