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<1>
Accession Number
625543899
Title
A Systematic Review of Caudal Anesthesia and Postoperative Outcomes in
Pediatric Cardiac Surgery Patients.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 23 (2) (pp 237-247),
2019. Date of Publication: 01 Jun 2019.
Author
Maharramova M.; Taylor K.
Institution
(Maharramova, Taylor) Hospital for Sick Children, Toronto, ON, Canada
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objectives. In pediatric cardiac surgery, does caudal anesthesia promote
early extubation, reduce pain scores, reduce stress responses, and length
of stay (LOS)? Design. A systematic review. Participants. Inclusion
criteria included cardiac surgical procedures (with or without
cardiopulmonary bypass) in any subject between the ages of full-term
newborn and 18 years receiving caudal anesthesia of any medication
combination. Searches were conducted with assistance of an Academic
librarian from 1947 to July 2017. Methods. Relevant studies selected were
randomized trials or cohort studies. Results. The total number of patients
was 2159 in 17 studies. There were 8 prospective randomized clinical
trials and 9 cohort studies. Caudal medications included dexmedetomidine,
bupivacaine, sufentanil, morphine, fentanyl, and neostigmine. Nine studies
reported earlier extubation in patients with caudal anesthesia.
Cardiopulmonary bypass and surgical duration mitigated early extubation
anesthetic strategies. Three of 5 studies showed reduced pain scores and
need for opiates, 2 studies showed no difference. Two of 3 studies showed
a reduction in stress response. Hemodynamic assessments were improved in 2
studies and unchanged in 3 studies. Four studies showed reduced hospital
LOS. Studies are difficult to interpret because of the comparative
techniques used. Conclusions. The data quality in this review is too poor
to make recommendations regarding incorporation of caudal anesthesia into
clinical practice. Caudal anesthesia may be favorable for early
extubation, improved pain, and hemodynamics and reduced LOS. There are
many other anesthetic alternatives to facilitate early extubation. Our
review is limited by heterogeneous populations, variable pain measurement
scales, and absent definitions of extubation indicators.<br/>Copyright
&#xa9; The Author(s) 2018.

<2>
Accession Number
619362219
Title
Relationship of C-reactive protein reduction to cardiovascular event
reduction following treatment with canakinumab: a secondary analysis from
the CANTOS randomised controlled trial.
Source
The Lancet. 391 (10118) (pp 319-328), 2018. Date of Publication: 27 Jan
2018.
Author
Ridker P.M.; MacFadyen J.G.; Everett B.M.; Libby P.; Thuren T.; Glynn
R.J.; Kastelein J.; Koenig W.; Genest J.; Lorenzatti A.; Varigos J.;
Siostrzonek P.; Sinnaeve P.; Fonseca F.; Nicolau J.; Gotcheva N.; Yong H.;
Urina-Triana M.; Milicic D.; Cifkova R.; Vettus R.; Anker S.D.; Manolis
A.J.; Wyss F.; Forster T.; Sigurdsson A.; Pais P.; Fucili A.; Ogawa H.;
Shimokawa H.; Veze I.; Petrauskiene B.; Salvador L.; Cornel J.H.; Klemsdal
T.O.; Medina F.; Budaj A.; Vida-Simiti L.; Kobalava Z.; Otasevic P.; Pella
D.; Lainscak M.; Seung K.-B.; Commerford P.; Dellborg M.; Donath M.; Hwang
J.-J.; Kultursay H.; Flather M.; Ballantyne C.; Bilazarian S.; Chang W.;
East C.; Forgosh L.; Harris B.; Ligueros M.
Institution
(Ridker, MacFadyen, Everett, Glynn) Center for Cardiovascular Disease
Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Ridker, Everett, Libby) Cardiovascular Division, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Thuren) Novartis Pharmaceutical Corporation, East Hanover, NJ, United
States
(Thuren) Novartis Pharmaceutical Corporation, Basel, Switzerland
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Canakinumab, a monoclonal antibody targeting interleukin-1beta
reduces inflammation and cardiovascular event rates with no effect on
lipid concentrations. However, it is uncertain which patient groups
benefit the most from treatment and whether reductions in the inflammatory
biomarker high-sensitivity C-reactive protein (hsCRP) correlate with
clinical benefits for individual patients. <br/>Method(s): The Canakinumab
Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) used
computer-generated codes to randomly allocate 10 061 men and women with a
history of myocardial infarction to placebo or one of three doses of
canakinumab (50 mg, 150 mg, or 300 mg) given subcutaneously once every 3
months. In a prespecified secondary analysis designed to address the
relationship of hsCRP reduction to event reduction in CANTOS, we evaluated
the effects of canakinumab on rates of major adverse cardiovascular
events, cardiovascular mortality, and all-cause mortality according to
on-treatment concentrations of hsCRP. We used multivariable modelling to
adjust for baseline factors associated with achieved hsCRP and multiple
sensitivity analyses to address the magnitude of residual confounding. The
median follow-up was 3.7 years. The trial is registered with
ClinicalTrials.gov, number NCT01327846. <br/>Finding(s): Baseline clinical
characteristics did not define patient groups with greater or lesser
cardiovascular benefits when treated with canakinumab. However, trial
participants allocated to canakinumab who achieved hsCRP concentrations
less than 2 mg/L had a 25% reduction in major adverse cardiovascular
events (multivariable adjusted hazard ratio [HR^adj]=0.75, 95%
CI 0.66-0.85, p<0.0001), whereas no significant benefit was observed among
those with on-treatment hsCRP concentrations of 2 mg/L or above
(HR^adj=0.90, 0.79-1.02, p=0.11). For those treated with
canakinumab who achieved on-treatment hsCRP concentrations less than 2
mg/L, cardiovascular mortality (HR^adj=0.69, 95% CI 0.56-0.85,
p=0.0004) and all-cause mortality (HR^adj=0.69, 0.58-0.81,
p<0.0001) were both reduced by 31%, whereas no significant reduction in
these endpoints was observed among those treated with canakinumab who
achieved hsCRP concentrations of 2 mg/L or above. Similar differential
effects were found in analyses of the trial prespecified secondary
cardiovascular endpoint (which additionally included hospitalisation for
unstable angina requiring unplanned revascularisation) and in sensitivity
analyses alternatively based on median reductions in hsCRP, on 50% or
greater reductions in hsCRP, on the median percent reduction in hsCRP, in
dose-specific analyses, and in analyses using a causal inference approach
to estimate the effect of treatment among individuals who would achieve a
targeted hsCRP concentration. <br/>Interpretation(s): The magnitude of
hsCRP reduction following a single dose of canakinumab might provide a
simple clinical method to identify individuals most likely to accrue the
largest benefit from continued treatment. These data further suggest that
lower is better for inflammation reduction with canakinumab.
<br/>Funding(s): Novartis Pharmaceuticals.<br/>Copyright &#xa9; 2018
Elsevier Ltd

<3>
Accession Number
2000731249
Title
Active Chest Tube Clearance After Cardiac Surgery Is Associated With
Reduced Reexploration Rates.
Source
Annals of Thoracic Surgery. 105 (6) (pp 1771-1777), 2018. Date of
Publication: June 2018.
Author
Grieshaber P.; Heim N.; Herzberg M.; Niemann B.; Roth P.; Boening A.
Institution
(Grieshaber, Heim, Herzberg, Niemann, Roth, Boening) Department of Adult
and Pediatric Cardiovascular Surgery, University Hospital Giessen,
Giessen, Germany
Publisher
Elsevier USA
Abstract
Background: Ineffective evacuation of intrathoracic fluid after cardiac
surgery (retained blood syndrome [RBS]) might increase postoperative
complications, morbidity, and mortality. Active tube clearance (ATC)
technology using an intraluminal clearing apparatus aims at increasing
chest tube drainage efficiency. This study evaluated whether ATC reduces
RBS in an all-comers collective undergoing scheduled cardiac surgery with
cardiopulmonary bypass and full or partial median sternotomy.
<br/>Method(s): In this nonrandomized prospective trial, 581 consecutive
patients undergoing scheduled cardiac surgery with median sternotomy
between January 2016 and December 2016 were assigned to receive
conventional chest tubes (control group) or a combination of conventional
tubes and as many as two ATC devices (ATC group), depending on their
operation date. Postoperative occurrence of RBS (one or more of the
following: reexploration for bleeding or tamponade, pericardial drainage
procedure, pleural drainage procedure) and other endpoints were compared.
Propensity score matching was applied. <br/>Result(s): In 222 ATC patients
and 222 matched control patients, RBS occurrence did not differ between
the groups (ATC 16%, control 22%; p = 0.15). However, reexploration rate
for bleeding or tamponade was significantly reduced in the ATC group
compared with the control group (4.1% versus 9.1%, respectively; p =
0.015). The mortality of RBS patients (21%) was higher compared with
patients without RBS (3.9%, p < 0.001). Among the RBS components, only
reexploration (odds ratio 16, 95% confidence interval: 5.8 to 43, p <
0.001) was relevant for inhospital mortality (ATC 6.8%, control 7.7%; p =
0.71). <br/>Conclusion(s): Active tube clearance is associated with
reduced reexploration rates in an all-comers collective undergoing cardiac
surgery. Reexploration is the only RBS component relevant for mortality.
The ATC effect does not translate into improved overall
survival.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<4>
Accession Number
2000730032
Title
Microvascular Responsiveness to Pulsatile and Nonpulsatile Flow During
Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. 105 (6) (pp 1745-1753), 2018. Date of
Publication: June 2018.
Author
O'Neil M.P.; Alie R.; Guo L.R.; Myers M.-L.; Murkin J.M.; Ellis C.G.
Institution
(Guo, Myers) Department of Surgery, Division of Cardiac Surgery, London
Health Sciences Centre, London, Ontario, Canada
(O'Neil, Alie) Department of Clinical Perfusion Services, Division of
Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
(Murkin) Department of Anesthesiology, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, Ontario, Canada
(O'Neil, Ellis) Department of Medical Biophysics, Schulich School of
Medicine and Dentistry, University of Western Ontario, London, Ontario,
Canada
Publisher
Elsevier USA
Abstract
Background: Pulsatile perfusion may offer microcirculatory advantages over
conventional nonpulsatile perfusion during cardiopulmonary bypass (CPB).
Here, we present direct visual evidence of microvascular perfusion and
vasoreactivity between perfusion modalities. <br/>Method(s): A
prospective, randomized cohort study of 20 high-risk cardiac surgical
patients undergoing pulsatile (n = 10) or nonpulsatile (n = 10) flow
during CPB was conducted. Changes in sublingual mucosal microcirculation
were assessed with orthogonal polarization spectral imaging along with
near-infrared spectroscopic indices of thenar muscle tissue oxygen
saturation (StO<inf>2</inf>) and its recovery during a vascular occlusion
test at the following time points: baseline (T<inf>0</inf>), 30 minutes on
CPB (T<inf>1</inf>), 90 minutes on CPB (T<inf>2</inf>), 1 hour after CPB
(T<inf>3</inf>), and 24 hours after CPB (T<inf>4</inf>). <br/>Result(s):
On the basis of our scoring scale, a shift in microcirculatory blood flow
occurred over time. The pulsatile group maintained normal perfusion
characteristics, whereas the nonpulsatile group exhibited deterioration in
perfusion during CPB (T<inf>2</inf>: 74.0% +/- 5.6% versus 57.6% +/- 5.0%)
and after CPB (T<inf>3</inf>: 76.2% +/- 2.7% versus 58.9% +/- 5.2%,
T<inf>4</inf>: 85.7% +/- 2.6% versus 69.8% +/- 5.9%). Concurrently, no
important differences were found between groups in baseline
StO<inf>2</inf> and consumption slope at all time points. Reperfusion
slope was substantially different between groups 24 hours after CPB
(T<inf>4</inf>: 6.1% +/- 0.6% versus 3.7% +/- 0.5%), indicating improved
microvascular responsiveness in the pulsatile group versus the
nonpulsatile group. <br/>Conclusion(s): Pulsatility generated by the
roller pump during CPB improves microcirculatory blood flow and tissue
oxygen saturation compared with nonpulsatile flow in high-risk cardiac
surgical patients, which may reflect attenuation of the systemic
inflammatory response and ischemia-reperfusion injury.<br/>Copyright
&#xa9; 2018 The Society of Thoracic Surgeons

<5>
Accession Number
2000825445
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
The Lancet. 391 (10137) (pp 2325-2334), 2018. Date of Publication: 09 Jun
2018.
Author
Devereaux P.J.; Duceppe E.; Guyatt G.; Tandon V.; Rodseth R.; Biccard
B.M.; Xavier D.; Szczeklik W.; Meyhoff C.S.; Vincent J.; Franzosi M.G.;
Srinathan S.K.; Erb J.; Magloire P.; Neary J.; Rao M.; Rahate P.V.;
Chaudhry N.K.; Mayosi B.; de Nadal M.; Iglesias P.P.; Berwanger O.; Villar
J.C.; Botto F.; Eikelboom J.W.; Sessler D.I.; Kearon C.; Pettit S.;
Connolly S.J.; Bangdiwala S.I.; Rao-Melacini P.; Hoeft A.; Yusuf S.;
Connolly S.; Eikelboom J.; Pogue J.; Di Diodato S.; Gasic Z.; Mastrangelo
L.J.; Molnar S.H.; Swanson J.L.; Tosh M.L.; Wells J.R.; Diaz R.; Chow
C.K.; Gonzales B.; Vasquez S.; Jansky P.; Dusek R.; Coriat P.; Wittmann
M.; Yonga G.; Mathur N.; Seletti E.; Malaga G.; Tumanan-Mendoza B.A.;
Tagle M.P.A.; Alonso-Coello P.; Popova E.; Shields M.; Le Manach Y.;
Moayyedi P.; van Zanten S.; Fleischmann E.; Garg A.; Karaye K.; McFalls
E.; Sigamani A.; Belley-Cote E.; Biedron G.; Borges F.; Frosi Stella S.;
Haarmark Nielsen C.; Leong D.P.; Spence J.; Tran A.; Wawrzycka-Adamczyk
K.; Yang S.S.; Yung T.; Wyse D.G.; Cheng D.; Johnstone D.E.; Wells G.A.;
Joseph P.; Patel A.; Gregus K.; Lawrence K.; Doharris L.; Conen D.; Cheung
J.; Douketis J.; Wright D.; Wikkerink S.; Dechert W.; Panju M.; Azzam K.;
Rapanos T.; Van Helder T.; Shroff A.; Hare J.; Kidane B.; Nguyen T.;
Leydier L.; Bayaraa V.; Parlow J.; DuMerton D.A.; Thakrar A.; Shelley J.;
Deligne B.; Carling R.D.; Mrkobrada M.; Dresser G.K.; Jacka M.J.;
Hornstein D.; Winkelaar G.B.; Haider Z.H.; Lanjewar P.P.; Varughese V.;
Calton R.; Ahuja H.; George P.; Sharma A.; Bhatt K.S.; Mangukiya D.O.;
Nandaniya K.V.; Parekh V.V.; Pillai A.B.; Menon V.P.; Desai S.C.; Sidhu
R.S.; Gupta S.K.; George R.K.; Gurunath T.R.; Drummond L.W.; Torborg A.M.;
Kusel B.S.; Naidoo P.; Naidoo D.P.; Rajah C.; Farina Z.; von Rahden R.P.;
Gumede S.; Chishala C.; Coetzee E.; Dyer R.A.; Diedericks J.; Bielanski
P.; Kaczmarek B.; Studzinska D.; Zaniewski M.; Libura M.J.;
Zacharias-Nalichowski T.M.; Sega A.A.S.; Salwa J.; Kozka M.; Gorka J.;
Wludarczyk A.; Nowak-Kozka I.; Grudzien P.S.; Gucwa J.W.; Slowiaczek M.P.;
Dobosz P.P.D.; Gogenur I.; Eriksen J.R.; Borup T.; Kirkegaard T.; Isbye
D.; Sonne A.; Rasmussen L.S.; Pedersen S.; Troensegaard H.; Duus C.L.;
Halle B.M.; Gundel O.N.; Bernholm K.F.; Martinsen K.R.; Itenov T.S.; Camio
E.; Vazquez C.; Matarin S.; Cano E.; Alvarez-Garcia J.; India I.;
Gonzalez-Osuna A.; Vives M.; Rossello E.; Serrano A.B.; Turiel M.; Drago
L.; Colombo C.; Marra F.; Mos L.; Arteni F.; Lembo R.; Ortalda A.;
Passarani S.; Mokini Z.; Figueiredo E.L.; Werner G.F.; Petriz J.L.; Maia
L.N.; Bergo R.R.; Precoma D.B.; Saraiva J.F.K.; Vilamajo O.G.; Allegrini
E.; Benzadon M.; Parody M.L.; Duronto E.A.; Ingaramo A.C.; Parra G.A.;
Novoa D.; Miller S.A.; Thomas S.; Karlapudi S.P.; Bourji M.H.; Banerjee
S.; Gupta A.; Opole I.O.; Fischer M.; Mendoza V.L.; Reyes E.B.; Pierson
R.J.; Shields M.O.; Piriou V.; Zacharowski K.; Rotta-Rotta A.; Paper M.;
Rahate P.; Chaudhry N.; Paniagua Iglesias P.; Sharma M.
Institution
(Devereaux, Duceppe, Guyatt, Kearon, Bangdiwala, Yusuf) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Tandon, Magloire, Neary, Eikelboom, Kearon, Sharma,
Connolly, Yusuf) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Devereaux, Vincent, Pettit, Sharma, Connolly, Bangdiwala, Rao-Melacini,
Yusuf) Population Health Research Institute, Hamilton, ON, Canada
(Duceppe) Department of Medicine, University of Montreal, Montreal, QC,
Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. <br/>Method(s): In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. <br/>Finding(s): Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). <br/>Interpretation(s): Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 100 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication. <br/>Funding(s):
Boehringer Ingelheim and Canadian Institutes of Health
Research.<br/>Copyright &#xa9; 2018 Elsevier Ltd

<6>
Accession Number
625728509
Title
B-type natriuretic peptide is associated with remodeling and exercise
capacity after transcatheter aortic valve replacement for aortic stenosis.
Source
Clinical Cardiology. 42 (2) (pp 270-276), 2019. Date of Publication:
Februaryy 2019.
Author
Sato K.; Kumar A.; Krishnaswamy A.; Mick S.; Desai M.Y.; Griffin B.P.;
Kapadia S.R.; Popovic Z.B.
Institution
(Sato, Kumar, Krishnaswamy, Mick, Desai, Griffin, Kapadia, Popovic)
Department of Cardiovascular Medicine, Heart and Vascular Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: We aimed to assess longitudinal changes of B-type natriuretic
peptide (BNP) in aortic stenosis (AS) patients treated by transcatheter
aortic valve replacement (TAVR). <br/>Method(s): From our TAVR database,
we identified 193 consecutive patients with severe symptomatic AS who
underwent TAVR and were prospectively followed using serial BNP levels and
echocardiography. Patients were divided into subgroups according to type
of left ventricular (LV) remodeling as having normal LV mass and relative
wall thickness, or showing concentric remodeling (CR), concentric
hypertrophy (CH), and eccentric hypertrophy (EH). <br/>Result(s): At
baseline, 30 patients (16%) had EH, 115 (60%) had CH, 37 (19%) had CR, and
11 (6%) had normal LV geometry. After TAVR, BNP decreased in the first 30
days, with further improvement during follow-up. Patients with EH had
higher BNP at baseline (P < 0.01) and a greater subsequent decrease (P <
0.001). During the median follow-up of 1331 days (interquartile range:
632-1678), 119 (62%) patients died. BNP showed a time-dependent
association with all-cause mortality both in a univariable (hazards ratio
[HR] 1.24, 95% confidence interval [CI]: 1.04-1.47, P = 0.017), and in a
multivariable model with Society of Thoracic Surgeons score and baseline
BNP forced into the analysis (HR 1.32, 95% CI: 1.001-1.73, P = 0.049).
Elevated BNP was associated with a larger LV end-diastolic volume index (P
< 0.001) and shorter 6-minute walk test distance (P = 0.013) throughout
follow-up. <br/>Conclusion(s): In patients with AS, BNP was associated
with LV remodeling phenotypes and functional status before and after TAVR.
Elevated BNP levels were associated with poor prognosis.<br/>Copyright
&#xa9; 2018 The Authors. Clinical Cardiology published by Wiley
Periodicals, Inc.

<7>
Accession Number
2001408332
Title
Disparities in death rates in women with peripartum cardiomyopathy between
advanced and developing countries: A systematic review and meta-analysis.
Source
Archives of Cardiovascular Diseases. 112 (3) (pp 187-198), 2019. Date of
Publication: March 2019.
Author
Kerpen K.; Koutrolou-Sotiropoulou P.; Zhu C.; Yang J.; Lyon J.-A.; Lima
F.V.; Stergiopoulos K.
Institution
(Kerpen, Stergiopoulos) Division of Cardiovascular Medicine, Department of
Medicine, Stony Brook University Medical Center, State University of New
York, Stony Brook, Nichols road, NY 11794, United States
(Koutrolou-Sotiropoulou) Division of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN 55905, United States
(Zhu) Department of Applied Mathematics and Statistics, Stony Brook
University, Stony Brook, NY 11794, United States
(Yang) Department of Family, Population and Preventive Medicine, Stony
Brook University Medical Center, Stony Brook, NY 11794, United States
(Lyon) Library Services, Children's Mercy Kansas City, Kansas City, MO
64108, United States
(Lima) Department of Medicine, Brown University, Rhode Island Hospital,
Providence, RI 02903, United States
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
There is limited information about differences in maternal deaths from
peripartum cardiomyopathy (PPCM) between advanced and developing
countries. To review the literature to define the global prevalence of
death from PPCM, and to determine the differences in PPCM mortality rates
and risk factors between advanced and developing countries. Studies in the
English language reporting mortality data on patients with PPCM were
included from searches of MEDLINE, Embase, CINAHL, the Cochrane Library,
the Web of Science Core Collection and Scopus from 01 January 2000 to 11
May 2016. Of the 4294 articles identified, 1.07% were included. The
primary outcome was death; rates of heart transplant, acute myocardial
infarction, heart failure, arrhythmia, cerebrovascular events, embolism
and cardiac arrest were recorded. Studies were categorized as having been
conducted in advanced or developing countries. Data from 46 studies, 4925
patients and 13 countries were included. There were 22 studies from
advanced countries (n = 3417) and 24 from developing countries (n = 1508);
mean follow-up was 2.6 (range 0-8.6) years. Overall mortality prevalence
was 9% (95% confidence interval [CI] 6-11%). The mortality rate in
developing countries (14%, 95% CI 10-18%) was significantly higher than
that in advanced countries (4%, 95% CI 2-7%). There was no difference in
the prevalence of risk factors (chronic hypertension, African descent,
multiple gestation and multiparity) between advanced and developing
countries. Studies with a higher prevalence of women of African descent
had higher death rates (correlation coefficient 0.29, 95% CI 0.13-0.52).
The risk of death in women with PPCM was higher in developing countries
than in advanced countries. Women of African descent had an increased risk
of death.<br/>Copyright &#xa9; 2018 Elsevier Masson SAS

<8>
Accession Number
625902220
Title
Comparing the placement of a left-sided double-lumen tube via fiberoptic
bronchoscopy guidance versus conventional intubation using a Macintosh
laryngoscope, to reduce the incidence of malpositioning: Study protocol
for a randomized controlled pilot trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 51. Date of
Publication: 15 Jan 2019.
Author
Ryu T.; Kim E.; Kim J.H.; Woo S.J.; Roh W.S.; Byun S.H.
Institution
(Ryu, Kim, Kim, Woo, Roh, Byun) Department of Anesthesiology and Pain
Medicine, School of Medicine, Catholic University of Daegu, 33,
Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A fiberoptic bronchoscope (FOB) is commonly used to identify
the proper placement of a double-lumen endotracheal tube (DLT) for good
lung isolation during thoracic surgery. We hypothesized that the
FOB-guided method for DLT placement composed of tracheal intubation under
initial guidance by a FOB via the bronchial lumen and subsequent selective
left-bronchial intubation could be used to reduce the incidence of DLT
malposition and reduce the time required for completion of DLT placement
and confirmation of proper DLT position during intubation using a
left-sided DLT, in comparison to the conventional method under direct
laryngoscopy using a Macintosh laryngoscope. Methods/design: In this
randomized controlled pilot trial, 50 patients, aged 18-70 years,
scheduled for elective thoracic surgery will be recruited and randomly
assigned to two groups according to the method of DLT placement: a
FOB-guided method (F) group and a conventional method (C) group.
Regardless of the group, the DLT placement processes will be followed by
subsequent confirmation processes, using a FOB. If the DLT is misplaced,
the position would be corrected. The primary outcome is the incidence of
DLT malpositioning observed via a FOB during confirmation after DLT
placement. The secondary outcomes consist of the time required to achieve
the entire DLT intubation process, which is the sum of the duration of DLT
placement and the duration of confirmation of the proper position, the
incidence of failed tracheal intubation on the first and second attempt,
and complications associated with the intubation process.
<br/>Discussion(s): This pilot study was designed as the first randomized
controlled trial to confirm our hypothesis. This should provide
information for a further full-scale trial, and the outcomes of the study
should provide clinical evidence on the usefulness of the FOB-guided
method for DLT placement, in comparison to the conventional method. Trial
registration: Clinical Research Information Service; CRIS, ID: KCT0002663.
Retrospectively registered on 24 January 2018.<br/>Copyright &#xa9; 2019
The Author(s).

<9>
Accession Number
627354624
Title
A fully magnetically levitated left ventricular assist device - Final
report.
Source
New England Journal of Medicine. 380 (17) (pp 1618-1627), 2019. Date of
Publication: 25 Apr 2019.
Author
Mehra M.R.; Uriel N.; Naka Y.; Cleveland J.C.; Yuzefpolskaya M.; Salerno
C.T.; Walsh M.N.; Milano C.A.; Patel C.B.; Hutchins S.W.; Ransom J.; Ewald
G.A.; Itoh A.; Raval N.Y.; Silvestry S.C.; Cogswell R.; John R.; Bhimaraj
A.; Bruckner B.A.; Lowes B.D.; Um J.Y.; Jeevanandam V.; Sayer G.; Mangi
A.A.; Molina E.J.; Sheikh F.; Aaronson K.; Pagani F.D.; Cotts W.G.;
Tatooles A.J.; Babu A.; Chomsky D.; Katz J.N.; Tessmann P.B.; Dean D.;
Krishnamoorthy A.; Chuang J.; Topuria I.; Sood P.; Goldstein D.J.
Institution
(Mehra) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, IL, United States
(Uriel, Jeevanandam, Sayer) University of Chicago, School of Medicine and
Medical Center, Chicago, IL, United States
(Cotts, Tatooles) Advocate Christ Medical Center, Oak Lawn, IL, United
States
(Chuang, Topuria, Sood) Abbott, Abbott Park, IL, United States
(Naka, Yuzefpolskaya) Columbia University, College of Physicians, Surg.
and New York-Presbyterian Hospital, New York, United States
(Goldstein) Montefiore Einstein Center for Heart and Vascular Care, New
York, United States
(Cleveland) University of Colorado, School of Medicine, Aurora, United
States
(Salerno, Walsh) St. Vincent Heart Center, Indianapolis, United States
(Milano, Patel) Duke University Medical Center, Durham, NC, United States
(Katz, Tessmann) University of North Carolina, Chapel Hill, NC, United
States
(Hutchins, Ransom) Baptist Health Medical Center, Little Rock, AR, United
States
(Ewald, Itoh) Washington University, School of Medicine, St. Louis, United
States
(Raval, Silvestry) Advent Health Transplant Institute, Orlando, FL, United
States
(Cogswell, John) University of Minnesota, Minneapolis, United States
(Bhimaraj, Bruckner) Houston Methodist Hospital, Houston, United States
(Lowes, Um) University of Nebraska Medical Center, Omaha, United States
(Mangi) Yale Medical School, New Haven, CT, United States
(Molina, Sheikh) MedStar Washington Hospital Center, Washington, DC,
United States
(Aaronson, Pagani) University of Michigan, Ann Arbor, United States
(Babu, Chomsky) St. Thomas Hospital, Nashville, United States
(Dean, Krishnamoorthy) Piedmont Hospital, Atlanta, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In two interim analyses of this trial, patients with advanced
heart failure who were treated with a fully magnetically levitated
centrifugal-flow left ventricular assist device were less likely to have
pump thrombosis or nondisabling stroke than were patients treated with a
mechanical-bearing axial-flow left ventricular assist device. METHODS We
randomly assigned patients with advanced heart failure to receive either
the centrifugal-flow pump or the axial-flow pump irrespective of the
intended goal of use (bridge to transplantation or destination therapy).
The composite primary end point was survival at 2 years free of disabling
stroke or reoperation to replace or remove a malfunctioning device. The
principal secondary end point was pump replacement at 2 years. RESULTS
This final analysis included 1028 enrolled patients: 516 in the
centrifugal-flow pump group and 512 in the axial-flow pump group. In the
analysis of the primary end point, 397 patients (76.9%) in the
centrifugal-flow pump group, as compared with 332 (64.8%) in the
axial-flow pump group, remained alive and free of disabling stroke or
reoperation to replace or remove a malfunctioning device at 2 years
(relative risk, 0.84; 95% confidence interval [CI], 0.78 to 0.91; P<0.001
for superiority). Pump replacement was less common in the centrifugal-flow
pump group than in the axial-flow pump group (12 patients [2.3%] vs. 57
patients [11.3%]; relative risk, 0.21; 95% CI, 0.11 to 0.38; P<0.001). The
numbers of events per patient-year for stroke of any severity, major
bleeding, and gastrointestinal hemorrhage were lower in the
centrifugal-flow pump group than in the axial-flow pump group. CONCLUSIONS
Among patients with advanced heart failure, a fully magnetically levitated
centrifugalflow left ventricular assist device was associated with less
frequent need for pump replacement than an axial-flow device and was
superior with respect to survival free of disabling stroke or reoperation
to replace or remove a malfunctioning device.<br/>Copyright &#xa9; 2019
Massachusetts Medical Society.

<10>
Accession Number
625859158
Title
Guided meditation as an adjunct to enhance postoperative recovery after
cardiac surgery: Study protocol for a prospective randomized controlled
feasibility trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 39. Date of
Publication: 11 Jan 2019.
Author
Packiasabapathy S.; Susheela A.T.; Mueller A.; Patxot M.; Gasangwa D.-V.;
O'Gara B.; Shaefi S.; Marcantonio E.R.; Yeh G.Y.; Subramaniam B.
Institution
(Susheela, Mueller, Patxot, Gasangwa, O'Gara, Shaefi, Subramaniam)
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel
Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United
States
(Susheela, Mueller, O'Gara, Shaefi, Marcantonio, Yeh, Subramaniam) Harvard
Medical School, 25 Shattuck St, Boston, MA 02115, United States
(Marcantonio, Yeh) Division of General Medicine and Primary Care, Beth
Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215,
United States
(Packiasabapathy) Department of Anesthesia, Critical Care and Pain
Medicine, Indiana University School of Medicine, 340 W 10th St #6200,
Indianapolis, IN 46202, United States
(Subramaniam) Beth Israel Deaconess Medical Center, 375 Longwood Avenue,
W/MASCO-414, Boston, MA 02215, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Cardiac surgical procedures are associated with postoperative
neurological complications such as cognitive decline and delirium, which
can complicate recovery and impair quality of life. Perioperative
depression and anxiety may be associated with increased mortality after
cardiac surgeries. Surgical prehabilitation is an emerging concept that
includes preoperative interventions to potentially reduce postoperative
complications. While most current prehabilitation interventions focus on
optimizing physical health, mind-body interventions are an area of growing
interest. Preoperative mind-body interventions such as Isha Kriya
meditation, may hold significant potential to improve postsurgical
outcomes. <br/>Method(s): This is a prospective, randomized controlled
feasibility trial. A total of 40 adult patients undergoing cardiac surgery
will be randomized to one of three study groups. Participants randomized
to either of the two intervention groups will receive meditative
intervention: (1) commencing two weeks before surgery; or (2) commencing
only from the day after surgery. Meditative intervention will last for
four weeks after the surgery in these groups. Participants in the third
control group will receive the current standard of care with no meditative
intervention. All participants will undergo assessments using
neurocognitive, sleep, depression, anxiety, and pain questionnaires at
various time points in the perioperative period. Blood samples will be
collected at baseline, preoperatively, and postoperatively to assess for
inflammatory biomarkers. The primary aim of this trial is to assess the
feasibility of implementing a perioperative meditative intervention
program. Other objectives include studying the effect of meditation on
postoperative pain, sleep, psychological wellbeing, cognitive function,
and delirium. These will be used to calculate effect size to design future
studies. <br/>Discussion(s): This study serves as the first step towards
understanding the feasibility of implementing a mind-body intervention as
a prehabilitative intervention to improve postoperative surgical outcomes
after cardiac surgery. Trial registration: Clinicaltrials.gov,
NCT03198039. Registered on 23 June 2017.<br/>Copyright &#xa9; 2019 The
Author(s).

<11>
Accession Number
2001742262
Title
Wearable activity trackers, accuracy, adoption, acceptance and health
impact: A systematic literature review.
Source
Journal of Biomedical Informatics. 93 (no pagination), 2019. Article
Number: 103153. Date of Publication: May 2019.
Author
Shin G.; Jarrahi M.H.; Fei Y.; Karami A.; Gafinowitz N.; Byun A.; Lu X.
Institution
(Shin, Jarrahi, Fei, Gafinowitz, Lu) School of Information and Library
Science, University of North Carolina at Chapel Hill, United States
(Karami) School of Library and Information Science, University of South
Carolina, United States
(Byun) College of Nursing, Seoul National University, Seoul, South Korea
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Wearable activity trackers (WAT) are electronic monitoring devices that
enable users to track and monitor their health-related physical fitness
metrics including steps taken, level of activity, walking distance, heart
rate, and sleep patterns. Despite the proliferation of these devices in
various contexts of use and rising research interests, there is limited
understanding of the broad research landscape. The purpose of this
systematic review is therefore to synthesize the existing wealth of
research on WAT, and to provide a comprehensive summary based on common
themes and approaches. This article includes academic work published
between 2013 and 2017 in PubMed, Embase, Scopus, Web of Science, ACM
Digital Library, and Google Scholar. A final list of 463 articles was
analyzed for this review. Topic modeling methods were used to identify six
key themes (topics) of WAT research, namely: (1) Technology Focus, (2)
Patient Treatment and Medical Settings, (3) Behavior Change, (4)
Acceptance and Adoption (Abandonment), (5) Self-monitoring Data Centered,
and (6) Privacy. We take an interdisciplinary approach to wearable
activity trackers to propose several new research questions. The most
important research gap we identify is to attempt to understand the rich
human-information interaction that is enabled by WAT
adoption.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<12>
Accession Number
2001281375
Title
Nitric oxide provides myocardial protection when added to the
cardiopulmonary bypass circuit during cardiac surgery: Randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp 2328-2336.e1),
2019. Date of Publication: June 2019.
Author
Kamenshchikov N.O.; Mandel I.A.; Podoksenov Y.K.; Svirko Y.S.; Lomivorotov
V.V.; Mikheev S.L.; Kozlov B.N.; Shipulin V.M.; Nenakhova A.A.;
Anfinogenova Y.J.
Institution
(Kamenshchikov, Podoksenov, Svirko, Kozlov, Shipulin, Nenakhova,
Anfinogenova) Cardiology Research Institute, Tomsk National Research
Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
(Mandel) Federal State Autonomous Educational Institution of Higher
Education I. M. Sechenov First Moscow State Medical University of the
Ministry of Health of the Russian Federation (Sechenov University),
Moscow, Russian Federation
(Mandel) Federal Research and Clinical Center for Specialized Medical Care
and Medical Technologies, Federal Medico-Biological Agency, Moscow,
Russian Federation
(Podoksenov, Svirko, Kozlov, Shipulin) Siberian State Medical University,
Tomsk, Russian Federation
(Lomivorotov) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Mikheev) Federal State Autonomous Institution "Treatment and
Rehabilitation Center" of the Ministry of Healthcare of the Russian
Federation, Moscow, Russian Federation
(Anfinogenova) National Research Tomsk Polytechnic University, Tomsk,
Russian Federation
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The aim of this pilot study was to elucidate the effects of
exogenous nitric oxide (NO) supply to the extracorporeal circulation
circuit for cardioprotection against ischemia-reperfusion injury during
coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).
<br/>Method(s): A total of 60 patients with coronary artery disease
scheduled for CABG with CPB were enrolled in a prospective randomized
study. Patients were allocated randomly to receive treatment according to
standard or modified CPB protocol where 40-ppm NO was added to the CPB
circuit during cardiac surgery. The primary endpoint was the measurement
of cardiac troponin I (cTnI). The secondary end points consisted in the
measurements of creatine kinase-muscle/brain fraction (CK-MB) and
vasoactive inotropic score (VIS). <br/>Result(s): NO delivered into the
CPB circuit had a cardioprotective effect. The level of cTnI was
significantly lower in NO-treated group compared with the control group 6
hours after surgery: 1.79 +/- 0.39 ng/mL versus 2.41 +/- 0.55 ng/mL,
respectively (P = .001). The CK-MB value was significantly lower in
NO-treated group compared with the control group 24 hours after surgery:
47.69 +/- 8.08 U/L versus 62.25 +/- 9.78 U/L, respectively (P = .001); and
the VIS was significantly lower in the NO-treated group 6 hours after the
intervention. <br/>Conclusion(s): NO supply to the CPB circuit during CABG
exerted a cardioprotective effect and was associated with lower levels of
VIS and cardiospecific blood markers cTnI and CK-MB.<br/>Copyright &#xa9;
2018 The American Association for Thoracic Surgery

<13>
Accession Number
2001326361
Title
Bioprosthetic aortic valve replacement in elderly patients: Meta-analysis
and microsimulation.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp
2189-2197.e14), 2019. Date of Publication: June 2019.
Author
Huygens S.A.; Etnel J.R.G.; Hanif M.; Bekkers J.A.; Bogers A.J.J.C.;
Rutten-van Molken M.P.M.H.; Takkenberg J.J.M.
Institution
(Huygens, Etnel, Hanif, Bekkers, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Huygens, Rutten-van Molken) Institute for Medical Technology Assessment,
Rotterdam/Erasmus School of Health Policy and Management, Erasmus
University, Rotterdam, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To support decision-making in aortic valve replacement (AVR) in
elderly patients, we provide a comprehensive overview of outcome after AVR
with bioprostheses. <br/>Method(s): A systematic review was conducted of
studies reporting clinical outcome after AVR with bioprostheses in elderly
patients (mean age >=70 years; minimum age >=65 years) published between
January 1, 2000, to September 1, 2016. Reported event rates and
time-to-event data were pooled and entered into a microsimulation model to
calculate life expectancy and lifetime event risks. <br/>Result(s):
Forty-two studies reporting on 34 patient cohorts were included,
encompassing a total of 12,842 patients with 55,437 patient-years of
follow-up (pooled mean follow-up 5.0 +/- 3.3 years). Pooled mean age was
76.5 +/- 5.5 years. Pooled early mortality risk was 5.42% (95% confidence
interval [CI], 4.49-6.55), thromboembolism rate was 1.83%/year (95% CI,
1.28-3.61), and bleeding rate was 0.75%/year (95% CI, 0.50-1.11).
Structural valve deterioration (SVD) was based on pooled time to SVD data
(Gompertz; shape: 0.124, rate: 0.003). For a 75-year-old patient, this
translated to an estimated life expectancy of 9.8 years (general
population: 10.2 years) and lifetime risks of bleeding of 7%,
thromboembolism of 17%, and reintervention of 9%. <br/>Conclusion(s): The
low risks of SVD and reintervention support the use of bioprostheses in
elderly patients in need of AVR. The estimated life expectancy after AVR
was comparable with the general population. The results of this study
inform patients and clinicians about the expected outcomes after
bioprosthetic AVR and thereby support treatment decision-making.
Furthermore, our results can be used as a benchmark for long-term outcomes
after transcatheter aortic valve implantation in patients who were
eligible for surgery and other (future) alternative treatments (eg,
tissue-engineered heart valves).<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<14>
Accession Number
2001489272
Title
Intravenous amino acid therapy for kidney protection in cardiac surgery
patients: A pilot randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp 2356-2366),
2019. Date of Publication: June 2019.
Author
Pu H.; Doig G.S.; Heighes P.T.; Allingstrup M.J.; Wang A.; Brereton J.;
Pollock C.; Chesher D.; Bellomo R.
Institution
(Pu, Doig, Heighes, Allingstrup) Northern Clinical School Intensive Care
Research Unit, Sydney Medical School, University of Sydney, Sydney,
Australia
(Wang, Brereton, Pollock) Northern Clinical School, Sydney Medical School,
University of Sydney, Sydney, Australia
(Pu) Department of Critical Care Medicine, Sichuan Academy of Medical
Sciences & Sichuan Provincial People's Hospital, Chengdu, China
(Chesher) New South Wales Health, Pathology, St. Leonards, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To determine whether a continuous intravenous infusion of
standard amino acids could preserve kidney function after on-pump cardiac
surgery. <br/>Method(s): Adult patients scheduled to receive cardiac
surgery lasting longer than 1 hour on-pump were randomized to standard
care (n = 36) or an infusion of amino acids initiated immediately after
induction of anesthesia (n = 33). The study's primary outcome measurements
assessed renal function. These assessments included duration of renal
dysfunction, duration and severity of acute kidney injury (AKI), estimated
glomerular filtration rate (eGFR) over time, urine output, and use of
renal-replacement therapy. Complications and other measures of morbidity
were also assessed. <br/>Result(s): Sixty-nine patients (mean age 71.5
[standard deviation 9.2] years; 19 of 69 women) were enrolled and
randomized. Patients received coronary artery bypass graft surgery
(37/69), valve surgery (24/69), coronary artery bypass graft and valve
surgery (6/69), or other procedures (2/69). Mean on-pump time was 268
[standard deviation 136] minutes. Duration of renal dysfunction did not
differ between the groups (relative risk, 0.86; 95% confidence interval
[CI], 0.19-3.79, P = .84). However, patients who received the amino acid
infusion had a reduced duration of AKI (relative risk, 0.02; 95% CI,
0.005-0.11, P < .0001) and greater eGFR (+10.8%; 95% CI, 1.0%-20.8%, P =
.033). Daily mean urine output was also significantly greater in patients
who received the amino acid infusion (1.4 +/- 0.5 vs 1.7 +/- 0.9 L/d; P =
.046). <br/>Conclusion(s): Commencing an infusion of standard amino acids
immediately after the induction of anesthesia did not alter duration of
renal dysfunction; however, other key measures of renal function (duration
of AKI, eGFR and urine output) were significantly improved. These results
warrant replication in multicenter clinical trials.<br/>Copyright &#xa9;
2018 The American Association for Thoracic Surgery

<15>
Accession Number
2001956172
Title
Myocardial Blood Flow and Coronary Flow Reserve During 3 Years Following
Bioresorbable Vascular Scaffold Versus Metallic Drug-Eluting Stent
Implantation: The VANISH Trial.
Source
JACC: Cardiovascular Interventions. 12 (10) (pp 967-979), 2019. Date of
Publication: 27 May 2019.
Author
Stuijfzand W.J.; Schumacher S.P.; Driessen R.S.; Lammertsma A.A.; Bakker
A.L.; Rijnierse M.T.; van Rossum A.C.; van de Ven P.M.; Nap A.; Appelman
Y.; van Royen N.; van Leeuwen M.A.; Lemkes J.S.; Raijmakers P.G.; Knaapen
P.
Institution
(Stuijfzand, Schumacher, Driessen, Bakker, Rijnierse, van Rossum, Nap,
Appelman, Lemkes, Knaapen) Department of Cardiology, Amsterdam UMC,
Location VU University Medical Center, Amsterdam, Netherlands
(Lammertsma, Raijmakers) Department of Radiology and Nuclear Medicine,
Amsterdam UMC, Location VU University Medical Center, Amsterdam,
Netherlands
(van de Ven) Department of Epidemiology and Biostatistics, Amsterdam UMC,
Location VU University Medical Center, Amsterdam, Netherlands
(van Royen) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(van Leeuwen) Department of Cardiology, Isala Heart Center, Zwolle,
Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The randomized clinical VANISH (Impact of Vascular Reparative
Therapy on Vasomotor Function and Myocardial Perfusion: A Randomized
[¹⁵O]H<inf>2</inf>O PET/CT Study) trial was conducted to assess
quantitative myocardial blood flow (MBF) during resting, hyperemia, and
cold pressor testing (CPT) with positron emission tomographic perfusion
imaging after the implantation of a bioresorbable everolimus-eluting
scaffold compared with a drug-eluting stent. <br/>Background(s): Long-term
resorption of the bioresorbable everolimus-eluting scaffold reinstates
normal vessel geometry, allowing natural regeneration of the newly formed
endothelium with revival of vasomotor function. <br/>Method(s): Sixty
patients (18 to 65 years of age) with single-vessel disease and type A or
B1 lesions were randomized in a 1-to-1 fashion. Approximately 1 month, 1
year, and 3 years after device implantation, patients underwent
[¹⁵O]H<inf>2</inf>O cardiac positron emission tomography. The
primary endpoint was the interaction of device type and evolution over
time of hyperemic MBF, coronary flow reserve, or CPT reserve. At 3-year
follow-up, control invasive coronary angiography with optical coherence
tomography was performed. <br/>Result(s): Fifty-nine (98%), 56 (93%), and
51 (85%) patients successfully completed 1-month, 1-year, and 3-year
follow-up positron emission tomography, respectively, and no culprit
vessel events were registered during follow-up time. The primary study
endpoint (i.e., interaction between device type and time) was
nonsignificant for hyperemic MBF, CPT reserve, and coronary flow reserve
(p > 0.05 for all). In all patients, hyperemic MBF decreased from 1 to 3
years (p = 0.02), while coronary flow reserve was lower at 3-year
follow-up compared with 1-month and 1-year follow-up (p = 0.03 for both).
After 3 years, percentage area stenosis measured with optical coherence
tomography was higher within the bioresorbable everolimus-eluting scaffold
compared with the drug-eluting stent (p = 0.03). <br/>Conclusion(s): The
hypothesized beneficial effects of scaffold resorption did not translate
to improved MBF during maximal hyperemia or endothelium-dependent
vasodilation by CPT.<br/>Copyright &#xa9; 2019 American College of
Cardiology Foundation

<16>
Accession Number
622056132
Title
Is MRI equivalent to CT in the guidance of TAVR? A pilot study.
Source
European Radiology. 28 (11) (pp 4625-4634), 2018. Date of Publication: 01
Nov 2018.
Author
Mayr A.; Klug G.; Reinstadler S.J.; Feistritzer H.-J.; Reindl M.; Kremser
C.; Kranewitter C.; Bonaros N.; Friedrich G.; Feuchtner G.; Metzler B.
Institution
(Mayr, Kremser, Kranewitter, Feuchtner) University Clinic of Radiology,
Medical University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Klug, Reinstadler, Feistritzer, Reindl, Friedrich, Metzler) University
Clinic of Internal Medicine III, Cardiology and Angiology, Medical
University of Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
(Bonaros) University Clinic of Cardiac Surgery, Medical University of
Innsbruck, Anichstrase 35, Innsbruck A-6020, Austria
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To compare a comprehensive cardiovascular magnetic resonance
imaging (MRI) protocol with contrast-enhanced computed tomography
angiography (CTA) for guidance in transcatheter aortic valve replacement
(TAVR) evaluation. <br/>Methods and Results: Non-contrast
three-dimensional (3D) 'whole heart' MRI imaging for aortic annulus sizing
and measurements of coronary ostia heights, contrast-enhanced MRI
angiography (MRA) for evaluation of transfemoral routes as well as
aortoiliofemoral-CTA were performed in 16 patients referred for evaluation
of TAVR. Aortic annulus measurements by MRI and CTA showed a very strong
correlation (r=0.956, p<0.0001; effective annulus area for MRI 430+/-74
vs. 428+/-78 mm² for CTA, p=0.629). Regarding decision for
valve size there was complete consistency between MRI and CTA. Moreover,
vessel luminal diameters and angulations of aortoiliofemoral access as
measured by MRA and CTA showed overall very strong correlations (r= 0.819
to 0.996, all p<0.001), the agreement of minimal vessel diameter between
the two modalities revealed a bias of 0.02 mm (upper and lower limit of
agreement: 1.02 mm and -0.98 mm). <br/>Conclusion(s): In patients referred
for TAVR, MRI measurements of aortic annulus and minimal aortoiliofemoral
diameters showed good to excellent agreement. Decisions based on MRI
measurements regrading prosthesis sizing and transfemoral access would not
have modified TAVR-strategy as compared to a CTA-based choice. Key Points:
* 'Whole heart' MRI and CTA measurements of aortic annulus correlate very
strongly. * MRI- and CTA-based prostheses sizing are in excellent
agreement. * MRA and CTA equally guide TAVR access strategy.<br/>Copyright
&#xa9; 2018, European Society of Radiology.

<17>
Accession Number
625820311
Title
Developmental Pharmacokinetics and Age-Appropriate Dosing Design of
Milrinone in Neonates and Infants with Acute Kidney Injury Following
Cardiac Surgery.
Source
Clinical Pharmacokinetics. 58 (6) (pp 793-803), 2019. Date of Publication:
01 Jun 2019.
Author
Mizuno T.; Gist K.M.; Gao Z.; Wempe M.F.; Alten J.; Cooper D.S.; Goldstein
S.L.; Vinks A.A.
Institution
(Mizuno, Vinks) Division of Clinical Pharmacology, Cincinnati Children's
Hospital Medical Center, 3333 Burnet Avenue, MLC6018, Cincinnati, OH
45229-3039, United States
(Gist) Department of Pediatrics, Children's Hospital Colorado, University
of Colorado, Aurora, CO, United States
(Gao, Alten, Cooper) Heart Institute, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Wempe) Skaggs School of Pharmacy and Pharmaceutical Sciences, University
of Colorado, Aurora, CO, United States
(Goldstein) Division of Nephrology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH, United States
(Mizuno, Alten, Cooper, Goldstein, Vinks) Department of Pediatrics,
College of Medicine, University of Cincinnati, Cincinnati, OH, United
States
Publisher
Springer International Publishing
Abstract
Background and Objective: Milrinone is used for the prevention of low
cardiac output syndrome in pediatric patients after cardiac surgery.
Milrinone is mainly eliminated by the kidneys; however, there is limited
information on milrinone pharmacokinetics in infants who have acute kidney
injury (AKI). The aim of this study was to develop a milrinone population
pharmacokinetic model in neonates and infants with or without AKI. The
developed milrinone pharmacokinetic model was utilized for a Monte Carlo
simulation analysis to identify age-appropriate dosing regimens in
neonates and infants. <br/>Method(s): Population pharmacokinetic analysis
was performed with a total of 1088 serum milrinone concentrations obtained
from 92 infants as part of a prospective clinical study in neonates and
infants following cardiac surgery (ClinicalTrials.gov identifier
NCT01966237). AKI stages were determined based on the Kidney Injury
Improving Global Outcomes (KDIGO) Clinical Practice Guideline within the
first three postoperative days. <br/>Result(s): A two-compartment model
was found to adequately describe the pharmacokinetic data. Allometrically
scaled body weight, AKI stages, and maturation function were identified as
significant predictors of milrinone clearance. The proposed dosing
regimens for milrinone continuous infusions were determined based on a
target concentration attainment of simulated steady-state concentration
and covered three age groups across 0-12 months of age for each AKI stage.
<br/>Conclusion(s): This study provides a milrinone population
pharmacokinetic model in neonates and infants and captures the
developmental changes in clearance. Age-appropriate dosing regimens were
determined based on the simulation analysis with the developed
pharmacokinetic model. The findings will facilitate model-informed
precision dosing of milrinone in infants with or without
AKI.<br/>Copyright &#xa9; 2019, Springer Nature Switzerland AG.

<18>
Accession Number
2001913331
Title
A Systematic Review and International Web-Based Survey of Randomized
Controlled Trials in the Perioperative and Critical Care Setting:
Interventions Increasing Mortality.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Sartini C.; Lomivorotov V.; Pisano A.; Riha H.; Baiardo Redaelli M.;
Lopez-Delgado J.C.; Pieri M.; Hajjar L.; Fominskiy E.; Likhvantsev V.;
Cabrini L.; Bradic N.; Avancini D.; Wang C.Y.; Lembo R.; Novikov M.;
Paternoster G.; Gazivoda G.; Alvaro G.; Roasio A.; Wang C.; Severi L.;
Pasin L.; Mura P.; Musu M.; Silvetti S.; Votta C.D.; Belletti A.; Corradi
F.; Brusasco C.; Tama S.; Ruggeri L.; Yong C.-Y.; Pasero D.; Mancino G.;
Spadaro S.; Conte M.; Lobreglio R.; Di Fraja D.; Saporito E.; D'Amico A.;
Sardo S.; Ortalda A.; Yavorovskiy A.; Riefolo C.; Monaco F.; Bellomo R.;
Zangrillo A.; Landoni G.
Institution
(Sartini, Baiardo Redaelli, Pieri, Fominskiy, Cabrini, Lembo, Votta,
Belletti, Tama, Ruggeri, Ortalda, Riefolo, Monaco, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Lomivorotov) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Pisano, Di Fraja) Division of Cardiac Anesthesia and Intensive Care Unit,
AORN dei Colli - Monaldi Hospital, Naples, Italy
(Riha) Institute for Clinical and Experimental Medicine, Prague, Czechia
(Lopez-Delgado) Hospital Universitari de Bellvitge, Barcelona, Spain
(Hajjar) Instituto do Coracao do Hospital das Clinicas, Sao Paulo, Brazil
(Likhvantsev, Yavorovskiy) Department of Anesthesiology and Intensive
Care, Sechenov First Moscow State Medical University, Moscow Regional
Clinical and Research Institute, Moscow, Russian Federation
(Bradic) Department of Cardiovascular Anesthesiology and Cardiac Intensive
Medicine, University Hospital Dubrava, Zagreb, Croatia
(Avancini) San Raffaele Telethon Institute for Gene Therapy (SR-Tiget),
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Wang) Anaesthesia and Intensive Care, University of Malaya, Kuala Lumpur,
Malaysia
(Novikov) Saint Petersburg State University, Saint Petersburg, Russian
Federation
(Paternoster) Anaesthesia and Intensive Care, San Carlo Hospital, Potenza,
Italy
(Gazivoda) Institute of Cardiovascular Diseases "Dedinje", Belgrade,
Serbia
(Alvaro, Saporito, D'Amico) AOU Mater Domini Germaneto, Catanzaro, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Wang) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Severi) Anesthesia and Intensive Care, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
(Pasin) S. Antonio Hospital, Padova, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU, Cagliari, Italy
(Musu, Sardo) Department of Medical Sciences and Public Health, University
of Cagliari, Monserrato, Italy
(Silvetti) IRCCS Istituto Giannina Gaslini, Ospedale Pediatrico, Genoa,
Italy
(Corradi, Brusasco) E.O. Ospedali Galliera, Genova, Italy and Universita
degli Studi di Pisa, Italy
(Yong) Anaesthesia and Intensive Care, Hospital Pulau Pinang, Georgetown,
Malaysia
(Pasero) Department of Anesthesia and Intensive Care, A.O.U. Cittadella
Salute e della Scienza, Turin, Italy
(Mancino) Hospital Santa Chiara, Pisa, Italy
(Spadaro) Department Morphology, Surgery and Experimental Medicine,
Intensive Care Unit, University of Ferrara, Italy
(Conte) Mater Dei Hospital, Bari, Italy
(Lobreglio) Anesthesia and Intensive Care A.O.U Citta della salute e della
Scienza, Turin, Italy
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Melbourne, Australia
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
W.B. Saunders
Abstract
Objective: Reducing mortality is a key target in critical care and
perioperative medicine. The authors aimed to identify all nonsurgical
interventions (drugs, techniques, strategies) shown by randomized trials
to increase mortality in these clinical settings. <br/>Design(s): A
systematic review of the literature followed by a consensus-based voting
process. <br/>Setting(s): A web-based international consensus conference.
<br/>Participant(s): Two hundred fifty-one physicians from 46 countries.
<br/>Intervention(s): The authors performed a systematic literature search
and identified all randomized controlled trials (RCTs) showing a
significant increase in unadjusted landmark mortality among surgical or
critically ill patients. The authors reviewed such studies during a
meeting by a core group of experts. Studies selected after such review
advanced to web-based voting by clinicians in relation to agreement,
clinical practice, and willingness to include each intervention in
international guidelines. <br/>Measurements and Main Results: The authors
selected 12 RCTs dealing with 12 interventions increasing mortality:
diaspirin-crosslinked hemoglobin (92% of agreement among web voters),
overfeeding, nitric oxide synthase inhibitor in septic shock, human growth
hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute
respiratory distress syndrome, plasma-derived protein C concentrate,
aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in
meningitis, methylprednisolone in traumatic brain injury, and albumin in
traumatic brain injury (72% of agreement). Overall, a high consistency
(ranging from 80% to 90%) between agreement and clinical practice was
observed. <br/>Conclusion(s): The authors identified 12 clinical
interventions showing increased mortality supported by randomized
controlled trials with nonconflicting evidence, and wide agreement upon
clinicians on a global scale.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<19>
Accession Number
627645544
Title
Advances in Clinical Cardiology 2018: A Summary of Key Clinical Trials.
Source
Advances in Therapy. (no pagination), 2019. Date of Publication: 2019.
Author
Linden K.; McQuillan C.; Brennan P.; Menown I.B.A.
Institution
(Linden, McQuillan, Brennan, Menown) Craigavon Cardiac Centre, SHSCT,
Craigavon, United Kingdom
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: Many important clinical trials in cardiology were published
or presented at major international meetings throughout 2018. This paper
aims to offer a concise overview of these significant advances and to put
them into clinical context. <br/>Method(s): Trials presented at the major
international cardiology meetings during 2018 were reviewed including The
American College of Cardiology, EuroPCR, The European Society of
Cardiology, PCR London Valves, Transcatheter Cardiovascular Therapeutics,
and the American Heart Association. In addition to this a literature
search identified several other publications eligible for inclusion based
on their relevance to clinical cardiology, their potential impact on
clinical practice and on future guidelines. <br/>Result(s): A total of 78
trials met the inclusion criteria. New interventional and structural data
include trials examining novel stent designs (BiofreedomTM, COMBO), use of
drug-coated balloons in patients with high bleeding risk, intervention in
stable coronary artery disease, revascularisation strategy in ST elevation
myocardial infarction, transcatheter aortic valve replacement in low-risk
patients, and percutaneous mitral or tricuspid valve interventions.
Preventative cardiology data included the use of sodium glucose
cotransporter-2 inhibitors (empagliflozin, dapagliflozin, canagliflozin),
proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors
(alirocumab) and approaches of hypertension management. Antiplatelet data
included trials evaluating both the optimal length of course and
combination of antiplatelet agents. Heart failure data included trials of
sacubitril-valsartan during acute hospital admission and the management of
chemotherapy-induced cardiotoxicity. Electrophysiology data included
trials examining atrial fibrillation ablation, wearable cardiac
defibrillators (LifeVest) and His-bundle pacing. <br/>Conclusion(s): This
article presents key clinical trials completed during 2018 and should be
valuable to both cardiology clinicians and researchers.<br/>Copyright
&#xa9; 2019, The Author(s).

<20>
Accession Number
624726924
Title
Transcutaneous Electrical Acupoint Stimulation Improves Immunological
Function During the Perioperative Period in Patients With Non-Small Cell
Lung Cancer Undergoing Video-Assisted Thoracic Surgical Lobectomy.
Source
Technology in cancer research & treatment. 17 (pp 1533033818806477), 2018.
Date of Publication: 01 Jan 2018.
Author
Tu Q.; Yang Z.; Gan J.; Zhang J.; Que B.; Song Q.; Wang Y.
Institution
(Tu, Gan) Department of Anesthesiology, Tangshan People's Hospital, North
China University of Science and Technology, Tangshan, China
(Tu) Tangshan, 2 The Graduate School of North China University of Science
and Technology, China
(Tu, Yang) Qing Tu and Zhou Yang contributed equally to this article
(Yang) Sichuan Academy of Medical Sciences, Sichuan Provincial People's
Hospital, 3 Department of Gastrointestinal Surgery, Chengdu, Sichuan,
China
(Zhang) Department of Anesthesiology, Third People's Hospital of Chengdu,
Southwest Jiao Tong University, Chendu, China
(Que) Department of Anesthesiology, Hangzhou Hospital of Traditional
Chinese Medicine, Hangzhou, China
(Song) Department of Cardiology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
(Wang) Department of Neurology, Tangshan People's Hospital, North China
University of Science and Technology, Tangshan, China
Publisher
NLM (Medline)
Abstract
The immunological function of patients with malignant tumors may be
suppressed during the perioperative period. However, details on the
effects of transcutaneous electrical acupoint stimulation (TEAS) on
immunological function are relatively lacking. We designed this study to
examine the effects of TEAS on the immunological function of patients with
non-small cell lung cancer (NSCLC) during the perioperative period.
Participants (n = 144) were enrolled and randomly assigned into group TEAS
or group sham TEAS. TEAS on bilateral Feishu (BL13), Hegu (L14), and
Zusanli (ST36) was performed continuously throughout the procedure. The
primary outcome was the quantities of natural killer (NK) cells at 30
minutes before induction (T0), 5 minutes after intubation (T1), at the
beginning of the operation (T2), at the beginning of the lobectomy (T3),
at the beginning of the lymphadenectomy (T4), and immediately after
extubation (T5). The secondary outcomes were the serum levels of tumor
necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) at T0 to T5,
the mean arterial pressure (MAP) and heart rate (HR), the intraoperative
consumption of propofol and remifentanil, the incidence of hypoxemia,
postoperative nausea and vomiting (PONV), and the length of hospital stay.
The quantities of NK cells were decreased in group sham TEAS after
intubation compared to that in group TEAS, while the quantities of NK
cells in group TEAS were similar at T0 to T5. Meanwhile, the quantities of
NK cells in group sham TEAS at T1 ( P = .012), T2 ( P < .001), T3 ( P =
.027), T4 ( P = .045), and T5 ( P = .021) were lower than those in group
TEAS. In group TEAS, the serum levels of TNF-alpha were lower at T1 to T5,
while the levels of IL-6 were lower at T2 to T5. Furthermore, the
intraoperative MAP and HR were more stable, the total propofol and
remifentanil consumptions were lower, and the length of hospital stay was
shorter than those in group sham TEAS. The application of TEAS can
effectively reverse the decrease in NK cells, decrease the serum levels of
TNF-alpha and IL-6, maintain hemodynamic stability during the
perioperative period, decrease the consumption of propofol and
remifentanil, and shorten the length of the hospital stay.

<21>
Accession Number
627737933
Title
Myocardial Involvement in Patients With Histologically Diagnosed Cardiac
Sarcoidosis: A Systematic Review and Meta-Analysis of Gross Pathological
Images From Autopsy or Cardiac Transplantation Cases.
Source
Journal of the American Heart Association. 8 (10) (pp e011253), 2019. Date
of Publication: 21 May 2019.
Author
Okasha O.; Kazmirczak F.; Chen K.-H.A.; Farzaneh-Far A.; Shenoy C.
Institution
(Okasha, Kazmirczak, Chen, Shenoy) Cardiovascular Division Department of
Medicine University of Minnesota Medical School Minneapolis MN
(Farzaneh-Far) Section of Cardiology Department of Medicine University of
Illinois at Chicago Chicago IL
Publisher
NLM (Medline)
Abstract
Background In patients with suspected cardiac sarcoidosis, late gadolinium
enhancement on cardiovascular magnetic resonance imaging and/or
18F-fluorodeoxyglucose uptake on positron emission tomography are often
used to reach a clinical diagnosis of cardiac sarcoidosis. On the basis of
data from the imaging literature of clinical cardiac sarcoidosis, no
specific features of myocardial involvement are regarded as pathognomonic
for cardiac sarcoidosis. Thus, a diagnosis of cardiac sarcoidosis is
challenging to make. There has been no systematic analysis of
histologically diagnosed cardiac sarcoidosis for patterns of myocardial
involvement. We hypothesized that certain patterns of myocardial
involvement are more frequent in histologically diagnosed cardiac
sarcoidosis. Methods and Results We performed a systematic review and
meta-analysis of gross pathological images from the published literature
of patients with histologically diagnosed cardiac sarcoidosis who
underwent autopsy or cardiac transplantation. Thirty-three eligible
articles provided images of 49 unique hearts. Analysis of these hearts
revealed certain features of myocardial involvement in >90% of cases: left
ventricular (LV) subepicardial, LV multifocal, septal, and right
ventricular free wall involvement. In contrast, other patterns were seen
in 0% to 6% of cases: absence of gross LV myocardial involvement, isolated
LV midmyocardial involvement, isolated LV subendocardial involvement,
isolated LV transmural involvement, absence of septal involvement, or
isolated involvement of only one LV level. Conclusions In this systematic
review and meta-analysis of histologically diagnosed cardiac sarcoidosis,
we identified certain features of myocardial involvement that occurred
frequently and others that occurred rarely or never. These patterns could
aid the interpretation of cardiovascular magnetic resonance imaging and
positron emission tomography imaging and improve the diagnosis and the
prognostication of patients with suspected cardiac sarcoidosis.

<22>
Accession Number
2001987870
Title
Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe
Ischemic Mitral Regurgitation: From the Cardiothoracic Surgical Trials
Network.
Source
JACC: Heart Failure. 7 (6) (pp 481-490), 2019. Date of Publication: June
2019.
Author
Giustino G.; Overbey J.; Taylor D.; Ailawadi G.; Kirkwood K.; DeRose J.;
Gillinov M.A.; Dagenais F.; Mayer M.-L.; Moskowitz A.; Bagiella E.; Miller
M.; Grayburn P.; Smith P.K.; Gelijns A.; O'Gara P.; Acker M.; Lala A.;
Hung J.
Institution
(Giustino, Lala) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Giustino, Overbey, Kirkwood, Moskowitz, Bagiella, Gelijns, Lala)
Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Taylor) Department of Regenerative Medicine Research, Texas Heart
Institute, Houston, TX, United States
(Ailawadi) Division of Thoracic and Cardiovascular Surgery, University of
Virginia, Charlottesville, VA, United States
(DeRose) Department of Cardiovascular and Thoracic Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, Bronx, NY, United
States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Dagenais) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec/Quebec Heart and Lung Institute, Laval University, Quebec City,
Quebec, Canada
(Mayer, Acker) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania School of Medicine, Philadelphia, PA, United
States
(Miller) National Heart, Lung, and Blood Institute of the National
Institutes of Health, Bethesda, MD, United States
(Grayburn) Division of Cardiology, Department of Internal Medicine, Baylor
University Medical Center, Dallas, TX, United States
(Smith) Division of Cardiothoracic Surgery, Department of Surgery, Duke
University, Durham, NC, United States
(O'Gara) Division of Cardiology, Brigham and Women's' Hospital, Boston,
MA, United States
(Hung) Division of Cardiology, Massachusetts General Hospital, Boston, MA,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study investigated sex-based differences in outcomes
after mitral valve (MV) surgery for severe ischemic mitral regurgitation
(SIMR). <br/>Background(s): Whether differences in outcomes exist between
men and women after surgery for SIMR remains unknown. <br/>Method(s):
Patients enrolled in a randomized trial comparing MV replacement versus MV
repair for SIMR were included and followed for 2 years. Endpoints for this
analysis included all-cause mortality, major adverse cardiovascular and
cerebrovascular events (MACCE) (defined as the composite of death, stroke,
hospitalization for heart failure, worsening New York Heart Association
functional class or MV re-operation), quality of life (QOL), functional
status, and percentage of change in left ventricular end-systolic volume
index (LVESVI) from baseline through 2 years. <br/>Result(s): Of 251
patients enrolled in the trial, 96 (38.2%) were women. Compared with men,
women had smaller LV volumes and effective regurgitant orifice areas
(EROA) but greater EROA/left ventricular (LV) end-diastolic volume ratios.
At 2 years, women had higher rates of all-cause mortality (27.1% vs.
17.4%, respectively; adjusted hazard ratio [adjHR]: 1.85; 95% confidence
interval [CI]: 1.05 to 3.26; p = 0.03) and of MACCE (49.0% vs. 38.1%,
respectively; adjHR: 1.58; 95% CI: 1.06 to 2.37; p = 0.02). Women also
reported worse QOL and functional status at 2 years. There were no
significant differences in the percentage of change over 2 years in LVESVI
between women and men (adjbeta: -10.4; 95% CI: -23.4 to 2.6; p = 0.12).
<br/>Conclusion(s): Women with SIMR displayed different echocardiographic
features and experienced higher mortality and worse QOL after MV surgery
than men. There were no significant differences in the degree of reverse
LV remodeling between sexes. (Comparing the Effectiveness of Repairing
Versus Replacing the Heart's Mitral Valve in People With Severe Chronic
Ischemic Mitral Regurgitation [Severe Ischemic Mitral Regurgitation];
NCT00807040)<br/>Copyright &#xa9; 2019 American College of Cardiology
Foundation

<23>
Accession Number
2001986702
Title
Efficacy of an Ultrasound-Guided Erector Spinae Plane Block for
Postoperative Analgesia Management After Video-Assisted Thoracic Surgery:
A Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Ciftci B.; Ekinci M.; Celik E.C.; Tukac I.C.; Bayrak Y.; Atalay Y.O.
Institution
(Ciftci, Ekinci, Tukac, Atalay) Istanbul Medipol University, School of
Medicine, Mega Medipol University Hospital, Department of Anesthesiology
and Reanimation, Istanbul, Turkey
(Celik) Erzurum Regional Training and Research Hospital, Department of
Anesthesiology and Reanimation, Yakutiye, Erzurum, Turkey
(Bayrak) Istanbul Medipol University, Mega Medipol University Hospital,
Department of Thoracic Surgery, Istanbul, Turkey
Publisher
W.B. Saunders
Abstract
Objectives: Investigate whether an ultrasound-guided erector spinae plane
block (ESPB) can be used to manage postoperative pain in video-assisted
thoracic surgery (VATS) patients. <br/>Design(s): Prospective, randomized
study. <br/>Setting(s): Single institution, academic university hospital.
<br/>Participant(s): Adult patients who underwent VATS under general
anesthesia between September 2018 and March 2019. <br/>Intervention(s):
This study was an interventional study. <br/>Measurements and Main
Results: A total of 60 patients were randomly assigned into 2 groups (n =
30 per group): an ESPB group and a control group. In the ESPB group, a
single-shot ultrasound-guided ESPB was administered preoperatively. The
control group received no such intervention. All of the patients received
intravenous patient-controlled postoperative analgesia, and they were
assessed using visual analogue scale (VAS) scores, opioid consumption, and
adverse events. There were no statistically significant intergroup
differences with respect to the age, sex, weight, American Society of
Anesthesiologists status, anesthesia duration, and surgery length (p >
0.05 for each). The opioid consumption at 1, 2, 4, 8, 16, and 24 hours and
the active and passive VAS scores at 0, 2, 4, 8, 16, and 24 hours were
statistically lower in the ESPB group at all of the time periods when
compared with the control group (p < 0.05). In the control group, the
nausea and itching rates were higher, but there were no intergroup
differences in terms of other adverse effects. <br/>Conclusion(s): A
preemptive single-shot ESPB may provide effective analgesia management
after VATS.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<24>
Accession Number
2001979453
Title
Prognostic impact of MitraClip in patients with left ventricular
dysfunction and functional mitral valve regurgitation: A comprehensive
meta-analysis of RCTs and adjusted observational studies.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Bertaina M.; Galluzzo A.; D'Ascenzo F.; Conrotto F.; Grosso Marra W.; Frea
S.; Alunni G.; Crimi G.; Moretti C.; Montefusco A.; D'Amico M.; Perl L.;
Rinaldi M.; Giustetto C.; De Ferrari G.M.
Institution
(Bertaina, Galluzzo, D'Ascenzo, Conrotto, Grosso Marra, Frea, Alunni,
Moretti, Montefusco, D'Amico, Rinaldi, Giustetto, De Ferrari) Cardiology
Department, Citta della Salute e della Scienza, Molinette Hospital, Turin,
Italy
(Crimi) Cardiology Department, IRCCS Policlinico San Matteo, Pavia, Italy
(Perl) Cardiology Department, Rabin Medical Center, Petach-tikva, Israel
(Perl) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Publisher
Elsevier Ireland Ltd
Abstract
The real prognostic impact of MitraClip in patients with significant
functional mitral regurgitation (FMR)and left ventricular (LV)dysfunction
remains to be elucidated. Two randomized controlled trials (RCTs)with
conflicting results have been recently published. We conducted a
comprehensive meta-analysis of all RCTs and adjusted observational studies
to evaluate the clinical impact of percutaneous mitral valve repair when
compared with optimal medical therapy (OMT)alone, in patients with
symptomatic FMR and LV dysfunction. Death from any cause and heart failure
rehospitalizations at the longest available follow-up were the primary
endpoints. Cardiac death, one year and short-term death were the secondary
ones. 2255 patients (1207 for MitraClip and 1048 for OMT-only)from 8
studies (2 RCTs and 6 observational studies)were included. At a median
(mid-term)follow-up of 438 days (IQR 360-625)MitraClip was associated with
a significant reduction of all-cause death (odds Ratio [OR]0.55, 95%CI
0.41-0.73, p < 0.001; [ORadj]0.66, 95%CI 0.49-0.90, p = 0.009)and
rehospitalization (OR 0.49, 95%CI 0.24-1.00, p = 0.05 and ORadj 0.63,
95%CI 0.43-0.94, p = 0.02). At one year, adjusted analysis demonstrated a
trend favoring the experimental cohort (ORadj 0.73, 95%CI 0.53-1.02, p =
0.07). Meta-regression suggested that benefit of MitraClip on mid-term
survival persists even after accounting for the prevalence of implanted
CRT, burden of comorbidities, NYHA class, cardiomyopathy etiology and LV
function and dimensions. In conclusion, MitraClip for FMR in patients with
LV dysfunction is associated with a considerable reduction of death and HF
hospitalization at mid-term follow-up. Further ongoing RCTs are needed to
strengthen present results.<br/>Copyright &#xa9; 2019 Elsevier B.V.

<25>
Accession Number
2001970386
Title
The association between decrease in cerebral oxygen saturation during
cardiac surgery and postoperative cognitive dysfunction: secondary
analysis of a randomised trial.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Holmgaard F.; Vedel A.G.; Rasmussen L.S.; Paulson O.B.; Nilsson J.C.; Ravn
H.B.
Institution
(Holmgaard, Vedel, Nilsson, Ravn) Department of Cardiothoracic Anesthesia,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Vedel, Rasmussen) Department of Anesthesia, Centre of Head and
Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Paulson) Neurobiological Research Unit, The Neuro Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
Elsevier Ltd
Abstract
Background: Postoperative cognitive dysfunction (POCD)occurs commonly
after cardiac surgery. Near-infrared spectroscopy (NIRS)has been used to
monitor regional cerebral oxygen saturation (rScO<inf>2</inf>)in order to
minimise the occurrence of POCD by applying dedicated interventions when
rScO<inf>2</inf> decreases. However, the association between
rScO<inf>2</inf> intraoperatively and POCD has not been clarified.
<br/>Method(s): This is a secondary analysis of a randomised trial with
physician-blinded NIRS monitoring and cognitive testing at discharge from
hospital and at 3 months after surgery. The association between
intraoperative rScO<inf>2</inf> values and POCD at discharge from hospital
and at 3 months after surgery was investigated. The prespecified candidate
predictive variable of interest was cumulative time during surgery with
rScO<inf>2</inf> >=10% below its preoperative value. <br/>Result(s): One
hundred and fifty-three patients had complete NIRS data and neurocognitive
assessments at discharge, and 44 of these patients (29%)had POCD. At 3
months, 148 patients had complete data, and 12 (8%)of these patients had
POCD. The median time with rScO<inf>2</inf> >10% below preoperative values
did not differ for patients with and without POCD at discharge
(difference=0.0 min; Hodges-Lehmann 95% confidence interval, -3.11-1.47,
P=0.88). Other rScO<inf>2</inf> time thresholds that were assessed were
also not significantly different between those with and without POCD at
discharge. This applied both to absolute rScO<inf>2</inf> values and
relative changes from preoperative values. Similar results were found in
relation to POCD at 3 months. <br/>Conclusion(s): No significant
association was found between intraoperative rScO<inf>2</inf> values and
POCD. These findings bring into question the rationale for attempting to
avoid decreases in rScO<inf>2</inf> if the motivation is to prevent POCD.
Clinical trial registration: NCT 02185885.<br/>Copyright &#xa9; 2019
British Journal of Anaesthesia

<26>
Accession Number
627739255
Title
Drug-Use and Post-Operative Mortality Following Valve Surgery for
Infective Endocarditis: A Systematic Review and Meta-Analysis.
Source
Clinical infectious diseases : an official publication of the Infectious
Diseases Society of America. (no pagination), 2018. Date of Publication:
22 Dec 2018.
Author
Hall R.; Shaughnessy M.; Boll G.; Warner K.; Boucher H.W.; Bannuru R.R.;
Wurcel A.G.
Institution
(Hall, Shaughnessy, Boucher) Tufts University School of Medicine, United
States
(Boll, Warner) Division of Cardiac Surgery, Department of Surgery, Tufts
Medical Center, United Arab Emirates
(Boucher, Wurcel) Divsion of Geographic Medicine and Infectious Diseases,
Department of Medicine, Tufts Medical Center, United States
(Bannuru) Center for Treatment Comparison and Integrative Analysis
(CTCIA), Tufts Medical Center
(Wurcel) Department of Public Health and Community Medicine, Tufts
University School of Medicine, United States
Publisher
NLM (Medline)
Abstract
Objective: Infective endocarditis (IE) often requires surgical
intervention. An increasingly common cause of infective endocarditis is
injection drug use (IDU-IE). There is conflicting evidence on whether
post-operative mortality differs between people with IDU-IE and people
with IE from etiologies other than injection drug use (nonIDU-IE). In this
manuscript, we compare short-term postoperative mortality in IDU-IE vs.
nonIDU-IE through systematic review and meta-analysis. <br/>Method(s): The
review was conducted according to the Cochrane Handbook for Systematic
Reviews of Interventions and PRISMA guidelines. Publication databases were
queried for key terms included in articles up to September, 2017.
Randomized controlled trials, prospective cohorts, or retrospective
cohorts that reported on 30-day mortality or in-hospital/operative
mortality following valve surgery and that compared outcomes between
IDU-IE and nonIDU-IE were included. <br/>Result(s): Thirteen studies with
1593 patients (n=341, 21.4% IDU-IE) were included in the meta-analysis.
IDU-IE patients more frequently had tricuspid valve infection,
Staphylococcus infection, and heart failure before surgery. Meta-analysis
revealed no statistically significant difference in 30-day post-surgical
mortality or in-hospital mortality between the two groups.
<br/>Conclusion(s): Despite differing pre-operative clinical
characteristics, early post-operative mortality does not differ between
IDU-IE and nonIDU-IE patients who undergo valve surgery. Future research
on long-term outcomes following valve replacement is needed to identify
opportunities for improved healthcare delivery with IDU-IE.

<27>
Accession Number
613651342
Title
Percutaneous coronary angioplasty versus coronary artery bypass grafting
in treatment of unprotected left main stenosis (NOBLE): a prospective,
randomised, open-label, non-inferiority trial.
Source
The Lancet. 388 (10061) (pp 2743-2752), 2016. Date of Publication: 03 Dec
2016.
Author
Makikallio T.; Holm N.R.; Lindsay M.; Spence M.S.; Erglis A.; Menown
I.B.A.; Trovik T.; Eskola M.; Romppanen H.; Kellerth T.; Ravkilde J.;
Jensen L.O.; Kalinauskas G.; Linder R.B.A.; Pentikainen M.; Hervold A.;
Banning A.; Zaman A.; Cotton J.; Eriksen E.; Margus S.; Sorensen H.T.;
Nielsen P.H.; Niemela M.; Kervinen K.; Lassen J.F.; Maeng M.; Oldroyd K.;
Berg G.; Walsh S.J.; Hanratty C.G.; Kumsars I.; Stradins P.; Steigen T.K.;
Frobert O.; Graham A.N.J.; Endresen P.C.; Corbascio M.; Kajander O.;
Trivedi U.; Hartikainen J.; Anttila V.; Hildick-Smith D.; Thuesen L.;
Christiansen E.H.
Institution
(Makikallio, Niemela, Kervinen) Department of Cardiology, Oulu University
Hospital, Oulu, Finland
(Holm, Lassen, Maeng, Christiansen) Department of Cardiology, Aarhus
University Hospital, Skejby, Aarhus, Denmark
(Lindsay, Oldroyd, Berg) Department of Cardiology, Golden Jubilee National
Hospital, Clydebank, United Kingdom
(Spence, Walsh, Hanratty, Graham) Belfast Heart Centre, Belfast Trust,
Belfast, Ireland
(Erglis, Kumsars, Stradins) Latvia Centre of Cardiology, Paul Stradins
Clinical Hospital, Riga, Latvia
(Menown) Craigavon Cardiac Centre, Craigavon, Ireland
(Trovik, Steigen) Department of Cardiology, University of Northern Norway,
Tromso, Norway
(Endresen) Department of Cardiovascular Surgery, University of Northern
Norway, Tromso, Norway
(Eskola, Kajander) Heart Hospital, Tampere University Hospital, Tampere,
Finland
(Romppanen, Hartikainen) Heart Center, Kuopio University Hospital, Kuopio,
Finland
(Kellerth, Frobert) Department of Cardiology, Orebro University Hospital,
Orebro, Sweden
(Ravkilde, Thuesen) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kalinauskas) Department of Cardiology, Vilnius University Hospital,
Vilnius, Lithuania
(Linder) Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
(Pentikainen) Heart and Lung Center, Helsinki University Hospital,
Helsinki, Finland
(Hervold) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Banning) Oxford Heart Centre, Oxford, United Kingdom
(Zaman) Department of Cardiology, Freeman Hospital and Institute of
Cellular Medicine, Newcastle, United Kingdom
(Cotton) Heart and Lung Centre, New Cross Hospital, Wolverhampton, United
Kingdom
(Eriksen) Department of Cardiology, Haukeland University Hospital, Bergen,
Norway
(Margus) Department of Cardiology, East Tallinn Hospital, Tallinn, Estonia
(Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
(Sorensen) Department of Health Research and Policy (Epidemiology),
Stanford University, Stanford, CA, United States
(Nielsen) Department of Cardiac Surgery, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Corbascio) Department of Cardiology, Karolinska University Hospital,
Huddinge, Stockholm, Sweden
(Anttila) Department of Cardiac Surgery, Oulu University Hospital, Finland
(Trivedi, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospital, Brighton, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Coronary artery bypass grafting (CABG) is the standard
treatment for revascularisation in patients with left main coronary artery
disease, but use of percutaneous coronary intervention (PCI) for this
indication is increasing. We aimed to compare PCI and CABG for treatment
of left main coronary artery disease. Methods In this prospective,
randomised, open-label, non-inferiority trial, patients with left main
coronary artery disease were enrolled in 36 centres in northern Europe and
randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable
angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial
infarction. Exclusion criteria were ST-elevation myocardial infarction
within 24 h, being considered too high risk for CABG or PCI, or expected
survival of less than 1 year. The primary endpoint was major adverse
cardiac or cerebrovascular events (MACCE), a composite of all-cause
mortality, non-procedural myocardial infarction, any repeat coronary
revascularisation, and stroke. Non-inferiority of PCI to CABG required the
lower end of the 95% CI not to exceed a hazard ratio (HR) of 1.35 after up
to 5 years of follow-up. The intention-to-treat principle was used in the
analysis if not specified otherwise. This trial is registered with
ClinicalTrials.gov identifier, number NCT01496651. Findings Between Dec 9,
2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI
and 603 to CABG, and 592 in each group entered analysis by intention to
treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121
events) and 19% for CABG (81 events), HR 1.48 (95% CI 1.11-1.96),
exceeding the limit for non-inferiority, and CABG was significantly better
than PCI (p=0.0066). As-treated estimates were 28% versus 19% (1.55,
1.18-2.04, p=0.0015). Comparing PCI with CABG, 5 year estimates were 12%
versus 9% (1.07, 0.67-1.72, p=0.77) for all-cause mortality, 7% versus 2%
(2.88, 1.40-5.90, p=0.0040) for non-procedural myocardial infarction, 16%
versus 10% (1.50, 1.04-2.17, p=0.032) for any revascularisation, and 5%
versus 2% (2.25, 0.93-5.48, p=0.073) for stroke. Interpretation The
findings of this study suggest that CABG might be better than PCI for
treatment of left main stem coronary artery disease. Funding Biosensors,
Aarhus University Hospital, and participating sites.<br/>Copyright &#xa9;
2016 Elsevier Ltd

<28>
Accession Number
612986952
Title
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet
Therapy in Patients With Coronary Artery Disease: A Report of the American
College of Cardiology/American Heart Association Task Force on Clinical
Practice Guidelines.
Source
Journal of the American College of Cardiology. 68 (10) (pp 1082-1115),
2016. Date of Publication: 06 Sep 2016.
Author
Levine G.N.; Bates E.R.; Bittl J.A.; Brindis R.G.; Fihn S.D.; Fleisher
L.A.; Granger C.B.; Lange R.A.; Mack M.J.; Mauri L.; Mehran R.; Mukherjee
D.; Newby L.K.; O'Gara P.T.; Sabatine M.S.; Smith P.K.; Smith S.C.
Publisher
Elsevier USA

<29>
[Use Link to view the full text]
Accession Number
609208670
Title
Diabetes mellitus and prevention of late myocardial infarction after
coronary Stenting in the randomized dual Antiplatelet therapy study.
Source
Circulation. 133 (18) (pp 1772-1782), 2016. Date of Publication: 03 May
2016.
Author
Meredith I.T.; Tanguay J.-F.; Kereiakes D.J.; Cutlip D.E.; Yeh R.W.;
Garratt K.N.; Lee D.P.; Steg P.G.; Weaver W.D.; Holmes D.R.; Brindis R.G.;
Trebacz J.; Massaro J.M.; Hsieh W.-H.; Mauri L.
Institution
(Meredith, Hsieh) Monash Heart and Monash University, Melbourne, Australia
(Tanguay) Montreal Heart Institute, Universite de Montreal, QC, Canada
(Kereiakes) Christ Hospital Heart, Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Cutlip, Yeh, Massaro, Mauri) Harvard Clinical Research Institute, Boston,
MA, United States
(Cutlip, Yeh, Mauri) Harvard Medical School, Boston, MA, United States
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Garratt) Lenox Hill Hospital, New York, NY, United States
(Lee) Stanford University, Stanford, CA, United States
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Weaver) Henry Ford Medical Group, Detroit, MI, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
(Brindis) Institute for Health Policy Studies, University of California,
San Francisco, United States
(Trebacz) Jan Pawel II Hospital Krakow, Poland
(Massaro) Boston University, School of Public Health, Boston, MA, United
States
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, 75 Francis -St, Boston, MA 02115, United
States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Patients with diabetes mellitus (DM) are at high risk for
recurrent ischemic events after coronary stenting. We assessed the effects
of continued thienopyridine among patients with DM participating in the
Dual Antiplatelet Therapy (DAPT) Study as a prespecified analysis. Methods
and Results - After coronary stent placement and 12 months treatment with
open-label thienopyridine plus aspirin, 11 648 patients free of ischemic
or bleeding events and who were medication compliant were randomly
assigned to continued thienopyridine or placebo, in addition to aspirin,
for 18 more months. After randomization, patients with DM (n=3391), in
comparison with patients without DM (n=8257), had increased composite
outcome of death, myocardial infarction (MI), or stroke (6.8% versus 4.3%,
P<0.001), increased death (2.5% versus 1.4%, P<0.001), and MI (4.2% versus
2.6%, P<0.001). Among patients with DM, in a comparison of continued
thienopyridine versus placebo, rates of stent thrombosis were 0.5% versus
1.1%, P=0.06, and rates of MI were 3.5% versus 4.8%, P=0.058; and among
patients without DM the rates were 0.4% versus 1.4%, P<0.001 (stent
thrombosis, P interaction=0.21) and 1.6% versus 3.6%, P<0.001 (MI, P
interaction=0.02). Bleeding risk with continued thienopyridine was similar
among patients with or without DM (interaction P=0.61). Conclusions - In
patients with DM, continued thienopyridine beyond 1 year after coronary
stenting is associated with reduced risk of MI, although this benefit is
attenuated in comparison with patients without DM. Clinical Trial
Registration - URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00977938.<br/>Copyright &#xa9; 2016 American Heart Association, Inc.

<30>
Accession Number
609613559
Title
Ixmyelocel-T for patients with ischaemic heart failure: a prospective
randomised double-blind trial.
Source
The Lancet. 387 (10036) (pp 2412-2421), 2016. Date of Publication: 11 Jun
2016.
Author
Patel A.N.; Henry T.D.; Quyyumi A.A.; Schaer G.L.; Anderson R.D.; Toma C.;
East C.; Remmers A.E.; Goodrich J.; Desai A.S.; Recker D.; DeMaria A.
Institution
(Patel) University of Utah Health Care, Salt Lake City, UT, United States
(Henry) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Quyyumi) Emory University Hospital, Atlanta, GA, United States
(Schaer) Rush University Medical Center, Chicago, IL, United States
(Anderson) University of Florida, Gainesville, FL, United States
(Toma) University of Pittsburgh, Pittsburgh, PA, United States
(East) Baylor University Medical Center, Dallas, TX, United States
(Remmers, Goodrich, Recker) Vericel Corporation, Cambridge, MA, United
States
(Desai) Brigham & Women's Hospital, Boston, MA, United States
(DeMaria) University of California San Diego, San Diego, CA, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Ixmyelocel-T is an expanded, multicellular therapy produced
from a patient's own bone marrow by selectively expanding two key types of
bone marrow mononuclear cells: CD90+ mesenchymal stem cells and CD45+
CD14+ auto-fluorescent+ activated macrophages. Early phase clinical trials
suggest that intramyocardial delivery of ixmyelocel-T might improve
clinical, functional, symptomatic, and quality-of-life outcomes in
patients with heart failure due to ischaemic dilated cardiomyopathy. We
aimed to assess the safety and efficacy of catheter-based transendocardial
injection of ixmyelocel-T cell therapy in patients with heart failure and
reduced ejection fractions. Methods In this randomised, double-blind,
placebo-controlled phase 2B trial (ixCELL-DCM), patients from 31 sites in
North America with New York Heart Association class III or IV symptomatic
heart failure due to ischaemic dilated cardiomyopathy, who had left
ventricular ejection fraction 35% or less, an automatic implantable
cardioverter defibrillator, and who were ineligible for revascularisation
procedures were randomly assigned (1:1) to receive ixmyelocel-T or placebo
at the time of bone marrow aspiration and followed for 12 months.
Randomisation was done through an interactive (voice/web) response system.
The pharmacist, treating physician, and coordinator at each site were
unblinded, but the the follow-up team was completely blinded. The primary
endpoint was a composite of all-cause death, cardiovascular admission to
hospital, and unplanned clinic visits to treat acute decompensated heart
failure based on the blinded adjudication of an independent clinical
endpoint committee. Primary efficacy endpoint analyses and safety analyses
were done by modified intention to treat. This trial is registered with
ClinicalTrials.gov, number NCT01670981. Findings Between April 2, 2013,
and Jan 28, 2015, 126 participants were randomly assigned to receive
either ixmyelocel-T (n=66) or placebo (n=60). 114 (90%) patients comprised
the modified intention-to-treat population and 109 (87%) patients were
included in the per-protocol primary efficacy analysis (58 in the
ixmyelocel-T group and 51 in the placebo group). The primary efficacy
endpoint was observed in 47 patients: 50 events in 25 (49%) of 51 patients
in the placebo group and 38 events in 22 (38%) of 58 patients in the
ixmyelocel-T group, which represents a 37% reduction in cardiac events
compared with placebo (risk ratio 0.63 [95% CI 0.42-0.97]; p=0.0344). 41
(75%) of 51 participants in the placebo group had serious adverse events
versus 31 (53%) of 58 in the ixmyelocel-T group (p=0.0197). Interpretation
To the best of our knowledge, ixCELL-DCM is the largest cell therapy study
done in patients with heart failure so far. The transendocardial delivery
of ixmyelocel-T in patients with heart failure and reduced ejection
fraction due to ischaemic dilated cardiomyopathy resulted in a significant
reduction in adjudicated clinical cardiac events compared with placebo
leading to improved patient outcomes. Funding Vericel
Corporation.<br/>Copyright &#xa9; 2016 Elsevier Ltd

<31>
Accession Number
606036338
Title
The Brazilian Cardioprotective Nutritional Program to reduce events and
risk factors in secondary prevention for cardiovascular disease: study
protocol (The BALANCE Program Trial).
Source
American Heart Journal. 171 (1) (pp 73-81.e2), 2016. Date of Publication:
01 Jan 2016.
Author
Weber B.; Bersch-Ferreira A.C.; Torreglosa C.R.; Ross-Fernandes M.B.; Da
Silva J.T.; Galante A.P.; De Sousa Lara E.; Costa R.P.; Soares R.M.; Biasi
Cavalcanti A.; Berwanger O.
Institution
(Weber, Bersch-Ferreira, Torreglosa, Ross-Fernandes, Da Silva, Galante, De
Sousa Lara, Costa, Soares, Biasi Cavalcanti, Berwanger) Research
Institute, Hospital do Coracao (IP-HCor), Rua Abilio Soares 250, 11th
floor, Sao Paulo, SP, Brazil
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
This article reports the rationale for the Brazilian Cardioprotective
Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter,
nationwide, randomized, concealed, controlled trial was designed to
investigate the effects of the BALANCE Program in reducing cardiovascular
events. The BALANCE Program consists of a prescribed diet guided by
nutritional content recommendations from Brazilian national guidelines
using a unique nutritional education strategy, which includes suggestions
of affordable foods. In addition, the Program focuses on intensive
follow-up through one-on-one visits, group sessions, and phone calls. In
this trial, participants 45 years or older with any evidence of
established cardiovascular disease will be randomized to the BALANCE or
control groups. Those in the BALANCE group will receive the afore
mentioned program interventions, while controls will be given generic
advice on how to follow a low-fat, low-energy, low-sodium, and
low-cholesterol diet, with a view to achieving Brazilian nutritional
guideline recommendations. The primary outcome is a composite of death
(any cause), cardiac arrest, acute myocardial infarction, stroke,
myocardial revascularization, amputation for peripheral arterial disease,
or hospitalization for unstable angina. A total of 2468 patients will be
enrolled in 34 sites and followed up for up to 48 months. If the BALANCE
Program is found to decrease cardiovascular events and reduce risk
factors, this may represent an advance in the care of patients with
cardiovascular disease.<br/>Copyright &#xa9; 2015 Elsevier Inc. All rights
reserved.

<32>
Accession Number
608168904
Title
Transcatheter valve-in-valve implantation versus reoperative conventional
aortic valve replacement: A systematic review.
Source
Journal of Thoracic Disease. 8 (1) (pp E83-E93), 2016. Date of
Publication: 2016.
Author
Phan K.; Zhao D.-F.; Wang N.; Huo Y.R.; Eusanio M.D.; Yan T.D.
Institution
(Phan, Zhao, Wang, Huo, Yan) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, NSW, Australia
(Eusanio) Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini'
Hospital Piazza Italia, Teramo 64100, Italy
Publisher
Pioneer Bioscience Publishing (E-mail: info@amepc.org)
Abstract
Transcatheter valve-in-valve (VIV) implantation for degenerated aortic
bioprostheses has emerged as a promising alternative to redo conventional
aortic valve replacement (cAVR). However there are concerns surrounding
the efficacy and safety of VIV. This systematic review aims to compare the
outcomes and safety of transcatheter VIV implantation with redoes cAVR.
Six databases were systematically searched. A total of 18 relevant studies
(823 patients) were included. Pooled analysis demonstrated VIV achieved
significant improvements in mean gradient (38 mmHg preoperatively to 15.2
mmHg postoperatively, P < 0.001) and peak gradient (59.2 to 23.2 mmHg,
P=0.0003). These improvements were similar to the outcomes achieved by
cAVR. The incidence of moderate paravalvular leaks (PVL) were
significantly higher for VIV compared to cAVR (3.3% vs. 0.4%, P=0.022). In
terms of morbidity, VIV had a significantly lower incidence of stroke and
bleeding compared to redo cAVR (1.9% vs. 8.8%, P=0.002 & 6.9% vs. 9.1%,
P=0.014, respectively). Perioperative mortality rates were similar for VIV
(7.9%) and redo cAVR (6.1%, P=0.35). In conclusion, transcatheter VIV
implantation achieves similar haemodynamic outcomes, with lower risk of
strokes and bleeding but higher PVL rates compared to redo cAVR. Future
randomized studies and prospective registries are essential to compare the
effectiveness of transcatheter VIV with cAVR, and clarify the rates of
PVLs.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<33>
Accession Number
604106989
Title
Optimal duration of dual antiplatelet therapy after percutaneous coronary
intervention with drug eluting stents: Meta-analysis of randomised
controlled trials.
Source
BMJ (Online). 350 (no pagination), 2015. Article Number: h1618. Date of
Publication: 16 Apr 2015.
Author
Navarese E.P.; Andreotti F.; Schulze V.; Kolodziejczak M.; Bufon A.;
Brouwer M.; Costa F.; Kowalewski M.; Parati G.; Lip G.Y.H.; Kelm M.;
Valgimigli M.
Institution
(Navarese, Schulze, Kolodziejczak, Kelm) Department of Internal Medicine,
Division of Cardiology, Pulmonology and Vascular Medicine,
Heinrich-Heine-University, Dusseldorf 40225, Germany
(Navarese, Andreotti, Schulze, Kolodziejczak, Bufon, Brouwer, Kowalewski,
Lip, Kelm) Systematic Investigation and Research on Interventions and
Outcomes (SIRIO), MEDICINE Research Network, Dusseldorf, Germany
(Andreotti, Bufon) Department of Cardiovascular Science, Catholic
University, Rome, Italy
(Kolodziejczak) Collegium Medicum in Bydgoszcz, University of Nicolaus
Copernicus, Torun, Poland
(Brouwer) Department of Cardiology, University Medical Centre St Radboud,
Nijmegen, Netherlands
(Costa, Valgimigli) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Kowalewski) Department of Cardiology, 10th Military Research Hospital and
Polyclinic, Bydgoszcz, Poland
(Parati) Department of Cardiovascular, Neural and Metabolic Sciences, San
Luca Hospital, University of Milan-Bicocca, Milan, Italy
(Lip) Department of Cardiology, University of Birmingham, Centre for
Cardiovascular Sciences, Birmingham, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
OBJECTIVE: To assess the benefits and risks of short term (<12 months) or
extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12
month therapy, following percutaneous coronary intervention with drug
eluting stents. DESIGN: Meta-analysis of randomised controlled trials.
Data SOURCES: PubMed, Embase, Cumulative Index to Nursing and Allied
Health Literature, Scopus, Web of Science, Cochrane Library, and major
congress proceedings, searched from 1 January 2002 to 16 February 2015.
review METHODS: Trials comparing short term (<12 months) or extended (>12
months) DAPT regimens with standard 12 month duration of therapy. Primary
outcomes were cardiovascular mortality, myocardial infarction, stent
thrombosis, major bleeding, and all cause mortality. <br/>RESULT(S): 10
randomised controlled trials (n=32 287) were included. Compared to 12
month DAPT, a short term course of therapy was associated with a
significant reduction in major bleeding (odds ratio 0.58 (95% confidence
interval 0.36 to 0.92); P=0.02) with no significant differences in
ischaemic or thrombotic outcomes. Extended versus 12 month DAPT yielded a
significant reduction in the odds of myocardial infarction (0.53 (0.42 to
0.66); P<0.001) and stent thrombosis (0.33 (0.21 to 0.51); P<0.001), but
more major bleeding (1.62 (1.26 to 2.09); P<0.001). All cause but not
cardiovascular death was also significantly increased (1.30 (1.02 to
1.66); P=0.03). <br/>CONCLUSION(S): Compared with a standard 12 month
duration, short term DAPT (<12 months) after drug eluting stent
implementation yields reduced bleeding with no apparent increase in
ischaemic complications, and could be considered for most patients. In
selected patients with low bleeding risk and very high ischaemic risk,
extended DAPT (>12 months) could be considered. The increase in all cause
but not cardiovascular death with extended DAPT requires further
investigation.<br/>Copyright &#xa9; BMJ Publishing Group Ltd 2015.

<34>
Accession Number
606305851
Title
Morphological and functional consequences of transradial coronary
angiography on the radial artery: Implications for its use as a bypass
conduit.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 370-374), 2015.
Date of Publication: 2015.
Author
Gaudino M.; Leone A.; Lupascu A.; Toesca A.; Mazza A.; Ponziani F.R.;
Flore R.; Tondi P.; Massetti M.
Institution
(Gaudino, Leone, Mazza, Massetti) Department of Cardiovascular Science,
Catholic University, Rome, Italy
(Lupascu, Ponziani, Flore, Tondi) Department of Angiology, Catholic
University, Rome, Italy
(Toesca) Department of Human Anatomy, Catholic University, Rome, Italy
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: To assess the degree of damage to the radial artery (RA) in
coronary artery bypass grafting (CABG) patients who underwent preoperative
transradial coronary angiography (RA-CA). <br/>METHOD(S): From May 2012 to
October 2013, 50 consecutive CABG patients who underwent RA-CA were
prospectively enrolled in the study. All patients underwent echo-Doppler
evaluation of the RA of the catheterized arm; the contralateral RA was
used as control. The distal segment of the RA was submitted to
immunohistochemical assessment of endothelial integrity. Patients were
divided in three groups according to the time interval from angiography to
evaluation: <=24 h, >24 h to <7 days and >=7 days. <br/>RESULT(S):
Baseline RA median diameters were 0.25 +/- 0.04 cm in the cannulated arm
and 0.22 +/- 0.04 cm in the non-cannulated arm (P = 0.01). The
flow-mediated dilatation (FMD) in the RA in the catheterized arm and in
the control arm were 11.6 +/- 7.9 and 14.2 +/- 8.9 (P = 0.01),
respectively. A statistically significant correlation was found between
FMD of the catheterized RA and the time from RA-CA (Pearson's r = 0.348).
Linear regression analysis confirmed that the FMD of the catheterized RA
was dependent on days elapsed from the procedure (P = 0.032; OR 1.11, CI
0.009-0.203). Immunohistochemical evaluation showed extensive endothelial
lesion in all examined RAs, with a trend towards reduction of the damage
with time. Endothelial function and integrity of the cannulated arm did
not reach those of the control arm in any of the study patients.
<br/>CONCLUSION(S): RA-CA produces extensive damage to the RA. The lesions
tend to heal with time but incomplete recovery of endothelial integrity
and function is still present more than 30 days after the procedure. After
RA-CA, the cannulated RA should not be used for CABG.<br/>Copyright &#xa9;
The Author 2015. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery.

<35>
Accession Number
53168157
Title
Dual antiplatelet therapy with or without oral anticoagulation in the
postdischarge management of acute coronary syndrome patients with an
indication for long term anticoagulation: A systematic review.
Source
Journal of Thrombosis and Thrombolysis. 38 (3) (pp 285-298), 2014. Date of
Publication: October 2014.
Author
Washam J.B.; Dolor R.J.; Jones W.S.; Halim S.A.; Hasselblad V.; Mayer
S.B.; Heidenfelder B.L.; Melloni C.
Institution
(Washam) Duke Heart Center, Duke University Medical Center, DUMC 3943,
Durham, NC 27710, United States
(Dolor, Jones, Halim, Hasselblad, Heidenfelder, Melloni) Duke Clinical
Research Institute, Duke University Medical Center, Durham, NC, United
States
(Mayer) Division of Endocrinology and Metabolism, Department of Medicine,
Virginia Commonwealth University, Richmond, VA, United States
Publisher
Kluwer Academic Publishers (E-mail: barbara.b.bertram@gsk.com)
Abstract
Currently, there is a lack of consensus among guidelines for the
postdischarge treatment of patients presenting with acute coronary
syndrome (ACS) who have a long-term indication for anticoagulation. We
conducted a systematic review comparing the safety and effectiveness of
dual antiplatelet therapy (DAPT) and triple therapy (TT; defined as DAPT
plus an oral anticoagulant) in patients with ACS and a long-term
indication for anticoagulation. We searched for clinical studies in
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews published
between January 1995 and September 2013. Each investigator screened and
abstracted data, assessed applicability and quality, and graded the
strength of evidence. Meta-analysis of direct comparison was performed
when outcomes and follow-up periods were comparable. Fourteen
observational studies were identified that contained comparative
effectiveness data on DAPT versus TT. No difference in the odds of
mortality (OR 1.04, 95 % CI 0.59-1.83) or stroke (OR 1.01, 95 % CI
0.38-2.67) at 1-5 years was found between TT and DAPT. Major bleeding at
1-5 years (OR 1.46, 95 % CI 1.07-2.00) and nonfatal MI at 1-5 years (OR
1.85, 95 % CI 1.13-3.02) occurred more frequently in patients receiving
TT. The results of this systematic review demonstrate that treatment with
TT was associated with increased rates of nonfatal MI and major bleeding
when compared with treatment with DAPT in the postdischarge management of
ACS patients with an indication for oral anticoagulation. Until results of
ongoing randomized trials assessing antithrombotic therapies define
optimal management strategies, the current analysis suggests using caution
when prescribing TT to these patients. &#xa9; 2014 Springer
Science+Business Media.

<36>
Accession Number
2001380210
Title
Postoperative Pain Management Strategies and Delirium After Transapical
Aortic Valve Replacement: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1668-1672),
2019. Date of Publication: June 2019.
Author
Strike E.; Arklina B.; Stradins P.; Cusimano R.J.; Osten M.; Horlick E.;
Styra R.; Poonawala H.; Carroll J.; Djaiani G.
Institution
(Strike, Arklina) Department of Anesthesiology, Paula Stradina University
Hospital, Riga, Latvia
(Stradins) Department of Cardiac Surgery, Paula Stradina University
Hospital, Riga, Latvia
(Cusimano) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, Canada
(Osten, Horlick) Department of Interventional Cardiology, Toronto General
Hospital, Toronto, Canada
(Styra) Department of Psychiatry, Toronto General Hospital, Toronto,
Canada
(Poonawala, Carroll, Djaiani) Department of Anesthesia and Pain
Management, Toronto General Hospital, Toronto, Canada
Publisher
W.B. Saunders
Abstract
Objective(s): This study was designed to compare 2 different perioperative
analgesia strategies with respect to the incidence of postoperative
delirium after a transapical approach for transcatheter aortic valve
replacement (TAVR). The authors hypothesized that perioperative thoracic
paravertebral analgesia with a local anesthetic would decrease opioid
consumption and in turn reduce the incidence of postoperative delirium
when compared with systemic opioid-based analgesia after a transapical
TAVR procedure. <br/>Design(s): Prospective, randomized controlled
clinical trial. <br/>Setting(s): Tertiary referral center, university
hospital. <br/>Participant(s): The study comprised 44 patients undergoing
a transapical TAVR procedure. Patients with a history of serious mental
illness, delirium, and severe dementia and/or patients with
contraindications to regional anesthesia were excluded.
<br/>Intervention(s): Patients were randomly assigned to either the
paravertebral group (perioperative continuous thoracic paravertebral block
with local anesthetic) or the patient-controlled analgesia group
(systemically administered opioids) using a computer-generated
randomization code in blocks of four patients. <br/>Measurements and Main
Results: Assessment of postoperative delirium was performed by trained
research staff using the confusion assessment method for intensive care
unit preoperatively and postoperatively every 12 hours or more often if
needed according to the patient's condition during the first 7
postoperative days or until discharge. Pain was assessed with a 10 cm
Visual Analog Scale pain score system during the 48 hours postoperatively.
The sedation level was assessed using the Sedation Agitation Scale during
the same period. Overall postoperative delirium was detected in 12/44
(27%) patients, with 7/22 (32%) in the patient-controlled analgesia and
5/22 (23%) in the paravertebral groups, respectively (p = 0.73). Both
groups were similar with respect to demographic data, preoperative
medications, and comorbidities. Paravertebral analgesia was associated
with an opioid-sparing effect during surgery and during the 48-hour
postoperative period. Sedation and pain scores were similar between the 2
groups. In addition, paravertebral analgesia was associated with earlier
extubation times; however, the overall morbidity and mortality were
similar between the 2 groups. <br/>Conclusion(s): Paravertebral analgesia
in patients undergoing transapical TAVR procedures appears to have an
opioid-sparing effect. However, it did not translate into a statistically
significant decrease in the rate of postoperative delirium.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<37>
Accession Number
627605936
Title
Thromboelastography or rotational thromboelastometry for bleeding
management in adults undergoing cardiac surgery: A systematic review with
meta-analysis and trial sequential analysis.
Source
Journal of Thoracic Disease. 11 (4) (pp 1170-1181), 2019. Date of
Publication: 01 Apr 2019.
Author
Li C.; Zhao Q.; Yang K.; Jiang L.; Yu J.
Institution
(Li) Lanzhou University Second Hospital, Lanzhou 730030, China
(Zhao, Yang, Jiang) Department of Cardiac Surgery ICU, Lanzhou University
Second Hospital, 82 Cuiyingmen Street, Lanzhou 730030, China
(Yu) Department of Cardiology, Lanzhou University Second Hospital, 82
Cuiyingmen Street, Lanzhou 730030, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Severe bleeding and massive transfusion of blood products may
be associated with increased morbidity and mortality of cardiac surgery. A
transfusion algorithm incorporating thromboelastography (TEG) or
rotational thromboelastometry (ROTEM) can help to determine the
appropriate time and target for the use of hemostatic blood products,
which may thus reduce the quantity of blood loss as well as blood products
transfused. <br/>Method(s): We conducted meta-analysis and trial
sequential analysis to evaluate the effects of TEG or ROTEM-guided
transfusion algorithms vs. standard treatments for patients undergoing
cardiac surgery with cardiac pulmonary bypass. <br/>Result(s): Nineteen
studies with a total of 15,320 participants, including 13 randomized
controlled trials (RCTs), were included. All-cause mortality was not
reduced either in overall studies or in RCTs. Blood loss volume was
reduced by 132 mL in overall studies [mean difference (MD): -132.46, 95%
CI: -207.49, -57.43; I² =53%, P<0.01], and by 103 mL in RCTs
(MD: -103.50, 95% CI: -156.52, -50.48; I² =0%, P<0.01). The
relative risks (RRs) in RCTs were 0.89 (95% CI: 0.80-0.98; I²
=0%, P=0.02) for red blood cells transfusion, 0.59 (95% CI: 0.42-0.82;
I² =55%, P<0.01) for fresh frozen plasma transfusion, and 0.81
(95% CI: 0.74-0.90; I² =0%, P<0.01) for platelet transfusion,
respectively. Trial sequential analysis of continuous data on blood loss
and dichotomous outcomes on transfusion of blood products suggested the
benefits of a TEG/ROTEM-guided algorithm. <br/>Conclusion(s): TEG or
ROTEM-guided transfusion strategies may reduce blood loss volume and the
transfusion rates in adult patients undergoing cardiac
surgery.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<38>
Accession Number
2001899824
Title
Current key issues in transcatheter aortic valve replacement undergoing a
paradigm shift.
Source
Circulation Journal. 83 (5) (pp 952-962), 2019. Date of Publication: 2019.
Author
Hwang I.-C.; Hayashida K.; Kim H.-S.
Institution
(Hwang) Division of Cardiology, Department of Internal Medicine, Seoul
National University Bundang Hospital, Gyeonggi-do, South Korea
(Hwang, Kim) Cardiovascular Center, Department of Internal Medicine, Seoul
National University Hospital, Seoul, South Korea
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Publisher
Japanese Circulation Society
Abstract
As a new technology in the management of valvular heart disease,
transcatheter aortic valve replacement (TAVR) has drawn much attention
since its emergence. To date, numerous studies have investigated the
safety and efficacy of TAVR in patients of various risk profiles with
severe aortic stenosis (AS) and demonstrated comparable or superior
outcomes of TAVR when compared with surgical aortic valve replacement
(SAVR). The favorable outcomes of TAVR in inoperable patients, as well as
in high- and intermediaterisk patients, are endorsed in current
guidelines, and trials of low-risk patients have shown non-inferior or
even superior results of TAVR than for SAVR, suggesting that the clinical
indications of TAVR can be expanded to low-risk patients. Moreover, a
therapeutic role of TAVR has been suggested in various aortic valve (AV)
diseases, such as bicuspid AV, moderate AS with heart failure, aortic
regurgitation, and bioprosthetic valve failure. In this review, we
summarize the current issues of TAVR in various patient populations and
discuss the expanding clinical indications of TAVR, which are driving a
major paradigm shift in the management of AV disease.<br/>Copyright &#xa9;
2019, Japanese Circulation Society. All rights reserved.

<39>
Accession Number
2001957823
Title
A Randomized Controlled Trial of Surgical Rib Fixation in Polytrauma
Patients With Flail Chest.
Source
Journal of Surgical Research. 242 (pp 223-230), 2019. Date of Publication:
October 2019.
Author
Liu T.; Liu P.; Chen J.; Xie J.; Yang F.; Liao Y.
Institution
(Liu, Chen, Xie, Yang, Liao) Trauma Center, Department of Emergency and
Trauma Surgery, Tongji Hospital, Tongji Medical College of Huazhong
University of Science and Technology, Wuhan, China
(Liu) Department of Emergency Surgery, Wuhan Pu'ai Hospital, Tongji
Medical College of Huazhong University of Science and Technology, Wuhan,
China
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Flail chest (FC)is known to account for high mortality and
morbidity and is typically treated with conservative care. Operative
fixation of FC has been advocated as an alternative treatment choice. This
prospective randomized controlled trial aims to compare surgical and
nonsurgical management of FC in patients with severe polytrauma.
<br/>Method(s): Severe polytrauma patients with FC admitted between
January 2015 and July 2017 to our trauma center were investigated. The
enrolled patients were randomly assigned to the surgical or nonsurgical
group. Basic characteristics of injury and clinical outcomes were
compared. <br/>Result(s): Fifty patients entered final analysis, with 25
patients in each group. Operative rib fixation was associated with shorter
duration of mechanical ventilation (7 d [interquartile range {IQR}
6-10]versus 9 d [IQR 7-12], P = 0.012), shorter ICU stay (10 d [IQR
7-12]versus 12 d [IQR 9-15], P = 0.032), lower risk of adult respiratory
distress syndrome (28% versus 60%, P = 0.045), pneumonia (48% versus 80%,
P = 0.038), and thoracic deformity (8% versus 36%, P = 0.037)and less pain
while coughing (pain score 6 [IQR 3-8]versus 8 [IQR 4-9], P = 0.029)and
deep breathing (pain score 5 [IQR 3-9]versus 7 [IQR 3-9], P = 0.038).
Subgroup analysis was conducted by presence of pulmonary contusion.
Shorter time on the ventilator use and ICU stay associated with rib
surgery was not observed in patients with pulmonary contusion.
<br/>Conclusion(s): This study reveals that surgical rib fixation may
provide some critical care benefits for severe polytrauma patients with
FC, including less medical resource use and lower risk of complications.
Further studies should be designed to optimally identify patients who are
most likely to benefit from this surgery.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<40>
Accession Number
2001490102
Title
Sildenafil for Pulmonary Hypertension in the Early Postoperative Period
After Mitral Valve Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1648-1656),
2019. Date of Publication: June 2019.
Author
Ram E.; Sternik L.; Klempfner R.; Eldar M.; Goldenberg I.; Peled Y.;
Raanani E.; Kogan A.
Institution
(Ram, Sternik, Raanani, Kogan) Department of Cardiac Surgery, Sheba
Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Klempfner, Eldar, Goldenberg, Peled) Heart Institute, Sheba Medical
Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University,
Tel Aviv, Israel
Publisher
W.B. Saunders
Abstract
Objectives: The phosphodiesterase-5 inhibitor sildenafil was developed for
the treatment of pulmonary hypertension. The authors investigated the
efficacy and safety of sildenafil in the early postoperative period after
mitral valve surgery in patients with pulmonary hypertension.
<br/>Design(s): A double-blind, placebo-controlled randomized trial was
performed. <br/>Setting(s): The trial was performed in a single tertiary
referral center. <br/>Participant(s): Fifty consecutive patients who
experienced pulmonary hypertension and underwent mitral valve surgery.
<br/>Intervention(s): Patients were randomly assigned to the following 2
groups: 25 patients received 20 mg sildenafil every 8 hours, and the
remaining 25 patients received placebo during the same period. Hemodynamic
parameters were studied by using a pulmonary artery catheter at baseline
and every 6 hours up to 36 hours. <br/>Result(s): Patients who received
sildenafil showed a decrease in mean pulmonary pressure, from 32 +/- 7
mmHg at baseline to 26 +/- 3 mmHg after 36 hours, whereas no change was
seen in patients who received placebo (mean pulmonary pressure 34 +/- 6
mmHg at baseline and 35 +/- 5 mmHg after 36 h) (p < 0.001). No significant
changes in systemic hemodynamic and oxygenation were observed. Patients
who received sildenafil compared with those who received placebo had a
median mechanical lung ventilation time of 16 (10-31) hours versus 19
(13-41) hours (p = 0.431), intensive care unit stay of 74 (44-106) hours
versus 91 (66-141) hours (p = 0.410), and a total hospitalization stay of
7 (5-10) days versus 11 (7-15) days (p = 0.009). <br/>Conclusion(s): The
immediate postoperative administration of sildenafil after mitral valve
surgery is safe. Sildenafil demonstrates a favorable decreasing effect on
pulmonary vascular pressure without systemic hypotension and
ventilation-perfusion mismatch.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<41>
Accession Number
625786707
Title
Estimating the additional costs per life saved due to transcatheter aortic
valve replacement: a secondary data analysis of electronic health records
in Germany.
Source
European Journal of Health Economics. 20 (4) (pp 625-632), 2019. Date of
Publication: 03 Jun 2019.
Author
Kaier K.; von zur Muhlen C.; Zirlik A.; Bothe W.; Hehn P.; Zehender M.;
Bode C.; Stachon P.
Institution
(Kaier, Hehn) Institute of Medical Biometry and Statistics, Faculty of
Medicine and Medical Center, University of Freiburg, Freiburg, Germany
(Kaier, von zur Muhlen, Zirlik, Zehender, Bode, Stachon) Department of
Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine,
University of Freiburg, Hugstetter Str. 55, Freiburg 79104, Germany
(Bothe) Department of Cardiac and Vascular Surgery, Heart Center Freiburg,
Faculty of Medicine, University of Freiburg, Freiburg, Germany
(Zirlik) Department of Cardiology, Medical University of Graz, Graz,
Austria
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Aortic stenosis (AS) is the most common valvular heart disease, with a
dismal prognosis when untreated. Recommended therapy is surgical (SAVR) or
transcatheter (TAVR) aortic valve replacement. Based on a retrospective
cohort of isolated SAVR and TAVR procedures performed in Germany in 2015
(N = 17,826), we examine the impact of treatment selection on in-hospital
mortality and total in-hospital costs for a variety of at-risk
populations. Since patients were not randomized to the two treatment
options, the two endpoints in-hospital mortality and reimbursement are
analyzed using logistic and linear regression models with 20 predefined
patient characteristics as potential confounders. Incremental
cost-effectiveness ratios were calculated as a ratio of the risk-adjusted
reimbursement and mortality differences with 95% confidence intervals
obtained by Fieller's theorem. Our study shows that TF-TAVR is more costly
that SAVR and that cost differences between the procedures vary little
between patient groups. Results regarding in-hospital mortality are mixed.
SAVR is the predominant procedure among younger patients. For patients
older than 85 years or at intermediate and higher pre-operative risk
TF-TAVR seems to be the treatment of choice. Incremental
cost-effectiveness ratios (ICER) are most favorable for patients older
than 85 years (ICER 154,839, 95% CI 89,163-302,862), followed by patients
at higher pre-operative risk (ICER 413,745, 95% CI 258,027-952,273). A
hypothetical shift from SAVR towards TF-TAVR among patients at
intermediate pre-operative risk is associated with a less favorable ICER
(1,486,118, 95% CI 764,732-23,692,323), as the risk-adjusted mortality
benefit is relatively small (- 0.97% point), while the additional
reimbursement is still eminent (+14,464). From a German healthcare system
payer's perspective, the additional costs per life saved due to TAVR are
most favorable for patients older than 85 and/or at higher pre-operative
risk.<br/>Copyright &#xa9; 2019, Springer-Verlag GmbH Germany, part of
Springer Nature.

<42>
Accession Number
626328282
Title
Pharmacological interventions for the prevention of acute kidney injury
after pediatric cardiac surgery: a network meta-analysis.
Source
Clinical and Experimental Nephrology. 23 (6) (pp 782-791), 2019. Date of
Publication: 01 Jun 2019.
Author
Bellos I.; Iliopoulos D.C.; Perrea D.N.
Institution
(Bellos, Iliopoulos, Perrea) Laboratory of Experimental Surgery and
Surgical Research N.S. Christeas, Athens University Medical School,
National and Kapodistrian University of Athens, 15B, Ag. Thoma str.,
Athens 115 27, Greece
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: Acute kidney injury constitutes a major complication of
cardiac surgery in pediatric patients. The present meta-analysis aims to
accumulate current literature and assess the efficacy of pharmacological
interventions in preventing postoperative renal dysfunction after
congenital heart surgery. <br/>Method(s): Literature search was conducted
using Medline (1966-2018), Scopus (2004-2018), Cochrane Central Register
of Controlled Trials CENTRAL (1999-2018), Clinicaltrials.gov (2008-2018),
and Google Scholar (2004-2018) databases. Statistical analysis was
performed with Review Manager 5.3 and R 3.4.3. <br/>Result(s):
Meta-analysis included 14 studies, with a total of 2,625 patients. AKI
incidence was significantly lower in the dexmedetomidine (OR 0.49, 95% CI
[0.28-0.87]) and acetaminophen (OR 0.43, 94% CI [0.28-0.67]) groups, while
no difference was present in patients receiving corticosteroid (OR 1.16,
95% CI [0.69-1.95]), fenoldopam (OR 0.47, 95% CI [0.22-1.02]), or
aminophylline (OR 0.98, 95% CI [0.29-3.34]). Network meta-analysis
proposed that dexmedetomidine had the greatest probability (44.5%) to rank
first, although significant overlap with the other treatments was
observed. <br/>Conclusion(s): The present meta-analysis suggests that no
firm evidence exists about the protective role of pharmacological
interventions in the pediatric population. Future randomized controlled
trials should clarify the effectiveness of dexmedetomidine and
acetaminophen and indicate the optimal protocol to be applied, to protect
renal function in the perioperative setting.<br/>Copyright &#xa9; 2019,
Japanese Society of Nephrology.

<43>
Accession Number
627731671
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. (no pagination), 2019. Date of
Publication: 2019.
Author
Dias J.D.; Sauaia A.; Achneck H.E.; Hartmann J.; Moore E.E.
Institution
(Dias) Haemonetics S.A., Signy, Switzerland
(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
Blackwell Publishing Ltd
Abstract
Essentials TEG-guided therapy has been shown to be valuable in a number of
surgical settings. This systematic review and analysis specifically
evaluated the effects of TEG-guided therapy. TEG-guided therapy can
improve blood product utilization and enhance resource management. Use of
TEG improved key patient outcomes, including bleed rate, length of stay
and mortality. <br/>Background(s): Thromboelastography (TEG 5000 and 6s
Thrombelastograph Hemostasis Analyzer; Haemonetics) 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. <br/>Objective(s): To conduct an analysis of
published clinical trials to evaluate the effects of TEG-guided
transfusion for the management of perioperative bleeding on patient
outcomes. Patients/Methods: We searched MEDLINE (PubMed) and EMBASE for
original articles reporting studies using TEG vs controls 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. <br/>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 vs controls. Although blood
product use was reduced, rates of mortality remained comparable between
the TEG group and control group. In the emergency setting evaluation, the
RCT reported lower mortality in the TEG group than in the control group (P
= 0.049). In addition, there were significant reductions 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 as compared with the
control group (P = 0.10). <br/>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.<br/>Copyright &#xa9; 2019 The Authors.
Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc.
on behalf of International Society on Thrombosis and Haemostasis

<44>
Accession Number
2000850445
Title
Genetic variation in the glucocorticoid receptor and psychopathology after
dexamethasone administration in cardiac surgery patients.
Source
Journal of Psychiatric Research. 103 (pp 167-172), 2018. Date of
Publication: August 2018.
Author
Kok L.; Hillegers M.H.; Veldhuijzen D.S.; Boks M.P.; Dieleman J.M.; van
Dijk D.; Joels M.; Vinkers C.H.
Institution
(Kok, Veldhuijzen, Dieleman, van Dijk) Department of Anesthesiology and
Intensive Care, Brain Center Rudolf Magnus, University Medical Center
Utrecht, Utrecht, Netherlands
(Hillegers, Boks, Vinkers) Department of Psychiatry, Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht, Netherlands
(Veldhuijzen) Leiden Institute for Brain and Cognition, Institute of
Psychology, Health, Medical and Neuropsychology Unit, Leiden University,
Leiden, Netherlands
(Kok, Joels) Department of Translational Neuroscience, Brain Center Rudolf
Magnus, University Medical Center Utrecht, Utrecht, Netherlands
(Joels) University of Groningen, Groningen, Netherlands
Publisher
Elsevier Ltd
Abstract
The glucocorticoid receptor (GR) agonist dexamethasone is frequently used
for its anti-inflammatory properties. We recently showed that a single
high-dose of dexamethasone had long-lasting protective effects on the
development of psychopathology after cardiac surgery and postoperative
intensive care unit stay. In this study, we investigated whether common
genetic variation in the hypothalamic-pituitary-adrenal (HPA)-axis would
influence the susceptibility for PTSD and depression after dexamethasone
administration. Participants (n = 996) of the Dexamethasone for Cardiac
Surgery (DECS) randomized clinical trial were followed after receiving a
single high intraoperative dose of dexamethasone (1 mg/kg), a GR agonist,
or placebo. PTSD and depressive symptoms were assessed up to four years
after cardiac surgery. We focused primarily on five common single
nucleotide polymorphisms (SNPs) in the glucocorticoid receptor (GR).
Secondarily, we comprehensively assessed common genetic variation in the
FK506 binding protein (FKBP5) and the mineralocorticoid receptor (MR). The
protective effects of dexamethasone on postoperative PTSD symptoms were
dependent on the GR polymorphisms rs41423247 (p =.009), rs10052957 (p
=.003), and rs6189 (p =.002), but not on rs6195 (p =.025) or rs6198, (p
=.026) after Bonferroni correction. No genotype-dependent effects were
found for postoperative depressive symptoms. Also, no associations of
FKBP5 and MR polymorphisms were found on PTSD and depression outcomes.
Protective effects of dexamethasone on PTSD symptoms after cardiac surgery
and ICU stay seem to depend on common genetic variation in its target
receptor, the GR. These effects indicate that pre-operative genetic
screening could potentially help in stratifying patients for their
vulnerability for developing PTSD symptoms after surgery.<br/>Copyright
&#xa9; 2018

<45>
Accession Number
2001730161
Title
Early interventions to prevent posttraumatic stress disorder symptoms in
survivors of life-threatening medical events: A systematic review.
Source
Journal of Anxiety Disorders. 64 (pp 24-39), 2019. Date of Publication:
May 2019.
Author
Birk J.L.; Sumner J.A.; Haerizadeh M.; Heyman-Kantor R.; Falzon L.;
Gonzalez C.; Gershengoren L.; Shapiro P.; Edmondson D.; Kronish I.M.
Institution
(Birk, Sumner, Haerizadeh, Heyman-Kantor, Falzon, Gonzalez, Edmondson,
Kronish) Center for Behavioral Cardiovascular Health, Department of
Medicine, Columbia University Medical Center, 622 West 168^th
Street, New York, NY 10032, United States
(Gershengoren) Department of Psychiatry, Weill Cornell Medical Center, 525
East 68^th Street, New York, NY 10065, United States
(Shapiro) Department of Psychiatry, Columbia University Medical Center,
622 West 168^th Street, New York, NY 10032, United States
Publisher
Elsevier Ltd
Abstract
Post-traumatic stress disorder (PTSD) induced by life-threatening medical
events has been associated with adverse physical and mental health
outcomes, but it is unclear whether early interventions to prevent the
onset of PTSD after these events are efficacious. We conducted a
systematic review to address this need. We searched six biomedical
electronic databases from database inception to October 2018. Eligible
studies used randomized designs, evaluated interventions initiated within
3 months of potentially traumatic medical events, included adult
participants, and did not have high risk of bias. The 21 included studies
(N = 4,486) assessed a heterogeneous set of interventions after critical
illness (9), cancer diagnosis (8), heart disease (2), and cardiopulmonary
surgery (2). Fourteen psychological, 2 pharmacological, and 5 other-type
interventions were assessed. Four of the psychological interventions
emphasizing cognitive behavioral therapy or meaning-making, 1 other-type
palliative care intervention, and 1 pharmacological-only intervention
(hydrocortisone administration) were efficacious at reducing PTSD symptoms
relative to control. One early, in-hospital counseling intervention was
less efficacious at lowering PTSD symptoms than an active control.
Clinical and methodological heterogeneity prevented quantitative pooling
of data. While several promising interventions were identified, strong
evidence of efficacy for any specific early PTSD intervention after
medical events is currently lacking.<br/>Copyright &#xa9; 2019 Elsevier
Ltd

<46>
Accession Number
2001902099
Title
Concomitant anti-platelet therapy in warfarin-treated patients undergoing
cardiac rhythm device implantation: A secondary analysis of the BRUISE
CONTROL trial.
Source
International Journal of Cardiology. 288 (pp 87-93), 2019. Date of
Publication: 1 August 2019.
Author
Essebag V.; AlTurki A.; Proietti R.; Healey J.S.; Wells G.A.; Verma A.;
Krahn A.D.; Simpson C.S.; Ayala-Paredes F.; Coutu B.; Leather R.; Ahmad
K.; Toal S.; Sapp J.; Sturmer M.; Kavanagh K.; Crystal E.; Leiria T.L.L.;
Seifer C.; Rinne C.; Birnie D.
Institution
(Essebag, AlTurki) McGill University Health Centre, Montreal, Quebec,
Canada
(Essebag, Sturmer) Hopital Sacre-Coeur de Montreal, Montreal, Quebec,
Canada
(Proietti) Department of Cardiac, Thoracic and Vascular Sciences,
University of Padua, Padua, Italy
(Healey) Population Health Research Institute, Hamilton, Ontario, Canada
(Wells, Birnie) University of Ottawa Heart Institute, Ottawa, Ontario,
Canada
(Verma) Southlake Regional Health Centre, Newmarket, Ontario, Canada
(Krahn) Division of Cardiology, University of British Columbia, Vancouver,
Canada
(Simpson) Queen's University and Kingston General Hospital, Kingston,
Ontario, Canada
(Ayala-Paredes) Universite de Sherbrooke, Sherbrooke, Quebec, Canada
(Coutu) Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec,
Canada
(Leather) Royal Jubilee Hospital, Victoria, British Columbia, Canada
(Ahmad) St Michael's Hospital, Toronto, Ontario, Canada
(Toal) New Brunswick Heart Center, St John, New Brunswick, Canada
(Sapp) Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia,
Canada
(Kavanagh) Libin Cardiovascular Institute of Alberta, Calgary, Alberta,
Canada
(Crystal) Sunnybrook Health Science Centre, Toronto, Ontario, Canada
(Leiria) Instituto de Cardiologia Fundacao Universitaria Cardiologia,
Porto Alegre, Brazil
(Seifer) University of Manitoba, Winnipeg, Manitoba, Canada
(Rinne) St Mary's General Hospital, Kitchener, Ontario, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: Anti-platelet therapy is commonly used in patients receiving
oral anticoagulation and may increase bleeding risk among patients
undergoing cardiac implantable electronic device (CIED) surgery. We sought
to determine the proportion of anticoagulated patients who are
concomitantly receiving anti-platelet therapy, the associated risk of
clinically significant hematoma (CSH), and the proportion of patients in
whom anti-platelet usage is guideline-indicated. <br/>Method(s): A
secondary analysis of the Bridge or Continue Coumadin for Device Surgery
Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving
warfarin, had an annual predicted risk of thromboembolism of >=5% and were
scheduled to undergo non-emergent CIED surgery were randomized to
continued warfarin versus heparin bridging. In the current analysis,
patients were divided into those receiving anti-platelet therapy and those
not receiving anti-platelet therapy. The incidence of CSH was compared in
both groups. The proportion of patients on potentially inappropriate and
potentially interruptible antiplatelet therapy was estimated.
<br/>Result(s): All 681 patients enrolled in BRUISE CONTROL were included,
of whom 280 received and 401 did not receive anti-platelet therapy.
Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95%
confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients
receiving anti-platelet therapy, 97 (34.6%) had no guideline indication
for concomitant anti-platelet therapy and an additional 146 (52.1%) were
on anti-platelet therapy that could potentially have been interrupted
around CIED surgery. <br/>Conclusion(s): Concomitant anti-platelet therapy
in patients receiving anticoagulation is associated with a significant
risk of CSH. The majority of concomitant anti-platelet therapy is
potentially inappropriate or interruptible. Trial registration:
clinicaltrials.gov Identifier: (NCT00800137)<br/>Copyright &#xa9; 2019
Elsevier B.V.

<47>
Accession Number
2001944772
Title
Intraoperative fetal heart monitoring for non-obstetric surgery: A
systematic review.
Source
European Journal of Obstetrics and Gynecology and Reproductive Biology.
238 (pp 12-19), 2019. Date of Publication: July 2019.
Author
Po G.; Olivieri C.; Rose C.H.; Saccone G.; McCurdy R.; Berghella V.
Institution
(Po) Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of
Medical and Surgical Sciences, University of Modena and Reggio Emilia,
Modena, Italy
(Olivieri) Sapienza University of Rome, Rome, Italy
(Rose) Division of Maternal-Fetal Medicine, Department of Obstetrics and
Gynecology, Mayo Clinic, Rochester, MN, United States
(Saccone) Department of Neuroscience, Reproductive Science and Dentistry,
School of Medicine, University of Naples Federico II, Naples, Italy
(McCurdy, Berghella) Division of Maternal Fetal Medicine, Department of
Obstetrics and Gynecology, Thomas Jefferson University Hospital,
Philadelphia, PA, United States
Publisher
Elsevier Ireland Ltd
Abstract
Limited data are available on fetal monitoring during non-obstetric
surgery in pregnancy. We performed a systematic review to evaluate the
incidence of emergent cesarean delivery performed for non-reassuring fetal
heart rate patterns during non-obstetric surgery. Electronic databases
were searched from their inception until October 2018 without limit for
language. We included studies evaluating at least five cases of
intraoperative fetal heart rate monitoring -either with ultrasound or
cardiotocography- during non-obstetric surgery in pregnant women at >=22
weeks of gestation. The primary outcome was the incidence of
intraoperative cesarean delivery performed for non-reassuring fetal heart
rate monitoring. Non-reassuring fetal heart rate monitoring was defined by
attendant personnel, meeting NICHD criteria for category II or III
patterns. Data extracted regarded type of study, demographic
characteristics, maternal and perinatal outcomes. Statistical analysis was
performed for continuous outcomes by calculating mean and standard
deviations for appropriate variables. Of 120 studies identified, 4 with 41
cases of intraoperative monitoring met criteria for inclusion and were
analyzed. Most (66%)surgeries were indicated for neurological or abdominal
maternal issues and were performed under general anesthesia (88%)at a mean
gestational age of 28 weeks. Minimal or absent fetal heart variability was
noted in most cases and a 10-25 beats per minutes decrease in fetal heart
rate baseline was observed in cases with general anesthesia. No
intraoperative cesarean deliveries were needed. The incidence of
non-reassuring fetal heart rate monitoring was 4.9% (2/41)and were limited
to fetal tachycardia during maternal fever. Two (4.9%)cases of
non-reassuring fetal heart rate monitoring were noted within the immediate
48 h after surgery, necessitating cesarean delivery. A single case of
intrauterine fetal demise occurred four days postoperatively in a woman
who had neurosurgery and remained comatose. In conclusion, limited data
exist regarding the clinical application of fetal heart rate monitoring at
viable gestational ages during non-obstetric surgical procedures. Fetal
heart rate monitoring during non-obstetric surgery at >=22 weeks was not
associated with need for intraoperative cesarean delivery, but two
(4.9%)cesarean deliveries were performed for non-reassuring fetal heart
rate monitoring within 48 h after surgery.<br/>Copyright &#xa9; 2019
Elsevier B.V.

<48>
Accession Number
2001457854
Title
Intraoperative Use of Nondepolarizing Neuromuscular Blocking Agents During
Cardiac Surgery and Postoperative Pulmonary Complications: A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1673-1681),
2019. Date of Publication: June 2019.
Author
Gerlach R.M.; Shahul S.; Wroblewski K.E.; Cotter E.K.H.; Perkins B.W.;
Harrison J.-H.; Ota T.; Jeevanandam V.; Chaney M.A.
Institution
(Gerlach, Shahul, Perkins, Harrison, Chaney) Department of Anesthesia and
Critical Care, University of Chicago Medicine, Chicago, IL, United States
(Wroblewski) Department of Public Health Sciences, University of Chicago,
Chicago, IL, United States
(Cotter) Department of Anesthesiology, University of Kansas Medical
Center, Kansas City, KS, United States
(Ota, Jeevanandam) Department of Cardiothoracic Surgery, University of
Chicago Medicine, Chicago, IL, United States
Publisher
W.B. Saunders
Abstract
Objective: Nondepolarizing neuromuscular blocking agents (NMBAs) are
associated with perioperative complications in noncardiac surgery;
however, little is known about their effect on cardiac surgery. This study
assessed the effect of neuromuscular blockade (NMB) on the incidence of
postoperative pulmonary complications (PPCs) after cardiac surgery and
operating conditions. <br/>Design(s): Prospective, randomized clinical
trial with blinded outcomes assessment. <br/>Setting(s): University
hospital, single institution. <br/>Participant(s): Adult patients having
cardiac surgery requiring cardiopulmonary bypass. <br/>Intervention(s):
One hundred patients were randomized to receive succinylcholine (group
SUX) for intubation with no further NMB administered or cisatracurium
(group CIS) for intubation and maintenance NMB. The primary outcome was a
composite incidence of PPCs in the 72 hours after elective cardiac
surgery. PPCs included failure to extubate within 24 hours, need for
reintubation, pneumonia, aspiration, unanticipated need for noninvasive
respiratory support, acute respiratory distress, and mortality from
respiratory arrest. The secondary outcome was the adequacy of operating
conditions as assessed by blinded surgeon survey (including a rating of
surgical conditions on a Likert scale from 1 = poor to 5 = excellent),
anesthesiologist report, and patient questionnaire. <br/>Measurements and
Main Results: The composite incidence of PPCs did not differ between
groups (8 of 50 patients in both groups; 16%). Mean surgeon rating of
surgical conditions was lower in the SUX group (4.65 +/- 0.85 v 4.96 +/-
0.20, p = 0.02). <br/>Conclusion(s): Although avoiding nondepolarizing
NMBA is feasible, doing so worsened operating conditions and did not
reduce the incidence of postoperative pulmonary
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<49>
[Use Link to view the full text]
Accession Number
627376542
Title
Hybrid coronary revascularization versus conventional coronary artery
bypass grafting systematic review and meta-analysis.
Source
Medicine (United States). 97 (33) (no pagination), 2018. Article Number:
e11941. Date of Publication: 01 Aug 2018.
Author
Reynolds A.C.; King N.
Institution
(Reynolds, King) School of Biomedical and Healthcare Sciences, University
of Plymouth, Plymouth PL4 8AA, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Hybrid coronary revascularization (HCR) combining minimally
invasive grafting of the left internal mammary artery to the left anterior
descending artery with percutaneous coronary intervention has become a
viable option for treating coronary artery disease. The aim of this
meta-analysis was to compare HCR with conventional coronary artery bypass
grafting (CABG) in a range of clinical outcomes and hospital costs.
<br/>Method(s): To identify potential studies, systematic searches were
carried out in various databases. The key search terms included "hybrid
revascularization" AND "coronary artery bypass grafting" OR "HCR" OR
"CABG." This was followed by a meta-analysis investigating the need for
blood transfusion, hospital costs, ventilation time, hospital stay,
cerebrovascular accident, myocardial infarction, mortality, postoperative
atrial fibrillation, renal failure, operation duration, and ICU stay.
<br/>Result(s): The requirement for blood transfusion was significantly
lower for HCR: odds ratio 0.38 (95% confidence intervals [CIs] 0.31-0.46,
P<.00001) as was the hospital stay: mean difference (MD) 1.48 days (95%
CI, 2.61 to 0.36, P=0.01) and the ventilation time: MD 8.99 hours (95% CI,
15.85 to 2.13, P=.01). On the contrary, hospital costs were more expensive
for HCR: MD $3970 (95% CI, 2570-5370, P<.00001). All other comparisons
were insignificant. <br/>Conclusion(s): In the short-term, HCR is as safe
as conventional CABG and may offer certain benefits such as a lower
requirement for blood transfusion and shorter hospital stays. However, HCR
is more expensive than conventional CABG.<br/>Copyright &#xa9; 2018 the
Author(s). Published by Wolters Kluwer Health, Inc.

<50>
Accession Number
619197728
Title
Clinical outcomes of coronary occlusion following transcatheter aortic
valve replacement: A systematic review.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 229-236), 2018. Date
of Publication: March 2018.
Author
Akinseye O.A.; Jha S.K.; Ibebuogu U.N.
Institution
(Akinseye, Jha, Ibebuogu) Division of Cardiovascular Diseases, Department
of Medicine, University of Tennessee Health Science Center, Memphis, TN,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Coronary occlusion (CO) is a rare but serious complication
following transcatheter aortic valve replacement (TAVR) with limited
published data. We sought to evaluate the immediate and short-term
outcomes of CO complicating TAVR. <br/>Method(s): Studies, including case
reports, case series and original articles published from 2002 to 2016
describing CO following TAVR were identified with a systematic electronic
search using the PRISMA Statement. Only studies reporting data on
demographic and procedural characteristics, management and follow up
outcomes were analyzed. <br/>Result(s): A total of 40 publications
describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean
age was 83 +/- 7 years and most (81%) were females. The mean logistic
EuroSCORE and STS score was 23.5 +/- 14.6% and 9.1 +/- 3.2% respectively.
TAVR access site was transfemoral in 73% and a balloon expandable valve
was used in 78%. Among those with LCA occlusion, the mean LCA ostium
height was 10.1 +/- 1.8 mm while the mean RCA ostium height was 10.4 +/-
2.0 mm among those with RCA occlusion. CO frequently involved the left
main coronary artery (80%) and the most common mechanism was displacement
of native valve leaflet (60%), and most cases occurred within 1-hour
post-implantation (88%). Percutaneous coronary intervention was attempted
in 82 patients and successful in 89%. Procedural death was 10.4%. CO
following TAVR in native aortic valve stenosis was associated with a
30-day mortality rate of 35.3%. <br/>Conclusion(s): CO following TAVR is
associated with a high procedural and 30-day mortality rate despite
aggressive resuscitative measures including percutaneous coronary
intervention.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<51>
Accession Number
617920749
Title
Comparison of outcomes in new-generation versus early-generation heart
valve in transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 186-191), 2018. Date
of Publication: March 2018.
Author
Ando T.; Takagi H.; Telila T.; Afonso L.
Institution
(Ando, Telila, Afonso) Detroit Medical Center/Wayne State University,
Division of Cardiology, Detroit, United States
(Takagi) Shizuoka Medical Center, Division of Cardiovascular Surgery,
Shizuoka, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: New-generation (NG) valves for transcatheter aortic valve
implantation (TAVI) has recently been widely used in real-world practice,
yet its comparative outcomes with early-generation (EG) valves remain
under-explored. <br/>Method(s): An electronic literature search using
PUBMED and EMBASE was conducted from inception to April 2017 for
matched-cohort studies. Articles that compared the outcomes of NG vs. EG
valves post TAVI with at least one of the following clinical outcome
reported were included: all-cause mortality, major or life-threatening
bleeding, major vascular complications (MVC), significant (more than
moderate) paravalvular regurgitation (PVR), cerebrovascular events,
significant (stage 2 or 3) acute kidney injury (AKI) and new permanent
pacemaker implantation (PPI) that occurred either in-hospital or within
30-days. <br/>Result(s): A total of 6 observational matched-cohort studies
with 585 and 647 patients included in NG and EG valves, respectively, were
included. EG valves were associated with a lower incidence of major or
life-threatening bleeding (5.7% vs. 15.7%, p < 0.00001), significant
paravalvular regurgitation (5.3% vs. 14.4%, p = 0.001), and significant
AKI (4.4% vs. 7.5, p = 0.03). All-cause mortality (3.5% vs. 5.0, p =
0.43), cerebrovascular events (3.4% vs. 2.3%, p = 0.34) and new PPI (11.0%
vs. 14.6%, p = 0.52) were similar between the two groups. NG demonstrated
lower tendency of MVC (2.5% vs. 7.2, p = 0.09) compared to EG valves.
<br/>Conclusion(s): NG demonstrated lower rates of significant AKI,
significant PVR and major or life-threatening bleeding while all-cause
mortality, new PPI, and cerebrovascular events remained similar compared
to EG valves.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<52>
Accession Number
2000632947
Title
Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts
Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary
Results of the International Multicenter iFR GRADIENT Registry.
Source
JACC: Cardiovascular Interventions. 11 (8) (pp 757-767), 2018. Date of
Publication: 23 April 2018.
Author
Kikuta Y.; Cook C.M.; Sharp A.S.P.; Salinas P.; Kawase Y.; Shiono Y.;
Giavarini A.; Nakayama M.; De Rosa S.; Sen S.; Nijjer S.S.; Al-Lamee R.;
Petraco R.; Malik I.S.; Mikhail G.W.; Kaprielian R.R.; Wijntjens G.W.M.;
Mori S.; Hagikura A.; Mates M.; Mizuno A.; Hellig F.; Lee K.; Janssens L.;
Horie K.; Mohdnazri S.; Herrera R.; Krackhardt F.; Yamawaki M.; Davies J.;
Takebayashi H.; Keeble T.; Haruta S.; Ribichini F.; Indolfi C.; Mayet J.;
Francis D.P.; Piek J.J.; Di Mario C.; Escaned J.; Matsuo H.; Davies J.E.
Institution
(Kikuta, Cook, Shiono, Sen, Nijjer, Al-Lamee, Petraco, Malik, Mikhail,
Kaprielian, Mayet, Francis, Davies) Imperial College London and
Hammersmith Hospital NHS Trust, London, United Kingdom
(Kikuta, Hagikura, Takebayashi, Haruta) Fukuyama Cardiovascular Hospital,
Fukuyama, Japan
(Sharp) Royal Devon and Exeter Hospital and University of Exeter, Exeter,
United Kingdom
(Salinas, Herrera, Escaned) Hospital Clinico San Carlos, Faculty of
Medicine, Complutense University, Madrid, Spain
(Kawase, Matsuo) Gifu Heart Center, Gifu, Japan
(Giavarini, Di Mario) Royal Brompton Hospital and Harefield Trust, London,
United Kingdom
(Nakayama) Toda Central General Hospital, Toda, Japan
(De Rosa, Indolfi) Universita degli Studi Magna Graecia di Catanzaro,
Catanzaro, Italy
(Wijntjens, Piek) Academic Medical Centre, Amsterdam, Netherlands
(Mori, Yamawaki) Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
(Mates) Na Homolce Hospital, Prague, Czechia
(Mizuno) St Luke's International Hospital, Tokyo, Japan
(Hellig) Sunninghill Hospital, Johannesburg, University of Cape Town,
South Africa
(Lee) United Lincolnshire Hospital, Lincoln, United Kingdom
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Horie) Sendai Kousei Hospital, Sendai, Japan
(Mohdnazri, Davies, Keeble) Essex Cardiothoracic Centre, Basildon and
Anglia Ruskin University, Chelmsford, Essex, United Kingdom
(Krackhardt) Charite-Universitatsmedizin Campus Virchow, Berlin, Germany
(Ribichini) University of Verona, Verona, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to evaluate the accuracy of instantaneous
wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous
coronary intervention (PCI) physiological outcomes, and to quantify how
often iFR pullback alters PCI strategy in real-world clinical settings.
<br/>Background(s): In tandem and diffuse disease, offline analysis of
continuous iFR pullback measurement has previously been demonstrated to
accurately predict the physiological outcome of revascularization.
However, the accuracy of the online analysis approach (iFR pullback)
remains untested. <br/>Method(s): Angiographically intermediate tandem
and/or diffuse lesions were entered into the international, multicenter
iFR GRADIENT (Single instantaneous wave-Free Ratio Pullback
Pre-Angioplasty Predicts Hemodynamic Outcome Without Wedge Pressure in
Human Coronary Artery Disease) registry. Operators were asked to submit
their procedural strategy after angiography alone and then after
iFR-pullback measurement incorporating virtual PCI and post-PCI iFR
prediction. PCI was performed according to standard clinical practice.
Following PCI, repeat iFR assessment was performed and the actual versus
predicted post-PCI iFR values compared. <br/>Result(s): Mean age was 67
+/- 12 years (81% male). Paired pre- and post-PCI iFR were measured in 128
patients (134 vessels). The predicted post-PCI iFR calculated online was
0.93 +/- 0.05; observed actual iFR was 0.92 +/- 0.06. iFR pullback
predicted the post-PCI iFR outcome with 1.4 +/- 0.5% error. In comparison
to angiography-based decision making, after iFR pullback, decision making
was changed in 52 (31%) of vessels; with a reduction in lesion number
(-0.18 +/- 0.05 lesion/vessel; p = 0.0001) and length (-4.4 +/- 1.0
mm/vessel; p < 0.0001). <br/>Conclusion(s): In tandem and diffuse coronary
disease, iFR pullback predicted the physiological outcome of PCI with a
high degree of accuracy. Compared with angiography alone, availability of
iFR pullback altered revascularization procedural planning in nearly
one-third of patients.<br/>Copyright &#xa9; 2018 The Authors

<53>
Accession Number
620707401
Title
Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting
Stent Implantation in Elderly Patients: A Meta-Analysis of Individual
Participant Data From 6 Randomized Trials.
Source
JACC: Cardiovascular Interventions. 11 (5) (pp 435-443), 2018. Date of
Publication: 12 Mar 2018.
Author
Lee S.-Y.; Hong M.-K.; Palmerini T.; Kim H.-S.; Valgimigli M.; Feres F.;
Colombo A.; Gilard M.; Shin D.-H.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi
D.; Jang Y.; Stone G.W.
Institution
(Lee) Sanbon Hospital, Wonkwang University College of Medicine, Gunpo,
South Korea
(Hong, Shin, Kim, Kim, Ko, Choi, Jang) Severance Cardiovascular Hospital,
Yonsei University Health System, Seoul, South Korea
(Hong, Shin, Kim, Kim, Ko, Choi, Jang) Cardiovascular Research Institute,
Yonsei University College of Medicine, Seoul, South Korea
(Hong, Jang) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Kim) Department of Internal Medicine, Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Valgimigli) Department of Cardiology, Bern University Hospital,
University of Bern, Switzerland
(Feres) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Gilard) Department of Cardiology, CHU de la Cavale Blanche, Brest, France
(Stone) Columbia University Medical Center/New York-Presbyterian Hospital
and the Cardiovascular Research Foundation, New York, New York, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to evaluate the optimal duration of dual
antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent
(DES) in elderly patients. <br/>Background(s): Qualified studies to
evaluate the optimal duration of DAPT in elderly patients have been very
limited. <br/>Method(s): Using 6 randomized trials that compared
short-term (<=6 months) and long-term (12 months) DAPT, individual
participant data meta-analysis was performed in elderly patients (>=65
years of age). The primary study outcome was the 12-month risk of a
composite of myocardial infarction, definite or probable stent thrombosis,
or stroke. The major secondary outcome was the 12-month risk of major
bleeding. <br/>Result(s): The primary outcome risk did not significantly
differ between patients receiving short-term and long-term DAPT (hazard
ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581)
in the overall group of study participants. In subgroup analysis, a
significant interaction between age and DAPT duration was observed for
primary outcome risk (p for interaction = 0.0384). In the subset of
younger patients (<65 years of age, n = 6,152), short-term DAPT was
associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to
2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of
primary outcome did not significantly differ between patients receiving
short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p =
0.2856). Short-term DAPT was associated with a significant reduction in
major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to
0.84; p = 0.0081) in the overall group, and particularly in elderly
patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196). <br/>Conclusion(s):
Short-term DAPT after new-generation DES implantation may be more
beneficial in elderly patients than in younger patients.<br/>Copyright
&#xa9; 2018 American College of Cardiology Foundation

<54>
Accession Number
618878302
Title
Electrocardiographic changes after successful recanalization of a chronic
total coronary occlusion. A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (2) (pp 221-228), 2018. Date
of Publication: March 2018.
Author
van Dongen I.M.; Elias J.; Meijborg V.M.F.; De Bakker J.M.T.; Limpens J.;
Conrath C.E.; Henriques J.P.S.
Institution
(van Dongen, Elias, Meijborg, De Bakker, Conrath, Henriques) Department of
Cardiology, Academic Medical Center Amsterdam, Netherlands
(Limpens) Medical Library, Academic Medical Center Amsterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Observational studies suggest that in patients with a CTO
successful recanalization is associated with better clinical outcome. This
could be related to a reduction in the occurrence of arrhythmias, which
may result from modifications of the hibernating myocardium in a CTO
region. <br/>Methods and Results: We aimed to evaluate the effect of CTO
PCI on electrophysiological parameters, and conducted a systematic review
and meta-analysis according to the PRISMA guidelines. MEDLINE and EMBASE
were searched. Titles and abstracts identified by the search strategy were
independently screened by two investigators. Data were extracted and used
for meta-analyses where possible. In total, eight studies incorporating
467 patients were included in this review, evaluating the effect of
successful CTO PCI on various ECG parameters. Three studies showed a
significant decrease in mean QT dispersion of 17.46 ms [95% CI
10.62-24.30] after successful CTO PCI. QTc dispersion also decreased
significantly, with a mean decrease of 18.74 ms [95% CI 11.53-25.94]. In
one trial a significant decrease in Tp-e interval in leads V2 and V5, and
a significant decrease in Tp-e/QT ratio in leads V2 and V5 post-CTO PCI
were observed. <br/>Conclusion(s): This first systematic review and
meta-analysis suggests that successful CTO PCI is associated with an
immediate decrease in ECG parameters that reflect heterogeneity in
depolarization and repolarization, which could lead to a reduction in the
risk for ventricular arrhythmias and sudden cardiac death. We raise the
hypothesis that hibernating myocardium in a CTO region may not be as
deeply "in sleep" as one would assume.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<55>
Accession Number
619086026
Title
Optimal duration of dual antiplatelet therapy after drug eluting stent
implantation: A network meta-analysis.
Source
Anatolian Journal of Cardiology. 18 (4) (pp 251-260), 2017. Date of
Publication: October 2017.
Author
Gajulapalli R.D.; Dias S.; Pattanshetty D.J.; Athappan G.
Institution
(Gajulapalli) Department of Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Dias) School of Social and Community Medicine, University of Bristol,
Bristol, United Kingdom
(Pattanshetty) Case Western University, Metro Health, Cleveland, OH,
United States
(Athappan) Department of Interventional Cardiology, Temple University
Hospital, Philadelphia-PA, United States
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: There has been much debate regarding the optimal duration of
dual antiplatelet therapy (DAPT) cover after drug eluting stent (DES)
implantation. We aimed to assess the relative benefits of shorter and
longer durations of DAPT coverage. <br/>Method(s): We performed a network
meta-analysis (NMA) of all the randomized clinical trials (RCT) comparing
different time durations of DAPT cover. <br/>Result(s): We included 11
unique trials with a total of 33,458 patients; the longest duration of
follow-up was 48 months and the shortest was 3 months. NMA results
demonstrated that compared with 12 months, longer DAPT of 30 months
reduced the hazard ratio (HR) of stent thrombosis (HR, 0.29; 95% CrI,
0.17-0.49). There was no difference in mortality between shorter and
longer durations of DAPT except for 30 vs. 48 months (HR, 0.48; 95% CrI,
0.23-0.98). Compared with 12 months, longer DAPT of 30 months reduced the
risk of myocardial infarction (HR, 0.47; 95% CrI, 0.37-0.61). Results also
demonstrated that compared with 12 months, a shorter-term DAPT reduced the
risk of major bleeding (6 months: HR, 0.53; 95% CrI, 0.29-0.98), whereas
longer-term DAPT increased the risk of major bleeding (30 months: HR,
1.61; 95% CrI, 1.21-2.15). <br/>Conclusion(s): As expected, bleeding was
less in the shorter duration regimens, whereas the ischemic outcomes were
better in the longer duration ones.<br/>Copyright &#xa9; 2017 by Turkish
Society of Cardiology.

<56>
Accession Number
2001910728
Title
The Influence of Suction on Chest Drain Duration After Lobectomy Using
Electronic Chest Drainage.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Lijkendijk M.; Licht P.B.; Neckelmann K.
Institution
(Lijkendijk, Licht, Neckelmann) Department of Cardiothoracic Surgery,
Odense University Hospital, Odense, Denmark
Publisher
Elsevier USA
Abstract
Background: Management of chest drains after thoracic surgery remains an
area with little consensus. To optimize chest drainage algorithms with
electronic chest drainage systems, a randomized controlled trial comparing
low variable suction (-5 cm H<inf>2</inf>O) versus high variable suction
(-20 cm H<inf>2</inf>O) was conducted. <br/>Method(s): This was a
prospective open label randomized trial in patients undergoing lobectomy.
Sample size was calculated from a clinical relevant difference in chest
drain duration as 1 full day. End points were chest drain duration and
length of hospitalization. Data were analyzed by Kaplan-Meier survival
analysis and multivariate Cox proportional hazards regression.
<br/>Result(s): The study randomized 106 patients. There was no
statistical significant difference in chest drain duration and length of
stay between the low-suction and the high-suction groups: Median chest
drain duration and hospitalization were 25 hours (interquartile range
[IQR] 21 to 55 hours) versus 28 hours (IQR 23 to 77 hours; p = 0.97) and 5
days (IQR 3 to 6 days) versus 5 days (IQR 3 to 7 days; p = 0.75),
respectively. Multivariate analysis demonstrated that the diffusing
capacity of the lung for carbon monoxide was the only significant
predictor of chest drain duration (p = 0.015) and length of
hospitalization (p = 0.003). Complications requiring reinsertion of the
chest drain were significantly more frequent in the low-suction group (p =
0.03). <br/>Conclusion(s): There was no clinically relevant difference in
chest drain duration or length of hospitalization, but reinsertions of
chest drains were significantly more frequent in the low-suction group, a
finding suggesting that low suction levels should not be used after
lobectomy. Trial registry number is ISRCTN10408356.<br/>Copyright &#xa9;
2019

<57>
Accession Number
625598980
Title
Effectiveness of reflexology on anxiety of patients undergoing
cardiovascular interventional procedures: A systematic review and
meta-analysis of randomized controlled trials.
Source
Journal of advanced nursing. 75 (1) (pp 43-53), 2019. Date of Publication:
01 Jan 2019.
Author
Chandrababu R.; Rathinasamy E.L.; Suresh C.; Ramesh J.
Institution
(Chandrababu) Manipal College of Nursing, Manipal Academy of Higher
Education, Manipal, Karnataka, India
(Rathinasamy) Department of Adult Health and Critical Care, College of
Nursing, Sultan Qaboos University, Muscat, Oman
(Suresh) Department of Physical and Health Sciences, SRM Institute of
Science and Technology, Chennai, TN, India
(Ramesh) Udupi College of Nursing, Sri Krishna Educational Trust, Manipal,
Karnataka, India
Publisher
NLM (Medline)
Abstract
AIM: To appraise the evidence concerning the effect of reflexology on the
anxiety in patients undergoing cardiovascular interventional procedures.
BACKGROUND: Anxiety, fear, and other unpleasant emotional experiences are
common among patients before and after cardiovascular interventional
procedures. The higher anxiety may affect prognosis and recovery of
patients. DESIGN: A systematic review and meta-analysis. DATA SOURCES: The
MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health
Literature), Cochrane Central Register of Controlled Trials (Cochrane
Library), EMBASE, PsycINFO, and Web of Science were searched between
2001-2017. REVIEW METHODS: Randomized controlled trials evaluated the
effectiveness of reflexology on anxiety among patients undergoing
cardiovascular interventional procedures were included. Meta-analysis was
done using Revman 5.3. <br/>RESULT(S): Ten trials, representing 760
patients with the mean age of 59, fulfilled the inclusion criteria.
Reflexology significantly decreased the anxiety of patients undergoing
cardiovascular interventional procedures in the treatment group compared
with the control group. <br/>CONCLUSION(S): Reflexology has some positive
effects on anxiety among patients undergoing cardiovascular procedures. It
may be a useful complementary therapy and further research is necessary to
create reliable evidence.<br/>Copyright &#xa9; 2018 John Wiley & Sons Ltd.

<58>
Accession Number
626115861
Title
Effect of Listening to Music on Patient Anxiety and Pain Perception during
Urodynamic Study: Randomized Controlled Trial.
Source
LUTS: Lower Urinary Tract Symptoms. 11 (1) (pp 39-42), 2019. Date of
Publication: January 2019.
Author
Ozturk E.; Hamidi N.; Yikilmaz T.N.; Ozcan C.; Basar H.
Institution
(Ozturk, Yikilmaz, Basar) Department of Urology, Dr Abdurrahman Yurtaslan
Training and Research Hospital, Ankara, Turkey
(Hamidi) Deparment of Urology, Ataturk Training and Research Hospital,
Ankara, Turkey
(Ozcan) Deparment of Urology, Gulhane Training and Research Hospital,
Ankara, Turkey
Publisher
Blackwell Publishing
Abstract
Objective: Urodynamic studies (UDS) include assessments of the physics and
physiology of the lower urinary tract (LUT). It is an invasive test and
patients can feel fear and anxiety, especially at the beginning of the
test. The aim of this study was to determine whether listening to music
during urodynamic study decreases patient anxiety and pain.
<br/>Method(s): Sixty-two patients who underwent urodynamic study were
randomized into the following groups: no music (group 1, n = 30) or
classical music (group 2, n = 32) during the procedure. Patient anxiety
levels were quantified using the State-Trait Anxiety Inventory (STAI) and
Beck's Anxiety Inventory (BAI). A visual analog scale (VAS) was used for
self-assessment of discomfort and willingness among patients to have a
repeat urodynamic study. <br/>Result(s): Demographic characteristics, mean
age, duration of procedure, systolic and diastolic blood pressure (SBP and
DBP) and heart rate before procedure were statistically significantly
similar between the two groups. Statistically significant differences were
detected between the two groups in the mean pain score on VAS (4.1 +/- 1.4
vs 2.6 +/- 1.8), mean post-procedural STAI score (46 +/- 5.8 vs 37.3 +/-
5) and mean BAI score (14.2 +/- 1.7 vs 3.5 +/- 0.7). SBP and DBP and heart
rate were similar between the groups. <br/>Conclusion(s): Music is a
cheap, safe and effective intervention that has gained increasing
recognition as an effective tool to reduce pain and anxiety. Listening to
music during urodynamic study reduced patient pain and
anxiety.<br/>Copyright &#xa9; 2017 John Wiley & Sons Australia, Ltd

<59>
Accession Number
2001912740
Title
Selected 2018 Highlights in Congenital Cardiac Anesthesia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Nasr V.G.; Gottlieb E.A.; Adler A.C.; Evans M.A.; Sawardekar A.; DiNardo
J.A.; Mossad E.B.; Mittnacht A.J.C.
Institution
(Nasr, DiNardo) Department of Anesthesiology, Critical Care and Pain
Medicine, Boston Children's Hospital, Boston, MA, United States
(Gottlieb) Department of Anesthesiology, Dell Medical School, University
of Texas in Austin, Austin, TX, United States
(Adler, Mossad) Division of Pediatric Cardiovascular Anesthesia, Baylor
College of Medicine, Texas Children's Hospital, Houston, TX, United States
(Evans, Sawardekar) Department of Anesthesiology, Northwestern
University's Feinberg School of Medicine, Chicago, IL, United States
(Mittnacht) Department of Anesthesiology, Perioperative and Pain Medicine,
The Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
W.B. Saunders
Abstract
THIS ARTICLE IS a review of the highlights of pertinent literature
published during the 12 months of 2018 that is of interest to the
congenital cardiac anesthesiologist. During a search of the US National
Library of Medicine PubMed database, several topics that displayed
significant contributions to the field in 2018 emerged. The authors of the
present review consider the following topics noteworthy: the patient with
high-risk congenital heart disease (CHD) presenting for noncardiac
surgery, cardiopulmonary resuscitation in infants and children with CHD,
dexmedetomidine use in pediatric patients, point-of-care lung ultrasound,
and regional anesthesia in pediatric cardiac surgery.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<60>
Accession Number
2001513139
Title
Are racial differences in hospital mortality after coronary artery bypass
graft surgery real? A risk-adjusted meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp 2216-2225.e4),
2019. Date of Publication: June 2019.
Author
Benedetto U.; Kamel M.K.; Khan F.M.; Angelini G.D.; Caputo M.; Girardi
L.N.; Gaudino M.
Institution
(Benedetto, Angelini, Caputo) Bristol Heart Institute, University of
Bristol, School of Clinical Sciences, Bristol, United Kingdom
(Kamel, Khan, Girardi, Gaudino) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Despite several reports, there are still conflicting data on
the influence of ethnicity on mortality rates associated with coronary
artery bypass grafting (CABG). We aimed to get further insights into the
effect of race on mortality following CABG by performing a risk adjusted
meta-analysis. <br/>Method(s): Relevant studies were searched on PubMed,
Embase, BioMed Central, and the Cochrane Central register. Pairwise
meta-analysis was used to estimate the relative risk of hospital death of
black, Hispanic, and Asian patients using white patients as reference.
Risk adjusted meta-analytic estimates were obtained using generic inverse
variance methods with random effect model. <br/>Result(s): A total of 28
studies were selected for analysis. A total of 21 studies reported on
hospital mortality in black (n = 222,892) versus white (n = 3,884,043)
patients, 7 studies reported on Hispanic (n = 91,256) versus white (n =
1,458,524) and 9 studies reported on Asian (n = 27,820) versus white (n =
1,081,642). When compared with white patients, adjusted risk of hospital
death was significantly greater for black patients (adjusted odds ratio
[OR], 1.25; 95% confidence interval [CI], 1.13-1.39; P < .001), and not
statistically different for Asian (OR, 1.33; 95% CI, 0.99-1.77; P = .05)
and Hispanic patients (adjusted OR, 1.08; 95% CI, 0.94-1.23; P = .26).
Meta-regression showed a significant trend toward lower mortality rates in
most recent series in both black (P = .02) and white (P = .0007) and Asian
(P = .01) but not for Hispanic (P = .41). However, as mortality rates were
lower across the different races, the relative disadvantage between the
study groups persisted, which may explain the lack of interaction between
study period and race effect on mortality for black (adjusted P = .09),
Asian (adjusted P = .63), and Hispanic (adjusted P = .97) patients.
<br/>Conclusion(s): The present meta-analysis showed that despite progress
is being made in lowering in-hospital mortality rates among the major
racial/ethnic groups, ethnical disparities in hospital mortality after
CABG remain.<br/>Copyright &#xa9; 2018 The American Association for
Thoracic Surgery

<61>
[Use Link to view the full text]
Accession Number
626634743
Title
Transcathether aortic valve implantation with the new repositionable
self-expandable Medtronic Evolut R vs. CoreValve system: evidence on the
benefit of a meta-analytical approach.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 20 (4) (pp 226-236),
2019. Date of Publication: 01 Apr 2019.
Author
Kowalewski M.; Gozdek M.; Raffa G.M.; Slomka A.; Zielinski K.; Kubica J.;
Anisimowicz L.; Kowalewski J.; Landes U.; Kornowski R.; Lorusso R.;
Suwalski P.
Institution
(Kowalewski, Suwalski) Clinical Department of Cardiac Surgery, Central
Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
(Kowalewski, Gozdek) Cardiothoracic Research Centre, Innovative Medical
Forum, Bydgoszcz, Poland
(Kowalewski, Raffa, Lorusso) Cardio-Thoracic Surgery Department, Heart and
Vascular Centre, Maastricht University Medical Centre, Maastricht,
Netherlands
(Gozdek, Kubica) Department of Cardiology and Internal Medicine, Collegium
Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Slomka) Chair and Department of Pathophysiology, Bydgoszcz, Poland
(Zielinski) Medical University of Warsaw, Warsaw, Poland
(Anisimowicz) Department of Cardiac Surgery, Collegium Medicum, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum, Nicolaus Copernicus University, Torun, Poland
(Landes, Kornowski) Department of Cardiology, Institute of Interventional
Cardiology, Petach Tikva and Tel Aviv University, Rabin Medical Center,
Tel Aviv, Israel
(Suwalski) Department of Cardiac Surgery, Centre of Postgraduate Medical
Education, Warsaw, Poland
Publisher
NLM (Medline)
Abstract
AIMS: To compare transcatheter aortic valve replacement TAVR with
self-expandable first-generation Medtronic CoreValve with new-generation
Evolut R devices in patients with aortic stenosis. <br/>METHOD(S):
Multiple databases were screened for all available reports directly or
indirectly comparing CoreValve vs Evolut R. Primary endpoint was device
success. Procedural, functional and clinical outcomes were assessed as
well. <br/>RESULT(S): Ten retrospective series including 12 294 pts. were
found. Overall device success rate was 95.5% and was statistically higher
in the Evolut R treated patients as compared with CoreValve: 96.6 vs.
94.8%, respectively; RR (risk ratio) 95%CIs (confidence intervals): 1.02
(1.00-1.04); P = 0.01. There were no statistical differences with regard
to postoperative mean aortic gradients 8.5 +/- 5.3 vs 7.9 +/- 4.6 with
Evolut R and CoreValve. Evolut R valve demonstrated nearly 50% reduction
of the risk for moderate-to-severe paravalvilar leak 0.55 (0.39-0.79); P =
0.001; 60% statistically significant lower risk of developing myocardial
injury 0.40 (0.22-0.72); P = 0.002 and numerical reductions in the risk of
acute kidney injury, vascular complications and bleeding. Together with
significantly reduced risk of permanent pacemaker implantation (0.80
[0.67-0.96]; P = 0.02) the above benefits were associated with 40%
reduction in the risk of 30-day all-cause mortality with Evolut R as
compared to CoreValve: 0.60 (0.37-1.00); P = 0.05. <br/>CONCLUSION(S): The
use of new-generation Evolut R was associated with improved procedural,
functional and clinical outcomes compared with the CoreValve device.

<62>
[Use Link to view the full text]
Accession Number
626633445
Title
Meta-analysis of impact of liver disease on mortality after transcatheter
aortic valve implantation.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 20 (4) (pp 237-244),
2019. Date of Publication: 01 Apr 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, NY,
United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
AIMS: To evaluate whether liver disease is associated with increased
mortality after transcatheter aortic valve implantation (TAVI) and whether
TAVI is associated with decreased mortality compared to surgical aortic
valve replacement (SAVR) in patients with liver disease, we performed
meta-analyses of currently available studies. <br/>METHOD(S): Studies
reporting mortality in TAVI patients with liver disease versus those
without liver disease and mortality after TAVI versus SAVR in patients
with liver disease were eligible to be included. A relative risk (RR) or
hazard ratio of mortality for TAVI patients with versus without liver
disease and mortality for TAVI versus SAVR in patients with liver disease
was extracted from each individual study. Study-specific estimates were
combined in the random-effects model. <br/>RESULT(S): We identified nine
studies of TAVI patients with versus without liver disease and four
studies of TAVI versus SAVR in patients with liver cirrhosis. Pooled
analyses demonstrated no association of liver disease with early
(in-hospital/30-day) mortality (P = 0.28), but a statistically significant
association of liver disease with increases mid-term (1-2-year) mortality
(hazard ratio 1.87, P < 0.00001) in TAVI patients, and no statistically
significant difference in in-hospital mortality between TAVI and SAVR in
patients with cirrhosis (RR 0.60, P = 0.12). <br/>CONCLUSION(S): There may
be no impact of liver disease on early mortality in TAVI patients,
negative impact of liver disease on mid-term mortality in TAVI patients,
and no difference in in-hospital mortality between TAVI and SAVR in
patients with liver cirrhosis.

<63>
[Use Link to view the full text]
Accession Number
624045530
Title
The Impact of Public Performance Reporting on Market Share, Mortality, and
Patient Mix Outcomes Associated with Coronary Artery Bypass Grafts and
Percutaneous Coronary Interventions (2000-2016).
Source
Medical Care. 56 (11) (pp 956-966), 2018. Date of Publication: 01 Nov
2018.
Author
Dunt D.; Prang K.-H.; Sabanovic H.; Kelaher M.
Institution
(Dunt, Prang, Sabanovic, Kelaher) Centre for Health Policy, Melbourne
School of Population and Global Health, University of Melbourne,
Parkville, VIC 3010, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Public performance reporting (PPR) of coronary artery bypass
graft (CABG) and percutaneous coronary intervention (PCI) outcomes aim to
improve the quality of care in hospitals, surgeons and to inform consumer
choice. Past CABG and PCI studies have showed mixed effects of PPR on
quality and selection. The aim of this study was to undertake a systematic
review and meta-analysis of the impact of PPR on market share, mortality,
and patient mix outcomes associated with CABG and PCI. <br/>Method(s): Six
online databases and 8 previous reviews were searched for the period
2000-2016. Data extraction, quality assessment, systematic critical
synthesis, and meta-analysis (where possible) were carried out on included
studies. <br/>Result(s): In total, 22 relevant articles covering mortality
(n=19), patient mix (n=14), and market share (n=6) outcomes were
identified. Meta-analyses showed that PPR led to a near but not
significant reduction in short-term mortality for both CABG and PCI. PPR
on CABG showed a positive effect on market share for hospitals (3 of 6
studies) and low-performing surgeons (2 of 2 studies). Five of 6 PCI
studies found that high-risk patients were less likely to be treated in
States with PPR. <br/>Conclusion(s): There is some evidence that PPR
reduces mortality rates in CABG/PCI-treated patients. The significance of
there being no strong evidence, in the period 2000-2016, should be
considered. There is need for both further development of PPR practice and
further research into the intended and unintended consequences of
PPR.<br/>Copyright &#xa9; 2018 The Author(s). Published by Wolters Kluwer
Health, Inc.

<64>
Accession Number
619886352
Title
Turkey's top publications in cardiovascular medicine in the past 25 years:
Evaluation of its impact.
Source
Anatolian Journal of Cardiology. 18 (6) (pp 417-424), 2017. Date of
Publication: December 2017.
Author
Onat A.
Institution
(Onat) Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul
University, Istanbul, Turkey
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: To identify "genuine" publications from Turkey's institutions
since 1992 that have cumulatively contributed the most to global
cardiovascular medicine. <br/>Method(s): Based on data from the Web of
Science, 146 publications from Turkey were identified having received >=50
citations as of late July, 2017. Papers with more than a minor share by
international authors were excluded. <br/>Result(s): Hundred and ten
primary authors generated 147 medical papers which received >=50
(interquartile range, 54; 86) citations. These articles corresponded in
quality to the top 12% global papers. Half of the articles were published
from 2002 to late 2007, with a median exposure period of 12 years. Peak
performance was reached in 2004-'07, with a mean of 15-20 papers annually,
which then regressed to five papers in 2008-'13, representing an estimated
50% decline. Cardiology generated 105 articles (20 in collaboration with
other branches), cardiovascular surgery generated 27 articles, and
pediatric cardiology generated 5 articles. Publications arose from 26
medical faculties, Gulhane Military Academy, and 9 hospitals not which
were not academically affiliated. The performance of many related Turkish
institutions was disappointing. <br/>Conclusion(s): Turkey's contribution
to cardiovascular medicine has further declined slightly in the current
assessment, particularly since 2007. To prevent a further gap in Turkey's
contribution to the field, an undelayed return is needed by building an
environment that allows focusing on research with a potential to
contribute to medicine.<br/>Copyright &#xa9; 2017 by Turkish Society of
Cardiology.

<65>
Accession Number
627710560
Title
Fluid management in patients undergoing cardiac surgery: effects of an
acetate- versus lactate-buffered balanced infusion solution on hemodynamic
stability (HEMACETAT).
Source
Critical care (London, England). 23 (1) (pp 159), 2019. Date of
Publication: 06 May 2019.
Author
Pfortmueller C.A.; Faeh L.; Muller M.; Eberle B.; Jenni H.; Zante B.;
Prazak J.; Englberger L.; Takala J.; Jakob S.M.
Institution
(Pfortmueller, Faeh, Zante, Prazak, Takala, Jakob) Department of Intensive
Care Medicine, Inselspital, Bern University Hospital, University of Bern,
Freiburgstrasse 10, Bern 3010, Switzerland
(Muller) Institute of Health Economics and Clinical Epidemiology,
University Hospital of Cologne, Cologne, Germany
(Muller) Department of Emergency Medicine, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Eberle) Department of Anaesthesiology and Pain Medicine, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
(Jenni, Englberger) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Recent evidence suggests that acetate-buffered infusions
result in better hemodynamic stabilization than 0.9% saline in patients
undergoing major surgery. The choice of buffer in balanced crystalloid
solutions may modify their hemodynamic effects. We therefore compared the
inopressor requirements of Ringer's acetate and lactate for perioperative
fluid management in patients undergoing cardiac surgery. <br/>METHOD(S):
Using a randomized controlled double-blind design, we compared Ringer's
acetate (RA) to Ringer's lactate (RL) with respect to the average rate of
inopressor administered until postoperative hemodynamic stabilization was
achieved. Secondary outcomes were the cumulative dose of inopressors, the
duration of inopressor administration, the total fluid volume
administered, and the changes in acid-base homeostasis. Patients
undergoing elective valvular cardiac surgery were included. Patients with
severe cardiac, renal, or liver disease were excluded from the study.
<br/>RESULT(S): Seventy-five patients were randomly allocated to the RA
arm, 73 to the RL. The hemodynamic profiles were comparable between the
groups. The groups did not differ with respect to the average rate of
inopressors (RA 2.1 mcg/kg/h, IQR 0.5-8.1 vs. RL 1.7 mcg/kg/h, IQR
0.7-8.2, p=0.989). Cumulative doses of inopressors and time on individual
and combined inopressors did not differ between the groups. No differences
were found in acid-base parameters and their evolution over time.
<br/>CONCLUSION(S): In this study, hemodynamic profiles of patients
receiving Ringer's lactate and Ringer's acetate were comparable, and the
evolution of acid-base parameters was similar. These study findings should
be evaluated in larger, multi-center studies. TRIAL REGISTRATION:
Clinicaltrials.gov NCT02895659 . Registered 16 September 2016.

<66>
[Use Link to view the full text]
Accession Number
627707386
Title
Effect of High-Intensity Interval Training in De Novo Heart Transplant
Recipients in Scandinavia.
Source
Circulation. 139 (19) (pp 2198-2211), 2019. Date of Publication: 07 May
2019.
Author
Nytroen K.; Rolid K.; Andreassen A.K.; Yardley M.; Gude E.; Dahle D.O.;
Bjorkelund E.; Relbo Authen A.; Grov I.; Philip Wigh J.; Have Dall C.;
Gustafsson F.; Karason K.; Gullestad L.
Institution
(Nytroen, Rolid, Andreassen, Yardley, Gude, Bjorkelund, Relbo Authen,
Grov, Gullestad) Departments of Cardiology (K.N., K.R., A.K.A., M.Y.,
E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet,
Norway
(Nytroen, Rolid, Andreassen, Yardley, Gullestad) Institute of Clinical
Medicine, Faculty of Medicine (K.N., University of Oslo, Norway
(Nytroen, Rolid, Gude, Gullestad) KG Jebsen Center for Cardiac Research
(K.N., E.G., University of Oslo, Norway
(Nytroen, Rolid, Gude, Gullestad) Center for Heart Failure Research, Oslo
University Hospital, E.G.
(Rolid, Yardley) Norwegian Health Association, Oslo, Norway
(Dahle) Transplantation Medicine (D.O.D.), Oslo University Hospital
Rikshospitalet, Norway
(Philip Wigh, Karason) Transplant Institute, Sahlgrenska University
Hospital, Gothenburg, Germany
(Have Dall) Department of Cardiology, Bispebjerg University Hospital,
Copenhagen, Denmark
(Have Dall, Gustafsson) University of Copenhagen, Denmark
(Gustafsson) Rigshospitalet, Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is no consensus on how, when, or at what intensity
exercise should be performed after heart transplantation (HTx). We have
recently shown that high-intensity interval training (HIT) is safe, well
tolerated, and efficacious in the maintenance state after HTx, but studies
have not investigated HIT effects in the de novo HTx state. We
hypothesized that HIT could be introduced early after HTx and that it
could lead to clinically meaningful increases in exercise capacity and
health-related quality of life. <br/>METHOD(S): This multicenter,
prospective, randomized, controlled trial included 81 patients a mean of
11 weeks (range, 7-16 weeks) after an HTx. Patients were randomized 1:1 to
9 months of either HIT (4x4-minute intervals at 85%-95% of peak effort) or
moderate-intensity continuous training (60%-80% of peak effort). The
primary outcome was the effect of HIT versus moderate-intensity continuous
training on the change in aerobic exercise capacity, assessed as the peak
oxygen consumption (Vo2peak). Secondary outcomes included tolerability,
safety, adverse events, isokinetic muscular strength, body composition,
health-related quality of life, left ventricular function, hemodynamics,
endothelial function, and biomarkers. <br/>RESULT(S): From baseline to
follow-up, 96% of patients completed the study. There were no serious
exercise-related adverse events. The population comprised 73% men, and the
mean+/-SD age was 49+/-13 years. At the 1-year follow-up, the HIT group
demonstrated greater improvements than the moderate-intensity continuous
training group; the groups showed significantly different changes in the
Vo2peak (mean difference between groups, 1.8 mL.kg-1.min-1), the anaerobic
threshold (0.28 L/min), the peak expiratory flow (11%), and the extensor
muscle exercise capacity (464 J). The 1.8-mL.kg-1.min-1 difference was
equal to =0.5 metabolic equivalents, which is regarded as clinically
meaningful and relevant. Health-related quality of life was similar
between the groups, as indicated by results from the Short Form-36
(version 2), Hospital Anxiety and Depression Scale, and a visual analog
scale. <br/>CONCLUSION(S): We demonstrated that HIT was a safe, efficient
exercise method in de novo HTx recipients. HIT, compared with
moderate-intensity continuous training, resulted in a clinically
significantly greater change in exercise capacity based on the Vo2peak
values (25% versus 15%), anaerobic threshold, peak expiratory flow, and
muscular exercise capacity. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov . Unique identifier NCT01796379.

<67>
[Use Link to view the full text]
Accession Number
627675043
Title
Modified Lung Ultrasound Examinations in Assessment and Monitoring of
Positive End-Expiratory Pressure-Induced Lung Reaeration in Young Children
With Congenital Heart Disease Under General Anesthesia.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 20 (5) (pp 442-449), 2019. Date of Publication: 01 May
2019.
Author
Wu L.; Hou Q.; Bai J.; Zhang J.; Sun L.; Tan R.; Zhang M.; Zheng J.
Institution
(Wu, Bai, Zhang, Sun) Department of Anesthesiology, Shanghai Children's
Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong
University, Shanghai, China
(Hou) Diagnostic imaging Center, Shanghai Children's Medical Center
Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai,
China
(Tan) Department of Obstetrics, Zhucheng People's Hospital, Shandong,
China
(Zhang, Zheng) Department of Anesthesiology & Pediatric Clinical
Pharmacology Laboratory, Shanghai Children's Medical Center Affiliated to
School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Lung ultrasound can reliably diagnose pulmonary atelectasis.
The object of this study is to determine the most efficient region to
assess changes in atelectasis in children with congenital heart disease
under general anesthesia. DESIGN: Randomized controlled trial. SETTING:
Operating room at university-affiliated children's hospital. PATIENTS:
Children between 3 months and 3 years old, scheduled for elective
congenital heart disease surgery under general anesthesia. INTERVENTIONS:
Forty children with congenital heart disease were randomly allocated to
either a 5cm H2O positive end-expiratory pressure group or a standard
therapy control group. MEASUREMENTS AND MAIN RESULTS: Preoperative lung
ultrasound was performed twice in each patient-after 1 and 15 minutes of
mechanical ventilation. Atelectatic areas and B-lines were compared
between two examinations. Different ultrasound regions were evaluated
using Bland-Altman plots. The occurrence rate of atelectasis was much
higher in inferoposterior lung regions (Scans 4-6) than in anterior and
lateral regions (Scans 1-3). The median (interquartile range) lung
ultrasound scores were lower in the positive end-expiratory pressure group
than in the control group after treatment: 8 (3.3-9.8) versus 13
(8.3-17.5; p < 0.001). The atelectatic area was significantly decreased
after treatment in the positive end-expiratory pressure group: 128mm
(34.5.5-213.3mm) versus 49.5mm (5.3-75.5mm; p < 0.001). Bland-Altman plots
revealed concordance between measurements in Scans 1-6 and those in Scans
4-6. In the posterior axillary line regions, changes in atelectatic area
were significantly larger in the positive end-expiratory pressure group
than in the control group (p = 0.03, 0.007, and 0.018).
<br/>CONCLUSION(S): Lung ultrasound in inferoposterior lung regions may be
more likely to reflect changes in atelectasis and save examination time;
5cm H2O positive end-expiratory pressure may be useful in lung reaeration
and can reduce, but not eliminate, atelectasis in children with congenital
heart disease.

<68>
Accession Number
627674953
Title
The effect of guided imagery on physiological and psychological outcomes
of adult ICU patients: A systematic literature review and methodological
implications.
Source
Australian critical care : official journal of the Confederation of
Australian Critical Care Nurses. 31 (2) (pp 73-86), 2018. Date of
Publication: 01 Mar 2018.
Author
Hadjibalassi M.; Lambrinou E.; Papastavrou E.; Papathanassoglou E.
Institution
(Hadjibalassi, Lambrinou, Papastavrou) Department of Nursing, Cyprus
University of Technology, Limassol, Cyprus
(Papathanassoglou) Faculty of Nursing, University of Alberta, Edmonton,
AB, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Guided imagery (GI) is a relaxation technique that is being
increasingly explored in various patients' populations. We systematically
reviewed evidence on the effects of GI on physiological and psychological
outcomes of adult critically ill patients and extracted implications for
future research. REVIEW METHOD USED: Systematic literature review of
published studies based on the Cochrane Guidelines. DATA SOURCES: Studies
were located through literature searches of CINAHL, PubMed, Embase,
Cochrane Database of Systematic Reviews and Psych-Info. REVIEW METHODS: We
explored effects of GI in critically illness. The outcome measures
included pain, anxiety, hemodynamic measurements, stress neuropeptides,
length of stay, sleep quality, inflammatory markers, patient satisfaction
and cost of care. The Cochrane Collaboration's tool for assessing risk of
bias was employed. Extracted data included pathophysiological framework,
sample, diagnoses of participants, specifics of intervention, design,
experimental groups, analyses and main outcomes. <br/>RESULT(S): Based on
the selection criteria, 10 studies were identified, involving N=1391
critically ill patients. The main limitations include incomplete outcome
data and selective reporting, incomplete blinding and lack of experimental
group allocation concealment. Due to heterogeneity and incomplete
reporting, a meta-analysis was not feasible. Our findings included: (a)
favourable effects of the intervention with regard to decrease of pain,
anxiety and LOS; (b) many studies employing randomised controlled trial
designs; (c) a predominant focus on patients with cardiac surgery; (d)
large heterogeneity in measurement of outcomes. Moreover, the evidence
suggests that improvements in sleep quality, patient satisfaction and cost
of care merit further investigation. Methodological implications include
the need to clarify the underlying physiological framework, the use of
repeated measure designs and the adjustment for confounders.
<br/>CONCLUSION(S): On the basis of these results, and of the absence of
reported side-effects, we conclude that GI is a promising patient-centered
approach for the improvement of a number of patients' outcomes that merits
further investigation in critical care.<br/>Copyright &#xa9; 2017
Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd.
All rights reserved.

<69>
Accession Number
2001964124
Title
N-acetylcysteine use among patients undergoing cardiac surgery: A
systematic review and meta-analysis of randomized trials.
Source
PLoS ONE. 14 (5) (no pagination), 2019. Article Number: e0213862. Date of
Publication: May 2019.
Author
Pereira J.E.G.; Dib R.E.; Braz L.G.; Escudero J.; Hayes J.; Johnston B.C.
Institution
(Pereira, Braz) Department of Anesthesiology, Botucatu Medical School,
Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil
(Pereira) Department of Anesthesiology, EsSEx, Hospital Central do
Exercito, Rio de Janeiro, Rio de Janeiro, Brazil
(Pereira) Department of Anesthesiology, Santa Casa de Misericordia de
Barra Mansa, Barra Mansa, Rio de Janeiro, Brazil
(Dib, Johnston) Department of Community Health and Epidemiology, Dalhousie
University, Faculty of Medicine, Halifax, Canada
(Dib, Escudero) Institute of Science and Technology, Univ Estadual
Paulista, Sao Paulo, Sao Jose dos Campos, Brazil
(Dib) McMaster Institute of Urology, McMaster University, Hamilton, ON,
Canada
(Hayes) Department of Anesthesia and Pain Medicine, Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Cardiac surgeries are complex procedures aiming to re-establish
coronary flow and correct valvular defects. Oxidative stress, caused by
inflammation and ischemia-reperfusion injury, is associated with these
procedures, increasing the risk of adverse outcomes. N-acetylcysteine
(NAC) acts as an antioxidant by replenishing the glutathione stores, and
emerging evidence suggests that NAC may reduce the risk of adverse
perioperative outcomes. We conducted a systematic review and meta-analysis
to investigate the addition of NAC to a standard of care among adult
patients undergoing cardiac surgery. Methods We searched four databases
(PubMed, EMBASE, CENTRAL, LILACS) from inception to October 2018 and the
grey literaure for randomized controlled trials (RCTs) investigating the
effect of NAC on pre-defined outcomes including mortality, acute renal
insufficiency (ARI), acute cardiac insufficiency (ACI), hospital length of
stay (HLoS), intensive care unit length of stay (ICULoS), arrhythmia and
acute myocardial infarction (AMI). Reviewers independently screened
potentially eligible articles, extracted data and assessed the risk of
bias among eligible articles. We used the GRADE approach to rate the
overall certainty of evidence for each outcome. Results Twenty-nine RCTs
including 2,486 participants proved eligible. Low to moderate certainty
evidence demonstrated that the addition of NAC resulted in a
non-statistically significant reduction in mortality (Risk Ratio (RR)
0.71; 95% Confidence Interval (CI) 0.40 to 1.25), ARI (RR 0.92; 95% CI
0.79 to 1.09), ACI (RR 0.77; 95% CI 0.44 to 1.38), HLoS (Mean Difference
(MD) 0.21; 95% CI -0.64 to 0.23), ICULoS (MD -0.04; 95% CI -0.29 to 0.20),
arrhythmia (RR 0.79; 95% CI 0.52 to 1.20), and AMI (RR 0.84; 95% CI 0.48
to 1.48). Limitations Among eligible trials, we observed heterogeneity in
the population and interventions including patients with and without
kidney dysfunction and interventions that differed in route of
administration, dosage, and duration of treatment. This observed
heterogeneity was not explained by our subgroup analyses. Conclusions The
addition of NAC during cardiac surgery did not result in a statistically
significant reduction in clinical outcomes. A large randomized
placebo-controlled multi-centre trial is needed to determine whether NAC
reduces mortality.<br/>Copyright &#xa9; 2019 Pereira et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<70>
Accession Number
627493080
Title
Pressure support ventilation, sigh adjunct to pressure support
ventilation, and neurally adjusted ventilatory assist in infants after
cardiac surgery: A physiologic crossover randomized study.
Source
Pediatric pulmonology. (no pagination), 2019. Date of Publication: 19 Apr
2019.
Author
Bonacina D.; Bronco A.; Nacoti M.; Ferrari F.; Fazzi F.; Bonanomi E.;
Bellani G.
Institution
(Bonacina, Nacoti, Ferrari, Fazzi, Bonanomi) Pediatric Intensive Care
Unit, A.S.S.T. Papa Giovanni XXIII, Bergamo, Italy
(Bronco, Bellani) Department of Emergency and Intensive Care, San Gerardo
Hospital, Monza, Italy
(Bellani) Department of Medicine and Surgery, University of Milan-Bicocca,
Monza, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to compare gas exchange, respiratory mechanics, and
asynchronies during pressure support ventilation (PSV), sigh adjunct to
PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in
hypoxemic infants after cardiac surgery. DESIGN: Prospective,
single-center, crossover, randomized physiologic study. SETTING:
Tertiary-care pediatric intensive care unit. PATIENTS: Fourteen hypoxemic
infants (median age 11.5 days [8.7-74]). INTERVENTIONS: The protocol
begins with a 1hour step of PSV, followed by two consecutive steps in PSV
SIGH and NAVA in random order, with a washout period of 30minutes (PSV)
between them. MAIN RESULTS: Three infants presented an irregular Eadi
signal because of diaphragmatic paralysis and were excluded from analysis.
For the remaining 11 infants, PaO2 /FiO 2 and oxygenation index improved
in PSV SIGH compared with PSV (P<0.05) but not in NAVA compared with PSV.
PSV SIGH showed increased tidal volumes and lower respiratory rate than
PSV (P<0.05), as well as a significant improvement in compliance with
respiratory system indexed to body weight when compared with both PSV and
NAVA (P<0.01). No changes in mean airway pressure was registered among
steps. Inspiratory time resulted prolonged for both PSV SIGH and NAVA than
PSV (P<0.05). NAVA showed the higher coefficient of variability in
respiratory parameters and a significative decrease in asynchrony index
when compared with both PSV and PSV SIGH (P<0.01). <br/>CONCLUSION(S): The
adjunct of one SIGH per minute to PSV improved oxygenation and lung
mechanics while NAVA provided the best patient-ventilator synchrony in
infants after cardiac surgery.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<71>
Accession Number
2001028866
Title
Outcomes of Surgical Management of Neurogenic Thoracic Outlet Syndrome: A
Systematic Review and Bayesian Perspective.
Source
Journal of Hand Surgery. 44 (5) (pp 416.e1-416.e17), 2019. Date of
Publication: May 2019.
Author
Yin Z.G.; Gong K.T.; Zhang J.B.
Institution
(Yin, Gong, Zhang) Department of Hand Surgery, Tianjin Hospital, Tianjin,
China
Publisher
W.B. Saunders
Abstract
Purpose: To provide a summary of the relevant evidence on outcomes of
transaxillary first rib excision (TAFRE), supraclavicular first rib
excision with scalenectomy (SCFRE), and supraclavicular release leaving
the first rib intact (SCR) for patients with neurogenic thoracic outlet
syndrome (TOS), and interpret the treatment effects from a Bayesian
perspective. <br/>Method(s): A systematic literature search and review
were performed. Random-effects meta-analyses were conducted to estimate
success rate and complete relief rate of each procedure. The probabilities
of specified success rates and complete relief rates were calculated using
a Bayesian method. Sensitivity analyses for TOS type, neck trauma, and
cervical rib were performed. Complications of each procedure were also
reviewed. <br/>Result(s): Data were extracted from 17 studies of TAFRE, 9
of SCFRE, and 14 of SCR to conduct the meta-analyses. The pooled success
rate and complete relief rate were 0.76 (95% confidence interval [95%
CI)], 0.65-0.85) and 0.53 (95% CI, 0.38-0.68) for TAFRE, 0.77 (95% CI,
0.68-0.85) and 0.57 (95% CI, 0.41-0.72) for SCFRE, and 0.85 (95% CI,
0.76-0.92) and 0.61 (95% CI, 0.35-0.84) for SCR, respectively. The
probabilities of success rate greater than 70% were 90%, 87%, and 99% for
TAFRE, SCFRE, and SCR, respectively. If the success rate of 80% or greater
was considered, the probabilities were 34%, 31%, and 91%, respectively.
The probabilities of complete relief rate of 50% or greater were 67%, 71%,
and 69% for TAFRE, SCFRE, and SCR, respectively. Sensitivity analyses
showed similar results. The complication rates for TAFRE, SCFRE, and SCR
were, respectively, 22.5%, 25.9%, and 12.6%. <br/>Conclusion(s): The SCR
has a high probability of success rate greater than 80%; both TAFRE and
SCFRE have high probabilities of a success rate greater than 70% but only
low probabilities of success rate greater than 80%. The TAFRE and SCFRE
have more complications than SCR. Type of study/level of evidence:
Therapeutic IV.<br/>Copyright &#xa9; 2019 American Society for Surgery of
the Hand

<72>
Accession Number
627461091
Title
Ventilation strategies with different inhaled Oxygen conceNTration during
CardioPulmonary Bypass in cardiac surgery (VONTCPB): Study protocol for a
randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 254. Date of
Publication: 03 May 2019.
Author
Zhang M.-Q.; Liao Y.-Q.; Yu H.; Li X.-F.; Feng L.; Yang X.-Y.
Institution
(Zhang, Yu, Liao, Yu, Li, Feng) Department of Anesthesiology, West China
Hospital, Sichuan University, Chengdu 610041, China
(Yang) Department of Obstetrics and Gynecology, West China Second
University Hospital, Sichuan University, Chengdu, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: There is no consensus on the ventilation management during
cardiopulmonary bypass (CPB), and the anesthesiologists or the surgeons
usually ventilate the lungs with different ventilation strategies or keep
them static. Better outcomes are more likely to occur when the ventilation
is administered during CPB according to the existing literatures. However,
the use of high fraction of inspired oxygen (FiO<inf>2</inf>) is debatable
in cardiac surgery. And the potential effects of strategies combining low
tidal volume (V<inf>T</inf>) ventilation with different FiO<inf>2</inf>
during CPB on postoperative pulmonary complications (PPCs) are unclear.
<br/>Design(s): The VONTCPB trial is a single-center, prospective,
double-blinded, randomized, controlled trial. We are going to recruit
total 420 elective cardiac surgery patients with median sternotomy under
CPB, who will be equally randomized into three different ventilation
strategy groups: NoV, LOV and HOV. (1) The NoV group receives no
mechanical ventilation during CPB; (2) the LOV group receives a low
V<inf>T</inf> of 3-4 ml/kg of ideal body weight (IBW) with the respiratory
rate (RR) of 10-12 acts/min, and the positive end-expiratory pressure
(PEEP) of 5-8 cmH<inf>2</inf>O during CPB; the FiO<inf>2</inf> is 30%; (3)
the HOV group receives a low V<inf>T</inf> of 3-4 ml/kg of IBW with the RR
of 10-12 acts/min, and the PEEP of 5-8 cmH<inf>2</inf>O during CPB; the
FiO<inf>2</inf> is 80%. The primary endpoints are the incidence of the
composite of PPCs and the PPCs score. The secondary endpoints refer to the
incidence of the oxygenation index (PaO<inf>2</inf>/FiO<inf>2</inf> ratio)
< 300 mmHg at three time points (the moment arriving in the ICU, 6 and 12
h after arrival in the ICU), the surgical incision healing grade, the
intubation time, the stay of ICU, the length of hospital stay, and
mortality at 30 days after the surgery. <br/>Discussion(s): The VONTCPB
trial is the first study to assess the effects of strategies combining low
tidal volume (V<inf>T</inf>) ventilation with different FiO<inf>2</inf>
during CPB on patients' outcomes.<br/>Copyright &#xa9; 2019 The Author(s).

<73>
Accession Number
627461090
Title
Hypotension Prediction Index software for management of hypotension during
moderate- to high-risk noncardiac surgery: Protocol for a randomized
trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 255. Date of
Publication: 03 May 2019.
Author
Maheshwari K.; Shimada T.; Fang J.; Ince I.; Mascha E.J.; Turan A.; Kurz
A.; Sessler D.I.
Institution
(Maheshwari, Shimada, Fang, Ince, Turan, Kurz, Sessler) Department of
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid
Avenue, E-31, Cleveland, OH 44195, United States
(Maheshwari, Turan, Kurz) Department of General Anesthesiology,
Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31,
Cleveland, OH 44195, United States
(Shimada) Department of Anesthesiology, National Defense Medical College,
Tokorozawa, Saitama, Japan
(Ince) Department of Anesthesiology and Reanimation, Ataturk University
School of Medicine, Erzurum, Turkey
(Mascha) Departments of Quantitative Health Sciences and Outcomes
Research, Lerner Research Institute and Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Hypotension is associated with serious complications,
including myocardial infarction, acute kidney injury, and mortality.
Consequently, predicting and preventing hypotension may improve outcomes.
We will therefore determine if use of a novel hypotension prediction tool
reduces the duration and severity of hypotension in patients having
non-cardiac surgery. Methods/design: We will conduct a two-center,
pragmatic, randomized controlled trial (N = 213) in noncardiac surgical
patients > 45 years old who require intra-arterial blood pressure
monitoring. All participating patients will be connected to a Flortrac IQ
sensor and EV1000 platform (Edwards Lifesciences, Irvine). They will be
randomly assigned to blinded or unblinded arms. The Hypotension Prediction
Index (HPI) and advanced hemodynamic information will be universally
recorded, but will only be available to clinicians when patients are
assigned to unblinded monitoring. The primary outcome will be the effect
of HPI software guidance on intraoperative time-weighted average mean
arterial pressure under a threshold of 65 mmHg, which will be assessed
with a Wilcoxon-Mann-Whitney 2-sample, two-tailed test.
<br/>Discussion(s): Our trial will determine whether the Hypotension
Prediction Index and associated hemodynamic information substantively
reduces hypotension during non-cardiac surgery.<br/>Copyright &#xa9; 2019
The Author(s).

<74>
Accession Number
2000791088
Title
Design and rationale for the Cardiovascular and Metabolic Effects of
Lorcaserin in Overweight and Obese Patients-Thrombolysis in Myocardial
Infarction 61 (CAMELLIA-TIMI 61) trial.
Source
American Heart Journal. 202 (pp 39-48), 2018. Date of Publication: August
2018.
Author
Bohula E.A.; Scirica B.M.; Fanola C.; Inzucchi S.E.; Keech A.; McGuire
D.K.; Smith S.R.; Abrahamsen T.; Francis B.H.; Miao W.; Perdomo C.A.;
Satlin A.; Wiviott S.D.; Sabatine M.S.
Institution
(Bohula, Scirica, Fanola, Abrahamsen, Wiviott, Sabatine) TIMI Study Group,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Inzucchi) Yale University School of Medicine, New Haven, CT, United
States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(McGuire) Division of Cardiology, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Smith) Translational Research Institute for Metabolism and Diabetes,
Florida Hospital, Orlando, FL, United States
(Francis, Miao, Perdomo, Satlin) Eisai, Inc., Woodcliff Lake, NJ, United
States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Lorcaserin, a selective serotonin 2C receptor agonist, is an
effective pharmacologic weight-loss therapy that improves several
cardiovascular risk factors. The long-term clinical cardiovascular and
metabolic safety and efficacy in patients with elevated cardiovascular
risk are unknown. Research design and methods: CAMELLIA-TIMI 61
(NCT02019264) is a randomized, double-blind, placebo-controlled,
multinational clinical trial designed to evaluate the safety and efficacy
of lorcaserin with regard to major adverse cardiovascular events and
progression to diabetes in overweight or obese patients at high
cardiovascular risk. Overweight or obese patients either with established
cardiovascular disease or with diabetes and at least 1 other
cardiovascular risk factor were randomized in a 1:1 ratio to lorcaserin 10
mg twice daily or matching placebo. The primary safety objective is to
assess for noninferiority of lorcaserin for the composite end point of
cardiovascular death, myocardial infarction, or stroke (major adverse
cardiovascular event [MACE]) (with noninferiority defined as the upper
bound of a 1-sided 97.5% CI excluding a hazard ratio of 1.4) compared with
placebo assessed at an interim analysis with 460 adjudicated events. The
efficacy objectives, assessed at study completion, will evaluate the
superiority of lorcaserin for the primary composite end point of
cardiovascular death, myocardial infarction, stroke, hospitalization for
unstable angina, heart failure, or any coronary revascularization (MACE+)
and the key secondary end point of conversion to diabetes. Recruitment
began in January 2014 and was completed in November 2015 resulting in a
total population of 12,000 patients. The trial is planned to continue
until at least 1,401 adjudicated MACE+ events are accrued and the median
treatment duration exceeds 2.5 years. <br/>Conclusion(s): CAMELLIA-TIMI 61
is investigating the safety and efficacy of lorcaserin for MACEs and
conversion to diabetes in overweight or obese patients with established
cardiovascular disease or multiple cardiovascular risk
factors.<br/>Copyright &#xa9; 2018

<75>
Accession Number
2000800778
Title
Randomized clinical comparison of the dual-therapy CD34 antibody-covered
sirolimus-eluting Combo stent with the sirolimus-eluting Orsiro stent in
patients treated with percutaneous coronary intervention: Rationale and
study design of the Scandinavian Organization for Randomized Trials with
Clinical Outcome (SORT OUT) X trial.
Source
American Heart Journal. 202 (pp 49-53), 2018. Date of Publication: August
2018.
Author
Jakobsen L.; Christiansen E.H.; Maeng M.; Kristensen S.D.; Botker H.E.;
Terkelsen C.J.; Madsen M.; Raungaard B.; Jensen S.E.; Christensen M.K.;
Hansen H.S.; Jensen L.O.
Institution
(Jakobsen, Christiansen, Maeng, Kristensen, Botker, Terkelsen) Department
of Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Madsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Raungaard, Jensen, Christensen) Department of Cardiology, Aalborg
University Hospital, Aalborg, Denmark
(Hansen, Jensen) Department of Cardiology, Odense University Hospital,
Odense, Denmark
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The Combo stent (OrbusNeich, Hoevelaken, the Netherlands)
combining an abluminal, bioabsorbable polymer eluting sirolimus with a
luminal CD34+ antibody to capture endothelial progenitor cells has been
developed to further improve safety and efficacy of coronary
interventions. We have designed a large-scale registry-based randomized
clinical trial to compare the Combo stent to the Orsiro stent (Biotronik,
Bulach, Switzerland) in patients undergoing percutaneous coronary
intervention. <br/>Method(s): The SORT OUT X study will randomly assign
3,140 patients to treatment with Combo or Orsiro stents at 3 sites in
Western Denmark. Patients are eligible if they are >=18 years old, have
chronic stable coronary artery disease or acute coronary syndromes, and
have >=1 coronary lesion with >50% diameter stenosis requiring treatment
with a drug-eluting stent. The primary end point target lesion failure is
a composite of cardiac death, myocardial infarction (not related to other
than index lesion), or target lesion revascularization within 12 months.
Clinically driven event detection will be derived from validated Danish
registries. An event rate of 4.2% is assumed in each stent group. With a
sample size of 1,570 patients in each treatment arm, a 2-group
large-sample normal approximation test of proportions with a 1-sided 5%
significance level will have 90% power to detect noninferiority of the
Combo stent compared with the Orsiro stent with a predetermined
noninferiority margin of 2.1%. <br/>Conclusion(s): The SORT OUT X trial
will determine whether the dual-therapy Combo stent is noninferior to the
Orsiro stent with respect to clinically driven events (ClinicalTrials.gov
NCT03216733).<br/>Copyright &#xa9; 2018 Elsevier Inc.

<76>
Accession Number
608301986
Title
Administration of low molecular weight and unfractionated heparin during
percutaneous coronary intervention.
Source
Indian Heart Journal. 68 (2) (pp 213-224), 2016. Date of Publication: 01
Mar 2016.
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Shahidzadeh A.; Mahdavi P.;
Tahernejad M.; Haddad F.; Lotfaliani M.R.; Sabashnikov A.; Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Shahidzadeh, Mahdavi, Tahernejad, Haddad,
Lotfaliani) Cardiovascular Research Center, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(Sabashnikov, Popov) Department of Cardiothoracic Transplantation and
Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Publisher
Elsevier B.V.
Abstract
This systematic review with meta-analysis sought to determine the efficacy
and safety of unfractionated heparin (UFH) and low molecular weight
heparin (LMWH) on clinical outcomes following percutaneous coronary
intervention. Medline, Embase, Elsevier, and web of knowledge as well as
Google scholar literature were used for selecting appropriate studies with
randomized controlled design. After screening 445 studies, a total of 23
trials (including a total of 43,912 patients) were identified that
reported outcomes. Pooled analysis revealed that LMWH compared to UFH
could significantly increase thrombolysis in myocardial infarction grade 3
flow (p < 0.001), which was associated with similar target vessel
revascularization (p = 0.6), similar incidence of stroke (p = 0.7), and
significantly lower incidence of re-myocardial infarction (p < 0.001),
major bleeding (p = 0.02) and mortality (p < 0.001). Overall, LMWH was
shown to be a useful type of heparin for patients with MI undergoing PCI,
due to its higher efficacy and lower rate of complication compared to UFH.
It is also associated with increased myocardial perfusion, decreased major
hemorrhage, and mortality.<br/>Copyright &#xa9; 2016 Cardiological Society
of India. Published by Elsevier B.V. All rights reserved.

<77>
Accession Number
627599270
Title
Comparison of the New Oral Anticoagulants and Warfarin in Patients with
Atrial Fibrillation and Valvular Heart Disease: Systematic Review and
Meta-Analysis.
Source
Drugs in R and D. (no pagination), 2019. Date of Publication: 2019.
Author
de Souza Lima Bitar Y.; Neto M.G.; Filho J.A.L.; Pereira L.V.; Travassos
K.S.O.; Akrami K.M.; Roever L.; Duraes A.R.
Institution
(de Souza Lima Bitar, Duraes) Medical School of Federal University of
Bahia, UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, Bahia 40025-010, Brazil
(Neto, Pereira) Federal University of Bahia, UFBA, Salvador, Brazil
(Filho, Duraes) General Hospital Roberto Santos, Salvador, Bahia, Brazil
(Travassos) Bahian School of Medicine and Public Health, BAHIANA,
Salvador, Brazil
(Akrami) Department of Medicine, University of California San Diego, San
Diego, United States
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
Publisher
Springer International Publishing
Abstract
Introduction: New oral anticoagulants (NOACs) are approved for use in
nonvalvular atrial fibrillation (AF). <br/>Objective(s): This study aimed
to evaluate the efficacy and safety of NOACs compared with warfarin in AF
and valvular heart disease (VHD). <br/>Method(s): We identified randomized
controlled trials (RCTs) and post-hoc analyses comparing NOACs and
warfarin in AF and VHD, including biological and mechanical heart valves
(MHV). Through systematic review and meta-analysis, with the aid of the
"Rev Man" program 5.3, the primary effectiveness endpoints were stroke and
systemic embolism (SE). The primary safety outcome was major bleeding, and
the secondary outcome included intracranial hemorrhage. Data were analyzed
using risk ratios (RRs) and 95% confidence intervals (CIs), and
heterogeneity was assessed using the I² statistic.
<br/>Result(s): Six RCTs were included, involving 13,850 patients with AF
and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95%
CI 0.66-0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI
0.33-0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95%
CI 0.58-1.02; P = 0.07) compared with warfarin. <br/>Conclusion(s): The
efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are
similar to those of warfarin.<br/>Copyright &#xa9; 2019, The Author(s).

<78>
Accession Number
627537910
Title
Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery
after Surgery Society Recommendations.
Source
JAMA Surgery. (no pagination), 2019. Date of Publication: 2019.
Author
Engelman D.T.; Ben Ali W.; Williams J.B.; Perrault L.P.; Reddy V.S.; Arora
R.C.; Roselli E.E.; Khoynezhad A.; Gerdisch M.; Levy J.H.; Lobdell K.;
Fletcher N.; Kirsch M.; Nelson G.; Engelman R.M.; Gregory A.J.; Boyle E.M.
Institution
(Engelman) Heart and Vascular Program, Baystate Medical Center, 759
Chestnut St, Springfield, MA 01199, United States
(Ben Ali, Perrault) Montreal Heart Institute, Montreal, Canada
(Williams) WakeMed Health and Hospitals, Raleigh, NC, United States
(Reddy) Centennial Heart and Vascular Center, Nashville, TN, United States
(Arora) St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
(Roselli) Cleveland Clinic, Cleveland, OH, United States
(Khoynezhad) MemorialCare Heart and Vascular Institute, Los Angeles, CA,
United States
(Gerdisch) Franciscan Health Heart Center, Indianapolis, IN, United States
(Levy) Duke University School of Medicine, Durham, NC, United States
(Lobdell) Atrium Health, Department of Cardiovascular and Thoracic
Surgery, NC, United States
(Fletcher) St Georges University of London, London, United Kingdom
(Kirsch) Centre Hospitalier, Universitaire Vaudois Cardiac Surgery Centre,
Lausanne, Switzerland
(Nelson, Gregory) University of Calgary, Calgary, AB, Canada
(Boyle) Department of Cardiac Surgery, St Charles Medical Center, Bend,
OR, United States
(Arora) Now with Department of Surgery, Max Rady College of Medicine,
University of Manitoba, Winnipeg, Canada
(Engelman) Department of Surgery, Baystate Medical Center, Springfield,
MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Enhanced Recovery After Surgery (ERAS) evidence-based protocols for
perioperative care can lead to improvements in clinical outcomes and cost
savings. This article aims to present consensus recommendations for the
optimal perioperative management of patients undergoing cardiac surgery. A
review of meta-analyses, randomized clinical trials, large nonrandomized
studies, and reviews was conducted for each protocol element. The quality
of the evidence was graded and used to form consensus recommendations for
each topic. Development of these recommendations was endorsed by the
Enhanced Recovery After Surgery Society..<br/>Copyright &#xa9; 2019
American Medical Association. All rights reserved.

<79>
Accession Number
2001900864
Title
Optimizing cerebral oxygenation in cardiac surgery: A randomized
controlled trial examining neurocognitive and perioperative outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Uysal S.; Lin H.-M.; Trinh M.; Park C.H.; Reich D.L.
Institution
(Uysal, Trinh, Park, Reich) Department of Anesthesiology, Perioperative
and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Lin) Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to determine whether targeted therapy
to optimize cerebral oxygenation is associated with improved
neurocognitive and perioperative outcomes. <br/>Method(s): In a
prospective trial, intraoperative cerebral oximetry monitoring using
bilateral forehead probes was performed in cardiac surgical patients who
were randomly assigned to an intervention group in which episodes of
cerebral oxygen desaturation (<60% for >60 consecutive seconds at either
probe) triggered an intervention protocol or a control group in which the
cerebral oximetry data were hidden from the clinical team, and no
intervention protocol was applied. Cognitive testing was performed
preoperatively and at postoperative months 3 and 6; domains studied were
response speed, processing speed, attention, and memory. Perioperative
outcomes studied were death, hospital length of stay, intensive care unit
length of stay, postoperative day of extubation, time on mechanical
ventilation, intensive care unit delirium, Sequential Organ Failure
Assessment on intensive care unit admission, and intensive care unit blood
transfusion. <br/>Result(s): Group mean memory change scores were
significantly better in the intervention group at 6 months (0.60 [standard
error, 0.30] vs -0.17 [standard error, 0.33], adjusted P = .008). However,
presence, duration, and severity of cerebral desaturation were not
associated with cognitive change scores. Perioperative outcomes did not
differ between the intervention and control groups. <br/>Conclusion(s):
Targeted therapy to optimize cerebral oxygenation was associated with
better memory outcome in a group of cardiac surgical patients. Some
aspects of the protocol other than desaturation duration and severity
contributed to the observed neuroprotective effect.<br/>Copyright &#xa9;
2019 The American Association for Thoracic Surgery

<80>
Accession Number
627657345
Title
Postoperative Cognitive Decline After Cardiac Surgery: A Narrative Review
of Current Knowledge in 2019.
Source
Medical science monitor : international medical journal of experimental
and clinical research. 25 (pp 3262-3270), 2019. Date of Publication: 03
May 2019.
Author
Glumac S.; Kardum G.; Karanovic N.
Institution
(Glumac, Karanovic) Department of Anesthesiology and Intensive Care,
University Hospital of Split, Split, Croatia
(Kardum) Department of Psychology, Faculty of Humanities and Social
Sciences, University of Split, Split, Croatia
(Karanovic) Department of Anesthesiology and Intensive Medicine, School of
Medicine, University of Split, Split, China
Publisher
NLM (Medline)
Abstract
The growing number of publications concerning postoperative cognitive
decline (POCD) after cardiac surgery is indicative of the health-related
and economic-related importance of this intriguing issue. Significantly,
the reported POCD incidence over the years has remained steady due to
various unresolved challenges regarding the examination of this
multidisciplinary topic. In particular, a universally accepted POCD
definition has not been established, and the pathogenesis is still vaguely
understood. However, numerous recent studies have focused on the role of
the inflammatory response to a surgical procedure in POCD occurrence.
Therefore, this traditional narrative review summarizes and evaluates the
latest findings, with special attention paid to the difficulties of
defining POCD as well as the involvement of inflammation in POCD
development. We searched the MEDLINE, Scopus, PsycINFO and CENTRAL
databases for the best evidence, which was classified according to the
Oxford Centre for Evidence-based Medicine. To our knowledge, this is the
first narrative review that identified class-1 evidence (systematic review
of randomized trials), although most evidence is still at class-2 or
below. Furthermore, we revealed that defining POCD is a very controversial
matter and that the inflammatory response plays an important role in the
mutually overlapping processes included in POCD development. Thus,
developing the definition of POCD represents an absolute priority in POCD
investigations, and the inflammatory response to cardiac surgery merits
further research.

<81>
Accession Number
627659239
Title
An Economic Analysis of Medical and Surgical Management of Aortopathy
Associated with Bicuspid Aortic Valve.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2019. Date of Publication: 03 May 2019.
Author
Hardikar A.; Marwick T.H.
Institution
(Hardikar, Marwick) Menzies Institute for Medical Research, University of
Tasmania, United States
(Hardikar) Department of Cardiothoracic Surgery, Royal Hobart Hospital,
Hobart, Australia
(Marwick) Baker Heart and Diabetes Institute, Melbourne, Australia
Publisher
NLM (Medline)
Abstract
AIMS: To develop a cost-effectiveness model to address the outcome and
economic implications of different thresholds for surgery in the
management of aortopathy associated with bicuspid aortic valve disease
(ABAV). METHODS AND RESULTS: A model was created from the perspective of
an Australian healthcare funding agency. The index case was a 65-year-old
with BAV and ascending aorta diameter of 5.0cm. Health states were defined
as; preoperative with dilated aorta, postoperative without complications,
post-complication and death. The mean and variance of risks and transition
probabilities were taken from a local surgical database and local costs
and utilities of elective and urgent thoracic aortic surgery with or
without aortic valve replacement, with a sensitivity analysis based on a
systematic review. Scenario analyses were provided for other aortic
dimensions. Implications for survival, quality-adjusted life years (QALYs)
and costs were calculated from healthcare delivery and economic
perspectives. After 10,000 simulations for the reference case, the utility
of watchful waiting (WW) exceeded that of elective aortic surgery (AoS)
(13+/-4 vs 10+/-5 QALY). The net monetary benefit was A$351,063+/-304,965
with immediate aortic surgery [AoS] vs. 534,797+/-198,570 with watchful
waiting surveillance [WW]. The most important variables affecting
effectiveness were utility value of survivors, rate of aortic growth and
probability of acute aortic event during WW. <br/>CONCLUSION(S): This
decision-analytic model informed by our practice, as well as a systematic
analysis, shows that aortic surgery in a BAV patient with aorta <5cm
diameter is costlier and less effective than watchful
waiting.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2019. For
permissions please email: journals.permissions@oup.com.

<82>
Accession Number
627668217
Title
Management of anticoagulation in patients with metastatic
castration-resistant prostate cancer receiving abiraterone + prednisone.
Source
Supportive Care in Cancer. (no pagination), 2019. Date of Publication:
2019.
Author
Dubinsky S.; Thawer A.; McLeod A.G.; McFarlane T.R.J.; Emmenegger U.
Institution
(Dubinsky, McFarlane) University of Waterloo School of Pharmacy, 10
Victoria St. S, Kitchener, ON, Canada
(Thawer, McFarlane, Emmenegger) Odette Cancer Centre, Sunnybrook Health
Sciences Centre, Toronto, ON, Canada
(McLeod) Department of Medicine, Division of Medical Oncology and
Hematology, Sunnybrook Hospital, University of Toronto, Toronto, ON,
Canada
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Abiraterone has been proven to be an effective agent used in the
management of metastatic castration-resistant prostate cancer,
significantly improving overall and progression-free survival. Due to the
pharmacodynamic and pharmacokinetic properties of abiraterone, concurrent
use with anticoagulation may pose a challenge for clinicians. Thrombosis
within the cancer setting continues to increase patient mortality;
therefore, appropriate anticoagulation through the use of a management
algorithm can reduce adverse events and increase quality of life.
<br/>Method(s): A review of the literature was preformed by a medical
oncologist, haematologist and pharmacists to identify relevant randomized
controlled trials, meta-analyses and retrospective studies. Major society
guidelines were reviewed to further aid in developing the anticoagulation
protocol for non-valvular atrial fibrillation and venous thromboembolism
within this patient population. After reviewing the literature, a clinical
framework was designed to aid clinicians in the management of those
patients receiving abiraterone concurrently with an anticoagulant.
<br/>Result(s): In this review, we describe the potential interactions
between abiraterone and various anticoagulants and provide management
strategies based on the most recent literature for atrial fibrillation,
venous thromboembolism and mechanical heart valves to avoid potential
drug-drug interactions. <br/>Conclusion(s): Abiraterone therapy has become
a mainstay of the management of advanced prostate cancer and is often used
over prolonged years. In this review, we have summarized a framework of
how to use abiraterone in men with prostate cancer on anticoagulants.
Evidence available to date suggests that patients with an indication for
anticoagulation such as atrial fibrillation, venous thromboembolism and
mechanical heart valves can be treated safely with abiraterone in the
appropriate setting, with appropriate monitoring.<br/>Copyright &#xa9;
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<83>
Accession Number
627543711
Title
Use of Topical Antibiotics before Primary Incision Closure to Prevent
Surgical Site Infection: A Meta-Analysis.
Source
Surgical Infections. 20 (4) (pp 261-270), 2019. Date of Publication:
May-June 2019.
Author
Lopez-Cano M.; Kraft M.; Curell A.; Puig-Asensio M.; Balibrea J.;
Armengol-Carrasco M.; Garcia-Alamino J.M.
Institution
(Lopez-Cano, Kraft, Curell, Balibrea, Armengol-Carrasco) Department of
General Surgery, Abdominal Wall Surgery Unit, General and Digestive
Surgery Research Group, Institut de Recerca Vall d'Hebron (VHIR), Hospital
Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona
E-08035, Spain
(Puig-Asensio) Department of Infectious Diseases, Hospital Universitari
Vall d'Hebron, Barcelona, Spain
(Garcia-Alamino) DPhil Programme in Evidence-Based Healthcare, University
of Oxford, Oxford, United Kingdom
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Surgical site infections (SSIs) remains a concern for surgeons
because of the negative impact on outcomes and health care costs. Our
purpose was to assess whether topical antibiotics before primary incision
closure reduced the rate of SSIs. <br/>Method(s): Systematic review of
MEDLINE/PubMed, Scopus, CINAHL, and Web of Science databases from
inception to January 2017. Only randomized controlled trials (RCTs) were
retrieved. The primary outcome was the SSI rate. Meta-analysis was
complemented with trial sequential analysis (TSA). <br/>Result(s):
Thirty-five RCTs (10,870 patients) were included. Only beta-lactams and
aminoglycosides were used. A substantial reduction of the incidence of
SSIs with the application of antibiotic agents before incision closure
(risk ratio [RR] 0.49, 95% confidence interval [CI] 0.37-0.64) was found,
which remained in the analysis of 12 RCTs after removal of studies of
uncertain quality. The use of beta-lactams was effective to reduce SSI in
elective surgery only (RR 0.33, 95% CI 0.13-0.85). In clean-contaminated
fields and as an irrigation solution, beta-lactams did not reduce the risk
of SSI. Aminoglycosides were not effective (RR 0.74, 95% CI 0.49-1.10).
After TSA, the evidence accumulated was far below the optimal information
size. The heterogeneity of studies was high and methodological quality of
most RCTs included in the meta-analysis was uncertain. <br/>Conclusion(s):
Results of this meta-analysis show the data present in the literature are
not sufficiently robust and, therefore, the use of topical beta-lactams or
aminoglycosides before incision closure to reduce SSI cannot be
recommended or excluded.<br/>&#xa9; Copyright 2019, Mary Ann Liebert,
Inc., publishers 2019.

<84>
Accession Number
627543654
Title
Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and
Where Do We Go? A Systematic Review.
Source
Surgical Infections. 20 (4) (pp 253-260), 2019. Date of Publication:
May-June 2019.
Author
Jaworski R.; Kansy A.; Dzierzanowska-Fangrat K.; Maruszewski B.
Institution
(Jaworski, Kansy, Maruszewski) Department of Pediatric Cardiothoracic
Surgery, Children's Memorial Health Institute, Al. Dzieci Polskich 20,
Warszawa 04-730, Poland
(Dzierzanowska-Fangrat) Department of Clinical Microbiology and
Immunology, Children's Memorial Health Institute, Warsaw, Poland
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Prophylactic antibiotic therapy is given routinely in the
peri-operative period to prevent surgical site infection. However, in
pediatric cardiac surgery, an optimal schedule has not been defined.
Pediatric recommendations follow the guidelines for adults, which might be
improper because of the inherent challenges in pediatric research and the
heterogeneity of the population. Implementation of an effective
prophylaxis protocol is needed for children undergoing cardiac surgery,
especially in view of worldwide antibiotic overuse and the development of
drug resistance. In this review, we analyze the current knowledge
supported by up-to-date publications about antibiotic prophylaxis in
pediatric cardiac surgery. <br/>Method(s): The PubMed database
was searched for full-text journal articles describing peri-operative
antibiotic prophylaxis in pediatric cardiac surgery published since 2000.
Antibiotics used for standard prophylaxis with dosing schema, time of the
first dose, additional dosage in extracorporeal circulation (ECC) priming,
and prophylaxis duration were analyzed. Additionally, we looked for
special clinical situations such as antibiotic prophylaxis in children
with the sternum left open after surgery and patients with beta-lactam
allergy or pre-operative methicillin-resistant Staphylococcus aureus
(MRSA) colonization or those requiring extracorporeal membrane oxygenation
(ECMO). <br/>Result(s): A total of 1,546 articles were evaluated, and we
identified 20 for further analysis. On the basis of the current
peri-operative antibiotic prophylaxis recommendations for cardiac surgery
and the papers reviewed, we tried to propose a schedule for peri-operative
antibiotic prophylaxis in pediatric cardiac surgery. <br/>Conclusion(s):
There is a need for careful use and examination of the schedule proposed
because the pharmacokinetics of antibiotics in pediatric patients with ECC
is not fully understood. This should be evaluated further. Formulating
uniform recommendations concerning peri-operative antibiotic prophylaxis
is difficult.<br/>&#xa9; Copyright 2019, Mary Ann Liebert, Inc.,
publishers 2019.

<85>
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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2019 The Author(s).

<86>
Accession Number
627538529
Title
Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic
Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (2) (pp 90-116), 2019. Date of Publication: 01 Apr 2019.
Author
Ng C.S.H.; Macdonald J.K.; Gilbert S.; Khan A.Z.; Kim Y.T.; Louie B.E.;
Blair Marshall M.; Santos R.S.; Scarci M.; Shargal Y.; Fernando H.C.
Institution
(Ng) Chinese University of Hong Kong, Shatin, China
(Macdonald) Western University, London, ON, Canada
(Gilbert) University of Ottawa, ON, Canada
(Khan) Medanta, Medicity, Gurgaon, India
(Kim) Seoul National University Hospital, Chongro-Ku, South Korea
(Louie) Swedish Cancer Institute, Medical Center, Seattle, WA, United
States
(Blair Marshall) Georgetown University Hospital, Washington, DC, United
States
(Santos) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Scarci) San Gerardo Hospital, Monza, MB, Italy
(Shargal) St Joseph's Healthcare, MacMaster University, Hamilton, ON,
Canada
(Fernando) Inova Fairfax Medical Campus, Virginia Commonwealth University,
Falls Church, Richmond, VA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective Video-assisted thoracic surgery (VATS) lobectomy was introduced
over 25 years ago. More recently, the technique has been modified from a
multiport video-assisted thoracic surgery (mVATS) to uniportal (uVATS) and
robotic (rVATS), with proponents for each approach. Additionally most
lobectomies are still performed using an open approach. We sought to
provide evidence-based recommendations to help define the optimal surgical
approach to lobectomy for early stage non-small cell lung cancer. Methods
Systematic review and meta-analysis of articles searched without limits
from January 2000 to January 2018 comparing open, mVATS, uVATS, and rVATS
using sources Medline, Embase, and Cochrane Library were considered for
inclusion. Articles were individually scrutinized by ISMICS consensus
conference members, and evidence-based statements were created and
consensus processes were used to determine the ensuing recommendations.
The ACC/AHA Clinical Practice Guideline Recommendation Classification
system was used to assess the overall quality of evidence and the strength
of recommendations. Results and recommendations One hundred and forty-five
studies met the predefined inclusion criteria and were included in the
meta-analysis. Comparisons were analyzed between VATS and open, and
between different VATS approaches looking at oncological outcomes
(survival, recurrence, lymph node evaluation), safety (adverse events),
function (pain, quality of life, pulmonary function), and
cost-effectiveness. Fifteen statements addressing these areas achieved
consensus. The highest level of evidence suggested that mVATS is
preferable to open lobectomy with lower adverse events (36% versus 42%;
88,460 patients) and less pain (IIa recommendation). Our meta-analysis
suggested that overall survival was better (IIb) with mVATS compared with
open (71.5% versus 66.7% 5-years; 16,200 patients). Different VATS
approaches were similar for most outcomes, although uVATS may be
associated with less pain and analgesic requirements (IIb). Conclusions
This meta-analysis supports the role of VATS lobectomy for non-small cell
lung cancer. Apart from potentially less pain and analgesic requirement
with uVATS, different minimally invasive surgical approaches appear to
have similar outcomes.<br/>Copyright &#xa9; International Society for
Minimally Invasive Cardiothoracic Surgery. All rights reserved.

<87>
Accession Number
627538525
Title
Expert Consensus Statement on Optimal Approach to Lobectomy for Non-Small
Cell Lung Cancer.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (2) (pp 87-89), 2019. Date of Publication: 01 Apr 2019.
Author
Ng C.S.H.; Macdonald J.K.; Gilbert S.; Khan A.Z.; Kim Y.T.; Louie B.E.;
Blair Marshall M.; Santos R.S.; Scarci M.; Shargal Y.; Fernando H.C.
Institution
(Ng) Chinese University of Hong Kong, Hong Kong, Hong Kong
(Macdonald) Western University, London, ON, Canada
(Gilbert) University of Ottawa, C-Ontario, Canada
(Khan) Medanta, Medicity, Gurgaon, India
(Kim) Seoul National University Hospital, South Korea
(Louie) Swedish Cancer Institute, Medical Center, Seattle, WA, United
States
(Blair Marshall) Georgetown University Hospital, Washington, DC, United
States
(Santos) Hospital Israelite Albert Einstein, Sao Paulo, Brazil
(Scarci) San Gerardo Hospital, Monza, Italy
(Shargal) St Joseph's Healthcare, MacMaster University, Canada
(Fernando) Inova Fairfax Medical Campus, Virginia Commonwealth University,
Falls Church, VA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
A systematic review and meta-analysis to help define the optimal approach
for lobectomy for non-small cell lung cancer was undertaken. Articles
comparing thoracotomy (open), multi-port Video-assisted thoracic surgery
(mVATS), robotic VATS (rVATS), and uniportal VATS (uVATS) were scrutinized
and evidence-based statements using the American College of
Cardiology/American Heart Association clinical practice guideline
recommendations made.1 A total of 145 studies met the inclusion criteria
and the following 15 evidence-based statements achieved consensus.2 The
statements are as follows.<br/>Copyright &#xa9; International Society for
Minimally Invasive Cardiothoracic Surgery. All rights reserved.

<88>
[Use Link to view the full text]
Accession Number
624836590
Title
Perioperative use of levosimendan improves clinical outcomes in patients
after cardiac surgery: A systematic review and meta-analysis.
Source
Journal of Cardiovascular Pharmacology. 72 (1) (pp 11-18), 2018. Date of
Publication: 2018.
Author
Qiang H.; Luo X.; Huo J.-H.; Wang Z.-Q.
Institution
(Qiang, Huo) Department of Cardiovascular Medicine, First Affiliated
Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
(Luo, Wang) Department of Hematology, Tongji Hospital, Tongji University
School of Medicine, Shanghai, China
(Wang) Department of Cardiology, Xinhua Hospital, School of Medicine,
Shanghai Jiao Tong University, 1665 Kongjiang Rd, Shanghai 200092, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Severe postoperative complications can affect cardiac surgery patients.
Levosimendan is a novel calcium sensitizer commonly administered after
cardiac surgery. However, the patient benefits are controversial. PubMed,
Embase, and the Cochrane library were systematically searched for
randomized controlled trials comparing levosimendan with control in adult
cardiac surgery patients. Twenty-five studies (3247 patients) were
included. Pooled data indicated that levosimendan reduced mortality after
cardiac surgery [odds ratio (OR) 0.63, 95% confidence interval (CI):
0.47-0.84, P = 0.001]. However, this reduction was restricted to patients
with low (<50%) left ventricular ejection fraction (OR 0.49, 95% CI:
0.35-0.70, P = 0.0001). It significantly reduced the incidence of
postoperative acute kidney injury (OR 0.55, 95% CI: 0.41-0.74, P < 0.0001)
and renal replacement therapy use (OR 0.56, 95% CI: 0.39-0.80, P = 0.002).
Moreover, levosimendan significantly shortened the duration of the
intensive care unit stay (weighted mean differences 20.49 day, 95% CI:
20.75 to 20.24, P = 0.0002) and mechanical ventilation use (weighted mean
differences 22.30 hours, 95% CI: 23.76 to 20.84, P = 0.002). In
conclusion, levosimendan reduced the mortality in patients with low left
ventricular ejection fraction and decreased the incidence of acute renal
injury and renal replacement therapy use. In addition, it shortened the
duration of the intensive care unit stay and mechanical ventilation
use.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc. All rights
reserved.

<89>
Accession Number
620569838
Title
Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic
Stroke: Updated Meta-Analysis of Randomized Clinical Trials.
Source
American Journal of Medicine. 131 (5) (pp 575-577), 2018. Date of
Publication: May 2018.
Author
Vaduganathan M.; Qamar A.; Gupta A.; Bajaj N.; Golwala H.B.; Pandey A.;
Bhatt D.L.
Institution
(Vaduganathan, Qamar, Gupta, Bajaj, Golwala, Bhatt) Brigham and Women's
Hospital Heart & Vascular Center and Harvard Medical School, Boston, Mass,
United States
(Pandey) Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, Tex, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Patent foramen ovale closure represents a potential secondary
prevention strategy for cryptogenic stroke, but available trials have
varied by size, device studied, and follow-up. <br/>Method(s): We
conducted a systematic search of published randomized clinical trials
evaluating patent foramen ovale closure versus medical therapy in patients
with recent stroke or transient ischemic attack using PubMED, EMBASE, and
Cochrane through September 2017. Weighting was by random effects models.
<br/>Result(s): Of 480 studies screened, we included 5 randomized clinical
trials in the meta-analysis in which 3440 patients were randomized to
patent foramen ovale closure (n = 1829) or medical therapy (n = 1611) and
followed for an average of 2.0 to 5.9 years. Index stroke/transient
ischemic attack occurred within 6 to 9 months of randomization. The
primary end point was composite stroke/transient ischemic attack and death
(in 3 trials) or stroke alone (in 2 trials). Patent foramen ovale closure
reduced the primary end point (0.70 vs 1.48 events per 100 patient-years;
risk ratio [RR], 0.52 [0.29-0.91]; I² = 55.0%) and
stroke/transient ischemic attack (1.04 vs 2.00 events per 100
patient-years; RR, 0.55 [0.37-0.82]; I² = 42.2%) with modest
heterogeneity compared with medical therapy. Procedural bleeding was not
different between study arms (1.8% vs 1.8%; RR, 0.94 [0.49-1.83];
I² = 29.2%), but new-onset atrial fibrillation/flutter was
increased with patent foramen ovale closure (6.6% vs 0.7%; RR, 4.69
[2.17-10.12]; I² = 29.3%). <br/>Conclusion(s): In patients with
recent cryptogenic stroke, patent foramen ovale closure reduces recurrent
stroke/transient ischemic attack compared with medical therapy, but is
associated with a higher risk of new-onset atrial
fibrillation/flutter.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<90>
[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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2018 American Heart Association,
Inc.

<91>
[Use Link to view the full text]
Accession Number
623433971
Title
Percutaneous coronary intervention for treating de-novo lesions in small
coronary vessels: Initial experience with the Essential paclitaxel-coated
balloon.
Source
Coronary Artery Disease. 29 (6) (pp 477-481), 2018. Date of Publication:
01 Sep 2018.
Author
Abellas-Sequeiros R.A.; Benezet J.; Agarrado Luna A.; Oneto Otero J.; Dery
J.-P.; Cieza T.; Delarochelliere R.; Duocastella L.; Gomez A.; Molina M.;
Asmarats L.; Pelletier-Beaumont E.; Puri R.; Rodes-Cabau J.
Institution
(Abellas-Sequeiros, Dery, Cieza, Delarochelliere, Asmarats,
Pelletier-Beaumont, Puri, Rodes-Cabau) Quebec Heart and Lung Institute,
Laval University, 2725 Chemin Ste-Foy, Quebec City, QC, Canada
(Benezet, Agarrado Luna, Oneto Otero) Department of Cardiology, Hospital
de Jerez de la Frontera, Jerez de la Frontera Cadiz, Spain
(Duocastella, Gomez, Molina) IVascular, Barcelona, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Paclitaxel-coated balloon (PCB) coronary angioplasty is an
alternative treatment for de-novo coronary lesions in small vessels. This
study with the new Essential PCB aimed to evaluate early and mid-Term
clinical outcomes following angioplasty with the Essential PCB in the
treatment of de-novo lesions in small vessels. Patients and methods We
included all patients who underwent PCB angioplasty for treating de-novo
coronary lesions in small vessels (reference diameter <2.5 mm) between
October 2015 and June 2016 in 2 centres. The primary endpoint was the
12-month target lesion failure (TLF) rate: A composite of cardiac death,
target vessel-related myocardial infarction, and target lesion
revascularization. The secondary endpoints were rates of target vessel
failure and global major adverse cardiac events (MACE). Results A total of
71 patients (comprising 71 lesions) were included, with a mean age of
66+/-11 years. A 56% were diabetic and 70% had an acute coronary syndrome
as an indication for coronary revascularization. The mean vessel diameter
and lesion length were 2.21+/-0.41 and 20.7+/-9.2 mm, respectively.
Predilatation was performed in 85.9% of patients. The median diameter,
length, and inflation pressure of the Essential balloon were 2.0
[interquartile range (IQR): 2.0-2.5] mm, 20 (IQR: 15-30) mm, and 12+/-2
atmospheres, respectively. Angiographic success was achieved in 97.2% of
cases, and bail-out stenting was required in nine (12.7%) cases. The
incidence of TLF at the 12-month follow-up was 4.2%, with a target lesion
revascularization rate of 4.2%. Target vessel failure and global MACE
rates were 4.2 and 9.9%, respectively. Conclusion Use of the Essential PCB
for treating de-novo coronary lesions in small vessels was safe, with low
TLF and MACE rates at the 12-month follow-up.<br/>&#xa9; Copyright 2018
Wolters Kluwer Health, Inc. All rights reserved.

<92>
Accession Number
619909836
Title
Anticoagulation of pregnant women with mechanical heart valves: Protecting
mother or child?.
Source
European Heart Journal. 38 (19) (pp 1517-1519), 2017. Date of Publication:
14 May 2017.
Author
Verhamme P.; Herregods M.-C.; Van Dewerf F.
Institution
(Verhamme, Herregods, Van Dewerf) Division of Cardiovascular Diseases,
University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
Publisher
Oxford University Press

<93>
Accession Number
627546038
Title
Optimizing health before elective thoracic surgery: Systematic review of
modifiable risk factors and opportunities for health services research.
Source
Journal of Thoracic Disease. 11 (Supplement4) (pp S537-S554), 2019. Date
of Publication: 2019.
Author
Stokes S.M.; Wakeam E.; Antonoff M.B.; Backhus L.M.; Meguid R.A.; Odell
D.; Varghese T.K.
Institution
(Stokes) Division of General Surgery, Department of Surgery, University of
Utah, Salt Lake City, UT, United States
(Wakeam) Division of Thoracic Surgery, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson, Cancer Center, Houston, TX, United States
(Backhus) Division of Thoracic Surgery, Department of Cardiothoracic
Surgery, Stanford University, Stanford, CA, United States
(Meguid) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado, Aurora, CO, United States
(Odell) Division of Thoracic Surgery, Department of Surgery, Northwestern
University, Chicago, IL, United States
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Despite progress in many different domains of surgical care, we are still
striving toward practices which will consistently lead to the best care
for an increasingly complex surgical population. Thoracic surgical
patients, as a group, have multiple medical co-morbidities and are at
increased risk for developing complications after surgical intervention.
Our healthcare systems have been focused on treating complications as they
occur in the hopes of minimizing their impact, as well as aiding in
recovery. In recent years there has emerged a body of evidence outlining
opportunities to optimize patients and likely prevent or decrease the
impact of many complications. The purpose of this review article is to
summarize four major domains-optimal pain control, nutritional status,
functional fitness, and smoking cessation-all of which can have a
substantial impact on the thoracic surgical patient's course in the
hospital-as well as to describe opportunities for improvement, and areas
for future research efforts.<br/>Copyright &#xa9; Journal of Thoracic
Disease. All rights reserved.

<94>
Accession Number
624425119
Title
Normothermic versus hypothermic cardiopulmonary bypass in low-risk
paediatric heart surgery: A randomised controlled trial.
Source
Heart. 105 (6) (pp 455-464), 2019. Date of Publication: 01 Mar 2019.
Author
Caputo M.; Pike K.; Baos S.; Sheehan K.; Selway K.; Ellis L.; Stoica S.;
Parry A.; Clayton G.; Culliford L.; Angelini G.D.; Pandey R.; Rogers C.A.
Institution
(Caputo, Sheehan, Selway, Stoica, Parry, Pandey) Bristol Royal Hospital
for Children, University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Pike, Baos, Ellis, Clayton, Culliford, Rogers) Clinical Trials and
Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol,
United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To compare normothermic (35degreeC-36degreeC) versus hypothermic
(28degreeC) cardiopulmonary bypass (CPB) in paediatric patients undergoing
open heart surgery to test the hypothesis that normothermic CPB perfusion
maintains the functional integrity of major organ systems leading to
faster recovery. Methods Two single-centre, randomised controlled trials
(known as Thermic-1 and Thermic-2, respectively) were carried out to
compare the effectiveness and acceptability of normothermic versus
hypothermic CPB in children with congenital heart disease undergoing open
heart surgery. In both studies, the co-primary clinical outcomes were
duration of inotropic support, intubation time and postoperative hospital
stay. Results In total, 200 participants were recruited; 59 to the
Thermic-1 study and 141 to the Thermic-2 study. 98 patients received
normothermic CPB and 102 patients received hypothermic CPB. There were no
significant differences between the treatment groups for any of the
co-primary outcomes: Inotrope duration HR=1.01, 95% CI (0.72 to 1.41);
intubation time HR=1.14, 95% CI (0.86 to 1.51); postoperative hospital
stay HR=1.06, 95% CI (0.80 to 1.40). Differences favouring normothermia
were found in urea nitrogen at 2 days geometric mean ratio (GMR)=0.86 95%
CI (0.77 to 0.97); serum creatinine at 3 days GMR=0.89, 95% CI (0.81 to
0.98); urinary albumin at 48 hours GMR=0.32, 95% CI (0.14 to 0.74) and
neutrophil gelatinase-associated lipocalin at 4 hours GMR=0.47, 95% CI
(0.22 to 1.02), but not at other postoperative time points. Conclusions
Normothermic CPB is as safe and effective as hypothermic CPB and can be
routinely adopted as a perfusion strategy in low-risk infants and children
undergoing open heart surgery. Trial registration number
ISRCTN93129502.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019.

<95>
[Use Link to view the full text]
Accession Number
627376307
Title
Pharmacologic interventions for preventing delirium in adult patients
after cardiac surgery Protocol of a systematic review and network
meta-analysis.
Source
Medicine (United States). 97 (52) (no pagination), 2018. Article Number:
e13881. Date of Publication: 01 Dec 2018.
Author
Wen J.; Zeng H.; Li Z.; He G.; Jin Y.
Institution
(Wen) Shanghai University of Traditional Chinese Medicine, Shanghai, China
(Wen, Jin) Shanghai University of Medicine and Health Sciences, Pudong New
Area, Shanghai, China
(Zeng, Li) Second Clinical College of Guangzhou, University of Chinese
Medicine, Guangzhou, China
(He) First Clinical College of Guangzhou, University of Chinese Medicine,
Guangzhou, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Delirium is common in adult patients undergoing cardiac
surgery and related to a high morbidity and mortality. Although a variety
of pharmacologic interventions have been applied in delirium prevention,
there is still uncertainty concerning which drug is optimal. Thus, we plan
to conduct a systematic review and network meta-analysis (NMA) of
published studies to assess the efficacy and safety of pharmacologic
interventions for preventing delirium among those patients.
<br/>Method(s): A systematic literature search will be conducted in
Embase, PubMed, and the Cochrane Library. The primary outcome will be the
incidence of postoperative delirium. Secondary outcomes will include
all-cause mortality and length of hospital or intensive care unit stay. A
frequentist NMA will be conducted using Stata version 14.0. The
inconsistency between direct and indirect comparisons will be evaluated
using a node splitting method. In addition, surface under the cumulative
ranking area will be used to evaluate superiority of different treatments.
<br/>Result(s): The findings of our review will be submitted to a
peer-reviewed publication. <br/>Conclusion(s): Our study will generate
convincing evidence regarding the effectiveness and safety of different
pharmacologic interventions for delirium prevention in cardiac surgery
patients. Abbreviations: CI = confidence interval, GRADE = grading of
recommendations.<br/>Copyright &#xa9; 2018 the Author(s).

<96>
Accession Number
625756754
Title
Impact of Early versus Late Initiation of Renal Replacement Therapy in
Patients with Cardiac Surgery-Associated Acute Kidney Injury:
Meta-Analysis with Trial Sequential Analysis of Randomized Controlled
Trials.
Source
BioMed Research International. 2018 (no pagination), 2018. Article Number:
6942829. Date of Publication: 2018.
Author
Cui J.; Tang D.; Chen Z.; Liu G.
Institution
(Cui) Head and Neck Surgery, Affiliated Cancer Hospital, Institute of
Guangzhou Medical University, Guangdong Province 510095, China
(Tang) Department of General Surgery, Third Xiangya Hospital, Central
South University, Changsha, Hunan Province 410008, China
(Chen) Intensive Care Unit, Shunde Hospital, Southern Medical University,
Foshan, Guangdong Province 528300, China
(Liu) Department of Pathology, Affiliated Cancer Hospital, Institute of
Guangzhou Medical University, Guangzhou, Guangdong Province 510095, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Previous studies have examined the effect of the initiation
time of renal replacement therapy (RRT) in patients with cardiac
surgery-associated acute kidney injury (CSA-AKI), but the findings remain
controversial. The aim of this meta-analysis was to systematically and
quantitatively compare the impact of early versus late initiation of RRT
on the outcome of patients with CSA-AKI. Methods. Four databases (PubMed,
the Cochrane Library, ISI Web of Knowledge, and Embase) were
systematically searched from inception to June 2018 for randomized
clinical trials (RCTs). Two investigators independently performed the
literature search, study selection, data extraction, and quality
evaluation. Meta-analysis and trial sequential analysis (TSA) were used to
examine the impact of RRT initiation time on all-cause mortality (primary
outcome). The Grading of Recommendations Assessment Development and
Evaluation (GRADE) was used to evaluate the level of evidence. Results. We
identified 4 RCTs with 355 patients that were eligible for inclusion.
Pooled analyses indicated no difference in mortality for patients
receiving early and late initiation of RRT (relative risk [RR] = 0.61, 95%
confidence interval [CI] = 0.33 to 1.12). However, the results were not
confirmed by TSA. Similarly, early RRT did not reduce the length of stay
(LOS) in the intensive care unit (ICU) (mean difference [MD] = -1.04; 95%
CI = -3.34 to 1.27) or the LOS in the hospital (MD = -1.57; 95% CI = -4.62
to 1.48). Analysis using GRADE indicated the certainty of the body of
evidence was very low for a benefit from early initiation of RRT.
Conclusion. Early initiation of RRT had no beneficial impacts on outcomes
in patients with CSA-AKI. Future larger and more adequately powered
prospective RCTs are needed to verify the benefit of reduced mortality
associated with early initiation of RRT. Trial Registration. This trial is
registered with PROSPERO registration number CRD42018084465, registered on
11 February 2018.<br/>Copyright &#xa9; 2018 Jie Cui et al.

<97>
Accession Number
627648738
Title
Effect of early second level rehabilitation on the quality of life in
patients with coronary heart disease after coronary artery bypass
graftings.
Source
Minerva Medica. Conference: 3rd International Scientific and Educational
Conference "The Internationalization of Continuing Medical Education.
Prospection". Kazakhstan. 110 (Supplement 1) (pp 63-64), 2019. Date of
Publication: April 2019.
Author
Almukhanova A.B.; Zelenskaya Y.; Pivtsova A.M.
Institution
(Almukhanova) JSC National Medical University PhD, Department of Internal
Diseases Department No.2, Almaty, Kazakhstan
(Zelenskaya) JSC National Medical University Intern of Surgical Diseases
Department, Kazakhstan
(Pivtsova) JSC National Medical University Intern of Inernal Diseases No.2
Department, Almaty, Kazakhstan
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Due to the WHO, 17.9 million people die each year from CVDs,
an estimated 31% of all deaths worldwide. Medical and social portrait of a
patient with ACS who underwent CABG is as follows: a man (77.6%), age
group 50-69 years (75.9%), a resident of the city (71.6%). New
methodological solutions which are introduced every year contributes to
increased use of high-tech interventions in patients with coronary heart
disease. Despite this, the quality of life in patients after treatment
increases insignificant. One of the components of the economic damage, is
subjective profesional disability, due to which, majority of patients of
working age do not return to work. <br/>METHOD(S): The following
activities were carried out with all patients of the experimental group:
psychoprophylac-tic conversation, instruction on exercise therapy, which
included breathing exercises and physical exercises in the postoperative
period. The basis of the complex exercise therapy was taken by a set of
exercises on Aronov. The quality of life was assessed using the EuroQoL
questionnaire. Also we used a six-minute walk test. <br/>RESULT(S): There
are 30 patients took part in the study. Patients were randomly divided
into 2 groups. At discharge, the weight of the experimental group patients
was significantly less (P=0.02) than that of the control group patients.
Similarly, in the experimental group, patients with a heavier functional
class of heart failure (NYHA) moved to lighter functional classes, while
patients from the control group on the contrary-had a deterioration and
moved to a heavier NYHA functional class of heart failure. Also,
statistically significant results were at the self-care indicator in the
first day after patients were discharged from the intensive care unit to
the wards(P=0.049). Patients of the experimental group on the day of
discharge reliably(P=0.02) were more optimistic about their ability to
engage in their daily activities: the usual daily activities are not
difficult for 33.3% of patients of the experimental group and for 5.9% of
patients of the control group. Answer "I am not able to engage in my usual
daily activities" was chosen by 13.3% and 29.4% of patients of the
experimental and control groups, respectively. Unlike patients in the
control groups, patients in the experimental group assessed their mobility
a month after the operation as "not experiencing difficulties when
walk-ing"(78.6%) or as "experiencing minor difficulties when
walking"(21.4%), while patients in the control group assessed their
mobility as "not experiencing difficulties when walking"(40%) or as
"experiencing minor difficulties when walking"(33.3%), "experiencing
moderate difficulties when walking"(20%). and "I have great difficulty
walking" (6.7%). There was no answer "I can not walking" in any group.
<br/>CONCLUSION(S): The early cardiorehabilitation at the stationary level
is cost-effective, as for therapeutic exercises do not require specialized
equipment or devices, but these techniques have a significant impact on
the quality of life of patients in the early and late postoperative
period. The topic requires further detailed study with the inclusion of
more patients.

<98>
Accession Number
2001818170
Title
Initial results: The effect of a physiotherapy prehabilitation programme
on postoperative outcomes in patients undergoing cardiac or thoracic
surgery.
Source
Clinical Nutrition ESPEN. Conference: 7th World Congress of the ERAS
Society. United Kingdom. 31 (pp 111), 2019. Date of Publication: June
2019.
Author
Nolan F.; Lyon K.; Lambie N.
Institution
(Nolan, Lyon, Lambie) Rehabilitation, Golden Jubilee National Hospital,
Glasgow, United Kingdom
Publisher
Elsevier Ltd
Abstract
Objectives: Prehabilitation is a concept by which patients are physically
and mentally optimised prior to surgery. Patients who are referred for
surgery are placed on a waiting list. A window of opportunity is noted in
these patients where prehabilitation may have a role. We evaluated
preliminary results of our physiotherapy prehabilitation programme which
is currently recruiting. The aim is to determine whether a home based
physiotherapy prehabilitation programme improves patients' functional
capacity measured by a 6 minute walk test (6MWT)prior to surgery and
improve post-operative outcomes. <br/>Method(s): On acceptance for surgery
participants will be consented for the study. Following completion of
initial 6MWT participants will be randomised into prehabilitation or
standard care (SC). The prehabilitation group will be provided with
instructions in the use of a patient diary, pedometer, incentive
spirometer and a home-based exercise programme including walking and
simple breathing exercises. SC will receive standard preoperative
physiotherapy information. 6MWT will be repeated on admission, discharge
from physiotherapy and follow-up (6-8 weeks). Patients report their
perceived health via EQ-5D-5L questionnaire on discharge Results:
Recruitment for the pilot study is ongoing. All participants showed an
increase in functional capacity from baseline to preop. As expected both
groups had a drop in functional capacity in the postoperative in-patient
phase, however, the prehab group had less of a decrease in both Cardiac
and Thoracic groups There was a decrease in total hospital (2.5 days
decrease in Cardiac group and 1 day decrease in Thoracic group)and
physiotherapy length of stay (1.5 day decrease in both groups)in the
prehabilitation groups. <br/>Conclusion(s): Physiotherapy prehabilitation
may be the next step in revolutionising Enhanced Recovery in cardiac and
thoracic surgery to improve postoperative outcomes. Although a small
sample size initial results are very encouraging with prehabilitation
groups for both cardiac and thoracic showing a reduced physiotherapy and
hospital length of stay. Disclosure of Interest: None
declared.<br/>Copyright &#xa9; 2019

<99>
Accession Number
2001818143
Title
To pee or not to pee a trial to establish a valid method to determine if
the bladder function has returned during thoracic epidural analgesia
(TEA).
Source
Clinical Nutrition ESPEN. Conference: 7th World Congress of the ERAS
Society. United Kingdom. 31 (pp 110), 2019. Date of Publication: June
2019.
Author
de Vor S.; Bouwman H.; Abusaris C.
Institution
(de Vor, Abusaris) Anesthesiology, Wilhelmina Hospital Assen, Assen,
Netherlands
(Bouwman) Surgery, Wilhelmina Hospital Assen, Assen, Netherlands
Publisher
Elsevier Ltd
Abstract
Objectives: To investigate a valid method in enhanced recovery after
surgery (ERAS)patients of bladder function during the use of TEA in order
to reduce the risk of development of an urinary tract infection. The
method investigated is to use an ice cube positioned on the Sacral 2
(S2)dermatome, which could determine whether the bladder function has
recovered or not. The bladder sphincter, which gives active control over
micturition function, is innervated by the same nerves that also innervate
the S2 dermatome. <br/>Method(s): Between November 2016 and February 2017,
a total of 12 patients, with TEA were included. We hypothesized, that if
sensation of the S2 dermatome (posteromedial side of the knee)has returned
to normal, as indicated by correctly recognizing cold sensation from an
ice-cube, then the micturition function should have returned, and the
urinary catheter could be removed. Checking for urinary retention was done
using ultrasound. <br/>Result(s): None of the patients in the study group
developed urinary retention. In addition, the bladder catheter could be
removed on average 20 hours earlier than described by Allen et
al¹, and even the first postoperative day, which is a reduction
of in-situ-time of 37%. <br/>Conclusion(s): Based on the results of this
trial, we recommend implementation of this method, testing the S2
dermatome in patients with a properly functioning TEA once they return to
the general ward. To implement this safely, we believe it is essential
that an ultrasound guided bladder scan protocol is established. The
benefit is that the patient still has effect from a working TEA after
removal of the urinary catheter. According to our results, the tested
method shows that no bladder retention is present with a positive ice-cube
test. Studies showed 31% required more intermittent catheterization if the
urinary catheter is removed within 48 hours and no test is performed.
Reference 1. Allen, Mark S., et al. "Optimal timing of urinary catheter
removal after thoracic operations: a randomized controlled study." The
Annals of thoracic surgery 102.3 (2016): 925-930. Disclosure of Interest:
None declared.<br/>Copyright &#xa9; 2019

<100>
Accession Number
627648866
Title
Ultrasound-guided versus fluoroscopy-guided femoral artery access in
transfemoral transcatheter aortic valve replacement using the medtronic
corevalve system: Single centre experience.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e24), 2018. Date of Publication: October 2018.
Author
Bettari L.; Maffeo D.; Maiandi C.; Zanotti L.; Leonzi L.; Cuccia C.
Institution
(Bettari, Maffeo, Maiandi, Leonzi, Cuccia) UO Cardiologia, Fondazione
Poliambulanza, Brescia, Italy
(Zanotti) UO Oncologia, Fondazione Poliambulanza, Brescia, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Driven by the clinical need for insertion of large-caliber
access sheaths in TAVR, vascular complications have been the most
frequently reported complication in transfemoral valve implant due to the
large-sized sheath needed to deliver the device. More importantly, this is
associated with major postprocedural morbidity and mortality and increased
length of hospital stay. Objectives. The best techniques for reduction of
femoral access site complications after transcatheter aortic valve
replacement (TAVR) remain the object of research. Aim. We report on a
single-center experience with TAVR performed via femoral access site using
ultrasound-guided versus fluoroscopy-guided femoral artery access.
Methods. Between October 2017 and July 2018, 92 consecutive patients
underwent TAVR in our department. All of them with CoreValve implant from
the femoral access site were included in the analysis. The
ultrasound-guided femoral artery access and cross-over technique was
introduced in order to reduce the rate of access-site complications.
Patients were randomly assigned to ultrasound-guided versus
fluoroscopy-guided femoral artery access. Results. The study patients were
divided into two subgroups: group A - patients treated with
fluoroscopy-guided femoral artery access (n=46); and group B - patients
treated with ultrasound-guided femoral artery access (n=46). No
significant difference between baseline characteristics of the 2 groups
was reported. No difference in VARC, haemotransfusion, haemoglobin
variation was noted. However mean glomerular filtration rate (GFR)
significantly decreased in group A compared to group B - 2.59 vs 0.8
ml/min (p<0.0021). Also, fluoroscopy time significantly decreased from
54.95 to 21.11 (p<0.0039) minutes, and procedure time significantly
decreased from 98.65 to 76.3 minutes (p<0.0002). In-hospital and 30-day
mortality was zero in both groups. Conclusions. Ultrasound-guided femoral
artery access did not reduce the incidence of access site complications in
TAVR patients. However, it significantly reduced fluoroscopy time,
procedure time, and worsening renal function. Further studies with larger
populations are warranted to determine if this approach could potentially
reduce morbidity and mortality.

<101>
Accession Number
627648717
Title
Periprocedural myocardial injury predicts short and long-term mortality in
patients undergoing transcatheter aortic valve implantation.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e23), 2018. Date of Publication: October 2018.
Author
Montone R.A.; Niccoli G.; Michail M.; Nerlekar N.; Ha F.J.; McCormick L.;
Brown A.J.; Crea F.
Institution
(Montone, Niccoli, Crea) Fondazione Policlinico A. Gemelli IRCCS, Rome,
Italy
(Michail, Nerlekar, Ha, McCormick, Brown) Monash Cardiovascular Research
Centre and Monash Heart, Monash Health, Melbourne, Australia
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Objectives. To assess whether periprocedural myocardial injury (PPMI)
predicts outcomes in patients undergoing transcatheter aortic valve
replacement (TAVR). Background. PPMI is a strong predictor of outcomes
following coronary intervention, but its impact in the context of TAVR
remains unclear. We performed a systematic review and meta-analysis to
ascertain the association between PPMI and short or long-term clinical
outcomes. Methods. Electronic searches identified studies reporting PPMI
following TAVR. Primary endpoint was 30-day all-cause mortality, with
secondary endpoints including 1-year all-cause mortality, neurological
events, post-TAVR pacemaker implantation and aortic regurgitation (AR).
Analyses were performed using random effects modelling and reported as
summary odds ratio (OR) with 95% confidence intervals (CI). Results. Nine
studies comprising 3,442 patients (mean age 81.0+/-6.6 years, 51.2%
female) were included. PPMI occurred in 25.5% of patients following TAVR.
The pooled all-cause mortality at 30 days and 1 year was 5.2% and 18.6%,
respectively. The occurrence of PPMI following TAVR was associated with
significantly increased risk of both 30-day (OR 4.23, CI 1.95-9.19,
p<0.001) and 1-year all-cause mortality (OR 1.77, CI 1.05-2.99, p<0.001).
Similarly, PPMI was associated with post-TAVR neurological events (OR
2.72, CI 1.69-4.37, p<0.001) and post-TAVR need for permanent pacing (OR
1.43, CI 1.02-2.00, p=0.04), but not with statistically significant
increase in AR post-TAVR (OR 1.39, CI 0.93-2.08, PVL (p=0.11).
Conclusions. PPMI is common following TAVR and is strongly associated with
30-day and 1-year mortality, with occurrence of post-TAVR neurological
events and need for permanent pacemaker implantation. Detection of PPMI
has potential to identify TAVR patients at highest risk of subsequent
adverse events.

<102>
Accession Number
627649211
Title
Incidence, predictors and cerebrovascular consequences of leaflet
thrombosis after transcatheter aortic valve implantation: A systematic
review and meta-analysis.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e4-e5), 2018. Date of Publication: October 2018.
Author
Saglietto A.; Cortese M.; Salizzoni S.; Conrotto F.; D'Ascenzo F.; D'Amico
M.
Institution
(Saglietto, Cortese, Conrotto, D'Ascenzo, D'Amico) Divisione di
Cardiologia, Dipartimento di Scienze Mediche, Citta della Salute e della
Scienza, Torino, Italy
(Salizzoni) Divisione di Cardiochirurgia, Dipartimento di Scienze
Chirurgiche, Citta della Salute e della Scienza, Torino, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction. Incidence, impact of subsequent cerebrovascular events and
clinical or procedural predictors of leaflet thrombosis (LT) for patients
undergoing transcatheter aortic valve implantation (TAVI) remain to be
defined. Methods. MEDLINE/PubMed was systematically screened for studies
reporting data on LT in TAVI patients. LT incidence (both clinical and
subclinical, that is detected with computed tomography-CT) was the primary
endpoint of the study. Predictors of LT evaluated at multivariate analysis
and impact of LT on stroke were the secondary ones. Results. Fifteen
studies encompassing 9133 patients evaluating incidence of LT were
included. Pooled incidence of LT was 0.37 events per 100 person-month
(0.17-0.62, I²=97%). Pooled incidence of subclinical LT was
1.98 events per 100 person-months (95% CI 0.69-3.83, I²=95%).
Clinical LT was less frequent (0.04 events per 100 personmonths, 95% CI
0.00-0.19, I²=93%). LT increased risk of stroke (OR 6.99,
2.3-21.29), and was more frequent in patients with valve of 28 mm of
diameter (OR 2.89, 1.55-5.8), for balloon expandable (OR 8, 2.1-9.7) or
after valve-in-valve procedures (OR 17.1, 3.1-84.9). Oral anticoagulation
therapy (OAT) both reduced risk of LT (OR 0.33, 0.17-0.67,
I²=55%, all CI 95%) and restore normal mean transvalvular
gradient after LT diagnosis. Conclusions. LT represents an infrequent
event after TAVI, although increasing risk of stroke. Given its full
reversal with warfarin, in high-risk patients (those with valve in valve
procedures, balloon expandable or large-size devices) a protocol with
control CT appears reasonable to tailor a patient-specific antithrombotic
therapy.

<103>
Accession Number
627649783
Title
Physiological versus angiographic guidance for myocardial
revascularization in patients undergoing transcatheter aortic valve
implantation.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e10), 2018. Date of Publication: October 2018.
Author
Lunardi M.; Scarsini R.; Venturi G.; Pesarini G.; Gratta A.; Piccoli A.;
Ferrero V.; Ribichini F.
Institution
(Lunardi, Scarsini, Venturi, Pesarini, Gratta, Piccoli, Ferrero,
Ribichini) Divisione di Cardiologia, Universita degli Studi di Verona,
Verona, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Management of coronary artery disease (CAD) in patients
undergoing transcatheter aortic valve implantation (TAVI) is uncertain.
Fractional flow reserve (FFR) has never been validated in aortic stenosis
(AS). Safety of deferring negative FFR coronary lesions in AS is not
established. Objectives. The study aim was to investigate FFR-guided
revascularization in TAVI patients, with focus on clinical outcome of
deferred patients (FFR negative: >0.80). Methods. Patients with severe AS
(n=413) underwent coronary angiography during workup for TAVI between
March 2010 and November 2017. Patients with significant CAD (coronary
narrowing >50% in the proximal segment of the main coronary branches) were
included in this retrospective analysis and divided into two groups:
angiographicallyguided (109/192, 56.8%) vs FFR-guided revascularization
(83/192, 43.2%), and followed for 24 months. Results. Most lesions in the
FFR group resulted negative (96/125, 77%) and were deferred. Less patients
were treated with PCI in the FFR-guided group (23% vs 32%) with a
significantly better MACCE-free survival compared with the angio-guided
group (94% vs. 83.5%, p=0.024). A similar effect was observed in deferred
patients against those who underwent angio-guided treatment (96.9% vs.
71.4%, p<0.001). When the clinical outcome of deferred patients with FFR
values between 0.75-0.85 was compared with those with FFR >0.85, no
significant difference was observed (MACCE-free 94.1% vs. 95.3%, p=0.83).
Conclusions. FFR-guided revascularization in patients undergoing TAVI is
safe (94% MACCE-free survival at 24 months). Prospective randomized trials
are needed to better investigate the long-term effects of FFR-guided
revascularization against angiographic guidance alone in patients with AS.

<104>
Accession Number
627649768
Title
Predictors of target lesion failure after drug-eluting stents implantation
at 5-year follow-up.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e41), 2018. Date of Publication: October 2018.
Author
Paradies V.; Smits P.C.; Vlachojannis G.J.; Rooyards K.J.; Wassing J.; Van
Der Ent M.
Institution
(Paradies) Ospedale San Paolo, Bari, Italy
(Smits, Vlachojannis, Rooyards, Wassing, Van Der Ent) Maasstad Hospital,
Rotterdam, Netherlands
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. The objective of this study was to define the incidence and
predictors of target lesion failure (TLF) after drug-eluting stent (DES)
implantation at long term follow-up. Methods. Patient-level data from
Compare trials were pooled (n= 4506 patients). Compare I and II trials
were prospective, randomized controlled clinical trials comparing
everolimus eluting stents (EES) to placlitaxeleluting stents (PES) and EES
to biolimus-eluting (BES), respectively. TLF was defined as cardiac death,
target-vessel related MI or clinical indicated Target Lesion
Revascularization (TLR). Baseline clinical, procedural and angiographic
characteristics in the overall pooled population were analyzed for
associations with TLF at univariate analysis. A multiple logistic
regression analysis was then performed. Results. TLF occurred in 586 out
of 3920 patients (14.9%) at 5 years follow-up. At multiple logistic
regression analysis the presence of diabetes mellitus, renal failure,
previous coronary artery revascularization and ostial lesions were
identified as independent predictors of TLF. Conclusions. In this large
pooled analysis of patients undergoing percutaneous coronary intervention
with DES, the incidence of TLF at 5 years follow-up is still relevant.
Clinical as well as angiographic independent predictors can be identified.

<105>
Accession Number
627649722
Title
Optimal medical therapy vs. coronary revascularization for patients
presenting with chronic total occlusion: A meta-analysis of randomized
controlled trials and propensity score adjusted studies.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e9), 2018. Date of Publication: October 2018.
Author
Piazza F.; Iannaccone M.; Debenedictis M.; Garbo R.; Doronzo B.; D'Ascenzo
F.
Institution
(Piazza, Iannaccone, Debenedictis, Doronzo) SS. Annunziata Hospital, ASL
CN 1, Savigliano, Italy
(Garbo) Ospedale S.G. Bosco, Torino, Italy
(D'Ascenzo) Citta della Scienza e dalla Salute Hospital, University of
Turin, Department of Cardiology, Turin, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction. The optimal management of patients with coronary chronic
total occlusions (CTO) remains controversial. This meta-analysis aims to
compare percutaneous coronary intervention of CTO (CTO-PCI) versus optimal
medical therapy (OMT) in CTO patients. Methods. A literature search with
highly specific terms was conducted using MEDLINE, EMBASE, and Web of
Science to identify most relevant randomized controlled trials (RCTs) and
observational studies with propensity score matching (PSMs) evaluating
differences in between CTO-PCI versus OMT. The primary endpoint was the
incidence of major adverse cardiac events (MACEs, composite of
cardiovascular death, acute coronary syndrome, and repeat PCI, re-PCI)
while its single components were defined as secondary endpoints. Results.
A total of 8 studies was included, 4 RCTs and 4 PSMs. 3971 patients were
included in the analysis (2050 CTO-PCI versus 1921 OMT) with a mean
follow-up of 3 years. No significant differences were found regarding
overall MACE, whereas a significant reduction of CV death only was found
in the CTO-PCI patients (OR 0.52, 0.33-0.81, p<0.01). Conclusions. As
compared to OMT, CTO-PCI was associated with a significant reduction in CV
mortality at 3 years.

<106>
Accession Number
627649611
Title
PCI or CABG in left main coronary artery disease: A comprehensive
meta-analysis of adjusted observational studies and randomized controlled
trials.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e39), 2018. Date of Publication: October 2018.
Author
De Filippo O.; D'Ascenzo F.; Bertaina M.; Iannaccone M.; Colombo A.; Stone
G.; Serruys P.; Mancone M.; Omede P.; Conrotto F.; Pennone M.; Kimura T.;
Kawamoto H.; Biondi Zoccai G.; Sheiban I.; Templin C.; Benedetto U.;
Cavalcante R.; Gaudino M.; Moretti C.; Gaita F.; D'Amico M.
Institution
(De Filippo, D'Ascenzo, Bertaina, Iannaccone, Omede, Conrotto, Pennone,
Moretti, Gaita, D'Amico) Dipartimento Di Cardiologia, AOU Citta della
Salute e della Scienza, Torino, Italy
(Colombo, Kawamoto) Interventional Cardiology,Cardio-Thoracic-Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Stone) Cardiovascular Research and Education Columbia University Medical
Center, New York, United States
(Serruys, Cavalcante) Department of Interventional Cardiology, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mancone) Department of
Cardiovascular,Respiratory,Nephrology,Anesthesiology and Geriatric
Sciences, Sapienza University of Rome, Roma, Italy
(Kimura) Department of Cardiovascular Medicine, Kyoto University, Kyoto,
Japan
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Sheiban) Cardiology Department, Pederzoli Hospital, Verona, Italy
(Templin) University Heart Center, Department of Cardiology, University
Hospital Zurich, Zurich, Switzerland
(Benedetto, Gaudino) Bristol Heart Institute, University of Bristol,
School of Clinical Sciences, Bristol, United Kingdom
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Treatment of patients with ULMCA (unprotected left main
coronary artery disease) with percutaneous coronary intervention (PCI) has
been compared with coronary artery bypass graft (CABG), without conclusive
results. Methods. 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
allcause 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. Subgroup analyses were
performed according to Syntax score. Results. 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), while 2.13% (1.28-2.98: all 95% CI) of patients
experienced stent thrombosis. Conclusion. 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.

<107>
Accession Number
627649580
Title
Angiographic and mid-term clinical outcomes of bioresorbable vascular
scaffold for coronary bifurcation lesions. Data from maasstad hospital.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e38), 2018. Date of Publication: October 2018.
Author
Paradies V.; Vlachojannis G.J.; Rooyards K.J.; Wassing J.; Van Der Ent M.;
Smits P.C.
Institution
(Paradies) Ospedale San Paolo, Bari, Italy
(Vlachojannis, Rooyards, Wassing, Van Der Ent, Smits) Maasstad Hospital,
Rotterdam, Netherlands
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. The objective of this study was to define the incidence and
predictors of target lesion failure (TLF) after drug-eluting stent (DES)
implantation at long term follow-up. Methods. Patient-level data from
Compare trials were pooled (n= 4506 patients). Compare I and II trials
were prospective, randomized controlled clinical trials comparing
everolimus eluting stents (EES) to placlitaxeleluting stents (PES) and EES
to biolimus-eluting (BES), respectively. TLF was defined as cardiac death,
target-vessel related MI or clinical indicated Target Lesion
Revascularization (TLR). Baseline clinical, procedural and angiographic
characteristics in the overall pooled population were analyzed for
associations with TLF at univariate analysis. A multiple logistic
regression analysis was then performed. Results. TLF occurred in 586 out
of 3920 patients (14.9%) at 5-year follow-up. At multiple logistic
regression analysis the presence of diabetes mellitus, renal failure,
previous coronary artery revascularization and ostial lesions were
identified as independent predictors of TLF. Conclusions. In this large
pooled analysis of patients undergoing percutaneous coronary intervention
with DES, the incidence of TLF at 5 years follow-up is still relevant.
Clinical as well as angiographic independent predictors can be identified.

<108>
Accession Number
627649505
Title
Beta-blocker therapy reduces mortality in patients with coronary artery
disease treated with percutaneous revascularization: A meta-analysis of
adjusted results.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e38), 2018. Date of Publication: October 2018.
Author
Peyracchia M.; Errigo D.; Raposeiras-Rubin S.; Conrotto F.; DiNicolantonio
J.J.; Omede P.; Iannaccone M.; Moretti C.; D'Amico M.
Institution
(Peyracchia, Errigo, Conrotto, Omede, Iannaccone, Moretti, D'Amico)
Division of Cardiology, Department of Internal Medicine, Citta della
Salute e della Scienza, Turin, Italy
(Raposeiras-Rubin) Department of Cardiology and Coronary Care Unit,
Hospital Clinico Universitario De Santiago De Compostela, Santiago De
Compostela, A Coruna, Spain
(DiNicolantonio) Saint Luke's Mid America Heart Institute, Kansas City,
MI, United States
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Aims. The long-term impact of beta-blockers (BB) on prognosis in patients
treated with contemporary therapies for coronary artery disease (CAD)
remains to be defined. Methods and Results. All observational studies
evaluating the impact of BB in patients treated with coronary
revascularization and contemporary therapies and adjusted with
multivariate analysis were included. All-cause death was the primary
endpoint, while major adverse cardiac events (MACE) (composite endpoint of
all cause death or myocardial infarction, MI) and myocardial infarction
were secondary endpoints. 26 studies were included, with 863335 patients.
After 3 (1-4.3) years, long-term risk of allcause death was lower in
patients on BB (odds ratio, OR 0.69 [0.66- 0.72]), both for acute coronary
syndrome (ACS) (OR 0.60 [0.56-0.65]), and stable angina patients (OR 0.84
[0.78-0.91]), independently from EF (OR 0.64 [0.42-0.98] for reduced EF
and OR 0.79 [0.69-0.91] for preserved EF). The risk of long-term MACE was
lower but not significant for ACS patients treated with BB (OR 0.83
[0.69-1.00]), as in stable angina. Similarly, risk of MI did not differ
between patients treated with BB or without BB. (OR 0.99 [0.89-1.09], all
CI 95%). Using meta-regression analysis, the benefit of BB was increased
for those with longer follow-up. The number needed to treat (NNT) was 52
to avoid 1 event of all cause death for ACS patients and 111 for stable
patients. Conclusion. Even in PCI era, BB reduce mortality in patients
with CAD, confirming their protective effect, which was consistent for
both ACS and stable patients indifferently of preserved or reduced EF.

<109>
Accession Number
627649474
Title
Outcomes of percutaneous coronary interventions in cardiac transplantation
patients: A meta-analysis of 21 studies with 1031 patients.
Source
Giornale Italiano di Cardiologia. Conference: 39. Congresso Nazionale
della Societa Italiana di Cardiologia Interventistica, GISE. Italy. 10
(Supplement 2) (pp e8), 2018. Date of Publication: October 2018.
Author
Vadala P.; D'Ascenzo F.; Hammad S.; Omede P.; Montefusco A.; Barbero C.;
Conrotto F.; Moretti C.; Marra W.G.; Pidello S.; Rinaldi M.; Boffini M.;
Tobis J.; Benza R.; Tarantini G.; D'Amico M.
Institution
(Vadala, D'Ascenzo, Hammad, Omede, Montefusco, Barbero, Conrotto, Moretti,
Marra, Pidello, Rinaldi, Boffini, D'Amico) Division of Cardiology,
Department of Internal Medicine, Citta della Salute e della Scienza,
Torino, Italy
(Tobis) Division of Cardiology, UCLA Medical Center, Los Angeles, United
States
(Benza) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, United States
(Tarantini) Department of Cardiac, Thoracic, and Vascular Sciences,
University of Padova Medical Center, Padova, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction. Outcomes of patients with orthotopic heart transplantation
(OHT) undergoing percutaneous coronary intervention (PCI) remain to be
defined, especially according to kind of stent and to use of intracoronary
imaging. Methods. All studies evaluating the impact of PCI on OHT patients
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 its components along with
cardiovascular death were the secondary ones Meta-regression analysis was
used to assess the impact of coronary stent medications (everolimus and
sirolimus), of IVUS, and of anti-reject drugs on TLR. Results. 21 studies
with 1031 patients were included, with a median time from OHT of 7.1 years
(6.5-8.7). Elective angiographic control was the most frequent indication
(65% of patients): multivessel disease was reported in 38.8% (28.9-39.0),
IVUS was used in 57% (29-80) and drug eluting stents (DES) were implanted
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]. At meta-regression, IVUS reduced TLR (-0.035:-0.045:-0.021),
while the type of antiproliferative drug coating the stents or the
adjunctive immunosuppressant therapy did not impact subsequent
revascularization. Conclusion. Patients with OHT undergoing PCI are at
high risk of recurrent revascularization, which are 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.

<110>
[Use Link to view the full text]
Accession Number
627641295
Title
Anesthesia for predelivery procedures: ex-utero intrapartum
treatment/intrauterine transfusion/surgery of the fetus.
Source
Current opinion in anaesthesiology. 32 (3) (pp 291-297), 2019. Date of
Publication: 01 Jun 2019.
Author
Weber S.U.; Kranke P.
Institution
(Weber) Department of Anesthesiology and Intensive Care Medicine, Heilig
Geist-Krankenhaus Koln
(Weber) Department of Anesthesiology and Intensive Care Medicine,
University of Bonn, Bonn, Germany
(Kranke) Department of Anesthesia and Critical Care Medicine, University
Hospital of Wurzburg, Wurzburg, Germany
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: The aim of this study was to review the current
literature on anesthesia for predelivery procedures and to summarize
recent findings on anesthesiological methods used. RECENT FINDINGS:
Ex-utero intrapartum treatment (EXIT)-procedures are performed to secure
the newborn's oxygenation in case of severe airway obstruction due to
multiple conditions. A key feature of EXIT is continued intactness of the
maternofetal circulation by uterine relaxation achieved by general
anesthesia with high doses of anesthetic gases. A dose reduction may be
achieved by combining inhaled anesthesia with propofol. After intrauterine
transfusion the anesthesia team needs to be prepared for a potential need
of emergency cesarean section. Temporary fetal endoluminal tracheal
occlusion and laser coagulation for twin-to-twin transfusion syndrome may
be either performed in monitored anesthesia care or neuraxial anesthesia.
Neuraxial anesthesia also is a method of choice for fetal valvuloplasty
and amniotic band release. Fetal myelomenigocele repair requires general
anesthesia with tocolysis. SUMMARY: Predelivery procedures require a
differentiated anesthesia approach depending on the invasiveness of the
intervention. Anesthesia ranges from monitored care to neuraxial
anesthesia and general anesthesia. Depending on the procedure uterine
relaxation and fetal immobilization are crucial for technical success.
Interdisciplinary consultation optimizes the anesthesia plan for complex
procedures.

<111>
[Use Link to view the full text]
Accession Number
627640370
Title
What is the state of hybrid coronary revascularization in 2018?.
Source
Current opinion in cardiology. 33 (5) (pp 540-545), 2018. Date of
Publication: 01 Sep 2018.
Author
Yanagawa B.; Hong K.; Cheema A.; Bagai A.; Verma S.
Institution
(Yanagawa, Hong, Verma) Divisions of Cardiac Surgery, Austria
(Cheema, Bagai) Cardiology, St Michael's Hospital, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Hybrid coronary revascularization (HCR) combines
minimally invasive surgical bypass with percutaneous coronary intervention
(PCI) using drug-eluting stents, the goal being to leverage the strengths
of each approach. Here we provide an update on HCR from the past 12
months. RECENT FINDINGS: HCR represents a minority of surgical
revascularization cases from a small number of highly experienced surgical
centers. Most single-center observational series show no differences in
major cardiovascular outcomes comparing HCR and coronary artery bypass
graft (CABG) or HCR and PCI. The 5-year results of the first randomized
study comparing HCR to CABG reported no difference in all-cause mortality,
myocardial infarction, and repeat revascularization. Comparing HCR with
multivessel PCI, a large, prospective observational study reported no
difference in risk-adjusted major adverse cardiovascular events at 12
months. The Hybrid Coronary Revascularization Trial is an international,
multicenter, randomized controlled trial to compare HCR versus PCI for
patients with proximal left anterior descending disease or left main
disease. This trial is currently recruiting patients. SUMMARY: HCR is a
potentially attractive alternative to both surgical revascularization and
multivessel PCI when performed in experienced centers for highly selected
patients. The results of a large, multicenter, prospective trial will
provide greater clarity on the clinical role and optimal coronary anatomy
for this third revascularization option.

<112>
[Use Link to view the full text]
Accession Number
627640290
Title
Diabetes and multivessel disease: coronary artery bypass grafting remains
king.
Source
Current opinion in cardiology. 33 (5) (pp 551-557), 2018. Date of
Publication: 01 Sep 2018.
Author
Godoy L.C.; Rao V.; Farkouh M.E.
Institution
(Godoy, Farkouh) Peter Munk Cardiac Centre and Heart and Stroke Richard
Lewar Centre, University of Toronto, Toronto, Canada
(Godoy) Instituto do Coracao (InCor), Faculdade de Medicina FMUSP,
Universidade de Sao Paulo, Sao Paulo, SP, Brazil
(Rao) Peter Munk Cardiac Centre and Toronto General Research Institute,
Division of Cardiovascular Surgery, Toronto General Hospital, Canada
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Review the recently published scientific evidence to
support the decision-making process of revascularization strategy in
patients with diabetes mellitus (DM) and multivessel coronary artery
disease (MVD). RECENT FINDINGS: Recently published observational analyses
have proven the superiority of coronary artery bypass grafting (CABG) in
patients presenting with other comorbidities together with DM, such as
renal disease or heart failure. SUMMARY: Significant challenges and
controversies surrounded the choice of the appropriate revascularization
method in patients with DM and MVD over the last decades. FREEDOM trial
was the first adequately powered randomized study to directly compare
percutaneous coronary intervention (PCI) versus CABG in the DM population,
showing the superiority of CABG in the long-term follow-up. Subsequently,
other studies confirmed that CABG is also preferable over PCI in diabetic
patients with particular comorbidities, such as renal failure and left
ventricular dysfunction, and also in patients with type 1 DM and in the
setting of an early acute coronary syndrome. Finally, in 2018, an
individual level data meta-analysis reported an expressive reduction in
all-cause mortality when comparing CABG versus PCI in patients with DM and
MVD enrolled in the most recent clinical trials (hazard ratio 1.44, 95%
confidence interval 1.20-1.74, P = 0.0001).

<113>
Accession Number
627643364
Title
Low-frequency ventilation during cardiopulmonary bypass for lung
protection: A randomized controlled trial.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 02
May 2019.
Author
Fiorentino F.; Jaaly E.A.; Durham A.L.; Adcock I.M.; Lockwood G.; Rogers
C.; Ascione R.; Reeves B.C.; Angelini G.D.
Institution
(Fiorentino, Lockwood) Department of Surgery & Cancer, Imperial College
London, London, United Kingdom
(Jaaly, Rogers, Ascione, Reeves, Angelini) Department of Cardiac Surgery,
Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary,
Bristol, United Kingdom
(Durham, Adcock) Department of Cardiac Surgery, National Heart & Lung
Institute, Imperial College London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Pulmonary dysfunction is a common complication in patients
undergoing heart surgery. Current clinical practice does not include any
specific strategy for lung protection. To compare the anti-inflammatory
effects of low-frequency ventilation (LFV), as measured by nuclear factor
kappa-light-chain-enhancer of activated B cells (NF-kappaB) p65 pathway
activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left
collapsed in patients undergoing coronary artery bypass grafting (CABG).
<br/>METHOD(S): Two groups parallel randomized controlled trial. The
primary outcome was inflammation measured by NF-kappaB p65 activation in
pre- and post-CPB lung biopsies. Secondary outcomes were additional
inflammatory markers in both biopsy tissue and blood. <br/>RESULT(S):
Thirty-seven patients were randomly allocated to LFV (18) and to both
lungs left collapsed (19). The mean concentration of NF-kappaB p65 in the
biopsies before chest closure (adjusted for pre-CPB concentration) was
higher in the LFV group compared to both lungs left collapsed group but
this was not significant (0.102, 95% confidence interval, -0.022 to 0.226,
P=0.104). There were no significant differences between groups in the
other inflammatory markers measured in tissue and blood.
<br/>CONCLUSION(S): In patients undergoing elective CABG, the use of LFV
during CPB when compared to both lungs left collapsed does not seem to
reduce inflammation in lung biopsies and blood.<br/>Copyright &#xa9; 2019
Wiley Periodicals, Inc.

<114>
Accession Number
627643089
Title
Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent
Stroke and/or Mortality.
Source
Stroke. (pp STROKEAHA118023921), 2019. Date of Publication: 02 May 2019.
Author
Lin M.-H.; Kamel H.; Singer D.E.; Wu Y.-L.; Lee M.; Ovbiagele B.
Institution
(Lin, Lee) From the Department of Neurology, Chang Gung University College
of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (Republic of
China)
(Kamel) Department of Neurology, Weill Cornell Medical College, China
(Singer) Division of General Internal Medicine, Massachusetts General
Hospital and Harvard Medical School
(Wu) Institute of Population Health Sciences, National Health Research
Institutes, Miaoli County, Taiwan (Republic of China)
(Ovbiagele) Department of Neurology, University of California, San
Francisco (B.O.)
Publisher
NLM (Medline)
Abstract
Background and Purpose- Although believed to be transient and
self-limiting, new-onset perioperative/postoperative atrial fibrillation
(POAF) might be a risk factor for stroke and mortality. We conducted a
systematic review and meta-analysis to qualitatively and quantitatively
evaluate the relationship of POAF with early and late risks of mortality
and stroke. Methods- We searched Pubmed, EMBASE, and Cochrane Library
(1966 through March 2018) to identify cohort studies that reported stroke
and mortality associated with POAF. We computed a random-effects estimate
based on the Mantel-Haenszel method. Odds ratios with 95% CI were used as
a measure of the association between POAF and early (in-hospital or within
30 days of surgery) stroke and mortality, while hazard ratios (HR) were
used for long-term outcomes. Results- Our analysis included 35 studies
with 2 458 010 patients. Pooling the results from the random-effects model
showed that POAF was associated with increased risks of early stroke (odds
ratio, 1.62; 95% CI, 1.47-1.80), early mortality (odds ratios, 1.44; 95%
CI, 1.11-1.88), long-term stroke (HR, 1.37; 95% CI, 1.07-1.77), and
long-term mortality (HR, 1.37; 95% CI, 1.27-1.49). Analyses focusing on
high-quality studies obtained similar results. In subgroup analyses, POAF
was more strongly associated with stroke in patients undergoing noncardiac
surgery (HR, 2.00; 95% CI, 1.70-2.35) than in patients undergoing cardiac
surgery (HR, 1.20; 95% CI, 1.07-1.34). Conclusions- New-onset POAF is
associated with an increased risk of stroke and mortality, both in the
short-term and long-term. The best strategy to reduce stroke risk among
these patients needs to be determined.

<115>
Accession Number
2001957489
Title
The effect of EDTA-based chelation on patients with diabetes and
peripheral artery disease in the Trial to Assess Chelation Therapy (TACT).
Source
Journal of Diabetes and its Complications. (no pagination), 2019. Date of
Publication: 2019.
Author
Ujueta F.; Arenas I.A.; Escolar E.; Diaz D.; Boineau R.; Mark D.B.; Golden
P.; Lindblad L.; Kim H.; Lee K.L.; Lamas G.A.
Institution
(Ujueta, Lamas) Department of Medicine, Mount Sinai Medical Center, 4300
Alton Road, Miami Beach, FL, United States
(Arenas, Escolar, Diaz, Lamas) Columbia University Division of Cardiology,
Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, United
States
(Boineau) National Center of Complementary and Integrative Health (NCCIH),
Bethesda, MD, United States
(Mark, Lindblad, Kim, Lee) Duke Clinical Research Institute, Durham, NC,
United States
(Golden) The Golden Center for Integrative Medicine, Fresno, CA, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: Approximately 1 in 7 US adults have diabetes; and over 60% of
deaths in patients with diabetes have cardiac disease as a principal or
contributing cause. Both coronary and peripheral artery disease (PAD)
identify high-risk cohorts among patients with diabetes. We have
previously demonstrated improved cardiovascular outcomes with edetate
disodium-based chelation in post-MI patients with diabetes, enrolled in
the Trial to Assess Chelation Therapy (TACT). In these analyses we further
studied the effect size of patients with diabetes and severe disease in 2
vascular beds; coronaries, and lower extremity arteries. We questioned
whether greater atherosclerotic burden would attenuate the observed
beneficial effect of edetate disodium infusions. Research design and
methods: The multicenter TACT used a double blind, placebo controlled, 2 x
2 factorial design with 1708 participants, randomly assigned to receive
edetate disodium-based chelation, or placebo and high dose oral vitamins
or placebo. There were 162 (9.5% of 1708) post-MI patients with a
diagnosis of diabetes mellitus and PAD for this post hoc analysis.
Patients received up to 40 double-blind intravenous infusions of edetate
disodium-based chelation, or placebo. The composite primary endpoint of
TACT consisted of death from any cause, myocardial infarction, stroke,
coronary revascularization and hospitalization for angina. <br/>Result(s):
The median age was 66 years, 15% female, 5% non-Caucasian, and BMI was 31.
Insulin was used by 32% of patients. Active infusions significantly
reduced the primary endpoint compared with placebo infusions (HR, 0.52;
95% CI, 0.30-0.92; P = 0.0069), with a 30% absolute risk reduction in the
primary endpoint. There was a marked reduction in total mortality from 24%
to 11%, although of borderline significance (P = 0.052).
<br/>Conclusion(s): Atherosclerotic disease in multiple vascular beds did
not attenuate the beneficial effect of edetate disodium infusions in post
MI patients with diabetes. Studies now in progress will prospectively test
this post hoc finding.<br/>Copyright &#xa9; 2019 The Authors