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<1>
Accession Number
625326671
Title
Alcohol septal ablation vs myectomy for symptomatic hypertrophic
obstructive cardiomyopathy: Systematic review and meta-analysis.
Source
Clinical Cardiology. 42 (1) (pp 190-197), 2019. Date of Publication:
January 2019.
Author
Osman M.; Kheiri B.; Osman K.; Barbarawi M.; Alhamoud H.; Alqahtani F.;
Alkhouli M.
Institution
(Osman, Alhamoud, Alqahtani, Alkhouli) Division of Cardiology, West
Virginia University School of Medicine, Morgantown, WV, United States
(Kheiri, Barbarawi) Hurley Medical Center, Michigan State University,
Flint, MI, United States
(Osman) Michigan Health Specialist, Flint, MI, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Surgical myectomy (SM) and Alcohol septal ablation (ASA) are
effective therapies for patients with hypertrophic cardiomyopathy who
remain symptomatic despite medical therapy. A plethora of data has
recently emerged on the long-term outcomes of these procedures. We hence
sought to perform an updated meta-analysis comparing both procedures.
<br/>Method(s): Studies reporting long-term (>3-years) outcomes of SM
and/or ASA were included. The primary endpoint was all-cause mortality.
Secondary endpoints included cardiovascular mortality, sudden cardiac
death (SCD), reintervention, and complications including death, pacemaker
implantation, and stroke. <br/>Result(s): Twenty-two ASA cohorts (n =
4213; follow-up = 6.6-years) and 23 SM cohorts (n = 4240; follow-up =
6.8-years) were included. Septal myectomy was associated with higher
periprocedural mortality and stroke (2% vs 1.2%, P = 0.009 and 1.5% vs
0.8% P = 0.013, respectively), but ASA was associated with more need of
pacemaker (10% vs 5%, P < 0.001). During long-term follow-up, all-cause
mortality, cardiovascular mortality, and sudden cardiac death rates were
1.5%, 0.4%, and 0.3% per person-year in the ASA group and 1.1%, 0.5%, and
0.3% per person-year in the SM group (P = 0.21, P = 0.53, P = 0.43),
respectively. Repeat septal reduction intervention(s) were more common
after ASA (11% vs 1.5%, P < 0.001). <br/>Conclusion(s): Compared with SM,
ASA is associated with lower periprocedural mortality and stroke but
higher rates of pacemaker implantations and reintervention. However, there
was no difference between ASA and SM with regards to long-term all-cause
mortality, cardiovascular mortality, or SCD.<br/>Copyright &#xa9; 2018
Wiley Periodicals, Inc.

<2>
Accession Number
625632253
Title
Impact of tricuspid regurgitation and right ventricular dysfunction on
outcomes after transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
Clinical Cardiology. 42 (1) (pp 206-212), 2019. Date of Publication:
January 2019.
Author
Fan J.; Liu X.; Yu L.; Sun Y.; Jaiswal S.; Zhu Q.; Chen H.; He Y.; Wang
L.; Ren K.; Wang J.
Institution
(Fan, Jaiswal, Zhu, Wang) Zhejiang University School of Medicine,
Hangzhou, China
(Liu, Chen, He, Wang, Ren, Wang) Department of Cardiology, Second
Affiliated Hospital Zhejiang University School of Medicine, Hangzhou,
China
(Yu) Department of Echocardiography, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
(Sun) Department of Cardiology, Guangdong People's Hospital, Guangzhou,
China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Far less attention has been paid to the prognostic effect of right-side
heart disease on outcomes after transcatheter aortic valve replacement
(TAVR) when compared with the left side. Therefore, we performed a
systematic review and meta-analysis on the impact of tricuspid
regurgitation (TR) and right ventricular (RV) dysfunction on outcomes
after TAVR. We hypothesized that TR and RV dysfunction may have a
deleterious effect on outcomes after TAVR. Article revealing the
prognostic effect of TR and RV dysfunction on outcomes after TAVR were
being integrated. Random or fixed effect model was adopted in accordance
with the heterogeneity. There were nine studies with a total of 6466
patients enrolled after a comprehensive literature search of the
MEDLINE/PubMed, EMBASE, ISI Web of Science, and Cochrane databases. The
overall analysis revealed that moderate or severe TR at baseline increased
all-cause mortality after TAVR (HR = 1.79, CI 95% 1.52-2.11, P < 0.001).
Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27-1.83, P < 0.001) and
presence of RV dilation (HR = 1.83, CI 95% 1.47-2.27, P < 0.001) were
associated with all-cause mortality. Both baseline moderate or severe TR
and RV dysfunction worsen prognosis after TAVR and careful assessment of
right heart function should be done for clinical decision by the heart
team before the TAVR procedure.<br/>Copyright &#xa9; 2018 The Authors.
Clinical Cardiology published by Wiley Periodicals, Inc.

<3>
Accession Number
627528329
Title
Effect of sequential nicorandil on myocardial microcirculation and
short-term prognosis in acute myocardial infarction patients undergoing
coronary intervention.
Source
Journal of Thoracic Disease. 11 (3) (pp 744-752), 2019. Date of
Publication: 2019.
Author
Pi S.-F.; Liu Y.-W.; Li T.; Wang Y.; Zhou Q.; Liu B.-J.; Peng W.-J.; Li
X.; Wang Y.-Y.; Huang L.
Institution
(Pi, Liu, Li, Wang, Zhou, Liu, Peng, Li, Wang, Huang) Department of
Cardiology, Third Central Hospital of Tianjin, Tianjin Institute of
Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell,
Artificial Cell Engineering Technology Research Center of Public Health
Ministry, Tianjin 300170, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: This study aims to observe the effects of the intracoronary
and peripheral venous administration of nicorandil for the postoperative
myocardial microcirculation and short-term prognosis of ST-segment
elevation myocardial infarction (STEMI) patients undergoing primary
percutaneous coronary intervention (PPCI) treatment. <br/>Method(s): A
total of 140 STEMI patients were divided into three groups according to
different patterns of administration: sequential nicorandil group,
intracoronary nicorandil group and control group. The main observation
indexes included coronary blood flow and myocardial perfusion immediately
after PPCI, while the secondary observation indexes included major adverse
cardiovascular events (MACE) and left ventricular ejection fraction (LVEF)
during the period of hospitalization. <br/>Result(s): After PPCI, the
difference in the proportion of patients with thrombolysis in myocardial
infarction (TIMI) flow grade 3 among the three groups was statistically
significant (P=0.036), where this proportion was higher in the sequential
nicorandil group and intracoronary nicorandil group than in the control
group (P=0.022 and P=0.047); The difference in corrected TIMI frame count
(CTFC) among the three groups was statistically significant (P=0.022),
where CTFC was lower in the sequential nicorandil group and intracoronary
nicorandil group than in the control group (P=0.010, P=0.031); The
differences in the proportion of patients with complete ST resolution
(STR) and advancing of enzyme peak time to within 12 h between each two
groups were statistically significant (P<0.001), where this proportion was
the highest in the sequential nicorandil group; The difference in the
CK-MB peak among the three groups was statistically significant (P=0.036),
where the CK-MB peak was lower in the sequential nicorandil group than in
the control group (P=0.012); The difference in the incidence of MACE
between each two groups was statistically significant (P<0.001), where
this incidence was the lowest in the sequential nicorandil group; The
differences in the proportion of patients with advancing of enzyme peak
time to within 14 h and LVEF among the three groups were not statistically
significant (P=0.722 and P=0.284). <br/>Conclusion(s): Compared with
intracoronary use alone, the intracoronary and peripheral intravenous use
of nicorandil can better improve myocardial microcirculation and
short-term prognosis.<br/>Copyright &#xa9; Journal of Thoracic Disease.
All rights reserved.

<4>
Accession Number
627528323
Title
Efficacy of 50 mg pregabalin for prevention of postoperative neuropathic
pain after video-assisted thoracoscopic surgery and thoracotomy: A 3-month
prospective randomized controlled trial.
Source
Journal of Thoracic Disease. 11 (3) (pp 694-701), 2019. Date of
Publication: 2019.
Author
Homma T.; Doki Y.; Yamamoto Y.; Ojima T.; Shimada Y.; Kitamura N.; Akemoto
Y.; Hida Y.; Yoshimura N.
Institution
(Homma, Doki, Yamamoto, Ojima, Shimada, Kitamura, Akemoto, Hida,
Yoshimura) Department of General Thoracic and Cardiovascular Surgery,
Graduate School of Medicine and Pharmaceutical Sciences, University of
Toyama, 2630 Sugitani, Toyama 930-0194, Japan
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: This study analyzed the preventive effect of 50 mg/day
pregabalin on postoperative neuropathic pain, and any additional benefits
related to sleep and respiratory function. <br/>Method(s): This
prospective randomized controlled study included lung resection patients
20-89 years of age. Patients were randomly assigned to the treatment
(pregabalin; initial dose, 50 mg/day) or control (non-steroidal
anti-inflammatory drugs) group. Pregabalin patients received non-steroidal
anti-inflammatory drugs and pregabalin (25 mg, twice daily) from the
second postoperative day. Pain scores, neuropathic pain, analgesic use,
respiratory function, and insomnia scale scores for 3 months after surgery
were evaluated. <br/>Result(s): This study included 46 patients who
received pregabalin and 46 control patients. Pregabalin patients had
significantly less postoperative neuropathic pain than control patients
(19.6% vs. 41.3%; P=0.0404), and their duration of neuropathic pain was
significantly shorter (30 vs. 90 days; P=0.024). The onset of
postoperative neuropathic pain, insomnia scale scores, and respiratory
function were similar between groups. No pregabalin-related adverse events
were reported. <br/>Conclusion(s): Pregabalin (50 mg/day) had a
significant preventive effect on postoperative neuropathic pain after
thoracic surgery, without side effects. Early postoperative administration
of pregabalin would help prevent neuropathic pain and provide better pain
control after thoracic surgery.<br/>Copyright &#xa9; Journal of Thoracic
Disease. All rights reserved.

<5>
Accession Number
627528287
Title
Aorto-atrial fistula formation and closure: A systematic review.
Source
Journal of Thoracic Disease. 11 (3) (pp 1031-1046), 2019. Date of
Publication: 2019.
Author
Jainandunsing J.S.; Linnemann R.; Bouma W.; Natour N.; Bidar E.; Lorusso
R.; Gelsomino S.; Johnson D.M.; Natour E.
Institution
(Jainandunsing) University of Groningen, University Medical Center
Groningen, Department of Anesthesiology, Netherlands
(Linnemann, Bouma, Natour) University of Groningen, University Medical
Center Groningen, Department of Cardiothoracic Surgery, Netherlands
(Natour) University of Maastricht, Department of Radiology,
Universiteitssingel 50, ER Maastricht 6229, Netherlands
(Bidar, Lorusso, Gelsomino, Johnson) University of Maastricht, Department
of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht -
CARIM, Universiteitssingel 50, ER Maastricht 6229, Netherlands
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Blood flow between the aorta and atrium is a rare but complex pathological
condition, also known as aorto-atrial fistula (AAF). The exact incidence
of this condition is unknown, as are the major precipitating factors and
best treatment options. We carried out a systematic review of the
available case report literature reporting AAF. We systematically reviewed
literature on AAF formation and closure. Separate Medline (PubMed),
EMBASE, and Cochrane database queries were performed. The following MESH
headings were used: atrium, ventricle, fistula, cardiac, shunts, aortic,
aorto-atrial tunnels and coronary cameral fistula. All papers were
considered for analysis irrespective of their quality, or the journal in
which they were published. Fistula formation from the ascending aorta to
the atria occurred more often in the right atrium compared to the left.
Endocarditis was the major cause of AAF formation, whilst congenital
causes were responsible for nearly 12%. In a number of cases fistula
formation occurred secondary to cardiac surgery, whilst chest traumas were
a relatively rare cause of AAF. Correction via an open surgical approach
occurred in 73.5% of cases, whilst percutaneous intervention was utilised
in 10% of patients. In 74.3% of all studied cases the fistula repair was
successful and patients survived the procedures. In 14.7% of the cases
patients did not survive. Similar outcomes were observed between
percutaneous and surgical interventions. Data from larger populations with
AAF is lacking, meaning that specific data regarding incidence and
prevalence does currently not exist.<br/>Copyright &#xa9; Journal of
Thoracic Disease. All rights reserved.

<6>
Accession Number
627528283
Title
Single or dual antiplatelet therapy after transcatheter aortic valve
replacement: An updated systemic review and meta-analysis.
Source
Journal of Thoracic Disease. 11 (3) (pp 959-968), 2019. Date of
Publication: 2019.
Author
Zuo W.; Yang M.; He Y.; Hao C.; Chen L.; Ma G.
Institution
(Zuo, Yang, He, Hao, Chen, Ma) Department of Cardiology, Zhongda Hospital,
Medical School of Southeast University, Nanjing 210009, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Although current guidelines recommend dual antiplatelet
therapy (DAPT) with aspirin and clopidogrel as an antiplatelet strategy
after transcatheter aortic valve replacement (TAVR), it is not based on
clinical evidence. Here we aim to review updated evidence systemically and
assess safety and efficacy of the two antiplatelet regimens.
<br/>Method(s): PubMed, Embase, and Cochrane Central Register of
Controlled Trials (CENTRAL) were searched to retrieve studies involving
single antiplatelet therapy (SAPT) versus DAPT after TAVR. We screened the
records and extracted the data from publications independently. Relative
risks (RRs) and the corresponding 95% confidence intervals (CIs) were used
to compare the efficacy and safety of SAPT with that of DAPT in
fixed-effects model with Mantel-Haenszel method. The quality of evidence
was assessed by the scoring system, GRADE (Grading of Recommendations
Assessment, Development, and Evaluation). <br/>Result(s): A total of 2,489
patients from 8 studies were enrolled in this meta-analysis. Compared with
DAPT, SAPT was associated with a lower all-cause mortality (RR =0.57; 95%
CI, 0.36-0.89; P=0.014) and major/life-threatening bleeding (RR =0.62; 95%
CI, 0.50-0.76; P=0.000) in 30 days. Furthermore, there was no significant
difference found between SAPT and DAPT group in terms of 30-day stroke (RR
=0.85; 95% CI, 0.45-1.63; P=0.631) and death beyond 3 months (RR =0.96;
95% CI, 0.81-1.15; P=0.664). <br/>Conclusion(s): This meta-analysis
suggests that compared with DAPT, SAPT after TAVR is more likely to lead
to a decline of 30-day mortality along with the reduced risk of bleeding
and no increased risk of stroke. However, more clinical data and evidence
from randomized controlled trials are warranted to clarify the optimal
post-TAVR antiplatelet strategy.<br/>Copyright &#xa9; Journal of Thoracic
Disease. All rights reserved.

<7>
Accession Number
627528278
Title
Aorto-atrial fistula formation and therapy.
Source
Journal of Thoracic Disease. 11 (3) (pp 1016-1021), 2019. Date of
Publication: 2019.
Author
Jainandunsing J.S.; Linnemann R.; Maessen J.; Natour N.E.; Lorusso R.;
Gelsomino S.; Johnson D.M.; Natour E.
Institution
(Jainandunsing) Department of Anesthesiology, University of Groningen,
Groningen, Netherlands
(Linnemann, Natour) Department of Cardiothoracic Surgery, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Maessen, Lorusso, Gelsomino, Johnson, Natour) Department of
Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht -
CARIM, University of Maastricht, Maastricht, Netherlands
(Natour) Department of Radiology, Maastricht University Medical Centre,
Maastricht, Netherlands
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Aorta-atrial fistulas (AAF) are a rare but complex pathological condition.
These fistulas are characterised by aberrant blood flow between the aorta
and either atrium. In the present manuscript, we present a comprehensive
overview of the clinical characteristics, formation and treatment of this
condition. A literature review was conducted using PubMed. Aorta-Atrial
Fistula was used as the primary search term. The clinical presentation of
AAF encompasses a wide range of signs and symptoms of heart failure
including dyspnoea, chest pain, palpitations, fatigue, weakness coughing
or oedema. Causes of fistulas can be congenital or acquired, whilst
diagnosis is normally achieved via echocardiography or MRI. Due to the low
incidence of AAF, no clinical trials have been performed in AAF patients
and treatment strategies are based on expert opinion and consensus amongst
the treating physicians. Uncorrected AAF may continue to impose a risk of
progression to overt heart failure. The repair of an AAF can either be
surgical or percutaneous. AAF is a relatively rare but very serious
condition. Clinicians should consider the possibility of AAF, when a new
continuous cardiac murmur occurs, especially in patients with a history of
cardiac surgery or with signs of heart failure. Closure of the AAF fistula
tract is generally recommended. Further studies are required to define
optimal therapeutic strategies, but these are hindered by the rarity of
the occurrence of this disorder.<br/>Copyright &#xa9; Journal of Thoracic
Disease. All rights reserved.

<8>
Accession Number
2001861188
Title
I-level positive airway pressure ventilation for patients with hypoxemia
after coronary artery bypass grafting.
Source
Journal of Biological Regulators and Homeostatic Agents. 33 (2) (pp
403-408), 2019. Date of Publication: March/April 2019.
Author
Cai W.W.; Hu J.; Wang H.; Zhu G.J.; Chen S.; Chen X.
Institution
(Cai, Hu, Wang, Zhu, Chen, Chen) Luoyang Central Hospital Affiliated to
Zhengzhou University, Luoyang, China
Publisher
Biolife s.a.s. (E-mail: biolife_sas@yahoo.it)
Abstract
Coronary artery bypass grafting (CABG) is an effective scheme for
treatment of myocardial ischemia. Hypoxemia is a common complication of
CABG, which can affect surgical effect and prognosis and even induce
multiple organ failure. To explore the clinical efficacy of bi-level
positive airway pressure ventilation in the treatment of CABG-associated
hypoxemia, 216 patients who were admitted to our hospital between August
2015 and April 2017 and developed CABG-associated hypoxemia were selected
and randomly divided into 2 groups, an observation group (n=108) and a
control group (n=108). Patients in the control group were given
conventional treatment including continuous oxygen inhalation through
nasal tube, antiinfection, bronchodilation, phlegm resolving, nutrition
support, analgesia, cardiac function maintenance, coronary dilatation,
anticoagulation and maintenance of stable internal environment, while
patients in the observation group were given positive airway pressure
ventilation via a breathing machine or nasal mask besides the conventional
treatment. The arterial blood gas indexes and blood circulation indexes of
patients in the two groups were detected before and after treatment, the
number of cases of reintubation was recorded, and the curative effects
were analyzed. The results demonstrated that the arterial gas indexes and
blood circulation indexes of patients in the observation group improved
after treatment, and the improvement of the observation group was
significantly superior to that of the control group (P<0.05). The
intensity of hypoxia of the observation group was higher, and the number
of cases of reintubation of the observation group was lower than that of
the control group (P<0.05). Thus bi-level positive airway pressure
ventilation is an effective non-invasive ventilation mode for treating
CABG-associated hypoxemia because it can improve p(O2), reduce p(CO2) in a
short time, relieve blood circulation, and reduce the rate of
reintubation. Patients who develop hypoxemia after removal of tracheal
intubation are advised to undergo bi-level positive airway pressure in the
early stage.<br/>Copyright &#xa9; by BIOLIFE, s.a.s.

<9>
Accession Number
625422931
Title
Impact of Patient and Lesion Characteristics on Drug-Coated Balloon
Angioplasty in the Femoropopliteal Artery: A Pooled Analysis of Four
Randomized Controlled Multicenter Trials.
Source
CardioVascular and Interventional Radiology. 42 (4) (pp 495-504), 2019.
Date of Publication: 15 Apr 2019.
Author
Albrecht T.; Ukrow A.; Werk M.; Tepe G.; Zeller T.; Meyer D.-R.; Kutschera
M.; Speck U.; Waliszewski M.
Institution
(Albrecht, Ukrow) Department of Radiology and Interventional Therapy,
Vivantes Klinikum Neukolln, Berlin, Germany
(Werk) Department of Radiology, Martin-Luther-Hospital, Berlin, Germany
(Tepe) Department of Radiology, RoMed Klinikum Rosenheim, Rosenheim,
Germany
(Zeller) Department of Angiology, Herzzentrum Bad Krozingen, Bad
Krozingen, Germany
(Meyer) Department of Diagnostic and Interventional Radiology, Hubertus
Hospital, Berlin, Germany
(Kutschera, Speck) Experimental Radiology, Department of Radiology,
Charite, Berlin, Germany
(Waliszewski) Medical Scientific Affairs, B.Braun Melsungen AG, Berlin,
Germany
(Waliszewski) Department of Internal Medicine and Cardiology, Charite -
Universitatsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
(Albrecht) Institut fur Radiologie und Interventionelle Therapie, Vivantes
Klinikum Neukolln, Rudower Str. 48, Berlin 12351, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objectives: The principal objective of this pooled analysis was to
investigate various patient and lesion characteristics on late lumen loss
(LLL) after drug-coated balloon (DCB) angioplasty. <br/>Background(s):
Four randomized controlled trials (THUNDER, FEMPAC, PACIFIER, CONSEQUENT)
were pooled to investigate the influence of various patient and lesion
characteristics on DCB angioplasty and on plain old balloon angioplasty
(POBA) in patients with femoropopliteal artery disease. <br/>Method(s):
Angiographic data from 355 patients were pooled to assess the impact of
patient (demographics, cardiovascular risk factors, cardiovascular
co-morbidities, Rutherford stages) and lesion-/procedure-related
(location, occlusion, length, restenosis, calcification, subintimal
crossing, post-dilatation, dissection, stenting) characteristics on LLL.
Linear regression models were utilized with LLL as the dependent variable
to determine the predictive value of cardiovascular and
lesion-/procedure-related factors. <br/>Result(s): Observational
statistics revealed that LLL was lower in the DCB group as compared to
POBA independent of all tested patient variables. LLL after DCB was also
independent of most lesion and procedural characteristics except for
lesion length and bailout stenting. LLL increased with lesion length in
both treatment groups. Bailout stenting did not improve LLL in the DCB
group but did so in the POBA group (0.74 +/- 1.07 mm vs. 1.22 +/- 1.36 mm,
p = 0.043). <br/>Conclusion(s): DCB was superior to POBA for all tested
patient subgroups and lesion subgroups. Our results suggest that all
patients and lesions benefit to a similar degree from the use of DCB.
DCB-PTA should therefore be preferred to POBA in all patients with
steno-occlusive femoropopliteal lesions.<br/>Copyright &#xa9; 2018,
Springer Science+Business Media, LLC, part of Springer Nature and the
Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

<10>
Accession Number
2001307535
Title
Correlates and outcomes of alcohol use after single solid organ
transplantation: A systematic review and meta-analysis.
Source
Transplantation Reviews. 33 (1) (pp 17-28), 2019. Date of Publication:
January 2019.
Author
Dobbels F.; Denhaerynck K.; Klem M.L.; Sereika S.M.; De Geest S.; De
Simone P.; Berben L.; Binet I.; Burkhalter H.; Drent G.; Duerinckx N.;
Engberg S.J.; Glass T.; Gordon E.; Kirsch M.; Kugler C.; Lerret S.;
Rossmeissl A.; Russell C.; Schmidt-Trucksass A.; de Almeida S.S.
Institution
(Berben) Institute of Nursing Science, University of Basel, Switzerland
(Binet) Nephrology and Transplantation Medicine, Cantonal Hospital St.
Gallen, Switzerland
(Burkhalter) Centre of Sleep Medicine, Hirslanden Group Zurich,
Switzerland
(Drent) Department of Gastroenterology and Hepatology, University Medical
center Groningen, Groningen, Netherlands
(Duerinckx) Academic Centre for Nursing and Midwifery, KU Leuven, Leuven,
Belgium
(Duerinckx) Heart Transplantation Program, University Hospitals Leuven,
Leuven, Belgium
(Sereika, Engberg) School of Nursing, University of Pittsburgh, United
States
(Glass) Department of Biostatistics, Swiss Tropical and Public Health
Institute, University of Basel, Basel, Switzerland
(Gordon) Department of Surgery, Center for Healthcare Studies, Center for
Bioethics and Medical Humanities, Northwestern University Feinberg School
of Medicine, Chicago, United States
(Kirsch) Department of Anaesthesiology, University Hospital of Basel,
Switzerland
(Kugler) Nursing Science, University of Witten/Herdecke, Germany
(Lerret) Department of Pediatric Gastroenterology and Transplant Surgery,
Medical College of Wisconsin, United States
(Rossmeissl) Departement fur Sport, Bewegung und Gesundheit, University
Hospital of Basel, Basel, Switzerland
(Russell) School of Nursing and Health Studies, University of Missouri
Kansas City, United States
(Schmidt-Trucksass) Departement fur Sport, Bewegung und Gesundheit,
University Hospital of Basel, Switzerland
(de Almeida) Transplantation program, Hospital Israelita Albert Einstein,
Sao Paulo, Brazil
(Dobbels, De Geest) Academic Centre for Nursing and Midwifery KU, Leuven,
Belgium
(Dobbels, Denhaerynck, De Geest) Institute of Nursing Science, Department
of Public Health, University of Basel, Switzerland
(Klem) Health Sciences Library System, University of Pittsburgh, United
States
(De Simone) Hepatobiliary surgery and liver Transplantation, University of
Pisa Medical School Hospital, Italy
Publisher
W.B. Saunders
Abstract
Background: Reviews on alcohol use in transplant recipients focus on liver
recipients and their risk of post-transplant rejection, but do not assess
alcohol use in kidney, heart, or lung transplant recipients. This
systematic review and meta-analysis aims to synthesize the evidence on
correlates and outcomes of any alcohol use and at-risk drinking after
solid organ transplantation (Tx). <br/>Method(s): We searched 4 databases
for quantitative studies in adult heart, liver, kidney and lung Tx
recipients, investigating associations between post-Tx alcohol use and
correlates and/or clinical, economic or quality of life outcomes. Paper
selection, data extraction and quality assessment were performed by 2
reviewers independently. A pooled odds ratio (OR) was computed for each
correlate/outcome reported >=5 times. <br/>Result(s): Of the 5331 studies
identified, 76 were included in this systematic review (93.3% on liver Tx;
mean sample size 148.9 (SD = 160.2); 71.9% male; mean age 48.9 years (SD =
6.5); mean time post-Tx 57.7 months (SD = 23.1)). On average, 23.6% of
patients studied used alcohol post-transplant. Ninety-three correlates of
any post-Tx alcohol use were identified, and 9 of the 19 pooled ORs were
significantly associated with a higher odds for any post-Tx alcohol use:
male gender, being employed post-transplant, smoking pre-transplant,
smoking post-transplant, a history of illicit drug use, having
first-degree relatives who have alcohol-related problems, sobriety <6
months prior to transplant, a history of psychiatric illness, and having
received treatment for alcohol-related problems pre-transplant. On average
15.1% of patients had at-risk drinking. A pooled OR was calculated for 6
of the 47 correlates of post-Tx at risk drinking investigated, of which
pre-transplant smoking was the only correlate being significantly
associated with this behavior. None of the outcomes investigated were
significantly associated with any use or at-risk drinking.
<br/>Conclusion(s): Correlates of alcohol use remain under-investigated in
solid organ transplant recipients other than liver transplantation.
Further research is needed to determine whether any alcohol use or at-risk
drinking is associated with poorer post-transplant outcomes. Our
meta-analysis highlights avenues for future research of higher
methodological quality and improved clinical care. <br/>Protocol
Registration: PROSPERO protocol CRD42015003333<br/>Copyright &#xa9; 2018
Elsevier Inc.

<11>
Accession Number
627526730
Title
Transcatheter aortic-valve replacement with a self-expanding valve in
low-risk patients.
Source
New England Journal of Medicine. 380 (18) (pp 1706-1715), 2019. Date of
Publication: 02 May 2019.
Author
Popma J.J.; Michael Deeb G.; Yakubov S.J.; Mumtaz M.; Gada H.; O'Hair D.;
Bajwa T.; Heiser J.C.; Merhi W.; Kleiman N.S.; Askew J.; Sorajja P.; Rovin
J.; Chetcuti S.J.; Adams D.H.; Teirstein P.S.; Zorn G.L.; Forrest J.K.;
Tchetche D.; Resar J.; Walton A.; Piazza N.; Ramlawi B.; Robinson N.;
Petrossian G.; Gleason T.G.; Oh J.K.; Boulware M.J.; Qiao H.; Mugglin
A.S.; Reardon M.J.
Institution
(Popma) Interventional Cardiology, Beth Israel Deaconess Medical Center,
185 Pilgrim Rd., Boston, MA 02215, United States
(Michael Deeb, Chetcuti) University of Michigan Hospitals, Ann Arbor, MI,
United States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, MI, United States
(Yakubov) Riverside Methodist, Ohio Health, Columbus, United States
(Mumtaz, Gada) University of Pittsburgh Medical Center Pinnacle Health,
Harrisburg, PA, United States
(Gleason) University of Pittsburgh, Pittsburgh, PA, United States
(O'Hair, Bajwa) Pennsylvania; Aurora-Saint Luke's Medical Center,
Milwaukee, United States
(Kleiman) Houston Methodist Debakey Heart and Vascular Center, Houston,
United States
(Askew, Sorajja) Abbott Northwestern Hospital, MN, United States
(Boulware, Qiao) Medtronic, MN, United States
(Oh) Minneapolis, Mayo Clinic, Rochester, MN, United States
(Mugglin) Paradigm Biostatistics, Anoka, MN, United States
(Rovin) Morton PlantHospital, Clearwater, FL, United States
(Adams) Mount Sinai Health System, New York, NY, United States
(Robinson, Petrossian) Saint Francis Hospital, Roslyn, NY, United States
(Teirstein) Scripps Clinic and Research Foundation, San Diego, CA, United
States
(Zorn) University of Kansas Hospital, Kansas City, United States
(Forrest) Yale New Haven Hospital, New Haven, CT, United States
(Tchetche) Clinique Pasteur, Toulouse, France
(Resar) Johns Hopkins Hospital, Baltimore, United States
(Walton) Alfred Hospital, Melbourne, VIC, Australia
(Piazza) McGill University Health Centre, Montreal, Canada
(Ramlawi) Winchester Medical Center, Winchester, VA, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) is an alternative
to surgery in patients with severe aortic stenosis who are at increased
risk for death from surgery; less is known about TAVR in low-risk
patients. METHODS We performed a randomized noninferiority trial in which
TAVR with a self-expanding supraannular bioprosthesis was compared with
surgical aortic-valve replacement in patients who had severe aortic
stenosis and were at low surgical risk. When 850 patients had reached
12-month follow-up, we analyzed data regarding the primary end point, a
composite of death or disabling stroke at 24 months, using Bayesian
methods. RESULTS Of the 1468 patients who underwent randomization, an
attempted TAVR or surgical procedure was performed in 1403. The patients'
mean age was 74 years. The 24-month estimated incidence of the primary end
point was 5.3% in the TAVR group and 6.7% in the surgery group
(difference, -1.4 percentage points; 95% Bayesian credible interval for
difference, -4.9 to 2.1; posterior probability of noninferiority >0.999).
At 30 days, patients who had undergone TAVR, as compared with surgery, had
a lower incidence of disabling stroke (0.5% vs. 1.7%), bleeding
complications (2.4% vs. 7.5%), acute kidney injury (0.9% vs. 2.8%), and
atrial fibrillation (7.7% vs. 35.4%) and a higher incidence of moderate or
severe aortic regurgitation (3.5% vs. 0.5%) and pacemaker implantation
(17.4% vs. 6.1%). At 12 months, patients in the TAVR group had lower
aortic-valve gradients than those in the surgery group (8.6 mm Hg vs. 11.2
mm Hg) and larger effective orifice areas (2.3 cm²vs. 2.0
cm²). CONCLUSIONS In patients with severe aortic stenosis who
were at low surgical risk, TAVR with a self-expanding supraannular
bioprosthesis was noninferior to surgery with respect to the composite end
point of death or disabling stroke at 24 months.<br/>Copyright &#xa9; 2019
Massachusetts Medical Society.

<12>
Accession Number
627526727
Title
Transcatheter aortic-valve replacement with a balloon-expandable valve in
low-risk patients.
Source
New England Journal of Medicine. 380 (18) (pp 1695-1705), 2019. Date of
Publication: 02 May 2019.
Author
Mack M.J.; Leon M.B.; Thourani V.H.; Makkar R.; Kodali S.K.; Russo M.;
Kapadia S.R.; Chris Malaisrie S.; Cohen D.J.; Pibarot P.; Leipsic J.; Hahn
R.T.; Blanke P.; Williams M.R.; McCabe J.M.; Brown D.L.; Babaliaros V.;
Goldman S.; Szeto W.Y.; Genereux P.; Pershad A.; Pocock S.J.; Alu M.C.;
Webb J.G.; Smith C.R.
Institution
(Mack, Brown) Baylor Scott and White Health, Plano, TX, United States
(Leon, Kodali, Hahn, Alu, Smith) Columbia University Irving Medical
Center, New York-Presbyterian Hospital, New York, United States
(Williams) New York University Langone Medical Center, New York, United
States
(Thourani) Medstar Heart and Vascular Institute, Georgetown University,
Washington, DC, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, United States
(Russo) Robert Wood Johnson Medical School, Rutgers University, New
Brunswick, NJ, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Kapadia) Cleveland Clinic, Cleveland, United States
(Chris Malaisrie) Feinberg School of Medicine, Northwestern University,
Chicago, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec, QC,
Canada
(Leipsic, Blanke, Webb) St. Paul's Hospital, University of British
Columbia, Vancouver, Canada
(McCabe) University of Washington, Seattle, United States
(Babaliaros) Emory University Hospital, Atlanta, United States
(Goldman) Lankenau Medical Center, Wynnewood, PA, United States
(Szeto) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Pershad) Banner University Medical Center, Phoenix, AZ, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Among patients with aortic stenosis who are at intermediate or
high risk for death with surgery, major outcomes are similar with
transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve
replacement. There is insufficient evidence regarding the comparison of
the two procedures in patients who are at low risk. METHODS We randomly
assigned patients with severe aortic stenosis and low surgical risk to
undergo either TAVR with transfemoral placement of a balloon-expandable
valve or surgery. The primary end point was a composite of death, stroke,
or rehospitalization at 1 year. Both noninferiority testing (with a
prespecified margin of 6 percentage points) and superiority testing were
performed in the as-treated population. RESULTS At 71 centers, 1000
patients underwent randomization. The mean age of the patients was 73
years, and the mean Society of Thoracic Surgeons risk score was 1.9% (with
scores ranging from 0 to 100% and higher scores indicating a greater risk
of death within 30 days after the procedure). The Kaplan-Meier estimate of
the rate of the primary composite end point at 1 year was significantly
lower in the TAVR group than in the surgery group (8.5% vs. 15.1%;
absolute difference, -6.6 percentage points; 95% confidence interval [CI],
-10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI,
0.37 to 0.79; P=0.001 for superiority). At 30 days, TAVR resulted in a
lower rate of stroke than surgery (P=0.02) and in lower rates of death or
stroke (P=0.01) and new-onset atrial fibrillation (P<0.001). TAVR also
resulted in a shorter index hospitalization than surgery (P<0.001) and in
a lower risk of a poor treatment outcome (death or a low Kansas City
Cardiomyopathy Questionnaire score) at 30 days (P<0.001). There were no
significant between-group differences in major vascular complications, new
permanent pacemaker insertions, or moderate or severe paravalvular
regurgitation. CONCLUSIONS Among patients with severe aortic stenosis who
were at low surgical risk, the rate of the composite of death, stroke, or
rehospitalization at 1 year was significantly lower with TAVR than with
surgery. (Funded by Edwards Lifesciences; PARTNER 3 ClinicalTrials.gov
number, NCT02675114.)<br/>Copyright &#xa9; 2019 Massachusetts Medical
Society.

<13>
Accession Number
625287564
Title
Transcatheter aortic valve replacement in patients with pure native aortic
valve regurgitation: A systematic review and meta-analysis.
Source
Clinical Cardiology. 42 (1) (pp 159-166), 2019. Date of Publication:
January 2019.
Author
Haddad A.; Arwani R.; Altayar O.; Sawas T.; Murad M.H.; de Marchena E.
Institution
(Haddad) Division of Cardiology, Temple University Lewis Katz School of
Medicine, Philadelphia, PA, United States
(Haddad) Harvard T.H Chan School of Public Health, Boston, MA, United
States
(Arwani) Ain Shams University-Faculty of Medicine, Cairo, Egypt
(Altayar) Department of Medicine, Washington University School of
Medicine, St. Louis, MO, United States
(Sawas) Department of Medicine, Mayo Clinic, Rochester, MN, United States
(Murad) Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia
E. Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
(de Marchena) Division of Cardiology, University of Miami-Miller School of
Medicine, Miami, FL, United States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
This systematic review and meta-analysis sought to summarize the available
evidence on the use of transcatheter aortic valve replacement (TAVR) in
patients with Native Aortic Valve Regurgitation (NAVR) and compare
outcomes between first and second generation valves. Owing to the
improvements in transcatheter heart valve design and procedural success,
TAVR has become increasingly performed in broader aortic valve
pathologies. We searched Medline, Embase, Cochrane, and Scopus databases
from 2007 to 2018 and performed a systematic review on reports with at
least 10 patients with aortic valve regurgitation undergoing TAVR
procedure. The main outcome of interest was all-cause mortality at 30
days. A total of 638 patients across 12 studies were included. Mean age
ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4%
to 13.1% and Logistic EuroSCORE ranged from 18.2% to 33%. The incidence
rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%;
I² = 20.86%). All-cause mortality at 30 days for first
generation valves had an incidence rate of 15% (95% CI 10%-20%;
I² = 10%) compared to 7% (95% CI 3%-13%; I² = 37%)
in second generation valves with subgroup interaction analysis P = 0.059.
Device success incidence rate in second generation valves was 92% (95% CI
83%-99%; I² = 67%) vs 68% (95% CI 59%-77%; I² = 53%)
in first generation valves with P = 0.001. TAVR appears to be a feasible
treatment choice for NAVR patients at high risk for surgical valve
replacement. Second generation valves show promising results in terms of
short-term outcomes.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<14>
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.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<15>
Accession Number
622485027
Title
Influence of external stenting on venous graft flow parameters in coronary
artery bypass grafting: A randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (6) (pp 926-931),
2018. Date of Publication: 01 Jun 2018.
Author
Amin S.; Werner R.S.; Madsen P.L.; Krasopoulos G.; Taggart D.P.
Institution
(Amin, Krasopoulos, Taggart) Nuffield Department of Surgical Sciences,
University of Oxford, Oxford, United Kingdom
(Amin, Krasopoulos, Taggart) Department of Cardiovascular Surgery, Oxford
University Hospitals Trust, University of Oxford, John Radcliffe Hospital,
Headley Way, Headington, Oxford OX3 9DU, United Kingdom
(Werner) Department of Thoracic Surgery, University Hospital Zurich,
Zurich, Switzerland
(Madsen) Department of Cardiology, Copenhagen University Hospital, Herlev,
Denmark
Publisher
Oxford University Press
Abstract
OBJECTIVES Long-term patency of saphenous vein grafts (SVGs) remains a
concern after coronary artery bypass grafting. Interventions to overcome
this problem include monitoring intraoperative flow profile and, more
recently, external stenting of SVGs. It is not known to what extent
external stenting changes the perioperative flow characteristics of SVGs.
The aim of this study was to assess whether the presence of an external
stent affects perioperative graft flow parameters as evaluated by transit
time flowmetry. METHODS Thirty-five patients were included from 1 centre
participating in a multicentre, randomized clinical trial of external
stenting of SVGs. Patients were eligible if scheduled for on-pump
multivessel coronary artery bypass grafting including planned SVGs to both
the right and the left coronary territories. Each patient received
external stenting of a single SVG randomly allocated intraoperatively to
either coronary territory. The primary end-points were mean graft flow,
pulsatility index, percentage of diastolic filling and percentage of
backward flow in stented versus non-stented SVGs. RESULTS External
stenting was performed in 17 SVGs supplying the left territory (20
non-stented SVGs for control) and in 18 SVGs supplying the right territory
(18 non-stented SVGs for control). No significant difference was found in
flow parameters between stented and non-stented SVGs in the overall group
or between pre-defined groups of SVGs supplying the right and left
territories, respectively. CONCLUSIONS External stenting of SVGs do not
affect intraoperative flow parameters significantly. CLINICAL TRIAL
REGISTRATION clinicaltrials.gov identifier: NCT02511834.<br/>Copyright
&#xa9; The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<16>
[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. <br/>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%). <br/>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). <br/>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.<br/>Copyright
&#xa9; 2017 American Heart Association, Inc.

<17>
[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. <br/>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.
<br/>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).
<br/>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.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<18>
Accession Number
2000702468
Title
Prolonged operative duration is associated with complications: a
systematic review and meta-analysis.
Source
Journal of Surgical Research. 229 (pp 134-144), 2018. Date of Publication:
September 2018.
Author
Cheng H.; Clymer J.W.; Po-Han Chen B.; Sadeghirad PhD B.; Ferko N.C.;
Cameron C.G.; Hinoul P.
Institution
(Cheng, Clymer, Po-Han Chen, Hinoul) Ethicon Inc, Cincinnati, Ohio, United
States
(Sadeghirad PhD, Ferko, Cameron) Cornerstone Research Group, Burlington,
Ontario, Canada
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: The aim of this study was to systematically synthesize the
large volume of literature reporting on the association between operative
duration and complications across various surgical specialties and
procedure types. <br/>Method(s): An electronic search of PubMed, Cochrane
Central Register of Controlled Trials, and Cochrane Database of Systematic
Reviews from January 2005 to January 2015 was conducted. Sixty-six
observational studies met the inclusion criteria. <br/>Result(s): Pooled
analyses showed that the likelihood of complications increased
significantly with prolonged operative duration, approximately doubling
with operative time thresholds exceeding 2 or more hours. Meta-analyses
also demonstrated a 14% increase in the likelihood of complications for
every 30 min of additional operating time. <br/>Conclusion(s): Prolonged
operative time is associated with an increase in the risk of
complications. Given the adverse consequences of complications, decreased
operative times should be a universal goal for surgeons, hospitals, and
policy-makers. Future study is recommended on the evaluation of
interventions targeted to reducing operating time.<br/>Copyright &#xa9;
2018 The Authors

<19>
Accession Number
621005723
Title
Association between serum calcium, serum phosphate and aortic stenosis
with implications for prevention.
Source
European Journal of Preventive Cardiology. 25 (5) (pp 551-556), 2018. Date
of Publication: 01 Mar 2018.
Author
Wald D.S.; Bestwick J.P.
Institution
(Wald, Bestwick) Queen Mary University of London, Wolfson Institute of
Preventive Medicine, Barts, The London School of Medicine and Dentistry,
United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Aortic stenosis is the most common cause of valvular heart
disease with no means of prevention. Lowering serum levels of calcium or
phosphate are potential preventive strategies but observational studies on
the associations with aortic stenosis are inconsistent. Design and
methods: A case-control study was conducted in 132 individuals undergoing
echocardiography (63 with aortic stenosis and 69 without) and the results
combined with three other comparable studies (914 individuals overall) to
provide a summary odds ratio of aortic stenosis for a 0.1 mmol/L increase
(approximately one standard deviation) in calcium and phosphate
respectively. The relationship between calcium and phosphate and the
severity of aortic stenosis, according to peak trans-aortic velocity, was
also examined in the case-control study using linear regression.
<br/>Result(s): Both calcium and phosphate were positively associated with
aortic stenosis. The summary odds ratio for a 0.1 mmol/L increase in
calcium was 1.79 (95% confidence interval 1.07-2.99), p = 0.027 and for
phosphate it was 1.47 (1.08-2.01), p = 0.015. Peak trans-aortic velocity
increased with phosphate levels, 9% (4%-14%) per 0.1 mmol/L, p = 0.001,
but not with calcium, p = 0.089. <br/>Conclusion(s): If the associations
are causal and reversible, these results indicate that a small reduction
in calcium or phosphate levels, within the physiological rage, would
translate into a clinically significant reduction in the risk of aortic
stenosis. Randomised trials of calcium and phosphate lowering therapies in
aortic stenosis are needed.<br/>Copyright &#xa9; 2018, &#xa9; The European
Society of Cardiology 2018.

<20>
Accession Number
622087351
Title
Cardiovascular safety of varenicline, bupropion, and nicotine patch in
smokers a randomized clinical trial.
Source
JAMA Internal Medicine. 178 (5) (pp 622-631), 2018. Date of Publication:
May 2018.
Author
Benowitz N.L.; Pipe A.; West R.; Hays J.T.; Tonstad S.; McRae T.; Lawrence
D.; St Aubin L.; Anthenelli R.M.
Institution
(Benowitz) Department of Medicine, University of California, PO Box 1220,
San Francisco, CA 94143, United States
(Benowitz) Department of Bioengineering and Therapeutic Sciences,
University of California, San Francisco, United States
(Pipe) Division of Prevention and Rehabilitation, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(West) Health Behaviour Research Centre, Department of Epidemiology and
Public Health, University College, London, United Kingdom
(Hays) Nicotine Dependence Center and General Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Tonstad) Department of Preventive Cardiology, Oslo University Hospital,
Oslo, Norway
(McRae, Lawrence, St Aubin) Global Product Development, Pfizer, New York,
NY, United States
(Anthenelli) Department of Psychiatry, University of California, San
Diego, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Quitting smoking is enhanced by the use of pharmacotherapies,
but concerns have been raised regarding the cardiovascular safety of such
medications. OBJECTIVE To compare the relative cardiovascular safety risk
of smoking cessation treatments. DESIGN, SETTING, AND PARTICIPANTS A
double-blind, randomized, triple-dummy, placeboand active-controlled trial
(Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES])
and its nontreatment extension trial was conducted at 140 multinational
centers. Smokers, with or without established psychiatric diagnoses, who
received at least 1 dose of study medication (n = 8058), as well as a
subset of those who completed 12 weeks of treatment plus 12 weeks of
follow up and agreed to be followed up for an additional 28 weeks (n =
4595), were included. INTERVENTIONS Varenicline, 1mg twice daily;
bupropion hydrochloride, 150mg twice daily; and nicotine replacement
therapy, 21-mg/d patch with tapering. MAIN OUTCOMES AND MEASURES The
primary end pointwas the time to development of a major adverse
cardiovascular event (MACE: cardiovascular death, nonfatalmyocardial
infarction, or nonfatal stroke) during treatment; secondary end points
were the occurrence of MACE and other pertinent cardiovascular events
(MACE+: MACE or new-onset or worsening peripheral vascular disease
requiring intervention, coronary revascularization, or hospitalization for
unstable angina). RESULTS Of the 8058 participants, 3553 (44.1%) were male
(mean [SD] age, 46.5 [12.3] years). The incidence of cardiovascular events
during treatment and follow-up was low (<0.5%for MACE; <0.8%forMACE+) and
did not differ significantly by treatment. No significant treatment
differences were observed in time to cardiovascular events, blood
pressure, or heart rate. There was no significant difference in time to
onset ofMACE for either varenicline or bupropion treatment vs placebo
(varenicline: hazard ratio, 0.29; 95%CI, 0.05-1.68 and bupropion: hazard
ratio, 0.50; 95%CI, 0.10-2.50). CONCLUSIONS AND RELEVANCE No evidence that
the use of smoking cessation pharmacotherapies increased the risk of
serious cardiovascular adverse events during or after treatment was
observed. The findings of EAGLES and its extension trial provide further
evidence that smoking cessation medications do not increase the risk of
serious cardiovascular events in the general population of
smokers.<br/>Copyright &#xa9; 2018 American Medical Association. All
rights reserved.

<21>
Accession Number
627556744
Title
Right coronary artery motion analysis: a novel method to measure right
ventricular systolic function by selective coronary angiography.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2019.
Date of Publication: 2019.
Author
Baumann F.; Obeid S.; Gilhofer T.; Siegrist P.; von Spiczak J.; Luscher
T.F.; Binder R.K.
Institution
(Baumann, Obeid, Gilhofer, Siegrist, von Spiczak, Luscher, Binder)
Department of Cardiology, University Hospital Zurich, University Heart
Center, Zurich, Switzerland
(Binder) Department of Cardiology and Intensive Care, University Teaching
Hospital Klinikum Wels-Grieskrichen, Grieskrichnerstrasse 42, Wels 4600,
Austria
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Abstract: Right ventricular systolic dysfunction is prognostic in various
cardiovascular diseases. Right ventricular systolic function is not
commonly assessed in the catheterization laboratory. Therefore, we
developed a novel, reproducible method to measure right ventricular
systolic function during selective coronary angiography. We analyzed the
angiographic systolic translational motion and maximum speed of the right
coronary artery (RCA) in 97 consecutive patients and compared it to the
tricuspid annular plane systolic excursion (TAPSE) as measured by
echocardiography. All measurements were performed by two independent
operators on two occasions. Inter-observer variability and intra-observer
variability were excellent for RCA motion distance and for RCA maximum
speed. There was a significant correlation of the RCA motion distance and
RCA maximum speed with the TAPSE measured by echocardiography (Pearson's
correlation for RCA distance: r = 0.59, p < 0.001, r² = 0.35;
for RCA speed: r = 0.40, p < 0.001, r² = 0.16). The area under
the receiver operating curve for the RCA motion distance was 0.88 (95% CI
0.80-0.96) for discrimination of normal and abnormal right ventricular
systolic function. A cut-off value less than 22.3 mm systolic RCA motion
had a specificity of 93.3% and a sensitivity of 75.6% for identifying an
abnormal right ventricular systolic function. Analysis of the RCA motion
is a reproducible and reliable method to measure right ventricular
systolic function during selective coronary angiography. It is a simple
and useful tool to assess right ventricular function in the
catheterization laboratory and may serve for risk assessment for right
ventricular failure. Clinical trial registration: Data for this study was
collected retrospectively from Swiss Transcatheter Aortic Valve
Implantation Registry (NCT01368250).
https://clinicaltrials.gov/show/NCT01368250.<br/>Copyright &#xa9; 2019,
Springer Nature B.V.

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

<23>
Accession Number
626882081
Title
Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery.
Source
Innovations (Philadelphia, Pa.). 14 (2) (pp 117-123), 2019. Date of
Publication: 01 Apr 2019.
Author
Kitahara H.; Nisivaco S.; Balkhy H.H.
Institution
(Kitahara, Nisivaco, Balkhy) University of Chicago Medicine, IL, United
States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: With advances in robotic instrumentation and technology, both
robotically assisted minimally invasive direct coronary artery bypass
(RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been
widely used over the past 20 years. Graft patency is the most important
outcome in coronary bypass surgery and is associated with long-term
prognosis. In this article we reviewed all experts' studies in the field
of robotic assisted coronary artery bypass and investigated graft patency
in patients who underwent RMIDCAB or TECAB. <br/>METHOD(S): We performed a
literature search in PubMed from 1999 to 2018 using the terms "Robotic"
and "Coronary bypass" and/or "Minimally invasive" and/or "Totally
endoscopic." Of the articles found, studies investigating graft patency
were specifically selected. <br/>RESULT(S): In 33 articles, a total of
4,000 patients underwent robotic assisted coronary artery bypass surgery
either by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft
patency was assessed by invasive angiography or computed tomographic
angiography in all studies. The mean graft patency at early (<1 month),
midterm (<5 years), and long-term (>5 years) follow-up was 97.7%, 96.1%,
and 93.2% in RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively.
<br/>CONCLUSION(S): The graft patency of robotic assisted coronary artery
bypass was equivalent to reported outcomes of the conventional approach.
These results should encourage the adoption of robotic approaches in
coronary bypass surgery.

<24>
Accession Number
2001490102
Title
Sildenafil for Pulmonary Hypertension in the Early Postoperative Period
After Mitral Valve Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1648-1656),
2019. Date of Publication: June 2019.
Author
Ram E.; Sternik L.; Klempfner R.; Eldar M.; Goldenberg I.; Peled Y.;
Raanani E.; Kogan A.
Institution
(Ram, Sternik, Raanani, Kogan) Department of Cardiac Surgery, Sheba
Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Klempfner, Eldar, Goldenberg, Peled) Heart Institute, Sheba Medical
Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University,
Tel Aviv, Israel
Publisher
W.B. Saunders
Abstract
Objectives: The phosphodiesterase-5 inhibitor sildenafil was developed for
the treatment of pulmonary hypertension. The authors investigated the
efficacy and safety of sildenafil in the early postoperative period after
mitral valve surgery in patients with pulmonary hypertension.
<br/>Design(s): A double-blind, placebo-controlled randomized trial was
performed. <br/>Setting(s): The trial was performed in a single tertiary
referral center. <br/>Participant(s): Fifty consecutive patients who
experienced pulmonary hypertension and underwent mitral valve surgery.
<br/>Intervention(s): Patients were randomly assigned to the following 2
groups: 25 patients received 20 mg sildenafil every 8 hours, and the
remaining 25 patients received placebo during the same period. Hemodynamic
parameters were studied by using a pulmonary artery catheter at baseline
and every 6 hours up to 36 hours. <br/>Result(s): Patients who received
sildenafil showed a decrease in mean pulmonary pressure, from 32 +/- 7
mmHg at baseline to 26 +/- 3 mmHg after 36 hours, whereas no change was
seen in patients who received placebo (mean pulmonary pressure 34 +/- 6
mmHg at baseline and 35 +/- 5 mmHg after 36 h) (p < 0.001). No significant
changes in systemic hemodynamic and oxygenation were observed. Patients
who received sildenafil compared with those who received placebo had a
median mechanical lung ventilation time of 16 (10-31) hours versus 19
(13-41) hours (p = 0.431), intensive care unit stay of 74 (44-106) hours
versus 91 (66-141) hours (p = 0.410), and a total hospitalization stay of
7 (5-10) days versus 11 (7-15) days (p = 0.009). <br/>Conclusion(s): The
immediate postoperative administration of sildenafil after mitral valve
surgery is safe. Sildenafil demonstrates a favorable decreasing effect on
pulmonary vascular pressure without systemic hypotension and
ventilation-perfusion mismatch.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<25>
Accession Number
624357719
Title
Effect of aspirin in vascular surgery in patients from a randomized
clinical trial (POISE-2).
Source
The British journal of surgery. 105 (12) (pp 1591-1597), 2018. Date of
Publication: 01 Nov 2018.
Author
Biccard B.M.; Sigamani A.; Chan M.T.V.; Sessler D.I.; Kurz A.; Tittley
J.G.; Rapanos T.; Harlock J.; Szalay D.; Tiboni M.E.; Popova E.; Vasquez
S.M.; Kabon B.; Amir M.; Mrkobrada M.; Mehra B.R.; El Beheiry H.; Mata E.;
Tena B.; Sabate S.; Zainal Abidin M.K.; Shah V.R.; Balasubramanian K.;
Devereaux P.J.
Institution
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Sigamani) Narayana Hrudayalaya Limited, Bangalore, India
(Chan) Department of Anaesthetics, Chinese University of Hong Kong, Hong
Kong, China
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Kurz) Department of General Anesthesiology, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
(Tittley, Rapanos, Harlock, Szalay) Division of Vascular Surgery, McMaster
University, Hamilton, ON, Canada
(Tiboni) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Popova) Biomedical Research Institute (IIB - Sant Pau), Barcelona, Spain
(Vasquez) Grupo de Cardiologia Preventiva Universidad Autonoma de
Bucaramanga, Bucaramanga, Colombia
(Kabon) Department of Anaesthesiology, Medical University of Vienna,
Vienna, Austria
(Amir) Department of Surgery, Shifa International Hospital/Shifa
Tameer-e-Millat University, Islamabad, Pakistan
(Mrkobrada) Department of Medicine, Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
(Mehra) Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
(El Beheiry) University of Toronto, Trillium Health Partners, Toronto, ON,
Canada
(Mata) Hospital Universitario La Princesa, Madrid, Spain
(Tena) Department of Anaesthesiology, Hospital Clinic, Barcelona, Spain
(Sabate) Department of Anaesthesiology, Fundacio Puigvert (IUNA),
Barcelona, Spain
(Zainal Abidin) Department of Anaesthesiology and Intensive Care, Sarawak
General Hospital, Kuching, Sarawak, Malaysia
(Shah) Viroc Hospital, Vadodara, India
(Balasubramanian, Devereaux) Population Health Research Institute,
Hamilton, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial,
perioperative aspirin did not reduce cardiovascular events, but increased
major bleeding. There remains uncertainty regarding the effect of
perioperative aspirin in patients undergoing vascular surgery. The aim of
this substudy was to determine whether there is a subgroup effect of
initiating or continuing aspirin in patients undergoing vascular surgery.
<br/>METHOD(S): POISE-2 was a blinded, randomized trial of patients having
non-cardiac surgery. Patients were assigned to perioperative aspirin or
placebo. The primary outcome was a composite of death or myocardial
infarction at 30days. Secondary outcomes included: vascular occlusive
complications (a composite of amputation and peripheral arterial
thrombosis) and major or life-threatening bleeding. <br/>RESULT(S): Of
10010 patients in POISE-2, 603 underwent vascular surgery, 319 in the
continuation and 284 in the initiation stratum. Some 272 patients had
vascular surgery for occlusive disease and 265 had aneurysm surgery. The
primary outcome occurred in 13.7 per cent of patients having aneurysm
repair allocated to aspirin and 9.0 per cent who had placebo (hazard ratio
(HR) 1.48, 95 per cent c.i. 0.71 to 3.09). Among patients who had surgery
for occlusive vascular disease, 15.8 per cent allocated to aspirin and
13.6 per cent on placebo had the primary outcome (HR 1.16, 0.62 to 2.17).
There was no interaction with the primary outcome for type of surgery
(P=0.294) or aspirin stratum (P=0.623). There was no interaction for
vascular occlusive complications (P=0.413) or bleeding (P=0.900) for
vascular compared with non-vascular surgery. <br/>CONCLUSION(S): This
study suggests that the overall POISE-2 results apply to vascular surgery.
Perioperative withdrawal of chronic aspirin therapy did not increase
cardiovascular or vascular occlusive complications. Registration number:
NCT01082874 ( http://www.clinicaltrials.gov).<br/>Copyright &#xa9; 2018
BJS Society Ltd Published by John Wiley & Sons Ltd.

<26>
Accession Number
627621481
Title
Myocardial Ischemia Presenting with Hiccups.
Source
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 29
(5) (pp 469-473), 2019. Date of Publication: 01 May 2019.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, Division of Cardiac Surgery,
First Hospital of Putian, Teaching Hospital, Fujian Medical University,
Putian, Fujian Province, China
Publisher
NLM (Medline)
Abstract
Myocardial infarction/ischemia can be an underlying etiology and a major
causative risk factor of cardiovascular hiccups. The objective of this
systematic review was to review the literature regarding clinical features
and treatments of hiccups of cardiac ischemia origin. PRISMA guidelines
were followed. In elderly patients with hiccups of uncertain causes,
electrocardiography is necessary to ensure the cardiogenic etiology. Both
symptomatic and etiologic treatments can be effective in terminating
hiccups. Of the therapeutic regimens, gabapentin is a second-line agent
alternative to baclofen in treating hiccups. It is especially helpful in
patients undergoing stroke rehabilitation or palliative care when
chlorpromazine is prohibited due to its adverse effects. Inferior
myocardial infarction is the most common cause of hiccups in this patient
setting. In addition to anti-myocardial ischemia agents and percutaneous
coronary intervention, coronary artery bypass grafting could be an
alternative to hiccups in such patients.

<27>
Accession Number
627623242
Title
Rate of peri-procedural stroke observed with cerebral embolic protection
during transcatheter aortic valve replacement: a patient-level
propensity-matched analysis.
Source
European heart journal. 40 (17) (pp 1334-1340), 2019. Date of Publication:
01 May 2019.
Author
Seeger J.; Kapadia S.R.; Kodali S.; Linke A.; Wohrle J.; Haussig S.;
Makkar R.; Mehran R.; Rottbauer W.; Leon M.
Institution
(Seeger, Wohrle, Rottbauer) Department of Internal Medicine II -
Cardiology, University of Ulm, Albert-Einstein-Allee 23, Ulm, Germany
(Kapadia) Cleveland Clinic, Department of Cardiology, Euclid Ave,
Cleveland, OH, United States
(Kodali, Leon) Columbia University Medical Centre, 161 Fort Washington
Ave, New York, NY, USA
(Linke, Haussig) Herzzentrum Dresden Universitatsklinik, Fetscherstrase
76, Dresden, Germany
(Makkar) Cedars-Sinai Medical Centre, 8631 W 3rd St, Los Angeles, CA,
United States
(Mehran) Mount Sinai School of Medicine, 1190 5th Avenue, 1 South, New
York, NY, USA
Publisher
NLM (Medline)
Abstract
AIMS: The role of cerebral embolic protection (CEP) in transcatheter
aortic valve replacement (TAVR) remains controversial. Randomized trials
have not been powered to demonstrate a reduction in stroke rates. The aim
of this patient level pooled analysis was to validate the impact of the
dual-filter CEP device (Claret Medical Inc., CA, USA) on peri-procedural
stroke in a large number of TAVR patients. METHODS AND RESULTS: Patients
from the SENTINEL US IDE trial were combined with the CLEAN-TAVI and
SENTINEL-Ulm study in a patient level pooled analysis (N=1306). Propensity
score matching was performed to adjust for possible confounders. The
primary endpoint was procedural stroke within 72h post-TAVR according to
Valve Academic Research Consortium-2 criteria. The secondary endpoint was
the combination of all-cause mortality or all-stroke within 72h after
TAVR. In the propensity-matched population, 533 patients underwent TAVR
without CEP and 533 patients underwent TAVR with CEP. TAVR patients
without vs. with CEP were similar with respect to baseline
characteristics, procedural approach, or valve type. In patients
undergoing TAVR with dual-filter CEP, procedural all-stroke was
significantly lower compared with unprotected procedures [1.88% vs. 5.44%,
odds ratio 0.35, 95% confidence interval (CI) 0.17-0.72, relative risk
reduction 65%, P=0.0028]. In addition, all-cause mortality and all-stroke
were significantly lower (2.06% vs. 6.00%, odds ratio 0.34, 95% CI
0.17-0.68, relative risk reduction 66%, P=0.0013). <br/>CONCLUSION(S): Our
findings suggest that TAVR with the dual-filter CEP device is associated
with a significant lower rate of peri-procedural stroke compared with
unprotected procedures. However, randomized trials are still needed to
clarify this issue.<br/>Copyright Published on behalf of the European
Society of Cardiology. All rights reserved. &#xa9; The Author(s) 2018. For
permissions, please email: journals.permissions@oup.com.

<28>
Accession Number
609109655
Title
The effects of positive airway pressure ventilation during cardiopulmonary
bypass on pulmonary function following open heart surgery.
Source
Research in Cardiovascular Medicine. 2 (2) (pp 79-84), 2013. Date of
Publication: 2013.
Author
Alavi M.; Pakrooh B.; Mirmesdagh Y.; Bakhshandeh H.; Babaee T.; Hosseini
S.; Kargar F.
Institution
(Alavi, Pakrooh, Bakhshandeh, Babaee, Kargar) Rajaie Cardiovascular
Medical and Research Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Mirmesdagh, Hosseini) Heart Valve Disease Research Center, Rajaie
Cardiovascular Medical and Research Center, Tehran University of medical
sciences, Tehran, Iran, Islamic Republic of
Publisher
KOWSAR Medical Publishing Company (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Intrapulmonary shunt as a result of atelectasis following cardiac
surgeries is an important and common postoperative complication that
results into pulmonary dysfunction typically lasting more than a week
following surgery. Different methods have been provided to prevent these
complications. <br/>Objective(s): In order to prevent postoperative
pulmonary complications, investigation of the effectiveness of continuous
positive airway pressure (CPAP) and intermittent mandatory ventilation
(IMV) during cardiopulmonary bypass (CPB) in patients undergoing coronary
artery bypass grafting (CABG). <br/>Material(s) and Method(s): In this
prospective interventional study, 300 patients, candidate for elective
CABG (On-Pump), were randomly allocated to 3 groups: A, B, C. Group A
(CPAP) patients received CPAP at 10 cm H2O during CPB. Group B (IMV)
patients received IMV with a tidal volume of 2 cc/kg and respiratory rate
of 15/min and group C (control) patients did not receive any type of
ventilation during CPB. Other procedures were similar between groups.
Arterial blood samples were taken at 8 moments and arterial blood gas
(ABG) analysis were compared between groups. Chest x-rays after CABG were
also evaluated with respect to atelectasis. <br/>Result(s): The
demographic data were similar in between three groups. Graft number, pump
time and preoperative ABGs were not significantly different. Postoperative
PaO<inf>2</inf> were significantly higher in the CPAP and IMV groups and
(A-a) DO2 were significantly lower in these two groups, compared to the
control group. <br/>Conclusion(s): In the present study, applying positive
airway pressure methods (CPAP or IMV) during CPB was associated with
better postoperative ABG measurements and (A-a)
DO<inf>2</inf>.<br/>Copyright &#xa9; 2013, Published by Kowsar Corp. All
rights reserved.

<29>
Accession Number
2001852995
Title
Levosimendan in patients with low cardiac output syndrome undergoing
cardiac surgery: A systematic review and meta-analysis.
Source
Anaesthesia Critical Care and Pain Medicine. 38 (3) (pp 243-249), 2019.
Date of Publication: June 2019.
Author
Zhu J.; Zhang Y.; Chen L.; He Y.; Qing X.
Institution
(Zhu, Chen, He, Qing) Department of Intensive Care Medicine, Affiliated
Hospital of Chengdu University, No.82, North Section 2, 2nd Ring Road,
Jinniu District, Chengdu, Sichuan 610081, China
(Zhang) Department of Cardiac Surgery, Affiliated Hospital of Chengdu
University, Chengdu, Sichuan, China
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Levosimendan is an inotropic agent that has been shown in small studies to
treat low cardiac output syndrome in cardiac surgery. However, large
randomised controlled trials (RCTs)have been recently published and
presented neutral results. We sought to determine the effect of
levosimendan on mortality in adults with low ejection fraction undergoing
cardiac surgery. We searched different databases: Medline, Embase,
Cochrane Central Register of Controlled Trials, and clinical trial
registries. We included RCTs comparing events in the levosimendan versus
placebo in adult patients with ejection fraction <= 35% undergoing cardiac
surgery. Outcomes were mortality at 30-day, mortality beyond 30-day, acute
kidney injury and myocardial infarction. Five trials with a total of 1519
patients were selected. Four trials were rated as low risk of bias. Our
meta-analysis showed no significant difference between levosimendan versus
placebo mortality at 30-day [odds radio (OR): 0.62; 95% confidence
intervals (CI): 0.32 to 1.20; I² = 33%; high quality
evidence]and mortality beyond 30-day (OR: 0.71; 95% CI: 0.46 to 1.11;
I² = 0%). Similarly, there were no significant differences
between the levosimendan versus placebo in the incidence of acute kidney
injury (OR: 0.61, 95% CI: 0.33-1.13)and myocardial infarction (OR: 0.41,
95% CI: 0.08 to 1.22). The current evidence suggests that levosimendan is
not associated with significantly reduced mortality in patients with
reduced ejection fraction undergoing cardiac surgery.<br/>Copyright &#xa9;
2018

<30>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<31>
Accession Number
2000974904
Title
Hemodynamic monitoring by pulse contour analysis during trans-catheter
aortic valve replacement: A fast and easy method to optimize procedure
results.
Source
Cardiovascular Revascularization Medicine. 20 (4) (pp 332-337), 2019. Date
of Publication: April 2019.
Author
Ristalli F.; Romano S.M.; Stolcova M.; Meucci F.; Squillantini G.; Valente
S.; Di Mario C.
Institution
(Ristalli, Romano, Stolcova, Meucci, Squillantini, Valente, Di Mario)
Structural Interventional Cardiology, Cardio-toraco-vascular Department,
Careggi University Hospital, Florence, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Residual aortic regurgitation (AR) complicates a not
negligible number of transcatheter aortic valve replacement (TAVR)
procedures, and its entity is not always clear at intraprocedural
angiographic and echocardiographic control. We applied a minimally
invasive hemodynamic monitoring system (Pressure Recording Analytical
Method, PRAM) in the setting of TAVR, with the aim of identifying
parameters that may help in detection and quantification of residual AR.
<br/>Method(s): We performed hemodynamic monitoring with PRAM in 43
patients undergoing trans-femoral TAVR. Investigated parameters were
systolic (Psys, mm Hg), diastolic (Pdia, mm Hg), mean (MAP, mm Hg) and
dicrotic pressure (Pdic, mm Hg), cardiac output (CO, L/min), stroke volume
(SV, mL), cardiac cycle efficiency (CCE, Units), dP/dt<inf>max_rad</inf>
(mm Hg/ms), MAP-Pdic (mm Hg). <br/>Result(s): Procedural success was
achieved in 86% of the patients; vascular complications occurred in 3
(6.9%), death in 2 (4.7%). Twenty (46.5%) patients had at least mild
residual AR. CO, SV, CCE and dP/dt<inf>max_rad</inf> changed significantly
(p < 0.001) between baseline and end of procedure in the overall
population, with more evident modifications in the subgroup without
residual AR. MAP-Pdic variations were statistically significant only in
the subgroup without AR (p = 0.05). <br/>Conclusion(s): TAVR determined an
improvement in hemodynamic parameters such as CO, SV, CCE,
dP/dt<inf>max_rad</inf>. MAP-Pdic was able to discriminate patients with
significant residual AR. Hemodynamic monitoring with PRAM system during
TAVR is easy and fast to obtain and may help in clinical decision-making
in controversial cases.<br/>Copyright &#xa9; 2018 Elsevier Inc.

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

<33>
Accession Number
625512844
Title
Optimal medical therapy vs. coronary revascularization for patients
presenting with chronic total occlusion: A meta-analysis of randomized
controlled trials and propensity score adjusted studies.
Source
Catheterization and Cardiovascular Interventions. 93 (6) (pp E320-E325),
2019. Date of Publication: 01 May 2019.
Author
Iannaccone M.; D'ascenzo F.; Piazza F.; De Benedictis M.; Doronzo B.;
Behnes M.; Garbo R.; Mashayekhi K.
Institution
(Iannaccone, Piazza, De Benedictis, Doronzo) SS. Annunziata Hospital, ASL
CN 1, Savigliano, Italy
(D'ascenzo) Department of Cardiology, Citta della Scienza e dalla Salute
Hospital, University of Turin, Turin, Italy
(Behnes) First Department of Medicine, University Medical Center Mannheim,
University of Heidelberg, Mannheim, Germany
(Behnes) DZHK (German Center for Cardiovascular Research) Partner Site,
Mannheim, Germany
(Garbo) S.G. Bosco Hospital, Turin, Italy
(Mashayekhi) Department of Cardiology and Angiology II, University Heart
Center Freiburg, Bad Krozingen, Germany
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction: The optimal management of patients with coronary chronic
total occlusions (CTO) remains controversial. This meta-analysis aims to
compare percutaneous coronary intervention of CTO (CTO-PCI) versus optimal
medical therapy (OMT) in CTO patients. <br/>Method(s): A literature search
with highly specific terms was conducted using MEDLINE, EMBASE, and Web of
Science to identify most relevant randomized controlled trials (RCTs) and
observational studies with propensity score matching (PSM) evaluating
differences in between CTO-PCI versus OMT. The primary endpoint was the
incidence of major adverse cardiac events (MACEs, composite of
cardiovascular death, acute coronary syndrome, and repeat PCI, re-PCI)
while its single components were defined as secondary endpoints.
<br/>Result(s): A total of eight studies was included, four RCTs and four
PSMs. 3,971 patients were included in the analysis (2,050 CTO-PCI versus
1,921 OMT) with a mean follow-up of 3 years. No significant differences
were found regarding overall MACE, re-PCI and AMI. Regarding CV-death,
CTO-PCI was associated with a better outcome compared with OMT driven by
PSMs (OR 0.52, 0.0.81, P < 0.01). <br/>Conclusion(s): As compared to OMT,
CTO-PCI was associated with similar MACE rate; however, CTO-PCI may be
associated with reduced CV death, mainly due to PSMs effect.<br/>Copyright
&#xa9; 2018 Wiley Periodicals, Inc.

<34>
Accession Number
624971429
Title
A perioperative surgeon-controlled open-lung approach versus conventional
protective ventilation with low positive end-expiratory pressure in
cardiac surgery with cardiopulmonary bypass (PROVECS): Study protocol for
a randomized controlled trial 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 624. Date of
Publication: 13 Nov 2018.
Author
Lagier D.; Fischer F.; Fornier W.; Fellahi J.-L.; Colson P.; Cholley B.;
Jaber S.; Baumstarck K.; Guidon C.; Quintana G.; Gaillat F.; Nedir P.;
Duponq R.; Gomert R.; Guinard B.; Heraud F.; Villacorta J.; Degirmenci S.;
Pernoud N.; Samarani G.; Lalande M.; Huynh T.M.; Gros C.; Elmiloudi F.;
Tacquard C.; Bilger A.; Levy F.; Cinca E.; Bongarzone C.; Heger B.; Balvay
V.; Berns M.; Oulehri W.; Ouattara A.
Institution
(Lagier, Guidon) Department of Cardiovascular Anesthesiology and Critical
Care Medicine, La Timone University Hospital, AP-HM, Aix-Marseille
University, 264 rue saint Pierre, Marseille, cedex 5 13005, France
(Fischer) Department of Cardiovascular and Thoracic Anesthesiology, Nouvel
Hopital Civil, Strasbourg, France
(Fornier, Fellahi) Department of Anesthesiology and Critical Care
Medicine, Louis Pradel University Hospital, University Claude Bernard, 28
Avenue du Doyen Lepine, Bron 69677, France
(Colson) Department of Anesthesiology and Critical Care Medicine, Arnaud
de Villeneuve University Hospital, 371 Avenue du Doyen Gaston Giraud,
Montpellier 34295, France
(Cholley) Department of Anesthesiology and Critical Care Medicine, Hopital
Europeen Georges Pompidou, AP-HP, University Paris Descartes-Sorbonne
Paris Cite, 20 Rue Leblanc, Paris 75015, France
(Jaber) Department of Anesthesiology and Critical Care Medicine, Saint
Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295,
France
(Baumstarck) Unite de Recherche EA3279, Aix-Marseille University, 27 bd
Jean Moulin, Marseille, Marseille, cedex 5 13385, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications (PPCs) are frequent
after on-pump cardiac surgery. Cardiac surgery results in a complex
pulmonary insult leading to high susceptibility to perioperative pulmonary
atelectasis. For technical reasons, ventilator settings interact with the
surgical procedure and traditionally, low levels of positive
end-expiratory pressure (PEEP) have been used. The objective is to compare
a perioperative, multimodal and surgeon-controlled open-lung approach with
conventional protective ventilation with low PEEP to prevent PPCs in
patients undergoing cardiac surgery. Methods/design: The perioperative
open-lung protective ventilation in cardiac surgery (PROVECS) trial is a
multicenter, two-arm, randomized controlled trial. In total, 494 patients
scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB)
and aortic cross-clamp will be randomized into one of the two treatment
arms. In the experimental group, systematic recruitment maneuvers and
perioperative high PEEP (8 cmH2O) are associated with ultra-protective
ventilation during CPB. In this group, the settings of the ventilator are
controlled by surgeons in relation to standardized protocol deviations. In
the control group, no recruitment maneuvers, low levels of PEEP (2 cmH2O)
and continuous positive airway pressure during CPB (2 cmH2O) are used. Low
tidal volumes (6-8 mL/kg of predicted body weight) are used before and
after CPB in each group. The primary endpoint is a composite of the single
PPCs evaluated during the first 7 postoperative days. <br/>Discussion(s):
The PROVECS trial will be the first multicenter randomized controlled
trial to evaluate the impact of a perioperative and multimodal open-lung
ventilatory strategy on the occurrence of PPCs after on-pump cardiac
surgery. The trial design includes standardized surgeon-controlled
protocol deviations that guarantee a pragmatic approach. The results will
help anesthesiologists and surgeons aiming to optimize ventilatory
settings during cardiac surgery. Trial registration: Clinical Trials.gov,
NCT 02866578. Registered on 15 August 2016. Last updated 11 July
2017.<br/>Copyright &#xa9; 2018 The Author(s).

<35>
Accession Number
2000570896
Title
Meta-Analysis of Trials on Prophylactic Use of Levosimendan in Patients
Undergoing Cardiac Surgery.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1403-1410), 2018. Date of
Publication: May 2018.
Author
Elbadawi A.; Elgendy I.Y.; Saad M.; Megaly M.; Mentias A.; Abuzaid A.S.;
Shahin H.I.; Goswamy V.; Abowali H.; London B.
Institution
(Elbadawi, Goswamy) Department of Internal Medicine, Rochester General
Hospital, Rochester, New York, United States
(Elbadawi, Abowali) Department of Cardiovascular Medicine, Ain Shams
University, Cairo, Egypt
(Elgendy) Division of Cardiovascular Medicine, University of Florida,
Gainesville, Florida, United States
(Saad) Department of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, Arkansas, United States
(Megaly) Division of Cardiovascular Medicine, Hennepin County Medical
Center/Minneapolis Heart Institute, Abbot Northwestern Hospital,
Minneapolis, Minnesota, United States
(Mentias, London) Department of Cardiovascular Medicine, University of
Iowa, Iowa City, Iowa, United States
(Abuzaid) Sidney Kimmel Medical College at Thomas Jefferson
University/Christiana Care Health System, Newark, Delaware, United States
(Shahin) Department of Pharmaceutics and Pharmaceutical Technology,
Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future
University in Egypt, Cairo, Egypt
Publisher
Elsevier USA
Abstract
Background: The role of prophylactic levosimendan in patients undergoing
cardiac surgery is controversial. <br/>Method(s): We performed a
computerized search of Medline, Embase, and Cochrane databases through
September 2017 for randomized trials evaluating the prophylactic use of
levosimendan in patients undergoing cardiac surgery (ie, patients without
low cardiac output syndrome). The main study outcome was mortality at 30
days. <br/>Result(s): The final analysis included 16 randomized trials
with total of 2,273 patients. There was no statistically significant
difference in mortality at 30 days between levosimendan and control groups
(relative risk 0.68, 95% confidence interval [CI]: 0.45 to 1.03). Subgroup
analysis showed no statistically significant difference in mortality at 30
days for patients with reduced left ventricular ejection fraction compared
with patients having preserved left ventricular ejection fraction (p for
interaction = 0.12). Further analysis suggested that levosimendan might be
associated with improved mortality at 30 days when compared with
active-control but not when compared with placebo (p for interaction =
0.01). The levosimendan group had a significant reduction in acute kidney
injury (relative risk 0.59, 95% CI: 0.38 to 0.92), intensive care unit
stay (standardized mean difference = -0.21, 95% CI: -0.29 to -0.13), and
ventilation time (standardized mean difference = -0.43, 95% CI: -0.61 to
-0.25), whereas it had higher rates of atrial fibrillation (relative risk
1.11, 95% CI: 1.00 to 1.24). No statistically significant differences were
observed between groups in mortality beyond 30 days, postoperative
dialysis, or myocardial infarction. <br/>Conclusion(s): Prophylactic use
of levosimendan does not appear to reduce the mortality at 30 days or
beyond 30 days in patients undergoing cardiac surgery. This lack of
benefit was noted irrespective of the LVEF.<br/>Copyright &#xa9; 2018 The
Society of Thoracic Surgeons

<36>
Accession Number
2000680316
Title
Rigid Plate Fixation Versus Wire Cerclage: Patient-Reported and Economic
Outcomes From a Randomized Trial.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1344-1350), 2018. Date of
Publication: May 2018.
Author
Allen K.B.; Thourani V.H.; Naka Y.; Grubb K.J.; Grehan J.; Patel N.; Guy
T.S.; Landolfo K.; Gerdisch M.; Bonnell M.; Cohen D.J.
Institution
(Allen) Department of Cardiothoracic Surgery, Saint Luke's Mid America
Heart Institute, Kansas City, Missouri, United States
(Thourani) Division of Cardiothoracic Surgery, Department of Surgery,
Emory University School of Medicine, Atlanta, Georgia
(Naka) Division of Cardiothoracic Surgery, Department of Surgery, Columbia
University Medical Center, New York, New York, United States
(Grubb) Department of Cardiovascular and Thoracic Surgery, University of
Louisville, Louisville, Kentucky, United States
(Grehan) Department of Cardiothoracic Surgery, Allina Health, St. Paul,
Minnesota, United States
(Patel) Department of Cardiothoracic Surgery, Lenox Hill Hospital, New
York, New York, United States
(Guy) Department of Cardiothoracic Surgery, Temple University,
Philadelphia, Pennsylvania, United States
(Landolfo) Department of Cardiothoracic Surgery, Mayo Clinic,
Jacksonville, Florida, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan St. Francis
Health, Indianapolis, Indiana, United States
(Bonnell) Department of Cardiothoracic Surgery, University of Toledo,
Toledo, Ohio, United States
(Cohen) Department of Cardiology, Saint Luke's Mid America Heart
Institute, Kansas City, Missouri, United States
Publisher
Elsevier USA
Abstract
Background: In a multicenter randomized trial, sternal closure after
cardiac operations using rigid plate fixation (RPF) compared with wire
cerclage (WC) resulted in improved sternal healing, reduced sternal
complications, and was cost neutral at 6 months. Additional secondary end
points are presented from this trial. <br/>Method(s): Twelve United States
centers randomized 236 patients to RPF (n = 116) or WC (n = 120).
Patient-reported outcomes measures, including pain, function, and quality
of life scores, were assessed through 6 months and correlated to computed
tomography-derived sternal healing scores using logistic regression. Cost
analysis through 90 days was performed to mimic bundled care models.
<br/>Result(s): All patient-reported outcomes measures were numerically
better in RPF patients than in WC patients at all assessments. RPF
resulted in more patients reporting no sternal pain after coughing at 3
weeks (41.1% vs 19.6%; p = 0.001) and 6 weeks (54.5% vs 35.1%; p = 0.005)
and at rest at 6 weeks (74.1% vs 58.8%; p = 0.02) and 3 months (87.6% vs
75.9%; p = 0.03) compared with WC. Better sternal healing scores
correlated to having no sternal pain at rest (odds ratio, 1.6; 95%
confidence interval, 1.2 to 2.2; p = 0.002) and after coughing (odds
ratio, 1.6; 95% confidence interval, 1.2 to 2.2; p = 0.0007). RPF resulted
in improvements in the 36-Item Short Form Health Survey quality of life
scores at 3 weeks (53.5 +/- 8.7 vs 50.5 +/- 10.4; p = 0.03), 6 weeks (45.3
+/- 8.4 vs 42.7 +/- 8.4; p = 0.03), and 6 months (56.4 +/- 6.8 vs 53.9 +/-
9.0; p = 0.04) compared with WC. Through 90 days, RPF compared with WC was
$1,888 less (95% confidence interval, -$8,889 to $4,273; p = 0.52).
<br/>Conclusion(s): In patients undergoing sternal closure after median
sternotomy, RPF compared with WC resulted in reduced sternal pain,
improved upper extremity function, and similar total 90-day
costs.<br/>Copyright &#xa9; 2018 The Authors

<37>
Accession Number
2000625913
Title
Role of Fish Oil in Post-Cardiotomy Bleeding: A Summary of the Basic
Science and Clinical Trials.
Source
Annals of Thoracic Surgery. 105 (5) (pp 1563-1567), 2018. Date of
Publication: May 2018.
Author
Carr J.A.
Institution
(Carr) Department of Thoracic Surgery, Hurley Medical Center, Flint,
Michigan, United States
Publisher
Elsevier USA
Abstract
Background: Omega-3 fatty acids are widely used. This article reviews the
coagulopathic effects of fish oil. <br/>Method(s): A review was performed
of all English articles that addressed the topic from 1980 to 2017.
<br/>Result(s): Fish oil induces an in vitro coagulopathy in humans due to
inhibitory effects in platelet-to-platelet adhesion and
platelet-stimulated thrombin generation. The effect from fish oil alone is
weak, but it is enhanced and may become clinically noticeable in patients
taking antiplatelet therapy, and, to a lesser extent, in patients on
factor Xa inhibitors and warfarin. In the absence of other anticoagulants,
fish oil alone is not capable of producing a clinically significant
coagulopathy that would induce or contribute to surgical bleeding.
<br/>Conclusion(s): Patients who are taking fish oil without other
anticoagulants do not have an increased risk of bleeding surgical
complications. Because of the highly variable amounts of actual
eicosapentaenoic acid and docosahexaenoic acid in commercially available
supplements, thromboelastography with platelet mapping would allow a
surgeon to know if a coagulopathic effect is present in a patient taking
fish oil, especially if the patient was also taking other
anticoagulants.<br/>Copyright &#xa9; 2018 The Society of Thoracic Surgeons

<38>
[Use Link to view the full text]
Accession Number
627082279
Title
NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide)-guided therapy in
acute decompensated heart failure PRIMA II randomized controlled trial
(Can NT-ProBNP-guided therapy during hospital admission for acute
decompensated heart failure reduce mortality and readmissions?).
Source
Circulation. 137 (16) (pp 1671-1683), 2018. Date of Publication: 2018.
Author
Stienen S.; Salah K.; Moons A.H.; Bakx A.L.; Van Pol P.; Kortz R.A.M.;
Ferreira J.P.; Marques I.; Schroeder-Tanka J.M.; Keijer J.T.; Bayes-Genis
A.; Tijssen J.G.P.; Pinto Y.M.; Kok W.E.
Institution
(Stienen, Salah, Tijssen, Pinto, Kok) Department of Cardiology, Academic
Medical Center, Amsterdam, Netherlands
(Moons) Department of Cardiology, Slotervaartziekenhuis, Amsterdam,
Netherlands
(Bakx) Department of Cardiology, BovenIJ Ziekenhuis, Amsterdam,
Netherlands
(Van Pol) Department of Cardiology, Alrijne Ziekenhuis, Leiderdorp,
Netherlands
(Kortz) Department of Cardiology, Flevoziekenhuis, Almere, Netherlands
(Ferreira) Department of Physiology and Cardiothoracic Surgery, Faculty of
Medicine, University of Porto, Porto, Portugal
(Ferreira) INSERM, Centre d'Investigations Cliniques Plurithematique,
Universite de Lorraine, CHRU de Nancy, France
(Marques) Department of Internal Medicine, Centro Hospitalar Do Porto,
Instituto de Ciencias Biomedicas de Abel Salazar, Porto, Portugal
(Schroeder-Tanka) Department of Cardiology, St Lucas Andreas Ziekenhuis,
Amsterdam, Netherlands
(Keijer) Department of Cardiology, Tergooiziekenhuizen, Blaricum,
Netherlands
(Bayes-Genis) Department of Cardiology, Hospital Universitari Germans
Trias i Pujol, Barcelona, Spain
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The concept of natriuretic peptide guidance has been
extensively studied in patients with chronic heart failure (HF), with only
limited success. The effect of NT-proBNP (N-terminal probrain natriuretic
peptide)-guided therapy in patients with acute decompensated HF using a
relative NT-proBNP target has not been investigated. This study aimed to
assess whether NT-proBNPguided therapy of patients with acute
decompensated HF using a relative NTproBNP target would lead to improved
outcomes compared with conventional therapy. <br/>METHOD(S): We conducted
a prospective randomized controlled trial to study the impact of
in-hospital guidance for acute decompensated HF treatment by a predefined
NT-proBNP target (>30% reduction from admission to discharge) versus
conventional treatment. Patients with acute decompensated HF with
NT-proBNP levels >1700 ng/L were eligible. After achieving clinical
stability, 405 patients were randomized to either NT-proBNP-guided or
conventional treatment (1:1). The primary end point was dual: A composite
of all-cause mortality and HF readmissions in 180 days and the number of
days alive out of the hospital in 180 days. Secondary end points were
all-cause mortality within 180 days, HF readmissions within 180 days, and
a composite of all-cause mortality and HF readmissions within 90 days.
<br/>RESULT(S): Significantly more patients in the NT-proBNP-guided
therapy group were discharged with an NT-proBNP reduction of >30% (80%
versus 64%, P=0.001). Nonetheless, NT-proBNP-guided therapy did not
significantly improve the combined event rate for all-cause mortality and
HF readmissions (hazard ratio, 0.96; 95% confidence interval, 0.72-1.37;
P=0.99) or the median number of days alive outside of the hospital (178
versus 179 days for NT-proBNP versus conventional patients, P=0.39).
Guided therapy also did not significantly improve any of the secondary end
points. <br/>CONCLUSION(S): The PRIMA II trial (Can NT-ProBNP-Guided
Therapy During Hospital Admission for Acute Decompensated Heart Failure
Reduce Mortality and Readmissions?) demonstrates that the guidance of HF
therapy to reach an NT-proBNP reduction of >30% after clinical
stabilization did not improve 6-month outcomes.<br/>Copyright &#xa9; 2017
American Heart Association, Inc.

<39>
Accession Number
2001861502
Title
Effects of tirofiban combined with Betaloc on serum P-selectin, BNP
levels, and cardiac function in patients with acute myocardial infarction
after PCI.
Source
International Journal of Clinical and Experimental Medicine. 12 (3) (pp
2667-2674), 2019. Article Number: IJCEM0084951. Date of Publication: 2019.
Author
Chen M.; Sun W.; Xu Y.; Xiao Q.
Institution
(Chen, Sun, Xu) Department of Pharmacy, Dezhou People's Hospital, Dezhou,
Shandong Province, China
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To investigate the effects of tirofiban combined with betaloc
on serum P-selectin, brain natriuretic peptide (BNP) levels, and cardiac
function in patients with acute myocardial infarction (AMI) after
percutaneous coronary intervention (PCI). <br/>Method(s): Ninety-five
patients were randomly divided into the observation group and the control
group. The control group was treated with betaloc alone, while the
observation group was treated with tirofiban and betaloc. Patient serum
P-selectin and BNP levels, hemodynamic parameters, cardiac function
indexes, troponin T (TNT), and C-reactive protein levels were observed and
compared. <br/>Result(s): The total effective rate of the observation
group was significantly higher than that of the control group (P=0.015).
Parameters were significantly lower in both groups after treatment, and
there was significant difference between the two groups (both P=0.000).
P-selectin and BNP levels in both groups significantly decreased after
treatment, and there was significant difference between the two groups
(both P=0.000). LVEF was significantly increased in both groups, with
significant difference between the two groups (P=0.000). The LVEDD and
LVESD of the observation group were significantly lower than those of the
control group after treatment (both P=0.000). Both TNT and hs-CRP were
significantly reduced and with significant differences between the two
groups (all P=0.000). <br/>Conclusion(s): Treatment with tirofiban
combined with betaloc after PCI in patients with AMI can improve clinical
outcomes and has a high clinical value owing to its ability to reduce
P-selectin and BNP levels and to improve cardiac function and hemodynamic
status.<br/>Copyright &#xa9; 2019, E-Century Publishing Corporation. All
rights reserved.

<40>
Accession Number
627543711
Title
Use of Topical Antibiotics before Primary Incision Closure to Prevent
Surgical Site Infection: A Meta-Analysis.
Source
Surgical Infections. 20 (4) (pp 261-270), 2019. Date of Publication:
May-June 2019.
Author
Lopez-Cano M.; Kraft M.; Curell A.; Puig-Asensio M.; Balibrea J.;
Armengol-Carrasco M.; Garcia-Alamino J.M.
Institution
(Lopez-Cano, Kraft, Curell, Balibrea, Armengol-Carrasco) Department of
General Surgery, Abdominal Wall Surgery Unit, General and Digestive
Surgery Research Group, Institut de Recerca Vall d'Hebron (VHIR), Hospital
Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona
E-08035, Spain
(Puig-Asensio) Department of Infectious Diseases, Hospital Universitari
Vall d'Hebron, Barcelona, Spain
(Garcia-Alamino) DPhil Programme in Evidence-Based Healthcare, University
of Oxford, Oxford, United Kingdom
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Surgical site infections (SSIs) remains a concern for surgeons
because of the negative impact on outcomes and health care costs. Our
purpose was to assess whether topical antibiotics before primary incision
closure reduced the rate of SSIs. <br/>Method(s): Systematic review of
MEDLINE/PubMed, Scopus, CINAHL, and Web of Science databases from
inception to January 2017. Only randomized controlled trials (RCTs) were
retrieved. The primary outcome was the SSI rate. Meta-analysis was
complemented with trial sequential analysis (TSA). <br/>Result(s):
Thirty-five RCTs (10,870 patients) were included. Only beta-lactams and
aminoglycosides were used. A substantial reduction of the incidence of
SSIs with the application of antibiotic agents before incision closure
(risk ratio [RR] 0.49, 95% confidence interval [CI] 0.37-0.64) was found,
which remained in the analysis of 12 RCTs after removal of studies of
uncertain quality. The use of beta-lactams was effective to reduce SSI in
elective surgery only (RR 0.33, 95% CI 0.13-0.85). In clean-contaminated
fields and as an irrigation solution, beta-lactams did not reduce the risk
of SSI. Aminoglycosides were not effective (RR 0.74, 95% CI 0.49-1.10).
After TSA, the evidence accumulated was far below the optimal information
size. The heterogeneity of studies was high and methodological quality of
most RCTs included in the meta-analysis was uncertain. <br/>Conclusion(s):
Results of this meta-analysis show the data present in the literature are
not sufficiently robust and, therefore, the use of topical beta-lactams or
aminoglycosides before incision closure to reduce SSI cannot be
recommended or excluded.<br/>&#xa9; Copyright 2019, Mary Ann Liebert,
Inc., publishers 2019.

<41>
Accession Number
627543654
Title
Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and
Where Do We Go? A Systematic Review.
Source
Surgical Infections. 20 (4) (pp 253-260), 2019. Date of Publication:
May-June 2019.
Author
Jaworski R.; Kansy A.; Dzierzanowska-Fangrat K.; Maruszewski B.
Institution
(Jaworski, Kansy, Maruszewski) Department of Pediatric Cardiothoracic
Surgery, Children's Memorial Health Institute, Al. Dzieci Polskich 20,
Warszawa 04-730, Poland
(Dzierzanowska-Fangrat) Department of Clinical Microbiology and
Immunology, Children's Memorial Health Institute, Warsaw, Poland
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Prophylactic antibiotic therapy is given routinely in the
peri-operative period to prevent surgical site infection. However, in
pediatric cardiac surgery, an optimal schedule has not been defined.
Pediatric recommendations follow the guidelines for adults, which might be
improper because of the inherent challenges in pediatric research and the
heterogeneity of the population. Implementation of an effective
prophylaxis protocol is needed for children undergoing cardiac surgery,
especially in view of worldwide antibiotic overuse and the development of
drug resistance. In this review, we analyze the current knowledge
supported by up-to-date publications about antibiotic prophylaxis in
pediatric cardiac surgery. <br/>Method(s): The PubMed database
was searched for full-text journal articles describing peri-operative
antibiotic prophylaxis in pediatric cardiac surgery published since 2000.
Antibiotics used for standard prophylaxis with dosing schema, time of the
first dose, additional dosage in extracorporeal circulation (ECC) priming,
and prophylaxis duration were analyzed. Additionally, we looked for
special clinical situations such as antibiotic prophylaxis in children
with the sternum left open after surgery and patients with beta-lactam
allergy or pre-operative methicillin-resistant Staphylococcus aureus
(MRSA) colonization or those requiring extracorporeal membrane oxygenation
(ECMO). <br/>Result(s): A total of 1,546 articles were evaluated, and we
identified 20 for further analysis. On the basis of the current
peri-operative antibiotic prophylaxis recommendations for cardiac surgery
and the papers reviewed, we tried to propose a schedule for peri-operative
antibiotic prophylaxis in pediatric cardiac surgery. <br/>Conclusion(s):
There is a need for careful use and examination of the schedule proposed
because the pharmacokinetics of antibiotics in pediatric patients with ECC
is not fully understood. This should be evaluated further. Formulating
uniform recommendations concerning peri-operative antibiotic prophylaxis
is difficult.<br/>&#xa9; Copyright 2019, Mary Ann Liebert, Inc.,
publishers 2019.

<42>
Accession Number
627461090
Title
Hypotension Prediction Index software for management of hypotension during
moderate- to high-risk noncardiac surgery: Protocol for a randomized
trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 255. Date of
Publication: 03 May 2019.
Author
Maheshwari K.; Shimada T.; Fang J.; Ince I.; Mascha E.J.; Turan A.; Kurz
A.; Sessler D.I.
Institution
(Maheshwari, Shimada, Fang, Ince, Turan, Kurz, Sessler) Department of
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid
Avenue, E-31, Cleveland, OH 44195, United States
(Maheshwari, Turan, Kurz) Department of General Anesthesiology,
Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, E-31,
Cleveland, OH 44195, United States
(Shimada) Department of Anesthesiology, National Defense Medical College,
Tokorozawa, Saitama, Japan
(Ince) Department of Anesthesiology and Reanimation, Ataturk University
School of Medicine, Erzurum, Turkey
(Mascha) Departments of Quantitative Health Sciences and Outcomes
Research, Lerner Research Institute and Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Hypotension is associated with serious complications,
including myocardial infarction, acute kidney injury, and mortality.
Consequently, predicting and preventing hypotension may improve outcomes.
We will therefore determine if use of a novel hypotension prediction tool
reduces the duration and severity of hypotension in patients having
non-cardiac surgery. Methods/design: We will conduct a two-center,
pragmatic, randomized controlled trial (N = 213) in noncardiac surgical
patients > 45 years old who require intra-arterial blood pressure
monitoring. All participating patients will be connected to a Flortrac IQ
sensor and EV1000 platform (Edwards Lifesciences, Irvine). They will be
randomly assigned to blinded or unblinded arms. The Hypotension Prediction
Index (HPI) and advanced hemodynamic information will be universally
recorded, but will only be available to clinicians when patients are
assigned to unblinded monitoring. The primary outcome will be the effect
of HPI software guidance on intraoperative time-weighted average mean
arterial pressure under a threshold of 65 mmHg, which will be assessed
with a Wilcoxon-Mann-Whitney 2-sample, two-tailed test.
<br/>Discussion(s): Our trial will determine whether the Hypotension
Prediction Index and associated hemodynamic information substantively
reduces hypotension during non-cardiac surgery.<br/>Copyright &#xa9; 2019
The Author(s).

<43>
Accession Number
627397905
Title
Effects of esmolol on QTc interval changes during tracheal intubation: A
systematic review.
Source
BMJ Open. 9 (4) (no pagination), 2019. Article Number: e028111. Date of
Publication: 01 Apr 2019.
Author
Thiruvenkatarajan V.; Lee J.Y.; Sembu M.; Watts R.; Van Wijk R.M.
Institution
(Thiruvenkatarajan, Watts, Van Wijk) Anaesthesia, Queen Elizabeth
Hospital, Adelaide, SA, Australia
(Lee) University of Adelaide, Adelaide, SA, Australia
(Sembu) University of New South Wales, Sydney, NSW, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction and aims Esmolol is an ultra-short-acting beta 1 antagonist
that has been shown to attenuate the corrected QT (QTc) interval
prolongation associated with laryngoscopy and endotracheal intubation
(LTI). Prolongation of the QTc interval can precipitate arrhythmias, the
most serious of which is torsades de pointes. The aim of this systematic
review was to compare esmolol and placebo on QTc changes occurring during
LTI. Materials and methods PubMed, EMBASE, Cochrane Registry of Clinical
Trials and CINAHL databases (up to August 2018) were screened for
randomised controlled trials comparing esmolol and placebo on QTc changes
during LTI in cardiac and non-cardiac surgeries. The primary outcome was
QTc changes during LTI and secondary outcome was related to adverse
effects from esmolol such as bradycardia and hypotension. Results Seven
trials were identified involving 320 patients, 160 patients receiving
esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in
the esmolol group compared with the placebo in four studies. Compared with
the baseline, the QTc was reduced post-LTI in the esmolol group. In the
placebo group, the QTc was prolonged compared with the baseline post LTI.
Nonetheless, esmolol did not prevent QTc prolongation in the remaining
three studies, and much of this was attributed to employing QTc prolonging
agents for premedication and anaesthetic induction. No significant adverse
events were noted. Conclusion Compared with placebo, esmolol reduced the
LTI-induced QTc prolongation when current non-QTc prolonging agents were
chosen for tracheal intubation. Future studies should explore whether
transmural dispersion (a marker of torsadogenicity) is also affected
during LTI by analysing parameters such as the Tp-e interval (interval
between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected
Tp-e interval). Trial registration number CRD42018090282.<br/>Copyright
&#xa9; 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.

<44>
Accession Number
627354624
Title
A fully magnetically levitated left ventricular assist device - Final
report.
Source
New England Journal of Medicine. 380 (17) (pp 1618-1627), 2019. Date of
Publication: 25 Apr 2019.
Author
Mehra M.R.; Uriel N.; Naka Y.; Cleveland J.C.; Yuzefpolskaya M.; Salerno
C.T.; Walsh M.N.; Milano C.A.; Patel C.B.; Hutchins S.W.; Ransom J.; Ewald
G.A.; Itoh A.; Raval N.Y.; Silvestry S.C.; Cogswell R.; John R.; Bhimaraj
A.; Bruckner B.A.; Lowes B.D.; Um J.Y.; Jeevanandam V.; Sayer G.; Mangi
A.A.; Molina E.J.; Sheikh F.; Aaronson K.; Pagani F.D.; Cotts W.G.;
Tatooles A.J.; Babu A.; Chomsky D.; Katz J.N.; Tessmann P.B.; Dean D.;
Krishnamoorthy A.; Chuang J.; Topuria I.; Sood P.; Goldstein D.J.
Institution
(Mehra) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, IL, United States
(Uriel, Jeevanandam, Sayer) University of Chicago, School of Medicine and
Medical Center, Chicago, IL, United States
(Cotts, Tatooles) Advocate Christ Medical Center, Oak Lawn, IL, United
States
(Chuang, Topuria, Sood) Abbott, Abbott Park, IL, United States
(Naka, Yuzefpolskaya) Columbia University, College of Physicians, Surg.
and New York-Presbyterian Hospital, New York, United States
(Goldstein) Montefiore Einstein Center for Heart and Vascular Care, New
York, United States
(Cleveland) University of Colorado, School of Medicine, Aurora, United
States
(Salerno, Walsh) St. Vincent Heart Center, Indianapolis, United States
(Milano, Patel) Duke University Medical Center, Durham, NC, United States
(Katz, Tessmann) University of North Carolina, Chapel Hill, NC, United
States
(Hutchins, Ransom) Baptist Health Medical Center, Little Rock, AR, United
States
(Ewald, Itoh) Washington University, School of Medicine, St. Louis, United
States
(Raval, Silvestry) Advent Health Transplant Institute, Orlando, FL, United
States
(Cogswell, John) University of Minnesota, Minneapolis, United States
(Bhimaraj, Bruckner) Houston Methodist Hospital, Houston, United States
(Lowes, Um) University of Nebraska Medical Center, Omaha, United States
(Mangi) Yale Medical School, New Haven, CT, United States
(Molina, Sheikh) MedStar Washington Hospital Center, Washington, DC,
United States
(Aaronson, Pagani) University of Michigan, Ann Arbor, United States
(Babu, Chomsky) St. Thomas Hospital, Nashville, United States
(Dean, Krishnamoorthy) Piedmont Hospital, Atlanta, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In two interim analyses of this trial, patients with advanced
heart failure who were treated with a fully magnetically levitated
centrifugal-flow left ventricular assist device were less likely to have
pump thrombosis or nondisabling stroke than were patients treated with a
mechanical-bearing axial-flow left ventricular assist device. METHODS We
randomly assigned patients with advanced heart failure to receive either
the centrifugal-flow pump or the axial-flow pump irrespective of the
intended goal of use (bridge to transplantation or destination therapy).
The composite primary end point was survival at 2 years free of disabling
stroke or reoperation to replace or remove a malfunctioning device. The
principal secondary end point was pump replacement at 2 years. RESULTS
This final analysis included 1028 enrolled patients: 516 in the
centrifugal-flow pump group and 512 in the axial-flow pump group. In the
analysis of the primary end point, 397 patients (76.9%) in the
centrifugal-flow pump group, as compared with 332 (64.8%) in the
axial-flow pump group, remained alive and free of disabling stroke or
reoperation to replace or remove a malfunctioning device at 2 years
(relative risk, 0.84; 95% confidence interval [CI], 0.78 to 0.91; P<0.001
for superiority). Pump replacement was less common in the centrifugal-flow
pump group than in the axial-flow pump group (12 patients [2.3%] vs. 57
patients [11.3%]; relative risk, 0.21; 95% CI, 0.11 to 0.38; P<0.001). The
numbers of events per patient-year for stroke of any severity, major
bleeding, and gastrointestinal hemorrhage were lower in the
centrifugal-flow pump group than in the axial-flow pump group. CONCLUSIONS
Among patients with advanced heart failure, a fully magnetically levitated
centrifugalflow left ventricular assist device was associated with less
frequent need for pump replacement than an axial-flow device and was
superior with respect to survival free of disabling stroke or reoperation
to replace or remove a malfunctioning device.<br/>Copyright &#xa9; 2019
Massachusetts Medical Society.

<45>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<46>
Accession Number
2001849388
Title
Effects of perioperative tight glycemic control on postoperative outcomes:
A meta-analysis.
Source
Endocrine Connections. 7 (12) (pp R316-R327), 2018. Date of Publication:
2018.
Author
Kang Z.-Q.; Huo J.-L.; Zhai X.-J.
Institution
(Kang, Zhai) Department of Nursing, Jin Qiu Hospital of Liaoning Province,
Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province,
China
(Huo) Department of Respiratory Medicine, Jin Qiu Hospital of Liaoning
Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning
Province, China
Publisher
BioScientifica Ltd. (Euro House, 22 Apex Court, Woodlands, Bradley Stoke,
Bristol BS32 4JT, United Kingdom)
Abstract
Background: The optimal glycemic target during the perioperative period is
still controversial. We aimed to explore the effects of tight glycemic
control (TGC) on surgical mortality and morbidity. <br/>Method(s): PubMed,
EMBASE and CENTRAL were searched from January 1, 1946 to February 28,
2018. Appropriate trails comparing the postoperative outcomes (mortality,
hypoglycemic events, acute kidney injury, etc.) between different levels
of TGC and liberal glycemic control were identified. Quality assessments
were performed with the Jadad scale combined with the allocation
concealment evaluation. Pooled relative risk (RR) and 95% CI were
calculated using random effects models. Heterogeneity was detected by the
I² test. <br/>Result(s): Twenty-six trials involving a total of
9315 patients were included in the final analysis. The overall mortality
did not differ between tight and liberal glycemic control (RR, 0.92; 95%
CI, 0.78-1.07; I² = 20.1%). Among subgroup analyses, obvious
decreased risks of mortality were found in the short-term mortality,
non-diabetic conditions, cardiac surgery conditions and compared to the
very liberal glycemic target. Furthermore, TGC was associated with
decreased risks for acute kidney injury, sepsis, surgical site infection,
atrial fibrillation and increased risks of hypoglycemia and severe
hypoglycemia. <br/>Conclusion(s): Compared to liberal control,
perioperative TGC (the upper level of glucose goal <=150 mg/dL) was
associated with significant reduction of short-term mortality, cardic
surgery mortality, non-diabetic patients mortality and some postoperative
complications. In spite of increased risks of hypoglycemic events,
perioperative TGC will benefits patients when it is done
carefully.<br/>Copyright &#xa9; 2018 The authors Published by
Bioscientifica Ltd.

<47>
Accession Number
614641045
Title
Perioperative gabapentin and pregabalin in cardiac surgery: a systematic
review and meta-analysis.
Source
Brazilian Journal of Anesthesiology. 67 (3) (pp 294-304), 2017. Date of
Publication: May 2017.
Author
Maitra S.; Baidya D.K.; Bhattacharjee S.; Som A.
Institution
(Maitra, Baidya, Bhattacharjee, Som) All India Institute of Medical
Sciences, Department of Anaesthesiology & Intensive Care, New Delhi, India
Publisher
Elsevier Editora Ltda
Abstract
Objectives Sternotomy for cardiac surgeries causes significant
postoperative pain and when not properly managed may cause significant
morbidity. As neuropathic pain is a significant component here, gabapentin
and pregabalin may be effective in these patients and may reduce
postoperative opioid consumption. The purpose of this systematic review
was to find out efficacy of gabapentin and pregabalin in acute
postoperative pain after cardiac surgery. Methods Published prospective
human randomized clinical trials, which compared preoperative and/or
postoperative gabapentin/pregabalin with placebo or no treatment for
postoperative pain management after cardiac surgery has been included in
this review. Results Four RCTs each for gabapentin and pregabalin have
been included in this systematic review. Three gabapentin and two
pregabalin studies reported decrease in opioid consumption in cardiac
surgical patients while one gabapentin and two pregabalin studies did not.
Three RCTs each for gabapentin and pregabalin reported lower pain scores
both during activity and rest. The drugs are not associated with any
significant complications. Conclusion Despite lower pain scores in the
postoperative period, there is insufficient evidence to recommend routine
use of gabapentin and pregabalin to reduce opioid consumption in the
cardiac surgical patients.<br/>Copyright &#xa9; 2016 Sociedade Brasileira
de Anestesiologia

<48>
Accession Number
614599465
Title
The effect of two different glycemic management protocols on postoperative
cognitive dysfunction in coronary artery bypass surgery.
Source
Brazilian Journal of Anesthesiology. 67 (3) (pp 258-265), 2017. Date of
Publication: May 2017.
Author
Kurnaz P.; Sungur Z.; Camci E.; Sivrikoz N.; Orhun G.; Senturk M.; Sayin
O.; Tireli E.; Gurvit H.
Institution
(Kurnaz, Sungur, Camci, Sivrikoz, Orhun, Senturk, Sayin) Istanbul
University Istanbul Medical Faculty, Department of Anesthesiology,
Istanbul, Turkey
(Tireli) Istanbul University Istanbul Medical Faculty, Department of
Cardiac Surgery, Istanbul, Turkey
(Gurvit) Istanbul University Istanbul Medical Faculty, Department of
Neurology, Istanbul, Turkey
Publisher
Elsevier Editora Ltda
Abstract
Introduction Postoperative cognitive dysfunction (POCD) is an adverse
outcome of surgery that is more common after open heart procedures. The
aim of this study is to investigate the role of tightly controlled blood
glucose levels during coronary artery surgery on early and late cognitive
decline. Methods 40 patients older than 50 years undergoing elective
coronary surgery were randomized into two groups. In the "Tight Control"
group (GI), the glycemia was maintained between 80 and 120
mg.dL^-1 while in the "Liberal" group (GII), it ranged between
80-180 mg.dL^-1. A neuropsychological test battery was performed
three times: baseline before surgery and follow-up first and 12th weeks,
postoperatively. POCD was defined as a drop of one standard deviation from
baseline on two or more tests. Results At the postoperative first week,
neurocognitive tests showed that 10 patients in the GI and 11 patients in
GII had POCD. The incidence of early POCD was similar between groups.
However the late assessment revealed that cognitive dysfunction persisted
in five patients in the GII whereas none was rated as cognitively impaired
in GI (p = 0.047). Conclusion We suggest that tight perioperative glycemic
control in coronary surgery may play a role in preventing persistent
cognitive impairment.<br/>Copyright &#xa9; 2016 Sociedade Brasileira de
Anestesiologia

<49>
Accession Number
2001474518
Title
Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an
Enhanced Recovery Program Is Associated with Decreased Opioid Consumption
and Improved Patient Postoperative Rehabilitation After Open Cardiac
Surgery-A Patient-Matched, Controlled Before-and-After Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1659-1667),
2019. Date of Publication: June 2019.
Author
Macaire P.; Ho N.; Nguyen T.; Nguyen B.; Vu V.; Quach C.; Roques V.;
Capdevila X.
Institution
(Macaire, Nguyen) Department of Anesthesiology and Critical Care Medicine,
Vinmec International Hospital, Hanoi, Vietnam
(Ho, Vu, Quach) Department of Cardiac Surgery, Vinmec International
Hospital, Ho Chi Minh City, Vietnam
(Nguyen) Department of Anesthesiology and Critical Care Medicine, Vinmec
International Hospital, Ho Chi Minh City, Vietnam
(Roques) Department of Anesthesiology and Critical Care Medicine, Hospital
Virgen de la Arrixaca, Murcia, Spain
(Capdevila) Department of Anesthesiology and Critical Care Medicine,
Lapeyronie University Hospital, Cedex, France
(Capdevila) Montpellier NeuroSciences Institute, Montpellier University,
Montpellier, France
Publisher
W.B. Saunders
Abstract
Objectives: Open cardiac surgery may cause severe postoperative pain. The
authors hypothesized that patients receiving a bundle of care using
continuous erector spinae plane blocks (ESPB) would have decreased
perioperative opioid consumption and improved early outcome parameters
compared with standard perioperative management. <br/>Design(s): A
consecutive, patient-matched, controlled before-and-after study.
<br/>Setting(s): Two tertiary teaching hospitals. <br/>Participant(s): The
study comprised 67 consecutive patients undergoing elective cardiac
surgery with cardiopulmonary bypass. <br/>Intervention(s): In a controlled
before-and-after trial, this study compared a historical group of 20
consecutive open cardiac surgery patients matched with a prospective group
of 47 consecutive patients receiving continuous bilateral ESPB (0.25
mL/kg/side of ropivacaine 0.5%) after general anesthesia induction. For
postoperative analgesia, both groups received paracetamol. The control
group received intravenous (IV) morphine, 0.5 mg/h, and IV nefopam, 100
mg/24 h. In the ESPB group, 8 hours after the loading dose, catheters were
connected to a pump infusing intermittent automatic boluses of ropivacaine
0.2% every 6 hours. If needed, for both groups, rescue analgesia was
provided with IV ketorolac, 30 mg, and IV morphine, 30 micro&#32;g/kg.
<br/>Measurements and Main Results: Morphine consumption in the first 48
hours was significantly decreased in the ESPB group (40 [25-45] mg in the
control group compared with 0 [0-0] mg in the ESPB group [p < 0.001]) as
was intraoperative sufentanil (0.8 [0.6-0.9] micro&#32;g/kg/h and 0.2
[0.16-0.3] micro&#32;g/kg/h, respectively; p < 0.001). Times to chest tube
removal, first mobilization, pain (Visual Analogue Scale) values 2 hours
after chest tube removal, pain values at rest 1 month after surgery, and
postoperative adverse events were significantly decreased in the ESPB
group. There was no difference for extubation time and pain during first
mobilization. <br/>Conclusion(s): The authors report for the first time
that the use of a bundle of care including a continuous bilateral ESPB is
associated with a significant decrease in intraoperative and postoperative
opioid consumption, optimized rapid patient mobilization, and chest tube
removal after open cardiac surgery.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<50>
Accession Number
2001848810
Title
Meta-analysis of transcatheter aortic valve implantation for bicuspid
versus tricuspid aortic valves.
Source
Journal of Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: We performed meta-analysis and meta-regression of
transcatheter aortic valve implantation (TAVI) for the bicuspid aortic
valve (B-AV) versus the tricuspid aortic valve (T-AV). <br/>Method(s):
MEDLINE and EMBASE were searched through June 2018 using PubMed and OVID.
We included comparative studies of TAVI patients with B-AV versus T-AV
reporting at least one of postprocedural transcatheter valve regurgitation
(TVR)/pacemaker implantation (PMI) incidence and early (30-day or
in-hospital)/late (including early) mortality. For each study, crude
(unadjusted) data regarding TVR/PMI incidence and early/late mortality in
both the B-AV and T-AV groups were used to generate risk ratios (RRs).
Study-specific estimates were combined in the random-effects model. Using
meta-regression, we assessed potential confounders identified in
preliminary meta-analysis. <br/>Result(s): We identified 12 eligible
studies including a total of 1045 B-AV and 4069 T-AV patients. Pooled
analysis demonstrated an association of B-AV with a statistically
significant increase in TVR incidence (RR, 1.42; p = 0.006) but no
statistically significant difference in PMI incidence (p = 0.54) and
30-day (p = 0.11)/midterm (1-year to 2-year) mortality (p = 0.99) between
patients with B-AV and those with T-AV. All meta-regression coefficients
of 6 identified potential confounders (age, mean aortic valve gradient,
aortic valve area, left ventricular ejection fraction, aortic
calcification, and B-AV types) for the outcomes (TVR/PMI incidence and
early/late mortality) were statistically non-significant.
<br/>Conclusion(s): Postprocedural PMI incidence and 30-day/midterm
(1-year to 2-year) mortality after TAVI may be similar between patients
with B-AV and those with T-AV despite the significant association of B-AV
with increased postprocedural TVR incidence.<br/>Copyright &#xa9; 2019
Japanese College of Cardiology

<51>
Accession Number
627519106
Title
The efficacy and safety of prophylactic use of levosimendan on patients
undergoing coronary artery bypass graft: a systematic review and
meta-analysis.
Source
Journal of Anesthesia. (no pagination), 2019. Date of Publication: 2019.
Author
Wang W.; Zhou X.; Liao X.; Liu B.; Yu H.
Institution
(Wang, Zhou, Liu, Yu) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu, Sichuan 610041, China
(Liao) Department of Urology, Institute of Urology, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Prophylactic use of levosimendan in cardiac surgery remains controversial
and no meta-analysis has been done exclusively about that in patients
undergoing coronary artery bypass graft (CABG) surgery. We conducted this
systematic review and meta-analysis of levosimendan in CABG using PubMed,
Embase, Scopus, and Cochrane Library (till April 20, 2018). Two-hundred
and forty manuscripts were identified and 21 randomized trials (1727
patients in total) investigating the effect of levosimendan on the
patients undergoing CABG surgery were finally included in this analysis.
We found that levosimendan was an effective, well-tolerated inotropic
agent in CABG, which was associated with a significantly reduced mortality
rate [odds ratio (OR) 0.43, 95% confidence interval (CI) (0.26, 0.71), p =
0.001, I² = 0%] and postoperative atrial fibrillation [OR 0.50,
95% CI (0.26, 0.97), p = 0.04, I² = 76%], but a higher
incidence of hypotension [OR 2.26, 95% CI (1.05, 4.85), p = 0.04,
I² = 79%]. Subgroup analyses revealed that such a benefit was
mainly observed in the isolated CABG, the preoperative administration,
with-bolus and on-pump subgroups. More high-quality and well-designed
prospective studies are needed to confirm or disprove our findings in
future.<br/>Copyright &#xa9; 2019, Japanese Society of Anesthesiologists.

<52>
Accession Number
2001457854
Title
Intraoperative Use of Nondepolarizing Neuromuscular Blocking Agents During
Cardiac Surgery and Postoperative Pulmonary Complications: A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1673-1681),
2019. Date of Publication: June 2019.
Author
Gerlach R.M.; Shahul S.; Wroblewski K.E.; Cotter E.K.H.; Perkins B.W.;
Harrison J.-H.; Ota T.; Jeevanandam V.; Chaney M.A.
Institution
(Gerlach, Shahul, Perkins, Harrison, Chaney) Department of Anesthesia and
Critical Care, University of Chicago Medicine, Chicago, IL, United States
(Wroblewski) Department of Public Health Sciences, University of Chicago,
Chicago, IL, United States
(Cotter) Department of Anesthesiology, University of Kansas Medical
Center, Kansas City, KS, United States
(Ota, Jeevanandam) Department of Cardiothoracic Surgery, University of
Chicago Medicine, Chicago, IL, United States
Publisher
W.B. Saunders
Abstract
Objective: Nondepolarizing neuromuscular blocking agents (NMBAs) are
associated with perioperative complications in noncardiac surgery;
however, little is known about their effect on cardiac surgery. This study
assessed the effect of neuromuscular blockade (NMB) on the incidence of
postoperative pulmonary complications (PPCs) after cardiac surgery and
operating conditions. <br/>Design(s): Prospective, randomized clinical
trial with blinded outcomes assessment. <br/>Setting(s): University
hospital, single institution. <br/>Participant(s): Adult patients having
cardiac surgery requiring cardiopulmonary bypass. <br/>Intervention(s):
One hundred patients were randomized to receive succinylcholine (group
SUX) for intubation with no further NMB administered or cisatracurium
(group CIS) for intubation and maintenance NMB. The primary outcome was a
composite incidence of PPCs in the 72 hours after elective cardiac
surgery. PPCs included failure to extubate within 24 hours, need for
reintubation, pneumonia, aspiration, unanticipated need for noninvasive
respiratory support, acute respiratory distress, and mortality from
respiratory arrest. The secondary outcome was the adequacy of operating
conditions as assessed by blinded surgeon survey (including a rating of
surgical conditions on a Likert scale from 1 = poor to 5 = excellent),
anesthesiologist report, and patient questionnaire. <br/>Measurements and
Main Results: The composite incidence of PPCs did not differ between
groups (8 of 50 patients in both groups; 16%). Mean surgeon rating of
surgical conditions was lower in the SUX group (4.65 +/- 0.85 v 4.96 +/-
0.20, p = 0.02). <br/>Conclusion(s): Although avoiding nondepolarizing
NMBA is feasible, doing so worsened operating conditions and did not
reduce the incidence of postoperative pulmonary
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<53>
Accession Number
2001782552
Title
Transcatheter Mitral Valve Replacement with Intrepid.
Source
Interventional Cardiology Clinics. 8 (3) (pp 287-294), 2019. Date of
Publication: July 2019.
Author
McCarthy P.M.; Kislitsina O.N.; Malaisrie S.C.; Davidson C.J.
Institution
(McCarthy) Division of Cardiac Surgery, Northwestern University Feinberg
School of Medicine, Northwestern University, 201 East Huron Street, Suite
11-140, Chicago, IL 60611-2908, United States
(Kislitsina) Cardiology, Northwestern University Feinberg School of
Medicine, 201 East Huron Street, Suite 11-140, Chicago, IL 60611-2908,
United States
(Malaisrie) Division of Cardiac Surgery, Northwestern University Feinberg
School of Medicine, 201 East Huron Street, Suite 11-140, Chicago, IL
60611, United States
(Davidson) Division of Cardiology, Northwestern University Feinberg School
of Medicine, 676 North St. Clair, Arkes 23 Suite 2330, Chicago, IL 60611,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter mitral valve replacement with the Intrepid device is
intended for patients who need mitral valve replacement and who are at an
increased risk for conventional surgery. The early published results of
the early feasibility trial are reviewed as well as device design and the
implant procedure. The Apollo trial is reviewed: a randomized trial of the
Intrepid device versus conventional surgery including a single arm study
for inoperable patients. The mitral valve structure, pathophysiology, and
postimplant physiology pose unique hurdles for any transcatheter
implant.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<54>
Accession Number
2001616708
Title
Isolated adult congenital uni-leaflet severe mitral valve stenosis, a case
report, and review of literature.
Source
Journal of Cardiology Cases. 19 (6) (pp 177-181), 2019. Date of
Publication: June 2019.
Author
Naeim H.A.; Taha E.A.; Taha R.A.; Alatawi F.O.; Amodi O.; Abuelatta R.
Institution
(Naeim, Alatawi, Amodi, Abuelatta) Madina Cardiac Centre, Saudi Arabia
(Taha, Taha) Faculty of Medicine, Banha University, Egypt
(Alatawi) Taiba University, Saudi Arabia
(Naeim) Al-Azhar university, Egypt
Publisher
Elsevier Ltd
Abstract
Reported cases of uni-leaflet mitral valve (MV) were related to the
absence or dysplasia of the posterior mitral leaflet with ample anterior
mitral leaflet. We present here a new entity of uni-leaflet MV where the
MV appears as a membrane-like structure with a single slit-like orifice at
its lateral part with no commissures. Case report: Continuous Doppler flow
revealed a mean pressure gradient of 19 mmHg across the mitral valve
indicating severe mitral stenosis. In 3D images from the left atrial view,
the MV appeared like a membrane with a single orifice in its lateral part
toward the left atrial appendage, the area of this orifice by 3D was 0.52
cm², there were no commissures or even any residual lines at
the site where commissures should be. The diagnosis of congenital severe
mitral stenosis due to acommissural MV was confirmed. During surgery, the
surgical appearance of the MV confirmed our diagnosis by 3D.
<br/>Conclusion(s): Isolated congenital severe mitral stenosis presenting
in adulthood is rare, uni-leaflet MV as a cause is only reported in a few
cases. MV replacement is usually indicated due to the abnormal anatomy of
MV leaflets and the subvalvular apparatus. <Learning objectives: How to
diagnose uni-leaflet congenital mitral stenosis and how to differentiate
it from other causes of congenital mitral stenosis.><br/>Copyright &#xa9;
2019 Japanese College of Cardiology

<55>
Accession Number
627535332
Title
Comparison of long-term clinical outcomes in multivessel coronary artery
disease patients treated either with bioresoarbable polymer
sirolimus-eluting stent or permanent polymer everolimus-eluting stent:
5-year results of the CENTURY II randomized clinical trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Iniguez A.; Chevalier B.; Richardt G.; Neylon A.; Jimenez V.A.; Kornowski
R.; Carrie D.; Moreno R.; Barbato E.; Serra-Penaranda A.; Guiducci V.;
Valdes-Chavarri M.; Yajima J.; Wijns W.; Saito S.
Institution
(Iniguez, Jimenez) Cardiology Department, Hospital Alvaro Cunqueiro,
University Hospital of Vigo, Vigo, Spain
(Chevalier) Interventional Cardiology Department, Institut
Cardiovasculaire Paris Sud, Massy, France
(Richardt) Department of Cardiology, Segeberger Kliniken, Bad Segeberg,
Germany
(Neylon) SAOLTA Health Care Group, Galway University Hospital and NUI,
Galway, Ireland
(Kornowski) Cardiology Department, Rabin Medical Centre, Petah Tikva,
Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
(Carrie) Department of Cardiology, Rangueil University Hospital, Toulouse,
France
(Moreno) Interventional Cardiology Department, La Paz University Hospital,
Madrid, Spain
(Barbato) Cardiovascular Centre, Onze Lieve Vrouwe Ziekenhuis, Aalst,
Belgium and Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Naples, Italy
(Serra-Penaranda) Cardiology Department, Hospital de la Santa Creu i Sant
Pau, IIB-SantPau, CIBERCV, Universidad Autonoma de Barcelona, Barcelona,
Spain
(Guiducci) Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio
Emilia, Italy
(Valdes-Chavarri) Cardiology Department, Hospital Universitario Virgen de
la Arrixaca, IMIB-Arrixaca, Murcia, Spain
(Yajima) Department of Cardiovascular Medicine, The Cardiovascular
Institute, Tokyo, Japan
(Wijns) The Lambe Institute, NUI Galway, Ireland
(Saito) Department of Cardiology and Catheterization Laboratory, Shonan
Kamakura General Hospital, Kamakura, Japan
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the long-term safety and efficacy of a
sirolimus-eluting stent with bioresorbable polymer (BP-SES; Ultimaster),
in comparison to a benchmark everolimus-eluting, permanent polymer stent
(PP-EES; Xience), in a prespecified subgroup of patients with multivessel
coronary artery disease (MVD) enrolled in the CENTURY II trial.
<br/>Background(s): The use of coronary stenting in high-risk subgroups,
like MVD patients, is rising. The clinical evidence, including long-term
comparative analysis of the efficacy and safety benefits of different
new-generation drug eluting stents, however, remains insufficient.
<br/>Method(s): Among 1,119 patients (intention-to-treat) enrolled in the
CENTURY II prospective, randomized, single-blind, multicenter trial, a
prespecified subgroup of 456 MVD patients were allocated by stratified
randomization to treatment with BP-SES (n = 225) or PP-EES (n = 231). The
previously reported primary endpoint of this study was freedom from target
lesion failure (TLF: a composite of cardiac death, target vessel-related
myocardial infarction [MI] and clinically-indicated target lesion
revascularization) at 9 months. <br/>Result(s): In this MVD substudy,
baseline patient, lesion and procedure characteristics were similar
between the treatment arms. At 1 and 5 years, both BP-SES and PP-EES
displayed low and comparable rates of TLF (5.3 vs. 7.8%; p =.29 and 10.2
vs. 13.4%; p =.29), and definite or probable stent thrombosis (0.4 vs.
1.3%; p =.33 and 0.9 vs. 1.7%; p =.43), respectively. Composite endpoint
of cardiac death and MI, and patient-oriented composite endpoint of any
death, MI, and coronary revascularizations were also similar.
<br/>Conclusion(s): These results confirm good long-term safety and
efficacy of the studied bioresorbable polymer stent in this high-risk
patient population.<br/>Copyright &#xa9; 2019 The Authors. Catheterization
and Cardiovascular Interventions published by Wiley Periodicals, Inc.

<56>
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. <br/>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. <br/>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.
<br/>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<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<57>
Accession Number
627605721
Title
Spinal cord stimulation for chronic refractory angina pectoris-does
frequency matter?.
Source
Neuromodulation. Conference: 22nd Annual Meeting of the North American
Neuromodulation Society, NANS 2019. United States. 22 (3) (pp E222), 2019.
Date of Publication: April 2019.
Author
Patel P.; Grewal S.; Nanavati N.; Morgan M.; Grubb W.R.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: 53 year old AA female with PMH of severe CAD s/p cardiac
stents x2, MI, HTN, HLD, DM, GERD, gout, depression and obesity presented
to the pain clinic ten months s/p CABG x2 (LIMA-LAD, SVG-RPDA) with
chronic chest pain. Post-operatively, all cardiac workup for angina were
negative. Patient complained of chest pain radiating to bilateral UEs.
Pain was described as constant, heavy, throbbing, radiating and VAS 9/10.
The pain resulted in difficulty sleeping, shortness of breath and
difficulty with grabbing objects. On exam, the patient had a well-healed
sternotomy scar which was tender to light palpation. Musculoskeletal and
neurological exams were WNL other than decreased muscle strength in
bilateral UEs. <br/>Result(s):The patient subsequently had a high
frequency (>9000 Hz) SCS trial performed for a diagnosis of chronic
refractory angina pectoris. A percutaneous epidural lead was placed under
fluoroscopy with the tip of the lead advanced to the superior aspect of
the T1 vertebral body. The patient tolerated the procedure well. During
subsequent follow-up, the patient noted minimal pain relief in her LUE and
no pain relief in her chest or RUE. Decision was made to exchange her
high-frequency external generator for a low frequency (<2000 Hz)
generator. The patient noted immediate, significant and global pain
relief. The patient was scheduled for neurosurgical follow-up for
permanent placement. Of note, twenty-four hours following removal of the
trial system, the patient had recurrence of severe angina and presented to
our ED with intolerable chest pain. <br/>Conclusion(s): In 2015, Eldabe et
al¹ performed a pilot randomized controlled trial (RASCAL)
which, although not formally powered, demonstrated larger improvements in
primary and secondary outcome measures for patients with refractory angina
who received SCS therapy versus those who received usual care. A
meta-analysis by Imran et al² in 2016 suggested that "SCS may
be associated with a longer exercise duration and lower angina frequency
and nitrate consumption in patients with chronic refractory angina
pectoris." Future research goals in this space will include exploring the
optimal frequency and waveform therapies for angina-type pain.

<58>
Accession Number
627605292
Title
Spinal cord stimulation as treatment for truncal crps after cardiac
surgery.
Source
Neuromodulation. Conference: 22nd Annual Meeting of the North American
Neuromodulation Society, NANS 2019. United States. 22 (3) (pp E89), 2019.
Date of Publication: April 2019.
Author
Poe L.M.; Sobey C.M.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: We describe a case of a 59-year-old male who presented seven
months after coronary artery bypass (CAB) surgery with symptoms and signs
of truncal CRPS. After pharmacologic and regional block treatments failed,
the patient underwent trial of a spinal cord stimulation (SCS) with
subsequent >90% relief of his pain and improvement in his daily life.
<br/>Method(s): Using fluoroscopic guidance, two introducer needles were
placed in the posterior epidural space using a loss of resistance
technique at the T10/11 level. Two 16-contact cylindrical SCS leads were
advanced in the posterior epidural space with the top contact of one lead
right para-median at the level of the seventh cervical vertebral body and
the top contact of the second lead was positioned left paramedian at the
level of the third thoracic vertebral body. Stimulation was concordant
along the entire right upper extremity and left flank corresponding to the
patient's previous pain description. Conventional stimulation using
continuous stimulation cycle and alternating programs using 60 or 70 Hz
and between 7.4-12.0mA were used for the trial. With this lead placement,
there is inhibition of signals from the ascending bilateral dorsal columns
to cover our patient's truncal and right upper extremity symptoms.
Additionally, lateral placement of the leads may inhibit signaling from
the bilateral spinothalamic tracts. <br/>Result(s): During the trial, the
patient reported >75% improvement in bilateral chest wall and bilateral
scapular pain and denied the need for any opioids after 1 week. After
permanent implantation, the patient continued to be satisfied with his
relief, stating > 90% relief of his CRPS pain complaints and described no
complications at two week follow up. At 6 week follow up, the patient
sustained >90% pain relief and had started an exercise regimen.
<br/>Conclusion(s): Our case report is an example of how precise lead
placement can provide full coverage for affected areas by manipulating the
input and output of the contributing spinal cord tracts. Truncal and
unilateral limb CRPS may be favorable for treatment with SCS when other
treatment modalities have failed, as shown in this case report. More
prospective randomized controlled trials are needed to determine the
success rate, optimal timing of placement and long-term benefits of SCS as
a standard treatment for truncal CRPS.

<59>
Accession Number
627605928
Title
Fibrinogen concentrate vs. cryoprecipitate for acquired hypofibrinogenemia
in cardiac surgery-The fibres study.
Source
Hamostaseologie. Conference: 63rd Annual Meeting of the Society of
Thrombosis and Haemostasis Research. Germany. 39 (Supplement 1) (no
pagination), 2019. Date of Publication: February 2019.
Author
Karkouti K.
Institution
(Karkouti) Toronto General Hospital, Toronto, Canada
Publisher
Georg Thieme Verlag
Abstract
Scientific Research Question: Cardiopulmonary bypass (CPB) is associated
with coagulopathy and excessive bleeding. This often requires the
transfusion of large volumes of allogeneic blood products and is linked to
an increased risk of adverse outcomes. A primary cause of coagulopathy is
acquired hypofibrinogenemia; when fibrinogen levels drop below 1.5-2 mg/L,
fibrinogen supplementation is required to maintain hemostasis. The
FIBrinogen REplenishment in Surgery (FIBERS) study aims to compare the
standard intervention, cryoprecipitate, with a new highly purified, double
virus-inactivated human fibrinogen concentrate. Methodology: The FIBERS
study (NCT03037424) is a pragmatic, multicenter, active-control,
randomized, single-blinded, non-inferiority phase 3 trial in adult
patients undergoing cardiac surgery with CPB. The study will enroll
patients with clinically significant bleeding associated with acquired
hypofibrinogenemia. Patients for whom fibrinogen supplementation is
ordered within 24 hours of surgery will be randomized to receive
fibrinogen concentrate (4 g) or cryoprecipitate (10 units; dose equivalent
to 4 g fibrinogen concentrate). All randomized patients will receive
fibrinogen supplementation as clinically indicated. Owing to the emergency
nature of the clinical setting, patient consent at the point of
randomization will be waived, with written informed consent obtained
within 24-48 hours thereafter. The primary outcome is total allogeneic
blood products (red blood cells, plasma, platelets) administered within
the first 24 hours of surgery. Secondary outcomes include blood product
use within 7 days, incidence of major bleeding within 24 hours, fibrinogen
levels, and adverse events (AEs) and serious AEs within 28 days. Enrolment
of 1,200 patients will provide >90% power to demonstrate non-inferiority,
assuming a 20% non-inferiority margin, >550 patients per group, and an
approximate 10% drop-out rate. One pre-planned interim analysis will be
conducted after data are available for 600 evaluable patients with the
option to stop early for futility or overwhelming efficacy. The pragmatic
design and treatment algorithm align with standard practice, aiding
adherence and generalizability. <br/>Finding(s): To date, 600 patients
have been treated across 11 sites. An IDMEAC review of safety has been
performed every 100 patients enrolled, with the recommendation to continue
as planned each time. An interim analysis of the study is expected to
complete in 2018 with final data available late 2019. <br/>Conclusion(s):
FIBERS is the largest randomized study to date of fibrinogen concentrate
versus cryoprecipitate in adult cardiac surgical patients, an
under-studied yet high-risk population. Non-inferiority of the new
fibrinogen concentrate would support its use for patients developing
acquired hypofibrinogenemia during cardiac surgery. Results from the
FIBERS study are likely to improve care for cardiac surgical patients
experiencing significant bleeding.

<60>
Accession Number
627592092
Title
Different Strategies in Simultaneous Coronary and Carotid Artery
Revascularization - A Single Center Experience.
Source
Archives of Iranian medicine. 22 (3) (pp 132-136), 2019. Date of
Publication: 01 Mar 2019.
Author
Zhang J.; Dong Z.; Liu P.; Fan X.; Chen J.; Zheng X.; Ma B.; Ye Z.
Institution
(Zhang, Liu, Fan, Chen, Zheng, Ma, Ye) Department of Cardiovascular
Surgery, China-Japan Friendship Hospital, Beijing 100029, China
(Dong) Department of Vascular Surgery, Daqing Oilfield General Hospital,
Daqing 16300, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal management for patients with concomitant severe
coronary artery disease (CAD) and carotid artery stenosis (CAS) remains
controversial. We reported our preliminary experience on a synchronous
hybrid strategy. <br/>METHOD(S): Seven patients with synchronous
percutaneous coronary intervention (PCI)/carotid endarterectomy
(CEA)/coronary artery bypass grafting (CABG) and 36 patients with
synchronous CEA/CABG were enrolled. Then we analyzed the demographics,
risk factors and 30-day results of the 2 groups, retrospectively.
<br/>RESULT(S): The 2 groups were comparable in demographics. The
operation time was 312.14 +/- 40.08 minutes for synchronous PCI/ CEA/CABG
and 294.58 +/- 47.62 minutes for synchronous CEA/CABG (P = 0.367). The
intraoperative blood loss was 814.29+/-195.18 mL for synchronous
PCI/CEA/CABG and 769.44 +/- 330.21 mL for synchronous CEA/CABG (P =
0.731). There was no death in the 2 groups within 30 days. The incidence
of primary endpoint [stroke, myocardial infarction (MI) and death] was
14.29% (1/7) in synchronous PCI/CEA/CABG group and 5.56% (2/36) in
synchronous CEA/CABG group. The difference between the 2 groups was not
statistically significant (P = 0.421). <br/>CONCLUSION(S): Synchronous
PCI, CEA and CABG may be safe and effective in the management of patients
with concomitant CAS and complicated multi-vessel CAD. The current data
suggested that more studies and randomized controlled trials may be
necessary to define whether this strategy is suitable for these
patients.<br/>Copyright &#xa9; 2019 The Author(s). This is an open-access
article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/4.0), which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.

<61>
Accession Number
627611236
Title
Coronary Chronic Total Occlusion (CTO): A Review.
Source
Reviews in cardiovascular medicine. 19 (1) (pp 33-39), 2018. Date of
Publication: 30 Mar 2018.
Author
Koelbl C.O.; Nedeljkovic Z.S.; Jacobs A.K.
Institution
(Koelbl) Columbia University Division of Cardiology Mount Sinai Heart
Institute 4300 Alton Road De Hirsch Meyer Tower Suite 2070 Miami Beach, FL
33140, United States
(Nedeljkovic, Jacobs) Section of Cardiology Boston Medical Center 88 East
Newton Street Boston, Massachusetts 02118-2393, United States
Publisher
NLM (Medline)
Abstract
Coronary artery chronic total occlusions (CTO) are frequently encountered
during coronary angiography; however percutaneous recanalization has
historically been technically challenging and an important determinant for
referral to coronary artery bypass surgery or for medical therapy alone.
Recent advances in interventional equipment and innovative approaches to
crossing CTO have significantly increased the success rate of percutaneous
treatment. Although there is only one relevant randomized control trial
(RCT) performed to date, several large, nonrandomized studies have
consistently reported improvement in clinical outcomes, including improved
survival and relief of angina, when successful percutaneous treatment of
CTO was compared with unsuccessful revascularization. These positive
observational results have encouraged the initiation of several RCTs which
will provide more robust evidence on clinical outcomes of CTO-PCI compared
with guideline-directed medical therapy (GDMT) alone.<br/>Copyright
&#xa9;2018 Koelbl et al. Published by IMR press. All rights reserved.

<62>
Accession Number
627594326
Title
New-Onset Atrial Fibrillation After Coronary Artery Bypass Graft and
Long-Term Risk of Stroke: A Meta-Analysis.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Date of Publication: 22 Dec 2017.
Author
Megens M.R.; Churilov L.; Thijs V.
Institution
(Megens, Churilov, Thijs) Florey Institute of Neuroscience and Mental
Health, University of Melbourne, Melbourne, Victoria, Australia
(Megens, Churilov) School of Sciences, RMIT University, Melbourne,
Victoria, Australia
(Thijs) Department of Neurology, Austin Health, Heidelberg, Victoria,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: New-onset atrial fibrillation (NOAF) after coronary artery
bypass graft is related to an increased short-term risk of stroke and
mortality. We investigated whether the long-term risk of stroke is
increased. METHODS AND RESULTS: We performed a systematic review and
meta-analysis of studies that included patients who had coronary artery
bypass graft and who afterwards developed NOAF during their index
admission; these patients did not have previous atrial fibrillation. The
primary outcome was risk of stroke at 6 months or more in patients who
developed NOAF compared with those who did not. Odds ratios, relative
risk, and hazard ratios were considered equivalent; outcomes were pooled
on the log-ratio scale using a random-effects model and reported as
exponentiated effect-sizes. We included 16 studies, comprising 108 711
participants with a median follow-up period of 2.05 years. Average
participant age was 66.8 years, with studies including an average of 74.8%
males. There was an increased long-term risk of stroke in the presence of
NOAF (unadjusted studies effect-sizes=1.36, 95% confidence interval,
1.12-1.65, P=0.001, adjusted studies effect-sizes=1.25, 95% confidence
interval, 1.09-1.42, P=0.001). There was evidence of moderate effect
variation because of heterogeneity in studies reporting unadjusted
(P=0.021, I2=49.8%) and adjusted data (P=0.081, I2=49.1%), and publication
bias in the latter group (Egger's test, P=0.031). Sensitivity analysis on
unadjusted data by study quality, design, and surgery did not alter the
effect direction. <br/>CONCLUSION(S): Presence of NOAF in patients
post-coronary artery bypass graft is associated with increased long-term
risk of stroke compared with patients without NOAF. Further studies may
show whether the increased risk is mediated by atrial fibrillation and
whether anticoagulation reduces risk.<br/>Copyright &#xa9; 2017 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

<63>
Accession Number
627605936
Title
Thromboelastography or rotational thromboelastometry for bleeding
management in adults undergoing cardiac surgery: A systematic review with
meta-analysis and trial sequential analysis.
Source
Journal of Thoracic Disease. 11 (4) (pp 1170-1181), 2019. Date of
Publication: 01 Apr 2019.
Author
Li C.; Zhao Q.; Yang K.; Jiang L.; Yu J.
Institution
(Li) Lanzhou University Second Hospital, Lanzhou 730030, China
(Zhao, Yang, Jiang) Department of Cardiac Surgery ICU, Lanzhou University
Second Hospital, 82 Cuiyingmen Street, Lanzhou 730030, China
(Yu) Department of Cardiology, Lanzhou University Second Hospital, 82
Cuiyingmen Street, Lanzhou 730030, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Severe bleeding and massive transfusion of blood products may
be associated with increased morbidity and mortality of cardiac surgery. A
transfusion algorithm incorporating thromboelastography (TEG) or
rotational thromboelastometry (ROTEM) can help to determine the
appropriate time and target for the use of hemostatic blood products,
which may thus reduce the quantity of blood loss as well as blood products
transfused. <br/>Method(s): We conducted meta-analysis and trial
sequential analysis to evaluate the effects of TEG or ROTEM-guided
transfusion algorithms vs. standard treatments for patients undergoing
cardiac surgery with cardiac pulmonary bypass. <br/>Result(s): Nineteen
studies with a total of 15,320 participants, including 13 randomized
controlled trials (RCTs), were included. All-cause mortality was not
reduced either in overall studies or in RCTs. Blood loss volume was
reduced by 132 mL in overall studies [mean difference (MD): -132.46, 95%
CI: -207.49, -57.43; I² =53%, P<0.01], and by 103 mL in RCTs
(MD: -103.50, 95% CI: -156.52, -50.48; I² =0%, P<0.01). The
relative risks (RRs) in RCTs were 0.89 (95% CI: 0.80-0.98; I²
=0%, P=0.02) for red blood cells transfusion, 0.59 (95% CI: 0.42-0.82;
I² =55%, P<0.01) for fresh frozen plasma transfusion, and 0.81
(95% CI: 0.74-0.90; I² =0%, P<0.01) for platelet transfusion,
respectively. Trial sequential analysis of continuous data on blood loss
and dichotomous outcomes on transfusion of blood products suggested the
benefits of a TEG/ROTEM-guided algorithm. <br/>Conclusion(s): TEG or
ROTEM-guided transfusion strategies may reduce blood loss volume and the
transfusion rates in adult patients undergoing cardiac
surgery.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<64>
Accession Number
627605350
Title
Intramuscular stimulation as a novel alternative method of pain management
after thoracic surgery.
Source
Journal of Thoracic Disease. 11 (4) (pp 1528-1535), 2019. Date of
Publication: 01 Apr 2019.
Author
Moon D.H.; Park J.; Kang D.-Y.; Lee H.S.; Lee S.
Institution
(Moon, Lee) Department of Thoracic and Cardiovascular Surgery, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, South
Korea
(Park) Department of Rehabilitation Medicine, Gangnam Severance Hospital,
Rehabilitation Institute of Neuromuscular Disease, Yonsei University
College of Medicine, Seoul, South Korea
(Kang) Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung
Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Lee) Biostatics Collaboration Unit, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: The purpose of this study was to determine whether electrical
twitch-obtaining intramuscular stimulation (ETOIMS) can be an alternative
to intravenous patient-controlled analgesia (IV-PCA) for postoperative
pain management in pneumothorax patients undergoing single-port
video-assisted thoracoscopic surgery (VATS). <br/>Method(s): This
preliminary prospective randomized study was conducted between March 2017
and July 2017. A total of 26 patients undergoing single-port VATS were
randomly assigned to two groups: the ETOIMS group (n=12), which received
intramuscular stimulation prior to chest tube insertion toward the end of
procedure, and the IV-PCA group (n=14), which received continuous infusion
of fentanyl with a basal rate of 10 mug/mL/h. To measure postoperative
pain, visual analogue scale (VAS; range, 0-10) was used as the primary
endpoint. <br/>Result(s): Baseline characteristics were not different
between the two groups. According to the linear mixed model, there was
statistical difference in the serial VAS score between the two groups
(P=0.007). The ETOIMS group showed a significantly lower VAS score
compared with the IV-PCA group, especially at postoperatively hour 8, day
1, and day 2. <br/>Conclusion(s): We showed that ETOIMS may be a safe,
effective, and simple alternative for pain management after single-port
VATS.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<65>
Accession Number
627595557
Title
Changes in Physical Performance and Their Association With Health-Related
Quality of Life in a Mixed Nonischemic Cardiac Population That
Participates in Rehabilitation.
Source
Journal of cardiopulmonary rehabilitation and prevention. (no pagination),
2019. Date of Publication: 24 Apr 2019.
Author
Tang L.H.; Zwisler A.-D.; Doherty P.; Oldridge N.; Berg S.K.; Christensen
J.
Institution
(Tang) National Centre for Rehabilitation and Palliative Care, University
of Southern Denmark and Odense University Hospital, Nyborg, Denmark (Drs
Tang and Zwisler); Department of Physiotherapy and Occupational Therapy,
Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark (Dr Tang);
Department of Health Sciences, University of York, England, United Kingdom
(Dr Doherty); College of Health Sciences, University of
Wisconsin-Milwaukee (Dr Oldridge); Department of Cardiology, The Heart
Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark (Dr Berg); and Department of Occupational Therapy and
Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark (Dr Christensen)
Publisher
NLM (Medline)
Abstract
PURPOSE: Exercise-based cardiac rehabilitation improves physical
performance and health-related quality of life (HRQoL). However, whether
improvements in physical performance are associated with changes in HRQoL
has not been adequately investigated in a nonischemic cardiac population.
<br/>METHOD(S): Patients who were ablated for atrial fibrillation, who
underwent heart valve surgery or who were treated for infective
endocarditis, and who participated in 1 of 3 randomized controlled
rehabilitation trials were eligible for the current study. Change in
physical performance and HRQoL were measured before and after a 12-wk
exercise intervention. Physical performance was assessed using a
cardiopulmonary exercise test, a 6-min walk test, and a sit-to-stand test.
Health-related quality of life was assessed using the generic 36-Item
Short Form Health Survey and the disease-specific HeartQoL questionnaire.
Spearman correlation coefficient (rho) and linear regressions quantified
the association between changes in physical outcome measures and changes
in HRQoL. <br/>RESULT(S): A total of 344 patients were included (mean age:
60.8 +/- 11.6 yr and 77% males). Associations between changes in physical
outcome measures and HRQoL ranged from very weak to weak (rho = -0.056 to
0.228). The observed associations were more dominant within physical
dimensions of the HRQoL compared with mental or emotional dimensions.
After adjusting for sex, age, and diagnosis, changes in physical
performance explained no more than 20% of the variation in the HRQoL.
<br/>CONCLUSION(S): The findings show that the positive improvement in
HRQoL from exercise-based cardiac rehabilitation cannot simply be
explained by an improvement in physical performance.

<66>
Accession Number
2001951616
Title
Hemorrhagic cardiac tamponade associated with Apixaban: A case report and
systematic review of literature.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Asad Z.U.A.; Ijaz S.H.; Chaudhary A.M.D.; Khan S.U.; Pakala A.
Institution
(Asad, Ijaz, Pakala) University of Oklahoma Health Sciences Center,
Oklahoma City, United States
(Chaudhary) Nishtar Medical College, Multan, Pakistan
(Khan) West Virginia University, Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Hemorrhagic cardiac tamponade (HCT)is characterized by rapid
accumulation of blood in the pericardium causing hemodynamic collapse. We
report a case of HCT due to Apixaban use in a patient with renal cell
carcinoma, supplemented with a systematic review of pericardial tamponade
associated with the use of direct oral anticoagulants (DOACs). Case
report: A 62-year-old African American male with a history of metastatic
renal cell carcinoma presented with dyspnea while taking Apixaban. He was
diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion
was drained. The pericardial fluid analysis was negative for malignancy
and suggestive of HCT. He had a complicated hospital course and died
several days later. <br/>Method(s): We searched MEDLINE, EMBASE and other
sources for published cases of pericardial tamponade associated with
DOACs. Our outcomes of interest included patient characteristics, risk
factors, timing from the start of anticoagulation to tamponade, treatment
and mortality. Simple descriptive statistics using percentages for
categorical variables were used to describe the included cases.
<br/>Result(s): A total of 26 cases were included in the final systematic
review after searching MEDLINE, EMBASE and other sources. The mean age was
70 years (range 43-88)with 19 (73%)males. Twelve cases (46%)were
associated with Rivaroxaban, 9 (37%)with Dabigatran and 5(19%)with
Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine.
Only 2 patients died but 24 had to undergo pericardiocentesis.
<br/>Conclusion(s): Cardiac tamponade is rarely associated with DOACs and
elderly male patients with renal and coagulation abnormalities appear to
have the highest risk.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<67>
Accession Number
627599270
Title
Comparison of the New Oral Anticoagulants and Warfarin in Patients with
Atrial Fibrillation and Valvular Heart Disease: Systematic Review and
Meta-Analysis.
Source
Drugs in R and D. (no pagination), 2019. Date of Publication: 2019.
Author
de Souza Lima Bitar Y.; Neto M.G.; Filho J.A.L.; Pereira L.V.; Travassos
K.S.O.; Akrami K.M.; Roever L.; Duraes A.R.
Institution
(de Souza Lima Bitar, Duraes) Medical School of Federal University of
Bahia, UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, Bahia 40025-010, Brazil
(Neto, Pereira) Federal University of Bahia, UFBA, Salvador, Brazil
(Filho, Duraes) General Hospital Roberto Santos, Salvador, Bahia, Brazil
(Travassos) Bahian School of Medicine and Public Health, BAHIANA,
Salvador, Brazil
(Akrami) Department of Medicine, University of California San Diego, San
Diego, United States
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
Publisher
Springer International Publishing
Abstract
Introduction: New oral anticoagulants (NOACs) are approved for use in
nonvalvular atrial fibrillation (AF). <br/>Objective(s): This study aimed
to evaluate the efficacy and safety of NOACs compared with warfarin in AF
and valvular heart disease (VHD). <br/>Method(s): We identified randomized
controlled trials (RCTs) and post-hoc analyses comparing NOACs and
warfarin in AF and VHD, including biological and mechanical heart valves
(MHV). Through systematic review and meta-analysis, with the aid of the
"Rev Man" program 5.3, the primary effectiveness endpoints were stroke and
systemic embolism (SE). The primary safety outcome was major bleeding, and
the secondary outcome included intracranial hemorrhage. Data were analyzed
using risk ratios (RRs) and 95% confidence intervals (CIs), and
heterogeneity was assessed using the I² statistic.
<br/>Result(s): Six RCTs were included, involving 13,850 patients with AF
and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95%
CI 0.66-0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI
0.33-0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95%
CI 0.58-1.02; P = 0.07) compared with warfarin. <br/>Conclusion(s): The
efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are
similar to those of warfarin.<br/>Copyright &#xa9; 2019, The Author(s).

<68>
Accession Number
626738298
Title
Preinterventional hydrocortisone sustains the endothelial glycocalyx in
cardiac surgery.
Source
Clinical Hemorheology and Microcirculation. 71 (1) (pp 59-70), 2019. Date
of Publication: 2019.
Author
Brettner F.; Chappell D.; Nebelsiek T.; Hauer D.; Schelling G.; Becker
B.F.; Rehm M.; Weis F.
Institution
(Brettner, Chappell, Nebelsiek, Hauer, Schelling, Rehm) Department of
Anaesthesiology, University Hospital of Munich, LMU Munich,
Marchioninistrasse 15, Munich 81377, Germany
(Brettner, Becker) Walter-Brendel Centre of Experimental Medicine,
Ludwig-Maximilians-University Munich, Martinsried, Germany
(Weis) Department of Anaesthesiology and Intensive Care Medicine, Klinikum
Furstenfeldbruck, Furstenfeldbruck, Germany
Publisher
IOS Press (Nieuwe Hemweg 6B, Amsterdam 1013 BG, Netherlands)
Abstract
BACKGROUND: Patients undergoing cardiac surgery commonly develop systemic
inflammation associated with tissue edema, which impairs outcome. One main
pathomechanism leading to the edema is the deterioration of the
endothelial glycocalyx, a key component of the vascular barrier. In animal
models hydrocortisone has proved to be protective for the glycocalyx.
<br/>OBJECTIVE(S): This trial evaluates the effect of hydrocortisone on
glycocalyx integrity in patients undergoing cardiac surgery with
cardiopulmonary bypass. <br/>METHOD(S): In a prospective, randomized
interventional pilot trial, 30 patients received either hydrocortisone
(100 mg over 10 min) or placebo (saline control) before surgery. Plasma
concentrations of glycocalyx constituents (syndecan-1, heparan sulfate)
and various clinical parameters (respiratory and renal function,
inflammatory markers, use of vasopressors, length of stay at the intensive
care unit) were measured. Primary endpoint was a significant difference of
glycocalyx constituents in plasma. Comparisons were made with Friedman's
and Wilcoxon tests (paired data), or the Kruskal-Wallis and Mann-Whitney U
tests (unpaired data). Holm-Bonferroni method was used for post-hoc
corrections. <br/>RESULT(S): Heparan sulfate and syndecan-1 increased
significantly during and after cardiac surgery with cardiopulmonary bypass
in both groups. Whereas the maximum increase of heparan sulfate was
12.3-fold in the control vs. 3.8-fold in the pretreated group (p < 0.05),
syndecan-1 values showed no significant difference between the groups
(maximal increase 3-fold). The inflammatory markers C-reactive protein and
interleukin-6 were also higher in the control than in the hydrocortisone
group, but there was no difference in patient mortality (zero), or in any
clinical parameters. <br/>CONCLUSION(S): Pretreatment with hydrocortisone
ameliorated shedding of heparan sulfate, a major constituent of the
endothelial glycocalyx, in patients undergoing cardiac surgery with
cardiopulmonary bypass, but had no relevant influence on various clinical
parameters or patient mortality. The relatively small number of patients
in this pilot study probably precluded detection of positive outcome
differences.<br/>Copyright &#xa9; 2019 IOS Press and the authors. All
rights reserved.

<69>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright
&#xa9; 2019 Wiley Periodicals, Inc.

<70>
Accession Number
2000680964
Title
Clinical trials evaluating red blood cell transfusion thresholds: An
updated systematic review and with additional focus on patients with
cardiovascular disease.
Source
American Heart Journal. 200 (pp 96-101), 2018. Date of Publication: June
2018.
Author
Carson J.L.; Stanworth S.J.; Alexander J.H.; Roubinian N.; Fergusson D.A.;
Triulzi D.J.; Goodman S.G.; Rao S.V.; Doree C.; Hebert P.C.
Institution
(Carson) Division of General Internal Medicine, Rutgers Robert Wood
Johnson Medical School, Rutgers Biomedical Health Sciences, New Brunswick,
NJ, United States
(Stanworth) National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, Oxford University Hospitals NHS Foundation
Trust and University of Oxford, Oxford, United Kingdom
(Alexander, Rao) The Duke Clinical Research Institute, Duke University,
Durham, NC, United States
(Roubinian) Blood Systems Research Institute, San Francisco, CA, United
States
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, Ontario, Canada
(Triulzi) The Institute for Transfusion Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
(Goodman) Centre for Research, Terrence Donnely Heart Centre, St.
Michael's Hospital, University of Toronto, Toronto, Canada
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada
(Doree) Systematic Review Initiative, NHS Blood and Transplant, Oxford,
United Kingdom
(Hebert) University of Montreal Hospital Research Centre, Montreal,
Quebec, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Several new trials evaluating transfusion strategies in
patients with cardiovascular disease have recently been published,
increasing the number of enrolled patients by over 30%. The objective was
to evaluate transfusion thresholds in patients with cardiovascular
disease. <br/>Method(s): We conducted an updated systematic review of
randomized trials that compared patients assigned to maintain a lower
(restrictive transfusion strategy) or higher (liberal transfusion
strategy) hemoglobin concentration. We focused on new trial data in
patients with cardiovascular disease. The primary outcome was 30-day
mortality. Specific subgroups were patients undergoing cardiac surgery and
with acute myocardial infarction. <br/>Result(s): A total of 37 trials
that enrolled 19,049 patients were appraised. In cardiac surgery,
mortality at 30 days was comparable between groups (risk ratio 0.99; 95%
confidence interval 0.74-1.33). In 2 small trials (n = 154) in patients
with myocardial infarction, the point estimate for the mortality risk
ratio was 3.88 (95% CI, 0.83-18.13) favoring the liberal strategy.
Overall, from 26 trials enrolling 15,681 patients, 30-day mortality was
not different between restrictive and liberal transfusion strategies (risk
ratio 1.0, 95% CI, 0.86-1.16). Overall and in the cardiovascular disease
subgroup, there were no significant differences observed across a range of
secondary outcomes. <br/>Conclusion(s): New trials in patients undergoing
cardiac surgery establish that a restrictive transfusion strategy of 7 to
8 g/dL is safe and decreased red cell use by 24%. Further research is
needed to define the optimal transfusion threshold in patients with acute
myocardial infarction.<br/>Copyright &#xa9; 2018

<71>
Accession Number
2000630351
Title
Oral anti-Xa anticoagulation after trans-aortic valve implantation for
aortic stenosis: The randomized ATLANTIS trial.
Source
American Heart Journal. 200 (pp 44-50), 2018. Date of Publication: June
2018.
Author
Collet J.-P.; Berti S.; Cequier A.; Van Belle E.; Lefevre T.; Leprince P.;
Neumann F.-J.; Vicaut E.; Montalescot G.
Institution
(Collet, Montalescot) Sorbonne Universite, ACTION Study Group, INSERM
UMR_S 1166, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP),
Paris, France
(Berti) Fondazione Toscana G. Monasterio, Ospedale del Cuore G.
Pasquinucci, Massa, Italy
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
(Van Belle) Department of Cardiology Centre, Hospitalier Universitaire
(CHU), Lille, France
(Lefevre) Hopital prive Jacques Cartier, Institut cardiovasculaire Paris
Sud, Massy, France
(Leprince) Sorbonne Universite (UPMC), INSERM UMR_S 1166, Chrirugie
Cardiaque, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP),
Paris, France
(Neumann) Herz-Zentrum Bad Krozingen, Germany
(Vicaut) ACTION Study Group, Unite de Recherche Clinique, Hopital
Lariboisiere, APHP, Paris, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Antithrombotic treatment regimen following transcatheter
aortic valve replacement (TAVR) is not evidence-based. Apixaban, a
non-vitamin K direct anticoagulant (NOAC) was shown to be superior to VKA
and superior to aspirin to prevent cardioembolic stroke in non-valvular
atrial fibrillation. It may have the potential to reduce TAVR-related
thrombotic complications including subclinical valve thrombosis along with
a better safety than the standard of care. <br/>Design(s): ATLANTIS is a
multicenter, randomized, phase IIIb, prospective, open-label, superiority
study comparing standard of care (SOC Group) versus an apixaban-based
strategy (Anti-Xa Group) after successful TAVR (ClinicalTrials.gov NCT
02664649). Randomization is stratified according to the need for chronic
anticoagulation therapy for a reason other than the TAVR procedure. In the
experimental arm, patients receive 5 mg bid of apixaban or a reduced dose
of 2.5 mg bid according to the drug label or when apixaban is combined
with antiplatelet therapy. In the control arm, patients receive VKA
therapy if there is an indication for oral anticoagulation or antiplatelet
therapy alone (single or dual) or the combination of both if needed. The
primary study end point is the composite of all-cause death, TIA/stroke,
myocardial infarction, symptomatic valve thrombosis, pulmonary embolism,
deep venous thrombosis, systemic embolism, life-threatening, disabling or
major bleeding, according to the Valve Academic Research Consortium
definitions. <br/>Conclusion(s): ATLANTIS tests the superiority of an
apixaban-based strategy versus the recommended standard of care strategy
to reduce the risk of post-TAVR thromboembolic and bleeding complications
in an all comer population.<br/>Copyright &#xa9; 2018 Elsevier B.V.

<72>
Accession Number
618556258
Title
Transcatheter aortic valve replacement for stenotic bicuspid aortic
valves: Systematic review and meta analyses of observational studies.
Source
Catheterization and Cardiovascular Interventions. 91 (5) (pp 975-983),
2018. Date of Publication: 01 Apr 2018.
Author
Reddy G.; Wang Z.; Nishimura R.A.; Greason K.L.; Yoon S.-H.; Makkar R.R.;
Holmes D.R.
Institution
(Reddy, Wang, Nishimura, Greason, Holmes) Department of Cardiovascular
Diseases, Mayo Clinic, Rochester, MN, United States
(Yoon, Makkar) Department of Cardiovascular Diseases, Cedars Sinai Medical
Center, Los Angeles, CA, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of this study was to perform a systematic review and
meta-analyses of observational studies of transcatheter aortic valve
replacement (TAVR) for bicuspid aortic valve stenosis (BcAV).
<br/>Background(s): TAVR for BcAV stenosis has been associated with an
increased incidence of paravalvular leaks, valve malposition, pacemaker
placement and all-cause mortality. The conclusions drawn have been limited
by small sample sizes. The use of TAVR for BcAV stenosis remains
controversial. <br/>Method(s): We searched multiple databases from the
inception of the databases through September 30, 2016 for studies of TAVR
for BcAV stenosis. We included all observational studies with more than
one patient and at least 1 month of outcomes. <br/>Result(s): We analyzed
13 observational studies with 758 patients. Meta analyses showed device
success rate of 95% [95% confidence interval (CI) 90.2% to 98.5%] and an
early safety event in 16.9% [95% CI 12.2% to 22%]. At 30 days, moderate to
severe paravalvular leak was seen in 12.2% [95% CI 3.1% to 24.8%] and new
pacemaker implantation in 17.9% [95% CI 14.2% to 22%]. All-cause mortality
was 3.7% [95% CI 2.1% to 5.6%], which should be viewed in the context of
an STS PROM of 5.0%. <br/>Conclusion(s): This analysis suggests that TAVR
for BcAV is not associated with excess mortality. The incidence of
paravalvular leaks and pacemaker implant is increased compared to
tricuspid aortic valve cohorts undergoing TAVR, and operators should weigh
these potential complications against the clinical benefit provided by
TAVR for BcAV patients at high risk for surgical valve
replacement.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<73>
Accession Number
627020617
Title
Transversus thoracis muscle plane block in cardiac surgery: a pilot
feasibility study.
Source
Regional anesthesia and pain medicine. 44 (5) (pp 556-560), 2019. Date of
Publication: 01 May 2019.
Author
Fujii S.; Roche M.; Jones P.M.; Vissa D.; Bainbridge D.; Zhou J.R.
Institution
(Fujii, Roche, Jones, Vissa, Bainbridge, Zhou) Department of Anesthesia
and Perioperative Medicine, London Health Sciences Centre, Western
University, London, ON, Canada
(Jones) Department of Epidemiology and Biostatistics, Western University,
London, ON, Canada
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Cardiac surgery patients often experience significant pain
after median sternotomy. The transversus thoracis muscle plane (TTP) block
is a newly developed, single-shot nerve block technique that provides
analgesia for the anterior chest wall. In this double-blind pilot study,
we assessed the feasibility of performing this novel block as an analgesic
adjunct. <br/>METHOD(S): All patients aged 18-90 undergoing elective
cardiac surgery were randomized to the block or standard care control
group on admission to the intensive care unit after surgery. Under
ultrasound guidance, patients in the block group received the TTP block
with 20mL of either 0.3% or 0.5% ropivacaine bilaterally, based on weight.
The control group did not receive any injections. All blocks were
performed by a single anesthesiologist, and data collection was performed
by blinded assessors. The primary feasibility outcomes were rate of
recruitment, adherence, and adverse events. The rate of recruitment was
defined as the ratio of patients giving informed consent to the number of
eligible patients who were approached to participate. Secondary outcomes
included 12-hour and 24-hour Numeric Rating Scale (NRS) pain scores,
24-hour hydromorphone and acetaminophen requirements, time to extubation,
time to first opioid administration, and patient satisfaction (on a yes/no
questionnaire) at 24hours. <br/>RESULT(S): Twenty patients were approached
for this study and 19 were enrolled. Eight patients received the intended
intervention in each group. The recruitment rate was 95% of all approached
eligible patients, and the adherence rate to treatment group was 94%.
There were no block-related adverse events. The mean (SD) NRS pain scores
at rest were 3.3 (3.2) in the block group vs 5.6 (3.2) in the control
group at 12hours. At 24hours, the pain scores were 4.1 (3.9) vs 4.1 (3.3)
in the block and control group, respectively. The mean (SD) 24-hour
hydromorphone administration was 1.9 (1.1) mg in the block group vs 1.8
(0.9) mg in the control group. DISCUSSION: The TTP block is a novel pain
management strategy poststernotomy. The results reveal a high patient
recruitment, adherence, and satisfaction rate, and provide some
preliminary data supporting safety. TRIAL REGISTRATION NUMBER:
NCT03128346.<br/>Copyright &#xa9; American Society of Regional Anesthesia
& Pain Medicine 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<74>
[Use Link to view the full text]
Accession Number
627376542
Title
Hybrid coronary revascularization versus conventional coronary artery
bypass grafting systematic review and meta-analysis.
Source
Medicine (United States). 97 (33) (no pagination), 2018. Article Number:
e11941. Date of Publication: 01 Aug 2018.
Author
Reynolds A.C.; King N.
Institution
(Reynolds, King) School of Biomedical and Healthcare Sciences, University
of Plymouth, Plymouth PL4 8AA, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Hybrid coronary revascularization (HCR) combining minimally
invasive grafting of the left internal mammary artery to the left anterior
descending artery with percutaneous coronary intervention has become a
viable option for treating coronary artery disease. The aim of this
meta-analysis was to compare HCR with conventional coronary artery bypass
grafting (CABG) in a range of clinical outcomes and hospital costs.
<br/>Method(s): To identify potential studies, systematic searches were
carried out in various databases. The key search terms included "hybrid
revascularization" AND "coronary artery bypass grafting" OR "HCR" OR
"CABG." This was followed by a meta-analysis investigating the need for
blood transfusion, hospital costs, ventilation time, hospital stay,
cerebrovascular accident, myocardial infarction, mortality, postoperative
atrial fibrillation, renal failure, operation duration, and ICU stay.
<br/>Result(s): The requirement for blood transfusion was significantly
lower for HCR: odds ratio 0.38 (95% confidence intervals [CIs] 0.31-0.46,
P<.00001) as was the hospital stay: mean difference (MD) 1.48 days (95%
CI, 2.61 to 0.36, P=0.01) and the ventilation time: MD 8.99 hours (95% CI,
15.85 to 2.13, P=.01). On the contrary, hospital costs were more expensive
for HCR: MD $3970 (95% CI, 2570-5370, P<.00001). All other comparisons
were insignificant. <br/>Conclusion(s): In the short-term, HCR is as safe
as conventional CABG and may offer certain benefits such as a lower
requirement for blood transfusion and shorter hospital stays. However, HCR
is more expensive than conventional CABG.<br/>Copyright &#xa9; 2018 the
Author(s). Published by Wolters Kluwer Health, Inc.

<75>
[Use Link to view the full text]
Accession Number
627575157
Title
Effects of on-pump versus off-pump coronary artery bypass grafting on
myocardial metabolism.
Source
Medicine. 98 (17) (pp e15351), 2019. Date of Publication: 01 Apr 2019.
Author
Xie H.-T.; Kang X.-Q.; Zhang S.; Tian Y.-C.; Liu D.-J.; Bai B.-J.
Institution
(Xie) Department of Cardiac Surgery, Second Affiliated Hospital of Shaanxi
University of Chinese Medicine, Xianyang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: On-pump coronary artery bypass grafting (ON-PCABG) and
off-pump coronary artery bypass grafting (OF-PCABG) greatly affect
myocardial metabolism (MCMB). However, no study has systematically
explored and compared the impacts of ON-PCABG and OF-PCABG on MCMB. This
study will aim to explore and to compare the effects of ON-PCABG and
OF-PCABG on MCMB systematically. <br/>METHOD(S): We will conduct the
comprehensive literature search from the following electronic databases
from inception to the present: Cochrane Library, EMBASE, MEDILINE, CINAHL,
AMED and 4 Chinese databases without language restrictions. This
systematic review will only concern randomized controlled trials (RCTs)
and case-control studies of ON-PCABG and OF-PCABG on MCMB. The
methodological quality of each entered study will be assessed by using
Cochrane risk of bias tool. <br/>RESULT(S): Primary outcomes include
myocardial cellular markers, myocardial lactate, oxygen utilization,
pyruvate, and intramyocardial concentrations of glucose, urea and lactate.
Secondary outcome comprises of glutathione, superoxide dismutase,
myeloperoxidase, and oxidative stress and any other complications post
surgery. <br/>CONCLUSION(S): This study will provide a high-quality
synthesis and will assess and compare the effects of ON-PCABG and OF-PCABG
on MCMB based on the current relevant literature evidence. DISSEMINATION
AND ETHICS: The results will be submitted to peer-reviewed journals for
publication. This study does not require ethic approval, because it only
analyzes the data from published literature. SYSTEMATIC REVIEW
REGISTRATION: PROSPERO CRD42019125381.

<76>
Accession Number
627569996
Title
Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review
and Meta-Analysis.
Source
Journal of the American Heart Association. 8 (9) (pp e010920), 2019. Date
of Publication: 07 May 2019.
Author
Indja B.; Woldendorp K.; Vallely M.P.; Grieve S.M.
Institution
(Indja, Grieve) Sydney Translational Imaging Laboratory Heart Research
Institute Charles Perkins Centre The University of Sydney Camperdown
Sydney NSW Australia
(Indja, Woldendorp, Vallely, Grieve) Sydney Medical School The University
of Sydney Camperdown Sydney NSW Australia
(Woldendorp) Department of Cardiothoracic Surgery Royal Prince Alfred
Hospital Camperdown Sydney NSW Australia
(Vallely) Sydney Heart and Lung Surgeons Camperdown Sydney NSW Australia
(Grieve) Department of Radiology Royal Prince Alfred Hospital Camperdown
Sydney NSW Australia
Publisher
NLM (Medline)
Abstract
Background Silent brain infarcts ( SBI ) are increasingly being recognized
as an important complication of cardiac procedures as well as a potential
surrogate marker for studies on brain injury. The extent of subclinical
brain injury is poorly defined. Methods and Results We conducted a
systematic review and meta-analysis utilizing studies of SBI s and focal
neurologic deficits following cardiac procedures. Our final analysis
included 42 studies with 49 separate intervention groups for a total of
2632 patients. The prevalence of SBI s following transcatheter aortic
valve implantation was 0.71 (95% CI 0.64-0.77); following aortic valve
replacement 0.44 (95% CI 0.31-0.57); in a mixed cardiothoracic surgery
group 0.39 (95% CI 0.28-0.49); coronary artery bypass graft 0.25 (95% CI
0.15-0.35); percutaneous coronary intervention 0.14 (95% CI 0.10-0.19);
and off-pump coronary artery bypass 0.14 (0.00-0.58). The risk ratio of
focal neurologic deficits to SBI in aortic valve replacement was 0.22 (95%
CI 0.15-0.32); in off-pump coronary artery bypass 0.21 (95% CI 0.02-2.04);
with mixed cardiothoracic surgery 0.15 (95% CI 0.07-0.33); coronary artery
bypass graft 0.10 (95% CI 0.05-0.18); transcatheter aortic valve
implantation 0.10 (95% CI 0.07-0.14); and percutaneous coronary
intervention 0.06 (95% CI 0.03-0.14). The mean number of SBI s per patient
was significantly higher in the transcatheter aortic valve implantation
group (4.58 +/- 2.09) compared with both the aortic valve replacement
group (2.16 +/- 1.62, P=0.03) and the percutaneous coronary intervention
group (1.88 +/- 1.02, P=0.03). Conclusions SBI s are a very common
complication following cardiac procedures, particularly those involving
the aortic valve. The high frequency of SBI s compared with strokes
highlights the importance of recording this surrogate measure in cardiac
interventional studies. We suggest that further work is required to
standardize reporting in order to facilitate the use of SBI s as a routine
outcome measure.

<77>
Accession Number
627554049
Title
Negative Pressure versus Conventional Sternal Wound Dressing in Coronary
Surgery Using Bilateral Internal Mammary Artery Grafts.
Source
The heart surgery forum. 22 (2) (pp E092-E096), 2019. Date of Publication:
25 Feb 2019.
Author
Ruggieri V.G.; Olivier M.-E.; Aludaat C.; Rosato S.; Marticho P.; Saade
Y.A.; Lefebvre A.; Poncet A.; Rubin S.; Biancari F.
Institution
(Ruggieri) Division of Cardiovascular and Thoracic Surgery, Robert Debre
University Hospital, Reims, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Sternal wound infection (SWI) is a major complication
occurring often after coronary artery bypass grafting (CABG) using
bilateral internal mammary artery (BIMA) grafts. The aim of this study is
to assess whether such a risk may be reduced by using incision negative
pressure wound therapy (INPWT). <br/>METHOD(S): Data on patients
undergoing isolated CABG using BIMA grafts at the Reims University
Hospital, France, from 2013 to 2016 without or with INPWT was
prospectively collected. Results: INPWT was used in 161 patients and
conventional sterile wound dressing was used in 266 patients. Propensity
score matching resulted in 128 pairs with similar characteristics. SWIs
were similarly distributed between the conventional sterile wound dressing
(10.9%) and the INPWT cohorts (10.2%) (P = 1.00). Patients treated with
INPWT had a lower rate of deep SWI/mediastinitis than patients who had
conventional sterile dressing (5.5% versus 10.2%, P = .210), but the
difference did not reach statistical significance. Tests for interaction
confirmed these findings in different patient subgroups.
<br/>CONCLUSION(S): The routine use of INPWT may not significantly reduce
the risk of SWI in patients undergoing BIMA grafting. In view of previous
reports showing a benefit with the use of this method, a large randomized
study is justified to assess the efficacy of INPWT in patients undergoing
cardiac surgery.

<78>
Accession Number
627554033
Title
Determining Which Prosthetic to Use During Aortic Valve Replacement in
Patients Aged Younger than 70 Years: A Systematic Review of the
Literature.
Source
The heart surgery forum. 22 (2) (pp E070-E081), 2019. Date of Publication:
28 Feb 2019.
Author
Borger P.; Charles E.J.; Smith E.D.; Mehaffey J.H.; Hawkins R.B.; Kron
I.L.; Ailawadi G.; Teman N.
Institution
(Borger) University of Virginia School of Medicine, Charlottesville, VA,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The choice of bioprosthesis versus mechanical prosthesis in
patients aged less than 70 years undergoing aortic valve replacement (AVR)
remains controversial, with guidelines disparate in their recommendations.
The objective of this study was to explore outcomes after AVR for various
age ranges based on type of prosthesis. <br/>METHOD(S): A systematic
review was undertaken according to the Preferred Reporting Instructions
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using
Medline (PubMed), Cochrane, Web of Science, Embase, and Scopus databases.
Rates of long-term survival (primary outcome), reoperation, major
bleeding, thromboembolism, stroke, structural valve deterioration, and
endocarditis were compared between subjects receiving biologic and
mechanical prostheses. Findings were grouped into patients aged <60 years,
aged <=65 years, and finally aged <70 years. <br/>RESULT(S): A total of 19
studies met inclusion criteria. Seven evaluated patients aged <60 years, 4
of which found mechanical prosthesis patients to have higher long-term
survival, whereas the remaining studies found no difference. Eight
additional studies included patients aged 65 years or younger, and 9
studies included patients aged <70 years. The former found no difference
in survival between prosthesis groups, whereas the latter favored
mechanical prostheses in 3 studies. Bleeding, thromboembolism, and stroke
were more prevalent in patients with a mechanical prosthesis, whereas
reoperation was more common in those receiving a bioprosthesis.
<br/>CONCLUSION(S): Published literature does not preclude the use of
bioprostheses for AVR in younger patients. As new valves are developed,
the use of bioprosthetic aortic valves in younger patients will likely
continue to expand. Clinical trials are needed to provide surgeons with
more accurate guidelines.

<79>
Accession Number
627552625
Title
Effects of transthoracic device closure on ventricular septal defects and
reasons for conversion to open-heart surgery: A meta-analysis.
Source
Scientific reports. 7 (1) (pp 12219), 2017. Date of Publication: 22 Sep
2017.
Author
Zhou Y.; Liu L.-X.; Zhao F.; Tang S.-H.; Peng H.-L.; Jiang Y.-H.
Institution
(Zhou, Liu, Zhao, Tang, Peng) Department of Cardiothoracic Surgery,
People's Hospital of Leshan, Leshan, Sichuan Province 614000, China
(Jiang) Department of Cardiovascular Surgery, Xinqiao Hospital, Third
Military Medical University, Chongqing 400030, China
Publisher
NLM (Medline)
Abstract
Transthoracic device closure (TTDC) is thought to be a promising
technology for the repair of ventricular septal defects (VSDs). However,
there is considerable controversy regarding the efficacy and safety of
TTDC. The present study aimed to compare the benefits and safety of TTDC
with those of conventional open-heart surgery (COHS) and analyze the
associated factors causing complications, conversion to COHS and
reoperation. Electronic database searches were conducted in PubMed,
EMBASE, Cochrane Library, Clinicaltrials.gov and several Chinese
databases. A total of 5 randomized controlled trials (RCTs), 7 cohort
studies, 13 case-control studies, 129 case series and 13 case reports were
included. Compared to COHS, TTDC exhibited superior efficacy with a
significantly lower risk of post-operative arrhythmia; however, no
significant differences in other outcomes were identified. Meta-regression
analysis showed that perimembranous VSDs (pmVSDs), a smaller VSD, a
smaller occluder, and a median or subxiphoid approach lowered the relative
risk of several post-operative complications, conversion to COHS and
reoperation. The current evidence indicates that TTDC is associated with a
lower risk of post-operative arrhythmia and is not associated with an
increased risk of complications. PmVSDs, a smaller VSD and occluder, and a
median or subxiphoid approach correlate with better outcomes when using
TTDC.

<80>
Accession Number
2001944772
Title
Intraoperative fetal heart monitoring for non-obstetric surgery: A
systematic review.
Source
European Journal of Obstetrics and Gynecology and Reproductive Biology.
238 (pp 12-19), 2019. Date of Publication: July 2019.
Author
Po G.; Olivieri C.; Rose C.H.; Saccone G.; McCurdy R.; Berghella V.
Institution
(Po) Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of
Medical and Surgical Sciences, University of Modena and Reggio Emilia,
Modena, Italy
(Olivieri) Sapienza University of Rome, Rome, Italy
(Rose) Division of Maternal-Fetal Medicine, Department of Obstetrics and
Gynecology, Mayo Clinic, Rochester, MN, United States
(Saccone) Department of Neuroscience, Reproductive Science and Dentistry,
School of Medicine, University of Naples Federico II, Naples, Italy
(McCurdy, Berghella) Division of Maternal Fetal Medicine, Department of
Obstetrics and Gynecology, Thomas Jefferson University Hospital,
Philadelphia, PA, United States
Publisher
Elsevier Ireland Ltd
Abstract
Limited data are available on fetal monitoring during non-obstetric
surgery in pregnancy. We performed a systematic review to evaluate the
incidence of emergent cesarean delivery performed for non-reassuring fetal
heart rate patterns during non-obstetric surgery. Electronic databases
were searched from their inception until October 2018 without limit for
language. We included studies evaluating at least five cases of
intraoperative fetal heart rate monitoring -either with ultrasound or
cardiotocography- during non-obstetric surgery in pregnant women at >=22
weeks of gestation. The primary outcome was the incidence of
intraoperative cesarean delivery performed for non-reassuring fetal heart
rate monitoring. Non-reassuring fetal heart rate monitoring was defined by
attendant personnel, meeting NICHD criteria for category II or III
patterns. Data extracted regarded type of study, demographic
characteristics, maternal and perinatal outcomes. Statistical analysis was
performed for continuous outcomes by calculating mean and standard
deviations for appropriate variables. Of 120 studies identified, 4 with 41
cases of intraoperative monitoring met criteria for inclusion and were
analyzed. Most (66%)surgeries were indicated for neurological or abdominal
maternal issues and were performed under general anesthesia (88%)at a mean
gestational age of 28 weeks. Minimal or absent fetal heart variability was
noted in most cases and a 10-25 beats per minutes decrease in fetal heart
rate baseline was observed in cases with general anesthesia. No
intraoperative cesarean deliveries were needed. The incidence of
non-reassuring fetal heart rate monitoring was 4.9% (2/41)and were limited
to fetal tachycardia during maternal fever. Two (4.9%)cases of
non-reassuring fetal heart rate monitoring were noted within the immediate
48 h after surgery, necessitating cesarean delivery. A single case of
intrauterine fetal demise occurred four days postoperatively in a woman
who had neurosurgery and remained comatose. In conclusion, limited data
exist regarding the clinical application of fetal heart rate monitoring at
viable gestational ages during non-obstetric surgical procedures. Fetal
heart rate monitoring during non-obstetric surgery at >=22 weeks was not
associated with need for intraoperative cesarean delivery, but two
(4.9%)cesarean deliveries were performed for non-reassuring fetal heart
rate monitoring within 48 h after surgery.<br/>Copyright &#xa9; 2019
Elsevier B.V.

<81>
Accession Number
627461091
Title
Ventilation strategies with different inhaled Oxygen conceNTration during
CardioPulmonary Bypass in cardiac surgery (VONTCPB): Study protocol for a
randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 254. Date of
Publication: 03 May 2019.
Author
Zhang M.-Q.; Liao Y.-Q.; Yu H.; Li X.-F.; Feng L.; Yang X.-Y.
Institution
(Zhang, Yu, Liao, Yu, Li, Feng) Department of Anesthesiology, West China
Hospital, Sichuan University, Chengdu 610041, China
(Yang) Department of Obstetrics and Gynecology, West China Second
University Hospital, Sichuan University, Chengdu, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: There is no consensus on the ventilation management during
cardiopulmonary bypass (CPB), and the anesthesiologists or the surgeons
usually ventilate the lungs with different ventilation strategies or keep
them static. Better outcomes are more likely to occur when the ventilation
is administered during CPB according to the existing literatures. However,
the use of high fraction of inspired oxygen (FiO<inf>2</inf>) is debatable
in cardiac surgery. And the potential effects of strategies combining low
tidal volume (V<inf>T</inf>) ventilation with different FiO<inf>2</inf>
during CPB on postoperative pulmonary complications (PPCs) are unclear.
<br/>Design(s): The VONTCPB trial is a single-center, prospective,
double-blinded, randomized, controlled trial. We are going to recruit
total 420 elective cardiac surgery patients with median sternotomy under
CPB, who will be equally randomized into three different ventilation
strategy groups: NoV, LOV and HOV. (1) The NoV group receives no
mechanical ventilation during CPB; (2) the LOV group receives a low
V<inf>T</inf> of 3-4 ml/kg of ideal body weight (IBW) with the respiratory
rate (RR) of 10-12 acts/min, and the positive end-expiratory pressure
(PEEP) of 5-8 cmH<inf>2</inf>O during CPB; the FiO<inf>2</inf> is 30%; (3)
the HOV group receives a low V<inf>T</inf> of 3-4 ml/kg of IBW with the RR
of 10-12 acts/min, and the PEEP of 5-8 cmH<inf>2</inf>O during CPB; the
FiO<inf>2</inf> is 80%. The primary endpoints are the incidence of the
composite of PPCs and the PPCs score. The secondary endpoints refer to the
incidence of the oxygenation index (PaO<inf>2</inf>/FiO<inf>2</inf> ratio)
< 300 mmHg at three time points (the moment arriving in the ICU, 6 and 12
h after arrival in the ICU), the surgical incision healing grade, the
intubation time, the stay of ICU, the length of hospital stay, and
mortality at 30 days after the surgery. <br/>Discussion(s): The VONTCPB
trial is the first study to assess the effects of strategies combining low
tidal volume (V<inf>T</inf>) ventilation with different FiO<inf>2</inf>
during CPB on patients' outcomes.<br/>Copyright &#xa9; 2019 The Author(s).

<82>
Accession Number
627568554
Title
Ultrasound-Guided Femoral Arterial Cannulation in Neonates Undergoing
Cardiac Surgery or Catheterization: Comparison of 0.014-Inch Floppy Versus
0.019-Inch Straight Guidewire.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. (no pagination), 2019. Date of Publication: 02 Apr 2019.
Author
Polat T.B.
Institution
(Polat) Department of Pediatric Cardiology, Altinbas University School of
Medicine, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Percutaneous femoral artery cannulation can be technically
challenging in small infants. DESIGN: We designed a prospective randomized
trial to compare the use of two different guidewires for femoral arterial
cannulation in neonates undergoing cardiac surgery or catheterization.
SETTINGS: Cardiac ICU in a university hospital. PATIENTS: One-hundred
twenty-four children were enrolled in this prospective study, with 64
being randomized to the 0.019-inch straight guidewire group and 60 to the
0.014-inch floppy guidewire group. INTERVENTIONS: Femoral artery
cannulation. MEASUREMENTS AND MAIN RESULTS: The study period was limited
to 10 minutes at the first site of arterial puncture. The time to complete
cannulation, number of successful cannulation on first attempt, number of
attempts, and number of successful cannulations were compared. The number
of successful cannulations and successful cannulations on first attempt
were higher in 0.014-inch floppy guidewire group (p = 0.001; p = 0.002,
respectively). The time to complete cannulation was significantly shorter,
and the number of attempts was lower in 0.014-inch floppy guidewire group
(p = 0.001). Among the neonates less than 2000g, the number of attempts
and time to complete cannulation were significantly lower (p < 0.001), and
number of successful cannulation on first attempt and number of successful
cannulations were significantly higher (p < 0.028; p < 0.001,
respectively) in the 0.014-inch floppy guidewire <br/>CONCLUSION(S)::
Using 0.014-inch floppy guidewire for femoral arterial cannulation in
particularly very small neonates provides significant improvement in first
attempt success, number of successful cannulations, number of attempts,
time to complete cannulation.

<83>
Accession Number
627566888
Title
The role of ministernotomy in aortic valve surgery-A prospective
randomized study.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 24
Apr 2019.
Author
Vukovic P.M.; Milojevic P.; Stojanovic I.; Micovic S.; Zivkovic I.; Peric
M.; Milicic M.; Milacic P.; Milojevic M.; Bojic M.
Institution
(Vukovic, Milojevic, Stojanovic, Micovic, Zivkovic, Peric, Milicic,
Milacic, Milojevic, Bojic) Department of Cardiac Surgery, Dedinje
Cardiovascular Institute, Belgrade, Serbia
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIMS: The purpose of this prospective randomized study was
to compare the early and midterm outcomes of aortic valve replacement
(AVR) through upper ministernotomy with conventional AVR through median
sternotomy. <br/>METHOD(S): One hundred patients undergoing elective AVR
were randomized into two groups: the M group (upper ministernotomy group,
n=50) and the C group (conventional sternotomy group, n=50). The operative
data, major adverse outcomes, and postoperative variables were compared
between the two groups of patients. A cross-sectional follow-up was
performed 24.9+/-5.8 months after surgery. <br/>RESULT(S): The aortic
cross-clamp time and cardiopulmonary bypass time were significantly longer
in the M group. Similar incidences of major cardiac, neurologic and renal
complications were recorded in both groups. Two patients (4%) in the C
group developed wound infections. The length of ICU stay was similar in
both groups. The patients in the M group had a shorter hospital stay
compared with the patients in the C group (7.6+/-2 days vs 9.3+/-4.8 days;
P=0.022). Follow-up revealed that the time period needed to reach full
recovery was significantly shorter in the ministernotomy group (1.7+/-1.2
months vs 2.8+/-1.6 months; P=0.001). Morbidity and mortality data did not
differ between the two groups. <br/>CONCLUSION(S): There was no difference
in the major outcomes between the patients who underwent upper
ministernotomy and those who underwent full sternotomy. The benefits of
the minimally invasive approach were the shorter hospital stay and
significantly faster recovery of patients after discharge from the
hospital.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<84>
Accession Number
627565961
Title
Efficacy of different analgesic or sedative drug therapies in pediatric
patients with congenital heart disease undergoing surgery: a network
meta-analysis.
Source
World journal of pediatrics : WJP. (no pagination), 2019. Date of
Publication: 23 Apr 2019.
Author
Liu R.-Z.; Li B.-T.; Zhao G.-Q.
Institution
(Liu, Zhao) Department of Anesthesiology, China-Japan Union Hospital of
Jilin University, Changchun 130000, China
(Li) Department of Rheumatology and Immunology, China-Japan Union Hospital
of Jilin University, Changchun 130000, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Surgery is an effective therapy for congenital heart disease
(CHD) and the management after surgery poses challenges for the clinical
workers. We performed this network meta-analysis to enhance the
corresponding evidence with respect to the relative efficacy of different
drug treatments applied after the CHD surgery. <br/>METHOD(S): Embase and
PubMed were systematically retrieved to identify all published controlled
trials investigating the effectiveness of drugs for patients up to 25
August, 2018. Mean differences (MD), odds ratios and their 95% credible
intervals (CrIs) were used to evaluate multi-aspect comparisons. Surface
under cumulative ranking curve (SUCRA) was used to analyze the relative
ranking of different treatments in each endpoint. <br/>RESULT(S): Compared
to saline, all the drugs achieved better preference under the efficacy
endpoints except fentanyl in JET. As for ventilator time, all drugs were
more effective than saline while only the difference of dexmedetomidine
was statistically obvious (MD=6.92, 95% CrIs 1.77-12.54). Under the
endpoint of ICU time, dexmedetomidine was superior to saline as well
(MD=1.26, 95% CrIs 0.11-2.45). When all the endpoints were taken into
consideration and with the help of ranking probabilities and SUCRA values,
fentanyl combined with dexmedetomidine was one of the recommended drugs
due to its shorter time on ventilator and stay in hospital as well as
lower mortality. <br/>CONCLUSION(S): Overall, based on the comprehensive
consideration of all the endpoints, fentanyl combined with dexmedetomidine
was considered to be the best-recommended clinical interventions among all
the methods.

<85>
Accession Number
627580011
Title
Peritoneal Dialysis versus Diuretics in Children after Congenital Heart
Surgery.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 23 Apr 2019.
Author
Flores S.; Loomba R.S.; Elhoff J.J.; Bronicki R.A.; Mery C.M.; Alsaied T.;
Alahdab F.
Institution
(Flores, Elhoff, Bronicki) Department of Pediatrics, Section of Critical
Care Medicine and Cardiology, Texas Children's Hospital, Baylor College of
Medicine, Houston, TX, United States
(Loomba) Advocate Children's Heart Institute/Advocate Children's Hospital,
Oak Lawn, IL, United States
(Mery) Department of Surgery, Section of Congenital Heart Surgery, Texas
Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Alsaied) Cincinnati Children's Hospital Heart Institute, Department of
Pediatrics, University of Cincinnati, Cincinnati, OH, United States
(Alahdab) Mayo Evidence-based Practice Center, Mayo Clinic, Rochester, MN,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: To evaluate outcomes of patients undergoing congenital heart
surgery who received peritoneal dialysis versus diuretic regimen.
<br/>METHOD(S): A comprehensive search in MEDLINE, EMBASE, Scopus,
Cochrane Central register of Controlled Trials and Cochrane Database of
Systematic reviews from the databases' inception through April 24th, 2018.
Independent reviewers selected studies and extracted data. We conducted a
random-effects meta-analysis to pool the outcomes of interest across
studies. <br/>RESULT(S): A total of 8 studies (2 prospective studies, 2
randomized clinical trials, and 4 retrospective studies) with 507 patients
were included in this review. A total of 204 (40%) underwent PD while the
rest underwent fluid removal with diuretics. The analyses demonstrated a
significantly shorter time of mechanical ventilation in those who received
peritoneal dialysis [mean difference -1.25 days, 95% CI -2.18 to -0.33,
p=0.008], and an increased odd of mortality [odds ratio 2.27, 95% CI 1.13
to 4.56, p=0.02] compared to the diuretic group. No differences were
identified in terms of incidence of negative fluid balance by
postoperative day 1, presence of peritonitis and ICU length of stay.
<br/>CONCLUSION(S): The meta-analysis did not identify differences between
the two groups with regards to negative fluid balance after postoperative
day 1, incidence of peritonitis or length of intensive care unit stay.
There is a need for large, prospective multicenter studies to further
evaluate the benefits and complications associated to peritoneal dialysis
utilization in selected children after congenital heart surgery. Since
some of the outcomes were present in only 2 studies, results from the
pooled analysis may be underpower.<br/>Copyright &#xa9; 2019. Published by
Elsevier Inc.

<86>
Accession Number
627577767
Title
Remote ischaemic preconditioning in isolated aortic valve and coronary
artery bypass surgery: a randomized trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2018.
Date of Publication: 12 Dec 2018.
Author
Moscarelli M.; Fiorentino F.; Suleiman M.-S.; Emanueli C.; Reeves B.C.;
Punjabi P.P.; Angelini G.D.
Institution
(Moscarelli, Suleiman, Reeves, Angelini) Faculty of Health Sciences,
Bristol Heart Institute, Bristol Medical School, University of Bristol,
Bristol, United Kingdom
(Fiorentino, Emanueli, Punjabi) Imperial College, National Heart and Lung
Institute, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This trial was designed and patients were recruited at a time
when the benefits of remote ischaemic preconditioning during open-heart
surgery were still controversial. We focused on a homogeneous patient
population undergoing either isolated aortic valve replacement or coronary
artery bypass grafting (CABG) surgery by investigating cardiac injury,
metabolic stress and inflammatory response. <br/>METHOD(S): A 2-centre
randomized controlled trial recruited a total of 124 patients between
February 2013 and April 2015. Of them, 64 patients underwent CABG and 60
patients underwent aortic valve replacement. Patients were randomized to
either sham or preconditioning. Remote ischaemic preconditioning was
applied following anaesthesia and before sternotomy. Myocardial injury and
inflammatory response were assessed by serially measuring cardiac troponin
I, and interleukin-6, 8, 10 and the tumour necrosis factor (TNF-alpha).
Biopsies from the left and the right ventricles were harvested after
ischaemic reperfusion injury for nucleotides analysis. <br/>RESULT(S):
Application of remote ischaemic preconditioning did not alter the degree
of troponin I release, levels of inflammatory markers and cardiac
energetics in both the CABG and the aortic valve replacement groups.
<br/>CONCLUSION(S): Preconditioning did not confer any additional
cardioprotection in terms of reducing the levels of troponin I and
inflammatory markers and preserving left and right ventricle energy
metabolites in patients undergoing isolated CABG or aortic valve surgery.
Clinical trial registration number: International Standard Randomized
Controlled Trial Number (ISRCTN) registry ID 33084113 (doi:
10.1186/ISRCTN33084113) and UK controlled randomized trial number (UKCRN)
registry ID 13672.

<87>
Accession Number
627538529
Title
Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic
Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (2) (pp 90-116), 2019. Date of Publication: 01 Apr 2019.
Author
Ng C.S.H.; Macdonald J.K.; Gilbert S.; Khan A.Z.; Kim Y.T.; Louie B.E.;
Blair Marshall M.; Santos R.S.; Scarci M.; Shargal Y.; Fernando H.C.
Institution
(Ng) Chinese University of Hong Kong, Shatin, China
(Macdonald) Western University, London, ON, Canada
(Gilbert) University of Ottawa, ON, Canada
(Khan) Medanta, Medicity, Gurgaon, India
(Kim) Seoul National University Hospital, Chongro-Ku, South Korea
(Louie) Swedish Cancer Institute, Medical Center, Seattle, WA, United
States
(Blair Marshall) Georgetown University Hospital, Washington, DC, United
States
(Santos) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Scarci) San Gerardo Hospital, Monza, MB, Italy
(Shargal) St Joseph's Healthcare, MacMaster University, Hamilton, ON,
Canada
(Fernando) Inova Fairfax Medical Campus, Virginia Commonwealth University,
Falls Church, Richmond, VA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective Video-assisted thoracic surgery (VATS) lobectomy was introduced
over 25 years ago. More recently, the technique has been modified from a
multiport video-assisted thoracic surgery (mVATS) to uniportal (uVATS) and
robotic (rVATS), with proponents for each approach. Additionally most
lobectomies are still performed using an open approach. We sought to
provide evidence-based recommendations to help define the optimal surgical
approach to lobectomy for early stage non-small cell lung cancer. Methods
Systematic review and meta-analysis of articles searched without limits
from January 2000 to January 2018 comparing open, mVATS, uVATS, and rVATS
using sources Medline, Embase, and Cochrane Library were considered for
inclusion. Articles were individually scrutinized by ISMICS consensus
conference members, and evidence-based statements were created and
consensus processes were used to determine the ensuing recommendations.
The ACC/AHA Clinical Practice Guideline Recommendation Classification
system was used to assess the overall quality of evidence and the strength
of recommendations. Results and recommendations One hundred and forty-five
studies met the predefined inclusion criteria and were included in the
meta-analysis. Comparisons were analyzed between VATS and open, and
between different VATS approaches looking at oncological outcomes
(survival, recurrence, lymph node evaluation), safety (adverse events),
function (pain, quality of life, pulmonary function), and
cost-effectiveness. Fifteen statements addressing these areas achieved
consensus. The highest level of evidence suggested that mVATS is
preferable to open lobectomy with lower adverse events (36% versus 42%;
88,460 patients) and less pain (IIa recommendation). Our meta-analysis
suggested that overall survival was better (IIb) with mVATS compared with
open (71.5% versus 66.7% 5-years; 16,200 patients). Different VATS
approaches were similar for most outcomes, although uVATS may be
associated with less pain and analgesic requirements (IIb). Conclusions
This meta-analysis supports the role of VATS lobectomy for non-small cell
lung cancer. Apart from potentially less pain and analgesic requirement
with uVATS, different minimally invasive surgical approaches appear to
have similar outcomes.<br/>Copyright &#xa9; International Society for
Minimally Invasive Cardiothoracic Surgery. All rights reserved.

<88>
Accession Number
627538525
Title
Expert Consensus Statement on Optimal Approach to Lobectomy for Non-Small
Cell Lung Cancer.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 14 (2) (pp 87-89), 2019. Date of Publication: 01 Apr 2019.
Author
Ng C.S.H.; Macdonald J.K.; Gilbert S.; Khan A.Z.; Kim Y.T.; Louie B.E.;
Blair Marshall M.; Santos R.S.; Scarci M.; Shargal Y.; Fernando H.C.
Institution
(Ng) Chinese University of Hong Kong, Hong Kong, Hong Kong
(Macdonald) Western University, London, ON, Canada
(Gilbert) University of Ottawa, C-Ontario, Canada
(Khan) Medanta, Medicity, Gurgaon, India
(Kim) Seoul National University Hospital, South Korea
(Louie) Swedish Cancer Institute, Medical Center, Seattle, WA, United
States
(Blair Marshall) Georgetown University Hospital, Washington, DC, United
States
(Santos) Hospital Israelite Albert Einstein, Sao Paulo, Brazil
(Scarci) San Gerardo Hospital, Monza, Italy
(Shargal) St Joseph's Healthcare, MacMaster University, Canada
(Fernando) Inova Fairfax Medical Campus, Virginia Commonwealth University,
Falls Church, VA, United States
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
A systematic review and meta-analysis to help define the optimal approach
for lobectomy for non-small cell lung cancer was undertaken. Articles
comparing thoracotomy (open), multi-port Video-assisted thoracic surgery
(mVATS), robotic VATS (rVATS), and uniportal VATS (uVATS) were scrutinized
and evidence-based statements using the American College of
Cardiology/American Heart Association clinical practice guideline
recommendations made.1 A total of 145 studies met the inclusion criteria
and the following 15 evidence-based statements achieved consensus.2 The
statements are as follows.<br/>Copyright &#xa9; International Society for
Minimally Invasive Cardiothoracic Surgery. All rights reserved.

<89>
[Use Link to view the full text]
Accession Number
613247687
Title
Oxygen Administration Does Not Influence the Prognosis of Acute Myocardial
Infarction: A Meta-Analysis.
Source
American Journal of Therapeutics. 26 (1) (pp e151-e160), 2019. Date of
Publication: 01 Jan 2019.
Author
Khan A.R.; Abdulhak A.B.; Luni F.K.; Farid T.A.; Riaz H.; Ruzieh M.; Pham
L.; Hirsch G.; Bolli R.
Institution
(Khan, Farid, Hirsch, Bolli) Division of Cardiovascular Medicine,
Department of Internal Medicine, University of Louisville, 550 S. Jackson
Street, Louisville, KY 40292, United States
(Abdulhak) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Iowa, Iowa City, IA, United States
(Luni) Division of Cardiovascular Medicine, Department of Internal
Medicine, Saint Vincent Mercy Hospital, Toledo, OH, United States
(Riaz) Department of Internal Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Ruzieh) Department of Internal Medicine, University of Toledo Medical
Center, Toledo, OH, United States
(Pham) Department of Internal Medicine, Harbor-UCLA, Los Angeles, CA,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:The safety and efficacy of supplemental oxygen in acute
myocardial infarction (AMI) remains unclear.Study Question:To evaluate the
safety and efficacy of supplemental oxygen in patients who present with
AMI. <br/>Data Sources:We systematically searched PubMed, Embase, Cochrane
Central Register of Controlled Trials, ISI Web of Science, Scopus, and
conference proceedings from inception through January 2016. <br/>Study
Design:Eligible studies were randomized trials that evaluated the role of
oxygen compared with room air in AMI. The clinical outcome measured was
30-day mortality, and odds ratio (OR) was calculated for the measured
outcome. The Mantel-Haenszel method was used to pool 30-day mortality in a
random-effects model. Sensitivity analysis was carried out to evaluate the
effect of revascularization of the culprit artery on the outcome.
<br/>Result(s):The pooled analysis suggested no difference in 30-day
mortality [OR 1.09; 95% confidence interval (CI), 0.30-4.00; P = 0.89]
between oxygen and room air. Metaregression demonstrated that all the
between-study variance was because of coronary revascularization (P =
0.01, R² = 1.0). A subgroup analysis suggested a trend toward
increased mortality with oxygen (OR 3.26; 95% CI, 0.94-11.29; P = 0.06)
when less than half of the patient population underwent revascularization.
On the other hand, there was a nonsignificant numerical decrease in
mortality with oxygen (OR 0.41; 95% CI, 0.14-1.19; P = 0.10) in the
presence of coronary revascularization. Metaregression confirmed that all
the between-study variance was because of coronary revascularization (P =
0.01, R² = 1.0). <br/>Conclusion(s):In this meta-analysis, we
found that the evidence on the safety and efficacy of oxygen was not only
weak and inconsistent but also had modest statistical power. The variation
in results was mainly because of the presence or absence of
revascularization of the culprit artery. Adequately powered studies are
needed to further delineate the role of oxygen in patients undergoing
coronary revascularization.<br/>Copyright &#xa9; 2018 Wolters Kluwer
Health, Inc.

<90>
[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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2019 Wolters Kluwer Health, Inc. All rights
reserved.

<91>
Accession Number
627472223
Title
Who benefits from percutaneous closure of patent foramen ovale vs medical
therapy for stroke prevention? In-depth and updated meta-analysis of
randomized trials.
Source
World Journal of Cardiology. 11 (4) (pp 126-136), 2019. Date of
Publication: 26 Apr 2019.
Author
Dahal K.; Yousuf A.; Watti H.; Liang B.; Sharma S.; Rijal J.; Katikaneni
P.; Modi K.; Tandon N.; Azrin M.; Lee J.
Institution
(Dahal, Yousuf, Watti, Katikaneni, Modi) Division of Cardiology,
Department of Medicine, Louisiana State University Health Sciences Center,
Shreveport, LA 71103, United States
(Liang) Department of Medicine, University of Connecticut Health Center,
Farmington, CT 06030, United States
(Sharma) Kansas City Heart Rhythm Institute, Overland Park, KS 66215,
United States
(Rijal) Division of Cardiology, Hartford Medical Center, Hartford, CT
06102, United States
(Tandon) Cardiology Section, Overton Brooks VA Medical Center, Shreveport,
LA 71101, United States
(Azrin, Lee) Division of Cardiology, University of Connecticut Health
Center, Farmington, CT 06030, United States
Publisher
Baishideng Publishing Group Co (7901 Stoneridge Drive, Suite 501,
Pleasanton, California 94588, United States. E-mail: bpg@baishideng.com)
Abstract
BACKGROUND A few randomized clinical trials (RCT) and their meta-analyses
have found patent foramen ovale closure (PFOC) to be beneficial in
prevention of stroke compared to medical therapy. Whether the benefit is
extended across all groups of patients remains unclear. AIM To evaluate
the efficacy and safety of PFOC vs medical therapy in different groups of
patients presenting with stroke, we performed this meta-analysis of RCTs.
METHODS Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and
ProQuest Central and manual search were performed from inception through
September 2018 for RCTs. Ischemic stroke (IS), transient ischemic attack
(TIA), a composite of IS, TIA and systemic embolism (SE), mortality, major
bleeding, atrial fibrillation (AF) and procedural complications were the
major outcomes. Random-effects model was used to perform analyses. RESULTS
Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,
compared to medical therapy reduced the risk of IS [odds ratio: 0.34; 95%
confidence interval: 0.15-0.78; P = 0.01] and the composite of IS, TIA and
SE [0.55 (0.32-0.93); P = 0.02] and increased the AF risk [4.79
(2.35-9.77); P < 0.0001]. No statistical difference was observed in the
risk of TIA [0.86 (0.54-1.38); P = 0.54], mortality [0.74 (0.28-1.93); P =
0.53] and major bleeding [0.81 (0.42-1.56); P = 0.53] between two
strategies. Subgroup analyses showed that compared to medical therapy,
PFOC reduced the risk of stroke in persons who were males, <= 45 years of
age and had large shunt or atrial septal aneurysm. CONCLUSION In certain
groups of patients presenting with stroke, PFOC is beneficial in
preventing future stroke compared to medical therapy.<br/>Copyright
&#xa9;The Author(s) 2019. Published by Baishideng Publishing Group Inc.
All rights reserved.

<92>
[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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2018 the Author(s).

<93>
[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.
<br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2018 the Author(s).

<94>
Accession Number
627546038
Title
Optimizing health before elective thoracic surgery: Systematic review of
modifiable risk factors and opportunities for health services research.
Source
Journal of Thoracic Disease. 11 (Supplement4) (pp S537-S554), 2019. Date
of Publication: 2019.
Author
Stokes S.M.; Wakeam E.; Antonoff M.B.; Backhus L.M.; Meguid R.A.; Odell
D.; Varghese T.K.
Institution
(Stokes) Division of General Surgery, Department of Surgery, University of
Utah, Salt Lake City, UT, United States
(Wakeam) Division of Thoracic Surgery, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson, Cancer Center, Houston, TX, United States
(Backhus) Division of Thoracic Surgery, Department of Cardiothoracic
Surgery, Stanford University, Stanford, CA, United States
(Meguid) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado, Aurora, CO, United States
(Odell) Division of Thoracic Surgery, Department of Surgery, Northwestern
University, Chicago, IL, United States
(Varghese) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Despite progress in many different domains of surgical care, we are still
striving toward practices which will consistently lead to the best care
for an increasingly complex surgical population. Thoracic surgical
patients, as a group, have multiple medical co-morbidities and are at
increased risk for developing complications after surgical intervention.
Our healthcare systems have been focused on treating complications as they
occur in the hopes of minimizing their impact, as well as aiding in
recovery. In recent years there has emerged a body of evidence outlining
opportunities to optimize patients and likely prevent or decrease the
impact of many complications. The purpose of this review article is to
summarize four major domains-optimal pain control, nutritional status,
functional fitness, and smoking cessation-all of which can have a
substantial impact on the thoracic surgical patient's course in the
hospital-as well as to describe opportunities for improvement, and areas
for future research efforts.<br/>Copyright &#xa9; Journal of Thoracic
Disease. All rights reserved.

<95>
Accession Number
627537735
Title
Application of standardized hemodynamic protocols within enhanced recovery
after surgery programs to improve outcomes associated with anastomotic
leak and conduit necrosis in patients undergoing esophagectomy.
Source
Journal of Thoracic Disease. 11 (Supplement5) (pp S692-S701), 2019. Date
of Publication: 2019.
Author
Klevebro F.; Boshier P.R.; Low D.E.
Institution
(Klevebro, Boshier, Low) Department of Thoracic Surgery, Virginia Mason
Medical Center, Seattle, United States
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Esophagectomy for cancer is associated with high risk for postoperative
morbidity. The most serious regularly encountered complication is
anastomotic leak and the most feared individual complication is conduit
necrosis. Both of these complications affect the length of stay,
mortality, quality of life, and survival for patients undergoing
esophageal resection. The maintenance of conduit viability is of primary
importance in the perioperative care of patients following esophageal
resection. It has been shown that restrictive fluid management may be
associated with improved postoperative outcomes in abdominal and other
types of surgery, but many factors can affect the incidence of anastomotic
leak and the viability of the gastric conduit. We have performed a
comprehensive review with the aim to give an overview of the available
evidence for the use of standardized hemodynamic protocols (SHPs) for
esophagectomy and review the hemodynamic protocol, which has been applied
within a standardized clinical pathway (SCP) at the Department of Thoracic
surgery at the Virginia Mason Medical Center between 2004-2018 where the
anastomotic leak rate over the period has been 5.2% and the incidence of
conduit necrosis requiring surgical management is zero. The literature
review demonstrates that there are few high quality studies that provide
scientific evidence for the use of a SHP. The evidence indicates that the
use of goal-directed hemodynamic monitoring might be associated with a
reduced risk for postoperative complications, shortened length of stay,
and decreased need for intensive care unit stay. We propose that the
routine application of a SHP can provide a uniform infrastructure to
optimize conduit perfusion and decrease the incidence of anastomotic
leak.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<96>
Accession Number
2001932092
Title
Cognitive outcomes following coronary artery bypass grafting: A systematic
review and meta-analysis of 91,829 patients.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Greaves D.; Psaltis P.J.; Ross T.J.; Davis D.; Smith A.E.; Boord M.S.;
Keage H.A.D.
Institution
(Greaves, Ross, Boord, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, School of Psychology, Social Work and Social
Policy, University of South Australia, Adelaide, Australia
(Psaltis) Vascular Research Centre, Heart Health Theme, South Australian
Health and Medical Research Institute, Adelaide, Australia and Adelaide
Medical School, University of Adelaide, Adelaide, Australia
(Davis) MRC Unit for Lifelong Health and Ageing Unit at University College
London, London, United Kingdom
(Smith) Alliance for Research in Exercise, Nutrition and Activity, School
of Health Sciences, University of South Australia, Adelaide, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Background: Cognitive impairments, including delirium, are common after
coronary artery bypass grafting (CABG)surgery, as described in over three
decades of research. Our aim was to pool estimates across the literature
for the first-time, relative to time (from pre- to post-CABG)and diagnosis
(cognitive impairment, delirium and dementia). <br/>Method(s): A
systematic search of four databases was undertaken. 215 studies
incorporating data from 91,829 patients were used to estimate the
prevalence of cognitive impairments pre- and post-CABG, including delirium
and dementia post-CABG, using random effects meta-analyses.
<br/>Result(s): Pre-surgical cognitive impairment was seen in 19% of
patients. Post-operatively, cognitive impairment was seen in around 43% of
patients acutely; this resolved to 19% at 4-6 months and then increased to
25% of patients between 6-months to 1-year post-operatively. In the long
term, between 1 and 5-years post-operatively, cognitive impairment
increased and was seen in nearly 40% of patients. Post-operative delirium
was apparent in 18% of CABG patients which increased to 24% when a
diagnostic instrument was utilized alongside clinical criteria. Dementia
was present in 7% of patients 5-7 years post-surgery. <br/>Conclusion(s):
The results of this meta-analysis demonstrate that cognitive impairment
and delirium are major issues in CABG patients which require specific
attention. It is imperative that appropriate methods for investigating
cognitive impairment, and screening for delirium using a diagnostic
instrument, occur in both pre-and post-CABG settings.<br/>Copyright &#xa9;
2019 The Authors

<97>
Accession Number
627537910
Title
Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery
after Surgery Society Recommendations.
Source
JAMA Surgery. (no pagination), 2019. Date of Publication: 2019.
Author
Engelman D.T.; Ben Ali W.; Williams J.B.; Perrault L.P.; Reddy V.S.; Arora
R.C.; Roselli E.E.; Khoynezhad A.; Gerdisch M.; Levy J.H.; Lobdell K.;
Fletcher N.; Kirsch M.; Nelson G.; Engelman R.M.; Gregory A.J.; Boyle E.M.
Institution
(Engelman) Heart and Vascular Program, Baystate Medical Center, 759
Chestnut St, Springfield, MA 01199, United States
(Ben Ali, Perrault) Montreal Heart Institute, Montreal, Canada
(Williams) WakeMed Health and Hospitals, Raleigh, NC, United States
(Reddy) Centennial Heart and Vascular Center, Nashville, TN, United States
(Arora) St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
(Roselli) Cleveland Clinic, Cleveland, OH, United States
(Khoynezhad) MemorialCare Heart and Vascular Institute, Los Angeles, CA,
United States
(Gerdisch) Franciscan Health Heart Center, Indianapolis, IN, United States
(Levy) Duke University School of Medicine, Durham, NC, United States
(Lobdell) Atrium Health, Department of Cardiovascular and Thoracic
Surgery, NC, United States
(Fletcher) St Georges University of London, London, United Kingdom
(Kirsch) Centre Hospitalier, Universitaire Vaudois Cardiac Surgery Centre,
Lausanne, Switzerland
(Nelson, Gregory) University of Calgary, Calgary, AB, Canada
(Boyle) Department of Cardiac Surgery, St Charles Medical Center, Bend,
OR, United States
(Arora) Now with Department of Surgery, Max Rady College of Medicine,
University of Manitoba, Winnipeg, Canada
(Engelman) Department of Surgery, Baystate Medical Center, Springfield,
MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Enhanced Recovery After Surgery (ERAS) evidence-based protocols for
perioperative care can lead to improvements in clinical outcomes and cost
savings. This article aims to present consensus recommendations for the
optimal perioperative management of patients undergoing cardiac surgery. A
review of meta-analyses, randomized clinical trials, large nonrandomized
studies, and reviews was conducted for each protocol element. The quality
of the evidence was graded and used to form consensus recommendations for
each topic. Development of these recommendations was endorsed by the
Enhanced Recovery After Surgery Society..<br/>Copyright &#xa9; 2019
American Medical Association. All rights reserved.

<98>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2019 The Author(s).

<99>
Accession Number
615452596
Title
Cardiovascular efficacy and safety of bococizumab in high-risk patients.
Source
New England Journal of Medicine. 376 (16) (pp 1527-1539), 2017. Date of
Publication: 20 Apr 2017.
Author
Ridker P.M.; Revkin J.; Amarenco P.; Brunell R.; Curto M.; Civeira F.;
Flather M.; Glynn R.J.; Jukema J.W.; Karpov Y.; Kastelein J.J.P.; Koenig
W.; Lorenzatti A.; Manga P.; Masiukiewicz U.; Miller M.; Mosterd A.; Murin
J.; Nicolau J.C.; Nissen S.; Ponikowski P.; Santos R.D.; Schwartz P.F.;
Soran H.; White H.; Wright R.S.; Vrablik M.; Yunis C.; Shear C.L.; Tardif
J.-C.; Conde D.; Colquhoun D.; Missault L.; Gregoire J.; Gao R.; Urina M.;
Solar M.; Jensen H.K.; Grobbee D.; Savolainen M.; Schiele F.N.;
Montalescot G.; Edes I.; Blake G.; Lotan C.; Maggioni A.; Savonitto S.;
Lee C.W.; Leiva Pons J.L.; Dan G.A.; Cortada J.B.; Mellbin L.; Kahan T.;
Noble S.; Hwang J.J.; Sritara P.; Tokgozoglu L.; Tarasenko L.; Borer J.S.;
Black H.; Carmena R.; Furie K.L.; McMurray J.; Neaton J.; Zannad F.;
O'Neill B.; Welty F.; McNamara R.; Chun H.; Abbott J.D.; Jacoby D.;
McPherson C.; Jadbabaie F.; Pinto D.; McCullough L.; Silverman I.E.;
Sansing L.H.; Dearborn-Tomazos J.; Foody J.; Schindler J.; Piazza G.;
Chakrabarti A.; Pride Y.; Gelfand E.; Baultrukonis D.; Chaudhuri S.;
Frederich R.; Johnson M.; Mridha K.; Powell C.; Wang E.; Wei C.; Anderson
P.; Buonanno M.; Epsley C.; Evans B.; Frolova M.; Goetsch M.; Hessinger
D.; Ikehara E.; Ivanac K.; Kizko J.; Le K.; McNally-Dufort C.; Morocco T.;
Nadkarni S.; Nye R.; Pak R.; Pence D.; Redifer P.; Sattler C.; Schade R.;
Sullivan B.; Wegner J.; Alvarez C.A.; Budassi N.; Vogel D.R.; Avaca H.;
Conde D.G.; Estol C.C.; Gelersztein E.; Glenny J.A.; Hershson A.R.; Bruno
R.L.; Maffei L.E.; Soler J.M.; Zaidman C.J.; Carnero G.S.; Colombo H.R.;
Jure H.O.; Luquez H.A.; Ramos H.R.; Resk J.H.; Rusculleda M.M.; Ulla M.R.;
Caccavo A.; Farias E.F.; Wenetz L.M.; Cabella P.R.; Cuadrado J.A.; Chahin
M.; Mackinnon I.J.; Zarandon R.B.; Schmidberg J.; Fernandez A.A.; Montana
O.; Codutti O.R.; Gorosito V.M.; Maldonado N.; Sala J.; De La Fuente R.A.;
Casabella T.E.; Di Gennaro J.P.; Guerrero R.A.; Alvarez M.S.; Berli M.;
Botta C.E.; Montenegro E.E.; Vico M.L.; Begg A.; Lehman R.; Gilfillan
C.P.; d'Emden M.; Markovic T.P.; Sullivan D.; Aroney C.; Stranks S.N.;
Crimmins D.S.; Arstall M.; Van Gaal W.; Davis T.; Aylward P.E.; Amerena
J.; William M.; Proietto J.; Purnell P.W.; Singh B.; Arya K.W.; Dart A.M.;
Thompson P.; Davis S.M.; Carroll P.A.; De Looze F.; Jayasinghe R.; Bhindi
R.; Buysschaert I.; Sarens T.; van de Borne P.; Scott B.P.; Roosen J.;
Cools F.; Missault L.H.; Debroye C.; Schoors D.F.; Hollanders G.; Schroe
H.H.; De Sutter J.; Hermans K.; Carlier M.; van Landegem P.; Verwerft J.;
Mulleners T.; Delforge M.D.; Soufflet V.; Elegeert I.; Descamps O.S.;
Janssens S.; Lemmens R.C.; Desfontaines P.; Scheen A.; Heijmans S.; Capiau
L.; Vervoort G.; Carlier S.G.; Faes D.; Alzand B.; Keuleers S.; De Wolf
L.; Thoeng J.; De Bruyne L.; de Santos M.O.; Felicio J.S.; Areas C.A.;
Figueiredo E.L.; Michalaros Y.L.; Neuenschwander F.C.; Reis G.; Saad J.A.;
Kormann A.P.; Nascimento C.V.; Precoma D.B.; Abib E.; dos Santos F.R.;
Mello Y.G.; Saraiva J.F.; Rech R.L.; Cerci R.; Fortes J.A.; Rossi P.R.; de
Lima e Silva F.A.; Hissa M.; Silva R.P.; de Souza W.K.; Guimaraes Filho
F.V.; Mangili O.C.; de Oliveira Paiva M.S.; Tumelero R.; Abrantes J.A.;
Caramori P.R.; Dutra O.P.; Leaes P.E.; Manenti E.R.; Polanczyk C.A.;
Bandeira e Farias F.A.; de Moraes Junior J.B.; Russo L.A.; Alves A.R.;
Dracoulakis M.D.; Ritt L.E.; Saporito W.F.; Herdy A.H.; Maia L.N.;
Sternieri M.V.; Ayoub J.C.; Bianco H.T.; da Costa F.A.; Eliaschewitz F.G.;
Fonseca F.A.; Nakandakare E.R.; Bonansea T.C.; Castro N.M.; de Barros e
Silva P.G.; Smith P.; Botelho R.V.; Resende E.S.; Barbieri D.S.; Hernandes
M.E.; Bajaj H.; Beaudry P.; Berlingieri J.C.; Salter T.J.; Ajala B.;
Anderson T.J.; Nanji A.; Ross S.; Pandey S.; Desrosiers D.; Gaudet D.;
Moran G.; Csanadi M.A.; St-Amour E.; Cusimano S.; Halperin F.A.; Babapulle
M.; Vizel S.; Petrella J.; Spence J.D.; Gupta N.; Tellier G.; Bourgeois
R.; Gregoire J.C.; Wesson T.; Zadra R.; Twum-Barima D.Y.; Cha J.Y.;
Hartleib M.C.; Bergeron J.; Chouinard G.; McPherson T.P.; Searles G.;
Peterson S.R.; Mukherjee A.; Lepage S.; Conway J.R.; Kouz S.M.; Dion D.;
Pesant Y.; Cheung S.S.; Goldenberg R.M.; Aronson R.; Gupta A.K.; O'Mahoney
M.; Pliamm L.; Teitelbaum I.; Hoag G.N.; Nadra I.J.; Yared Z.; Yao L.C.;
Nguyen T.; Saunders K.K.; Potthoff S.; Varleta P.; Assef V.; Godoy J.G.;
Olivares C.; Roman O.; Vejar M.; Montecinos H.; Pincetti C.; Li Y.; Wang
D.; Li J.; Yang X.; Du Y.; Wang G.; Yang P.; Zhang X.; Xu P.; Zhao Y.;
Chen J.; Li S.; Li W.; Zhang L.; Zhu Y.; Zhang Y.; Zhou C.; Wang Y.; Liu
F.; Ma Y.; Ti Z.; Zeng X.; Zhou Y.; Cui G.; Li D.; Xue L.; Jiang J.; Lian
Y.; He Y.; Mendoza J.A.; Bonfanti J.A.; Dada F.A.; Urina-Triana M.A.;
Rodriguez W.R.; Sanchez M.L.; Lozno H.Y.; Triana E.H.; Arambula R.M.;
Rico-Carrillo A.E.; Gallo H.J.; Catano J.S.; Jattin F.G.; Plazas J.A.;
Gomez J.E.; Botero-Lopez R.; Gomez N.I.; Munoz C.F.; Pelaez S.V.; Eraso
A.M.; Goyes A.R.; Elbl L.; Fiserova N.; Vesely J.; Wasserburger B.; Blaha
V.; Vojacek J.; Maskova P.; Hutyra M.; Vrkoc J.; Hala T.; Vodnansky P.;
Bocek P.; Cifkova R.; Bufka V.; Ceska R.; Machkova M.; Zidkova E.; Lukac
M.; Mikusova T.; Kellnerova I.; Kuchar L.; Ferkl R.; Cech V.; Zemek S.;
Monhart Z.; Davidsen F.; Joensen A.; Lihn A.S.; Rasmussen T.K.; Wiggers
H.; Lindgren L.M.; Schmidt U.; Galatius S.; Sillesen H.; Bronnum Schou J.;
Thomsen K.K.; Urhammer S.; Jeppensen J.; Schou M.; May O.; Steffensen R.;
Nielsen W.B.; Nielesen T.; Jepsen J.M.; Rai A.; Sykulski R.; Andersen
L.T.; Rickers H.; Frost L.; Lomholdt J.; Egstrup K.; Wermuth S.; Klausen
L.; Lassus J.; Palomaki A.; Khari J.; Tatlisumak T.; Kekki S.; Vanttinen
E.; Strandberg A.; Valtonen M.; Sia S.M.; Nerg O.; Puhakka M.; Strand J.;
Timonen M.; Levola J.; Arstila L.; Taurio J.; Kantola I.; Suomi J.;
Humaloja K.; Askonen K.; Schiele F.; Sibon I.; Zemour G.; Goube P.; Petit
C.; Chati Z.; Range G.; Rabahi F.; Rihani R.; Bergerot C.; Roubille F.;
Boye A.; Probst V.; Ferrari E.; Cayla G.; Thouvenot E.; Delarche N.;
Couffinhal T.; Coisne D.; Paillard F.; Elbaz M.; Decoulx E.; Angoulvant
D.; Agraou B.; Caudmont S.; Berrouschot J.; Lauer B.; Schoell I.; Trenk
D.; Derwahl K.M.; Khariouzov A.; Proepper F.; Stawowy P.; Da Stephan U.;
Stoessel J.; Voehringer H.F.; Dorsel T.; Stellbrink C.; Rinke A.;
Northroff J.; Bourhaial H.; Stratmann M.; Wetzel T.; Axthelm C.; Guenzel
A.; Weigmann I.; Faghih M.; Hagemann D.; Schaefer A.; Weber D.; Luedemann
J.; Contzen C.; Kornmann M.O.; Winkelmann B.; Simon J.; Felix S.; Brauer
C.; Laufs U.; Schmidt E.; Marten I.; Licka M.; Heisters J.; Appel K.F.;
Kleinecke-Pohl U.; Klein C.; von Hodenberg E.F.; Maus O.; Sigal H.;
Taeschner H.; Schwimmbeck P.; Lemke B.; Perings C.; Illies G.; Pfuetzner
A.; Salbach P.; Hengstenberg C.; Kohler A.; Mudra H.; Behnke T.; Baar M.;
Jeserich M.; Scholz G.; Naudts I.; Voller H.; Herrmann H.J.; von
Engelhardt C.B.; Gerke S.; Pohlmeier L.; Schaufele T.; Woehrle J.;
Al-Zoebi A.; Horacek T.; Peterfai E.; Kemeny V.; Lakatos F.; Bod E.;
Andrassy P.; Andreka P.; Balo T.; Davidovits Z.; Laszlo Z.; Nagy K.; Papp
A.; Somogyi A.; Toldy-Schedel E.; Vertes A.; Voros P.; Paragh G.; Martyin
T.; Hajdu C.; Deak L.; Farago K.; Nagy A.; Kirschner R.; Koszegi Z.;
Zilahi Z.; Toth K.; Wittmann I.; Bajcsi D.; Reiber I.; Toth L.; Benczur
B.; Nagy L.; Sydo T.; Lupkovics G.; Oroszlan T.; Crean P.; Mahon N.G.;
McAdam B.; MacNeill B.; Katz A.; Tsalihin D.; Vazan A.; Eitan A.; Lewis
B.S.; Gavish D.; Wainstein J.; Mosenzon O.; Mosseri M.; Vishlitzky V.;
Atar S.; Nseir W.B.; Brenner H.; Elis A.; Fuchs S.; Shimon I.; Solodky A.;
Goldhaber A.; Tanne D.; Knobler H.; Kracoff O.H.; Hussein O.; Auriel E.;
Chorin E.; Sharir T.; Bitzur R.; Shechter M.; Antonicelli R.; Franceschini
E.; Porcu M.; Sesti G.; Maggiolini S.; Salvioni A.; Filardi P.P.; Trimarco
B.; Averna M.; Pasqualini L.; Pirro M.; Pantaleoni M.; Piovaccari G.; Arca
M.; Fedele F.; Roncon L.; Anselmi M.; Sganzerla P.; Morocutti G.; Bonora
E.; Dimas A.L.; Esperon G.A.; Morales-Villegas E.; Isunza J.M.; Beltran
L.G.; Molina C.A.; Garcia D.K.; Ruiz L.A.; Reyna L.S.; De los Rios Ibarra
M.O.; Soto J.R.; Gonzalez-Ortiz M.; Herrera-Marmolejo M.; Ramos S.A.;
Ramos-Lopez G.A.; Stobschinski C.A.; AguilarSalinas C.A.; Alpizar-Salazar
M.; Jimenez-Sanchez M.; Sanchez Mijangos J.H.; Elizondo Moreno E.R.;
Garcia Castillo A.; Garcia Hernandez P.A.; Gonzalez-Gonzalez J.G.; Riojas
Charles C.M.; Valdez Lopez H.G.; Nuriulu Escobar P.L.; Lechuga Martin del
Campo A.; Castro Montes B.E.; Mendez Bucio A.; Rodriguez-Briones I.; Torre
Amione G.; Violante Ortiz R.; Luna Ceballos R.I.; Lopez Rosas E.; Bax
W.A.; Alhakim M.; van de Wiel A.; Liem S.S.; Groutars R.G.; Herrman J.P.;
Hovingh G.K.; van de Wetering M.L.; van Royen N.; Groenemeijer B.E.;
Hoedemaker G.; Schaap J.; Ronner E.; Angun M.; Mairuhu A.T.; Van Alem
A.P.; Martens F.M.; Heijmeriks J.A.; van Hal J.M.; Schoofs M.W.; den
Hartog F.R.; Kentgens S.; Post J.C.; Louwerenburg J.W.; van Rossum P.;
Viergever E.P.; Donders S.H.; Kamphuisen P.W.; van Beek E.; Nijmeijer R.;
Lenderink T.; Schreuder T.; Kuijper A.F.; The S.H.; Van het Hof-Wiersma
J.J.; Tichelaar P.; Westerndorp I.; Breedveld R.W.; Karalis I.; Romer
T.J.; Bogaard K.; Van Koningsbruggen P.; Kroon A.A.; Hoogslag P.A.;
Rensing B.J.; Cramer E.; Remmen J.J.; Riksen N.P.; Bokern M.J.; Cabezas
M.C.; Mulder H.; Nierop P.R.; van Kempen W.W.; Zoet-Nugteren S.K.; van
Daele M.E.; Swart H.P.; van der Zwaan C.T.; Hermans W.R.; Magro M.; van de
Wal R.M.; Hassink R.J.; Visseren F.; Veenendaal A.; De Nooijer C.; Troquay
R.P.; Imholz B.P.; van der Meer P.; Visser R.P.; van Leendert R.J.;
Gosselink M.A.; Baker J.; Benatar J.R.; Kerr J.; Pryke J.R.; Scott R.S.;
Millar-Corte G.D.; Williams M.; Montgomery B.; Venter D.J.; Ternouth I.F.;
DeCaigney S.C.; Hart H.H.; Corin A.; Garden P.I.; Sheahan D.; Harding
S.A.; Korecki J.; Supronik J.; Styczkiewicz M.; Bijata-Bronisz R.; Rusicka
T.; Walczak M.; Krolikowski Z.; Ostrowski J.; Lukaszewicz M.;
Przekwas-Jaruchowska M.; Zieba B.; Miekus P.; Orkwiszewska-Nalewajko A.;
Piepiorka M.; Kubalski P.; Wychota K.; Blach E.; Ochala A.; Okopien B.;
Wronska D.; Janion M.; Czarnecka D.; Kolodziejczyk J.; Konieczynska M.;
Landa K.; Mirek-Bryniarska E.; Necki M.; Pasternak D.A.; Rozpondek P.;
Trebacz J.; Walczewska J.; Sidor M.; Broncel M.; Drozdz J.; Kosmider M.;
Saryusz-Wolska M.; Kucharska D.; Opalinska E.; Pijanowski Z.; Wozniak I.;
Banaszkiewicz K.; Klecha A.; Horodecki M.; Piskorz-Wapinska J.;
Kobielusz-Gembala I.; Kim M.H.; Kim D.K.; Cho B.R.; Kim K.S.; Her S.H.;
Lee S.Y.; Rhee M.Y.; Kim K.; Kang W.C.; Kim D.H.; Cho Y.S.; Kim S.H.; Rim
S.J.; Tahk S.J.; Jeon H.K.; Yoon J.; Mociran M.; Pop C.F.; Minescu B.;
Andrei L.D.; Radoi M.; Calin A.; Ciomag R.M.; Copaci I.; Fruntelata A.G.;
Popescu M.; Tivadar S.; Roman G.; Avram R.I.; Mistodie C.V.; Morosanu M.;
Popa A.R.; Popescu M.L.; Popoviciu M.S.; Tase A.; Busegeanu M.; Popescu
A.; Szilagyi I.; Sitterli-Natea C.N.; Maximov D.M.; Munteanu M.; Negrisanu
G.D.; Kuzin A.; Popov D.; Shapovalova J.; Vishneva E.; Shutemova E.;
Pasechnik E.; Bogdanov E.; Khasanov N.; Barbarash O.L.; Shangina O.A.;
Tarasov N.; Solonev O.; Kosmacheva E.; Chernyatina M.A.; Ginzburg M.;
Blokhin A.; Bulanova N.; Drapkina O.M.; Gordeev I.G.; Libov I.A.; Lomakin
N.; Panchenko E.; Shogenov Z.S.; Zateyshchikov D.; Klein G.; Motylev I.;
Belenkiy D.I.; Demin A.; Nikolaev K.Y.; Oleynikov V.; Zrazhevskiy K.;
Katelnitskiy I.; Khaisheva L.; Aksentiev S.; Nedoshivin A.; Popova V.B.;
Agafina A.S.; Ballyuzek M.; Baranova E.; Burova N.; Eryshev S.; Filippov
A.; Goloshchekin B.M.; Konstantinov V.; Kostenko V.A.; Simanenkov V.I.;
Volkova A.; Duplyakov D.; Reshetko O.; Shvarts Y.; Kuznetsov V.A.;
Samoylova Y.G.; Tolkacheva V.; Shalaev S.V.; Khokhlov A.L.; Malygin A.;
Shilkina N.P.; Yakusevich V.V.; Margoczy R.; Zubek V.; Dzupina A.; Dubrava
J.; Dulkova K.; Fabryova L.; Gaspar L.; Kamensky G.; Kokles M.; Raslova
K.; Soosova I.; Stevlik J.; Strbova J.; Sumbal J.; Uhliar R.; Micik J.;
Truban J.; Fedacko J.; Pastrnakova E.; Pella D.; Fazekas F.; Ambrovicova
V.; Kycina P.; Martinka E.; Nociar J.; Belicova M.; Banik M.; Kanderkova
D.; Hranai M.; Duris T.; Krahulec B.; Benacka J.; Vinanska D.; Roskova E.;
Skripova D.; Macek V.; Vohnout B.; Buganova I.; Engelbrecht J.M.;
Pretorius M.M.; Ebrahim I.O.; Bayat J.; Ganesh S.; Ranjith N.; Coetzer
T.F.; Jacovides A.; Distiller L.A.; Hellig F.S.; Engelbrecht I.V.; Mahomed
A.A.; Blignault S.C.; Burgess L.J.; Kotze H.J.; van Nieuwenhuizen E.;
Musungaie D.B.; Emanuel S.; van der Walt E.; Pretorius C.E.; Roos J.S.;
Roux S.M.; Badat A.E.; Fouche L.; Vahed Y.A.; Jansen van Resburg D.; van
Zyl L.J.; Soto Gonzalez A.; Diaz J.L.; Segura T.; Botella Serrano M.;
Botas Rodrigues J.; Molto-Jorda J.M.; Dominguez Escribano J.R.; Sogorb
Garri F.; Blanco Coronado J.L.; Gaztambide Saenz M.S.; Brotons Cuixart C.;
Bruguera Cortada J.; Garcia-Moll Marimon X.; Gonzalbez Morgaez J.D.;
Maisterra Santos O.; Roquer Gonzalez J.; Sobrino-Martinez J.; Chueca
Fernandez J.E.; Narejos S.; Suarez Garcia S.; Perez Martinez P.; Figueras
Camos R.; Medrano Martinez V.; Bellido Guerrero D.; Martinez Deben F.;
Vila Belmonte A.; Mediavilla Garcia J.D.; Romero Hinojosa J.A.; Martorell
Mateu E.; Cequier Fillat A.R.; Pinto Sala X.; Adroer Martori R.; Bueno
Diez M.; Lopez Cano C.; Worner Diz F.; Gonzalez Juanatey C.; Alvarez-Sala
Walther L.A.; De Dios Garcia Diaz J.; Garcia Puig J.; Jodar Gimeno E.;
Plaza Perez I.; Suarez-Fernandez C.; Tunon J.; Zamorano Gomez J.L.; Brito
Sanfiel M.A.; Escudier Villa J.M.; de Mora Martin M.; Dominguez Lopez M.;
Hernandez Garcia J.M.; Tinahones Madueno F.J.; Perez Paredes M.; Aracil
Villar J.; Barreda Gonzalez M.J.; Ripoll Vera T.V.; Tofe Povedano S.;
Sanchez Alvarez J.; Martinez Via L.; Robles Iniesta A.; Masana L.;
Vinyoles Bargallo E.; Calvo Gomez C.; Gonzalez Juanatey J.R.; Cruz
Fernandez J.M.; De La Cuesta Mayor C.; Duran Garcia S.; Jimenez Hernandez
M.D.; Morales Portillo C.; Muniz Grijalvo O.; De Castro R.; Taverna
Llaurado E.; Pons Amate J.M.; Terns Riera M.; Linderfalk C.; Curiac D.;
Saldeen-Nilehn K.; Koskinen P.; Khalili P.; Tortensson I.; Lindholm C.J.;
Luts A.; Koskinen P.T.; Gottsater A.; Persson B.E.; Mooe T.; Larnefeldt
H.; Boman K.; Crisby M.; Rasmanis G.; Tengmark B.O.; Witt N.; Hagstrom E.;
Viklund J.; Muller C.; Mach F.; Burnier M.; Nanchen D.; Wuerzner G.;
Banyai M.; Moccetti T.; Miserez A.R.; Bilz S.; Weber K.; Lai W.T.; Chang
K.C.; Ueng K.C.; Tsai W.C.; Chiang C.E.; Hou C.; Pei D.; Krittayaphong R.;
Kiatchoosakun S.; Srimahachota S.; Boonyavarakul A.; Jintapakorn W.; Gullu
H.; Onrat E.; Erkan A.F.; Demirci D.; Sari R.; Ceyhan C.; Ari H.; Araz M.;
Degertekin M.; Goktekin O.; Uresin A.Y.; Yigit Z.; Akdeniz B.; Comlekci
A.; Kayikcioglu M.; Sahin T.; Ozcan T.; Durakoglugil E.; Asamoah-Owusu N.;
Reed R.; Bakhai A.; Dixon L.; Sharma R.; Avornyo A.A.; Jones A.F.; Lip G.;
Clark R.; Banerjee M.; Wakeling J.; Arden C.; Blagden M.D.; Walukiewica
P.; Marshall A.; Maxwell T.G.; Gunstone A.E.; Kadr H.H.; Patle R.; Arif
I.; Jhund P.S.; McKaig G.; Douglas F.; Mierzejewski L.; Turner W.;
Sathyapalan T.; Ivan P.; Manoj A.; Rice S.; Collier D.J.; Nair D.R.; Thom
S.; Fiore G.; De Belder M.; Price D.; Sobolewska J.; Martin S.; Takhar A.;
Moriarty A.; Kondagunta V.; Myhill T.; Gibson J.M.; Cecil J.T.; Halcox J.;
Annamalai N.; Gorog D.A.; McCormack T.; Pegge N.; Field A.; Adams F.;
Klein J.J.; Busch R.S.; Bretton E.M.; Jaffrani N.; Salacata A.;
Assadourian A.; Gogia H.S.; Dyke C.K.; Rubenfire M.; Essandoh L.K.; Welker
J.A.; Ledesma G.; Lupovitch S.; Delgado J.P.; Hendrix E.L.; Quyyumi A.A.;
Riesenberg R.A.; Robertson D.G.; Weinstein D.L.; Weiss R.; Casaubon L.;
Gammon R.S.; Brar H.S.; Bittar G.D.; Guarnieri T.T.; Ince C.S.; Quraishi
A.M.; Saeed S.; Albert M.; Sotolongo R.P.; Bernard J.V.; Karlsbergg R.P.;
Lepor N.E.; Kirby W.E.; McLean B.; Ovalle F.; Townsend J.C.; Beckett P.L.;
Eaves W.B.; West S.H.; Kosinski E.J.; Zarich S.W.; Mahal S.S.; Maw K.;
Maynard K.M.; Chen J.C.; Gelormini J.; Gottlieb D.W.; Gabra N.W.; Narayan
P.; Sparks J.; Field J.C.; Willits V.L.; O'Steen M.B.; Pasquini J.A.;
Sensebrenner J.W.; Yarows S.A.; Hiotis L.; Jagielo T.J.; Levinson D.J.;
Diller P.M.; Kereiakes D.J.; Turner T.A.; Vincent S.; Camp A.D.; Denker
P.S.; Manning M.B.; Rocco M.B.; Stamps H.B.; Strader J.R.; Uusinarkaus
K.T.; Kennett J.D.; Leichter S.B.; McNeil D.L.; Schumacher D.R.; Chang
A.R.; Ellison H.S.; Updegrove J.D.; Hamroff G.S.; Kay J.S.; Marar I.E.;
Flores E.; Saini S.; Abdullah S.; Berk M.R.; Fordan S.; Joshi P.H.;
McCullough P.A.; Reynolds R.D.; Rosenstock J.; Sachson R.A.; Shammas N.;
Fishbein G.J.; Randall W.J.; Henderson D.A.; Nash M.L.; Barker B.A.; Cohen
S.S.; Seidman B.; Odekirk L.L.; Grillo R.S.; Martinez L.M.; Multani P.;
Alwine L.K.; McGarvey J.F.; Mollerus M.E.; Miller A.B.; Kotek L.W.;
Changlani M.; Zavaro S.H.; Munoz F.; Mehta P.M.; Helm R.J.; Farhat N.Z.;
Farsad R.; Raoof T.J.; Shultz J.H.; Geohas J.G.; Allaw M.A.; Dela Llana
A.; Gutmann J.E.; Inzerello A.T.; Alappat P.; George A.R.; Haddad T.M.;
Lillestol M.J.; Grodman R.; Peniston J.H.; Wadud K.; Garcia B.; Hamilton
M.E.; Lerman S.; Perloff D.E.; Graff A.; Saxena S.; Alvarado O.P.; Malik
A.; Reddy R.D.; Kinzfogl G.; Cornett G.M.; Norwood P.C.; Gilbert J.M.;
Willis J.G.; McGrew F.; Sharma S.; Castro M.A.; Cucher F.H.; Altafullah
I.M.; Khurana S.; Knutson T.J.; Kinnaman S.J.; Stuckey T.; Pudi K.K.;
Mayfield R.K.; Funk G.S.; Nixon W.A.; Dor I.; Boyett B.E.; Srivastava S.;
Elosegui A.M.; Isserman S.M.; Cheek H.B.; Promisloff S.D.; Tami L.F.; Zeig
S.; fitz-Patrick D.; Dave K.N.; Ahmad A.; Arain S.; Ballantyne C.M.; Doshi
A.; El Hafi S.E.; Feldman J.; Fragoso V.G.; Gilford T.; Hoffman A.S.;
Pouzar J.E.; Vivekananthan K.; Ansari S.H.; Strzinek R.A.; Crater T.A.;
Robinson J.G.; Fulmer J.J.; Patel A.M.; Pereira E.S.; Stich M.A.; Sultan
S.; Geskin G.; Ruoff G.E.; Gillespie E.; Bybee K.A.; Moriarty P.M.; Savin
V.; Agaiby J.M.; Melucci M.B.; Jantzi C.M.; Davidson E.; Smith W.B.;
Treasure C.B.; Wakefield P.H.; Deck K.; Edris M.A.; Gilmore R.M.; Seep
M.K.; Andersen J.L.; Detweiler R.O.; Rosenfeld J.C.; Strobl D.J.;
Steinhoff J.P.; Adams A.; Estevez R.; Molin C.J.; Kim C.Y.; Dy J.; Fox
K.E.; Farris N.R.; Wayne J.D.; Whitney R.T.; Randhawa P.M.; Mego D.M.;
MacDolnald L.; Caputo R.P.; Rigolosi R.; VanNatta B.; Pacheco T.R.;
El-Shahawy M.; Gonzalez E.J.; Guice M.J.; Cherlin R.S.; Bays H.E.;
Shoukfeh M.; Morris F.H.; Loy J.; Vora S.K.; Staab P.K.; Frisoli A.;
Kimmel M.A.; Cohen A.J.; Green C.B.; Whitlock L.; Butuk D.J.; McCartney
M.J.; Ables L.R.; Acosta R.; Alvarez J.G.; Barrera C.M.; Benitez O.;
Berenguer R.A.; Breton C.F.; Chiong R.; Delgado M.I.; Dufreny A.; Fialkow
J.A.; Franczek S.; Frias J.J.; Iglesias C.; Landron-Garcia L.; Llerena
S.N.; Martinez R.F.; Miranda A.A.; Morytko J.A.; Rodriguez I.J.; Sotolongo
R.; Suarez-Sarmiento A.; Terrelonge A.E.; Vaca C.E.; Venereo J.M.; Verdeza
C.; Zeno M.L.; Chilka S.; Felten W.R.; Hartman A.N.; Shayani S.S.; Duprez
D.; Knickelbine T.; Chambers J.D.; Cone C.L.; Broughton R.; Napoli M.C.;
Seaton B.L.; Smith S.K.; Reedy M.A.; Kesani M.K.; Nicol P.R.; Stringam
S.O.; Talano J.V.; Barnum O.; Desai V.; Montero M.; Jacks R.K.; Kostis
J.B.; Owen J.G.; Makam S.K.; Grosman I.; Underberg J.A.; Masri B.E.;
Peters S.S.; Serje J.; Lenhard M.J.; Glover R.; Paraboschi C.F.; Lim E.H.;
Connery L.; Kipgen W.; Bravo P.; DiGiovanna M.J.; Tayoum H.; Gabriel J.D.;
Ariani M.K.; Robinson M.F.; Clemens P.C.; Corder C.N.; Schifferdecker B.;
Tahirkheli N.K.; Hurling R.T.; Rendell M.S.; Shivaswamy V.; Madu I.J.;
Dahl C.F.; Ayesu K.; Kim C.; Barettella M.B.; Jamidar H.A.; Bloom S.A.;
Vora K.N.; Ong S.T.; Aggarwala G.; Sack G.; Blaze K.; Krichmar P.; Murcia
A.; Teltser M.; Villaman-Bencosme Y.; Fahdi I.E.; Williams D.G.; Lain
E.L.; Garcia H.L.; Karim S.N.; Francyk D.M.; Gordon M.B.; Palchick B.A.;
McKenzie M.E.; Gimness M.P.; Greiff J.; Ruiz-R L.; Vazquez-Tanus J.B.;
Schlager D.; Connelly T.; Soroka E.; Hastings W.L.; O'Dea D.J.; Purdy
D.A.; Jackson B.; Arcanese M.L.; Strain J.E.; Schmedtje J.F.; Davis M.G.;
Prasada S.; Scott D.L.; Vukotic G.; Akhtar N.; Larsen D.C.; Rhudy J.M.;
Zebrack J.S.; Bailey S.R.; Grant D.C.; Mora A.; Perez J.A.; Reyes R.G.;
Sutton J.C.; Brandon D.M.; First B.P.; Risser J.A.; Claudio J.;
Figueroa-Cruz W.L.; Sosa-Padilla M.A.; Tan A.E.; Traboulssi M.A.; Morcos
N.C.; Glaser L.A.; Bredlau C.E.; El Shahawy M.; Ramos M.J.; Kandath D.D.;
Kaluski E.; Akright L.; Rictor K.W.; Pluto T.M.; Hermany P.R.; Bellingar
B.; Clark G.B.; Herrod J.N.; Goisse M.; Hook M.; Barrington P.; Lentz
J.D.; Singal D.K.; Gleason G.P.; Lipetz R.S.; Schuchard T.N.; Bonner J.H.;
Forgosh L.B.; Lefebvre G.C.; Pierpoint B.E.; Radin D.M.; Stoller S.R.;
Segall N.; Shah S.A.; Ramstad D.S.; Nisnisan J.M.; Trippett J.M.; Benjamin
S.A.; Labissiere J.C.; Nashed A.N.; Maaieh M.; Aslam A.A.; Mandviwala M.;
Budoff M.J.; French W.J.; Vlach J.J.; DeStefano P.; Bayron C.J.; Fraser
N.J.; Sandberg J.H.; Fagan T.C.; Peart B.C.; Suryanarayana P.G.; Gupta
D.K.; Lee M.W.; Bertolet B.D.; Hartley P.A.; Kelberman M.; Behmanesh B.;
Buynak R.J.; Chochinov R.H.; Steinberg A.A.; Chandna H.; Bjasker K.R.;
Perlman R.L.; Ball E.M.; Pock J.; Singh S.; Baldari D.; Kaster S.; Lovell
J.P.; Horowitz B.S.; Gorman T.A.; Pham D.N.; Landzberg J.S.; Mootoo K.I.;
Moon E.; Krawczyk J.; Alfieri A.D.; Janik M.J.; Herrington D.M.;
Koilpillai R.N.; Waxler A.R.; Hoffman D.A.; Sahul Z.H.; Gumbiner B.; Cropp
A.; Fujita K.; Garzone P.; Imai K.; Levisetti M.; Plowchalk D.; Sasson S.;
Skaggs J.; Sweeney K.; Vincent J.
Institution
(Ridker, Glynn) Center for Cardiovascular Disease Prevention, Brigham and
Women's Hospital, Harvard Medical School, 900 Commonwealth Ave., Boston,
MA 02215, United States
(Revkin, Brunell, Curto, Masiukiewicz, Schwartz, Yunis, Shear) Pfizer, New
York, United States
(Amarenco) Paris-Diderot Sorbonne Paris Cite University, Paris, France
(Civeira) Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain
(Flather) University of East Anglia, Norwich, United Kingdom
(Soran) Central Manchester University Hospital, Manchester, United Kingdom
(Gregoire, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, Canada
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Kastelein) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Mosterd) Meander Medical Center, Amersfoort, Netherlands
(Karpov) Russian Cardiology Research and Production Center, Moscow,
Russian Federation
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich Heart Alliance, Munich, Germany
(Lorenzatti) Cordoba Hospital, Cordoba, Argentina
(Manga) University of the Witwatersrand, Johannesburg, South Africa
(Miller) University of Maryland, Baltimore, United States
(Murin) University of Comenius, Bratislava, Slovakia
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Sao
Paulo, Brazil
(Santos) Lipid Clinic Heart Institute, University of Sao Paulo Medical
School Hospital, Sao Paulo, Brazil
(Nissen) Cleveland Clinic Foundation, Cleveland, United States
(Ponikowski) Wroclaw Medical University, Wroclaw, Poland
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wright) Mayo Clinic, Rochester, MN, United States
(Vrablik) First Faculty of Medicine, Charles University, Prague, Czechia
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Bococizumab is a humanized monoclonal antibody that inhibits
proprotein convertase subtilisin- kexin type 9 (PCSK9) and reduces levels
of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the
efficacy of bococizumab in patients at high cardiovascular risk. METHODS
In two parallel, multinational trials with different entry criteria for
LDL cholesterol levels, we randomly assigned the 27,438 patients in the
combined trials to receive bococizumab (at a dose of 150 mg)
subcutaneously every 2 weeks or placebo. The primary end point was
nonfatal myocardial infarction, nonfatal stroke, hospitalization for
unstable angina requiring urgent revascularization, or cardiovascular
death; 93% of the patients were receiving statin therapy at baseline. The
trials were stopped early after the sponsor elected to discontinue the
development of bococizumab owing in part to the development of high rates
of antidrug antibodies, as seen in data from other studies in the program.
The median follow-up was 10 months. RESULTS At 14 weeks, patients in the
combined trials had a mean change from baseline in LDL cholesterol levels
of -56.0% in the bococizumab group and +2.9% in the placebo group, for a
between-group difference of -59.0 percentage points (P<0.001) and a median
reduction from baseline of 64.2% (P<0.001). In the lower-risk,
shorter-duration trial (in which the patients had a baseline LDL
cholesterol level of >=70 mg per deciliter [1.8 mmol per liter] and the
median follow-up was 7 months), major cardiovascular events occurred in
173 patients each in the bococizumab group and the placebo group (hazard
ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P = 0.94). In the
higher-risk, longer-duration trial (in which the patients had a baseline
LDL cholesterol level of >=100 mg per deciliter [2.6 mmol per liter] and
the median follow-up was 12 months), major cardiovascular events occurred
in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to
0.97; P = 0.02). The hazard ratio for the primary end point in the
combined trials was 0.88 (95% CI, 0.76 to 1.02; P = 0.08). Injection-site
reactions were more common in the bococizumab group than in the placebo
group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS In two randomized trials
comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no
benefit with respect to major adverse cardiovascular events in the trial
involving lower-risk patients but did have a significant benefit in the
trial involving higher-risk patients.<br/>Copyright &#xa9; 2017
Massachusetts Medical Society. All rights reserved.

<100>
[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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health,
Inc.

<101>
Accession Number
625903383
Title
Intracardiac vs transesophageal echocardiography for percutaneous left
atrial appendage occlusion: A meta-analysis.
Source
Journal of Cardiovascular Electrophysiology. 30 (4) (pp 461-467), 2019.
Date of Publication: April 2019.
Author
Velagapudi P.; Turagam M.K.; Kolte D.; Khera S.; Gupta T.; Garg J.; Abbott
J.D.; George I.; Khalique O.; Vahl T.; Nazif T.; Lakkireddy D.; Kodali S.;
Sommer R.
Institution
(Velagapudi, Khera, George, Khalique, Vahl, Nazif, Kodali, Sommer)
Structural Heart and Valve Center, Center for Interventional Vascular
Therapy, Division of Cardiology, Columbia University Medical Center, New
York, NY, United States
(Turagam, Garg) Helmsley Centre for Cardiac Electrophysiology, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Kolte, Abbott) Division of Cardiovascular Medicine, Brown University,
Providence, RI, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Overland Park, KS, United States
(Gupta) Division of Cardiovascular Medicine, Albert Einstein College of
Medicine/Montefiore Medical Center, Bronx, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Percutaneous left atrial appendage closure (LAAC) is
typically performed utilizing transesophageal echocardiography (TEE) and
fluoroscopy. Intracardiac echocardiography (ICE) can be a suitable
alternative to guide implantation. Given the limited data, we performed a
meta-analysis of all studies that compared ICE vs TEE for percutaneous
LAAC. <br/>Method(s): A comprehensive literature search was performed in
PubMed, Embase, Scopus, Google Scholar, and major scientific conference
sessions for published abstracts and manuscripts until 1 August 2018.
Studies reporting clinical outcomes comparing TEE vs ICE for endocardial
LAAC in human subjects aged greater than or equal to 18 years were
included. Two investigators independently extracted the data and
individual quality assessment was performed. The analysis was performed
using Cochrane Collaboration software, RevMan 5.3. <br/>Result(s): Five
eligible studies consisting of 1157 patients (ICE-391 patients and TEE-766
patients) were included. Four studies were retrospective and one was
prospective, nonrandomized. Two studies included Watchman, two included
the Amplatzer Cardiac Plug/Amulet device, and one included both devices.
There was no significant difference in CHA2DS2VASC or HAS-BLED scores
between both groups. There was no significant difference in acute
procedural success between ICE vs TEE (risk ratio, 1.01; 95% CI,
0.99-1.04; P = 0.24). There was no significant difference in fluoroscopy
time (mean difference [MD], 1.84 minutes; 95% CI, 0.59-4.27; P = 0.14) and
total procedure time (MD, -5.06 minutes; 95% CI, -24.6-14.4; P = 0.61)
between both groups. There was also no significant difference in
complications including pericardial tamponade, device embolization, and
stroke between both groups. <br/>Conclusion(s): In our meta-analysis, ICE
was as effective as TEE during percutaneous LAAC.<br/>Copyright &#xa9;
2018 Wiley Periodicals, Inc.

<102>
Accession Number
2001214205
Title
Systematic review of native and graft-related aortic infection outcome
managed with orthotopic xenopericardial grafts.
Source
Journal of Vascular Surgery. 69 (2) (pp 614-618), 2019. Date of
Publication: February 2019.
Author
Hostalrich A.; Ozdemir B.A.; Sfeir J.; Solovei L.; Alric P.; Canaud L.
Institution
(Hostalrich, Ozdemir, Sfeir, Solovei, Alric, Canaud) Department of
Thoracic and Vascular Surgery, Hopital A de Villeneuve, Montpellier,
France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Limited data are available on the use of xenopericardium in the
treatment of native and graft-related aortic infections. The aim of this
review was to assess outcomes of neoaortic reconstruction using
xenopericardium in this challenging group of patients. <br/>Method(s):
Studies involving xenopericardial graft reconstruction to treat native and
aortic graft infections were systematically searched and reviewed (Embase,
Medline, and Cochrane databases) for the period of January 2007 to
December 2017. <br/>Result(s): A total of 4 studies describing 71 patients
treated for aortic graft (n = 54) and native aortic (n = 17) infections
were included; 25 patients (35%) were operated on in an acute setting. The
technical success rate was 100%. The mean 30-day mortality was 25% (range,
7.7%-31%). Only one death (1.4%) was linked to the operator-made
pericardial tube graft (acute postoperative bleeding from proximal
anastomosis). Septic multiorgan failure was the most common cause of
perioperative death (72% [13/18]). Among the 53 patients who survived,
only 3 presented with recurrent infection (5.7%), so 70.4% of patients
were alive after intervention without evidence of infection (50/71).
During follow-up, 2 false aneurysms (3.7% [2/53]), 1 early rupture (1.4%
[1/71]), and 2 cases (3.7% [2/53]) of late rupture were reported. Other
causes of late deaths unrelated to the aortic xenopericardial repair were
not reported in the different series. The early reintervention rate was
1.4% (1/71), treated by open repair for rupture. The late reintervention
rate was 7.5% (4/53) with thoracic endovascular aortic repair in three
patients (one false aneurysm and two ruptures) and open repair in one
patient (one false aneurysm). There were no cases of early or late graft
thrombosis. One-year mortality rate was 38% but only 4.2% were related to
the aortic repair using orthotopic xenopericardium (one early and two late
ruptures). <br/>Conclusion(s): These data confirm the high morbidity of
native and graft-related aortic infections and provide insight into the
results of orthotopic xenografts as a treatment alternative. Larger series
and longer follow-up will be required to compare the role of operator-made
pericardial tube graft with other treatment options in infected
fields.<br/>Copyright &#xa9; 2018 Society for Vascular Surgery

<103>
Accession Number
625852891
Title
A systematic review of isolated radial artery harvesting as a conduit for
lower limb bypass grafting.
Source
Vascular. 27 (2) (pp 224-230), 2019. Date of Publication: 01 Apr 2019.
Author
Wee I.; Choong A.M.T.L.
Institution
(Wee, Choong) SingVaSC, Singapore Vascular Surgical Collaborative,
Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Whilst autologous vein conduits have been heralded as the
first-line approach for patients undergoing lower limb bypass grafting
procedures, patients with peripheral arterial occlusive disease may have
exhausted venous options given prior use for cardiac surgery, varicose
vein surgery, or lower limb revascularization. Hence, the use of a radial
artery graft may serve as a viable alternative. <br/>Method(s): The
systematic review was performed in accordance to the Preferred Reporting
Items for Systematic Review and Meta-analysis guidelines. An electronic
search was performed on the following databases: Medline (via PubMed);
EMBASE; Cochrane library to search for relevant publications. A narrative
analysis was conducted. <br/>Result(s): Four publications were included in
this review including two retrospective cohort studies, one case series,
and one case report, with a total of 43 patients. The most common
indication for lower limb bypass grafting was critical limb ischemia, and
the radial artery was chosen as graft conduit, most commonly due to the
absence of suitable arm or leg vein. There was one case of 30-day
mortality and 11 reinterventions. <br/>Conclusion(s): Despite the
encouraging results, the paucity of high-quality studies prevents the
establishment of any firm conclusion. This warrants the need for
appropriately conducted randomized controlled trials to compare the radial
artery graft to autologous vein grafts and prosthetic grafts for lower
limb bypass grafting.<br/>Copyright &#xa9; The Author(s) 2018.

<104>
Accession Number
622485032
Title
Effect of levosimendan on clinical outcomes in adult patients undergoing
cardiac surgery: A meta-analysis of randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 26 (6) (pp 1016-1026),
2018. Date of Publication: 01 Jun 2018.
Author
Zhou X.; Hu C.; Xu Z.; Liu P.; Zhang Y.; Sun L.; Wang Y.; Gao X.
Institution
(Zhou, Xu, Liu, Zhang, Wang) Department of Intensive Care Unit, Ningbo No.
2 Hospital, Ningbo, Zhejiang 315000, China
(Hu) Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou, China
(Sun) Department of Geriatrics, Ningbo No. 2 Hospital, Ningbo, China
(Gao) Department of Cardiology, Hangzhou First People's Hospital,
Hangzhou, China
Publisher
Oxford University Press
Abstract
It is currently unknown whether levosimendan can improve clinical outcomes
in patients undergoing cardiac surgery. This meta-analysis aimed to assess
the effect of levosimendan on mortality and the duration of intensive care
unit (ICU) and hospital stay in adult patients undergoing cardiac surgery.
A comprehensive search for eligible articles was conducted in PubMed, OVID
and Cochrane databases of clinical trials and the Web of Science from
database inception to August 2017. Stata/SE 11.0 was used to calculate the
pooled odds ratio for postoperative mortality and the pooled standardized
mean difference (SMD) for the duration of ICU stay and hospital stay. A
total of 30 randomized controlled trials were included in the final
analysis; the pooled results indicated that perioperative administration
of levosimendan was associated with a reduction in postoperative mortality
[5.8% vs 8.5%; odds ratio 0.66, 95% confidence interval 0.50-0.86, P =
0.002; I 2 = 17.1%; 25 trials; 3239 patients] and length of ICU stay (SMD
-0.32, 95% CI -0.58 to 0.06, P = 0.017; I 2 = 88.0%; 23 trials; 2536
patients) compared with the control group but not in length of hospital
stay (SMD -0.41, 95% CI -0.89 to 0.07, P = 0.094; I 2 = 95.9%; 18 trials;
2047 patients). A subanalysis was conducted for trials published after
2015, and it suggested that levosimendan could not reduce the
postoperative mortality (odds ratio = 0.91, 95% CI 0.63-1.31, P = 0.626; I
2 = 0.9%), length of ICU stay (SMD -0.03, 95% CI -0.32 to 0.27, P = 0.850;
I 2 = 81.2%) or length of hospital stay (SMD 0.06, 95%CI -0.43 to 0.54, P
= 0.821; I 2 = 91.3%). To summarize, the evidence from studies published
in the last 3 years indicated that perioperative administration of
levosimendan was not associated with better clinical outcomes in adult
patients undergoing cardiac surgery.<br/>Copyright &#xa9; The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<105>
Accession Number
624465199
Title
Surgical ablation of atrial fibrillation: A systematic review
andmeta-analysis of randomized controlled trials.
Source
Europace. 20 (9) (pp 1442-1450), 2018. Date of Publication: 2018.
Author
McClure G.R.; Belley-Cote E.P.; Jaffer I.H.; Dvirnik N.; An K.R.; Fortin
G.; Spence J.; Healey J.; Singal R.K.; Whitlock R.P.
Institution
(McClure, An) Michael G. DeGroote School of Medicine, McMaster University,
1280 Main St W, Hamilton, ON L8S 4L8, Canada
(McClure, Belley-Cote, Dvirnik, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Healey) Department of Medicine, McMaster University, 1280
Main St W, Hamilton, ON L8S 4L8, Canada
(Belley-Cote, Dvirnik, Healey, Whitlock) Population Health Research
Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
(Belley-Cote, Fortin) Department of Medicine, Universite de Sherbrooke,
2500 Boulevard de l'Universite, Sherbrooke, QC J1K 2R1, Canada
(Jaffer) Thrombosis and Atherosclerosis Research Institute (TaARI),
McMaster University, 20 Copeland Ave, Hamilton, ON L8L 2X2, Canada
(Jaffer, Dvirnik, Whitlock) Department of Cardiac Surgery, McMaster
University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
(Spence) Department of Anesthesia, McMaster University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Singal) Department of Surgery, University of Manitoba, 66 Chancellors
Cir, Winnipeg, MB R3T 2N2, Canada
(Singal) I.H. Asper Clinical Research Institute, St. Boniface General
Hospital, 69 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Publisher
Oxford University Press
Abstract
Aims: The aim of this review was to assess the effect of concomitant
surgical atrial fibrillation (AF) ablation on postoperative freedom from
AF and patient-important outcomes. <br/>Methods and Results: We searched
Cochrane CENTRAL, MEDLINE, and EMBASE databases from inception to May 2016
for randomized controlled trials (RCTs) evaluating surgical AF ablation
using any lesion set vs. no surgical AF ablation in adults with AF
undergoing cardiac surgery. We performed screening, risk-of-bias
evaluation, and data collection independently and in duplicate. We
evaluated risk of bias with the modified Cochrane tool, quality of
evidence using GRADE framework, and pooled data with a random-effects
model. Of the 23 included studies, only one was considered at low risk of
bias. Surgical AF ablation was associated with more freedom from AF at 12
months [relative risk (RR) = 2.32, 95% confidence interval (CI) 1.92-2.80;
P < 0.001, low quality]. However, no significant difference was seen in
mortality (RR = 1.07, 95% CI 0.72-1.52; P = 0.41, moderate quality),
stroke (RR = 1.19, 95% CI 0.59-2.39; P = 0.63, moderate quality), or
pacemaker implantation (RR = 1.28, 95% CI 0.85-1.95; P = 0.24, high
quality). Comparing biatrial and left-sided lesion sets showed no
difference in mortality (P-interaction = 0.60) or stroke (Pinteraction =
0.12). At 12 months, biatrial procedures led to more freedom from AF (RR =
2.80, 95% CI 2.13-3.68; P < 0.0001) when compared with left-sided ablation
(RR = 2.00, 95% CI 1.68-2.39; P < 0.0001) (P-interaction = 0.04) Biatrial
procedures appear to increase the risk for pacemaker (RR = 2.68, 95% CI
1.41-5.11; P = 0.002) compared with no ablation while left-sided ablation
does not (RR = 1.08, 95% CI 0.67-1.74; P = 0.76) (P-interaction = 0.03).
<br/>Conclusion(s): Surgical AF ablation during cardiac surgery improves
freedom from AF. However, impact on patient-important outcomes including
mortality and stroke has not shown statistical significance in current RCT
evidence. Biatrial compared with left-sided lesion sets showed no
difference in mortality or stroke but were associated with significantly
increased freedom from AF and risk for pacemaker
requirement.<br/>Copyright &#xa9; 2017 The Author(s).

<106>
Accession Number
627374805
Title
The impact of preoperative frailty status on outcomes after transcatheter
aortic valve replacement: An update of systematic review and
meta-analysis.
Source
Medicine (United States). 97 (51) (no pagination), 2018. Article Number:
e13475. Date of Publication: December 2018.
Author
Huang L.; Zhou X.; Yang X.; Yu H.
Institution
(Huang, Zhou, Yu) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu 610041, China
(Yang) Department of Obstetrics and Gynecology, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Frailty is a syndrome of impaired physiologic reserve and
decreased resistance to stressors and can often be seen in high-risk
patients undergoing transcatheter aortic valve replacement (TAVR).
Preoperative frailty status is thought to be related to adverse outcomes
after TAVR. We conducted this systematic review and meta-analysis to
determine the impact of preoperative frailty status on outcomes among
patients after TAVR. <br/>Method(s): PubMed, Embase, and the Cochrane
Library were searched for relevant studies through January 2018. Fourteen
articles (n = 7489) meeting the inclusion criteria were finally included.
Possible effects were calculated using meta-analysis. <br/>Result(s): The
pooled risk ratios (RRs) of late mortality (>6 months) and acute kidney
injury after TAVR in frail group were 2.81 (95% confidence interval (CI)
1.90-4.15, P < .001, I²= 84%) and 1.41 (95% CI 1.02-1.94, P =
.04, I²= 24%), respectively. Compared with non-frail group,
significantly higher incidence of 30-day mortality (RR 2.03, 95% CI
1.63-2.54, P < .001, I²= 0%) and life threatening or major
bleeding after TAVR (RR 1.48, 95% CI 1.20-1.82, P < .001, I²=
14%) was found in frail group. There was no significant association
between frailty and incidence of stroke after TAVR (RR 0.93, 95% CI
0.53-1.63, P = .80, I²= 0%). <br/>Conclusion(s): Preoperative
frailty status is proved to be significantly associated with poor outcomes
after TAVR. Our findings may remind doctors in the field of a more
comprehensive preoperative evaluation for TAVR candidates. More
well-designed and large-sample sized prospective studies are further
needed to figure out the best frailty assessment tool for patients
undergoing TAVR.<br/>Copyright &#xa9; 2018 the Author(s). Published by
Wolters Kluwer Health, Inc. This is an open access article distributed
under the terms of the Creative Commons Attribution-Non Commercial License
4.0 (CCBY-NC), where it is permissible to download, share, remix,
transform, and buildup the work provided it is properly cited. The work
cannot be used commercially without permission from the journal.

<107>
[Use Link to view the full text]
Accession Number
627374780
Title
Efficacy of mineralocorticoid receptor antagonists in postmyocardial
infarction patients with or without left ventricular dysfunction: A
meta-analysis of randomized controlled trials.
Source
Medicine (United States). 97 (51) (no pagination), 2018. Article Number:
e13690. Date of Publication: December 2018.
Author
Xu Y.; Qiu Z.; Yang R.; Wu Y.; Cheng X.
Institution
(Xu, Yang, Wu, Cheng) Department of Cardiovascular, Institute of
Cardiovascular Disease, Second Affiliated Hospital of Nanchang University,
Nanchang, Jiangxi 330006, China
(Qiu) Department of Orthopedics, Second Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: There is heated debate about the benefits of using
mineralocorticoid receptor antagonists (MRAs) in addition to standard
therapy in patients admitted for myocardial infarction (MI) with or
without left ventricular dysfunction (LVD). <br/>Method(s): Randomized
controlled trials (RCTs) were scanned by a formal search of electronic
databases (PubMed, EMBASE, Cochrane Library, Ovid, and clinical trials)
from their inception to April 2018. A meta-analysis was conducted using
Review Manager 5.3 to identify studies reporting the efficacy of MRAs use
in post-MI patients with or without LVD. <br/>Result(s): Thirteen RCTs
involving 11,365 individuals were eligible for this study. MRAs treatment
reduced all-cause mortality by 16%, cardiovascular death by 16%, and death
from heart failure (HF) by 22% in post-MI patients. MRAs use reduced
all-cause mortality by 13% and cardiovascular death by 15% in post-MI
patients with LVD, but there was no significant difference in all-cause
mortality and cardiovascular death in post-MI patients without LVD
(relative ratios [RR] 0.83, 95% confidence interval [CI] 0.26-2.69, P =
.76, I² = 0%; RR 1.01, 95% CI 0.33-3.09, P = .99, I²
= 0%). In 6 RCTs involving post-MI patients, MRAs treatment had a
significant effect on improving left ventricular ejection fraction (LVEF)
(mean difference 3.33, 95% CI 0.91-5.75, P = .007, I² = 94%).
Patients treated with MRAs did not show a decrease in recurrent MI or
repeat revascularization compared with patients treated without MRAs (RR
0.95, 95% CI [0.80-1.12], P = .54, I² = 0%; RR 1.09, 95% CI
[0.79-1.50], P = .61, I² = 0%). However, MRAs treatment
significantly increased the incidence of hyperkalemia compared with
patients treated without MRAs (RR 2.05, 95% CI [1.60, 2.61], P < .00001,
I² = 49%). <br/>Conclusion(s): MRAs treatment reduced all-cause
mortality, cardiovascular death, and death from HF in post-MI patients.
MRAs treatment also demonstrated a significant improvement in LVEF. MRAs
reduced cardiovascular death and all-cause mortality in patients with LVD.
Eplerenone significantly reduced all-cause mortality and cardiovascular
death in post-MI patients. However, MRAs failed to show any cardiovascular
benefit in post-MI patients without LVD.<br/>Copyright &#xa9; 2018 the
Author(s). Published by Wolters Kluwer Health, Inc. This is an open access
article distributed under the Creative Commons Attribution License 4.0
(CCBY), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.

<108>
[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.
<br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc.

<109>
[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. <br/>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. <br/>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.
<br/>Conclusion(s): Transcatheter closure has more benefit than
mini-invasive closure and open-heart surgical repair to treat
pmVSDs.<br/>Copyright &#xa9; 2018 the Author(s). Published by Wolters
Kluwer Health, Inc. This is an open access article distributed under the
terms of the Creative Commons Attribution-Non Commercial-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.

<110>
[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. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2018 the Author(s). Published by
Wolters Kluwer Health, Inc.

<111>
[Use Link to view the full text]
Accession Number
627376042
Title
Prevalence and risk factors of atrial fibrillation during lung and
esophageal surgery: A Prospective observational study.
Source
Medicine (United States). 97 (30) (no pagination), 2018. Article Number:
e11549. Date of Publication: 01 Jul 2018.
Author
Xie K.; Zhang W.; Fang J.; Guo Y.; Fang M.; Ding Z.; Hu Y.; Yu W.; Li F.
Institution
(Xie) Third Affiliated Hospital, Soochow University, Changzhou, China
(Xie, Zhang, Fang, Guo, Fang, Ding) Department of Anesthesiology, Zhejiang
Cancer Hospital, Hangzhou, China
(Hu) Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou,
China
(Yu) Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital,
No 225 Changhai Road, Shanghai 200438, China
(Li) Department of Anesthesiology, Qinghai Provincial People's Hospital,
Xining, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this prospective observational study was to screen for risk
factors of intraoperative atrial fibrillation (AF) during noncardiac
thoracic surgery. The study was conducted as a single-institution study in
Zhejiang Cancer Hospital, Hangzhou, China All the participants were
patients with cancer scheduled for thoracotomy.
ThisstudywasconductedfromJuly2013toAugust2016andincluded144patientsschedul
edfor thoracotomyundergeneralanesthesia.
Wecollectedthepatients'demographicandperioperativemedicaldatainourhospital
.AFwasdiagnosedusingelectrocardiography(ECG),on the basis of the presence
of characteristic ECG features of AF by one or more ECG leads for at least
30seconds. Of the participants, 144 completed the study and 18 developed
intraoperative AF. Higher percentages of subjects in the AF group than in
the non-AF group had histories of chemotherapy (P=.014) and alcohol
consumption (P=.034) before surgery. The AF group had a lower mean body
mass index (P=.019), significantly higher mean heart rate (P<.001), and
lower tidal volume (P=.01) than the non-AF group. After the logistic
regression analysis, only alcohol consumption (odds ratio [OR]=5.279; 95%
confidence interval [CI]: 1.432-19.467), history of chemotherapy
(OR=4.019; 95% CI: 1.504-15.334), and high heart rate (OR=1.093; 95% CI:
1.033- 1.156) during 1-lung ventilation were identified as the risk
factors of AF during lung and esophageal surgeries. The incidence of
intraoperative AF during noncardiac thoracic surgery was 12.5%. Alcohol
consumption, history of chemotherapy, and high heart rate during 1-lung
ventilation were the risk factors related to intraoperative
AF.<br/>Copyright &#xa9; 2018 the Author(s).

<112>
Accession Number
627513114
Title
The effects of five days of intensive preoperative inspiratory muscle
training on postoperative complications and outcome in patients having
cardiac surgery: a randomized controlled trial.
Source
Clinical rehabilitation. 33 (5) (pp 913-922), 2019. Date of Publication:
01 May 2019.
Author
Chen X.; Hou L.; Zhang Y.; Shao B.; Yuan B.; Li J.; Li M.; Cheng H.; Teng
L.; Guo M.; Wang Z.; Chen T.; Liu J.; Liu Y.; Liu Z.; Liu X.; Guo Q.
Institution
(Chen, Hou, Zhang, Liu, Shao, Yuan, Li, Guo) Department of Rehabilitation
Medicine, TEDA International Cardiovascular Hospital, Cardiovascular
Clinical College of Tianjin Medical University, Tianjin, China
(Chen, Hou, Zhang, Guo) Department of Rehabilitation Medicine, Tianjin
Medical University, Tianjin, China
(Li, Cheng, Teng, Guo, Wang, Chen, Liu, Liu, Liu, Liu) Department of
Cardiac Surgery, TEDA International Cardiovascular Hospital,
Cardiovascular Clinical College of Tianjin Medical University, Tianjin,
China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the prophylactic efficacy of short-term intensive
preoperative inspiratory muscle training on the incidence of postoperative
pulmonary complications in patients scheduled for cardiac surgery. DESIGN:
Single-blind, randomized controlled pilot study. SETTING: TEDA
International Cardiovascular Hospital, China. SUBJECTS: In total, 197
subjects aged 50years scheduled for cardiac surgery were selected.
INTERVENTION: The intervention group ( n=98) received five days of
preoperative inspiratory muscle training on top of the usual care received
by the patients in the control group ( n=99). MAIN MEASURES: The primary
outcome variable was the occurrence of postoperative pulmonary
complications. The secondary outcome variables were inspiratory muscle
strength, lung function and length of hospitalization. <br/>RESULT(S):
After cardiac surgery, a total of 10 (10.2%) of the 98 patients in the
intervention group and 27 (27.3%) of 99 patients in the control group had
postoperative pulmonary complications (risk ratio, 0.23; 95% confidence
interval (CI), 0.09-0.58, P=0.002). The study revealed that, compared with
the control group, the intervention group had a significant increase in
inspiratory muscle strength (by 10.48cmH2O, P<0.001), forced expiratory
volume in the first second of expiration (FEV1) %predicted (by 3.75%,
P=0.030), forced vital capacity (FVC) %predicted (by 4.15%, P=0.008) and
maximal voluntary ventilation (MVV) %predicted (by 6.44%, P=0.034). Length
of hospital stay was 7.51 (2.83) days in the intervention group and 9.38
(3.10) days in the control group ( P=0.039). <br/>CONCLUSION(S): A
five-day intensive pattern of preoperative inspiratory muscle training
reduced the incidence of postoperative pulmonary complications and
duration of postoperative hospitalization in patients undergoing cardiac
surgery.

<113>
Accession Number
2001934144
Title
Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: A
Systematic Review.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2019. Date of Publication: 2019.
Author
Waskowski J.; Pfortmueller C.A.; Erdoes G.; Buehlmann R.; Messmer A.S.;
Luedi M.M.; Schmidli J.; Schefold J.C.
Institution
(Waskowski, Pfortmueller, Messmer, Schefold) Department of Intensive Care
Medicine, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Waskowski, Erdoes, Luedi) Department of Anaesthesiology and Pain
Medicine, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Buehlmann, Schmidli) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background: Post-operative acute kidney injury (AKI)is a
frequent peri-operative complication that negatively affects morbidity and
mortality. Mannitol is frequently used peri-operatively for renal
protection, although evidence for its use is ambiguous. A systematic
review was conducted to clarify whether there is evidence supporting
peri-operative mannitol administration for the prevention of
post-operative AKI. <br/>Method(s): A systematic literature search was
performed in MEDLINE/Pubmed, Embase, the Cochrane Library, Clinical Trials
registry, and the Cochrane Central Register of Controlled Trials
(CENTRAL). Eligibility criteria were (i)population (studies involving
adult patients undergoing surgery or a related intervention);
(ii)intervention (intravenous mannitol administered in either the pre- or
intra-operative period with comparison to controls); and (iii)predefined
outcomes (post-operative AKI or respective renal end points/surrogates).
<br/>Result(s): In total, 1,538 articles published between January 1990
and October 2018 were identified. After checking for eligibility, 22
studies, including 17 prospective and/or randomised controlled trials and
five retrospective studies, were included. The investigations involved
various fields of surgery, such as aortic surgery, cardiac surgery with
cardiopulmonary bypass, and urological procedures, including partial
nephrectomy. Significant heterogeneity, limited sample size, and mostly
short follow up periods were noted. <br/>Conclusion(s): Given the
available evidence, the peri-operative use of mannitol to prevent AKI
cannot be considered an evidence based intervention in cardiac surgery,
partial nephrectomy, and/or other major surgery. Further research is
required with a focus on patients at high risk of post-operative
AKI.<br/>Copyright &#xa9; 2019 European Society for Vascular Surgery

<114>
Accession Number
2001926871
Title
Patient Blood Management for Neonates and Children Undergoing Cardiac
Surgery: 2019 NATA Guidelines.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Faraoni D.; Meier J.; New H.V.; Van der Linden P.J.; Hunt B.J.
Institution
(Faraoni) Division of Cardiac Anesthesia, Department of Anesthesia and
Pain Medicine, The Hospital for Sick Children, University of Toronto,
Toronto, Canada
(Meier) Clinic of Anesthesiology and Critical Care Medicine, Kepler
University Clinic, Johannes Kepler University Linz, Linz, Austria
(New) NHS Blood and Transplant/Imperial College London, London, United
Kingdom
(Van der Linden) Department of Anesthesiology, Centre Hospital
Universitaire Brugmann, Hopital Universitaire Des Enfants Reine Fabiola,
Universite Libre de Bruxelles, Brussels, Belgium
(Hunt) Thrombosis & Haemophilia Centre, St Thomas' Hospital, London,
United Kingdom
Publisher
W.B. Saunders
Abstract
Pediatric cardiac surgery is associated with a substantial risk of
bleeding, frequently requiring the administration of allogeneic blood
products. Efforts to optimize preoperative hemoglobin, limit blood
sampling, improve hemostasis, reduce bleeding, correct coagulopathy, and
incorporate blood sparing techniques (including restrictive transfusion
practices) are key elements of patient blood management (PBM) programs,
and should be applied to the pediatric cardiac surgical population as
across other disciplines. Many guidelines for implementation of PBM in
adults undergoing cardiac surgery are available, but evidence regarding
the implementation of PBM in children is limited to systematic reviews and
specific guidelines for the pediatric cardiac population are missing. The
objective of the task force from the Network for the Advancement of
Patient Blood Management, Haemostasis and Thrombosis (NATA,
www.nataonline.com) is to provide evidence-based recommendations regarding
anemia management and blood transfusion practices in the perioperative
care of neonates and children undergoing cardiac surgery, and to highlight
potential areas where additional research is urgently
required.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<115>
Accession Number
2001926721
Title
Comparison of early and midterm outcomes after transsubclavian/axillary
versus transfemoral, transapical, or transaortic transcatheter aortic
valve implantation.
Source
Heart and Lung. (no pagination), 2019. Date of Publication: 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611,
Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Outcomes after transsubclavian/transaxillary
(TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been
unclear. <br/>Objective(s): To compare outcomes after TSc/TAx-TAVI versus
transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI,
we performed meta-analysis of currently available studies. <br/>Method(s):
Studies considered for inclusion met the following criteria: the study
population was patients undergoing TAVI; patients were assigned to
TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of
postprocedural early (30-day or in-hospital) or late (including early)
outcomes was reported. An odds or hazard ratio of each early or late
outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other
approach was extracted from each individual study and combined in the
random-effects model. <br/>Result(s): Our search identified 15 eligible
reports from 12 studies including 10,528 patients. Pooled analysis of
early all-cause mortality demonstrated a statistically significant
reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or
TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation
demonstrated a statistically significant increase after TSc/TAx-TAVI
compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled
analysis of midterm all-cause mortality demonstrated a statistically
significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007).
<br/>Conclusion(s): Early all-cause mortality was lower after TSc/TAx-TAVI
than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent
after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause
mortality was higher after TSc/TAx-TAVI than TF-TAVI.<br/>Copyright &#xa9;
2019 Elsevier Inc.