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

<2>
Accession Number
2001400494
Title
Preventing Ventricular Fibrillation in Patients With Left Ventricular
Hypertrophy Undergoing Aortic Valve Replacement: Time to Consider
Prophylactic Amiodarone Infusion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1214-1215),
2019. Date of Publication: May 2019.
Author
Dalia A.A.; Essandoh M.K.
Institution
(Dalia) Department of Anesthesiology, Pain Medicine, and Critical Care,
The Massachusetts General Hospital, Harvard Medical School, Boston, MA,
United States
(Essandoh) Department of Anesthesiology, Wexner Medical Center, The Ohio
State University, Columbus, OH, United States
Publisher
W.B. Saunders

<3>
Accession Number
2001116317
Title
Establishment of Predictive Models for Nonocclusive Mesenteric Ischemia
Comparing 8,296 Control with 452 Study Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1290-1297),
2019. Date of Publication: May 2019.
Author
Bomberg H.; Stroeder J.; Karrenbauer K.; Groesdonk H.V.; Wagenpfeil S.;
Klingele M.; Bucker A.; Schafers H.-J.; Minko P.
Institution
(Bomberg, Karrenbauer, Schafers) Department of Thoracic and Cardiovascular
Surgery, Saarland University Medical Center, Homburg/Saar, Germany
(Bomberg, Groesdonk) Department of Anesthesiology, Intensive Care Medicine
and Pain Medicine, Saarland University Medical Center, Homburg/Saar,
Germany
(Stroeder, Bucker, Minko) Department of Diagnostic and Interventional
Radiology, Saarland University Medical Center, Homburg/Saar, Germany
(Wagenpfeil) Institute for Medical Biometry, Epidemiology and Medical
Informatics, Saarland University Medical Center, Homburg/Saar, Germany
(Klingele) Department of Medicine, Division of Nephrology and
Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
(Klingele) Department of Nephrology, Hochtaunus-Kliniken, Bad Homburg,
Germany
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to develop clinical preoperative,
intraoperative, and postoperative scores for early identification of
patients who are at risk of nonocclusive mesenteric ischemia (NOMI).
 Design(s): A retrospective analysis. Setting(s): Single center.
 Participant(s): From January 2008 to December 2014, all patients from
the Department of Thoracic and Cardiovascular Surgery were included on the
basis of the hospital database. Intervention(s): All mesenteric
angiographically identified NOMI patients were compared with non-NOMI
patients. Measurements and Main Results: The study population of
8,748 patients was randomized into a cohort for developing the scores
(non-NOMI 4,214 and NOMI 235) and a cohort for control (non-NOMI 4,082 and
NOMI 217). Risk factors were identified using forward and backward Wald
test and were included in the predictive scores for the occurrence of
NOMI. C statistic showed that the scores had a high discrimination for the
prediction of NOMI preoperatively (C statistic 0.79; p < 0.001),
intraoperatively (C statistic 0.68; p < 0.001), and postoperatively (C
statistic 0.85; p < 0.001). A combination of the preoperative,
intraoperative, and postoperative risk scores demonstrated the highest
discrimination (C statistic 0.87; p < 0.001). The combined score included
the following risk factors: renal insufficiency (preoperative); use of
cardiopulmonary bypass and intra-aortic balloon pump support
(intraoperative); and reexploration for bleeding, renal replacement
therapy, and packed red blood cells >= 4 units (postoperative). The
results were similar in the control group. Conclusion(s): These
scores could be useful to identify patients at risk for NOMI and promote a
rapid diagnosis and therapy. Copyright © 2018 Elsevier Inc.

<4>
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

<5>
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).

<6>
Accession Number
2001457219
Title
Fragility of Red Blood Cells Collected Under Different Conditions With a
Cell Saver Device.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1224-1229),
2019. Date of Publication: May 2019.
Author
Chung Y.S.; Kim H.R.; Kang H.; Ryu C.; Park B.; Hong J.
Institution
(Chung, Park, Hong) Department of Thoracic and Cardiovascular Surgery,
Chung-Ang University Hospital, Seoul, South Korea
(Kim) Department of Laboratory Medicine, Chung-Ang University Hospital,
Seoul, South Korea
(Kang, Ryu) Department of Anesthesiology and Pain Medicine, Chung-Ang
University Hospital, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objective: To quantify the degree of lethal and sublethal damage to red
blood cells (RBCs) by cell saver (CS) processing among different
conditions of shed blood in cardiac surgery. Design(s): Prospective
randomized, double-blinded, controlled study. Setting(s): Single
university hospital. Participant(s): Twenty rabbits were divided
randomly into non-heparinized and heparinized groups. Thereafter, each
group was subdivided into non-gauze and gauze groups based on whether the
blood was collected with gauze and squeezed out. Intervention(s):
Blood from each group was aspirated directly from the heart and underwent
CS processing. Mechanical fragility index (MFI) and percent hemolysis were
measured pre- and post-CS processing. Measurements and Main Results:
In RBCs after CS processing, the MFI and percent hemolysis were increased
significantly in both the non-heparinized and heparinized groups compared
to pre-CS processing. The MFI was significantly higher in the heparinized
group than in the non-heparinized group (p = 0.002). However, no
differences in percent hemolysis were detected between groups (p = 0.696).
The MFI and percent hemolysis of the non-gauze and gauze groups did not
differ. Conclusion(s): This study reports the increase in sublethal
and lethal injuries to RBCs from heparinized and non-heparinized blood
after CS processing. CS-processed heparinized blood contained more
sublethally injured RBCs compared to CS-processed non-heparinized blood.
RBCs collected by squeezing blood-saturated gauze did not exhibit
additional trauma. Further investigation is required to determine the
clinical implications of transfusing rescued but injured RBCs using a
CS. Copyright © 2018 Elsevier Inc.

<7>
Accession Number
2001111602
Title
Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac
Surgery and Their Parents: Effect of Brief Intervention-A Randomized
Control Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1244-1250),
2019. Date of Publication: May 2019.
Author
Kumar A.; Das S.; Chauhan S.; Kiran U.; Satapathy S.
Institution
(Kumar, Das, Chauhan, Kiran) Department of Cardiac Anaesthesia, All India
Institute of Medical Sciences, New Delhi, India
(Satapathy) Department of Clinical Psychology, All India Institute of
Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To know the effects of psychological preparation on
perioperative stress, anxiety, and mood in children undergoing cardiac
surgery and their parents. Design(s): Prospective randomized control
nonblinded trial. Setting(s): Single-center tertiary teaching
hospital. Participant(s): A total of 60 children aged 5 to 15 years
undergoing cardiac surgery were included in the study. One of the parents,
preferably the father, was selected from the respective children.
 Intervention(s): Subjects were randomized into 2 groups:
noninterventional (group 1) and interventional (group 2). Intervention was
in the form of toys and video games in children, and counseling and
information in parents. Preoperative and postoperative anxiety in parents
was measured using the State-Trait Anxiety Inventory (STAI), stress using
the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood
scale. In children, the STAI-C (child version of STAI), Ottawa mood and
Ottawa stress scales, and Wong-Baker faces pain scale were applied and
serum cortisol was measured. Measurements and Main Results: Group 2
children had significantly less (p < 0.001) stress, anxiety, and pain and
improved mood. Group 2 parents had a significant reduction in state
anxiety (42 +/- 4.4 v 54.5 +/- 7.8; p < 0.001) and ICS score (68.1+/-9.6 v
84.2 +/- 9.2; p < 0.001) and an improvement in mood (7.5 +/- 0.7 v 5.9 +/-
1; p < 0.001) compared with group 1. Postoperatively, cortisol levels in
group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9
nmol/L [53-1642.0]). Conclusion(s): Providing video games and toys
preoperatively reduced postoperative stress and anxiety and improved mood
in children undergoing congenital cardiac surgery. Parents were relieved
of anxiety and stress with proper counseling and
information. Copyright © 2018 Elsevier Inc.

<8>
Accession Number
2001254585
Title
Prophylactic Effect of Amiodarone Infusion on Reperfusion Ventricular
Fibrillation After Release of Aortic Cross-Clamp in Patients with Left
Ventricular Hypertrophy Undergoing Aortic Valve Replacement: ARandomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1205-1213),
2019. Date of Publication: May 2019.
Author
Mita N.; Kagaya S.; Miyoshi S.; Kuroda M.
Institution
(Mita, Kagaya, Miyoshi) Department of Anesthesiology, Saitama
Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
(Kuroda) Department of Anesthesiology, Saiseikai Utsunomiya Hospital,
Utsunomiya City, Tochigi, Japan
Publisher
W.B. Saunders
Abstract
Objective: To investigate whether prophylactic amiodarone infusion
prevents ventricular fibrillation after aortic cross-clamp release and
attenuates cytokine production in patients with left ventricular
hypertrophy undergoing cardiac surgery. Design(s): Prospective,
randomized controlled trial. Setting(s): A public hospital.
 Participant(s): The study comprised 68 patients undergoing aortic
valve replacement for severe aortic stenosis. Intervention(s):
Patients were randomly assigned to receive a 150mg bolus then 30mg/h
continuous infusion of amiodarone (amiodarone group) or a 1 mg/kg bolus
then 1 mg/kg/h continuous infusion of lidocaine (lidocaine group). The
primary outcome was the ventricular fibrillation incidence rate after
aortic cross-clamp release. Secondary outcomes included perioperative
serum interleukin-6 and tumor necrosis factor-alpha levels.
 Measurements and Main Results: The ventricular fibrillation incidence
rate was significantly lower in the amiodarone than in the lidocaine group
(20.6% v 50%, relative risk 0.41; 95% confidence interval [CI] 0.20-0.86;
p = 0.021). Interleukin-6 levels 1hour after aortic cross-clamp release
and at intensive care unit admission were significantly lower in the
amiodarone than in the lidocaine group (geometric mean [95% CI] 117.4pg/mL
[87.1-158.4] v 339.5pg/mL [210.6-547.2]; p < 0.01 and 211.1pg/mL
[162.8-73.6] v 434.1pg/mL [293.7-641.5]; p < 0.01, respectively). Tumor
necrosis factor-alpha levels 1hour after aortic cross-clamp release were
significantly lower in the amiodarone than in the lidocaine group
(geometric mean [95% CI] 1.624pg/mL [1.359-1.940] v 2.283pg/mL
[1.910-2.731]; p = 0.02). Conclusion(s): Amiodarone prevented
reperfusion ventricular fibrillation in patients with left ventricular
hypertrophy undergoing aortic valve replacement to a greater extent than
did lidocaine. Furthermore, amiodarone inhibited postoperative
interleukin-6 and tumor necrosis factor-alpha production. Copyright
© 2018 Elsevier Inc.

<9>
Accession Number
2001352697
Title
Optimal Position of Inferior Vena Cava Cannula in Pediatric Cardiac
Surgery: A Prospective, Randomized, Controlled, Double-Blind Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1253-1259),
2019. Date of Publication: May 2019.
Author
Seino Y.; Ohashi N.; Imai H.; Baba H.
Institution
(Seino, Ohashi, Imai, Baba) Division of Anesthesiology, Niigata University
Graduate School of Medical and Dental Sciences, Asahimachi, Niigata, Japan
Publisher
W.B. Saunders
Abstract
Objective: To examine the authors' hypothesis that during the
cardiopulmonary bypass (CPB) in children, the inferior vena cava cannula
tip placed proximal to the right hepatic vein orifice would produce a
higher venous drainage compared with that placed distally. Design(s):
A prospective, randomized, controlled, double-blind study.
 Setting(s): Single university hospital. Participant(s):
Thirty-two patients aged <6years, scheduled for elective cardiac surgery
using CPB for congenital heart disease. Intervention(s): Participants
were randomized to 2 groups: the proximal group with the cannula tip
placed proximally within 1cm of the right hepatic vein orifice and the
distal group with the cannula placed distally within 1cm of the right
hepatic vein orifice. Measurements and Main Results: The primary
outcome of this study was the perfusion flow rate at the time of
establishment of total CPB with cardioplegia. The authors initially
planned to enroll 60 patients, but before reaching the target sample size,
the authors terminated this study owing to patient safety, and 18 patients
in the proximal group and 14 patients in the distal group finally were
analyzed. No significant differences in patient characteristics were
observed between the 2 groups. The mean perfusion flow rate in the
proximal group was significantly greater (2.55 +/- 0.27
L/min/m2) than that in the distal group (2.37 +/- 0.20
L/min/m2, p = 0.04). Conclusion(s): The inferior vena cava
cannula tip placed in the proximal position was clinically superior,
compared with a distal placement, in producing higher perfusion flow in
children. Copyright © 2018 Elsevier Inc.

<10>
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.

<11>
Accession Number
622087351
Title
Cardiovascular safety of varenicline, bupropion, and nicotine patch in
smokers a randomized clinical trial.
Source
JAMA Internal Medicine. 178 (5) (pp 622-631), 2018. Date of Publication:
May 2018.
Author
Benowitz N.L.; Pipe A.; West R.; Hays J.T.; Tonstad S.; McRae T.; Lawrence
D.; St Aubin L.; Anthenelli R.M.
Institution
(Benowitz) Department of Medicine, University of California, PO Box 1220,
San Francisco, CA 94143, United States
(Benowitz) Department of Bioengineering and Therapeutic Sciences,
University of California, San Francisco, United States
(Pipe) Division of Prevention and Rehabilitation, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(West) Health Behaviour Research Centre, Department of Epidemiology and
Public Health, University College, London, United Kingdom
(Hays) Nicotine Dependence Center and General Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Tonstad) Department of Preventive Cardiology, Oslo University Hospital,
Oslo, Norway
(McRae, Lawrence, St Aubin) Global Product Development, Pfizer, New York,
NY, United States
(Anthenelli) Department of Psychiatry, University of California, San
Diego, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Quitting smoking is enhanced by the use of pharmacotherapies,
but concerns have been raised regarding the cardiovascular safety of such
medications. OBJECTIVE To compare the relative cardiovascular safety risk
of smoking cessation treatments. DESIGN, SETTING, AND PARTICIPANTS A
double-blind, randomized, triple-dummy, placeboand active-controlled trial
(Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES])
and its nontreatment extension trial was conducted at 140 multinational
centers. Smokers, with or without established psychiatric diagnoses, who
received at least 1 dose of study medication (n = 8058), as well as a
subset of those who completed 12 weeks of treatment plus 12 weeks of
follow up and agreed to be followed up for an additional 28 weeks (n =
4595), were included. INTERVENTIONS Varenicline, 1mg twice daily;
bupropion hydrochloride, 150mg twice daily; and nicotine replacement
therapy, 21-mg/d patch with tapering. MAIN OUTCOMES AND MEASURES The
primary end pointwas the time to development of a major adverse
cardiovascular event (MACE: cardiovascular death, nonfatalmyocardial
infarction, or nonfatal stroke) during treatment; secondary end points
were the occurrence of MACE and other pertinent cardiovascular events
(MACE+: MACE or new-onset or worsening peripheral vascular disease
requiring intervention, coronary revascularization, or hospitalization for
unstable angina). RESULTS Of the 8058 participants, 3553 (44.1%) were male
(mean [SD] age, 46.5 [12.3] years). The incidence of cardiovascular events
during treatment and follow-up was low (<0.5%for MACE; <0.8%forMACE+) and
did not differ significantly by treatment. No significant treatment
differences were observed in time to cardiovascular events, blood
pressure, or heart rate. There was no significant difference in time to
onset ofMACE for either varenicline or bupropion treatment vs placebo
(varenicline: hazard ratio, 0.29; 95%CI, 0.05-1.68 and bupropion: hazard
ratio, 0.50; 95%CI, 0.10-2.50). CONCLUSIONS AND RELEVANCE No evidence that
the use of smoking cessation pharmacotherapies increased the risk of
serious cardiovascular adverse events during or after treatment was
observed. The findings of EAGLES and its extension trial provide further
evidence that smoking cessation medications do not increase the risk of
serious cardiovascular events in the general population of
smokers. Copyright © 2018 American Medical Association. All
rights reserved.

<12>
[Use Link to view the full text]
Accession Number
624836480
Title
Protective ventilation during anaesthesia reduces major postoperative
complications after lung cancer surgery: A double-blind randomised
controlled trial.
Source
European Journal of Anaesthesiology. 35 (10) (pp 727-735), 2018. Date of
Publication: 2018.
Author
Marret E.; Cinotti R.; Berard L.; Piriou V.; Jobard J.; Barrucand B.; Radu
D.; Jaber S.; Bonnet F.
Institution
(Marret, Bonnet) Department of Anaesthesia and Intensive Care Medicine,
American Hospital of Paris, 63 Bd Victor Hugo, Neuilly-sur-Seine, Paris,
France
(Cinotti) Department of Anaesthesia and Intensive Care Medicine, Hotel
Dieu, CHU de Nantes, Nantes Cedex, France
(Berard) Clinical Research Platform (URC-CRC-CRB), AP-HP Hopital
Saint-Antoine, Paris, France
(Berard) INSERM, U-698, UPMC-Paris 06, Paris, France
(Piriou) Critical Care and Anaesthesia Department, CHU Lyon Sud,
University Lyon 1, Lyon, France
(Jobard) Department of Anesthesia and Intensive Care Medicine, Princess
Grace Hospital, Monaco, France
(Barrucand) Department of Anaesthesia and Intensive Care Medicine,
University Hospital of Besancon, Besancon, France
(Radu) Department of Anaesthesia and Intensive Care Medicine, Hotel Dieu,
Cochin University Hospitals, AP-HP, Universite Paris Descartes, Paris,
France
(Jaber) Research Unit, INSERM U1046, Saint Eloi University Hospital,
Montpellier School of Medicine, Montpellier, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Thoracic surgery for lung resection is associated with a high
incidence of postoperative pulmonary complications. Controlled ventilation
with a large tidal volume has been documented to be a risk factor for
postoperative respiratory complications after major abdominal surgery,
whereas the use of low tidal volumes and positive end-expiratory pressure
(PEEP) has a protective effect. OBJECTIVE To evaluate the effects of
ventilation with low tidal volume and PEEP on major complications after
thoracic surgery. DESIGN A double-blind, randomised controlled study.
SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A
total of 346 patients undergoing lobectomy or pneumonectomy for lung
cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of
major postoperative complications (pneumonia, acute lung injury, acute
respiratory distress syndrome, pulmonary embolism, shock, myocardial
infarction or death) within 30 days after surgery. INTERVENTIONS Patients
were randomly assigned to receive either lung-protective ventilation (LPV
group) [tidal volume 5 ml kg1 ideal body weight R PEEP between
5 and 8 cmH<inf>2</inf>O] or nonprotective ventilation (control group)
(tidal volume 10 ml kg1 ideal body weight without PEEP) during
anaesthesia. RESULTS The trial was stopped prematurely because of an
insufficient inclusion rate. Major postoperative complications occurred in
23/172 patients in the LPV group (13.4%) vs. 38/ 171 (22.2%) in the
control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P
1/4 0.03). The incidence of other complications (supraventricular cardiac
arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia,
bronchial fistula and persistent air leak) was also lower in the LPV group
(37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P
1/4 0.02).The duration of hospital stay was shorter in the LPV group, 11
[interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P 1/4 0.048.
CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low
tidal volume and PEEP during anaesthesia for lung cancer surgery seems to
improve postoperative outcomes. Copyright © 2018 European Society
of Anaesthesiology. All rights reserved.

<13>
Accession Number
2000821648
Title
Critical evaluation on proper antithrombotic treatment in different groups
of patients undergoing vascular surgery.
Source
Hellenic Journal of Cardiology. 59 (6) (pp 313-316), 2018. Date of
Publication: November - December 2018.
Author
Filis K.; Tsioufis C.; Sianou A.; Triantafillou K.; Sigala F.; Galyfos G.
Institution
(Filis, Sigala, Galyfos) First Department of Propedeutic Surgery,
Hippocration Hospital, National and Kapodistrian University of Athens,
School of Medicine, Athens, Greece
(Tsioufis) First Cardiology Clinic, Medical School, National and
Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
(Sianou) Department of Microbiology, Areteion Hospital, National and
Kapodistrian University of Athens, School of Medicine, Athens, Greece
(Triantafillou) First Department of Cardiac Surgery, Hippocration
Hospital, Athens, Greece
Publisher
Hellenic Cardiological Society
Abstract
Antithrombotic treatment including anticoagulants and antiplatelets has
evolved during the last decades, and several recommendations have been
included in the latest guidelines regarding the proper management of
patients undergoing vascular surgery. However, there are significant
differences compared to older recommendations, and indications vary among
patients with peripheral artery disease, carotid disease, and abdominal
aortic aneurysm. In this mini review, we critically evaluate all these
data to produce useful conclusions for everyday clinical
practice. Copyright © 2018 Hellenic Society of Cardiology

<14>
Accession Number
615452596
Title
Cardiovascular efficacy and safety of bococizumab in high-risk patients.
Source
New England Journal of Medicine. 376 (16) (pp 1527-1539), 2017. Date of
Publication: 20 Apr 2017.
Author
Ridker P.M.; Revkin J.; Amarenco P.; Brunell R.; Curto M.; Civeira F.;
Flather M.; Glynn R.J.; Jukema J.W.; Karpov Y.; Kastelein J.J.P.; Koenig
W.; Lorenzatti A.; Manga P.; Masiukiewicz U.; Miller M.; Mosterd A.; Murin
J.; Nicolau J.C.; Nissen S.; Ponikowski P.; Santos R.D.; Schwartz P.F.;
Soran H.; White H.; Wright R.S.; Vrablik M.; Yunis C.; Shear C.L.; Tardif
J.-C.; Conde D.; Colquhoun D.; Missault L.; Gregoire J.; Gao R.; Urina M.;
Solar M.; Jensen H.K.; Grobbee D.; Savolainen M.; Schiele F.N.;
Montalescot G.; Edes I.; Blake G.; Lotan C.; Maggioni A.; Savonitto S.;
Lee C.W.; Leiva Pons J.L.; Dan G.A.; Cortada J.B.; Mellbin L.; Kahan T.;
Noble S.; Hwang J.J.; Sritara P.; Tokgozoglu L.; Tarasenko L.; Borer J.S.;
Black H.; Carmena R.; Furie K.L.; McMurray J.; Neaton J.; Zannad F.;
O'Neill B.; Welty F.; McNamara R.; Chun H.; Abbott J.D.; Jacoby D.;
McPherson C.; Jadbabaie F.; Pinto D.; McCullough L.; Silverman I.E.;
Sansing L.H.; Dearborn-Tomazos J.; Foody J.; Schindler J.; Piazza G.;
Chakrabarti A.; Pride Y.; Gelfand E.; Baultrukonis D.; Chaudhuri S.;
Frederich R.; Johnson M.; Mridha K.; Powell C.; Wang E.; Wei C.; Anderson
P.; Buonanno M.; Epsley C.; Evans B.; Frolova M.; Goetsch M.; Hessinger
D.; Ikehara E.; Ivanac K.; Kizko J.; Le K.; McNally-Dufort C.; Morocco T.;
Nadkarni S.; Nye R.; Pak R.; Pence D.; Redifer P.; Sattler C.; Schade R.;
Sullivan B.; Wegner J.; Alvarez C.A.; Budassi N.; Vogel D.R.; Avaca H.;
Conde D.G.; Estol C.C.; Gelersztein E.; Glenny J.A.; Hershson A.R.; Bruno
R.L.; Maffei L.E.; Soler J.M.; Zaidman C.J.; Carnero G.S.; Colombo H.R.;
Jure H.O.; Luquez H.A.; Ramos H.R.; Resk J.H.; Rusculleda M.M.; Ulla M.R.;
Caccavo A.; Farias E.F.; Wenetz L.M.; Cabella P.R.; Cuadrado J.A.; Chahin
M.; Mackinnon I.J.; Zarandon R.B.; Schmidberg J.; Fernandez A.A.; Montana
O.; Codutti O.R.; Gorosito V.M.; Maldonado N.; Sala J.; De La Fuente R.A.;
Casabella T.E.; Di Gennaro J.P.; Guerrero R.A.; Alvarez M.S.; Berli M.;
Botta C.E.; Montenegro E.E.; Vico M.L.; Begg A.; Lehman R.; Gilfillan
C.P.; d'Emden M.; Markovic T.P.; Sullivan D.; Aroney C.; Stranks S.N.;
Crimmins D.S.; Arstall M.; Van Gaal W.; Davis T.; Aylward P.E.; Amerena
J.; William M.; Proietto J.; Purnell P.W.; Singh B.; Arya K.W.; Dart A.M.;
Thompson P.; Davis S.M.; Carroll P.A.; De Looze F.; Jayasinghe R.; Bhindi
R.; Buysschaert I.; Sarens T.; van de Borne P.; Scott B.P.; Roosen J.;
Cools F.; Missault L.H.; Debroye C.; Schoors D.F.; Hollanders G.; Schroe
H.H.; De Sutter J.; Hermans K.; Carlier M.; van Landegem P.; Verwerft J.;
Mulleners T.; Delforge M.D.; Soufflet V.; Elegeert I.; Descamps O.S.;
Janssens S.; Lemmens R.C.; Desfontaines P.; Scheen A.; Heijmans S.; Capiau
L.; Vervoort G.; Carlier S.G.; Faes D.; Alzand B.; Keuleers S.; De Wolf
L.; Thoeng J.; De Bruyne L.; de Santos M.O.; Felicio J.S.; Areas C.A.;
Figueiredo E.L.; Michalaros Y.L.; Neuenschwander F.C.; Reis G.; Saad J.A.;
Kormann A.P.; Nascimento C.V.; Precoma D.B.; Abib E.; dos Santos F.R.;
Mello Y.G.; Saraiva J.F.; Rech R.L.; Cerci R.; Fortes J.A.; Rossi P.R.; de
Lima e Silva F.A.; Hissa M.; Silva R.P.; de Souza W.K.; Guimaraes Filho
F.V.; Mangili O.C.; de Oliveira Paiva M.S.; Tumelero R.; Abrantes J.A.;
Caramori P.R.; Dutra O.P.; Leaes P.E.; Manenti E.R.; Polanczyk C.A.;
Bandeira e Farias F.A.; de Moraes Junior J.B.; Russo L.A.; Alves A.R.;
Dracoulakis M.D.; Ritt L.E.; Saporito W.F.; Herdy A.H.; Maia L.N.;
Sternieri M.V.; Ayoub J.C.; Bianco H.T.; da Costa F.A.; Eliaschewitz F.G.;
Fonseca F.A.; Nakandakare E.R.; Bonansea T.C.; Castro N.M.; de Barros e
Silva P.G.; Smith P.; Botelho R.V.; Resende E.S.; Barbieri D.S.; Hernandes
M.E.; Bajaj H.; Beaudry P.; Berlingieri J.C.; Salter T.J.; Ajala B.;
Anderson T.J.; Nanji A.; Ross S.; Pandey S.; Desrosiers D.; Gaudet D.;
Moran G.; Csanadi M.A.; St-Amour E.; Cusimano S.; Halperin F.A.; Babapulle
M.; Vizel S.; Petrella J.; Spence J.D.; Gupta N.; Tellier G.; Bourgeois
R.; Gregoire J.C.; Wesson T.; Zadra R.; Twum-Barima D.Y.; Cha J.Y.;
Hartleib M.C.; Bergeron J.; Chouinard G.; McPherson T.P.; Searles G.;
Peterson S.R.; Mukherjee A.; Lepage S.; Conway J.R.; Kouz S.M.; Dion D.;
Pesant Y.; Cheung S.S.; Goldenberg R.M.; Aronson R.; Gupta A.K.; O'Mahoney
M.; Pliamm L.; Teitelbaum I.; Hoag G.N.; Nadra I.J.; Yared Z.; Yao L.C.;
Nguyen T.; Saunders K.K.; Potthoff S.; Varleta P.; Assef V.; Godoy J.G.;
Olivares C.; Roman O.; Vejar M.; Montecinos H.; Pincetti C.; Li Y.; Wang
D.; Li J.; Yang X.; Du Y.; Wang G.; Yang P.; Zhang X.; Xu P.; Zhao Y.;
Chen J.; Li S.; Li W.; Zhang L.; Zhu Y.; Zhang Y.; Zhou C.; Wang Y.; Liu
F.; Ma Y.; Ti Z.; Zeng X.; Zhou Y.; Cui G.; Li D.; Xue L.; Jiang J.; Lian
Y.; He Y.; Mendoza J.A.; Bonfanti J.A.; Dada F.A.; Urina-Triana M.A.;
Rodriguez W.R.; Sanchez M.L.; Lozno H.Y.; Triana E.H.; Arambula R.M.;
Rico-Carrillo A.E.; Gallo H.J.; Catano J.S.; Jattin F.G.; Plazas J.A.;
Gomez J.E.; Botero-Lopez R.; Gomez N.I.; Munoz C.F.; Pelaez S.V.; Eraso
A.M.; Goyes A.R.; Elbl L.; Fiserova N.; Vesely J.; Wasserburger B.; Blaha
V.; Vojacek J.; Maskova P.; Hutyra M.; Vrkoc J.; Hala T.; Vodnansky P.;
Bocek P.; Cifkova R.; Bufka V.; Ceska R.; Machkova M.; Zidkova E.; Lukac
M.; Mikusova T.; Kellnerova I.; Kuchar L.; Ferkl R.; Cech V.; Zemek S.;
Monhart Z.; Davidsen F.; Joensen A.; Lihn A.S.; Rasmussen T.K.; Wiggers
H.; Lindgren L.M.; Schmidt U.; Galatius S.; Sillesen H.; Bronnum Schou J.;
Thomsen K.K.; Urhammer S.; Jeppensen J.; Schou M.; May O.; Steffensen R.;
Nielsen W.B.; Nielesen T.; Jepsen J.M.; Rai A.; Sykulski R.; Andersen
L.T.; Rickers H.; Frost L.; Lomholdt J.; Egstrup K.; Wermuth S.; Klausen
L.; Lassus J.; Palomaki A.; Khari J.; Tatlisumak T.; Kekki S.; Vanttinen
E.; Strandberg A.; Valtonen M.; Sia S.M.; Nerg O.; Puhakka M.; Strand J.;
Timonen M.; Levola J.; Arstila L.; Taurio J.; Kantola I.; Suomi J.;
Humaloja K.; Askonen K.; Schiele F.; Sibon I.; Zemour G.; Goube P.; Petit
C.; Chati Z.; Range G.; Rabahi F.; Rihani R.; Bergerot C.; Roubille F.;
Boye A.; Probst V.; Ferrari E.; Cayla G.; Thouvenot E.; Delarche N.;
Couffinhal T.; Coisne D.; Paillard F.; Elbaz M.; Decoulx E.; Angoulvant
D.; Agraou B.; Caudmont S.; Berrouschot J.; Lauer B.; Schoell I.; Trenk
D.; Derwahl K.M.; Khariouzov A.; Proepper F.; Stawowy P.; Da Stephan U.;
Stoessel J.; Voehringer H.F.; Dorsel T.; Stellbrink C.; Rinke A.;
Northroff J.; Bourhaial H.; Stratmann M.; Wetzel T.; Axthelm C.; Guenzel
A.; Weigmann I.; Faghih M.; Hagemann D.; Schaefer A.; Weber D.; Luedemann
J.; Contzen C.; Kornmann M.O.; Winkelmann B.; Simon J.; Felix S.; Brauer
C.; Laufs U.; Schmidt E.; Marten I.; Licka M.; Heisters J.; Appel K.F.;
Kleinecke-Pohl U.; Klein C.; von Hodenberg E.F.; Maus O.; Sigal H.;
Taeschner H.; Schwimmbeck P.; Lemke B.; Perings C.; Illies G.; Pfuetzner
A.; Salbach P.; Hengstenberg C.; Kohler A.; Mudra H.; Behnke T.; Baar M.;
Jeserich M.; Scholz G.; Naudts I.; Voller H.; Herrmann H.J.; von
Engelhardt C.B.; Gerke S.; Pohlmeier L.; Schaufele T.; Woehrle J.;
Al-Zoebi A.; Horacek T.; Peterfai E.; Kemeny V.; Lakatos F.; Bod E.;
Andrassy P.; Andreka P.; Balo T.; Davidovits Z.; Laszlo Z.; Nagy K.; Papp
A.; Somogyi A.; Toldy-Schedel E.; Vertes A.; Voros P.; Paragh G.; Martyin
T.; Hajdu C.; Deak L.; Farago K.; Nagy A.; Kirschner R.; Koszegi Z.;
Zilahi Z.; Toth K.; Wittmann I.; Bajcsi D.; Reiber I.; Toth L.; Benczur
B.; Nagy L.; Sydo T.; Lupkovics G.; Oroszlan T.; Crean P.; Mahon N.G.;
McAdam B.; MacNeill B.; Katz A.; Tsalihin D.; Vazan A.; Eitan A.; Lewis
B.S.; Gavish D.; Wainstein J.; Mosenzon O.; Mosseri M.; Vishlitzky V.;
Atar S.; Nseir W.B.; Brenner H.; Elis A.; Fuchs S.; Shimon I.; Solodky A.;
Goldhaber A.; Tanne D.; Knobler H.; Kracoff O.H.; Hussein O.; Auriel E.;
Chorin E.; Sharir T.; Bitzur R.; Shechter M.; Antonicelli R.; Franceschini
E.; Porcu M.; Sesti G.; Maggiolini S.; Salvioni A.; Filardi P.P.; Trimarco
B.; Averna M.; Pasqualini L.; Pirro M.; Pantaleoni M.; Piovaccari G.; Arca
M.; Fedele F.; Roncon L.; Anselmi M.; Sganzerla P.; Morocutti G.; Bonora
E.; Dimas A.L.; Esperon G.A.; Morales-Villegas E.; Isunza J.M.; Beltran
L.G.; Molina C.A.; Garcia D.K.; Ruiz L.A.; Reyna L.S.; De los Rios Ibarra
M.O.; Soto J.R.; Gonzalez-Ortiz M.; Herrera-Marmolejo M.; Ramos S.A.;
Ramos-Lopez G.A.; Stobschinski C.A.; AguilarSalinas C.A.; Alpizar-Salazar
M.; Jimenez-Sanchez M.; Sanchez Mijangos J.H.; Elizondo Moreno E.R.;
Garcia Castillo A.; Garcia Hernandez P.A.; Gonzalez-Gonzalez J.G.; Riojas
Charles C.M.; Valdez Lopez H.G.; Nuriulu Escobar P.L.; Lechuga Martin del
Campo A.; Castro Montes B.E.; Mendez Bucio A.; Rodriguez-Briones I.; Torre
Amione G.; Violante Ortiz R.; Luna Ceballos R.I.; Lopez Rosas E.; Bax
W.A.; Alhakim M.; van de Wiel A.; Liem S.S.; Groutars R.G.; Herrman J.P.;
Hovingh G.K.; van de Wetering M.L.; van Royen N.; Groenemeijer B.E.;
Hoedemaker G.; Schaap J.; Ronner E.; Angun M.; Mairuhu A.T.; Van Alem
A.P.; Martens F.M.; Heijmeriks J.A.; van Hal J.M.; Schoofs M.W.; den
Hartog F.R.; Kentgens S.; Post J.C.; Louwerenburg J.W.; van Rossum P.;
Viergever E.P.; Donders S.H.; Kamphuisen P.W.; van Beek E.; Nijmeijer R.;
Lenderink T.; Schreuder T.; Kuijper A.F.; The S.H.; Van het Hof-Wiersma
J.J.; Tichelaar P.; Westerndorp I.; Breedveld R.W.; Karalis I.; Romer
T.J.; Bogaard K.; Van Koningsbruggen P.; Kroon A.A.; Hoogslag P.A.;
Rensing B.J.; Cramer E.; Remmen J.J.; Riksen N.P.; Bokern M.J.; Cabezas
M.C.; Mulder H.; Nierop P.R.; van Kempen W.W.; Zoet-Nugteren S.K.; van
Daele M.E.; Swart H.P.; van der Zwaan C.T.; Hermans W.R.; Magro M.; van de
Wal R.M.; Hassink R.J.; Visseren F.; Veenendaal A.; De Nooijer C.; Troquay
R.P.; Imholz B.P.; van der Meer P.; Visser R.P.; van Leendert R.J.;
Gosselink M.A.; Baker J.; Benatar J.R.; Kerr J.; Pryke J.R.; Scott R.S.;
Millar-Corte G.D.; Williams M.; Montgomery B.; Venter D.J.; Ternouth I.F.;
DeCaigney S.C.; Hart H.H.; Corin A.; Garden P.I.; Sheahan D.; Harding
S.A.; Korecki J.; Supronik J.; Styczkiewicz M.; Bijata-Bronisz R.; Rusicka
T.; Walczak M.; Krolikowski Z.; Ostrowski J.; Lukaszewicz M.;
Przekwas-Jaruchowska M.; Zieba B.; Miekus P.; Orkwiszewska-Nalewajko A.;
Piepiorka M.; Kubalski P.; Wychota K.; Blach E.; Ochala A.; Okopien B.;
Wronska D.; Janion M.; Czarnecka D.; Kolodziejczyk J.; Konieczynska M.;
Landa K.; Mirek-Bryniarska E.; Necki M.; Pasternak D.A.; Rozpondek P.;
Trebacz J.; Walczewska J.; Sidor M.; Broncel M.; Drozdz J.; Kosmider M.;
Saryusz-Wolska M.; Kucharska D.; Opalinska E.; Pijanowski Z.; Wozniak I.;
Banaszkiewicz K.; Klecha A.; Horodecki M.; Piskorz-Wapinska J.;
Kobielusz-Gembala I.; Kim M.H.; Kim D.K.; Cho B.R.; Kim K.S.; Her S.H.;
Lee S.Y.; Rhee M.Y.; Kim K.; Kang W.C.; Kim D.H.; Cho Y.S.; Kim S.H.; Rim
S.J.; Tahk S.J.; Jeon H.K.; Yoon J.; Mociran M.; Pop C.F.; Minescu B.;
Andrei L.D.; Radoi M.; Calin A.; Ciomag R.M.; Copaci I.; Fruntelata A.G.;
Popescu M.; Tivadar S.; Roman G.; Avram R.I.; Mistodie C.V.; Morosanu M.;
Popa A.R.; Popescu M.L.; Popoviciu M.S.; Tase A.; Busegeanu M.; Popescu
A.; Szilagyi I.; Sitterli-Natea C.N.; Maximov D.M.; Munteanu M.; Negrisanu
G.D.; Kuzin A.; Popov D.; Shapovalova J.; Vishneva E.; Shutemova E.;
Pasechnik E.; Bogdanov E.; Khasanov N.; Barbarash O.L.; Shangina O.A.;
Tarasov N.; Solonev O.; Kosmacheva E.; Chernyatina M.A.; Ginzburg M.;
Blokhin A.; Bulanova N.; Drapkina O.M.; Gordeev I.G.; Libov I.A.; Lomakin
N.; Panchenko E.; Shogenov Z.S.; Zateyshchikov D.; Klein G.; Motylev I.;
Belenkiy D.I.; Demin A.; Nikolaev K.Y.; Oleynikov V.; Zrazhevskiy K.;
Katelnitskiy I.; Khaisheva L.; Aksentiev S.; Nedoshivin A.; Popova V.B.;
Agafina A.S.; Ballyuzek M.; Baranova E.; Burova N.; Eryshev S.; Filippov
A.; Goloshchekin B.M.; Konstantinov V.; Kostenko V.A.; Simanenkov V.I.;
Volkova A.; Duplyakov D.; Reshetko O.; Shvarts Y.; Kuznetsov V.A.;
Samoylova Y.G.; Tolkacheva V.; Shalaev S.V.; Khokhlov A.L.; Malygin A.;
Shilkina N.P.; Yakusevich V.V.; Margoczy R.; Zubek V.; Dzupina A.; Dubrava
J.; Dulkova K.; Fabryova L.; Gaspar L.; Kamensky G.; Kokles M.; Raslova
K.; Soosova I.; Stevlik J.; Strbova J.; Sumbal J.; Uhliar R.; Micik J.;
Truban J.; Fedacko J.; Pastrnakova E.; Pella D.; Fazekas F.; Ambrovicova
V.; Kycina P.; Martinka E.; Nociar J.; Belicova M.; Banik M.; Kanderkova
D.; Hranai M.; Duris T.; Krahulec B.; Benacka J.; Vinanska D.; Roskova E.;
Skripova D.; Macek V.; Vohnout B.; Buganova I.; Engelbrecht J.M.;
Pretorius M.M.; Ebrahim I.O.; Bayat J.; Ganesh S.; Ranjith N.; Coetzer
T.F.; Jacovides A.; Distiller L.A.; Hellig F.S.; Engelbrecht I.V.; Mahomed
A.A.; Blignault S.C.; Burgess L.J.; Kotze H.J.; van Nieuwenhuizen E.;
Musungaie D.B.; Emanuel S.; van der Walt E.; Pretorius C.E.; Roos J.S.;
Roux S.M.; Badat A.E.; Fouche L.; Vahed Y.A.; Jansen van Resburg D.; van
Zyl L.J.; Soto Gonzalez A.; Diaz J.L.; Segura T.; Botella Serrano M.;
Botas Rodrigues J.; Molto-Jorda J.M.; Dominguez Escribano J.R.; Sogorb
Garri F.; Blanco Coronado J.L.; Gaztambide Saenz M.S.; Brotons Cuixart C.;
Bruguera Cortada J.; Garcia-Moll Marimon X.; Gonzalbez Morgaez J.D.;
Maisterra Santos O.; Roquer Gonzalez J.; Sobrino-Martinez J.; Chueca
Fernandez J.E.; Narejos S.; Suarez Garcia S.; Perez Martinez P.; Figueras
Camos R.; Medrano Martinez V.; Bellido Guerrero D.; Martinez Deben F.;
Vila Belmonte A.; Mediavilla Garcia J.D.; Romero Hinojosa J.A.; Martorell
Mateu E.; Cequier Fillat A.R.; Pinto Sala X.; Adroer Martori R.; Bueno
Diez M.; Lopez Cano C.; Worner Diz F.; Gonzalez Juanatey C.; Alvarez-Sala
Walther L.A.; De Dios Garcia Diaz J.; Garcia Puig J.; Jodar Gimeno E.;
Plaza Perez I.; Suarez-Fernandez C.; Tunon J.; Zamorano Gomez J.L.; Brito
Sanfiel M.A.; Escudier Villa J.M.; de Mora Martin M.; Dominguez Lopez M.;
Hernandez Garcia J.M.; Tinahones Madueno F.J.; Perez Paredes M.; Aracil
Villar J.; Barreda Gonzalez M.J.; Ripoll Vera T.V.; Tofe Povedano S.;
Sanchez Alvarez J.; Martinez Via L.; Robles Iniesta A.; Masana L.;
Vinyoles Bargallo E.; Calvo Gomez C.; Gonzalez Juanatey J.R.; Cruz
Fernandez J.M.; De La Cuesta Mayor C.; Duran Garcia S.; Jimenez Hernandez
M.D.; Morales Portillo C.; Muniz Grijalvo O.; De Castro R.; Taverna
Llaurado E.; Pons Amate J.M.; Terns Riera M.; Linderfalk C.; Curiac D.;
Saldeen-Nilehn K.; Koskinen P.; Khalili P.; Tortensson I.; Lindholm C.J.;
Luts A.; Koskinen P.T.; Gottsater A.; Persson B.E.; Mooe T.; Larnefeldt
H.; Boman K.; Crisby M.; Rasmanis G.; Tengmark B.O.; Witt N.; Hagstrom E.;
Viklund J.; Muller C.; Mach F.; Burnier M.; Nanchen D.; Wuerzner G.;
Banyai M.; Moccetti T.; Miserez A.R.; Bilz S.; Weber K.; Lai W.T.; Chang
K.C.; Ueng K.C.; Tsai W.C.; Chiang C.E.; Hou C.; Pei D.; Krittayaphong R.;
Kiatchoosakun S.; Srimahachota S.; Boonyavarakul A.; Jintapakorn W.; Gullu
H.; Onrat E.; Erkan A.F.; Demirci D.; Sari R.; Ceyhan C.; Ari H.; Araz M.;
Degertekin M.; Goktekin O.; Uresin A.Y.; Yigit Z.; Akdeniz B.; Comlekci
A.; Kayikcioglu M.; Sahin T.; Ozcan T.; Durakoglugil E.; Asamoah-Owusu N.;
Reed R.; Bakhai A.; Dixon L.; Sharma R.; Avornyo A.A.; Jones A.F.; Lip G.;
Clark R.; Banerjee M.; Wakeling J.; Arden C.; Blagden M.D.; Walukiewica
P.; Marshall A.; Maxwell T.G.; Gunstone A.E.; Kadr H.H.; Patle R.; Arif
I.; Jhund P.S.; McKaig G.; Douglas F.; Mierzejewski L.; Turner W.;
Sathyapalan T.; Ivan P.; Manoj A.; Rice S.; Collier D.J.; Nair D.R.; Thom
S.; Fiore G.; De Belder M.; Price D.; Sobolewska J.; Martin S.; Takhar A.;
Moriarty A.; Kondagunta V.; Myhill T.; Gibson J.M.; Cecil J.T.; Halcox J.;
Annamalai N.; Gorog D.A.; McCormack T.; Pegge N.; Field A.; Adams F.;
Klein J.J.; Busch R.S.; Bretton E.M.; Jaffrani N.; Salacata A.;
Assadourian A.; Gogia H.S.; Dyke C.K.; Rubenfire M.; Essandoh L.K.; Welker
J.A.; Ledesma G.; Lupovitch S.; Delgado J.P.; Hendrix E.L.; Quyyumi A.A.;
Riesenberg R.A.; Robertson D.G.; Weinstein D.L.; Weiss R.; Casaubon L.;
Gammon R.S.; Brar H.S.; Bittar G.D.; Guarnieri T.T.; Ince C.S.; Quraishi
A.M.; Saeed S.; Albert M.; Sotolongo R.P.; Bernard J.V.; Karlsbergg R.P.;
Lepor N.E.; Kirby W.E.; McLean B.; Ovalle F.; Townsend J.C.; Beckett P.L.;
Eaves W.B.; West S.H.; Kosinski E.J.; Zarich S.W.; Mahal S.S.; Maw K.;
Maynard K.M.; Chen J.C.; Gelormini J.; Gottlieb D.W.; Gabra N.W.; Narayan
P.; Sparks J.; Field J.C.; Willits V.L.; O'Steen M.B.; Pasquini J.A.;
Sensebrenner J.W.; Yarows S.A.; Hiotis L.; Jagielo T.J.; Levinson D.J.;
Diller P.M.; Kereiakes D.J.; Turner T.A.; Vincent S.; Camp A.D.; Denker
P.S.; Manning M.B.; Rocco M.B.; Stamps H.B.; Strader J.R.; Uusinarkaus
K.T.; Kennett J.D.; Leichter S.B.; McNeil D.L.; Schumacher D.R.; Chang
A.R.; Ellison H.S.; Updegrove J.D.; Hamroff G.S.; Kay J.S.; Marar I.E.;
Flores E.; Saini S.; Abdullah S.; Berk M.R.; Fordan S.; Joshi P.H.;
McCullough P.A.; Reynolds R.D.; Rosenstock J.; Sachson R.A.; Shammas N.;
Fishbein G.J.; Randall W.J.; Henderson D.A.; Nash M.L.; Barker B.A.; Cohen
S.S.; Seidman B.; Odekirk L.L.; Grillo R.S.; Martinez L.M.; Multani P.;
Alwine L.K.; McGarvey J.F.; Mollerus M.E.; Miller A.B.; Kotek L.W.;
Changlani M.; Zavaro S.H.; Munoz F.; Mehta P.M.; Helm R.J.; Farhat N.Z.;
Farsad R.; Raoof T.J.; Shultz J.H.; Geohas J.G.; Allaw M.A.; Dela Llana
A.; Gutmann J.E.; Inzerello A.T.; Alappat P.; George A.R.; Haddad T.M.;
Lillestol M.J.; Grodman R.; Peniston J.H.; Wadud K.; Garcia B.; Hamilton
M.E.; Lerman S.; Perloff D.E.; Graff A.; Saxena S.; Alvarado O.P.; Malik
A.; Reddy R.D.; Kinzfogl G.; Cornett G.M.; Norwood P.C.; Gilbert J.M.;
Willis J.G.; McGrew F.; Sharma S.; Castro M.A.; Cucher F.H.; Altafullah
I.M.; Khurana S.; Knutson T.J.; Kinnaman S.J.; Stuckey T.; Pudi K.K.;
Mayfield R.K.; Funk G.S.; Nixon W.A.; Dor I.; Boyett B.E.; Srivastava S.;
Elosegui A.M.; Isserman S.M.; Cheek H.B.; Promisloff S.D.; Tami L.F.; Zeig
S.; fitz-Patrick D.; Dave K.N.; Ahmad A.; Arain S.; Ballantyne C.M.; Doshi
A.; El Hafi S.E.; Feldman J.; Fragoso V.G.; Gilford T.; Hoffman A.S.;
Pouzar J.E.; Vivekananthan K.; Ansari S.H.; Strzinek R.A.; Crater T.A.;
Robinson J.G.; Fulmer J.J.; Patel A.M.; Pereira E.S.; Stich M.A.; Sultan
S.; Geskin G.; Ruoff G.E.; Gillespie E.; Bybee K.A.; Moriarty P.M.; Savin
V.; Agaiby J.M.; Melucci M.B.; Jantzi C.M.; Davidson E.; Smith W.B.;
Treasure C.B.; Wakefield P.H.; Deck K.; Edris M.A.; Gilmore R.M.; Seep
M.K.; Andersen J.L.; Detweiler R.O.; Rosenfeld J.C.; Strobl D.J.;
Steinhoff J.P.; Adams A.; Estevez R.; Molin C.J.; Kim C.Y.; Dy J.; Fox
K.E.; Farris N.R.; Wayne J.D.; Whitney R.T.; Randhawa P.M.; Mego D.M.;
MacDolnald L.; Caputo R.P.; Rigolosi R.; VanNatta B.; Pacheco T.R.;
El-Shahawy M.; Gonzalez E.J.; Guice M.J.; Cherlin R.S.; Bays H.E.;
Shoukfeh M.; Morris F.H.; Loy J.; Vora S.K.; Staab P.K.; Frisoli A.;
Kimmel M.A.; Cohen A.J.; Green C.B.; Whitlock L.; Butuk D.J.; McCartney
M.J.; Ables L.R.; Acosta R.; Alvarez J.G.; Barrera C.M.; Benitez O.;
Berenguer R.A.; Breton C.F.; Chiong R.; Delgado M.I.; Dufreny A.; Fialkow
J.A.; Franczek S.; Frias J.J.; Iglesias C.; Landron-Garcia L.; Llerena
S.N.; Martinez R.F.; Miranda A.A.; Morytko J.A.; Rodriguez I.J.; Sotolongo
R.; Suarez-Sarmiento A.; Terrelonge A.E.; Vaca C.E.; Venereo J.M.; Verdeza
C.; Zeno M.L.; Chilka S.; Felten W.R.; Hartman A.N.; Shayani S.S.; Duprez
D.; Knickelbine T.; Chambers J.D.; Cone C.L.; Broughton R.; Napoli M.C.;
Seaton B.L.; Smith S.K.; Reedy M.A.; Kesani M.K.; Nicol P.R.; Stringam
S.O.; Talano J.V.; Barnum O.; Desai V.; Montero M.; Jacks R.K.; Kostis
J.B.; Owen J.G.; Makam S.K.; Grosman I.; Underberg J.A.; Masri B.E.;
Peters S.S.; Serje J.; Lenhard M.J.; Glover R.; Paraboschi C.F.; Lim E.H.;
Connery L.; Kipgen W.; Bravo P.; DiGiovanna M.J.; Tayoum H.; Gabriel J.D.;
Ariani M.K.; Robinson M.F.; Clemens P.C.; Corder C.N.; Schifferdecker B.;
Tahirkheli N.K.; Hurling R.T.; Rendell M.S.; Shivaswamy V.; Madu I.J.;
Dahl C.F.; Ayesu K.; Kim C.; Barettella M.B.; Jamidar H.A.; Bloom S.A.;
Vora K.N.; Ong S.T.; Aggarwala G.; Sack G.; Blaze K.; Krichmar P.; Murcia
A.; Teltser M.; Villaman-Bencosme Y.; Fahdi I.E.; Williams D.G.; Lain
E.L.; Garcia H.L.; Karim S.N.; Francyk D.M.; Gordon M.B.; Palchick B.A.;
McKenzie M.E.; Gimness M.P.; Greiff J.; Ruiz-R L.; Vazquez-Tanus J.B.;
Schlager D.; Connelly T.; Soroka E.; Hastings W.L.; O'Dea D.J.; Purdy
D.A.; Jackson B.; Arcanese M.L.; Strain J.E.; Schmedtje J.F.; Davis M.G.;
Prasada S.; Scott D.L.; Vukotic G.; Akhtar N.; Larsen D.C.; Rhudy J.M.;
Zebrack J.S.; Bailey S.R.; Grant D.C.; Mora A.; Perez J.A.; Reyes R.G.;
Sutton J.C.; Brandon D.M.; First B.P.; Risser J.A.; Claudio J.;
Figueroa-Cruz W.L.; Sosa-Padilla M.A.; Tan A.E.; Traboulssi M.A.; Morcos
N.C.; Glaser L.A.; Bredlau C.E.; El Shahawy M.; Ramos M.J.; Kandath D.D.;
Kaluski E.; Akright L.; Rictor K.W.; Pluto T.M.; Hermany P.R.; Bellingar
B.; Clark G.B.; Herrod J.N.; Goisse M.; Hook M.; Barrington P.; Lentz
J.D.; Singal D.K.; Gleason G.P.; Lipetz R.S.; Schuchard T.N.; Bonner J.H.;
Forgosh L.B.; Lefebvre G.C.; Pierpoint B.E.; Radin D.M.; Stoller S.R.;
Segall N.; Shah S.A.; Ramstad D.S.; Nisnisan J.M.; Trippett J.M.; Benjamin
S.A.; Labissiere J.C.; Nashed A.N.; Maaieh M.; Aslam A.A.; Mandviwala M.;
Budoff M.J.; French W.J.; Vlach J.J.; DeStefano P.; Bayron C.J.; Fraser
N.J.; Sandberg J.H.; Fagan T.C.; Peart B.C.; Suryanarayana P.G.; Gupta
D.K.; Lee M.W.; Bertolet B.D.; Hartley P.A.; Kelberman M.; Behmanesh B.;
Buynak R.J.; Chochinov R.H.; Steinberg A.A.; Chandna H.; Bjasker K.R.;
Perlman R.L.; Ball E.M.; Pock J.; Singh S.; Baldari D.; Kaster S.; Lovell
J.P.; Horowitz B.S.; Gorman T.A.; Pham D.N.; Landzberg J.S.; Mootoo K.I.;
Moon E.; Krawczyk J.; Alfieri A.D.; Janik M.J.; Herrington D.M.;
Koilpillai R.N.; Waxler A.R.; Hoffman D.A.; Sahul Z.H.; Gumbiner B.; Cropp
A.; Fujita K.; Garzone P.; Imai K.; Levisetti M.; Plowchalk D.; Sasson S.;
Skaggs J.; Sweeney K.; Vincent J.
Institution
(Ridker, Glynn) Center for Cardiovascular Disease Prevention, Brigham and
Women's Hospital, Harvard Medical School, 900 Commonwealth Ave., Boston,
MA 02215, United States
(Revkin, Brunell, Curto, Masiukiewicz, Schwartz, Yunis, Shear) Pfizer, New
York, United States
(Amarenco) Paris-Diderot Sorbonne Paris Cite University, Paris, France
(Civeira) Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain
(Flather) University of East Anglia, Norwich, United Kingdom
(Soran) Central Manchester University Hospital, Manchester, United Kingdom
(Gregoire, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, Canada
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Kastelein) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Mosterd) Meander Medical Center, Amersfoort, Netherlands
(Karpov) Russian Cardiology Research and Production Center, Moscow,
Russian Federation
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich Heart Alliance, Munich, Germany
(Lorenzatti) Cordoba Hospital, Cordoba, Argentina
(Manga) University of the Witwatersrand, Johannesburg, South Africa
(Miller) University of Maryland, Baltimore, United States
(Murin) University of Comenius, Bratislava, Slovakia
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Sao
Paulo, Brazil
(Santos) Lipid Clinic Heart Institute, University of Sao Paulo Medical
School Hospital, Sao Paulo, Brazil
(Nissen) Cleveland Clinic Foundation, Cleveland, United States
(Ponikowski) Wroclaw Medical University, Wroclaw, Poland
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wright) Mayo Clinic, Rochester, MN, United States
(Vrablik) First Faculty of Medicine, Charles University, Prague, Czechia
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Bococizumab is a humanized monoclonal antibody that inhibits
proprotein convertase subtilisin- kexin type 9 (PCSK9) and reduces levels
of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the
efficacy of bococizumab in patients at high cardiovascular risk. METHODS
In two parallel, multinational trials with different entry criteria for
LDL cholesterol levels, we randomly assigned the 27,438 patients in the
combined trials to receive bococizumab (at a dose of 150 mg)
subcutaneously every 2 weeks or placebo. The primary end point was
nonfatal myocardial infarction, nonfatal stroke, hospitalization for
unstable angina requiring urgent revascularization, or cardiovascular
death; 93% of the patients were receiving statin therapy at baseline. The
trials were stopped early after the sponsor elected to discontinue the
development of bococizumab owing in part to the development of high rates
of antidrug antibodies, as seen in data from other studies in the program.
The median follow-up was 10 months. RESULTS At 14 weeks, patients in the
combined trials had a mean change from baseline in LDL cholesterol levels
of -56.0% in the bococizumab group and +2.9% in the placebo group, for a
between-group difference of -59.0 percentage points (P<0.001) and a median
reduction from baseline of 64.2% (P<0.001). In the lower-risk,
shorter-duration trial (in which the patients had a baseline LDL
cholesterol level of >=70 mg per deciliter [1.8 mmol per liter] and the
median follow-up was 7 months), major cardiovascular events occurred in
173 patients each in the bococizumab group and the placebo group (hazard
ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P = 0.94). In the
higher-risk, longer-duration trial (in which the patients had a baseline
LDL cholesterol level of >=100 mg per deciliter [2.6 mmol per liter] and
the median follow-up was 12 months), major cardiovascular events occurred
in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to
0.97; P = 0.02). The hazard ratio for the primary end point in the
combined trials was 0.88 (95% CI, 0.76 to 1.02; P = 0.08). Injection-site
reactions were more common in the bococizumab group than in the placebo
group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS In two randomized trials
comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no
benefit with respect to major adverse cardiovascular events in the trial
involving lower-risk patients but did have a significant benefit in the
trial involving higher-risk patients. Copyright © 2017
Massachusetts Medical Society. All rights reserved.

<15>
Accession Number
627212869
Title
A comparative study of safety and efficacy of ultrasound-guided
infra-clavicular axillary vein cannulation versus ultrasound-guided
internal jugular vein cannulation in adult cardiac surgical patients.
Source
Annals of Cardiac Anaesthesia. 22 (2) (pp 177-186), 2019. Date of
Publication: April-June 2019.
Author
Shinde P.; Jasapara A.; Bansode K.; Bunage R.; Mulay A.; Shetty V.
Institution
(Shinde, Jasapara, Bansode, Bunage, Mulay) Department of Anaesthesiology
and Cardiac Surgery, Fortis Hospital, Mulund Goregaon Link Road,
Mulund-West-Maharashtra 400 078, India
(Shetty) Department of Anaesthesiology, Fortis Hospital, Mumbai,
Maharashtra, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Ultrasound (US)-guided internal jugular vein (IJV) cannulation
is a widely accepted standard procedure. The axillary vein (AV) in
comparison to the subclavian vein is easily visualized, but its
cannulation is not extensively studied in cardiac patients. Aim(s):
This study is an attempt to study the efficacy of real-time US-guided
axillary venous cannulation as a safe alternative for the time-tested
US-guided IJV cannulation. Design(s): This is a prospective
randomized controlled study. Material(s) and Method(s): A total of
100 adult patients scheduled for cardiac surgery were divided equally in
Group A-US-guided IJV cannulation, and Group B-US-guided axillary venous
cannulation. Under local anesthesia and real-time US guidance the IJV or
AV was secured. The access time, guidewire time, and procedure time were
noted. Furthermore, the number of needle attempts, malposition, change of
site, and complications were noted. Result(s): The data were analyzed
for 49 patients in Group A and 48 patients in the Group B due to
exclusions. The access time and the guidewire time were comparable in both
groups. The first attempt needle puncture was successful for the IJV group
in 98% of patients in comparison to 95% of patients in Group B. Guidewire
was passed in the first attempt in 94% in Group A and 89% in the Group B.
Except for arterial puncture in one case in group A, the complications
were insignificant in both groups. Conclusion(s): The study shows
that the US-guided AV cannulation may serve as an effective alternative to
the IJV cannulation in cardiac surgery. Copyright © 2019 Medknow
Publications. All rights reserved.

<16>
Accession Number
627212864
Title
The effect of perioperative magnesium sulfate on blood sugar in patients
with diabetes mellitus undergoing cardiac surgery: A double-blinded
randomized study.
Source
Annals of Cardiac Anaesthesia. 22 (2) (pp 151-157), 2019. Date of
Publication: April-June 2019.
Author
Soliman R.; Nofal H.
Institution
(Soliman) Department of Anesthesia, Cairo University, Cairo, Egypt
(Soliman) Department of Cardiac Anesthesia, Cardiac Center, Aldar
Hospital, Almadinah Almonwarah, Saudi Arabia
(Nofal) Department of Cardiac Surgery, Cardiac Center, Aldar Hospital,
Almadinah Almonwarah, Saudi Arabia
(Nofal) National Heart Institute, Giza, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The aim of the present study was to evaluate the perioperative
effect of magnesium infusion on blood sugar level in patients with
diabetes mellitus undergoing cardiac surgery. Design(s): This was a
double-blind randomized study. Setting(s): The study was conducted at
cardiac center. Patient(s): The study included 122 adult patients.
 Intervention(s): Group M - The patients received a continuous
infusion of magnesium sulfate (without a loading dose) at 15 mg/kg/h. The
infusion rate was started 20 min before induction maintained during
surgery and the first postoperative 24 h. The medication was prepared by
adding 5 g magnesium sulfate in 50 ml syringe. Group C - The patients
received equal amount of normal saline. Measurements: The monitors
included heart rate, mean arterial blood pressure, central venous
pressure, urine output, blood levels of magnesium, sugar, and potassium.
 Result(s): The blood sugar level and the required insulin
significantly decreased with Group M than Group C (P < 0.05). There were
minimal changes in the potassium level in Group M, but potassium decreased
in patients of Group C (P < 0.05). The amount of urine output was too much
higher in Group M than Group C (P < 0.05). The pharmacological and
mechanical support significantly decreased with Group M than Group C (P <
0.05). The hospital and Intensive Care Unit length of stay significantly
decreased with Group M than Group C (P < 0.05). Conclusion(s): The
magnesium sulfate produced a better-controlled effect on the blood sugar
level. It decreased the requirement of insulin infusion and minimized the
changes in the blood level of potassium. Copyright © 2019 Medknow
Publications. All rights reserved.

<17>
Accession Number
2001790781
Title
Vitamin C can shorten the length of stay in the ICU: A meta-analysis.
Source
Nutrients. 11 (4) (no pagination), 2019. Article Number: 708. Date of
Publication: April 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
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
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. Copyright © 2019 by the authors. Licensee MDPI,
Basel, Switzerland.

<18>
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

<19>
Accession Number
627092693
Title
Effects of lowering diastolic blood pressure to <80 mmHg on cardiovascular
mortality and events in patients with coronary artery disease: a
systematic review and meta-analysis.
Source
Hypertension Research. 42 (5) (pp 650-659), 2019. Date of Publication: 01
May 2019.
Author
Okamoto R.; Kumagai E.; Kai H.; Shibata R.; Ohtsubo T.; Kawano H.;
Fujiwara A.; Ito M.; Fukumoto Y.; Arima H.
Institution
(Okamoto, Ito) Department of Cardiology and Nephrology, Mie University
Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
(Kumagai, Fukumoto) Division of Cardiovascular Medicine, Department of
Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi,
Kurume, Fukuoka 830-0011, Japan
(Kai) Department of Cardiology, Kurume University Medical Center, 155-1
Kokubu-machi, Kurume, Fukuoka 839-0863, Japan
(Shibata) Department of Advanced Cardiovascular Therapeutics, Nagoya
University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya
466-8550, Japan
(Ohtsubo) Department of Medicine and Clinical Science, Graduate School of
Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka
812-8582, Japan
(Kawano) Department of Cardiovascular Medicine, Nagasaki University
Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501,
Japan
(Fujiwara) Divition of Nephrology and Hypertension, Yokohama City
University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024,
Japan
(Arima) Department of Preventive Medicine and Public Health, Fukuoka
University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, Fukuoka 814-0180, Japan
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
The target of diastolic blood pressure (DBP) remains controversial in
patients with coronary artery disease (CAD). We systematically searched
PubMed/Medline and the Cochrane Central database for randomized controlled
trials (RCTs) assessing the efficacy and safety of reducing DBP in CAD
patients from January 1965 to July 2017. Seven placebo-controlled RCTs
enrolling 34,814 CAD patients who achieved DBP <80 mmHg were included in
the drug-intervention group. The average achieved blood pressures (BPs)
were 126.3/75.1 and 131.5/77.8 mmHg in the drug-intervention and
placebo-control groups, respectively. Drug intervention was associated
with an 11% reduction in coronary revascularization and a 31% reduction in
heart failure. In the drug-intervention group, all-cause death, myocardial
infarction, angina pectoris, and stroke were reduced with marginal
significance, whereas hypotension was increased by 123%. A meta-analysis
of four RCTs, in which the achieved DBP was <75 mmHg, showed that the drug
intervention was associated with a 22% reduction in heart failure. These
results suggest that reducing DBP to 80 mmHg or less would significantly
reduce coronary revascularization and heart failure but at the expense of
causing hypotension in CAD patients. Further trials are warranted to prove
this issue. Copyright © 2019, The Japanese Society of
Hypertension.

<20>
[Use Link to view the full text]
Accession Number
627081118
Title
High-target versus low-target blood pressure management during
cardiopulmonary bypass to prevent cerebral injury in cardiac surgery
patients: A randomized controlled trial.
Source
Circulation. 137 (17) (pp 1770-1780), 2018. Date of Publication: 2018.
Author
Vedel A.G.; Holmgaard F.; Rasmussen L.S.; Langkilde A.; Paulson O.B.;
Lange T.; Thomsen C.; Olsen P.S.; Ravn H.B.; Nilsson J.C.
Institution
(Vedel, Holmgaard, Ravn, Nilsson) Department of Cardiothoracic Anesthesia,
Heart Center, University of Copenhagen, Blegdamsvej 9, Copenhagen DK-2200,
Denmark
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
University of Copenhagen, Denmark
(Langkilde, Thomsen) Department of Radiology, Diagnostic Center,
University of Copenhagen, Denmark
(Paulson) Neurobiological Research Unit, Neuro Center, University of
Copenhagen, Denmark
(Olsen) Department of Cardiothoracic Surgery, Heart Center,
Rigshospitalet, University of Copenhagen, Denmark
(Lange) Department of Biostatistics, University of Copenhagen, Denmark
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Cerebral injury is an important complication after cardiac
surgery with the use of cardiopulmonary bypass. The rate of overt stroke
after cardiac surgery is 1% to 2%, whereas silent strokes, detected by
diffusion-weighted magnetic resonance imaging, are found in up to 50% of
patients. It is unclear whether a higher versus a lower blood pressure
during cardiopulmonary bypass reduces cerebral infarction in these
patients. METHOD(S): In a patient- and assessor-blinded randomized
trial, we allocated patients to a higher (70-80 mm Hg) or lower (40-50 mm
Hg) target for mean arterial pressure by the titration of norepinephrine
during cardiopulmonary bypass. Pump flow was fixed at 2.4
L.min-1.m-2. The primary outcome was the total
volume of new ischemic cerebral lesions (summed in millimeters cubed),
expressed as the difference between diffusion-weighted imaging conducted
preoperatively and again postoperatively between days 3 and 6. Secondary
outcomes included diffusion-weighted imaging-evaluated total number of new
ischemic lesions. RESULT(S): Among the 197 enrolled patients, mean
(SD) age was 65.0 (10.7) years in the low-target group (n=99) and 69.4
(8.9) years in the high-target group (n=98). Procedural risk scores were
comparable between groups. Overall, diffusion-weighted imaging revealed
new cerebral lesions in 52.8% of patients in the low-target group versus
55.7% in the high-target group (P=0.76). The primary outcome of volume of
new cerebral lesions was comparable between groups, 25 mm3
(interquartile range, 0-118 mm3; range, 0-25 261
mm3) in the low-target group versus 29 mm3
(interquartile range, 0-143 mm3; range, 0-22 116
mm3) in the high-target group (median difference estimate, 0;
95% confidence interval, -25 to 0.028; P=0.99), as was the secondary
outcome of number of new lesions (1 [interquartile range, 0-2; range,
0-24] versus 1 [interquartile range, 0-2; range, 0-29] respectively;
median difference estimate, 0; 95% confidence interval, 0-0; P=0.71). No
significant difference was observed in frequency of severe adverse events.
 CONCLUSION(S): Among patients undergoing on-pump cardiac surgery,
targeting a higher versus a lower mean arterial pressure during
cardiopulmonary bypass did not seem to affect the volume or number of new
cerebral infarcts. Copyright © 2018 American Heart Association,
Inc.

<21>
Accession Number
620843382
Title
Baden Prevention and Reduction of Incidence of Postoperative Delirium
Trial (PRIDe): A phase IV multicenter, randomized, placebo-controlled,
double-blind clinical trial of ketamine versus haloperidol for prevention
of postoperative delirium.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 142. Date of
Publication: 26 Feb 2018.
Author
Riegger H.; Hollinger A.; Seifert B.; Toft K.; Blum A.; Zehnder T.;
Siegemund M.
Institution
(Riegger, Hollinger, Blum, Zehnder, Siegemund) University Hospital Basel,
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency
Medicine and Pain Therapy, Basel, Switzerland
(Seifert) University of Zurich, Epidemiology, Biostatistics and Prevention
Institute, Zurich, Switzerland
(Toft) See-Spital, Horgen and Kilchberg branches, Department for
Anesthesia, Intensive Care and Emergency Medicine, Horgen and Kilchberg,
Switzerland
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is a neurobehavioural syndrome that frequently
develops in the postoperative setting. The incidence of elderly patients
who develop delirium during hospital stay ranges from 10 to 80% (Schonauer
et al., J Pept Sci. 2017). Delirium was first described more than half a
century ago in the cardiac surgery population (Blachy and Starr, Am J
Psychiatry 121:371-5, 1964), where it was already discovered as a state
that might be accompanied by serious complications such as prolonged ICU
and hospital stay, reduced quality of life and increased mortality.
Furthermore, the duration of delirium is associated with worse long-term
cognitive function in the general ICU population (Sessler et al., Am J
Respir Crit Care Med 166:1338-44, 2002). This long-term experience with
delirium suggests a high socioeconomic burden and has been a focus of many
studies (Nishio et al., Crit Care Med 5:953-7, 1997; Ehlenbach et al.,
JAMA 303:763-70, 2010; Jahangir et al., World J Cardiol 3:383-7, 2011;
Abegunde et al., Lancet 370:1929-1938, 2007; Darmon et al., Intensive Care
Med 43:829-840, 2017; Marino et al., J Nephrol 28:717-24, 2015; Ng LL et
al., J Am Coll Cardiol 69:56-69, 2017; Sezen et al., J Pharmacol Exp Ther
287:238-45, 1998; Kim et al., Ann Lab Med 37:388-97, 2017). Due to the
multifactorial origin of delirium, we have several but no incontestable
options for prevention and symptomatic treatment. Overall, delirium
represents a high burden not only for patient and family members, but also
for the medical care team that aims to prevent postoperative delirium to
avoid serious consequences associated with it. The purpose of this study
is to determine whether postoperative delirium can be prevented by the
combination of established preventive agents. In addition, measured levels
of pre- and postoperative cortisol, neuron specific enolase (NSE) and
S-100beta will be used to investigate dynamics of these parameters in
delirious and non-delirious patients after surgery. Methods/design: The
Baden PRIDe Trial is an investigator-initiated, phase IV, two-centre,
randomised, placebo-controlled, double-blind clinical trial for the
prevention of delirium with haloperidol, ketamine, and the combination of
both vs. placebo in 200 patients scheduled for surgery. We would like to
investigate superiority of one of the three treatment arms (i.e.,
haloperidol, ketamine, combined treatment) to placebo. Discussion(s):
There is limited but promising evidence that haloperidol and ketamine can
be used to prevent delirium. Clinical care for patients might improve as
the results of this study may lead to better algorithms for the prevention
of delirium. Copyright © 2018 The Author(s).

<22>
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

<23>
Accession Number
2001643581
Title
OPTIMAL MEDICAL THERAPY USE AND LONG-TERM OUTCOMES IN CABG-ELIGIBLE HEART
FAILURE PATIENTS: INSIGHTS FROM THE STICH TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 45), 2019.
Date of Publication: 12 March 2019.
Author
Farsky P.S.; White J.; Sueta C.; Dabrowski R.; Djokovic L.; Drazner M.;
Haddad H.; Ali I.; Keltai M.; Naik A.; Sopko G.; Golba K.; Andersson B.;
Carson P.; Kukulski T.; Al-Khalidi H.; Rouleau J.; Velazquez E.
Institution
(Farsky, White, Sueta, Dabrowski, Djokovic, Drazner, Haddad, Ali, Keltai,
Naik, Sopko, Golba, Andersson, Carson, Kukulski, Al-Khalidi, Rouleau,
Velazquez) Christopher O'Connor, Instituto Dante Pazzanese de Cardiologia,
Sao Paulo, Brazil; Duke Clinical Research Institute, Durhan, NC, USA
Publisher
Elsevier USA
Abstract
Background: Coronary Artery Bypass Grafting (CABG) reduces mortality in
Heart Failure (HF) and coronary artery disease (CAD) patients (pts). There
is a paucity of data on the utilization of optimal medical therapy (OMT)
in HF and CAD pts after revascularization and the impact on long term
outcomes. We evaluate the impact of baseline use of OMT versus Non-OMT on
long-term clinical outcomes in pts receiving CABG compared to patients
with Medical treatment alone (MED). Method(s): The STICH trial
randomized 1212 pts with CAD and left ventricular ejection fraction (LVEF)
<= 35% to CABG + MED versus MED alone. OMT was defined as a combination of
4 drugs: ACEI/ARB, BB, statin, and at least one antiplatelet drug at
baseline, with a median follow up over 9.8 years. Result(s): At
baseline, 58.7% of the pts were on OMT (CABG 56.1%; MED 61.5%), remaining
stable or increasing similarly for both groups during follow up, for
example, at 1 year, CABG 73.2% and Med 74.3%. Age, gender, diabetes were
similar. OMT pts had less atrial fibrillation, lower angina score class,
less advance heart failure class and better renal function. There were no
differences in LVEF and end systolic and diastolic volume index. OMT use
at baseline was associated with a significantly lower all-cause mortality
compared to Non-OMT pts (58.8% vs 67.6%, log-rank P<0.001), lower
cardiovascular mortality (40.3% vs 51.4%, log-rank P<0.001) and lower HF
death, 11.2% vs 15.6%, log-rank P<0.001). Sudden death was not different
(21.5% vs 23.4%, P=0.058). In a multivariable Cox model, OMT was
associated with a lower All-cause mortality (HR 0.78, 95%CI 0.66-0.91
P=0.001). The effect of OMT was similar for both CABG and MED only pts for
these outcomes (p=0.189 for interaction). Hospitalization for HF was not
reduced with OMT. Conclusion(s): OMT is associated with lower
all-cause mortality in CABG eligible HF pts, regardless of the lower
baseline risk among OMT pts and the performance of CABG. OMT should be
strongly considered for all pts with ischemic cardiomyopathy regardless of
whether CABG is performed. Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<24>
Accession Number
2001643293
Title
EFFICACY AND SAFETY OF TRANSCAROTID TRANSCATHETER AORTIC VALVE REPLACEMENT
IN 495 PATIENTS: 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 1374), 2019.
Date of Publication: 12 March 2019.
Author
Bob-Manuel T.; Nanda A.; Anunobi C.I.; Soto J.T.; Jenkins J.; Ibebuogu U.
Institution
(Bob-Manuel, Nanda, Anunobi, Soto, Jenkins, Ibebuogu) University of
Tennessee Health Science Center, Memphis, TN, USA; Ochsner Clinic
Foundation, New Orleans, LA, USA
Publisher
Elsevier USA
Abstract
Background: In patients who are unsuitable for traditional access routes
for transcatheter aortic valve replacement (TAVR) due to severe peripheral
vascular disease (PVD), carotid artery (CA) access is an emerging route
for TAVR. This study represents the most up to date outcomes on carotid
access TAVR. Method(s): A systematic review was conducted as per the
Preferred Reporting Instructions for Systematic Reviews and Meta-analysis
(PRISMA). We performed a thorough electronic search through Pubmed, SCOPUS
and Embase databases. Studies including case series and original articles
published between 2012 and 2018 with regards to Transcarotid access TAVR
were included. Only studies reporting data on demographic and procedural
characteristics, management and follow up outcomes were analyzed. Data
were analyzed using the SPSS version 23 (SPSS Inc., Chicago, Illinois).
 Result(s): A total of 11 studies were included in this systematic
review comprising of 495 patients that received CA TAVR. The mean age of
included patients was 80.15 +/- 8.2 and 59% were male. The mean STS score
was 7.7 +/- 4.6. 16% had prior stroke or TIA. 82% of patients had severe
PVD. Mean AVA pre-TAVR was 0.62 +/-0.31. Left Carotid access was used in
85% of patients (n =270), 72% received Self-expanding valves while 28%
received Balloon-Expanding valves (BEV). Device success was achieved in
93% of cases (n=318) Periprocedural mortality occured in 1.6% of cases,
30-day and 1-yr mortality was 5.4% and 10.1% respectively. Major bleeding
and vascular complications occurred in 3.6% and 6.4% of patients
respectively. 18.7% of patients required new pacemaker implantation.
In-hospital stroke or TIA occurred in 3.6% of cases, 30 day stroke or TIA
occurred 4.48% of cases. There were no hemorrhagic strokes. Mean time to
discharge was 10.3 +/- 6.4 days. Conclusion(s): The most contemporary
data on Carotid access TAVR shows impressive device success, low rates of
stroke and pacemaker implantation and an acceptable 30-day and 1-year
mortality. Copyright 2019 American College of Cardiology Foundation.
All rights reserved.

<25>
Accession Number
2001643228
Title
AN OUTCOME COMPARISON OF PERCUTANEOUS CORONARY INTERVENTION VERSUS
CORONARY ARTERY BYPASS GRAFTING IN ELDERLY PATIENT WITH MULTI-VESSEL
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 43), 2019.
Date of Publication: 12 March 2019.
Author
Alkhawam H.; Muskula P.R.; Ghrair F.; Windish S.; Ampadu J.; Kichura A.;
Lieber J.; Lim M.; Helmy T.
Institution
(Alkhawam, Muskula, Ghrair, Windish, Ampadu, Kichura, Lieber, Lim, Helmy)
Saint Louis University School of Medicine, St. Louis, MO, USA; Icahn
School of Medicine at Mount Sinai (Elmhurst), Elmhurst, NY, USA
Publisher
Elsevier USA
Abstract
Background: Elderly patients have classically been inadequately
represented in clinical trials. As such, the outcomes of coronary
revascularization strategy (coronary artery bypass grafting [CABG] or
percutaneous coronary intervention [PCI]) in older adults with
multi-vessel coronary artery disease (MVCAD) is unknown. Method(s):
We performed a retrospective analysis of consecutive patients who
underwent cardiac catheterization between 2005-2015. We included the
patients aged 75-89 years old with MVCAD and underwent for
revascularization. Result(s): Out of 9,034 patients underwent cardiac
catheterization, 884 (9.8%) patients were 75-89 years old. Of 884 pts, 45%
found to have MVCAD. Out of 415 pts with MVCAD, 41.7% underwent PCI and
58.3% underwent CABG. Baseline characteristics between both groups were
similar (table 1). Pts who underwent CABG had a higher length of stay
(0.01). The 30-day readmission rate did not differ between both groups
(p=0.2) while the 6-month and 1-year readmission rates were higher in PCI
group (0.004 and 0.007, respectively). No difference between both groups
in term of in-hospital or 30-day post-discharge mortality (0.7 and 0.3,
respectively). Conclusion(s): In our observation study, pts between
75 and 89 years old with MVCAD who underwent CABG had lower 6-month and
1-year readmission rates compared to PCI group. No difference in
short-term mortality between PCI and CABG groups. Randomized trials are
warranted to assess the long-term outcomes among this high-risk
population. [Figure presented] Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<26>
Accession Number
2001643194
Title
IMPACT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON TRANSCATHETER AND
SURGICAL AORTIC VALVE REPLACEMENT: FROM THE PARTNER 2 COHORT A TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1200), 2019.
Date of Publication: 12 March 2019.
Author
Ando T.; Dvir D.; Nazif T.; Chen S.; Briasoulis A.; Kirtane A.; Afonso L.;
Takagi H.; Crowley A.; Alu M.; Leon M.; Kodali S.
Institution
(Ando, Dvir, Nazif, Chen, Briasoulis, Kirtane, Afonso, Takagi, Crowley,
Alu, Leon, Kodali) Columbia University Medical Center, New York, NY, USA;
Wayne State Medical Center, Detroit, MI, USA
Publisher
Elsevier USA
Abstract
Background: The impact of chronic obstructive pulmonary disease (COPD), an
independent risk factor for worse outcomes after surgery, in patients at
intermediate surgical risk undergoing transcatheter aortic valve
replacement (TAVR) versus surgical aortic valve replacement (SAVR) has not
been investigated in detail. Method(s): Patients in the transfemoral
(TF) cohort of the PARTNER 2A Trial (intermediate surgical risk)
randomized to TF-TAVR or SAVR were analyzed according to COPD status at
baseline. The primary endpoint was 2-year all-cause mortality. Secondary
endpoints were 2-year cardiovascular mortality, composite of all-cause
mortality or re-hospitalization, and changes in Kansas City Cardiomyopathy
Questionnaire overall score (KCCQ-OS). Result(s): A total of 1,542
patients (771 TF-TAVR and 771 SAVR) were included in the analysis. Stroke
was observed less in TF-TAVR (P<inf>interaction</inf> = 0.01) but other
major complications were similar between TF-TAVR and SAVR at 30-days.
Two-year mortality with vs without COPD was 17.5% vs 12.9%, p=0.10, in the
TF-TAVR arm and 17.4% vs 17.3%, p=0.91 in the SAVR arm. In fully adjusted
models*, the primary endpoint for both TF-TAVR (HR 1.52, 95 %CI 0.97-2.39)
and SAVR (HR 0.91, 95% CI 0.55-1.51) was not affected by the presence of
COPD, and no significant interaction was observed between treatment arm
and COPD status (p=0.13). For secondary endpoints, the relative
effectiveness of TF-TAVR vs. SAVR was similar in patients with or without
COPD (all P<inf>interaction</inf> >0.05). The degree of improvement in
KCCQ-OS in both TF-TAVR and SAVR arms was lower in patients with COPD
compared with non-COPD (TAVR: adjusted mean difference [aMD] -5.7, 95% CI
-9.9 to -1.6; SAVR: aMD -4.0, 95% CI -8.6 to 0.5), P<inf>interaction</inf>
= 0.57). *Variables in the regression models included age, sex, STS score,
diabetes mellitus, renal insufficiency, congestive heart failure, 15-foot
walk test >7 seconds, serum albumin < 3.5 mg/dl, LVEF, and moderate or
severe RV dysfunction at baseline. Conclusion(s): Outcomes of
intermediate surgical risk patients who underwent TF-TAVR or SAVR were not
significantly affected by the presence of COPD, and both treatment
modalities conferred similar outcomes in COPD patients. Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<27>
Accession Number
2001642388
Title
PRIOR EXPOSURE TO A CONVENTIONAL RENIN-ANGIOTENSIN SYSTEM ANTAGONIST AND
ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITION IN ACUTE DECOMPENSATED HEART
FAILURE: A PRESPECIFIED SUBGROUP ANALYSIS OF THE PIONEER-HF TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 1020), 2019.
Date of Publication: 12 March 2019.
Author
Ambrosy A.P.; DeVore A.; Morrow D.; Braunwald E.; Duffy C.; McCague K.;
Rocha R.; Velazquez E.
Institution
(Ambrosy, DeVore, Morrow, Braunwald, Duffy, McCague, Rocha, Velazquez)
Department of Cardiology, The Permanente Medical Group, San Francisco, CA,
USA; Division of Research, Kaiser Permanente Northern California, Oakland,
CA, USA
Publisher
Elsevier USA
Abstract
Background: There are limited data on the efficacy, safety, and
tolerability of sacubitril/valsartan (S/V) in heart failure with a reduced
ejection fraction (HFrEF) patients not previously treated with an
angiotensin converting-enzyme inhibitor (ACEi)/angiotensin receptor
blocker (ARB). Method(s): The PIONEER-HF trial was a prospective,
multicenter, double-blind, active-controlled, randomized clinical trial
which enrolled 887 patients at 129 sites in the United States. Medically
stable patients >18 years of age with an EF <40% and a NT-proBNP >=1600
pg/mL or BNP >=400 pg/mL were eligible for participation no earlier than
24 hours and up to 10 days while still hospitalized for acute
decompensated HF (ADHF). Patients were randomly assigned 1:1 to
in-hospital initiation of S/V titrated to 97/103 mg vs. enalapril titrated
to 10 mg both by mouth twice daily. The primary endpoint was the
time-averaged proportional change in NT-proBNP from baseline to week 8.
Safety endpoints included the incidence of worsening renal function,
hyperkalemia, and hypotension. Exploratory endpoints included death from
any cause, all-cause and HF hospitalizations, left ventricular assist
device implantation, and listing for cardiac transplantation.
 Result(s): Between May 26, 2016 and May 1, 2018, 881 patients (99.3%)
were randomly assigned to S/V (N = 440) or enalapril (N = 441) and
received at least one dose of study drug. Patients were enrolled a median
(25th, 75th) of 68 hours (48, 98) hours from initial
presentation. The mean age was 61+14 years, 72% (N = 635) were male, and
36% (N = 316) were self-reported black. At the time of enrollment, 52% (N
= 459) of patients were not currently being treated with an ACEi/ARB. This
analysis will describe clinical characteristics based on prior ACEi/ARB
exposure and assess the interaction between previous treatment with an
ACEi/ARB and the effects of S/V vs. enalapril on change in NT-proBNP
levels, the incidence of adverse events, and clinical outcomes.
 Conclusion(s): This pre-specified subgroup analysis will provide the
first opportunity to explore the potential benefits of S/V, compared to
enalapril, in HFrEF patients not previously tolerating at least a moderate
dose of an ACEi/ARB. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<28>
Accession Number
2001638430
Title
MITRACLIP PLUS OPTIMAL MEDICAL THERAPY VERSUS OPTIMAL MEDICAL THERAPY
ALONE FOR FUNCTIONAL MITRAL REGURGITATION: A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC.19 68th
Annual Scientific Session and Expo. United States. 73 (9) (pp 814), 2019.
Date of Publication: 12 March 2019.
Author
Goel S.; Teja R.; Wats K.; Zakin E.; Chava S.; Ayzenberg S.; Malik B.;
Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Teja, Wats, Zakin, Chava, Ayzenberg, Malik, Frankel, Shani,
Gidwani) Maimonides Medical Center, Brooklyn, NY, USA; Icahn School of
Medicine at Mount Sinai, New York, NY, USA
Publisher
Elsevier USA
Abstract
Background: Functional mitral regurgitation (FMR) caused by left
ventricular dysfunction is associated with poor prognosis. Whether
MitraClip improves clinical outcomes in this patient population remains
controversial. The purpose of this meta-analysis is to compare the
efficacy of MitraClip plus optimal medical therapy (OMT) versus OMT alone
in patients with FMR Methods: We conducted an electronic database search
of all published data for studies that compared Mitraclip plus OMT with
OMT alone for patients with FMR and reported on subsequent mortality,
re-hospitalizations and other outcomes of interest. Event rates were
compared using a Forest plot of relative risk using a random-effects model
assuming interstudy heterogeneity Results: A total of 5 studies (n= 1513,
Mitraclip= 796, OMT= 717) were included in the final analysis. Mitraclip
compared to OMT was associated with a significant reduction in overall
mortality (RR = 0.66, 95% CI = 0.44-0.99, P = 0.04) and re-hospitalization
rates for heart failure (RR = 0.57, 95% CI = 0.36-0.91, P = 0.02). There
was reduced need for heart transplantation or mechanical support
requirement (RR = 0.48, 95% CI = 0.25-0.91, P = 0.02) and unplanned mitral
valve surgery (RR = 0.21, 95% CI = 0.07-0.61, P = 0.004) in the Mitraclip
group. No effect was observed on cardiac mortality (P = 0.42) and the 6
minute walking distance (P=0.22) between two groups Conclusion(s):
Mitraclip improves overall mortality and reduces re-hospitalization rates
in patients with FMR [Figure presented] Copyright 2019 American
College of Cardiology Foundation. All rights reserved.

<29>
Accession Number
627284022
Title
Weight management telehealth intervention for overweight and obese rural
cardiac rehabilitation participants: A randomised trial.
Source
Journal of clinical nursing. 28 (9-10) (pp 1808-1818), 2019. Date of
Publication: 01 May 2019.
Author
Barnason S.; Zimmerman L.; Schulz P.; Pullen C.; Schuelke S.
Institution
(Barnason, Zimmerman, Schulz, Schuelke) College of Nursing-Lincoln
Division, University of Nebraska Medical Center, Lincoln, NE, United
States
(Pullen) College of Nursing-Omaha Division, University of Nebraska Medical
Center, Omaha, NE, United States
Publisher
NLM (Medline)
Abstract
AIMS AND OBJECTIVES: To determine whether a weight management intervention
(WMI) plus cardiac rehabilitation (CR) compared to CR alone improves
outcomes for overweight and obese cardiac revascularisation patients.
BACKGROUND: Despite participating in cardiac rehabilitation (CR), few
cardiac patients lose enough weight to achieve clinically significant
cardiovascular disease risk reduction. DESIGN: A randomised controlled
design was used with measurements at baseline, 4 and 6 months, guided by
the CONSORT checklist, see Supporting Information File S1. Adults who had
undergone either coronary artery bypass surgery (CABS) or percutaneous
coronary intervention (PCI) and participated in a rural CR programmes were
recruited. Subjects were randomised to a 12-week telehealth WMI or control
group. The primary outcome was weight loss. Secondary outcomes included
physical activity, patient activation, perceived self-efficacy and use of
weight management behaviours. RESULT(S): A total of 43 subjects
participated, with a mean age of 63 (+/-9.3) years. The WMI group had
significantly more weight loss averaged across the 4 and 6 months of 13.8
(+/-2.8) pounds compared to the control group [mean = 7.8 (+/-2.2)
pounds]. There were no significant differences in physical activity
(activity counts or daily minutes in moderate or more intense activity).
The WMI group had significantly higher levels of patient activation. They
also had significantly higher total scores on the Diet and Exercise
Self-Management survey, and subscales that included self-efficacy for
specific eating habits and managing diet behaviour. CONCLUSION(S):
Findings demonstrated the usefulness and feasibility of using telehealth
delivery of the WMI for cardiac rehabilitation participants in rural
communities to improve weight management outcomes. RELEVANCE TO PRACTICE:
Study findings underscore the opportunity to further improve weight loss
of overweight and obese cardiac participants using a weight management
intervention to augment CR participation. Copyright © 2019 John
Wiley & Sons Ltd.

<30>
Accession Number
2001846943
Title
Computed tomography quantitative volume imaging guides postoperative
nursing of patients with lung cancer.
Source
Journal of Medical Imaging and Health Informatics. 9 (5) (pp 945-950),
2019. Date of Publication: June 2019.
Author
Zhou L.; Ye J.; Wu W.; Wang J.
Institution
(Zhou, Ye, Wu, Wang) Department of Cardiothoracic Surgery, Second People's
Hospital of Wuhu, Anhui 241000, China
Publisher
American Scientific Publishers (E-mail: order@aspbs.com)
Abstract
Objective: The evaluation of pulmonary function after operation is useful
for the choice of treatment plan. The aim of this study is to explore the
guiding role of computed tomography (CT) quantitative volume imaging in
postoperative nursing of patients with lung cancer. Method(s): Sixty
patients with lung cancer treated by thoracic surgery were selected.
Before and 3 months after operation, the lung volume was measured by CT
quantitative volume imaging technology and lung function was examined. The
correlation between CT lung volume and lung function was evaluated. All
patients were randomly divided into observation and control group. The
patients in observation group were given targeted nursing according to the
predicted results of preoperative CT quantitative volume imaging. The
patients in control group were given routine nursing, and the prognosis
was compared between two groups. Result(s): The highest correlation
coefficient between the measured data and the preoperative pulmonary
function was 0.92, and the correlation coefficient between the predicted
pulmonary function and the measured pulmonary function was 0.95. Compared
with the control group, the incidence of cardiopulmonary complications,
hospitalization time and hospitalization expenses in the observation group
were reduced, and the difference was statistically significant (P <0.05).
 Conclusion(s): The CT quantitative volume imaging can predict the
pulmonary function of patients with lung cancer after operation. Targeted
nursing after operation guided by this quantitative measurement technology
can promote the rehabilitation of patients. Copyright © 2019
American Scientific Publishers.

<31>
Accession Number
627286945
Title
Oropharyngeal dysphagia and laryngeal dysfunction after lung and heart
transplantation: A systematic review.
Source
Disability and rehabilitation. (pp 1-10), 2019. Date of Publication: 29
Jan 2019.
Author
Black R.; McCabe P.; Glanville A.; Bogaardt H.; MacDonald P.; Madill C.
Institution
(Black, Glanville, MacDonald) St Vincents Hospital, Darlinghurst,
Australia
(Black, McCabe, Bogaardt, Madill) Speech Pathology, Faculty of Health
Sciences, University of Sydney, Australia
Publisher
NLM (Medline)
Abstract
PURPOSE: Oropharyngeal dysphagia and laryngeal dysfunction are known to
impact on health outcomes of patients with critical illness. The incidence
in patients after heart and/or lung transplantation is unknown. This paper
investigates the frequency, characteristics and risk factors for these
complications following such transplantation. METHOD(S): Eight
databases were systematically searched. Inclusion criteria were (a) adults
who underwent heart and/or lung transplantation as their primary surgery,
(b) new onset of oropharyngeal dysphagia and/or laryngeal dysfunction and
dysphonia identified in the acute hospital phase (c) original studies (d)
in English. RESULT(S): Two thousand six hundred and sixteen articles
were identified. Five met the inclusion criteria. Studies were few and
heterogeneous in design and sample size, therefore meta-analysis was not
performed. All included studies were of relatively low quality. However,
rates of oropharyngeal dysphagia up to 70.5% were reported, with 25% of
these patients presenting with vocal cord palsy. CONCLUSION(S):
Limited conclusions can be drawn from the available evidence regarding the
frequency, characteristics and risk factors for the development of
oropharyngeal dysphagia and/or laryngeal dysfunction after heart and/or
lung transplantation due to limited evidence and low quality of the
included studies. This highlights the need for high quality studies in
this population. Implications for rehabilitation Oropharyngeal dysphagia
and dysphonia are known to impact on mortality and quality of life There
is a paucity of literature describing these complications after lung
and/or heart transplantation, however the data available indicates high
rates of swallowing and voice disorders in this immunosuppressed
population Early identification and management of oropharyngeal dysphagia
and dysphonia is vital to aid rehabilitation and improve mortality and
quality of life in patients following lung and/or heart transplantation.

<32>
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.

<33>
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.

<34>
Accession Number
624632544
Title
Heart transplantation for infective endocarditis: Viable option for a
limited few?.
Source
Transplant Infectious Disease. 21 (1) (no pagination), 2019. Article
Number: e13006. Date of Publication: Februaryy 2019.
Author
Murphy K.M.; Vikram H.R.
Institution
(Murphy) Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ,
United States
(Vikram) Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ, United
States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Active infection in the recipient is considered a relative
contraindication for solid organ transplantation. However, heart
transplantation (HT) can be curative in patients with ventricular assist
device infections. For patients with infective endocarditis (IE), valve
replacement is part of the management strategy based on emergent, acute,
or elective indications. HT has been utilized as an uncommon and sporadic
treatment option for carefully selected patients with refractory or
recurrent IE after all other surgical treatment options have been
exhausted or are not feasible. Herein, we review 19 published cases of IE
in whom HT was undertaken in the setting of ongoing active infection with
reported good outcomes. We attempt to propose general criteria for HT in
the setting of IE and discuss challenges and hurdles that clinicians might
encounter when considering HT for active IE in the absence of robust data
or clearly defined criteria. Copyright © 2018 John Wiley & Sons
A/S. Published by John Wiley & Sons Ltd

<35>
Accession Number
624409922
Title
Risk factors and therapies in vascular diseases: An umbrella review of
updated systematic reviews and meta-analyses.
Source
Journal of Cellular Physiology. 234 (6) (pp 8221-8232), 2019. Date of
Publication: June 2019.
Author
Hong X.-Y.; Lin J.; Gu W.-W.
Institution
(Hong, Lin) Department of Vascular Surgery, China-Japan Union Hospital of
JiLin University, ChangChun, China
(Gu) Department of Hepatopancreatobility Surgery, China-Japan Union
Hospital of JiLin University, ChangChun, China
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Aberrant blood vessel functioning and systemic circulation are key causes
for vascular disorders; cardiovascular, cerebrovascular, renal artery
stenosis, and peripheral artery diseases. Epidemiological and basic
science evidence supported genetic reasons, compounded by obesity,
hypercholesterolemia, hypertension, diabetes, and smoking as risk factors.
This is an umbrella review of risk factors and therapies in vascular
disorders, exploring systematic reviews and meta-analyses studies in
PubMed, Cochrane, Embase, and Central published in January 2000-May 2018.
We made qualitative eligibility gradation of the articles based on
inclusion criteria, and independently extracted descriptive and
methodologic data to compile their outcomes. We considered 95% confidence
interval and the between-study heterogeneity, designated by I
2. Overall, we extracted 217 studies of impressive quality and
at low risk of bias, including 124, 30, 23, 32, and 8, respectively, for
the search terms "cardiovascular," "renal," "cerebral," and "limb
ischemia" each in combination with "risk factors" and "therapeutics." Our
search on genome-wide analyses revealed genes associated with
HDL-cholesterol, matrix metalloproteases, angiogenesis, notch3,
renin-angiotensin, apolipoprotein E, insulin, and cytokine levels as
critical participants in the pathogenesis of vascular diseases.
Hypertension and endothelial growth factor-linked polymorphisms were found
to contribute to vascular damage. The studies reinforced that lifestyle
and dietary patterns influenced susceptibility of circulatory system
diseases. Additionally, endovascular medicines, surgical vascularization,
angioplasty, and renal artery stenting appeared as major therapeutic
approaches in vascular patients. Altogether, our review offers up-to-date
information on pathophysiology of vascular diseases and provides insight
into existing research, clinical management and clinical gaps in the
field. Copyright © 2018 Wiley Periodicals, Inc.

<36>
Accession Number
627140813
Title
Protective ventilation with high versus low positive end-expiratory
pressure during one-lung ventilation for thoracic surgery (PROTHOR): Study
protocol for a randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 213. Date of
Publication: 11 Apr 2019.
Author
Kiss T.; Wittenstein J.; Becker C.; Birr K.; Cinnella G.; Cohen E.; El
Tahan M.R.; Falcao L.F.; Gregoretti C.; Granell M.; Hachenberg T.;
Hollmann M.W.; Jankovic R.; Karzai W.; Krassler J.; Loop T.; Licker M.J.;
Marczin N.; Mills G.H.; Murrell M.T.; Neskovic V.; Nisnevitch-Savarese Z.;
Pelosi P.; Rossaint R.; Schultz M.J.; Serpa Neto A.; Severgnini P.;
Szegedi L.; Vegh T.; Voyagis G.; Zhong J.; Gama De Abreu M.; Senturk M.
Institution
(Kiss, Wittenstein, Becker, Birr, Gama De Abreu) Department of
Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group,
University Hospital Carl Gustav Carus, Technische Universitat Dresden,
Dresden, Germany
(Cinnella) Department of Anesthesia and Intensive Care, OO Riuniti
Hospital, University of Foggia, Foggia, Italy
(Cohen) Department of Anesthesiology, Mount Sinai Hospital, New York,
United States
(El Tahan) Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
(Falcao) Federal University of Sao Paulo, Sao Paulo, Brazil
(Gregoretti) UOC Anestesia e Rianimazione A.O.Universitaria p. Giaccone,
Dipartimento Di.Chir.On.S., Universita Degli Studi di Palermo, Palermo,
Italy
(Granell) Hospital General Universitario de Valencia, Valencia, Spain
(Hachenberg) University Hospital Magdeburg, Magdeburg, Germany
(Hollmann) Department of Anesthesiology, Amsterdam UMC, Location AMC,
Amsterdam, Netherlands
(Jankovic) Clinic for Anesthesia and Intensive Therapy, Clinical Center
Nis, School of Medicine, University of Nis, Nis, Serbia
(Karzai) Zentralklinik Bad Berka, Bad Berka, Germany
(Krassler) Thoracic Center Coswig, Coswig, Germany
(Loop) Department of Anesthesiology and Intensive Care Medicine Clinic,
Medical Center, University of Freiburg, Faculty of Medicine, University of
Freiburg, Freiburg, Germany
(Licker) University Hospital Geneva, Geneva, Switzerland
(Marczin) Section of Anaesthetics, Pain Medicine and Intensive Care,
Department of Surgery and Cancer, Faculty of Medicine, Imperial College
London, London, United Kingdom
(Marczin) Department of Anaesthesia, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield, G-Middlesex, United
Kingdom
(Marczin) Centre of Anaesthesia and Intensive Care, Semmelweis University,
Budapest, Hungary
(Mills) Department of Anaesthesia and Intensive Care Medicine, Sheffield
Teaching Hospitals, Sheffield University, Sheffield, United Kingdom
(Murrell) Department of Anesthesiology, Weill Cornell Medicine, New York,
United States
(Neskovic) Military Medical Academy, Belgrade, Serbia
(Nisnevitch-Savarese) Penn State Hershey Anesthesiology and Perioperative
Medicine, Hershey, United States
(Pelosi) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Pelosi) IRCCS San Martino Policlinico Hospital, Genoa, Italy
(Rossaint) Department of Anaesthesiology, University Hospital Aachen,
Aachen, Germany
(Schultz) Department of Intensive Care and Laboratory of Experimental
Intensive Care and Anesthesiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Schultz) Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol
University, Bangkok, Thailand
(Serpa Neto) Department of Critical Care, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Severgnini) Dipartimento di Biotecnologie e Scienze della Vita,
Universita Degli Studi dell'Insubria, Varese, Italy
(Szegedi) Department of Anesthesiology, Centre Hospitalier Universitaire
de Charleroi, Charleroi, Belgium
(Vegh) Department of Anesthesiology and Intensive Care, University of
Debrecen, Debrecen, Hungary
(Vegh) Outcomes Research Consortium, Cleveland, United States
(Voyagis) Department of Anaesthesia, Postoperative ICU, Pain Relief and
Palliative Care Clinic, Sotiria Chest Diseases Hospital, Athens, Greece
(Voyagis) Department of Anaesthesiology and Critical Care Medicine,
University of Patras, Patra, Greece
(Zhong) Department of Anesthesiology, Fudan University Shanghai Cancer
Center, Shanghai, China
(Zhong) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai, China
(Senturk) Department of Anaesthesiology and Intensive Care, Istanbul
University, Istanbul Medical Faculty, Istanbul, Turkey
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPC) may result in
longer duration of in-hospital stay and even mortality. Both thoracic
surgery and intraoperative mechanical ventilation settings add
considerably to the risk of PPC. It is unclear if one-lung ventilation
(OLV) for thoracic surgery with a strategy of intraoperative high positive
end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC,
compared to low PEEP without RM. Method(s): PROTHOR is an
international, multicenter, randomized, controlled, assessor-blinded,
two-arm trial initiated by investigators of the PROtective VEntilation
NETwork. In total, 2378 patients will be randomly assigned to one of two
different intraoperative mechanical ventilation strategies. Investigators
screen patients aged 18 years or older, scheduled for open thoracic or
video-assisted thoracoscopic surgery under general anesthesia requiring
OLV, with a maximal body mass index of 35 kg/m2, and a planned
duration of surgery of more than 60 min. Further, the expected duration of
OLV shall be longer than two-lung ventilation, and lung separation is
planned with a double lumen tube. Patients will be randomly assigned to
PEEP of 10 cmH<inf>2</inf>O with lung RM, or PEEP of 5 cmH<inf>2</inf>O
without RM. During two-lung ventilation tidal volume is set at 7 mL/kg
predicted body weight and, during OLV, it will be decreased to 5 mL/kg.
The occurrence of PPC will be recorded as a collapsed composite of single
adverse pulmonary events and represents the primary endpoint.
 Discussion(s): PROTHOR is the first randomized controlled trial in
patients undergoing thoracic surgery with OLV that is adequately powered
to compare the effects of intraoperative high PEEP with RM versus low PEEP
without RM on PPC. The results of the PROTHOR trial will support
anesthesiologists in their decision to set intraoperative PEEP during
protective ventilation for OLV in thoracic surgery. Trial registration:
The trial was registered in clinicaltrials.gov (NCT02963025) on 15
November 2016. Copyright © 2019 The Author(s).

<37>
Accession Number
627234039
Title
Influence of oral premedication and prewarming on core temperature of
cardiac surgical patients: A prospective, randomized, controlled trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 55. Date
of Publication: 12 Apr 2019.
Author
Brauer A.; Muller M.M.; Wetz A.J.; Quintel M.; Brandes I.F.
Institution
(Brauer, Muller, Wetz, Quintel, Brandes) Department of Anaesthesiology,
University Medical Center Gottingen, Robert-Koch-Str. 40, Gottingen 37075,
Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative hypothermia is still very common and associated
with numerous adverse effects. The effects of benzodiazepines,
administered as premedication, on thermoregulation have been studied with
conflicting results. We investigated the hypotheses that premedication
with flunitrazepam would lower the preoperative core temperature and that
prewarming could attenuate this effect. Method(s): After approval by
the local research ethics committee 50 adult cardiac surgical patients
were included in this prospective, randomized, controlled, single-centre
study with two parallel groups in a university hospital setting. Core
temperature was measured using a continuous, non-invasive zero-heat flux
thermometer from 30 min before administration of the oral premedication
until beginning of surgery. An equal number of patients was randomly
allocated via a computer-generated list assigning them to either
prewarming or control group using the sealed envelope method for blinding.
The intervention itself could not be blinded. In the prewarming group
patients received active prewarming using an underbody forced-air warming
blanket. The data were analysed using Student's t-test, Mann-Whitney
U-test and Fisher's exact test. Result(s): Of the randomized 25
patients per group 24 patients per group could be analysed. Initial core
temperature was 36.7 +/- 0.2 degreeC and dropped significantly after oral
premedication to 36.5 +/- 0.3 degreeC when the patients were leaving the
ward and to 36.4 +/- 0.3 degreeC before induction of anaesthesia. The
patients of the prewarming group had a significantly higher core
temperature at the beginning of surgery (35.8 +/- 0.4 degreeC vs. 35.5 +/-
0.5 degreeC, p = 0.027), although core temperature at induction of
anaesthesia was comparable. Despite prewarming, core temperature did not
reach baseline level prior to premedication (36.7 +/- 0.2 degreeC).
 Conclusion(s): Oral premedication with benzodiazepines on the ward
lowered core temperature significantly at arrival in the operating room.
This drop in core temperature cannot be offset by a short period of active
prewarming. Trial registration: This trial was prospectively registered
with the German registry of clinical trials under the trial number
DRKS00005790 on 20th February 2014. Copyright © 2019 The
Author(s).

<38>
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).

<39>
[Use Link to view the full text]
Accession Number
626232017
Title
The Effects of Cardiac Rehabilitation on Mortality and Morbidity in Women:
A META-ANALYSIS ATTEMPT.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 39 (1) (pp
39-42), 2019. Date of Publication: 01 Jan 2019.
Author
Ghisi G.L.D.M.; Chaves G.S.D.S.; Bennett A.; Lavie C.J.; Grace S.L.
Institution
(Ghisi, Grace) Cardiovascular Prevention and Rehabilitation Program,
Toronto Rehabilitation Institute, University Health Network, Toronto,
Canada
(Chaves) Physical Therapy Department, Federal University of Minas Gerais,
Belo Horizonte, Brazil
(Bennett) Division of Cardiology, Department of Medicine, University of
Rochester, Rochester, NY, United States
(Lavie) Department of Cardiovascular Diseases, John Ochsner Heart and
Vascular Institute, University of Queensland School of Medicine, Brisbane,
Australia
(Ghisi, Grace) School of Kinesiology and Health Science, York University,
Bethune 368, 4700 Keele St, Toronto, ON M3J 1P3, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Cardiac rehabilitation (CR) is associated with significant
reductions in mortality and morbidity, but few women are included in
trials. Therefore, a meta-Analysis of the effects of CR in women is
warranted. Method(s): Randomized controlled trials from recent
systematic reviews that included women attending comprehensive CR and
reporting the outcomes of mortality and morbidity (hospitalization,
myocardial infarction, bypass surgery, percutaneous coronary intervention)
were considered for inclusion. An updated search of the literature was
performed from the end date of the last search, based on the Cochrane
strategy. Authors were contacted to provide results on women where none
were reported. Result(s): On the basis of 2 recent systematic
reviews, 80 trials were identified. Fifty (62.5%) were excluded, most
commonly due to lack of inclusion of women (n = 18; 22.5%). One trial was
identified through the search update. Of 31 potential trials meeting
inclusion criteria, 1 reported results on women and many were old, and
hence data by sex were no longer available. Ultimately, data for women
were available in 2 trials. Therefore, it was deemed inappropriate to
undertake this meta-Analysis. Conclusion(s): This review corroborates
the dearth of data on CR in women despite the fact that cardiovascular
disease is the leading cause of death in women. Given the totality of
evidence, including reductions in mortality and morbidity in nonrandomized
studies, and evidence of benefit for other important outcomes such as
functional capacity and quality of life, women should continue to be
referred to CR. Copyright © 2019 Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.

<40>
Accession Number
626370946
Title
A model-based cost-effectiveness analysis of Patient Blood Management.
Source
Blood Transfusion. 17 (1) (pp 16-26), 2019. Date of Publication:
January-February 2019.
Author
Kleineruschkamp A.; Meybohm P.; Straub N.; Zacharowski K.; Choorapoikayil
S.
Institution
(Kleineruschkamp, Meybohm, Zacharowski, Choorapoikayil) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Theodor Stern Kai 7, Frankfurt 60590, Germany
(Straub) Institute of Market Research, Statistics and Prognosis, Munich,
Germany
Publisher
Edizioni SIMTI (E-mail: luisa.stea@bloodtransfusion.it)
Abstract
Background. Patient blood management (PBM) is a multidisciplinary concept
focused on the management of anaemia, minimisation of iatrogenic blood
loss and rational use of allogeneic blood products. The aims of this study
were: (i) to analyse post-operative outcome in patients with liberal vs
restrictive exposure to allogeneic blood products and (ii) to evaluate the
cost-effectiveness of PBM in patients undergoing surgery. Materials and
methods. A systematic literature review and meta-analysis were performed
to compare post-operative complications in predominantly non-transfused
patients (restrictive transfusion group) and patients who received one to
three units of red blood cells (liberal transfusion group). Outcome
measures included sepsis with/without pneumonia, acute renal failure,
acute myocardial infarction and acute stroke. In a second step, a health
economic model was developed to calculate cost-effectiveness of PBM
(PBM-arm vs control-arm) for simulated cohorts of 10,000 cardiac and
non-cardiac surgical patients based on the results of the meta-analysis
and costs. Results. Out of 478 search results, 22 studies were analysed in
the meta-analysis. The pooled relative risk of any complication in the
restrictive transfusion group was 0.43 for non-cardiac and 0.34 for
cardiac surgical patients. In the simulation model, PBM was related to
reduced complications (1,768 vs 1,245) and complication-related deaths
(411 vs 304) compared to standard care. PBM-related costs of therapy
exceeded costs of the control arm by 150 per patient. However, total
costs, including hospitalisation, were higher in the control-arm for both
non-cardiac ( 2,885.11) and cardiac surgery patients ( 1,760.69). The
incremental cost-effectiveness ratio including hospitalisation showed
savings of 30,458 (non-cardiac and cardiac surgery patients) for
preventing one complication and 128,023 (non-cardiac and cardiac surgery
patients) for prevention of one complication-related death in the PBM-arm.
Discussion. Our results indicate that PBM may be associated with fewer
adverse clinical outcomes compared to control management and may, thereby,
be cost-effective. Copyright © SIMTIPRO Srl

<41>
[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.

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

<43>
Accession Number
623655565
Title
Methods used to assess the performance of biomarkers for the diagnosis of
acute kidney injury: a systematic review and meta-analysis.
Source
Biomarkers. 23 (8) (pp 766-772), 2018. Date of Publication: 17 Nov 2018.
Author
Codorniu A.; Lemasle L.; Legrand M.; Blet A.; Mebazaa A.; Gayat E.
Institution
(Codorniu, Lemasle, Legrand, Blet, Mebazaa, Gayat) Department of
Anesthesiology, Intensive Care and Burn Unit, University Hospital Saint
Louis-Lariboisiere, Paris, France
(Codorniu, Lemasle, Legrand, Blet, Mebazaa, Gayat) Biomarkers in
CArdio-Neuro-VAScular Diseases (BioCANVAS), Paris, France
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose: Methods used to explore biomarkers for acute kidney injury (AKI)
might have a major impact on the results and the use of these biomarkers.
We evaluated the methods used to investigate biomarkers of AKI.
 Material(s) and Method(s): A systematic review and meta-analysis were
performed using a computerized search of the MEDLINE and the EMBASE
databases (PROSPERO CRD42017059618). Articles reporting biomarker's
performance to diagnose AKI were included. The outcome included a
description of the methods used to assess the performance of biomarkers to
diagnose AKI. Result(s): Among the 295 included studies, assessment
of biomarkers was the primary endpoint in 284 with sample size calculation
in only 8% of cases. Eighty-five percent of the studies summarized the
performance of biomarkers with receiver operating characteristic (ROC)
curves; however, 74 studies (25%) did not provide the threshold,
sensibility or specificity. A total of 176 studies evaluated more than one
biomarker, and only 25% combined biomarkers to increase diagnostic
performance. We determined that the definition of AKI and study design
impacted the diagnostic performance using uNGAL (urinary neutrophil
gelatinase-associated lipocalin) as an example. Major publication bias was
identified. Conclusion(s): Most articles that reported biomarkers of
AKI performance present methodological weaknesses. Basic rules should be
provided to increase the quality of reporting in this area. Copyright
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis
Group.

<44>
Accession Number
2001764620
Title
Is the era of bilateral internal thoracic artery grafting coming for
diabetic patients? An updated meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Zhou P.; Zhu P.; Nie Z.; Zheng S.
Institution
(Zhou, Zhu, Zheng) Department of Cardiovascular Surgery, Nanfang Hospital,
Southern Medical University, Guangzhou, Guangdong, China
(Nie) Department of Epidemiology, Guangdong Cardiovascular Institute,
Guangdong Provincial Key Laboratory of South China Structural Heart
Disease, Guangdong General Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Because of an increased risk of sternal wound complications,
the use of bilateral internal thoracic artery grafting in diabetic
patients remains controversial. The objective of the present meta-analysis
is to compare the safety and efficacy of single internal thoracic artery
and bilateral internal thoracic artery grafting in the diabetic
population. Method(s): Four electronic databases, including PubMed,
the Cochrane Library, Embase, and ISI Web of Knowledge, were
comprehensively searched. Prospective randomized trials or observational
studies comparing single internal thoracic artery and bilateral internal
thoracic artery were considered eligible for the current study.
 Result(s): A literature search yielded 1 randomized controlled trial
and 17 observational studies (129,871 diabetic patients: 124,233 single
internal thoracic arteries and 5638 bilateral internal thoracic arteries).
Pooled analysis demonstrated overall incidence of deep sternal wound
infection in the bilateral internal thoracic artery grafting group was
significantly higher than in the single internal thoracic artery grafting
group (3.26% for bilateral internal thoracic artery vs 1.70% for single
internal thoracic artery). No significant difference was found between
both groups in terms of risk of deep sternal wound infection when the
skeletonized harvesting technique was adopted. Furthermore, in-hospital
mortality was comparable between both groups (2.80% for bilateral internal
thoracic artery vs 2.36% for single internal thoracic artery). However,
compared with single internal thoracic artery grafting, bilateral internal
thoracic artery grafting could confer a lower risk for long-term overall
mortality (hazard ratio, 1.41; 95% confidence interval, 1.18-1.67; P
<.001; I2 = 63%) and cardiac mortality (hazard ratio, 3.15; 95%
confidence interval, 2.23-4.46; P <.001; I2 = 0%).
 Conclusion(s): Compared with single internal thoracic artery
grafting, bilateral internal thoracic artery grafting is associated with
enhanced long-term survival among diabetic patients. Skeletonization of
bilateral internal thoracic artery is not associated with an increased
risk of deep sternal wound infection. Therefore, surgeons should be
encouraged to adopt bilateral internal thoracic artery grafting in a
skeletonized manner more routinely in diabetic patients. Copyright
© 2019 The American Association for Thoracic Surgery

<45>
Accession Number
2001728271
Title
Antithrombotic Strategies After Bioprosthetic Aortic Valve Replacement: A
Systematic Review.
Source
Annals of Thoracic Surgery. 107 (5) (pp 1571-1581), 2019. Date of
Publication: May 2019.
Author
Papak J.N.; Chiovaro J.C.; Noelck N.; Healy L.D.; Freeman M.; Quin J.A.;
Paynter R.; Low A.; Kondo K.; McCarty O.J.T.; Kansagara D.
Institution
(Papak, Chiovaro, Noelck, Kansagara) Department of Medicine, VA Portland
Healthcare System, Portland, OR, United States
(Papak, Chiovaro, Noelck, Kansagara) Department of Medicine, Oregon Health
& Science University, Portland, OR, United States
(Healy, McCarty) Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR, United States
(Freeman, Paynter, Low, Kondo, Kansagara) Evidence-based Synthesis Program
Center, VA Portland Health Care System, Portland, OR, United States
(Quin) Department of Surgery, VA Boston Health Care System, Boston, MA,
United States
Publisher
Elsevier USA
Abstract
Background: The optimal antithrombotic regimen after bioprosthetic aortic
valve replacement (bAVR) is unclear. We conducted a systematic review of
various anticoagulation strategies following surgical or transcatheter
bAVR (TAVR). Method(s): We searched Medline, PubMed, Embase,
Evidence-Based Medicine Reviews, and gray literature through June 2017 for
controlled clinical trials and cohort studies that directly compared
different antithrombotic strategies in nonpregnant adults who had
undergone bAVR. We assessed risk of bias and graded the strength of the
evidence using established methods. Result(s): Of 4,554 titles
reviewed, 6 clinical trials and 13 cohort studies met inclusion criteria.
We found moderate-strength evidence that mortality, thromboembolic events,
and bleeding rates are similar between aspirin and warfarin after surgical
bAVR. Observational data suggest lower mortality and thromboembolic events
with aspirin combined with warfarin compared with aspirin alone after
surgical bAVR, but the effect size is small and the combination is
associated with a substantial increase in bleeding risk. We found
insufficient evidence for all other treatment comparisons in surgical
bAVR. In TAVR patients, we found moderate-strength evidence that
mortality, stroke, and major cardiac events are similar between dual
antiplatelet therapy and aspirin alone, though a nonsignificantly lower
rate of bleeding occurred with aspirin alone. Conclusion(s):
Treatment with warfarin or aspirin leads to similar outcomes after
surgical bAVR. Combining aspirin with warfarin may lead to a small
decrease in thromboembolism and mortality, but is accompanied by increased
bleeding. For TAVR patients, aspirin is equivalent to dual antiplatelet
therapy for reducing thromboembolism and mortality, with a possible
decrease in bleeding. Copyright © 2019 The Society of Thoracic
Surgeons

<46>
Accession Number
2001765138
Title
Sex difference and outcome after percutaneous intervention in patients
with chronic total occlusion: A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Mannem S.; Rattanawong P.; Riangwiwat T.; Vutthikraivit W.; Putthapiban
P.; Sukhumthammarat W.; Kanitsoraphan C.; Chongsathidkiet P.
Institution
(Mannem) The Queen's Medical Center, Honolulu, HI, United States
(Rattanawong, Riangwiwat, Kanitsoraphan) University of Hawaii Internal
Medicine Residency Program, Honolulu, HI, United States
(Rattanawong) Faculty of Medicine Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
(Vutthikraivit) Department of Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, United States
(Putthapiban, Sukhumthammarat) Department of Medicine, Einstein Medical
Center, Philadelphia, PA, United States
(Chongsathidkiet) Department of Pathology, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Recent studies suggest that sex difference is an outcome
predictor in chronic total occlusion (CTO) patients who are undergoing
percutaneous intervention (PCI). However, a systematic review and
meta-analysis of the literature have not been done. We assessed the
outcome of PCI in CTO between male and female. Method(s): We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to September 2017. Included studies were published cohort
(prospective or retrospective) and case control studies of CTO patients
who underwent PCI that compared successful procedure and major cardiac
event (MACE), including cardiac death, target vessel revascularization,
myocardial infarction, and stroke, between male and female. Data from each
study were combined using the random-effects, generic inverse variance
method of DerSimonian and Laird to calculate risk ratios and 95%
confidence intervals. Result(s): Nine studies were included in this
meta-analysis involving 30,830 CTO subjects (8350 female and 22,480 male)
who underwent PCI. Females were not significantly associated with reduced
risk of MACE (pooled risk ratio = 0.86, 95% confidence interval:
0.66-1.12, p = 0.262, I2 = 47.0%) as well as successful rate of
PCI (pooled risk ratio = 1.04, 95% confidence interval: 0.99-1.10, p =
0.161, I2 = 76.6%) in CTO patients who underwent PCI.
 Conclusion(s): Our study suggests that sex is not an independent risk
factor of MACE or successful procedure in CTO patients who underwent
PCI. Copyright © 2019 Elsevier Inc.

<47>
Accession Number
627259568
Title
Cardiac surgery 2018 reviewed.
Source
Clinical Research in Cardiology. (no pagination), 2019. Date of
Publication: 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
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
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. Copyright © 2019,
Springer-Verlag GmbH Germany, part of Springer Nature.

<48>
Accession Number
627259567
Title
A prospective randomized comparison of airway seal using the novel
vision-guided insertion of LMA-Supreme and LMA-Protector.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2019. Date
of Publication: 2019.
Author
van Zundert A.A.J.; Wyssusek K.H.; Pelecanos A.; Roets M.; Kumar C.M.
Institution
(van Zundert, Wyssusek, Roets) Department of Anaesthesia and Perioperative
Medicine, Royal Brisbane and Women's Hospital, The University of
Queensland, Brisbane, QLD, Australia
(Pelecanos) Statistics Unit, QIMR Berghofer Medical Research Institute,
The University of Queensland, Brisbane, QLD, Australia
(Kumar) Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun
Central, Singapore
(Kumar) Newcastle University, Newcastle, United Kingdom
(van Zundert) Queensland University of Technology, Brisbane, QLD,
Australia
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
The laryngeal mask airways supreme (LMA-SupremeTM) and protector
(LMA-ProtectorTM) are generally placed blindly, often resulting in a less
than optimal position and vision-guided placement has been recommended.
This prospective, randomized controlled study compared the efficacy of
airway seal by measuring the oropharyngeal leak pressure in 100 surgical
patients who underwent a variety of non-thoracic surgery under general
anaesthesia, suitable with a supraglottic airway device. Patients were
allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50)
group. All insertions were performed under vision of a videolaryngoscope
using an 'insert-detect-correct-as-you-go' technique with standardized
corrective measures. Our primary endpoint, mean oropharyngeal leak
pressure, was significantly higher in the LMA-Protector (31.7 +/- 2.9 cm
H<inf>2</inf>O) compared to the LMA-Supreme (27.7 +/- 3.5 cm
H<inf>2</inf>O) group (mean difference 4.0 cm H<inf>2</inf>O, 95%
confidence interval (CI) 2.7-5.3 cm H<inf>2</inf>O, p < 0.001) after
achieving a near-optimal fibreoptic position in the LMA-Protector (94%)
and LMA-Supreme (96%) groups. No statistically significant differences
were shown for secondary outcomes of alignment, number of insertion
attempts and malpositions, and final anatomical position as scored by
fibreoptic evaluation. Corrective manoeuvres were required in virtually
all patients to obtain a correct anatomically positioned LMA. Position
outcomes of the two devices were similar except for the proportion of
procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2%
LMA-Protector, p < 0.001), the need for intracuff pressure adjustments
(80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction
(18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher
oropharyngeal leak pressure can be achieved with LMA-Protector compared to
LMA-Supreme with optimal anatomical position when insertion is
vision-guided. Copyright © 2019, Springer Nature B.V.

<49>
Accession Number
627110359
Title
Aortic valve repair or replacement in patients with aortic regurgitation:
A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Wong C.H.M.; Chan J.S.K.; Sanli D.; Rahimli R.; Harky A.
Institution
(Wong, Chan) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Sanli) Gundogmus National Town Hospital, Antalya, Turkey
(Rahimli) Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
(Harky) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To systematically compare clinical outcomes between aortic
valve repair and replacement in patients with aortic regurgitation.
 Method(s): A comprehensive literature search was undertaken among the
four major databases (PubMed, Embase, Scopus, and Ovid) to identify all
published data comparing clinical outcomes of aortic valve repair vs
replacement. Database searched from inception to November 2018.
 Result(s): A total of 1071 patients were analyzed in eight articles.
Mean age was similar in both groups of patients (47.2 +/- 12.8 vs 48.3 +/-
12.7 years, P = 0.83, aortic valve repair and replacement, respectively).
The preoperative left ventricular ejection fraction was better in the
repair group (56.7% +/- 4.8 vs 53.3% +/- 4.2, P = 0.005). The rate of
moderate-to-severe regurgitation and bicuspid aortic valve were similar in
both cohorts (81% vs 78%, P = 0.90% and 58% vs 55%, P = 0.46). In-hospital
and 1-year mortality was lower in repair cohort, although not reaching
statistical significance (1.3% vs 3.6%, P = 0.12; 5.9% vs 9.3%, P = 0.77).
Reoperation rate was higher in repair patients at 1 year (8.8% vs 3.7%, P
= 0.03). Conclusion(s): Aortic valve repair offers comparable
perioperative outcomes to aortic valve replacement in aortic regurgitation
patients at the expense of higher late reintervention rate. Larger trials
with long-term follow-up are required to confirm the long-term benefits of
aortic valve repair. Copyright © 2019 Wiley Periodicals, Inc.

<50>
Accession Number
2001844617
Title
Endovascular Versus Open Repair for Chronic Type B Dissection Treatment: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. 107 (5) (pp 1559-1570), 2019. Date of
Publication: May 2019.
Author
Boufi M.; Patterson B.O.; Loundou A.D.; Boyer L.; Grima M.J.; Loftus I.M.;
Holt P.J.
Institution
(Boufi, Patterson, Grima, Loftus, Holt) St George's Vascular Institute, St
George's Hospital NHS Trust, London, United Kingdom
(Boufi) Department of Vascular Surgery, University Hospital Nord,
Assistance Publique-Hopitaux de Marseille, Marseille, France
(Boufi) UMR T24, IFSTTAR, Aix-Marseille Universite, Marseille, France
(Loundou, Boyer) SPMC EA3279, Department of Public Health, Aix-Marseille
Universite, Marseille, France
Publisher
Elsevier USA
Abstract
Background: The respective place of endovascular repair (ER) versus open
surgery (OS) in thoracic dissecting aneurysm treatment remains debatable.
This comprehensive review seeks to compare the outcomes of ER versus OS in
chronic type B aortic dissection treatment. Method(s): Embase and
Medline searches (2000 to 2017) were performed following PRISMA (Preferred
Reporting Items for Systematic Review and Meta-Analyses) guidelines.
Outcomes data extracted comprised (1) early mortality and major
complications: stroke, spinal cord ischemia (SCI), dialysis, and
respiratory complications; and (2) late survival and reinterventions.
Reintervention causes were divided into proximal, adjacent, and distal.
Comparative studies allowed comparative meta-analysis. Noncomparative
studies were analyzed in pooled proportion meta-analyses for each group.
 Result(s): A total of 39 studies were identified after exclusions, of
which 4 were comparative. Comparative meta-analysis demonstrated lower
early mortality for ER (odds ratio [OR], 4.13; 95% confidence interval
[CI], 1.10 to 15.4), stroke (OR, 4.33; 95% CI, 1.02 to 18.35), SCI (OR,
3.3; 95% CI, 0.97 to 11.25), and respiratory complications (OR, 6.88; 95%
CI,1.52 to 31.02), but higher reintervention rate (OR, 0.34; 95% CI, 0.16
to 0.69). Midterm survival was similar (OR, 1.19; 95% CI, 0.42 to 3.32).
Noncomparative studies demonstrated that most reinterventions were related
to the aortic segment distal to primary intervention in both groups (OS
73%, ER 59%). Reintervention procedures were mainly surgical for OS (85%),
mainly endovascular for ER (75%). Rupture rates were 1.2% (OS) and 3%
(ER). Conclusion(s): Endovascular repair is associated with
significant early benefits, but this is not sustained at midterm.
Reintervention is more frequent, but the OS is not exempt from
reintervention or late rupture. Both techniques have their place, but
patient selection is key. Copyright © 2019 The Society of
Thoracic Surgeons

<51>
Accession Number
2001795051
Title
Comparing the effects of propofol and N-acetylcysteine on inflammatory
markers after coronary artery bypass surgery, a randomized clinical trial.
Source
International Journal of Pharmaceutical Research. 11 (1) (pp 586-591),
2019. Date of Publication: January-March 2019.
Author
Abdorasoul A.; Houshang S.; Ebrahim S.; Kamran M.
Institution
(Abdorasoul, Houshang) Anesthesiology and Critical Care Department,
Bushehr University of Medical Sciences, Bushehr, Iran, Islamic Republic of
(Ebrahim) Cardiac surgery Department, Bushehr University of Medical
Sciences, Bushehr, Iran, Islamic Republic of
(Kamran) Community Medicine Department, Bushehr University of Medical
Sciences, Bushehr, Iran, Islamic Republic of
Publisher
Advanced Scientific Research
Abstract
Anesthetic drugs used during cardiac surgery are posited to have
anti-inflammatory effects. N-Acetylcysteine (NAC)is suggested to have
antioxidant effects and is suggested to preserve systolic function, reduce
myocardial oxidative stress, and enhance myocardial edema resolution after
CPB or cardioplegic arrest. We aimed to compare the effects propofol and
NAC on inflammatory markers after cardiopulmonary bypass (CPB). In this
prospective parallel single- blind randomized clinical trial 80 candidates
of elective coronary artery bypass grafting were recruited and allocated
to two groups of propofol (P group) and N -Acetylcysteine (NAC group). The
P group received propofol 100 micro g/kg/minute peri-operatively with
sufentanil (0.02 micro g/kg/min), midazolam (1 micro g/kg/min) and
cis-atracurium (2.5 micro g/kg/min) The NAC group received 600 mg
N-acetylcysteine the day before surgery and 2 hours before induction of
anesthesia with 100 cc water. In the NAC group, propofol was omitted in
induction and maintenance of anesthesia and etomidate was used in
induction of anesthesia as hypnotic agent. Serum levels of IL-1, IL-6 and
TNF-alpha and systolic/diastolic blood pressure and heart rate were
measured after induction of anesthesia, 15 minutes, 3 hours, and 24 hours
after surgery. The groups were compared using non-parametric tests and
analyzed by SPSS software. After intervention, IL-alpha levels
significantly decreased in NAC group, while it increased significantly in
P group. TNF-alpha levels significantly increased in NAC group, then
decreased 24 hours after surgery, while it significantly increased in P
group (15 min than baseline), but then decreased at 3 and 24 hours post
-operatively. IL-6 levels decreased in both groups after 15 minutes
postoperatively than baseline, but significantly increased in both groups
at 3 hours and again decreased in both groups after 24 hours. IL-alpha
level was significantly different after 15 minutes, 3 and 24 hours after
surgery in both groups. But changes in the level of IL-beta and IL-6 were
only significant at 24 hours and 15 minutes post-operatively,
respectively, in both groups.Both drugs had similar anti-inflammatory
effects, and can be used during CPB. Copyright © 2019, Advanced
Scientific Research. All rights reserved.

<52>
Accession Number
2001839223
Title
Risk factors for death or heart transplantation in single-ventricle
physiology (tricuspid atresia, pulmonary atresia, and heterotaxy): A
systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Kulkarni A.; Patel N.; Singh T.P.; Mossialos E.; Mehra M.R.
Institution
(Kulkarni) London School of Economics and Political Science, London,
United Kingdom
(Patel, Mossialos) Department of Health Policy, London School of Economics
and Political Science, London, United Kingdom
(Singh) Department of Cardiology, Boston Children's Hospital, Boston, MA,
United States
(Mehra) Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
Publisher
Elsevier USA
Abstract
BACKGROUND: In this study we sought to evaluate risk factors (RFs) for
death or heart transplantation (D-HT) in single-ventricle (SV) physiology
due to tricuspid atresia (TA), pulmonary atresia-intact ventricular septum
(PA-IVS), and heterotaxy with SV (HX), clinical conditions for which
outcome data are limited. METHOD(S): To conduct a systematic review,
we included citations that evaluated occurrence of D-HT in SV physiology
of TA, PA-IVS, and HX in English articles published between January 1998
and December 2017 based on inclusion and exclusion criteria, following the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
(PRISMA) guidelines. The Cochrane Risk of Bias in Non-Randomized
Studies-Interventions (ROBINS-I) tool for non-randomized studies was used
to assess the risk of bias. Meta-analysis was performed if RF data were
available in more than 3 studies. RESULT(S): Of 11,629 citations
reviewed, 30 met inclusion criteria. All 30 were observational,
retrospective studies. In all, 1,770 patients were included, 481 died and
21 underwent HT (63 lost to follow-up); 723 patients reached Fontan
completion. We found that systemic ventricular dysfunction (odds ratio
[OR] 20.7, confidence interval [CI] 10.0-42.5, I2 = 0%) and
atrioventricular valve regurgitation (AVR) were associated with risk of
D-HT (OR 3.7, CI 1.9-6.9, I2 = 14%). RF associations with D-HT
could not be derived for right ventricle-dependent coronary circulation,
pulmonary arteriovenous malformations, total anomalous pulmonary venous
return, arrhythmias, and pulmonary atresia. CONCLUSION(S): This
systematic review and meta-analysis has identified a high mortality rate
in children born with non-HLHS SV heart disease and points to potential
under-utilization of HT. Systemic ventricular dysfunction and AVR were
identified as RFs for D-HT in this subset of patients SV with TA, PA-IVS,
and HX. Copyright © 2019 International Society for Heart and Lung
Transplantation

<53>
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.

<54>
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.

<55>
[Use Link to view the full text]
Accession Number
627081522
Title
Safety and efficacy of intracoronary infusion of allogeneic human cardiac
stem cells in patients with st-segment elevation myocardial infarction and
left ventricular dysfunction a multicenter randomized, double-blind, and
placebo-controlled clinical trial.
Source
Circulation Research. 123 (5) (pp 579-589), 2018. Date of Publication:
2018.
Author
Fernandez-Aviles F.; Sanz-Ruiz R.; Bogaert J.; Plasencia A.C.; Gilaberte
I.; Belmans A.; Fernandez-Santos M.E.; Charron D.; Mulet M.; Yotti R.;
Palacios I.; Luque M.; Sadaba R.; Roman J.A.S.; Larman M.; Sanchez P.L.;
Sanchis J.; Jimenez M.F.; Claus P.; Al-Daccak R.; Lombardo E.; Abad J.L.;
Delarosa O.; Corcostegui L.; Bermejo J.; Janssens S.
Institution
(Sanz-Ruiz, Bogaert, Plasencia, Fernandez-Santos, Yotti, Bermejo)
Instituto de Investigacion Sanitaria Gregorio Maranon, Universidad
Complutense, Hospital General Universitario Gregorio Maranon, Madrid,
Spain
(Fernandez-Aviles, Sanz-Ruiz, Bogaert, Plasencia, Fernandez-Santos, Yotti,
Roman, Sanchez, Jimenez, Bermejo, Janssens) Instituto de Salud Carlos III,
CIBERCV, Madrid, Spain
(Bogaert, Belmans, Claus, Bermejo, Janssens) Department of Cardiovascular
Medicine, University Hospitals, Herestraat 49, Leuven B-3000, Belgium
(Gilaberte, Mulet, Palacios, Luque, Lombardo, Abad, Delarosa, Corcostegui)
Coretherapix S.L.U., Tigenix Group Madrid, Spain
(Charron, Al-Daccak) Hopital Saint-Louis, HLA et Medicine (HLA-MED),
Paris, France
(Sadaba) Department of Cardiac Surgery, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Roman) Department of Cardiology, Instituto de Ciencias del Corazon
(ICICOR), Valladolid, Spain
(Larman) Department of Cardiology, Policlinia Guipuzcoa, San Sebastian,
Spain
(Sanchez) Department of Cardiology, Hospital Clinico Universitario,
Salamanca, Spain
(Sanchis) Department of Cardiology, Hospital Clinico Universitario,
Valencia, Spain
(Jimenez) Department of Cardiology, UGC Corazon Hospital Clinico Virgen de
la Victoria, IBIMA, UMA, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Allogeneic cardiac stem cells (AlloCSC-01) have shown
protective, immunoregulatory, and regenerative properties with a robust
safety profile in large animal models of heart disease. Objective(s):
To investigate the safety and feasibility of early administration of
AlloCSC-01 in patients with STsegment- elevation myocardial infarction.
 Methods and Results: CAREMI (Safety and Efficacy of Intracoronary
Infusion of Allogeneic Human Cardiac Stem Cells in Patients With STEMI and
Left Ventricular Dysfunction) was a phase I/II multicenter, randomized,
double-blind, placebo-controlled trial in patients with
ST-segment-elevation myocardial infarction, left ventricular ejection
fraction <=45%, and infarct size >=25% of left ventricular mass by cardiac
magnetic resonance, who were randomized (2:1) to receive AlloCSC-01 or
placebo through the intracoronary route at days 5 to 7. The primary end
point was safety and included all-cause death and major adverse cardiac
events at 30 days (all-cause death, reinfarction, hospitalization because
of heart failure, sustained ventricular tachycardia, ventricular
fibrillation, and stroke). Secondary safety end points included major
adverse cardiac events at 6 and 12 months, adverse events, and immunologic
surveillance. Secondary exploratory efficacy end points were changes in
infarct size (percentage of left ventricular mass) and indices of
ventricular remodeling by magnetic resonance at 12 months. Forty-nine
patients were included (92% male, 55+/-11 years), 33 randomized to
AlloCSC-01 and 16 to placebo. No deaths or major adverse cardiac events
were reported at 12 months. One severe adverse events in each group was
considered possibly related to study treatment (allergic dermatitis and
rash). AlloCSC-01 elicited low levels of donor-specific antibodies in 2
patients. No immune-related adverse events were found, and no differences
between groups were observed in magnetic resonance-based efficacy
parameters at 12 months. The estimated treatment effect of AlloCSC-01 on
the absolute change from baseline in infarct size was -2.3% (95%
confidence interval, -6.5% to 1.9%). Conclusion(s): AlloCSC-01 can be
safely administered in ST-segment-elevation myocardial infarction patients
with left ventricular dysfunction early after revascularization. Low
immunogenicity and absence of immune-mediated events will facilitate
adequately powered studies to demonstrate their clinical efficacy in this
setting. Copyright © 2018 American Heart Association, Inc.

<56>
Accession Number
627237536
Title
A Systematic Review of Direct Cardiovascular Event Costs: An International
Perspective.
Source
PharmacoEconomics. (no pagination), 2019. Date of Publication: 2019.
Author
Ryder S.; Fox K.; Rane P.; Armstrong N.; Wei C.-Y.; Deshpande S.; Stirk
L.; Qian Y.; Kleijnen J.
Institution
(Ryder, Armstrong, Wei, Deshpande, Stirk) Kleijnen Systematic Reviews Ltd,
Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD,
United Kingdom
(Fox) Strategic Healthcare Solutions LLC, 133 Cottonwood Creek Lane,
Aiken, SC 29803, United States
(Rane, Qian) Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA
91320-1799, United States
(Kleijnen) School for Public Health and Primary Care, Maastricht
University, Maastricht, Netherlands
Publisher
Springer International Publishing
Abstract
Introduction: There is a lack of comprehensive cost information for
cardiovascular events since 2013. Objective(s): A systematic review
on the contemporary cost of cardiovascular events was therefore
undertaken. Method(s): Methods complied with those recommended by the
Cochrane Collaboration and the Centre for Reviews and Dissemination.
Studies were unrestricted by language, were from 2013 to 23 December 2017,
and included cost-of-illness data in adults with the following
cardiovascular conditions: myocardial infarction (MI), stroke, transient
ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary
artery bypass graft (CABG), percutaneous coronary intervention (PCI), or
peripheral artery disease (PAD). Seven electronic databases were searched,
namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and
Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health
Technology Assessment (HTA) database, Cochrane Central Register of
Controlled Trials (CENTRAL), and PubMed. The included studies reported
data from a variety of years (sometimes prior to 2013), so costs were
inflated and converted to $US, year 2018 values, for standardization.
 Result(s): After de-duplication, 29,945 titles and abstracts and then
403 full papers were screened; 82 studies (88 papers) were extracted. Year
1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in
the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in
Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA),
UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to
$45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One
Swedish study reported PAD costs in a format convertible to $US, 2018
values, with a mean annual cost of $15,565. Conclusion(s): There was
considerable unexplained variation in contemporary costs for all major
cardiovascular events. One emerging theme was that average costs in the
USA were considerably higher than anywhere else. Copyright ©
2019, Springer Nature Switzerland AG.

<57>
Accession Number
627248574
Title
Opportunities for mechanistic studies of stroke in collaboration with the
Cardiothoracic Surgical Trials Network.
Source
Neurology Genetics. Conference: 24th workshop of the International Stroke
Genetics Consortium, ISGC 2018. United States. 5 (Supplement 1) (pp 6-7),
2019. Date of Publication: April 2019.
Author
Kirkwood K.A.; Messe S.R.; Taylor D.A.
Institution
(Kirkwood) Icahn School of Medicine at Mount Sinai, New York, United
States
(Messe) University of Pennsylvania School of Medicine, Philadelphia,
United States
(Taylor) Texas Heart Institute, Houston, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective To describe the Cardiothoracic Surgical Trials Network (CTSN),
its research, and opportunities for col-laboration with the International
Stroke Genetics Consortium (ISGC). Background Cardiovascular disease (CVD)
is a leading cause of morbidity and mortality in the United States and
worldwide. In response to the growing burden of CVD and the need for
rigorous clinical evaluation of new treat-ments, the National Heart Lung
and Blood Institute, along with the Canadian Institutes for Health
Research and the National Institute of Neurological Disorders and Stroke,
created the CTSN in 2007 to design, conduct, and analyze collaborative
clinical trials that evaluate surgical interventions and management
approaches for the treatment of CVD in adult patients. CTSN includes
clinical sites enrolling patients throughout the US, Canada, and Europe,
and is supported by a data and clinical coordinating center; a
biorepository facility; and neurocognitive, imaging, and biospecimen core
laboratories. Importantly, stroke is a known and feared complication of
cardiac surgery, and CTSN has focused on neurologic outcomes of surgery as
a core mission, in order to improve outcomes for patients. Design/Methods
CTSN has com-pleted 7 randomized controlled trials (RCTs) with nearly
3,500 patients focusing on ischemic mitral regurgitation, atrial
fibrillation, advanced heart failure, and intra-operative em-bolic
protection; biospecimens were collected and banked in 5 of these trials
and are linked to clinical data. The results of these trials will be used
to inform the design of up to 5 future clinical trials focused on
management of the risk of peri-operative and long-term neurologic events
and outcomes. Results CTSN is currently planning trials of anticoagulation
for post-operative atrial fibrillation and bioprosthetic valve surgery,
neuroprotection in valve surgery, and novel left ventricular assist
devices. The Network hopes to collaborate with the ISGC on design and
analysis of genetic analyses related to stroke events in these
populations. Conclusions In conclusion, CTSN has successfully completed
multiple CVD RCTs including studies focused on stroke and neurologic
outcomes of surgery. New trials in populations at high risk of stroke
provide an ideal opportunity for collaboration with the ISGC.

<58>
Accession Number
627250090
Title
Dobutamine after cardiac surgery: A randomised controlled clinical trial.
Source
Critical Care. Conference: 39th International Symposium on Intensive Care
and Emergency Medicine. Belgium. 23 (Supplement 2) (no pagination), 2019.
Date of Publication: March 2019.
Author
Franco R.; Vincent J.L.; Almeida J.; Fukushima J.; Oliveira G.; Rizk S.;
Park C.; Mourao M.; Landoni G.; Hajjar L.
Institution
(Franco, Fukushima, Oliveira, Rizk, Park, Mourao, Hajjar) Heart Institute,
Cardiology, Sao Paulo, Brazil
(Vincent) Dept of Intensive Care, Erasme Hospital (Universite libre de
Bruxelles), Brussels, Belgium
(Almeida) Heart Institute, Surgical ICU, Sao Paulo, Brazil
(Landoni) IRCCS San Raffaele Scientific Institute, Milan, Italy
Publisher
BioMed Central Ltd.
Abstract
Introduction: The purpose of the study was to evaluate whether a
restrictive strategy regarding dobutamine use was non-inferior to a
liberal strategy in patients undergoing cardiac surgery. Method(s):
Clinical trial, randomised, unicentric, controlled, parallel-group,
non-inferiority trial. Patients were randomly assigned preoperatively to
two distinct dobutamine strategies: a liberal strategy, in which all
patients would receive dobutamine after weaning from CPB; or a restrictive
strategy, in which the use of dobutamine after CPB weaning would be guided
by hemodynamic evidence of low cardiac output. The primary outcome was
composite endpoint of arrhythmias (ventricular or supraventricular
tachyarrhythmias), acute myocardial infarction, stroke, and death from all
causes within 30 days after cardiac surgery. Result(s): A total of
160 patients were included in the final analysis; 80 assigned to the
restrictive strategy and 80 to the liberal strategy. The use of dobutamine
was lower in the restrictive group (67.1 vs. 100%, P <0.001). The primary
outcome occurred in 31.3% of the restrictive group and 33.8% of the
liberal group (P = 0.736). There were no significant differences between
the restrictive and liberal strategies regarding the incidence of
supraventricular or ventricular tachyarrhythmias (23.8% vs. 27.5%, P =
0.587), cardiogenic shock (11.3% vs. 13.8%, P = 0.633), low cardiac output
syndrome (13.8% vs. 15%, P = 0.822), acute myocardial infarction (1.3% vs.
2.5%, P = 1,000), stroke, 5% vs. 0%, P = 0.497) and death from all causes
(2.5% vs. 6.3%, P = .443). Conclusion(s): The use of a restrictive
strategy regarding the use of dobutamine, based on a clinical scenario of
reduction of the cardiac index associated with signs of tissue
hypoperfusion, is non-inferior to a liberal strategy in patients
undergoing cardiac surgery.

<59>
Accession Number
627249277
Title
Proceedings of the 24th International Stroke Genetics Consortium Workshop.
Source
Neurology Genetics. Conference: 24th workshop of the International Stroke
Genetics Consortium, ISGC 2018. United States. 5 (Supplement 1) (no
pagination), 2019. Date of Publication: April 2019.
Author
Anonymous
Publisher
Lippincott Williams and Wilkins
Abstract
The proceedings contain 20 papers. The topics discussed include: the role
of mitochondrial DNA variations on intracranial atherosclerosis in Han
chinese patients; improved genomic coverage of the SiGN dataset:
Imputation using TOPMED vs HRC reference panels; the promise of
standardized biobanking in regenerative medicine; the second phase GISCOME
initiative: a genome-wide association meta-analysis of functional outcome
after ischemic stroke; seven loci identified in epigenome-wide survival
analysis of time to recurrent stroke, composite vascular endpoint, and
disabling/fatal stroke, myocardial infarction or death in participants
from the VISP clinical trial; beyond the brain: a systematic review of
phenotypes associated with mutations in mendelian cerebral small vessel
disease genes; opportunities for mechanistic studies of stroke in
collaboration with the cardiothoracic surgical trials network; power to
detect associations with polygenic risk scores; and mendelian
randomization of thousands of blood biomarkers identifies potential causal
mediators for ischemic stroke subtypes.

<60>
Accession Number
627249263
Title
Spectrum of clinical phenotypes and genotypes in 5310 patients with
hypertrophic cardiomyopathy.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 986), 2018. Date of
Publication: August 2018.
Author
Sedaghat-Hamedani F.; Kayvanpour E.; Tugrul O.F.; Amr A.; Lai A.; Haas J.;
Proctor T.; Ehlermann P.H.; Jensen K.; Katus H.A.; Meder B.
Institution
(Sedaghat-Hamedani, Kayvanpour, Tugrul, Amr, Lai, Haas, Ehlermann, Katus,
Meder) University Hospital of Heidelberg, Heidelberg, Germany
(Proctor, Jensen) University of Heidelberg, Institute of Medical Biometry
and Informatics, Heidelberg, Germany
Publisher
Oxford University Press
Abstract
Background: Hypertrophic cardiomyopathy (HCM), with a prevalence of about
1 in 500 individuals, is the most common genetic cardiovascular disease.
Despite the knowledge about the different causal genes, the relationship
between individual genotypes and phenotypes is incomplete. The aim of this
study was to create a comprehensive picture on the clinical outcomes of
sarcomere mutation positive patients to support better personalized
management of HCM patients. Methods and Results: Firstly, we
performed a retrospective study in 88 genotyped HCM patients of our
registry and analyzed their genotype-phenotype correlations. Next, we
retrieved PubMed/Medline literature on genotype-phenotype correlation in
patients with HCM and mutations in MYBPC3, MYH7, TNNT2 and TNNI3 as well
as HCM patients without sarcomeric mutations. We reviewed all studies that
passed selection criteria and performed a meta-analysis. Together, 47
studies with 5310 HCM patients could be included. The average frequency of
mutations in MYBPC3 (20%) and MYH7 (14%) was higher than in TNNT2 and
TNNI3 (2% each). The mean age of HCM onset for MYH7 and TNNT2 mutation
carriers was the beginning of the fourth decade, significantly earlier
than in patients without sarcomeric mutations. A high male proportion was
observed in TNNT2 (69%), MYBPC3, and mutation negative group (62% each).
Cardiac conduction disease, ventricular arrhythmia, left ventricular
outflow tract obstruction, and heart transplantation (HTx) rate were
higher in HCM patients with MYH7 mutations in comparison to MYBPC3
(p<0.05). Furthermore, sudden cardiac death (SCD) was significantly higher
in patients with sarcomeric mutations (p<0.01). Conclusion(s): This
comprehensive genotype-phenotype analysis show that the age at disease
onset of HCM patients with sarcomeric mutations is earlier and leads to a
more severe phenotype than in patient without such mutations. Furthermore,
patients with MYH7 and TNNT2 mutations are more susceptible to arrhythmia
and SCD. The present study further supports the clinical interpretation of
sarcomeric mutations in HCM patients and help physicians in decision
making procedures such as ICD implantation or reassurement of patients
with specific benign mutations.

<61>
Accession Number
627249166
Title
Percutaneous balloon mitral valvuloplasty in pregnant women with severe
mitral stenosis: A review of literature and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 937), 2018. Date of
Publication: August 2018.
Author
Verardi R.; Visconti M.; Fioravanti F.; Peyracchia M.; D'Ascenzo F.
Institution
(Verardi, Visconti, Fioravanti, Peyracchia, D'Ascenzo) Hospital 'Citta
della Salute e della Scienza di Torino', Cardiology, Turin, Italy
Publisher
Oxford University Press
Abstract
Aims: Mitral stenosis (MS) is the most common heart valvulopathy in
pregnant women worldwide. Percutaneous Mitral Balloon Valvuloplasty (PMBV)
is frequently performed to address heart failure in this subset of
patients. However, todate scarse evidence exists on this subject. We
performed a meta-analysis and review of literature to evaluate efficacy
and safety of PMBV in pregnant women with severe symptomatic MS.
 Method(s): We searched in The Cochrane Collaboration Central Register
of Controlled Trials, EMBASE and MEDLINE/Pubmed. All published literature
after year 2000 was included in the analysis. Primary efficacy endpoints
were short and long-term maternal mortality and improvement of symptoms,
while primary safety endpoint was fetal mortality. Secondary efficacy
endpoints were increase in Mitral Valve Area (MVA) and decrease in mean
transmitral pressure gradient. Secondary safety endpoints were in-hospital
stroke, cardiac tamponade and de novo severe mitral regurgitation (MR).
 Result(s): 620 patients from 15 studies were included. Median age was
27 (IQR 23.35-28.68). 19.6% (IQR 8.6-33.4%) of patients presented with
NYHA IV functional class, while 55.5% (IQR 45,4-75,4%) with NYHA III. No
in-hospital death was observed. At a median follow-up was 44 months (IQR
33-61) 3 patients died. Fetal death occurred in 8 cases (1.3%). Symptoms
improvement was observed in 100% of patients. No in-hospital stroke was
observed, while cardiac tamponade occurred in 2 cases and de novo severe
MR in 8 cases. MVA passed from 0.87 cm2 (IQR 0.80-0.95) to 1.97
cm2 (IQR 1.75-2.1). Mean transmitral pressure gradient passed
from 17.8 mmHg (IQR 15.97-21.3) to 5.45 mmHg (IQR 4.97-5.92).
 Conclusion(s): PMBV is safe and effective in the treatment of severe
symptomatic mitral stenosis in pregnant women.

<62>
Accession Number
627249402
Title
Network meta-analysis comparing iFR vs. FFR vs. coronary angiography to
drive coronary revascularization.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 954), 2018. Date of
Publication: August 2018.
Author
Verardi R.; Fioravanti F.; D'Ascenzo F.; Barbero U.; Conrotto F.;
Montefusco A.; Omede P.; Moretti C.; D'Amico M.; Escaned J.
Institution
(Verardi, Fioravanti, D'Ascenzo, Barbero, Conrotto, Montefusco, Omede,
Moretti, D'Amico) Hospital 'Citta della Salute e della Scienza di Torino',
Cardiology, Turin, Italy
(Escaned) Hospital Clinic San Carlos, Cardiovascular Institute, Madrid,
Spain
Publisher
Oxford University Press
Abstract
Aims: Instantaneous free-wave ratio (iFR) has been recently demonstrated
noninferior to fractional flow reserve (FFR) in guiding coronary
revascularization; however, no study has compared iFR versus Coronary
Angiography (CA). We performed a network meta- analysis to evaluate
efficacy and safety of iFR compared to angio-guided strategy. Methods
and Results: We searched for randomized trials and studies with propensity
score matching in The Cochrane Collaboration Central Register of
Controlled Trials, EMBASE and MEDLINE/Pubmed. CA, FFR and iFR were the 3
competitive arms, MACE (a composite endpoint of death, myocardial
infarction, target vessel revascularization) was the primary endpoint,
while its single components the secondary ones. Subgroup analysis was
performed including patients presenting with stable coronary artery
disease (SCAD). 8 studies were selected, including 8500 patients. 4126
patients were evaluated with FFR, 2160 with iFR and 2214 with CA. Acute
Coronary syndrome (ACS) was the most frequent admission diagnosis. After
12 months, rates of MACE and all-cause death did not differ between groups
(respectively OR 1.04 and OR 0.86 for iFR vs. FFR). Both FFR and iFR
reduced Target Vessel Revascularization (TVR) compared to CA (respectively
OR 0.68 and OR 0.70). In patients with SCAD both FFR and iFR reduced risk
of subsequent MI compared to CA (respectively OR 0.66 and OR 0.79).
 Conclusion(s): Compared to CA alone, both FFR and iFR are safe and
effective in guiding coronary revascularization at 12 months. In patients
with SCAD, both FFR and iFR- guided revascularization reduce the risk of
subsequent MI at 12 months.

<63>
Accession Number
627249350
Title
Effectiveness of cardiac resynchronization therapy in heart failure
patients with valvular heart disease: Comparison with patients with
dilated cardiomyopathy.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 827-828), 2018. Date of
Publication: August 2018.
Author
Marinho V.; Milner J.; Alves P.; Domingues C.; Ferreira J.; Antonio N.;
Ventura M.; Cristovao J.; Elvas L.; Goncalves F.; Pego M.
Institution
(Marinho, Milner, Alves, Domingues, Ferreira, Antonio, Ventura, Cristovao,
Elvas, Goncalves, Pego) University Hospitals of Coimbra, Cardiology,
Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Introduction: Heart failure (HF) may occur in the presence of a wide range
of underlying heart diseases, including valvular heart disease (VHD). In
the majority of randomized clinical trials that validated the clinical use
of cardiac resynchronization therapy (CRT), the presence of a clinically
significant VHD or of previous valvular surgery were exclusion criteria.
The aim of this study was to analyze the effectiveness of CRT in patients
with valvular heart in comparison with dilated cardiomyopathy (DCM)
patients. Method(s): Retrospective single-centre study that included
all patients submitted to CRT therapy between January 2006 and December
2015. For the aims of current analysis, the following groups were
considered: 1) patients with VHD (evidence of clinically significant
primary valvular disease or previous valve replacement or repair for
organic valvular disease; 2) patients with DCM (presence of a typical
pattern of this heart disease, without ischaemic or organic valvular heart
diseases). The response to CRT was evaluated comparing the baseline with 6
month follow-up echo data. In long term follow-up we evaluated all-cause
mortality, transplantation rate and admissions for heart failure.
 Result(s): A total of 431 patients submitted to CRT in our centre
were included. Of these, 199 patients (46%) had DCM and 26 (6.0%) had VHD.
Age did not differ between groups [65 (+11) vs 69 (+9) years, p=0.253)].
There were no differences between the distribution of Diabetes Mellitus
(29% vs 24%, p=0.574), hypertension (51% vs 42%, p=0.531), dyslipidemia
(62% vs 75%, p=0, 331) and chronic kidney disease (29% vs 53%, p=0.07).
The distribution of LBBB (82% vs 89%, p=0.402), and basal LV end diastolic
volume [219 (104) vs 210 (110), p=0.867] was similar between groups. At 6
months echo, there was a trend to a more positive response to CRT in group
of patients with DCM (55% vs 49%, p=0.06). Interestingly, group 1 patients
were more frequently super responders (29 vs 6.3%, p=0.04). The mean
follow up was 42 (+33) months. Mortality (18% vs 35%, p=0.04) was
significantly lower in dilated cardiomyopathy. Both groups did not differ
in transplantation rate (6.1 vs 3.8, p=0.538) and admissions for acute
heart failure (29% vs 35%,p=0.33). The survival curves for all-cause
mortality obtained by Kaplan-Meier analysis are shown in Figure1 and
revealed a worse prognosis of patients with VHD (Log-rank test, P=0,037).
In multivariate logistic regression analysis, the presence of Diabetes
Mellitus [4.0 (1.1-16), p=0.04] and the valvular disease etiology [6.1
(1.1-33), p=0.03] significantly increased the risk, while responsiveness
to CRT proved to have a significant protective role in the whole patient
population [0.13 (0.03-0.4), p=0.02]. Conclusion(s): No randomized
controlled trial has specifically evaluated the ef-fects of CRT in
patients affected by a valvular heart disease, but on the basis of real
world clinical practice, CRT appears more effective in DCM than VHD.
(Table Presented) .

<64>
Accession Number
627248671
Title
Asymptomatic coronary artery disease in type 2 diabetes (T2D), a
prospective invasive coronary angiographic (ICA) study with intravascular
ultrasound (IVUS) evaluation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 752), 2018. Date of
Publication: August 2018.
Author
Ofstad A.P.; Arora S.; Ulimoen G.R.; Birkeland K.I.; Endresen K.;
Gullestad L.; Johansen O.E.
Institution
(Ofstad, Johansen) Baerum Hospital, Baerum, Norway
(Arora, Birkeland, Endresen, Gullestad) Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Ulimoen) Akershus University Hospital, Loerenskog, Norway
Publisher
Oxford University Press
Abstract
Background and aims: The prevalence of asymptomatic CAD in T2D is unclear.
We investigated 1) the CAD burden cross-sectionally using IVUS in an
asymptomatic T2D-cohort compared to a reference population without T2D and
2) whether the disease progression of CAD in the T2D cohort, evaluated by
ICA, could be modulated with a program to reduce cardiovascular (CV) risk.
 Method(s): Patients with T2D and >=1 CV risk factor were randomized
to 2 years of a hospital based multi-intervention (MULTI, n=30), or
standard care by general physicians (STAND, n=26), with a pre-planned
follow-up at year 7. ICA was performed at baseline (BL) whereas at year 7
both ICA and IVUS. Angiograms were scored as: grade 0:<25% diameter
stenosis (st), 1:<50% st, 2: <75% st, 3: >75% st, 4: occlusion. CAD burden
was described conventionally by the extent score (number of segments
graded >=1, adjusted to 16 segments) and severity score (average grade of
the diseased segments graded >=1). IVUS was described by maximal intimal
thickness (MIT), percent atheroma volume and total atheroma volume and
compared with individuals without T2D and CAD (heart transplant donors)
who had IVUS performed 7-11 weeks post transplantation (n=76).
 Result(s): At year 7, atheroma burden was significantly greater
(Table) and the age-stratified prevalence of CAD defined by MIT
significantly higher (Figure) in T2D than in the reference population. The
2 year multi-intervention reduced CV risk factors (HbA1c, blood pressure,
lipids) in MULTI, but did not result in long-term between-group
differences in CAD progression by ICA or in atheroma burden, by IVUS, at
year 7 (Table). (Figure presented) Conclusion(s): Our data suggest
that asymptomatic T2D patients have extensive CAD, that progresses over
time and is not modulated by a 2 year multiintervention, suggesting a need
for more durable residual CV risk management using alternative approaches.
(Table presented).

<65>
Accession Number
627248660
Title
Short term use of corticosteroids in the prophylaxis of atrial
fibrillation after cardiac surgery and impact on the levels of acute phase
proteins in this context.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 668-669), 2018. Date of
Publication: August 2018.
Author
Gomez Polo J.C.; Vilacosta I.; Gomez-Alvarez Z.; Vivas D.; Martin-Garcia
A.G.; Fortuny-Frau E.; Ferrera C.; Garcia-Bouza M.; Olmos C.; Ramchandany
B.; Martin-Benitez J.C.; Carnero M.; Higueras J.; Fernadez C.;
Maroto-Castellanos L.C.
Institution
(Gomez Polo) Hospital Clinic San Carlos, Madrid, Spain
(Vilacosta, Gomez-Alvarez, Vivas, Martin-Garcia, Fortuny-Frau, Ferrera,
Garcia-Bouza, Olmos, Ramchandany, Martin-Benitez, Carnero, Higueras,
Fernadez, Maroto-Castellanos) Hospital Clinic San Carlos, Cardiovascular
Institute, Madrid, Spain
Publisher
Oxford University Press
Abstract
Introduction: Atrial fibrilation (AF) is a prevalent complication after
cardiac surgery. Its incidence is frequently associated with a longer
hospital stay, as well as higher rates of hemodynamic lability, greater
risk of ischemic stroke and mortality. Although the pathogenesis of
postoperative AF is multifactorial, Inflammatory cascade seems to be
implicated in the phatophysiology of this entity. Purpose(s): The aim
of this study, was to analyse the effects of corticosteroid administration
in acute phase proteins (APPs) levels after cardiac surgery, and its
relationship with the AF development. Method(s): A prospective,
randomized, double-blind, placebo-controlled clinical trial (ECOFA study)
was designed. Patients without prior history of AF or atrial flutter and
scheduled to undergo cardiac surgery (coronary artery bypass graft
surgery, valve replacement or combined surgery) were randomized to receive
either corticoids or placebo as follows: 500 mg of methylprednisolone or
an equal volume of normal saline after induction of anesthesia and 4 mg of
dexamethasone or placebo every 8 hours during 24 hours after surgery. All
patients were treated with oral carvedilol before and after surgery.
Patient rhythm was monitored by continuous telemetry during the immediate
postoperative period and with a Holter recording throughout the patients'
hospital stay. APPs levels were measured at baseline, and at 24, 48 and
72-120 hours after cardiac surgery. Result(s): A total of 104
consecutive patients were randomized to either of the two (Figure
presented) strategies (52 patients each arm), with similar distribution of
cardiovascular risk factors and baseline characteristics. No differences
between APPs levels in both groups except for Interleukin 6 (IL-6) were
found in the different samples. This protein levels were significantly
higher in the control group, mainly in the samples taken in the 24 and 48
h after cardiac surgery (P=0,008), compared with the placebo group.
Besides, at 48h after cardiac surgery took place the peak of incidence of
postoperative AF in control group (matching with the higher levels of
IL-6), developing AF 14 patients (28,6%) in contrast to 9 patients (18,4%)
in the treatment group. Conclusion(s): Prophylactic short-term use of
corticosteroids during and after cardiac surgery has proved to be safe and
effective in reducing the incidence of postoperative AF and IL-6 seems to
be the APPs with a strongest relationship with inflammatory activity in
this context, and with the development of AF.

<66>
Accession Number
627251596
Title
Does cardiac rehabilitation improve functional, independence, frailty and
emotional outcomes following trans catheter aortic valve replacement?.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1121), 2018. Date of
Publication: August 2018.
Author
Rogers P.; Banya W.; Kabir T.; Panoulas V.; Probert H.; Prendergast C.;
Taylor R.; Dalby M.
Institution
(Rogers, Kabir, Panoulas, Probert, Prendergast) Harefield Hospital,
Cardiology, London, United Kingdom
(Banya) Royal Brompton Hospital, Statistics, London, United Kingdom
(Taylor, Dalby) University of Exeter, Exeter, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Transcatheter Aortic Valve Replacement (TAVI) is often
undertaken in the oldest frailest cohort of patients undergoing cardiac
interventions. There is currently insufficient evidence to support the
routine recommendation of CR in this population. Purpose(s): We
undertook a pilot trial of CR following TAVI to inform the feasibility and
design of a future fully powered randomised trial. Method(s): We
screened patients undergoing TAVI at our institution between June 2016 and
February 2017 and randomised selected patients post-TAVI to either
standard of care alone (control group) or standard of care plus exercise
based CR (CR group). We assessed recruitment and attrition rates, uptake
of CR and explored changes in the 6 minute walk test, the Nottingham
Activities of Daily Living, Fried and Edmonton Frailty scores and Hospital
Anxiety and Depression Score, from baseline (30 days post TAVI) to 3 and 6
months post randomisation. Result(s): Of 82 patients screened
undergoing TAVI, 52 met the inclusion criteria and 27 were recruited (3
patients/month) and randomised (14 control, 13 CR,). In the CR group,
10/13 (77%) patients completed the prescribed course of 6 sessions of CR.
No significant differences were seen between SOC and CR at 3 or 6-months
in 6 minute walk test, the Nottingham Activities of Daily Living, Fried
and Edmonton Frailty scores and Hospital Anxiety and Depression Score.
 Conclusion(s): We have demonstrated the feasibility of recruiting
from this often frail and comorbid cohort of post TAVI patients into a
randomised trial of CR within a single centre. Study participation and CR
were acceptable to patients with a high rate of recruitment, retention and
completion at six months.

<67>
Accession Number
627251493
Title
Transcatheter aortic valves replacement for pure aortic valve
regurgitation constitutes a valid option in high risk patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 717), 2018. Date of
Publication: August 2018.
Author
Wernly B.; Eder S.; Navarese E.P.; Marcus F.; Lichtenauer M.; Datz C.;
Frank F.; Landmesser U.; Hoppe U.C.; Jung C.; Lauten A.
Institution
(Wernly, Lichtenauer, Hoppe) Paracelsus Private Medical University,
Salzburg, Austria
(Eder, Datz) Hospital Oberndorf, Internal Medicine, Oberndorf, Austria
(Navarese) Inova Heart and Vascular Institute, Interventional Cardiology
and Cardiovascular Medicine Research, Falls Church, United States
(Marcus) University Hospital of Jena, Department of Cardiology, Jena,
Germany
(Frank, Landmesser, Lauten) Charite - Universitatsmedizin Berlin,
Department of Cardiology, Berlin, Germany
(Jung) University Duesseldorf, Division of Cardiology, Pulmonology, and
Vascular Medicine, Duesseldorf, Germany
Publisher
Oxford University Press
Abstract
Introduction: In aortic stenosis, transcatheter aortic valve replacement
(TAVR) has become the mainstay of treatment for in patients with high and
intermediate risk for surgical valve replacement (SAVR). Approximately 10%
of patients with a native left sided valve disease present with pure
aortic regurgitation (PAR), which was considered a relative
contraindication for interventional treatment. Still, for patients
suffering from PAR with unfavorable risk profile for SAVR, transcatheter
treatment options are required. We aimed to summarize the available data
on TAVR for PAR. Methods and Results: Pubmed was searched for studies
of patients suffering from PAR undergoing TAVR. Pooled estimated event
rates were calculated and primary outcome was 30 day-mortality. Twelve
studies including 640 patients were identified and analyzed, the search
was conducted on December 16th 2017. First-generation valves (CoreValve or
Sapien XT) were implanted in 39% (n=247), wheras second-generation
(J-Valve, JenaValve, DirectFlow, Acurate TA, Evolut R, Lotus, Sapien 3,
Engager, Portico) valves in 61% (n=393) of cases. Mean age ranged from
73+/-9 years to 80+/-6 years, logistic EuroScore from 17.7+/-14.8 to
34+/-8, STS score from 4.9+/-3.5 to 13.1+/-2. Access route was reported
for 617 patients. 350 underwent transfemoral, 20 subclavian, 12 direct, 3
carotid and 232 apical TAVR. 71 Patients required the implantation of a
second valve for persistence of severe AR due to misplacement or migration
of the first valve. Conversion to open surgery was necessary in 15
patients (0.02%). In the overall group, all-cause 30-day-mortality was
12.2% (95% CI 8.7%-16.2%; I2 31%), stroke rate was 3.5% (95% CI 2.2%-5.0%;
I2 0%), more than moderate AR post-interventional was present in 9.9% (95%
CI 2.6%-21.1%; I2 91%) and success rate was 89.5% (95% CI 81.7%-95.3%; I2
82%). Mortality in the first-generation group was 16.6% (95% CI
11.7%-22.2%; I2 17%), device success was at 68.0% (95% CI 58.5%-76.8%; I2
54%), stroke rate 2.8% (95% CI 1.2%-5.3%; I2 0%). In the second-generation
group 30-day-mortality was 9.2% (95% CI 6.3%-12.7%; I2 9%), stroke
occurred in 3.9% (95% CI 2.2%-6.0%; I2 0%), device success rate was 92.2%
(95% CI 85.9%-96.7%; I2 64%) and more than moderate AR rate 3.1% (95% CI
1.6%-5.0%; I2 0%). Conclusion(s): Based on our review and analysis of
available studies, TAVR for PAR seems to be feasible in a selected
high-risk patient collective with a success rate of 90% in the overall
group. Comparing first- versus second-generation valves, there seems to be
a trend towards higher device success and lower 30-day-mortality.

<68>
Accession Number
627250700
Title
Outcome after ROSS procedure in adult patients: A systematic review,
meta-analysis and microsimulation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 718-719), 2018. Date of
Publication: August 2018.
Author
Sibilio S.; Koziarz A.; McClure G.; Alsagheir A.; Alraddadi H.; Lengyel
A.; Reza S.; Um K.; Mendoza P.; Mclsaac S.; Paparella D.; El-Hamamsy I.;
Parry D.; Belley-Cote E.; Whitlock R.
Institution
(Sibilio, Paparella) University of Bari, Hospital Policlinico, Bari, Italy
(Koziarz) McMaster University, Department of Health Research
Methods,Evidence,and Impact, Hamilton, Canada
(McClure, Um) McMaster University, Michael G. DeGroote School of Medicine,
Hamilton, Canada
(Alsagheir, Mclsaac, Belley-Cote, Whitlock) Population Health Research
Institute, Cardiac surgery, Hamilton, Canada
(Alraddadi, Parry) McMaster University, Department of surgery, Hamilton,
Canada
(Lengyel, Mendoza) McMaster University, Undergraduate Faculty of Health
Sciences, Hamilton, Canada
(Reza) Waterloo University, Undergraduate Faculty of Health Sciences,
Waterloo, Canada
(El-Hamamsy) Montreal Heart Institute, Department of surgery, Montreal,
Canada
Publisher
Oxford University Press
Abstract
Background: Contemporary data suggest that aortic valve replacement with
biological and mechanical prostheses reduces life expectancy in
non-elderly adults compared to age and gender matched controls. The Ross
procedure may yield outcomes more similar to an age- and gender- matched
general population. Purpose(s): We conducted a systematic review and
meta-analysis to estimate the risk of adverse events and event-free life
expectancy after the Ross procedure in adult patients. Method(s): We
searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to June 2017
for reports evaluating the Ross procedure in patients >=16 years of age.
We performed screening, full-text assessment, risk-of-bias evaluation and
data collection independently and in duplicate. We pooled data using a
random effects model for the outcome-based analysis. We used a
microsimulation model to evaluate age- and gender-specific life
expectancy. Result(s): We pooled data from 66 articles, totalling
21348 participants in 20 countries. We judged thirty-seven papers to be at
low risk of bias, 21 at high risk and 8 at unclear risk. Twenty-eight
studies reported on early mortality (N=10041), with a rate of 2.47% (95%
CI [1.89, 3.13]). At a mean of 7.2 years of follow-up (N=7635), we found a
mortality risk of 5.89% (95% CI [4.74; 7.15%]) based on 33 studies. The
rate of early clinically significant bleeding was 1.36% (95% CI [0.37,
2,96]), 13 studies (N=4217); re-exploration for bleeding 4.58% (95% CI
[3.10, 6.32]), 20 studies (N=7563); clinically significant bleeding
occurring from 30 days until a mean of 7.1 years post-operative was 0.54%,
(95% CI[0.24,0.97]), 10 studies (N=3634). At a mean of 6.9 years of
follow-up, 29 studies reported on aortic (N=7600) and pulmonary
re-interventions (N=7087), the re-intervention rate of any operated valve
site was 7.85% (95% CI [5.69, 10.32]) based on 25 studies (N=7767): 5.75%
(95% CI [4.41, 7.25]) at the aortic site and 3.53% (95% CI [2.76, 4.40])
at the pulmonary site. The risk of valve thrombosis was 0.28% (95% CI
[0.15, 0.46]) at 7.6 years, 15 studies (N=4377); peripheral embolism,
0.27% (95% CI [0.15, 0.43]) at 6.4 years, 18 studies (N=5091); and stroke
0.91% (95% CI [0.65, 1.22]) at 6.5 years, 19 studies (N=5506). We present
microsimulationbased estimates of age-specific life-expectancy in Figure
1. Conclusion(s): Our results suggest that, in adult patients, the
Ross procedure is associated with a low mortality and low risk of adverse
events at both short and long-term follow-up. The surgical community
should prioritize the generation of a large, expertise-based randomized
controlled trial, to definitively address the risks and benefits of the
Ross procedure compared to conventional AVR.

<69>
Accession Number
627252487
Title
A meta-analysis of percutaneous coronary interventions in cardiac
transplantation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1337), 2018. Date of
Publication: August 2018.
Author
Hammad S.A.R.A.; Vadala Paolo P.V.
Institution
(Hammad, Vadala Paolo) Hospital Molinette of the University Hospital S.
Giovanni Battista/City University Hosp of Health an, Cardiology, Turin,
Italy
Publisher
Oxford University Press
Abstract
Introduction: Outcomes of patients with orthotopic heart transplantation
(OHT) undergoing Percutaneous Coronary Intervention (PCI) remain to be
defined, especially according to the kind of stent and use of
intracoronary imaging. Method(s): All studies evaluating the impact
of PCI on patients with OHT were included. MACE, a composite and mutually
exclusive end point of all cause death, Target Lesion Revascularization
(TLR) and Stent Thrombosis (ST), was the primary end point, while MACE
components along with cardiovascular death were secondary endpoints.
Regression analysis was used to assess the impact of coronary stent
medications (everolimus and sirolimus), use of IVUS, and use of orally
administered anti-rejection drugs on TLR. Result(s): 21 studies with
1.031 patients were included, with a median time from OHT of 7.1 years
(6.5-8.7). An angiographic control study was the most frequent indication
(65%): multivessel disease was reported in 38.8% (28.9-39.0), IVUS was
used in 57% (29-80) and BMS (Bare Metal Stents) were implanted in 37.8% of
cases (36.2-50.0) while Drug Eluting Stents (DES) were used in 62.2%
(53.5- 10). After 1.3 years, MACE occurred in 39.4% of patients
(20.82-57.98), mainly driven by TLR (11.78% [5.57-17-98] for patients with
DES and 34.23% [22.21- 46.25] for BMS), while ST occurred in 2.03%
[0.57-2.30]. By logistic regression, IVUS reduced TLR
(-0.035:-0.045:-0.021), while the type of antiproliferative drug in the
stents or the adjunctive immunosuppressant therapy did not impact
subsequent revascularization. Conclusion(s): Patients with OHT
undergoing PCI are at high risk of recurrent revascularization, which is
reduced by use of intracoronary imaging and DES. Although DES is
preferable to BMS in preventing restenosis in OHT lesions, the type of
antiproliferative drug in the DES did not impact TLR. Further studies are
needed to evaluate the effectiveness of adjuvant immunosuppressant
therapy.

<70>
Accession Number
627252161
Title
Left vs right radial access: A randomized comparative study of routine
catheterization in heart transplanted patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1147), 2018. Date of
Publication: August 2018.
Author
Robles C.; Martin Yuste V.; Brugaletta S.; Freixa X.; Regueiro A.; Castell
A.; Perez Villa F.; Sabate M.
Institution
(Robles) University Hospital of Virgen Macarena, Endovascular Service.,
Seville, Spain
(Martin Yuste, Brugaletta, Freixa, Regueiro, Sabate) Hospital Clinic de
Barcelona, Hemodynamics and Interventional Cardiology, Barcelona, Spain
(Castell, Perez Villa) Hospital Clinic de Barcelona, Heart Failure and
Transplant, Barcelona, Spain
Publisher
Oxford University Press
Abstract
Objective: The coronary angiography in heart transplant patients is
characterized by some technical difficulties given the rotation of the
graft. There is little information about the most favorable access in this
procedures, therefore we perform a monocentric, prospective, randomized
and comparative study between the left radial access (L-TRA) and right
radial access (R-TRA) in heart transplant patients that undergo to
coronary angiography, regarding radiation measurements, duration of the
procedure, contrast volume, radiation, and complications. Method(s):
Baseline characterics were collected and between 48-72 hours of the
procedure, a clinical and blood sample test was carried out. The
procedures were performed by experienced interventionists in the radial
approach. The data are presented in median +/- SD, for continuous
variables and in percentage for categorical variables. All analyzes were
performed with intention to treat (ITT). A value of p<0.05 was determined
for statistical significance. Result(s): From June 2014 to December
2016, 88 heart transplant patients were sent for coronary angiography. The
main cause of exclusion was the need for concurrent biopsy. We include 50
(n=50) 25 assigned to the L-TRA group and 25 to the R-TRA group. 2
patients from the L-TRA group had crossover to R-TRA due to puncture
failure. The total dose of radiation (AK) (889+/-693mGy vs 664+/-338mGy,
p=0.39), the dose-area product (DAP) (4800+/-3755 vs 3497+/-2360, p=0.21)
and fluoroscopy time (4.7+/-3.2 vs 3.7+/-2.5 minutes, p=0.39), were higher
in the L-TRA group compared to the R-TRA but did not reach statistical
differences. The duration of the procedure (18.2+/-10.5 minutes vs
13.6+/-5.8 minutes, p=0.13) and the contrast volume were higher in the
L-TRA group (62+/-26 vs 56+/-25 ml, p: 0.34), without statistical
difference. No patient had contrast-induced nephropathy (CIN). A patient
from the L-TRA group developed a pseudoaneurysm. Hematomas were recorded
in 4 patients (16.7%) L-TRA vs vs 2 patients (9.1) of the R-TRA group
(p=0.68). Conclusion(s): The L-TRA showed a tendency to use more
radiation, more procedure time and more contrast than the R -TRA, but the
results do not reach statistical differences, in this group of patients is
feaseible and safe. Therefore, in the hope of more extensive studies
confirming these results, we prefer to use D-TRA in these patients.

<71>
Accession Number
627248223
Title
Transcatheter and surgical aortic bioprosthetic valve leaflet thrombosis
defined by computed tomography is associated with cerebrovascular events:
Contemporary meta-analysis of 8 observational studies.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1314-1315), 2018. Date
of Publication: August 2018.
Author
Rashid H.; Gooley R.; Nerlekar N.; Ihdayhid A.R.; McCormick L.; Be K.K.;
Amiruddin A.; Nasis A.; Cameron J.; Brown A.
Institution
(Rashid, Gooley, Nerlekar, Ihdayhid, McCormick, Be, Amiruddin, Nasis,
Cameron, Brown) Monash Health, Monash Heart, Melbourne, Australia
Publisher
Oxford University Press
Abstract
Aims: Leaflet thrombosis (LT) has become increasingly recognised following
transcatheter and surgical aortic bioprosthetic valve (ABV) replacement
and can be reliably identified by computed tomography (CT). However, it is
unclear whether CT-defined LT is associated with adverse cerebrovascular
outcomes. We performed a meta-analysis to assess the incidence and
clinical outcomes associated with CT-defined LT following ABV replacement.
 Method(s): Electronic databases were searched for studies that
performed manda-tory CT imaging following ABV. The primary endpoint was
the incidence of cerebrovascular events (CVE), defined as composite of
stroke and transient ischaemic attack (TIA). Secondary endpoints included
major adverse cerebrovascular and cardiovascular events (MACCE), stroke,
TIA, death or myocardial infarction. Pre-specified analysis was also
performed to compare the CT imaging features of reduced leaflet motion
(RELM) and hypoattenuated leaflet thickening (HALT) with regards to risk
of CVE. In Makkar et al., we only reported the Portico cohort as the rest
was later updated in Chakravarty et al. Result(s): 8 studies met
inclusion criteria with a prevalence of 12.5% (229/1828) patients having
CT-defined LT. The prevalence of LT following transcatheter and surgical
ABV was 12.8% and 9.8%, respectively. CVE were significantly increased in
patients with LT(Odds Ratio (OR) 2.96, 95% CI 1.63-5.38, p<0.01). The risk
of stroke (OR2.45, 95% CI 1.19-5.03, p=0.02)and MACCE (OR2.14, 95% CI
1.26-3.64, p<0.01) were also increased in patients with LT. The risk of
TIA increased in patients with LT, reaching borderline statistical
significance (OR 3.19, 95% CI 0.99-10.29, p=0.05). The risk of death and
myocardial infarction were similar between groups. CT feature of RELM was
related with higher CVE (OR 3.34, 95% CI 1.7-6.56, p<0.01) than HALT (OR
1.88, 95% CI 0.51-6.9, p=0.34) [Table Presented] Conclusion(s):
CT-defined LT following ABV replacement is associated with a
sig-nificantly increased risk of CVE. CT feature of RELM was strongly
associated with CVE when compared to HALT.

<72>
Accession Number
627247915
Title
Transcatheter versus surgical aortic valve replacement in patients with
prior cardiac surgery in the randomized PARTNER 2A Trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1041), 2018. Date of
Publication: August 2018.
Author
Chen S.; Redfors B.; Ben-Yehuda O.; Crowley A.; Greason K.L.; Alu M.; Finn
M.T.; Vahl T.; Nazif T.; Thourani V.H.; Suri R.M.; Svensson L.; Webb J.G.;
Kodali S.; Leon M.B.
Institution
(Chen, Redfors, Ben-Yehuda, Crowley) Cardiovascular Research Foundation,
New York, United States
(Greason) Mayo Clinic, Dept. of Cardiovascular Surgery, Rochester, United
States
(Alu, Finn, Vahl, Nazif, Kodali, Leon) Columbia University Medical Center,
New York, United States
(Thourani) Washington Hospital Center, Washington, United States
(Suri, Svensson) Cleveland Clinic Foundation, Cleveland, United States
(Webb) St Paul's Hospital, Vancouver, Canada
Publisher
Oxford University Press
Abstract
Background: Prior cardiac surgery (PCS) is associated with increased risk
and post-op complications following surgical aortic valve replacement
(SAVR), but whether this risk is similar in transcatheter aortic valve
replacement (TAVR) is unclear. Purpose(s): To evaluate clinical
outcomes in pts with and without PCS undergoing TAVR or SAVR.
 Method(s): In the PARTNER 2A trial, 2032 pts with severe AS at
intermediate surgical risk (STS 4-8) were randomized to TAVR with SAPIEN
XT or SAVR. Outcomes at 30d and 2y were compared using KM event rates, and
association of PCS with outcomes was assessed using multivariable Cox
models. The primary endpoint was all cause death and disabling stroke.
 Result(s): 509 pts (25.1%) had PCS. Pts with PCS were younger, with
higher BMI and STS score, and were more often male and diabetic. There
were no significant differences between TAVR and SAVR in patients with or
without PCS, in rates of the primary endpoint or its components at 30d
(Table). Bleeding was significantly higher in SAVR in both PCS groups
(Figure), but an interaction between PCS group and treatment arm was
observed for bleeding, driven by life threatening or disabling bleeding,
such that the gap between bleeding rates was more pro-found in PCS pts
(adjusted TAVR vs SAVR HR [95% CI]: 0.13 [0.08, 0.21] for PCS vs 0.24
[0.19, 0.31] for no-PCS; adj p-interaction=0.02). 2-year clinical outcomes
did not differ significantly between TAVR and SAVR, in pts with or without
PCS. 80 [Figure Presented] Conclusion(s): In the PARTNER 2A Trial of
intermediate-risk pts with severe AS undergoing SAVR versus TAVR with
SAPIEN XT, the relative risk of 30-day life-threatening bleeding
associated with SAVR was disproportionately higher amongst patients with
PCS compared to those without PCS. Contrary to prior re-ports in high-risk
patients, two-year clinical outcomes in intermediate-risk patients with
PCS were similar for SAVR and TAVR. Funding Acknowledgements: The PARTNER
2 Trial was funded by Edwards Lifesciences.

<73>
Accession Number
627247913
Title
Clinical outcomes, mortality, and causes of death in patients with NSTEMI
according to heart failure at admission: Insights from a large
contemporary revascularization trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1152-1153), 2018. Date
of Publication: August 2018.
Author
Popovic B.; Sorbets E.; Abtan J.; Cohen M.; Pollack C.; Bode C.; Wiviott
S.D.; Sabatine M.; Mehta S.R.; Elbez Y.; Ducrocq G.; Steg P.G.
Institution
(Popovic) Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
(Sorbets, Abtan, Elbez, Ducrocq, Steg) Hospital Bichat-Claude Bernard,
Paris, France
(Cohen) Newark Beth Israel Medical Center, Newark, United States
(Pollack) Thomas Jefferson University Hospital, Philadelphia, United
States
(Bode) University of Freiburg, Freiburg, Germany
(Wiviott, Sabatine) Harvard Medical School, Boston, United States
(Mehta) Hamilton Health Sciences, Hamilton, Canada
Publisher
Oxford University Press
Abstract
Background: Patients with non-ST-elevation myocardial infarction (NSTEMI)
and heart failure (HF) are recognized as a high-risk subgroup; mortality
in patients without HF is low. In historical cohorts, revascularization
has been underused in patients with HF. Outcomes of these patients in the
current era of widespread revascularization are unknown. Purpose(s):
We describe the clinical characteristics, outcomes, and causes of death in
patients according to HF status in a large NSTEMI population scheduled to
undergo systematic coronary angiography (CAG). Method(s): The TAO
(Treatment of Acute Coronary Syndrome with Otamixaban) trial randomized
NSTEMI patients with systematic CAG scheduled within 72 h to heparin +
eptifibatide vs otamixaban. In a post hoc analysis, patients were
cate-gorized according to presence or absence of HF (Killip grade >2) at
admission Events were adjudicated and causes of death were categorized.
 Result(s): A total of 13,184 NSTEMI patients were enrolled, of whom
944 (7.2%) had HF at admission (Killip 2 in 85.1% of cases). Useof
invasive procedures was, per protocol, almost universal in both HF and non
HF patients (98.3% vs 99.3% [with vs without HF] p<0.0003), with more
frequent coronary revascularization (PCI or CABG) in no HF group (63.1% vs
81.1%, p<0.001). At day 30, death oc-curred in 57/944 (6%) patients with
HF and 156/12228 patients (1.3%) without HF Cardiovascular death (CV) was
the dominant cause of death (78.8% vs 78.4%, p=0.94) and the distribution
of the causes of CV death including worsening HF (22.6% vs 26%, p=0.65)
and no CV death did not differ according to baseline HF status. At six
months follow-up, mortality remained higher in patients presenting with HF
(9.5% vs 2.1%, p<0.0001). The composite ischemic criteria of CV death, MI,
stent thrombosis, and stroke at day 30 was significantly higher in
patients with HF (12.2% vs 7.1%, p<0.0001). After adjustment, HF was an
independent predictor of all-cause mortality at day 30 (OR: 1.58; 95% CI,
1.06-2.36, p=0.023) and at day 180 (OR: 1.77; 95% CI, 1.3-2.42, p=0.0003).
Moreover, HF was an independent predictor of composite ischemic criteria
of CV death, MI, stent thrombosis, and stroke at day 30 (OR 1.28; 95% CI,
1.01-1.62, p=0.044). [Table Presented] Conclusion(s): In this large
cohort of NSTEMI patients managed invasively, HF at admission was
associated with mortality and composite ischemic criteria. How-ever, the
majority of deaths occurred in patients without HF and causes of death did
not differ according to HF status. Further efforts to reduce mortality in
NSTEM patients need therefore to address both patients with and without HF
Funding Acknowledgements: TAO trial was sponsored and funded by SANOFI.

<74>
Accession Number
627253062
Title
The efficacy and safety of the use of drug-eluting stents vs bare metal
stents stratifying by antithrombotic therapy in atrial fibrillation
patients undergoing coronary stenting: A systematic review.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1142), 2018. Date of
Publication: August 2018.
Author
Sambola Ayala A.; Rello P.; Soriano T.; Pasupuleti V.; Bueno H.; Fauchier
L.; Airaksinen J.; Dewilde W.; Raber L.; Sung-Won J.; Bhatt D.L.; Banach
M.; Lip G.Y.; Hernandez A.V.
Institution
(Sambola Ayala, Rello, Soriano) University Hospital Vall d'Hebron,
Barcelona, Spain
(Pasupuleti) Cleveland Clinic Foundation, Caridology, Cleveland, United
States
(Bueno) University Hospital 12 De Octubre, Cardiology, Madrid, Spain
(Fauchier) University Hospital of Tours, Cardiology, Tours, France
(Airaksinen) Turku University Hospital, Cardiology, Turku, Finland
(Dewilde) Catharina Hospital, Cardiology, Eindhoven, Netherlands
(Raber) Bern University Hospital, Cardiology, Bern, Switzerland
(Sung-Won) Korea University, Cardiology, Seoul, South Korea
(Bhatt) Brigham and Women's Hospital, Cardiology, Boston, United States
(Banach) Medical University of Lodz, Cardiology, Lodz, Poland
(Lip) University Hospital Birmingham, Cardiology, Birmingham, United
Kingdom
(Hernandez) Hartford Hospital, Cardiology, Hartford, United States
Publisher
Oxford University Press
Abstract
Background: Patients with atrial fibrillation (AF) requiring percutaneous
coronary intervention (PCI) are exposed to aggressive antithrombotic
regimes. The new ESC guidelines recommend the use of drug-eluting stents
(DES) in these patients based on current evidence. Purpose(s): The
aims of our study were to analyze the efficacy and safety between the use
of DES compared to bare metal stents (BMS) stratifying by antithrombotic
therapy. Method(s): We performed a systematic review and
meta-analysis of studies comparing DES vs BMS in AF patients undergoing
PCI with stent placement for acute coronary syndromes (ACS) or stable
ischemic heart disease. We stratified by: a. type of antithrombotic
therapy (Triple Teraphy:TT, DAPT: dual antiplatelet therapy or Dual
therapy: DT) and b. duration of antithrombotic therapy (short and
long-term). Primary outcome of efficacy was major adverse cardiovascular
events (MACE) and of safety was major bleeding.We used random effects
meta-analysis using inverse variance or Mantel-Haenzel methods for common
or rare outcomes, respectively. Our measure of effect was relative risk
(RR) and its 95% confidence interval (CI). Result(s): Six studies
were selected (five cohort studies, one RCT) with 1,170 DES and 1,104 BMS
patients. There was a non-significant differences in the incidence of MACE
between patients on TT between DES and BMS. TT long-term treatment showed
a similar risk of MACE (190/949 [20%] vs 38/180 [21.1%] RR 0.96 95% IC
0.69-1.33, p=0.80). However, there was a trend a reduced risk of MACE in
patients on TT short-term in DES vs BMS (59/403 [14.6%] vs 174/957 [18.1%]
RR 1.32 95% IC 0.99-1.75, p=0.06). DAPT long and short-term showed a
similar risk of MACE between DES vs BMS: (p=0.78; p=0.27), respectively.
DT long-term showed a reduction in the risk of MACE in favor of DES vs BMS
(6/32 [14.2%] vs 14/35 [19.5%] RR 0.45 95% IC 0.20-1.01, p=0.05) and DT at
short-term was prescribed in few cases (4/5 [14.2%] vs 13/22 [19.5%] RR
1.35 95% IC 0.77-2.37, p=0.29). The risk of major bleeding in patients on
TT long-term was similar between DES and BMS, although there was a trend
to be higher in BMS (40/949 [4.2%] vs 14/180 [7.8%] RR 0.87 95% IC
0.48-1.61, p=0.67) as well as in patients on TT short-term with BMS
(13/403 [3.2%] vs 71/957 [7.4%] RR 1.55 95% IC 0.49-4.97, p=0.46).
Similarly, few patients on DT long-term did not show differences in the
risk of major bleeding (p=0.46). Neither in dual therapy short-term
(p=0.68). Conclusion(s): In our meta-analysis we observe no
differences between the use of DES and BMS stratifying by antithrombotic
treatment regarding MACE and the presence of major bleeding events. Few
cases on DT did not allow stablish conclusions at this respect. The
heterogeneity of the definitions, bias in the selection of population and
the fact of most bleeding events occur during the first 30-days after PCI
could explain these results.

<75>
Accession Number
627253030
Title
Normal values for doppler echocardiographic assessment of prosthetic valve
function after TAVR-A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1315), 2018. Date of
Publication: August 2018.
Author
Winter M.-P.; Zbiral M.; Kietaibl A.; Sulzgruber P.; Kastner J.; Rosenhek
R.; Binder T.; Lang I.; Goliasch G.
Institution
(Winter, Zbiral, Kietaibl, Sulzgruber, Kastner, Rosenhek, Binder, Lang,
Goliasch) Medical University of Vienna, Department of Internal Medicine
II, Division of Cardiology, Vienna, Austria
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
an attractive, minimally invasive alternative to surgical AVR in patients
at high and intermediate surgical risk. Particularities specific to TAVR
and a rapidly growing number of available prosthesis make post-procedural
assessment of valve function challenging. Aim of the present analysis was
to collect and pool all available data cin the literature regarding normal
doppler values for transcatheter prosthetic heart valves and to provide a
comprehensive overview. Method(s): A PRISMA checklist-guided
systematic review and meta-analysis of prospective observational studies
or national and device specific registries or randomized clinical trials
was conducted. Studies were identified by searching PUBMED, SCOPUS,
Cochrane Central Register of Controlled Trials and LILACs from 01/2000 to
03/2017. Result(s): Out of 240 abstracts, 155 studies (entailing a
total of 27,159 patients) reported echocardiographic parameters. 55
studies in 7778 patients for the CoreValve, SAPIEN valve: 35 studies with
4942 patients, SAPIEN XT: 32 studies with 3557, SAPIEN III:12 studies with
6231 patients, Direct Flow Medical Transcatheter valve: 12 studies with
816 patients, LOTUSTM Valve: 8 studies with 984 patients, EvolutTM R
valve: 4 studies with 872 patients, JenaValveTM: 4 studies with 206
patients, ACURATE TATM: 10 studies with 1161 patients, ACURATE neoTM
valve: 5 studies with 273 patients, PorticoTM valve: 4 studies with 191
patients for the and the EngagerTM valve: 4 studies with 148 patients. The
pooled means and standard deviations for all available TAVR prosthesis
were classified according to implanted valve size and time since
implantation. We observed a mild increase in the different doppler indices
from the discharge to the long term follow up (figure 1). However the
changes were minor reassuring the stable haemodynamic performance of the
different TAVR prosthesis. Second and third generation successors of the
available TAVR prosthesis tended to show superior hemodynamic
characteristics as compared to first generation devices. We found no
significant difference in mean transprosthetic gradient between the
Edwards Sapien and the Sapien XT (9.85+/-4.19 mmHg, vs. 9.94+/-4.7 mmHg,
p=0.40). Interestingly the analysis revealed a significant higher mean
gradient of the Edwards Sapien III valve as compared to the Sapien
(10.45+/-4.91 vs. 9.85+/-4.19 mmHg. p<0.001) and the Sapien XT
(10.45+/-4.91 vs. 9.94+/-4.7 mmHg, p<0.001). In contrast to this, the
newer Medtronic EvolutTM R showed significant lower mean gradients at
baseline as compared to the Medtronic CoreValve (7.41+/-4.7 vs.
8.53+/-4.7, p<0.001). Conclusion(s): The present study firstly
describes a pooled analysis of normal values for all available TAVR
prosthesis to empower physicians with a reliable tool to perform follow-up
echocardiographic assessment in TAVR patients and to safely identify
patients with prostheses dysfunction. (Figure Presented).

<76>
Accession Number
627253016
Title
CTCA for detection of significant CAD in routine TAVI work-up, a
systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1258), 2018. Date of
Publication: August 2018.
Author
Van Den Boogert T.P.W.; Vendrik J.; Claessen B.E.P.M.; Baan J.; Beijk
M.A.; Limpens J.; Boekholdt S.A.M.; Hoek R.; Planken R.N.; Henriques
J.P.S.
Institution
(Van Den Boogert, Vendrik, Claessen, Baan, Beijk, Limpens, Boekholdt,
Hoek, Planken, Henriques) Academic Medical Center of Amsterdam,
Cardiology, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic-valve implantation (TAVI) has evolved to
standard treatment of severe aortic stenosis in patients with an
intermediate to high surgical risk. Computed tomography coronary
angiography (CTCA) could partially replace invasive coronary angiography
(CAG) to diagnose significant coronary artery disease (CAD) in the work-up
for TAVI. Objective(s): To summarize the available literature on the
diagnostic accuracy for CTCA for detection of significant CAD in patients
referred for TAVI. Method(s): A literature search was performed in
MEDLINE and EMBASE for papers comparing CTCA and CAG in TAVI candidates
from inception till December 23, 2017. The primary endpoint was the
diagnostic accuracy of CTCA, compared to CAG, for detection of significant
(>50% diameter stenosis) CAD in patients referred for TAVI, measured as
sensitivity, specificity, positive - (PPV) and negative predictive value
(NPV). Result(s): A total of 7 studies were included, with a
cumulative sample size of 1275 patients. The patient-based pooled
sensitivity, specificity, PPV and NPV were 95%, 65%, 71% and 94%
respectively. Conclusion(s): On the basis of a significance cut-off
value of 50% diameter stenosis, CTCA provides acceptable diagnostic
accuracy for the exclusion of CAD in patients referred for TAVI. Using the
routinely performed preoperative CT scans as a gatekeeper for CAG in the
work-up for TAVI could decrease the number of additional CAGs by 37% in
this high risk and fragile population. (Table Presented).

<77>
Accession Number
627252959
Title
Effect of empagliflozin on cardiovascular events including recurrent
events in the EMPA-REG OUTCOME trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1091), 2018. Date of
Publication: August 2018.
Author
McGuire D.K.; Zinman B.; Inzucchi S.E.; Anker S.D.; Wanner C.; Kaspers S.;
George J.T.; Elsasser U.; Woerle H.J.; Lund S.S.; Fitchett D.
Institution
(McGuire) University of Texas, Southwestern Medical School, Dallas, United
States
(Zinman) Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
University of Toronto, Toronto, Canada
(Inzucchi) Section of Endocrinology, Yale University, School of Medicine,
New Haven, United States
(Anker) Division of Cardiology and Metabolism, Charite -
Universitatsmedizin Berlin, Berlin, Germany
(Wanner) Wurzburg University Clinic, Wurzburg, Germany
(Kaspers, George, Elsasser, Woerle, Lund) Boehringer Ingelheim
International GmbH, Ingelheim, Germany
(Fitchett) St Michael's Hospital, Division of Cardiology, University of
Toronto, Toronto, Canada
Publisher
Oxford University Press
Abstract
Background: In the EMPA-REG OUTCOME trial in patients with type 2 diabetes
and established CV disease, empagliflozin reduced the risk of 3-point MACE
(composite of CV death, MI, or stroke) by 14%, CV death by 38% and
hospitalisation for heart failure (HHF) by 35% vs placebo in analyses of
time to first event. We assessed the effect of empagliflozin on all (first
and recurrent) CV events. Method(s): Patients were randomised to
receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo in addition
to standard of care. We assessed the effects of empagliflozin pooled vs
placebo based on all adjudicated CV events using a negative binomial model
with confidence intervals based on robust error variance estimators to
account for within-subject correlation. Result(s): A total of 7020
patients were treated (mean [SD] age 63 [9] years, 71% male, 47% with
history of MI, 23% with history of stroke, 10% with HF). In analyses
including all events, the event rate ratio (95% CI) with empagliflozin vs
placebo was 0.78 (0.67, 0.91; p=0.0020) for 3-point MACE, 0.79 (0.620,
0.998; p=0.0486) for MI, 1.10 (0.82, 1.49; p=0.5248) for stroke, 0.62
(0.49, 0.77) for CV death, 0.58 (0.42, 0.81; p=0.0012) for HHF, 0.56
(0.45, 0.69; p<0.0001) for the composite of CV death or HHF, and 0.80
(0.67, 0.95; p=0.0119) for the composite of MI or coronary
revascularisation. Results were consistent with analyses of first events
(Figure). Conclusion(s): Analyses of all (first and recurrent) CV
events in the EMPA-REG OUTCOME trial complement previous analyses and
confirm the consistency of the results. (Figure Presented) .

<78>
Accession Number
627252676
Title
Percutaneous coronary intervention with drug-eluting stent versus coronary
artery bypass grafting for diabetic patients with multivessel and/or left
main disease: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1284), 2018. Date of
Publication: August 2018.
Author
Cui K.Y.; Lyu S.Z.
Institution
(Cui, Lyu) Beijing Anzhen Hospital, Cardiology, Beijing, China
Publisher
Oxford University Press
Abstract
Background: Diabetic patients account for approximately 25% of referrals
for coronary revascularization and have poorer prognosis, especially those
with multivessel and/or left main (LM) disease. However, there has been
intense debate regarding optimal revascularization strategy in these
patients. This meta-analysis was conducted to compare the outcomes of
percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and
coronary artery bypass graft surgery (CABG) for multivessel and/or LM
disease in patients with diabetes mellitus. Method(s): A
comprehensive search of electronic database in PubMed, EMBASE, and
Cochrane Library up to January 4, 2018 was performed. Only randomized
controlled trials (RCTs) or adjusted observational studies comparing PCI
with DES to CABG were included. The main outcomes were the composite
endpoint of death, myocardial infarction (MI), or stroke, all-cause
mortality, MI, stroke, and repeat revascularization. Quantitative analysis
with the generic inverse variance random-effect model was performed to
estimate the pooled odds ratios (ORs) with their 95% confidence internals
(CIs). Result(s): Two RCTs and eleven adjusted observational studies
involving 14576 patients were included. Overall, PCI with DES was
comparable to CABG regarding the risk of the composite endpoint of death,
MI, or stroke (OR: 1.00, 95% CI: 0.83 to 1.22) as well as all-cause
mortality (OR: 1.15, 95% CI: 0.94 to 1.42) in diabetic patients with
multivessel and/or LM disease. Additionally, DES was significantly
associated with higher risk of MI (OR: 1.76, 95% CI: 1.49 to 2.08) and
repeat revascularization (OR: 3.78, 95% CI: 2.74 to 5.23) compared with
CABG. Nevertheless, the risk of stroke was significantly lower in the DES
group (OR: 0.60, 95% CI: 0.44 to 0.83). No differences were found between
the two treatment strategies regard as the risk of the composite endpoint
of death, MI or stroke for lesions with low (OR: 1.34, 95% CI: 0.97 to
1.84) to intermediate (OR: 1.14, 95% CI: 0.63 to 2.07) anatomic
complexity, whereas PCI with DES was associated with increased risk of the
composite endpoint of death, MI or stroke for complex lesions (OR: 1.66,
95% CI: 1.15 to 2.39). Conclusion(s): Although with higher risk of MI
and repeat revascularization, PCI with DES appears to be as safe as CABG
for diabetic patients with multivessel and/or LM disease in terms of the
composite endpoint of death, MI, or stroke and all-cause mortality.
Furthermore, PCI with DES can reduce the incidence of stroke. Treatment
with DES could be an alternative interventional strategy to CABG for
diabetic patients with multivessel and/or LM lesions with low to
intermediate anatomic complexity.

<79>
Accession Number
627247550
Title
Contemporary and real-life picture of cardiogenic shock in France: A
descriptive analysis of the FRENSHOCK multicenter prospective registry.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 625-626), 2018. Date of
Publication: August 2018.
Author
Delmas C.; Elbaz M.; Manzo-Silberman S.; Puymirat E.; Leurent G.; Levy B.;
Bonello L.; Aissaoui N.; Hugon-Vallet E.; Morel O.; Gerbaud E.; Lamblin
N.; Roubille F.; Bonnefoy-Cudraz E.; Henry P.
Institution
(Delmas, Elbaz) Toulouse Rangueil University Hospital (CHU), Cardiology
Department, Toulouse, France
(Manzo-Silberman, Henry) Hospital Lariboisiere, Cardiology Department,
Paris, France
(Puymirat) Hopital Europeen Georges Pompidou, Universite Paris Descartes,
Cardiology Department, Paris, France
(Leurent) University Hospital of Rennes, Cardiology Department, Rennes,
France
(Levy) Hospital Brabois of Nancy, Critical Care Department, Vandoeuvre les
Nancy, France
(Bonello) Hospital Nord of Marseille, Cardiology Department, Marseille,
France
(Aissaoui) Hopital Europeen Georges Pompidou, Universite Paris Descartes,
Critical Care Department, Paris, France
(Hugon-Vallet, Bonnefoy-Cudraz) Hospital Louis Pradel of Bron, Cardiology
Department, Lyon, France
(Morel) University Hospital of Strasbourg, Cardiology Department,
Strasbourg, France
(Gerbaud) Hospital Haut Leveque, Cardiology Department, Bordeaux-Pessac,
France
(Lamblin) Lille University Hospital, Cardiology Department, Lille, France
(Roubille) University Hospital of Montpellier, Cardiology Department,
Montpellier, France
Publisher
Oxford University Press
Abstract
Background: Epidemiologic data about cardiogenic shock (CS) are still
poor. Moreover, previous studies focused on ischemic CS, forgetting all
part of the CS encountered in clinical practice. We conducted a large,
prospective and multicentric registry of non-selected CS patients admitted
in cardiac and general critical care units. Method(s): FRENSHOCK
registry (Clinicaltrials.gov: NCT02703038) was a multicenter survey
realized during a 6 month period (April to October 2016) in France.
Patients were prospectively included regardless of the CS etiology if they
met at least one criterion for each of the following three points: (1) a
low cardiac output defined by a systolic blood pressure (SBP) <90mmHg
and/or the need of amines to maintain SBP >90 mmHg, or a low cardiac
output defined by cardiac index <2.2L/min/m2 on
echocardiography or right heart catheterization; (2) an elevation of the
left and/or right heart pressures defined by clinical or radiological, or
biological (NtproBNP/BNP), or echocardiographical, or invasive
hemodynamics overload signs; and (3) a clinical (oliguria, marbling,
confusion) and/or biological hypoperfusion (lactates >2mmol/L, hepatic
failure, renal failure). Result(s): 772 patients were included in 48
centers (male 71.5%, mean age of 65.7y +/-14.9). Comorbidities were
classical: previous coronary revascularization 26.2%, history of extra
cardiac arterial disease 14.8%, previous renal failure 21.3% and COPD
6.5%. Cardiovascular risk factors included diabetes (28.2%), active
tobacco (27.8%), dyslipidemia (35.2%) and hypertension (47.2%). 56% were
known for previous cardiomyopathy (especially 29.8% ischemic origin, 10.1%
idiopathic, valvular 8.4%). CS etiology often associated several triggers
but ischemic was retained for only 36.4% (n=281) of patients with type 1
infarction for 17.4% (n=134). Non-ischemic trigger factors were
predominant (n=491; 63.9%): supra ventricular (13.2%) and ventricular
arrythmia (12.6%), infection (11.9%), iatrogenic (6.1%), conductive
disorders (2.3%), non-observance (3.5%), and others (13.7%). At admission
median SBP was 101.2 mmHg +/-25.2. Sinusal rhythm was present in only
52.1%. Right heart failure signs were present in 49.2% and left signs in
71.9% (Killip IV for 48.7%). Biological analysis found signs of
hypoperfusion with high lactate (3.0 95% CI [2.0-4.8]), renal (eGFR
49.6+/-26.8 ml/min/m2) and hepatic alteration (ASAT 90.0 UI/ml, 95% IC
[39-300]; Prothrombin time 57.1+/-25.4%). Biventricular failure was
frequent (LVEF was 26.3% +/-13.4; TAPSE 13.4mm +/-5). When realized
(n=399; 51.7%) coronarography was pathological in 81.3% (n=321)
(monotroncular 31.1%, bitroncular 35% and tritroncular 33.9%). A culprit
lesion was found in 78.8% and concern LVA in 48.4%, RCA in 22.6% and left
main in 15.3%. Conclusion(s): This large multicentric and prospective
registry confirmed the heterogeneity of CS in terms of etiology,
presentation and prognosis with a predominance of non-ischemic CS in
practice.

<80>
Accession Number
627247534
Title
The five-year clinical and angiographic follow-up outcomes of
intra-coronary transfusion of circulation-derived CD34+ cells for patients
with end-cad unsuitable for coronary intervention-phase i trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1362), 2018. Date of
Publication: August 2018.
Author
Sung P.H.; Yip H.K.
Institution
(Sung, Yip) Chang Gung Memorial Hospital Kaohsiung, Division of
Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (Republic
of China)
Publisher
Oxford University Press
Abstract
Objective: This study investigated the clinical and angiographic long-term
out-comes of intra-coronary transfusion of circulation-derived CD34+ cells
for pa-tients with end-stage diffuse coronary artery disease (EnD-CAD)
unsuitable for coronary intervention. Design and setting: A single-center
prospective randomized double-blinded phase I clinical trial. Thirty-eight
patients undergoing stem cell therapy were ran-domly allocated into groups
1 (1.0 x 107 cells/each vessel; n=18) and 2 (3.0 x 107 cells/each vessel;
n=20). Patient(s): Those with EnD-CAD were unsuitable for
percutaneous and surgical coronary revascularization.
 Intervention(s): Intracoronary delivery of circulation-derived CD34+
cells Measurements and Main Results: Five-year clinical,
echocardiographic, and angiographic outcomes were compared between
survivors and non-survivors. By the end of 5-year follow-up, the survival
rate and major-adverse car-dio/cerebrovascular event were 78.9% (30/38)
and 36.8% (14/38), respectively. During follow-up period, 31.6% (12/38)
patients received coronary stenting for reason of sufficient target vessel
size grown-up after stem cell treatment. En-dothelial function measured by
flow-mediated dilatation (FMD) was significantly reduced in the
non-survivors than the survivors (p=0.039). Wimasis image anal-ysis of
angiographic findings showed that the angiogenesis was significantly and
progressively increased from baseline to 1 and 5 years (all p<.001). The
3D echocardiography showed left ventricular ejection fraction (LVEF)
increased from baseline to 1 year, and then remained stable from 1 to 5
years, whereas LV chamber diameter (i.e., end-diastolic/end-systolic)
exhibited an opposite pattern to LVEF among the survivors. The clinical
scores for angina and heart failure were significantly progressively
reduced from baseline to 1 and 5 years (all p<.001). Conclusion(s):
CD34+ cell therapy for EnD-CAD patients had persistently longterm effects
on improvement of LV systolic function, angina pectoris and heart failure
as well as amelioration of LV remodeling Funding Acknowledgements: Chang
Gung Memorial Hospital and Chang Gung University.

<81>
Accession Number
627247464
Title
The prevalence of leaflet thrombosis in intra-versus supra-annular
transcatheter aortic valve prostheses.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1081-1082), 2018. Date
of Publication: August 2018.
Author
Rashid H.; Amiruddin A.; Be K.K.; Nasis A.; Gooley R.; Cameron J.; Brown
A.
Institution
(Rashid, Amiruddin, Be, Nasis, Gooley, Cameron, Brown) Monash Health,
Monash Heart, Melbourne, Australia
Publisher
Oxford University Press
Abstract
Introduction: Leaflet thrombosis (LT) defined by computed tomography (CT)
following transcatheter aortic valve replacement (TAVR) has been
increasingly recognised. The neo-sinus plays an important role in the
development of LT. Intra-annular valves (IAV) have a larger neo-sinus when
compared to supra-annular valves (SAV), and has been associated with
larger thrombus burden. The prevalence of LT with IAV and SAV in a larger,
diverse cohort is unknown. Method(s): We performed a systematic
review to assess the prevalence of LT in IAV versus SAV in TAVR prostheses
only. 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.
 Result(s): Overall, 1,644 patients were included from 7 observational
studies and [Figure Presented] the 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%. LToccurred morefre-quently in IAVthan SAV
(13.5% vs 7%, p=0.02). Sub-analysis of IAVvs. SAV with the exclusion of
the Portico valve was performed to ensure results were not influ-enced by
this valve system and revealed IAV still had higher rates of LT (12.1% vs
7%, p=0.05). Conclusion(s): In summary, IAV prostheses appear to be
associated with higher rates of LT when compared with SAV.

<82>
Accession Number
627247455
Title
Impact of fractional flow reserve on surgical coronary revascularization
strategy.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 1145-1146), 2018. Date
of Publication: August 2018.
Author
Fournier S.; Toth G.G.; De Bruyne B.; Kala P.; Ribichini F.L.; Casselman
F.L.; Ramos R.; Piroth Z.; Pellicano M.; Penicka M.; Mates M.; Van Praet
F.; Stockman B.; Degriek I.; Barbato E.
Institution
(Fournier, De Bruyne, Casselman, Pellicano, Penicka, Van Praet, Stockman,
Degriek, Barbato) Cardiovascular Center Aalst, Aalst, Belgium
(Toth) Graz University of Technology, Graz, Austria
(Kala) University Hospital Brno, Brno, Czechia
(Ribichini) University of Verona, Verona, Italy
(Ramos) University of Lisbon, Lisbon, Portugal
(Piroth) Hungarian Academy of Sciences, Budapest, Hungary
(Mates) Na Homolce Hospital, Prague, Czechia
Publisher
Oxford University Press
Abstract
Background: Fractional flow reserve (FFR) during angiography is associated
with hemodynamic reclassification of coronary disease severity with
significant impact on revascularization strategies. However, no
prospective data exist on the impact of FFR on surgical coronary
revascularization strategies. Method(s): GRAFFITI is a
single-blinded, open-label, prospective 1:1 random-ized controlled
multi-center pilot trial comparing FFR-guided versus angiography-guided
coronary artery bypass graft surgery. Patients with a significantly
dis-eased left anterior descending or left main stem and at least one more
major coronary artery with angiographically intermediate stenosis were
randomized to angiography-guided or to FFR-guided group. FFR was measured
in the intermediate stenoses in both groups, but disclosed to the surgeons
only if patients were allotted to the FFR-guided strategy. Patients in the
angiography-guided group were operated following the initial
angiogram-based strategy. Patients in the FFR-guided group were operated
according to the hemodynamic stenosis significance by FFR. In this latter
group, surgeons had to detail the intended procedure before and after
disclosing the FFR values. Result(s): After randomization, 88
patients were included into the FFR-guided group. Among them disclosure of
FFR has changed bypass strategy in 55%. Disclosing FFR was associated with
a significant reduction in on-pump surgery (81% vs. 69% after FFR
disclosure, p=0.006) and in total number of bypass grafts per patient (3
[2; 3] vs. 2 [2; 3] after FFR disclosure, p=0.018). Among the 64 vessels
for which no revascularization was indicated based on the initial
angiogram, 16 (25%) were finally bypassed due to significant FFR. Among
108 lesions for which SVG implantation was indicated based on the initial
angiogram, 25 (23%) were not bypassed after disclosing a preserved FFR
value; while among 128 lesions for which arterial graft was indicated, 15
(12%) were eventually not bypassed. At 1-year follow-up, outcomes were
similar between patients with at least 1 change in strategy according to
FFR and patient without any change in therapeutic decision
 Conclusion(s): Change of procedural strategies after FFR assessment
occurs in more than half of the cases, significantly simplifying the
surgical protocol and without untoward impact on 1-year clinical outcome.

<83>
Accession Number
627247433
Title
Prognostic implications of pathogenic truncating variants in the TTN gene.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 876), 2018. Date of
Publication: August 2018.
Author
Cicerchia M.N.; Pena Pena M.L.; Salazar Mendiguchia J.; Ochoa J.;
Lamounier Junior A.; Trujillo J.P.; Palomino Doza J.; Cardenar Reyes I.;
Garcia Giustiniani D.; Fernandez Fernandez X.; Barraza Garcia J.;
Rodriguez Garrido J.; Barriales Villa R.; Ortiz-Genga M.; Monserrat
Iglesias L.
Institution
(Cicerchia, Salazar Mendiguchia, Ochoa, Lamounier Junior, Trujillo,
Cardenar Reyes, Garcia Giustiniani, Barraza Garcia, Ortiz-Genga, Monserrat
Iglesias) Health in Code, A Coruna, Spain
(Pena Pena) University Hospital of Virgen Del Rocio, Seville, Spain
(Palomino Doza) University Hospital 12 de Octubre, Madrid, Spain
(Fernandez Fernandez) Instituto Universitario de Ciencias de la Salud, A
Coruna, Spain
(Rodriguez Garrido, Barriales Villa) Hospital General A Coruna, A Coruna,
Spain
Publisher
Oxford University Press
Abstract
Prognostic implications of pathogenic truncating variants in the TTN gene
Background: TTN truncating mutations are the most common genetic cause of
dilated cardiomyopathy. However, few data about prognosis is available in
genetic carriers. Purpose(s): To evaluate the prognostic implications
of truncating pathogenic variants in the TTN gene. Method(s): Through
a systematic literature research, we collected in a dedicated database
clinical and genetic data about all the carriers and affected relatives of
families with nonsense and frameshift pathogenic or likely pathogenic
variants in TTN gene, according to the ACMG criteria. We evaluated
available follow up data and constructed Kaplan-Meier survival curves free
from cardiovascular death (sudden death, heart transplant, heart failure
death, appropriate implantable cardiac defibrillator discharge and stroke
related death). Long-rank test was used to compare event-free survival
time between males and females. Result(s): 573 individuals were
included in the final analysis (354 males; 204 females, 15 unknown sex),
carrying 347 different variants (186 frameshift; 161 nonsense). 266 were
index cases and 307 first-degree relatives. 357 had titin truncating
variants phenotypes: 309 dilated cardiomyopathy; 28 muscular diseases; 20
isolated left ventricular non-compaction. Of the remaining, 58 were
healthy carriers, 97 had not phenotypic data, and 61 had unrelated
phenotypes to the one expected. 112 patients suffered events: 63 sudden
deaths (46 males; 17 females), 22 transplants (19 males; 3 females), 23
heart failure deaths (11 males; 12 females) and 4 stroke-related deaths (2
men; 2 women). No cardiac defibrillator discharges were reported.
Incidence of cardiovascular death was higher in males than females
(p<0.01). Annual incidence of cardiovascular death between ages 30 to 70
was 1.3%/year in males (almost 60% of these were sudden death) and
0.6%/year in females. (Figure presented) Conclusion(s): TTN
truncating variants are associated with a relevant risk of cardiovascular
death, which is higher in males, especially after age 30. More than 50% of
the events were sudden deaths, suggesting that ICDs could have been
under-indicated in this population.

<84>
Accession Number
627234012
Title
Checkpoint inhibitor therapy for cancer in solid organ transplantation
recipients: An institutional experience and a systematic review of the
literature.
Source
Journal for ImmunoTherapy of Cancer. 7 (1) (no pagination), 2019. Article
Number: 106. Date of Publication: 16 Apr 2019.
Author
Abdel-Wahab N.; Safa H.; Abudayyeh A.; Johnson D.H.; Trinh V.A.; Zobniw
C.M.; Lin H.; Wong M.K.; Abdelrahim M.; Gaber A.O.; Suarez-Almazor M.E.;
Diab A.
Institution
(Abdel-Wahab, Suarez-Almazor) Section of Rheumatology and Clinical
Immunology, Department of General Internal Medicine, University of Texas,
MD Anderson Cancer Center, Houston, TX, United States
(Abdel-Wahab) Department of Rheumatology and Rehabilitation, Faculty of
Medicine, Assiut University Hospitals, Assiut, Egypt
(Safa, Johnson, Trinh, Zobniw, Wong, Diab) Department of Melanoma Medical
Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX,
United States
(Abudayyeh) Section of Nephrology, Division of Internal Medicine,
University of Texas, MD Anderson Cancer Center, Houston, TX, United States
(Lin) Department of Biostatistics, University of Texas, MD Anderson Cancer
Center, Houston, TX, United States
(Abdelrahim, Gaber) Houston Methodist Hospital, Houston, TX, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Checkpoint inhibitors (CPIs) have revolutionized the treatment
of cancer, but their use remains limited by off-target inflammatory and
immune-related adverse events. Solid organ transplantation (SOT)
recipients have been excluded from clinical trials owing to concerns about
alloimmunity, organ rejection, and immunosuppressive therapy. Thus, we
conducted a retrospective study and literature review to evaluate the
safety of CPIs in patients with cancer and prior SOT. Method(s): Data
were collected from the medical records of patients with cancer and prior
SOT who received CPIs at The University of Texas MD Anderson Cancer Center
from January 1, 2004, through March 31, 2018. Additionally, we
systematically reviewed five databases through April 2018 to identify
studies reporting CPIs to treat cancer in SOT recipients. We evaluated the
safety of CPIs in terms of alloimmunity, immune-related adverse events,
and mortality. We also evaluated tumor response to CPIs. Result(s):
Thirty-nine patients with allograft transplantation were identified. The
median age was 63 years (range 14-79 years), 74% were male, 62% had
metastatic melanoma, 77% received anti-PD-1 agents, and 59% had prior
renal transplantation, 28% hepatic transplantation, and 13% cardiac
transplantation. Median time to CPI initiation after SOT was 9 years
(range 0.92-32 years). Allograft rejection occurred in 41% of patients
(11/23 renal, 4/11 hepatic, and 1/5 cardiac transplantations), at similar
rates for anti-CTLA-4 and anti-PD-1 therapy. The median time to rejection
was 21 days (95% confidence interval 19.3-22.8 days). There were no
associations between time since SOT and frequency, timing, or type of
rejection. Overall, 31% of patients permanently discontinued CPIs because
of allograft rejection. Graft loss occurred in 81%, and death was reported
in 46%. Of the 12 patients with transplantation biopsies, nine (75%) had
acute rejection, and five of these rejections were T cell-mediated. In
melanoma patients, 36% responded to CPIs. Conclusion(s): SOT
recipients had a high allograft rejection rate that was observed shortly
after CPI initiation, with high mortality rates. Further studies are
needed to optimize the anticancer treatment approach in these
patients. Copyright © 2019 The Author(s).

<85>
[Use Link to view the full text]
Accession Number
627082606
Title
Neurocognitive function after cardiac surgery from phenotypes to
mechanisms.
Source
Anesthesiology. 129 (4) (pp 829-851), 2018. Date of Publication: 2018.
Author
Berger M.; Terrando N.; Kendall Smith S.; Browndyke J.N.; Newman M.F.;
Mathew J.P.
Institution
(Berger, Terrando, Kendall Smith, Browndyke, Newman, Mathew) Department of
Anesthesiology, Division of Geriatric Behavioral Health, Department of
Psychiatry and Behavioral Sciences, Duke University Medical Center,
Durham, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
For half a century, it has been known that some patients experience
neurocognitive dysfunction after cardiac surgery; however, defining its
incidence, course, and causes remains challenging and controversial.
Various terms have been used to describe neurocognitive dysfunction at
different times after cardiac surgery, ranging from "postoperative
delirium" to "postoperative cognitive dysfunction or decline." Delirium is
a clinical diagnosis included in the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5). Postoperative cognitive
dysfunction is not included in the DSM-5 and has been heterogeneously
defined, though a recent international nomenclature effort has proposed
standardized definitions for it. Here, the authors discuss
pathophysiologic mechanisms that may underlie these complications, review
the literature on methods to prevent them, and discuss novel approaches to
understand their etiology that may lead to novel treatment strategies.
Future studies should measure both delirium and postoperative cognitive
dysfunction to help clarify the relationship between these important
postoperative complications. Copyright © 2018 Lippincott Williams
and Wilkins. All Rights Reserved.

<86>
Accession Number
2001848810
Title
Meta-analysis of transcatheter aortic valve implantation for bicuspid
versus tricuspid aortic valves.
Source
Journal of Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; 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
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: We performed meta-analysis and meta-regression of
transcatheter aortic valve implantation (TAVI) for the bicuspid aortic
valve (B-AV) versus the tricuspid aortic valve (T-AV). Method(s):
MEDLINE and EMBASE were searched through June 2018 using PubMed and OVID.
We included comparative studies of TAVI patients with B-AV versus T-AV
reporting at least one of postprocedural transcatheter valve regurgitation
(TVR)/pacemaker implantation (PMI) incidence and early (30-day or
in-hospital)/late (including early) mortality. For each study, crude
(unadjusted) data regarding TVR/PMI incidence and early/late mortality in
both the B-AV and T-AV groups were used to generate risk ratios (RRs).
Study-specific estimates were combined in the random-effects model. Using
meta-regression, we assessed potential confounders identified in
preliminary meta-analysis. Result(s): We identified 12 eligible
studies including a total of 1045 B-AV and 4069 T-AV patients. Pooled
analysis demonstrated an association of B-AV with a statistically
significant increase in TVR incidence (RR, 1.42; p = 0.006) but no
statistically significant difference in PMI incidence (p = 0.54) and
30-day (p = 0.11)/midterm (1-year to 2-year) mortality (p = 0.99) between
patients with B-AV and those with T-AV. All meta-regression coefficients
of 6 identified potential confounders (age, mean aortic valve gradient,
aortic valve area, left ventricular ejection fraction, aortic
calcification, and B-AV types) for the outcomes (TVR/PMI incidence and
early/late mortality) were statistically non-significant.
 Conclusion(s): Postprocedural PMI incidence and 30-day/midterm
(1-year to 2-year) mortality after TAVI may be similar between patients
with B-AV and those with T-AV despite the significant association of B-AV
with increased postprocedural TVR incidence. Copyright © 2019
Japanese College of Cardiology

<87>
Accession Number
2001848688
Title
Why should we extend transcatheter aortic valve implantation to low-risk
patients? A comprehensive review.
Source
Archives of Cardiovascular Diseases. (no pagination), 2019. Date of
Publication: 2019.
Author
Overtchouk P.; Prendergast B.; Modine T.
Institution
(Overtchouk, Modine) Department of Cardiology and Cardiovascular Surgery,
Centre Hospitalier Regional et Universitaire de Lille, Lille 59000, France
(Prendergast) Department of Cardiology, St Thomas' Hospital, London SE1
7EH, United Kingdom
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Within the past decade, transcatheter aortic valve implantation (TAVI) has
become established as the optimal treatment option for elderly, inoperable
and high-risk patients with severe aortic stenosis, and is now recommended
by international guidelines. Randomized controlled trials have
demonstrated the non-inferiority of TAVI to open surgery in
intermediate-risk patients and, most recently, in low-risk patients.
Further randomized controlled trials are underway, but existing studies
have already provided reassuring data in this cohort, and TAVI is offered
routinely to younger and lower-risk patients in numerous centers.
Improvements in the design of devices and delivery systems, accompanied by
increased operator experience, have dramatically improved the safety of
the procedure, and further expansion into low-risk groups seems inevitable
once concerns about valve durability and device cost have been addressed.
In this article, we provide a review of the existing literature, and
estimate the clinical impact of TAVI in low-risk patients. Abbreviated
title: Why should we extend TAVI to low-risk patients? Copyright
© 2019

<88>
Accession Number
2001845758
Title
Combined profiles derived from cardiovascular risk factors,
health-promoting lifestyle, and post-traumatic stress disorder symptoms.
Source
Clinical Epidemiology and Global Health. (no pagination), 2019. Date of
Publication: 2019.
Author
Ahmadi M.; Komasi S.
Institution
(Ahmadi) Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Komasi) Clinical Research Development Center, Imam Reza Hospital,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
Publisher
Elsevier B.V.
Abstract
Background: Obviously, determining and organizing patients' health profile
is important after a cardiac event or procedure. Therefore, the present
study was conducted with the aim of cluster analysis of the post-traumatic
stress disorder (PTSD) symptoms, illness risk factors, and
health-promoting lifestyle profile (HPLP) in patients with heart disease.
 Method(s): This cross-sectional study was conducted on 201 patients
with established heart disease in a hospital in the west of Iran. The
participants were randomly selected during January-May 2017. The
self-report checklist for demographics and cardiovascular risk factors,
the Health-Promoting Lifestyle Profile II (HPLP-II), and the NSESSS-PTSD
were the measurement tools. The results were analyzed using two-stage
cluster analysis (TSCA), one-way ANOVA, and Bonferroni post hoc test.
 Result(s): The mean age of patients (50.2% female) was 53.4 +/- 11.9
years old. TSCA provided the three clusters: (A) samples with poor
lifestyle/high PTSD (36.3%); (B) samples with a relatively poor
lifestyle/moderate PTSD (20.9%); and (C) samples with a relatively good
lifestyle/mild PTSD (42.8%). In most variables, there is a significant
difference between clusters A and C (p < 0.05). Conclusion(s): The
profiles of risk factors, lifestyle, and experienced PTSD symptoms are not
the same for all patients with heart disease. So, specialists should focus
on high-risk groups through the design and delivery of appropriate
interventions and cardiac rehabilitation programs tailored to the unique
Profiles. Copyright © 2019

<89>
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.

<90>
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.

<91>
Accession Number
627231639
Title
Thromboelastography-guided therapy improves patient blood management and
certain clinical outcomes in elective cardiac and liver surgery and
emergency resuscitation: a systematic review and analysis.
Source
Journal of thrombosis and haemostasis : JTH. (no pagination), 2019. Date
of Publication: 04 Apr 2019.
Author
Dias J.D.; Sauaia A.; Achneck H.E.; Hartmann J.; Moore E.E.
Institution
(Dias) SignySwitzerland
(Sauaia) Department of Health Systems Management and Policy, University of
Colorado Denver, Denver, CO, United States
(Achneck, Hartmann) Haemonetics Corporation, Braintree, MA, United States
(Moore) Department of Surgery, University of Colorado Denver, Denver, CO,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Thromboelastography (TEG 5000/6s Thrombelastograph Hemostasis
Analyzer; Haemonetics , Braintree, MA) is a point-of-care system designed
to monitor and analyze the entire coagulation process in real time. TEG
-guided therapy has been shown to be valuable in a variety of surgical
settings. OBJECTIVE(S): While guidelines recommend viscoelastic
monitoring for the management of perioperative bleeding, there are no
meta-analyses specifically evaluating the effects of TEG -guided
transfusion on patient outcomes. PATIENTS/METHODS: We searched MEDLINE
(PubMed) and EMBASE for original articles using TEG versus control in a
perioperative setting for inclusion in this systematic review. We
identified nine eligible randomized controlled trials (RCTs) in two
elective surgery settings (cardiac surgery and liver surgery), but only
one RCT in the emergency setting. RESULT(S): In the elective surgery
study meta-analysis, platelet (p=0.004), plasma (p<0.001) and red blood
cell transfusion (p=0.14), operating room length of stay (LoS) (p=0.005),
intensive care unit LoS (p=0.04) and bleeding rate (p=0.002) were reduced
with TEG -guided transfusion versus control. Although blood product use
was reduced, rates of mortality remained comparable between TEG and
control groups. In the emergency setting evaluation, the RCT reported
lower mortality in the TEG group versus the controls (p=0.049). In
addition, there was a significant reduction in platelet and plasma
transfusion (p=0.04 and p=0.02, respectively), and the number of
ventilator-free days increased in the TEG group compared with the controls
(p=0.10). CONCLUSION(S): This systematic review and analysis indicate
that TEG -guided hemostatic therapy can enhance blood product management
and improve key patient outcomes, including LoS, bleeding rate and
mortality. This article is protected by copyright. All rights reserved.

<92>
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.

<93>
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.

<94>
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).

<95>
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).

<96>
Accession Number
2000644715
Title
Feasibility of initiating early enteral nutrition after congenital heart
surgery in neonates and infants.
Source
Clinical Nutrition ESPEN. 25 (pp 100-102), 2018. Date of Publication: June
2018.
Author
Kalra R.; Vohra R.; Negi M.; Aggarwal N.; Aggarwal M.; Joshi R.
Institution
(Kalra, Vohra, Negi, Joshi, Aggarwal, Aggarwal, Joshi) Pediatric Cardiac
Sciences, Sir Ganga Ram Hospital, New Delhi 110060, India
Publisher
Elsevier Ltd
Abstract
Objective: To assess the feasibility of initiating enteral nutrition
support with first 24 h of congenital heart repairs in neonates and
Infants and its impact on outcomes following surgery. Design(s): It
is a prospective randomized control single blind study. Setting(s):
It is a single centre prospective study carried out in a tertiary care
centre at Pediatric cardiac intensive care unit. Patient(s): All
patients with the cyanotic congenital heart disease with increase
pulmonary blood flow, weighing less than 5 kg and undergoing congenital
heart repair during the study period were included in the study. Patients
with single ventricle status, those undergoing palliative procedures (PA
band), open chest, requiring ECMO before leaving operating room, having
any other contraindication for starting enteral feeding or those who
refuse for consent were excluded from study. Intervention(s): The
patients were randomized into two groups. Group 1 received trophic feeds
(10-20 ml/kg/day) starting 4-6 h after surgery while feeds children in
group 2 were kept NPO and received feeds after 48 h after surgery.
 Measurements and Main Results: 15 children enrolled in both the
groups. Both pre-operative and intraoperative variables were comparable in
both the groups. There was no complication (vomiting, diarrhea, NEC, bowel
necrosis) noted in the children who received feeds after surgery. Mean
duration of mechanical ventilation in the feeds group was 58.2 +/- 4.71 h,
which was less then significantly less than those in the NPO group (P
value 0.05). Similarly, duration of ICU stay was only 179.04 +/- 41.28 h
in feeds group as compared to 228.72 +/- 85.44 h in the NPO group.
 Conclusion(s): Neonates and Infants tolerate feeds immediately
following congenital heart repairs. Moreover, feeds appear to decrease
duration of mechanical ventilation and duration of ICU stay. Copyright
© 2018 European Society for Clinical Nutrition and Metabolism

<97>
Accession Number
623771658
Title
Maintaining intraoperative normothermia reduces blood loss in patients
undergoing major operations: A pilot randomized controlled clinical trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 126.
Date of Publication: 08 Sep 2018.
Author
Yi J.; Liang H.; Song R.; Xia H.; Huang Y.
Institution
(Yi, Liang, Song, Xia, Huang) Chinese Academy of Medical Science,
Department of Anesthesia, Peking Union Medical College Hospital, 1
Shuaifuyuan, Dongcheng District, Beijing 100730, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Inadvertent intraoperative hypothermia (core
temperature<36degreeC) is a common but preventable adverse event. This
study aimed to determine whether active intraoperative warming reduced
bleeding in patients undergoing major operations: open thoracic surgery
and hip replacement surgery. Methods/Design: The study was a pilot,
prospective, parallel two-arm randomized controlled trial. Eligible
patients were randomly allocated to two groups: passive warming (PW), with
application of a cotton blanket (thermal insulation), or active warming
(AW), with a forced-air warming system. The primary endpoint was
intraoperative blood loss, and secondary endpoints were surgical-site
infection, cardiovascular events, and length of stay in the
post-anesthesia care unit, intensive care unit, and hospital.
 Result(s): Sixty-two patients were enrolled. Forced-air active
warming maintained intraoperative normothermia in all AW subjects, whereas
intraoperative hypothermia occurred in 21/32 (71.8%) of PW patients
(p=0.000). The volume of blood loss was more in the PW group (682+/-426ml)
than in the AW group (464+/-324ml) (p<0.021), and the perioperative
hemoglobin value declined more in the PW group (28.6+/-17.5g/L) than in
the AW group (21.0+/-9.9g/L) (p=0.045). However, there were no difference
in other clinical outcomes between two groups. Conclusion(s):
Intraoperative active warming is associated with less blood loss than
passive warming in open thoracic and hip replacement operations in this
pilot study. Copyright © 2018 The Author(s).

<98>
Accession Number
2000702468
Title
Prolonged operative duration is associated with complications: a
systematic review and meta-analysis.
Source
Journal of Surgical Research. 229 (pp 134-144), 2018. Date of Publication:
September 2018.
Author
Cheng H.; Clymer J.W.; Po-Han Chen B.; Sadeghirad PhD B.; Ferko N.C.;
Cameron C.G.; Hinoul P.
Institution
(Cheng, Clymer, Po-Han Chen, Hinoul) Ethicon Inc, Cincinnati, Ohio, United
States
(Sadeghirad PhD, Ferko, Cameron) Cornerstone Research Group, Burlington,
Ontario, Canada
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: The aim of this study was to systematically synthesize the
large volume of literature reporting on the association between operative
duration and complications across various surgical specialties and
procedure types. Method(s): An electronic search of PubMed, Cochrane
Central Register of Controlled Trials, and Cochrane Database of Systematic
Reviews from January 2005 to January 2015 was conducted. Sixty-six
observational studies met the inclusion criteria. Result(s): Pooled
analyses showed that the likelihood of complications increased
significantly with prolonged operative duration, approximately doubling
with operative time thresholds exceeding 2 or more hours. Meta-analyses
also demonstrated a 14% increase in the likelihood of complications for
every 30 min of additional operating time. Conclusion(s): Prolonged
operative time is associated with an increase in the risk of
complications. Given the adverse consequences of complications, decreased
operative times should be a universal goal for surgeons, hospitals, and
policy-makers. Future study is recommended on the evaluation of
interventions targeted to reducing operating time. Copyright ©
2018 The Authors

<99>
Accession Number
623904994
Title
A method for addressing right upper lobe obstruction with right-sided
double-lumen endobronchial tubes during surgery: A randomized controlled
trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 130.
Date of Publication: 18 Sep 2018.
Author
Yu W.; Wang Z.; Gao D.; Zhang W.; Jin W.; Ma X.; Qi S.
Institution
(Yu, Wang, Gao, Zhang, Jin, Ma, Qi) Department of Anaesthesiology, Fourth
Affiliated Hospital, Harbin Medical University, 37 Yiyuan Road, Harbin
Heilongjiang Province 150001, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A right-sided double-lumen tube (R-DLT) tends to obstruct the
right upper lobe intraoperatively due to anatomical distortion during
surgery. If the R-DLT is poorly matched with the patient's airway anatomy,
it will not be possible to correctly replace the tube with a fiberoptic
bronchoscope (FOB). In our study, we aimed to explore an efficient method
for difficult repositioning caused by right upper lobe occlusion during
surgery: repositioning the R-DLT from the right main bronchus into the
left main bronchus. The current study was designed to assess the efficacy
and safety of this method. Method(s): Sixty adult patients scheduled
to undergo left-sided thoracic surgery were randomly assigned to two
groups. With the patient in the right lateral position during surgery, the
R-DLT was pulled back to the trachea while being rotated 90degree
clockwise; it was then either rotated 90degree clockwise for placement
into the left main bronchus (Group L) or rotated 90degree anticlockwise
and returned to the right main bronchus (Group R) using FOB guidance. The
primary outcomes included clinical performance, which was measured by
intubation time, and the quality of lung collapse. A secondary outcome was
safety, which was determined according to bronchial injury and vocal cord
injury. Result(s): The median intubation time (IQR [range]) required
for placement of a R-DLT into the left main bronchus was shorter than the
time required for placement into the right main bronchus (15.0 s [IQR,
12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups
showed comparable overall results for the quality of lung collapse during
the total period of one-lung ventilation (P = 1.000). The numbers of
patients with bronchial injuries or vocal cord injuries were also
comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for
bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal
cord injuries). Conclusion(s): Repositioning a R-DLT from the right
main bronchus into the left main bronchus had good clinical performance
without causing additional injury. This may be an efficient method for the
difficult repositioning of a R-DLT due to right upper lobe occlusion
during surgery. Trial registration: Chinese Clinical Trial Registry,
ChiCTR-IPR-15006933, registered on 15 August 2015. Copyright ©
2018 The Author(s).

<100>
Accession Number
2000975905
Title
Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult
Cardiac Surgical Patients: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 368-375),
2019. Date of Publication: February 2019.
Author
Krishna S.N.; Chauhan S.; Bhoi D.; Kaushal B.; Hasija S.; Sangdup T.;
Bisoi A.K.
Institution
(Krishna, Chauhan, Kaushal, Hasija) Department of Cardiac Anesthesiology,
Cardio and Neurosciences Center, All India Institute of Medical Sciences,
New Delhi, India
(Bhoi) Department of Anesthesiology, Pain Medicine and Critical Care, All
India Institute of Medical Sciences, New Delhi, India
(Sangdup, Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio
and Neurosciences Center, All India Institute of Medical Sciences, New
Delhi, India
Publisher
W.B. Saunders
Abstract
Objectives: To examine the analgesic efficacy of bilateral erector spinae
plane (ESP) block compared with conventional treatment for pain after
cardiac surgery in adult patients. Design(s): A prospective,
randomized, controlled, single-blinded study. Setting(s):
Single-center tertiary teaching hospital. Participant(s): One hundred
and six adult patients undergoing elective cardiac surgery with
cardiopulmonary bypass. Intervention(s): Patients were randomized
into 2 groups. Patients in group 1 (ESP block group, n = 53) received
ultrasound-guided bilateral ESP block with 3 mg/kg of 0.375% ropivacaine
before anesthesia induction at the T6 transverse process level. Patients
in group 2 (paracetamol and tramadol group, n = 53) received paracetamol
(1 gm every 6 hours) and tramadol (50 mg every 8 hours) intravenously in
the postoperative period. The primary study outcome was to evaluate pain
at rest using an 11-point numeric rating scale (NRS). Mann-Whitney U test
was used for comparing NRS scores. Measurements and Main Results: The
postoperative pain level after extubation and duration of analgesia during
which NRS was < 4 of 10 was compared between the groups. The median pain
score at rest after extubation in group 1 was 0 of 10 until hour 6, 3 of
10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were
significantly less in comparison with group 2 (p = 0.0001). Patients in
group 1 had a significantly higher mean duration of analgesia (8.98 +/-
0.14 hours), during which NRS was < 4 of 10, compared with group 2 (4.60
+/- 0.12 hours) (p = 0.0001). Conclusion(s): ESP block safely
provided significantly better pain relief at rest for longer duration as
compared to intravenous paracetamol and tramadol. Copyright ©
2018 Elsevier Inc.

<101>
Accession Number
2001283379
Title
Haemodynamic profiles of etomidate vs propofol for induction of
anaesthesia: a randomised controlled trial in patients undergoing cardiac
surgery.
Source
British Journal of Anaesthesia. 122 (2) (pp 198-205), 2019. Date of
Publication: February 2019.
Author
Hannam J.A.; Mitchell S.J.; Cumin D.; Frampton C.; Merry A.F.; Moore M.R.;
Kruger C.J.
Institution
(Hannam) Department of Pharmacology and Clinical Pharmacology, Faculty of
Medical and Health Sciences, University of Auckland, Auckland, New Zealand
(Hannam, Mitchell, Cumin, Merry, Moore) Department of Anaesthesiology,
Faculty of Medical and Health Sciences, University of Auckland, Auckland,
New Zealand
(Mitchell) Department of Anaesthesia, Auckland City Hospital, Auckland,
New Zealand
(Frampton) Department of Medicine, Christchurch School of Medicine and
Health Sciences, University of Otago, Dunedin, New Zealand
(Merry, Kruger) Department of Cardiothoracic and ORL Anaesthesia, Auckland
City Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Etomidate is frequently selected over propofol for induction
of anaesthesia because of a putatively favourable haemodynamic profile,
but data confirming this perception are limited. Method(s): Patients
undergoing cardiac surgery were randomised to induction of anaesthesia
with propofol or etomidate. Phase I (n=75) was conducted as open-label,
whereas Phase II (n=75) was double blind. Mean arterial blood pressure
(MAP) and boluses of vasopressor administered after induction were
recorded. The primary endpoint was the area under the curve below baseline
MAP (MAP-time integral) during the 10 min after induction. Secondary
endpoints were the use of vasopressors over the same period, and the
effect of blinding on the aforementioned endpoints. Groups were compared
using regression models with phase and anaesthetist as factors.
 Result(s): The mean difference between etomidate and propofol in the
MAP-time integral below baseline was 2244 mm Hg s (95% confidence
interval, 581-3906; P=0.009), representing a 34% greater reduction with
propofol. Overall, vasopressors were used in 10/75 patients in the
etomidate group vs 21/75 in the propofol group (P=0.38), and in 20/74
patients during the blinded phase vs 11/76 during the open-label phase
(P=0.31). The interaction between randomisation and phase (open-labelled
or blinded) was not significant for either primary (P=0.73) or secondary
endpoints (P=0.90). Conclusion(s): Propofol caused a 34% greater
reduction in MAP-time integral from baseline after induction of
anaesthesia than etomidate, despite more frequent use of vasopressors with
propofol, confirming the superior haemodynamic profile of etomidate in
this context. The proportion of patients receiving vasopressors increased
slightly, albeit not significantly, in both groups in the blinded phase.
Clinical trial registration: Australian and New Zealand Clinical Trials
Registry, ACTRN12614000717651. Copyright © 2018 British Journal
of Anaesthesia

<102>
Accession Number
2001157263
Title
Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane
Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the
Management of Postoperative Thoracotomy Pain After Pediatric Cardiac
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 418-425),
2019. Date of Publication: February 2019.
Author
Kaushal B.; Chauhan S.; Saini K.; Bhoi D.; Bisoi A.K.; Sangdup T.; Khan
M.A.
Institution
(Kaushal, Chauhan) Department of Cardiac Anesthesiology, Cardio and
Neurosciences Center, AIIMS, New Delhi, India
(Saini, Bhoi) Department of Anesthesiology, Pain Medicine and Critical
Care, AIIMS, New Delhi, India
(Bisoi, Sangdup) Department of Cardiothoracic and Vascular Surgery, Cardio
and Neurosciences Center, AIIMS, New Delhi, India
(Khan) Department of Biostatistics, AIIMS, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: The aim of this study was to compare the relative efficacy of
ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves
(Pecs) II block, and intercostal nerve block (ICNB) for the management of
post-thoracotomy pain in pediatric cardiac surgery. Design(s): A
prospective, randomized, single-blind, comparative study. Setting(s):
Single-institution tertiary referral cardiac center. Participant(s):
The study comprised 108 children with congenital heart disease requiring
surgery through a thoracotomy. Intervention(s): Children were
allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All
participants received 3 mg/kg of 0.2% ropivacaine for ultrasound-guided
block after induction of anesthesia. Postoperatively, intravenous
paracetamol was used for multimodal and fentanyl was used for rescue
analgesia. Measurements and Main Results: A modified objective pain
score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12 hours
post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in
the 3 groups. The late mean MOPS was significantly lower in the SAPB group
compared with that of the ICNB group (p < 0.001). The Pecs II group also
had a lower MOPS compared with the ICNB group at 6, 8, and 10 hours (p <
0.001), but the MOPS was comparable at hour 12 (p = 0.301). The
requirement for rescue fentanyl was significantly higher in ICNB group in
contrast to the SAPB and Pecs II groups. Conclusion(s): SAPB and Pecs
II fascial plane blocks are equally efficacious in post-thoracotomy pain
management compared with ICNB, but they have the additional benefit of
being longer lasting and are as easily performed as the traditional
ICNB. Copyright © 2018

<103>
Accession Number
2001155484
Title
Continuous Ropivacaine Infusion Offers No Benefit in Treating
Postoperative Pain After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 378-384),
2019. Date of Publication: February 2019.
Author
Florkiewicz P.; Musialowicz T.; Hippelainen M.; Lahtinen P.
Institution
(Florkiewicz, Musialowicz, Lahtinen) Department of Anesthesia and
Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
(Hippelainen) Heart Center, Kuopio University Hospital, Kuopio, Finland
Publisher
W.B. Saunders
Abstract
Objective: One multimodal pain management method for reducing
postoperative opioid need after cardiac surgery is to continuously infuse
local anesthetic into a median sternotomy wound. Previous studies have
shown contradictory results with this method; therefore, no consensus
exists on its effectiveness. The authors tested the effectiveness of
continuous 0.2% ropivacaine infusion into a sternotomy wound after cardiac
surgery. Design(s): Prospective, randomized, double-blinded,
placebo-controlled trial. Setting(s): Single-institution,
tertiary-level, university hospital. Participant(s): Total of 90
patients undergoing coronary artery bypass grafting or heart valve
surgery. Intervention(s): Patients were assigned randomly to receive
0.2% ropivacaine or placebo into a sternotomy wound for 48 hours
postoperatively. Pain was controlled with standardized oxycodone boluses
after surgery and patient-controlled analgesia oxycodone after extubation;
total oxycodone consumption was recorded. Pain was assessed 3 times daily,
at rest and during deep breathing, with the visual analogue scale.
 Measurements and Main Results: Forty-seven patients were assigned to
receive ropivacaine and 43 to receive placebo infusion. Cumulative
oxycodone consumption was 97 +/- 27 mg with ropivacaine and 96 +/- 29 mg
with placebo (p = 0.813). Pain scores were similar between groups, both at
rest (p = 0.630) and during deep breathing (p = 0.793). Adverse event
incidences and surgical wound infection rates were similar between groups.
 Conclusion(s): Continuous 0.2% ropivacaine infusions at the median
sternotomy wound did not reduce postoperative pain or opioid consumption
during the first 48 hours after cardiac surgery. This technique apparently
was not beneficial for post-sternotomy pain treatment. Copyright
© 2018 Elsevier Inc.

<104>
[Use Link to view the full text]
Accession Number
2001072974
Title
Impact of Isolyte Versus 0.9% Saline on Postoperative Event of Acute
Kidney Injury Assayed by Urinary [TIMP-2]x[IGFBP7] in Patients Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 348-356),
2019. Date of Publication: February 2019.
Author
Lee N.M.; Deriy L.; Petersen T.R.; Shah V.O.; Hutchens M.P.; Gerstein N.S.
Institution
(Lee, Deriy, Petersen, Gerstein) Department of Anesthesiology and Critical
Care Medicine, University of New Mexico School of Medicine, Albuquerque,
N, United States
(Shah) Department of Internal Medicine, Division of Nephrology, University
of New Mexico School of Medicine, Albuquerque, NM, United States
(Hutchens) Department of Anesthesiology and Perioperative Medicine, Oregon
Health & Science University, Portland, OR, United States
Publisher
W.B. Saunders
Abstract
Objective: Administration of excess chloride in 0.9% normal saline (NS)
decreases renal perfusion and glomerular filtration rate, thereby
increasing the risk for acute kidney injury (AKI). In this study, the
effect of NS versus Isolyte use during cardiac surgery on urinary levels
of tissue inhibitor of metalloproteinase 2 and insulin-like growth
factor-binding protein 7 [TIMP-2] x [IGFBP7] and postoperative risk of AKI
were examined. Design(s): Prospective, randomized, and single-blinded
trial. Setting(s): Single university medical center.
 Participant(s): Thirty patients over 18 years without chronic renal
insufficiency or recent AKI undergoing elective cardiac surgery.
 Intervention(s): Subjects were randomized to receive either NS or
Isolyte during the intraoperative period. Measurements and Main
Results: The primary outcome was the change in urinary levels of [TIMP2] x
[IGFBP7] from before surgery to 24 hours postoperatively. Secondary
outcomes included serum creatinine pre- and postoperatively at 24 and 48
hours, serum chloride pre- and postoperatively at 24 and 48 hours, need
for dialysis prior to discharge, and arterial pH measured 24 hours
postoperatively. Sixteen patients received NS and 14 patients received
Isolyte. Three patients developed AKI within the first 3 postoperative
days, all in the NS group. The authors found increases in [TIMP-2] x
[IGFBP7] in both groups. However, the difference in this increase between
study arms was not significant (p = 0.92; -0.097 to 0.107).
 Conclusion(s): The authors observed no change in urinary [TIMP-] x
[IGFBP7] levels in patients receiving NS versus Isolyte during cardiac
surgery. Future larger studies in patients at higher risk for AKI are
recommended to evaluate the impact of high- versus lower-chloride
solutions on the risk of postoperative AKI after cardiac
surgery. Copyright © 2018 Elsevier Inc.

<105>
Accession Number
626053671
Title
Antiplatelet Therapy versus Anticoagulation after Surgical Bioprosthetic
Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Thrombosis and Haemostasis. 119 (2) (pp 328-339), 2019. Date of
Publication: 2019.
Author
An K.R.; Belley-Cote E.P.; Um K.J.; Gupta S.; McClure G.R.; Jaffer I.H.;
Pandey A.; Spence J.; Van Der Wall S.J.; Eikelboom J.W.; Whitlock R.P.
Institution
(An, Um, McClure) Michael G. DeGroote School of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote, Gupta, Jaffer, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote) Division of Cardiology, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Jaffer, Eikelboom, Whitlock) Population Health Research
Institute, Hamilton, ON, Canada
(Gupta, Jaffer, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Pandey) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(Van Der Wall) Department of Thrombosis and Hemostasis, Leiden University
Medical Centre, Leiden University, Leiden, Netherlands
(Eikelboom) Division of Hematology and Thromboembolism, McMaster
University, Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular, Stroke Research Institute, 237
Barton Street East, Hamilton, ON L8L 2X2, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background The optimal antithrombotic therapy after surgical bioprosthetic
aortic valve replacement (BAVR) is uncertain. We conducted a systematic
review and meta-analysis of observational studies and randomized
controlled trials (RCTs) comparing antiplatelet therapy and
anticoagulation in patients with surgical BAVR. Methods We searched
Cochrane CENTRAL, MEDLINE and EMBASE from inception to 3 November 2017 for
studies evaluating antiplatelet therapy versus anticoagulation early after
surgical BAVR. We performed title and abstract screening, full-text
review, risk of bias evaluation and data collection independently and in
duplicate. We evaluated overall quality of evidence using the Grading of
Recommendations Assessment, Development and Evaluation framework, and
pooled data using a random effects model. Results We identified 2 RCTs (n
= 397) and 5 observational studies (n = 2,012) meeting our eligibility
criteria. The mean follow-up for all outcomes was 3 months in RCTs, and 10
months for observational studies. Antiplatelet compared with anticoagulant
therapy demonstrated a trend towards fewer major bleeds in RCTs (relative
risk [RR], 0.34; 95% confidence interval [CI], 0.11-1.04, p = 0.06, I
2 = 0%, low quality evidence), and significantly fewer major
bleeds in observational studies (RR, 0.34; 95% CI, 0.20-0.58, p <= 0.0001,
I 2 = 0%, very low quality evidence), but stroke,
thromboembolism and mortality did not show a significant difference in
either RCTs or observational studies. Conclusion Antiplatelet therapy
demonstrated reduced bleeding risk with no negative effects on stroke,
thromboembolism or mortality compared with anticoagulation therapy after
surgical BAVR. Our confidence in the results is reduced by the low quality
of the available evidence. Copyright © 2019 Georg Thieme Verlag
KG Stuttgart New York.

<106>
Accession Number
2001137503
Title
Shifts of Transfusion Demand in Cardiac Surgery After Implementation of
Rotational Thromboelastometry-Guided Transfusion Protocols: Analysis of
the HEROES-CS (HEmostasis Registry of patiEntS in Cardiac Surgery)
Observational, Prospective Open Cohort Database.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 307-317),
2019. Date of Publication: February 2019.
Author
Kuiper G.J.A.J.M.; van Egmond L.T.; Henskens Y.M.C.; Roekaerts P.M.;
Maessen J.G.; ten Cate H.; Buhre W.F.; Lance M.D.
Institution
(Kuiper, Buhre, Lance) Department of Anaesthesiology and Pain Treatment,
Maastricht University Medical Center, Maastricht, Netherlands
(Kuiper, ten Cate) Laboratory for Clinical Thrombosis and Haemostasis,
Department of Internal Medicine, Cardiovascular Research Institute
Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
(van Egmond, Henskens) Central Diagnostic Laboratory, Cluster for
Haemostasis and Transfusion, Maastricht University Medical Center,
Maastricht, Netherlands
(Roekaerts) Department of Intensive Care Medicine, Maastricht University
Medical Center, Maastricht, Netherlands
(Maessen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(ten Cate) Department of Internal Medicine, Maastricht University Medical
Center, Maastricht, Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: Rotational thromboelastometry (ROTEM)-guided transfusion
algorithms in cardiac surgery have been proven to be successful in
reducing blood loss in randomized controlled trials. Using an
institutional hemostasis registry of patients in cardiac surgery
(HEROES-CS), the authors hypothesized that the use of ROTEM-guided
transfusion algorithms would save blood products and overall costs in
cardiac surgery in every day practice. Design(s): Observational,
prospective open cohort database. Setting(s): Single-center academic
hospital. Participant(s): Cardiac surgery patients.
 Intervention(s): Implementation of ROTEM-guided bleeding management.
 Measurements and Main Results: A classical-guided algorithm and a
ROTEM-guided algorithm were used for patient blood management in 2
cohorts. Primary outcome was the use and amount of blood products and
hemostatic medication. Secondary outcomes were amount of rethoracotomies,
length of stay, and 30-day mortality. Finally, costs and savings were
calculated. The classical-guided cohort comprised 204 patients, and
ROTEM-guided cohort comprised 151 patients. Baseline characteristics
showed excellent similarities after propensity score matching of 202
patients. Blood loss was lower after ROTEM guidance (p < 0.001). Absolute
risk reduction was 17% for red blood cells (p = 0.024), 12% for fresh
frozen plasma (p = 0.019), and 4% for thrombocyte concentrates (p =
0.582). More tranexamic acid was given, but not more fibrinogen
concentrate, while desmopressin was given less often. Hospital length of
stay was reduced by an overall median of 2 and a mean of 4 days (p <
0.001). Mortality and rethoracotomy rates were not affected. Potential
savings were about 4,800 ($5,630) per patient. Conclusion(s):
Implementation of a ROTEM-guided transfusion algorithm in cardiac surgery
patients reduced the use of blood products and hemostatic medication,
hereby saving costs. Reductions in mortality and rethoracotomy rates could
not be found. Copyright © 2018 The Authors

<107>
Accession Number
627158451
Title
A meta-analysis of randomized controlled trials to compare long-term
clinical outcomes of bioabsorbable polymer and durable polymer
drug-eluting stents.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 5 (2) (pp
105-113), 2019. Date of Publication: 01 Apr 2019.
Author
Mridha N.; Subhaharan D.; Niranjan S.; Rashid M.K.; Psaltis P.; Singh K.
Institution
(Mridha, Subhaharan, Niranjan, Singh) Department of Cardiology, Gold Coast
University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
(Mridha, Niranjan, Singh) Department of Medicine, Griffith University,
Parklands Dr, Southport, QLD 4215, Australia
(Mridha, Subhaharan, Niranjan, Singh) School of Medicine, Bond University,
14 University Dr, Robina, QLD 4226, Australia
(Rashid) Department of Medicine, Mc Master University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Psaltis, Singh) Department of Medicine, University of Adelaide, North
Terrace, Adelaide, SA 5000, Australia
(Psaltis) Department of Medicine, South Australian Health and Medical
Research Institute, North Terrace, Adelaide, SA 5000, Australia
Publisher
Oxford University Press
Abstract
Aims The durable polymer (DP) of a drug-eluting stent (DES) serves no
function once drug elution is complete. To ascertain the benefits of
bioabsorbable polymer (BP) over DP-DESs requires a longer follow-up
period, to overcome the time taken for polymer absorption. The primary aim
of this meta-analysis was to compare the safety and efficacy of BP-DES
with the DP-DES over mid (2 years) to long-term (3-5 years) follow-up.
Methods and results A thorough computer-based search was performed using
Ovid MEDLINE, EMBASE, Google Scholar, and PubMed databases. We only
included randomized controlled studies comparing clinical outcomes between
BP-DESs and DP-DESs. Only studies where data were available for a minimum
of 2 years were included. A separate analysis of 2-year outcomes and 3- to
5-year outcomes were conducted. Data from 6 and 8 studies were included in
3- to 5-year and 2-year follow-up, respectively. There were no differences
between stent groups in cardiac mortality, stent thrombosis (ST), target
lesion revascularization, target vessel failure, and reinfarction rates
for either 2-year or 3- to 5-year follow-up. Subgroup analysis according
to strut thickness (<100 mum, >100 mum) of BP-DES demonstrated similar
results. The analyses of ST and very late ST favoured BP-DESs but did not
reach statistically significant level. Conclusion There were no
differences in clinical outcomes between BP-DESs and DP-DESs over mid- and
long-term follow-up. Copyright © Published on behalf of the
European Society of Cardiology. All rights reserved.

<108>
Accession Number
2000990084
Title
Effect of Dexmedetomidine Infusion on Sublingual Microcirculation in
Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery: A
Prospective Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 334-340),
2019. Date of Publication: February 2019.
Author
Mohamed H.; Hosny H.; Tawadros, MD P.; Elayashy, MD, DESA, FCAI M.;
El-Ashmawi, MD H.
Institution
(Mohamed, Hosny, Tawadros, MD, Elayashy, MD, DESA, FCAI, El-Ashmawi, MD)
Department of Anesthesia and Intensive Care, Kasr Al-Ainy Faculty of
Medicine, Cairo University, London, United Kingdom
(Hosny) Department of Cardiothoracic Anaesthesia, Royal Brompton Hospital,
Sydney Street, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Cardiac surgery is characterized by attenuation of
microcirculatory perfusion. Dexmedetomidine has been proved to attenuate
the microcirculatory derangements evoked by experimental sepsis. The
authors investigated the effects of dexmedetomidine infusion on sublingual
microcirculation in patients undergoing on-pump coronary artery bypass
graft (CABG) surgery. Design(s): Prospective, randomized blinded
study. Setting(s): Tertiary university hospital. Participant(s):
A total of 70 adults undergoing elective on-pump CABG surgery.
 Intervention(s): After a standard general anesthesia, participants
were allocated randomly to receive either propofol continuous intravenous
infusion, 50 to 70 micro g/kg/min, or propofol infusion, 50 to 70
micro g/kg/min plus dexmedetomidine infusion, 0.5 micro g/kg/h,
during cardiopulmonary bypass. Microcirculation was studied with
side-stream dark field imaging at 3 times: immediately before starting
bypass (T0), 30 minutes after initiation of bypass (T1), and 30 minutes
after weaning from bypass (T2). Measurements and Main Results:
Microvascular flow index was significantly higher in the dexmedetomidine
group at T2 compared to the control group (2.20 +/- 0.29 and 1.47 +/-
0.30, respectively; p = 0.001). The perfused vessel density was
significantly higher in the dexmedetomidine group at T2 compared to the
control group (6.1 [3-8.9] mm/mm2 and 3.3 [2.2-4.3] mm/mm2 respectively; p
= 0.01). The total vascular density was significantly higher in the
dexmedetomidine group compared to the control group at T1 and T2 (9.9
[7.8-12.6] mm/mm2 v 7.4 [6.1-9] mm/mm2 p = 0.005; and 9.27 +/- 2.27 mm/mm2
v 7.24 +/- 1.66 mm/mm2 p = 0.003, respectively). Conclusion(s): This
trial demonstrated that dexmedetomidine infusion improved sublingual
microcirculation indices in patients undergoing on-pump CABG
surgery. Copyright © 2018 Elsevier Inc.

<109>
Accession Number
2000988720
Title
Double-Blind, Randomized, Placebo-Controlled Trial Comparing the Effects
of Antithrombin Versus Placebo on the Coagulation System in Infants with
Low Antithrombin Undergoing Congenital Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (2) (pp 396-402),
2019. Date of Publication: February 2019.
Author
Jooste E.H.; Scholl R.; Wu Y.-H.; Jaquiss R.D.B.; Lodge A.J.; Ames W.A.;
Homi H.M.; Machovec K.A.; Greene N.H.; Donahue B.S.; Shah N.; Benkwitz C.
Institution
(Jooste, Scholl, Ames, Homi, Machovec, Greene) Pediatric Anesthesiology,
Department of Anesthesiology, Duke University Medical Center, Durham, NC,
United States
(Wu) Department of Biostatistics and Bioinformatics, Duke University
Medical Center, Durham, NC, United States
(Jaquiss) Department of Cardiovascular and Thoracic Surgery, UT
Southwestern Medical Center and Children's Medical Center, Dallas, TX,
United States
(Lodge) Division of Congenital Cardiac Surgery, Department of
Cardiothoracic Surgery, Duke University Medical Center, Durham, United
Kingdom
(Donahue) Division of Pediatric Cardiac Anesthesiology, Monroe Carell Jr
Children's Hospital, Vanderbilt University Medical Center, Nashville, TN,
United States
(Shah) Division of Pediatric Hematology/Oncology, Duke University Medical
Center, Durham, NC, United States
(Benkwitz) Department of Anesthesia and Perioperative Care, UCSF Benioff
Children's Hospital, San Francisco, CA, United States
Publisher
W.B. Saunders
Abstract
Objectives: To determine whether precardiopulmonary bypass (CPB)
normalization of antithrombin levels in infants to 100% improves heparin
sensitivity and anticoagulation during CPB and has beneficial effects into
the postoperative period. Design(s): Randomized, double-blinded,
placebo-controlled prospective study. Setting(s): Multicenter study
performed in 2 academic hospitals. Participant(s): The study
comprised 40 infants younger than 7 months with preoperative antithrombin
levels <70% undergoing CPB surgery. Intervention(s): Antithrombin
levels were increased with exogenous antithrombin to 100% functional level
intraoperatively before surgical incision. Measurements and Main
Results: Demographics, clinical variables, and blood samples were
collected up to postoperative day 4. Higher first post-heparin activated
clotting times (sec) were observed in the antithrombin group despite
similar initial heparin dosing. There was an increase in heparin
sensitivity in the antithrombin group. There was significantly lower
24-hour chest tube output (mL/kg) in the antithrombin group and lower
overall blood product unit exposures in the antithrombin group as a whole.
Functional antithrombin levels (%) were significantly higher in the
treatment group versus placebo group until postoperative day 2. D-dimer
was significantly lower in the antithrombin group than in the placebo
group on postoperative day 4. Conclusion(s): Supplementation of
antithrombin in infants with low antithrombin levels improves heparin
sensitivity and anticoagulation during CPB without increased rates of
bleeding or adverse events. Beneficial effects may be seen into the
postoperative period, reflected by significantly less postoperative
bleeding and exposure to blood products and reduced generation of
D-dimers. Copyright © 2018 Elsevier Inc.

<110>
Accession Number
624079539
Title
International consensus statement on the peri-operative management of
direct oral anticoagulants in cardiac surgery.
Source
Anaesthesia. 73 (12) (pp 1535-1545), 2018. Date of Publication: December
2018.
Author
Erdoes G.; Martinez Lopez De Arroyabe B.; Bolliger D.; Ahmed A.B.; Koster
A.; Agarwal S.; Boer C.; von Heymann C.
Institution
(Erdoes) Department of Anaesthesiology and Pain Medicine, Inselspital,
University Hospital Bern, University of Bern, Bern, Switzerland
(Martinez Lopez De Arroyabe) Cardiac Anaesthesia Unit, Department of
Emergency, University Hospital of Trieste, Trieste, Italy
(Bolliger) Department of Anaesthesia, Surgical Intensive Care, Prehospital
Emergency Medicine, and Pain Therapy, University Hospital Basel, Basel,
Switzerland
(Ahmed) Department of Anaesthesia, University Hospitals of Leicester NHS
Trust, Leicester, United Kingdom
(Ahmed) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Koster) Institute for Anaesthesiology, Heart and Diabetes Centre NRW,
Ruhr-University Bochum, Bad Oeynhausen, Germany
(Agarwal) Department of Anaesthesia, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Boer) Department of Anaesthesiology, VU University Medical Centre,
Amsterdam, Netherlands
(von Heymann) Department of Anaesthesia, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain,
Berlin, Germany
Publisher
Blackwell Publishing Ltd
Abstract
Despite current recommendations on the management of severe peri-operative
bleeding, there is no pragmatic guidance for the peri-operative monitoring
and management of cardiac surgical patients taking direct oral
anticoagulants. Members of the Transfusion and Haemostasis Subcommittee of
the European Association of Cardiothoracic Anaesthesiology, of their own
volition, performed an independent systematic review of peer-reviewed
original research, review articles and case reports and developed the
following consensus statement. This has been endorsed by the European
Association of Cardiothoracic Anaesthesiology. In our opinion, most
patients on direct oral anticoagulant therapy presenting for elective
cardiac surgery can be safely managed in the peri-operative period if the
following conditions are fulfilled: direct oral anticoagulants have been
discontinued two days before cardiac surgery, corresponding to five
elimination half-live periods; in patients with renal or hepatic
impairment or a high risk of bleeding, a pre-operative plasma level of
direct oral anticoagulants has been determined and found to be below 30
ng.ml-1 (currently only valid for dabigatran, rivaroxaban and
apixaban). In cases where plasma level monitoring is not possible (e.g.
assay was not available), discontinuation for 10 elimination half-live
periods (four days) is required. For FXa inhibitors, a standard
heparin-calibrated anti-Xa level of < 0.1 IU.ml-1 should be
measured, indicating sufficient reduction in the anticoagulant effect.
Finally, short-term bridging with heparin is not required in the
pre-operative period. Copyright © 2018 Association of
Anaesthetists

<111>
[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).

<112>
[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.

<113>
Accession Number
623266506
Title
The effect of high-flow nasal oxygen on hospital length of stay in cardiac
surgical patients at high risk for respiratory complications: a randomised
controlled trial.
Source
Anaesthesia. 73 (12) (pp 1478-1488), 2018. Date of Publication: December
2018.
Author
Zochios V.; Collier T.; Blaudszun G.; Butchart A.; Earwaker M.; Jones N.;
Klein A.A.
Institution
(Zochios) Department of Intensive Care Medicine, University Hospitals
Birmingham National Health Service Foundation Trust, Queen Elizabeth
Hospital Birmingham, University of Birmingham, United Kingdom
(Collier) Medical Statistics Department, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Blaudszun) Department of Anaesthesia, Pharmacology and Intensive Care
Medicine, Geneva University Hospitals, Geneve, Switzerland
(Butchart, Jones, Klein) Department of Cardiothoracic Anaesthesia and
Intensive Care Medicine, Royal Papworth Hospital National Health Service
Foundation Trust, Cambridge, United Kingdom
(Earwaker) Research and Development Department, Royal Papworth Hospital
National Health Service Foundation Trust, Cambridge, United Kingdom
(Jones, Klein) Department of Anaesthesia and Intensive Care, Royal
Papworth Hospital National Health Service Foundation Trust, Cambridge,
United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
There has been increased interest in the prophylactic and therapeutic use
of high-flow nasal oxygen in patients with, or at risk of, non-hypercapnic
respiratory failure. There are no randomised trials examining the efficacy
of high-flow nasal oxygen in high-risk cardiac surgical patients. We
sought to determine whether routine administration of high-flow nasal
oxygen, compared with standard oxygen therapy, leads to reduced hospital
length of stay after cardiac surgery in patients with pre-existing
respiratory disease at high risk for postoperative pulmonary
complications. Adult patients with pre-existing respiratory disease
undergoing elective cardiac surgery were randomly allocated to receive
high-flow nasal oxygen (n = 51) or standard oxygen therapy (n = 49). The
primary outcome was hospital length of stay and all analyses were carried
out on an intention-to-treat basis. Median (IQR [range]) hospital length
of stay was 7 (6-9 [4-30]) days in the high-flow nasal oxygen group and 9
(7-16 [4-120]) days in the standard oxygen group (p=0.012). Geometric mean
hospital length of stay was 29% lower in the high-flow nasal group (95%CI
11-44%, p = 0.004). High-flow nasal oxygen was also associated with fewer
intensive care unit re-admissions (1/49 vs. 7/45; p = 0.026). When
compared with standard care, prophylactic postoperative high-flow nasal
oxygen reduced hospital length of stay and intensive care unit
re-admission. This is the first randomised controlled trial examining the
effect of prophylactic high-flow nasal oxygen use on patient-centred
outcomes in cardiac surgical patients at high risk for postoperative
respiratory complications. Copyright © 2018 The Authors.
Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<114>
Accession Number
620594411
Title
The effect of a peer support intervention on early recovery outcomes in
men recovering from coronary bypass surgery: A randomized controlled
trial.
Source
European Journal of Cardiovascular Nursing. 17 (5) (pp 408-417), 2018.
Date of Publication: 01 Jun 2018.
Author
Colella T.J.F.; King-Shier K.
Institution
(Colella) University Health Network/Toronto Rehab Cardiovascular
Prevention & Rehabilitation Program, Lawrence S. Bloomberg Faculty of
Nursing, University of Toronto, Toronto, ON, Canada
(King-Shier) Faculty of Nursing, Department of Community Health Sciences,
University of Calgary, AB, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background and aim: Examine the effect of a professionally-guided
telephone peer support intervention on recovery outcomes including
depression, perceived social support, and health services utilization
after coronary artery bypass graft surgery (CABG). Method(s): A
randomized controlled trial was conducted with post-coronary artery bypass
graft surgery men (N=185) who were randomized before hospital discharge.
The intervention arm received telephone-based peer support through weekly
telephone calls from a peer volunteer over six weeks, initiated within 3-4
days of discharge. Result(s): Although a significant difference was
detected in pre-intervention depression scores at discharge, there were no
differences between groups in changes in depression scores at six weeks
(p=0.08), 12 weeks (0.49) or over time (p=0.51); and no significant
differences in perceived social support scores over time (p=0.94). At 12
weeks, the intervention group had significantly lower incidence of health
services utilization (family physician (p=0.02) and emergency room
(p=0.04)). Conclusion(s): Healthcare providers need to continue to
investigate novel interventions to enhance social support and reduce
depression in cardiac patients. Copyright © 2017, © The
European Society of Cardiology 2017.

<115>
Accession Number
620560845
Title
Differences between Slovak and Dutch patients scheduled for coronary
artery bypass graft surgery regarding clinical and psychosocial predictors
of physical and mental health-related quality of life.
Source
European Journal of Cardiovascular Nursing. 17 (4) (pp 324-335), 2018.
Date of Publication: 01 Apr 2018.
Author
El-Baz N.; Ondusova D.; Studencan M.; Rosenberger J.; Reijneveld S.A.; van
Dijk J.P.; Middel B.
Institution
(El-Baz) University of Groningen, University Medical Center Groningen,
Department of Epidemiology, Groningen, Netherlands
(El-Baz) Alexandria University, Faculty of Nursing, Department of
Emergency and Critical Care Nursing, Alexandria, Egypt
(El-Baz, Reijneveld, van Dijk, Middel) University of Groningen, University
Medical Center Groningen, Department of Community & Occupational Medicine,
Netherlands
(Ondusova) East Slovakian Institute for Cardiac and Vascular Diseases,
Kosice, Slovakia
(Studencan) Cardiocentre of Teaching Hospital of J.A. Reiman, Presov,
Slovakia
(Rosenberger, van Dijk) Pavol Jozef Safarik University, Faculty of
Medicine, Graduate School Kosice Institute for Society and Health, Kosice,
Slovakia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Differences in health-related quality of life in coronary
artery disease patients and associated factors between patients of central
and western European descent are rarely investigated. We aim to test
differences between Dutch and Slovak health-related quality of life,
whether nationality predicted health-related quality of life and if
standardised beta weights of health-related quality of life determinants
differ across countries. Design(s): An observational multicentre
study at university cardiac centres in the Netherlands and Slovakia.
 Method(s): In 226 coronary artery disease patients, health-related
quality of life was measured by the Short Form Health Survey 36, anxiety
and depression were measured using the Hospital Anxiety and Depression
Scale, and type D personality was assessed with the 14-item Type D Scale.
Multivariate analysis was used to explore the effect of patient
characteristics on the physical and mental component summaries. Estimates
of each predictor's beta value of the physical and mental component
summaries in the Slovak and Dutch patient sample were separately
calculated using the Cummings criterion for comparison of two independent
betas. Result(s): Stronger predictors of physical health-related
quality of life in Slovak patients were educational level, current
smoking, poor functional status, history of diabetes and amount of social
support. In Dutch patients, only more symptoms of depression was a
stronger predictor (P<0.05). Regarding Slovak mental health-related
quality of life, stronger predictors were educational level, current
smoking and amount of social support. Female gender, history of myocardial
infarction and more symptoms of depression were stronger predictors in
Dutch patients (P<0.05). Conclusion(s): Descent and differences
between both populations in determinants of health-related quality of life
should be considered while planning care, follow-up, health education and
rehabilitation. Copyright © 2017, © The European Society of
Cardiology 2017.

<116>
Accession Number
620560223
Title
Quality of life in patients with implantable cardioverter-defibrillator:
systematic review of randomized controlled trials.
Source
European Journal of Cardiovascular Nursing. 17 (3) (pp 196-206), 2018.
Date of Publication: 01 Mar 2018.
Author
da Silva K.R.; Costa R.; Rodrigues C.G.; Schasechter A.; Nobre M.C.;
Passman R.; Mark D.B.
Institution
(da Silva, Costa, Nobre) Heart Institute (InCor), Hospital das Clinicas,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Rodrigues) Global Research and Innovation Network (GRINN), Porto Alegre,
Brazil
(Schasechter, Passman) Northwestern University, Feinberg School of
Medicine, Chicago, IL, United States
(Mark) Duke Clinical Research Institute, Durham, NC, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Implantable cardioverter-defibrillator (ICD) therapy
significantly improves the survival of patients who are at high risk for
sudden cardiac death. However, it is unclear whether this survival is
accompanied by impairment on quality of life (QoL). Objective(s):
This systematic review sought to describe whether ICD therapy, as compared
with standard treatment, can have an impact on QoL outcomes.
 Method(s): Extensive literature searches were carried out in PubMed,
EMBASE, LILACS and Cochrane Library. Eligible studies were randomized
controlled trials (RCTs) of ICD versus medical therapy that reported valid
and reliable measures of QoL. Included studies were reviewed to determine
baseline patient characteristics, mean duration of follow-up,
questionnaires used to assess QoL and association between QoL scores and
ICD shock therapy. Result(s): Seven studies, enrolling a total of
5,701 patients, were included in this review. The analyzed trials showed
conflicting results about the impact of ICD on QoL outcomes. Among the
secondary prevention studies, CIDS reported a clear benefit from ICD and
AVID showed no difference between ICD and amiodarone groups. Of the
primary prevention trials, AMIOVIRT, MADIT II, DEFINITE, and SCD-HeFT
found no evidence of impaired QoL in patients with an ICD. Evidence for an
association between ICD shocks and QoL was mixed and seemed to depend on
the interval between shocks and QoL assessment. Conclusion(s): There
was no evidence of impaired QoL in patients with an ICD. However, ICD
patients must be educated of all possible risks and benefits, including
transitory declines in QoL after ICD shocks. Copyright © 2017,
© The European Society of Cardiology 2017.

<117>
Accession Number
623735451
Title
A randomised trial of serratus anterior plane block for analgesia after
thoracoscopic surgery.
Source
Anaesthesia. 73 (10) (pp 1260-1264), 2018. Date of Publication: October
2018.
Author
Park M.H.; Kim J.A.; Ahn H.J.; Yang M.K.; Son H.J.; Seong B.G.
Institution
(Park, Ahn, Yang, Seong) Department of Anesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
(Kim, Son) Department of Anesthesiology and Pain Medicine, Kangwon
National University School of Graduate Medicine, Chuncheon, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We evaluated the effect of pre-operative serratus anterior plane block on
postoperative pain and opioid consumption after thoracoscopic surgery. We
randomly allocated 89 participants to block with 30 ml ropivacaine 0.375%
(n = 44), or no block without placebo or sham procedure (n = 45). We
analysed results from 42 participants in each group. Serratus anterior
plane block reduced mean (SD) remifentanil dose during surgery, 0.12
(0.06) mg.h-1 vs. 0.16 (0.06) mg.h-1, p = 0.016, and
reduced mean (SD) fentanyl consumption in the first 24 postoperative
hours, 3.8 (1.9) mug.kg-1 vs. 5.7 (1.6) mug.kg-1, p
= 0.000004. Block also reduced the worst median (IQR [range]) pain scores
reported in the first 24 postoperative hours: 6 (5-7 [3-10]) vs. 7 (6-7
[3-10]), p = 0.027. Block decreased dissatisfaction with pain management,
categorised as 'highly unsatisfactory', 'unsatisfactory', 'neutral',
'satisfactory' or 'highly satisfactory': 1/2/21/18/0 vs. 1/14/15/11/1, p =
0.0038. There were no differences in the rates of nausea, vomiting,
dizziness or length of hospital stay. Serratus anterior plane block may be
used to reduce pain and opioid use after thoracoscopic lung
surgery. Copyright © 2018 Association of Anaesthetists

<118>
Accession Number
620755833
Title
Simulation-Based Skill Training for Trainees in Cardiac Surgery: A
Systematic Review.
Source
Annals of Thoracic Surgery. 105 (3) (pp 972-982), 2018. Date of
Publication: March 2018.
Author
Ribeiro I.B.; Ngu J.M.C.; Lam B.-K.; Edwards R.A.
Institution
(Ribeiro, Ngu, Lam) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, Ontario, Canada
(Edwards) Center for Interprofessional Studies and Innovation,
Massachusetts General Hospital Institute of Health Professions, Boston,
Massachusetts, United States
Publisher
Elsevier USA
Abstract
Background: Simulation-based training has been an important part of the
solution to address the shortfalls in cardiac surgery training. This
review was conducted to identify and systematically summarize existing
evidence on outcomes and methodological quality of simulation-based skills
training for cardiac surgery trainees. Method(s): MEDLINE, Embase,
and ERIC (Education Resources Information Center) databases were searched.
Studies included peer-reviewed publications with simulation-based skill
training in cardiac surgery programs with outcome measures of performance.
Data extraction covered the type of skills training, simulator type and
fidelity, the level of trainees, assessment tools, assessors, study design
and its components, strengths and limitations, and elements required for
the Medical Education Research Study Quality Instrument score. The review
followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Result(s): Of 16 studies that met the
criteria, only four (25%) randomized controlled trials were identified,
and the remaining were observational studies. Seven observational studies
(43.7%) were single-group pre-post tests. The mean number of trainees was
20.4 (SD, 14.1). Low-fidelity simulators were used in 13 studies (81.2%).
Most of the studies (81.3%) were high quality based on a Medical Education
Research Study Quality Instrument score of 12 or more. Evidence of
assessment tool validation was absent among all studies. No study outcome
measures were directed to skills transfer to the operating room or patient
outcomes. Overall learning outcomes' effect sizes were consistently high
(2.2; SD, 1.6), with junior residents benefitting most (effect size, 2.8;
SD, 2.2) Conclusion(s): Simulation-based skill training is associated
with improved learning outcomes for cardiac surgery trainees with large
effect sizes, but more behavior-level outcomes are required to fully
assess its value. Copyright © 2018 The Society of Thoracic
Surgeons

<119>
Accession Number
620625700
Title
Cardiac rehabilitation after percutaneous coronary intervention: Results
from a nationwide survey.
Source
European Journal of Cardiovascular Nursing. 17 (3) (pp 273-279), 2018.
Date of Publication: 01 Mar 2018.
Author
Olsen S.J.S.; Schirmer H.; Bonaa K.H.; Hanssen T.A.
Institution
(Olsen) Division of Internal Medicine, University Hospital of North
Norway, Norway
(Olsen, Schirmer, Hanssen) Cardiovascular Research Group, The Arctic
University of Norway, Norway
(Schirmer, Hanssen) Department of Heart Disease, University Hospital of
North Norway, Norway
(Bonaa) Department of Community Medicine, The Arctic University of Norway,
Norway
(Bonaa) Department of Public Health and Nursing, Norwegian University of
Science and Technology, Norway
(Bonaa) Clinic for Heart Disease, St. Olavs University Hospital,
Trondheim, Norway
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aim: The purpose of this study was to estimate the proportion of Norwegian
coronary heart disease patients participating in cardiac rehabilitation
programmes after percutaneous coronary intervention, and to determine
predictors of cardiac rehabilitation participation. Method(s):
Participants were patients enrolled in the Norwegian Coronary Stent Trial.
We assessed cardiac rehabilitation participation in 9013 of these patients
who had undergone their first percutaneous coronary intervention during
2008-2011. Of these, 7068 patients (82%) completed a self-administered
questionnaire on cardiac rehabilitation participation within three years
after their percutaneous coronary intervention. Result(s):
Twenty-eight per cent of the participants reported engaging in cardiac
rehabilitation. Participation rate differed among the four regional health
authorities in Norway, varying from 20%-31%. Patients undergoing
percutaneous coronary intervention for an acute coronary syndrome were
more likely to participate in cardiac rehabilitation than patients with
stable angina (odds ratio 3.2; 95% confidence interval 2.74-3.76). A
multivariate statistical model revealed that men had a 28% lower
probability (p<0.001) of participating in cardiac rehabilitation, and the
odds of attending cardiac rehabilitation decreased with increasing age
(p<0.001). Contributors to higher odds of cardiac rehabilitation
participation were educational level >12 years (odds ratio 1.50; 95%
confidence interval 1.32-1.71) and body mass index>25 (odds ratio 1.19;
95% confidence interval 1.05-1.36). Prior coronary artery bypass graft was
associated with lower odds of cardiac rehabilitation participation (odds
ratio 0.47; 95% confidence interval 0.32-0.70) Conclusion(s): The
estimated cardiac rehabilitation participation rate among patients
undergoing first-time percutaneous coronary intervention is low in Norway.
The typical participant is young, overweight, well-educated, and had an
acute coronary event. These results varied by geographical
region. Copyright © 2017, © The European Society of
Cardiology 2017.

<120>
Accession Number
619323234
Title
The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in
paediatric cardiac surgery: a prospective, randomised trial.
Source
Anaesthesia. 73 (2) (pp 205-215), 2018. Date of Publication: Februaryy
2018.
Author
Oh H.-W.; Lee J.-H.; Kim H.-C.; Kim E.-H.; Song I.-K.; Kim H.-S.; Kim
J.-T.
Institution
(Oh) Department of Anaesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
(Lee, Kim, Kim, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, Dongsan Medical
Centre, Keimyung University College of Medicine, Daegu, South Korea
(Song) Department of Anaesthesiology and Pain Medicine, Asan Medical
Centre, University of Ulsan College of Medicine, Seoul, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We have evaluated the effect of a colloid solution on acute kidney injury
in paediatric cardiac surgery. A total of 195 patients were ramdomly
divided into an hydroxyethyl starch group and a control group. In the
starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte) was
used as the primary fluid for volume resuscitation but was limited to 30
ml.kg-1. In the control group, only crystalloid fluid was used
during the peri-operative period. The incidence of acute kidney injury,
peri-operative transfusion, clinical outcomes and laboratory data were
compared. The incidence of acute kidney injury determined by Paediatric
Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute
Kidney Injury Network (AKIN) criteria were no different between the two
groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using
pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no
differences in clinical outcomes such as mortality, major adverse events,
intensive care unit stay or duration of mechanical ventilation. Clotting
time as measured using rotational thromboelastometry (ROTEM) was
prolonged, and clot firmness after 10 min and maximal clot firmness were
shorter in the starch group compared with the control group after sternal
closure. There was no difference in transfusion between the two groups.
Patients with acute kidney injury had worse clinical courses than those
without acute kidney injury. We conclude that intra-operative use of 6%
hydroxyethyl starch 130/0.4 up to 30 ml.kg-1 was not associated
with postoperative acute kidney injury in paediatric cardiac
patients. Copyright © 2017 The Association of Anaesthetists of
Great Britain and Ireland

<121>
Accession Number
623897589
Title
Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic
Review and Meta-Analysis.
Source
Artificial Organs. 42 (12) (pp 1139-1147), 2018. Date of Publication:
December 2018.
Author
Choi J.H.; Luc J.G.Y.; Moncho Escriva E.; Phan K.; Rizvi S.S.A.; Patel S.;
Entwistle J.W.; Morris R.J.; Massey H.T.; Tchantchaleishvili V.
Institution
(Choi, Rizvi, Patel, Entwistle, Morris, Massey, Tchantchaleishvili)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
(Luc) Division of Cardiovascular Surgery, Department of Surgery,
University of British Columbia, Vancouver, BC, Canada
(Moncho Escriva) Department of Statistics, University of Granada, Granada,
Spain
(Phan) Faculty of Medicine, University of New South Wales, Sydney, NSW,
Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The aim of this systematic review and meta-analysis was to evaluate the
outcomes of concomitant mitral valve surgery for significant preexisting
mitral regurgitation (MR) in patients undergoing continuous-flow left
ventricular assist device (CF-LVAD) implantation. Electronic search was
performed to identify all studies in the English literature examining
concurrent mitral valve surgery in patients with CF-LVAD implantation.
Identified articles were systematically assessed for inclusion and
exclusion criteria. Of 2319 studies identified, 8 studies were included.
Among 445 patients with moderate to severe or severe MR, 113 (25.4%)
patients received concurrent mitral valvular intervention during CF-LVAD
implantation. There were no significant differences in cardiopulmonary
bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or
hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P =
0.93). On follow-up, there were no significant differences in freedom from
greater than moderate MR (MR Surgery 100% vs. no MR Surgery 74%, P = 0.12)
or left ventricular end-diastolic diameter (MR Surgery: 60 mm vs. no MR
Surgery 65 mm, P = 0.51). Survival was comparable at 6-months (MR Surgery
77% vs. no MR Surgery 81%, P = 0.75), 1-year (MR Surgery 72% vs. no MR
Surgery 80%, P = 0.36), and 2-years of follow-up (MR Surgery 65% vs. no MR
Surgery 70%, P = 0.56). The results of our systematic review and
meta-analysis of 8 studies consisting of 445 patients demonstrates that
the addition of mitral valve intervention to CF-LVAD implantation appears
to be safe with comparable survival to those undergoing CF-LVAD
implantation alone. Large prospective randomized clinical trials are
needed to elucidate whether concomitant mitral valve intervention during
CF-LVAD implantation in patients with severe MR is
necessary. Copyright © 2018 International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<122>
Accession Number
619459883
Title
An Absorbable Hydrogel Spray Reduces Postoperative Mediastinal Adhesions
After Congenital Heart Surgery.
Source
Annals of Thoracic Surgery. 105 (3) (pp 837-842), 2018. Date of
Publication: March 2018.
Author
Hasaniya N.; Razzouk A.; Newcombe J.; Hassneiah D.; Heimes J.; Gysbers J.;
Martens T.; Bailey L.
Institution
(Hasaniya, Razzouk, Newcombe, Hassneiah, Heimes, Gysbers, Martens, Bailey)
Department of Cardiovascular and Thoracic Surgery, Loma Linda University
Children's Hospital, Loma Linda, California, United States
Publisher
Elsevier USA
Abstract
Background: Adhesions encountered during reoperative cardiac surgery can
prolong operative time and increase operative risk. The purpose of this
clinical study was to investigate the antiadhesion property of a synthetic
bioabsorbable polymer spray after cardiac reoperations in infants.
 Method(s): A prospective randomized double-blinded study was
designed. Forty infants requiring staged cardiac operations were randomly
allocated to a study group (n = 20) or a control group (n = 20). The
appropriate volume of the polymer was sprayed onto the mediastinal
surfaces before chest closure after the first surgical procedure in the
study group. At reoperation, adhesions were evaluated by a blinded
investigator following a 5-grade scoring system. Five predetermined
anatomic areas were scored. Incision to extracorporeal circulation time
was also analyzed. Result(s): In all, 40 subjects were enrolled into
the study. Four babies died before the second operation. Three others were
missed for reevaluation. The control group (n = 16) had longer incision to
extracorporeal circulation time (38 +/- 10 minutes) than the study group
(n = 17; 23 +/- 6 minutes; p < 0.001). The control subjects had
significantly more severe adhesions than the study group at all five
mediastinal areas: (1) retrosternal (p < 0.001); (2) base of the heart
(large vessels [p < 0.05]); (3) right side (p < 0.01); (4) left side (p <
0.02); and (5) diaphragmatic side of the mediastinum (p < 0.001).
 Conclusion(s): The use of synthetic bioabsorbable polymer sealant
spray at the end of primary pediatric cardiac surgery reduces the
intensity of mediastinal adhesions and the reentry time in infants
undergoing repeat median sternotomy. Copyright © 2018 The Society
of Thoracic Surgeons

<123>
Accession Number
622247456
Title
Dexmedetomidine improves the outcomes in paediatric cardiac surgery: A
meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 852-858),
2018. Date of Publication: 01 May 2018.
Author
Liu Y.; Bian W.; Liu P.; Zang X.; Gu X.; Chen W.
Institution
(Liu, Bian, Liu, Zang, Gu, Chen) Department of Intensive Care Unit,
Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road,
Haidian District, Beijing 100038, China
Publisher
Oxford University Press
Abstract
OBJECTIVES Dexmedetomidine has been shown to decrease cardiac
complications in adults undergoing cardiac surgery. Results from clinical
trials of dexmedetomidine on outcomes following paediatric cardiac surgery
are controversial. METHODS We searched EMBASE, PubMed and Cochrane CENTRAL
databases for randomized controlled trials comparing the effect of
dexmedetomidine versus placebo or other anaesthetic drugs in paediatric
patients undergoing cardiac surgery. The primary outcome was the duration
of mechanical ventilation. The secondary outcomes were intensive care unit
stay, hospital length of stay (LOS), incidence of junctional ectopic
tachycardia and postoperative deaths. RESULTS Nine trials with a total of
837 patients were selected. Compared with controls, dexmedetomidine
significantly reduced the postoperative duration of mechanical ventilation
[in hours; n = 837; weighted mean difference-2.20, 95% confidence interval
(CI)-3.51 to-0.90; P = 0.001; I 2 = 97%], intensive care unit LOS (in
days; n = 737; weighted mean difference-0.47, 95% CI-0.90 to-0.03; P =
0.03; I 2 = 97%) and hospital LOS (in days; n = 291; weighted mean
difference-1.80, 95% CI-3.36 to-0.25; P = 0.02; I 2 = 96%).
Dexmedetomidine also significantly reduced the incidence of postoperative
junctional ectopic tachycardia (21/292 vs 50/263; risk ratio 0.40, 95% CI
0.25-0.64; P = 0.0001; I 2 = 0.0%), but there was no difference between
groups in postoperative deaths (4/182 vs 6/153; odds ratio 0.54, 95% CI
0.15-1.93; P = 0.34; I 2 = 0.0%). CONCLUSIONS Perioperative administration
of dexmedetomidine to paediatric patients undergoing cardiac surgery may
shorten the duration of mechanical ventilation, LOS in the intensive care
unit and in the hospital and reduce the incidence of junctional ectopic
tachycardia. More high-quality randomized controlled trials are encouraged
to verify the beneficial effect of dexmedetomidine before its clinical
application in paediatric patients undergoing surgery for congenital heart
disease. Copyright © 2018 The Author.

<124>
Accession Number
622247434
Title
Comparison of right ventricular function after ministernotomy and full
sternotomy aortic valve replacement: A randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (5) (pp 790-797),
2018. Date of Publication: 01 May 2018.
Author
Dalen M.; Da Silva C.O.; Sartipy U.; Winter R.; Franco-Cereceda A.;
Barimani J.; Back M.; Svenarud P.
Institution
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Cardiac Surgery,
Karolinska University Hospital, Stockholm 17176, Sweden
(Dalen, Sartipy, Franco-Cereceda, Svenarud) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Da Silva, Winter, Barimani, Back) Department of Cardiology, Karolinska
University Hospital, Stockholm, Sweden
(Back) Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Publisher
Oxford University Press
Abstract
OBJECTIVES Right ventricular (RV) function is impaired after cardiac
surgery, possibly because of the opening of the pericardium. In minimally
invasive aortic valve replacement, the pericardium is only partially
incised. METHODS A randomized trial compared RV function after
ministernotomy versus full sternotomy in 40 adults undergoing aortic valve
replacement at the Karolinska University Hospital. Primary outcomes were
tricuspid annular plane systolic excursion, RV pulsed-wave tissue Doppler
velocity, RV fractional area change and basal and mid-RV transversal
diameters on postoperative Days 4 and 40. RESULTS On postoperative Day 4,
the tricuspid annular plane systolic excursion had decreased in both
groups [ministernotomy: median (Q1-Q3) 25 (21-28) vs 16 (11-18), P <
0.001; sternotomy: 22.5 (22-22.5) vs 8 (7-12) mm, P < 0.001] but was
higher in the ministernotomy group (P < 0.001). Pulsed-wave tissue Doppler
RV velocity decreased significantly in patients who underwent sternotomy
[10.5 (10-12) vs 6.5 (5-8) cm/s, P < 0.001] but did not decrease
significantly in patients who underwent ministernotomy [11.5 (11-12) vs 10
(9-11) cm/s, P = 0.054]. Fractional area change was equally decreased in
both groups [ministernotomy: 46 (39-51) vs 38 (34-44)%, P < 0.001;
sternotomy: 45 (40-49) vs 37 (25-39.5)%, P = 0.003]. RV dimensions did not
change on postoperative Day 4 in both groups. The differences between the
2 groups were similar 40 days postoperatively. CONCLUSIONS RV long-axis
function was reduced after both ministernotomy and full sternotomy aortic
valve replacement, but the reduction was more pronounced in the full
sternotomy group. Global RV function was equally impaired in both groups
postoperatively. Clinical trial registration
http://www.clinicaltrials.gov. Unique identifier:
NCT01972555. Copyright © 2018 The Author.

<125>
Accession Number
627110349
Title
Adiposity in relation to readmission and all-cause mortality following
coronary artery bypass grafting: A systematic review and meta-analysis.
Source
Obesity Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
Zhang K.; Wang J.; Yang Y.; An R.
Institution
(Zhang) Beijing Aortic Disease Center, Beijing Anzhen Hospital, Beijing,
Capital Medical University, Beijing, China
(Wang) Department of Physical Education, Dalian University of Technology,
Dalian, Liaoning, China
(Yang) Cabot Microelectronics, Aurora, IL, United States
(An) Guangzhou Sport University, Guangzhou, Guangdong, China
(An) Department of Kinesiology and Community Health, University of
Illinois at Urbana-Champaign, Champaign, IL, United States
(An) Brown School, Washington University, St. Louis, MO, United States
Publisher
Blackwell Publishing Ltd
Abstract
This study systemically reviewed evidence linking adiposity to readmission
and all-cause mortality in post-coronary artery bypass grafting (CABG)
patients. Keyword/reference search was performed in PubMed, Web of
Science, CINAHL, and Cochrane Library for articles published before June,
2018. Eligibility criteria included study designs:
experimental/observational studies; subjects: adult patients undergoing
CABG; and outcomes: hospital/clinic readmissions, and short-term (<=30
days) and mid-to-long-term (>30 days) all-cause mortality. Seventy-two
studies were identified. Meta-analysis showed that the odds of post-CABG
readmission among patients with overweight was 30% lower than their
normal-weight counterparts and the odds of mid-to-long-term post-CABG
mortality among patients with overweight were 20% lower than their
normal-weight counterparts. In contrast, no difference in post-CABG
readmission rate was found between patients with obesity and their
nonobese counterparts; no difference in short-term or in-hospital
post-CABG mortality rate was found between patients with overweight or
obesity and their normal-weight counterparts; and no difference in
mid-to-long-term post-CABG mortality rate was found between patients with
obesity and their normal-weight counterparts. In conclusion, patients with
overweight but not obesity had a lower readmission and mid-to-long-term
mortality rate following CABG relative to their normal-weight
counterparts. Preoperative weight loss may not be advised to patients with
overweight undergoing CABG. Copyright © 2019 World Obesity
Federation

<126>
Accession Number
2001594465
Title
Association of intraoperative circulating-brain injury biomarker and
neurodevelopmental outcomes at 1 year among neonates who have undergone
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (5) (pp 1996-2002),
2019. Date of Publication: May 2019.
Author
Graham E.M.; Martin R.H.; Atz A.M.; Hamlin-Smith K.; Kavarana M.N.;
Bradley S.M.; Alsoufi B.; Mahle W.T.; Everett A.D.
Institution
(Graham, Atz) Division of Pediatric Cardiology, Department of Pediatrics,
Medical University of South Carolina, Charleston, SC, United States
(Martin) Department of Public Health Sciences, Medical University of South
Carolina, Charleston, SC, United States
(Hamlin-Smith) Department of Pediatrics, Medical University of South
Carolina, Charleston, SC, United States
(Kavarana, Bradley) Department of Cardiothoracic Surgery, Medical
University of South Carolina, Charleston, SC, United States
(Alsoufi) Department of Cardiothoracic Surgery, Children's Healthcare of
Atlanta and Emory University, Atlanta, Ga, United States
(Mahle) Division of Pediatric Cardiology, Department of Pediatrics,
Children's Healthcare of Atlanta and Emory University, Atlanta, Ga, United
States
(Everett) Division of Cardiology, Department of Pediatrics, Johns Hopkins
University, Baltimore, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Neurodevelopmental disability is the most significant
complication for survivors of infant surgery for congenital heart disease.
In this study we sought to determine if perioperative circulating brain
injury biomarker levels are associated with neurodevelopmental outcomes at
12 months. Method(s): A secondary analysis of a randomized controlled
trial of neonates who underwent cardiac surgery was performed. Glial
fibrillary acidic protein (GFAP) was measured: (1) before skin incision;
(2) immediately after bypass; (3) 4 and (4) 24 hours postoperatively.
Linear regression models were used to determine an association with the
highest levels of GFAP and Bayley Scales of Infant and Toddler Development
third edition (BSID) composite scores. Result(s): There were 97
subjects who had cardiac surgery at a mean age of 9 +/- 6 days and
completed a BSID at 12.5 +/- 0.6 months of age. Median (25th-75th
percentile) levels of GFAP were 0.01 (0.01-0.02), 0.85 (0.40-1.55), 0.07
(0.05-0.11), and 0.03 (0.02-0.04) ng/mL at the 4 time points,
respectively. In univariate analysis GFAP was negatively associated with
cognitive, language, and motor composite scores. GFAP levels immediately
after bypass differed between institutions; 1.57 (0.92-2.48) versus 0.77
(0.36-1.21) ng/mL (P =.01). After adjusting for center and potential
confounders, GFAP was independently associated with BSID motor score (P
=.04). Conclusion(s): Higher GFAP levels at the time of neonatal
cardiac operations were independently associated with decreased BSID motor
scores at 12 months. GFAP might serve as a diagnostic means to acutely
identify perioperative brain-specific injury and serve as a benchmark of
therapeutic efficacy for investigational treatments, discriminate
center-specific effects, and provide early prognostic information for
intervention. Copyright © 2019 The American Association for
Thoracic Surgery

<127>
Accession Number
627214947
Title
Obesity survival paradox in patients with acute pulmonary embolism.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 497), 2018. Date of
Publication: August 2018.
Author
Keller K.; Hobohm L.; Munzel T.; Ostad M.A.; Espinola-Klein C.; Lavie C.;
Konstantinides S.; Lankeit M.
Institution
(Keller, Hobohm, Konstantinides, Lankeit) University Medical Center of
Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
(Munzel, Ostad, Espinola-Klein) University Medical Center of Mainz,
Department of Cardiology, Cardiology I, Mainz, Germany
(Lavie) John Ochsner Heart and Vascular Institute, University of
Queensland School of Medicine, Department of Cardiovascular Disease, New
Orleans, United States
Publisher
Oxford University Press
Abstract
Background: Obesity is an established risk factor for cardiovascular
diseases (CVD). However, numerous studies and meta-analyses have
demonstrated a better prognosis for obese compared to lean CVD patients.
However, only a few studies have investigated the so-called "obesity
paradox" in pulmonary embolism (PE), and the prognostic impact of obesity
in PE remains controversial. Purpose(s): We aimed to investigate the
influence of obesity and underweight on adverse in-hospital outcomes in PE
patients. Method(s): The nationwide inpatient data source of Germany
containing diagnoses coded according to ICD-10-GM (International
Classification of Diseases, 10th Revision with German Modification) of
in-patients provided by Federal Statistical Offices of Germany was used
for present study (source: RDC of the Federal Statistical Office and the
Statistical Offices of the federal states, DRG Statistics 2011-2014, own
calculations). Patients aged >=18 years diagnosed with PE (ICD code I26)
between 2011 and 2014 were included in the analysis. Obese (ICD code E66)
and underweight patients (ICD code R63.4) were compared to patients
without abnormal body weight (reference group), and obesity was further
stratified in classes I (body mass index [BMI] 30 to <35 kg/m2), II (BMI
35 to <40 kg/m2) and III (BMI >40 kg/m2). Result(s): Overall, 345,831
PE patients (53.3% females) were included in the analysis. Of those,
29,817 (8.6%) were obese and 1,675 (0.5%) underweight. Obese patients were
younger (median 67.0 vs. 73.0 years, P<0.001), had more frequently heart
failure (28.7% vs. 21.2%, P<0.001), but less often cancer (13.6% vs.
20.5%, P<0.001) and were more often treated with systemic thrombolysis
(6.4% vs. 4.3%, P<0.001) and surgical embolectomy (0.3% vs. 0.1%, P<0.001)
compared to the reference group. In total, 51,226 (14.8%) died
in-hospital. Obese patients had a lower mortality rate (10.9% vs. 15.2%,
P<0.001) compared to the reference group and a reduced risk of in-hospital
mortality (OR, 0.74 [95% CI, 0.71-0.77], P<0.001) independently of age,
sex, comorbidities and reperfusion therapies (multivariate regression was
adjusted for age, sex, surgery, cancer, heart failure, COPD, arterial
hypertension, renal insufficiency, diabetes, coronary artery disease,
atrial fibrillation/flutter, stroke, systemic thrombolysis and surgical
embolectomy). This "obesity paradox" was observed in obesity classes I
(OR, 0.56 [0.52-0.60], P<0.001) and II (OR, 0.63 [0.58-0.69], P<0.001),
but not in class III. At the other side of the weight spectrum,
underweight patients showed a higher prevalence of cancer (41.9% vs.
20.5%, P<0.001) and a higher case-fatality rate (OR, 1.15 [1.00-1.31],
P=0.044). Conclusion(s): Mild and moderate (class I and II) obesity
is associated with lower in-hospital mortality rate in PE patients.
Although obese patients were more often treated with reperfusion
therapies, this "obesity survival paradox" was independently of age, sex,
comorbidities and treatment.

<128>
Accession Number
627214924
Title
Hybrid coronary revascularization in selected patients with multivessel
disease - 5 year clinical outcomes of the prospective randomized pilot
study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 273), 2018. Date of
Publication: August 2018.
Author
Tajstra M.; Hrapkowicz T.; Hawranek M.; Filipiak K.; Gierlotka M.; Zembala
M.; Gasior M.; Zembala M.O.
Institution
(Tajstra, Hrapkowicz, Hawranek, Filipiak, Gierlotka, Zembala, Gasior,
Zembala) Slaskie Centrum Chorob Serca, Zabrze, Poland
Publisher
Oxford University Press
Abstract
Objectives: This study aimed to investigate the 5-year clinical follow-up
of the Hybrid Revascularization for Multivessel Coronary Artery Disease
(HYBRID) trial. Background(s): HYBRID trial is the only randomized
study involving thorough analysis of outcome after the two procedures,
suggested that hybrid coronary revascularization is feasible in selected
patients with multivessel coronary disease referred for conventional
coronary artery bypass grafting. There are currently no long-term outcome
data from randomized trials in this setting. Method(s): A total of
200 patients with multivessel coronary disease referred for conventional
surgical revascularization, were randomly assigned to undergo hybrid
coronary revascularization or coronary artery bypass grafting. The primary
endpoint was the occurrence of all-cause mortality at 5 years.
 Result(s): Nine patients (4 in HCR and 5 in CABG group) were lost to
the 5-year follow-up. Finally, 191 patients (94 in HCR and 97 in CABG
group) formed the basis of this study. The groups were well balanced in
terms of pre-procedural characteristics. All-cause mortality at 5-year
follow-up was similar in the two groups (6.4% for HCR vs. 9.2% for CABG,
p=0.69). The rates of myocardial infarction (4.3% vs. 7.2%, p=0.30),
repeat revascularization (37.2% vs. 45.4%, p=0.38), stroke (2.1% vs. 4.1%,
p=0.35), and major adverse cardiac and cerebrovascular events (45.2% vs.
53.4%, p=0.39) were also similar in the two groups. Conclusion(s):
Hybrid coronary revascularization has similar 5-year all-cause mortality
when compared with conventional coronary bypass grafting. (Figure
Presented) .

<129>
Accession Number
627214817
Title
Clinicopathological profiles responsible for advanced heart failure, heart
transplantation, left ventricular assist device implantation and death for
heart failure in Hypertrophic cardiomyopathy.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 516), 2018. Date of
Publication: August 2018.
Author
Galati G.; Di Lenarda A.; Cappelletti A.; Volpe M.; Ancona F.;
Mazzavillani M.; Magni V.; Capogrosso C.; Stella S.; Castelvecchio S.;
Margonato A.
Institution
(Galati, Cappelletti, Ancona, Mazzavillani, Magni, Capogrosso, Stella,
Margonato) San Raffaele Hospital and Scientific Institute (IRCCS), Heart
Failure Unit and Division of Cardiology, Cardiothoracic and vascular
Department, Milan, Italy
(Di Lenarda) Cardiovascular Center A.S.S. 1 of Trieste, Cardiovascular
Department, Trieste, Italy
(Volpe, Castelvecchio) IRCCS,Policlinico San Donato, Cardiac Surgery
Division, Cardiovascular Department, San Donato Milanese, Italy
Publisher
Oxford University Press
Abstract
Background: Over the last 50 years, advanced heart failure (AdvHF) in
hypertrophic cardiomyopathy (HCM) was overlooked. Neither large case
series nor clinical trials on this topic have been reported. The main
clinical-pathological profiles responsible for AdvHF in HCM are: 1)
End-stage HCM (ES-HCM) defined by an ejection fraction (EF) <=50%; 2)
Left-Ventricular outflow obstruction despite optimal pharmacological and
not pharmacological therapy (Refractory HOCM); 3) Nonobstructive HCM with
preserved EF (HNOCMpEF). Purpose(s): Based on a systematic revision
of all published manuscripts on this topic, this study describes the
prevalence of the three main HCM phenotypes responsible for AdvHF, heart
transplantation (HTx), left ventricular assist device (LVAD) implantation
and death for heart failure (HF-death) with the contemporary management of
HCM. Method(s): The study screened 120 manuscripts in MEDLINE and
EMBASE on HCM cases of AdvHF and HTx published since 2000 until December
2017, in adult patients (>=18 years old). The authors identified 8
manuscripts eligible for the analysis, 4 of whom were excluded for
incomplete information before HTx. 205 patients with AdvHF due to HCM,
despite optimal therapy, were included in the main analysis. AdvHF was
defined in presence of severe NYHA symptoms (class III and IV), because in
all the manuscripts this definition was used. Minimum reported follow-up
was 6.1 years. Result(s): Table 1 shows the prevalence of phenotypes
responsible for AdvHF/ HTx/LVAD implantation/HF-Death. Of 205 HCM
patients, 119 (58%) underwent HTx, LVAD implantation or died for HF.
(Figure Presented) Conclusion(s): AdvHF in HCM has a poor prognosis.
With the current management of HOCM only a very little percentage of these
patients experiences AdvHF. Less than 1/3 of HNOCMpEF patients had AdvHF
due to restrictive physiology and less than 1/4 of these patients had a
poor prognosis. Nowadays, ES-HCM represents the main cause of AdvHF in HCM
and the major determinant for poor outcome. Although it has been managed
with HTx or LVAD implantation, a significant percentage (78.5%) died for
HF. This reflects poor attention and portrays an unmet need for ES-HCM
patients. These findings reinforce the emphasis on long-term surveillance
of HCM patient in order to timely identify patients at risk of ES
evolution and early start the standard HF therapeutic (pharmacological and
not) armamentarium.

<130>
Accession Number
627214794
Title
Tricuspid valve repair at the time of mitral valve surgery is safe and
reduces the incidence of late tricuspid regurgitation and reoperation: A
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 310-311), 2018. Date of
Publication: August 2018.
Author
Tam D.; Tran A.; Friedrich J.O.; Mazine A.; Tang G.L.; Gaudino M.F.L.;
Calafiore A.M.; Fremes S.E.
Institution
(Tam, Tran, Mazine, Fremes) Sunnybrook Health Sciences Centre, Toronto,
Canada
(Friedrich) St. Michael's Hospital, Toronto, Canada
(Tang) Mount Sinai School of Medicine, New York, United States
(Gaudino) Weill Cornell Medical College, New York, United States
(Calafiore) Centro di Ricerca e Formazione ad Alta Tecnologia nelle
Scienze Biomediche-"Giovanni Paolo II", Campobasso, Italy
Publisher
Oxford University Press
Abstract
Background: The surgical management of tricuspid regurgitation (TR) at the
time of mitral valve surgery remains controversial. The incidence of
tricuspid valve repair (TVR) during mitral valve surgery ranges from 7% to
65% in the literature. Our objectives were to determine the safety and
efficacy of TVR during mitral valve repair or replacement in a
meta-analysis. Method(s): MEDLINE and EMBASE was searched from 1946
to 2017 for all studies comparing TVR (TVR+) to no TVR (TVR-) at the time
of mitral valve surgery on early and late mortality and late TR. A
random-effects meta-analysis of all outcomes was performed. Short term
binary outcomes were pooled as risk ratios (RR) and late outcomes were
pooled as incident rate ratios (IRR) to account for differences in
follow-up between groups. Result(s): 1417 studies were retrieved and
a total of 19 studies (one randomized clinical trial (RCT, n=44), six
adjusted observational studies (n=2389) and 12 unadjusted observational
studies (n=67,814)) were included in the final analysis that compared TVR+
(n=11,787) to TVR-(n=56,027) at a mean follow-up of 5.0 years. The
indication(s) for TVR were: any TR with an enlarged annulus (n=6),
moderate or less TR (n=5), moderate or more (n=5), any TR (n=3). The
majority of patients underwent repair with an annuloplasty ring while a
minority underwent suture annuloplasty. There was no difference in
30-day/in-hospital mortality between TVR+ and TVR-(RR: 1.31 95% confidence
interval (95% CI): 0.85, 2.02, p=0.25). The incidence of new permanent
pacemaker implantation was higher in the TVR+ group (RR: 2.73, 95% CI:
2.57, 2.89, p<0.01). TVR+ was protective against late moderate to severe
TR (IRR: 0.26, 95% CI: 0.16, 0.43; p<0.01) and severe TR (IRR: 0.32, 95%
CI: 0.11, 0.91, p=0.03). There was a trend towards a lower rate of late TV
reoperation in a pooled analysis of five studies (IRR: 0.36, 95% CI:
0.13,1.02; p=0.06). Overall, there was no difference in late mortality
between TVR+ and TVR-(Figure - IRR: 0.87, 95% CI: 0.63, 1.20 p=0.39).
 Conclusion(s): TVR at the time of mitral valve surgery was not
associated with peri-operative mortality but a more than double the risk
of permanent pacemaker implantation. At late follow-up, TVR was associated
with less than moderate or severe TR with a trend towards less repeat
TV-related reoperation reported in a limited number of studies. However,
there was no difference in late mortality at 5 years. TVR appears safe in
the post-operative period and may reduce the need for future reoperation
without survival benefit.

<131>
Accession Number
627214564
Title
Long-term analysis of ventricular functionin patients with stable coronary
disease submitted to on-pump or off-pump coronary artery bypass graft in
MASS III.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 534-535), 2018. Date of
Publication: August 2018.
Author
Silva R.R.; Lima E.G.; Batista D.V.; Linhares Filho J.P.P.; Martins E.B.;
Rezende P.C.; Garzillo C.L.; Ribas F.F.; Hueb W.; Ramires J.A.F.; Kalil
Filho R.
Institution
(Silva, Lima, Batista, Linhares Filho, Martins, Rezende, Garzillo, Ribas,
Hueb, Ramires, Kalil Filho) Heart Institute (InCor) - University of Sao
Paulo Clinics Hospital, Sao Paulo, Brazil
Publisher
Oxford University Press
Abstract
Background: Deleterious effects of cardiopulmonary bypass (CB) associated
to inadequate myocardial protection may have implications in left
ventricular function on short-term analysis. Interventions without the use
of this circuit aimed at min- imizing these conditions have inconclusive
results and few data are available to assess the long-term evolution of
ventricular function among patients submitted to off-pump coronary artery
bypass graft (OPCAB). Purpose(s): To compare the evolution of left
ventricular ejection fraction (LVEF) in a long-term follow-up among
patients with Coronary Artery Disease submitted to OPCAB or on-pump
coronary artery bypass graft (ONCAB). Method(s): Patients with stable
coronary artery disease and initially preserved systolic left ventricular
function were randomized to OPCAB or ONCAB and followed for long-term.
They underwent a new evaluation of ventricular function by transthoracic
echocardiogram as a post-hoc analysis of MASS III study. Result(s):
Of 308 patients randomized to OPCAB (n=155) or ONCAB (n=153), 213 had a
new assessment of ventricular function by echocardiogram in a median of
5.9 years follow-up: 106 in ONCAB group and 107 in OPCAB group. There was
no difference in LVEF in the beginning (65+/-7.5 and 70+/-7.8,
respectively, for ONCAB and OPCAB, p=0.063), in the end of follow-up
(60+/-10.8 and 60+/-11.9, respectively, for ONCAB and OPCAB, p=0.182) and
regarding the decline of LVEF (reduction delta of 6+/-9.7 and 5+/-10.6,
p=0.876). The number of grafts per patients was higher in the ONCAB versus
the OPCAB group (3.65 vs. 2.75 grafts, p<0.001). Conclusion(s):
Although there was a small decline in LVEF in both groups, regardless of
the surgical technique applied, there was no difference in the long-term
evolution of LVEF between ONCAB and OPCAB. Incomplete revascularization in
OPCAB does not seem to have influenced these results.

<132>
Accession Number
627215442
Title
Continued vs. interrupted oral anticoagulation in patients with atrial
fibrillation undergoing transfemoral transcatheter aortiv valve
implantation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 429-430), 2018. Date of
Publication: August 2018.
Author
Mangner N.; Crusius L.; Woitek F.; Haussig S.; Spindler A.; Schlotter F.;
Stachel G.; Hoellriegel R.; Leontyev S.; Kiefer P.; Thiele H.; Borger M.;
Holzhey D.; Linke A.
Institution
(Mangner, Crusius, Woitek, Spindler, Schlotter, Stachel, Thiele)
University of Leipzig, Heart Center, Leipzig, Germany
(Haussig, Hoellriegel, Linke) Technische Universitat Dresden, Department
of Internal Medicine and Cardiology, Heart Center, Dresden, Germany
(Leontyev, Kiefer, Borger, Holzhey) University of Leipzig, Heart Center,
Leipzig, Department of Cardiac Surgery, Leipzig, Germany
Publisher
Oxford University Press
Abstract
Introduction: The role of continued vs. interrupted oral anticoagulation
(OAC) in patients with atrial fibrillation (AF) undergoing transfemoral
transcatheter aortic valve implantation (TF-AVI) is uncertain.
 Purpose(s): The aim of this single center registry based
investigation was to evaluate the risk of periprocedural bleeding and
thromboembolic complications in patients undergoing TF-AVI under continued
OAC. Method(s): Consecutive patients with AF and on OAC at admission
(n=551) treated between 2011 and 2016 were stratified according to
interrupted OAC (iOAC) vs. continued (cOAC) vs. continued novel oral
anticoagulants (NOAC) at the time of TF-AVI. VARC-2 defined bleeding and
stroke were the primary end points. 30-day and 1-year mortality was
calculated using Kaplan-Meier statistics. Result(s): Patients with
iOAC (n=299), cOAC (n=117) and NOAC (n=182) had comparable baseline
characteristics including age (80 (76; 83) vs. 80 (77; 83) vs. 80 (77;
84), p=0.250), gender (male: 42.5% vs. 47.9% vs. 48.9%, p=0.33) and
STS-Score (6.9 (4.2; 10.8) vs. 6.7 (4.4; 10.8) vs. 5.9 (3.6; 9.5),
p=0.072). The proportion of patients having a CHA2DS2-VASc-Score >=3
(p=0.791) and HASBLED-Score >=3 (p=0.185) were not different between
groups. The majority of patients received a self-expandable valve (70.9%
vs. 59.8% vs. 67%, p=0.094). VARC-2 defined stroke did not differ between
groups (4.1% vs. 3.5% vs. 2.2%, p=0.527) including major stroke (3.8% vs.
1.7% vs. 1.1%), minor stroke (0% vs. 0.9% vs. 0.5%) and TIA (0.3% vs. 0.9%
vs. 0.5%). VARC-2 defined bleeding did also not differ between iOAC, cOAC
and NOAC (34.8% vs. 38.8% vs. 27.5%, p=0.097) including life threatening
bleeding (3.8% vs. 4.3% vs. 2.7%) and major bleeding (14.8% vs. 12.1% vs.
11.0%). Renal failure occurred more often in iOAC compared to cOAC and
NOAC (15.8% vs. 9.5% vs. 7.7%, p=0.02). 30-day mortality tended to be
lower in NOAC (iOAC: 4.3% vs. iOAC: 3.4% vs. NOAC: 0.5%, p=0.061).
1-year-mortality was lower in NOAC (cOAC: 20.1% vs. iOAC: 13.7% vs. NOAC:
8.8%, p=0.015). Conclusion(s): TF-AVI under continued OAC seems to be
safe and effective. In particular, continued OAC using NOAC was associated
with a favourable outcome compared to interrupted OAC. An adequately
powered randomized clinical trial is necessary to prove this hypothesis.

<133>
Accession Number
627215418
Title
Type of oral anticoagulants and outcomes after transcatheter aortic valve
implantation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 429), 2018. Date of
Publication: August 2018.
Author
Jochheim D.; Barbanti M.; Capretti G.; Zadrozny M.; Baquet M.; Fischer J.;
Todaro D.; Stefanini G.C.; Massberg S.; Chieffo A.; Presbitero P.; Colombo
A.; Tamburino C.; Mehilli J.
Institution
(Jochheim, Zadrozny, Baquet, Fischer, Massberg, Mehilli)
Ludwig-Maximilians University, Munich, Germany
(Barbanti, Todaro, Tamburino) Ferrarotto Hospital, Catania, Italy
(Capretti, Chieffo, Colombo) San Raffaele Hospital of Milan (IRCCS),
Milan, Italy
(Stefanini, Presbitero) Clinical Institute Humanitas IRCCS, Rozzano, Italy
Publisher
Oxford University Press
Abstract
Background: Although new oral anticoagulants (NOAC) are frequently used
after TAVI in patients in need of OAC, comparisons between NOAC and
vitamin K antagonists (VKA) are still lacking. Purpose(s): To
investigate the impact of oral anticoagulants type on clinical outcomes
one year after transcatheter aortic valve implantation (TAVI) in patients
with symptomatic aortic stenosis in need of oral anticoagulation (OAC).
 Method(s): A total of 962 patients who underwent TAVI in 2 tertiary
European centers were included in this analysis. At discharge, 326
patients were on NOAC and 636 on VKA. Outcomes of interest were incidence
of bleeding complications, any clinically relevant cerebrovascular events
(CVE) and all-cause mortality one year after TAVI. All events were defined
in according to the Valve Academic Research Consortium 2 definitions
(VARC-2). Result(s): Patients were aged 81.3+/-6.3 years; 52.5% were
women and mean STS-score was 6.2+/-5.8 percent. Compared to patients
discharged with VKA, those on NOAC treatment less frequently presented
with permanent atrial fibrillation (62.0% vs. 75.2%, p<0.001), peripheral
artery disease (4.0% vs. 11.5%, p<0.001), less frequently underwent
balloon post-dilation (7.1% vs. 14.6%, p<0.001) and implantation of
non-balloon expandable valves (22.7% vs. 44.8%, p<0.001). One-year
incidence of any, major or life-threatening bleeding and incidence of
clinically relevant CVEs was comparable between both groups (Figure). No
differences were observed on manifest valve thrombosis (NOAC, 0.3% vs. VKA
0.6%, p=0.78) or all-cause mortality rates (NOAC, 14.4% vs. VKA, 11.0%,
p=0.14). Patients on VKA therapy on admission were associated with higher
major or life-threatening bleeding rates within 48 hours after TAVI (11.7%
vs. 21.4%, p=0.009). In multivariate analysis, chronic kidney disease (HR
1.61; 95% CI 1.18- 2.19), impaired left ventricular function (HR 1.70; 95%
CI 1.29-2.23) and balloon pre-dilation (HR 0.56; 95% CI 0.35-0.90) were
identified as independent predictors of mortality at one year.
 Conclusion(s): In patients in need of OAC after TAVI, NOAC and VKA as
maintenance therapy are associated with comparable risk for bleeding and
ischemic events at one-year follow-up. Randomized trials are warranted to
proof effectiveness and safety of type of OAC among TAVI patients. (Figure
Presented) .

<134>
Accession Number
627215102
Title
Impact of remote ischemic preconditioning in cardiosurgical patients on
contractile and mitochondrial function of right atrial tissue.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 453), 2018. Date of
Publication: August 2018.
Author
Kleinbongard P.; Gedik N.; Kirca M.; Stoian L.; Frey U.; Zandi A.;
Thielmann M.; Jakob H.; Peters J.; Kamler M.; Heusch G.
Institution
(Kleinbongard, Gedik, Kirca, Stoian, Heusch) University of Essen Medical
School, Institute of Pathophysiology, Essen, Germany
(Frey, Peters) University of Duisburg-Essen Medical School, Klinik fur
Anasthesiologie und Intensivmedizin, Essen, Germany
(Zandi, Kamler) Essen-Huttrop, Herzzentrum, Essen, Germany
(Thielmann, Jakob) University of Duisburg-Essen, West German Heart Center,
3Klinik fur Thorax- und Kardiovaskulare Chirurgie, Essen, Germany
Publisher
Oxford University Press
Abstract
Introduction: Remote ischemic preconditioning (RIPC) by repeated cycles of
brief limb ischemia/reperfusion attenuates postoperative troponin release
in patients undergoing surgical coronary revascularization and improves
clinical outcome in some, but not all studies. Purpose(s): We aimed
to identify a functional parameter reflecting the RIPCinduced protection
in humans. We measured a) the contractile function of isolated right
atrial trabeculae before and during hypoxia/reoxygenation, and b)
mitochondrial function in right atrial tissue, both obtained from patients
undergoing coronary artery bypass grafting (CABG) with RIPC or placebo,
respectively. Method(s): Patients undergoing elective CABG surgery
under isoflurane/sufentanil anaesthesia, cardiopulmonary bypass and
ischemic cardioplegic arrest were randomized to RIPC by 3 cycles of 5 min
blood pressure cuff inflation on the left upper arm /5 min deflation or
placebo (cuff left uninflated) before skin incision. Right atrial
appendages from 94 patients were harvested prior to cardioplegic arrest
(RIPC: n=45, placebo: n=49). Myocardial protection by RIPC was assessed
from serum troponin I/T concentrations over 72 h after surgery. Trabeculae
(RIPC: n=35, placebo: n=39) were isolated in cardioplegic buffer and
transferred to Tyrode buffer. Electrically initiated developed force of
contraction (mN) was measured. After baseline measurements,
hypoxia/reoxygenation (60 min/30 min) was induced by changing the buffer
gas and electrical stimulation frequency (1 to 3 Hz). Mitochondria were
isolated (RIPC: n=10, placebo: n=10), and respiration, adenosine
triphosphate (ATP) production, reactive oxygen species (ROS) production
and calcium retention capacity (CRC) to estimate mitochondrial
permeability transition pore (mPTP) opening were measured at 37degreeC.
 Result(s): Associated with the observed cardioprotection (13%
decrease in the area under the curve of troponin I/T with RIPC vs.
placebo), baseline contractile function and recovery of contractile
function during reoxygenation were improved (Fig. 1A). Basal respiration
was not different, but adenosine diphosphate (ADP)- stimulated complex I
respiration was greater with RIPC than with placebo. Mitochondrial
ascorbate/tetramethyl-p-phenylenediamine (TMPD)-stimulated complex IV
respiration and maximal oxygen uptake of uncoupled mitochondria were not
different between RIPC and placebo, reflecting an equal loading of viable
mitochondria (Fig. 1B). Mitochondrial ATP production (Fig. 1C) was greater
whereas mitochondrial ROS production (Fig 1D) was less with RIPC vs.
placebo. Mitochondrial CRC (Fig 1E) was improved with RIPC vs. placebo,
with and without cyclosporine A. Conclusion(s): RIPC by repetitive
upper arm ischemia/reperfusion reduces troponin release and improves ex
vivo contractile function of human right atrial trabeculae before and
after hypoxia/reoxygenation. Improved contractile function goes along with
improved mitochondrial function. (Figure Presented).

<135>
Accession Number
627215198
Title
Randomized cluster trial to improve guideline-adherence of secondary
preventive drugs prescription after coronary artery bypass grafting in
China.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 343), 2018. Date of
Publication: August 2018.
Author
Du J.; Rao C.; Zheng Z.
Institution
(Du, Rao, Zheng) Fuwai Hospital, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
Publisher
Oxford University Press
Abstract
Background: The benefits of secondary preventive drugs after coronary
artery bypass grafting have been thoroughly established. However, the
prescription rates of these drugs are low at discharge in China.
 Objective(s): We sought to evaluate the effectiveness of continuous
quality improvement with mobile-based interventions for clinicians on
improving the guideline-adherence of secondary preventive drugs
prescription. Method(s): MISSION-1 study is a cluster-randomized
controlled trial. Hospitals participating in the China cardiac surgery
registry were invited and randomly into the intervention group or the
control group in a 1:1 ratio. The intervention group undertakes a series
of mobile-based interventions, while the control group maintains a routine
practice pattern. All sites consecutively register patients underwent
isolated CABG and submit in-hospital data. We require supporting documents
regarding prescription information at discharge to adjudicate the outcome
measures. The primary outcome measure is the prescription rate of statins
for eligible patients at discharge. The secondary outcome measures are
antiplatelet drugs, beta-blockers and AECIs or ARBs. Result(s): A
total of 58 hospitals and treating 11782 patients undergoing isolated CABG
were randomized to either the intervention group (n=6659) or the control
group (n=5124). Prerandomization treatment patterns and baseline were
similar in the intervention group and control group. Secondary prevention
medication prescription rate for eligible patients at discharge increased
over 15 months in both groups, with an increment for statins (73.7% to
86.8%, 74.1% to 86.3%), beta- blockers (74.7% to 89.6%, 77.3% to 86.1%),
anti-platelets drugs (90.7% to 95.8%, 90.5% to 95.6%) and ACEI/ARB (24.5%
to 28.2%, 25.6% to 28.1%) of intervention group and control group
respectively. We also made time trend analysis with interrupted
time-series model. Conclusion(s): Continuous quality improvement
clinicians can improve the guideline-adherence of secondary preventive
drugs prescription. The findings of this trial can be an example for
ongoing cardiac surgery quality improvement in China. (Figure Presented) .

<136>
Accession Number
627214409
Title
Effect of intra-coronary (IC) Tirofiban following aspiration thrombectomy
on infarct size, in patients with large anterior ST-segment elevation
myocardial infarction (STEMI) undergoing primary PCI.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 135), 2018. Date of
Publication: August 2018.
Author
Basuoni A.; El-Naggar W.A.E.L.; Mahdy M.; Al-Kaffas S.
Institution
(Basuoni, El-Naggar, Mahdy, Al-Kaffas) Cairo University Hospitals,
Cardiology, Cairo, Egypt
Publisher
Oxford University Press
Abstract
Background: Thrombus embolization during percutaneous coronary
intervention (PCI) in ST-segment elevation myocardial infarction (STEMI)
is common and results in sub-optimal myocardial perfusion and increased
infarct size. Two strategies were proposed to reduce distal embolization
and improve outcomes after primary PCI are bolus intra-coronary (IC)
Tirofiban and manual Aspiration Thrombectomy. Objective(s): To
evaluate effect of Intra-coronary delivery of bolus Tirofiban following
Aspiration Thrombectomy on reduction of infarct size using cardiac
magnetic resonance imaging (cMRI) in patients with large anterior STEMI
undergoing primary PCI. Method(s): A Prospective single-blind
randomized controlled trial was conducted between August, 2014 and
September, 2017. 100 patients with large anterior STEMI were screened at 2
sites in one country (Egypt). Aspiration Thrombectomy was performed in all
patients using a 6 F aspiration catheter. Patients were randomized to IC
Tirofiban (Study group) and no IC Tirofiban (control group). To ensure
high intra-thrombus drug concentrations, a 25 mcg/kg bolus of Tirofiban
was administered locally at the site of the infarct lesion via the
aspiration catheter after flushing of the aspiration catheter well.
Primary end point was the infarct Size at 30 Days measured by cMRI.
Secondary end point was myocardial blush grade at the end of the PCI
procedure. Major Adverse Cardiac and Cerebrovascular events (MACCE) at 30
days defined as re-infarction, stroke, severe heart failure and death.
 Result(s): Evaluable MRI results at 30 days where present in only 80%
of patients, with the most common reasons for missing data being patient
re-infarction prior to 30 days and inability to tolerate the procedure.
Patients randomized to IC Tirofiban compared with no IC Tirofiban had a
significant reduction at 30 days infarct size (median, 15451 mm3 - IQR,
17404 mm3 - n=40) vs (median, 43828 mm3 - IQR, 49599 mm3 - n=40) P value=
0.002. myocardial blush grade results at the end of the PCI where present
in 100 patients, randomized to IC Tirofiban compared with no IC Tirofiban
had no significant difference (P value= 0.67). There is no significant
difference in MACCE at 30 days between patients received bolus IC
Tirofiban and patients who did not receive (P value= 0.723).
 Conclusion(s): In patients with large anterior STEMI presenting early
after symptoms onset and undergoing primary PCI, infarct size at 30 days
was significantly reduced by bolus IC Tirofiban delivered to the infarct
lesion site following manual aspiration thrombectomy. There is no
significant difference in MACCE at 30 days between patients received bolus
IC Tirofiban and patients who did not receive.

<137>
Accession Number
627214357
Title
Impact of short-term exercise training on QT dispersion and double product
in patients after surgical aortic valve replacement.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 85-86), 2018. Date of
Publication: August 2018.
Author
Stoickov V.; Deljanin Ilic M.; Stoickov M.; Marinkovic D.; Simonovic D.;
Golubovic M.; Tasic I.; Nikolic L.J.; Mitic S.
Institution
(Stoickov, Deljanin Ilic, Tasic) University of Nis, Medical Faculty,
Institute of Cardiology Niska Banja, Nis, Serbia
(Stoickov, Marinkovic, Simonovic, Nikolic, Mitic) Institute of Cardiology,
Niska Banja, Serbia
(Golubovic) Clinical Center, Nis, Serbia
Publisher
Oxford University Press
Abstract
Background/Introduction: QT dispersion (QTd) represents the heterogeneity
in the repolarization of the ventricular myocardium and electrical
instability of the myocardium, reflecting the increased tendency towards
ventricular arrhythmias. Abnormally high QTd has been correlated with risk
of cardiac death. Purpose(s): The aim of this study was to establish
the influence of short-term exercise training on QT dispersion and double
product (DP), in patients after surgical aortic valve replacement (SAVR).
 Method(s): The study involved 91 patients after SAVR, in the sinus
rhythm without AV blocks or branch blocks. Average age of patients was
61.2 years. Patients were randomly divided into the physical training
group (training group: 76 patients) and control group (non-training group:
15 patients). Patients were similar as to age and baseline stress test
duration. In all subjects clinical examination, standard ECG and exercise
test on treadmill according to Bruce protocol were performed and after
that training group patients were included in physical training program
for three weeks. Training group patients were instructed to follow a
training program using the bicycle ergometer (10 min, 2 times a day),
gymnastic exercises and walking. The patients continued to take the same
medicaments in same doses. From standard ECG corrected QT dispersion
(QTdc) was calculated. Result(s): After three weeks, we have found
significant reduction of QTdc from 78.6+/-19.4 to 70.4+/-20.8 ms; p<0.02
in the training group. Also, in the training group, we have found
significant reduction of heart rate from 75.8+/-6.9 to 66.7+/-5.8
beats/min (p<0.001), of systolic blood pressure from 135.3+/-12.8 to
126.3+/-11.4 mmHg (p<0.025), of diastolic blood pressure from 87.2+/-8.8
to 83.7+/-7.5 mmHg (p<0.01) and of double product from 11852.3+/-1184.3 to
10733.8+/-735.2 beat/min x mmHg; p<0.001. In contrast, the non-training
group showed no significant changes. Conclusion(s): The study showed
that short-term exercise training have favourable effects on QT dispersion
and double product in patients after SAVR. Physical training led to the
significant decrease of myocardial oxygen uptake at rest and probably
decreased the possibility of arrhythmia events in patients after SAVR.

<138>
Accession Number
627214346
Title
ESC Congress 2018.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (no pagination), 2018. Date
of Publication: August 2018.
Author
Anonymous
Publisher
Oxford University Press
Abstract
The proceedings contain 646 papers. The topics discussed include: clinical
efficacy and safety of standard-dose and low-dose non-vitamin K antagonist
oral anticoagulants in Asian patients with non-valvular atrial
fibrillation: results from a nationwide cohort study; effect of
concomitant antiplatelet agents on clinical outcomes in the edoxaban
versus warfarin in subjects undergoing cardioversion of atrial
fibrillation (ENSURE-AF) randomized trial; anticoagulation and cardiac
tamponade among patients with pericardial effusion; galectin-3 levels are
normal in patients with constrictive pericarditis and are associated with
exercise intolerance after pericardiectomy; effects of
tele-case-management program on the improvements of symptoms distress, and
depressive symptoms in heart transplant recipients; pulmonary artery
denervation for the treatment of pulmonary arterial hypertension:
preliminary results of the TROPHY 1 study; a national study evaluating
cardiac device implantation and usage in patients with fabry disease; and
European multicentre registry on idiopathic ventricular fibrillation in
subjects with otherwise normal electrocardiograms.

<139>
Accession Number
627214335
Title
Benzodiazepine-free cardiac anesthesia for reduction of delirium (B-Free):
A two-centre pilot study to determine the feasibility of a multi-centre,
randomized, cluster crossover trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 150), 2018. Date of
Publication: August 2018.
Author
Spence J.; Belley-Cote E.; Jacobsohn E.; Syed S.; Whitlock R.; Lee S.F.;
Bangdiwala S.; Arora R.; Sarkaria A.; MacIsaac S.; Girling L.; Lemanach
Y.; Lamy A.; Devereaux P.J.; Connolly S.
Institution
(Spence, Belley-Cote, Whitlock, Devereaux) Population Health Research
Institute, Perioperative Medicine and Surgical Research Group, Hamilton,
Canada
(Jacobsohn, Girling) St. Boniface General Hospital, Department of
Anesthesia, Winnipeg, Canada
(Syed, Lemanach) McMaster University, Department of Anesthesia, Hamilton,
Canada
(Lee, Bangdiwala, Sarkaria, MacIsaac, Lamy, Connolly) Population Health
Research Institute, Hamilton, Canada
(Arora) Institute of Cardiovascular Sciences, Department of Surgery,
Section of Cardiac Surgery, Winnipeg, Canada
Publisher
Oxford University Press
Abstract
Background: Postoperative delirium affects 15-30% of adult cardiac surgery
patients and is associated with adverse outcomes. Intensive care unit
(ICU) data suggest that benzodiazepines are linked to delirium. While the
benefit of alternate forms of sedation after cardiac surgery have been
studied, no trials have examined the impact of changes to intraoperative
benzodiazepine use. Purpose(s): To determine the feasibility of a
multicentre, randomized cluster crossover trial evaluating whether an
institutional policy of limited intraoperative benzodiazepine
administration (B-Free) during adult cardiac surgery was associated with a
decrease in the incidence of postoperative delirium, when compared with a
policy of "ad libitum" intraoperative benzodiazepine administration.
 Method(s): We conducted a two-centre, pilot randomized cluster
crossover trial with four-four-week crossover periods. We obtained
research ethics board approval for waiver of individual patient consent in
both sites; all patients undergoing cardiac surgery during the pilot
period were studied. Each site was randomized to either the B-Free or ad
libitum policy and then alternated between intervention arms during the
remaining 3 crossover periods. Our feasibility outcomes were: 1) obtaining
at least one postoperative Confusion Assessment Method (CAM) delirium
evaluation in 95% of enrolled patients, 2) obtaining at least one CAM per
24h in the ICU in 90% of enrolled patients, and 3) to achieve adherence to
each of the intervention arm policies in 80% of patients. In one site, we
evaluated the incidence of intraoperative awareness using serial Brice
questionnaires and blinded adjudication, aiming to demonstrate an
incidence of intraoperative awareness during the limited benzodiazepine
period of <=2%. Result(s): We studied 800 patients, of which 362/388
(93.3%) of patients managed during the ad libitum periods and 365/412
(88.6%) of patients managed during the B-Free periods were managed
according to the appropriate policy. We have obtained outcomes for 750/800
(93.8%) patients; remaining patients are still being entered into
administrative databases. Of these, 735/750 (98.0%) had at least one CAM,
and 692/750 (92.3%) had at least one CAM per 24h in ICU. We screened
521/540 (96.5%) enrolled patients at one site for intraoperative
awareness; 19/540 (3.5%) of patients were not screened because of
intraoperative death, transfer or death prior to extubation, or
communication barrier. 1/521 (0.2%), managed during the B-Free period but
who received benzodiazepine, was adjudicated as having awareness.
 Conclusion(s): Data obtained demonstrates the feasibility of
conducting a multicentre, randomized, cluster crossover trial evaluating
whether an institutional policy of limited intraoperative benzodiazepine
use during adult cardiac surgery is associated with a decrease in the
incidence of postoperative delirium, when compared with a policy of "ad
libitum" intraoperative benzodiazepine use.

<140>
Accession Number
627214222
Title
Effect of renin-angiotensin system blockade in long term outcomes
following transcatheter aortic valve implantation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 50), 2018. Date of
Publication: August 2018.
Author
Amat Santos I.J.; Catala P.; Munoz Garcia A.J.; Nombela Franco L.; Serra
V.; Regueiro A.; Rivero F.; Ribeiro H.B.; Fernandez Diaz J.A.; Jimenez
Diaz V.A.; Lopez Diaz J.; Revilla Orodea A.; Varela Falcon L.H.; Carrasco
Moraleja M.; San Roman J.A.
Institution
(Amat Santos, Catala, Lopez Diaz, Revilla Orodea, Varela Falcon, Carrasco
Moraleja, San Roman) University Hospital of Vallodolid, ICICOR,
Valladolid, Spain
(Munoz Garcia) University Hospital Virgen de la Victoria, Cardiology,
Malaga, Spain
(Nombela Franco) Hospital Clinic San Carlos, Cardiology, Madrid, Spain
(Serra) University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
(Regueiro) Hospital Clinic de Barcelona, Barcelona, Spain
(Rivero) University Hospital De La Princesa, Madrid, Spain
(Ribeiro) Heart Institute of the University of Sao Paulo (InCor), Sao
Paulo, Brazil
(Fernandez Diaz) University Hospital Puerta de Hierro Majadahonda, Madrid,
Spain
(Jimenez Diaz) Hospital of Meixoeiro, Vigo, Spain
Publisher
Oxford University Press
Abstract
Introduction: Several studies have demonstrated the benefits of
transcatheter aortic valve implantation (TAVI) in high-risk and
intermediate-risk patients, but there is still a gap in the evidence of
pharmacological therapies with potential impact in long-term outcomes. In
particular, the presence of fibrosis and myocardial hypertrophy in
patients with aortic stenosis has been related to worse prognosis.
Therefore, better outcomes may be achieved with the use of strategies
improving cardiac remodelling by reversing fibrosis and hypertrophy. In
this regard, reninangiotensin system (RAS) blockade has been shown to have
a positive impact in remodelling and in major clinical outcomes in
alternative scenarios. We aimed to determine the effects of this therapy
following successful TAVI procedures. Method(s): Patients from 9
institutions with severe aortic stenosis who underwent TAVI between
August/2007 and August/2017 were included. All baseline clinical,
echocardiographic and procedural data were prospectively recorded in a
dedicated database, and pre-specified follow up was performed. Dose and
type of RAS blockade therapy was also recorded. Patients were compared
according to the prescription of RAS blockade or not. Only those patients
surviving the inhospital period and under continuous RAS blockade therapy
for at least 1 month after TAVI were included in the treatment group.
Also, a matched comparison was performed according to baseline
characteristics, use of other medications, procedural approach, left
ventricular ejection fraction, and residual aortic regurgitation degree.
 Result(s): A total of 1980 patiens were included. Mean age of the
study population was 81.3+/-9.1 years and 65.3% were males. STS and
EuroSCORE-II mean values were 7.2+/-1.3 and 6.5+/-2.4%, respectively, with
35.5% of diabetes mellitus, 13.9% of prior myocardial infarction, and left
ventricular ejection fraction <40% in 32.6%of the patients. Of them, 706
(59.5%) received RAS blockade therapy after the procedure. At a median
follow up of 3 years post-TAVI, the RAS blockade group had significantly
lower cumulative mortality than the no-RAS blockade group (9.5% vs 16.5%;
log-rank test, p=0.001). After matching, RAS blockade therapy was still
associated with significantly lower mortality (HR, 0.581; 95% CI 0.310 to
0.893; p=0.002). In addition, the rates of myocardial infarction,
new-onset atrial fibrillation, stroke, and re-admission due to heart
failure remained lower in the RAS blockade group for the entire cohort and
the matched one. Conclusion(s): Post-TAVI RAS blockade therapy is
associated to lower all-cause mortality at 3-year follow up and presents a
global cardiovascular protective effect irrespective of the left
ventricular ejection fraction and the residual aortic regurgitation. An
ongoing randomised controlled trial (RASTAVI Study, NCT03201185) will help
to determine the accuracy of these findings.

<141>
Accession Number
627214114
Title
Effects of tele-case-management program on the improvements of symptoms
distress, and depressive symptoms in heart transplant recipients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 64), 2018. Date of
Publication: August 2018.
Author
Kao C.W.; Lin P.H.
Institution
(Kao, Lin) Tri-Service General Hospital, Nursing Department, Taipei,
Taiwan (Republic of China)
Publisher
Oxford University Press
Abstract
Background: Patients have to receive the heart transplantation when they
have severe heart failure (NYHA Fc IV) without effective responses to
medical therapy. Although patients may prolong their life after heart
transplantation, they have to take immunosuppressive drugs lifelong. How
to strike a balance between avoiding infection and preventing rejection
causes patients both physiological and psychological distress. The
tele-health care could provide immediate care, and reduce the degrees of
anxiety and depression for heart transplant recipients. Therefore, the
purposes of this study were to develop the Tele-Case-Management Program,
and determine its effects on the improvements of the symptom distress, and
depressive symptom in heart transplant recipients. Method(s): This
study used experimental design with pretest and post-test. According to
pretest of depression scores, we stratified and randomly assigned
participants to the experimental group and control group. The heart
transplant recipients in experimental group (n=31) received
Tele-Case-Management Program intervention, and the recipients in control
group (n=30) received the usual care. Each study participants was
evaluated by Symptom Frequency and Symptom Distress Scale, Beck Depression
Inventory-II Scale, and Fatigue Scale at pretest, and one-month and
three-month follow-up. The generalized estimating equation (GEE) was used
to examine the effects of the Tele-Case-Management Program on the
improvements of symptom distress, and depressive symptoms. Result(s):
The majority of participants were male (78.7%), with a mean age of
53.2+/-12.28 years, and mean ejection fraction (EF) after heart transplant
of 61.74+/-10.04%. The participants receiving the Tele-Case-Management
Program intervention showed significantly greater improvement than those
in the control group in the symptom frequency (p=0.029, 0.001), symptom
distress (p=0.014, 0.001), and depressive symptom (p=0.029, 0.001) at
one-month and 3-month follow-up. Conclusion(s): The
Tele-Case-Management Program is able to improve symptom frequency and
distress, and depressive symptoms in heart transplant recipients.

<142>
Accession Number
627214009
Title
Predicting recurrent CVD events among adults with stable CVD: A new risk
model based on pooled NIH cohorts.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 45), 2018. Date of
Publication: August 2018.
Author
Navar A.M.; Wojdyla D.M.; Sanchez R.J.; Steen D.L.; Khan I.; Peterson
E.D.; Pencina M.J.
Institution
(Navar, Wojdyla, Peterson, Pencina) Duke Clinical Research Institute,
Durham, United States
(Sanchez) Regeneron Pharmaceuticals, Tarrytown, NY, United States
(Steen) University of Cincinnati, Cincinnati, United States
(Khan) Sanofi, Bridgewater, NJ, United States
Publisher
Oxford University Press
Abstract
Background: Estimating downstream risk for cardiovascular disease (CVD)
events among those with known CVD is important as it can influence
estimated treatment benefit, cost effectiveness, and treatment selection.
 Purpose(s): To develop a prediction model to estimate the risk of
recurrent CVD events among adults with established atherosclerotic CVD.
 Method(s): Pooled data from the Atherosclerotic Risk in Communities
(ARIC) study, Cardiovascular Health Study (CHS), and Framingham Original
and Offspring Studies were used to identify adults with known CVD (prior
myocardial infarction [MI], angina, coronary revascularization, stroke,
transient ischemic attack, or peripheral arterial disease). Multivariable
Cox regression was used to develop a model for hard CVD events (MI,
stroke, or CV death) at 5-years. Result(s): Overall, 1,835 adults
with known CVD were included in the analysis. Over 5 years, the CVD event
rate was 4.1 per 100 person years. The final model included age, race,
sex, diastolic blood pressure, non-HDL-C, creatinine clearance, statin
use, blood pressure medication use, peripheral arterial disease, heart
failure, diabetes (on insulin, on orals, no diabetes), and history of
stroke or MI in the past 5 years. Model risk estimates varied widely among
patient risk deciles (from under 10% to >50%) and were calibrated with
observed risk (Figure). After bootstrap correction, model discrimination
(c-index) was 0.70 (95% CI: 0.67- 0.73). Conclusion(s): Using readily
available demographic and clinical characteristics, the risk for recurrent
CVD events can be accurately estimated among those known CVD. Validation
work is underway in an electronic health record-based sample. Targeting
those at highest risk may help improve the selection and cost
effectiveness of CVD therapies.

<143>
Accession Number
627213901
Title
Treatment of degenerated aortic bioprostheses: A comparison between
conventional reoperation and valve-in-valve transfemoral transcatheter
aortic valve replacement.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 24-25), 2018. Date of
Publication: August 2018.
Author
Stachel G.; Woitek F.J.; Holzey D.; Kiefer P.; Haussig S.; Leontyev S.;
Schlotter F.; Adam J.; Crusius L.; Mohr F.W.; Schuler G.C.; Thiele H.;
Borger M.A.; Linke A.; Mangner N.
Institution
(Stachel, Woitek, Haussig, Schlotter, Adam, Crusius, Schuler, Thiele,
Mangner) Heart Center of Leipzig, University Department of Cardiology,
Leipzig, Germany
(Holzey, Kiefer, Leontyev, Mohr, Borger) Heart Center of Leipzig,
University Department of Cardiac Surgery, Leipzig, Germany
(Linke) Dresden University of Technology, Heart Center, Dresden, Germany
Publisher
Oxford University Press
Abstract
Introduction: Bioprosthetic valves are currently preferred over mechanical
ones, but the major drawback is their deterioration and failure over time,
requiring redo surgery. Conventional surgical replacement of these valves
(re-SAVR) has been standard of care; however, valve-in-valve deployment of
transcatheter aortic valve prostheses (VinV) has been used increasingly in
the last years. Data comparing both methods are scarce. We sought to
evaluate 30-day-and 1-year-mortality and the incidence of adverse outcomes
in patients receiving either VinV or re-SAVR. Method(s): All patients
(pts) receiving either VinV or re-SAVR for a degenerated bioprosthesis in
aortic position (excluding pts with active endocarditis) between 01/2006
and 05/2016 were included in the analysis. We defined all-cause-30-day and
1-year mortality as the primary end points. Continuous variables are
displayed median (IQR). All end point definitions were according to the
Valve Academic Research Consortium-2 definitions. Result(s): Overall,
229 pts were treated for aortic valve prosthesis failure, with 121
receiving VinV and 108 receiving re-SAVR. Pts receiving VinV had a higher
STSPROM (7.1% (4.2; 9.9) vs. 2.0% (1.5; 3.3), p<0.01), were older (78
years (73; 82) vs 60 years (47; 71), p<0.01) and had lower baseline GFR
(62.2 ml/min/1.73m2 (46.9; 73.6) vs. 77.9 ml/min/1.73m2 (62.2; 89.9),
p<0.05). Baseline ejection fraction did not differ significantly between
groups (58% (46.0; 65.0) vs. 60% (50.3; 65.0), p=0.308). Duration of
postoperative stay was shorter for pts receiving VinV (10 days (8; 13) vs.
12 days (9; 15), p<0.01). Compared to VinV, re-SAVR had a higher rate of
life threatening bleeding events (5.5% vs 13.9%, p<0.05) and a
significantly higher incidence of renal failure (any renal failure: 13.2%
vs 32.4%, p<0.01; stage 3 renal failure: 4.1% vs 12.0%, p<0.05). There
were no significant differences regarding periprocedural myocardial
infarction (4.2% vs 1.9%, p=0.45), stroke (any stroke: 7.5% vs 7.5%,
p=1.0) or need for permanent pacemaker implantation (17.4% vs 13.9%,
p=0.586). 30-day mortality (4.1% (VinV) vs. 4.6% (re-SAVR), p=0.882) and
1-year mortality (7.4% (VinV) vs. 12.0% (re-SAVR), p=0.182) did not differ
significantly between groups. Conclusion(s): Despite a higher risk
profile in VinV, 30-day and 1-year mortality rates were not different
compared to re-SAVR which might be explained by a higher complication rate
in re-SAVR. VinV seems to be a safe and feasible therapeutic option for
patients with degenerated aortic bioprosthesis. A randomized controlled
clinical trial is necessary to elucidate the impact of VinV vs. re-SAVR on
functional outcome and mortality.

<144>
Accession Number
627213882
Title
The Ross procedure versus mechanical aortic valve replacement in adults: A
systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 125), 2018. Date of
Publication: August 2018.
Author
Mazine A.; Rocha R.V.; El-Hamamsy I.; Ouzounian M.; Yanagawa B.; Bhatt
D.L.; Verma S.; Friedrich J.O.
Institution
(Mazine, Rocha) University of Toronto, Cardiac Surgery, Toronto, Canada
(El-Hamamsy) Montreal Heart Institute, Cardiac Surgery, Montreal, Canada
(Ouzounian) Toronto General Hospital, Cardiac Surgery, Toronto, Canada
(Yanagawa, Verma) St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Center, Boston,
United States
(Friedrich) St. Michael's Hospital, Critical Care Medicine, Toronto,
Canada
Publisher
Oxford University Press
Abstract
Background: Young and middle-aged adults with diseased aortic valves
constitute a challenging population. Owing to a longer life expectancy,
these patients present a higher cumulative lifetime risk of
prosthesis-related complications. The ideal aortic valve substitute in
young and middle-aged adults remains unknown. Purpose(s): We aimed to
compare long-term outcomes in adult patients who undergo the Ross
procedure versus mechanical aortic valve replacement (AVR).
 Method(s): We conducted a systematic review and meta-analysis in
accordance with the PRISMA (Preferred Reporting Items for Systematic
reviews and Meta- Analyses) guidelines. We systematically searched OVID
versions of MEDLINE (1946 to December, 2016) and EMBASE Classic (1947 to
December, 2016) for relevant studies using the following text word search
in the title or abstract: ("Ross" OR "autograft") AND ("aortic" OR
"mechanical"). We included all randomised controlled trials (RCT) and
observational studies comparing the Ross procedure to the use of
mechanical prostheses in adults undergoing AVR. The primary outcome was
all-cause mortality and was assessed using a random effects model.
 Result(s): Our search identified 1893 reports, of which 17 studies
(2966 patients) met our inclusion criteria, including one RCT and 16
observational studies, with a median follow-up of 5.7 years (interquartile
range 3.1-7.9 years). Analysis of the primary outcome demonstrated a 42%
lower all-cause mortality in patients undergoing the Ross procedure
compared with mechanical AVR (incidence rate ratio [IRR] 0.58, 95%
confidence interval [CI] 0.36-0.92; I2=27%). The Ross procedure was also
associated with lower rates of stroke (IRR 0.26, 95% CI 0.09-0.80; I2=8%)
and major bleeding (IRR 0.17, 95% CI 0.07-0.40; I2=0%), but higher rates
of reintervention (IRR 1.76, 95% CI 1.16-2.65; I2=0%). Conclusion(s):
Data from primarily observational studies suggest that the Ross procedure
is associated with a lower risk of all-cause mortality compared with
mechanical AVR. These findings highlight the need for a large, prospective
RCT comparing long-term outcomes between these two interventions. (Figure
Presented).

<145>
Accession Number
627213863
Title
Risk of infective endocarditis after trans-catheter aortic valve
replacement and surgery. Meta-analysis of 4 randomized studies and 3754
patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 124-125), 2018. Date of
Publication: August 2018.
Author
Rial Baston V.; Moreno Gomez R.; Jimenez Valero S.; Galeote Garcia G.;
Sanchez Recalde A.; Irazusta Cordoba J.; Meras Colunga P.; Gonzalez Davia
R.; Plaza Perez I.; Lopez Sendon J.L.
Institution
(Rial Baston, Moreno Gomez, Jimenez Valero, Galeote Garcia, Sanchez
Recalde, Irazusta Cordoba, Meras Colunga, Lopez Sendon) University
Hospital La Paz, Cardiology, Madrid, Spain
(Gonzalez Davia) University Hospital Infanta Cristina, Madrid, Spain
(Plaza Perez) University Hospital Infanta Sofia, Madrid, Spain
Publisher
Oxford University Press
Abstract
Background and objectives: Trans-catheter aortic valve replacement (TAVR)
is a technique which is replacing surgery (SAVR) in a broad spectrum of
patients (P.). One of the less known aspects, however, is whether there is
a difference in the incidence of infective endocarditis (IE) between both
techniques. We aimed to compare the risk of developing infective
endocarditis after TAVR implantation versus SAVR in patients with severe
aortic stenosis. Method(s): We performed a meta-analysis of 4
randomized studies comparing aortic valve surgery and TAVR in patients
with severe aortic stenosis: PARTNER 1A, PARTNER 2, NOTION, US-Corevalve.
 Result(s): A total 3754 patients were included, of whom 1891 were
assigned to TAVR and 1863 to surgery. The incidence of IE was very low in
the first month after the procedure in both groups (0.05% versus 0.05%,
p=0.98). During the first year, the incidence of IE was 0.8% in P. who
underwent TAVR vs 0.9% in P. treated with surgery (p=0.80). In the maximum
follow-up period (range 1-5 years) the incidence was 1.2% versus 1.0%,
respectively, without statistical significant differences (p=0.58) (see
figure). Conclusion(s): The risk of developing IE after treatment of
severe aortic stenosis is low, either after trans-catheter aortic valve
replacement or after surgery. No significant statistical differences were
found between both groups.

<146>
Accession Number
627213696
Title
Amiodarone plus ranolazine for conversion of post-cardiac surgery atrial
fibrillation: Enhanced effectiveness in low versus preserved ejection
fraction patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 204), 2018. Date of
Publication: August 2018.
Author
Simopoulos V.; Chevas A.; Desimonas N.; Kalafati G.; Hatziefthimiou A.;
Skoularigis I.; Tsilimingas N.; Aidonidis I.
Institution
(Simopoulos, Chevas, Desimonas, Kalafati, Tsilimingas) Univ. of Thessaly,
Dept. of Thoracic and Cardiovascular Surgery, Univ. Hospital of Larissa,
Larissa, Greece
(Hatziefthimiou, Aidonidis) Univ. of Thessaly, Dept. of Physiology, School
of Medicine, Larissa, Greece
(Skoularigis) University General Hospital of Larissa, Cardiology, Larissa,
Greece
Publisher
Oxford University Press
Abstract
Postoperative atrial fibrillation (POAF) is a common complication in
patients (pts) undergoing cardiac bypass surgery. In principle, there is
no doupt that this arrhythmia should be terminated for several reasons,
especially in pts with compromised left ventricular function. This summary
compares the results of two separately evaluated single-center prospective
studies executing during the last 4 years comprising patients with HFrEF
(<40%) or HFpEF (>45%) and POAF. Investigated was the antiarrhythmic
potency of amiodarone (A) as monotherapy vs. amiodarone+ranolazine (A+R)
for converting POAF during a max. of 36-h period after initiation of
treatment. Primary endpoints were conversion rate and time to conversion
of arrhythmia in both groups. All pts were randomly assigned to receive
either A or A+R within each group. In the HFrEF group 511 pts (446 M/65 F,
65+/-9 years) were enrolled and in the HFpEF group 301 pts (257 M/44 F,
66+/-10 years). From the HFrEF group, 255 pts were treated with i.v. A
(loading dose 300 mg in 30 min + 1125 mg in 36 h) and 256 with A plus R
(loading dose 500 mg p.o. + 375 mg after 6 h and then 375 mg twice daily);
from the HFpEF group, 150 pts received only A while 151 the combined
regimen at the same doses given for HFrEF pts. Pts treated only with A
reverted to sinus rhythm (SR) later than those receiving A+R in both
groups. In particular, A-only therapy was more effective in the HFrEF
group restoring SR earlier (8-21 h, mean 14.4+/-3.9 h) than in the HFpEF
group (22-36 h, mean 26.8+/-2.8 h). Similarly, A+R treatment led also to
earlier AF conversion in pts with HFrEF vs. HFpEF (9.1+/-0.9 h vs.
11.3+/-0.6 h, respectively; mean+/-SD, p<.001, 1-way ANOVA, Bonferroni's
Multiple Comparison Test). Left atrial diameter was significantly greater
in HFrEF vs. HFpEF pts (48.2+/-2.6 vs. 35.2+/-2.9 mm, p<.0001). No serious
adverse drug effects were observed in any patient of the two groups. Post
AF conversion heart rate, P-wave, QRS, QTc, and Tp-Te duration, albeit
modestly changed after A+R vs. A alone in HFrEF/HFpEF pts, remained within
normal limits. In conclusion, A-only treatment converted POAF earlier in
HFrEF pts compared to those with HFpEF. The combination of A+R resulted in
shorter time to AF conversion than A monotherapy in both groups, while it
was more effective in HFrEF vs. HFpEF pts which were treated with A+R.
These data are consistent with experimental findings demonstrating that R
produces greater inhibition of INa in atrial cells of failing vs. normal
hearts, possibly translating into more pronounced increase of atrial
postrepolarization refractoriness in HFrEF pts. (Figure Presented) .

<147>
Accession Number
627215509
Title
PCI or CABG in left main coronary artery disease: A comprehensive
meta-analysis of adjusted observational studies and randomized controlled
trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 325), 2018. Date of
Publication: August 2018.
Author
De Filippo O.; Bertaina M.; Iannaccone M.; Colombo A.; Stone G.; Serruys
P.; Mancone M.; Biondi-Zoccai G.; Kimura T.; Kawamoto H.; Sheiban I.;
Templin C.; Benedetto U.; Moretti C.; D'Ascenzo F.
Institution
(De Filippo, Bertaina, Iannaccone, Moretti, D'Ascenzo) Hospital Molinette,
University Hospital S. Giovanni Battista, City University Hosp of Health
an, Turin, Italy
(Colombo, Kawamoto) San Raffaele Hospital of Milan (IRCCS), Milan, Italy
(Stone) Columbia University Medical Center, New York, United States
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
(Mancone) Sapienza University of Rome, Rome, Italy
(Biondi-Zoccai) Neuromed Institute IRCCS, Pozzilli, Italy
(Kimura) Kyoto University, Kyoto, Japan
(Sheiban) Casa Di Cura Pederzoli, Verona, Italy
(Templin) University Heart Center, Zurich, Switzerland
(Benedetto) Bristol Heart Institute, Bristol, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Treatment of patients with ULMCA (Unprotected Left Main
Coronary Artery Disease) with either Percutaneous Coronary Intervention
(PCI) has been compared with Coronary Artery Bypass Graft (CABG), without
conclusive results. Method(s): All randomized controlled trials
(RCTs) and observational studies with multivariate analysis comparing PCI
and CABG for ULMCA were included. Major cardiovascular events (Maces,
composite of all-cause death, MI, definite or probable ST, target vessel
revascularization and stroke) were the primary end points, while its
single components the secondary ones, along with stent thrombosis, graft
occlusion and in hospital death and stroke. Sensitivity analyses were
performed according to Syntax score. Result(s): 6 Randomized
Controlled Trials (4717 patients) and 20 observational studies with
multivariate adjustment (14597 patients) were included. After 5 (3- 5.5)
years, MACE rate was higher for PCI (OR 1.10, 95% CI 1.07-1.14), without
difference in death, while more relevant risk of MI was due to
observational studies. Coronary stenting increased risk of
revascularization (OR 1.52:1.34-1.72). At meta-regression, performance of
PCI was improved by use of intra-coronary imaging and worsened by first
generation stents, while two arterial grafts increased benefit of CABG.
For patients with Syntax score <22, MACE rates did not differ, while for
higher values CABG reduced MACE due to lower risk of revascularization.
Incidence of graft occlusion was 3.24% (2.25-4.23), while2.13% (1.28-
2.98: all CI 95%) of patients. experienced stent thrombosis
 Conclusion(s): Surgical revascularization reduces risk of
revascularization for ULMCA patients, especially for those with Syntax
Score>22, with a higher risk of in hospital death. Intra-coronary imaging
and use of arterial grafts improved performance of revascularization
strategies.

<148>
Accession Number
627215466
Title
Comparison of safety and benefits between single vs. dual antiplatelet
therapy in patients undergoing transcatheter bioprosthetic aortic valve
replacement: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 430), 2018. Date of
Publication: August 2018.
Author
Makkiya M.; Algodi M.; Villablanca P.; Javed S.; Golive A.; Garcia M.
Institution
(Makkiya, Javed, Garcia) Albert Einstein College of Medicine, Cardiology,
New York, United States
(Algodi) St. Barnabas Hospital, New York, United States
(Villablanca) New York University Langone Medical Center, Interventional
Cardiology, New York, United States
(Golive) Montefiore Medical Center (Bronx), Cardiology, New York, United
States
Publisher
Oxford University Press
Abstract
Background: The relative benefits of single vs. dual antiplatelet therapy
for the prevention of cerebro-vascular complications after transcatheter
bioprosthetic aortic valve replacement (TAVR) remains controversial.
 Purpose(s): Our objective was to compare efficacy and safety of
single vs. dual antiplatelet therapy used for prevention of
cerebrovascular accidents (CVA) in patients undergoing TAVR.
 Method(s): We conducted a comprehensive search of PubMed, EMBASE,
Cochrane Central Register of Controlled Trials, conference proceedings,
and relevant Web sites from inception of TAVR both in Europe and US
through January 2018. The primary endpoint was incidence of combined
ischemic and hemorrhagic CVA. Secondary endpoints included major bleeding,
all-cause mortality, myocardial infarction (MI), and major adverse cardiac
events (MACE). Odds ratios (OR) and 95% confidence intervals (CI) were
computed using the Mantel-Haenszel (MH) method. Fixed-effect model was
used; if heterogeneity (I2)>25, effects were obtained using a random model
Results: Three randomized clinical trial and two cohort studies were
included, with a total of 752 patients. No significant difference was
found for CVA (OR, 0.81; 95% CI 0.30-2.21) all-cause mortality (OR, 1.04;
95% CI 0.59-1.83), and MI (OR, 0.46; 95% CI 0.14-1.55) between the two
groups. We identified significant difference with lower rates of major
bleeding favoring Aspirin therapy (OR, 0.30; 95% CI 0.18-0.51); we also
found a trend toward lower MACE rates favoring aspirin group (OR, 0.50;
95% CI 0.22-1.12). Exclusion of a single study from the analysis did not
alter the overall result (Figure 1). Conclusion(s): Our meta-analysis
showed that there is no difference between aspirin and dual antiplatelet
therapy for the risk of CVA, MI, and all-cause mortality in patients who
underwent TAVR. Aspirin resulted in lower rates of major bleeding and
MACE. (Figure Presented).

<149>
Accession Number
627215460
Title
Platelet function monitoring for the prediction of clinical outcomes: A
pooled analysis of the randomized ARCTIC and ANTARCTIC trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2018. Germany. 39 (Supplement 1) (pp 349-350), 2018. Date of
Publication: August 2018.
Author
Lattuca B.; Yan Y.; Kerneis M.; Cuisset T.; Silvain J.; Range G.; Elhadad
S.; Pouillot C.; Leclercq F.; Manzo-Silberman S.; Bellemain-Appaix A.;
Vicaut E.; Cayla G.; Collet J.P.; Montalescot G.
Institution
(Lattuca, Yan, Kerneis, Silvain, Collet, Montalescot) Hospital
Pitie-Salpetriere, Institute of Cardiology, Paris, France
(Cuisset) Hospital La Timone of Marseille, Cardiology, Marseille, France
(Range) Hospital Louis Pasteur of Chartres, Cardiology, Chartres, France
(Elhadad) Hospital of Lagny Marne La Vallee, Cardiology, Jossigny, France
(Pouillot) Clinic Sainte Clotilde, Cardiology, Saint Denis De La Reunion,
France
(Leclercq) University Hospital Arnaud De Villeneuve, Cardiology,
Montpellier, France
(Manzo-Silberman) Hospital Lariboisiere, Cardiology, Paris, France
(Bellemain-Appaix) Hospital Juan-Les-Pins, Cardiology, Antibes, France
(Vicaut) Hospital Lariboisiere, Epidemiology and Clinical Research Unit,
Paris, France
(Cayla) University Hospital of Nimes, Cardiology, Nimes, France
Publisher
Oxford University Press
Abstract
Background: Platelet function monitoring offers the possibility to
individualize antiplatelet therapy in coronary artery disease patients but
failed to improve clinical outcomes in randomized clinical trials.
However, high-on-treatment platelet reactivity (HPR) remains a risk factor
for recurrent ischemic events and low-ontreatment platelet reactivity
(LPR) is a risk factor for bleeding events. Method(s): We collected
data of patients assigned to the monitoring arm of the randomized ARCTIC
and ANTARCTIC trials that evaluated the platelet reactivity by the
VerifyNow P2Y12 test two weeks after coronary stenting. HPR was defined by
PRU>=208, LPR by PRU<=85 and optimal platelet reactivity (OPR) by 85
Results: Among the 1,418 patients included, HPR was present in 269
patients (18.9%), OPR was reached in 681 patients (48.0%) and LPR in 468
patients (33.0%). The primary composite endpoint occurred in 9.7%, 11.5%
and 14.3% respectively. There was no significant difference in the net
clinical benefit between HPR and OPR patients (adjusted HR: 0.91; 95% CI:
0.48-1.72; p=0.77) and between LPR and OPR patients (adjusted HR: 1.13;
95% CI: 0.67-1.90; p=0.64) (Figure). There were no differences in the
individual clinical endpoints between the three groups. Receiver operating
characteristic curve analysis demonstrated that PRU when used for
treatment adjustment has a limited ability to discriminate net clinical
benefit, ischemic events or bleeding complications (curve - c index=0.55,
0.51 or 0.59, respectively). Conclusion(s): Two weeks after stenting,
optimal platelet reactivity was obtained in less than half of the
population. The net clinical benefit of these patients was not different
from that of patients with HPR and LPR who had treatment adjustment.
(Figure Presented) .

<150>
[Use Link to view the full text]
Accession Number
627222688
Title
A novel method of Uniblocker placement: extraluminal technique supported
by trachea length measurement: A CONSORT-compliant article.
Source
Medicine. 98 (14) (pp e15116), 2019. Date of Publication: 01 Apr 2019.
Author
Liu Z.; Zhao L.; He W.; Zhu Y.; Bao L.; Jia Q.; Yang X.; Liang S.
Institution
(Liu, He, Zhu, Bao, Jia, Yang, Liang) Department of Anesthesiology, First
Hospital of Qinhuangdao, Qinhuangdao, China
(Zhao) Department of Thoracic Surgery, First Hospital of Qinhuangdao,
Qinhuangdao, Hebei, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The use of bronchial blockers has been increased for one-lung
ventilation; however, the placement of bronchial blockers is time
consuming. The objective of this study was to compare the novel
extraluminal technique of Uniblocker placement supported by trachea length
measurement on computerized tomography images with conventional
intraluminal Uniblocker placement method. METHOD(S): Seventy adult
patients undergoing left side thoracic surgery were included in the study.
All the patients were randomly assigned to one of two groups: conventional
intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT
guided group (CT-EX group, n = 35). The primary endpoints were the optimal
positions of Uniblocker and the injuries of bronchi and carina. The
secondary outcomes included the time of Uniblocker placement, the adequacy
of lung collapse, the incidences of Uniblocker displacement, sore throat,
and hoarseness postoperative. RESULT(S): In the CV-IN group, 19 of 35
Uniblockers went to the left main-stem bronchus on the initial blind
insertion and 15 of 35 Uniblockers were considered as in optimal depth,
whereas in the CT-EX group, 32 of 35 Uniblockers went to the left
main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers
were considered as in optimal depth (P < .01). The incidence of bronchi
and carina injuries was obviously lower in the CT-EX group (occurred in 1
of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P <
.05). The time of Uniblocker placement took 145.4 s in the CV-IN group and
85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the
degree of pulmonary collapse and the adverse events postoperative such as
sore throat and hoarseness were not significantly different between the
two groups (P > .05). CONCLUSION(S): The novel extraluminal technique
of Uniblocker placement supported by trachea length measurement on
computerized tomography images was proved to be more rapid, more accurate
and less complications than conventional intraluminal Uniblocker placement
method.

<151>
Accession Number
627212102
Title
Clinical and genetic insights into non-compaction: a meta-analysis and
systematic review on 7598 individuals.
Source
Clinical Research in Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Kayvanpour E.; Sedaghat-Hamedani F.; Gi W.-T.; Tugrul O.F.; Amr A.; Haas
J.; Zhu F.; Ehlermann P.; Uhlmann L.; Katus H.A.; Meder B.
Institution
(Kayvanpour, Sedaghat-Hamedani, Gi, Tugrul, Amr, Haas, Zhu, Ehlermann,
Katus, Meder) Department of Medicine III, Institute for Cardiomyopathy,
University of Heidelberg, INF 410, Heidelberg 69120, Germany
(Kayvanpour, Sedaghat-Hamedani, Gi, Tugrul, Amr, Haas, Katus, Meder) DZHK
(German Centre for Cardiovascular Research), Berlin, Germany
(Uhlmann) Institute of Medical Biometry and Informatics, University of
Heidelberg, Heidelberg, Germany
(Zhu) Department of Cardiology, Institute of Cardiology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430022, China
(Meder) Department of Genetics, Stanford Genome Technology Center,
Stanford University School of Medicine, Stanford, CA, United States
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Left ventricular non-compaction has been increasingly
diagnosed in recent years. However, it is still debated whether
non-compaction is a pathological condition or a physiological trait. In
this meta-analysis and systematic review, we compare studies, which
investigated these two different perspectives. Furthermore, we provide a
comprehensive overview on the clinical outcome as well as genetic
background of left ventricular non-compaction cardiomyopathy in adult
patients. Methods and Results: We retrieved PubMed/Medline
literatures in English language from 2000 to 19/09/2018 on clinical
outcome and genotype of patients with non-compaction. We summarized and
extensively reviewed all studies that passed selection criteria and
performed a meta-analysis on key phenotypic parameters. Altogether, 35
studies with 2271 non-compaction patients were included in our
meta-analysis. The mean age at diagnosis was the mid of their fifth
decade. Two-thirds of patients were male. Congenital heart diseases
including atrial or ventricular septum defect or Ebstein anomaly were
reported in 7% of patients. Twenty-four percent presented with family
history of cardiomyopathy. The mean frequency of neuromuscular diseases
was 5%. Heart rhythm abnormalities were reported frequently: conduction
disease in 26%, supraventricular tachycardia in 17%, and sustained or
non-sustained ventricular tachycardia in 18% of patients. Three important
outcome measures were reported including systemic thromboembolic events
with a mean frequency of 9%, heart transplantation with 4%, and adequate
ICD therapy with 15%. Nine studies investigated the genetics of
non-compaction cardiomyopathy. The most frequently mutated gene was TTN
with a pooled frequency of 11%. The average frequency of MYH7 mutations
was 9%, for MYBPC3 mutations 5%, and for CASQ2 and LDB3 3% each. TPM1,
MIB1, ACTC1, and LMNA mutations had an average frequency of 2% each.
Mutations in PLN, HCN4, TAZ, DTNA, TNNT2, and RBM20 were reported with a
frequency of 1% each. We also summarized the results of eight studies
investigating the non-compaction in altogether 5327 athletes, pregnant
women, patients with sickle cell disease, as well as individuals from
population-based cohorts, in which the presence of left ventricular
hypertrabeculation ranged from 1.3 to 37%. Conclusion(s): The
summarized data indicate that non-compaction may lead to unfavorable
outcome in different cardiomyopathy entities. The presence of key features
in a multimodal diagnostic approach could distinguish between benign
morphological trait and manifest cardiomyopathy. Copyright ©
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

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