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<1>
Accession Number
2000630351
Title
Oral anti-Xa anticoagulation after trans-aortic valve implantation for
aortic stenosis: The randomized ATLANTIS trial.
Source
American Heart Journal. 200 (pp 44-50), 2018. Date of Publication: June
2018.
Author
Collet J.-P.; Berti S.; Cequier A.; Van Belle E.; Lefevre T.; Leprince P.;
Neumann F.-J.; Vicaut E.; Montalescot G.
Institution
(Collet, Montalescot) Sorbonne Universite, ACTION Study Group, INSERM
UMR_S 1166, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP),
Paris, France
(Berti) Fondazione Toscana G. Monasterio, Ospedale del Cuore G.
Pasquinucci, Massa, Italy
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
(Van Belle) Department of Cardiology Centre, Hospitalier Universitaire
(CHU), Lille, France
(Lefevre) Hopital prive Jacques Cartier, Institut cardiovasculaire Paris
Sud, Massy, France
(Leprince) Sorbonne Universite (UPMC), INSERM UMR_S 1166, Chrirugie
Cardiaque, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP),
Paris, France
(Neumann) Herz-Zentrum Bad Krozingen, Germany
(Vicaut) ACTION Study Group, Unite de Recherche Clinique, Hopital
Lariboisiere, APHP, Paris, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Antithrombotic treatment regimen following transcatheter
aortic valve replacement (TAVR) is not evidence-based. Apixaban, a
non-vitamin K direct anticoagulant (NOAC) was shown to be superior to VKA
and superior to aspirin to prevent cardioembolic stroke in non-valvular
atrial fibrillation. It may have the potential to reduce TAVR-related
thrombotic complications including subclinical valve thrombosis along with
a better safety than the standard of care. <br/>Design(s): ATLANTIS is a
multicenter, randomized, phase IIIb, prospective, open-label, superiority
study comparing standard of care (SOC Group) versus an apixaban-based
strategy (Anti-Xa Group) after successful TAVR (ClinicalTrials.gov NCT
02664649). Randomization is stratified according to the need for chronic
anticoagulation therapy for a reason other than the TAVR procedure. In the
experimental arm, patients receive 5 mg bid of apixaban or a reduced dose
of 2.5 mg bid according to the drug label or when apixaban is combined
with antiplatelet therapy. In the control arm, patients receive VKA
therapy if there is an indication for oral anticoagulation or antiplatelet
therapy alone (single or dual) or the combination of both if needed. The
primary study end point is the composite of all-cause death, TIA/stroke,
myocardial infarction, symptomatic valve thrombosis, pulmonary embolism,
deep venous thrombosis, systemic embolism, life-threatening, disabling or
major bleeding, according to the Valve Academic Research Consortium
definitions. <br/>Conclusion(s): ATLANTIS tests the superiority of an
apixaban-based strategy versus the recommended standard of care strategy
to reduce the risk of post-TAVR thromboembolic and bleeding complications
in an all comer population.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<2>
Accession Number
2000680964
Title
Clinical trials evaluating red blood cell transfusion thresholds: An
updated systematic review and with additional focus on patients with
cardiovascular disease.
Source
American Heart Journal. 200 (pp 96-101), 2018. Date of Publication: June
2018.
Author
Carson J.L.; Stanworth S.J.; Alexander J.H.; Roubinian N.; Fergusson D.A.;
Triulzi D.J.; Goodman S.G.; Rao S.V.; Doree C.; Hebert P.C.
Institution
(Carson) Division of General Internal Medicine, Rutgers Robert Wood
Johnson Medical School, Rutgers Biomedical Health Sciences, New Brunswick,
NJ, United States
(Stanworth) National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, Oxford University Hospitals NHS Foundation
Trust and University of Oxford, Oxford, United Kingdom
(Alexander, Rao) The Duke Clinical Research Institute, Duke University,
Durham, NC, United States
(Roubinian) Blood Systems Research Institute, San Francisco, CA, United
States
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, Ontario, Canada
(Triulzi) The Institute for Transfusion Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
(Goodman) Centre for Research, Terrence Donnely Heart Centre, St.
Michael's Hospital, University of Toronto, Toronto, Canada
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada
(Doree) Systematic Review Initiative, NHS Blood and Transplant, Oxford,
United Kingdom
(Hebert) University of Montreal Hospital Research Centre, Montreal,
Quebec, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Several new trials evaluating transfusion strategies in
patients with cardiovascular disease have recently been published,
increasing the number of enrolled patients by over 30%. The objective was
to evaluate transfusion thresholds in patients with cardiovascular
disease. <br/>Method(s): We conducted an updated systematic review of
randomized trials that compared patients assigned to maintain a lower
(restrictive transfusion strategy) or higher (liberal transfusion
strategy) hemoglobin concentration. We focused on new trial data in
patients with cardiovascular disease. The primary outcome was 30-day
mortality. Specific subgroups were patients undergoing cardiac surgery and
with acute myocardial infarction. <br/>Result(s): A total of 37 trials
that enrolled 19,049 patients were appraised. In cardiac surgery,
mortality at 30 days was comparable between groups (risk ratio 0.99; 95%
confidence interval 0.74-1.33). In 2 small trials (n = 154) in patients
with myocardial infarction, the point estimate for the mortality risk
ratio was 3.88 (95% CI, 0.83-18.13) favoring the liberal strategy.
Overall, from 26 trials enrolling 15,681 patients, 30-day mortality was
not different between restrictive and liberal transfusion strategies (risk
ratio 1.0, 95% CI, 0.86-1.16). Overall and in the cardiovascular disease
subgroup, there were no significant differences observed across a range of
secondary outcomes. <br/>Conclusion(s): New trials in patients undergoing
cardiac surgery establish that a restrictive transfusion strategy of 7 to
8 g/dL is safe and decreased red cell use by 24%. Further research is
needed to define the optimal transfusion threshold in patients with acute
myocardial infarction.<br/>Copyright &#xa9; 2018

<3>
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.

<4>
Accession Number
622640991
Title
Efficacy and safety of triple therapy versus dual antiplatelet therapy in
patients with atrial fibrillation undergoing coronary stenting: A
meta-analysis.
Source
PLoS ONE. 13 (6) (no pagination), 2018. Article Number: e0199232. Date of
Publication: June 2018.
Author
Liu L.; Huang J.; Zhang X.; Tang X.
Institution
(Liu, Zhang, Tang) Department of Cardiology, First Affiliated Hospital,
Chongqing Medical University, Chongqing, China
(Huang) Department of Cardiology, Chongqing Emergency Medical Center,
Chongqing, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The optimal antithrombotic therapy for atrial fibrillation (AF)
patients undergoing coronary stenting is unknown. The present
meta-analysis sought to investigate the efficacy and safety of triple
therapy (TT; warfarin, clopidogrel and aspirin) vs dual antiplatelet
therapy (DAPT; clopidogrel plus aspirin) in those patients. Methods PubMed
and Cochrane Library were searched for studies enrolling AF patients
undergoing coronary stenting on TT and DAPT up to September 2016, and
fourteen studies were included. Efficacy outcomes included ischemic
stroke, stent thrombosis, major adverse cardiovascular event (MACE),
all-cause mortality and myocardial infarction (MI); safety outcome was
major bleeding. We conducted meta-analysis and used odds ratio (OR) with
95% confidence intervals (CI) to compare TT and DAPT. Meta-regression,
sensitivity and subgroup analysis were taken to investigate the source of
heterogeneity in the outcome of major bleeding. Results 14 eligible
observational studies with 11,697 subjects were identified. Compared with
DAPT, TT had decreased the risk of ischemic stroke [OR = 0.74, 95% CI
(0.59, 0.93), P = 0.009] and stent thrombosis [OR = 0.40, 95% CI (0.18,
0.93), P = 0.033]. While, there was an increased risk of major bleeding
[OR = 1.55, 95% CI (1.16, 2.09), P = 0.004] associated with TT. The risk
of MACE, all-cause mortality and MI had no significant statistical
difference between TT and DAPT. Furthermore, the results of univariate and
multivariate meta-regression analysis implicated that there were no
obvious correlations between certain baseline characteristics (age,
gender, race, hypertension, study design) and risk of major bleeding. Also
of major bleeding, the findings of sensitivity analysis were generally
robust, and a prespecified subgroup analysis of race demonstrated that the
source of heterogeneity might attribute to Asian studies mostly.
Conclusions TT reduced the risk of ischemic stroke and stent thrombosis
with an acceptable major bleeding risk compared with DAPT, and TT was
considered as a valid alternative in AF patients undergoing coronary
stenting. Further prospective randomized trials are needed to ensure the
reliability of these data and find the optimal therapeutic strategy in
this setting of patients.<br/>Copyright &#xa9; 2018 Liu 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.

<5>
Accession Number
620605196
Title
Comparison of Fractional FLow Reserve And Intravascular ultrasound-guided
Intervention Strategy for Clinical OUtcomes in Patients with InteRmediate
Stenosis (FLAVOUR): Rationale and design of a randomized clinical trial.
Source
American Heart Journal. 199 (pp 7-12), 2018. Date of Publication: May
2018.
Author
Kang J.; Koo B.-K.; Hu X.; Lee J.M.; Hahn J.-Y.; Yang H.-M.; Shin E.-S.;
Nam C.-W.; Doh J.-H.; Lee B.-K.; Ahn C.; Wang J.; Tahk S.-J.
Institution
(Kang, Koo) Seoul National University Hospital, Seoul, South Korea
(Koo) Institute on Aging, Seoul National University, Seoul, South Korea
(Hu, Wang) 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China
(Lee, Hahn) Samsung Medical Center, Seoul, South Korea
(Yang, Tahk) Ajou University Hospital, Suwon, South Korea
(Shin) Ulsan University Hospital, Seoul, South Korea
(Shin) Division of Cardiology, Dietrich Bonhoeffer Hospital, Academic
Teaching Hospital of University of Greifswald, Griefwald, Germany
(Nam) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Doh) Inje University Ilsan Hospital, Ilsan, South Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Ahn) Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Coronary angiography has limitations in defining the
ischemia-causing stenotic lesion, especially in cases with intermediate
coronary stenosis. Fractional flow reserve (FFR) is a current standard
method to define the presence of ischemia, and intravascular ultrasound
(IVUS) is the most commonly used invasive imaging tool that can provide
the lesion geometry and can provide the information on plaque
vulnerability. The primary aim of this study is to compare the safety and
efficacy of FFR-guided and IVUS-guided percutaneous coronary intervention
(PCI) strategies in patients with intermediate coronary stenosis. Trial
design: Comparison of Fractional FLow Reserve And Intravascular
ultrasound-guided Intervention Strategy for Clinical OUtcomes in Patients
with InteRmediate Stenosis (FLAVOUR) trial is an international,
multicenter, prospective, randomized clinical trial. A total of 1,700
consecutive patients with intermediate stenosis (40%-70% by visual
estimation) in a major epicardial coronary artery will be randomized 1:1
to receive either FFR-guided or IVUS-guided PCI strategy. Patients will be
treated with PCI according to the predefined criteria for
revascularization; FFR <= 0.80 in the FFR-guided group and Minimal Lumen
Area (MLA) <=3 mm² (or 3 mm² < MLA <=4
mm² and plaque burden >70%) in the IVUS-guided group. The
primary end point is the patient-oriented composite outcome, which is a
composite of all-cause death, myocardial infarction, and any repeat
revascularization at 24 months after randomization. We will test
noninferiority of current standard FFR-guided PCI strategy compared with
IVUS-guided decision for PCI and stent optimization strategy.
<br/>Conclusion(s): The FLAVOUR trial will compare the safety and efficacy
of FFR- and IVUS-guided PCI strategies in patients with intermediate
coronary stenosis. This study will provide an insight on optimal
evaluation and treatment strategy for patients with intermediate coronary
stenosis.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<6>
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Accession Number
624093791
Title
Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent
Postoperative Decreases in Renal Function: A Randomized Clinical Trial.
Source
Anesthesiology. 128 (4) (pp 710-717), 2018. Date of Publication: 01 Apr
2018.
Author
Ederoth P.; Dardashti A.; Grins E.; Bronden B.; Metzsch C.; Erdling A.;
Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson L.; Jovinge
S.; Bjursten H.
Institution
(Ederoth, Dardashti, Grins, Bronden, Metzsch, Erdling, Algotsson)
Departments of Anesthesiology and Intensive Care, Sweden
(Nozohoor, Mokhtari, Bjursten) Departments of Cardiothoracic Surgery,
Clinical Sciences, Lund University, Skane University Hospital, Lund 221
85, Sweden
(Hansson, Elmer) Department of Mitochondrial Medicine Clinical Sciences,
Lund University, Lund, Sweden
(Jovinge) Frederik Meijer Heart and Vascular Institute, Spectrum Health,
Grand Rapids, MI, United States
(Jovinge) Van Andel Institute, Grand Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Stanford, CA,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Acute kidney injury is a common complication after cardiac
surgery, leading to increased morbidity and mortality. One suggested cause
for acute kidney injury is extracorporeal circulation-induced
ischemia-reperfusion injury. In animal studies, cyclosporine has been
shown to reduce ischemia-reperfusion injury in the kidneys. We
hypothesized that administering cyclosporine before extracorporeal
circulation could protect the kidneys in patients undergoing cardiac
surgery. <br/>Method(s): The Cyclosporine to Protect Renal Function in
Cardiac Surgery (CiPRICS) study was an investigator-initiated,
double-blind, randomized, placebo-controlled, single-center study. The
primary objective was to assess if cyclosporine could reduce acute kidney
injury in patients undergoing coronary artery bypass grafting surgery with
extracorporeal circulation. In the study, 154 patients with an estimated
glomerular filtration rate of 15 to 90 ml . min^-1 . 1.73
m^-2 were enrolled. Study patients were randomized to receive
2.5 mg/kg cyclosporine or placebo intravenously before surgery. The
primary endpoint was relative plasma cystatin C changes from the
preoperative day to postoperative day 3. Secondary endpoints included
biomarkers of kidney, heart, and brain injury. <br/>Result(s): All
enrolled patients were analyzed. The cyclosporine group (136.4 +/- 35.6%)
showed a more pronounced increase from baseline plasma cystatin C to day 3
compared to placebo (115.9 +/- 30.8%), difference, 20.6% (95% CI, 10.2 to
31.2%, P < 0.001). The same pattern was observed for the other renal
markers. The cyclosporine group had more patients in Risk Injury Failure
Loss End-stage (RIFLE) groups R (risk), I (injury), or F (failure; 31% vs.
8%, P < 0.001). There were no differences in safety parameter distribution
between groups. <br/>Conclusion(s): Administration of cyclosporine did not
protect coronary artery bypass grafting patients from acute kidney injury.
Instead, cyclosporine caused a decrease in renal function compared to
placebo that resolved after 1 month.<br/>Copyright &#xa9; 2018, the
American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
All Rights Reserved.

<7>
Accession Number
619465272
Title
Efficacy and safety of bivalirudin in coronary artery disease patients
with mild to moderate chronic kidney disease: Meta-analysis.
Source
Journal of Cardiology. 71 (5) (pp 494-504), 2018. Date of Publication: May
2018.
Author
Zeng X.; Lincoff A.M.; Schulz-Schupke S.; Steg P.G.; Elbez Y.; Mehran R.;
Stone G.W.; McAndrew T.; Lin J.; Zhang X.; Shi W.; Lei H.; Jing Z.; Huang
W.
Institution
(Zeng, Zhang, Shi, Lei, Huang) Department of Cardiology, The First
Affiliated Hospital, Chongqing Medical University, Chongqing, China
(Lincoff) Cleveland Clinic Foundation, Cleveland, OH, United States
(Schulz-Schupke) ISA Research Center, Deutsches Herzzentrum, Technische
Universitat, Munich, Germany
(Schulz-Schupke) German Center for Cardiovascular Research (DZHK), Partner
Site Munich Heart Alliance, France
(Steg, Elbez) French Alliance for Cardiovascular Clinical Trials (FACT),
DHU-FIRE, Hopital Bichat (Assistance Publique-Hopitaux de Paris),
Universite Paris-Diderot, Sorbonne-Paris Cite and INSERM U-1148, Paris,
France
(Mehran) Department of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, United States
(Stone) Department of Cardiology, New York-Presbyterian Hospital/Columbia
University Medical Center, New York, United States
(McAndrew) Clinical Trials Center, Cardiovascular Research Foundation, New
York, United States
(Lin) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield Medical School, Sheffield, United Kingdom
(Jing) State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital,
Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing, China
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Patients with chronic kidney disease (CKD) have elevated
bleeding and ischemic outcomes. We aim to assess the short- and long-term
efficacy and safety of bivalirudin compared to heparin plus glycoprotein
IIb/IIIa inhibitors (GPIs) in coronary artery disease (CAD) patients with
CKD. <br/>Method(s): Randomized trials were searched in PubMed, Cochrane,
and Embase databases up to January 2017. Among the trials retrieved,
efficacy endpoints were defined as mortality, myocardial infarction (MI),
repeat revascularization, stent thrombosis, and major adverse cardiac
events (MACEs). Safety endpoints were reported as non-coronary artery
bypass grafting (CABG) related major bleeding and thrombolysis in
myocardial infarction (TIMI) major bleeding. Risk ratio (RR) and 95%
confidence interval (CI) were calculated for each outcome using a fixed
effect model. <br/>Result(s): Five studies with a total of 3796 patients
were included. In short-term follow up (30 days), bivalirudin
significantly reduced non-CABG related major bleeding (p = 0.0004) and
TIMI major bleeding (p = 0.007) compared to heparin plus GPIs. No
significant differences were observed in rates of mortality, MI, repeat
revascularization, stent thrombosis, and MACEs between the two groups in
short- and long-term follow up (6 months to 3 years). In patients with ST
elevated myocardial infarction (STEMI) with concurrent CKD, the decreased
non-CABG related major bleeding (p = 0.04) without increasing ischemic
events was also observed after short-term follow up. <br/>Conclusion(s):
(1) Bivalirudin is safer than and as effective as heparin plus GPIs in CAD
patients with CKD. (2) Impaired renal function does not affect the safety
benefits of bivalirudin. (3) Similar efficacy profiles were identified
between the two groups after both short- and long-term follow up in the
CAD patients with CKD.<br/>Copyright &#xa9; 2017 Japanese College of
Cardiology

<8>
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

<9>
Accession Number
2001846705
Title
Medical graphic narratives to improve patient comprehension and
periprocedural anxiety before coronary angiography and percutaneous
coronary intervention: A randomized trial.
Source
Annals of Internal Medicine. 170 (8) (pp 579-581), 2019. Date of
Publication: 2019.
Author
Brand A.; Gao L.; Hamann A.; Crayen C.; Brand H.; Squier S.M.; Stangl K.;
Kendel F.; Stangl V.
Institution
(Brand, Stangl, Stangl) Charite - Universitatsmedizin Berlin, DZHK (German
Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
(Gao, Brand, Kendel) Charite - Universitatsmedizin Berlin, Berlin, Germany
(Hamann) Mintwissen BerlinGermany
(Crayen) Freie Universitat Berlin, Berlin, Germany
(Squier) Pennsylvania State University University, Park, PA, United States
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<10>
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

<11>
Accession Number
627212102
Title
Clinical and genetic insights into non-compaction: a meta-analysis and
systematic review on 7598 individuals.
Source
Clinical Research in Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Kayvanpour E.; Sedaghat-Hamedani F.; Gi W.-T.; Tugrul O.F.; Amr A.; Haas
J.; Zhu F.; Ehlermann P.; Uhlmann L.; Katus H.A.; Meder B.
Institution
(Kayvanpour, Sedaghat-Hamedani, Gi, Tugrul, Amr, Haas, Zhu, Ehlermann,
Katus, Meder) Department of Medicine III, Institute for Cardiomyopathy,
University of Heidelberg, INF 410, Heidelberg 69120, Germany
(Kayvanpour, Sedaghat-Hamedani, Gi, Tugrul, Amr, Haas, Katus, Meder) DZHK
(German Centre for Cardiovascular Research), Berlin, Germany
(Uhlmann) Institute of Medical Biometry and Informatics, University of
Heidelberg, Heidelberg, Germany
(Zhu) Department of Cardiology, Institute of Cardiology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430022, China
(Meder) Department of Genetics, Stanford Genome Technology Center,
Stanford University School of Medicine, Stanford, CA, United States
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Left ventricular non-compaction has been increasingly
diagnosed in recent years. However, it is still debated whether
non-compaction is a pathological condition or a physiological trait. In
this meta-analysis and systematic review, we compare studies, which
investigated these two different perspectives. Furthermore, we provide a
comprehensive overview on the clinical outcome as well as genetic
background of left ventricular non-compaction cardiomyopathy in adult
patients. <br/>Methods and Results: We retrieved PubMed/Medline
literatures in English language from 2000 to 19/09/2018 on clinical
outcome and genotype of patients with non-compaction. We summarized and
extensively reviewed all studies that passed selection criteria and
performed a meta-analysis on key phenotypic parameters. Altogether, 35
studies with 2271 non-compaction patients were included in our
meta-analysis. The mean age at diagnosis was the mid of their fifth
decade. Two-thirds of patients were male. Congenital heart diseases
including atrial or ventricular septum defect or Ebstein anomaly were
reported in 7% of patients. Twenty-four percent presented with family
history of cardiomyopathy. The mean frequency of neuromuscular diseases
was 5%. Heart rhythm abnormalities were reported frequently: conduction
disease in 26%, supraventricular tachycardia in 17%, and sustained or
non-sustained ventricular tachycardia in 18% of patients. Three important
outcome measures were reported including systemic thromboembolic events
with a mean frequency of 9%, heart transplantation with 4%, and adequate
ICD therapy with 15%. Nine studies investigated the genetics of
non-compaction cardiomyopathy. The most frequently mutated gene was TTN
with a pooled frequency of 11%. The average frequency of MYH7 mutations
was 9%, for MYBPC3 mutations 5%, and for CASQ2 and LDB3 3% each. TPM1,
MIB1, ACTC1, and LMNA mutations had an average frequency of 2% each.
Mutations in PLN, HCN4, TAZ, DTNA, TNNT2, and RBM20 were reported with a
frequency of 1% each. We also summarized the results of eight studies
investigating the non-compaction in altogether 5327 athletes, pregnant
women, patients with sickle cell disease, as well as individuals from
population-based cohorts, in which the presence of left ventricular
hypertrabeculation ranged from 1.3 to 37%. <br/>Conclusion(s): The
summarized data indicate that non-compaction may lead to unfavorable
outcome in different cardiomyopathy entities. The presence of key features
in a multimodal diagnostic approach could distinguish between benign
morphological trait and manifest cardiomyopathy.<br/>Copyright &#xa9;
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<12>
Accession Number
625512844
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
Catheterization and Cardiovascular Interventions. 93 (6) (pp E320-E325),
2019. Date of Publication: 01 May 2019.
Author
Iannaccone M.; D'ascenzo F.; Piazza F.; De Benedictis M.; Doronzo B.;
Behnes M.; Garbo R.; Mashayekhi K.
Institution
(Iannaccone, Piazza, De Benedictis, Doronzo) SS. Annunziata Hospital, ASL
CN 1, Savigliano, Italy
(D'ascenzo) Department of Cardiology, Citta della Scienza e dalla Salute
Hospital, University of Turin, Turin, Italy
(Behnes) First Department of Medicine, University Medical Center Mannheim,
University of Heidelberg, Mannheim, Germany
(Behnes) DZHK (German Center for Cardiovascular Research) Partner Site,
Mannheim, Germany
(Garbo) S.G. Bosco Hospital, Turin, Italy
(Mashayekhi) Department of Cardiology and Angiology II, University Heart
Center Freiburg, Bad Krozingen, Germany
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
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. <br/>Method(s): 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 (PSM) 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.
<br/>Result(s): A total of eight studies was included, four RCTs and four
PSMs. 3,971 patients were included in the analysis (2,050 CTO-PCI versus
1,921 OMT) with a mean follow-up of 3 years. No significant differences
were found regarding overall MACE, re-PCI and AMI. Regarding CV-death,
CTO-PCI was associated with a better outcome compared with OMT driven by
PSMs (OR 0.52, 0.0.81, P < 0.01). <br/>Conclusion(s): As compared to OMT,
CTO-PCI was associated with similar MACE rate; however, CTO-PCI may be
associated with reduced CV death, mainly due to PSMs effect.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<13>
Accession Number
2001882857
Title
Unforeseen N2 Disease after Negative Endosconography Findings with or
without Confirmatory Mediastinoscopy in Resectable Non-Small Cell Lung
Cancer: A Systematic Review and Meta-Analysis.
Source
Journal of Thoracic Oncology. (no pagination), 2019. Date of Publication:
2019.
Author
Bousema J.E.; van Dorp M.; Noyez V.J.J.M.; Dijkgraaf M.G.W.; Annema J.T.;
van den Broek F.J.C.
Institution
(Bousema, van den Broek) Department of Surgery, Maxima Medical Center,
Veldhoven, The Netherlands, Netherlands
(van Dorp) Department of Surgery, Northwest Hospital Group, Alkmaar, The
Netherlands, Netherlands
(Noyez) Department of Vascular and Thoracic Surgery, Sint-Maarten General
Hospital, Mechelen, Belgium
(Dijkgraaf) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The
Netherlands, Netherlands
(Annema) Department of Respiratory Medicine, Amsterdam UMC, University of
Amsterdam, Amsterdam, The Netherlands, Netherlands
Publisher
Elsevier Inc
Abstract
Introduction: Confirmatory mediastinoscopy after negative endosonography
findings is advised by the guidelines on patients with resectable NSCLC
and suspected intrathoracic nodes on fludeoxyglucose F 18 positron
emission tomography-computed tomography. Its role however is under debate
owing to its limited nodal metastasis detection rate, morbidity,
associated treatment delay, and unknown impact on survival.
<br/>Method(s): Systematic review and meta-analysis of studies on invasive
mediastinal staging in patients with (suspected)NSCLC. The Medline,
Embase, and Cochrane databases were searched until September 19, 2018,
without year or language restrictions. The Quality Assessment Tool for
Diagnostic Accuracy Studies, version 2, was used to evaluate the risk of
bias and applicability of the included studies. Rates of unforeseen N2
disease were assessed for endobronchial ultrasound and/or endoscopic
ultrasound staging strategies with or without confirmatory
mediastinoscopy. Additionally, the complication rates of cervical video
mediastinoscopy for mediastinal staging of NSCLC were investigated.
<br/>Result(s): A total of 5073 articles were found, of which 42 studies
or subgroups (covering a total of 3248 patients undergoing the surgical
reference standard of treatment)were considered in the analysis. Random
effects meta-analysis of endosonography with or without confirmatory
mediastinoscopy showed rates of unforeseen N2 disease of 9.6% (95%
confidence interval [CI]: 7.8%-11.7%, I² = 30%)versus 9.9% (95%
CI: 6.3%-15.2%, I² = 73%), respectively. Random effects
meta-analysis of mediastinoscopy (eight studies [1245 patients in
total])showed a complication rate of 6.0% (95% CI: 4.8%-7.5%), with
laryngeal recurrent nerve palsy accounting for 2.8% (95% CI: 2.0%-4.0%).
<br/>Conclusion(s): The rate of unforeseen N2 disease after negative
endosonography findings was similar in patients undergoing immediate lung
tumor resection to those undergoing confirmatory mediastinoscopy first, at
the cost of 6.0% rate of complications by mediastinoscopy.<br/>Copyright
&#xa9; 2019 International Association for the Study of Lung Cancer

<14>
Accession Number
627392787
Title
Comparison between two low-cost models for ultrasound-guided
pericardiocentesis training.
Source
EMA - Emergency Medicine Australasia. Conference: 35th Australasian
College of Emergency Medicine Annual Scientific Meeting, ACEM-ASM 2018.
Australia. 31 (Supplement 1) (pp 31), 2019. Date of Publication: March
2019.
Author
Lin Z.; Soh C.; Chua M.; Yau Y.; Kuan W.
Institution
(Lin, Soh, Chua, Yau, Kuan) Emergency Medicine Department, National
University Hospital, National University Health System, Singapore,
Singapore
(Chua, Kuan) Department of Surgery, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore
Publisher
Blackwell Publishing
Abstract
Background: Pericardiocentesis is a life-saving procedure that occurs
rarely. Training relies on simulators which are expensive. We constructed
and compared two lowcost ultrasound-capable pericardiocentesis training
models. <br/>Objective(s): We evaluated the effectiveness, fidelity and
participants' satisfaction in both models. <br/>Method(s): This was a
randomized crossover study involving doctors from the Emergency Medicine
Department of National University Hospital, Singapore. The first was an
agar-based model with a water-filled balloon embedded within. The second
was a newer model (Centesys) using psyllium to simulate subcutaneous
tissues and a plastic ball as pericardium. The plastic ball was kept under
tension with an electrical water pump to maintain the realistic feeling of
puncture. Participants rated their knowledge and confidence, the
effectiveness and realism of the 2 models on a 7-point Likert scale pre-
and post-training. They were assessed objectively using a checklist and
12-question multiple choice test. <br/>Result(s): Twenty participants were
involved, comprising 12 junior residents, 6 senior residents and 2
resident physicians. The median post-graduate year was 4 (interquartile
range [IQR] 3.75-6). None had prior experience in performing
pericardiocentesis. The median score for confidence in performing
pericardiocentesis was higher after training with Centesys (median 5, IQR
4-6) compared to the agar-based model (median 4, IQR 3-5, P = 0.002).
Centesys was perceived to be a more realistic (median 5, IQR 4-6 versus
median 4, IQR 3-4, P = 0.001) and effective training tool (median 5, IQR
4.75-6.25 versus median 4, IQR 4-4, P = 0.001) compared to the agarbased
model. <br/>Conclusion(s): Centesys was more realistic and effective in
ultrasound-guided pericardiocentesis training.

<15>
[Use Link to view the full text]
Accession Number
627370738
Title
Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction:
Randomized SHOCK-COOL Trial.
Source
Circulation. 139 (4) (pp 448-457), 2019. Date of Publication: 22 Jan 2019.
Author
Fuernau G.; Beck J.; Desch S.; Eitel I.; Jung C.; Erbs S.; Mangner N.;
Lurz P.; Fengler K.; Jobs A.; Vonthein R.; De Waha-Thiele S.; Sandri M.;
Schuler G.; Thiele H.
Institution
(Fuernau, Desch, Jobs, De Waha-Thiele) Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), University Heart Center
Luebeck, University Hospital Schleswig-Holstein, University of Luebeck,
Germany
(Vonthein) Institute of Medical Biometry and Statistics and Center for
Clinical Trials, University of Luebeck, Germany
(Eitel) German Center for Cardiovascular Research, Deutsches Zentrum fur
Herz-Kreislauf-Forschung DZHK, Partner Site Hamburg/Kiel/Lubeck, Luebeck,
Germany
(Beck, Erbs, Mangner, Lurz, Fengler, Sandri, Schuler, Thiele) Department
of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital,
Germany
(Jung) Medical Faculty, Division of Cardiology, Pulmonology and Vascular
Medicine, University Hospital Dusseldorf, Heinrich-Heine-University
Dusseldorf, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Experimental trials suggest improved outcome by mild therapeutic
hypothermia for cardiogenic shock after acute myocardial infarction. The
objective of this study was to investigate the hemodynamic effects of mild
therapeutic hypothermia in patients with cardiogenic shock complicating
acute myocardial infarction. <br/>Method(s): Patients (n=40) with
cardiogenic shock undergoing primary percutaneous coronary intervention
without classic indications for mild therapeutic hypothermia underwent
randomization in a 1:1 fashion to mild therapeutic hypothermia for 24
hours or control. The primary end point was cardiac power index at 24
hours; secondary end points included other hemodynamic parameters and
serial measurements of arterial lactate. <br/>Result(s): No relevant
differences were observed for the primary end point of cardiac power index
at 24 hours (mild therapeutic hypothermia versus control: 0.41
[interquartile range, 0.31-0.52] versus 0.36 [interquartile range,
0.31-0.48] W/m²; P=0.50; median difference, -0.025
W/m²; 95% CI, -0.12 to 0.06). Similarly, all other hemodynamic
measurements were not statistically different. Arterial lactate levels at
6, 8, and 10 hours were significantly higher in patients in the mild
therapeutic hypothermia group with a slower decline (P for
interaction=0.03). There were no differences in 30-day mortality (60%
versus 50%; hazard ratio, 1.27; 95% CI, 0.55-2.94; P=0.55).
<br/>Conclusion(s): In this randomized trial, mild therapeutic hypothermia
failed to show a substantial beneficial effect on cardiac power index at
24 hours in patients with cardiogenic shock after acute myocardial
infarction. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01890317.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<16>
[Use Link to view the full text]
Accession Number
627391931
Title
One-Year Outcomes after MitraClip for Functional Mitral Regurgitation.
Source
Circulation. 139 (1) (pp 37-47), 2019. Date of Publication: 02 Jan 2019.
Author
Ailawadi G.; Lim D.S.; Mack M.J.; Trento A.; Kar S.; Grayburn P.A.; Glower
D.D.; Wang A.; Foster E.; Qasim A.; Weissman N.J.; Ellis J.; Crosson L.;
Fan F.; Kron I.L.; Pearson P.J.; Feldman T.
Institution
(Ailawadi, Kron) Division of Thoracic and Cardiovascular Surgery,
University of Virginia, PO Box 800679, 1215 Lee St, Charlottesville
22908-0679, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Mack) Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, TX,
United States
(Trento, Kar) Heart Institute, Cedars Sinai Medical Center, Los Angeles,
CA, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Glower, Wang) Duke University Medical Center, Durham, NC, United States
(Foster, Qasim) Division of Cardiology, University of California, San
Francisco, United States
(Weissman) MedStar Health Research Institute, Hyattsville, MD, United
States
(Ellis, Crosson, Fan) Abbott Vascular, Santa Clara, CA, United States
(Pearson, Feldman) Northshore University Health System, Evanston, IL,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Secondary mitral regurgitation (SMR) occurs in the absence of
organic mitral valve disease and may develop as the left ventricle dilates
or remodels or as a result of leaflet tethering with impaired coaptation,
most commonly from apical and lateral distraction of the subvalvular
apparatus, with late annular dilatation. The optimal therapy for SMR is
unclear. This study sought to evaluate the 1-year adjudicated outcomes of
all patients with SMR undergoing the MitraClip procedure in the EVEREST II
(Endovascular Valve Edge-to-Edge Repair Study) Investigational Device
Exemption program, which is comprised of the randomized clinical trial,
the prospective High-Risk Registry, and the REALISM Continued Access
Registry (Multicenter Study of the MitraClip System). <br/>Method(s):
Patients with 3+/4+ SMR enrolled in EVEREST II were stratified by non-high
surgical risk (non-HR) and high surgical risk (HR) status (defined as
Society of Thoracic Surgeons risk of mortality >=12% or predefined risk
factors). Clinical, echocardiographic, and functional outcomes at 1 year
were evaluated. <br/>Result(s): A total of 616 patients (482 HR, 134
non-HR; mean age, 73.3+/-10.5 years; Society of Thoracic Surgeons risk,
10.2+/-6.9%) with SMR underwent the MitraClip procedure. At baseline,
80.5% of patients were in New York Heart Association class III/IV. Major
adverse events at 30 days included death (3.6%), stroke (2.3%), and renal
failure (1.5%). At discharge, 88.8% had MR <=2+. At 1 year, there were 139
deaths, and the Kaplan-Meier estimate of freedom from mortality was 76.8%.
The majority of surviving patients (84.7%) remained with MR <=2+ and New
York Heart Association class I/II (83.0%). Kaplan-Meier survival at 1 year
was 74.1% in HR patients and 86.4% in non-HR patients (P=0.0175). At 1
year, both groups achieved comparable MR reduction (MR <=2+, 84.0% versus
87.0%) and improvement in left ventricular end-diastolic volume (-8.0 mL
versus -12.7 mL), whereas New York Heart Association class I/II was found
in 80.1% versus 91.8% (P=0.008) of HR and non-HR patients, respectively.
In HR patients, the annualized rate of heart failure hospitalizations
decreased from 0.68 to 0.46 in the 12 months before to 12 months after the
procedure (P<0.0001). <br/>Conclusion(s): Transcatheter mitral valve
repair with the MitraClip in patients with secondary MR is associated with
acceptable safety, reduction of MR severity, symptom improvement, and
positive ventricular remodeling. Clinical Trial Registration:
https://www.clinicaltrials.gov. Unique identifiers: NCT00209274,
NCT01940120, and NCT01931956.<br/>Copyright &#xa9; 2019 American Heart
Association, Inc.

<17>
[Use Link to view the full text]
Accession Number
627389987
Title
Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve
Replacement in Patients with Severe Aortic Stenosis at Intermediate Risk:
Results from the PARTNER 2 Trial.
Source
Circulation. 139 (7) (pp 877-888), 2019. Date of Publication: 12 Feb 2019.
Author
Baron S.J.; Wang K.; House J.A.; Magnuson E.A.; Reynolds M.R.; Makkar R.;
Herrmann H.C.; Kodali S.; Thourani V.H.; Kapadia S.; Svensson L.; Mack
M.J.; Brown D.L.; Russo M.J.; Smith C.R.; Webb J.; Miller C.; Leon M.B.;
Cohen D.J.
Institution
(Baron, Wang, Magnuson, Leon, Cohen) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, 4401 Wornall Rd, Kansas
City, MO 64111, United States
(House) Premier Research Services Inc, Charlotte, NC, United States
(Reynolds) Lahey Hospital and Medical Center, Burlington, MA, United
States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Herrmann) Hospital of University of Pennsylvania, Philadelphia, United
States
(Kodali, Smith) Columbia University Medical Center, New York, United
States
(Thourani) MedStar Heart and Vascular Institute, Georgetown University,
Washington, DC, United States
(Kapadia, Svensson) Cleveland Clinic, OH, United States
(Mack, Brown) Baylor Scott and White Healthcare, Plano, TX, United States
(Russo) RWJ Barnabas Health, West Orange, NJ, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Miller) Stanford Medical Center, Palo Alto, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: In patients with severe aortic stenosis (AS) at intermediate
surgical risk, treatment with transcatheter aortic valve replacement
(TAVR) or surgical aortic valve replacement (SAVR) results in similar
rates of death or stroke at 2 years. Whether TAVR is cost-effective
compared with SAVR for intermediate-risk patients remains uncertain.
<br/>Method(s): Between 2011 and 2014, 3110 intermediate-risk AS patients
were treated with TAVR or SAVR in the PARTNER 2 trial (Placement of Aortic
Transcatheter Valves 2). A total of 2032 patients were randomized to
receive TAVR using the SAPIEN XT valve (XT-TAVR) or SAVR in the PARTNER 2A
trial, whereas the PARTNER S3i registry included an additional 1078
patients treated with TAVR using the SAPIEN 3 valve (S3-TAVR), which
offers a lower delivery profile and sealing skirt designed to reduce
paravalvular regurgitation compared with XT-TAVR. Procedural costs were
estimated using measured resource utilization. Other in-trial costs were
assessed by linkage of trial data with Medicare claims (n=2333) or by
linear regression models for unlinked patients (n=682). Health utilities
were estimated using the EQ-5D at baseline and 1, 12, and 24 months. Using
a Markov model informed by in-trial costs, utilities, and survival data,
lifetime cost-effectiveness from the perspective of the US healthcare
system was estimated in terms of cost per quality-adjusted life-year
gained. <br/>Result(s): Although procedural costs were =$20 000 higher
with TAVR than SAVR, total cost differences for the index hospitalization
were only $2888 higher with XT-TAVR (P=0.014) and were $4155 lower with
S3-TAVR (P<0.001) owing to reductions in length of stay with TAVR.
Follow-up costs were significantly lower with XT-TAVR (DELTA=-$9304;
P<0.001) and S3-TAVR (DELTA=-$11 377; P<0.001) than with SAVR. Over a
lifetime horizon, TAVR was projected to lower total costs by $8000 to $10
000 and to increase quality-adjusted survival by 0.15 to 0.27 years.
XT-TAVR and S3-TAVR were found to be economically dominant compared with
SAVR in 84% and 97% of bootstrap replicates, respectively.
<br/>Conclusion(s): Among intermediate-risk AS patients, TAVR is projected
to be economically dominant from the perspective of the US healthcare
system by providing both greater quality-adjusted life expectancy and
lower long-term costs than SAVR. If long-term data demonstrate comparable
late mortality with TAVR and SAVR, these findings suggest that TAVR might
be the preferred treatment strategy for intermediate-risk AS patients
based on both clinical and economic considerations. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01314313.<br/>Copyright &#xa9; 2019 American Heart Association, Inc.

<18>
Accession Number
627212869
Title
A comparative study of safety and efficacy of ultrasound-guided
infra-clavicular axillary vein cannulation versus ultrasound-guided
internal jugular vein cannulation in adult cardiac surgical patients.
Source
Annals of Cardiac Anaesthesia. 22 (2) (pp 177-186), 2019. Date of
Publication: April-June 2019.
Author
Shinde P.; Jasapara A.; Bansode K.; Bunage R.; Mulay A.; Shetty V.
Institution
(Shinde, Jasapara, Bansode, Bunage, Mulay) Department of Anaesthesiology
and Cardiac Surgery, Fortis Hospital, Mulund Goregaon Link Road,
Mulund-West-Maharashtra 400 078, India
(Shetty) Department of Anaesthesiology, Fortis Hospital, Mumbai,
Maharashtra, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Ultrasound (US)-guided internal jugular vein (IJV) cannulation
is a widely accepted standard procedure. The axillary vein (AV) in
comparison to the subclavian vein is easily visualized, but its
cannulation is not extensively studied in cardiac patients. <br/>Aim(s):
This study is an attempt to study the efficacy of real-time US-guided
axillary venous cannulation as a safe alternative for the time-tested
US-guided IJV cannulation. <br/>Design(s): This is a prospective
randomized controlled study. <br/>Material(s) and Method(s): A total of
100 adult patients scheduled for cardiac surgery were divided equally in
Group A-US-guided IJV cannulation, and Group B-US-guided axillary venous
cannulation. Under local anesthesia and real-time US guidance the IJV or
AV was secured. The access time, guidewire time, and procedure time were
noted. Furthermore, the number of needle attempts, malposition, change of
site, and complications were noted. <br/>Result(s): The data were analyzed
for 49 patients in Group A and 48 patients in the Group B due to
exclusions. The access time and the guidewire time were comparable in both
groups. The first attempt needle puncture was successful for the IJV group
in 98% of patients in comparison to 95% of patients in Group B. Guidewire
was passed in the first attempt in 94% in Group A and 89% in the Group B.
Except for arterial puncture in one case in group A, the complications
were insignificant in both groups. <br/>Conclusion(s): The study shows
that the US-guided AV cannulation may serve as an effective alternative to
the IJV cannulation in cardiac surgery.<br/>Copyright &#xa9; 2019 Medknow
Publications. All rights reserved.

<19>
Accession Number
627212864
Title
The effect of perioperative magnesium sulfate on blood sugar in patients
with diabetes mellitus undergoing cardiac surgery: A double-blinded
randomized study.
Source
Annals of Cardiac Anaesthesia. 22 (2) (pp 151-157), 2019. Date of
Publication: April-June 2019.
Author
Soliman R.; Nofal H.
Institution
(Soliman) Department of Anesthesia, Cairo University, Cairo, Egypt
(Soliman) Department of Cardiac Anesthesia, Cardiac Center, Aldar
Hospital, Almadinah Almonwarah, Saudi Arabia
(Nofal) Department of Cardiac Surgery, Cardiac Center, Aldar Hospital,
Almadinah Almonwarah, Saudi Arabia
(Nofal) National Heart Institute, Giza, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The aim of the present study was to evaluate the perioperative
effect of magnesium infusion on blood sugar level in patients with
diabetes mellitus undergoing cardiac surgery. <br/>Design(s): This was a
double-blind randomized study. <br/>Setting(s): The study was conducted at
cardiac center. <br/>Patient(s): The study included 122 adult patients.
<br/>Intervention(s): Group M - The patients received a continuous
infusion of magnesium sulfate (without a loading dose) at 15 mg/kg/h. The
infusion rate was started 20 min before induction maintained during
surgery and the first postoperative 24 h. The medication was prepared by
adding 5 g magnesium sulfate in 50 ml syringe. Group C - The patients
received equal amount of normal saline. Measurements: The monitors
included heart rate, mean arterial blood pressure, central venous
pressure, urine output, blood levels of magnesium, sugar, and potassium.
<br/>Result(s): The blood sugar level and the required insulin
significantly decreased with Group M than Group C (P < 0.05). There were
minimal changes in the potassium level in Group M, but potassium decreased
in patients of Group C (P < 0.05). The amount of urine output was too much
higher in Group M than Group C (P < 0.05). The pharmacological and
mechanical support significantly decreased with Group M than Group C (P <
0.05). The hospital and Intensive Care Unit length of stay significantly
decreased with Group M than Group C (P < 0.05). <br/>Conclusion(s): The
magnesium sulfate produced a better-controlled effect on the blood sugar
level. It decreased the requirement of insulin infusion and minimized the
changes in the blood level of potassium.<br/>Copyright &#xa9; 2019 Medknow
Publications. All rights reserved.

<20>
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).

<21>
Accession Number
2001411245
Title
The Intrarater and Interrater Reliability of Measures Derived from
Cardiopulmonary Exercise Testing in Patients with Abdominal Aortic
Aneurysms.
Source
Annals of Vascular Surgery. 56 (pp 175-182), 2019. Date of Publication:
April 2019.
Author
Harwood A.E.; Pymer S.; Hitchman L.; Totty J.; Wallace T.; Smith G.E.;
Carradice D.; Carroll S.; Chetter I.C.
Institution
(Harwood, Pymer, Hitchman, Totty, Wallace, Smith, Carradice, Chetter)
Academic Vascular Surgical Unit, Hull York Medical School, Hull Royal
Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom
(Harwood) Thermal Ergonomics Laboratory, University of Sydney, Cumberland
Campus, Lidcombe, New South Wales, Australia
(Carroll) School of Sport and Exercise Science, University of Hull,
Cottingham Road, Hull HU6 7RX, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Patients with abdominal aortic aneurysms (AAAs) often have low
exercise tolerance due to comorbidities and advanced age. Cardiopulmonary
exercise testing (CPET) is predictive of postoperative morbidity and
mortality in patients with AAA. We aimed to assess the intrarater and
interrater reliability of both treadmill-based and cycle ergometer-based
CPET variables. <br/>Method(s): Patients with an AAA (>3.5 cm) were
randomized to a treadmill or bike CPET. Patients were asked to perform two
separate CPETs seven days apart after a familiarization protocol. All
CPETs were carried out using a ramp cycle or modified Bruce treadmill
protocol with breath-by-breath gas analysis. <br/>Result(s): Twenty-two
male and 2 female patients, aged 73.6 +/- 6.0 years, completed the study.
Intrarater analysis (intraclass correlation coefficients) demonstrated
high reliability on both the treadmill and bike for ventilatory anaerobic
threshold (r = 0.834 and r = 0.975, respectively). All other CPET
variables demonstrated high intrarater reliability on both modalities, bar
the highest point for the ventilatory slope of oxygen (VE/VO<inf>2</inf>)
on the treadmill (substantial agreement r = 0.755). Furthermore,
interrater reliability demonstrated high agreement for ventilatory
anaerobic threshold on both the treadmill and cycle (r = 0.983 and r =
0.905, respectively). All other CPET variables demonstrated high
intrarater reliability on both modalities, with the exception of
VO<inf>2Peak</inf> on the cycle ergometer (fair agreement r = 0.400).
<br/>Conclusion(s): CPET in patients with AAAs is a reliable tool test and
among CPET test reviewers for common testing modalities/protocols. These
findings provide further support for the use of CPET, especially treadmill
walking, as a clinical measure of perioperative cardiorespiratory fitness
in patients with AAAs.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<22>
Accession Number
626735574
Title
The epidemiology of multicomponent blood transfusion: a systematic review.
Source
Transfusion Medicine. 29 (2) (pp 80-94), 2019. Date of Publication: April
2019.
Author
Perelman I.; Khair S.; Dermer E.; Tinmouth A.; Saidenberg E.; Fergusson D.
Institution
(Perelman, Khair, Dermer, Tinmouth, Saidenberg, Fergusson) Faculty of
Medicine, University of Ottawa, Ottawa, ON, Canada
(Perelman, Tinmouth, Saidenberg, Fergusson) Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Tinmouth, Saidenberg) Ottawa Hospital, Ottawa, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
We performed a systematic review to describe the prevalence of
multicomponent blood transfusion and, as a secondary objective, to
determine patient characteristics and outcomes associated with
multicomponent transfusion. There is a lack of literature on the
epidemiology of multicomponent transfusion as most studies concentrate on
a single blood product and its utilisation. Patient care and blood
management can be optimised by better understanding the patients who
receive multicomponent transfusions. The databases Medline, EMBASE and the
Cochrane Library of Systematic Reviews were searched. Observational cohort
and cross-sectional studies of hospital patients reporting on
multicomponent transfusion prevalence or on patient characteristics and
outcomes associated with multicomponent transfusion were included. A
descriptive synthesis of studies was performed. A total of 37 eligible
studies were included. It was found that multicomponent transfusion
prevalence varied greatly by patient population and by the combination of
blood products given in the multicomponent transfusion.
Multicomponent-transfused patients included burn, cardiac surgery, liver
surgery and transplant, cancer, infectious diseases, trauma and intensive
care unit patients. Five studies found associations between multicomponent
transfusion and adverse health outcomes; however, these findings are
likely confounded by indication. The overall quality of evidence was low
given a fair-to-poor individual study quality, inconsistent multicomponent
transfusion prevalence estimates and confounding by indication. Further
research is needed to better understand the epidemiology of multicomponent
transfusion, including studies on multicomponent transfusion in
haematological cancer patients and studies looking for patient
characteristics that can better predict multicomponent transfusion
need.<br/>Copyright &#xa9; 2019 British Blood Transfusion Society

<23>
Accession Number
2001707101
Title
Interventional Therapy Versus Medical Therapy for Secundum Atrial Septal
Defect: A Systematic Review (Part 2) for the 2018 AHA/ACC Guideline for
the Management of Adults With Congenital Heart Disease: A Report of the
American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines.
Source
Journal of the American College of Cardiology. 73 (12) (pp 1579-1595),
2019. Date of Publication: 2 April 2019.
Author
Oster M.; Bhatt A.B.; Zaragoza-Macias E.; Dendukuri N.; Marelli A.
Publisher
Elsevier USA
Abstract
Secundum atrial septal defect (ASD) is the most common adult congenital
heart defect and can present with wide variation in clinical findings.
With the intention of preventing morbidity and mortality associated with
late presentation of ASD, consensus guidelines have recommended surgical
or percutaneous ASD closure in adults with right heart enlargement, with
or without symptoms. The aim of the present analysis was to determine if
the protective effect of secundum ASD closure in adults could be qualified
by pooling data from published studies. A systematic review and
meta-analysis were performed by using EMBASE, MEDLINE (through PubMed),
and the Cochrane Library databases to assess the effect of secundum ASD
percutaneous or surgical closure in unoperated adults >=18 years of age.
Data were pooled across studies with the DerSimonian-Laird random-effects
model or a Bayesian meta-analysis model. Between-study heterogeneity was
assessed with Cochran's Q test. Bias assessment was performed with the
Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and statistical
risk of bias was assessed with Begg and Mazumdar's test and Egger's test.
A total of 11 nonrandomized studies met the inclusion criteria,
contributing 603 patients. Pooled analysis showed a protective effect of
ASD closure on New York Heart Association functional class and on right
ventricular systolic pressure, volumes, and dimensions. Two additional
studies comprising 652 patients were reviewed separately for mortality
outcome and primary outcome of interest because they did not meet the
inclusion criteria. Those studies showed that ASD closure was associated
with a weak protective effect on adjusted mortality rate but no
significant impact on atrial arrhythmias in patients >50 years of age.
Across all studies, there was significant heterogeneity between studies
for nearly all clinical outcomes. The overall body of evidence was limited
to observational cohort studies, the limitations of which make for
low-strength evidence. Even within the parameters of the included studies,
quality of evidence was further diminished by the lack of well-defined
clinical outcomes. In conclusion, pooled data analysis on the impact of
secundum ASD closure in adults was notably limited because of the lack of
randomized controlled trials in patients with only secundum ASD. The few
cohort studies in this population demonstrated improvement in functional
status and right ventricular size and function as shown by echocardiogram.
However, our findings suggest that at the time of this publication,
insufficient data are available to determine the impact of ASD repair on
mortality rate in adults.<br/>Copyright &#xa9; 2019 American Heart
Association, Inc., and the American College of Cardiology Foundation

<24>
Accession Number
623713797
Title
Adverse clinical outcomes associated with double dose clopidogrel compared
to the other antiplatelet regimens in patients with coronary artery
disease: A systematic review and meta-analysis.
Source
BMC Pharmacology and Toxicology. 19 (1) (no pagination), 2018. Article
Number: 54. Date of Publication: 03 Sep 2018.
Author
Zhuo X.; Zhuo B.; Ouyang S.; Niu P.; Xiao M.
Institution
(Zhuo, Ouyang, Niu, Xiao) Affiliated Changsha Hospital of Hunan Normal
University, The Fourth Hospital of Changsha, Department of Cardiology,
Changsha, Hunan 410006, China
(Zhuo) People's Hospital of Laibin, Department of Pharmacology, Laibin,
Guangxi 546100, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently, several newer antiplatelet treatment strategies have
been used in patients with coronary artery disease (CAD). Apart from the
dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel,
double dose clopidogrel (DDC), triple antiplatelet therapy (TAPT)
consisting of aspirin, clopidogrel and cilostazol and other newer
antiplatelet agents have shown to be effective in different ways. In this
analysis, we aimed to systematically compare the adverse clinical outcomes
and the bleeding events which were observed when DDC was compared to the
other antiplatelet regimens in patients with CAD. <br/>Method(s): English
publications comparing DDC with other antiplatelet regimens were searched
from MEDLARS/MEDLINE, EMBASE, www.ClinicalTrials.gov and Google Scholar.
Adverse cardiovascular outcomes and bleeding events were the study
endpoints. Statistical analysis was carried out by the RevMan 5.3 software
whereby odds ratios (OR) with 95% confidence intervals (CIs) were
calculated. <br/>Result(s): A total number of 23,065 participants were
included. Results of this analysis showed major adverse cardiac events
(MACEs), all-cause mortality, cardiac death, stroke, stent thrombosis,
revascularization and myocardial infarction (MI) to have been similarly
manifested in patients who were treated with DDC versus the control group
with OR: 0.98, 95% CI: 0.78-1.22; p = 0.83, OR: 0.95, 95% CI: 0.77-1.17; p
= 0.62, OR: 0.97, 95% CI: 0.79-1.20; p = 0.81, OR: 0.98, 95% CI:
0.65-1.48; p = 0.94, OR: 0.84, 95% CI: 0.40-1.75; p = 0.64, OR: 0.88, 95%
CI: 0.52-1.49; p = 0.63, and OR: 0.89, 95% CI: 0.65-1.21; p = 0.45
respectively. Any minor and major bleedings were also similarly
manifested. When DDC was compared to DAPT, no significant difference was
observed in any bleeding event with OR: 1.58, 95% CI: 0.86-2.91; p = 0.14.
Even when DDC was compared with either ticagrelor or prasugrel or TAPT,
still no significant difference was observed in terms of bleeding
outcomes. <br/>Conclusion(s): In patients with CAD, adverse clinical
outcomes were not significantly different when DDC was compared to the
other antiplatelet regimens. In addition, bleeding events were also
similarly manifested when DDC was compared to DAPT, TAPT or
ticagrelor/prasugrel.<br/>Copyright &#xa9; 2018 The Author(s).

<25>
Accession Number
624181533
Title
Advanced image processing with fusion and calcification enhancement in
transcatheter aortic valve implantation: Impact on radiation exposure.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (4) (pp 512-519),
2018. Date of Publication: 01 Oct 2018.
Author
Overtchouk P.; Sudre A.; Delhaye C.; Juthier F.; Van Belle E.; Coisne A.;
Koussa M.; Mylotte D.; Modine T.
Institution
(Overtchouk, Sudre, Delhaye, Juthier, Van Belle, Coisne, Koussa, Modine)
Department of Cardiology and Cardiovascular Surgery, Institut Coeur
Poumon, Centre Hospitalier Regional et Universitaire de Lille (CHRU de
Lille), 2 Avenue Oscar Lambret, Lille 59037, France
(Juthier, Van Belle, Coisne) INSERM UMR 1011, Lille, France
(Juthier, Van Belle, Coisne) Faculte de Medecine, Universite de Lille 2,
Lille, France
(Coisne) Institut Pasteur de Lille, Lille, France
(Coisne) European Genomic Institute for Diabetes (E.G.I.D), Lille, France
(Coisne) CHU Lille, Department of Clinical Physiology and
Echocardiography, Lille, France
(Mylotte) Department of Cardiology, Galway University Hospital, Galway,
Ireland
Publisher
Oxford University Press
Abstract
OBJECTIVES Radiation exposure is a concern for both patients and operators
during transcatheter aortic valve implantation (TAVI). Efforts to reduce
radiation dose are warranted. We aimed at investigating if per-operative
advanced image processing can reduce patient and operator irradiation use
during TAVI. METHODS We performed a prospective single-centre
observational study comparing patient and operator radiation exposure
using standard fluoroscopy (control group) or a novel technology of live
advanced fluoroscopic image processing (test group) among consecutive
patients undergoing TAVI between August 2015 and April 2016. Patient
irradiation (dose-area product, effective dose and air kerma), contrast
media volume and clinical outcomes were assessed. RESULTS Among 152
elderly [median age (interquartile range): 83 (78-87)] patients (n = 76
per group) undergoing TAVI, baseline clinical characteristics were similar
between the control and test groups, except for a higher median EuroSCORE
II (2.8% vs 2.3%, P = 0.02) and higher rate of TAVI for failing surgical
bioprosthesis (11.8% vs 2.6%, P = 0.03) in the control group. The
dose-area product was reduced in the test group: mean reduction of -27.5
Gy x cm² [95% confidence intervals (CIs): 15.9-39.1, P <
0.001]. Furthermore, effective dose [mean reduction -6.5 (95% CI: 5.9-7.2)
mSv, P < 0.001] and air kerma [mean reduction -167.5 (95% CI 163.4-177.3)
mGy, P < 0.001] were lower in the test group. Fluoroscopy time, contrast
volume and clinical outcomes were similar. CONCLUSIONS Patient radiation
exposure was significantly reduced using a novel live advanced fluoroscopy
image processing with calcification enhancement and fusion of the virtual
aortic annulus without compromising patient safety.<br/>Copyright &#xa9;
The Author(s) 2018. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<26>
Accession Number
624181500
Title
Is administration of dual-antiplatelet therapy beneficial for patients
following off-pump coronary artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (4) (pp 548-554),
2018. Date of Publication: 01 Oct 2018.
Author
Peksa M.; Aboul-Hassan S.S.; Marczak J.; Cichon R.
Institution
(Peksa, Aboul-Hassan, Marczak) Department of Cardiac Surgery, MEDINET
Heart Center Ltd., Chalubinskiego 7 street, Nowa Sol 67-100, Poland
(Marczak) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Cichon) Department of Cardiac Surgery, Warsaw Medical University, Warsaw,
Poland
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether administration of
dual-antiplatelet therapy (DAPT) following off-pump coronary artery bypass
grafting (OPCAB) would improve postoperative clinical outcomes or minimize
the incidence of postoperative graft failure. In total, 101 papers were
found using the reported search, 14 of which represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. One meta-analysis and 3 randomized
controlled trials showed that DAPT following OPCAB is associated with
decreased incidence of saphenous vein graft occlusion. One randomized
controlled trial and 4 observational studies showed no effect of DAPT on
mortality following OPCAB, whereas 3 observational studies showed that
DAPT decreased mortality. One meta-analysis and 4 observational studies
showed that DAPT reduced the incidence of cardiac events following OPCAB.
One randomized controlled trial and 4 observational studies showed that
DAPT did not increase the incidence of major or minor bleeding
complications following OPCAB. The results presented suggest that
administration of DAPT in patients following OPCAB for at least 3 months
improves saphenous vein graft patency and could be protective against
recurrence of cardiac events, especially acute coronary syndrome, in
comparison with aspirin monotherapy. The administration of DAPT following
OPCAB is safe and is not associated with increased incidence of major or
minor bleeding complications when compared with aspirin
alone.<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<27>
Accession Number
625096611
Title
Switching from ticagrelor to clopidogrel in patients with ST-segment
elevation myocardial infarction undergoing successful percutaneous
coronary intervention in real-world China: Occurrences, reasons, and
long-term clinical outcomes.
Source
Clinical Cardiology. 41 (11) (pp 1446-1454), 2018. Date of Publication:
November 2018.
Author
Li X.-Y.; Su G.-H.; Wang G.-X.; Hu H.-Y.; Fan C.-J.
Institution
(Li, Su, Wang, Hu, Fan) Department of Cardiology, Jinan Central Hospital
Affiliated to Shandong University, Shangdong, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Although switching between ticagrelor and clopidogrel is
common in clinical practice, the efficacy and safety of this de-escalation
remain controversial. Hypothesis: We assessed the occurrences, reasons,
and outcomes of switching from ticagrelor to clopidogrel in patients with
ST-segment elevation myocardial infarction (STEMI) undergoing successful
primary percutaneous coronary intervention (PCI). <br/>Method(s): A total
of 653 patients with STEMI were randomly assigned to receive loading dose
of ticagrelor or clopidogrel before PCI and then received maintenance
dose, respectively, for 12 months follow-up. The primary outcome was major
adverse cardiac events (MACE), including cardiovascular death, nonfatal
myocardial infarction, and stroke. The secondary outcome included
unexpected rehospitalization for angina, coronary revascularization, and
stent thrombosis. The safety outcome was bleeding described by the
Bleeding Academic Research Consortium (BARC) criteria. <br/>Result(s): A
total of 602 participants completed the study. The rate of switching from
ticagrelor to clopidogrel was 48.6% and the main reason was financial
burden. The rate of secondary ischemic events in the de-escalation group
was higher than that in the ticagrelor group (15.1% vs 5.6%, P = 0.008),
but lower than that in the clopidogrel group (15.1% vs 24.6%, P = 0.03),
while there were no significant differences in MACE among the three groups
(P = 0.16). De-escalation, ticagrelor, and clopidogrel did not cause
significant differences in the rates of major bleeding among the three
groups (BARC >= 2, P = 0.34). <br/>Conclusion(s): Switching from
ticagrelor to clopidogrel is very common in patients with STEMI in China.
De-escalation might be safe but associated with high risk of ischemic
events as compared to ticagrelor.<br/>Copyright &#xa9; 2018 Wiley
Periodicals, Inc.

<28>
Accession Number
619070096
Title
Contribution of the straightening effect of the parent artery to decreased
recanalization in stent-assisted coiling of large aneurysms.
Source
Journal of Neurosurgery. 127 (5) (pp 1063-1069), 2017. Date of
Publication: November 2017.
Author
Ishii A.; Chihara H.; Kikuchi T.; Arai D.; Ikeda H.; Miyamoto S.
Institution
(Ishii, Chihara, Kikuchi, Arai, Ikeda, Miyamoto) Department of
Neurosurgery, Kyoto University, Graduate School of Medicine, 54
Kawahara-cho, Syogo-in, Sakyo-ku, Kyoto 606-8507, Japan
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE The durability of embolization of large aneurysms is enhanced by
use of the neck-bridging stent. However, it remains unclear what factors
contribute to decreased recanalization. The purpose of this study was to
demonstrate the contribution of the straightening effect of the parent
artery to the durability of stent-assisted coiling for large aneurysms.
METHODS Of the 182 aneurysms treated by embolization since the
introduction of the neurovascular stent, 82 consecutive unruptured
aneurysms with a diameter greater than 7 mm were selected. There were 52
aneurysms treated with a stent (Group S) and 30 treated without a stent
(Group NS). Occlusion status was evaluated 12 months after embolization
with digital subtraction angiography. The vascular angle of the parent
artery was measured before, immediately after, and 12 months after
embolization. The rates of recanalization were compared between Group S
and Group NS. In Group S, the rates of recanalization were further
compared between those aneurysms with and without a significant angle
change. RESULTS The rate of major recanalization was 9.6% in Group S and
26.7% in Group NS. The volume embolization ratio was 32.6% in Group S and
31.6% in Group NS, with no statistically significant difference. However,
the angulation change before and after coiling was significantly higher in
Group S (10.6degree) than in Group NS (0.9degree). The difference in the
angulation was more evident 12 months after coiling (19.1degree in Group S
and 1.5degree in Group NS). In Group S, recanalization was found in 14.3%
of 35 stented aneurysms without a significant angular change when a
significant angular change was defined as more than 20degree. In contrast,
all 17 aneurysms with >=20degree of angular change remained occluded.
CONCLUSIONS Significant angular change of >=20degree most likely leads to
decreased recanalization following stentassisted embolization of large
aneurysms.<br/>Copyright &#xa9; AANS, 2017.

<29>
Accession Number
614075888
Title
Use of noninvasive and invasive mechanical ventilation in cardiogenic
shock: A prospective multicenter study.
Source
International Journal of Cardiology. 230 (pp 191-197), 2017. Date of
Publication: 01 Mar 2017.
Author
Hongisto M.; Lassus J.; Tarvasmaki T.; Tolppanen H.; Lindholm M.G.;
Banaszewski M.; Parissis J.; Spinar J.; Silva-Cardoso J.; Carubelli V.; Di
Somma S.; Masip J.; Harjola V.-P.; Kober L.; Mebazaa A.; Metra M.; Sionis
A.; Koniari K.; Voumvourakis A.; Karavidas A.; Sans-Rosello J.; Vila M.;
Duran-Cambra A.; Bulgari B.; Lazzarini V.; Parenica J.; Stipal R.; Ludka
O.; Palsuva M.; Ganovska E.; Kubena P.; Hassager C.; Backlund T.; Jurkko
R.; Jarvinen K.; Nieminen T.; Pulkki K.; Soininen L.; Sund R.; Tierala I.;
Tolonen J.; Varpula M.; Korva T.; Pietila M.; Pitkala A.; Marino R.; Sousa
A.; Sousa C.; Paiva M.; Rangel I.; Almeida R.; Pinho T.; Julia Maciel M.;
Stepinska J.; Skrobisz A.; Goral P.
Institution
(Hongisto, Tarvasmaki, Harjola) Emergency Medicine, University of
Helsinki, Department of Emergency Care, Helsinki University Hospital,
Helsinki, Finland
(Lassus, Tolppanen) Helsinki University Hospital, Heart and Lung Center,
Division of Cardiology, Helsinki, Finland
(Sionis) Intensive Cardiac Care Unit, Cardiology Department, Hospital de
la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant
Pau) Barcelona, Spain
(Lindholm) Rigshospitalet, Copenhagen University Hospital, Intensive
Cardiac Care Unit, Copenhagen, Denmark
(Banaszewski) Institute of Cardiology, Intensive Cardiac Therapy Clinic,
Warsaw, Poland
(Parissis) Attikon University Hospital, Heart Failure Clinic and Secondary
Cardiology Department, Athens, Greece
(Spinar) University Hospital Brno, Department of Internal Medicine and
Cardiology, Brno, Czechia
(Silva-Cardoso) University of Porto, CINTESIS, Department of Cardiology,
Porto Medical School, Sao Joao Hospital Center, Porto, Portugal
(Carubelli) Division of Cardiology, Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, University and
Civil Hospital of Brescia, Italy
(Di Somma) Department of Medical Sciences and Translational Medicine,
University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital,
Rome, Italy
(Masip) University of Barcelona, Hospital Sant Joan Despi Moises Broggi,
Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite scarce data, invasive mechanical ventilation (MV) is
widely recommended over non-invasive ventilation (NIV) for ventilatory
support in cardiogenic shock (CS). We assessed the real-life use of
different ventilation strategies in CS and their influence on outcome
focusing on the use of NIV and MV. Methods 219 CS patients were
categorized by the maximum intensity of ventilatory support they needed
during the first 24 h into MV (n = 137; 63%), NIV (n = 26; 12%), and
supplementary oxygen (n = 56; 26%) groups. We compared the clinical
characteristics and 90-day outcome between the MV and the NIV groups.
Results Mean age was 67 years, 74% were men. The MV and NIV groups did not
differ in age, medical history, etiology of CS,
PaO<inf>2</inf>/FiO<inf>2</inf> ratio, baseline hemodynamics or LVEF. MV
patients predominantly presented with hypoperfusion, with more severe
metabolic acidosis, higher lactate levels and greater need for vasoactive
drugs, whereas NIV patients tended to be more often congestive. 90-day
outcome was significantly worse in the MV group (50% vs. 27%), but after
propensity score adjustment, mortality was equal in both groups.
Confusion, prior CABG, ACS etiology, higher lactate level, and lower
baseline PaO<inf>2</inf> were independent predictors of mortality, whereas
ventilation strategy did not have any influence on outcome. Conclusions
Although MV is generally recommended mode of ventilatory support in CS, a
fair number of patients were successfully treated with NIV. Moreover,
ventilation strategy was not associated with outcome. Thus, NIV seems a
safe option for properly chosen CS patients.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<30>
Accession Number
364880105
Title
Inflammatory response to colloids compared to crystalloid priming in
cardiac surgery patients with cardiopulmonary bypass.
Source
Chinese Journal of Physiology. 55 (3) (pp 1-9), 2012. Date of Publication:
2012.
Author
Liou H.-L.; Shih C.-C.; Chao Y.-F.C.; Lin N.-T.; Lai S.-T.; Wang S.-H.;
Chen H.I.
Institution
(Liou) Department of Nursing, Taipei Veterans General Hospital, Taipei,
Taiwan (Republic of China)
(Shih) Institue of Clinical Medicine, National Yang Ming Medical
University; Division of Cardiovascular Surgery, Taipei Veterans General
Hospital, Taipei, Taiwan (Republic of China)
(Chao) Department of Nursing, Mackay Medical College, New Taipei City,
Taiwan (Republic of China)
(Lin) Department of Microbiology Immunology and Molecular Medicine, Tzu
Chi University, Hualien, Taiwan (Republic of China)
(Lai) Division of Cardiovascular Surgery, Taipei Veterans General
Hospital, Taipei, Taiwan (Republic of China)
(Wang) Department of Anesthesiology, Veterans General Hospital, Taipei,
Taiwan (Republic of China)
(Chen) Institue of Physiological and Anatomical Medicine, Tzu Chi
University, Hualien, Taiwan (Republic of China)
Publisher
Chinese Physiological Society
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic
inflammatory response syndrome that may contribute to postoperative
morbidity and mortality. We investigated the inflammatory responses to
colloids compared to crystalloid priming in cardiac surgery patients with
cardiopulmonary bypass. Thirty patients undergoing coronary artery bypass
grafting (CABG) preparing for CPB were randomized into Ringer's solution
(RS), 10% hydroxyethyl starch (HES) or 25% human albumin (HA) group. Serum
concentrations of tumor necrosis factor-alpha (TNF-alpha),
interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and interleukin-10
(IL-10) were measured before CPB, at the end of CPB and 1, 6 and 12 h
after CPB. Serum C-reactive protein (CRP) was determined pre-operatively
and then daily for 2 days. Body-weight gain was significantly decreased on
the day after surgery in the HES group than in the RS group. Volume
priming in CPB for CABG patients using HA or HES preparation had less
tendency for intense inflammatory response with lower levels of TNF-alpha,
IL-1beta, IL-6 and higher levels of IL-10 compared to patients treated
with RS. HES prime had lower levels of circulating CRP than in patients
treated with HA or Ringer prime on the second post-operative day. Our data
indicate that volume priming using colloid during CPB in CABG patients
might exert beneficial effects on inflammatory responses. &#xa9; 2012 by
The Chinese Physiological Society and Airiti Press Inc.

<31>
Accession Number
626037968
Title
Ten-Year Follow-Up of Off-Pump and On-Pump Multivessel Coronary Artery
Bypass Grafting: MASS III.
Source
Angiology. 70 (4) (pp 337-344), 2019. Date of Publication: 01 Apr 2019.
Author
Hueb W.; Rezende P.C.; Gersh B.J.; Soares P.R.; Favarato D.; Lima E.G.;
Garzillo C.L.; Jatene F.B.; Ramires J.A.F.; Filho R.K.
Institution
(Hueb, Rezende, Soares, Favarato, Lima, Garzillo, Jatene, Ramires, Filho)
Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas
HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo,
Brazil
(Gersh) Mayo Clinic Foundation, Rochester, MN, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
It was a randomized trial, and 308 patients undergoing revascularization
were randomly assigned: 155 to off-pump coronary artery bypass (OPCAB) and
153 to on-pump coronary artery bypass (ONCAB). End points were freedom
from death, myocardial infarction, revascularization, and cerebrovascular
accidents. The rates for 10-year, event-free survival for ONCAB versus
OPCAB were 69.6% and 64%, (hazard ratio [HR]: 0.88; 95% confidence
interval [CI] 0.86-1.02; P =.41), respectively. Adjusted Cox proportional
hazard ratio was similar (HR: 0.92; 95% CI 0.61-1.38, P =.68). A
difference occurred between the duration of OPCAB and ONCAB, respectively
(4.9 +/- 1.5 vs 6.6 +/- 1.1 h, P <.001). Statistical differences occurred
between OPCAB and ONCAB in the length of intensive care unit (ICU) stay
(20 +/- 2.5 vs 48 +/- 10 hours, P <.001), time to extubation (5.5 +/- 4.2
vs 10.2 +/- 3.5 hours, P <.001), hospital stay (6.7 +/- 1.4 vs 9.2 +/- 1.3
days, P <.001), higher incidence of atrial fibrillation (AF; 33 vs 5
patients, P <.001), and blood requirements (46 vs 64 patients, P <.001).
Grafts per patient was higher in ONCAB (3.15 vs 2.55 grafts, P <.001). No
difference existed between the groups in primary composite end points at
10-year follow-up. Although OPCAB surgery was related to a lower number of
grafts and higher incidence of AF, it had no effects related to long-term
outcomes.<br/>Copyright &#xa9; The Author(s) 2018.

<32>
Accession Number
627092693
Title
Effects of lowering diastolic blood pressure to <80 mmHg on cardiovascular
mortality and events in patients with coronary artery disease: a
systematic review and meta-analysis.
Source
Hypertension Research. 42 (5) (pp 650-659), 2019. Date of Publication: 01
May 2019.
Author
Okamoto R.; Kumagai E.; Kai H.; Shibata R.; Ohtsubo T.; Kawano H.;
Fujiwara A.; Ito M.; Fukumoto Y.; Arima H.
Institution
(Okamoto, Ito) Department of Cardiology and Nephrology, Mie University
Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
(Kumagai, Fukumoto) Division of Cardiovascular Medicine, Department of
Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi,
Kurume, Fukuoka 830-0011, Japan
(Kai) Department of Cardiology, Kurume University Medical Center, 155-1
Kokubu-machi, Kurume, Fukuoka 839-0863, Japan
(Shibata) Department of Advanced Cardiovascular Therapeutics, Nagoya
University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya
466-8550, Japan
(Ohtsubo) Department of Medicine and Clinical Science, Graduate School of
Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka
812-8582, Japan
(Kawano) Department of Cardiovascular Medicine, Nagasaki University
Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501,
Japan
(Fujiwara) Divition of Nephrology and Hypertension, Yokohama City
University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024,
Japan
(Arima) Department of Preventive Medicine and Public Health, Fukuoka
University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, Fukuoka 814-0180, Japan
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
The target of diastolic blood pressure (DBP) remains controversial in
patients with coronary artery disease (CAD). We systematically searched
PubMed/Medline and the Cochrane Central database for randomized controlled
trials (RCTs) assessing the efficacy and safety of reducing DBP in CAD
patients from January 1965 to July 2017. Seven placebo-controlled RCTs
enrolling 34,814 CAD patients who achieved DBP <80 mmHg were included in
the drug-intervention group. The average achieved blood pressures (BPs)
were 126.3/75.1 and 131.5/77.8 mmHg in the drug-intervention and
placebo-control groups, respectively. Drug intervention was associated
with an 11% reduction in coronary revascularization and a 31% reduction in
heart failure. In the drug-intervention group, all-cause death, myocardial
infarction, angina pectoris, and stroke were reduced with marginal
significance, whereas hypotension was increased by 123%. A meta-analysis
of four RCTs, in which the achieved DBP was <75 mmHg, showed that the drug
intervention was associated with a 22% reduction in heart failure. These
results suggest that reducing DBP to 80 mmHg or less would significantly
reduce coronary revascularization and heart failure but at the expense of
causing hypotension in CAD patients. Further trials are warranted to prove
this issue.<br/>Copyright &#xa9; 2019, The Japanese Society of
Hypertension.

<33>
Accession Number
626675021
Title
Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients
after Cardiac Surgery.
Source
Thoracic and Cardiovascular Surgeon. 67 (2) (pp 107-116), 2019. Date of
Publication: 2019.
Author
Yamashita K.; Hu N.; Ranjan R.; Selzman C.H.; Dosdall D.J.
Institution
(Yamashita, Ranjan, Selzman, Dosdall) Nora Eccles Harrison Cardiovascular
Research and Training Institute, University of Utah, 95 South 2000 East
84112, United States
(Yamashita, Ranjan, Dosdall) Division of Cardiovascular Medicine,
Department of Internal Medicine, University of Utah, Salt Lake City, UT,
United States
(Hu) Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,
United States
(Hu) Division of Epidemiology, Department of Internal Medicine, University
of Utah, Salt Lake City, UT, United States
(Selzman, Dosdall) Division of Cardiothoracic Surgery, Department of
Surgery, University of Utah, Salt Lake City, UT, United States
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background a?Postoperative atrial fibrillation (POAF) is a common
arrhythmia following cardiac surgery and is associated with increased
health-care costs, complications, and mortality. The etiology of POAF is
incompletely understood and its prediction remains suboptimal. Using data
from published studies, we performed a systemic review and meta-analysis
to identify preoperative clinical risk factors associated with patients at
increased risk of POAF. Methods a?A systematic search of PubMed, MEDLINE,
and EMBASE databases was performed. Results a?Twenty-four studies that
reported univariate analysis results regarding POAF risk factors,
published from 2001 to May 2017, were included in this meta-analysis with
a total number of 36,834 subjects. Eighteen studies were performed in the
United States and Europe and 16 studies were prospective cohort studies.
The standardized mean difference (SMD) between POAF and non-POAF groups
was significantly different (reported as [SMD: 95% confidence interval,
CI]) for age (0.55: 0.47-0.63), left atrial diameter (0.45: 0.15-0.75),
and left ventricular ejection fraction (0.30: 0.14-0.47). The pooled odds
ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure
(1.56: 1.31-1.96), chronic obstructive pulmonary disease (1.36:
1.13-1.64), hypertension (1.29: 1.12-1.48), and myocardial infarction
(1.18: 1.05-1.34) were significant predictors of POAF incidence, while
diabetes was marginally significant (1.06: 1.00-1.13). Conclusion a?The
present analysis suggested that older age and history of heart failure
were significant risk factors for POAF consistently whether the included
studies were prospective or retrospective datasets.<br/>Copyright &#xa9;
2019 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY
10001, USA.

<34>
Accession Number
2001400494
Title
Preventing Ventricular Fibrillation in Patients With Left Ventricular
Hypertrophy Undergoing Aortic Valve Replacement: Time to Consider
Prophylactic Amiodarone Infusion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (5) (pp 1214-1215),
2019. Date of Publication: May 2019.
Author
Dalia A.A.; Essandoh M.K.
Institution
(Dalia) Department of Anesthesiology, Pain Medicine, and Critical Care,
The Massachusetts General Hospital, Harvard Medical School, Boston, MA,
United States
(Essandoh) Department of Anesthesiology, Wexner Medical Center, The Ohio
State University, Columbus, OH, United States
Publisher
W.B. Saunders

<35>
Accession Number
627234012
Title
Checkpoint inhibitor therapy for cancer in solid organ transplantation
recipients: An institutional experience and a systematic review of the
literature.
Source
Journal for ImmunoTherapy of Cancer. 7 (1) (no pagination), 2019. Article
Number: 106. Date of Publication: 16 Apr 2019.
Author
Abdel-Wahab N.; Safa H.; Abudayyeh A.; Johnson D.H.; Trinh V.A.; Zobniw
C.M.; Lin H.; Wong M.K.; Abdelrahim M.; Gaber A.O.; Suarez-Almazor M.E.;
Diab A.
Institution
(Abdel-Wahab, Suarez-Almazor) Section of Rheumatology and Clinical
Immunology, Department of General Internal Medicine, University of Texas,
MD Anderson Cancer Center, Houston, TX, United States
(Abdel-Wahab) Department of Rheumatology and Rehabilitation, Faculty of
Medicine, Assiut University Hospitals, Assiut, Egypt
(Safa, Johnson, Trinh, Zobniw, Wong, Diab) Department of Melanoma Medical
Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX,
United States
(Abudayyeh) Section of Nephrology, Division of Internal Medicine,
University of Texas, MD Anderson Cancer Center, Houston, TX, United States
(Lin) Department of Biostatistics, University of Texas, MD Anderson Cancer
Center, Houston, TX, United States
(Abdelrahim, Gaber) Houston Methodist Hospital, Houston, TX, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Checkpoint inhibitors (CPIs) have revolutionized the treatment
of cancer, but their use remains limited by off-target inflammatory and
immune-related adverse events. Solid organ transplantation (SOT)
recipients have been excluded from clinical trials owing to concerns about
alloimmunity, organ rejection, and immunosuppressive therapy. Thus, we
conducted a retrospective study and literature review to evaluate the
safety of CPIs in patients with cancer and prior SOT. <br/>Method(s): Data
were collected from the medical records of patients with cancer and prior
SOT who received CPIs at The University of Texas MD Anderson Cancer Center
from January 1, 2004, through March 31, 2018. Additionally, we
systematically reviewed five databases through April 2018 to identify
studies reporting CPIs to treat cancer in SOT recipients. We evaluated the
safety of CPIs in terms of alloimmunity, immune-related adverse events,
and mortality. We also evaluated tumor response to CPIs. <br/>Result(s):
Thirty-nine patients with allograft transplantation were identified. The
median age was 63 years (range 14-79 years), 74% were male, 62% had
metastatic melanoma, 77% received anti-PD-1 agents, and 59% had prior
renal transplantation, 28% hepatic transplantation, and 13% cardiac
transplantation. Median time to CPI initiation after SOT was 9 years
(range 0.92-32 years). Allograft rejection occurred in 41% of patients
(11/23 renal, 4/11 hepatic, and 1/5 cardiac transplantations), at similar
rates for anti-CTLA-4 and anti-PD-1 therapy. The median time to rejection
was 21 days (95% confidence interval 19.3-22.8 days). There were no
associations between time since SOT and frequency, timing, or type of
rejection. Overall, 31% of patients permanently discontinued CPIs because
of allograft rejection. Graft loss occurred in 81%, and death was reported
in 46%. Of the 12 patients with transplantation biopsies, nine (75%) had
acute rejection, and five of these rejections were T cell-mediated. In
melanoma patients, 36% responded to CPIs. <br/>Conclusion(s): SOT
recipients had a high allograft rejection rate that was observed shortly
after CPI initiation, with high mortality rates. Further studies are
needed to optimize the anticancer treatment approach in these
patients.<br/>Copyright &#xa9; 2019 The Author(s).

<36>
Accession Number
627237015
Title
Fractional flow reserve-guided complete revascularization versus
culprit-only revascularization in acute ST-segment elevation myocardial
infarction and multi-vessel disease patients: A meta-analysis and
systematic review.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 49. Date of Publication: 01 Mar 2019.
Author
Wang L.-J.; Han S.; Zhang X.-H.; Jin Y.-Z.
Institution
(Wang, Han, Zhang, Jin) Department of Cardiology, Fourth Affiliated
Hospital, China Medical University, Shenyang, Liaoning 110032, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Approximately 30-50% patients with acute ST-segment elevation
myocardial infarction (STMEI) were found to have non-infarct-related
coronary artery (IRA) disease, which was significantly associated with
worse prognosis. However, challenges still remain for these patients:
which non-infarct-related lesion should be treated and when should the
procedure be performed? The present study aims to investigate Fractional
flow reserve (FFR)-guided complete revascularization (CR) in comparison to
culprit-only revascularization (COR) in patients with ST-segment elevation
myocardial infarction (STEMI) and multi-vessel disease (MVD).
<br/>Method(s): Three appropriate randomized controlled trials (RCTs) were
selected from the PubMed/Medline, EMBASE, and the Cochrane library
/CENTRAL databases. 1631 patients (688 patients underwent FFR-guided CR
and 943 patients underwent COR) following-up 12-44 months was evaluated.
<br/>Result(s): FFR-guided CR significantly reduced major adverse cardiac
event (MACE) (OR 0.47, 95% CI: 0.35-0.62, P < 0.00001) and ischemia-driven
repeat revascularization (OR 0.36, 0.26-0.51, P < 0.00001), as compared to
COR. However, there is no difference in all-cause mortality (OR 1.24,
0.65-2.35, P = 0.51). <br/>Conclusion(s): In patients with STEMI and MVD,
FFR-guided CR is better than COR in terms of MACE and ischemia-driven
repeat revascularization, while there are almost similar in all-cause
mortality. Trial registration: All analyses were based on previous
published studies, thus no ethical approval and patient consent are
required COMPARE-ACUTE trial number NCT01399736; DANAMI-3-PRIMULTI trial
number NCT01960933.<br/>Copyright &#xa9; 2019 The Author(s).

<37>
Accession Number
625415467
Title
Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and
Meta-Analysis.
Source
Urologia Internationalis. 102 (2) (pp 131-144), 2019. Date of Publication:
01 Mar 2019.
Author
Hosseini J.; Hosseini S.; Hosseini M.A.; Rezaei Y.
Institution
(Hosseini) Infertility and Reproductive Health Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hosseini, Rezaei) Heart Valve Disease Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Stud. Research Committee, Qazvin University of Medical
Sciences, Qazvin 1995614331, Iran, Islamic Republic of
Publisher
S. Karger AG
Abstract
Introduction: The use of pericardium has been expanded into different
surgical modalities; however, there are scarce data regarding the
feasibility of the pericardium in reconstructive urologic surgeries. We
systematically reviewed the literature on the effectiveness of the
pericardial tissue for reconstructive urologic surgeries. <br/>Material(s)
and Method(s): PubMed and Scopus were searched online for evidence on the
use of the pericardium in urologic surgeries. Through the methodology
recommended by the Preferred Reporting Items for Systematic Reviews and
Meta-analysis guidelines, 38 of 4,071 studies were identified.
<br/>Result(s): A total of 715 patients and 139 animals underwent
reconstructive urologic surgeries using the pericardium. Bladder,
urethral, and renal reconstructions were successful in 100% of the human
cases. The rates of dissatisfaction, glans hypoesthesia, and penile
shortening were comparable between the pericardial graft surgeries and the
other operations during penile straightening, but there was a trend among
the patients with pericardial grafts toward having a more penile curvature
at follow-up (risk ratio [RR] 2.03, 95% CI 0.90-4.61, p = 0.09;
I² = 0%). Among the animal studies, there were 4 reports of
penile reconstruction, 7 studies of bladder reconstruction, and 1 study of
urethroplasty. Bladder reconstruction and urethroplasty were successful in
83 and 20% of the animals, respectively. The pooled result of the
stimulated intracorporeal pressure 5 V significantly favored pericardial
grafts during penile reconstruction (RR 2.61, 95% CI 1.26-3.97, p =
0.0002; I² = 0%). <br/>Conclusion(s): Our systematic review
demonstrates the feasibility of the pericardium, regardless of its type,
in urologic surgeries. It, however, seems that urethral substitution needs
further investigation. Given the lower cost, easier handling, and less
immunogenicity of the pericardium, further studies are required to examine
its pros and cons.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel.

<38>
Accession Number
2000974904
Title
Hemodynamic monitoring by pulse contour analysis during trans-catheter
aortic valve replacement: A fast and easy method to optimize procedure
results.
Source
Cardiovascular Revascularization Medicine. 20 (4) (pp 332-337), 2019. Date
of Publication: April 2019.
Author
Ristalli F.; Romano S.M.; Stolcova M.; Meucci F.; Squillantini G.; Valente
S.; Di Mario C.
Institution
(Ristalli, Romano, Stolcova, Meucci, Squillantini, Valente, Di Mario)
Structural Interventional Cardiology, Cardio-toraco-vascular Department,
Careggi University Hospital, Florence, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Residual aortic regurgitation (AR) complicates a not
negligible number of transcatheter aortic valve replacement (TAVR)
procedures, and its entity is not always clear at intraprocedural
angiographic and echocardiographic control. We applied a minimally
invasive hemodynamic monitoring system (Pressure Recording Analytical
Method, PRAM) in the setting of TAVR, with the aim of identifying
parameters that may help in detection and quantification of residual AR.
<br/>Method(s): We performed hemodynamic monitoring with PRAM in 43
patients undergoing trans-femoral TAVR. Investigated parameters were
systolic (Psys, mm Hg), diastolic (Pdia, mm Hg), mean (MAP, mm Hg) and
dicrotic pressure (Pdic, mm Hg), cardiac output (CO, L/min), stroke volume
(SV, mL), cardiac cycle efficiency (CCE, Units), dP/dt<inf>max_rad</inf>
(mm Hg/ms), MAP-Pdic (mm Hg). <br/>Result(s): Procedural success was
achieved in 86% of the patients; vascular complications occurred in 3
(6.9%), death in 2 (4.7%). Twenty (46.5%) patients had at least mild
residual AR. CO, SV, CCE and dP/dt<inf>max_rad</inf> changed significantly
(p < 0.001) between baseline and end of procedure in the overall
population, with more evident modifications in the subgroup without
residual AR. MAP-Pdic variations were statistically significant only in
the subgroup without AR (p = 0.05). <br/>Conclusion(s): TAVR determined an
improvement in hemodynamic parameters such as CO, SV, CCE,
dP/dt<inf>max_rad</inf>. MAP-Pdic was able to discriminate patients with
significant residual AR. Hemodynamic monitoring with PRAM system during
TAVR is easy and fast to obtain and may help in clinical decision-making
in controversial cases.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<39>
Accession Number
2001594465
Title
Association of intraoperative circulating-brain injury biomarker and
neurodevelopmental outcomes at 1 year among neonates who have undergone
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (5) (pp 1996-2002),
2019. Date of Publication: May 2019.
Author
Graham E.M.; Martin R.H.; Atz A.M.; Hamlin-Smith K.; Kavarana M.N.;
Bradley S.M.; Alsoufi B.; Mahle W.T.; Everett A.D.
Institution
(Graham, Atz) Division of Pediatric Cardiology, Department of Pediatrics,
Medical University of South Carolina, Charleston, SC, United States
(Martin) Department of Public Health Sciences, Medical University of South
Carolina, Charleston, SC, United States
(Hamlin-Smith) Department of Pediatrics, Medical University of South
Carolina, Charleston, SC, United States
(Kavarana, Bradley) Department of Cardiothoracic Surgery, Medical
University of South Carolina, Charleston, SC, United States
(Alsoufi) Department of Cardiothoracic Surgery, Children's Healthcare of
Atlanta and Emory University, Atlanta, Ga, United States
(Mahle) Division of Pediatric Cardiology, Department of Pediatrics,
Children's Healthcare of Atlanta and Emory University, Atlanta, Ga, United
States
(Everett) Division of Cardiology, Department of Pediatrics, Johns Hopkins
University, Baltimore, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Neurodevelopmental disability is the most significant
complication for survivors of infant surgery for congenital heart disease.
In this study we sought to determine if perioperative circulating brain
injury biomarker levels are associated with neurodevelopmental outcomes at
12 months. <br/>Method(s): A secondary analysis of a randomized controlled
trial of neonates who underwent cardiac surgery was performed. Glial
fibrillary acidic protein (GFAP) was measured: (1) before skin incision;
(2) immediately after bypass; (3) 4 and (4) 24 hours postoperatively.
Linear regression models were used to determine an association with the
highest levels of GFAP and Bayley Scales of Infant and Toddler Development
third edition (BSID) composite scores. <br/>Result(s): There were 97
subjects who had cardiac surgery at a mean age of 9 +/- 6 days and
completed a BSID at 12.5 +/- 0.6 months of age. Median (25th-75th
percentile) levels of GFAP were 0.01 (0.01-0.02), 0.85 (0.40-1.55), 0.07
(0.05-0.11), and 0.03 (0.02-0.04) ng/mL at the 4 time points,
respectively. In univariate analysis GFAP was negatively associated with
cognitive, language, and motor composite scores. GFAP levels immediately
after bypass differed between institutions; 1.57 (0.92-2.48) versus 0.77
(0.36-1.21) ng/mL (P =.01). After adjusting for center and potential
confounders, GFAP was independently associated with BSID motor score (P
=.04). <br/>Conclusion(s): Higher GFAP levels at the time of neonatal
cardiac operations were independently associated with decreased BSID motor
scores at 12 months. GFAP might serve as a diagnostic means to acutely
identify perioperative brain-specific injury and serve as a benchmark of
therapeutic efficacy for investigational treatments, discriminate
center-specific effects, and provide early prognostic information for
intervention.<br/>Copyright &#xa9; 2019 The American Association for
Thoracic Surgery

<40>
Accession Number
2001672743
Title
Danon disease: Gender differences in presentation and outcomes.
Source
International Journal of Cardiology. 286 (pp 92-98), 2019. Date of
Publication: 1 July 2019.
Author
Brambatti M.; Caspi O.; Maolo A.; Koshi E.; Greenberg B.; Taylor M.R.G.;
Adler E.D.
Institution
(Brambatti, Caspi, Maolo, Koshi, Greenberg, Adler) Division of Cardiology,
University of California San Diego, San Diego, CA, United States
(Taylor) Cardiovascular Institute and Adult Medical Genetics Program,
University of Colorado Denver, CO, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Danon disease (DD) is a rare X-linked autophagic vacuolar
myopathy, characterized by high penetrance and severe cardiomyopathy.
Because of its rarity, the natural history (NH) is uncertain.
<br/>Objective(s): We aimed to describe disease variability and outcomes
through a systematic review of all published DD cases. <br/>Method(s):
Among 83 manuscripts in MEDLINE and EMBASE on DD cases published until
October 2017, we identified 146 patients with positive genetic testing for
DD or positive muscle biopsy in a relative of a genetically diagnosed
proband. <br/>Result(s): 56 females and 90 males were identified. 92.5% of
patients had cardiac abnormalities. Females presented with either
hypertrophic cardiomyopathy (HCM, 70.3%) or dilated cardiomyopathy (DCM,
29.3%) whereas males presented with HCM 96.2% of the time. The composite
outcome of death, heart transplant or ventricular assist devices occurred
equally in both sexes (32% of females and 37% of males, p = 0.60) but
later in females (median age 38 years) than in males (median age 21 years,
p < 0.001). Whereas women present with isolated cardiac disease 73% of the
time, in males DD was frequently multisystemic and presented as a triad of
cognitive impairment, skeletal myopathy, and HCM in 42% of patients.
<br/>Conclusion(s): In this first systematic review of DD, we confirmed
the severe morbidity and mortality associated with disease in both sexes.
Women presented with both HCM and DCM and generally with isolated cardiac
disease, whereas in men DD usually presented as HCM and was frequently
multi-systemic. Further prospective NH studies will be required to confirm
these findings.<br/>Copyright &#xa9; 2019 Elsevier B.V.

<41>
Accession Number
2001844617
Title
Endovascular Versus Open Repair for Chronic Type B Dissection Treatment: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. 107 (5) (pp 1559-1570), 2019. Date of
Publication: May 2019.
Author
Boufi M.; Patterson B.O.; Loundou A.D.; Boyer L.; Grima M.J.; Loftus I.M.;
Holt P.J.
Institution
(Boufi, Patterson, Grima, Loftus, Holt) St George's Vascular Institute, St
George's Hospital NHS Trust, London, United Kingdom
(Boufi) Department of Vascular Surgery, University Hospital Nord,
Assistance Publique-Hopitaux de Marseille, Marseille, France
(Boufi) UMR T24, IFSTTAR, Aix-Marseille Universite, Marseille, France
(Loundou, Boyer) SPMC EA3279, Department of Public Health, Aix-Marseille
Universite, Marseille, France
Publisher
Elsevier USA
Abstract
Background: The respective place of endovascular repair (ER) versus open
surgery (OS) in thoracic dissecting aneurysm treatment remains debatable.
This comprehensive review seeks to compare the outcomes of ER versus OS in
chronic type B aortic dissection treatment. <br/>Method(s): Embase and
Medline searches (2000 to 2017) were performed following PRISMA (Preferred
Reporting Items for Systematic Review and Meta-Analyses) guidelines.
Outcomes data extracted comprised (1) early mortality and major
complications: stroke, spinal cord ischemia (SCI), dialysis, and
respiratory complications; and (2) late survival and reinterventions.
Reintervention causes were divided into proximal, adjacent, and distal.
Comparative studies allowed comparative meta-analysis. Noncomparative
studies were analyzed in pooled proportion meta-analyses for each group.
<br/>Result(s): A total of 39 studies were identified after exclusions, of
which 4 were comparative. Comparative meta-analysis demonstrated lower
early mortality for ER (odds ratio [OR], 4.13; 95% confidence interval
[CI], 1.10 to 15.4), stroke (OR, 4.33; 95% CI, 1.02 to 18.35), SCI (OR,
3.3; 95% CI, 0.97 to 11.25), and respiratory complications (OR, 6.88; 95%
CI,1.52 to 31.02), but higher reintervention rate (OR, 0.34; 95% CI, 0.16
to 0.69). Midterm survival was similar (OR, 1.19; 95% CI, 0.42 to 3.32).
Noncomparative studies demonstrated that most reinterventions were related
to the aortic segment distal to primary intervention in both groups (OS
73%, ER 59%). Reintervention procedures were mainly surgical for OS (85%),
mainly endovascular for ER (75%). Rupture rates were 1.2% (OS) and 3%
(ER). <br/>Conclusion(s): Endovascular repair is associated with
significant early benefits, but this is not sustained at midterm.
Reintervention is more frequent, but the OS is not exempt from
reintervention or late rupture. Both techniques have their place, but
patient selection is key.<br/>Copyright &#xa9; 2019 The Society of
Thoracic Surgeons

<42>
Accession Number
2001795051
Title
Comparing the effects of propofol and N-acetylcysteine on inflammatory
markers after coronary artery bypass surgery, a randomized clinical trial.
Source
International Journal of Pharmaceutical Research. 11 (1) (pp 586-591),
2019. Date of Publication: January-March 2019.
Author
Abdorasoul A.; Houshang S.; Ebrahim S.; Kamran M.
Institution
(Abdorasoul, Houshang) Anesthesiology and Critical Care Department,
Bushehr University of Medical Sciences, Bushehr, Iran, Islamic Republic of
(Ebrahim) Cardiac surgery Department, Bushehr University of Medical
Sciences, Bushehr, Iran, Islamic Republic of
(Kamran) Community Medicine Department, Bushehr University of Medical
Sciences, Bushehr, Iran, Islamic Republic of
Publisher
Advanced Scientific Research
Abstract
Anesthetic drugs used during cardiac surgery are posited to have
anti-inflammatory effects. N-Acetylcysteine (NAC)is suggested to have
antioxidant effects and is suggested to preserve systolic function, reduce
myocardial oxidative stress, and enhance myocardial edema resolution after
CPB or cardioplegic arrest. We aimed to compare the effects propofol and
NAC on inflammatory markers after cardiopulmonary bypass (CPB). In this
prospective parallel single- blind randomized clinical trial 80 candidates
of elective coronary artery bypass grafting were recruited and allocated
to two groups of propofol (P group) and N -Acetylcysteine (NAC group). The
P group received propofol 100 micro&#32;g/kg/minute peri-operatively with
sufentanil (0.02 micro&#32;g/kg/min), midazolam (1 micro&#32;g/kg/min) and
cis-atracurium (2.5 micro&#32;g/kg/min) The NAC group received 600 mg
N-acetylcysteine the day before surgery and 2 hours before induction of
anesthesia with 100 cc water. In the NAC group, propofol was omitted in
induction and maintenance of anesthesia and etomidate was used in
induction of anesthesia as hypnotic agent. Serum levels of IL-1, IL-6 and
TNF-alpha and systolic/diastolic blood pressure and heart rate were
measured after induction of anesthesia, 15 minutes, 3 hours, and 24 hours
after surgery. The groups were compared using non-parametric tests and
analyzed by SPSS software. After intervention, IL-alpha levels
significantly decreased in NAC group, while it increased significantly in
P group. TNF-alpha levels significantly increased in NAC group, then
decreased 24 hours after surgery, while it significantly increased in P
group (15 min than baseline), but then decreased at 3 and 24 hours post
-operatively. IL-6 levels decreased in both groups after 15 minutes
postoperatively than baseline, but significantly increased in both groups
at 3 hours and again decreased in both groups after 24 hours. IL-alpha
level was significantly different after 15 minutes, 3 and 24 hours after
surgery in both groups. But changes in the level of IL-beta and IL-6 were
only significant at 24 hours and 15 minutes post-operatively,
respectively, in both groups.Both drugs had similar anti-inflammatory
effects, and can be used during CPB.<br/>Copyright &#xa9; 2019, Advanced
Scientific Research. All rights reserved.

<43>
[Use Link to view the full text]
Accession Number
627082476
Title
Association of blood pressure measurements with peripheral artery disease
events reanalysis of the ALLHAT data.
Source
Circulation. 138 (17) (pp 1805-1814), 2018. Date of Publication: 2018.
Author
Itoga N.K.; Tawfik D.S.; Lee C.K.; Maruyama S.; Leeper N.J.; Chang T.I.
Institution
(Itoga, Lee, Leeper) Division of Vascular Surgery, Department of Surgery,
Stanford University School of Medicine, CA, United States
(Tawfik, Maruyama) Department of Health Research and Policy, Stanford
University School of Medicine, CA, United States
(Tawfik) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, Stanford University School of Medicine, CA, United States
(Chang) Division of Nephrology, Department of Medicine, Stanford
University School of Medicine, 777 Welch Road, Suite DE, Room D100, Palo
Alto, CA 94305, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Current guidelines recommend treating hypertension in patients
with peripheral artery disease (PAD) to reduce the risk of cardiac events
and stroke, but the effect of reducing blood pressure on lower extremity
PAD events is largely unknown. We investigated the association of blood
pressure with lower extremity PAD events using data from the ALLHAT trial
(Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial). <br/>METHOD(S): ALLHAT investigated the effect of different
antihypertensive medication classes (chlorthalidone, amlodipine,
lisinopril, or doxazosin) on cardiovascular events. With the use of these
data, the primary outcome in our analysis was time to first lower
extremity PAD event, defined as PAD-related hospitalization, procedures,
medical treatment, or PAD-related death. Given the availability of
longitudinal standardized blood pressure measurements, we analyzed
systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse
pressure as time-varying categorical variables (reference categories
120-129 mm Hg for SBP, 70-79 mm Hg for DBP, and 45-54 mm Hg for pulse
pressure) in separate models. We used extended Cox regression with death
as a competing risk to calculate the association of each blood pressure
component with PAD events, and report the results as subdistribution
hazard ratios and 95% CIs. <br/>RESULT(S): The present analysis included
33 357 patients with an average age of 67.4 years, 53.1% men, 59.7% white
race, and 36.2% with diabetes mellitus. The median baseline blood pressure
was 146/84 mm Hg. Participants were followed for a median of 4.3
(interquartile range, 3.6-5.3) years, during which time 1489 (4.5%) had a
lower extremity PAD event, and 4148 (12.4%) died. In models adjusted for
demographic and clinical characteristics, SBP <120 mm Hg was associated
with a 26% (CI, 5%-52%; P=0.015) higher hazard and SBP>=160 mm Hg was
associated with a 21% (CI, 0%-48%; P=0.050) higher hazard for a PAD event,
in comparison with SBP 120 to 129 mm Hg. In contrast, lower, but not
higher, DBP was associated with a higher hazard of PAD events: for DBP <60
mm Hg (hazard ratio, 1.72; CI, 1.38-2.16). Pulse pressure had a U-shaped
association with PAD events. <br/>CONCLUSION(S): In this reanalysis of
data from ALLHAT, we found a higher rate of lower extremity PAD events
with higher and lower SBP and pulse pressure and with lower DBP. Given the
recent revised blood pressure guidelines advocating lower SBP targets for
overall cardiovascular risk reduction, further refinement of optimal blood
pressure targets specific to PAD is needed.<br/>Copyright &#xa9; 2018
American Heart Association, Inc.

<44>
[Use Link to view the full text]
Accession Number
622577731
Title
Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve-Guided
Percutaneous Coronary Intervention in Patients with Stable Coronary Artery
Disease.
Source
Circulation. 137 (5) (pp 480-487), 2018. Date of Publication: 30 Jan 2018.
Author
Fearon W.F.; Nishi T.; De Bruyne B.; Boothroyd D.B.; Barbato E.; Tonino
P.; Juni P.; Pijls N.H.J.; Hlatky M.A.
Institution
(Fearon, Nishi, Hlatky) Division of Cardiovascular Medicine, Stanford
Cardiovascular Institute, Stanford University School of Medicine, 300
Pasteur Dr, H2103, Stanford, CA 94305-5218, United States
(Boothroyd) Quantitative Sciences Unit, United States
(Hlatky) Department of Health Research and Policy, United States
(De Bruyne, Barbato) Stanford University School of Medicine, Stanford
Cardiovascular Institute, CA. Cardiovascular Center Aalst, Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Tonino, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Previous studies found that percutaneous coronary intervention
(PCI) does not improve outcome compared with medical therapy (MT) in
patients with stable coronary artery disease, but PCI was guided by
angiography alone. FAME 2 trial (Fractional Flow Reserve Versus
Angiography for Multivessel Evaluation) compared PCI guided by fractional
flow reserve with best MT in patients with stable coronary artery disease
to assess clinical outcomes and cost-effectiveness. <br/>Method(s): A
total of 888 patients with stable single-vessel or multivessel coronary
artery disease with reduced fractional flow reserve were randomly assigned
to PCI plus MT (n=447) or MT alone (n=441). Major adverse cardiac events
included death, myocardial infarction, and urgent revascularization. Costs
were calculated on the basis of resource use and Medicare reimbursement
rates. Changes in quality-adjusted life-years were assessed with utilities
determined by the European Quality of Life-5 Dimensions health survey at
baseline and over follow-up. <br/>Result(s): Major adverse cardiac events
at 3 years were significantly lower in the PCI group compared with the MT
group (10.1% versus 22.0%; P<0.001), primarily as a result of a lower rate
of urgent revascularization (4.3% versus 17.2%; P<0.001). Death and
myocardial infarction were numerically lower in the PCI group (8.3% versus
10.4%; P=0.28). Angina was significantly less severe in the PCI group at
all follow-up points to 3 years. Mean initial costs were higher in the PCI
group ($9944 versus $4440; P<0.001) but by 3 years were similar between
the 2 groups ($16 792 versus $16 737; P=0.94). The incremental
cost-effectiveness ratio for PCI compared with MT was $17 300 per
quality-adjusted life-year at 2 years and $1600 per quality-adjusted
life-year at 3 years. The above findings were robust in sensitivity
analyses. ConclusionS: PCI of lesions with reduced fractional flow reserve
improves long-term outcome and is economically attractive compared with MT
alone in patients with stable coronary artery disease. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01132495.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<45>
Accession Number
623735451
Title
A randomised trial of serratus anterior plane block for analgesia after
thoracoscopic surgery.
Source
Anaesthesia. 73 (10) (pp 1260-1264), 2018. Date of Publication: October
2018.
Author
Park M.H.; Kim J.A.; Ahn H.J.; Yang M.K.; Son H.J.; Seong B.G.
Institution
(Park, Ahn, Yang, Seong) Department of Anesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
(Kim, Son) Department of Anesthesiology and Pain Medicine, Kangwon
National University School of Graduate Medicine, Chuncheon, South Korea
Publisher
Blackwell Publishing Ltd
Abstract
We evaluated the effect of pre-operative serratus anterior plane block on
postoperative pain and opioid consumption after thoracoscopic surgery. We
randomly allocated 89 participants to block with 30 ml ropivacaine 0.375%
(n = 44), or no block without placebo or sham procedure (n = 45). We
analysed results from 42 participants in each group. Serratus anterior
plane block reduced mean (SD) remifentanil dose during surgery, 0.12
(0.06) mg.h^-1 vs. 0.16 (0.06) mg.h^-1, p = 0.016, and
reduced mean (SD) fentanyl consumption in the first 24 postoperative
hours, 3.8 (1.9) mug.kg^-1 vs. 5.7 (1.6) mug.kg^-1, p
= 0.000004. Block also reduced the worst median (IQR [range]) pain scores
reported in the first 24 postoperative hours: 6 (5-7 [3-10]) vs. 7 (6-7
[3-10]), p = 0.027. Block decreased dissatisfaction with pain management,
categorised as 'highly unsatisfactory', 'unsatisfactory', 'neutral',
'satisfactory' or 'highly satisfactory': 1/2/21/18/0 vs. 1/14/15/11/1, p =
0.0038. There were no differences in the rates of nausea, vomiting,
dizziness or length of hospital stay. Serratus anterior plane block may be
used to reduce pain and opioid use after thoracoscopic lung
surgery.<br/>Copyright &#xa9; 2018 Association of Anaesthetists

<46>
[Use Link to view the full text]
Accession Number
627169283
Title
Effect of Digital Storytelling on Anxiety in Patients Who Are Candidates
for Open-Heart Surgery.
Source
The Journal of cardiovascular nursing. 34 (3) (pp 231-235), 2019. Date of
Publication: 01 May 2019.
Author
Moghimian M.; Akbari M.; Moghaddasi J.; Niknajad R.
Institution
(Moghimian) Nursing & Midwifery Sciences Development Research Center and
Department of Nursing, Najafabad Branch, PhD Member of Young Researcher
Club and Department of Nursing, Khoorasgan Branch, Islamic Azad
University, Department of Medical Surgical Nursing, Shahrekord University
of Medical Sciences, MSc Instructor, Nursing and Midwifery Student
Research Committee and Department of Operative Room, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Open-heart surgery in persons with cardiovascular disease is
associated with high levels of anxiety. <br/>OBJECTIVE(S): The goal of
this study was to determine the effect of digital storytelling on anxiety
in patients who were candidates for open-heart surgery. <br/>METHOD(S): In
this quasi-experimental study, 80 patients were randomly allocated into 2
groups. The intervention group received routine training and digital
storytelling. In each group, anxiety was measured by the State-Trait
Anxiety Inventory anxiety scale before surgery and 5 days after surgery.
The collected data were analyzed using SPSS software V18. <br/>RESULT(S):
There was no significant difference in the anxiety of both groups during
the 2 days before the surgery (P = .40). After the surgery, the mean of
anxiety scores in the intervention group was lower than that of the
control group (P < .001). <br/>CONCLUSION(S): Digital storytelling is an
effective method to reduce anxiety in patients who are candidates for
open-heart surgery.

<47>
Accession Number
627205268
Title
Effect of an Incentive Spirometer Patient Reminder after Coronary Artery
Bypass Grafting: A Randomized Clinical Trial.
Source
JAMA Surgery. (no pagination), 2019. Date of Publication: 2019.
Author
Eltorai A.E.M.; Baird G.L.; Eltorai A.S.; Healey T.T.; Agarwal S.;
Ventetuolo C.E.; Martin T.J.; Chen J.; Kazemi L.; Keable C.A.; Diaz E.;
Pangborn J.; Fox J.; Connors K.; Sellke F.W.; Elias J.A.; Daniels A.H.
Institution
(Eltorai, Baird, Healey, Agarwal, Ventetuolo, Martin, Chen, Kazemi,
Keable, Diaz, Pangborn, Fox, Connors, Sellke, Elias, Daniels) Warren
Alpert Medical School, Brown University, 222 Richmond St, Providence, RI
02903, United States
(Eltorai) Yale University, School of Medicine, New Haven, CT, United
States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Incentive spirometers (ISs) were developed to reduce
atelectasis and are in widespread clinical use. However, without IS use
adherence data, the effectiveness of IS cannot be determined.
<br/>Objective(s): To evaluate the effect of a use-tracking IS reminder on
patient adherence and clinical outcomes following coronary artery bypass
grafting (CABG) surgery. <br/>Design, Setting, and Participant(s): This
randomized clinical trial was conducted from June 5, 2017, to December 29,
2017, at a tertiary referral teaching hospital and included 212 patients
who underwent CABG, of whom 160 participants were randomized (intent to
treat), with 145 completing the study per protocol. Participants were
stratified by surgical urgency (elective vs nonelective) and sex (men vs
women). <br/>Intervention(s): A use-tracking, IS add-on device
(SpiroTimer) with an integrated use reminder bell recorded and timestamped
participants' inspiratory breaths. Patients were randomized by hourly
reminder "bell on" (experimental group) or "bell off" (control group).
<br/>Main Outcomes and Measures: Incentive spirometer use was recorded for
the entire postoperative stay and compared between groups. Radiographic
atelectasis severity (score, 0-10) was the primary clinical outcome.
Secondary respiratory and nonrespiratory outcomes were also evaluated.
<br/>Result(s): A total of 145 per-protocol participants (112 men [77%];
mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective
procedure) were evaluated, with 74 (51.0%) in the bell off group and 71
(49.0%) in the bell on group. The baseline medical and
motivation-to-recover characteristics of the 2 groups were similar. The
mean number of daily inspiratory breaths was greater in bell on (35; 95%
CI, 29-43 vs 17; 95% CI, 13-23; P <.001). The percentage of recorded hours
with an inspiratory breath event was greater in bell on (58%; 95% CI,
51-65 vs 28%; 95% CI, 23-32; P <.001). Despite no differences in the first
postoperative chest radiograph mean atelectasis severity scores (2.3; 95%
CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P =.48), the mean atelectasis
severity scores for the final chest radiographs conducted before discharge
were significantly lower for bell on than bell off group (1.5; 95% CI,
1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P =.04). Of those with early
postoperative fevers, fever duration was shorter for bell on (3.2 hours;
95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P =.04). Having the bell
turned on reduced noninvasive positive pressure ventilation use rates
(37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P =.03) for
participants undergoing nonelective procedures. Bell on reduced the median
postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7;
P =.048) and the intensive care unit length of stay for patients
undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI,
3-4; P =.02). At 6 months, the bell off mortality rate was higher than
bell on (9% vs 0%, P =.048) for participants undergoing nonelective
procedures. <br/>Conclusions and Relevance: The incentive spirometer
reminder improved patient adherence, atelectasis severity, early
postoperative fever duration, noninvasive positive pressure ventilation
use, ICU and length of stay, and 6-month mortality in certain patients.
With the reminder, IS appears to be clinically effective when used
appropriately.<br/>Copyright &#xa9; 2019 American Medical Association. All
rights reserved.

<48>
[Use Link to view the full text]
Accession Number
627222688
Title
A novel method of Uniblocker placement: extraluminal technique supported
by trachea length measurement: A CONSORT-compliant article.
Source
Medicine. 98 (14) (pp e15116), 2019. Date of Publication: 01 Apr 2019.
Author
Liu Z.; Zhao L.; He W.; Zhu Y.; Bao L.; Jia Q.; Yang X.; Liang S.
Institution
(Liu, He, Zhu, Bao, Jia, Yang, Liang) Department of Anesthesiology, First
Hospital of Qinhuangdao, Qinhuangdao, China
(Zhao) Department of Thoracic Surgery, First Hospital of Qinhuangdao,
Qinhuangdao, Hebei, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The use of bronchial blockers has been increased for one-lung
ventilation; however, the placement of bronchial blockers is time
consuming. The objective of this study was to compare the novel
extraluminal technique of Uniblocker placement supported by trachea length
measurement on computerized tomography images with conventional
intraluminal Uniblocker placement method. <br/>METHOD(S): Seventy adult
patients undergoing left side thoracic surgery were included in the study.
All the patients were randomly assigned to one of two groups: conventional
intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT
guided group (CT-EX group, n = 35). The primary endpoints were the optimal
positions of Uniblocker and the injuries of bronchi and carina. The
secondary outcomes included the time of Uniblocker placement, the adequacy
of lung collapse, the incidences of Uniblocker displacement, sore throat,
and hoarseness postoperative. <br/>RESULT(S): In the CV-IN group, 19 of 35
Uniblockers went to the left main-stem bronchus on the initial blind
insertion and 15 of 35 Uniblockers were considered as in optimal depth,
whereas in the CT-EX group, 32 of 35 Uniblockers went to the left
main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers
were considered as in optimal depth (P < .01). The incidence of bronchi
and carina injuries was obviously lower in the CT-EX group (occurred in 1
of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P <
.05). The time of Uniblocker placement took 145.4 s in the CV-IN group and
85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the
degree of pulmonary collapse and the adverse events postoperative such as
sore throat and hoarseness were not significantly different between the
two groups (P > .05). <br/>CONCLUSION(S): The novel extraluminal technique
of Uniblocker placement supported by trachea length measurement on
computerized tomography images was proved to be more rapid, more accurate
and less complications than conventional intraluminal Uniblocker placement
method.

<49>
Accession Number
625833075
Title
Optimization of heart allocation: The transplant risk score.
Source
American Journal of Transplantation. 19 (5) (pp 1507-1517), 2019. Date of
Publication: May 2019.
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Nubret-Le Coniat K.; Flecher E.;
Cantrelle C.; Audry B.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent) Agence
de la Biomedecine, Direction Prelevement Greffe Organes-Tissus,
Saint-Denis La Plaine, France
(Nubret-Le Coniat) Departement d'Anesthesie-Reanimation II, Centre
Hospitalier Universitaire de Bordeaux, Pessac, France
(Flecher) Service de Chirurgie Cardio-Vasculaire, Centre Hospitalier
Universitaire de Rennes, Rennes, France
Publisher
Blackwell Publishing Ltd
Abstract
The new French heart allocation system is designed to minimize waitlist
mortality and extend the donor pool without a detrimental effect on
posttransplant survival. This study was designed to construct a 1-year
posttransplant graft-loss risk score incorporating recipient and donor
characteristics. The study included all adult first single-organ
recipients transplanted between 2010 and 2014 (N = 1776). This population
was randomly divided in a 2:1 ratio into derivation and validation
cohorts. The association of variables with 1-year graft loss was
determined with a mixed Cox model with center as random effect. The
predictors were used to generate a transplant-risk score (TRS).
Donor-recipient matching was assessed using 2 separate recipient- and
donor-risk scores. Factors associated with 1-year graft loss were
recipient age >50 years, valvular cardiomyopathy and congenital heart
disease, previous cardiac surgery, diabetes, mechanical ventilation,
glomerular filtration rate and bilirubin, donor age >55 years, and donor
sex: female. The C-index of the final model was 0.70. Correlation between
observed and predicted graft loss rate was excellent for the overall
cohort (r = 0.90). Hearts from high-risk donors transplanted to low-risk
recipients had similar survival as those from low-risk donors. The TRS
provides an accurate prediction of 1-year graft-loss risk and allows
optimal donor-recipient matching.<br/>Copyright &#xa9; 2018 The American
Society of Transplantation and the American Society of Transplant Surgeons

<50>
Accession Number
626907798
Title
I-level positive airway pressure ventilation for patients with hypoxemia
after coronary artery bypass grafting.
Source
Journal of biological regulators and homeostatic agents. 33 (2) (pp
403-408), 2019. Date of Publication: 01 Mar 2019.
Author
Cai W.W.; Hu J.; Wang H.; Zhu G.J.; Chen S.; Chen X.P.
Institution
(Cai, Hu, Wang, Zhu, Chen) Luoyang Central Hospital Affiliated to
Zhengzhou University, Luoyang, China
(Chen) Luoyang Central Hospital Affiliated to Zhengzhou University,
Luoyang, China
Publisher
NLM (Medline)
Abstract
Coronary artery bypass grafting (CABG) is an effective scheme for
treatment of myocardial ischemia. Hypoxemia is a common complication of
CABG, which can affect surgical effect and prognosis and even induce
multiple organ failure. To explore the clinical efficacy of bi-level
positive airway pressure ventilation in the treatment of CABG-associated
hypoxemia, 216 patients who were admitted to our hospital between August
2015 and April 2017 and developed CABG-associated hypoxemia were selected
and randomly divided into 2 groups, an observation group (n=108) and a
control group (n=108). Patients in the control group were given
conventional treatment including continuous oxygen inhalation through
nasal tube, anti-infection, bronchodilation, phlegm resolving, nutrition
support, analgesia, cardiac function maintenance, coronary dilatation,
anticoagulation and maintenance of stable internal environment, while
patients in the observation group were given positive airway pressure
ventilation via a breathing machine or nasal mask besides the conventional
treatment.

<51>
[Use Link to view the full text]
Accession Number
627378519
Title
The effect of dexmedetomidine on the perioperative hemodynamics and
postoperative cognitive function of elderly patients with hypertension:
Study protocol for a randomized controlled trial.
Source
Medicine (United States). 97 (43) (no pagination), 2018. Article Number:
e12851. Date of Publication: October 2018.
Author
Du X.; Yu J.; Mi W.
Institution
(Du, Mi) Department of Anesthesiology, Chinese PLA Medical School, Chinese
PLA General Hospital, Beijing, China
(Yu) Department of Anesthesiology, Affiliated Hospital, Inner Mongolia,
Medical University, Hohhot, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction: Cognitive dysfunction after surgery, a common clinical
manifestation of postoperative psychonosema. It usually occurs after heart
surgery, hip replacement, mandibular fractures, and other major
operations. Dexmedetomidine can exert sedative, analgesic, anxiolytic
effect, inhibits the sympathetic activity, maintains hemodynamic balance,
helps reduce the amount of anesthetic agents, and relatively slightly
depresses respiration. Preoperative administration of dexmedetomidine for
sedation has been reported to reduce the incidence of acute postoperative
delirium. But currently there is no study on the effect of dexmedetomidine
on the postoperative cognitive function of elderly patients with essential
hypertension. Methods/Design: This study is a prospective, single-center,
double-blind controlled clinical trial. Elderly patients aged between 60
and 80 years old, diagnosed with primary hypertension for 1 year or longer
will be included, and randomized into 2 groups. Patients in observational
group will be given a loading dose of dexmedetomidine at 0.8 mg/kg, pumped
for over 10 minutes. Although patients in control group will be pumped of
the same volume of normal saline within 10 minutes, before the induction
of anesthesia. Minimental state examination and levels of interleukin-6,
tumor necrosis factor alpha, and C-reactive protein will be set as primary
endpoints. Baseline characteristics of patients will be summarized by
groups and compared using Chi-square or Fisher exact tests for categorical
variables and 2-sample t tests or Wilcoxon rank sum test for the
continuous variables. Repeated measurement analysis of covariance model
will also be used for the comparison of endpoints between 2 groups.
<br/>Conclusion(s): The present study is designed to investigate the
effect of the application of dexmedetomidine on postoperative myocardial
injury and postoperative cognitive dysfunction, also to explore the
association between inflammatory factors and postoperative cognitive
function. With this study, we are expecting to find out an appropriate
anesthesia method for elderly people with hypertension to alleviate the
postoperative adverse effects caused by medical treatments. Trials
registration: This study was registered on Chinese Clinical Trial Registry
(http://www.chictr.org.cn/) with the ID ChiCTR-IPR-16009156.<br/>Copyright
&#xa9; 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

<52>
[Use Link to view the full text]
Accession Number
627378509
Title
Choosing between ticagrelor and clopidogrel following percutaneous
coronary intervention: A systematic review and Meta-Analysis (2007-2017).
Source
Medicine (United States). 97 (43) (no pagination), 2018. Article Number:
e12978. Date of Publication: October 2018.
Author
Guan W.; Lu H.; Yang K.
Institution
(Guan, Lu, Yang) Department of Cardiology, Jingzhou Central Hospital,
Second Clinical Medical College, Yangtze University, Jingzhou, Hubei
434020, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Limitations have been observed with the use of clopidogrel
following percutaneous coronary intervention (PCI) indicating the urgent
need of a more potent anti-platelet agent. We aimed to compare the
efficacy and safety of ticagrelor versus clopidogrel following PCI.
<br/>Method(s): Online databases were searched for relevant studies
(published between the years 2007 and 2017) comparing ticagrelor versus
clopidogrel following coronary stenting. Primary outcomes assessed
efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with
95% confidence intervals (CIs) based on a random effect model were
calculated and the analysis was carried out by the RevMan 5.3 software.
<br/>Result(s): A total number of 25,632 patients with acute coronary
syndrome (ACS) [12,992 patients with ST segment elevation myocardial
infarction (STEMI) and 14,215 patients with non-ST segment elevation
myocardial infarction (NSTEMI)] were included in this analysis, of whom
23,714 patients were revascularized by PCI. Results of this analysis did
not show any significant difference in all-cause mortality, major adverse
cardiac events (MACEs), myocardial infarction, stroke and stent thrombosis
observed between ticagrelor and clopidogrel with (OR: 0.83, 95% CI:
0.67-1.03; P =.09), (OR: 0.64, 95% CI: 0.41-1.01; P =.06), (OR: 0.77, 95%
CI: 0.57-1.03; P =.08), (OR: 0.85, 95% CI: 0.57-1.26; P =.42) and (OR:
0.70, 95% CI: 0.47-1.05; P =.09). However, ticagrelor was associated with
a significantly higher minor and major bleeding with (OR: 1.57, 95% CI:
1.30-1.89; P =.00001) and (OR: 1.52, 95% CI: 1.01-2.29; P = 0.04)
respectively. Dyspnea was also significantly higher in the ticagrelor
group (OR: 2.64, 95% CI: 1.87-3.72; P =.00001). <br/>Conclusion(s):
Ticagrelor and clopidogrel were comparable in terms of efficacy in these
patients with ACS. However, the safety outcomes of ticagrelor should
further be investigated.<br/>Copyright &#xa9; 2018 the Author(s).
Published by Wolters Kluwer Health, Inc.

<53>
[Use Link to view the full text]
Accession Number
627378445
Title
Pharmacologic prevention of postoperative delirium after on-pump cardiac
surgery: A meta-analysis of randomized trials.
Source
Medicine (United States). 97 (43) (no pagination), 2018. Article Number:
e12771. Date of Publication: October 2018.
Author
Tao R.; Wang X.-W.; Pang L.-J.; Cheng J.; Wang Y.-M.; Gao G.-Q.; Liu Y.;
Wang C.
Institution
(Wang) Department of Cardiothoracic Surgery, First Affiliated Hospital,
Chongqing Medical University, No. 001 YouYi Road, Chongqing 400016, China
(Tao, Pang, Cheng, Wang, Gao, Liu, Wang) Hefei No. 4 People's Hospital,
Anhui Mental Health Center, Mental Health Clinical College, Anhui Medical
University, Hefei 230022, China
(Tao, Pang, Cheng, Wang, Wang) Mental Health Clinical College, Anhui
Medical University, Hefei, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Postoperative delirium is a prevalent and disabling mental
disorder in patients undergoing on-pump cardiac surgery. There is some
evidence that the use of pharmacological interventions may reduce the risk
of developing of postoperative delirium. Therefore, the aim of this
meta-analysis was to determine the effect of pharmacologic agents for the
prevention postoperative delirium after cardiac surgery. <br/>Method(s):
Randomized controlled trials (RCTs) were identified through a systematic
literature search of electronic databases and article references up to
October 2016. End points included incidence of postoperative delirium,
severity of postoperative delirium, cognitive disturbances of
postoperative delirium, duration of postoperative delirium, length of stay
in intensive care unit (ICU) and hospital, and short-term mortality.
<br/>Result(s): A total of 14 RCTs with an aggregate of 14,139 patients
were included. The results of the present meta-analysis show that
pharmacologic agents significantly decrease postoperative delirium
[relative risk (RR), 0.83; 95% confidence interval (95% CI), 0.75-0.91, P
<.00001] and duration of postoperative delirium (RR = 0.37, 95% CI = 0.47
to 0.27, P <.00001) after on-pump cardiac surgery. In addition, subgroup
analysis shows that dexamethasone and dexamethasone were associated with a
trend toward a reduction in postoperative delirium (RR, 0.45; 95% CI,
0.30-0.66, P <.0001; RR, 0.80; 95% CI, 0.68-0.93, P =.003, respectively).
However, our results fail to support the assumption that pharmacologic
prophylaxis is associated with a positively reduction in short-term
mortality, length of ICU, or hospital stay. <br/>Conclusion(s): This
meta-analysis suggests that the perioperative use of pharmacologic agents
can prevent postoperative delirium development in patients undergoing
cardiac surgery. However, there remain important gaps in the evidence base
on a few small studies with multiple limitations. Further large-scale,
high-quality RCTs are needed in this area.<br/>Copyright &#xa9; 2018 the
Author(s). Published by Wolters Kluwer Health, Inc.

<54>
Accession Number
627374805
Title
The impact of preoperative frailty status on outcomes after transcatheter
aortic valve replacement: An update of systematic review and
meta-analysis.
Source
Medicine (United States). 97 (51) (no pagination), 2018. Article Number:
e13475. Date of Publication: December 2018.
Author
Huang L.; Zhou X.; Yang X.; Yu H.
Institution
(Huang, Zhou, Yu) 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, Sichuan 610041, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Frailty is a syndrome of impaired physiologic reserve and
decreased resistance to stressors and can often be seen in high-risk
patients undergoing transcatheter aortic valve replacement (TAVR).
Preoperative frailty status is thought to be related to adverse outcomes
after TAVR. We conducted this systematic review and meta-analysis to
determine the impact of preoperative frailty status on outcomes among
patients after TAVR. <br/>Method(s): PubMed, Embase, and the Cochrane
Library were searched for relevant studies through January 2018. Fourteen
articles (n = 7489) meeting the inclusion criteria were finally included.
Possible effects were calculated using meta-analysis. <br/>Result(s): The
pooled risk ratios (RRs) of late mortality (>6 months) and acute kidney
injury after TAVR in frail group were 2.81 (95% confidence interval (CI)
1.90-4.15, P < .001, I²= 84%) and 1.41 (95% CI 1.02-1.94, P =
.04, I²= 24%), respectively. Compared with non-frail group,
significantly higher incidence of 30-day mortality (RR 2.03, 95% CI
1.63-2.54, P < .001, I²= 0%) and life threatening or major
bleeding after TAVR (RR 1.48, 95% CI 1.20-1.82, P < .001, I²=
14%) was found in frail group. There was no significant association
between frailty and incidence of stroke after TAVR (RR 0.93, 95% CI
0.53-1.63, P = .80, I²= 0%). <br/>Conclusion(s): Preoperative
frailty status is proved to be significantly associated with poor outcomes
after TAVR. Our findings may remind doctors in the field of a more
comprehensive preoperative evaluation for TAVR candidates. More
well-designed and large-sample sized prospective studies are further
needed to figure out the best frailty assessment tool for patients
undergoing TAVR.<br/>Copyright &#xa9; 2018 the Author(s). Published by
Wolters Kluwer Health, Inc. This is an open access article distributed
under the terms of the Creative Commons Attribution-Non Commercial License
4.0 (CCBY-NC), where it is permissible to download, share, remix,
transform, and buildup the work provided it is properly cited. The work
cannot be used commercially without permission from the journal.

<55>
[Use Link to view the full text]
Accession Number
627374605
Title
The efficacy of thoracic paravertebral block for thoracoscopic surgery: A
meta-analysis of randomized controlled trials.
Source
Medicine (United States). 97 (51) (no pagination), 2018. Article Number:
e13771. Date of Publication: December 2018.
Author
Hu Z.; Liu D.; Wang Z.-Z.; Wang B.; Dai T.
Institution
(Hu, Wang, Wang, Dai) Department of Thoracic Surgery, Affiliated Hospital
of Southwest Medical University, China
(Liu) Department of Respiratory and Critical Care Medicine, Affiliated
Hospital of Southwest Medical University, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The efficacy of thoracic paravertebral block for thoracoscopic
surgery remains controversial. We conduct a systematic review and
meta-analysis to explore the impact of thoracic paravertebral block on
thoracoscopic surgery. <br/>Method(s): We search PubMed, EMbase, Web of
science, EBSCO, and Cochrane library databases through August 2018 for
randomized controlled trials (RCTs) assessing the effect of thoracic
paravertebral block on thoracoscopic surgery. This meta-analysis is
performed using the random-effect model. <br/>Result(s): Six RCTs
involving 300 patients are included in the meta-analysis. Overall,
compared with control group for thoracoscopic surgery, thoracic
paravertebral block results in significantly reduced pain scores within 6
hours (Std. MD = 2.15; 95% CI = 3.67 to 0.62; P = .006), postoperative
anesthesia consumption during 48 hours (Std. MD = 1.81; 95% CI = 3.05 to
0.58; P = .004), and hospital stay (Std. MD = 1.19; 95% CI = 2.13 to 0.26;
P = .01), but has no important impact on pain scores at 24 hours (Std. MD
= 1.10; 95% CI = 2.77-0.57; P = .20), and 48 hours (Std. MD = 1.25; 95% CI
= 2.86-0.36; P = .13). <br/>Conclusion(s): Thoracic paravertebral block
can substantially enhance pain management for thoracoscopic
surgery.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<56>
Accession Number
2001868760
Title
XLIMus drug eluting stent: A randomIzed controlled Trial to assess
endothelialization. The XLIMIT trial.
Source
IJC Heart and Vasculature. 23 (no pagination), 2019. Article Number:
100363. Date of Publication: June 2019.
Author
Testa L.; Pero G.; Bollati M.; Matteo C.; Popolo Rubbio A.; Cuman M.;
Moreno R.; Serra A.; Gomez J.A.; Bedogni F.
Institution
(Testa, Pero, Bollati, Matteo, Popolo Rubbio, Cuman, Bedogni) Dept. of
Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
(Moreno) Hospital La Paz, Madrid, Spain
(Serra) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Gomez) Hospital Bellvitge, Barcelona, Spain
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Thin strut 3rd generation drug eluting stents offer the
potential advantage over the previous generation of better technical
performance and reduced neointimal proliferation parameters, which are
linked to mid and late term device failure. <br/>Aim(s): To evaluate the
performance of the Xlimus sirolimus-eluting stent (SES) against the
Synergy everolimus-eluting stent (EES) in terms of device
reendothelialization in patients undergoing PCI for coronary artery
disease (CAD). <br/>Method(s): XLIMIT is a multicenter randomized
controlled trial targeting 180 patients requiring percutaneous coronary
interventions (PCI). Patients will be treated with Xlimus SES or Synergy
EES implantation and randomization will be performed in a 2:1 ratio. The
primary endpoint will be the reendothelialization grade of the Xlimus
stent in terms of strut coverage and neointimal hyperplasia volume as
compared to Synergy. Secondary endpoints will be represented by clinical
and procedural outcomes. The first patient was enrolled on February 2019.
<br/>Conclusion(s): A clearer understanding of the endothelialization
process of new generation DES could significantly impact the treatment
with dual antiplatelet therapy in the future. Moreover, although not
powered for clinical end-points, the XLIMIT trial will provide randomized
data in a population with minimal exclusion criteria. Trial registration:
ClinicalTrials.gov Identifier: NCT03745053. Registered on November 19,
2018.<br/>Copyright &#xa9; 2019 The Authors

<57>
[Use Link to view the full text]
Accession Number
627371611
Title
Early peritoneal dialysis and major adverse events after pediatric cardiac
surgery: A propensity score analysis.
Source
Pediatric Critical Care Medicine. 20 (2) (pp 158-165), 2019. Date of
Publication: 01 Feb 2019.
Author
Namachivayam S.P.; Butt W.; Millar J.; Konstantinov I.E.; Nguyen C.;
D'Udekem Y.
Institution
(Namachivayam, Butt, Millar) Cardiac Intensive Care Unit, Royal Children's
Hospital, Melbourne, VIC, Australia
(Namachivayam, Butt, Millar, Konstantinov, D'Udekem) Murdoch Children's
Research Institute, Melbourne, VIC, Australia
(Namachivayam, Butt, Millar, Konstantinov, Nguyen, D'Udekem) Department of
Paediatrics, University of Melbourne, Melbourne, VIC, Australia
(Konstantinov, D'Udekem) Cardiac Surgery, Royal Children's Hospital,
Melbourne, VIC, Australia
(Nguyen) Clinical Epidemiology and Biostatistics Unit, Murdoch Children's
Research Institute, Melbourne, VIC, Australia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Early peritoneal dialysis may have a role in modulating the
inflammatory response after cardiopulmonary bypass. This study sought to
test the effect of early peritoneal dialysis on major adverse events after
pediatric cardiac surgery involving cardiopulmonary bypass.
<br/>Design(s): In this observational study, the outcomes in infants post
cardiac surgery who received early peritoneal dialysis (within 6 hr of
completing cardiopulmonary bypass) were compared with those who received
late peritoneal dialysis. The primary outcome was a composite of one or
more of cardiac arrest, emergency chest reopening, requirement for
extracorporeal membrane oxygenation, or death. Secondary outcomes included
duration of mechanical ventilation, length of intensive care, and hospital
stay. A propensity score methodology utilizing inverse probability of
treatment weighting was used to minimize selection bias due to timing of
peritoneal dialysis. <br/>Setting(s): Cardiac ICU, The Royal Children's
Hospital, Melbourne, VIC, Australia. <br/>Patient(s): From 2012 to 2015,
infants who were commenced on peritoneal dialysis after cardiac surgery
were included. <br/>Measurements and Main Results: Among 239 eligible
infants, 56 (23%) were commenced on early peritoneal dialysis and 183
(77%) on late peritoneal dialysis. At 90 days, early peritoneal dialysis
as compared with late peritoneal dialysis was associated with a decreased
risk of primary outcome (relative risk, 0.16; 95% CI, 0.05-0.47; p < 0.001
and absolute risk difference, -18.1%; 95% CI, -25.1 to -11.1; p < 0.001).
Early peritoneal dialysis was also associated with a decrease in duration
of mechanical ventilation and intensive care stay. Among infants with a
cardiopulmonary bypass greater than 150 minutes, early peritoneal dialysis
was also associated with a survival advantage (relative risk, 0.14; 95%
CI, 0.03-0.84; p = 0.03 and absolute risk difference, -7.8; 95% CI, -13.6
to -2; p = 0.008). <br/>Conclusion(s): Early peritoneal dialysis in
infants post cardiac surgery is associated with a decrease in the rate of
major adverse events. The role of early peritoneal dialysis warrants the
conduct of randomized trials both in high and low-to-middle income
countries; any beneficial effects if confirmed have the potential to
strongly influence outcomes for children born with congenital heart
disease.<br/>Copyright &#xa9; 2018 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.

<58>
[Use Link to view the full text]
Accession Number
627370813
Title
Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial.
Source
Anesthesiology. 130 (3) (pp 385-393), 2019. Date of Publication: 01 Mar
2019.
Author
Park M.; Ahn H.J.; Kim J.A.; Yang M.; Heo B.Y.; Choi J.W.; Kim Y.R.; Lee
S.H.; Jeong H.; Choi S.J.; Song I.S.
Institution
(Park, Ahn, Kim, Yang, Heo, Choi, Kim, Lee, Jeong, Choi, Song) Department
of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Park) Kangwon National University, School of Graduate Medicine in
Chuncheon, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Editor's Perspective What We Already Know about This Topic Driving
pressure (plateau minus end-expiratory airway pressure) is a target in
patients with acute respiratory distress syndrome, and is proposed as a
target during general anesthesia for patients with normal lungs. It has
not been reported for thoracic anesthesia where isolated, inflated lungs
may be especially at risk. What This Article Tells Us That Is New In a
double-blinded, randomized trial (292 patients), minimized driving
pressure compared with standard protective ventilation was associated with
less postoperative pneumonia or acute respiratory distress syndrome.
<br/>Background(s): Recently, several retrospective studies have suggested
that pulmonary complication is related with driving pressure more than any
other ventilatory parameter. Thus, the authors compared driving
pressure-guided ventilation with conventional protective ventilation in
thoracic surgery, where lung protection is of the utmost importance. The
authors hypothesized that driving pressure-guided ventilation decreases
postoperative pulmonary complications more than conventional protective
ventilation. <br/>Method(s): In this double-blind, randomized, controlled
study, 292 patients scheduled for elective thoracic surgery were included
in the analysis. The protective ventilation group (n = 147) received
conventional protective ventilation during one-lung ventilation: tidal
volume 6 ml/kg of ideal body weight, positive end-expiratory pressure
(PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n =
145) received the same tidal volume and recruitment, but with
individualized PEEP which produces the lowest driving pressure (plateau
pressure-PEEP) during one-lung ventilation. The primary outcome was
postoperative pulmonary complications based on the Melbourne Group Scale
(at least 4) until postoperative day 3. <br/>Result(s): Melbourne Group
Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving
pressure group, as compared with 18 of 147 (12.2%) in the protective
ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The
number of patients who developed pneumonia or acute respiratory distress
syndrome was less in the driving pressure group than in the protective
ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio
0.42; 95% CI, 0.19 to 0.92). <br/>Conclusion(s): Application of driving
pressure-guided ventilation during one-lung ventilation was associated
with a lower incidence of postoperative pulmonary complications compared
with conventional protective ventilation in thoracic
surgery.<br/>Copyright &#xa9; 2019, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<59>
Accession Number
2001839863
Title
Safety of celecoxib versus traditional nonsteroidal anti-inflammatory
drugs in older patients with arthritis.
Source
Journal of Pain Research. 11 (pp 3211-3219), 2018. Date of Publication:
2018.
Author
Shin S.
Institution
(Shin) Department of Clinical Pharmacy, College of Pharmacy, Ajou
University, Yeongtong-gu, Suwon, South Korea
(Shin) Research Institute of Pharmaceutical Science and Technology
(RIPST), Ajou University, Yeongtong-gu, Suwon, South Korea
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: A 2011 systematic review found an increased cardiovascular
(CV) risk at both <=200 mg/day and >200 mg/day doses of celecoxib. This
study aimed to evaluate adverse drug events with celecoxib relative to
traditional nonsteroidal anti-inflammatory drugs (NSAIDs) in real-world
practice settings, focusing on gastrointestinal (GI), CV, and renal
toxicity, in older patients with osteoarthritis or rheumatoid arthritis.
<br/>Method(s): In this population-based retrospective cohort study using
national health insurance claims data in Korea, patients aged 65 years and
older with arthritis who were treated with celecoxib or traditional NSAIDs
for >=30 days in 2016, were included for study analyses. The primary
outcome was hospital encounter for GI bleeding associated with celecoxib
vs traditional NSAIDs use. The secondary outcomes included a composite of
CV diseases, coronary revascularization, and incident renal events.
<br/>Result(s): After 1:1 propensity score matching, 73,748 patients in
each cohort were identified for study entry. Celecoxib treatment which
lasted for >=120 days was associated with a lower risk of GI bleeding than
traditional NSAIDs (OR=0.84, P=0.03). Such a relationship was not observed
in shorter treatment strata and overall in all strata combined. When
patients with gastroprotective prophylaxis were excluded from subgroup
analysis, no evidence of improved GI tolerability was observed with
celecoxib. CV and renal risks appeared higher with celecoxib than with
traditional NSAIDs (OR=1.08, P<0.001 and OR=1.22, P<0.001, respectively).
About 4.7 % of celecoxib users received a higher than maximum dose (400
mg/day); a dose-dependent increase in CV and renal risks was assessed with
celecoxib. <br/>Conclusion(s): Celecoxib was associated with decreased
risk of GI bleeding compared with traditional NSAIDs when treatment lasted
for >=120 days, but such a relationship was not found among subgroup
patients with no concomitant use of gastroprotective prophylaxis.
Celecoxib users were more likely to experience CV and renal events than
traditional NSAIDs users, and a dose-dependent risk relationship was
observed with celecoxib.<br/>Copyright &#xa9; 2018 Shin.

<60>
Accession Number
626012636
Title
Comparison between blood and non-blood cardioplegia in tetralogy of
Fallot.
Source
Asian Cardiovascular and Thoracic Annals. 27 (2) (pp 75-79), 2019. Date of
Publication: 01 Feb 2019.
Author
Romolo H.; Hernisa L.; Fakhri D.; Rachmat J.; Dwi Mulia D.; Rahmat B.
Institution
(Romolo, Hernisa, Fakhri, Rachmat, Rahmat) Department of Pediatric Cardiac
Surgery, Rumah Sakit Jantung dan Pembuluh Darah Nasional Harapan Kita,
Jakarta, Indonesia
(Dwi Mulia) Department of Surgery, Rumah Sakit Cipto Mangunkusumo, Faculty
of Medicine, Universitas Indonesia, Jakarta, Indonesia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Cardioplegia is an integral part of myocardial protection. The
superiority of blood cardioplegia in adult patients has been reported.
However, this is yet to be studied in cyanotic pediatric patients.
<br/>Method(s): A randomized open-label trial was conducted in 70 patients
with tetralogy of Fallot. They were divided into two groups: 35 patients
had crystalloid cardioplegia (controls), and 35 had blood cardioplegia.
Lactate and coronary oxygen extraction in arterial blood and the coronary
sinus were measured immediately after cessation of cardiopulmonary bypass,
15 and 30 min later. Postoperative mortality, major adverse cardiac
events, mechanical ventilation time, inotrope administration, arrhythmias,
right ventricular function, intensive care unit and hospital length of
stay were observed. <br/>Result(s): There were no significant differences
in clinical outcomes or lactate levels. There was a significant difference
in coronary oxygen extraction immediately and 15 min after cessation of
cardiopulmonary bypass (p = 0.038, p = 0.015). <br/>Conclusion(s): Blood
cardioplegia gave a better postoperative oxygen extraction value but there
were no differences in myocardial damage or clinical outcome between the
two groups.<br/>Copyright &#xa9; The Author(s) 2018.

<61>
Accession Number
620079079
Title
Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in
Patients With Acute Coronary Syndromes Undergoing Invasive Management:
Data From the Randomized MATRIX-Access Trial.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 36-50), 2018. Date of
Publication: 08 Jan 2018.
Author
Gargiulo G.; Ariotti S.; Vranckx P.; Leonardi S.; Frigoli E.; Ciociano N.;
Tumscitz C.; Tomassini F.; Calabro P.; Garducci S.; Crimi G.; Ando G.;
Ferrario M.; Limbruno U.; Cortese B.; Sganzerla P.; Lupi A.; Russo F.;
Garbo R.; Ausiello A.; Zavalloni D.; Sardella G.; Esposito G.; Santarelli
A.; Tresoldi S.; Nazzaro M.S.; Zingarelli A.; Petronio A.S.; Windecker S.;
da Costa B.R.; Valgimigli M.
Institution
(Gargiulo, Ariotti, Frigoli, Windecker, da Costa, Valgimigli) Department
of Cardiology, Bern University Hospital, Bern, Switzerland
(Gargiulo, Esposito) Department of Advanced Biomedical Sciences, Federico
II University of Naples, Naples, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Leonardi, Crimi, Ferrario) UOC Cardiologia, Dipartimento
CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
(Ciociano) EUSTRATEGY Association, Forli, Italy
(Tumscitz) Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara,
Cona, Italy
(Tomassini) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Calabro) Division of Cardiology, Department of Cardiothoracic Sciences,
University of Campania "Luigi Vanvitelli," Naples, Italy
(Garducci) Struttura complessa di Cardiologia ASST di Vimercate, Desio,
Italy
(Crimi) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino, "
University of Messina, Messina, Italy
(Limbruno) UO Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
(Cortese) ASST Fatebenefratelli-Sacco, Milan, Italy
(Cortese) Fondazione Toscana Gabriele Monasterio, Pisa, Italy
(Sganzerla) ASST Bergamo Ovest, Ospedale di Treviglio, Bergamo, Italy
(Lupi) Cardiology Unit, University Hospital "Maggiore della Carita,"
Novara, Italy
(Russo) Cardiovascular Interventional Unit, Cardiology Department, S.Anna
Hospital, Como, Italy
(Garbo) Interventional Cardiology Unit, Ospedale San Giovanni Bosco,
Turin, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Zavalloni) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Sardella) Department of Cardiovascular, Respiratory, Nephrologic,
Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza"
University of Rome, Rome, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Tresoldi) Cardiology Unit, A.O. Ospedale di Desio, Desio, Italy
(Nazzaro) Interventional Cardiology Unit, San Camillo-Forlanini, Rome,
Italy
(Zingarelli) Interventional Cardiology Unit, IRCCS AOU San Martino, Genoa,
Italy
(Petronio) Catheterisation Laboratory, Cardiothoracic and Vascular
Department, University of Pisa, Pisa, Italy
(da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to assess whether transradial access (TRA)
compared with transfemoral access (TFA) is associated with consistent
outcomes in male and female patients with acute coronary syndrome
undergoing invasive management. Background There are limited and
contrasting data about sex disparities for the safety and efficacy of TRA
versus TFA for coronary intervention. Methods In the MATRIX (Minimizing
Adverse Haemorrhagic Events by TRansradial Access Site and Systemic
Implementation of angioX) program, 8,404 patients were randomized to TRA
or TFA. The 30-day coprimary outcomes were major adverse cardiovascular
and cerebrovascular events (MACCE), defined as death, myocardial
infarction, or stroke, and net adverse clinical events (NACE), defined as
MACCE or major bleeding. Results Among 8,404 patients, 2,232 (26.6%) were
women and 6,172 (73.4%) were men. MACCE and NACE were not significantly
different between men and women after adjustment, but women had higher
risk of access site bleeding (male vs. female rate ratio [RR]: 0.64; p =
0.0016), severe bleeding (RR: 0.17; p = 0.0012), and transfusion (RR:
0.56; p = 0.0089). When comparing radial versus femoral, there was no
significant interaction for MACCE and NACE stratified by sex
(p<inf>int</inf> = 0.15 and 0.18, respectively), although for both
coprimary endpoints the benefit with TRA was relatively greater in women
(RR: 0.73; p = 0.019; and RR: 0.73; p = 0.012, respectively). Similarly,
there was no significant interaction between male and female patients for
the individual endpoints of all-cause death (p<inf>int</inf> = 0.79),
myocardial infarction (p<inf>int</inf> = 0.25), stroke (p<inf>int</inf> =
0.18), and Bleeding Academic Research Consortium type 3 or 5
(p<inf>int</inf> = 0.45). Conclusions Women showed a higher risk of severe
bleeding and access site complications, and radial access was an effective
method to reduce these complications as well as composite ischemic and
ischemic or bleeding endpoints.<br/>Copyright &#xa9; 2018 American College
of Cardiology Foundation

<62>
Accession Number
618953020
Title
Meta-analysis of transfemoral TAVR versus surgical aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. 91 (4) (pp 806-812),
2018. Date of Publication: 01 Mar 2018.
Author
Arora S.; Vaidya S.R.; Strassle P.D.; Misenheimer J.A.; Rhodes J.A.; Ramm
C.J.; Wheeler E.N.; Caranasos T.G.; Cavender M.A.; Vavalle J.P.
Institution
(Arora, Misenheimer, Ramm, Cavender, Vavalle) Division of Cardiology,
University of North Carolina, Chapel Hill, NC 27599-7075, United States
(Vaidya) Division of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC 28304, United States
(Strassle) Department of Epidemiology, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, NC 27599-7400, United
States
(Strassle, Caranasos) Department of Surgery, UNC School of Medicine,
Chapel Hill, NC 27599-7050, United States
(Misenheimer) Division of Cardiology, The Medical College of Georgia at
Augusta University, Augusta, GA 30912, United States
(Rhodes, Wheeler) Campbell University School of Osteopathic Medicine,
Lillington, NC 27546, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was
shown to have lower risks of death or disabling strokes as compared to
SAVR, whereas the outcomes with transthoracic TAVR were comparable with
SAVR. <br/>Method(s): We searched PubMed, EMBASE, Web of Science, and
Google Scholar for all comparison studies between TAVR and SAVR and
mortality as an outcome, irrespective of surgical risk. Randomized
controlled trials and propensity-score-matched cohort studies that used a
transfemoral approach exclusively or stratified results by route of access
and reported data for TF-TAVR patients were eligible for inclusion.
Outcomes of interest included 30-day and 1-year mortality, and 30-day
complications. If significant heterogeneity was found in the random
effects meta-analyses, a sensitivity analysis which individually removed
each study was conducted. <br/>Result(s): Seven studies reported results
on TF-TAVR. Compared with SAVR, TF-TAVR had comparable 30-day mortality
(RR 0.79, 95% CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78,
1.08) and 30-day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However,
TF-TAVR was associated with lower 30-day risks of atrial fibrillation (RR
0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20,
0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of
higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73)
and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65).
<br/>Conclusion(s): TF-TAVR is associated with lower 30-day risks of
myocardial infarction compared to SAVR. Further studies are required to
investigate the role of myocardial injury on overall TF-TAVR
outcomes.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<63>
Accession Number
622635366
Title
Catheter ablation of incisional atrial tachycardia using remote magnetic
navigation in patients after heart surgery: Comparison between acquired
and congenital heart disease.
Source
Europace. 20 (Supplement 2) (pp ii33-ii39), 2018. Date of Publication: 01
May 2018.
Author
Liu X.-Y.; Jacobsen P.K.; Pehrson S.; Chen X.
Institution
(Liu) Department of Cardiology, Wuxi People's Hospital Affiliated to
Nanjing Medical University, No 299, Qingyang Road, Wuxi 214023, China
(Liu, Jacobsen, Pehrson, Chen) Department of Cardiology, Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen
2100, Denmark
Publisher
Oxford University Press
Abstract
Aims The objectives of this study were to assess the acute and long-term
outcomes of catheter ablation in incisional atrial tachycardia (IAT) using
remote magnetic navigation (RMN) in patients after heart surgery. Methods
and results A total of 46 patients with IAT after heart surgery who
underwent catheter ablation using RMN were included. Of these patients, 22
patients had acquired heart disease (AHD) and the remaining 24 patients
had various types of congenital heart disease (CHD). In these 46 patients,
57 re-entry circuits were found in 56 procedures. The re-entry circuits
were mainly distributed in right atrium (RA). Acute success of first
ablation reached in 42 of 46 (91%) patients. Mean procedure duration was
115 +/- 39 min, ablation duration was 678 (920.5) s, X-ray time was 4
(4.8) min, and X-ray dose was 3 (6.0) gy cm 2. After a mean follow-up of
28 +/- 19 months, 39 of 46 (85%) patients were free from IAT. No major
complications were observed. There were no significant differences in
procedure durations (AHD 113 +/- 40 min vs. CHD 119 +/- 38 min), ablation
durations [AHD 643 (1027) s vs. CHD 712 (929) s], X-ray time [AHD 4 (4.5)
min vs. CHD 4 (5.0) min], circuits in RA (AHD 85% vs. CHD 86%), acute
success rates (AHD 91% vs. CHD 92%), and long-term success rates (AHD 86%
vs. CHD 83%) between the two groups (P > 0.05). Conclusion Catheter
ablation of IAT in patients after heart surgery using RMN is safe and
effective. No significant differences related to success rates and
procedure characteristics were found between patients with AHD and
CHD.<br/>Copyright &#xa9; The Author(s) 2018.

<64>
Accession Number
625468090
Title
Prevention of post-operative complications by using a HMG-CoA reductase
inhibitor in patients undergoing one-lung ventilation for non-cardiac
surgery: Study protocol for a randomised controlled trial 11 Medical and
Health Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 690. Date of
Publication: 18 Dec 2018.
Author
Shyamsundar M.; O'Kane C.; Perkins G.D.; Kennedy G.; Campbell C.; Agus A.;
Phair G.; McAuley D.
Institution
(Shyamsundar, O'Kane, McAuley) Centre for Experimental Medicine, Queen's
University Belfast, Belfast BT9 7BL, United Kingdom
(Perkins) Warwick Trials Unit, University of Warwick, Coventry CV4 7AL,
United Kingdom
(Kennedy, Campbell, Agus, Phair) Northern Ireland Clinical Trials Unit,
Royal Hospitals, 1st Floor Elliott Dynes Building, Belfast BT12 6BA,
United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPC) and peri-operative
myocardial infarction (MI) have a significant impact on the long-term
mortality of surgical patients. Patients undergoing one-lung ventilation
(OLV) for surgery are at a high risk of developing these complications.
These complications could be associated with intensive care unit (ICU)
admissions and longer hospital stay with associated resource and economic
burden. Simvastatin, a HMG-CoA reductase enzyme inhibitor has been shown
to have pleiotropic anti-inflammatory effects as well as being endothelial
protective. The benefits of statins have been shown in various
observational studies and in small proof-of-concept studies. There is an
urgent need for a well-designed, large clinical trial powered to detect
clinical outcomes. The Prevention HARP 2 trial will test the hypothesis
'simvastatin 80 mg when compared to placebo will reduce cardiac and
pulmonary complications in patients undergoing elective oesophagectomy,
lobectomy or pneumonectomy'. Methods/design: The Prevention HARP 2 trial
is a UK multi-centre, randomised, double-blind, placebo-controlled trial.
Adult patients undergoing elective oesophagectomy, lobectomy or
pneumonectomy will be eligible. Patients who are already on statins will
be excluded from this trial. Patients will be randomised to receive
simvastatin 80 mg or matched placebo for 4 days pre surgery and for up to
7 days post surgery. The primary outcome is a composite outcome of PPC and
MI within 7 days post surgery. Various secondary outcome measures
including clinical outcomes, safety outcomes and health economic outcomes
will be collected. The study aims to recruit 452 patients in total across
12 UK sites. <br/>Discussion(s): The results of the Prevention HARP 2
trial should add to our understanding of the benefits of peri-operative
statins and influence clinical decision-making. Analysis of blood and
urine samples from the patients will provide insight into the mechanism of
simvastatin action. Trial registration: International Standard Randomised
Controlled Trials registry, ID: ISRCTN48095567. Registered on 11 November
2016.<br/>Copyright &#xa9; 2018 The Author(s).

<65>
Accession Number
625456211
Title
Prevention of Infections in Cardiac Surgery study (PICS): Study protocol
for a pragmatic cluster-randomized factorial crossover pilot trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 688. Date of
Publication: 17 Dec 2018.
Author
Van Oostveen R.B.; Romero-Palacios A.; Whitlock R.; Lee S.F.; Connolly S.;
Carignan A.; Mazer C.D.; Loeb M.; Mertz D.
Institution
(Van Oostveen, Whitlock, Lee, Connolly, Mertz) Population Health Research
Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada
(Romero-Palacios, Whitlock, Connolly, Loeb, Mertz) McMaster University,
Hamilton, ON, Canada
(Carignan) Department of Microbiology and Infectious Diseases, Universite
de Sherbrooke, Sherbrooke, QC, Canada
(Carignan) Centre de Recherche du Centre Hospitalier Universitaire de
Sherbrooke, Sherbrooke, QC, Canada
(Mazer) Li Ka Shing Knowledge Institute, St. Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Mertz) Juravinski Hospital and Cancer Center, 711 Concession Street,
Hamilton, ON L8V 1C3, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A wide range of prophylactic antibiotic regimens are used for
patients undergoing open-heart cardiac surgery. This reflects clinical
equipoise in choice and duration of antibiotic agents. Although
individual-level randomized control trials (RCT) are considered the gold
standard when evaluating the efficacy of an intervention, this approach is
highly resource intensive and a cluster RCT can be more appropriate for
testing clinical effectiveness in a real-world setting. Methods/design: We
are conducting a factorial cluster-randomized crossover pilot trial in
cardiac surgery patients to evaluate the feasibility of this design for a
definite trial to evaluate the optimal duration and choice of
perioperative antibiotic prophylaxis. Specifically, we will evaluate: (a)
the non-inferiority of a single preoperative dose compared to prolonged
prophylaxis and (b) the potential superiority of adding vancomycin to
routine cefazolin in terms of preventing deep and organ/space sternal
surgical site infections (s-SSIs). There are four strategies: (i)
short-term cefazolin, (ii) long-term cefazolin, (iii) short-term cefazolin
+ vancomycin, and (iv) long-term cefazolin + vancomycin. These strategies
are delivered in a different order in each health-care center
participating in the trial. The centers are randomized to an order, and
the current strategy becomes the standard operating procedure in that
center during the study. The three feasibility outcomes include: (1) the
proportion of patients receiving preoperative, intra-operative, and
postoperative antibiotics according to the study protocol, (2) the
proportion of completed follow-up assessments, and (3) a full and final
assessment of the incidence of s-SSIs by the outcome adjudication
committee. <br/>Discussion(s): We believe that a cluster-randomized
factorial crossover trial is an effective and feasible design for these
research questions, allowing an evaluation of the clinical effectiveness
in a real-world setting. A waiver of individual informed consent was
considered appropriate by the research ethics boards in each participating
site in Canada as long as an information letter with an opt-out option was
provided. However, a waiver of consent was not approved at two sites in
Germany and Switzerland, respectively. Trial registration:
Clinicaltrials.gov, NCT02285140. Registered on 15 October
2015.<br/>Copyright &#xa9; 2018 The Author(s).

<66>
Accession Number
620572051
Title
Psychological interventions for coronary heart disease: Cochrane
systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 25 (3) (pp 247-259), 2018. Date
of Publication: 01 Feb 2018.
Author
Richards S.H.; Anderson L.; Jenkinson C.E.; Whalley B.; Rees K.; Davies
P.; Bennett P.; Liu Z.; West R.; Thompson D.R.; Taylor R.S.
Institution
(Richards) Leeds Institute of Health Sciences, University of Leeds, Leeds,
United Kingdom
(Richards, Jenkinson) Primary Care, University of Exeter Medical School,
Exeter, United Kingdom
(Anderson, Taylor) Institute of Health Research, University of Exeter
Medical School, Exeter, United Kingdom
(Whalley) School of Psychology, University of Plymouth, Plymouth, United
Kingdom
(Rees) Division of Health Sciences, Warwick Medical School, University of
Warwick, Coventry, United Kingdom
(Davies) School of Social and Community Medicine, University of Bristol,
Bristol, United Kingdom
(Bennett) Department of Psychology, University of Swansea, Swansea, United
Kingdom
(Liu) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(West) Wales Heart Research Institute, Cardiff University, Cardiff, United
Kingdom
(Thompson) School of Nursing & Midwifery, Queen's University, Belfast,
United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although psychological interventions are recommended for the
management of coronary heart disease (CHD), there remains considerable
uncertainty regarding their effectiveness. <br/>Design(s): Systematic
review and meta-analysis of randomised controlled trials (RCTs) of
psychological interventions for CHD. <br/>Method(s): The Cochrane Central
Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PsycINFO were
searched to April 2016. Retrieved papers, systematic reviews and trial
registries were hand-searched. We included RCTs with at least 6 months of
follow-up, comparing the direct effects of psychological interventions to
usual care for patients following myocardial infarction or
revascularisation or with a diagnosis of angina pectoris or CHD defined by
angiography. Two authors screened titles for inclusion, extracted data and
assessed risk of bias. Studies were pooled using random effects
meta-analysis and meta-regression was used to explore study-level
predictors. <br/>Result(s): Thirty-five studies with 10,703 participants
(median follow-up 12 months) were included. Psychological interventions
led to a reduction in cardiovascular mortality (rfcelative risk 0.79, 95%
confidence interval [CI] 0.63 to 0.98), although no effects were observed
for total mortality, myocardial infarction or revascularisation.
Psychological interventions improved depressive symptoms (standardised
mean difference [SMD] -0.27, 95% CI -0.39 to -0.15), anxiety (SMD -0.24,
95% CI -0.38 to -0.09) and stress (SMD -0.56, 95% CI -0.88 to -0.24)
compared with controls. <br/>Conclusion(s): We found that psychological
intervention improved psychological symptoms and reduced cardiac mortality
for people with CHD. However, there remains considerable uncertainty
regarding the magnitude of these effects and the specific techniques most
likely to benefit people with different presentations of
CHD.<br/>Copyright &#xa9; 2017, &#xa9; The European Society of Cardiology
2017.

<67>
[Use Link to view the full text]
Accession Number
622304261
Title
Sex difference in patients with ischemic heart failure undergoing surgical
revascularization results from the STICH trial (surgical treatment for
ischemic heart failure).
Source
Circulation. 137 (8) (pp 771-780), 2018. Date of Publication: 2018.
Author
Pina I.L.; Zheng Q.; She L.; Szwed H.; Lang I.M.; Farsky P.S.;
Castelvecchio S.; Biernat J.; Paraforos A.; Kosevic D.; Favaloro L.E.;
Nicolau J.C.; Varadarajan P.; Velazquez E.J.; Pai R.G.; Cyrille N.; Lee
K.L.; Desvigne-Nickens P.
Institution
(Pina, Zheng, Cyrille) Albert Einstein College of Medicine, Montefore
Medical Center, New York, NY, United States
(She) Duke Clinical Research Institute, United States
(Lee) Department of Biostatistics and Bioinformatics, United States
(Velazquez) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
(Szwed) National Institute of Cardiology, Warsaw, Poland
(Lang) Medical University of Vienna, Austria
(Farsky) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Castelvecchio) Istituti di Ricovero e Cura A Carattere Scientifco
Policlinico San Donato, Milan, Italy
(Biernat) Medical University of Silesia, Katowice, Poland
(Paraforos) Department of Surgery-Cardiac, University of Trier, Germany
(Kosevic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Favaloro) University Hospital Favaloro Foundation, Buenos Aires,
Argentina
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Brazil
(Varadarajan, Pai) Department of Medicine/Cardiology, University of
California, Riverside School of Medicine, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Female sex is conventionally considered a risk factor for
coronary artery bypass grafting (CABG) and has been included as a poor
prognostic factor in multiple cardiac operative risk evaluation scores. We
aimed to investigate the association of sex and the long-term beneft of
CABG in patients with ischemic left ventricular dysfunction enrolled in
the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure
Study). <br/>METHOD(S): The STICH trial randomized 1212 patients (148
[12%] women and 1064 [88%] men) with coronary artery disease and left
ventricular ejection fraction =35% to CABG+medical therapy (MED) versus
MED alone. Long-term (10-year) outcomes with each treatment were compared
according to sex. <br/>RESULT(S): At baseline, women were older (63.4
versus 59.3 years; P=0.016) with higher body mass index (27.9 versus 26.7
kg/m2; P=0.001). Women had more coronary artery disease risk factors
(diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%;
hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus
21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P<0.05) than
men. Moreover, women had higher New York Heart Association class (class
III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350
m), and lower Kansas City Cardiomyopathy Questionnaire overall summary
scores (51 versus 63; all P<0.05). Over 10 years of followup, all-cause
mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confdence
interval, 0.52-0.86; P=0.002) and cardiovascular mortality (34.3% versus
52.3%; adjusted hazard ratio, 0.65; 95% confdence interval, 0.48-0.89;
P=0.006) were signifcantly lower in women compared with men. With
randomization to CABG+MED versus MED treatment, there was no signifcant
interaction between sex and treatment group in all-cause mortality,
cardiovascular mortality, or the composite of all-cause mortality or
cardiovascular hospitalization (all P>0.05). In addition, surgical deaths
were not statistically different (1.5% versus 5.1%; P=0.187) between sexes
among patients randomized to CABG per protocol as initial treatment.
<br/>CONCLUSION(S): Sex is not associated with the effect of CABG+MED
versus MED on all-cause mortality, cardiovascular mortality, the composite
of death or cardiovascular hospitalization, or surgical deaths in patients
with ischemic left ventricular dysfunction. Thus, sex should not influence
treatment decisions about CABG in these patients.<br/>Copyright &#xa9;
2017 American Heart Association, Inc.

<68>
Accession Number
623387581
Title
Epicardial left atrial appendage AtriClip occlusion reduces the incidence
of stroke in patients with atrial fibrillation undergoing cardiac surgery.
Source
Europace. 20 (7) (pp e105-e114), 2018. Date of Publication: 01 Jul 2018.
Author
Caliskan E.; Sahin A.; Yilmaz M.; Seifert B.; Hinzpeter R.; Alkadhi H.;
Cox J.L.; Holubec T.; Reser D.; Falk V.; Grunenfelder J.; Genoni M.;
Maisano F.; Salzberg S.P.; Emmert M.Y.
Institution
(Caliskan, Sahin, Yilmaz, Holubec, Reser, Genoni, Maisano, Emmert) Clinic
for Cardiovascular Surgery, University Hospital Zurich, University of
Zurich, Raemistrasse 100, Zurich, Switzerland
(Caliskan, Falk) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin, Germany
(Caliskan, Falk) Department of Cardiothoracic and Vascular Surgery, German
Heart Institute Berlin, Augustenburger Platz 1, Berlin, Germany
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Hirschengraben 84, Zurich,
Switzerland
(Hinzpeter, Alkadhi) Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Raemistrasse 100,
Zurich, Switzerland
(Cox) Feinberg School of Medicine, Northwestern University, Arthur J.
Rubloff Building, 420 East Superior Street, Chicago, IL, United States
(Grunenfelder, Salzberg) HeartClinic, Hirslanden Hospital,
Witellikerstrasse 40, Zurich, Switzerland
Publisher
Oxford University Press
Abstract
Aims Left atrial appendage (LAA) occlusion has emerged as an interesting
alternative to oral anticoagulation (OAC) for stroke prevention in
patients with atrial fibrillation (AF). We report the safety, efficacy,
and durability of concomitant device-enabled epicardial LAA occlusion
during open-heart surgery. In addition to long-term follow-up, we evaluate
the impact on stroke risk in this selected population. Methods and results
A total of 291 AtriClip devices were deployed epicardially in patients
(mean CHA2DS2-VASc-Score: 3.1+/- 1.5) undergoing open-heart surgery
(including isolated coronary artery bypass grafting, valve, or combined
procedures) comprising of forty patients from a first-in-man device trial
(NCT00567515) and 251 patients from a consecutive institutional registry
thereafter. In all patients (n= 291), the LAA was successfully excluded
and overall mean follow-up (FU) was 36+/- 23months (range: 1?97months). No
device-related complications were detected throughout the FU period.
Longterm imaging work-up (computed tomography) in selected patients
>5years post-implant (range: 5.1?8.1 years) displayed complete LAA
occlusion with no signs of residual reperfusion or significant LAA stumps.
Subgroup analysis of patients with discontinued OAC during FU (n= 166)
revealed a relative risk reduction of 87.5% with an observed ischaemic
stroke-rate of 0.5/100 patient-years compared with what would have been
expected in a group of patients with similar CHA2DS2-VASc scores (expected
rate of 4.0/100 patient-years). No strokes occurred in the subgroup with
OAC. Conclusion The long-term results from our first-in-man prospective
human trial plus our institutional registry of epicardial LAA occlusion
with the AtriClip in patients with AF undergoing cardiac surgery
demonstrate the safety and durability of the procedure. In addition, our
data are suggestive for the potential efficacy of LAA occlusion in
reducing the incidence of stroke. If validated in future large randomized
trials, routine LAA occlusion in patients undergoing cardiac surgery (with
contraindications to treatment with oral anticoagulants) may represent a
reasonable adjunct procedure to reduce the risk of future
stroke.<br/>Copyright &#xa9;The Author(s) 2018.

<69>
Accession Number
620799646
Title
The impact of prehabilitation on post-surgical complications in patients
undergoing non-urgent cardiovascular surgical intervention: Systematic
review and meta-analysis.
Source
European Journal of Preventive Cardiology. 25 (4) (pp 404-417), 2018. Date
of Publication: 01 Mar 2018.
Author
Marmelo F.; Rocha V.; Goncalves D.
Institution
(Marmelo, Rocha, Goncalves) Department of Surgery and Physiology of the
Faculty of Medicine of Porto, Porto, Portugal
(Rocha) Sao Martinho Hospital, Valongo, Portugal
(Goncalves) Ave Valley Superior School of Health, Famalicao, Portugal
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Cardiac surgery is an aggressive procedure, inducing a great
level of stress and disturbance to the homeostasis of the organism and
underlying several postoperative complications. Surgical prehabilitation
comprises pre-operative physical conditioning designed to improve the
physiological and functional capacities of the individual, prepare the
organism for surgical stress and reduce the risk of postoperative
morbidity. <br/>Aim(s): This systematic review and meta-analysis is aimed
at evaluating the ability of prehabilitation to prevent post-surgical
complications in cardiac patients. <br/>Method(s): We selected studies
conducted among patients who were waiting for non-urgent cardiac surgical
procedures, where a comparison between prehabilitation and standard
treatment was made. A total of 3650 possible studies were researched, of
which eight were selected for inclusion. <br/>Result(s): A reduction in
the number of complications in the groups submitted to prehabilitation
(odds ratio = 0.41; 95% confidence interval (CI): 0.28-0.62; p < 0.001;
I²= 0%) was observed, as well as a significant increase in
maximal inspiratory pressure (standard mean difference (SMD) = 0.66; 95%
CI: 0.35-0.96; p < 0.001; I²= 58%), a non-significant decrease
in the length of stay (SMD = -0.56; 95% CI: -1.13, 0.01; p = 0.05;
I²= 93%), a non-significant increase in the distance walked by
the intervention group in the six-minute walk test (SMD = 0.89; 95% CI
-0.06, 1.84; p = 0.07) and a lack of effect on mechanical ventilation time
(SMD = -0.03; 95% CI: -0.22, 0.16; p = 0.75; I²= 0%).
<br/>Conclusion(s): Prehabilitation reduces the number of post-surgical
complications and increases maximal inspiratory pressure; a reduction in
the length of stay and an improvement of functional capacities are also
probable.<br/>Copyright &#xa9; 2018, &#xa9; The European Society of
Cardiology 2018.

<70>
Accession Number
623215729
Title
Does body mass index truly affect mortality and cardiovascular outcomes in
patients after coronary revascularization with percutaneous coronary
intervention or coronary artery bypass graft? A systematic review and
network meta-analysis.
Source
Obesity Reviews. 19 (9) (pp 1236-1247), 2018. Date of Publication:
September 2018.
Author
Ma W.-Q.; Sun X.-J.; Wang Y.; Han X.-Q.; Zhu Y.; Liu N.-F.
Institution
(Ma, Sun, Wang, Han, Zhu, Liu) Department of Cardiology, Zhongda Hospital,
School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing, China
Publisher
Blackwell Publishing Ltd
Abstract
Background: Obesity, a comorbid medical condition, is usually observed in
patients with established coronary artery disease. Paradoxically, patients
with a higher body mass index (BMI) usually have better clinical outcomes
after coronary revascularization. <br/>Method(s): We searched five online
databases through December 2017. We identified studies reporting the rate
of all-cause mortality or cardiovascular-related outcomes among patients
after coronary revascularization with percutaneous coronary intervention
or coronary artery bypass graft based on various BMI categories. Network
meta-analysis was performed using Bayesian methods. <br/>Result(s):
Sixty-five records involving 865,774 participants were included in our
study. A U-shaped association was observed across BMI categories for
all-cause mortality. Using normal weight as the reference, all-cause
mortality was increased for (relative risk [RR]: 2.4; 95% credibility
interval [CrI]: 2.1-2.7) patients with underweight, whereas it was lowered
in patients with overweight, obese, and severely obese. This association
remained significant in many subgroups. We also observed that the risk of
major adverse cardiovascular events (MACE) was lowest among patients with
overweight. Furthermore, patients with underweight were associated with
greater risks of myocardial infarction (RR: 1.9; 95% CrI: 1.4-2.5),
cardiovascular-related mortality (RR: 2.8; 95% CrI: 1.6-4.7), stroke (RR:
2.0; 95% CrI: 1.3-3.3) and heart failure (RR: 1.7; 95% CrI: 1.1-2.7)
compared with normal weight patients; no significant association was
observed among individuals with higher BMI. <br/>Conclusion(s): The
'obesity paradox' does exist in patients after coronary revascularization,
especially for patients with post-percutaneous coronary intervention.
All-cause mortality in patients with high BMI is significantly lower
compared with patients with normal weight. Furthermore, patients with
underweight experience higher rates of cardiovascular outcomes compared
with patients with normal weight.<br/>Copyright &#xa9; 2018 World Obesity
Federation

<71>
Accession Number
618863087
Title
Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women
Compared With Men: Evidence From a Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 11 (1) (pp 24-35), 2018. Date of
Publication: 08 Jan 2018.
Author
Saad M.; Nairooz R.; Pothineni N.V.K.; Almomani A.; Kovelamudi S.; Sardar
P.; Katz M.; Abdel-Wahab M.; Bangalore S.; Kleiman N.S.; Block P.C.;
Abbott J.D.
Institution
(Saad, Pothineni, Almomani, Kovelamudi) Division of Cardiovascular
Medicine, University of Arkansas for Medical Sciences, Little Rock,
Arkansas, United States
(Nairooz) Division of Cardiology, University of Southern California, Los
Angeles, California, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, Utah, United States
(Katz) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Abdel-Wahab) Heart Center, Segeberger Kliniken (Academic Teaching
Hospital of the Universities of Kiel, Lubeck, and Hamburg), Bad Segeberg,
Germany
(Bangalore) Division of Cardiovascular Medicine, New York University
School of Medicine, New York, New York, United States
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, Houston
Methodist Hospital, Houston, Texas, United States
(Block) Division of Cardiovascular Medicine, Emory University School of
Medicine, Atlanta, Georgia
(Abbott) Division of Cardiovascular Medicine, Warren Alpert School of
Medicine at Brown University, Providence, Rhode Island, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to examine long-term outcomes with
transcatheter aortic valve replacement (TAVR) in women versus men.
Background TAVR is commonly performed in women. Previous studies have
shown conflicting results with respect to sex differences in outcomes with
TAVR. In addition, short-term outcomes have primarily been reported.
Methods Electronic search was performed until March 2017 for studies
reporting outcomes with TAVR in women versus men. Random effects
DerSimonian-Laird risk ratios were calculated. Outcomes included all-cause
mortality and major cardiovascular events at short- (30 days) and
long-term (>1 year) follow-up. Results Seventeen studies (8 TAVR
registries; 47,188 patients; 49.4% women) were analyzed. Women were older
but exhibited fewer comorbidities. At 30 days, women had more bleeding (p
< 0.001), vascular complications (p < 0.001), and stroke/transient
ischemic attack (p = 0.02), without difference in all-cause (p = 0.19) or
cardiovascular mortality (p = 0.91) compared with men. However, female sex
was associated with lower all-cause mortality at 1 year (risk ratio: 0.85;
95% confidence interval: 0.79 to 0.91; p < 0.001), and longest available
follow-up (mean 3.28 +/- 1.04 years; risk ratio: 0.86; 95% confidence
interval: 0.81 to 0.92; p < 0.001), potentially caused by less
moderate/severe aortic insufficiency (p = 0.001), and lower cardiovascular
mortality (p = 0.009). The female survival advantage remained consistent
across multiple secondary analyses. The risk of stroke, moderate/severe
aortic insufficiency, and all-cause mortality seemed to vary based on the
type of valve used; however, without significant subgroup interactions.
Conclusions Despite a higher upfront risk of complications, women derive a
better long-term survival after TAVR compared with men.<br/>Copyright
&#xa9; 2018 American College of Cardiology Foundation

<72>
Accession Number
620683244
Title
A Randomized Trial Comparing the NeoVas Sirolimus-Eluting Bioresorbable
Scaffold and Metallic Everolimus-Eluting Stents.
Source
JACC: Cardiovascular Interventions. 11 (3) (pp 260-272), 2018. Date of
Publication: 12 Feb 2018.
Author
Han Y.; Xu B.; Fu G.; Wang X.; Xu K.; Jin C.; Tao L.; Li L.; Hou Y.; Su
X.; Fang Q.; Chen L.; Liu H.; Wang B.; Yuan Z.; Gao C.; Zhou S.; Sun Z.;
Zhao Y.; Guan C.; Stone G.W.
Institution
(Han, Wang, Xu) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Xu, Sun, Zhao, Guan) Catheter Lab, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing,
China
(Fu, Jin) Department of Cardiology, Sir Run Run Shaw Hospital, Hangzhou,
China
(Tao) Department of Cardiology, Xijing Hospital, The Fourth Military
Medical University, Xi'an, China
(Li) Department of Cardiology, The First Affiliated Hospital of Guangxi
Medical University, Nanning, China
(Hou) Department of Cardiology, Nanfang Hospital, Guangzhou, China
(Su) Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
(Fang) Department of Cardiology, Peking Union Medical College Hospital,
Beijing, China
(Chen) Department of Cardiology, Fujian Medical University Union Hospital,
Fuzhou, China
(Liu) Department of Cardiology, General Hospital of Chinese People's Armed
Police Forces, Beijing, China
(Wang) Department of Cardiology, Aero Space Center Hospital, Beijing,
China
(Yuan) Department of Cardiology, The First Affiliated Hospital of Xi'an
Jiongtong University, Xi'an, China
(Gao) Department of Cardiology, Henan Provincial People's Hospital,
Zhengzhou, China
(Zhou) Department of Cardiology, The Second Xiangya Hospital of Central
South University, Changsha, China
(Stone) Center for Interventional Vascular Therapy, Division of
Cardiology, Presbyterian Hospital and Columbia University, New York, New
York, United States
(Stone) Cardiovascular Research Foundation, New York, New York, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The authors sought to evaluate the safety and effectiveness of
the NeoVas bioresorbable scaffold (BRS) compared with metallic
drug-eluting stents. <br/>Background(s): BRS have the potential to improve
very late outcomes compared with metallic drug-eluting stents, but some
BRS have been associated with increased rates of device thrombosis before
complete bioresorption. NeoVas is a new poly-L-lactic acid BRS that elutes
sirolimus from a poly-D, L-lactide coating. <br/>Method(s): Eligible
patients with a single de novo native coronary artery lesion with a
reference vessel diameter 2.5 to 3.75 mm and a lesion length <=20 mm were
randomized 1:1 to NeoVas BRS versus cobalt-chromium everolimus-eluting
stents (CoCr-EES). Angiographic follow-up was performed in all patients at
1 year. The primary endpoint was angiographic in-segment late loss (LL),
and the major secondary endpoint was the rate of angina. Baseline and
follow-up optical coherence tomography and fractional flow reserve were
performed in a pre-specified subgroup of patients. <br/>Result(s): The
authors randomized 560 patients at 32 centers to treatment with NeoVas (n
= 278) versus CoCr-EES (n = 282). One-year in-segment LL with NeoVas and
CoCr-EES were 0.14 +/- 0.36 mm versus 0.11 +/- 0.34 mm (difference 0.03
mm; upper 1-sided 97.5% confidence interval 0.09 mm;
p<inf>noninferiority</inf> < 0.0001; p<inf>superiority</inf> = 0.36).
Clinical outcomes at 1 year were similar in the 2 groups, as were the
rates of recurrent angina (27.9% vs. 32.1%; p = 0.26). Optical coherence
tomography at 1 year demonstrated a higher proportion of covered struts
(98.7% vs. 96.2%; p < 0.001), less strut malapposition (0% vs. 0.6%; p
<0.001), and a smaller minimal lumen area (4.71 +/- 1.64 vs. 6.00 +/- 2.15
mm²; p < 0.001) with NeoVas compared with CoCr-EES
respectively, with nonsignificant differences in fractional flow reserve
(0.89 +/- 0.08 vs. 0.91 +/- 0.06; p = 0.07). <br/>Conclusion(s): The
NeoVas BRS was noninferior to CoCr-EES for the primary endpoint of 1-year
angiographic in-segment LL, and resulted in comparable 1-year clinical
outcomes, including recurrent angina. (NeoVas Bioresorbable Coronary
Scaffold Randomized Controlled Trial; NCT02305485)<br/>Copyright &#xa9;
2018

<73>
Accession Number
622037763
Title
Amaze: A double-blind, multicentre randomised controlled trial to
investigate the clinical effectiveness and cost-effectiveness of adding an
ablation device-based maze procedure as an adjunct to routine cardiac
surgery for patients with pre-existing atrial fibrillation.
Source
Health Technology Assessment. 22 (19) (no pagination), 2018. Date of
Publication: April 2018.
Author
Sharples L.; Everett C.; Singh J.; Mills C.; Spyt T.; Abu-Omar Y.; Fynn
S.; Thorpe B.; Stoneman V.; Goddard H.; Fox-Rushby J.; Nashef S.
Institution
(Sharples) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, London, United Kingdom
(Everett, Thorpe) Leeds Institute of Clinical Trials Research, University
of Leeds, Leeds, United Kingdom
(Singh) Health Economics Research Group (HERG), Brunel University London,
London, United Kingdom
(Mills, Stoneman, Goddard) Papworth Trials Unit Collaboration, Papworth
Hospital, Cambridge, United Kingdom
(Spyt) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Abu-Omar, Fynn, Nashef) Department of Cardiology and Department of
Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
(Fox-Rushby) Department of Population Science, King's College London,
London, United Kingdom
Publisher
NIHR Journals Library (NETSCCAlpha HouseUniversity of Southampton, Science
Park, Southampton SO167NS, United Kingdom)
Abstract
Background: Atrial fibrillation (AF) can be treated using a maze procedure
during planned cardiac surgery, but the effect on clinical patient
outcomes, and the cost-effectiveness compared with surgery alone, are
uncertain. <br/>Objective(s): To determine whether or not the maze
procedure is safe, improves clinical and patient outcomes and is
cost-effective for the NHS in patients with AF. <br/>Design(s):
Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised
controlled trial. Patients were randomised on a 1: 1 basis using random
permuted blocks, stratified for surgeon and planned procedure.
<br/>Setting(s): Eleven acute NHS specialist cardiac surgical centres.
<br/>Participant(s): Patients aged >= 18 years, scheduled for elective or
in-house urgent cardiac surgery, with a documented history (> 3 months) of
AF. <br/>Intervention(s): Routine cardiac surgery with or without an
adjunct maze procedure administered by an AF ablation device. <br/>Main
Outcome Measure(s): The primary outcomes were return to sinus rhythm (SR)
at 12 months and quality-adjusted life-years (QALYs) over 2 years after
randomisation. Secondary outcomes included return to SR at 2 years,
overall and stroke-free survival, drug use, quality of life (QoL),
cost-effectiveness and safety. <br/>Result(s): Between 25 February 2009
and 6 March 2014, 352 patients were randomised to the control (n = 176) or
experimental (n = 176) arms. The odds ratio (OR) for return to SR at 12
months was 2.06 [95% confidence interval (CI) 1.20 to 3.54; p = 0.0091].
The mean difference (95% CI) in QALYs at 2 years between the two trial
arms (maze/control) was -0.025 (95% CI 0.129 to 0.078; p = 0.6319). The OR
for SR at 2 years was 3.24 (95% CI 1.76 to 5.96). The number of patients
requiring anticoagulant drug use was significantly lower in the maze arm
from 6 months after the procedure. There were no significant differences
between the two arms in operative or overall survival, stroke-free
survival, need for cardioversion or permanent pacemaker implants, New York
Heart Association Functional Classification (for heart failure), EuroQol-5
Dimensions, three-level version score and Short Form questionnaire-36
items score at any time point. Sixty per cent of patients in each trial
arm had a serious adverse event (p = 1.000); most events were mild, but 71
patients (42.5%) in the maze arm and 84 patients (45.5%) in the control
arm had moderately severe events; 31 patients (18.6%) in the maze arm and
38 patients (20.5%) in the control arm had severe events. The mean
additional cost of the maze procedure was 3533 (95% CI 1321 to 5746); the
mean difference in QALYs was -0.022 (95% CI -0.1231 to 0.0791). The maze
procedure was not cost-effective at 30,000 per QALY over 2 years in any
analysis. In a small substudy, the active left atrial ejection fraction
was smaller than that of the control patients (mean difference of -8.03,
95% CI -12.43 to -3.62), but within the predefined clinically equivalent
range. <br/>Limitation(s): Low recruitment, early release of trial
summaries and intermittent resource-use collection may have introduced
bias and imprecise estimates. <br/>Conclusion(s): Ablation can be
practised safely in routine NHS cardiac surgical settings and increases
return to SR rates, but not survival or QoL up to 2 years after surgery.
Lower anticoagulant drug use and recovery of left atrial function support
anticoagulant drug withdrawal provided that good atrial function is
confirmed.<br/>Copyright &#xa9; Queen's Printer and Controller of HMSO
2018.

<74>
Accession Number
621870186
Title
Perioperative management of hyperlipidemia medications.
Source
Current Clinical Pharmacology. 12 (3) (pp 152-156), 2017. Date of
Publication: 01 Aug 2017.
Author
Renew J.R.
Institution
(Renew) Department of Anesthesiology and Perioperative Medicine, Mayo
Clinic, Jacksonville, FL 32224, United States
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Coronary artery disease is a common comorbidity encountered
during the perioperative period. Whether patients are scheduled for
cardiac or noncardiac surgery, this cardiovascular disease must be
addressed in the preoperative period to decrease the accompanying risks
and potential postoperative problems. Lipid-lowering medications are often
used to treat hyperlipidemia, a risk factor for the development of
atherosclerosis and coronary artery disease. <br/>Objective(s): To discuss
the medications most commonly used to treat hyperlipidemia and to describe
strategies for handling these treatment regimens in the perioperative
period. <br/>Method(s): An online search of studies and review articles
was conducted through PubMed and Medline that addressed pharmacology and
perioperative management of hyperlipidemia medications. <br/>Result(s):
Statins are the most commonly prescribed lipid-lowering agents, with
benefits that extend beyond correcting lipid levels. However, statins can
have clinically significant adverse effects that may necessitate the use
of other lipid-lowering medications with different mechanisms of action.
Alternative medications such as nicotinic acid and omega-3 fatty acids
should be withheld in the preoperative period because these agents have
been associated with hypotension and increased bleeding.
<br/>Conclusion(s): Clinicians must be familiar with the various
lipid-lowering agents because it is very likely they will encounter such
medications during preoperative visits.<br/>Copyright &#xa9; 2017 Bentham
Science Publishers.

<75>
Accession Number
619331991
Title
Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary
Angiography-Guided Percutaneous Coronary Intervention With Stent
Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31
Studies and 17,882 Patients.
Source
JACC: Cardiovascular Interventions. 10 (24) (pp 2488-2498), 2017. Date of
Publication: 26 Dec 2017.
Author
Buccheri S.; Franchina G.; Romano S.; Puglisi S.; Venuti G.; D'Arrigo P.;
Francaviglia B.; Scalia M.; Condorelli A.; Barbanti M.; Capranzano P.;
Tamburino C.; Capodanno D.
Institution
(Buccheri, Franchina, Romano, Puglisi, Venuti, D'Arrigo, Francaviglia,
Scalia, Condorelli, Barbanti, Capranzano, Tamburino, Capodanno) Division
of Cardiology, Cardio-Thoracic-Vascular Department, Azienda
Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of
Catania, Catania, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to explore the comparative clinical efficacy
of different imaging modalities for guiding percutaneous coronary
interventions (PCI). Background Coronary angiography (CA) is the standard
imaging modality for intraprocedural guidance of PCI. Intracoronary
imaging techniques, including intravascular ultrasound (IVUS) and optical
coherence tomography (OCT), can overcome some limitations of CA. Methods
Comprehensive hierarchical Bayesian network meta-analysis of randomized
clinical trials and adjusted observational studies comparing clinical
outcomes of PCI with stent implantation guided by CA, IVUS, or OCT.
Results A total of 31 studies encompassing 17,882 patients were included.
Compared with CA guidance, the risks of all-cause death (odds ratio [OR]:
0.74; 95% credible interval [CrI]: 0.58 to 0.98), myocardial infarction
(OR: 0.72; 95% CrI: 0.52 to 0.93), target lesion revascularization (OR:
0.74, 95% CrI: 0.58 to 0.90) and stent thrombosis (OR: 0.42; 95% CrI: 0.20
to 0.72) were significantly reduced by IVUS guidance. PCI guidance using
either IVUS or OCT was associated with a significant reduction of major
adverse cardiovascular events (OR: 0.79; 95% CrI: 0.67 to 0.91 and OR:
0.68; 95% CrI: 0.49 to 0.97, respectively) and cardiovascular death (OR:
0.47; 95% CrI: 0.32 to 0.66 and OR: 0.31; 95% CrI: 0.13 to 0.66,
respectively). No differences in terms of comparative clinical efficacy
were found between IVUS and OCT for all the investigated outcomes. Pooled
estimates were consistent across several sensitivity analyses. However,
the treatment effect of IVUS on all-cause death was neutralized in the
analysis restricted to randomized clinical trials (OR: 1.03; 95% CrI: 0.41
to 2.14). Conclusions Compared with CA, the use of intravascular imaging
techniques for PCI guidance reduces the risk of cardiovascular death and
adverse events.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<76>
Accession Number
620999453
Title
The role of N-acetylcysteine in platelet aggregation and reperfusion
injury in recent years.
Source
Current Clinical Pharmacology. 12 (2) (pp 83-91), 2017. Date of
Publication: 01 May 2017.
Author
Nikbakht M.; Ahmadi F.; Vaseghi G.; Talasaz A.H.; Eshraghi A.; Naderi J.;
Daneshme M.A.
Institution
(Nikbakht) Department of Pharmacology, Faculty of Medicine, Yasuj
University of Medical Sciences, Yasuj, Iran, Islamic Republic of
(Ahmadi, Daneshme) Department of Medicinal Chemistry, School of
Pharmacy-International Campus, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Vaseghi) Isfahan Cardiovascular Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Talasaz) Department of Clinical Pharmacy, School of Pharmacy, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Eshraghi) Department of Clinical Pharmacy, School of
Pharmacy-International Campus, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Naderi) Applied Physiology Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: N-acetylcysteine (NAC) is an amino acid that contains a
cysteine group and is currently used widely in various fields of medical
research especially in cardiology. In this review, potential benefits of
NAC in the aggregation of platelet and reperfusion injury are evaluated.
<br/>Method(s): The available evidence was collected by searching Scopus,
Pub-Med, Medline, Cochrane central register of controlled trials, and
Cochrane database systematic reviews. Our searching was performed without
time limitation and only English language articles were included in this
review. Key words used as search terms included "N-acetylcysteine",
"platelet aggregation", "reperfusion injury". <br/>Result(s): Over the
past decade, several investigations were carried out to ascertain
reperfusion injury and antiplatelet properties of NAC, and in this article
the results of investigations in both models (human and animal) were
addressed in detail. The results revealed that NAC has an important
antiplatelet property in animal models while this effect is not very
significant in human models and needs more investigations. However, its
reperfusion injury in both models is worth noticing. <br/>Conclusion(s):
Due to the limited data about effectiveness of NAC in both human and
animal as antiplatelet agent, more investigation is needed to evaluate NAC
efficacy in platelet aggregation and reperfusion injury especially in
human studies in the future.<br/>Copyright &#xa9; 2017 Bentham Science
Publishers.

<77>
Accession Number
620078857
Title
Benefit of Switching Dual Antiplatelet Therapy After Acute Coronary
Syndrome According to On-Treatment Platelet Reactivity: The TOPIC-VASP
Pre-Specified Analysis of the TOPIC Randomized Study.
Source
JACC: Cardiovascular Interventions. 10 (24) (pp 2560-2570), 2017. Date of
Publication: 26 Dec 2017.
Author
Deharo P.; Quilici J.; Camoin-Jau L.; Johnson T.W.; Bassez C.; Bonnet G.;
Fernandez M.; Ibrahim M.; Suchon P.; Verdier V.; Fourcade L.; Morange
P.E.; Bonnet J.L.; Alessi M.C.; Cuisset T.
Institution
(Deharo, Bassez, Bonnet, Bonnet, Cuisset) Departement de Cardiologie, CHU
Timone, Marseille, France
(Deharo, Morange, Bonnet, Alessi, Cuisset) "Nutrition, Obesity and Risk of
Thrombosis," UMR1062, INSERM, Marseille, France
(Deharo, Bassez, Bonnet, Ibrahim, Suchon, Morange, Bonnet, Alessi,
Cuisset) Faculte de Medecine, Aix-Marseille Universite, Marseille, France
(Quilici, Fernandez) Departement de Cardiologie, Centre Hospitalier de
GAP, France
(Camoin-Jau, Morange, Alessi) Laboratoire d'Hematologie, CHU Timone,
Marseille, France
(Johnson) Interventional Cardiology Department, Bristol Heart Institute,
Bristol, United Kingdom
(Ibrahim, Fourcade) Cardiologie, Hopital Laveran, Marseille, France
(Suchon, Verdier) Research Unit, asistance publique des hopitaux de
Marseille, Unite Medicale des Maladies Auto-Inflammatoires, Marseille,
France
(Morange, Alessi) Department of Hematology, CHU Timone, asistance publique
des hopitaux de Marseille, Marseille, France
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate the impact of initial platelet
reactivity on the benefit of switched strategy. Background TOPIC (Timing
Of Platelet Inhibition after acute Coronary Syndrome) study suggested that
switched dual antiplatelet therapy (DAPT) could improve net clinical
benefit after acute coronary syndrome by preventing bleeding. Methods
Acute coronary syndrome patients, 1 month after coronary stenting and
event free, were randomly assigned to aspirin and clopidogrel (switched
DAPT) or continuation of drug regimen (unchanged DAPT). All patients
underwent platelet function testing at this time and were classified as
low on-treatment platelet reactivity (LTPR) (platelet reactivity index
vasodilator-stimulated phosphoprotein <=20%) or non-LTPR (platelet
reactivity index vasodilator-stimulated phosphoprotein >20%). The primary
endpoint aimed to evaluate the impact of platelet reactivity on clinical
outcomes and benefit of switched DAPT strategy. Results A total of 645
patients were included, 305 (47%) of whom were classified as LTPR. LTPR
patients were less often diabetic (p = 0.01), had lower body mass index (p
< 0.01), and were more often on ticagrelor (p < 0.01). Patients defined as
LTPR and randomized to unchanged DAPT were at the highest risk of primary
endpoint occurrence (31%; p < 0.01). Conversely, in the switched arm, LTPR
patients had no significant difference in primary outcome incidence
compared with non-LTPR patients (hazard ratio [HR]: 0.78; 95% confidence
interval [CI]: 0.40 to 1.49; p = 0.45). The switched strategy was
associated with important reduction in primary endpoint incidence in LTPR
patients (HR: 0.29; 95% CI: 0.17 to 0.51; p < 0.01) and only numerically
lower incidence in non-LTPR patients (HR: 0.79; 95% CI: 0.46 to 1.35; p =
0.39). Conclusions Switched DAPT was superior regardless of initial
platelet reactivity but the benefit was greater in LTPR patients. Indeed,
the switched strategy was highly effective in this group, which had
impaired prognosis with unchanged DAPT but similar prognosis after
switching.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<78>
Accession Number
626358666
Title
A self-efficacy enhancing intervention for pulmonary rehabilitation based
on motivational interviewing for postoperative lung cancers patients:
modeling and randomized exploratory trial.
Source
Psychology, health & medicine. 23 (7) (pp 804-822), 2018. Date of
Publication: 01 Aug 2018.
Author
Huang F.-F.; Yang Q.; Zhang J.; Han X.Y.; Zhang J.-P.; Ye M.
Institution
(Huang) School of Nursing, Fujian Medical University, Fuzhou, China
(Yang) Department of Anesthesia, Massachusetts General Hospital, Boston,
MA, United States
(Zhang) Department of Cardiothoracic Surgery, Nanjing General Hospital,
Fuzhou, China
(Han) Department of Neurosurgery, Second Affiliated Hospital of Harbin
Medical University, Harbin, China
(Zhang) Xiangya School of Nursing, Central South University, Changsha,
China
(Ye) Department of Nursing, Thoracic Surgery Department, Second Xiangya
Hospital of Central South University, Changsha, China
Publisher
NLM (Medline)
Abstract
The objective of this study was to evaluate the feasibility and
preliminary efficacy of a self-efficacy enhancing intervention designed
for pulmonary rehabilitation based on motivational interviewing (MI) for
postsurgical non-small cell lung cancer (NSCLC) patients. This study was a
2-arm pilot randomized controlled trial and was conducted in two
cardiothoracic surgery departments, a tertiary hospital in Fuzhou, China.
28 postsurgical NSCLC patients were randomized to a 3 month (6 session)
self-efficacy enhancing intervention based on MI or usual care (UC). Data
were measured at baseline and after intervention. The MI based
self-efficacy enhancing intervention group was superior to the UC group
for reducing anxiety and depression, improving self-efficacy, quality of
life, confrontational coping, social support and functional capacity.
However, no statistically significant difference was observed in
subjective well-being, posttraumatic growth, body mass index and pulmonary
function between the two groups. This pilot study demonstrated the
feasibility of MI based self-efficacy enhancing intervention for
postsurgical NSCLC patients. A larger randomized trial would demonstrate a
more rigorous test of efficacy.

<79>
Accession Number
627329750
Title
Anesthesia with propofol and sevoflurane on postoperative cognitive
function of elderly patients undergoing general thoracic surgery.
Source
Pakistan journal of pharmaceutical sciences. 30 (3) (pp 1107-1110), 2017.
Date of Publication: 01 May 2017.
Author
Yu W.
Institution
(Yu) Fudan University, Shanghai, China
Publisher
NLM (Medline)
Abstract
This study is to analyze the effects and variations on cognitive function
for elderly patients undergoing general thoracic surgery, who accepted the
anesthesia with propofol and sevoflurane. A total of 500 elderly general
thoracic surgical patients were selected randomly, all receiving the
propofol anesthesia (Propofol group). Meanwhile, another totality of 500
patients in the same condition and period were selected and accepted the
sevoflurane anesthesia (Sevoflurane group). Mini-mental state examination
(MMSE) and recovery quality after anesthesia were compared among the
patients in both groups respectively at the time of pre-operation and 1 h,
6 h and 12 h after surgery. There was no statistic difference in
preoperative MMES of patients in both two groups (P<0.05); while the
results of postoperative MMSE showed that both Propofol group and
Sevoflurane group had a certain statistical difference, and that in
Propofol group was larger compared that in Sevoflurane group. Moreover,
P<0.05 was obtained on comparing the MMSE at the time of 1h, 6h and 12h
after surgery and that at pre-operation, revealing statistical
significance. Either propofol or sevoflurane, to certain extent, can
affect patients' cognitive function when they are applied in the general
thoracic surgery for elderly patients. However, the influence of propofol
on cognitive function is relatively smaller, which presents a better
application value.

<80>
Accession Number
2001871127
Title
Effects of Melissa officinalis on anxiety and sleep quality in patients
undergoing coronary artery bypass surgery: A double-blind randomized
placebo controlled trial.
Source
European Journal of Integrative Medicine. 28 (pp 27-32), 2019. Date of
Publication: June 2019.
Author
Soltanpour A.; Alijaniha F.; Naseri M.; Kazemnejad A.; Heidari M.R.
Institution
(Soltanpour) Traditional Medicine Clinical Trial Research Center, Faculty
of Nursing and Midwifery, Shahed University, Tehran, Iran, Islamic
Republic of
(Alijaniha, Naseri) Traditional Medicine Clinical Trial Research Center,
Shahed University, Tehran, Iran, Islamic Republic of
(Kazemnejad) Department of Biostatistics, Faculty of Medical Sciences,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
(Heidari) Department of Nursing, Faculty of Nursing and Midwifery, Shahed
University, Tehran, Iran, Islamic Republic of
Publisher
Elsevier GmbH
Abstract
Introduction: Coronary artery disease is prevalent with high morbidity and
coronary artery bypass grafting is one of its most important treatments.
Anxiety and sleep disorders after surgery are very common and need
appropriate control. The current study aimed to evaluate the efficacy of
Melissa officinalis L. (Lemon Balm) for managing this problem.
<br/>Method(s): A double-blind randomized placebo controlled clinical
trial was conducted with 80 in-patients who underwent coronary artery
bypass surgery. The patients were randomized into either the herbal
medicine or the placebo group. Capsules containing 500 mg of Melissa
officinalis L. dried leaf powder as herbal medicine or wheat starch as
placebo were administered three times a day. Sleep quality and anxiety
measures were the main outcomes and St Mary's Hospital Sleep Quality and
Hospital Anxiety Depression Scale were used questionnaires respectively.
<br/>Result(s): At baseline there were no significant differences in the
anxiety scores between the two groups. After the intervention, anxiety
scores were 7.15 +/- 1.2 and 10.18 +/- 3.1 in the herbal medicine and
placebo groups respectively (P = 0.001). Moreover, the mean changes of
sleep quality in the herbal medicine group was significantly higher than
the placebo group; 14.40 +/- 5.1 vs 7.52 +/- 4.4 (P < 0.001).
<br/>Conclusion(s): The results of current study showed that seven-day
treatment with 1.5 g/day dried leaf powder of Melissa officinalis appeared
to reduce the levels of anxiety and improve the sleep quality in patients
after coronary artery bypass surgery, by 49% and 54%
respectively.<br/>Copyright &#xa9; 2019 Elsevier GmbH

<81>
Accession Number
2001870851
Title
Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After
Coronary Bypass Surgery.
Source
Journal of the American College of Cardiology. 73 (18) (pp 2299-2306),
2019. Date of Publication: 14 May 2019.
Author
Gaudino M.; Benedetto U.; Fremes S.E.; Hayward P.; Moat N.; Moscarelli M.;
Di Franco A.; Nasso G.; Peric M.; Petrovic I.; Speziale G.; Yoo K.J.;
Taggart D.P.; Buxton B.; Fremes S.; Girardi L.N.; Goldman S.; Hare D.L.;
Holman W.L.; Habib R.; Mao J.; Puskas J.D.; Ruttmann-Ulmer E.; Schwann
T.A.; Tatoulis J.; Tranbaugh R.
Institution
(Gaudino, Di Franco, Girardi) Department of Cardiothoracic Surgery,
Cornell Medicine, New York, NY, United States
(Benedetto) Bristol Heart Institute, Bristol, United Kingdom
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Ontario, Canada
(Hare, Hayward) University of Melbourne, Melbourne, Victoria, Australia
(Hare) The Austin Hospital, Melbourne, Victoria, Australia
(Moat) Royal Brompton & Harefield Trust, London, United Kingdom
(Moscarelli, Nasso, Speziale) Anthea Hospital, Bari, Italy
(Peric, Petrovic) Dedinje Cardiovascular Institute and Belgrade University
School of Medicine, Belgrade, Serbia
(Puskas) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Yoo) Yonsei University College of Medicine, Seoul, South Korea
(Taggart) University of Oxford, Oxford, United Kingdom
Publisher
Elsevier USA
Abstract
Background: Few studies have evaluated the effect of chronic
calcium-channel blocker therapy (CCB) on the angiographic and clinical
outcome of radial artery (RA) grafts used for coronary bypass surgery.
<br/>Objective(s): The purpose of this study was to evaluate if CCB
influences midterm clinical and angiographic outcomes of RA grafts.
<br/>Method(s): Patient-level data of 6 angiographic randomized trials
evaluating RA graft status at midterm follow-up were joined in this
observational analysis. Cox regression and propensity score methods were
used to evaluate the effect of CCB on the incidence of a composite of
major adverse cardiac events (MACE) (death, myocardial infarction, and
repeat revascularization) and graft occlusion. <br/>Result(s): The study
population included 732 patients (502 on CCB). The median clinical
follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and
108 months was 3.7% vs. 9.3%, 13.4% vs. 17.6%, and 16.8% vs. 20.5% in the
CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven
angiographic follow-up was available in 243 patients in the CCB group and
200 in the no CCB group. The median angiographic follow-up was 55 months.
The cumulative incidence of RA occlusion at 36, 72, and 108 months was
0.9% vs. 8.6%, 9.6% vs. 21.4%, and 14.3% vs. 38.9% in the CCB and no CCB
groups, respectively (log-rank p < 0.001). After controlling for known
confounding, CCB therapy was found to be consistently associated with a
significantly lower risk of MACE (multivariate Cox hazard ratio: 0.52; 95%
confidence interval: 0.31 to 0.89; p = 0.02) and RA graft occlusion
(multivariate Cox hazard ratio: 0.20; 95% confidence interval: 0.08 to
0.49; p < 0.001). <br/>Conclusion(s): In patients with RA grafts CCB is
associated with significantly better midterm clinical and angiographic RA
outcomes.<br/>Copyright &#xa9; 2019 American College of Cardiology
Foundation

<82>
Accession Number
627340324
Title
Efficacy and safety of figure-of-eight suture versus manual pressure for
venous access closure: a systematic review and meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. (no pagination),
2019. Date of Publication: 2019.
Author
Atti V.; Turagam M.K.; Garg J.; Alratroot A.; Abela G.S.; Rayamajhi S.;
Lakkireddy D.
Institution
(Atti, Alratroot, Abela, Rayamajhi) Michigan State University-Sparrow
Hospital, East Lansing, MI, United States
(Turagam, Garg) Helmsley Electrophysiology Center, Icahn School of
medicine at Mount Sinai, New York City, NY, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Kansas City, KS, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Vascular hemostasis after venous access in cardiovascular
procedures remains a challenge. Figure-of-eight (FoE) emerged as an
alternative technique to manual pressure. However, its feasibility and
safety is unknown. <br/>Method(s): A comprehensive search in
clinicalTrials.gov, PubMed, Web of Science, EBSCO Services, Cochrane
Central Register of Controlled Trials, Google Scholar, and various
scientific conference sessions from inception to December 1, 2018, was
performed. A meta-analysis was performed using random effects model to
calculate risk ratio (RR) and mean difference (MD) with 95% confidence
interval (CI). <br/>Result(s): Seven studies were eligible and included
1978 patients, of whom 982 patients received the FoE suture, while 996
received manual pressure. There was no difference in the risk of access
site pseudoaneurysm (RR 0.48, 95%CI 0.13 to 1.73, p = 0.26) and fistula
(RR 0.90, 95%CI 0.22 to 3.75, p = 0.89) between the two techniques.
Compared with manual pressure, FoE was associated with lower risk of
access site complications (RR 0.37, 95%CI 0.24 to 0.58, 0.65, p < 0.0001)
including bleeding (RR 0.30, 95%CI 0.18 to 0.50, p < 0.00001) and hematoma
(RR 0.41, 95%CI 0.25 to 0.68, 0.83, p = 0.0005). Time to hemostasis was
significantly lower in FoE group compared with manual pressure (MD - 21.04
min, 95%CI - 35.66 to - 6.42, p = 0.005). <br/>Conclusion(s): The results
of our meta-analysis showed that there was no difference in the risk of
access site pseudoaneurysm and fistula between FoE and manual pressure.
FoE was associated with lower risk of access site hematoma and bleeding
compared with manual pressure. Our results reiterate the safety and
feasibility of FoE suture for venous access closure.<br/>Copyright &#xa9;
2019, Springer Science+Business Media, LLC, part of Springer Nature.

<83>
Accession Number
627340221
Title
Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Diabetic
Patients With Multivessel and/or Left Main Coronary Artery Disease: A
Meta-Analysis.
Source
Angiology. (no pagination), 2019. Date of Publication: 2019.
Author
Cui K.; Lyu S.; Song X.; Liu H.; Yuan F.; Xu F.; Wang W.; Zhang M.; Zhang
D.; Tian J.
Institution
(Cui, Lyu, Song, Liu, Yuan, Xu, Zhang, Wang, Zhang, Zhang, Tian)
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart, Lung and Blood Vessel Diseases,
Beijing, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
With the development of stent design and surgical techniques, the relative
benefit of percutaneous coronary intervention (PCI) versus coronary artery
bypass grafting (CABG) in patients with diabetes and complex coronary
artery disease are highly debated. This meta-analysis was conducted to
compare the outcomes of drug-eluting stent (DES) implantation and CABG in
these cohorts. A comprehensive search of PubMed, Embase, and Cochrane
Library up to January 4, 2018, was performed. Only randomized controlled
trials (RCTs), subgroup analysis from RCTs, or adjusted observational
studies were eligible. Five RCTs and 13 adjusted observational studies
involving 17 532 patients were included. Overall, PCI with DES was
significantly associated with higher risk of all-cause mortality (hazard
ratio [HR]: 1.16, 95% confidence interval [CI]: 1.05-1.29), myocardial
infarction (MI; HR: 1.69, 95% CI: 1.43-2.00), and repeat revascularization
(HR: 3.77, 95% CI: 2.76-5.16) compared with CABG. Nevertheless, the risk
of stroke was significantly lower in the DES group (HR: 0.67, 95% CI:
0.54-0.83). The incidence of the composite end point of death, MI, or
stroke was comparable between the 2 groups (HR: 0.99, 95% CI: 0.84-1.17).
Despite the higher risk of stroke, CABG was better than PCI with DES for
diabetic patients with multivessel and/or left main coronary artery
disease.<br/>Copyright &#xa9; The Author(s) 2019.

<84>
Accession Number
627333253
Title
Efficacy and safety of robot-assisted thoracic surgery (RATS) compare with
video-assisted thoracoscopic surgery (VATS) for lung lobectomy in patients
with non-small cell lung cancer.
Source
Combinatorial chemistry & high throughput screening. (no pagination),
2019. Date of Publication: 11 Apr 2019.
Author
Hu X.; Wang M.
Institution
(Hu) Department of thoracic surgery, second Hospital of Jiaxing, Zhejiang.
China, Jiaxing 314000, China
(Wang) Department of thoracic surgery,Zhejiang University International
Hospital, Shulan (Hangzhou) Hospital, Zhejiang. China, Hangzhou 310022,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the past decade, many researchers focused on to robotic-
assisted thoracoscopic surgery (RATS), which have been introduced as an
alternative minimally invasive approach, versus video-assisted
thoracoscopic surgery (VATS) for lung lobectomy in patients with non-small
cell lung cancer. However, the advantage of RVATS compared to VATS is
still under investigation. The results are unclear. <br/>METHOD(S): A
systematic electronic search of online electronic databases: Pubmed,
Embase, Cochrane library updated on June 2017. The meta-analysis was
performed including the studies are designed as randomized or non-
randomized controlled. AIM: The aim of this study is to compare the
efficacy and safety of robot-assisted thoracic surgery (RATS) lobectomy
versus video-assisted thoracic surgery (VATS) for lobectomy in patients
with non-small cell lung cancer (NSCLC). <br/>RESULT(S): Twenty
retrospective cohort studies met our inclusion criteria. The pooled
analysis of mortality showed that RATS lobectomy significantly reduced the
mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 -
0.76; P = 0.0005). With the pooled result of duration of surgery indicated
that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI
0.23- 0.81; P <0.0004=). However, the meta-analysis on the median length
of hospital stay (MD =0.00, 95% CI -0.03 - 0.03; P = 0.91), number of
dissected lymph nodes station (SMD =0.39, 95% CI -0.60 - 1.38; P = 0.44),
the number of removed lymph nodes (SMD =0.98, 95% CI -0.61 - 2.56; P =
0.23), mean duration of drainage (SMD =0.29, 95% CI -0.15 - 0.73; P =
0.20), prolonged air leak (RR =1.01, 95% CI 0.84- 1.21; P = 0.93),
arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia
(RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR
=0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90
- 1.23; P = 0.055) all showed no significant differences between RATS and
VATS lobectomy. <br/>CONCLUSION(S): RATS result in better mortality as
compared with VATS. However, robotics seems to have longer operative time
and higher hospital costs, without superior advantages in morbidity rates
and oncologic efficiency. Since the advantages of RATS has been performed
in some area, the continuation of a comparative investigation with VATS
may be necessary. And some effort need to be taken into consideration to
reduce the operative time and cost.<br/>Copyright&#xa9; Bentham Science
Publishers; For any queries, please email at epub@benthamscience.net.

<85>
Accession Number
627352824
Title
Systematic review of pre-operative electroconvulsive therapy (ect)
protocols.
Source
Journal of the American Geriatrics Society. Conference: 2019 Annual
Scientific Meeting of the American Geriatrics Society, AGS 2019. United
States. 67 (Supplement 1) (pp S82), 2019. Date of Publication: April 2019.
Author
Akid I.; Liew E.; Espinoza R.
Institution
(Liew) Anesthesiology, UCLA, Los Angeles, CA, United States
(Espinoza) Psychiatry, UCLA, Los Angeles, CA, United States
(Akid) Geriatrics, UCLA, Los Angeles, CA, United States
Publisher
Blackwell Publishing Inc.
Abstract
Background: The objective of this review is to survey current
pre-operative ECT evaluation guidelines and determine what can be done to
facilitate their implementation. <br/>Method(s): PubMed/MEDLINE, ERIC,
COCHRANE and NIH databases were searched from January 1950 to November
2018. We looked for articles with the key words "Electroconvulsive
therapy", "ECT", "Guidelines" and "protocols". We included English and
non-English language articles for review. Relevant articles were
consid-ered. We also included the AHA/ASA guidelines for pre-operative
evaluation of non-cardiac procedures as well as the APA and New York state
guidelines for ECT therapy. Studies were included with patients of all
ages but special attention was placed on studies includ-ing geriatric
patients (age 65 and older). The majority of patients had depression as
the main impetus for their needing ECT. Risk of bias was assessed
regarding blinding, allocation sequence concealment, randomization,
incomplete outcome data and other biases. <br/>Result(s): The office of
Mental health in the State of New York has recently updated guidelines
with regards to ECT therapy and Pre-ECT evaluation, as does the American
Psychiatric Association. Changes to medication and anesthetic used during
ECT may impact and improve ECT outcomes. A thorough Pre-ECT evaluation may
help determine which medications used during ECT will be most beneficial
or what additional work-up may be necessary. <br/>Conclusion(s): While
protocols exist for the pre-operative ECT evaluation of older adults,
these should be individualized to meet individual needs and current ECT
practices. Currently, guidelines for preoperative anesthesia clearance in
the geriatric population follow an amalgam of guidelines through multiple
regulating bodies. Streamlining a single guideline to be followed will
help protect patients and improve outcomes following ECT treatment.

<86>
Accession Number
627351540
Title
Value of emergent pediatric cardiac computed tomographic angiography
service: Initial experience at a large children's hospital.
Source
Pediatric Radiology. Conference: 62nd Meeting of the Society for Pediatric
Radiology, SPR 2019. United States. 49 (Supplement 1) (pp S84), 2019. Date
of Publication: April 2019.
Author
Jadhav S.P.; Ketwaroo P.; More S.R.; Rizarri G.; Masand P.M.
Institution
(Jadhav, Ketwaroo, Rizarri, Masand) Radiology, Texas Children's Hospital,
Houston, TX, United States
(More) VRad, Eden Prairie, MN, United States
Publisher
Springer Verlag
Abstract
Purpose or Case Report: With newer generation scanners providing
free-breathing, high-resolution cardiac imaging at sub milli-Sievert
radiation dose, demand for pediatric cardiac computed tomography
angiography (CTA) is increasing. It is only a matter of time before
sub-specialized emergent cardiac CTA service during weekends and
after-hours on weekdays will become an expectation for optimal patient
care. The purpose of this study is to describe our experience of providing
this service and its effect on patient care. Methods & Materials: We
retrospectively identified all patients that underwent after-hours weekday
or weekend emergent cardiac CTA between January 2017 and August 2018.
Sub-specialized cardiac CTA in the setting of congenital heart disease and
coronary imaging were included. Routine vascular imaging in patients
without structural heart disease, such as for aortic dissection, is
commonly handled by non-cardiac trained radiologists and was therefore
excluded. Data collected included day and time of CTA, patient age,
indication, patient location, post-op status, need for anesthesia, need
for surgery, intervention and/or change in medical management based on the
emergent CTA. <br/>Result(s): A total of 47 studies were identified, 26
(55%) of which were performed on a weekend or holiday and 21(45%) after 5
PM on a weekday. These were performed under direct supervision of a
cardiac imager (1 of 3 FTE's). 28 (60%) were male. 34 (72%) were in
infants out of which 19 (40%) were neonates. 16 (34%) patients were imaged
for coronary artery evaluation, 9 (19%) for post-op conduit and shunt
evaluation and 8 (17%) for aortic arch. Only 7 (15%) patients needed
sedation with breath-holding for CTA, all of which were infants needing
evaluation of coronaries. One patient was already intubated prior to CTA.
27 (57%) patients were from the ICU, 9 (19%) from intermediate care unit
and 11 (23%) from the emergency room. Half (n=24, 51%) had at least 1
surgery for congenital heart disease at time of imaging. 29 (62%) CTA's
had positive findings explaining patient's symptoms. Following CTA, 20
(43%) patients underwent either surgery or an interventional procedure,
and 9 (19%) had change in medical management based on CTA findings.
Surgery/intervention delay from CTA ranged from 0 days to 29 days with
median of 3.5 days. <br/>Conclusion(s): Emergent pediatric cardiac CTA is
a valuable service leading to a change in management in 62% of our cases.
Larger multi-institutional studies will be needed to ascertain if outcomes
are affected by this service.

<87>
Accession Number
627135439
Title
Association between anaesthetic technique and unplanned admission to
intensive care after thoracic lung resection surgery: the second
Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC)
National Audit.
Source
Anaesthesia. (no pagination), 2019. Date of Publication: 2019.
Author
Shelley B.G.; McCall P.J.; Glass A.; Orzechowska I.; Klein A.A.; Hemming
A.E.; Knight T.; Janson M.; Fogg K.J.; Bailey A.; Palomino P.R.; Lau G.;
Errico M.; Williams A.; Hurley R.; Petko M.; Giri R.; Nelapatla M.K.;
Auldin M.; Kumar S.; Hartley M.; Malpas C.; Agarwal S.; Lane B.; Irvine
M.; Elayaperumal A.K.; Easaw B.S.; Feddy L.; Heward S.; Ware M.; Abel R.;
Jooste R.; Fanning N.P.
Institution
(Shelley, McCall, Glass) University of Glasgow Academic Unit of
Anaesthesia, Pain and Critical Care Medicine, Glasgow, United Kingdom
(Orzechowska) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Unplanned intensive care admission is a devastating complication of lung
resection and is associated with significantly increased mortality. We
carried out a two-year retrospective national multicentre cohort study to
investigate the influence of anaesthetic and analgesic technique on the
need for unplanned postoperative intensive care admission. All patients
undergoing lung resection surgery in 16 thoracic surgical centres in the
UK in the calendar years 2013 and 2014 were included. We defined critical
care admission as the unplanned need for either tracheal intubation and
mechanical ventilation or renal replacement therapy, and sought an
association between mode of anaesthesia (total intravenous anaesthesia vs.
volatile) and analgesic technique (epidural vs. paravertebral) and need
for intensive care admission. A total of 253 out of 11,208 patients
undergoing lung resection in the study period had an unplanned admission
to intensive care in the postoperative period, giving an incidence of
intensive care unit admission of 2.3% (95%CI 2.0-2.6%). Patients who had
an unplanned admission to intensive care unit had a higher mortality
(29.00% vs. 0.03%, p < 0.001), and hospital length of stay was increased
(26 vs. 6 days, p < 0.001). Across univariate, complete case and multiple
imputation (multivariate) models, there was a strong and significant
effect of both anaesthetic and analgesic technique on the need for
intensive care admission. Patients receiving total intravenous anaesthesia
(OR 0.50 (95%CI 0.34-0.70)), and patients receiving epidural analgesia (OR
0.56 (95%CI 0.41-0.78)) were less likely to have an unplanned admission to
intensive care after thoracic surgery. This large retrospective study
suggests a significant effect of both anaesthetic and analgesic technique
on outcome in patients undergoing lung resection. We must emphasise that
the observed association does not directly imply causation, and suggest
that well-conducted, large-scale randomised controlled trials are required
to address these fundamental questions.<br/>Copyright &#xa9; 2019
Association of Anaesthetists

<88>
Accession Number
627304485
Title
Hybrid Coronary Revascularization in Selected Patients with Multivessel
Disease - 5 year clinical outcomes of the Prospective Randomized Pilot
Study - HYBRID.
Source
Kardiologia Polska. Conference: 22nd International Congress of the Polish
Cardiac Society. Poland. 76 (Supplement 1) (pp 333-334), 2018. Date of
Publication: September 2018.
Author
Tajstra M.; Hrapkowicz T.; Hawranek M.; Filipiak K.; Gierlotka M.; Gasior
M.; Zembala M.
Institution
(Tajstra, Hawranek, Filipiak, Gasior, Zembala) IIi Kat. i Oddzia Kliniczny
Kardiologii, Wydzia Lekarski Z Oddziaem Lekarsko-Dentystycznym W Zabrzu,
Slaski Uniwersytet Medyczny W Katowicach, Slaskie Centrum Chorob Serca W
Zabrzu, Curie-Sklodowskiej 9, Zabrze, Poland
(Hrapkowicz) Kat. i Oddzia Kliniczny Kardiochirurgii, Transplantologii,
Chirurgii Naczyniowej i Endowaskularnej, SUM, Slaskie Centrum Chorob
Serca, ul. M. Curie-Sklodowskiej 9, Zabrze, Poland
(Gierlotka) Slaski Uniwersytet Medyczny W Katowicach, Wydzial Lekarski Z
Oddzialem Lekarsko-Dentystycznym W Zabrzu, IIi Katedra i Oddzial Kliniczny
Kardiologii, Sklodowskiej - Curie, Zabrze, Poland
(Zembala) Katedra i Oddzial Kliniczny Kardiochirurgii, Transplantacji i
Chirurgii Endowaskularnej, Wydzial Lekarski Z Oddzialem
Lekarsko-Dentystycznym W Zabrzu, SUM W Katowicach, Marii Sklodowskiej
Curie 9, Zabrze, Poland
Publisher
Via Medica
Abstract
OBJECTIVES This study aimed to investigate the 5-year clinical follow-up
of the Hybrid Revascularization for Multivessel Coronary Artery Disease
(HYBRID) trial. BACKGROUND Hybrid trial is the only randomized study
involving thorough analysis of outcome after the two procedures, suggested
that hybrid coronary revascularization is feasible in selected patients
with multivessel coronary disease referred for conventional coronary
artery bypass grafting. There are currently no long-term outcome data from
randomized trials in this setting. METHODS A total of 200 patients with
multivessel coronary disease referred for conventional surgical
revascularization, were randomly assigned to undergo hybrid coronary
revascularization or coronary artery bypass grafting. The primary endpoint
was the occurrence of all-cause mortality at 5 years. RESULTS Nine
patients (4 in HCR and 5 in CABG group) were lost to the 5-year follow-up.
Finally, 191 patients (94 in HCR and 97 in CABG group) formed the basis of
this study. The groups were well balanced in terms of pre-procedural
characteristics. All-cause mortality at 5-year follow-up was similar in
the two groups (6.4% for HCR vs. 9.2% for CABG, p=0.69). The rates of
myocardial infarction (4.3% vs. 7.2%, p=0.30), repeat revascularization
(37.2% vs. 45.4%, p=0.38), stroke (2.1% vs. 4.1%, p=0.35), and major
adverse cardiac and cerebrovascular events (45.2% vs. 53.4%, p=0.39) were
also similar in the two groups. CONCLUSIONS Hybrid coronary
revascularization has similar 5-year all-cause mortality when compared
with conventional coronary bypass grafting. (Figure Presented).

<89>
Accession Number
2001852995
Title
Levosimendan in patients with low cardiac output syndrome undergoing
cardiac surgery: A systematic review and meta-analysis.
Source
Anaesthesia Critical Care and Pain Medicine. (no pagination), 2019. Date
of Publication: 2019.
Author
Zhu J.; Zhang Y.; Chen L.; He Y.; Qing X.
Institution
(Zhu, Chen, He, Qing) Department of Intensive Care Medicine, Affiliated
Hospital of Chengdu University, No.82, North Section 2, 2nd Ring Road,
Jinniu District, Chengdu, Sichuan 610081, China
(Zhang) Department of Cardiac Surgery, Affiliated Hospital of Chengdu
University, Chengdu, Sichuan, China
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Levosimendan is an inotropic agent that has been shown in small studies to
treat low cardiac output syndrome in cardiac surgery. However, large
randomised controlled trials (RCTs) have been recently published and
presented neutral results. We sought to determine the effect of
levosimendan on mortality in adults with low ejection fraction undergoing
cardiac surgery. We searched different databases: Medline, Embase,
Cochrane Central Register of Controlled Trials, and clinical trial
registries. We included RCTs comparing events in the levosimendan versus
placebo in adult patients with ejection fraction <= 35% undergoing cardiac
surgery. Outcomes were mortality at 30-day, mortality beyond 30-day, acute
kidney injury and myocardial infarction. Five trials with a total of 1519
patients were selected. Four trials were rated as low risk of bias. Our
meta-analysis showed no significant difference between levosimendan versus
placebo mortality at 30-day [odds radio (OR): 0.62; 95% confidence
intervals (CI): 0.32 to 1.20; I² = 33%; high quality evidence]
and mortality beyond 30-day (OR: 0.71; 95% CI: 0.46 to 1.11; I²
= 0%). Similarly, there were no significant differences between the
levosimendan versus placebo in the incidence of acute kidney injury (OR:
0.61, 95% CI: 0.33-1.13) and myocardial infarction (OR: 0.41, 95% CI: 0.08
to 1.22). The current evidence suggests that levosimendan is not
associated with significantly reduced mortality in patients with reduced
ejection fraction undergoing cardiac surgery.<br/>Copyright &#xa9; 2018