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<1>
Accession Number
625852891
Title
A systematic review of isolated radial artery harvesting as a conduit for
lower limb bypass grafting.
Source
Vascular. 27 (2) (pp 224-230), 2019. Date of Publication: 01 Apr 2019.
Author
Wee I.; Choong A.M.T.L.
Institution
(Wee, Choong) SingVaSC, Singapore Vascular Surgical Collaborative,
Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Whilst autologous vein conduits have been heralded as the
first-line approach for patients undergoing lower limb bypass grafting
procedures, patients with peripheral arterial occlusive disease may have
exhausted venous options given prior use for cardiac surgery, varicose
vein surgery, or lower limb revascularization. Hence, the use of a radial
artery graft may serve as a viable alternative. <br/>Method(s): The
systematic review was performed in accordance to the Preferred Reporting
Items for Systematic Review and Meta-analysis guidelines. An electronic
search was performed on the following databases: Medline (via PubMed);
EMBASE; Cochrane library to search for relevant publications. A narrative
analysis was conducted. <br/>Result(s): Four publications were included in
this review including two retrospective cohort studies, one case series,
and one case report, with a total of 43 patients. The most common
indication for lower limb bypass grafting was critical limb ischemia, and
the radial artery was chosen as graft conduit, most commonly due to the
absence of suitable arm or leg vein. There was one case of 30-day
mortality and 11 reinterventions. <br/>Conclusion(s): Despite the
encouraging results, the paucity of high-quality studies prevents the
establishment of any firm conclusion. This warrants the need for
appropriately conducted randomized controlled trials to compare the radial
artery graft to autologous vein grafts and prosthetic grafts for lower
limb bypass grafting.<br/>Copyright &#xa9; The Author(s) 2018.

<2>
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Accession Number
622577731
Title
Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve-Guided
Percutaneous Coronary Intervention in Patients with Stable Coronary Artery
Disease.
Source
Circulation. 137 (5) (pp 480-487), 2018. Date of Publication: 30 Jan 2018.
Author
Fearon W.F.; Nishi T.; De Bruyne B.; Boothroyd D.B.; Barbato E.; Tonino
P.; Juni P.; Pijls N.H.J.; Hlatky M.A.
Institution
(Fearon, Nishi, Hlatky) Division of Cardiovascular Medicine, Stanford
Cardiovascular Institute, Stanford University School of Medicine, 300
Pasteur Dr, H2103, Stanford, CA 94305-5218, United States
(Boothroyd) Quantitative Sciences Unit, United States
(Hlatky) Department of Health Research and Policy, United States
(De Bruyne, Barbato) Stanford University School of Medicine, Stanford
Cardiovascular Institute, CA. Cardiovascular Center Aalst, Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Tonino, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Previous studies found that percutaneous coronary intervention
(PCI) does not improve outcome compared with medical therapy (MT) in
patients with stable coronary artery disease, but PCI was guided by
angiography alone. FAME 2 trial (Fractional Flow Reserve Versus
Angiography for Multivessel Evaluation) compared PCI guided by fractional
flow reserve with best MT in patients with stable coronary artery disease
to assess clinical outcomes and cost-effectiveness. <br/>Method(s): A
total of 888 patients with stable single-vessel or multivessel coronary
artery disease with reduced fractional flow reserve were randomly assigned
to PCI plus MT (n=447) or MT alone (n=441). Major adverse cardiac events
included death, myocardial infarction, and urgent revascularization. Costs
were calculated on the basis of resource use and Medicare reimbursement
rates. Changes in quality-adjusted life-years were assessed with utilities
determined by the European Quality of Life-5 Dimensions health survey at
baseline and over follow-up. <br/>Result(s): Major adverse cardiac events
at 3 years were significantly lower in the PCI group compared with the MT
group (10.1% versus 22.0%; P<0.001), primarily as a result of a lower rate
of urgent revascularization (4.3% versus 17.2%; P<0.001). Death and
myocardial infarction were numerically lower in the PCI group (8.3% versus
10.4%; P=0.28). Angina was significantly less severe in the PCI group at
all follow-up points to 3 years. Mean initial costs were higher in the PCI
group ($9944 versus $4440; P<0.001) but by 3 years were similar between
the 2 groups ($16 792 versus $16 737; P=0.94). The incremental
cost-effectiveness ratio for PCI compared with MT was $17 300 per
quality-adjusted life-year at 2 years and $1600 per quality-adjusted
life-year at 3 years. The above findings were robust in sensitivity
analyses. ConclusionS: PCI of lesions with reduced fractional flow reserve
improves long-term outcome and is economically attractive compared with MT
alone in patients with stable coronary artery disease. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01132495.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<3>
Accession Number
625357028
Title
Hybrid Coronary Revascularization vs Complete Coronary Artery Bypass
Grafting for Multivessel Coronary Artery Disease: A Systematic Review and
Meta-Analysis.
Source
Journal of Invasive Cardiology. 30 (12) (pp E131-E149), 2018. Date of
Publication: December 2018.
Author
Nolan S.; Filion K.B.; Atallah R.; Moss E.; Reynier P.; Eisenberg M.J.
Institution
(Nolan, Filion, Atallah, Reynier, Eisenberg) Centre for Clinical
Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill
University, 3755 Cote Ste-Catherine Road, Montreal, QC H3T 1E2, Canada
(Nolan, Filion, Moss, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Filion) Department of Medicine, McGill University, Montreal, QC, Canada
(Moss) Division of Cardiac Surgery, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
Publisher
HMP Communications
Abstract
BACKGROUND: Hybrid coronary revascularization (HCR) has emerged as a
potential alternative to complete coronary artery bypass graft (CABG)
surgery. However, the efficacy and safety of HCR vs CABG remain unclear.
We therefore conducted a systematic review and meta-analysis to compare
these interventions. Methods. We systematically searched PubMed, MEDLINE
(via Ovid), EMBASE (via Ovid), Cochrane Library of Clinical Trials, and
the Web of Science for studies comparing HCR to CABG in patients with
multivessel coronary artery disease. The primary outcome was major adverse
cardiovascular and cerebrovascular events (MACCE) and its components
(myocardial infarction, stroke, mortality, and target-vessel
revascularization [TVR]) at >=1 year. Secondary outcomes included MACCE at
<=30 days, its components, and postoperative safety outcomes (renal
failure, blood transfusion, new-onset atrial fibrillation, and infection).
<br/>RESULT(S): One randomized controlled trial and 9 cohort studies were
included in our systematic review. Pooled results indicate that HCR is
associated with a lower risk for postoperative blood transfusion (odds
ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68) and infection
(OR, 0.19; 95% CI, 0.04-0.98), and a shorter hospital stay (6.0 days for
HCR vs 7.8 days for CABG) and intensive care unit (ICU) stay (25.4 hours
for HCR vs 45.7 hours for CABG). Long-term outcome data showed an
association between HCR and long-term TVR (OR, 3.10; 95% CI, 1.39-6.90).
<br/>CONCLUSION(S): Our results suggest that compared to CABG, HCR is
associated with a lower risk of postoperative blood transfusion and
infection, as well as a shorter ICU stay and hospital stay. HCR was also
associated with a higher risk of long-term TVR.<br/>Copyright &#xa9; 2018
HMP Communications.

<4>
Accession Number
618556258
Title
Transcatheter aortic valve replacement for stenotic bicuspid aortic
valves: Systematic review and meta analyses of observational studies.
Source
Catheterization and Cardiovascular Interventions. 91 (5) (pp 975-983),
2018. Date of Publication: 01 Apr 2018.
Author
Reddy G.; Wang Z.; Nishimura R.A.; Greason K.L.; Yoon S.-H.; Makkar R.R.;
Holmes D.R.
Institution
(Reddy, Wang, Nishimura, Greason, Holmes) Department of Cardiovascular
Diseases, Mayo Clinic, Rochester, MN, United States
(Yoon, Makkar) Department of Cardiovascular Diseases, Cedars Sinai Medical
Center, Los Angeles, CA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of this study was to perform a systematic review and
meta-analyses of observational studies of transcatheter aortic valve
replacement (TAVR) for bicuspid aortic valve stenosis (BcAV).
<br/>Background(s): TAVR for BcAV stenosis has been associated with an
increased incidence of paravalvular leaks, valve malposition, pacemaker
placement and all-cause mortality. The conclusions drawn have been limited
by small sample sizes. The use of TAVR for BcAV stenosis remains
controversial. <br/>Method(s): We searched multiple databases from the
inception of the databases through September 30, 2016 for studies of TAVR
for BcAV stenosis. We included all observational studies with more than
one patient and at least 1 month of outcomes. <br/>Result(s): We analyzed
13 observational studies with 758 patients. Meta analyses showed device
success rate of 95% [95% confidence interval (CI) 90.2% to 98.5%] and an
early safety event in 16.9% [95% CI 12.2% to 22%]. At 30 days, moderate to
severe paravalvular leak was seen in 12.2% [95% CI 3.1% to 24.8%] and new
pacemaker implantation in 17.9% [95% CI 14.2% to 22%]. All-cause mortality
was 3.7% [95% CI 2.1% to 5.6%], which should be viewed in the context of
an STS PROM of 5.0%. <br/>Conclusion(s): This analysis suggests that TAVR
for BcAV is not associated with excess mortality. The incidence of
paravalvular leaks and pacemaker implant is increased compared to
tricuspid aortic valve cohorts undergoing TAVR, and operators should weigh
these potential complications against the clinical benefit provided by
TAVR for BcAV patients at high risk for surgical valve
replacement.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<5>
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Accession Number
616268191
Title
Effect of perioperative statin therapy on renal outcome in patients
undergoing cardiac surgery.
Source
Medicine (United States). 96 (19) (no pagination), 2017. Article Number:
e6883. Date of Publication: 01 May 2017.
Author
Wang S.; Yao H.; Chen C.; Zhou R.; Wang R.; Yu H.; Liu B.
Institution
(Wang, Yao, Yu, Chen, Zhou, Wang, Yu, Liu) Department of Anesthesiology,
West China Hospital of Sichuan University, No. 37 Guoxuexiang, Chengdu,
China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Acute renal injury (AKI) is a common renal complication after
cardiac surgery. The aim of this study was to determine the effect of
perioperative statin therapy (PST) on postoperative renal outcome in
patients undergoing cardiac procedures. <br/>Method(s): We searched for
the reports that evaluating the effect of PST on renal outcomes after
cardiac surgery between March 1983 and June 2016 in the electronic
database Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE/PubMed, and EMBASE/OVID. <br/>Result(s): Nine randomized
controlled trials (RCTs) enrolling 2832 patients, with 1419 in the PST
group and 1413 in the control group, were included in this meta-analysis.
Our results suggested that PST increased the incidence of postoperative
renal complication (relative risk [RR] 1.18, 95% confidence interval [CI]
1.01-1.36, P=.03) with low heterogeneity (I 2 =30%, P=.18). Six studies
with 3116 patients detected no significant difference in severe renal
complication between PST and control groups (RR 1.23, 95%CI 0.84-1.79,
P=.28). Postoperative serum creatinine (sCr) at 48hours was shown to be
higher in the PST group (mean difference [MD] 0.03, 95% CI 0.03-0.03;
P<.01). The length of hospital stay was decreased slightly by 0.59 day in
the PST group (95% CI-0.85 to-0.33; P<.01). <br/>Conclusion(s):
Perioperative statin therapy seems to jeopardize short-term renal outcome
in patients undergoing cardiac surgery, but the occurrence of severe renal
complication was not affected.<br/>Copyright &#xa9; 2017 the Author(s).

<6>
Accession Number
2001618293
Title
Combined primary PCI with multiple thrombus burden reduction therapy
improved cardiac function in patients with acute anterior myocardial
infarction.
Source
International Heart Journal. 60 (1) (pp 27-36), 2019. Date of Publication:
2019.
Author
Wang K.; Zhang J.; Zhang N.; Shen Y.; Wang L.; Gu R.; Xu B.; Ji Y.
Institution
(Wang, Zhang, Zhang, Shen, Wang, Gu, Xu) Department of Cardiology, Drum
Tower Hospital of Nanjing Medical University, Nanjing, China
(Ji) Key laboratory of Cardiovascular & Cerebrovascular Medicine, School
of Pharmacy, Nanjing Medical University, 101 Longmian Road, Nanjing,
Jiangsu 211166, China
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
High thrombus burden induced slow-flow and no-reflow during primary
percutaneous coronary intervention (PCI) and is associated with a poor
prognosis. We aimed to investigate whether a combined thrombus burden
reduction therapy during primary PCI, could improve microcirculation and
enhance cardiac function in the long-term. Anterior wall STEMI patients
with high thrombus burden were randomly assigned to receive a combined
thrombus burden reduction therapy or thrombus aspiration alone. The
primary end points included the percentage of patients with TMPG (TIMI
myocardial perfusion grade) 3, STR (ST-segment resolution) above 70%, the
index of microcirculatory resistance (IMR) and left ventricular ejection
fraction (LVEF) difference. Twenty-two patients in the combined
interventional group and 24 in the control group completed 1-year
follow-up. The percentages of patients with TMPG 3 (68.2% versus 33.3%, P
= 0.006) and STR above 70% (63.6% versus 25%, P = 0.016) were
significantly higher in the combined group. IMR was significantly lower in
the combined interventional group (31.50 +/- 13.39 U versus 62.72 +/-
22.80 U, P = 0.002). At 3 months and 1 year, the overall LVEF value was
better in the combined interventional group (42.1% versus 40.0%, P =
0.049; 41.9% versus 39.8%, P = 0.042), respectively. The IMR value was
negatively correlated with the EF value at 3 months (r = -0.145, P =
0.013) and 1 year (r = -0.333, P = 0.031). A combined thrombus burden
reduction therapy during primary PCI can safely reduce thrombus burden,
improve myocardial tissue perfusion, and improve cardiac function among
STEMI patients with high thrombus burden. IMR might be a good predictor
for post-myocardial infarction cardiac function.<br/>Copyright &#xa9;
2019, International Heart Journal Association. All rights reserved.

<7>
Accession Number
626938672
Title
Congress of neurological surgeons systematic review and evidence-based
guidelines on the evaluation and treatment of patients with thoracolumbar
spine trauma: Novel surgical strategies.
Source
Neurosurgery. 84 (1) (pp E59-E62), 2019. Date of Publication: 01 Jan 2019.
Author
Chi J.H.; Eichholz K.M.; Anderson P.A.; Arnold P.M.; Dailey A.T.; Dhall
S.S.; Harrop J.S.; Hoh D.J.; Qureshi S.; Rabb C.H.; Raksin P.B.; Kaiser
M.G.; O'Toole J.E.
Institution
(Chi, Harrop) Department of Neurosurgery, Harvard Medical School, Brigham
and Women's Hospital, Boston, MA, United States
(Eichholz) St. Louis Minimally Invasive Spine Center, St. Louis, MO,
United States
(Anderson) Department of Orthopedics and Rehabilitation, University of
Wisconsin, Madison, WI, United States
(Arnold) Department of Neurosurgery, University of Kansas School of
Medicine, Kansas City, KS, United States
(Dailey, Rabb) Department of Neurosurgery, University of Utah, Salt Lake
City, UT, United States
(Dhall) Department of Neurological Surgery, University of California, San
Francisco, San Francisco, CA, United States
(Harrop) Department of Neurological Surgery and Orthopedic Surgery, Thomas
Jefferson University, Philadelphia, PA, United States
(Hoh) Lillian S. Wells Department of Neurological Surgery, University of
Florida, Gainesville, FL, United States
(Qureshi) Department of Orthopaedic Surgery, Weill Cornell Medical
College, New York, NY, United States
(Raksin) Division of Neurosurgery, John H. Stroger, Jr Hospital of Cook
County, Department of Neurological Surgery, Rush University Medical
Center, Chicago, IL, United States
(Kaiser) Department of Neurosurgery, Columbia University, New York, NY,
United States
(O'Toole) Department of Neurological Surgery, Rush University Medical
Center, Chicago, IL, United States
Publisher
Oxford University Press
Abstract
BACKGROUND: Treatment of thoracolumbar burst fractures has traditionally
involved spinal instrumentation with fusion performed with standard open
surgical techniques. Novel surgical strategies, including instrumentation
without fusion and percutaneous instrumentation alone, have been
considered less invasive and more efficient treatments. <br/>OBJECTIVE(S):
To review the current literature and determine the role of fusion in
instrumented fixation, as well as the role of percutaneous
instrumentation, in the treatment of patients with thoracolumbar burst
fractures. <br/>METHOD(S): The task force members identified search
terms/parameters and a medical librarian implemented the literature
search, consistent with the literature search protocol (see Appendix I),
using the National Library of Medicine PubMed database and the Cochrane
Library for the period from January 1, 1946 to March 31, 2015.
<br/>RESULT(S): A total of 906 articles were identified and 38 were
selected for full-text review. Of these articles, 12 articles met criteria
for inclusion in this systematic review. <br/>CONCLUSION(S): There is
grade A evidence for the omission of fusion in instrumented fixation for
thoracolumbar burst fractures. There is grade B evidence that percutaneous
instrumentation is as effective as open instrumentation for thoracolumbar
burst fractures. RECOMMENDATIONS: QUESTION: Does the addition of
arthrodesis to instrumented fixation improve outcomes in patients with
thoracic and lumbar burst fractures? RECOMMENDATION: It is recommended
that in the surgical treatment of patients with thoracolumbar burst
fractures, surgeons should understand that the addition of arthrodesis to
instrumented stabilization has not been shown to impact clinical or
radiological outcomes, and adds to increased blood loss and operative
time. Strength of Recommendation: Grade A QUESTION: How does the use of
minimally invasive techniques (including percutaneous instrumentation)
affect outcomes in patients undergoing surgery for thoracic and lumbar
fractures compared to conventional open techniques? RECOMMENDATION:
Stabilization using both open and percutaneous pedicle screws may be
considered in the treatment of thoracolumbar burst fractures as the
evidence suggests equivalent clinical outcomes. Strength of
Recommendation: Grade B The full version of the guideline can be reviewed
at:
https://www.cns.org/guidelinechapters/congress-neurological-surgeons-syste
matic-review-evidence-based-guidelines/chapter 12.<br/>Copyright &#xa9;
2018 by the Congress of Neurological Surgeons.

<8>
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Accession Number
613856650
Title
Heart Rate Turbulence is a Powerful Predictor of Cardiac Death and
Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure
Patients: A Systematic Review and Meta-Analysis.
Source
Circulation: Arrhythmia and Electrophysiology. 9 (12) (no pagination),
2016. Article Number: e004610. Date of Publication: 01 Dec 2016.
Author
Disertori M.; Mase M.; Rigoni M.; Nollo G.; Ravelli F.
Institution
(Disertori, Rigoni, Nollo) Healthcare Research and Innovation Program,
PAT-FBK, Via Sommarive no. 18, Trento 38123, Italy
(Disertori) Department of Cardiology, Santa Chiara Hospital, Trento, Italy
(Mase, Ravelli) Department of Physics, University of Trento, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Heart rate turbulence (HRT) has been proposed as a candidate
marker of altered autonomic tone, and some studies showed its prognostic
value for both cardiac death (CD) and sudden death. Nevertheless, HRT is
not currently used in the clinical practice. Methods and Results - We
performed a systematic review and meta-analysis of the predictive value of
HRT for the end points of total mortality, CD, and fatal and nonfatal
ventricular arrhythmias in postacute myocardial infarction and heart
failure patients. MEDLINE and The Cochrane Library databases were
systematically searched to identify studies, which analyzed the predictive
value of abnormal HRT for the defined end points. Twenty studies (25
cohorts: 12 832 patients) were identified by the systematic review, and 15
studies (20 cohorts: 11 499 patients) were included in the meta-analyses.
Abnormal HRT was a predictive marker for all the end points in heart
failure patients and more markedly in postacute myocardial infarction
patients, where 9 out of the 10 cohorts had an ejection fraction >30%. In
postacute myocardial infarction patients, HRT had pooled risk ratios of
3.53 (95% confidence interval [CI], 2.54-4.90), 4.82 (95% CI, 3.12-7.45),
and 4.48 (95% CI, 3.04-6.60), and positive likelihood ratios of 3.5 (95%
CI, 2.6-4.8), 4.1 (95% CI, 3.0-5.7), and 2.7 (95% CI, 2.2-3.3) for total
mortality, CD, and arrhythmic events, respectively. The combination of
abnormal HRT and T-wave alternans (5 cohorts: 1516 patients) increased the
predictive power for CD and arrhythmic events. Conclusions - HRT is a
powerful predictor of both CD and arrhythmic events, particularly in
postacute myocardial infarction patients with ejection fraction >30%. HRT
power increases in combination with T-wave alternans
analysis.<br/>Copyright &#xa9; 2016 American Heart Association, Inc.

<9>
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Accession Number
613856628
Title
Follow-Up of a Prospective Surgical Strategy to Prevent Intra-Atrial
Reentrant Tachycardia after the Fontan Operation.
Source
Circulation: Arrhythmia and Electrophysiology. 9 (12) (no pagination),
2016. Article Number: e004478. Date of Publication: 01 Dec 2016.
Author
Law I.H.; Alam O.; Bove E.L.; Ohye R.G.; Bradley D.J.; Yu S.; Dick M.
Institution
(Law) Division of Pediatric Cardiology, Department of Pediatrics, Carver
College of Medicine, University of Iowa, Iowa City, United States
(Alam, Bradley, Yu, Dick) Division of Pediatric Cardiology, Department of
Pediatrics and Communicable Diseases, United States
(Bove, Ohye, Dick) Department of Cardiac Surgery, University of Michigan
Medical School, 1540 E Hospital Dr, Ann Arbor, MI 48109, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Intra-atrial reentrant tachycardia (IART) after the Fontan
operation had an early reported incidence of 10% to 35% during early and
intermediate follow-up and posed substantial management challenges.
Methods and Results - To reduce the incidence of IART after the Fontan
procedure, we performed a randomized, double-blind study to evaluate the
impact of an incision in the right atrium joining the lateral tunnel
suture line and the tricuspid valve annulus. Between March 1998 and
September 2003, 134 subjects (median age: 1.8 years; range: 1.3-5.2 years;
91 men) were randomly assigned to receive the incision. All 134 patients
had a form of single ventricle pathological anatomy. The clinical course,
electrocardiograms, and Holter monitoring were available for review in 114
subjects at a median of 8.2-year follow-up (range: 0.9-11.9 years). There
were 2 late deaths, neither subject had IART. The combined incidence of
sustained IART was 3.5% (4/114). There was no difference in the occurrence
of sustained IART between those subjects receiving the incision and those
who did not (2 in each group) during follow-up. No patients of either
group experienced short-term complications. Conclusions - Despite the fact
that the primary outcome of this trial was not reached, the most
significant finding was that with current management, the incidence of
IART is considerably lower than the early retrospective, observational
studies suggested.<br/>Copyright &#xa9; 2016 American Heart Association,
Inc.

<10>
Accession Number
626735698
Title
Intraoperative infusion of noradrenaline improves platelet aggregation in
patients undergoing coronary artery bypass grafting: a randomized
controlled trial.
Source
Journal of Thrombosis and Haemostasis. 17 (4) (pp 657-665), 2019. Date of
Publication: April 2019.
Author
Singh S.; Damen T.; Dellborg M.; Jeppsson A.; Nygren A.
Institution
(Singh, Dellborg, Jeppsson) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Damen, Nygren) Department of Anesthesiology and Intensive Care Medicine,
Institute of Clinical Sciences, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Damen, Nygren) Department of Cardiothoracic Anesthesia and Intensive
Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Blackwell Publishing Ltd
Abstract
Essentials Strategies to improve platelet function may reduce excessive
bleeding during cardiac surgery. Patients were randomized to standard care
or standard care + noradrenaline infusion. Low-dose noradrenaline improved
intraoperative platelet aggregation and clot formation. Noradrenaline may
be considered to improve intraoperative hemostasis during cardiac surgery.
<br/>Summary: Background New approaches to prevent bleeding complications
during cardiac surgery are needed. Objective To investigate if
noradrenaline (NA) enhances platelet aggregation in patients undergoing
coronary artery bypass grafting (CABG). Patients/Methods Twenty-four
patients undergoing coronary artery bypass grafting (CABG) were included
in a prospective parallel-group randomized study. All patients but one
were treated with acetylsalicylic acid (ASA). In the treatment group (n =
12), mean arterial blood pressure (MAP) was maintained at pre-induction
levels by NA infusion. In the control group (n = 12), NA was administered
only if MAP decreased below 60 mmHg. Platelet aggregation (impedance
aggregometry with ADP, arachidonic acid [AA] and thrombin-receptor
activating peptide [TRAP] as initiators) and clot formation (clotting
time, clot formation time and maximum clot firmness by EXTEM, INTEM and
FIBTEM tests with thromboelastometry) were assessed before and 50 min
after anesthesia induction (before cardiopulmonary bypass was initiated).
Results All patients in the treatment group received NA (median dose after
50 min 0.09 (range 0-0.26) mug kg^-1 min^-1). Four
patients in the control group also received NA (0.03-0.12 mug
kg^-1 min^-1). There were differences between the
treatment group and the control group in ADP- and AA-induced aggregation
changes (ADP, +16 [25th-75th percentiles, 5-26] vs. -7 [-19 to -1] U; AA,
+12 [-4 to 16] vs. -9 [-13 to 1] U). INTEM maximum clot firmness increased
in the treatment group but not in the control group. Conclusion Infusion
of clinically relevant doses of NA enhanced platelet aggregation and clot
firmness in ASA-treated CABG patients. NA infusion is hence a potential
new method to acutely improve platelet reactivity in patients on
antiplatelet therapy undergoing surgery.<br/>Copyright &#xa9; 2019
International Society on Thrombosis and Haemostasis

<11>
Accession Number
626733829
Title
Multivessel coronary revascularization strategies in patients with chronic
kidney disease: A meta-analysis.
Source
CardioRenal Medicine. 9 (3) (pp 145-159), 2019. Date of Publication: 01
Mar 2019.
Author
Wu P.; Luo F.; Fang Z.
Institution
(Wu, Luo, Fang) Department of Cardiovascular Medicine, Second Xiangya
Hospital, Central South University, Changsha, Hunan 410011, China
Publisher
S. Karger AG
Abstract
Background: Early revascularization can lead to better prognosis in
multivessel coronary artery disease (CAD) patients with chronic kidney
disease (CKD). However, whether coronary artery bypass grafting (CABG) or
percutaneous coronary intervention (PCI) is better remains unknown.
<br/>Method(s): We searched PubMed and the Cochrane Library database from
inception until December 9, 2017, for articles that compare outcomes of
CABG and PCI in multivessel CAD patients with CKD. We pooled the odds
ratios with a fixed-effects model when I² < 50% or a
random-effects model when I² > 75% and conducted heterogeneity
and quality assessments as well as publication bias analyses.
<br/>Result(s): A total of 17 studies with 62,343 patients were included.
Compared with CABG, the pooled analysis showed that PCI had a lower risk
of short-term all-cause death (OR, 0.56; 95% CI, 0.37-0.84) and
cerebrovascular accidents (OR, 0.65; 95% CI, 0.53-0.79) but a higher risk
of cardiac death (OR, 1.29; 95% CI, 1.21-1.37), myocardial infarction (MI)
(OR, 1.73; 95% CI, 1.35-2.21), and repeat revascularization (RR) (OR, 3.9;
95% CI, 2.99-5.09). There was no significant difference in the risk of
long-term all-cause death (OR, 1.08; 95% CI, 0.95-1.23) and major adverse
cardiac and cerebrovascular events (MACCE) (OR, 1.58; 95% CI, 0.99-2.52)
between the PCI and CABG groups. A subgroup analysis restricted to
patients treated with dialysis or with PCI-drug-eluting stent yielded
similar results. <br/>Conclusion(s): PCI for patients with CKD and
multivessel disease (multivessel CAD) had advantages over CABG with regard
to short-term all-cause death and cerebrovascular accidents, but
disadvantages regarding the risk of myocardial death, MI, and RR; there
was no significant difference in the risk of long-term all-cause death and
MACCE. Large randomized controlled trials are needed to confirm our
findings.<br/>Copyright &#xa9; 2019 S. Karger AG, Basel. All rights
reserved.

<12>
Accession Number
2001617457
Title
A randomized trial of acupressure on pain management after cardiac
surgery.
Source
International Journal of Clinical and Experimental Medicine. 12 (2) (pp
1731-1738), 2019. Article Number: IJCEM0075778. Date of Publication: 2019.
Author
Sen S.; Aygin D.
Institution
(Sen, Aygin) Sakarya University, Health Science Institute, Serdivan,
Sakarya 54050, Turkey
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
This randomized controlled study aimed to determine the effects of
acupressure on pain management after cardiac surgery. The sample included
100 patients who underwent cardiac surgery, divided into two groups: the
intervention group (n=50), who received acupressure and daily nursing
care, and the control group (n=50), who only received daily nursing care.
Randomization was done by assigning the patients in even-numbered rooms to
the intervention group and assigning the patients in odd-numbered rooms to
the control group. In the postoperative period, the severity of pain was
evaluated using the Visual Analogue Scale (VAS) for 3 days starting from
the day that the patients returned to the clinic. Acupressure application
decreased the level of pain by 1.86 points in the intervention group in
comparison to 0.38 points in the control group. It was found that the
acupressure intervention had a significant effect on relieving
postoperative pain after cardiac surgery in the intervention group
(P<0.001), while the difference in the control group was not statistically
significant (P>0.05). Moreover, in the intervention group, acupressure was
found to be 59.2% effective for pain management (P<0.001).<br/>Copyright
&#xa9; 2019, E-Century Publishing Corporation. All rights reserved.

<13>
Accession Number
2001765138
Title
Sex difference and outcome after percutaneous intervention in patients
with chronic total occlusion: A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Mannem S.; Rattanawong P.; Riangwiwat T.; Vutthikraivit W.; Putthapiban
P.; Sukhumthammarat W.; Kanitsoraphan C.; Chongsathidkiet P.
Institution
(Mannem) The Queen's Medical Center, Honolulu, HI, United States
(Rattanawong, Riangwiwat, Kanitsoraphan) University of Hawaii Internal
Medicine Residency Program, Honolulu, HI, United States
(Rattanawong) Faculty of Medicine Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
(Vutthikraivit) Department of Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, United States
(Putthapiban, Sukhumthammarat) Department of Medicine, Einstein Medical
Center, Philadelphia, PA, United States
(Chongsathidkiet) Department of Pathology, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Recent studies suggest that sex difference is an outcome
predictor in chronic total occlusion (CTO) patients who are undergoing
percutaneous intervention (PCI). However, a systematic review and
meta-analysis of the literature have not been done. We assessed the
outcome of PCI in CTO between male and female. <br/>Method(s): We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to September 2017. Included studies were published cohort
(prospective or retrospective) and case control studies of CTO patients
who underwent PCI that compared successful procedure and major cardiac
event (MACE), including cardiac death, target vessel revascularization,
myocardial infarction, and stroke, between male and female. Data from each
study were combined using the random-effects, generic inverse variance
method of DerSimonian and Laird to calculate risk ratios and 95%
confidence intervals. <br/>Result(s): Nine studies were included in this
meta-analysis involving 30,830 CTO subjects (8350 female and 22,480 male)
who underwent PCI. Females were not significantly associated with reduced
risk of MACE (pooled risk ratio = 0.86, 95% confidence interval:
0.66-1.12, p = 0.262, I² = 47.0%) as well as successful rate of
PCI (pooled risk ratio = 1.04, 95% confidence interval: 0.99-1.10, p =
0.161, I² = 76.6%) in CTO patients who underwent PCI.
<br/>Conclusion(s): Our study suggests that sex is not an independent risk
factor of MACE or successful procedure in CTO patients who underwent
PCI.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<14>
Accession Number
620755833
Title
Simulation-Based Skill Training for Trainees in Cardiac Surgery: A
Systematic Review.
Source
Annals of Thoracic Surgery. 105 (3) (pp 972-982), 2018. Date of
Publication: March 2018.
Author
Ribeiro I.B.; Ngu J.M.C.; Lam B.-K.; Edwards R.A.
Institution
(Ribeiro, Ngu, Lam) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, Ontario, Canada
(Edwards) Center for Interprofessional Studies and Innovation,
Massachusetts General Hospital Institute of Health Professions, Boston,
Massachusetts, United States
Publisher
Elsevier USA
Abstract
Background: Simulation-based training has been an important part of the
solution to address the shortfalls in cardiac surgery training. This
review was conducted to identify and systematically summarize existing
evidence on outcomes and methodological quality of simulation-based skills
training for cardiac surgery trainees. <br/>Method(s): MEDLINE, Embase,
and ERIC (Education Resources Information Center) databases were searched.
Studies included peer-reviewed publications with simulation-based skill
training in cardiac surgery programs with outcome measures of performance.
Data extraction covered the type of skills training, simulator type and
fidelity, the level of trainees, assessment tools, assessors, study design
and its components, strengths and limitations, and elements required for
the Medical Education Research Study Quality Instrument score. The review
followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. <br/>Result(s): Of 16 studies that met the
criteria, only four (25%) randomized controlled trials were identified,
and the remaining were observational studies. Seven observational studies
(43.7%) were single-group pre-post tests. The mean number of trainees was
20.4 (SD, 14.1). Low-fidelity simulators were used in 13 studies (81.2%).
Most of the studies (81.3%) were high quality based on a Medical Education
Research Study Quality Instrument score of 12 or more. Evidence of
assessment tool validation was absent among all studies. No study outcome
measures were directed to skills transfer to the operating room or patient
outcomes. Overall learning outcomes' effect sizes were consistently high
(2.2; SD, 1.6), with junior residents benefitting most (effect size, 2.8;
SD, 2.2) <br/>Conclusion(s): Simulation-based skill training is associated
with improved learning outcomes for cardiac surgery trainees with large
effect sizes, but more behavior-level outcomes are required to fully
assess its value.<br/>Copyright &#xa9; 2018 The Society of Thoracic
Surgeons

<15>
Accession Number
623740753
Title
Randomized controlled trial of a self-administered five-day antiseptic
bundle versus usual disinfectant soap showers for preoperative eradication
of Staphylococcus aureus colonization.
Source
Infection Control and Hospital Epidemiology. 39 (9) (pp 1049-1057), 2018.
Date of Publication: 01 Sep 2018.
Author
Kline S.E.; Neaton J.D.; Lynfield R.; Ferrieri P.; Kulasingam S.; Dittes
K.; Glennen A.; Jawahir S.; Kaizer A.; Menk J.; Johnson J.R.
Institution
(Kline, Dittes, Johnson) University of Minnesota Medical School,
Department of Medicine, Division of Infectious Diseases, 420 Delaware St
SE, MMC# 250, Minneapolis, MN 55455, United States
(Neaton) Division of Biostatistics, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Lynfield, Glennen, Jawahir) Minnesota Department of Health, St Paul, MN,
United States
(Ferrieri) Department of Laboratory Medicine and Pathology, University of
Minnesota Medical School, Minneapolis, MN, United States
(Kulasingam) Division of Epidemiology, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Kaizer, Menk) Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, MN, United States
(Johnson) Veterans Affairs Medical Center, Minneapolis, MN, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective To determine the efficacy in eradicating Staphylococcus aureus
(SA) carriage of a 5-day preoperative decolonization bundle compared to 2
disinfectant soap showers, with both regimens self-administered at
home.Design Open label, single-center, randomized clinical trial.Setting
Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular,
and general surgery clinics at a tertiary-care referral center in the
United States.Participants Patients at the University of Minnesota Medical
Center planning to have elective surgery and not on antibiotics.Methods
Consenting participants were screened for SA colonization using nasal,
throat, axillary, and perianal swab cultures. Carriers of SA were
randomized, stratified by methicillin resistance status, to a
decolonization bundle group (5 days of nasal mupirocin, chlorhexidine
gluconate [CHG] bathing, and CHG mouthwash) or control group (2
preoperative showers with antiseptic soap). Colonization status was
reassessed preoperatively. The primary endpoint was absence of SA at all 4
screened body sites.Results Of 427 participants screened between August
31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers.
Of these, 121 were randomized and 110 were eligible for efficacy analysis
(57 decolonization bundle group, 53 control group). Overall, 90% of
evaluable participants had methicillin-susceptible SA strains. Eradication
of SA at all body sites was achieved for 41 of 57 participants (71.9%) in
the decolonization bundle group and for 13 of 53 participants (24.5%) in
the control group, a difference of 47.4% (95% confidence interval [CI],
29.1%-65.7%; P<.0001).Conclusion An outpatient preoperative antiseptic
decolonization bundle aimed at 4 body sites was significantly more
effective in eradicating SA than the usual disinfectant showers (ie, the
control).Trial Registration ClinicalTrials.gov identifier:
NCT02182115<br/>Copyright &#xa9; 2018 by The Society for Healthcare
Epidemiology of America. All rights reserved.

<16>
Accession Number
619459883
Title
An Absorbable Hydrogel Spray Reduces Postoperative Mediastinal Adhesions
After Congenital Heart Surgery.
Source
Annals of Thoracic Surgery. 105 (3) (pp 837-842), 2018. Date of
Publication: March 2018.
Author
Hasaniya N.; Razzouk A.; Newcombe J.; Hassneiah D.; Heimes J.; Gysbers J.;
Martens T.; Bailey L.
Institution
(Hasaniya, Razzouk, Newcombe, Hassneiah, Heimes, Gysbers, Martens, Bailey)
Department of Cardiovascular and Thoracic Surgery, Loma Linda University
Children's Hospital, Loma Linda, California, United States
Publisher
Elsevier USA
Abstract
Background: Adhesions encountered during reoperative cardiac surgery can
prolong operative time and increase operative risk. The purpose of this
clinical study was to investigate the antiadhesion property of a synthetic
bioabsorbable polymer spray after cardiac reoperations in infants.
<br/>Method(s): A prospective randomized double-blinded study was
designed. Forty infants requiring staged cardiac operations were randomly
allocated to a study group (n = 20) or a control group (n = 20). The
appropriate volume of the polymer was sprayed onto the mediastinal
surfaces before chest closure after the first surgical procedure in the
study group. At reoperation, adhesions were evaluated by a blinded
investigator following a 5-grade scoring system. Five predetermined
anatomic areas were scored. Incision to extracorporeal circulation time
was also analyzed. <br/>Result(s): In all, 40 subjects were enrolled into
the study. Four babies died before the second operation. Three others were
missed for reevaluation. The control group (n = 16) had longer incision to
extracorporeal circulation time (38 +/- 10 minutes) than the study group
(n = 17; 23 +/- 6 minutes; p < 0.001). The control subjects had
significantly more severe adhesions than the study group at all five
mediastinal areas: (1) retrosternal (p < 0.001); (2) base of the heart
(large vessels [p < 0.05]); (3) right side (p < 0.01); (4) left side (p <
0.02); and (5) diaphragmatic side of the mediastinum (p < 0.001).
<br/>Conclusion(s): The use of synthetic bioabsorbable polymer sealant
spray at the end of primary pediatric cardiac surgery reduces the
intensity of mediastinal adhesions and the reentry time in infants
undergoing repeat median sternotomy.<br/>Copyright &#xa9; 2018 The Society
of Thoracic Surgeons

<17>
Accession Number
621391592
Title
Can tolvaptan protect renal function in the early postoperative period of
cardiac surgery?: - Results of a single-center randomized controlled study
-.
Source
Circulation Journal. 82 (4) (pp 999-1007), 2018. Date of Publication:
2018.
Author
Kishimoto Y.; Nakamura Y.; Harada S.; Onohara T.; Kishimoto S.; Kurashiki
T.; Fujiwara Y.; Nishimura M.
Institution
(Kishimoto, Nakamura, Harada, Onohara, Kishimoto, Kurashiki, Fujiwara,
Nishimura) Department of Cardiovascular Surgery, Tottori University
Faculty of Medicine, Yonago, Japan
Publisher
Japanese Circulation Society
Abstract
Background: Oral administration of tolvaptan, a vasopressin V<inf>2</inf>
receptor antagonist, significantly reduces deterioration of renal
function, which has recently been highlighted as an exacerbating factor
for adverse events in patients with acute heart failure. In the present
study we tested the hypothesis that concomitant administration of
tolvaptan with a conventional diuretic is beneficial for perioperative
body fluid management in patients who have undergone cardiac surgery.
<br/>Methods and Results: In all, 280 patients who underwent cardiac
surgery were prospectively randomized to concomitant treatment with
tolvaptan and a conventional diuretic (tolvaptan group; 147 patients) or
treatment with a conventional diuretic alone (control group; 133
patients). Groups were compared in terms of the time required to restore
preoperative body weight and the incidence of worsening renal function
(WRF), defined as an increase in the serum creatinine level >=0.3 mg/dL.
The time required to restore preoperative body weight was significantly
shorter in the tolvaptan than control group (mean [+/-SD] 3.97+/-1.95 vs.
5.02+/-2.83 days, respectively; P<0.001). The incidence of WRF was
significantly lower in the tolvaptan than control group (n=11 [7.5%] vs.
n=25 [18.8%], respectively; P=0.011). <br/>Conclusion(s): Administration
of tolvaptan with conventional diuretics in the early postoperative period
after cardiac surgery could be beneficial in maintaining urine output
without affecting renal function and may thus help avoid
WRF.<br/>Copyright &#xa9; 2018, Japanese Circulation Society. All rights
reserved.

<18>
Accession Number
622127401
Title
Aortic centres should represent the standard of care for acute aortic
syndrome.
Source
European Journal of Preventive Cardiology. 25 (1_suppl) (pp 3-14), 2018.
Date of Publication: 01 Jun 2018.
Author
Mariscalco G.; Maselli D.; Zanobini M.; Ahmed A.; Bruno V.D.; Benedetto
U.; Gherli R.; Gherli T.; Nicolini F.
Institution
(Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Glenfield Hospital, Leicester, United Kingdom
(Maselli) Department of Cardiac Surgery, St. Anna Hospital, Catanzaro,
Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Italy
(Ahmed) Department of Anaesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Bruno, Benedetto) Heart Centre, Bristol University, Bristol, United
Kingdom
(Gherli) Department of Cardiovascular Sciences, Cardiac Surgery Unit, San
Camillo Hospital, Rome, Italy
(Gherli, Nicolini) Division of Cardiac Surgery, University of Parma,
Parma, Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Existing evidence suggests that patients affected by acute
aortic syndromes (AAS) may benefit from treatment at dedicated specialized
aortic centres. The purpose of the present study was to perform a
meta-analysis to evaluate the impact aortic service configuration has in
clinical outcomes in AAS patients. <br/>Method(s): The design was a
quantitative and qualitative review of observational studies. We searched
PubMed/MEDLINE, EMBASE, and Cochrane Library from inception to the end of
December 2017 to identify eligible articles. Areas of interest included
hospital and surgeon volume activity, presence of a multidisciplinary
thoracic aortic surgery program, and a dedicated on-call aortic team.
Participants were patients undergoing repair for AAS, and odds ratios
(ORs) with corresponding 95% confidence intervals (CIs) were adopted for
synthesizing hospital/30-day mortality. <br/>Result(s): A total of 79,131
adult patients from a total of 30 studies were obtained. No randomized
studies were identified. Pooled unadjusted ORs showed that patients
treated in high-volume centres or by high-volume surgeons were associated
with lower mortality rates (OR 0.51; 95% CI 0.46-0.56, and OR 0.41, 95% CI
0.25-0.66, respectively). Pooled adjusted estimates for both high-volume
centres and surgeons confirmed these survival benefits (adjusted OR, 0.56;
95% CI 0.45-0.70, respectively). Patients treated in centres that
introduced a specific multidisciplinary aortic program and a dedicated
on-call aortic team also showed a significant reduction in mortality (OR
0.31; 95% CI 0.19-0.5, and OR 0.37; 95% CI 0.15-0.87, respectively).
<br/>Conclusion(s): We found that specialist aortic care improves outcomes
and decreases mortality in patients affected by AAS.<br/>Copyright &#xa9;
2018, &#xa9; The European Society of Cardiology 2018.

<19>
Accession Number
622127391
Title
The use of RemoweLL oxygenator-integrated device in the prevention of the
complications related to aortic valve surgery in the elderly patient:
Preliminary results.
Source
European Journal of Preventive Cardiology. 25 (1_suppl) (pp 59-65), 2018.
Date of Publication: 01 Jun 2018.
Author
Molardi A.; Di Chicco M.V.; Carino D.; Goldoni M.; Ricci M.; Borrello B.;
Gripshi F.; Gherli T.; Nicolini F.
Institution
(Molardi, Borrello) Department of General and Specialized Surgery, Cardiac
Surgery Unit, University Hospital of Parma, Italy
(Di Chicco, Carino, Goldoni, Ricci, Gripshi, Gherli, Nicolini) Department
of Medicine and Surgery, University Medical School, University of Parma,
Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The effects of fat microembolization due to cardiopulmonary
bypass are well known in cardiac surgery. Our aim is to evaluate the use
of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic
valve replacement in elderly patients (>70 years old) to rate its
biochemical and clinical effects. The RemoweLL device is an
oxygenator-integrated reservoir which combines two strategies for fat
emboli and leucocytes removal: filtration and supernatant elimination.
<br/>Method(s): Forty-four elderly patients were enrolled and assigned
randomly to a Group A (standard device) and a Group B (RemoweLL).
Biochemical effects were evaluated by blood samples, which were tested for
white blood cells, neutrophils, protein SP-100 and interleukin 6 besides
standard lab tests. Our clinical endpoints were any type of neurological,
cardiac, respiratory, gastrointestinal or renal complications, and length
of stay in the intensive care unit. Statistical analysis was carried out
with chi square test for non-parametric data; t test and analysis of
variance for repeated measures were used for parametric data.
<br/>Result(s): Group B showed lower levels of white blood cells,
neutrophils, interleukin 6 and protein SP-100 immediately and 24 hours
after the operation. Group B also showed a lower amount of neurocognitive
type II dysfunction even if the length of stay in the ICU did not change.
<br/>Conclusion(s): The RemoweLL system is safe and effective in reducing
inflammatory response to cardiopulmonary bypass and it could be a useful
tool in minimizing negative effects of cardiopulmonary bypass; however, it
does not seem to have any effect on elderly patients' hospital
stay.<br/>Copyright &#xa9; 2018, &#xa9; The European Society of Cardiology
2018.

<20>
Accession Number
621206174
Title
Effect of hybrid treatment on rehabilitation and clinical condition of
patients with multivessel coronary artery disease.
Source
Polish Archives of Internal Medicine. 128 (2) (pp 77-88), 2018. Date of
Publication: 2018.
Author
Foik J.; Brzek A.; Gierlotka M.J.; Zembala M.O.; Gasior M.; Zembala M.
Institution
(Foik) Department of Rehabilitation, Silesian Center for Heart Diseases,
Zabrze, Poland
(Brzek) Department of Kinesiology, Department of Physiotherapy, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Gierlotka, Gasior) 3rd Department of Cardiology, Medical University of
Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
(Zembala, Zembala) Department of Cardiac Surgery and Transplantation,
Medical University of Silesia, Katowice, Silesian Center for Heart
Diseases, Zabrze, Poland
(Brzek) Wydzial Nauk O Zdrowiu W Katowicach, Zaklad Kinezjologii Katedry
Fizjoterapii, Slaski Uniwersytet Medyczny W Katowicach, ul. Medykow 12,
Katowice 40-754, Poland
Publisher
Medycyna Praktyczna (E-mail: listy@mp.pl)
Abstract
Introduction: Rehabilitation after coronary revascularization procedures
is an intrinsic part of treatment during the in-hospital period.
<br/>Objective(s): We aimed to compare the course and effects of
rehabilitation in patients receiving hybrid treatment (minimally invasive
direct coronary artery bypass / percutaneous coronary intervention) or
classic treatment (coronary artery bypass grafting / off-pump coronary
artery bypass) during hospitalization. Patient s and methods: The study
included 200 patients participating in a prospective randomized clinical
trial (POLMIDES) that assessed the effect of hybrid treatment on
in-hospital outcomes and long-term results in patients with multivessel
coronary artery disease. Patients were divided into the classic and hybrid
groups. Result s: The classic group showed a higher perioperative risk
than the hybrid group (mean [SD] EuroSCORE, 3.54 [2.12] and 2.89 [1.97],
respectively). During all the rehabilitation cycles, lower arterial oxygen
saturation (SaO<inf>2</inf>) was reported in the hybrid group (P = 0.002).
The classic group showed lower systolic blood pressure (P <0.001), lower
diastolic blood pressure (P = 0.029), and a higher rate of blood pressure
drops during rehabilitation (P = 0.02). Patients from the classic group
were able to sit (P <0.001), assume a vertical position (P <0.001), and
walk (P = 0.01) earlier than those from the hybrid group. In the hybrid
group, earlier completion of rehabilitation and discharge from the
hospital were noted (P = 0.001). <br/>Conclusion(s): Patients receiving
hybrid coronary revascularization less often suffer from hypotonia events
but show lower SaO<inf>2</inf> values than patients receiving classic
treatment. Mobilization of patients receiving the hybrid treatment is
slower during the initial days and cycles of rehabilitation, but they
achieve full self-reliance earlier, which enables a shorter
hospitalization period. Copyright by Medycyna Praktyczna, Krakow
2018.<br/>Copyright &#xa9; 2018 Medycyna Praktyczna. All rights reserved.

<21>
[Use Link to view the full text]
Accession Number
611774807
Title
Mind over matter? The hidden epidemic of cognitive dysfunction in the
older surgical patient.
Source
Annals of Surgery. 265 (4) (pp 677-691), 2017. Date of Publication: 01 Apr
2017.
Author
O'Brien H.; Mohan H.; Hare C.O.; Reynolds J.V.; Kenny R.A.
Institution
(O'Brien, Hare, Kenny) Irish Longitudinal Study on Ageing (TILDA), Trinity
College Dublin, Lincoln Gate, Dublin 2, Ireland
(O'Brien, Hare, Kenny) Department of Medical Gerontology, St. James's
Hospital, Trinity College Dublin, Dublin, Ireland
(Mohan) Department of Surgery, Cork University Hospital, Wilton, Co. Cork,
Ireland
(Reynolds) Department of Surgery, St. James's Hospital, Trinity College
Dublin, Dublin, Ireland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: The aim of this study was to highlight the vulnerability of the
aging brain to surgery and anesthesia, examine postoperative cognitive
outcomes, and recommend possible interventions. <br/>Background(s):
Surgeons are facing increasingly difficult ethical and clinical decisions
given the rapidly expanding aging demographic. Cognitive function is not
routinely assessed either preoperatively or postoperatively. Potential
short and long-term cognitive implications are rarely discussed with the
patient despite evidence that postoperative cognitive impairment occurs in
up to 65% of older patients. Furthermore, surgery may accelerate the
trajectory of cognitive decline and dementia. <br/>Method(s): An
electronic search was conducted using Pubmed/Medline. References from
selected studies were cross-referenced and relevant articles retrieved.
Data were summarized in a narrative format. <br/>Result(s): There is a
hidden epidemic of cognitive dysfunction in the perioperative setting. Up
to 40% of patients who develop postoperative delirium (POD) never return
to their preoperative cognitive baseline. POD can lead to postoperative
cognitive dysfunction (POCD), a more prolonged cognitive impairment
associated with longer length of hospital stay and cost, premature
withdrawal from the workforce, and greater 1-year mortality. Standardized
perioperative cognitive assessment is needed to enable progress. Improving
outcomes will depend on a multifaceted approach, including correction of
modifiable preoperative risk factors and prompt treatment of POD. Risk
factors are discussed and possible interventional strategies are
presented. <br/>Conclusion(s): Closer preoperative collaboration between
surgeons, geriatricians, and anesthetists will enable identification of
complex at-risk older patients. A paradigm shift in the approach to
management of the older surgical patient is critical to improve
postoperative cognitive outcomes in modern surgery.<br/>Copyright &#xa9;
2016 Wolters Kluwer Health, Inc.

<22>
Accession Number
2001613449
Title
A prospective randomized controlled double-blind study comparing
auscultation and lung ultrasonography in the assessment of double lumen
tube position in elective thoracic surgeries involving one lung
ventilation at a tertiary care cancer institute.
Source
Korean Journal of Anesthesiology. 72 (1) (pp 24-31), 2019. Date of
Publication: February 2019.
Author
Parab S.Y.; Kumar P.; Divatia J.V.; Sharma K.
Institution
(Parab, Kumar, Divatia, Sharma) Department of Anesthesiology, Critical
Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute,
Mumbai, India
Publisher
Korean Society of Anesthesiologists
Abstract
Background: As lung ultrasound (LUS) can be used to identify regional lung
ventilation and collapse, we hypothesize that LUS can be better than
auscultation in assessing lung isolation and determining double lumen tube
(DLT) position. <br/>Method(s): A randomized controlled study was
conducted in tertiary care cancer institute from November 2014 to December
2015, including 100 adult patients undergoing elective thoracic surgeries.
Patients with tracheostomy, difficult airway and pleural-based pathologies
were excluded. After anesthesia induction and DLT insertion, patients were
randomized into group A (auscultation) and group B (LUS). Regional
ventilation was assessed by experienced anesthesiologists using the
respective method for each group. Final confirmation of DLT position with
a bronchoscope was performed by a blinded anesthesiologist. Contingency
tables were plotted to determine sensitivity, specificity, positive
predictive value (PPV), negative predictive value (NPV), and accuracy for
each method. <br/>Result(s): Data from 91 patients were analyzed (group A
= 47, group B = 44). Compared with auscultation, LUS had significantly
higher sensitivity (94.1% vs. 73.3%, P = 0.010), PPV (57.1% vs. 35.5%, P =
0.044), NPV (93.8% vs. 75.0%, P = 0.018), accuracy (70.5% vs. 48.9%, P =
0.036) and required longer median time (161.5 vs. 114 s, P < 0.001) for
assessment of DLT position. Differences in specificity (55.6% vs. 37.5%, P
= 0.101) and area under curve (0.748; 95% CI: 0.604-0.893 vs. 0.554, 95%
CI: 0.379-0.730; P = 0.109) were not significant. <br/>Conclusion(s):
Compared to auscultation, LUS is a superior method for assessing lung
isolation and determining DLT position.<br/>Copyright &#xa9; The Korean
Society of Anesthesiologists, 2019.

<23>
Accession Number
626935299
Title
There may be a role for addition of rivaroxaban to aspirin in patients
with stable coronary artery disease.
Source
BMJ Evidence-Based Medicine. 24 (2) (pp 78-79), 2019. Date of Publication:
April 2019.
Author
Banerjee A.
Institution
(Banerjee) Farr Institute of Health Informatics, University College
London, London WC1E 6BT, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<24>
Accession Number
623277154
Title
Effects of lowest-dose vs. highest-dose pitavastatin on coronary
neointimal hyperplasia at 12-month follow-up in type 2 diabetic patients
with non-ST elevation acute coronary syndrome: an optical coherence
tomography analysis.
Source
Heart and Vessels. 34 (1) (pp 62-73), 2019. Date of Publication: 22 Jan
2019.
Author
Lim J.W.; Jeong H.S.; Hong S.J.; Kim H.J.; Kim Y.C.; Kang B.G.; Jeon S.M.;
Cho J.Y.; Lee S.H.; Joo H.J.; Park J.H.; Yu C.W.
Institution
(Lim, Jeong, Hong, Kim, Kim, Kang, Jeon, Cho, Lee, Joo, Park, Yu)
Department of Cardiology, Cardiovascular Center, Korea University Anam
Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul 136-705, South Korea
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Current ACC/AHA guidelines recommend high-dose statin therapy after
coronary stenting, especially in diabetic patients; however, pitavastatin
4 mg or pitavastatin 1 mg are frequently used after coronary stenting in
Asia, even in patients with acute coronary syndrome. We compared the
effects of highest-dose and lowest-dose pitavastatin therapy on coronary
neointimal hyperplasia at 12-month follow-up in diabetic patients with
non-ST-elevation acute coronary syndrome (NSTE-ACS) using optical
coherence tomography. A total of 72 diabetic patients with NSTE-ACS were
randomized to lowest-dose pitavastatin [1 mg (n = 36)] or highest-dose
pitavastatin [4 mg (n = 36)] after everolimus-eluting stent implantation.
The primary endpoint was to compare the normalized neointimal volume at
12-month follow-up. Normalized neointimal volume was significantly lower
in the pitavastatin 4 mg group (4.00 +/- 2.80 vs. 8.24 +/- 2.83
mm³/mm, p < 0.01) at 12-month follow-up. There was also
significant difference in neointimal area between the pitavastatin 4 mg
group and pitavastatin 1 mg group (0.41 +/- 0.28 vs. 0.74 +/- 0.23
mm², p < 0.01). Improvement of brachial artery flow-mediated
dilation (baFMD) was significantly higher in the pitavastatin 4 mg group
than in pitavastatin 1 mg group (0.15 +/- 0.15 vs. - 0.03 +/- 0.19 mm, p <
0.001). In addition, the improvement of adiponectin levels was
significantly greater in the pitavastatin 4 mg group than in the
pitavastatin 1 mg group (2.97 +/- 3.98 vs. 0.59 +/- 2.80 mug/mL, p <
0.05). Pitavastatin 4 mg significantly improved inflammatory cytokines and
lipid profiles compared to pitavastatin 1 mg during the 12-month
follow-up, contributing to the reduction of neointimal hyperplasia and to
the improvement of baFMD in diabetic patients with NSTE-ACS requiring
coronary stenting. Thus, the administration of pitavastatin 4 mg can be
safely and effectively used in high-risk patients requiring coronary
stenting. Trial registration NCT02545231 (Clinical Trial registration
information:
https://clinicaltrials.gov/ct2/show/NCT02545231).<br/>Copyright &#xa9;
2018, Springer Japan KK, part of Springer Nature.

<25>
Accession Number
624756885
Title
Circulating delta-like Notch ligand 1 is correlated with cardiac allograft
vasculopathy and suppressed in heart transplant recipients on
everolimus-based immunosuppression.
Source
American Journal of Transplantation. 19 (4) (pp 1050-1060), 2019. Date of
Publication: April 2019.
Author
Norum H.M.; Michelsen A.E.; Lekva T.; Arora S.; Otterdal K.; Olsen M.B.;
Kong X.Y.; Gude E.; Andreassen A.K.; Solbu D.; Karason K.; Dellgren G.;
Gullestad L.; Aukrust P.; Ueland T.
Institution
(Norum, Michelsen, Lekva, Otterdal, Olsen, Kong, Aukrust, Ueland) Research
Institute of Internal Medicine, Oslo University Hospital Rikshospitalet,
Oslo, Norway
(Norum, Michelsen, Kong, Gullestad, Aukrust, Ueland) Institute of Clinical
Medicine, Medical Faculty, University of Oslo, Oslo, Norway
(Norum) Division of Emergencies and Critical Care, Department for Research
and Development, Oslo University Hospital, Oslo, Norway
(Arora, Gude, Andreassen, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Arora) Center for Heart Failure Research, Medical Faculty, University of
Oslo, Oslo, Norway
(Solbu) Novartis Norge AS, Oslo, Norway
(Karason, Dellgren) Sahlgrenska University Hospital, Transplant Institute,
Gothenburg, Sweden
(Karason) Institute of Medicine, University of Gothenburg, Gothenburg,
Sweden
(Dellgren) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, University of Gothenburg, Gothenburg, Sweden
(Dellgren) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Ueland) K.G. Jebsen TREC, University of Tromso, Tromso, Norway
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac allograft vasculopathy (CAV) causes heart failure after heart
transplantation (HTx), but its pathogenesis is incompletely understood.
Notch signaling, possibly modulated by everolimus (EVR), is essential for
processes involved in CAV. We hypothesized that circulating Notch ligands
would be dysregulated after HTx. We studied circulating delta-like Notch
ligand 1 (DLL1) and periostin (POSTN) and CAV in de novo HTx recipients (n
= 70) randomized to standard or EVR-based, calcineurin inhibitor-free
immunosuppression and in maintenance HTx recipients (n = 41). Compared to
healthy controls, plasma DLL1 and POSTN were elevated in de novo (P <.01;
P <.001) and maintenance HTx recipients (P <.001; P <.01). Use of EVR was
associated with a treatment effect for DLL1. For de novo HTx recipients, a
change in DLL1 correlated with a change in CAV at 1 (P =.021) and 3 years
(P =.005). In vitro, activation of T cells increased DLL1 secretion,
attenuated by EVR. In vitro data suggest that also endothelial cells and
vascular smooth muscle cells (VSMCs) could contribute to circulating DLL1.
Immunostaining of myocardial specimens showed colocalization of DLL1 with
T cells, endothelial cells, and VSMCs. Our findings suggest a role of DLL1
in CAV progression, and that the beneficial effect of EVR on CAV could
reflect a suppressive effect on DLL1. Trial registration numbers-SCHEDULE
trial: ClinicalTrials.gov NCT01266148; NOCTET trial: ClinicalTrials.gov
NCT00377962.<br/>Copyright &#xa9; 2018 The American Society of
Transplantation and the American Society of Transplant Surgeons

<26>
Accession Number
621531250
Title
Dual antiplatelet therapy after coronary artery bypass surgery: Is there
an increase in bleeding risk? A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 573-582),
2018. Date of Publication: 01 Apr 2018.
Author
Zhao Y.; Peng H.; Li X.; Qin Y.; Cao F.; Peng D.; Liu J.
Institution
(Zhao, Peng, Cao, Peng) Department of Cardiology, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Li, Qin, Liu) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Anzhen Road, Chaoyang District, Beijing 100029, China
Publisher
Oxford University Press
Abstract
OBJECTIVES: There is increasing evidence that dual antiplatelet therapy
(DAPT) when compared with single antiplatelet therapy may improve venous
graft patency after coronary artery bypass graft. However, it is not yet
known whether postoperative administration of DAPT may increase the
potential risk of bleeding, especially in the early postoperative period.
<br/>METHOD(S): We searched studies on PubMed, Embase, Web of Science and
the Cochrane Central Register of Controlled Trials. Relative risk (RR) was
pooled with 95% confidence intervals (CIs) for dichotomous data. Prior
subgroup analyses were performed to look for potential heterogeneity.
<br/>RESULT(S): Thirteen studies involving 23 591 participants were
included. Our meta-analysis showed that DAPT does not increase the risk of
major bleeding (randomized controlled trials group: RR = 1.28, 95% CI
0.951.71; cohort studies group: RR = 0.99, 95% CI 0.661.51) and minor
bleeding (randomized controlled trials group: RR = 1.15, 95% CI 0.731.81;
cohort studies group: RR = 0.84, 95% CI 0.371.93) when compared with
single antiplatelet therapy. Meanwhile, DAPT does not increase the
incidence of major bleeding events during hospitalization (randomized
controlled trials group: RR = 1.27, 95% CI 0.911.78; cohort studies group:
RR = 0.50, 95% CI 0.122.09). Sensitivity analyses showed that our results
are stable, and there was no evidence of publication bias.
<br/>CONCLUSION(S): DAPT does not increase the risk of major bleeding and
minor bleeding when compared with single antiplatelet therapy.
Postoperative administration of DAPT is considered to be safe in patients
after coronary artery bypass graft, even in the early postoperative
period.<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.

<27>
Accession Number
621531233
Title
Outcome reporting for surgical treatment of degenerative mitral valve
disease: A systematic review and critical appraisal.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (4) (pp 566-572),
2018. Date of Publication: 01 Apr 2018.
Author
Tomsic A.; Arabkhani B.; Schoones J.W.; Van Brakel T.J.; Takkenberg
J.J.M.; Palmen M.; Klautz R.J.M.
Institution
(Tomsic, Arabkhani, Van Brakel, Palmen, Klautz) Department of
Cardiothoracic Surgery, Leiden University Medical Center, PO Box 9600,
Leiden 2300, Netherlands
(Schoones) Walaeus Library, Leiden University Medical Centre, Leiden,
Netherlands
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Standardized outcome reporting is of critical importance for
performance monitoring, improvement of existing techniques and
introduction of novel technologies. Whether outcome reporting for surgical
treatment of degenerative mitral valve disease complies with the
guidelines has not been assessed to date. <br/>METHOD(S): A systematic
review of PubMed, EMBASE, Web of Science and the Cochrane Library was
conducted for articles published between 1 January 2009 and 7 March 2016.
Inclusion criteria were adult patient population (n >- 200) and surgical
intervention for degenerative mitral valve disease. The quality of
reported outcome was compared with the standard recommended by the
guidelines on reporting morbidity and mortality after cardiac valve
interventions. <br/>RESULT(S): Forty-two non-randomized clinical studies
were included: 4 provided early and 38 provided early and late outcome
data. Early echocardiographic outcome was reported in 49% of studies.
Freedom from reintervention, the indication for reintervention and the
follow-up echocardiographic outcome were reported in 97%, 59% and 79% of
studies providing late outcome data, respectively. The KaplanMeier method
was used to assess the freedom from recurrent mitral regurgitation in 60%
(18/30) of studies, whereas 7% (2/30) of studies applied a longitudinal
data analysis. Recurrent mitral regurgitation was most commonly defined as
moderate (Grade 2+; 60%) or severe (Grade 4+; 37%) regurgitation.
<br/>CONCLUSION(S): There is a significant discordance between the
guidelines-based recommendations and actual reporting of outcome for
surgical treatment of degenerative mitral valve disease. Better adherence
to the guidelines would raise the quality and generalizability of clinical
data reporting.<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.

<28>
Accession Number
624545848
Title
Three-dimensional transesophageal echocardiography is an attractive
alternative to cardiac multi-detector computed tomography for aortic
annular sizing: Systematic review and meta-analysis.
Source
Echocardiography. 35 (10) (pp 1626-1634), 2018. Date of Publication:
October 2018.
Author
Elkaryoni A.; Nanda N.C.; Baweja P.; Arisha M.J.; Zamir H.; Elgebaly A.;
Altibi A.M.A.; Sharma R.
Institution
(Elkaryoni, Zamir, Sharma) Division of Internal Medicine, University of
Missouri Kansas City, Kansas City, MO, United States
(Nanda, Arisha) Division of Cardiovascular Disease, University of Alabama
at Birmingham, Birmingham, AL, United States
(Baweja) Division of Cardiovascular Disease, University of Missouri Kansas
City, Kansas City, MO, United States
(Elgebaly) Faculty of Medicine, Al Azhar University, Cairo, Egypt
(Altibi) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Cardiac imaging is the cornerstone of the pretranscatheter
aortic valve replacement (TAVR) assessment. Multi-detector computed
tomography (MDCT) is considered the conventional imaging modality.
However, there is still no definitive gold standard. Targeted cohort of
inoperable high-risk patients with underlying comorbidities, particularly
renal impairment, makes apparent the need for MDCT alternative. We aimed
to demonstrate the correlation extent between MDCT and three-dimensional
transesophageal echocardiography (3DTEE) aortic annular area measures and
to answer the question: Is 3DTEE a good alternative to MDCT?.
<br/>Method(s): A systematic literature search and meta-analysis were
conducted to evaluate the degree of correlation and agreement between
3DTEE and MDCT aortic annular sizing. A thorough assessment of EMBASE,
PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) was
performed. All studies comparing 3DTEE and MDCT in relation to aortic
annular sizing were included. <br/>Result(s): Thirteen studies were
included (N = 1228 patients). A strong linear correlation was found
between 3DTEE and MDCT measurements of aortic annulus area (r = 0.84, P <
0.001), mean perimeter (r = 0. 0.85, P < 0.001), and mean diameter (r =
0.80, P < 0.001). Bland-Altman plots revealed smaller mean 3DTEE values in
comparison to MDCT for aortic annular area, the mean difference being
-2.22 mm² with 95% limits of agreement -12.79 to 8.36.
<br/>Conclusion(s): Aortic annulus measurements obtained by 3DTEE
demonstrated a high level of correlation with those evaluated by MDCT.
This makes 3DTEE a feasible choice for aortic annulus assessment, with
advantage of real time assessment, lack of contrast, and no radiation
exposure.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<29>
Accession Number
2000956154
Title
Ablation strategies for the management of symptomatic Brugada syndrome: A
systematic review.
Source
Heart Rhythm. 15 (8) (pp 1140-1147), 2018. Date of Publication: August
2018.
Author
Fernandes G.C.; Fernandes A.; Cardoso R.; Nasi G.; Rivera M.; Mitrani
R.D.; Goldberger J.J.
Institution
(Fernandes, Nasi, Rivera) Department of Internal Medicine, University of
Miami Miller School of Medicine, Miami, Florida, United States
(Fernandes) Centro de Ciencias Medicas, Universidade Federal da Paraiba,
Joao Pessoa, Brazil
(Cardoso) Division of Cardiology, Johns Hopkins University, Baltimore,
Maryland, United States
(Mitrani, Goldberger) Division of Cardiology, University of Miami Miller
School of Medicine, Miami, Florida, United States
Publisher
Elsevier B.V.
Abstract
Background: Ablation approaches have been described for the management of
symptomatic ventricular arrhythmias in patients with Brugada syndrome, but
this treatment is still considered experimental. <br/>Objective(s): We
aimed to perform a systematic review of the current evidence on the use of
catheter ablation in Brugada syndrome. <br/>Method(s): MEDLINE, Embase,
and Scopus were searched for articles describing the use of catheter
ablation for ventricular arrhythmia management in Brugada syndrome.
<br/>Result(s): We included 11 case series and 11 case reports including a
total of 233 patients. Ablation strategies included epicardial mapping
with substrate modification (n = 180; 77.3%), endocardial-only mapping
with substrate modification (n = 17; 7.3%), ventricular fibrillation
(VF)-triggering premature ventricular complex ablation (n = 5; 2.1%), and
mixed approaches (n = 31; 13.3%). During a 2.5- to 78-month follow-up
period, the success rates in preventing ventricular tachycardia or VF
(VT/VF) were 96.7%, 70.6%, and 80% with epicardial, endocardial, and
triggering premature ventricular complex ablation approaches,
respectively. Among patients who underwent both epicardial and endocardial
mapping, there was no identifiable endocardial substrate in 92.9% of
cases. Elimination of type 1 Brugada-pattern electrocardiogram was
attained in 98.3% and 34.8% of the epicardial and endocardial ablation
groups, respectively. VT/VF occurred in 7 of 9 patients (77.8%) who had
persistent or recurrent J-ST elevation and in none of the 24 patients with
complete resolution during follow-up. Pharmacologic provocation augmented
the abnormal area. <br/>Conclusion(s): Epicardial substrate modification
appears to be more effective than endocardial-only approach in preventing
VT/VF. Persistent or recurrent J-ST elevation appears to represent a
marker of failure of ablation. Ablation seems to be an acceptable strategy
for patients with Brugada syndrome and VT/VF.<br/>Copyright &#xa9; 2018
Heart Rhythm Society

<30>
[Use Link to view the full text]
Accession Number
624014832
Title
Individualized Biventricular Epicardial Augmentation Technology in a
Drug-Induced Porcine Failing Heart Model.
Source
ASAIO Journal. 64 (4) (pp 480-488), 2018. Date of Publication: 2018.
Author
Jagschies L.; Hirschvogel M.; Matallo J.; Maier A.; Mild K.; Brunner H.;
Hinkel R.; Gee M.W.; Radermacher P.; Wildhirt S.M.; Hafner S.
Institution
(Jagschies, Hirschvogel, Gee) Mechanics and High Performance Computing
Group, Technical University of Munich, Garching, Germany
(Maier, Wildhirt) AdjuCor GmbH, Garching, Germany
(Mild, Brunner) Klinik fur Diagnostische und Interventionelle Radiologie,
Universitatsklinikum Ulm, Ulm, Germany
(Hinkel) Institute for Cardiovascular Prevention (IPEK), LMU, Munich,
Germany
(Hinkel) . Medizinische Klinik, Klinikum Rechts der Isar, TUM, Munich,
Germany
(Hinkel) DZHK (German Center for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Hafner) Klinik fur Anasthesiologie, Universitatsklinikum Ulm, Ulm,
Germany
(Matallo, Hafner) Institut fur Anasthesiologische Pathophysiologie und
Verfahrensentwicklung, Universitatsklinikum Ulm, Helmholtzstrasse 8-1, Ulm
89081, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
For treatment of advanced heart failure, current strategies include
cardiac transplantation or blood-contacting pump technology associated
with complications, including stroke and bleeding. This study investigated
an individualized biventricular epicardial augmentation technology in a
drug-induced porcine failing heart model. A total of 11 pigs were used,
for the assessment of hemodynamics and cardiac function under various
conditions of support pressures and support durations (n = 4), to assess
device positioning and function by in vivo computer tomographic imaging (n
= 3) and to investigate a minimally invasive implantation on the beating
heart (n = 4). Support pressures of 20-80 mm Hg gradually augmented
cardiac function parameters in this animal model as indicated by increased
left ventricular stroke volume, end-systolic pressures, and decreased
end-diastolic pressures. Strong evidence was found regarding the necessity
of mechanical synchronization of support end with the isovolumetric
relaxation phase of the heart. In addition, the customized,
self-expandable implant enabled a marker-guided minimally invasive
implantation through a 4 cm skin incision using fluoroscopy. Correct
positioning was confirmed in computer tomographic images. Continued
long-term survival investigations will deliver preclinical evidence for
further development of this concept. ASAIO Journal 2018;
64:480-488.<br/>Copyright &#xa9; 2017 by the ASAIO.

<31>
Accession Number
623906721
Title
Evaluation of pain and patient satisfaction by music therapy in patients
with endoscopy/colonoscopy.
Source
Turkish Journal of Gastroenterology. 29 (5) (pp 574-579), 2018. Date of
Publication: September 2018.
Author
Bashiri M.; Akcali D.; Coskun D.; Cindoruk M.; Dikmen A.; Cifdaloz B.U.
Institution
(Bashiri, Akcali, Coskun) Department of Anesthesiology and Reanimation,
Gazi University School of Medicine, Ankara, Turkey
(Cindoruk) Department of Gastroenterology, Gazi University School of
Medicine, Ankara, Turkey
(Dikmen) Department of Public Health, Gazi University School of Medicine,
Ankara, Turkey
(Cifdaloz) Department of Musicology, Gazi University Turkish Music
National Conservatory, Ankara, Turkey
Publisher
AVES Ibrahim KARA (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Background/Aims: Endoscopy and colonoscopy are frequently performed
procedures to evaluate the gastrointestinal system. These procedures are
sometimes disturbing and painful for the patient. In gastrointestinal
suits, endoscopy and colonoscopy may be performed on awake or sedated
patients. Music therapy is a common and non-pharmacological treatment for
various medical conditions, pain, and anxiety. The aim of the present
study was to add music therapy to sedation administered during endoscopy
and colonoscopy. The effect of music treatment on drug consumption,
anxiety, and pain was investigated. <br/>Material(s) and Method(s):
American Anesthesiologist Association I-III adult patients scheduled for
endo/colonoscopy were randomized to music treatment and no music treatment
groups. Patients with endoscopic ultrasound and endoscopic retrograde
colangiopancreaticography were excluded from the study. Anxiety score and
pain severity were evaluated before and after the procedure. Heart rate,
mean arterial pressure, and oxygen saturation were recorded before,
during, and after the procedure. Total drug consumption was recorded.
Patient satisfaction and desire for the same protocol for recurrent
procedures were investigated. <br/>Result(s): Music therapy added to deep
sedation administered by anesthesiologists provided decreased anxiety
score and propofol consumption. Patient satisfaction was increased, and
patients reported a desire for the same protocol for recurrent procedures.
<br/>Conclusion(s): The present study may serve as the beginning of using
music therapy for pain treatment in gastroenterology procedures in our
hospital with/without sedation. Music and other non-pharmacological
treatment methods must be remembered to increase patient comfort during
enco/colonoscopies and other painful procedures.<br/>&#xa9; Copyright 2018
by The Turkish Society of Gastroenterology * Available online at
www.turkjgastroenterol.org

<32>
Accession Number
623937687
Title
The efficacy and safety of dexmedetomidine in cardiac surgery patients: A
systematic review and meta-analysis.
Source
PLoS ONE. 13 (9) (no pagination), 2018. Article Number: e0202620. Date of
Publication: September 2018.
Author
Wang G.; Niu J.; Li Z.; Lv H.; Cai H.
Institution
(Wang, Niu, Li, Lv, Cai) Department of Surgical Intensive Care Unit, First
Affiliated Hospital, Medical College, Zhejiang University, Hangzhou,
Zhejiang, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
This study aimed to evaluate the efficacy and safety of dexmedetomidine
versus any other treatment without dexmedetomidine in patients who have
undergone cardiac surgery. Electronic databases including PubMed, Embase,
and Cochrane Library were systematically searched without limitations of
language and publication time. Randomized controlled trials (RCTs) aiming
to evaluate the efficacy and safety of dexmedetomidine versus any other
treatment without dexmedetomidine in patients that have undergone cardiac
surgery were selected. Endpoints such as hemodynamic indexes and adverse
events in eligible studies were extracted by two researchers,
independently. The data was analyzed using RevMan 5.3 and Stata 11.0
software. A total of 18 RCTs met the inclusion criteria, involving 1730
patients. Compared to control (any treatment without dexmedetomidine),
dexmedetomidine showed a pooled mean difference (MD) of -14.46 [95%
confidence interval(CI): -24.69, -4.23; p<0.01] for systolic arterial
pressure, a standardized mean difference (SMD) of -1.74 for mean arterial
blood pressure (95% CI: -2.80, -0.68; P < 0.01), -2.12 (95%CI: -3.23,
-1.00; p<0.01) for heart rate, and combined odds ratio (OR) of 0.22
(95%CI: 0.11, 0.44; p<0.01) for tachycardia, 3.44 (95%CI: 1.95, 5.96;
p<0.01) for bradycardia, 0.74 (95%CI: 0.49, 1.12; p>0.05) for atrial
fibrillation, and 0.99 (95%CI: 0.51, 1.90; p>0.05) for hypotension. In
addition, dexmedetomidine could reduce time of surgery and stay in
intensive care units, improve delirium with good safety. Our study shows
clinical application of dexmedetomidine in cardiac surgery patients can
reduce risks of abnormal hemodynamics with good safety.<br/>Copyright
&#xa9; 2018 Wang 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.

<33>
Accession Number
626366127
Title
Right minithoracotomy versus median sternotomy for reoperative mitral
valve surgery: A systematic review and meta-analysis of observational
studies.
Source
European Journal of Cardio-thoracic Surgery. 54 (5) (pp 817-825), 2018.
Date of Publication: 2018.
Author
Daemen J.H.T.; Heuts S.; Olsthoorn J.R.; Maessen J.G.; Nia P.S.
Institution
(Heuts, Maessen, Nia) Faculty of Health, Medicine and Life Sciences,
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Daemen, Heuts, Olsthoorn, Maessen, Nia) Department of Cardiothoracic
Surgery, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25,
Maastricht 6229 HX, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Reoperative mitral valve surgery (MVS) through a median sternotomy
(ST-MVS) can be particularly challenging due to dense adhesions and is
known to carry a substantial risk of injuries to vascular structures.
These injuries occur in 7-9% of cases and are associated with increased
mortality rates. A valid alternative that could avoid the risks associated
with redo ST-MVS is the right anterolateral minithoracotomy (MT-MVS)
approach. The aim of this study was to quantify the effects of MT-MVS
compared with those of ST-MVS on morbidity and mortality among patients
who underwent prior cardiac surgery through a sternotomy. The MEDLINE and
EMBASE databases were searched through 1 November 2017. Data regarding
mortality, stroke, reoperation for bleeding and length of hospital stay
were extracted and submitted to a meta-analysis using random effects
modelling and the I²-test for heterogeneity. Six retrospective
observational studies were included, enrolling a total of 777 patients. In
a pooled analysis, MT-MVS demonstrated reduced mortality rates compared to
a standard sternotomy [odds ratio (OR) 0.41, 95% confidence interval (CI)
0.18-0.96; P = 0.04]. MT-MVS was, moreover, associated with reduced length
of hospital stay [difference between the means was -3.81, 95% CI -5.53 to
-2.08; P < 0.0001) and reoperation for bleeding (OR 0.32, 95% CI
0.10-0.99; P = 0.0488). The incidence of stroke was similar (OR 1.51, 95%
CI 0.65-3.54; P = 0.34), all in the absence of heterogeneity. In
conclusion, reoperative minimally invasive MVS through a minithoracotomy
is a safe alternative to standard sternotomy, with reduced mortality
rates, length of hospital stay and reoperations for bleeding and a
comparable risk of stroke. However, because the existing literature
provided limited, low-quality evidence, more methodologically rigorous
randomized controlled trials are needed.<br/>Copyright &#xa9; The
Author(s) 2018.

<34>
Accession Number
626390306
Title
Acute and long-term efficacy and safety with a single cryoballoon
application as compared with the standard dual application strategy: A
prospective randomized study using the second-generation cryoballoon for
pulmonary vein isolation in patients with symptomatic atrial fibrillation.
Source
Europace. 20 (10) (pp 1598-1605), 2018. Date of Publication: 2018.
Author
Mortsell D.; Malmborg H.; Lonnerholm S.; Jansson V.; Blomstrom-Lundqvist
C.
Institution
(Malmborg, Lonnerholm, Jansson, Blomstrom-Lundqvist) Department of Medical
Sciences, Department of Cardiology, Uppsala University, Sjukhusvagen 85,
Uppsala SE 751 85, Sweden
Publisher
Oxford University Press
Abstract
Aims A single cryoballoon (CB) application per vein for pulmonary vein
isolation (PVI) in patients with atrial fibrillation (AF) could save time
and was therefore compared to the standard approach of two consecutive CB
applications for acute and long-term efficacy and safety. Methods Patients
with symptomatic AF were randomized to a single CB application per vein
guided by an Achieve catheter and results (Single cryo-arm) or to two CB
applications using a standard guidewire (Routine cryo-arm). The primary
endpoint was the rate of acute complete PVI. Secondary endpoints were
freedom from AF evaluated by electrocardiogram and 7 days Holter at 6 and
12 months, symptoms by Symptom Severity Questionnaires and EHRA score and
quality of life (QoL) by EQ5D-5L at 12 months. Among 140 patients
included, PVI was achieved in 271 (100%) veins in the Single cryo-arm and
in 269/271 (99.3%) veins in the Routine cryo-arm, P=0.25. The procedure
time was shorter in the Single cryo-arm, mean +/- standard deviation
99.4+/-33.3min vs. 118.4+/-34.3min, P=0.0015. Freedom from AF after one
procedure at 12 months did not differ; 73.9.0% (Single cryo) vs. 71.4%
(Routine), P=0.74. Symptoms and QoL did also not differ between the two
groups. There was a lower complication rate in the Single cryo-group, 2.9%
vs. 12.9%, P=0.03. Conclusion A single CB application shortens the
procedure time without affecting acute or long-term efficacy, as compared
to the routine two-application strategy, which with the lower complication
rates has important implications when defining standards for
PVI.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2018.

<35>
Accession Number
624995494
Title
Atrial fibrillation following heart transplantation: A systematic review
and meta-analysis of observational studies.
Source
Journal of Evidence-Based Medicine. 11 (4) (pp 261-271), 2018. Date of
Publication: November 2018.
Author
Chokesuwattanaskul R.; Bathini T.; Thongprayoon C.; Preechawat S.;
O'Corragain O.A.; Pachariyanon P.; Ungprasert P.; Cheungpasitporn W.
Institution
(Chokesuwattanaskul, Preechawat) Faculty of Medicine, Division of
Cardiology, Department of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
(Bathini) Department of Internal Medicine, University of Arizona, Tucson,
AZ, United States
(Thongprayoon) Department of Internal Medicine, Mayo Clinic, Rochester,
MN, United States
(O'Corragain) Department of Internal Medicine, Temple University,
Philadelphia, PA, United States
(Pachariyanon) Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, United States
(Ungprasert) Clinical Epidemiology Unit, Faculty of Medicine Siriraj
Hospital, Department of Research and Development, Mahidol University,
Bangkok, Thailand
(Cheungpasitporn) Division of Nephrology, Department of Medicine,
University of Mississippi Medical Center, MS, United States
Publisher
Blackwell Publishing
Abstract
Objective: Previous studies have suggested a high incidence of atrial
fibrillation (AF) in heart transplant recipients. However, incidence
trends of AF in heart transplant recipients remain unclear. The study's
aims were (1) to investigate the pooled incidence/incidence trends of AF
following heart transplantation and (2) to assess the mortality risk of
heart transplant recipients with AF. <br/>Method(s): A literature search
for studies that reported the incidence of AF following heart
transplantation was conducted using MEDLINE, EMBASE, and The Cochrane
Database from inception through March 2018. Pooled incidence and odds
ratios (OR) with 95%CI were calculated using a random-effects model.
<br/>Result(s): Eighteen studies (2 cohorts from clinical trials and 16
cohort studies) with 5393 heart transplant recipients were enrolled. The
pooled estimated incidence of AF in heart transplant was 10.1% (95%CI:
7.6%-13.2%). Meta-analysis based on the type of anastomotic technique
demonstrated a pooled estimated incidence of AF following heart
transplantation of 18.7% (95%CI: 10.3%-31.5%) and 11.1% (95%CI:
6.5%-18.4%) by biatrial and bicaval techniques, respectively. There was a
significant association between AF following a heart transplant and
increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08-3.93).
Meta-regression analyses showed no significant correlations between the
year of study and incidence of AF (P = 0.47) or mortality risk of AF after
heart transplantation (P = 0.99). <br/>Conclusion(s): The overall
estimated incidence of AF following heart transplantation is 10.1%. There
is a significant association between AF and increased mortality after
transplantation. Furthermore, incidence and mortality risk of AF following
heart transplant does not seem to decrease over time.<br/>Copyright &#xa9;
2018 Chinese Cochrane Center, West China Hospital of Sichuan University
and John Wiley & Sons Australia, Ltd

<36>
Accession Number
612908366
Title
Impact of Statin Use after Heart Transplantation.
Source
Circulation: Heart Failure. 9 (10) (no pagination), 2016. Article Number:
e003265. Date of Publication: 01 Oct 2016.
Author
Vallakati A.; Reddy S.; Dunlap M.E.; Taylor D.O.
Institution
(Vallakati) Division of Cardiovascular Diseases, Ohio State University
Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, United States
(Reddy, Dunlap) Division of Cardiovascular Diseases, Metrohealth Medical
Center, Case Western Reserve University, Cleveland, OH, United States
(Taylor) Department of Cardiovascular Medicine, Heart and Vascular
Institute Cleveland Clinic, Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Although various studies revealed the beneficial effects of
statins in post-cardiac transplant patients, these were relatively small
and low-powered studies. We performed a meta-analysis of published studies
to evaluate the role of statins in post-cardiac transplant patients,
specifically examining the effects on hemodynamically significant/fatal
graft rejection, coronary vasculopathy, terminal cancer, and overall
survival. Methods and Results - We searched PubMed, Cochran CENTRAL, and
Web of Science databases using the search terms "cardiac transplant" or
"heart transplant," and "statin" for a literature search. A random-effects
model with Mantel-Haenszel method was used to pool the data. We identified
10 studies, 4 randomized controlled trials, and 6 nonrandomized studies,
which compared outcomes in heart transplant recipients undergoing statin
therapy to statin-naive patients. A pooled analysis of 9 studies reporting
mortality revealed that the use of statins was associated with significant
reduction in all-cause mortality (odds ratio, 0.26; 95% confidence
interval, 0.20-0.35; P<0.0001). Statins also decreased the odds of
hemodynamically significant/fatal rejection (odds ratio, 0.37; 95%
confidence interval, 0.21-0.65; P=0.0005), incidence of coronary
vasculopathy (odds ratio, 0.33; 95% confidence interval, 0.16-0.68;
P=0.003), and terminal cancer (odds ratio, 0.30; 95% confidence interval,
0.15-0.63; P=0.002). Conclusions - The evidence from a pooled analysis
suggests that statins improve survival in heart transplant recipients.
Statins may prevent fatal rejection episodes, decrease terminal cancer
risk, and reduce the incidence of coronary vasculopathy. Additional
prospective studies are needed to further investigate and explain this
association.<br/>Copyright &#xa9; 2016 American Heart Association, Inc.

<37>
Accession Number
626109585
Title
RhoA/rho-kinase, nitric oxide and inflammatory response in LIMA during
OPCABG with isoflurane preconditioning.
Source
Journal of cardiothoracic surgery. 14 (1) (pp 22), 2019. Date of
Publication: 25 Jan 2019.
Author
Zhang L.; Wang C.-B.; Li B.; Lin D.-M.; Ma J.
Institution
(Zhang, Wang, Lin, Ma) Department of Anesthesiology, Beijing Anzhen
Hospital, Capital Medical University-Beijing Institute of Heart Lung and
Blood Vessel Diseases, No.2 Anzhen Road ,Chaoyang District, Beijing
100029, China
(Li) Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital
Medical University-Beijing Institute of Heart Lung and Blood Vessel
Diseases, No.2 Anzhen Road ,Chaoyang District, Beijing 100029, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Grafting vessel with LIMA to the left anterior descending
coronary artery plays a most important role in the long-term prognosis of
OPCABG surgery. The aim of this study was to compare the effects of
isoflurane preconditioning on miRs and mRNAs levels in the left internal
mammary arterie (LIMA) graft with propofol in patients undergoing off-pump
coronary artery bypass surgery (OPCABG). <br/>METHOD(S): Patients were
randomly assigned to receive either propofol (n=15), or interrupted
isoflurane (n=15). In group P, propofol administration was continued at
3-5mg/kg/h intravenous injection for the duration of surgery. Five minutes
prior to incision, patients of the isoflurane group (group Iso) received
2cycles of 1 MAC isoflurane. <br/>RESULT(S): miR-221 were significantly
lower in group Iso (P<0 .05). E-selectin mRNA, RhoA mRNA and ROK mRNA were
significantly lower at specimens of LIMA in group Iso compared with those
in group P patients (P<0 .05). The expression of NOS3 mRNA was
significantly higher in group Iso patients (P<0 .05). <br/>CONCLUSION(S):
Our findings provide some insight that prior interrupted isoflurane
administration could regulate miR-221, and downstream effectors (mRNAs)
and resulted in actual attenuation of inflammation and spasm of LIMA in
patients undergoing OPCABG surgery. TRIAL REGISTRATION: NCT No. (
ClinicalTrials.gov ): NCT02678650; Registration date: January 23, 2016.

<38>
[Use Link to view the full text]
Accession Number
626979235
Title
Alirocumab reduces total nonfatal cardiovascular and fatal events in the
odyssey outcomes trial.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Szarek M.; White H.D.; Schwartz G.G.; Alings M.; Bhatt D.L.; Bittner V.A.;
Chiang C.-E.; Diaz R.; Edelberg J.M.; Goodman S.G.; Hanotin C.; Harrington
R.A.; Wouter Jukema J.; Kimura T.; Kiss R.G.; Lecorps G.; Mahaffey K.W.;
Moryusef A.; Pordy R.; Roe M.T.; Tricoci P.; Xavier D.; Zeiher A.M.; Steg
P.G.
Institution
(Szarek, White, Schwartz, Alings, Bhatt, Bittner, Chiang, Diaz, Edelberg,
Goodman, Hanotin, Harrington, Wouter Jukema, Kimura, Kiss, Lecorps,
Mahaffey, Moryusef, Pordy, Roe, Tricoci, Xavier, Zeiher, Steg)
1Epidemiology and Biostatistics, SUNY Downstate Med Cntr Sch of Public
Health, Brooklyn, NY2Green Lane Cardiovascular Services, Auckland City
Hosp, Auckland, New Zealand3Div of Cardiology, Univ of Colorado Sch of
Medicine, Aurora, CO4Cardiology, Amphia Ziekenhuis Molengracht, Breda,
Breda, Netherlands5Div of Cardiovascular Medicine, Brigham and Women's
Hosp Heart & Vascular Cntr and Harvard Med Sch, Boston, MA6Div of
Cardiovascular Disease, Univ of Alabama at Birmingham, Birmingham, NY7Div
of Cardiology, Taipei Veterans General Hosp, Taipei, Taiwan8Instituto
Cardiovascular de Rosario, Estudios Cardiologicos Latinoamerica, Rosario,
Argentina9R and D, Sanofi, Bridgewater, NJ10Cardiology, Univ of Toronto,
Toronto, Canada11R and D, Sanofi, Paris, France12Dept of Medicine,
Stanford Univ, Stanford, CA13Dept of Cardiology, Leiden Univ Med Cntr,
Leiden, Netherlands14Sch of Medicine, Kyoto Univ Graduate Sch of Medicine,
Kyoto, Japan15Epidemiology and Biostatistics, Magyar Honvedseg
Egeszsegugyi Kozpont, Budapest, Budapest, Hungary16R and D, Sanofi,
Chilly-Mazarin, France17Dept of Medicine, Stanford Cntr for Clinical Rsch,
Stanford, CA18R and D, Regeneron, Tarrytown, NY19Duke Clinical Rsch
Institute, Duke Univ Med Cntr, Durham, NC20Clinical Rsch and Training, St
John's Med College, Bangalore, India21Dept of Medicine III, Goethe Univ,
Frankfurt am Main, Germany22Departement Hospo-Universitaire FIRE, Hopital
Bichat, Brooklyn, France
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In ODYSSEY OUTCOMES, first occurrence of coronary heart
disease (CHD) death, myocardial infarction (MI), fatal/nonfatal ischemic
stroke, or hospitalization for unstable angina (UA) was reduced from 1052
for placebo to 903 for alirocumab (hazard ratio [HR] 0.85? p=0.0003).
However, this does not reflect the full impact of treatment, as many
patients had multiple events, and non-CHD death and other nonfatal
cardiovascular (CV) events were excluded. In this prespecified analysis,
we describe effects of alirocumab on total (first and subsequent) nonfatal
CV events and all-cause death by a model that accounts for the
relationship between nonfatal and fatal events. <br/>Method(s): Patients
with acute coronary syndrome (ACS) and LDL cholesterol >=70 mg/dL, non-HDL
cholesterol >=100 mg/dL, or apolipoprotein B >=80 MG/DL on maximum
tolerated dose of atorvastatin or rosuvastatin were randomized 1:1 to
treatment with alirocumab or placebo. The present analysis included
all-cause death and total nonfatal CV events (MI, stroke, hospitalization
for UA or heart failure, or ischemia-driven coronary revascularization). A
sensitivity analysis restricted nonfatal events to MI, stroke, or UA.
Total nonfatal and fatal event hazard functions were jointly estimated,
linked by a shared frailty accounting for patient risk heterogeneity and
correlated within-patient nonfatal events. The model also determines if
nonfatal events are associated with increased risk for death. Treatment
effects were summarized by HRs and compared against the customary analysis
of first nonfatal CV event or death. <br/>Result(s): There were 5425 total
deaths or nonfatal CV events, 77% greater than first events (3064).
Alirocumab produced similar relative reductions in first and total events
when compared with placebo. Importantly, there were 385 fewer total events
with alirocumab versus 190 fewer first events. Nonfatal CV events were
associated with a higher risk of death, and the frailty variance indicated
substantial inter-patient heterogeneity in risk. <br/>Conclusion(s): In
patients with ACS, the total number of deaths and nonfatal CV events
prevented with alirocumab was twice the number of first events prevented.
Total event reduction may be a useful metric to gauge alirocumab efficacy
after ACS.

<39>
[Use Link to view the full text]
Accession Number
626979120
Title
Anti-inflammatory therapy with canakinumab and reduction in total
cardiovascular events.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Everett B.M.; MacFadyen J.G.; Thuren T.; Libby P.; Glynn R.J.; Ridker P.
Institution
(Everett, MacFadyen, Thuren, Libby, Glynn, Ridker) 1Medicine, Brigham
Womens Hosp, Boston, MA2Cardio-Metabolic Development Unit, Novartis, East
Hanover, NJ
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Inflammation reduction with the interleukin (IL)-1beta
inhibitor canakinumab significantly reduces the first major adverse
cardiovascular event in patients with prior myocardial infarction (MI) and
residual inflammatory risk (high-sensitivity C-reactive protein >= 2
mg/L). Hypothesis: This analysis tested the hypothesis that canakinumab
would reduce the total number of cardiovascular events, including those
collected after a first event, compared to placebo. <br/>Method(s): In
total, 10,061 patients were randomly allocated to placebo or canakinumab
50 mg, 150 mg, or 300 mg once every three months. For this analysis, we
compared the numbers of a composite of all serious cardiovascular events,
including non-fatal MI, non-fatal stroke, all coronary revascularization,
and cardiovascular death in active treatment as compared to placebo. Our
primary analysis censored all events that occurred within 30 days of a
first non-fatal serious adverse cardiovascular event, and negative
binomial regression was used to account for correlations among repeated
events in the same person in the estimation of rate ratios (RR) and 95%
CI. <br/>Result(s): There were a total of 3417 total serious
cardiovascular events among 10,061 patients with a median follow up time
of 3.7 years. Canakinumab reduced the incidence of total serious
cardiovascular events, with rates per 100 person-years in the placebo, 50
mg, 150 mg, and 300 mg canakinumab groups of 10.4, 8.4, 8.3, and 8.3,
respectively. The rate ratios were significantly reduced for all three
canakinumab doses compared to placebo when events occurring within 30 days
of the first serious cardiovascular event were censored, and when those
events were included (Table). The observed reduction in recurrent events
was driven by reductions in coronary revascularization for the 50 mg (RR
0.73, 95% CI 0.61-0.88), 150 mg (RR 0.73, 95% CI 0.61-0.88) and 300 mg (RR
0.70, 95% CI 0.59-0.84) doses and by reduction in MI for the 150 mg (RR
0.75, 95% CI 0.61-0.93) and 300 mg (RR 0.80, 95% CI 0.65-0.98) doses.
<br/>Conclusion(s): Anti-inflammatory therapy with canakinumab
significantly reduced the total number of cardiovascular events in
patients with prior MI and evidence of residual inflammatory risk.

<40>
Accession Number
626979098
Title
Speckle-tracking based assessment of early diastolic mitral annular
velocity.
Source
Swiss Medical Weekly. Conference: Annual Meeting Swiss Society of
Anaesthesiology and Resuscitation, SGAR/SSAR and Swiss Association of
Nurse Anesthesists SIGA/FSIA. Switzerland. 148 (Supplement 233) (pp
9S-10S), 2018. Date of Publication: November 2018.
Author
Mauermann E.; Bouchez S.; Vandenheuvel M.; Bove T.; Wouters P.
Institution
(Mauermann) Department of Anesthesiology, University Hospital Basel,
Switzerland
(Mauermann, Bouchez, Vandenheuvel, Wouters) Department for Anesthesiology
and Perioperative Medicine, University Hospital Ghent, Belgium
(Bove) Division of Cardiac Surgery, University Hospital Ghent, Belgium
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Background: Recently, speckle-tracking derived displacement of the
tricuspid annulus in transesophageal echocardiography [TEE] has been shown
to agree with TAPSE in transthoracic echocardiography [TTE]. Furthermore,
we have shown that differentiating speckletracking based displacement of
the tricuspid annulus over time (i.e. a velocity) represents a TEE
surrogate for the myocardial systolic excursion velocity (S') in TTE. As
measuring diastolic dysfunction by E' (the peak mitral annular velocity
during early filling) in TEE may be inaccurate due to misalignment of the
Doppler beam and is often forgotten, we sought to examine the accuracy of
speckle-tracking based early diastolic velocity of the mitral annulus.
<br/>Method(s): In 25 adult patients undergoing elective cardiac surgery,
E' was assessed after induction in a randomized order by TTE and TEE by
two echocardiographers. Views used were the apical 4-chamber view in TTE
(AP4CTTE) and midesophageal 4-chamber view in TEE (ME4CTEE). In both
views, E' was measured by both Tissue Doppler Imaging (E'TDI) and by
speckle-tracking (E'STE). For the main comparison, E'TDI by TTE was
compared to E'STE by TEE by correlation and Bland-Altman plots.
<br/>Result(s): E'TDI by TTE was available in 24 of 25 patients and E'STE
by TEE was available in 22 of 25 patients. Frame rates were 160 Hz for
E'TDI by TTE and 52 Hz for E'STE by TTE. Mean E'TDI by TTE was 6.9 +/- 1.6
cm/s and mean E'STE by TEE was 5.4 +/- 1.7 cm/s (P <0.001). Correlation,
however, was fair (slope = 0.61, P <0.001, r = .55). <br/>Discussion(s):
Measuring E' by speckle-tracking in TEE is feasible and correlates with E'
measured by Tissue Doppler in TTE. However, it is uncertain why
speckle-tracking based velocities are systematically underestimated. One
potential cause may be the relatively lower frame rate. Further studies
are needed and ongoing for this interesting alternative.

<41>
Accession Number
626979764
Title
Meta-analysis of late outcomes of PCI versus cabg for unprotected left
main coronary artery disease.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Ali W.; Arora S.; Strassle P.; Vaidya S.; Gupta S.; Bahekar A.;
Jyothidasan A.; Vavalle J.
Institution
(Ali, Arora, Strassle, Vaidya, Gupta, Bahekar, Jyothidasan, Vavalle)
1Hypertension Unit, Univ of Chicago, Chicago, IL2Cardiology, Univ of North
Carolina, Chapel Hill, NC3Depatrment of Cardiology, Univ of North
Carolina, Chapel Hill, NC4Internal Medicine, Emory Univ, Atlanta,
GA5Cardiovascular Cntr, Emory Univ, Atlanta, GA6Depatrment of Cardiology,
Cape Fear Valley Med Cntr, Fayetteville, NC
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Long-term efficacy of percutaneous coronary intervention
(PCI) compared to coronary artery bypass grafting (CABG) for treatment of
unprotected left main (ULM) disease remains controversial across clinical
trials. <br/>Method(s): PubMed, EMBASE, Google Scholar, Medline, and
reference lists of relevant articles were searched for studies comparing
PCI and CABG for ULM disease. Studies comparing PCI (drug eluting stents
only) to CABG, and had at least 5-years follow-up were included.
Mantel-Haenszel statistical method with random effects was utilized.
Heterogeneity was examined using the Q-test. A meta-regression analysis
was conducted to explain significant heterogeneity in revascularization.
<br/>Result(s): A total of 11 studies met inclusion criteria (3 randomized
trials? 8 observational studies)? including 7963 patients (PCI: 3910?
CABG: 4053). As compared to CABG, PCI was associated with similar
incidence of all-cause mortality (OR 0.90 95% CI 0.74, 1.11, p=0.32).
However, patients undergoing PCI had higher incidences of myocardial
infarction (OR 1.57, 95% CI 1.16, 2.11, p=0.0003) and repeat
revascularization (OR 2.89, 95% CI 2.21, 3.77, P &It? 0.0001), compared to
CABG (Figure). Additionally, PCI appeared to be associated with higher
incidence of major adverse cardiovascular and cerebrovascular events,
although the effect was not statistically significant (OR 1.22 95% CI
0.95, 1.56, p=0.12). PCI was also associated with lower incidence of
stroke (OR 0.48 95% CI 0.27, 0.84, p=0.01). Differences in the average
SYNTAX score among patients across studies was significantly associated
with the heterogeneity seen in revascularization (p=0.01).
<br/>Conclusion(s): Compared to CABG, PCI is associated with more MIs and
therefore, a higher 5-year incidence for repeat revascularization for ULM
coronary disease.

<42>
[Use Link to view the full text]
Accession Number
626979543
Title
Comparing adverse clinical outcomes between drug eluting stents and bare
metal stents in patients undergoing non-cardiac surgery: A meta-analysis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Ranka S.; Joshi U.; Poudyal A.; Rawal H.; Kolkailah A.A.; Siddamsetti S.;
Munoz E.; Sreenivasan J.; Parekh J.; Fugar S.; Sleiman J.
Institution
(Ranka, Joshi, Poudyal, Rawal, Kolkailah, Siddamsetti, Munoz, Sreenivasan,
Parekh, Fugar, Sleiman) 1Internal Medicine, John H Stroger Hosp of Cook
County, Chicago, IL2Internal Medicine, Univ of Illinois at Urbana
Champaign, Urbana, IL3Internal Medicine, Creighton Univ Med Cntr, Omaha,
NE4Cardiology, Rush Univ Med Cntr, Chicago, IL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: History of coronary stents is risk factor for short term
adverse clinical events (ACE) after a non-cardiac surgery (NCS). Safety of
Drug-Eluting Stent (DES) or Bare-Metal Stent (BMS) has been studied in
such patients, but no clear optimal choice of stent type exists. Thus, we
performed a meta-analysis to compare the two stents in patients undergoing
NCS. <br/>Method(s): PubMed, Medline, EMBASE databases were queried from
inception to January 2018 for all studies comparing DES vs BMS in patients
undergoing NCS. ACE was defined as 30-day event rate of myocardial
infarction (MI) or death after NCS. Two subgroups created by difference in
time from stent placement to NCS: Within 30-45 days and >45 days after
stent placement. Random effect model was used to estimate the odds ratio
(OR). Two tailed p value < 0.05 were considered significant.
<br/>Result(s): Four retrospective cohort studies with 6708 patients were
identified. Out of 2597 BMS patients, 8.9% had an ACE compared to rate of
6.5% ACE in DES patients (n=4111). In the overall cohort, there was no
difference was observed with either stent type irrespective of duration of
NCS after stent placement (OR: 0.85, 95% CI 0.70-1.03, P=0.46). In
patients undergoing NCS shortly(30-45days) after stent placement, no
significant difference in ACE was observed {Odds Ratio (OR): 0.90, CI
0.63-1.28, P=0.82}. Similarly, no difference was noted in ACE in patients
undergoing NCS after 45 days of stent placement (OR: 0.88, CI 0.56-1.40,
P=0.10). <br/>Conclusion(s): In patients undergoing NCS after coronary
stenting, there is no difference in rate of ACE with BMS vs DES placement.
Thus, choice of stent may not play a role in prediction of adverse
clinical outcomes after an non-cardiac surgery.

<43>
[Use Link to view the full text]
Accession Number
626979482
Title
Long-term secondary prevention with ticagrelor for prior myocardial
infarction in patients with no coronary stenting: A sub-analysis from
pegasus TIMI 54.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Furtado R.H.; Bhatt D.L.; Steg P.G.; Cohen M.; Storey R.F.; Im K.W.;
Sabatine M.S.; Bonaca M.P.
Institution
(Furtado, Bhatt, Steg, Cohen, Storey, Im, Sabatine, Bonaca) 1TIMI Study
Group, Brigham and Women's Hosp, Boston, MA2French Alliance for
Cardiovascular Trials, Universite Paris-Diderot, Paris,
France3Cardiovascular Div, Dept of Medicine, Newark Beth Israel Med Cntr,
Newark, NJ4Dept of Cardiovascular Science, Univ of Sheffield, Sheffield,
United Kingdom5TIMI Study Group, Brigham and Women's Hosp, boston, MA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Prolonged dual antiplatelet therapy (DAPT) with
acetylsalicylic acid (ASA) and a P2Y<inf>12</inf> inhibitor was initially
developed to reduce risk of stent thrombosis. However, data has emerged
showing that, in patients with MI, prolonged DAPT is beneficial,
irrespective of stenting. Moreover, previous reports have suggested that
MI patients not treated with coronary stenting may be at higher long-term
risk. Hypothesis: Patients with a history of MI without coronary stenting,
when compared with MI patients with a history of stenting, are at higher
risk of adverse cardiovascular events and derive similar relative and
greater absolute risk reduction with prolonged DAPT. <br/>Method(s):
PEGASUS-TIMI 54 randomized 21,162 patients with prior MI (1-3 years) to
ticagrelor 60 mg, 90 mg or placebo twice daily. Primary efficacy outcome
was MACE composite of: cardiovascular (CV) death, MI or stroke. History of
coronary stenting or not was prespecified as subgroups of interest. Risk
of MACE and benefit of ticagrelor (pooled doses) in patients with and
without a history of stenting are compared. <br/>Result(s): 4,199
individuals had no history of coronary stenting at baseline whereas 16,891
did. The relative risk reduction (RRR) in MACE with ticagrelor was
consistent in patients without (18% RRR) and with prior stenting (15% RRR)
(P<inf>int</inf> = 0.95, Figure). Given the higher baseline risk, patients
without a history of stenting had a higher absolute risk reduction (2.1%
vs. 1.0%). Furthermore, ticagrelor reduced all-cause mortality in these
high-risk patients. (Figure) <br/>Conclusion(s): Prolonged DAPT with
ticagrelor was equally beneficial in reducing relative risk of MACE in
patients with and without prior stenting. In the latter group, absolute
risk reduction was even higher due to their baseline risk profile. These
data indicate that the benefits of long-term DAPT are driven primarily
through reduction of de-novo atherothrombosis rather than stent
protection.

<44>
[Use Link to view the full text]
Accession Number
626979469
Title
A randomized controlled trial assessing the efficacy and safety of
prasugrel for prevention of early saphenous vein graft thrombosis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Danek B.A.; Abdullah K.; Karatasakis A.; Iwnetu R.; Shunk K.; Zimmet J.;
Vidovich M.; Bavry A.; Rangan B.V.; Roesle M.; Griza D.; Stanley K.;
Banerjee S.; Khalili H.; Brilakis E.S.; Abdullah S.
Institution
(Danek, Abdullah, Karatasakis, Iwnetu, Shunk, Zimmet, Vidovich, Bavry,
Rangan, Roesle, Griza, Stanley, Banerjee, Khalili, Brilakis, Abdullah)
1Cardiology, Univ of Texas Southwestern/Dallas VA Med Cntr, Dallas,
TX2Cardiology, Dallas VA Med Cntr/Univ of Texas Southwestern, Dallas,
TX3Cardiology, Univ of San Francisco/San Francisco VA Med Cntr, San
Francisco, CA4Cardiology, Univ of Illinois at Chicago/Jesse Brown VA Med
Cntr, Chicago, NJ5Cardiology, Univ of Florida/Malcolm Randall VA Med Cntr,
Gainesville, FL6Cardiology, Univ of Illinois at Chicago/Jesse Brown VA Med
Ctr, Chicago, IL7Cardiology, Minneapolis Heart Institute, Minneapolis, MN
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Aortocoronary saphenous vein graft (SVG) failure is common
and associated with high morbidity. Thrombus formation may play an
important role in early SVG failure. <br/>Method(s): We performed a
double-blind, randomized trial at four centers. Patients were randomized
to prasugrel 10mg daily or placebo after coronary artery bypass surgery.
Follow-up angiography, optical coherence tomography (OCT), intravascular
ultrasound (IVUS), and near-infrared spectroscopy (NIRS) was performed at
12 months. The primary efficacy objective was the prevalence of
OCT-detected SVG thrombus. The primary safety endpoint was the incidence
of Global Utilization of Streptokinase and t-PA for Occluded Coronary
Arteries (GUSTO) severe bleeding. <br/>Result(s): The study was stopped
early due to slow enrollment after randomizing 84 patients (target
enrollment was 120). Mean age was 64+/-6 years? 98% of the patients were
men. Follow up angiography was performed in 59 patients. SVG IVUS was
performed in 52 patients, OCT in 53 patients, and NIRS in 33 patients.
Angiographic SVG failure occurred in 29% of patients in the treatment arm
vs. 36% in the control arm (p=0.78). Thrombus was identified by OCT in 52%
vs. 54% of patients in the treatment vs. control arm (p>0.99). There were
no differences in total SVG plaque volume or normalized SVG plaque volumes
(301 [IQR (interquartile range) 219-457] vs. 347 [IQR 203-415]
mm³, p=0.83? and 0.08 [IQR 0.06-0.12] vs. 0.07 [IQR 0.06-0.09]
mm³/frame, p=0.20). There was no difference in lipid core
burden index (1 [IQR 0-15] vs. 0 [IQR 0-10], p=0.48). The 1-year Kaplan
Meier incidence of major adverse cardiovascular events in the treatment
group was 14.3% vs. 2.4% in the control group (log rank p=0.21), and
incidence of severe bleeding was 2.4% in the treatment arm vs. 0% in the
control arm (log rank p=0.32). <br/>Conclusion(s): Use of prasugrel was
not associated with lower prevalence of SVG thrombus 12 months after
coronary bypass graft surgery. Further investigation is needed into
strategies to prevent early vein graft failure.

<45>
[Use Link to view the full text]
Accession Number
626979467
Title
Triple therapy versus dual antiplatelet therapy in atrial fibrillation
patients that underwent coronary artery stenting: Systematic review and
meta-analysis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Knijnik L.M.; Rivera M.; Cardoso R.M.; Fernandes A.D.; Fernandes G.C.;
Cohen M.
Institution
(Knijnik, Rivera, Cardoso, Fernandes, Fernandes, Cohen) 1Internal
Medicine, Jackson Memorial Hosp, Miami, FL2Cardiology, Johns Hopkins,
Baltimore, MD3Cardiology, Univ of Miami Miller Sch of Medicine, Miami, FL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Recent guidelines still recommend triple therapy (TT) for
atrial fibrillation (AF) patients that underwent stent placement.
<br/>Objective(s): To compare TT and Dual Antiplatelet Therapy in AF
patients after PCI with stent implantation. <br/>Method(s): We performed a
systematic review and meta-analysis comparing dual antiplatelet therapy
(DAPT) to TT in AF patients after coronary artery stenting. PubMed,
Scopus, and Cochrane Central were searched. We performed a subgroup
analysis including only studies with low to moderate risk of bias and
using study-reported adjusted hazard ratios based on baseline confounders.
<br/>Result(s): All-cause mortality was higher with DAPT as compared to TT
(HR 1.20? 95% CI 1.01-1.43), but this difference was not seen in the lower
risk of bias subgroup (Adjusted HR 1.15? 95% CI 0.89-1.49). Ischemic
stroke was also not significantly different between DAPT and TT (AHR 1.27?
95% CI 0.83-1.95). Major bleeding was lower with DAPT was compared to TT
(HR 0.72? 95% CI 0.60-0.87). This finding also seen in the lower risk of
bias subgroup (AHR 0.37? 95% CI 0.27-0.51) but not in the severe risk of
bias subgroup (HR 1.01? 95% CI 0.8-1.27? test for subgroup differences
p<0.001). <br/>Conclusion(s): DAPT appears to significantly reduce major
bleeding rates, albeit with higher all-cause mortality, possibly explained
by underlying confounder effects, as evidence by the difference in major
bleeding seen in major bleeding depending on study quality.

<46>
Accession Number
626975187
Title
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF
ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF
CARDIOVASCULAR DISEASE.
Source
Endocrine practice : official journal of the American College of
Endocrinology and the American Association of Clinical Endocrinologists.
23 (Supplement 2) (pp 1-87), 2017. Date of Publication: 01 Apr 2017.
Author
Jellinger P.S.; Handelsman Y.; Rosenblit P.D.; Bloomgarden Z.T.; Fonseca
V.A.; Garber A.J.; Grunberger G.; Guerin C.K.; Bell D.S.H.; Mechanick
J.I.; Pessah-Pollack R.; Wyne K.; Smith D.; Brinton E.A.; Fazio S.;
Davidson M.
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The development of these guidelines is mandated by the American
Association of Clinical Endocrinologists (AACE) Board of Directors and
American College of Endocrinology (ACE) Board of Trustees and adheres with
published AACE protocols for the standardized production of clinical
practice guidelines (CPGs). <br/>METHOD(S): Recommendations are based on
diligent reviews of the clinical evidence with transparent incorporation
of subjective factors, according to established AACE/ACE guidelines for
guidelines protocols. <br/>RESULT(S): The Executive Summary of this
document contains 87 recommendations of which 45 are Grade A (51.7%), 18
are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D.
These detailed, evidence-based recommendations allow for nuance-based
clinical decision-making that addresses multiple aspects of real-world
medical care. The evidence base presented in the subsequent Appendix
provides relevant supporting information for Executive Summary
Recommendations. This update contains 695 citations of which 203 (29.2 %)
are EL 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL
3 (weak), and 236 (34.0%) are EL 4 (no clinical evidence).
<br/>CONCLUSION(S): This CPG is a practical tool that endocrinologists,
other health care professionals, health-related organizations, and
regulatory bodies can use to reduce the risks and consequences of
dyslipidemia. It provides guidance on screening, risk assessment, and
treatment recommendations for a range of individuals with various lipid
disorders. The recommendations emphasize the importance of treating
low-density lipoprotein cholesterol (LDL-C) in some individuals to lower
goals than previously endorsed and support the measurement of coronary
artery calcium scores and inflammatory markers to help stratify risk.
Special consideration is given to individuals with diabetes, familial
hypercholesterolemia, women, and youth with dyslipidemia. Both clinical
and cost-effectiveness data are provided to support treatment decisions.
ABBREVIATIONS: 4S = Scandinavian Simvastatin Survival Study A1C = glycated
hemoglobin AACE = American Association of Clinical Endocrinologists AAP =
American Academy of Pediatrics ACC = American College of Cardiology ACE =
American College of Endocrinology ACS = acute coronary syndrome ADMIT =
Arterial Disease Multiple Intervention Trial ADVENT = Assessment of
Diabetes Control and Evaluation of the Efficacy of Niaspan Trial
AFCAPS/TexCAPS = Air Force/Texas Coronary Atherosclerosis Prevention Study
AHA = American Heart Association AHRQ = Agency for Healthcare Research and
Quality AIM-HIGH = Atherothrombosis Intervention in Metabolic Syndrome
With Low HDL/High Triglycerides trial ASCVD = atherosclerotic
cardiovascular disease ATP = Adult Treatment Panel apo = apolipoprotein
BEL = best evidence level BIP = Bezafibrate Infarction Prevention trial
BMI = body mass index CABG = coronary artery bypass graft CAC = coronary
artery calcification CARDS = Collaborative Atorvastatin Diabetes Study CDP
= Coronary Drug Project trial CI = confidence interval CIMT = carotid
intimal media thickness CKD = chronic kidney disease CPG(s) = clinical
practice guideline(s) CRP = C-reactive protein CTT = Cholesterol Treatment
Trialists CV = cerebrovascular CVA = cerebrovascular accident EL =
evidence level FH = familial hypercholesterolemia FIELD = Secondary
Endpoints from the Fenofibrate Intervention and Event Lowering in Diabetes
trial FOURIER = Further Cardiovascular Outcomes Research with PCSK9
Inhibition in Subjects With Elevated Risk trial HATS = HDL-Atherosclerosis
Treatment Study HDL-C = high-density lipoprotein cholesterol HeFH =
heterozygous familial hypercholesterolemia HHS = Helsinki Heart Study HIV
= human immunodeficiency virus HoFH = homozygous familial
hypercholesterolemia HPS = Heart Protection Study HPS2-THRIVE = Treatment
of HDL to Reduce the Incidence of Vascular Events trial HR = hazard ratio
HRT = hormone replacement therapy hsCRP = high-sensitivity CRP IMPROVE-IT
= Improved Reduction of Outcomes: Vytorin Efficacy International Trial
IRAS = Insulin Resistance Atherosclerosis Study JUPITER = Justification
for the Use of Statins in Primary Prevention: An Intervention Trial
Evaluating Rosuvastatin LDL-C = low-density lipoprotein cholesterol
Lp-PLA2 = lipoprotein-associated phospholipase A2 MACE = major
cardiovascular events MESA = Multi-Ethnic Study of Atherosclerosis MetS =
metabolic syndrome MI = myocardial infarction MRFIT = Multiple Risk Factor
Intervention Trial NCEP = National Cholesterol Education Program NHLBI =
National Heart, Lung, and Blood Institute PCOS = polycystic ovary syndrome
PCSK9 = proprotein convertase subtilisin/kexin type 9 Post CABG = Post
Coronary Artery Bypass Graft trial PROSPER = Prospective Study of
Pravastatin in the Elderly at Risk trial QALY = quality-adjusted life-year
ROC = receiver-operator characteristic SOC = standard of care SHARP =
Study of Heart and Renal Protection T1DM = type 1 diabetes mellitus T2DM =
type 2 diabetes mellitus TG = triglycerides TNT = Treating to New Targets
trial VA-HIT = Veterans Affairs High-Density Lipoprotein Cholesterol
Intervention Trial VLDL-C = very low-density lipoprotein cholesterol WHI =
Women's Health Initiative.

<47>
Accession Number
2001613472
Title
Self-made thoracic needled suspending device with a snare: An excellent
aid for uniportal video-assisted thoracic lobectomy and segmentectomy for
lung cancer.
Source
Oncology Letters. 17 (4) (pp 3671-3676), 2019. Date of Publication: April
2019.
Author
Wang S.; Meng C.; Jiang Z.; Gonzalez-Rivas D.; Ruan J.; Xu W.; Liu C.;
Zhang L.; Gao G.; Yu G.; Teng H.; Ju J.
Institution
(Wang, Jiang) Department of Thoracic Surgery, Mount Qianfuo Attatched
Hospital of Shandong University, Jinan, Shandong 250000, China
(Wang, Meng, Ruan, Xu, Liu, Zhang, Gao, Yu, Teng, Ju) Department of
Thoracic Surgery, Weihai Municipal Hospital, Weihai, Shandong 264200,
China
(Gonzalez-Rivas) Department of Thoracic Surgery, Coruna University
Hospital, Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruna 15008,
Spain
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Safety and feasibility of the self-made thoracic needled suspending device
with a snare in the uniportal video-assisted thoracic lobectomy and
segmentectomy for the treatment of non-small cell lung cancer were
explored. In total, 80 pulmonary lung major resections (including
lobectomy and segmental resections) with systematic mediastinal
lymphadenectomy were retrospectively analyzed. Patients were randomly
divided into an observation group and a control group. In the observation
group, the device was used to hang affected lungs, left and right vagus
nerve at the level of tracheal bifurcation, the arch of azygos vein, left
phrenic nerve and left and right bronchus on the chest wall to offer a
better exposure of the operation field. In the control group, the
conventional uniportal video-assisted thoracic surgery was performed
without using the self-made device. Systematic mediastinal lymphadenectomy
was performed in both groups. Operation time, intraoperative blood loss,
postoperative extubation time, hospital stay and perioperative
complications in the early stage of patients in both groups were compared.
The operation time 120.2+/-40.32 min, intraoperative blood loss
100.51+/-50.23ml<inf>/</inf>dayml, and postoperative suction drainage
volume 208+/-97.56 in the observation group were significantly different
from those in the control group (P<0.05), and there were no significant
differences in postoperative extubation time, hospital stay and
perioperative complications between the two groups (P>0.05). The self-made
thoracic needled suspending device with a snare is an excellent helper for
uniportal video-assisted thoracic surgery, because it helps to expose
surgical field and has no postoperative cicatrisation at puncture point on
the wall of the chest. The device and its use are worthy of
promotion.<br/>Copyright &#xa9; 2019, Spandidos Publications. All rights
reserved.

<48>
Accession Number
626972357
Title
S1Everolimus Initiation With Early Calcineurin Inhibitor Withdrawal in De
Novo Heart Transplant Recipients: Long-term Follow-up From the Randomized
SCHEDULE Study.
Source
Transplantation. (no pagination), 2019. Date of Publication: 12 Mar 2019.
Author
Gustafsson F.; Andreassen A.K.; Andersson B.; Eiskjaer H.; Radegran G.;
Gude E.; Jansson K.; Solbu D.; Karason K.; Arora S.; Dellgren G.;
Gullestad L.
Institution
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Gustafsson) Department of Clinical Medicine, University of Copenhagen,
Denmark
(Andreassen, Gude, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Andersson, Karason) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Radegran) Section for Heart Failure and Valvular Disease, Skane
University Hospital and Department of Clinical Sciences, Cardiology, Lund
University, Denmark
(Jansson) Department of Cardiology, Heart and Medicine Center County
Council of Ostergotland and Linkoping University, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) K.G.Jebsen Cardiac Research Center and Center for Heart
Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Publisher
NLM (Medline)
Abstract
BACKGROUND: A calcineurin inhibitor free immunosuppressive regimen has
been demonstrated to improve renal function early after heart
transplantation, but long-term outcome of such a strategy has not been
well described. <br/>METHOD(S): In the randomized SCHEDULE trial, de novo
heart transplant recipients received (1) everolimus with reduced-exposure
calcineurin inhibitor (CNI, cyclosporine) followed by CNI withdrawal at
weeks 7-11 post-transplant or (2) standard-exposure cyclosporine, both
with mycophenolate mofetil and corticosteroids; 95/115 randomized patients
were followed up at 5-7 years post-transplant. <br/>RESULT(S): Mean
measured GFR was 74.7mL/min and 62.4mL/min with everolimus and CNI,
respectively. The mean difference was in favor of everolimus by 11.8
mL/min in the intent-to-treat population (P = 0.004) and 17.2 mL/min in
the per protocol population (n = 75; P < 0.001). From transplantation to
last follow-up, the incidence of biopsy-proven acute rejection (BPAR) was
77% (37/48) and 66% (31/47) (P = 0.23) with treated BPAR in 50% and 23% (P
< 0.01), in the everolimus and CNI groups, respectively; no episode led to
hemodynamic compromise. Coronary allograft vasculopathy (CAV) assessed by
coronary intravascular ultrasound was present in 53% (19/36) and 74%
(26/35) of everolimus- and CNI-treated patients, respectively (P = 0.037).
Graft dimensions and function were similar between groups. Late adverse
events were comparable. <br/>CONCLUSION(S): These results suggest that de
novo heart transplant patients randomized to everolimus and low-dose CNI
followed by CNI-free therapy maintain significantly better long-term renal
function as well as significantly reduced CAV, than patients randomized to
standard CNI treatment. Increased BPAR in the everolimus group during year
1 did not impair long-term graft function.

<49>
Accession Number
626971941
Title
Health Status After Transcatheter Mitral-Valve Repair in Heart Failure and
Secondary Mitral Regurgitation: COAPT Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2019. Date
of Publication: 04 Mar 2019.
Author
Arnold S.V.; Chinnakondepalli K.M.; Spertus J.A.; Magnuson E.A.; Baron
S.J.; Kar S.; Lim D.S.; Mishell J.M.; Abraham W.T.; Lindenfeld J.A.; Mack
M.J.; Stone G.W.; Cohen D.J.
Institution
(Arnold, Chinnakondepalli, Spertus, Magnuson, Baron, Cohen) Saint Luke's
Mid America Heart Institute and University of Missouri-Kansas City, Kansas
City, MO, United States
(Kar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Lim) University of Virginia, Charlottesville, VA, United States
(Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco, CA,
United States
(Abraham) Ohio State University, Columbus, OH, United States
(Lindenfeld) Vanderbilt Heart and Vascular Institute, Nashville, TN,
United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Stone) New York-Presbyterian Hospital and Cardiovascular Research
Foundation, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the COAPT (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients with Functional
Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) led
to reduced heart failure (HF) hospitalizations and improved survival in
patients with symptomatic HF and 3+ to 4+ secondary mitral regurgitation
(MR) on maximally-tolerated medical therapy. Given the advanced age and
comorbidities of these patients, improvement in health status is also an
important treatment goal. <br/>OBJECTIVE(S): The purpose of this study was
to understand the health status outcomes of patients with HF and 3+ to 4+
secondary MR treated with TMVr versus standard care. <br/>METHOD(S): The
COAPT trial randomized patients with HF and 3+ to 4+ secondary MR to TMVr
(n = 302) or standard care (n = 312). Health status was assessed at
baseline and at 1, 6, 12, and 24 months with the Kansas City
Cardiomyopathy Questionnaire (KCCQ) and the SF-36 health status survey.
The primary health status endpoint was the KCCQ overall summary score
(KCCQ-OS; range 0 to 100; higher = better; minimum clinically important
difference = 5 points). <br/>RESULT(S): At baseline, patients had
substantially impaired health status (mean KCCQ-OS 52.4 +/- 23.0). While
health status was unchanged over time in the standard care arm, patients
randomized to TMVr demonstrated substantial improvement in the KCCQ-OS at
1 month (mean between-group difference 15.9 points; 95% confidence
interval [CI]: 12.3 to 19.5 points), with only slight attenuation of this
benefit through 24 months (mean between-group difference 12.8 points; 95%
CI: 7.5 to 18.2 points). At 24 months, 36.4% of TMVr patients were alive
with a moderately large (>=10-point) improvement versus 16.6% of standard
care patients (p < 0.001), for a number needed to treat of 5.1 patients
(95% CI: 3.6 to 8.7 patients). TMVr patients also reported better generic
health status at each timepoint (24-month mean difference in SF-36 summary
scores: physical 3.6 points; 95% CI: 1.4 to 5.8 points; mental 3.6 points;
95% CI: 0.8 to 6.4 points). <br/>CONCLUSION(S): Among patients with
symptomatic HF and 3+ to 4+ secondary MR receiving maximally-tolerated
medical therapy, edge-to-edge TMVr resulted in substantial early and
sustained health status improvement compared with medical therapy alone.
(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT
Trial] [COAPT]; NCT01626079).<br/>Copyright &#xa9; 2019 American College
of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<50>
Accession Number
626971919
Title
Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac
Surgery: A Randomized Controlled Trial.
Source
Anesthesiology. (no pagination), 2019. Date of Publication: 11 Mar 2019.
Author
Klinger R.Y.; Cooter M.; Bisanar T.; Terrando N.; Berger M.; Podgoreanu
M.V.; Stafford-Smith M.; Newman M.F.; Mathew J.P.
Institution
(Klinger) From the Department of Anesthesiology, Duke University Medical
Center, Durham, North Carolina (R.Y.K., M.C., T.B., N.T., M.B., M.V.P.,
M.S.-S., J.P.M.) the Department of Anesthesiology, University of
Louisville School of Medicine, Lexington, Kentucky (M.F.N.)
Publisher
NLM (Medline)
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Preclinical and clinical studies
suggest that lidocaine might be neuroprotective, which could benefit
surgical patients at risk of neurologic compromise WHAT THIS ARTICLE TELLS
US THAT IS NEW: This multicenter trial of intravenous lidocaine
administered during and after cardiac surgery did not show an effect on
cognition at 6 weeks postoperatively BACKGROUND:: Cognitive decline after
cardiac surgery occurs frequently and persists in a significant proportion
of patients. Preclinical studies and human trials suggest that intravenous
lidocaine may confer protection in the setting of neurologic injury. It
was hypothesized that lidocaine administration would reduce cognitive
decline after cardiac surgery compared to placebo. <br/>METHOD(S): After
institutional review board approval, 478 patients undergoing cardiac
surgery were enrolled into this multicenter, prospective, randomized,
double-blinded, placebo-controlled, parallel group trial. Subjects were
randomized to lidocaine 1 mg/kg bolus after the induction of anesthesia
followed by a continuous infusion (48 mug . kg . min for the first hour,
24 mug . kg . min for the second hour, and 10 mug . kg . min for the next
46 h) or saline with identical volume and rate changes to preserve
blinding. Cognitive function was assessed preoperatively and at 6 weeks
and 1 yr postoperatively using a standard neurocognitive test battery. The
primary outcome was change in cognitive function between baseline and 6
weeks postoperatively, adjusting for age, years of education, baseline
cognition, race, and procedure type. <br/>RESULT(S): Among the 420
allocated subjects who returned for 6-week follow-up (lidocaine: N = 211;
placebo: N = 209), there was no difference in the continuous cognitive
score change (adjusted mean difference [95% CI], 0.02 (-0.05, 0.08); P =
0.626). Cognitive deficit (greater than 1 SD decline in at least one
cognitive domain) at 6 weeks occurred in 41% (87 of 211) in the lidocaine
group versus 40% (83 of 209) in the placebo group (adjusted odds ratio
[95% CI], 0.94 [0.63, 1.41]; P = 0.766). There were no differences in any
quality of life outcomes between treatment groups. At the 1-yr follow-up,
there continued to be no difference in cognitive score change, cognitive
deficit, or quality of life. <br/>CONCLUSION(S): Intravenous lidocaine
administered during and after cardiac surgery did not reduce postoperative
cognitive decline at 6 weeks.

<51>
Accession Number
626892025
Title
Guidelines for enhanced recovery after lung surgery: Recommendations of
the Enhanced Recovery after Surgery (ERAS) Society and the
European Society of Thoracic Surgeons (ESTS).
Source
European Journal of Cardio-thoracic Surgery. 55 (1) (pp 91-115), 2019.
Date of Publication: 01 Jan 2019.
Author
Batchelor T.J.P.; Rasburn N.J.; Abdelnour-Berchtold E.; Brunelli A.;
Cerfolio R.J.; Gonzalez M.; Ljungqvist O.; Petersen R.H.; Popescu W.M.;
Slinger P.D.; Naidu B.
Institution
(Batchelor) Department of Thoracic Surgery, University Hospitals Bristol
NHS Foundation Trust, Upper Maudlin Street, Bristol BS28HW, United Kingdom
(Rasburn) Department of Anaesthesia, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Abdelnour-Berchtold, Gonzalez) Division of Thoracic Surgery, Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Brunelli) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
(Cerfolio) Department of Cardiothoracic Surgery, New York University
Langone Health, New York, NY, United States
(Ljungqvist) Department of Surgery, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Petersen) Department of Thoracic Surgery, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Popescu) Department of Anesthesiology, Yale University School of
Medicine, New Haven, CT, United States
(Slinger) Department of Anesthesia, University Health Network, Toronto
General Hospital, Toronto, ON, Canada
(Naidu) Department of Thoracic Surgery, Heart of England NHS Foundation
Trust, Birmingham, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Enhanced recovery after surgery is well established in specialties such as
colorectal surgery. It is achieved through the introduction of multiple
evidence-based perioperative measures that aim to diminish postoperative
organ dysfunction while facilitating recovery. This review aims to present
consensus recommendations for the optimal perioperative management of
patients undergoing thoracic surgery (principally lung resection). A
systematic review of meta-analyses, randomized controlled trials, large
non-randomized studies and reviews was conducted for each protocol
element. Smaller prospective and retrospective cohort studies were
considered only when higher-level evidence was unavailable. The quality of
the evidence base was graded by the authors and used to form consensus
recommendations for each topic. Development of these recommendations was
endorsed by the Enhanced Recovery after Surgery Society and the European
Society for Thoracic Surgery. Recommendations were developed for a total
of 45 enhanced recovery items covering topics related to preadmission,
admission, intraoperative care and postoperative care. Most are based on
good-quality studies. In some instances, good-quality data were not
available, and subsequent recommendations are generic or based on data
extrapolated from other specialties. In other cases, no recommendation can
currently be made because either equipoise exists or there is a lack of
available evidence. Recommendations are based not only on the quality of
the evidence but also on the balance between desirable and undesirable
effects. Key recommendations include preoperative counselling, nutritional
screening, smoking cessation, prehabilitation for high-risk patients,
avoidance of fasting, carbohydrate loading, avoidance of preoperative
sedatives, venous thromboembolism prophylaxis, prevention of hypothermia,
short-acting anaesthetics to facilitate early emergence, regional
anaesthesia, nausea and vomiting control, opioid-sparing analgesia,
euvolemic fluid management, minimally invasive surgery, early chest drain
removal, avoidance of urinary catheters and early mobilization after
surgery. These guidelines outline recommendations for the perioperative
management of patients undergoing lung surgery based on the best available
evidence. As the recommendation grade for most of the elements is strong,
the use of a systematic perioperative care pathway has the potential to
improve outcomes after surgery.<br/>Copyright &#xa9; 2018 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<52>
Accession Number
2001605137
Title
Dual anti-thrombotic therapy with dabigatran after percutaneous coronary
intervention in atrial fibrillation: Japanese and East-Asian Subgroup
Analysis of the RE-DUAL PCI trial.
Source
Circulation Journal. 83 (2) (pp 327-333), 2019. Date of Publication:
February 2019.
Author
Ako J.; Okumura K.; Nakao K.; Kozuma K.; Morino Y.; Okazaki K.; Fukaya T.;
Kimura T.
Institution
(Ako) Department of Cardiovascular Medicine, Kitasato University,
Sagamihara, Japan
(Okumura, Nakao) Division of Cardiology, Saiseikai Kumamoto Hospital
Cardiovascular Center, Kumamoto, Japan
(Kozuma) Department of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
(Morino) Division of Cardiology, Iwate Medical University, Morioka, Japan
(Okazaki, Fukaya) Medicine Division, Nippon Boehringer Ingelheim Co.,
Ltd., Tokyo, Japan
(Kimura) Department of Cardiovascular Medicine, Kyoto University Graduate
School of Medicine, Kyoto, Japan
Publisher
Japanese Circulation Society
Abstract
Background: In the RE-DUAL PCI trial, dual anti-thrombotic therapy with
dabigatran and a P2Y<inf>12</inf> inhibitor had a lower risk of bleeding
and similar risk reduction of thromboembolic events, compared with
warfarin triple therapy, in patients with NVAF undergoing PCI. This
subanalysis investigated whether the efficacy and safety of dabigatran
dual therapy in Japanese and East-Asian patients enrolled in the RE-DUAL
PCI trial were similar to those of the overall patient population of the
trial. <br/>Methods and Results: RE-DUAL PCI was a multicenter, randomized
trial. The primary endpoint was the time to first International Society on
Thrombosis and Hemostasis major or clinically relevant non-major bleeding
events. Of the East-Asian patients (n=240) enrolled in the RE-DUAL PCI
trial, 111 were Japanese and received dabigatran 110 mg (n=50) or 150 mg
(n=13) dual therapy, or warfarin triple therapy (n=48). The incidence of
the primary endpoint in Japanese patients was 26.0% and 29.2% with
dabigatran 110-mg dual therapy and the corresponding warfarin triple
therapy, and 23.1% and 30.8% with dabigatran 150-mg dual therapy and the
corresponding warfarin triple therapy, respectively. Similar results were
observed in the East-Asian population. <br/>Conclusion(s): This
subanalysis of the RE-DUAL PCI trial demonstrated that, like in the
overall patient population, dabigatran dual therapy may offer physicians
additional options for managing Japanese and East-Asian patients with NVAF
receiving PCI.<br/>Copyright &#xa9; 2019, Japanese Circulation Society.

<53>
Accession Number
626851362
Title
PACMAN trial protocol, Perioperative Administration of Corticotherapy on
Morbidity and mortality after Non-cardiac major surgery: A randomised,
multicentre, double-blind, superiority study.
Source
BMJ Open. 9 (3) (no pagination), 2019. Article Number: e021262. Date of
Publication: 01 Mar 2019.
Author
Asehnoune K.; Futier E.; Feuillet F.; Roquilly A.
Institution
(Asehnoune) Anaesthesia and Intensive Care Unit, CHU Nantes, Nantes,
France
(Futier) Anaesthesia and Intensive Care Unit, Centre Hospitalier
Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
(Feuillet) Plateforme de Biometrie, Direction de la Recherche, Departement
Promotion, CHU Nantes, Nantes, France
(Feuillet) INSERM, SPHERE U1246, Universite de Nantes, Nantes, France
(Roquilly) SAR, CHU Nantes, Nantes, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Postoperative complications are major healthcare problems and
are associated with a reduced short-Term and long-Term survival after
surgery. An excessive postoperative inflammatory response participates to
the development of postoperative infection and mortality. The aim of the
Perioperative Administration of Corticotherapy on Morbidity and mortality
After Non-cardiac surgery (PACMAN) study is to assess the effectiveness of
perioperative administration of corticosteroid to reduce postoperative
morbidity and mortality in patients undergoing major non-cardiac surgery.
Methods and analysis The PACMAN is a multicentre, randomised, controlled,
double-blind, superiority, two-Arm trial of 1222 high-risk patients aged
50 years or older undergoing major non-cardiac surgery at 32 acute care
hospital in France. Patients are randomly assigned to dexamethasone (0.2
mg/kg at the end of the surgical procedure and at day +1, n=611) or to
placebo (n=611). The primary outcome is a composite of predefined 14-day
major pulmonary complications and mortality. Secondary outcomes are
surgical complications, infections, organ failures, critical care-free
days, length of hospital stay and all-cause mortality at 28 days. Ethics
and dissemination The PACMAN trial protocol has been approved by the
ethics committee of Sud Mediterranee V, and will be carried out according
to the Good Clinical Practice guidelines and the principles of the
Declaration of Helsinki. The PACMAN trial is a randomised controlled trial
powered to investigate whether perioperative administration of
corticosteroids in patients undergoing non-cardiac major surgery reduces
postoperative complications. The results of this study will be
disseminated through presentation at scientific conferences and
publication in peer-reviewed journals. Trial registration number
NCT03218553; Pre-results.<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<54>
Accession Number
622811123
Title
Health-related quality of life in congenital heart disease surgery in
children and young adults: A systematic review and meta-Analysis.
Source
Archives of Disease in Childhood. 104 (4) (no pagination), 2019. Article
Number: 313653. Date of Publication: 01 Apr 2019.
Author
Ladak L.A.; Hasan B.S.; Gullick J.; Gallagher R.
Institution
(Ladak, Gallagher) Charles Perkins Centre, Sydney Nursing School,
University of Sydney, Sydney, NSW 2006, Australia
(Hasan) Department of Pediatrics and Child Health, Aga Khan University,
Karachi, Pakistan
(Gullick) Sydney Nursing School, University of Sydney, Sydney, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background As survival improves in the congenital heart disease (CHD)
population, health-related quality of life (HRQOL) outcomes become
increasingly important. While surgery improves survival, poor HRQOL occurs
postoperatively and cardiac-related HRQOL outcomes are rarely reported.
Objective To conduct a systematic review and meta-Analyses of general and
cardiac-related HRQOL in CHD surgical children and young adults. Method
Medline, CINAHL and EMBASE were searched. Quantitative designs with a
minimum of 80% CHD surgical patients and mean age <=18 years compared with
healthy controls were included in the review. Data were analysed in RevMan
V.5.3 using a random effects model. Outcome measures General and
cardiac-related HRQOL. Results Studies (n=20) were conducted in
high-income countries and included 3808 patients plus 2951 parental
reports of patients. HRQOL was worse in postoperative patients with CHD
versus healthy controls in all domains with the largest difference seen
for physical function (standard mean difference (SMD) of-0.56, 95% CI-0.82
to-0.30). Cardiac-related HRQOL was worse in complex compared with simple
CHD with the largest SMD (-0.60, 95% CI-0.80 to-0.40) for symptoms.
Heterogeneity ranged from 0% to 90%. Conclusions CHD surgical patients
have substantially worse HRQOL compared with age-matched healthy controls.
Strategies should focus on improving HRQOL in this subgroup. Results may
not be applicable to low/middle-income countries given the dearth of
relevant research.<br/>Copyright &#xa9; Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2019. All
rights reserved. No commercial use is permitted unless otherwise expressly
granted.

<55>
[Use Link to view the full text]
Accession Number
626956422
Title
Impact of baseline low-density lipoprotein cholesterol level and
aggressive lipid-lowering therapy by ezetimibe on prognosis of statin
naive acute coronary syndrome patients: A sub-analysis of the hij-proper
trial.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Kawada-Watanabe E.; Yamaguchi J.; Sekiguchi H.; Im J.; Suzuki K.; Ogiso
M.; Arashi H.; Ogawa H.; Hagiwara N.
Institution
(Kawada-Watanabe, Yamaguchi, Sekiguchi, Im, Suzuki, Ogiso, Arashi, Ogawa,
Hagiwara) 1Dept of Cardiology, Tokyo Women's Med Univ, Shinjyuku Ward,
Japan2Dept of Cardiology, Tokyo Women's Med Univ, Tokyo, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There were few reports examining the difference of treatment
effect of lipid lowering therapy by ezetimibe in accordance with baseline
low-density lipoprotein cholesterol (LDL-C) level in acute coronary
syndrome (ACS) patients. <br/>Method(s): In the HIJ-PROPER study, 1,734
ACS patients with dyslipidaemia were randomly assigned to receive
pitavastatin monotherapy (P-mono) or pitavastatin+ezetimibe therapy (P+E).
In this study, statin naive participants (N=1,429) were divided into two
groups by LDL-C level (cut-off value of 140mg/dl). The primary endpoint
was a composite of all-cause death, non-fatal myocardial infarction,
non-fatal stroke, unstable angina, and ischemia-driven coronary
revascularisation. <br/>Result(s): The median follow-up period was 3.4
years; the follow-up rate was 99%. In low baseline LDL-C group (<
140mg/dl), LDL-C value at baseline and 3-year in P-mono group were
118.6+/-11.9 and 84.8+/-20.6mg/dl, and in P+E group, 119.0+/-12.2 and
65.4+/-22.3mg/dl, respectively, ANOVA P<0.001), however, Kaplan-Meier
analyses revealed that the incidence of primary endpoint was not
statistically different between two groups (Figure A). Whereas, in high
baseline LDL-C group (>= 140mg/dl), LDL-C value at baseline and 3-year in
P-mono group were167.1+/-24.mg/dl and 94.3+/-23.2md/dl and, in P+E group,
166.2+/-26.2mg/dl and 74.7+/-21.5mg/dl, respectively, ANOVA P<0.001).
Kaplan-Meier analyses revealed that the incidence of primary endpoint was
significantly lower in P+E group than P-mono group. (Figure B).
<br/>Conclusion(s): In statin naive ACS patients showing LDL-C value less
than 140mg/dl on admission, intensive lipid lowering therapy, adding
ezetimibe to pitavastatin, did not improve clinical outcome in comparison
with pitavastatin monotherapy, regardless significant lower LDL-C value
after 3-year. Another approach, other than ezetimibe, for lipid lowering
should be warranted in this population. (Figure Presented).

<56>
[Use Link to view the full text]
Accession Number
626956362
Title
An implantable cardioverter defibrillator is not associated with a
reduction in mortality in advanced heart failure patients with continuous
flow left ventricular assist device: A systematic review and
meta-analysis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Elkaryoni A.; Khan M.S.; Al Badarin F.; Poonia J.; Potturi N.; Ellakany
K.; Wimmer A.P.
Institution
(Elkaryoni, Khan, Al Badarin, Poonia, Potturi, Ellakany, Wimmer) 1Internal
Medicine, Univ of Missouri Kansas City, Kansas City, MO2Internal Medicine,
John H Stroger Jr Hosp of Cook Count, Chicago, IL3Cardiovascular Disease,
Saint Luke's Mid America Heart Institute, Kansas City, MO4Sch of Medicine,
Univ of Missouri Kansas City, Kansas City, MO5Cardiovascular Disease, Univ
of Alexandria, Alexandria, Egypt
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Ventricular arrhythmias are common in patients with advanced
heart failure and a continuous flow left ventricular assist device
(CF-LVAD) and result in a drop in device output, increased risk of device
thrombosis and, if sustained, may lead to right heart failure. However,
the effect of an implantable cardioverter defibrillator (ICD) on mortality
in patients with CF-LVAD is not known and there is no consensus about the
role of an ICD in these patients. <br/>Method(s): We conducted a
systematic literature review and meta-analysis to assess the effect of an
ICD on mortality for patients with advanced heart failure and CF-LVAD.
PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and
Embase were searched from inception through March 2018. Original studies
of patients with a CF-LVAD that compared mortality among those with and
without an ICD were included. The primary outcome was mortality. The
analysis was done using a random-effects model. Hazard ratios are
expressed with 95% confidence intervals (CIs). <br/>Result(s): Eight
observational studies with a total of 5982 patients met inclusion
criteria. An ICD was present in 3064 (51.2%) patients and there was no ICD
in 2918 (48.8%) patients. Propensity score matching was done on the
largest two observational studies with a total number of 5160 (86.2%)
patients to ensure a targeted cohort with similar baseline
characteristics. CF-LVAD was used as a bridge to heart transplantation in
73.7%. Meta-analysis showed no difference in mortality for patients using
CF-LVAD with and without an ICD (HR: 0.94, 95% confidence interval (CI):
[0.66 - 1.22]; p=0.203, I2=28.3%) <br/>Conclusion(s): Having an ICD was
not associated with improved mortality for advanced heart failure patients
with a CF-LVAD. However all included studies were observational.
Randomized controlled study is needed to determine the effect of an ICD in
patients with a CF-LVAD.

<57>
Accession Number
626955878
Title
Vitamin D supplementation, cardiac events, and stroke: A systematic review
and meta-analysis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Nudy M.; Krakowksi G.; Ghahramani M.; Ruzieh M.; Foy A.J.
Institution
(Nudy, Krakowksi, Ghahramani, Ruzieh, Foy) 1Internal Medicine, PennState
Health, Hershey, PA2Cardiology, PennState Health, Hershey, PA3Cardiology
and Public Health Sciences, PennState Health, Hershey, PA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Emerging observational data has suggested a link between
vitamin D deficiency and coronary heart disease (CHD). However, randomized
controlled trials (RCTs) have failed to show benefit. The objective of
this study is to analyze the available RCTs investigating vitamin D
supplementation on the risk of CHD and stroke. <br/>Method(s): A database
search identified all RCTs that compared vitamin D supplementation to
placebo and evaluated at least one of the primary endpoints, which
included nonfatal myocardial infarction (MI), cardiac mortality, stroke
and CHD events (a composite of cardiac mortality, nonfatal MI, unstable
angina and coronary revascularization). The primary aim was to calculate
summary odds ratios (OR) for each endpoint. The secondary aim was to test
for heterogeneity of treatment effect (HTE) using the Chi and
I² tests for younger (average age <=60 years) vs. older
(average age >60 years) participants, shorter (<= 2 years) vs. longer (>2
years) trial duration, vitamin D supplements with vs. without calcium,
lower vs. higher baseline plasma vitamin D concentrations and daily vs.
monthly dosages of vitamin D. <br/>Result(s): In total, 21 RCTs were
identified that compared vitamin D supplementation to placebo (n=57,329).
Vitamin D supplementation had no effect on nonfatal MI (OR 1.00, 95%
confidence interval (CI) 0.90-1.12), cardiac death (OR 0.89, CI
0.78-1.02), CHD events (OR 1.03, CI 0.95-1.10), or stroke (OR, 1.02, CI
0.91-1.13). However, when analyzing CHD events there was significant HTE
suggesting reduced CHD when using vitamin D supplements without calcium
compared to with calcium (Chi²=4.57, p=0.03,
I²=78.1%) and with monthly dosages compared to daily doses
(Chi²=5.24, p=0.02, I²=80.9%). No HTE was observed
based on average age of participants, trial duration and baseline plasma
vitamin D concentrations. <br/>Conclusion(s): Vitamin D supplementation
did not reduce the risk of cardiac events and stroke. However, high
monthly doses of vitamin D and vitamin D without calcium may improve CHD
outcomes. The RCT that contributed the most weight to this analysis (>50%)
tested 400 IU/day of vitamin D, a dose below the recommended daily intake
and thus, further prospective studies investigating higher doses of
vitamin D with CHD outcomes are needed.

<58>
Accession Number
626948156
Title
The clinical impact of pre-operative exercise therapy on respiratory
complications after major surgery: A meta- analysis.
Source
Swiss Medical Weekly. Conference: Annual Meeting Swiss Society for
Anesthesiology and Resuscitation SGAR/SSAR , Swiss Association of Nurse
Anesthesists, SIGA. Switzerland. 147 (Supplement 226) (pp 5S), 2017. Date
of Publication: November 2017.
Author
Cools E.; Assouline B.; Elia N.; Licker M.
Institution
(Cools, Assouline, Elia, Licker) Departement of Anaesthesia, University
Hospital Geneva, Switzerland
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Background: Postoperative respiratory complications are associated with a
longer hospital stay, a higher mortality rate and an increased admission
rate in the intensive care unit (ICU). The health benefits of exercises
are well known in terms of prolonged survival and quality of life. A
growing interest has emerged to implement rehabilitation programs before
surgery with the aim to reduce postoperative complications by improving
aerobic fitness and muscular strength. <br/>Objective(s): The aim of this
meta- analysis is to analyze the functional changes and clinical outcome
associated with preoperative rehabilitation in patients undergoing major
surgery (abdominal, thoracic, cardiac, vascular & urologic). The main
study endpoints will be VO2max, anaerobic threshold, muscular strength
(measured pre-surgery, after performing exercises), mortality and
postoperative pulmonary complications (PPC). Secondary endpoints will be
postoperative cardiovascular complications, hospital length of stay (LOS),
admission in ICU and duration of mechanical ventilation. <br/>Method(s):
Medline, Embase and the Cochrane library were used as databases. We
included published Randomised Control Trials, concerning adults undergoing
major surgery and performing preoperative exercises. <br/>Result(s): 15
articles were included. In the prehabilitation group, the maximum
inspiratory pressure (P 0.009) and Peak Work Ratio (VO2 max) (P <0.00001)
were higher than in the control group. Postoperative, there was less
atelectasis (P <0.0001) and pneumonia (P <0.008) in the intervention
group. In addition, the duration of mechanical ventilation (P = 0.16),
length of stay in the ICU (P = 0.01) and hospital (P <0.0001), were
shorter. No adverse effect due to prehabilitation was reported.
<br/>Discussion(s): Patients who performed preoperative exercises did
better than their controls. For some outcomes, there are no sufficient
data available to examine the effect. Future research has to point out the
impact of preoperative exercises on the anaerobic threshold and
postoperative cardiovascular complications. <br/>Conclusion(s): Patients
undergoing major surgery and performing preoperative exercises, had
preoperative a higher peak work rate and inspiratory pressure.
Postoperative, they experienced less pulmonary complications and the
duration of mechanical ventilation, stay in ICU and hospital were shorter.

<59>
Accession Number
2001633919
Title
Autologous bone marrow stem cell therapy for patients undergoing coronary
artery bypass grafting: A meta-analysis of 14 randomized controlled
trials.
Source
Experimental and Therapeutic Medicine. 17 (4) (pp 2985-2994), 2019. Date
of Publication: April 2019.
Author
Wu S.; Yao L.; Yan P.; Bao Q.; Dong X.; Liu X.; Zhu Y.; Su X.; Wang A.;
Duan Y.; Yang K.; Zhang M.; Cao Y.
Institution
(Wu, Bao) Department of Pathology, School of Basic Medicine, Gansu
University of Chinese Medicine, China
(Wu, Bao, Zhang) Department of Pathology, Gansu Provincial Hospital, China
(Wu, Yao, Yan, Yang) Institute of Clinical Research and Evidence-Based
Medicine, Gansu Provincial Hospital, China
(Wu, Yang) Department of Evidence-Based Medicine Center, School of Basic
Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China
(Dong) Department of Ultrasound, The Third Hospital of Gansu Province,
Lanzhou, Gansu 730020, China
(Liu) Departments of Cardiac Surgery, The Third Hospital of Gansu
Province, Lanzhou, Gansu 730020, China
(Zhu, Su, Wang, Duan, Cao) Departments of Cardiology, Gansu Provincial
Hospital, Gansu University of Chinese Medicine, Lanzhou, Gansu 730000,
China
(Su, Wang) Department of Cardiology, School of Clinical Medicine, Gansu
University of Chinese Medicine, Lanzhou, Gansu 730000, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Autologous bone marrow stem cell (BMSC) therapy is a novel option for
regenerative therapy in patients with ischemic heart disease. The aim of
the present meta-analysis was to evaluate the effectiveness of BMSCs
combined with coronary artery bypass grafting (CABG). The PubMed, Cochrane
Library, EMBASE and Web of Science databases were searched from inception
to November 22, 2017 for randomized controlled trials on BMSC therapy
combined with CABG. Finally, 14 trials with a total of 596 participants
were included. Data were analyzed using a random-effects model. Compared
with the control group, the BMSC therapy group exhibited an improvement in
the left ventricular (LV) ejection fraction from baseline to follow-up
[mean difference (MD)=4.36%; 95% confidence interval (CI): 1.90-6.81%;
P<0.01]. Analysis of the pooled results revealed non-significant
differences in the LV end-diastolic volume (MD=-6.27 ml; 95% CI: -22.34 to
9.80 ml; P=0.44), LV end-diastolic volume index (MD=-15.11
ml/m²; 95% CI: -31.53 to 1.30 ml/m²; P=0.07), LV
end-systolic volume (MD=-11.52 ml; 95% CI: -26.97 to 3.93 ml; P=0.14) and
LV end-systolic volume index (MD=-16.56 ml/m²; 95% CI: -37.75
to 4.63 ml/m²; P=0.13) between the BMSC and CABG alone groups.
Therefore, autologous BMSC therapy for patients undergoing CABG appears to
be associated with an improvement in LV function compared with CABG
alone.<br/>Copyright &#xa9; 2019, Spandidos Publications. All rights
reserved.

<60>
Accession Number
2001633868
Title
Puerarin pre-conditioning on the expression levels of CK-MB, cTnI and
inflammatory factors in patients undergoing cardiac valve replacement.
Source
Experimental and Therapeutic Medicine. 17 (4) (pp 2598-2602), 2019. Date
of Publication: April 2019.
Author
Zhou Y.; Liu L.; Gao C.; Liu N.; Fa X.
Institution
(Zhou, Liu, Gao, Liu, Fa) Department of Cardiovascular Surgery, The Second
Affiliated Hospital oZhengzhou University, Zhengzhou, Henan 450014, China
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Effect of puerarin preconditioning on the expression levels of nuclear
factor kappaB (NF-kappaB), interleukin 6 (IL-6), interleukin 8 (IL-8),
troponin I (cTnI), and creatine kinase isoenzyme MB (CK-MB) in the
neutrophils of patients undergoing cardiac valve replacement under
cardiopulmonary bypass (CPB) was evaluated. We enrolled 50 patients
scheduled for cardiac valve replacement and assigned them randomly divided
into either a puerarin or a control group. Puerarin was dissolved in 10 ml
normal saline before CPB, and administered by intravenous infusion to
patients in the puerarin group. The control group was administered an
equivalent amount of saline. We used flow cytometry to determine the
expression levels of NF-kappaB, IL-6 and IL-8 in neutrophils and an auto
chemistry analyzer to determine the serum levels of cTnI and CK-MB before
anesthesia induction (T0), 30 min after aortic declamping (T1), 4 h after
aortic declamping (T2), and 8 h after aortic declamping (T3). We found the
mean serum cTnI and CK-MB levels of the puerarin group tended to decrease
with time. The positive rates of NF-kappaB, IL-6 and IL-8 at different
time-points were lower in patients of the puerarin group than in those of
the control group (and the differences at T3 were statistically
significant). The clinical manifestations of patients in the puerarin
group after operation were better than those in the control group
(P<0.05). We found that the expression levels of NF-kappaB, IL-6 and IL-8
were positively correlated with the levels of CK-MB and cTnI (P<0.05).
Puerarin preconditioning can reduce the NF-kappaB activation and the
overexpression of IL-6 and IL-8 in neutrophils, and it inhibits the
release of myocardial enzyme cTnI and.<br/>Copyright &#xa9; 2019,
Spandidos Publications. All rights reserved.

<61>
Accession Number
2001617417
Title
Colchicine for prevention of postoperative atrial fibrillation following
cardiac surgery: A meta-analysis of randomized controlled trials.
Source
International Journal of Clinical and Experimental Medicine. 12 (2) (pp
1344-1354), 2019. Article Number: IJCEM0069275. Date of Publication: 2019.
Author
Li Z.; Han H.; Liu Y.; Zhang Y.; Yu L.; Zhu Y.; Xue X.; He Y.; Wang H.
Institution
(Li, Han, Liu, Zhang, Yu, Zhu, Xue, He, Wang) Department of Cardiovascular
Surgery, General Hospital of Shenyang Military Command, Shenyang, China
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
The most common complication following cardiac surgery, postoperative
atrial fibrillation (POAF) increases hospital costs and morbidity.
Inflammation may be an important pathogenic factor for POAF. Colchicine,
an ancient and natural anti-inflammatory drug, has potential
antiarrhythmic properties which have aroused interest regarding its use
for POAF prevention. To evaluate effects of colchicine on POAF prevention
following cardiac surgery, published randomized controlled trials (RCTs),
reporting the effects of colchicine on POAF prevention, were searched up
to the end of January 2017 in Cochrane library, PubMed, and EMBASE
databases. Four RCTs, involving 1272 patients (636 in colchicine group,
636 in controls group), were included in the meta-analysis. Data are
expressed as odds ratio (OR) or mean difference (MD) with 95% confidence
interval (CI). Colchicine significantly reduced incidence of POAF
following cardiac surgery (OR = 0.6, 95% CI = 0.45-0.79; P<0.001),
especially Coronary Artery Bypass Grafting (CABG) (OR = 0.5, 95% CI =
0.31-0.80; P<0.01), and shortened length of hospitalization (MD =-1.35,
95% CI =-1.76--0.94; P<0.001), compared with controls. Although colchicine
therapy has been associated with increased incidence of gastrointestinal
side effects (OR = 3.44, 95% CI = 2.27-5.22; P<0.001), it did not increase
treatment discontinuation (OR = 1.45; 95% CI = 0.95-2.24; P = 0.09).
Collectively, colchicine may prove beneficial in POAF prevention following
cardiac surgery, especially CABG. However, because of the small number of
studies in CABG, further research with larger RCTs is warranted to confirm
the effects of colchicine for POAF prevention.<br/>Copyright &#xa9; 2019,
E-Century Publishing Corporation. All rights reserved.

<62>
Accession Number
2001628738
Title
Effectiveness of saphenous vein Y-grafts in patients undergoing off-pump
completmyocardial revascularization.
Source
Medical Science Monitor. 25 (pp 598-604), 2019. Date of Publication: 2019.
Author
Yu S.; Zhang W.; Wang L.; Li Z.; Li Q.; Lv M.; Liu B.; Zhang Y.
Institution
(Yu, Wang, Zhang) Key Laboratory of Arrhythmias of the Ministry of
Education of China, East Hospital, Tongji University School of Medicine,
Shanghai, China
(Yu) Heart Health Center, East Hospital, Tongji University School of
Medicine, Shanghai, China
(Zhang) Department of Cardiothoracic Surgery, BenQ Hospital, Affiliated
Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
(Wang, Lv) Shanghai East Hospital of Clinical Medical College, Nanjing
Medical University, Nanjing, Jiangsu, China
(Li, Li) Department of Cardiothoracic Surgery, The First Affiliated
Hospital with Nanjing Medical University, Nanjing Medical University,
Nanjing, Jiangsu, China
(Lv, Zhang) Department of Cardiovascular Surgery, East Hospital, Tongji
University School of Medicine, Shanghai, China
(Liu) Department of Cardiology, Shanghai Tenth People's Hospital, Tongji
University School of Medicine, Shanghai, China
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Background: To evaluate perioperative and mid-term outcomes of saphenous
vein Y-grafts in patients with multi-vessel coronary artery disease.
Material/Methods: Sixty patients who underwent off-pump coronary surgery
with Y-graft between 2005 and 2016 were enrolled, including 38 patients
with natural Y-graft. Sixty patients with multi-vessel lesions in the same
period were randomly selected as a control group. <br/>Result(s): A total
of 484 conduits were employed. The intraoperative variables were
insignificantly different between groups, but Y-graft group compared with
control group had more grafts (4.2+/-0.84 vs. 3.87+/-0.85) and anastomoses
(6.30+/-1.39 vs. 5.62+/-1.15). No patient died during coronary artery
bypass grafting and no episode of perioperative myocardial infarction was
found. Follow-up duration lasted from 1 to 137 (40.0+/-27.7) months. No
significant difference between Y-graft group and control group was found
in Kaplan-Meier 3-year survival rate (93.4% vs. 88.0%) or 5-year survival
rate (81.4% vs. 88.0%). <br/>Conclusion(s): Saphenous vein Y-graft is a
feasible and safe revascularization strategy for multi-vessel coronary
artery disease patients and brings about satisfactory
outcomes.<br/>Copyright &#xa9; Med Sci Monit, 2019.

<63>
Accession Number
2001745066
Title
Intraoperative intercostal nerve cryoablation during the Nuss procedure
reduces length of stay and opioid requirement: A randomized clinical
trial.
Source
Journal of Pediatric Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Graves C.E.; Moyer J.; Zobel M.J.; Mora R.; Smith D.; O'Day M.; Padilla
B.E.
Institution
(Graves, Moyer, Zobel, Mora, Smith, O'Day, Padilla) Division of Pediatric
Surgery, Department of Surgery, University of California, San Francisco,
United States
Publisher
W.B. Saunders
Abstract
Purpose: Minimally-invasive repair of pectus excavatum by the Nuss
procedure is associated with significant postoperative pain, prolonged
hospital stay, and high opiate requirement. We hypothesized that
intercostal nerve cryoablation during the Nuss procedure reduces hospital
length of stay (LOS) compared to thoracic epidural analgesia.
<br/>Design(s): This randomized clinical trial evaluated 20 consecutive
patients undergoing the Nuss procedure for pectus excavatum between May
2016 and March 2018. Patients were randomized evenly via closed-envelope
method to receive either cryoanalgesia or thoracic epidural analgesia.
Patients and physicians were blinded to study arm until immediately
preoperatively. <br/>Setting(s): Single institution, UCSF-Benioff
Children's Hospital. <br/>Participant(s): 20 consecutive patients were
recruited from those scheduled for the Nuss procedure. Exclusion criteria
were age < 13 years, chest wall anomaly other than pectus excavatum,
previous repair or other thoracic surgery, and chronic use of pain
medications. <br/>Main Outcomes and Measures: Primary outcome was
postoperative LOS. Secondary outcomes included total operative time,
total/daily opioid requirement, inpatient/outpatient pain score, and
complications. Primary outcome data were analyzed by the Mann-Whitney
U-test for nonparametric continuous variables. Other continuous variables
were analyzed by two-tailed t-test, while categorical data were compared
via Chi-squared test, with alpha = 0.05 for significance. <br/>Result(s):
20 patients were randomized to receive either cryoablation (n = 10) or
thoracic epidural (n = 10). Mean operating room time was 46.5 min longer
in the cryoanalgesia group (p = 0.0001). Median LOS decreased by 2 days in
patients undergoing cryoablation, to 3 days from 5 days (Mann-Whitney U, p
= 0.0001). Cryoablation patients required significantly less inpatient
opioid analgesia with a mean decrease of 416 mg oral morphine equivalent
per patient (p = 0.0001), requiring 52%-82% fewer milligrams on
postoperative days 1-3 (p < 0.01 each day). There was no difference in
mean pain score between the groups at any point postoperatively, up to one
year, and no increased incidence of neuropathic pain in the cryoablation
group. No complications were noted in the cryoablation group; among
patients with epidurals, one patient experienced a symptomatic
pneumothorax and another had urinary retention. Conclusions and relevance:
Intercostal nerve cryoablation during the Nuss procedure decreases
hospital length of stay and opiate requirement versus thoracic epidural
analgesia, while offering equivalent pain control. <br/>Type of Study:
Treatment study. <br/>Level of Evidence: Level I.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<64>
Accession Number
2001744272
Title
Does prior coronary angioplasty affect outcomes of surgical coronary
revascularization? Insights from the STICH trial.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Nicolau J.C.; Stevens S.R.; Al-Khalidi H.R.; Jatene F.B.; Furtado R.H.M.;
Dallan L.A.O.; Lisboa L.A.F.; Desvigne-Nickens P.; Haddad H.; Jolicoeur
E.M.; Petrie M.C.; Doenst T.; Michler R.E.; Ohman E.M.; Maddury J.; Ali
I.; Deja M.A.; Rouleau J.L.; Velazquez E.J.; Hill J.A.
Institution
(Nicolau, Jatene, Furtado, Dallan, Lisboa) Instituto do Coracao (InCor),
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, SP, Brazil
(Stevens, Al-Khalidi, Ohman) Duke Clinical Research Institute and
Department of Biostatistics and Bioinformatics, Duke University School of
Medicine, Durham, NC, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
(Haddad) Department of Medicine, University of Saskatchewan, Saskatoon,
Saskatchewan, Canada
(Jolicoeur, Rouleau) Montreal Heart Institute, Universite de Montreal,
Quebec, Canada
(Petrie) BHF Cardiovascular Research Centre, University of Glasgow,
Glasgow, United Kingdom
(Doenst) Department of Cardiothoracic Surgery, University of Jena, Jena,
Germany
(Michler) Department of Cardiothoracic Surgery, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Maddury) Department of Cardiology, Nizams Institute of Medical Sciences,
Hyderabad, India
(Ali) Libin Cardiovascular Institute of Alberta, University of Calgary,
Foothills Medical Centre, Calgary, Alberta, Canada
(Deja) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Velazquez) Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Hill) Department of Medicine, University of Florida, Gainesville, FL,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The STICH trial showed superiority of coronary artery bypass
plus medical treatment (CABG) over medical treatment alone (MED) in
patients with left ventricular ejection fraction (LVEF) <=35%. In previous
publications, percutaneous coronary intervention (PCI) prior to CABG was
associated with worse prognosis. <br/>Objective(s): The main purpose of
this study was to analyse if prior PCI influenced outcomes in STICH.
<br/>Methods and Results: Patients in the STICH trial (n = 1212), followed
for a median time of 9.8 years, were included in the present analyses. In
the total population, 156 had a prior PCI (74 and 82, respectively, in the
MED and CABG groups). In those with vs. without prior PCI, the adjusted
hazard-ratios (aHRs) were 0.92 (95% CI = 0.74-1.15) for all-cause
mortality, 0.85 (95% CI = 0.64-1.11) for CV mortality, and 1.43 (95% CI =
1.15-1.77) for CV hospitalization. In the group randomized to CABG without
prior PCI, the aHRs were 0.82 (95% CI = 0.70-0.95) for all-cause
mortality, 0.75 (95% CI = 0.62-0.90) for CV mortality and 0.67 (95% CI =
0.56-0.80) for CV hospitalization. In the group randomized to CABG with
prior PCI, the aHRs were 0.76 (95% CI = 0.50-1.15) for all-cause
mortality, 0.81 (95% CI = 0.49-1.36) for CV mortality and 0.61 (95% CI =
0.41-0.90) for CV hospitalization. There was no evidence of interaction
between randomized treatment and prior PCI for any endpoint (all adjusted
p > 0.05). <br/>Conclusion(s): In the STICH trial, prior PCI did not
affect the outcomes of patients whether they were treated medically or
surgically, and the superiority of CABG over MED remained unchanged
regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov;
Identifier: NCT00023595<br/>Copyright &#xa9; 2019 Elsevier B.V.

<65>
Accession Number
2001741548
Title
Intravenous Iron Versus Placebo in the Management of Postoperative
Functional Iron Deficiency Anemia in Patients Undergoing Cardiac Valvular
Surgery: A Prospective, Single-Blinded, Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Xu H.; Duan Y.; Yuan X.; Wu H.; Sun H.; Ji H.
Institution
(Xu, Duan, Yuan, Wu, Sun) Department of Adult Cardiac Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Ji) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: To compare the efficacy of intravenous iron versus placebo to
correct postoperative functional iron deficiency anemia in patients
undergoing cardiac valvular surgery. <br/>Design(s): A prospective,
single-blinded, randomized controlled study. <br/>Setting(s): National
Center for Cardiovascular Diseases and a university hospital.
<br/>Participant(s): The study comprised 150 patients with postoperative
functional iron deficiency anemia after cardiac valvular surgery.
<br/>Intervention(s): The patients were randomly assigned (1:1) to either
the treatment (intravenous iron) group or the control (placebo) group.
<br/>Measurements and Main Results: The hemoglobin and ferritin
concentrations and postoperative adverse events were collected and
compared between the 2 groups. The hemoglobin concentration and the
proportion of patients who had their anemia corrected or achieved
hemoglobin increments of >20g/L in the intravenous iron group were
significantly higher than that in the placebo group at postoperative day
14 (p = 0.023, p = 0.037, and p = 0.001), whereas there was no statistical
difference at postoperative day 7. The ferritin concentration was
substantially higher at postoperative day 7 and postoperative day 14 in
the intravenous iron group compared with the placebo group (both p <
0.001). There were no significant differences in rates of death, blood
tranfusion, antibiotic upgrade, ventilator time >24hours, postoperative
hospital stay >10days, poor wound healing, and perivalvular leakage
between the 2 groups. <br/>Conclusion(s): Intravenous iron could
significantly increase the hemoglobin level in patients with postoperative
functional iron deficiency anemia at postoperative day 14. However, there
is no difference in blood transfusion requirements or postoperative
adverse outcomes between the 2 groups.<br/>Copyright &#xa9; 2019 Elsevier
Inc.

<66>
Accession Number
2001730161
Title
Early interventions to prevent posttraumatic stress disorder symptoms in
survivors of life-threatening medical events: A systematic review.
Source
Journal of Anxiety Disorders. 64 (pp 24-39), 2019. Date of Publication:
May 2019.
Author
Birk J.L.; Sumner J.A.; Haerizadeh M.; Heyman-Kantor R.; Falzon L.;
Gonzalez C.; Gershengoren L.; Shapiro P.; Edmondson D.; Kronish I.M.
Institution
(Birk, Sumner, Haerizadeh, Heyman-Kantor, Falzon, Gonzalez, Edmondson,
Kronish) Center for Behavioral Cardiovascular Health, Department of
Medicine, Columbia University Medical Center, 622 West 168^th
Street, New York, NY 10032, United States
(Gershengoren) Department of Psychiatry, Weill Cornell Medical Center, 525
East 68^th Street, New York, NY 10065, United States
(Shapiro) Department of Psychiatry, Columbia University Medical Center,
622 West 168^th Street, New York, NY 10032, United States
Publisher
Elsevier Ltd
Abstract
Post-traumatic stress disorder (PTSD) induced by life-threatening medical
events has been associated with adverse physical and mental health
outcomes, but it is unclear whether early interventions to prevent the
onset of PTSD after these events are efficacious. We conducted a
systematic review to address this need. We searched six biomedical
electronic databases from database inception to October 2018. Eligible
studies used randomized designs, evaluated interventions initiated within
3 months of potentially traumatic medical events, included adult
participants, and did not have high risk of bias. The 21 included studies
(N = 4,486) assessed a heterogeneous set of interventions after critical
illness (9), cancer diagnosis (8), heart disease (2), and cardiopulmonary
surgery (2). Fourteen psychological, 2 pharmacological, and 5 other-type
interventions were assessed. Four of the psychological interventions
emphasizing cognitive behavioral therapy or meaning-making, 1 other-type
palliative care intervention, and 1 pharmacological-only intervention
(hydrocortisone administration) were efficacious at reducing PTSD symptoms
relative to control. One early, in-hospital counseling intervention was
less efficacious at lowering PTSD symptoms than an active control.
Clinical and methodological heterogeneity prevented quantitative pooling
of data. While several promising interventions were identified, strong
evidence of efficacy for any specific early PTSD intervention after
medical events is currently lacking.<br/>Copyright &#xa9; 2019 Elsevier
Ltd

<67>
Accession Number
2001547957
Title
Patient Phenotypes, Cardiovascular Risk, and Ezetimibe Treatment in
Patients After Acute Coronary Syndromes (from IMPROVE-IT).
Source
American Journal of Cardiology. 123 (8) (pp 1193-1201), 2019. Date of
Publication: 15 April 2019.
Author
Sharma A.; Sun J.-L.; Lokhnygina Y.; Roe M.T.; Ahmad T.; Desai N.R.;
Blazing M.A.
Institution
(Sharma, Sun, Lokhnygina, Roe, Blazing) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, United States
(Sharma) Division of Cardiology, Stanford University, Palo Alto, CA,
United States
(Sharma) Division of Cardiology, McGill University Health Centre,
Montreal, Quebec, Canada
(Ahmad, Desai) Yale New Haven Hospital, Yale University, New Haven, CT,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Risk prediction following acute coronary syndrome (ACS) remains
challenging. Data-driven machine-learning algorithms can potentially
identify patients at high risk of clinical events. The Improved Reduction
of Outcomes: Vytorin Efficacy International Trial randomized 18,144
post-ACS patients to ezetimibe + simvastatin or placebo + simvastatin. We
performed hierarchical cluster analysis to identify patients at high risk
of adverse events. Associations between clusters and outcomes were
assessed using Cox proportional hazards models. The primary outcome was
cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
unstable angina hospitalization, or coronary revascularization >=30 days
after randomization. We evaluated ezetimibe's impact on outcomes across
clusters and the ability of the cluster analysis to discriminate for
outcomes compared with the Global Registry of Acute Coronary Events
(GRACE) score. Five clusters were identified. In cluster 1 (n = 13,252),
most patients experienced a non-STEMI (54.8%). Cluster 2 patients (n =
2,719) had the highest incidence of unstable angina (n = 83.3%). Cluster 3
patients (n = 782) all identified as Spanish descent, whereas cluster 4
patients (n = 803) were primarily from South America (56.2%). In cluster 5
(n = 587), all patients had ST elevation. Cluster analysis identified
patients at high risk of adverse outcomes (log-rank p <0.0001); Cluster 2
(vs 1) patients had the highest risk of outcomes (hazards ratio 1.33, 95%
confidence interval 1.24 to 1.43). Compared with GRACE risk, cluster
analysis did not provide superior outcome discrimination. A consistent
ezetimibe treatment effect was identified across clusters (interaction p =
0.882). In conclusion, cluster analysis identified significant difference
in risk of outcomes across cluster groups. Data-driven strategies to
identify patients who may differentially benefit from therapies and for
risk stratification require further evaluation.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<68>
Accession Number
626853023
Title
Coronary Computed Tomography Angiography Improving Outcomes in Patients
with Chest Pain.
Source
Current Cardiovascular Imaging Reports. 12 (5) (no pagination), 2019.
Article Number: 15. Date of Publication: 01 May 2019.
Author
Tzolos E.; Newby D.E.
Institution
(Tzolos, Newby) British Heart Foundation, Centre for Cardiovascular
Science, University of Edinburgh, Chancellor's Building, Edinburgh EH16
4SA, United Kingdom
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: To provide an overview of recent studies of coronary
computed tomography angiography (CCTA) and how it has helped to improve
clinical outcomes for patients presenting with chest pain. Recent
Findings: Randomised controlled trials have uniformly demonstrated that
the use of CCTA is associated with improvements in patient diagnosis,
management and treatments as well as the avoidance of unnecessary invasive
coronary angiography. These changes have been associated with consistent
reductions in long-term rates of fatal or non-fatal myocardial infarction.
<br/>Summary: Major beneficial effects in clinical management and patient
outcomes are seen with the use of coronary computed tomography
angiography. CCTA might be considered to be the first test of choice for
the investigation of coronary heart disease.<br/>Copyright &#xa9; 2019,
The Author(s).

<69>
Accession Number
626927993
Title
Aspirin alone versus dual antiplatelet therapy following coronary artery
bypass surgery: comprehensive pairwise and network metaanalyses of
randomized controlled trials.
Source
Journal of Investigative Medicine. Conference: Southern Regional Meeting
2019. United States. 67 (2) (pp 354-355), 2019. Date of Publication:
February 2019.
Author
Hesterberg K.G.; Jagadish P.S.; Latham S.B.; Shah R.
Institution
(Hesterberg, Jagadish, Latham, Shah) UTHSC, Memphis, TN, United States
(Shah) VAMC, Memphis, TN, United States
Publisher
BMJ Publishing Group
Abstract
Purpose of study Aspirin (ASA) therapy is class 1 indication following
CABG to prevent graft occlusion. Several small-sized trials suggest that
dual antiplatelet therapy (DAPT) including ASA plus a p2y12 inhibitor
could be more effective than ASA alone. However, the findings of
individual trials have been scrutinized for small sample size and lack of
statistical power. In addition, it is unclear whether some p2y12
inhibitors are more effective than others. Therefore, we performed
standard pairwise metaanalyses and a Bayesian network meta-analysis with
the largest sample to date by including trails from recent months. Methods
used In pairwise analyses, the pooled risk difference (RD) was estimated
using a random model. For the network meta-analysis, we converted events
rate to events/per 10 000 patient-days because follow-up duration varied
across trials. Summary of results Data from nine trials including 1677
patients were analyzed. Compared to ASA alone, DAPT decreased the absolute
risk for graft occlusion by 7.4% (RD=-0.074; 95% CI, -0.132 to -0.017,
p=0.011) and for MACE by 3.8% (figure 1B). It was also associated with a
numerically higher risk of major bleeding, but without statistical
significance (figure 1C). Results of the network meta-analysis was
consistent with those from pairwise analyses (figure 1D). In addition, the
rate of graft occlusion was not different between ASA +clopidogrel and ASA
+ticagrelor (figure 1D). Conclusions Following CABG, DAPT seems to be more
effective at preventing graft occlusion compared to ASA alone.
Clopidogrel- and ticagrelor-based DAPT seem to be equally effective for
this indication. (Table Presented) .

<70>
Accession Number
2001738720
Title
IMPACT OF DURATION OF CARDIOPULMONARY BYPASS UPON POSTOPERATIVE MECHANICAL
VENTILATION DURATION IN PATIENTS UNDERGOING CARDIAC SURGERIES: REGRESSION
ANALYSIS OF METADATA.
Source
Chest. Conference: CHEST Congress 2019. Thailand. 155 (4 Supplement) (pp
26A), 2019. Date of Publication: April 2019.
Author
Muhammad Dawood N.; nadeem R.; Agarwal S.; Jawed S.; Khan A.B.; Hallak Y.
Institution
(Muhammad Dawood) Cedar College, F11, Block 9 Clifton, Karachi, education,
karachi, Pakistan
(nadeem) Dubai hospital, Intensive care unit, Dubai, United Arab Emirates
(Agarwal) Rashid Hospital, 315 Umm Hurair Second, PO Box 4545, Dubai,
United Arab Emirates, Department of Internal Medicine, Dubai, United Arab
Emirates
(Jawed) Jinnah Sindh Medical University, Rafiqi H J Road, Karachi
Cantonment, Karachi, Karachi City, Sindh 75510, Pakistan, medicine,
Karachi, Pakistan
(Khan) Illinois Institute of Technology, biomedical engineering, chicago,
IL, United States
(Hallak) Mohammad Bin Rashid University of Medicine And Health Sciences,
Medicine, Dubai, United Arab Emirates
Publisher
Elsevier Inc.
Abstract
PURPOSE: Patients who undergo cardiac surgery utilizing cardiopulmonary
bypass (CPB) have adverse outcomes compared to those who undergo such
surgeries without CPB. Data suggests prolonged mechanical ventilator (PMV)
dependence is associated with prolonged exposure to CPB. We aim to perform
regression analysis of this metadata of studies to explore the nature of
the relationship between PMV and duration of CPB. <br/>METHOD(S): PubMed
and Cochrane libraries were searched by utilizing different combinations
of keywords: Cardiopulmonary bypass, mechanical ventilation, Prolonged
mechanical ventilation and their combinations. Inclusion criteria were:
(1) English articles and (2) studies with an adult population who undergo
cardiac surgeries with CPB (3) where time duration of CPB is provided (4)
duration of post op mechanical ventilation is provided. Eight with 13
datasets were included for regression analysis of this metadata (table 1).
<br/>RESULT(S): Eight studies with 13 data set (as some studies provide
data in subgroups) include total number of subjects (N= 989). Duration of
CPB range from 55-173.5 minutes for these operations. Incidence of
postoperative MV hours range from 9-408 hours (Figure 1). Regression
analysis showed an increase in duration of required MV with increasing
duration of CPB time; 37 minutes of increased CPB time will lead to one
more day of mechanical ventilation. <br/>CONCLUSION(S): Increase in
cardiopulmonary bypass duration may lead to prolonged mechanical
ventilation. CLINICAL IMPLICATIONS: Increase in cardiopulmonary bypass
duration may lead to prolonged mechanical ventilation. physicians and
surgeons taking care of these patients should be cognizant of this risk
factor. Time duration of cardiopulmonary bypass should be kept to
minimum.<br/>Copyright &#xa9; 2019 American College of Chest Physicians

<71>
Accession Number
626929540
Title
The routine use of post-operative NSAIDs in the pediatric patient is
effective and safe.
Source
Journal of Investigative Medicine. Conference: Southern Regional Meeting
2019. United States. 67 (2) (pp 545), 2019. Date of Publication: February
2019.
Author
Gaid E.; Waller J.; Mehta R.
Institution
(Gaid, Waller, Mehta) Medical College of Georgia, Augusta University,
Augusta, GA, United States
Publisher
BMJ Publishing Group
Abstract
Purpose of study Effective and appropriate post-operative pain management
in the pediatric population is important for a safe and comfortable
recovery process. Opioids, non-steroidal anti-inflammatory drugs (NSAIDs),
and acetaminophen remain the current pharmacologic therapy for
post-operative pain management, with an increasing preference for the use
of scheduled NSAIDs to avoid opioid-related side effects. The objective of
this study is to examine the renal and bleeding complications of scheduled
post-operative NSAID use in the pediatric population (ages 0-18). We
hypothesize that pediatric patients started on a scheduled regimen of
NSAIDs immediately post-operatively are at an equal risk of bleeding and
renal complications for the first 5 days post-op compared to those not
receiving the medications. Methods used A retrospective chart review of
patients admitted to the pediatric intensive care unit from July 2015-May
2018 status post congenital heart defect or other surgery requiring pain
control was conducted. Renal effects were evaluated by serum creatinine
level, while significant bleeding events were assessed by clinically
documented intracranial hemorrhage, GI consult or significant upper GI
bleed, or bleeding requiring additional surgical exploration or
transfusion. Summary of results Analyses were conducted using descriptive
statistics to evaluate the significance of abnormal creatinine values by
age. Due to a low frequency of abnormal creatinine levels, the percent of
days with abnormal creatinine was used to assess for differences between
groups. There was no overall statistically significant difference in
creatinine levels among cardiac surgery and NSAID groups over time. There
was no significant association between patients with scheduled NSAIDs and
any bleeding event in cardiac or non-cardiac surgeries. Conclusions There
is no association with increased bleeding or adverse renal effects
following the use of NSAIDs in the pediatric post-operative setting in
both cardiac and non-cardiac surgeries. A randomized prospective study is
needed to confirm the safety and efficacy of NSAIDs in the post-operative
pediatric population.

<72>
Accession Number
626928546
Title
Investigating the safety and opioid sparing effects of a scheduled regimen
of acetaminophen and nonsteroidal antiinflammatory drug in postoperative
pediatric cardiac surgery patients.
Source
Journal of Investigative Medicine. Conference: Southern Regional Meeting
2019. United States. 67 (2) (pp 614), 2019. Date of Publication: February
2019.
Author
Passmore K.; Mehta R.; Waller J.
Institution
(Passmore, Mehta) Medical College of Georgia, Augusta, GA, United States
(Mehta) Children's Hospital of Georgia, Augusta, GA, United States
(Waller) Augusta University, Augusta, GA, United States
Publisher
BMJ Publishing Group
Abstract
Purpose of study Opioids are currently the first-line agents for
postoperative pain management, despite their significant side effects.
Evidence is increasing for safer alternatives to opioids, however those
alternatives are used sparingly in pediatric patients recovering from
congenital heart disease (CHD) surgery. The purpose of this study was to
examine if a scheduled regimen of Acetaminophen and nonsteroidal
anti-inflammatory drug (NSAID) during the first 48 postoperative hours
decreases the need for opioid analgesia and the number of opioid-related
adverse effects. Methods used Patients admitted to the pediatric intensive
care unit at Children's Hospital of Georgia post-CHD surgery from January
2012-March 2018 were retrospectively recruited. Patient medical records
were reviewed for durations of opioid and alternative analgesia usage and
any instances of adverse effects. Many patients were given Lortab
(Hydrocodone-Acetaminophen combination) to fulfill the scheduled regimen
of Acetaminophen, which prompted further investigation of non-Lortab
opioid usage. These outcomes were compared between 120 patients who
received the Acetaminophen-NSAID regimen and 100 who did not. Statistical
analysis included chi-square test, two-sample t-test, Fisher's Exact test,
and Wilcoxon Rank Sum test using an alpha level of 0.05. Summary of
results The mean length of stay (p=0.0072), number of days of overall
opioid usage (p=0.136), and number of days of non-Lortab opioid usage
(p=0.0068) were lower in patients receiving the scheduled regimen of
Acetaminophen-NSAID. There was no significant difference in occurrences of
constipation, hypotension, rash, and pruritus between the two groups.
Conclusions Our data indicates that a scheduled regimen of Acetaminophen
and NSAID may decrease length of stay and a dependence on opioid
analgesia, but not decrease the number of opioid-related adverse effects.
This study highlights the need for prospective randomized controlled
trials that evaluate the efficacy of non-opioid alternatives for pain
management in pediatric post-CHD surgery patients.

<73>
Accession Number
626416220
Title
Why does a point of care guided transfusion algorithm not improve blood
loss and transfusion practice in patients undergoing high-risk cardiac
surgery? A prospective randomized controlled pilot study 11 Medical and
Health Sciences 1102 Cardiorespiratory Medicine and Haematology.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 24. Date
of Publication: 18 Feb 2019.
Author
Lehmann F.; Rau J.; Malcolm B.; Sander M.; Von Heymann C.; Moormann T.;
Geyer T.; Balzer F.; Wernecke K.D.; Kaufner L.
Institution
(Lehmann, Geyer, Balzer, Kaufner) Department of Anaesthesiology and
Intensive Care Medicine, Charite-Universitatsmedizin Berlin, Campus
Virchow-Klinikum and Campus Charite Mitte, Berlin, Germany
(Rau) Division of Medical Biotechnology, Paul-Ehrlich-Institut, Federal
Institute for Vaccines and Biomedicines, Langen Hessen, Germany
(Malcolm) Department of Internal Medicine, Hegau-Bodensee-Klinikum, Singen
Baden-Wurttemberg, Germany
(Sander) Department of Anaesthesiology Intensive Care Medicine and Pain
Therapy, University Hospital Giesen UKGM, Justus-Liebig-University
Giessen, Giessen Hessen, Germany
(Von Heymann) Department of Anaesthesia Intensive Care Medicine Emergency
Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin,
Germany
(Moormann) Department of Anaesthesiology and Intensive Care Medicine,
Martin-Luther-Krankenhaus, Berlin, Germany
(Wernecke) CRO SOSTANA GmbH and Charite, Universitatsmedizin Berlin,
Berlin, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Adult cardiac surgery is often complicated by elevated blood
losses that account for elevated transfusion requirements. Perioperative
bleeding and transfusion of blood products are major risk factors for
morbidity and mortality. Timely diagnostic and goal-directed therapies aim
at the reduction of bleeding and need for allogeneic transfusions.
<br/>Method(s): Single-centre, prospective, randomized trial assessing
blood loss and transfusion requirements of 26 adult patients undergoing
elective cardiac surgery at high risk for perioperative bleeding. Primary
endpoint was blood loss at 24 h postoperatively. Random assignment to
intra-and postoperative haemostatic management following either an
algorithm based on conventional coagulation assays (conventional group:
platelet count, aPTT, PT, fibrinogen) or based on point-of-care
(PoC-group) monitoring, i.e. activated rotational thromboelastometry
(ROTEM) combined with multiple aggregometry (Multiplate). Differences
between groups were analysed using nonparametric tests for independent
samples. <br/>Result(s): The study was terminated after interim analysis
(n = 26). Chest tube drainage volume was 360 ml (IQR 229-599 ml) in the
conventional group, and 380 ml (IQR 310-590 ml) in the PoC-group (p =
0.767) after 24 h. Basic patient characteristics, results of PoC
coagulation assays, and transfusion requirements of red blood cells and
fresh frozen plasma did not differ between groups. Coagulation results
were comparable. Platelets were transfused in the PoC group only.
<br/>Conclusion(s): Blood loss via chest tube drainage and transfusion
amounts were not different comparing PoC-and central lab-driven
transfusion algorithms in subjects that underwent high-risk cardiac
surgery. Routine PoC coagulation diagnostics do not seem to be beneficial
when actual blood loss is low. High risk procedures might not suffice as a
sole risk factor for increased blood loss. Trial registration:
NCT01402739, Date of registration July 26, 2011.<br/>Copyright &#xa9; 2019
The Author(s).

<74>
Accession Number
2001737966
Title
The Effect of Simultaneous Renal Replacement Therapy on Extracorporeal
Membrane Oxygenation Support for Postcardiotomy Patients with Cardiogenic
Shock: A Pilot Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Li C.; Wang H.; Liu N.; Jia M.; Hou X.
Institution
(Li, Wang, Liu, Jia, Hou) Center for Cardiac Intensive Care, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: The objectives of this study were to determine the feasibility
and safety of simultaneous renal replacement therapy (RRT) during
extracorporeal membrane oxygenation (ECMO) support for postcardiotomy
patients with cardiogenic shock and whether simultaneous RRT with ECMO
would improve survival and reduce morbidity. The authors hypothesized that
simultaneous RRT could facilitate effective fluid management and rapid
metabolic control in postcardiotomy patients with cardiogenic shock who
were undergoing ECMO support. <br/>Design(s): A parallel, open-label,
single-center pilot randomized trial. <br/>Setting(s):
University-affiliated cardiac surgery intensive care unit.
<br/>Participant(s): The study comprised 41 postcardiotomy patients with
cardiogenic shock who received ECMO support. <br/>Intervention(s):
Participants were enrolled and randomly assigned via a 1:1 allocation to a
simultaneous RRT arm versus a standard care arm. The patients in the
simultaneous RRT arm received RRT within 12 hours of the start of ECMO
regardless of the conventional RRT indication. Simultaneous RRT was
delivered with the RRT machine connected to the ECMO circuit. The patients
in the standard care arm did not receive RRT at the start of ECMO unless
the conventional RRT indications were fulfilled. <br/>Measurements and
Main Results: All 41 patients enrolled were followed-up for 30 days and
the results analyzed. The primary feasibility outcome was the time from
randomization to simultaneous RRT of <12 hours in the simultaneous RRT
arm. All participants in simultaneous RRT arm fulfilled with a median time
from randomization to simultaneous RRT of 4.4 (2.7-5.6) hours. The 30-day
all-cause mortality was 61.9% in the simultaneous RRT arm and 75.0% in the
standard care arm (p = 0.51). The lactate clearance was higher in the
simultaneous RRT arm (0.56 +/- 0.4 v 0.28 +/- 0.4 mmol/L/h; p = 0.04).
There was lower cumulative fluid balance in the simultaneous RRT arm on
ECMO day 3 (-1,510 [-3560 to 1,162] v -332 [-2,027 to 2,181]; p = 0.38)
and ECMO day 5 (-2,671 [-5,197 to 3,334] v -1,509 [-3,595 to 1,162]; p =
0.41) without significance. There were no significant differences in
adverse events reported and no hemodynamic instability owing to
simultaneous RRT delivery. <br/>Conclusion(s): This pilot study suggests
the feasibility and safety of simultaneous RRT during ECMO support for
postcardiotomy patients with cardiogenic shock, providing an efficient
means for controlling fluid status and metabolics. A large trial based on
this pilot study is required to confirm the clinical
benefits.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<75>
Accession Number
2001737193
Title
Glycated Hemoglobin and the Risk of Sternal Wound Infection After Adult
Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Biancari F.; Giordano S.
Institution
(Biancari) Heart Center, Turku University Hospital and Department of
Surgery, University of Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
(Giordano) Department of Surgery, Satakunta Central Hospital, Pori,
Finland
(Giordano) Department of Plastic and General Surgery, Turku University
Hospital and University of Turku, Turku, Finland
Publisher
W.B. Saunders
Abstract
Increased glycated hemoglobin (HbA1c) has been shown to increase the risk
of mortality, myocardial infarction, and stroke after cardiac surgery,
whereas its impact on the development of sternal wound infection (SWI) is
less clear. A systematic review and meta-analysis were performed to
evaluate the impact of preoperative HbA1c levels on the occurrence of SWI
after adult cardiac surgery. Fourteen studies including 17,609 patients
fulfilled the inclusion criteria and were included in this analysis.
Diagnostic test meta-analysis of studies evaluating baseline HbA1c cut-off
values ranging from 6% to 7% DCCT units (42-53mmol/mol IFCC units) showed
that the diagnostic odds ratio for deep SWI was 3.02 (95% confidence
interval [CI] 2.10-4.35), while the diagnostic odds ratio for any SWI was
2.81 (95% CI 2.02-3.93). Binary meta-analysis confirmed that baseline
HbA1c cut-off values ranging from 6% to 7% increased the risk for deep SWI
(pooled incidence 2.7% vs 0.8%, risk ratio [RR] 3.01, 95% CI 2.32-3.90,
I² 0%). Six studies included only diabetics and their pooled RR
for deep SWI was 2.94 (1.59-5.45, I² 0%). Nine studies
evaluated an HbA1c cut-off value of 7% and their RR for deep SWI was 3.22
(95% CI 2.38-4.37, I² 0%). The RR for any SWI was 2.92 (95% CI
2.42-3.53, I² 0%). This pooled analysis showed that the risk of
SWI is substantially increased when preoperative HbA1c levels are over
6-7%. Future studies should evaluate whether postponing surgery for
optimization of the glycemic control can reduce the risk of SWI in
patients with increased levels of HbA1c.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<76>
Accession Number
2001736909
Title
Rationale and Study Design for an Individualized Perioperative Open Lung
Ventilatory Strategy in Patients on One-Lung Ventilation (iPROVE-OLV).
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Carraminana A.; Ferrando C.; Unzueta M.C.; Navarro R.; Suarez-Sipmann F.;
Tusman G.; Garutti I.; Soro M.; Pozo N.; Librero J.; Gallego L.; Ramasco
F.; Rabanal J.M.; Rodriguez A.; Sastre J.; Martinez J.; Coves S.; Garcia
P.; Aguirre-Puig P.; Yepes J.; Lluch A.; Lopez-Herrera D.; Leal S.; Vives
M.; Bellas S.; Socorro T.; Trespalacios R.; Salazar C.J.; Mugarra A.;
Cinnella G.; Spadaro S.; Futier E.; Ferrer L.; Cabrera M.; Ribeiro H.;
Celestino C.; Kucur E.; Cervantes O.; Morocho D.; Delphy D.; Ramos C.;
Villar J.; Belda J.
Institution
(Carraminana, Ferrando, Navarro) Department of Anesthesia and Critical
Care, Hospital Clinic i Provincial, Barcelona, Spain
(Ferrando, Suarez-Sipmann, Villar) CIBER de Enfermedades Respiratorias,
Instituto de Salud Carlos III, Madrid, Spain
(Unzueta) Department of Anesthesia and Critical Care, Hospital de la Santa
Creu i Sant Pau, Barcelona, Spain
(Suarez-Sipmann) Intensive Care Unit, Hospital de La Princesa, Madrid,
Spain
(Suarez-Sipmann) Hedenstierna Laboratory, Department of Surgical Sciences,
Uppsala University Hospital, Uppsala, Sweden
(Tusman) Department of Anesthesiology, Hospital Privado de Mar de Plata,
Mar de Plata, Argentina
(Garutti) Department of Anesthesia and Critical Care, Hospital
Universitario Gregorio Maranon, Madrid, Spain
(Soro, Mugarra, Belda) Department of Anesthesia and Critical Care,
Hospital Clinico of Valencia, Valencia, Spain
(Pozo) Institute INCLIVA, Hospital Clinico Universitario de Valencia,
Valencia, Spain
(Librero) Navarrabiomed-Fundacion Miguel Servet, Red de Investigacion en
Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
(Gallego) Department of Anesthesia and Critical Care, Hospital Miguel
Servet, Zaragoza, Spain
(Ramasco) Department of Anesthesiology and Critical Care, Hospital La
Princesa, Madrid, Spain
(Rabanal) Department of Anesthesia and Critical Care, Hospital Marques de
Valdecilla, Santander, Spain
(Rodriguez) Department of Anesthesiology, Hospital Universitario Dr.
Negrin, Las Palmas de Gran Canaria, Spain
(Sastre) Department of Anesthesia and Critical Care t, Hospital de
Salamanca, Salamanca, Spain
(Martinez) Department of Anesthesia and Critical Care, Hospital
Universitari Mutua of Terrassa, Terrassa, Spain
(Coves) Department of Anesthesia and Critical Care, Hospital Univeristari
de Vinalopo, Elche, Spain
(Garcia) Department of Anesthesia and Critical Care, Hospital 12 de
Octubre, Madrid, Spain
(Aguirre-Puig) Department of Anesthesia and Critical Care, Hospital Alvaro
Cunqueiro, Vigo, Spain
(Yepes) Department of Anesthesia and Critical Care, Clinica Universitaria
Pamplona, Spain
(Lluch) Department of Anesthesia and Critical Care, Hospital Universitario
La Fe, Valencia, Spain
(Lopez-Herrera) Department of Anesthesia and Critical Care, Hospital
Virgen del Rocio, Sevilla, Spain
(Leal) Department of Anesthesia and Critical Care, Hospital Povisa, Vigo,
Spain
(Vives) Department of Anesthesia and Critical Care, Hospital Dr. Josep
Trueta, Girona, Spain
(Bellas) Department of Anesthesia and Critical Care, Fundacion Jimenez
Diaz, Madrid, Spain
(Socorro) Department of Anesthesia, Complejo Universitario
Materno-Insular, Las Palmas, Spain
(Trespalacios) Department of Anesthesia and Critical Care, Hospital
Universitario Central de Asturias, Oviedo, Spain
(Salazar) Department of Anesthesia and Critical Care, Hospital
Universitario de Canarias, Tenerife, Spain
(Cinnella) Department of Anesthesia and Critical Care, Universita di
Foggia, Foggia, Italy
(Spadaro) Department of Anesthesia and Critical Care, Universita di
Ferrara, Ferrara, Italy
(Futier) Anesthesia and Critical Care, Centre Hospitalier Universitaire,
Clermont-Ferrand, France
(Ferrer) Department of Anesthesia, Universidad El Bosque, Bogota, Colombia
(Cabrera) Department of Anesthesia, Hospital Clinico de la Fuerza Aerea de
Chile, Las Condes, Chile
(Ribeiro) Department of Anesthesia and Critical Care, Centro Hospitalar
Sao Joao, Porto, Portugal
(Celestino) Department of Anesthesia and Critical Care, Centro Hospitalar
de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
(Kucur) Anesthesia and Critical Care, Medical Park Bahcelievler Hospital,
Istanbul, Turkey
(Cervantes) Department of Anesthesia and Critical Care, Hospital
Universitari Germans Trias i Pujol, Badalona, Spain
(Morocho) Critical Care Department, Hospital de especialidades Eugenio
Espejo, Quito, Ecuador
(Delphy) Department of Anesthesia, Alexandria University Hospital and
Kafrelsheikh University Hospital, Alexandria, Egypt
(Ramos) Department of Anesthesia and Critical Care, Hospital Universitario
Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain
(Villar) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
Publisher
W.B. Saunders
Abstract
Objective: The aim of this clinical trial is to examine whether it is
possible to reduce postoperative complications using an individualized
perioperative ventilatory strategy versus using a standard lung-protective
ventilation strategy in patients scheduled for thoracic surgery requiring
one-lung ventilation. <br/>Design(s): International, multicenter,
prospective, randomized controlled clinical trial. <br/>Setting(s): A
network of university hospitals. <br/>Participant(s): The study comprises
1,380 patients scheduled for thoracic surgery. <br/>Intervention(s): The
individualized group will receive intraoperative recruitment maneuvers
followed by individualized positive end-expiratory pressure (open lung
approach) during the intraoperative period plus postoperative ventilatory
support with high-flow nasal cannula, whereas the control group will be
managed with conventional lung-protective ventilation. <br/>Measurements
and Main Results: Individual and total number of postoperative
complications, including atelectasis, pneumothorax, pleural effusion,
pneumonia, acute lung injury; unplanned readmission and reintubation;
length of stay and death in the critical care unit and in the hospital
will be analyzed for both groups. The authors hypothesize that the
intraoperative application of an open lung approach followed by an
individual indication of high-flow nasal cannula in the postoperative
period will reduce pulmonary complications and length of hospital stay in
high-risk surgical patients.<br/>Copyright &#xa9; 2019

<77>
Accession Number
626925100
Title
Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic
Acid in Open Cardiac Surgery (DEPOSITION) study: Results of a pilot study.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Habbab L.M.; Hussain S.; Power P.; Bashir S.; Gao P.; Semelhago L.;
VanHelder T.; Parry D.; Chu V.; Lamy A.
Institution
(Habbab, Hussain, Power, Bashir, Gao, Semelhago, VanHelder, Parry, Chu,
Lamy) Division of Cardiac Surgery, David Braley Cardiac, Vascular and
Stroke Research Institute, Hamilton General Hospital, McMaster University,
Hamilton, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Cardiac surgery patients are at high risk for postoperative
bleeding. Intravenous (IV) tranexamic acid (TxA) is a commonly used
antifibrinolytic drug, but is associated with postoperative seizures. We
conducted this pilot randomized controlled trial (RCT) to determine the
feasibility of a larger trial that will be designed to investigate the
impact of TxA administration route, intrapericardial (IP) vs IV, on
postoperative bleeding and seizures. <br/>Method(s): In this
single-center, double-blinded, pilot RCT we enrolled adult patients
undergoing nonemergent on-pump cardiac operations through a median
sternotomy. Participants were randomized to IP or IV TxA groups. The
primary outcomes were cumulative chest tube drainage, transfusion
requirements, and incidence of postoperative seizures. <br/>Result(s): A
total of 97 participants were randomized to the intervention and control
groups. Baseline characteristics were similar in both groups. Most
participants underwent a CABG and/or aortic valve replacement. There was
no statistical difference. The IP TxA group was found to have a tendency
for less chest tube drainage in comparison to the IV TxA group, 500.5
(370.0-700.0) and 540.0 (420.0-700.0) mL, respectively, which was not
statistically significant (P = 0.2854). Fewer participants in the IP TxA
group with cardiac tamponade and/or required a reoperation for bleeding
and fewer packed red blood cell transfusions. None of the IP TxA group
developed seizure vs one from the IV TxA group. <br/>Conclusion(s): This
is the first known pilot RCT to investigate the role of TxA route of
administration in open cardiac surgery. Intrapericardial TxA shows
promising results with decreased bleeding, transfusion requirements,
reoperations, and postoperative seizures. A larger RCT is needed to
confirm these results and lead to a change in practice.<br/>Copyright
&#xa9; 2019 Wiley Periodicals, Inc.

<78>
Accession Number
2001715176
Title
ST-Elevation Myocardial Infarction Associated With Infective Endocarditis.
Source
American Journal of Cardiology. 123 (8) (pp 1239-1243), 2019. Date of
Publication: 15 April 2019.
Author
Nazir S.; Elgin E.; Loynd R.; Zaman M.; Donato A.
Institution
(Nazir, Loynd) Department of Internal Medicine, Reading Hospital-Tower
Health System, West Reading, Pennsylvania, United Kingdom
(Elgin) Division of Cardiology, Reading Hospital-Tower Health System, West
Reading, Pennsylvania, United Kingdom
(Zaman) Division of Pulmonary and Critical Care, Reading Hospital-Tower
Health System, West Reading, Pennsylvania, United Kingdom
(Donato) Sidney Kimmel Medical College at Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
ST-elevation myocardial infarction (STEMI) as a complication of infective
endocarditis (IE) is a rarely reported entity. No clear guidelines exist
with regards to the management of this medical emergency. We sought to
systematically review the clinical presentation and management of this
condition. We searched relevant articles on STEMI associated with IE and
extracted data on demographic variables, key clinical characteristics upon
presentation, treatment strategies, and clinical outcomes. We identified
100 patients from 95 articles. The mean age at presentation was 53 +/- 17
years with male preponderance (n = 63, 63%, p = 0.01). Most patients (63
of 100, 63%) presented with STEMI as their first manifestation of IE, with
others occurring at 15 +/- 17 days after diagnosis of IE. Findings that
suggested possible septic emboli were not consistently present, including
history of prosthetic valve placement (15%), presence of other embolic
disease (27%), fever (42%) increased leukocyte count (80%), and presence
of murmur (88%). Atherosclerotic disease was absent in 95% on cardiac
catheterization. Eleven patients receiving tissue plasminogen activator
fared poorly, with 9 major bleeds; balloon angioplasty was successful in
56% (9 of 16 cases), aspiration thombectomy in 68% (21 of 31 cases), and
coronary stenting in 81% (14 of 16 cases). The 30-day mortality was 43%.
In conclusion, patients with STEMI in the face of recent IE, new
precordial murmur, fever, increased leukocyte count or other embolic
events, septic emboli should be considered as a cause for STEMI. Best
practices for management are not known, but thrombolytics appear to carry
significant bleeding and embolic risks.<br/>Copyright &#xa9; 2019 Elsevier
Inc.

<79>
[Use Link to view the full text]
Accession Number
617003416
Title
Chest Wall Resection for Recurrent Breast Cancer in the Modern Era.
Source
Annals of Surgery. 267 (4) (pp 646-655), 2018. Date of Publication: 01 Apr
2018.
Author
Wakeam E.; Acuna S.A.; Keshavjee S.
Institution
(Wakeam, Keshavjee) Division of Thoracic Surgery, Toronto General
Hospital, University Health Network, Department of Surgery, University of
Toronto, 200 Elizabeth St, 9N-946, Toronto, ON M5G 2C4, Canada
(Acuna) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To review the literature on chest wall resection for recurrent
breast cancer and evaluate overall survival (OS) and quality-of-life (QOL)
outcomes. <br/>Background(s): Full-thickness chest wall resection for
recurrent breast cancer is controversial, as historically these
recurrences have been thought of as a harbinger of systemic disease.
<br/>Method(s): A systematic search in MEDLINE, EMBASE, and Cochrane
CENTRAL identified 48 eligible studies, all retrospective, accounting for
1305 patients. The review is reported following Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guidelines. Primary end points
were patient-centered QOL outcomes and OS; secondary outcomes included
disease-free survival (DFS) and 30-day morbidity. Risk of bias was
assessed using the Methodological Index for Non-Randomized Studies
instrument and the Oxford Centre for Evidence-Based Medicine's levels of
evidence tool. Random-effects meta-analysis was used to create pooled
estimates. Meta-regressions and sensitivity analyses were used to explore
study heterogeneity by age, year of publication, risk of bias, and
surgical intent (curative vs palliative). <br/>Result(s): Studies
consistently reported excellent OS and DFS in properly selected patients.
Pooled estimates for 5-year OS in all studies and those from the past 15
years were 40.8% [95% confidence interval (CI) 35.2-46.7) and 43.1% (95%
CI 35.8-50.7), whereas pooled 5-year DFS was 27.1% (95% CI 16.6-41.0).
Eight studies reported excellent outcomes related to QOL. Mortality was
consistently low (<1%) and 30-day pooled morbidity was 20.2% (95% CI
15.3%-26.3%). Study quality varied, and risk of selection bias in included
studies was high. <br/>Conclusion(s): Full-thickness chest wall resection
can be performed with excellent survival and low morbidity. Few studies
report on QOL; prospective studies should focus on patient-centered
outcomes in this population.<br/>Copyright &#xa9; 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<80>
Accession Number
365787657
Title
Prasugrel versus clopidogrel for acute coronary syndromes without
revascularization.
Source
New England Journal of Medicine. 367 (14) (pp 1297-1309), 2012. Date of
Publication: 04 Oct 2012.
Author
Roe M.T.; Armstrong P.W.; Fox K.A.A.; White H.D.; Prabhakaran D.; Goodman
S.G.; Cornel J.H.; Bhatt D.L.; Clemmensen P.; Martinez F.; Ardissino D.;
Nicolau J.C.; Boden W.E.; Gurbel P.A.; Ruzyllo W.; Dalby A.J.; McGuire
D.K.; Leiva-Pons J.L.; Parkhomenko A.; Gottlieb S.; Topacio G.O.; Hamm C.;
Pavlides G.; Goudev A.R.; Oto A.; Tseng C.D.; Merkely B.; Gasparovic V.;
Corbalan R.; McLendon R.C.; Winters K.J.; Brown E.B.; Lokhnygina Y.;
Aylward P.E.; Huber K.; Hochman J.S.; Ohman E.M.; Ohman E.; Bassand J.P.;
Castillo V.R.; Chua T.; Cinteza M.; Erlinge D.; Foley D.P.; Fridrich V.;
Ge J.; Goodman S.; Goudev A.; Gratsiansky N.; Hamm C.W.; Jeong M.H.;
Jun-Ren Z.; Lopez-Sendon J.; Luscher T.; Mogrovejo W.E.; Nicolau J.;
Petrauskiene B.; Roe M.; Sritara P.; Syvanne M.; Topacio G.; Verheugt F.;
Widimsky P.; Wiviott S.D.; Zambahari R.; Van de Werf F.; Budaj A.; Gersh
B.J.; Montalescot G.; Pocock S.J.; Wilcox R.G.; Williams D.O.; Wilson M.;
Mehta R.H.; Alexander J.H.; Kong D.F.; Lopes R.; Mahaffey K.W.; Melloni
C.; Newby L.; Shah B.R.; Tricoci P.; George D.J.; Beaven A.W.; Blackwell
K.L.; Morse M.A.; Onken J.E.; Ready N.E.; Strickler J.H.; Zafar S.; Hafley
G.; Pieper K.; Stevens S.; Schibler T.; Chan M.; Chin C.T.; Gharacholou
S.; Subherwal S.; McLendon R.; Marshall D.; Macias W.; Lenarz L.; Petijean
H.; Plat F.; van Kranen R.; Zamoryakhin D.; Albisu J.; Alvarez C.;
Amuchastegui M.; Astesiano A.L.; Beloscar J.; Bergallo J.; Bono J.;
Bordonava A.; Botta C.E.; Budassi N.; Caccavo A.; Cartasegna L.; Colombo
H.; Costello R.; Covelli G.; De Valais F.; Dran R.; Duronto E.; Forte
E.H.; Garcia D.F.; Garcia Escudero A.; Hominal M.; Hrabar A.D.; Ibanez
J.O.; Jure H.; Leon de la Fuente R.; Lobo Marquez L.; Luciardi H.; Luquez
H.; Marino J.; Martingano R.; Moises Azize G.; Nul D.; Patocchi C.; Piombo
A.; Prado A.; Rodriguez M.; Romero Acuna A.; Scaro G.B.; Sosa Liprandi A.;
Varini S.D.; Vigo S.J.; Aroney G.; Arstall M.; Blenkhorn A.; Carroll P.;
Chew D.; Collins N.; Hammett C.; Lee A.; Marrinan M.; Roberts-Thomson P.;
Waites J.; Benzer W.; Lang I.; Podczeck-Schweighofer A.; Baetsle P.;
Beauloye C.; De Tollenaere M.; Lancellotti P.; Marechal P.; Van Dorpe A.;
Albuquerque D.; Andrade Lotufo P.; Ardnt M.; Arminio G.; Alves da Cost
F.A.; Baracioli L.M.; Bertolim Precoma D.; Carvalho Neuenschwander F.;
Damiao Gomes Seabra M.; De Souza J.; Duda N.T.; Dutra O.P.; Feitosa A.;
Filho H.; Finimundi H.C.; Gomes M.; Gubolino L.; Guimaraes A.E.; Hernandes
M.; Jardim C.A.; Kunz Sebba Barroso de Souza W.; Leaes P.E.; Maia L.N.;
Manenti E.; Marin Neto J.A.; Marino R.; Michalaros Y.; Mora Junior R.;
Moraes Junior J.B.; Nogueira Liberato de Sousa L.; Pimentel Filho P.;
Polanczyk C.; Rabelo Alves A.; Ramos R.; Reis G.; Rocha Faria Neto J.;
Rossi Dos Santos F.; Saporito W.; Saraiva J.F.; Sartori P.C.; Scholz Issa
J.; Silva Junior D.; Sousa A.; Teixeira M.; Zimmermann S.L.; Lazov P.;
Tokmakova M.; Penchev K.; Petrov I.; Baldjiev E.; Georgiev P.;
Hergeldjieva V.; Manolova A.; Dimov B.; Mihov A.; Pencheva G.; Raev D.;
Ramshev K.; Tumbev H.; Tzekova M.; Boichev B.; Kadiiski A.; Devedzhiev T.;
Bakbak A.; Berlingieri J.; Burstein J.; Dery J.P.; Heath J.; Huynh T.;
Kassam S.; Kostuk W.; Labonte R.; Maccallum C.; Nawaz S.; Quraishi A.U.;
Senaratne M.; Syan G.; Syan R.; Vizel S.; Castro P.; Florenzano F.; Lamich
R.; Manriquez L.; Potthoff S.; Stockins B.; Bugueno C.; Cobos J.;
Sepulveda P.; Opazo M.; Montecinos H.; Ke Y.; Chen Y.D.; Chen J.; Wang J.;
Li W.; Xu B.; Ma G.; Li Z.; Sun Y.; Tang J.; Yuan Z.; Tang L.; Zhou Y.; He
Q.; Xu J.; Zhang H.; Yang K.; Zhou S.; Zhao S.; Zheng Z.; Li X.; Wang D.;
Hong X.; Guan R.; Wang L.; Huang H.; Xia Y.; Hao Y.; Zhang S.; Zhao X.;
Liu X.; Yan J.; Huang Y.; Wang B.; Vallejo G.S.; Bohorquez R.; Gomez N.I.;
Fernandez R.; Mayorga L.E.; Gomez J.; Quintero A.; Figueredo A.; Senior
J.; Accini J.L.; Roncallo E.; Frischwasser S.; Sanchez M.S.; Bouzid Y.;
Ciglenecki N.; Certic J.F.; Grman J.; Sutalo K.; Bergovec M.; Knezevic A.;
Mirat J.; Padovan M.; Car S.; Samardzic P.; Bagatin J.; Kraus L.; Coufal
Z.; Janota T.; Kettner J.; Linhart A.; Hondl M.; Osmancik P.; Padour M.;
Telekes P.; Vojacek J.; Vojtisek P.; Francek L.; Sedlon P.; Bronnum-Schou
J.; Hansen P.; Nielsen H.; El-Etreby A.; El Hawary A.; El Rakshy Y.;
Mowafy A.; Ragy H.; Reda A.; Sabri S.; Nyman K.; Laine M.; Bressollette
E.; Rifai A.; Danchin N.; Ovize M.; Cottin Y.; Farah B.; Furber A.; Coste
P.; Elbaz M.; Morel O.; Schiele F.; Elhadad S.; Belhassane A.; El Mansour
N.; Leroy F.; Coisne D.; Ferrari E.; Nguyen-Khac O.; Range G.; Moulin F.;
Poulard J.E.; Sechtem U.; Kaelsch T.; Ebelt H.; Gawaz M.; Genth-Zotz S.;
Moellmann H.; Heuer H.; Kadel C.; Klein H.; Werner G.; Boudriot E.;
Kruells-Muench J.; Baer F.; Alexopoulos D.; Manolis A.; Platogiannis D.;
Anastasiou-Nana M.; Nanas I.; Cokkinos D.; Fotiadis I.; Koliopoulos N.;
Moschos N.; Olympios C.; Ples Z.; Illyes L.; Csikasz J.; Zolyomi S.; Kis
E.; Kovacs Z.; Lupkovics G.; Nagy A.; Regos L.; Tomcsanyi J.; Janosi A.;
Medvegy M.; Szakal I.; Vertes A.; Szalai G.; Banker D.; Dani S.; Kumar S.;
Sarna M.K.; Seerangachar R.K.; Deshpande A.; Khan I.A.; Gupta S.K.;
Dharmadhikari A.; Babu P.; Fulwani M.; Kerkar P.G.; Varma S.; Singh P.;
Babu R.; Menon J.; Sengupta S.; Sathe S.; Premchand R.K.; Kalra R.;
Kalashetti S.; Pai V.; Bose V.; Jain V.; Kale V.; Benjarge P.; Ghaisas N.;
Thanvi S.; Durgaprasad R.; Kulkarni R.L.; Joshi H.; Abyankar A.; Bisne V.;
Chopra V.; Reddy P.; Sarma R.; Garg N.; Agarwal D.K.; Arneja J.;
Bandyopadhyay S.; Bharani A.; Yadav R.; Dutta S.; Chidambaram N.; Dande
A.; Gadkari M.; Grant P.; Khan A.; Gupta R.; Gupta J.B.; Shetty G.; Lavhe
P.V.; Jain R.; Joseph J.; Calambur N.; Joseph S.; Mardikar H.; Mathur A.;
Mohanan P.; Kumbla M.; Nair T.; Nambiar A.; Jathappa N.; Parale G.; Patel
T.; Puri A.; Rao B.; Saligrama R.; Sawhney J.; Sethi S.; Singh B.;
Srinivas A.; Jagadesa B.S.; Foley D.; Mahon N.; Mulvihill N.; Nash P.;
Arad T.; Balkin J.; Francis A.; Hammerman H.; Hasin Y.; Katz A.; Kracoff
O.; Marmor A.; Mosseri M.; Atar S.; Roth A.; Zahger D.; Turgeman Y.; Weiss
A.; De Luca M.; Antonelli G.; Piovaccari G.; Barbiero M.; Cuccia C.; De
Servi S.; Fedele F.; Golino P.; Manari A.; Menozzi A.; Berti S.; Moretti
L.; Musumeci G.; Pajes G.; Paloscia L.; Mos L.; Salvioni A.; Volpe M.; De
Luca G.; Astarita C.; Merlini P.; Di Lorenzo L.; Fattore L.; Ambrosio G.;
Mircoli L.; Galvani M.; Cavallini C.; Nassiacos D.; Scioli R.; Yoon J.;
Kim D.K.; Hur S.H.; Bae J.H.; Rha S.W.; Lee S.R.; Kim K.S.; Ko Y.G.; Jeong
J.O.; Lee S.K.; Hong T.J.; Kim M.; Hwang J.Y.; Shin E.K.; Kim S.W.;
Anusauskiene J.; Dambrauskaite A.; Jarasuniene D.; Raugaliene R.;
Babarskiene M.R.; Ahmad W.A.; Yusof Z.; Maskon O.; Ong T.K.; Abdullah
H.N.; Chandran A.; Chong Y.S.; Lee C.Y.; Ramanathan L.; Sciberras R.;
Xuereb R.G.; Fajardo P.; Ramos-Lopez G.; Alcocer M.A.; Ramirez M.C.;
Ibarra M.O.; Esperon G.L.; Diaz C.S.; Hamer A.; Elliott J.; Harding S.;
Hart H.; Castillo B.G.; Ortega R.N.; Frago G.; Henriquez F.; Acosta D.C.;
Zambrano E.C.; Mogrovejo W.; Chois A.; Gamio C.F.; Barrera M.A.; Cabrera
J.; Dextre L.Z.; Reyes M.; Tellez D.; Castillo R.; Chavez C.; Godoy A.;
Llerena N.; Morales C.A.; Habaluyas R.; Rogelio G.; Ramos E.J.; Chua P.;
Mendoza V.; Tirador L.; Abanilla J.; Edmilao M.I.; Coching R.M.; Morales
D.; Dalkowski M.; Sciborski R.; Lewczuk J.; Hoffmann A.; Lesnik J.;
Andruszkiewicz B.; Wojciechowski D.; Kus W.; Jozwa R.; Kasprzak J.;
Lubinski A.; Karczmarczyk A.; Wojcik J.; Gruchala M.; Bartus S.; Bronisz
M.; Mirek-Bryniarska E.; Dudek D.; Gorny J.; Grzywna R.; Kawka-Urbanek T.;
Niezgoda K.; Olszewski R.; Ogorek M.; Gniot J.; Nessler J.; Ponikowski P.;
Wita K.; Zinka E.; Zmudka K.; Szelemej R.; Moreira J.; Bastos J.M.;
Ferreira J.; Martins D.; Providencia L.; Ribeiro V.G.; Silva G.; Seixo F.;
Morais J.; Rinaldi R.; Rodriguez-Ospina L.; Colon-Hernandez P.; Matei C.;
Tatu-Chitoiu G.P.; Iordachescu-Petica D.; Teodorescu I.; Ochean V.;
Constantinescu M.C.; Stanciulescu G.E.; Bobescu E.; Bolohan F.R.; Coman
I.M.; Creteanu M.; Dan G.A.; Dobre I.; Ionescu P.; Minescu B.; Olinic
D.M.; Pop C.; Stamate S.C.; Gurevich V.; Bichan N.; Baranov E.;
Zateyshchikov D.; Barbarich V.; Gordeev I.; Tereshchenko S.; Dovgalevskiy
Y.; Boyarkin M.; Shogenov Z.; Suprun E.; Shalaev S.; Arutyunov G.;
Supryadkina T.; Perepech N.; Nikolskaya I.; Rossovskaya M.; Khaisheva L.;
Simanenkov V.; Boldueva S.; Zrazhevskiy K.; Barbarash O.; Egorova L.;
Markov V.; Novikova N.; Alexeeva N.; Ermoshkina L.; Ishmurzin G.;
Miloradovic V.; Pavlovic M.; Ilic S.; Krotin M.; Neskovic A.; Otasevic P.;
Vasiljevic-Pokrajcic Z.; Ostojic M.; Chan M.Y.; Goh P.P.; Kokles M.; Bugan
V.; Urban M.; Sirotiakova J.; Belicova M.; Duris T.; Poliacik P.; Slanina
M.; Letcher G.; Abelson M.; Dalby A.; Gould T.; Manga P.; Pillay T.;
Theron H.; Venter T.; van Zyl L.; Essop M.; van der Merwe N.; Alegret
J.M.; Gomez D.L.; Vera T.R.; Bruguera I Cortada J.; Garcia J.H.; Dalli E.;
Paz M.A.; Ridocci F.; Coronado J.L.; Romero C.; Urbano R.H.; Carlsson R.;
Falck G.; Gallino A.; Linka A.; Lai W.T.; Shyu K.G.; Li A.H.; Chiang C.E.;
Hou J.Y.; Kuanprasert S.; Srimahachota S.; Wongvipaporn C.; Laothavorn P.;
Krittayaphong R.; Tangsuntornwiwat S.; Moleerergpoom W.; Kaewsuwanna P.;
Sakulsaengprapha T.; Viboolkitvarakul N.; Buakhamsri A.; Braam R.; Basart
D.C.; Troquay R.P.; Herrman J.P.; van der Heijden D.J.; Broeders M.; Romer
T.; Post J.C.; Viergever E.; Zwart P.; Groutars R.; Breedveld R.; Ronner
E.; Hoedemaker G.; van Kalmthout P.; Kuijper A.; Geertman J.H.; Hamer B.;
Werter C.; Westendorp I.; Kruik H.J.; Zouari S.B.; Boughzala E.; Boujnah
R.; Gamra H.; Haouala H.; Kammoun S.; Ben Khalfallah A.; Maatouk F.; Ural
D.; Kutlu M.; Sahin M.; Ebinc H.; Kucukoglu S.; Demirtas M.; Kirma C.;
Altun A.; Aydinlar A.; Aydogdu S.; Cayli M.; Bozkurt E.; Buyukoner E.E.;
Erdogan D.; Acikel M.; Ozdemir M.; Ozdemir K.; Yazici M.; Goloborodko B.;
Nykonov V.; Vakaliuk I.; Yagensky A.; Vatutin M.; Shcherbak V.; Kovalskyy
I.; Bagriy A.; Ushakov O.; Zhurba S.; Sierkova V.; Bashkirtsev O.;
Vasylenko A.; Karpenko Y.; Kaidashev I.; Amosova K.; Batushkin V.; Faynyk
A.; Horbach L.; Karpenko O.; Koval' O.; Kraiz I.; Potapenko P.; Rudenko
L.; Malynovsky Y.; Tseluyko V.; Volkov V.; Prokhorov O.; Sarkar D.;
Moriarty A.; El-Harari M.; Brigden G.; Qureshi N.; Alamgir F.; de Belder
A.; Keeling P.; Cooke J.; Brown N.; Junejo S.; Vuyyuru R.; Connolly D.;
Kadr H.; Griffiths H.; Tang K.; Cotton J.; Barr C.; Lindsay S.;
Venkataraman A.; Rittoo D.; Jacob A.; Watkin R.; Lang C.; Pye M.; Chambers
J.; Mavromatis K.; Rossi P.; Ahmad A.; Anderson H.; Roberts J.; Klugherz
B.; Haidar A.; Downes T.; Russo D.; Wallace W.; Bhagwat R.; Mathew T.;
Jetty P.; Henderson D.; Dy J.; Isserman S.; Kondle V.; Quintana O.; Brener
S.; Masud Z.; Vijay N.; Jain M.; Longo J.; Safley D.; Pancholy S.;
Shaoulian E.; Allan J.; Bazzi A.; Chahin J.; Shurmur S.; Santos R.;
Goldberg J.; Gigliotti O.; Irimpen A.; Khan M.; Kusnick B.; Treasure C.;
Rogers J.; Zebrack J.; Turner M.; Adjei N.; Ingram C.; Mathis C.; Buchanan
W.; Heins G.; Ahsan C.; Anderson J.; Atassi K.; Bachinsky W.; Baig M.;
Rodriguez A.; Tang A.; Foreman R.; Berlin H.; Bouchard A.; Thew S.;
Borromeo S.; Bowden W.; Boyek T.; Arter J.; Blair J.; Chandna H.; Katz J.;
Conn E.; Connelly T.; Del Core M.; Shanes J.; Dotani I.; Drenning D.;
Bustros N.; Fastabend C.; Flores E.; Goudreau E.; Gredler F.; Greenfield
R.; Guidera S.; Gogia H.; Hearne S.; Hermany P.; Taheri H.; Izzo M.;
Jaffrani N.; Johnson G.; Keedy D.; Waxman F.; Kesselbrenner M.; Floro J.;
Korban E.; Labroo A.; Lui H.; Georgeson S.; Breall J.; Baman R.; Mandak
J.; Marais H.; Lee D.; Meisner J.; Micale P.; Meymandi S.; Vicari R.;
Mouhaffel A.; Moscoso R.; Papademetriou V.; Piegari G.; Promisloff S.;
Rivera E.; Rogers W.; Roth D.; Sadler D.; Canto J.; Schmedtje J.; Shaikh
S.; Shalev Y.; Sharma M.; Rahman A.; Schwartz S.; Sporn D.; Staniloae C.;
Tami L.; Barnum O.; Tu T.; Tuma J.; Wali A.; Welka S.; Wilson V.; Younis
L.; Zakhary B.; Ziperman D.; Singh N.; Kukuy E.; Leimbach W.; Chang M.;
Carter M.; Simpson P.; Miklin J.; Niess G.; Schaefer S.; Lambert C.; Soh
E.; Heintz K.; Miller J.; Chandrashekhar Y.; Pappas J.; Rashid H.U.;
Wright W.; Rees A.; Bach R.; Wu W.; Singhi S.; Quyyumi A.; Lau T.; Nobel
J.; Kamdar A.; Kabour A.; Stys T.; Keller N.; Kumar A.; Danisa K.; Smith
S.; Espinoza A.; Deac D.; Roberts D.; Gumm D.; Saucedo J.; Gimple L.;
Weinstein D.; Blonder R.; Moran M.; Iwaoka R.; Bayron C.; Tejada L.; White
L.; Ingersoll H.; Casterella P.; Chiaramida S.; Harris J.; Rodriguez R.;
Vo A.; Dave K.; Giacomini J.; Kotha P.; Park C.; Arif I.; McGrew F.; Atieh
M.; Huang X.; Zarrella G.; McGarvey J.; Koganti D.; Albirini A.; Kozman
H.; Slepian M.; Quion J.A.; Ramanathan K.; Bessen M.; Rafael A.; Aycock G.
Institution
(Roe, McLendon, Lokhnygina, Ohman) Duke Clinical Research Institute, Duke
University Medical Center, 2400 Pratt St, Durham, NC 27705, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Armstrong) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Goodman) Division of Cardiology, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(White) Auckland City Hospital, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Prabhakaran) Center for Chronic Disease Control, New Delhi, India
(Cornel) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Bhatt) VA Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Clemmensen) Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Martinez) Department of Cardiology, Cordoba National University, Cordoba,
Argentina
(Ardissino) Division of Cardiology, Azienda Ospedaliero-Universitaria di
Parma, Parma, Italy
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Boden) Department of Medicine, Stratton VA Medical Center, Albany Medical
College, Albany, NY, United States
(Hochman) Leon H. Charney Division of Cardiology, New York University
School of Medicine, NYU Langone Medical Center, NY, United States
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, United States
(Ruzyllo) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Dalby) Milpark Hospital, Johannesburg, South Africa
(McGuire) University of Texas-Southwestern Medical Center, Dallas, TX,
United States
(Leiva-Pons) Cardiology Department, Hospital Central Dr. Morones Prieto,
San Luis Potosi, Mexico
(Parkhomenko) Emergency Cardiology, Institute of Cardiology, Kiev, Ukraine
(Gottlieb) Department of Cardiology, Bikur Cholim Hospital, Jerusalem,
Israel
(Topacio) Department of Medicine, Medical Center Manila, Manila,
Philippines
(Hamm) Kerckhoff Heart Center, Bad Nauheim, Germany
(Pavlides) Cardiology Division, Onassis Cardiac Surgery Center, Kallithea,
Greece
(Goudev) Cardiology Department, Queen Giovanna University Hospital, Sofia,
Bulgaria
(Oto) Department of Cardiology, Hacettepe University Faculty of Medicine,
Ankara, Turkey
(Tseng) Division of Cardiology, National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Merkely) Heart Center, Semmelweis University, Budapest, Hungary
(Gasparovic) Department of Intensive Care Medicine, Clinical Hospital
Center Zagreb, Zagreb, Croatia
(Corbalan) Cardiovascular Division, Faculty of Medicine, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Cinteza) Division of Cardiology, Emergency University Hospital of
Bucharest, Bucharest, Romania
(Winters, Brown) Eli Lilly, Indianapolis, IN, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Huber) Third Department of Medicine, Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: The effect of intensified platelet inhibition for patients
with unstable angina or myocardial infarction without ST-segment elevation
who do not undergo revascularization has not been delineated.
<br/>METHOD(S): In this double-blind, randomized trial, in a primary
analysis involving 7243 patients under the age of 75 years receiving
aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg
daily) versus clopidogrel (75 mg daily). In a secondary analysis involving
2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel
versus 75 mg of clopidogrel. <br/>RESULT(S): At a median follow-up of 17
months, the primary end point of death from cardiovascular causes,
myocardial infarction, or stroke among patients under the age of 75 years
occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel
group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval
[CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the
overall population. The prespecified analysis of multiple recurrent
ischemic events (all components of the primary end point) suggested a
lower risk for prasugrel among patients under the age of 75 years (hazard
ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and
intracranial bleeding were similar in the two groups in all age groups.
There was no significant between-group difference in the frequency of
nonhemorrhagic serious adverse events, except for a higher frequency of
heart failure in the clopidogrel group. <br/>CONCLUSION(S): Among patients
with unstable angina or myocardial infarction without ST-segment
elevation, prasugrel did not significantly reduce the frequency of the
primary end point, as compared with clopidogrel, and similar risks of
bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY
ACS ClinicalTrials.gov number, NCT00699998.) Copyright &#xa9; 2012
Massachusetts Medical Society.

<81>
Accession Number
625633979
Title
Comment on "Transcatheter aortic valve replacement in patients with pure
native aortic valve regurgitation: A systematic review and meta-analysis".
Source
Clinical Cardiology. 42 (1) (pp 167-168), 2019. Date of Publication:
January 2019.
Author
Shoar S.; Naderan M.; Hosseini F.; Shoar N.
Institution
(Shoar) Clinical Research Scholar and Scientist, ScientificWriting
Corporation, Houston, TX, United States
(Shoar, Naderan) Faculty of Medicine, Tehran University of Medical
Science, Tehran, Iran, Islamic Republic of
(Hosseini) School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Shoar) Faculty of Medicine, Kashan University of Medical Sciences,
Kashan, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)

<82>
Accession Number
624048641
Title
Effects of Cilostazol-Based Triple Antiplatelet Therapy Versus Dual
Antiplatelet Therapy After Coronary Drug-Eluting Stent Implantation: An
Updated Meta-Analysis of the Randomized Controlled Trials.
Source
Clinical Drug Investigation. 39 (1) (no pagination), 2019. Date of
Publication: 31 Jan 2019.
Author
Zhao S.; Zhong Z.; Qi G.; Shi L.; Tian W.
Institution
(Zhao, Qi, Shi, Tian) Department of Geriatric Cardiology, First Affiliated
Hospital, China Medical University, No. 155 Nanjingbei Street, 110001
Heping District, Shenyang, China
(Zhong) Department of Respiratory, Central Hospital, Shenyang Medical
College, Shenyang, China
Publisher
Springer International Publishing
Abstract
Background and Objective: The results of studies on cilostazol-based
triple antiplatelet therapy (TAT) after drug-eluting stent (DES)
implantation were inconsistent. To assess the effects of TAT compared with
dual antiplatelet therapy (DAT) after DES/second-generation DES
implantation, we performed a meta-analysis of randomized controlled trials
(RCTs). <br/>Method(s): All relevant studies evaluated were identified by
searching the PubMed, EMBASE, Cochrane Library, and ISI Web of Science
databases without time and language limitation. Subgroup analyses were
performed to evaluate the efficacy and safety of TAT after
second-generation DES implantation. <br/>Result(s): Eleven RCTs involving
a total of 4684 patients were included. The meta-analysis showed TAT was
associated with significant beneficial effects on angiographic findings of
in-stent restenosis [risk ratio (RR) 0.645, 95% confidence interval (CI)
0.470-0.885; P = 0.007], in-segment restenosis (RR 0.606, 95% CI
0.450-0.817; P = 0.001), in-stent late loss (RR - 0.095, 95% CI - 0.136 to
- 0.054; P < 0.0001), in-segment late loss (RR - 0.100, 95% CI - 0.139 to
- 0.061; P < 0.0001), target lesion revascularization (TLR) (RR 0.570, 95%
CI 0.430-0.755; P < 0.0001), and target vessel revascularization (TVR) (RR
0.523, 95% CI 0.380-0.719; P < 0.0001). No significant difference was
found in outcomes of all-cause death, cardiac death, definite/probable
stent thrombosis (ST), non-fatal myocardial infarction (MI), overall
bleeding, and major bleeding between the two groups, as well as some minor
adverse effects including palpitations, thrombocytopenia, neutropenia, and
hepatic dysfunction. However, the incidence rate of rash, gastrointestinal
disorders, and headache was significantly higher in TAT. The
second-generation DES subgroup showed similar results, except for the
indicators of all-cause death (RR 2.161, 95% CI 1.007-4.635; P = 0.048)
and hepatic dysfunction (RR 0.176, 95% CI 0.031-0.995; P = 0.049).
<br/>Conclusion(s): Compared with DAT, cilostazol-based TAT can
significantly improve the angiographic findings of in-stent and in-segment
late loss, in-stent and in-segment restenosis, TLR, and TVR after
DES/second-generation DES implantation. However, no benefits were observed
in outcomes of all-cause death, cardiac death, ST, and MI.<br/>Copyright
&#xa9; 2018, Springer Nature Switzerland AG.

<83>
Accession Number
626818204
Title
Predicting the Quality of Warfarin Therapy: Reframing the Question.
Source
Thrombosis and Haemostasis. 119 (4) (pp 509-511), 2019. Date of
Publication: 2019.
Author
Barnes G.D.
Institution
(Barnes) Department of Internal Medicine, University of Michigan, Frankel
Cardiovascular Center, Ann Arbor, MI, United States
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)

<84>
Accession Number
624533683
Title
A prospective, observational study of cerebrovascular autoregulation and
its association with delirium following cardiac surgery.
Source
Anaesthesia. 74 (1) (pp 33-44), 2019. Date of Publication: January 2019.
Author
Chan B.; Aneman A.
Institution
(Chan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
(Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
Publisher
Blackwell Publishing Ltd
Abstract
This aim of this prospective observational cohort study was to evaluate
any association between postoperatively impaired cerebrovascular
autoregulation and the onset of delirium following cardiac surgery.
Previous studies have shown that impaired intra-operative cerebrovascular
autoregulation during cardiopulmonary bypass is associated with delirium.
However, postoperative changes in cerebrovascular autoregulation and its
association with delirium have not been investigated. One-hundred and
eight consecutive adult cardiac surgical patients without baseline
cognitive dysfunction or aphasia were included in the study.
Cerebrovascular autoregulation was assessed by the Pearson correlation
between near-infrared spectroscopy-derived cerebral tissue oxygen
saturation and mean arterial pressure to derive the tissue oximetry index.
Cerebrovascular autoregulation was monitored for a minimum of 90 min on
postoperative day 0 and postoperative day 1. Delirium was assessed
throughout intensive care unit admission using the confusion assessment
method for the intensive care unit. We observed delirium in 24 of the 108
patients studied. The mean (SD) tissue oximetry index was higher in
delirious patients on postoperative day 0 compared with non-delirious
patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on
postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All
patients showed improvement in tissue oximetry index on postoperative day
1 compared with postoperative day 0. Logistic regression analysis
demonstrated tissue oximetry index on postoperative day 0 to be
independently associated with delirium; odds ratio 1.05 (95%CI 1.01-1.10),
p = 0.043. In conclusion, we found an association between impaired
cerebrovascular autoregulation, measured by near-infrared spectroscopy,
and delirium in the early postoperative period.<br/>Copyright &#xa9; 2018
Association of Anaesthetists

<85>
Accession Number
2001581983
Title
Impact of Heparin- or Nonheparin-Coated Circuits on Platelet Function in
Pediatric Cardiac Surgery.
Source
Annals of Thoracic Surgery. 107 (4) (pp 1241-1247), 2019. Date of
Publication: April 2019.
Author
Giorni C.; Pezzella C.; Bojan M.; Ricci Z.; Pouard P.; Raisky O.; Tourneur
L.; La Salvia O.; Favia I.; Borgel D.; Cogo P.; Carotti A.; Lasne D.
Institution
(Giorni, Pezzella, Ricci, La Salvia, Favia, Cogo, Carotti) Pediatric
Intensive Care, Cardiac Surgery and Perfusion Unit, Bambino Gesu
Children's Hospital, Rome, Italy
(Bojan, Pouard) Department of Anesthesiology and Critical Care, Assistance
Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
(Raisky, Tourneur) Department of Pediatric Cardiac Surgery, Assistance
Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
(Borgel, Lasne) Hematology Laboratory, Assistance Publique-Hopitaux de
Paris, Hopital Necker-Enfants Malades, Paris, France
(Borgel, Lasne) Hemostase Inflammation Thrombose, Unite Mixte de Recherche
-S1176, Institut National de la Sante et de la Recherche Medicale,
University Paris-Sud, Universite Paris-Saclay, Le Kremlin-Bicetre, France
Publisher
Elsevier USA
Abstract
Background: Extracorporeal circuit coating has been shown to improve
coagulation derangements during pediatric cardiopulmonary bypass (CPB).
This study compared platelet function and hemostasis activation in
pediatric cardiac surgery conducted with nonheparin coating (Balance;
Medtronic, Minneapolis, MN) versus heparin-based coating (Carmeda;
Medtronic) circuits. <br/>Method(s): A prospective, randomized,
double-center trial was conducted in children older than 1 month
undergoing congenital heart disease treatment. Blood samples were
collected at baseline (T0), 15 minutes after the start of CPB (T1), and 15
minutes (T2) and 1 hour after the conclusion of CPB (T3). The primary end
point of the study was to detect potential differences in
beta-thromboglobulin levels between the two groups at T2. Other
coagulation and platelet function indicators were analyzed as secondary
end points. <br/>Result(s): The concentration of beta-thromboglobulin
increased significantly at T2 in both groups. However, there was no
significant difference between the groups across all time points. There
was no difference in the secondary end points between the groups.
<br/>Conclusion(s): The two circuits showed similar biological effects on
platelet function and coagulation. This observation may be useful in
optimizing the conduct of CPB and in rationalizing its cost for the
treatment of congenital heart disease.<br/>Copyright &#xa9; 2019 The
Society of Thoracic Surgeons

<86>
Accession Number
625590485
Title
Safety and efficacy of a novel abluminal groove-filled biodegradable
polymer sirolimus-eluting stent for the treatment of de novo coronary
lesions: Final five-year results of the patient-level pooled analysis from
the TARGET I and TARGET II trials.
Source
Catheterization and Cardiovascular Interventions. 93 (S1) (pp 818-824),
2019. Date of Publication: 15 Feb 2019.
Author
Li C.; Guan C.; Zhang R.; Yang Y.; Ma C.; Li H.; Chen S.; Han Y.; Xu B.;
Gao R.
Institution
(Li, Guan, Yang, Xu, Gao) Fu Wai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Zhang) Affiliated Ruijin Hospital of Shanghai Jiaotong University School
of Medicine, Shanghai, China
(Ma) Affiliated Anzhen Hospital of Capital Medical University, Beijing,
China
(Li) Daqing Oil Field General Hospital, Daqing, China
(Chen) Affiliated Nanjing First Hospital of Nanjing Medical University,
Nanjing, China
(Han) General Hospital of Shenyang Military Region, Shenyang, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The study reports the final 5-year safety and effectiveness
outcomes of the novel abluminal groove-filled biodegradable polymer-coated
FIREHAWK sirolimus-eluting stent in a large patient cohort.
<br/>Background(s): The TARGET clinical program was conducted to evaluate
the performance of the FIREHAWK stent, and this objective performance
criterion study pooled long-term safety and efficacy data from three
TARGET trials for greater statistical power to analyze low-frequency
events. <br/>Method(s): Patient-level pooled data from 1,007 individuals
in the TARGET I randomized controlled trial (n = 227), TARGET I long
lesion cohort (n = 50), and TARGET II registry (n = 730) were
prospectively collected and analyzed. The primary endpoint, target lesion
failure (TLF), was defined as a composite of cardiac death, target vessel
myocardial infarction (TV-MI), and ischemia-driven indicated target lesion
revascularization (ID-TLR) at 5 years. All patients were exclusively
treated with the FIREHAWK stent and had annual follow-up visits for up to
5 years. <br/>Result(s): Among 947 patients (94.0%) who completed the
5-year clinical follow-up, the 5-year TLF event rate was 8.1%; the events
included 18 cardiac deaths, 36 TV-MIs, and 33 ID-TLRs. Only four (0.4%)
very late probable or definite stent thrombosis events were observed
beyond 1 year after stent implantation. In the subgroup analysis, lesion
length >= 30 mm was associated with higher long-term TLF incidence, while
the use of a predilation-sizing-postdilation technique showed no
significant effect on long-term outcomes. <br/>Conclusion(s): Five-year
results demonstrate the continuing safety and efficacy of the FIREHAWK
Stent, with relatively lower incidence of thrombotic events.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<87>
Accession Number
624628505
Title
Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary
Intervention in ST-Segment Elevation Myocardial Infarction:
ATLANTIC-Morphine.
Source
American Journal of Cardiovascular Drugs. 19 (2) (pp 173-183), 2019. Date
of Publication: 08 Apr 2019.
Author
Lapostolle F.; van't Hof A.W.; Hamm C.W.; Stibbe O.; Ecollan P.; Collet
J.-P.; Silvain J.; Lassen J.F.; Bolognese L.; Cantor W.J.; Cequier A.;
Chettibi M.; Goodman S.G.; Hammett C.J.; Huber K.; Janzon M.; Merkely B.;
Storey R.F.; ten Berg J.; Zeymer U.; Licour M.; Tsatsaris A.; Bougherbal
R.; Bouafia M.T.; Nibouche D.; Moklati A.; Benalia A.; Kaid O.; Krim M.;
Hammett C.; Garraby P.; Jayasinghe R.; Rashford S.; Neunteufl T.; Brussee
H.; Alber H.; Weidinger F.; Brunner M.; Sipoetz J.; Prause G.; Baubin M.;
Sebald D.; Cantor W.; Vijayaraghavan R.; Bata I.; Lavoie A.; Ravkilde J.;
Jensen L.O.; Christensen A.M.; Toftegaard M.; Kohler D.; Montalescot G.;
Ducrocq G.; Danchin N.; Henry P.; Livarek B.; Berthier R.; Hovasse T.;
Garot P.; Payot L.; Benamer H.; Esteve J.B.; Elhadad S.; Teiger E.; Bonnet
J.L.; Paganelli F.; Cottin Y.; Schiele F.; Thuaire C.; Cayla G.; Coste P.;
Ohlmann P.; Cudraz E.B.; Lantelme P.; Perret T.; Tron C.; De Labriolle A.;
Aptecar E.; Beliard O.; Varenne O.; Mahmoud R.E.; Filippi-Codaccioni E.;
Angoulvant D.; Peycher P.; Poitrineau O.; Tabone X.; Broche C.; Lambert
Y.; Briole N.; Beruben A.; Porcher N.; Auffray J.-P.; Freysz M.; Depardieu
F.; Poubel D.; De La Cousaye J.-E.; Bartier J.-C.; Jardel B.; Boulanger
B.; Labourel H.; Soulat L.-C.; Julie V.; Thicoipe M.; Capel O.; Carli P.;
Tazarourte K.; Alcouffe F.; Aboucaya D.; Aubert G.; Kierzek G.;
Cahun-Giraud S.; Hamm C.; Dengler T.; Prondzinsky R.; Biever P.M.; Schafer
A.; Seyfarth M.; Lemke B.; Werner G.; Nef H.; Steiger H.; Leschke M.;
Munzel T.; Orto M.C.D.; Loges C.; Schinke M.; Koberne F.; Reiffen H.P.;
Tiroch K.; Wierich D.; Kneussel M.; Little S.; Sauer H.;
Laufenberg-Feldmann R.; Ungi I.; Horvath I.; Edes I.; Martai I.; Berti S.;
Chiarella F.; Calabria P.; Fineschi M.; Galvani M.; Valgimigli M.; Moretti
L.; Tespili M.; Mando M.; Bermano F.; Biagioni R.; Fabbri A.; Ricciardelli
A.; Petroni M.R.; Vatteroni U.R.; Palumbo F.; Willems F.F.; mafragi A.A.;
Heestermans T.A.A.C.M.; Van Eck M.J.; Heutz W.M.J.M.; Meppelder H.H.; Jong
A.R.-D.; Van de Pas H.; Fillat A.C.; Tenas M.S.; Ferrer J.M.; Penaranda
A.S.; Ferrer J.A.; Del Blanco B.G.; Guardiola F.M.; Nodar J.M.R.; Romo
A.I.; Gonzalez N.V.; Nouche R.T.; De La Llera L.D.; Garcia J.M.H.;
Rivero-Crespo F.; Hernandez F.H.; Gomez J.L.Z.; Farega X.J.; Fernandez
G.A.; Toboso J.L.; Carrasco M.; Barreiro V.; Vazquez J.A.I.; del Mar Ruiz
Montero M.; Ortiz F.R.; Escudero G.G.; Ingelmo V.S.-B.; Garcia A.L.;
Oldgren J.; Calais F.; Kastberg R.; Bergsten P.-A.; Blomberg H.; Thorn K.;
Skoog G.; Zaman A.; Gerber R.; Ryding A.; Spence M.; Swanson N.; Been M.;
Grosser K.; Schofield P.; Mackin D.; Fell P.; Foster T.Q.T.; McManus D.;
Carson A.
Institution
(Lapostolle) SAMU 93 - UF Recherche-Enseignement-Qualite, Universite Paris
13, Sorbonne Paris Cite, Inserm U942, Hopital Avicenne, 125, rue de
Stalingrad, Bobigny 93009, France
(van't Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Stibbe) Service Medical d'Urgence, Brigade de Sapeurs-Pompiers de Paris,
Paris, France
(Ecollan, Collet, Silvain, Montalescot) Sorbonne Universite, ACTION Study
Group, Hopital Pitie-Salpetriere (AP-HP), 47 boul de l'Hopital, Paris
75013, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus N, Denmark
(Heutz) Regionale Ambulance Voor ziening Gelderland-Midden, Arnhem,
Netherlands
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Cantor) Southlake Regional Health Centre, University of Toronto,
Newmarket, ON, Canada
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
(Chettibi) Centre Hospito-universitaire Frantz Fanon, Blida, Algeria
(Goodman) Division of Cardiology, Canadian Heart Research Centre, St
Michael's Hospital, University of Toronto, Toronto, Canada
(Hammett) Department of Cardiology, Royal Brisbane and Women's Hospital,
Brisbane, QLD, Australia
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Sigmund Freud University, Medical School,
Vienna, Austria
(Janzon) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(ten Berg) Department of Cardiology, St Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Zeymer) Klinikum Ludwigshafen and Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Licour, Tsatsaris) AstraZeneca, Rueil Malmaison, France
(van't Hof) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
Publisher
Springer International Publishing
Abstract
Background: Morphine adversely impacts the action of oral adenosine
diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial
infarction (STEMI) patients, and is possibly associated with differing
patient characteristics. This retrospective analysis investigated whether
interaction between morphine use and pre-percutaneous coronary
intervention (pre-PCI) ST-segment elevation resolution in STEMI patients
in the ATLANTIC study was associated with differences in patient
characteristics and management. <br/>Method(s): ATLANTIC was an
international, multicenter, randomized study of treatment in the acute
ambulance/hospital setting where STEMI patients received ticagrelor 180 mg
+/- morphine. Patient characteristics, cardiovascular history, risk
factors, management, and outcomes were recorded. <br/>Result(s): Opioids
(97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were
no significant differences in age, sex or cardiovascular history, but more
morphine-treated patients had anterior myocardial infarction and left-main
disease. Time from chest pain to electrocardiogram and ticagrelor loading
was shorter with morphine (both p = 0.01) but not total ischemic time.
Morphine-treated patients more frequently received glycoprotein IIb/IIIa
inhibitors (p = 0.002), thromboaspiration and stent implantation (both p <
0.001). No significant difference between the two groups was found
regarding pre-PCI >= 70% ST-segment elevation resolution, death,
myocardial infarction, stroke, urgent revascularization and definitive
acute stent thrombosis. More morphine-treated patients had an absence of
pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow (85.8% vs.
79.7%; p = 0.001) and more had TIMI major bleeding (1.1% vs. 0.1%; p =
0.02). <br/>Conclusion(s): Morphine-treatment was associated with
increased GP IIb/IIIa inhibitor use, less pre-PCI TIMI 3 flow, and more
bleeding. Judicious morphine use is advised with non-opioid analgesics
preferred for non-severe acute pain. Trial Registration:
clinicaltrials.gov identifier: NCT01347580.<br/>Copyright &#xa9; 2018,
Springer Nature Switzerland AG.

<88>
Accession Number
2001700472
Title
Effect of methylprednisolone on acute kidney injury in patients undergoing
cardiac surgery with a cardiopulmonary bypass pump: A randomized
controlled trial.
Source
CMAJ. 191 (9) (pp E247-E256), 2019. Date of Publication: 04 Mar 2019.
Author
Garg A.X.; Chan M.T.V.; Cuerden M.S.; Devereaux P.J.; Abbasi S.H.;
Hildebrand A.; Lamontagne F.; Lamy A.; Noiseux N.; Parikh C.R.; Perkovic
V.; Quantz M.; Rochon A.; Royse A.; Sessler D.I.; Shah P.J.; Sontrop J.M.;
Tagarakis G.I.; Teoh K.H.; Vincent J.; Walsh M.; Yared J.-P.; Yusuf S.;
Whitlock R.P.
Institution
(Garg, Cuerden, Sontrop) Division of Nephrology, Department of Medicine,
London Health Sciences Centre, London, ON, Canada
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong, Hong Kong
(Devereaux, Walsh) Departments of Health Research Methods, Evidence, and
Impact, Medicine, McMaster University, Hamilton, ON, Canada
(Abbasi) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Hildebrand) Division of Nephrology, Department of Medicine, University of
Alberta, Edmonton, AB, Canada
(Lamontagne) Departement de medecine, Faculte de medecine et des Sciences
de la Sante, Universite de Sherbrooke, Sherbrooke, QC, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, ON, Canada
(Noiseux) Department of Cardiac Surgery, Universite de Montreal, Montreal,
QC, Canada
(Parikh) Division of Nephrology, Johns Hopkins School of Medicine,
Baltimore, MD, United States
(Perkovic) George Institute for Global Health, Sydney, Australia
(Quantz) Division of Cardiac Surgery, London Health Sciences Centre,
University Hospital, London, ON, Canada
(Rochon) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Royse) Department of Surgery, University of Melbourne, Melbourne,
Australia
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Shah) Department of Cardiac Surgery, Princess Alexandra Hospital,
Brisbane, Australia
(Sontrop, Tagarakis) Department of Cardiovascular and Thoracic Surgery,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Teoh) Division of Cardiac Surgery, Southlake Regional Health Centre,
Newmarket, ON, Canada
(Vincent, Whitlock) Population Health Research Institute, Hamilton, ON,
Canada
(Yared) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
(Yusuf) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, ON, Canada
Publisher
Canadian Medical Association (1867 Alta Vista Drive, Ottawa KIG5W8,
Canada)
Abstract
BACKGROUND: Perioperative corticosteroid use may reduce acute kidney
injury. We sought to test whether methylprednisolone reduces the risk of
acute kidney injury after cardiac surgery. <br/>METHOD(S): We conducted a
prespecified substudy of a randomized controlled trial involving patients
undergoing cardiac surgery with cardiopulmonary bypass (2007-2014);
patients were recruited from 79 centres in 18 countries. Eligibility
criteria included a moderate-to-high risk of perioperative death based on
a preoperative score of 6 or greater on the European System for Cardiac
Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned
(1:1) to receive intravenous methylprednisolone (250 mg at anesthetic
induction and 250 mg at initiation of cardiopulmonary bypass) or placebo.
Patients, caregivers, data collectors and outcome adjudicators were
unaware of the assigned intervention. The primary outcome was
postoperative acute kidney injury, defined as an increase in the serum
creatinine concentration (from the preoperative value) of 0.3 mg/dL or
greater (>= 26.5 micro&#32;mol/L) or 50% or greater in the 14-day period
after surgery, or use of dialysis within 30 days after surgery.
<br/>RESULT(S): Acute kidney injury occurred in 1479/3647 patients (40.6%)
in the methylprednisolone group and in 1426/3639 patients (39.2%) in the
placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96
to 1.11). Results were consistent across several definitions of acute
kidney injury and in patients with preoperative chronic kidney disease.
INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk
of acute kidney injury in patients with a moderate-to-high risk of
perioperative death who had cardiac surgery with cardiopulmonary bypass.
Our results do not support the prophylactic use of steroids during
cardiopulmonary bypass surgery.<br/>Copyright &#xa9; 2019 Joule Inc.

<89>
Accession Number
621249026
Title
Induction immunosuppressive therapy in cardiac transplantation: a
systematic review and meta-analysis.
Source
Heart Failure Reviews. 23 (5) (pp 641-649), 2018. Date of Publication: 01
Sep 2018.
Author
Briasoulis A.; Inampudi C.; Pala M.; Asleh R.; Alvarez P.; Bhama J.
Institution
(Briasoulis, Inampudi, Pala, Alvarez, Bhama) Division of Cardiovascular
Diseases, Section of Heart Failure and Transplant, University of Iowa
Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, United States
(Asleh) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Approximately 50% of heart transplant programs currently employ a strategy
of induction therapy (IT) with either interleukin-2 receptor antagonists
(IL2RA) or polyclonal anti-thymocyte antibodies (ATG) during the early
postoperative period. However, the overall utility of such therapy is
uncertain and data comparing induction protocols are limited. The authors
searched PubMed, the Cochrane Central Register of Controlled Trials, and
ClinicalTrials.gov through January 2018 for randomized controlled trials
(RCTs) or observational controlled studies of IT vs no IT and IL2RA vs
ATG. Inverse variance fixed effects models with odds ratio (OR) as the
effect measure were used for primary analyses. Main outcomes include
moderate and severe rejection, all-cause mortality, infection, and cancer.
The authors' search retrieved 2449 studies, of which 11 met criteria for
inclusion (8 RCTs and 3 observational case-control studies). Quality of
evidence for RCTs was moderate to high. Overall, patients receiving IT had
similar risk of moderate-to-severe rejection, all-cause death, infection,
and cancer with patients who did not receive IT. The use of IL2RA was
associated with significantly higher risk of moderate-to-severe rejection
than ATG (OR 3.4; 95% CI 1.4 to 8.1), but similar risk of death,
infections, and cancer. The use of IT was not associated with any benefits
or harms compared with no IT. Moderate-to-severe rejection may be reduced
by ATG compared with IL2RA.<br/>Copyright &#xa9; 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<90>
Accession Number
626882081
Title
Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery.
Source
Innovations (Philadelphia, Pa.). (pp 1556984519836896), 2019. Date of
Publication: 18 Mar 2019.
Author
Kitahara H.; Nisivaco S.; Balkhy H.H.
Institution
(Kitahara, Nisivaco, Balkhy) University of Chicago Medicine, IL, United
States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: With advances in robotic instrumentation and technology, both
robotically assisted minimally invasive direct coronary artery bypass
(RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been
widely used over the past 20 years. Graft patency is the most important
outcome in coronary bypass surgery and is associated with long-term
prognosis. In this article we reviewed all experts' studies in the field
of robotic assisted coronary artery bypass and investigated graft patency
in patients who underwent RMIDCAB or TECAB. <br/>METHOD(S): We performed a
literature search in PubMed from 1999 to 2018 using the terms "Robotic"
and "Coronary bypass" and/or "Minimally invasive" and/or "Totally
endoscopic." Of the articles found, studies investigating graft patency
were specifically selected. <br/>RESULT(S): In 33 articles, a total of
4,000 patients underwent robotic assisted coronary artery bypass surgery
either by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft
patency was assessed by invasive angiography or computed tomographic
angiography in all studies. The mean graft patency at early (<1 month),
midterm (<5 years), and long-term (>5 years) follow-up was 97.7%, 96.1%,
and 93.2% in RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively.
<br/>CONCLUSION(S): The graft patency of robotic assisted coronary artery
bypass was equivalent to reported outcomes of the conventional approach.
These results should encourage the adoption of robotic approaches in
coronary bypass surgery.

<91>
Accession Number
626916286
Title
Western Medical Research Conference 2019.
Source
Journal of Investigative Medicine. Conference: American Federation for
Medical Research Midwestern Regional Meeting, AFMR 2019. United States. 67
(1) (no pagination), 2019. Date of Publication: January 2019.
Author
Anonymous
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 492 papers. The topics discussed include:
dysphagia in children after congenital cardiac surgery: a systematic
review; assessing nutritional intakes in children with nephrotic syndrome;
shoulder and elbow function following the supination-external rotation
protocol in children with birth related brachial plexus injuries: a pilot
study; summary of online parenting resource recommendations for children's
media use; assessment of providers' baseline knowledge to design an
effective curriculum on LGBTQ health for pediatric residents; the Fresno
fit project: bringing healthy eating inside the inner-city classroom;
investigating parental concerns at the first well child visit; educational
impact of restricting resident work hours: a comprehensive literature
review; and mechanical circulatory support patients awaiting heart
transplantation with positive AT1R antibodies have acceptable outcome
postheart transplant.

<92>
Accession Number
626915850
Title
Dysphagia in children after congenital cardiac surgery: A systematic
review.
Source
Journal of Investigative Medicine. Conference: American Federation for
Medical Research Midwestern Regional Meeting, AFMR 2019. United States. 67
(1) (pp 162), 2019. Date of Publication: January 2019.
Author
Wong I.; Wilson J.; Zamora S.; Brigger M.T.
Institution
(Wong) College of Osteopathic Medicine of the Pacific, Western University
of Health Sciences, Pomona, CA, United States
(Wong, Zamora, Brigger) Rady Children's Hospital, San Diego, CA, United
States
(Wilson) Naval Medical Center, San Diego, CA, United States
Publisher
BMJ Publishing Group
Abstract
Purpose of study As the morbidity and mortality of congenital cardiac
surgery has improved, attention to postoperative feeding outcomes has
become increasingly important[SF1]. While centers have embarked on various
strategies to achieve oral feeding postoperatively, there is still wide
variability in common practice. Methods used The literature was searched
using the MEDLINE, EMBASE, and CINAHL databases for publications up to
March 2018. All papers discussing pediatric patients with congenital heart
defects, surgical intervention, and swallowing dysfunction were reviewed
in a systematic fashion. Exclusion criteria were non-English publications,
only >18 year old patients, and no outcome data regarding feeding or
swallowing. Summary of results In total, 19 studies were included[SF1]. Of
these, 6 studies focused on dysphagia specifically, but notably included
heterogenous assessment methods and outcomes. 9 studies discussed vocal
fold dysfunction (VFD). Among those, only 5 assessed swallowing function
discreetly and none found dysphagia in more than half of the patients with
VFD. There were 5 studies evaluating feeding disorders in general, and
only 1 study evaluated long-term results greater than 2 years. Conclusions
The available data on dysphagia after congenital cardiac surgery is
heterogenous and sparse. In particular, there is a lack of common outcomes
that are reported. Additional studies that focus on dysphagia in this
population are needed to better isolate the risk factors and to develop
comprehensive postoperative feeding strategies. A consensus of
standardized, trackable outcomes will provide the basis for evidence
driven feeding programs in this fragile population.

<93>
Accession Number
2001733875
Title
Bypass Surgery or Stenting for Left Main Coronary Artery Disease in
Patients With Diabetes.
Source
Journal of the American College of Cardiology. 73 (13) (pp 1616-1628),
2019. Date of Publication: 9 April 2019.
Author
Milojevic M.; Serruys P.W.; Sabik J.F.; Kandzari D.E.; Schampaert E.; van
Boven A.J.; Horkay F.; Ungi I.; Mansour S.; Banning A.P.; Taggart D.P.;
Sabate M.; Gershlick A.H.; Bochenek A.; Pomar J.; Lembo N.J.; Noiseux N.;
Puskas J.D.; Crowley A.; Kosmidou I.; Mehran R.; Ben-Yehuda O.; Genereux
P.; Pocock S.J.; Simonton C.A.; Stone G.W.; Kappetein A.P.
Institution
(Milojevic, Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) UH Cleveland Medical Center, Cleveland, OH, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Schampaert, Genereux) Hopital du Sacre-Coeur de Montreal, Montreal,
Quebec, Canada
(van Boven) Medical Center Leeuwarden, Leeuwarden, Netherlands
(Horkay) Semmelweis University, Budapest, Hungary
(Ungi) University of Szeged, Szeged, Hungary
(Mansour, Noiseux) Centre Hospitalier de l'Universite de Montreal,
Montreal, Quebec, Canada
(Banning, Taggart) John Radcliffe Hospital, Oxford, United Kingdom
(Sabate, Pomar) Hospital Clinic, Barcelona, Spain
(Gershlick) Glenfield Hospital, Leicester, United Kingdom
(Bochenek) American Heart of Poland, Katowice, Poland
(Lembo, Kosmidou, Ben-Yehuda, Stone) NewYork-Presbyterian
Hospital/Columbia University Medical Center, New York, NY, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY,
United States
(Crowley, Kosmidou, Mehran, Ben-Yehuda, Genereux, Stone) Clinical Trials
Center, Cardiovascular Research Foundation, New York, NY, United States
(Mehran) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
Publisher
Elsevier USA
Abstract
Background: The randomized EXCEL (Evaluation of XIENCE versus Coronary
Artery Bypass Surgery for Effectiveness of Left Main Revascularization)
trial reported a similar rate of the 3-year composite primary endpoint of
death, myocardial infarction (MI), or stroke in patients with left main
coronary artery disease (LMCAD) and site-assessed low or intermediate
SYNTAX scores treated with percutaneous coronary intervention (PCI) and
coronary artery bypass grafting (CABG). Whether these results are
consistent in high-risk patients with diabetes, who have fared relatively
better with CABG in most prior trials, is unknown. <br/>Objective(s): In
this pre-specified subgroup analysis from the EXCEL trial, the authors
sought to examine the effect of diabetes in patients with LMCAD treated
with PCI versus CABG. <br/>Method(s): Patients (N = 1,905) with LMCAD and
site-assessed low or intermediate CAD complexity (SYNTAX scores <=32) were
randomized 1:1 to PCI with everolimus-eluting stents versus CABG,
stratified by the presence of diabetes. The primary endpoint was the rate
of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were
examined in patients with (n = 554) and without (n = 1,350) diabetes.
<br/>Result(s): The 3-year composite primary endpoint was significantly
higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p
< 0.001). The rate of the 3-year primary endpoint was similar after
treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%,
respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p
= 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard
ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause
death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p =
0.046), although no significant interaction was present between diabetes
status and treatment for all-cause death (p = 0.22) or other endpoints,
including the 3-year primary endpoint (p = 0.82) or the major secondary
endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI,
stroke, or ischemia-driven revascularization at 3 years (p = 0.65).
<br/>Conclusion(s): In the EXCEL trial, the relative 30-day and 3-year
outcomes of PCI with everolimus-eluting stents versus CABG were consistent
in diabetic and nondiabetic patients with LMCAD and site-assessed low or
intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery
Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL];
NCT01205776)<br/>Copyright &#xa9; 2019

<94>
Accession Number
615705362
Title
Hypogammaglobulinemia in pediatric heart transplant candidates is not
corrected by transplantation.
Source
American Journal of Transplantation. Conference: 17th American Transplant
Congress, ATC 2017. United States. 17 (Supplement 3) (pp 649), 2017. Date
of Publication: April 2017.
Author
Madan R.; Penkert R.; Dara J.; Lamour J.; Herold B.; Hurwitz J.
Institution
(Madan, Dara, Lamour, Herold) Pediatrics, Albert Einstein College of
Medicine, Children's Hospital at Montefiore, Bronx, NY, United States
(Penkert, Hurwitz) Infectious Diseases, St Jude Children's Research
Hospital, Memphis, TN, United States
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Hypogammaglobulinemia (HG) is associated with poor outcomes
in adult heart transplant recipients but is not well studied in pediatric
recipients. We therefore investigated longitudinal immunoglobulin (Ig)
levels in 15 pediatric heart transplant cases. <br/>Method(s): Sera were
collected from 15 recipients at a median of 3.2 mo (visit 1), 8.5 mo
(visit 2), and 22.3 mo (visit 3) post transplant and from 9/15 candidates
pre transplant. IgG subclasses 1-4, IgM, and IgA were quantified by
bead-based multiplex immunoassay. Total IgG was calculated by summation of
subclasses, using scoreable values or the assay's lower limit of
detection. HG was defined as Ig level below the lower limit of the 95% CI
for age. <br/>Result(s): Median age at transplant was 12.9 yrs
(1.4-21yrs); 5/15 required ECMO or LVAD pre transplant. Induction
consisted of ATG and solumedrol, followed by maintenance tacrolimus and
MMF. No participant received anti-CD20 mAb or IVIG. All 9 transplant
candidates had HG pre transplant (mean IgG 306 +/-144 mg/dL), which was
attributed primarily to low IgG1 (8, 1, 4, and 6 candidates had IgG1,
IgG2, IgG3, and IgG4 <95%CI for age, respectively). HG persisted post
transplant, with mean IgG levels of 332 +/- 142 at visit 1, 324 +/- 133 at
visit 2, and 390 +/- 162 at visit 3. Low IgG again reflected primarily low
IgG1; 11, 3, 3, and 8 participants had IgG1, IgG2, IgG3 and IgG4 <95% CI
for age, respectively. In addition, at least 50% of participants had low
IgM and/or IgA at visits 1-3. Only 1 child with pre transplant HG had
normal levels of all isotypes by visit 3. 2 candidates had bacteremia, and
1 had fungemia pre transplant. 6 children had opportunistic infection post
transplant (4 CMV, 1 EBV, 1 adenovirus). <br/>Conclusion(s): Studies in
adult solid organ transplant recipients suggest that HG is
medication-induced. However we found that HG began prior to transplant and
persisted until at least 2 years post transplant. HG reflected low levels
of IgG1, which may result in recurrent infections and impaired vaccine
responses. The mechanisms contributing to both pre transplant HG and
persistent HG beyond the early post transplant period require further
investigation. If confirmed in larger studies, these data may provide a
rationale for randomized trials of IVIG replacement in pediatric SOT
recipients.

<95>
Accession Number
615705231
Title
Routine surveillance of heart transplant recipients with gene expression
profiling: Lack of an impact of race on outcomes.
Source
American Journal of Transplantation. Conference: 17th American Transplant
Congress, ATC 2017. United States. 17 (Supplement 3) (pp 647-648), 2017.
Date of Publication: April 2017.
Author
Teuteberg J.; Shullo M.; Rinde-Hoffman D.; Wigger M.; Wang Y.; Wolf T.;
Arnold P.; Sninsky J.; Berman P.
Institution
(Teuteberg, Shullo) University of Pittsburgh Medical Center, Pittsburgh,
PA, United States
(Rinde-Hoffman, Berman) Tampa General Hospital, Tampa, FL, United States
(Wigger) Vanderbilt Heart and Vascular Institution, Nashville, TN, United
States
(Wang, Wolf, Arnold, Sninsky) CareDx, Brisbane, CA, United States
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Patients of African descent have been reported to have less
favorable outcomes after heart transplantation than patients of European
descent. However, the impact of race on outcomes in patients who are
followed clinically with gene expression profiling (GEP) has not been well
described. <br/>Method(s): Heart transplant patients from the 31
transplant centers in Outcomes AlloMap Registry (OAR) were studied. We
compared the time of first visit using gene expression profiling (GEP) as
the primary surveillance method, panel reactive antibodies (PRA) and
pre-transplantation mechanical circulatory support (MCS), and allograft
rejections in patients of African descent and of European descent. GEP
scores (AlloMap) were analyzed upon first and subsequent
post-transplantation visits. <br/>Result(s): Of the 1049 patients, 760 are
of European descent (ED) and 195 are of African descent (AD). At baseline
there was no significant difference in PRA 6% v 7%, p=0.42 or use of MCS
53% v 57%, p=0.32 for ED and AD, respectively. There was also no
difference between ED and AD in the mean time post-transplant the patients
were enrolled (12.9 v 10.5 months, p=0.16). GEP scores are comparable
across groups. GEP scores show equivalence between European descent and
African American patients in both first visits (mean 26.8 for Caucasian,
27.4 for African American; p-value 0.31 between the two groups) and across
all post-transplantation visits to date (p-value 0.13). 715 patients had
1983 visits of where biopsy results are available, there were fewer Grade
>=2R rejection events in AD compared to ED 2.26% and 6.13%, respectively,
but it did not reach statistical significance, p-value 0.12.
<br/>Conclusion(s): Patients of African descent had similar application of
GEP surveillance and were not different from patients of European descent
in the risk factors for rejection and outcomes. Further, the GEP scores
for African descent patients were comparable to those for European
patients. For those who are candidates for surveillance with GEP, race of
the patient does not appear to have an impact on outcomes.

<96>
Accession Number
616680467
Title
Are cardiac valve patients 'dentally fit' and can oral and maxillofacial
surgery provide a means of optimising patient outcome?.
Source
International Journal of Oral and Maxillofacial Surgery. Conference: 23rd
International Conference on Oral and Maxillofacial Surgery, ICOMS 2017.
Hong Kong. 46 (Supplement 1) (pp 109), 2017. Date of Publication: March
2017.
Author
Isaac R.E.; Hayes J.; Ashraf S.
Institution
(Isaac, Hayes, Ashraf) Morriston Hospital, Swansea, United Kingdom
Publisher
Churchill Livingstone
Abstract
Background: The 2008 NICE guidelines revised the need for routine
prescription of prophylactic antibiotics for 'high-risk' cardiac patients
about to undergo invasive dental procedures. Nevertheless, all
preoperative patients for cardiac surgery are advised to see their dentist
and achieve an optimal level of dental health in order to reduce the
possibility of dental pathogens later causing infective endocarditis.
Despite British and European guidelines advocating such measures, there is
no direct guidance to cardiologists/cardiac surgeons nor to the dentists
to what standard of dental health such patients must obtain.
<br/>Objective(s): 1. Identify the state of oral pathology within
preoperative cardiac patients. 2. Produce structured, coherent guidelines
between cardiac surgeons, community dentist and oral and maxillofacial
surgery units. <br/>Method(s): A prospective assessment of dental health
in all preoperative cardiac surgery patients over a two-month period was
performed. Following this a comprehensive literature review was conducted.
<br/>Finding(s): The results of the data obtained will be disclosed at
presentation. <br/>Conclusion(s): Whilst the paucity of evidence of
antibiotics for dentoalveolar surgery is widely understood, there is
little evidence in the mainstay for optimising dental health precardiac
surgery. We identify the 'state of play' of dental health prior to such
surgery and advocate guidelines for community dentists and cardiac
surgeons to adopt.

<97>
Accession Number
615705109
Title
Sequential surgical strategy for heart-kidney transplantation.
Source
American Journal of Transplantation. Conference: 17th American Transplant
Congress, ATC 2017. United States. 17 (Supplement 3) (pp 646), 2017. Date
of Publication: April 2017.
Author
Mital D.; Petruccione M.; Brown J.; Vasquez S.; Wheaton S.; Johnson W.;
Desai C.; Chhabra D.; Kinzler G.; Sankary H.; Lawrecki T.; Pappas P.;
Tatooles A.; Bresticker M.; Cotts W.; Bhat G.
Institution
(Mital, Petruccione, Brown, Vasquez, Wheaton, Johnson, Desai, Chhabra,
Kinzler, Sankary, Lawrecki) Kidney Transplant Program, General Surgery,
Advocate Christ Medical Center, Oak Lawn, IL, United States
(Lawrecki, Pappas, Tatooles, Bresticker, Cotts, Bhat) Heart Failure and
Transplant Program, Advocate Christ Medical Center, Oak Lawn, IL, United
States
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: To describe a unique sequential surgical strategy for
heart-kidney transplantation. <br/>Method(s): We reviewed all 6 patients
who received combined heart-kidney transplants at our institution between
2013-2016. We waited 16-39 hours after the cardiac transplant before
transplanting the kidney. The donor kidney was preserved with pulsatile
perfusion. This allowed us to stabilize the hemodynamics, and control any
coagulopathy and bleeding from the thorax. Demographics: The 6 recipients
were males, ages 54-67 years (62.7 +/- 5.7). Their HLA mismatches were
5-6. Heart failure was ischemic in 3 patients. 5 patients had one or more
LVAD's pre-transplant. 2 patients were on dialysis. The kidney failure was
associated with diabetes in 3 patients, hypertension in 6 patients, and
hepatitis C in 1. The donors were all males, ages 26-32 years (29 +/-
2.5). All donors but 1 died of a CVA. Their initial serum creatinine was
1.00-1.23 mg/dl, and terminal serum creatinine was 0.6-1.68 mg/dl. Only 1
donor had hypertension. The cold ischemic time was 16-39 hours (26.3 +/-
8.7) for the kidney transplant. <br/>Result(s): We had excellent outcomes
with immediate renal allograft function, with 100% patient and allograft
survival. This is in contrast to previous reports with higher mortality in
simultaneous heart-kidney transplant patients. The immunosuppression
included Thymoglobulin induction and Tacrolimus, MMF, Prednisone
maintenance. 5 of the 6 patients had no acute cellular rejection at
anytime. 1 patient had 5 episodes of 1 R rejection, 2 of which were
treated with IV Methylprednisolone followed by an oral Prednisone taper.
There was no hemodynamic compromise or antibody mediated rejection.
<br/>Conclusion(s): Our unique strategy allows us to transplant the donor
kidney once the patient is stable. This avoids exposing the kidney to
nephrotoxic byproducts of cardiopulmonary bypass like plasma-free
hemoglobin, as well as acute tubular necrosis from hypotension and
pressors in the immediate post-cardiac transplant period. We feel this
technique will result in better patient and renal allograft survival in
the long-term. Randomized clinical trials are warranted to further examine
this surgical strategy.

<98>
Accession Number
614780551
Title
Critical review of the current management of pleural infection in a UK
district general hospital. Applying the MIST II (multicentre intrapleural
sepsis trial) evidence to our current practice.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Peirce B.; Pulimood T.; Harris C.
Publisher
European Respiratory Society
Abstract
Introduction: Since the publication of MIST II , there has been a
transition in the management of empyema, with an increase in medical
treatment. Currently there is a wide variation in our treatment approach
to these patients. <br/>Aim(s): To critically appraise our current
practice with regard to management of pleural infection in light of MIST
II. To provide evidence to standardise our future practice.
<br/>Method(s): We retrospectively identified all patients with empyema
from discharge coding in the year following June 2014. Data was collected
from hospital records. Collaborative working with Papworth Hospital
(tertiary referral centre for thoracic surgery) determined outcomes in
those referred for surgery. Primary outcome was length of inpatient stay.
<br/>Result(s): 21 patients were identified. 3 patients excluded as no
evidence of empyema. We were unable to replicate the reduced length of
stay shown in MIST II for those patients treated with fibrinolysis. The
median length of inpatient stay for those treated with drainage - 14 days,
fibrinolysis - 21 days, surgical management - 8 days. <br/>Conclusion(s):
Our patients differed from those in MIST II with increased age and
comorbidity. Current practice was to start fibrinolysis as a rescue; after
failed drainage. MIST II would suggest benefit in length of stay if
fibrinolysis is initiated at diagnosis. This study has shaped our
management of empyema; specifically initiation of fibrinolysis at
diagnosis for those managed medically.

<99>
Accession Number
614780406
Title
Updating the EORTC questionnaire for assessing quality of life in lung
cancer patients (EORTC QLQLC13).
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Schulz C.K.J.; Himpel A.; Hofmann H.-S.; Koller M.
Publisher
European Respiratory Society
Abstract
Abstract Background: The EORTC QLQ-LC13 was the first module developed to
be used in conjunction with the core questionnaire C30. Major advances
have been made with regard to diagnostic and therapeutic options in lung
cancer. Therefore, research objective was to develop a revised lung cancer
module supported by the EORTC. <br/>Method(s): EORTC employs a four phase
methodology of modules development and Phases I to III have been
completed. Phase I generates quality of life issues using a mix of
sources. Phase II converts issues into questionnaire items. The Phase III
study pre-tests a provisional module to evaluate the importance and
acceptability of the items. Biometrical methods primarily included
descriptive statistics and basic psychometric analyses. The 48 lung cancer
items that emerged from Phases I to III were assessed against a set of
pre-specified criteria comprised of patient ratings and distribution
properties of the items. <br/>Result(s): 12 international centers
participated in the Phase III study. 200 patients were enrolled. Mean age
64 years. 59% were male, 82% had NSCLC, 56% were treated with a palliative
approach. Patients had to fill in the EORTC QLQ-C30 and a 48-item
provisional lung cancer module and rated the lung cancer items. 29 lung
cancer items met the pre-specified cut-off levels. Psychometric analyses
suggested a five multiitem scale structure. <br/>Conclusion(s): The
updated module retained 12 of the 13 original LC13 items. Further items
were identified assessing side effects of targeted therapy,
radiochemotherapy, and thoracic surgery. Phase IV will be a field study
analyzing the proposed scale structure and assessing the psychometric
properties of the module.

<100>
Accession Number
614780312
Title
Effectiveness of an early mobilization program on functional capacity
after coronary artery bypass surgery: Randomized controlled trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Da Costa Torres D.; Da Silva P.R.; Lima Reis H.J.; Paisani D.M.;
Chiavegato L.
Publisher
European Respiratory Society
Abstract
Muscle atrophy and prolonged inactivity are associated with reduced
functional capacity in patients submitted to coronary artery bypass
surgery. Cardiac rehabilitation contributes to improvement in functional
capacity and quality of life; however, the effect of early mobilization in
these patients is poorly known. <br/>Objective(s): To evaluate the effects
of an early mobilization program in the functional capacity, postoperative
complications and length of hospital stay in patients undergoing coronary
artery bypass grafting. <br/>Method(s): This prospective, randomized,
controlled and blinded trial included 66 consecutive patients randomized
into Control (CG; N=33) and Intervention groups (IG; N=33). CG was
submitted to general orientations while IG performed early mobilization.
The intervention was performed from the 1 to 7 postoperative day, 2xday.
The functional capacity (6MWT) was evaluated before surgery and
reevaluated in the 7 day and the 60 day after discharge. The length of
hospital stay and pulmonary complications was also evaluated. The
statistical analysis used linear mixed models and the level of
significance was set at alpha= 5%. <br/>Result(s): compared with CG, IG
patients presented an improvement in the functional capacity after 7 days
(respectively, 355.42+/-42.44 vs. 434.69 +/- 48.38 meters; p<0.05) but no
difference was observed at follow-up. Patients from the IG presented a
reduction in hospital staying than CG (4.3 +/- 1.1 vs 7.2 +/- 1.6 days;
p<0.05) and less pulmonary complications (24% vs. 48%; p=0.01).
<br/>Conclusion(s): Our results shows that early mobilization improves
functional capacity and reduces pulmonary complications and hospital
staying.

<101>
Accession Number
614780171
Title
The effect of iloprost on arterial oxygenation during one-lung
ventilation.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Hw ang W.; Jeon J.
Publisher
European Respiratory Society
Abstract
Background During one-lung ventilation in patients undergoing thoracic
surgery, the persistent flow in the non-ventilated lung increases
intrapulmonary shunt and decreases systemic arterial oxygenation. Aims and
objectives This study was conducted to evaluate the effects of iloprost on
arterial oxygenation during one-lung ventilation in the lateral decubitus
position during thoracic surgery. Methods 72 patients undergoing
thoracoscopic lobectomy were randomly allocated to three groups: DW
(distilled water), IL2.5 (iloprost 2.5mcg), and IL5 (iloprost 5mcg). Study
drug was inhaled to ventilated lung for 5 minutes after one-lung
ventilation in the lateral decubitus position. Hemodynamic variables,
shunt fraction, and arterial oxygenation were obtained at these points:
after induction of anesthesia with two-lung ventilation (TLV-i), before
treatment with one-lung ventilation in lateral decubitus posisiton (OLV),
10, 20 and 30 min after treatment (OLV+T10, OLV+T20 and OLV+T30), and at
the end of surgery with two-lung ventilation in the supine position
(TLV-e). Results Hemodynamic variables were comparable between three
groups. Shunt fraction was significantly lower in IL5 compared with that
in DW and IL2.5 during one-lung ventilation. PaO2 was significantly higher
in IL5 compared with that in DW and IL2.5 at 10 (198+/-78 vs. 146+/-68,
148+/-70 mmHg, P<0.05), 20 (215+/-92 vs. 154+/-70, 156+/-68 mmHg, P<0.05),
and 30min (214+/-90 vs. 152+/-64, 154+/-70 Conclusions Inhaled iloprost at
5 mcg improves arterial oxygenation during one-lung ventilation in the
lateral decubitus position during thoracic surgery.

<102>
Accession Number
614780067
Title
Preliminary efficacy of preoperative exercise training in patients with
lung malignancies undergoing VATS.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Garcia R.S.; Paz A.L.; Brage M.I.Y.; Moolhuyzen E.G.; Rioboo M.S.; Mate
J.M.B.
Publisher
European Respiratory Society
Abstract
Introduction: Preoperative exercise training can improve the baseline
status of patients undergoing open thoracic surgery and therefore improve
surgical tolerability and enhance postoperative recovery. The aim of this
study was to assess the feasibility and preliminary efficacy of a
preoperative exercise-based programme (PEP) in patients undergoing
Video-assisted thoracic surgery (VATS) for lung cancer. <br/>Material(s)
and Method(s): In a randomized, single blinded controlled trial, 20
patients were allocated to receive a PEP consisted of 3 - 5 sessions per
week of interval endurance training, strength training with elastic bands
and breathing exercises. Exercise capacity (endurance time), muscle
strength (Senior Fitness Test) and health-related quality of life (SF-36)
were assessed at the beginning and at the end of the training.
<br/>Result(s): 10 patients completed the intervention attending a median
of 16 sessions. Mean therapeutic delay was 54 days and no adverse events
were recorded. There were statistically significant improvements in
endurance time measured at 80% of the maximal workload (mean difference
+396.6+/-197.9 seconds, p<.001), upper and lower body strength (mean
difference +2.9+/-2.1 repetitions, p=.002 and +0.9+/-1.2 repetitions,
p=.041) and in the role physical and physical summary component of the
SF-36 (p=.038 and .008 respectively). <br/>Conclusion(s): preoperative
exercise training in patients with lung malignancies awaiting THANK YOU
FOR ACCEPTING COOKIES VATS is safe and can be achieved without any delay
in the surgical management and results effective to improve exercise
capacity, muscle strength and physical functioning, which could
potentially enhance postoperative recovery.

<103>
Accession Number
614779979
Title
Does preoperative exercise training prevent functional decline after
video-assisted thoracic surgery?.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Garcia R.S.; Paz A.L.; Brage M.I.Y.; Moolhuyzen E.G.; Rioboo M.S.; Mate
J.M.B.
Publisher
European Respiratory Society
Abstract
Introduction: Prehabilitation of surgical patients is gaining popularity
specially among those who exhibit poor baseline status. In this study, we
aimed to evaluate whether prehabilitation of patients undergoing lung
resection surgery by Video-assisted thoracic surgery (VATS) prevents the
functional decline observed after surgery and enhances postoperative
recovery. <br/>Material(s) and Method(s): 40 patients scheduled for lung
resection surgery were initially randomized in two groups. Patients in the
Rehabilitation Group (RG) received a preoperative exercise-based
intervention consisted of 3 - 5 sessions per week of interval endurance
training, resistance training with elastic bands and breathing exercises.
Patients in the Control Group (CG) received standard care (no
prehabilitation). Exercise capacity (endurance time), functional capacity
(6-minute walk test), muscle strength (Senior Fitness Test) and
health-related quality of life (SF-36) were measured at baseline (T0) and
three weeks (T1) and three months (T2) post-surgery. <br/>Result(s): 22
patients completed the study and were analysed. There were no
statistically significant differences between groups at T1 in any of the
main outcomes. However, at T2, patients in the RG had improved their
endurance time and lower muscle strength comparing to baseline which led
to statistically significant differences with the CG in the endurance time
and both upper and lower muscle strength (p<.05). There were also
significant differences in the physical component summary and bodily pain
of the SF-36 (p<.01). <br/>Conclusion(s): Preoperative exercise training
seems to prevent the functional decline observed after VATS and hastens
postoperative recovery.

<104>
Accession Number
614778489
Title
Safety, feasibility and efficacy of 2% polidocanol in endobronchial
sealing of bronchopleural fistulae-phase 2 interventional clinical trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Zaric B.; Stojanovic G.; Budisin E.; Potic M.; Kovacevic T.; Perin B.
Publisher
European Respiratory Society
Abstract
Introduction: Broncho-pleural fistula (BPF) is rare but serious
complication following thoracic surgery. Primary goal of this trial was
determination of safety and feasibility of endobronchial sealing of the
BPF with 2% polidocanol. Secondary objective was determination of the
procedural efficacy. <br/>Method(s): This was a phase II interventional
trial that recruited 15 patients with BPF. Endobronchial sealing was
performed by submucosal application of 1-2 mL of 2% polidocanol through
TBNA needle. Number of punctures and procedures were determined on case by
case basis. Selected patient, procedure and technique related factors were
evaluated for multivariate analysis regarding efficacy. <br/>Result(s):
Incidence of BPF in investigated study population was 1.12%. Endobronchial
sealing was successful in 80% (12/15) patients. Mean age of the patients
was 54+/-16 years, mean size of fistulae 7+/-5.5 mm, duration of
intervention 20+/-3 minutes, number of punctures 9+/-6, number of
interventions 1.5, time from surgery 42+/-34 days, time to closure 10+/-9
days. In majority of patients age under 50 years, male gender, non-smoking
status, absence of respiratory comorbidity and lobectomy led to
bronchoscopic sealing. Neoadjuvant therapy, shorter time from surgery and
positive margins led to failure of bronchoscopic sealing. Size of fistula
(p=0.018) and time to closure (p=0.004) were significantly correlated to
success of bronchoscopic sealing. We did not observe any procedure-related
adverse effects. <br/>Conclusion(s): Endobronchial sealing with 2%
polidocanol is safe, feasible and possibly very efficient technique for
treatment of BPF.

<105>
Accession Number
614777137
Title
Strategies to reverse lung function deterioration to cardiopulmonary
bypass: Comparison of ventilation management and/or bronchodilator
therapies.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. 48 (Supplement 60) (no pagination),
2016. Date of Publication: 01 Sep 2016.
Author
Petak F.; Balogh A.L.; Fodor G.H.; Vigh E.; Sudy R.; Babik B.
Publisher
European Respiratory Society
Abstract
The lung function deterioration to cardiopulmonary bypass (CPB) can be
alleviated by recruitment manoeuvres (RM), elevating the positive
end-expiratory pressure (PEEP), and/or bronchodilator therapies. We aimed
at comparing the efficiency of these treatment strategies. Airway
resistance (Raw), respiratory compliance (C), capnogram phase III slope
(SIII), and Horowitz coefficient (HQ) were measured in anaesthetized,
mechanically ventilated patients undergoing cardiac surgeries. Five
different therapeutic interventions were compared to the standard post-CPB
lung management with 4 cmH<inf>2</inf>O PEEP: i) application of elevated
PEEP (8 cmH<inf>2</inf>O), ii) administration of 1 MAC sevoflurane (SEV)
during either PEEP4 or iii) PEEP8, iv) a RM followed by PEEP8, and v)
concomitant use of a RM, PEEP8, and SEV. The Raw decreased significantly
in all groups, with the greatest drop after the combined application of
RM, PEEP and SEV (-60+/-21[SD]%, p<0.001). C decreased similarly in all
groups (43+/-33%, p<0.001) with the exception of SEV alone. SIII decreased
in all patients; elevated PEEP and SEV induced the greatest changes
(-32+/-16%, p<0.001). Significant increases in HQ were only observed in
the patients receiving RM (iv: 32+/-27%, v: 47+/-28%, p<0.001). We
conclude that elevated PEEP combined with RM recruit alveoli, thereby
decreasing ventilation heterogeneities, increasing C and improving gas
exchange. SEV contributes to the homogenization of the lungs via its
bronchodilation potential. The adverse respiratory effects of CPB are
complex; combination of lung recruitment and bronchodilator therapies is
the most efficient as a reversal.

<106>
Accession Number
614983545
Title
Prosthetic valve endocarditis after transcatheter CoreValve Evolut R
bioprosthesis implantantion.
Source
Kardiologia Polska. Conference: 20th International Congress of the Polish
Cardiac Society. Poland. 74 (Supplement 4) (pp 487-488), 2016. Date of
Publication: September 2016.
Author
Zbronski K.; Huczek Z.; Scislo P.; Wilimski R.; Rymuza B.M.; Kochman J.;
Filipiak K.J.; Opolski G.
Institution
(Zbronski, Huczek, Scislo, Rymuza, Kochman, Filipiak, Opolski) Warszawa I
Katedra I Klinika Kardiologii, Warszawskiego Uniwersytetu Medycznego,
Banacha 1a Warszawa, Poland
(Wilimski) Warszawa Klinika Kardiochirurgii I Katedry I Kliniki
Kardiologii, Warszawskiego Uniwersytetu Medycznego, Banacha 1a Warszawa,
Poland
Publisher
Via Medica
Abstract
Prosthetic valve endocarditis (PVE) accounts for up to 30% of overall
infective endocarditis (IE) incidence and affects 1-6% of prosthetic valve
recipients. PVE after transcatheter aortic valve implantation (TAVI) has
an incidence of 0.1%-3.4% and has been fairly well described. Up to date,
however, there are no reported cases of PVE on new type of resheathable,
self-expanding valves - CoreValve Evolut R. We report a case of
79-year-old male affected by PVE 7 months after TAVI with CoreValve Evolut
R. We use this opportunity to deliberate on three PVE-related issues -
difficulties in diagnosis, risk factors and potential lower susceptibility
of the new valves to IE. Atypical presentation, possibility of negative
blood cultures and difficult echocardiographic examination in patients
after TAVI may cause significant delay in PVE confirmation. Recent
guidelines suggest using new imaging modalities, repeated blood cultures,
caution and persistence in patients with strong clinical PVE suspicion.
Several risk factors of post-TAVI IE have been described in recent studies
including orotracheal intubation, use of self-expandable valve, low
implantation, implantation of >1 valve and paravalvular regurgitation.
Given certain changes in design, Evolut R bioprosthesis might be less
prone to IE than previous generations of self-expandable valves.
Prosthetic valve endocarditis, however, may still occur, as demonstraed in
our case. In order to accurately assess PVE prevalence after Evolut R
valves implantation, randomized trials are required. (Figure Presented).

<107>
Accession Number
614123165
Title
Low dose glyceryl trinitrate during cardiopulmonary bypass rewarming
reduces early postoperative serum lactate: A prospective observational
study.
Source
Anaesthesia. Conference: Winter Scientific Meeting of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI WSM 2017. United
Kingdom. 72 (Supplement 2) (pp 74), 2017. Date of Publication: January
2017.
Author
Wall T.; Heaney A.; O'Flynn J.; Flood G.
Institution
(Wall, Heaney, O'Flynn, Flood) Mater Hospital, Belfast, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Hypothermia-induced peripheral vasoconstriction can impair rewarming of
the peripheral compartment during cardiopulmonary bypass (CPB). This may
contribute to postoperative hypothermia and hyperlactataemia in the ICU as
the periphery slowly vasodilates and core and peripheral temperatures
equalise. Glyceryl trinitrate (GTN) infusion during the re warming phase
of CPB is commonly used as a means of improving rewarming of the
peripheral compartment. However, evidence of the effect of low dose GTN
(50 mug.min^-1 or less) on temperature and lactate in this
context is lacking. The aim of this observational study was to assess the
influence of low dose GTN infusion during rewarming on early postoperative
serum lactate and patient temperature. Methods In total, 64 consecutive
patients undergoing cardiac surgery over an 8-week period were included in
the study. Those who received 10 mug.min^-1 or more of GTN
during rewarming were analysed in the GTN group (n = 27), while those in
the Control group (n = 37) received 0-1 mug.min^-1. Serum
lactate and patient temperature values were collected for both the
intra-operative period and the first 10 h in ICU postoperatively. Results
The average GTN infusion rate received by the patients in the GTN group
was 25 mug.min^-1 (range 10-50 mug.min^-1). The main
results of the study are shown in Table 1. Discussion A recently published
study of high dose GTN (> 100 mug.min^-1) during rewarming
demonstrated a reduction in serum lactate during CPB [1]. Our study shows
that postoperative peak serum lactate may be reduced with much smaller
doses of GTN, an effect that is most significant in the first 5 h in ICU.
Whether this has a clinically meaningful effect on outcomes (e.g. time to
extubation) remains unclear. Despite the improvement in lactate, no
statistically significant differences were detected in temperature on
arrival to ICU or lowest bladder temperatures in the first 5 h and 10 h in
ICU. A randomised controlled trial is planned to further elucidate the
effect of low dose GTN on postoperative biochemistry and clinical
outcomes. (Table Presented).

<108>
Accession Number
611620759
Title
18f-fluorodeoxyglucose PET/CT is a sensitive and specific test for
diagnosis of prosthetic valve and cardiac implantable electrical device
infective endocarditis.
Source
Journal of Nuclear Cardiology. Conference: 21st Annual Scientific Session
of the American Society of Nuclear Cardiolog. United States. 23 (4) (pp
904), 2016. Date of Publication: August 2016.
Author
Weinberg R.L.; Yun H.; Shah R.V.; Corbett J.R.; Hulten E.; Murthy V.L.
Institution
(Weinberg, Yun, Corbett, Murthy) University of Michigan, Ann Arbor, MI,
United States
(Shah) Massachusetts General Hospital, Boston, MA, United States
(Hulten) Walter Reed National Military Medical Center, Bethesda, MD,
United States
Publisher
Springer New York LLC
Abstract
Background: Infective endocarditis affecting cardiac implantable
electronic devices (CIED) and prosthetic valves (PV) is increasingly
common and is associated with substantial morbidity and mortality.
Application of the modified Duke criteria for the diagnosis of CIED or PV
endocarditis is challenging due to the relative insensitivity of
echocardiography, particularly during the early stages.
18F-fluorodeoxyglucose (FDG) PET/CT is emerging as method with improved
accuracy for PV and CIED infective endocarditis, although most studies to
date have been modest in size. <br/>Method(s): We systematically searched
PubMed for studies reporting the accuracy of 18F-FDG PET/CT to diagnose
CIED or PV endocarditis. Effect sizes, patient, and study characteristics
were abstracted. We performed meta-analysis of the overall sensitivity
(Se) and specificity (Sp) using bivariate mixed-effects binary regression
with fixed (device studies) and random (prosthetic valve studies) effects
models. <br/>Result(s): 493 patients from 15 studies were included. On a
per patient level, the overall Se was 84% (95% CI 78-89%), Sp 89% (95% CI
90- 95%), and AUC 0.93 (95% CI 0.90-0.95). There was substantial
variability in the imaging protocol and preparation of patients for their
18FFDG PET/CT scan, and only 5 of 15 studies addressed nonspecific
myocardial uptake of 18F-FDG. 9 studies (n = 321) evaluated CIED with Se
88% (95% CI 82-92%), Sp 91% (95% CI 82-96%), and AUC 0.94 (95% CI
0.92-0.96). 6 studies (n = 170) of PV infection demonstrated Se 77% (95%
CI 65-86%), Sp 83% (95% CI 64-93%, AUC 0.87 (95% CI 0.84-0.90).
<br/>Conclusion(s): 18F-FDG PET/CT is a highly accurate method for the
diagnosis of prosthetic valve and cardiac implantable electronic device
infective endocarditis. Further studies are required to elucidate optimal
protocols and to establish whether clinical outcomes are improved by early
application of 18F-FDG PET/CT. (Figure Presented).

<109>
Accession Number
611615636
Title
Neurological complications in icu after on-pump cardiac surgery: A Chinese
study.
Source
Journal of Cerebral Blood Flow and Metabolism. Conference: 27th
International Symposium on Cerebral Blood Flow, Metabolism and Function
and 12th International Conference on Quantification of Brain Function with
PET. Canada. 36 (Supplement 1) (pp 806-807), 2016. Date of Publication:
June 2016.
Author
Sosorburam T.; Yao L.; Xiao P.
Institution
(Sosorburam, Yao) Anesthesiology, Tongji Medical College, Wuhan, China
(Xiao) ICU, Tongji Medical College, Wuhan, China
Publisher
Nature Publishing Group
Abstract
Objectives: Despite having advanced medical care and surgical techniques,
neurological complications remain significant causes of postoperative
mortality and morbidity in patients underwent cardiac surgery. Whether
anesthetic drugs influence the outcome or not is still unclear. Therefore,
we conduct the research to determine effects of different anesthetic
drugs. <br/>Method(s): The study was conducted at Union Hospital, China
from May 2013 to December 2014. Total 120 patients, who are undergoing
on-pump cardiac surgeries without any history of cerebrovascular diseases
are recruited. The subjects randomly selected into two most commonly used
anesthetic agents groups: volatile anesthetic/VA/ or total intravenous
anesthetic/TIVA/ groups. Evaluation of major neurological and
physiological dysfunctions were recorded until the patient discharged from
the hospital. Comparisons between the groups were analyzed using the
t-Student test, and P values of less than 0.05 were considered
statistically significant. <br/>Result(s): There was no significant
difference found between the demographics data, intraoperative monitoring
and cerebral protective measures between the groups. The incidence of
postoperative stroke and postoperative delirium were 2.5% and 5.8% in TIVA
group and 3.7% and 6.4% in VA group. Early mortality was higher in VA
(4.3% vs 3.5%). Multivariate analysis revealed that postoperative
cognitive disorder was associated with longer duration of cardiopulmonary
bypass (mean time 132+/-2.4min in VA vs 118+/-4.8min in TIVA). Another
significant difference was transient ischemic attack, which was 7.1% in VA
and 6.5% in TIVA. The hospital length of stay and ICU stay were longer in
VA group (14.1 and 5.2 days vs 12.3 and 6.2 days). <br/>Conclusion(s):
TIVA associated with lower postoperative mortality and morbidity than VA.
The advantage of TIVA over VA is evident regarding interference with
neurological and cognitive disorders. However, all the potential
neuroprotective effect of TIVA cannot be measured by single anesthetic
drug or technique, TIVA appears to be the first choice for on-pump cardiac
surgery. We suggest further systemic and multi-centered study should be
conducted to implement guidelines regarding the neuroprotective
anesthesia.

<110>
Accession Number
612841249
Title
A prospective observation multicentre feasibility study investigating
ankle brachial pressure index for stratifying risk of colorectal
anastomotic leak: Results from ASLAN.
Source
Colorectal Disease. Conference: Association of Coloproctology of Great
Britain and Ireland Annual Meeting 2016. United Kingdom. 18 (Supplement 2)
(pp 4), 2016. Date of Publication: October 2016.
Author
Battersby N.; Battersby C.; Johnstone M.; Dittani M.; Li E.; Pinkney T.
Institution
(Battersby, Johnstone, Dittani, Li, Pinkney) West Midlands Research
Collaborative, Birmingham, United Kingdom
(Battersby) Mersey Deanery School of Surgery, Liverpool, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Background: Over 25 000 colorectal anastomoses are constructed in the UK
each year. The most feared complication is an anastomotic leak, which
occurs in 3-25% of cases. A sound anastomosis is dependent of an adequate
blood supply. The anklebrachial pressure index (ABPI) is a marker of
vascular disease and therefore it may serve as a proxy for anastomotic
blood supply. The purpose of this study was to assess whether the ABPI
could serve as a simple, non-invasive, reproducible, reliable test to
predict the risk of anastomotic leak. <br/>Method(s): A multicentre,
prospective, observational, feasibility study was performed as per IDEAL
framework recommendations. The ethically approved study (REC 12/WM/0140),
recruited 101 patients across 4 centres. ABPI was measured preoperatively
with a standardised technique. Risk factors for anastomotic leak and
abnormal ABPI including demographics, operation type, cardiovascular risk,
and ASA were recorded. <br/>Result(s): The ABPI was abnormal in 25.7%
patients (ABPI <=0.9, n = 12 and >1.4, n = 14). Anastomotic leak occurred
in 8.9% (6 anterior resection, 1 Hartmann's reversal, 2 right
hemicolectomy). Leak was associated with pre-operative radiotherapy (OR
2.0 [95% CI 2-41], P < 0.001) but not an abnormal ABPI (OR 2.3 [95% CI
0.6-9.1], P = 0.24). ABPI correlated with an abnormal ASA (rs 0.31, P =
0.002). An abnormal ABPI predicted leak with sensitivity 44% and
specificity 73.9% compared with 26.1% and 88.9% for high ASA respectively.
<br/>Conclusion(s): The ABPI did not predict for anastomotic leak with
greater certainty than ASA and therefore the test is unlikely to be
useful. We do not recommend proceeding to a full study.

<111>
Accession Number
611647016
Title
Prophylactic negative pressure wound therapy to reduce the risk of
surgical site infections. A systematic review and meta-analysis.
Source
Hernia. Conference: 38th International Congress of the European Hernia
Society. Netherlands. 20 (Supplement 2) (pp S233), 2016. Date of
Publication: June 2016.
Author
De Vries F.E.E.; Wallert E.D.; Solomkin J.S.; Allegranzi B.; Egger M.;
Dellinger E.P.; Boermeester M.A.
Institution
(De Vries, Wallert, Boermeester) Academic Medical Center, Surgery,
Amsterdam, Netherlands
(Solomkin) University of Cincinnati, College of Medicine, Surgery,
Cincinnati, United States
(Allegranzi) World Health Organization, Health Systems and Innovation,
Geneva, Switzerland
(Egger) University of Bern, Institute of Social and Preventive Medic,
Bern, Switzerland
(Dellinger) University of Washington, Surgery, Seattle, United States
Publisher
Springer-Verlag France
Abstract
Background: First introduced in orthopaedic surgery in 2006, prophylactic
negative pressure wound therapy (NPWT) has been suggested as a new method
to prevent wound complications, specifically surgical site infections
(SSI) by its application on a closed incisional wound. <br/>Method(s):
This review was conducted in line with the development of the Global
Guidelines for prevention of surgical site infections commissioned by
World Health Organisation (WHO) in Geneva. Pubmed, Embase, CENTRAL,
Cinahl, World Health Organisation database and African Index Medicus
between 01-01-1990 and 07-10- 2015 were searched. Inclusion criteria were
randomized controlled trials and observational studies comparing
prophylactic NPWT with conventional wound dressings and reporting on the
incidence of SSI. Meta-analyses were performed with a random effect model.
<br/>Result(s): Nineteen articles describing 21 studies (6 RCTs and 15
observational) were included. We found 9 studies on abdominal surgery of
which four involved ventral hernia repair surgery, six studies on
orthopaedic or trauma surgery, two studies on cardiac surgery and two
studies on vascular surgery. One study included both abdominal and breast
surgery. Either dry gauze, conventional-, occlusive- or absorbent
dressings were used in the control group. Summary estimate showed a
significant benefit of prophylactic NPWT over standard wound dressings in
reducing surgical site infections in both RCTs and observational studies,
respectively OR 0.56 (95 % CI 0.32-0.96), p = 0.04 and OR 0.30 (95 % CI
0.21-0.41), p<0.00001. A subgroup meta-analysis of nine observational
studies in abdominal surgery including ventral hernia repair also revealed
a significant benefit of pNPWT (OR 0.31(95 % CI 0.19-0.49), p <= 0.00001).
<br/>Conclusion(s): Prophylactic NPWT seems a promising solution to
prevent SSI. More randomized controlled trials are needed to identify the
group of patients in who pNPWT is cost-effective. This answers is most
likely to be found in patients at high risk of surgical site infections
due to contamination or patient characteristics.