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<1>
Accession Number
2001791180
Title
Complete Revascularization Versus Culprit Lesion Only in Patients With
ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A
DANAMI-3-PRIMULTI Cardiac Magnetic Resonance Substudy.
Source
JACC: Cardiovascular Interventions. 12 (8) (pp 721-730), 2019. Date of
Publication: 22 April 2019.
Author
Kyhl K.; Ahtarovski K.A.; Nepper-Christensen L.; Ekstrom K.; Ghotbi A.A.;
Schoos M.; Goransson C.; Bertelsen L.; Helqvist S.; Holmvang L.; Jorgensen
E.; Pedersen F.; Saunamaki K.; Clemmensen P.; De Backer O.; Hofsten D.E.;
Kober L.; Kelbaek H.; Vejlstrup N.; Lonborg J.; Engstrom T.
Institution
(Kyhl, Ahtarovski, Nepper-Christensen, Ekstrom, Ghotbi, Schoos, Goransson,
Bertelsen, Helqvist, Holmvang, Jorgensen, Pedersen, Saunamaki, De Backer,
Hofsten, Kober, Engstrom) Department of Cardiology, Rigshospitalet,
Copenhagen, Denmark
(Clemmensen) Department of Medicine, Nykoebing F Hospital, Nykoebing F and
University of Southern Denmark, Odense, Denmark
(Clemmensen) University Clinic of Hamburg-Eppendorf, The Heart Centre,
Hamburg, Germany
(Kelbaek, Vejlstrup, Lonborg) Department of Cardiology, Zealand
University, Roskilde, Denmark
(Engstrom) Department of Cardiology, University of Lund, Lund, Sweden
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate the effect of fractional
flow reserve (FFR)-guided revascularization compared with culprit-only
percutaneous coronary intervention (PCI) in patients with ST-segment
elevation myocardial infarction (STEMI) on infarct size, left ventricular
(LV), function, LV remodeling, and the presence of nonculprit infarctions.
 Background(s): Patients with STEMI with multivessel disease might
have improved clinical outcomes after complete revascularization compared
with PCI of the infarct-related artery only, but the impact on infarct
size, LV function, and remodeling as well as the risk for periprocedural
infarction are unknown. Method(s): In this substudy of the DANAMI-3
(Third Danish Trial in Acute Myocardial Infarction)-PRIMULTI (Primary PCI
in Patients With ST-Elevation Myocardial Infarction and Multivessel
Disease: Treatment of Culprit Lesion Only or Complete Revascularization)
randomized trial, patients with STEMI with multivessel disease were
randomized to receive either complete FFR-guided revascularization or PCI
of the culprit vessel only. The patients underwent cardiac magnetic
resonance imaging during index admission and at 3-month follow-up.
 Result(s): A total of 280 patients (136 patients with infarct-related
and 144 with complete FFR-guided revascularization) were included. There
were no differences in final infarct size (median 12% [interquartile
range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62),
myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89]
vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection
fraction (mean 58 +/- 9% vs. 59 +/- 9%; p = 0.39), and LV end-systolic
volume remodeling (mean 7 +/- 22 ml vs. 7 +/- 19 ml; p = 0.63). New
nonculprit infarction occurring after the nonculprit intervention was
numerically more frequent among patients treated with complete
revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12). Conclusion(s):
Complete FFR-guided revascularization in patients with STEMI and
multivessel disease did not affect final infarct size, LV function, or
remodeling compared with culprit-only PCI. Copyright © 2019
American College of Cardiology Foundation

<2>
Accession Number
2001791173
Title
Pre-Dilatation Versus No Pre-Dilatation for Implantation of a
Self-Expanding Valve in All Comers Undergoing TAVR: The DIRECT Trial.
Source
JACC: Cardiovascular Interventions. 12 (8) (pp 767-777), 2019. Date of
Publication: 22 April 2019.
Author
Toutouzas K.; Benetos G.; Voudris V.; Drakopoulou M.; Stathogiannis K.;
Latsios G.; Synetos A.; Antonopoulos A.; Kosmas E.; Iakovou I.;
Katsimagklis G.; Mastrokostopoulos A.; Moraitis S.; Zeniou V.; Danenberg
H.; Vavuranakis M.; Tousoulis D.
Institution
(Toutouzas, Benetos, Drakopoulou, Stathogiannis, Latsios, Synetos,
Antonopoulos, Vavuranakis, Tousoulis) First Department of Cardiology,
Athens School of Medicine, Hippokration Hospital, Athens, Greece
(Voudris, Kosmas, Iakovou) Department of Cardiology, Onassis Cardiac
Surgery Center, Athens, Greece
(Katsimagklis, Mastrokostopoulos, Moraitis) Naval Hospital of Athens,
Athens, Greece
(Zeniou, Danenberg) Heart Institute, Hadassah Hebrew University Medical
Center, Jerusalem, Israel
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare the implantation of a
self-expanding valve with or without balloon aortic valvuloplasty (BAV) in
an open-label, noninferiority, randomized trial. Background(s): There
are no randomized studies comparing the implantation of a self-expanding
valve with (pre-BAV) or without BAV. Method(s): Consecutive patients
with severe aortic stenosis were randomly assigned to undergo
transcatheter aortic valve replacement with the use of self-expanding
prostheses with (pre-BAV) or without (no-BAV) pre-dilatation. The primary
endpoint was device success according to the Valve Academic Research
Consortium 2 criteria. Secondary endpoints included periprocedural
mortality and stroke, new permanent pacemaker implantation, vascular
complications, and 1-year mortality. The trial was scheduled to show
noninferiority (DELTA = 15%) of the direct versus the pre-BAV approach.
 Result(s): A total of 171 patients were randomized at 4 centers. Of
these, 86 underwent transcatheter aortic valve replacement with
pre-dilatation and 85 without. Device success was noninferior in the
no-BAV group compared with the pre-BAV group (65 of 85 [76.5%] for no-BAV
vs. 64 of 86 [74.4%] for pre-BAV; mean difference 2.1%; 90% confidence
interval: -8.9% to 13%). In the no-BAV group, 25 patients (29.4%)
underwent post-balloon dilatation, and in the pre-BAV group, 13 patients
(15.1%) underwent post-balloon dilatation (p = 0.03). Regarding major
vascular complications and permanent pacemaker implantation, there was no
difference between the 2 groups (log-rank p = 0.49, log-rank p = 0.54). In
1-month completed follow-up for all patients, there was 1 periprocedural
stroke (0.5%), without any deaths. Conclusion(s): Direct, without
balloon pre-dilatation, transcatheter aortic valve replacement with a
self-expanding prosthesis system is noninferior to the pre-dilatation
procedure. Lower post-dilatation rates were encountered in the group with
pre-dilatation. (The Predilatation in Transcatheter Aortic Valve
Implantation Trial [DIRECT]; NCT02448927) Copyright © 2019
American College of Cardiology Foundation

<3>
Accession Number
620125977
Title
Is 300 Seconds ACT Safe and Efficient during MiECC Procedures?.
Source
Thoracic and Cardiovascular Surgeon. 67 (3) (pp 191-202), 2019. Date of
Publication: 2019.
Author
Bauer A.; Hausmann H.; Schaarschmidt J.; Szlapka M.; Scharpenberg M.;
Eberle T.; Hasenkam J.M.
Institution
(Bauer, Schaarschmidt) Department of Cardiovascular Perfusion, MediClin
Heart Center Coswig, Lerchenfeld 1, Coswig, Saxony-Anhalt 06869, Germany
(Bauer, Hasenkam) Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Aarhus, Denmark
(Bauer, Hasenkam) Department of Clinical Medicine, Aarhus University,
Aarhus, Denmark
(Hausmann, Szlapka) Department of Cardiothoracic and Vascular Surgery,
MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany
(Scharpenberg) Competence Center for Clinical Trials Bremen, University of
Bremen, Bremen, Germany
(Eberle) Department of Anesthesia and Intensive Care Medicine, MediClin
Heart Center Coswig, Coswig, Saxony-Anhalt, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Introduction The recommended minimum activated clotting time (ACT) level
for cardiopulmonary bypass (CPB) of 480 seconds originated from
investigations with bubble oxygenators and uncoated extracorporeal
circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are
completely closed circuits containing a membrane oxygenator and a
tip-to-tip surface coating. We hypothesized that surface coating and the
closed-loop design allow the MiECC to safely run with lower ACT levels and
that an ACT level of 300 seconds can be safely applied without
thromboembolic complications. The aim of this study was to investigate the
potential risks during application of reduced heparin levels in patients
undergoing coronary surgery. Methods In this study, 68 patients undergoing
coronary artery bypass grafting with MiECC were randomized to either the
study group with an ACT target of 300 seconds or the control group with an
ACT of 450 seconds. All other factors of MiECC remained unchanged. Results
The study group received significantly less heparin and protamine (heparin
[international units] median [min-max], Red-AC: 32,800 [23,000-51,500] vs.
Full-AC: 50,000 [35,000-65,000] p < 0.001; protamine [international
units], Red-AC: 18,000 [10,000-35,000] vs. Full-AC: 30,000 [20,000-45,000]
p < 0.001). The ACT in the study group was significantly lower at the
start of MiECC (mean +/- standard deviation: study group 400 +/- 112 vs.
control group 633 +/- 177; p < 0.0001). Before termination of CPB the ACT
levels were: study group 344 +/- 60 versus control group 506 +/- 80. In
both groups, the values of the endogenous thrombin potential (ETP)
decreased simultaneously. None of the study participants experienced
thromboembolic complications. Conclusion Since no evidence of increased
thrombin formation (ETP) was found from a laboratory standpoint, we
concluded that the use of MiECC with a reduced anticoagulation strategy
seems possible. This alternative anticoagulation strategy leads to
significant reduction in dosages of both heparin and protamine. We can
confidently move forward with investigating this anticoagulation concept.
However, to establish clinical safety of ACT below 300 seconds, we need
larger clinical studies. Copyright © 2019 Georg Thieme Verlag KG
Stuttgart. New York.

<4>
Accession Number
2001369150
Title
Radial artery versus saphenous vein as the second conduit for coronary
artery bypass surgery: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (5) (pp
1819-1825.e10), 2019. Date of Publication: May 2019.
Author
Gaudino M.; Rahouma M.; Abouarab A.; Leonard J.; Kamel M.; Di Franco A.;
Demetres M.; Tam D.Y.; Tranbaugh R.; Girardi L.N.; Fremes S.E.
Institution
(Gaudino, Rahouma, Abouarab, Leonard, Kamel, Di Franco, Tranbaugh,
Girardi) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Individual studies may be limited by sample size to detect
differences in late survival between radial artery (RA) or saphenous vein
graft (SVG) as a second conduit for coronary artery bypass surgery. Here
we undertook a meta-analysis of the best evidence available on the
comparison of early and late clinical outcomes of the RA and the SVG.
 Method(s): MEDLINE and EMBASE were searched for studies comparing use
of the RA versus SVG for isolated coronary artery bypass surgery.
Time-to-event outcomes for long-term mortality, repeat revascularization,
and myocardial infarction (MI) were extracted as incidence rate ratios
(IRR) with 95%confidence intervals (95% CI). Odds ratios (OR) were
extracted for perioperative mortality, stroke, and MI. A random effects
meta-analysis was performed. Sensitivity analyses included
leave-one-out-analyses and meta-regression. Result(s): Among 1201
articles, 14 studies (20,931 patients) were included (mean follow-up: 6.6
years). Operative mortality was 1.25% in the RA versus 1.33% in the SVG
group (OR, 0.93; 95% CI, 0.68-1.28). No difference in perioperative MI
(OR, 0.96; 95% CI, 0.59-1.56) or stroke (OR, 0.70; 95% CI, 0.43-1.13) was
found between RA and SVG. Long-term mortality (mean follow-up 6.6 years)
was 24.5% in RA versus 34.2% in SVG group (IRR, 0.74; 95% CI, 0.63-0.87, P
<.001). No difference in follow-up MI or repeat revascularization was
found (IRR, 0.76; 95% CI, 0.42-1.36 and IRR, 0.68; 95% CI, 0.42-1.09
respectively). At meta-regression, RA survival advantage was independent
of age, sex, diabetes, and ventricular function. Conclusion(s):
Compared with the SVG, using the RA as the second conduit is associated
with a 26% relative risk reduction in mortality at 6.6-year
follow-up. Copyright © 2018 The American Association for Thoracic
Surgery

<5>
Accession Number
2001411245
Title
The Intrarater and Interrater Reliability of Measures Derived from
Cardiopulmonary Exercise Testing in Patients with Abdominal Aortic
Aneurysms.
Source
Annals of Vascular Surgery. 56 (pp 175-182), 2019. Date of Publication:
April 2019.
Author
Harwood A.E.; Pymer S.; Hitchman L.; Totty J.; Wallace T.; Smith G.E.;
Carradice D.; Carroll S.; Chetter I.C.
Institution
(Harwood, Pymer, Hitchman, Totty, Wallace, Smith, Carradice, Chetter)
Academic Vascular Surgical Unit, Hull York Medical School, Hull Royal
Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom
(Harwood) Thermal Ergonomics Laboratory, University of Sydney, Cumberland
Campus, Lidcombe, New South Wales, Australia
(Carroll) School of Sport and Exercise Science, University of Hull,
Cottingham Road, Hull HU6 7RX, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Patients with abdominal aortic aneurysms (AAAs) often have low
exercise tolerance due to comorbidities and advanced age. Cardiopulmonary
exercise testing (CPET) is predictive of postoperative morbidity and
mortality in patients with AAA. We aimed to assess the intrarater and
interrater reliability of both treadmill-based and cycle ergometer-based
CPET variables. Method(s): Patients with an AAA (>3.5 cm) were
randomized to a treadmill or bike CPET. Patients were asked to perform two
separate CPETs seven days apart after a familiarization protocol. All
CPETs were carried out using a ramp cycle or modified Bruce treadmill
protocol with breath-by-breath gas analysis. Result(s): Twenty-two
male and 2 female patients, aged 73.6 +/- 6.0 years, completed the study.
Intrarater analysis (intraclass correlation coefficients) demonstrated
high reliability on both the treadmill and bike for ventilatory anaerobic
threshold (r = 0.834 and r = 0.975, respectively). All other CPET
variables demonstrated high intrarater reliability on both modalities, bar
the highest point for the ventilatory slope of oxygen (VE/VO<inf>2</inf>)
on the treadmill (substantial agreement r = 0.755). Furthermore,
interrater reliability demonstrated high agreement for ventilatory
anaerobic threshold on both the treadmill and cycle (r = 0.983 and r =
0.905, respectively). All other CPET variables demonstrated high
intrarater reliability on both modalities, with the exception of
VO<inf>2Peak</inf> on the cycle ergometer (fair agreement r = 0.400).
 Conclusion(s): CPET in patients with AAAs is a reliable tool test and
among CPET test reviewers for common testing modalities/protocols. These
findings provide further support for the use of CPET, especially treadmill
walking, as a clinical measure of perioperative cardiorespiratory fitness
in patients with AAAs. Copyright © 2018 Elsevier Inc.

<6>
Accession Number
2001793164
Title
Contemporary Outcomes Following Coronary Artery Bypass Graft Surgery for
Left Main Disease.
Source
Journal of the American College of Cardiology. 73 (15) (pp 1877-1886),
2019. Date of Publication: 23 April 2019.
Author
Modolo R.; Chichareon P.; Kogame N.; Dressler O.; Crowley A.; Ben-Yehuda
O.; Puskas J.; Banning A.; Taggart D.P.; Kappetein A.P.; Sabik J.A.; Onuma
Y.; Stone G.W.; Serruys P.W.
Institution
(Modolo, Chichareon, Kogame) Department of Cardiology, Academic Medical
Center, University of Amsterdam, Amsterdam, Netherlands
(Modolo) Department of Internal Medicine, Cardiology Division, University
of Campinas (UNICAMP), Campinas, Brazil
(Chichareon) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
(Dressler, Crowley, Ben-Yehuda) Cardiovascular Research Foundation, New
York, NY, United States
(Puskas) Mount Sinai Heart at Mount Sinai St. Luke's, New York, NY, United
States
(Banning, Taggart) Oxford Heart Centre, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Kappetein) Medtronic, Dublin, Ireland
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Onuma) Erasmus Medical Center, Rotterdam, Netherlands
(Onuma) Cardialysis Clinical Trials Management and Core Laboratories,
Rotterdam, Netherlands
(Stone) NewYork-Presbyterian Hospital, Columbia University Medical Center,
and the Cardiovascular Research Foundation, New York, NY, United States
(Serruys) Department of Cardiology, Imperial College of London, London,
United Kingdom
Publisher
Elsevier USA
Abstract
Background: Although results of percutaneous coronary intervention (PCI)
have been steadily improving, whether surgical outcomes have improved over
time is not fully elucidated. Objective(s): This study sought to
compare the current outcomes of patients undergoing coronary artery bypass
grafting (CABG) with prior surgical results, in the context of randomized
trials including the left main (LM) coronary artery stem. Method(s):
The authors performed a propensity-matched analysis of patients randomized
to CABG in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery)
(enrollment period 2005 to 2007) and EXCEL (Evaluation of XIENCE Versus
Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization) (enrollment period 2010 to 2014) trials. All patients
had left main (LM) disease with or without multivessel disease. Adjustment
was based on 15 clinical and angiographic variables, including anatomic
SYNTAX score, with a 2:1 ratio for the EXCEL and SYNTAX trials,
collectively analyzing 909 subjects (n = 580 and n = 329, respectively).
The primary endpoint was the composite of all-cause death, myocardial
infarction (MI), stroke, or ischemia-driven revascularization at 3 years.
 Result(s): Baseline characteristics, anatomic SYNTAX score, number
and types of grafts, and duration of hospitalization for the procedures
were similar in both groups. CABG procedures in the EXCEL compared with
the SYNTAX trial were more often off-pump (29.6% vs. 15.4%; p < 0.001),
and guideline-directed medical therapies were used more frequently in the
EXCEL surgical cohort. The primary endpoint occurred in 14.0% and 20.9% (p
= 0.008) of patients in the EXCEL and SYNTAX trials, respectively. With
the exception of MI (4.1% vs. 3.7%), all nonhierarchical events tended to
contribute to the improved outcomes in the more recent trial: all-cause
death (5.5% vs. 8.5%), stroke (3.1% vs. 5.1%), and ischemia-driven
revascularization (7.1% vs. 9.4%) in the EXCEL and SYNTAX trials,
respectively. Conclusion(s): Over a 5- to 7-year period, significant
improvement in event-free survival after surgical revascularization for LM
disease at 3 years was noted between the SYNTAX and EXCEL trials,
consistent with improving results with cardiac surgery over time. (Synergy
Between PCI With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972;
Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization [EXCEL];
NCT01205776) Copyright © 2019 American College of Cardiology
Foundation

<7>
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Accession Number
627079999
Title
Intravenous heme arginate induces HO-1 (heme oxygenase-1) in the human
Heart randomized, placebo-controlled, safety, and feasibility
pharmacokinetic study-brief report.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 38 (11) (pp
2755-2762), 2018. Date of Publication: 2018.
Author
Andreas M.; Oeser C.; Kainz F.-M.; Shabanian S.; Aref T.; Bilban M.;
Messner B.; Heidtmann J.; Laufer G.; Kocher A.; Wolzt M.
Institution
(Andreas, Oeser, Kainz, Shabanian, Aref, Messner, Heidtmann, Laufer,
Kocher) Department of Cardiac Surgery, Medical University of Vienna,
Austria
(Bilban) Department of Laboratory Medicine, Medical University of Vienna,
Austria
(Bilban, Wolzt) Department of Clinical Pharmacology, Medical University of
Vienna, Austria
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective-HO-1 (heme oxygenase-1) induction may prevent or reduce
ischemia-reperfusion injury. We previously evaluated its in vivo induction
after a single systemic administration of heme arginate in peripheral
blood mononuclear cells. The current trial was designed to assess the
pharmacological tissue induction of HO-1 in the human heart with heme
arginate in vivo. Approach and Results-Patients planned for conventional
aortic valve replacement received placebo (n=8), 1 mg/kg (n=7) or 3 mg/kg
(n=9) heme arginate infused intravenously 24 hours before surgery. A
biopsy of the right ventricle was performed directly before aortic
cross-clamping and after cross-clamp release. In addition, the right
atrial appendage was partially removed for analysis. HO-1 protein and mRNA
concentrations were measured in tissue samples and in peripheral blood
mononuclear cells before to and up to 72 hours after surgery. No study
medication-related adverse events occurred. A strong, dose-dependent
effect on myocardial HO-1 mRNA levels was observed (right ventricle:
7.9+/-5.0 versus 88.6+/-49.1 versus 203.6+/-148.7; P=0.002 and right
atrium: 10.8+/-8.8 versus 229.8+/-173.1 versus 392.7+/-195.7; P=0.001).
This was paralleled by a profound increase of HO-1 protein concentration
in atrial tissue (8401+/-3889 versus 28 585+/-10 692 versus 29 022+/-8583;
P<0.001). Surgery and heme arginate infusion significantly increased HO-1
mRNA concentration in peripheral blood mononuclear cells (P<0.001). HO-1
induction led to a significant increase of postoperative carboxyhemoglobin
(1.7% versus 1.4%; P=0.041). No effect on plasma HO-1 protein levels could
be detected. Conclusions-Myocardial HO-1 mRNA and protein can be
dose-dependently induced by heme arginate. Protective effects of this
therapeutic strategy should be evaluated in upcoming clinical
trials. Copyright © 2018 American Heart Association, Inc.

<8>
[Use Link to view the full text]
Accession Number
627079468
Title
Peri-operative oral caffeine does not prevent postoperative atrial
fibrillation after heart valve surgery with cardiopulmonary bypass: A
randomised controlled clinical trial.
Source
European Journal of Anaesthesiology. 35 (12) (pp 911-918), 2018. Date of
Publication: 2018.
Author
Lagier D.; Nee L.; Guieu R.; Kerbaul F.; Fenouillet E.; Roux N.; Giorgi
R.; Theron A.; Grisoli D.; Gariboldi V.; Collart F.; Bruder N.; Velly L.;
Guidon C.
Institution
(Lagier, Nee, Kerbaul, Bruder, Velly, Guidon) Department of Anaesthesia
and Intensive Care Medicine, La Timone University Hospital, Aix-Marseille
University, Marseille, France
(Guieu, Fenouillet) Department of Biochemistry, La Timone University
Hospital, Aix-Marseille University, Marseille, France
(Roux, Giorgi) Department of Biostatistics, La Timone University Hospital,
Aix-Marseille University, Marseille, France
(Theron, Grisoli, Gariboldi, Collart) Department of Cardiac Surgery, La
Timone University Hospital, Aix-Marseille University, Marseille, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND: Raised plasma levels of endogenous adenosine after cardiac
surgery using cardiopulmonary bypass (CPB) have been related to the
incidence of postoperative atrial fibrillation (POAF). OBJECTIVE(S):
We wished to assess if caffeine, an adenosine receptor antagonist could
have a beneficial effect on the incidence of POAF. DESIGN A randomised
controlled study. SETTING: Single University Hospital. PATIENTS: One
hundred and ten patients scheduled for heart valve surgery with CPB.
INTERVENTIONS: We randomly assigned patients to receive peri-operative
oral caffeine (400mg every 8 h for 2 days) or placebo. Adenosine plasma
concentrations and caffeine pharmacokinetic profile were evaluated in a
subgroup of 50 patients. MAIN OUTCOME MEASURES: The primary endpoint was
the rate of atrial fibrillation during postoperative hospital stay.
RESULTS The current study was stopped for futility by the data monitoring
board after an interim analysis. The incidence of atrial fibrillation was
similar in the caffeine and in the placebo group during hospital stay (33
vs. 29%, P=0.67) and the first 3 postoperative days (18 vs. 15%; P=0.60).
Basal and postoperative adenosine plasma levels were significantly
associated with the primary outcome. Adenosine plasma levels were similar
in the two treatment groups. Caffeine administration was associated with a
higher incidence of postoperative nausea and vomiting (27 vs. 7%,
P=0.005). CONCLUSION(S): Oral caffeine does not prevent POAF after
heart valve surgery with CPB but increased the incidence of postoperative
nausea and vomiting. Copyright © 2018 European Society of
Anaesthesiology. All rights reserved.

<9>
Accession Number
626735574
Title
The epidemiology of multicomponent blood transfusion: a systematic review.
Source
Transfusion Medicine. 29 (2) (pp 80-94), 2019. Date of Publication: April
2019.
Author
Perelman I.; Khair S.; Dermer E.; Tinmouth A.; Saidenberg E.; Fergusson D.
Institution
(Perelman, Khair, Dermer, Tinmouth, Saidenberg, Fergusson) Faculty of
Medicine, University of Ottawa, Ottawa, ON, Canada
(Perelman, Tinmouth, Saidenberg, Fergusson) Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Tinmouth, Saidenberg) Ottawa Hospital, Ottawa, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
We performed a systematic review to describe the prevalence of
multicomponent blood transfusion and, as a secondary objective, to
determine patient characteristics and outcomes associated with
multicomponent transfusion. There is a lack of literature on the
epidemiology of multicomponent transfusion as most studies concentrate on
a single blood product and its utilisation. Patient care and blood
management can be optimised by better understanding the patients who
receive multicomponent transfusions. The databases Medline, EMBASE and the
Cochrane Library of Systematic Reviews were searched. Observational cohort
and cross-sectional studies of hospital patients reporting on
multicomponent transfusion prevalence or on patient characteristics and
outcomes associated with multicomponent transfusion were included. A
descriptive synthesis of studies was performed. A total of 37 eligible
studies were included. It was found that multicomponent transfusion
prevalence varied greatly by patient population and by the combination of
blood products given in the multicomponent transfusion.
Multicomponent-transfused patients included burn, cardiac surgery, liver
surgery and transplant, cancer, infectious diseases, trauma and intensive
care unit patients. Five studies found associations between multicomponent
transfusion and adverse health outcomes; however, these findings are
likely confounded by indication. The overall quality of evidence was low
given a fair-to-poor individual study quality, inconsistent multicomponent
transfusion prevalence estimates and confounding by indication. Further
research is needed to better understand the epidemiology of multicomponent
transfusion, including studies on multicomponent transfusion in
haematological cancer patients and studies looking for patient
characteristics that can better predict multicomponent transfusion
need. Copyright © 2019 British Blood Transfusion Society

<10>
Accession Number
2001648019
Title
Perioperative Quality Initiative consensus statement on postoperative
blood pressure, risk and outcomes for elective surgery.
Source
British Journal of Anaesthesia. 122 (5) (pp 575-586), 2019. Date of
Publication: May 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.; Grocott M.P.; 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, 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
(Edwards, Grocott) 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

<11>
Accession Number
627199046
Title
Pharmacological and non-surgical renal protective strategies for cardiac
surgery patients undergoing cardiopulmonary bypass: a systematic review.
Source
ANZ journal of surgery. 89 (4) (pp 296-302), 2019. Date of Publication: 01
Apr 2019.
Author
Tan S.I.; Brewster D.J.; Horrigan D.; Sarode V.
Institution
(Tan) Central Clinical School, Monash University, Melbourne, Victoria,
Australia
(Brewster) Cabrini Clinical School, Cabrini Institute, Melbourne,
Victoria, Australia
(Brewster, Sarode) Department of Medicine, Central Clinical School, Monash
University, Melbourne, Victoria, Australia
(Horrigan) Cabrini Library, Cabrini Institute, Melbourne, Victoria,
Australia
(Sarode) Department of Intensive Care Medicine, Cabrini Hospital,
Melbourne, Victoria, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Post-operative acute kidney injury after cardiopulmonary
bypass (AKI-CPB) for cardiac surgery is a frequent complication. It may
require renal replacement therapy (RRT), which is associated with an
increased morbidity and mortality. This review explores the efficacy of
proposed pharmacological and non-surgical renal protective strategies.
 METHOD(S): A comprehensive literature search was done using Ovid
MEDLINE, Embase and Scopus databases. Keywords included were
cardiopulmonary bypass, cardiac surgery, coronary artery bypass, renal
protection and renal preservation. Eligible articles consisted of all
studies on patients who had undergone cardiac surgery via CPB with an
outcome of AKI and/or RRT reported. All studies underwent a quality check
via the risk of bias tool. The three most researched interventions (based
on number of randomized controlled trials and total patients analysed) and
their renal outcomes were then analysed with Review Manager Software.
 RESULT(S): Eighty-eight articles were extracted. A total of 26
management strategies for renal protection following CPB were identified.
N-acetylcysteine (NAC), remote ischaemic preconditioning (RIPC) and the
use of volatile anaesthetic agents (VAAs) were further analysed. NAC, RIPC
and VAA had no statistically significant benefit in reducing either
AKI-CPB or the need for RRT following CPB. CONCLUSION(S): NAC, RIPC
and VAA were found to have no statistical significant benefit in reducing
either AKI-CPB or the need for RRT following CPB. There remains clinical
uncertainty with all currently proposed pharmacological and non-surgical
renal protective strategies for CPB. Future research in this area should
analyse the effects of combined interventions or specifically focus on
'at-risk' patients. Copyright © 2018 Royal Australasian College
of Surgeons.

<12>
Accession Number
627198234
Title
Point-of-care viscoelastic assay devices (rotational thromboelastometry
and thromboelastography): a primer for surgeons.
Source
ANZ journal of surgery. 89 (4) (pp 291-295), 2019. Date of Publication: 01
Apr 2019.
Author
Sharp G.; Young C.J.
Institution
(Sharp, Young) Department of Colorectal Surgery, Royal Prince Alfred
Hospital, Sydney, NSW, Australia
(Young) Discipline of Surgery, University of Sydney, Sydney, NSW,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Bleeding is a common occurrence in surgery. Point-of-care
testing with viscoelastic (VE) assays such as thromboelastography (TEG)
and rotational thromboelastometry (ROTEM) has become more common place.
TEG and ROTEM have the potential to guide management of coagulopathy. Many
healthcare professionals still rely upon standard laboratory tests (SLTs)
to manage a bleeding patient. It was our aim to investigate the literature
surrounding management of the surgically bleeding patient via VE assays.
 METHOD(S): Literature review of Embase, MEDLINE, PubMed and the
Cochrane Library using 'TEG, ROTEM and surgery' search terms was
conducted. RESULT(S): Through the literature search and reference
lists reviewed by both authors, a total of 62 articles have been
evaluated, 35 of these have been included in this review.
 CONCLUSION(S): VE assays are used most commonly during orthotopic
liver transplantation, trauma, postpartum haemorrhage and cardiac surgery.
Although the evidence is not overwhelming, we have identified recurrent
themes where VE assays seem to be beneficial. VE assay use, especially
when incorporated into an algorithm, appears to reduce blood product
administration which in turn reduces cost and potential adverse events.
They are quicker than SLTs and they can detect hyperfibrinolysis, the
hallmark of coagulopathy, via in vivo clot analyses which SLTs are unable
to do. Ultimately more randomized controlled trials are
required. Copyright © 2018 Royal Australasian College of
Surgeons.

<13>
[Use Link to view the full text]
Accession Number
627080098
Title
Cerebral small vessel, but not large vessel disease, is associated with
impaired cerebral autoregulation during cardiopulmonary bypass: A
retrospective Cohort Study.
Source
Anesthesia and Analgesia. 127 (6) (pp 1314-1322), 2018. Date of
Publication: 2018.
Author
Nomura Y.; Faegle R.; Hori D.; Al-Qamari A.; Nemeth A.J.; Gottesman R.;
Yenokyan G.; Brown C.; Hogue C.W.
Institution
(Nomura, Hori) Division of Cardiac Surgery, Department of Surgery, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Faegle, Gottesman) Department of Neurology, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
(Al-Qamari, Hogue) Department of Anesthesiology, Bluhm Cardiovascular
Institute, Northwestern University Feinberg School of Medicine, 251 E
Huron St., Feinberg 5-704, Chicago, IL 60611, United States
(Nemeth) Department of Radiology, Division of Neuroradiology, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Nemeth) Department of Neurology, Northwestern University Feinberg School
of Medicine, Chicago, IL, United States
(Yenokyan) Bloomberg School of Public Health, Johns Hopkins University,
Baltimore, MD, United States
(Brown) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during
cardiopulmonary bypass (CPB) is associated with stroke and other adverse
outcomes. Large and small arterial stenosis is prevalent in patients
undergoing cardiac surgery. We hypothesize that large and/or small vessel
cerebral arterial disease is associated with impaired cerebral
autoregulation during CPB. METHOD(S): A retrospective cohort analysis
of data from 346 patients undergoing cardiac surgery with CPB enrolled in
an ongoing prospectively randomized clinical trial of autoregulation
monitoring were evaluated. The study protocol included preoperative
transcranial Doppler (TCD) evaluation of major cerebral artery flow
velocity by a trained vascular technician and brain magnetic resonance
imaging (MRI) between postoperative days 3 and 5. Brain MRI images were
evaluated for chronic white matter hyperintensities (WMHI) by a vascular
neurologist blinded to autoregulation data. "Large vessel" cerebral
vascular disease was defined by the presence of characteristic TCD changes
associated with stenosis of the major cerebral arteries. "Small vessel"
cerebral vascular disease was defined based on accepted scoring methods of
WMHI. All patients had continuous TCD-based autoregulation monitoring
during surgery. RESULT(S): Impaired autoregulation occurred in 32.4%
(112/346) of patients. Preoperative TCD demonstrated moderate-severe large
vessel stenosis in 67 (25.2%) of 266 patients with complete data. In
adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence
interval [CI], 0.25-0.86; P =.014) and higher average temperature during
CPB (OR, 1.23; 95% CI, 1.02-1.475; P =.029), but not moderate-severe large
cerebral arterial stenosis (P =.406), were associated with impaired
autoregulation during CPB. Of the 119 patients with available brain MRI
data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral
vascular disease was associated with impaired CBF autoregulation (OR,
3.25; 95% CI, 1.21-8.71; P =.019) after adjustment for age, history of
peripheral vascular disease, preoperative hemoglobin level, and
preoperative treatment with calcium channel blocking drugs.
 CONCLUSION(S): These data confirm that impaired CBF autoregulation is
prevalent during CPB predisposing affected patients to brain hypoperfusion
or hyperperfusion with low or high blood pressure, respectively. Small
vessel, but not large vessel, cerebral vascular disease, male sex, and
higher average body temperature during CPB appear to be associated with
impaired autoregulation. Copyright © 2018 International
Anesthesia Research Society.

<14>
Accession Number
2001754923
Title
Safety assessment of omeprazole use: A review.
Source
Sao Paulo Medical Journal. 136 (6) (pp 557-570), 2018. Date of
Publication: 2018.
Author
Forgerini M.; Mieli S.; Mastroianni P.C.
Institution
(Forgerini, Mieli) Universidade Estadual Paulista (UNESP), Araraquara, SP,
Brazil
(Mastroianni) Department of Drugs and Medicines, Universidade Estadual
Paulista (UNESP), Araraquara, SP, Brazil
Publisher
Associacao Paulista de Medicina (E-mail: revistas@apm.org.br)
Abstract
BACKGROUND: Risks regarding hospital admission due to adverse drug
reactions and drug interactions from use of omeprazole have been reported.
The question guiding the present review was "Which adverse events occur in
patients using omeprazole in a Food and Drug Administration-approved
and/or off-label manner?" It was also proposed to evaluate the safety of
use of omeprazole. DESIGN AND SETTING: Qualitative narrative review with
critical evaluation, in a public university. METHOD(S): The PubMed,
SCOPUS, LILACS, SciELO, EMBASE and EBSCO databases were searched on July
31, 2018. Studies evaluating adverse events were screened. RESULT(S):
72 articles were included, among which 58 reported on adverse drug events
(47, adverse drug reactions; 5, drug interactions; and 6, situations of
ineffectiveness). 28 adverse drug reactions not described in compendia and
drug leaflets were described in these studies: myocardial infarction (6);
stroke (2); spontaneous abortion (1); proliferative changes (1); chills
(1); heart failure (1); thrombosis (2); and dementia (1), among others.
Severe adverse reactions, for instance cardiac problems, Steven-Johnson
syndrome and proliferative changes, were identified. The antiplatelet
effects of drugs such as clopidogrel, in patients who underwent
heart-related surgery, increased the risk of developing cardiac problems,
such as cardiovascular death, myocardial infarction and stroke. In newly
transplanted patients, decreased absorption of mycophenolate mofetil
occurred, thus leading to rejection of transplanted organs.
 CONCLUSION(S): Use of omeprazole should be monitored primarily in
patients with heart disorders using antiplatelet agents concomitantly, and
in newly transplanted patients using mycophenolic acid, in order to avoid
serious adverse reactions. Copyright © 2018 by Associacao
Paulista de Medicina.

<15>
Accession Number
2001782802
Title
Improving epidural catheter fixation using benzoin tincture with
transparent film dressing for postoperative pain control: A randomized
controlled trial.
Source
Journal of the Medical Association of Thailand. 101 (9 Supplement 9) (pp
S51-S58), 2018. Date of Publication: September 2018.
Author
Pongraweewan O.; Sanansilp V.; Rattanamung S.; Namsawat S.; Rungmongkolsab
P.; Triyasunant N.; Mandee S.; Wongyingsinn M.; Soontarinka S.
Institution
(Pongraweewan, Sanansilp, Rattanamung, Namsawat, Rungmongkolsab,
Triyasunant, Mandee, Wongyingsinn, Soontarinka) Department
ofAnesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol
University, Bangkok, Thailand
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To evaluate the incidences of the peeling-off of transparent
dressings and the migration of epidural catheters after the application of
benzoin tincture. Material(s) and Method(s): This double-blinded,
randomized controlled trial was performed on 552 patients receiving
continuous epidural analgesia after abdominal and thoracic surgeries at
Siriraj Hospital. Patients were equally allocated into 2 groups. In "Group
B", patients were painted before the placement of dressings with benzoin
tincture on the skin and the epidural catheters; the tincture was provided
in ready-to-use packs produced by the Division of Pharmacy, Siriraj
Hospital. In "Group T", patients were not painted. Photos were taken upon
completion of the dressings, at the finish of operations, and once daily
until the dressings were removed. The dressings were assessed by two
independent researchers who did not know the patient groups.
 Result(s): A total of 523 patients were analyzed. The incidences of
the whole sheet peeling off, and the consequential need for redressing as
the catheters were no longer secured, were 71 (27.8%) in Group T and 47
(17.5%) in Group B (p = 0.005). This gave the number needed to benefit of
9.7, 95% confidence interval [CI] 5.75 to 31.92; absolute risk reduction
0.10, 95% CI 0.03 to 0.17; relative risk 0.55, 95% CI 0.39 to 0.77; and
relative risk reduction 0.4505, 95% CI 0.22-0.6. The overall migration of
the catheters was significantly less in the benzoin tincture group.
 Conclusion(s): Applying benzoin tincture on the skin and epidural
catheters before placing transparent film dressings significantly reduced
the incidences of dressing peeling off and migration of the epidural
catheter on the second postoperative day. Copyright © 2018,
Medical Association of Thailand. All rights reserved.

<16>
Accession Number
627205268
Title
Effect of an Incentive Spirometer Patient Reminder after Coronary Artery
Bypass Grafting: A Randomized Clinical Trial.
Source
JAMA Surgery. (no pagination), 2019. Date of Publication: 2019.
Author
Eltorai A.E.M.; Baird G.L.; Eltorai A.S.; Healey T.T.; Agarwal S.;
Ventetuolo C.E.; Martin T.J.; Chen J.; Kazemi L.; Keable C.A.; Diaz E.;
Pangborn J.; Fox J.; Connors K.; Sellke F.W.; Elias J.A.; Daniels A.H.
Institution
(Eltorai, Baird, Healey, Agarwal, Ventetuolo, Martin, Chen, Kazemi,
Keable, Diaz, Pangborn, Fox, Connors, Sellke, Elias, Daniels) Warren
Alpert Medical School, Brown University, 222 Richmond St, Providence, RI
02903, United States
(Eltorai) Yale University, School of Medicine, New Haven, CT, United
States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Incentive spirometers (ISs) were developed to reduce
atelectasis and are in widespread clinical use. However, without IS use
adherence data, the effectiveness of IS cannot be determined.
 Objective(s): To evaluate the effect of a use-tracking IS reminder on
patient adherence and clinical outcomes following coronary artery bypass
grafting (CABG) surgery. Design, Setting, and Participant(s): This
randomized clinical trial was conducted from June 5, 2017, to December 29,
2017, at a tertiary referral teaching hospital and included 212 patients
who underwent CABG, of whom 160 participants were randomized (intent to
treat), with 145 completing the study per protocol. Participants were
stratified by surgical urgency (elective vs nonelective) and sex (men vs
women). Intervention(s): A use-tracking, IS add-on device
(SpiroTimer) with an integrated use reminder bell recorded and timestamped
participants' inspiratory breaths. Patients were randomized by hourly
reminder "bell on" (experimental group) or "bell off" (control group).
 Main Outcomes and Measures: Incentive spirometer use was recorded for
the entire postoperative stay and compared between groups. Radiographic
atelectasis severity (score, 0-10) was the primary clinical outcome.
Secondary respiratory and nonrespiratory outcomes were also evaluated.
 Result(s): A total of 145 per-protocol participants (112 men [77%];
mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective
procedure) were evaluated, with 74 (51.0%) in the bell off group and 71
(49.0%) in the bell on group. The baseline medical and
motivation-to-recover characteristics of the 2 groups were similar. The
mean number of daily inspiratory breaths was greater in bell on (35; 95%
CI, 29-43 vs 17; 95% CI, 13-23; P <.001). The percentage of recorded hours
with an inspiratory breath event was greater in bell on (58%; 95% CI,
51-65 vs 28%; 95% CI, 23-32; P <.001). Despite no differences in the first
postoperative chest radiograph mean atelectasis severity scores (2.3; 95%
CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P =.48), the mean atelectasis
severity scores for the final chest radiographs conducted before discharge
were significantly lower for bell on than bell off group (1.5; 95% CI,
1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P =.04). Of those with early
postoperative fevers, fever duration was shorter for bell on (3.2 hours;
95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P =.04). Having the bell
turned on reduced noninvasive positive pressure ventilation use rates
(37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P =.03) for
participants undergoing nonelective procedures. Bell on reduced the median
postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7;
P =.048) and the intensive care unit length of stay for patients
undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI,
3-4; P =.02). At 6 months, the bell off mortality rate was higher than
bell on (9% vs 0%, P =.048) for participants undergoing nonelective
procedures. Conclusions and Relevance: The incentive spirometer
reminder improved patient adherence, atelectasis severity, early
postoperative fever duration, noninvasive positive pressure ventilation
use, ICU and length of stay, and 6-month mortality in certain patients.
With the reminder, IS appears to be clinically effective when used
appropriately. Copyright © 2019 American Medical Association. All
rights reserved.

<17>
Accession Number
2001707101
Title
Interventional Therapy Versus Medical Therapy for Secundum Atrial Septal
Defect: A Systematic Review (Part 2) for the 2018 AHA/ACC Guideline for
the Management of Adults With Congenital Heart Disease: A Report of the
American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines.
Source
Journal of the American College of Cardiology. 73 (12) (pp 1579-1595),
2019. Date of Publication: 2 April 2019.
Author
Oster M.; Bhatt A.B.; Zaragoza-Macias E.; Dendukuri N.; Marelli A.
Publisher
Elsevier USA
Abstract
Secundum atrial septal defect (ASD) is the most common adult congenital
heart defect and can present with wide variation in clinical findings.
With the intention of preventing morbidity and mortality associated with
late presentation of ASD, consensus guidelines have recommended surgical
or percutaneous ASD closure in adults with right heart enlargement, with
or without symptoms. The aim of the present analysis was to determine if
the protective effect of secundum ASD closure in adults could be qualified
by pooling data from published studies. A systematic review and
meta-analysis were performed by using EMBASE, MEDLINE (through PubMed),
and the Cochrane Library databases to assess the effect of secundum ASD
percutaneous or surgical closure in unoperated adults >=18 years of age.
Data were pooled across studies with the DerSimonian-Laird random-effects
model or a Bayesian meta-analysis model. Between-study heterogeneity was
assessed with Cochran's Q test. Bias assessment was performed with the
Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and statistical
risk of bias was assessed with Begg and Mazumdar's test and Egger's test.
A total of 11 nonrandomized studies met the inclusion criteria,
contributing 603 patients. Pooled analysis showed a protective effect of
ASD closure on New York Heart Association functional class and on right
ventricular systolic pressure, volumes, and dimensions. Two additional
studies comprising 652 patients were reviewed separately for mortality
outcome and primary outcome of interest because they did not meet the
inclusion criteria. Those studies showed that ASD closure was associated
with a weak protective effect on adjusted mortality rate but no
significant impact on atrial arrhythmias in patients >50 years of age.
Across all studies, there was significant heterogeneity between studies
for nearly all clinical outcomes. The overall body of evidence was limited
to observational cohort studies, the limitations of which make for
low-strength evidence. Even within the parameters of the included studies,
quality of evidence was further diminished by the lack of well-defined
clinical outcomes. In conclusion, pooled data analysis on the impact of
secundum ASD closure in adults was notably limited because of the lack of
randomized controlled trials in patients with only secundum ASD. The few
cohort studies in this population demonstrated improvement in functional
status and right ventricular size and function as shown by echocardiogram.
However, our findings suggest that at the time of this publication,
insufficient data are available to determine the impact of ASD repair on
mortality rate in adults. Copyright © 2019 American Heart
Association, Inc., and the American College of Cardiology Foundation

<18>
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.

<19>
Accession Number
2000971783
Title
The effect of revascularization of a chronic total coronary occlusion on
electrocardiographic variables. A sub-study of the EXPLORE trial.
Source
Journal of Electrocardiology. 51 (5) (pp 906-912), 2018. Date of
Publication: September - October 2018.
Author
van Dongen I.M.; Kolk M.Z.H.; Elias J.; Meijborg V.M.F.; Coronel R.; de
Bakker J.M.T.; Claessen B.E.P.M.; Delewi R.; Ouweneel D.M.; Scheunhage
E.M.; van der Schaaf R.J.; Suttorp M.-J.; Bax M.; Marques K.M.; Postema
P.G.; Wilde A.A.M.; Henriques J.P.S.
Institution
(van Dongen, Kolk, Elias, Meijborg, Coronel, de Bakker, Claessen, Delewi,
Ouweneel, Scheunhage, Postema, Wilde, Henriques) Academic Medical Center -
University of Amsterdam, Amsterdam, Netherlands
(van der Schaaf) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Suttorp) Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
(Bax) Haga Teaching Hospital, The Hague, Netherlands
(Marques) Free University Medical Center, Amsterdam, Netherlands
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: Chronic total coronary occlusions (CTOs) have been
associated with a higher prevalence of ventricular arrhythmias compared to
patients without a CTO. We evaluated the effect of CTO revascularization
on electrocardiographic (ECG) variables. Method(s): We studied a
selection of ST-elevation myocardial infarction patients with a
concomitant CTO enrolled in the EXPLORE trial. ECG variables and cardiac
function were analysed at baseline and at 4 months follow-up.
 Result(s): Patients were randomized to percutaneous coronary
intervention (PCI) of their CTO (n = 77) or to no-CTO PCI (n = 81). At
follow-up, median QT dispersion was significantly lower in the CTO PCI
group compared to the no-CTO PCI group (46 ms [33-58] vs. 54 ms [37-68], P
= 0.043). No independent association was observed between ECG variables
and cardiac function. Conclusion(s): Revascularization of a CTO after
STEMI significantly shortened QT dispersion at 4 months follow-up. These
findings support the hypothesis that CTO revascularization reduces the
pro-arrhythmic substrate in CTO patients. Copyright © 2018

<20>
Accession Number
622265424
Title
Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: A
meta-analysis of randomized controlled trials.
Source
European Heart Journal. 39 (18) (pp 1638-1649), 2018. Date of Publication:
07 May 2018.
Author
Ahmad Y.; Howard J.P.; Arnold A.; Shin M.S.; Cook C.; Petraco R.; Demir
O.; Williams L.; Iglesias J.F.; Sutaria N.; Malik I.; Davies J.; Mayet J.;
Francis D.; Sen S.
Institution
(Ahmad, Howard, Arnold, Shin, Cook, Petraco, Demir, Williams, Iglesias,
Sutaria, Malik, Davies, Mayet, Francis, Sen) National Heart and Lung
Institute, Hammersmith Hospital, Imperial College London W12 0HS, United
Kingdom
Publisher
Oxford University Press
Abstract
Aims The efficacy of patent foramen ovale (PFO) closure for cryptogenic
stroke has been controversial. We undertook a meta-analysis of randomized
controlled trials (RCTs) comparing device closure with medical therapy to
prevent recurrent stroke for patients with PFO. Methods and results We
systematically identified all RCTs comparing device closure to medical
therapy for cryptogenic stroke in patients with PFO. The primary efficacy
endpoint was recurrent stroke, analysed on an intention-to-treat basis.
The primary safety endpoint was new onset atrial fibrillation (AF). Five
studies (3440 patients) were included. In all, 1829 patients were
randomized to device closure and 1611 to medical therapy. Across all
patients, PFO closure was superior to medical therapy for prevention of
stroke [hazard ratio (HR) 0.32, 95% confidence interval (95% CI)
0.13-0.82; P = 0.018, I 2 = 73.4%]. The risk of AF was significantly
increased with device closure [risk ratio (RR) 4.68, 95% CI 2.19-10.00,
P<0.001, heterogeneity I 2 = 27.5%)]. In patients with large shunts, PFO
closure was associated with a significant reduction in stroke (HR 0.33,
95% CI 0.16-0.72; P = 0.005), whilst there was no significant reduction in
stroke in patients with a small shunt (HR 0.90, 95% CI 0.50-1.60; P =
0.712). There was no effect from the presence or absence of an atrial
septal aneurysm on outcomes (P = 0.994). Conclusion In selected patients
with cryptogenic stroke, PFO closure is superior to medical therapy for
the prevention of further stroke: this is particularly true for patients
with moderate-to-large shunts. Guidelines should be updated to reflect
this. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<21>
Accession Number
620728255
Title
A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve
Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2562-2569),
2018. Date of Publication: December 2018.
Author
Moscarelli M.; Terrasini N.; Nunziata A.; Punjabi P.; Angelini G.; Solinas
M.; Buselli A.; Sarto P.D.; Haxhiademi D.
Institution
(Moscarelli) GVM Care & Research, Anthea Hospital, Bari, Italy
(Terrasini, Nunziata, Sarto, Haxhiademi) Operative Unit of Anesthesiology,
G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, Massa,
Italy
(Punjabi) Imperial College of London, Hammersmith Hospital, London, United
Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Solinas) Operative Unit of Cardiac Surgery, G. Pasquinucci Heart
Hospital, Fondazione Toscana G. Monasterio, Massa, Italy
(Buselli) Perfusion Department, G. Pasquinucci Heart Hospital, Fondazione
Toscana G. Monasterio, Massa, Italy
Publisher
W.B. Saunders
Abstract
Objective: Minimally invasive mitral valve repair may be associated with
prolonged cardioplegic arrest times and ischemic reperfusion injury.
Intravenous (propofol) and volatile (sevoflurane) anesthesia are used
routinely during cardiac surgery and are thought to provide
cardioprotection; however, the individual contribution of each regimen to
cardioprotection is unknown. Therefore, the authors sought to compare the
cardioprotective effects of propofol and sevoflurane anesthesia in
patients undergoing minimally invasive mitral valve repair.
 Design(s): A single-center single-blind randomized controlled trial.
 Setting(s): A specialized regional cardiac surgery center in Italy.
 Participant(s): The study enrolled 62 adults undergoing elective
isolated minimally invasive mitral valve repair for degenerative disease.
Exclusion criteria included secondary mitral regurgitation, previously
treated coronary artery disease, diabetes mellitus, chronic renal failure
requiring dialysis, atrial fibrillation, and documented allergy to either
propofol or sevoflurane. Intervention(s): All patients received
video-assisted minimally invasive right minithoracotomy. Patients were
randomized to receive propofol or sevoflurane anesthesia in a 1:1 ratio.
 Measurements and Main Results: Cardiac troponin I release was
measured over the first 72 hours postoperatively. Operative, cross-clamp,
and total bypass times were similar between groups. Cardiac troponin I
release was reduced nonsignificantly in the propofol group (p = 0.62), and
peak troponin I release was correlated with cross-clamp time in both
groups. There were no differences in terms of intraoperative lactate
release and blood pH between groups. Conclusion(s): Propofol and
sevoflurane anesthesia were associated with similar degrees of myocardial
injury, indicating comparable cardioprotection. Myocardial injury was
related directly to the duration of cardioplegic arrest. Copyright
© 2018 Elsevier Inc.

<22>
Accession Number
620208381
Title
Cost-effectiveness analysis in cardiac surgery: A review of its concepts
and methodologies.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (4) (pp
1671-1681.e11), 2018. Date of Publication: April 2018.
Author
Ferket B.S.; Oxman J.M.; Iribarne A.; Gelijns A.C.; Moskowitz A.J.
Institution
(Ferket, Oxman, Gelijns, Moskowitz) Department of Population Health
Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Ferket) Institute for Healthcare Delivery Science, Department of
Population Health Science and Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Iribarne) Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center,
Lebanon, NH, United States
(Iribarne) The Dartmouth Institute for Health Policy and Clinical
Practice, One Medical Center Drive, Lebanon, NH, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<23>
Accession Number
627063259
Title
Cardioprotective effect of remote ischemic preconditioning with
postconditioning on donor hearts in patients undergoing heart
transplantation: A single-center, double-blind, randomized controlled
trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 48. Date
of Publication: 06 Apr 2019.
Author
Wang G.; Zhang Y.; Yang L.; Chen Y.; Fang Z.; Zhou H.; Zhang C.; Lei G.;
Shi S.; Li J.
Institution
(Wang) Department of Anesthesiology, Beijing Tongren Hospital, Capital
Medical University, Beijing 100730, China
(Zhang) Department of Anesthesiology, Traditional Chinese Medicine
Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
(Wang, Yang, Chen, Fang, Zhou, Zhang, Lei, Shi, Li) Department of
Anesthesiology, Fuwai Hospital, Natl. Ctr. for Cardiovasc. Diseases,
Chinese Acad. of Med. Sciences, Peking Union Med. Coll., Beijing 100037,
China
(Zhou) Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200025, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The cardioprotective effect of remote ischemic preconditioning
(RIPC) in cardiovascular surgery is controversial. This study investigated
whether RIPC combined with remote ischemic postconditioning (RIPostC)
reduces myocardial injury to donor hearts in patients undergoing heart
transplantation. Method(s): One hundred and twenty patients scheduled
for orthotopic heart transplantation were enrolled and randomly assigned
to an RIPC+RIPostC group (n = 60) or a control (n = 60) group. In the
RIPC+RIPostC group, after anesthesia induction, four cycles of 5-min of
ischemia and 5-min of reperfusion were applied to the right upper limb by
a cuff inflated to 200 mmHg (RIPC) and 20 min after aortic declamping
(RIPostC). Serum cardiac troponin I (cTnI) levels were determined
preoperatively and at 3, 6, 12, and 24 h after aortic declamping.
Postoperative clinical outcomes were recorded. The primary endpoint was a
comparison of serum cTnI levels at 6 h after aortic declamping.
 Result(s): Compared with the preoperative baseline, in both groups,
serum cTnI levels peaked at 6 h after aortic declamping. Compared with the
control group, RIPC+RIPostC significantly reduced serum cTnI levels at 6 h
after aortic declamping (38.87 +/- 31.81 vs 69.30 +/- 34.13 ng/ml, P =
0.02). There were no significant differences in in-hospital morbidity and
mortality between the two groups. Conclusion(s): In patients
undergoing orthotopic heart transplantation, RIPC combined with RIPostC
reduced myocardial injury at 6 h after aortic declamping, while we found
no evidence of this function provided by RIPC+RIPostC could improve
clinical outcomes. Copyright © 2019 The Author(s).

<24>
Accession Number
627053058
Title
Reliability of three-dimensional color flow Doppler and two-dimensional
pulse wave Doppler transthoracic echocardiography for estimating cardiac
output after cardiac surgery.
Source
Cardiovascular Ultrasound. 17 (1) (no pagination), 2019. Article Number:
5. Date of Publication: 03 Apr 2019.
Author
Hao G.-W.; Liu Y.; Ma G.-G.; Hou J.-Y.; Zhu D.-M.; Liu L.; Zhang Y.; Liu
H.; Zhuang Y.-M.; Luo Z.; Tu G.-W.; Yang X.-M.; Chen H.-Y.
Institution
(Hao, Ma, Hou, Zhu, Liu, Zhang, Liu, Zhuang, Luo, Tu, Yang) Department of
Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180
Fenglin Road, Xuhui District, Shanghai 200032, China
(Liu, Chen) Department of Echocardiography, Zhongshan Hospital, Fudan
University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Three-dimensional color flow Doppler (3DCF) is a new
convenient technique for cardiac output (CO) measurement. However, to
date, no one has evaluated the accuracy of 3DCF echocardiography for CO
measurement after cardiac surgery. Therefore, this single-center,
prospective study was designed to evaluate the reliability of
three-dimensional color flow and two-dimensional pulse wave Doppler
(2D-PWD) transthoracic echocardiography for estimating cardiac output
after cardiac surgery. Method(s): Post-cardiac surgical patients with
a good acoustic window and a low dose or no dose of vasoactive drugs
(norepinephrine < 0.05 mug/kg/min) were enrolled for CO estimation. Three
different methods (third generation FloTrac/VigileoTM [FT/V] system as the
reference method, 3DCF, and 2D-PWD) were used to estimate CO before and
after interventions (baseline, after volume expansion, and after a
dobutamine test). Result(s): A total of 20 patients were enrolled in
this study, and 59 pairs of CO measurements were collected (one pair was
not included because of increasing drainage after the dobutamine test).
Pearson's coefficients were 0.260 between the CO-FT/V and CO-PWD
measurements and 0.729 between the CO-FT/V and CO-3DCF measurements.
Bland-Altman analysis showed the bias between the absolute values of
CO-FT/V and CO-PWD measurements was - 0.6 L/min with limits of agreement
between - 3.3 L/min and 2.2 L/min, with a percentage error (PE) of 61.3%.
The bias between CO-FT/V and CO-3DCF was - 0.14 L/min with limits of
agreement between - 1.42 L /min and 1.14 L/min, with a PE of 29.9%.
Four-quadrant plot analysis showed the concordance rate between
DELTACO-PWD and DELTACO-3FT/V was 93.3%. Conclusion(s): In a
comparison with the FT/V system, 3DCF transthoracic echocardiography could
accurately estimate CO in post-cardiac surgical patients, and the two
methods could be considered interchangeable. Although 2D-PWD
echocardiography was not as accurate as the 3D technique, its ability to
track directional changes was reliable. Copyright © 2019 The
Author(s).

<25>
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.

<26>
Accession Number
625223968
Title
Impact of concurrent tricuspid regurgitation on mortality after
transcatheter aortic-valve implantation.
Source
Catheterization and Cardiovascular Interventions. 93 (5) (pp 946-953),
2019. Date of Publication: 01 Apr 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To determine whether concomitant tricuspid regurgitation (TR)
is associated with increased mortality in patients with severe aortic
stenosis (AS) undergoing transcatheter aortic-valve implantation (TAVI),
we performed a meta-analysis of currently available studies.
 Method(s): MEDLINE and EMBASE were searched through May 2018. We
included comparative or cohort studies enrolling patients with AS
undergoing TAVI and reporting early (in-hospital or 30-day) and late
(including early) all-cause mortality in patients stratified by baseline
TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of
late mortality with its 95% CI for significant versus non-significant
(typically, >=moderate versus <moderate) TR was extracted. Study-specific
estimates were combined in the random-effects model. Result(s): Our
search identified 12 eligible studies enrolling a total of 41,485 TAVI
patients. The meta-analysis for early mortality combining 3 ORs
demonstrated a significant 1.80-fold increase in mortality with
significant TR (OR, 1.80; 95% CI, 1.01 to 3.19; P = 0.05). The primary
meta-analysis for midterm (6-month to 30-month) mortality combining all
the 12 HRs/ORs indicated a significant 1.96-fold increase in mortality
(HR/OR, 1.96; 95% CI, 1.35 to 2.85; P = 0.0004). The secondary
meta-analysis for midterm mortality combining 7 homogeneous HRs (adjusted
HRs for >=moderate versus <moderate TR) showed a significant 2.25-fold
increase in mortality (HR, 2.25; 95% CI, 1.20-4.24; P = 0.01).
 Conclusion(s): Concurrent significant (typically, >=moderate) TR is
associated with an approximately two-fold increase in both early and
midterm all-cause mortality in patients with AS undergoing
TAVI. Copyright © 2018 Wiley Periodicals, Inc.

<27>
[Use Link to view the full text]
Accession Number
617003416
Title
Chest Wall Resection for Recurrent Breast Cancer in the Modern Era.
Source
Annals of Surgery. 267 (4) (pp 646-655), 2018. Date of Publication: 01 Apr
2018.
Author
Wakeam E.; Acuna S.A.; Keshavjee S.
Institution
(Wakeam, Keshavjee) Division of Thoracic Surgery, Toronto General
Hospital, University Health Network, Department of Surgery, University of
Toronto, 200 Elizabeth St, 9N-946, Toronto, ON M5G 2C4, Canada
(Acuna) Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To review the literature on chest wall resection for recurrent
breast cancer and evaluate overall survival (OS) and quality-of-life (QOL)
outcomes. Background(s): Full-thickness chest wall resection for
recurrent breast cancer is controversial, as historically these
recurrences have been thought of as a harbinger of systemic disease.
 Method(s): A systematic search in MEDLINE, EMBASE, and Cochrane
CENTRAL identified 48 eligible studies, all retrospective, accounting for
1305 patients. The review is reported following Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guidelines. Primary end points
were patient-centered QOL outcomes and OS; secondary outcomes included
disease-free survival (DFS) and 30-day morbidity. Risk of bias was
assessed using the Methodological Index for Non-Randomized Studies
instrument and the Oxford Centre for Evidence-Based Medicine's levels of
evidence tool. Random-effects meta-analysis was used to create pooled
estimates. Meta-regressions and sensitivity analyses were used to explore
study heterogeneity by age, year of publication, risk of bias, and
surgical intent (curative vs palliative). Result(s): Studies
consistently reported excellent OS and DFS in properly selected patients.
Pooled estimates for 5-year OS in all studies and those from the past 15
years were 40.8% [95% confidence interval (CI) 35.2-46.7) and 43.1% (95%
CI 35.8-50.7), whereas pooled 5-year DFS was 27.1% (95% CI 16.6-41.0).
Eight studies reported excellent outcomes related to QOL. Mortality was
consistently low (<1%) and 30-day pooled morbidity was 20.2% (95% CI
15.3%-26.3%). Study quality varied, and risk of selection bias in included
studies was high. Conclusion(s): Full-thickness chest wall resection
can be performed with excellent survival and low morbidity. Few studies
report on QOL; prospective studies should focus on patient-centered
outcomes in this population. Copyright © 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<28>
Accession Number
621179874
Title
Lipid peroxidation in cardiac surgery: Towards consensus on biomonitoring,
diagnostic tools and therapeutic implementation.
Source
Journal of Breath Research. 12 (2) (no pagination), 2018. Article Number:
027109. Date of Publication: April 2018.
Author
Romano R.; Cristescu S.M.; Risby T.H.; Marczin N.
Institution
(Romano, Marczin) Section of Anaesthetics, Pain Medicine and Intensive
Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial
College London, London, United Kingdom
(Cristescu) Department of Molecular and Laser Physics, Institute of
Molecules and Materials, Radboud University, Nijmegen, Netherlands
(Risby) Department of Environmental Health Sciences, Bloomberg School of
Public Health, Johns Hopkins University, Baltimore, United States
(Marczin) Centre of Anaesthesia and Intensive Care, Semmelweis University,
Budapest, Hungary
Publisher
Institute of Physics Publishing (E-mail: helen.craven@iop.org)
Abstract
This review focuses on oxidative stress and more specifically lipid
peroxidation in cardiac surgery, one of the fundamental theories of
perioperative complications. We present the molecular pathways leading to
lipid peroxidation and integrate analytical methods that allow detection
of lipid peroxidation markers in the fluid phase with those focusing on
volatile compounds in exhaled breath. In order to explore the accumulated
data in the literature, we present a systematic review of quantitative
analysis of malondialdehyde, a widely used lipid peroxidation product at
various stages of cardiac surgery. This exploration reveals major
limitations of existing studies in terms of variability of reported values
and significant gaps due to discrete and variable sampling times during
surgery. We also appraise methodologies that allow real-time and
continuous monitoring of oxidative stress. Complimentary techniques
highlight that beyond the widely acclaimed contribution of the
cardiopulmonary bypass technology and myocardial reperfusion injury, the
use of diathermy contributes significantly to intraoperative lipid
peroxidation. We conclude that there is an urgent need to implement the
theory of oxidative stress towards a paradigm change in the clinical
practice. Firstly, we need to acquire definite and irrefutable information
on the link between lipid peroxidation and post-operative complications by
building international consensus on best analytical approaches towards
generating qualitatively and quantitatively comparable datasets in
coordinated multicentre studies. Secondly, we should move away from
routine low-risk surgeries towards higher risk interventions where there
is major unmet clinical need for improving patient journey and outcomes.
There is also need for consensus on best therapeutic interventions which
could be tested in convincing large scale clinical trials. As future
directions, we propose combination of fluid phase platforms and
'metabography', an extended form of capnography - including real-time
analysis of lipid peroxidation and volatile footprints of metabolism - for
better patient phenotyping prior to and during high risk surgery towards
molecular prediction, stratification and monitoring of the patient's
journey. Copyright © 2018 IOP Publishing Ltd.

<29>
Accession Number
2001026578
Title
Cost effectiveness and clinical efficacy of patent foramen ovale closure
as compared to medical therapy in cryptogenic stroke patients: A detailed
cost analysis and meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 273 (pp 74-79), 2018. Date of
Publication: 15 December 2018.
Author
Pickett C.A.; Villines T.C.; Resar J.R.; Hulten E.A.
Institution
(Pickett, Villines, Hulten) Uniformed Services University of the Health
Sciences, Bethesda, MD, United States
(Pickett) Brooke Army Medical Center, San Antonio, TX, United States
(Villines) Walter Reed National Military Medical Center, Bethesda, MD,
United States
(Resar) Johns Hopkins Hospital and Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Hulten) Cardiology Service, Evans Army Hospital, Fort Carson, CO, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Up to half the patients with cryptogenic stroke under the age
of 55 years have been found to have a PFO. Observational studies have
demonstrated a benefit from closure of PFO and several RCTs have shown a
trend toward benefit. The cost and clinical effectiveness of PFO closure
is unclear. Methods and Results: We searched for RCTs of PFO closure
in patients with cryptogenic stroke and performed a detailed cost analysis
and meta-analysis of treatment outcomes based on the results of the
meta-analysis. Five RCTs containing 3404 patients with cryptogenic stroke
were included. Of these 1829 underwent PFO closure and 1611 received
medical therapy. Mean follow-up was 4.0 years. PFO closure achieved cost
effectiveness (<$50,000/Quality-adjusted life-year gained) 2.7 years (95%
Confidence Interval (CI) 2.2-3.4) after closure. The incremental cost to
prevent one combined end point (CEP, combined transient ischemic attack
(TIA), stroke, and death) by PFO closure was $535,655(95% CI
$458,329-$642,674). After 55.4 years (95%CI 51.1-60.5) of follow-up, the
per patient total cost of medical therapy exceeded that of PFO closure.
PFO closure demonstrated clinical efficacy with a decreased risk of CEP
(pooled hazard ratio (HR = 0.43(95%CI 0.27-0.59))) and a decreased risk of
stroke (HR = 0.29(95%CI 0.02-0.57)). Conclusion(s): In comparison to
medical therapy alone, PFO closure appears to be cost-effective and
clinically efficacious. Copyright © 2018 Elsevier B.V.

<30>
Accession Number
2001056213
Title
Cost-effectiveness of on-pump and off-pump coronary artery bypass grafting
for patients with coronary artery disease: Results from the MASS III
trial.
Source
International Journal of Cardiology. 273 (pp 63-68), 2018. Date of
Publication: 15 December 2018.
Author
Scudeler T.L.; Hueb W.A.; Farkouh M.E.; Maron D.J.; de Soarez P.C.;
Campolina A.G.; Takiuti M.E.; Rezende P.C.; Godoy L.C.; Hueb A.C.; Lima
E.G.; Garzillo C.L.; Ramires J.A.F.; Kalil Filho R.
Institution
(Scudeler, Hueb, Takiuti, Rezende, Godoy, Hueb, Lima, Garzillo, Ramires,
Kalil Filho) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Farkouh, Godoy) Peter Munk Cardiac Centre and the Heart and Stroke
Richard Lewar Centre of Excellence in Cardiovascular Research, University
of Toronto, Toronto, Ontario, Canada
(Maron) Division of Cardiovascular Medicine and Cardiovascular Institute,
Stanford University, Stanford, CA, United States
(de Soarez) Departamento de Medicina Preventiva da Universidade de Sao
Paulo, Sao Paulo, Brazil
(Campolina) Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
(Farkouh) 585 University Avenue - 4N474, Toronto, Ontario M5G 2N2, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: Recent trials have reported similar clinical outcomes between
on-pump and off-pump coronary artery bypass graft (CABG). However,
long-term cost-effectiveness of these strategies is unknown.
 Method(s): A prespecified economic study was performed based on the
MASS III trial. Costs were estimated for all patients based on observed
healthcare resource usage over a 5-year follow-up. Health state utilities
were evaluated with the SF-6D questionnaire. Cost-effectiveness was
assessed as cost per quality-adjusted life-year (QALY) gained using a
Markov model. Probabilistic sensitivity analysis with the Monte-Carlo
simulation and cost-effectiveness acceptability curve were used to address
uncertainty. Result(s): Quality of life improved significantly in
both groups during follow-up compared with baseline. At 5 years, when
comparing on-pump and off-pump CABG groups, no differences were found in
cumulative life-years (4.851 and 4.766 years, P =.319) and QALY gained
(4.150 and 4.105 QALYs, P =.332). Mean cost in US dollars per patient
during the trial did not differ significantly between the on-pump and
off-pump groups ($5890.29 and $5674.75, respectively, P =.409). Over a
lifetime horizon, the incremental cost-effectiveness ratio of on-pump
versus off-pump CABG was $12,576 per QALY gained, which is above the
suggested cost-effectiveness threshold range (from $3210 to 10,122). In
the sensitivity analysis, the probability that on-pump CABG is
cost-effective compared to off-pump surgery for a willingness-to-pay
threshold of $3212 per QALY gained was <1%. For the $10,122 per QALY
threshold, the same probability was 35%. Conclusion(s): This
decision-analytic model suggests that on-pump CABG is not cost-effective
when compared to off-pump CABG from a public health system
perspective. Copyright © 2018 Elsevier B.V.

<31>
Accession Number
2001022665
Title
Dual versus triple therapy in patients on oral anticoagulants and
undergoing coronary stent implantation: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 273 (pp 80-87), 2018. Date of
Publication: 15 December 2018.
Author
Fortuni F.; Ferlini M.; Leonardi S.; Angelini F.; Crimi G.; Somaschini A.;
Cornara S.; Potenza A.; De Servi S.; Oltrona Visconti L.; De Ferrari G.M.
Institution
(Fortuni, Leonardi, Somaschini, Cornara, De Ferrari) Coronary Care Unit
and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Fortuni, Somaschini, Cornara, De Ferrari) Department of Molecular
Medicine, University of Pavia, Pavia, Italy
(Ferlini, Crimi, Potenza, Oltrona Visconti) Division of Cardiology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Angelini) Division of Cardiology, University of Torino, Citta della
Salute e della Scienza Hospital, Italy
(De Servi) IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: There is contrasting evidence regarding the optimal
antithrombotic regimen after percutaneous coronary stent implantation in
patients on oral anticoagulants. A systematic review and meta-analysis was
performed to explore the comparative efficacy and safety of dual (an
antiplatelet plus an oral anticoagulant) versus triple therapy (dual
antiplatelet therapy plus an oral anticoagulant). Method(s): We
searched the literature for randomized controlled trials (RCTs) or
observational studies (OSs) addressing this issue. The efficacy outcomes
were all-cause mortality, cardiovascular mortality, myocardial infarction
and stent thrombosis. The safety outcomes were major bleeding events and
all bleeding events. The analyses were stratified by type of anticoagulant
and of antiplatelet used in dual therapy. Result(s): Four RCTs and
ten OSs met our inclusion criteria including a total of 10,126 patients.
5671 patients received triple therapy whereas 4455 received dual therapy.
Median follow up was 12 months. There was no difference between dual
therapy and triple therapy regarding efficacy outcomes. Dual therapy
significantly reduced the risk of major bleeding (RR 0.66; CI 95%
0.52-0.83; P = 0.0005) and of all bleeding events (RR 0.67, CI 95%
0.55-0.80; P < 0.0001). The effect was consistent regardless of the type
of antiplatelet and anticoagulant used in dual therapy.
 Conclusion(s): Dual antithrombotic therapy after coronary stenting in
anticoagulated patients significantly reduces bleeding events compared
with triple therapy. Dual therapy might be considered in this setting
especially when bleeding risk outweighs ischemic risk, although our study
was not sufficiently powered to detect a difference in ischemic
endpoints. Copyright © 2018

<32>
Accession Number
623740179
Title
Early survival following in utero myocardial infarction.
Source
Cardiology in the Young. 28 (10) (pp 1079-1087), 2018. Date of
Publication: 01 Oct 2018.
Author
Cosgrove P.; Modi S.; Lawson K.; Hancock-Friesen C.; Johnson G.
Institution
(Cosgrove) Department of Emergency Medicine, Boston Children's Hospital,
300 Longwood Ave, Boston, MA 02115, United States
(Modi) Department of Medicine, University of Texas Medical Branch at
Galveston, Galveston, TX, United States
(Lawson) Department of Trauma and Injury Research Center, University of
Texas at Austin, Dell Children's Medical Center, Austin, TX, United States
(Hancock-Friesen) Department of Pediatric Cardiovascular Surgery Division,
Dell Children's Regional Heart Center, University of Texas at Austin, Dell
Children's Medical Center, Austin, TX, United States
(Johnson) Department of Pediatric Cardiology, University of Texas at
Austin, Dell Children's Medical Center, Austin, TX, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Intrauterine myocardial infarction is a rare and frequently fatal
diagnosis. It has been presented in the literature only as case reports
and short series. We present a case report of a coronary occlusive
intrauterine myocardial infarction and survival and present a systematic
review of the literature. This is the first summative description of
current data on intrauterine and perinatal myocardial infarction. We
performed the systematic review based on the guidelines established by the
PRISMA statement. Our population of intrauterine and perinatal myocardial
infarction included published cases who presented as a live birth within
the first 28 postnatal days, and had a diagnosis of myocardial infarction.
We conducted descriptive statistics and regression analysis on short-term
mortality as the primary outcome. After applying exclusion criteria we
described 84 individual cases of myocardial infarction from 63 full-text
articles including our own case. Presentation within the first 12 hours
was associated with mortality (OR 3.90, p=0.004). Treatment modalities
were varied and inconsistently recorded. The aetiologies and comorbidities
are varied in our systematic review. We would have a low threshold to
perform viral testing, consider anticoagulation early and coronary imaging
if feasible. The use of extracorporeal membranous oxygenation may serve as
a bridge to cardiac recovery. Copyright © Cambridge University
Press 2018.

<33>
[Use Link to view the full text]
Accession Number
627082528
Title
Periprocedural outcomes of direct oral anticoagulants versus warfarin in
nonvalvular atrial fibrillation meta-analysis of phase III trials.
Source
Circulation. 138 (14) (pp 1402-1411), 2018. Date of Publication: 2018.
Author
Nazha B.; Pandya B.; Cohen J.; Zhang M.; Lopes R.D.; Garcia D.A.; Sherwood
M.W.; Spyropoulos A.C.
Institution
(Spyropoulos) Center for Health Innovations and Outcomes Research,
Feinstein Institute for Medical Research System, United States
(Spyropoulos) Anticoagulation and Clinical Thrombosis Services Northwell
Health, Lenox Hill Hospital, 130 E 77th St, New York, NY 10075, United
States
(Nazha) Department of Hematology and Medical Oncology, Emory University
School of Medicine, Atlanta, GA, United States
(Pandya) Division of Cardiology, Staten Island University
Hospital-Northwell Health, NY, United States
(Cohen) Division of Hospital Medicine, Northwell Health at North Shore
University Hospital, Manhasset, NY, United States
(Zhang, Spyropoulos) Center for Health Innovations and Outcomes Research,
Feinstein Institute for Medical Research, Manhasset, NY, United States
(Lopes) Division of Cardiology, Duke University Medical Center, Duke
Clinical Research Institute, Durham, NC, United States
(Garcia) Department of Medicine, Division of Hematology, University of
Washington School of Medicine, Seattle, United States
(Sherwood) Inova Heart and Vascular Institute, Fairfax, VA, United States
(Spyropoulos) Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell, Hempstead, NY, United States
(Spyropoulos) Department of Medicine, Anticoagulation and Clinical
Thrombosis Service, Northwell Health at Lenox Hill Hospital, New York, NY,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Direct oral anticoagulants (DOACs) are surpassing warfarin as
the anticoagulant of choice for stroke prevention in nonvalvular atrial
fibrillation. DOAC outcomes in elective periprocedural settings have not
been well elucidated and remain a source of concern for clinicians. The
aim of this meta-analysis was to evaluate the periprocedural safety and
efficacy of DOACs versus warfarin in patients with nonvalvular atrial
fibrillation. METHOD(S): We reviewed the literature for data from
phase III randomized controlled trials comparing DOACs with warfarin in
the periprocedural period among patients with nonvalvular atrial
fibrillation. Substudies from 4 trials (RELY [Randomized Evaluation of
Long-Term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral
Direct Factor Xa Inhibitor Compared with Vitamin K Antagonism for
Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE
[Apixaban for the Prevention of Stroke in Subjects With Atrial
Fibrillation], and ENGAGE-AF [Effective Anticoagulation With Factor xA
Next Generation in Atrial Fibrillation]) were included in the
meta-analysis. DOACs as a group and warfarin were compared in terms of the
30-day pooled risk for stroke/systemic embolism, major bleeding, and
death, according to whether the study drug was interrupted or not
periprocedurally. The overall relative risk (RR) was estimated with a
random-effects model. The I2 test was used to assess
heterogeneity in RR among the studies. RESULT(S): In the
uninterrupted anticoagulant strategy, there were no differences in the
rates of stroke/systemic embolism (pooled risk, 0.6% [29 events/4519
procedures] versus 1.1% [31/2971]; RR, 0.70; 95% confidence interval [CI],
0.41-1.18) and death (1.4% versus 1.8%; RR, 0.77; 95% CI, 0.53-1.12)
between DOACs and warfarin and significantly fewer major bleeding events
(2.0% versus 3.3%; RR, 0.62; 95% CI, 0.47-0.82) with DOACs compared to
warfarin. Under an interrupted strategy, there was no significant
difference between DOACs versus warfarin for stroke/ systemic embolism
(0.4% [41/9260] versus 0.5% [31/7168]; RR, 0.95; 95% CI, 0.59-1.55), major
bleeding (2.1% versus 2.0%; RR, 1.05; 95% CI, 0.85-1.30), and death (0.7%
versus 0.6%; RR, 1.24; 95% CI, 0.76-2.04). The studies were homogeneous
(I2=0.0%) for all calculated pooled associations except for the
RR of death in the interrupted strategy (I2=26.3%).
 CONCLUSION(S): The short-term safety and efficacy of DOACs and
warfarin are not different in patients with nonvalvular atrial
fibrillation periprocedurally. Under an uninterrupted anticoagulation
strategy, DOACs are associated with a 38% lower risk of major bleeding
compared with warfarin. Copyright © 2018 American Heart
Association, Inc.

<34>
[Use Link to view the full text]
Accession Number
627082390
Title
Myocardial revascularization trials: Beyond the printed word.
Source
Circulation. 138 (25) (pp 2943-2951), 2018. Date of Publication: 2018.
Author
Ruel M.; Falk V.; Farkouh M.E.; Freemantle N.; Gaudino M.F.; Glineur D.;
Cameron D.E.; Taggart D.P.
Institution
(Ruel, Glineur) University of Ottawa Heart Institute, University of
Ottawa, Ottawa, Canada
(Falk) German Heart Center, Charite Universitatsmedizin Berlin, Berlin,
Germany
(Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Canada
(Freemantle) Institute of Clinical Trials and Methodology, University
College London, London, United Kingdom
(Gaudino) New York Presbyterian Hospital, Weill Cornell Medicine, NY,
United States
(Cameron) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Taggart) Oxford University Hospitals, Oxford, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This article reviews the context and evidence of recent myocardial
revascularization trials that compared percutaneous coronary intervention
with coronary artery bypass grafting for the treatment of left main and
multivessel coronary artery disease. We develop the rationale that some of
the knowledge synthesis resulting from these trials, particularly with
regard to the claimed noninferiority of percutaneous coronary intervention
beyond nondiabetic patients with low anatomic complexity, may have been
affected by trial design, patient selection based on suitability for
percutaneous coronary intervention, and end point optimization favoring
percutaneous coronary intervention over coronary artery bypass grafting.
We provide recommendations that include holding a circumspect
interpretation of the currently available evidence, as well as suggestions
for the collaborative design and conduct of future clinical trials in this
and other fields. Copyright © 2018 American Heart Association,
Inc.

<35>
[Use Link to view the full text]
Accession Number
627082279
Title
NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide)-guided therapy in
acute decompensated heart failure PRIMA II randomized controlled trial
(Can NT-ProBNP-guided therapy during hospital admission for acute
decompensated heart failure reduce mortality and readmissions?).
Source
Circulation. 137 (16) (pp 1671-1683), 2018. Date of Publication: 2018.
Author
Stienen S.; Salah K.; Moons A.H.; Bakx A.L.; Van Pol P.; Kortz R.A.M.;
Ferreira J.P.; Marques I.; Schroeder-Tanka J.M.; Keijer J.T.; Bayes-Genis
A.; Tijssen J.G.P.; Pinto Y.M.; Kok W.E.
Institution
(Stienen, Salah, Tijssen, Pinto, Kok) Department of Cardiology, Academic
Medical Center, Amsterdam, Netherlands
(Moons) Department of Cardiology, Slotervaartziekenhuis, Amsterdam,
Netherlands
(Bakx) Department of Cardiology, BovenIJ Ziekenhuis, Amsterdam,
Netherlands
(Van Pol) Department of Cardiology, Alrijne Ziekenhuis, Leiderdorp,
Netherlands
(Kortz) Department of Cardiology, Flevoziekenhuis, Almere, Netherlands
(Ferreira) Department of Physiology and Cardiothoracic Surgery, Faculty of
Medicine, University of Porto, Porto, Portugal
(Ferreira) INSERM, Centre d'Investigations Cliniques Plurithematique,
Universite de Lorraine, CHRU de Nancy, France
(Marques) Department of Internal Medicine, Centro Hospitalar Do Porto,
Instituto de Ciencias Biomedicas de Abel Salazar, Porto, Portugal
(Schroeder-Tanka) Department of Cardiology, St Lucas Andreas Ziekenhuis,
Amsterdam, Netherlands
(Keijer) Department of Cardiology, Tergooiziekenhuizen, Blaricum,
Netherlands
(Bayes-Genis) Department of Cardiology, Hospital Universitari Germans
Trias i Pujol, Barcelona, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The concept of natriuretic peptide guidance has been
extensively studied in patients with chronic heart failure (HF), with only
limited success. The effect of NT-proBNP (N-terminal probrain natriuretic
peptide)-guided therapy in patients with acute decompensated HF using a
relative NT-proBNP target has not been investigated. This study aimed to
assess whether NT-proBNPguided therapy of patients with acute
decompensated HF using a relative NTproBNP target would lead to improved
outcomes compared with conventional therapy. METHOD(S): We conducted
a prospective randomized controlled trial to study the impact of
in-hospital guidance for acute decompensated HF treatment by a predefined
NT-proBNP target (>30% reduction from admission to discharge) versus
conventional treatment. Patients with acute decompensated HF with
NT-proBNP levels >1700 ng/L were eligible. After achieving clinical
stability, 405 patients were randomized to either NT-proBNP-guided or
conventional treatment (1:1). The primary end point was dual: A composite
of all-cause mortality and HF readmissions in 180 days and the number of
days alive out of the hospital in 180 days. Secondary end points were
all-cause mortality within 180 days, HF readmissions within 180 days, and
a composite of all-cause mortality and HF readmissions within 90 days.
 RESULT(S): Significantly more patients in the NT-proBNP-guided
therapy group were discharged with an NT-proBNP reduction of >30% (80%
versus 64%, P=0.001). Nonetheless, NT-proBNP-guided therapy did not
significantly improve the combined event rate for all-cause mortality and
HF readmissions (hazard ratio, 0.96; 95% confidence interval, 0.72-1.37;
P=0.99) or the median number of days alive outside of the hospital (178
versus 179 days for NT-proBNP versus conventional patients, P=0.39).
Guided therapy also did not significantly improve any of the secondary end
points. CONCLUSION(S): The PRIMA II trial (Can NT-ProBNP-Guided
Therapy During Hospital Admission for Acute Decompensated Heart Failure
Reduce Mortality and Readmissions?) demonstrates that the guidance of HF
therapy to reach an NT-proBNP reduction of >30% after clinical
stabilization did not improve 6-month outcomes. Copyright © 2017
American Heart Association, Inc.

<36>
[Use Link to view the full text]
Accession Number
627081477
Title
Liraglutide reduces cardiovascular events and mortality in type 2 diabetes
mellitus independently of baseline low-density lipoprotein cholesterol
levels and statin use results from the LEADER trial.
Source
Circulation. 138 (15) (pp 1605-1607), 2018. Date of Publication: 2018.
Author
Verma S.; Leiter L.A.; David Mazer C.; Bain S.C.; Buse J.; Marso S.; Nauck
M.; Zinman B.; Bosch-Traberg H.; Rasmussen S.; Michelsen M.M.; Bhatt D.L.
Institution
(Verma) Division of Cardiac Surgery, St. Michael's Hospital, University of
Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON M5B 1W8, Canada
(Leiter) Division of Endocrinology and Metabolism, St. Michael's Hospital,
University of Toronto, Ontario, Canada
(David Mazer) Department of Anasthesia, St. Michael's Hospital, University
of Toronto, Ontario, Canada
(Bain) Institute of Life Science, Swansea University, United Kingdom
(Buse) University of North Carolina, School of Medicine, Chapel Hill, NC,
United States
(Marso) HCA Midwest Health Heart and Vascular Institute, Kansas City, MO,
United States
(Nauck) Diabetes Center Bochum-Hattingen, St. Josef-Hospital,
Ruhr-University Bochum, Germany
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
University of Toronto, ON, Canada
(Bosch-Traberg, Rasmussen, Michelsen) Novo Nordisk A/S, Soborg, Denmark
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<37>
[Use Link to view the full text]
Accession Number
627081099
Title
Early versus standard care invasive examination and treatment of patients
with non-ST-segment elevation acute coronary syndrome verdict randomized
controlled trial.
Source
Circulation. 138 (24) (pp 2741-2750), 2018. Date of Publication: 2018.
Author
Kofoed K.F.; Kelbaek H.; Riis Hansen P.; Torp-Pedersen C.; Hofsten D.;
Klovgaard L.; Holmvang L.; Helqvist S.; Jorgensen E.; Galatius S.;
Pedersen F.; Bang L.; Saunamaki K.; Clemmensen P.; Linde J.J.; Heitmann
M.; Wendelboe Nielsen O.; Raymond I.E.; Peter Kristiansen O.; Hastrup
Svendsen I.; Bech J.; Dominguez Vall-Lamora M.H.; Kragelund C.; Fritz
Hansen T.; Dahlgaard Hove J.; Jorgensen T.; Fornitz G.G.; Steffensen R.;
Jurlander B.; Abdulla J.; Lyngbaek S.; Elming H.; Krohn Therkelsen S.;
Abildgaard U.; Skov Jensen J.; Gislason G.; Kober L.V.; Engstrom T.
Institution
(Kofoed) Department of Cardiology, Section 2014, Heart Centre,
Rigshospitalet, University of Copenhagen, Blegdamsvej 9 2100-CPH, Denmark
(Kofoed, Hofsten, Klovgaard, Holmvang, Helqvist, Jorgensen, Pedersen,
Bang, Saunamaki, Clemmensen, Linde, Kober, Engstrom) Department of
Cardiology, Heart Centre, Rigshospitalet, Roskilde, Denmark
(Riis Hansen, Torp-Pedersen, Galatius, Bech, Kragelund, Fritz Hansen,
Abildgaard, Skov Jensen, Gislason) Department of Cardiology, Herlev and
Gentofte Hospitals, Roskilde, Denmark
(Heitmann, Wendelboe Nielsen, Raymond, Peter Kristiansen, Hastrup
Svendsen, Dominguez Vall-Lamora) Department of Cardiology, Bispebjerg and
Frederiksberg Hospitals, Roskilde, Denmark
(Dahlgaard Hove, Jorgensen, Fornitz) Department of Cardiology, Hvidovre
and Amager Hospitals, Roskilde, Denmark
(Steffensen, Jurlander) Department of Cardiology, Hillerod Hospital,
Roskilde, Denmark
(Abdulla, Lyngbaek) Department of Cardiology, Glostrup Hospital, Roskilde,
Denmark
(Kelbaek, Elming, Krohn Therkelsen) University of Copenhagen, Denmark
(Kelbaek, Elming, Krohn Therkelsen) Department of Cardiology, Zealand
University Hospital, Roskilde, Denmark
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The optimal timing of invasive coronary angiography (ICA) and
revascularization in patients with non-ST-segment elevation acute coronary
syndrome is not well defined. We tested the hypothesis that a strategy of
very early ICA and possible revascularization within 12 hours of diagnosis
is superior to an invasive strategy performed within 48 to 72 hours in
terms of clinical outcomes. METHOD(S): Patients admitted with
clinical suspicion of non-ST-segment elevation acute coronary syndrome in
the Capital Region of Copenhagen, Denmark, were screened for inclusion in
the VERDICT trial (Very Early Versus Deferred Invasive Evaluation Using
Computerized Tomography) (ClinicalTrials.gov NCT02061891). Patients with
ECG changes indicating new ischemia or elevated troponin, in whom ICA was
clinically indicated and deemed logistically feasible within 12 hours,
were randomized 1:1 to ICA within 12 hours or standard invasive care
within 48 to 72 hours. The primary end point was a combination of
all-cause death, nonfatal recurrent myocardial infarction, hospital
admission for refractory myocardial ischemia, or hospital admission for
heart failure. RESULT(S): A total of 2147 patients were randomized;
1075 patients allocated to very early invasive evaluation had ICA
performed at a median of 4.7 hours after randomization, whereas 1072
patients assigned to standard invasive care had ICA performed 61.6 hours
after randomization. Among patients with significant coronary artery
disease identified by ICA, coronary revascularization was performed in
88.4% (very early ICA) and 83.1% (standard invasive care). Within a median
follow-up time of 4.3 (interquartile range, 4.1-4.4) years, the primary
end point occurred in 296 (27.5%) of participants in the very early ICA
group and 316 (29.5%) in the standard care group (hazard ratio, 0.92; 95%
CI, 0.78-1.08). Among patients with a GRACE risk score (Global Registry of
Acute Coronary Events) >140, a very early invasive treatment strategy
improved the primary outcome compared with the standard invasive treatment
(hazard ratio, 0.81; 95% CI, 0.67-1.01; P value for interaction=0.023).
 CONCLUSION(S): A strategy of very early invasive coronary evaluation
does not improve overall long-term clinical outcome compared with an
invasive strategy conducted within 2 to 3 days in patients with
non-ST-segment elevation acute coronary syndrome. However, in patients
with the highest risk, very early invasive therapy improves long-term
outcomes. Copyright © 2018 American Heart Association, Inc.

<38>
Accession Number
624440895
Title
Non-invasive screening for coronary artery disease in asymptomatic
diabetic patients: A systematic review and meta-analysis of randomised
controlled trials.
Source
European Heart Journal Cardiovascular Imaging. 19 (8) (pp 838-846), 2018.
Date of Publication: 2018.
Author
Clerc O.F.; Fuchs T.A.; Stehli J.; Benz D.C.; Grani C.; Messerli M.;
Giannopoulos A.A.; Buechel R.R.; Luscher T.F.; Pazhenkottil A.P.; Kaufmann
P.A.; Gaemperli O.
Institution
(Clerc, Fuchs, Stehli, Benz, Grani, Messerli, Giannopoulos, Buechel,
Luscher, Pazhenkottil, Kaufmann, Gaemperli) University Heart Centre,
University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
Publisher
Oxford University Press
Abstract
It is unclear whether non-invasive screening of asymptomatic diabetic
patients for coronary artery disease (CAD) may improve cardiac outcomes.
Thus, we performed a systematic literature review and meta-analysis of
randomised controlled trials (RCT's) on this topic. We searched
appropriate RCT's in five online databases (PubMed/MEDLINE, Cochrane
Library, Embase, Scopus, and Web of Science) from January 2000 to November
2017 and in 41 recent reviews. Two investigators independently extracted
and assessed study data using standardised forms. Additional unpublished
data were obtained from trial authors. The primary endpoint 'any cardiac
event' was a composite of cardiac death, non-fatal myocardial infarction
(MI), unstable angina (UA), or heart failure (HF) hospitalisation. We
performed a meta-analysis of relative risks (RRs) with 95% confidence
intervals (CI) using the Mantel-Haenszel method. We included five RCT's
with 3299 patients, of which 189 (5.7%) experienced any cardiac event on
follow-up (weighted mean 4.1 years). Non-invasive CAD screening
significantly reduced any cardiac event by 27% [RR 0.73 (95% CI
0.55-0.97), P = 0.028, number needed to screen 56]. This result was driven
by important, albeit non-significant decreases in non-fatal MI [RR 0.65
(95% CI 0.41-1.02), P = 0.062] and HF hospitalisation [RR 0.61 (95% CI
0.33-1.10), P = 0.100]. Non-invasive CAD screening did not significantly
affect cardiac death [RR 0.92 (95% CI 0.53-1.60), P = 0.77] and UA [RR
0.73 (95% CI 0.41-1.31), P = 0.29]. Compared with the standard care,
non-invasive CAD screening reduced cardiac events by 27% in asymptomatic
diabetic patients, largely through reductions in non-fatal MIs, and HF
hospitalisations. The present results justify larger, appropriately
powered trials to potentially revisit current
recommendations. Copyright Published on behalf of the European Society
of Cardiology. All rights reserved. VC The Author(s) 2018.

<39>
Accession Number
627145401
Title
Efficacy and safety of apixaban vs 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: 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) Department of Cardiovascular Medicine, 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) Department of Cardiology, University of Medicine and Pharmacy
Carol Davila, University and Emergency Hospital, Bucharest, Romania
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
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 vs warfarin in patients with AF and a history of BPV
replacement or native valve repair. Method(s): Using data from
Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial
Fibrillation (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.
ClinicalTrials.gov: NCT00412984. Copyright © 2019 Wiley
Periodicals, Inc.

<40>
Accession Number
2001745066
Title
Intraoperative intercostal nerve cryoablation during the Nuss procedure
reduces length of stay and opioid requirement: A randomized clinical
trial.
Source
Journal of Pediatric Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Graves C.E.; Moyer J.; Zobel M.J.; Mora R.; Smith D.; O'Day M.; Padilla
B.E.
Institution
(Graves, Moyer, Zobel, Mora, Smith, O'Day, Padilla) Division of Pediatric
Surgery, Department of Surgery, University of California, San Francisco,
United States
Publisher
W.B. Saunders
Abstract
Purpose: Minimally-invasive repair of pectus excavatum by the Nuss
procedure is associated with significant postoperative pain, prolonged
hospital stay, and high opiate requirement. We hypothesized that
intercostal nerve cryoablation during the Nuss procedure reduces hospital
length of stay (LOS) compared to thoracic epidural analgesia.
 Design(s): This randomized clinical trial evaluated 20 consecutive
patients undergoing the Nuss procedure for pectus excavatum between May
2016 and March 2018. Patients were randomized evenly via closed-envelope
method to receive either cryoanalgesia or thoracic epidural analgesia.
Patients and physicians were blinded to study arm until immediately
preoperatively. Setting(s): Single institution, UCSF-Benioff
Children's Hospital. Participant(s): 20 consecutive patients were
recruited from those scheduled for the Nuss procedure. Exclusion criteria
were age < 13 years, chest wall anomaly other than pectus excavatum,
previous repair or other thoracic surgery, and chronic use of pain
medications. Main Outcomes and Measures: Primary outcome was
postoperative LOS. Secondary outcomes included total operative time,
total/daily opioid requirement, inpatient/outpatient pain score, and
complications. Primary outcome data were analyzed by the Mann-Whitney
U-test for nonparametric continuous variables. Other continuous variables
were analyzed by two-tailed t-test, while categorical data were compared
via Chi-squared test, with alpha = 0.05 for significance. Result(s):
20 patients were randomized to receive either cryoablation (n = 10) or
thoracic epidural (n = 10). Mean operating room time was 46.5 min longer
in the cryoanalgesia group (p = 0.0001). Median LOS decreased by 2 days in
patients undergoing cryoablation, to 3 days from 5 days (Mann-Whitney U, p
= 0.0001). Cryoablation patients required significantly less inpatient
opioid analgesia with a mean decrease of 416 mg oral morphine equivalent
per patient (p = 0.0001), requiring 52%-82% fewer milligrams on
postoperative days 1-3 (p < 0.01 each day). There was no difference in
mean pain score between the groups at any point postoperatively, up to one
year, and no increased incidence of neuropathic pain in the cryoablation
group. No complications were noted in the cryoablation group; among
patients with epidurals, one patient experienced a symptomatic
pneumothorax and another had urinary retention. Conclusions and relevance:
Intercostal nerve cryoablation during the Nuss procedure decreases
hospital length of stay and opiate requirement versus thoracic epidural
analgesia, while offering equivalent pain control. Type of Study:
Treatment study. Level of Evidence: Level I. Copyright ©
2019 Elsevier Inc.

<41>
Accession Number
627182683
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
International Journal of Cardiovascular Imaging. (no pagination), 2019.
Date of Publication: 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, Garcia-Garcia)
Section of Interventional Cardiology, MedStar Washington Hospital Center,
110 Irving St NW, Washington, DC 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
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
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. Copyright © 2019, Springer Nature B.V.

<42>
[Use Link to view the full text]
Accession Number
626858283
Title
Red blood cell transfusion threshold after pediatric cardiac surgery: A
systematic review and meta-analysis.
Source
Medicine. 98 (11) (pp e14884), 2019. Date of Publication: 01 Mar 2019.
Author
Deng X.; Wang Y.; Huang P.; Luo J.; Xiao Y.; Qiu J.; Yang G.
Institution
(Deng, Wang, Huang, Luo, Xiao, Yang) Heart Center, Austria
(Qiu) Department of Emergency Center, Hunan Children's Hospital, Changsha,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Restrictive red blood cell transfusion strategy is implemented
to minimize risk following allogeneic blood transfusion in adult cardiac
surgery. However, it is still unclear if it can be applied to pediatric
cardiac patients. The purpose of this systematic review and meta-analysis
was to determine the effect of postoperative restrictive transfusion
thresholds on clinical outcomes based on up-to-date results of randomized
controlled trials (RCTs) and observational studies in pediatric cardiac
surgery. METHOD(S): We searched for RCTs and observational studies in
the following databases: the Cochrane Central Register of Controlled
Trials, MEDLINE, EMBASE, and ClinicalTrials.gov from their inception to
October 26, 2017. We also searched reference lists of published
guidelines, reviews, and relevant articles, as well as conference
proceedings. No language restrictions were applied and no observational
study met the inclusion criteria. RESULT(S): Four RCTs on cardiac
surgery involving 454 patients were included. There were no differences in
the pooled fixed effects of intensive care unit (ICU) stay between the
liberal and restrictive transfusion thresholds (standardized mean
difference SMD, 0.007; 95% confidence interval CI, -0.18-0.19; P = .94).
There were also no differences in the length of hospital stay (SMD,
-0.062; 95% CI, -0.28-0.15; P = .57), ventilation duration (SMD, -0.015;
95% CI, -0.25-0.22; P = .90), mean arterial lactate level (SMD, 0.071; 95%
CI, -0.22-0.36; P = .63), and mortality (risk ratio, 0.49; 95% CI,
0.13-1.94; P = .31). There was no inter-trial heterogeneity for any pooled
analysis. Publication bias was tested using Egger, Begg, or the
trim-and-fill test, and the results indicated no significant publication
bias. CONCLUSION(S): Evidence from RCTs in pediatric cardiac surgery,
though limited, showed non-inferiority of restrictive thresholds over
liberal thresholds in length of ICU stay and other outcomes following red
blood cell transfusion. Further high-quality RCTs are necessary to confirm
the findings.

<43>
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.

<44>
Accession Number
2001513139
Title
Are racial differences in hospital mortality after coronary artery bypass
graft surgery real? A risk-adjusted meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Benedetto U.; Kamel M.K.; Khan F.M.; Angelini G.D.; Caputo M.; Girardi
L.N.; Gaudino M.
Institution
(Benedetto, Angelini, Caputo) Bristol Heart Institute, University of
Bristol, School of Clinical Sciences, Bristol, United Kingdom
(Kamel, Khan, Girardi, Gaudino) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Despite several reports, there are still conflicting data on
the influence of ethnicity on mortality rates associated with coronary
artery bypass grafting (CABG). We aimed to get further insights into the
effect of race on mortality following CABG by performing a risk adjusted
meta-analysis. Method(s): Relevant studies were searched on PubMed,
Embase, BioMed Central, and the Cochrane Central register. Pairwise
meta-analysis was used to estimate the relative risk of hospital death of
black, Hispanic, and Asian patients using white patients as reference.
Risk adjusted meta-analytic estimates were obtained using generic inverse
variance methods with random effect model. Result(s): A total of 28
studies were selected for analysis. A total of 21 studies reported on
hospital mortality in black (n = 222,892) versus white (n = 3,884,043)
patients, 7 studies reported on Hispanic (n = 91,256) versus white (n =
1,458,524) and 9 studies reported on Asian (n = 27,820) versus white (n =
1,081,642). When compared with white patients, adjusted risk of hospital
death was significantly greater for black patients (adjusted odds ratio
[OR], 1.25; 95% confidence interval [CI], 1.13-1.39; P <.001), and not
statistically different for Asian (OR, 1.33; 95% CI, 0.99-1.77; P =.05)
and Hispanic patients (adjusted OR, 1.08; 95% CI, 0.94-1.23; P =.26).
Meta-regression showed a significant trend toward lower mortality rates in
most recent series in both black (P =.02) and white (P =.0007) and Asian
(P =.01) but not for Hispanic (P =.41). However, as mortality rates were
lower across the different races, the relative disadvantage between the
study groups persisted, which may explain the lack of interaction between
study period and race effect on mortality for black (adjusted P =.09),
Asian (adjusted P =.63), and Hispanic (adjusted P =.97) patients.
 Conclusion(s): The present meta-analysis showed that despite progress
is being made in lowering in-hospital mortality rates among the major
racial/ethnic groups, ethnical disparities in hospital mortality after
CABG remain. Copyright © 2018 The American Association for
Thoracic Surgery

<45>
[Use Link to view the full text]
Accession Number
627081758
Title
Beta-blocker therapy reduces mortality in patients with coronary artery
disease treated with percutaneous revascularization: A meta-analysis of
adjusted results.
Source
Journal of Cardiovascular Medicine. 19 (7) (pp 337-343), 2018. Date of
Publication: 2018.
Author
Peyracchia M.; Errigo D.; Rubin S.R.; Conrotto F.; Dinicolantonio J.J.;
Omede P.; Rettegno S.; Iannaccone M.; Moretti C.; Damico M.; Gait F.;
Dascenzo F.
Institution
(Peyracchia, Errigo, Conrotto, Omede, Rettegno, Iannaccone, Moretti,
Damico, Gait, Dascenzo) Division of Cardiology, Department of Internal
Medicine, Turin, Italy
(Dinicolantonio) Saint Luke's Mid America Heart Institute, Kansas City,
MO, United States
(Rubin) Department of Cardiology and Coronary Care Unit, Hospital Clnico
Universitario de Santiago de Compostela, A Coruna, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims The long-term impact of beta blockers on prognosis in patients
treated with contemporary therapies for coronary artery disease remains to
be defined. Methods and results All observational studies evaluating the
impact of beta blockers in patients treated with coronary
revascularization and contemporary therapies and adjusted with
multivariate analysis were included. All-cause death was the primary
endpoint, while Major Adverse Cardiac Events (MACE) (composite endpoint of
all-cause death ormyocardial infarction, MI) and MI were secondary
endpoints. A total of 26 studies were included, with 863 335 patients.
After 3 (1-4.3) years, long-term risk of all-cause death was lower in
patients on beta blockers [odds ratio, OR 0.69 (0.66-0.72)], both for
Acute Coronary Syndrome (ACS) [OR 0.60 (0.56-0.65)], and stable angina
patients [OR 0.84 (0.78-0.91)], independently from ejection fraction [OR
0.64 (0.42-0.98) for reduced ejection fraction and OR 0.79 (0.69-0.91) for
preserved ejection fraction]. The risk of long-term MACE was lower but
NSforACSpatients treated with beta blockers [OR 0.83 (0.69-1.00)], as in
stable angina. Similarly, risk of MI did not differ between patients
treated with beta blockers or without beta blockers [OR 0.99 (0.89-1.09),
all 95% confidence intervals]. Using meta-regression analysis, the benefit
of beta blockers was increased for those with longer follow-up. The number
needed to treatwas 52 to avoidone event of all-causedeath for ACS patients
and 111 for stable patients. Conclusion Even in percutaneous coronary
intervention era, beta blockers reduce mortality in patients with coronary
artery disease, confirming their protective effect, which was consistent
for both ACS and stable patients indifferently of preserved or reduced
ejection fraction. Copyright © 2018 Italian Federation of
Cardiology.

<46>
Accession Number
627189492
Title
Periprocedural anticoagulation in mechanical heart valve patients - a
single centre review of practice.
Source
British Journal of Haematology. Conference: 59th Annual Scientific Meeting
of the British Society for Hematology. United Kingdom. 185 (Supplement 1)
(pp 193-194), 2019. Date of Publication: March 2019.
Author
Mullally R.; Swallow G.
Institution
(Mullally, Swallow) Department of Clinical Haematology, Nottingham
University Hospitals NHS Trust, Nottingham, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Patients with mechanical heart valves (MHVs) require lifelong
anticoagulation, usually with a Vitamin K antagonist (VKA), to prevent
valve thrombosis. There are certain situations where VKA treatment needs
to be interrupted; for example to allow certain invasive procedures. The
perioperative anticoagulation management of these patients is
controversial; some would recommend that formal bridging anticoagulation
is not always required, some would recommend treatment dose low molecular
weight heparin (LMWH), whereas others recommend the use of intravenous
(IV) unfractionated heparin (UFH) depending on circumstances. Recent BCSH
guidelines have sought to address this, but within our centre consensus
had not been reached for the management of this patient group. We
retrospectively examined the perioperative anticoagulation management of
patients with MHVs in terms of their anticoagulant management over a
1-year period. This work was undertaken as part of an ongoing project
within our centre to produce local perioperative guidelines for patients
taking VKAs. The Anticoagulation Clinic electronic database was searched
for patients with metallic cardiac valves who required interruption of
anticoagulation to facilitate an invasive procedure between
01.01.2017-31.12.2017. The hospital records for each patient were searched
to identify the valve site, usual anticoagulant used, procedure
undertaken, duration of interruption of anticoagulation, whether bridging
anticoagulation was used, the choice of agent and who made the
perioperative plan. Finally, data was collected on any bleeding or
thrombotic complications associated with anticoagulant interruption or use
of bridging anticoagulation. 38 patients on a VKA underwent interruption
for an invasive procedure or surgery during the 12 month period. 55
procedures were undertaken. Some patients had more than 1 interruption in
12 months (n = 11) and some had more than 1 procedure in a single period
of interruption of VKA (n = 3). 25 patients had a metallic aortic valve
and 13 had a metallic mitral valve. A wide variety of specialists were
involved in making perioperative anticoagulation plans, but it was
surprising that despite that lack of local written guidelines at this time
at our centre, a Haematologist was involved in only 1/55 (1.8%) of cases
and a Cardiology/Cardiothoracic Consultant or Registrar were involved in
only 23/55 (41.8%) of cases. In 25/55 (45.5%) none of the aforementioned
teams were involved in planning and in 6/55 (10.9%) it was not recorded.
Hence, there is a clear need for formalised local guidance to ensure these
patients are managed safely and effectively. In terms of choice of
anticoagulant, 25.4% of cases used IVUFH as part of the bridging protocol
however only 6 cases (10.9%) received IV UFH as the sole therapy. There
was some concern that the use of LMWH as opposed to IVUFH could put
patients at increased risk of valve thrombosis however this was not
reflected in our data. There was one case of suspected valve thrombosis
whilst being bridged with LMWH, but further investigation it was found
that there was valve dysfunction before LMWH was commenced. A published
meta-analysis including 1042 patients with MHVs is consistent with our
findings of low rates of valve thrombosis with LMWH. There were 9 bleeding
incidents in the 55 procedure episodes in our cohort, all of which
occurred in the post-operative period. Anticoagulation was not the direct
cause of any of these events.

<47>
[Use Link to view the full text]
Accession Number
627173142
Title
Randomized Trial Evaluating Percutaneous Coronary Intervention for the
Treatment of Chronic Total Occlusion.
Source
Circulation. 139 (14) (pp 1674-1683), 2019. Date of Publication: 02 Apr
2019.
Author
Lee S.-W.; Lee P.H.; Ahn J.-M.; Park D.-W.; Yun S.-C.; Han S.; Kang H.;
Kang S.-J.; Kim Y.-H.; Lee C.W.; Park S.-W.; Hur S.H.; Rha S.-W.; Her
S.-H.; Choi S.W.; Lee B.-K.; Lee N.-H.; Lee J.-Y.; Cheong S.-S.; Kim M.H.;
Ahn Y.-K.; Lim S.W.; Lee S.-G.; Hiremath S.; Santoso T.; Udayachalerm W.;
Cheng J.J.; Cohen D.J.; Muramatsu T.; Tsuchikane E.; Asakura Y.; Park
S.-J.
Institution
(Lee, Lee, Ahn, Park, Kang, Kang, Kim, Lee, Park, Park) Department of
Cardiology (S-W.L., P.H.L., J.-M.A., S.-W.P., Center for Medical Research
and Information, University of Ulsan College of Medicine, Asan Medical
Center, Seoul, South Korea
(Yun) Biostatistics (S.-C.Y.), Center for Medical Research and
Information, University of Ulsan College of Medicine, Asan Medical Center,
Seoul, South Korea
(Han) Department of Applied Statistics, Gachon University, Seongnam
(Hur) Department of Cardiology, Keimyung University Dongsan Medical
Center, Daegu, South Korea
(Rha) Department of Cardiology, Korea University Guro Hospital
(Her) Department of Cardiology, Catholic University of Korea, Daejeon St.
Mary's Hospital (S.-H.H.)
(Choi) Department of Cardiology, Chungnam National University Hospital,
Daejeon, South Korea
(Lee) Department of Cardiology, Kangwon National University Hospital,
Chuncheon, South Korea
(Lee) Department of Cardiology, Soon Chun Hyang University Hospital
Bucheon
(Lee) Department of Cardiology, Kangbuk Samsung Medical Center, Seoul,
South Korea
(Cheong) Department of Cardiology, Gangneung Asan Hospital
(Kim) Department of Cardiology, Dong-A University Hospital, Busan, South
Korea
(Ahn) Department of Cardiology, Chonnam National University Hospital,
Gwangju
(Lim) Department of Cardiology, CHA Bundang Medical Center, Seongnam
(Lee) Department of Cardiology, Ulsan University Hospital
(Hiremath) Department of Cardiology, Ruby Hall Clinic, Pune, India
(Santoso) Department of Cardiology, Medistra Hospital, Jakarta, Indonesia
(Udayachalerm) Department of Cardiology, King Chulalongkorn Memorial
Hospital, Bangkok, Thailand
(Cheng) Department of Cardiology, Shin Kong Hospital, Taipei, Taiwan
(Republic of China)
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, United
States
(Muramatsu) Department of Cardiology, Tokyo General Hospital, Japan (T.M.)
(Tsuchikane) Toyohashi Heart Center, Japan (E.T.), Aichi, Japan
(Asakura) Department of Cardiology, Hakujikai Memorial Hospital, Japan
(Y.A.), Tokyo, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Procedural results for percutaneous coronary intervention
(PCI) in coronary vessels with chronic total occlusion (CTO) have improved
in recent years, and PCI strategies have moved toward more complete
revascularization with more liberal use of CTO-PCI. However, evidence
evaluating CTO-PCI is limited to observational studies and small clinical
trials. METHOD(S): In this open-label, multicenter, randomized,
noninferiority trial, PCI-eligible patients were assigned to receive
either 1 of 2 strategies: PCI or no PCI for the qualifying de novo CTO
lesion with the option for PCI of obstructive non-CTO lesions at the
discretion of the operator. The primary end point was a composite of
death, myocardial infarction, stroke, or any revascularization.
Health-related quality of life was assessed at baseline and at 1, 6, 12,
24, and 36 months. Because of slow recruitment, the trial was stopped
before completion of the 1284 planned enrollments. RESULT(S): Between
March 2010 and September 2016, 834 patients were randomly assigned to the
CTO-PCI (n=417) or no CTO-PCI (n=398) strategy. Among the patients
assigned to the no CTO-PCI strategy, 78 (19.6%) crossed over to receive
staged CTO-PCI within 3 days of randomization. The overall CTO-PCI success
rate was 90.6%. Serious nonfatal complications associated with CTO-PCI
occurred in 3 patients (1 stroke, 1 cardiac tamponade, and 1 patient with
recurrent episodes of ventricular tachyarrhythmia induced by intracoronary
thrombus). Approximately half of the patients in each group underwent PCI
for an average of 1.3 non-CTO lesions, resulting in a comparable residual
SYNTAX score (Synergy Between PCI With TAXUS and Cardiac Surgery;
3.7+/-5.4 versus 4.0+/-5.9, P=0.42) confined to non-CTO vessels. During a
median follow-up of 4.0 years (interquartile range, 2.4 to 5.1 years),
there was no significant difference between the CTO-PCI and the no CTO-PCI
strategies in the incidence of the primary end point (22.3% versus 22.4%,
hazard ratio, 1.03; 95% CI, 0.77 to 1.37; P=0.86). Both CTO-PCI and no
CTO-PCI strategy were associated with significant improvements but without
between-group differences in disease-specific health status that was
sustained through 36 months. CONCLUSION(S): CTO-PCI was feasible with
high success rates. There was no difference in the incidence of major
adverse cardiovascular events with CTO-PCI versus no CTO-PCI, but the
study was limited by low power for clinical end points and high crossover
rates between groups. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov . Unique identifier: NCT01078051.

<48>
Accession Number
627177149
Title
Identification of Low Cardiac Output Syndrome at the Bedside: A Pediatric
Cardiac Intensive Care Unit Survey.
Source
Critical care nurse. 39 (2) (pp e1-e7), 2019. Date of Publication: 01 Apr
2019.
Author
Nordness M.J.; Westrick A.C.; Chen H.; Clay M.A.
Institution
(Nordness, Westrick, Chen, Clay) Matthew J. Nordness is a first-year
medical student at the Vanderbilt University School of MedicineTennessee.
At the time this work was performed ,he was a registered nurse in the
pediatric cardiac intensive care unit at the Monroe Carell Jr Children's
Hospital at Vanderbilt, Nashville, United States
(Nordness, Westrick, Chen, Clay) University of Miami, Vanderbilt
University Medical Center, a clinical research coordinator for Surgical
Outcomes Center for Kids Nashville, Ashly C. Westrick is a graduate
studentFlorida. At the time this work was performed ,she was a site
manager, Miami, TN, United States
(Nordness, Westrick, Chen, Clay) Vanderbilt University School of Medicine,
Heidi Chen is a research assistant professor of biostatistics, Nashville,
TN, United States
(Nordness, Westrick, Chen, Clay) Division of Critical Care Medicine,
Department of Pediatrics at Vanderbilt University School of Medicine, Mark
A. Clay is an assistant professor of pediatrics
Publisher
NLM (Medline)
Abstract
BACKGROUND: Low cardiac output syndrome is a transient constellation of
signs and symptoms that indicate the heart's inability to supply
sufficient oxygen to tissues and end-organs to meet metabolic demand.
Because the term lacks a standard clinical definition, the bedside
diagnosis of this syndrome can be difficult. OBJECTIVE(S): To
evaluate concordance among pediatric cardiac intensive care unit nurses in
their identification of low cardiac output syndrome in pediatric patients
after cardiac surgery. METHOD(S): An anonymous survey was distributed
to 69 pediatric cardiac intensive care unit nurses. The survey described
10 randomly selected patients aged 6 months or younger who had undergone
corrective or palliative cardiac surgery at a freestanding children's
hospital in a tertiary academic center. For each patient, data were
presented corresponding to 5 time points (0, 6, 12, 18, and 24 hours
postoperatively). The respondent was asked to indicate whether the patient
had low cardiac output syndrome (yes or no) at each time point on the
basis of the data presented. RESULT(S): The response rate was 46% (32
of 69 nurses). The overall Fleiss k value was 0.30, indicating fair
agreement among raters. When the results were analyzed by years of
experience, agreement remained only slight to fair. CONCLUSION(S):
Regardless of years of experience, nurses have difficulty agreeing on the
presence of low cardiac output syndrome. Further research is needed to
determine whether the development of objective guidelines could improve
recognition and facilitate communication between the pediatric cardiac
intensive care unit nurse and the medical team. Copyright ©2019
American Association of Critical-Care Nurses.

<49>
Accession Number
627177127
Title
Effect of perioperative administration of dexmedetomidine on delirium
after cardiac surgery in elderly patients: a double-blinded, multi-center,
randomized study.
Source
Clinical interventions in aging. 14 (pp 571-575), 2019. Date of
Publication: 2019.
Author
Shi C.; Jin J.; Qiao L.; Li T.; Ma J.; Ma Z.
Institution
(Shi, Jin, Qiao, Li, Ma, Ma) Department of Anesthesiology, Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong
264000, China
Publisher
NLM (Medline)
Abstract
Objective: Postoperative delirium (POD) is a serious complication in
elderly patients undergoing cardiac surgery. This study was aimed at
investigating the effect of perioperative administration of
dexmedetomidine for general anesthesia maintenance on occurrence and
duration of POD in elderly patients after cardiac surgery. Method(s):
One hundred and sixty-four patients were enrolled after cardiac surgery
between June 2009 and December 2016. Patients were assigned by a
computer-generated randomization sequence in a 1:1 ratio to receive
dexmedetomidine general anesthesia maintenance or propofol general
anesthesia maintenance. POD was assessed every day with confusion
assessment method for intensive care units (ICU) during the first 5
postoperative days. Result(s): There was no significance in incidence
of POD between the dexmedetomidine group and the propofol group
(P=0.0758). In patients treated with dexmedetomidine, the median onset
time of delirium was delayed (second day vs first day) and the duration of
delirium reduced (2 days vs 3 days) when compared with propofol-treated
patients. The dexmedetomidine-treated patients also displayed a lower VAS
score and less opiate analgesic consumption. No difference was observed in
respect to other postoperative outcomes. Conclusion(s): For elderly
patients, perioperative administration of dexmedetomidine reduced
incidence, delayed onset and shortened duration of POD after cardiac
surgery.

<50>
Accession Number
627176506
Title
Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis.
Source
Nutrients. 11 (4) (no pagination), 2019. Date of Publication: 27 Mar 2019.
Author
Hemila H.; Chalker E.
Institution
(Hemila) Department of Public Health, University of Helsinki, POB 41,
Helsinki FI-00014, Finland
(Chalker) School of Public Health, University of Sydney, Sydney 2006,
Australia
Publisher
NLM (Medline)
Abstract
A number of controlled trials have previously found that in some contexts,
vitamin C can have beneficial effects on blood pressure, infections,
bronchoconstriction, atrial fibrillation, and acute kidney injury.
However, the practical significance of these effects is not clear. The
purpose of this meta-analysis was to evaluate whether vitamin C has an
effect on the practical outcomes: length of stay in the intensive care
unit (ICU) and duration of mechanical ventilation. We identified 18
relevant controlled trials with a total of 2004 patients, 13 of which
investigated patients undergoing elective cardiac surgery. We carried out
the meta-analysis using the inverse variance, fixed effect options, using
the ratio of means scale. In 12 trials with 1766 patients, vitamin C
reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%;
p = 0.00003). In six trials, orally administered vitamin C in doses of 1-3
g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p
= 0.003). In three trials in which patients needed mechanical ventilation
for over 24 hours, vitamin C shortened the duration of mechanical
ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the
insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth
exploring. The effects of vitamin C on ICU patients should be investigated
in more detail.

<51>
Accession Number
627131064
Title
Paraplegia prevention in aortic aneurysm repair by thoracoabdominal
staging with 'minimally invasive staged segmental artery coil
embolisation' (MIS2ACE): Trial protocol for a randomised
controlled multicentre trial.
Source
BMJ Open. 9 (3) (no pagination), 2019. Article Number: e025488. Date of
Publication: 01 Mar 2019.
Author
Petroff D.; Czerny M.; Kolbel T.; Melissano G.; Lonn L.; Haunschild J.;
Von Aspern K.; Neuhaus P.; Pelz J.; Epstein D.M.; Romo-Aviles N.;
Piotrowski K.; Etz C.D.
Institution
(Petroff, Neuhaus, Piotrowski) Clinical Trial Centre, University of
Leipzig, Leipzig, Germany
(Czerny) Department of Cardiovascular Surgery, Universitats-Herzzentrum
Freiburg, Bad Krozingen GmbH, Bad Krozingen, Germany
(Czerny) Department of Cardiovascular Surgery, Albert-Ludwigs-Universitat,
Freiburg Medizinische Fakultat, Freiburg, Germany
(Kolbel) Department of Vascular Medicine, University Heart Center Hamburg,
Hamburg, Germany
(Melissano) Division of Vascular Surgery, Universita Vita Salute San
Raffaele, Milano, Italy
(Lonn) Department of (Interventional) Radiology, Rigshospitalet,
Kobenhavn, Denmark
(Haunschild, Von Aspern, Etz) Department of Cardiac Surgery, University
Heart Center Leipzig, Leipzig, Germany
(Pelz) Department of Neurology, Universitatsklinikum Leipzig, Leipzig,
Germany
(Epstein) Economia Aplicada, Universidad de Granada, Campus de Cartuja,
Granada, Spain
(Romo-Aviles) Department of Social Anthropology, University of Granada,
Granada, Spain
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Spinal cord injury (SCI) including permanent paraplegia
constitutes a common complication after repair of thoracoabdominal aortic
aneurysms. The staged-repair concept promises to provide protection by
inducing arteriogenesis so that the collateral network can provide a
robust blood supply to the spinal cord after intervention. Minimally
invasive staged segmental artery coil embolisation (MIS 2 ACE) has been
proved recently to be a feasible enhanced approach to staged repair.
Methods and analysis This randomised controlled trial uses a multicentre,
multinational, parallel group design, where 500 patients will be
randomised in a 1:1 ratio to standard aneurysm repair or to MIS 2 ACE in
1-3 sessions followed by repair. Before randomisation, physicians document
whether open or endovascular repair is planned. The primary endpoint is
successful aneurysm repair without substantial SCI 30 days after aneurysm
repair. Secondary endpoints include any form of SCI, mortality (up to 1
year), length of stay in the intensive care unit, costs and
quality-adjusted life years. A generalised linear mixed model will be used
with the logit link function and randomisation arm, mode of repair (open
or endovascular repair), the Crawford type and the European System for
Cardiac Operative Risk Evaluation (euroSCORE) II as fixed effects and the
centre as a random effect. Safety endpoints include kidney failure,
respiratory failure and embolic events (also from debris). A qualitative
study will explore patient perceptions. Ethics and dissemination This
trial has been approved by the lead Ethics Committee from the University
of Leipzig (435/17-ek) and will be reviewed by each of the Ethics
Committees at the trial sites. A dedicated project is coordinating
communication and dissemination of the trial. Copyright © 2019
Author(s).

<52>
[Use Link to view the full text]
Accession Number
627081693
Title
Effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 16 (12) (pp
2304-2329), 2018. Date of Publication: 2018.
Author
Mares M.A.; McNally S.; Fernandez R.S.
Institution
(Mares, McNally) School of Nursing and Midwifery, Western Sydney
University, Parramatta, Australia
(Mares) Centre for Applied Nursing Research, Liverpool, Australia
(Mares, McNally) New S. Wales Centre for Evidence Based Health Care: A
Joanna Briggs Institute Centre of Excellence, Liverpool, Australia
(Mares) Ingham Institute for Applied Medical Research, Liverpool,
Australia
(Fernandez) School of Nursing, University of Wollongong, Wollongong,
Australia
(Fernandez) Centre for Research in Nursing and Health, St George Hospital,
Kogarah, Australia
(Fernandez) Centre for Evidence Based Initiatives in Health Care: A Joanna
Briggs Institute Centre of Excellence, Australia
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review objective: The objective of this review was to investigate the
effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery on patients' health-related quality
of life and hospital readmission. Introduction: Coronary heart disease is
a major cause of death and disability worldwide, putting a great strain on
healthcare resources. For the past two decades, population-wide primary
prevention and individual healthcare approaches have resulted in a
dramatic decline in overall cardiac mortality. Over the intervening years,
surgical techniques in cardiology have also improved substantially. As a
result, long-term outcomes in patients treated with coronary artery bypass
graft surgery have established the treatment's effectiveness and survival
benefit. Furthermore, participating in cardiac rehabilitation following
coronary artery bypass graft surgery has also demonstrated a significant
decrease in all-cause cardiac mortality in these patients. Inclusion
criteria: This review included studies with participants aged 18 years and
over, post coronary artery bypass graft surgery that evaluated nurse-led
cardiac rehabilitation (CR) programs compared with usual care or other
forms of CR. The outcomes of interest were the health-related quality of
life and hospital readmissions following coronary artery bypass graft
surgery and measured using validated scales. Randomized controlled trials
reported in English between 2000 to June 2017 were considered for
inclusion. Method(s): The search strategy aimed to find both
published and unpublished studies using a three-step search strategy. An
initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a
search for unpublished studies including Dissertation Abstracts
International, ProQuest Dissertations and Theses, Google Scholar, MedNar
and ClinicalTrials.gov. Papers selected for retrieval were assessed by two
independent reviewers for methodological validity prior to inclusion in
the review using the standardized critical appraisal tools from the Joanna
Briggs Institute System for the Unified Management, Assessment and Review
of Information (JBI SUMARI). Quantitative data was extracted from papers
included in the review using the standardized data extraction tool from
JBI-SUMARI. No meta-analysis was undertaken due to heterogeneity of the
outcome measures. All results were subject to double data entry. Effect
sizes expressed as risk ratio (for categorical data) and weighted mean
differences (for continuous data) and their 95% confidence intervals were
calculated for analysis. Result(s): Three trials involving 329
patients were included in the final review. The trials that investigated
the effect of home based cardiac rehabilitation programs compared to usual
care at six weeks, three months and six months follow-up demonstrated no
statistically significant difference in health-related quality of life at
any of the follow-up periods. However, one study demonstrated
significantly higher scores related to health-related quality of life
among those who received nurse-led home based cardiac rehabilitation
(154.93+/-4.6) compared to those who received usual care (134.20+/-8.2) at
two months follow-up. No trials were identified that compared the
effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery on readmissions to hospital.
 Conclusion(s): There is not enough evidence to support or discourage
nurse-led cardiac rehabilitation programs on health-related quality of
life in patients following coronary artery bypass graft surgery. However,
the sparse data available suggests improvements in health-related quality
of life at two months follow-up among those who received a nurse-led
program. Further large-scale multicenter trials with standardized
methodology are needed to determine the effect of nurse-led cardiac
rehabilitation programs on health-related quality of life and rates of
readmission to hospital following coronary artery bypass graft
surgery. Copyright © 2018 THE JOANNA BRIGGS INSTITUTE.

<53>
Accession Number
627179088
Title
Sutured and sutureless repair of postinfarction left ventricular free-wall
rupture: a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 01 Apr 2019.
Author
Matteucci M.; Fina D.; Jiritano F.; Blankesteijn W.M.; Raffa G.M.;
Kowaleski M.; Beghi C.; Lorusso R.
Institution
(Matteucci, Fina, Jiritano, Lorusso) Department of Cardiothoracic Surgery,
Heart and Vascular Centre, Maastricht University Medical Centre,
Maastricht, Netherlands
(Matteucci, Beghi) Department of Cardiac Surgery, Circolo Hospital,
University of Insubria, Varese, Italy
(Fina) Department of Cardiology, University of Milan, IRCCS Policlinico
San Donato, Milan, Italy
(Jiritano) Department of Cardiac Surgery, University Magna Graecia of
Catanzaro, Catanzaro, Italy
(Blankesteijn) Department of Pharmacology and Toxicology, Cardiovascular
Research Institute Maastricht, Maastricht University, Maastricht,
Netherlands
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, Palermo, Italy
(Kowaleski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
Postinfarction left ventricular free-wall rupture is a potentially
catastrophic event. Emergency surgical intervention is almost invariably
required, but the most appropriate surgical procedure remains
controversial. A systematic review, from 1993 onwards, of all available
reports in the literature about patients undergoing sutured or sutureless
repair of postinfarction left ventricular free-wall rupture was performed.
Twenty-five studies were selected, with a total of 209 patients analysed.
Sutured repair was used in 55.5% of cases, and sutureless repair in the
remaining cases. Postoperative in-hospital mortality was 13.8% in the
sutured group, while it was 14% in the sutureless group. A trend towards a
higher rate of in-hospital rerupture was observed in the sutureless
technique. The most common cause of in-hospital mortality (44%) was low
cardiac output syndrome. In conclusion, sutured and sutureless repair for
postinfarction left ventricular free-wall rupture showed comparable
in-hospital mortality. However, because of the limited number of patients
and the variability of surgical strategies in each reported series,
further studies are required to provide more consistent data and lines of
evidence. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<54>
Accession Number
2001817942
Title
Efficacy of preoperative amino acid supplements on postoperative physical
function and complications in open heart surgery patients: A study
protocol for a randomized controlled trial.
Source
Journal of Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Ogawa M.; Yoshida N.; Satomi-Kobayashi S.; Tsuboi Y.; Komaki K.; Wakida
K.; Gotake Y.; Inoue T.; Tanaka H.; Yamashita T.; Sakai Y.; Izawa K.P.;
Takahashi M.; Ogawa W.; Hirata K.-I.
Institution
(Ogawa, Tsuboi, Komaki) Division of Rehabilitation Medicine, Kobe
University Hospital, Kobe, Japan
(Ogawa, Izawa) Department of Public Health, Kobe University Graduate
School of Health Sciences, Kobe, Japan
(Yoshida, Satomi-Kobayashi, Yamashita, Hirata) Division of Cardiovascular
Medicine, Department of Internal Medicine, Kobe University Graduate School
of Medicine, Kobe, Japan
(Wakida, Takahashi, Ogawa) Department of Nutrition, Kobe University
Hospital, Kobe, Japan
(Gotake, Inoue, Tanaka) Division of Cardiovascular Surgery, Department of
Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
(Sakai) Division of Rehabilitation Medicine, Kobe University Graduate
School of Medicine, Kobe, Japan
(Takahashi, Ogawa) Division of Diabetes and Endocrinology, Department of
Internal Medicine, Kobe University Graduate School of Medicine, Kobe,
Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Elderly patients undergoing cardiac surgery often show poor
nutritional status, muscle wasting, and sarcopenia, which are reported to
affect postoperative functional recovery and incidence of complications.
Amino acids are essential in maintaining nutritional status, synthesizing
muscle protein, and promoting beneficial energy balance of the heart
muscle. beta-Hydroxy beta-methylbutyric acid (HMB) is a leucine metabolite
known to increase muscle protein synthesis and inhibit protein catabolism;
it has been used to more effectively support patients with muscle wasting
due to wearing diseases. However, the efficacy of amino acid
administration comprising HMB in patients undergoing open heart surgery
remains unclear. This study aims to examine whether preoperative
short-term aggressive amino acid administration helps support
postoperative recovery of physical function and prevent complications.
 Method(s): This is a single-center prospective randomized controlled
trial (UMIN000030490). Patients aged >=65 years who will be hospitalized
for medical examination before cardiac surgery will be recruited. The
participants will be randomly assigned to the experimental or control
group. The experimental group will be administered with an amino acid
supplement with HMB 1200 mg, L-glutamine 7000 mg, and L-arginine 7000 mg
once or twice per day depending on the degree of renal dysfunction, for
14-28 days preoperatively. The control group will not receive any
nutritional intervention. The main outcome will be a change in the 6-min
walking test distance pre- and postoperatively as a sign of functional
recovery. Secondary outcomes such as the incidence of complications;
physical, nutritional, and psychological states; mortality; and length of
hospital stay will also be evaluated. Conclusion(s): This clinical
study will determine the effects of preoperative short-term oral amino
acid supplementation with HMB, L-glutamine, and L-arginine on
postoperative physical function in elderly patients undergoing cardiac
surgery. Copyright © 2019

<55>
Accession Number
2001800699
Title
TCTAP A-093 The Prevalence of Leaflet Thrombosis in Intra-annular Versus
Supra-annular Transcatheter Aortic Valve Prostheses.
Source
Journal of the American College of Cardiology. Conference: 24th
Cardiovascular Summit Transcatheter Cardiovascular Therapeutics Asia
Pacific (TCTAP). South Korea. 73 (15 Supplement) (pp S50), 2019. Date of
Publication: 23 April 2019.
Author
Rashid H.; Khav N.; Gooley R.; Amiruddin A.; Nasis A.; Cameron J.; Brown
A.
Institution
(Rashid) Monash Health and Monash University, Australia
(Khav) Monash Health and Monash University, Melbourne, Victoria
(Australia)h and Monash University, Melbourne, Australia
(Gooley) Monash Health, Australia
(Amiruddin) Monash Health and Monash University, Victoria, Melbourne,
Australia
(Nasis, Cameron, Brown) Monash Heart, Australia
Publisher
Elsevier USA
Abstract
Background: Leaflet thrombosis (LT) defined by computed tomography (CT)
following transcatheter aortic valve replacement (TAVR) has been
increasingly recognized. The neo-sinus plays an important role in the
development of LT. Bench-side studies and small observational registries
have demonstrated a larger neo-sinus is associated with higher blood
stasis and larger weighted thrombus volumes. Intra-annular valves (IAV)
have a larger neo-sinus when compared to supra-annular valves (SAV), and
has been associated with larger thrombus burden and blood stasis. The
prevalence of LT with IAV and SAV in a larger, diverse cohort is unknown.
 Method(s): We performed a systematic review and pooled analysis to
assess the prevalence of LT in IAV versus SAV in TAVR prostheses.
Inclusion criteria were 1) reported CT-defined LT following TAVR, 2)
comparison between LT and non-LT cohort, 3) separate registry/database and
4) fully published status. A total of 2013 citations were reviewed and 7
studies were included. We defined the following valve systems as IAV;
Edwards SAPIEN (I, XT and 3), Lotus, Portico, Centera and Direct Flow,
while the Medtronic Corevalve (Corevalve/Evolut R) and Symetis Acurate Neo
TF were defined as SAV prostheses. In Makkar et al., we only reported the
Portico cohort as the rest was later updated in Chakravarty et al. Pooled
analysis of LT was assessed with Chi-Square Test of Independence.
 Result(s): Overall, 1,644 patients were included from 7 observational
studies and the pooled prevalence of LT following TAVR was 12.8%. The
Portico valve system (IAV) had the highest prevalence of LT with 35.2%,
followed by Symetis Acurate Neo (SAV) at 15.4% and the Lotus valve system
(IAV) at 14.5%. LT occurred more frequently in IAV than SAV (13.5% vs. 7%,
p = 0.02). Majority of the IAV was represented by the Sapien valves whilst
the Corevalve represented most of the SAV. The higher rates of LT in
Portico valves (35.2%) could have skewed the results. Therefore, a
sub-analysis of IAV vs. SAV with the exclusion of the Portico valve was
performed to ensure results were not influenced by this valve system. This
revealed IAV had a trend of higher rates of LT (12.1% vs. 7%, p = 0.06).
 Limitation(s): 1. Limited available studies which were observational
in nature 2. Variability in CT scanners and timing of CT 3. Did not
include other potential factors that impact LT (antithrombotic regimen) 4.
A small number of supra-annular valves [Figure presented] [Figure
presented] Conclusion(s): In summary, IAV prostheses appear to be
associated with higher rates of LT when compared with SAV. Future
randomized trials are warranted to assess the prevalence of LT between
different TAVR designs. Copyright © 2019

<56>
Accession Number
2001644179
Title
REPORTING OF CARDIOVASCULAR EVENTS IN CLINICAL TRIALS SUPPORTING
FDA-APPROVAL OF CONTEMPORARY CANCER DRUGS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1879), 2019.
Date of Publication: 12 March 2019.
Author
Addison D.; Bonsu J.; Charles L.; Guha A.; Baker B.; Woyach J.; Awan F.;
Rogers K.; Lustberg M.; Reinbolt R.; Brammer J.; Miller E.; Jneid H.;
Paskett E.
Institution
(Addison, Bonsu, Charles, Guha, Baker, Woyach, Awan, Rogers, Lustberg,
Reinbolt, Brammer, Miller, Jneid, Paskett) Ohio State University,
Columbus, OH, United States
Publisher
Elsevier USA
Abstract
Background: Cardiovascular disease (CVD) is a leading cause of morbidity
and mortality among patients treated with anticancer therapies. In the US,
novel cancer therapy trials are required to report concerning adverse
events prior to Food and Drug Administration (FDA) approval. Yet, the
pattern and reported incidence of CVD events in these pivotal clinical
trials is unknown. Method(s): From the Drugs@FDA database, MEDLINE,
clinicaltrial.gov, and publicly available FDA reviews we identified all
pivotal (phase II and III) clinical trials tied to anticancer drug
approvals from 1998-2018. The primary outcome was the report of major
adverse cardiovascular events (MACE), defined as incident myocardial
infarction (MI), stroke, heart failure (HF), coronary or peripheral
revascularization, atrial fibrillation (AF) and CVD death, irrespective of
treatment arm. Pooled reported annualized incidence-rates of MACE were
compared to reported rates in a large contemporary similar-aged general
population using relative risks (RR). Population risk difference (RD) for
MACE was estimated. Differences in drug efficacy using pooled binary
endpoint hazard ratios (HR), based on the presence or absence of reported
MACE events were also assessed. Result(s): Overall, there were 189
trials, linked to 123 drugs, enrolling 97,365 participants (58.5+/-5
years, 46.0% female, 80.4% on biologic, targeted or immune-based
therapies) with 148,138 person-years of follow-up. Over a median follow-up
of 18 months, 954 cases of incident MACE (370 HF, 65 MI, 179 stroke, 29
revascularizations, 65 AF and 246 CVD deaths; 680 in the intervention vs
274 control arm; P<0.01) were reported, from the 48.7% of trials noting
any CVD. The overall weighted average incidence was 644 events per 100,000
person-years (777 per 100,000 in the intervention arm), compared to a
reported incidence of 1,408 among similar aged non-cancer trial subjects
(RR 0.46, P<0.01), translating into an RD of 764. There was no association
between reporting CVD events and drug efficacy (HR 0.60 vs 0.65; P =0.22).
 Conclusion(s): Among pivotal clinical trials linked to contemporary
FDA-approved cancer drugs, reported CVD event rates dramatically trail
reported population rates. Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<57>
Accession Number
2001644149
Title
NEGATIVE CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY PREDICTS LOW RISK OF
MAJOR ADVERSE CARDIOVASCULAR EVENTS FOLLOWING NON-CARDIAC SURGERY.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1510), 2019.
Date of Publication: 12 March 2019.
Author
Bajwa M.T.; Mathew S.; Pakala A.
Institution
(Bajwa, Mathew, Pakala) University of Oklahoma Health Sciences Center,
Oklahoma City, OK, United States
Publisher
Elsevier USA
Abstract
Background: Pre-operative cardiac risk stratification is an integral part
of surgical planning; stress testing and invasive coronary angiography
have not accurately predicted perioperative risk. Diagnostic accuracy of
coronary computed tomography angiography (CCTA) in this setting is not
well-established. Herein we aim to conduct a review of available
literature on CCTA in patients undergoing non-cardiac surgery (NCS).
 Method(s): Medline, Embase, and PubMed were systematically searched
for studies of CCTA to risk stratify the patients prior to a NCS. A
positive CCTA was defined as at least 50% coronary artery stenosis. The
primary outcome measure was major adverse cardiovascular events (MACE) at
3-6 months post-NCS. Result(s): A total of 7 observational studies
with 2549 (n) patients were included in the analysis. The negative
predictive value of CCTA was 97%, suggesting that a negative CCTA was
associated with a very low risk of MACE following NCS. The positive
predictive value of CCTA was 12%, suggesting that a positive CCTA may not
be associated with increased perioperative MACE. Conclusion(s): Our
study suggests that negative CCTA is associated with reduced risk of MACE
following NCS. This negative predictive value in the setting of NCS
correlates with that observed for CCTA in non-surgical patients. Low
positive predictive value of CCTA for peri-operative risk is likely
related to the high false positive rate of CCTA in detecting significant
coronary artery stenosis. Our analysis suggests that CCTA may have a
significant role in predicting MACE in patients undergoing NCS; randomized
controlled trials for CCTA and CCTA-FFR in the setting of NCS are needed.
Our study was limited by the fact that all the included studies were
observational studies rather than randomized controlled trials; location
of the lesion and peri-operative management was not clearly described in
the studies. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<58>
Accession Number
2001643918
Title
INITIAL RESULTS FROM A NEWLY ESTABLISHED SOLID STATE SPECT MYOCARDIAL FLOW
QUANTIFICATION PROGRAM.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1658), 2019.
Date of Publication: 12 March 2019.
Author
Nieves R.; Dietz J.; Soman P.
Institution
(Nieves, Dietz, Soman) University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
Publisher
Elsevier USA
Abstract
Background: We report data from our first twelve months of experience with
flow quantification with CZT SPECT Methods: Patients referred for
vasodilator stress MPI were randomly selected for dynamic imaging on a
DSPECT camera. The patient population was reflective of referral patterns
for MPI or post-heart transplant (HT)evaluation. Patient positioning was
accomplished with a hand-injected 1mCi Tc-99m sestamibi (MIBI) pre-scan.
Vasodilator stress, and rest/ stress MIBI injection using an automated
syringe pump, were performed with the patient under the camera. The
protocol consists of 9mCi and 30mCi of MIBI in 2ml saline followed by a 40
mL saline flush for the rest and stress studies, respectively, with the
tracer injection performed 50s after Regadenoson stress. Data acquired in
list mode were processed on the INVIA 4DM platform. Significant manual
adjustments were made to the blood pool and tissue ROI positions for input
and myocardial activity curve derivation. Result(s): Of 104
non-transplant patients, 83 had normal MPI. Global myocardial flow reserve
(MFR), peak stress flow (PSF) and rest flow (RF) were compared between
patients with normal and abnormal MPI (2.17 vs 1.89, p = .16; 2.91 vs
1.91, p= .00; and 1.5 vs 1.1, p= .028, respectively). Among patients with
normal MPI, MFR (2.1 vs 2.01, p= .287), PSF (3.1 vs 2.7, p= .044), and RF
(1.6 vs 1.5, p=.48) were compared between men and women. Among 16 HT
patients the RF was higher compared to non-transplant patients (1.8 vs
1.4, p=.032) while MF and PSF were similar. Conclusion(s): Myocardial
flow quantification with dynamic SPECT is feasible in the clinical setting
and provides physiologically tenable values. Further studies are needed to
evaluate its additive value to relative perfusion imaging. Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<59>
Accession Number
2001643837
Title
ANTITHROMBOTIC THERAPY AND CARDIOVASCULAR RISK IN PATIENTS WITH ATRIAL
FIBRILLATION AT HIGH RISK FOR THROMBOEMBOLIC EVENTS AFTER TRANSCATHETER
AORTIC VALVE REPLACEMENT: FROM THE PARTNER 2 TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1036), 2019.
Date of Publication: 12 March 2019.
Author
Kosmidou I.; Madhavan M.; Liu Y.; Alu M.; Biviano A.; Chakravarty T.;
Makkar R.; Thourani V.; Kodali S.; Leon M.
Institution
(Kosmidou, Madhavan, Liu, Alu, Biviano, Chakravarty, Makkar, Thourani,
Kodali, Leon) Cardiovascular Research Foundation, New York, NY, United
States
Publisher
Elsevier USA
Abstract
Background: We sought to determine patterns of antithrombotic therapy use
and impact on clinical outcomes in patients with AF and
CH<inf>2</inf>ADS<inf>2</inf>-VASc<inf>2</inf> score >= 2 undergoing
transcatheter aortic valve replacement (TAVR). Method(s): In the
randomized PARTNER 2 trial and associated registries, 1662 patients with
history of AF and CH<inf>2</inf>ADS<inf>2</inf>-VASc<inf>2</inf> score >=
2 comprised the study cohort. Outcomes at 2yrs were analyzed according to
antithrombotic therapy at discharge. Result(s): During the enrollment
period, 947 patients (47.7%) were discharged on oral anticoagulant therapy
(OAT) [793 (47.4%) on warfarin and 154 (9.3%) on Non-Vitamin K
antagonists]. Antiplatelet therapy (APT) was used for at least 6 months or
until an endpoint event in 364/793 (38.4%) of patients on OAT and 272/715
(38%) of patients not on OAT. At 2 yrs, the rate of the composite outcome
of death or stroke was similar in patients on OAT alone compared to no
therapy (31.5% vs 36.6%, p=0.18) but OAT plus APT significantly reduced
the rate of death or stroke compared to no therapy (21.8% vs 36.6%,
p<0.0001). By multivariable analyses, OAT alone conferred a similar
adjusted risk of death or stroke compared to no therapy. However, OAT plus
APT was associated with a significantly lower risk of death or stroke
compared to no therapy (HR 0.42, 95% CI 0.30-0.59, p<0.0001).
 Conclusion(s): In patients with AF and an absolute indication for OAT
undergoing TAVR for severe AS, OAT significantly reduced the risk of death
or stroke at 2 yrs only when used concomitantly with antiplatelet therapy.
[Figure presented] Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<60>
Accession Number
2001643702
Title
NON-TRANSFEMORAL TRANSCATHETER AORTIC VALVE REPLACEMENT APPROACH IS
ASSOCIATED WITH A HIGHER RISK OF NEW-ONSET ATRIAL FIBRILLATION: A
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1258), 2019.
Date of Publication: 12 March 2019.
Author
Angsubhakorn N.; Kittipibul V.; Prasitlumkum N.; Kewcharoen J.; Ungprasert
P.
Institution
(Angsubhakorn, Kittipibul, Prasitlumkum, Kewcharoen, Ungprasert)
University of Minnesota Medical School, Minneapolis, MN, United States
Publisher
Elsevier USA
Abstract
Background: New-onset atrial fibrillation (NOAF) is a frequent
complication of Transcatheter Aortic Valve Replacement (TAVR). Choice of
access routes for TAVR could be a factor that determines the risk of NOAF
although the data is not well-characterized. We aimed to assess the
association between different access routes for TAVR (transfemoral versus
non-transfemoral) and the risk of NOAF. Method(s): A comprehensive
literature review was performed through September 2018 using EMBASE and
MEDLINE. Eligible studies must compare the incidence of NOAF in patients
without pre-existing atrial fibrillation who underwent TAVR. Relative risk
(RR) and 95% confidence intervals (CI) were extracted from each study and
combined together using the random-effects model, generic inverse variance
method of DerSimonian and Laird. Result(s): Seven retrospective
studies with 18,425 patients who underwent TAVR (12,744 with transfemoral
approach, 5,681 with non-transfemoral approach) met the eligibility
criteria. After the procedures, 2,205 (12.0%) patients developed NOAF (656
(5.1%) patients in transfemoral group and 1,549 (27.3%) patients in
non-transfemoral group). There was a significant association between
non-transfemoral approach and the increased risk of NOAF with the pooled
RR of 2.94 (95%CI = 2.53-3.41, p < 0.00001). Conclusion(s): A
significantly increased risk of NOAF following TAVR among those underwent
non-transfemoral approach compared with transfemoral approach was observed
in this meta-analysis. [Figure presented] Copyright 2019 American
College of Cardiology Foundation. All rights reserved.

<61>
Accession Number
2001643613
Title
IMPACT OF MODERATE/SEVERE MITRAL REGURGITATION ON 2-YEAR OUTCOMES AFTER
TRANSCATHETER AORTIC VALVE REPLACEMENT IN THE REPRISE III RANDOMIZED
CONTROLLED TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1347), 2019.
Date of Publication: 12 March 2019.
Author
Little S.; Vannan M.; Singh S.; Khandheria B.; Allocco D.; Feldman T.;
Weissman N.; Asch F.
Institution
(Little, Vannan, Singh, Khandheria, Allocco, Feldman, Weissman, Asch)
Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
Publisher
Elsevier USA
Abstract
Background: Mitral (MR) and tricuspid regurgitation (TR) often coexist
with aortic stenosis. The impact of preoperative MR and TR on outcomes and
changes in MR and TR after transcatheter aortic valve replacement (TAVR)
were assessed. Method(s): Patients (pts, n=912) with high/extreme
risk and severe, symptomatic aortic stenosis were randomized to receive
either the Lotus or CoreValve (2:1) in REPRISE III. Relevant imaging
parameters were collected and echocardiograms were analyzed by an
independent core laboratory. MR and TR were graded as none/trace, mild,
moderate, or severe. Echocardiographic and clinical results were evaluated
at 2 years. Result(s): In REPRISE III, 11% of patients had baseline
>=moderate MR or >=moderate TR. MR and TR severity improved or was
unchanged in most pts 2 years post-TAVR (MR: 30% improved, 35% unchanged,
7% worsened; TR: 22%, 36%, 18%, respectively). Outcomes at 2 years were
worse in pts with baseline >=moderate MR or TR; rates of hospitalization
and death/hospitalization were significantly worse in pts with baseline
>=moderate MR or TR compared to those without (Table). Bleeding and repeat
procedures were more common in pts with >=moderate MR than without
(Table). Predictors of improvement and impact of persistent MR and TR on
outcomes will be available for the presentation. [Table presented]
 Conclusion(s): Preoperative >=moderate MR or TR contribute to poorer
outcomes in pts undergoing TAVR. Moderate/severe MR and TR were associated
with more frequent hospitalization and
death/hospitalization. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<62>
Accession Number
2001643265
Title
TEMPORAL TRENDS IN 30-DAY AND 1-YEAR MORTALITY RATES AFTER TRANSCATHETER
AORTIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND META-REGRESSION
ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1091), 2019.
Date of Publication: 12 March 2019.
Author
Mattke S.; Schneider S.; Orr P.; Lakdawalla D.; Goldman D.
Institution
(Mattke, Schneider, Orr, Lakdawalla, Goldman) University of Southern
California, Los Angeles, CA, United States
Publisher
Elsevier USA
Abstract
Background: Anecdotal evidence suggests that risk-adjusted mortality rates
after TAVR have been declining over the years as the procedure became more
routinized and device technology improved. Confirming this finding with a
systematic assessment of the evidence could have substantial implications
for the choice between TAVR and surgical valve replacements in patients
who are eligible for both approaches. Method(s): We conducted a
systematic review of the published literature up to June 20, 2018 and
extracted data on 30-day and 1-year mortality rates, surgical risk, device
type, study design, and the proportion of procedures that used a
transapical approach. We used meta-regression techniques to test whether
risk-adjusted 30-day and 1-year mortality rates declined over time.
 Result(s): We identified 145 studies, which yielded 179 subsamples
for the analyses, once results for separately reported subgroups were
broken out. Of these, 160 subsamples (89%) representing 137 studies and
91,652 patients contained information on 30-day mortality, and 93
subsamples (52%) representing 84 studies and 40,765 patients information
on 1-year mortality. The adjusted 30-day mortality rate after TAVR fell
from 10.48% (95% CI 7.97-11.65%) in 2007 to 2.27% (95% CI 1.14-4.49%) in
2016, corresponding to a relative decrease of 78% over 10 years. The
adjusted mortality rate within one year after TAVR was 30.24% (95% CI
24.53-36.65%) in 2007 and fell to 11.35% (95% CI 8.32-15.31%) in 2014,
corresponding to a relative decrease of 63% over 8 years.
 Conclusion(s): The results suggest that near-term survival after TAVR
has improved substantially within the short period of time after the
procedure was introduced and support the increasing utilization of
TAVR. Copyright 2019 American College of Cardiology Foundation. All
rights reserved.

<63>
Accession Number
2001643143
Title
BASELINE SIGNIFICANT TRICUSPID REGURGITATION INCREASES RISK OF MORTALITY
IN POST TRANSCATHETER AORTIC VALVE REPLACEMENT: SYSTEMIC REVIEW AND
META-ANALYSIS OF MULTIVARIABLE ADJUSTED OBSERVATIONAL STUDIES.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1198), 2019.
Date of Publication: 12 March 2019.
Author
Prasitlumkum N.; Kewcharoen J.; Kittipibul V.; Angsubhakorn N.; Tokavanich
N.; Vutthikraivit W.; Cheungpasitporn W.
Institution
(Prasitlumkum, Kewcharoen, Kittipibul, Angsubhakorn, Tokavanich,
Vutthikraivit, Cheungpasitporn) University of Hawaii Internal Medicine
Residency, Honolulu, HI, United States
Publisher
Elsevier USA
Abstract
Background: Significant tricuspid regurgitation (TR) is a well-recognized
indicator of right ventricular dysfunction. Recent studies showed that
significant TR is potentially associated with increased mortality in
patients with severe aortic stenosis (AS) who underwent Transcatheter
aortic valve replacement (TAVR). However, data remained sparse and
inconclusive. Thus, we assessed the association between significant TR and
mortality in patients undergoing TAVR by a systematic review of the
literature and a meta-analysis. Method(s): We comprehensively
searched the databases of MEDLINE and EMBASE from inception to October
2018. Included studies were published observational studies that evaluated
the effects of significant TR and mortality among patients undergoing
TAVR. Data from each study were combined using the random-effects, generic
inverse variance method of DerSimonian and Laird to calculate risk ratios
and 95% confidence intervals (CIs). Result(s): Eight cohort studies
from August 2011 to May 2018 were included in this meta-analysis involving
27,154 subjects with severe AS undergoing TAVR (6,180 with 20,974 without
significant TR). The presence of significant TR was associated with higher
mortality (pooled risk ratio=2.15, 95 % CI: 1.30-3.57, p = 0.003,
I2=90.4 %). Conclusion(s): Significant TR increased risk
of mortality up to 2-fold among patients with severe AS undergoing TAVR.
Our study suggests that the significant TR should be considered as a part
of risk stratification tools. [Figure presented] Copyright 2019
American College of Cardiology Foundation. All rights reserved.

<64>
Accession Number
2001643060
Title
IN-HOSPITAL OUTCOMES OF ORBITAL VERSUS ROTATIONAL ATHERECTOMY
INTERVENTIONS FOR TREATMENT OF CORONARY ARTERY DISEASE.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1155), 2019.
Date of Publication: 12 March 2019.
Author
Mansour A.; Allaham H.; Alahdab F.; Yasar S.; Aggarwal K.; Abdullah O.
Institution
(Mansour, Allaham, Alahdab, Yasar, Aggarwal, Abdullah) University of
Missouri-Columbia, Columbia, MO, United States
Publisher
Elsevier USA
Abstract
Background: Rotational (RA) and Orbital atherectomy (OA) are the most
widely used devices as an adjunct therapy to conventional angioplasty with
or without stenting. The role of their use is controversial. We evaluated
short-term safety outcomes of RA in comparison with OA in coronary
interventions. Method(s): PubMed, Elsevier, EBSCO, Spring databases
and Cochrane Library were queried from 1985 through 2018. Two independent
reviewers selected and appraised studies and extracted data in duplicate.
Patients were divided into OA group and RA group. Primary safety endpoints
included, the rate of in-hospital Major Adverse Cardiac Events (MACE),
myocardial infarction (MI), cardiac and all-cause mortality, stroke,
target vessel revascularization (TVR) and target lesion revascularization
(TLR). Two independent reviewers selected and appraised studies and
extracted data in duplicate. Random-effects meta-analysis was used to pool
outcomes across studies. Result(s): A total of 4569 patients were
included from 13 studies. There was no significant difference between both
modalities in terms of cardiac and all-cause mortality, stroke, target
lesion and vessel revascularization and rate of emergent coronary artery
bypass (CABG). There was a trend for a higher rate of in-hospital major
adverse cardiac events (MACE) with OA 9.8% (95% CI, 7.5% - 12.1%) versus
5.5% (95% CI, 2% - 9.1%) with RA, and myocardial infarction (STEMI and
NSTEMI) with OA 9.5% (95% CI, 7.2% - 11.7%) versus 5.2% (95% CI, 2.2% -
8.2%) with RA use. Conclusion(s): In patients undergoing percutaneous
coronary interventions (PCI), Orbital and Rotational atherectomy have
yielded similar outcomes in terms of cardiac and all-cause mortality,
stroke, target lesion and vessel revascularization and rate of emergent
coronary artery bypass (CABG). Orbital atherectomy was associated with
higher major adverse cardiac events (MACE) and myocardial infarction when
compared with Rotational atherectomy. Copyright 2019 American College
of Cardiology Foundation. All rights reserved.

<65>
Accession Number
2001643056
Title
VESSEL PREPARATION IMPROVES DRUG ELUTING STENT (DES) EXPANSION PARAMETERS
VERSUS DIRECT CORONARY STENTING IN NON-COMPLEX LESIONS AS ASSESSED BY
HIGH-RESOLUTION OPTICAL COHERENCE TOMOGRAPHY (OCT).
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1154), 2019.
Date of Publication: 12 March 2019.
Author
Bharmal M.I.; Marginean A.; Lloyd J.; Matsukage H.; Hashim F.; Brummel K.;
Kanelidis A.; Blair J.; Paul J.; Shah A.; Nathan S.
Institution
(Bharmal, Marginean, Lloyd, Matsukage, Hashim, Brummel, Kanelidis, Blair,
Paul, Shah, Nathan) University of Chicago, Chicago, IL, United States
Publisher
Elsevier USA
Abstract
Background: DES may be deployed with or without vessel prep in uncalcified
CAD. It is unknown if vessel prep improves DES expansion/apposition vs.
high-pressure direct stenting and if the architecture of individual DES
platforms impacts expansion. High-resolution OCT is an ideal tool for
measuring DES sizing/expansion. Method(s): We randomized 20 PCI
patients with de novo, minimally calcified (ACC/AHA Type A/B1) lesions to
3 DES implant strategies: semi-compliant PTCA- vs AngioSculpt-predilation
(nominal pressures) followed by DES implant vs direct stenting. Resolute
(R), Promus (P), or Xience (X) DES selection was per operator choice.
Illumien Optis OCT (54 mm pullback, 10 frames/mm) was performed before and
after each prep/implant step. Stent expansion was analyzed every 10 frames
(n = 417 frames) for stent expansion deficit (SED,
observed:bench-predicted expansion), stent-to-vessel ratio (SV), stent
symmetry and expansion (SSE, [diameter<inf>max</inf> -
diameter<inf>min</inf>]/diameter<inf>max</inf>), and strut malapposition
(>=0.3mm strut to intimal vessel wall). Metrics were averaged for prep
strategy and DES type. Result(s): Predilated (PTCA+AngioSculpt) vs
direct stented lesions showed significant differences for SSE (0.13+/-0.01
vs 0.11+/-0.01; p<0.01) but not for malapposition (20/296 frames, 6.6% vs
13/121, 10.7%; p=1.87). AngioSculpt vs PTCA showed significant differences
in SED (0.78+/-0.02 vs 0.87+/-0.02; p<0.01) and SSE (0.15+/-0.01 vs
0.12+/-0.01; p<0.01), but not for malapposition (9/146 frames, 6.2% vs
11/150, 7.3%; p=0.16). DES type predicted SED (0.83+/-0.27 X vs
0.88+/-0.03 R vs 0.78+/-0.01 P, p=0.03) and malapposition (3/131 frames,
2.3% X vs 15/139, 10.8% R; p<0.01 and 3/131 frames, 2.3% X vs 15/147,
10.2% P; p<0.01). Conclusion(s): Even simple coronary lesions
predilated with PTCA or AngioSculpt evidenced better DES expansion vs
direct stenting despite high pressure deployment (16-18 atm).
Malapposition differed by DES type (but not prep strategy), perhaps due to
differences in stent architecture, challenging the belief that same sized
DES from different manufacturers yield identical dimensions. Future
analyses will focus on the interaction between the 3 strategies and DES
type, stratified by stent size. Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<66>
Accession Number
2001642986
Title
META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS COMPARING MECHANICALLY
EXPANDABLE VERSUS SELF EXPANDABLE VALVES FOR PATIENTS UNDERGOING
TRANSCATHETER AORTIC VALVE IMPLANTATION.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1381), 2019.
Date of Publication: 12 March 2019.
Author
Parekh J.; Kanmanthareddy A.; Saadi A.; Pandya J.
Institution
(Parekh, Kanmanthareddy, Saadi, Pandya) Creighton University Medical
Center, Omaha, NE, United States
Publisher
Elsevier USA
Abstract
Background: Mechanically expandable (MEV) and self expandable (SEV) valves
are the two major types utilized for Transcatheter Aortic Valve
Implantation (TAVI). There are two previous meta-analysis published but
only one Randomized Controlled Trial (RCT) was included in both analysis.
Previous registry and observational studies have found conflicting
results. We performed a meta-analysis of RCTs published till date to
compare their safety and efficacy. Method(s): PubMed, Medline and
Google Scholar databases were searched for available RCTs. Analysis was
performed using random effects model. The analyzed outcomes were all-cause
mortality, stroke, new permanent pacemaker (PPM) implantation and moderate
aortic regurgitation (AR) at follow up. Result(s): A total of 3 RCTs
with 1591 patients were included in the analysis. MEV and SEV were used
for TAVI in 947 and 644 patients respectively. The MEV include Edwards
Sapiens XT, Lotus valve system and Sapiens 3 while SEV include
commercially available CoreValve Classic or EvoluteR. There was no
difference in the all-cause mortality with the use of either valve types
(RR 0.94, 95 % CI 0.51 to 1.71). There was no difference in the risk of
stroke (RR 2.16, 95 % CI 0.71 to 6.54), PPM (RR 0.92, 95 % CI 0.43 to
1.97) and AR (RR 0.29, 95 % CI 0.02 to 4.18). Conclusion(s): Compared
to MEV, SEV implantation was associated with a similar risk of all-cause
mortality, stroke, PPM and moderate AR. Due to small sample sizes, larger
RCTs may be needed in the future to show significant differences. [Figure
presented] Copyright 2019 American College of Cardiology Foundation.
All rights reserved.

<67>
Accession Number
2001642484
Title
SURGICAL OUTCOMES IN PATIENTS WITH ANOMALOUS AORTIC ORIGIN OF CORONARY
ARTERY: A SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 625), 2019.
Date of Publication: 12 March 2019.
Author
Chakraborty A.; Sandhu S.
Institution
(Chakraborty, Sandhu) University of Miami, Miami, FL, United States
Publisher
Elsevier USA
Abstract
Background: Anomalous Aortic origin of Coronary Artery (AAOCA) can be life
threatening and surgical intervention maybe indicated. A systematic review
was done to assess symptoms and the risk of sudden cardiac death (SCD) pre
and post-surgery Methods: A review of articles from 1998-2018 was done
with key words AAOCA, Anomalous Right Coronary Artery (ARCA), Anomalous
Left Coronary Artery (ALCA) and the MeSH term coronary vessel anomaly.
Presenting and residual symptoms, coronary artery anatomy, type of
surgery, ischemia on stress test and coronary stenosis on CT scan were
recorded. Statistical analysis was done with STATA software Results: There
were 691 patients with a mean age of 21.6 +14.2yrs. ARCA was present in
74% and ALCA in 25%. The vessel course was interarterial in 97.7% and
intramural in 91.5%. Surgical intervention was unroofing in 84% and
reimplantation in 13.5%. Symptoms were present in 70% at presentation and
decreased to 20.5% following surgery (Fig I): chest pain decreased from
47% to 11.1% (p<0.001), syncope/presyncope from 21% to 1.6% (p<0.001),
palpitations from 5% to 2.2% (p=0.003) and dyspnea from 7% to 1%
(p=<0.001). Following surgery coronary artery stenosis by CT scan was
present in 2.2% and a positive stress test in 3.5 % of the patients.
Aborted SCD in 28 patients prior to surgery and in 5 following surgery
(p<0.00001). Conclusion(s): Symptoms and risk of SCD decreased after
surgery for AAOCA. Residual coronary artery stenosis after AAOCA surgery
continues to be a risk factor for SCD. [Figure presented] Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<68>
Accession Number
2001642478
Title
COMPARISON OF PERCUTANEOUS MITRAL VALVE REPAIR AND OPTIMAL MEDICAL THERAPY
VERSUS OPTIMAL MEDICAL THERAPY ALONE FOR PATIENTS WITH SEVERE FUNCTIONAL
MITRAL REGURGITATION: AN UPDATED META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1132), 2019.
Date of Publication: 12 March 2019.
Author
Rivera M.; Olarte N.; Knijnik L.; Toirac A.; Fernandes A.; Fernandes G.
Institution
(Rivera, Olarte, Knijnik, Toirac, Fernandes, Fernandes) University of
Miami Miller School of Medicine, Miami, FL, United States
Publisher
Elsevier USA
Abstract
Background: The efficacy of percutaneous mitral valve repair (pMVR) for
severe functional mitral regurgitation (FMR) has been a subject of debate
for many years. New evidence derived from well-designed randomized
controlled trials has shown conflicting results. We conducted a
meta-analysis including high quality observational studies and recently
published randomized controlled trials to investigate further the role of
pMVR for this indication. Method(s): PubMed, EMBASE and Cochrane
library were searched for randomized studies and high quality
retrospective cohorts comparing pMVR plus optimal medical therapy (OMT)
and OMT alone for severe FMR. Odds-ratios (OR) were calculated using
random effect models based on I2 statistics. Result(s):
Pooled analysis of 7 studies (3,440 participants) showed that pMVR + OMT
was associated with better survival than OMT alone (OR 0.48 [95% CI, 0.34
to 0.68]); as well as with a reduction in unplanned heart failure
hospitalizations, (OR 0.52 [95% CI, 0.28-0.98]). Egger's regression test
showed no evidence of publication bias (p=0.245). Conclusion(s): Our
meta-analysis demonstrates that pMVR for subjects with severe FMR already
on optimal medical therapy, led to a significant mortality reduction and
less unplanned hospital admissions. [Figure presented] Copyright 2019
American College of Cardiology Foundation. All rights reserved.

<69>
Accession Number
2001642313
Title
THE EFFECT OF PLATELET INHIBITON BY CANGRELOR AMONG OBESE PATIENTS
UNDERGOING CORONARY STENTING: INSIGHTS FROM THE CHAMPION TRIALS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1333), 2019.
Date of Publication: 12 March 2019.
Author
Peterson B.; Harrington R.; Stone G.; Steg P.G.; Gibson C.M.; Hamm C.;
Price M.; Lopes R.; Leonardi S.; Prats J.; Deliargyris E.; Mahaffey K.;
White H.; Bhatt D.L.
Institution
(Peterson, Harrington, Stone, Steg, Gibson, Hamm, Price, Lopes, Leonardi,
Prats, Deliargyris, Mahaffey, White, Bhatt) Brigham and Women's Hospital,
Boston, MA, United States
Publisher
Elsevier USA
Abstract
Background: In clinical trials, cangrelor reduced periprocedural ischemic
events related to percutaneous coronary stenting (PCI) without increasing
bleeding. However, some antiplatelet agents have shown a differential
treatment effect by body mass index (BMI). Method(s): Patients from
the three CHAMPION trials who were randomized to cangrelor vs control
during PCI were included for analysis and stratified by BMI. The primary
endpoint was a composite of death, myocardial infarction, ischemia-driven
revascularization, or stent thrombosis within 48 hours. The principal
safety outcome was GUSTO severe bleeding at 48 hours. Result(s):
There were 24,893 patients, with 8979 (36.1%) having BMI of >= 30. There
was no significant difference in the primary endpoint among obese vs
non-obese patients (4.3% vs 4.2%; OR 1.02; 95% CI, 0.89-1.15; p=0.82).
There was a consistent benefit in the primary endpoint in patients who
received cangrelor who were obese (3.9% vs 4.7%, OR 0.82; 95% CI,
0.67-1.01; P=0.06) and not obese (3.8% vs 4.7%; OR 0.80; 95% CI,
0.68-0.93; p=0.004); interaction p-value=0.81. There was no difference in
severe bleeding among patients who received cangrelor who were obese (0.1%
vs 0.2%; OR 0.66; 95% CI, 0.23-1.85; p=0.42) or non-obese (0.3% vs 0.2%;
OR 1.7; 95% CI, 0.85-3.37; p=0.13); interaction p-value=0.13.
 Conclusion(s): There was no difference in short term efficacy or
bleeding between obese and non-obese patients. Cangrelor at the time of
PCI is an attractive antiplatelet agent, irrespective of BMI. [Figure
presented] Copyright 2019 American College of Cardiology Foundation.
All rights reserved.

<70>
Accession Number
2001642004
Title
CARDIAC STRUCTURAL CHANGES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
(TAVR): SYSTEMATIC REVIEW AND META-ANALYSIS OF MAGNETIC RESONANCE IMAGING
(MRI) STUDIES.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1543), 2019.
Date of Publication: 12 March 2019.
Author
Mehdipoor G.; Chen S.; Chatterjee S.; Torkian P.; Ben-Yehuda O.; Stone G.;
Prince M.
Institution
(Mehdipoor, Chen, Chatterjee, Torkian, Ben-Yehuda, Stone, Prince)
Cardiovascular Research Foundation, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is increasingly
used to treat patients with severe aortic stenosis (AS). We sought to
assess the impact of TAVR on ventricular volumes, mass and function.
 Method(s): Using Meta-analysis of Observational Studies in
Epidemiology (MOOSE) guidelines, we searched PubMed and Embase for studies
reporting cardiac magnetic resonance imaging (MRI) findings before and at
least 1 month after TAVR. Main factors of interest were LV end-diastolic
volume index (LVEDVi), LV end-systolic volume index (LVESVi), LV mass
index (LVMi), and left and right ventricular ejection fraction (LVEF and
RVEF). Standardized mean differences (SMD) were pooled by random effects
meta-analytic techniques. Result(s): We screened 453 publications, 15
of which reported cardiac changes post-TAVR. After excluding studies with
duplicate data, 10 studies (published between 2012-2018) were included for
meta-analysis. A total of 305 patients completed pre- and post-TAVR
follow-up cardiac MRI (163 male (53.4%), age range 78.6-85 years, MRI
follow-up range 6-15 months). TAVR resulted in a significant reduction in
LVEDVi (SMD: -0.25, 95% CI: -0.43 to -0.07, P=0.006), LVESVi (SMD: -0.24,
95% CI: -0.44 to -0.05, P=0.01), LVMi (SMD: -0.82, 95% CI: -1.0 to -0.63,
P<0.001) and a significant increase in LVEF (SMD: 0.22, 95% CI: 0.06 to
0.38, P=0.006). RVEF was not significantly changed after TAVR (SMD: 0.11,
95% CI: -0.15 to 0.38, P=0.40). There was no evidence of heterogeneity
across the included studies (I2: 0%, P<inf>heterogeneity</inf>
>0.05 for all). Across the included studies, the median average reduction
was 4ml/m2 (IQR: 3.1 to 8.2) for LVEDVi, 5ml/m2
(IQR: 3.9 to 5.5) for LVESVi, and 15.1g/m2 (IQR: 11.8 to 18.3)
for LVMi. The median average improvement in LVEF was 3.4% (IQR: 1.0 to
4.6). Conclusion(s): LV reverse remodeling occurred within 6-15
months after TAVR, with reduction in LVEDVi, LVESVi and LVMi. As a result
LVEF improved, with no significant changes observed in RVEF. Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<71>
Accession Number
2001641147
Title
MITRAL REGURGITATION BEFORE TRANSCATHETER AORTIC VALVE IMPLANTATION FOR
AORTIC STENOSIS AND MORTALITY: A META-ANALYSIS AND SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1239), 2019.
Date of Publication: 12 March 2019.
Author
Sethi A.; Kodumuri V.; Singbal Y.; Prasad V.; Chaudhary A.; Kassotis J.
Institution
(Sethi, Kodumuri, Singbal, Prasad, Chaudhary, Kassotis) Rutgers Robert
Wood Johnson Medical School, New Brunswick, NJ, United States
Publisher
Elsevier USA
Abstract
Background: Mitral regurgitation (MR) is commonly encountered in patients
with severe aortic stenosis. However, its impact on mortality, as an
independent risk factor, in patients undergoing transcatheter aortic valve
implantation (TAVI) has not been established. Method(s): We performed
a systematic search of electronic databases for studies reporting
characteristics and outcomes of patients with and without significant MR
and/or the adjusted mortality risk associated with MR. We conducted a
random effect meta-analysis. Result(s): Seventeen studies, a total of
20,717 patients, compared outcomes and group characteristics. Twenty-one
studies, a total of 32,257 patients, reported odds of mortality associated
with significant MR adjusting for other variables. The difference in group
characteristics are shown below. The patients with significant MR had a
higher unadjusted short-term (RR = 1.46 95% CI 1.30-1.65) and long-term
mortality (RR = 1.40 95% CI 1.18 - 1.65). Sixteen out of twenty-one
studies with 27,777 patients found no association between MR and mortality
after adjusting for baseline variables. Greater than half of the patients
(0.56 95% CI 0.45 - 0.66) with MR improved by at least a grade upon follow
up. Conclusion(s): The patients with pre-procedural MR undergoing
TAVI have a higher burden of risk factors; however, in our analysis we
found no evidence that patients with MR, after adjusting for other
factors, exhibited a higher mortality. In fact, MR tends to improve in the
majority of patients post TAVI. [Figure presented] Copyright 2019
American College of Cardiology Foundation. All rights reserved.

<72>
Accession Number
2001640400
Title
A META-ANALYSIS OF EFFICACY AND SAFETY OF TRANSRADIAL VERSUS TRANSFEMORAL
ACCESS FOR PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL OCCLUSIONS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1283), 2019.
Date of Publication: 12 March 2019.
Author
Apala D.R.; Jhand A.; Thandra A.; Ahsan M.
Institution
(Apala, Jhand, Thandra, Ahsan) Toufik Mahfood Haddad, Venkata Alla,
Creighton University School of Medicine, Omaha, NE, United States
Publisher
Elsevier USA
Abstract
Background: Transradial access (TRA) is now increasingly used for
percutaneous coronary intervention (PCI) of chronic total occlusions (CTO)
vis-a-vis Transfemoral access (TFA). We conducted a meta-analysis to
evaluate the efficacy and safety of TRA compared to TFA for CTO-PCI.
 Method(s): PubMed, Cochrane and Web of Science databases were
systematically searched for studies comparing TRA with TFA for CTO-PCI.
Outcomes of interest were procedural success, technical success and
complications. Odds ratios (OR) and 95% Confidence Intervals (CI) were
calculated. The analysis was performed using DerSimonian and Laird random
effect model. Result(s): Six studies met our inclusion criteria with
a total of 3733 patients (TRA group: 1593 and TFA group: 2140). There was
no statistically significant difference in lesion complexity as calculated
by the J-CTO score (standardized mean difference: -0.16; 95% CI: -0.56 -
0.25, p= 0.45). Procedural and technical success rates were similar in
both the groups. No statistically significant difference was observed in
terms of early complications of death, myocardial infarction, stroke,
major bleeding, pericardial tamponade and urgent coronary artery bypass
surgery. Rates of access site complications were lower in TRA as compared
to TFA (OR: 0.38; 95% CI: 0.19 - 0.75, p= 0.005) (figure1). [Figure
presented] Conclusion(s): Our analysis shows that TRA is as effective
and safe as TFA for CTO-PCI with lower rates of access site
complications. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<73>
Accession Number
2001638527
Title
GETTING THE LEAD OUT OF RV PACING: MICRA ACCORDING TO MAUDE.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 527), 2019.
Date of Publication: 12 March 2019.
Author
Rousseau L.A.; Henien S.; Sharma E.; McCauley B.; Wu M.; Chu A.
Institution
(Rousseau, Henien, Sharma, McCauley, Wu, Chu) Brown University,
Providence, RI, United States
Publisher
Elsevier USA
Abstract
Background: Leadless pacing has promised to reduce lead- and
pocket-related complications when compared with traditional permanent
transvenous pacing. Early data from the leadless transcatheter pacemaker
Micra has demonstrated safety and efficacy. Observed short-term
complication rates of leadless pacing (4.8%), however, are higher than
conventional single-chamber permanent pacing (4.1%). To further
characterize this phenomenon, we performed a systematic review of
real-world complications reported from the Manufacturer and User Facility
Device Experience (MAUDE) database involving the Micra TPS leadless
pacemaker. Method(s): We performed a systematic review of published
clinical studies comparing the rates of complications from leadless pacing
(Medtronic Micra TPS system) versus historical transvenous permanent
pacing. Observational studies of adverse event rates were identified using
the Cochrane Library, EMBASE, and PubMed. This data was compared with the
MAUDE database reporting Micra adverse events. Result(s): A total of
740 adverse reported events were reviewed from the MAUDE database. Of
these adverse events, a total of 132 pericardial effusions (17.8%) and 50
deaths (6.7%) were reported. 98 of the 132 (74.2%) pericardial effusions
required pericardiocentesis. 24 patients required further surgical
intervention due to failed pericardiocentesis. 25 of 50 deaths were linked
to procedural complications of cardiac tamponade and/or cardiac
perforation. Difficulty in sheath manipulation at the tricuspid valve and
right ventricle as well as kinking of the delivery sheath were cited as
procedural related issues preceding the development of pericardial
effusion. Conclusion(s): MAUDE database adverse events rates for
Micra include the development of pericardial effusions in 17.8% of
patients. 74.2% of these patients required pericardiocentesis. In
addition, 25 of 50 deaths (3.4%) were linked to procedural cardiac
perforation and effusion. The reported rate of cardiac perforation for
leadless pacing in clinical studies is 1.52%. This data suggests that
cardiac perforation remains a significant driver of morbidity and
mortality with leadless pacemaker Micra. Copyright 2019 American
College of Cardiology Foundation. All rights reserved.

<74>
Accession Number
2001638471
Title
SEX-BASED DIFFERENCES IN OUTCOMES AFTER MITRAL VALVE SURGERY FOR SEVERE
ISCHEMIC MITRAL REGURGITATION: FROM THE CARDIOTHORACIC SURGICAL TRIALS
NETWORK.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1951), 2019.
Date of Publication: 12 March 2019.
Author
Giustino G.; Overbey J.; Taylor D.; Ailawadi G.; Kirkwood K.; Gillinov A.;
Dagenais F.; Mayer M.-L.; Gelijns A.; Moskowitz A.; Bagiella E.; Miller
M.; Smith P.; O'Gara P.; Acker M.; Lala-Trindade A.A.; Hung J.
Institution
(Giustino, Overbey, Taylor, Ailawadi, Kirkwood, Gillinov, Dagenais, Mayer,
Gelijns, Moskowitz, Bagiella, Miller, Smith, O'Gara, Acker, Lala-Trindade,
Hung) Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Sex-based differences in outcomes after cardiac interventions
have become a major focus of research. However, there is little known
about such differences after mitral valve surgery. The objective of this
analysis was to investigate sex-based differences in clinical and
patient-centered outcomes among patients undergoing mitral valve (MV)
surgery for severe ischemic mitral regurgitation (MR). Method(s): We
evaluated the outcomes of women and men enrolled in a randomized trial
comparing MV replacement versus MV repair for severe ischemic MR. Patients
were followed for 2 years. Endpoints were all-cause death, treatment
failure (defined as the composite of death, MV reoperation, or moderate or
severe recurrent MR), quality of life (QOL) scores and percentage change
in left ventricular end-systolic volume index (LVESVI) from baseline
through 2 years assessed by an echo core-lab. Multiple regression models
were used for analysis Results: Of 251 patients enrolled in the trial, 96
(38.2%) were women. While there was no significant difference in age
between women and men (68.8+/-9.6 vs. 68.2+/-9.7; p=0.60), at baseline
women had a higher burden of diabetes, hypertension and thyroid disease.
Women had higher risk of mortality at 2 years (27.1% vs. 17.4%; absolute
risk increase [ARI]: +9.7%; adjusted hazard ratio: 1.86; 95% CI:
1.05-3.29; p=0.03), and a trend toward higher risk of treatment failure
(57.0% vs. 43.2%; ARI: +13.8%; adjusted odds ratio: 1.78; 95% CI:
0.98-3.23; p=0.06). Adjusting for baseline QOL scores, at 2 years women
had lower median European QOL-5 Dimensions score (75.0 vs. 77.0; adjusted
beta: -7.82; 95% CI: -14.04 to -1.6; p=0.01) and higher (i.e., worse)
median Minnesota Living with Heart Failure score (24.0 vs. 11.0; adjusted
beta: 8.61; 1.85 to 15.37; p=0.01). There was no significant difference
between women and men in the median percentage change in LVESVI from
baseline through 2 years (-15.8% vs. -11.1%; adjusted beta: -10.71%; 95%
CI: -22.97 to 1.55; p=0.09). Conclusion(s): Our analysis suggests
that there are important outcome differences between women and men after
surgery for severe ischemic MR. Women had lower survival and worse QOL
scores at 2 years compared with men. Copyright 2019 American College
of Cardiology Foundation. All rights reserved.

<75>
Accession Number
2001638435
Title
TRANSTHORACIC ECHOCARDIOGRAPHY VERSUS CARDIAC MAGNETIC RESONANCE FOR THE
ASSESSMENT OF AORTIC REGURGITATION AFTER TRANSCATHETER AORTIC VALVE
REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1182), 2019.
Date of Publication: 12 March 2019.
Author
Jonnalagadda A.K.; Papanastasiou C.A.; Kokkinidis D.; Oikonomou E.; Garcia
M.; Karamitsos T.
Institution
(Jonnalagadda, Papanastasiou, Kokkinidis, Oikonomou, Garcia, Karamitsos)
MedStar Washington Hospital Center, Washington, DC, United States
Publisher
Elsevier USA
Abstract
Background: Residual aortic regurgitation (AR) is a major complication
after transcatheter aortic valve replacement (TAVR). Our aim is to review
the level of agreement between two-dimensional transthoracic
echocardiography (2D TTE) and CMR on grading the severity of AR after
TAVR, and determine the accuracy of 2D TTE in detecting moderate or severe
AR. Method(s): Electronic databases were searched in order to
identify studies comparing 2D TTE to CMR for post-TAVR AR assessment.
Kappa coefficient was used to determine the level of agreement between the
two imaging modalities. CMR was used as the reference standard in order to
assess the diagnostic accuracy of 2D TTE. Result(s): Seven studies
were included in this systematic review. Six studies reported a low
correlation between 2D TTE and CMR (kappa coefficient ranging from -0.02
to 0.41), while one study showed good agreement with a kappa coefficient
of 0.72. Given the heterogeneity among the included studies the diagnostic
accuracy of TTE was evaluated by estimating the hierarchical summary
receiver operator characteristic curve. The area under the curve (AUC) for
detection of moderate or severe AR with TTE was 0.83 (95% CI: 0.79 to
0.86). Conclusion(s): Despite the reported significant disconcordance
between TTE and CMR grading of AR, 2D TTE has sufficient ability to
discriminate moderate or severe AR from mild or none AR after TAVR in the
clinical setting [Figure presented] Copyright 2019 American College
of Cardiology Foundation. All rights reserved.

<76>
Accession Number
627138534
Title
Ticab: A randomized, double-blind study of ticagrelor versus aspirin in
patients undergoing coronary bypass surgery.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2018 and Resuscitation Science Symposium. United States. 138 (25) (pp
e764), 2018. Date of Publication: December 2018.
Author
Schunkert H.
Institution
(Schunkert) Dept of Cardiology, German Heart Cntr Munich, Munich, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The antiplatelet treatment strategy providing optimal balance
of bleeding and thrombotic risks in patients undergoing coronary artery
bypass grafting (CABG) is unclear. We prospectively compared the efficacy
of aspirin and ticagrelor monotherapy in patients undergoing CABG.
 Method(s): We randomly assigned patients scheduled for CABG in a 1:1
fashion to receive either 100mg aspirin once daily or ticagrelor 90mg
twice daily. The primary outcome was the composite of cardiovascular
death, myocardial infarction, repeat revascularization, and stroke twelve
months after CABG surgery. The main safety endpoint was major bleeding.
Power calculations estimated that randomization of 3850 patients may
reveal superiority for ticagrelor. The study was prematurely halted
following withdrawal of funding by the manufacturer of ticagrelor and
recommendations of the data safety monitoring board. Result(s):
Twelve months after CABG, the primary endpoint occurred in 73 out of 928
patients (7.9%) in the aspirin group and in 86 out of 931 patients (9.2 %)
in the ticagrelor group (hazard ratio, 1.19; 95% confidence interval (CI)
0.87-1.62; P=0.27). All cause mortality (aspirin 2.5% vs ticagrelor 2.4%,
hazard ratio 0.96, CI 0.53-1.72, P=0.89) and cardiovascular mortality
(aspirin 1.40% vs ticagrelor 1.18%, hazard ratio 0.85, CI 0.38-1.89,
P=0.68) were similar in both groups. The individual components of the
primary outcome did not significantly differ between the two groups. No
difference with respect to the rate of major bleeding as defined by the
Bleeding Academic Research Consortium was observed (aspirin 4.74% vs
ticagrelor 4.83%, hazard ratio 1.02, CI 0.67-1.55, P=0.92).
 Conclusion(s): The use of ticagrelor instead of aspirin in patients
undergoing CABG did not significantly impact the rates of major
cardiovascular events nor major bleeding events.

<77>
Accession Number
627138516
Title
Endoscopic vein harvest for coronary bypass surgery in a randomized
multicenter trial with long-term follow-up.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2018 and Resuscitation Science Symposium. United States. 138 (25) (pp
e763), 2018. Date of Publication: December 2018.
Author
Zenati M.A.; Bhatt D.L.; Bakaeen F.G.; Stock E.M.; Biswas K.; Gaziano
J.M.; Kelly R.F.; Tseng E.; Bitondo J.; Quin J.A.; Almassi G.H.; Haime M.;
Hattler B.; Jessen M.; DeMatt E.; Scrymgeour A.
Institution
(Zenati, Quin, Haime) Cardiac Surgery, Veterans Affairs Boston Healthcare
System and Harvard Med Sch, Boston, MA, United States
(Bhatt) Heart and Vascular Cntr, Brigham and Women's Hosp and Harvard Med
Sch, Boston, MA, United States
(Bakaeen) Dept of Thoracic and Cardiovascular Surgery, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Stock, Biswas, DeMatt) Biostatistics, Cooperative Studies Program
Coordinating Cntr, Dept of Veterans Affairs, Perry Point, MD, United
States
(Gaziano) Cardiovascular Medicine, Veterans Affairs Boston Healthcare
System and Harvard Med Sch, Boston, MA, United States
(Kelly) Cardiothoracic Surgery, Minneapolis Veterans Affairs Med Cntr,
Univ of Minnesota, Minneapolis, MN, United States
(Tseng) Cardiac Surgery, San Francisco Veterans Affairs Med Cntr, Univ of
California San Francisco, San Francisco, CA, United States
(Bitondo) Cardiac Surgery, Massachusetts General Hosp, Boston, MA, United
States
(Almassi) Cardiac Surgery, Zablocki Veterans Affairs Med Cntr, Med College
of Wisconsin, Milwaukee, WI, United States
(Hattler) Cardiology, VA Eastern Colorado Healthcare System, Denver, CO,
United States
(Jessen) Cardiac Surgery, UT Southwestern Med Cntr, Dallas, TX, United
States
(Scrymgeour) Biostatistics, Coperative Studies Program Coordinating Cntr,
Dept of Veterans Affairs, Perry Point, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The greater saphenous vein is the most commonly used conduit
worldwide for coronary artery bypass grafting (CABG). The association
between endoscopic vein harvesting (EVH) technique and late clinical
outcomes has not previously been studied with an adequately powered,
multicenter randomized controlled trial. Method(s): The REGROUP Trial
(NCT 01850082) was designed to assess the long-term impact of EVH on a
composite end-point of major adverse cardiac events (MACE) including
all-cause mortality, nonfatal myocardial infarction or repeat
revascularization compared with a non-endoscopic ("open" - OVH) technique.
EVH was performed by expert harvesters at 16 participating sites in the
U.S. Department of Veterans Affairs. The sample size was 1,150 subjects:
574 randomized to OVH and 576 to EVH during 2014-2017. The primary outcome
was MACE over the active follow-up period. Result(s): The average age
of participants was 66.4 +/- 6.9 years; 99.5% were male. The mean SYNTAX
score was 28.5 +/- 11.5 (median 27). Median follow-up for the active phase
was 2.78 years, with 169 participants experiencing 230 MACE. Final
analysis for the primary outcome will be presented at the meeting.
 Conclusion(s): In patients undergoing CABG within REGROUP, we
assessed long-term MACE for EVH compared to OVH. Future analyses will
explore differences in risk among prognostic factors.

<78>
Accession Number
627138495
Title
Empa-heart cardiolink-6 trial: A randomized trial evaluating the effect of
empagliflozin on left ventricular structure, function and biomarkers in
people with type 2 diabetes (T2D) and coronary heart disease.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2018 and Resuscitation Science Symposium. United States. 138 (25) (pp
e762), 2018. Date of Publication: December 2018.
Author
Verma S.; Mazer C.D.; Yan A.T.; Mason T.; Slabiak A.; Bello O.O.; Opingari
E.; Fitchett D.H.; Goldenberg R.M.; Goodman S.G.; Farkouh M.E.; Partridge
A.C.; Bonneau C.; Bakbak E.; Dhingra N.; Williams A.H.; Lambotharan S.G.;
Gupta N.; Chowdhury B.; Dai D.W.; Juni P.; Teoh H.; Quan A.; Liuni A.;
Leiter L.A.; Bhatt D.L.; Zinman B.; Connelly K.A.
Institution
(Verma, Mason, Opingari, Partridge, Bonneau, Bakbak, Dhingra, Williams,
Lambotharan, Gupta, Chowdhury, Quan) Cardiac Surgery, St Michaels Hosp,
Toronto, Canada
(Mazer, Slabiak) Anaesthesia, St Michaels Hosp, Toronto, Canada
(Yan, Bello, Fitchett, Goodman, Connelly) Cardiology, St Michaels Hosp,
Toronto, Canada
(Goldenberg) Endocrinology and Metabolsim, LMC Thornhill and Vaughan,
Thornhill, Canada
(Farkouh) Cardiology, Peter Munk Cntr of Excellence, Toronto, Canada
(Dai) AHRC, St Michaels Hosp, Toronto, Canada
(Juni) Applied Health Rsch Cntr, St Michaels Hosp, Toronto, Canada
(Teoh) Endocrinolgy and Metabolism and Cardiac Surgery, St Michaels Hosp,
Toronto, Canada
(Liuni) Cardiometabolic, Boehringer Ingelheim, Burlington, Canada
(Leiter) Endocrinology and Metabolism, St Michaels Hosp, Toronto, Canada
(Bhatt) Cardiology, Harvard Med Sch, Boston, MA, United States
(Zinman) Endocrinology and Metabolism, Mount Sinai Hosp, Toronto, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Although SGLT2 inhibitors reduce CV death/heart failure in
T2D, whether they promote LV remodeling remains an important and
unanswered question. EMPA-HEART is the first randomized, double-blind,
parallel-group study investigating the effect of empagliflozin vs. placebo
on LV structure/function (assessed by cMRI) in individuals with T2D and
established CVD (NCT02998970). Methods/Results: A total of 152 individuals
with T2D (A1C >=6.5% and <=10%) and a prior history of either MI or
coronary revascularization consented to participate in the study. Key
exclusion criteria were eGFR <60 ml/min/1.73 m2, EF<30%, or moderate to
severe valvular disease. Following baseline cMRI, participants were
randomized 1:1 to receive empagliflozin 10 mg QD or placebo for 6 months,
with repeat cMRI evaluation. The primary endpoint was the change in LV
mass index at 6 months. Key secondary endpoints included changes in
indexed LV end-systolic/ diastolic volumes, LVEF, regional LV
systolic/diastolic function, NT-proBNP and troponin levels. As of the date
of abstract submission, randomization has been completed and data are
being analyzed, with planned presentation/publication at AHA 2018.
Baseline characteristics are shown in the Table. Conclusion(s):
EMPA-HEART is the first RCT to evaluate the effect of an SGLT2i on LV
structure and function using cMRI in people with T2D. These data provide
critical translational/mechanistic clues to explain the benefits of
empagliflozin on heart failure and CV death.

<79>
Accession Number
627138199
Title
Characteristics and management of hospitalized adult patients treated with
extracorporeal cardiopulmonary resuscitation and conventional
cardiopulmonary resuscitation-an analysis of the american heart
association get with the guidelines-resuscitation registry.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2018 and Resuscitation Science Symposium. United States. 138 (25) (pp
e778), 2018. Date of Publication: December 2018.
Author
Tonna J.; Becker L.; Girotra S.; Selzman C.; Thiagarajan R.; Presson A.;
Zhang C.; Keenan H.
Institution
(Tonna, Selzman, Presson, Zhang, Keenan) Univ of Utah, Salt Lake City, UT,
United States
(Becker) Hofstra Northwell Sch of Medicine, Hempstea, NY, United States
(Girotra) Univ of Iowa, Iowa City, IA, United States
(Thiagarajan) Boston Children's Hosp, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Extracorporeal life support is increasingly used as a
resuscitative adjunct during adult cardiac arrest (eCPR). To prepare for
design of randomized clinical trials comparing eCPR to conventional CPR
(cCPR), we sought to understand the current use of eCPR among hospitalized
patients in the United States. Method(s): We identified all adult
patients (age >/=18 years) with in-hospital cardiac arrest (IHCA) within
the American Heart Association (AHA) Get With The Guidelines-Resuscitation
(GWTG-R) registry (January 2000-December 2017). Baseline, admission and
intra-arrest characteristics were compared between IHCA patients treated
with cCPR alone vs the adjunctive use of eCPR. Result(s): We retained
289,114 unique patients with IHCA. Patients receiving eCPR (n=1,085) were
significantly younger (<40 years 15.3% vs 6.8%), more likely to have had a
myocardial infarction during hospitalization (27.1% vs 15.2%), but less
likely to have diabetes (23% vs. 32%), liver disease (5% vs 8%), cancer
(4% vs 12%), renal disease 22% vs 34%), or sepsis (8% vs 17%)(p<0.001 for
all). eCPR patients were more often cardiac surgical patients (48.9% vs
6.6%), more likely to arrest in a cardiac catheterization laboratory
(13.5% vs 2.8%) or operating room (22.6% vs 2%), and were more likely to
have a ventricular arrhythmia as the initial arrest rhythm (54.2% vs
35.2%) (p<0.001 for all). Likewise, a higher proportion of eCPR patients
had Cerebral Performance Category of 1 on admission (78.2% vs 58.6%), were
receiving mechanical ventilation (50.7% vs 27.8%) and had arterial lines
(43.8% vs 9.9%)(p<0.001 for all) at the time of arrest. Compared to cCPR,
eCPR patients were more likely to receive longer resuscitations (36 vs 15
min) and induced hypothermia (12.6% vs 3.4%)(p<0.001 for all).
 Conclusion(s): Overall, eCPR was deployed for a defined cohort of
younger, healthier patients undergoing cardiac catheterization or surgery
for cardiac disease. Given baseline differences in eCPR use, it may be
difficult to randomize patient populations who historically have received
eCPR to cCPR, and arrest management will have to be standardized.

<80>
Accession Number
627138192
Title
Ezetimibe in prevention of cerebro- and cardiovascular events in middle-
to high-risk, elderly (75 Years Old Or Over) patients with elevated
LDL-cholesterol: A multicenter, randomized, controlled, open-label trial.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2018 and Resuscitation Science Symposium. United States. 138 (25) (pp
e753), 2018. Date of Publication: December 2018.
Author
Arai H.; Sasaki J.; Yokote K.; Kuwabara M.; Harada K.; Imai T.; Tanaka S.;
Ohashi Y.; Ito H.; Ouchi Y.
Institution
(Arai) Dept of Geriatric Medicine, NCGG, Obu, Japan
(Sasaki) Dept of Physical Therapy, International Univ of Health and
Welfare, Fukuoka, Japan
(Yokote) Dept of Internal Medicine, Chiba Univ, Graduate Sch of Medicine,
Chiba, Japan
(Kuwabara) Dept of Cardiology, Toranomon Hosp, Tokyo, Japan
(Harada) Dept of Cardiology, Tokyo Metropolitan Institute of Gerontology,
Tokyo, Japan
(Imai, Tanaka) Dept of Clinical Biostatistics, Kyoto Univ, Graduate Sch of
Medicine, Kyoto, Japan
(Ohashi) Dept of Integrated Science and Engineering for Sustainable
Society, Chuo Univ, Tokyo, Japan
(Ito) Hosp and Rsch Institute, Tokyo Metropolitan Institute of
Gerontology, Tokyo, Japan
(Ouchi) Hosp, Toranomon Hosp, Tokyo, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The efficacy of lipid-lowering therapy with statins for
high-risk patients is well established. However, there is no evidence
about its clinical benefits in Japanese elderly (> 75 years old) patients
with elevated low-density lipoprotein cholesterol (LDL-C) levels who have
no history of coronary artery disease. Hypothesis: We hypothesized that
the onset of cerebral and cardiovascular events can be prevented by
decreasing LDL-C levels with ezetimibe in these patients. Method(s):
Between 2009 and 2016, a prospective, multicenter, open-label, blinded end
point, randomized controlled trial was conducted in these patients whose
LDL-C level was > 140 mg/dL and who had one or more cardiovascular risk
factors (e.g., diabetes, hypertension, smoking, how high-density
lipoprotein cholesterol levels, and high triglyceride levels). The primary
endpoint was a composite of sudden cardiac death, fatal myocardial
infarction, nonfatal myocardial infarction, coronary revascularization,
fatal stroke, and/or nonfatal stroke. Result(s): A total of 3,796
patients were enrolled, and 1898 patients each were randomly assigned to
the ezetimibe group (ezetimibe 10 mg/day plus diet counseling) or the
control group (diet counseling alone). Baseline demographic
characteristics were as follows: mean age, 80.7+/-4.8 years; body mass
index, 23.4+/-3.6; male, 25.7%; hypertension, 78.0%; and diabetes, 22.8%.
Despite the high incidence (78.0%) of concomitant hypertension, systolic
and diastolic blood pressures were well controlled (136.1+/-15.9 mmHg and
74.1+/-10.5 mmHg, respectively). Mean LDL-C, highdensity lipoprotein
cholesterol, and triglycerides at baseline were 161.6+/-19.7 mg/dL,
56.8+/-14.1 mg/dL, and 131.3+/-55.3 mg/dL, respectively. Mean LDL-C levels
at 1 year after randomization were 126.1+/-26.2 mg/dL and 144.0+/-29.2
mg/dL in the ezetimibe and control groups, respectively, and the
difference was statistically significant. Conclusion(s): The present
study provides valuable evidence about the clinical relevance of
lipid-lowering therapy with ezetimibe in the study population. Clinical
outcomes from the present study will be presented at the meeting.
(UMIN000001988).

<81>
Accession Number
627138175
Title
The primary results of the reduce-it trial.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2018 and Resuscitation Science Symposium. United States. 138 (25) (pp
e752-e753), 2018. Date of Publication: December 2018.
Author
Bhatt D.L.; Steg 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.; Ballantyne
C.M.
Institution
(Bhatt) Heart and Vascular Cntr, Brigham and Women's Hosp, Boston, MA,
United States
(Steg) Cardiology, Hopital Bichat, Paris, France
(Miller) Dept of Medicine, Univ of Maryland, Sch of Medicine, Baltimore,
MD, United States
(Brinton) Utah Lipid Cntr, Utah Lipid Cntr, Salt Lake City, UT, United
States
(Jacobson) Lipid Clinic and Cardiovascular Risk Reduction Program, Dept of
Medicine, Emory Univ Sch of Medicine, Atlanta, GA, United States
(Ketchum, Doyle, Juliano, Jiao) Rsch and Development, Amarin Pharma Inc.,
Bedminster, NJ, United States
(Granowitz) Med Affairs, Amarin Pharma Inc., Bedminster, NJ, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal,
Canada
(Ballantyne) Cntr for Cardiovascular Disease Prevention, Methodist DeBakey
Heart and Vascular Cntr, Baylor College of Medicine, Houston, TX, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Despite therapy with statins, residual cardiovascular risk
remains, especially in patients with persistent hypertriglyceridemia.
Icosapent ethyl is a highly purified ethyl ester of eicosapentaenoic acid
that lowers triglyceride levels and also has anti-oxidative,
anti-inflammatory, and other potentially anti-atherogenic properties.
 Method(s): Reduction of Cardiovascular Events with Icosapent Ethyl -
Intervention Trial (REDUCE-IT, NCT01492361) is a Phase 3b randomized,
double-blinded, placebo-controlled trial of icosapent ethyl in patients
with fasting triglycerides greater than or equal to 150 mg/dL and less
than 500 mg/dL and LDL-C greater than 40 mg/dL and less than or equal to
100 mg/dL on stable statin therapy and with a prior cardiovascular event
or diabetes and other cardiovascular risk factors. The primary endpoint is
a composite of cardiovascular death, non-fatal myocardial infarction,
non-fatal stroke, coronary revascularization, or unstable angina. The key
secondary endpoint is the composite of cardiovascular death, non-fatal
myocardial infarction, or non-fatal stroke. Several other secondary,
tertiary, and exploratory endpoints will be examined. Result(s): Over
8000 patients were randomized to icosapent ethyl versus placebo. Over 1600
adjudicated primary efficacy endpoint events have occurred. The median
follow-up time in the trial is over 4.5 years. Results of the primary, key
secondary, and other selected endpoints will be presented.
 Conclusion(s): The primary results of the REDUCE-IT trial will
establish whether treating at-risk patients with high-dose icosapent ethyl
will lower the rates of important ischemic events beyond statin therapy,
and when combined with the results of other triglyceride-lowering trials,
will provide insight into whether the triglyceride-lowering,
anti-oxidative, anti-inflammatory, or other effects of icosapent ethyl are
clinically relevant.

<82>
Accession Number
627138165
Title
The vitamin D and omega-3 trial (VITAL): Principal results for vitamin d
and omega-3 fatty acid supplementation in the primary prevention of
cardiovascular disease and cancer.
Source
Circulation. Conference: American Heart Association's Scientific Sessions
2018 and Resuscitation Science Symposium. United States. 138 (25) (pp
e752), 2018. Date of Publication: December 2018.
Author
Manson J.A.E.; Cook N.R.; Lee I.-M.; Christen W.; Mora S.; Gibson H.;
Albert C.M.; Bassuk S.; Gordon D.; Copeland T.; D'Agostino D.; Friedenberg
G.; Ridge C.; Bubes V.; Buring J.E.
Institution
(Manson, Cook, Lee, Christen, Mora, Gibson, Albert, Bassuk, Gordon,
Copeland, D'Agostino, Friedenberg, Ridge, Bubes, Buring) Medicine, Harvard
Med Sch, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Supplemental vitamin D and marine omega-3 fatty acids have promise for
reducing risks of cardiovascular disease (CVD) and cancer, but the
evidence remains inconclusive regarding causality. The VITamin D and
Omega-A 3 TriaL (VITAL) is a recently completed nationwide, randomized,
double-blind, placebo-controlled clinical trial designed to fill this
knowledge gap. The study population includes 25,871 U.S. adults (men aged
>=50 and women aged >=55), without CVD or cancer at baseline, with an
oversampling of African Americans (n=5,106). Participants were randomized
in a 2x2 factorial design to one of four supplement groups: (1) vitamin D3
(cholecalciferol; 2000 IU daily) and marine omega-3 fatty acids (Omacor
fish oil, eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA], 1 g
daily, ratio of EPA to DHA = 1.3:1); (2) vitamin D and omega-3 placebo;
(3) vitamin D placebo and omega-3 fatty acids; or (4) both placebos. The
median duration of the randomized treatment period was 5.3 (range 3.8-6.1)
years. Randomization was successful, as evidenced by similar distributions
of baseline demographic, clinical, and behavioral characteristics across
treatment groups. Baseline blood samples were collected from willing
participants (n=~17,000), with follow-up blood samples from >6000. Assays
for serum 25(OH)D and plasma omega-3 (EPA+DHA) concentrations were
performed on baseline and follow-up samples. The primary endpoints of
VITAL are: (a) major CVD events (a composite endpoint of MI, stroke, and
CVD mortality) and (b) total invasive cancer. Secondary CVD endpoints
include: (a) an expanded composite of major CVD events plus coronary
revascularization (i.e., coronary artery bypass grafting or percutaneous
coronary intervention) and (b) the individual components of the composite
CVD endpoints. Secondary cancer endpoints include site-specific cancers
and total cancer mortality. In addition, all-cause and cause-specific
mortality is ascertained, and monitored safety outcomes include
hypercalcemia, parathyroid disorders, and kidney stones. Randomized
treatment ended as scheduled at the end of December 2017. VITAL will
provide important information on the benefit-risk balance of vitamin D and
omega-3 fatty acid supplementation. The principal findings of VITAL, for
each intervention and with a particular emphasis on CVD outcomes, will be
presented for the first time.

<83>
[Use Link to view the full text]
Accession Number
627151394
Title
Metabolic Surgery for Hypertension in Patients With Obesity.
Source
Circulation research. 124 (7) (pp 1009-1024), 2019. Date of Publication:
29 Mar 2019.
Author
Pareek M.; Bhatt D.L.; Schiavon C.A.; Schauer P.R.
Institution
(Pareek, Bhatt) From the Brigham and Women's Hospital Heart & Vascular
Center, Harvard Medical School, Boston, United Kingdom
(Pareek) Department of Cardiology, Nephrology, Endocrinology, North
Zealand Hospital, Hillerod
(Schiavon) Research Institute, Heart Hospital, Sao Paulo, Brazil
(Schauer) Bariatric and Metabolic Institute, Cleveland Clinic, Canada
Publisher
NLM (Medline)
Abstract
The global prevalence of overweight and obesity has risen substantially
over the past 4 decades and is accompanied by an increasing burden of
cardiovascular risk factors such as hypertension. Metabolic surgery is the
most effective method to treat obesity and may further improve associated
conditions. Although most research has been directed toward the glycemic
effects of weight loss surgery, there has been a growing interest in
exploring its potential blood pressure-reducing properties. Systematic
reviews and meta-analyses based primarily on observational data have
suggested that metabolic surgery may aid in controlling hypertension. Only
one randomized controlled trial specifically addressing this concept has
been conducted, though supportive of the findings from observational
studies. We review contemporary procedures for weight loss and their
effects on cardiometabolic risk, particularly hypertension. In addition,
we describe potential pathophysiological mechanisms and the effects of
metabolic surgery on cardiovascular events and mortality.

<84>
Accession Number
627158445
Title
Restrictive compared with liberal red cell transfusion strategies in
cardiac surgery: A meta-analysis.
Source
European Heart Journal. 40 (13) (pp 1081-1088), 2019. Date of Publication:
01 Apr 2019.
Author
Shehata N.; Mistry N.; Da Costa B.R.; Pereira T.V.; Whitlock R.; Curley
G.F.; Scott D.A.; Hare G.M.T.; Juni P.; Mazer C.D.
Institution
(Shehata) Division of Hematology, Departments of Medicine, Laboratory
Medicine and Pathobiology, Institute of Health Policy Management and
Evaluation, University of Toronto, Mount Sinai Hospital, 600 University
Avenue, Toronto, ON M5G 1X5, Canada
(Mistry) Department of Anesthesia, St. Michael's Hospital, 30 Bond Street,
Toronto, ON M5B 1W8, Canada
(Da Costa, Pereira) Applied Health Research Center (AHRC), Li Ka Shing
Knowledge Institute of St. Michael's Hospital, Institute of Health Policy
Management and Evaluation, University of Toronto, 30 Bond Street, Toronto,
ON M5B 1W8, Canada
(Da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Mittelstrasse 43, Bern 3012, Switzerland
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, David Braley Cardiac Vascular and Stroke Research
Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Curley) Department of Anesthesia and Critical Care, Royal College in
Ireland, 123 St Stephen's Green, Dublin 2, Ireland
(Scott) Department of Anesthesia and Acute Pain Medicine, St Vincent's
Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065,
Australia
(Hare, Mazer) Departments of Anesthesia and Physiology, Li Ka Shing
Knowledge Institute of St. Michael's Hospital, University of Toronto, St.
Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
(Juni) Department of Medicine, Institute of Health Policy, Management and
Evaluation, Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute of St. Michael's Hospital, University of Toronto, 30 Bond
Street, Toronto, ON M5B 1W8, Canada
Publisher
Oxford University Press
Abstract
Aims To determine whether a restrictive strategy of red blood cell (RBC)
transfusion at lower haemoglobin concentrations is inferior to a liberal
strategy of RBC transfusion at higher haemoglobin concentrations in
patients undergoing cardiac surgery. Methods and results We conducted a
systematic review, meta-analysis, and trial sequential analysis of
randomized controlled trials of the effect of restrictive and liberal RBC
transfusion strategies on mortality within 30 days of surgery as the
primary outcome. Secondary outcomes were those potentially resulting from
anaemia-induced tissue hypoxia and transfusion outcomes. We searched the
electronic databases MEDLINE, EMBASE, and the Cochrane Library until 17
November 2017. Thirteen trials were included. The risk ratio (RR) of
mortality derived from 4545 patients assigned to a restrictive strategy
when compared with 4547 transfused according to a liberal strategy was
0.96 [95% confidence interval (CI) 0.76-1.21, I 2 = 0]. A restrictive
strategy did not have a statistically significant effect on the risk of
myocardial infarction (RR 1.01, 95% CI 0.81-1.26; I 2 =0), stroke (RR
0.93, 95% CI 0.68-1.27, I 2 = 0), renal failure (RR 0.96, 95% CI
0.76-1.20, I 2 = 0), or infection (RR 1.12, 95% CI 0.98-1.29, I 2 = 0).
Subgroup analysis of adult and paediatric trials did not show a
significant interaction. At approximately 70% of the critical information
size, the meta-analysis of mortality crossed the futility boundary for
inferiority of the restrictive strategy. Conclusion The current evidence
does not support the notion that restrictive RBC transfusion strategies
are inferior to liberal RBC strategies in patients undergoing cardiac
surgery. Copyright © Published on behalf of the European Society
of Cardiology. All rights reserved.

<85>
[Use Link to view the full text]
Accession Number
627081063
Title
Resuscitation of endotheliopathy and bleeding in thoracic aortic
dissections: The VIPER-OCTA randomized clinical pilot trial.
Source
Anesthesia and Analgesia. 127 (4) (pp 920-927), 2018. Date of Publication:
2018.
Author
Stensballe J.; Ulrich A.G.; Nilsson J.C.; Henriksen H.H.; Olsen P.S.;
Ostrowski S.R.; Johansson P.I.
Institution
(Stensballe, Henriksen, Ostrowski, Johansson) Section for Transfusion
Medicine, Capital Region Blood Bank, Copenhagen University Hospital,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Stensballe) Department of Anesthesia, Centre of Head and Orthopedics,
Copenhagen University Hospital, Copenhagen, Denmark
(Ulrich, Nilsson) Departments of Cardiothoracic Anesthesia, Copenhagen
University Hospital, Copenhagen, Denmark
(Olsen) Departments of Cardiothoracic Surgery, Heart Centre, Copenhagen
University Hospital, Copenhagen, Denmark
(Johansson) Division of Acute Care Surgery, University of Texas, Medical
School at Houston, Houston, TX, United States
(Johansson) Center for Systems Biology, School of Engineering and Natural
Sciences, University of Iceland, Reykjavik, Iceland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Thoracic aorta dissection is an acute critical condition
associated with shockinduced endotheliopathy, coagulopathy, massive
bleeding, and significant morbidity and mortality. Our aim was to compare
the effect of coagulation support with solvent/detergent-treated pooled
plasma (OctaplasLG) versus standard fresh frozen plasma (FFP) on
glycocalyx and endothelial injury, bleeding, and transfusion requirements.
 METHOD(S): Investigator-initiated, single-center, blinded, randomized
clinical pilot trial of adult patients undergoing emergency surgery for
thoracic aorta dissection. Patients were randomized to receive OctaplasLG
or standard FFP as coagulation factor replacement related to bleeding. The
primary outcome was glycocalyx and endothelial injury. Other outcomes
included bleeding, transfusions and prohemostatics at 24 hours, organ
failure, length of stay in the intensive care unit and in the hospital,
safety, and mortality at 30 and 90 days. RESULT(S): Fifty-seven
patients were included to obtain 44 evaluable on the primary outcome. The
OctaplasLG group displayed significantly reduced damage to the endothelial
glycocalyx (syndecan- 1) and reduced endothelial tight junction injury
(sVE-cadherin) compared to standard FFP. In the OctaplasLG group compared
to the standard FFP, days on ventilator (1 day [interquartile range, 0-1]
vs 2 days [1-3]; P = .013), bleeding during surgery (2150 [1600-3087] vs
2750 [2130-6875]; P = .046), 24-hour total transfusion and platelet
transfusion volume (3975 mL [2640-6828 mL] vs 6220 mL [4210-10,245 mL]; P
= .040, and 1400 mL [1050-2625 mL] vs 2450 mL [1400-3500 mL]; P = .027),
and goal-directed use of prohemostatics (7/23 [30.4%] vs 13/21 [61.9%]; P
= .036) were all significantly lower. Among the 57 patients randomized,
30-day mortality was 20.7% (6/29) in the OctaplasLG group and 25% (7/28)
in the standard FFP group (P = .760). No safety concern was raised.
 CONCLUSION(S): In this randomized, clinical pilot trial of patients
undergoing emergency surgery for thoracic aorta dissections, we found that
OctaplasLG reduced glycocalyx and endothelial injury, reduced bleeding,
transfusions, use of prohemostatics, and time on ventilator after surgery
compared to standard FFP. An adequately powered multicenter trial is
warranted to confirm the clinical importance of the
findings. Copyright © 2018 The Author(s).

<86>
[Use Link to view the full text]
Accession Number
627080165
Title
Prothrombin complex concentrates for perioperative Vitamin K antagonist
and non-Vitamin K anticoagulant reversal.
Source
Anesthesiology. 129 (6) (pp 1171-1184), 2018. Date of Publication: 2018.
Author
Levy J.H.; Douketis J.; Steiner T.; Goldstein J.N.; Milling T.J.
Institution
(Levy) Department of Anesthesiology, Cardiothoracic Intensive Care Unit,
Duke University School of Medicine, Durham, NC 27710, United States
(Douketis) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Steiner) Department of Neurology, Heidelberg University Hospital,
Heidelberg, Germany
(Goldstein) Department of Emergency Medicine, Massachusetts General
Hospital, Boston, MA, United States
(Milling) Departments of Neurology and Surgery and Perioperative Care,
Seton dell Medical School Stroke Institute, Austin, TX, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Vitamin K antagonist therapy is associated with an increased bleeding
risk, and clinicians often reverse anticoagulation in patients who require
emergency surgical procedures. Current guidelines for rapid
anticoagulation reversal for emergency surgery recommend four-factor
prothrombin complex concentrate and vitamin K coadministration. Te authors
reviewed the current evidence on prothrombin complex concentrate treatment
for vitamin K antagonist reversal in the perioperative setting, focusing
on comparative studies and in the context of intracranial hemorrhage and
cardiac surgery. Te authors searched Cochrane Library and PubMed between
January 2008 and December 2017 and retrieved 423 English-language papers,
which they then screened for relevance to the perioperative setting; they
identifed 36 papers to include in this review. Prothrombin complex
concentrate therapy was consistently shown to reduce international
normalized ratio rapidly and control bleeding effectively. In comparative
studies with plasma, prothrombin complex concentrate use was associated
with a greater proportion of patients achieving target international
normalized ratios rapidly, with improved hemostasis. No differences in
thromboembolic event rates were seen between prothrombin complex
concentrate and plasma, with prothrombin complex concentrate also
demonstrating a lower risk of fluid overload events. Overall, the studies
the authors reviewed support current recommendations favoring prothrombin
complex concentrate therapy in patients requiring vitamin K antagonist
reversal before emergency surgery. Copyright © 2018, the American
Society of Anesthesiologists, Inc.

<87>
[Use Link to view the full text]
Accession Number
627081498
Title
The ROMA trial: Why it is needed.
Source
Current Opinion in Cardiology. 33 (6) (pp 622-626), 2018. Date of
Publication: 2018.
Author
Gaudino M.F.L.; Taggart D.P.; Fremes S.E.
Institution
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
525 E 68th St, New York, NY 10065, United States
(Taggart) University of Oxford, Oxford, United Kingdom
(Fremes) Schulich Heart Centre, Sunnybrook Health Science, University of
Toronto, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review We herein summarize the current evidence on the clinical
outcome associated with the use of single and multiple arterial grafts for
coronary bypass surgery and the role and importance of the Randomized
comparison of the clinical Outcome of single versus Multiple Arterial
grafts (ROMA) trial. Recent findings Observational evidence suggests that
the use of multiple arterial grafts is associated with better clinical
outcomes compared to the use of a single arterial graft. Randomized
evidence is inconclusive; the 5-year interim analysis of the largest
randomized trial on the topic did not show any clinical benefit associated
with the use of bilateral versus single internal thoracic arteries,
whereas a pooled analysis of the trials comparing the radial artery and
the saphenous vein as a second graft showed a significant reduction in
follow-up cardiac events using the radial artery. Hidden confounders and
treatment allocation biases as well as methodological flaws are the most
likely explanation of this contradiction. Summary ROMA was conceived based
on the lessons learned from a critical analysis of the existing randomized
and observational evidence with the aim to provide a definitive answer to
the question of the potential clinical benefit of multiple arterial grafts
for coronary bypass. Copyright © 2018 Wolters Kluwer Health, Inc.
All rights reserved.

<88>
[Use Link to view the full text]
Accession Number
627081444
Title
Restrictive versus liberal strategy for red blood-cell transfusion: A
systematic review and meta-analysis in orthopaedic patients.
Source
Journal of Bone and Joint Surgery - American Volume. 100 (8) (pp 686-695),
2018. Date of Publication: 2018.
Author
Gu W.-J.; Gu X.-P.; Wu X.-D.; Chen H.; Kwong J.S.W.; Zhou L.-Y.; Chen S.;
Ma Z.-L.
Institution
(Gu, Gu, Zhou, Ma) Department of Anesthesiology, Nanjing Drum Tower
Hospital, Medical College of Nanjing University, Nanjing, China
(Wu) Department of Orthopaedic Surgery, First Affiliated Hospital,
Chongqing Medical University, Chongqing, China
(Chen) Second Clinical Medical College, Nanjing University of Chinese
Medicine, Nanjing, China
(Kwong) Department of Health Policy, National Center for Child Health and
Development, Tokyo, Japan
(Chen) Department of Medical Information, Chinese People's Liberation Army
General Hospital, Beijing, China
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Current guidelines recommend restrictive criteria for red
blood-cell transfusion in most clinical settings. However, patients
undergoing orthopaedic surgery may require distinct transfusion criteria
since benefits and potential harm often vary considerably based on patient
characteristics and surgical procedures. We aimed to assess the efficacy
and safety of restrictive transfusion in patients undergoing orthopaedic
surgery, especially in important subgroups. Method(s): Electronic
databases were searched to identify randomized controlled trials
investigating restrictive (mostly a hemoglobin level of 8.0 g/dL or
symptomatic anemia) versus liberal (mostly a hemoglobin level of 10.0
g/dL) transfusion in patients undergoing orthopaedic surgery. For the
primary outcome of cardiovascular events, we performed randomeffects
meta-analyses to synthesize the evidence and to assess the effects in
different subgroups according to patient characteristics (with versus
without preexisting cardiovascular disease) and surgical procedures (hip
fracture surgery versus elective arthroplasty). Result(s): Ten trials
involving 3,968 participants who underwent hip or knee surgery were
included. Mean participant age ranged from 68.7 to 86.9 years. Compared
with liberal transfusion, restrictive transfusion increased the risk of
cardiovascular events (8 trials; 3,618 participants; relative risk [RR],
1.51; 95% confidence interval [CI], 1.16 to 1.98; p = 0.003; with no
heterogeneity across all trials), irrespective of preexisting
cardiovascular disease (pinteraction = 0.63). In a subgroup analysis, the
increase was observed in patients undergoing hip fracture surgery (RR,
1.51; 95% CI, 1.08 to 2.10; p = 0.02), but did not reach significance in
those undergoing elective arthroplasty (RR, 1.53; 95% CI, 0.96 to 2.44; p
= 0.07). To minimize the bias caused by variations in transfusion
threshold, we conducted an analysis that only included trials using 8.0
g/dL hemoglobin or symptomatic anemia as the threshold for restrictive
transfusion and obtained identical results (6 trials; 2,872 participants;
RR, 1.51; 95% CI, 1.09 to 2.08; p = 0.01; I2 = 0%). The 2 arms
did not differ with respect to the rates of all infections, 30-day
mortality, thromboembolic events, wound infection, pulmonary infection
(mainly pneumonia), and cerebrovascular accidents (mainly stroke).
 Conclusion(s): In patients undergoing orthopaedic surgery, when
compared with liberal transfusion, restrictive transfusion increases the
risk of cardiovascular events irrespective of preexisting cardiovascular
disease. Importantly, the increased risk was observed in patients
undergoing hip fracture surgery but did not reach significance in those
undergoing elective arthroplasty. Level of Evidence: Therapeutic
Level I. See Instructions for Authors for a complete description of levels
of evidence. Copyright © 2018 by the Journal of Bone and Joint
Surgery, Incorporated.

<89>
Accession Number
627169283
Title
Effect of Digital Storytelling on Anxiety in Patients Who Are Candidates
for Open-Heart Surgery.
Source
The Journal of cardiovascular nursing. (no pagination), 2019. Date of
Publication: 27 Mar 2019.
Author
Moghimian M.; Akbari M.; Moghaddasi J.; Niknajad R.
Institution
(Moghimian) Nursing & Midwifery Sciences Development Research Center and
Department of Nursing, Najafabad Branch, PhD Member of Young Researcher
Club and Department of Nursing, Khoorasgan Branch, Islamic Azad
University, Department of Medical Surgical Nursing, Shahrekord University
of Medical Sciences, MSc Instructor, Nursing and Midwifery Student
Research Committee and Department of Operative Room, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Open-heart surgery in persons with cardiovascular disease is
associated with high levels of anxiety. OBJECTIVE(S): The goal of
this study was to determine the effect of digital storytelling on anxiety
in patients who were candidates for open-heart surgery. METHOD(S): In
this quasi-experimental study, 80 patients were randomly allocated into 2
groups. The intervention group received routine training and digital
storytelling. In each group, anxiety was measured by the State-Trait
Anxiety Inventory anxiety scale before surgery and 5 days after surgery.
The collected data were analyzed using SPSS software V18. RESULT(S):
There was no significant difference in the anxiety of both groups during
the 2 days before the surgery (P = .40). After the surgery, the mean of
anxiety scores in the intervention group was lower than that of the
control group (P < .001). CONCLUSION(S): Digital storytelling is an
effective method to reduce anxiety in patients who are candidates for
open-heart surgery.

<90>
Accession Number
627168452
Title
In Search of the Ideal Valve: Optimizing Genetic Modifications to Prevent
Bioprosthetic Degeneration.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 02 Mar 2019.
Author
Smood B.; Hara H.; Cleveland D.; Cooper D.K.C.
Institution
(Smood, Hara, Cooper) Xenotransplantation Program, Department of Surgery,
United Arab Emirates
(Cleveland) Division of Pediatric Cardiovascular Surgery, University of
Alabama at Birmingham, Birmingham, AL, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Bioprosthetic heart valves undergo structural degeneration and
calcification. Similarities exist in the histopathologic features of
explanted bioprosthetic valves and rejected pig tissues and organs after
xenotransplantation into nonhuman primates. The development of more
durable bioprosthetic valves, namely from genetically-modified pigs, could
negate the need for the insertion of mechanical prostheses in children and
young adults with the requirement for life-long anticoagulation, and might
avoid the need for reoperation in elderly patients. METHOD(S): We
reviewed the literature (MedlinePlus, PubMed, Google Scholar) through
September 1, 2018, under 4 key terms: (1) bioprosthetic heart valves; (2)
xenograft antigens; (3) immunologic responses to bioprosthetic valves; and
(4) genetic modification of xenografts. RESULT(S): Advances in tissue
and organ xenotransplantation have elucidated important immunologic
barriers that provide innovative approaches to prevent structural
degeneration of bioprosthetic heart valves. The current evidence suggests
that bioprosthetic valves derived from genetically-modified pigs lacking
xenogeneic antigens (namely Gal, Neu5Gc, and Sda), termed triple-knockout
pigs, would function considerably longer than current wild-type
(genetically-unmodified) porcine valves in human recipients.
 CONCLUSION(S): Preclinical and clinical studies determining the
safety and efficacy of triple-knockout porcine bioprosthetic valves will
likely establish that they are more resistant to human immune responses
and thus less susceptible to structural degeneration. Copyright ©
2019. Published by Elsevier Inc.

<91>
Accession Number
627035943
Title
Off pump' self-expanding injectable tissue valves (IPVR) versus a on
pump' conventional tissue valves (PVR) for replacement of the pulmonary
valve: Trial protocol for a randomised controlled trial (InVITe trial).
Source
BMJ Open. 9 (4) (no pagination), 2019. Article Number: e026221. Date of
Publication: 01 Apr 2019.
Author
Heys R.; Angelini G.; Caputo M.; Culliford L.; Pufulete M.; Reeves B.C.;
Rogers C.A.; Stoica S.; Parry A.
Institution
(Heys, Culliford, Pufulete, Reeves, Rogers) Clinical Trials and Evaluation
Unit, Bristol Trials Centre, University of Bristol, Bristol, United
Kingdom
(Angelini, Parry) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
(Caputo, Stoica) Bristol Royal Hospital for Children, University Hospitals
Bristol NHS Foundation Trust, Bristol, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Patients with congenital heart disease often need repeated
operations throughout life to replace the pulmonary valve. Valve
replacement with a injectable' self-expanding valves (which is performed
a off pump' without the use of cardiopulmonary bypass, CPB) may result in
quicker recovery and lower risk of major complications than valve
replacement with conventional valves (which is performed a on pump' with
the use of CPB). Methods and analysis We are conducting a multicentre,
single-blind randomised controlled trial in patients with congenital heart
disease and aged between 12 and 80 years. We will randomise participants
in a 1:1 ratio to receive either a off pump' injectable pulmonary valve
replacement or a on pump' conventional pulmonary valve replacement. The
primary outcome will be the difference between the groups with respect to
post-surgery blood loss (as measured by chest drain volume) in the first
24 hours. Secondary outcomes will include in-hospital outcomes (intensive
care unit stay, inotropic/vasodilator support, chest drain volume in the
first 12 hours post-surgery, time of readiness for extubation, blood
products used in the first 24 hours post-surgery, time of fitness for
discharge, valve and heart function 6 months post-surgery (assessed using
cardiovascular magnetic resonance and ECHOCARDIOGRAPHY) and health-related
quality of life 6 weeks and 6 months post-surgery. Ethics and
dissemination This trial has been approved by the South West Exeter
Research Ethics Committee. Findings will be shared with participating
hospitals and disseminated to the academic community through peer reviewed
publications and presentation at national and international meetings.
Patients will be informed of the results through patient organisations and
newsletters to participants. Trial registration number
ISRCTN23538073. Copyright © © Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

<92>
[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.

<93>
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).

<94>
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.

<95>
Accession Number
627137582
Title
Sudden cardiac death associated with cardiac catheterization in Williams
syndrome: A case report and review of literature.
Source
Cardiology in the Young. (no pagination), 2019. Date of Publication: 2019.
Author
Abu-Sultaneh S.; Gondim M.J.; Alexy R.D.; Mastropietro C.W.
Institution
(Abu-Sultaneh, Mastropietro) Department of Pediatrics, Division of
Pediatric Critical Care Medicine, Indiana University, School of Medicine,
Riley Hospital for Children, Indiana University Health, Indianapolis, IN,
United States
(Gondim) Department of Pathology and Laboratory Medicine, Indiana
University, School of Medicine, Indianapolis, IN, United States
(Alexy) Department of Pediatrics, Division of Pediatric Cardiology,
Indiana University, School of Medicine, Riley Hospital for Children,
Indiana University Health, Indianapolis, IN, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Williams syndrome is a rare genetic disease that affects elastin
production, leading to medium and large vessel stenoses and other
abnormalities. Cardiac manifestations of Williams syndrome are the most
life-threatening, occurring in 80% of children. Children with Williams
syndrome are known to be at risk for sudden cardiac death. These tragic
events are often precipitated by diagnostic or therapeutic procedures
requiring anaesthesia or sedation, such as cardiac catheterisation. We
present the case of a 3-month-old infant with Williams syndrome who
suffered sudden cardiac arrest during cardiac catheterisation and
subsequent arrest approximately 48 hours after the procedure. We also
review the current literature focused on children with Williams syndrome
who have suffered sudden cardiac arrest during or after cardiac
catheterisation procedures. Copyright © Cambridge University
Press 2019.

<96>
Accession Number
627135439
Title
Association between anaesthetic technique and unplanned admission to
intensive care after thoracic lung resection surgery: the second
Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC)
National Audit.
Source
Anaesthesia. (no pagination), 2019. Date of Publication: 2019.
Author
Shelley B.G.; McCall P.J.; Glass A.; Orzechowska I.; Klein A.A.; Hemming
A.E.; Knight T.; Janson M.; Fogg K.J.; Bailey A.; Palomino P.R.; Lau G.;
Errico M.; Williams A.; Hurley R.; Petko M.; Giri R.; Nelapatla M.K.;
Auldin M.; Kumar S.; Hartley M.; Malpas C.; Agarwal S.; Lane B.; Irvine
M.; Elayaperumal A.K.; Easaw B.S.; Feddy L.; Heward S.; Ware M.; Abel R.;
Jooste R.; Fanning N.P.
Institution
(Shelley, McCall, Glass) University of Glasgow Academic Unit of
Anaesthesia, Pain and Critical Care Medicine, Glasgow, United Kingdom
(Orzechowska) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Unplanned intensive care admission is a devastating complication of lung
resection and is associated with significantly increased mortality. We
carried out a two-year retrospective national multicentre cohort study to
investigate the influence of anaesthetic and analgesic technique on the
need for unplanned postoperative intensive care admission. All patients
undergoing lung resection surgery in 16 thoracic surgical centres in the
UK in the calendar years 2013 and 2014 were included. We defined critical
care admission as the unplanned need for either tracheal intubation and
mechanical ventilation or renal replacement therapy, and sought an
association between mode of anaesthesia (total intravenous anaesthesia vs.
volatile) and analgesic technique (epidural vs. paravertebral) and need
for intensive care admission. A total of 253 out of 11,208 patients
undergoing lung resection in the study period had an unplanned admission
to intensive care in the postoperative period, giving an incidence of
intensive care unit admission of 2.3% (95%CI 2.0-2.6%). Patients who had
an unplanned admission to intensive care unit had a higher mortality
(29.00% vs. 0.03%, p < 0.001), and hospital length of stay was increased
(26 vs. 6 days, p < 0.001). Across univariate, complete case and multiple
imputation (multivariate) models, there was a strong and significant
effect of both anaesthetic and analgesic technique on the need for
intensive care admission. Patients receiving total intravenous anaesthesia
(OR 0.50 (95%CI 0.34-0.70)), and patients receiving epidural analgesia (OR
0.56 (95%CI 0.41-0.78)) were less likely to have an unplanned admission to
intensive care after thoracic surgery. This large retrospective study
suggests a significant effect of both anaesthetic and analgesic technique
on outcome in patients undergoing lung resection. We must emphasise that
the observed association does not directly imply causation, and suggest
that well-conducted, large-scale randomised controlled trials are required
to address these fundamental questions. Copyright © 2019
Association of Anaesthetists

<97>
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

<98>
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.

<99>
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.

<100>
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.

<101>
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

<102>
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.

<103>
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.

<104>
Accession Number
627120816
Title
Cardiac surgery 2018 reviewed.
Source
Clinical research in cardiology : official journal of the German Cardiac
Society. (no pagination), 2019. Date of Publication: 30 Mar 2019.
Author
Doenst T.; Bargenda S.; Kirov H.; Moschovas A.; Tkebuchava S.; Safarov R.;
Diab M.; Faerber G.
Institution
(Doenst, Bargenda, Kirov, Moschovas, Tkebuchava, Safarov, Diab, Faerber)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University of
Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
NLM (Medline)
Abstract
For the year 2018, more than 22,000 published references can be found in
PubMed when entering the search term "cardiac surgery". As in the last 4
years, this review focusses on conventional cardiac surgery publications
which provide important and interesting information especially relevant
for non-surgical colleagues. Interventional techniques have been
considered if they were published in the context of classic surgical
techniques. We have again reviewed the fields of coronary
revascularization and valve surgery and briefly touched on aortic surgery
and surgery for terminal heart failure. For revascularization of complex
coronary artery disease, bypass grafting was reconfirmed as gold standard
and computer-tomographic angiography established equipoise for
decision-making with classic angiography. For aortic valve treatment, some
new longer-term outcomes from TAVI vs. SAVR trials confirmed equipoise of
both treatments for high and medium risk. New information was provided for
INR-management of mechanical aortic valves as well as long-term
experiences for alternatives to mechanical valves (i.e., Ross and the
relatively new Ozaki procedure). In the mitral and tricuspid field,
prevalence data illustrate a significant amount of under-treatment for
mitral and tricuspid valve regurgitation and evidence for life
prolonging-effects of surgery. Finally, elongation of the ascending aorta
was identified as new risk factor for aortic dissection and 2 years
outcome of the newest generation of left ventricular assist devices
demonstrate impressive improvements in outcome. While this article
attempts to summarize the most pertinent publications, it does not expect
to be complete and cannot be free of individual interpretation. As in
recent years, it provides a condensed summary that is intended to give the
reader "solid ground" for up-to-date decision-making in cardiac surgery
and a stimulus for in-depth reading.

<105>
Accession Number
627125123
Title
Five-year costs from a randomised comparison of bilateral and single
internal thoracic artery grafts.
Source
Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Little M.; Gray A.; Altman D.; Benedetto U.; Flather M.; Gerry S.; Lees
B.; Murphy J.; Campbell H.; Taggart D.
Institution
(Little) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Gray, Murphy, Campbell) Nuffield Department of Population Health,
University of Oxford, Health Economics Research Centre, Oxford, United
Kingdom
(Altman) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Centre for Statistics in Medicine, University of
Oxford, Oxford, United Kingdom
(Benedetto) University of Bristol School of Clinical Science, Bristol,
United Kingdom
(Flather) University of East Anglia, Faculty of Medicine and Health
Sciences, Norwich, United Kingdom
(Flather) Norfolk and Norwich University Hospitals NHS Foundation Trust,
Norwich, United Kingdom
(Gerry) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sci., Centre for Statistics in Medicine, Oxford, United
Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, Oxfordshire, Oxford, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: The use of bilateral internal thoracic arteries (BITA) for
coronary artery bypass grafting (CABG) may improve survival compared with
CABG using single internal thoracic arteries (SITA). We assessed the
long-term costs of BITA compared with SITA. Method(s): Between June
2004 and December 2007, 3102 patients from 28 hospitals in seven countries
were randomised to CABG surgery using BITA (n=1548) or SITA (n=1554).
Detailed resource use data were collected from the initial hospital
episode and annually up to 5 years. The associated costs of this resource
use were assessed from a UK perspective with 5 year totals calculated for
each trial arm and pre-selected patient subgroups. Result(s): Total
costs increased by approximately 1000 annually in each arm, with no
significant annual difference between trial arms. Cumulative costs per
patient at 5-year follow-up remained significantly higher in the BITA
group (18 629) compared with the SITA group (17 480; mean cost difference
1149, 95% CI 330 to 1968, p=0.006) due to the higher costs of the initial
procedure. There were no significant differences between the trial arms in
the cost associated with healthcare contacts, medication use or serious
adverse events. Conclusion(s): Higher index costs for BITA were still
present at 5-year follow-up mainly driven by the higher initial cost with
no subsequent difference emerging between 1 year and 5 years of follow-up.
The overall cost-effectiveness of the two procedures, to be assessed at
the primary endpoint of the 10-year follow-up, will depend on composite
differences in costs and quality-adjusted survival. Copyright ©
Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY.
Published by BMJ.

<106>
Accession Number
627122834
Title
Is microwave ablation more effective than radiofrequency ablation in
achieving local control for primary pulmonary malignancy?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 30 Mar 2019.
Author
Tsakok M.T.; Jones D.; MacNeill A.; Gleeson F.V.
Institution
(Tsakok, Gleeson) Department of Radiology, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Tsakok, Jones, MacNeill) Medical Sciences Division, University of Oxford,
Oxford, 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 microwave ablation
(MWA) more effective than radiofrequency ablation (RFA) in achieving local
control for primary lung cancer?'. Altogether, 439 papers were found, of
which 7 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.
Both are thermal ablative techniques, with microwave ablation (MWA) the
newer technique and radiofrequency ablation (RFA) with a longer track
record. Lack of consensus with regard to definitions of technical success
and efficacy and heterogeneity of study inclusions limits studies for
both. The only direct comparison study does not demonstrate a difference
with either technique in achieving local control. The quality of evidence
for MWA is very limited by retrospective nature and heterogeneity in
technique, power settings and tumour type. Tumour size and late-stage
cancer were shown to be associated with higher rates of local recurrence
in 1 MWA study. RFA studies were generally of a higher level of evidence
comprising prospective trials, systematic review and meta-analysis. The
recurrence rates for MWA and RFA overlapped, and for the included studies
ranged between 16% and 44% for MWA and 9% and 58% for RFA. The current
evidence, therefore, does not clearly demonstrate a benefit of MWA over
RFA in achieving local control in primary lung cancer. Copyright
© The Author(s) 2019. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<107>
Accession Number
627121574
Title
Clinical outcomes of paediatric patients supported by the Berlin Heart
EXCOR: a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 01 Apr 2019.
Author
Rohde S.; Antonides C.F.J.; Dalinghaus M.; Muslem R.; Bogers A.J.J.C.
Institution
(Rohde, Antonides, Muslem, Bogers) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Dalinghaus) Department of Paediatric Cardiology, Erasmus University
Medical Centre, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
Ventricular assist devices (VADs) are widely accepted as therapy to bridge
children to heart transplantation. We provide a systematic review of the
current state of clinical outcomes in children after paediatric VAD
support by the Berlin Heart EXCOR (BH EXCOR) device. A systematic
literature search was performed in April 2018. Studies reporting clinical
outcomes in at least 15 children supported by a BH EXCOR VAD were
included. Additionally, we focused on outcomes in small children and
compared outcomes of children supported by a left ventricular assist
device (LVAD) versus children supported by a biventricular assist device
(BiVAD). Eighteen publications fulfilled the inclusion criteria and were
included in this systematic review. Mortality rates ranged from 6.3%
[confidence interval (CI) 0.0-18.1%] to 38.9% (2.8-75.0%) while
transplantation rates ranged from 37.0% (CI 18.8-55.2%) to 72.5% (CI
63.9-81.2%) and successful weaning rates from 0.0% to 20.7% (CI
6.0-35.5%). In children under 1 year of age, mortality rates ranged from
20.0% to 55.5% and transplantation rates ranged from 0.0% to 62.5%. BiVAD
support seemed to result in worse clinical outcomes than LVAD support.
Incidence of stroke ranged from 5.0% to 47.0% in all children supported
with the BH EXCOR. Although a high incidence of adverse events such as
stroke and pump thrombosis is reported, VAD support should be considered
in children with end-stage heart failure awaiting heart transplantation.
Further research is warranted, especially on optimal timing of device
implantation and anticoagulation regimens. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

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