EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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

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

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

<4>
Accession Number
620031659
Title
Meta-Analysis of Culprit-Only Versus Multivessel Percutaneous Coronary
Intervention in Patients With ST-Segment Elevation Myocardial Infarction
and Multivessel Coronary Disease.
Source
American Journal of Cardiology. 121 (5) (pp 529-536), 2018. Date of
Publication: 01 Mar 2018.
Author
Bangalore S.; Toklu B.; Stone G.W.
Institution
(Bangalore) Division of Cardiology, New York University School of
Medicine, New York, New York, United States
(Toklu) Division of Cardiology, Mt. Sinai Beth Israel Medical Center, New
York, New York, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical Center
and the Cardiovascular Research Foundation, New York, New York, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Recently, several randomized controlled trials (RCT) in patients with
ST-segment elevation myocardial infarction (STEMI) and multivessel disease
(MVD) have compared a strategy of routine multivessel percutaneous
coronary intervention (PCI) performed either as a single procedure or as
staged procedures to culprit-only PCI. All of these trials have been
underpowered for clinical end points. We searched PubMed, Embase, and
Cochrane Central Register of Controlled Trials for RCT comparing
multivessel PCI with culprit-only PCI in patients with STEMI and MVD. The
primary efficacy outcome was the composite rate of death or MI. Other
efficacy outcomes included death, MI, and repeat revascularization. Safety
outcomes were contrast-associated acute kidney injury, stroke, and major
bleeding. Pairwise direct comparison and mixed-treatment comparison
network meta-analyses were performed. Eleven trials that enrolled 3,150
patients with a total of 5,296 patient-years of follow-up were included.
In direct comparison meta-analysis, single-procedure multivessel PCI was
associated with a reduction in the risk of death or MI (rate ratio [RR] =
0.52; 95% confidence interval [CI] 0.37 to 0.73; p <0.001), due to less
death (RR = 0.64; 95% CI 0.40 to 1.02; p = 0.06) and MI (RR = 0.42; 95% CI
0.25 to 0.69; p <0.0001) compared with culprit-only PCI. No heterogeneity
(I2 = 0) was present between studies. In contrast, staged
multivessel PCI did not significantly reduce death or MI compared with
culprit-only PCI. Both multivessel PCI strategies reduced the risk of
repeat revascularization without significant differences in safety
outcomes. Results were consistent in the mixed-treatment comparison
meta-analysis. In conclusion, the present meta-analysis suggests that
single-procedure multivessel PCI may be the preferred strategy in patients
with STEMI and MVD. Copyright © 2017 Elsevier Inc.

<5>
[Use Link to view the full text]
Accession Number
624066425
Title
Angiography versus hemodynamics to predict the natural history of coronary
stenoses: Fractional flow reserve versus angiography in multivessel
evaluation 2 substudy.
Source
Circulation. 137 (14) (pp 1475-1485), 2018. Date of Publication: 03 Apr
2018.
Author
Ciccarelli G.; Barbato E.; Toth G.G.; Gahl B.; Xaplanteris P.; Fournier
S.; Milkas A.; Bartunek J.; Vanderheyden M.; Pijls N.; Tonino P.; Fearon
W.F.; Juni P.; De Bruyne B.
Institution
(Ciccarelli, Barbato, Xaplanteris, Fournier, Milkas, Bartunek,
Vanderheyden, De Bruyne) Cardiovascular Center, OLV Hospital, Moorselbaan,
Aalst 9300, Belgium
(Barbato) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Italy
(Toth) University Heart Centre Graz, Austria
(Gahl) Department of Clinical Research, CTU Bern, University of Bern,
Switzerland
(Pijls) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Tonino) Stanford University Medical Center, CA, United States
(Fearon) Applied Health Research Centre, Li Ka Shing Knowledge Institute
of St Michael's Hospital, Toronto, ON, Canada
(Juni) Department of Medicine, University of Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Among patients with documented stable coronary artery disease
and in whom no revascularization was performed, we compared the respective
values of angiographic diameter stenosis (DS) and fractional flow reserve
(FFR) in predicting natural history. Method(s): The present analysis
included the 607 patients from the FAME 2 trial (Fractional Flow Reserve
Versus Angiography in Multivessel Evaluation 2) in whom no
revascularization was performed. FFR varied from 0.20 to 1.00 (average
0.74+/-0.16), and DS (by quantitative coronary analysis) varied from 8% to
98% (average 53+/-15). The primary end point, defined as vessel-oriented
clinical end point (VOCE) at 2 years, was a composite of prospectively
adjudicated cardiac death, vessel-related myocardial infarction,
vessel-related urgent, and not urgent revascularization. The stenoses were
divided into 4 groups according to FFR and %DS values: positive
concordance (FFR<=0.80; DS>=50%), negative concordance (FFR>0.80; DS<50%),
positive mismatch (FFR<=0.80; DS<50%), and negative mismatch (FFR>0.80;
DS>=50%). Result(s): The rate of VOCE was highest in the positive
concordance group (log rank: X 2 =80.96; P=0.001) and lowest in the
negative concordance group. The rate of VOCE was higher in the positive
mismatch group than in the negative mismatch group (hazard ratio, 0.38;
95% confidence interval, 0.21-0.67; P=0.001). There was no significant
difference in VOCE between the positive concordance and positive mismatch
groups (FFR<=0.80; hazard ratio, 0.77; 95% confidence interval, 0.57-1.09;
P=0.149) and no significant difference in rate of VOCE between the
negative mismatch and negative concordance groups (FFR>0.80; hazard ratio,
1.89; 95% confidence interval, 0.96-3.74; P=0.067). Conclusion(s): In
patients with stable coronary disease, physiology (FFR) is a more
important determinant of the natural history of coronary stenoses than
anatomy (DS). Clinical Trial Registration: URL:
https://clinicaltrials.gov. Unique identifier: NCT01132495. Copyright
© 2017 American Heart Association, Inc.

<6>
[Use Link to view the full text]
Accession Number
624066407
Title
Effect of losartan on right ventricular dysfunction: Results from the
Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in
Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone
System) in Adults with Repaired Tetralogy of Fallot.
Source
Circulation. 137 (14) (pp 1463-1471), 2018. Date of Publication: 03 Apr
2018.
Author
Bokma J.P.; Winter M.M.; Van Dijk A.P.; Vliegen H.W.; Van Melle J.P.;
Meijboom F.J.; Post M.C.; Berbee J.K.; Boekholdt S.M.; Groenink M.;
Zwinderman A.H.; Mulder B.J.M.; Bouma B.J.
Institution
(Bokma, Winter, Boekholdt, Groenink, Mulder, Bouma) Department of
Cardiology, Academic Medical Center Amsterdam, Rm B2-256, Meibergdreef 9,
Amsterdam 1105 AZ, United States
(Bokma, Mulder, Bouma) Netherlands Heart Institute, Utrecht, Netherlands
(Van Dijk) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Vliegen) Department of Cardiology, Leiden University Medical Center,
Netherlands
(Van Melle) Department of Cardiology, Groningen University Medical Center,
Netherlands
(Meijboom) Department of Cardiology, Utrecht University Medical Center,
Netherlands
(Post) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Berbee) Department of Hospital Pharmacy, Academic Medical Center
Amsterdam, Netherlands
(Zwinderman) Department of Clinical Epidemiology and Biostatistics,
Academic Medical Center Amsterdam, Netherlands
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The effect of angiotensin II receptor blockers on right
ventricular (RV) function is still unknown. Angiotensin II receptor
blockers are beneficial in patients with acquired left ventricular
dysfunction, and recent findings have suggested a favorable effect in
symptomatic patients with systemic RV dysfunction. The current study aimed
to determine the effect of losartan, an angiotensin II receptor blocker,
on subpulmonary RV dysfunction in adults after repaired tetralogy of
Fallot. Method(s): The REDEFINE trial (Right Ventricular Dysfunction
in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone
System) is an investigator-initiated, multicenter, prospective, 1:1
randomized, double-blind, placebo-controlled study. Adults with repaired
tetralogy of Fallot and RV dysfunction (RV ejection fraction [EF] <50%)
but without severe valvular dysfunction were eligible. Patients were
randomly assigned between losartan (150 mg daily) and placebo with target
treatment duration between 18 and 24 months. The primary outcome was RV EF
change, determined by cardiovascular MRI in intention-to-treat analysis.
 Result(s): Of 95 included patients, 47 patients received 150 mg
losartan daily (age, 38.0+/-12.4 years; 74% male), and 48 patients
received placebo (age, 40.6+/-11.4 years; 63% male). Overall, RV EF did
not change in patients allocated to losartan (n=42) (44.4+/-5.1% to
45.2+/-5.0%) and placebo (n=46) (43.2+/-6.3% to 43.6+/-6.9%). Losartan did
not significantly improve RV EF in comparison with placebo (+0.51%; 95%
confidence interval, -1.0 to +2.0; P=0.50). No significant treatment
effects were found on secondary outcomes: left ventricular EF, peak
aerobic exercise capacity, and N-terminal pro-brain natriuretic peptide
(P>0.30 for all). In predefined subgroup analyses, losartan did not have a
statistically significant impact on RV EF in subgroups with symptoms,
restrictive RV, RV EF<40%, pulmonary valve replacement, or QRS
fragmentation. However, in a post hoc analysis, losartan was associated
with improved RV EF in a subgroup (n=30) with nonrestrictive RV and
incomplete remodeling (QRS fragmentation and previous pulmonary valve
replacement) (+2.7%; 95% confidence interval, +0.1 to +5.4; P=0.045).
 Conclusion(s): Losartan had no significant effect on RV dysfunction
or secondary outcome parameters in repaired tetralogy of Fallot. Future
larger studies may determine whether there might be a role for losartan in
specific vulnerable subgroups. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT02010905. Copyright © 2017 American Heart Association, Inc.

<7>
Accession Number
624144220
Title
Clinical complete response after chemoradiotherapy for carcinoma of
thoracic esophagus: Is esophagectomy always necessary? A systematic review
and meta-analysis.
Source
Thoracic Cancer. 9 (12) (pp 1638-1647), 2018. Date of Publication:
December 2018.
Author
Wang J.; Qin J.; Jing S.; Liu Q.; Cheng Y.; Wang Y.; Cao F.
Institution
(Wang, Jing, Liu, Cheng, Wang, Cao) Department of Radiation Oncology, The
Fourth Hospital of Hebei Medical University, Shijiazhuang, China
(Qin) Department of Thoracic Surgery, Cancer Hospital of Chinese Academy
of Medical Sciences, Beijing, China
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although a clinical complete response (cCR) after
chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a
following strategy, such as surgical or non-surgical approach, remains
controversial. Method(s): All articles relevant to a comparison of
surgical and non-surgical treatment (including further definitive
chemoradiotherapy or active surveillance) for esophageal carcinoma
patients with a cCR after CRT were retrieved for meta-analysis. The final
date for data retrieval was 30 June 2018. Result(s): Four
retrospective studies including 648 patients met the inclusion criteria:
620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT +
surgery group had an advantage over the non-surgery group in regard to
two-year disease-free survival (DFS); however, the two groups showed
similar results in five-year DFS. The CRT + surgery group had an advantage
over the non-surgery group in two-year overall survival (OS);
nevertheless, the two groups showed similar results in five-year OS.
 Conclusion(s): Based on the available evidence, the addition of
surgery to thoracic locally advanced esophageal carcinoma patients with a
cCR after neoadjuvant CRT provided no advantage to long-term survival. As
an exception, the two-year DFS and OS could be improved. This research
conclusion might be more suitable to patients with squamous cell
carcinoma. Copyright © 2018 The Authors. Thoracic Cancer
published by China Lung Oncology Group and John Wiley & Sons Australia,
Ltd

<8>
Accession Number
618786080
Title
Electrical support during outdoor cycling in patients with coronary artery
disease: impact on exercise intensity, volume and perception of effort.
Source
Acta Cardiologica. 73 (4) (pp 343-350), 2018. Date of Publication: 04 Jul
2018.
Author
Hansen D.; Soors A.; Deluyker V.; Frederix I.; Dendale P.
Institution
(Hansen, Soors, Deluyker, Frederix, Dendale) Faculty of Medicine and Life
Sciences, Hasselt University, Agoralaan gebouw D, Diepenbeek, Belgium
(Hansen, Frederix, Dendale) Department of Cardiology/Heart Centre Hasselt,
Jessa Hospital, Hasselt, Belgium
(Frederix) Faculty of Medicine and Health Sciences, Antwerp University,
Antwerp, Belgium
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: Electrical assisted bicycles (EAB's) could be used to overcome
barriers and difficulties to outdoor cycling and thus assist in achieving
a sufficient physical activity level in coronary artery disease (CAD)
patients, but it is unknown whether sufficient exercise intensities and
volumes could be elicited during cycling on EAB's. In this study we
examined, for the first time, the acute physiological impact of electrical
support during outdoor cycling in CAD patients (ISRCTN32238279).
 Method(s): Fifteen CAD patients (13 males), aged 64 +/- 7 years
executed a maximal cardiopulmonary exercise test and afterwards cycled a
predefined outdoor route of 10 km, in three different conditions:
classical cycling (no support), EAB with low support (EAB<inf>low</inf>)
and high support (EAB<inf>high</inf>). Oxygen uptake (VO<inf>2</inf>) and
carbon dioxide output (VCO<inf>2</inf>) was measured continuously by a
portable gas-analysing system. Cycling time was recorded and ratings of
perceived exertion (RPE) was assessed at 3 and 7 km. Result(s): Mean
VO<inf>2</inf> during EAB<inf>high</inf> (1721 +/- 537
ml*min-1) was significantly lower compared to EAB<inf>low</inf>
(1890 +/- 619 ml*min-1, p <.05), but no differences were found
between EAB<inf>low</inf> and classical cycling (1846 +/- 523
ml*min-1). EAB<inf>low</inf> and EAB<inf>high</inf> elicited a
sufficient volume and intensity (6.6 +/- 2.0 MET's (74 +/- 6%
VO<inf>2peak</inf>) and 6.0 +/- 1.8 MET's (68 +/- 7% VO<inf>2peak</inf>),
respectively) to adhere to the guidelines for secondary prevention in CAD.
RPE was significantly lower p <.05) during EAB<inf>high</inf> (9 +/- 2),
than during EAB<inf>low</inf> (11 +/- 2) or classical cycling (11 +/- 2).
 Conclusion(s): Outdoor cycling with electrical support leads to a
sufficiently high exercise intensity and volume in CAD patients, and may
be considered as an alternative exercise modality. Copyright ©
2017, © 2017 Belgian Society of Cardiology.

<9>
Accession Number
2001075224
Title
Preoperative STOP-BANG Scores and Postoperative Delirium and Coma in
Thoracic Surgery Patients.
Source
Annals of Thoracic Surgery. 106 (4) (pp 966-972), 2018. Date of
Publication: October 2018.
Author
Wang S.; Sigua N.L.; Manchanda S.; Gradney S.; Khan S.H.; Perkins A.;
Kesler K.; Khan B.
Institution
(Wang) Department of Psychiatry, Indiana University School of Medicine,
Indiana University Health Neuroscience Center, Indianapolis, Indiana,
United States
(Wang, Khan) Sandra Eskenazi Center for Brain Care Innovation, Eskenazi
Hospital, Indianapolis, Indiana, United States
(Sigua, Manchanda, Gradney, Khan, Khan) Division of Pulmonary, Critical
Care, Sleep and Occupational Medicine, Department of Internal Medicine,
Indiana University School of Medicine, Indianapolis, Indiana, United
States
(Khan, Khan) Indiana University Center for Aging Research, Regenstrief
Institute, Indianapolis, Indiana, United States
(Perkins) Department of Biostatistics, Indiana University School of
Medicine, Indianapolis, Indiana, United States
(Kesler) Department of Cardiothoracic Surgery, Indiana University School
of Medicine, Indianapolis, Indiana, United States
Publisher
Elsevier USA
Abstract
Background: Obstructive sleep apnea (OSA) is associated with higher rates
of postoperative delirium. The relationship between preoperative OSA risk
and postoperative delirium and coma in thoracic surgery patients
hospitalized in the intensive care unit (ICU) is not well understood. This
study tests the hypothesis that thoracic surgery patients hospitalized in
ICU with a higher preoperative risk for OSA are more likely to develop
postoperative delirium and coma, resulting in longer hospital stays.
 Method(s): Preoperative OSA risk was measured using the STOP-BANG
questionnaire. STOP-BANG scores of greater than or equal to 3 were defined
as intermediate-high risk for OSA; 128 patients who underwent major
thoracic surgery completed the STOP-BANG questionnaire preoperatively. The
Richmond Agitation and Sedation Scale was used to assess level of
consciousness. The Confusion Assessment Method for the ICU was used to
assess for delirium. Linear regression was used to assess the relationship
between risk of OSA and outcome measures. Results were adjusted for age,
sex, body mass index, Charlson Comorbidity Index, instrumental activities
of daily living, and surgery type. Result(s): A total of 96 of 128
patients (76%) were in the intermediate-high-risk OSA group. Adjusted
analyses showed that the intermediate-high-risk OSA group had a longer
duration of postoperative ICU delirium and coma compared with the low-risk
OSA group (1.4 +/- 1.3 days versus 0.9 +/- 1.4 days; P = 0.04). Total
number of hospital days was not significantly different.
 Conclusion(s): Higher preoperative risk for OSA in thoracic surgery
patients was associated with a longer duration of postoperative delirium
and coma. Copyright © 2018 The Society of Thoracic Surgeons

<10>
Accession Number
627428897
Title
Efficacy and safety of Shen-Yuan-Dan capsules for peri-procedural
myocardial injury following percutaneous coronary intervention: Study
protocol for a randomized, double-blind, placebo-controlled trial.
Source
Annals of Translational Medicine. 7 (6) (no pagination), 2019. Article
Number: 119. Date of Publication: 01 Mar 2019.
Author
Li X.; Lai X.-L.; Fei Y.-T.; Shang J.-J.; Zhou Q.; Sun X.-Y.; Xing W.-L.;
Jia S.-H.; Liu H.-X.
Institution
(Li, Lai, Shang, Zhou, Sun, Xing, Liu) Cardiovascular Department, Capital
Medical University, Beijing Hospital of Traditional Chinese Medicine, 23
Back Road of Art Gallery, Dong Cheng District, Beijing 100010, China
(Fei, Jia) Centre for Evidence-Based Chinese Medicine, Beijing University
of Traditional Chinese Medicine, Beijing 100029, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Peri-procedural myocardial injury (PMI) during percutaneous
coronary intervention (PCI) will result in an unfavorable clinical
prognosis in patients, thus urgently necessitating effective drug
treatment measures. Shen-Yuan-Dan (SYD) capsules are a traditional Chinese
medicine (TCM) preparation that have been found to have potential
myocardial protection effects during the peri-procedural phase of PCI in
previous clinical and basic research; however, there is a lack of
rigorous, randomized, and controlled studies. The aim of this study is to
evaluate the efficacy and safety of SYD in decreasing PMI. Method(s):
This is a randomized, double-blind, placebo-controlled clinical trial. A
total of 284 patients with unstable angina will be randomized into test
and control groups. The two groups will be given SYD or a placebo (three
times each day, four capsules each time) 3 days before PCI on the basis of
conventional treatment. Twelve hours before PCI, an additional 4 capsules
will be given, and drug treatment is planned to be maintained for 1 month
after surgery. Dynamic changes in the myocardial enzyme in four
time-points (before PCI, and 4, 24, 48 hours after PCI) in both groups of
patients that will be observed. The follow-up period will be 1 month. The
primary observation markers are planned to evaluate the efficacy and
safety of SYD in decreasing PMI. The secondary observation markers will be
to evaluate the major adverse cardiovascular events (MACEs) status at day
30 after PCI, (all-cause mortality, non-fatal myocardial infarction,
repeated revascularization of target blood vessel) and Seattle Angina
Questionnaire scores. GRACE scores will be used for risk stratification,
and the intervention efficacy of SYD on PMI patients with different risks
will be retrospectively evaluated. Discussion(s): This study will
provide a rigorous clinical evidence to evaluate the efficacy and safety
of SYD in decreasing PMI and the results are worth
anticipating. Copyright © 2019 AME Publishing Company. All Rights
Reserved.

<11>
[Use Link to view the full text]
Accession Number
627462214
Title
Anti-inflammatory therapy with canakinumab for the prevention of
hospitalization for heart failure.
Source
Circulation. 139 (10) (pp 1289-1299), 2019. Date of Publication: 05 Mar
2019.
Author
Everett B.M.; Cornel J.H.; Lainscak M.; Anker S.D.; Abbate A.; Thuren T.;
Libby P.; Glynn R.J.; Ridker P.M.
Institution
(Everett, Libby, Ridker) Divisions of CardiovascularBrigham and Women's
Hospital, Harvard Medical School, 900 Commonwealth Ave, Boston, MA 02215,
United States
(Everett, Glynn) Preventive Medicine Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Cornel) Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar,
Netherlands
(Lainscak) Division of Cardiology, General Hospital Murska Sobota, Faculty
of Medicine University of Ljubljana, Slovenia
(Anker) Department of Cardiology and Berlin-Brandenburg Center for
Regenerative Therapies, German Centre for Cardiovascular Research, Partner
Site Berlin Charite Universitatsmedizin Berlin, Germany
(Abbate) Pauley Heart Center, Virginia Commonwealth University, Richmond,
United States
(Thuren) Novartis, East Hanover, Basel, NJ, Switzerland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Subclinical inflammation is associated with an increased risk
of heart failure and with adverse prognosis in patients with established
heart failure. Yet, treatments specifically directed at reducing
inflammation in patients with heart failure have not yet shown improved
clinical outcomes. We tested the hypothesis that the interleukin-1beta
inhibitor canakinumab would prevent hospitalization for heart failure
(HHF) and the composite of HHF or heart failure-related mortality.
 Method(s): We randomized 10 061 patients with prior myocardial
infarction and high-sensitivity C-reactive protein >=2 mg/L to canakinumab
50, 150, or 300 mg or placebo, given subcutaneously once every 3 months.
In total, 2173 (22%) reported a history of heart failure at baseline. We
tested the hypothesis that canakinumab prevents prospectively collected
HHF events and the composite of HHF or heart failure-related mortality.
 Result(s): A total of 385 patients had an HHF event during a median
follow-up of 3.7 years. Patients who had HHF were older, had higher body
mass index, and were more likely to have diabetes mellitus, hypertension,
and prior coronary bypass surgery. As anticipated, median (quartile 1, 3)
baseline concentrations of high-sensitivity C-reactive protein were higher
among those who had HHF during follow-up than those who did not (5.7 [3.5,
9.9] mg/L versus 4.2 [2.8, 6.9] mg/L, respectively; P<0.0001). The
unadjusted hazard ratios for HHF with each dose of canakinumab compared
with placebo were 1.04 (95% CI, 0.79-1.36) for 50 mg, 0.86 (95% CI,
0.65-1.13) for 150 mg, and 0.76 (95% CI, 0.57-1.01) for 300 mg (P for
trend=0.025). The composite of HHF or heart failure-related mortality was
also reduced by canakinumab, with unadjusted hazard ratios of 1.00 (95%
CI, 0.78-1.29) for 50 mg, 0.88 (95% CI, 0.68-1.13) for 150 mg, and 0.78
(95% CI, 0.60-1.02) for 300 mg (P for trend=0.042). Conclusion(s):
These randomized double-blind placebo-controlled data suggest that therapy
with canakinumab, an interleukin-1beta inhibitor, is related to a
dose-dependent reduction in HHF and the composite of HHF or heart
failure-related mortality in a population of patients with prior
myocardial infarction and elevations in high-sensitivity C-reactive
protein. Clinical Trial Registration: URL: http://www.clinicaltrials.gov.
Unique identifier: NCT01327846. Copyright © 2019 American Heart
Association, Inc.

<12>
[Use Link to view the full text]
Accession Number
627432677
Title
Survival, Quality of Life, and Functional Status Following Prolonged ICU
Stay in Cardiac Surgical Patients: A Systematic Review.
Source
Critical Care Medicine. 47 (1) (pp E52-E63), 2019. Date of Publication: 01
Jan 2019.
Author
Trivedi V.; Bleeker H.; Kantor N.; Visintini S.; McIsaac D.I.; McDonald B.
Institution
(Trivedi, McIsaac, McDonald) Department of Anesthesiology and Pain
Medicine, University of Ottawa, Ottawa, ON, Canada
(Trivedi, Bleeker, Kantor, McIsaac, McDonald) Faculty of Medicine,
University of Ottawa, Ottawa, ON, Canada
(Trivedi, Visintini, McDonald) Division of Cardiac Anesthesiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(McIsaac) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(McIsaac) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Compared with noncardiac critical illness, critically ill
postoperative cardiac surgical patients have different underlying
pathophysiologies, are exposed to different processes of care, and thus
may experience different outcome trajectories. Our objective was to
systematically review the outcomes of cardiac surgical patients requiring
prolonged intensive care with respect to survival, residential status,
functional recovery, and quality of life in both hospital and long-term
follow-up. Data Sources: MEDLINE, Embase, CINAHL, Web of Science, and
Dissertations and Theses Global up to July 21, 2017. Study Selection:
Studies were included if they assessed hospital or long-term survival
and/or patient-centered outcomes in adult patients with prolonged ICU
stays following major cardiac surgery. After screening 10,159 citations,
114 articles were reviewed in full; a final 34 articles met criteria for
data extraction. Data Extraction: Two reviewers independently
extracted data and assessed risk of bias using the National Institutes of
Health Quality Assessment Tool for Observational Studies. Extracted data
included the used definition of prolonged ICU stay, number and
characteristics of prolonged ICU stay patients, and any comparator short
stay group, length of follow-up, hospital and long-term survival,
residential status, patient-centered outcome measure used, and relevant
score. Data Synthesis: The definition of prolonged ICU stay varied
from 2 days to greater than 14 days. Twenty-eight studies observed greater
in-hospital mortality among all levels of prolonged ICU stay. Twenty-five
studies observed greater long-term mortality among all levels of prolonged
ICU stay. Multiple tools were used to assess patient-centered outcomes.
Long-term health-related quality of life and function was equivalent or
worse with prolonged ICU stay. Conclusion(s): We found consistent
evidence that patients with increases in ICU length of stay beyond 48
hours have significantly increasing risk of hospital and long-term
mortality. The significant heterogeneity in exposure and outcome
definitions leave us unable to precisely quantify the risk of prolonged
ICU stay on mortality and patient-centered outcomes. Copyright ©
2018 by the Society of Critical Care Medicine and Wolters Kluwer Health,
Inc. All Rights Reserved.

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

<14>
Accession Number
2001791173
Title
Pre-Dilatation Versus No Pre-Dilatation for Implantation of a
Self-Expanding Valve in All Comers Undergoing TAVR: The DIRECT Trial.
Source
JACC: Cardiovascular Interventions. 12 (8) (pp 767-777), 2019. Date of
Publication: 22 April 2019.
Author
Toutouzas K.; Benetos G.; Voudris V.; Drakopoulou M.; Stathogiannis K.;
Latsios G.; Synetos A.; Antonopoulos A.; Kosmas E.; Iakovou I.;
Katsimagklis G.; Mastrokostopoulos A.; Moraitis S.; Zeniou V.; Danenberg
H.; Vavuranakis M.; Tousoulis D.
Institution
(Toutouzas, Benetos, Drakopoulou, Stathogiannis, Latsios, Synetos,
Antonopoulos, Vavuranakis, Tousoulis) First Department of Cardiology,
Athens School of Medicine, Hippokration Hospital, Athens, Greece
(Voudris, Kosmas, Iakovou) Department of Cardiology, Onassis Cardiac
Surgery Center, Athens, Greece
(Katsimagklis, Mastrokostopoulos, Moraitis) Naval Hospital of Athens,
Athens, Greece
(Zeniou, Danenberg) Heart Institute, Hadassah Hebrew University Medical
Center, Jerusalem, Israel
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to compare the implantation of a
self-expanding valve with or without balloon aortic valvuloplasty (BAV) in
an open-label, noninferiority, randomized trial. Background(s): There
are no randomized studies comparing the implantation of a self-expanding
valve with (pre-BAV) or without BAV. Method(s): Consecutive patients
with severe aortic stenosis were randomly assigned to undergo
transcatheter aortic valve replacement with the use of self-expanding
prostheses with (pre-BAV) or without (no-BAV) pre-dilatation. The primary
endpoint was device success according to the Valve Academic Research
Consortium 2 criteria. Secondary endpoints included periprocedural
mortality and stroke, new permanent pacemaker implantation, vascular
complications, and 1-year mortality. The trial was scheduled to show
noninferiority (DELTA = 15%) of the direct versus the pre-BAV approach.
 Result(s): A total of 171 patients were randomized at 4 centers. Of
these, 86 underwent transcatheter aortic valve replacement with
pre-dilatation and 85 without. Device success was noninferior in the
no-BAV group compared with the pre-BAV group (65 of 85 [76.5%] for no-BAV
vs. 64 of 86 [74.4%] for pre-BAV; mean difference 2.1%; 90% confidence
interval: -8.9% to 13%). In the no-BAV group, 25 patients (29.4%)
underwent post-balloon dilatation, and in the pre-BAV group, 13 patients
(15.1%) underwent post-balloon dilatation (p = 0.03). Regarding major
vascular complications and permanent pacemaker implantation, there was no
difference between the 2 groups (log-rank p = 0.49, log-rank p = 0.54). In
1-month completed follow-up for all patients, there was 1 periprocedural
stroke (0.5%), without any deaths. Conclusion(s): Direct, without
balloon pre-dilatation, transcatheter aortic valve replacement with a
self-expanding prosthesis system is noninferior to the pre-dilatation
procedure. Lower post-dilatation rates were encountered in the group with
pre-dilatation. (The Predilatation in Transcatheter Aortic Valve
Implantation Trial [DIRECT]; NCT02448927) Copyright © 2019
American College of Cardiology Foundation

<15>
Accession Number
627405321
Title
Bioprosthetic aortic valve replacement in nonelderly adults: A systematic
review, meta-analysis, and microsimulation.
Source
Circulation: Cardiovascular Quality and Outcomes. 12 (2) (no pagination),
2019. Article Number: e005481. Date of Publication: 01 Feb 2019.
Author
Etnel J.R.G.; Huygens S.A.; Grashuis P.; Pekbay B.; Papageorgiou G.; Roos
Hesselink J.W.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Etnel, Huygens, Grashuis, Pekbay, Papageorgiou, Bogers, Takkenberg)
Department of Cardiothoracic Surgery, BD-565, Erasmus University Medical
Center, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Grashuis) Department of Biostatistics, Erasmus University Medical Center,
Rotterdam, Netherlands
(Roos Hesselink) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Huygens) Erasmus School of Health Policy and Management, Erasmus
University Rotterdam, Rotterdam, Netherlands
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: To support decision-making in aortic valve replacement in
nonelderly adults, we aim to provide a comprehensive overview of reported
outcome after bioprosthetic aortic valve replacement and to translate this
to age-specific patient outcome estimates. Methods and Results: A
systematic review was conducted for papers reporting clinical outcome
after aortic valve replacement with currently available bioprostheses in
patients with a mean age <55 years, published between January 1, 2000, and
January 9, 2016. Pooled reported event rates and time-to-event data were
pooled and entered into a microsimulation model to calculate life
expectancy and lifetime event risk for the ages of 25, 35, 45, and 55
years at surgery. Nineteen publications were included, encompassing a
total of 2686 patients with 21 117 patient-years of follow-up (pooled mean
follow-up: 7.9+/-4.2 years). Pooled mean age at surgery was 50.7+/-11.0
years. Pooled early mortality risk was 3.30% (95% CI, 2.39-4.55), late
mortality rate was 2.39%/y (95% CI, 1.13-2.94), reintervention 1.82%/y
(95% CI, 1.31-2.52), structural valve deterioration 1.59%/y (95% CI,
1.21-2.10), thromboembolism 0.53%/y (95% CI, 0.42-0.67), bleeding 0.22%/y
(95% CI, 0.16-0.32), endocarditis 0.48%/y (95% CI, 0.37-0.62), and 20-year
pooled actuarial survival was 58.7% and freedom from reintervention was
29.0%. Median time to structural valve deterioration was 17.3 years and
median time to all-cause first reintervention was 16.9 years. For a
45-year-old adult, for example, this translated to a microsimulation-based
estimated life expectancy of 21 years (general population: 32 years) and
lifetime risk of reintervention of 78%, structural valve deterioration
71%, thromboembolism 12%, bleeding 5%, and endocarditis 9%.
 Conclusion(s): Aortic valve replacement with bioprostheses in young
adults is associated with high structural valve deterioration and
reintervention rates and low, though not absent, hazards of
thromboembolism and bleeding. Foremostly, most patients will require one
or more reinterventions during their lifetime and survival is impaired in
comparison with the age- and sex-matched general population. Prosthesis
durability remains the main concern in nonelderly patients. Copyright
© 2019 American Heart Association, Inc.

<16>
Accession Number
2001869595
Title
Fifty shades of gradients: Does the pressure gradient in venous sinus
stenting for idiopathic intracranial hypertension matter? A systematic
review.
Source
Journal of Neurosurgery. 130 (3) (pp 999-1005), 2019. Date of Publication:
March 2019.
Author
McDougall C.M.; Ban V.S.; Beecher J.; Pride L.; Welch B.G.
Institution
(McDougall, Pride, Welch) Departments of Radiology, University of Texas
Southwestern, Dallas, TX, United States
(McDougall, Ban, Beecher, Welch) Departments of Neurosurgery, University
of Texas Southwestern, Dallas, TX, United States
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE The role of venous sinus stenting (VSS) for idiopathic
intracranial hypertension (IIH) is not well understood. The aim of this
systematic review is to attempt to identify subsets of patients with IIH
who will benefit from VSS based on the pressure gradients of their venous
sinus stenosis. METHODS MEDLINE/PubMed was searched for studies reporting
venous pressure gradients across the stenotic segment of the venous sinus,
pre- and post-stent pressure gradients, and clinical outcomes after VSS.
Findings are reported according to the PRISMA (Preferred Reporting Items
for Systematic Reviews and Meta-Analyses) guidelines. RESULTS From 32
eligible studies, a total of 186 patients were included in the analysis.
Patients who had favorable outcomes had higher mean pressure gradients
(22.8 +/- 11.5 mm Hg vs 17.4 +/- 8.0 mm Hg, p = 0.033) and higher changes
in pressure gradients after stent placement (19.4 +/- 10.0 mm Hg vs 12.0
+/- 6.0 mm Hg, p = 0.006) compared with those with unfavorable outcomes.
The post-stent pressure gradients between the 2 groups were not
significantly different (2.8 +/- 4.0 mm Hg vs 2.7 +/- 2.0 mm Hg, p =
0.934). In a multivariate stepwise logistic regression controlling for
age, sex, body mass index, CSF opening pressure, pre-stent pressure
gradient, and post-stent pressure gradient, the change in pressure
gradient with stent placement was found to be an independent predictor of
favorable outcome (p = 0.028). Using a pressure gradient of 21 as a
cutoff, 81/86 (94.2%) of patients with a gradient > 21 achieved favorable
outcomes, compared with 82/100 (82.0%) of patients with a gradient <= 21
(p = 0.022). CONCLUSIONS There appears to be a relationship between the
pressure gradient of venous sinus stenosis and the success of VSS in IIH.
A randomized controlled trial would help elucidate this relationship and
potentially guide patient selection. Copyright © AANS 2019.

<17>
[Use Link to view the full text]
Accession Number
627462438
Title
Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute
Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized
IABP-SHOCK II Trial.
Source
Circulation. 139 (3) (pp 395-403), 2019. Date of Publication: 15 Jan 2019.
Author
Thiele H.; Zeymer U.; Thelemann N.; Neumann F.-J.; Hausleiter J.;
Abdel-Wahab M.; Meyer-Saraei R.; Fuernau G.; Eitel I.; Hambrecht R.; Bohm
M.; Werdan K.; Felix S.B.; Hennersdorf M.; Schneider S.; Ouarrak T.; Desch
S.; De Waha-Thiele S.
Institution
(Thiele, Abdel-Wahab, Desch) Department of Internal Medicine/Cardiology,
Heart Center Leipzig, University of Leipzig, Strumpellstrase 39, Leipzig
04289, Germany
(Thiele, Abdel-Wahab, Desch) Leipzig Heart Institute, Germany
(Zeymer, Schneider, Ouarrak) Klinikum Ludwigshafen, Institut fur
Herzinfarktforschung, Germany
(Thelemann, Meyer-Saraei, Fuernau, Eitel, De Waha-Thiele) University Heart
Center, Luebeck, Germany
(Neumann) Heart Center Bad Krozingen, University of Freiburg, Germany
(Hausleiter) Klinikum der Ludwig-Maximilians, Universitat Munchen, Germany
(Abdel-Wahab) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Fuernau, Eitel, Desch, De Waha-Thiele) German Center for Cardiovascular
Research, Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany
(Hambrecht) Klinikum Links der Weser, Bremen, Germany
(Bohm) University Clinic of Saarland, Homburg/Saar, Germany
(Werdan) Department of Internal Medicine/Cardiology, Martin-Luther
University Halle-Wittenberg, Germany
(Felix) University Medicine Greifswald, Germany
(Hennersdorf) Department of Internal Medicine/Cardiology, SLK Kliniken
Heilbronn, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The role of intraaortic balloon counterpulsation (IABP) in
cardiogenic shock is still a subject of intense debate despite the neutral
results of the IABP-SHOCK II trial (Intraaortic Balloon Pump in
Cardiogenic Shock II) with subsequent downgrading in international
guidelines. So far, randomized data on the impact of IABP on long-term
clinical outcomes in patients with cardiogenic shock complicating acute
myocardial infarction are lacking. Furthermore, only limited evidence is
available on general long-term outcomes of patients with cardiogenic shock
treated by contemporary practice. Method(s): The IABP-SHOCK II trial
is a multicenter, randomized, open-label trial. Between 2009 and 2012, 600
patients with cardiogenic shock complicating acute myocardial infarction
undergoing early revascularization were randomized to IABP versus control.
 Result(s): Long-term follow-up was performed 6.2 years (interquartile
range 5.6-6.7) after initial randomization. Follow-up was completed for
591 of 600 patients (98.5%). Mortality was not different between the IABP
and the control group (66.3% versus 67.0%; relative risk, 0.99; 95% CI,
0.88-1.11; P=0.98). There were also no differences in recurrent myocardial
infarction, stroke, repeat revascularization, or rehospitalization for
cardiac reasons (all P>0.05). Survivors' quality of life as assessed by
the EuroQol 5D questionnaire and the New York Heart Association class did
not differ between groups. Conclusion(s): IABP has no effect on
all-cause mortality at 6-year long-term follow-up. Mortality is still very
high, with two thirds of patients with cardiogenic shock dying despite
contemporary treatment with revascularization therapy. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov/. Unique identifier:
NCT00491036. Copyright © 2018 American Heart Association, Inc.

<18>
[Use Link to view the full text]
Accession Number
627434147
Title
Is use of Vitamin K antagonists associated with the risk of prostate
cancer? A meta-analysis.
Source
Medicine (United States). 97 (49) (no pagination), 2018. Article Number:
e13489. Date of Publication: 01 Dec 2018.
Author
Luo J.-D.; Luo J.; Lai C.; Chen J.; Meng H.-Z.
Institution
(Luo, Luo, Lai, Chen, Meng) Department of Urology, First Affiliated
Hospital, School of Medicine, Zhejiang University, Qingchun Road 79,
Hangzhou 310003, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Vitamin K antagonists (VKAs) may have potential antitumor
effects in prostate cancer. However, the findings of observational studies
are inconsistent. The purpose of the present study was to estimate the
quantitative association between VKAs use and prostate cancer risk by
combining the results of all eligible observational studies.
 Method(s): PubMed and Web of Science database were searched from
inception until May, 2018. A DerSimonian random-effects model was used to
combine the studies. Study heterogeneity was measured using the
chi-squared and I2 statistics. Result(s): Six eligible
studies were eventually included in our meta-analysis. There was an
inverse but not statistically significant association between ever use of
VKAs and the risk of prostate cancer (relative risk [RR] 0.84, 95%
confidence interval [CI] 0.70-1.01, P = .063) with large heterogeneity
across studies (P < .001 for heterogeneity, I2 = 94.6%). When
analysis restricted to long term of VKAs user (>3 years), the pooled risk
estimate was 0.83 (0.77-0.90) without obvious heterogeneity (P = .597,
I2 = 0.0%). Conclusion(s): This meta-analysis indicates
that VKAs use may be associated with a decreased risk of prostate cancer,
especially in long-term users. Copyright © 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-No Derivatives License 4.0 (CCBY-NC-ND), where it is
permissible to download and share the work provided it is properly cited.
The work cannot be changed in any way or used commercially without
permission from the journal.

<19>
[Use Link to view the full text]
Accession Number
627433908
Title
Modified double-stent strategy may be an optimal choice for coronary
bifurcation lesions A systematic review and meta-analysis.
Source
Medicine (United States). 97 (48) (no pagination), 2018. Article Number:
e13377. Date of Publication: 01 Nov 2018.
Author
Lv Y.-H.; Guo C.; Li M.; Zhang M.-B.; Wang Z.-L.
Institution
(Lv, Guo, Li, Zhang) First Medical Clinical College, Lanzhou University,
China
(Wang) Department of Cardiology, First Hospital, Lanzhou University,
Lanzhou, Gansu 730000, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and objective: The modified double-stent and provisional
stenting strategies have been widely used in patients with coronary
bifurcation lesions, but what is the optimization has not been clearly
defined. This meta-analysis is to elucidate the benefits from modified
double-stent and provisional stenting strategies in patients with coronary
bifurcation lesions. Method(s): Electronic databases were searched to
identify studies comparing the modified double-stent and provisional
stenting strategies in patients with coronary bifurcation lesions. The
clinical outcomes were divided into early (6 months) and late (>6 months)
events according to the follow-up duration. The early endpoints included
cardiac death, myocardial infarction, target lesion revascularization or
target vessel revascularization, and major adverse cardiac events (MACE),
and the late endpoints also include stent thrombosis in addition to the
early endpoints index. The angiographic endpoint was in-stent restenosis.
Data were analyzed by the statistical software RevMan (version 5.3).
 Result(s): A total of 6 studies involving 1683 patients with coronary
bifurcation lesions were included in this meta-analysis, which found that
the modified double-stent strategy was associated with a lower risk of
cardiac death (odds ratio [OR] = 0.29, 95% confidence intervals [CI]
0.11-0.78, P = .01), myocardial infarction (OR = 0.41, 95% CI 0.21-0.82, P
= .01), target lesion revascularization or target vessel revascularization
(OR = 0.31, 95% CI 0.15-0.63, P = .001), and MACE (OR = 0.41, 95% CI
0.22-0.74, P = .003) compared with provisional stenting in the early
follow-up endpoint events, while the risk of cardiac death and stent
thrombosis were similar between both strategies (OR = 0.59, 95% CI
0.31-1.10, P = .09; and OR = 0.62, 95% CI 0.34-1.15, P = .13;
respectively) in the late follow-up endpoint events. There were
significant differences between both strategies in myocardial infarction
(OR = 0.42, 95% CI 0.24-0.75, P = .003), MACE (OR = 0.44, 95% CI
0.31-0.62, P < .00001), and target lesion revascularization or target
vessel revascularization (OR 0.35, 95% CI 0.25-0.49, P < .00001) between
both strategies in the late follow-up endpoint events. The risk of
in-stent restenosis favored the modified double-stent strategy (OR 0.29,
95% CI 0.20-0.43, P < .00001). Conclusion(s): The modified
double-stent strategy is associated with excellent clinical and
angiographic outcomes except for the occurrence of cardiac death and stent
thrombosis late-term outcome compared with provisional stenting strategy
in patients with coronary bifurcation lesions. These findings suggest that
the modified double-stent strategy can be recommended as an optimization
in patients with coronary bifurcation lesions. Copyright A© 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-No Derivatives License 4.0 (CCBY-NC-ND), where
it is permissible to download and share the work provided it is properly
cited. The work cannot be changed in any way or used commercially without
permission from the journal.

<20>
Accession Number
623313980
Title
Inhaled levosimendan versus intravenous levosimendan in patients with
pulmonary hypertension undergoing mitral valve replacement.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 328-332), 2018. Date of
Publication: July-September 2018.
Author
Kundra T.S.; Nagaraja P.S.; Bharathi K.S.; Kaur P.; Manjunatha N.
Institution
(Kundra, Nagaraja, Bharathi, Manjunatha) Department of Cardiac
Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
(Kaur) Department of Critical Care, Sir Ganga Ram Hospital, New Delhi,
India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context: Inhaled levosimendan may act as selective pulmonary vasodilator
and avoid systemic side effects of intravenous levosimendan, which include
decrease in systemic vascular resistance (SVR) and systemic hypotension,
but with same beneficial effect on pulmonary artery pressure (PAP) and
right ventricular (RV) function. Aim(s): The aim of this study was to
compare the effect of inhaled levosimendan with intravenous levosimendan
in patients with pulmonary hypertension undergoing mitral valve
replacement. Settings and Design: The present prospective randomized
comparative study was conducted in a tertiary care hospital. Subjects and
Methods: Fifty patients were randomized into two groups (n = 25). Group A:
Levosimendan infusion was started immediately after coming-off of
cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B:
Total dose of levosimendan which would be given through intravenous route
over 24 h was calculated and then divided into four equal parts and
administered through inhalational route 6th hourly over 24 h.
Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery
systolic pressure [PASP], SVR) and RV function were assessed immediately
after shifting, at 1, 8, 24, and 36 h after shifting to recovery.
Statistical Analysis Used: Intragroup analysis was done using paired
student t-test, and unpaired student t-test was used for analysis between
two groups. Result(s): PASP and RV-fractional area change (RV-FAC)
were comparable in the two groups at different time intervals. There was a
significant reduction in PASP and significant improvement in RV-FAC with
both intravenous and inhalational levosimendan. SVR was significantly
decreased with intravenous levosimendan, but no significant decrease in
SVR was observed with inhalational levosimendan. Conclusion(s):
Inhaled levosimendan is a selective pulmonary vasodilator. It causes
decrease in PAP and improvement in RV function, without having a
significant effect on SVR. Copyright © 2018 Medknow Publications.
All rights reserved.

<21>
Accession Number
623313977
Title
Comparison of continuous thoracic epidural analgesia with bilateral
erector spinae plane block for perioperative pain management in cardiac
surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 323-327), 2018. Date of
Publication: July-September 2018.
Author
Nagaraja P.S.; Ragavendran S.; Singh N.G.; Asai O.; Bhavya G.; Manjunath
N.; Rajesh K.
Institution
(Nagaraja, Ragavendran, Singh, Asai, Bhavya, Manjunath) Departments of
Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences
and Research, Bengaluru, Karnataka, India
(Rajesh) CTVS, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: Continuous thoracic epidural analgesia (TEA) is compared with
erector spinae plane (ESP) block for the perioperative pain management in
patients undergoing cardiac surgery for the quality of analgesia,
incentive spirometry, ventilator duration, and intensive care unit (ICU)
duration. Methodology: A prospective, randomized comparative clinical
study was conducted. A total of 50 patients were enrolled, who were
randomized to either Group A: TEA (n = 25) or Group B: ESP block (n = 25).
Visual analog scale (VAS) was recorded in both the groups during rest and
cough at the various time intervals postextubation. Both the groups were
also compared for incentive spirometry, ventilator, and ICU duration.
Statistical analysis was performed using the independent Student's t-test.
A value of P < 0.05 was considered statistically significant.
 Result(s): C omparable VAS scores were revealed at 0 h, 3 h, 6 h, and
12 h (P > 0.05) at rest and during cough in both the groups. Group A had a
statistically significant VAS score than Group B (P <= 0.05) at 24 h, 36
h, and 48 h but mean VAS in either of the Group was <=4 both at rest and
during cough. Incentive spirometry, ventilator, and ICU duration were
comparable between the groups. Conclusion(s): ESP block is easy to
perform and can serve as a promising alternative to TEA in optimal
perioperative pain management in cardiac surgery. Copyright ©
2018 Medknow Publications. All rights reserved.

<22>
Accession Number
623313928
Title
Sedation effects by dexmedetomidine versus propofol in decreasing duration
of mechanical ventilation after open heart surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 235-242), 2018. Date of
Publication: July-September 2018.
Author
Elgebaly A.S.; Sabry M.
Institution
(Elgebaly) Department of Anesthesia and PSIC, Faculty of Medicine, Tanta
University, Tanta, Gharbia 31111, Egypt
(Sabry) Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta
University Hospital, Tanta, Gharbia 31111, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to compare the suitability
(efficacy and safety) of dexmedetomidine versus propofol for patients
admitted to the intensive care unit (ICU) after the cardiovascular surgery
for the postoperative sedation before weaning from mechanical ventilation.
 Background(s): Sedation is prescribed in patients admitted to the ICU
after cardiovascular surgery to reduce the patient discomfort, ventilator
asynchrony, to make mechanical ventilation tolerable, prevent accidental
device removal, and to reduce metabolic demands during respiratory and
hemodynamic instability. Careful drug selection for sedation by the ICU
team, postcardiovascular surgery should be done so that patients can be
easily weaned from mechanical ventilation after sedation is stopped to
achieve a shorter duration of mechanical ventilation and decreased the
length of stay in ICU. Method(s): A total of 50 patients admitted to
the ICU after cardiovascular surgery, aged from 18 to 55 years and
requiring mechanical ventilation on arrival to the ICU were enrolled in a
prospective and comparative study. They were randomly divided into two
groups as follows: Group D patients (n = 25) received dexmedetomidine in a
maintenance infusion dose of 0.8 mug/kg/h and Group P patients (n = 25)
received propofol in a maintenance infusion dose of 1.5 mg/kg/h. The
patients were assessed for 12 h postoperatively, and dosing of the study
drug was adjusted based on sedation assessment performed with the Richmond
Agitation-Sedation Scale (RASS). The patients were required to be within
the RASS target range of -2 to +1 at the time of study drug initiation. At
every 4 h, the following information was recorded from each patient such
as heart rate (HR), mean arterial pressure (MAP), arterial blood gases
(ABG), tidal volume (TV), exhaled TV, maximum inspiratory pressure,
respiratory rate and the rapid shallow breathing index, duration of
mechanical ventilation, midazolam and fentanyl dose requirements, and
financial costs. Result(s): The study results showed no statistically
significant difference between both groups with regard to age and body
mass index. Group P patients were more associated with lower MAP and HR
than Group D patients. There was no statistically significant difference
between groups with regard to ABG findings, oxygenation, ventilation, and
respiratory parameters. There was significant difference between both the
groups in midazolam and fentanyl dose requirement and financial costs with
a value of P < 0.05. Conclusion(s): Dexmedetomidine is safer and
equally effective agent for the sedation of mechanically ventilated
patients admitted to the ICU after cardiovascular surgery compared to the
patients receiving propofol, with good hemodynamic stability, and equally
rapid extubation time. Copyright © 2018 Medknow Publications. All
rights reserved.

<23>
Accession Number
2000828202
Title
Do surgeons and patients/parents value shared decision-making in pediatric
surgery? A systematic review.
Source
Journal of Surgical Research. 231 (pp 49-53), 2018. Date of Publication:
November 2018.
Author
Carlisle E.M.; Shinkunas L.A.; Kaldjian L.C.
Institution
(Carlisle) Department of Surgery, University of Iowa Hospitals and
Clinics, Iowa City, Iowa, United States
(Shinkunas, Kaldjian) Program in Bioethics and Humanities, University of
Iowa Carver College of Medicine, Iowa City, Iowa, United States
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Shared decision-making (SDM) is touted as the preferred
approach to clinical counseling. However, few data exist regarding whether
patients prefer SDM over surgeon-guided discussions for complex surgical
decision-making. Even fewer data exist regarding surgeon preferences. Such
issues may be especially pronounced in pediatric surgery given the complex
decision-making triad between patients/parents and surgeons. The objective
of this systematic review was to evaluate patient/parent and surgeon
attitudes toward SDM in pediatric surgery. Method(s): A systematic
review of English language articles in Medline, EMBASE, and Cochrane
databases was performed. Inclusion and exclusion criteria were predefined.
Text screening and data abstraction were performed by two investigators.
 Result(s): Seven thousand five hundred eighty-four articles were
screened. Title/abstract review excluded 7544 articles, and full-text
review excluded four articles. Thirty-six articles were identified as
addressing patient/parent or surgeon preferences toward SDM in pediatric
surgery. Subspecialties included Otolaryngology (33%), General Surgery
(30%), Plastics (14%), Cardiac (11%), Urology (8%), Neurosurgery (6%),
Orthopedics (6%), and Gynecology (3%). Most studies (94%) evaluated
elective/nonurgent procedures. The majority (97%) concentrated on
patient/parent preferences, whereas only 22% addressed surgeon
preferences. Eleven percent of studies found that surgeons favored SDM,
and 73% demonstrated that patients/parents favored SDM.
 Conclusion(s): Despite recommendations that SDM is the preferred
approach to clinical counseling, our systematic literature review shows
that few studies evaluate patient/parent and surgeon attitudes toward SDM
in pediatric surgery. Of these studies, very few focus on complex,
urgent/emergent decision-making. Further research is needed to understand
whether patients/parents, as well as surgeons, may prefer a more
surgeon-guided approach to decision-making, especially when surgery is
complex or taking place in urgent/emergent settings. Copyright ©
2018 Elsevier Inc.

<24>
[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.
 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. Copyright
© 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

<25>
[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.
 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.
 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). 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. Copyright © 2018 the Author(s).
Published by Wolters Kluwer Health, Inc.

<26>
[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. 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.
 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. 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. Copyright © 2018 the
Author(s). Published by Wolters Kluwer Health, Inc.

<27>
Accession Number
627432151
Title
Effects of N-acetyl cysteine and melatonin on early reperfusion injury in
patients undergoing coronary artery bypass grafting: A randomized,
open-labeled, placebo-controlled trial.
Source
Medicine (United States). 97 (30) (no pagination), 2018. Article Number:
e11383. Date of Publication: 01 Jul 2018.
Author
Shafiei E.; Bahtoei M.; Raj P.; Ostovar A.; Iranpour D.; Akbarzadeh S.;
Shahryari H.; Anvaripour A.; Tahmasebi R.; Netticadan T.; Movahed A.
Institution
(Shafiei, Iranpour, Akbarzadeh, Shahryari, Anvaripour) Department of
Cardiology, Faculty of Medicine, Bushehr, Iran, Islamic Republic of
(Bahtoei) Department of Internal Medicine, Faculty of Medicine, Bushehr,
Iran, Islamic Republic of
(Ostovar, Tahmasebi, Movahed) Biochemistry Group, Persian Gulf Tropical
Medicine Research Center, Bushehr University of Medical Sciences, Bushehr,
Iran, Islamic Republic of
(Raj, Netticadan) Physiology and Pathophysiology, University of Manitoba,
Canada
(Raj, Netticadan) Canadian Center for Agri-food Research in Health and
Medicine, Winnipeg, MB, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: This study assessed the efficacy of oral consumption of
N-acetyl cysteine (NAC) and melatonin (ML) in reducing early reperfusion
injury and acute oxidative stress in patients undergoing coronary artery
bypass grafting (CABG) with respect to the measurements of cardiac
troponin I, lactate, malondealdehyde (MDA), and tumor necrosis factor-a
(TNF-a) levels in the blood. Method(s): This study was a randomized,
open-label, placebo-controlled trial. Eighty eight patients, aged between
39 to 76 years and eligible for CABG, were recruited and randomly assigned
into 3 intervention groups through a simple randomization method and
underwent CABG surgery. Blood samples were withdrawn from arterial line,
before the induction of anesthesia (before the start of surgery), after
incision (before aortic cross-clamping), during global ischemia (during
aortic cross-clamping), after aortic cross-clamping (on set of
reperfusion), 15 minutes after reperfusion, and after recovery at the
intense care unit. The blood samples were analyzed for troponin I,
lactate, MDA and TNF-a levels. Result(s): There was no significant
difference in influencing variables among the groups at the baseline.
Overall mean troponin I, lactate, and TNF- a levels were significantly
different between the intervention groups (all P < .001) at the recovery
phase. Post-hoc pairwise comparisons showed that the differences of mean
serum levels between ML and control groups were statistically significant
for MDA, TNF- a, lactate, and troponin I (P < .001, P = .001, and P =
.001, respectively). The differences between NAC and control groups and
between ML and NAC groups were only significant for mean lactate level (P
< .001). Conclusion(s): The current study revealed that ML and NAC
are potent antioxidants with similar efficacy in terms of reducing CABG
related cardiac injury and oxidative stress with the dosage employed for
the intervention. Copyright © 2018 the Author(s).

<28>
Accession Number
620744398
Title
Investigation of Motivational Interviewing and Prevention Consults to
Achieve Cardiovascular Targets (IMPACT) trial.
Source
American Heart Journal. 199 (pp 37-43), 2018. Date of Publication: May
2018.
Author
Gianos E.; Schoenthaler A.; Guo Y.; Zhong J.; Weintraub H.; Schwartzbard
A.; Underberg J.; Schloss M.; Newman J.D.; Heffron S.; Fisher E.A.; Berger
J.S.
Institution
(Gianos, Weintraub, Schwartzbard, Underberg, Schloss, Newman, Heffron,
Fisher, Berger) Department of Medicine, Division of Cardiology, Center for
the Prevention of Cardiovascular Disease, New York University School of
Medicine, New York, NY, United States
(Heffron, Fisher, Berger) Marc and Ruti Bell Program in Vascular Biology,
New York University School of Medicine, New York, NY, United States
(Schoenthaler, Guo, Zhong) Department of Population Health, Center for
Healthful Behavioral Change, New York University School of Medicine, New
York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Patients undergoing cardiovascular (CV) procedures often have
suboptimal CV risk factor control and may benefit from strategies
targeting healthy lifestyle behaviors and education. Implementation of
prevention strategies may be particularly effective at this point of
heightened motivation. Method(s): A prospective, randomized, pilot
study was conducted in 400 patients undergoing a nonurgent CV procedure
(cardiac catheterization +/- revascularization) to evaluate the impact of
different prevention strategies. Patients were randomized in a 1:1:1
fashion to usual care (UC; group A, n = 134), in-hospital CV prevention
consult (PC; group B, n = 130), or PC plus behavioral intervention program
(telephone-based motivational interviewing and optional tailored text
messages) (group C, n = 133). The primary end point was the DELTA change
in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6
month. Result(s): The mean age was 64.6 +/- 10.8 years, 23.7% were
female, and 31.5% were nonwhite. After 6 months, the absolute difference
in non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6,
P <.001). There were no between-group differences in the primary end point
for the combined PC groups (B and C) versus UC, with a DELTA adjusted
between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P =.16).
Patients in the PC groups were more likely to be on high-intensity statins
at 6 months (52.9% vs 38.1%, P =.01). After excluding participants with
baseline non-HDL-C <100 mg/dL (initial exclusion criterion), DELTA
non-HDL-C and DELTA low-density lipoprotein cholesterol were improved in
the PC groups compared to UC (non-HDL-C -8.13 mg/dL [-16.00 to -0.27], P
=.04; low-density lipoprotein cholesterol -7.87mg/dL [-15.10 to -0.64], P
=.03). Conclusion(s): Although non-HDL-C reduction at 6 months
following a nonurgent CV procedure was not significant in the overall
cohort, an increased uptake in high-potency statins may translate into
improved long-term health outcomes and cost reductions. Copyright
© 2018

<29>
[Use Link to view the full text]
Accession Number
624837963
Title
Del Nido cardioplegia for myocardial protection in adult cardiac surgery:
A systematic review and meta-analysis.
Source
ASAIO Journal. 64 (3) (pp 360-367), 2018. Date of Publication: 2018.
Author
Li Y.; Lin H.; Zhao Y.; Li Z.; Liu D.; Wu X.; Ji B.; Gao B.
Institution
(Li, Lin, Zhao, Liu, Wu) Department of Cardiac Surgery, Lanzhou University
Second Hospital, Lanzhou University, Lanzhou, China
(Li) Department of Cardiopulmonary Bypass, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, Beijing, China
(Li) Department of Cardiopulmonary Bypass, Lanzhou University Second
Hospital, Lanzhou University, Lanzhou, China
(Ji) Department of Cardiopulmonary Bypass, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 10010,
China
(Gao) Department of Cardiac Surgery, Lanzhou University Second Hospital,
No. 80, Cuiyingmen, Chengguan District, Lanzhou 730030, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Cardioplegia is an important strategy for myocardial protection during
cardiac surgery. This meta-analysis was to compare the effects of del Nido
and conventional cardioplegia in adult patients. Systematic searches were
performed to identify studies using PubMed, Embase, the Cochrane Library,
and the International Clinical Trials Registry Platform. A total of nine
studies were included. Cardiopulmonary bypass and cross-clamp time were
significantly shorter in the del Nido than conventional cardioplegia (mean
difference [MD]: -7.52, 95% confidence interval [95% CI]: -14.76 to -0.29,
p = 0.04; MD: -5.74, 95% CI: -10.14 to -1.34, p = 0.01). During the
operation, cardioplegia volume and blood glucose level were lower in the
del Nido group (MD: -522.53, 95% CI: -926.68 to -118.37, p = 0.01;
standardized mean difference [SMD]: -1.11, 95% CI: -1.74 to -0.48, p =
0.0006). Ventilation time and length of intensive care unit were decreased
significantly with del Nido cardioplegia (MD: -1.05, 95% CI: -1.79 to
-0.31, p = 0.006; MD: -0.65, 95% CI: -0.92 to -0.38, p < 0.00001). There
were no differences in myocardial enzyme, postoperative inotropic support,
atrial fibrillation, hospital, and mortality between the two groups. In
adult cardiac surgery, myocardial protection used with the del Nido or
conventional cardioplegia solution yield similar short-term clinical
outcomes. ASAIO Journal 2018; 64:360-367. Copyright © 2017 by the
ASAIO

<30>
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.
 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. Copyright © 2017 Elsevier Inc.

<31>
Accession Number
2001848688
Title
Why should we extend transcatheter aortic valve implantation to low-risk
patients? A comprehensive review.
Source
Archives of Cardiovascular Diseases. 112 (5) (pp 354-362), 2019. Date of
Publication: May 2019.
Author
Overtchouk P.; Prendergast B.; Modine T.
Institution
(Overtchouk, Modine) Department of Cardiology and Cardiovascular Surgery,
Centre Hospitalier Regional et Universitaire de Lille, Lille 59000, France
(Prendergast) Department of Cardiology, St Thomas' Hospital, London SE1
7EH, United Kingdom
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Within the past decade, transcatheter aortic valve implantation (TAVI)has
become established as the optimal treatment option for elderly, inoperable
and high-risk patients with severe aortic stenosis, and is now recommended
by international guidelines. Randomized controlled trials have
demonstrated the non-inferiority of TAVI to open surgery in
intermediate-risk patients and, most recently, in low-risk patients.
Further randomized controlled trials are underway, but existing studies
have already provided reassuring data in this cohort, and TAVI is offered
routinely to younger and lower-risk patients in numerous centers.
Improvements in the design of devices and delivery systems, accompanied by
increased operator experience, have dramatically improved the safety of
the procedure, and further expansion into low-risk groups seems inevitable
once concerns about valve durability and device cost have been addressed.
In this article, we provide a review of the existing literature, and
estimate the clinical impact of TAVI in low-risk patients. Abbreviated
title: Why should we extend TAVI to low-risk patients? Copyright
© 2019

<32>
Accession Number
2001839223
Title
Risk factors for death or heart transplantation in single-ventricle
physiology (tricuspid atresia, pulmonary atresia, and heterotaxy): A
systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Kulkarni A.; Patel N.; Singh T.P.; Mossialos E.; Mehra M.R.
Institution
(Kulkarni) London School of Economics and Political Science, London,
United Kingdom
(Patel, Mossialos) Department of Health Policy, London School of Economics
and Political Science, London, United Kingdom
(Singh) Department of Cardiology, Boston Children's Hospital, Boston, MA,
United States
(Mehra) Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
Publisher
Elsevier USA
Abstract
BACKGROUND: In this study we sought to evaluate risk factors (RFs) for
death or heart transplantation (D-HT) in single-ventricle (SV) physiology
due to tricuspid atresia (TA), pulmonary atresia-intact ventricular septum
(PA-IVS), and heterotaxy with SV (HX), clinical conditions for which
outcome data are limited. METHOD(S): To conduct a systematic review,
we included citations that evaluated occurrence of D-HT in SV physiology
of TA, PA-IVS, and HX in English articles published between January 1998
and December 2017 based on inclusion and exclusion criteria, following the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
(PRISMA) guidelines. The Cochrane Risk of Bias in Non-Randomized
Studies-Interventions (ROBINS-I) tool for non-randomized studies was used
to assess the risk of bias. Meta-analysis was performed if RF data were
available in more than 3 studies. RESULT(S): Of 11,629 citations
reviewed, 30 met inclusion criteria. All 30 were observational,
retrospective studies. In all, 1,770 patients were included, 481 died and
21 underwent HT (63 lost to follow-up); 723 patients reached Fontan
completion. We found that systemic ventricular dysfunction (odds ratio
[OR] 20.7, confidence interval [CI] 10.0-42.5, I2 = 0%) and
atrioventricular valve regurgitation (AVR) were associated with risk of
D-HT (OR 3.7, CI 1.9-6.9, I2 = 14%). RF associations with D-HT
could not be derived for right ventricle-dependent coronary circulation,
pulmonary arteriovenous malformations, total anomalous pulmonary venous
return, arrhythmias, and pulmonary atresia. CONCLUSION(S): This
systematic review and meta-analysis has identified a high mortality rate
in children born with non-HLHS SV heart disease and points to potential
under-utilization of HT. Systemic ventricular dysfunction and AVR were
identified as RFs for D-HT in this subset of patients SV with TA, PA-IVS,
and HX. Copyright © 2019 International Society for Heart and Lung
Transplantation

<33>
Accession Number
627499544
Title
Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and
attenuate myocardial ischemia-reperfusion injury after cardiac surgery
with cardiopulmonary bypass in children: A randomized, double-blind,
placebo-controlled trial.
Source
Medicine (United States). 97 (36) (no pagination), 2018. Article Number:
e12100. Date of Publication: September 2018.
Author
Zhang J.-Q.; Yang Q.-Y.; Xue F.-S.; Zhang W.; Yang G.-Z.; Liao X.; Meng
F.-M.
Institution
(Zhang, Zhang, Meng) Department of Anesthesiology, Henan Provincial
People's Hospital of Zhengzhou University, Zhengzhou, China
(Yang, Yang, Liao) Department of Anesthesiology, Plastic Surgery Hospital,
Chinese Academy of Medical Sciences, Peking Union Medical College, China
(Xue) Department of Anesthesiology, Beijing Friendship Hospital, Capital
Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing
100050, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Both euthyroid sick syndrome and myocardial
ischemia-reperfusion injury are common and have been significantly
associated with morbidity and mortality after pediatric cardiac surgery
with cardiopulmonary bypass. This single-center, prospective,
double-blind, randomized placebo-controlled clinical pilot trial was
designed to assess if preoperative oral thyroid hormone therapy could
prevent the occurrence of euthyroid sick syndrome (ESS) and attenuate
myocardial ischemia-reperfusion injury (IRI) after cardiac surgery with
cardiopulmonary bypass (CPB) in children. Method(s): Forty children
aged 3 to 12 year, scheduled for elective congenital heart disease repair
surgery with CPB, were randomized into 2 groups of equal size to receive
the following treatments in a double-blind manner: placebo (control group)
and thyroid tablet 0.4 mg/kg (trial group) taken orally once a day for 4
days before surgery. The perioperative serum thyroid hormone levels and
hemodynamic variables were determined. The extubation time, duration of
intensive care unit (ICU) stay, and use of inotropic drugs in the ICU were
recorded. The myocardial expressions of heat shock protein 70 (HSP70),
myosin heavy chain (MHC) mRNA, and thyroid hormone receptor (TR) mRNA were
detected. The serum creatine kinase-MB (CK-MB) activity and troponin I
(TnI) positive ratio at 24 hour after surgery were assessed.
 Result(s): There were no significant differences in hemodynamic
variables at all observed points, extubation time, and duration of ICU
stay between groups. As compared with baselines on administration, serum
triiodothyronine (T<inf>3</inf>) and free T<inf>3</inf> (FT<inf>3</inf>)
levels on the first, second, and fourth postoperative day, and serum
thyrotropic-stimulating hormone (TSH), tetraiodothyronine (T<inf>4</inf>),
and free T<inf>4</inf> (FT<inf>4</inf>) levels on the first postoperative
day were significantly decreased in the 2 groups. Serum T<inf>3</inf>,
FT<inf>3</inf>, and T<inf>4</inf> levels on the first and second
postoperative day, and serum FT<inf>4</inf> level on the first
postoperative day were significantly higher in the trial group than in
control group. As compared with the control group, the number of patients
requiring inotropic drugs in the ICU, serum CK-MB activity, serum positive
TnI ratio, and myocardial expression of MHCb mRNA were significantly
decreased, and myocardial expressions of both HSP70 and MHCa mRNA were
significantly increased in the trial group. Conclusion(s): In
children undergoing cardiac surgery with CPB, preoperative oral small-dose
thyroid hormone therapy reduces severity of postoperative ESS and provides
a protection against myocardial IRI by increasing HSP70 and MHCa
expression. Copyright © 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<34>
Accession Number
627493398
Title
Sindrome vasoplejico en cirugia cardiaca: definicion, fisiopatologia,
enfoque diagnostico y manejo, Vasoplegic syndrome in cardiac surgery:
Definitions, pathophysiology, diagnostic approach and management.
Source
Revista espanola de anestesiologia y reanimacion. 66 (5) (pp 277-287),
2019. Date of Publication: 01 May 2019.
Author
Orozco Vinasco D.M.; Triana Schoonewolff C.A.; Orozco Vinasco A.C.
Institution
(Orozco Vinasco) Departamento de Anestesia cardiovascular, Instituto del
Corazon de Bucaramanga sede Bogota, Clinica Colsubsidio Calle 100, Bogota,
Colombia
(Triana Schoonewolff) Departamento de Anestesia cardiovascular, Hospital
Universitario Fundacion Santa Fe de Bogota, Bogota, Colombia
(Orozco Vinasco) Departamento de Anestesia, Hospital Universitario Severo
Ochoa, Leganes Madrid, Spain
Publisher
NLM (Medline)

<35>
Accession Number
627507062
Title
Long-Term Comparison of Ethyl Icosapentate vs. Omega-3-Acid Ethyl in
Patients With Cardiovascular Disease and Hypertriglyceridemia (DEFAT
Trial).
Source
Circulation journal : official journal of the Japanese Circulation
Society. (no pagination), 2019. Date of Publication: 19 Apr 2019.
Author
Sezai A.; Unosawa S.; Taoka M.; Osaka S.; Obata K.; Kanno S.; Sekino H.;
Tanaka M.
Institution
(Sezai, Unosawa, Taoka, Osaka, Tanaka) Department of Cardiovascular
Surgery, Nihon University School of Medicine, Japan
(Obata, Kanno, Sekino) Sekino Hospital
Publisher
NLM (Medline)
Abstract
BACKGROUND: Numerous studies have demonstrated a reduction in
cardiovascular events when the low-density lipoprotein cholesterol (LDL)
level is decreased by statin therapy. However, despite good control of
LDL, cardiovascular events may increase if the triglyceride (TG) level is
high. We conducted a long-term comparison of treatment of
hypertriglyceridemia with ethyl icosapentate (EPA) vs. omega-3-acid ethyl
(EPA+docosahexaenoic acid [DHA]).Methods and Results:Cardiac surgery
patients with hypertriglyceridemia were randomized to an EPA group (1.8 g
t.i.d.) or an EPA+DHA group (2 g s.i.d.) and observed for 3 years. The
primary endpoints were the serum TG level and its percent change.
Secondary endpoints included lipid markers, fatty acid parameters, serum
creatinine, cystatin-C, oxidized LDL, high-sensitivity C-reactive protein,
and MACCE. An interview to assess study drug adherence was conducted 6
months after completing the study. TG levels were significantly lower in
the EPA+DHA group than in the EPA group. Levels of remnant-like
particles-cholesterol, oxidized LDL, and cystatin-C were also
significantly lower in the EPA+DHA group than in the EPA group. Compliance
with treatment was significantly worse in the EPA group.
 CONCLUSION(S): Better results were obtained in the EPA+DHA group, but
more patients showed poor compliance with treatment in the EPA group,
making detailed comparison of the 2 groups difficult. Even so, TG were
reduced while EPA and DHA levels were increased in the EPA+DHA group,
together with a reduction in oxidative stress and remnant-like
particles-cholesterol. Decreased compliance with medication in the EPA
group significantly affected the results of this study, clearly indicating
the importance of good compliance.

<36>
Accession Number
2001926683
Title
Combined Approach Versus 2 Conventional Approaches in Ultrasound-Guided
Central Venous Catheterization: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Takeshita J.; Nishiyama K.; Fukumoto A.; Shime N.
Institution
(Takeshita) Department of Intensive Care Medicine, Osaka Prefectural
Hospital Organization, Osaka Women's and Children's Hospital, Izumi,
Osaka, Japan
(Nishiyama) Department of Emergency and Critical Care Medicine, National
Hospital Organization, Kyoto Medical Center, Mukaihata-cho, Fushimi-ku,
Kyoto, Japan
(Fukumoto) Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital,
Yamashina-ku, Kyoto, Japan
(Shime) Department of Emergency and Critical Care Medicine, Graduate
School of Biomedical & Health Sciences, Hiroshima University, Minami-ku,
Hiroshima, Japan
Publisher
W.B. Saunders
Abstract
Objective: The authors compared the occurrence of posterior wall puncture
using the short-axis out-of-plane and long-axis in-plane approaches with
that using the combined short-axis-and-long-axis approach that the authors
previously showed to be effective in observational and manikin studies.
 Design(s): Randomized controlled study. Setting(s): Single
tertiary institution. Participant(s): One hundred twenty patients who
underwent cardiac or vascular surgery under general anesthesia.
 Intervention(s): The patients were divided randomly into combined
short-axis-and-long-axis (n = 40), short-axis out-of-plane (SA-OOP) (n =
40), and long-axis in-plane (LA-IP) (n = 40) groups and received
ultrasound-guided central venous catheterization at the right internal
jugular vein. Measurements and Main Results: Successful guidewire
insertion without posterior wall puncture was performed in 40 patients
(100%) in the combined short-axis-and-long-axis approach group, 28 (70%)
in the short-axis out-of-plane approach group, and 38 (95%) in the LA-IP
approach group (combined short-axis-and-long-axis v SA-OOP, p = 0.0002
[relative risk = 1.43; 95% CI: 1.17-1.75]; combined
short-axis-and-long-axis v LA-IP, p = 0.49 [relative risk = 1.05; 95% CI:
0.98-1.13]). Procedure durations were 28.5 (24.1-36.4) seconds in the
combined short-axis-and-long-axis group, 31.7 (24.4-40.6) seconds in the
SA-OOP group, and 24.3 (20.8-32.1) seconds in the long-axis in-plane group
(combined short-axis-and-long-axis v SA-OOP, p = 0.53; combined
short-axis-and-long-axis v LA-IP, p = 0.044). Conclusion(s): The
combined short-axis-and-long-axis approach for ultrasound-guided central
venous catheterization had a lower posterior wall puncture rate than the
SA-OOP approach, but there was no significant difference with the
long-axis in-plane approach. Copyright © 2019 Elsevier Inc.

<37>
Accession Number
2001920368
Title
A Pilot Randomized Controlled Study of Mild Hypercapnia During Cardiac
Surgery With Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Chan M.J.; Lucchetta L.; Cutuli S.; Eyeington C.; Glassford N.J.;
Martensson J.; Angelopoulos P.; Matalanis G.; Weinberg L.; Eastwood G.M.;
Bellomo R.
Institution
(Chan, Lucchetta, Cutuli, Eyeington, Glassford, Martensson, Eastwood,
Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Angelopoulos) Department of Cardiac Perfusion, Austin Hospital,
Melbourne, Australia
(Matalanis) Department of Cardiac Surgery, Austin Hospital, Melbourne,
Australia
(Weinberg) Department of Anaesthesia, Austin Hospital, Melbournez,
Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
(Bellomo) Data Assessment Research Evaluation Centre, University of
Melbourne and Austin Hospital, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objectives: To test whether targeted therapeutic mild hypercapnia (TTMH)
would attenuate cerebral oxygen desaturation detected using near-infrared
spectroscopy during cardiac surgery requiring cardiopulmonary bypass
(CPB). Design(s): Randomized controlled trials. Setting(s):
Operating rooms and intensive care unit of tertiary hospital.
 Participant(s): The study comprised 30 patients undergoing cardiac
surgery with CPB. Intervention(s): Patients were randomly assigned to
receive either standard carbon dioxide management (normocapnia) or TTMH
(target arterial carbon dioxide partial pressure between 50 and 55 mmHg)
throughout the intraoperative period and postoperatively until the onset
of spontaneous ventilation. Measurements and Main Results: Relevant
biochemical and hemodynamic variables were measured, and cerebral tissue
oxygen saturation (SctO<inf>2</inf>) was monitored with near-infrared
spectroscopy. Patients were followed-up with neuropsychological testing.
Patient demographics between groups were compared using the Fisher exact
and Mann-Whitney tests, and SctO<inf>2</inf> between groups was compared
using repeated measures analysis of variance. The median patient age was
67 years (interquartile range [IQR] 62-72 y), and the median EuroSCORE II
was 1.1. The median CPB time was 106 minutes. The mean intraoperative
arterial carbon dioxide partial pressure for each patient was
significantly higher with TTMH (52.1 mmHg [IQR 49.9-53.9 mmHg] v 40.8 mmHg
[IQR 38.7-41.7 mmHg]; p < 0.001) as was pulmonary artery pressure (23.9
mmHg [IQR 22.4-25.3 mmHg] v 18.5 mmHg [IQR 14.8-20.7 mmHg]; p = 0.004).
There was no difference in mean percentage change in SctO<inf>2</inf>
during CPB in the control group for both hemispheres (left: -6.7% v -2.3%;
p = 0.110; right: -7.9% v -1.0%; p = 0.120). Compliance with
neuropsychological test protocols was poor. However, the proportion of
patients with drops in test score >20% was similar between groups in all
tests. Conclusion(s): TTMH did not increase SctO<inf>2</inf>
appreciably during CPB but increased pulmonary artery pressures before and
after CPB. These findings do not support further investigation of TTMH as
a means of improving SctO<inf>2</inf> during and after cardiac surgery
requiring CPB. Copyright © 2019 Elsevier Inc.

<38>
Accession Number
2001920356
Title
Development and Validation of a Score to Identify Cardiac Surgery Patients
at High Risk of Prolonged Mechanical Ventilation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Hessels L.; Coulson T.G.; Seevanayagam S.; Young P.; Pilcher D.; Marhoon
N.; Bellomo R.
Institution
(Hessels, Marhoon, Bellomo) Data Analytics, Research and Evaluation
Centre, Austin Hospital, University of Melbourne, Melbourne, Australia
(Hessels, Bellomo) Department of Intensive Care, Austin Hospital,
Melbourne, Australia
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
(Coulson) Department of Anaesthesia, Austin Hospital, Melbourne, Australia
(Seevanayagam) Department of Cardiac Surgery, Austin Hospital, Melbourne,
Australia
(Young) Medical Research Institute of New Zealand, Wellington, New Zealand
(Young) Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
(Pilcher) Department of Intensive Care, Alfred Hospital, Melbourne,
Australia
(Pilcher) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Bellomo) Centre of Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Publisher
W.B. Saunders
Abstract
Objective: To develop and validate a score for the early identification of
cardiac surgery patients at high risk of prolonged mechanical ventilation
(MV) who may be suitable targets for interventional trials.
 Design(s): Retrospective analysis. Setting(s): Tertiary
intensive care unit. Participant(s): Cardiac surgery patients.
 Intervention(s): Observational study. Measurements and Main
Results: The study comprised 1,994 patients. Median age was 67 years, and
1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A
total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for >=24,
>=36, and >=48 hours, respectively. In-hospital mortality was 13%, 15%,
and 17%, respectively. For the study model, all preoperative,
intraoperative, and early (first 4 hours) postoperative variables were
considered. A multivariable logistic regression model was developed, and a
predictive scoring system was derived. Using MV >=24 hours as the primary
outcome, the model performance in the development set was good with a
c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score
of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948),
Brier's score was 0.059, and the model remained well calibrated.
 Conclusion(s): The authors developed a simple score to predict
prolonged MV after cardiac surgery. This score, if externally validated,
is potentially suitable for identifying a high-risk target population for
future randomized controlled trials of postoperative care after cardiac
surgery. Copyright © 2019 Elsevier Inc.

<39>
Accession Number
627234012
Title
Checkpoint inhibitor therapy for cancer in solid organ transplantation
recipients: An institutional experience and a systematic review of the
literature.
Source
Journal for ImmunoTherapy of Cancer. 7 (1) (no pagination), 2019. Article
Number: 106. Date of Publication: 16 Apr 2019.
Author
Abdel-Wahab N.; Safa H.; Abudayyeh A.; Johnson D.H.; Trinh V.A.; Zobniw
C.M.; Lin H.; Wong M.K.; Abdelrahim M.; Gaber A.O.; Suarez-Almazor M.E.;
Diab A.
Institution
(Abdel-Wahab, Suarez-Almazor) Section of Rheumatology and Clinical
Immunology, Department of General Internal Medicine, University of Texas,
MD Anderson Cancer Center, Houston, TX, United States
(Abdel-Wahab) Department of Rheumatology and Rehabilitation, Faculty of
Medicine, Assiut University Hospitals, Assiut, Egypt
(Safa, Johnson, Trinh, Zobniw, Wong, Diab) Department of Melanoma Medical
Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX,
United States
(Abudayyeh) Section of Nephrology, Division of Internal Medicine,
University of Texas, MD Anderson Cancer Center, Houston, TX, United States
(Lin) Department of Biostatistics, University of Texas, MD Anderson Cancer
Center, Houston, TX, United States
(Abdelrahim, Gaber) Houston Methodist Hospital, Houston, TX, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Checkpoint inhibitors (CPIs) have revolutionized the treatment
of cancer, but their use remains limited by off-target inflammatory and
immune-related adverse events. Solid organ transplantation (SOT)
recipients have been excluded from clinical trials owing to concerns about
alloimmunity, organ rejection, and immunosuppressive therapy. Thus, we
conducted a retrospective study and literature review to evaluate the
safety of CPIs in patients with cancer and prior SOT. Method(s): Data
were collected from the medical records of patients with cancer and prior
SOT who received CPIs at The University of Texas MD Anderson Cancer Center
from January 1, 2004, through March 31, 2018. Additionally, we
systematically reviewed five databases through April 2018 to identify
studies reporting CPIs to treat cancer in SOT recipients. We evaluated the
safety of CPIs in terms of alloimmunity, immune-related adverse events,
and mortality. We also evaluated tumor response to CPIs. Result(s):
Thirty-nine patients with allograft transplantation were identified. The
median age was 63 years (range 14-79 years), 74% were male, 62% had
metastatic melanoma, 77% received anti-PD-1 agents, and 59% had prior
renal transplantation, 28% hepatic transplantation, and 13% cardiac
transplantation. Median time to CPI initiation after SOT was 9 years
(range 0.92-32 years). Allograft rejection occurred in 41% of patients
(11/23 renal, 4/11 hepatic, and 1/5 cardiac transplantations), at similar
rates for anti-CTLA-4 and anti-PD-1 therapy. The median time to rejection
was 21 days (95% confidence interval 19.3-22.8 days). There were no
associations between time since SOT and frequency, timing, or type of
rejection. Overall, 31% of patients permanently discontinued CPIs because
of allograft rejection. Graft loss occurred in 81%, and death was reported
in 46%. Of the 12 patients with transplantation biopsies, nine (75%) had
acute rejection, and five of these rejections were T cell-mediated. In
melanoma patients, 36% responded to CPIs. Conclusion(s): SOT
recipients had a high allograft rejection rate that was observed shortly
after CPI initiation, with high mortality rates. Further studies are
needed to optimize the anticancer treatment approach in these
patients. Copyright © 2019 The Author(s).

<40>
Accession Number
627429112
Title
The combined effect of surgeon and hospital volume on health outcomes: A
systematic review.
Source
Clinica Terapeutica. 170 (2) (pp E148-E161), 2019. Date of Publication: 01
Mar 2019.
Author
Saulle R.; Vecchi S.; Cruciani F.; Mitrova Z.; Amato L.; Davoli M.
Institution
(Saulle, Vecchi, Cruciani, Mitrova, Amato, Davoli) Department of
Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112,
Rome 00147, Italy
Publisher
Societa Editrice Universo (E-mail: amministrazione@seu-roma.it)
Abstract
Objectives. To explore the interaction between surgeon volumes (SVs) and
hospital volumes (HVs) on health outcomes. Materials and Methods. We
searched MEDLINE, Embase, CINAHL, Web of Science as of May 2017. We
included studies investigating the interaction between high or low SVs
operating in high or low HVs. Review process follows the PRISMA
guidelines. We assessed the methodological quality of the included studies
using validated critical appraisal checklists. Results. Sixteen studies
were included. Due to the heterogeneity of studies, it was not possible to
perform a quantitative analysis. Heath outcome are worse when high SV
operating in low HV vs high HV, for the majority of the conditions
(colorectal cancer, cystectomy, liver resection, mitral valve surgery,
pancreatico-duodenectomy). Results for low SV are better when operating in
high HV vs low HV for patients undergoing pancreatic-duodenectomy for
mortality, 30 days complications and length of stay. Results for low SV
are worse vs high SV when operating in high HV for most considered
conditions. Results were in favour of higher SV vs low SV when operating
in low HV for digital replantation success after injuries, 30 days
mortality and complications after pancreatic-duodenectomy. Conclusion. The
available evidence is limited. It is necessary to increase the monitoring
of the association between surgeons volumes and hospitals volumes in which
they operate, to ensure fairness and accuracy of care for better health
outcomes. Copyright © 2019 Societa Editrice Universo. All Rights
Reserved.

<41>
Accession Number
620707401
Title
Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting
Stent Implantation in Elderly Patients: A Meta-Analysis of Individual
Participant Data From 6 Randomized Trials.
Source
JACC: Cardiovascular Interventions. 11 (5) (pp 435-443), 2018. Date of
Publication: 12 Mar 2018.
Author
Lee S.-Y.; Hong M.-K.; Palmerini T.; Kim H.-S.; Valgimigli M.; Feres F.;
Colombo A.; Gilard M.; Shin D.-H.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi
D.; Jang Y.; Stone G.W.
Institution
(Lee) Sanbon Hospital, Wonkwang University College of Medicine, Gunpo,
South Korea
(Hong, Shin, Kim, Kim, Ko, Choi, Jang) Severance Cardiovascular Hospital,
Yonsei University Health System, Seoul, South Korea
(Hong, Shin, Kim, Kim, Ko, Choi, Jang) Cardiovascular Research Institute,
Yonsei University College of Medicine, Seoul, South Korea
(Hong, Jang) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Kim) Department of Internal Medicine, Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Valgimigli) Department of Cardiology, Bern University Hospital,
University of Bern, Switzerland
(Feres) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Gilard) Department of Cardiology, CHU de la Cavale Blanche, Brest, France
(Stone) Columbia University Medical Center/New York-Presbyterian Hospital
and the Cardiovascular Research Foundation, New York, New York, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to evaluate the optimal duration of dual
antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent
(DES) in elderly patients. Background(s): Qualified studies to
evaluate the optimal duration of DAPT in elderly patients have been very
limited. Method(s): Using 6 randomized trials that compared
short-term (<=6 months) and long-term (12 months) DAPT, individual
participant data meta-analysis was performed in elderly patients (>=65
years of age). The primary study outcome was the 12-month risk of a
composite of myocardial infarction, definite or probable stent thrombosis,
or stroke. The major secondary outcome was the 12-month risk of major
bleeding. Result(s): The primary outcome risk did not significantly
differ between patients receiving short-term and long-term DAPT (hazard
ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581)
in the overall group of study participants. In subgroup analysis, a
significant interaction between age and DAPT duration was observed for
primary outcome risk (p for interaction = 0.0384). In the subset of
younger patients (<65 years of age, n = 6,152), short-term DAPT was
associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to
2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of
primary outcome did not significantly differ between patients receiving
short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p =
0.2856). Short-term DAPT was associated with a significant reduction in
major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to
0.84; p = 0.0081) in the overall group, and particularly in elderly
patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196). Conclusion(s):
Short-term DAPT after new-generation DES implantation may be more
beneficial in elderly patients than in younger patients. Copyright
© 2018 American College of Cardiology Foundation

<42>
Accession Number
615488249
Title
Obstructive sleep apnea increases the risk of cardiac events after
percutaneous coronary intervention: a meta-analysis of prospective cohort
studies.
Source
Sleep and Breathing. 22 (1) (pp 33-40), 2018. Date of Publication: 01 Mar
2018.
Author
Qu H.; Guo M.; Zhang Y.; Shi D.-Z.
Institution
(Qu, Guo, Zhang, Shi) China Heart Institute of Chinese Medicine, China
Academy of Chinese Medical Sciences, Beijing, China
(Qu) Graduate School of Beijing University of Traditional Chinese
Medicine, Beijing, China
(Qu, Guo, Zhang, Shi) Xiyuan Hospital, China Academy of Traditional
Chinese, Beijing, China
(Guo) Graduate School of China Academy of Chinese Medical Sciences,
Beijing, China
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Recent studies have shown an association between obstructive
sleep apnea (OSA) and coronary artery disease; however, the association
between OSA and cardiac outcomes in patients after percutaneous coronary
intervention (PCI) remains undetermined. Method(s): PubMed, EMBASE,
and CENTRAL were searched from inception to July 2016 for cohort studies
that followed up with patients after PCI, and evaluated their overnight
sleep patterns within 1 month for major adverse cardiac events (MACEs) as
primary outcomes including cardiac death, non-fatal myocardial infarction
(MI), and coronary revascularization and secondary outcomes including
re-admission for heart failure and stroke. Outcomes data were pooled using
fixed-effect meta-analysis, and heterogeneity was assessed with the
I2 statistics. The methodological quality of the studies was
assessed using the Newcastle-Ottawa Scale checklist, and publication bias
was evaluated by a visual investigation of funnel plots. Result(s):
We identified seven pertinent studies including 2465 patients from 178
related articles. OSA was associated with MACEs (odds ratio [OR], 1.52,
95% confidence interval [CI], 1.20-1.93, I2 = 29%), which
included cardiac death (OR 2.05, 95% CI, 1.15-3.65, I2 = 0%),
non-fatal MI (OR 1.59, 95% CI, 1.14-2.23, I2 = 15%), and
coronary revascularization (OR 1.69, 95% CI, 1.28-2.23, I2 =
0%). However, OSA was not associated with re-admission for heart failure
(OR 1.71, 95% CI, 0.99-2.96, I2 = 0%) and/or stroke (OR 1.68,
95% CI, 0.91-3.11, I2 = 0%) according to the pooled results.
 Conclusion(s): In patients after PCI, OSA appears to increase the
risk of cardiac death, non-fatal MI, and coronary
revascularization. Copyright © 2017, Springer-Verlag Berlin
Heidelberg.

<43>
Accession Number
619384508
Title
Influence of Bayesian optimization on the performance of propofol
target-controlled infusion.
Source
British Journal of Anaesthesia. 119 (5) (pp 918-927), 2017. Date of
Publication: 01 Nov 2017.
Author
Van Den Berg J.P.; Eleveld D.J.; De Smet T.; Van Den Heerik A.V.M.; Van
Amsterdam K.; Lichtenbelt B.J.; Scheeren T.W.L.; Absalom A.R.; Struys
M.M.R.F.
Institution
(Van Den Berg, Eleveld, Van Den Heerik, Van Amsterdam, Lichtenbelt,
Scheeren, Absalom, Struys) Department of Anesthesiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(De Smet) Demed Medical, Temse, Belgium
(Struys) Department of Anaesthesia and Peri-Operative Medicine, Ghent
University, Ghent, Belgium
Publisher
Oxford University Press
Abstract
Background Target controlled infusion (TCI) systems use population-based
pharmacokinetic (PK) models that do not take into account inter-individual
residual variation. This study compares the bias and inaccuracy of a
population-based vs a personalized TCI propofol titration using Bayesian
adaptation. Haemodynamic and hypnotic stability, and the prediction
probability of alternative PK models, was studied. Methods. A
double-blinded, prospective randomized controlled trial of 120 subjects
undergoing cardiac surgery was conducted. Blood samples were obtained at
10, 35, 50, 65, 75 and 120 min and analysed using a point-of-care propofol
blood analyser. Bayesian adaptation of the PK model was applied at 60 min
in the intervention group. Median (Absolute) Performance Error (Md(A)PE)
was used to evaluate the difference between bias and inaccuracy of the
models. Haemodynamic (mean arterial pressure [MAP], heart rate) and
hypnotic (bispectral index [BIS]) stability was studied. The predictive
performance of four alternative propofol PK models was studied. Results.
MdPE and MdAPE did not differ between groups during the pre-Adjustment
period (control group: 6.3% and 16%; intervention group: 5.4% and 18%).
MdPE differed in the post-Adjustment period (12% vs.-0.3%), but MdAPE did
not (18% vs. 15%). No difference in heart rate, MAP or BIS was found.
Compared with the other models, the Eleveld propofol PK model (patients)
showed the best prediction performance. Conclusions. When an accurate
population-based PK model was used for propofol TCI, Bayesian adaption of
the model improved bias but not precision. Clinical trial registration
Dutch Trial Registry NTR4518. Copyright © The Author 2017.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia.All rights reserved.

<44>
Accession Number
2001817942
Title
Efficacy of preoperative amino acid supplements on postoperative physical
function and complications in open heart surgery patients: A study
protocol for a randomized controlled trial.
Source
Journal of Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Ogawa M.; Yoshida N.; Satomi-Kobayashi S.; Tsuboi Y.; Komaki K.; Wakida
K.; Gotake Y.; Inoue T.; Tanaka H.; Yamashita T.; Sakai Y.; Izawa K.P.;
Takahashi M.; Ogawa W.; Hirata K.-I.
Institution
(Ogawa, Tsuboi, Komaki) Division of Rehabilitation Medicine, Kobe
University Hospital, Kobe, Japan
(Ogawa, Izawa) Department of Public Health, Kobe University Graduate
School of Health Sciences, Kobe, Japan
(Yoshida, Satomi-Kobayashi, Yamashita, Hirata) Division of Cardiovascular
Medicine, Department of Internal Medicine, Kobe University Graduate School
of Medicine, Kobe, Japan
(Wakida, Takahashi, Ogawa) Department of Nutrition, Kobe University
Hospital, Kobe, Japan
(Gotake, Inoue, Tanaka) Division of Cardiovascular Surgery, Department of
Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
(Sakai) Division of Rehabilitation Medicine, Kobe University Graduate
School of Medicine, Kobe, Japan
(Takahashi, Ogawa) Division of Diabetes and Endocrinology, Department of
Internal Medicine, Kobe University Graduate School of Medicine, Kobe,
Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Elderly patients undergoing cardiac surgery often show poor
nutritional status, muscle wasting, and sarcopenia, which are reported to
affect postoperative functional recovery and incidence of complications.
Amino acids are essential in maintaining nutritional status, synthesizing
muscle protein, and promoting beneficial energy balance of the heart
muscle. beta-Hydroxy beta-methylbutyric acid (HMB) is a leucine metabolite
known to increase muscle protein synthesis and inhibit protein catabolism;
it has been used to more effectively support patients with muscle wasting
due to wearing diseases. However, the efficacy of amino acid
administration comprising HMB in patients undergoing open heart surgery
remains unclear. This study aims to examine whether preoperative
short-term aggressive amino acid administration helps support
postoperative recovery of physical function and prevent complications.
 Method(s): This is a single-center prospective randomized controlled
trial (UMIN000030490). Patients aged >=65 years who will be hospitalized
for medical examination before cardiac surgery will be recruited. The
participants will be randomly assigned to the experimental or control
group. The experimental group will be administered with an amino acid
supplement with HMB 1200 mg, L-glutamine 7000 mg, and L-arginine 7000 mg
once or twice per day depending on the degree of renal dysfunction, for
14-28 days preoperatively. The control group will not receive any
nutritional intervention. The main outcome will be a change in the 6-min
walking test distance pre- and postoperatively as a sign of functional
recovery. Secondary outcomes such as the incidence of complications;
physical, nutritional, and psychological states; mortality; and length of
hospital stay will also be evaluated. Conclusion(s): This clinical
study will determine the effects of preoperative short-term oral amino
acid supplementation with HMB, L-glutamine, and L-arginine on
postoperative physical function in elderly patients undergoing cardiac
surgery. Copyright © 2019

<45>
[Use Link to view the full text]
Accession Number
611972454
Title
Oral Anticoagulation in the Elderly: New Oral Anticoagulants-Innovative
Solution for an Old Problem?.
Source
American Journal of Therapeutics. 26 (1) (pp e133-e142), 2019. Date of
Publication: 01 Jan 2019.
Author
Barbosa M.; Menezes Falcao L.
Institution
(Barbosa, Menezes Falcao) Emergency Department, Vila Franca de Xira
Hospital and Internal Medicine Department of the CUF Torres Vedras
Hospital, Torres Vedras, Portugal
(Menezes Falcao) Department of Internal Medicine, Santa Maria Hospital,
Lisbon University of Medicine, Avenue Prof. Egas Moniz, Lisboa 1649-035,
Portugal
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Direct oral anticoagulants emerge as the most innovative and promising
drug toward preventing and treating cardiovascular disease, raising great
interest among the scientific community. Numerous studies and
meta-analysis generated much data clarifying clinicians' doubts; however,
uncertainties remain regarding their use in particular groups such as
patients with prosthetic valves, in valvular atrial fibrillation (defined
as atrial fibrillation related to mitral rheumatic heart disease or
prosthetic heart valves), among the elderly, in paraneoplastic
thromboembolism, in pulmonary embolism with hemodynamic compromise, and
scarcity of specific antidotes. This review article intends to condense
the vast scientific production addressing new oral anticoagulants by
focusing on their advantages and disadvantages when used on the
elderly. Copyright © 2018 Wolters Kluwer Health, Inc.

<46>
Accession Number
626815385
Title
Outcomes after Ross procedure in adult patients: A meta-analysis and
microsimulation.
Source
Journal of Cardiac Surgery. 34 (5) (pp 285-292), 2019. Date of
Publication: May 2019.
Author
Sibilio S.; Koziarz A.; Belley-Cote E.P.; McClure G.R.; MacIsaac S.; Reza
S.J.; Um K.J.; Lengyel A.; Mendoza P.; Alsagheir A.; Alraddadi H.; Gupta
S.; Schneider A.W.; Patel P.M.; Brown J.W.; Chu M.W.A.; Peterson M.D.;
Ouzounian M.; Paparella D.; El-Hamamsy I.; Whitlock R.P.
Institution
(Sibilio) Facolta di Medicina e Chirugia, University of Bari "Aldo Moro",
Bari, Italy
(Koziarz) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Koziarz, McClure, MacIsaac, Reza, Lengyel, Mendoza, Alsagheir, Alraddadi,
Gupta, Whitlock) Department of Surgery, Division of Cardiac Surgery,
McMaster University, Hamilton, ON, Canada
(Belley-Cote, Um) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Belley-Cote, McClure, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(MacIsaac) School of Medicine, Faculty of Medicine and Health Sciences,
Royal College of Surgeons in Ireland, Dublin, Ireland
(Alsagheir) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Schneider) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Patel) Department of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States
(Brown) Section of Cardiothoracic Surgery, Indiana University School of
Medicine, Indianapolis, IN, United States
(Chu) Department of Surgery, Division of Cardiac Surgery, London Health
Sciences Centre, Western University, London, ON, Canada
(Peterson) Division of Cardiac Surgery, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Ouzounian) Division of Cardiac Surgery, Peter Munk Cardiac Center,
University of Toronto, Toronto, ON, Canada
(Paparella) Department of Emergency and Organ Transplant, Division of
Cardiac Surgery and Santa Maria Hospital, GVM Care & Research, University
of Bari "Aldo Moro", Bari, Italy
(El-Hamamsy) Division of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: We conducted a meta-analysis to estimate the risk of adverse
events, life expectancy, and event-free life expectancy after the Ross
procedure in adults. Method(s): We searched databases for reports
evaluating the Ross procedure in patients aged more than or equal to 16
years of age. A microsimulation model was used to evaluate age- and
gender-specific life expectancy for patients undergoing the Ross
procedure. Result(s): Data were pooled from 63 articles totaling 19
155 patients from 20 countries. Perioperative mortality was 2.5% (95%
confidence interval [CI]: 1.9-3.1; N = 9978). We found a mortality risk of
5.9% (95% CI: 4.8-7.2) at a mean follow-up of 7.2 years (N = 7573). The
rate of perioperative clinically significant bleeding was 1.0% (95% CI:
0.1-3.0); re-exploration for bleeding 4.6% (95% CI: 3.1-6.3);
postoperative clinically significant bleeding from 30 days until a mean of
7.1 years was 0.5% (95% CI: 0.2-1.0). At a mean of 6.9 years of follow-up,
reintervention rate of any operated valve was 7.9% (95% CI: 5.7-10.3). The
risk of valve thrombosis was 0.3% (95% CI: 0.2-0.5) at 7.6 years;
peripheral embolism 0.3% (95% CI: 0.2-0.4) at 6.4 years; stroke 0.9% (95%
CI: 0.7-1.2) at 6.5 years; and endocarditis 2.1% (95% CI: 1.6-2.6) at 8.0
years. Microsimulation reported a 40-year-old undergoing the Ross
procedure to have a life expectancy of 35.4 years and event-free life
expectancy of 26.6 years. Conclusion(s): Ross procedure in nonelderly
adults is associated with low mortality and low risk of adverse events
both at short- and long-term follow-up. The surgical community must
prioritize a large, expertize-based randomized controlled trial to
definitively address the risks and benefits of the Ross procedure compared
to conventional aortic valve replacement. Copyright © 2019 Wiley
Periodicals, Inc.

<47>
Accession Number
626925100
Title
Decreasing Postoperative Blood Loss by Topical vs. Intravenous Tranexamic
Acid in Open Cardiac Surgery (DEPOSITION) study: Results of a pilot study.
Source
Journal of Cardiac Surgery. 34 (5) (pp 305-311), 2019. Date of
Publication: May 2019.
Author
Habbab L.M.; Hussain S.; Power P.; Bashir S.; Gao P.; Semelhago L.;
VanHelder T.; Parry D.; Chu V.; Lamy A.
Institution
(Habbab, Hussain, Power, Bashir, Gao, Semelhago, VanHelder, Parry, Chu,
Lamy) Division of Cardiac Surgery, David Braley Cardiac, Vascular and
Stroke Research Institute, Hamilton General Hospital, McMaster University,
Hamilton, ON, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Cardiac surgery patients are at high risk for postoperative
bleeding. Intravenous (IV) tranexamic acid (TxA) is a commonly used
antifibrinolytic drug, but is associated with postoperative seizures. We
conducted this pilot randomized controlled trial (RCT) to determine the
feasibility of a larger trial that will be designed to investigate the
impact of TxA administration route, intrapericardial (IP) vs IV, on
postoperative bleeding and seizures. Method(s): In this
single-center, double-blinded, pilot RCT we enrolled adult patients
undergoing nonemergent on-pump cardiac operations through a median
sternotomy. Participants were randomized to IP or IV TxA groups. The
primary outcomes were cumulative chest tube drainage, transfusion
requirements, and incidence of postoperative seizures. Result(s): A
total of 97 participants were randomized to the intervention and control
groups. Baseline characteristics were similar in both groups. Most
participants underwent a CABG and/or aortic valve replacement. There was
no statistical difference. The IP TxA group was found to have a tendency
for less chest tube drainage in comparison to the IV TxA group, 500.5
(370.0-700.0) and 540.0 (420.0-700.0) mL, respectively, which was not
statistically significant (P = 0.2854). Fewer participants in the IP TxA
group with cardiac tamponade and/or required a reoperation for bleeding
and fewer packed red blood cell transfusions. None of the IP TxA group
developed seizure vs one from the IV TxA group. Conclusion(s): This
is the first known pilot RCT to investigate the role of TxA route of
administration in open cardiac surgery. Intrapericardial TxA shows
promising results with decreased bleeding, transfusion requirements,
reoperations, and postoperative seizures. A larger RCT is needed to
confirm these results and lead to a change in practice. Copyright
© 2019 Wiley Periodicals, Inc.

<48>
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. 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). 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). 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. Copyright ©
2019, Springer Science+Business Media, LLC, part of Springer Nature.

<49>
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. Copyright © The Author(s) 2019.

<50>
Accession Number
2001513448
Title
Moraxella nonliquefaciens septic arthritis in a hematopoietic stem cell
transplant patient a case report and review of the literature.
Source
Journal of Infection and Public Health. 12 (3) (pp 309-312), 2019. Date of
Publication: May - June 2019.
Author
Khalife M.; Merashli M.; Kanj S.S.
Institution
(Khalife, Kanj) From the Division of Infectious Diseases, Department of
Internal Medicine, American University of Beirut Medical Center, Beirut,
Lebanon
(Merashli) Division of Allergy, Immunology and Rheumatology, Department of
Internal Medicine, American University of Beirut Medical Center, Beirut,
Lebanon
Publisher
Elsevier Ltd
Abstract
Background: Septic arthritis is a common rheumatologic condition with
myriad microbiological causative agents. Moraxella is one of the very rare
causes of septic arthritis. We hereby present the third case of Moraxella
nonliquefaciens septic arthritis and the first case in a hematopoietic
stem cell transplant patient (HSCT) along with a brief review of the
literature. Method(s): We used PubMed with google search engine to
search the literature for reported cases of moraxella septic arthritis.
 Result(s): Information on 19 other cases of moraxella infectious
arthritis was found. M. catarrhalis was the most common species isolated.
Only 2 reports on M. nonliquefaciens were found; the first one in a
multiple myeloma patient and the second one in a diabetic patient on
hemodialysis. Predisposing conditions included inflammatory arthritis,
prosthetic joints, diabetes, Human Immunodeficiency Virus (HIV) infection,
Hepatitis C, hemodialysis, esophageal cancer, valve replacements,
alcoholism and Intravenous (IV) drug use. The age group of the reported
cases ranged from 3 months to 78 years. Conclusion(s): Infectious
arthritis with Moraxella spp. is a very rare entity which can occur in any
age group and in the setting of various underlying medical
conditions. Copyright © 2019 The Authors

<51>
[Use Link to view the full text]
Accession Number
627482834
Title
Heart Transplantation With Donation After Circulatory Death.
Source
Circulation. Heart failure. 12 (4) (pp e005517), 2019. Date of
Publication: 01 Apr 2019.
Author
Niederberger P.; Farine E.; Raillard M.; Dornbierer M.; Freed D.H.; Large
S.R.; Chew H.C.; MacDonald P.S.; Messer S.J.; White C.W.; Carrel T.P.;
Tevaearai Stahel H.T.; Longnus S.L.
Institution
(Niederberger, Farine, Dornbierer, Carrel, Tevaearai Stahel, Longnus)
Department of Cardiovascular Surgery, Inselspital, Bern University
Hospital and Department for BioMedical Research, University of Bern, E.F.,
T.P.C., M.D, United States
(Raillard) Experimental Surgery Unit (ESI), Experimental Surgery Unit,
Department for BioMedical Research and Vetsuisse Faculty, Department of
Clinical Veterinary Medicine, University of Bern, Czechia
(Freed, White) Cardiac Surgery, University of Alberta, Edmonton, Canada
(Large, Messer) Department of Transplantation, Royal Papworth Hospital,
Papworth Everard, Cambridge, United Kingdom (S.R.L., S.J.M.)
(Chew, MacDonald) University of New South Wales, Victor Chang Cardiac
Research Institute, St Vincent's Hospital, Sydney, Australia
Publisher
NLM (Medline)
Abstract
Heart transplantation remains the preferred option for improving quality
of life and survival for patients suffering from end-stage heart failure.
Unfortunately, insufficient supply of cardiac grafts has become an
obstacle. Increasing organ availability with donation after circulatory
death (DCD) may be a promising option to overcome the organ shortage.
Unlike conventional donation after brain death, DCD organs undergo a
period of warm, global ischemia between circulatory arrest and graft
procurement, which raises concerns for graft quality. Nonetheless, the
potential of DCD heart transplantation is being reconsidered, after
reports of more than 70 cases in Australia and the United Kingdom over the
past 3 years. Ensuring optimal patient outcomes and generalized adoption
of DCD in heart transplantation, however, requires further development of
clinical protocols, which in turn require a better understanding of
cardiac ischemia-reperfusion injury and the various possibilities to limit
its adverse effects. Thus, we aim to provide an overview of the knowledge
obtained with preclinical studies in animal models of DCD heart
transplantation, to facilitate and promote the most effective and
efficient advancement in preclinical research. A literature search of the
PubMed database was performed to identify all relevant preclinical studies
in DCD heart transplantation. Specific aspects relevant for DCD heart
transplantation were analyzed, including animal models, graft procurement
and storage conditions, cardioprotective approaches, and graft evaluation
strategies. Several potential therapeutic strategies for optimizing graft
quality are identified, and recommendations for further preclinical
research are provided.

<52>
[Use Link to view the full text]
Accession Number
627472092
Title
ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols
Eliminate Testing Disparities in Patients With Chest Pain.
Source
Critical Pathways in Cardiology. 18 (1) (pp 5-9), 2019. Date of
Publication: 01 Mar 2019.
Author
Miller C.D.; Stopyra J.P.; Mahler S.A.; Case L.D.; Vasu S.; Bell R.A.;
Hundley W.G.
Institution
(Miller, Stopyra, Mahler) Department of Emergency Medicine, Wake Forest
School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157,
United States
(Case) Department of Internal Medicine/Cardiology, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Vasu, Hundley) Department of Biostatistical Sciences, Wake Forest School
of Medicine, Winston-Salem, NC, United States
(Bell) Department of Epidemiology and Prevention, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Bell) Maya Angelou Center for Health Equity, Wake Forest School of
Medicine, Winston-Salem, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Patients from racial and ethnic minority groups presenting to
the Emergency Department (ED) with chest pain experience lower odds of
receiving stress testing compared with nonminorities. Studies have
demonstrated that care pathways administered within the ED can reduce
health disparities, but this has yet to be studied as a strategy to
increase stress testing equity. Method(s): A secondary analysis from
3 randomized clinical trials involving ED patients with acute chest pain
was performed to determine whether a care pathway, ACES (Accelerated Chest
pain Evaluation with Stress imaging), reduces the racial disparity in
index visit cardiac testing between African American (AA) and White
patients. Three hundred thirty-four participants with symptoms and
findings indicating intermediate to high risk for acute coronary syndrome
were enrolled in 3 clinical trials. Major exclusions were ST-segment
elevation, initial troponin elevation, and hemodynamic instability.
Participants were randomly assigned to receive usual inpatient care, or
ACES. The ACES care pathway includes placement in observation for serial
cardiac markers, with an expectation for stress imaging. The primary
outcome was index visit objective cardiac testing, compared among AA and
White participants. Result(s): AA participants represented 111/329
(34%) of the study population, 80/220 (36%) of the ACES group and 31/109
(28%) of the usual care group. In usual care, objective testing occurred
less frequently among AA (22/31, 71%) than among White (69/78, 88%, P =
0.027) participants, primarily driven by cardiac catheterization (3% vs.
24%; P = 0.012). In ACES, testing rates did not differ by race [AA 78/80
(98%) vs. White 138/140 (99%); P = 0.623]. At 90 days, death, MI, and
revascularization did not differ in either group between AA and White
participants. Conclusion(s): A care pathway with the expectation for
stress imaging eliminates the racial disparity among AA and White
participants with chest pain in the acquisition of index-visit
cardiovascular testing. Copyright © 2018 Wolters Kluwer Health,
Inc.

<53>
[Use Link to view the full text]
Accession Number
627473689
Title
Therapeutic challenges in patients with noncardioembolic acute ischemic
stroke in need of double antiplatelet therapy for coronary artery disease.
Source
American Journal of Therapeutics. 26 (2) (pp E213-E221), 2019. Date of
Publication: 01 Mar 2019.
Author
Oana Darabont R.; Stoicescu C.; Tiu C.
Institution
(Oana Darabont, Stoicescu) Discipline of Internal Medicine and Cardiology,
University Emergency Hospital Bucharest, University of Medicine and
Pharmacy Carol Davila, 169 Splaiul Independentei, 5th District, Bucharest
050098, Romania
(Tiu) Discipline of Neurology, University Emergency Hospital Bucharest,
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:The risk of ischemic stroke (IS) is significant within 6-12
months from the myocardial revascularization for an acute cardiac event.
Consequently, we can expect to have patients with an acute IS occurring
right in the time frame of dual antiplatelet therapy (DAPT) imposed by the
coronary heart disease (CHD).Areas of Uncertainty:Until present, there are
no evidence-based guidelines for the management of patients with acute IS
in need of DAPT for ischemic heart disease. The aim of this article was to
go through the available data and to depict the appropriate therapeutic
strategy for this category of patients. Data Sources:We have
performed a systematic review of the literature through June 2018, using
Medline/PubMed database.Therapeutic Advances:DAPT (aspirin and only
clopidogrel among all P2Y<inf>12</inf> inhibitors) might be maintained or
initiated for CHD in patients with minor acute stroke and high-risk
transient ischemic attack patient with IS attributable to an important
intracranial stenosis, as long as this drug combination proved to be safe
for them in the prevention of stroke recurrence. In patients with IS
receiving thrombolysis, with increased size of infarction or high National
Institute of Health Stroke Score (NIHSS), the risk of hemorrhagic
transformation under DAPT must be weighed against the risk of stent
thrombosis in the coronary arteries, which, on its turn, depends on the
clinical form for which myocardial revascularization was performed, the
time interval from the complexity of a certain interventional procedure.
 Conclusion(s):In the acute phase of an IS, maintenance or initiation
of DAPT therapy imposed by CHD relies, on one hand, on the risk of
hemorrhagic transformation of the brain injury and, on the other hand, on
the risk of stent thrombosis in the coronary arteries. The management of
these patients must be carried on by a vascular team, on an individualized
basis. Copyright © 2019 Wolters Kluwer Health, Inc. All rights
reserved.

<54>
Accession Number
627478789
Title
New-onset atrial fibrillation after percutaneous coronary intervention or
coronary artery bypass grafting for left main disease.
Source
Medicinski glasnik : official publication of the Medical Association of
Zenica-Doboj Canton, Bosnia and Herzegovina. 16 (2) (no pagination), 2019.
Date of Publication: 01 Aug 2019.
Author
Avdagic H.; Iveljic I.; Jahic E.; Sijercic S.; Krdzalic A.; Skakic A.;
Radovic J.; Ahmetasevic E.
Institution
(Avdagic, Jahic, Krdzalic, Skakic) Clinic for Cardiovascular Surgery,
University Clinical Center Tuzla, Bosnia and Herzegovina
(Iveljic, Radovic) Clinic for Invasive Cardiology, University Clinical
Center Tuzla, Bosnia and Herzegovina
(Sijercic) Clinic for Anesthesiology, University Clinical Center Tuzla,
Bosnia and Herzegovina
(Ahmetasevic) Clinic for Surgery, University Clinical Center Tuzla, Bosnia
and Herzegovina
Publisher
NLM (Medline)
Abstract
Aim To determine the prevalence of new-onset atrial fibrillation (NOAF)
following percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) for left main coronary artery disease (LMCAD) and
its effect on 6-month cardiovascular outcomes. Methods This prospective
study included 40 patients diagnosed with LMCAD, in the period from 2017
to 2018. The patients with LMCAD and low or intermediate SYNTAX score were
randomized to PCI with zotarolimus-eluting stents versus CABG. Outcomes
were analyzed according to the development of NOAF during the initial
hospitalization following revascularization. Results Among 40 patients
without atrial fibrillation on presentation, NOAF developed 3.1+/-1.3 days
during hospitalization in three CABG treated patients, and one PCI treated
patient. One patient that was CABG treated developed NOAF after two
months. Patients with versus patients without NOAF had a significantly
longer duration of hospitalization, probably because they were discharged
on anticoagulant therapy. Myocardial infarction was presented in one CABG
treated patient after 3 months, and also in one PCI treated patient after
4 months. One patient died 2 months after the operation, and one developed
stroke 5 months after the CABG operation. Conclusion The NOAF was common
after CABG, but extremely rare after PCI, and it occurred almost
exclusively following CABG. There was a clear statistical tendency for
all-cause death, cardiovascular death and stroke at 6-month follow-up
period. Copyright© by the Medical Assotiation of Zenica-Doboj
Canton.

<55>
Accession Number
2001912740
Title
Selected 2018 Highlights in Congenital Cardiac Anesthesia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Nasr V.G.; Gottlieb E.A.; Adler A.C.; Evans M.A.; Sawardekar A.; DiNardo
J.A.; Mossad E.B.; Mittnacht A.J.C.
Institution
(Nasr, DiNardo) Department of Anesthesiology, Critical Care and Pain
Medicine, Boston Children's Hospital, Boston, MA, United States
(Gottlieb) Department of Anesthesiology, Dell Medical School, University
of Texas in Austin, Austin, TX, United States
(Adler, Mossad) Division of Pediatric Cardiovascular Anesthesia, Baylor
College of Medicine, Texas Children's Hospital, Houston, TX, United States
(Evans, Sawardekar) Department of Anesthesiology, Northwestern
University's Feinberg School of Medicine, Chicago, IL, United States
(Mittnacht) Department of Anesthesiology, Perioperative and Pain Medicine,
The Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
W.B. Saunders
Abstract
THIS ARTICLE IS a review of the highlights of pertinent literature
published during the 12 months of 2018 that is of interest to the
congenital cardiac anesthesiologist. During a search of the US National
Library of Medicine PubMed database, several topics that displayed
significant contributions to the field in 2018 emerged. The authors of the
present review consider the following topics noteworthy: the patient with
high-risk congenital heart disease (CHD) presenting for noncardiac
surgery, cardiopulmonary resuscitation in infants and children with CHD,
dexmedetomidine use in pediatric patients, point-of-care lung ultrasound,
and regional anesthesia in pediatric cardiac surgery. Copyright ©
2019 Elsevier Inc.

<56>
Accession Number
2001900864
Title
Optimizing cerebral oxygenation in cardiac surgery: A randomized
controlled trial examining neurocognitive and perioperative outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Uysal S.; Lin H.-M.; Trinh M.; Park C.H.; Reich D.L.
Institution
(Uysal, Trinh, Park, Reich) Department of Anesthesiology, Perioperative
and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Lin) Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to determine whether targeted therapy
to optimize cerebral oxygenation is associated with improved
neurocognitive and perioperative outcomes. Method(s): In a
prospective trial, intraoperative cerebral oximetry monitoring using
bilateral forehead probes was performed in cardiac surgical patients who
were randomly assigned to an intervention group in which episodes of
cerebral oxygen desaturation (<60% for >60 consecutive seconds at either
probe) triggered an intervention protocol or a control group in which the
cerebral oximetry data were hidden from the clinical team, and no
intervention protocol was applied. Cognitive testing was performed
preoperatively and at postoperative months 3 and 6; domains studied were
response speed, processing speed, attention, and memory. Perioperative
outcomes studied were death, hospital length of stay, intensive care unit
length of stay, postoperative day of extubation, time on mechanical
ventilation, intensive care unit delirium, Sequential Organ Failure
Assessment on intensive care unit admission, and intensive care unit blood
transfusion. Result(s): Group mean memory change scores were
significantly better in the intervention group at 6 months (0.60 [standard
error, 0.30] vs -0.17 [standard error, 0.33], adjusted P = .008). However,
presence, duration, and severity of cerebral desaturation were not
associated with cognitive change scores. Perioperative outcomes did not
differ between the intervention and control groups. Conclusion(s):
Targeted therapy to optimize cerebral oxygenation was associated with
better memory outcome in a group of cardiac surgical patients. Some
aspects of the protocol other than desaturation duration and severity
contributed to the observed neuroprotective effect. Copyright ©
2019 The American Association for Thoracic Surgery

<57>
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. 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.
 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). 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. Copyright
© 2018 Wiley Periodicals, Inc.

<58>
Accession Number
627378649
Title
Common Incidental Findings on Cardiac CT: a Systematic Review.
Source
Current Cardiovascular Imaging Reports. 12 (6) (no pagination), 2019.
Article Number: 21. Date of Publication: 01 Jun 2019.
Author
Kay F.U.; Canan A.; Abbara S.
Institution
(Kay, Canan, Abbara) Department of Radiology, Cardiothoracic Imaging
Division, UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Boulevard, Dallas, TX 75390-9316, United States
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Cardiac computed tomography (CT) is an established tool
for evaluating cardiovascular disease, which may incidentally depict
extracardiac findings (ECF). The aim of this study is to identify the
spectrum and the prevalence of incidental findings detected on cardiac CT.
Recent Findings: This systematic review found a median ECF occurrence of
45% in cardiac CT (range, 7-100%) among papers published between 2006 and
2018. The median clinically significant ECF occurrence was 17% (1-67%)
among studies. Respectively, the five most commonly reported ECF were lung
nodules or masses, lung parenchymal changes, lymphadenopathy, emphysema,
and liver nodules or cysts. Summary: ECF are frequently encountered
on cardiac CT. Therefore, interpreting physicians should be aware of the
occurrence of clinically significant findings and be familiar with the
follow-up recommendations endorsed by current guidelines. Copyright
© 2019, Springer Science+Business Media, LLC, part of Springer
Nature.

<59>
Accession Number
624784470
Title
Interaction between warfarin and cannabis.
Source
Basic and Clinical Pharmacology and Toxicology. 124 (1) (pp 28-31), 2019.
Date of Publication: January 2019.
Author
Damkier P.; Lassen D.; Christensen M.M.H.; Madsen K.G.; Hellfritzsch M.;
Pottegard A.
Institution
(Damkier, Christensen, Hellfritzsch) Department of Clinical Biochemistry
and Pharmacology, Odense University Hospital, Odense, Denmark
(Damkier, Christensen) Department of Clinical Research, University of
Southern Denmark, Odense, Denmark
(Lassen) Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
(Christensen) Hospital Pharmacy, Hospital of South West Denmark, Esbjerg,
Denmark
(Madsen) Department of Oncology, Odense University Hospital, Odense,
Denmark
(Madsen, Hellfritzsch, Pottegard) Clinical Pharmacology and Pharmacy,
Department of Public Health, University of Southern Denmark, Odense,
Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Delta-9-tetrahydrocannabinol (THC), the main psychoactive cannabinoid in
cannabis, may inhibit the cytochrome P450 enzyme CYP2C9. Consequently,
cannabis use might infer a risk of drug-drug interaction with substrates
for this enzyme, which includes drugs known to have a narrow therapeutic
window. In this study, we describe a case report of a 27-year-old man
treated with warfarin due to mechanical heart valve replacement who
presented with elevated international normalized ratio (INR) value (INR =
4.6) following recreational cannabis use. We conducted a review of the
available literature, using the PubMed and EMBASE databases while
following PRISMA guidelines. Following screening of 85 articles, three
eligible articles were identified, including one in vitro study and two
case reports. The in vitro study indicated that THC inhibits the
CYP2C9-mediated metabolism of warfarin. One case study reported of a man
who on two occasions of increased marijuana use experienced INR values
above 10 as well as bleeding. The other case study reported of a patient
who initiated treatment with a liquid formulation of cannabidiol for the
management of epilepsy, ultimately necessitating a 30% reduction in
warfarin dose to maintain therapeutic INR values. The available, although
sparse, data suggest that use of cannabinoids increases INR values in
patients receiving warfarin. Until further data are available, we suggest
patients receiving warfarin be warned against cannabis use. Copyright
© 2018 Nordic Association for the Publication of BCPT (former Nordic
Pharmacological Society)

<60>
[Use Link to view the full text]
Accession Number
627391862
Title
NHLBI-Sponsored Randomized Trial of Postconditioning during Primary
Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction.
Source
Circulation Research. 124 (5) (pp 769-778), 2019. Date of Publication: 01
Mar 2019.
Author
Traverse J.H.; Swingen C.M.; Henry T.D.; Fox J.; Wang Y.L.; Chavez I.J.;
Lips D.L.; Lesser J.R.; Pedersen W.R.; Burke N.M.; Pai A.; Lindberg J.L.;
Garberich R.F.
Institution
(Traverse, Henry, Fox, Wang, Chavez, Lips, Lesser, Pedersen, Burke, Pai,
Lindberg, Garberich) Minneapolis Heart Institute Foundation, Abbott
Northwestern Hospital, 920 E 28th St, Minneapolis, MN 55407, United States
(Swingen) Cardiovascular Division, University of Minnesota School of
Medicine, Minneapolis, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Postconditioning at the time of primary percutaneous coronary
intervention (PCI) for ST-segment-elevation myocardial infarction may
reduce infarct size and improve myocardial salvage. However, clinical
trials have shown inconsistent benefit. Objective(s): We performed
the first National Heart, Lung, and Blood Institute-sponsored trial of
postconditioning in the United States using strict enrollment criteria to
optimize the early benefits of postconditioning and assess its long-term
effects on left ventricular (LV) function. Methods and Results: We
randomized 122 ST-segment-elevation myocardial infarction patients to
postconditioning (4, 30 seconds PTCA [percutaneous transluminal coronary
angioplasty] inflations/deflations)+PCI (n=65) versus routine PCI (n=57).
All subjects had an occluded major epicardial artery (thrombolysis in
myocardial infarction=0) with ischemic times between 1 and 6 hours with no
evidence of preinfarction angina or collateral blood flow. Cardiac
magnetic resonance imaging measured at 2 days post-PCI showed no
difference between the postconditioning group and control in regards to
infarct size (22.5+/-14.5 versus 24.0+/-18.5 g), myocardial salvage index
(30.3+/-15.6% versus 31.5+/-23.6%), or mean LV ejection fraction. Magnetic
resonance imaging at 12 months showed a significant recovery of LV
ejection fraction in both groups (61.0+/-11.4% and 61.4+/-9.1%; P<0.01).
Subjects randomized to postconditioning experienced more favorable
remodeling over 1 year (LV end-diastolic volume =157+/-34 to 150+/-38 mL)
compared with the control group (157+/-40 to 165+/-45 mL; P<0.03) and
reduced microvascular obstruction (P=0.05) on baseline magnetic resonance
imaging and significantly less adverse LV remodeling compared with control
subjects with microvascular obstruction (P<0.05). No significant adverse
events were associated with the postconditioning protocol and all patients
but one (hemorrhagic stroke) survived through 1 year of follow-up.
 Conclusion(s): We found no early benefit of postconditioning on
infarct size, myocardial salvage index, and LV function compared with
routine PCI. However, postconditioning was associated with improved LV
remodeling at 1 year of follow-up, especially in subjects with
microvascular obstruction. Clinical Trial Registration: URL:
http://www.clinicaltrials.gov. Unique identifier:
NCT01324453. Copyright © 2019 American Heart Association, Inc.

<61>
Accession Number
627345848
Title
High-resolution respirometry in human endomyocardial biopsies shows
reduced ventricular oxidative capacity related to heart failure.
Source
Experimental and Molecular Medicine. 51 (2) (no pagination), 2019. Article
Number: 16. Date of Publication: 01 Feb 2019.
Author
Scheiber D.; Jelenik T.; Zweck E.; Horn P.; Schultheiss H.-P.; Lassner D.;
Boeken U.; Saeed D.; Kelm M.; Roden M.; Westenfeld R.; Szendroedi J.
Institution
(Scheiber, Zweck, Horn, Kelm, Westenfeld) Division of Cardiology,
Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine
University, Dusseldorf, Germany
(Scheiber, Jelenik, Zweck, Roden, Szendroedi) Institute for Clinical
Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research,
Heinrich Heine University, Dusseldorf, Germany
(Scheiber, Jelenik, Zweck, Roden, Szendroedi) German Center for Diabetes
Research (DZD e.V.), Munchen-Neuherberg, Partner Dusseldorf, Dusseldorf,
Germany
(Schultheiss, Lassner) Institute for Cardiac Diagnostics and Therapy
(IKDT), Berlin, Germany
(Boeken, Saeed) Clinic for Cardiovascular Surgery, Medical Faculty,
Heinrich-Heine University, Dusseldorf, Germany
(Kelm) Cardiovascular Research Institute Dusseldorf, Medical Faculty,
Heinrich-Heine University, Dusseldorf, Germany
(Roden, Szendroedi) Division of Endocrinology and Diabetology, Medical
Faculty, Heinrich-Heine University, Dusseldorf, Germany
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
The lifetime risk of developing heart failure is approximately 20%, and
survival rates remain poor. Myocardial mitochondrial function has been
suggested to play a pivotal role in heart failure pathophysiology. Human
studies on ex vivo mitochondrial function have mostly been limited to
atrial tissue obtained during open heart surgery and have provided
contradictory results. This study aimed at measuring myocardial
mitochondrial function in transcatheter ventricular endomyocardial
biopsies and assessing the relationship between oxidative capacity and
heart function. We enrolled 40 heart failure patients undergoing
ventricular assist device surgery or heart transplantation (34 males, age
57 +/- 11 years, body mass index 26.6 +/- 4.8 kg/m2) and 29
heart transplant recipients of comparable age and body mass index with
normal left ventricular function undergoing surveillance biopsies (23
males, 57 +/- 12 years, body mass index 26.2 +/- 4.1 kg/m2).
High-resolution respirometry was established in the myocardium to measure
oxidative capacity ex vivo. The mitochondrial oxidative capacity was 90%
higher in ventricular compared to atrial tissues (n = 11, p < 0.01) of
explanted hearts. Respiration rates were comparable in ventricular samples
of heart failure patients obtained during open heart surgery by standard
tissue preparation or ex vivo endomyocardial biopsy (r = 0.9988, p <
0.0001, n = 8), and the mitochondrial oxidative capacity in samples from
these patients remained stable for 8 h when stored in either of two common
preservation buffers. The oxidative capacity was 44% lower in heart
failure than in transplant recipients (67 +/- 3 vs. 97 +/- 5 pmol/[s mg],
p < 0.0001) and correlated positively with heart function (r = 0.49, p <
0.01). High-resolution respirometry of ventricular tissue is feasible in
transcatheter biopsies, facilitating clinical studies on myocardial
mitochondrial function in patients not undergoing heart
surgery. Copyright © 2019, The Author(s).

<62>
[Use Link to view the full text]
Accession Number
624732755
Title
Serum Uric Acid and Atrial Fibrillation: Meta-analysis.
Source
Critical Pathways in Cardiology. 17 (3) (pp 161-166), 2018. Date of
Publication: 01 Sep 2018.
Author
Pak S.; Yatsynovich Y.; Valencia D.; Chen T.
Institution
(Pak, Yatsynovich, Valencia) Department of Medicine, Kettering Medical
Center, Kettering, OH 45429, United States
(Chen) Department of Mathematics and Statistics, Toledo University,
Toledo, OH, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Hyperuricemia has been recently speculated to be associated with the
development of atrial fibrillation (AF). A meta-analysis of observational
studies was conducted to explore the relationship between serum uric acid
(SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and
performed extensive bibliography search to identify studies with mean SUA
level for patients with and without AF. Key search terms were "atrial
fibrillation" and "uric acid." Under the random-effects model, the pooled
standardized difference in means between patients with and without AF was
calculated. A total of 24 studies with 30,609 patients were included for
quantitative analyzation of the difference in SUA levels between the
patients with and without AF. The SUA level of patients with atrial AF was
found to be significantly higher compared with those without AF
(standardized difference in means = 0.66; 95% confidence interval,
0.43-0.88; P < 0.0001). The mean SUA level of patients with AF
significantly is higher than those without AF. Copyright © 2018
Wolters Kluwer Health, Inc. All rights reserved.

<63>
Accession Number
621206174
Title
Effect of hybrid treatment on rehabilitation and clinical condition of
patients with multivessel coronary artery disease.
Source
Polish Archives of Internal Medicine. 128 (2) (pp 77-88), 2018. Date of
Publication: 2018.
Author
Foik J.; Brzek A.; Gierlotka M.J.; Zembala M.O.; Gasior M.; Zembala M.
Institution
(Foik) Department of Rehabilitation, Silesian Center for Heart Diseases,
Zabrze, Poland
(Brzek) Department of Kinesiology, Department of Physiotherapy, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Gierlotka, Gasior) 3rd Department of Cardiology, Medical University of
Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
(Zembala, Zembala) Department of Cardiac Surgery and Transplantation,
Medical University of Silesia, Katowice, Silesian Center for Heart
Diseases, Zabrze, Poland
(Brzek) Wydzial Nauk O Zdrowiu W Katowicach, Zaklad Kinezjologii Katedry
Fizjoterapii, Slaski Uniwersytet Medyczny W Katowicach, ul. Medykow 12,
Katowice 40-754, Poland
Publisher
Medycyna Praktyczna (E-mail: listy@mp.pl)
Abstract
Introduction: Rehabilitation after coronary revascularization procedures
is an intrinsic part of treatment during the in-hospital period.
 Objective(s): We aimed to compare the course and effects of
rehabilitation in patients receiving hybrid treatment (minimally invasive
direct coronary artery bypass / percutaneous coronary intervention) or
classic treatment (coronary artery bypass grafting / off-pump coronary
artery bypass) during hospitalization. Patient s and methods: The study
included 200 patients participating in a prospective randomized clinical
trial (POLMIDES) that assessed the effect of hybrid treatment on
in-hospital outcomes and long-term results in patients with multivessel
coronary artery disease. Patients were divided into the classic and hybrid
groups. Result s: The classic group showed a higher perioperative risk
than the hybrid group (mean [SD] EuroSCORE, 3.54 [2.12] and 2.89 [1.97],
respectively). During all the rehabilitation cycles, lower arterial oxygen
saturation (SaO<inf>2</inf>) was reported in the hybrid group (P = 0.002).
The classic group showed lower systolic blood pressure (P <0.001), lower
diastolic blood pressure (P = 0.029), and a higher rate of blood pressure
drops during rehabilitation (P = 0.02). Patients from the classic group
were able to sit (P <0.001), assume a vertical position (P <0.001), and
walk (P = 0.01) earlier than those from the hybrid group. In the hybrid
group, earlier completion of rehabilitation and discharge from the
hospital were noted (P = 0.001). Conclusion(s): Patients receiving
hybrid coronary revascularization less often suffer from hypotonia events
but show lower SaO<inf>2</inf> values than patients receiving classic
treatment. Mobilization of patients receiving the hybrid treatment is
slower during the initial days and cycles of rehabilitation, but they
achieve full self-reliance earlier, which enables a shorter
hospitalization period. Copyright by Medycyna Praktyczna, Krakow
2018. Copyright © 2018 Medycyna Praktyczna. All rights reserved.

<64>
[Use Link to view the full text]
Accession Number
617717434
Title
Thoracic paravertebral block for postoperative pain management after renal
surgery: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 34 (9) (pp 596-601), 2017. Date of
Publication: 01 Sep 2017.
Author
Copik M.; Bialka S.; Daszkiewicz A.; Misiolek H.
Institution
(Copik, Bialka, Daszkiewicz, Misiolek) Department of Anaesthesiology and
Critical Care, School of Medicine, Division of Dentistry, Medical
University of Silesia, Zabrze, Poland
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Thoracic paravertebral block (ThPVB) combined with general
anaesthesia is used in thoracic and general surgery. It provides effective
analgesia, reduces surgical stress response and the incidence of chronic
postoperative pain. Objective(s): To assess the efficacy of ThPVB in
reducing opioid requirements and decreasing the intensity of pain after
renal surgery. Design(s): A randomised, open label study.
 Setting(s): A single university hospital. Study conducted from August
2013 to February 2014. Participant(s): In total, 68 patients
scheduled for elective renal surgery (open nephrectomy or open
nephron-sparing surgery). Intervention(s): Preoperative ThPVB with
0.5% bupivacaine combined with general anaesthesia, followed by
postoperative oxycodone combined with nonopioid analgesics as rescue
drugs. Follow-up period: 48 h. Main Outcome Measure(s): Total dose of
postoperative oxycodone required, pain intensity, occurrence of opioid
related adverse events, ThPVB-related adverse events and patient
satisfaction. Result(s): A total of 68 patients were randomised into
two groups and, of these, 10 were subsequently excluded from analysis.
Patients in group paravertebral block (PVB; n = 27) had general
anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n =
31) formed a control group receiving general anaesthesia only. Compared
with patients in group GEN, patients who received ThPVB required 39% less
i.v. oxycodone over the first 48 h and had less pain at rest (P < 0.01)
throughout the first 24 h. Group PVB patients also experienced fewer
opioid-related adverse events and were less sedated during the first 12
postoperative hours. Patients in the PVB group had higher satisfaction
scores at 48 h compared with the control group. There were no serious
adverse events. Conclusion(s): In our study, preoperative ThPVB was
an effective part of a multimodal analgesia regimen for reducing opioid
consumption and pain intensity. Methods and drugs used in both groups were
well tolerated with no serious adverse events. Compared with the control
group, patients in the ThPVB group reported increased
satisfaction. Copyright © 2017 European Society of
Anaesthesiology. All rights reserved.

<65>
Accession Number
623717497
Title
Cardioplegia practice in paediatric cardiac surgery: a UK & Ireland
survey.
Source
Perfusion (United Kingdom). 34 (2) (pp 125-129), 2019. Date of
Publication: 01 Mar 2019.
Author
Drury N.E.; Horsburgh A.; Bi R.; Willetts R.G.; Jones T.J.
Institution
(Drury, Horsburgh, Bi, Willetts, Jones) Department of Paediatric Cardiac
Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Many techniques are available for cardioplegic arrest in
children, but there is a lack of late phase clinical trials to guide
practice. We surveyed paediatric cardiac surgeons and perfusionists to
establish current practice and willingness to change within a clinical
trial. Method(s): An online survey was sent to all consultant
paediatric cardiac surgeons and chief perfusionists in paediatric centres
in the UK and Ireland. Information was sought on cardioplegia type,
composition, temperature, topical cooling, dosing for induction and
maintenance, interval between doses, whether practice changed with patient
age or complexity and whether respondents would be willing and able to use
different cardioplegia solutions within a randomised trial.
 Result(s): Responses were obtained from 32 (78.0%) surgeons and 12
(100%) perfusionists. Twenty-seven (84.4%) surgeons use blood cardioplegia
in infants, with St. Thomas' Harefield preparation the most popular (19,
59.4%), used routinely in eight (66.7%) centres. Twenty-two (68.8%)
administer at 4-6degreeC, 18 (56.3%) use topical cooling, 18 (56.3%) give
30 ml/kg induction and 15 ml/kg maintenance, with 23 (71.9%) re-dosing
every 20-25 minutes. Thirty (93.8%) surgeons were open to randomising
patients in a trial, with del Nido (29, 90.6%) the most popular.
 Conclusion(s): This survey demonstrates heterogeneity in cardioplegia
practice. Whilst most surgeons use blood cardioplegia, there is variation
in type, temperature, topical cooling, dosing and intervals. Combined with
a lack of evidence from late phase trials, our findings support the
presence of clinical equipoise. Surgeons are willing to change practice,
suggesting that a pragmatic, multi-centre, randomised, controlled trial of
cardioplegia in children is feasible. Copyright © The Author(s)
2018.

<66>
[Use Link to view the full text]
Accession Number
627460800
Title
Sevoflurane is an effective adjuvant to propofol-based total intravenous
anesthesia for attenuating cough reflex in nonintubated video-assisted
thoracoscopic surgery.
Source
Medicine (United States). 97 (42) (no pagination), 2018. Article Number:
e12927. Date of Publication: 01 Oct 2018.
Author
Lai H.-C.; Huang T.-W.; Tseng W.-C.; Lin W.-L.; Chang H.; Wu Z.-F.
Institution
(Huang, Chang) Division of Chest Surgery, Department of Surgery,
Tri-Service General Hospital, National Defense Medical Center, Taipei,
Taiwan (Republic of China)
(Lai, Tseng, Lin, Wu) Department of Anesthesiology, Tri-Service General
Hospital, National Defense Medical Center, #325, Section 2, Chenggung
Road, Neihu, Taipei 114, Taiwan (Republic of China)
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Nonintubated video-assisted thoracic surgery (VATS) has been
widely developed during the recent years. Cough reflex is an inevitably
encountered problem while approaching lung lesions, and it may induce
major bleeding. Sevoflurane anesthesia may attenuate cough reflex by
inhibiting the pulmonary irritant receptors. However, the incidence of
postoperative nausea and vomiting (PONV) in inhalational anesthesia is
higher than in the propofol-based total intravenous anesthesia (TIVA). We
investigated the effect of sevoflurane combination with propofol-based
TIVA on cough reflex and PONV in nonintubated VATS. Method(s): Ninety
patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and
spontaneous breathing were randomly assigned for TIVA or
propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia
was induced and maintained with propofol and fentanyl; in the
propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was
added to propofol and fentanyl anesthesia. The primary outcome
measurements were cough reflex. In addition, the incidence of PONV and
extubation time were investigated. Result(s): Patients with cough
reflex were significantly fewer in the P/S group than in the TIVA group
(10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P
< .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in
the P/S group than in the TIVA group. Besides, incremental fentanyl bolus
for cough reflex was 5 (0 [0-1]) in the P/S group and 17 (0 [0-3]) in the
TIVA group (P < .05). And there was no conversion to general anesthesia,
postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups.
Besides, there was no significant difference in extubation time (TIVA:
5.04 +/- 2.88 vs P/S: 4.44 +/- 2.98 minutes; P = .33). Conclusion(s):
Sevoflurane attenuated cough reflex under propofol-based TIVA and did not
increase the incidence of PONV and extubation time in nonintubated
VATS. Copyright © 2018 the Author(s).

<67>
[Use Link to view the full text]
Accession Number
627460744
Title
Ambulation capacity and functional outcome in patients undergoing
neuromuscular electrical stimulation after cardiac valve surgery A
randomised clinical trial.
Source
Medicine (United States). 97 (46) (no pagination), 2018. Article Number:
e13012. Date of Publication: 01 Nov 2018.
Author
Fontes Cerqueira T.C.; De Cerqueira Neto M.L.; De Assis Pereira Cacau L.;
Oliveira G.U.; Da Silva W.M.; Carvalho V.O.; De Mendonca J.T.; De Santana
Filho V.J.
Institution
(Fontes Cerqueira) Department of Physiotherapy, Universidade Federal de
Sergipe, Lagarto, Brazil
(De Cerqueira Neto, Carvalho, De Santana Filho) Department of
Physiotherapy, Universidade Federal de Sergipe, Sao, Cristovao, Brazil
(De Assis Pereira Cacau) Department of Physiotherapy, Universidade
Tiradentes, Aracaju, Brazil
(Oliveira) Universidade Federal de Sergipe, Aracaju, Brazil
(Da Silva) Department of Physiotherapy, Universidade Federal de Sergipe,
Sao Cristovao, Brazil
(Da Silva) Hospital Universitario de Sergipe, Aracaju, Brazil
(De Mendonca) Department of Medicine, Universidade Federal de Sergipe, Sao
Cristovao, SE, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Early mobilization and physical exercise are considered
fundamental components in cardiovascular surgery rehabilitation; however,
occasionally they are inadequate for inhibiting functional decline.
Neuromuscular electrical stimulation (NMES) is a promising tool in
cardiovascular rehabilitation; however, to date, no randomized clinical
trial has measured the effects of NMES on functional capacity and quality
of life in patients who undergo routine cardiac surgery with a short
intensive care unit (ICU) stay. Therefore, we aimed to investigate the
effects of NMES on walking ability, muscle strength, functional
independence, and quality of life in cardiac valve surgery patients in the
immediate postoperative period. Method(s): A randomized, parallel,
controlled, 2-arm clinical trial with assessor blinding was conducted.
Fifty-nine adult patients in the preoperative period after cardiac valve
reconstruction and/or replacement were randomly assigned to a control or
intervention group. The intervention group underwent NMES in the
quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10
sessions. The primary outcome was ambulation ability, assessed through the
Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO).
Secondary outcomes were muscular strength (assessed through the Medical
Research Council scale), functional independence measure (assessed through
the Functional Independence Measurement Questionnaire), and quality of
life (assessed through the Nottingham Health Profile) at baseline
(preoperative) and at postoperative days 3 and 5. Result(s): The
baseline characteristics were similar in both groups, except for body mass
index. There was no statistically significant difference, with a small
effect size, between both groups regarding the distance walked (95% CI,
64.87 to 65.97) and walking speed (95% CI, 0.55 to 0.57). There was a
statistically significant difference in upper-limb muscle strength loss
and decline in mobility at postoperative day 3, which had a tendency to
recover to initial values at 5PO, in both groups. No significant
between-group difference was noted for muscle strength, functional
independence, and quality of life. Conclusion(s): The use of NMES had
no effect on walking ability, strength, quality of life, or functional
outcome in the postoperative period for patients that underwent regular
valve replacement. Copyright © 2018 the Author(s).

<68>
[Use Link to view the full text]
Accession Number
627460618
Title
Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen
therapy on adult postcardiothoracic operation A meta-analysis.
Source
Medicine (United States). 97 (41) (no pagination), 2018. Article Number:
e12783. Date of Publication: 01 Oct 2018.
Author
Wu X.; Cao W.; Zhang B.; Wang S.
Institution
(Wu, Cao, Zhang, Wang) Department of Pulmonary and Critical Care Medicine,
First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi,
China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction: The effect of high-flow nasal cannula (HFNC) on adult post
cardiothoracic operation remains controversial. We conducted a
meta-analysis of randomized controlled trials to evaluate the effect of
HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery.
 Method(s): A search was conducted in Embase, MEDLINE, Ovid, and
Cochrane databases until December, 2017 for all the controlled study to
compare HFNC with COT in adult postcardiothoracic surgery. Two authors
extracted data and assessed the quality of each study independently. The
meta-analysis was performed by using RevMan 5.3. The primary outcome was
the rate of escalation of respiratory support rate and pulmonary
complications; secondary outcome included the length of intensive care
unit (ICU) stay and length of hospital stay and the rate of intubation.
 Result(s): Four studies that involved 649 patients were included in
the analysis. No significant heterogeneity was found in outcome measures.
Compared with COT, HFNC were associated with a significant reduction in
the escalation of respiratory support (odds ratio [OR] = 0.44, 95%
confidence interval [CI] = 0.290.66, P < .001) and pulmonary complications
(OR = 0.28, 95% CI = 0.130.6, P = .001). There were no significant
differences in the reintubation rate (OR = 0.33, 95% CI = 0.025.39, P =
.43), length of ICU stay (weighted mean difference = 0.11; 95% CI = 0.44
0.26, P = .14) or length of hospital stay (weighted mean difference =
0.15, 95% CI = 0.46 0.17, P = .36) between the 2 groups. No severe
complications were reported in either group. Conclusion(s): The HFNC
could reduce respiratory support and pulmonary complications, and it could
be safely administered for adult postcardiothoracic surgery. Further
large-scale, randomized, and controlled trials are needed to update this
finding. Copyright © 2018 the Author(s).

<69>
[Use Link to view the full text]
Accession Number
627376307
Title
Pharmacologic interventions for preventing delirium in adult patients
after cardiac surgery Protocol of a systematic review and network
meta-analysis.
Source
Medicine (United States). 97 (52) (no pagination), 2018. Article Number:
e13881. Date of Publication: 01 Dec 2018.
Author
Wen J.; Zeng H.; Li Z.; He G.; Jin Y.
Institution
(Wen) Shanghai University of Traditional Chinese Medicine, Shanghai, China
(Wen, Jin) Shanghai University of Medicine and Health Sciences, Pudong New
Area, Shanghai, China
(Zeng, Li) Second Clinical College of Guangzhou, University of Chinese
Medicine, Guangzhou, China
(He) First Clinical College of Guangzhou, University of Chinese Medicine,
Guangzhou, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Delirium is common in adult patients undergoing cardiac
surgery and related to a high morbidity and mortality. Although a variety
of pharmacologic interventions have been applied in delirium prevention,
there is still uncertainty concerning which drug is optimal. Thus, we plan
to conduct a systematic review and network meta-analysis (NMA) of
published studies to assess the efficacy and safety of pharmacologic
interventions for preventing delirium among those patients.
 Method(s): A systematic literature search will be conducted in
Embase, PubMed, and the Cochrane Library. The primary outcome will be the
incidence of postoperative delirium. Secondary outcomes will include
all-cause mortality and length of hospital or intensive care unit stay. A
frequentist NMA will be conducted using Stata version 14.0. The
inconsistency between direct and indirect comparisons will be evaluated
using a node splitting method. In addition, surface under the cumulative
ranking area will be used to evaluate superiority of different treatments.
 Result(s): The findings of our review will be submitted to a
peer-reviewed publication. Conclusion(s): Our study will generate
convincing evidence regarding the effectiveness and safety of different
pharmacologic interventions for delirium prevention in cardiac surgery
patients. Abbreviations: CI = confidence interval, GRADE = grading of
recommendations. Copyright © 2018 the Author(s).

<70>
Accession Number
625553255
Title
Stented Versus Stentless Aortic Valve Replacement in Patients With Small
Aortic Root: A Systematic Review and Meta-Analysis.
Source
Innovations (Philadelphia, Pa.). 13 (6) (pp 404-416), 2018. Date of
Publication: 01 Nov 2018.
Author
Harky A.; Wong C.H.M.; Hof A.; Froghi S.; Ahmad M.U.; Howard C.; Rimmer
L.; Bashir M.
Institution
(Wong) Faculty of Medicine, Chinese University of Hong Kong, Hong Kong,
China
(Hof, Froghi) Department of Cardiovascular Surgery,
Heinrich-Heine-University, Medical Faculty, Germany
(Ahmad, Howard, Rimmer) School of Medicine, University of Liverpool,
Liverpool, United Kingdom
(Bashir) Manchester Royal Infirmary, Manchester, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of the study was to compare hemodynamic and
perioperative outcomes of stented against stentless aortic valve
replacement in patients with small aortic root (21 mm or less).
 METHOD(S): A comprehensive search was undertaken among the four major
databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized
and nonrandomized controlled trials comparing stentless to stented
bioprosthetic valves in small aortic root patients. Odds ratios, weighted
mean differences, or standardized mean differences and their 95%
confidence intervals were analyzed. RESULT(S): A total of seven
studies with a total of 965 patients fulfilled the inclusion criteria.
There was no significant difference in preoperative baselines including
mean age between both groups (P = 0.08), peak aortic valve gradient (P =
0.06), and effective orifice area (P = 0.28), whereas higher mean aortic
valve gradient in the stented group (P = 0.007). No difference in
cardiopulmonary bypass time (P = 0.74), aortic cross-clamp times (P =
0.88), intensive care unit stay (P = 0.13), and stroke rate (P = 0.56)
were noted. However, stented group of patients showed higher rate of
patient prosthesis mismatch (P = 0.0001) and longer total hospital stay (P
= 0.002). Postoperatively, stentless group showed lower peak and mean
aortic valve gradient (P = 0.003 and P = 0.008, respectively) with a
better effective orifice area (P < 0.00001) at 6 months of follow-up.
Mortality rates while in-hospital and at 1 year were similar in both
groups (P = 0.94 and P = 0.86, respectively). CONCLUSION(S):
Stentless aortic valves offer superior short-term hemodynamic outcomes in
patients with small aortic root when compared with stented aortic valves.
Although both groups have similar perioperative complications rates,
stentless valves bring about a shorter hospital stay. A further large
multicenter randomized controlled trial should address the longer-term
benefit of stentless aortic valve over stented valve.

<71>
Accession Number
625642537
Title
The Safe Addition of Nitric Oxide into the Sweep Gas of the Extracorporeal
Circuit during Cardiopulmonary Bypass and Extracorporeal Life Support.
Source
The journal of extra-corporeal technology. 50 (4) (pp 260-264), 2018. Date
of Publication: 01 Dec 2018.
Author
Bennett M.; Thuys C.; Augustin S.; Schultz B.; Bottrell S.; Horton A.;
Bednarz A.; Horton S.
Institution
(Bennett, Thuys, Augustin, Schultz, Bottrell, Horton, Horton) Department
of Cardiac Surgery, Perfusion Unit, Royal Children's Hospital, Parkville,
Victoria, Australia
(Bednarz) Department of Biomedical Engineering, Royal Children's Hospital,
Parkville, Victoria, Australia
(Horton) Faculty of Medicine, Department of Paediatrics, The University of
Melbourne, Parkville, Victoria, Australia; and
(Horton) Murdoch Children's Research Institute, Parkville, Victoria,
Australia
Publisher
NLM (Medline)
Abstract
Low cardiac output syndrome and the systemic inflammatory response are
consequences of the cardiac surgical perioperative course. The mechanisms
responsible are multifactorial, but recent studies have shown that nitric
oxide (NO) may be a key component in mitigating some of these processes.
Following on from literature reports detailing the use of inhaled NO added
to the gas phase of the extracorporeal circuit, we set about developing a
technique to perform this addition safely and efficiently. In the setting
of cardiopulmonary bypass, the technique was validated in a randomized
prospective trial looking at 198 children. The benefits observed in this
trial then stimulated the incorporation of NO into all extracorporeal life
support (ECLS) circuits. This required additional hardware modifications
all of which were able to be performed safely. Initial results from the
first series of ECLS patients using NO also appear promising.

<72>
Accession Number
627343835
Title
Exercise-based cardiac rehabilitation for patients following open surgical
aortic valve replacement and transcatheter aortic valve implant: A
systematic review and meta-analysis.
Source
Open Heart. 6 (1) (no pagination), 2019. Article Number: e000922. Date of
Publication: 01 Apr 2019.
Author
Anayo L.; Rogers P.; Long L.; Dalby M.; Taylor R.
Institution
(Anayo) Institure of Infection, Immunity and Inflammation, University of
Glasgow, Glasgow, United Kingdom
(Anayo) Home Address, Kingswood, Bristol, United Kingdom
(Anayo, Long, Taylor) Institute of Health Research, University of Exeter
Medical School, Exeter, United Kingdom
(Rogers, Dalby) Royal Brompton and Harefield NHS Foundation Trust
Hospital, Uxbridge, United Kingdom
(Taylor) Institute of Health and Well Being, University of Glasgow,
Glasgow, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Exercise-based cardiac rehabilitation (CR) may be beneficial to
patients following transcatheter aortic valve implantation (TAVI) and open
surgical aortic valve replacement (SAVR). We aimed to undertake a
systematic review and meta-analysis to evaluate the efficacy, safety and
costs of exercise-based CR post-TAVI and post-SAVR. Methods We searched
numerous databases, including Embase, CENTRAL and MEDLINE, up to October
2017. We included randomised controlled trials (RCTs) and non-randomised
controlled trials (non-RCTs) of exercise-based CR compared with no
exercise control in TAVI or SAVR patients >=18 years. Data extraction and
risk of bias assessments were performed independently by two reviewers.
Narrative synthesis and meta-analysis (where appropriate) were carried out
for all relevant outcomes, and a Grading of Recommendations Assessment,
Development and Evaluation (GRADE) analysis was also performed. Results
Six studies, all at low risk of bias, were included: three RCTs and three
non-RCTs (total of 27 TAVI, 99 SAVR and 129 mixed patients), with
follow-up of 2-12 months. There was an increase in pooled exercise
capacity (standardised mean difference: 0.41, 95% CI 0.11 to 0.70;
moderate certainty evidence as assessed by GRADE), with exercise-based
rehabilitation compared with control. Data on other outcomes including
quality of life and clinical events were limited. Conclusions
Exercise-based CR probably improves exercise capacity of post-TAVI and
post-SAVR patients in the short term. Well conducted multicentre fully
powered RCTs of >=12 months follow-up are needed to fully assess the
clinical and cost-effectiveness of exercise-based CR in this patient
population. PROSPERO Protocol Registration Number
CRD42017084716. Copyright © Author(s) (or their employer(s))
2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<73>
[Use Link to view the full text]
Accession Number
627451196
Title
Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in
Surgical Patients: Results From a Systematic Review and Meta-analysis.
Source
Anesthesia and analgesia. 128 (5) (pp 981-992), 2019. Date of Publication:
01 May 2019.
Author
Cho B.C.; Serini J.; Zorrilla-Vaca A.; Scott M.J.; Gehrie E.A.; Frank
S.M.; Grant M.C.
Institution
(Cho, Frank, Grant) From the Department of Anesthesiology/Critical Care
Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States
(Serini) Department of Anesthesiology/Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Zorrilla-Vaca) Universidad del Valle School of Medicine, Cali, Columbia
(Scott) Department of Anesthesiology, Virginia Commonwealth University
School of Medicine, Richmond, VA, United States
(Gehrie) Departments of Pathology, United Arab Emirates
(Gehrie) Surgery, Johns Hopkins Medical Institutions, Baltimore, MD,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Erythropoietic-stimulating agents such as erythropoietin have
been used as part of patient blood management programs to reduce or even
avoid the use of allogeneic blood transfusions. We review the literature
to evaluate the effect of preoperative erythropoietin use on the risk of
exposure to perioperative allogeneic blood transfusions. METHOD(S):
The study involved a systematic review and meta-analysis of randomized
controlled trials evaluating the use of preoperative erythropoietin. The
primary outcome was the reported incidence of allogeneic red blood cell
transfusions during inpatient hospitalizations. Secondary outcomes
included phase-specific allogeneic red blood cell transfusions (ie,
intraoperative, postoperative), intraoperative estimated blood loss,
perioperative hemoglobin levels, length of stay, and thromboembolic
events. RESULT(S): A total of 32 randomized controlled trials (n =
4750 patients) were included, comparing preoperative erythropoietin (n =
2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin
is associated with a significant decrease in incidence of allogeneic blood
transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI,
0.47-0.73; P < .001) as well as patients undergoing cardiac (n = 9
studies; risk ratio, 0.55; 95% CI, 0.37-0.81; P = .003) and elective
orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28-0.46; P < .001)
surgery compared to placebo, respectively. Preoperative erythropoietin was
also associated with fewer phase-specific red blood cell transfusions.
There was no difference between groups in incidence of thromboembolic
events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78-1.33; P = .68).
 CONCLUSION(S): Preoperative erythropoietin is associated with a
significant reduction in perioperative allogeneic blood transfusions. This
finding is also confirmed among the subset of patients undergoing cardiac
and orthopedic surgery. Furthermore, our study demonstrates no significant
increase in risk of thromboembolic complications with preoperative
erythropoietin administration.

<74>
Accession Number
2001913331
Title
A Systematic Review and International Web-Based Survey of Randomized
Controlled Trials in the Perioperative and Critical Care Setting:
Interventions Increasing Mortality.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Sartini C.; Lomivorotov V.; Pisano A.; Riha H.; Baiardo Redaelli M.;
Lopez-Delgado J.C.; Pieri M.; Hajjar L.; Fominskiy E.; Likhvantsev V.;
Cabrini L.; Bradic N.; Avancini D.; Wang C.Y.; Lembo R.; Novikov M.;
Paternoster G.; Gazivoda G.; Alvaro G.; Roasio A.; Wang C.; Severi L.;
Pasin L.; Mura P.; Musu M.; Silvetti S.; Votta C.D.; Belletti A.; Corradi
F.; Brusasco C.; Tama S.; Ruggeri L.; Yong C.-Y.; Pasero D.; Mancino G.;
Spadaro S.; Conte M.; Lobreglio R.; Di Fraja D.; Saporito E.; D'Amico A.;
Sardo S.; Ortalda A.; Yavorovskiy A.; Riefolo C.; Monaco F.; Bellomo R.;
Zangrillo A.; Landoni G.
Institution
(Sartini, Baiardo Redaelli, Pieri, Fominskiy, Cabrini, Lembo, Votta,
Belletti, Tama, Ruggeri, Ortalda, Riefolo, Monaco, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Lomivorotov) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Pisano, Di Fraja) Division of Cardiac Anesthesia and Intensive Care Unit,
AORN dei Colli - Monaldi Hospital, Naples, Italy
(Riha) Institute for Clinical and Experimental Medicine, Prague, Czechia
(Lopez-Delgado) Hospital Universitari de Bellvitge, Barcelona, Spain
(Hajjar) Instituto do Coracao do Hospital das Clinicas, Sao Paulo, Brazil
(Likhvantsev, Yavorovskiy) Department of Anesthesiology and Intensive
Care, Sechenov First Moscow State Medical University, Moscow Regional
Clinical and Research Institute, Moscow, Russian Federation
(Bradic) Department of Cardiovascular Anesthesiology and Cardiac Intensive
Medicine, University Hospital Dubrava, Zagreb, Croatia
(Avancini) San Raffaele Telethon Institute for Gene Therapy (SR-Tiget),
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Wang) Anaesthesia and Intensive Care, University of Malaya, Kuala Lumpur,
Malaysia
(Novikov) Saint Petersburg State University, Saint Petersburg, Russian
Federation
(Paternoster) Anaesthesia and Intensive Care, San Carlo Hospital, Potenza,
Italy
(Gazivoda) Institute of Cardiovascular Diseases "Dedinje", Belgrade,
Serbia
(Alvaro, Saporito, D'Amico) AOU Mater Domini Germaneto, Catanzaro, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Wang) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Severi) Anesthesia and Intensive Care, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
(Pasin) S. Antonio Hospital, Padova, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU, Cagliari, Italy
(Musu, Sardo) Department of Medical Sciences and Public Health, University
of Cagliari, Monserrato, Italy
(Silvetti) IRCCS Istituto Giannina Gaslini, Ospedale Pediatrico, Genoa,
Italy
(Corradi, Brusasco) E.O. Ospedali Galliera, Genova, Italy and Universita
degli Studi di Pisa, Italy
(Yong) Anaesthesia and Intensive Care, Hospital Pulau Pinang, Georgetown,
Malaysia
(Pasero) Department of Anesthesia and Intensive Care, A.O.U. Cittadella
Salute e della Scienza, Turin, Italy
(Mancino) Hospital Santa Chiara, Pisa, Italy
(Spadaro) Department Morphology, Surgery and Experimental Medicine,
Intensive Care Unit, University of Ferrara, Italy
(Conte) Mater Dei Hospital, Bari, Italy
(Lobreglio) Anesthesia and Intensive Care A.O.U Citta della salute e della
Scienza, Turin, Italy
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Melbourne, Australia
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
W.B. Saunders
Abstract
Objective: Reducing mortality is a key target in critical care and
perioperative medicine. The authors aimed to identify all nonsurgical
interventions (drugs, techniques, strategies) shown by randomized trials
to increase mortality in these clinical settings. Design(s): A
systematic review of the literature followed by a consensus-based voting
process. Setting(s): A web-based international consensus conference.
 Participant(s): Two hundred fifty-one physicians from 46 countries.
 Intervention(s): The authors performed a systematic literature search
and identified all randomized controlled trials (RCTs) showing a
significant increase in unadjusted landmark mortality among surgical or
critically ill patients. The authors reviewed such studies during a
meeting by a core group of experts. Studies selected after such review
advanced to web-based voting by clinicians in relation to agreement,
clinical practice, and willingness to include each intervention in
international guidelines. Measurements and Main Results: The authors
selected 12 RCTs dealing with 12 interventions increasing mortality:
diaspirin-crosslinked hemoglobin (92% of agreement among web voters),
overfeeding, nitric oxide synthase inhibitor in septic shock, human growth
hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute
respiratory distress syndrome, plasma-derived protein C concentrate,
aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in
meningitis, methylprednisolone in traumatic brain injury, and albumin in
traumatic brain injury (72% of agreement). Overall, a high consistency
(ranging from 80% to 90%) between agreement and clinical practice was
observed. Conclusion(s): The authors identified 12 clinical
interventions showing increased mortality supported by randomized
controlled trials with nonconflicting evidence, and wide agreement upon
clinicians on a global scale. Copyright © 2019 Elsevier Inc.

<75>
Accession Number
2001910728
Title
The Influence of Suction on Chest Drain Duration After Lobectomy Using
Electronic Chest Drainage.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Lijkendijk M.; Licht P.B.; Neckelmann K.
Institution
(Lijkendijk, Licht, Neckelmann) Department of Cardiothoracic Surgery,
Odense University Hospital, Odense, Denmark
Publisher
Elsevier USA
Abstract
Background: Management of chest drains after thoracic surgery remains an
area with little consensus. To optimize chest drainage algorithms with
electronic chest drainage systems, a randomized controlled trial comparing
low variable suction (-5 cm H<inf>2</inf>O) versus high variable suction
(-20 cm H<inf>2</inf>O) was conducted. Method(s): This was a
prospective open label randomized trial in patients undergoing lobectomy.
Sample size was calculated from a clinical relevant difference in chest
drain duration as 1 full day. End points were chest drain duration and
length of hospitalization. Data were analyzed by Kaplan-Meier survival
analysis and multivariate Cox proportional hazards regression.
 Result(s): The study randomized 106 patients. There was no
statistical significant difference in chest drain duration and length of
stay between the low-suction and the high-suction groups: Median chest
drain duration and hospitalization were 25 hours (interquartile range
[IQR] 21 to 55 hours) versus 28 hours (IQR 23 to 77 hours; p = 0.97) and 5
days (IQR 3 to 6 days) versus 5 days (IQR 3 to 7 days; p = 0.75),
respectively. Multivariate analysis demonstrated that the diffusing
capacity of the lung for carbon monoxide was the only significant
predictor of chest drain duration (p = 0.015) and length of
hospitalization (p = 0.003). Complications requiring reinsertion of the
chest drain were significantly more frequent in the low-suction group (p =
0.03). Conclusion(s): There was no clinically relevant difference in
chest drain duration or length of hospitalization, but reinsertions of
chest drains were significantly more frequent in the low-suction group, a
finding suggesting that low suction levels should not be used after
lobectomy. Trial registry number is ISRCTN10408356. Copyright ©
2019

<76>
Accession Number
627234039
Title
Influence of oral premedication and prewarming on core temperature of
cardiac surgical patients: A prospective, randomized, controlled trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 55. Date
of Publication: 12 Apr 2019.
Author
Brauer A.; Muller M.M.; Wetz A.J.; Quintel M.; Brandes I.F.
Institution
(Brauer, Muller, Wetz, Quintel, Brandes) Department of Anaesthesiology,
University Medical Center Gottingen, Robert-Koch-Str. 40, Gottingen 37075,
Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative hypothermia is still very common and associated
with numerous adverse effects. The effects of benzodiazepines,
administered as premedication, on thermoregulation have been studied with
conflicting results. We investigated the hypotheses that premedication
with flunitrazepam would lower the preoperative core temperature and that
prewarming could attenuate this effect. Method(s): After approval by
the local research ethics committee 50 adult cardiac surgical patients
were included in this prospective, randomized, controlled, single-centre
study with two parallel groups in a university hospital setting. Core
temperature was measured using a continuous, non-invasive zero-heat flux
thermometer from 30 min before administration of the oral premedication
until beginning of surgery. An equal number of patients was randomly
allocated via a computer-generated list assigning them to either
prewarming or control group using the sealed envelope method for blinding.
The intervention itself could not be blinded. In the prewarming group
patients received active prewarming using an underbody forced-air warming
blanket. The data were analysed using Student's t-test, Mann-Whitney
U-test and Fisher's exact test. Result(s): Of the randomized 25
patients per group 24 patients per group could be analysed. Initial core
temperature was 36.7 +/- 0.2 degreeC and dropped significantly after oral
premedication to 36.5 +/- 0.3 degreeC when the patients were leaving the
ward and to 36.4 +/- 0.3 degreeC before induction of anaesthesia. The
patients of the prewarming group had a significantly higher core
temperature at the beginning of surgery (35.8 +/- 0.4 degreeC vs. 35.5 +/-
0.5 degreeC, p = 0.027), although core temperature at induction of
anaesthesia was comparable. Despite prewarming, core temperature did not
reach baseline level prior to premedication (36.7 +/- 0.2 degreeC).
 Conclusion(s): Oral premedication with benzodiazepines on the ward
lowered core temperature significantly at arrival in the operating room.
This drop in core temperature cannot be offset by a short period of active
prewarming. Trial registration: This trial was prospectively registered
with the German registry of clinical trials under the trial number
DRKS00005790 on 20th February 2014. Copyright © 2019 The
Author(s).

<77>
Accession Number
623140912
Title
Management of acute tandem occlusions: Stent-retriever thrombectomy with
emergency stenting or angioplasty.
Source
Journal of International Medical Research. 46 (7) (pp 2578-2586), 2018.
Date of Publication: 01 Jul 2018.
Author
Li W.; Chen Z.; Dai Z.; Liu R.; Yin Q.; Wang H.; Hao Y.; Han Y.; Qiu Z.;
Xiong Y.; Sun W.; Zi W.; Xu G.; Liu X.
Institution
(Li, Chen, Liu, Yin, Wang, Hao, Han, Xiong, Sun, Zi, Xu, Liu) Department
of Neurology, Jinling Hospital, Southern Medical University, Nanjing,
China
(Li) Department of Neurology, Third Affiliated Hospital of Guangzhou
Medical University, Guangzhou, China
(Dai) Department of Neurology, Wuxi People's Hospital, Jiangsu, China
(Qiu) Department of Neurology, 117th hospital of the people's liberation
army, Hangzhou, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To compare outcomes following intracranial stent
retriever-based intracranial thrombectomy (SRT) with emergency
extracranial internal carotid artery (EICA) stenting or angioplasty alone
in patients presenting with acute stroke due to tandem occlusions of the
ICA. Method(s): Consecutive patients with acute anterior tandem
occlusion who received an endovascular intervention within 6h of symptom
onset between January 2013 and June 2016 were included in this prospective
study. Demographic, radiological, procedural and clinical outcome data
were compared between the stenting and the angioplasty alone groups.
 Result(s): Of the 37 patients eligible for the study, 18 had
angioplasty alone and 19 underwent stent placement. Successful
recanalization rate was statistically significantly higher in the stenting
group than in angioplasty alone group (74% vs. 39%) and although not
statistically significant, more patients in the stenting group than in the
angioplasty alone group had favourable outcomes (63% vs. 50%). There was
no significant difference between groups in rates of symptomatic
intracranial haemorrhage (SICH), cerebral herniation or mortality.
 Conclusion(s): This study in a small sample size suggests that among
patients with acute anterior tandem occlusion, SRT with EICA stenting
tended to achieve higher recanalization and improved clinical outcomes at
three months compared with SRT and angioplasty alone with a similar rate
of SICH and mortality. Copyright © The Author(s) 2018.

<78>
Accession Number
614230170
Title
Malignant pericardial mesothelioma: A systematic review of current
practice.
Source
Herz. 43 (1) (pp 61-68), 2018. Date of Publication: 01 Feb 2018.
Author
Cao S.; Jin S.; Cao J.; Shen J.; Zhang H.; Meng Q.; Pan B.; Yu Y.
Institution
(Cao, Jin, Cao, Shen, Zhang, Meng, Pan, Yu) Department of Medical
Oncology, Harbin Medical University Cancer Hospital, No. 150 Haping Road,
Harbin 150081, China
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Malignant mesothelioma is a rare but aggressive tumor, with a
high misdiagnosis rate and overall bleak prognosis. In 0.7% of all cases,
the origin is the pericardium. Method(s): The present study is a
review of the literature published in recent decades focusing on the
advances in clinical manifestations, radiological findings, diagnosis,
differential diagnosis, and treatment of malignant pericardial
mesothelioma (MPM). Result(s): No clear relationship has been
established between the etiologies and the development of MPM. Clinical
symptoms and signs are nonspecific when present. The main presentations
are chest pain and dyspnea. Imaging plays an important role in the
detection, characterization, staging, and posttreatment follow-up. The
definitive diagnosis is made on the basis of pathological findings. Chest
radiography and echocardiography are common techniques used initially, but
their roles are limited. Computed tomography and magnetic resonance
imaging have an advantage in depicting the thickened pericardium,
mediastinal lymph node, tumor, and the extension of adjacent structures.
Surgery is the most important treatment modality and remains palliative in
most cases, while the roles of chemo- and radiotherapy are unsatisfactory.
 Conclusion(s): Clinical trials of malignant pleural and peritoneal
mesothelioma remain important for MPM management. Multimodality treatment
of surgery, chemotherapy, radiotherapy, and immunotherapy is expected to
have a role in the treatment of MPM. Copyright © 2016, Springer
Medizin Verlag Berlin.

<79>
Accession Number
617792696
Title
Early versus late initiation of renal replacement therapy impacts
mortality in patients with acute kidney injury post cardiac surgery: A
meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 150. Date of
Publication: 2017.
Author
Zou H.; Hong Q.; Xu G.
Institution
(Zou) Medical Center of the Graduate School, Nanchang University,
Nanchang, China
(Hong) Science and Technology College, Jiangxi University of Traditional
Chinese Medicine, Nanchang, China
(Zou, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006,
China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) is a common clinical complication of
cardiac surgery and increases mortality and hospitalization. We aimed to
explore and perform an updated meta-analysis of qualitative and
quantitative evaluations of the relationship between early renal
replacement therapy (RRT) and mortality. Method(s): We searched the
Chinese Biomedical Database, the Cochrane Library, EMBASE, Global Health,
MEDLINE and PubMed. Result(s): Fifteen studies (five randomized
controlled trials (RCTs), one prospective cohort and nine retrospective
cohorts) including 1479 patients were identified for detailed evaluation.
The meta-analysis suggested that early RRT initiation reduced 28-day
mortality (odds ratio (OR) 0.36; 95% confidence interval (CI) 0.23 to
0.57; I2 60%), and shortened intensive care unit (ICU) length
of stay (LOS) (mean difference (MD) -2.50; 95% CI -3.53 to -1.47; I2 88%)
and hospital LOS (MD -0.69; 95% CI -1.13 to -0.25; I2 88%), and
also reduced the duration of RRT (MD -1.18; 95% CI -2.26 to -0.11;
I2 69%), especially when RRT was initiated early within 12
hours (OR 0.23; 95% CI 0.08 to 0.63; I2 73%) and within 24
hours (OR 0.52; 95% CI 0.28 to 0.95; I2 58%) in patients with
AKI after cardiac surgery. Conclusion(s): Early RRT initiation
decreased 28-day mortality, especially when it was started within 24 hours
after cardiac surgery in patients with AKI. Copyright © The
Author(s). 2017.

<80>
Accession Number
627405715
Title
Predictive model for high-risk coronary artery disease: Insights from the
PROMISE trial.
Source
Circulation: Cardiovascular Imaging. 12 (2) (no pagination), 2019. Article
Number: e007940. Date of Publication: 01 Feb 2019.
Author
Jang J.J.; Bhapkar M.; Coles A.; Vemulapalli S.; Fordyce C.B.; Lee K.L.;
Udelson J.E.; Hoffmann U.; Tardif J.-C.; Jones W.S.; Mark D.B.; Sorrell
V.L.; Espinoza A.; Douglas P.S.; Patel M.R.
Institution
(Jang) San Jose Medical Center, Division of Cardiology, 270 International
Cir, Kaiser Permanente, San Jose, CA, United States
(Bhapkar, Coles, Vemulapalli, Fordyce, Lee, Jones, Mark, Douglas, Patel)
Duke Clinical Research Institute, Duke University School of Medicine,
Durham, NC, United States
(Fordyce) Division of Cardiology, University of British Columbia,
Vancouver, Canada
(Udelson) Department of Medicine, Tufts Medical Center, Boston, MA, United
States
(Hoffmann) Massachusetts General Hospital, Harvard Medical School, Boston,
United States
(Tardif) Research Centre, Montreal Heart Institute, Montreal, QC, Canada
(Sorrell) University of Kentucky Hospital, Lexington, KY, United States
(Espinoza) Hunterdon Medical Center, Flemington, NJ, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Patients with high-risk coronary artery disease (CAD) may be
difficult to identify. Method(s): Using the PROMISE (Prospective
Multicenter Imaging Study for Evaluation of Chest Pain) cohort randomized
to coronary computed tomographic angiography (n=4589), 2 predictive models
were developed for high-risk CAD, defined as left main stenosis (>=50%
stenosis) or either (1) >=50% stenosis [50] or (2) >=70% stenosis [70] of
3 vessels or 2-vessel CAD involving the proximal left anterior descending
artery. Pretest predictors were examined using stepwise logistic
regression and assessed for discrimination and calibration.
 Result(s): High-risk CAD was identified in 6.6% [50] and 2.4% [70] of
patients. Models developed to predict high-risk CAD discriminated well:
[50], bias-corrected C statistic=0.73 (95% CI, 0.71-0.76); [70],
bias-corrected C statistic=0.73 (95% CI, 0.68-0.77). Variables predictive
of CAD in both models included family history of premature CAD, age, male
sex, lower glomerular filtration rate, diabetes mellitus, elevated
systolic blood pressure, and angina. Additionally, smoking history was
predictive of [50] CAD and sedentary lifestyle of [70] CAD. Both models
characterized high-risk CAD better than the Pooled Cohort Equation (area
under the curve=0.70 and 0.71 for [50] and [70], respectively) and
Diamond-Forrester risk scores (area under the curve=0.68 and 0.71,
respectively). Both [50] and [70] CAD was associated with more frequent
invasive interventions and adverse events than non-high-risk CAD (all
P<0.0001). Conclusion(s): In contemporary practice, 2.4% to 6.6% of
stable, symptomatic patients requiring noninvasive testing have high-risk
CAD. A simple combination of pretest clinical variables improves
prediction of high-risk CAD over traditional risk
assessments. Copyright © 2019 American Heart Association, Inc.

<81>
Accession Number
624549192
Title
A prospective, randomized, comparison study on effect of perioperative use
of chloride liberal intravenous fluids versus chloride restricted
intravenous fluids on postoperative acute kidney injury in patients
undergoing off-pump coronary artery bypass grafting surgeries.
Source
Annals of Cardiac Anaesthesia. 21 (4) (pp 413-418), 2018. Date of
Publication: October-December 2018.
Author
Bhaskaran K.; Arumugam G.; Vinay Kumar P.V.
Institution
(Bhaskaran, Arumugam) Department of Anaesthesia, Apollo Hospitals,
Chennai, Tamil Nadu, India
(Vinay Kumar) Department of Anaesthesia, Sri Siddhartha Medical College,
Tumakur, Karnataka, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Context and Aims: Off-pump coronary artery bypass graft (OPCABG) is a form
of CABG surgery. It is performed without the use of cardiopulmonary bypass
machine as a surgical treatment for coronary heart disease. Acute kidney
injury (AKI) is one of the common postoperative complications of OPCABG.
Previous studies suggest important differences related to intravenous
fluid (IVF) chloride content and renal function. We hypothesize that
perioperative use of chloride restricted IVFs may decrease incidence and
severity of postoperative AKI in patients undergoing OPCABG.
 Method(s): Six hundred patients were randomly divided into two groups
of 300 each. In Group A (n = 300), chloride liberal IVFs, namely,
hydroxyethyl starch (130/0.4) in 0.9% normal saline (Voluven), 0.9% normal
saline, and Ringer's lactate were used for perioperative fluid management.
In Group B (n = 300), chloride-restricted IVFs, namely, hydroxyethyl
starch (130/0.4) in balanced colloid solution (Volulyte) and balanced salt
crystalloid solution (PlasmaLyte A), were used for perioperative fluid
management. Serum creatinine values were taken preoperatively,
postoperatively at 24 h and at 48 h. Postoperative AKI was determined by
AKI network (AKIN) criteria. Result(s): In Group A, 9.2% patients and
in Group B 4.6% patients developed Stage-I AKI determined by AKIN criteria
which was statistically significant (P < 0.05). Conclusion(s):
Perioperative use of chloride restricted IVF was found to decrease
incidence of postoperative AKI. The use of chloride liberal IVF was
associated with hyperchloremic metabolic acidosis. Copyright ©
2018 Annals of Cardiac Anaesthesia Published by Wolters
Kluwer-Medknow.

<82>
Accession Number
624549189
Title
Evaluation of local intra-pleural application of tranexamic acid on
postoperative blood loss in lung decortication surgery, a prospective,
randomized, double-blind, placebo-controlled study.
Source
Annals of Cardiac Anaesthesia. 21 (4) (pp 409-412), 2018. Date of
Publication: October-December 2018.
Author
Sabry M.M.; Sallam A.A.; Elgebaly A.S.; Abdelwahab A.A.
Institution
(Sabry, Sallam, Elgebaly, Abdelwahab) Department of Cardiothoracic
Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: During decortication surgery, fibrous peel over the lung was
removed to allow expansion of the lung and therefore, wide raw area was
created with surface oozing. The phenomenon of fibrinolysis usually
activated after such procedure, resulting in increasing the postoperative
bleeding. Tranexamic acid is one of antifibrinolytic therapies that could
be used topically and to targets directly the source of bleeding and
reducing the local activation of the fibrinolytic process and consequently
reducing the postoperative bleeding. Patients and Methods: A total of
70 patients underwent lung decortication surgery in Cardiothoracic Surgery
Department at Tanta University Hospital from January 2015 to May 2017.
Patients were randomly allocated into two groups, Group I (35 patients)
receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II
(35 patients) receiving 100 ml of saline solution as placebo. At the end
of the operation and before closing the chest, in both groups, drug or
placebo solution was distributed locally all over the pleural cavity.
Comparison between the groups was done regarding the amount of
postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h
postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and
hospital stay. Result(s): Both groups were comparable regarding
demographic and surgical data. Group I patients had the significantly
lesser amount of postoperative blood loss than Group II during the first
postoperative 48 h, and hence, the need of postoperative blood transfusion
was significantly lower in Group I with better postoperative hemoglobin
level than Group II. However, there was no difference in overall ICU and
hospital stay. Conclusion(s): The local intrapleural use of
tranexamic acid after decortication surgery of the lung is safe and
significantly reduces the amount of postoperative blood loss and in
consequence reduces the amount of postoperative blood
transfusion. Copyright © 2018 Annals of Cardiac Anaesthesia 
Published by Wolters Kluwer-Medknow.

<83>
Accession Number
624549155
Title
The efficacy of different modes of analgesia in postoperative pain
management and early mobilization in postoperative cardiac surgical
patients: A systematic review.
Source
Annals of Cardiac Anaesthesia. 21 (4) (pp 371-375), 2018. Date of
Publication: October-December 2018.
Author
Nachiyunde B.; Lam L.
Institution
(Nachiyunde) Department of Health Sciences, School of Nursing and
Midwifery, University of South Australia, City East Campus, Adelaide, SA
5001, Australia
(Lam) School of Nursing and Healthcare Professions, Federation University
Australia, Offce 1121, Building 903, Berwick Campus, PO Box 859, Berwick,
VIC 3806, Australia
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Cardiac surgery induces severe postoperative pain and impairment of
pulmonary function, increases the length of stay (LOS) in hospital, and
increases mortality and morbidity; therefore, evaluation of the evidence
is needed to assess the comparative benefits of different techniques of
pain management, to guide clinical practice, and to identify areas of
further research. A systematic search of the Cochrane Central Register of
Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar,
PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search
premier was conducted retrieving 1875 articles. This was for pain
management postcardiac surgery in intensive care. Four hundred and
seventy-one article titles and 266 abstracts screened, 52 full text
articles retrieved for critical appraisal, and ten studies were included
including 511 patients. Postoperative pain (patient reported),
complications, and LOS in intensive care and the hospital were evaluated.
Anesthetic infiltrations and intercostal or parasternal blocks are
recommended the immediate postoperative period (4-6 h), and
patient-controlled analgesia (PCA) and local subcutaneous anesthetic
infusions are recommended immediate postoperative and 24-72 h postcardiac
surgery. However, the use of mixed techniques, that is, PCA with opioids
and local anesthetic subcutaneous infusions might be the way to go in pain
management postcardiac surgery to avoid oversedation and severe nausea and
vomiting from the narcotics. Adequate studies in the use of ketamine for
pain management postcardiac surgery need to be done and it should be used
cautiously. Copyright © 2018 Annals of Cardiac Anaesthesia 
Published by Wolters Kluwer-Medknow.

<84>
Accession Number
621978576
Title
Reducing risk of spinal haematoma from spinal and epidural pain
procedures.
Source
Scandinavian Journal of Pain. 18 (2) (pp 129-150), 2018. Date of
Publication: 25 Apr 2018.
Author
Breivik H.; Norum H.; Fenger-Eriksen C.; Alahuhta S.; Vigfusson G.; Thomas
O.; Lagerkranser M.
Institution
(Breivik) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Pain Management and Research, Oslo 0424, Norway
(Breivik) University of Oslo, Faculty of Medicine, Oslo, Norway
(Norum) Oslo University Hospital, Division of Emergencies and Critical
Care, Department of Anaesthesiology, Oslo, Norway
(Fenger-Eriksen) Department of Anaesthesiology, Aarhus University
Hospital, Aarhus, Denmark
(Alahuhta) Department of Anaesthesiology, MRC Oulu, University of Oulu,
Oulu University Hospital, Oulu, Finland
(Vigfusson) Department of Anaesthesia and Intensive Care, University
Hospital Landspitalinn, Reykjavik, Iceland
(Thomas) Institute of Clinical Sciences, University of Lund, Department of
Paediatric Anaesthesiology and Intensive Care, SUS Lund University
Hospital, Lund, Sweden
(Lagerkranser) Section for Anaesthesiology and Intensive Care Medicine,
Department of Physiology and Pharmacology, Karolinska Institute,
Stockholm, Sweden
Publisher
Walter de Gruyter GmbH (E-mail: peter.golla@degruyter.com)
Abstract
Central neuraxial blocks (CNB: epidural, spinal and their combinations)
and other spinal pain procedures can cause serious harm to the spinal cord
in patients on antihaemostatic drugs or who have other risk-factors for
bleeding in the spinal canal. The purpose of this narrative review is to
provide a practise advisory on how to reduce risk of spinal cord injury
from spinal haematoma (SH) during CNBs and other spinal pain procedures.
Scandinavian guidelines from 2010 are part of the background for this
practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS
and EMBASE for new and relevant randomised controlled trials (RCT),
case-reports and original articles concerning benefits of neuraxial
blocks, risks of SH due to anti-haemostatic drugs, patient-related risk
factors, especially renal impairment with delayed excretion of
antihaemostatic drugs, and specific risk factors related to the neuraxial
pain procedures. Epidural and spinal analgesic techniques, as well as
their combination provide superior analgesia and reduce the risk of
postoperative and obstetric morbidity and mortality. Spinal pain procedure
can be highly effective for cancer patients, less so for chronic
non-cancer patients. We did not identify any RCT with SH as outcome. We
evaluated risks and recommend precautions for SH when patients are treated
with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients'
comorbidities may increase risks, and when procedure-specific risk factors
are present. Inserting and withdrawing epidural catheters appear to have
similar risks for initiating a SH. Invasive neuraxial pain procedures,
e.g. spinal cord stimulation, have higher risks of bleeding than
traditional neuraxial blocks. We recommend robust monitoring routines and
treatment protocol to ensure early diagnosis and effective treatment of SH
should this rare but potentially serious complication occur. When
neuraxial analgesia is considered for a patient on anti-haemostatic
medication, with patient-related, or procedure-related risk factors, the
balance of benefits against risks of bleeding is decisive; when CNB are
offered exclusively to patients who will have a reduction of postoperative
morbidity and mortality, then a higher risk of bleeding may be accepted.
Robust routines should ensure appropriate discontinuation of
anti-haemostatic drugs and early detection and treatment of SH. There is
an on-going development of drugs for prevention of thromboembolic events
following surgery and childbirth. The present practise advisory provides
up-to-date knowledge and experts' experiences so that patients who will
greatly benefit from neuraxial pain procedures and have increased risk of
bleeding can safely benefit from these procedures. There are always
individual factors for the clinician to evaluate and consider.
Increasingly it is necessary for the anaesthesia and analgesia provider to
collaborate with specialists in haemostasis. Surgeons and obstetricians
must be equally well prepared to collaborate for the best outcome for
their patients suffering from acute or chronic pain. Optimal pain
management is a prerequisite for enhanced recovery after surgery, but
there is a multitude of additional concerns, such as early mobilisation,
early oral feeding and ileus prevention that surgeons and anaesthesia
providers need to optimise for the best outcome and least risk of
complications. Copyright © 2018 2018 Harald Breivik et al.,
published by De Gruyter, Berlin/Boston.

<85>
[Use Link to view the full text]
Accession Number
627446673
Title
Comprehensive preoperative regime of selective gut decontamination in
combination with probiotics, and smectite for reducing endotoxemia and
cytokine activation during cardiopulmonary bypass: A pilot randomized,
controlled trial.
Source
Medicine (United States). 97 (46) (no pagination), 2018. Article Number:
e12685. Date of Publication: 01 Nov 2018.
Author
Liu W.-C.; Zhan Y.-P.; Wang X.-H.; Hou B.-C.; Huang J.; Chen S.-B.
Institution
(Liu, Zhan, Wang, Hou, Huang, Chen) Department of Anesthesiology, First
Affiliated Hospital of Nanchang University, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Both selective digestive decontamination (SDD) and probiotics
have been reported to reduce endotoxemia. However, the available results
are conflicting and few studies have investigated the combined effect of
SDD and probiotics. This study aimed to examine the effectiveness of a
comprehensive preoperative regimen of SDD in combination with probiotics
and smectite on perioperative endotoxemia and cytokine activation in
patients who underwent elective cardiac surgery with cardiopulmonary
bypass (CPB) in a pilot, prospective, randomized, controlled trial.
 Method(s): Patients who underwent elective Aortic Valve Replacement
or Mitral Valve Replacement surgery from July 2010 to March 2015 were
included. In total, 30 eligible patients were randomly assigned to receive
either the comprehensive preoperative regimen (n = 15) (a combination of
preoperative SDD, probiotics, and smectite) or the control group (n = 15)
who did not receive this treatment. The levels of endotoxin, IL-6, and
procalcitonin were measured at the time before anesthesia induction,
immediately after cardiopulmonary bypass (CPB), 24 hours after CPB, and 48
hours after CPB. The primary outcomes were changes in endotoxin, IL-6, and
procalcitonin concentrations after CPB. Result(s): The mean levels of
change in endotoxin levels after CPB in patients receiving the
comprehensive preoperative regimen was marginally significantly lower than
those in control group (F = 4.0, P = .0552) but was not significantly
different for procalcitonin (F = .14, P = .7134). An interaction between
group and time for IL-6 was identified (F = 4.35, P = .0231). The increase
in IL-6 concentration immediately after CPB in the comprehensive
preoperative group was significantly lower than that in the control group
(P = .0112). The changes in IL-6 concentration at 24 hours and 48 hours
after CPB were not significant between the comprehensive preoperative
group and control group. Conclusion(s): The present pilot,
prospective, randomized, controlled study in patients undergoing cardiac
surgery with CPB demonstrated that 3 days of a comprehensive preoperative
regime of SDD in combination with probiotics and smectite may reduce the
endotoxin and IL-6 levels after CPB compared with the control
group. Copyright © 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<86>
[Use Link to view the full text]
Accession Number
627446598
Title
Comparison of transcatheter closure, mini-invasive closure, and open-heart
surgical repair for treatment of perimembranous ventricular septal defects
in children: A PRISMA-compliant network meta-analysis of randomized and
observational studies.
Source
Medicine (United States). 97 (40) (no pagination), 2018. Article Number:
e12583. Date of Publication: 01 Oct 2018.
Author
Yi K.; You T.; Ding Z.-H.; Hou X.-D.; Liu X.-G.; Wang X.-K.; Tian J.-H.
Institution
(Yi, You, Hou, Liu, Wang) Department of Cardiovascular Surgery, Gansu
Provincial Hospital, No. 204, Dong gang West Road, Chengguan District,
Lanzhou City, Gansu province, China
(Yi, You) International Congenital Heart Disease Diagnosis and Treatment
Regional Center, Lanzhou, China
(Ding) Nursing Department, Gansu Provincial Hospital, Lanzhou, China
(Tian) Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Our study was aimed to comprehensively compare the relative
efficacy, safety, and the cost of transcatheter closure, mini-invasive
closure, and open-heart surgical repair to treat perimembranous
ventricular septal defects (pmVSDs) in children using network
meta-analysis method. Method(s): Five databases were systematically
searched including Chinese Biomedical Literature Database, China National
Knowledge Infrastructure, PubMed, EMBASE.com, and the Cochrane Central
Register of Controlled Trials from the starting date of each database to
February 2017. Tools for assessing the risk of bias in nonrandomized
studies of interventions (ROBINS-I) were used to evaluate the risk of bias
in observational studies and Cochrane Handbook version 5.1.0 was used for
randomized controlled trials (RCTs). Data were analyzed using R-3.4.0
software and Review Manager 5.2. Result(s): Three RCTs and 24
observational studies were included in our study. Network meta-analysis
result demonstrated that transcatheter closure was the most effective
treatment in terms of operative time [standardized mean difference (SMD) =
2.02, 95% confidence interval (CI): 3.92 to 0.12], major complications
[odds ratio (OR) = 0.52, 95% CI = 0.30-0.91], ICU stay (SMD = 1.11, 95% CI
= 2.13 to 0.08), and hospital stay (SMD = 1.81, 95% CI = 2.24 to 1.39).
However, open-heart surgical repair showed a higher success rate of the
procedure than transcatheter closure (OR = 0.36, 95% CI =
0.17-0.77).Statistical analysis result demonstrated that transcatheter
closure had the best potential to lessen major complications, ICU stay,
hospital stay, operative time, and significant residual shunt.
 Conclusion(s): Transcatheter closure has more benefit than
mini-invasive closure and open-heart surgical repair to treat
pmVSDs. Copyright © 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-No Derivatives
License 4.0 (CCBY-NC-ND), where it is permissible to download and share
the work provided it is properly cited. The work cannot be changed in any
way or used commercially without permission from the journal.

<87>
[Use Link to view the full text]
Accession Number
627434139
Title
The clinical and economic consequences of practice style variations in
common surgical interventions A protocol for systematic review.
Source
Medicine (United States). 97 (42) (no pagination), 2018. Article Number:
e12439. Date of Publication: 01 Oct 2018.
Author
Nouhi M.; Hadian M.; Olyaeemanesh A.
Institution
(Nouhi, Hadian) School of Health Management and Information Sciences, Iran
University of Medical Sciences, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Olyaeemanesh) National Institute of Health Research, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Olyaeemanesh) Health Equity Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Surgical intervention is one of the common therapeutic
interventions applied to a vast class of diseases. Unwarranted variation
in practice style in different locations is considered as practice style
variations (PSVs), which cause undesirable effects on patient health
status and economic consequences. The magnitude of the variations in
surgical interventions and its effects on clinical outcomes of patients
and also utilization of resources have been investigated in recent years.
But the findings show considerable heterogeneities in magnitude and
consequences. We develop a protocol to systematically review the current
literature of PSV to explain the magnitude of PSV and its clinical and
economic consequences. Method(s): This systematic review will include
observational and experimental studies to investigate magnitude and
consequences of PSV in common surgical interventions, cardiovascular
disease, urological, and ophthalmological diseases. Source of information
is scientific databases, theses, clinical trials registrations website,
and grey literature. A comprehensive electronic search will be conducted
through PubMed, Web of Science, EBSCO, EMBASE, and Scopus databases.
Studies are assessed systematically by 2 investigators. Methodological
quality of the included studies is evaluated by the STROBE and CONSORT
checklists. In case of data availability, we will pool findings of
included studies by meta-analysis techniques in the CMA software. Subgroup
analyses are based on the type of the interventions and selected diseases.
 Result(s): This study has ethical approval from ethical committee of
Iran University of Medical Sciences, ethic code: IR.IUMS.
REC1395.9221504203. The results will be published in a peer-reviewed
journal. Conclusion(s): A systematic review is considered as an
appropriate scientific method for reaching a consensus on magnitude as
well as consequences of PSV. Results of this study will help clinical
experts to attain more knowledge about PSV and encourage them to use some
tools such as clinical guidelines and shared decision making to alleviate
its consequences. Copyright © 2018 the Author(s). Published by
Wolters Kluwer Health, Inc.

<88>
Accession Number
627466365
Title
Extracorporeal membrane oxygenation without systemic anticoagulation: What
we can learn from literature.
Source
Perfusion (Germany). Conference: 8th EuroELSO Congress on ECMO-ECLS.
Spain. 34 (1 Supplement) (pp 108-110), 2019. Date of Publication: April
2019.
Author
Fina D.; Jiritano F.; Matteucci M.; Meani P.; Raffa G.M.; Kowaleski M.;
Natour E.; Bidar E.; Heuts S.; Maessen J.; Lorusso R.
Institution
(Fina, Jiritano, Matteucci, Meani, Raffa, Kowaleski, Natour, Bidar, Heuts,
Maessen, Lorusso) Department of Cardiothoracic Surgery, Heart and Vascular
Centre, Maastricht University Medical Centre, Maastricht, Netherlands
(Fina) University of Milan, IRCCS Policlinico San Donato, Milan, Italy
(Jiritano) Department of Cardiac Surgery, Magna Graecia University,
Catanzaro, Italy
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese, Italy
(Raffa) Dept. for the Treatm. and Stud. of Cardiothorac. Dis. and
Cardiothorac. Transplant. and Dept. of Anesthesia and Intensive Care,
IRCCS-ISMETT, Palermo, Italy
(Kowaleski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
Publisher
Verlag Perfusion GmbH
Abstract
Objective: Extracorporeal Membrane Oxygenation (ECMO) is essential for the
treatment of refractory car-diopulmonary failure. Its use in patients for
post-cardi-otomy or post-trauma cardiogenic shock, however, may be
complicated by worse haemorrhagic events exacer-bated by ECMO-related
systemic anticoagulation (SA). Recent technological advancements have made
ECMO components less thrombogenic, potentially allowing its application
with temporary avoidance of systemic anti-coagulants. Available data about
this peculiar ECMO management are scattered, and they refer to different
clinical backgrounds. A systematic review was consid-ered relevant to
analyse published reports on the application and results of ECMO without
administration of any kind of SA. Method(s): A systematic review of
all the available studies reporting the use of ECMO without SA was
performed. Only patient series were included, irrespective of the clinical
indication. Subjects receiving heparin or any other anticoagulation
therapy before or during ECMO were excluded, with the following
exceptions: cases in which heparin was completely reverted by protamine
after cardiopulmonary bypass, anticoagulation was administered for other
clinical indications (hemodialy-sis, mechanical valve prosthesis or atrial
fibrillation, deep vein thrombosis prophylaxis), and those in whom heparin
was given only in the late-weaning phase. Survival rate, ECMO
system-related dysfunction and complications, as well as the in-hospital
outcome were analyzed. Result(s): Six studies were selected for the
analysis. Veno-arterial ECMO was used in 84% of patients, while
veno-venous ECMO was applied in the remaining cases (see Image, Table A).
Anticoagulation was avoided because of high risk of bleeding after cardiac
surgery (64%), active major bleeding (23%), or presence of severe
traumatic injury (9%). Mean duration of support was 91 hours (range
0,8-336 hours). Heparin was reverted by protamine in all the
post-cardiotomy cases. Successfully ECMO weaning was achieved in 75% of
the treated cases, with a hospital discharge of 50% of the patients. Rates
of ECMO malfunctioning due to clot for-mation, and blood transfusion
requirement varied remarkably in the published series (see Image, Table
B). Conclusion(s): ECMO without SA appears feasible and void of
significant ECMO dysfunction-related complications. Further investigations
are warranted to elucidate actual aspects regarding ECMO system
performance, related adverse events, benefits associated with this
management.

<89>
Accession Number
627465459
Title
Emergent central venoarterial ECMO insertion in the intensive care unit
the nurses perspective.
Source
Perfusion (Germany). Conference: 8th EuroELSO Congress on ECMO-ECLS.
Spain. 34 (1 Supplement) (pp 217-218), 2019. Date of Publication: April
2019.
Author
Querol Valles E.; Gonzalez Cilleros M.; Prats Barrera J.
Institution
(Querol Valles, Gonzalez Cilleros, Prats Barrera) Hospital Clinic
Provincial de Barcelona, Intensive Care Unit of Cardiac Surgery,
Barcelona, Spain
Publisher
Verlag Perfusion GmbH
Abstract
Objective: Venoarterial ECMO (VA-ECMO) offers immediate circulatory and
pulmonary support in rap-idly deteriorating patients. The new guidelines
consider Extracorporeal Cardiopulmonary Resuscitation (ECPR) as a valuable
tool while managing refractory cardiac arrest. Patients recovering from a
cardiac surgery represent a specific group when ECPR is required and it
should be started in the first minutes in case of refractory cardiac
arrest in order to gain time, by maintaining end-organ perfusion, for the
correction of the primary cause, as a bridge to other therapies or bridge
to decision. Our objective is to describe the role of the intensive care
unit (ICU) nurses Methods: An extense literatue research has been
per-formed both guidelines and publications being MEDLINE and Cochrane the
main source of articles research. Result(s): We are a 16 bed ICU
specializad in Cardiac Surgery in a tertiary University Hospital with the
adequate material and human resources to perform ECPR. In refractory
cardiac arrest situations that might need VA-ECMO, nurses in the ICU split
in two teams of two and four nurses respectively. The first team remains
out-side the room taking care of the other patients. The sec-ond team
performs different roles in the implant being one of us in charge of drugs
and blood samples, a second one is responsible of the airway and
monitoring of the vital signs, a third one actively helps the medical team
in the implant and the last one coordinates with external services.
 Conclusion(s): This separation of tasks has allowed us to have a
better control of the cardiac arrest and ease the implant of central
VA-ECMO as ECPR in our unit.

<90>
Accession Number
627465261
Title
Meta-analysis to assess in-hospital and remote outcomes after ECMO
implantation for refractory cardiogenic shock in heart transplantation
centres as compared to non-transplant units.
Source
Perfusion (Germany). Conference: 8th EuroELSO Congress on ECMO-ECLS.
Spain. 34 (1 Supplement) (pp 89-90), 2019. Date of Publication: April
2019.
Author
Kowalewski M.; Zieliski K.; Raffa G.; Gozdek M.; Pilato M.; Alanazi M.;
Gilbers M.; Heuts S.; Natour E.; Bidar E.; Schreurs R.; Delnoij T.;
Driessen R.; Sels J.W.; Van De Poll M.; Roekaerts P.; Meani P.; Maessen
J.; Suwalski P.; Lorusso R.
Institution
(Kowalewski, Suwalski) Central Clinical Hospital of the Ministry of
Interior, Department of Cardiac Surgery, Warsaw, Poland
(Kowalewski) Cardiothoracic Research Centre, Bydgoszcz, Poland
(Zieliski) Medical University of Warsaw, Warsaw, Poland
(Raffa, Pilato) ISMETT-IRCCS, Palermo, Department for the Treatment and
Study of Cardiothoracic Diseases and Cardiothoracic Transplantation,
Palermo, Italy
(Gozdek) Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz,
Department of Cardiology and Internal Medicine, Bydgoszcz, Poland
(Alanazi, Gilbers, Heuts, Natour, Bidar, Schreurs, Maessen, Lorusso)
Maastricht University Medical Centre, Cardio-Thoracic Surgery Department,
Maastricht, Netherlands
(Delnoij, Driessen, Sels, Van De Poll, Roekaerts, Meani) Maastricht
University Medical Centre, Department of Intensive Care, Maastricht,
Netherlands
(Delnoij, Driessen, Sels, Meani) Maastricht University Medical Centre,
Cardiology Department, Maastricht, Netherlands
(Suwalski) Centre of Postgraduate Medical Education, Department of Cardiac
Surgery, Warsaw, Poland
Publisher
Verlag Perfusion GmbH
Abstract
Objective: Cardiogenic shock (CS) that is refractory to inotropic support
remains a major concern in cardiol-ogy, cardiac surgery and intensive
care. It is almost uni-versally fatal unless treated with mechanical
support. While reported mortality rates on ECMO vary from center to
center, aim of the current report is assess if the outcomes differ between
heart transplantation-(HTX) performing centres and non-HTX units.
 Method(s): A systematic search was performed according to PRISMA
statement using PubMed/Medline databases between 2010 and 2018. Relevant
articles were scrutinized and included in the meta-analysis only if
reporting in-hospital/30-day mortality and heart trans-plantation status
of the centre. Than differences were assessed by means of subgroup
meta-analysis. In-hospital complications and long term survival were
analysed as well. Result(s): 159 studies (N=11,808) were included.
Studies were divided into HTX vs non-HTX centres sub-groups: 140 studies
(10,972 pts [92.9%]) vs 19 studies (881 pts [7.1%]) in HTx and non-HTx
centres respec-tively. Median ECMO duration was 5.76 days without
differences between HTx(5.84 days) vs non-HTx-(4.88 days) centres
(P=0.204). Overall successful wean-ing rates were estimated at 57.9%
(55.4-60.4%) and were significantly higher across HTx vs non-HTx cen-tres
58.9% (56.2-61.5%) vs 50.0% (42.3-57.6%): p=0.029. All 159 studies
contributed to the analysis of survival: Overall, 4,829 patients survived
to hospital discharge which translated to estimated overall in-hos-pital
mortality of 56.6% (54.0-59.1%). Mortality rates were significantly higher
in non-HTx (64.7% [58.5-70.4%]) as compared to HTx centres (57.7%
[55.3-60.1%]); P=0.018) No differences were observed with regard to
neuro-logic complications, sepsis, limb complications and acute kidney
injury. Lower rates of mortality were observed with increasing (%) of
ECMOs for acute myocardial infarction(p=0.0381); graft failure (p=0.0083),
acute decompensated heart failure (p=0.0181); myocarditis (p<0.001); and
cardiomyopathy (p=0.0010); higher with increasing % of postc ardiotomy
shock ECMOs (p<0.001). Conclusion(s): Survival after ECMO
implantation for car-diogenic shock was higher in centres which perform
heart transplantations as compared to those which do not. Underlying
pathologies influenced the results with postcardiotomy shock associated
with worse survival rates. Potentially different risk profiles of patients
in these centres must be taken account for before definite conclusions are
drawn.

<91>
Accession Number
627464192
Title
A meta-analysis of protective effect of allopurinol in preventing contrast
induced nephropathy in patients undergoing percutaneous coronary
intervention.
Source
Circulation. Conference: American Heart Association's Epidemiology and
Prevention/Lifestyle and Cardiometabolic Health 2019 Scientific Sessions.
United States. 139 (Supplement 1) (no pagination), 2019. Date of
Publication: March 2019.
Author
Mansoor K.; Amro A.; El-Hamdani M.; Ogu I.
Institution
(Mansoor, Amro, El-Hamdani, Ogu) Marshall Univ, Huntington, WV, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Contrast- induced nephropathy (CIN) is an a major adverse
outcome of both diagnostic and therapeutic cardiac catheterization
procedures. It has been assoicated with prolonged hospitalization,
morbidity and mortality. Aim of this study was to understand the
protective effect on Allopurinol on CIN. Method(s): Search for the
literature was done of Science Direct, Pubmed/Medline, and Cochrane
library. A total of 385 papers were reviewed according to the PRISMA
protocol by two investigators, out of which 5 manuscripts were inculded in
this study. Manuscripts which studied effect of allopurinol on CIN in
patient undergoing PCI were included in the meta-analysis. In all studies
CIN was diagnosed if there was >25% elevation in serum creatinine.
 Result(s): A total of 5 studies met the inclusion criteria. Risk
difference was calculated for each study and was tabulated in a forest
plot. Heterogeneity was 83.81% with P < 0.001 hence a random effect model
was used. Overall Risk difference was -0.140 (CI 95% -0.257, -0.022).
 Conclusion(s): Our study demonstrates that Allopurinol potentially
has a protective in preventing contrast induced nephropathy in patients
undergoing percutaneous coronary intervention. Further large clinical
trails are warranted to better understand this effect.

<92>
Accession Number
627437894
Title
Surgical correction of anomalous origin of the right coronary artery from
the left sinus of Valsalva: How, where, and when.
Source
Multimedia manual of cardiothoracic surgery : MMCTS. 2019 (no pagination),
2019. Date of Publication: 05 Mar 2019.
Author
Belluschi I.; Blasio A.; Pozzoli A.; Vicentini L.; Alfieri O.
Institution
(Belluschi, Blasio, Vicentini) Cardiac Surgery Department San Raffaele
University Hospital Milan, Italy
(Pozzoli) University Heart Center Zurich Switzerland
Publisher
NLM (Medline)
Abstract
Anomalous origin of the right coronary artery from the left sinus of
Valsalva has a very low prevalence in the general population. Although the
vast majority of patients are asymptomatic, the clinical consequence of
this heart disorder can be sudden death. In many of these sudden death
cases the right coronary artery is running between the anterior aspect of
the aorta and behind the common trunk of the pulmonary artery, where
systolic compression may have an impact on myocardial perfusion.
Asymptomatic patients with this malignant course present the surgeon with
a difficult decision, and they should be carefully evaluated in order to
facilitate a tailored surgical approach. In this video tutorial we present
a patient with this anomalous course of the right coronary artery, which
was documented by coronary computed tomography angiography using a 3D
reconstruction. The patient received an off-pump coronary artery bypass
graft using an original surgical technique that prevents any type of flow
competition. The case had an excellent final outcome, with good results at
follow-up. Finally, a systematic review of the literature with a
discussion of the different treatment modalities is
provided. Copyright © The Author 2016. Published by MMCTS on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<93>
[Use Link to view the full text]
Accession Number
627434247
Title
Five-Year Outcome After Off-Pump or On-Pump Coronary Artery Bypass
Grafting in Elderly Patients.
Source
Circulation. 139 (16) (pp 1865-1871), 2019. Date of Publication: 16 Apr
2019.
Author
Diegeler A.; Borgermann J.; Kappert U.; Hilker M.; Doenst T.; Boning A.;
Albert M.; Farber G.; Holzhey D.; Conradi L.; Riess F.-C.; Veeckmann P.;
Minorics C.; Zacher M.; Reents W.
Institution
(Diegeler, Zacher, Reents) Herz- und Gefas-Klinik, Germany (A.D., Bad
Neustadt, Germany
(Borgermann) Herz- und Diabeteszentrum, Germany (J.B.), Bad Oeynhausen
(Kappert) Herzzentrum Dresden, Germany (U.K.)
(Hilker) Universitatsklinik Regensburg, Germany (M.H.)
(Doenst, Farber) Universitatsklinik Jena, Germany (T.D.
(Boning) Universitatsklinik Giessen, Germany (A.B.)
(Albert) Robert Bosch Krankenhaus, Germany (M.A.), Stuttgart, Germany
(Holzhey) Herzzentrum Universitat Leipzig, Germany (D.H.)
(Conradi) Universitatsklinik Hamburg-Eppendorf, Germany (L.C.), Hamburg,
Germany
(Ries) Germany (F.-C.R.), Hamburg, Germany
(Veeckmann) Germany (P.V.)
(Minorics) Universitat Bochum, Germany (C.M.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The 30-day and 1-year follow-up analysis of the GOPCABE trial
(German Off-Pump Coronary Artery Bypass Grafting in Elderly Patients)
revealed no significant difference in the composite end point consisting
of death, stroke, myocardial infarction, new renal replacement therapy, or
repeat revascularization. The 5-year follow-up data of this trial are
reported here. METHOD(S): From June 2008 to September 2011, a total
of 2539 patients aged >=75 years were randomly assigned to undergo
off-pump or on-pump coronary artery bypass grafting (CABG) at 12 centers
in Germany. The primary outcome was all-cause mortality at 5 years. The
secondary 5-year outcomes were a composite of death, myocardial
infarction, and repeat revascularization. Furthermore, the impact of
complete versus incomplete revascularization was assessed. RESULT(S):
After a median follow-up of 5 years, 361 patients (31%) assigned to
off-pump CABG and 352 patients (30%) assigned to on-pump CABG had died
(hazard ratio off-pump/on-pump CABG, 1.03; 95% CI, 0.89-1.19; P=0.71). The
composite outcome of death, myocardial infarction, and repeat
revascularization occurred in 397 (34%) after off-pump and in 389 (33%)
after on-pump CABG (hazard ratio, 1.03; 95% CI, 0.89-1.18; P=0.704).
Incomplete revascularization occurred in 403 (34%) patients randomly
assigned to off-pump and 354 (29%) patients randomly assigned to on-pump
CABG ( P<0.001). Five-year survival rates were 72% (95% CI, 67-76) with
incomplete versus 76% (95% CI, 74-80) with complete revascularization
(log-rank test: P=0.02) after off-pump CABG and 72% (95% CI, 67-76) versus
77% (95% CI, 74-80) after on-pump CABG (log-rank test: P=0.03),
respectively. Cox regression analysis revealed a hazard ratio
incomplete/complete revascularization of 1.19 (95% CI, 1.01-1.39; P=0.04).
 CONCLUSION(S): In elderly patients >=75 years of age, the 5-year
survival rates and the combined outcome of death, myocardial infarction,
and repeat revascularization, as well, were similar after on-pump and
off-pump CABG. Incomplete revascularization was associated with a lower
5-year survival rate, irrespective of the type of surgery. CLINICAL TRIAL
REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier:
NCT00719667.

<94>
Accession Number
627434445
Title
Cardiovascular Disease Among Women Who Gave Birth to an Infant With a
Major Congenital Anomaly.
Source
JAMA network open. 1 (5) (pp e182320), 2018. Date of Publication: 07 Sep
2018.
Author
Cohen E.; Horvath-Puho E.; Ray J.G.; Pedersen L.; Ehrenstein V.; Adler N.;
Vigod S.; Milstein A.; Sorensen H.T.
Institution
(Cohen) Department of Pediatrics, Hospital for Sick Children, University
of Toronto, Toronto, ON, Canada
(Cohen, Horvath-Puho, Pedersen, Ehrenstein, Sorensen) Department of
Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
(Cohen, Ray, Vigod) Institute of Health Policy, Management, Evaluation,
University of Toronto, Toronto, ON, Canada
(Ray) Department of Medicine, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Adler) Center for Health and Community, School of Medicine, University of
California, San Francisco, Argentina
(Vigod) Reproductive Life Stages Program, Department of Psychiatry,
Women's College Hospital, Toronto, ON, Canada
(Milstein) Clinical Excellence Research Center, Stanford University School
of Medicine, Stanford, CA, United States
(Sorensen) Division of Epidemiology, Department of Health Research and
Policy, Stanford University, Stanford, CA, United States
Publisher
NLM (Medline)
Abstract
Importance: Having a child with a major birth defect can be a
life-changing and stressful event that may be associated with higher
cardiovascular disease (CVD) risk, yet the long-term burden of CVD for the
child's mother is unknown. Objective(s): To assess whether mothers of
an infant born with a major congenital anomaly are at higher risk of CVD
compared with a comparison cohort. Design, Setting, and
Participant(s): A population-based cohort study using individual-level
linked registry data in Denmark included 42943 women who gave birth to an
infant with a major congenital anomaly between January 1, 1979, and
December 31, 2013; and follow-up was conducted until 2015. A comparison
group, comprising 428401 randomly selected women, was 10:1 matched to each
affected mother by maternal age, parity, and her infant's year of birth.
Data analyses were performed between November 1, 2017, and February 28,
2018. Exposures: Live birth of an infant with a major congenital anomaly.
 Main Outcomes and Measures: The primary outcome was a CVD composite
outcome of acute myocardial infarction, coronary revascularization, or
stroke. Secondary outcomes included individual components of the CVD
composite and other cardiovascular outcomes, including unstable angina,
congestive heart failure, atrial fibrillation, peripheral artery disease,
ischemic heart disease, and aortic aneurysm. Cox proportional hazards
regression analyses generated hazard ratios (HRs), adjusted for maternal
demographic, socioeconomic, and chronic health indicators. Result(s):
Median maternal age at baseline was 28.8 years (interquartile range,
25.3-32.5 years). After a median follow-up of 19.5 years (interquartile
range, 9.9-27.6 years), 914 women whose infant had a major congenital
anomaly experienced a CVD event (1.21 per 1000 person-years; 95% CI,
1.13-1.28 per 1000 person-years) vs 7516 women in the comparison group
(0.99 per 1000 person-years; 95% CI, 0.97-1.01 per 1000 person-years),
corresponding to an unadjusted HR of 1.23 (95% CI, 1.15-1.32), and an
adjusted HR (aHR) of 1.15 (95% CI, 1.07-1.23). Women who gave birth to an
infant with multiorgan anomalies had an even higher aHR (1.37; 95% CI,
1.08-1.72). Mothers of infants with a major anomaly also had an increased
aHR of the individual components of the composite outcome and the other
cardiovascular outcomes. Conclusions and Relevance: Women whose child
had a major congenital anomaly experienced a 15% to 37% higher risk of
premature cardiovascular disease. These women may benefit from targeted
interventions aimed at improving their cardiovascular health.

<95>
Accession Number
627429233
Title
Computed tomographic coronary angiography in risk stratification prior to
non-cardiac surgery: A systematic review and meta-analysis.
Source
Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Koshy A.N.; Ha F.J.; Gow P.J.; Han H.-C.; Amirul-Islam F.M.; Lim H.S.; Teh
A.W.; Farouque O.
Institution
(Koshy, Ha, Han, Lim, Teh, Farouque) Department of Cardiology, Austin
Health, Melbourne, VIC, Australia
(Koshy, Gow, Han, Lim, Teh, Farouque) Austin Health Clinical School,
University of Melbourne, Parkville, Melbourne, VIC, Australia
(Koshy, Gow) Victorian Liver Transplant Unit, Austin Health, Melbourne,
VIC, Australia
(Amirul-Islam) Department of Statistics, Data Science and Epidemiology,
Swinburne University of Technology, Melbourne, VIC, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Utility of CT coronary angiography (CTA) and coronary artery
calcium (CAC) scoring in risk stratification prior to non-cardiac surgery
is unclear. Although current guidelines recommend stress testing in
intermediate-high risk individuals, over one-third of perioperative major
adverse cardiovascular events (MACE) occur in patients with a negative
study. This systematic review and meta-analysis evaluates the value of CTA
and CAC score in preoperative risk prognostication prior to non-cardiac
surgery. Method(s): MEDLINE, PubMed and EMBASE databases were
searched for articles published up to June 2018. Summary ORs for degree of
coronary artery disease (CAD) and perioperative MACE were pooled using a
random-effects model. Result(s): Eleven studies were included. Two
hundred and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of
perioperative MACE rose with the severity and extent of CAD on CTA (no CAD
2.0%; non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive
multivessel 23.1%, p<0.001). Multivessel disease (MVD) demonstrated the
greatest risk (OR 8.9, 95% CI 5.1 to 15.3, p<0.001). Increasing CAC score
was associated with higher perioperative MACE (CAC score: >=100 OR 5.1,
>=1000 OR 10.4, both p<0.01). In a cohort deemed high risk by established
clinical indices, absence of MVD on CTA demonstrated a negative predictive
value of 96% (95% CI 92.8 to 98.4) for predicting freedom from MACE.
 Conclusion(s): Severity and extent of CAD on CTA conferred
incremental risk for perioperative MACE in patients undergoing non-cardiac
surgery. The 'rule-out' capability of CTA is comparable to other
non-invasive imaging modalities and offers a viable alternative for risk
stratification of patients undergoing non-cardiac surgery. Trial
registration number: CRD42018100883 Copyright © Author(s) (or
their employer(s)) 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<96>
Accession Number
627442357
Title
Neutrophil gelatinase-associated lipocalin as a marker of postoperative
acute kidney injury following cardiac surgery in patients with
pre-operative kidney impairment.
Source
Cardiovascular & hematological disorders drug targets. (no pagination),
2019. Date of Publication: 15 Apr 2019.
Author
Tidbury N.; Browning N.; Shaw M.; Morgan M.; Kemp I.; Matata B.
Institution
(Tidbury, Browning, Shaw, Morgan, Kemp, Matata) Liverpool Heart & Chest
Hospital NHS Foundation Trust, Liverpool L14 3PE. United Kingdom, Thomas
Drive, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Acute kidney injury (AKI) is a serious complication of
cardiac surgery. The current 'gold standard' for determining AKI is change
in serum creatinine and urine output, however, this change occurs
relatively late after actual injury occurs. Identification of new
biomarkers that detect early AKI is required. Recently new biomarkers,
such as the NephroCheck Test and AKIRisk have also been tested and found
to be good indicators of AKI. Neutrophil gelatinase-associated lipocalin
(NGAL) has shown promise in paediatric patients but has displayed varied
results in adult populations, particularly post cardiac surgery. The aim
of this study was to assess the value of urinary NGAL as a biomarker of
AKI in patients with pre-existing renal impairment (eGFR >15ml/min to
eGFR<60ml/min). METHOD(S): A post-hoc analysis of urinary NGAL
concentrations from 125 patients with pre-existing kidney impairment, who
participated in a randomised trial of haemofiltration during cardiac
surgery, was undertaken. Urinary NGAL was measured using ELISA at
baseline, post-operatively and 24 and 48 hours after surgery and serum
creatinine was measured pre and post operatively and then at 24, 48, 72
and 96 hours as routine patient care. NGAL concentrations were compared in
patients with and without AKI determined by changes in serum creatinine
concentrations. A Kaplan-Meier plot compared survival for patients with or
without AKI and a Cox proportional hazards analysis was performed to
identify factors with the greatest influence on survival. RESULT(S):
Following surgery 43% of patients developed AKI (based on KDIGO
definition). Baseline urinary NGAL was not found to be significantly
different between patients that did and did not develop AKI. Urinary NGAL
concentration was increased in all patients following surgery, regardless
of whether they developed AKI and was also significant between groups at
24 (p=0.003) and 48 hours (p<0.0001). Urinary NGAL concentrations at 48
hours correlated with serum creatinine concentrations at 48 hours
(r=0.477, p<0.0001), 72 hours (r=0.488, p<0.0001) and 96 hours (r=0.463,
p<0.0001). Urinary NGAL at 48 hours after surgery strongly predicted AKI
(AUC=0.76; P=0.0001). A Kaplan-Meier plot showed that patients with
postoperative AKI had a significantly lower 7-year survival compared with
those without AKI. Postoperative urinary NGAL at 48 hours >156ng/mL also
strongly predicted 7 year survival. However, additive EuroSCORE, age,
current smoking and post-operative antibiotics usage were distinctly
significantly more predictive of 7-year survival as compared with
postoperative urinary NGAL at 48 hours >156ng/mL. CONCLUSION(S): Our
study demonstrated that postoperative urinary NGAL levels at 48 hours
post-surgery strongly predicts the onset or severity of postoperative AKI
based on KDIGO classification in patients with preoperative kidney
impairment and was also strongly related to 7-year
survival. Copyright© Bentham Science Publishers; For any queries,
please email at epub@benthamscience.net.

<97>
Accession Number
627442072
Title
Video-assisted Thoracoscopic Surgery versus Thoracotomy for Non-Small Cell
Lung Cancer: A Meta-Analysis.
Source
Combinatorial chemistry & high throughput screening. (no pagination),
2019. Date of Publication: 14 Apr 2019.
Author
Ye B.; Wang M.
Institution
(Ye) Department of Thoracic Surgery, Hangzhou Red Cross Hospital,
Zhejiang. China, Hangzhou, China
(Wang) Department of Thoracic Surgery, Zhejiang University International
Hospital, Zhejiang. China, Hangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients undergoing surgery for non-small cell lung cancer
(NSCLC) are often elderly amd have co-morbidities conditions and decreased
performance status. Compared with open thoracotomy, video- assisted
thoracoscopic lobectomy is associated with fewer postoperative
complications. Despite encouraging results for patients with NSCLC who
underwent VATS, the procedure is still not widely accepted, and large
retrospective studies have yielded conflicting results. OBJECTIVE(S):
In video-assisted lobectomy for NSCLC, it has remained controversial
whether mediastinal lymphadenectomy can be performed as effectively as an
open procedure via thoracotomy. To deal with inherent biases in any
non-randomized comparison, we analyzed propensity-matched studies and
randomized controlled trials. The aim of this study was to evaluate the
treatment outcomes of VATS and open thoracotomy for NSCLC patients.
 METHOD(S): We collected publications on comparison of VATS versus
open thoracotomy for NSCLC patients from 2007 to 2017. All trials analyzed
the summary hazard ratios (HRs) of the end points of interest, including
perioperative mortality and morbidity, and individual postoperative
complications. Revman 5.3 software was used to analyze the combined pooled
HRs using fixed- or random-effects models according to heterogeneity.
 RESULT(S): A systematic literature search was conducted including 15
studies. The results indicated that VATS was associated with lower
postoperative morbidity and mortality, and significantly lower rates of
prolonged pneumonia, atrial arrhythmias and renal failure.
 CONCLUSION(S): Compared with lobectomy by thoracotomy, thoracoscopic
lobectomy is associated with a lower incidence of major complications,
including lower rates of prolonged pneumonia, atrial arrhythmias and renal
failure. Lobectomy via VATs may be the preferred strategy for
appropriately selected NSCLC patients. The determinants of this advantage
should be analyzed to improve the safety and outcomes of other thoracic
procedures. Copyright© Bentham Science Publishers; For any
queries, please email at epub@benthamscience.net.

<98>
Accession Number
611367894
Title
Myocardial tissue remodeling after orthotopic heart transplantation: a
pilot cardiac magnetic resonance study.
Source
International Journal of Cardiovascular Imaging. 34 (1) (pp 15-24), 2018.
Date of Publication: 01 Jan 2018.
Author
Coelho-Filho O.R.; Shah R.; Lavagnoli C.F.R.; Barros J.C.; Neilan T.G.;
Murthy V.L.; de Oliveira P.P.M.; Souza J.R.M.; de Oliveira Severino
E.S.B.; de Souza Vilarinho K.A.; da Mota Silveira Filho L.; Garcia J.;
Semigran M.J.; Coelho O.R.; Jerosch-Herold M.; Petrucci O.
Institution
(Coelho-Filho, Lavagnoli, Barros, de Oliveira, Souza, de Oliveira
Severino, de Souza Vilarinho, da Mota Silveira Filho, Coelho, Petrucci)
Faculty of Medical Science, State University of Campinas (UNICAMP),
Campinas, Sao Paulo, Brazil
(Shah) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Neilan, Garcia, Semigran) Massaschussetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Murthy) Cardiovascular Medicine Division, Department of Medicine,
University of Michigan, Ann Arbor, MI, United States
(Murthy) Nuclear Medicine Division, Department of Radiology, University of
Michigan, Ann Arbor, MI, United States
(Jerosch-Herold) Noninvasive Cardiovascular Imaging Program,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Jerosch-Herold) Department of Radiology, Brigham and Women's Hospital,
Boston, MA, United States
(Petrucci) Division of Cardiothoracic Surgery, Section of Pediatric
Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, MO,
United States
(Coelho-Filho) Discipline of Cardiology, Department of Internal Medicine,
Hospital das Clinicas, State University of Campinas, UNICAMP, Rua Vital
Brasil, 251-Cidade Universitaria "Zeferino Vaz", Campinas-SP, Sao Paulo
CEP 13083-888, Brazil
(Coelho-Filho) Fundacao Centro Medico de Campinas, Campinas, Sao Paulo,
Brazil
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
After orthotopic heart transplantation (OHT), the allograft undergoes
characteristic alterations in myocardial structure, including hypertrophy,
increased ventricular stiffness, ischemia, and inflammation, all of which
may decrease overall graft survival. Methods to quantify these phenotypes
may clarify the pathophysiology of progressive graft dysfunction post-OHT.
We performed cardiac magnetic resonance (CMR) with T1 mapping in 26 OHT
recipients (mean age 47 +/- 7 years, 30 % female, median follow-up
post-OHT 6 months) and 30 age-matched healthy volunteers (mean age 50.5
+/- 15 years; LVEF 63.5 +/- 7 %). OHT recipients had a normal left
ventricular ejection fraction (LVEF 65.3 +/- 11 %) with higher LV mass
relative to age-matched healthy volunteers (114 +/- 27 vs. 85.8 +/- 18 g;
p < 0.001). There was no late gadolinium enhancement in either group. Both
myocardial extracellular volume fraction (ECV) and intracellular lifetime
of water (tau<inf>ic</inf>), a measure of cardiomyocyte hypertrophy, were
higher in patients post-OHT (ECV: 0.39 +/- 0.06 vs. 0.28 +/- 0.03, p <
0.0001; tau<inf>ic</inf>: 0.12 +/- 0.08 vs. 0.08 +/- 0.03, p < 0.001). ECV
was associated with LV mass (r = 0.74, p < 0.001). In follow-up, OHT
recipients with normal biopsies by pathology (ISHLT grade 0R) in the first
year post-OHT exhibited a lower ECV relative to patients with any
rejection >=2R (0.35 +/- 0.02 for 0R vs. 0.45 +/- 0, p < 0.001). Higher
ECV but not LVEF was significantly associated with a reduced
rejection-free survival. After OHT, markers of tissue remodeling by CMR
(ECV and tau<inf>ic</inf>) are elevated and associated with myocardial
hypertrophy. Interstitial myocardial remodeling (by ECV) is associated
with cellular rejection. Further research on the impact of graft
preservation and early immunosuppression on tissue-level remodeling of the
allograft is necessary to delineate the clinical implications of these
findings. Copyright © 2016, Springer Science+Business Media
Dordrecht.

<99>
Accession Number
605909981
Title
Local Anesthetics delivered through Pleural Drainages improve Pain and
Lung Function after Cardiac Surgery.
Source
Thoracic and Cardiovascular Surgeon. 66 (2) (pp 198-202), 2018. Date of
Publication: 01 Mar 2018.
Author
Mashaqi B.; Ismail I.; Siemeni T.T.; Ruemke S.; Fleissner F.; Zhang R.;
Wiegmann B.; Filitz J.; Gottlieb J.; Haverich A.
Institution
(Mashaqi, Ismail, Siemeni, Ruemke, Fleissner, Zhang, Wiegmann, Haverich)
Department of Thoracic, Transplant and Cardiovascular Surgery, Hannover
Medical School, Carl-Neuberg-Str.1, Hannover 30625, Germany
(Filitz) Department of Anesthesiology and Intensive Care, Hannover Medical
School, Hannover, Germany
(Gottlieb) Department of Respiratory Medicine, Hannover Medical School,
Hannover, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Objective Pleural tubes after coronary artery bypass graft (CABG) surgery
usually cause pain resulting interalia in an impact of postoperative
breathing. Therefore, the influence of intrapleural lidocaine application
through special double-lumen chest tubes with respect to pain relief and
lung function was investigated and compared with placebo. Methods In this
study, 40 patients who underwent CABG got intrapleural injection either
with 2% lidocaine (n = 20) or placebo (0.9% saline solution) (n = 20) on
the first 2 days after surgery. Pain was measured by pain intensity
numeric rating scale (NRS) (0 = no pain; 10 = the most intense pain) and
lung function by portable spirometer. Results On the first postoperative
day (POD1), mean pain reduction was NRS 1.9 for the lidocaine group with
an improvement of the forced expiratory volume in 1 second (FEV1) of 0.51
L. Similar results were shown on the second postoperative day (POD2) with
a decreased pain level of mean NRS 1.65 and an FEV1 improvement of 0.26 L.
In comparison, results of the placebo group showed no significant pain
reduction, neither on the POD1 (NRS 0.35; p = 0.429) nor on the POD2 (NRS
0.55; p = 0.159). Also, there was no significant influence of FEV1 after
placebo on the POD1 (FEV1 = 0.048 L; p = 0.70) or on the POD2 (FEV1 =
0.0135 L; p = 0.925). Conclusion Intrapleural application of lidocaine is
a safe and feasible method to reduce drainage-related pain and improving
lung function after CABG. Copyright © 2018 Georg Thieme Verlag KG
Stuttgart, New York.

<100>
[Use Link to view the full text]
Accession Number
608646250
Title
Role of the funny current inhibitor ivabradine in cardiac pharmacotherapy:
A systematic review.
Source
American Journal of Therapeutics. 25 (2) (pp e247-e266), 2018. Date of
Publication: March-April 2018.
Author
Petite S.E.; Bishop B.M.; Mauro V.F.
Institution
(Petite, Bishop, Mauro) University of Toledo College of Pharmacy, 3000
Arlington Avenue, MS# 1013, Toledo, OH 43614, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The pharmacology, pharmacokinetics, efficacy and safety of ivabradine are
reviewed. Ivabradine is an oral medication that directly and selectively
inhibits the hyperpolarization-activated cyclicnucleotide gated funny (If)
current in the sinoatrial node resulting in heart rate reduction. It has a
plasma elimination half-life of 6 hours and is administered twice daily.
Ivabradine is extensively metabolized by cytochrome P450 3A4, and its
metabolism is affected by inducers and inhibitors of the 3A4 enzyme.
Studies in patients with heart failure indicate that ivabradine improves
surrogate markers such as exercise tolerance. The results of (1) phase III
trial demonstrated ivabradine significantly reduced heart failure
hospitalizations but had no effect on mortality. Ivabradine has been
extensively evaluated for coronary artery disease wherein (2) large trials
was shown to have no mortality benefit. Ivabradine has been associated
with improved symptoms in stable chronic angina pectoris. Ivabradine has
been evaluated for other cardiovascular conditions including tachycardias
of various natures, arrhythmia prevention postcardiac surgery, in acute
coronary syndrome, and for heart rate control during coronary computed
tomography angiogram. The most common adverse events reported in clinical
trials were bradycardia, new-onset atrial fibrillation, and phosphenes.
Ivabradine, a novel cardiac medication, has been studied in numerous
cardiac conditions. It is only currently approved in the United States to
reduce hospitalizations for systolic heart failure. The role of this
medication in other conditions has not been fully
elucidated. Copyright © 2016 Wolters Kluwer Health, Inc. All
rights reserved.

<101>
Accession Number
609692152
Title
Comparative effectiveness of coronary CT angiography vs stress cardiac
imaging in patients following hospital admission for chest pain work-up:
The Prospective First Evaluation in Chest Pain (PERFECT) Trial.
Source
Journal of Nuclear Cardiology. 24 (4) (pp 1267-1278), 2017. Date of
Publication: 01 Aug 2017.
Author
Uretsky S.; Argulian E.; Supariwala A.; Agarwal S.K.; El-Hayek G.; Chavez
P.; Awan H.; Jagarlamudi A.; Puppala S.P.; Cohen R.; Rozanski A.
Institution
(Uretsky) Department of Cardiovascular Medicine, Morristown Medical
Center, Gagnon Cardiovascular Institute, 100 Madison Ave, Morristown, NJ
07960, United States
(Argulian, El-Hayek, Chavez, Awan, Jagarlamudi, Puppala, Cohen, Rozanski)
Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's
Hospital, New York, NY, United States
(Supariwala) Northshore LIJ Southside Hospital, Hofstra School of
Medicine, NSLIJHS, Bayshore, NY, United States
(Agarwal) Department of Cardiovascular Medicine, University of Arkansas
for Medical Sciences, Little Rock, AR, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Because the frequency of cardiac event rates is low among
chest pain patients following either performance of coronary CT
angiography (CCTA) or stress testing, there is a need to better assess how
these tests influence the central management decisions that follow from
cardiac testing. The present study was performed to assess the relative
impact of CCTA vs stress testing on medical therapies and downstream
resource utilization among patients admitted for the work-up of chest
pain. Method(s): The admitted patients were randomized in a 1:1 ratio
to either cardiac imaging stress test or CCTA. Primary outcomes were time
to discharge, change in medication usage, and frequency of downstream
testing, cardiac interventions, and cardiovascular re-hospitalizations. We
randomized 411 patients, 205 to stress testing, and 206 to CCTA.
 Result(s): There were no differences in time to discharge or
initiation of new cardiac medications at discharge. At 1 year follow-up,
there was no difference in the number of patients who underwent
cardiovascular downstream tests in the CCTA vs stress test patients (21%
vs 15%, P = .1) or cardiovascular hospitalizations (14% vs 16%, P = .5).
However, there was a higher frequency of invasive angiography in the CCTA
group (11% vs 2%, P = .001) and percutaneous coronary interventions (6% vs
0%, P < .001). Conclusion(s): Randomization of hospitalized patients
admitted for chest pain work-up to either CCTA or to stress testing
resulted in similar discharge times, change in medical therapies at
discharge, frequency of downstream noninvasive testing, and repeat
hospitalizations. However, a higher frequency of invasive coronary
angiography and revascularization procedures were performed in the CCTA
arm. (ClinicalTrials.gov number, NCT01604655.). Copyright © 2016,
American Society of Nuclear Cardiology.

<102>
Accession Number
612986952
Title
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet
Therapy in Patients With Coronary Artery Disease: A Report of the American
College of Cardiology/American Heart Association Task Force on Clinical
Practice Guidelines.
Source
Journal of the American College of Cardiology. 68 (10) (pp 1082-1115),
2016. Date of Publication: 06 Sep 2016.
Author
Levine G.N.; Bates E.R.; Bittl J.A.; Brindis R.G.; Fihn S.D.; Fleisher
L.A.; Granger C.B.; Lange R.A.; Mack M.J.; Mauri L.; Mehran R.; Mukherjee
D.; Newby L.K.; O'Gara P.T.; Sabatine M.S.; Smith P.K.; Smith S.C.
Publisher
Elsevier USA

<103>
Accession Number
611990368
Title
Perioperative erythropoietin protects the CNS against ischemic lesions in
patients after open heart surgery.
Source
Wiener Klinische Wochenschrift. 128 (23-24) (pp 875-881), 2016. Date of
Publication: 01 Dec 2016.
Author
Lakic N.; Mrak M.; Sustersic M.; Rakovec P.; Bunc M.
Institution
(Lakic) Department for Cardiovascular Surgery, University Medical Centre
Ljubljana, Ljubljana, Slovenia
(Mrak, Sustersic, Rakovec, Bunc) Department of Cardiology, University
Medical Centre Ljubljana, Zaloska cesta 7, Ljubljana 1000, Slovenia
Publisher
Springer-Verlag Wien (E-mail: michaela.bolli@springer.at)
Abstract
Aim: The aim of this study was to establish erythropoietin as a protective
factor against brain ischemia during open heart surgery. Method(s): A
total of 36 consecutive patients scheduled for revascularization heart
surgery were included in the study. Of the patients 18 received 3
intravenous doses of recombinant human erythropoietin (rHuEpo, 24,000 IU)
and 18 patients received a placebo. Magnetic resonance imaging (MRI) to
detect new brain ischemic lesions was performed. Additionally, S100A,
S100B, neuron-specific enolase A and B (NSE-A and B) and the concentration
of antibodies against N-methyl-D-aspartate receptors (NMDAR) to identify
new neurological complications were determined. Result(s): Patients
who received rHuEpo showed no postoperative ischemic changes in the brain
on MRI images. In the control group 5 (27.8 %) new ischemic lesions were
found. The NMDAR antibody concentration, S100A, S100B and NSE showed no
significant differences between the groups for new cerebral ischemia. High
levels of lactate before and after external aortic compression (p = 0.022
and p = 0.048, respectively) and duration of operation could predict new
ischemic lesions (p = 0.009). Conclusion(s): The addition of rHuEpo
reduced the formation of lesions detectable by MRI in the brain and could
be used clinically as neuroprotection in cardiac surgery. Copyright
© 2016, Springer-Verlag Wien.

<104>
Accession Number
602248146
Title
Infective endocarditis in patients with an implanted transcatheter aortic
valve: Clinical characteristics and outcome of a new entity.
Source
Journal of Infection. 70 (6) (pp 565-576), 2015. Date of Publication: 01
Jun 2015.
Author
Pericas J.M.; Llopis J.; Cervera C.; Sacanella E.; Falces C.; Andrea R.;
Garcia de la Maria C.; Ninot S.; Almela M.; Pare J.C.; Sabate M.; Moreno
A.; Marco F.; Mestres C.A.; Miro J.M.; Miro J.M; Pericas J.M; Tellez A.;
Castaneda X.; Gatell J.M.; de la Maria C.G.; Armero Y.; Vila J.; Carlos
Pare J.; Azqueta M.; Sitges M.; Vidal B.; Quintana E.; Cartana R.; Pereda
D.; Pomar; Castella M.; Ramirez J.; Ribalta T.; Brunet M.; Soy D.; Fuster
D.; Granados U.
Institution
(Pericas, Cervera, Garcia de la Maria, Moreno, Miro) Infectious Diseases
Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi
i Sunyer, University of Barcelona, Barcelona, Spain
(Llopis) Department of Statistics, Faculty of Biology, University of
Barcelona, Spain
(Sacanella) Internal Medicine Service, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona,
Barcelona, Spain
(Falces, Andrea, Vidal, Pare, Sabate) Cardiology Service, Hospital Clinic,
Institut d'Investigacions Biomediques August Pi i Sunyer, University of
Barcelona, Barcelona, Spain
(Ninot, Mestres) Department of Cardiovascular Surgery, Hospital Clinic,
Institut d'Investigacions Biomediques August Pi i Sunyer, University of
Barcelona, Barcelona, Spain
(Almela) Microbiology Service, Hospital Clinic, Institut d'Investigacions
Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
(Marco) ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Microbiology
Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
(Miro, Pericas, Tellez, Castaneda, Gatell, de la Maria, Armero, Vila,
Carlos Pare, Azqueta, Sitges, Vidal, Quintana, Cartana, Pereda, Pomar,
Castella, Ramirez, Ribalta, Brunet, Soy, Fuster, Granados) Hospital
Clinic-IDIBAPS, University of Barcelona School of Medicine, Barcelona,
Spain
Publisher
W.B. Saunders Ltd
Abstract
Aims: This study reports one case and review the literature on
TAVI-associated endocarditis (TAVIE), to describe its clinical picture and
to perform an analysis on prognostic factors. Methods and Results: A
MEDLINE search from January 2002 to October 2014 revealed 31 cases of
TAVIE, including 1 from our hospital. Median age was 81 years (IQR,
78-85), 53% of patients were males and the median age-adjusted Charlson
score was 7 (IQR, 5-8). Heart failure was recorded in 42%, embolic events
in 19%, and periannular complications in 45%. The most common causative
agent was Enterococcus spp (36%). Ten patients (32%) underwent surgery and
nine patients died (29%). The prognostic factors for 6-month mortality
were heart failure (HR, 9.97 [3.7-24.5]; p=0.001), periannular
complications (HR, 11.82 [3.3-41.3]; p=0.004), and
nonenterococcal/streptococcal etiology (HR, 4.76 [2.1-11.1]; p=0.03). In
patients with heart failure who did not undergo surgery, mortality was 89%
(8 out of 9); in those who did undergo surgery, mortality was 0%
(p<0.001). Conclusion(s): TAVIE is an emerging entity with high
mortality. Patients with heart failure who did not undergo surgery had a
higher probability of dying. Surgical treatment provided better outcomes
even in patients in whom surgery had previously been ruled
out. Copyright © 2015 The British Infection Association.

<105>
[Use Link to view the full text]
Accession Number
627390086
Title
Open-Label Randomized Trial Comparing Oral Anticoagulation With and
Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation
and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent
Implantation: OAC-ALONE Study.
Source
Circulation. 139 (5) (pp 604-616), 2019. Date of Publication: 29 Jan 2019.
Author
Matsumura-Nakano Y.; Shizuta S.; Komasa A.; Morimoto T.; Masuda H.; Shiomi
H.; Goto K.; Nakai K.; Ogawa H.; Kobori A.; Kono Y.; Kaitani K.; Suwa S.;
Aoyama T.; Takahashi M.; Sasaki Y.; Onishi Y.; Mano T.; Matsuda M.;
Motooka M.; Tomita H.; Inoko M.; Wakeyama T.; Hagiwara N.; Tanabe K.; Akao
M.; Miyauchi K.; Yajima J.; Hanaoka K.; Morino Y.; Ando K.; Furukawa Y.;
Nakagawa Y.; Nakao K.; Kozuma K.; Kadota K.; Kimura K.; Kawai K.; Ueno T.;
Okumura K.; Kimura T.
Institution
(Matsumura-Nakano, Shizuta, Komasa, Shiomi, Sasaki, Okumura, Kimura)
Department of Cardiovascular Medicine, Kyoto University Graduate School of
Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Masuda, Ando) Department of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Goto) Department of Cardiology, Saitama Medical University International
Medical Center, Japan
(Nakai) Department of Cardiovascular Medicine, Uji Tokushukai Medical
Center, Japan
(Ogawa, Akao) Department of Cardiology, National Hospital Organization
Kyoto Medical Center, Japan
(Kobori, Furukawa) Department of Cardiovascular Medicine, Kobe City
Medical Center General Hospital, Japan
(Kono) Kono Clinic, Kyoto, Japan
(Kaitani) Department of Cardiovascular Medicine, Japanese Red Cross Otsu
Hospital, Japan
(Suwa) Department of Cardiology, Juntendo University Shizuoka Hospital,
Izunokuni, Japan
(Aoyama) Division of Cardiology, Shimada Municipal Hospital, Japan
(Takahashi) Department of Cardiology, Shimabara Hospital, Kyoto, Japan
(Onishi) Department of Cardiology, Hiratsuka Kyosai Hospital, Japan
(Mano) Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
(Matsuda) Division of Cardiology, Kishiwada City Hospital, Japan
(Motooka) Division of Cardiology, Shizuoka General Hospital, Japan
(Tomita) Department of Cardiology, Hirosaki University Graduate School of
Medicine, Japan
(Inoko) Cardiovascular Center, Tazuke Kofukai Medical Research Institute,
Kitano Hospital, Osaka, Japan
(Wakeyama) Division of Cardiology, Tokuyama Central Hospital, Shunan,
Japan
(Hagiwara) Department of Cardiology, Heart Institute of Japan, Tokyo
Women's Medical University, Japan
(Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Miyauchi) Department of Cardiovascular Medicine, Juntendo University
Hospital, Tokyo, Japan
(Yajima) Department of Cardiovascular Medicine, Cardiovascular Institute,
Tokyo, Japan
(Hanaoka) Hanaoka Seishu Memorial Cardiovascular Clinic, Sapporo, Japan
(Morino) Department of Cardiology, Iwate Medical University, Morioka,
Japan
(Nakagawa) Department of Cardiology, Tenri Hospital, Japan
(Nakao) Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular
Center, Japan
(Kozuma) Department of Cardiology, Teikyo University Hospital, Tokyo,
Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Japan
(Kimura) Division of Cardiology, Yokohama City University Medical Center,
Japan
(Kawai) Department of Cardiovascular Medicine, Chikamori Hospital, Kochi,
Japan
(Ueno) Division of Cardiovascular Medicine, Kurume University Hospital,
Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Despite recommendations in the guidelines and consensus
documents, there has been no randomized controlled trial evaluating oral
anticoagulation (OAC) alone without antiplatelet therapy (APT) in patients
with atrial fibrillation and stable coronary artery disease beyond 1 year
after coronary stenting. Method(s): This study was a prospective,
multicenter, open-label, noninferiority trial comparing OAC alone to
combined OAC and single APT among patients with atrial fibrillation beyond
1 year after stenting in a 1:1 randomization fashion. The primary end
point was a composite of all-cause death, myocardial infarction, stroke,
or systemic embolism. The major secondary end point was a composite of the
primary end point or major bleeding according to the International Society
on Thrombosis and Haemostasis classification. Although the trial was
designed to enroll 2000 patients during 12 months, enrollment was
prematurely terminated after enrolling 696 patients in 38 months.
 Result(s): Mean age was 75.0+/-7.6 years, and 85.2% of patients were
men. OAC was warfarin in 75.2% and direct oral anticoagulants in 24.8% of
patients. The mean CHADS2 score was 2.5+/-1.2. During a median
follow-up interval of 2.5 years, the primary end point occurred in 54
patients (15.7%) in the OAC-alone group and in 47 patients (13.6%) in the
combined OAC and APT group (hazard ratio, 1.16; 95% CI, 0.79-1.72; P=0.20
for noninferiority, P=0.45 for superiority). The major secondary end point
occurred in 67 patients (19.5%) in the OAC-alone group and in 67 patients
(19.4%) in the combined OAC and APT group (hazard ratio, 0.99; 95% CI,
0.71-1.39; P=0.016 for noninferiority, P=0.96 for superiority). Myocardial
infarction occurred in 8 (2.3%) and 4 (1.2%) patients, whereas stroke or
systemic embolism occurred in 13 (3.8%) and 19 (5.5%) patients,
respectively. Major bleeding occurred in 27 (7.8%) and 36 (10.4%)
patients, respectively. Conclusion(s): This randomized trial did not
establish noninferiority of OAC alone to combined OAC and APT in patients
with atrial fibrillation and stable coronary artery disease beyond 1 year
after stenting. Because patient enrollment was prematurely terminated, the
study was underpowered and inconclusive. Future larger studies are
required to establish the optimal antithrombotic regimen in this
population. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01962545. Copyright © 2019 American Heart Association, Inc.

<106>
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.
 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.
 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).
 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. Copyright © 2019 Elsevier GmbH

<107>
Accession Number
627269754
Title
Complete versus culprit-only revascularization in patients with ST-segment
elevation myocardial infarction and multivessel disease: a meta-analysis
of randomized trials.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 91. Date of Publication: 22 Apr 2019.
Author
Xu H.; Zhang X.; Li J.; Liu H.; Hu X.; Yang J.
Institution
(Xu, Zhang, Li, Liu, Hu, Yang) Department of Cardiology, Huaian No.1
People's Hospital of Nanjing Medical University, 6 Beijing Road West,
Huai'an, Jiangsu 223300, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The best strategy for the treatment of the non-infarct artery
in patients with ST-elevation myocardial infarction (STEMI) and
multivessel disease (MVD) undergoing primary percutaneous coronary
intervention (PCI) is not yet defined. Method(s): We searched the
literature for randomized controlled trials (RCTs) that compared complete
revascularization (CR) with infarct-related coronary artery (IRA) only
revascularization in hemodynamically stable patients with STEMI. Random
effect risk ratios (RRs) were calculated for clinical outcomes.
 Result(s): Nine RCTs with 2989 patients were included. No significant
difference in all-cause mortality emerged between CR and IRA-only groups
(relative risk [RR] = 0.74; 95% confidence interval [CI]: 0.52 to 1.04; p
= 0.08). Compared with IRA-only, CR was associated with significantly
lower rates of major adverse cardiac events (MACE) (RR = 0.53; 95% CI:
0.41 to 0.68; p < 0.001), cardiac death (RR = 0.48; 95% CI: 0.29 to 0.79;
p = 0.004) and repeat revascularization (RR = 0.38; 95% CI: 0.30 to 0.47;
p < 0.001). In subgroups analysis, immediate complete revascularization
(ICR) reduced the risk of all-cause mortality (RR = 0.62; 95% CI: 0.39 to
0.97; p = 0.04), whereas staged complete revascularization (SCR) did not
show any significant benefit in all-cause mortality (RR = 0.92; 95% CI:
0.46 to 1.86; p = 0.82). Stroke, contrast-induced nephropathy and major
bleeding were not different between CR and IRA-only. Conclusion(s):
For patients with STEMI and multivessel disease undergoing primary PCI,
complete revascularization did not decrease the risk of all-cause
mortality in current evidence from randomized trials. When feasible,
immediate complete revascularization might be considered in patients with
STEMI and multivessel disease. Copyright © 2019 The Author(s).

<108>
[Use Link to view the full text]
Accession Number
627410931
Title
The design of an adaptive clinical trial to evaluate the efficacy of
platelets stored at low temperature in surgical patients.
Source
The journal of trauma and acute care surgery. 84 (6S Suppl 1) (pp
S41-S46), 2018. Date of Publication: 01 Jun 2018.
Author
Krachey E.; Viele K.; Spinella P.C.; Steiner M.E.; Zantek N.D.; Lewis R.J.
Institution
(Krachey) From Berry Consultants, LLC (E.K., K.V., R.J.L.), Austin, Texas;
Division Critical Care, Department of Pediatrics (P.C.S.), Washington
University in St Louis, St Louis, Missouri; Divisions of
Hematology/Oncology and Critical Care Medicine, Department of Pediatrics
(M.E.S.), Department of Laboratory Medicine and Pathology (N.D.Z.),
University of Minnesota, Minneapolis, Minnesota; Department of Emergency
Medicine (R.J.L.), Harbor-UCLA Medical Center; Los Angeles Biomedical
Research Institute (R.J.L.), Torrance; and Department of Emergency
Medicine (R.J.L.), David Geffen School of Medicine at UCLA, Los Angeles,
California
Publisher
NLM (Medline)
Abstract
BACKGROUND: Storage of platelets at 4degreeC compared with 22degreeC may
increase both hemostatic activity and storage duration; however, the
maximum duration of cold storage is unknown. We report the design of an
innovative, prospective, randomized, Bayesian adaptive, "duration finding"
clinical trial to evaluate the efficacy and maximum duration of storage of
platelets at 4degreeC. METHOD(S): Patients undergoing cardiac surgery
and requiring platelet transfusions will be enrolled. Patients will be
randomized to receive platelets stored at 22degreeC up to 5 days or
platelets stored at 4degreeC up to 5 days, 10 days, or 15 days. Longer
durations of cold storage will only be used if shorter durations at
4degreeC appear noninferior to standard storage, based on a four-level
clinical hemostatic efficacy score with a NIM of a half level. A Bayesian
linear model is used to estimate the hemostatic efficacy of platelet
transfusions based on the actual duration of storage at 4degreeC.
 RESULT(S): The type I error rate, if platelets stored at 4degreeC are
inferior, is 0.0247 with an 82% probability of early stopping for
futility. With a maximum sample size of 1,500, the adaptive trial design
has a power of over 90% to detect noninferiority and a high probability of
correctly identifying the maximum duration of storage at 4degreeC that is
noninferior to 22degreeC. CONCLUSION(S): An adaptive,
duration-finding trial design will generate Level I evidence and allow the
determination of the maximum duration platelet storage at 4degreeC that is
noninferior to standard storage at 22degreeC, with respect to hemostatic
efficacy. The adaptive trial design helps to ensure that longer cold
storage durations are only explored once substantial supportive data are
available for the shorter duration(s) and that the trial stops early if
continuation is likely to be futile.

<109>
Accession Number
627415110
Title
Myocardial Injury after Non-Cardiac Surgery: A Systematic Review and
Meta-analysis.
Source
Cardiology in review. (no pagination), 2019. Date of Publication: 04 Apr
2019.
Author
Smilowitz N.R.; Redel-Traub G.; Hausvater A.; Armanious A.; Nicholson J.;
Puelacher C.; Berger J.S.
Institution
(Smilowitz, Redel-Traub, Hausvater, Armanious, Berger) Division of
Cardiology, Department of Medicine, New York University School of
Medicine, New York, NY
(Nicholson) Department of Library Sciences, New York University School of
Medicine, New York, NY
(Puelacher) Department of Cardiology and Cardiovascular Research Institute
Basel, University of Basel, Switzerland
(Berger) Division of Hematology, Department of Medicine, New York
University School of Medicine, New York, NY
(Berger) Division of Vascular Surgery, Department of Surgery, New York
University School of Medicine, New York, NY
Publisher
NLM (Medline)
Abstract
Myocardial injury after non-cardiac surgery (MINS) is a common
post-operative complication associated with adverse cardiovascular
outcomes. The purpose of this systematic review was to determine the
incidence, clinical features, pathogenesis, management, and outcomes of
MINS. We searched PubMed, Embase, Central and Web of Science databases for
studies reporting the incidence, clinical features, and prognosis of MINS.
Data analysis was performed with a mixed-methods approach, with
quantitative analysis of meta-analytic methods for incidence, management,
and outcomes, and a qualitative synthesis of the literature to determine
associated pre-operative factors and MINS pathogenesis. A total of 195
studies met study inclusion criteria. Among 169 studies reporting outcomes
of 530,867 surgeries, the pooled incidence of MINS was 17.9% (95% CI
16.2%-19.6%). Patients with MINS were older, more frequently men, and more
likely to have cardiovascular risk factors and known coronary artery
disease. Post-operative mortality was higher among patients with MINS than
those without MINS, both in-hospital (8.1%, 95% CI 4.4%-12.7% versus 0.4%,
95% CI 0.2%-0.7%; relative risk 8.3, 95% CI 4.2 - 16.6, p<0.001) and at
1-year after surgery (20.6%, 95% CI 15.9%-25.7% versus 5.1%, 95% CI
3.2%-7.4%; relative risk 4.1, 95% CI 3.0 - 5.6, p<0.001). Few studies
reported mechanisms of MINS or the medical treatment provided. In
conclusion, MINS occurs frequently in clinical practice, is most common in
patients with cardiovascular disease and its risk factors, and is
associated with increased short- and long-term mortality. Additional
investigation is needed to define strategies to prevent MINS and treat
patients with this diagnosis.

<110>
Accession Number
627413382
Title
Impact of risk factors and surgical techniques in coronary endarterectomy:
a network meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 14 Apr 2019.
Author
Wang C.; Chen J.; Gu C.; Qiao R.; Li J.
Institution
(Wang, Gu, Qiao, Li) Department of Cardiac Surgery, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
(Chen) People's Hospital of Deyang City, Sichuan, China
Publisher
NLM (Medline)
Abstract
The goal of this network meta-analysis was to compare the early mortality
rate of patients who underwent coronary endarterectomy (CE) combined with
coronary artery bypass grafting (CABG) with different techniques and with
isolated CABG. This analysis also evaluated potential risk factors in
patients who undergo CE. Eighteen studies were included, covering 21 752
different patients, among whom 3352 underwent CE+CABG with either open or
closed techniques and 18 400 underwent isolated CABG. Patients who had
CE+CABG had a statistically significant higher mortality rate [odds ratio
(OR) 1.76; P<0.001]. Subgroup analyses showed that, with closed CE,
mortality was 52% (OR 1.52, P=0.001) more likely to occur, whereas with
open CE, mortality was 279% (OR 3.79, P<0.001) more likely to occur, when
both were compared with isolated CABG. A network meta-analysis indicated
that both the open and closed methods had poorer results than CABG alone
and that the open method had a higher risk of mortality than the closed
one. For risk factors, diabetes mellitus (DM), hypertension, prior
myocardial infarction, peripheral vascular disease and renal failure were
significant contributors to inclusion in the CE group, whereas other risk
factors showed no significant difference. However, none of these factors
indicated significant correlations with the incidence of mortality between
the groups. CE+CABG has a significantly higher risk of death than isolated
CABG, and open CE is more risky than closed CE, even though most of the
individual studies did not show that CE had a higher risk of mortality.
Moreover, DM, hypertension, prior myocardial infarction, peripheral
vascular disease and renal failure were more common in the patients who
had CE+CABG, but these factors may not necessarily increase the mortality
risk of patients who have CE. Copyright © The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

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