EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2001540461
Title
VEITHsymposium.
Source
Journal of Vascular Surgery. Conference: VEITHsymposium. United States. 68
(5) (no pagination), 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

<2>
Accession Number
626728647
Title
Patient Blood Management: Recommendations from the 2018 Frankfurt
Consensus Conference.
Source
JAMA - Journal of the American Medical Association. 321 (10) (pp 983-997),
2019. Date of Publication: 12 Mar 2019.
Author
Mueller M.M.; Van Remoortel H.; Meybohm P.; Aranko K.; Aubron C.; Burger
R.; Carson J.L.; Cichutek K.; De Buck E.; Devine D.; Fergusson D.; Follea
G.; French C.; Frey K.P.; Gammon R.; Levy J.H.; Murphy M.F.; Ozier Y.;
Pavenski K.; So-Osman C.; Tiberghien P.; Volmink J.; Waters J.H.; Wood
E.M.; Seifried E.; Albaladejo P.; Allard S.; Gabriel C.; Greinacher A.;
Van Kraaij M.; Liumbruno G.; Saxon B.; Shehata N.; Velati C.; Bischof D.;
Hamilton J.; Lasocki S.; Gomez M.M.; Schmitz-Rixen T.; Serve H.; Thomson
A.; Beckers E.; Benson K.; Juffermans N.; Maze D.; Mirski M.; Murphy G.;
Ries J.-J.; Walsh T.; Anthony L.; Bielby L.; Donald G.; Estcourt L.; Frank
S.; Freedman J.; Humbrecht C.
Institution
(Mueller, Seifried) German Red Cross Blood Transfusion Service, Goethe
University Clinics, Baden-Wuerttemberg-Hessen, Institute for Transfusion
Medicine and Immunohematology, University Hospital of the Goethe
University, Sandhofstrasse 1, Frankfurt/Main 60528, Germany
(Van Remoortel, De Buck) Centre for Evidence-Based Practice (CEBaP),
Belgian Red Cross, Mechelen, Belgium
(Meybohm, Schmitz-Rixen, Serve) Department of Anaesthesiology, Intensive
Care Medicine and Pain Therapy, University Hospital Frankfurt,
Frankfurt/Main, Germany
(Aranko, Seifried) European Blood Alliance (EBA), Amsterdam, Netherlands
(Aubron, Ozier) Departments of Intensive Care and of Anesthesia,
University Hospital of Brest, Brest, France
(Burger) Robert-Koch-Institut (RKI), Berlin, Germany
(Carson) Robert Wood Johnson Medical School, Rutgers University, New
Brunswick, NJ, United States
(Cichutek) Paul-Ehrlich-Institut (PEI), Langen, Germany
(De Buck) Department of Public Health and Primary Care, Faculty of
Medicine, KU Leuven, Leuven, Belgium
(Devine, Hamilton) Canadian Blood Services, Ottawa, ON, Canada
(Fergusson) Departments of Medicine, Surgery, Epidemiology and Public
Health, University of Ottawa, Ottawa, ON, Canada
(Aubron, Follea) Societe Francaise de Transfusion Sanguine (SFTS), Paris,
France
(French) Intensive Care, Western Health, Melbourne, Australia
(Frey) Fairview Health Services, Minneapolis, MN, United States
(Gammon) OneBlood, Orlando, FL, United States
(Levy) Department of Cardiothoracic Intensive Care Medicine, Duke
University Medical Centre, Durham, NC, United States
(Murphy, Allard, Donald, Estcourt) National Health Service Blood and
Transplant and University of Oxford, Oxford, United Kingdom
(Pavenski, Maze) St. Michael's Hospital and University of Toronto,
Toronto, Canada
(So-Osman) Sanquin Blood Bank, Leiden and Department of Haematology,
Groene Hart Hospital, Gouda, Netherlands
(So-Osman, Wood, Seifried, Allard) International Society of Blood
Transfusion (ISBT), Amsterdam, Netherlands
(Tiberghien) Etablissement Francais du Sang (EFS), Saint-Denis, France
(Volmink) Department of Clinical Epidemiology, Faculty of Medicine and
Health Sciences, Stellenbosch University, Stellenbosch, South Africa
(Waters) Departments of Anesthesiology and Bioengineering, University of
Pittsburgh Medical Centre, Pittsburgh, PA, United States
(Wood) Transfusion Research Unit, Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, Australia
(Albaladejo) Grenoble University Hospital, France
(Albaladejo) International Society on Thrombosis and Haemostasis ISTH,
France
(Frey, Gammon, Murphy, Tiberghien, Van Kraaij, Liumbruno, Velati) American
Association of Blood Banks AABB, EBA, United States
(Gabriel) Ludwig Boltzmann Institute for Clinical and Experimental
Traumatology, Austria
(Gabriel) Deutsche Gesellschaft Fr Transfusionsmedizin und
Immunhamatologie DGTI, Germany
(Greinacher) Institut Fr Immunologie und Transfusionsmedizin, Greifswald,
Germany
(Greinacher, Shehata) International Collaboration for Transfusion Medicine
Guidelines ICTMG, United States
(Van Kraaij) Sanquin Blood Bank, Amsterdam, Netherlands
(Liumbruno) Italian National Institute of Health, Rome, Italy
(Saxon, Thomson, Bielby) Australian Red Cross Blood Service, Australia
(Shehata) Mount Sinai Hospital Toronto, C-Ontario, Canada
(Velati) Societa Italiana di Medicina Trasfusionale e Immunoematologia,
Italy
(Bischof) Mt. Sinai Hospital, Toronto, ON, Canada
(Gomez) University of Malaga, Malaga, Spain
(Lasocki) University Hospital, Angers, France
(Beckers) Maastricht University Medical Center, Maastricht, Netherlands
(Benson) Moffitt Cancer Center, Tampa, FL, United States
(Juffermans) University of Amsterdam, Amsterdam, Netherlands
(Mirski, Frank) Johns Hopkins Medical Institutions, Baltimore, MD, United
States
(Murphy) British Heart Foundation, University of Leicester, United Kingdom
(Ries) University Hospital Basel, Basel, Switzerland
(Walsh) University of Edinburgh, Edinburgh, United Kingdom
(Anthony) Allina Health, Minneapolis, MN, United States
(Freedman) St. Michael's Hospital, Toronto, ON, Canada
(Humbrecht) Etablissement Francais du Sang, Strasbourg, France
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Blood transfusion is one of the most frequently used therapies
worldwide and is associated with benefits, risks, and costs.
<br/>Objective(s): To develop a set of evidence-based recommendations for
patient blood management (PBM) and for research. Evidence Review: The
scientific committee developed 17
Population/Intervention/Comparison/Outcome (PICO) questions for red blood
cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia
(3 questions), RBC transfusion thresholds (11 questions), and
implementation of PBM programs (3 questions). These questions guided the
literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane
Library, Transfusion Evidence Library), searched from inception to January
2018. Meta-analyses were conducted with the GRADE (Grading of
Recommendations, Assessment, Development, and Evaluation) methodology and
the Evidence-to-Decision framework by 3 panels including clinical and
scientific experts, nurses, patient representatives, and methodologists,
to develop clinical recommendations during a consensus conference in
Frankfurt/Main, Germany, in April 2018. <br/>Finding(s): From 17607
literature citations associated with the 17 PICO questions, 145 studies,
including 63 randomized clinical trials with 23143 patients and 82
observational studies with more than 4 million patients, were analyzed.
For preoperative anemia, 4 clinical and 3 research recommendations were
developed, including the strong recommendation to detect and manage anemia
sufficiently early before major elective surgery. For RBC transfusion
thresholds, 4 clinical and 6 research recommendations were developed,
including 2 strong clinical recommendations for critically ill but
clinically stable intensive care patients with or without septic shock
(recommended threshold for RBC transfusion, hemoglobin concentration <7
g/dL) as well as for patients undergoing cardiac surgery (recommended
threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For
implementation of PBM programs, 2 clinical and 3 research recommendations
were developed, including recommendations to implement comprehensive PBM
programs and to use electronic decision support systems (both conditional
recommendations) to improve appropriate RBC utilization. <br/>Conclusions
and Relevance: The 2018 PBM International Consensus Conference defined the
current status of the PBM evidence base for practice and research purposes
and established 10 clinical recommendations and 12 research
recommendations for preoperative anemia, RBC transfusion thresholds for
adults, and implementation of PBM programs. The relative paucity of strong
evidence to answer many of the PICO questions supports the need for
additional research and an international consensus for accepted
definitions and hemoglobin thresholds, as well as clinically meaningful
end points for multicenter trials.<br/>Copyright &#xa9; 2019 American
Medical Association. All rights reserved.

<3>
Accession Number
621398121
Title
Cerebrovascular autoregulation monitoring and patient-centred outcomes
after cardiac surgery: a systematic review.
Source
Acta Anaesthesiologica Scandinavica. 62 (5) (pp 588-599), 2018. Date of
Publication: May 2018.
Author
Chan B.; Butler E.; Frost S.A.; Chuan A.; Aneman A.
Institution
(Chan, Butler) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Frost, Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
(Frost, Chuan, Aneman) Ingham Institute for Applied Medical Research,
Sydney, NSW, Australia
(Frost, Chuan, Aneman) South Western Sydney Clinical School, University of
New South Wales, Sydney, NSW, Australia
(Frost) Centre for Applied Nursing Research, Western Sydney University,
Sydney, NSW, Australia
(Chuan) Department of Anaesthesia, Liverpool Hospital, Liverpool, NSW,
Australia
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Impaired cerebrovascular autoregulation (CVAR) is observed in
up to 20% of cardiac surgical patients. This systematic review aims to
evaluate the association between impaired CVAR, measured by current
monitoring techniques, and patient-centred outcomes in adults following
cardiac surgery. <br/>Method(s): MEDLINE, EMBASE, PubMed, MEDLINE
In-Process and Cochrane Library were systematically searched through 8
December 2017. Studies were included if they assessed associations between
CVAR and patient-centred outcomes in the adult cardiac surgical
population. The primary outcome of this systematic review was mortality.
Secondary outcomes were stroke, delirium and acute kidney injury. Risk of
bias was systematically assessed, and the GRADE methodology was used to
evaluate the quality of evidence across outcomes. <br/>Result(s): Eleven
observational studies and no randomised controlled trials met the
inclusion criteria. Due to methodological heterogeneity, meta-analysis was
not possible. There was a high risk of bias within individual studies and
low quality of evidence across outcomes. Of the included studies, one
assessed mortality, five assessed stroke, four assessed delirium, and
three assessed acute kidney injury. No reliable conclusions can be drawn
from the one study assessing mortality. Interpretation of studies
investigating CVAR and stroke, delirium and acute kidney injury was
complicated by the lack of standardisation of monitoring techniques as
well as varying definitions of impaired CVAR. <br/>Conclusion(s): There is
a paucity of high quality evidence for CVAR monitoring and its
associations with outcome measures in post-cardiac surgical patients,
highlighting the need for future studies.<br/>Copyright &#xa9; 2018 The
Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley &
Sons Ltd

<4>
Accession Number
620867060
Title
Scandinavian SSAI clinical practice guideline on choice of inotropic agent
for patients with acute circulatory failure.
Source
Acta Anaesthesiologica Scandinavica. 62 (4) (pp 420-450), 2018. Date of
Publication: April 2018.
Author
Moller M.H.; Granholm A.; Junttila E.; Haney M.; Oscarsson-Tibblin A.;
Haavind A.; Laake J.H.; Wilkman E.; Sverrisson K.O.; Perner A.
Institution
(Moller, Granholm, Perner) Department of Intensive Care 4131, Copenhagen
University Hospital, Rigshospitalet, Copenhagen, Denmark
(Junttila) Department of Anaesthesiology, Tampere University Hospital,
Tampere, Finland
(Haney) Anaesthesiology and Intensive Care Medicine, Umea University,
Umea, Sweden
(Oscarsson-Tibblin) Department of Anaesthesiology and Intensive Care,
Department of Medicine and Health, Linkoping University, Linkoping, Sweden
(Haavind) Department of Anaesthesiology and Intensive Care, University
Hospital Northern Norway, Tromso, Norway
(Laake) Division of Critical Care, Oslo University Hospital, Oslo, Norway
(Wilkman) Division of Intensive Care Medicine, Department of
Perioperative, Intensive Care and Pain Medicine, Helsinki University
Hospital, University of Helsinki, Helsinki, Finland
(Sverrisson) Department of Anesthesia & Critical Care, Landspitali
University Hospital of Iceland, Reykjavik, Iceland
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Adult critically ill patients often suffer from acute
circulatory failure and those with low cardiac output may be treated with
inotropic agents. The aim of this Scandinavian Society of Anaesthesiology
and Intensive Care Medicine guideline was to present patient-important
treatment recommendations on this topic. <br/>Method(s): This guideline
was developed according to GRADE. We assessed the following subpopulations
of patients with shock: (1) shock in general, (2) septic shock, (3)
cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery,
and (6) other types of shock, including vasodilatory shock. We assessed
patient-important outcome measures, including mortality and serious
adverse reactions. <br/>Result(s): For all patients, we suggest against
the routine use of any inotropic agent, including dobutamine, as compared
to placebo/no treatment (very low quality of evidence). For patients with
shock in general, and in those with septic and other types of shock, we
suggest using dobutamine rather than levosimendan or epinephrine (very low
quality of evidence). For patients with cardiogenic shock and in those
with shock after cardiac surgery, we suggest using dobutamine rather than
milrinone (very low quality of evidence). For the other clinical
questions, we refrained from giving any recommendations or suggestions.
<br/>Conclusion(s): We suggest against the routine use of any inotropic
agent in adult patients with shock. If used, we suggest using dobutamine
rather than other inotropic agents for the majority of patients, however,
the quality of evidence was very low, implying high uncertainty on the
balance between the benefits and harms of inotropic agents.<br/>Copyright
&#xa9; 2018 The Authors. Acta Anaesthesiologica Scandinavica published by
John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica
Foundation

<5>
Accession Number
621363859
Title
Incidence and predictors of sudden cardiac death after heart
transplantation: A systematic review and meta-analysis.
Source
Clinical Transplantation. 32 (3) (no pagination), 2018. Article Number:
e13206. Date of Publication: March 2018.
Author
Alba A.C.; Foroutan F.; Ng Fat Hing N.K.V.; Fan C.-P.S.; Manlhiot C.; Ross
H.J.
Institution
(Alba, Foroutan, Ng Fat Hing, Ross) Heart Failure and Transplantation
Program, Toronto General Hospital, University Health Network, Toronto, ON,
Canada
(Fan, Manlhiot) The Hospital for Sick Children, University of Toronto,
Toronto, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Sudden cardiac death (SCD) is an important post-transplant
problem being responsible for ~10% of deaths. We conducted a systematic
review and meta-analysis to evaluate incidence and predictors of
post-heart transplant SCD and the use of implantable cardiac defibrillator
(ICD). <br/>Method(s): Citations were identified in electronic databases
and references of included studies. Observational studies on adults
reporting on incidence and predictors of post-transplant SCD and ICD use
were selected. We meta-analyzed SCD in person-years using random effects
models. We qualitatively summarized predictors. <br/>Result(s): This study
includes 55 studies encompassing 47 901 recipients. The pooled incidence
rate of SCD was 1.30 per 100 person-years (95% CI: 1.08-1.52). Cardiac
allograft vasculopathy (CAV) was associated with higher SCD risk (2.40 per
100 patient-years, 95% CI: 1.46-3.34). Independent predictors of SCD
identified by two moderate-quality studies were older donor age, younger
recipient age, non-Caucasian race, reduced left ventricular ejection
fraction, rejection, infection, and cancer. Authors rarely reported on ICD
use. <br/>Conclusion(s): This meta-analysis found that post-transplant SCD
risk in heart transplant recipients is higher than that in the general
population. CAV was associated with increased SCD risk. Observational
studies reporting on absolute risk of SCD are needed to better identify
populations at a clinically significant increased risk.<br/>Copyright
&#xa9; 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<6>
Accession Number
51715356
Title
Cardiac stem cells in patients with ischaemic cardiomyopathy (SCIPIO):
Initial results of a randomised phase 1 trial.
Source
The Lancet. 378 (9806) (pp 1847-1857), 2011. Date of Publication: November
26-December 2, 2011.
Author
Bolli R.; Chugh A.R.; D'Amario D.; Loughran J.H.; Stoddard M.F.; Ikram S.;
Beache G.M.; Wagner S.G.; Leri A.; Hosoda T.; Sanada F.; Elmore J.B.;
Goichberg P.; Cappetta D.; Solankhi N.K.; Fahsah I.; Rokosh D.G.;
Slaughter M.S.; Kajstura J.; Anversa P.
Institution
(Bolli, Chugh, Loughran, Stoddard, Ikram, Wagner, Elmore, Solankhi,
Fahsah, Rokosh) Division of Cardiovascular Medicine, University of
Louisville, Ambulatory Care Building, 550 S Jackson Street, Louisville, KY
40202, United States
(Slaughter) Cardiothoracic Surgery, University of Louisville, Louisville,
KY, United States
(Beache) Department of Radiology, University of Louisville, Louisville,
KY, United States
(D'Amario, Leri, Hosoda, Sanada, Goichberg, Cappetta, Kajstura, Anversa)
Department of Anesthesia and Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
c-kit-positive, lineage-negative cardiac stem cells (CSCs) improve
post-infarction left ventricular (LV) dysfunction when administered to
animals. We undertook a phase 1 trial (Stem Cell Infusion in Patients with
Ischemic cardiOmyopathy [SCIPIO]) of autologous CSCs for the treatment of
heart failure resulting from ischaemic heart disease. In stage A of the
SCIPIO trial, patients with post-infarction LV dysfunction (ejection
fraction [EF] <=40) before coronary artery bypass grafting were
consecutively enrolled in the treatment and control groups. In stage B,
patients were randomly assigned to the treatment or control group in a 2:3
ratio by use of a computer-generated block randomisation scheme. 1 million
autologous CSCs were administered by intracoronary infusion at a mean of
113 days (SE 4) after surgery; controls were not given any treatment.
Although the study was open label, the echocardiographic analyses were
masked to group assignment. The primary endpoint was short-term safety of
CSCs and the secondary endpoint was efficacy. A per-protocol analysis was
used. This study is registered with ClinicalTrials.gov, number
NCT00474461. This study is still in progress. 16 patients were assigned to
the treatment group and seven to the control group; no CSC-related adverse
effects were reported. In 14 CSC-treated patients who were analysed, LVEF
increased from 30.3 (SE 1.9) before CSC infusion to 38.5 (2.8) at 4 months
after infusion (p=0.001). By contrast, in seven control patients, during
the corresponding time interval, LVEF did not change (30.1 [2.4] at 4
months after CABG vs 30.2 [2.5] at 8 months after CABG). Importantly, the
salubrious effects of CSCs were even more pronounced at 1 year in eight
patients (eg, LVEF increased by 12.3 ejection fraction units [2.1] vs
baseline, p=0.0007). In the seven treated patients in whom cardiac MRI
could be done, infarct size decreased from 32.6 g (6.3) by 7.8 g (1.7; 24)
at 4 months (p=0.004) and 9.8 g (3.5; 30) at 1 year (p=0.04). These
initial results in patients are very encouraging. They suggest that
intracoronary infusion of autologous CSCs is effective in improving LV
systolic function and reducing infarct size in patients with heart failure
after myocardial infarction, and warrant further, larger, phase 2 studies.
University of Louisville Research Foundation and National Institutes of
Health. &#xa9; 2011 Elsevier Ltd.

<7>
Accession Number
626675065
Title
Nine contemporary therapeutic directions in heart failure.
Source
Heart Asia. 11 (1) (no pagination), 2019. Article Number: e011150. Date of
Publication: 01 Mar 2019.
Author
Almarzooq Z.; Pareek M.; Sinnenberg L.; Vaduganathan M.; Mehra M.R.
Institution
(Almarzooq, Pareek, Sinnenberg, Vaduganathan, Mehra) Brigham and Women's
Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA
02115, United States
(Pareek) Department of Cardiology, North Zealand Hospital, Hillero,
Denmark
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
The global burden of heart failure has continued to increase dramatically
with 26 million people affected and an estimated health expenditure of 31
billion worldwide. Several practice-influencing studies were reported
recently, bringing advances along many frontiers in heart failure,
particularly heart failure with reduced ejection fraction. In this
article, we discuss nine distinct therapeutic areas that were
significantly influenced by this scientific progress. These distinct areas
include the emergence of sodium-glucose cotransporter-2 inhibitors,
broadening the application of angiotensin-neprilysin inhibition, clinical
considerations in therapy withdrawal in those patients with heart failure
that a recover' myocardial function, benefits of low-dose direct oral
anticoagulants in sinus rhythm, targeted therapy for treating cardiac
amyloidosis, usefulness of mitral valve repair in heart failure, the
advent of newer left ventricular assist devices for advanced heart
failure, the role of ablation in atrial fibrillation in heart failure, and
finally the use of wearable defibrillators to address sudden
death.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2019.

<8>
Accession Number
626675021
Title
Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients
after Cardiac Surgery.
Source
Thoracic and Cardiovascular Surgeon. 67 (2) (pp 107-116), 2019. Date of
Publication: 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, 95 South 2000 East
84112, 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
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background a?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. Methods a?A systematic search of PubMed, MEDLINE,
and EMBASE databases was performed. Results a?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). Conclusion a?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 &#xa9;
2019 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY
10001, USA.

<9>
Accession Number
626738298
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,
Marchioninistrasse 15, Munich 81377, Germany
(Brettner, Becker) Walter-Brendel Centre of Experimental Medicine,
Ludwig-Maximilians-University Munich, Martinsried, Germany
(Weis) Department of Anaesthesiology and Intensive Care Medicine, Klinikum
Furstenfeldbruck, Furstenfeldbruck, Germany
Publisher
IOS Press (Nieuwe Hemweg 6B, Amsterdam 1013 BG, Netherlands)
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.<br/>Copyright &#xa9; 2019 IOS Press and the authors. All
rights reserved.

<10>
Accession Number
626686782
Title
Rationale and design of a prospective substudy of clinical endpoint
adjudication processes within an investigator-reported randomised
controlled trial in patients with coronary artery disease: The GLOBAL
LEADERS Adjudication Sub-StudY (GLASSY).
Source
BMJ Open. 9 (3) (no pagination), 2019. Article Number: e026053. Date of
Publication: 01 Mar 2019.
Author
Leonardi S.; Franzone A.; Piccolo R.; McFadden E.; Vranckx P.; Serruys P.;
Benit E.; Liebetrau C.; Janssens L.; Ferrario M.; Zurakowski A.; Van Geuns
R.-J.; Dominici M.; Huber K.; Slagboom T.; Buszman P.; Bolognese L.;
Tumscitz C.; Bryniarski K.; Aminian A.; Vrolix M.; Petrov I.; Garg S.;
Naber C.; Prokopczuk J.; Hamm C.; Steg G.; Heg D.; Juni P.; Windecker S.;
Valgimigli M.
Institution
(Leonardi) University of Pavia, Department of Molecular Medicine,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Franzone, Piccolo) Department of Advanced Biomedical Sciences, Federico
II University of Naples, Naples, Italy
(McFadden) Department of Cardiology, Cork University Hospital Group, Cork,
Ireland
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Hasselt, Belgium
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
(Benit) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Liebetrau) Department of Cardiology, Kerckhoff Heart and Thorax Centre,
Bad Nauheim, Germany
(Janssens) Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
(Ferrario) Department of Cardiology, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Zurakowski) Center of Cardiovascular Research and Development, American
Heart of Poland, Katowice, Poland
(Van Geuns) Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
(Dominici) Department of Cardiology, S. Maria University-Hospital, Terni,
Italy
(Huber) 3rd Med Department of Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria
(Slagboom) Department of Cardiology, OLVG, Amsterdam, Netherlands
(Buszman) Center for Cardiovascular Research and Development, American
Heart of Poland, Poland
(Bolognese) Department of Cardiology, Azienda Toscana USL Sudest, Arezzo,
Italy
(Tumscitz) Department of Cardiology, Azienda Ospedaliero Universitaria di
Ferrara Arcispedale sant'Anna, Cona, Italy
(Bryniarski) Jagiellonian University Medical College, John Paul II
Hospital, Krakow, Poland
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Vrolix) Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
(Petrov) Department of Cardiology, Adzhibadem Siti Klinik Surdechno-sudovi
Center, Sofia, Bulgaria
(Garg) Department of Cardiology, East Lancashire Hospitals NHS Trust,
Blackburn, United Kingdom
(Naber) Department of Cardiology and Angiology, Contilia Heart and
Vascular Centre, Essen, Germany
(Prokopczuk) Department of Cardiology, PAKS Kozle, Kozle, Poland
(Hamm) Kerckhoff Heart Center, Bad Nauheim, Germany
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Heg) CTU, Institute of Social and Preventive Medicine and Clinical Trials
Unit, Bern, Switzerland
(Juni) Department of Medicine, Applied Health Research Centre, Li Ka Shing
Knowledge Institute, St Michael's Hospital, Toronto, Canada
(Windecker, Valgimigli) Department of Cardiology, Inselspital
Universitatsspital Bern, Bern, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction The GLOBAL LEADERS is an open-label, pragmatic and
superiority randomised controlled trial designed to challenge the current
treatment paradigm of dual antiplatelet therapy (DAPT) for 12 months
followed by aspirin monotherapy among patients undergoing percutaneous
coronary intervention. By design, all study endpoints are investigator
reported (IR) and not subject to formal adjudication by an independent
Clinical Event Committee (CEC), which may introduce detection, reporting
or ascertainment bias. Methods and analysis We designed the GLOBAL LEADERS
Adjudication Sub-StudY (GLASSY) to prospectively implement, in a large
sample of patients enrolled within the GLOBAL LEADERS trial (7585 of 15
991, 47.5%), an independent adjudication process of reported and
unreported potential endpoints, using standardised CEC procedures, in
order to assess whether 23-month ticagrelor monotherapy (90 mg twice
daily) after 1-month DAPT is non-inferior to a standard regimen of DAPT
for 12 months followed by aspirin monotherapy for the primary efficacy
endpoint of death, non-fatal myocardial infarction, non-fatal stroke or
urgent target vessel revascularisation and superior for the primary safety
endpoint of type 3 or 5 bleeding according to the Bleeding Academic
Research Consortium criteria. This study will comprehensively assess the
comparative safety and efficacy of the two tested antithrombotic
strategies on CEC-adjudicated ischaemic and bleeding endpoints and will
provide insights into the role of a standardised CEC adjudication process
on the interpretation of study findings by quantifying the level of
concordance between IR-reported and CEC-adjudicated events. Ethics and
dissemination GLASSY has been approved by local ethics committee of all
study sites and/or by the central ethics committee for the country
depending on country-specific regulations. In all cases, they deemed that
it was not necessary to obtain further informed consent from individual
subjects.<br/>Copyright &#xa9; 2019 Author(s).

<11>
Accession Number
2001567659
Title
Cardiovascular effects of liraglutide.
Source
Current Hypertension Reviews. 15 (1) (pp 64-69), 2019. Date of
Publication: 2019.
Author
Mikhail N.
Institution
(Mikhail) David-Geffen School of Medicine, OliveView-UCLA Medical Center,
14445 Olive View Dr, Sylmar, CA 91342, United States
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Liraglutide is a glucagon-like 1 (GLP-1) agonist approved for
treatment of type 2 diabetes and obesity. <br/>Objective(s): To review the
cardiovascular effects of liraglutide including macrovascular and
microvascular events, its use in heart failure, and its effects on heart
rate and blood pressure. <br/>Result(s): The impact of liraglutide on
cardiovascular outcomes was examined in a large welldesigned study
published in 2016, the LEADER trial. This study included 9,340 patients
with advanced type 2 diabetes and high baseline cardiovascular risk. The
primary outcome was the first occurrence of death from cardiovascular
causes, non-fatal myocardial infarction, or non-fatal stroke. After a
median follow-up of 3.8 years, patients randomized to liraglutide had
significant reduction in the composite primary outcome compared to
patients randomized to placebo, hazard ratio (HR) 0.87; 95% CI 0.78-0.97.
Death from cardiovascular causes was significantly reduced with
liraglutide therapy (HR, 0.78; 95% CI 0.66-0.93), as well as death from
any cause (HR, 0.85; 95% CI 0.74-0.97). In 2017, the LEADER investigators
reported that nephropathy events were significantly lower after
liraglutide therapy than placebo (HR 0.78; 95% CI 0.67-0.92), but there
was no significant difference in retinopathy events. Meanwhile, other
studies suggested that the use of liraglutide may be harmful in patients
with severe heart failure, in part due to increase in heart rate.
<br/>Conclusion(s): Liraglutide is a useful therapy in patients with
advanced type 2 diabetes complicated by cardiovascular disease, except
patients with severe heart failure. Further studies are needed to evaluate
the long-term effects of liraglutide, and to see whether its beneficial
effects extend to patients with type 2 diabetes and low cardiac
risk.<br/>Copyright &#xa9; 2019 Bentham Science Publishers.

<12>
Accession Number
2001567364
Title
A longitudinal examination of the social-ecological correlates of exercise
in men and women following cardiac rehabilitation.
Source
Journal of Clinical Medicine. 8 (2) (no pagination), 2019. Article Number:
250. Date of Publication: February 2019.
Author
Moghei M.; Reid R.D.; Wooding E.; Ghisi G.M.; Pipe A.; Chessex C.; Prince
S.A.; Blanchard C.; Oh P.; Grace S.L.
Institution
(Moghei, Grace) School of Kinesiology and Health Science, York
University-Bethune 368, 4700 Keele St., Toronto, ON M3J 1P3, Canada
(Reid, Wooding, Pipe, Prince) Heart Institute, University of Ottawa, 40
Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Reid, Oh) Faculty of Medicine, University of Ottawa, 451 Smyth Rd,
Ottawa, ON K1H 8M5, Canada
(Ghisi, Chessex, Grace) Toronto Rehabilitation Institute, University
Health Network, University of Toronto, 347 Rumsey Rd, Toronto, ON M4G 1R7,
Canada
(Blanchard) Department of Medicine, Dalhousie University, 5790 University
Avenue, Halifax, NS B3H 1V7, Canada
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Cardiac patients who engage in >=150 min of moderate- to
vigorous-intensity physical activity (MVPA)/week have lower mortality, yet
MVPA declines even following cardiac rehabilitation (CR), and is lower in
women. A randomized trial of nine socioecological theory-based exercise
facilitation contacts over 50weeks versus usual care (1:1 parallel
arms)was undertaken (NCT01658683). The tertiary objective, as presented in
this paper, was to test whether the intervention impacted socioecological
elements, and in turn their association with MVPA. The 449 participants
wore an accelerometer and completed questionnaires post-CR, and 26, 52 and
78 weeks later. At 52 weeks, exercise task self-efficacy was significantly
greater in the intervention arm (p = 0.01), but no other differences were
observed except more encouragement from other cardiac patients at 26 weeks
(favoring controls). Among women adherent to the intervention, the group
in whom the intervention was proven effective, physical activity (PA)
intentions at 26 weeks were significantly greater in the intervention arm
(p = 0.04), with no other differences. There were some differences in
socioecological elements associated with MVPA by arm. There were also some
differences by sex, with MVPA more often associated with exercise
benefits/barriers in men, versus with working and the physical environment
in women.<br/>Copyright &#xa9; 2019 by the authors. Licensee MDPI, Basel,
Switzerland.

<13>
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. 59 (3) (pp 989-994), 2019. Date of Publication: March 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

<14>
Accession Number
626770016
Title
Section on Cardiology and Cardiac Surgery Annual Meeting, SOCCS 2019.
Source
Congenital Heart Disease. Conference: American Academy of Pediatrics
Section on Cardiology and Cardiac Surgery, SOCCS 2019. United States. 14
(1) (no pagination), 2019. Date of Publication: January - February 2019.
Author
Anonymous
Publisher
Wiley Blackwell
Abstract
The proceedings contain 9 papers. The topics discussed include: harmonic
imaging aids visualization of medtronic micro vascular plug during
transcatheter PDA closure in premature infants; a randomized trial of
intravenous acetaminophen versus indomethacin for treatment of PDA in VLBW
infants; adding paracetamol to ibuprofen for treatment of patent ductus
arteriosus in preterm infants: a pilot, double blind, randomized,
placebo-control trial; echocardiographic guidance for transcatheter device
closure of patent ductus arteriosus in extremely low birth weight infants;
PDA closure in a premature neonate after recovery from accidental left
pulmonary artery ligation; and use of a Doppler tipped umbilical artery
catheter to display continuous cardiac output derived indices and
direction of ductal shunting to optimize ventilation perfusion matching.

<15>
Accession Number
626785247
Title
Intracoronary transplantation of autologous bone marrow-derived
mononuclear cells for idiopathic dilated cardiomyopathy in pediatric: A
phase I/II, randomized, single blind clinical trial.
Source
BioImpacts. Conference: 3rd National Festival and the International
Congress on Stem cells and Regenerative Medicine. Iran, Islamic Republic
of. 8 (Supplement 1) (pp 92-93), 2018. Date of Publication: 2018.
Author
Mahdavi M.; Madani H.; Vahidshahi K.; Pouraliakbar H.; Moeininia F.;
Hosseini S.E.; Zareaskari F.; Jaroughi N.; Aghdami N.
Institution
(Mahdavi, Vahidshahi) Department of Pediatric Cardiology, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Madani, Moeininia, Hosseini, Zareaskari, Jaroughi, Aghdami) Department of
Regenerative Medicine, Cell Science Research Center, Royan Institute for
Stem Cell Biology and Technology ACECR, Tehran, Iran, Islamic Republic of
(Pouraliakbar) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences
Abstract
Background and Aim: Dilated cardiomyopathy as the most common form of
cardiomyopathy is a rare but life-threatening disorder in children.
Despite the developing in the medical and surgical treatment, standard
treatments may stabilize the condition, but will not restore heart
function to its previous condition. Therapy remains complex and expensive.
For some not all children the heart transplantation is the only option.
Cellbased therapies offer an innovative approach to reverse cardiac
function towards normal, possibly reducing the need for aggressive
therapies and cardiac transplantation. <br/>Method(s): In this study
children with idiopathic dilated cardiomyopathy were enrolled at Shahid
Rajaie Cardiovascular, Medical & Research Center in collaboration with
Royan Institute. According to the inclusion and exclusion criteria of the
trial, 24 patients with left ventricular ejection fraction less than 45%
who resistance to the standard medical therapy signed a consent form and
was randomly allocated in 2 groups including BM-derived mononuclear
(BMMNC) (n=12) and control (n=12). Only the MNC group underwent the bone
marrow aspiration and intracoronary injection. We followed all of the
patients at 2 weeks, 1, 2, 4 and 6 months after transplantation for cell
therapy group or registration for placebo by physical examination,
laboratory tests and imaging such as echocardiography, CXR, and CMR.
(ClinicalTrials.gov Identifier: NCT02256501) Results: The mean (SD) age of
24 patients was 8.0 (5.2) years in control and 9.4 (2.9) in MNC. 28.6% and
62.5% of participants were female in control and MNC group, respectively.
We have no significant differences in baseline characteristics between
groups. Almost 583x10⁶ mononuclear cells were injected to the
coronary artery during less than 6 hours of autologous bone marrow
aspiration for MNC group. The primary outcome was safety assessment. No
procedure-related unexpected adverse events occurred. The MNC group
patients showed an improvement with respect to New York Heart Association
classification (greater than or equal to 1) and reducing in brain
natriuretic peptide serum levels. Although LVEF improvement, relative to
baseline was significant in the BMMNC group. <br/>Conclusion(s): In this
clinical trial, intracoronary injection of BMMNC was feasible and safe.
Additionally, transplantation of BM-derived mononuclear cells compared to
the control group can improve the imaging, laboratory and clinical cardiac
function.

<16>
Accession Number
626728419
Title
Use of echocardiograms in the Medicare population: A diagnostic tool in
the fight against severe aortic stenosis.
Source
Journal of Comparative Effectiveness Research. 8 (4) (pp 265-275), 2019.
Date of Publication: March 2019.
Author
Grossi E.A.; Moore K.A.; Gunnarsson C.
Institution
(Grossi) Department of Cardiothoracic Surgery, NYU-Langone Medical Center,
New York, NY 10016, United States
(Moore) Edwards Lifesciences, Irvine, CA 92614, United States
(Gunnarsson) Gunnarsson Consulting, Jupiter, FL 33477, United States
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: To estimate undiagnosed aortic stenosis (AS) in the Medicare
population. <br/>Method(s): Patients enrolled (2011-2014) were eligible.
After criteria were applied, time zero was the first record of an
echocardiogram (ECHO) for the ECHO-AS cohort and randomly assigned for the
no-ECHO cohort. The ECHO-AS cohort was propensity matched to patients in
the no-ECHO cohort, and survival analysis was performed. <br/>Result(s):
Of the 854,493 (25%) patients who received an ECHO, 1 in 4 were diagnosed
with AS. After propensity matching, the no-ECHO cohort who died, almost
half (49%) had a record of a cardiovascular event prior to their death.
The no-ECHO cohort had statistically significant (p = 0.003) higher risk
of death than their ECHO-AS counterparts. <br/>Conclusion(s): In the
Medicare population, patients aged 65 years or older, with increased risk
factors for and symptoms common in AS patients, should be considered for
diagnostic ECHOs.<br/>Copyright &#xa9; 2019 EA Grossi, KA Moore & C
Gunnarsson.

<17>
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).

<18>
Accession Number
626673983
Title
Optimal strategy of primary percutaneous coronary intervention for acute
myocardial infarction due to unprotected left main coronary artery
occlusion (OPTIMAL): Study protocol for a randomised controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 162. Date of
Publication: 08 Mar 2019.
Author
Gao Y.; Zhang F.; Li C.; Dai Y.; Yang J.; Qu Y.; Qian J.; Ge J.
Institution
(Gao, Zhang, Li, Dai, Yang, Qu, Qian, Ge) Department of Cardiology,
Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular
Diseases, 180 Fenglin Road, Shanghai 200032, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Primary percutaneous coronary intervention (PCI) for patients
presenting with acute myocardial infarction (AMI) caused by left main
coronary artery occlusion is associated with significantly higher
mortality and risks of major adverse cardiovascular events. Deferred stent
implantation may improve prognosis of primary PCI by reducing distal
embolization and no-reflow phenomenon. There is no randomized clinical
trial focusing on the effect and outcome of deferred stent implantation on
primary PCI for left main coronary artery occlusion in contrast with
conventional strategy. <br/>Method(s): The Optimal Strategy of Primary
Percutaneous Coronary Intervention for Acute Myocardial Infarction due to
Unprotected Left Main Coronary Artery Occlusion (OPTIMAL) study
(ClinicalTrials.gov Identifier: NCT03282773) is an open-label, randomized,
multicenter clinical trial in which 480 patients presenting with AMI
caused by left main coronary artery occlusion recruited from 30 hospitals
in mainland China will be randomly assigned 1:1 to immediate stenting or
deferred stenting (scheduled 4-10 days after primary angioplasty) groups.
The primary endpoint is a composite of all-cause mortality or recurrent
myocardial infarction at 30 days after randomization. The secondary
outcomes include all-cause mortality, cardiac death, recurrent myocardial
infarction, and unplanned target vessel revascularization at 30 days, 6
months, and 12 months. <br/>Discussion(s): The OPTIMAL study is designed
to compare the clinical performance of deferred stenting with that of
immediate stenting for AMI caused by left main coronary artery occlusion.
Trial registration: ClinicalTrials.gov Identifier: NCT03282773. Registered
on 10 September 2017.<br/>Copyright &#xa9; 2019 The Author(s).

<19>
Accession Number
626710181
Title
Leukodepleted Packed Red Blood Cells Transfusion in Patients Undergoing
Major Cardiovascular Surgical Procedure: Systematic Review and
Meta-Analysis.
Source
Cardiology Research and Practice. 2019 (no pagination), 2019. Article
Number: 7543917. Date of Publication: 2019.
Author
Simancas-Racines D.; Arevalo-Rodriguez I.; Urrutia G.; Buitrago-Garcia D.;
Nunez-Gonzalez S.; Martinez-Zapata M.J.; Madrid E.; Bonfill X.;
Hidalgo-Ottolenghi R.
Institution
(Simancas-Racines, Arevalo-Rodriguez, Buitrago-Garcia, Nunez-Gonzalez,
Hidalgo-Ottolenghi) Cochrane Ecuador, Centro de Investigacion en Salud
Publica y Epidemiologia Clinica, Facultad de Ciencias de la Salud Eugenio
Espejo, Universidad UTE, Quito 170129, Ecuador
(Arevalo-Rodriguez) Clinical Biostatistics Unit, Hospital Universitario
Ramon y Cajal (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP),
Madrid 28034, Spain
(Urrutia, Martinez-Zapata, Bonfill) CIBER Epidemiologia y Salud Publica
(CIBERESP), Iberoamerican Cochrane Centre Biomedical Research Institute
Sant Pau (IIB Sant Pau), Barcelona 08041, Spain
(Madrid) Centro Interdisciplinario de Estudios en Salud (CIESAL), Escuela
de Medicina, Universidad de Valparaiso, Cochrane Chile, Valparaiso
2391415, Chile
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Leukocytes contained in the allogeneic packed red blood cell
(PRBC) are the cause of certain adverse reactions associated with blood
transfusion. Leukoreduction consists of eliminating leukocytes in all
blood products below the established safety levels for any patient type.
In this systematic review, we appraise the clinical effectiveness of
allogeneic leukodepleted (LD) PRBC transfusion for preventing infections
and death in patients undergoing major cardiovascular surgical procedures.
Methods. We searched randomized controlled trials (RCT), enrolling
patients undergoing a major cardiovascular surgical procedure and
transfused with LD-PRBC. Data were extracted, and risk of bias was
assessed according to Cochrane guidelines. In addition, trial sequential
analysis (TSA) was used to assess the need of conducting additional
trials. Quality of the evidence was assessed using the GRADE approach.
Results. Seven studies met the eligibility criteria. Quality of the
evidence was rated as moderate for both outcomes. The risk ratio for death
from any cause comparing the LD-PRBC versus non-LD-PRBC group was 0.69 (CI
95% = 0.53 to 0.90; I² = 0%). The risk ratio for infection in
the same comparison groups was 0.77 (CI 95% = 0.66 to 0.91; I²
= 0%). TSA showed a conclusive result in this outcome. Conclusions. We
found evidence that supports the routine use of leukodepletion in patients
undergoing a major cardiovascular surgical procedure requiring PRBC
transfusion to prevent death and infection. In the case of infection, the
evidence should be considered sufficient and conclusive and hence
indicated that further trials would not be required.<br/>Copyright &#xa9;
2019 Daniel Simancas-Racines et al.

<20>
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.

<21>
Accession Number
624939850
Title
Anesthesiological risks in mucopolysaccharidoses.
Source
Italian Journal of Pediatrics. 44 (Supplement 2) (no pagination), 2018.
Article Number: 116. Date of Publication: 16 Nov 2018.
Author
Moretto A.; Bosatra M.G.; Marchesini L.; Tesoro S.
Institution
(Moretto, Bosatra) Department of Perioperative Medicine and Intensive
Care, ASST San Gerardo, Via Pergolesi 33, Monza, MB 20900, Italy
(Marchesini, Tesoro) Department of Surgical and Biological Sciences,
Section of Anesthesia, Analgesia and Intensive Care, Perugia University,
Azienda Ospedaliero Universitaria di Perugia, Piazzale Menghini 1,
Perugia, PG 06100, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients suffering from mucopolysaccharidosis are among the
most complex from the anesthesiological point of view, especially
regarding the management of the airway. The evidence base for anesthesia
management is often limited to case reports and small case series.
<br/>Aim(s): To identify useful information about experience with each
subtype of mucopolysaccharidosis reported in the literature and propose a
guide on the best options for airway management to the anesthesiologists
who take care of these patients. <br/>Method(s): A query of the PubMed
database specific for "anesthesia" and "mucopolysaccharidosis" and a
further query specific for "mucopolysaccharidosis and difficult airway
management" was conducted. We looked for those items that offered
practical guidance to anesthesiological management. We did not exclude
case reports, especially those that reported a specific technique, because
of their practical suggestions. <br/>Result(s): We identified 15 reviews,
17 retrospective case series, 5 prospective studies, and 28 case reports
that focused on airway managements in anesthesia or had practical
suggestions for preoperative evaluation and risk assessment. An accurate
preoperative evaluation and the need for an experienced team are
emphasized in all the reviewed articles and for each type of
mucopolysaccharidosis. Many suggestions on how to plan the perioperative
period have been highlighted. Insertion of a laryngeal mask airway
generally improves ventilation and facilitates intubation with a
fiberoptic bronchoscope. Furthermore, the videolaryngoscope is very useful
in making intubation easier and facilitating bronchoscope passage.
<br/>Conclusion(s): Patients with mucopolysaccharidosis are at high risk
for anesthesia-related complications and require a high level of
attention. However, a multidisciplinary approach, combined with expertise
in the use of new techniques and new devices for airway management, makes
anesthesiological management safer. Further research with prospective
studies would be useful.<br/>Copyright &#xa9; 2018 The Author(s).

<22>
Accession Number
624895183
Title
Routine angiographic follow-up for left main percutaneous coronary
intervention: Back to the old times?.
Source
Cardiology Journal. 25 (5) (pp 571-573), 2018. Date of Publication: 30 Oct
2018.
Author
Sanmartin M.; Daggubati R.
Institution
(Sanmartin) Hospital Universitario Ramon y Cajal, Carretera Colmenar
Viejo, Madrid, Spain
(Daggubati) Interventional Cardiology Fellowship, NYU Winthrop Hospital,
Mineola, NY, United States
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)

<23>
Accession Number
626327954
Title
Diagnostic accuracy of dobutamine stress echocardiography in the detection
of cardiac allograft vasculopathy in heart transplant recipients: A
systematic review and meta-analysis study.
Source
Echocardiography. 36 (3) (pp 528-536), 2019. Date of Publication: March
2019.
Author
Elkaryoni A.; Abu-Sheasha G.; Altibi A.M.; Hassan A.; Ellakany K.; Nanda
N.C.
Institution
(Elkaryoni, Hassan) Division of Internal Medicine, University of Missouri
Kansas City, Kansas City, MO, United States
(Abu-Sheasha) Division of Biomedical Statistics and Medical Informatics,
Medical Research Institute, Alexandria University, Alexandria, Egypt
(Altibi) Division of Internal Medicine, Henry Ford Allegiance Health,
Jackson, MI, United States
(Ellakany) Division of Cardiovascular Disease, University of Alexandria
School of medicine, Alexandria, Egypt
(Nanda) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Dobutamine stress echocardiography (DSE) is a well-established
imaging modality used to screen patients with mild-to-moderate risk for
coronary artery disease. In heart transplantation recipients, cardiac
allograft vasculopathy (CAV) is a common and lethal complication. The use
of DSE to detect CAV showed promising results initially, but later studies
showed limitation in its use to detect CAV. It is unclear if this cohort
of patients derives benefit from DSE. <br/>Method(s): We searched PubMed,
Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and
Scopus from inception through March 2018 for studies examining the
accuracy of DSE in correlation to coronary angiography (CA) or
intravascular ultrasound (IVUS) to detect CAV. Original studies comparing
the ability of DSE to detect CAV in comparison with CA or IVUS were
included. Relevant data were extracted and hierarchical summary receiver
operating characteristic analysis was conducted to test the overall
diagnostic accuracy of DSE for patients with CAV. <br/>Result(s): Eleven
studies (749 participants) met the inclusion criteria. The sensitivity of
DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%.
Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%-82.3%)
and specificity 85.7% (95% CI, 73.8%-92.7%). DSE had an overall diagnostic
odds ratio (OR) of 9.1 (95% CI, 4.6-17.8), positive likelihood ratio (LR+)
of 4.1 (95% CI, 2.8-6.1), negative likelihood ratio (LR-) of 0.47 (95% CI:
0.23-0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72-0.75).
Heterogeneity among studies was not statistically significant
(tau²= 0.32, Cochran's Q = 9.5, P = 0.483). <br/>Conclusion(s):
Dobutamine stress echocardiography has a limited sensitivity to detect
early CAV but its specificity is much higher. There remains a need for an
alternative noninvasive modality which will have both high sensitivity and
high specificity for detecting CAV.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<24>
Accession Number
2001374431
Title
A randomized controlled trial evaluating general endotracheal anesthesia
versus monitored anesthesia care and the incidence of sedation-related
adverse events during ERCP in high-risk patients.
Source
Gastrointestinal Endoscopy. 89 (4) (pp 855-862), 2019. Date of
Publication: April 2019.
Author
Smith Z.L.; Mullady D.K.; Lang G.D.; Das K.K.; Hovis R.M.; Patel R.S.;
Hollander T.G.; Elsner J.; Ifune C.; Kushnir V.M.
Institution
(Smith, Mullady, Lang, Das, Patel, Hollander, Elsner, Kushnir) Division of
Gastroenterology, Washington University School of Medicine, St Louis, MO,
United States
(Hovis, Ifune) Department of Anesthesiology, Washington University School
of Medicine, St Louis, MO, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background and Aims: ERCP is a complex procedure often performed in
patients at high risk for sedation-related adverse events (SRAEs).
However, there is no current standard of care with regard to mode of
sedation and airway management during ERCP. The aim of this study was to
assess the safety of general endotracheal anesthesia (GEA) versus
propofol-based monitored anesthesia care (MAC) without endotracheal
intubation in patients undergoing ERCP at high risk for SRAEs.
<br/>Method(s): Consecutive patients undergoing ERCP at high risk for
SRAEs at a single center were invited to participate in this randomized
controlled trial comparing GEA and MAC. Inclusion criteria were STOP-BANG
score >=3, abdominal ascites, body mass index >=35, chronic lung disease,
American Society of Anesthesiologists class >3, Mallampati class 4 airway,
and moderate to heavy alcohol use. Exclusion criteria were preceding EUS,
emergent ERCP, tracheostomy, unstable airway, gastric outlet obstruction
or delayed gastric emptying, and altered foregut anatomy. The primary
endpoint was composite incidence of SRAEs: hypoxemia, use of airway
maneuvers, hypotension requiring vasopressors, sedation-related procedure
interruption, cardiac arrhythmia, and respiratory failure. Secondary
outcomes included procedure duration, cannulation success, in-room time,
and immediate adverse events. <br/>Result(s): Two hundred patients (mean
age, 61.1 +/- 13.6 years; 36.5% women) were randomly assigned to GEA (n =
101) or MAC (n = 99) groups. Composite SRAEs were significantly higher in
the MAC group compared with the GEA group (51.5% vs 9.9%, P <.001). This
was primarily driven by the frequent need for airway maneuvers in the MAC
group. Additionally, ERCP was interrupted in 10.1% of patients in the MAC
group to convert to GEA because of respiratory instability refractory to
airway maneuvers (n = 8) or significant retained gastric contents (n = 2).
There were no statistically significant differences in cannulation,
in-room, procedure, or fluoroscopy times between the 2 groups. All
patients undergoing GEA were successfully extubated in the procedure room
at completion of ERCP, and Aldrete scores in recovery did not differ
between the 2 groups. There were no immediate adverse events.
<br/>Conclusion(s): In patients at high risk for SRAEs undergoing ERCP,
sedation with GEA is associated with a significantly lower incidence of
SRAEs, without impacting procedure duration, success, recovery, or in-room
time. These data suggest that GEA should be used for ERCP in patients at
high risk for SRAEs (Clinical trial registration number:
NCT02850887.)<br/>Copyright &#xa9; 2019

<25>
Accession Number
2001693337
Title
Transfusion of standard-issue packed red blood cells induces pulmonary
vasoconstriction in critically ill patients after cardiac surgery-A
randomized, double-blinded, clinical trial.
Source
PLoS ONE. 14 (3) (no pagination), 2019. Article Number: e0213000. Date of
Publication: March 2019.
Author
Baron-Stefaniak J.; Leitner G.C.; Kuntzel N.K.I.; Meyer E.L.; Hiesmayr
M.J.; Ullrich R.; Baron D.M.
Institution
(Baron-Stefaniak, Kuntzel, Hiesmayr, Ullrich, Baron) Department of
Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University
of Vienna, Vienna, Austria
(Leitner) Department of Blood Group Serology and Transfusion Medicine,
Medical University of Vienna, Vienna, Austria
(Meyer) Section for Medical Statistics, Center for Medical Statistics,
Informatics, and Intelligent Systems, Medical University of Vienna,
Vienna, Austria
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Experimental and volunteer studies have reported pulmonary
vasoconstriction during transfusion of packed red blood cells (PRBCs)
stored for prolonged periods. The primary aim of this study was to
evaluate whether transfusion of PRBCs stored over 21 days (standard-issue,
siPRBCs) increases pulmonary artery pressure (PAP) to a greater extent
than transfusion of PRBCs stored for less then 14 days (fresh, fPRBCs) in
critically ill patients following cardiac surgery. The key secondary aim
was to assess whether the pulmonary vascular resistance index (PVRI)
increases after transfusion of siPRBCs to a greater extent than after
transfusion of fPRBCs. Methods The study was performed as a single-center,
double-blinded, parallel-group, randomized clinical trial. Leukoreduced
PRBCs were transfused while continuously measuring hemodynamic parameters.
Systemic concentrations of syndecan-1 were measured to assess glycocalyx
injury. After randomizing 19 patients between January 2014 and June 2016,
the study was stopped due to protracted patient recruitment. Results Of 19
randomized patients, 11 patients were transfused and included in
statistical analyses. Eight patients were excluded prior to transfusion, 6
patients received fPRBCs (10+/-3 storage days), whereas 5 patients
received siPRBCs (33+/-4 storage days). The increase in PAP (7 +/-3 vs.
2+/-2 mmHg, P = 0.012) was greater during transfusion of siPRBCs than
during transfusion of fPRBCs. In addition, the change in PVRI (150+/-89
vs. -4+/-37 dynscm^-5m², P = 0.018) was greater after
transfusion of siPRBCs than after transfusion of fPRBCs. The increase in
PAP correlated with the change of systemic syndecan-1 concentrations at
the end of transfusion (R = 0.64,P = 0.034). Conclusion Although this
study is underpowered and results require verification in larger clinical
trials, our findings suggest that transfusion of siPRBCs increases PAP and
PVRI to a greater extent than transfusion of fPRBCs in critically ill
patients following cardiac surgery. Glycocalyx injury might contribute to
pulmonary vasoconstriction associated with transfusion of stored
blood.<br/>Copyright: &#xa9; 2019 Baron-Stefaniak et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<26>
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.

<27>
Accession Number
2000971326
Title
The Edmonton Frail Scale Improves the Prediction of 30-Day Mortality in
Elderly Patients Undergoing Cardiac Surgery: A Prospective Observational
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 945-952),
2019. Date of Publication: April 2019.
Author
Amabili P.; Wozolek A.; Noirot I.; Roediger L.; Senard M.; Donneau A.-F.;
Hubert M.B.; Brichant J.-F.; Hans G.A.
Institution
(Amabili, Wozolek, Noirot, Roediger, Senard, Hubert, Brichant, Hans)
Department of Anesthesia and Intensive Care Medicine, CHU of Liege, Liege,
Belgium
(Donneau) Department of Public Health, Biostatistics, University of Liege,
Liege, Belgium
Publisher
W.B. Saunders
Abstract
Objectives: To investigate whether the Edmonton Frail Scale (EFS), a
multidimensional frailty assessment tool, improves the prediction of
30-day or in-hospital mortality over the use of the European System for
Cardiac Outcome Risk Evaluation (EuroSCORE) II alone. <br/>Design(s):
Single-center prospective observational study. <br/>Setting(s): University
hospital. <br/>Participant(s): Patients aged 75 years or older undergoing
cardiac surgery between February 2014 and May 2017. <br/>Intervention(s):
No intervention was performed. The EFS was administered the day before
surgery. <br/>Measurements and Main Results: The primary endpoint was
30-day or in-hospital mortality. Secondary endpoints were times to
discharge from the intensive care unit (ICU) and from the hospital,
discharge to a health care facility, and ability to return home by
postoperative day 30. The EFS had a good discriminative ability for 30-day
mortality (area under the receiver operating characteristic curve = 0.69;
95% confidence interval [CI], 0.56-0.82). Adding frailty, defined by an
EFS >=8, to the EuroSCORE II significantly improved the prediction of
30-day (p = 0.04) mortality. The integrated discrimination index was 0.03
(95% CI, 0.01-0.06, p = 0.01), meaning that the difference in predicted
risk between patients who died and those who survived increased by 3% due
to the addition of frailty determined by the EFS to the EuroSCORE II.
Frailty also was associated significantly with a decreased cumulative
probability of discharge from the ICU (p = 0.02) and an increased
incidence of discharge to a health care facility (p = 0.01).
<br/>Conclusion(s): The EFS has a good predictive ability for 30-day
mortality after cardiac surgery in elderly patients and improves the
prediction of 30-day mortality over the use of the EuroSCORE
II.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<28>
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.

<29>
Accession Number
621206984
Title
ZipFix Versus Conventional Sternal Closure: One-Year Follow-Up.
Source
Heart Lung and Circulation. 28 (3) (pp 443-449), 2019. Date of
Publication: March 2019.
Author
Nezafati P.; Shomali A.; Kahrom M.; Omidvar Tehrani S.; Dianatkhah M.;
Nezafati M.H.
Institution
(Nezafati) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Shomali) Javad Al Aemeh Hospital, Mashhad, Iran, Islamic Republic of
(Kahrom, Nezafati) Cardiac Surgery, Ghaem Hospital, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Omidvar Tehrani) Student Research Committee, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Dianatkhah) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
Publisher
Elsevier Ltd
Abstract
Background: The present study aimed to compare postoperative complications
commonly revealed after sternotomy closure by new sternal ZipFixTM
(Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire.
<br/>Method(s): Among the initial 360 subjects, 326 patients enrolled in
this randomised control trial who were candidates for cardiac surgery from
April 2014 to March 2015. After the surgery, the sternal closure was
randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix
(ZF) on the sternal body (n = 168) or with conventional wires (CWs) (n =
158). Patients were followed postoperatively as well as 1, 3, 6, and 12
months after discharge regarding postoperative complications such as pain
severity, dehiscence, and infection including incisional infections
(superficial or deep), and organ/space infection (mediastinitis or
osteomyelitis). <br/>Result(s): The mean age of the ZF and CW groups were
63.58 +/- 10.9 and 62.42 +/- 7.1 years, respectively (p = 0.262). In
addition, there was no significant difference between the two groups'
baseline characteristics (p > 0.05). Our study showed higher mean pain
severity score in the conventional closure group compared with ZipFix
closure group at all study time points (p < 0.001). Infection was seen in
2.76% of the overall participants with no significant difference of
incisional and organ infection between the two groups throughout the
study. After 1-month follow-up, five patients in the CW group had sternal
dehiscence whereas no patients in ZF had dehiscence (p < 0.001).
<br/>Conclusion(s): Our trial demonstrates greater clinical advantages in
terms of pain and sternal dehiscence post surgery by using sternal ZipFix
compared to conventional steel wire.<br/>Copyright &#xa9; 2018 Australian
and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<30>
Accession Number
626568345
Title
Impact of Obesity on Postoperative Outcomes following cardiac Surgery (The
OPOS study): Rationale and design of an investigator-initiated prospective
study.
Source
BMJ Open. 9 (3) (no pagination), 2019. Article Number: e023418. Date of
Publication: 01 Mar 2019.
Author
Aguiar C.; Macleod J.; Yip A.; Melville S.; Legare J.-F.; Pulinilkunnil
T.; Kienesberger P.; Brunt K.; Hassan A.
Institution
(Aguiar, Macleod, Yip) Cardiovascular Research New Brunswick, Saint John
Regional Hospital, Saint John, NB, Canada
(Melville, Brunt) Department of Pharmacology, Dalhousie Medicine New
Brunswick, Saint John, NB, Canada
(Legare, Hassan) Cardiovascular Research New Brunswick and Department of
Cardiac Surgery, Saint John Regional Hospital, Saint John, NB, Canada
(Pulinilkunnil, Kienesberger) Department of Biochemistry and Molecular
Biology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Increasing levels of obesity worldwide have led to a rise in
the prevalence of obesity-related complications including cardiovascular
risk factors such as diabetes, hypertension and dyslipidaemia. Healthcare
providers believe that overweight and obese cardiac surgery patients are
more likely to experience adverse postoperative outcomes. The body mass
index (BMI) is the primary measure of obesity in clinical practice,
without accounting for a patient's level of cardiopulmonary fitness or
muscle mass. The objective of this study is to determine whether fitness
capacity of obese cardiac surgical patients and biomarkers, alone or in
combination, will help identify patients at risk for adverse outcomes when
undergoing cardiac surgery. Methods and analysis Patients between the ages
of 18 and 75 years undergoing elective cardiac surgery are consented to
participate in this prospective observational study. Patients will be
invited to participate in measures of obesity, functional capacity and
exercise capacity assessments, quality of life questionnaires, and blood
and tissue sampling for biomarker analysis. The endpoints evaluated are
measures other than BMI that could be predictive of short-term and
long-term postoperative outcomes. Clinical outcomes of interest are
prolonged ventilation, hospital length of stay, renal failure and
all-cause mortality. Biomarkers of interest will largely focus on
metabolism (lipids, amino acids) and inflammation (adipokines, cytokines
and chemokines). Ethics and dissemination This study has been approved by
the institutional review board at the Horizon Health Network. On
completion of the study, the results shall be disseminated through
conference presentations and publications in peer-reviewed journals.
Additionally, the report shall also be diffused more broadly to the
general public and the cardiovascular community. Trial registration number
NCT03248921.<br/>Copyright &#xa9; 2019 Author(s).

<31>
Accession Number
626419169
Title
Effect of Intravenous Acetaminophen vs Placebo Combined with Propofol or
Dexmedetomidine on Postoperative Delirium among Older Patients Following
Cardiac Surgery: The DEXACET Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 321 (7) (pp 686-696),
2019. Date of Publication: 19 Feb 2019.
Author
Subramaniam B.; Shankar P.; Shaefi S.; Mueller A.; O'Gara B.;
Banner-Goodspeed V.; Gallagher J.; Gasangwa D.; Patxot M.; Packiasabapathy
S.; Mathur P.; Eikermann M.; Talmor D.; Marcantonio E.R.
Institution
(Subramaniam, Shankar, Shaefi, Mueller, O'Gara, Banner-Goodspeed,
Gasangwa, Patxot, Packiasabapathy, Mathur, Eikermann, Talmor) Department
of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, 375 Longwood Ave, W/MS-414,
Boston, MA 02215, United States
(Gallagher, Marcantonio) Department of Medicine, Division of Gerontology,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Postoperative delirium is common following cardiac surgery and
may be affected by choice of analgesic and sedative. <br/>Objective(s): To
evaluate the effect of postoperative intravenous (IV) acetaminophen
(paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on
postoperative delirium among older patients undergoing cardiac surgery.
<br/>Design, Setting, and Participant(s): Randomized, placebo-controlled,
factorial clinical trial among 120 patients aged 60 years or older
undergoing on-pump coronary artery bypass graft (CABG) surgery or combined
CABG/valve surgeries at a US center. Enrollment was September 2015 to
April 2018, with follow-up ending in April 2019. <br/>Intervention(s):
Patients were randomized to 1 of 4 groups receiving postoperative
analgesia with IV acetaminophen or placebo every 6 hours for 48 hours and
postoperative sedation with dexmedetomidine or propofol starting at chest
closure and continued for up to 6 hours (acetaminophen and
dexmedetomidine: n = 29; placebo and dexmedetomidine: n = 30;
acetaminophen and propofol: n = 31; placebo and propofol: n = 30).
<br/>Main Outcomes and Measures: The primary outcome was incidence of
postoperative in-hospital delirium by the Confusion Assessment Method.
Secondary outcomes included delirium duration, cognitive decline,
breakthrough analgesia within the first 48 hours, and ICU and hospital
length of stay. <br/>Result(s): Among 121 patients randomized (median age,
69 years; 19 women [15.8%]), 120 completed the trial. Patients treated
with IV acetaminophen had a significant reduction in delirium (10% vs 28%
placebo; difference, -18% [95% CI, -32% to -5%]; P =.01; HR, 2.8 [95% CI,
1.1-7.8]). Patients receiving dexmedetomidine vs propofol had no
significant difference in delirium (17% vs 21%; difference, -4% [95% CI,
-18% to 10%]; P =.54; HR, 0.8 [95% CI, 0.4-1.9]). There were significant
differences favoring acetaminophen vs placebo for 3 prespecified secondary
outcomes: delirium duration (median, 1 vs 2 days; difference, -1 [95% CI,
-2 to 0]), ICU length of stay (median, 29.5 vs 46.7 hours; difference,
-16.7 [95% CI, -20.3 to -0.8]), and breakthrough analgesia (median, 322.5
vs 405.3g morphine equivalents; difference, -83 [95% CI, -154 to -14]).
For dexmedetomidine vs propofol, only breakthrough analgesia was
significantly different (median, 328.8 vs 397.5g; difference, -69 [95% CI,
-155 to -4]; P =.04). Fourteen patients in both the
placebo-dexmedetomidine and acetaminophen-propofol groups (46% and 45%)
and 7 in the acetaminophen-dexmedetomidine and placebo-propofol groups
(24% and 23%) had hypotension. <br/>Conclusions and Relevance: Among older
patients undergoing cardiac surgery, postoperative scheduled IV
acetaminophen, combined with IV propofol or dexmedetomidine, reduced
in-hospital delirium vs placebo. Additional research, including comparison
of IV vs oral acetaminophen and other potentially opioid-sparing
analgesics, on the incidence of postoperative delirium is warranted. Trial
Registration: ClinicalTrials.gov Identifier: NCT02546765.<br/>Copyright
&#xa9; 2019 American Medical Association. All rights reserved.

<32>
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.

<33>
Accession Number
626037968
Title
Ten-Year Follow-Up of Off-Pump and On-Pump Multivessel Coronary Artery
Bypass Grafting: MASS III.
Source
Angiology. 70 (4) (pp 337-344), 2019. Date of Publication: 01 Apr 2019.
Author
Hueb W.; Rezende P.C.; Gersh B.J.; Soares P.R.; Favarato D.; Lima E.G.;
Garzillo C.L.; Jatene F.B.; Ramires J.A.F.; Filho R.K.
Institution
(Hueb, Rezende, Soares, Favarato, Lima, Garzillo, Jatene, Ramires, Filho)
Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas
HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo,
Brazil
(Gersh) Mayo Clinic Foundation, Rochester, MN, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
It was a randomized trial, and 308 patients undergoing revascularization
were randomly assigned: 155 to off-pump coronary artery bypass (OPCAB) and
153 to on-pump coronary artery bypass (ONCAB). End points were freedom
from death, myocardial infarction, revascularization, and cerebrovascular
accidents. The rates for 10-year, event-free survival for ONCAB versus
OPCAB were 69.6% and 64%, (hazard ratio [HR]: 0.88; 95% confidence
interval [CI] 0.86-1.02; P =.41), respectively. Adjusted Cox proportional
hazard ratio was similar (HR: 0.92; 95% CI 0.61-1.38, P =.68). A
difference occurred between the duration of OPCAB and ONCAB, respectively
(4.9 +/- 1.5 vs 6.6 +/- 1.1 h, P <.001). Statistical differences occurred
between OPCAB and ONCAB in the length of intensive care unit (ICU) stay
(20 +/- 2.5 vs 48 +/- 10 hours, P <.001), time to extubation (5.5 +/- 4.2
vs 10.2 +/- 3.5 hours, P <.001), hospital stay (6.7 +/- 1.4 vs 9.2 +/- 1.3
days, P <.001), higher incidence of atrial fibrillation (AF; 33 vs 5
patients, P <.001), and blood requirements (46 vs 64 patients, P <.001).
Grafts per patient was higher in ONCAB (3.15 vs 2.55 grafts, P <.001). No
difference existed between the groups in primary composite end points at
10-year follow-up. Although OPCAB surgery was related to a lower number of
grafts and higher incidence of AF, it had no effects related to long-term
outcomes.<br/>Copyright &#xa9; The Author(s) 2018.

<34>
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

<35>
Accession Number
2000985828
Title
Dual versus single antiplatelet therapy after coronary artery bypass graft
surgery: An updated meta-analysis.
Source
International Journal of Cardiology. 269 (pp 80-88), 2018. Date of
Publication: 15 October 2018.
Author
Cardoso R.; Knijnik L.; Whelton S.P.; Rivera M.; Gluckman T.J.; Metkus
T.S.; Blumenthal R.S.; McEvoy J.W.
Institution
(Cardoso, Whelton, Gluckman, Metkus, Blumenthal, McEvoy) Ciccarone Center
for the Prevention of Cardiovascular Disease, Division of Cardiology,
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD,
United States
(Knijnik, Rivera) Division of Cardiology, Department of Medicine,
University of Miami-Jackson Memorial Hospital, Miami, FL, United States
(Gluckman) Center for Cardiovascular Analytics, Research, and Data Science
(CARDS), Providence Heart Institute, Providence St. Joseph Health,
Portland, OR, United States
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: The potential benefit and risks of dual antiplatelet therapy
(DAPT) over single antiplatelet therapy (SAPT) in patients who undergo
coronary artery bypass graft surgery (CABG) is controversial.
<br/>Method(s): We performed a systematic review and meta-analysis of
observational and randomized clinical trial (RCT) data comparing DAPT to
SAPT following urgent or elective CABG. Subanalyses were performed
restricted to: a) RCTs; b) stable ischemic heart disease (SIHD); c)
extended duration DAPT (>=6 months); and d) follow-up >=2 years.
<br/>Result(s): Twenty-two studies comprising 20,315 patients undergoing
CABG were included. Of the participants studied, 7481 (37%) received
postoperative DAPT and 12,834 (63%) received SAPT. Overall, DAPT was
associated with a lower cardiovascular (CV) mortality (OR 0.67; p = 0.02)
and a trend towards lower all-cause mortality (OR 0.78; p = 0.08). There
were no differences in rates of myocardial infarction or stroke.
Subanalyses in RCTs, SIHD, and prolonged follow-up failed to demonstrate
improvement in these outcomes with DAPT. However, in studies with extended
duration DAPT, stroke was significantly reduced in the DAPT group (OR
0.47; p = 0.04). Saphenous vein graft (SVG) occlusion up to 1 year after
CABG was significantly lower with DAPT overall (OR 0.64; p < 0.01) and in
the RCT subanalysis (OR 0.58; p < 0.01). Major bleeding was significantly
higher with DAPT (OR 1.31; p = 0.03). <br/>Conclusion(s): While DAPT has
been associated with lower CV mortality in observational samples
undergoing CABG, such findings were not replicated in RCTs. Lower rates of
SVG occlusion with DAPT are offset by a higher rate of major
bleeding.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<36>
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.

<37>
Accession Number
2000776132
Title
Thirty-day readmissions in surgical and transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 268 (pp 85-91), 2018. Date of
Publication: 1 October 2018.
Author
Danielsen S.O.; Moons P.; Sandven I.; Leegaard M.; Solheim S.; Tonnessen
T.; Lie I.
Institution
(Danielsen, Lie) Centre for Patient-centered Heart and Lung research,
Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo,
Norway
(Danielsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Danielsen, Moons) KU Leuven Department of Public Health and Primary Care,
KU Leuven-University of Leuven, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Sandven) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Leegaard) Department of Nursing and Health Promotion, Faculty of Health
Sciences, Oslo Metropolitan University, Oslo, Norway
(Solheim) Center for Clinical Heart Research and Department of Cardiology,
Division of Medicine, Oslo University Hospital, Ulleval, Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ulleval,
Oslo, Norway
Publisher
Elsevier Ireland Ltd
Abstract
Background: The 30-day all-cause readmission rate after surgical aortic
valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR)
vary substantially. We conducted a systematic review and meta-analysis to
examine the overall incidence, causes, and risk factors of 30-day
all-cause readmission rate after SAVR and TAVR. <br/>Method(s): Eight
medical research databases were searched; Cochrane, Medline, Embase,
UpToDate, PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We
followed The Preferred Reporting Items for Systematic reviews and
Meta-analysis (PRISMA) for this study. <br/>Result(s): Thirty-three
articles were included in the systematic review, 32 of which were
appropriate for the meta-analysis. Overall, 17% (95% CI: 16-18%) of
patients in the SAVR group, and 16% (95% CI: 15-18%) in the TAVR groups
were readmitted within 30 days. Heart failure, arrhythmia, infection, and
respiratory problems were the most frequent causes of all-cause
readmission after SAVR and TAVR. Most frequent reported prior risk factors
for all-cause readmission following TAVR were diabetes, chronic lung
disease/chronic obstructive pulmonary disease, atrial fibrillation, kidney
problems, and transapical approach/nonfemoral access. For SAVR, no risk
factors for 30-day all-cause readmission were reported in the literature
to date. <br/>Conclusion(s): In conclusion, the overall proportion of
30-day all-cause readmission after SAVR and TAVR are high. Interventions
to prevent avoidable readmissions ought to be developed and
implemented.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<38>
Accession Number
2001056198
Title
Ramipril and left ventricular diastolic function in stable patients with
pulmonary regurgitation after repair of tetralogy of Fallot.
Source
International Journal of Cardiology. 272 (pp 64-69), 2018. Date of
Publication: 1 December 2018.
Author
Krupickova S.; Li W.; Cheang M.H.; Rigby M.L.; Uebing A.; Davlouros P.;
Dimopoulos K.; Di Salvo G.; Fraisse A.; Swan L.; Alonso-Gonzalez R.;
Kempny A.; Pennell D.J.; Senior R.; Gatzoulis M.A.; Babu-Narayan S.V.
Institution
(Krupickova, Rigby, Uebing, Davlouros, Dimopoulos, Di Salvo, Fraisse,
Swan, Alonso-Gonzalez, Kempny, Pennell, Senior, Gatzoulis, Babu-Narayan)
Royal Brompton Hospital, London, United Kingdom
(Li, Dimopoulos, Di Salvo, Fraisse, Kempny, Pennell, Senior, Gatzoulis,
Babu-Narayan) National Heart and Lung Institute, Imperial College London,
United Kingdom
(Pennell, Gatzoulis, Babu-Narayan) Cardiovascular Research Unit, Royal
Brompton & Harefield NHS Foundation Trust, Imperial College London, United
Kingdom
(Cheang) UCL Institute of Cardiovascular Science, University College
London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Measures of left ventricular (LV) systolic and diastolic
function are known predictors of mortality after repair of tetralogy of
Fallot. We aimed to characterise LV reverse remodelling achievable with
ramipril therapy. <br/>Methods and Results: A blinded post-hoc analysis of
baseline and 6-month follow-up echocardiograms from the APPROPRIATE
(ISRCTN: 97515585) randomised double-blinded placebo-controlled trial of
ramipril therapy was performed in 64 patients: 32 in ramipril and 32 in
placebo group. Tissue Doppler systolic and diastolic myocardial
velocities, mitral inflow velocities and time intervals were measured.
Left atrial area and left atrial emptying fraction were calculated. There
was significant increase in long axis shortening mean (standard
deviation); MAPSE [1.9 (4.2) mm vs -0.2 (3.7) mm; p = 0.030], peak lateral
systolic velocity; S' lateral [1.0 (2.0) cm/s vs -0.3 (2.2) cm/s; p =
0.025], peak lateral early diastolic velocity; E' lateral [0.57 (2.4) cm/s
vs -3.3 (3.9) cm/s; p < 0.001], transmitral to lateral mitral annular
early diastolic velocity ratio; E/E' lateral [-0.7 (1.9) vs 1.5 (1.9); p <
0.001] over the study period in the ramipril compared to the placebo
group. Significantly higher measurements were observed in the ramipril arm
of the subgroup of patients with right ventricular restrictive physiology
in terms of peak late diastolic velocity; A [5.9 (13.5) cm/s vs -5.8
(12.5) cm/s; p = 0.041] and early to late diastolic transmitral velocity
ratio; E/A [-0.18 (0.42) vs 0.23 (0.48); p = 0.037]. <br/>Conclusion(s):
Six months' ramipril treatment appears to limit progression of both
diastolic and systolic LV function in adults late after tetralogy of
Fallot repair. With increased appreciation that even subtle LV disease
predicts tetralogy of Fallot outcomes, further clinical trials of drug
therapies are justified.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<39>
Accession Number
2000701390
Title
Safety of intermediate left main stenosis revascularization deferral based
on fractional flow reserve and intravascular ultrasound: A systematic
review and meta-regression including 908 deferred left main stenosis from
12 studies.
Source
International Journal of Cardiology. 271 (pp 42-48), 2018. Date of
Publication: 15 November 2018.
Author
Cerrato E.; Echavarria-Pinto M.; D'Ascenzo F.; Gonzalo N.; Quadri G.;
Quiros A.; de la Torre Hernandez J.M.; Tomassini F.; Barbero U.;
Nombela-Franco L.; Nunez-Gil I.; Biondi-Zoccai G.; Macaya C.; Varbella F.;
Escaned J.
Institution
(Cerrato, Quadri, Tomassini, Varbella) Interventional Cardiology, San
Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital,
Rivoli, Turin, Italy
(Echavarria-Pinto) Department of Cardiology, Hospital General ISSSTE,
Queretaro, Mexico
(D'Ascenzo) Division of Cardiology, Citta della Salute e della Scienza,
University of Turin, Turin, Italy
(Gonzalo, Nombela-Franco, Nunez-Gil, Macaya, Escaned) Interventional
Cardiology, Hospital Clinico San Carlos, Madrid, Spain
(Quiros) Statistical Department, Univeristy of Leon, Leon, Spain
(de la Torre Hernandez) Interventional Cardiology, Hospital Universitario
Marques de Valdecilla, Valdecilla, Santander, Spain
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Barbero) Division of Cardiology, Santissima Annunziata Hospital,
Savigliano, Italy
(Barbero) Cardiovascular Research Unit, Royal Brompton Hospital, London,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Current guidelines recommend intravascular ultrasound (IVUS)
or fractional flow reserve (FFR) to decide upon ambiguous left main (LM)
disease. However, no study has compared the safety of LM revascularization
deferral based on FFR or IVUS. <br/>Method(s): MEDLINE/PubMed was
systematically screened for studies reporting on deferred treatment of
angiographically ambiguous LM based upon FFR or IVUS evaluation. Baseline,
angiographic and outcome data were appraised and pooled separately for
each strategy according to random-effect models with inverse-variance
weighting. <br/>Result(s): A total of 908 LM stenoses from 7 FFR and 5
IVUS studies were included with median follow-up of 29.0 and 31.5 months
respectively. Per year of follow-up occurrence of overall MACE were 5.1%
in FFR group and 6.4% in IVUS group while death, myocardial infarction, LM
revascularization were respectively 2.6%, 1.5% and 1.8% vs. 3.0%, 0.5% and
2.2%. Meta-regression analysis suggested the influence of a distal LM
stenosis on MACE in FFR group (beta = 0.06, p = 0.01) and age in IVUS
group (beta = 0.4, p = 0.001). In individual studies several independent
predictors of MACE were identified including use of lower doses of
intracoronary adenosine (OR 1.39, p = 0.04) in FFR group and plaque burden
(OR 1.34, p = 0.025), number of other diseased vessels (OR 1.39, p = 0.04)
and any untreated stenosis (OR 3.80; p = 0.037) in IVUS- studies.
<br/>Conclusion(s): Deferring LM intermediate stenosis on the basis of FFR
or IVUS showed an acceptable and similar risk of events in a mid-term
follow-up. Conversely, several different variables related to each
technique showed an interaction on outcome.<br/>Copyright &#xa9; 2018
Elsevier B.V.

<40>
[Use Link to view the full text]
Accession Number
620231804
Title
Strategies for Prevention and Management of Bleeding Following Pediatric
Cardiac Surgery on Cardiopulmonary Bypass: A Scoping Review.
Source
Pediatric Critical Care Medicine. 19 (1) (pp 40-47), 2018. Date of
Publication: 01 Jan 2018.
Author
Siemens K.; Sangaran D.P.; Hunt B.J.; Murdoch I.A.; Tibby S.M.
Institution
(Siemens, Sangaran, Murdoch, Tibby) PICU, Evelina London Children's
Hospital, St Thomas' Hospital, Westminster Bridge Road, London, United
Kingdom
(Hunt) Department of Haematology, St Thomas' Hospital, London, United
Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: We aimed to systematically describe, via a scoping review, the
literature reporting strategies for prevention and management of
mediastinal bleeding post pediatric cardiopulmonary bypass surgery.
<br/>Data Sources: MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL Register.
Study Selection: Two authors independently screened publications from 1980
to 2016 reporting the effect of therapeutic interventions on
bleeding-related postoperative outcomes, including mediastinal drain loss,
transfusion, chest re-exploration rate, and coagulation variables.
Inclusions: less than 18 years, cardiac surgery on cardiopulmonary bypass.
<br/>Data Extraction: Data from eligible studies were extracted using a
standard data collection sheet. <br/>Data Synthesis: Overall, 299 of 7,434
screened articles were included, with observational studies being almost
twice as common (n = 187, 63%) than controlled trials (n = 112, 38%). The
most frequently evaluated interventions were antifibrinolytic drugs (75
studies, 25%), blood products (59 studies, 20%), point-of-care testing (47
studies, 16%), and cardiopulmonary bypass circuit modifications (46
studies, 15%). The publication rate for controlled trials remained
constant over time (4-6/yr); however, trials were small (median
participants, 51; interquartile range, 57) and overwhelmingly single
center (98%). Controlled trials originated from 22 countries, with the
United States, India, and Germany accounting for 50%. The commonest
outcomes were mediastinal blood loss and transfusion requirements;
however, these were defined inconsistently (blood loss being reported over
nine different time periods). The majority of trials were aimed at
bleeding prevention (98%) rather than treatment (10%), nine studies
assessed both. <br/>Conclusion(s): Overall, this review demonstrates small
trial sizes, low level of evidence, and marked heterogeneity of reported
endpoints in the included studies. The need for more, higher quality
studies reporting clinically relevant, comparable outcomes is highlighted.
Emerging fields such as the use of coagulation factor concentrates,
goal-directed guidelines, and anti-inflammatory therapies appear to be of
particular interest. This scoping review can potentially guide future
trial design and form the basis for therapy-specific systematic
reviews.<br/>Copyright &#xa9; 2017 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.

<41>
[Use Link to view the full text]
Accession Number
620231785
Title
Near-Infrared Spectroscopy and Vascular Occlusion Test for Predicting
Clinical Outcome in Pediatric Cardiac Patients: A Prospective
Observational Study.
Source
Pediatric Critical Care Medicine. 19 (1) (pp 32-39), 2018. Date of
Publication: 01 Jan 2018.
Author
Lee J.-H.; Jang Y.-E.; Song I.-K.; Kim E.-H.; Kim H.-S.; Kim J.-T.
Institution
(Lee, Jang, Kim, Kim, Kim) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul, South Korea
(Song) Department of Anesthesiology and Pain Medicine, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: This study is designed to determine the feasibility and
utility of vascular occlusion test variables as measured by INVOS
⁽Medtronic, Dublin, Ireland) in pediatric cardiac patients.
<br/>Design(s): A prospective observational study. <br/>Setting(s): A
tertiary children's hospital. <br/>Patient(s): Children less than or equal
to 8 years old who were scheduled for elective cardiac surgery under
cardiopulmonary bypass. <br/>Intervention(s): A vascular occlusion test (3
min of ischemia and reperfusion) was performed on the calf at three time
points: after induction of anesthesia (T0), during cardiopulmonary bypass
(T1), and after sternal closure (T2). <br/>Measurements and Main Results:
Baseline regional tissue hemoglobin oxygen saturation, deoxygenation rate,
minimum regional tissue hemoglobin oxygen saturation, and reoxygenation
rate were measured using INVOS. Influence of age on variables at each
measurement point was also checked using linear regression analysis.
Receiver operating characteristics curve analysis was performed to
determine the ability of vascular occlusion test variables at T2 to
predict the occurrence of major adverse events. Both the deoxygenation and
reoxygenation rates were lowest in T1. There was a tendency to decreased
regional tissue hemoglobin oxygen saturation in younger patients at T0 (r
= 0.37; p < 0.001), T1 (r = 0.33; p < 0.001), and T2 (r = 0.42; p < 0.001)
during vascular occlusion. Minimum regional tissue hemoglobin oxygen
saturation was correlated with age at T0 (r = 0.51; p < 0.001) and T2 (r =
0.35; p = 0.001). Patients with major adverse events had similar baseline
regional tissue hemoglobin oxygen saturation but lower minimum regional
tissue hemoglobin oxygen saturation (48.8% +/- 19.3% vs 63.3% +/- 13.9%; p
< 0.001) and higher reoxygenation rate (4.30 +/- 3.20 vs 2.57 +/- 2.39
%/s; p = 0.008) at T2 compared with those without. The minimum regional
tissue hemoglobin oxygen saturation less than 51% after sternal closure
could predict the occurrence of major adverse events with a sensitivity of
61.1% and a specificity of 85.4%. <br/>Conclusion(s): Vascular occlusion
test using INVOS can be applied in children undergoing cardiac surgery.
Vascular occlusion test variables are influenced by age and
cardiopulmonary bypass. The minimum regional tissue hemoglobin oxygen
saturation less than 51% after sternal closure is associated with worse
clinical outcomes in pediatric cardiac patients.<br/>Copyright &#xa9; 2017
by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<42>
Accession Number
624532740
Title
Clinical impact of baseline chronic kidney disease in patients undergoing
transcatheter or surgical aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. 93 (4) (pp 740-748),
2019. Date of Publication: 01 Mar 2019.
Author
Pineda A.M.; Kevin Harrison J.; Kleiman N.S.; Reardon M.J.; Conte J.V.;
O'Hair D.P.; Chetcuti S.J.; Huang J.; Yakubov S.J.; Popma J.J.; Beohar N.
Institution
(Pineda) Division of Cardiology, University of Florida College of
Medicine-Jacksonville, Jacksonville, FL, United States
(Kevin Harrison) Department of Medicine, Duke University Medical Center,
Durham, NC, United States
(Kleiman) Department of Cardiology, Houston Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Conte) Division of Cardiac Surgery, Johns Hopkins University, Baltimore,
MD, United States
(O'Hair) Department of Cardiothoracic Surgery, Aurora Healthcare,
Milwaukee, WI, United States
(Chetcuti) Department of Internal Medicine, Division of Cardiology,
University of Michigan, Ann Arbor, MI, United States
(Huang) Coronary and Structural Heart Clinical Department, Mounds View,
MN, United States
(Yakubov) Department of Cardiology, Riverside Methodist Hospital,
Columbus, OH, United States
(Popma) Department of Internal Medicine, Cardiovascular Division, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Beohar) Division of Cardiology at Mount Sinai Medical Center, Columbia
University, Miami Beach, FL, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the treatment effect of TAVR versus SAVR on clinical
outcomes to 3 years in patients stratified by chronic kidney disease (CKD)
by retrospectively studying patients randomized to TAVR or SAVR.
<br/>Background(s): The impact of CKD on mid-term outcomes of patients
undergoing TAVR versus SAVR is unclear. <br/>Method(s): Patients
randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial
were retrospectively stratified by eGFR: none/mild or moderate/severe CKD.
To evaluate the impact of baseline CKD in TAVR patients only, all patients
undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were
stratified by baseline eGFR into none/mild, moderate, and severe CKD. The
primary endpoint was major adverse cardiovascular and renal events
(MACRE), a composite of all-cause mortality, myocardial infarction,
stroke/TIA, and new requirement of dialysis. <br/>Result(s):
Moderate/severe CKD was present in 62.7% and 60.7% of high-risk patients
randomized to TAVR or SAVR, respectively. Baseline characteristics were
similar between TAVR and SAVR patients in both CKD subgroups, except for
higher rates of diabetes and higher serum creatinine in SAVR patients.
Among high-risk patients with moderate/severe CKD, TAVR provided a lower
3-year MACRE rate compared with SAVR: 42.1% vs. 51.0, P =.04. Of 3,733
extreme- and high-risk TAVR patients, 39.9% had none/mild, 53.8% moderate,
and 6.4% severe CKD. Worsening baseline CKD was associated with increased
3-year MACRE rates [none/mild 51.5%, moderate 54.5%, severe 63.1%, P
=.001]. <br/>Conclusion(s): TAVR results in lower 3-year MACRE versus SAVR
in high-risk patients with moderate/severe CKD. In patients undergoing
TAVR, worsening CKD increases mid-term mortality and MACRE. Randomized
trials of TAVR vs. SAVR in patients with moderate-severe CKD would help
elucidate the best treatment for these complex patients. Trial
Registration: CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued
Access Study: NCT01531374.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.

<43>
Accession Number
625122150
Title
Relationship of mildly increased albuminuria and coronary artery
revascularization outcomes in patients with diabetes.
Source
Catheterization and Cardiovascular Interventions. 93 (4) (pp E217-E224),
2019. Date of Publication: 01 Mar 2019.
Author
Siddique A.; Murphy T.P.; Naeem S.S.; Siddiqui E.U.; Pencina K.M.;
McEnteggart G.E.; Sellke F.W.; Dworkin L.D.
Institution
(Siddique, Siddiqui, McEnteggart) Department of Diagnostic Imaging, Rhode
Island Hospital, The Warren Alpert Medical School of Brown University,
Providence, RI, United States
(Murphy) Department of Diagnostic Imaging, The Warren Alpert Medical
School of Brown University, Providence, RI, United States
(Naeem, Sellke) Division of Cardiothoracic Surgery, Rhode Island Hospital,
Warren Alpert Medical School of Brown University, Providence, RI, United
States
(Pencina) Brigham and Women's, Harvard Medical School, Boston, MA, United
States
(Dworkin) Department of Medicine, University of Toledo, Toledo, OH, United
States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The aim of this study was to examine the relationship of
albuminuria to cardiovascular disease outcomes in diabetic patients
undergoing treatment for stable coronary artery disease. <br/>Methods and
Results: We analyzed data from 2176 participants of the Bypass Angioplasty
Revascularization Investigation in type-2 diabetes (BARI-2D) trial, a
randomized clinical trial comparing Percutaneous coronary
intervention/Coronary artery bypass grafting (PCI/CABG) to medical therapy
for people with diabetes. The population was stratified by baseline spot
urine albumin-creatinine ratio (uACR) into normal (uACR <10 mg/g), mildly
(uACR >=10 mg/g < 30 mg/g), moderately (uACR >=30 mg/g < 300 mg/g) and
severely increased (uACR >=300 mg/g) groups, and outcomes compared between
groups. Death, myocardial infarction (MI) and/or stroke were experienced
by 489 patients at a mean follow-up of 4.3 +/- 1.5 years. Compared with
normal uACR, mildly increased uACR was associated with a 1.4 times (P =
0.042) increase in all-cause mortality. Additionally, nonwhites with
type-II diabetes and stable coronary artery disease who had mildly
increased albuminuria had a Hazard ratio (HR) of 3.3 times (P = 0.028) for
cardiovascular death, 3.1 times for (P = 0.002) all-cause mortality, and
two times for (P = 0.015) MI during follow-up. <br/>Conclusion(s): Mildly
increased albuminuria is a significant predictor of all-cause mortality in
those with type-II diabetes mellitus and stable coronary artery disease,
as well as for cardiovascular events those who are
nonwhites.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<44>
Accession Number
626551447
Title
Comparison of sufentanil-midazolam and sevoflurane for anesthesia
induction in children undergoing cardiac surgery by real-time hemodynamic
and cardiac efficiency monitoring: A prospective randomized study.
Source
The heart surgery forum. 22 (1) (pp E038-E044), 2019. Date of Publication:
18 Feb 2019.
Author
Han D.; Liu Y.-G.; Pan S.-D.; Luo Y.; Li J.; Ou-Yang C.
Institution
(Han, Pan, Ou-Yang) Department of Anesthesia, Capital Institute of
Pediatrics Affiliated Children's Hospital, Beijing, China
(Liu, Ou-Yang) Anesthesia Center, Capital Medical University Affiliated
Beijing Anzhen Hospital, Beijing, China
(Luo) Department of Cardiac Surgery, Capital Institute of Pediatrics
Affiliated Children's Hospital, Beijing, China
(Li) Department of Clinical Physiology Laboratory, Capital Institute of
Pediatrics Affiliated Children's Hospital, Beijing, China
Publisher
NLM (Medline)
Abstract
Background Intravenous sufentanil-midazolam and inhalational sevoflurane
are widely used for anesthetic induction in children undergoing cardiac
surgery. However, knowledge about their effects on hemodynamics and
cardiac efficiency remains limited due largely to the lack of direct
monitoring method. We used minimally invasive technique pressure recording
analytical method (PRAM) to directly monitor hemodynamics and cardiac
efficiency and compared the effects of the two anesthetic regimens in
children undergoing ventricular septal defect repair. Methods Forty-Four
children (2.3+/-0.9 years) were randomly divided into two groups to
receive either intravenous sufentanil (1 mug/kg) and midazolam (0.2 mg/kg)
(Group SM) or 2.0 minimal alveolar concentration (MAC) sevoflurane (Group
S) to complete induction after sedation was obtained with 2.0 MAC
sevoflurane. Systemic hemodynamic data recorded by PRAM included heart
rate (HR), systolic (SBP) and mean (MBP) blood pressure, stroke volume
index (SVI), cardiac index (CI), systemic vascular resistance index
(SVRI), the maximal slope of systolic upstroke (dp/dtmax) and cardiac
cycle efficiency (CCE) after sedation obtained, 1, 2, 5 min after
induction achieved, 1, 2, 5 and 10 min after intubation. Results HR, SVRI
showed a decrease in Group SM but an increase in Group S
(Ptime*group<0.0001) in the study period. SVI and CCE showed an increase
in Group SM but a decrease in Group S (Ptime*group<0.0001). SBP, MBP and
CI were related to time after polynomial transformation, and showed an
increase after intubation in Group SM but a decrease in Group S
(Ptime2*group<0.0001). Conclusion PRAM provides meaningful and direct
monitoring of hemodynamics and cardiac efficiency during the dynamic
period of anesthetic induction in children undergoing cardiac surgery. As
compared to inhalational sevoflurane, intravenous sufentanil-midazolam
exerts more favorable effects on systemic hemodynamics and cardiac
efficiency during anesthetic induction in this group of patients.

<45>
Accession Number
625544649
Title
Glycaemic efficacy and safety of linagliptin compared to a basal-bolus
insulin regimen in patients with type 2 diabetes undergoing non-cardiac
surgery: A multicentre randomized clinical trial.
Source
Diabetes, Obesity and Metabolism. 21 (4) (pp 837-843), 2019. Date of
Publication: April 2019.
Author
Vellanki P.; Rasouli N.; Baldwin D.; Alexanian S.; Anzola I.; Urrutia M.;
Cardona S.; Peng L.; Pasquel F.J.; Umpierrez G.E.; Bakhtiari H.; Wang
C.L.; Jones J.; Modzelewski K.; Ensminger E.; Haw J.S.; Fayfman M.; Ramos
C.; Gomez P.
Institution
(Vellanki, Anzola, Urrutia, Cardona, Pasquel, Umpierrez) Division of
Endocrinology, Metabolism and Lipids, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
(Rasouli) Division of Endocrinology, Metabolism and Diabetes, Department
of Medicine, University of Colorado-Denver, Denver, CO, United States
(Baldwin) Division of Endocrinology, Department of Medicine, Rush
University Medical Center, Chicago, IL, United States
(Alexanian) Division of Endocrinology, Diabetes and Nutrition, Department
of Medicine, Boston University, Boston, MA, United States
(Peng) Department of Biostatistics, Rollins School of Public Health, Emory
University, Atlanta, GA, United States
(Bakhtiari, Wang) University of Colorado, Division of Endocrinology,
United States
(Jones) Rush University, Division of Endocrinology, United States
(Modzelewski, Ensminger) Boston University, Division of Endocrinology,
United States
(Haw, Fayfman, Ramos, Gomez) Emory University, Division of Endocrinology,
Metabolism and Lipids, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aims: The use of incretin-based therapy, rather than or complementary to,
insulin therapy is an active area of research in hospitalized patients
with type 2 diabetes (T2D). We determined the glycaemic efficacy and
safety of linagliptin compared to a basal-bolus insulin regimen in
hospitalized surgical patients with T2D. <br/>Material(s) and Method(s):
This prospective open-label multicentre study randomized T2D patients
undergoing non-cardiac surgery with admission blood glucose (BG) of 7.8 to
22.2 mmol/L who were under treatment with diet, oral agents or total
insulin dose (TDD) <= 0.5 units/kg/day to either linagliptin (n = 128)
daily or basal-bolus (n = 122) with glargine once daily and rapid-acting
insulin before meals. Both groups received supplemental insulin for BG >
7.8 mmol/L. The primary endpoint was difference in mean daily BG between
groups. <br/>Result(s): Mean daily BG was higher in the linagliptin group
compared to the basal-bolus group (9.5 +/- 2.6 vs 8.8 +/- 2.3 mmol/L/dL, P
= 0.03) with a mean daily BG difference of 0.6 mmol/L (95% confidence
interval 0.04, 1.2). In patients with randomization BG < 11.1 mmol/L (63%
of cohort), mean daily BG was similar in the linagliptin and basal-bolus
groups (8.9 +/- 2.3 vs 8.7 +/- 2.3 mmol/L, P = 0.43); however, patients
with BG >= 11.1 mmol/L who were treated with linagliptin had higher BG
compared to the basal-bolus group (10.9 +/- 2.6 vs 9.2 +/- 2.2 mmol/L, P <
0.001). Linagliptin resulted in fewer hypoglycaemic events (1.6% vs 11%, P
= 0.001; 86% relative risk reduction), with similar supplemental insulin
and fewer daily insulin injections (2.0 +/- 3.3 vs 3.1 +/- 3.3, P < 0.001)
compared to the basal-bolus group. <br/>Conclusion(s): For patients with
T2D undergoing non-cardiac surgery who presented with mild to moderate
hyperglycaemia (BG < 11.1 mmol/L), daily linagliptin is a safe and
effective alternative to multi-dose insulin therapy, resulting in similar
glucose control with lower hypoglycaemia.<br/>Copyright &#xa9; 2018 John
Wiley & Sons Ltd

<46>
Accession Number
625010555
Title
Aprotinin Impacts 8-Isoprostane after Coronary Artery Bypass Grafting.
Source
Scandinavian journal of surgery : SJS : official organ for the Finnish
Surgical Society and the Scandinavian Surgical Society. 107 (4) (pp
329-335), 2018. Date of Publication: 01 Dec 2018.
Author
Toikkanen V.; Rinne T.; Nieminen R.; Moilanen E.; Laurikka J.; Porkkala
H.; Tarkka M.; Mennander A.A.
Institution
(Toikkanen, Laurikka, Tarkka, Mennander) Department of Cardiothoracic
Surgery, SDSKIR Heart Center, Tampere University Hospital, University of
Tampere, Tampere, Finland
(Rinne, Porkkala) Division of Cardiac Anesthesia, Heart Center, Tampere
University Hospital, University of Tampere, Tampere, Finland
(Nieminen, Moilanen) The Immunopharmacology Research Group, Faculty of
Medicine and Life Sciences, University of Tampere and Tampere University
Hospital, Tampere, Finland
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIMS:: The lungs participate in the modulation of the
circulating inflammatory factors induced by coronary artery bypass
grafting. We investigated whether aprotinin-which has been suggested to
interact with inflammation-influences lung passage of key inflammatory
factors after coronary artery bypass grafting. MATERIAL AND METHODS:: A
total of 40 patients undergoing coronary artery bypass grafting were
randomized into four groups according to aprotinin dose: (1) high dose,
(2) early low dose, (3) late low dose, and (4) without aprotinin.
Pulmonary artery and radial artery blood samples were collected for the
evaluation of calculated lung passage (pulmonary artery/radial artery) of
the pro-inflammatory factors interleukin 6 and interleukin 8,
8-isoprostane, myeloperoxidase and the anti-inflammatory interleukin 10
immediately after induction of anesthesia (T1), 1min after releasing
aortic cross clamp (T2), 15min after releasing aortic cross clamp (T3), 1h
after releasing aortic cross clamp (T4), and 20h after releasing aortic
cross clamp (T5). <br/>RESULT(S):: Pulmonary artery/radial artery
8-isoprostane increased in patients with high aprotinin dose as compared
with lower doses (1.1 range 0.97 vs 0.9 range 1.39, p=0.001). The main
effect comparing high aprotinin dose with lower doses was significant
(F(1, 38)=7.338, p=0.01, partial eta squared=0.16) further supporting
difference in the effectiveness of high aprotinin dose for pulmonary
artery/radial artery 8-isoprostane. <br/>CONCLUSION(S):: According to the
pulmonary artery/radial artery equation, the impact of aprotinin on
8-isoprostane after coronary artery bypass grafting is dose dependent.
Aprotinin may aid the lung passage of circulating factors toward a
beneficial anti-inflammatory milieu.

<47>
Accession Number
626738676
Title
Further cardiovascular outcomes research with PCSK9 inhibition in subjects
with eelevated risk, the FOURIER trial.
Source
Kardiovaskulare Medizin. Conference: Joint Annual Meeting of the Swiss
Society of Cardiology and the Swiss Society of Cardiac and Thoracic
Vascular Surgery. Switzerland. 20 (5 Supplement 27) (pp S115), 2017. Date
of Publication: May 2017.
Author
Mach F.; Sabatine M.; Giugliano R.; Keech A.; Honarpour N.; Wasserman
S.M.; Scott R.; Sever P.; Pedersen T.
Institution
(Mach) Cardiology, Geneva University Hospitals, Geneva, Switzerland
(Sabatine, Giugliano) Cardiology, Brigham and Women's Hospital Boston,
Boston, MA, United States
(Keech) NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Honarpour, Wasserman, Scott) Amgen, Thousand Oaks, CA, United States
(Sever) International Centre for Circulatory Health, Imperial College
London, London, United Kingdom
(Pedersen) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Background: Despite current therapies, patients with vascular disease
remain at high risk for major adverse cardiovascular events. Low-density
lipoprotein cholesterol is a well-established modifiable cardiovascular
risk factor. Evolocumab is a fully human monoclonal antibody inhibitor of
proprotein convertase subtilisin/kexin type 9 that reduces lowdensity
lipoprotein cholesterol by approximately 60% across various populations.
Study design: FOURIER is a randomized, placebo-controlled, double-blind,
parallel-group, multinational trial testing the hypothesis that adding
evolocumab to statin therapy will reduce the incidence of major adverse
cardiovascular events in patients with clinically evident vascular
disease. The study population consists of 27,564 patients who have had a
myocardial infarction (MI), an ischemic stroke, or symptomatic peripheral
artery disease and have a low-density lipoprotein >=70 mg/dL or a
non-high-density lipoprotein cholesterol >=100 mg/dL on an optimized
statin regimen. Patients were randomized in a 1:1 ratio to receive either
evolocumab (either 140 mg subcutaneously every 2 weeks or 420 mg
subcutaneously every month, according to patient preference) or matching
placebo injections. The primary end point is major cardiovascular events
defined as the composite of cardiovascular death, MI, stroke,
hospitalization for unstable angina, or coronary revascularization. The
key secondary end point is the composite of cardiovascular death, MI, or
stroke. The trial is planned to continue until at least 1,630 patients
experience the secondary end point, thereby providing 90% power to detect
a relative reduction of >=15% in this end point. Primary results will be
ready for presentation at ACC 2017. <br/>Conclusion(s): FOURIER will
determine whether the addition of evolocumab to statin therapy reduces
cardiovascular morbidity and mortality in patients with vascular disease.

<48>
Accession Number
626738041
Title
Impact of clopidogrel and aspirin therapy after off pump coronary artery
bypass surgery. Is postoperative double anti platelet therapy mandatory?.
Source
Kardiovaskulare Medizin. Conference: Joint Annual Meeting of the Swiss
Society of Cardiology and the Swiss Society of Cardiac and Thoracic
Vascular Surgery. Switzerland. 20 (5 Supplement 27) (pp S44), 2017. Date
of Publication: May 2017.
Author
Haeussler A.; Rings L.; Dushaj S.; Odavic D.; Graves K.; Dzemali O.;
Genoni M.
Institution
(Haeussler, Rings, Dushaj, Odavic, Graves, Dzemali, Genoni) Herzchirurgie,
Stadtspital Triemli Zurich, Zurich, Switzerland
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Introduction: Hypercoagolabity in off pump coronary artery bypass grafting
(OPCAB) is well known problem in literature. Therefore, double-anti
platelet therapy of clopidogrel and aspirin is maybe important for the
impact of patency rate of bypass grafts in OPCAB surgery. <br/>Method(s):
143 patients were enrolled in this prospective randomized study. All pts
underwent OPCAB surgery. Blood platelet function test was drawn 5 d
before, 5d after surgery, at 3 month after surgery and at one year of
follow up. Platelet function analyser (PFA-100TM) was used for evaluation
of clotting time. Turbidimetric platelet aggregation and impedance
platelet aggregation was induced by arachidonic acid, collagen and
adenosine di- phosphate to monitor effect on the thrombocytes. To evaluate
bypass graft patency rate a 64-slice cardiac computer tomogram was
performed after one year. Endpoint were patency rate of bypass grafts,
mortality, rate of reintervention, course of cardiac enzymes (CK, CK-MB
and TropT), C reactive protein and bleeding complications. <br/>Result(s):
Mean age was 68+/-4.65y, 120 were men and 23 women. Average risk rate
(EuroScore logistic) was 4.04+/-1.4%. Use of bilateral mammarian artery
was 54%. Rate of non-responders for Clopidogrel was significant elevated
than for aspirin (13.3% vs. 4.2 %). 3.8 bypass grafts per patient were
done. Patency rate does not differ in all pts. There was no significant
difference in postoperative bleeding rates, CK and CK-MB rates, Trop T and
CRP. Cardiac CT scan at on 1 year follow up showed no significant
difference regarding graft patency rates. No mortality was recorded.
<br/>Conclusion(s): Administration of a combined regime of clopidogrel and
aspirin after OPCAB is not associated with increased postoperative
bleeding rates. The pts, who were non-responders for clopidogrel showed
the same in patency rate of the bypass grafts as the responders. Finally,
we could not find any benefit for pts undergoing double antiplatelet
therapy with aspirin and clopidogrel.

<49>
Accession Number
626735698
Title
Intraoperative infusion of noradrenaline improves platelet aggregation in
patients undergoing coronary artery bypass grafting: a randomized
controlled trial.
Source
Journal of Thrombosis and Haemostasis. (no pagination), 2019. Date of
Publication: 2019.
Author
Singh S.; Damen T.; Dellborg M.; Jeppsson A.; Nygren A.
Institution
(Singh, Dellborg, Jeppsson) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Damen, Nygren) Department of Anesthesiology and Intensive Care Medicine,
Institute of Clinical Sciences, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Damen, Nygren) Department of Cardiothoracic Anesthesia and Intensive
Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Blackwell Publishing Ltd
Abstract
Essentials Strategies to improve platelet function may reduce excessive
bleeding during cardiac surgery. Patients were randomized to standard care
or standard care + noradrenaline infusion. Low-dose noradrenaline improved
intraoperative platelet aggregation and clot formation. Noradrenaline may
be considered to improve intraoperative hemostasis during cardiac surgery.
<br/>Summary: Background New approaches to prevent bleeding complications
during cardiac surgery are needed. Objective To investigate if
noradrenaline (NA) enhances platelet aggregation in patients undergoing
coronary artery bypass grafting (CABG). Patients/Methods Twenty-four
patients undergoing coronary artery bypass grafting (CABG) were included
in a prospective parallel-group randomized study. All patients but one
were treated with acetylsalicylic acid (ASA). In the treatment group (n =
12), mean arterial blood pressure (MAP) was maintained at pre-induction
levels by NA infusion. In the control group (n = 12), NA was administered
only if MAP decreased below 60 mmHg. Platelet aggregation (impedance
aggregometry with ADP, arachidonic acid [AA] and thrombin-receptor
activating peptide [TRAP] as initiators) and clot formation (clotting
time, clot formation time and maximum clot firmness by EXTEM, INTEM and
FIBTEM tests with thromboelastometry) were assessed before and 50 min
after anesthesia induction (before cardiopulmonary bypass was initiated).
Results All patients in the treatment group received NA (median dose after
50 min 0.09 (range 0-0.26) mug kg^-1 min^-1). Four
patients in the control group also received NA (0.03-0.12 mug
kg^-1 min^-1). There were differences between the
treatment group and the control group in ADP- and AA-induced aggregation
changes (ADP, +16 [25th-75th percentiles, 5-26] vs. -7 [-19 to -1] U; AA,
+12 [-4 to 16] vs. -9 [-13 to 1] U). INTEM maximum clot firmness increased
in the treatment group but not in the control group. Conclusion Infusion
of clinically relevant doses of NA enhanced platelet aggregation and clot
firmness in ASA-treated CABG patients. NA infusion is hence a potential
new method to acutely improve platelet reactivity in patients on
antiplatelet therapy undergoing surgery.<br/>Copyright &#xa9; 2019
International Society on Thrombosis and Haemostasis

<50>
Accession Number
626735574
Title
The epidemiology of multicomponent blood transfusion: a systematic review.
Source
Transfusion Medicine. (no pagination), 2019. Date of Publication: 2019.
Author
Perelman I.; Khair S.; Dermer E.; Tinmouth A.; Saidenberg E.; Fergusson D.
Institution
(Perelman, Khair, Dermer, Tinmouth, Saidenberg, Fergusson) Faculty of
Medicine, University of Ottawa, Ottawa, ON, Canada
(Perelman, Tinmouth, Saidenberg, Fergusson) Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Tinmouth, Saidenberg) Ottawa Hospital, Ottawa, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
We performed a systematic review to describe the prevalence of
multicomponent blood transfusion and, as a secondary objective, to
determine patient characteristics and outcomes associated with
multicomponent transfusion. There is a lack of literature on the
epidemiology of multicomponent transfusion as most studies concentrate on
a single blood product and its utilisation. Patient care and blood
management can be optimised by better understanding the patients who
receive multicomponent transfusions. The databases Medline, EMBASE and the
Cochrane Library of Systematic Reviews were searched. Observational cohort
and cross-sectional studies of hospital patients reporting on
multicomponent transfusion prevalence or on patient characteristics and
outcomes associated with multicomponent transfusion were included. A
descriptive synthesis of studies was performed. A total of 37 eligible
studies were included. It was found that multicomponent transfusion
prevalence varied greatly by patient population and by the combination of
blood products given in the multicomponent transfusion.
Multicomponent-transfused patients included burn, cardiac surgery, liver
surgery and transplant, cancer, infectious diseases, trauma and intensive
care unit patients. Five studies found associations between multicomponent
transfusion and adverse health outcomes; however, these findings are
likely confounded by indication. The overall quality of evidence was low
given a fair-to-poor individual study quality, inconsistent multicomponent
transfusion prevalence estimates and confounding by indication. Further
research is needed to better understand the epidemiology of multicomponent
transfusion, including studies on multicomponent transfusion in
haematological cancer patients and studies looking for patient
characteristics that can better predict multicomponent transfusion
need.<br/>Copyright &#xa9; 2019 British Blood Transfusion Society

<51>
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

<52>
Accession Number
2001599970
Title
Mechanical thrombectomy for acute ischaemic stroke.
Source
South African Medical Journal. 109 (2) (pp 77-80), 2019. Date of
Publication: February 2019.
Author
Harrichandparsad R.
Institution
(Harrichandparsad) Department of Neurosurgery, College of Health Sciences,
University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital,
Durban, South Africa
Publisher
South African Medical Association (Lansdale Building, Gardener Way,
Pinelands, Cape Town 7405, South Africa)
Abstract
Rapid, safe and effective arterial recanalisation to restore blood flow
and improve functional outcome is the primary goal of hyperacute
management of acute ischaemic stroke. This is possible either through
thrombolysis or direct mechanical removal of clot from the blocked artery.
Current evidence from randomised controlled trials shows that, for
correctly selected patients, functional independence can be achieved in 32
- 71% of those who undergo clot removal. It is estimated that 10 - 15% of
all ischaemic stroke patients have large-vessel occlusion and qualify for
mechanical thrombectomy. It is important to have systems in place to
identify and treat these patients.<br/>Copyright &#xa9; 2019, South
African Medical Association. All rights reserved.

<53>
Accession Number
626655871
Title
Edoxaban and implantable cardiac device interventions: Insights from the
ENGAGE AF-TIMI 48 trial.
Source
Europace. 21 (2) (pp 306-312), 2019. Date of Publication: 01 Feb 2019.
Author
Steffel J.; Ruff C.T.; Braunwald E.; Hamershock R.A.; Murphy S.A.;
Nieminen M.; Lanz H.-J.; Mercuri M.F.; Peterson N.; Antman E.M.; Giugliano
R.P.
Institution
(Steffel) Department of Cardiology, University Heart Center Zurich,
Zurich, Switzerland
(Ruff, Braunwald, Hamershock, Murphy, Antman, Giugliano) Cardiovascular
Division, TIMI Study Group, Brigham and Women's Hospital, 350 Longwood
Avenue, Boston, MA 02115, United States
(Nieminen) University Central Hospital, Helsinki, Finland
(Lanz) Daiichi-Sankyo Europe GmbH, Munich, Germany
(Mercuri, Peterson) Daiichi-Sankyo Pharma Development, Baskin Ridge, NJ,
United States
Publisher
Oxford University Press
Abstract
Aims Pacemaker, implantable cardioverter-defibrillator, and cardiac
resynchronization therapy device implantations and generator changes are
frequently performed in patients receiving direct oral anticoagulants. In
an exploratory analysis, we investigated the outcome of patients
undergoing such device procedures in the ENGAGE AF-TIMI 48 trial. Methods
During the trial, 1217 device procedures were performed in 1145 patients,
with intervention dates available for and results 1203 procedures. Two
hundred and twenty-five procedures (in 212 patients) were performed >30
days after study drug was stopped and are not included in the event
analysis. For most interventions (n = 728, 74%), study drug was
interrupted >3 days (median for the entire cohort: 5 days, interquartile
range 0-11 days); 250 interventions were performed with <_3 days study
drug interruption. During the first 30 days after the procedure, six
strokes/systemic embolic events (SEEs) (three each in the lower-dose
edoxaban and warfarin arm) and one major bleeding event (in the lower-dose
edoxaban arm) occurred; no stroke/SEEs or major bleeds occurred around the
295 device procedures in the higher-dose edoxaban arm. Two ischaemic and
one major bleeding event occurred after the 288 device procedures
performed with <_3 days periprocedural interruption of study drug.
Conclusion In this first experience of patients undergoing device surgery
with edoxaban, a low risk of ischaemic and bleeding events was observed
during the first 30days post-procedure. Our data are in line with current
recommendations of no or only brief interruption of non-vitamin K
antagonist oral anticoagulants prior to cardiac device
surgery.<br/>Copyright European Society of Cardiology. All rights
reserved. &#xa9; The Author(s) 2018. For permissions.

<54>
Accession Number
626669510
Title
Outcomes following surgical revascularization with single versus bilateral
internal thoracic arterial grafts in patients with left main coronary
artery disease undergoing coronary artery bypass grafting: Insights from
the EXCEL trial.
Source
European Journal of Cardio-thoracic Surgery. 55 (3) (pp 501-509), 2019.
Date of Publication: 01 Mar 2019.
Author
Thuijs D.J.F.M.; Head S.J.; Stone G.W.; Puskas J.D.; Taggart D.P.; Serruys
P.W.; Dressler O.; Crowley A.; Brown W.M.; Horkay F.; Boonstra P.W.;
Bogats G.; Noiseux N.; Sabik J.F.; Kappetein A.P.
Institution
(Thuijs, Head, Kappetein) Department of Cardiothoracic Surgery, Erasmus
MC, University Medical Centre, 230, PO Box 2040, Rotterdam 3000,
Netherlands
(Stone) Department of Cardiology, Columbia University Medical Center, New
York-Presbyterian Hospital, Cardiovascular Research Foundation, New York,
NY, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's,
New York, NY, United States
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Dressler, Crowley) Cardiovascular Research Foundation, New York, NY,
United States
(Brown) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, GA, United States
(Horkay) Department of Cardiology, National Institute of Cardiology,
Budapest, Hungary
(Boonstra) Department of Cardiothoracic Surgery, Medical Center
Leeuwarden, Leeuwarden, Netherlands
(Bogats) Department of Cardiac Surgery, University of Szeged, Szeged,
Hungary
(Noiseux) Department of Surgery, FacultCrossed D Signde MCrossed D
Signdecine, UniversitCrossed D Sign de MontrCrossed D Signal, Montreal,
QC, Canada
(Sabik) Department of Cardiovascular Surgery, University Hospitals,
Cleveland, OH, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Observational data suggest that the use of a single internal thoracic
artery (SITA) may result in inferior outcomes compared with bilateral
internal thoracic artery (BITA) use for coronary artery bypass grafting
(CABG) - A finding not yet supported by randomized trial outcomes.
However, the optimal number of internal thoracic artery grafts in patients
with left main coronary artery disease has not been investigated.
<br/>METHOD(S): The EXCEL trial randomized 1905 patients with left main
coronary artery disease to percutaneous coronary intervention with
everolimus-eluting stents versus CABG. Among the 905 patients undergoing
CABG, 688 (76.0%) received SITA and 217 (24.0%) received BITA. Differences
in clinical event rates were estimated using the Kaplan-Meier method and
compared with the log-rank test. Multivariable Cox regression was used to
adjust for differences in baseline covariates. <br/>RESULT(S): Compared to
SITA, patients treated with BITA were younger (66.1 9.5 vs 64.5 9.3 years,
P = 0.020), were less likely female (24.3% vs 14.3%, P = 0.002) and
diabetic (28.8% vs 15.2%, P < 0.001), and had a lower prevalence of
peripheral vessel disease (10.2% vs 5.5%, P = 0.040). The unadjusted
3-year composite primary endpoint of death, stroke or myocardial
infarction (MI) occurred in 15.6% of SITA vs 11.6% of BITA patients (P =
0.17). The SITA group tended to have a higher 3-year rate of all-cause
death compared with the BITA group (6.7% vs 3.3%; P = 0.070). Stroke, MI
and ischaemia-driven revascularization outcomes were not significantly
different between groups. After adjusting for baseline differences,
neither the composite of death, stroke or MI [hazard ratio (HR) 1.12, 95%
confidence interval (CI) 0.71-1.78; P = 0.62] nor mortality (HR 1.36, 95%
CI 0.60-3.12; P = 0.46) was significantly higher with SITA. The
rehospitalization rate after 3 years was higher in the SITA group (35.8%
vs 26.0%, P = 0.008), a difference which was no longer present after
multivariable adjustment (HR 1.27, 95% CI 0.93-1.74; P = 0.13). Sternal
wound dehiscence within 30 days did not occur more often in the BITA group
compared to the SITA group (1.8% vs 2.2%, P>0.99). <br/>CONCLUSION(S): In
the EXCEL trial, there were no clinical differences at 3 years between
SITA or BITA revascularization in patients with left main coronary artery
disease.<br/>Copyright &#xa9; 2018. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.

<55>
Accession Number
2000888513
Title
Perioperative dexmedetomidine reduces delirium after cardiac surgery: A
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 50 (pp 33-42), 2018. Date of Publication:
November 2018.
Author
Wu M.; Liang Y.; Dai Z.; Wang S.
Institution
(Wu, Liang, Dai, Wang) Department of anesthesiology, The Affiliated
Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266071, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To evaluate the efficiency of dexmedetomidine on the
incidence of delirium in patients after cardiac surgery. <br/>Design(s):
Meta-analysis of randomized controlled trials. <br/>Setting(s): Operating
room and Intensive Care Unit (ICU). <br/>Patient(s): Ten trials with a
total of 1387 patients undergoing cardiac surgery met the inclusion
criteria. <br/>Intervention(s): Randomized controlled trials (RCTs)
comparing the effect of dexmedetomidine versus non-treatment of
dexmedetomidine (normal saline (NS), propofol and other anesthetic drugs)
on delirium in patients undergoing cardiac surgery were retrieved from
PubMed/Medline, Embase, the Cochrane Library and Web of science. The
primary outcome was the incidence of delirium. The secondary outcomes were
the rate of bradycardia and hypotension, the duration of mechanical
ventilation and the length of ICU and hospital stay. <br/>Main Result(s):
Compared with the control group, Dexmedetomidine significantly decreased
the incidence of postoperative delirium, (risk ratio 0.46; 95% confidence
intervals, 0.34 to 0.62; P < 0.00001), while the incidence of bradycardia
was increased in dexmedetomidine group (risk ratio 1.86; 95% confidence
intervals, 1.16 to 2.99; P = 0.01). There was no significant difference
between groups with regarding to the occurrence of hypotension (risk ratio
0.90; 95% confidence intervals, 0.59 to 1.38; P = 0.63), the duration of
mechanical ventilation (Mean Difference 0.21; 95% confidence intervals,
-0.70 to 1.12; P = 0.65), and the length of ICU (Standard Mean Difference
- 0.07; 95% confidence intervals, -0.19 to 0.06; P = 0.3) and hospital
stay (Mean Difference - 0.13; 95% confidence intervals, -0.56 to 0.30; P =
0.56). <br/>Conclusion(s): Perioperative dexmedetomidine administration
decreased the incidence of delirium in patients after cardiac surgery, but
might increase the rate of bradycardia. Furthermore, we did not observe
significant differences in the incidence of hypotension, the duration of
mechanical ventilation and length of ICU and hospital stay between groups.
Future studies are needed to ascertain the effect of dexmedetomidine on
the incidence of delirium after coronary artery bypass grafting (CABG) and
in patient with cognitive disorder at baseline, whether intraoperative
dexmedetomidine infusion could reduce postoperative delirium and the
optimal dose of dexmedetomidine.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<56>
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.

<57>
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.

<58>
[Use Link to view the full text]
Accession Number
626721768
Title
A randomized study on the effect of sequential acupoint stimulation on
pulmonary function of patients with spontaneous pneumothorax during VATS
perioperative period.
Source
Medicine. 98 (10) (pp e14575), 2019. Date of Publication: 01 Mar 2019.
Author
Sui T.-Q.; Zhang F.-Y.; Jiang A.-L.; Zhang X.-Q.; Zhang Z.-W.; Yang Y.;
Sun L.-P.
Institution
(Sui, Zhang, Zhang, Yang) Department of Thoracic Surgery, Austria
(Zhang, Jiang) Department Nursing of Thoracic Surgery
(Sun) Department of Emergency Services, 5th Central Hospital of Tianjin,
Tianjin, China
Publisher
NLM (Medline)
Abstract
This study aims to explore the effect of sequential acupoint stimulation
on the postoperative pulmonary function of patients with spontaneous
pneumothorax who underwent video-assisted thoracoscopic surgery
(VATS).Using a random number table, the patients were randomly divided
into 2 groups: routine nursing group and sequential acupoint stimulation
group. Patients in the routine nursing group received standard nursing
care of thoracic surgery, while patients in the acupoint group received
sequential acupoint stimulation on Shenshu (BL23), Gaohuang (BL43), Feishu
(BL13), and Tiantu (CV22). Then, the maximal ventilatory volume (MVV),
oxygen saturation (SpO2), postoperative drainage volume, postoperative
drainage time, postoperative hospitalization days, and procalcitonin (PCT)
were observed on the first, third, fifth and 30th day after VATS
operation.On the fifth day after spontaneous pneumothorax was treated with
VATS, MVV, and SpO2 of the sequential acupoint stimulation group were
significantly higher than those of the routine nursing group (P < .05). On
both the third day and fifth day after VATS, PCT of the sequential
acupoint stimulation group was significantly lower than that of the
routine nursing group (P < .01). Furthermore, the difference in
postoperative drainage volume between the 2 groups was not statistically
significant (P > .05), while chest tube drainage time (P < .01) and
postoperative hospitalization days (P < .05) of the sequential acupoint
stimulation group were significantly lower than those of the routine
nursing group.In spontaneous pneumothorax patients who underwent VATS,
sequential acupoint stimulation nursing was significantly more effective
than routine postoperative nursing in promoting postoperative recovery of
lung function, alleviating inflammatory response and shortening
hospitalization days.

<59>
Accession Number
626733829
Title
Multivessel Coronary Revascularization Strategies in Patients with Chronic
Kidney Disease: A Meta-Analysis.
Source
CardioRenal Medicine. (pp 145-159), 2019. Date of Publication: 2019.
Author
Wu P.; Luo F.; Fang Z.
Institution
(Wu, Luo, Fang) Department of Cardiovascular Medicine, Second Xiangya
Hospital, Central South University, Changsha, Hunan 410011, China
Publisher
S. Karger AG
Abstract
Background: Early revascularization can lead to better prognosis in
multivessel coronary artery disease (CAD) patients with chronic kidney
disease (CKD). However, whether coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI) is better remains unknown.
<br/>Method(s): We searched PubMed and the Cochrane Library database from
inception until December 9, 2017, for articles that compare outcomes of
CABG and PCI in multivessel CAD patients with CKD. We pooled the odds
ratios with a fixed-effects model when I² < 50% or a
random-effects model when I² > 75% and conducted heterogeneity
and quality assessments as well as publication bias analyses.
<br/>Result(s): A total of 17 studies with 62,343 patients were included.
Compared with CABG, the pooled analysis showed that PCI had a lower risk
of short-term all-cause death (OR, 0.56; 95% CI, 0.37-0.84) and
cerebrovascular accidents (OR, 0.65; 95% CI, 0.53-0.79) but a higher risk
of cardiac death (OR, 1.29; 95% CI, 1.21-1.37), myocardial infarction (MI)
(OR, 1.73; 95% CI, 1.35-2.21), and repeat revascularization (RR) (OR, 3.9;
95% CI, 2.99-5.09). There was no significant difference in the risk of
long-term all-cause death (OR, 1.08; 95% CI, 0.95-1.23) and major adverse
cardiac and cerebrovascular events (MACCE) (OR, 1.58; 95% CI, 0.99-2.52)
between the PCI and CABG groups. A subgroup analysis restricted to
patients treated with dialysis or with PCI-drug-eluting stent yielded
similar results. <br/>Conclusion(s): PCI for patients with CKD and
multivessel disease (multivessel CAD) had advantages over CABG with regard
to short-term all-cause death and cerebrovascular accidents, but
disadvantages regarding the risk of myocardial death, MI, and RR; there
was no significant difference in the risk of long-term all-cause death and
MACCE. Large randomized controlled trials are needed to confirm our
findings.<br/>Copyright &#xa9; 2019 S. Karger AG, Basel.

<60>
Accession Number
626727482
Title
Bilateral versus single internal thoracic artery for coronary artery
bypass grafting with end-stage renal disease: A systematic review and
meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Tam D.Y.; Rahouma M.; An K.R.; Gaudino M.F.L.; Karkhanis R.; Fremes S.E.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Department of Surgery, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Canada
(Rahouma, An, Gaudino, Karkhanis) Department of Cardiovascular Sciences,
Catholic University, Rome, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, New York, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The incidence of severe coronary artery disease (CAD) in
patients with end-stage renal disease (ESRD) on dialysis is high. Coronary
artery bypass grafting (CABG) is the preferred treatment in those with
severe CAD. Bilateral internal thoracic artery (BITA) vs single internal
thoracic artery (SITA) grafting has been shown to improve late survival in
other high-risk populations. In ESRD, comparative studies are limited by
sample size to detect outcome differences. We sought to determine the late
survival and early outcomes of BITA compared with SITA in patients with
ESRD. <br/>Method(s): MEDLINE and EMBASE were searched from inception to
2017 for studies directly comparing BITA to SITA in patients with ESRD
undergoing CABG. The primary outcome was late survival; secondary outcomes
were in-hospital/30-day mortality, stroke, and deep sternal wound
infection (DSWI). Kaplan-Meier curve reconstruction for late mortality was
performed. <br/>Result(s): Five studies (three adjusted [n = 197] and two
unadjusted observational studies [n = 231]) were included in the analysis.
Reported ITA skeletonization ranged from 83% to 100% (median: 100%). There
was no difference in in-hospital mortality (risk risk [RR], 0.84; 95%
confidence interval [95%CI], 0.36,1.98; P = 0.70), perioperative stroke
(RR, 1.97; 95%CI, 0.58,6.66; P = 0.28), and DSWI (RR, 1.56; 95%CI,
0.60,4.07; P = 0.36) between BITA and SITA. All studies reported adjusted
late mortality, which was similar between BITA and SITA (incident rate
ratio, 0.81; 95%CI, 0.59,1.11) at mean 3.7-year follow-up.
<br/>Conclusion(s): BITA grafting is safe in patients with ESRD although
there was no survival benefit at 3.7 years. Additional studies with longer
follow-up are required to determine the potential late benefits of BITA
grafting in patients with ESRD.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<61>
Accession Number
626725484
Title
Myocardial protection and clinical outcomes in Tetralogy of Fallot
patients undergoing intracardiac repair: a randomized study of two
cardioplegic techniques.
Source
Perfusion (United Kingdom). (no pagination), 2019. Date of Publication:
2019.
Author
Negi S.L.; Mandal B.; Singh R.S.; Puri G.D.
Institution
(Negi, Mandal, Puri) Department of Anaesthesia and Intensive Care,
Postgraduate Institute of Medical Education and Research, Chandigarh,
India
(Singh) Department of Cardiothoracic and Vascular Surgery, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Myocardial protection in Tetralogy of Fallot patients
undergoing intracardiac repair is suboptimal due to hypertrophied right
ventricle. Hypertrophied myocardium is more susceptible to poor myocardial
preservation because of inadequate capillary density as compared to the
myocytes. There is a capillary to myocyte ratio mismatch. But del Nido
Cardioplegia owing to its less viscosity is able to get more evenly
distributed under hypothermic cardiopulmonary bypass as opposed to blood
Cardioplegia. We hypothesized that the del Nido Cardioplegia technique,
would be beneficial in myocardial protection because of its composition
and method of delivery, leading into better early and late clinical
outcomes in patients undergoing Tetralogy of Fallot repair as compared to
blood cardioplegia reconstituted using St Thomas Cardioplegia solution.
The objective of the study was to identify a better technique of
myocardial preservation in Tetralogy of Fallot patient. <br/>Method(s): In
total, 56 Tetralogy of Fallot patients undergoing intracardiac repair
under mild hypothermic cardiopulmonary bypass were randomly allocated to
receive antegrade Cardioplegia with either standard blood Cardioplegia
(Group I) or del Nido Cardioplegia (Group II). Preoperative as well as
postoperative data including echocardiographic parameters for right
ventricle functions, creatine kinase MB level, inotropic requirement,
mechanical ventilation duration, intensive care unit stay and hospital
mortality were evaluated. <br/>Result(s): Inotropic score in the first 24
hours postoperatively was significantly lower in Group II compared to
Group I (13.4 +/- 7.2 vs. 21.2 +/- 9.6, p = 0.003). Creatine kinase MB
level (ng/mL) was comparable between the groups. Echocardiographic
parameters for right ventricle functions were also comparable between the
groups during early as well as after 3 to 6 months postoperatively.
<br/>Conclusion(s): Del Nido Cardioplegia is equally efficacious in
providing myocardial protection during intracardiac repair under mild
hypothermic cardiopulmonary bypass in Tetralogy of Fallot patients as
compared to blood Cardioplegia solution with the added benefit of reducing
inotropic requirement in first 24 hours postoperative
period.<br/>Copyright &#xa9; The Author(s) 2019.