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<1>
Accession Number
620365390
Title
Early treatment of intrapericardial teratoma: a case presentation and
systematic literature review.
Source
Journal of Maternal-Fetal and Neonatal Medicine. 32 (13) (pp 2262-2268),
2019. Date of Publication: 03 Jul 2019.
Author
Cavalcante C.T.D.M.B.; Pinto Junior V.C.; Pompeu R.G.; Ferrer J.V.C.C.;
Cavalcante M.B.; Araujo Junior E.; Peixoto A.B.; Castello Branco K.M.
Institution
(Cavalcante, Pinto Junior, Pompeu, Ferrer, Castello Branco) Department of
Cardiology and Pediatric Cardiovascular Surgery, Carlos Alberto Studart
Gomes Hospital, Fortaleza, Brazil
(Cavalcante) Department of Pediatrics, Fortaleza University (UNIFOR),
Fortaleza, Brazil
(Cavalcante) Department of Obstetrics and Gynecology, Fortaleza University
(UNIFOR), Fortaleza, Brazil
(Araujo Junior) Department of Obstetrics, Paulista School of Medicine,
Federal University of Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
(Peixoto) Mario Palmerio University Hospital, University of Uberaba
(UNIUBE), Uberaba, Brazil
(Peixoto) Discipline of Obstetrics and Gynecology, Federal University of
Triangulo Mineiro (UFTM), Uberaba, Brazil
(Castello Branco) Post graduation Program in Organ Transplantation, State
University of Ceara (UECE), Fortaleza, Brazil
Publisher
Taylor and Francis Ltd
Abstract
Objective: To present a case of an early treatment of cardiac
intraperitoneal teratoma (IPT) in a newborn and its associated systematic
literature review. Method(s): We presented a case of a newborn with
IPT but without hydrops and having a good perinatal outcome after cardiac
surgery. Using the PubMed database, we conducted a systematic literature
review of articles regarding cases with cardiac IPT diagnosed and treated
in the neonatal period and published in English from 2004 onward. We
excluded cases that involved fetal death or interrupted gestation events.
 Result(s): In total, 38 cases of IPT from 31 articles were included.
The mean +/- standard deviation of the gestational age at diagnosis and
delivery were 27.9 +/- 5.7 and 33.0 +/- 3.5 weeks, respectively, and that
of birth weight was 2373 +/- 834.5 g. The majority of fetuses (42.1%) were
males. Pericardial effusion was the most common symptom (60.5%) followed
by hydrops (42.1%) and respiratory distress (42.1%). Intrauterine
procedure was not performed in 63.1% of cases, and 71.0% of newborns were
alive. Conclusion(s): IPT in newborns is usually associated with a
good prognosis without the need for intrauterine procedures. Cases with
IPT-related death are associated with hemodynamic impairment in fetuses
with hydrops. Copyright © 2018, © 2018 Informa UK Limited,
trading as Taylor & Francis Group.

<2>
Accession Number
2001541737
Title
C-reactive protein and prognosis after percutaneous coronary intervention
and bypass graft surgery for left main coronary artery disease: Analysis
from the EXCEL trial.
Source
American Heart Journal. 210 (pp 49-57), 2019. Date of Publication: April
2019.
Author
Kosmidou I.; Redfors B.; Chen S.; Crowley A.; Lembo N.J.; Karmpaliotis D.;
Brown W.M.; Maupas E.; Durrleman N.; Shah A.; Reardon M.J.; Dressler O.;
Ben-Yehuda O.; Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Kosmidou, Redfors, Chen, Crowley, Lembo, Karmpaliotis, Dressler,
Ben-Yehuda, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Kosmidou, Lembo, Karmpaliotis, Ben-Yehuda, Stone) NewYork-Presbyterian
Hospital/Columbia University Medical Center, New York, NY, United States
(Brown) Piedmont Heart Institute, Atlanta, GA, United States
(Maupas, Durrleman) Hopital Prive Les Franciscaines, Nimes, France
(Shah, Reardon) Houston Methodist Hospital, Houston, TX, United States
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The prognostic impact of high-sensitivity C-reactive protein
(CRP) levels in patients with left main coronary artery disease (LMCAD)
treated with percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) is unknown. We sought to determine the effect of
elevated baseline CRP levels on the 3-year outcomes after LMCAD
revascularization and to examine whether CRP influenced the relative
outcomes of PCI versus CABG. Method(s): In the EXCEL trial, patients
with LMCAD and Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX)
scores <=32 were randomized to PCI versus CABG. The primary composite
outcome of death, myocardial infarction (MI), or stroke was analyzed
according to baseline CRP levels. Result(s): Among 999 patients with
available CRP levels, median CRP was 3.10 mg/L (interquartile range
1.12-6.40 mg/L). The rate of the primary composite end point of death, MI,
or stroke at 3 years steadily increased with greater baseline CRP levels.
The adjusted relationship between the 3-year composite rate of death, MI,
or stroke and baseline CRP modeled as a continuous log-transformed
variable demonstrated steadily increasing event rates with greater CRP
levels (adjusted hazard ratio, 1.26, 95% CI 1.10-1.44, P =.0008).
Similarly, patients with CRP >=10 mg/L had a 3-fold higher risk of the
3-year primary end point compared to patients with lower CRP levels
(adjusted hazard ratio 2.92, 95% CI 1.88-4.54, P <.0001). The association
between an elevated CRP level and the adjusted 3-year risk of the primary
composite end point did not differ according to revascularization strategy
(P<inf>interaction</inf> =.75). Conclusion(s): In patients with LMCAD
undergoing revascularization, elevated baseline CRP levels were strongly
associated with subsequent death, MI, and stroke at 3 years, irrespective
of the mode of revascularization. Further studies are warranted to
determine whether anti-inflammatory therapies may improve the prognosis of
high-risk patients with LMCAD following revascularization. Copyright
© 2019 Elsevier Inc.

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

<4>
Accession Number
2001710882
Title
Prothrombin Complex Concentrate in Cardiac Surgery: A Systematic Review
and Meta-Analysis.
Source
Annals of Thoracic Surgery. 107 (4) (pp 1275-1283), 2019. Date of
Publication: April 2019.
Author
Roman M.; Biancari F.; Ahmed A.B.; Agarwal S.; Hadjinikolaou L.; Al-Sarraf
A.; Tsang G.; Oo A.Y.; Field M.; Santini F.; Mariscalco G.
Institution
(Roman, Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Glenfield Hospital, Leicester, United Kingdom
(Biancari) Heart Center, Turku University Hospital and University of
Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
(Ahmed) Department of Anesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Agarwal) Department of Anesthesia, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Hadjinikolaou, Al-Sarraf, Mariscalco) Cardiac Surgery Unit, Glenfield
Hospital, University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Tsang) Cardiac Surgery Unit, University Hospital Southampton NHS
Foundation Trust, Southampton, United Kingdom
(Oo) Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's
Hospital, London, United Kingdom
(Field) Department of Cardiac Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Santini) Department of Integrated Surgical and Diagnostic Sciences,
Division of Cardiac Surgery, University of Genoa, Italy
Publisher
Elsevier USA
Abstract
Background: Prothrombin complex concentrate (PCC) has recently emerged as
an effective alternative to fresh frozen plasma (FFP) in treating
excessive perioperative bleeding. This systematic review and meta-analysis
evaluated the safety and efficacy of PCC administration as first-line
treatment for coagulopathy after adult cardiac surgery. Method(s):
PubMed/MEDLINE, EMBASE, and the Cochrane Library were searched from
inception to the end of March 2018 to identify eligible articles. Adult
patients undergoing cardiac surgery and receiving perioperative PCC were
compared with patients receiving FFP. Result(s): A total of 861 adult
patients from four studies were retrieved. No randomized studies were
identified. Pooled odds ratios (ORs) showed that the PCC cohort was
associated with a significant reduction in the risk of RBC transfusion
(OR, 2.22; 95% confidence interval [CI], 1.45 to 3.40) and units of RBC
received (OR, 1.34; 95% CI, 0.78 to 1.90). No differences were observed
between the groups for reexploration for bleeding (OR, 1.09; 95% CI, 0.66
to 1.82), chest drain output at 24 hours (OR, 66.36; 95% CI, -82.40 to
216.11), hospital mortality (OR, 0.94; 95% CI, 0.59 to 1.49), stroke (OR,
0.80; 95% CI, 0.41 to 1.56), and occurrence of acute kidney injury (OR,
0.80; 95% CI, 0.58 to 1.12). A trend toward increased risk of renal
replacement therapy was observed in the PCC group (OR, 0.41; 95% CI, 0.16
to 1.02). Conclusion(s): In patients with significant bleeding after
cardiac surgery, PCC administration seems to be more effective than FFP in
reducing perioperative blood transfusions. No additional risks of
thromboembolic events or other adverse reactions were observed. Randomized
controlled trials are needed to establish the safety of PCC in cardiac
surgery definitively. Copyright © 2019 The Society of Thoracic
Surgeons

<5>
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. 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. 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.
 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. Copyright © 2019 The
Society of Thoracic Surgeons

<6>
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 168th
Street, New York, NY 10032, United States
(Gershengoren) Department of Psychiatry, Weill Cornell Medical Center, 525
East 68th Street, New York, NY 10065, United States
(Shapiro) Department of Psychiatry, Columbia University Medical Center,
622 West 168th 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. Copyright © 2019 Elsevier
Ltd

<7>
Accession Number
626942955
Title
Volatile anesthetics versus total intravenous anesthesia for cardiac
surgery.
Source
New England Journal of Medicine. 380 (13) (pp 1214-1225), 2019. Date of
Publication: 28 Mar 2019.
Author
Landoni G.; Lomivorotov V.V.; Neto C.N.; Monaco F.; Pasyuga V.V.; Bradic
N.; Lembo R.; Gazivoda G.; Likhvantsev V.V.; Lei C.; Lozovskiy A.; Di
Tomasso N.; Nazar A.R.B.; Silva F.S.; Bautin A.E.; Ma J.; Crivellari M.;
Farag A.M.G.A.; Uvaliev N.S.; Carollo C.; Pieri M.; Kunstyr J.; Wang C.Y.;
Belletti A.; Hajjar L.A.; Grigoryev E.V.; Agro F.E.; Riha H.; El-Tahan
M.R.; Mara Scandroglio A.; Elnakera A.M.; Baiocchi M.; Navalesi P.;
Shmyrev V.A.; Severi L.; Hegazy M.A.; Crescenzi G.; Ponomarev D.N.; Brazzi
L.; Arnoni R.; Tarasov D.G.; Jovic M.; Calabro M.G.; Bove T.; Bellomo R.;
Zangrillo A.
Institution
(Landoni, Monaco, Lembo, Di Tomasso, Crivellari, Pieri, Belletti, Mara
Scandroglio, Calabro, Zangrillo) Department of Anesthesia and Intensive
Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan
20132, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Carollo) Istituto di Anestesia e Rianimazione, Azienda Ospedaliera di
Padova, Padua, Italy
(Bautin, Agro) Anesthesia and Intensive Care Department, University Campus
Bio-Medico of Rome, Italy
(Severi) Anestesia e Rianimazione, Dipartimento Cardiovascolare, Azienda
Ospedaliera San Camillo Forlanini, Rome, Italy
(Baiocchi) Department of Cardiothoracic and Vascular Anesthesia and
Intensive Care, University Hospital Policlinico S. Orsola, Bologna, Italy
(Navalesi) Dipartimento di Scienze Mediche e Chirurgiche, Universita Magna
Graecia di Catanzaro, Catanzaro, Italy
(Crescenzi) Anestesia e Terapia Intensiva Cardiochirurgica, Istituto
Clinico Humanitas, Rozzano, Italy
(Crescenzi, Brazzi) Department of Anesthesia, Intensive Care and
Emergency, Citta della Salute e della Scienza Hospital, Department of
Surgical Sciences, University of Turin, Turin, Italy
(Bove) Anesthesiology and Intensive Care Clinic, Department of Medicine,
University of Udine, Udine, Italy
(Lomivorotov, Shmyrev, Ponomarev) Department of Anesthesiology and
Intensive Care, E. Meshalkin National Medical Research Center,
Novosibirsk, Russian Federation
(Pasyuga) Departments of Anesthesiology and Intensive Care, Astrakhan,
Russian Federation
(Tarasov) Cardiac Surgery, Astrakhan, Russian Federation
(Lomivorotov, Pasyuga, Likhvantsev) Federal Center for Cardiovascular
Surgery Astrakhan, Department of Anesthesia and Intensive Care, First
Moscow State Medical University, Astrakhan, Russian Federation
(Lomivorotov) Department of Intensive Care, Moscow Regional Clinical and
Research Institute, Moscow, Russian Federation
(Lozovskiy) Department of Anesthesia and Intensive Care, Ural Institute of
Cardiology, Ekaterinburg, Russian Federation
(Bautin) Laboratory for Anesthesiology and Intensive Care, Almazov
National Medical Research Center, Saint Petersburg, Russian Federation
(Grigoryev) Intensive Care Unit, Scientific Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Neto) Anesthesia Section, Department of Surgery, Dante Pazzanese
Institute of Cardiology, Sao Paulo, Brazil
(Hajjar) Department of Cardiopneumology, Instituto do Coracao,
Universidade de Sao Paulo, Intensive Care Unit, Hospital SirioLibanes, Sao
Paulo, Brazil
(Arnoni) Cardiac Surgery Section, Department of Surgery, Dante Pazzanese
Institute of Cardiology, Sao Paulo, Brazil
(Bradic) Department of Cardiovascular Anesthesiology and Intensive Care
Medicine, Clinical Department of Anesthesiology, Resuscitation and
Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
(Bradic) Department of Biomedical Sciences, University North, Varazdin,
Croatia
(Gazivoda, Jovic) Department of Anesthesia and Intensive Care,
Cardiovascular Institute Dedinje, Belgrade, Serbia
(Jovic) School of Medicine, University of Belgrade, Belgrade, Serbia
(Lei) Department of Anesthesiology and Perioperative Medicine, Xijing
Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
(Ma) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Nazar) Cardiothoracic Intensive Care Unit and Anesthesia Department,
Mohammed Bin Khalifa Cardiac Center, Riffa, Bahrain
(Silva) Department of Anesthesiology, Hospital de Santa Maria, Lisbon,
Portugal
(Farag) Department of Anesthesia, King Abdullah Medical City-Holy Capital,
Makkah, Saudi Arabia
(El-Tahan) Anesthesiology Department, College of Medicine, Imam
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
(Uvaliev) Anesthesia and Intensive Care, Acibadem City Clinic-Cardiac
Surgery Center, Burgas, Bulgaria
(Kunstyr) Department of Anesthesiology, Resuscitation and Intensive
Medicine, Charles University in Prague, First Faculty of Medicine, General
Teaching Hospital, Prague, Czech Republic
(Riha) Cardiothoracic Anesthesiology and Intensive Care, Department of
Anesthesiology and Intensive Care Medicine, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Wang) Department of Anesthesiology, Faculty of Medicine, University of
Malaya, Kuala Lumpur, Malaysia
(Elnakera) Anesthesia and Surgical Intensive Care Department, Faculty of
Medicine, Zagazig University Hospitals, Zagazig, Egypt
(Hegazy) Department of Anesthesia and Surgical Intensive Care, Mansoura
University, Mansoura, Egypt
(Bellomo) School of Medicine, University of Melbourne, Melbourne, VIC,
Australia
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Volatile (inhaled) anesthetic agents have cardioprotective
effects, which might improve clinical outcomes in patients undergoing
coronary-artery bypass grafting (CABG). METHODS We conducted a pragmatic,
multicenter, single-blind, controlled trial at 36 centers in 13 countries.
Patients scheduled to undergo elective CABG were randomly assigned to an
intraoperative anesthetic regimen that included a volatile anesthetic
(desflurane, isoflurane, or sevoflurane) or to total intravenous
anesthesia. The primary outcome was death from any cause at 1 year.
RESULTS A total of 5400 patients were randomly assigned: 2709 to the
volatile anesthetics group and 2691 to the total intravenous anesthesia
group. On-pump CABG was performed in 64% of patients, with a mean duration
of cardiopulmonary bypass of 79 minutes. The two groups were similar with
respect to demographic and clinical characteristics at baseline, the
duration of cardiopulmonary bypass, and the number of grafts. At the time
of the second interim analysis, the data and safety monitoring board
advised that the trial should be stopped for futility. No significant
difference between the groups with respect to deaths from any cause was
seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the
total intravenous anesthesia group; relative risk, 0.94; 95% confidence
interval [CI], 0.69 to 1.29; P=0.71), with data available for 5353
patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative
risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients
(99.9%). There were no significant differences between the groups in any
of the secondary outcomes or in the incidence of prespecified adverse
events, including myocardial infarction. CONCLUSIONS Among patients
undergoing elective CABG, anesthesia with a volatile agent did not result
in significantly fewer deaths at 1 year than total intravenous
anesthesia. Copyright © 2019 Massachusetts Medical Society.

<8>
Accession Number
2001632095
Title
Usefulness of Clopidogrel Loading in Patients Who Underwent Transcatheter
Aortic Valve Implantation (from the BRAVO-3 Randomized Trial).
Source
American Journal of Cardiology. 123 (9) (pp 1494-1500), 2019. Date of
Publication: 1 May 2019.
Author
Nijenhuis V.J.; ten Berg J.M.; Hengstenberg C.; Lefevre T.; Windecker S.;
Hildick-Smith D.; Kupatt C.; Van Belle E.; Tron C.; Hink H.U.; Colombo A.;
Claessen B.; Sartori S.; Chandrasekhar J.; Mehran R.; Anthopoulos P.;
Deliargyris E.N.; Dangas G.
Institution
(Nijenhuis, ten Berg) Department of Cardiology, St. Antonius hospital,
Nieuwegein, Netherlands
(Hengstenberg, Kupatt) DZHK (German Centre for Cardiovascular Research),
Partner Site Munich Heart Alliance, Munich, Germany
(Hengstenberg) Deutsches Herzzentrum Munchen, Technische Universitat
Munchen, Munich, Germany
(Lefevre) Institut cardiovasculaire Paris Sud, Hopital Prive Jacques
Cartier, Ramsay generale de sante, Massy, France
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Hildick-Smith) Sussex Cardiac Centre-Brighton & Sussex University
Hospitals NHS Trust, Brighton, East Sussex, United Kingdom
(Kupatt) Medizinische Klinik und Poliklinik, Klinikum rechts der Isar,
Technische Universitat Munchen, Munich, Germany
(Van Belle) Department of Cardiology CHU Lille, Inserm, U1011, Univ.
Lille, Institut Pasteur de Lille-EGID, Lille, France
(Tron) Department of Cardiology, Rouen University Hospital, hopital
Charles-Nicolle, Rouen, France
(Hink) Department of Cardiology, Johannes Gutenberg University Hospital,
Mainz, Germany
(Colombo) Department of Cardiology, San Raffaele Hospital, Milan, Italy
(Claessen, Sartori, Chandrasekhar, Mehran) The Zena and Michael A. Wiener
Cardiovascular Institute, The Icahn School of Medicine, Mount Sinai, NY,
United States
(Anthopoulos) The Medicines Company, Zurich, Switzerland
(Deliargyris, Dangas) Science and Strategy Consulting Group, Basking
Ridge, NJ, United States
(Hengstenberg) Division of Cardiology, Department of Internal Medicine II,
Medical University of Vienna, Department of Internal Medicine II, Medical
University of Vienna, Vienna, Austria
(Kupatt) Walter-Brendel-Centre for Experimental Medicine, Ludwig
Maximilian University of Munich, Munich, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
P2Y<inf>12</inf>-inhibitor initiation with clopidogrel using a loading
dose (LD) versus no LD (NLD) provides more rapid inhibition of platelet
activation and reduced risk of ischemic events after coronary stenting.
Whether a similar beneficial effect is achieved in the setting of
transcatheter aortic valve implantation (TAVI) is unknown. We evaluate the
effects of preprocedural clopidogrel LD versus no NLD on 48-hour and
30-day clinical outcomes after TAVI. In the BRAVO-3 trial, 802 patients
with severe aortic stenosis who underwent transfemoral TAVI were
randomized to intraprocedural anticoagulation with bivalirudin or
unfractionated heparin. Administration of clopidogrel LD was left to the
discretion of the treating physician. For this analysis, patients were
stratified according to receiving clopidogrel LD (n = 294, 36.6%) or NLD
(n = 508, 63.4%) before TAVI. LD patients more often received a
self-expandable prosthesis using larger sheaths.
P2Y<inf>12</inf>-inhibitor maintenance therapy pre-TAVI was similar in
patients with LD versus NLD (28.2% vs 33.1%, p = 0.16). LD versus NLD was
associated with similar incidences of major adverse cardiovascular events
(i e., death, myocardial infarction, or stroke) (4.1% vs 4.1%, p = 0.97)
and major bleeding (8.5% vs 7.7%, p = 0.68), but a higher rate of major
vascular complications (11.9% vs 7.1%, p = 0.02). Multivariable adjustment
showed that clopidogrel LD did not affect any of the studied clinical
events, including major vascular complications (odds ratio 0.91, 95%
confidence interval 0.60 to 1.39, p = 0.67). Also patients on clopidogrel
maintenance therapy and thus considered in steady state were not at
reduced risk of major adverse cardiovascular events compared with patients
not on clopidogrel (3.7% vs 5.2%, p = 0.36). In conclusion, in patients
who underwent TAVI, use of clopidogrel LD was associated with higher
vascular complications and otherwise similar clinical events compared to
NLD patients. Copyright © 2019

<9>
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.
 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. Copyright © 2019
International Society on Thrombosis and Haemostasis

<10>
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. Objective(s): The main purpose of
this study was to analyse if prior PCI influenced outcomes in STICH.
 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). 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 Copyright © 2019 Elsevier B.V.

<11>
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. Design(s): A prospective,
single-blinded, randomized controlled study. Setting(s): National
Center for Cardiovascular Diseases and a university hospital.
 Participant(s): The study comprised 150 patients with postoperative
functional iron deficiency anemia after cardiac valvular surgery.
 Intervention(s): The patients were randomly assigned (1:1) to either
the treatment (intravenous iron) group or the control (placebo) group.
 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. 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. Copyright © 2019 Elsevier
Inc.

<12>
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. Design(s): A parallel, open-label,
single-center pilot randomized trial. Setting(s):
University-affiliated cardiac surgery intensive care unit.
 Participant(s): The study comprised 41 postcardiotomy patients with
cardiogenic shock who received ECMO support. 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. 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. 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. Copyright © 2019 Elsevier Inc.

<13>
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. Copyright © 2019
Elsevier Inc.

<14>
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. Design(s): International, multicenter,
prospective, randomized controlled clinical trial. Setting(s): A
network of university hospitals. Participant(s): The study comprises
1,380 patients scheduled for thoracic surgery. 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. 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. Copyright © 2019

<15>
Accession Number
2001399799
Title
Quadruple valve infective endocarditis presenting with suspected Austrian
syndrome: a case report and a case series of quadruple valve infective
endocarditis.
Source
Diagnostic Microbiology and Infectious Disease. 94 (1) (pp 60-65), 2019.
Date of Publication: May 2019.
Author
Zheng S.; Soh J.X.J.; Shafi H.
Institution
(Zheng) Department of Infectious Diseases, Singapore General Hospital,
Outram Road, Singapore 169608, South Africa
(Soh) Department of General Medicine, Sengkang General Hospital, 110
Sengkang E Way, Singapore 544886, South Africa
(Shafi) Division of Infectious Diseases, Changi General Hospital, 2 Simei
Street 3, Singapore 529889, South Africa
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: Austrian syndrome comprises the triad of pneumonia,
meningitis, and endocarditis secondary to Streptococcus pneumonia. We
present what we believe to be the first reported case of Austrian syndrome
with quadruple heart valve involvement and review the literature detailing
cases of quadruple valve infective endocarditis. Case presentation and
results: A case is presented of a patient with radiographic evidence of a
left lower lobe pneumonia. Sequential transthoracic followed by
transesophageal echocardiogram done to evaluate the presence of a cardiac
murmur revealed the presence of quadruple valve vegetations. Multiple
blood cultures were persistently negative. The patient went on to develop
seizures secondary to proven meningitis. Microbiological diagnosis was
eventually established through positive Streptococcus pneumoniae antigen
(Alere BinaxNOW) from cerebrospinal fluid, establishing a presumptive
clinical diagnosis of Austrian syndrome. A computerized PubMed search for
reports of quadruple valve infective endocarditis and their references was
collated. A total of 22 patients were found, including our patient. The
median age of presentation was 47.5 years. Five patients had a history of
intravenous drug abuse, another 5 had underlying congenital heart disease,
and 1 had both. Two patients (9.1%) had 2 microorganisms isolated.
Staphylococcus aureus and Streptococcus viridans (3 cases, 13.6% each)
were the most commonly implicated microorganism. Heart failure was the
commonest complication, afflicting 11 patients (50.0%). Ten patients
(45.5%) underwent surgery. Overall case fatality rate was 50.0%. Cardiac
surgery was of statistical significance in predicting survival (P =
0.009). Conclusion(s): Quadruple valve endocarditis is associated
with a high mortality rate, and cardiac surgery may be
protective. Copyright © 2018 Elsevier Inc.

<16>
Accession Number
625341084
Title
Efficacy and safety of intravenous esmolol for cardiac protection in
non-cardiac surgery. A systematic review and meta-analysis.
Source
Annals of Medicine. 51 (1) (pp 17-27), 2019. Date of Publication: 02 Jan
2019.
Author
Ollila A.; Vikatmaa L.; Sund R.; Pettila V.; Wilkman E.
Institution
(Ollila, Vikatmaa, Pettila, Wilkman) Department of Perioperative,
Intensive Care and Pain Medicine, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Sund) Institute of Clinical Medicine, University of Eastern Finland,
Kuopio, Finland
(Sund) Faculty of Social Sciences, Centre for Research Methods, University
of Helsinki, Helsinki, Finland
Publisher
Taylor and Francis Ltd
Abstract
Haemodynamic instability predisposes patients to cardiac complications in
non-cardiac surgery. Esmolol, a short-acting cardioselective
beta-adrenergic blocker might be efficient in perioperative cardiac
protection, but could affect other vital organs, such as the kidneys, and
post-discharge survival. We performed a systematic review on the use of
esmolol for perioperative cardiac protection. We searched PubMed, Ovid
Medline and Cochrane Central Register for Controlled trials. Eligible
randomized controlled studies (RCTs) reported a perioperative esmolol
intervention with at least one of the primary (major cardiac or renal
complications during the first 30 postoperative days) or secondary
(postoperative adverse effects and all-cause mortality) outcomes. We
included 196 adult patients from three RCTs. Esmolol significantly reduced
postoperative myocardial ischaemia, RR =0.43 [95% confidence interval, CI:
0.21-0.88], p =.02. No association with clinically significant bradycardia
and hypotension compared to patients receiving control treatment could be
confirmed (RR =7.4 [95% CI: 0.29-139.81], p =.18 and RR =2.21 [95% CI:
0.34-14.36], p =.41, respectively). No differences regarding other
outcomes were observed. No study reported postoperative renal outcomes.
Esmolol seems promising for the prevention of perioperative myocardial
ischaemia. However, the association with bradycardia and hypotension
remains unclear. Randomized trials investigating the effect of
beta1-selective blockade on clinically relevant outcomes and non-cardiac
vital organs are warranted.Key messages Short-acting cardioselective
esmolol seems efficient in the prevention of perioperative myocardial
ischaemia. The possibly increased risk of bradycardia and hypotension with
short-acting intravenous beta blockade could not be confirmed or refuted
by available data. Future adequately powered trials investigating the
effect of beta1-selective blockade on clinically relevant outcomes and
non-cardiac vital organs are warranted. Copyright © 2018, ©
2018 Informa UK Limited, trading as Taylor & Francis Group.

<17>
Accession Number
627104643
Title
Nitric oxide exerts organoprotective effects in cardiac surgery.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Kamenshchikov N.O.; Mandel I.A.; Podoksenov Y.K.; Svirko Y.S.; Lomivorotov
V.V.; Mikheev S.L.; Kozlov B.N.; Nenakhova A.A.; Anfinogenova Y.; Shipulin
V.M.; Atochin D.N.
Institution
(Kamenshchikov, Mandel, Podoksenov, Svirko, Lomivorotov, Mikheev, Kozlov,
Nenakhova, Anfinogenova, Shipulin, Atochin) 1Cardiology Rsch Institute,
Tomsk National Rsch Med Cntr, Russian Academy of Sciences, Tomsk, Russian
Federation2Intensive Care, I.M. Sechenov First Moscow State Med Univ,
Moscow, Russian Federation3Cardiology Rsch Institute, E. Meshalkin
National Med Rsch Cntr, Novosibirsk, Russian Federation4Federal Rsch
Clinical Cntr, Federal Med-Biological Agency, Moscow, Russian
Federation5Cardiovascular Rsch Cntr and Cardiology Div, Massachusetts
General Hosp, Harvard Med Sch, Boston, MA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Nitric oxide (NO) signaling is involved in the mechanisms of
organoprotection during ischemia and reperfusion. Hypothesis: We assessed
the hypothesis that NO supply to the extracorporeal circulation circuit
exerts organoprotective effects during cardiac surgery with
cardiopulmonary bypass (CPB). Method(s): A total of 71 patients were
randomly allocated to undergo standard CPB-based cardiac surgery (control
group) or surgery where 40-ppm NO was added to CPB circuit (NO-group).
Four subgroups were assigned to study cardio- or nephroprotective
properties of NO administration. Two clinical trials were registered as
ClinicalTrials.gov: (#NCT03527381 and #NCT03500783). Cardiac troponin I
(cTnI), creatine kinase-muscle/brain (CK-MB), vasoactive inotropic score
(VIS), frequency of acute kidney injury (AKI), diuresis during CPB, urine
neutrophil gelatinase-associated lipocalin (uNGAL) level, cumulative
hydrobalance, diuresis, Lasix doses, and serum creatinine dynamics were
studied. Result(s): cTnI level was lower in NO-group compared to
control 6 h after surgery: 1.8+/-0.4 vs 2.4+/-0.6 ng/mL (p=0.001). CK-MB
was lower in NO-group compared to control 24 h after surgery: 47.7+/-8.1
vs 62.3+/-9.8 U/L (p=0.001). VIS was significantly lower in NO-group 6 h
after surgery. AKI rate significantly decreased: 14.3% in NO-group vs
44.4% in control group (p=0.0053). Stage-2 AKI was absent in NO-group, but
not in control group (4 cases). Diuresis was higher in NO-group
(p=0.0003). Compared to baseline, uNGAL level was lower in NO-group 4 h
after surgery (p=0.007). In control group, creatinine level at 24 h
significantly exceeded baseline value (p=0.0006) and remained increased
for up to 5 days after surgery (p=0.03). Creatinine level in NO-group did
not change during early postoperative period compared to baseline.
Cumulative hydrobalance, diuresis, Lasix doses, and complication rates did
not differ between groups after surgery. Conclusion(s): NO supply to
CPB circuit during cardiac surgery exerted organoprotective effects.

<18>
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Accession Number
627104609
Title
The fate of unrepaired moderately dilated ascending aorta in bicuspid
aortic valve replacement.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Kim W.K.; Park S.J.; Kim H.J.; Kim J.B.; Jung S.-H.; Choo S.J.; Chung
C.H.; Lee J.W.
Institution
(Kim, Park, Kim, Kim, Jung, Choo, Chung, Lee) Thoracic and Cardiovascular
Surgery, Asan Med Cntr, Seoul, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The uncertainty in etiology of bicuspid aortic valve
(BAV)-aortopathy whether genetic or hemodynamic led current guidelines to
offer a conservative surgical thresholds (i.e., 45mm in concomitant
cardiac operation) regarding the BAV-aortopathy as same as other
genetically-derived aortopathies. In the interest of evaluation on the
natural courses of unrepaired aorta after BAV replacement, we investigated
those patients with moderately dilated (40-55mm) ascending aorta.
 Method(s): Using our institutional electronic database, we retrieved
305 patients with moderately dilated aorta who underwent BAV replacement
from 2006 to 2015. Among those patients, 202 (66.2%) did not undergo aorta
replacements (AVR-alone group, 61.4+/-9.9years; 68 females). Clinical
endpoints were defined as occurrences of sudden death, aortic dissection
or rupture, and elective aortic repair. To estimate the change of remnant
aorta after BAV replacement, a yearly aortic expansion rate was calculated
in AVR-alone group. Multiple linear regression models were applied to
evaluate the risk for aortic expansion. For benchmark comparison,
cardiovascular-related deaths were reviewed in 103 (33.8%) patients who
received concomitant aorta replacements (Aorta-replaced group,
57.4+/-13.0years; 32 females). Result(s): In the AVR-alone group,
mean of baseline aortic diameters was 43.0+/-2.6 mm. Among these patients,
and 10 (5.0%) were revealed as having BAV without raphe. During follow-up
(53.2+/-39.1 months), no aortic dissection or rupture was observed while 3
(0.3%/person-year) sudden deaths occurred. On linear regression analysis,
there was no significant correlation between the baseline ascending aortic
diameters and postoperative aortic expansion (R square=0.007; Beta=-2.73;
p=0.24, Central Figure). No baseline factor was associated with aortic
expansion in multiple linear regression analyses. In Aorta-replaced group,
3 (0.7%/ person-year) postoperative cardiovascular-related deaths
occurred. Conclusion(s): Remaining moderately dilated ascending aorta
during BAV replacement was not associated with further aortic expansion,
aortic dissection or rupture. Further evaluations on larger or randomized
subjects should be followed.

<19>
Accession Number
627104574
Title
Resource utilization in risk stratification of patients presenting to the
emergency department with chest discomfort.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Krishnan S.; Selvaraj S.; Tamrat R.; Davis S.; Murthy A.; Gopal D.;
McCarthy D.; Litwack A.; Riley M.; Kolanksy D.; Silvestry F.; Adusumalli
S.
Institution
(Krishnan, Selvaraj, Tamrat, Davis, Murthy, Gopal, McCarthy, Litwack,
Riley, Kolanksy, Silvestry, Adusumalli) 1Div of Cardiology, Hosp of the
Univ of Pennsylvania, Philadelphia, PA2Data Analytics Cntr, Univ of
Pennsylvania Health System, Philadelphia, PA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Chest discomfort is a common clinical challenge in emergency
departments nationwide and stress testing is frequently used to risk
stratify patients presenting with this complaint. Understanding
contemporary patterns of stress test utilization according to pretest risk
and downstream consequences is critical in this era of value-based
healthcare. Method(s): We conducted a retrospective study of patients
who presented to one academic emergency department with chest discomfort
and who underwent non-invasive imaging for risk stratification in 2017.
Physicians reviewed charts of a randomly selected subset of 175 patients
who underwent stress testing and stratified them by retrospectively
calculated HEART scores. Among patients with reversible ischemia on stress
testing, we assessed downstream testing and subsequent coronary
interventions. Result(s): Among 175 patients, the mean age was
60+/-10 years, 51% were female, 56% were black, and 22% had a history of
coronary artery disease (CAD). By HEART score, 18%, 72%, and 10% were low,
intermediate, and high risk for clinically significant CAD, respectively.
Twenty-four (13.7%) had stress tests positive for ischemia, and 11 (6.3%)
underwent diagnostic cardiac catheterization. Of the 175 patients, four
(2.3%) underwent coronary revascularization, all of whom were
intermediate-risk. Among the 18% of low-risk individuals, two had
reversible ischemia without significant CAD on catheterization.
 Conclusion(s): In a contemporary cohort at a large academic center,
there is a low yield of detecting clinically significant CAD with stress
testing among patients presenting with chest discomfort. In addition, 18%
of all patients undergoing stress testing were low risk and did not
require further risk stratification but underwent unnecessary downstream
testing. Development of a clear pathway may help to optimize resource
utilization in this population.

<20>
Accession Number
627104566
Title
Cardiovascular evaluation of the selective bet inhibitor, apabetalone, in
acs patients with diabetes: Baseline characteristics of the betonmace cv
outcomes study.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Ray K.K.; Nicholls S.J.; Sweeney M.; Johansson J.O.; Toth P.P.; Ginsberg
H.; Kalantar-Zadeh K.; Schwartz G.G.
Institution
(Ray, Nicholls, Sweeney, Johansson, Toth, Ginsberg, Kalantar-Zadeh,
Schwartz) 1Dept of Primary Care and Public Health, Imperial College
London, London, United Kingdom2Dept of Cardiology, South Australian Health
and Med Rsch Institute, Adelaide, Australia3Clinical Development,
Resverlogix Inc., San Francisco, CA4Preventative Cardiology, CGH Med Cntr,
Chicago, IL5Clinical and Translational Rsch, Columbia Univ College of
Physicians and Surgeons, New York, NY6Nephrology and Hypertension, Univ of
California Irvine, Orange, CA7Sch of Medicine, Univ of Colorado, Aurora,
CO
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Vascular perturbation in acute coronary syndrome (ACS) is
linked to inflammation. Bromodomain and extraterminal (BET) proteins
coordinate gene transcription following inflammatory insult. Apabetalone
(ABL) selectively inhibits binding between BET proteins and acetyl-lysine
marks on histone tails reducing the effects of inflammation. Post-hoc
analysis of phase 11b trials with ABL demonstrated a 55% RRR in major
adverse cardiac events (MACE) in patients with coronary heart disease ,
with more pronounced benefit among patients with diabetes (DM) and low HDL
cholesterol (HDL-C). Hypothesis: BETonMACE is the first Phase III
cardiovascular (CV) outcome study with a BET inhibitor. It tests the
hypothesis that ABL reduces MACE in patients with T2D, recent ACS, and low
HDL-C. Method(s): At 195 centers in 13 countries, BETonMACE includes
patients with ACS during the preceding 7-90 days, DM, HDL-C <40 mg/dL
(males) or <45 mg/dL (females), and treatment with atorvastatin 40-80 mg,
rosuvastatin 20-40 mg daily, or the maximum tolerated dose of these
agents. Qualifying patients were randomized 1:1 to treatment with ABL 100
mg orally twice daily or placebo. The primary endpoint is time to first
occurrence of CV death, non-fatal myocardial infarction or stroke. The
trial will continue until at least 250 patients have a primary endpoint.
With an assumed event rate of 10.5% in the placebo group over 1.5 years,
2400 patients provide 80% power to detect a 30% reduction in MACE with
ABL. Result(s): Enrollment of 2418 patients was completed on Mar 6,
2018. Baseline characteristics include: male sex 74.5%; mean age 61 (SD
9.5) years; median (interquartile range) LDL-C 65.0 (36) mg/dL, HDL-C 33.0
(7) mg/dL, HbA1c 7.3 (2.3) %, and blood pressure 129/76 mmHg; eGFR<60
ml/min 11%; treatment with atorvastatin (40/80mg) or rosuvastatin
(20/40mg) 91.6%; dual anti-platelet therapy 85%; index ACS event MI 75% ;
coronary revascularization for index ACS 78%; and median time from index
ACS to randomization 34 days. Conclusion(s): BETonMACE is a unique
proof-of-concept trial that will determine if selective BET inhibition
with ABL, added to evidence-based treatments, reduces MACE in high-risk
patients with DM, recent ACS, and low HDL-C.

<21>
[Use Link to view the full text]
Accession Number
627104474
Title
Prevention of stroke in atrial fibrillation patients undergoing coronary
artery stenting: Systematic review and network 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 - Univ of Miami, Miami, FL2Internal
Medicine, Jackson Memorial Hosp - Univ of Miami, Miami, FL3Cardiology,
Johns Hopkins, Baltimore, MD4Cardiology, Univ of Miami Miller Sch of
Medicine, Miami, FL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Recent guidelines still recommend triple therapy (TT) for a
trial fibrillation (AF) patients that underwent stent placement. The
optimal antithrombotic strategy to balance thrombotic and bleeding events,
especially acute stroke, is still not completely known in that population.
 Method(s): We performed a systematic review and network meta-analysis
of randomized and prospective studies for safety and efficacy outcomes
using different antithrombotic strategies in a trial fibrillation patients
after coronary stenting. PubMed, Scopus, and Cochrane Central were
searched until March 2018. Stroke was the outcome of interest.
 Result(s): Two randomized and 8 prospective studies were included,
with a total of 13,625 participants. Stroke was not significantly
different between dual antiplatelet therapy (DAPT) and TT groups. A
combination with a DOAC and clopidogrel had lower stroke rates than TT or
DAPT. DOAC plus clopidogrel combination had no significant difference as
compared to a combination of a vitamin K-antagonist and single
antiplatelet therapy. Overall, DOAC plus clopidogrel had the highest
probability to be the best strategy to reduce stroke rates.
 Conclusion(s): A DOAC plus clopidogrel combination appears to be the
best strategy to reduce the incidence of stroke in Atrial Fibrillation
patients undergoing coronary artery stenting.

<22>
[Use Link to view the full text]
Accession Number
627104464
Title
Preoperative CT scans reduce the risk of stroke in minimally invasive
mitral valve 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
Leonard J.R.; Henry M.; Rahouma M.; Guy T.S.; Girardi L.N.; Gaudino M.F.
Institution
(Leonard, Henry, Rahouma, Guy, Girardi, Gaudino) Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Minimally invasive mitral valve surgery (MIMVS) is performed
with increasing frequency. However, recent evidence suggests that patients
who undergo MIMVS have an increased risk of perioperative stroke, mainly
due to retrograde aortic embolization during the femoral cardio-pulmonary
bypass that is used for MIMVS. Systematic pre-operative CT screening
allows visualization of the aorta and femoro-iliac vessels and
individualization of the surgical approach to the anatomic and pathologic
characteristics of the single patient. In this meta-analysis, we aim to
determine if systematic pre-operative CT screening decreases the incidence
of perioperative stroke and other complications following MIMVS.
 Method(s): A comprehensive online review was performed in PubMed from
inception to May 2018. Eligible studies included those which reported on
MIMVS (either mini-thoracotomy, port access or robotic approach) with
retrograde arterial perfusion. Studies were separated into two subgroups:
systematic pre-operative CT screening (CT group) and no CT screening
(Non-CT). Pooled event rates (PER) for operative mortality, perioperative
stroke, perioperative myocardial infarction (MI), and new onset renal
failure requiring dialysis (new dialysis) were estimated and inter-group
comparisons were performed. Result(s): Data from 57 studies (13,602
patients) were analyzed (19 CT group and 38 Non-CT). The PER for
perioperative stroke was 1.98% with a statistically significant difference
between the groups (CT group: 1.46% vs Non-CT 2.21%, p =.03). The PER for
new dialysis was 1.87%, significantly lower in the CT group (0.83% vs
2.33%, p=.02) (see Table for details). The PER for operative mortality was
1.36% with a trend towards better outcomes in the CT group (0.80% vs.
1.60%, p =.052). Conclusion(s): Systematic pre-operative CT screening
is associated with significantly lower risk of perioperative stroke and
need for dialysis and a trend toward lower operative mortality after
MIMVS. (Table Presented).

<23>
[Use Link to view the full text]
Accession Number
627104376
Title
Long-term analysis of ventricular function in patients with stable
coronary disease underwent on-pump or off-pump coronary artery bypass
graft in mass iii.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Silva R.R.; Hueb W.; Lima E.G.; Martins E.B.; Batista D.V.; Linhares Filho
J.P.; Rezende P.C.; Garzillo C.L.; Ramires J.A.; Filho R.K.
Institution
(Silva, Hueb, Lima, Martins, Batista, Linhares Filho, Rezende, Garzillo,
Ramires, Filho) 1Clinical Div, Instituto do Coracao (InCor), Hosp das
Clinicas HCFMUSP, Faculdade de Medicina, Univ de Sao Paulo, SP, BR, Sao
Paulo,Brazil, Sao Paulo, Brazil
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Deleterious effects of cardiopulmonary bypass (CB)
associated with inadequate myocardial protection may have implications in
left ventricular function on short-term analysis. Interventions without
the use of this circuit aimed to minimizing these conditions have
inconclusive results and few data are available to assess the long-term
evolution of ventricular function among patients who underwent off-pump
coronary artery bypass graft (OPCAB). Hypothesis: To compare the evolution
of left ventricular ejection fraction (LVEF) in a long-term follow-up
among patients with Coronary Artery Disease underwent OPCAB or on-pump
coronary artery bypass graft (ONCAB). Method(s): Patients with stable
coronary artery disease and initially preserved systolic left ventricular
function were randomized to OPCAB or ONCAB and followed for long-term.
They submitted to a new evaluation of ventricular function by
transthoracic echocardiogram as a post-hoc analysis of MASS III study.
 Result(s): Of 308 patients randomized to OPCAB (n=155) or ONCAB
(n=153), 213 had a new assessment of ventricular function by
echocardiogram in a median of 5.9 years of follow-up: 106 in ONCAB group
and 107 in OPCAB group. There was no difference in LVEF in the beginning
(65+/-7.5 and 70+/-7.8, respectively, for ONCAB and OPCAB, p=0.063) and in
the end of follow-up (60+/-10.8 and 60+/-11.9, respectively, for ONCAB and
OPCAB, p=0.182). On the other hand, it was observed a decrease in LVEF for
ONCAB and OPCAB groups (p<0.001 for both groups). Despite of this, the
decrease was not significantly different between groups (reduction delta
of 6+/-9.7 and 5+/-10.6 for ONCAB and OPCAB respectively, p=0.876).
Moreover, number of grafts per patient was higher in the ONCAB versus the
OPCAB group (3.65 vs. 2.75 grafts, p<0.001). Conclusion(s): Although
there was a small decline in LVEF in both groups, regardless of the
surgical technique applied, there was no difference in the long-term
evolution of LVEF between ONCAB and OPCAB. Incomplete revascularization in
OPCAB does not seem to have influenced these results. (Figure Presented).

<24>
Accession Number
627104351
Title
Machine learning-based early identification of hemodynamic recovery
process after heart transplantation.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Nakamura Y.; Asanoi H.; Toda K.; Miyagawa S.; Yoshikawa Y.; Hata H.;
Yoshioka D.; Kainuma S.; Yoshida S.; Sawa Y.
Institution
(Nakamura, Asanoi, Toda, Miyagawa, Yoshikawa, Hata, Yoshioka, Kainuma,
Yoshida, Sawa) 1Cardiovascular surgery, Osaka Univ, Suita, Japan2Med
Engineering, Osaka Univ, Suita, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Functional recovery of a cardiac allograft varies depending on
various factors, which should be defined individually. The early
prediction of residual allograft dysfunction allows to enforce hemodynamic
management from the early period after heart transplantation (HTX). The
present study was designed to define important variables and predict the
recovery process of the individual allograft during 2 months after HTX
using a machine learning of donor heart conditions, operative factors, and
postoperative hemodynamics. Method(s): Thirty-eight patients, who
underwent HTX in our institution between June 2013 and April 2018, were
enrolled in this study. Residual cardiac dysfunction of allograft in 2
months after HTX was defined by a sustained increase in mean pulmonary
wedge pressure (mPCWP) above 12 mmHg. Important variables for predicting
the residual high mPCWP were searched with an iterative forward selection
method. The optimal classification algorithm for this analysis was
selected by comparing an area under the curve (AUC) and prediction
accuracy. Seventy-five percent of patients were randomly assigned as
training data and the remaining 25% as test data for cross-validation.
 Result(s): Postoperative hemodynamics was characterized by diastolic
dysfunction of the allograft as reflected by an increase in mPCWP and mean
right atrial pressure (RAP) and a non-compliant pattern of RAP waveform.
In 9 patients (24%), mPCWP remained high for 2 months, whereas the others
showed a progressive decline below 12 mmHg. Of a set of 24 features,
useful predictors of residual high mPCWP involve dopamine usage before
donor heart retrieval, cardiac ischemic time, cardiopulmonary bypass time,
operative time, mean RAP, mean pulmonary artery pressure, and mPCWP. Among
various combinations of the above features, a support vector machine
predicted the residual diastolic dysfunction of the allograft 2 months
after HTX with an accuracy of 87.9 % and AUC of 0.71. Conclusion(s):
Machine learning of early postoperative data makes it possible to identify
a delayed recovery of diastolic dysfunction of the allograft. These
methods would provide a new approach to optimize individual management
after HTX.

<25>
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Accession Number
627104317
Title
Prognostic assessment of right ventricular systolic dysfunction on
post-transcatheter aortic valve replacement short term outcomes: 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
Grevious S.N.; Croix G.R.S.; Ibrahim M.; Fernandes M.; Cohen M.; De
Marchena E.; Alfonso C.E.
Institution
(Grevious, Croix, Ibrahim, Fernandes, Cohen, De Marchena, Alfonso)
Internal Medicine, Univ of Miami, Miller Sch of Med, Miami, FL, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Right ventricular systolic dysfunction (RVSD) is a risk
factor for adverse effect with surgical aortic valve replacement (SAVR).
Previous studies demonstrated the beneficial effect of transcatheter
aortic valve replacement (TAVR) on right ventricular (RV) systolic
function. Although RVSD is not a contraindication to TAVR, its overall
prognostic significance has not been clearly determined. We conducted a
systematic review and meta-analysis to define the impact of RVSD on
outcomes in terms of 1-year mortality in patients with severe aortic
stenosis (AS) undergoing TAVR. Method(s): An extensive literature
review was performed, analyzing articles published in peerreviewed
journals between January 2002 and July 2017, available in 8 databases
including PubMed, Embase, Cochrane Library, ACP Journal Club, DARE, Google
Scholars, and Scopus. The aim was to identify randomized and nonrandomized
clinical studies that focused on the prognosis and short-term mortality of
patients with severe symptomatic AS who underwent TAVR. Emphases were
placed on studies that noted a history of RVSD, RV dilation, and tricuspid
regurgitation (TR) compared to patients with normal right heart function
(Figure 1). Result(s): A total of 3166 patients from 8 selected
studies conducted in single-centers were included. Mean age was 80.4 +/-
3.7 years, with no difference in sex distribution (Table 1). RVSD, as
assessed with TAPSE, FAC or ejection fraction was not an independent
predictor of adverse procedural outcome after TAVR (Hazard Ratio [HR]
1.26; 95% confidence interval [CI], 0.84-1.88; P = 0.27) (Figure 2).
Overall, we found that RVSD did not affect post-TAVR prognosis in 1-year
mortality rate. In addition, the funnel plot revealed similar outcomes
distribution thereby publication bias not suggested (Figure 3).
 Conclusion(s): Despite the presence of RVSD, patients with severe,
symptomatic AS had similar 1-year mortality post-TAVR as those without
RVSD. RV dilation and severe TR were associated with increased 1-year
morality post-TAVR and should be considered as independent risk factors.
Further evaluation of long-term morbidity, mortality, and sustained
improvement in functional class and symptoms need to be evaluated in order
to determine the long-term effects. (Figure Presented).

<26>
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Accession Number
627104292
Title
Perioperative myocardial injury after non-cardiac surgery: 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
Redel-Traub G.; Hausvater A.; Armanious A.; Nicholson J.; Berger J.;
Smilowitz N.
Institution
(Redel-Traub, Hausvater, Armanious, Nicholson, Berger, Smilowitz) Sch of
Medicine, NYU Sch of Medicine, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Myocardial injury after non-cardiac surgery (MINS) is a major
perioperative complication of non-cardiac surgery and is associated with
increased risk for morbidity and mortality. The purpose of this systematic
review was to determine the incidence, clinical features, and outcomes of
MINS. Method(s): We searched PubMed, Embase, Central and Web of
Science databases for full-text manuscripts reporting the incidence,
clinical features, and outcomes of MINS. A full-text review of the 425
studies by two independent reviewers found 195 studies that met inclusion
criteria. Result(s): Among the 195 studies, 173 studies provided data
on the incidence of MINS in 546,788 surgeries. Overall, the incidence of
MINS was 17.9% (95% CI 16.2%-19.6%). Patients with MINS were significantly
more likely to have hypertension, coronary artery disease, prior
myocardial infarction, heart failure, and kidney disease compared with
patients without MINS (Table). In-hospital post-operative mortality was
higher among patients with MINS than among patients without MINS (8.1%
versus 0.4%, p<0.001). Mortality at 1 year was 20.6% among patients with
MINS and 5.1% among patients without MINS (p<0.001). Beyond 1 year,
mortality was 42.7% among patients with MINS and 19.7% among patients
without MINS (p<0.001). Conclusion(s): MINS occurs frequently in
clinical practice among patients with cardiovascular disease and risk
factors and is associated with significantly increased short and long-term
mortality.

<27>
Accession Number
627104229
Title
Renal function and coronary bypass surgery in patients with ischemic heart
failure-insights from the stich trial.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Doenst T.; Haddad H.; Stebbins A.; Hill J.A.; Velazquez E.J.; Lee K.L.;
Rouleau J.L.; Sopko G.; Jeemon P.; Farsky P.S.; Szwed H.; Tan R.S.;
Bigalli D.R.; Kosevic D.; Benke K.; Kalil R.A.; Jasinski M.; Smith P.K.;
Chua Y.L.; Al-Khalidi H.R.
Institution
(Doenst, Haddad, Stebbins, Hill, Velazquez, Lee, Rouleau, Sopko, Jeemon,
Farsky, Szwed, Tan, Bigalli, Kosevic, Benke, Kalil, Jasinski, Smith, Chua,
Al-Khalidi) 1Cardiothoracic Surgery, Univ Jena, Jena, Germany2Dept of
Medicine, Univ of Saskatchewan, Saskatoon, Canada3Duke Clinical Rsch
Institute, Duke Clinical Rsch Institute, Durham, NC4Dept of Medicine Div
of Cardiovascular Medicine, Univ of Florida, Gainesville, FL5Dept of
Medicine (Cardiology), Duke Univ Sch of Medicine, Durham, NC6Dept of
Biostatistics and Bioinformatics, Duke Univ Sch of Medicine Duke Clinical
Rsch Institute, Durham, NC7Dept of Medicine Montreal Heart Institute, Univ
of Montreal, Montreal, Canada8Div of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute National Institutes of Health, Bethesda,
MD9Epidemiology, Sree Chitra Tirunal Institute for Med Sciences and
Technology, Thiruvananthapuram, Kerala 695011, India10Dept of Cardiology,
Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil112nd Dept of
Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland12Dept of
Cardiology, National Heart Cntr Singapore, Singapore, Singapore13Dept of
Cardiac Surgery, CICU, Casa De Galicia, Montevideo, Uruguay14Dept of
Cardiology, Dedinje Cardiovascular Institute, Belgrade, Serbia15Heart and
Vascular Cntr, Semmelweis Univ, Budapest, Hungary16Postgraduate Program,
Instituto de Cardiologia/FUC and UFCSPA, Porto Alegre, Brazil17Dept of
Cardiac Surgery, Wroclaw Med Univ, Wroclaw, Poland18Dept of Surgery
(Cardiothoracic), Duke Univ Sch of Medicine Duke Clinical Rsch Institute,
Durham, NC19Dept of Cardiothoracic Surgery, National Heart Cntr Singapore,
Singapore, Singapore
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Impaired renal function is a known risk factor in
cardiovascular (CV) disease but its influence on the treatment effect of
bypass surgery (CABG) is not clear, specifically in heart failure (HF).
Hypothesis: To assess the influence of renal function on 10-year mortality
and CV outcomes in ischemic HF patients (pts) treated with medical therapy
(MED) with or without CABG. Method(s): We calculated baseline
estimated glomerular filtration rate (eGFR, CKD-EPI formula) from 1209 pts
randomized to either MED or CABG in the Surgical Treatment for IsChemic
Heart failure (STICH) trial. Pts were classified by established chronic
kidney disease (CKD) stages (Stage 1: eGFR >90ml/min, n=232; Stage 2: eGFR
60-89ml/min, n=646; Stage 3: eGFR 30-59ml/min, n=303; Stage 4/5:
<30ml/min, n=28). Cox proportional hazard models were used to assess the
effect of CKD on death, CV death, stroke, and death or CV
rehospitalization (rehosp) and its interaction with treatment effect (CABG
vs. MED). Result(s): In the overall STICH cohort, pts in CKD stages
3-5 were older, had more diabetes, peripheral vascular disease, a trial
fibrillation, angina pectoris, triple-vessel disease and strokes than
those in stages 1/2 (all p<0.05). Cox regression revealed an independent
linear relationship between the risk of death and eGFR (HR=0.94, 95% CI
0.92-0.97, for each 5ml/min increase in GFR; p<0.001). The same was true
for CV death and/or CV rehosp (both p<0.001) but not for stroke (p=0.169).
There were no differences in the baseline characteristics between the two
treatment arms for each CKD stage. The trial's primary outcome showed a
significant 10-year survival improvement by CABG. Significant improvements
in death or CV rehosp rates with CABG were present in CKD stages 1-3.
These data were inconclusive in stages 4/5 due to small sample size.
Interaction testing between treatment and CKD stages revealed no
significant interaction of eGFR with the treatment effect of CABG (p=0.25
for death and 0.54 for death or CV rehosp). Conclusion(s): Impaired
renal function is an independent risk factor for mortality in pts with
ischemic HF with or without CABG. However, mild to moderate impairment of
renal function does not appear to influence the long-term treatment effect
of CABG.

<28>
[Use Link to view the full text]
Accession Number
627104223
Title
A meta-analysis on performance of current risk models in predicting short
term mortality after transcatheter aortic valve replacement.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Khan M.S.; Usman M.S.; Siddiqi T.J.; Khan M.A.; Riaz H.; Murad M.H.;
Kavinsky C.J.; Kalra A.; Doukky R.; Desai M.Y.; Bhatt D.L.
Institution
(Khan, Usman, Siddiqi, Khan, Riaz, Murad, Kavinsky, Kalra, Doukky, Desai,
Bhatt) 1nternal Medicine, John H Stroger Jr Hosp of Cook, Chicago,
IL2Internal Medicine, Dow Univ of Health Sciences, Karachi,
Pakistan3Cardiology, Cleveland Clinic, Cleveland, OH4Evidence-based
Practice Cntr, Mayo Clinic, Rochester, MN5Cardiology, Rush Univ Med Cntr,
Chicago, IL6Heart & Vascular Institute, Univ Hosps Cleveland Med Cntr,
Cleveland, OH7Cardiology, John H Stroger Jr Hosp of Cook, Chicago,
IL8Cardiology, Brigham and Women's Hosp Heart & Vascular Cntr, Boston, MA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Several risk models have been designed to assess the risk of
short-term mortality after transcatheter aortic valve replacement (TAVR).
However, it is unknown which of these models provide optimal results.
Furthermore, the value of surgical risk models in predicting post-TAVR
mortality remains controversial. Objective(s): To conduct a
meta-analysis to evaluate and compare available risk models.
 Method(s): MEDLINE and Scopus were queried to identify studies which
validated risk models designed to assess short term (30-day or
in-hospital) mortality after TAVR. Discrimination and calibration were
assessed using C-statistics and observed/expected ratios (OERs)
respectively. Results from studies validating a particular model were
pooled together. C-statistics were pooled using a random-effects inverse
variance method while OERs were pooled using the Peto odds ratio
technique. A c-statistic >0.7 and OER close to 1.0 were used to define a
good risk model. Result(s): Seventeen studies (n=41,364) validating
nine risk models (6 TAVR, 3 surgical) were identified. Discrimination
among models was generally poor (Figure 1a), with only one having a C>0.7;
however, a wide confidence interval makes even this result less reliable
(C=0.75 [0.41, 1.36]). The STS-PROM and STS/ACC-TVT models (Figure 1b) had
good calibration (OERs: 1.13 [0.94, 1.35] and 1.08 [0.93, 1.27],
respectively). All other models either significantly underestimated or
overestimated mortality. Conclusion(s): The majority of new TAVR
scales did not report OER data. Amongst currently available models, the
STS/ACC-TVT risk model appears to be the most useful when both
discrimination and calibration are taken into account.

<29>
[Use Link to view the full text]
Accession Number
627104133
Title
Del nido versus blood cardioplegia in isolated coronary artery bypass
surgery with left ventricular dysfunction.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Umana-Pizano J.B.; Estrera A.L.; Hoffmann C.; Lambeth K.; Guercio A.;
Nguyen S.; Zaki J.; Nguyen T.C.
Institution
(Umana-Pizano, Estrera, Hoffmann, Lambeth, Guercio, Nguyen, Zaki, Nguyen)
1Cardiothoracic and Vascular Surgery, Univ of Texas Heath Science Cntr at
Houston, Houston, TX2McGovern Med Sch, Univ of Texas Heath Science Cntr at
Houston, Houston, TX3Cardiothoracic and Vascular Surgery, Memorial Hermann
Hosp, Houston, TX4Anesthesiology, Univ of Texas Heath Science Cntr at
Houston, Houston, TX
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There exists a paucity of data supporting the use of Del
Nido (DN) cardioplegia in isolated coronary artery bypass patients with
left ventricular dysfunction and at times anecdotally cautioned. The
objective of this study is to therefore compare DN versus whole blood
cardioplegia (BC) in this high-risk cohort. Method(s): A
single-center retrospective review of 1,473 patients undergoing isolated
coronary artery bypass (CABG) was performed from 2013 to 2017. Patients
with left ventricular dysfunction (ejection fraction <40%, EF) were
included in the analysis (n=383) and stratified based on cardioplegia
strategy: del Nido (n=70) versus blood cardioplegia (n=313). DN was
delivered primarily antegrade while BC was delivered via both antegrade
and retrograde. Short-term outcomes were compared. Result(s): There
was no difference in the STS risk score between DN (6.0+/-9.8%) and BC
(5.1+/-7.7%) groups, p=0.2. The mean age and EF for DN and BC were 63.0
+/-11.3 vs. BC 63.3 +/-10.3 years (p=0.8) and 29.9+/-6.0 vs. 29.1+/-6.3 %
(p=0.4), respectively. Aortic cross clamp and cardiopulmonary bypass times
were shorter with DN: 49.0 vs. 75.5 (minutes) and 100.0 vs.110.0
(minutes), respectively, p<0.0. The total volume of delivered cardioplegia
was higher in DN (800.0 vs. 582.6mL, p<0.01). Both DN and BC resulted in
postoperative EF improvement (DN: 29.9% to 34.2%; BC: 29.1% to 34.2%).
There was no difference in postoperative stroke, blood transfusions,
inotropic support, new atrial fibrillation or 30-day mortality between
groups. ICU hours were lower in DN (120.6 vs.141.4 hours, p=0.04).
Intraoperative defibrillation was lower in DN (10.2% vs. 31.7%, p<0.01).
 Conclusion(s): Del Nido cardioplegia can be safely used in i1solated
CABG patients with left ventricular dysfunction and may be associated with
decreased ICU length of stay, need for intraoperative defibrillation,
bypass and aortic clamp times although further prospective randomized
trials are needed. (Table Presented).

<30>
Accession Number
627104103
Title
Transfusion strategies in cardiac surgery-meta-analysis of the randomized
clinical trials.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Fatima U.; Khan S.; Venkata S.D.; Sumon M.; Awan A.; Yaqoob H.; Akanbi O.;
Alaie P.; Mehrotra P.; Opoku-Asare I.
Institution
(Fatima, Khan, Venkata, Sumon, Awan, Yaqoob, Akanbi, Alaie, Mehrotra,
Opoku-Asare) 1DEPARTMENT OF CARDIOLOGY, Howard Univ Hosp, Washington,
DC2DEPARTMENT OF CARDIOLOGY, Safi Khan, Sayre, PA3DEPARTMENT OF INTERNAL
MEDICINE, Howard Univ Hosp, Washington, DC4Internal medicine, Howard Univ
Hosp, Washington, DC5College of medicine, Howard Univ College of Medicine,
Washington, DC
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Pre-operative anemia is common in patients undergoing cardiac
surgery. Recent randomized controlled trial TRICS, showed that restrictive
transfusion strategy was non-inferior to liberal approach, however, the
optimal transfusion threshold in these patients remains uncertain.
Hypothesis: Restrictive versus liberal transfusion strategy in patients
undergoing cardiac surgery should generate clinical differences.
 Method(s): 8 randomized controlled trials that predominantly compared
liberal versus restrictive transfusion strategy in patients undergoing
coronary artery bypass grafting and valve surgery were selected using
Medline, EMBASE, CENTRAL from inception of the databases to March, 2018.
Restrictive and liberal strategy was defined as indicated in each trial.
Mean hemoglobin in the restrictive arm was 8.1 g/dl and that in liberal
strategy was 9.8g/dl. Primary outcome of interest was all-cause mortality
and secondary outcomes measured were myocardial infarction, arrhythmia,
gastrointestinal, infectious, neurological, pulmonary and renal events.
Estimates were reported as random effects relative risk (RR) with 95 %
confidence interval (CI). Result(s): In analysis of 8,658 patients,
there were no differences between restrictive strategy versus liberal
strategy in decreasing all-cause mortality (RR, 1.12, 95 % CI, 0.76-1.65,
P = 0.56), myocardial infarction (RR, 1.00, 95 % CI, 0.80-1.24, P = 0.99),
arrhythmia (RR, 0.98, 95 % CI, 0.751.29, P = 0.88), gastrointestinal
events (RR, 0.89, 95 % CI, 0.54-1.48, P = 0.66), infections (RR, 1.08, 95
% CI, 0.96-1.22, P = 0.21), neurological events (RR, 1.13, 95 % CI,
1.00-1.27, P = 0.05), pulmonary events (RR, 1.05, 95 % CI, 0.89-1.24, P =
0.56) or renal events (RR, 1.00, 95 % CI, 0.93-1.07, P = 0.91).
 Conclusion(s): There were no significant differences between
restrictive transfusion strategy versus liberal transfusion strategy in
decreasing mortality and adverse clinical outcomes in patients undergoing
cardiac surgery. Therefore it can be postulated that hemoglobin of around
8.1 g/dl is likely optimum for patients undergoing cardiac surgery.
However, adequately powered randomized trials are needed to confirm these
findings.

<31>
Accession Number
627103937
Title
Cerebrovascular microemboli in TAVI patients the role of drug related
platelet inhibition.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Vavouranakis M.; Kalantzis C.; Kariori M.; Voudris V.; Toutouzas K.;
Kosmas E.; Kalogeras K.; Moldovan C.-M.; Latsios G.; Kolokathis A.-M.; Bei
E.; Vrachatis D.; Katsarou R.; Siasos G.; Tousoulis D.; Vavuranakis M.
Institution
(Vavouranakis, Kalantzis, Kariori, Voudris, Toutouzas, Kosmas, Kalogeras,
Moldovan, Latsios, Kolokathis, Bei, Vrachatis, Katsarou, Siasos,
Tousoulis, Vavuranakis) 11st Dept of Cardiology, Hippokration Hosp, Med
Sch, National & Kapodistrian Univ of Athens, Athens, Greece22nd Div of
Interventional Cardiology, Onassis Cardiac Surgery Cntr, Athens, Greece,
Kallithea, Greece
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Whether non-thienopyridines (ticagrelor) may protect
patients more efficiently from microembolic events during Transcatheter
Aortic Valve Implantation (TAVI) has not been investigated. We assessed
the hypothesis that ticagrelor+ASA will reduce the number of microemboli
towards the cerebral circulation during TAVI comparing to the combination
of clopidogrel+ASA. Method(s): Consecutive patients from PTOLEMAIOS
study who underwent TAVI with EvolutTM R bioprosthesis, were randomized
into two groups. Group 1 patients treated with clopidogrel plus ASA, Group
2 patients treated with ticagrelor plus ASA. All patients received ASA
80mg od 7 days prior to the TAVI procedure and for 90 days afterwards.
Patients randomized in Group 2 received ticagrelor 90mg bid one day prior
to the procedure and for 90 days afterwards, while those randomized in
Group 1 received a loading dose of 300 mg one day prior to the TAVI,
followed by 75mg od for 90 days. The number of high intensity transient
signals (HITS) was assessed with Rimed Digi-LiteTM Transcranial Doppler on
both cerebral arteries peri-operatively during the following phases; Phase
0: 30 minutes prior to procedure initiation, Phase I: between access site
puncture and introduction of the delivery system, Phase II: during the
implantation of the bioprosthesis, until the removal of the delivery
system. Patients were evaluated by neurologist before TAVI and on
discharge day. Safety was evaluated by VARC-2 criteria. Result(s):
Twenty eight patients were evaluated (81+/-7 years, 18 males (64%)) and
16969 HITS were recorded. Group 1 had higher number of total (737+/-133
vs. 475+/-71, p<0.001) as well as Phase I HITS (413+/-107 vs. 212+/-78,
p<0.001). All implantations were performed without predilation. One
cerebrovascular event was recorded in Group 1 and one patient randomized
to Ticagrelor developed major bleeding due to conversion to femoral
surgical cut-down. The average number of received blood units, was higher
in Ticagrelor compared to Clopidogrel group (Group 1: 0.7+/-0.8 vs. Group
2: 1.4+/-2.8, p: 0.886), without however, reaching statistical
significant. Conclusion(s): Ticagrelor+ASA decreased the number of
HITS during TAVI. However, the long term clinical impact of this study
needs to be further evaluated.

<32>
Accession Number
627103918
Title
More-vs. Less-intensive lipid lowering therapy: Systematic review and 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
Toyota T.; Morimoto T.; Yamashita Y.; Shiomi H.; Kato T.; Makiyama T.;
Nakagawa Y.; Saito N.; Shizuta S.; Ono K.; Kimura T.
Institution
(Toyota, Morimoto, Yamashita, Shiomi, Kato, Makiyama, Nakagawa, Saito,
Shizuta, Ono, Kimura) 1Dept of Cardiovascular Medicine, Kyoto Univ Hosp,
Kyoto, Japan2Dept Of Clinical Epidemiology, Hyogo College Of Medicine,
Nishinomiya, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: It has not been yet adequately addressed whether the
addition of the non-statin low-density lipoprotein cholesterol (LDL-C)
lowering agents on top of statins has the same magnitude of risk reduction
in the cardiovascular events as compared with more intensive statin
therapy. Method(s): We performed a systematic review and
meta-analysis of randomized controlled trials comparing the more- versus
less-intensive lipid-lowering therapy (LLT) on clinical outcomes in
patients with atherosclerotic cardiovascular risk. The primary outcome
measure was major adverse cardiovascular events (MACE), which was
equivalent to the composite of coronary heart death, nonfatal myocardial
infarction, stroke, or coronary revascularization. Result(s): We
included 23 studies involving 133,037 patients (more-intensive LLT: 67,691
patients, and less-intensive LLT: 65,346 patients). We evaluated 3 types
of more- versus less-intensive LLT, including more- versus less-statins
(12 studies, 57,672 patients), combination therapy of ezetimibe versus
statins alone (4 studies, 20,688 patients) or a proprotein convertase
subtilisin-kexin type 9 (PCSK9) inhibitors with statins versus statins
alone (7 studies, 54,677 patients). The risk for MACE was significantly
lower in the more-intensive LLT group compared with the less-intensive LLT
group in the entire study population (odds ratio [OR] 0.84, 95% confidence
interval [CI] [0.79-0.88], P<0.001), and in all the 3 categories of more
intensive LLT strategies (more-intensive statin therapy: OR 0.83, 95%CI
[0.76-0.90], P<0.001, ezetimibe: OR 0.90, 95%CI [0.85-0.96], P<0.001, and
PCSK9 inhibitors: OR 0.81, 95%CI [0.73-0.90], P<0.001) with numerically
greater relative risk reduction by more-intensive statin therapy and PCSK9
inhibitors than by ezetimibe. Relative risk reduction for MACE per 20mg/dl
LDL-C reduction was also different across the 3 types of more-intensive
LLT (more-intensive statin therapy: 17.4%, ezetimibe: 11.0%, and PCSK9
inhibitors: 6.6%). Conclusion(s): In this meta-analysis of 23
randomized controlled trials, more-intensive LLT as compared with
less-intensive LLT was associated with significant risk reduction for MACE
in the entire study population and in all the 3 categories of
more-intensive LLT such as more-intensive statin therapy, ezetimibe, and
PCSK9 inhibitors. However, overall relative risk reduction for MACE, as
well as relative risk reduction for MACE per 20mg/dl LDL-C reduction were
different across the 3 types of more-intensive LLT.

<33>
Accession Number
627103912
Title
The role of anticoagulation on neurological complication events and
mortality in patients with infective endocarditis, 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.; Sherrod C.F.; Thakker J.; Abbas M.; Noman A.; Abdulhak
A.A.B.
Institution
(Elkaryoni, Sherrod, Thakker, Abbas, Noman, Abdulhak) 1nternal Medicine,
Univ of Missouri Kansas City, Kansas City, MO2Sch of Medicine, Univ of
Missouri Kansas City, Kansas City, MO3Neurology, Univ of Alexandria,
Alexandria, Egypt4Cardiovascular Disease, Univ of Iowa Carver College of
Medicine, Iowa City, IA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Anticoagulation (AC) and infective endocarditis (IE) is an
area of unestablished evidence of advantage or safety. The absence of
randomized control trials and the high risk of bleeding generated this
uncertainty. Neurological complication is common, fatal and associated
with high mortality. Observational studies were conflicting in this
context however given deficient data about the role of AC in preventing
thromboembolic complications, the decision was to personalize using AC to
the underlying comorbidities as in prosthetic valves and atrial
fibrillation. Hypothesis: We conducted a systematic literature review and
meta-analysis to assess the role of AC on neurological complications and
mortality in IE Methods: PubMed, Cochrane Central Register of Controlled
Trials (CENTRAL), and Embase were searched from inception through March
2018. Original studies of IE patients that compared neurological
complications and mortality among those with and without AC were included.
Primary outcomes were neurological events and mortality. The analysis was
done using a random-effects model. Odds ratios are expressed with 95%
confidence intervals (CIs). Result(s): Seven observational studies
with a total 2863 patients with IE met the inclusion criteria. AC during
the initial diagnosis of IE 551 patients and no AC 2312 patients. Among
2863 patients with IE, total neurological complications events (ischemic
infarction, cerebral hemorrhage, mycotic aneurysm, and meningitis) were
686. Meta-analysis showed no difference in neurological complications
events in patient with and without AC (OR: 1.01, 95% (CI): [0.53 - 1.93];
p=0.000, I2=81.3%). Mortality did not have significant difference
regardless of being on AC or not (OR: 1.33, 95% (CI): [1.076 - 1.651 ];
p=0.0085). Subgroup analysis was done to assess odds of cerebral
hemorrhage while on AC (OR: 2.496, 95% (CI): [1.658 - 3.757]; p=0.0001).
Subgroup analysis was done for Odds of neurological complications in the
setting of prosthetic valve (OR: 0.933, 95% confidence interval (CI):
[0.734 - 1.185]; p=0.5706). Conclusion(s): No significant effect for
AC on Neurological complications and mortality in IE. However, AC showed
increased incidence of cerebral hemorrhage events. Prosthetic valve did
not show higher odds for neurological complications but keep in mind most
of these patients usually on AC during diagnosis of IE. AC showed be
individualized according to underlying comorbidities and estimated risk of
bleeding.

<34>
[Use Link to view the full text]
Accession Number
627103883
Title
Antithrombotic regimens to prevent major cardiovascular events in atrial
fibrillation patients after coronary stenting: systematic review and
network 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 - Univ of Miami, Miami, FL2Cardiology,
Johns Hopkins, Baltimore, MD3Cardiology, Univ of Miami Miller Sch of
Medicine, Miami, FL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The optimal antithrombotic regimen in atrial fibrillation
patients after an acute coronary syndrome is still controversial.
 Method(s): Systematic review and network meta-analysis of randomized
and prospective studies for safety and efficacy outcomes using different
antithrombotic strategies in atrial fibrillation patients after coronary
stenting. PubMed, Scopus, and Cochrane Central were searched until March
2018. Result(s): Two randomized and 16 prospective studies were
included, with a total of 23,996 participants. A DOAC in association with
clopidogrel had the highest probability to be the best strategy to reduce
all-cause mortality and MACE. Both Triple therapy had a DOACs with
clopidogrel had a lower all-cause mortality than dual antiplatelet therapy
(DAPT). DOACs with clopidogrel showed a lower incidence of MACE when
compared to DOAC. DOACs in association clopidogrel had a nominally lower
major bleeding rate than triple therapy, and a significantly lower major
bleeding as compared to DAPT. Conclusion(s): In the treatment of
atrial fibrillation patients after coronary stenting, a DOAC plus
clopidogrel combination, not triple therapy or dual antiplatelet therapy,
appears to provide the best balance between thrombotic and bleeding
events.

<35>
[Use Link to view the full text]
Accession Number
627103844
Title
Gender differences in the presentation and prognosis of patients with
danon disease.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Brambatti M.; Maolo A.; Koshi E.; Taylor M.; Adler E.
Institution
(Brambatti, Maolo, Koshi, Taylor, Adler) 1Medicine, Univ of California San
Diego, San Diego, CA2Medicine, Univ of Colorado and Adult Med Genetics,
Aurora, CO
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Danon Disease (DD) is a rare X-linked disorder with high
morbidity and mortality. Clinical features include skeletal myopathy,
hypertrophic cardiomyopathy (HCM), and neurologic symptoms. The first
cases were described in 1981; however, gender differences are still poorly
understood. Method(s): From 773 manuscripts published from 20002017
in MEDLINE and EMBASE, we identified 180 cases. We included in the
principal analysis 146 patients diagnosed with a genetic test (if index
case) or muscle biopsy (if a relative of the index case). Result(s):
Symptoms first occurred in males significantly earlier than females
(median age 9 years vs. 23 p<0.001). Cardiomyopathy occurred in 91% of
patients, the majority of whom had HCM. Thirty-seven (25.3%) patients
received automated cardiac defibrillators, as primary prevention in 64.9%
of cases. Males with hypertrophy were twice as likely to develop advanced
heart failure at a median age of 21 years. Conversely, dilated
cardiomyopathy (DCM) was 4 times more prevalent in females (n=12, 75%)
compared to males (n=3, 19%). Intellectual disability was significantly
more frequent in males (53.9% males vs. 9% females with a median age of
onset of 6 and 19, respectively, p=0.829). Abnormalities in the laboratory
tests, such as AST, ALT or CK were described in 62.5 % of the population
(83.3% of males and 15.6% female). Muscle myopathy was described in 64
(49%) cases 57 (63.3%) males and 7 (12.7%) female-sat a median age of 13
years and 19, respectively (p=0.826). Overall, 51 patients (34.9 %) died
or required a left ventricular assist device (LVAD) or heart transplant
(HTx). Median age at the time of death/HTx/LVAD was 26 years and 52 years
in males and females, respectively (p <0.001 by the log-rank test) (fig
1). Although not statistically significant, males were more likely to
experience temporary complications after HTx compared to females (25% vs.
0%, p=0.136). Conclusion(s): Despite being an X linked disease,
females with Danon have significant morbidity and a shortened lifespan.
DCM is more prevalent in females, while HCM and postHtx complications were
more prevalent in males. Both genders had a prolonged survival as compared
to prior studies, possibly reflecting increased awareness and earlier
diagnosis.

<36>
[Use Link to view the full text]
Accession Number
627103789
Title
A new risk model for prognostic prediction after transcatheter aortic
valve replacement.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Maeda K.; Kuratani T.; Pak K.; Shimamura K.; Yamamoto J.; Mizote I.;
Ichibori Y.; Toda K.; Sakata Y.; Sawa Y.
Institution
(Maeda, Kuratani, Pak, Shimamura, Yamamoto, Mizote, Ichibori, Toda,
Sakata, Sawa) 1Dept of Cardiovascular Surgery, Osaka Univ Graduate Sch of
Medicine, Osaka, Japan2Dept of Clinical Medicine (Biostatistics), Kitasato
Univ Shool of Pharmacy, Tokyo, Japan3Dept of Cardiology, Osaka Univ
Graduate Sch of Medicine, Osaka, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Current recommendations for transcatheter aortic valve
replacement (TAVR) by the guidelines are that TAVR should be carried out
in patients with a life expectancy >1 year. Furthermore, patients with a
life expectancy >2 year are enrolled in the recent lowrisk trials.
However, it is challenging to predict the patients' life expectancy
because it is associated with various factors including frailty and
nutritional status. Hypothesis: A new risk model can predict prognosis of
patients after TAVR. Method(s): 388 patients undergoing TAVR between
Oct. 2009 and Aug. 2016 were randomly divided into 2 groups with 2:1 ratio
(259 as training and 129 as validation cohorts). Using 94 baseline factors
in the training cohorts, possible scoring models were developed by Cox
proportional hazard regression model with the overall survival as the
endpoint. Cross validated 5year Cstatistics was calculated to evaluate the
accuracy of the model. Result(s): Among 94 baseline factors, 12
factors were finally determined (5year Cstatistics in the training cohort:
0.709); age, gender, body mass index (BMI), ejection fraction (EF), %
vital capacity (%VC), forced expiratory volume 1.0(sec) % (FEV ), albumin,
hemoglobin, creatine, platelet, creatine kinase (CK), and prothrombin time
international normalized ratio (PTINR)). The cross validated 1, 3and 5year
Cstatistics in the validation cohort were 0.792, 0.758, and 0.778,
respectively. Furthermore, calibration plots in the validation cohort
revealed that the actual survivals until 5 years were well predicted
(r=0.962; Figure). Conclusion(s): The new survival prediction model
for AS patients would be helpful in appropriate guidance for the decision
to implement TAVR.

<37>
Accession Number
627103754
Title
Diagnostic accuracy of dobutamine stress echocardiography in the detection
of cardiac allograft vasculopathy in heart transplant recipients: A
systematic review and meta-analysis study.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Elkaryoni A.; Altibi A.M.; Hassan A.; Elgebaly A.; Elsabbagh E.M.; Nanda
N.C.
Institution
(Elkaryoni, Altibi, Hassan, Elgebaly, Elsabbagh, Nanda) 1Internal Medicine
Univ of Missouri Kansas City, Kansas City, MO2Internal Medicine, Univ of
Pittsburgh Med Cntr, Pittsburgh, PA3Sch of Medicine, Univ of Missouri
Kansas City, Kansas City, MO4Internal Medicine, Faculty of Medicine,
AlAzhar Univ, Cairo, Egypt5Pediatrics, Univ of Chicago, Chicago,
IL6Cardiovascular Disease, Univ of Alabama at Birmingham, Birmingham, AL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Cardiac allograft vasculopathy (CAV) is an important cause
of death after the first year following cardiac transplantation. The
absence of classic signs of myocardial ischemia because of cardiac
denervation and the presence of concentric hypertrophy tend to prevent
early recognition. Currently, cardiac catheterization (CC) and
intravascular ultrasound represent the gold standard for identifying CAV
but their use is limited due to high cost, limited number of trained
professionals, and risk of contrast toxicity in patients with underlying
kidney disease especially those using nephrotoxic immunosuppressive
medication. Hence, there is a need to find a noninvasive alternative to
CC. Dobutamine stress echocardiography (DSE), a noninvasive technique,
initially showed promise but later studies showed limitations in
predicting CAV. Hypothesis: We conducted a systematic literature review
and meta-analysis to assess the effectiveness of DSE in detecting CAV
Methods: We searched PubMed, Cochrane Central Register of Controlled
Trials (CENTRAL), and Embase from inception till January 2018. Original
articles that compared the diagnostic accuracy of DSE for early CAV
detection were included. Relevant data were extracted and analyzed using
RevMan version 5.3 for window and summary receiveroperating characteristic
(SROC) curve was constructed. Result(s): Seven studies with 606
patients were included. The study quality ranged from low to high
according to QUADAS2 tool. The sensitivity and specificity of DSE varied
greatly, the sensitivity range was 15 to 99%, and the specificity 83 to
99%. In a SROC model, the area under curve was 0.88 (SE =0.05) and index
Q* value was 0.812 (SE =0.059). Overall, the pooled sensitivity of DSE was
15.27% (95% CI 11.14% to 20.20%) and the pooled specificity was 95.47 %
(95% CI 92.64% to 97.44%). The pooled effect estimates were significantly
heterogeneous (p <0.01). Conclusion(s): DSE has a limited sensitivity
to detect early CAV but its specificity is very high. There remains a need
for an alternative noninvasive modality which will have both high
sensitivity and high specificity for detecting CAV.

<38>
[Use Link to view the full text]
Accession Number
627103751
Title
Quality of life improvements at one and twelve months post-TAVR: Results
from a mixed meta-regression.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Knoepke C.E.; Carroll A.M.; Allen L.A.; Carroll J.D.; Ingle P.; Gama K.D.;
Valle J.A.; Kunkel F.; Matlock D.D.
Institution
(Knoepke, Carroll, Allen, Carroll, Ingle, Gama, Valle, Kunkel, Matlock)
1Div of Cardiology, Univ of Colorado Sch of Medicine, Aurora, CO2Sch of
Medicine, Univ of Colorado, Aurora, CO3Adult & Child Consortium for
Outcomes Rsch & Delivery Science, Univ of Colorado Sch of Medicine,
Aurora, CO4Cardiology, Denver Veterans Affairs Hosp, Aurora, CO5Div of
Geriatric Medicine, Univ of Colorado Sch of Medicine, Aurora, CO
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Many patients with severe aortic stenosis (AS) have the option
of transcatheter aortic valve replacement (TAVR). Individual treatment
considerations hinge on the likelihood of improvements to quality of life
(QOL), especially when uncertainty is amplified by the presence of
comorbidities or the necessity of non-transfemoral approaches.
 Method(s): Using PRISMA guidelines, we conducted an ongoing
multi-database search for all trials of TAVR including QOL assessment at 1
and 12 mos post-procedure. Trials were included if they were published in
English since 2013 and used either the KCCQ or SF-12 as outcome measures.
We performed a mixed-effects meta-regression of extant trial data to
determine whether short and long-term quality of life (QOL) improvements
attributable to TAVR differed according to patient surgical risk
(inoperable, high, or intermediate) or access approach (transfemoral or
alternate). Result(s): We identified 29 total trial-cohorts meeting
criteria. After removing duplicate analyses, we were left with 15 cohorts
including 4383 total patients who received TAVR. Due to heterogeneity of
variance, random effects models were fit, illustrating a consistent
positive effect on QOL across trials, both at 1mo (log relative mean
difference=-0.6, 95% CI: -0.91 to -0.37), and 12mos (lrmd=-0.99, 95% CI:
-1.25 to --0.73). At 1mo, QOL impact was moderated according to whether
trans-femoral or alternate approaches were used (p<.02) but not by
surgical risk. At 12 mos, neither factor moderated improvements to QOL.
 Conclusion(s): TAVR is consistently associated with improved QOL at 1
and 12mos post-procedure. Pooled analyses suggest that short-term QOL
improvement is moderated by procedural approach, but not surgical risk,
and longitudinal QOL is independent of both. These data support the
adoption of TAVR among patients with varied surgical risk, even in need
for alternative access approaches.

<39>
[Use Link to view the full text]
Accession Number
627103659
Title
Adverse events in endovascular robotic assisted procedures.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Sankaran N.K.; Rachakonda S.R.; Kocheril A.; Kapa S.; Kesavadas T.
Institution
(Sankaran, Rachakonda, Kocheril, Kapa, Kesavadas) 1College of Engineering,
Univ of Illinois, Urbana, IL2OSF Cardiovascular Institute, OSF Heart of
Mary Med Cntr, Urbana, IL3Dept of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Endovascular procedures are traditionally performed for a
variety of indications. However, guidewire/catheter manipulation and
hazardous radiation exposure are limitations to manual interventions.
Thus, significant work has been done to develop robotic approaches to
therapies. These devices have FDA clearance for performing procedures like
cardiac arrhythmias, angioplasty, aneurysm repair and stenting etc. With
the increasing usage of robotic assistance in endovascular procedures, it
is essential to understand the adverse events that may occur. This study
aims to provide an understanding of adverse events with currently
available robotic systems. Method(s): The analysis of adverse events
is performed with the FDA MAUDE (Manufacturer and User Facility Device
Experience) database. MAUDE database is a collection of reports on medical
devices reported by manufacturers, distributors, users, volunteers. In
case of occurrence of adverse events, FDA regulations requires that event
to be reported for further investigation. Based on the impact of events on
the patient's outcome, the reported events were grouped into 3 categories
death (patient death), injury (patient injury) or device malfunction.
 Result(s): A total of 71 different events were reported collectively
for all the four robotic devices (Hansen Medical- 37, Corindus Inc.-27,
Stereotaxis Inc.-5 & Catheter Robotics Inc.-2). The major adverse events
included death and common injuries such as perforation, pseudo-aneurysm /
blockage/ tamponade/ clot, blood pressure dropped or an effusion, or
hemodynamic instability. The table summarizes the events by brand of
system. Conclusion(s): While robotic approaches to intervention
reflect a potentially useful means to improve outcomes of endovascular
procedures by optimizing catheter manipulation with finer robotic motions
or limiting radiation exposure, there are potentially significant risks.
Whether these reflect higher or lower risk than traditional manual
approaches requires randomized studies. Use of robotic technologies may
present additional risks in light of potential malfunctions that occur
from system errors that a human system may not be prone to. Future studies
will be needed to better understand incremental benefit.

<40>
Accession Number
627103638
Title
Effect of chronic calcium-channel blocker therapy after coronary artery
bypass with the radial artery: Insights from the radial database.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Gaudino M.F.; Benedetto U.; Fremes S.; Hare D.L.; Hayward P.; Moat N.;
Nasso G.; Peric M.; Yoo K.J.; Speziale G.; Taggart D.
Institution
(Gaudino, Benedetto, Fremes, Hare, Hayward, Moat, Nasso, Peric, Yoo,
Speziale, Taggart) 1Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY2Bristol Heart Institute, Univ of Bristol, Bristol, United
Kingdom3Schulich Heart Cntr, Univ of Toronto, Toronto, Canada4Dept of
Cardiology, Univ of Melbourne, Melbourne, Australia5Dept of Surgery, Univ
of Melbourne, Heidelberg, Australia6Cardiac Surgery, The Royal Brompton
Hosp, London, United Kingdom7Dept of Cardiac Surgery, Anthea Hosp, Bari,
Italy8Dedinje Cardiovascular Institute, Belgrade Univ Sch of Medicine,
Belgrade, Serbia9Dept of Thoracic and Cardiovascular Surgery, Yonsei Univ
College of Medicine, Seoul, Korea, Republic of10Div of Cardiac Surgery,
GVM Hosps of Care and Rsch, Bari, Italy11Cardiovascular Surgery, Oxford
Univ Hosps Trust, Oxford, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Aim: To evaluate if chronic calcium-channel blocker therapy (CCB)
influences mid-term clinical and angiographic outcomes of radial artery
(RA) grafts used for coronary bypass surgery (CABG). Method(s):
Patient-level data of all six angiographic randomized trials that
evaluated RA graft status at mid-term follow-up were combined. Cox
regression analysis was used to evaluate the effect of CCB on the
incidence of a composite of major adverse cardiac events (death,
myocardial infarction (MI) and repeat revascularization, MACE) and graft
occlusion. Variables tested were: CCB, age, gender, diabetes, previous MI,
surgical priority, renal insufficiency, target vessel, percentage of
target vessel stenosis >=90%, and location of proximal anastomosis.
 Result(s): The study population included 732 patients (502 CCB and
230 non-CCB). At mean follow-up of 55+/-20 months, graft failure occurred
in 14 (5.8%) vs. 27 (13.5%) patients in the CCB and non-CCB group
respectively (log-rank P<.001). After controlling for confounders, CCB
therapy was significantly associated with better patency rate (HR 0.20;
95%CI 0.08-0.49; P<.0001). At mean follow-up of 60+/-27 months, the number
of MACE was 56 (11.2%) in the CCB group vs 31 (13.5%) in the non-CCB
group, respectively (log-rank P=.003). After controlling for confounders,
CCB therapy was independently associated with a significantly lower risk
of MACE (HR 0.51; 95%CI 30-87; P=.01). Protocol-driven angiography was
available in 243 CCB patients and 200 non-CCB patients.
 Conclusion(s): CCB is associated with significantly better mid-term
clinical and angiographic RA outcomes. Our results support the routine use
of CCB after CABG using the RA.

<41>
Accession Number
627103541
Title
Comparing patient profiles of clopidogrel versus ticagrelor: A systematic
literature 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
Cuisset T.; Aponte Z.; Paek D.; Del Aguila M.; Girotra S.; Sibbing D.
Institution
(Cuisset, Aponte, Paek, Del Aguila, Girotra, Sibbing) 1Dept of Cardiology,
CHU Timone, Marseille, France2Clinical Operations, Doctor Evidence, Santa
Monica, CA3Principal Consultancy, Doctor Evidence, Santa Monica,
CA4General Medicines and Emerging Markets, Sanofi, Singapore,
Singapore5Dept of Cardiology, Ludwig-Maximilians Univ Munchen, Munchen,
Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The ischemic benefit of ticagrelor over clopidogrel seen in
randomized trial data has not been fully reproduced in real world data.
The discrepancies in efficacy or safety outcomes between the two therapies
may be influenced by differences in prescribing practices. We aimed to
investigate if patients treated with clopidogrel are more likely to be at
higher risk of ischemic events than those treated with ticagrelor.
 Method(s): A systematic literature review and meta-analysis was
conducted to compare differences in characteristics between clopidogrel
and ticagrelor-treated patients. Odds ratios (OR; 95% CI) and mean
differences (MD; 95% CI) were used to evaluate the magnitude and
statistical significance of any observed differences. Result(s): The
search identified 1,459 potential publications, of which 26 studies
(190,662 patients) were selected for analysis. A total of 138,736 patients
were treated with clopidogrel and 51,926 with ticagrelor within the
selected studies. Twenty-five key clinical and procedural variables were
analyzed, and of these, 19 showed statistically significant differences
between the treatment groups. The following demographic and procedural
variables were greater in clopidogrel groups compared to ticagrelor
groups: age (MD 3.46; 2.54-4.38), females (OR 1.34; 1.26-1.43), bare metal
stent placement (2.05; 1.56-2.68), multiple vessel disease (OR 1.20;
1.03-1.40), and prior percutaneous coronary intervention (OR 1.28;
1.09-1.51) or coronary artery bypass graft (OR 1.57; 1.23-2.00).
Clopidogrel-treated patients also had significantly higher history of CV
events and comorbidities: prior stroke/transient ischemic attack (OR 1.59;
1.39-1.81), prior myocardial infarction (OR 1.39; 1.16-1.65), hypertension
(OR 1.23, 1.12-1.35), dyslipidemia (OR 1.15; 1.04-1.26), peripheral artery
disease (OR 1.60; 1.32, 1.95), and diabetes (OR 1.24; 1.14-1.34), compared
to patients treated with ticagrelor. Conclusion(s): Patients treated
with clopidogrel at initiation were more likely to have a history of CV
events and comorbidities than those treated with ticagrelor. This may
indicate differences in prescribing practices, but further research is
warranted.

<42>
Accession Number
627103338
Title
Maverick-HCM: Phase 2 randomized, multi-center, double-blind,
placebo-controlled concentration-guided study to evaluate mavacamten
(MYK-461) in adults with symptomatic non-obstructive hypertrophic
cardiomyopathy.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Heitner S.; Wang A.; Jacoby D.; Lester S.; Carlson T.; Zhang D.; Sehnert
A.; Ho C.
Institution
(Heitner, Wang, Jacoby, Lester, Carlson, Zhang, Sehnert, Ho) 1Knight
Cardiovascular Institute, Oregon Health & Sciences Univ, Portland,
OR2Cardiovascular Medicine, Duke Univ, Durham, NC3Cardiovascular Medicine,
Yale Univ, New Haven, CT4Cardiovascular Medicine, Mayo Clinic, Scottsdale,
AZ5Drug Metabolism and Pharmacokinetics, MyoKardia, Inc., South San
Francisco, CA6Clinical Development, MyoKardia, Inc., South San Francisco,
CA7Cardiovascular Medicine, Brigham and Women's Hosp, Boston, MA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Hypertrophic cardiomyopathy (HCM) carries substantial
lifelong morbidity. Mutations in sarcomeric proteins that lead to HCM
cause excess contractility, poor relaxation, and inefficient energy
utilization. Although obstructive physiology is a prominent feature of
disease, approximately 30% of HCM patients experience symptoms in the
context of non-obstructive HCM (nHCM). Management options are extremely
limited with little other than cardiac transplantation to offer severely
affected patients. Mavacamten (MAVA), a first-in-class small molecule, is
a selective modulator of cardiac myosin that inhibits the cardiac myosin
ATPase to reversibly attenuate cardiac contractility. In addition to its
effects on contractility, MAVA has been shown to improve LV compliance in
preclinical and clinical studies. The Phase 2 MAVERICK-HCM study is
designed to evaluate safety and tolerability, and to provide pilot data on
the effects of MAVA on biomarkers, cardiac function, and exercise capacity
in nHCM. Method(s): This double-blind study will enroll 60
individuals with nHCM (Left ventricular outflow tract gradient <30 mmHg;
resting or provoked), NYHA Class II or III, and LVEF >=55%. Subjects will
be randomized 1:1:1 to one of two target plasma drug concentrations (Group
1: ~200 ng/mL and Group 2: ~500 ng/mL) or placebo for 16 weeks. The
starting dose of MAVA is 5 mg, with onestep dose titration at Week 6 based
on plasma drug concentration. Predefined criteria, including LVEF, will
guide study drug discontinuation if indicated. Cardiopulmonary exercise
testing will be performed at baseline and Week 16 to assess the impact on
exercise capacity. The primary endpoint is the frequency and severity of
treatment-emergent adverse events. The study design also includes multiple
secondary endpoints including echocardiographic measures of diastolic
function, NT-pro-BNP levels, patient reported outcomes, and physical
activity by wearable accelerometer. An independent data monitoring
committee will oversee safety. Conclusion(s): MAVERICK-HCM is testing
a novel therapy to improve symptom burden in nHCM; a patient cohort
currently lacking effective treatment. By targeting a core molecular
mechanism of disease, MAVA has the potential to alter natural history.

<43>
Accession Number
627103322
Title
A pragmatic approach to prioritizing genetic variants in heart failure.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Salazar I.M.C.; Morley M.; Denduluri S.; Cappola T.P.; Margulies K.B.
Institution
(Salazar, Morley, Denduluri, Cappola, Margulies) 1Dept of Medicine, Univ
of Pennsylvania, Philadelphia, PA2Cardiovascular Institute, Univ of
Pennsylvania, Philadelphia, PA3Div of Cardiovascular Medicine, Univ of
Pennsylvania, Philadelphia, PA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Genome-wide association studies have had limited success in
identifying genetic variants associated with heart failure as most
variants are noncoding and likely alter gene expression rather than
protein function. Further, functional validation in experimental models is
challenging and often lacking. Conversely, experimental models have
identified many potentially pathogenic genes, but few have translated into
patient care. We hypothesized that high value targets can be identified by
combining human tissue analyses with existing reports to support the
functional impact of implicated genes. Methods and Results: Whole
genome SNP genotyping and whole genome expression profiling were performed
using left ventricle (LV) tissue from 136 failing and 177 non-failing
hearts obtained during heart transplantation and donation, respectively.
This analysis identified 1,673 expression quantitative trait loci (eQTLs)
in the LV (linear regression, p < 1E-6). A systematic PubMed search found
218 genes shown to modify hypertrophic responses to pressure overload in
mice from which EDNRA, ABCC8, APHX2, ITGB1, SIRT3, C 1QTNF9 and EIF2AK3
were regulated by cis-eQTLS in the human LV. Of these, EDNRA, ABCC8 and
SIRT3 were especially compelling. EDNRA encodes the endothelin A receptor
and is a known vasoconstrictor. Though endothelin antagonists lacked
efficacy in prior heart failure clinical trials, our findings raise the
possibility that efficacy might depend on genotype. ABCC8 encodes for an
ATP-sensitive potassium channel expressed in the heart and pancreas. SNPs
in this gene are associated with both a higher risk of type 2 diabetes
mellitus as well as decreased response to therapy suggesting that this
subpopulation may warrant aggressive monitoring and treatment. Finally,
SIRT3 is a mitochondrial NAD-dependent deacetylase that regulates
metabolic enzymes in various organs; deficiency may promote heart failure
via dysfunctional energy utilization. Conclusion(s): Human tissue
eQTL maps combined with experimental data from standardized disease models
enable prioritization of heart failure variants and genes. These variants
and genes should be selected for experimental studies to prove or refute a
casual influence on heart failure.

<44>
Accession Number
627103267
Title
The potential role of sentinel cerebral protection system in improving
outcomes of transcatheter aortic valve replacement patients: 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
Ndunda P.M.; Vindhyal M.; Muutu T.M.; Khayyat S.; Srinivasan S.; Fanari Z.
Institution
(Ndunda, Vindhyal, Muutu, Khayyat, Srinivasan, Fanari) Internal Medicine,
Univ of Kansas Sch of Medicine - Wichita, Wichita, KS, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Stroke is still a major complication that is reported in
2-5% of patients at 30 days, after a transcatheter aortic valve
replacement (TAVR). The Sentinel Cerebral Protection System (CPS) (Claret
Medical Inc., Santa Rosa, CA. USA) is the only FDA approved cerebral
embolic protection device (CEPD). This meta-analysis aims to assess the
potential benefits of the routine use of CPS after TAVR. Method(s):
The Cochrane library, PubMed and Web of science were searched for relevant
studies. Two authors independently screened and included studies that were
randomized controlled trials or controlled observational studies comparing
the use of Sentinel CPS with no CEPD in TAVR. Data was extracted and the
risk of bias assessed using the Cochrane Collaboration tools (RoB2.0 and
ROBINS-I). Result(s): Four studies betarandomized controlled trials
and 1 quasi experimental study) comparing 847 patients in whom sentinel
CPS was used to 483 in whom it was not used. Two of the studies had low
risk of bias and 2 had some concerns for risk of bias. The primary
outcomes were the number or size of ischemic lesions on brain MRI in 2
studies, major cardiac and cerebrovascular events in 1 study and a
composite of mortality or stroke in 1 study. Patients in whom Sentinel CPS
was used had lower rates of 30-day clinical stroke (3.5% vs 6.1%; RR 0.51
[95% CI 0.29, 0.90] I2 = 0%), 30-day mortality (0.8% vs 2.7%;
RR 0.34 [95% CI 0.12, 0.92] I2 = 0%) and major or
life-threatening bleeding (3.3% vs 6.6%; RR 0.50 [95% CI 0.26, 0.98]
I2 = 16%). There was no significant difference between the two
arms in the incidence of acute kidney injury (0.8% vs 1%; RR 0.85 [95% CI
0.22, 3.24] I2 = 0%) and major vascular complications (5.1% vs
6%; RR 0.74 [95% CI 0.33, 1.67] I2 = 45%). Conclusion(s):
Sentinel CPS use in TAVR can be helpful in reducing the risk of stroke,
mortality and major or life-threatening bleeding at 30 days.

<45>
Accession Number
627102998
Title
Reducing radiation exposure to operators during invasive cardiac
procedures with a novel lead-based arm-board (RADAR).
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Choudhury T.; Hayman S.; McLellan A.; Bagur R.; Lavi S.; Solomonica A.;
Israeli Z.; Yadegari A.; McPherson T.; Teefy P.; Garg P.
Institution
(Choudhury, Hayman, McLellan, Bagur, Lavi, Solomonica, Israeli, Yadegari,
McPherson, Teefy, Garg) 1MEDICINE, London Health Sciences Cntr, London,
Canada2Medicine, London Health Sciences Cntr, London, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Radiation exposure to patients and operators during cardiac
catheterization may be hazardous. We evaluated whether the use of a novel
lead-based arm-board reduces radiation exposure to the operator compared
to usual practice, and if it affects patient exposure. Hypothesis: That
lead-based arm-board, in addition to standard shielding, significantly
reduces radiation exposure to the primary operator. Method(s): We
performed a single center randomized trial to evaluate primary operator
radiation exposure during invasive cardiac procedures with or without the
use of the lead-based arm-board compared with standard (ceiling and table
mounted, pelvic) lead shielding alone. Operator radiation dose was
measured using a personal dosimeter at the level of the left chest pocket
(external to worn lead) and left forearm. Co-primary outcomes included
radiation dose (uSv; mean +/- SD) to the operator at the chest and forearm
level. Secondary outcomes included air kerma, dose area product, and
radiation dose to the patient (measured with dosimeter over umbilicus).
 Result(s): 346 patients who underwent 351 procedures (175 with
lead-based arm-board) were randomized. Mean age was 66.2 (+/-11) and 66%
were male. 333 (95%) were radial procedures and 135 (38.5%) had
percutaneous coronary intervention. Baseline clinical and procedural
characteristics, including fluoroscopy time (p=0.654) and number of cine
acquisitions (p=0.611), were similar between the two groups. Compared with
standard lead shielding alone, use of lead-based arm-board significantly
reduced the radiation dose to the primary operator at the chest (58%
reduction; 7.3+/-10.3 vs. 17.3+/-17.2 uSv; p<0.001) and forearm (65%
reduction; 14.8+/-19.1 vs. 42.4+/-48.9 uSv; p<0.001). There was no
difference between the two groups in air kerma (0.97+/-0.91 vs.
0.99+/-0.68 Gy; p=0.840) or dose area product (54.7+/-45.9 vs. 59.4+/-41.6
Gy*cm2; p=0.318). Radiation dose to the patient at the abdomen was not
increased with the lead-based arm-board (184+/-289 vs. 215+/-303 uSv;
p=0.318). Conclusion(s): Radiation dose to the primary operator was
significantly reduced, without an increase in dose to the patient, with
the addition of a novel, lead-based arm-board when compared to the
standard lead shielding. We recommend the integration of the lead-based
arm-board in everyday clinical practice.

<46>
[Use Link to view the full text]
Accession Number
627102866
Title
Concomitant transthyretin cardiac amyloidosis and aortic stenosis: 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
Sleiman J.; Khan M.S.; Usman M.S.; Munoz E.; Ranka S.; Muhammad H.N.;
Ijeli A.; Fatima K.; Raza S.; Deo S.
Institution
(Sleiman, Khan, Usman, Munoz, Ranka, Muhammad, Ijeli, Fatima, Raza, Deo)
1Medicine, John H Stroger Jr Hosp, Chicago, IL2Medicine, Dow Univ of
Health Sciences Pakistan Internal Medicine, Karachi, Pakistan3Surgery Div
Cardiovascular Surgery, Case Western Reserve Univ, Cleveland, OH
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Concomitant aortic stenosis (AS) and transthyretin cardiac
amyloidosis (TTR-CA) in elderly population remains poorly described.
Moreover, prognosis in patients with TTRCA who undergo aortic valve
replacement (AVR) is uncertain. We conducted a systematic review and
meta-analysis to gain further insight. Method(s): Medline, Scopus and
Embase were searched from inception of these databases to May 2018 for
studies reporting prevalence of TTR-CA in AS patients (surgical or
transcatheter) or prognosis of TTRCA patients who received AVR. Pooled
estimates were calculated using a random-effects model. Result(s):
Eight studies comprising of 598 patients with AS (mean age: 75.1; males:
57.5%) were included. 63 cases had concomitant TTR-CA, with a pooled
prevalence of 11.5% [6.6, 17.4]; I =74%. Four studies (mean age: 76.5;
males: 72.7%)] reported prognosis in patients with TTR-CA after AVR. Over
a mean follow-up duration of 2.4 years, 14 of 37 patients suffered
all-cause mortality (pooled incidence of mortality: 37.5% [22.8, 53.4];
I2 =0%). Conclusion(s): Current meta-analysis suggests
that TTR-CA in AS patients is relatively common, and has high risk of
all-cause mortality after AVR. However, low event rates with wide
confidence interval limit us from making conclusive statements. Further
studies are needed to explore this association.

<47>
Accession Number
627102817
Title
The utility of traditional chinese medicine (SHENMAI) in the cardiac
rehabilitation after coronary artery bypass grafting: A single-center
randomized clinical trial.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Zhang C.; Zheng Y.; Chen T.; Wang S.; Zhao T.; Chen H.; Zhang M.; Xu J.
Institution
(Zhang, Zheng, Chen, Wang, Zhao, Chen, Zhang, Xu) 1Dept of Cardiovascular
Surgery, Beijing Anzhen Hosp, Beijing, China2Sch of Nursing, Boston
College, Chestnut Hill, MA3Dept of clinical sciences, Liverpool school of
tropical medicines, Liverpool, United Kingdom4Dept of Cardiovascular
Surgery, Fuwai Hosp, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The effect of Shenmai, a traditional Chinese medicine, as a
complement to the cardiac rehabilitation for patients received coronary
artery bypass grafting (CABG) remains unclear. Thus, the study aim is to
examine the efficacy of Shenmai as a complement to the cardiac
rehabilitation in patients received CABG. Hypothesis: Participants who
received standard cardiac rehabilitation plus Shenmai treatment showed
longer walking distance compared with those who only received standard
cardiac rehabilitation. Method(s): The study was a single-center
randomized clinical trial. Patients who received CABG were randomized into
one of two groups: Shenmai vs. Control. All participants received standard
cardiac rehabilitation according to the clinical guidelines, while
participants in the Shenmai group were additionally treated with Shenmai
(injection and capsule sequential). The primary outcome was walking
distance assessed by the 6-Minute Walking Test, which was measured before
operation, on the day of discharge and 30-day follow up. Linear mixed
model was used for data analysis. Result(s): The sample (n=166) was
predominately male (83.73%), with mean age was 61.12 +/- 9.13 years. There
was no significant difference between groups in baseline characteristics
(e.g., age, gender, and medical conditions) and the procedural
characteristics (e.g., on pump CABG, CPB time). There was one mortality in
Control group and one stroke in Shenmai group right after the surgery.
Overall, there was group (p=.005) and time effect (p<.001) on the 6-min
walking distance. Participants in the Shenmai group walked longer distance
in meters compared with Control group on the day of discharge (314.54 +/-
64.14 vs. 271.29 +/- 76.82, P<.001), while no significant differences
before operation (399.72+/- 93.19 vs. 403.67 +/- 91.99, p=.78) and on
30-day follow up (436.54 +/- 67.64 vs. 421.64 +/- 83.53, p =.21). Also,
there was greater improvement in walking distance at the point of 30-day
follow-up compared to the point of pre-operation and discharge within both
groups (ps<.001). Conclusion(s): Shenmai improves the exercise
tolerance in the early stage of the cardiac rehabilitation for patients
received CABG. Shemai can be complement to the contemporary cardiac
rehabilitation in this population.

<48>
Accession Number
627102792
Title
Hybrid coronary revascularization versus coronary artery bypass graft
surgery in patients with multivessel coronary artery disease: 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
SayedAhmad Z.; Darmoch F.; Al-khadra Y.; Soud M.; Pacha H.M.; Idris A.;
Zaitoun A.; Laktineh A.; Kaki A.; Alraies M.C.
Institution
(SayedAhmad, Darmoch, Al-khadra, Soud, Pacha, Idris, Zaitoun, Laktineh,
Kaki, Alraies) 1Internal Medicine, Beaumont Hosp, Royal Oak, MI2Internal
Medicine, Cleveland Clinic Foundation, Cleveland, OH3Internal Medicine,
Cleveland Clinic Foundation, Cleavland, OH4Internal Medicine, MedStar
Heart and Vascular Institute, Washington, DC5Internal Medicine, MedStar
Washington Hosp Cntr, Washington, DC6Internal Medicine, Univ of Central
Florida, Gainesville, FL7Cardiology, St. John Hosp and Med Cntr, Detroit,
MI8Internal Medicine, Wayne State Univ Sch of Medicine, Detroit Med Cntr,
Detroit, MI9Cardiology, Wayne State Univ Sch of Medicine, Detroit Med
Cntr, Detroit, MI
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Hybrid coronary artery revascularization (HCR) refers to
complete or near complete revascularization using the combination of
single vessel CABG with left internal mammary artery (LIMA) to LAD and PCI
of other significant coronary lesions. Multiple studies have compared the
safety and outcomes of HCR versus CABG for multivessel coronary artery
disease (MCAD). The purpose of this meta-analysis is to study short-term
outcomes of HCR compared to CABG for patients with MCAD. Method(s): A
search of PubMed, Medline and Cochrane Central Register from January 1969
through April 2018 for studies comparing the outcomes of HCR versus CABG
for MCAD. The data were pooled for the primary outcome measure using the
random-effects model as pooled Rate Ratio (RR). The primary outcomes were
30 days mortality, myocardial infarction, and stroke. Result(s): A
total of 7,116 patients from 8 studies were included. 850 patient
underwent HCR and 6316 patient had CABG procedure. HCR group had
comparable 30 days mortality rates (OR, 0.74; 95% CI, 0.33-1.65),
myocardial infarction (OR, 0.78; 95% CI, 0.35-1.75), stroke (OR, 0.66; 95%
CI, 0.32-1.38). Although not reported in all included studies, HCR
patients had shorter intensive care unit stay, shorter mechanical
ventilation time and fewer wound complications. Conclusion(s): The
outcome of HCR was comparable to CABG for patients with MCAD with no
difference in mortality or major adverse events. This suggests that HCR
might be an attractive option for selected patients with MCAD.

<49>
[Use Link to view the full text]
Accession Number
627102776
Title
Outcomes with transcatheter mitral valve repair using mitraclip in
patients with impaired left ventricular systolic function: 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
Zaghloul A.; Lorgoveanu C.; Elkaryoni A.; Elsaid O.; Megaly M.; Saad M.
Institution
(Zaghloul, Lorgoveanu, Elkaryoni, Elsaid, Megaly, Saad) 1Internal
Medicine, Univ of Connecticut Health Cntr, Farmington, CT2Internal
Medicine, Univ of Missouri Kansas City, Kansas City, MO3Cardiovascular
Disease, Hartford Hosp, Farmington, CT4Cardiovascular Disease, Minneapolis
heart Institute, Minneapolis, MN5Cardiovascular Disease, Univ of Arkansas
Med Cntr, Little Rock, AR
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter mitral valve repair (TMVR) is a novel
treatment option for patients with severe mitral regurgitation (MR) who
are at high risk for surgery. While left ventricular (LV) systolic
dysfunction is associated with poor outcomes after MV surgeries, its
impact on outcomes after TMVR is unknown. Hypothesis: To examine outcomes
with TMVR using MitraClip device in patients with severe MR and LV
systolic dysfunction. Method(s): Systematic electronic review was
performed from January 2010 to December 2017 for studies that reported
outcomes with TMVR in patients with LV ejection fraction (EF) <30% versus
>=30%. The primary outcome was long-term (12-months) all-cause mortality.
Secondary outcomes included stroke, MV re-intervention and short-term
(30-days) mortality. DerSimonian and Laird method was used for estimation
of summary risk ratios (RR). Result(s): Five prospective
observational studies (1616 patients, mean age 76.38, 73.04 % men, 64%
with LVEF >30%) met our inclusion criteria. Patients with LVEF<30% were at
increased risk of long-term mortality compared to those with LVEF>30% (OR
1.61, 95% CI 1.25 - 2.08, P=0.0002). No difference was observed between
both groups regarding the risk of 30-days mortality (P=0.19), stroke
(P=0.59), MV re-intervention (P=0.07). Conclusion(s): In patients
with severe MR undergoing TMVR with MitraClip, severe LV systolic
dysfunction (EF <30%) may be associated with increased long-term mortality
compared to patients with LV EF > 30%.

<50>
Accession Number
627102540
Title
Saphenous vein harvesting techniques for coronary artery bypass grafting:
A systematic review and network 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
Mokhtar M.A.; Vuong N.L.; Elfaituri M.K.; Eid P.S.; Eldoadoa M.F.; Mostafa
M.R.; Bendary A.H.; Radwan I.; Aboelhossen M.M.; Ibrahim D.A.; Abdallah
N.A.; El-Ghar H.A.; Zaki M.M.M.; Elshafay A.; Huy N.T.
Institution
(Mokhtar, Vuong, Elfaituri, Eid, Eldoadoa, Mostafa, Bendary, Radwan,
Aboelhossen, Ibrahim, Abdallah, El-Ghar, Zaki, Elshafay, Huy) 1Faculty of
Medicine, Sohag Univ, Nasser City, Egypt2Cardiology Dept, Univ of Medicine
and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam3Faculty of
Medicine, Tripoli Univ, Tripoli, Libyan Arab Jamahiriya4Faculty of
Medicine, Ain Shams Univ, Cairo, Egypt5Faculty of Medicine, Mansoura
university, Mansoura, Egypt6Faculty of Medicine, Tanta Univ, Tanta,
Egypt7Faculty of Medicine, Al-Azhar Univ, Cairo, Egypt8Faculty of
Medicine, Aswan university, Aswan, Egypt9Faculty of Medicine, AinShams
Univ, Cairo, Egypt10Faculty of Medicine, Menofia Univ, Menofia,
Egypt11Faculty of Clinical Pharmacy, Fayoum Univ, Al Fayoum, Egypt12Dept
of Clinical Product Development, Institute of Tropical Medicine (NEKKEN),
Nagasaki Univ, Nagasaki, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The great saphenous vein (GSV) graft remains the most
frequent used conduit for coronary artery bypass graft (CABG) surgery. A
lot of debates about technique of GSV harvesting have occurred.
Hypothesis: Evaluating the short-term and long-term outcomes of all
different GSV harvesting techniques. Method(s): A systematic review
of 12 electronic databases was performed to identify all randomized
controlled trials (RCTs) of any GSV harvesting techniques, including
conventional, no-touch, minimally open, closed endoscopic vein harvesting
(EVH), and open EVH techniques. The outcomes were short-term
complications, pain, and other technique measurements, and long-term
efficacy, including death, myocardial infarction (MI), and graft patency.
All outcomes were analyzed using the frequentist network meta-analysis.
The methodological quality of each RCT was assessed using the Cochrane
Collaboration's tool. The study protocol has been registered in PROSPERO
with registration number CRD42017073468. Result(s): Regarding the
risk of infection/inflammation, compared to open EVH, minimally open, and
closed EVH techniques, no-touch technique increased 17.7, 18.7, and 29
times; while conventional technique increased 2.6, 2.7, and 4.2 times,
respectively. Conventional technique increased 8.5 and 3.2 times of the
risk of post-operative lymph problems and sensibility disorders, compared
to closed EVH technique. However, open EVH technique increased the risk of
hematoma/ecchymosis of 1.5, 1.7, and 2.2 times, compared to minimally
open, conventional, and closed EVH techniques. Regarding post-operative
pain, no-touch and conventional techniques increased the mean score of
visual analogue scale of 3.7 and 1.2, compared to open EVH technique. EVH
and minimally open techniques reduced approximately 25-44 cm of length of
skin incision, compared to conventional and open techniques. Those
techniques were not significantly different regarding time of GSV
harvesting, converting to conventional technique, length of harvested
vein, vein injury, poor vein quality, length of hospitalization, and the
long-term outcomes, including death, MI, and graft patency.
 Conclusion(s): For GSV harvesting for CABG surgery, the minimally
invasive techniques, including minimally open and EVH, reduce the risks of
in-situ complications and the length of skin incision, with the comparable
quality of vein and long-term death, MI, and graft patency.

<51>
Accession Number
627102437
Title
Genomic risk stratification predicts all- cause mortality after cardiac
catheterization.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Levin M.; Kember R.; Judy R.; Birtwell D.; Williams H.; Giri J.; Cappola
T.; Rader D.; Damrauer S.
Institution
(Levin, Kember, Judy, Birtwell, Williams, Giri, Cappola, Rader, Damrauer)
1Penn Medicine Bio Bank Dept of Medicine, Univ of Pennsylvania,
Philadelphia, PA2Depts of Medicine and Genetics, Univ of Pennsylvania,
Philadelphia, PA3Dept of Surgery, Univ of Pennsylvania, Philadelphia, PA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Coronary artery disease (CAD) is influenced by traditional
risk factors, including diabetes, hypertension, hyperlipidemia, BMI, and
smoking. More than 75 genetic loci have also been associated with CAD at
the genome-wide level. Polygenic risk scores (PRS), which can be
identified prior to the development of traditional risk factors, have been
proposed to identify individuals at elevated risk of CAD and adverse
cardiovascular events. Here, we use a genomewide PRS to identify patients
at elevated risk of all-cause mortality following coronary angiography.
 Method(s): Individuals of European ancestry who underwent angiography
and genotyping (N = 1504) were included. Individuals with prior myocardial
infarction or heart transplant were excluded. A genome-wide PRS, based on
the CARDIoGRAMplusC4D 1000 Genomes-based genome-wide association
meta-analysis for CAD, was calculated for each individual using PRSice.
Individuals were stratified into high PRS (hiPRS) and control groups using
the maximally selected rank statistic. Individuals were sub-divided into 3
groups (obstructive CAD, non-obstructive CAD, and no angiographic CAD),
based on angiographic extent of CAD. The primary outcome was all-cause
mortality following index coronary angiogram. Result(s): Individuals
with high polygenic risk scores (hiPRS) were younger than control subjects
(median age 65.8 vs. 68.8; p = 1.8 x 10-5), but did not differ
by sex, BMI, diagnosis of diabetes or hypertension, smoking, statin use,
lipid levels, or extent of CAD at time of index cardiac catheterization.
Individuals with hiPRS were at increased risk of all-cause mortality
following cardiac catheterization (HR 1.61; 95% CI 1.16-2.22; p = 0.004)
after adjustment for traditional risk factors and angiographic extent of
CAD. When stratified by angiographic extent of CAD, individuals with no
angiographic CAD but with hiPRS remained at significantly increased risk
of all-cause mortality (HR 2.39; 95% CI 1.02-5.3; p = 0.038).
 Conclusion(s): The addition of a genome-wide PRS to traditional risk
factors and coronary angiography improves risk stratification,
particularly in individuals with no angiographic CAD. Individuals at high
genetic risk of CAD may benefit from more aggressive prevention
strategies.

<52>
[Use Link to view the full text]
Accession Number
627102299
Title
Post-dilation in primary percutaneous coronary stenting of patients with
ST-elevation myocardial infarction: A cohort study and pooled analysis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Saadat M.; Saadat N.; Ebtehaj S.; Nargesi A.A.; Alidoosti M.; Poorhosseini
H.; Amirzadegan A.; Lashkari R.; Mortazavi S.H.; Salarifar M.
Institution
(Saadat, Saadat, Ebtehaj, Nargesi, Alidoosti, Poorhosseini, Amirzadegan,
Lashkari, Mortazavi, Salarifar) 1Tehran Heart Cntr, Tehran Univ of Med
Sciences, Tehran, Iran, Islamic Republic of2Dept of Medicine, Mayo Clinic,
Rochester, MN
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Benefits of coronary stent post-dilation (PD) in primary PCI
is still a matter of debate. We studied patient- and device-oriented
outcomes after PD in a cohort of patients with STEMI and performed pooled
analysis to shed light on the role of PD in this population.
 Method(s): A total number of 1224 patients presenting with STEMI and
undergoing primary PCI with DES stents were included (500 PD and 724
controls). Patient-oriented composite endpoint (POCE) was defined as
cardiac death, non-fatal MI, or repeat revascularization. Device-oriented
composite endpoint (DOCE) was defined as cardiac death, target lesion
revascularization (TLR), or target vessel revascularization (TVR). Four
previous studies reporting angiographic and clinical outcomes after PD in
patient with STEMI were used for pooled analysis. Result(s): Patients
in PD group were older, less hypertensive, and more likely to be current
smoker at baseline. Patients were followed for 348+/-399 days. PD group
had lower rates of POCE (7.8% vs. 11.3%; p<0.05) and DOCE (2.2% vs. 5.8%;
p<0.001) compared to controls. Among individual outcomes, cardiac
mortality (1.2% vs. 3.2%, p<0.05) and TVR (1% vs. 2.6%, p<0.05) rates were
significantly lower in PD compared to controls. In univariate Cox
regression analysis, PD was associated with decreased incident DOCE
(HR=0.36 [0.17-0.70], p<0.005), which remained significant after multiple
adjustments (HR=0.22 [0.07-0.73], p<0.05). However, decreased incident
rate of POCE in PD group failed to reach the significance level in
univariate Cox model (HR=0.65 [0.40-1.04], p=0.07). In pooled analysis, PD
was associated with neither decreased nor increased cardiac mortality,
non-fatal MI, TVR, or TIMI=3 achievement rates after primary PCI.
 Conclusion(s): In this observational study, we found improved
device-oriented outcomes in STEMI patients undergoing stent PD during
primary PCI. We did not find any worsened angiographic or clinical
outcomes after PD in pooled analysis. Using PD to achieve proper stent
apposition in primary PCI should not be discouraged in patients with
STEMI.

<53>
[Use Link to view the full text]
Accession Number
627102114
Title
Impact of stroke volume and left ventricular ejection fraction on
mortality after surgical and transcatheter aortic valve replacement in
patients with severe aortic stenosis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Ito S.; Popma J.J.; Calvalcante J.L.; Reardon M.J.; Lin G.; Oh J.K.
Institution
(Ito, Popma, Calvalcante, Reardon, Lin, Oh) 1Echocardiography Laboratory,
Mayo Clinic, Rochester, MN2Interventional Cardiology, Beth Israel
Deaconess Hosp, Boston, MA3Cardiology, Univ of Pittsburgh, Pittsburgh,
PA4Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular
Cntr, Houston, TX
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Reduced stroke volume index (SVI) and LVEF are associated
with increased mortality after aortic valve replacement (AVR) in patients
with severe AS. Their interaction with the AVR strategy has not been
thoroughly investigated. Hypothesis: Our aim was to assess the impact of
SVI and LVEF on 1-year mortality after surgical (S)AVR and transcatheter
(T)AVR. Method(s): The analysis cohort comprised 742 patients of the
multi center, randomized (1:1) Core Valve US Pivotal High Risk Trial,
implanted with the Core Valve self-expanding aortic bioprosthesis (n=389)
or a surgical aortic bioprosthetic valve (n=353). SV and LVEF were
measured as a part of comprehensive echocardiography analysis by an
independent core lab. Normal SVI was > 35 mL/m2 and preserved LVEF was >=
50%. Mortality rates were Kaplan-Meier estimates. Result(s): Baseline
reduced SVI was present in 35.8% of TAVR and 31.3% of SAVR patients.
Compared to patients with normal SVI, TAVR patients with reduced SVI were
more often male (61.6% vs. 47.3%, p = 0.01), had AF (55.6% vs. 32.6%, p <
0.001) and a higher log Euro SCORE (20.9 +/- 15.7% vs. 15.7 +/- 10.6%, p =
0.001). For SAVR, male sex (62.5% vs. 49.3%, p = 0.03), AF (55.2% vs.
42.2%, p = 0.03), log Euro SCORE (20.6 +/- 14.9% vs. 16.9 +/- 11.0%, p =
0.04) and coronary artery disease (84.4% vs. 72.0%, p = 0.02) were more
prevalent in patients with reduced SVI. Baseline reduced LVEF was present
in 18.1% of TAVR and 19.6% of SAVR patients. In patients with reduced LVEF
(left panel), 1- year mortality was higher with reduced SVI after AVR
without treatment interaction. In patients with preserved LVEF (right
panel), there was a clinically significant interaction between 1-year
mortality and treatment, without any impact of SVI status on the mortality
within the same AVR strategy. Conclusion(s): In high-risk patients
with severe AS, there is a clinically significant interaction between AVR
strategy and 1-year survival when LVEF is > 50% and between SVI status and
1-year survival when LVEF <50%. (Figure Presented) .

<54>
[Use Link to view the full text]
Accession Number
627101626
Title
Thromboelastography and rotational thromboelastometry for the surgical
intensivist: A narrative review.
Source
Journal of Trauma and Acute Care Surgery. 86 (4) (pp 710-721), 2019. Date
of Publication: 01 Apr 2019.
Author
Drumheller B.C.; Stein D.M.; Moore L.J.; Rizoli S.B.; Cohen M.J.
Institution
(Drumheller, Stein) Program in Trauma, Department of Surgery, R Adams
Cowley Shock Trauma Center, University of Maryland School of Medicine,
Baltimore, MD, United States
(Moore) Department of Surgery, University of Texas Health Sciences Center
at Houston, McGovern Medical School, Houston, TX, United States
(Rizoli) Department of Surgery, Department of Critical Care Medicine, St.
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Cohen) Department of Surgery, Denver Health Medical Center, University of
Colorado, Boulder, CO, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND Viscoelastic tests (VETs), specifically thromboelastography
(TEG) and rotational thromboelastometry (ROTEM), are gaining popularity in
the management of critically ill surgical patients with hemorrhage or
thrombosis due to their comprehensive characterization of the coagulation
process and point-of-care availability in comparison to conventional
coagulation tests (CCTs). We review current evidence for VET use in
patients in the surgical intensive care unit (SICU). METHODS We searched
PUBMED, EMBASE and the Cochrane Library through May 30, 2018 for articles
that evaluated the use of VETs in patient populations and clinical
scenarios germane to the surgical intensivist. Individual articles were
critically evaluated for relevance and appropriate methodology using a
structured technique. Information on patient characteristics, timing and
methods of CCTs/VETs, and outcomes was collected and summarized in
narrative form. RESULTS Of 2,589 identified articles, 36 were included.
Five (14%) were interventional studies and 31 (86%) were observational.
Twenty-five (69%) evaluated TEG, 11 (31%) ROTEM and 18 (50%) CCTs.
Investigated outcomes included quantitative blood loss (13 (36%)), blood
product transfusion (9 (25%)), thromboembolic events (9 (25%)) and
mortality (6 (17%)). We identified 12 clinical scenarios with sufficient
available evidence, much of which was of limited quantity and poor
methodological quality. Nonetheless, research supports the use of VETs for
guiding early blood product administration in severe traumatic hemorrhage
and for the prediction of abstract excess bleeding following routine
cardiac surgery. In contrast, evidence suggests VET-based heparin dosing
strategies for venous thromboembolism prophylaxis are not superior to
standard dosing in SICU patients. CONCLUSION While VETs have the potential
to impact the care of critically ill surgical patients in many ways,
current evidence for their use is limited, mainly because of poor
methodological quality of most available studies. Further high-quality
research, including several ongoing randomized controlled trials, is
needed to elucidate the role of TEG/ROTEM in the SICU population. LEVEL OF
EVIDENCE Systematic review, level IV. Copyright © 2019 Wolters
Kluwer Health, Inc. All rights reserved.

<55>
Accession Number
627053000
Title
Cytokine clearance with CytoSorb during cardiac surgery: A pilot
randomized controlled trial.
Source
Critical Care. 23 (1) (no pagination), 2019. Article Number: 108. Date of
Publication: 03 Apr 2019.
Author
Poli E.C.; Alberio L.; Bauer-Doerries A.; Marcucci C.; Roumy A.; Kirsch
M.; De Stefano E.; Liaudet L.; Schneider A.G.
Institution
(Poli, Liaudet, Schneider) Adult Intensive Care Unit, Centre Hospitalier,
Universitaire Vaudois, Lausanne, Switzerland
(Alberio) Division of Haematology, Central Haematology Laboratory, Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Bauer-Doerries, Marcucci) Department of Anaesthesiology, Centre
Hospitalier, Universitaire Vaudois, Lausanne, Switzerland
(Roumy, Kirsch, De Stefano) Departement of Cardiovascular Surgery, Centre
Hospitalier Universitaire Vaudois (CHUV), Centre Hospitalier,
Universitaire Vaudois, Lausanne, Switzerland
(Alberio, Marcucci, Kirsch, Liaudet, Schneider) Faculty of Biology and
Medicine, University of Lausanne, Lausanne, Switzerland
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiopulmonary bypass (CPB) is often associated with degrees
of complex inflammatory response mediated by various cytokines. This
response can, in severe cases, lead to systemic hypotension and organ
dysfunction. Cytokine removal might therefore improve outcomes of patients
undergoing cardiac surgery. CytoSorb (Cytosorbents, NJ, USA) is a recent
device designed to remove cytokine from the blood using haemoadsorption
(HA). This trial aims to evaluate the potential of CytoSorb to decrease
peri-operative cytokine levels in cardiac surgery. Method(s): We have
conducted a single-centre pilot randomized controlled trial in 30 patients
undergoing elective cardiac surgery and deemed at risk of complications.
Patients were randomly allocated to either standard of care (n = 15) or
CytoSorb HA (n = 15) during cardiopulmonary bypass (CPB). Our primary
outcome was the difference between the two groups in cytokines levels
(IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-10, TNF-alpha, IFN-gamma, MCP-1)
measured at anaesthesia induction, at the end of CPB, as well as 6 and 24
h post-CPB initiation. In a consecutive subgroup of patients (10 in HA
group, 11 in control group), we performed cross-adsorber as well as serial
measurements of coagulation factors' activity (antithrombin, von
Willebrand factor, factor II, V, VIII, IX, XI, and XII). Result(s):
Both groups were similar in terms of baseline and peri-operative
characteristics. CytoSorb HA during CPB was not associated with an
increased incidence of adverse event. The procedure did not result in
significant coagulation factors' adsorption but only some signs of
coagulation activation. However, the intervention was associated neither
with a decrease in pro- or anti-inflammatory cytokine levels nor with any
improvement in relevant clinical outcomes. Conclusion(s): CytoSorb HA
during CPB was not associated with a decrease in pro- or anti-inflammatory
cytokines nor with an improvement in relevant clinical outcomes. The
procedure was feasible and safe. Further studies should evaluate the
efficacy of CytoSorb HA in other clinical contexts. Trial registration:
ClinicalTrials.gov NCT02775123. Registered 17 May 2016. Copyright
© 2019 The Author(s).

<56>
Accession Number
627110359
Title
Aortic valve repair or replacement in patients with aortic regurgitation:
A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Wong C.H.M.; Chan J.S.K.; Sanli D.; Rahimli R.; Harky A.
Institution
(Wong, Chan) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Sanli) Gundogmus National Town Hospital, Antalya, Turkey
(Rahimli) Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
(Harky) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To systematically compare clinical outcomes between aortic
valve repair and replacement in patients with aortic regurgitation.
 Method(s): A comprehensive literature search was undertaken among the
four major databases (PubMed, Embase, Scopus, and Ovid) to identify all
published data comparing clinical outcomes of aortic valve repair vs
replacement. Database searched from inception to November 2018.
 Result(s): A total of 1071 patients were analyzed in eight articles.
Mean age was similar in both groups of patients (47.2 +/- 12.8 vs 48.3 +/-
12.7 years, P = 0.83, aortic valve repair and replacement, respectively).
The preoperative left ventricular ejection fraction was better in the
repair group (56.7% +/- 4.8 vs 53.3% +/- 4.2, P = 0.005). The rate of
moderate-to-severe regurgitation and bicuspid aortic valve were similar in
both cohorts (81% vs 78%, P = 0.90% and 58% vs 55%, P = 0.46). In-hospital
and 1-year mortality was lower in repair cohort, although not reaching
statistical significance (1.3% vs 3.6%, P = 0.12; 5.9% vs 9.3%, P = 0.77).
Reoperation rate was higher in repair patients at 1 year (8.8% vs 3.7%, P
= 0.03). Conclusion(s): Aortic valve repair offers comparable
perioperative outcomes to aortic valve replacement in aortic regurgitation
patients at the expense of higher late reintervention rate. Larger trials
with long-term follow-up are required to confirm the long-term benefits of
aortic valve repair. Copyright © 2019 Wiley Periodicals, Inc.

<57>
Accession Number
627110349
Title
Adiposity in relation to readmission and all-cause mortality following
coronary artery bypass grafting: A systematic review and meta-analysis.
Source
Obesity Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
Zhang K.; Wang J.; Yang Y.; An R.
Institution
(Zhang) Beijing Aortic Disease Center, Beijing Anzhen Hospital, Beijing,
Capital Medical University, Beijing, China
(Wang) Department of Physical Education, Dalian University of Technology,
Dalian, Liaoning, China
(Yang) Cabot Microelectronics, Aurora, IL, United States
(An) Guangzhou Sport University, Guangzhou, Guangdong, China
(An) Department of Kinesiology and Community Health, University of
Illinois at Urbana-Champaign, Champaign, IL, United States
(An) Brown School, Washington University, St. Louis, MO, United States
Publisher
Blackwell Publishing Ltd
Abstract
This study systemically reviewed evidence linking adiposity to readmission
and all-cause mortality in post-coronary artery bypass grafting (CABG)
patients. Keyword/reference search was performed in PubMed, Web of
Science, CINAHL, and Cochrane Library for articles published before June,
2018. Eligibility criteria included study designs:
experimental/observational studies; subjects: adult patients undergoing
CABG; and outcomes: hospital/clinic readmissions, and short-term (<=30
days) and mid-to-long-term (>30 days) all-cause mortality. Seventy-two
studies were identified. Meta-analysis showed that the odds of post-CABG
readmission among patients with overweight was 30% lower than their
normal-weight counterparts and the odds of mid-to-long-term post-CABG
mortality among patients with overweight were 20% lower than their
normal-weight counterparts. In contrast, no difference in post-CABG
readmission rate was found between patients with obesity and their
nonobese counterparts; no difference in short-term or in-hospital
post-CABG mortality rate was found between patients with overweight or
obesity and their normal-weight counterparts; and no difference in
mid-to-long-term post-CABG mortality rate was found between patients with
obesity and their normal-weight counterparts. In conclusion, patients with
overweight but not obesity had a lower readmission and mid-to-long-term
mortality rate following CABG relative to their normal-weight
counterparts. Preoperative weight loss may not be advised to patients with
overweight undergoing CABG. Copyright © 2019 World Obesity
Federation

<58>
Accession Number
2001444962
Title
Preoperative Exercise Rehabilitation in Cardiac and Vascular
Interventions.
Source
Journal of Surgical Research. 237 (pp 3-11), 2019. Date of Publication:
May 2019.
Author
Drudi L.M.; Tat J.; Ades M.; Mata J.; Landry T.; MacKenzie K.S.; Steinmetz
O.K.; Gill H.L.
Institution
(Drudi, Tat, Ades, Mata, MacKenzie, Steinmetz, Gill) Division of Vascular
Surgery, Department of Surgery, McGill University, Montreal, Quebec,
Canada
(Landry) Montreal General Hospital Medical Library, Montreal, Quebec,
Canada
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Exercise-based interventions have become part of the standard
of care in rehabilitation programs for cardiovascular risk reduction and
the promotion of a healthy lifestyle. The systematic review describes the
current state of knowledge of the effects of preoperative exercise
training (prehabilitation) on perioperative clinical outcomes in patients
undergoing cardiac and vascular interventions. Method(s): Studies
were systematically searched within 14 databases from inception to October
2016. Only studies that assessed a preoperative exercise program in adult
patients undergoing cardiac or vascular interventions with clinical or
patient-centered endpoints were included in the review. Two independent
reviewers selected studies for inclusion, extracted data, and assessed
quality using Cochrane Collaboration's tool for
RCTs11111111111111111 and ROBINS-I tool for nonrandomized
studies. Result(s): Nine studies met our inclusion criteria and were
stratified for qualitative analyses by cardiac (n = 7) and vascular (n =
2) procedures. Prehabilitation was associated with decreased length of
stay, reduced postoperative complications, improved objective physical
functioning, and improved subjective quality of life (SF-36 physical and
mental health domains) measures in patients undergoing cardiac and
vascular procedures. Given the amount of heterogeneity that was present in
the designs, populations, and comparators among the included studies, we
were unable to statistically pool data across trials. Conclusion(s):
Our qualitative findings suggest that prehabilitation may improve clinical
outcomes, physical performance, and health-related quality-of-life
measures in patients undergoing cardiac and vascular surgery
procedures. Copyright © 2019 Elsevier Inc.

<59>
Accession Number
621978576
Title
Reducing risk of spinal haematoma from spinal and epidural pain
procedures.
Source
Scandinavian Journal of Pain. 18 (2) (pp 129-150), 2018. Date of
Publication: 25 Apr 2018.
Author
Breivik H.; Norum H.; Fenger-Eriksen C.; Alahuhta S.; Vigfusson G.; Thomas
O.; Lagerkranser M.
Institution
(Breivik) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Pain Management and Research, Oslo 0424, Norway
(Breivik) University of Oslo, Faculty of Medicine, Oslo, Norway
(Norum) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Anaesthesiology, Oslo, Norway
(Fenger-Eriksen) Department of Anaesthesiology, Aarhus University
Hospital, Aarhus, Denmark
(Alahuhta) Department of Anaesthesiology, MRC Oulu, University of Oulu,
Oulu University Hospital, Oulu, Finland
(Vigfusson) Department of Anaesthesia and Intensive Care, University
Hospital Landspitalinn, Reykjavik, Iceland
(Thomas) Institute of Clinical Sciences, University of Lund, Department of
Paediatric Anaesthesiology and Intensive Care, SUS Lund University
Hospital, Lund, Sweden
(Lagerkranser) Section for Anaesthesiology and Intensive Care Medicine,
Department of Physiology and Pharmacology, Karolinska Institute,
Stockholm, Sweden
Publisher
Walter de Gruyter GmbH (E-mail: peter.golla@degruyter.com)
Abstract
Central neuraxial blocks (CNB: epidural, spinal and their combinations)
and other spinal pain procedures can cause serious harm to the spinal cord
in patients on antihaemostatic drugs or who have other risk-factors for
bleeding in the spinal canal. The purpose of this narrative review is to
provide a practise advisory on how to reduce risk of spinal cord injury
from spinal haematoma (SH) during CNBs and other spinal pain procedures.
Scandinavian guidelines from 2010 are part of the background for this
practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS
and EMBASE for new and relevant randomised controlled trials (RCT),
case-reports and original articles concerning benefits of neuraxial
blocks, risks of SH due to anti-haemostatic drugs, patient-related risk
factors, especially renal impairment with delayed excretion of
antihaemostatic drugs, and specific risk factors related to the neuraxial
pain procedures. Epidural and spinal analgesic techniques, as well as
their combination provide superior analgesia and reduce the risk of
postoperative and obstetric morbidity and mortality. Spinal pain procedure
can be highly effective for cancer patients, less so for chronic
non-cancer patients. We did not identify any RCT with SH as outcome. We
evaluated risks and recommend precautions for SH when patients are treated
with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients'
comorbidities may increase risks, and when procedure-specific risk factors
are present. Inserting and withdrawing epidural catheters appear to have
similar risks for initiating a SH. Invasive neuraxial pain procedures,
e.g. spinal cord stimulation, have higher risks of bleeding than
traditional neuraxial blocks. We recommend robust monitoring routines and
treatment protocol to ensure early diagnosis and effective treatment of SH
should this rare but potentially serious complication occur. When
neuraxial analgesia is considered for a patient on anti-haemostatic
medication, with patient-related, or procedure-related risk factors, the
balance of benefits against risks of bleeding is decisive; when CNB are
offered exclusively to patients who will have a reduction of postoperative
morbidity and mortality, then a higher risk of bleeding may be accepted.
Robust routines should ensure appropriate discontinuation of
anti-haemostatic drugs and early detection and treatment of SH. There is
an on-going development of drugs for prevention of thromboembolic events
following surgery and childbirth. The present practise advisory provides
up-to-date knowledge and experts' experiences so that patients who will
greatly benefit from neuraxial pain procedures and have increased risk of
bleeding can safely benefit from these procedures. There are always
individual factors for the clinician to evaluate and consider.
Increasingly it is necessary for the anaesthesia and analgesia provider to
collaborate with specialists in haemostasis. Surgeons and obstetricians
must be equally well prepared to collaborate for the best outcome for
their patients suffering from acute or chronic pain. Optimal pain
management is a prerequisite for enhanced recovery after surgery, but
there is a multitude of additional concerns, such as early mobilisation,
early oral feeding and ileus prevention that surgeons and anaesthesia
providers need to optimise for the best outcome and least risk of
complications. Copyright © 2018 2018 Harald Breivik et al.,
published by De Gruyter, Berlin/Boston.

<60>
Accession Number
624399324
Title
Does oesophageal stenosis have any impact on survival of oesophageal
cancer patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (3) (pp 384-386),
2018. Date of Publication: 2018.
Author
Deng H.-Y.; Li G.; Luo J.
Institution
(Deng) Lung Cancer Center, West China Hospital, Sichuan University, No. 37
Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng, Li, Luo) Department of Thoracic Surgery, West China Hospital,
Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does oesophageal stenosis
have any impact on survival of oesophageal cancer patients?'. A total of
542 papers were found using the reported search, of which 8 cohort studies
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
Most of these studies defined stenosis as failure to cross the tumour at
endoscopic ultrasonography. Seven studies demonstrated that oesophageal
cancer patients with stenosis had significantly poorer survival than those
without, while 2 studies found that oesophageal stenosis was also a
predictor of poor recurrence-free survival. We conclude that oesophageal
stenosis is a predictor of poor prognosis in patients with oesophageal
cancer. Copyright © 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<61>
Accession Number
2001254585
Title
Prophylactic Effect of Amiodarone Infusion on Reperfusion Ventricular
Fibrillation After Release of Aortic Cross-Clamp in Patients with Left
Ventricular Hypertrophy Undergoing Aortic Valve Replacement: ARandomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1205-1213),
2019. Date of Publication: May 2019.
Author
Mita N.; Kagaya S.; Miyoshi S.; Kuroda M.
Institution
(Mita, Kagaya, Miyoshi) Department of Anesthesiology, Saitama
Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
(Kuroda) Department of Anesthesiology, Saiseikai Utsunomiya Hospital,
Utsunomiya City, Tochigi, Japan
Publisher
W.B. Saunders
Abstract
Objective: To investigate whether prophylactic amiodarone infusion
prevents ventricular fibrillation after aortic cross-clamp release and
attenuates cytokine production in patients with left ventricular
hypertrophy undergoing cardiac surgery. Design(s): Prospective,
randomized controlled trial. Setting(s): A public hospital.
 Participant(s): The study comprised 68 patients undergoing aortic
valve replacement for severe aortic stenosis. Intervention(s):
Patients were randomly assigned to receive a 150mg bolus then 30mg/h
continuous infusion of amiodarone (amiodarone group) or a 1 mg/kg bolus
then 1 mg/kg/h continuous infusion of lidocaine (lidocaine group). The
primary outcome was the ventricular fibrillation incidence rate after
aortic cross-clamp release. Secondary outcomes included perioperative
serum interleukin-6 and tumor necrosis factor-alpha levels.
 Measurements and Main Results: The ventricular fibrillation incidence
rate was significantly lower in the amiodarone than in the lidocaine group
(20.6% v 50%, relative risk 0.41; 95% confidence interval [CI] 0.20-0.86;
p = 0.021). Interleukin-6 levels 1hour after aortic cross-clamp release
and at intensive care unit admission were significantly lower in the
amiodarone than in the lidocaine group (geometric mean [95% CI] 117.4pg/mL
[87.1-158.4] v 339.5pg/mL [210.6-547.2]; p < 0.01 and 211.1pg/mL
[162.8-73.6] v 434.1pg/mL [293.7-641.5]; p < 0.01, respectively). Tumor
necrosis factor-alpha levels 1hour after aortic cross-clamp release were
significantly lower in the amiodarone than in the lidocaine group
(geometric mean [95% CI] 1.624pg/mL [1.359-1.940] v 2.283pg/mL
[1.910-2.731]; p = 0.02). Conclusion(s): Amiodarone prevented
reperfusion ventricular fibrillation in patients with left ventricular
hypertrophy undergoing aortic valve replacement to a greater extent than
did lidocaine. Furthermore, amiodarone inhibited postoperative
interleukin-6 and tumor necrosis factor-alpha production. Copyright
© 2018 Elsevier Inc.

<62>
Accession Number
2001610580
Title
Off-pump coronary surgery: An updated systematic review and meta-analysis.
Source
Cirugia Cardiovascular. 26 (2) (pp 81-91), 2019. Date of Publication:
March - April 2019.
Author
Tena M.A.; Urso S.; Martinez-Comendador J.M.; Bellot R.; Gutierrez E.M.;
Gonzalez J.M.; Sadaba R.; Meca J.; Rios L.; Abad C.; Portela F.
Institution
(Tena, Urso, Bellot, Rios, Abad, Portela) Servicio de Cirugia Cardiaca,
Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Las Palmas,
Spain
(Martinez-Comendador, Gutierrez) Servicio de Cirugia Cardiaca, Hospital
Universitario de Leon, Leon, Spain
(Gonzalez) Unidad de Investigacion, Hospital Universitario Dr. Negrin, Las
Palmas de Gran Canaria, Las Palmas, Spain
(Sadaba) Servicio de Cirugia Cardiaca, Complejo Hospitalario de Navarra,
Pamplona, Navarra, Spain
(Meca) Servicio de Cirugia Cardiaca, Hospital La Paz, Madrid, Spain
Publisher
Elsevier Doyma
Abstract
Introduction and objectives: After 30 years, off-pump coronary artery
bypass grafting benefits are still controversial when compared with the
on-pump technique. For this reason, a meta-analysis is presented that
compares the early and long-term results of the 2 surgical strategies.
 Method(s): A search was made of PubMed, EMBASE, and the Cochrane
library database for clinical trials up to December 2017 for randomised
clinical trials investigating off-pump versus on-pump coronary surgery
with sample size of >= 100 patients. Result(s): A total of 34
clinical trials, with a total of 16,435 patients and 9643 examined grafts
were included in this meta-analysis. Off-pump surgery achieved similar
30-day and 1-year mortality compared with on-pump surgery. The off-pump
technique significantly decreased the risk of 30-day stroke (RR 0.73; 95%
CI; 0.57-0.94; p=0.015), but it increases 1-year repeat revascularization
risk (RR 1.52; 95% CI; 1.18-1.96; p=0.001), 5-year mortality risk (RR=
1.15; 95% CI; 1.03-1.29; p=0.012) and it is associated with worse graft
patency (RR 0.97; 95% CI; 0.94-0.99; p=0.007) compared with on-pump
surgery. Conclusion(s): Off-pump coronary surgery may provide better
short-term neurological results compared with the on-pump technique, at
the expense of a worse graft patency, increased risk of 1-year repeat
revascularisation, and of 5-years mortality. Copyright © 2019
Sociedad Espanola de Cirugia Toracica-Cardiovascular

<63>
Accession Number
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. 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%). 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. Copyright © Med Sci Monit, 2019.

<64>
Accession Number
625580055
Title
Transfusion of red blood cells stored for shorter versus longer duration
for all conditions.
Source
Cochrane Database of Systematic Reviews. 2018 (12) (no pagination), 2018.
Article Number: CD010801. Date of Publication: 22 Dec 2018.
Author
Shah A.; Brunskill S.J.; Desborough M.J.; Doree C.; Trivella M.; Stanworth
S.J.
Institution
(Shah) University of Oxford, Radcliffe Department of Medicine, Oxford,
United Kingdom
(Brunskill, Doree) NHS Blood and Transplant, Systematic Review Initiative,
Level 2, John Radcliffe Hospital, Headington, Oxford, Oxon OX3 9BQ, United
Kingdom
(Desborough) NHS Blood and Transplant, Haematology/Transfusion Medicine,
Oxford, United Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Red blood cell (RBC) transfusion is a common treatment for
anaemia in many conditions. The safety and efficacy of transfusing RBC
units that have been stored for different durations before a transfusion
is a current concern. The duration of storage for a RBC unit can be up to
42 days. If evidence from randomised controlled trials (RCT) were to
indicate that clinical outcomes are affected by storage duration, the
implications for inventory management and clinical practice would be
significant. Objective(s): To assess the effects of using red blood
cells (RBCs) stored for a shorter versus a longer duration, or versus RBCs
stored for standard practice duration, in people requiring a RBC
transfusion. Search Method(s): We searched the Cochrane Central
Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PubMed
(for epublications), LILACS, Transfusion Evidence Library, Web of Science
CPCI-S and four international clinical trial registries on 20 November
2017. Selection Criteria: We included RCTs that compared transfusion
of RBCs of shorter versus longer storage duration, or versus standard
practice storage duration. Data Collection and Analysis: We used
standard Cochrane methods. Main Result(s): We included 22 trials
(42,835 participants) in this review. The GRADE quality of evidence ranged
from very low to moderate for our primary outcome of in-hospital and
short-term mortality reported at different time points. Transfusion of
RBCs of shorter versus longer storage duration Eleven trials (2249
participants) compared transfusion of RBCs of shorter versus longer
storage duration. Two trials enrolled low birth weight neonates, two
enrolled children with severe anaemia secondary to malaria or sickle cell
disease, and eight enrolled adults across a range of clinical settings
(intensive care, cardiac surgery, major elective surgery, hospitalised
in-patients, haematology outpatients). We judged only two trials to be at
low risk of bias across all domains; most trials had an unclear risk for
multiple domains. Transfusion of RBCs of shorter versus longer storage
duration probably leads to little or no difference in mortality at
seven-day follow-up (risk ratio (RR) 1.42, 95% confidence interval (CI)
0.66 to 3.06; 1 trial, 3098 participants; moderate quality evidence) or
30-day follow-up (RR 0.85, 95%CI 0.50 to 1.45; 2 trials, 1121
participants; moderate quality evidence) in adults undergoing major
elective cardiac or non-cardiac surgery. For neonates, no studies reported
on the primary outcome of in-hospital or short-term mortality. At 40 weeks
gestational age, the effect of RBCs of shorter versus longer storage
duration on the risk of death was uncertain, as the quality of evidence is
very low (RR 0.90, 95% CI 0.41 to 1.85; 1 trial, 52 participants). The
effect of RBCs of shorter versus longer storage duration on the risk of
death in children with severe anaemia was also uncertain within 24 hours
of transfusion (RR 1.50, 95% CI 0.43 to 5.25; 2 trials, 364 participants;
very low quality evidence), or at 30-day follow-up (RR 1.40, 95% CI 0.45
to 4.31; 1 trial, 290 participants; low quality evidence). Only one trial,
in children with severe anaemia (290 participants), reported adverse
transfusion reactions. Only one child in each arm experienced an adverse
reaction within 24 hours of transfusion. Transfusion of RBCs of shorter
versus standard practice storage duration Eleven trials (40,588
participants) compared transfusion of RBCs of shorter versus standard
practice storage duration. Three trials enrolled critically ill term
neonates; two of these enrolled very low birth weight neonates. There were
no trials in children. Eight trials enrolled critically ill and
non-critically ill adults, with most being hospitalised. We judged four
trials to be at low risk of bias across all domains with the others having
an unclear risk of bias across multiple domains. Transfusion of RBCs of
shorter versus standard practice storage duration probably leads to little
or no difference in adult in-hospital mortality (RR 1.05, 95% CI 0.97 to
1.14; 4 trials, 25,704 participants; moderate quality evidence), ICU
mortality (RR 1.06, 95% CI 0.98 to 1.15; 3 trials, 13,066 participants;
moderate quality evidence), or 30-day mortality (RR 1.04, 95% CI 0.96 to
1.13; 4 trials, 7510 participants;moderate quality evidence). Two of the
three trials that enrolled neonates reported that there were no adverse
transfusion reactions. One trial reported an isolated case of
cytomegalovirus infection in participants assigned to the standard
practice storage duration group. Two trials in critically ill adults
reported data on transfusion reactions: one observed no difference in
acute transfusion reactions between arms (RR 0.67, 95% CI 0.19 to 2.36,
2413 participants), but the other observed more febrile nonhaemolytic
reactions in the shorter storage duration arm (RR 1.48, 95% CI 1.13 to
1.95, 4919 participants). Trial sequential analysis showed that we may now
have sufficient evidence to reject a 5% relative risk increase or decrease
of death within 30 days when transfusing RBCs of shorter versus longer
storage duration across all patient groups. Authors' conclusions: The
effect of storage duration on clinically important outcomes has now been
investigated in large, high quality RCTs, predominantly in adults. There
appears to be no evidence of an effect on mortality that is related to
length of storage of transfused RBCs. However, the quality of evidence in
neonates and children is low. The current practice in blood banks of using
the oldest available RBCs can be continued safely. Additional RCTs are not
required, but research using alternative study designs, should focus on
particular subgroups (e.g. those requiring multiple RBC units) and on
factors affecting RBC quality. Copyright © 2018 The Cochrane
Collaboration.

<65>
Accession Number
2000821648
Title
Critical evaluation on proper antithrombotic treatment in different groups
of patients undergoing vascular surgery.
Source
Hellenic Journal of Cardiology. 59 (6) (pp 313-316), 2018. Date of
Publication: November - December 2018.
Author
Filis K.; Tsioufis C.; Sianou A.; Triantafillou K.; Sigala F.; Galyfos G.
Institution
(Filis, Sigala, Galyfos) First Department of Propedeutic Surgery,
Hippocration Hospital, National and Kapodistrian University of Athens,
School of Medicine, Athens, Greece
(Tsioufis) First Cardiology Clinic, Medical School, National and
Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
(Sianou) Department of Microbiology, Areteion Hospital, National and
Kapodistrian University of Athens, School of Medicine, Athens, Greece
(Triantafillou) First Department of Cardiac Surgery, Hippocration
Hospital, Athens, Greece
Publisher
Hellenic Cardiological Society
Abstract
Antithrombotic treatment including anticoagulants and antiplatelets has
evolved during the last decades, and several recommendations have been
included in the latest guidelines regarding the proper management of
patients undergoing vascular surgery. However, there are significant
differences compared to older recommendations, and indications vary among
patients with peripheral artery disease, carotid disease, and abdominal
aortic aneurysm. In this mini review, we critically evaluate all these
data to produce useful conclusions for everyday clinical
practice. Copyright © 2018 Hellenic Society of Cardiology

<66>
Accession Number
2001648019
Title
Perioperative Quality Initiative consensus statement on postoperative
blood pressure, risk and outcomes for elective surgery.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
McEvoy M.D.; Gupta R.; Koepke E.J.; Feldheiser A.; Michard F.; Levett D.;
Thacker J.K.M.; Hamilton M.; Grocott M.P.W.; Mythen M.G.; Miller T.E.;
Edwards M.R.; Ackland G.L.; Brudney C.S.; Cecconi M.; Ince C.; Irwin M.G.;
Lacey J.; Pinsky M.R.; Sanders R.; Hughes F.; Bader A.; Thompson A.; Hoeft
A.; Williams D.; Shaw A.D.; Sessler D.I.; Aronson S.; Berry C.; Gan T.J.;
Kellum J.; Plumb J.; Bloomstone J.; Koepke E.
Institution
(McEvoy, McEvoy, Shaw) Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, TN, United States
(Gupta) Department of Anesthesiology, Stony Brook School of Medicine,
Stony Brook, NY, United States
(Koepke, Miller, Thompson, Williams, Aronson, Koepke) Department of
Anesthesiology, Duke University Medical Center, Durham, NC, United States
(Thacker) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Feldheiser) Department of Anesthesiology and Operative Intensive Care
Medicine, Charite Universitatsmedizin, Berlin, Germany
(Michard) MiCo Sarl, Lausanne, Switzerland
(Levett) Department of Perioperative Medicine and Critical Care,
Southampton University Hospital NHS Foundation Trust, Southampton, United
Kingdom
(Hamilton) Department of Intensive Care Medicine and Anaesthesia, St.
George's Hospital and Medical School NHS Foundation Trust, London, United
Kingdom
(Grocott, Edwards) Critical Care Research Group, NIHR Biomedical Research
Centre, University Hospital Southampton NHS Foundation Trust/University of
Southampton, Southampton, United Kingdom
(Grocott, Edwards) Department of Anaesthesia, University Hospital
Southampton NHS Foundation Trust/University of Southampton, Southampton,
United Kingdom
(Mythen) UCL/UCLH National Institute of Health Research Biomedical
Research Centre, London, United Kingdom
(Grocott, Edwards) Respiratory and Critical Care Research Area, NIHR
Biomedical Research Centre, University Hospital Southampton, NHS
Foundation Trust, Southampton, United Kingdom
(Ackland) Translational Medicine & Therapeutics, William Harvey Research
Institute, Barts and The London School of Medicine and Dentistry, Queen
Mary University of London, John Vane Science Centre, Charterhouse Square,
London, United Kingdom
(Brudney) Department of Anesthesiology, University of Manitoba, Canada
(Cecconi) Department of Intensive Care Medicine, St George's Healthcare
NHS Trust and St George's University of London, United Kingdom
(Ince) Department of Intensive Care, University Medical Center Rotterdam,
Rotterdam, Netherlands
(Irwin) Department of Anaesthesiology, University of Hong Kong, Hong Kong
(Lacey, Hughes) University College London Hospitals NHS Trust, London,
United Kingdom
(Pinsky) Department of Critical Care Medicine, University of Pittsburgh,
Pittsburgh, PA, United States
(Sanders) Department of Anesthesiology, University of Wisconsin School of
Medicine and Public Health, Madison, WI, United States
(Bader) Department of Anesthesiology, Brigham and Women's Hospital,
Boston, MA, United States
(Hoeft) Department of Anaesthesiology and Intensive Care, University
Hospital Bonn, Bonn, Germany
(Sessler) Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
(Berry) Royal Devon and Exeter NHS Foundation Trust, Exeter, United
Kingdom
(Gupta, Gan) Department of Anesthesiology, Stony Brook University School
of Medicine, Stony Brook, NY, United States
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Levett, Plumb) University Hospital Southampton, NHS Foundation Trust,
Southampton, United Kingdom
(Bloomstone) University of Arizona College of Medicine-Phoenix, Phoenix,
AZ, United States
(Thacker) Department of Surgery, Division of Advanced Oncologic and GI
Surgery, Duke University Medical Center, Durham, NC, United States
(Feldheiser) Department of Anesthesiology and Operative Intensive Care
Medicine, Charite - Universitatsmedizin Berlin, Berlin, Germany
(Michard) MiCo, Denens, Switzerland
(Hamilton) Department of Anaesthesia & Critical Care Medicine, St.
George's Hospital and Medical School, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Postoperative hypotension and hypertension are frequent events
associated with increased risk of adverse outcomes. However, proper
assessment and management is often poorly understood. As a part of the
PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed
a consensus document addressing this topic. The target population includes
adult, non-cardiac surgical patients in the postoperative phase outside of
the ICU. Method(s): A modified Delphi technique was used, evaluating
papers published in MEDLINE examining postoperative blood pressure
monitoring, management, and outcomes. Practice recommendations were
developed in line with National Institute for Health and Care Excellence
guidelines. Result(s): Consensus recommendations were that (i) there
is evidence of harm associated with postoperative systolic arterial
pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the
threshold at which harm occurs may be higher than a systolic arterial
pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely
define the level of postoperative hypertension above which harm will
occur; (iv) a greater frequency of postoperative blood pressure
measurement is likely to identify risk of harm and clinical deterioration
earlier; and (v) there is evidence of harm from withholding beta-blockers,
angiotensin receptor blockers, and angiotensin-converting enzyme
inhibitors in the postoperative period. Conclusion(s): Despite
evidence of associations with postoperative hypotension or hypertension
with worse postoperative outcome, further research is needed to define the
optimal levels at which intervention is beneficial, to identify the best
methods and timing of postoperative blood pressure measurement, and to
refine the management of long-term antihypertensive treatment in the
postoperative phase. Copyright © 2019 British Journal of
Anaesthesia

<67>
Accession Number
626200172
Title
Early physical and psycho-educational rehabilitation in patients with
coronary artery bypass grafting: A randomized controlled trial.
Source
Journal of rehabilitation medicine. 51 (2) (pp 136-143), 2019. Date of
Publication: 01 Feb 2019.
Author
Hojskov I.E.; Moons P.; Egerod I.; Olsen P.S.; Thygesen L.C.; Hansen N.V.;
La Cour S.; Bech K.H.; Borregaard B.; Gluud C.; Winkel P.; Lindschou J.;
Kikkenborg Berg S.
Institution
(Hojskov) Department of Cardiothoracic Surgery/Department of Nursing,
Faculty of Health and Technology, Rigshospitalet, University of
Copenhagen/ Metropolitan University College, Copenhagen 2100, Denmark
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Rehabilitation of patients following coronary artery bypass
grafting (CABG) has been widely studied; however, research into early
rehabilitation after CABG is sparse. The aim of this trial was to assess
the impact of early rehabilitation, compared with usual care in patients
following CABG. DESIGN: Randomized controlled trial. PATIENTS: A total of
326 patients treated with CABG. METHOD(S): Patients treated with CABG
were randomized 1:1 to 4 weeks of comprehensive early rehabilitation or
usual care. The primary outcome was the Six Minute Walk Test (6MWT).
Secondary outcomes were mental health and physical activity (Medical
Outcome Study Short Form; SF-12); anxiety and depression (Hospital Anxiety
and Depression Scale; HADS); physical and emotional scores; sleep
(Pittsburgh Sleep Quality Index; PSQI); pain (Orebro Musculoskeletal
Screening Questionnaire; OMSQ) and muscle endurance (Sit-To-Stand test).
 RESULT(S): Sixteen patients dropped out. No significant differences
between groups in the primary outcome (6MWT) were found after 4 weeks
(p=0.27). For secondary outcomes the odds ratio of HADS-D >=8 decreased in
favour of the experimental intervention (p=0.04). There was non-adherence
to parts of the intervention. Per-protocol analysis showed differences
between groups for the 6MWT (p=0.02) and the Sit-To-Stand test (p=0.046).
 CONCLUSION(S): In general, the intervention had no effect on the
6MWT, or secondary outcomes, except for depressive symptoms. However, in
adherent participants, the intervention had a positive effect for the
primary and several secondary outcomes.

<68>
Accession Number
626727482
Title
Bilateral versus single internal thoracic artery for coronary artery
bypass grafting with end-stage renal disease: A systematic review and
meta-analysis.
Source
Journal of Cardiac Surgery. 34 (4) (pp 196-201), 2019. Date of
Publication: April 2019.
Author
Tam D.Y.; Rahouma M.; An K.R.; Gaudino M.F.L.; Karkhanis R.; Fremes S.E.
Institution
(Tam, An, Karkhanis, Fremes) Division of Cardiac Surgery, Schulich Heart
Centre, Department of Surgery, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Canada
(Gaudino) Department of Cardiovascular Sciences, Catholic University,
Rome, Italy
(Rahouma, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medical College, New York, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The incidence of severe coronary artery disease (CAD) in
patients with end-stage renal disease (ESRD) on dialysis is high. Coronary
artery bypass grafting (CABG) is the preferred treatment in those with
severe CAD. Bilateral internal thoracic artery (BITA) vs single internal
thoracic artery (SITA) grafting has been shown to improve late survival in
other high-risk populations. In ESRD, comparative studies are limited by
sample size to detect outcome differences. We sought to determine the late
survival and early outcomes of BITA compared with SITA in patients with
ESRD. Method(s): MEDLINE and EMBASE were searched from inception to
2017 for studies directly comparing BITA to SITA in patients with ESRD
undergoing CABG. The primary outcome was late survival; secondary outcomes
were in-hospital/30-day mortality, stroke, and deep sternal wound
infection (DSWI). Kaplan-Meier curve reconstruction for late mortality was
performed. Result(s): Five studies (three adjusted [n = 197] and two
unadjusted observational studies [n = 231]) were included in the analysis.
Reported ITA skeletonization ranged from 83% to 100% (median: 100%). There
was no difference in in-hospital mortality (risk risk [RR], 0.84; 95%
confidence interval [95%CI], 0.36,1.98; P = 0.70), perioperative stroke
(RR, 1.97; 95%CI, 0.58,6.66; P = 0.28), and DSWI (RR, 1.56; 95%CI,
0.60,4.07; P = 0.36) between BITA and SITA. All studies reported adjusted
late mortality, which was similar between BITA and SITA (incident rate
ratio, 0.81; 95%CI, 0.59,1.11) at mean 3.7-year follow-up.
 Conclusion(s): BITA grafting is safe in patients with ESRD although
there was no survival benefit at 3.7 years. Additional studies with longer
follow-up are required to determine the potential late benefits of BITA
grafting in patients with ESRD. Copyright © 2019 Wiley
Periodicals, Inc.

<69>
Accession Number
627090924
Title
Comparing everolimus-based immunosuppression with reduction or withdrawal
of calcineurin inhibitor reduction from 6 months after heart
transplantation: The randomized MANDELA study.
Source
American Journal of Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Barten M.J.; Hirt S.W.; Garbade J.; Bara C.; Doesch A.O.; Knosalla C.;
Grinninger C.; Stypmann J.; Sieder C.; Lehmkuhl H.B.; Porstner M.; Schulz
U.
Institution
(Barten) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg, Germany
(Hirt) Department of Cardiothoracic Surgery, University Hospital
Regensburg, Regensburg, Germany
(Garbade) University Department of Cardiac Surgery, Leipzig Heart Center,
Leipzig, Germany
(Bara) Division of Cardiovascular, Thoracic and Transplantation Surgery,
Hannover Medical School, Hannover, Germany
(Doesch) Department of Cardiology, University Hospital Heidelberg,
Heidelberg, Germany
(Knosalla, Lehmkuhl) Department of Cardiothoracic and Vascular Surgery,
German Heart Institute Berlin, DZHK (German Centre for Cardiovascular
Research), partner site Berlin, Berlin, Germany
(Grinninger) Department of Cardiac Surgery, Munich Transplantation Center,
Klinikum Groshadern LMU, Munich, Germany
(Stypmann) Department of Cardiovascular Medicine, Division of Cardiology,
University Hospital Munster, Munster, Germany
(Sieder, Porstner) Novartis Pharma GmbH, Nuremberg, Germany
(Schulz) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
Publisher
Blackwell Publishing Ltd
Abstract
In the 12-month, open-label MANDELA study, patients were randomized at
month 6 after heart transplantation to (1) convert to calcineurin
inhibitor (CNI)-free immunosuppression with everolimus (EVR), mycophenolic
acid and steroids (CNI-free, n = 71), or to (2) continue reduced-exposure
CNI, with EVR and steroids (EVR/redCNI, n = 74). Tacrolimus was
administered in 48.8% of EVR/redCNI patients and 52.6% of CNI-free
patients at randomization. Both strategies improved and stabilized renal
function based on the primary endpoint (estimated GFR at month 18
posttransplant postrandomization) with superiority of the CNI-free group
vs EVR/redCNI: mean 64.1 mL/min/1.73 m2 vs 52.9 mL/min/1.73
m2; difference + 11.3 mL/min/1.73 m2 (P <.001). By
month 18, estimated GFR had increased by >= 10 mL/min/1.73 m2
in 31.8% and 55.2% of EVR/redCNI and CNI-free patients, respectively, and
by >= 25 mL/min/1.73 m2 in 4.5% and 20.9%. Rates of
biopsy-proven acute rejection (BPAR) were 6.8% and 21.1%; all cases were
without hemodynamic compromise. BPAR was less frequent with EVR/redCNI vs
the CNI-free regimen (P =.015); 6 of 15 episodes in CNI-free patients
occurred with EVR concentration < 5 ng/mL. Rates of adverse events and
associated discontinuations were comparable. EVR/redCNI from month 6
achieved stable renal function with infrequent BPAR. One-year renal
function can be improved by early conversion to EVR-based CNI-free therapy
but requires close EVR monitoring. Clinical trials registry:
ClinicalTrials.gov NCT00862979. Copyright © 2019 The American
Society of Transplantation and the American Society of Transplant Surgeons

<70>
Accession Number
2001732388
Title
P050. Perioperative management of anticoagulation in high-risk breast
surgery patients: development of a multidisciplinary consensus pathway.
Source
European Journal of Surgical Oncology. Conference: ABS Conference 2019.
United Kingdom. 45 (5) (pp 898-899), 2019. Date of Publication: May 2019.
Author
Tan K.T.; Winter H.; Hu J.
Institution
(Tan, Winter, Hu) Department of Breast Surgery, Barts Health NHS Trust,
London, United Kingdom
Publisher
W.B. Saunders Ltd
Abstract
Introduction: Patients at high risk for thromboembolism undergoing breast
surgery require multidisciplinary management of their anticoagulation to
carefully balance the risk of thromboembolism and bleeding. However, there
is a lack of published guidelines on the perioperative management of
anticoagulation specific to the wide range of breast surgery operations
and insufficient evidence to justify the application of guidelines
developed for other specialties. Method(s): A literature search was
performed, reviewing evidence regarding venous thromboembolic events in
breast surgery and perioperative risk assessment and management of
anticoagulated patients at high risk for thromboembolism. Data regarding
post-operative haematomas was also reviewed. Literature was presented in a
multidisciplinary forum and a consensus pathway developed in conjunction
with cardiologists, haematologists and surgeons. Result(s): In
patients deemed to be low risk for thromboembolic events, the risk in
breast cancer surgery is low. However, the high-risk group require
individual assessment. A balance of risks between thromboembolism and
bleeding is essential. Thromboembolism in this group has potential severe
sequelae. Our local pathway includes a risk assessment model to stratify
those patients who require bridging anticoagulation with heparin. In
particular we review the assessment of patients with atrial fibrillation,
coronary stents, and mechanical heart valves. Conclusion(s): There is
a need for a structured pathway for the multidisciplinary management of
high-risk patients. Risk stratification is paramount in ensuring safe
patient care. National guidelines are needed to ensure that these patients
receive the appropriate cancer treatment whilst their risk of
thromboembolism and bleeding is managed safely and
appropriately. Copyright © 2019

<71>
Accession Number
627074419
Title
Prosthesis-Patient Mismatch Negatively Affects Outcomes after Mitral Valve
Replacement: Meta-Analysis of 10,239 Patients.
Source
Brazilian journal of cardiovascular surgery. 34 (2) (pp 203-212), 2019.
Date of Publication: 01 Mar 2019.
Author
Sa M.P.B.O.; Cavalcanti L.R.P.; Rayol S.D.C.; Diniz R.G.S.; Menezes A.M.;
Clavel M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Rayol, Diniz, Menezes, Lima) Department of Cardiovascular
Surgery at the Pronto Socorro Cardiologico de Pernambuco (PROCAPE),
Recife, PE, Brazil
(Sa, Cavalcanti, Rayol, Diniz, Menezes, Lima) Universidade de Pernambuco
(UPE), Recife, PE, Brazil
(Sa, Lima) Nucleus of Postgraduate Studies and Research in Health Sciences
at Faculdade de Ciencias Medicas and Instituto de Ciencias Biologicas
(FCM/ICB), Recife, PE, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie et de Pneumologie
du Quebec, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This study sought to evaluate the impact of prosthesis-patient
mismatch on the risk of perioperative and long-term mortality after mitral
valve replacement. METHOD(S): Databases were researched for studies
published until December 2018. Main outcomes of interest were
perioperative and 10-year mortality and echocardiographic parameters.
 RESULT(S): The research yielded 2,985 studies for inclusion. Of
these, 16 articles were analyzed, and their data extracted. The total
number of patients included was 10,239, who underwent mitral valve
replacement. The incidence of prosthesis-patient mismatch after mitral
valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and
4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI
1.194-1.931, P<0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P<0.001)
mortality was increased in patients with prosthesis-patient mismatch.
Patients with prosthesis-patient mismatch after mitral valve replacement
had higher systolic pulmonary artery pressure and transprosthethic
gradient and lower indexed effective orifice area and left ventricle
ejection fraction. CONCLUSION(S): Prosthesis-patient mismatch
increases perioperative and long-term mortality. Prosthesis-patient
mismatch is also associated with pulmonary hypertension and depressed left
ventricle systolic function. The findings of this study support the
implementation of surgical strategies to prevent prosthesis-patient
mismatch in order to decrease mortality rates.

<72>
Accession Number
627074380
Title
Comparison of Biological and Mechanical Prostheses for Heart Valve
Surgery: A Systematic Review of Randomized Controlled Trials.
Source
Arquivos brasileiros de cardiologia. 112 (3) (pp 292-301), 2019. Date of
Publication: 01 Mar 2019.
Author
Kiyose A.T.; Suzumura E.A.; Laranjeira L.; Buehler A.M.; Santo J.A.E.;
Berwanger O.; Carvalho A.C.C.; Paola A.A.; Moises V.A.; Cavalcanti A.B.
Institution
(Kiyose, Carvalho, Paola, Moises) Universidade Federal de Sao Paulo
(UNIFESP), Sao Paulo, Brazil
(Kiyose, Suzumura, Laranjeira, Buehler, Santo, Berwanger, Cavalcanti)
Hospital do Coracao (HCOR), Sao Paulo, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: The choice of a mechanical (MP) or biological prosthesis (BP)
for patients with valvular heart disease undergoing replacement is still
not a consensus. OBJECTIVE(S): We aimed to determine the clinical
outcomes of MP or BP placement in those patients. METHOD(S): We
conducted a systematic review and meta-analysis of randomized controlled
trials (RCTs) that compared biological prostheses and mechanical
prostheses in patients with valvular heart diseases and assessed the
outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL,
SCOPUS and Web of Science (from inception to November 2014) databases.
Meta-analyses were performed using inverse variance with random effects
models. The GRADE system was used to rate the quality of the evidence. A
P-value lower than 0.05 was considered significant. RESULT(S): A
total of four RCTs were included in the meta-analyses (1,528 patients)
with follow up ranging from 2 to 20 years. Three used old generation
mechanical and biological prostheses, and one used contemporary
prostheses. No significant difference in mortality was found between BP
and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of
bleeding was significantly lower in BP patients than MP patients (RR =
0.64; 95% CI 0.52-0.78); however, reoperations were significantly more
frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no
statistically significant differences between BP and MP patients with
respect to systemic arterial embolisms and infective endocarditis (RR =
0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results
in the trials with modern and old prostheses were similar.
 CONCLUSION(S): The mortality rate and the risk of thromboembolic
events and endocarditis were similar between BP and MP patients. The risk
of bleeding was approximately one third lower for BP patients than for MP
patients, while the risk of reoperations was more than three times higher
for BP patients.

<73>
Accession Number
627074074
Title
Benefits of Fasting Abbreviation with Carbohydrates and Omega-3 Infusion
During CABG: a Double-Blind Controlled Randomized Trial.
Source
Brazilian journal of cardiovascular surgery. 34 (2) (pp 125-135), 2019.
Date of Publication: 01 Mar 2019.
Author
Feguri G.R.; Lima P.R.L.; Franco A.C.; Cruz F.R.H.; Borges D.C.; Toledo
L.R.; Segri N.J.; Aguilar-Nascimento J.E.
Institution
(Feguri, Lima, Borges) Department of Cardiology and Cardiovascular
Surgery, Hospital Geral Universitario, Universidade de Cuiaba (HGU-UNIC),
Cuiaba, MT, Brazil
(Franco, Cruz) Department of Cardiovascular Surgery, Hospital Geral
Universitario, Universidade de Cuiaba (HGU-UNIC), Cuiaba, MT, Brazil
(Toledo) Department of Physical Therapy, Hospital Geral Universitario,
Universidade de Cuiaba (HGU-UNIC), Cuiaba, MT, Brazil
(Segri) Department of Statistics, Universidade Federal do Mato Grosso
(UFMT), Cuiaba, MT, Brazil
(Aguilar-Nascimento) Universidade Federal do Mato Grosso (UFMT), Cuiaba,
MT, Brazil
(Aguilar-Nascimento) Universidade de Varzea Grande (UNIVAG), MT, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess postoperative clinical data considering the
association of preoperative fasting with carbohydrate (CHO) loading and
intraoperative infusion of omega-3 polyunsaturated fatty acids (omega-3
PUFA). METHOD(S): 57 patients undergoing coronary artery bypass
grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200
mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before
anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before
anesthesia) plus intraoperative infusion of omega-3 PUFA (0.2 g/kg),
(CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus
intraoperative infusion of omega-3 PUFA (0.2 g/kg), (W3, n=14). The need
for vasoactive drugs was analyzed, in addition to postoperative
inflammation and metabolic control. RESULT(S): There were two deaths
(3.5%). Patients in CHO groups presented a lower incidence of hospital
infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive
drugs during surgery and ICU stay (P<0.05); and had better blood glucose
levels in the first six hours of recovery (P=0.015), requiring less
exogenous insulin (P=0.018). Incidence of postoperative atrial
fibrillation (POAF) varied significantly among groups (P=0.009). Subjects
who receive omega-3 PUFA groups had fewer occurrences of POAF (RR=4.83,
95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower
ultrasensitive-CRP levels at 36 h postoperatively (P=0.008).
Interleukin-10 levels varied among groups (P=0.013), with the highest
levels observed in the postoperative of patients who received
intraoperative infusion of omega-3 PUFA (P=0.049). CONCLUSION(S):
Fasting abbreviation with carbohydrate loading and intraoperative infusion
of omega-3 PUFA is safe and supports faster postoperative recovery in
patients undergoing on-pump CABG.

<74>
Accession Number
627072861
Title
Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic
Review and Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. 34 (2) (pp 213-221), 2019.
Date of Publication: 01 Mar 2019.
Author
Harky A.; Chan J.S.; Bithas C.; Hof A.; Sharif M.; Froghi S.; Bashir M.
Institution
(Harky, Bithas) Department of Vascular Surgery, Countess of Chester,
United Kingdom of Great Britain and Northern Ireland, Chester, Canada
(Chan) Faculty of Medicine, Chinese University of Hong Kong, Region of the
People's Republic of China, Hong Kong
(Hof) Department of Cardiovascular Surgery, Heinrich-Heine-University,
Medical Faculty, Germany
(Sharif) School of Medicine, University of Liverpool, United Kingdom of
Great Britain and Northern Ireland, Liverpool, Australia
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith
Hospital, Du Cane Rd London, United Kingdom of Great Britain and Northern
Ireland
(Bashir) Manchester Royal Infirmary, United Kingdom of Great Britain and
Northern Ireland
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate whether axillary artery cannulation has
supremacy over innominate artery cannulation in thoracic aortic surgery.
 METHOD(S): A comprehensive search was undertaken among the four major
databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to
identify all randomized and nonrandomized controlled trials comparing
axillary to innominate artery cannulation in thoracic aortic surgery.
Databases were evaluated and assessed up to March 2017. RESULT(S):
Only three studies fulfilled the criteria for this meta-analysis,
including 534 patients. Cardiopulmonary bypass time was significantly
shorter in the innominate group (P=0.004). However, the innominate group
had significantly higher risk of prolonged intubation > 48 hours (P=0.04)
than the axillary group. Further analysis revealed no significant
difference between the innominate and axillary groups for deep hypothermic
circulatory arrest time (P=0.06). The relative risks for temporary and
permanent neurological deficits as well as in-hospital mortality were not
significantly different for both groups (P=0.90, P=0.49, and P=0.55,
respectively). Length of hospital stay was similar for both groups.
 CONCLUSION(S): There is no superiority of axillary over innominate
artery cannulation in thoracic aortic surgery in terms of perioperative
outcomes; however, as the studies were limited, larger scale comparative
studies are required to provide a solid evidence base for choosing optimal
arterial cannulation site.

<75>
Accession Number
2001782552
Title
Transcatheter Mitral Valve Replacement with Intrepid.
Source
Interventional Cardiology Clinics. (no pagination), 2019. Date of
Publication: 2019.
Author
McCarthy P.M.; Kislitsina O.N.; Malaisrie S.C.; Davidson C.J.
Institution
(McCarthy) Division of Cardiac Surgery, Northwestern University Feinberg
School of Medicine, Northwestern University, 201 East Huron Street, Suite
11-140, Chicago, IL 60611-2908, United States
(Kislitsina) Cardiology, Northwestern University Feinberg School of
Medicine, 201 East Huron Street, Suite 11-140, Chicago, IL 60611-2908,
United States
(Malaisrie) Division of Cardiac Surgery, Northwestern University Feinberg
School of Medicine, 201 East Huron Street, Suite 11-140, Chicago, IL
60611, United States
(Davidson) Division of Cardiology, Northwestern University Feinberg School
of Medicine, 676 North St. Clair, Arkes 23 Suite 2330, Chicago, IL 60611,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter mitral valve replacement with the Intrepid device is
intended for patients who need mitral valve replacement and who are at an
increased risk for conventional surgery. The early published results of
the early feasibility trial are reviewed as well as device design and the
implant procedure. The Apollo trial is reviewed: a randomized trial of the
Intrepid device versus conventional surgery including a single arm study
for inoperable patients. The mitral valve structure, pathophysiology, and
postimplant physiology pose unique hurdles for any transcatheter
implant. Copyright © 2019 Elsevier Inc.

<76>
Accession Number
627092693
Title
Effects of lowering diastolic blood pressure to <80 mmHg on cardiovascular
mortality and events in patients with coronary artery disease: a
systematic review and meta-analysis.
Source
Hypertension Research. (no pagination), 2019. Date of Publication: 2019.
Author
Okamoto R.; Kumagai E.; Kai H.; Shibata R.; Ohtsubo T.; Kawano H.;
Fujiwara A.; Ito M.; Fukumoto Y.; Arima H.
Institution
(Okamoto, Ito) Department of Cardiology and Nephrology, Mie University
Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
(Kumagai, Fukumoto) Division of Cardiovascular Medicine, Department of
Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi,
Kurume, Fukuoka 830-0011, Japan
(Kai) Department of Cardiology, Kurume University Medical Center, 155-1
Kokubu-machi, Kurume, Fukuoka 839-0863, Japan
(Shibata) Department of Advanced Cardiovascular Therapeutics, Nagoya
University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya
466-8550, Japan
(Ohtsubo) Department of Medicine and Clinical Science, Graduate School of
Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka
812-8582, Japan
(Kawano) Department of Cardiovascular Medicine, Nagasaki University
Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501,
Japan
(Fujiwara) Divition of Nephrology and Hypertension, Yokohama City
University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024,
Japan
(Arima) Department of Preventive Medicine and Public Health, Fukuoka
University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, Fukuoka 814-0180, Japan
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
The target of diastolic blood pressure (DBP) remains controversial in
patients with coronary artery disease (CAD). We systematically searched
PubMed/Medline and the Cochrane Central database for randomized controlled
trials (RCTs) assessing the efficacy and safety of reducing DBP in CAD
patients from January 1965 to July 2017. Seven placebo-controlled RCTs
enrolling 34,814 CAD patients who achieved DBP <80 mmHg were included in
the drug-intervention group. The average achieved blood pressures (BPs)
were 126.3/75.1 and 131.5/77.8 mmHg in the drug-intervention and
placebo-control groups, respectively. Drug intervention was associated
with an 11% reduction in coronary revascularization and a 31% reduction in
heart failure. In the drug-intervention group, all-cause death, myocardial
infarction, angina pectoris, and stroke were reduced with marginal
significance, whereas hypotension was increased by 123%. A meta-analysis
of four RCTs, in which the achieved DBP was <75 mmHg, showed that the drug
intervention was associated with a 22% reduction in heart failure. These
results suggest that reducing DBP to 80 mmHg or less would significantly
reduce coronary revascularization and heart failure but at the expense of
causing hypotension in CAD patients. Further trials are warranted to prove
this issue. Copyright © 2019, The Japanese Society of
Hypertension.

<77>
Accession Number
627090096
Title
Impact of large periprocedural myocardial infarction on mortality after
percutaneous coronary intervention and coronary artery bypass grafting for
left main disease: an analysis from the EXCEL trial.
Source
European heart journal. (no pagination), 2019. Date of Publication: 28 Mar
2019.
Author
Ben-Yehuda O.; Chen S.; Redfors B.; McAndrew T.; Crowley A.; Kosmidou I.;
Kandzari D.E.; Puskas J.D.; Morice M.-C.; Taggart D.P.; Leon M.B.; Lembo
N.J.; Brown W.M.; Simonton C.A.; Dressler O.; Kappetein A.P.; Sabik J.F.;
Serruys P.W.; Stone G.W.
Institution
(Ben-Yehuda, Chen, Redfors, McAndrew, Crowley, Kosmidou, Leon, Lembo,
Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
(Ben-Yehuda, Leon, Lembo, Stone) Division of Cardiology,
NewYork-Presbyterian Hospital, Columbia University Medical Center, New
York, NY, USA
(Kosmidou) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Kandzari, Brown) Piedmont Heart Institute, Atlanta, GA, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY, USA
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Taggart) Department Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
NLM (Medline)
Abstract
AIMS: The prognostic implications of periprocedural myocardial infarction
(PMI) after percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) remain controversial. We examined the 3-year rates
of mortality among patients with and without PMI undergoing left main
coronary artery intervention randomized to PCI with everolimus-eluting
stents vs. CABG in the large-scale, multicentre, prospective, randomized
EXCEL trial. METHODS AND RESULTS: By protocol, PMI was defined using an
identical threshold for PCI and CABG [creatinine kinase-MB (CK-MB)
elevation >10x the upper reference limit (URL) within 72h post-procedure,
or >5x URL with new Q-waves, angiographic vessel occlusion, or loss of
myocardium on imaging]. Cox proportional hazards modelling was performed
controlling for age, sex, hypertension, diabetes mellitus, left
ventricular ejection fraction, SYNTAX score, and chronic obstructive
pulmonary disease (COPD). A total of 1858 patients were treated as
assigned by randomization. Periprocedural MI occurred in 34/935 (3.6%) of
patients in the PCI group and 56/923 (6.1%) of patients in the CABG group
[odds ratio 0.61, 95% confidence interval (CI) 0.40-0.93; P=0.02].
Periprocedural MI was associated with SYNTAX score, COPD, cross-clamp
duration and total procedure duration, and not using antegrade
cardioplegia. By multivariable analysis, PMI was associated with
cardiovascular death and all-cause death at 3years [adjusted hazard ratio
(HR) 2.63, 95% CI 1.19-5.81; P=0.02 and adjusted HR 2.28, 95% CI
1.22-4.29; P=0.01, respectively]. The effect of PMI was consistent for PCI
and CABG for cardiovascular death (Pinteraction = 0.56) and all-cause
death (Pinteraction = 0.59). Peak post-procedure CK-MB >=10x URL strongly
predicted mortality, whereas lesser degrees of myonecrosis were not
associated with prognosis. CONCLUSION(S): In the EXCEL trial, PMI was
more common after CABG than PCI, and was strongly associated with
increased 3-year mortality after controlling for potential confounders.
Only extensive myonecrosis (CK-MB >=10x URL) was prognostically
important. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2019. For
permissions, please email: journals.permissions@oup.com.

<78>
Accession Number
627079240
Title
Usefulness of skeletal muscle area detected by computed tomography to
predict mortality in patients undergoing transcatheter aortic valve
replacement: a meta-analysis study.
Source
The international journal of cardiovascular imaging. (no pagination),
2019. Date of Publication: 26 Mar 2019.
Author
Soud M.; Alahdab F.; Ho G.; Kuku K.O.; Cejudo-Tejeda M.; Hideo-Kajita A.;
de Araujo Goncalves P.; Teles R.C.; Waksman R.; Garcia-Garcia H.M.
Institution
(Soud, Ho, Kuku, Cejudo-Tejeda, Hideo-Kajita, Waksman) Section of
Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving
St NW, WA 20010, United States
(Alahdab) Mayo Clinic Evidence-based Practice Center, Mayo Clinic,
Rochester, MN, United States
(de Araujo Goncalves) Hospital da Luz, Luz-Saude. Av. Lusiada 100, Lisbon
1500-650, Portugal
(de Araujo Goncalves, Teles) Hospital de Santa Cruz - Centro Hospitalar de
Lisboa Ocidental, Carnaxide, Lisbon, Portugal
(de Araujo Goncalves) Chronic Diseases Research Center - Nova Medical
School, Lisbon, Portugal
(Garcia-Garcia) Section of Interventional Cardiology, MedStar Washington
Hospital Center, 110 Irving St NW, WA 20010, United States
Publisher
NLM (Medline)
Abstract
Measures of sarcopenia, such as low muscle mass measured from the readily
available preoperative computed tomography (CT) images, have been recently
suggested as a predictor of outcomes in patients undergoing transcatheter
aortic valve replacement (TAVR). However, results of these studies are
variable and, therefore, we performed a systematic review of current
literature to evaluate sarcopenia as a predictor of outcome post TAVR. The
search was carried out in electronic databases between 2008 and 2018. We
identified studies that reported CT-derived skeletal muscle area (SMA) and
survival outcomes post TAVR. Studies were evaluated for the incidence of
early (<=30 days) and late all-cause mortality (>30 days) post TAVR. Eight
studies with 1881 patients were included (mean age of 81.8 years+/-12,
55.9% men). Mean body mass index was (28.2 kg/m2+/-1.1), mean Society of
Thoracic Surgeons risk score (7.0+/-0.6), and mean albumin level was (3.8
g/dL+/-0.1). Higher SMA was associated with lower long-term mortality
[odds ratio (OR) 0.49, 95% confidence interval (CI) 0.28-0.83, p=0.049],
compared with low SMA. Also, higher SMA was associated with lower early
mortality but was not statistically significant (OR 0.72; 95% CI
0.44-1.18; p=0.285). CT-derived SMA provides value in predicting post-TAVR
long-term outcomes for patients undergoing TAVR. This is a simple risk
assessment tool that may help in making treatment decisions and help
identifying and targeting high-risk patients with interventions to improve
muscle mass prior to and following the procedures.

<79>
Accession Number
604381414
Title
The effects of cinacalcet in older and younger patients on hemodialysis:
The evaluation of cinacalcet HCL therapy to lower cardiovascular events
(EVOLVE) trial.
Source
Clinical Journal of the American Society of Nephrology. 10 (5) (pp
791-799), 2015. Date of Publication: 01 Jan 2015.
Author
Parfrey P.S.; Drueke T.B.; Block G.A.; Herzog C.A.; London G.M.; Mahaffey
K.W.; Moe S.M.; Wheeler D.; Kubo Y.; Dehmel B.; Goodman W.G.; Chertow
G.M.; Santos J.; Najun Zarazaga C.; Marin I.; Garrote N.; Cusumano A.;
Penalba N.; Del Valle E.; Juncos L.; Martinez Saye J.; Lef L.; Altobelli
V.; Petraglia G.; Rosa Diez G.; Douthat W.; Lobo J.; Gallart C.; Lafalla
A.; Diez G.; Linares B.; Lopez N.; Ramirez N.; Gonzalez R.; Valtuille R.;
Beresan H.; Hermida O.; Rudolf G.; Marchetta N.; Rano M.; Ramirez M.;
Garcia N.; Gillies A.; Jones B.; Pedagogos E.; Walker R.; Talaulikar G.;
Bannister K.; Suranyi M.; Kark A.; Roger S.; Kerr P.; Disney A.; Mount P.;
Fraenkel M.; Mathew M.; Fassett R.; Jose M.; Hawley C.; Lonergan M.;
Mackie J.; Ferrari P.; Menahem S.; Sabto J.; Hutchison B.; Langham R.;
Pollock C.; Holzer H.; Oberbauer R.; Arias I.; Graf H.; Mayer G.; Lhotta
K.; Neyer U.; Klauser R.; Hoerl W.; Horn S.; Kovarik J.; Kramar R.; Eigner
M.; Dhaene M.; Billiouw J.; De Meester J.; Warling X.;
Cambier-Dwelschauwers P.; Evenepoel P.; Daelemans R.; Dratwa M.; Maes B.;
Stolear J.; Dejagere T.; Vanwalleghem J.; Bouman K.; Jadoul M.; Peeters
J.; Vanholder R.; Tielemans C.; Donck J.; Almeida F.; Picollo de Oliveira
J.; Burdmann E.; Garcia V.; Saldanha Thome F.; Deboni L.; Bregman R.;
Lugon J.; Araujo S.; Ferreira Filho S.; de Francesco Daher E.; Sperto
Baptista M.; Carvalho A.; d'Avila D.; Moyses Neto M.; Yu L.; Bastos M.;
Sampaio Lacativa P.; Jorgetti V.; de Almeida Romao E.; Cardeal da Costa
J.; Pecoits Filho R.; Gordan P.; Salgado N.; Teixeira Araujo M.; Neiva
Coelho S.; Oliveira I.; Moyses R.; Vasconcellos L.; Batista P.; Luiz Gross
J.; Pedrosa A.; Cournoyer S.; LeBlanc M.; Chow S.; Karunakaran S.; Wong
G.; Tobe S.; Desmeules S.; Zimmerman D.; Murphy S.; Montambault P.;
Donnelly S.; MacRae J.; Culleton B.; Soroka S.; Rabbat C.; Jindal K.;
Vasilevsky M.; Michaud M.; Wijeyesinghe E.; Zacharias J.; Lok C.; Muirhead
N.; Verrelli M.; Da Roza G.; Sapir D.; Olgaard K.; Daugaard H.; Brandi L.;
Jensen P.; Boulechfar H.; Ang K.; Simon P.; Rieu P.; Brunet P.; Touchard
G.; London G.; Urena Torres P.; Combe C.; Durrbach A.; Ortiz J.;
Hannedouche T.; Vela C.; Lionet A.; Ryckelynck P.; Zaoui P.; Choukroun G.;
Fessi H.; Lang P.; Stroumza P.; Joly D.; Mousson C.; Laville M.; Dellanna
F.; Erley C.; Braun J.; Rambausek M.; Riegel W.; Klingberg M.;
Schwertfeger E.; Wizemann V.; Eckardt K.; Reichel H.; Floege J.; Passauer
J.; Hubel E.; Frischmuth N.; Liebl R.; Fiedler R.; Schwenger V.;
Vosskuhler A.; Kunzendorf U.; Renders L.; Rattensberger D.; Rump L.;
Ketteler M.; Neumayer H.; Zantvoort F.; Stahl R.; Ladanyi E.; Kulcsar I.;
Mezei I.; Csiky B.; Rikker C.; Arkossy O.; Berta K.; Szegedi J.; Major L.;
Ferenczi S.; Fekete A.; Szabo T.; Zakar G.; Wagner G.; Kazup Erdelyine S.;
Borbas B.; Eustace J.; Reddan D.; Capasso G.; Locatelli F.; Villa G.;
Cozzolino M.; Brancaccio D.; Messa P.; Bolasco P.; Ricciardi B.; Malberti
F.; Moriero E.; Cannella G.; Ortalda V.; Stefoni S.; Frasca G.; Cappelli
G.; Albertazzi A.; Zoccali C.; Farina M.; Elli A.; Avella F.; Ondei P.;
Mingardi G.; Errico R.; Losito A.; Di Giulio S.; Pertosa G.; Schena F.;
Grandaliano G.; Gesualdo L.; Auricchio M.; Bochicchio-Ricardelli T.;
Correa-Rotter R.; Aranda Verastegui F.; Pena J.; Chew Wong A.; Cruz-Valdez
J.; Torres Zamora M.; Solis M.; Sebastian Diaz M.; Vital Flores M.;
Alvarez Sandoval E.; van den Dorpel M.; Brink H.; Van Kuijk W.; Vermeij
C.; Smak Gregoor P.; Hagen E.; van der Sande F.; Klinger M.; Nowicki M.;
Muszytowski M.; Bidas K.; Bentkowski W.; Wiecek A.; Ksiazek A.; Marczewski
K.; Ostrowski M.; Switalski M.; Sulowicz W.; Matuszkiewicz-Rowinska J.;
Mysliwiec M.; Durlik M.; Rutkowski B.; Macario F.; Carvalho B.; Frazao J.;
Machado D.; Weigert A.; Andrusev A.; Khrustalev O.; Zemtchenkov A.;
Gurevich K.; Staroselsky K.; Khadikova N.; Rozhinskaya L.; Timokhovskaya
G.; Strokov A.; Balkarova O.; Ermolenko V.; Kolmakova E.; Komandenko M.;
Timofeev M.; Shilo V.; Shostka G.; Smirnov A.; Anashkin V.; Volgina G.;
Domashenko O.; Gurevich A.; Perlin D.; Martinez Garcia J.; Andres Ribes
E.; Coll Piera E.; Fernandez Lucas M.; Galicia M.; Prados M.; Gonzalez M.;
Romero R.; Martin de Francisco A.; Montenegro J.; Santiago C.; Garcia F.;
Alcazar de La Ossa J.; Arrieta J.; Pons J.; Martin-Malo A.; Soler Amigo
J.; Cases A.; Sterner G.; Jensen G.; Wikstrom B.; Jacobson S.; Lund U.;
Weiss L.; Stahl A.; von Albertini B.; Burnier M.; Meier P.; Martin P.;
Uehlinger D.; Dickenmann M.; Yaqoob M.; Zehnder D.; Kalra P.; Padmanabhan
N.; Roe S.; Eadington D.; Pritchard N.; Hutchison A.; Davies S.; Wilkie
M.; Davies M.; Pai P.; Swift P.; Kwan J.; Goldsmith D.; Tomson C.;
Stratton J.; Dasgupta I.; Sarkar S.; Moustafa M.; Gandhi K.; Jamal A.;
Galindo-Ramos E.; Tuazon J.; Batlle D.; Tucker K.; Schiller-Moran B.;
Assefi A.; Martinez C.; Samuels L.; Goldman J.; Cangiano-Rivera J.;
Darwish R.; Lee M.; Topf J.; Kapatkin K.; Baer H.; Kopelman R.; Acharya
M.; Tharpe D.; Bernardo M.; Nader P.; Guzman-Rivera J.; Pergola P.;
Sekkarie M.; Alas E.; Zager P.; Liss K.; Navarro J.; Roppolo M.;
Denu-Ciocca C.; Kshirsagar A.; El Khatib M.; Kant K.; Scott D.; Murthyr
B.; Finkelstein F.; Keightley G.; McCrary R.; Pitone J.; Cavalieri T.;
Tsang A.; Pellegrino B.; Schmidt R.; Ahmad S.; Brown C.; Friedman E.;
Mittman N.; Fadem S.; Shapiro W.; Reddy M.; Goldberger S.; Woredekal Y.;
Agarwal A.; Anger M.; Haque M.; Chidester P.; Kohli R.; Rubinstein S.;
Newman G.; Gladish R.; Ayodeji O.; Soman S.; Sprague S.; Hunt N.; Gehr T.;
Rizk D.; Warnock D.; Polack D.; Pahl M.; Fischer D.; Dreyer P.; James G.;
Husserl F.; Rogers T.; Raff A.; Sedor J.; Silver M.; Smith M.; Steinberg
S.; DelGiorno T.; Jones E.; Cunha P.D.; Cheng J.; Pogue V.; Block G.;
Blumenthal S.; Brown E.; Charytan C.; Buerkert J.; Cook M.; Felsenfeld A.;
Tareen N.; Herman T.; Diamond S.; Hura C.; Laski M.; MacLaurin J.; Plumb
T.; Brosnahan G.; Kumar J.; Henriquez M.; Poole C.; Osanloo E.; Matalon
A.; Sholer C.; Arfeen S.; Azer M.; Belledonne M.; Gross M.; Dunnigan E.;
McConnell K.; Becker B.; Skinner F.; Rigolosi R.; Spiegel D.; Stegman M.;
Patak R.; Streja D.; Ranjit U.; Youell T.; Wooldridge T.; Stafford C.;
Cottiero R.; Weinberg M.; Schonefeld M.; Shahmir E.; Hazzan A.; Ashfaq A.;
Bhandari K.; Cleveland W.; Culpepper M.; Golden J.; Lai L.; Lien Y.;
Lorica V.; Robertson J.; Malireddi K.; Morse S.; Thakur V.; Israelit A.;
Raguram P.; Alfred H.; Weise W.; Al-Saghir F.; El Shahawy M.; Rastogi A.;
Nissenson A.; Kopyt N.; Lynn R.; Lea J.; McClellan W.; Teredesai P.; Ong
S.; Tolkan S.; Sugihara J.; Minga T.; Mehrotra R.; Minasian R.; Bhatia D.;
Specter R.; Capelli J.; Sidhu P.; Dalal S.; Dykes P.; Khan M.; Rahim F.;
Saklayen M.; Thomas A.; Michael B.; Torres M.; Al-Bander H.; Murray B.;
Abukurah A.; Gupta B.; Nosrati S.; Raja R.; Zeig S.; Braun M.; Amatya A.;
Endsley J.; Sharon Z.; Gupta A.; Dolson G.; Dumler F.; Ntoso K.; Rosansky
S.; Kumar N.; Gura V.; Thompson N.; Goldfarb D.; Halligan R.; Middleton
J.; Widerhorn A.; Arbeit L.; Arruda J.; Crouch T.; Friedman L.; Khokhar
S.; Mittleman J.; Light P.; Taparia B.; West C.; Cotton J.; Dhingra R.;
Kleinman L.; Arif F.; Lew S.; Nammour T.; Sterrett J.; Williams M.;
Ramirez J.; Rubin J.; McCarthy J.; Noble S.; Chaffin M.; Rekhi A.;
Evaluation of Cinacalcet HCL Therapy to Lower Cardiovascular Events
(EVOLVE) Trial Investigators
Institution
(Parfrey) Department of Medicine, Health Sciences Center, St. John's, NL,
Canada
(Drueke) French Institute of Health and Medical Research Unit 1088,
University of Picardie, Amiens, France
(Block) Denver Nephrology, Denver, CO, United States
(Correa-Rotter) Department of Nephrology and Mineral Metabolism, Salvador
Zubiran National Institute of Health Sciences and Nutrition, Mexico City,
Mexico
(Floege) Department of Nephrology, RWTH Aachen University Hospital,
Aachen, Germany
(Herzog) Department of Internal Medicine, University of Minnesota,
Minneapolis, MN, United States
(London) Service of Nephrology, Manhes Hospital, Paris, France
(Mahaffey, Chertow) Department of Medicine, Stanford University School of
Medicine, Palo Alto, CA, United States
(Moe) Department of Medicine, Indiana University School of Medicine,
Roudebush Veterans Administration Medical Center, Indianapolis, IN, United
States
(Wheeler) Centre for Nephrology, University College London, United Kingdom
(Kubo, Dehmel, Goodman) Amgen Inc, Thousand Oaks, CA, United States
(Santos, Najun Zarazaga, Marin, Garrote, Cusumano, Penalba, Del Valle,
Juncos, Martinez Saye, Lef, Altobelli, Petraglia, Rosa Diez, Douthat,
Lobo, Gallart, Lafalla, Diez, Linares, Lopez, Ramirez, Gonzalez,
Valtuille, Beresan, Hermida, Rudolf, Marchetta, Rano, Ramirez, Garcia)
Argentina
(Gillies, Jones, Pedagogos, Walker, Talaulikar, Bannister, Suranyi, Kark,
Roger, Kerr, Disney, Mount, Fraenkel, Mathew, Fassett, Jose, Hawley,
Lonergan, Mackie, Ferrari, Menahem, Sabto, Hutchison, Langham, Pollock)
Australia
(Holzer, Oberbauer, Arias, Graf, Mayer, Lhotta, Neyer, Klauser, Hoerl,
Horn, Kovarik, Kramar, Eigner) Austria
(Dhaene, Billiouw, De Meester, Warling, Cambier-Dwelschauwers, Evenepoel,
Daelemans, Dratwa, Maes, Stolear, Dejagere, Vanwalleghem, Bouman, Jadoul,
Peeters, Vanholder, Tielemans, Donck) Belgium
(Almeida, Picollo de Oliveira, Burdmann, Garcia, Saldanha Thome, Deboni,
Bregman, Lugon, Araujo, Ferreira Filho, de Francesco Daher, Sperto
Baptista, Carvalho, d'Avila, Moyses Neto, Yu, Bastos, Sampaio Lacativa,
Jorgetti, de Almeida Romao, Cardeal da Costa, Pecoits Filho, Gordan,
Salgado, Teixeira Araujo, Neiva Coelho, Oliveira, Moyses, Vasconcellos,
Batista, Luiz Gross, Pedrosa) Brazil
(Cournoyer, LeBlanc, Chow, Karunakaran, Wong, Tobe, Desmeules, Zimmerman,
Murphy, Montambault, Donnelly, MacRae, Culleton, Soroka, Rabbat, Jindal,
Vasilevsky, Michaud, Wijeyesinghe, Zacharias, Lok, Muirhead, Verrelli, Da
Roza, Sapir) Canada
(Olgaard, Daugaard, Brandi, Jensen) Denmark
(Boulechfar, Ang, Simon, Rieu, Brunet, Touchard, London, Urena Torres,
Combe, Durrbach, Ortiz, Hannedouche, Vela, Lionet, Ryckelynck, Zaoui,
Choukroun, Fessi, Lang, Stroumza, Joly, Mousson, Laville) France
(Dellanna, Erley, Braun, Rambausek, Riegel, Klingberg, Schwertfeger,
Wizemann, Eckardt, Reichel, Floege, Passauer, Hubel, Frischmuth, Liebl,
Fiedler, Schwenger, Voskuhler, Kunzendorf, Renders, Rattensberger, Rump,
Ketteler, Neumayer, Zantvoort, Stahl) Germany
(Ladanyi, Kulcsar, Mezei, Csiky, Rikker, Arkossy, Berta, Szegedi, Major,
Ferenczi, Fekete, Szabo, Zakar, Wagner, Kazup Erdelyine, Borbas) Hungary
(Eustace, Reddan) Ireland
(Capasso, Locatelli, Villa, Cozzolino, Brancaccio, Messa, Bolasco,
Ricciardi, Malberti, Moriero, Cannella, Ortalda, Stefoni, Frasca,
Cappelli, Albertazzi, Zoccali, Farina, Elli, Avella, Ondei, Mingardi,
Errico, Losito, Di Giulio, Pertosa, Schena, Grandaliano, Gesualdo,
Auricchio) Italy
(Bochicchio-Ricardelli, Correa-Rotter, Aranda Verastegui, Pena, Chew Wong,
Cruz-Valdez, Torres Zamora, Solis, Sebastian Diaz, Vital Flores, Alvarez
Sandoval) Mexico
(van den Dorpel, Brink, Van Kuijk, Vermeij, Smak Gregoor, Hagen, van der
Sande) Netherlands
(Klinger, Nowicki, Muszytowski, Bidas, Bentkowski, Wiecek, Ksiazek,
Marczewski, Ostrowski, Switalski, Sulowicz, Matuszkiewicz-Rowinska,
Mysliwiec, Durlik, Rutkowski) Poland
(Macario, Carvalho, Frazao, Machado, Weigert) Portugal
(Andrusev, Khrustalev, Zemtchenkov, Gurevich, Staroselsky, Khadikova,
Rozhinskaya, Timokhovskaya, Strokov, Balkarova, Ermolenko, Kolmakova,
Komandenko, Timofeev, Shilo, Shostka, Smirnov, Anashkin, Volgina,
Domashenko, Gurevich, Perlin) Russian Federation
(Martinez Garcia, Andres Ribes, Coll Piera, Fernandez Lucas, Galicia,
Prados, Gonzalez, Romero, Martin de Francisco, Montenegro, Santiago,
Garcia, Alcazar de La Ossa, Arrieta, Pons, Martin-Malo, Soler Amigo,
Cases) Spain
(Sterner, Jensen, Wikstrom, Jacobson, Lund, Weiss, Stahl) Sweden
(von Albertini, Burnier, Meier, Martin, Uehlinger, Dickenmann) Switzerland
(Wheeler, Yaqoob, Zehnder, Kalra, Padmanabhan, Roe, Eadington, Pritchard,
Hutchison, Davies, Wilkie, Davies, Pai, Swift, Kwan, Goldsmith, Tomson,
Stratton, Dasgupta) United Kingdom
(Sarkar, Moustafa, Gandhi, Jamal, Galindo-Ramos, Tuazon, Batlle, Tucker,
Schiller-Moran, Assefi, Martinez, Samuels, Goldman, Cangiano-Rivera,
Darwish, Lee, Topf, Kapatkin, Baer, Kopelman, Acharya, Tharpe, Bernardo,
Nader, Guzman-Rivera, Pergola, Sekkarie, Alas, Zager, Liss, Navarro,
Roppolo, Denu-Ciocca, Kshirsagar, El Khatib, Kant, Scott, Murthyr,
Finkelstein, Keightley, McCrary, Pitone, Cavalieri, Tsang, Pellegrino,
Schmidt, Ahmad, Brown, Friedman, Mittman, Fadem, Shapiro, Reddy,
Goldberger, Woredekal, Agarwal, Anger, Haque, Chidester, Kohli,
Rubinstein, Newman, Gladish, Ayodeji, Soman, Sprague, Hunt, Gehr, Rizk,
Warnock, Polack, Pahl, Fischer, Dreyer, James, Husserl, Rogers, Raff,
Sedor, Silver, Smith, Steinberg, DelGiorno, Jones, Cunha, Cheng, Pogue,
Block, Blumenthal, Brown, Charytan, Buerkert, Cook, Felsenfeld, Tareen,
Gupta, Herman, Diamond, Hura, Laski, MacLaurin, Plumb, Brosnahan, Kumar,
Henriquez, Poole, Osanloo, Matalon, Sholer, Arfeen, Azer, Belledonne,
Gross, Dunnigan, McConnell, Becker, Skinner, Rigolosi, Spiegel, Stegman,
Patak, Streja, Ranjit, Youell, Wooldridge, Stafford, Cottiero, Weinberg,
Schonefeld, Shahmir, Hazzan, Ashfaq, Bhandari, Cleveland, Culpepper,
Golden, Lai, Lien, Lorica, Robertson, Malireddi, Morse, Thakur, Israelit,
Raguram, Alfred, Weise, Al-Saghir, El Shahawy, Rastogi, Nissenson, Kopyt,
Lynn, Lea, McClellan, Teredesai, Ong, Tolkan, Sugihara, Minga, Mehrotra,
Minasian, Bhatia, Specter, Capelli, Sidhu, Dalal, Dykes, Khan, Rahim,
Saklayen, Thomas, Michael, Torres, Al-Bander, Murray, Abukurah, Gupta,
Nosrati, Raja, Zeig, Braun, Amatya, Endsley, Sharon, Gupta, Dolson,
Dumler, Ntoso, Rosansky, Kumar, Gura, Thompson, Goldfarb, Halligan,
Middleton, Widerhorn, Arbeit, Arruda, Crouch, Friedman, Khokhar,
Mittleman, Light, Taparia, West, Cotton, Dhingra, Kleinman, Arif, Lew,
Nammour, Sterrett, Williams, Ramirez, Rubin, McCarthy, Noble, Chaffin,
Rekhi) United States
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background and objectives The calcimimetic cinacalcet reduced the risk of
death or cardiovascular (CV) events in older, but not younger, patients
with moderate to severe secondary hyperparathyroidism (HPT) who were
receiving hemodialysis. To determine whether the lower risk in younger
patients might be due to lower baseline CV risk and more frequent use of
cointerventions that reduce parathyroid hormone (kidney transplantation,
parathyroidectomy, and commercial cinacalcet use), this study examined the
effects of cinacalcet in older (>= 65 years, n=1005) and younger (<65
years, n=2878) patients. Design, setting, participants, & measurements
Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events
(EVOLVE) was a global, multicenter, randomized placebo-controlled trial in
3883 prevalent patients on hemodialysis, whose outcomes included death,
major CV events, and development of severe unremitting HPT. The age
subgroup analysis was prespecified. ResultsOlder patients had higher
baseline prevalence of diabetesmellitus and CV comorbidity. Annualized
rates of kidney transplantation and parathyroidectomy were > 3-fold higher
in younger relative to older patients and were more frequent in patients
randomized to placebo. In older patients, the adjusted relative hazard
(95% confidence interval) for the primary composite (CV) end point
(cinacalcet versus placebo) was 0.70 (0.60 to 0.81); in younger patients,
the relative hazard was 0.97 (0.86 to 1.09). Corresponding adjusted
relative hazards for mortality were 0.68 (0.51 to 0.81) and 0.99 (0.86 to
1.13). Reduction in the risk of severe unremitting HPT was similar in both
groups. Conclusions In the EVOLVE trial, cinacalcet decreased the risk of
death and of major CV events in older, but not younger, patients with
moderate to severe HPT who were receiving hemodialysis. Effect
modification by age may be partly explained by differences in underlying
CV risk and differential application of cointerventions that reduce
parathyroid hormone. Copyright © 2015 by the American Society of
Nephrology.

<80>
Accession Number
2001116317
Title
Establishment of Predictive Models for Nonocclusive Mesenteric Ischemia
Comparing 8,296 Control with 452 Study Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1290-1297),
2019. Date of Publication: May 2019.
Author
Bomberg H.; Stroeder J.; Karrenbauer K.; Groesdonk H.V.; Wagenpfeil S.;
Klingele M.; Bucker A.; Schafers H.-J.; Minko P.
Institution
(Bomberg, Karrenbauer, Schafers) Department of Thoracic and Cardiovascular
Surgery, Saarland University Medical Center, Homburg/Saar, Germany
(Bomberg, Groesdonk) Department of Anesthesiology, Intensive Care Medicine
and Pain Medicine, Saarland University Medical Center, Homburg/Saar,
Germany
(Stroeder, Bucker, Minko) Department of Diagnostic and Interventional
Radiology, Saarland University Medical Center, Homburg/Saar, Germany
(Wagenpfeil) Institute for Medical Biometry, Epidemiology and Medical
Informatics, Saarland University Medical Center, Homburg/Saar, Germany
(Klingele) Department of Medicine, Division of Nephrology and
Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
(Klingele) Department of Nephrology, Hochtaunus-Kliniken, Bad Homburg,
Germany
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to develop clinical preoperative,
intraoperative, and postoperative scores for early identification of
patients who are at risk of nonocclusive mesenteric ischemia (NOMI).
 Design(s): A retrospective analysis. Setting(s): Single center.
 Participant(s): From January 2008 to December 2014, all patients from
the Department of Thoracic and Cardiovascular Surgery were included on the
basis of the hospital database. Intervention(s): All mesenteric
angiographically identified NOMI patients were compared with non-NOMI
patients. Measurements and Main Results: The study population of
8,748 patients was randomized into a cohort for developing the scores
(non-NOMI 4,214 and NOMI 235) and a cohort for control (non-NOMI 4,082 and
NOMI 217). Risk factors were identified using forward and backward Wald
test and were included in the predictive scores for the occurrence of
NOMI. C statistic showed that the scores had a high discrimination for the
prediction of NOMI preoperatively (C statistic 0.79; p < 0.001),
intraoperatively (C statistic 0.68; p < 0.001), and postoperatively (C
statistic 0.85; p < 0.001). A combination of the preoperative,
intraoperative, and postoperative risk scores demonstrated the highest
discrimination (C statistic 0.87; p < 0.001). The combined score included
the following risk factors: renal insufficiency (preoperative); use of
cardiopulmonary bypass and intra-aortic balloon pump support
(intraoperative); and reexploration for bleeding, renal replacement
therapy, and packed red blood cells >= 4 units (postoperative). The
results were similar in the control group. Conclusion(s): These
scores could be useful to identify patients at risk for NOMI and promote a
rapid diagnosis and therapy. Copyright © 2018 Elsevier Inc.

<81>
Accession Number
2001352697
Title
Optimal Position of Inferior Vena Cava Cannula in Pediatric Cardiac
Surgery: A Prospective, Randomized, Controlled, Double-Blind Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1253-1259),
2019. Date of Publication: May 2019.
Author
Seino Y.; Ohashi N.; Imai H.; Baba H.
Institution
(Seino, Ohashi, Imai, Baba) Division of Anesthesiology, Niigata University
Graduate School of Medical and Dental Sciences, Asahimachi, Niigata, Japan
Publisher
W.B. Saunders
Abstract
Objective: To examine the authors' hypothesis that during the
cardiopulmonary bypass (CPB) in children, the inferior vena cava cannula
tip placed proximal to the right hepatic vein orifice would produce a
higher venous drainage compared with that placed distally. Design(s):
A prospective, randomized, controlled, double-blind study.
 Setting(s): Single university hospital. Participant(s):
Thirty-two patients aged <6years, scheduled for elective cardiac surgery
using CPB for congenital heart disease. Intervention(s): Participants
were randomized to 2 groups: the proximal group with the cannula tip
placed proximally within 1cm of the right hepatic vein orifice and the
distal group with the cannula placed distally within 1cm of the right
hepatic vein orifice. Measurements and Main Results: The primary
outcome of this study was the perfusion flow rate at the time of
establishment of total CPB with cardioplegia. The authors initially
planned to enroll 60 patients, but before reaching the target sample size,
the authors terminated this study owing to patient safety, and 18 patients
in the proximal group and 14 patients in the distal group finally were
analyzed. No significant differences in patient characteristics were
observed between the 2 groups. The mean perfusion flow rate in the
proximal group was significantly greater (2.55 +/- 0.27
L/min/m2) than that in the distal group (2.37 +/- 0.20
L/min/m2, p = 0.04). Conclusion(s): The inferior vena cava
cannula tip placed in the proximal position was clinically superior,
compared with a distal placement, in producing higher perfusion flow in
children. Copyright © 2018 Elsevier Inc.

<82>
Accession Number
2001400494
Title
Preventing Ventricular Fibrillation in Patients With Left Ventricular
Hypertrophy Undergoing Aortic Valve Replacement: Time to Consider
Prophylactic Amiodarone Infusion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1214-1215),
2019. Date of Publication: May 2019.
Author
Dalia A.A.; Essandoh M.K.
Institution
(Dalia) Department of Anesthesiology, Pain Medicine, and Critical Care,
The Massachusetts General Hospital, Harvard Medical School, Boston, MA,
United States
(Essandoh) Department of Anesthesiology, Wexner Medical Center, The Ohio
State University, Columbus, OH, United States
Publisher
W.B. Saunders

<83>
Accession Number
627034347
Title
Outcomes of transcatheter aortic valve replacement in bicuspid aortic
valve stenosis.
Source
Annals of Translational Medicine. 7 (5) (no pagination), 2019. Article
Number: 102. Date of Publication: 01 Mar 2019.
Author
Bob-Manuel T.; Heckle M.R.; Ifedili I.A.; Wang J.; Ibebuogu U.N.
Institution
(Bob-Manuel, Ibebuogu) Division of Cardiovascular Diseases, Ochsner Clinic
Foundation, New Orleans, United States
(Heckle, Ifedili) Division of Cardiovascular Diseases, Department of
Medicine, University of Tennessee Health Science Center, Methodist
University Hospital, Memphis, United States
(Wang) Division of Biostatistics and Epidemiology, Department of
Preventive Medicine, University of Tennessee Health Science Center,
Memphis, United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Due to abnormal valve geometry, patients with bicuspid aortic
valve (BAV) have been excluded in many transcatheter aortic valve
replacement (TAVR) trials resulting in very limited data with regards to
its safety and efficacy. Method(s): We searched electronic databases
including Cochrane Database of Systematic Reviews, MEDLINE and EMBASE for
all studies including case series, and original reports published before
December 2018 that assessed outcomes following TAVR in BAV stenosis. We
also included studies that had patients with TAV for comparison. Pooled
effect size was calculated with a random-effect model and weighted for the
inverse of variance, to compare outcomes post-TAVR between BAV and TAV.
The heterogeneity of effect estimates across the studies was assessed
using I2. Publication bias was assessed with funnel plots. Statistical
analysis was performed using SPSS version 24 (IBM Corp., SPSS Statistics
for Windows, Version 24.0. Armonk, NY.) Results: A total of 19 studies
describing 1,332 patients with BAV and 3,610 with TAV. There was no
significant difference in the30-day mortality between patients with BAV
and TAV [odds ratio (OR): 1.18, 95% confidence interval (CI): 0.7-1.7,
P=0.41, I2=0]. One-year mortality rate in the BAV population
was 13.1% compared to 15.4% in the TAV patients (P=0.75). Patients with
BAV had significantly more moderate to severe paravalvular leak (PVL) post
TAVR (PVL >=3) 8.8% vs. 4.2% in TAV patients (OR: 1.478, 95% CI:
1.000-2.184, P=0.050, I2=0. Device success was significantly
higher in TAV patients compared to BAV patients 93.5% vs. 87% (OR: 0.63,
95% CI: 0.49-0.86, P=0.003). Conclusion(s): TAVR in patients with BAV
is associated with a high incidence of paravalvular regurgitation with a
comparable 30-day mortality rate to TAV patients. The use of newer
generation valve prosthesis improved outcomes. Copyright © AME
Publishing Company. All rights reserved.

<84>
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.
 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.
 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. 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. Copyright © 2019 S. Karger AG, Basel. All rights
reserved.

<85>
Accession Number
2001457219
Title
Fragility of Red Blood Cells Collected Under Different Conditions With a
Cell Saver Device.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1224-1229),
2019. Date of Publication: May 2019.
Author
Chung Y.S.; Kim H.R.; Kang H.; Ryu C.; Park B.; Hong J.
Institution
(Chung, Park, Hong) Department of Thoracic and Cardiovascular Surgery,
Chung-Ang University Hospital, Seoul, South Korea
(Kim) Department of Laboratory Medicine, Chung-Ang University Hospital,
Seoul, South Korea
(Kang, Ryu) Department of Anesthesiology and Pain Medicine, Chung-Ang
University Hospital, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objective: To quantify the degree of lethal and sublethal damage to red
blood cells (RBCs) by cell saver (CS) processing among different
conditions of shed blood in cardiac surgery. Design(s): Prospective
randomized, double-blinded, controlled study. Setting(s): Single
university hospital. Participant(s): Twenty rabbits were divided
randomly into non-heparinized and heparinized groups. Thereafter, each
group was subdivided into non-gauze and gauze groups based on whether the
blood was collected with gauze and squeezed out. Intervention(s):
Blood from each group was aspirated directly from the heart and underwent
CS processing. Mechanical fragility index (MFI) and percent hemolysis were
measured pre- and post-CS processing. Measurements and Main Results:
In RBCs after CS processing, the MFI and percent hemolysis were increased
significantly in both the non-heparinized and heparinized groups compared
to pre-CS processing. The MFI was significantly higher in the heparinized
group than in the non-heparinized group (p = 0.002). However, no
differences in percent hemolysis were detected between groups (p = 0.696).
The MFI and percent hemolysis of the non-gauze and gauze groups did not
differ. Conclusion(s): This study reports the increase in sublethal
and lethal injuries to RBCs from heparinized and non-heparinized blood
after CS processing. CS-processed heparinized blood contained more
sublethally injured RBCs compared to CS-processed non-heparinized blood.
RBCs collected by squeezing blood-saturated gauze did not exhibit
additional trauma. Further investigation is required to determine the
clinical implications of transfusing rescued but injured RBCs using a
CS. Copyright © 2018 Elsevier Inc.

<86>
Accession Number
2001645346
Title
Complementary role of cardiac computed tomography angiography in the
diagnosis of prosthetic aortic valve endocarditis and septic coronary
embolism - A case report.
Source
Journal of Radiology Case Reports. 13 (2) (pp 9-14), 2019. Date of
Publication: February 2019.
Author
van den Boogert T.; Claessen B.; Robbers-Visser D.; Henriques J.; Planken
R.N.
Institution
(van den Boogert, Claessen, Robbers-Visser, Henriques) Department of
Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Planken) Department of Radiology and nuclear medicine, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
Publisher
EduRad (P.O. Box 1570 Lincoln, California 95648, United States)
Abstract
A 73-year old man presented with a posterolateral ST-elevated myocardial
infarction 9 months after biological aortic valve replacement for aortic
valve stenosis. Invasive coronary angiography showed a filling defect
across the left main coronary artery bifurcation extending into the left
anterior descending artery and the ramus circumflex. Transthoracic
echocardiography revealed a thickened prosthesis leaflet with signs of
slight stenosis. Cardiac computed tomography angiography showed a mass on
the left coronary cusp of the valve prosthesis, suggestive for vegetation
or thrombus. The scan also revealed central luminal filling defects,
indicative for thrombus or septic emboli. Blood cultures proved positive
for Propionibacterium acnes, therefore the patient was treated for
prosthetic valve endocarditis. Computed tomography angiography offers high
diagnostic accuracy for detecting infective endocarditis and renders
complementary information about valvular anatomy, coronary artery disease
and the extension of infections. Copyright © 2019, EduRad. All
rights reserved.

<87>
Accession Number
626728647
Title
Patient Blood Management: Recommendations from the 2018 Frankfurt
Consensus Conference.
Source
JAMA - Journal of the American Medical Association. 321 (10) (pp 983-997),
2019. Date of Publication: 12 Mar 2019.
Author
Mueller M.M.; Van Remoortel H.; Meybohm P.; Aranko K.; Aubron C.; Burger
R.; Carson J.L.; Cichutek K.; De Buck E.; Devine D.; Fergusson D.; Follea
G.; French C.; Frey K.P.; Gammon R.; Levy J.H.; Murphy M.F.; Ozier Y.;
Pavenski K.; So-Osman C.; Tiberghien P.; Volmink J.; Waters J.H.; Wood
E.M.; Seifried E.; Albaladejo P.; Allard S.; Gabriel C.; Greinacher A.;
Van Kraaij M.; Liumbruno G.; Saxon B.; Shehata N.; Velati C.; Bischof D.;
Hamilton J.; Lasocki S.; Gomez M.M.; Schmitz-Rixen T.; Serve H.; Thomson
A.; Beckers E.; Benson K.; Juffermans N.; Maze D.; Mirski M.; Murphy G.;
Ries J.-J.; Walsh T.; Anthony L.; Bielby L.; Donald G.; Estcourt L.; Frank
S.; Freedman J.; Humbrecht C.
Institution
(Mueller, Seifried) German Red Cross Blood Transfusion Service, Goethe
University Clinics, Baden-Wuerttemberg-Hessen, Institute for Transfusion
Medicine and Immunohematology, University Hospital of the Goethe
University, Sandhofstrasse 1, Frankfurt/Main 60528, Germany
(Van Remoortel, De Buck) Centre for Evidence-Based Practice (CEBaP),
Belgian Red Cross, Mechelen, Belgium
(Meybohm, Schmitz-Rixen, Serve) Department of Anaesthesiology, Intensive
Care Medicine and Pain Therapy, University Hospital Frankfurt,
Frankfurt/Main, Germany
(Aranko, Seifried) European Blood Alliance (EBA), Amsterdam, Netherlands
(Aubron, Ozier) Departments of Intensive Care and of Anesthesia,
University Hospital of Brest, Brest, France
(Burger) Robert-Koch-Institut (RKI), Berlin, Germany
(Carson) Robert Wood Johnson Medical School, Rutgers University, New
Brunswick, NJ, United States
(Cichutek) Paul-Ehrlich-Institut (PEI), Langen, Germany
(De Buck) Department of Public Health and Primary Care, Faculty of
Medicine, KU Leuven, Leuven, Belgium
(Devine, Hamilton) Canadian Blood Services, Ottawa, ON, Canada
(Fergusson) Departments of Medicine, Surgery, Epidemiology and Public
Health, University of Ottawa, Ottawa, ON, Canada
(Aubron, Follea) Societe Francaise de Transfusion Sanguine (SFTS), Paris,
France
(French) Intensive Care, Western Health, Melbourne, Australia
(Frey) Fairview Health Services, Minneapolis, MN, United States
(Gammon) OneBlood, Orlando, FL, United States
(Levy) Department of Cardiothoracic Intensive Care Medicine, Duke
University Medical Centre, Durham, NC, United States
(Murphy, Allard, Donald, Estcourt) National Health Service Blood and
Transplant and University of Oxford, Oxford, United Kingdom
(Pavenski, Maze) St. Michael's Hospital and University of Toronto,
Toronto, Canada
(So-Osman) Sanquin Blood Bank, Leiden and Department of Haematology,
Groene Hart Hospital, Gouda, Netherlands
(So-Osman, Wood, Seifried, Allard) International Society of Blood
Transfusion (ISBT), Amsterdam, Netherlands
(Tiberghien) Etablissement Francais du Sang (EFS), Saint-Denis, France
(Volmink) Department of Clinical Epidemiology, Faculty of Medicine and
Health Sciences, Stellenbosch University, Stellenbosch, South Africa
(Waters) Departments of Anesthesiology and Bioengineering, University of
Pittsburgh Medical Centre, Pittsburgh, PA, United States
(Wood) Transfusion Research Unit, Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, Australia
(Albaladejo) Grenoble University Hospital, France
(Albaladejo) International Society on Thrombosis and Haemostasis ISTH,
France
(Frey, Gammon, Murphy, Tiberghien, Van Kraaij, Liumbruno, Velati) American
Association of Blood Banks AABB, EBA, United States
(Gabriel) Ludwig Boltzmann Institute for Clinical and Experimental
Traumatology, Austria
(Gabriel) Deutsche Gesellschaft Fr Transfusionsmedizin und
Immunhamatologie DGTI, Germany
(Greinacher) Institut Fr Immunologie und Transfusionsmedizin, Greifswald,
Germany
(Greinacher, Shehata) International Collaboration for Transfusion Medicine
Guidelines ICTMG, United States
(Van Kraaij) Sanquin Blood Bank, Amsterdam, Netherlands
(Liumbruno) Italian National Institute of Health, Rome, Italy
(Saxon, Thomson, Bielby) Australian Red Cross Blood Service, Australia
(Shehata) Mount Sinai Hospital Toronto, C-Ontario, Canada
(Velati) Societa Italiana di Medicina Trasfusionale e Immunoematologia,
Italy
(Bischof) Mt. Sinai Hospital, Toronto, ON, Canada
(Gomez) University of Malaga, Malaga, Spain
(Lasocki) University Hospital, Angers, France
(Beckers) Maastricht University Medical Center, Maastricht, Netherlands
(Benson) Moffitt Cancer Center, Tampa, FL, United States
(Juffermans) University of Amsterdam, Amsterdam, Netherlands
(Mirski, Frank) Johns Hopkins Medical Institutions, Baltimore, MD, United
States
(Murphy) British Heart Foundation, University of Leicester, United Kingdom
(Ries) University Hospital Basel, Basel, Switzerland
(Walsh) University of Edinburgh, Edinburgh, United Kingdom
(Anthony) Allina Health, Minneapolis, MN, United States
(Freedman) St. Michael's Hospital, Toronto, ON, Canada
(Humbrecht) Etablissement Francais du Sang, Strasbourg, France
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Blood transfusion is one of the most frequently used therapies
worldwide and is associated with benefits, risks, and costs.
 Objective(s): To develop a set of evidence-based recommendations for
patient blood management (PBM) and for research. Evidence Review: The
scientific committee developed 17
Population/Intervention/Comparison/Outcome (PICO) questions for red blood
cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia
(3 questions), RBC transfusion thresholds (11 questions), and
implementation of PBM programs (3 questions). These questions guided the
literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane
Library, Transfusion Evidence Library), searched from inception to January
2018. Meta-analyses were conducted with the GRADE (Grading of
Recommendations, Assessment, Development, and Evaluation) methodology and
the Evidence-to-Decision framework by 3 panels including clinical and
scientific experts, nurses, patient representatives, and methodologists,
to develop clinical recommendations during a consensus conference in
Frankfurt/Main, Germany, in April 2018. Finding(s): From 17607
literature citations associated with the 17 PICO questions, 145 studies,
including 63 randomized clinical trials with 23143 patients and 82
observational studies with more than 4 million patients, were analyzed.
For preoperative anemia, 4 clinical and 3 research recommendations were
developed, including the strong recommendation to detect and manage anemia
sufficiently early before major elective surgery. For RBC transfusion
thresholds, 4 clinical and 6 research recommendations were developed,
including 2 strong clinical recommendations for critically ill but
clinically stable intensive care patients with or without septic shock
(recommended threshold for RBC transfusion, hemoglobin concentration <7
g/dL) as well as for patients undergoing cardiac surgery (recommended
threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For
implementation of PBM programs, 2 clinical and 3 research recommendations
were developed, including recommendations to implement comprehensive PBM
programs and to use electronic decision support systems (both conditional
recommendations) to improve appropriate RBC utilization. Conclusions
and Relevance: The 2018 PBM International Consensus Conference defined the
current status of the PBM evidence base for practice and research purposes
and established 10 clinical recommendations and 12 research
recommendations for preoperative anemia, RBC transfusion thresholds for
adults, and implementation of PBM programs. The relative paucity of strong
evidence to answer many of the PICO questions supports the need for
additional research and an international consensus for accepted
definitions and hemoglobin thresholds, as well as clinically meaningful
end points for multicenter trials. Copyright © 2019 American
Medical Association. All rights reserved.

<88>
Accession Number
2001742262
Title
Wearable activity trackers, accuracy, adoption, acceptance and health
impact: A systematic literature review.
Source
Journal of Biomedical Informatics. 93 (no pagination), 2019. Article
Number: 103153. Date of Publication: May 2019.
Author
Shin G.; Jarrahi M.H.; Fei Y.; Karami A.; Gafinowitz N.; Byun A.; Lu X.
Institution
(Shin, Jarrahi, Fei, Gafinowitz, Lu) School of Information and Library
Science, University of North Carolina at Chapel Hill, United States
(Karami) School of Library and Information Science, University of South
Carolina, United States
(Byun) College of Nursing, Seoul National University, Seoul, South Korea
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Wearable activity trackers (WAT) are electronic monitoring devices that
enable users to track and monitor their health-related physical fitness
metrics including steps taken, level of activity, walking distance, heart
rate, and sleep patterns. Despite the proliferation of these devices in
various contexts of use and rising research interests, there is limited
understanding of the broad research landscape. The purpose of this
systematic review is therefore to synthesize the existing wealth of
research on WAT, and to provide a comprehensive summary based on common
themes and approaches. This article includes academic work published
between 2013 and 2017 in PubMed, Embase, Scopus, Web of Science, ACM
Digital Library, and Google Scholar. A final list of 463 articles was
analyzed for this review. Topic modeling methods were used to identify six
key themes (topics) of WAT research, namely: (1) Technology Focus, (2)
Patient Treatment and Medical Settings, (3) Behavior Change, (4)
Acceptance and Adoption (Abandonment), (5) Self-monitoring Data Centered,
and (6) Privacy. We take an interdisciplinary approach to wearable
activity trackers to propose several new research questions. The most
important research gap we identify is to attempt to understand the rich
human-information interaction that is enabled by WAT
adoption. Copyright © 2019 Elsevier Inc.

<89>
Accession Number
2001111602
Title
Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac
Surgery and Their Parents: Effect of Brief Intervention-A Randomized
Control Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1244-1250),
2019. Date of Publication: May 2019.
Author
Kumar A.; Das S.; Chauhan S.; Kiran U.; Satapathy S.
Institution
(Kumar, Das, Chauhan, Kiran) Department of Cardiac Anaesthesia, All India
Institute of Medical Sciences, New Delhi, India
(Satapathy) Department of Clinical Psychology, All India Institute of
Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To know the effects of psychological preparation on
perioperative stress, anxiety, and mood in children undergoing cardiac
surgery and their parents. Design(s): Prospective randomized control
nonblinded trial. Setting(s): Single-center tertiary teaching
hospital. Participant(s): A total of 60 children aged 5 to 15 years
undergoing cardiac surgery were included in the study. One of the parents,
preferably the father, was selected from the respective children.
 Intervention(s): Subjects were randomized into 2 groups:
noninterventional (group 1) and interventional (group 2). Intervention was
in the form of toys and video games in children, and counseling and
information in parents. Preoperative and postoperative anxiety in parents
was measured using the State-Trait Anxiety Inventory (STAI), stress using
the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood
scale. In children, the STAI-C (child version of STAI), Ottawa mood and
Ottawa stress scales, and Wong-Baker faces pain scale were applied and
serum cortisol was measured. Measurements and Main Results: Group 2
children had significantly less (p < 0.001) stress, anxiety, and pain and
improved mood. Group 2 parents had a significant reduction in state
anxiety (42 +/- 4.4 v 54.5 +/- 7.8; p < 0.001) and ICS score (68.1+/-9.6 v
84.2 +/- 9.2; p < 0.001) and an improvement in mood (7.5 +/- 0.7 v 5.9 +/-
1; p < 0.001) compared with group 1. Postoperatively, cortisol levels in
group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9
nmol/L [53-1642.0]). Conclusion(s): Providing video games and toys
preoperatively reduced postoperative stress and anxiety and improved mood
in children undergoing congenital cardiac surgery. Parents were relieved
of anxiety and stress with proper counseling and
information. Copyright © 2018 Elsevier Inc.

<90>
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). Copyright
© 2019, E-Century Publishing Corporation. All rights reserved.

<91>
Accession Number
622975188
Title
A meta-analysis of the efficacy of allopurinol in reducing the incidence
of myocardial infarction following coronary artery bypass grafting.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 143. Date of Publication: 11 Jul 2018.
Author
Singh T.P.; Skalina T.; Nour D.; Murali A.; Morrison S.; Moxon J.V.;
Golledge J.
Institution
(Singh, Skalina, Nour, Murali, Morrison, Moxon, Golledge) James Cook
University, Queensland Research Centre for Peripheral Vascular Disease,
College of Medicine and Dentistry, Townsville, QLD 4811, Australia
(Singh, Golledge) The Townsville Hospital, The Department of Vascular and
Endovascular Surgery, Townsville, QLD, Australia
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The xanthine oxidase inhibitor allopurinol that is commonly
used to treat gout, has been suggested to have pleiotropic effects that
are likely to reduce the incidence of myocardial infarction (MI) in at
risk individuals. The aim of this meta-analysis was to assess the efficacy
of allopurinol treatment in reducing the incidence of MI. Method(s):
MEDLINE, Scopus, Web of Science, and Cochrane Library databases were
searched for randomised controlled trials examining the efficacy of
allopurinol in reducing the incidence of MI. The quality of study
methodology was assessed by two independent reviewers using the Cochrane
Collaboration's tool for assessing risk of bias. This meta-analysis was
conducted using a fixed-effects model, and heterogeneity was assessed with
the I2 index. Result(s): One thousand one hundred
twenty-three citations were screened and only six studies satisfied the
inclusion criterion. Published between 1988 and 1995, all studies examined
the cardioprotective efficacy of allopurinol in the setting of coronary
artery bypass graft (CABG). From a total pooled sample size of 229, MI was
reported in 2 (1.77%) allopurinol and 14 (12.07%) control patients. A
fixed-effects meta-analysis (I2 = 0%) identified a
statistically significant reduced incidence of myocardial infarction (RR
0.21, 95% CI: 0.06, 0.70, p = 0.01) in patients allocated to allopurinol.
However, in the leave-one-out sensitivity analyses, the treatment effect
became non-significant with the removal of one of the studies.
 Conclusion(s): Based on the limited evidence available, allopurinol
appears to reduce the incidence of perioperative MI following CABG.
Further research is required to confirm these findings. Copyright
© 2018 The Author(s).

<92>
Accession Number
625266952
Title
Effect of continuous local anesthetic in post-cardiac surgery patients: A
systematic review.
Source
Pain Medicine (United States). 19 (5) (pp 1077-1090), 2018. Date of
Publication: 01 May 2018.
Author
Hong S.S.; Milross M.A.; Alison J.A.
Institution
(Hong, Milross, Alison) Physiotherapy Department, Liverpool Hospital,
Sydney, NSW 2170, Australia
(Hong) Discipline of Physiotherapy and Discipline of Physiotherapy,
Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
(Alison) Physiotherapy Department, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Oxford University Press
Abstract
Objective. The purpose of this review was to determine the effect of CLA
infusion post cardiac surgery on pain, time to ambulation, severe adverse
events, patient satisfaction, time to extubation, length of stay in the
intensive care unit and in the hospital, total narcotic consumption, and
pulmonary function. Design. Systematic review with meta-Analysis (PROSPERO
CRD42014010188). Methods. We searched the following electronic databases:
The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE;
EMBASE; CINAHL; Allied and Complementary Medicine (AMED); and PsycINFO; as
well as hand-searching cardiothoracic surgery and anesthetic journals and
meeting abstracts. Results. Ten eligible trials with a total of 546
participants were identified. Meta-Analyses showed that CLA infusion
significantly reduced the total mean visual analog pain score at 72 hours
(mean difference [MD] 5 ?14.31mm, 95% confidence interval [CI] 5 ?25.59 to
?3.03); time to ambulation (MD 5 ?2.81 hours, 95% CI 5 ?5.23 to ?0.4);
morphine requirement (MD 5 ?10.19 mg, 95% CI 5 ?11.80 to ?8.58) but did
not reduce time to ambulate to chair (MD 5 ?1.65 hours, 95% CI 5 ?4.04 to
0.74); time to extubation (MD 5 ?0.18 hours, 95% CI 5 ?1.24 to 0.89);
length of ICU stay (MD50.9 hours, 95% CI 5 ?2.96 to 4.75); and hospital
length of stay (MD 5 ?0.59 days, 95% CI 5 ?1.24 to 0.07). There were
insufficient data to perform a meta-Analysis on severe adverse events,
patient satisfaction, or pulmonary function. Conclusions. CLA infusion
after cardiac surgery reduces pain score at 72 hours, shortens time to
ambulation, and reduces morphine consumption at 48 hours. Copyright
© 2018 Oxford University Press. All Rights Reserved.

<93>
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. 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. 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. 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. Copyright
© 2019 Wiley Periodicals, Inc.

<94>
Accession Number
2001716430
Title
Impact of Chronic Kidney Disease on Decision Making and Management in
Transcatheter Aortic Valve Interventions.
Source
Canadian Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Hensey M.; Murdoch D.J.; Sathananthan J.; Wood D.A.; Webb J.G.
Institution
(Hensey, Murdoch, Sathananthan, Wood, Webb) Centre for Heart Valve
Innovation, St Paul's Hospital, University of British Columbia, Vancouver,
British Columbia, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The coexistence of chronic kidney disease (CKD) and severe aortic stenosis
(AS) is common, and the prevalence of both is rising. The 2 conditions are
inherently linked in that significant CKD may accelerate the development
of AS and severe AS may result in deteriorating kidney function. The
volume of and indications for transcatheter aortic valve implantation
(TAVI) procedures are ever-increasing, and there are many challenges that
need to be considered in patients with concomitant severe AS and CKD being
assessed for TAVI. Throughout the process of working these patients up for
definitive management of their valvular heart disease, the presence of CKD
impacts on diagnostic investigations, treatment decisions, and therapeutic
interventions. Herein we review the current literature regarding TAVI in
patients with CKD focusing on the decision-making process and specific
risks involved in TAVI and CKD. We also provide specific practical
strategies to best manage this challenging patient cohort. Copyright
© 2018

<95>
[Use Link to view the full text]
Accession Number
626721768
Title
A randomized study on the effect of sequential acupoint stimulation on
pulmonary function of patients with spontaneous pneumothorax during VATS
perioperative period.
Source
Medicine. 98 (10) (pp e14575), 2019. Date of Publication: 01 Mar 2019.
Author
Sui T.-Q.; Zhang F.-Y.; Jiang A.-L.; Zhang X.-Q.; Zhang Z.-W.; Yang Y.;
Sun L.-P.
Institution
(Sui, Zhang, Zhang, Yang) Department of Thoracic Surgery, Austria
(Zhang, Jiang) Department Nursing of Thoracic Surgery
(Sun) Department of Emergency Services, 5th Central Hospital of Tianjin,
Tianjin, China
Publisher
NLM (Medline)
Abstract
This study aims to explore the effect of sequential acupoint stimulation
on the postoperative pulmonary function of patients with spontaneous
pneumothorax who underwent video-assisted thoracoscopic surgery
(VATS).Using a random number table, the patients were randomly divided
into 2 groups: routine nursing group and sequential acupoint stimulation
group. Patients in the routine nursing group received standard nursing
care of thoracic surgery, while patients in the acupoint group received
sequential acupoint stimulation on Shenshu (BL23), Gaohuang (BL43), Feishu
(BL13), and Tiantu (CV22). Then, the maximal ventilatory volume (MVV),
oxygen saturation (SpO2), postoperative drainage volume, postoperative
drainage time, postoperative hospitalization days, and procalcitonin (PCT)
were observed on the first, third, fifth and 30th day after VATS
operation.On the fifth day after spontaneous pneumothorax was treated with
VATS, MVV, and SpO2 of the sequential acupoint stimulation group were
significantly higher than those of the routine nursing group (P < .05). On
both the third day and fifth day after VATS, PCT of the sequential
acupoint stimulation group was significantly lower than that of the
routine nursing group (P < .01). Furthermore, the difference in
postoperative drainage volume between the 2 groups was not statistically
significant (P > .05), while chest tube drainage time (P < .01) and
postoperative hospitalization days (P < .05) of the sequential acupoint
stimulation group were significantly lower than those of the routine
nursing group.In spontaneous pneumothorax patients who underwent VATS,
sequential acupoint stimulation nursing was significantly more effective
than routine postoperative nursing in promoting postoperative recovery of
lung function, alleviating inflammatory response and shortening
hospitalization days.

<96>
Accession Number
2001774394
Title
Pentraxin-3 in coronary artery disease: A meta-analysis.
Source
Cytokine. 119 (pp 197-201), 2019. Date of Publication: July 2019.
Author
Chu Y.; Teng J.; Feng P.; Liu H.; Wang F.; Li X.
Institution
(Chu, Teng, Feng, Liu, Wang, Li) Department of Cardiology, The Second
Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
Publisher
Academic Press
Abstract
Aims: Studies on the prognostic significance of circulating pentraxin-3
level in patients with coronary artery disease (CAD) have yielded
conflicting results. The aim of this meta-analysis was to evaluate the
prognostic value of circulating pentraxin-3 level in CAD patients.
Materials/methods: We made a systematic literature search in Pubmed,
Embae, CNKI, Wanfang, and VIP database from their inception to January 10,
2019 for prospective cohort studies that investigated the association
between pentraxin-3 level and adverse outcomes in patients with CAD. The
outcome measures were all-cause mortality, cardiac death, and cardiac
events (cardiac death, nonfatal myocardial infarction, heart failure or
coronary revascularization). Multivariable-adjusted risk ratio (RR) with
95% confidence intervals (CI) was pooled for the highest versus the lowest
pentraxin-3 group to summarize the predictive value. Result(s): Nine
studies were included, enrolling 5,174 CAD patients. Overall, CAD patients
with the highest pentraxin-3 level had an increased risk of all-cause
mortality (RR 1.81; 95% CI 1.43-2.28), cardiac death (RR 1.77; 95% CI
1.38-2.26), and cardiac events (RR 1.61; 95% CI 1.16-2.25). However,
elevated pentraxin-3 level appeared to not significantly increase the risk
of cardiac events (RR 1.63; 95% CI 0.71-3.72) in stable CAD subgroup.
 Conclusion(s): In CAD patients, elevated circulating pentraxin-3
level is possibly an independent predictor of all-cause mortality, cardiac
death, and cardiac events. However, interpretation of these findings
should be with caution due to the small number of studies
analyzed. Copyright © 2019

<97>
Accession Number
2001788177
Title
Skeletonized versus pedicled internal mammary artery: A systematic review.
Source
Cirugia Cardiovascular. (no pagination), 2019. Date of Publication: 2019.
Author
Urso S.; Sadaba R.; Tena M.A.; Bellot R.; Rios L.; Martinez-Comendador
J.M.; Abad C.; Portela F.
Institution
(Urso, Tena, Bellot, Rios, Abad, Portela) Servicio de Cirugia Cardiaca,
Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Servicio de Cirugia Cardiaca, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Martinez-Comendador) Servicio de Cirugia Cardiaca, Hospital Universitario
de Leon, Leon, Spain
Publisher
Elsevier Doyma
Abstract
The European Society of Cardiology (ESC) and European Association for
Cardio-Thoracic Surgery (EACTS) 2018 guidelines state "skeletonised
internal mammary artery (IMA) dissection is recommended in patients with a
high risk of sternal wound infection". This indication does not clarify in
which type of patients the IMA skeletonisation technique should be
applied. For this reason, review is presented. A Medline search was
conducted up to November 2018. The inclusion criteria were: studies
published in English, conducted on humans, those that compared
skeletonised versus pedicled IMA, and published at least one of the
following results: flow, permeability, length and graft calibre, and
incidence or risk of sternal wound infection. A total of 208 articles were
found, of which 30 were included. Most of the studies included in the
present systematic review show that IMA skeletonisation provides a
significant benefit in terms of lower risk of sternal infection, and
increase in length, calibre, and flow of the graft, in comparison with
pedicled IMA. The clinical benefits of skeletonisation are evident,
especially, but not exclusively, in patients undergoing double IMA surgery
and in diabetic patients. In conclusion, IMA skeletonisation should be
recommended in patients undergoing surgery with the use of double IMA and
in diabetic patients. The clinical benefits of skeletonisation in patients
undergoing surgery with the use of a single IMA are not supported by solid
evidence. Copyright © 2019 Sociedad Espanola de Cirugia
Toracica-Cardiovascular

<98>
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. Copyright © Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<99>
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. Copyright © 2018 The American Society of
Transplantation and the American Society of Transplant Surgeons

<100>
Accession Number
2001374431
Title
A randomized controlled trial evaluating general endotracheal anesthesia
versus monitored anesthesia care and the incidence of sedation-related
adverse events during ERCP in high-risk patients.
Source
Gastrointestinal Endoscopy. 89 (4) (pp 855-862), 2019. Date of
Publication: April 2019.
Author
Smith Z.L.; Mullady D.K.; Lang G.D.; Das K.K.; Hovis R.M.; Patel R.S.;
Hollander T.G.; Elsner J.; Ifune C.; Kushnir V.M.
Institution
(Smith, Mullady, Lang, Das, Patel, Hollander, Elsner, Kushnir) Division of
Gastroenterology, Washington University School of Medicine, St Louis, MO,
United States
(Hovis, Ifune) Department of Anesthesiology, Washington University School
of Medicine, St Louis, MO, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background and Aims: ERCP is a complex procedure often performed in
patients at high risk for sedation-related adverse events (SRAEs).
However, there is no current standard of care with regard to mode of
sedation and airway management during ERCP. The aim of this study was to
assess the safety of general endotracheal anesthesia (GEA) versus
propofol-based monitored anesthesia care (MAC) without endotracheal
intubation in patients undergoing ERCP at high risk for SRAEs.
 Method(s): Consecutive patients undergoing ERCP at high risk for
SRAEs at a single center were invited to participate in this randomized
controlled trial comparing GEA and MAC. Inclusion criteria were STOP-BANG
score >=3, abdominal ascites, body mass index >=35, chronic lung disease,
American Society of Anesthesiologists class >3, Mallampati class 4 airway,
and moderate to heavy alcohol use. Exclusion criteria were preceding EUS,
emergent ERCP, tracheostomy, unstable airway, gastric outlet obstruction
or delayed gastric emptying, and altered foregut anatomy. The primary
endpoint was composite incidence of SRAEs: hypoxemia, use of airway
maneuvers, hypotension requiring vasopressors, sedation-related procedure
interruption, cardiac arrhythmia, and respiratory failure. Secondary
outcomes included procedure duration, cannulation success, in-room time,
and immediate adverse events. Result(s): Two hundred patients (mean
age, 61.1 +/- 13.6 years; 36.5% women) were randomly assigned to GEA (n =
101) or MAC (n = 99) groups. Composite SRAEs were significantly higher in
the MAC group compared with the GEA group (51.5% vs 9.9%, P <.001). This
was primarily driven by the frequent need for airway maneuvers in the MAC
group. Additionally, ERCP was interrupted in 10.1% of patients in the MAC
group to convert to GEA because of respiratory instability refractory to
airway maneuvers (n = 8) or significant retained gastric contents (n = 2).
There were no statistically significant differences in cannulation,
in-room, procedure, or fluoroscopy times between the 2 groups. All
patients undergoing GEA were successfully extubated in the procedure room
at completion of ERCP, and Aldrete scores in recovery did not differ
between the 2 groups. There were no immediate adverse events.
 Conclusion(s): In patients at high risk for SRAEs undergoing ERCP,
sedation with GEA is associated with a significantly lower incidence of
SRAEs, without impacting procedure duration, success, recovery, or in-room
time. These data suggest that GEA should be used for ERCP in patients at
high risk for SRAEs (Clinical trial registration number:
NCT02850887.) Copyright © 2019

<101>
Accession Number
2001228443
Title
Intraoperative prediction of cardiac surgery-associated acute kidney
injury using urinary biomarkers of cell cycle arrest.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (4) (pp 1545-1553.e5),
2019. Date of Publication: April 2019.
Author
Cummings J.J.; Shaw A.D.; Shi J.; Lopez M.G.; O'Neal J.B.; Billings F.T.
Institution
(Cummings, Shaw, O'Neal, Billings) Division of Cardiothoracic
Anesthesiology, Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, Tenn, United States
(Lopez, Billings) Division of Critical Care Medicine, Department of
Anesthesiology, Vanderbilt University Medical Center, Nashville, Tenn,
United States
(Shi) Department of Statistics, Walker Bioscience, Carlsbad, Calif, United
States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Tissue inhibitor of metalloproteinases 2 (TIMP-2) and
insulin-like growth factor-binding protein 7 (IGFBP7) are postoperative
urinary biomarkers of renal stress and acute kidney injury (AKI). We
conducted this study to test the hypothesis that intraoperative
concentrations of urinary [TIMP-2].[IGFBP7] are associated with
postoperative AKI. Method(s): We measured urinary [TIMP-2].[IGFBP7]
at 8 perioperative timepoints in 400 patients who participated in a
randomized controlled trial of atorvastatin for AKI in cardiac surgery. We
compared [TIMP-2].[IGFBP7] between subjects who did and did not develop
KDIGO stage 2 or 3 AKI within 48 hours of surgery, adjusted for AKI risk
factors. Result(s): Fourteen patients (3.5%) met the primary endpoint
of stage 2 or 3 AKI within 48 hours of surgery, and an additional 77
patients (19.3%) developed stage 1 AKI. Patients who developed stage 2 or
3 AKI displayed bimodal elevations of [TIMP-2].[IGFBP7], with a first
elevation (median, 0.45 [ng/mL]2/1000) intraoperatively and a
second elevation (1.45 [ng/mL]2/1000) 6 hours postoperatively.
Patients who did not develop AKI did not have any elevations in
[TIMP-2].[IGFBP7]. Each 10-fold increase in intraoperative
[TIMP-2].[IGFBP7] was independently associated with a 290% increase in the
odds of stage 2 or 3 AKI (P =.01), and each 10-fold increase in the 6
hours postoperative [TIMP-2].[IGFBP7] was independently associated with a
650% increase in the odds of stage 2 or 3 AKI (P <.001). The maximum
[TIMP-2].[IGFBP7] between these 2 timepoints provided an area under the
receiver operating characteristic curve of 0.82 (95% confidence interval
[CI], 0.73-0.90), 100% sensitivity, and 100% negative predictive value
using the >0.3 cutoff to predict stage 2 or 3 AKI. Conclusion(s):
Intraoperative elevations of [TIMP-2].[IGFBP7] can predict moderate or
severe AKI and could provide an opportunity to alter postoperative
management to prevent kidney injury. Copyright © 2018 The
American Association for Thoracic Surgery

<102>
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. Copyright © 2019
Elsevier Inc.

<103>
Accession Number
2001408332
Title
Disparities in death rates in women with peripartum cardiomyopathy between
advanced and developing countries: A systematic review and meta-analysis.
Source
Archives of Cardiovascular Diseases. 112 (3) (pp 187-198), 2019. Date of
Publication: March 2019.
Author
Kerpen K.; Koutrolou-Sotiropoulou P.; Zhu C.; Yang J.; Lyon J.-A.; Lima
F.V.; Stergiopoulos K.
Institution
(Kerpen, Stergiopoulos) Division of Cardiovascular Medicine, Department of
Medicine, Stony Brook University Medical Center, State University of New
York, Stony Brook, Nichols road, NY 11794, United States
(Koutrolou-Sotiropoulou) Division of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN 55905, United States
(Zhu) Department of Applied Mathematics and Statistics, Stony Brook
University, Stony Brook, NY 11794, United States
(Yang) Department of Family, Population and Preventive Medicine, Stony
Brook University Medical Center, Stony Brook, NY 11794, United States
(Lyon) Library Services, Children's Mercy Kansas City, Kansas City, MO
64108, United States
(Lima) Department of Medicine, Brown University, Rhode Island Hospital,
Providence, RI 02903, United States
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
There is limited information about differences in maternal deaths from
peripartum cardiomyopathy (PPCM) between advanced and developing
countries. To review the literature to define the global prevalence of
death from PPCM, and to determine the differences in PPCM mortality rates
and risk factors between advanced and developing countries. Studies in the
English language reporting mortality data on patients with PPCM were
included from searches of MEDLINE, Embase, CINAHL, the Cochrane Library,
the Web of Science Core Collection and Scopus from 01 January 2000 to 11
May 2016. Of the 4294 articles identified, 1.07% were included. The
primary outcome was death; rates of heart transplant, acute myocardial
infarction, heart failure, arrhythmia, cerebrovascular events, embolism
and cardiac arrest were recorded. Studies were categorized as having been
conducted in advanced or developing countries. Data from 46 studies, 4925
patients and 13 countries were included. There were 22 studies from
advanced countries (n = 3417) and 24 from developing countries (n = 1508);
mean follow-up was 2.6 (range 0-8.6) years. Overall mortality prevalence
was 9% (95% confidence interval [CI] 6-11%). The mortality rate in
developing countries (14%, 95% CI 10-18%) was significantly higher than
that in advanced countries (4%, 95% CI 2-7%). There was no difference in
the prevalence of risk factors (chronic hypertension, African descent,
multiple gestation and multiparity) between advanced and developing
countries. Studies with a higher prevalence of women of African descent
had higher death rates (correlation coefficient 0.29, 95% CI 0.13-0.52).
The risk of death in women with PPCM was higher in developing countries
than in advanced countries. Women of African descent had an increased risk
of death. Copyright © 2018 Elsevier Masson SAS

<104>
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. Copyright © 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.

<105>
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. Copyright © 2019,
E-Century Publishing Corporation. All rights reserved.

<106>
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. Copyright © 2019 Elsevier
Inc.

<107>
Accession Number
626128168
Title
The impact of person-centred care on patients' care experiences in
relation to educational level after acute coronary syndrome: secondary
outcome analysis of a randomised controlled trial.
Source
European Journal of Cardiovascular Nursing. 18 (4) (pp 299-308), 2019.
Date of Publication: 01 Apr 2019.
Author
Wolf A.; Vella R.; Fors A.
Institution
(Wolf, Fors) Institute of Health and Care Sciences, University of
Gothenburg, Sweden
(Wolf, Vella, Fors) Centre for Person-Centred Care (GPCC), University of
Gothenburg, Sweden
(Wolf) Department of Anaesthesiology and Intensive Care Medicine,
Sahlgrenska University Hospital Ostra, Gothenburg, Sweden
(Fors) Narhalsan Research and Development Primary Health Care, Sweden
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Research supporting the benefits of person-centred care is
growing, still knowledge about patients' experiences of person-centred
care is limited. Aim(s): To evaluate the effects of person-centred
care on patients' experiences of care, and also in relation to educational
level, after an acute coronary syndrome. Method(s): A total of 199
patients aged less than 75 years, hospitalised for acute coronary
syndrome, were randomly assigned to either standard cardiac care (n=105)
or person-centred care plus standard cardiac care (n=94). Experience of
care was assessed at three healthcare settings (hospital, outpatient and
primary care) using the 15-item Picker patient experience questionnaire
plus two questions concerning information and documentation.
 Result(s): No significant difference was found at the three
healthcare settings between the two study groups in the Picker patient
experience questionnaire total score. Item level analysis showed that the
person-centred care group significantly improved at all three healthcare
settings on information received and in documentation of care compared
with the standard cardiac care group (P<0.05). In outpatient care, the
person-centred care group reported significantly better family-physician
communication (P=0.004) and information for the family (P=0.007) compared
with the standard cardiac care group. In patients without postsecondary
education, the corresponding figures were even more in favour of the
person-centred care group (P=0.0005 and P=0.0049, respectively), and they
also reported higher involvement in care decisions (P=0.023).
 Conclusion(s): A person-centred care approach after an event of acute
coronary syndrome improves patients' care experiences for information,
shared documentation and involvement of family and friends. This effect
was especially prominent in patients with a low educational level, who
were also more involved in care decisions. Trial registration: Swedish
registry, Researchweb.org, ID NR 65 791. Copyright © The European
Society of Cardiology 2019.

<108>
Accession Number
624971429
Title
A perioperative surgeon-controlled open-lung approach versus conventional
protective ventilation with low positive end-expiratory pressure in
cardiac surgery with cardiopulmonary bypass (PROVECS): Study protocol for
a randomized controlled trial 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 624. Date of
Publication: 13 Nov 2018.
Author
Lagier D.; Fischer F.; Fornier W.; Fellahi J.-L.; Colson P.; Cholley B.;
Jaber S.; Baumstarck K.; Guidon C.; Quintana G.; Gaillat F.; Nedir P.;
Duponq R.; Gomert R.; Guinard B.; Heraud F.; Villacorta J.; Degirmenci S.;
Pernoud N.; Samarani G.; Lalande M.; Huynh T.M.; Gros C.; Elmiloudi F.;
Tacquard C.; Bilger A.; Levy F.; Cinca E.; Bongarzone C.; Heger B.; Balvay
V.; Berns M.; Oulehri W.; Ouattara A.
Institution
(Lagier, Guidon) Department of Cardiovascular Anesthesiology and Critical
Care Medicine, La Timone University Hospital, AP-HM, Aix-Marseille
University, 264 rue saint Pierre, Marseille, cedex 5 13005, France
(Fischer) Department of Cardiovascular and Thoracic Anesthesiology, Nouvel
Hopital Civil, Strasbourg, France
(Fornier, Fellahi) Department of Anesthesiology and Critical Care
Medicine, Louis Pradel University Hospital, University Claude Bernard, 28
Avenue du Doyen Lepine, Bron 69677, France
(Colson) Department of Anesthesiology and Critical Care Medicine, Arnaud
de Villeneuve University Hospital, 371 Avenue du Doyen Gaston Giraud,
Montpellier 34295, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, AP-HP, University Paris Descartes-Sorbonne
Paris Cite, 20 Rue Leblanc, Paris 75015, France
(Jaber) Department of Anesthesiology and Critical Care Medicine, Saint
Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295,
France
(Baumstarck) Unite de Recherche EA3279, Aix-Marseille University, 27 bd
Jean Moulin, Marseille, Marseille, cedex 5 13385, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPCs) are frequent
after on-pump cardiac surgery. Cardiac surgery results in a complex
pulmonary insult leading to high susceptibility to perioperative pulmonary
atelectasis. For technical reasons, ventilator settings interact with the
surgical procedure and traditionally, low levels of positive
end-expiratory pressure (PEEP) have been used. The objective is to compare
a perioperative, multimodal and surgeon-controlled open-lung approach with
conventional protective ventilation with low PEEP to prevent PPCs in
patients undergoing cardiac surgery. Methods/design: The perioperative
open-lung protective ventilation in cardiac surgery (PROVECS) trial is a
multicenter, two-arm, randomized controlled trial. In total, 494 patients
scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB)
and aortic cross-clamp will be randomized into one of the two treatment
arms. In the experimental group, systematic recruitment maneuvers and
perioperative high PEEP (8 cmH2O) are associated with ultra-protective
ventilation during CPB. In this group, the settings of the ventilator are
controlled by surgeons in relation to standardized protocol deviations. In
the control group, no recruitment maneuvers, low levels of PEEP (2 cmH2O)
and continuous positive airway pressure during CPB (2 cmH2O) are used. Low
tidal volumes (6-8 mL/kg of predicted body weight) are used before and
after CPB in each group. The primary endpoint is a composite of the single
PPCs evaluated during the first 7 postoperative days. Discussion(s):
The PROVECS trial will be the first multicenter randomized controlled
trial to evaluate the impact of a perioperative and multimodal open-lung
ventilatory strategy on the occurrence of PPCs after on-pump cardiac
surgery. The trial design includes standardized surgeon-controlled
protocol deviations that guarantee a pragmatic approach. The results will
help anesthesiologists and surgeons aiming to optimize ventilatory
settings during cardiac surgery. Trial registration: Clinical Trials.gov,
NCT 02866578. Registered on 15 August 2016. Last updated 11 July
2017. Copyright © 2018 The Author(s).

<109>
Accession Number
622077222
Title
Comparison of the analgesic effects of modified continuous intercostal
block and paravertebral block under surgeon's direct vision after
video-assisted thoracic surgery: a randomized clinical trial.
Source
General Thoracic and Cardiovascular Surgery. 66 (7) (pp 425-431), 2018.
Date of Publication: 01 Jul 2018.
Author
Kadomatsu Y.; Mori S.; Ueno H.; Uchiyama M.; Wakai K.
Institution
(Kadomatsu) Department of Thoracic Surgery, Nagoya University Graduate
School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
(Mori, Ueno, Uchiyama) Department of Thoracic Surgery, Japanese Red Cross
Nagoya Daiichi Hospital, Mitishita-cho 3-35, Nakamura-ku, Nagoya 453-8511,
Japan
(Kadomatsu, Wakai) Department of Preventive Medicine, Nagoya University
Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550,
Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objective: Clinical evidence comparing paravertebral (PVB) and continuous
intercostal nerve (ICB) blocks for pain management post video-assisted
thoracic surgery (VATS) is limited. This study confirms the analgesic
effect of ICB using two catheters is not inferior to that of PVB under
direct vision. Method(s): Fifty patients who underwent VATS lobectomy
from July 2015 to March 2016 were prospectively recruited and randomly
assigned to PVB and ICB groups. Postoperative pain was assessed using the
visual analog scale (VAS). VAS score at rest at 24 h was the primary
endpoint. Data on time required for catheter insertion, adverse effects,
and frequency of additional analgesics as secondary endpoints were also
collected. Noninferiority was assessed by adding a VAS margin of 15 mm to
the PVB group. Result(s): No significant differences were observed
between the VAS scores of the two groups except at 48 h after surgery,
with a margin noted for the PVB group. No significant differences were
detected in the frequency of additional analgesics and occurrence of
adverse effects. Conclusion(s): Our results could not clearly
establish noninferiority of ICB to PVB. Improvements in ICB may be
necessary for it to be used as an alternative method to PVB. Copyright
© 2018, The Japanese Association for Thoracic Surgery.

<110>
Accession Number
625135398
Title
Effect of magnesium on arrhythmia incidence in patients undergoing
coronary artery bypass grafting.
Source
ANZ journal of surgery. 88 (6) (pp 612-615), 2018. Date of Publication: 01
Jun 2018.
Author
Mohammadzadeh A.; Towfighi F.; Jafari N.
Institution
(Mohammadzadeh, Towfighi, Jafari) Department of Cardiothoracic, Imam
Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran,
Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac arrhythmia after coronary artery bypass grafting
(CABG) surgery is a common complication of cardiac surgery. The effect of
serum magnesium, hypomagnesaemia treatment and prophylactic administration
of magnesium in the development and prevention of arrhythmias is
controversial and there are many different ideas. This study evaluates the
therapeutic effects of magnesium in cardiac arrhythmia after CABG surgery.
 METHOD(S): The clinical trial enrolled 250 patients who underwent
CABG. Based on the initial serum levels of magnesium, patients were
divided into two groups: hypomagnesium and normomagnesium. Based on
bioethics committee requirements, patients in the hypo-magnesium group
received magnesium treatments until they attained normal magnesium blood
levels. Both groups underwent CABG with normal blood levels of magnesium.
After surgery, each group was randomly divided into two subgroups: one
subgroup received a bolus dose of magnesium sulphate (30 mg/kg in 5 min)
and the other subgroup received a placebo. Subgroups were under
observation in the intensive care unit for 3 days and arrhythmias were
recorded. Data from all four subgroups were analysed statistically and
interpreted. RESULT(S): The results of this study showed that the
occurrence of arrhythmia was not significantly different among subgroups
(P > 0.05). There was no significant relationship between blood levels of
magnesium and arrhythmia during the 3 days post-surgery (P > 0.05).
 CONCLUSION(S): The results of this study showed that magnesium
sulphate administration did not significantly improve the incidence of
arrhythmias in hypo- and normo-magnesium patients after CABG. There was no
significant correlation between post-operative serum levels of magnesium
and arrhythmia during 3 days. Copyright © 2017 Royal Australasian
College of Surgeons.

<111>
Accession Number
627034378
Title
Risk factors associated with prolonged air leak after video-assisted
thoracic surgery pulmonary resection: A predictive model and
meta-analysis.
Source
Annals of Translational Medicine. 7 (5) (no pagination), 2019. Article
Number: 103. Date of Publication: 01 Mar 2019.
Author
Pan H.; Chang R.; Zhou Y.; Gao Y.; Cheng Y.; Zhang C.
Institution
(Pan, Chang, Zhou, Gao, Cheng, Zhang) Department of Thoracic Surgery,
Xiangya Hospital Central South University, 87 Xiangya Road, Kaifu
District, Changsha 410000, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: This study aimed to establish a predictive model for prolonged
air leak (PAL) after video-assisted thoracic surgery (VATS) lung
resection; and additionally, to present a meta-analysis of the relevant
literature to estimate the association between various clinical factors
and PAL. Method(s): A retrospective, case-control study was conducted
using univariate analysis and logistic regression based on 493 medical
records from patients who underwent VATS lung resection between January
2015 and August 2017 at our institution. PAL was defined as air leak more
than 5 days after lung surgery. Subsequently, a nomogram was established
as a predictive model. Relevant studies were screened from PubMed, Embase
and Cochrane for relevant studies and data was extracted from those
enrolled. Pooled odds ratios or weighted mean differences with
corresponding 95% confidence intervals were calculated to estimate the
association between various clinical factors and PAL. Result(s):
Incidence of PAL after VATS lung resection was observed in 54 (10.8%) of
493 patients. Logistic regression revealed that smoking (P=0.014),
pulmonary function (P=0.011), pleural adhesion (P<0.001), stapling length
(P<0.001), early postoperative drainage (P=0.002) were significantly
associated with PAL. Our meta-analysis, including 17 eligible studies and
14 potential risk factors, further validating our findings. Upper
lobectomy was determined to be a significant risk factor for PAL in
Europeans and North Americans (OR =2.03, P<0.001), but not in Asians (OR
=1.04, P=0.610). Importantly, the constructed nomogram demonstrated a good
predictive ability (C-index =0.858). Conclusion(s): Lung stapling
length and early postoperative drainage are important indicators for the
evaluation of PAL occurrence. Upper pulmonary resection is a factor with
particular regional differences as its association with PAL is not
significant within Asian populations. Our nomogram, incorporating multiple
factors, provided a simple and practical predictive model with value for
clinical application. Copyright © AME Publishing Company. All
rights reserved.

<112>
Accession Number
627026257
Title
Randomized evaluation of fibrinogen versus placebo in complex
cardiovascular surgery: post hoc analysis and interpretation of phase III
results.
Source
Interactive cardiovascular and thoracic surgery. 28 (4) (pp 566-574),
2019. Date of Publication: 01 Apr 2019.
Author
Rahe-Meyer N.; Levy J.H.; Mazer C.D.; Schramko A.; Klein A.A.; Brat R.;
Okita Y.; Ueda Y.; Schmidt D.S.; Gill R.
Institution
(Rahe-Meyer) Department of Anaesthesiology and Critical Care, Franziskus
Hospital, Bielefeld, Germany
(Levy) Department of Anesthesiology and Critical Care, Duke University
School of Medicine, Durham, NC, United States
(Mazer) Department of Anesthesia, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Schramko) Department of Anesthesiology, Intensive Care and Pain Medicine,
Helsinki University Hospital, Helsinki, Finland
(Klein) Department of Anaesthesia and Intensive Care, Papworth Hospital,
Cambridge, United Kingdom
(Brat) Department of Cardiac Surgery, Faculty of Medicine, University of
Ostrava, Ostrava, Czech Republic
(Okita) Department of Cardiovascular Surgery, Kobe University Hospital,
Kobe, Japan
(Ueda) Department of Cardiac Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
(Schmidt) CSL Behring, Marburg, Germany
(Gill) Department of Anaesthesia, University Hospital of Southampton,
Southampton, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: In a multicentre, randomized-controlled, phase III trial in
complex cardiovascular surgery (Randomized Evaluation of Fibrinogen vs
Placebo in Complex Cardiovascular Surgery: REPLACE), single-dose human
fibrinogen concentrate (FCH) was associated with the transfusion of
increased allogeneic blood products (ABPs) versus placebo. Post hoc
analyses were performed to identify possible reasons for this result.
 METHOD(S): We stratified REPLACE results by adherence to the
transfusion algorithm, pretreatment fibrinogen level (<=2g/l vs >2g/l) and
whether patients were among the first 3 treated at their centre.
 RESULT(S): Patients whose treatment was adherent with the transfusion
algorithm [FCH, n=47 (60.3%); placebo, n=57 (77.0%); P=0.036] received
smaller quantities of ABPs than those with non-adherent treatment
(P<0.001). Among treatment-adherent patients with pretreatment plasma
fibrinogen <=2g/l, greater reduction in 5-min bleeding mass was seen with
FCH versus placebo (median -22.5g vs -15.5g; P=0.071). Considering
patients with the above conditions and not among the first 3 treated at
their centre (FCH, n=15; placebo, n=22), FCH was associated with trends
towards reduced transfusion of ABPs (median 2.0 vs 4.0 units; P=0.573) and
greater reduction in 5-min bleeding mass (median -21.0g vs -9.5g;
P=0.173). Differences from a preceding single-centre phase II study with
positive outcomes included more patients with pretreatment fibrinogen
>2g/l and fewer patients undergoing thoracoabdominal aortic aneurysm
repair. CONCLUSION(S): None of the patient stratifications provided a
clear explanation for the lack of efficacy seen for FCH in the REPLACE
trial versus the positive phase II outcomes. However, together, the 3
factors demonstrated trends favouring FCH. Less familiarity with the
protocol and procedures and unavoidable differences in the study
populations may explain the differences seen between the phase II study
and REPLACE. CLINICAL TRIAL REGISTRATION: NCT01475669
https://clinicaltrials.gov/ct2/show/NCT01475669; EudraCT trial no:
2011-002685-20. Copyright © The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<113>
[Use Link to view the full text]
Accession Number
627025221
Title
Blood Pressure in De Novo Heart Transplant Recipients Treated With
Everolimus Compared With a Cyclosporine-based Regimen: Results From the
Randomized SCHEDULE Trial.
Source
Transplantation. 103 (4) (pp 781-788), 2019. Date of Publication: 01 Apr
2019.
Author
Andreassen A.K.; Broch K.; Eiskjaer H.; Karason K.; Gude E.; Molbak D.;
Stueflotten W.; Gullestad L.
Institution
(Andreassen, Broch, Gude, Stueflotten, Gullestad) Department of
Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
(Andreassen, Gullestad) Faculty of Medicine, University of Oslo, Oslo,
Norway
(Eiskjaer, Molbak) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Karason) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: Systemic hypertension is prevalent in heart transplant
recipients and has been partially attributed to treatment with calcineurin
inhibitors (CNIs). SCandinavian HEart transplant De-novo stUdy with earLy
calcineurin inhibitors avoidancE trial was the first randomized trial to
study early withdrawal of CNIs in de novo heart transplant recipients,
comparing an everolimus-based immunosuppressive regimen with conventional
CNI-based treatment. As a prespecified secondary endpoint, blood pressure
was repeatedly compared across treatment arms. METHOD(S): The The
SCandinavian HEart transplant De-novo stUdy with earLy calcineurin
inhibitors avoidancE trial was a prospective, multicenter, randomized,
controlled, parallel-group, open-label trial in de novo adult heart
transplant recipients, undertaken at transplant centers in Scandinavia.
Blood pressure was assessed with 24-hour ambulatory blood pressure
monitoring up to 3 years after heart transplantation (HTx) in 83 patients.
 RESULT(S): Overall, systolic blood pressure fell with time, from 138
+/- 15mm Hg 2 weeks after HTx to 134 +/- 11mm Hg after 12 months and 132
+/- 14mm Hg after 36 months (P = 0.003). Diastolic blood pressure did not
change over time. After 12 months, there was a numerically larger fall in
systolic blood pressure in the everolimus arm (between-group difference
8mm Hg; P = 0.053), and after 36 months, there was a significant between
group difference of 13mm Hg (P = 0.02) in favor of everolimus.
 CONCLUSION(S): In this first, randomized trial with early CNI
avoidance in de novo HTx recipients, we observed a modest fall in systolic
blood pressure over the first 1 to 3 years after transplantation. The fall
in systolic blood pressure was more pronounced in patients allocated to
everolimus.

<114>
Accession Number
627026912
Title
Is systematic lymph node dissection mandatory or is sampling adequate in
patients with stage I non-small-cell lung cancer?.
Source
Interactive cardiovascular and thoracic surgery. 28 (4) (pp 550-554),
2019. Date of Publication: 01 Apr 2019.
Author
Mitsos S.; Panagiotopoulos N.; Patrini D.; George R.S.
Institution
(Mitsos, Panagiotopoulos, Patrini, George) Thoracic Surgery Department,
University College London Hospitals, NHS Foundation Trust, London, United
Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Is systematic lymph node
dissection (SLND) mandatory or is sampling adequate in stage I
non-small-cell lung cancer (NSCLC)? Two hundred and eleven papers were
identified, of which 12 papers represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and the results of
these papers are tabulated. There are 7 retrospective cohort reviews, 3
meta-analyses and 2 randomized controlled clinical trials (RCTs) to answer
the clinical question. Four of the 7 retrospective studies demonstrated
that the total number of resected lymph nodes and the number of lymph node
stations sampled affected the accuracy of staging in patients with
early-stage NSCLC and had an impact on overall survival and disease-free
survival. Two RCTs, 1 meta-analysis and 1 cohort study revealed no
significant benefit in overall survival and disease-free survival in
patients undergoing SLND. One meta-analysis, which contained only 1 RCT,
revealed significantly better 3- and 5-year survival with SLND. One
further meta-analysis revealed improved survival with SLND in cohort
studies but no significant difference in the 4 RCTs included. Two further
studies identified specific subgroups of patients in whom LN sampling
could be justified and SLND avoided. We conclude that there is no
significant difference in the recurrence rate when performing either SLND
or LN sampling in patients with stage I NSCLC. While retrospective cohort
studies implied survival benefit with SLND, this was not borne out in RCTs
and meta-analyses. However, there may be a potential survival benefit for
patients who are upstaged by SLND identifying mediastinal nodal
involvement. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<115>
Accession Number
627030890
Title
Improving coronary artery bypass grafting: a systematic review and
meta-analysis on the impact of adopting transit-time flow measurement.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 25 Mar 2019.
Author
Thuijs D.J.F.M.; Bekker M.W.A.; Taggart D.P.; Kappetein A.P.; Kieser T.M.;
Wendt D.; Di Giammarco G.; Trachiotis G.D.; Puskas J.D.; Head S.J.
Institution
(Thuijs, Bekker, Kappetein, Head) Department of Cardiothoracic Surgery,
Erasmus MC, University Medical Centre, Rotterdam, Netherlands
(Taggart) Department of Cardiovascular Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Kieser) Division of Cardiac Surgery, Department of Cardiac Sciences,
Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary,
Canada
(Wendt) Department of Thoracic and Cardiovascular Surgery, West German
Heart and Vascular Centre, University of Duisburg-Essen, Duisburg, Germany
(Di Giammarco) Department of Cardiac Surgery, Chieti, Italy
(Trachiotis) Department of Cardiothoracic Surgery, Veterans Affairs
Medical Centre, WA, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's,
New York, NY, USA
Publisher
NLM (Medline)
Abstract
Despite there being numerous studies of intraoperative graft flow
assessment by transit-time flow measurement (TTFM) on outcomes after
coronary artery bypass grafting (CABG), the adoption of contemporary TTFM
is low. Therefore, on 31 January 2018, a systematic literature search was
performed to identify articles that reported (i) the amount of grafts
classified as abnormal or which were revised or (ii) an association
between TTFM and outcomes during follow-up. Random-effects models were
used to create pooled estimates with 95% confidence intervals (CI) of (i)
the rate of graft revision per patient, (ii) the rate of graft revision
per graft and (iii) the rate of graft revision among grafts deemed
abnormal based on TTFM parameters. The search yielded 242 articles, and 66
original articles were included in the systematic review. Of those
articles, 35 studies reported on abnormal grafts or graft revisions (8943
patients, 15 673 grafts) and were included in the meta-analysis. In 4.3%
of patients (95% CI 3.3-5.7%, I2=73.9) a revision was required and 2.0% of
grafts (95% CI 1.5-2.5%; I2=66.0) were revised. The pooled rate of graft
revisions among abnormal grafts was 25.1% (95% CI 15.5-37.9%; I2=80.2).
Studies reported sensitivity ranging from 0.250 to 0.457 and the
specificity from 0.939 to 0.984. Reported negative predictive values
ranged from 0.719 to 0.980 and reported positive predictive values ranged
from 0.100 to 0.840. This systematic review and meta-analysis showed that
TTFM could improve CABG procedures. However, due to heterogeneous data,
drawing uniform conclusions appeared challenging. Future studies should
focus on determining the optimal use of TTFM and assessing its diagnostic
accuracy. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<116>
Accession Number
627030547
Title
Unforeseen N2 disease following negative endosonography with or without
confirmatory mediastinoscopy in resectable non-small cell lung cancer: a
systematic review and meta-analysis.
Source
Journal of thoracic oncology : official publication of the International
Association for the Study of Lung Cancer. (no pagination), 2019. Date of
Publication: 21 Mar 2019.
Author
Bousema J.E.; van Dorp M.; Noyez V.J.J.M.; Dijkgraaf M.G.W.; Annema J.T.;
van den Broek F.J.C.
Institution
(Bousema) Department of Surgery, Maxima Medical Center, Veldhoven, PO BOX
7777, 5500 MB Veldhoven, the Netherlands
(van Dorp) Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar PO
BOX 501, AM Alkmaar 1800, Netherlands
(Noyez) Department of Vascular and Thoracic Surgery, Sint-Maarten General
Hospital, Mechelen PO BOX 2800, Mechelen 2800, Belgium
(Dijkgraaf) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, PO BOX
22700 (J.1B-226), 1100 DE Amsterdam, the Netherlands
(Annema) Department of Respiratory Medicine, University of Amsterdam PO
BOX 22700, DE Amsterdam 1100, Netherlands
(van den Broek) Department of Surgery, Maxima Medical Center, Veldhoven,
PO BOX 7777, 5500 MB Veldhoven, the Netherlands. Electronic address:
lung.resurge@mmc.nl
Publisher
NLM (Medline)

<117>
Accession Number
627029291
Title
Efficacy and Safety of Apixaban versus Warfarin in Patients with Atrial
Fibrillation and Prior Bioprosthetic Valve Replacement or Valve Repair:
Insights from the ARISTOTLE Trial.
Source
Clinical cardiology. (no pagination), 2019. Date of Publication: 24 Mar
2019.
Author
Guimaraes P.O.; Pokorney S.D.; Lopes R.D.; Wojdyla D.M.; Gersh B.J.;
Giczewska A.; Carnicelli A.; Lewis B.S.; Hanna M.; Wallentin L.; Vinereanu
D.; Alexander J.H.; Granger C.B.
Institution
(Guimaraes, Pokorney, Lopes, Wojdyla, Giczewska, Carnicelli, Alexander,
Granger) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
(Gersh) Division of Cardiovascular Diseases, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Giczewska) Department of Biomedical Engineering, Faculty of Electronics,
Telecommunications and Informatics, Gdansk University of Technology,
Poland
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Hanna) Bristol-Myers Squibb, Princeton, NJ, United States
(Wallentin) Uppsala Clinical Research Center, Department of Medical
Sciences, Cardiology, Uppsala University, Uppsala, Sweden
(Vinereanu) University of Medicine and Pharmacy Carol Davila, University
and Emergency Hospital, Bucharest, Romania
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal anticoagulation strategy for patients with atrial
fibrillation (AF) and bioprosthetic valve (BPV) replacement or native
valve repair remains uncertain. HYPOTHESIS: We evaluated the safety and
efficacy of apixaban versus warfarin in patients with AF and a history of
BPV replacement or native valve repair. METHOD(S): Using data from
ARISTOTLE (n=18,201), a randomized trial comparing apixaban with warfarin
in patients with AF, we analyzed the subgroup of patients (n=251) with
prior valve surgery. We contacted sites by telephone to obtain additional
data about prior valve surgery. Full data were available for 156 patients.
The primary efficacy endpoint was stroke/systemic embolism. The primary
safety endpoint was major bleeding. Treatment groups were compared using a
Cox regression model. RESULT(S): In ARISTOTLE, 104 (0.6%) patients
had a history of BPV replacement (n=73 [aortic], n=26 [mitral], n=5
[mitral and aortic]) and 52 (0.3%) had a history of valve repair (n=50
[mitral], n=2 [aortic]). Among patients with BPVs, 55 were randomized to
apixaban and 49 to warfarin. Among those with a history of native valve
repair, 32 were randomized to apixaban and 20 to warfarin. Overall
clinical event rates were low, with no significant differences between
apixaban and warfarin for any outcomes. CONCLUSION(S): In patients
with AF and a history of BPV replacement or repair, the safety and
efficacy of apixaban compared with warfarin was consistent with results
from ARISTOTLE. These data suggest that apixaban may be reasonable for
patients with BPVs or prior valve repair, though future larger randomized
trials are needed. Copyright This article is protected by copyright.
All rights reserved.

<118>
Accession Number
627035261
Title
Clinical outcomes of percutaneous mitral valve repair with MitraClip for
the management of functional mitral regurgitation.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Marmagkiolis K.; Hakeem A.; Ebersole D.G.; Iliescu C.; Ates I.;
Cilingiroglu M.
Institution
(Marmagkiolis) Pepin Heart Institute, Florida Hospital Tampa, Tampa, FL,
United States
(Hakeem) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Ebersole) Watson Clinic LLP, Lakeland, FL, United States
(Iliescu) Division of Cardiology, Department of Medicine, MD Anderson
Cancer Center, University of Texas at Houston, Houston, TX, United States
(Ates, Cilingiroglu) School of Medicine, Bahcesehir University, Istanbul,
Turkey
(Cilingiroglu) Arkansas Heart Hospital, Little Rock, AR, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the safety and efficacy of percutaneous mitral
valve repair for the management of functional mitral insufficiency.
 Background(s): Severe FMR is present in 25-30% of patients with heart
failure and is an independent predictor of mortality and hospitalizations
in patients with both ischemic and nonischemic cardiomyopathy. MitraClip
therapy has been approved for high surgical risk patients with primary
mitral regurgitation. Recent studies including two randomized trials have
yielded conflicting results in terms of its clinical efficacy and outcomes
for FMR. A quantitative evaluation and synthesis of this information are
essential in elucidating the role of MitraClip repair for FMR.
 Method(s): We performed a literature search using PubMed, EMBASE, and
Cochrane Central Register of Controlled Trials from September 2008 to
September 2018. Studies comparing percutaneous mitral valve repair using
the MitraClip device against conservative therapy for the management of
functional mitral regurgitation were included. Result(s): Seven
studies with 1,174 patients in MitraClip group and 1,015 patients in
medical therapy group met inclusion criteria. The 12-month mortality in
the MitraClip group was 18.4% compared with 25.9% in the medical therapy
group (odds ratio [OR]: 0.65 [0.50, 0.86]; p <.002). The rate of
readmission at 12 months was 29.9% in the MitraClip group compared with
54.1% in the medical therapy group (OR: 040 [0.32-0.49]; p <.0001. The
prognostic efficacy of MitraClip repair appears to be more substantial
over longer follow-up period over medical therapy alone.
 Conclusion(s): Based on the results of this meta-analysis,
percutaneous mitral valve repair with MitraClip appears to be superior to
medical therapy for symptomatic moderate-to-severe functional mitral
insufficiency. Further clinical research is needed to identify the ideal
patient subgroups who receive maximum benefit with the MitraClip
therapy. Copyright © 2019 Wiley Periodicals, Inc.

<119>
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. Copyright © 2019, Spandidos Publications. All rights
reserved.

<120>
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.
 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. 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.
 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. Copyright © 2019
The Author(s).

<121>
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. Copyright © 2019, Spandidos Publications. All rights
reserved.

<122>
Accession Number
618484830
Title
Sevoflurane-induced cardioprotection in coronary artery bypass graft
surgery: Randomised trial with clinical and ex-vivo endpoints.
Source
Anaesthesia Critical Care and Pain Medicine. 37 (3) (pp 217-223), 2018.
Date of Publication: June 2018.
Author
Lemoine S.; Zhu L.; Gerard J.-L.; Hanouz J.-L.
Institution
(Lemoine, Zhu, Gerard, Hanouz) Department of Anaesthesiology and Intensive
Care, Universite Caen-Normandie, Centre Hospitalier Universitaire de Caen,
Caen 14033, France
(Hanouz) EA 4650, Universite Caen-Normandie, Centre Hospitalier
Universitaire de Caen, Caen 14033, France
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Myocardial ischaemia reperfusion injury following cardiac
surgery with cardiopulmonary bypass (CPB) increases postoperative
mortality. Setting techniques to protect the heart during this critical
period therefore represents a considerable challenge. Method(s): A
randomised controlled study in Caen University Hospital Centre,
investigated whether the clinical cardio protective effects of
administration sevoflurane before cardiopulmonary bypass during coronary
artery bypass graft surgery (CABG) could translate into protected atrial
trabeculae contractility against hypoxia-reoxygenation in vitro. Patients
undergoing elective on-pump CABG surgery were allocated to receive either
sevoflurane (n = 24) or no halogenated volatile anaesthetic (n = 21).
 Main Outcome Measure(s): the relationship between sevoflurane
exposure before CPB and the incidence of major adverse cardiac events,
with primary endpoint: the postoperative troponin I peak level, and
secondary endpoints: the inotropic support, and the duration of stay in
intensive unit and in-hospital stay were chosen as study endpoints. The
right atrial was collected at the beginning of bypass surgery for the in
vitro experimentation. Isometrically contracting isolated human right
atrial trabeculae obtained from the two groups were exposed to 30-min
hypoxia followed by 60-min reoxygenation. Result(s): The patients
receiving sevoflurane prior to aortic clamping significantly exhibited
less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64]
ng.mL-1 in Control; P = 0.03) and required a reduced inotropic
drug support (P < 0.001). Isolated trabeculae from patients receiving
sevoflurane enhanced the recovery of force after reoxygenation compared to
the Control group (79 +/- 5% vs. 53 +/- 8% of baseline in Control; P <
0.001). Conclusion(s): Administration of sevoflurane before CPB
induced cardioprotection in patients undergoing CABG and preconditioned
human myocardium against hypoxia-reoxygenation in vitro. Copyright
© 2018 Societe francaise d'anesthesie et de reanimation (Sfar)

<123>
Accession Number
622870113
Title
The effect of perioperative intravenously administered iron isomaltoside
1000 (Monofer) on transfusion requirements for patients undergoing complex
valvular heart surgery: Study protocol for a randomized controlled trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 350. Date of
Publication: 04 Jul 2018.
Author
Lee S.H.; Shim J.-K.; Soh S.; Song J.W.; Chang B.C.; Lee S.; Kwak Y.-L.
Institution
(Lee, Chang, Lee) Yonsei University Health System, Department of Thoracic
and Cardiovascular Surgery, Severance Cardiovascular Hospital, College of
Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Shim, Soh, Song, Kwak) Yonsei University Health System, Department of
Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute,
Yonsei, South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Anemia is a frequent complication after cardiac surgery
especially following reoperation due to previous prosthetic valve failure
or multiple valve surgery (including combined coronary artery bypass
grafting). This trial explores whether intravenously administered iron
isomaltoside 1000 (Monofer) results in better clinical outcomes in
patients undergoing complex heart valve surgery who are expected to
receive transfusion. Methods/design: In this prospective, single-center,
double-blinded, randomized controlled trial, 214 patients undergoing
reoperation or multiple valve surgery are randomly allocated to either the
iron isomaltoside 1000 (IVFe) or the control group from August 2016 to
August 2018. The IVFe group receives iron isomaltoside 1000 mg (maximum
dose 20 mg/kg) intravenously 3 days before and after the surgery. The
control group receives an equivalent volume of normal saline. The primary
endpoint is transfusion requirement (more than 1 unit of packed
erythrocytes) for postoperative care until discharge and secondary
endpoint are major complications, such as delayed ventilator therapy,
acute kidney injury, and mortality. Reticulocyte count, plasma hepcidin,
iron profiles (serum iron, serum ferritin, total iron-binding capacity,
transferrin, transferrin saturation), coagulation profiles, urinary
analysis, and chemical profiles are measured for three preoperative
baseline-data days and just before surgery, except for hepcidin. After
surgery, daily routine basic laboratory tests are measured just before
discharge and reticulocyte count, iron profiles, and hepcidin are
repeatedly checked for three postoperative days. Discussion(s): From
our study, we can clarify the following points: the first is the
perioperative IVFe effect on the demand for transfusion, and clinical
outcomes in reoperation or complex valve surgery and the second is the
role of hepcidin in the effect of IVFe on the hemoglobin level
increase. Copyright © 2018 The Author(s).

<124>
Accession Number
626966756
Title
Adverse side effects of dexamethasone in surgical patients.
Source
Cochrane Database of Systematic Reviews. 2018 (11) (no pagination), 2018.
Article Number: CD011940. Date of Publication: 23 Nov 2018.
Author
Polderman J.A.W.; Farhang-Razi V.; Van Dieren S.; Kranke P.; DeVries J.H.;
Hollmann M.W.; Preckel B.; Hermanides J.
Institution
(Polderman, Farhang-Razi, Van Dieren, Hollmann, Preckel, Hermanides)
Department of Anaesthesiology, Academic Medical Center (AMC), University
of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
(Kranke) Department of Anaesthesia and Critical Care, University of
Wurzburg, Wurzburg, Germany
(DeVries) Department of Internal Medicine, Academic Medical Centre,
Amsterdam, Netherlands
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background In the perioperative period, dexamethasone is widely and
effectively used for prophylaxis of postoperative nausea and vomiting
(PONV), for pain management, and to facilitate early discharge after
ambulatory surgery. Long-term treatment with steroids has many side
effects, such as adrenal insufficiency, increased infection risk,
hyperglycaemia, high blood pressure, osteoporosis, and development of
diabetes mellitus. However, whether a single steroid load during surgery
has negative effects during the postoperative period has not yet been
studied. Objectives To assess the effects of a steroid load of
dexamethasone on postoperative systemic or wound infection, delayed wound
healing, and blood glucose change in adult surgical patients (with planned
subgroup analysis of patients with and without diabetes). Search methods
We searchedMEDLINE, Embase, the Cochrane Central Register of Controlled
Trials (CENTRAL), in the Cochrane Library, and the Web of Science for
relevant articles on 29 January 2018. We searched without language or date
restriction two clinical trial registries to identify ongoing studies, and
we handsearched the reference lists of relevant publications to identify
all eligible trials. Selection criteria We searched for randomized
controlled trials comparing an incidental steroid load of dexamethasone
versus a control intervention for adult patients undergoing surgery. We
required that studies include a follow-up of 30 days for proper assessment
of the number of postoperative infections, delayed wound healing, and the
glycaemic response. Data collection and analysis Two review authors
independently screened studies for eligibility, extracted data from
relevant studies, and assessed all included studies for bias.We resolved
differences by discussion and pooled included studies in a
meta-analysis.We calculated Peto odds ratios (ORs) for dichotomous
outcomes and mean differences (MDs) for continuous outcomes. Our primary
outcomes were postoperative systemic or wound infection, delayed wound
healing, and glycaemic response within 24 hours. We created a funnel plot
for the primary outcome postoperative (wound or systemic) infection. We
used GRADE to assess the quality of evidence for each outcome. Main
results We included in the meta-analysis 37 studies that included adults
undergoing a large variety of surgical procedures (i.e. abdominal surgery,
cardiac surgery, neurosurgery, and orthopaedic surgery). We excluded one
previously included study, as this study was recently retracted. Age range
of participants was 18 to 80 years. There is probably little or no
difference in the risk of postoperative (wound or systemic) infection with
dexamethasone compared with no treatment, placebo, or active control
(ramosetron, ondansetron, or tropisetron) (Peto OR 1.01, 95% confidence
interval (CI) 0.80 to 1.27; 4603 participants, 26 studies; I2 = 32%;
moderate-quality evidence). The effects of dexamethasone on delayed wound
healing are unclear because the wide confidence interval includes both
meaningful benefit and harm (Peto OR 0.99, 95% CI 0.28 to 3.43; 1072
participants, eight studies; I2 = 0%; low-quality evidence). Dexamethasone
may produce a mild increase in glucose levels among participants without
diabetes during the first 12 hours after surgery (MD 13 mg/dL, 95% CI 6 to
21; 10 studies; 595 participants; I2 = 50%; low-quality evidence). We
identified two studies reporting on glycaemic response after dexamethasone
in participants with diabetes within 24 hours after surgery (MD 32 mg/dL,
95% CI 15 to 49; 74 participants; I2 = 0%; very low-quality evidence).
Authors' conclusions A single dose of dexamethasone probably does not
increase the risk for postoperative infection. It is uncertain whether
dexamethasone has an effect on delayed wound healing in the general
surgical population owing to imprecision in trial results. Participants
with increased risk for delayed wound healing (e.g. participants with
diabetes, those taking immunosuppressive drugs) were not included in the
randomized studies reporting on delayedwound healing included in
thismeta-analysis; therefore our findings should be extrapolated to the
clinical setting with caution. Furthermore, one has to keep in mind that
dexamethasone induces a mild increase in glucose. For patients with
diabetes, very limited evidence suggests a more pronounced increase in
glucose. Whether this influences wound healing in a clinically relevant
way remains to be established. Once assessed, the two studies awaiting
classification and three that are ongoing may alter the conclusions of
this review. Copyright © 2019 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<125>
[Use Link to view the full text]
Accession Number
627000817
Title
Single ventricle physiology (Tricuspid Atresia, Pulmonary Atresia and
Heterotaxy) and death or heart transplantation: 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
Kulkarni A.; Singh T.P.; Mehra M.R.
Institution
(Kulkarni, Singh, Mehra) Pediatrics, Mount Sinai Sch of Medicine, New
York, NY2Pediatrics, Boston Children's Hosp, Boston, MA3Cardiology,
Brigham and Women's Hosp, Boston, MA
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Data regarding predictors of death or heart transplantation
(D-HT) in non-hypoplastic left heart syndrome (non-HLHS) single ventricle
(SV) physiology is limited. We sought to evaluate risk factors (RF) for
D-HT in tricuspid atresia (TA), pulmonary atresia-intact ventricular
septum (PA-IVS) and heterotaxy-SV (HX). Method(s): We included
outcome studies of D-HT in TA, PA-IVS and HX, from a MESH search for SV
and death-HT in CINAHL, CINAHL PLUS and MEDLINE, in English between
January 1998-October 2017. Case reports, systematic reviews, mixed
lesions, database duplicates and prenatal outcomes were excluded. Cochrane
ROBINS-I risk of bias (ROB) tool for non-randomized studies was used to
assess ROB. Meta-analysis was performed if RF data was available
for >3 studies. Result(s): The search yielded 1,149 citations,
reduced to 67 full text screening of which 15 studies met eligibility
criteria. All were observational retrospective analysis (12 single center,
1 from 2 centers and 2 using congenital heart surgeon's society registry
database). ROB was serious in 10, moderate in 2 and low in 2 studies. In
all, 1,409 pts were followed to a mean age of 8.3 years; 419 died and 19
underwent HT (161-lost to follow-up); outcomes were available on 555 pts
up to Fontan completion. Ventricular dysfunction was found to be
predictive of D-HT (10 studies, OR 2.2, CI 1.27-3.81, I2 83%).
Sepsis was associated with the highest odds of D-HT (5 studies, OR 15.92,
CI 3.97-63.85, I2 0%). Systemic atrioventricular valve
regurgitation was not associated with D-HT (4 studies, OR 0.72, CI
0.19-2.72, I2 74.9%). Right ventricle dependent coronary
circulation was predictive of D-HT (5 studies, OR 2.4, CI 0.91-6.31,
I2 41.7%) in PA-IVS. Conclusion(s): Our systematic review
and meta-analysis suggests a high mortality rate in children born with
non-HLHS SV heart disease in the first decade and points to potential
under-utilization of HT. Use of our RF may serve to identify children
likely to benefit from early HT.

<126>
[Use Link to view the full text]
Accession Number
627000613
Title
Corticosteroid therapy in neonates undergoing cardiopulmonary bypass: A
randomized controlled trial.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Graham E.M.; Martin R.H.; Buckley J.R.; Zyblewski S.C.; Kavarana M.N.;
Bradley S.M.; Alsoufi B.; Mahle W.T.; Hassid M.; Atz A.M.
Institution
(Graham, Martin, Buckley, Zyblewski, Kavarana, Bradley, Alsoufi, Mahle,
Hassid, Atz) Pediatric Cardiology, Med Univ of South Carolina, Charleston,
SC2Public Health Sciences, Med Univ of South Carolina, Charleston,
SC3Pediatric Cardiac Surgery, Med Univ of South Carolina, Charleston,
SC4Pediatric Cardiac Surgery, Emory Univ, Atlanta, GA5Pediatric
Cardiology, Emory Univ, Atlanta, GA6Anesthesia, Med Univ of South
Carolina, Charleston, SC
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The efficacy of perioperative corticosteroids to improve
outcomes following congenital cardiac surgery has been debated for over 5
decades. This study sought to determine whether intraoperative
methylprednisolone improves postoperative recovery in neonates undergoing
cardiac surgery. Method(s): Neonates (age <1 month) undergoing
cardiac surgery with cardiopulmonary bypass at 2 centers were enrolled in
a double-blind randomized controlled trial of methylprednisolone (30
mg/kg) or placebo after the induction of anesthesia. Subjects were
stratified by surgeon/center and corrective/palliative procedure. The
primary outcome was a previously validated mortality-morbidity composite
that included any of the following events following surgery before
discharge: death, mechanical circulatory support, cardiac arrest, hepatic
injury, renal injury, or rising lactate level (>5 mmol/L). Secondary
outcomes included duration of mechanical ventilation, ICU and hospital
stays. Result(s): Of the 190 subjects enrolled, 176 (n = 81 steroid,
n = 95 placebo) were included in this analysis. A total of 27 (33%)
subjects in the methylprednisolone group and 40 (42%) in the placebo group
reached the primary study endpoint (OR=0.63;95% CI, 0.31-1.3; p=0.21).
There was a significant interaction between treatment effect and center
(p=0.02). Steroid treatment was protective at 1 center with an OR=0.35
(95% CI, 0.15-0.84; p=0.02) and not so at the other center with OR=5.13
(95% CI, 0.85-30.9; p=0.07). There were no differences between groups in
duration of mechanical ventilation, ICU and hospital stays (Table).
 Conclusion(s): Intraoperative methylprednisolone had differing
effects by center on a composite mortality-morbidity outcome in neonates
undergoing cardiac surgery. This work suggests that multiple factors
influence postoperative outcomes; however there may be center or patient
characteristics which make prophylactic methylprednisolone beneficial.

<127>
Accession Number
627000271
Title
Early peritoneal dialysis and major adverse events after paediatric
cardiac surgery: A propensity score analysis.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Namachivayam S.; Butt W.; Millar J.; Nguyen C.; Konstantinov I.; D'Udekem
Y.
Institution
(Namachivayam, Butt, Millar, Nguyen, Konstantinov, D'Udekem) Paediatric
Intensive Care Unit, Royal Children's Hosp & Murdoch Children's Rsch
Institute, Melbourne, Australia2Clinical Epidemiology & Biostatistics,
Murdoch Children's Rsch Institute, Melbourne, Australia3Cardiac Surgery,
Royal Children's Hosp & Murdoch Children's Rsch Institute, Melbourne,
Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Early peritoneal dialysis (PD) may have a role in modulating
the inflammatory response after cardiopulmonary bypass (CPB). The aim of
this study was to test the effect of early PD on major adverse events
after paediatric cardiac surgery involving CPB. Method(s): In a
single center observational study, we compared the outcomes in infants
post cardiac surgery who received early PD (within 6 hours of completing
CPB) with those who received late PD. The primary outcome was a composite
of one or more of cardiac arrest, emergency chest reopening, requirement
for extracorporeal membrane oxygenation (ECMO) or death. Secondary
outcomes included duration of mechanical ventilation, length of intensive
care and hospital stay. A propensity score methodology utilizing inverse
probability of treatment weighting was used to minimize selection bias due
to timing of PD. Result(s): Among 239 eligible infants, 56 (23%) were
commenced on early PD and 183 (77%) on late PD. At 90-days after surgery,
early PD as compared with late PD, was associated with a decreased risk of
composite primary outcome (relative risk 0.16 [0.05, 0.47], p <0.001;
absolute risk-difference-18.1 % [-25.1,-11.1], p<0.001; Number needed to
treat=6). Early PD was also associated with a decrease in duration of
mechanical ventilation and intensive care stay. In a post-hoc sub-group
analysis which involved only those with a CPB duration of 150 minutes or
more, early PD was also associated with a survival advantage (relative
risk 0.14 [0.03, 0.84], p=0.03; absolute risk-difference-7.8 [-13.6,-2],
p=0.008; Number needed to treat=13) Conclusion(s): This single-center
study shows that early commencement of PD in infants post cardiac surgery
is associated with a decrease in the rate of major adverse events. The
role of early PD warrants the conduct of randomized trials both in high
and low-to-middle income countries; any positive beneficial effects if
confirmed, has the potential to strongly influence outcomes for children
born with congenital heart disease.

<128>
Accession Number
627000381
Title
Reach: Does telehealth influence maternal and neonatal outcomes in
post-cardiac surgery for congenital heart disease.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Medoff-Cooper B.; Fleck D.A.; Ravishankar C.; Costello J.M.; Huang L.;
Hanlon A.L.; Marino B.S.; Curley M.A.
Institution
(Medoff-Cooper, Fleck, Ravishankar, Costello, Huang, Hanlon, Marino,
Curley) Sch of Nursing Family Child Health, Univ of Pennsylvania,
Philadelphia, PA2Sch of Nursing, Univ of Pennsylvania, Philadelphia,
PA3Cardiology, Children's Hosp of Philadelphia, Philadelphia,
PA4Caridology, Anne & Robert H Lurie Children's Hosp of Chicago, Chicago,
IL5Sch of Nursing, Office of Nursing Rsch, Univ of Pennsylvania,
Philadelphia, PA6Sch of Nursing Office of Nursing Rsch, Univ of
Pennsylvania, Philadelphia, PA7Pediatrics (Cardiology), Ann & Robert H.
Lurie Children's Hosp of Chicago, Chicago, IL
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Parents of infants who have undergone cardiac surgery
experience significant stress when transitioning home. To date, home
monitoring programs have not been prospectively evaluated and have not
included all infants known to be at risk for both morbidity and mortality.
Hypothesis: We hypothesized that REACH (home telehealth monitoring program
would decrease parental stress, increase parental quality of life and
increase infant stability as evidenced by weight gain. Method(s): We
conducted a three center randomized clinical trial to test the effect of a
4-month Telehealth Home Care intervention (REACH) on post-discharge
outcomes in parents and their infants who were recovering from cardiac
surgery. Parental outcome measures included the Parental Stress Index (PSI
long form), Posttraumatic Diagnostic Scale (PTDS), and quality of life
(ULQIE). Infant outcomes included weight-for-age z-score at study end and
hospital readmissions. Result(s): A total of 178 parent-infant dyads
were enrolled. In both groups, parental PSI scores at study end were above
the 99th percentile. The percent of parent participants meeting
diagnostic criteria for PTSD was high but not different between groups
(44% REACH intervention, 39% control; p=0.68). Overall, at study end, the
mean weight for age z-score did not differ between treatment groups (REACH
intervention,-1.08 +/- 1.23, Control,-1.35 +/-1.08; p=0.19); nor did the
number of infants with at least one hospital readmission during the study
(REACH intervention 45%; Control, 40%; p=0.14) Conclusion(s): Stress
levels and PTSD rates remain high during the first four months after
neonatal cardiac surgery, and suboptimal infant growth and hospital
readmission rates remain problematic. The intensive telehealth home care
intervention (REACH) was not associated with improvement in parent or
infant outcomes.

<129>
Accession Number
627000376
Title
A comparison of bidirectional glenn vs. hemi-fontan using data from the
single ventricle reconstruction trial.
Source
Circulation. Conference: 2018 American Heart Association Scientific
Sessions. United States. 138 (Supplement 1) (no pagination), 2018. Date of
Publication: November 2018.
Author
Edelson J.B.; Ravishankar C.; Griffis H.; Zhang X.; Faerber J.; Naim M.Y.;
Mascio C.E.; Glatz A.C.; Goldberg D.J.
Institution
(Edelson, Ravishankar, Griffis, Zhang, Faerber, Naim, Mascio, Glatz,
Goldberg) Pediatric Cardiology, Children's Hosp of Philadelphia,
Philadelphia, PA2Healthcare Analytics Unit, Children's Hosp of
Philadelphia, Philadelphia, PA3Critical Care and Anesthesia, Children's
Hosp of Philadelphia, Philadelphia, PA4Pediatric Cardiothoracic Surgery,
Children's Hosp of Philadelphia, Philadelphia, PA
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: For patients with single ventricle heart defects (SV), there
are two primary surgical options for second stage palliation:
bidirectional Glenn (BDG) and hemi-Fontan (HF). Limited data exist
comparing outcomes between these options. Method(s): We conducted a
retrospective cohort study using the Single Ventricle Reconstruction (SVR)
Trial public-use dataset, which included data on infants with hypoplastic
left heart syndrome (HLHS) and related SV anomalies randomized to receive
either the Blalock-Taussig shunt or right ventricle-pulmonary artery shunt
during the Norwood procedure at 15 hospitals from 2005 to 2008. Outcomes
were evaluated from stage II through one year of age. To estimate the
effect of stage II surgery on outcomes, multivariable negative binomial
regression, logistic regression or linear mixed-effect models were used,
adjusted for the following covariates: race, insurance, shunt type at
Norwood, length of stay after Norwood and age at stage II, with a random
intercept for center. Result(s): The cohort included 343 patients,
250 underwent the BDG and 93 the HF. HLHS was present in 89%. The groups
were equally likely to have been randomized to a BT shunt (BDG 44% vs HF
51%, p=0.33). Those who underwent BDG were more likely to have been
referred to Stage II for progressive hypoxemia (40% vs 26%, p=0.02), and
less likely to have been referred for elective palliation (63% vs 76%,
p=0.02), though age at Stage II was similar (162 days (134-185) vs 158
days (127-190), p=0.52). Following stage II, re-intervention was higher in
the BDG group (11% vs 3%, p=0.04) and the BDG group showed a trend towards
increased post-operative complications (54% vs 41% p=0.05). The BDG group
also showed a trend towards smaller right pulmonary artery size by echo at
1 year follow up (z score-2.43 (-3.06 to-1.75) vs-2.15 (-2.86 to-1.49),
p=0.13). Median length of stay after stage II was 8 days (BDG 6-14 vs HF
7-13) for both groups (p=0.64). Mortality was not different between BDG
and HF (7% vs 4%, p=0.76). Conclusion(s): In this analysis of the SVR
public-use dataset, there was a higher prevalence of complications and
re-intervention at one year following BDG compared to HF. These data
suggest that a more detailed evaluation of these two surgical surgeries is
warranted and that the HF may offer certain advantages.

<130>
Accession Number
2001649959
Title
Reversal of DIRECT-ACTING oral anticoagulants in urgent surgery of the
proximal aorta: Case series and review of the literature.
Source
Current Pharmaceutical Design. 24 (38) (pp 4534-4539), 2018. Date of
Publication: 2018.
Author
Zimmermann E.; Ameer F.; Worku B.; Avgerinos D.
Institution
(Zimmermann) Department of Surgery, NewYork-Presbyterian/Queens, Flushing,
NY, United States
(Ameer) Department of Cardiology, NewYork-Presbyterian/ Queens, Flushing,
NY, United States
(Worku, Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, NewYork Presbyterian, New York, NY, United States
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Introduction: Proximal aorta interventions impose significant bleeding
risk. Patients on concomitant anticoagulation regimens compound the risk
of bleeding in any surgery, but especially cardiothoracic interventions.
The employment of direct-acting oral anticoagulants (DOAC), namely those
that target clotting factors II or X, has expanded at a precipitous rate
over the last decade. The emergence of their reversal agents has followed
slowly, leaving clinicians with management dilemmas in urgent surgery. We
discuss current reversal strategies based on the available published data
and our experience with proximal aortic surgery in patients taking DOACs.
Literature Search: We performed a review of literature and present three
cases from our experience to offer insight into management strategies that
have been historically successful. A review of literature was conducted
via PubMed with the following search string: (NOAC or DOAC or TSOAC) and
(aorta or aortic or (Stanford and type and a)). Case Presentation: We
present three case presentations that illustrate the importance of DOAC
identification and offer management strategies in mitigating associated
bleeding risks in urgent or emergent surgeries. Conclusion(s):
Treatment teams should be aware of the technical limitations of
identifying and reversing DOACs. In view of the tendency toward publishing
positive outcomes, more scientific rigor is required in the area of
emergency DOAC reversal strategies. Copyright © 2018 Bentham
Science Publishers.

<131>
Accession Number
627020617
Title
Transversus thoracis muscle plane block in cardiac surgery: a pilot
feasibility study.
Source
Regional anesthesia and pain medicine. (no pagination), 2019. Date of
Publication: 21 Mar 2019.
Author
Fujii S.; Roche M.; Jones P.M.; Vissa D.; Bainbridge D.; Zhou J.R.
Institution
(Fujii, Roche, Jones, Vissa, Bainbridge, Zhou) Department of Anesthesia
and Perioperative Medicine, London Health Sciences Centre, Western
University, London, ON, Canada
(Jones) Department of Epidemiology and Biostatistics, Western University,
London, ON, Canada
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Cardiac surgery patients often experience significant pain
after median sternotomy. The transversus thoracis muscle plane (TTP) block
is a newly developed, single-shot nerve block technique that provides
analgesia for the anterior chest wall. In this double-blind pilot study,
we assessed the feasibility of performing this novel block as an analgesic
adjunct. METHOD(S): All patients aged 18-90 undergoing elective
cardiac surgery were randomized to the block or standard care control
group on admission to the intensive care unit after surgery. Under
ultrasound guidance, patients in the block group received the TTP block
with 20mL of either 0.3% or 0.5% ropivacaine bilaterally, based on weight.
The control group did not receive any injections. All blocks were
performed by a single anesthesiologist, and data collection was performed
by blinded assessors. The primary feasibility outcomes were rate of
recruitment, adherence, and adverse events. The rate of recruitment was
defined as the ratio of patients giving informed consent to the number of
eligible patients who were approached to participate. Secondary outcomes
included 12-hour and 24-hour Numeric Rating Scale (NRS) pain scores,
24-hour hydromorphone and acetaminophen requirements, time to extubation,
time to first opioid administration, and patient satisfaction (on a yes/no
questionnaire) at 24hours. RESULT(S): Twenty patients were approached
for this study and 19 were enrolled. Eight patients received the intended
intervention in each group. The recruitment rate was 95% of all approached
eligible patients, and the adherence rate to treatment group was 94%.
There were no block-related adverse events. The mean (SD) NRS pain scores
at rest were 3.3 (3.2) in the block group vs 5.6 (3.2) in the control
group at 12hours. At 24hours, the pain scores were 4.1 (3.9) vs 4.1 (3.3)
in the block and control group, respectively. The mean (SD) 24-hour
hydromorphone administration was 1.9 (1.1) mg in the block group vs 1.8
(0.9) mg in the control group. DISCUSSION: The TTP block is a novel pain
management strategy poststernotomy. The results reveal a high patient
recruitment, adherence, and satisfaction rate, and provide some
preliminary data supporting safety. TRIAL REGISTRATION NUMBER:
NCT03128346. Copyright © American Society of Regional Anesthesia
& Pain Medicine 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<132>
Accession Number
626999726
Title
American Society for Enhanced Recovery and Perioperative Quality
Initiative-4 Joint Consensus Statement on Persistent Postoperative Opioid
Use: Definition, Incidence, Risk Factors, and Health Care System
Initiatives.
Source
Anesthesia and analgesia. (no pagination), 2019. Date of Publication: 14
Mar 2019.
Author
Kent M.L.; Hurley R.W.; Oderda G.M.; Gordon D.B.; Sun E.; Mythen M.;
Miller T.E.; Shaw A.D.; Gan T.J.; Thacker J.K.M.; McEvoy M.D.
Institution
(Kent, Miller) From the Department of Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Hurley) Departments of Anesthesiology and Public Health Sciences, Wake
Forest University School of Medicine, Winston Salem, NC, United States
(Oderda) College of Pharmacy, University of Utah, Salt Lake City, UT,
United States
(Gordon) Department of Anesthesiology and Pain Medicine, University of
Washington, Seattle, WA, United States
(Sun) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University, Palo Alto, CA, United States
(Mythen) University College London National Institute of Health Research
(NIHR) Biomedical Research Centre, London, United Kingdom
(Shaw) Department of Anesthesiology and Pain Medicine, University of
Alberta, Edmonton, AB, Canada
(Gan) Department of Anesthesiology, Stony Brook School of Medicine, Stony
Brook, NY, United States
(Thacker) Division of Advanced Oncologic and Gastrointestinal Surgery,
Duke University Medical Center, Durham, NC, United States
(McEvoy) Department of Anesthesiology, Vanderbilt University Medical
Center, Nashville, TN, United States
Publisher
NLM (Medline)
Abstract
Persistent postoperative opioid use is thought to contribute to the
ongoing opioid epidemic in the United States. However, efforts to study
and address the issue have been stymied by the lack of a standard
definition, which has also hampered efforts to measure the incidence of
and risk factors for persistent postoperative opioid use. The objective of
this systematic review is to (1) determine a clinically relevant
definition of persistent postoperative opioid use, and (2) characterize
its incidence and risk factors for several common surgeries. Our approach
leveraged a group of international experts from the Perioperative Quality
Initiative-4, a consensus-building conference that included representation
from anesthesiology, surgery, and nursing. A search of the medical
literature yielded 46 articles addressing persistent postoperative opioid
use in adults after arthroplasty, abdominopelvic surgery, spine surgery,
thoracic surgery, mastectomy, and thoracic surgery. In opioid-naive
patients, the overall incidence ranged from 2% to 6% based on
moderate-level evidence. However, patients who use opioids preoperatively
had an incidence of >30%. Preoperative opioid use, depression, factors
associated with the diagnosis of substance use disorder, preoperative
pain, and tobacco use were reported risk factors. In addition, while
anxiety, sex, and psychotropic prescription are associated with persistent
postoperative opioid use, these reports are based on lower level evidence.
While few articles addressed the health policy or prescriber
characteristics that influence persistent postoperative opioid use,
efforts to modify prescriber behaviors and health system characteristics
are likely to have success in reducing persistent postoperative opioid
use.

<133>
Accession Number
626999068
Title
Effects of Icosapent Ethyl on Total Ischemic Events: From REDUCE-IT.
Source
Journal of the American College of Cardiology. (no pagination), 2019. Date
of Publication: 14 Mar 2019.
Author
Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Gregson J.; Pocock S.J.; Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School (D.L.B.) Boston, MA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), an F-CRIN
network, Departement Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat,
Universite Paris-Diderot, INSERM U-1148, Paris, France; NHLI, Imperial
College, Royal Brompton Hospital, London, United Kingdom
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, MD, United States
(Brinton) Utah Lipid Center, Salt Lake City, UT, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
(Ketchum, Doyle, Juliano, Jiao, Granowitz) Amarin Pharma, Inc.,
Bedminster, NJ, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Gregson, Pocock) Department of Medical Statistics, London School of
Hygiene & Tropical Medicine, London, United Kingdom
(Ballantyne) Department of Medicine, Baylor College of Medicine; Center
for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX
Publisher
NLM (Medline)
Abstract
BACKGROUND: In time-to-first-event analyses, icosapent ethyl significantly
reduced the risk of ischemic events, including cardiovascular death, among
patients with elevated triglycerides receiving statins. These patients are
at risk for not only first but also subsequent ischemic events.
 OBJECTIVE(S): Pre-specified analyses determined the extent to which
icosapent ethyl reduced total ischemic events. METHOD(S): The
Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT)
randomized 8,179 statin-treated patients with triglycerides >=135 and <500
mg/dL (median baseline of 216 mg/dL) and LDL-cholesterol >40 and <=100
mg/dL (median baseline of 75 mg/dL), and a history of atherosclerosis (71%
patients) or diabetes (29% patients) to icosapent ethyl 4g/day or placebo.
The main outcomes were total (first and subsequent) primary composite
endpoint events (cardiovascular death, nonfatal myocardial infarction,
nonfatal stroke, coronary revascularization, or hospitalization for
unstable angina) and total key secondary composite endpoint events
(cardiovascular death, nonfatal myocardial infarction, or nonfatal
stroke). As a pre-specified statistical method, we determined differences
in total events using negative binomial regression. We also determined
differences in total events using other statistical models, including
Andersen-Gill, Wei-Lin-Weissfeld (Li and Lagakos modification), both
pre-specified, and a post hoc joint-frailty analysis. RESULT(S): In
8,179 patients, followed for a median of 4.9 years, 1,606 (55.2%) first
primary endpoint events and 1,303 (44.8%) subsequent primary endpoint
events occurred (which included 762 second events, and 541 third or more
events). Overall, icosapent ethyl reduced total primary endpoint events
(61 versus 89 per 1000 patient years for icosapent ethyl versus placebo,
respectively; RR 0.70, 95% CI 0.62-0.78, P<0.0001). Icosapent ethyl also
reduced each component of the primary composite endpoint, as well as the
total key secondary endpoint events (32 versus 44 per 1000 patient years
for icosapent ethyl versus placebo, respectively, RR 0.72, 95% CI
0.63-0.82, P<0.0001). CONCLUSION(S): Among statin-treated patients
with elevated triglycerides and cardiovascular disease or diabetes,
multiple statistical models demonstrate that icosapent ethyl substantially
reduces the burden of first, subsequent, and total ischemic
events. Copyright © 2019. Published by Elsevier Inc.

<134>
Accession Number
626997385
Title
Tolerability and Effects of the Use of Energy-Enriched Infant Formula
After Congenital Heart Surgery: A Randomized Controlled Trial.
Source
JPEN. Journal of parenteral and enteral nutrition. (no pagination), 2019.
Date of Publication: 22 Mar 2019.
Author
Scheeffer V.A.; Ricachinevsky C.P.; Freitas A.T.; Salamon F.; Rodrigues
F.F.N.; Brondani T.G.; Sutil A.T.; Ferreira C.H.T.; Matte U.D.S.; da
Silveira T.R.
Institution
(Scheeffer, Rodrigues, Sutil, da Silveira) Hospital da Crianca Santo
Antonio, Porto Alegre, Brazil
(Scheeffer, Ferreira) Department of Pediatric Gastroenterology, Hospital
da Crianca Santo Antonio, Porto Alegre, Brazil
(Scheeffer, Matte) Postgraduate Programme of Child and Adolescent Health,
Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
(Ricachinevsky, Brondani) Intensive Care Unit at Hospital da Crianca Santo
Antonio, Porto Alegre, Brazil
(Freitas, Salamon) Fundacao Faculdade Federal de Ciencias da Saude de
Porto Alegre, Porto Alegre, Brazil
(Ferreira, da Silveira) Postgraduate Programme of Pediatrics, Universidade
Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Undernutrition is a common problem among children with
congenital heart disease (CHD) and may lead to poorer surgical outcomes. A
higher intake of energy during the postoperative period of CHD surgery
seems to be associated with better outcomes. This study aimed to
investigate the effect of the use of energy-enriched formula (EE-formula)
compared with normocaloric formula during 30 days after CHD surgery.
 METHOD(S): A randomized controlled trial with patients undergoing
heart surgery in a tertiary hospital in southern Brazil from March 2017 to
December 2017 was performed. The intervention group received EE-formula (1
kcal/mL), and the control group received normocaloric formula (0.67
kcal/mL). The researcher in charge of anthropometric evaluation was
blinded to the randomization. RESULT(S): Fifty-nine patients were
included; 30 in control group and 29 in intervention group. There were no
statistically significant differences between groups regarding age,
gender, anthropometry, and surgical risk classification after
randomization. A statistically significant difference in z-score of weight
for age and in weight gain variation rate between groups after
intervention was observed. Antibiotic use was less frequent in the
intervention group, and hospital length of stay was shorter. General
gastrointestinal side effects were similar between groups, whereas
diarrhea was more frequent in the intervention group. However, this side
effect was limited and had spontaneous resolution in 4 out of 6 cases.
 CONCLUSION(S): This study demonstrates that EE-formula use after
heart surgery of patients with CHD is well tolerated and may improve
short-term nutrition outcome, decrease hospital stay, and reduce
antibiotic use. Copyright © 2019 American Society for Parenteral
and Enteral Nutrition.

<135>
Accession Number
2001764620
Title
Is the era of bilateral internal thoracic artery grafting coming for
diabetic patients? An updated meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Zhou P.; Zhu P.; Nie Z.; Zheng S.
Institution
(Zhou, Zhu, Zheng) Department of Cardiovascular Surgery, Nanfang Hospital,
Southern Medical University, Guangzhou, Guangdong, China
(Nie) Department of Epidemiology, Guangdong Cardiovascular Institute,
Guangdong Provincial Key Laboratory of South China Structural Heart
Disease, Guangdong General Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Because of an increased risk of sternal wound complications,
the use of bilateral internal thoracic artery grafting in diabetic
patients remains controversial. The objective of the present meta-analysis
is to compare the safety and efficacy of single internal thoracic artery
and bilateral internal thoracic artery grafting in the diabetic
population. Method(s): Four electronic databases, including PubMed,
the Cochrane Library, Embase, and ISI Web of Knowledge, were
comprehensively searched. Prospective randomized trials or observational
studies comparing single internal thoracic artery and bilateral internal
thoracic artery were considered eligible for the current study.
 Result(s): A literature search yielded 1 randomized controlled trial
and 17 observational studies (129,871 diabetic patients: 124,233 single
internal thoracic arteries and 5638 bilateral internal thoracic arteries).
Pooled analysis demonstrated overall incidence of deep sternal wound
infection in the bilateral internal thoracic artery grafting group was
significantly higher than in the single internal thoracic artery grafting
group (3.26% for bilateral internal thoracic artery vs 1.70% for single
internal thoracic artery). No significant difference was found between
both groups in terms of risk of deep sternal wound infection when the
skeletonized harvesting technique was adopted. Furthermore, in-hospital
mortality was comparable between both groups (2.80% for bilateral internal
thoracic artery vs 2.36% for single internal thoracic artery). However,
compared with single internal thoracic artery grafting, bilateral internal
thoracic artery grafting could confer a lower risk for long-term overall
mortality (hazard ratio, 1.41; 95% confidence interval, 1.18-1.67; P
<.001; I2 = 63%) and cardiac mortality (hazard ratio, 3.15; 95%
confidence interval, 2.23-4.46; P <.001; I2 = 0%).
 Conclusion(s): Compared with single internal thoracic artery
grafting, bilateral internal thoracic artery grafting is associated with
enhanced long-term survival among diabetic patients. Skeletonization of
bilateral internal thoracic artery is not associated with an increased
risk of deep sternal wound infection. Therefore, surgeons should be
encouraged to adopt bilateral internal thoracic artery grafting in a
skeletonized manner more routinely in diabetic patients. Copyright
© 2019 The American Association for Thoracic Surgery

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