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<1>
Accession Number
2001580530
Title
Interval From Initiation of Prasugrel to Coronary Angiography in Patients
With Non-ST-Segment Elevation Myocardial Infarction.
Source
Journal of the American College of Cardiology. 73 (8) (pp 906-914), 2019.
Date of Publication: 5 March 2019.
Author
Silvain J.; Rakowski T.; Lattuca B.; Liu Z.; Bolognese L.; Goldstein P.;
Hamm C.; Tanguay J.-F.; ten Berg J.; Widimsky P.; Miller D.; Portal J.-J.;
Collet J.-P.; Vicaut E.; Montalescot G.; Dudek D.
Institution
(Silvain, Lattuca, Collet, Montalescot) Sorbonne University, ACTION Study
Group, INSERM UMRS 1166, ICAN, Institut de Cardiologie, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Rakowski, Dudek) Institute of Cardiology, Jagiellonian University Medical
College, Krakow, Poland
(Lattuca) Service de Cardiologie, Centre Hospitalier Universitaire Nimes,
ACTION Study Group, Universite Montpellier, Montpellier, France
(Liu) Department of Cardiology, Peking Union Medical College Hospital,
Beijing, China
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera, Arezzo, Italy
(Goldstein) SAMU and Emergency Department, Lille University Hospital,
Lille, France
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim and Medical Clinic
I, University of Giessen, Giessen, Germany
(Tanguay) Montreal Heart Institute, Montreal University, Montreal, Quebec,
Canada
(ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Widimsky) Third Medical Faculty of Charles University and University
Hospital Royal Vineyards, Prague, Czech Republic
(Miller) Eli Lilly and Company, Indianapolis, Indiana, India
(Portal, Vicaut) Methodology and Statistical Unit, Centre Hospitalier
Universitaire Lariboisiere (ACTION Study Group, AP-HP, Universite Paris
7), Paris, France
Publisher
Elsevier USA
Abstract
Background: In the ACCOAST (A Comparison of Prasugrel at PCI or Time of
Diagnosis of Non-ST Elevation Myocardial Infarction) trial, the prasugrel
pre-treatment strategy versus placebo was associated with excess bleeding
complications and no improved ischemic outcome in non-ST-segment elevation
myocardial infarction (MI). Whether patients with the longest
pre-treatment duration had an ischemic benefit is unknown.
<br/>Objective(s): This pre-specified analysis of the ACCOAST trial aimed
to assess the effect of pre-treatment duration with prasugrel (time from
randomization to angiography) on outcomes. <br/>Method(s): Within the
4,033 patients randomized in the ACCOAST trial, pre-treatment duration was
available in 4,001 patients (99.2%). The population of the trial was
divided into quartiles of pre-treatment duration (0.1 to 2.5 h, 2.5 to 3.9
h, 3.9 to 13.6 h, and >13.6 h) with an evaluation of the primary efficacy
endpoint of cardiovascular death, MI, stroke, urgent revascularization or
glycoprotein IIb/IIIa inhibitor bailout use. Secondary efficacy outcomes
including cardiovascular death, MI, or stroke; all-cause death; stent
thrombosis and safety outcomes (all coronary artery bypass graft [CABG] or
non-CABG TIMI [Thrombolysis In Myocardial Infarction] major bleeding) were
also evaluated at 7 days. <br/>Result(s): The primary efficacy outcome of
cardiovascular death, MI, stroke, urgent revascularization or glycoprotein
IIb/IIIa inhibitor bailout use did not differ between the quartiles of
pre-treatment duration in the trial population (p = 0.17 for interaction).
None of the secondary efficacy outcomes were found to be dependent on
pre-treatment duration. The safety outcome of all CABG or non-CABG TIMI
major bleeding did not differ between the quartiles of pre-treatment
duration (p = 0.37 for interaction). <br/>Conclusion(s): In non-ST-segment
elevation MI patients, the excess risk of bleeding and the absence of
ischemic benefit were consistent across the quartiles of increasing
duration of prasugrel pre-treatment. (A Comparison of Prasugrel at PCI or
Time of Diagnosis of Non-ST Elevation Myocardial Infarction [ACCOAST];
NCT01015287)<br/>Copyright &#xa9; 2019 American College of Cardiology
Foundation

<2>
Accession Number
626481745
Title
Low-dose methotrexate for the prevention of atherosclerotic events.
Source
New England Journal of Medicine. 380 (8) (pp 752-762), 2019. Date of
Publication: 21 Feb 2019.
Author
Ridker P.M.; Everett B.M.; Pradhan A.; MacFadyen J.G.; Solomon D.H.;
Zaharris E.; Mam V.; Hasan A.; Rosenberg Y.; Iturriaga E.; Gupta M.;
Tsigoulis M.; Verma S.; Clearfield M.; Libby P.; Goldhaber S.Z.; Seagle
R.; Ofori C.; Saklayen M.; Butman S.; Singh N.; May M.L.; Bertrand O.;
Johnston J.; Paynter N.P.; Glynn R.J.
Institution
(Ridker, Everett, Pradhan, MacFadyen, Zaharris, Mam, Paynter, Glynn)
Center for Cardiovascular Disease Prevention, Brigham and Women's
Hospital, Boston, MA 02115, United States
(Ridker, Everett, Libby, Goldhaber) Divisions of Cardiovascular Medicine,
Brigham and Women's Hospital, Boston, Canada
(Solomon) Divisions of Rheumatology, Brigham and Women's Hospital, Boston,
Canada
(Hasan, Rosenberg, Iturriaga) National Heart, Lung, Blood Institute,
Bethesda, MD, Canada
(Gupta) McMaster University, Hamilton, Canada
(Tsigoulis) Canadian Collaborative Research Network, Brampton, Canada
(Verma) St. Michael's Hospital, Toronto, Canada
(May) University of Ottawa Heart Institute, Ottawa, Canada
(Johnston) KMH Cardiology, Diagnostic and Research Centres, Mississauga,
ON, Canada
(Bertrand) Laval University, Quebec City, QB, Canada
(Clearfield) Touro University, Vallejo, CA, United States
(Seagle) CardiologyAssociates Carolina, Morganton, NC, United States
(Ofori) Wooster Community Hospital, Wooster, OH, United States
(Saklayen) Dayton Veteran Affairs Medical Center, Dayton, OH, United
States
(Butman) Verde Valley Medical Center, Cottonwood, AZ, United States
(Singh) Heart Specialists, Atlanta, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Inflammation is causally related to atherothrombosis.
Treatment with canakinumab, a monoclonal antibody that inhibits
inflammation by neutralizing interleukin-1beta, resulted in a lower rate
of cardiovascular events than placebo in a previous randomized trial. We
sought to determine whether an alternative approach to inflammation
inhibition with low-dose methotrexate might provide similar benefit.
METHODS :We conducted a randomized, double-blind trial of low-dose
methotrexate (at a target dose of 15 to 20 mg weekly) or matching placebo
in 4786 patients with previous myocardial infarction or multivessel
coronary disease who additionally had either type 2 diabetes or the
metabolic syndrome. All participants received 1 mg of folate daily. The
primary end point at the onset of the trial was a composite of nonfatal
myocardial infarction, nonfatal stroke, or cardiovascular death. Near the
conclusion of the trial, but before unblinding, hospitalization for
unstable angina that led to urgent revascularization was added to the
primary end point. <br/>RESULT(S): The trial was stopped after a median
follow-up of 2.3 years. Methotrexate did not result in lower
interleukin-1beta, interleukin-6, or C-reactive protein levels than
placebo. The final primary end point occurred in 201 patients in the
methotrexate group and in 207 in the placebo group (incidence rate, 4.13
vs. 4.31 per 100 person-years; hazard ratio, 0.96; 95% confidence interval
[CI], 0.79 to 1.16). The original primary end point occurred in 170
patients in the methotrexate group and in 167 in the placebo group
(incidence rate, 3.46 vs. 3.43 per 100 person-years; hazard ratio, 1.01;
95% CI, 0.82 to 1.25). Methotrexate was associated with elevations in
liver-enzyme levels, reductions in leukocyte counts and hematocrit levels,
and a higher incidence of non-basal-cell skin cancers than placebo.
<br/>CONCLUSION(S): Among patients with stable atherosclerosis, low-dose
methotrexate did not reduce levels of interleukin-1beta, interleukin-6, or
C-reactive protein and did not result in fewer cardiovascular events than
placebo.<br/>Copyright &#xa9; 2018 Massachusetts Medical Society.

<3>
Accession Number
626389708
Title
Statins for the Primary Prevention of Coronary Heart Disease.
Source
BioMed Research International. 2019 (no pagination), 2019. Article Number:
4870350. Date of Publication: 2019.
Author
Li M.; Wang X.; Li X.; Chen H.; Hu Y.; Zhang X.; Tang X.; Miao Y.; Tian
G.; Shang H.
Institution
(Li, Wang, Li, Chen, Hu, Zhang, Tang, Tian, Shang) Key Laboratory of
Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen
Hospital, Beijing University of Chinese Medicine, Beijing, China
(Miao) First Teaching Hospital of Tianjin University of Traditional
Chinese Medicine, Tianjin, China
(Shang) Institute of Integration of Traditional Chinese and Western
Medicine, Guangzhou Medical University, Guangzhou, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Object. The purpose of this study was to fully assess the role of statins
in the primary prevention of coronary heart disease (CHD). Methods. We
searched six databases (PubMed, the Cochrane Library, Web of Science,
China National Knowledge Infrastructure, Wanfang Database, and Chinese
Scientific Journal Database) to identify relevant randomized controlled
trials (RCTs) from inception to 31 October 2017. Two review authors
independently assessed the methodological quality and analysed the data
using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95%
CI) were pooled using fixed/random-effects models. Funnel plots and Begg's
test were conducted to assess publication bias. The quality of the
evidence was evaluated using the Grading of Recommendations Assessment,
Development and Evaluation (GRADE) approach. Results. Sixteen RCTs with
69159 participants were included in this review. Statins can effectively
decrease the occurrence of angina (RR=0.70, 95% CI: 0.580.85,
I² =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI:
0.510.69, I² =14%), fatal MI (RR=0.49, 95% CI: 0.240.98,
I² =0%), any MI (RR=0.53, 95% CI: 0.420.67, I² =0%),
any coronary heart events (RR=0.73, 95% CI: 0.680.78, I²=0%),
coronary revascularization (RR=0.66, 95% CI: 0.550.78, I² =
0%), and any cardiovascular events (RR=0.77, 95% CI: 0.7282, I²
= 0%). However, based on the current evidence, there were no significant
differences in CHD deaths (RR=0.82, 95% CI: 0.661.02, I²=0%)
and all-cause mortality (RR=0.88, 95% CI: 0.76 1.01, I² =58%)
between the two groups. Additionally, statins were more likely to result
in diabetes (RR=1.21, 95% CI: 1.051.39, I² =0%). There was no
evidence of publication biases, and the quality of the evidence was
considered moderate. Conclusion. Statins seemed to be beneficial for the
primary prevention of CHDs but have no effect on CHD death and all-cause
mortality.<br/>Copyright &#xa9; 2019 Min Li et al.

<4>
Accession Number
622796742
Title
Subannular reconstruction in secondary mitral regurgitation: A
meta-analysis.
Source
Heart. 104 (21) (pp 1783-1790), 2018. Date of Publication: 01 Nov 2018.
Author
Harmel E.K.; Reichenspurner H.; Girdauskas E.
Institution
(Harmel, Reichenspurner, Girdauskas) Department of Cardiothoracic Surgery,
University Heart Center Hamburg, Hamburg 20251, Germany
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Mitral valve repair using an undersized complete annuloplasty
ring in secondary mitral regurgitation with restricted leaflet motion
during systole (Carpentier's surgical classification of mitral valve
pathology: type IIIb) only inadequately addresses the underlying left
ventricular disease. This may lead to an ongoing ventricular remodelling
and progressive papillary muscle displacement with increasing leaflet
tethering. Several subannular techniques have been proposed to counteract
the reoccurrence of mitral regurgitation after mitral valve repair. We
aimed to evaluate the potential additive effect of such subannular
techniques on the late reoccurrence rate of secondary mitral
regurgitation. Methods Systematic literature review and meta-analysis were
performed on PubMed, Embase and Google Scholar for studies published up to
March 2016 and reporting late reoccurrence of mitral regurgitation after
mitral valve repair using standard annuloplasty (control group) versus
annuloplasty with subannular correction (study group) cohorts. Primary
endpoint was late reoccurrence of mitral regurgitation >=2 after surgical
mitral valve repair, as defined by follow-up echocardiography. Results The
cumulative number of 1093 patients in 12 included studies served as our
study population. A total of 743 patients underwent combined mitral valve
repair including annuloplasty and subannular manoeuvre (ie, study group),
while the remaining 350 patients underwent an isolated ring annuloplasty
(ie, control group). Secondary mitral regurgitation was caused by
ischaemic heart disease in 733/743 patients in the study group and 334/350
patients in the control group. Mean echocardiographic follow-up was
42.7+/-13.9 months. Pooled outcome analysis demonstrated that the
combination of subannular repair with ring annuloplasty was associated
with a significantly lower reoccurrence rate of mitral regurgitation >=2
as compared with annuloplasty alone (OR 0.27, 95% CI 0.19 to 0.38,
P=0.0001). Conclusion The combination of subannular reconstruction and
mitral valve annuloplasty is associated with a lower late reoccurrence of
mitral regurgitation after surgical mitral valve repair, as compared with
annuloplasty alone.<br/>Copyright &#xa9; 2018 Article author(s) (or their
employer(s) unless otherwise stated in the text of the article). All
rights reserved. No commercial use is permitted unless otherwise expressly
granted.

<5>
Accession Number
625044093
Title
Impact of dexmedetomidine infusion during general anaesthesia on incidence
of postoperative delirium in elderly patients after major non-cardiac
surgery: Study protocol of a randomised, double-blinded and
placebo-controlled trial.
Source
BMJ Open. 8 (4) (no pagination), 2018. Article Number: e019549. Date of
Publication: 01 Apr 2018.
Author
Wang B.-J.; Li C.-J.; Hu J.; Li H.-J.; Guo C.; Wang Z.-H.; Zhang Q.-C.; Mu
D.-L.; Wang D.-X.
Institution
(Wang, Li, Hu, Li, Guo, Zhang, Mu, Wang) Department of Anesthesiology and
Critical Care Medicine, Peking University First Hospital, Beijing, China
(Wang) Department of Anesthesiology, Dongping People's Hospital, Dongping,
China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Delirium is a common complication in the elderly after
surgery and is associated with worse outcomes. Multiple risk factors are
related with postoperative delirium, such as exposure to general
anaesthetics, pain and postoperative inflammatory response. Preclinical
and clinical studies have shown that dexmedetomidine attenuated
neurotoxicity induced by general anaesthetics, improved postoperative
analgesia and inhibited inflammatory response after surgery. Several
studies found that intraoperative use of dexmedetomidine can prevent
postoperative delirium, but data were inconsistent. This study was
designed to investigate the impact of dexmedetomidine administered during
general anaesthesia in preventing delirium in the elderly after major
non-cardiac surgery. Methods and analysis: This is a randomised,
double-blinded and placebo-controlled trial. 620 elderly patients (age
>=60 years) who are scheduled to undertake elective major non-cardiac
surgery (with an expected duration >=2 hours) are randomly divided into
two groups. For patients in the dexmedetomidine group, a loading dose
dexmedetomidine (0.6 mug/kg) will be administered 10 min before
anaesthesia induction, followed by a continuous infusion at a rate of 0.5
mug/kg/hour until 1 hour before the end of surgery. For patients in the
control group, normal saline will be administered with an identical rate
as in the dexmedetomidine group. The primary endpoint is the incidence of
delirium during the first five postoperative days. The secondary endpoints
include pain intensity, cumulative opioid consumption and subjective sleep
quality during the first three postoperative days, as well as the
incidence of non-delirium complications and all-cause mortality within 30
days after surgery. Ethics and dissemination: The study protocol was
approved by the Clinical Research Ethics Committee of Peking University
First Hospital (2015-987) and registered at Chinese Clinical Trial
Registry (http://www.chictr.org.cn) with identifier ChiCTR-IPR-15007654.
The results of the study will be presented at academic conferences and
submitted to peer-reviewed journals.<br/>Copyright &#xa9; 2018 Article
author(s).

<6>
Accession Number
623751668
Title
Preoperative rehabilitation in lung cancer patients: Yoga approach.
Source
Advances in Experimental Medicine and Biology. 1096 (pp 19-29), 2018. Date
of Publication: 2018.
Author
Barassi G.; Bellomo R.G.; Di Iulio A.; Lococo A.; Porreca A.; Di Felice
P.A.; Saggini R.
Institution
(Barassi, Porreca, Di Felice, Saggini) Department of Medical Oral and
Biotechnological Science, "Gabriele d'Annunzio" University,
Chieti-Pescara, Italy
(Bellomo) Department of Biomolecular Sciences, 'Carlo Bo' University,
Urbino, Italy
(Di Iulio, Lococo) Division of Thoracic Surgery, Santo Spirito Hospital of
Pescara, Pescara, Italy
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Lung cancer is one of the leading causes of cancer death worldwide.
Surgical removal remains the best option for most tumors of this type.
Reduction of cigarette consumption in patients with lung cancer candidates
for the surgery could limit the impact of tobacco on postsurgical
outcomes. Breathing exercises appear to help combat cigarette cravings.
Yoga exercise benefits have been studied in lung cancer survivors, rather
than in the preoperative setting. In this study, we have recruited 32
active smokers affected by lung cancer and being candidates for pulmonary
surgery. The patients were randomly assigned to two groups: one treated by
standard breathing and the other treated by yoga breathing (YB). The
groups were evaluated at times T0 (baseline) and T1 (after 7 days of
treatment) to compare the effects of the two breathing treatments on
pulmonary performance in a presurgery setting. Pulmonary and
cardiocirculatory functions have been tested using a self-calibrating
computerized spirometer and a portable pulse oximetry device. The findings
demonstrate appreciable short-term improvement in lung function assessed
by spirometry. We conclude that yoga breathing can be a beneficial
preoperative support for thoracic surgery.<br/>Copyright &#xa9; 2018,
Springer International Publishing AG, part of Springer Nature.

<7>
Accession Number
623585944
Title
Association of body mass index with short-term outcomes after cardiac
surgery: Retrospective study and meta-analysis.
Source
Medicina (Argentina). 78 (3) (pp 171-179), 2018. Date of Publication: June
2018.
Author
Borracci R.A.; Ingino C.A.; Miranda J.M.
Institution
(Borracci) Departamento de Cirugia Cardiaca, Hospital de Clinicas,
Facultad de Medicina, Universidad de Buenos Aires, Argentina
(Borracci, Ingino, Miranda) Departamento de Cardiologia y Cirugia
Cardiaca, ENERI-Sagrada Familia, Buenos Aires, Argentina
Publisher
Instituto de Investigaciones Medicas (E-mail: revmed@intramed.net.ar)
Abstract
The relationship between higher body mass index (BMI), decreased morbidity
and mortality is known as the "obesity paradox", and has been described in
cohorts of patients with hypertension, diabetes, heart failure, coronary
and peripheral artery diseases, non-cardiac surgery, and end-stage renal
disease. Here we investigated the relationship between BMI and short-term
outcomes after adult cardiac surgery to explore the existence of an
obesity paradoxical effect. A secondary objective was to perform an
updated systematic review to further analyze the association between BMI
and 30-day in-hospital mortality after cardiac surgery. A retrospective
analysis was performed from a consecutive series of 1823 adult patients
who underwent cardiac surgery, that were assigned to five BMI groups:
normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), class I obese
(30-34.9 kg/m2), class II obese (35-39.9 kg/m2), and class III obese or
morbidly obese (40-49.9 kg/m2). A systematic review search was performed
including controlled trials and observational studies identified in
MEDLINE, Embase, SCOPUS, and the Cochrane library (to the end of June
2017). In the present series, overweight and obese patients had similar or
slightly lower in-hospital mortality rates after cardiac surgery compared
with normal-weight individuals. Conversely, postoperative complication
rates increased with higher BMI levels. Most studies included in the
review showed that overweight and obese patients had at least the same
mortality rate as normal-weight patients, or even a lower death risk.
Pooled-data of the meta-analysis provided evidence on the association
between higher BMI levels and a lower all-cause in-hospital mortality rate
after cardiac surgery.<br/>Copyright &#xa9; 2018, Instituto de
Investigaciones Medicas. All rights reserved.

<8>
Accession Number
619209723
Title
Cerebral oximetry and postoperative delirium after cardiac surgery: a
randomised, controlled trial.
Source
Anaesthesia. 72 (12) (pp 1456-1466), 2017. Date of Publication: December
2017.
Author
Lei L.; Katznelson R.; Fedorko L.; Carroll J.; Poonawala H.; Machina M.;
Styra R.; Rao V.; Djaiani G.
Institution
(Lei, Katznelson, Fedorko, Carroll, Poonawala, Machina, Djaiani)
Departments of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
(Styra) Department of Psychiatry, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Postoperative delirium is associated with increased morbidity and
mortality. We hypothesised that restoration of regional cerebral oxygen
desaturation would reduce the incidence of postoperative delirium in
elderly patients after cardiac surgery. After institutional ethics review
board approval and informed consent, a double-blinded, prospective,
randomised, controlled trial was conducted in patients >= 60 years of age
undergoing cardiac surgery with cardiopulmonary bypass. In the
intervention group, an algorithm was commenced if regional cerebral oxygen
saturation decreased below 75% of baseline value for 1 min or longer. In
the control group, the cerebral oximetry monitor screen was electronically
blinded. Assessment of delirium was performed with confusion assessment
method for intensive care unit or confusion assessment method after
discharge from intensive care unit at 12-h intervals for seven
postoperative days. Postoperative delirium was present in 30 out of 123
(24.4%) and 31 out of 126 (24.6%) patients in the intervention and control
groups, respectively, odds ratio 0.98 (95%CI 0.55-1.76), p = 0.97.
Postoperative delirium was present in 20 (71%) out of 28 and in 41 (18%)
out of 221 patients with baseline regional cerebral oxygen saturation <=
50, or > 50%, respectively, p = 0.0001. Higher baseline regional cerebral
oxygen saturation and body mass index were protective against
postoperative delirium. Restoration of regional cerebral oxygen
desaturation did not result in lower postoperative delirium after cardiac
surgery. Pre-operative regional cerebral oxygen saturation <= 50% was
associated with increased postoperative delirium rates in elderly patients
following cardiac surgery.<br/>Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<9>
Accession Number
624425119
Title
Normothermic versus hypothermic cardiopulmonary bypass in low-risk
paediatric heart surgery: A randomised controlled trial.
Source
Heart. 105 (6) (pp 455-464), 2019. Date of Publication: 01 Mar 2019.
Author
Caputo M.; Pike K.; Baos S.; Sheehan K.; Selway K.; Ellis L.; Stoica S.;
Parry A.; Clayton G.; Culliford L.; Angelini G.D.; Pandey R.; Rogers C.A.
Institution
(Caputo, Sheehan, Selway, Stoica, Parry, Pandey) Bristol Royal Hospital
for Children, University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Pike, Baos, Ellis, Clayton, Culliford, Rogers) Clinical Trials and
Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol,
United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To compare normothermic (35degreeC-36degreeC) versus hypothermic
(28degreeC) cardiopulmonary bypass (CPB) in paediatric patients undergoing
open heart surgery to test the hypothesis that normothermic CPB perfusion
maintains the functional integrity of major organ systems leading to
faster recovery. Methods Two single-centre, randomised controlled trials
(known as Thermic-1 and Thermic-2, respectively) were carried out to
compare the effectiveness and acceptability of normothermic versus
hypothermic CPB in children with congenital heart disease undergoing open
heart surgery. In both studies, the co-primary clinical outcomes were
duration of inotropic support, intubation time and postoperative hospital
stay. Results In total, 200 participants were recruited; 59 to the
Thermic-1 study and 141 to the Thermic-2 study. 98 patients received
normothermic CPB and 102 patients received hypothermic CPB. There were no
significant differences between the treatment groups for any of the
co-primary outcomes: Inotrope duration HR=1.01, 95% CI (0.72 to 1.41);
intubation time HR=1.14, 95% CI (0.86 to 1.51); postoperative hospital
stay HR=1.06, 95% CI (0.80 to 1.40). Differences favouring normothermia
were found in urea nitrogen at 2 days geometric mean ratio (GMR)=0.86 95%
CI (0.77 to 0.97); serum creatinine at 3 days GMR=0.89, 95% CI (0.81 to
0.98); urinary albumin at 48 hours GMR=0.32, 95% CI (0.14 to 0.74) and
neutrophil gelatinase-associated lipocalin at 4 hours GMR=0.47, 95% CI
(0.22 to 1.02), but not at other postoperative time points. Conclusions
Normothermic CPB is as safe and effective as hypothermic CPB and can be
routinely adopted as a perfusion strategy in low-risk infants and children
undergoing open heart surgery. Trial registration number
ISRCTN93129502.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019.

<10>
Accession Number
626579137
Title
Fibrinogen concentrate vs. cryoprecipitate for acquired hypofibrinogenemia
in cardiac surgery ? the FIBRES study.
Source
Blood. Conference: 60th Annual Meeting of the American Society of
Hematology, ASH 2018. United States. 132 (Suppl. 1) (no pagination), 2018.
Date of Publication: November 2018.
Author
Carroll J.; Karkouti K.
Institution
(Carroll) Toronto General Hospital, Toronto, Canada
(Karkouti) University Health Network, Toronto General Hospital, Toronto,
Canada
Publisher
American Society of Hematology
Abstract
Introduction: Cardiac surgery involving cardiopulmonary bypass (CPB) is
associated with coagulopathy and excessive bleeding. This often requires
the transfusion of large volumes of allogeneic blood products and is
linked to an increased risk of adverse outcomes. A primary cause of
coagulopathy is acquired hypofibrinogenemia; when fibrinogen levels drop
below 1.5-2 mg/L, fibrinogen supplementation is required to maintain
hemostasis. The FIBrinogen REplenishment in Surgery (FIBRES) study aims to
compare the standard intervention, cryoprecipitate, with a new highly
purified, double virus-inactivated human fibrinogen concentrate.
<br/>Method(s): The FIBRES study (NCT03037424) is a pragmatic,
multicenter, active-control, randomized, single-blinded, non-inferiority
phase 3 trial in adult patients undergoing cardiac surgery with CPB. The
study will enroll patients with clinically significant bleeding associated
with acquired hypofibrinogenemia. Patients for whom fibrinogen
supplementation is ordered within 24 hours of surgery will be randomized
to receive fibrinogen concentrate (4 g; Fibryga; Octapharma) or
cryoprecipitate (10 units; dose equivalent to 4 g fibrinogen concentrate)
(Figure 1). All randomized patients will receive fibrinogen
supplementation as clinically indicated. Owing to the emergency nature of
the clinical setting, patient consent at the point of randomization will
be waived, with written informed consent obtained within 24-48 hours
thereafter. The primary outcome is total allogeneic blood products (red
blood cells, plasma, platelets) administered within the first 24 hours of
surgery. Secondary outcomes include blood product use within 7 days,
incidence of major bleeding within 24 hours, fibrinogen levels, and
adverse events (AEs) and serious AEs within 28 days. Enrolment of 1,200
patients will provide >90% power to demonstrate non-inferiority, assuming
a 20% non-inferiority margin, >=550 patients per group, and an approximate
10% drop-out rate. One pre-planned interim analysis will be conducted
after data are available for 600 evaluable patients with the option to
stop early for futility or overwhelming efficacy. The pragmatic design and
treatment algorithm align with standard practice, aiding adherence and
generalizability. <br/>Result(s): To date, 530 patients have been treated
across 11 sites. An IDMEAC review of safety has been performed every 100
patients enrolled, with the recommendation to continue as planned each
time. The study is expected to complete in late 2018, with results
available in early 2019. <br/>Conclusion(s): The FIBRES study is the
largest randomized study to date of fibrinogen concentrate versus
cryoprecipitate in adult cardiac surgical patients, an under-studied yet
high-risk population. Non-inferiority of the new fibrinogen concentrate
would support its use for patients developing acquired hypofibrinogenemia
during cardiac surgery. Results from the FIBRES study are likely to
improve care for cardiac surgical patients experiencing significant
bleeding. (Figure Presented) .

<11>
Accession Number
619127124
Title
A systematic review of the incidence of and risk factors for postoperative
atrial fibrillation following general surgery.
Source
Anaesthesia. 73 (4) (pp 490-498), 2018. Date of Publication: April 2018.
Author
Chebbout R.; Heywood E.G.; Drake T.M.; Wild J.R.L.; Lee J.; Wilson M.; Lee
M.J.
Institution
(Chebbout) Department of General Surgery, Wishaw General Hospital, Wishaw,
United Kingdom
(Heywood) Department of General Surgery, University of Edinburgh, United
Kingdom
(Drake) Department of Clinical Surgery, University of Edinburgh, United
Kingdom
(Wild) Leeds Teaching Hospitals NHS FT, FT, Leeds, United Kingdom
(Lee) Department of Cardiology, Sheffield Teaching Hospitals NHS FT,
Sheffield, United Kingdom
(Wilson) School of Health and Related Research (ScHARR) University of
Sheffield, Sheffield, United Kingdom
(Lee) Department of General Surgery, Sheffield Teaching Hospitals,
Sheffield, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Atrial fibrillation is a common cardiac arrhythmia and can occur de novo
following a surgical procedure. It is associated with increased inpatient
and long-term mortality. There is limited evidence concerning new-onset
atrial fibrillation following abdominal surgery. This study aimed to
identify the prevalence of and risk factors for postoperative atrial
fibrillation in the general surgical population. A systematic search of
the Embase, MEDLINE and Cochrane (CENTRAL) databases was conducted.
Studies were included in the review if they reported cases of new-onset
atrial fibrillation within 30 days of the index operation. Results were
evaluated qualitatively due to substantial clinical heterogeneity.
Incidence rates were pooled using a weighted random-effects meta-analysis
model. A total of 835 records were initially identified, from which 32
full texts were retrieved. Following review, 13 studies were included that
involved 52,959 patients, of whom 10.94% (95%CI 7.22-15.33) developed
atrial fibrillation. Five studies of patients undergoing oesophagectomy (n
= 376/1923) had a weighted average rate of 17.66% (95%CI 12.16-21.47),
compared with 7.63% (95%CI 4.39-11.98) from eight studies of
non-oesophageal surgery (n = 2927/51,036). Identified risk factors
included: increasing age; history of cardiac disease; postoperative
complications, particularly, sepsis, pneumonia and pleural effusions.
New-onset postoperative atrial fibrillation is common, and is more
frequent after surgery involving the thorax. Future work should focus on
stratifying risk to allow targeted prophylaxis of atrial fibrillation and
other peri-operative complications.<br/>Copyright &#xa9; 2017 The
Association of Anaesthetists of Great Britain and Ireland

<12>
Accession Number
620683244
Title
A Randomized Trial Comparing the NeoVas Sirolimus-Eluting Bioresorbable
Scaffold and Metallic Everolimus-Eluting Stents.
Source
JACC: Cardiovascular Interventions. 11 (3) (pp 260-272), 2018. Date of
Publication: 12 Feb 2018.
Author
Han Y.; Xu B.; Fu G.; Wang X.; Xu K.; Jin C.; Tao L.; Li L.; Hou Y.; Su
X.; Fang Q.; Chen L.; Liu H.; Wang B.; Yuan Z.; Gao C.; Zhou S.; Sun Z.;
Zhao Y.; Guan C.; Stone G.W.
Institution
(Han, Wang, Xu) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Xu, Sun, Zhao, Guan) Catheter Lab, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing,
China
(Fu, Jin) Department of Cardiology, Sir Run Run Shaw Hospital, Hangzhou,
China
(Tao) Department of Cardiology, Xijing Hospital, The Fourth Military
Medical University, Xi'an, China
(Li) Department of Cardiology, The First Affiliated Hospital of Guangxi
Medical University, Nanning, China
(Hou) Department of Cardiology, Nanfang Hospital, Guangzhou, China
(Su) Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
(Fang) Department of Cardiology, Peking Union Medical College Hospital,
Beijing, China
(Chen) Department of Cardiology, Fujian Medical University Union Hospital,
Fuzhou, China
(Liu) Department of Cardiology, General Hospital of Chinese People's Armed
Police Forces, Beijing, China
(Wang) Department of Cardiology, Aero Space Center Hospital, Beijing,
China
(Yuan) Department of Cardiology, The First Affiliated Hospital of Xi'an
Jiongtong University, Xi'an, China
(Gao) Department of Cardiology, Henan Provincial People's Hospital,
Zhengzhou, China
(Zhou) Department of Cardiology, The Second Xiangya Hospital of Central
South University, Changsha, China
(Stone) Center for Interventional Vascular Therapy, Division of
Cardiology, Presbyterian Hospital and Columbia University, New York, New
York, United States
(Stone) Cardiovascular Research Foundation, New York, New York, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to evaluate the safety and effectiveness of
the NeoVas bioresorbable scaffold (BRS) compared with metallic
drug-eluting stents. <br/>Background(s): BRS have the potential to improve
very late outcomes compared with metallic drug-eluting stents, but some
BRS have been associated with increased rates of device thrombosis before
complete bioresorption. NeoVas is a new poly-L-lactic acid BRS that elutes
sirolimus from a poly-D, L-lactide coating. <br/>Method(s): Eligible
patients with a single de novo native coronary artery lesion with a
reference vessel diameter 2.5 to 3.75 mm and a lesion length <=20 mm were
randomized 1:1 to NeoVas BRS versus cobalt-chromium everolimus-eluting
stents (CoCr-EES). Angiographic follow-up was performed in all patients at
1 year. The primary endpoint was angiographic in-segment late loss (LL),
and the major secondary endpoint was the rate of angina. Baseline and
follow-up optical coherence tomography and fractional flow reserve were
performed in a pre-specified subgroup of patients. <br/>Result(s): The
authors randomized 560 patients at 32 centers to treatment with NeoVas (n
= 278) versus CoCr-EES (n = 282). One-year in-segment LL with NeoVas and
CoCr-EES were 0.14 +/- 0.36 mm versus 0.11 +/- 0.34 mm (difference 0.03
mm; upper 1-sided 97.5% confidence interval 0.09 mm;
p<inf>noninferiority</inf> < 0.0001; p<inf>superiority</inf> = 0.36).
Clinical outcomes at 1 year were similar in the 2 groups, as were the
rates of recurrent angina (27.9% vs. 32.1%; p = 0.26). Optical coherence
tomography at 1 year demonstrated a higher proportion of covered struts
(98.7% vs. 96.2%; p < 0.001), less strut malapposition (0% vs. 0.6%; p
<0.001), and a smaller minimal lumen area (4.71 +/- 1.64 vs. 6.00 +/- 2.15
mm²; p < 0.001) with NeoVas compared with CoCr-EES
respectively, with nonsignificant differences in fractional flow reserve
(0.89 +/- 0.08 vs. 0.91 +/- 0.06; p = 0.07). <br/>Conclusion(s): The
NeoVas BRS was noninferior to CoCr-EES for the primary endpoint of 1-year
angiographic in-segment LL, and resulted in comparable 1-year clinical
outcomes, including recurrent angina. (NeoVas Bioresorbable Coronary
Scaffold Randomized Controlled Trial; NCT02305485)<br/>Copyright &#xa9;
2018

<13>
Accession Number
625462429
Title
High-sensitivity troponin T is a prognostic marker of hemodynamic
instability in patients undergoing valve surgery.
Source
Biomarkers in Medicine. 12 (12) (pp 1303-1309), 2018. Date of Publication:
December 2018.
Author
Duchnowski P.; Hryniewiecki T.; Kozma M.; Mariusz K.; Piotr S.
Institution
(Duchnowski, Hryniewiecki, Kozma, Piotr) Department of Acquired Cardiac
Defects, Institute of Cardiology, Warsaw, Poland
(Mariusz) Department of Cardiosurgery and Transplantology, Institute of
Cardiology, Warsaw, Poland
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor
of perioperative hemodynamic instability is currently unknown.
<br/>Method(s): A prospective study was conducted on a group of 708
consecutive patients with significant valvular heart disease that
underwent elective valve surgery. The primary end point was postoperative
hemodynamic instability. The secondary end point was death from all causes
in patients with perioperative hemodynamic instability. <br/>Result(s):
The postoperative hemodynamic instability occurred in 131 patients. At
multivariate analysis hs-TnT measured immediately after surgery and New
York Heart Association classes remained independent predictors of the
primary end point. Age and hs-TnT measured immediately after surgery were
associated with an increased risk of death. <br/>Conclusion(s): Elevated
postoperative hs-TnT was associated with a higher risk of postoperative
hemodynamic instability and death.<br/>Copyright &#xa9; 2018 2018 Future
Medicine Ltd.

<14>
Accession Number
620079079
Title
Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in
Patients With Acute Coronary Syndromes Undergoing Invasive Management:
Data From the Randomized MATRIX-Access Trial.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 36-50), 2018. Date of
Publication: 08 Jan 2018.
Author
Gargiulo G.; Ariotti S.; Vranckx P.; Leonardi S.; Frigoli E.; Ciociano N.;
Tumscitz C.; Tomassini F.; Calabro P.; Garducci S.; Crimi G.; Ando G.;
Ferrario M.; Limbruno U.; Cortese B.; Sganzerla P.; Lupi A.; Russo F.;
Garbo R.; Ausiello A.; Zavalloni D.; Sardella G.; Esposito G.; Santarelli
A.; Tresoldi S.; Nazzaro M.S.; Zingarelli A.; Petronio A.S.; Windecker S.;
da Costa B.R.; Valgimigli M.
Institution
(Gargiulo, Ariotti, Frigoli, Windecker, da Costa, Valgimigli) Department
of Cardiology, Bern University Hospital, Bern, Switzerland
(Gargiulo, Esposito) Department of Advanced Biomedical Sciences, Federico
II University of Naples, Naples, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Leonardi, Crimi, Ferrario) UOC Cardiologia, Dipartimento
CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
(Ciociano) EUSTRATEGY Association, Forli, Italy
(Tumscitz) Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara,
Cona, Italy
(Tomassini) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Calabro) Division of Cardiology, Department of Cardiothoracic Sciences,
University of Campania "Luigi Vanvitelli," Naples, Italy
(Garducci) Struttura complessa di Cardiologia ASST di Vimercate, Desio,
Italy
(Crimi) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino, "
University of Messina, Messina, Italy
(Limbruno) UO Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
(Cortese) ASST Fatebenefratelli-Sacco, Milan, Italy
(Cortese) Fondazione Toscana Gabriele Monasterio, Pisa, Italy
(Sganzerla) ASST Bergamo Ovest, Ospedale di Treviglio, Bergamo, Italy
(Lupi) Cardiology Unit, University Hospital "Maggiore della Carita,"
Novara, Italy
(Russo) Cardiovascular Interventional Unit, Cardiology Department, S.Anna
Hospital, Como, Italy
(Garbo) Interventional Cardiology Unit, Ospedale San Giovanni Bosco,
Turin, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Zavalloni) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Sardella) Department of Cardiovascular, Respiratory, Nephrologic,
Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza"
University of Rome, Rome, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Tresoldi) Cardiology Unit, A.O. Ospedale di Desio, Desio, Italy
(Nazzaro) Interventional Cardiology Unit, San Camillo-Forlanini, Rome,
Italy
(Zingarelli) Interventional Cardiology Unit, IRCCS AOU San Martino, Genoa,
Italy
(Petronio) Catheterisation Laboratory, Cardiothoracic and Vascular
Department, University of Pisa, Pisa, Italy
(da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to assess whether transradial access (TRA)
compared with transfemoral access (TFA) is associated with consistent
outcomes in male and female patients with acute coronary syndrome
undergoing invasive management. Background There are limited and
contrasting data about sex disparities for the safety and efficacy of TRA
versus TFA for coronary intervention. Methods In the MATRIX (Minimizing
Adverse Haemorrhagic Events by TRansradial Access Site and Systemic
Implementation of angioX) program, 8,404 patients were randomized to TRA
or TFA. The 30-day coprimary outcomes were major adverse cardiovascular
and cerebrovascular events (MACCE), defined as death, myocardial
infarction, or stroke, and net adverse clinical events (NACE), defined as
MACCE or major bleeding. Results Among 8,404 patients, 2,232 (26.6%) were
women and 6,172 (73.4%) were men. MACCE and NACE were not significantly
different between men and women after adjustment, but women had higher
risk of access site bleeding (male vs. female rate ratio [RR]: 0.64; p =
0.0016), severe bleeding (RR: 0.17; p = 0.0012), and transfusion (RR:
0.56; p = 0.0089). When comparing radial versus femoral, there was no
significant interaction for MACCE and NACE stratified by sex
(p<inf>int</inf> = 0.15 and 0.18, respectively), although for both
coprimary endpoints the benefit with TRA was relatively greater in women
(RR: 0.73; p = 0.019; and RR: 0.73; p = 0.012, respectively). Similarly,
there was no significant interaction between male and female patients for
the individual endpoints of all-cause death (p<inf>int</inf> = 0.79),
myocardial infarction (p<inf>int</inf> = 0.25), stroke (p<inf>int</inf> =
0.18), and Bleeding Academic Research Consortium type 3 or 5
(p<inf>int</inf> = 0.45). Conclusions Women showed a higher risk of severe
bleeding and access site complications, and radial access was an effective
method to reduce these complications as well as composite ischemic and
ischemic or bleeding endpoints.<br/>Copyright &#xa9; 2018 American College
of Cardiology Foundation

<15>
[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.

<16>
[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.

<17>
Accession Number
618863087
Title
Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women
Compared With Men: Evidence From a Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 24-35), 2018. Date of
Publication: 08 Jan 2018.
Author
Saad M.; Nairooz R.; Pothineni N.V.K.; Almomani A.; Kovelamudi S.; Sardar
P.; Katz M.; Abdel-Wahab M.; Bangalore S.; Kleiman N.S.; Block P.C.;
Abbott J.D.
Institution
(Saad, Pothineni, Almomani, Kovelamudi) Division of Cardiovascular
Medicine, University of Arkansas for Medical Sciences, Little Rock,
Arkansas, United States
(Nairooz) Division of Cardiology, University of Southern California, Los
Angeles, California, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, Utah, United States
(Katz) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Abdel-Wahab) Heart Center, Segeberger Kliniken (Academic Teaching
Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg,
Germany
(Bangalore) Division of Cardiovascular Medicine, New York University
School of Medicine, New York, New York, United States
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, Houston
Methodist Hospital, Houston, Texas, United States
(Block) Division of Cardiovascular Medicine, Emory University School of
Medicine, Atlanta, Georgia
(Abbott) Division of Cardiovascular Medicine, Warren Alpert School of
Medicine at Brown University, Providence, Rhode Island, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to examine long-term outcomes with
transcatheter aortic valve replacement (TAVR) in women versus men.
Background TAVR is commonly performed in women. Previous studies have
shown conflicting results with respect to sex differences in outcomes with
TAVR. In addition, short-term outcomes have primarily been reported.
Methods Electronic search was performed until March 2017 for studies
reporting outcomes with TAVR in women versus men. Random effects
DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause
mortality and major cardiovascular events at short- (30 days) and
long-term (>1 year) follow-up. Results Seventeen studies (8 TAVR
registries; 47,188 patients; 49.4% women) were analyzed. Women were older
but exhibited fewer comorbidities. At 30 days, women had more bleeding (p
< 0.001), vascular complications (p < 0.001), and stroke/transient
ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or
cardiovascular mortality (p = 0.91) compared with men. However, female sex
was associated with lower all-cause mortality at 1 year (risk ratio: 0.85;
95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available
follow-up (mean 3.28 +/- 1.04 years; risk ratio: 0.86; 95% confidence
interval: 0.81 to 0.92; p < 0.001), potentially caused by less
moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular
mortality (p = 0.009). The female survival advantage remained consistent
across multiple secondary analyses. The risk of stroke, moderate/severe
aortic insufficiency, and all-cause mortality seemed to vary based on the
type of valve used; however, without significant subgroup interactions.
Conclusions Despite a higher upfront risk of complications, women derive a
better long-term survival after TAVR compared with men.<br/>Copyright
&#xa9; 2018 American College of Cardiology Foundation

<18>
Accession Number
619847431
Title
Pilot multi-centre randomised trial of the impact of pre-operative focused
cardiac ultrasound on mortality and morbidity in patients having surgery
for femoral neck fractures (ECHONOF-2 pilot).
Source
Anaesthesia. 73 (4) (pp 428-437), 2018. Date of Publication: April 2018.
Author
Canty D.J.; Heiberg J.; Yang Y.; Royse A.G.; Margale S.; Nanjappa N.;
Scott D.; Maier A.; Sessler D.I.; Chuan A.; Palmer A.; Bucknill A.; French
C.; Royse C.F.
Institution
(Canty, Yang, Royse, Bucknill) Department of Surgery, University of
Melbourne, Australia
(Canty) Royal Melbourne and Monash Hospitals, Melbourne, Australia
(Heiberg, Royse) Department of Anesthesia and Pain Management, Royal
Melbourne Hospital, Melbourne, Australia
(Heiberg) Department of Anesthesia and Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
(Yang, French, Royse) Department of Intensive Care, Western Health,
Melbourne, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Australia
(Margale) Northside Clinical School, University of Queensland, Brisbane,
Australia
(Margale) Department of Anaesthesia and Perfusion services, Prince Charles
Hospital, Brisbane, Australia
(Nanjappa) University of Adelaide, Australia
(Nanjappa) Queen Elizabeth Hospital, Adelaide, Australia
(Scott) School of Medicine, University of Melbourne, Australia
(Scott) St. Vincent's Hospital Melbourne, Australia
(Maier) Department of Medicine and Aged Care, Royal Melbourne Hospital,
University of Melbourne, Australia
(Maier) Department of Human Movement Sciences, MOVE Research Institute
Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
(Sessler) Anesthesiology Institute, Cleveland Clinic, Cleveland, OH,
United States
(Chuan) University of New South Wales, Sydney, Australia
(Chuan) Liverpool Hospital, Sydney, Australia
(Palmer) Health Economics Research Unit, Menzies Institute for Medical
Research, University of Tasmania, Hobart, Australia
(Bucknill) Royal Melbourne Hospital, Melbourne, Australia
Publisher
Blackwell Publishing Ltd
Abstract
Hip fracture surgery is common, usually occurs in elderly patients who
have multiple comorbidities, and is associated with high morbidity and
mortality. Pre-operative focused cardiac ultrasound can alter diagnosis
and management, but its impact on outcome remains uncertain. This pilot
study assessed feasibility and group separation for a proposed large
randomised clinical trial of the impact of pre-operative focused cardiac
ultrasound on patient outcome after hip fracture surgery. Adult patients
requiring hip fracture surgery in four teaching hospitals in Australia
were randomly allocated to receive focused cardiac ultrasound before
surgery or not. The primary composite outcome was any death, acute kidney
injury, non-fatal myocardial infarction, cerebrovascular accident,
pulmonary embolism or cardiopulmonary arrest within 30 days of surgery. Of
the 175 patients screened, 100 were included as trial participants
(screening:recruitment ratio 1.7:1), 49 in the ultrasound group and 51 as
controls. There was one protocol failure among those recruited. The
primary composite outcome occurred in seven of the ultrasound group
patients and 12 of the control group patients (relative group separation
39%). Death, acute kidney injury and cerebrovascular accident were
recorded, but no cases of myocardial infarction, pulmonary embolism or
cardiopulmonary arrest ocurred. Focused cardiac ultrasound altered the
management of 17 participants, suggesting an effect mechanism. This pilot
study demonstrated that enrolment and the protocol are feasible, that the
primary composite outcome is appropriate, and that there is a treatment
effect favouring focused cardiac ultrasound - and therefore supports a
large randomised clinical trial.<br/>Copyright &#xa9; 2017 The Association
of Anaesthetists of Great Britain and Ireland

<19>
Accession Number
619331991
Title
Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary
Angiography-Guided Percutaneous Coronary Intervention With Stent
Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31
Studies and 17,882 Patients.
Source
JACC: Cardiovascular Interventions. 10 (24) (pp 2488-2498), 2017. Date of
Publication: 26 Dec 2017.
Author
Buccheri S.; Franchina G.; Romano S.; Puglisi S.; Venuti G.; D'Arrigo P.;
Francaviglia B.; Scalia M.; Condorelli A.; Barbanti M.; Capranzano P.;
Tamburino C.; Capodanno D.
Institution
(Buccheri, Franchina, Romano, Puglisi, Venuti, D'Arrigo, Francaviglia,
Scalia, Condorelli, Barbanti, Capranzano, Tamburino, Capodanno) Division
of Cardiology, Cardio-Thoracic-Vascular Department, Azienda
Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of
Catania, Catania, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to explore the comparative clinical efficacy
of different imaging modalities for guiding percutaneous coronary
interventions (PCI). Background Coronary angiography (CA) is the standard
imaging modality for intraprocedural guidance of PCI. Intracoronary
imaging techniques, including intravascular ultrasound (IVUS) and optical
coherence tomography (OCT), can overcome some limitations of CA. Methods
Comprehensive hierarchical Bayesian network meta-analysis of randomized
clinical trials and adjusted observational studies comparing clinical
outcomes of PCI with stent implantation guided by CA, IVUS, or OCT.
Results A total of 31 studies encompassing 17,882 patients were included.
Compared with CA guidance, the risks of all-cause death (odds ratio [OR]:
0.74; 95% credible interval [CrI]: 0.58 to 0.98), myocardial infarction
(OR: 0.72; 95% CrI: 0.52 to 0.93), target lesion revascularization (OR:
0.74, 95% CrI: 0.58 to 0.90) and stent thrombosis (OR: 0.42; 95% CrI: 0.20
to 0.72) were significantly reduced by IVUS guidance. PCI guidance using
either IVUS or OCT was associated with a significant reduction of major
adverse cardiovascular events (OR: 0.79; 95% CrI: 0.67 to 0.91 and OR:
0.68; 95% CrI: 0.49 to 0.97, respectively) and cardiovascular death (OR:
0.47; 95% CrI: 0.32 to 0.66 and OR: 0.31; 95% CrI: 0.13 to 0.66,
respectively). No differences in terms of comparative clinical efficacy
were found between IVUS and OCT for all the investigated outcomes. Pooled
estimates were consistent across several sensitivity analyses. However,
the treatment effect of IVUS on all-cause death was neutralized in the
analysis restricted to randomized clinical trials (OR: 1.03; 95% CrI: 0.41
to 2.14). Conclusions Compared with CA, the use of intravascular imaging
techniques for PCI guidance reduces the risk of cardiovascular death and
adverse events.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<20>
Accession Number
620078857
Title
Benefit of Switching Dual Antiplatelet Therapy After Acute Coronary
Syndrome According to On-Treatment Platelet Reactivity: The TOPIC-VASP
Pre-Specified Analysis of the TOPIC Randomized Study.
Source
JACC: Cardiovascular Interventions. 10 (24) (pp 2560-2570), 2017. Date of
Publication: 26 Dec 2017.
Author
Deharo P.; Quilici J.; Camoin-Jau L.; Johnson T.W.; Bassez C.; Bonnet G.;
Fernandez M.; Ibrahim M.; Suchon P.; Verdier V.; Fourcade L.; Morange
P.E.; Bonnet J.L.; Alessi M.C.; Cuisset T.
Institution
(Deharo, Bassez, Bonnet, Bonnet, Cuisset) Departement de Cardiologie, CHU
Timone, Marseille, France
(Deharo, Morange, Bonnet, Alessi, Cuisset) "Nutrition, Obesity and Risk of
Thrombosis," UMR1062, INSERM, Marseille, France
(Deharo, Bassez, Bonnet, Ibrahim, Suchon, Morange, Bonnet, Alessi,
Cuisset) Faculte de Medecine, Aix-Marseille Universite, Marseille, France
(Quilici, Fernandez) Departement de Cardiologie, Centre Hospitalier de
GAP, France
(Camoin-Jau, Morange, Alessi) Laboratoire d'Hematologie, CHU Timone,
Marseille, France
(Johnson) Interventional Cardiology Department, Bristol Heart Institute,
Bristol, United Kingdom
(Ibrahim, Fourcade) Cardiologie, Hopital Laveran, Marseille, France
(Suchon, Verdier) Research Unit, asistance publique des hopitaux de
Marseille, Unite Medicale des Maladies Auto-Inflammatoires, Marseille,
France
(Morange, Alessi) Department of Hematology, CHU Timone, asistance publique
des hopitaux de Marseille, Marseille, France
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate the impact of initial platelet
reactivity on the benefit of switched strategy. Background TOPIC (Timing
Of Platelet Inhibition after acute Coronary Syndrome) study suggested that
switched dual antiplatelet therapy (DAPT) could improve net clinical
benefit after acute coronary syndrome by preventing bleeding. Methods
Acute coronary syndrome patients, 1 month after coronary stenting and
event free, were randomly assigned to aspirin and clopidogrel (switched
DAPT) or continuation of drug regimen (unchanged DAPT). All patients
underwent platelet function testing at this time and were classified as
low on-treatment platelet reactivity (LTPR) (platelet reactivity index
vasodilator-stimulated phosphoprotein <=20%) or non-LTPR (platelet
reactivity index vasodilator-stimulated phosphoprotein >20%). The primary
endpoint aimed to evaluate the impact of platelet reactivity on clinical
outcomes and benefit of switched DAPT strategy. Results A total of 645
patients were included, 305 (47%) of whom were classified as LTPR. LTPR
patients were less often diabetic (p = 0.01), had lower body mass index (p
< 0.01), and were more often on ticagrelor (p < 0.01). Patients defined as
LTPR and randomized to unchanged DAPT were at the highest risk of primary
endpoint occurrence (31%; p < 0.01). Conversely, in the switched arm, LTPR
patients had no significant difference in primary outcome incidence
compared with non-LTPR patients (hazard ratio [HR]: 0.78; 95% confidence
interval [CI]: 0.40 to 1.49; p = 0.45). The switched strategy was
associated with important reduction in primary endpoint incidence in LTPR
patients (HR: 0.29; 95% CI: 0.17 to 0.51; p < 0.01) and only numerically
lower incidence in non-LTPR patients (HR: 0.79; 95% CI: 0.46 to 1.35; p =
0.39). Conclusions Switched DAPT was superior regardless of initial
platelet reactivity but the benefit was greater in LTPR patients. Indeed,
the switched strategy was highly effective in this group, which had
impaired prognosis with unchanged DAPT but similar prognosis after
switching.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<21>
Accession Number
618505139
Title
Safety of parecoxib when used for more than 3 days for the management of
postoperative pain.
Source
Pain Management. 7 (5) (pp 383-389), 2017. Date of Publication: September
2017.
Author
Essex M.N.; Cheung R.; Li C.; Xie L.
Institution
(Essex, Cheung) Global Medical Affairs Pfizer Inc., 235 East 42nd St, New
York, NY 10017, United States
(Li) Biostatistics and Analysis Pfizer Inc., 1 Giralda Farms, Madison, NJ
07940, United States
(Xie) China Medical Affairs, Pfizer Investment Co. Ltd, 3-7 Chaoyangmen
North Avenue Dongcheng District, Beijing 100010, China
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: To assess parecoxib safety when used for >3 days for postoperative
pain management. <br/>Method(s): Treatment-emergent adverse event (TEAE)
occurrence after day 3 was examined in a pooled analysis of three
placebo-controlled trials of parecoxib following general or gynecologic
surgery, or total hip arthroplasty. A total of 358 patients received
parecoxib, and 318 placebo. <br/>Result(s): Mean treatment duration was
similar between treatment groups. The overall frequency of all TEAEs after
day 3 was also similar between treatment groups. Most TEAEs occurred in
<1% of patients after day 3; frequencies were similar between treatment
groups. Most TEAEs were considered mild or moderate in severity.
<br/>Conclusion(s): TEAE occurrence in patients receiving parecoxib for >3
days was low and similar to placebo after treatment day 3.<br/>Copyright
&#xa9; 2017 Future Medicine Ltd.

<22>
Accession Number
617433519
Title
Evaluation of flow after transcatheter aortic valve replacement in
patients with low-flow aortic stenosis: A secondary analysis of the
PARTNER randomized clinical trial.
Source
JAMA Cardiology. 1 (5) (pp 584-592), 2016. Date of Publication: August
2016.
Author
Anjan V.Y.; Herrmann H.C.; Pibarot P.; Stewart W.J.; Kapadia S.; Tuzcu
E.M.; Babaliaros V.; Thourani V.H.; Szeto W.Y.; Bavaria J.E.; Kodali S.;
Hahn R.T.; Williams M.; Miller D.C.; Douglas P.S.; Leon M.B.
Institution
(Anjan, Herrmann) Cardiovascular Division, Hospital of the University of
Pennsylvania, 9038 Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104,
United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
(Stewart, Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Babaliaros) Department of Medicine, Emory University, Atlanta, GA, United
States
(Thourani) Department of Surgery, Emory University, Atlanta, GA, United
States
(Szeto, Bavaria) Division of Cardiothoracic Surgery, University of
Pennsylvania, Philadelphia, PA, United States
(Kodali, Hahn, Leon) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Williams) Division of Cardiac Surgery, New York University Langone
Medical Center, New York, NY, United States
(Miller) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
(Douglas) Department of Medicine, Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent
predictor of mortality in patients undergoing aortic valve replacement
(AVR). Little is known about improvement in flow after AVR and its effects
on survival. <br/>Objective(s): To determine whether higher flow
(left-ventricular stroke volume index [LVSVI]) after transcatheter AVR
(TAVR) would indicate better clinical outcomes in this at-risk population.
<br/>Design, Setting, and Participant(s): A substudy analysis of data from
the Placement of Aortic Transcatheter Valves (PARTNER) randomized clinical
trial and continued-access registry was conducted. A total of 984
participants with evaluable echocardiograms and baseline LF AS (LVSVI<=35
mL/m²) were included. The trial was conducted at 26 sites in
the United States and Canada. Patients were stratified after TAVR into
tertiles by discharge LVSVI status (severe low flow [SLF], moderate low
flow [MLF], and normal flow [(NF]). The present study was conducted from
May 11, 2007, to January 9, 2012, with data analysis performed from April
25, 2014, to January 21, 2016. <br/>Main Outcomes and Measures: The
primary end pointwas all-cause mortality at 1 year. <br/>Result(s):
Baseline characteristics of 984 patients with LF AS included mean (SD)
age, 84 (7) years; 582 (59.1%) men; mean Society of Thoracic Surgeons
(STS) score, 11.4%(4.0%); and mean LVSVI, 27.6 (5.0) mL/m². The
discharge LVSVI values by group were SLF, 23.1 (3.5) mL/m²;
MLF, 31.7 (2.2) mL/m²; and NF, 43.1 (7.0). All-cause mortality
at 1 year was SLF, 26.5%; MLF, 20.1%; and NF, 19.6%(P = .045). Mean LVSVI
normalized by 6 months in the MLF (35.9 [9.3] mL/m²) and NF
(38.8 [11.1] mL/m²) groups, but remained low in the SLF group
at 6 months and 1 year (31.4 [8.4] and 33.0 [8.3] mL/m²],
respectively) (P < .001 for all groups). Reported as multivariate hazard
ratio, mortality at 1 year was higher in the SLF group compared with the
other groups (1.61; 95%CI, 1.17-2.23; P = .004). In addition to SLF, sex
(1.59; 95%CI, 1.18-2.13; P = .002), presence of atrial fibrillation (1.41;
95%CI, 1.06-1.87; P = .02), STS score (1.03; 95%CI, 1.01-1.06; P = .02),
presence of moderate or severe mitral regurgitation at discharge (1.65;
95%CI, 1.21-2.26; P = .001), pre-TAVR mean transvalvular gradient (0.98;
95%CI, 0.97-0.99; P = .004), and effective orifice area index (1.87;
95%CI, 1.09-3.19; P = .02) were independent predictors of 1-year
mortality. <br/>Conclusions and Relevance: Severe LF at discharge is
associated with an increased risk of mortality following TAVR in patients
with severe AS and preexisting LF. The identification of remedial causes
of persistent LF after TAVR may represent an opportunity to improve the
outcome of these patients.<br/>Copyright &#xa9; 2016 American Medical
Association. All rights reserved.

<23>
Accession Number
2001626817
Title
The Effect of Cardiac Rehabilitation on Health-Related Quality of Life in
Patients With Coronary Artery Disease: A Meta-analysis.
Source
Canadian Journal of Cardiology. 35 (3) (pp 352-364), 2019. Date of
Publication: March 2019.
Author
Francis T.; Kabboul N.; Rac V.; Mitsakakis N.; Pechlivanoglou P.; Bielecki
J.; Alter D.; Krahn M.
Institution
(Francis, Kabboul, Rac, Mitsakakis, Bielecki, Krahn) Toronto Health
Economics and Technology Assessment (THETA) Collaborative, Toronto General
Hospital Research Institute, University Health Network, Toronto, Ontario,
Canada
(Rac, Mitsakakis, Krahn) Institute of Health Policy, Management and
Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
(Pechlivanoglou) Child Health Evaluative Sciences, The Hospital for Sick
Children, Toronto, Ontario, Canada
(Alter, Krahn) Faculty of Medicine, University of Toronto, Toronto,
Ontario, Canada
(Alter) Toronto Rehabilitation Institute (TRI), University Health Network,
Toronto, Ontario, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The clinical effectiveness of cardiac rehabilitation (CR) on
health-related quality of life (HRQOL) is an area that has not been
consistently explored. The objective of this systematic review was to
evaluate the effectiveness of providing any core component of CR on HRQOL
domains. <br/>Method(s): We performed a meta-analysis and meta-regression
of randomized controlled trials (RCTs) on the core components of CR. RCTs
included adult patients with diagnosed coronary artery disease via
angiography, myocardial infarction, angina, or who had undergone coronary
revascularization. The Cochrane Library, MEDLINE, EMBASE, CINAHL,
SCI-EXPANDED, Psych INFO, and Web of Science were searched from inception
to April 27, 2017. Outcomes included overall, physical, emotional, and
social HRQOL. Outcomes were reported as standardized mean change (SMC)
with 95% confidence intervals (CIs). Effect size changes of 0.2, 0.5, and
0.8 SD units reflect a small, moderate, and large effect, respectively.
<br/>Result(s): Forty-nine reports of 41 RCTs with 11,747 patients were
included. Summary effect sizes were: overall HRQOL SMC, 0.28 (95% CI,
0.05-0.50), physical HRQOL SMC, 0.47 (95% CI, 0.13-0.81), emotional HRQOL
SMC, 0.37 (95% CI, -0.02 to 0.77), and social HRQOL SMC, 0.13 (95% CI,
-0.06 to 0.32). Meta-regression revealed type of CR intervention and year
of publication as positive statistically significant treatment effect
modifiers. <br/>Conclusion(s): Receiving CR was shown to improve HRQOL,
with exercise-, nonexercise-, and psychological-based interventions
playing a vital role. Although these improvements in HRQOL were modest
they still reflect an incremental benefit compared with receiving usual
care.<br/>Copyright &#xa9; 2018 Canadian Cardiovascular Society

<24>
Accession Number
2001554710
Title
Study to determine the effect of oral pregabalin premedication on
haemodynamic response to laryngoscopy, intubation and carbon dioxide
insufflation during laparoscopic cholecystectomy.
Source
Sri Lankan Journal of Anaesthesiology. 27 (1) (pp 8-14), 2019. Date of
Publication: 06 Feb 2019.
Author
Allu H.; Kulkarni M.; Dinesh E.
Institution
(Allu, Kulkarni, Dinesh) Department of Anaesthesia, Kasturba Medical
College, Manipal Academy of Higher Education, Manipal, Karnataka, India
Publisher
College of Anaesthesiologists of Sri Lanka (44/5A, Gnanartha
Pradeepaya,Mawatha, Colombo 8, Sri Lanka)
Abstract
Background: The process of laryngoscopy and endotracheal intubation is
usually associated with exaggerated haemodynamic response. In extreme
cases this response may result in myocardial ischaemia, cardiac failure,
increase in intracranial pressure and intracranial haemorrhage. Hence our
prospective randomized double blinded placebo control study was designed
to observe the effect of pregabalin in attenuating this haemodynamic
response. <br/>Method(s): In this study, 100 adult patients of ASAPS I and
II undergoing elective laparoscopic cholecystectomy were included. The
patients were randomly allocated into two groups, group P received 150mg
oral pregabalin and group C received similarly looking B complex capsules
one hour before the surgery. Heart rate (HR), systolic blood pressure
(SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP)
were observed. Sedation score was assessed using Ramsay sedation scale.
<br/>Result(s): We observed an increase in all the haemodynamic parameters
in both the groups. The percentage change in HR and MAP from baseline at
one-minute following intubation was +33% and +28.5% in control group
compared to +14% and +3% in pregabalin group. Similarly, the percentage
change at five minutes after carboperitoneum was +24% and +26% in control
group compared to +4% and +0.8% in pregabalin group. This difference was
statistically significant with P value <0.05. We also found all the
patients in acceptable sedation state (score 3 and 4 based on Ramsay
sedation scale) in pregabalin group whereas only 40% patients had a score
of 3 in placebo group at 15minutes following extubation.
<br/>Conclusion(s): Oral pregabalin in a dose of 150mg one hour before the
surgery is a safe and effective premedicant in attenuating pressor
response to laryngoscopy, intubation and laparoscopy. It also produces
good sedation without any adverse effects.<br/>Copyright &#xa9; 2019,
College of Anaesthesiologists of Sri Lanka. All rights reserved.

<25>
Accession Number
626537657
Title
Percutaneous closure of the patent ductus arteriosus: opportunities moving
forward.
Source
Congenital Heart Disease. 14 (1) (pp 95-99), 2019. Date of Publication:
January/Februaryy 2019.
Author
Mitchell C.C.; Rivera B.K.; Cooper J.N.; Smith C.V.; Berman D.P.;
Slaughter J.L.; Backes C.H.
Institution
(Mitchell, Rivera, Slaughter, Backes) Center for Perinatal Research, The
Research Institute at Nationwide Children's Hospital, Columbus, OH, United
States
(Cooper) Center for Surgical Outcomes Research, The Research Institute at
Nationwide Children's Hospital, Columbus, OH, United States
(Smith) Center for Integrated Brain Research, Seattle Children's Research
Institute, University of Washington School of Medicine, Seattle, WA,
United States
(Cooper, Berman, Slaughter, Backes) Department of Pediatrics, The Ohio
State University Wexner Medical Center, Columbus, OH, United States
(Berman, Backes) The Heart Center at Nationwide Children's Hospital,
Columbus, OH, United States
Publisher
Blackwell Publishing Ltd
Abstract
The optimal treatment method for infants with a patent ductus arteriosus
(PDA) necessitating closure remains a subject of controversy and debate.
While the risks associated with surgical PDA ligation are well described,
the available evidence base for alternative management strategies during
infancy, including percutaneous closure or conservative (nonintervention)
management, are not well explored. Among infants, the goals of this review
are to: (a) use rigorous systematic review methodology to assess the
quality and quantity of published reports on percutaneous closure vs
surgical ligation; (b) compare outcomes of percutaneous closure vs
conservative management; and (c) based on recommendations from the
International PDA symposium, to elucidate needs and opportunities for
future research and interdisciplinary collaboration. The available
evidence base, as well as on broad consensus reached at the International
PDA Symposium, suggests that a contemporary, pragmatic clinical trial
comparing PDA treatment strategies is warranted. Additionally, quality
assurance safeguards are necessary in the implementation of newer PDA
closure devices. Finally, to determine best approaches to treatment for
infants with PDA, tools for consistent data collection and reporting
across centers and disciplines are needed to minimize heterogeneity and
permit pooled analysis.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<26>
Accession Number
619004332
Title
Topical vancomycin to reduce surgical-site infections in neurosurgery:
Study protocol for a multi-center, randomized controlled trial.
Source
Contemporary Clinical Trials. 64 (pp 195-200), 2018. Date of Publication:
January 2018.
Author
Jonokuchi A.J.; Knopman J.; Radwanski R.E.; Martinez M.A.; Taylor B.E.S.;
Rothbaum M.; Sullivan S.; Robison T.R.; Lo E.; Christophe B.R.; Bruce
E.M.; Khan S.; Kellner C.P.; Sigounas D.; Youngerman B.; Bagiella E.;
Angevine P.D.; Lowy F.D.; Sander Connolly E.
Institution
(Jonokuchi, Radwanski, Martinez, Taylor, Robison, Lo, Christophe, Bruce,
Kellner, Youngerman, Angevine, Sander Connolly) Department of Neurological
Surgery, Columbia University College of Physicians and Surgeons, 710 W
168th Street, New York, NY 10032, United States
(Knopman, Rothbaum, Sigounas) Department of Neurological Surgery, Weill
Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065,
United States
(Sullivan, Khan, Lowy) Department of Pathology and Cell Biology, Columbia
University College of Physicians and Surgeons, 630 W 168th Street, New
York, NY 10032, United States
(Bagiella) Center for Biostatistics, Department of Population Health
Science & Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy Place,
New York, NY 10029, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Surgical-site infections (SSIs) account for 20% of all
healthcare-associated infections, are the most common nosocomial infection
among surgical patients, and are a focus of quality improvement
initiatives. Despite implementation of many quality care measures (e.g.
prophylactic antibiotics), SSIs remain a significant cause of morbidity,
mortality, and economic burden, particularly in the field of neurosurgery.
Topical vancomycin is increasingly utilized in instrumented spinal and
cardiothoracic procedures, where it has been shown to reduce the risk of
SSIs. However, a randomized controlled trial assessing its efficacy in the
general neurosurgical population has yet to be done. The principle aim of
"Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is
to determine whether prophylactic, topical vancomycin reduces the risk of
SSIs in the adult neurosurgical population. This prospective, multicenter,
patient-blinded, randomized controlled trial will enroll patients to
receive the standard of care plus topical vancomycin, or the standard of
care alone. The primary endpoint of this study is a SSI by postoperative
day (POD) 30. Patients must be over 18 years of age. Patients are excluded
for renal insufficiency, vancomycin allergy, and some ineligible
procedures. Univariate analysis and logistic regression will determine the
effect of topical vancomycin on SSIs at 30 days. A randomized controlled
trial is needed to determine the efficacy of this treatment. Results of
this trial are expected to directly influence the standard of care and
prevention of SSIs in neurosurgical patients.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<27>
Accession Number
626512976
Title
Restrictive versus liberal red blood cell transfusion for cardiac surgery:
a systematic review and meta-analysis of randomized controlled trials.
Source
Journal of Thrombosis and Thrombolysis. 47 (2) (pp 179-185), 2019. Date of
Publication: 15 Feb 2019.
Author
Kheiri B.; Abdalla A.; Osman M.; Haykal T.; Chintalapati S.; Cranford J.;
Sotzen J.; Gwinn M.; Ahmed S.; Hassan M.; Bachuwa G.; Bhatt D.L.
Institution
(Kheiri, Haykal, Chintalapati, Cranford, Sotzen, Ahmed, Hassan, Bachuwa)
Department of Internal Medicine, Hurley Medical Center/Michigan State
University, Flint, MI 48503, United States
(Abdalla) Division of Hematology & Oncology, Ascension St. John Hospital,
Grosse Pointe Woods, MI 48236, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV 26506, United States
(Gwinn) Michigan State University-College of Human Medicine, Flint, MI
48502, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, 75 Francis Street, Boston, MA 02115, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Patients undergoing cardiac surgery are among the most common recipients
of allogeneic red blood cell (RBC) transfusions. However, whether
restrictive RBC transfusion strategies for cardiac surgery achieve a
similar clinical outcome in comparison with liberal strategies remains
unclear. We searched electronic databases from inception to December 2017
for randomized controlled trials (RCTs). We calculated the risk ratios
(RRs) and weighted-mean difference (MD) using a random-effects model. We
included 9 RCTs with a total of 9005 patients. There was no significant
difference in mortality between groups [RR 1.03; 95% confidence interval
(CI) 0.74-1.45; P = 0.86]. In addition, there were no significant
differences between groups in the clinical outcomes of infections (RR
1.09; 95% CI 0.94-1.26; P = 0.26), stroke (RR 0.98; 95% CI 0.72-1.35; P =
0.91), respiratory morbidity (RR 1.05; 95% CI 0.89-1.24; P = 0.58), renal
morbidity (RR 1.02; 95% CI 0.94-1.09; P = 0.68), myocardial infarction (RR
1.00; 95% CI 0.80-1.24; P = 0.99), cardiac arrhythmia (RR 1.05; 95% CI
0.88-1.26; P = 0.56), gastrointestinal morbidity (RR 1.93; 95% CI
0.81-4.63; P = 0.14), or reoperation (RR 0.90; 95% CI 0.67-1.20; P =
0.46). There was a significant difference in the intensive care unit
length of stay (h) (MD 4.29; 95% CI 2.19-6.39, P < 0.01) favoring the
liberal group. However, there was no significant difference in the
hospital length of stay (days) (MD 0.15; 95% CI - 0.18 to 0.48; P = 0.38).
In conclusion, this meta-analysis showed that restrictive strategies for
RBC transfusion are as safe as liberal strategies in patients undergoing
cardiac surgery with regards to short-term clinical
outcomes.<br/>Copyright &#xa9; 2018, Springer Science+Business Media, LLC,
part of Springer Nature.

<28>
[Use Link to view the full text]
Accession Number
626305275
Title
Postoperative outcomes of patients with chronic obstructive pulmonary
disease undergoing coronary artery bypass grafting surgery: A
meta-analysis.
Source
Medicine. 98 (6) (pp e14388), 2019. Date of Publication: 01 Feb 2019.
Author
Zhao H.; Li L.; Yang G.; Gong J.; Ye L.; Zhi S.; Zhang X.; Li J.
Institution
(Zhao, Li, Yang, Gong, Ye, Zhi, Li) Department of Respiratory Medicine,
Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
(Zhang) Department of Plastic Surgery, Plastic Surgery Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing,
China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a frequent
comorbid disease in patients undergoing coronary artery bypass grafting
(CABG) surgery, with an incidence ranging from 4% to 20.5%.
Conventionally, COPD was recognized as a surgical contraindication to
CABG. Because of the recent improvements in surgical techniques,
anesthesia, and postoperative management, CABG has been performed more
commonly in patients with COPD. However, studies have shown the various
effects of COPD on postoperative morbidity and mortality after CABG, and
this remains to be well defined. <br/>OBJECTIVE(S): To compare the
postoperative outcomes after CABG between patients with and those without
COPD. <br/>METHOD(S): A systematic search was conducted in the Cochrane
Library, PubMed, EmBase, and Ovid databases (until May 10, 2018). Studies
comparing perioperative results and mortality outcomes after CABG between
patients with and those without COPD were evaluated independently by 2
reviewers to identify the potentially eligible studies. Review Manager and
STATA software were used for statistical analyses. <br/>RESULT(S): No
significant difference in the mortality rates were found between patients
with and those without COPD. COPD was associated with a higher respiratory
failure rate (odds ratio [OR] = 4.01; 95% CI: 1.19-13.51, P = .03; P <.001
for heterogeneity), higher pneumonia rate (OR = 2.92; 95% CI: 2.37-3.60, P
<.00001; P = .73 for heterogeneity), higher stroke rate (OR = 2.91; 95%
CI: 1.37-6.18, P = .005; P = .60 for heterogeneity), higher renal failure
rate (OR = 1.60; 95% CI: 1.30-1.97, P <.00001; P = .19 for heterogeneity),
and higher wound infection rate (OR = 2.16; 95% CI: 1.21-3.88, P = .01; P
= .53 for heterogeneity) after CABG. <br/>CONCLUSION(S): Patients with
COPD were at higher risks for developing postoperative morbidities,
particularly pneumonia, respiratory failure, stroke, renal failure, and
wound infection. Although COPD was not associated with a higher risk of
mortality, caution should be taken when a patient with COPD is indicated
for CABG, considering the higher odds of postoperative complications
involving the respiratory system and others.

<29>
Accession Number
625422931
Title
Impact of Patient and Lesion Characteristics on Drug-Coated Balloon
Angioplasty in the Femoropopliteal Artery: A Pooled Analysis of Four
Randomized Controlled Multicenter Trials.
Source
CardioVascular and Interventional Radiology. 42 (4) (pp 495-504), 2019.
Date of Publication: 15 Apr 2019.
Author
Albrecht T.; Ukrow A.; Werk M.; Tepe G.; Zeller T.; Meyer D.-R.; Kutschera
M.; Speck U.; Waliszewski M.
Institution
(Albrecht, Ukrow) Department of Radiology and Interventional Therapy,
Vivantes Klinikum Neukolln, Berlin, Germany
(Werk) Department of Radiology, Martin-Luther-Hospital, Berlin, Germany
(Tepe) Department of Radiology, RoMed Klinikum Rosenheim, Rosenheim,
Germany
(Zeller) Department of Angiology, Herzzentrum Bad Krozingen, Bad
Krozingen, Germany
(Meyer) Department of Diagnostic and Interventional Radiology, Hubertus
Hospital, Berlin, Germany
(Kutschera, Speck) Experimental Radiology, Department of Radiology,
Charite, Berlin, Germany
(Waliszewski) Medical Scientific Affairs, B.Braun Melsungen AG, Berlin,
Germany
(Waliszewski) Department of Internal Medicine and Cardiology, Charite -
Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
(Albrecht) Institut fur Radiologie und Interventionelle Therapie, Vivantes
Klinikum Neukolln, Rudower Str. 48, Berlin 12351, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objectives: The principal objective of this pooled analysis was to
investigate various patient and lesion characteristics on late lumen loss
(LLL) after drug-coated balloon (DCB) angioplasty. <br/>Background(s):
Four randomized controlled trials (THUNDER, FEMPAC, PACIFIER, CONSEQUENT)
were pooled to investigate the influence of various patient and lesion
characteristics on DCB angioplasty and on plain old balloon angioplasty
(POBA) in patients with femoropopliteal artery disease. <br/>Method(s):
Angiographic data from 355 patients were pooled to assess the impact of
patient (demographics, cardiovascular risk factors, cardiovascular
co-morbidities, Rutherford stages) and lesion-/procedure-related
(location, occlusion, length, restenosis, calcification, subintimal
crossing, post-dilatation, dissection, stenting) characteristics on LLL.
Linear regression models were utilized with LLL as the dependent variable
to determine the predictive value of cardiovascular and
lesion-/procedure-related factors. <br/>Result(s): Observational
statistics revealed that LLL was lower in the DCB group as compared to
POBA independent of all tested patient variables. LLL after DCB was also
independent of most lesion and procedural characteristics except for
lesion length and bailout stenting. LLL increased with lesion length in
both treatment groups. Bailout stenting did not improve LLL in the DCB
group but did so in the POBA group (0.74 +/- 1.07 mm vs. 1.22 +/- 1.36 mm,
p = 0.043). <br/>Conclusion(s): DCB was superior to POBA for all tested
patient subgroups and lesion subgroups. Our results suggest that all
patients and lesions benefit to a similar degree from the use of DCB.
DCB-PTA should therefore be preferred to POBA in all patients with
steno-occlusive femoropopliteal lesions.<br/>Copyright &#xa9; 2018,
Springer Science+Business Media, LLC, part of Springer Nature and the
Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

<30>
[Use Link to view the full text]
Accession Number
626102871
Title
Application of intrapulmonary wire combined with intrapleural fibrin glue
in preoperative localization of small pulmonary nodules.
Source
Medicine. 98 (4) (pp e14029), 2019. Date of Publication: 01 Jan 2019.
Author
Zhang W.-H.; Bai Y.-Y.; Guo W.; Li M.; Chang G.-X.; Liu W.; Mao Y.
Institution
(Zhang, Guo, Li, Chang, Liu, Mao) Department of Thoracic Surgery, First
Hospital of Hohhot
(Bai) Department of Anesthesiology, First Hospital of Hohhot, Inner
Mongolia, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This study aims to investigate the accuracy of the preoperative
localization of small nodules by computerized tomography (CT)-guided
placing wire and intrapleural fibrin glue near the nodules at 3 days
before the operation. <br/>METHOD(S): From October 2015 to December 2017,
a total of 79 patients, who received preoperative localization of small
pulmonary nodules and surgical treatment in the Department of Thoracic
Surgery of Hohhot First Hospital, were enrolled into this study. These
patients were randomly divided into 2 groups: methylene blue localization
group (n = 47), and modified localization group (n = 32), where the
patients received preoperative localization of the small nodules by
CT-guided placing wire and intrapleural fibrin glue near the nodule at 3
days before the operation. Localization accuracy, operation time and
difficulty in postoperative seeking for pathological specimens were
compared between these 2 groups. <br/>RESULT(S): In the methylene blue
localization group, 3 patients had localization failure due to the
intrathoracic diffusion of methylene blue, and the success rate was
93.61%. In the modified localization group, all 32 patients succeeded in
the localization, and the success rate was 100%. Operation time and
difficulty of finding the specimen was significantly lower in the modified
localization group than in the methylene blue localization group (P <
.05). <br/>CONCLUSION(S): The application of preoperative localization of
small nodules by placing wire and intrapleural fibrin glue improves the
success rate of resection, reduces operation time and the risk of the
operation, and lowers the difficulty of finding pathological specimens
after the operation. Hence this operative procedure is worthy of
popularization.

<31>
Accession Number
625415470
Title
Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve
Regurgitation: A Systematic Review.
Source
Cardiology (Switzerland). (pp 132-140), 2018. Date of Publication: 2018.
Author
Jiang J.; Liu X.; He Y.; Xu Q.; Zhu Q.; Jaiswal S.; Wang L.; Hu P.; Gao
F.; Sun Y.; Liu C.; Lin X.; Liang J.; Ren K.; Wang J.
Institution
(Jiang, Liu, He, Xu, Zhu, Jaiswal, Wang, Hu, Gao, Liu, Lin, Liang, Ren,
Wang) Department of Cardiology, Second Affiliated Hospital, Zhejiang
University School of Medicine, Hangzhou 310009, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangdong,
China
Publisher
S. Karger AG
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a recent and
an effective treatment option for high- or extreme-surgical-risk patients
with symptomatic severe aortic stenosis. However, pure severe native
aortic valve regurgitation (NAVR) without aortic stenosis remains a
contraindication to TAVR. The aim of our systemic review analysis was to
evaluate TAVR in patients with pure NAVR. <br/>Method(s): We searched the
published articles in the PubMed and Web of Science databases (2002-2017)
using the Boolean operators for studies of NAVR patients undergoing TAVR.
Reference lists of all returned articles were searched recursively for
other relevant citations. Pooled estimates were calculated using a
random-effects meta-analysis. <br/>Result(s): Finally, a total of 10
studies were included in this analysis. The CoreValve was more frequently
used with a lower rate of device success and a higher rate of residual
aortic regurgitation. The new-generation transcatheter heart valves (THVs)
performed a significantly higher rate with less residual aortic
regurgitation and a success rate close to 100%. The 30-day all-cause
mortality rates ranged from 0 to 30% with an estimate summary rate of 9%
(95% CI: 5-15%; I² = 33%). Cerebrovascular events, major or
life-threatening bleeding, major vascular complications, acute kidney
disease, and new permanent pacemaker implantation occurred similarly in
both the new- and old-generation THV devices. <br/>Conclusion(s): Aortic
regurgitation remains a challenging pathology for TAVR. TAVR is a feasible
and reasonable option for carefully selected patients with pure aortic
regurgitation.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel.

<32>
Accession Number
626575068
Title
The effect of hyperoxia on mortality in critically ill patients: a
systematic review and meta analysis.
Source
BMC pulmonary medicine. 19 (1) (pp 53), 2019. Date of Publication: 26 Feb
2019.
Author
Ni Y.-N.; Wang Y.-M.; Liang B.-M.; Liang Z.-A.
Institution
(Ni, Liang, Liang) Department of Respiratory and Critical Care, West China
School of Medicine and West China Hospital, Sichuan University, No.37
Guoxue Alley, Chengdu 610041, China
(Wang) Department of Respiratory Medicine, Sichuan Second Hospital of
Traditional Chinese Medicine, Chengdu, Sichuan 610031, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Studies investigating the role of hyperoxia in critically ill
patients have reported conflicting results. We did this analysis to reveal
the effect of hyperoxia in the patients admitted to the intensive care
unit (ICU). <br/>METHOD(S): Electronic databases were searched for all the
studies exploring the role of hyperoxia in adult patients admitted to ICU.
The primary outcome was mortality. Random-effect model was used for
quantitative synthesis of the adjusted odds ratio (aOR). <br/>RESULT(S):
We identified 24 trials in our final analysis. Statistical heterogeneity
was found between hyperoxia and normoxia groups in patients with
mechanical ventilation (I2 =92%, P<0.01), cardiac arrest(I2 =63%, P=0.01),
traumatic brain injury (I2 =85%, P<0.01) and post cardiac surgery (I2
=80%, P=0.03). Compared with normoxia, hyperoxia was associated with
higher mortality in overall patients (OR 1.22, 95% CI 1.12~1.33), as well
as in the subgroups of cardiac arrest (OR 1.30, 95% CI 1.08~1.57) and
extracorporeal life support (ELS) (OR 1.44, 95% CI 1.03~2.02).
<br/>CONCLUSION(S): Hyperoxia would lead to higher mortality in critically
ill patients especially in the patients with cardiac arrest and ELS.

<33>
Accession Number
621179874
Title
Lipid peroxidation in cardiac surgery: Towards consensus on biomonitoring,
diagnostic tools and therapeutic implementation.
Source
Journal of Breath Research. 12 (2) (no pagination), 2018. Article Number:
027109. Date of Publication: April 2018.
Author
Romano R.; Cristescu S.M.; Risby T.H.; Marczin N.
Institution
(Romano, Marczin) Section of Anaesthetics, Pain Medicine and Intensive
Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial
College London, London, United Kingdom
(Cristescu) Department of Molecular and Laser Physics, Institute of
Molecules and Materials, Radboud University, Nijmegen, Netherlands
(Risby) Department of Environmental Health Sciences, Bloomberg School of
Public Health, Johns Hopkins University, Baltimore, United States
(Marczin) Centre of Anaesthesia and Intensive Care, Semmelweis University,
Budapest, Hungary
Publisher
Institute of Physics Publishing (E-mail: helen.craven@iop.org)
Abstract
This review focuses on oxidative stress and more specifically lipid
peroxidation in cardiac surgery, one of the fundamental theories of
perioperative complications. We present the molecular pathways leading to
lipid peroxidation and integrate analytical methods that allow detection
of lipid peroxidation markers in the fluid phase with those focusing on
volatile compounds in exhaled breath. In order to explore the accumulated
data in the literature, we present a systematic review of quantitative
analysis of malondialdehyde, a widely used lipid peroxidation product at
various stages of cardiac surgery. This exploration reveals major
limitations of existing studies in terms of variability of reported values
and significant gaps due to discrete and variable sampling times during
surgery. We also appraise methodologies that allow real-time and
continuous monitoring of oxidative stress. Complimentary techniques
highlight that beyond the widely acclaimed contribution of the
cardiopulmonary bypass technology and myocardial reperfusion injury, the
use of diathermy contributes significantly to intraoperative lipid
peroxidation. We conclude that there is an urgent need to implement the
theory of oxidative stress towards a paradigm change in the clinical
practice. Firstly, we need to acquire definite and irrefutable information
on the link between lipid peroxidation and post-operative complications by
building international consensus on best analytical approaches towards
generating qualitatively and quantitatively comparable datasets in
coordinated multicentre studies. Secondly, we should move away from
routine low-risk surgeries towards higher risk interventions where there
is major unmet clinical need for improving patient journey and outcomes.
There is also need for consensus on best therapeutic interventions which
could be tested in convincing large scale clinical trials. As future
directions, we propose combination of fluid phase platforms and
'metabography', an extended form of capnography - including real-time
analysis of lipid peroxidation and volatile footprints of metabolism - for
better patient phenotyping prior to and during high risk surgery towards
molecular prediction, stratification and monitoring of the patient's
journey.<br/>Copyright &#xa9; 2018 IOP Publishing Ltd.

<34>
Accession Number
625955735
Title
Cardiogenic Necrotizing Enterocolitis: A Clinically Distinct Entity from
Classical Necrotizing Enterocolitis.
Source
European Journal of Pediatric Surgery. 29 (1) (pp 14-22), 2019. Date of
Publication: 2019.
Author
Siano E.; Lauriti G.; Ceccanti S.; Zani A.
Institution
(Siano, Zani) Division of General and Thoracic Surgery, Hospital for Sick
Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
(Lauriti) Department of Pediatric Surgery, Spirito Santo Hospital,
Pescara, G. d'Annunzio University, Chieti-Pescara, Italy
(Ceccanti) Pediatric Surgery Unit, Sapienza University of Rome, Azienda
Policlinico Umberto i, Rome, Italy
(Zani) Department of Surgery, University of Toronto, Toronto, ON, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Aim The main purpose of this study was to investigate if necrotizing
enterocolitis (NEC) has a different presentation and outcome in patients
with congenital heart defect (CHD) (cardiogenic NEC) from those without
(classical NEC). Materials and Methods A systematic review of the
literature on the characteristics of infants with NEC and CHD was
performed by three independent investigators using a defined strategy
(PubMed, Cochrane, Embase, and Web of Science). A meta-analysis was
conducted on studies comparing NEC in infants with CHD and non-CHD infants
using RevMan 5.3. Results Systematic review: Of 7,291 abstracts screened,
126 full-text articles were analyzed and 51 studies were included. NEC had
an incidence of 5.1% in CHD infants (7,728/151,046, range 0-24%) and 0.8%
in non-CHD infants (26,430/3,256,891, range 0.1-8.9%; p < 0.0001). In very
low birth weight infants, NEC occurred in 6.3% of CHD patients
(6,361/100,454pts) and in 8.9% of non-CHD (23,201/257,794pts; p < 0.0001).
In CHD cases, NEC occurred before cardiac surgery in 48% cases and surgery
for NEC was required in 31% infants (2,037/6,683). Meta-analysis: In eight
comparative studies, the incidence of NEC was higher in CHD infants (6%,
768/13,145) than in infants with no CHD (0.9%, 32,625/3,354,323pts; p <
0.00001, odds ratio [OR] 1.84, 95% confidence interval [CI] 1.7-1.9). The
overall mortality was higher in infants with CHD and NEC (38%, 243/640)
than in those without CHD (27%, 6651/24810; p < 0.00001, OR 3.4, 95% CI
2.8-4.1). Conclusion This is the first evidence-based study showing that
infants with cardiogenic NEC have different demographics and outcomes than
those with classical NEC. The risk of developing NEC and the mortality
rate are higher among infants with CHD than in those without. Conversely,
the need for intestinal surgery is lower in babies with cardiogenic NEC
than in those with classical NEC. Further studies are needed to establish
preventative and management interventions that are specific to infants
with or at risk of developing cardiogenic NEC.<br/>Copyright &#xa9; 2019
Georg Thieme Verlag KG Stuttgart - New York.

<35>
Accession Number
624224548
Title
Zero-Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and
Improves the Respiratory Function in Infants After Cardiopulmonary Bypass:
A Randomized Controlled Trial.
Source
Artificial Organs. 43 (2) (pp 167-172), 2019. Date of Publication:
Februaryy 2019.
Author
Gholampour Dehaki M.; Niknam S.; Azarfarin R.; Bakhshandeh H.; Mahdavi M.
Institution
(Gholampour Dehaki, Niknam, Azarfarin, Bakhshandeh, Mahdavi) Rajaie
Cardiovascular, Medical & Research Center-Perfusion, Tehran Province,
Tehran, Iran, Islamic Republic of
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and
infants to avoid exceeding hemodilution; however, transfusion-related
inflammation affects post-CPB outcomes in infant open-heart surgery.
Procalcitonin, a newly detected inflammatory moderator and a sensitive
parameter for predicting pulmonary dysfunction secondary to CPB, rises
after CPB. We hypothesized that the hemofiltration of priming blood before
CPB might decrease inflammatory mediators in the blood and post-CPB
inflammatory replications, thereby improving the respiratory function
after CPB in infants. Sixty infants with a weight below 10 kg were divided
randomly into two equal groups of CPB with the zero-balance
ultrafiltration (Z-BUF) of priming blood and CPB without it. The
procalcitonin level was measured before anesthesia, after admission to the
intensive care unit (ICU), and 24 h afterward. The respiratory index and
pulmonary compliance were measured after anesthesia, at the end of CPB,
and 2 h after admission to the ICU. Additionally, time to extubation was
recorded. The Z-BUF of priming blood maintained electrolytes within a
physiologic level, and procalcitonin had a slighter rise in the Z-BUF
Group at 24 h after admission to the ICU (P = 0.05). The respiratory index
was decreased in the Z-BUF Group, but the difference with the control
group did not reach statistical significance (P > 0.05). The change in
pulmonary compliance was significantly increased in the cyanotic patients
in the intervention group, but there was no significant difference between
the two groups. The time to extubation and the ICU stay were shorter in
the Z-BUF Group (P < 0.05). A positive correlation was found between the
peak procalcitonin concentration and the time to extubation directly and
pulmonary compliance reversely. These results suggest that the Z-BUF of
priming blood may have some beneficial clinical effects such as improved
respiratory function and attenuated procalcitonin.<br/>Copyright &#xa9;
2018 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<36>
Accession Number
2001598863
Title
Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting
in Unprotected Left Main Coronary Artery Stenosis.
Source
American Journal of the Medical Sciences. 357 (3) (pp 230-241), 2019. Date
of Publication: March 2019.
Author
Wang Z.; Zhan B.; Bao H.; Huang X.; Wu Y.; Liang Q.; Zhang W.; Jiang L.;
Cheng X.
Institution
(Wang, Zhan, Bao, Huang, Wu, Jiang, Cheng) Department of Cardiovascular
Medicine, Second Affiliated Hospital of Nanchang University, Nanchang,
Jiangxi, China
(Liang) Jiangxi Key Laboratory of Molecular Medicine, Second Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi, China
(Zhang) Department of Pharmacy, Second Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
Publisher
Elsevier B.V.
Abstract
Background: The present study performed a meta-analysis of randomized and
prospective trials to compare the outcomes of percutaneous coronary
intervention (PCI) with stents versus coronary artery bypass graft surgery
(CABG) for unprotected left main coronary artery (UPLM) stenosis.
<br/>Method(s): The Cochrane Library, PubMed and EMBASE databases were
systematically searched until July 2017. The Newcastle-Ottawa scale was
used for quality assessment. <br/>Result(s): A total of 19 studies with
16,900 participants were included. Pooled analysis showed no significant
differences in all-cause mortality (odds ratio [OR] 0.94; 95% CI
0.74-1.20) and cardiac death (OR 1.04; 95% CI 0.74-1.47). However,
subgroup analysis showed that PCI was associated with a low all-cause
mortality rate at 30-day follow up (OR 0.48; 95% CI 0.26-0.89). The stroke
rate in PCI was lower in short-term follow up (OR 0.45; 95% CI 0.23-0.88)
and long-term follow up (OR 0.36; 95% CI 0.27-0.47). On the other hand,
PCI was associated with higher risk of myocardial infarction (OR 1.59; 95%
CI 1.34-1.88), repeat revascularization (OR 2.47; 95% CI 1.80-3.37) and
target vessel revascularization (OR 2.10; 95% CI 1.72-2.57) compared to
CABG in the pooled analysis. <br/>Conclusion(s): The current evidence
suggests that the risk of stroke was significantly reduced in PCI compared
to that in CABG. Therefore, PCI is the preferred treatment for patients
with a high risk of stroke. Additionally, in short-term follow up, PCI was
reported to be safe and effective for UPLM patients compared to CABG.
However, CABG caused fewer complications long term.<br/>Copyright &#xa9;
2019 Southern Society for Clinical Investigation

<37>
Accession Number
625325929
Title
Astaxanthin ameliorates cardiomyocyte apoptosis after coronary
microembolization by inhibiting oxidative stress via Nrf2/HO-1 pathway in
rats.
Source
Naunyn-Schmiedeberg's Archives of Pharmacology. 392 (3) (pp 341-348),
2019. Date of Publication: 05 Mar 2019.
Author
Xue Y.; Sun C.; Hao Q.; Cheng J.
Institution
(Xue, Sun, Hao, Cheng) Department of Cardiology, Tangdu Hospital, Air
Force Military Medical University, Xinsi Road, Xi'an 710000, China
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Coronary microembolization (CME) caused by physical obstruction in
coronary microcirculation induces myocardial apoptosis and cardiac
dysfunction, and it was reported that the inactivation of the Nrf2/HO-1
signaling was involved in this process. Astaxanthin (AST) is a reddish
pigment that belongs to keto-carotenoids. It is also a potent antioxidant
and has been reported to activate Nrf2/HO-1 signaling in vein endothelial
cells. However, it is still unknown whether AST is able to activate
Nrf2/HO-1 signaling pathway to protect cardiac functions from CME in vivo.
To address this question, rats were orally administrated with AST or AST
plus Zinc protoporphyrin IX (ZnPP, a HO-1 inhibitor), followed by CME
modeling operation. Then, cardiac function was evaluated by
echocardiographic measurement. Myocardial infarction was measured by HBFP
staining, and apoptosis was assessed by TUNEL staining. The protein levels
and mRNA expressions of Bax and Bcl-2 were measured by Western blot and
qRT-PCR, respectively. ELISA was performed to measure the activity of
enzymes related to oxidative stress. AST pretreatment dramatically
attenuated CME-induced cardiac dysfunction, myocardial infarction, and
cardiomyocyte apoptosis. Mechanistically, AST suppressed CME-induced
oxidative stress by re-activating Nrf2/HO-1 signaling. HO-1 inhibitor ZnPP
completely eliminated the benefits of AST in CEM, supporting the critical
role of Nrf2/HO-1 signaling in mediating the cardioprotective function of
AST in CME. <br/>Conclusion(s): AST suppresses oxidative stress via
activating Nrf2/HO-1 pathway and thus prevents CME-induced cardiomyocyte
apoptosis and ameliorates cardiac dysfunction in rats.<br/>Copyright
&#xa9; 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

<38>
Accession Number
626464313
Title
Pre-operative biomarkers and imaging tests as predictors of post-operative
delirium in non-cardiac surgical patients: A systematic review.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 25. Date
of Publication: 23 Feb 2019.
Author
Ayob F.; Lam E.; Ho G.; Chung F.; El-Beheiry H.; Wong J.
Institution
(Ayob, Lam, Chung, Wong) Department of Anesthesia, Toronto Western
Hospital, University Health Network, 2-434 McLaughlin Wing, 399 Bathurst
Street, Toronto, ON M5T 2S8, Canada
(Ho) Faculty of Medicine, University of Toronto, Medical Sciences
Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
(El-Beheiry) Department of Anesthesia, Trillium Health Partners,
Mississauga Hospital, 100 Queensway, West, Mississauga, ON L5B 1B, Canada
(Wong) Women's College Hospital, 76 Grenville St, Toronto, ON M5S 1B2,
Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative delirium (POD) is a common post-operative
complication in elderly individuals and imposes a significant health and
financial burden. Identifying predictive biomarkers may help understand
the pathophysiology of POD. Our objective is to summarize the evidence of
pre-operative biomarkers and imaging tests to predict POD in patients
undergoing non-cardiac surgery. <br/>Method(s): A systematic search of
English language articles in MEDLINE, EMBASE, Cochrane Database,
PsychINFO, PubMed and ClinicalTrials. Gov up to January 2018 was
performed. Studies that used biomarkers or imaging tests to predict POD
and a validated POD assessment tool were included. Animal studies,
paediatric, cardiac and intracranial surgery were excluded. Risk of bias
was assessed using the Quality In Prognosis Study tool. <br/>Result(s):
Thirty-four prospective cohort studies involving 4424 patients were
included. Nineteen studies described serum tests [Interleukin-6,
Insulin-like Growth Factor 1, C-Reactive Protein (CRP), cholinesterases,
apolipoprotein-E genotype, leptin, hypovitaminosis, hypoalbuminaemia,
gamma-amino butyric acid], 10 described cerebral-spinal fluid tests
(monoamine precursor, melatonin, acute phase proteins, S100B and
neurofibrillary tangles), and 5 described imaging tests. Two studies had
high risk of bias due to unclear outcome measurement and study
participation. CRP was significantly associated with POD in 5 studies.
Other biomarkers were either examined by only a single study or two or
more studies with conflicting results. <br/>Conclusion(s): CRP is the most
promising biomarker associated with POD. However, we are still in the
early stages in identifying biomarkers and imaging tests that may further
understanding of the pathophysiology of POD.<br/>Copyright &#xa9; 2019 The
Author(s).

<39>
Accession Number
624573416
Title
A prospective, single-center, randomized study to assess whether automated
coregistration of optical coherence tomography with angiography can reduce
geographic miss.
Source
Catheterization and Cardiovascular Interventions. 93 (3) (pp 411-418),
2019. Date of Publication: 15 Feb 2019.
Author
Koyama K.; Fujino A.; Maehara A.; Yamamoto M.H.; Alexandru D.; Jennings
J.; Krug P.; Santiago L.M.; Murray M.; Bongiovanni L.; Lee T.; Kim S.-Y.;
Wang X.; Lin Y.; Matsumura M.; Ali Z.A.; Sosa F.; Haag E.; Mintz G.S.;
Shlofmitz R.A.
Institution
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Ali) Division of
Cardiology, Department of Medicine, Columbia University Medical Center,
New York, NY, United States
(Koyama, Fujino, Maehara, Yamamoto, Lee, Kim, Wang, Lin, Matsumura, Ali,
Mintz) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Alexandru, Jennings, Krug, Santiago, Murray, Bongiovanni, Haag,
Shlofmitz) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Wang) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Lin) Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangzhou, China
(Sosa) Abbott Vascular, Santa Clara, CA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We sought to evaluate whether automated coregistration of
optical coherence tomography (OCT) with angiography reduces geographic
miss (GM) during coronary stenting. <br/>Background(s): Previous
intravascular ultrasound or OCT studies have showed that residual disease
at the stent edge or stent edge dissection was associated with stent
thrombosis or edge restenosis. This has been termed GM. <br/>Method(s):
Two hundred de novo coronary lesions were randomized in a 1:1 ratio to
OCT-guided percutaneous coronary intervention (PCI) with versus without
automated coregistration of OCT with angiography. GM, the primary
endpoint, was defined as angiographic >=type B dissection or diameter
stenosis >50% or OCT minimum lumen area <4.0 mm² with
significant residual disease or dissection (dissection flap >60degree)
within 5 mm from the stent edge. <br/>Result(s): The prevalence of GM was
not different comparing OCT-guided PCI with versus without automated
coregistration (27.6% vs 34.0%, P = 0.33). However, there was a trend
toward a reduced prevalence of significant distal stent edge dissection in
lesions with automated coregistration (11.1% vs 20.8%, P = 0.07). The
discrepancy in the distance between planned versus actual implanted stent
location with automated coregistration was significantly shorter than
without coregistration (1.9 +/- 1.6 mm vs 2.6 +/- 2.7 mm, P = 0.03),
especially the prevalence of >=5 mm discrepancy that was less frequent
with automated coregistration. <br/>Conclusion(s): Automated
coregistration of OCT with angiography did not reduce the primary endpoint
of GM after stent implantation.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<40>
Accession Number
625375867
Title
A process for academic societies to develop scientific statements and
white papers: Experience of the Pediatric Cardiac Intensive Care Society.
Source
Cardiology in the Young. 29 (2) (pp 174-177), 2019. Date of Publication:
01 Feb 2019.
Author
Reddy S.; Polito A.; Staveski S.; Dalton H.
Institution
(Reddy) Department of Pediatrics (Cardiology), Stanford University, 750
Welch Road, Palo Alto, CA 94305, United States
(Polito) Pediatric and Neonatal Intensive Care Unit, Department of
Pediatrics, University Hospital of Geneva, Geneva, Switzerland
(Staveski) Research in Patient Services and the Heart Institute,
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United
States
(Dalton) Department of Pediatrics, Adult and Pediatric ECMO, INOVA Fairfax
Medical Center, Falls Church, VA, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
There are substantial knowledge gaps, practice variation, and paucity of
controlled trials owing to the relatively small number of patients with
critical heart disease. The Pediatric Cardiac Intensive Care Society has
recognised this knowledge gap as an area needing a more comprehensive and
evidence-based approach to the management of the critically ill child with
heart disease. To address this, the Pediatric Cardiac Intensive Care
Society created a scientific statements and white papers committee.
Scientific statements and white papers will present the current
state-of-the-art in areas where controversy exists, providing clinicians
with guidance in diagnostic and therapeutic strategies, particularly where
evidence-based data are lacking. This paper provides a template for other
societies and organisations faced with the task of developing scientific
statements and white papers. We describe the methods used to perform a
systematic literature search and evidence rating that will be used by all
scientific statements and white papers emerging from the Pediatric Cardiac
Intensive Care Society. The Pediatric Cardiac Intensive Care Society aims
to revolutionise the care of children with heart disease by shifting our
efforts from individual institution-based practices to national
standardised protocols and to lay the ground work for multicentre
high-impact research directions.<br/>Copyright &#xa9; 2018 Cambridge
University Press.

<41>
Accession Number
2000744045
Title
Off-Pump Versus On-Pump Coronary Artery Bypass Grafting-A Systematic
Review and Analysis of Clinical Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (1) (pp 232-244),
2019. Date of Publication: January 2019.
Author
Shaefi S.; Mittel A.; Loberman D.; Ramakrishna H.
Institution
(Shaefi) Divisions of Cardiac Anesthesia and Critical Care, Department of
Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Mittel) Cardiothoracic Anesthesiology, New York-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Loberman) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Loberman) Department of Surgery, Harvard Medical School, Boston, MA,
United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology,
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in
Arizona, Phoenix, AZ, United States
Publisher
W.B. Saunders
Abstract
Surgical coronary artery bypass grafting (CABG) is the standard of care
for revascularization of left main or three-vessel coronary artery
disease. The off-pump coronary artery bypass graft (OPCAB) procedure
avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve
long-term outcomes by reducing the rates of perioperative myocardial
injury, stroke, neurocognitive impairment, and cardiac-related mortality.
Several high-quality clinical trials have been conducted since OPCAB
became popular in the 1990s and have demonstrated no benefit of OPCAB over
traditional CABG with respect to these outcomes despite favorable
short-term reductions in transfusion requirements and other postoperative
complications. Ultimately, OPCAB is associated with less effective
myocardial revascularization and does not entirely prevent complications
traditionally associated with cardiopulmonary bypass. This article reviews
major high-quality trials of OPCAB versus traditional CABG with respect to
both short- and long-term clinical outcomes.<br/>Copyright &#xa9; 2018
Elsevier Inc.

<42>
Accession Number
2001516901
Title
Efficacy and safety of statin therapy in older people: a meta-analysis of
individual participant data from 28 randomised controlled trials.
Source
The Lancet. 393 (10170) (pp 407-415), 2019. Date of Publication: 2 - 8
February 2019.
Author
Armitage J.; Baigent C.; Barnes E.; Betteridge D.J.; Blackwell L.; Blazing
M.; Bowman L.; Braunwald E.; Byington R.; Cannon C.; Clearfield M.;
Colhoun H.; Collins R.; Dahlof B.; Davies K.; Davis B.; de Lemos J.; Downs
J.R.; Durrington P.; Emberson J.; Fellstrom B.; Flather M.; Ford I.;
Franzosi M.G.; Fulcher J.; Fuller J.; Furberg C.; Gordon D.; Goto S.;
Gotto A.; Halls H.; Harper C.; Hawkins C.M.; Herrington W.; Hitman G.;
Holdaas H.; Holland L.; Jardine A.; Jukema J.W.; Kastelein J.; Kean S.;
Keech A.; Kirby A.; Kjekshus J.; Knatterud (deceased) G.; Knopp (deceased)
R.; Koenig W.; Koren M.; Krane V.; Landray M.J.; LaRosa J.; Lonn E.;
MacFarlane P.; MacMahon S.; Maggioni A.; Marchioli R.; Marschner I.;
Mihaylova B.; Moye L.; Murphy S.; Nakamura H.; Neil A.; Newman C.;
O'Connell R.; Packard C.; Parish S.; Pedersen T.; Peto R.; Pfeffer M.;
Poulter N.; Preiss D.; Reith C.; Ridker P.; Robertson M.; Sacks F.; Sattar
N.; Schmieder R.; Serruys P.; Sever P.; Shaw J.; Shear C.; Simes J.;
Sleight P.; Spata E.; Tavazzi L.; Tobert J.; Tognoni G.; Tonkin A.;
Trompet S.; Varigos J.; Wanner C.; Wedel H.; White H.; Wikstrand J.;
Wilhelmsen L.; Wilson K.; Young R.; Yusuf S.; Zannad F.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Statin therapy has been shown to reduce major vascular events
and vascular mortality in a wide range of individuals, but there is
uncertainty about its efficacy and safety among older people. We undertook
a meta-analysis of data from all large statin trials to compare the
effects of statin therapy at different ages. <br/>Method(s): In this
meta-analysis, randomised trials of statin therapy were eligible if they
aimed to recruit at least 1000 participants with a scheduled treatment
duration of at least 2 years. We analysed individual participant data from
22 trials (n=134 537) and detailed summary data from one trial (n=12 705)
of statin therapy versus control, plus individual participant data from
five trials of more intensive versus less intensive statin therapy (n=39
612). We subdivided participants into six age groups (55 years or younger,
56-60 years, 61-65 years, 66-70 years, 71-75 years, and older than 75
years). We estimated effects on major vascular events (ie, major coronary
events, strokes, and coronary revascularisations), cause-specific
mortality, and cancer incidence as the rate ratio (RR) per 1.0 mmol/L
reduction in LDL cholesterol. We compared proportional risk reductions in
different age subgroups by use of standard chi² tests for
heterogeneity when there were two groups, or trend when there were more
than two groups. <br/>Finding(s): 14 483 (8%) of 186 854 participants in
the 28 trials were older than 75 years at randomisation, and the median
follow-up duration was 4.9 years. Overall, statin therapy or a more
intensive statin regimen produced a 21% (RR 0.79, 95% CI 0.77-0.81)
proportional reduction in major vascular events per 1.0 mmol/L reduction
in LDL cholesterol. We observed a significant reduction in major vascular
events in all age groups. Although proportional reductions in major
vascular events diminished slightly with age, this trend was not
statistically significant (p<inf>trend</inf>=0.06). Overall, statin or
more intensive therapy yielded a 24% (RR 0.76, 95% CI 0.73-0.79)
proportional reduction in major coronary events per 1.0 mmol/L reduction
in LDL cholesterol, and with increasing age, we observed a trend towards
smaller proportional risk reductions in major coronary events
(p<inf>trend</inf>=0.009). We observed a 25% (RR 0.75, 95% CI 0.73-0.78)
proportional reduction in the risk of coronary revascularisation
procedures with statin therapy or a more intensive statin regimen per 1.0
mmol/L lower LDL cholesterol, which did not differ significantly across
age groups (p<inf>trend</inf>=0.6). Similarly, the proportional reductions
in stroke of any type (RR 0.84, 95% CI 0.80-0.89) did not differ
significantly across age groups (p<inf>trend</inf>=0.7). After exclusion
of four trials which enrolled only patients with heart failure or
undergoing renal dialysis (among whom statin therapy has not been shown to
be effective), the trend to smaller proportional risk reductions with
increasing age persisted for major coronary events
(p<inf>trend</inf>=0.01), and remained non-significant for major vascular
events (p<inf>trend</inf>=0.3). The proportional reduction in major
vascular events was similar, irrespective of age, among patients with
pre-existing vascular disease (p<inf>trend</inf>=0.2), but appeared
smaller among older than among younger individuals not known to have
vascular disease (p<inf>trend</inf>=0.05). We found a 12% (RR 0.88, 95% CI
0.85-0.91) proportional reduction in vascular mortality per 1.0 mmol/L
reduction in LDL cholesterol, with a trend towards smaller proportional
reductions with older age (p<inf>trend</inf>=0.004), but this trend did
not persist after exclusion of the heart failure or dialysis trials
(p<inf>trend</inf>=0.2). Statin therapy had no effect at any age on
non-vascular mortality, cancer death, or cancer incidence.
<br/>Interpretation(s): Statin therapy produces significant reductions in
major vascular events irrespective of age, but there is less direct
evidence of benefit among patients older than 75 years who do not already
have evidence of occlusive vascular disease. This limitation is now being
addressed by further trials. <br/>Funding(s): Australian National Health
and Medical Research Council, National Institute for Health Research
Oxford Biomedical Research Centre, UK Medical Research Council, and
British Heart Foundation.<br/>Copyright &#xa9; 2019 The Author(s).
Published by Elsevier Ltd. This is an Open Access article under the CC
BY-NC-ND 4.0 license

<43>
Accession Number
626066430
Title
Pharmacokinetics of tacrolimus granules in pediatric de novo liver,
kidney, and heart transplantation: The OPTION study.
Source
Pediatric Transplantation. 23 (1) (no pagination), 2019. Article Number:
e13328. Date of Publication: Februaryy 2019.
Author
Webb N.J.A.; Baumann U.; Camino M.; Frauca E.; Undre N.; Garcia-Guereta
L.; Tonshoff B.; Reding R.; Rubik J.; Di-Filippo S.; Deschenes G.
Institution
(Webb) Department of Paediatric Nephrology and NIHR/Wellcome Trust
Manchester Clinical Research Facility, University of Manchester,
Manchester Academic Health Science Centre, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Baumann) Division of Paediatric Gastroenterology and Hepatology,
Children's Hospital, Hannover Medical School, Hannover, Germany
(Camino) Hospital Universitario Gregorio Maranon, Madrid, Spain
(Frauca) Hospital Universitario La Paz, Madrid, Spain
(Undre) Astellas Pharma EMEA, Chertsey, Surrey, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Tacrolimus granules were developed for patients who are unable to swallow
capsules. Therapeutic drug monitoring (TDM) is required to optimize
efficacy and safety, which is based on C<inf>trough</inf> for tacrolimus
capsules. Pharmacokinetic (PK) data for tacrolimus granules are required
to establish the basis for TDM in those who are unable to swallow
capsules. In this phase IV study (NCT01371331) of children undergoing
liver, kidney, or heart transplantation, patients received tacrolimus
granules 0.15 mg/kg twice daily; first dose was administered within 24
hours of reperfusion. PK analysis samples were collected after
reperfusion, after first dose of tacrolimus (Day 1), and at steady state
(Day 7; >4 days stable dose). Of the 52 transplant recipients enrolled, 38
had two evaluable PK profiles. Mean AUC<inf>tau</inf> after first dose of
tacrolimus was 211, 97, and 224 hour*ng/mL in liver, kidney, and heart
transplant recipients, respectively; corresponding mean AUC<inf>tau</inf>
at steady state was 195, 208, and 165 hour*ng/mL. C<inf>trough</inf> and
AUC<inf>tau</inf> were positively correlated after first dose of
tacrolimus and at steady state (Pearson's coefficients: r = 0.81 and r =
0.87, respectively). This study demonstrated that C<inf>trough</inf> is a
reliable marker for TDM in pediatric transplant recipients treated with
tacrolimus granules, consistent with TDM for other tacrolimus
formulations.<br/>Copyright &#xa9; 2019 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<44>
Accession Number
623831954
Title
Risk stratification and role for additional diagnostic testing in patients
with acute chest pain and normal high-sensitivity cardiac troponin levels.
Source
PLoS ONE. 13 (9) (no pagination), 2018. Article Number: e0203506. Date of
Publication: September 2018.
Author
Smulders M.W.; Bekkers S.C.A.M.; van Cauteren Y.J.M.; Liefhebber A.;
Vermeer J.R.; Vervuurt J.; Van Dieijen-Visser M.P.; Mingels A.M.A.; Rocca
H.-P.B.-L.; Dagnelie P.C.; Wildberger J.E.; Crijns H.J.G.M.; Kietselaer
B.L.J.H.
Institution
(Smulders, Bekkers, van Cauteren, Liefhebber, Vermeer, Vervuurt, Rocca,
Crijns, Kietselaer) Department of Cardiology, Maastricht University
Medical Center, Maastricht, Netherlands
(Smulders, Bekkers, van Cauteren, Van Dieijen-Visser, Mingels, Rocca,
Dagnelie, Wildberger, Crijns, Kietselaer) Cardiovascular Research
Institute Maastricht (CARIM), Maastricht University, Maastricht,
Netherlands
(Bekkers, van Cauteren, Wildberger, Kietselaer) Department of Radiology,
Maastricht University Medical Center, Maastricht, Netherlands
(Van Dieijen-Visser, Mingels) Department of Clinical Chemistry, Maastricht
University Medical Center, Maastricht, Netherlands
(Dagnelie) Department of Epidemiology, Maastricht University, Maastricht,
Netherlands
(Dagnelie) School for Public Health and Primary Care (CAPHRI), Maastricht
University, Maastricht, Netherlands
(Kietselaer) Department of Cardiology, Zuyderland Medical Center7,
Heerlen, Netherlands
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Normal high sensitivity cardiac troponin (hs-cTn) assays rule
out acute myocardial infarction (AMI) with great accuracy, but additional
non-invasive testing is frequently ordered. This observational study
evaluates whether clinical characteristics can contribute to risk
stratification and could guide referral for additional testing. Methods
918 serial patients with acute chest pain and normal hs-cTnT levels were
prospectively included. Major adverse cardiac events (MACE) and
non-invasive test results were assessed during one-year follow-up.
Patients were classified as low and high risk based on clinical
characteristics. Results MACE occurred in 6.1% of patients and mainly
comprised revascularizations (86%). A recent abnormal stress test,
suspicious history, a positive family history and higher baseline hs-cTnT
levels were independent predictors of MACE with odds ratios of 16.00 (95%
CI:6.25-40.96), 16.43 (6.36-42.45), 2.33 (1.22-4.42) and 1.10 (1.01-1.21),
respectively. Absence of both recent abnormal stress test and suspicious
history identified 86% of patients. These patients were at very low risk
for MACE (0.4% in 30-days and 2.3% in one-year). Despite this, the
majority (287/345 = 83%) of additional tests were performed in low risk
patients, with <10% abnormal test findings. The diagnostic yield was
significantly higher in the remaining higher risk patients, 40% abnormal
test findings and a positive predictive value of 70% for MACE. Similar
results were observed in patients without known coronary artery disease.
Conclusions Clinical characteristics can be used to identify low risk
patients with acute chest pain and normal hs-cTnT levels. Current
strategies in the emergency department result in numerous additional
tests, which are mostly ordered in patients at very low risk and have a
low diagnostic yield.<br/>Copyright &#xa9; 2018 Smulders 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.

<45>
Accession Number
624138201
Title
Six months versus 12 months dual antiplatelet therapy after drug-eluting
stent implantation in ST-elevation myocardial infarction (DAPT-STEMI):
Randomised, multicentre, non-inferiority trial.
Source
BMJ (Online). 363 (no pagination), 2018. Article Number: k3793. Date of
Publication: 2018.
Author
Kedhi E.; Fabris E.; Van Der Ent M.; Buszman P.; Von Birgelen C.; Roolvink
V.; Zurakowski A.; Schotborgh C.E.; Hoorntje J.C.A.; Eek C.H.; Cook S.;
Togni M.; Meuwissen M.; Van Royen N.; Van Vliet R.; Wedel H.; Delewi R.;
Zijlstra F.
Institution
(Kedhi, Fabris, Roolvink) Isala Hartcentrum, Isala Klinieken, Zwolle,
Netherlands
(Fabris) Cardiovascular Department, University of Trieste, Trieste, Italy
(Van Der Ent, Van Vliet) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Buszman) American Heart of Poland, Ustro, Poland
(Buszman) Medical University of Silesia, Katowice, Poland
(Von Birgelen, Zijlstra) Thoraxcenter, Erasmus Medisch Centrum, Rotterdam,
Netherlands
(Von Birgelen) University of Twente, Enschede, Netherlands
(Zurakowski) American Heart of Poland, Chrzanow, Poland
(Schotborgh) Haga Hospital, The Hague, Netherlands
(Hoorntje) Zuyderland Medical Centre, Heerlen, Netherlands
(Eek) Department of Cardiology, Oslo Academic University, Oslo, Norway
(Cook, Togni) Department of Cardiology, University and Hospital, Fribourg,
Switzerland
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Van Royen) Department of Cardiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Wedel) Sahlgrenska Academy, University of Gothenburg, Nordic School of
Public Health, Gothenburg, Sweden
(Delewi) Heart Centre, Academic Medical Centre, University of Amsterdam,
Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To show that limiting dual antiplatelet therapy (DAPT) to six
months in patients with event-free ST-elevation myocardial infarction
(STEMI) results in a non-inferior clinical outcome versus DAPT for 12
months. Design Prospective, randomised, multicentre, non-inferiority
trial. Setting Patients with STEMI treated with primary percutaneous
coronary intervention (PCI) and second generation zotarolimus-eluting
stent. Participants Patients with STEMI aged 18 to 85 that underwent a
primary PCI with the implantation of second generation drug-eluting stents
were enrolled in the trial. Patients that were event-free at six months
after primary PCI were randomised at this time point. Interventions
Patients that were taking DAPT and were event-free at six months were
randomised 1:1 to single antiplatelet therapy (SAPT) (ie, aspirin only) or
to DAPT for an additional six months. All patients that were randomised
were then followed for another 18 months (ie, 24 months after the primary
PCI). Main outcome measures The primary endpoint was a composite of all
cause mortality, any myocardial infarction, any revascularisation, stroke,
and thrombolysis in myocardial infarction major bleeding at 18 months
after randomisation. Results A total of 1100 patients were enrolled in the
trial between 19 December 2011 and 30 June 2015. 870 were randomised: 432
to SAPT versus 438 to DAPT. The primary endpoint occurred in 4.8% of
patients receiving SAPT versus 6.6% of patients receiving DAPT (hazard
ratio 0.73, 95% confidence interval 0.41 to 1.27, P=0.26). Non-inferiority
was met (P=0.004 for non-inferiority), as the upper 95% confidence
interval of 1.27 was smaller than the prespecified non-inferiority margin
of 1.66. Conclusions DAPT to six months was non-inferior to DAPT for 12
months in patients with event-free STEMI at six months after primary PCI
with second generation drug-eluting stents. Trial registration
Clinicaltrials.gov NCT01459627.<br/>Copyright &#xa9; Published by the BMJ
Publishing Group Limited. For permission to use (where not already granted
under a licence) please go to.

<46>
Accession Number
2000878518
Title
Safety of FFR-guided revascularisation deferral in Anatomically prognostiC
diseasE (FACE: CARDIOGROUP V STUDY): A prospective multicentre study.
Source
International Journal of Cardiology. 270 (pp 107-112), 2018. Date of
Publication: 1 November 2018.
Author
Barbero U.; D'Ascenzo F.; Campo G.; Kleczynski P.; Dziewierz A.; Menozzi
M.; Jimenez Diaz V.A.; Cerrato E.; Raposeiras-Roubin S.; Ielasi A.;
Rognoni A.; Fineschi M.; Kanji R.; Jaguszewski M.J.; Picchi A.; Ando G.;
Soraci E.; Mancone M.; Sardella G.; Calcagno S.; Gallo F.; Huczek Z.;
Krakowian M.; Verardi R.; Montefusco A.; Omede P.; Lococo M.; Moretti C.;
D'Amico M.; Rigattieri S.; Gaita F.; Rinaldi M.; Escaned J.
Institution
(Barbero, D'Ascenzo, Campo, Kleczynski, Dziewierz, Menozzi, Jimenez Diaz,
Cerrato, Raposeiras-Roubin, Ielasi, Rognoni, Fineschi, Kanji, Jaguszewski,
Picchi, Ando, Soraci, Mancone, Sardella, Calcagno, Gallo, Huczek,
Krakowian, Verardi, Montefusco, Omede, Lococo, Moretti, D'Amico,
Rigattieri, Gaita, Rinaldi, Escaned) Division of Cardiology,
Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Citta della
Salute e della Scienza di Torino, Corso A. M. Dogliotti, 14, Torino 10126,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: FFR-guided coronary intervention is recommended for patients
with intermediate stenoses. However, concerns exist with this approach in
anatomically prognostic disease. <br/>Method(s): In this prospective,
multicentre study, we consecutively enrolled patients found to have FFR
negative lesions in anatomically significant sites: left main; proximal
LAD; last remaining patent vessel; and multiple vessels with concomitant
impaired left ventricular systolic function (EF < 40%). As per
recommendation, revascularisation was deferred, and patients included into
a registry. The primary endpoint was MACE (death, myocardial infarction
and unplanned target lesion revascularization). Secondary endpoints were
the above individual components. Subgroup analyses were performed for
clinical presentation (stable vs. ACS), localization of lesion (ostial vs.
non ostial) and renal function. <br/>Result(s): The registry included 292
patients with 297 deferred stenoses. After 1-year, the primary endpoint
occurred in 5% of patients, mainly driven by TLR (2.7%). Cardiovascular
death occurred in 0.8% and AMI in 0.8%. During a follow-up of 22.2 +/- 11
months, MACE occurred in 11.6%. Cardiovascular death occurred in 1.8% and
AMI in 2.1%. After multivariate analysis, impaired renal function (OR
1.99; CI 95% 1.74-5.41; p = 0.046) and ostial disease (OR 2.88; CI 95%
1.04-7.38; p = 0.041) were found to be predictors of MACE. Impaired renal
function also predicted TLR (OR 2.43; CI 95% 1.17-5.02; p = 0.017).
<br/>Conclusion(s): FFR-guided revascularisation deferral is safe in the
majority of anatomically prognostic disease. However, further evaluation
is required in the risk stratification of those patients with ostial
disease and renal disease. Registered on ClinicalTrials,
NCT02590926.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<47>
Accession Number
618243389
Title
Performance of the Minto model for the target-controlled infusion of
remifentanil during cardiopulmonary bypass.
Source
Anaesthesia. 72 (10) (pp 1196-1205), 2017. Date of Publication: October
2017.
Author
Cho Y.J.; Jo W.Y.; Oh H.; Koo C.-H.; Oh J.; Cho J.-Y.; Yu K.-S.; Jeon Y.;
Kim T.K.
Institution
(Cho, Jo, Oh, Jeon, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Koo) CHA Bundang Medical Centre, Department of Anaesthesiology and Pain
Medicine, Seongnam-si, South Korea
(Oh, Cho, Yu) Department of Clinical Pharmacology and Therapeutics, Seoul
National University College of Medicine and Hospital, Seoul, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We studied the predictive performance of the Minto pharmacokinetic model
during cardiopulmonary bypass in patients undergoing cardiac surgery.
Patients received remifentanil target-controlled infusion using the Minto
model during total intravenous anaesthesia with propofol. From 56
patients, 275 arterial blood samples were drawn before, during and after
bypass to determine the plasma concentration of remifentanil, and the
predicted concentrations were recorded at each time. For pooled data, the
median prediction error and median absolute prediction error were 21.3%
and 21.8%, respectively, and 22.1% and 22.3% during bypass. Both were
148.4% during hypothermic circulatory arrest and measured concentrations
were more than three times greater than predicted (26.9 (17.0) vs. 7.1
(1.6) ng.ml^-1). The Minto model showed considerable bias but
overall acceptable precision during bypass. The target concentration of
remifentanil should be reduced when using the Minto model during
hypothermic circulatory arrest.<br/>Copyright &#xa9; 2017 The Association
of Anaesthetists of Great Britain and Ireland

<48>
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.

<49>
Accession Number
623636185
Title
A comparison of haemostatic biomarkers during low-risk patients undergoing
cardiopulmonary bypass using either conventional centrifugal cell salvage
or the HemoSep device.
Source
Perfusion (United Kingdom). 34 (1) (pp 76-83), 2019. Date of Publication:
01 Jan 2019.
Author
Boyle G.; Kuffel A.; Parmar K.; Gibson K.; Smith M.; Grehan A.; Hunt B.J.;
Chambers D.J.
Institution
(Boyle, Grehan) Clinical Perfusion Department, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Kuffel, Parmar, Hunt) Thrombosis & Vascular Biology Group, The Rayne
Institute, United Kingdom
(Gibson, Smith) Cardiovascular Research, Guy's and St Thomas' NHS
Foundation Trust, St Thomas' Hospital, United Kingdom
(Hunt) Thrombosis & Haemophilia, Guy's & St Thomas' NHS Foundation Trust,
St Thomas' Hospital, United Kingdom
(Chambers) Cardiothoracic Surgery/Cardiac Surgical Research, The Rayne
Institute, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital,
United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardiac surgery using cardiopulmonary bypass (CPB) is
associated with a coagulopathy due to haemodilution, thrombocytopenia and
platelet dysfunction and the activation of coagulation and fibrinolysis,
despite the use of large doses of unfractionated heparin. Conventional red
cell salvage may exacerbate post-operative bleeding as plasma containing
haemostatic factors is discarded. We hypothesized that a novel cell
salvage device (HemoSep) may attenuate haemostatic changes associated with
red cell salvage. We studied haemostatic markers following autologous
transfusion from conventional cell salvage or the HemoSep device.
<br/>Method(s): This randomised, controlled trial compared haemostatic
markers in patients undergoing coronary artery bypass grafting or aortic
valve replacement who received autologous blood returned from cell salvage
(control) or HemoSep (study). Blood samples were taken pre-operatively,
end of CPB, post-transfusion of salvaged blood and 3 hours
post-operatively and analysed for full blood count (FBC), prothrombin time
(PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer
and endogenous thrombin potential (ETP). <br/>Result(s): Fifty-four
patients were recruited (n=28 control, n=26 study). Processed blood volume
for transfusion was significantly (p<0.001) higher in the HemoSep group.
In the HemoSep group, the PT was shorter (18.7+/-0.3 vs 19.9+/-0.3 sec;
p<0.05) post-operatively and the aPTT was longer (48.6+/-3.8 vs 37.3+/-1.0
sec; p<0.01) following autologous transfusion. In the control group,
D-dimer and ETP levels were higher (1903+/-424 vs.1088+/-151; p<0.05 and
739+/-46 vs. 394+/-60; p<0.001, respectively) following autologous
transfusion. <br/>Conclusion(s): Although centrifuged cell salvage is
known to adequately haemoconcentrate and remove unwanted substrates and
bacteriological contamination, the process can exacerbate coagulopathy.
The HemoSep device demonstrated some increase in haemostatic markers when
used in low-risk cardiac surgery patients.<br/>Copyright &#xa9; The
Author(s) 2018.

<50>
Accession Number
2001407955
Title
Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary
Review of 103 Published Cases.
Source
Clinical Lung Cancer. 20 (2) (pp e152-e157), 2019. Date of Publication:
March 2019.
Author
McGehee E.; Gerber D.E.; Reisch J.; Dowell J.E.
Institution
(McGehee, Gerber, Dowell) Department of Internal Medicine, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Gerber, Reisch) Department of Clinical Sciences, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Gerber, Dowell) Harold C. Comprehensive Cancer Center, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Dowell) Veterans Affairs, North Texas Health Care System, Dallas, TX,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Primary pericardial mesothelioma (PPM) is a rare cancer for which there is
no consensus on treatment. We evaluated and summarized a large
contemporary population of published PPM cases to characterize risk
factors, treatment patterns, and clinical outcomes. Using Ovid and PubMed,
literature published from 2000 through 2016 was searched using the terms
"primary pericardial mesothelioma," "pericardial mesothelioma," and
"malignant pericardial mesothelioma." We identified 6 case series and 84
case reports for a total of 103 PPM cases published from 2000 through
2016. The median age at diagnosis was 55 years, and the median overall
survival was 6 months. In univariate analyses of clinical characteristics
including gender, asbestos exposure, tobacco use, prior radiation
exposure, histologic subtype, and metastasis and/or mediastinal spread,
only the presence of metastasis and/or mediastinal spread was a
significant predictor of decreased survival (P = .015). Surgery did not
provide a statistically significant survival benefit (P = .12). A survival
benefit was noted in those who received chemotherapy (median survival, 13
months vs. 0.5 months, P = .002), specifically chemotherapy with a
platinum agent with or without pemetrexed. In multivariate analysis, only
the receipt of chemotherapy was associated with improved survival. PPM
remains a rare and poorly understood malignancy with unclear etiology and
a poor prognosis. In this retrospective systematic review, a survival
benefit was seen in patients who received chemotherapy.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<51>
Accession Number
2000972670
Title
Effects of Nicorandil Versus Nitroglycerin on Arterial Oxygenation During
Two-Lung Ventilation and One-Lung Ventilation in Patients With Risk
Factors for Myocardial Ischemia: A Prospective, Randomized, Double-Blind
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 702-709),
2019. Date of Publication: March 2019.
Author
Murakami C.; Kawano H.; Kinoshita M.; Kondo A.; Inoue M.
Institution
(Murakami, Kawano, Kinoshita, Kondo, Inoue) Department of Anesthesiology,
Tokushima Prefectural Central Hospital, Tokushima, Japan
Publisher
W.B. Saunders
Abstract
Objectives: To compare the effects of nicorandil and nitroglycerin on
arterial oxygenation during two-lung ventilation (TLV) and one-lung
ventilation (OLV) in patients with risk factors for myocardial ischemia.
<br/>Design(s): A prospective, randomized, double-blind study.
<br/>Setting(s): A tertiary care hospital. <br/>Participant(s): Fifty-six
patients scheduled for elective video-assisted thoracic surgery were
assigned randomly to either the nicorandil group or the nitroglycerin
group. <br/>Intervention(s): Patients in the nicorandil group received a
bolus dose of nicorandil, 0.08 mg/kg during induction of anesthesia,
followed by a continuous infusion at a rate of 0.08 mg/kg/h. Patients in
the nitroglycerin group received a continuous infusion of nitroglycerin at
a rate of 1 micro&#32;g/kg/min from the induction of anesthesia.
<br/>Measurements and Main Results: Arterial blood gas analysis was
performed at the following points: before induction of anesthesia; during
TLV; at 5, 10, 20, and 30 minutes after the initiation of OLV.
PaO<inf>2</inf> at TLV (479.7 +/- 57.1 v 408.2 +/- 70.9 mmHg, p < 0.001);
and at 5 minutes (344.8 +/- 85.1 v 282.6 +/- 85.8 mmHg, p = 0.012), 20
minutes (215.7 +/- 103.0 v 158.2 +/- 74.5 mmHg, p = 0.027), and 30 minutes
(198.8 +/- 103.5 v 147.5 +/- 64.1 mmHg, p = 0.039) after OLV was
significantly higher in the nicorandil group than in the nitroglycerin
group. <br/>Conclusion(s): This study demonstrated that oxygenation during
TLV and OLV was significantly higher in patients receiving nicorandil than
in those receiving nitroglycerin.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<52>
Accession Number
2001149356
Title
Intravenous and Inhaled Milrinone in Adult Cardiac Surgery Patients: A
Pairwise and Network Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 663-673),
2019. Date of Publication: March 2019.
Author
Rong L.Q.; Rahouma M.; Abouarab A.; Di Franco A.; Calautti N.M.;
Fitzgerald M.M.; Arisha M.J.; Ibrahim D.A.; Girardi L.N.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Calautti, Fitzgerald, Arisha, Ibrahim, Pryor) Department of
Anesthesiology, Weill Cornell Medicine, New York, NY, United States
(Rahouma, Abouarab, Di Franco, Girardi, Gaudino) Department of
Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
Publisher
W.B. Saunders
Abstract
Objective: To summarize the evidence on the hemodynamic,
echocardiographic, and clinical effects of inhaled and intravenous
milrinone (iMil and IvMil) in adult cardiac surgery patients.
<br/>Design(s): Systematic review, pairwise and network meta-analysis.
<br/>Setting(s): Multi-institutional. <br/>Participant(s): Adult cardiac
surgery patients. <br/>Intervention(s): Comparison between iMil and IvMil
versus other agents or placebo. <br/>Measurements and Main Results: The
primary endpoints were mean pulmonary artery pressure (MPAP) and
peripheral vascular resistance (PVR). Secondary endpoints included the
following: (1) mean arterial pressure, heart rate, and cardiac index (CI);
(2) echocardiographic data; and (3) clinical outcomes. Random model,
leave-one-out-analysis, and meta-regression were used. Thirty studies (6
iMil and 24 IvMil) were included for a total of 1,438 patients (194 iMil
and 521 IvMil). IvMil was associated with a lower MPAP, lower PVR, and
higher CI compared to placebo (standardized mean difference [SMD] = -0.22
[95% CI = -0.48 to 0.05], SMD = -0.49 [95% CI = -0.71 to -0.27], and SMD =
0.94 [95% CI = 0.51 to 1.37]). No difference in any outcome was found
between iMil and placebo. At network meta-analysis, significantly lower
PVR and shorter hospital length of stay were found for IvMil compared to
iMil (SMD = -0.82 [95% CI = -1.53 to -0.10] and SMD = -0.50 [95% CI =
-0.95 to -0.05], respectively). <br/>Conclusion(s): These results support
the clinical use of IvMil in cardiac surgery patients. No evidence at
present supports the adoption of iMil.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<53>
Accession Number
2000778461
Title
Palliative Care for Patients With Advanced Heart Disease.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 833-843),
2019. Date of Publication: March 2019.
Author
Klinedinst R.; Kornfield Z.N.; Hadler R.A.
Institution
(Klinedinst) Division of Palliative Care, Department of Medicine, Hospital
of the University of Pennsylvania, Philadelphia, PA, United States
(Kornfield, Hadler) Department of Anesthesiology and Critical Care,
Hospital of the University of Pennsylvania, Philadelphia, PA, United
States
Publisher
W.B. Saunders
Abstract
Over the past 2 decades, the discipline of palliative care has evolved and
expanded such that it is now the standard of care for a variety of acute
and chronic processes. Although there are recommendations encouraging
incorporation of palliative care into the routine management of patients
with chronic cardiac processes, such as congestive heart failure,
implementation has been challenging, and nowhere more so than in the
cardiac surgical population. However, as the boundaries of surgical care
have expanded to include progressively more complex cases, increasing
attention has been given to the integration of palliative care into their
management. In this review article, the authors describe the existing
evidence for palliative care team involvement in patients with
non-operative and surgical cardiac diseases and examine future directions
for growth in this field.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<54>
Accession Number
2001589904
Title
Minimally Invasive coronary surgery compared to STernotomy coronary artery
bypass grafting: The MIST trial.
Source
Contemporary Clinical Trials. 78 (pp 140-145), 2019. Date of Publication:
March 2019.
Author
Guo M.H.; Wells G.A.; Glineur D.; Fortier J.; Davierwala P.M.; Kikuchi K.;
Lemma M.G.; Mishra Y.K.; McGinn J.; Ramchandani M.; Rabindra P.; Nambala
S.; Chiu K.M.; Kiaii B.; Gibson S.; Ruel M.
Institution
(Guo, Glineur, Fortier, Gibson, Ruel) Division of cardiac surgery,
University of Ottawa Heart Institute, Ottawa, Canada
(Wells) Department of Epidemiology, University of Ottawa, Ottawa, Canada
(Davierwala) Division of cardiovascular surgery, Herzzentrum Leipzig,
Leipzig, Germany
(Kikuchi) Division of cardiac surgery, Wuhan Asian Heart Hospital, Wuhan,
China
(Lemma) Division of cardiac surgery, Jilin Heart Hospital, Jilin, China
(Mishra) Division of cardiac surgery, Fortis Escorts Heart Institute, New
Delhi, India
(McGinn) Division of cardiothoracic surgery, Carolinas Medical Center,
Charlotte, United States
(Ramchandani) Division of cardiothoracic surgery, Houston Methodist,
Houston, United States
(Rabindra) Division of cardiothoracic surgery, Gundersen Lutheran Medical
Center, La Crosse, United States
(Nambala) Division of cardiac surgery, Apollo Hospital, Bangalore, India
(Chiu) Division of cardiac surgery, Far Eastern Memorial Hospital, Taipei,
Taiwan (Republic of China)
(Kiaii) Division of cardiac surgery, London Health Sciences Center,
London, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rationale: Minimally invasive cardiac surgery has emerged as a safe
alternative to standard cardiac surgery. Minimally invasive coronary
surgery (MICS CABG) was developed to allow adequate exposure and complete
revascularization in CABG from a small thoracotomy incision without
cardiopulmonary bypass. Multiple studies have reported significant shorter
length of hospital stay and earlier postoperative physical recovery for
MICS CABG patients when compared to sternotomy CABG patients. However,
there have been no convincing clinical trials that demonstrate improvement
in post-operative quality of life for patients who undergo MICS CABG.
Study design: The Minimally Invasive Coronary Surgery compared to
Sternotomy Coronary Artery Bypass Grafting (MIST) trial is a
multi-centered, prospective randomized controlled trial that compares the
quality of life and recovery in the early post-operative period between
patients undergoing MICS CABG versus patients undergoing sternotomy CABG.
Patients will be randomized either to the MICS CABG group or the
sternotomy CABG group, and the target enrollment is 88 patients per group.
The primary outcome is quality of life assessment performed by SF-36
questionnaire at 1 month. <br/>Conclusion(s): The MIST trial is the first
prospective study that compares the quality of life between MICS CABG and
sternotomy CABG patients. The results of this trial may enhance the
procedural desirability of MICS CABG by patients and provide an incentive
for surgeons and institutions to increase the availability of MICS CABG in
suitable patients.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<55>
Accession Number
623035616
Title
Low systolic blood pressure for predicting all-cause mortality in patients
hospitalised with heart failure: a systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 26 (4) (pp 439-443), 2019. Date
of Publication: 01 Mar 2019.
Author
Zhang Y.; Wang C.; Zhang J.; Zhang H.; Yin Z.; Chen Y.; Xie Q.
Institution
(Zhang, Wang, Zhang, Zhang, Yin, Chen) Department of Cardiology, Shanghai
Ninth People's Hospital, China
(Xie) School of Foreign Studies, Shanghai University of Finance and
Economics, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<56>
Accession Number
626465839
Title
Outcomes of patients with and without baseline lipid-lowering therapy
undergoing revascularization for left main coronary artery disease:
Analysis from the EXCEL trial.
Source
Coronary Artery Disease. 30 (2) (pp 143-149), 2019. Date of Publication:
01 Mar 2019.
Author
Chen S.; Redfors B.; Liu Y.; Vrolix M.; Macaya C.; Ben-Yehuda O.;
Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Chen, Redfors, Liu, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, Columbia University Medical Center,
1700 Broadway, New York, NY 10019, United States
(Ben-Yehuda, Stone) Division of Cardiology, NewYork-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden
(Vrolix) Ziekenhuis Oost Limburg, Genk, Belgium
(Macaya) Hospital Clinico de San Carlos, Madrid, Spain
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives There is a paucity of data on the effect of baseline
lipid-lowering therapy (LLT) in patients undergoing revascularization for
left main (LM) coronary artery disease (CAD). We compared outcomes for
patients with LMCAD randomized to percutaneous coronary intervention (PCI)
or coronary artery bypass grafting (CABG) according to the presence of
baseline LLT in the EXCEL trial. Patients and methods The EXCEL trial
randomized 1905 patients with LMCAD and SYNTAX scores up to 32 to PCI with
everolimus-eluting stents versus CABG. Patients were categorized according
to whether they were medically treated with LLT at baseline, and their
outcomes were examined using multivariable Cox proportional hazards
regression. The primary endpoint was a composite of death, stroke, or
myocardial infarction at 3 years. Results Among 1901 patients with known
baseline LLT status, 1331 (70.0%) were medically treated with LLT at
baseline. There were no significant differences between the PCI and CABG
groups in the 3-year rates of the primary endpoint in patients with versus
without baseline LLT (P interaction =0.62). Among patients with baseline
LLT, the 3-year rate of ischemia-driven revascularization was higher after
PCI compared with CABG (13.7 vs. 5.3%; adjusted hazard ratio=2.97; 95%
confidence interval: 1.95-4.55; P<0.0001), in contrast to patients without
baseline LLT (9.8 vs. 12.1%; adjusted hazard ratio=0.79; 95% confidence
interval: 0.47-1.33; P=0.39) (P interaction =0.0003). Conclusion In the
EXCEL trial, 3-year major adverse event rates after PCI versus CABG for
LMCAD were similar and consistent in patients with and without LLT at
baseline; however, revascularization during follow-up was more common
after PCI compared with CABG in patients with baseline LLT, but not in
those without baseline LLT.<br/>Copyright &#xa9; 2019 Wolters Kluwer
Health, Inc.

<57>
Accession Number
626464946
Title
Omission of aspirin in patients taking oral anticoagulation after
percutaneous coronary intervention: A systematic review and meta-analysis.
Source
Coronary Artery Disease. 30 (2) (pp 109-115), 2019. Date of Publication:
01 Mar 2019.
Author
Zhang J.; Wang Z.; Sang W.; Wei M.; Xu F.; Chen Y.
Institution
(Zhang, Wang, Sang, Wei, Xu, Chen) Department of Emergency Medicine and
Chest Pain Center, Qilu Hospital, Shandong University, No. 107,Wen Hua Xi
Road, Jinan, Shandong 250012, China
(Zhang, Wang, Sang, Wei, Xu, Chen) Clinical Research Center for Emergency
and Critical Care Medicine of Shandong Province, Institute of Emergency
and Critical Care Medicine, Jinan, China
(Zhang, Wang, Sang, Wei, Xu, Chen) Key Laboratory of Emergency and
Critical Care Medicine of Shandong Province, Key Laboratory of
Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province,
Jinan, China
(Zhang, Wang, Sang, Wei, Xu, Chen) Key Laboratory of Cardiovascular
Remodeling and Function Research, Chinese Ministry of Education, Chinese
Ministry of Health, Chinese Academy of Medical Sciences, Jinan, China
(Zhang, Wang, Sang, Wei, Xu, Chen) State and Shandong Province Joint Key
Laboratory of Translational Cardiovascular Medicine, Shandong University,
Jinan, China
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background There is no consensus on optimal antiplatelet and
anticoagulation therapy after coronary stenting. Methods We identified
randomized controlled trials (RCTs) published in PubMed, Cochrane Library,
and Embase using the following keywords: 'antiplatelet', 'dual therapy',
'triple therapy', 'antithrombosis', 'indication for anticoagulation',
'percutaneous coronary intervention', and 'RCTs'. Primary safety end
points were relative bleeding events, and secondary efficacy end points
were major adverse cardiovascular events including stent thrombosis,
death, myocardial infarction, and stroke. Results We identified three RCTs
including 5387 patients, of whom 2719 (50.5%) received dual therapy (DT)
and 2668 (49.5%) received triple therapy. Relative to triple therapy, DT
was associated with lower Thrombolysis in Myocardial Infarction major
bleeding [risk ratio (RR): 0.58; 95% confidence interval (CI): 0.42-0.82],
Thrombolysis in Myocardial Infarction minor bleeding (RR: 0.46; 95% CI:
0.34-0.62), and clinical bleeding events (RR: 0.61; 95% CI: 0.47-0.81).
There was no significant difference for the secondary efficacy end point.
In subgroup analyses, results were similar by sex, bleeding risk, and
stent type; however, DT appeared suitable for patients aged less than 75
years but not more than or equal to 75 years, implying that there may be
no ideal therapy for patients older than 75 years to balance the risk of
ischemia and bleeding at the same time. Conclusion Among patients with an
indication for oral anticoagulation after percutaneous coronary
intervention, DT appears to be the optimal strategy.<br/>Copyright &#xa9;
2019 Wolters Kluwer Health, Inc. All rights reserved.

<58>
Accession Number
622485032
Title
Effect of levosimendan on clinical outcomes in adult patients undergoing
cardiac surgery: A meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (6) (pp 1016-1026),
2018. Date of Publication: 01 Jun 2018.
Author
Zhou X.; Hu C.; Xu Z.; Liu P.; Zhang Y.; Sun L.; Wang Y.; Gao X.
Institution
(Zhou, Xu, Liu, Zhang, Wang) Department of Intensive Care Unit, Ningbo No.
2 Hospital, Ningbo, Zhejiang 315000, China
(Hu) Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou, China
(Sun) Department of Geriatrics, Ningbo No. 2 Hospital, Ningbo, China
(Gao) Department of Cardiology, Hangzhou First People's Hospital,
Hangzhou, China
Publisher
Oxford University Press
Abstract
It is currently unknown whether levosimendan can improve clinical outcomes
in patients undergoing cardiac surgery. This meta-analysis aimed to assess
the effect of levosimendan on mortality and the duration of intensive care
unit (ICU) and hospital stay in adult patients undergoing cardiac surgery.
A comprehensive search for eligible articles was conducted in PubMed, OVID
and Cochrane databases of clinical trials and the Web of Science from
database inception to August 2017. Stata/SE 11.0 was used to calculate the
pooled odds ratio for postoperative mortality and the pooled standardized
mean difference (SMD) for the duration of ICU stay and hospital stay. A
total of 30 randomized controlled trials were included in the final
analysis; the pooled results indicated that perioperative administration
of levosimendan was associated with a reduction in postoperative mortality
[5.8% vs 8.5%; odds ratio 0.66, 95% confidence interval 0.50-0.86, P =
0.002; I 2 = 17.1%; 25 trials; 3239 patients] and length of ICU stay (SMD
-0.32, 95% CI -0.58 to 0.06, P = 0.017; I 2 = 88.0%; 23 trials; 2536
patients) compared with the control group but not in length of hospital
stay (SMD -0.41, 95% CI -0.89 to 0.07, P = 0.094; I 2 = 95.9%; 18 trials;
2047 patients). A subanalysis was conducted for trials published after
2015, and it suggested that levosimendan could not reduce the
postoperative mortality (odds ratio = 0.91, 95% CI 0.63-1.31, P = 0.626; I
2 = 0.9%), length of ICU stay (SMD -0.03, 95% CI -0.32 to 0.27, P = 0.850;
I 2 = 81.2%) or length of hospital stay (SMD 0.06, 95%CI -0.43 to 0.54, P
= 0.821; I 2 = 91.3%). To summarize, the evidence from studies published
in the last 3 years indicated that perioperative administration of
levosimendan was not associated with better clinical outcomes in adult
patients undergoing cardiac surgery.<br/>Copyright &#xa9; The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<59>
Accession Number
622485027
Title
Influence of external stenting on venous graft flow parameters in coronary
artery bypass grafting: A randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (6) (pp 926-931),
2018. Date of Publication: 01 Jun 2018.
Author
Amin S.; Werner R.S.; Madsen P.L.; Krasopoulos G.; Taggart D.P.
Institution
(Amin, Krasopoulos, Taggart) Nuffield Department of Surgical Sciences,
University of Oxford, Oxford, United Kingdom
(Amin, Krasopoulos, Taggart) Department of Cardiovascular Surgery, Oxford
University Hospitals Trust, University of Oxford, John Radcliffe Hospital,
Headley Way, Headington, Oxford OX3 9DU, United Kingdom
(Werner) Department of Thoracic Surgery, University Hospital Zurich,
Zurich, Switzerland
(Madsen) Department of Cardiology, Copenhagen University Hospital, Herlev,
Denmark
Publisher
Oxford University Press
Abstract
OBJECTIVES Long-term patency of saphenous vein grafts (SVGs) remains a
concern after coronary artery bypass grafting. Interventions to overcome
this problem include monitoring intraoperative flow profile and, more
recently, external stenting of SVGs. It is not known to what extent
external stenting changes the perioperative flow characteristics of SVGs.
The aim of this study was to assess whether the presence of an external
stent affects perioperative graft flow parameters as evaluated by transit
time flowmetry. METHODS Thirty-five patients were included from 1 centre
participating in a multicentre, randomized clinical trial of external
stenting of SVGs. Patients were eligible if scheduled for on-pump
multivessel coronary artery bypass grafting including planned SVGs to both
the right and the left coronary territories. Each patient received
external stenting of a single SVG randomly allocated intraoperatively to
either coronary territory. The primary end-points were mean graft flow,
pulsatility index, percentage of diastolic filling and percentage of
backward flow in stented versus non-stented SVGs. RESULTS External
stenting was performed in 17 SVGs supplying the left territory (20
non-stented SVGs for control) and in 18 SVGs supplying the right territory
(18 non-stented SVGs for control). No significant difference was found in
flow parameters between stented and non-stented SVGs in the overall group
or between pre-defined groups of SVGs supplying the right and left
territories, respectively. CONCLUSIONS External stenting of SVGs do not
affect intraoperative flow parameters significantly. CLINICAL TRIAL
REGISTRATION clinicaltrials.gov identifier: NCT02511834.<br/>Copyright
&#xa9; The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<60>
Accession Number
626525309
Title
Intravenous iron does not effectively correct preoperative anaemia in
cardiac surgery: a pilot randomized controlled trial.
Source
Interactive cardiovascular and thoracic surgery. 28 (3) (pp 447-454),
2019. Date of Publication: 01 Mar 2019.
Author
Padmanabhan H.; Siau K.; Nevill A.M.; Morgan I.; Cotton J.; Ng A.; Brookes
M.J.; Luckraz H.
Institution
(Padmanabhan, Siau, Brookes) Department of Gastroenterology, Royal
Wolverhampton NHS Trust, Wolverhampton, United Kingdom
(Nevill) Faculty of Education, Health and Wellbeing, University of
Wolverhampton, Wolverhampton, United Kingdom
(Morgan, Luckraz) Department of Cardiothoracic Surgery, Heart & Lung
Centre, Wolverhampton, United Kingdom
(Cotton) Department of Cardiology, Heart & Lung Centre, Wolverhampton,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart & Lung Centre,
Wolverhampton, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Preoperative anaemia is a strong predictor of blood
transfusion requirements and must be assessed for appropriate optimization
before elective surgery. Iron therapy is a transfusion-sparing approach
effective for increasing haemoglobin concentrations. However, its role in
elective cardiac surgery and the optimal route of administration remain
unknown. This single-centre, non-blinded, randomized, controlled trial
compared the effectiveness of intravenous ferric carboxymaltose therapy
with oral iron for anaemic patients undergoing elective cardiac surgery.
<br/>METHOD(S): Fifty anaemic patients scheduled for elective cardiac
surgery were randomized to receive either oral or intravenous iron therapy
3-8weeks preoperatively. Changes in haemoglobin concentration were
measured. Blood transfusion and postoperative outcome data were collected.
<br/>RESULT(S): Preoperative median increases in haemoglobin were 1.0g/l
(interquartile range -3.25 to 7.25 g/l) and 3.0g/l (interquartile range
-1.25 to 6.25 g/l) for patients receiving intravenous and oral iron,
respectively (P=0.42). The median first 12-h blood loss was significantly
higher in the intravenous group (655ml; interquartile range 162-1540ml)
compared to the oral group (313ml; interquartile range 150-1750ml;
P<0.007). Median increments in serum ferritin were superior for the
intravenous group (median difference 313micro&#32;g/l; interquartile range
228-496) compared to the oral group (median difference 5.5micro&#32;g/l;
interquartile range -1.4 to 19.4; P<0.001). <br/>CONCLUSION(S): Increases
in ferritin after intravenous iron administration were significantly
greater than those after oral iron administration. There was no
significant difference in haemoglobin increments between groups. Despite
significantly higher intraoperative blood loss in the group receiving
intravenous iron, blood transfusion requirements for both groups were not
statistically different. CLINICAL TRIAL REGISTRATION:
ISRCTN22158788.<br/>Copyright &#xa9; The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<61>
Accession Number
626524528
Title
Is the modified single-patch repair superior to the double-patch repair of
complete atrioventricular septal defects?.
Source
Interactive cardiovascular and thoracic surgery. 28 (3) (pp 427-431),
2019. Date of Publication: 01 Mar 2019.
Author
Fong L.S.; Winlaw D.S.; Orr Y.
Institution
(Fong, Winlaw, Orr) University of Sydney Children's Hospital Westmead
Clinical School, Australia
(Fong, Winlaw, Orr) Department of Cardiothoracic Surgery, Heart Centre for
Children, Children's Hospital at Westmead, Sydney, NSW, Australia
(Winlaw, Orr) Sydney Children's Hospital Network, Sydney, NSW, Australia
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, 'Is the modified
single-patch repair superior to the double-patch repair of complete
atrioventricular septal defects?'. A total of 634 papers were found using
the reported search, of which 9 represented the best evidence to answer
the clinical question, which included 1 meta-analysis and 8 cohort
studies. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
were tabulated. There was limited high-quality evidence available, with
all the included studies being retrospective and observational in nature.
One meta-analysis and 8 cohort studies provided evidence that there was no
significant difference in survival or other postoperative outcomes based
on a surgical technique during follow-up ranging from 6months to 4.2years.
Surgical reintervention for development of left ventricular outflow tract
obstruction, left atrioventricular valve dysfunction or residual septal
defects after the initial repair of complete atrioventricular septal
defect was not significantly different between cohorts in almost all
studies. Cardiopulmonary bypass and aortic cross-clamp times were
significantly shorter with the modified single-patch repair compared to
the double-patch repair in all studies that examined these variables, but
this did not correspond to a difference in outcomes. We conclude, based on
the available evidence, that the modified single-patch repair of complete
atrioventricular septal defect is similar to the double-patch repair in
terms of postoperative outcomes. However, this conclusion is limited by
the retrospective nature of all studies, small cohort sizes and short
durations of follow-up in addition to lack of statistical analysis in 1
study.<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<62>
Accession Number
626524307
Title
Myectomy with mitral valve repair versus replacement in adult patients
with hypertrophic obstructive cardiomyopathy: a systematic review and
meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 28 (3) (pp 465-472),
2019. Date of Publication: 01 Mar 2019.
Author
Afanasyev A.; Bogachev-Prokophiev A.; Lenko E.; Sharifulin R.; Ovcharov
M.; Kozmin D.; Karaskov A.
Institution
(Afanasyev, Bogachev-Prokophiev, Lenko, Sharifulin, Ovcharov, Karaskov)
New surgical technology, National Medical Research Center, Novosibirsk,
Russian Federation
(Kozmin) Cardiac surgery department, Federal Center for Cardiovascular
Surgery, Astrakhan, Russian Federation
Publisher
NLM (Medline)
Abstract
We evaluated the differences in mitral valve (MV) plasty (MVP) and MV
replacement (MVR) with respect to death, postoperative MV dysfunction,
reoperation rates and thromboembolic events (DFRE) in patients with
hypertrophic obstructive cardiomyopathy and systolic anterior motion of
the anterior mitral leaflet-mediated MV regurgitation (HOCM & MR). We
followed the Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines, searching PubMed, Cochrane library and
ClinicalTrials.gov for studies that evaluated DFRE in adults with HOCM &
MR after MVP/MVR. We used a risk of bias assessment tool for
non-randomized studies, and analyses were performed using Cochrane Review
Manager 5.3.5 for I2 statistics, funnel plots and forest plot and the
generic inverse variance method for hazard ratios (HRs). We developed
qualitative and quantitative syntheses of 35 and 23 studies, respectively,
including levels of evidence of 1/2/3/4/5=3/1/11/11/9 and
1/2/3/4/5=0/1/11/11/0, respectively, from January 1980 to August 2017. A
statistically significant difference between MVP and MVR favoured MVP for
the prevention of DFRE in patients with HOCM & MR, on the basis of a
significant reduction of the HR for DFRE: HR=0.68 (0.57, 0.82), I2=68%
(P=0.002). The findings were as follows: (i) MVP should be the first-line
treatment in patients with HOCM & MR (accuracy LEVEL A) and (ii) MVR may
be harmful if it is used as the first-line treatment (accuracy LEVEL
A).<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<63>
Accession Number
626523459
Title
Epidural analgesia versus paravertebral block in video-assisted
thoracoscopic surgery.
Source
Interactive cardiovascular and thoracic surgery. 28 (3) (pp 404-406),
2019. Date of Publication: 01 Mar 2019.
Author
Harky A.; Clarke C.G.; Kar A.; Bashir M.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester, Chester,
United Kingdom
(Clarke) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Kar) Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's
Hospital, London, United Kingdom
(Bashir) Department of Aortovascular Surgery, Manchester Royal Infirmary,
Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In patients undergoing
video-assisted thoracoscopic surgery, is paravertebral block (PVB)
superior to epidural analgesia (EP) in terms of pain control and its
postoperative complication rates? Altogether, 153 papers were found using
the reporting search, of which 4 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. At present, there are a limited
number of studies directly comparing pain control and postoperative
outcomes between PVB and EP, and no large-scale randomized trials have
been reported. Three of the 4 papers are small prospective randomized
trials, with a small cohort study featuring as the final piece of
literature. There is no conclusive body of evidence to recommend either
route as more efficacious from a pain control perspective; one study
demonstrated significantly lower levels of pain with EP (P=0.01), with a
second study demonstrating significantly better pain control with PVB
(P<0.01) and a third failing to demonstrate any significant difference
(P=0.899). The frequency of requiring supplemental analgesia was similar
between the PVB and EP cohorts (56% vs 48%, P=0.26). PVB is associated
with lower rates of postoperative complications compared to EP,
specifically urinary retention (64% vs 34.6%, P=0.0036) and hypotension
(32% vs 7%, P=0.0031; 21% vs 3%, P=0.02). In summary, PVBs appear to offer
an equivalent level of analgesic effect following video-assisted
thoracoscopic surgery, with a more favourable side-effect profile,
compared to EP. This does need to be contextualized in light of the
scarcity of published material, with the available studies each containing
a small number of participants.<br/>Copyright &#xa9; The Author(s) 2018.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<64>
Accession Number
2001632235
Title
Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac
surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Bardia A.; Blitz D.; Dai F.; Hersey D.; Jinadasa S.; Tickoo M.;
Schonberger R.B.
Institution
(Bardia, Blitz, Schonberger) Department of Anesthesiology, Yale School of
Medicine, New Haven, Conn, United States
(Dai) Department of Biostatistics, Yale School of Public Health, New
Haven, Conn, United States
(Hersey) Science Libraries, Scholarly Collections and Research Services,
Princeton University, Princeton, NJ, United States
(Jinadasa) Department of Surgery, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, Mass, United States
(Tickoo) Pulmonary and Critical Care Medicine, Department of Internal
Medicine, Yale School of Medicine, New Haven, Conn, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Postoperative pneumonia is one of the most common complications
after cardiac surgery, entailing increased patient morbidity, mortality,
and health care burden. The primary aim of this study was to assess
whether preoperative chlorhexidine mouthwash is associated with reduced
postoperative pneumonia after cardiac surgery. <br/>Method(s): A
comprehensive systematic search of NLM Pubmed, Embase, Scopus, and
Cumulative Index of Nursing and Allied Health was executed to include the
studies since inception to June 27, 2017, which assessed the effects of
preoperative chlorhexidine gluconate mouthwash on postoperative pneumonia.
Studies were identified by 2 independent reviewers, and data were
extracted using a predefined protocol. Random effects models were run to
obtain risk ratios with 95% confidence intervals. Quality of evidence was
evaluated using Grading of Recommendations Assessment, Development and
Evaluation criteria. Postoperative pneumonia after cardiac surgery was the
primary outcome of the study. <br/>Result(s): Five studies including a
cumulative of 2284 patients were included. A total of 1125 patients
received preoperative chlorhexidine. Use of chlorhexidine gluconate was
associated with reduced risk of postoperative pneumonia compared with the
patients who did not receive it (risk ratio, 0.52; 95% confidence
interval, 0.39-0.70; P <.001). No adverse effects from chlorhexidine
gluconate mouthwash were reported by any of these studies.
<br/>Conclusion(s): Among the patients receiving preoperative
chlorhexidine mouthwash, the risk of postoperative pneumonia is reduced by
approximately one-half; its adoption in preoperative protocols could help
improve patient outcomes.<br/>Copyright &#xa9; 2019 The American
Association for Thoracic Surgery

<65>
Accession Number
2001630099
Title
Outcomes of Evolut R Versus CoreValve After Transcatheter Aortic Valve
Implantation: A Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Sun Y.; Li J.; Fan R.; Li G.; Fu M.; Luo S.; Ding H.; Luo J.
Institution
(Sun, Li, Li, Fu, Luo, Ding, Luo) Department of Cardiology, Vascular
Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key
Laboratory of Coronary Heart Disease Prevention, Guangdong General
Hospital, Guangdong Academy of Medical Sciences, Hong Kong
(Fan) Department of Cardiovascular Surgery, Vascular Center, Guangdong
Cardiovascular Institute, Guangdong Provincial Key Laboratory of South
China Structural Heart Disease, Guangdong General Hospital, Guangdong
Academy of Medical Sciences, Hong Kong
Publisher
Elsevier Ltd
Abstract
Background: Superiority of the new-generation, self-expanding Evolut R
compared with the first-generation CoreValve on outcomes after
transcatheter aortic valve implantation (TAVI) is unclear. This
meta-analysis sought to investigate the outcomes of Evolut R vs CoreValve
after TAVI. <br/>Method(s): A systematic review of studies comparing
outcomes of Evolut R and CoreValve after TAVI was performed through
PubMed, EMBASE and Cochrane Library. Crude risk ratios (RRs) were
calculated with 95% confidence intervals using a random effects model.
Outcomes of interest were mortality, myocardial infarction (MI), stroke or
transient ischaemic attack (TIA), severe bleeding, acute kidney injury
(AKI), major vascular complications (MVC), permanent pacemaker
implantation (PPI), moderate or severe paravalvular regurgitation (PVR),
and device failure. <br/>Result(s): Six studies involving 11,530 patients
(4,597 receiving Evolut R and 6,933 receiving CoreValve) were included.
There was no significant difference in 30-day all-cause mortality between
Evolut R and CoreValve (3.4% vs 5.0%, p = 0.10). The incidence of MI (0.2%
vs 0.5%, p = 0.02), AKI (6.0% vs 9.2%, p = 0.001), moderate or severe PVR
(6.4% vs 8.0%, p = 0.04), and device failure (3.5% vs 5.2%, p = 0.04) were
significantly lower in Evolut R than CoreValve. There were trends toward
less severe bleeding (7.2% vs 8.8%, p = 0.05) and PPI (18.6% vs 20.8%, p =
0.05) in Evolut R. The rates of stroke or TIA and MVC were similar between
the two prostheses. <br/>Conclusion(s): Compared with CoreValve, Evolut R
did not reduce 30-day all-cause mortality, but significantly improved
periprocedural complications after TAVI.<br/>Copyright &#xa9; 2019
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<66>
Accession Number
2001593954
Title
Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST
Guideline and Expert Panel Report.
Source
Chest. 155 (3) (pp 565-586), 2019. Date of Publication: March 2019.
Author
Klinger J.R.; Elliott C.G.; Levine D.J.; Bossone E.; Duvall L.; Fagan K.;
Frantsve-Hawley J.; Kawut S.M.; Ryan J.J.; Rosenzweig E.B.; Sederstrom N.;
Steen V.D.; Badesch D.B.
Institution
(Klinger) Brown University, Providence, RI, United States
(Elliott) Intermountain Healthcare and the University of Utah School of
Medicine, Murray, UT, United States
(Levine) University of Texas Health Science Center at San Antonio, San
Antonio, TX, United States
(Bossone) A. Cardarelli Hospital, Naples, Italy
(Duvall) OhioHealth/The Ohio State University, Columbus, OH, United States
(Fagan) University of South Alabama, Mobile, AL, United States
(Frantsve-Hawley) CHEST, Glenview, IL, United States
(Kawut) Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, United States
(Ryan) University of Utah, Salt Lake City, UT, United States
(Rosenzweig) Columbia University Medical Center, New York, NY, United
States
(Sederstrom) Children's Hospitals and Clinics of Minnesota, Minneapolis,
MN, United States
(Steen) Georgetown University Medical Center, Washington, DC, United
States
(Badesch) University of Colorado School of Medicine, Aurora, CO, United
States
Publisher
Elsevier Inc
Abstract
Background: Pulmonary arterial hypertension (PAH) carries a poor prognosis
if not promptly diagnosed and appropriately treated. The development and
approval of 14 medications over the last several decades have led to a
rapidly evolving approach to therapy, and have necessitated periodic
updating of evidence-based treatment guidelines. This guideline statement,
which now includes a visual algorithm to enhance its clinical utility,
represents the fourth iteration of the American College of Chest
Physicians Guideline and Expert Panel Report on Pharmacotherapy for PAH.
<br/>Method(s): The guideline panel conducted an updated systematic review
to identify studies published after those included in the 2014 guideline.
A systematic literature search was conducted using MEDLINE via PubMed and
the Cochrane Library. The quality of the body of evidence was assessed for
each critical or important outcome of interest using the Grading of
Recommendations Assessment, Development and Evaluation approach. Graded
recommendations and ungraded consensus-based statements were developed and
voted on using a modified Delphi technique to achieve consensus.
<br/>Result(s): Two new recommendations on combination therapy and two
ungraded consensus-based statements on palliative care were developed. An
evidence-based and consensus-driven treatment algorithm was created to
guide the clinician through an organized approach to management, and to
direct readers to the appropriate area of the document for more detailed
information. <br/>Conclusion(s): Therapeutic options for the patient with
PAH continue to expand through basic discovery, translational science, and
clinical trials. Optimal use of new treatment options requires prompt
evaluation at an expert center, utilization of current evidence-based
guidelines, and collaborative care using sound clinical
judgment.<br/>Copyright &#xa9; 2019 American College of Chest Physicians

<67>
Accession Number
626235914
Title
Compliance with ethical standards in the reporting of donor sources and
ethics review in peer-reviewed publications involving organ
transplantation in China: A scoping review.
Source
BMJ Open. 9 (2) (no pagination), 2019. Article Number: e024473. Date of
Publication: 01 Feb 2019.
Author
Rogers W.; Robertson M.P.; Ballantyne A.; Blakely B.; Catsanos R.;
Clay-Williams R.; Fiatarone Singh M.
Institution
(Rogers) Department of Clinical Medicine and Department of Philosophy,
Macquarie University, Sydney, NSW, Australia
(Rogers) Department of Philosophy, Macquarie University, Sydney, NSW,
Australia
(Robertson) Human Rights Law Foundation, New York, United States
(Ballantyne) Department of Primary Health Care and General Practice,
University of Otago, Wellington, New Zealand
(Blakely, Clay-Williams) Australian Institute of Health Innovation,
Macquarie University, Sydney, NSW, Australia
(Catsanos) SydneyAustralia
(Fiatarone Singh) Faculty of Health Sciences, University of Sydney,
Sydney, NSW, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The objective of this study is to investigate whether papers
reporting research on Chinese transplant recipients comply with
international professional standards aimed at excluding publication of
research that: (1) involves any biological material from executed
prisoners; (2) lacks Institutional Review Board (IRB) approval and (3)
lacks consent of donors. Design Scoping review based on Arksey and
O'Mallee's methodological framework. Data sources Medline, Scopus and
Embase were searched from January 2000 to April 2017. Eligibility criteria
We included research papers published in peer-reviewed English-language
journals reporting on outcomes of research involving recipients of
transplanted hearts, livers or lungs in mainland China. Data extraction
and synthesis Data were extracted by individual authors working
independently following training and benchmarking. Descriptive statistics
were compiled using Excel. Results 445 included studies reported on
outcomes of 85 477 transplants. 412 (92.5%) failed to report whether or
not organs were sourced from executed prisoners; and 439 (99%) failed to
report that organ sources gave consent for transplantation. In contrast,
324 (73%) reported approval from an IRB. Of the papers claiming that no
prisoners' organs were involved in the transplants, 19 of them involved
2688 transplants that took place prior to 2010, when there was no
volunteer donor programme in China. Discussion The transplant research
community has failed to implement ethical standards banning publication of
research using material from executed prisoners. As a result, a large body
of unethical research now exists, raising issues of complicity and moral
hazard to the extent that the transplant community uses and benefits from
the results of this research. We call for retraction of this literature
pending investigation of individual papers.<br/>Copyright &#xa9; Author(s)
(or their employer(s)) 2019.

<68>
Accession Number
2001537578
Title
Uniportal Lung Cancer Surgery: State of the Evidence.
Source
Annals of Thoracic Surgery. 107 (3) (pp 962-972), 2019. Date of
Publication: March 2019.
Author
Sihoe A.D.L.
Institution
(Sihoe) Department of Surgery, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Hong Kong, Hong Kong
(Sihoe) Division of Thoracic Surgery, The University of Hong Kong Shenzhen
Hospital, Shenzhen, China
(Sihoe) Department of Thoracic Surgery, Tongji University Shanghai
Pulmonary Hospital, Shanghai, China
Publisher
Elsevier USA
Abstract
Background: Uniportal video-assisted thoracic surgery (VATS) has generated
much attention in recent years, but questions remain regarding the
adequacy of evidence to support its use in lung cancer surgery. This
review aims to explore what the currently published literature suggests
the role of the uniportal approach may be and to critically appraise that
literature. <br/>Method(s): A systematic review was conducted using the
Ovid Medline database to identify articles related to uniportal VATS.
Articles were selected for review on the basis of ability to provide
original clinical data on the role of uniportal VATS for lung cancer
surgery. <br/>Result(s): The literature search revealed that only some
publications on uniportal VATS provided original clinical data. Twenty-two
articles were selected for review, including 9 case series and 13
comparative studies. No concerns about the safety of the uniportal VATS
were noted. Some but not all comparative studies provided data suggesting
that uniportal VATS may hold advantages over multiportal VATS in some
simple clinical outcomes (such as reduced lengths of stay and
postoperative pain). However, the quantity and quality of evidence thus
far are limited. <br/>Conclusion(s): It remains premature to declare
superiority for uniportal VATS in lung cancer surgery. A higher level of
evidence is needed, especially in investigating objective benefits and
treatment efficacy of the single-incision approach.<br/>Copyright &#xa9;
2019 The Society of Thoracic Surgeons

<69>
Accession Number
626462179
Title
Radial artery versus right internal thoracic artery versus saphenous vein
as the second conduit for coronary artery bypass surgery: A network
meta-analysis of clinical outcomes.
Source
Journal of the American Heart Association. 8 (2) (no pagination), 2019.
Article Number: e010839. Date of Publication: 01 Jan 2019.
Author
Gaudino M.; Lorusso R.; Rahouma M.; Abouarab A.; Tam D.Y.; Spadaccio C.;
Saint-Hilary G.; Leonard J.; Iannaccone M.; D'Ascenzo F.; Di Franco A.;
Soletti G.; Kamel M.K.; Lau C.; Girardi L.N.; Schwann T.A.; Benedetto U.;
Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Rahouma, Abouarab, Leonard, Di Franco, Soletti, Kamel, Lau,
Girardi) Department of Cardio-Thoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Lorusso) Department of Cardio-Thoracic Surgery, Heart & Vascular Centre,
Maastricht University Medical Hospital and CARIM (Cardiovascular Research
Institute Maastricht), Maastricht, Netherlands
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, Canada
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Spadaccio) Institute of Cardiovascular and Medical Sciences, University
of Glasgow, United Kingdom
(Saint-Hilary) Department of Matematical Sciences, Politecnico di Torino,
Turin, Italy
(Iannaccone, D'Ascenzo) Department of Cardiology, Citta della Scienza e
della Salute, University of Turin, Italy
(Schwann) University of Toledo Medical Center, Toledo, OH, United States
(Benedetto) School of Clinical Sciences, Bristol Heart Institute,
University of Bristol, United Kingdom
(Taggart) University of Oxford, United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background There remains uncertainty regarding the second-best conduit
after the internal thoracic artery in coronary artery bypass grafting. Few
studies directly compared the clinical results of the radial artery (RA),
right internal thoracic artery (RITA), and saphenous vein (SV). No network
meta-analysis has compared these 3 strategies. Methods and Results
andEMBASEwere searched for adjusted observational studies and randomized
controlled trials comparing theRA,SV, and/orRITAas the second conduit for
coronary artery bypass grafting. The primary end point was all-cause
long-term mortality. Secondary end points were operative mortality,
perioperative stroke, perioperative myocardial infarction, and deep
sternal wound infection (DSWI). Pairwise and network meta-analyses were
performed. A total of 149902 patients (4 randomized, 31 observational
studies) were included (RA, 16201, SV, 112018, RITA,21683). AtNMA, the use
ofSVwas associated with higher long-term mortality compared with
theRA(incidence rate ratio, 1.23; 95%CI, 1.12-1.34) andRITA(incidence rate
ratio, 1.26; 95%CI, 1.17-1.35). The risk ofDSWIforSVwas similar toRAbut
lower thanRITA(odds ratio, 0.71; 95%CI, 0.55-0.91). There were no
differences for any outcome betweenRITAandRA, althoughDSWItrended higher
withRITA(odds ratio, 1.39; 95%CI, 0.92-2.1). The risk ofDSWIin bilateral
internal thoracic artery studies was higher when the skeletonization
technique was not used. Conclusions The use of theRAor theRITAis
associated with a similar and statistically significant long-term clinical
benefit compared with theSV. There are no differences in operative risk or
complications between the 2 arterial conduits, butDSWIremains a concern
with bilateralITAwhen skeletonization is not used.<br/>Copyright &#xa9;
2019 The Authors. Published on behalf of the American Heart Association,
Inc., by Wiley.

<70>
Accession Number
626516014
Title
Increase in cardiovascular events in patients treated with cholesteryl
ester transfer protein inhibitors is associated with rs1967309
single-nucleotide polymorphism in ADCY9 gene.
Source
Journal of the Hong Kong College of Cardiology. Conference: 26th Annual
Scientific Congress of Hong Kong College of Cardiology. Hong Kong. 26 (1)
(pp 54), 2018. Date of Publication: April 2018.
Author
Fei Y.; Tsoi M.F.; Cheung B.M.Y.
Institution
(Fei, Tsoi, Cheung) Department of Medicine, University of Hong Kong, Hong
Kong
Publisher
Medcom Limited
Abstract
Purpose: The AA genotype of the single-nucleotide polymorphism, rs1967309,
in the ADCY9 gene was associated with reduction in major adverse
cardiovascular events (MACE) by treatment with dalcetrapib, a cholesteryl
ester transfer protein (CETP) inhibitor in the dal-OUTCOMES trial. This
interaction was not found with evacetrapib, another CETP inhibitor, in the
ACCELERATE trial. We performed a meta-analysis to investigate if the
cardiovascular benefit or harm of CETP inhibitors is determined by
polymorphisms in the ADCY9 gene. <br/>Method(s): We searched for trials of
CETP inhibitors that included genotyping of trial subjects and reporting
of MACE, defined as comprising cardiovascular death, myocardial
infarction, stroke, coronary revascularisation, or unstable angina.
Random-effects model was used to pool odds ratios (ORs) and 95% confidence
intervals (CIs). <br/>Result(s): Out of 12 trials identified, two trials
involving altogether 8700 patients were eligible for inclusion in the
meta-analysis. Compared to placebo, CETP inhibition did not reduce MACE in
patients with the AA (OR 0.74; 95% CI: 0.52-1.06) or AG genotype (OR 0.96;
95% CI: 0.83-1.12). In contrast, it increased the risk of MACE in patients
with the GG genotype (OR 1.24; 95% CI: 1.05-1.48, p=0.01).
<br/>Conclusion(s): Our study suggests a significant association between
the ADCY9 SNP rs1967309 and cardiovascular events in patients taking
dalcetrapib and evacetrapib. The previously observed benefit of the AA
genotype is uncertain, but patients with the GG genotype appear to be
harmed by the two CETP inhibitors.

<71>
Accession Number
2001632095
Title
Usefulness of Clopidogrel Loading in Patients Who Underwent Transcatheter
Aortic Valve Implantation (from the BRAVO-3 Randomized Trial).
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Nijenhuis V.J.; ten Berg J.M.; Hengstenberg C.; Lefevre T.; Windecker S.;
Hildick-Smith D.; Kupatt C.; Van Belle E.; Tron C.; Hink H.U.; Colombo A.;
Claessen B.; Sartori S.; Chandrasekhar J.; Mehran R.; Anthopoulos P.;
Deliargyris E.N.; Dangas G.
Institution
(Nijenhuis, ten Berg) Department of Cardiology, St. Antonius hospital,
Nieuwegein, Netherlands
(Hengstenberg, Kupatt) DZHK (German Centre for Cardiovascular Research),
Partner Site Munich Heart Alliance, Munich, Germany
(Hengstenberg) Deutsches Herzzentrum Munchen, Technische Universitat
Munchen, Munich, Germany
(Lefevre) Institut cardiovasculaire Paris Sud, Hopital Prive Jacques
Cartier, Ramsay generale de sante, Massy, France
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Hildick-Smith) Sussex Cardiac Centre-Brighton & Sussex University
Hospitals NHS Trust, Brighton, East Sussex, United Kingdom
(Kupatt) Medizinische Klinik und Poliklinik, Klinikum rechts der Isar,
Technische Universitat Munchen, Munich, Germany
(Van Belle) Department of Cardiology CHU Lille, Inserm, U1011, Univ.
Lille, Institut Pasteur de Lille-EGID, Lille, France
(Tron) Department of Cardiology, Rouen University Hospital, hopital
Charles-Nicolle, Rouen, France
(Hink) Department of Cardiology, Johannes Gutenberg University Hospital,
Mainz, Germany
(Colombo) Department of Cardiology, San Raffaele Hospital, Milan, Italy
(Claessen, Sartori, Chandrasekhar, Mehran) The Zena and Michael A. Wiener
Cardiovascular Institute, The Icahn School of Medicine, Mount Sinai, NY,
United States
(Anthopoulos) The Medicines Company, Zurich, Switzerland
(Deliargyris, Dangas) Science and Strategy Consulting Group, Basking
Ridge, NJ, United States
(Hengstenberg) Division of Cardiology, Department of Internal Medicine II,
Medical University of Vienna, Department of Internal Medicine II, Medical
University of Vienna, Vienna, Austria
(Kupatt) Walter-Brendel-Centre for Experimental Medicine, Ludwig
Maximilian University of Munich, Munich, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
P2Y<inf>12</inf>-inhibitor initiation with clopidogrel using a loading
dose (LD) versus no LD (NLD) provides more rapid inhibition of platelet
activation and reduced risk of ischemic events after coronary stenting.
Whether a similar beneficial effect is achieved in the setting of
transcatheter aortic valve implantation (TAVI) is unknown. We evaluate the
effects of preprocedural clopidogrel LD versus no NLD on 48-hour and
30-day clinical outcomes after TAVI. In the BRAVO-3 trial, 802 patients
with severe aortic stenosis who underwent transfemoral TAVI were
randomized to intraprocedural anticoagulation with bivalirudin or
unfractionated heparin. Administration of clopidogrel LD was left to the
discretion of the treating physician. For this analysis, patients were
stratified according to receiving clopidogrel LD (n = 294, 36.6%) or NLD
(n = 508, 63.4%) before TAVI. LD patients more often received a
self-expandable prosthesis using larger sheaths.
P2Y<inf>12</inf>-inhibitor maintenance therapy pre-TAVI was similar in
patients with LD versus NLD (28.2% vs 33.1%, p = 0.16). LD versus NLD was
associated with similar incidences of major adverse cardiovascular events
(i e., death, myocardial infarction, or stroke) (4.1% vs 4.1%, p = 0.97)
and major bleeding (8.5% vs 7.7%, p = 0.68), but a higher rate of major
vascular complications (11.9% vs 7.1%, p = 0.02). Multivariable adjustment
showed that clopidogrel LD did not affect any of the studied clinical
events, including major vascular complications (odds ratio 0.91, 95%
confidence interval 0.60 to 1.39, p = 0.67). Also patients on clopidogrel
maintenance therapy and thus considered in steady state were not at
reduced risk of major adverse cardiovascular events compared with patients
not on clopidogrel (3.7% vs 5.2%, p = 0.36). In conclusion, in patients
who underwent TAVI, use of clopidogrel LD was associated with higher
vascular complications and otherwise similar clinical events compared to
NLD patients.<br/>Copyright &#xa9; 2019