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<1>
Accession Number
625544649
Title
Glycaemic efficacy and safety of linagliptin compared to a basal-bolus
insulin regimen in patients with type 2 diabetes undergoing non-cardiac
surgery: A multicentre randomized clinical trial.
Source
Diabetes, Obesity and Metabolism. 21 (4) (pp 837-843), 2019. Date of
Publication: April 2019.
Author
Vellanki P.; Rasouli N.; Baldwin D.; Alexanian S.; Anzola I.; Urrutia M.;
Cardona S.; Peng L.; Pasquel F.J.; Umpierrez G.E.; Bakhtiari H.; Wang
C.L.; Jones J.; Modzelewski K.; Ensminger E.; Haw J.S.; Fayfman M.; Ramos
C.; Gomez P.
Institution
(Vellanki, Anzola, Urrutia, Cardona, Pasquel, Umpierrez) Division of
Endocrinology, Metabolism and Lipids, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
(Rasouli) Division of Endocrinology, Metabolism and Diabetes, Department
of Medicine, University of Colorado-Denver, Denver, CO, United States
(Baldwin) Division of Endocrinology, Department of Medicine, Rush
University Medical Center, Chicago, IL, United States
(Alexanian) Division of Endocrinology, Diabetes and Nutrition, Department
of Medicine, Boston University, Boston, MA, United States
(Peng) Department of Biostatistics, Rollins School of Public Health, Emory
University, Atlanta, GA, United States
(Bakhtiari, Wang) University of Colorado, Division of Endocrinology,
United States
(Jones) Rush University, Division of Endocrinology, United States
(Modzelewski, Ensminger) Boston University, Division of Endocrinology,
United States
(Haw, Fayfman, Ramos, Gomez) Emory University, Division of Endocrinology,
Metabolism and Lipids, United States
Publisher
Blackwell Publishing Ltd
Abstract
Aims: The use of incretin-based therapy, rather than or complementary to,
insulin therapy is an active area of research in hospitalized patients
with type 2 diabetes (T2D). We determined the glycaemic efficacy and
safety of linagliptin compared to a basal-bolus insulin regimen in
hospitalized surgical patients with T2D. Material(s) and Method(s):
This prospective open-label multicentre study randomized T2D patients
undergoing non-cardiac surgery with admission blood glucose (BG) of 7.8 to
22.2 mmol/L who were under treatment with diet, oral agents or total
insulin dose (TDD) <= 0.5 units/kg/day to either linagliptin (n = 128)
daily or basal-bolus (n = 122) with glargine once daily and rapid-acting
insulin before meals. Both groups received supplemental insulin for BG >
7.8 mmol/L. The primary endpoint was difference in mean daily BG between
groups. Result(s): Mean daily BG was higher in the linagliptin group
compared to the basal-bolus group (9.5 +/- 2.6 vs 8.8 +/- 2.3 mmol/L/dL, P
= 0.03) with a mean daily BG difference of 0.6 mmol/L (95% confidence
interval 0.04, 1.2). In patients with randomization BG < 11.1 mmol/L (63%
of cohort), mean daily BG was similar in the linagliptin and basal-bolus
groups (8.9 +/- 2.3 vs 8.7 +/- 2.3 mmol/L, P = 0.43); however, patients
with BG >= 11.1 mmol/L who were treated with linagliptin had higher BG
compared to the basal-bolus group (10.9 +/- 2.6 vs 9.2 +/- 2.2 mmol/L, P <
0.001). Linagliptin resulted in fewer hypoglycaemic events (1.6% vs 11%, P
= 0.001; 86% relative risk reduction), with similar supplemental insulin
and fewer daily insulin injections (2.0 +/- 3.3 vs 3.1 +/- 3.3, P < 0.001)
compared to the basal-bolus group. Conclusion(s): For patients with
T2D undergoing non-cardiac surgery who presented with mild to moderate
hyperglycaemia (BG < 11.1 mmol/L), daily linagliptin is a safe and
effective alternative to multi-dose insulin therapy, resulting in similar
glucose control with lower hypoglycaemia. Copyright © 2018 John
Wiley & Sons Ltd

<2>
Accession Number
627237536
Title
A Systematic Review of Direct Cardiovascular Event Costs: An International
Perspective.
Source
PharmacoEconomics. 37 (7) (pp 895-919), 2019. Date of Publication: 01 Jul
2019.
Author
Ryder S.; Fox K.; Rane P.; Armstrong N.; Wei C.-Y.; Deshpande S.; Stirk
L.; Qian Y.; Kleijnen J.
Institution
(Ryder, Armstrong, Wei, Deshpande, Stirk) Kleijnen Systematic Reviews Ltd,
Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD,
United Kingdom
(Fox) Strategic Healthcare Solutions LLC, 133 Cottonwood Creek Lane,
Aiken, SC 29803, United States
(Rane, Qian) Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA
91320-1799, United States
(Kleijnen) School for Public Health and Primary Care, Maastricht
University, Maastricht, Netherlands
Publisher
Springer International Publishing
Abstract
Introduction: There is a lack of comprehensive cost information for
cardiovascular events since 2013. Objective(s): A systematic review
on the contemporary cost of cardiovascular events was therefore
undertaken. Method(s): Methods complied with those recommended by the
Cochrane Collaboration and the Centre for Reviews and Dissemination.
Studies were unrestricted by language, were from 2013 to 23 December 2017,
and included cost-of-illness data in adults with the following
cardiovascular conditions: myocardial infarction (MI), stroke, transient
ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary
artery bypass graft (CABG), percutaneous coronary intervention (PCI), or
peripheral artery disease (PAD). Seven electronic databases were searched,
namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and
Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health
Technology Assessment (HTA) database, Cochrane Central Register of
Controlled Trials (CENTRAL), and PubMed. The included studies reported
data from a variety of years (sometimes prior to 2013), so costs were
inflated and converted to $US, year 2018 values, for standardization.
 Result(s): After de-duplication, 29,945 titles and abstracts and then
403 full papers were screened; 82 studies (88 papers) were extracted. Year
1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in
the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in
Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA),
UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to
$45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One
Swedish study reported PAD costs in a format convertible to $US, 2018
values, with a mean annual cost of $15,565. Conclusion(s): There was
considerable unexplained variation in contemporary costs for all major
cardiovascular events. One emerging theme was that average costs in the
USA were considerably higher than anywhere else. Copyright ©
2019, Springer Nature Switzerland AG.

<3>
Accession Number
625447359
Title
Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3,
Centera, and SAPIEN 3 Ultra.
Source
Expert Review of Medical Devices. 16 (2) (pp 81-87), 2019. Date of
Publication: 01 Feb 2019.
Author
Solomonica A.; Choudhury T.; Bagur R.
Institution
(Solomonica, Choudhury, Bagur) London Health Sciences Centre, London,
Canada
(Bagur) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Institute of Primary Care and Health Sciences, University of
Keele, Stoke-on-Trent, United Kingdom
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has become
the standard of care for patients with severe symptomatic aortic stenosis
at moderate to high surgical risk. Newer devices are now available and
broader indications are expected in the near future. Areas covered: The
Placement of Aortic Transcatheter Valves (PARTNER) trials initially proved
the efficacy of TAVI with the balloon-expandable Edwards SAPIEN valve in
patients deemed in-operable and at high-risk, and later on in
intermediate-risk patients using the balloon-expandable SAPIEN-XT valve.
These trials had laid the groundwork for advancements incorporated in the
balloon-expandable SAPIEN-3 system such as the introduction of the
anti-leak skirt and improved delivery system. In this review, we summarize
the available data on the SAPIEN-3 transcatheter heart valve system and we
highlight the special features of the newly designed self-expanding
Edwards CENTERA valve, and the latest generation of balloon-expanable
SAPIEN-3 UltraTM system. A detailed literature search on these devices was
undertaken using Ovid, PubMed, and Web of Science. Expert commentary: Data
from clinical trials show that TAVI with newer-generation of Edwards
transcatheter heart valve systems have shown significant improvement in
terms of reduced paravalvular leak and have been associated with extremely
good clinical outcomes. Copyright © 2018, © 2018 Informa UK
Limited, trading as Taylor & Francis Group.

<4>
Accession Number
2001061650
Title
Comparison of Health Related Quality of Life in Transcatheter Versus
Surgical Aortic Valve Replacement: A Meta-Analysis.
Source
Heart Lung and Circulation. 28 (8) (pp 1235-1245), 2019. Date of
Publication: August 2019.
Author
Ando T.; Takagi H.; Briasoulis A.; Grines C.L.; Afonso L.
Institution
(Ando, Afonso) Division of Cardiology, Wayne State University/Detroit
Medical Center, Detroit, MI, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Cardiology, University of Iowa Hospitals and
Clinics, IA, United States
(Grines) Division of Cardiology, North Shore University Hospital, Hofstra
Northwell School of Medicine, Manhasset, NY, United States
Publisher
Elsevier Ltd
Abstract
Background: Data on the effects of transcatheter aortic valve replacement
(TAVR) compared to surgical aortic valve replacement (SAVR) on
health-related quality of life (HRQOL) outcomes are limited. To assess the
comparative HRQOL outcomes between TAVR and SAVR, we performed a
systematic review and meta-analysis. Method(s): PubMed and EMBASE
databases were searched for articles that compared the HRQOL scores,
Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study
Short-Form Health Survey 12 or 36 (SF-12/36), or the EuroQoL 5 Dimension
score (EQ-5D) at 30 days and 1 year between TAVR and SAVR. Mean difference
(MD) and 95% confidence interval (CI) was calculated with inverse variance
statistical method and random-effects model. Result(s): A total of
four studies with 4,125 patients (1268 transfemoral [TF]-TAVR, 1261 Non-TF
TAVR [transsubclavian, transapical or transaortic], and 1,596 SAVR) were
included in the studies. KCCQ overall summary scores and its subscales,
SF-12/36, and EQ-5D were significantly higher in TF-TAVR compared to SAVR
but were similar in non-TF TAVR vs. SAVR at 30 days. At 1-year follow-up,
TF-TAVR and non-TF TAVR conferred similar HRQOL scores in KCCQ overall
summary and subscales scores, SF-12/36, and EQ-5D compared to SAVR.
 Conclusion(s): Transfermoral-TAVR achieved better HRQOL at 30 days
but similar HRQOL at 1 year compared to SAVR. Non-TF TAVR resulted in
similar improvements in HRQOL at both 30 days and 1 year compared with
SAVR. Copyright © 2018

<5>
Accession Number
2002019573
Title
Individualized decision aid for diverse women with lupus nephritis
(IDEA-WON): A randomized controlled trial.
Source
PLoS Medicine. 16 (5) (no pagination), 2019. Article Number: e1002800.
Date of Publication: May 2019.
Author
Singh J.A.; Fraenkel L.; Green C.; Alarcon G.S.; Barton J.L.; Saag K.G.;
Hanrahan L.M.; Raymond S.C.; Kimberly R.P.; Leong A.L.; Reyes E.; Street
R.L.; Suarez-Almazor M.E.; Eakin G.S.; Marrow L.; Morgan C.J.; Caro B.;
Sloan J.A.; Jandali B.; Garcia S.R.; Grossman J.; Winthrop K.L.; Trupin
L.; Dall'era M.; Meara A.; Rizvi T.; Chatham W.W.; Yazdany J.
Institution
(Singh, Green, Alarcon, Saag, Kimberly, Morgan, Chatham) University of
Alabama at Birmingham, Birmingham, AL, United States
(Singh) Birmingham VA Medical Center, Birmingham, AL, United States
(Fraenkel) Yale University, New Haven, CT, United States
(Barton, Winthrop) Oregon Health Science University, Portland, OR, United
States
(Barton) VA Portland Health Care System, Portland, OR, United States
(Hanrahan, Raymond) Lupus Foundation of America, Washington, DC, United
States
(Leong) Healthy Motivation, Inc., Los Angeles, CA, United States
(Reyes) Elyse Reyes Consulting, Los Angeles, CA, United States
(Street) Texas A&M University, College Station, TX, United States
(Suarez-Almazor) University of Texas MD Anderson Cancer Center, Houston,
TX, United States
(Eakin, Marrow) Arthritis Foundation, Atlanta, GA, United States
(Caro) Georgia State University, Atlanta, GA, United States
(Sloan) Mayo Clinic School of Medicine, Rochester, MN, United States
(Jandali, Garcia, Rizvi) Baylor College of Medicine, Houston, TX, United
States
(Grossman) University of California, Los Angeles (UCLA), Los Angeles, CA,
United States
(Trupin, Dall'era, Yazdany) University of California at San Francisco
(UCSF), San Francisco, CA, United States
(Meara) Ohio State University, Columbus, OH, United States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Treatment decision-making regarding immunosuppressive therapy
is challenging for individuals with lupus. We assessed the effectiveness
of a decision aid for immunosuppressive therapy in lupus nephritis.
Methods and findings In a United States multicenter, open-label,
randomized controlled trial (RCT), adult women with lupus nephritis,
mostly from racial/ethnic minority backgrounds with low socioeconomic
status (SES), seen in in-or outpatient settings, were randomized to an
individualized, culturally tailored, computerized decision aid versus
American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using
computer-generated randomization. We hypothesized that the co-primary
outcomes of decisional conflict and informed choice regarding
immunosuppressive medications would improve more in the decision aid
group. Of 301 randomized women, 298 were analyzed; 47% were
African-American, 26% Hispanic, and 15% white. Mean age (standard
deviation [SD]) was 37 (12) years, 57% had annual income of < $40,000, and
36% had a high school education or less. Compared with the provision of
the ACR lupus pamphlet (n = 147), participants randomized to the decision
aid (n = 151) had (1) a clinically meaningful and statistically
significant reduction in decisional conflict, 21.8 (stan-dard error [SE],
2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed
choice in the main analysis, 41% versus 31% (p = 0.08), but clinically
meaningful and statistically significant difference in sensitivity
analysis (net values for immunosuppressives positive [in favor] versus
negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional
conflict was lower in the decision aid versus pamphlet groups, 22% versus
44% (p < 0.001). Significantly more patients in the decision aid versus
pamphlet group rated information to be excellent for understanding lupus
nephritis (49% versus 33%), risk factors (43% versus 27%), medication
options (50% versus 33%; p <= 0.003 for all); and the ease of use of
materials was higher in the decision aid versus pamphlet groups (51%
versus 38%; p = 0.006). Key study limitations were the exclusion of men,
short follow-up, and the lack of clinical outcomes, including medication
adherence. Conclusions An individualized decision aid was more effective
than usual care in reducing decisional conflict for choice of
immunosuppressive medications in women with lupus nephritis. Trial
registration Clinicaltrials.gov, NCT02319525. Copyright © 2019,
Public Library of Science. All rights reserved.

<6>
Accession Number
628150880
Title
Dual antiplatelet therapy following percutaneous coronary intervention:
Protocol for a systematic review.
Source
BMJ Open. 9 (6) (no pagination), 2019. Article Number: e022271. Date of
Publication: 01 Jun 2019.
Author
Elliott J.; Kelly S.E.; Bai Z.; Skidmore B.; Boucher M.; So D.Y.F.; Wells
G.A.
Institution
(Elliott, Kelly, Bai, Skidmore, So, Wells) Cardiovascular Research Methods
Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
(Elliott, Kelly, Wells) School of Epidemiology and Public Health,
University of Ottawa, Ottawa, ON, Canada
(Boucher) Program and Policy Development, Canadian Agency for Drugs and
Technologies in Health (CADTH), Ottawa, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Dual antiplatelet therapy (DAPT) is routinely given to
patients after percutaneous coronary intervention (PCI) with stenting;
however, there is ongoing debate about the optimal duration, especially in
specific patient groups. In the proposed systematic review, we intend to
assess the optimal duration of DAPT following PCI with stenting, with a
focus on clinically relevant patient subgroups. Methods and analysis: We
will perform a comprehensive search of the published literature for
randomised controlled trials (RCTs) assessing the benefits and harms of
extended DAPT (>12 months) compared with short-term DAPT (6-12 months)
following PCI with stenting (bare metal or drug eluting).
ClinicalTrials.gov and ICTRP will also be searched to identify ongoing and
completed clinical trials. Two independent reviewers will select studies
for inclusion, and the risk of bias will be assessed by use of Cochrane's
Risk of Bias tool. The primary outcome of interest is death (all-cause,
cardiovascular, non-cardiovascular). Secondary outcomes are bleeding
(major, minor, gastrointestinal), urgent target vessel revascularisation,
major adverse cardiovascular events, myocardial infarction, stroke and
stent thrombosis. Subgroup data will be sought for patients with prior
myocardial infarction, acute coronary syndrome at presentation and
diabetes, and based on smoking status and age group. Data will be analysed
by random-effects meta-analysis, and separate analyses will be performed
for patient subgroups. Bayesian network meta-analysis will be performed to
investigate the effect of individual P2Y12 inhibitors at different DAPT
durations longer than 6 months. Ethics and dissemination: This review will
provide a comprehensive overview of the available evidence of the benefits
and harms associated with extending DAPT beyond 12 months following PCI
with stenting and the effects on clinically important subgroups. The
results of this review will inform clinical and policy decisions regarding
the optimal treatment duration of DAPT following PCI with
stenting. Copyright © 2019 Author(s).

<7>
Accession Number
626155330
Title
Silent brain infarcts on diffusion-weighted imaging after carotid
revascularisation: A surrogate outcome measure for procedural stroke? A
systematic review and meta-analysis.
Source
European Stroke Journal. 4 (2) (pp 127-143), 2019. Date of Publication: 01
Jun 2019.
Author
Traenka C.; Engelter S.T.; Brown M.M.; Dobson J.; Frost C.; Bonati L.H.
Institution
(Traenka, Engelter, Bonati) Stroke Center and Department of Neurology,
University Hospital Basel and University of Basel, Basel, Switzerland
(Traenka, Engelter) Neurorehabilitation Unit, University of Basel,
University Center for Medicine of Aging and Rehabilitation, Felix Platter
Hospital, Basel, Switzerland
(Brown, Bonati) Stroke Research Group, Department of Brain Repair &
Rehabilitation, UCL Institute of Neurology, London, United Kingdom
(Dobson, Frost) Department of Medical Statistics, Faculty of Epidemiology
and Population Health, London School of Hygiene and Tropical Medicine,
London, United Kingdom
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Aim: To investigate whether lesions on diffusion-weighted imaging (DWI+)
after carotid artery stenting (CAS) or endarterectomy (CEA) might provide
a surrogate outcome measure for procedural stroke. Material(s) and
Method(s): Systematic MedLine database search with selection of all
studies published up to the end of 2016 in which DWI scans were obtained
before and within seven days after CAS or CEA. The correlation between the
underlying log odds of stroke and of DWI+ across all treatment groups
(i.e. CAS or CEA groups) from included studies was estimated using a
bivariate random effects logistic regression model. Relative risks of DWI+
and stroke in studies comparing CAS vs. CEA were estimated using
fixed-effect Mantel-Haenszel models. Result(s): We included data of
4871 CAS and 2099 CEA procedures (85 studies). Across all treatment groups
(CAS and CEA), the log odds for DWI+ was significantly associated with the
log odds for clinically manifest stroke (correlation coefficient 0.61 (95%
CI 0.27 to 0.87), p = 0.0012). Across all carotid artery stenting groups,
the correlation coefficient was 0.19 (p = 0.074). There were too few CEA
groups to reliably estimate a correlation coefficient in this subset
alone. In 19 studies comparing CAS vs. CEA, the relative risks (95%
confidence intervals) of DWI+ and stroke were 3.83 (3.17-4.63, p <
0.00001) and 2.38 (1.44-3.94, p = 0.0007), respectively.
 Discussion(s): This systematic meta-analysis demonstrates a
correlation between the occurrence of silent brain infarcts on
diffusion-weighted imaging and the risk of clinically manifest stroke in
carotid revascularisation procedures. Conclusion(s): Our findings
strengthen the evidence base for the use of DWI as a surrogate outcome
measure for procedural stroke in carotid revascularisation procedures.
Further randomised studies comparing treatment effects on DWI lesions and
clinical stroke are needed to fully establish surrogacy. Copyright
© European Stroke Organisation 2019.

<8>
Accession Number
628083573
Title
The safety and efficiency of intravenous administration of tranexamic acid
in coronary artery bypass grafting (CABG): A meta-analysis of 28
randomized controlled trials.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 104.
Date of Publication: 14 Jun 2019.
Author
Zhang Y.; Bai Y.; Chen M.; Zhou Y.; Yu X.; Zhou H.; Chen G.
Institution
(Zhang, Bai, Chen, Zhou, Yu, Zhou, Chen) Department of Anesthesiology, Sir
Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
310020, China
(Bai) Department of Anesthesiology, Fifth People's Hospital of Yuhang
District, Hangzhou 311100, China
(Chen) Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou
310008, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The safety and efficiency of intravenous administration of
tranexamic acid (TXA) in coronary artery bypass grafting (CABG) remains
unconfirmed. Therefore, we conducted a meta-analysis on this topic.
 Method(s): We searched the Cochrane Central Register of Controlled
Trials (CENTRAL), PUBMED and EMBASE for randomized controlled trials on
the topic. The results of this work are synthetized and reported in
accordance with the PRISMA statement. Result(s): Twenty-eight studies
met our inclusion criteria. TXA reduced the incidence of postoperative
reoperation of bleeding (relative risk [RR], 0.46; 95% confidence interval
[CI]; 0.31-0.68), the frequency of any allogeneic transfusion (RR, 0.64;
95% CI, 0.52-0.78) and the postoperative chest tube drainage in the first
24 h by 206 ml (95% CI - 248.23 to - 164.15). TXA did not significantly
affect the incidence of postoperative cerebrovascular accident (RR, 0.93;
95%CI, 0.62-1.39), mortality (RR, 0.82; 95%CI, 0.53-1.28), myocardial
infarction (RR, 0.90; 95%CI, 0.78-1.05), acute renal insufficiency (RR,
1.01; 95%CI, 0.77-1.32). However, it may increase the incidence of
postoperative seizures (RR, 6.67; 95%CI, 1.77-25.20). Moreover, the
subgroup analyses in on-pump and off-pump CABG, the sensitivity analyses
in trials randomized more than 99 participants and sensitivity analyses
that excluded the study with the largest number of participants further
strengthened the above results. Conclusion(s): TXA is effective to
reduce reoperation for bleeding, blood loss and the need for allogeneic
blood products in patients undergoing CABG without increasing
prothrombotic complication. However, it may increase the risk of
postoperative seizures. Copyright © 2019 The Author(s).

<9>
Accession Number
626790824
Title
Additional effects of psychological interventions on subjective and
objective outcomes compared with exercise-based cardiac rehabilitation
alone in patients with cardiovascular disease: A systematic review and
meta-analysis.
Source
European Journal of Preventive Cardiology. 26 (10) (pp 1035-1049), 2019.
Date of Publication: 01 Jul 2019.
Author
Albus C.; Herrmann-Lingen C.; Jensen K.; Hackbusch M.; Munch N.; Kuncewicz
C.; Grilli M.; Schwaab B.; Rauch B.
Institution
(Albus, Munch) Department of Psychosomatics and Psychotherapy, University
of Cologne, Germany
(Herrmann-Lingen, Kuncewicz) Department of Psychosomatic Medicine and
Psychotherapy, University of Gottingen Medical Centre, Germany
(Herrmann-Lingen) German Centre for Cardiovascular Research, partner site
Gottingen, Germany
(Jensen, Hackbusch) Institute of Medical Biometry and Informatics,
University of Heidelberg, Germany
(Grilli) Library of the Medical Faculty, University of Mannheim, Germany
(Schwaab) Curschmann Klinik, Timmendorfer Strand, Germany
(Rauch) IHF-Institut fur Herzinfarktforschung, Ludwigshafen am Rhein,
Germany
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Exercise-based cardiac rehabilitation (ebCR) often includes
various psychological interventions for lifestyle change or distress
management. However, the additional benefit of specific psychological
interventions on depression, anxiety, quality of life, cardiac morbidity
and cardiovascular or total mortality is not well investigated.
 Design(s): Systematic review and meta-analysis. Method(s):
Randomized controlled trials and controlled cohort trials published
between January 1995 and October 2017 comparing ebCR with or without
pre-specified psychosocial interventions were selected and evaluated on
the basis of predefined inclusion and outcome criteria. Result(s):
Out of 15,373 records, 20 studies were identified, including 4450 patients
with coronary artery disease (88.5%) or congestive heart failure (11.5%),
respectively. Studies were of low to moderate quality and methodological
heterogeneity was high. As compared with ebCR alone, additional
psychological interventions for lifestyle change or distress management
showed a trend to reduce depressive symptoms (standardized mean difference
-0.13, 95% confidence interval (CI) -0.30; 0.05). Furthermore, during a
follow-up of five years, distress management was associated with a trend
to reduce cardiac morbidity (risk ratio 0.74, 95% CI 0.51; 1.07). There
was no evidence for an additional impact of either psychological lifestyle
change interventions or distress management on anxiety, quality of life,
cardiovascular or total mortality. Conclusion(s): Specific
psychological interventions offered during ebCR may contribute to a
reduction of depressive symptoms and cardiac morbidity, but there remains
considerable uncertainty under which conditions these interventions exert
their optimal effects. (CRD42015025920). Copyright © The European
Society of Cardiology 2019.

<10>
Accession Number
628227010
Title
Utility of preoperative exercise therapy in reducing postoperative
morbidity after surgery; a clinical overview of current evidence.
Source
Expert Review of Cardiovascular Therapy. 17 (6) (pp 395-412), 2019. Date
of Publication: 03 Jun 2019.
Author
Topal B.; Smelt H.J.M.; Van Helden E.V.; Celik A.; Verseveld M.; Smeenk
F.; Pouwels S.
Institution
(Topal) Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Smelt) Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
(Van Helden, Verseveld, Pouwels) Department of Surgery, Franciscus
Gasthuis & Vlietland, Rotterdam/Schiedam, Netherlands
(Celik) Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli,
Istanbul, Turkey
(Smeenk) Department of Respiratory Medicine, Catharina Hospital,
Eindhoven, Netherlands
(Smeenk) SHE School of Health Professions Education, Maastricht
University, Maastricht, Netherlands
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Surgery is a major stressor especially for older patients
that are prone for postoperative complications and mortality.
Hospitalization due to surgery and illness can be major life events, and
the age-related impairments in physiological function and the decreased
ability to respond to metabolic and hormonal perturbations in response to
surgery often lead to a longer convalescence. Areas covered: This article
gives an overview of the effects of PET in various surgical fields and
also what to account for and expect of PET after various types of surgery.
A comprehensive literature search was performed in Pubmed, Embase,
Medline, Cochrane Library, and PEDro database (from the earliest date of
each database to March 2019) using search words 'Preoperative Exercise
Therapy', 'Physical Therapy' and 'surgery'. Secondly, the literature
searches were modified depending on the surgical specialty. Expert
opinion: Evidence is growing that preoperative exercise therapy in various
surgical specialties is well tolerated and effective, with by far the most
evidence in the cardiac surgical field. Future improvements in standards
of care and optimal pre-operative preparation should not only focus on the
surgical team and the hospital organization but also on incorporating the
active role of the patient. Copyright © 2019, © 2019 Informa
UK Limited, trading as Taylor & Francis Group.

<11>
Accession Number
628222474
Title
Coronary-subclavian steal syndrome, an easily overlooked entity in
interventional cardiology.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
De Roeck F.; Tijskens M.; Segers V.F.M.
Institution
(De Roeck, Tijskens, Segers) Department of Cardiology, University Hospital
Antwerp, Edegem, Belgium
(Segers) Laboratory of Physiopharmacology, University of Antwerp, Wilrijk,
Belgium
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Coronary-subclavian steal syndrome (CSSS) is a severe complication of
coronary artery bypass graft (CABG) surgery with internal mammary artery
grafting. It is caused by functional graft failure due to a
hemodynamically significant proximal subclavian artery stenosis. In this
manuscript, we provide a comprehensive review of literature and we report
a series of five consecutive CSSS cases. This case series illustrates the
variable clinical presentation, thereby emphasizing the importance of
raised awareness concerning this pathology in CABG patients. Copyright
© 2019 Wiley Periodicals, Inc.

<12>
Accession Number
2002154751
Title
PCV30 ESTIMATING HEALTH-STATE UTILITY IN PATIENTS WITH HEART FAILURE:
MAPPING THE KANSAS CITY CARDIOMYOPATHY QUESTIONNAIRE TO SF-6D UTILITY
SCORES.
Source
Value in Health. Conference: ISPOR 2019: Rapid. Disruptive. Innovative: A
New Era in HEOR. United States. 22 (Supplement 2) (pp S124), 2019. Date of
Publication: May 2019.
Author
Goates S.; Baron S.J.; Arnold S.V.; Prillinger J.B.; Cohen D.; Spertus
J.A.
Institution
(Goates, Arnold) Abbott Laboratories, Sylmar, CA, United States
(Baron) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Prillinger) Abbott Laboratories, Sunnyvale, CA, United States
(Cohen) Saint Luke's Mid America Heart Institute/University of Missouri
Kansas City School of Medicine, Kansas City, MO, United States
(Spertus) Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO,
United States
Publisher
Elsevier Ltd
Abstract
Objectives: The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been
widely used to measure heart failure (HF) patients' perception of their
health status, symptoms, physical and social function and quality of life.
However, as a disease specific measure, the KCCQ is not designed to
estimate health-state utilities, precluding its use in cost-effectiveness
research. This study used data from the COAPT trial to map KCCQ scores to
the SF-6D utility index. Method(s): Data were obtained from the COAPT
trial--a prospective, randomized controlled trial of transcatheter mitral
valve repair vs. standard care in 614 patients with HF and secondary
mitral regurgitation. Patients completed the SF-36 and the KCCQ at
baseline and at 1, 6, 12, and 24 months. We calculated SF-6D utility
scores and KCCQ overall summary (KCCQ-OS) scores for both the full and
short form (KCCQ-12) for each subject. Using mixed linear models with
random effects for subjects, we regressed SF-6D utility scores on the
KCCQ-OS and the KCCQ-12, testing for age and sex effects. Model fit was
evaluated using conditional AIC, R2 and correlation.
 Result(s): Both the KCCQ-OS and the KCCQ-12 score were closely
correlated with SF-6D derived health utility (correlation of 0.76 and 0.77
for the KCCQ-OS and KCCQ-12). Model testing revealed a conditional
R2 of 0.71 for the model using the KCCQ-OS and 0.73 for the
KCCQ-12. The addition of age and gender to the models had negligible
impact on the results. Based on these data, the final mapping equations
were 0.44 + 0.0035*(KCCQ-OS) and 0.45 + 0.0034*(KCCQ-12).
 Conclusion(s): The KCCQ-OS and the KCCQ-12 are excellent predictors
of health state utility in patients with HF, as compared with the SF-6D
utility estimates. Further studies are needed to validate these predictive
models in other heart failure populations. Copyright © 2019

<13>
Accession Number
2002154138
Title
PNS193 MODELING ADOPTION AND OPTIMIZATION OF AUTOMATION SUPPLY CHAIN
MANAGEMENT TECHNOLOGY WITH RFID (UHF) IN THE US ACUTE HOSPITAL SETTING.
Source
Value in Health. Conference: ISPOR 2019: Rapid. Disruptive. Innovative: A
New Era in HEOR. United States. 22 (Supplement 2) (pp S318), 2019. Date of
Publication: May 2019.
Author
Callahan P.; Smith L.
Institution
(Callahan, Smith) BD, San Diego, CA, United States
Publisher
Elsevier Ltd
Abstract
Objectives: US hospital supply expenditures range from 15% - 40% of total
hospital expenditures, depending on case-mix and hospital operating
status. Economic modeling investigated the operational and organizational
management of hospital supplies across procedural and nursing care areas
for two scenarios; (1) manual or no technology to automated supply
management technology and (2) automated technology optimized with RFID
(UHF) capabilities. Method(s): A literature analysis was performed
using PubMed and Google from 2008 to 2018 with 38 relevant articles
identified. Hospital supplies are managed and, or reimbursed differently,
therefore five clinical settings were defined and modeled separately;
operating room (OR), cardiac catheter lab (CCL), interventional radiology
(RAD), emergency department (ED) and all other nursing care areas (NCAs).
An average 300-bed hospital facility was estimated to have (10) OR suites,
(2) CCL, (1) RAD, (1) ED and other NCAs. Technology acquisition and
hospital implementation costs were also included for this analysis. The
following benefits ranges were modeled; 3 - 10% utilization reduction on
supply spend, 25% range of average missed changes captured to realize
billable revenue and a one-time on-hand inventory optimization (10-12%).
Data inputs came from literature, Definitive Healthcare, American Hospital
Directory (reimbursement payer mix), and real-world practice engagements.
 Result(s): Total hospital-system supply expenses estimated for the
base-case was $23.9M and $1.9B annual revenue. Scenario 1 (automation
adoption) resulted in $3.45M annual benefit. Technology adoption costs
estimated at $290K/year. ROI break-even point at 6 months. Scenario 2
(RFID optimization) resulted in $1.34M annual benefit. Additional
technology adoption costs estimated at $36K/year. ROI break-even point was
7 months. Conclusion(s): Hospital supply expenses represent
significant costs for hospital systems, and supply management, from
procurement to reimbursement, is complex. Hospital systems may engage a
multi-year journey to adopt best practices, policies and technology
requiring subsequently optimization at the device, staff or data
management level to fully realize expected benefits. Copyright ©
2019

<14>
Accession Number
628151645
Title
The effect of low- dose tranexamic acid on postoperative blood loss in
patients treated with clopidogrel and aspirin.
Source
Caspian Journal of Internal Medicine. 10 (2) (pp 156-161), 2019. Date of
Publication: 2019.
Author
Banihashem N.; Khorasani M.; Vaffai H.; Naziri F.; Khafri S.; Seyfi S.
Institution
(Banihashem, Khorasani, Vaffai, Naziri) Clinical Research Development Unit
of Ayatollah Rouhani Hospital, Babol University of Medical Sciences,
Babol, Iran, Islamic Republic of
(Banihashem, Seyfi) Department of Anesthesiology, School of Medicine,
Babol University of Medical Sciences, Babol, Iran, Islamic Republic of
(Khorasani, Vaffai) Department of Surgery, School of Medicine, Babol
University of Medical Sciences, Babol, Iran, Islamic Republic of
(Khafri) Infertility and Health Reproductive Research Center, Health
Research Institute, Babol University of Medical Sciences, Babol, Iran,
Islamic Republic of
Publisher
Babol University of Medical Sciences (Journal office,Ganj Afrooz Avenue,
Babol 4717641367, Iran, Islamic Republic of)
Abstract
Background: Clopidogrel in combination with aspirin increases bleeding,
allogeneic red cell transfusion and reoperation rates after CABG.
Tranexamic acid, an antifibrinolytic agent, has been approved for use in
cardiac surgery to reduce bleeding. In the present study, we evaluated the
impact of tranexamic acid on the transfusion and post-operative blood loss
after CABG in patients treated with clopidogrel less than 5 days before
surgery. Method(s): This study was a prospective, randomized,
double-blinded clinical trial. Patients undergoing on-pump CABG with their
last dose of clopidogrel and aspirin less than 5 days preoperatively were
randomly assigned to receive tranexamic acid (10 mg/kg before surgical
incision and 10 mg/kg after protamine neutralization) or a corresponding
volume of saline solution. The incidence of allogeneic red cell
transfusion and 48h postoperative blood loss were recorded.
 Result(s): The average volume of blood loss was 776.92+/-459.81mL for
the TXA group and 1075.00+/-670.91mL for the control group (P=0.03) in the
patients with clopidogrel exposure within 48 h before surgery. The average
volume of blood loss was not different between two groups in the patients
with clopidogrel exposure within 5 days before surgery and also
transfusion rate. Conclusion(s): The result of this study shows that
tranexamic acid reduced blood loss in the patients with clopidogrel
exposure within 48 h before surgery. So, it is better that we use
tranexamic acid before surgery in all patients. Copyright © 2019
Babol University of Medical Sciences. All rights reserved.

<15>
Accession Number
628133479
Title
Network meta-analysis of new-generation valves for transcatheter aortic
valve implantation.
Source
Heart and vessels. (no pagination), 2019. Date of Publication: 29 May
2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
762-1 Nagasawa ,Shimizu-cho ,Sunto-gun, Shizuoka 411-8611, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa ,Shimizu-cho ,Sunto-gun, Shizuoka 411-8611, Japan
(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, USA
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
To comprehensively compare and rank new-generation valves (NGVs) for
transcatheter aortic valve implantation, we performed a network
meta-analysis (NMA) of all eligible comparative studies. MEDLINE and
EMBASE were searched through September 2018. We included all studies
comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early
generation valve (CoreValve) as the reference transcatheter heart valve
(THV) each other and reporting at least one of postprocedural incidence of
all-cause death,>=moderate aortic regurgitation (AR), and new permanent
pacemaker implantation (PMI). To compare different THVs, a random-effects
restricted-maximum-likelihood NMA based on a frequentist framework for
indirect and mixed comparisons was used. Using surface under the
cumulative ranking curve (SUCRA), the relative ranking probability of each
THV was estimated and the hierarchy of competing THVs was obtained. We
identified 29 eligible studies enrolling a total of 17,817 patients. In
accordance with the estimated SUCRA probability, SAPIEN 3 was the best
effective for a reduction in death (80.6%) and the second best for
decreased>=moderate AR (74.4%) and PMI (74.1%) compared with the other
THVs. Lotus was ranked the best for a reduction in>=moderate AR (94.5%;),
whereas the worst for decreased PMI (1.2%) and the second worst for a
reduction in mortality (38.6%). ACURATE was the best for decreased PMI
(99.2%) and the second best for a reduction in mortality (77.9%). As a
whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs
(ACURATE, Evolut R, Lotus, and SAPIEN 3).

<16>
Accession Number
628223195
Title
Comparison of Outcomes after Transcatheter vs Surgical Aortic Valve
Replacement among Patients at Intermediate Operative Risk with a History
of Coronary Artery Bypass Graft Surgery: A Post Hoc Analysis of the
SURTAVI Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Reardon M.J.; Heijmen R.H.; Van Mieghem N.M.; Williams M.R.; Yakubov S.J.;
Watson D.; Kleiman N.S.; Conte J.; Chawla A.; Hockmuth D.; Petrossian G.;
Robinson N.; Kappetein A.P.; Li S.; Popma J.J.
Institution
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Heijmen) St Antonius Hospital, Nieuwegein, Netherlands
(Van Mieghem) Erasmus University Medical Center, Rotterdam, Netherlands
(Williams) NYU Langone Medical Center, New York, NY, United States
(Yakubov, Watson) OhioHeath Riverside Methodist Hospital, Columbus, OH,
United States
(Conte) Johns Hopkins University, Baltimore, MD, United States
(Chawla, Hockmuth) Iowa Heart Center, Des Moines, United States
(Petrossian, Robinson) St Francis Hospital, Roslyn, NY, United States
(Kappetein, Li) Medtronic, Minneapolis, MN, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Surgical aortic valve replacement (SAVR) has increased risk
for patients with aortic stenosis (AS) and a history of coronary artery
bypass graft (CABG) surgery. Transcatheter aortic valve replacement (TAVR)
may be an alternative. Objective(s): To compare TAVR with SAVR
outcomes in patients at intermediate operative risk with prior CABG
surgery. Design, Setting, and Participant(s): In this post hoc
analysis of the Surgical Replacement and Transcatheter Aortic Valve
Implantation (SURTAVI) noninferiority randomized clinical trial, patients
with severe, symptomatic AS at intermediate operative risk were enrolled
from 87 centers across the United States, Europe, and Canada from June
2012 to June 2016 and followed-up with up to July 2017. Those with a
history of CABG surgery were considered for analysis. Data were analyzed
from September to December 2017. Intervention(s): A total of 1746
patients were enrolled and randomized 1:1 to self-expanding TAVR or SAVR.
An implant was attempted in 1660 patients, of whom 273 had prior CABG
surgery, including 136 who underwent attempted TAVR and 137 who underwent
attempted SAVR. Main Outcomes and Measures: The primary outcome was
all-cause mortality or disabling stroke at 1-year follow-up. Efficacy
outcomes included quality of life, measured using the Kansas City
Cardiomyopathy Questionnaire at 30 days, 6 months, and 1 year, and
distance walked in 6 minutes, measured using the 6-minute walk test at 30
days and 1 year. Result(s): Of the 136 patients in the TAVR cohort,
111 (81.6%) were male, and the mean (SD) age was 76.9 (6.5) years; of the
137 in the SAVR cohort, 117 (85.4%) were male, and the mean (SD) age was
76.6 (6.5) years. The mean (SD) Society of Thoracic Surgeons Predicted
Risk of Mortality score was 5.0% (1.6%) in the TAVR cohort and 5.2% (1.7%)
in the SAVR cohort. All-cause mortality or disabling stroke at 1-year
follow-up was 8.9% (95% CI, 5.2-15.2) in the TAVR cohort and 6.7% (95% CI,
3.5-12.8) in the SAVR cohort (log-rank P =.53). Compared with patients
receiving SAVR, the mean (SD) Kansas City Cardiomyopathy Questionnaire
summary score was significantly better among patients receiving TAVR at 30
days (81.4 [19.2] vs 69.7 [22.6]; P <.001); treatments were similar at 1
year (85.7 [14.6] vs 82.8 [18.4]; P =.19). Compared with patients in the
SAVR cohort, those in the TAVR cohort showed greater mean (SD) improvement
in distance walked at 1 year (48.3 [120.6] m vs 16.8 [88.7] m; P =.04).
 Conclusions and Relevance: Both TAVR and SAVR were safe for
intermediate-risk patients with AS and prior CABG surgery. The
transcatheter approach facilitated faster improvement in quality of life
and better exercise capacity at 1-year follow-up. Trial Registration:
ClinicalTrials.gov identifier: NCT01586910. Copyright © 2019
American Medical Association. All rights reserved.

<17>
Accession Number
2002065626
Title
Spironolactone and perioperative atrial fibrillation occurrence in cardiac
surgery patients: Rationale and design of the ALDOCURE trial.
Source
American Heart Journal. 214 (pp 88-96), 2019. Date of Publication: August
2019.
Author
Alexandre J.; Ollitrault P.; Fischer M.-O.; Fellahi J.-L.; Rozec B.;
Cholley B.; Dolladille C.; Chequel M.; Allouche S.; Legallois D.; Saplacan
V.; Buklas D.; Beygui F.; Parienti J.-J.; Milliez P.
Institution
(Alexandre, Dolladille) Department of Pharmacology, CHU de Caen, Caen
F-14000, France
(Alexandre, Fischer, Allouche, Legallois, Beygui, Milliez) Universite Caen
Normandie, Medical School, UNICAEN, CHU Caen, 4650, Signalisation,
electrophysiologie et imagerie des lesions d'ischemie-reperfusion
myocardique, Caen, EA F-14000, France
(Ollitrault, Dolladille, Chequel, Legallois, Beygui, Milliez) Department
of Cardiology, CHU de Caen, Caen F-14000, France
(Fischer) Pole Reanimations Anesthesie SAMU/SMUR, CHU de Caen, Caen
F-14000, France
(Fellahi) Service d'Anesthesie-Reanimation, Hopital Cardiologique Louis
Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, Lyon Cedex 03, France
(Rozec) Service d'Anesthesie-Reanimation, Hopital Laennec, Hospitalier
Universitaire, Nantes, Centre, France
(Cholley) Anesthesiology and Critical Care Medicine Department, Hopital
Europeen Georges Pompidou, AP-, Universite Paris Descartes-Sorbonne Paris
Cite, Paris, HP, France
(Allouche) Department of Biochemistry, CHU de Caen, Caen F-14000, France
(Saplacan, Buklas) Department of Cardiac Surgery, CHU de Caen, Caen
F-14000, France
(Parienti) Department of Biostatistics and Clinical Research, CHU de Caen,
Caen F-14000, France
(Parienti) Medical School, Universite Caen Normandie, UNICAEN, CHU, EA2656
Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Caen, Caen
F-14000, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: After artery bypass grafting (CABG), the presence of
perioperative AF (POAF) is associated with greater short- and long-term
cardiovascular morbidity. Underlying POAF mechanisms are complex and
include the presence of an arrhythmogenic substrate, cardiac fibrosis and
electrical remodeling. Aldosterone is a key component in this process. We
hypothesize that perioperative mineralocorticoid receptor (MR) blockade
may decrease the POAF incidence in patients with a left ventricular
ejection fraction (LVEF) >=50% who are referred for CABG with or without
aortic valve replacement (AVR). Study design: The ALDOCURE trial
(NCT03551548) will be a multicenter, randomized, double-blind,
placebo-controlled trial testing the superiority of a low-cost MR
antagonist (MRA, spironolactone) on POAF in 1500 adults referred for
on-pump elective CABG surgery with or without AVR, without any history of
heart failure or atrial arrhythmia. The primary efficacy end point is the
occurrence of POAF from randomization to within 5 days after surgery,
assessed in a standardized manner. The main secondary efficacy end points
include the following: postoperative AF occurring within 5 days after
cardiac surgery, perioperative myocardial injury, major cardiovascular
events and death occurring within 30 days of surgery, hospital and
intensive care unit length of stay, need for readmission, LVEF at
discharge and significant ventricular arrhythmias within 5 days after
surgery. Safety end points, including blood pressure, serum potassium
levels and renal function, will be monitored regularly throughout the
trial duration. Conclusion(s): The ALDOCURE trial will assess the
effectiveness of spironolactone in addition to standard therapy for
reducing POAF in patients undergoing CABG. Clinical trial registration:
NCT03551548 Copyright © 2019 Elsevier Inc.

<18>
Accession Number
2000795810
Title
Effect of SAPIEN 3 Transcatheter Valve Implantation on Health Status in
Patients With Severe Aortic Stenosis at Intermediate Surgical Risk:
Results From the PARTNER S3i Trial.
Source
JACC: Cardiovascular Interventions. 11 (12) (pp 1188-1198), 2018. Date of
Publication: 25 June 2018.
Author
Baron S.J.; Thourani V.H.; Kodali S.; Arnold S.V.; Wang K.; Magnuson E.A.;
Pichard A.D.; Babaliaros V.; George I.; Miller D.C.; Tuzcu E.M.; Greason
K.; Herrmann H.C.; Smith C.R.; Leon M.B.; Cohen D.J.
Institution
(Baron, Thourani, Kodali, Arnold, Wang, Magnuson, Pichard, Babaliaros,
George, Miller, Tuzcu, Greason, Herrmann, Smith, Leon, Cohen) Saint Luke's
Mid America Heart Institute, Kansas City, Missouri, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to evaluate whether transcatheter
aortic valve replacement (TAVR) with the SAPIEN 3 valve (S3-TAVR) results
in improved quality of life (QoL) compared with previous-generation TAVR
devices or surgical aortic valve replacement (SAVR). Background(s):
In patients with severe aortic stenosis at intermediate surgical risk,
TAVR using the SAPIEN XT valve (XT-TAVR) results in similar QoL compared
with SAVR. Compared with SAPIEN XT, the SAPIEN 3 valve offers a lower
delivery profile and modifications to reduce paravalvular regurgitation.
 Method(s): Between February and December 2014, 1,078 patients at
intermediate surgical risk with severe aortic stenosis were treated with
S3-TAVR in the PARTNER S3i (Placement of Aortic Transcatheter Valve)
trial. QoL was assessed at baseline, 1 month, and 1 year using the Kansas
City Cardiomyopathy Questionnaire, Medical Outcomes Study Short Form-36,
and EQ-5D. QoL outcomes of S3-TAVR patients were compared with those in
the SAVR and XT-TAVR arms of the PARTNER 2A trial using propensity score
stratification to adjust for differences between the treatment groups.
 Result(s): Over 1 year, S3-TAVR was associated with substantial
improvements in QoL compared with baseline. At 1 month, S3-TAVR was
associated with better QoL than either SAVR or XT-TAVR (adjusted
differences in Kansas City Cardiomyopathy Questionnaire overall summary
score 15.6 and 3.7 points, respectively; p < 0.001). At 1 year, the
differences in QoL between S3-TAVR and both SAVR and XT-TAVR were reduced
but remained statistically significant (adjusted differences 2.0 and 2.2
points, respectively; p < 0.05). Similar results were seen for generic QoL
outcomes. Conclusion(s): Among patients at intermediate surgical risk
with severe aortic stenosis, S3-TAVR resulted in improved QoL at both 1
month and 1 year compared with both XT-TAVR and SAVR. Copyright ©
2018 American College of Cardiology Foundation

<19>
Accession Number
622467410
Title
Single- versus 2-stent strategies for coronary bifurcation lesions: A
systematic review and meta-analysis of randomized trials with long-term
follow-up.
Source
Journal of the American Heart Association. 7 (11) (no pagination), 2018.
Article Number: e008730. Date of Publication: 01 Jun 2018.
Author
Ford T.J.; McCartney P.; Corcoran D.; Collison D.; Hennigan B.; McEntegart
M.; Hildick-Smith D.; Oldroyd K.G.; Berry C.
Institution
(Ford, McCartney, Corcoran, Collison, Hennigan, McEntegart, Oldroyd,
Berry) West of Scotland Heart and Lung Centre, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Ford, McCartney, Corcoran, Collison, Hennigan, McEntegart, Oldroyd,
Berry) British Heart Foundation Glasgow Cardiovascular Research Centre,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
United Kingdom
(Ford) University of New South Wales, Sydney, Australia
(Hildick-Smith) Division of Cardiology, Royal Sussex County Hospital,
Brighton, United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background--The majority of coronary bifurcation lesions are treated with
a provisional single-stent strategy rather than an upfront 2-stent
strategy. This approach is supported by multiple randomized controlled
clinical trials with short- to medium-term follow-up; however, long-term
follow-up data is evolving from many data sets. Methods and
Results--Meta-analysis of randomized controlled trials evaluating
long-term outcomes (>=1 year) according to treatment strategy for coronary
bifurcation lesions. Nine randomized controlled trials with 3265 patients
reported long-term clinical outcomes at mean weighted follow-up of
3.1+/-1.8 years. Provisional single stenting was associated with lower
all-cause mortality (2.94% versus 4.23%; risk ratio: 0.69; 95% confidence
interval, 0.48-1.00; P=0.049; I2=0). There was no difference in
major adverse cardiac events (15.8% versus 15.4%; P=0.79), myocardial
infarction (4.8% versus 5.5%; P=0.51), target lesion revascularization
(9.3% versus 7.6%; P=0.19), or stent thrombosis (1.8% versus 1.6%; P=0.28)
between the groups. Prespecified sensitivity analysis of long-term
mortality at a mean of 4.7 years of follow-up showed that the provisional
single-stent strategy was associated with reduced all-cause mortality
(3.9% versus 6.2%; risk ratio: 0.63; 95% confidence interval, 0.42-0.97;
P=0.036; I2=0). Conclusions--Coronary bifurcation percutaneous
coronary intervention using a provisional single-stent strategy is
associated with a reduction in all-cause mortality at long-term
follow-up. Copyright © 2018 The Authors.

<20>
Accession Number
2000778461
Title
Palliative Care for Patients With Advanced Heart Disease.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 833-843),
2019. Date of Publication: March 2019.
Author
Klinedinst R.; Kornfield Z.N.; Hadler R.A.
Institution
(Klinedinst) Division of Palliative Care, Department of Medicine, Hospital
of the University of Pennsylvania, Philadelphia, PA, United States
(Kornfield, Hadler) Department of Anesthesiology and Critical Care,
Hospital of the University of Pennsylvania, Philadelphia, PA, United
States
Publisher
W.B. Saunders
Abstract
Over the past 2 decades, the discipline of palliative care has evolved and
expanded such that it is now the standard of care for a variety of acute
and chronic processes. Although there are recommendations encouraging
incorporation of palliative care into the routine management of patients
with chronic cardiac processes, such as congestive heart failure,
implementation has been challenging, and nowhere more so than in the
cardiac surgical population. However, as the boundaries of surgical care
have expanded to include progressively more complex cases, increasing
attention has been given to the integration of palliative care into their
management. In this review article, the authors describe the existing
evidence for palliative care team involvement in patients with
non-operative and surgical cardiac diseases and examine future directions
for growth in this field. Copyright © 2018 Elsevier Inc.

<21>
Accession Number
2001149356
Title
Intravenous and Inhaled Milrinone in Adult Cardiac Surgery Patients: A
Pairwise and Network Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 663-673),
2019. Date of Publication: March 2019.
Author
Rong L.Q.; Rahouma M.; Abouarab A.; Di Franco A.; Calautti N.M.;
Fitzgerald M.M.; Arisha M.J.; Ibrahim D.A.; Girardi L.N.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Calautti, Fitzgerald, Arisha, Ibrahim, Pryor) Department of
Anesthesiology, Weill Cornell Medicine, New York, NY, United States
(Rahouma, Abouarab, Di Franco, Girardi, Gaudino) Department of
Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
Publisher
W.B. Saunders
Abstract
Objective: To summarize the evidence on the hemodynamic,
echocardiographic, and clinical effects of inhaled and intravenous
milrinone (iMil and IvMil) in adult cardiac surgery patients.
 Design(s): Systematic review, pairwise and network meta-analysis.
 Setting(s): Multi-institutional. Participant(s): Adult cardiac
surgery patients. Intervention(s): Comparison between iMil and IvMil
versus other agents or placebo. Measurements and Main Results: The
primary endpoints were mean pulmonary artery pressure (MPAP) and
peripheral vascular resistance (PVR). Secondary endpoints included the
following: (1) mean arterial pressure, heart rate, and cardiac index (CI);
(2) echocardiographic data; and (3) clinical outcomes. Random model,
leave-one-out-analysis, and meta-regression were used. Thirty studies (6
iMil and 24 IvMil) were included for a total of 1,438 patients (194 iMil
and 521 IvMil). IvMil was associated with a lower MPAP, lower PVR, and
higher CI compared to placebo (standardized mean difference [SMD] = -0.22
[95% CI = -0.48 to 0.05], SMD = -0.49 [95% CI = -0.71 to -0.27], and SMD =
0.94 [95% CI = 0.51 to 1.37]). No difference in any outcome was found
between iMil and placebo. At network meta-analysis, significantly lower
PVR and shorter hospital length of stay were found for IvMil compared to
iMil (SMD = -0.82 [95% CI = -1.53 to -0.10] and SMD = -0.50 [95% CI =
-0.95 to -0.05], respectively). Conclusion(s): These results support
the clinical use of IvMil in cardiac surgery patients. No evidence at
present supports the adoption of iMil. Copyright © 2018 Elsevier
Inc.

<22>
Accession Number
2000972670
Title
Effects of Nicorandil Versus Nitroglycerin on Arterial Oxygenation During
Two-Lung Ventilation and One-Lung Ventilation in Patients With Risk
Factors for Myocardial Ischemia: A Prospective, Randomized, Double-Blind
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (3) (pp 702-709),
2019. Date of Publication: March 2019.
Author
Murakami C.; Kawano H.; Kinoshita M.; Kondo A.; Inoue M.
Institution
(Murakami, Kawano, Kinoshita, Kondo, Inoue) Department of Anesthesiology,
Tokushima Prefectural Central Hospital, Tokushima, Japan
Publisher
W.B. Saunders
Abstract
Objectives: To compare the effects of nicorandil and nitroglycerin on
arterial oxygenation during two-lung ventilation (TLV) and one-lung
ventilation (OLV) in patients with risk factors for myocardial ischemia.
 Design(s): A prospective, randomized, double-blind study.
 Setting(s): A tertiary care hospital. Participant(s): Fifty-six
patients scheduled for elective video-assisted thoracic surgery were
assigned randomly to either the nicorandil group or the nitroglycerin
group. Intervention(s): Patients in the nicorandil group received a
bolus dose of nicorandil, 0.08 mg/kg during induction of anesthesia,
followed by a continuous infusion at a rate of 0.08 mg/kg/h. Patients in
the nitroglycerin group received a continuous infusion of nitroglycerin at
a rate of 1 micro g/kg/min from the induction of anesthesia.
 Measurements and Main Results: Arterial blood gas analysis was
performed at the following points: before induction of anesthesia; during
TLV; at 5, 10, 20, and 30 minutes after the initiation of OLV.
PaO<inf>2</inf> at TLV (479.7 +/- 57.1 v 408.2 +/- 70.9 mmHg, p < 0.001);
and at 5 minutes (344.8 +/- 85.1 v 282.6 +/- 85.8 mmHg, p = 0.012), 20
minutes (215.7 +/- 103.0 v 158.2 +/- 74.5 mmHg, p = 0.027), and 30 minutes
(198.8 +/- 103.5 v 147.5 +/- 64.1 mmHg, p = 0.039) after OLV was
significantly higher in the nicorandil group than in the nitroglycerin
group. Conclusion(s): This study demonstrated that oxygenation during
TLV and OLV was significantly higher in patients receiving nicorandil than
in those receiving nitroglycerin. Copyright © 2018 Elsevier Inc.

<23>
Accession Number
2002077425
Title
Could Short-Term Perioperative High-Dose Atorvastatin Offer Antiarrhythmic
and Cardio-Protective Effects in Rheumatic Valve Replacement Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Allah E.A.; Kamel E.Z.; Osman H.M.; Abd-Elshafy S.K.; Nabil F.; Elmelegy
T.T.H.; Elkhayat H.; Ibrahim A.S.; Minshawy A.A.
Institution
(Allah, Kamel, Osman, Abd-Elshafy, Nabil, Ibrahim) Faculty of Medicine,
Assiut University, Assiut, Egypt
(Elmelegy) Clinical pathology department, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Elkhayat, Minshawy) Cardiothoracic Surgery department, Faculty of
Medicine, Assiut, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate the role of prophylactic high-dose atorvastatin
for prevention of postoperative atrial fibrillation (POAF), inflammatory
response attenuation, and myocardial protection after valve replacement
cardiac surgery. Design(s): Randomized controlled trial.
 Setting(s): Assiut University Hospitals. Participant(s):
Sixty-four adult patients undergoing cardiac valve replacement surgery.
 Intervention(s): The participants were equally divided into 2 groups.
Group S received 80 mg of atorvastatin (oral tablets), 12 and 2 hours
preoperatively, and on the 2nd, 3rd, 4th, and 5th postoperative days.
Control group C received placebo at the same time periods. Measurements:
The incidence of POAF, postoperative white blood cell count, serum
C-reactive protein, interleukin 6, and troponin I. Main Result(s):
Group S patients showed a lower incidence of POAF compared with the
placebo group (p = 0.031). The white blood cell count showed significant
reductions in group S compared with group C on the second, third, fourth,
and fifth postoperative days. The C-reactive protein level showed
significant reductions on the third, fourth, and fifth postoperative days
in group S compared with group C (p = 0.001, 0.001, and 0.001,
respectively). The serum level of interleukin 6 showed a significant
reduction on the fifth postoperative day in group S compared with group C
(p = 0.001). There was no significant difference between the 2 groups
regarding the troponin I level and inotropic score. Conclusion(s):
Prophylactic use of high dose atorvastatin can decrease the incidence of
POAF and attenuate the inflammatory process in adult patients undergoing
isolated rheumatic cardiac valve replacement surgery. Copyright ©
2019 Elsevier Inc.

<24>
Accession Number
2002075752
Title
Prophylactic Intra-Aortic Balloon Counterpulsation in High Risk Cardiac
Surgery: The PINBALL Pilot Multicentre, Registry-Linked, Randomised,
Controlled Feasibility Trial.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Litton E.; Bass F.; Dickson C.; Hillis G.; Inskip D.; Jacques T.; McGiffin
D.; McGuiness S.; Miller J.; Parke R.; Playford H.; Reid C.; Smith J.;
Solman N.; Tran L.; Yarad E.; Delaney A.
Institution
(Litton) Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
(Litton, Hillis) School of Medicine, University of Western Australia,
Perth, WA, Australia
(Bass, Yarad, Delaney) Malcolm Fischer Department of Intensive Care
Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
(Dickson) Department of cardiothoracic surgery, Westmead Hospital, Sydney,
NSW, Australia
(Hillis) Department of Cardiology, Royal Perth Hospital, Perth, WA,
Australia
(Inskip, Jacques, Miller) Intensive Care Unit, The St George Hospital,
Sydney, NSW, Australia
(McGiffin, McGuiness) Department of Cardiothoracic Surgery, The Alfred
Hospital, Melbourne, Vic, Australia
(Parke) Cardiovascular Intensive Care Unit, Auckland City Hospital,
Auckland, New Zealand
(Playford) Department of Anaesthesia, Westmead Hospital, Sydney, NSW,
Australia
(Reid, Solman, Tran) School of Public Health and Preventive Medicine,
Monash University, Melbourne Vic, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Melbourne,
Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Prophylactic intra-aortic balloon counterpulsation (IABC) is
commonly used in selected patients undergoing coronary artery bypass graft
(CABG) surgery, but definitive evidence is lacking. The aim of the
multicentre PINBALL Pilot randomised controlled trial (RCT) was to assess
the feasibility of performing a definitive trial to address this question.
 Method(s): Patients listed for CABG surgery with impaired left
ventricular function and at least one additional risk factor for
postoperative low cardiac output syndrome were eligible for inclusion if
the treating surgical team was uncertain as to the benefit of prophylactic
IABC. The primary outcome of feasibility was based on exceeding a
pre-specified recruitment rate, protocol compliance and follow-up.
 Result(s): The recruitment rate of 0.5 participants per site per
month did not meet the feasibility threshold of two participants per site
per month and the study was stopped early after enrolment of 24 out of the
planned sample size of 40 participants. For 20/24 (83%) participants,
preoperative IABC use occurred according to study assignment. Six
(6)-month follow-up was available for all enrolled participants, [IABC 1
death (8%) vs. control 1 death (9%), p = 0.95]. Conclusion(s): The
PINBALL Pilot recruitment rate was insufficient to demonstrate feasibility
of a multicentre RCT of prophylactic IABC in high risk patients undergoing
CABG surgery. Copyright © 2019

<25>
Accession Number
2002071922
Title
Exercise Parameters and Outcome Measures Used in Cardiac Rehabilitation
Programs Following Median Sternotomy in the Elderly: A Systematic Review
and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Pengelly J.; Pengelly M.; Lin K.-Y.; Royse C.; Karri R.; Royse A.; Bryant
A.; Williams G.; El-Ansary D.
Institution
(Pengelly, El-Ansary) Department of Health Professions, Swinburne
University of Technology, Melbourne, Vic, Australia
(Pengelly) Independent Researcher, Melbourne, Vic, Australia
(Lin) Department of Physiotherapy, School of Primary and Allied Health
Care, Faculty of Medicine, Nursing and Health Science, Monash University,
Melbourne, Vic, Australia
(Royse, Karri, Royse, El-Ansary) Department of Surgery, University of
Melbourne, Melbourne, Vic, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Vic, Australia
(Bryant, Williams) Department of Physiotherapy, University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Objective: The aim of this systematic review was to identify exercise
parameters and outcome measures used in cardiac rehabilitation programs
following median sternotomy, in the elderly cardiac population. Data
Sources: Five (5)electronic databases were searched for relevant studies
published in English after 1997. Study Selection: The screening process
was completed by two independent researchers, with a third independent
reviewer for overall agreement. Studies were selected if they included
only cardiac patients aged >=65 years who had undergone valve surgery
and/or coronary artery bypass grafting via median sternotomy, and who had
undertaken a postoperative cardiac rehabilitation exercise intervention
assessing physical function and/or cognitive recovery as outcomes.
 Data Extraction: Two researchers independently completed the data
extraction and quality assessment. Quality was assessed using a modified
Downs and Black tool. Data Synthesis: In total, 11 articles were
included for appraisal with respect to the quality of the study. Only two
randomised controlled trials were suitable for meta-analysis. A higher
volume of exercise was shown to have a positive effect on functional
recovery, assessed using the 6-minute walk test (6MWT)(mean difference =
26.97 m; 95% confidence interval [CI], 6.96-46.97; p = 0.008;
I2 = 0%). No significant improvement was shown between
additional exercise compared to standard care in improving
VO<inf>2peak</inf>, maximal power output or quality of life. No studies
evaluated the effect of exercise on cognitive recovery.
 Conclusion(s): Exercise significantly improves functional recovery in
the post-surgical elderly cardiac population, however uncertainty still
exists with regard to which modes of exercise and their specific
parameters are most effective in improving cognitive
recovery. Copyright © 2019 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS)and the Cardiac Society of
Australia and New Zealand (CSANZ)

<26>
Accession Number
2002063597
Title
Clinical outcomes of sentinel cerebral protection system use during
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Ndunda P.M.; Vindhyal M.R.; Muutu T.M.; Fanari Z.
Institution
(Ndunda, Vindhyal, Muutu, Fanari) Internal Medicine, University of Kansas
School of Medicine - Wichita, 1010 N Kansas Street, Wichita, KS 67214,
United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas
School of Medicine - Wichita, 551 N. Hillside, Suite 520, Wichita, KS
67214, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To compare the clinical outcomes following transcatheter aortic
valve replacement (TAVR)with and without the use of the Sentinel Cerebral
Protection System (Sentinel CPS). Background(s): Stroke occurs in
2-5% of patients at 30 days after TAVR and increases mortality >3 fold.
The Sentinel CPS is the only FDA (Food and Drug Administration)approved
cerebral embolic protection device. Method(s): The Cochrane Library,
PubMed and Web of Science were searched for relevant studies for inclusion
in the meta-analysis. Two authors independently screened and included
studies comparing the clinical outcomes after TAVR with and without the
Sentinel CPS. Risk of bias was assessed using the Cochrane tools (RoB2.0
and ROBINS-I). Result(s): Four studies comparing 606 patients
undergoing TAVR with Sentinel CPS to 724 without any embolic protection
device were included. Sentinel CPS use was associated with lower rates of
30-day mortality [0.8% vs 2.7%; RR 0.34 (95% CI 0.12, 0.92)I2 =
0%], 30-day symptomatic stroke [3.5% vs 6.1%; RR 0.51 (95% CI 0.29,
0.90)I2 = 0]and major or life-threatening bleeding [3.3% vs
6.6%; RR 0.50 (0.26, 0.98)I2 = 16%]. There was no significant
difference between the two arms in the incidence of acute kidney injury
[0.8% vs 1%; RR 0.85 (95% CI 0.22, 3.24)I2 = 0%]and major
vascular complications [5.1% vs 6%; RR 0.74 (0.33, 1.67)I2 =
45%]. Conclusion(s): The results suggest that Sentinel CPS use in
TAVR is associated with a lower risk of stroke, mortality and major or
life-threatening bleeding at 30 days. Copyright © 2019 Elsevier
Inc.

<27>
Accession Number
628143983
Title
Cost-effectiveness of coronary artery bypass graft and percutaneous
coronary intervention compared to medical therapy in patients with
coronary artery disease: a systematic review.
Source
Heart Failure Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
Gholami S.S.; Azar F.E.F.; Rezapour A.; Tajdini M.
Institution
(Gholami) Department of Health Economics, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Azar, Rezapour) Health Management and Economics Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Tajdini) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Coronary artery disease (CAD) has significant social and economic
implications. It is necessary to create tools to identify the most
cost-effectiveness treatments, which can assist clinicians in their
therapeutic decisions so that the maximum possible benefit is reached with
the lowest possible cost. Effectiveness must be measured by final
treatment goals in which the most effective interventions are those with
the lowest costs. This study is aimed to systematically review and compare
the studies conducted on the cost-effectiveness of the three coronary
artery disease treatment strategies (medical treatment, percutaneous
coronary intervention, and coronary artery bypass graft). In this
systematic review, the databases NHS Economic Evaluation Database, Embase,
MEDLINE, Science Direct, and Scopus were searched for studies on the
cost-effectiveness of coronary artery bypass graft (CABG) and percutaneous
coronary intervention (PCI) compared to medical therapy (MT) in patients
with coronary artery disease between 1 January 2004 to 30 September 2018.
The quality appraisal of the included studies was examined using the
Consolidated Health Economics Evaluation Reporting Standards (CHEERS)
statement. Out of 186 unique retrievals, 8 studies were included. The
results showed that the all studies clearly stated the time horizon of the
study and included direct medical costs in their analysis. In addition, in
most of the studies, quality-adjusted life years (QALY) were the main
outcome used for measuring the effectiveness. The studies reported various
ranges of the incremental cost-effectiveness ratio (ICER); accordingly,
the highest ratio was observed in the USA ($212,800) for PCI v MT and the
lowest ratio was observed in Brazil ($4403) for CABG v MT. Although the
results of the studies were different in terms of a number of aspects,
such as the viewpoint of the study, the study horizons, and the costs of
expenditure items, they reached similar results. Based on the result of
the present study, it seems that each three treatment strategies for CAD
yielded improvements in QALY. Copyright © 2019, Springer
Science+Business Media, LLC, part of Springer Nature.

<28>
Accession Number
628206345
Title
Effects and Tolerance of Protein and Energy-Enriched Formula in Infants
Following Congenital Heart Surgery: A Randomized Controlled Trial.
Source
Journal of Parenteral and Enteral Nutrition. 42 (1) (pp 196-204), 2018.
Date of Publication: January 2018.
Author
Cui Y.; Li L.; Hu C.; Shi H.; Li J.; Gupta R.K.; Liang H.; Chen X.; Gong
S.
Institution
(Cui, Gupta, Gong) The First Affiliated Hospital of Jinan University,
Guangzhou, China
(Cui, Li, Hu, Li, Chen) Cardiac Intensive Care Unit, Heart Center,
Guangzhou Women and Children's Medical Center, Guangzhou Medical
University, Guangzhou, China
(Shi, Liang) Institute of Pediatrics, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
(Gong) Department of Gastroenterology, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Nutrition support is important for clinical management to
improve outcomes of infants following congenital heart surgery.
Protein-enriched and energy-enriched formula (PE-formula) may help provide
adequate nutrition and promote wound healing. However, the effects and
tolerance of increased protein and energy intakes of these infants have
not been well defined. Objective(s): To evaluate nutrition effects
and tolerance of a PE-formula compared with the standard formula
(S-formula) in infants in the first 5 days after congenital heart surgery.
 Method(s): Fifty infants were randomly assigned to S-formula
(S-group, n = 24) or PE-formula (PE-group, n = 26). Daily nutrient intakes
and tolerance were recorded. Plasma amino acid concentrations were
measured. Cumulative energy balance and nitrogen balance were calculated.
 Result(s): Nutrient intakes were significantly higher in the PE-group
after day 1, and all met the adequate intakes as early as day 2. Nitrogen
balance in the PE-group met positive balance from day 2, whereas in the
S-group, this was not until day 5. The PE-group also had a significantly
higher increase in many essential amino acids. With the exception of
tolerable diarrhea (multivariate adjusted hazard ratio, 3.16; 95%
confidence interval, 1.24-8.01), the PE-group did not have a significantly
higher incidence of intolerable events. Conclusion(s): In infants
during the early postoperative period after congenital heart surgery,
early administration of PE-formula was as well tolerated as S-formula and
effective in achieving higher nutrition intakes and earlier nitrogen
balance. Further research is warranted to support the use of PE-formula in
this special group of infants. Copyright © 2017 American Society
for Parenteral and Enteral Nutrition

<29>
Accession Number
628215663
Title
Does pregabalin effectively and safely relieve postoperative pain in
patients undergoing pulmonary resections?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 10 Jun 2019.
Author
Li S.; Zhang W.; Cheng S.; Li Y.
Institution
(Li, Zhang) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Li, Zhang, Cheng, Li) West China Medical Center, West China Hospital,
Sichuan University, Chengdu, China
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether pregabalin could
effectively and safely reduce postoperative pain in patients undergoing
pulmonary resections. Altogether 23 papers were found using the reported
search, of which 6 randomized controlled trials represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Five of 6 randomized
controlled trials demonstrated that the application of oral pregabalin
during the perioperative period could effectively reduce postoperative
pain after pulmonary resections without compromising patients' safety. One
randomized controlled trial reported no difference in the postoperative
pain levels between the pregabalin group and the control group. The rates
of adverse effects were generally found to be decreased in patients who
received pregabalin compared to the patients who received routine
analgesia, although 2 studies reported significantly higher incidences of
mild drowsiness and dizziness among the pregabalin-treated patients.
Currently available evidence supports that the perioperative
administration of pregabalin can effectively and safely relieve
postoperative pain for patients undergoing pulmonary
resections. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<30>
Accession Number
628214302
Title
In thoracic aortic surgery, is innominate artery cannulation a safe and
effective alternative to axillary artery cannulation?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 10 Jun 2019.
Author
Harky A.; Grafton-Clarke C.; Hadlett M.; Shuttleworth E.
Institution
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Grafton-Clarke) College of Life Sciences, University of Leicester,
Leicester, United Kingdom
(Hadlett, Shuttleworth) Department of Surgery, Countess of Chester
Hospital, Chester, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: in a patient undergoing
thoracic aortic surgery, is innominate artery cannulation superior to
axillary artery cannulation in terms of postoperative outcomes? Five
hundred and thirty-one papers were found using the reported search
strategy, of which 5 represented the best evidence to answer the clinical
question. A total of 1338 participants were included across the 5 studies.
Seven hundred and twenty-two patients were cannulated via the axillary
artery and 616 were cannulated via the innominate artery. The included 5
studies were 2 prospective observational cohorts, 2 retrospective
case-series analysis and a single-blinded randomized trial. Thirty-day or
in-hospital mortality rates were reported in all 5 studies. There were no
significant differences in mortality with innominate artery cannulation
compared to axillary artery cannulation (P>0.05), with slightly lower
mortality rates in 2 studies, slightly higher mortality rates in 2 and
equal in 1 study. Though statistical significance was not demonstrated
(P>0.05), a stroke occurred slightly less frequently in patients receiving
innominate artery cannulation compared to axillary artery cannulation in 3
of the 4 studies. Innominate artery cannulation is non-inferior to
axillary artery cannulation for thoracic aortic surgery, with a similar
level of neuroprotection and is not associated with increased levels of
mortality. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<31>
Accession Number
628212730
Title
Multivariate meta-analysis model for the difference in restricted mean
survival times.
Source
Biostatistics (Oxford, England). (no pagination), 2019. Date of
Publication: 08 Jun 2019.
Author
Weir I.R.; Tian L.; Trinquart L.
Institution
(Weir) Department of Biostatistics, Boston University School of Public
Health, 801 Massachusetts Avenue, Boston, MA, United States
(Tian) Department of Health Research and Policy, Stanford University, 150
Governor's Lane, Palo Alto, CA, United States
(Trinquart) Department of Biostatistics, Boston University School of
Public Health, 801 Massachusetts Avenue, Boston, MA, United States
Publisher
NLM (Medline)
Abstract
In randomized controlled trials (RCTs) with time-to-event outcomes, the
difference in restricted mean survival times (RMSTD) offers an absolute
measure of the treatment effect on the time scale. Computation of the
RMSTD relies on the choice of a time horizon, $\tau$. In a meta-analysis,
varying follow-up durations may lead to the exclusion of RCTs with
follow-up shorter than $\tau$. We introduce an individual patient data
multivariate meta-analysis model for RMSTD estimated at multiple time
horizons. We derived the within-trial covariance for the RMSTD enabling
the synthesis of all data by borrowing strength from multiple time points.
In a simulation study covering 60 scenarios, we compared the statistical
performance of the proposed method to that of two univariate meta-analysis
models, based on available data at each time point and based on
predictions from flexible parametric models. Our multivariate model yields
smaller mean squared error over univariate methods at all time points. We
illustrate the method with a meta-analysis of five RCTs comparing
transcatheter aortic valve replacement (TAVR) with surgical replacement in
patients with aortic stenosis. Over 12, 24, and 36 months of follow-up,
those treated by TAVR live 0.28 [95% confidence interval (CI) 0.01 to
0.56], 0.46 (95% CI $-$0.08 to 1.01), and 0.79 (95% CI $-$0.43 to 2.02)
months longer on average compared to those treated by surgery,
respectively. Copyright © The Author 2019. Published by Oxford
University Press. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<32>
Accession Number
628212487
Title
Analysis of survival after coronary endarterectomy combined with coronary
artery bypass grafting compared with isolated coronary artery bypass
grafting: a meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 10 Jun 2019.
Author
Wang C.; Chen J.; Gu C.; Li J.
Institution
(Wang, Gu, Li) Department of Cardiac Surgery, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Chen) People's Hospital of Deyang City, Sichuan, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this analysis was to compare survival outcomes of
coronary endarterectomy (CE) combined with coronary artery bypass grafting
(CABG) with those of conventional CABG. METHOD(S): Eight
observational studies were included in this analysis, including 10 529
different patients in Asia, Europe and North America, from 1985 to 2012,
among whom 1925 underwent CE+CAGB and 8604 underwent conventional CAGB.
The follow-up period ranged from 4 to 14years. This meta-analysis was
performed with the fixed-effects model. RESULT(S): After rigorous
assessment of the quality of the studies included, this analysis showed
that CE+CABG had a statistically significant weaker short-term outcome,
with a higher risk of mortality [odds ratio (OR)] 1.61; P=0.002]. Further,
this phenomenon was exacerbated in the midterm. One-year and 2-year
results indicated that death was, respectively, 163% (OR 2.63; P<0.001)
and 133% (OR 2.60; P<0.001) more likely to occur in the CE+CABG group.
However, the long-term results indicated no difference between the 2
groups. The 4-year hazard ratio (1.13; P=0.10) did not show significant
differences between the groups, and the Kaplan-Meier survival curves had
the same level and pattern. CONCLUSION(S): CE+CABG had a
significantly weaker short-term outcome than conventional CABG, and this
trend continued in the midterm. The survival rate had the largest gap in
the midterm. However, there was no significant difference between these 2
groups in the long run. Copyright © The Author(s) 2019. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<33>
Accession Number
2001761535
Title
Smaller brain volumes at two years of age in patients with hypoplastic
left heart syndrome - Impact of surgical approach.
Source
International Journal of Cardiology. 291 (pp 42-44), 2019. Date of
Publication: 15 September 2019.
Author
Knirsch W.; Heye K.N.; Tuura R.O.; Hahn A.; Wetterling K.; Latal B.;
Schranz D.; Reich B.
Institution
(Knirsch, Heye) Pediatric Cardiology, Pediatric Heart Center, University
Children's Hospital, Zurich, Switzerland
(Knirsch, Heye, Tuura, Latal) Children's Research Center, University
Children's Hospital, Zurich, Switzerland
(Heye, Tuura) Diagnostic Imaging, MR-Center, University Children's
Hospital, Zurich, Switzerland
(Hahn) Pediatric Neurology, University Hospital Giessen,
Justus-Liebig-University, Giessen, Germany
(Wetterling) Child Development Center, SPZ Frankfurt Mitte,
Frankfurt/Main, Germany
(Latal) Child Development Center, University Children's Hospital, Zurich,
Switzerland
(Schranz, Reich) Pediatric Heart Center, University Hospital Giessen,
Justus-Liebig-University, Giessen, Germany
Publisher
Elsevier Ireland Ltd
Abstract
Background: Brain growth in hypoplastic left heart syndrome (HLHS) is
reduced before and after birth. Little is known about further brain growth
until two years of age before Fontan procedure and the potential impact of
type of surgery. Method(s): In a prospective, two-center study 29
patients with HLHS and variants were treated by Norwood (n = 5) or Hybrid
procedure (n = 24). At two years of age a cerebral MRI was performed and
brain volumes (total gray, deep gray, white matter) and cerebrospinal
fluid volume were calculated using FreeSurfer image analysis suite and
compared to a healthy control group (n = 8). Result(s): The total
brain volumes in patients with HLHS were smaller compared to controls
(HLHS: 893 +/- 76 ml vs. controls: 1015 +/- 148 ml, p = 0.005). This
difference was found in all three brain compartments after Norwood
procedure, whereas patients after Hybrid procedure had total and deep gray
volumes comparable to controls. When comparing Norwood to Hybrid patients,
deep gray matter volume reduction was more pronounced (Norwood: 38.4 +/-
4.1 ml vs. Hybrid: 44.4 +/- 3.9 ml, p = 0.005) than white matter reduction
(Norwood: 255 +/- 19 ml vs. Hybrid: 285 +/- 31 ml, p = 0.032).
 Conclusion(s): Smaller total and regional brain volumes were found
two years after Norwood or Hybrid procedure in children with HLHS. The
brain volume reduction was more distinct after Norwood than after Hybrid
procedure. Longitudinal studies are needed to identify impact of early
staged-surgeries on brain development and may become part of the
decision-making process in individual patients. Copyright © 2019
Elsevier B.V.

<34>
Accession Number
628083739
Title
Efficacy of programmed intermittent bolus epidural analgesia in thoracic
surgery: A randomized controlled trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 107.
Date of Publication: 15 Jun 2019.
Author
Higashi M.; Shigematsu K.; Nakamori E.; Sakurai S.; Yamaura K.
Institution
(Higashi, Nakamori, Sakurai, Yamaura) Department of Anesthesiology,
Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka
814-0180, Japan
(Shigematsu) Operation Rooms, Fukuoka University Hospital, Fukuoka, Japan
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Continuous epidural infusion (CEI) has some disadvantages,
such as increased local anesthetic consumption and limited area of
anesthetic distribution. Programmed intermittent bolus (PIB) is a
technique of epidural anesthesia in which boluses of local anesthetic are
automatically injected into the epidural space. The usefulness of PIB in
thoracic surgery remains unclear. In this study, we aimed to compare the
efficacies of PIB epidural analgesia and CEI in patients undergoing
thoracic surgery. Method(s): This randomized prospective study was
approved by the Institutional Review Board. The study included 42
patients, who were divided into CEI (n = 21) and PIB groups (n = 21). In
the CEI group, patients received continuous infusion of the local
anesthetic at a rate of 5.1 mL/90 min. In the PIB group, a pump delivered
the local anesthetic at a dose of 5.1 mL every 90 min. The primary
endpoints were the frequency of patient-controlled analgesia (PCA) and the
total dose of local anesthetic until 36 h following surgery. Student's
t-test, the chi-square test, and the Mann-Whitney U test were used for
statistical analyses. Result(s): The mean number of PCA
administrations and total amount of local anesthetic were not
significantly different between the two groups up to 24 h following
surgery. However, the mean number of PCA administrations and total amount
of local anesthetic at 24-36 h after surgery were significantly lower in
the PIB group than in the CEI group (median [lower-upper quartiles]: 0
[0-2.5] vs. 2 [0.5-5], P = 0.018 and 41 [41-48.5] vs. 47 [43-56], P =
0.035, respectively). Hypotension was significantly more frequent in the
PIB group than in the CEI group at 0-12 h and 12-24 h (3.3% vs. 0.5%, P =
0.018 and 7.9% vs. 0%, P = 0.017, respectively). Conclusion(s): PIB
can reduce local anesthetic consumption in thoracic surgery. However, it
might result in adverse events, such as hypotension. Trial registration:
This randomized prospective study was approved by the Institutional Review
Board (IRB No. 15-9-06) of the Fukuoka University Hospital, Fukuoka,
Japan, and was registered in the clinical trials database UMIN (ID
000019904) on 24 November 2015. Written informed consent was obtained from
all patients. Copyright © 2019 The Author(s).

<35>
Accession Number
628043357
Title
Transcatheter versus surgical aortic valve replacement in low- and
intermediate-risk patients: an updated systematic review and
meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. 34 (3) (pp 216-225), 2019.
Date of Publication: 16 Jul 2019.
Author
Ueshima D.; Fovino L.N.; D'Amico G.; Brener S.J.; Esposito G.; Tarantini
G.
Institution
(Ueshima, Fovino, D'Amico, Tarantini) Cardiology Unit, Department of
Cardiac, Thoracic and Vascular Sciences, University of Padua Medical
School, Padua, Italy
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, NY, United States
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Naples, Italy
(Tarantini) Clinica Cardiologica, Ospedale di Padova, Centro Cardiologico
Gallucci, Via Giustiniani, 2, Padua 35128, Italy
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Transcatheter aortic valve replacement (TAVR) has been recognized as a
well-established alternative to surgical aortic valve replacement (SAVR)
for symptomatic aortic stenosis with high surgical risk. With this updated
systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low-
and intermediate-risk subjects. Studies comparing TAVR and SAVR in
low-risk patients (defined as STS <= 8% or EuroSCORE <= 20%) were
identified with electronic searches. The principal endpoint was all-cause
mortality at short term (< 3 months), 1, and 2 years. Other outcomes of
interest were cardiac mortality, neurological events, paravalvular leakage
(PVL), myocardial infarction (MI), major bleeding, acute kidney injury
(AKI), vascular complications, and new pacemaker (PM) implantation.
Seventeen articles including 9805 (4956 TAVR and 4849 SAVR) patients were
eligible. There was no significant difference in all-cause mortality at
short term [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.63-1.09],
1 year (OR 1.01, 95% CI 0.86-1.20) and 2 years (OR 0.86, 95% CI 0.64-1.16)
between treatment groups. Subgroup analyses stratified by surgical risk
score (low-risk subgroup: STS < 4% or EuroSCORE < 10%, intermediate-risk
subgroup: the others) did not show interaction on primary endpoints.
Compared to SAVR, TAVR had similar rates of neurological events,
significantly lower risk of MI and AKI, but higher risk of vascular
complications, new PM implantation and moderate/severe PVL. In low- and
intermediate-risk patients, TAVR and SAVR have similar short- and mid-term
all-cause mortality. Compared to SAVR, TAVR carries higher rates of
vascular complications, PM implantation and moderate/severe PVL, but lower
risk of MI and AKI. Copyright © 2018, Japanese Association of
Cardiovascular Intervention and Therapeutics.

<36>
Accession Number
2001969916
Title
Diagnostic Accuracy of Microcatheter Derived Fractional Flow Reserve.
Source
American Journal of Cardiology. 124 (2) (pp 183-189), 2019. Date of
Publication: 15 July 2019.
Author
Demir O.M.; Mitomo S.; Mangieri A.; Ancona M.B.; Regazzoli D.; Lanzillo
G.; Giannini F.; Testa L.; Wijns W.; Colombo A.; Latib A.
Institution
(Demir, Mitomo, Ancona, Regazzoli, Lanzillo, Latib) IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Demir) Department of Cardiology, Hammersmith Hospital, Imperial College
Healthcare NHS Trust, London, United Kingdom
(Mangieri, Giannini, Colombo) GVM Care and Research, Maria Cecilia
Hospital, Cotignola, Ravenna, Italy
(Testa) IRCCS Policlinico San Donato, Milan, Italy
(Wijns) The Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway, Ireland
(Latib) Division of Cardiology, Department of Medicine, University of Cape
Town, Cape Town, South Africa
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Microcatheter derived fractional flow reserve (FFR<inf>MC</inf>) system
has an increased profile compared with pressure-wire derived fractional
flow reserve (FFR<inf>W</inf>). Consequently, the FFR<inf>MC</inf> system
itself may increase the degree of coronary artery stenosis and lower the
measured FFR value. This can affect the diagnostic accuracy of the
FFR<inf>MC</inf> system and inadvertently result in erroneous therapy for
patients. Our aim was to evaluate the diagnostic accuracy FFR<inf>MC</inf>
measurements and provide a means for clinicians to interpret individual
FFR<inf>MC</inf> results with respect to FFR<inf>W</inf>. Correlation
between FFR measurement techniques was analyzed in this lesion level
analysis of 413 patients and 441 lesions from 6 studies. The reference
standard to determine physiological significant stenosis was
FFR<inf>W</inf> value <=0.80. The mean values for FFR<inf>MC</inf> and
FFR<inf>W</inf> were 0.80 +/- 0.11 and 0.83 +/- 0.09, respectively.
Bland-Altman analysis demonstrated a bias toward overestimation of FFR by
FFR<inf>MC</inf> (bias, -0.03 [0.05]). The overall lesion level diagnostic
accuracy of the FFR<inf>MC</inf> system was 80.4% (95% confidence interval
[CI] 76.2% to 84.0%). The diagnostic accuracy for FFR<inf>MC</inf> values
<0.75, 0.75 to 0.85 and >0.85 were 83.7% (95% CI 71.4% to 92.4%), 72.3%
(95% CI 59.8% to 75.6%), and 99.2% (95% CI 94.8% to 99.8%), respectively.
Using the FFR<inf>W</inf> threshold of <=0.80, 16.3% of lesions would have
had inappropriate revascularization according to FFR<inf>MC</inf>
measurements. Receiver-operating characteristics suggested the optimal
cut-off value of FFR<inf>MC</inf> to determine ischemia was 0.78. In
conclusion, the diagnostic accuracy of FFR<inf>MC</inf> varies markedly
across the spectrum of disease with marked deterioration for values
between 0.75 and 0.85. This may result in clinicians to inadvertently
revascularize patients with FFR measurements >0.80. Copyright ©
2019

<37>
Accession Number
628044461
Title
Bilateral thoracic paravertebral block combined with general anesthesia
vs. general anesthesia for patients undergoing off-pump coronary artery
bypass grafting: A feasibility study.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 101.
Date of Publication: 12 Jun 2019.
Author
Sun L.; Li Q.; Wang Q.; Ma F.; Han W.; Wang M.
Institution
(Sun, Li, Wang, Ma, Wang) Department of Anesthesiology, Qingdao Municipal
Hospital, Qingdao, Shandong 266011, China
(Han) Department of Respiratory Medicine, Qingdao Municipal Hospital, 1
Jiaozhou Road, Qingdao, Shandong 266011, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Whether thoracic paravertebral block (PVB) is useful in
patients undergoing off-pump coronary artery bypass grafting (OPCABG)
remains unknown. This study aimed to investigate the feasibility of
bilateral PVB combined with general anesthesia (GA) in patients undergoing
OPCABG. Method(s): This feasibility study assessed 60 patients
scheduled for OPCABG at the Qingdao Municipal Hospital in 2016-2017.
Patients were randomly assigned to receive nerve stimulator-guided
bilateral PVB combined with GA (PVB + GA) or GA alone (n = 30/group).
Patients were asked to rate rest and cough pain hourly after the surgery.
The primary endpoint was the visual analogue scale (VAS) pain score within
48 h postoperatively. Secondary endpoints were rescue analgesia and
morphine consumption, fentanyl dose within 48 h postoperatively, as well
as operative time, time to extubation, intensive care unit (ICU) stay,
hospital stay and other postoperative adverse events. Result(s): Both
rest and cough pains were lower in the PVB + GA group at 12, 24, 36, and
48 h after surgery compared with the GA group. There were fewer patients
who needed rescue analgesia in the PVB + GA group at 12 and 24 h than in
the GA group. Morphine consumptions at 24 and 48 h were lower in the PVB +
GA group compared with the GA group. Time to extubation (P = 0.035) and
ICU stay (P = 0.028) were shorter in the PVB + GA group compared with the
GA group. AEs showed no differences between the two groups.
 Conclusion(s): Nerve stimulator-guided bilateral thoracic PVB
combined with GA in OPCABG is associated with a reduced rescue analgesia
and morphine consumption, compared to GA. Copyright © 2019 The
Author(s).

<38>
Accession Number
2002113617
Title
A systematic review of the use of near-infrared fluorescence imaging in
patients with peripheral artery disease.
Source
Journal of Vascular Surgery. 70 (1) (pp 286-297.e1), 2019. Date of
Publication: July 2019.
Author
van den Hoven P.; Ooms S.; van Manen L.; van der Bogt K.E.A.; van Schaik
J.; Hamming J.F.; Vahrmeijer A.L.; van der Vorst J.R.; Mieog J.S.D.
Institution
(van den Hoven, Ooms, van Manen, van der Bogt, van Schaik, Hamming,
Vahrmeijer, van der Vorst, Mieog) Department of Surgery, Leiden University
Medical Center, Leiden, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: In the diagnosis of peripheral artery disease (PAD), the
ankle-brachial index plays an important role. However, results of the
ankle-brachial index are unreliable in patients with severe media
sclerosis. Near-infrared (NIR) fluorescence imaging using indocyanine
green (ICG) can provide information about tissue perfusion and has already
been studied in oncologic, reconstructive, and cardiac surgery. For
patients with PAD, this technique might give insight into skin perfusion
and thereby guide treatment. We performed a systematic review of the
literature on the use of NIR fluorescence imaging in patients with PAD.
 Method(s): PubMed, MEDLINE, Embase, and Cochrane were searched for
articles and abstracts on the application of NIR fluorescence imaging
using ICG as fluorescent dye in patients with PAD. Our search strategy
combined the terms "fluorescence," "ICG," or synonyms and "peripheral
artery disease" or synonyms. The extracted data included fluorescence
parameters and test characteristics for diagnosis of PAD. Result(s):
Twenty-three articles were found eligible for this review using 18
different parameters for evaluation of the fluorescence signal intensity.
NIR fluorescence imaging was used for four main indications: diagnosis,
quality control in revascularization, guidance in amputation surgery, and
visualization of vascular structures. For the diagnosis of PAD, NIR
fluorescence imaging yields a sensitivity ranging from 67% to 100% and a
specificity varying between 72% and 100%. Significant increases in
multiple fluorescence parameters were found in comparing patients before
and after revascularization. Conclusion(s): NIR fluorescence imaging
can be used for several indications in patients with PAD. NIR fluorescence
imaging seems promising in diagnosis of PAD and guidance of surgeons in
treatment, especially in patients in whom current diagnostic methods are
not applicable. Further standardization is needed to reliably use this
modality in patients with PAD. Copyright © 2018 Society for
Vascular Surgery

<39>
Accession Number
2002113612
Title
A systematic review and meta-analysis of bivalirudin application in
peripheral endovascular procedures.
Source
Journal of Vascular Surgery. 70 (1) (pp 274-284.e5), 2019. Date of
Publication: July 2019.
Author
Hu Y.; Liu A.Y.; Zhang L.; Wu X.; Shi S.; Elmore J.R.; Zhang X.
Institution
(Hu) Biomedical & Translational Informatics, Geisinger Medical Center,
Danville, Penn, United States
(Liu) Department of Cell and Systems Biology, University of Toronto,
Toronto, Ontario, Canada
(Zhang, Wu, Zhang) Division of Anesthesiology, Geisinger Medical Center,
Danville, Penn, United States
(Shi) Gillings School of Global Public Health, University of North
Carolina-Chapel Hill, Chapel Hill, NC, United States
(Elmore) Department of Vascular Surgery, Geisinger Medical Center,
Danville, Penn, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The direct thrombin inhibitor bivalirudin (BIV) was shown to be
superior to unfractionated heparin (UFH) in percutaneous coronary
interventions for reducing procedural blood loss. The aim of this study
was to compare outcome profiles of BIV and UFH in peripheral endovascular
procedures (PEPs) by synthesizing the currently available data.
 Method(s): Following the PRISMA statement, we conducted a
comprehensive literature search using Medline, Cochrane CENTRAL, PubMed,
EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We recruited
randomized, controlled trials and well-conducted observational studies
that compared UFH and BIV in PEPs requiring anticoagulation, excluding
endovascular cardiac procedures and coronary interventions. Random-effects
meta-analyses were conducted to compare the outcome profiles of these two
agents. Result(s): Thirteen articles containing 17 studies involving
a total of 21,057 patients were enrolled. Of these, 2 were randomized
controlled trials, 2 were prospective cohort studies, and 10 were
retrospective studies. There were no significant differences between BIV
and UFH in terms of procedural success rates, major and minor
perioperative bleeding, transfusion, perioperative transient ischemic
attack, or hemorrhagic strokes. However, compared with UFH, BIV had
significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58;
95% confidence interval [CI], 0.40-0.86), major adverse cardiovascular
events (OR, 0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR,
0.75; 95% CI, 0.63-0.88), perioperative myocardial infarction (OR, 0.73;
95% CI, 0.55-0.98), major vascular complications (OR, 0.59; 95% CI,
0.39-0.91), and minor vascular complications (OR, 0.58; 95% CI,
0.40-0.84). Conclusion(s): Compared with UFH, PEPs using BIV had
comparable procedural success rates and odds of perioperative transient
ischemic attack and hemorrhagic stroke. However, procedures with BIV had a
lower but nonsignificant odds of perioperative bleeding and transfusion.
Depending on the procedures conducted, the patients who received BIV will
have reduced or comparable odds of perioperative mortality, myocardial
infarction, major adverse cardiovascular events, net adverse clinical
events, and major and minor vascular complications. Therefore, BIV may be
chosen solely as an alternative procedural anticoagulant to UFH for
PEPs. Copyright © 2019 The Authors

<40>
Accession Number
2002072268
Title
Spontaneous lumbar artery rupture and massive retroperitoneal hematoma,
successfully treated with arteriographic embolization.
Source
Pakistan Journal of Medical Sciences. 35 (2) (pp 569-574), 2019. Date of
Publication: 26 Feb 2019.
Author
Kim J.Y.; Lee S.A.; Hwang J.J.; Park J.B.; Park S.W.; Kim Y.H.; Moon H.J.;
Lee W.S.
Institution
(Kim) Department of Emergency Medicine, School of Medicine, Konkuk
University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk,
South Korea
(Kim, Moon, Lee) Department of Thoracic and Cardiovascular Surgery, School
of Medicine, Konkuk University, Konkuk University Chungju Hospital,
Chungju-si, Chungbuk, South Korea
(Lee, Hwang, Park, Park) Department of Radiology, School of Medicine,
Konkuk University, Konkuk University Seoul Hospital, Seoul, South Korea
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Background and Objective: Massive retroperitoneal hematoma caused by
lumbar artery rupture is generally associated with trauma or
retroperitoneal malignancy. However, despite recent advances in
technologies and tools, spontaneous lumbar artery rupture is a very rare
disease entity but remains a challenging problem because it is frequently
associated with significantly high mortality and morbidity and is very
difficult to make a correct diagnosis. Method(s): We evaluated the
databases of the PubMed, Embase, Cochrane Central Register of Controlled
Trial, Google Scholar, the KoreaMed and the Research Information Sharing
Service databases, and a detailed systematic review was performed by
searching in PubMed. The initial search was performed on 3 February 2018
and a second search conducted in 29 January 2019. Result(s): A total
of 10 case reports on massive hemoperitoneum caused by spontaneous lumbar
artery rupture were identified. Of the 10 case reports involving 14
patients, eight were male and six were female under 62.71 +/- 13.93. Of
the 14 patients, 9 (64.3%) surviving with transcatheter arterial
embolization, three (21.4%) died of multi-organ failure or hypovolemia,
and two (14.3%) had no definite records on survival or death.
 Conclusion(s): A massive retroperitoneal hematoma caused by lumbar
artery rupture should be considered in patients with late-onset shock
accompanied by blunt abdominal/pelvic trauma. Furthermore, early detection
and urgent embolization would prevent further complications and eliminate
the need for surgical interventions. Copyright © 2019,
Professional Medical Publications. All rights reserved.

<41>
Accession Number
2001983601
Title
Effect of perioperative administration of dexmedetomidine on delirium
after cardiac surgery in elderly patients: A double-blinded, multi-center,
randomized study.
Source
Clinical Interventions in Aging. 14 (pp 571-575), 2019. Date of
Publication: 2019.
Author
Shi C.; Jin J.; Qiao L.; Li T.; Ma J.; Ma Z.
Institution
(Shi, Jin, Qiao, Li, Ma, Ma) Department of Anesthesiology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong
264000, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Objective: Postoperative delirium (POD) is a serious complication in
elderly patients undergoing cardiac surgery. This study was aimed at
investigating the effect of perioperative administration of
dexmedetomidine for general anesthesia maintenance on occurrence and
duration of POD in elderly patients after cardiac surgery. Method(s):
One hundred and sixty-four patients were enrolled after cardiac surgery
between June 2009 and December 2016. Patients were assigned by a
computer-generated randomization sequence in a 1:1 ratio to receive
dexmedetomidine general anesthesia maintenance or propofol general
anesthesia maintenance. POD was assessed every day with confusion
assessment method for intensive care units (ICU) during the first 5
postoperative days. Result(s): There was no significance in incidence
of POD between the dexmedetomidine group and the propofol group
(P=0.0758). In patients treated with dexmedetomidine, the median onset
time of delirium was delayed (second day vs first day) and the duration of
delirium reduced (2 days vs 3 days) when compared with propofol-treated
patients. The dexmedetomidine-treated patients also displayed a lower VAS
score and less opiate analgesic consumption. No difference was observed in
respect to other postoperative outcomes. Conclusion(s): For elderly
patients, perioperative administration of dexmedetomidine reduced
incidence, delayed onset and shortened duration of POD after cardiac
surgery. Copyright © 2019 Shi et al.

<42>
Accession Number
2002055392
Title
Randomized Trial of Miniaturized Versus Standard Extracorporeal
Circulation in Aortic Valve Surgery.
Source
Annals of Thoracic Surgery. 108 (1) (pp 37-44), 2019. Date of Publication:
July 2019.
Author
Halfwerk F.R.; Knol K.; Mariani S.; Grandjean J.G.; Mecozzi G.
Institution
(Halfwerk, Knol, Mariani, Grandjean, Mecozzi) Department of
Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente
Hospital, Enschede, Netherlands
(Halfwerk, Grandjean) Department of Biomechanical Engineering, Faculty of
Engineering Technology, University of Twente, Enschede, Netherlands
(Mecozzi) Department of Cardio-Thoracic Surgery, University Medical Center
Groningen, Groningen, Netherlands
Publisher
Elsevier USA
Abstract
Background: Complications related to extracorporeal circulation remain
serious. Although a minimal invasive extra corporeal circulation (MiECC)
system was developed to cope with these complications, its effectivity on
patient-related outcomes such as blood loss remain uncertain. Therefore,
the aim of this study is to compare MiECC to an advanced standard system
with respect to blood loss. Method(s): A total of 128 adult patients
undergoing elective isolated aortic valve replacement were enrolled in a
randomized clinical trial. Patients who had undergone previous heart
surgery and with preexisting kidney failure were excluded. The primary end
point was postoperative blood loss after 12 hours and at drain removal.
Secondary end points included intensive care and total length of stay and
intubation time. At 1 hour and 12 hours after surgery, clinical laboratory
data were determined. Early clinical outcomes and long-term survival were
determined. Result(s): MiECC patients (n = 63) had a significant
lower blood loss (230 mL, 95% confidence interval: 203 to 261 mL) than
regular patients (n = 62) after 12 hours (288 mL, 95% confidence interval:
241 to 344 mL, p = 0.04). A preservation of hemoglobin levels 1 hour and
12 hours after surgery in the MiECC group were observed (p < 0.001). No
difference was found in early clinical outcomes and long-term survival.
 Conclusion(s): This randomized controlled trial compares MiECC and an
advanced system for aortic valve replacement with blood loss as primary
end point. We conclude that using MiECC is clinically equal for short- and
long-term follow-up regarding blood loss. Clinical trial registration:
NTR3378. Copyright © 2019 The Society of Thoracic Surgeons

<43>
Accession Number
2001839223
Title
Risk factors for death or heart transplantation in single-ventricle
physiology (tricuspid atresia, pulmonary atresia, and heterotaxy): A
systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 38 (7) (pp 739-747), 2019. Date
of Publication: July 2019.
Author
Kulkarni A.; Patel N.; Singh T.P.; Mossialos E.; Mehra M.R.
Institution
(Kulkarni) London School of Economics and Political Science, London,
United Kingdom
(Patel, Mossialos) Department of Health Policy, London School of Economics
and Political Science, London, United Kingdom
(Singh) Department of Cardiology, Boston Children's Hospital, Boston, MA,
United States
(Mehra) Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
Publisher
Elsevier USA
Abstract
BACKGROUND: In this study we sought to evaluate risk factors (RFs) for
death or heart transplantation (D-HT) in single-ventricle (SV) physiology
due to tricuspid atresia (TA), pulmonary atresia-intact ventricular septum
(PA-IVS), and heterotaxy with SV (HX), clinical conditions for which
outcome data are limited. METHOD(S): To conduct a systematic review,
we included citations that evaluated occurrence of D-HT in SV physiology
of TA, PA-IVS, and HX in English articles published between January 1998
and December 2017 based on inclusion and exclusion criteria, following the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
(PRISMA) guidelines. The Cochrane Risk of Bias in Non-Randomized
Studies-Interventions (ROBINS-I) tool for non-randomized studies was used
to assess the risk of bias. Meta-analysis was performed if RF data were
available in more than 3 studies. RESULT(S): Of 11,629 citations
reviewed, 30 met inclusion criteria. All 30 were observational,
retrospective studies. In all, 1,770 patients were included, 481 died and
21 underwent HT (63 lost to follow-up); 723 patients reached Fontan
completion. We found that systemic ventricular dysfunction (odds ratio
[OR] 20.7, confidence interval [CI] 10.0-42.5, I2 = 0%) and
atrioventricular valve regurgitation (AVR) were associated with risk of
D-HT (OR 3.7, CI 1.9-6.9, I2 = 14%). RF associations with D-HT
could not be derived for right ventricle-dependent coronary circulation,
pulmonary arteriovenous malformations, total anomalous pulmonary venous
return, arrhythmias, and pulmonary atresia. CONCLUSION(S): This
systematic review and meta-analysis has identified a high mortality rate
in children born with non-HLHS SV heart disease and points to potential
under-utilization of HT. Systemic ventricular dysfunction and AVR were
identified as RFs for D-HT in this subset of patients SV with TA, PA-IVS,
and HX. Copyright © 2019 International Society for Heart and Lung
Transplantation

<44>
Accession Number
2002135518
Title
Meta-analysis of Effects of Triglyceride Modifiers on Cardiovascular
Outcomes*.
Source
Journal of Clinical Lipidology. Conference: National Lipid Association
2019 Scientific Sessions. United States. 13 (3) (pp e23-e24), 2019. Date
of Publication: May - June 2019.
Author
Rahman H.; Khan S.; Talluri S.; Asif M.; Hammad T.; Kaluski E.
Institution
(Rahman, Khan, Talluri, Asif, Hammad, Kaluski) SayrePAUnited States
Publisher
Elsevier Ltd
Abstract
Lead Author's Financial Disclosures: None. Study Funding: None.
Background/Synopsis: The impact of triglyceride (TG) lowering therapy on
cardiovascular (CV) outcomes remains unclear. Objective/Purpose: To
investigate the effects of TG modifiers on CV disease. Method(s): 30
randomized trials having >=200 patients with >=6-month follow-up period
were selected using PubMed/Medline, EMBASE and the CENTRAL (Inception- 30
May 2018) comparing TG modifiers [fibrates, niacin or omega-3 fatty acids
(-3)] with the control group. Outcomes were major adverse cardiovascular
events (MACE) [composite of myocardial infarction (MI), stroke, CV
mortality and coronary revascularization (CR)], its components and
all-cause mortality. These were reported as relative risk (RR) with 95 %
confidence interval (CI) using random effects model. Result(s): In
analysis of 140,529 patients with mean follow-up of 46 +/- 19.8 months,
TG-modifiers significantly reduced MACE (RR: 0.92; 95 % CI, 0.89-0.96;
P<0.001), CV mortality (RR: 0.94; 95 % CI, 0.89-0.98; P=0.008), MI (RR:
0.86; 95% CI, 0.80-0.92; P<0.001) and CR (RR: 0.94; 95% CI, 0.91-0.98;
P=0.005) but had neutral effect on stroke (RR: 1.02; 95% CI, 0.93-1.12;
P=0.64) and all-cause mortality (RR: 0.99; 95% CI, 0.95-1.04; P=0.78).
Subgroup analysis revealed significantly lower MACE, CV mortality and MI
rates limited to studies without background statin therapy. Significant
reduction of MACE and MI was derived mostly from fibrates while CV
mortality was limited to -3 use. Moment of meta regression analyses
demonstrated significantly decreased MI and CR associated with absolute
reduction (mmol/L) of LDL-C; however no beneficial effect was noted by
absolute reduction of triglycerides or absolute increase of HDL-C.
 Conclusion(s): TG modifiers significantly reduced MACE, CV mortality
and MI in the absence of concurrent statin therapy. [Figure
presented] Copyright © 2019

<45>
Accession Number
2002135513
Title
Effects of Marine Omega-3 Fatty Acids on Cardiovascular Outcomes in
Patients with Ischemic Heart Disease: A Meta-Analysis*.
Source
Journal of Clinical Lipidology. Conference: National Lipid Association
2019 Scientific Sessions. United States. 13 (3) (pp e52-e53), 2019. Date
of Publication: May - June 2019.
Author
Rahman H.U.; Hammad T.; Kaluski E.
Institution
(Rahman, Hammad, Kaluski) SayrePAUnited States
Publisher
Elsevier Ltd
Abstract
Lead Author's Financial Disclosures: None. Study Funding: None.
Background/Synopsis: Previous meta-analyses had not addressed the impact
of marine omega-3 fatty acids (n-3 FAs) specifically in the ischemic heart
disease (IHD) patients. The role of n-3 FAs in the IHD population remains
uncertain. Objective/Purpose: To investigate the effects of n-3 FAs on
cardiovascular (CV) outcomes in the IHD patients. Method(s): Total of
8 randomized trials having >= 200 patients with at least >= 1-year
follow-up period were selected using PubMed/Medline, EMBASE and the
CENTRAL (Inception- 30 November 2018) evaluating n-3 FAs supplementation
in patients with IHD (excluded trials with fish advice alone). The primary
outcome was major adverse cardiovascular events (MACE) [composite of
myocardial infarction (MI), stroke, CV mortality and coronary
revascularization (CR)]. The secondary outcomes were components of the
MACE and all-cause mortality. The outcomes were estimated as relative risk
(RR) with 95 % confidence interval (CI) using a random effects model.
 Result(s): In analysis of 23,383 patients with IHD (mean age of
57+/-7 years and mean follow-up of 31+/-17 months), use of n-3 FAs did not
result in significant reduction of MACE (RR: 0.93; 95% CI, 0.84-1.04;
P=0.22) as compared to the control group (Figure. 1). In contrast, n-3 FAs
significantly lowered CV mortality (RR: 0.79; 95% CI, 0.65-0.96; P=0.02)
in patients with IHD. There was no significant reduction in terms of MI
(RR: 0.87; 95% CI, 0.67-1.12; P=0.27), all-cause mortality (RR: 0.97; 95%
CI, 0.80-1.18; P=0.75), stroke (RR: 0.72; 95% CI, 0.10-4.95; P=0.74), and
CR (RR: 0.99; 95% CI, 0.92-1.06; P=0.69) with the n-3 FA use.
 Conclusion(s): Use of n-3 FAs led to improved CV mortality in
patients with IHD, however, it failed to reduce the overall MACE. [Figure
presented] Copyright © 2019

<46>
Accession Number
2002135508
Title
Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events in the
ODYSSEY OUTCOMES Trial+.
Source
Journal of Clinical Lipidology. Conference: National Lipid Association
2019 Scientific Sessions. United States. 13 (3) (pp e54-e55), 2019. Date
of Publication: May - June 2019.
Author
Pordy R.; White H.; Schwartz G.; Alings M.; Bhatt D.; Bittner V.; Chiang
C.E.; Diaz R.; Edelberg J.; Goodman S.; Hanotin C.; Harrington R.; Jukema
J.W.; Kimura T.; Kiss R.G.; Lecorps G.; Mahaffey K.; Moryusef A.; Szarek
M.; Roe M.T.; Tricoci P.; Xavier D.; Zeiher A.; Steg G.
Institution
(Pordy, White, Schwartz, Alings, Bhatt, Bittner, Chiang, Diaz, Edelberg,
Goodman, Hanotin, Harrington, Jukema, Kimura, Kiss, Lecorps, Mahaffey,
Moryusef, Szarek, Roe, Tricoci, Xavier, Zeiher, Steg) TarrytownNYUnited
States
Publisher
Elsevier Ltd
Abstract
Lead Author's Financial Disclosures: Employment, Regeneron
Pharmaceuticals, Inc; Ownership interest: Regeneron Pharmaceuticals, Inc.
Study Funding: Sanofi & Regeneron Pharmaceuticals, Inc.
Background/Synopsis: In ODYSSEY OUTCOMES, first occurrence of coronary
heart disease (CHD) death, myocardial infarction (MI), fatal/nonfatal
ischemic stroke, or hospitalization for unstable angina (UA) was reduced
from 1052 for placebo to 903 for alirocumab (hazard ratio [HR] 0.85;
p=0.0003). However, this does not reflect the full impact of treatment, as
many patients had multiple events and non-CHD death and other nonfatal
cardiovascular (CV) events were excluded. Objective/Purpose: Here we
describe effects of alirocumab on total (first and subsequent) nonfatal CV
events and all-cause death by a model that accounts for the relationship
between nonfatal and fatal events. Method(s): Patients with acute
coronary syndrome (ACS) and LDL cholesterol >=70 mg/dL, non-HDL
cholesterol >=100 mg/dL, or apolipoprotein B >=80 mg/dL on maximum
tolerated dose of atorvastatin or rosuvastatin were randomized 1:1 to
treatment with alirocumab or placebo. The present analysis included
all-cause death and total nonfatal CV events (MI, stroke, hospitalization
for UA or heart failure, or ischemia-driven coronary revascularization). A
sensitivity analysis restricted nonfatal events to MI, stroke, or UA.
Total nonfatal and fatal event hazard functions were jointly estimated,
linked by a shared frailty accounting for patient risk heterogeneity and
correlated within-patient nonfatal events. The model also determines if
nonfatal events are associated with an increased risk for death. Treatment
effects were summarized by HRs and compared against the customary analysis
of first nonfatal CV event or death. Result(s): There were 5425 total
deaths or nonfatal CV events, 77% greater than first events (3064).
Alirocumab produced similar relative reductions in first and total events
when compared with placebo. Importantly, there were 385 fewer total events
with alirocumab versus 190 fewer first events. Nonfatal CV events were
associated with a higher risk of death, and the frailty variance indicated
substantial inter-patient heterogeneity in risk. Conclusion(s): In
patients with ACS, the total number of deaths and nonfatal CV events
prevented with alirocumab was twice the number of first events prevented.
Total event reduction may be a useful metric to gauge the efficacy of
alirocumab after ACS. [Figure presented] Copyright © 2019

<47>
Accession Number
628192624
Title
Neonatal chylothorax: A pathway based on a literature review and ten years
experience in a tertiary neonatal referral centre.
Source
Archives of Disease in Childhood. Conference: Royal College of Paediatrics
and Child Health Annual Conference, RCPCH 2019. United Kingdom. 104
(Supplement 2) (pp A88), 2019. Date of Publication: May 2019.
Author
White M.K.; Bhat R.; Greenough A.
Institution
(White, Bhat) Neonatal Intensive Care Centre, King's College Hospital NHS
Foundation Trust, London, United Kingdom
(Greenough) Women and Children's Health, School of Life Course Sciences,
King's College London, London, United Kingdom
(Greenough) Medical Research Council and Asthma UK Centre for Allergic
Mechanisms in Asthma, King's College London, London, United Kingdom
(Greenough) National Institute for Health Research Biomedical Research
Centre, King's College London, London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Aim Neonatal chylothorax is a rare condition with an incidence of 1 in
5775 [1] to 24000 [2] and has a high mortality rate of up to 64% [2]. Our
aim was to create a pathway for the diagnosis and management of neonatal
chylothorax based on experience in a tertiary neonatal referral centre and
a review of the literature. Methods A 10 year retrospective audit of all
neonates with a chylothorax was performed. A search of electronic
databases including keywords such as neonates and chylothorax identified
all relevant papers. A pathway was created based on the audit results and
the literature review. Results Over 10 years, six patients were diagnosed
with a chylothorax, two were congenital and four iatrogenic post thoracic
surgery or instrumentation. Patients were ventilated for a median of 30
days with a maximum daily pleural fluid output of 218 mls/kg/day. All
patients received medium-chain triglyceride (MCT) feeds which five
tolerated with no increase in pleural output. Octreotide was used in three
patients with no reduction in pleural fluid output. Two neonates needed
surgical intervention: one had thoracic duct ligation and the other
bilateral pleurodesis. The median length of stay was 68 days and five
neonates survived. Two patients with follow up had normal growth and
development at one year of age. The literature review revealed that
supportive care and MCT feeds were the mainstay of conservative management
of neonatal chylothorax. Somatostatin and more recently octreotide, a
somatostatin analogue, have been used with variable dosing regimens,
length of treatment and outcomes. Surgical intervention including thoracic
duct ligation or pleurodesis is used for those cases not responding to
conservative or medical management. A pathway was then created
highlighting which cohort of patients are at risk of neonatal chylothorax,
how to diagnose it and a flow chart for the management of neonatal
chylothorax. Conclusion Neonatal chylothorax is a rare condition and there
is no standardised management, hence we have created an evidence and
experience based pathway to improve diagnosis and management.

<48>
Accession Number
628191386
Title
Transfusion of washed and unwashed red blood cells: A pediatric
prospective randomized controlled clinical trial.
Source
Thoracic and Cardiovascular Surgeon. Conference: 48th Annual Meeting of
the German Society for Pediatric Cardiology, DGPK 2016. Germany. 64
(Supplement 2) (no pagination), 2016. Date of Publication: January 2016.
Author
Busch C.; Wollersheim S.; Berger F.; Redlin M.; Miera O.; Schmitt K.R.
Institution
(Busch, Wollersheim, Berger, Miera, Schmitt) Deutsches Herzzentrum Berlin,
Department of Congenital Heart Disease, Berlin, Germany
(Redlin) Deutsches Herzzentrum Berlin, Department of Anesthesiology,
Berlin, Germany
Publisher
Georg Thieme Verlag
Abstract
Objectives: After cardiac surgery children often need red blood cell (RBC)
transfusions. RBC transfusions generate an inflammatory response and are
associated with increased morbidity and mortality. The aim of this study
was to evaluate the clinical effect and inflammatory response in children
with RBC transfusion. We hypothesized that washing RBCs before transfusion
would reduce the pro-inflammatory response. Method(s): In a
prospective randomized controlled clinical trial 48 children treated in
the DHZB were randomized to an unwashed or washed RBC transfusion group.
The RBCs were washed by a cell savage machine. Blood gas analysis was
performed in the packed RBCs and in all patients before and 6 hours after
receiving a RBC transfusion. Vital parameters were documented before and
24 hours after transfusion and blood was taken for laboratory analysis and
analysis of cytokine concentration using Dry Blood Spots (DBS) and Instant
Leukocyte Culture System (ILCS). Result(s): A total of 45 children
were analyzed, 23 receiving unwashed RBCs and 22 receiving washed RBCs.
Threechildren were excluded. Washing reduced hemoglobin, potassium and
glucose and increased sodium concentration in the RBCs. After transfusion
an increased diastolic blood pressure was seen in the unwashed group.
Increased hemoglobin levels and oxygen saturation in the venous blood gas
analysis were found in both groups. A reduced sodium concentration was
seen in the unwashed group and a reduced standard bicarbonate
concentration was seen in the washed group. In laboratory analysis
hemoglobin, hematocrit and number of erythrocytes were increased in both
groups and CRP was reduced. A reduced creatine kinase and an increased
serum albumin and calcium were seen in the unwashed group. In the washed
group a drop of serum leukocytes and thrombocytes was found. After
transfusion an increase of MCP-1 and TARC in the DBS as well as an
increase of IL-1alpha, IL-6, IL-8 and MCP-1 in the ILCS was found in
patients receiving unwashed RBCs. IL-8 was reduced in patients receiving
washed RBCs. Among the patients receiving washed RBCs the ratio of MCP-1
and GP-VI in the DBS analysis as well as IL-6, IL-8 and MCP-1 in the ILCS
analysis was significantly reduced. Conclusion(s): Transfusion of
RBCs induces a proinflammatory reaction which can be diminished by washing
the packed RBCs before transfusion. Further clinical trials using a larger
amount of patients and multiple transfusions are needed to evaluate
especially the clinical outcome.

<49>
Accession Number
628180981
Title
Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review
and Meta-Analysis.
Source
Journal of the American Heart Association. 8 (9) (no pagination), 2019.
Article Number: e010920. 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
(Vallely) Sydney Heart and Lung Surgeons, Camperdown, Sydney, NSW,
Australia
(Woldendorp) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Camperdown, Sydney, NSW, Australia
(Grieve) Department of Radiology, Royal Prince Alfred Hospital,
Camperdown, Sydney, NSW, Australia
Publisher
American Heart Association Inc.
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 SBIs 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 SBIs 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 SBIs 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). Conclusion(s): SBIs are a very common
complication following cardiac procedures, particularly those involving
the aortic valve. The high frequency of SBIs 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 SBIs as a routine
outcome measure. Copyright © 2019 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<50>
Accession Number
628150846
Title
Multicentre, open-label, randomised, controlled clinical trial comparing
2% chlorhexidine-70% isopropanol and 5% povidone iodine-69% ethanol for
skin antisepsis in reducing surgical-site infection after cardiac surgery:
The CLEAN 2 study protocol.
Source
BMJ Open. 9 (6) (no pagination), 2019. Article Number: e026929. Date of
Publication: 01 Jun 2019.
Author
Boisson M.; Corbi P.; Kerforne T.; Camilleri L.; Debauchez M.; Demondion
P.; Eljezi V.; Flecher E.; Lepelletier D.; Leprince P.; Nesseler N.; Nizou
J.Y.; Roussel J.C.; Rozec B.; Ruckly S.; Lucet J.-C.; Timsit J.-F.; Mimoz
O.
Institution
(Boisson, Kerforne) Anaesthesia and Intensive Care Unit, Centre
Hospitalier Universitaire de Poitiers, Poitiers, France
(Boisson, Mimoz) INSERM U1070, Universite de Poitiers UFR Medecine et
Pharmacie, Poitiers, France
(Corbi) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de
Poitiers, Poitiers, France
(Camilleri) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire
de Clermont-Ferrand, Clermont-Ferrand, France
(Debauchez) Cardiothoracic Surgery Unit, Institut Mutualiste Montsouris,
Paris, France
(Demondion, Leprince) Cardiothoracic Surgery Unit, Hopitaux Universitaires
Pitie, Alpetriere-Charles Foix, Paris, France
(Eljezi) Anaesthesia and Intensive Care Unit, Centre Hospitalier
Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
(Flecher) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de
Rennes, Rennes, France
(Lepelletier) Infection Control Unit, Centre Hospitalier Universitaire de
Nantes, Nantes, France
(Nesseler) Anaesthesia and Intensive Care Unit, Centre Hospitalier
Universitaire de Rennes, Rennes, France
(Nizou) Infection Control Unit, Institut Mutualiste Montsouris, Paris,
France
(Roussel) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de
Nantes, Nantes, France
(Rozec) Anesthesia and Intensive Care Unit, Centre Hospitalier
Universitaire de Nantes, Nantes, France
(Ruckly, Timsit) INSERM UMR 1137, Universite Paris Diderot UFR de Medecine
Site Xavier-Bichat, Paris, France
(Lucet) Infection Control Unit, Hopital Bichat - Claude-Bernard, Paris,
France
(Lucet) Iame, INSERM, Paris, France
(Timsit) Medical and Infectious Diseases Intensive Care Unit, Hopital
Bichat - Claude-Bernard, Paris, France
(Mimoz) Emergency Department and Prehospital Care, Centre Hospitalier
Universitaire de Poitiers, Poitiers, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Surgical-site infection (SSI) is the second most frequent
cause of healthcare-associated infection worldwide and is associated with
increased morbidity, mortality and healthcare costs. Cardiac surgery is
clean surgery with low incidence of SSI, ranging from 2% to 5%, but with
potentially severe consequences. Perioperative skin antisepsis with an
alcohol-based antiseptic solution is recommended to prevent SSI, but the
superiority of chlorhexidine (CHG)-alcohol over povidone iodine
(PVI)-alcohol, the two most common alcohol-based antiseptic solutions used
worldwide, is controversial. We aim to evaluate whether 2% CHG-70%
isopropanol is more effective than 5% PVI-69% ethanol in reducing the
incidence of reoperation after cardiac surgery. Methods and analysis The
CLEAN 2 study is a multicentre, open-label, randomised, controlled
clinical trial of 4100 patients undergoing cardiac surgery. Patients will
be randomised in 1:1 ratio to receive either 2% CHG-70% isopropanol or 5%
PVI-69% ethanol for perioperative skin preparation. The primary endpoint
is the proportion of patients undergoing any re-sternotomy between day 0
and day 90 after initial surgery and/or any reoperation on saphenous
vein/radial artery surgical site between day 0 and day 30 after initial
surgery. Data will be analysed on the intention-to-treat principle. Ethics
and dissemination This protocol has been approved by an independent ethics
committee and will be carried out according to the principles of the
Declaration of Helsinki and the Good Clinical Practice guidelines. The
results of this study will be disseminated through presentation at
scientific conferences and publication in peer-reviewed journals. Trial
registration number EudraCT 2017-005169-33 and NCT03560193. Copyright
© 2019 BMJ Publishing Group Limited.

<51>
Accession Number
2002143671
Title
Selective Referral Using CCTA Versus Direct Referral for Individuals
Referred to Invasive Coronary Angiography for Suspected CAD: A Randomized,
Controlled, Open-Label Trial.
Source
JACC: Cardiovascular Imaging. Part 2. 12 (7) (pp 1303-1312), 2019. Date of
Publication: July 2019.
Author
Chang H.-J.; Lin F.Y.; Gebow D.; An H.Y.; Andreini D.; Bathina R.;
Baggiano A.; Beltrama V.; Cerci R.; Choi E.-Y.; Choi J.-H.; Choi S.-Y.;
Chung N.; Cole J.; Doh J.-H.; Ha S.-J.; Her A.-Y.; Kepka C.; Kim J.-Y.;
Kim J.-W.; Kim S.-W.; Kim W.; Pontone G.; Valeti U.; Villines T.C.; Lu Y.;
Kumar A.; Cho I.; Danad I.; Han D.; Heo R.; Lee S.-E.; Lee J.H.; Park
H.-B.; Sung J.-M.; Leflang D.; Zullo J.; Shaw L.J.; Min J.K.
Institution
(Chang, An, Chung, Han, Lee, Lee, Sung) Severance Cardiovascular Hospital,
Yonsei University Health System, Seoul, South Korea
(Lin, Lu, Kumar, Danad, Han, Lee, Shaw, Min) Dalio Institute of
Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell
Medicine, New York, NY, United States
(Gebow, Leflang, Zullo) MDDX, San Francisco, CA, United States
(Andreini, Baggiano, Beltrama, Pontone) Centro Cardiologico Monzino,
IRCCS, Milan, Italy
(Bathina) CARE Hospital and FACTS Foundation, Hyderabad, India
(Cerci) Quanta Diagnostico Nuclear, Curitiba, Brazil
(Choi) Gangnam Severance Hospital, Seoul, South Korea
(Choi) Pusan National University Hospital, Busan, South Korea
(Choi) Ajou University Hospital, Gyeonggi-do, South Korea
(Cole) Cardiology Associates of Mobile, Mobile, AL, United States
(Doh) Inje University, Ilsan Paik Hospital, Gyeonggi-do, South Korea
(Ha) Gangneung Asan Hospital, Gangwon-do, South Korea
(Her) Kangwon National University Hospital, Gangwon-do, South Korea
(Kepka) Institute of Cardiology, Warsaw, Poland
(Kim) Wonju Severance Hospital, Gangwon-do, South Korea
(Kim) Korea University Guro Hospital, Seoul, South Korea
(Kim, Cho) Chung-Ang University Hospital, Seoul, South Korea
(Kim) Yeungnam University Hospital, Daegu, South Korea
(Valeti) University of Minnesota, Minneapolis, MN, United States
(Villines) Walter Reed Medical Center, Bethesda, MD, United States
(Danad) VU Medical Center, Amsterdam, Netherlands
(Heo) Asan Medical Center, University of Ulsan College of Medicine, Seoul,
South Korea
(Park) Myongji Hospital, Seonam University College of Medicine,
Gyeonggi-do, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study compared the safety and diagnostic yield of a
selective referral strategy using coronary computed tomographic
angiography (CCTA) compared with a direct referral strategy using invasive
coronary angiography (ICA) as the index procedure. Background(s):
Among patients presenting with signs and symptoms suggestive of coronary
artery disease (CAD), a sizeable proportion who are referred to ICA do not
have a significant, obstructive stenosis. Method(s): In a
multinational, randomized clinical trial of patients referred to ICA for
nonemergent indications, a selective referral strategy was compared with a
direct referral strategy. The primary endpoint was noninferiority with a
multiplicative margin of 1.33 of composite major adverse cardiovascular
events (blindly adjudicated death, myocardial infarction, unstable angina,
stroke, urgent and/or emergent coronary revascularization or cardiac
hospitalization) at a median follow-up of 1-year. Result(s): At 22
sites, 823 subjects were randomized to a selective referral and 808 to a
direct referral strategy. At 1 year, selective referral met the
noninferiority margin of 1.33 (p = 0.026) with a similar event rate
between the randomized arms of the trial (4.6% vs. 4.6%; hazard ratio:
0.99; 95% confidence interval: 0.66 to 1.47). Following CCTA, only 23% of
the selective referral arm went on to ICA, which was a rate lower than
that of the direct referral strategy. Coronary revascularization occurred
less often in the selective referral group compared with the direct
referral to ICA (13% vs. 18%; p < 0.001). Rates of normal ICA were 24.6%
in the selective referral arm compared with 61.1% in the direct referral
arm of the trial (p < 0.001). Conclusion(s): In stable patients with
suspected CAD who are eligible for ICA, the comparable 1-year major
adverse cardiovascular events rates following a selective referral and
direct referral strategy suggests that both diagnostic approaches are
similarly effective. In the selective referral strategy, the reduced use
of ICA was associated with a greater diagnostic yield, which supported the
usefulness of CCTA as an efficient and accurate method to guide decisions
of ICA performance. (Coronary Computed Tomographic Angiography for
Selective Cardiac Catheterization [CONSERVE]; NCT01810198) Copyright
© 2019

<52>
Accession Number
628176265
Title
Patency of Individual and Sequential Coronary Artery Bypass in Patients
with Ischemic Heart Disease: A Meta-analysis.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2019. Date
of Publication: 05 Jun 2019.
Author
Li Z.; Liu L.
Institution
(Li) Shandong Provincial PKUcare Luzhong Hospital Department of Thoracic
and Cardiovascular Surgery Zibo Shandong People's Republic of China
Department of Thoracic and Cardiovascular Surgery, Shandong Provincial
PKUcare Luzhong Hospital, Zibo, Shandong, China
(Li, Liu) Shandong University Shandong Provincial Qianfoshan Hospital
Department of Cardiac Surgery Jinan Shandong People's Republic of China
Department of Cardiac Surgery, Shandong Provincial Qianfoshan Hospital,
Shandong University, Jinan, Shandong, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the patency of individual and sequential coronary
artery bypass in patients with ischemic heart disease. METHOD(S): We
searched PubMed, Cochrane Library, Excerpta Medica Database, and
ClinicalTrials.gov databases for controlled trials. Endpoints included
graft patency, anastomosis patency, occluded rates in left anterior
descending (LAD) system and right coronary artery (RCA) system,
in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs)
and standardized mean difference (SMD) were used to assess the relative
data. RESULT(S): Nine cohorts, including 7100 patients and 1440
grafts under individual or sequential coronary artery bypass. There were
no significant differences between individual and sequential coronary
artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16;
I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%),
occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%),
occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%),
in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and
follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%).
 CONCLUSION(S): No significant differences on clinical data were
observed regarding anastomosis patency, occluded rate in LAD system,
occluded rate in RCA system, in-hospital mortality, and follow-up
mortality, indicating that the patency of individual and the patency of
sequential coronary artery bypass are similar to each other.

<53>
Accession Number
628172949
Title
Is local anaesthesia superior to general anaesthesia in endovascular
repair of abdominal aortic aneurysm?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 07 Jun 2019.
Author
Harky A.; Grafton-Clarke C.; Chan J.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Grafton-Clarke) College of Life Sciences, University of Leicester,
Leicester, United Kingdom
(Chan) Department of Cardiothoracic Surgery, Morriston Hospital, Swansea,
United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiovascular surgery was written in accordance
to a structured protocol. The question addressed was: in patients
undergoing endovascular repair of abdominal aortic aneurysm (EVAR), is
local anaesthetic (LA) superior to general anaesthetic in terms of
perioperative outcomes? Altogether, 630 publications were found using the
reported search protocol, of which 3 represented the best evidence to
answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type and primary outcomes were
tabulated. The 3 included studies are systematic reviews with
meta-analyses, with no randomized trials identified. Within the studies,
there is a degree of heterogeneity in terms of surgical case-mix (elective
or emergency EVAR or both) and anaesthetic technique (LA, regional
anaesthetic, local-regional anaesthetic and general anaesthetic). With 1
study not providing pooled estimates, the second study demonstrated
statistical significance in favour of local-regional anaesthetic within
the elective setting in terms of mortality [pooled odds ratio (OR) 0.70,
95% confidence interval (CI) 0.52-0.95; P=0.02], morbidity (pooled OR
0.73, 95% CI 0.55-0.96; P=0.0006) and total length of hospital admission
(pooled mean difference: -1.53, 95% CI -2.53 to -0.53; P=0.00001). The
third study failed to demonstrate a statistically significant mortality
benefit with LA (pooled OR 0.54, 95% CI 0.21-1.41; P=0.211). While the
results of these studies fail to provide a clear answer to a complex
surgical problem, it would be appropriate, in the light of current
evidence, to recommend LA as non-inferior to general anaesthetic in both
emergency and elective settings. Copyright © The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<54>
Accession Number
628172331
Title
Effects of Drug Abuse, Smoking and Alcohol on Donor Hearts and Lungs.
Source
Transplant international : official journal of the European Society for
Organ Transplantation. (no pagination), 2019. Date of Publication: 06 Jun
2019.
Author
MacGowan G.A.; Dark J.H.; Corris P.A.; Nair A.R.
Institution
(MacGowan) Departments of Cardiology, Newcastle upon Tyne, United Kingdom
(MacGowan, Nair) Cardiothoracic Transplantation, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(MacGowan) Institutes of Genetic Medicine, Newcastle upon Tyne, United
Kingdom
(Dark, Corris, Nair) Cellular Medicine, Newcastle University, Newcastle
upon Tyne, United Kingdom
(Nair) Respiratory Medicine, Newcastle upon Tyne, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Potential heart and lung donors with a history of illicit
drugs and/or smoking and alcohol are frequently offered, though there is
no clear guidance on when it is safe to use these organs. METHOD(S):
Review of literature on effects of drugs, alcohol and smoking on donor
outcomes, and the effects of these on the intact heart and lung.
 RESULT(S): There has been a marked increase in deaths from opioid
abuse in many developed countries, though recent evidence suggests that
outcomes after cardiothoracic transplantation are equivalent to non-opioid
donor causes of death. For donor smoking, there is an increased risk with
lung transplantation, however that risk is less when compared to further
waiting on the transplant list for a non-smoking alternative. Heavy
alcohol consumption does not adversely affect heart transplantation, and
there is no clear evidence of adverse outcomes after lung transplantation.
There are no overall effects of cannabis or cocaine on survival after
heart or lung transplantation. In all these cases, careful donor
assessment can establish if a particular organ can be used.
 CONCLUSION(S): In most cases use of drugs requires careful
assessment, but is not in of itself a contraindication to cardiothoracic
transplantation. This article is protected by copyright. All rights
reserved.

<55>
Accession Number
628170863
Title
Inotropes and vasopressors use in cardiogenic shock: when, which and how
much?.
Source
Current opinion in critical care. (no pagination), 2019. Date of
Publication: 03 Jun 2019.
Author
Levy B.; Buzon J.; Kimmoun A.
Institution
(Levy, Buzon, Kimmoun) Service de Reanimation Medicale Brabois, CHRU Nancy
(Levy, Buzon, Kimmoun) INSERM U1116, Faculte de Medecine
(Levy, Buzon, Kimmoun) Universite de Lorraine, Nancy, France
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Data and interventional trials regarding vasopressor
and inotrope use during cardiogenic shock are scarce. Their use is limited
by their side-effects and the lack of solid evidence regarding their
effectiveness in improving outcomes. In this article, we review the
current use of vasopressor and inotrope agents during cardiogenic shock.
RECENT FINDINGS: Two recent Cochrane analyses concluded that there was not
sufficient evidence to prove that any one vasopressor or inotrope was
superior to another in terms of mortality. A recent RCT and a
meta-analysis on individual data suggested that norepinephrine may be
preferred over epinephrine in patients with cardiogenic shock . For
inotrope agents, when norepinephrine fails to restore perfusion,
dobutamine represents the first-line agent. Levosimendan is a calcium
sensitizer agent, which improves acute hemodynamics, albeit with uncertain
effects on mortality. SUMMARY: When blood pressure needs to be restored,
norepinephrine is a reasonable first-line agent. Dobutamine is the
first-line inotrope agent wheraes levosimendan can be used as a
second-line agent or preferentially in patients previously treated with
beta-blockers. Current information regarding comparative effective
outcomes is nonetheless sparse and their use should be limited as a
temporary bridge to recovery, mechanical circulatory support or heart
transplantation.

<56>
Accession Number
628168611
Title
Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2019. Date of
Publication: 06 Jun 2019.
Author
Habbab L.M.; Semelhago L.; Lamy A.
Institution
(Habbab, Semelhago, Lamy) Division of Cardiac Surgery, Hamilton General
Hospital, McMaster University, Hamilton, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: This meta-analysis was conducted to investigate the evidence
for the efficacy and safety of intrapericardial tranexamic acid (TXA) in
cardiac surgery. METHOD(S): We searched MEDLINE from 2000 to 2017
for randomized controlled trials that compared intrapericardial TXA to
placebo. We performed a meta-analysis for the eligible trials that focused
on chest tube drainage measured during the first 24 hours after surgery as
a primary outcome. We also examined the secondary outcome measures of
these trials such as the incidence of transfusion requirements following
surgery and the evidence for any increase in complication rates.
 RESULT(S): A total of seven randomized controlled trials (six
on-pump and one off-pump) comparing topical application of TXA to placebo
in 692 patients were eligible for the blood loss outcome data. These
trials randomized 372 patients to receive TXA and 320 patients as
controls. The use of intrapericardial TXA was associated with a
considerable reduction in 24-hour blood loss in all seven studies and a
weighted mean difference of -343.56 mL (95% confidence interval: -316.41,
-370.72) significantly differed from zero (p=0.005) with a heterogeneity
of I2=0%. The incidence of packed RBC transfusion in TXA patients was
significantly lower in one study and was not significant but with trend in
favor of TXA in five out of the six studies in which it was reported. In
one trial, TXA was not detected in any patient and in another the studied
groups were similar in postoperative complications, such as graft patency,
myocardial infarction, cerebral infarction, atrial fibrillation, seizures,
and infections. CONCLUSION(S): Findings from this meta-analysis
suggest that intrapericardial use of TXA in patients undergoing cardiac
surgery can decrease postoperative bleeding without increasing the risk of
postoperative seizures. Future large randomized, double-blind, controlled
clinical trials are needed to confirm these promising
findings. Copyright Georg Thieme Verlag KG Stuttgart . New York.

<57>
Accession Number
628023093
Title
The role of evidence-based algorithms for rotational
thromboelastometry-guided bleeding management.
Source
Korean journal of anesthesiology. (no pagination), 2019. Date of
Publication: 17 May 2019.
Author
Gorlinger K.; Perez-Ferrer A.; Dirkmann D.; Saner F.; Maegele M.;
Calatayud AA.P.; Kim T.-Y.
Institution
(Gorlinger, Dirkmann) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Essen, University Duisburg-Essen, Essen,
Germany
(Perez-Ferrer) Department of Anesthesiology, Infanta Sofia University
Hospital, San Sebastian de los Reyes, Madrid, Spain
(Saner) Department of General, Visceral and Transplant Surgery, University
Hospital Essen, University Duisburg-Essen, Essen, Germany
(Maegele) Department for Trauma and Orthopedic Surgery, Cologne-Merheim
Medical Center (CMMC) and Institute for Research in Operative Medicine
(IFOM), University Witten/Herdecke (UW/H) ,Campus Cologne-Merheim,
Cologne, Germany
(Calatayud) Terapia Intensiva Adultos, Hospital de Especialidades del Nino
y la Mujer, Coordinador Grupo Mexicano para el Estudio de la Medicina
Intensiva, Colegio Mexicano de Especialistas en Obstetrica Critica
(COMEOC), Mexico
(Kim) Department of Anesthesiology, Konkuk University Medical Center,
Konkuk University School of Medicine, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
Rotational thromboelastometry (ROTEM) is a point-of care viscoelastic
method and enables to assess viscoelastic profiles of whole blood in
various clinical settings. ROTEM-guided bleeding management has become an
essential part of patient blood management (PBM) which is an important
concept in improving patient safety. Here, ROTEM testing and hemostatic
interventions should be linked by evidence-based, setting specific
algorithms adapted to the specific patient population of the hospitals and
the local availability of hemostatic interventions. Accordingly,
ROTEM-guided algorithms implement the concept of personalized or precision
medicine in perioperative bleeding management ('theranostic' approach).
ROTEM-guided PBM has been shown to be effective in reducing bleeding,
transfusion requirements, complication rates and health care costs.
Accordingly, several randomized-controlled trials, meta-analyses and
health technology assessments provided evidence that using ROTEM-guided
algorithms in bleeding patients resulted in improved patient's safety and
outcomes including perioperative morbidity and mortality. However, the
implementation of ROTEM in PBM concept requires adequate technical and
interpretation training, education and logistics, as well as
interdisciplinary communication and collaboration.

<58>
Accession Number
2002148411
Title
Official Statement of the Spanish Society of Pulmonology and Thoracic
Surgery (SEPAR) on Electronic Cigarettes and IQOS.
Source
Archivos de Bronconeumologia. (no pagination), 2019. Date of Publication:
2019.
Author
Signes-Costa J.; de Granda-Orive J.I.; Ramos Pinedo A.; Camarasa Escrig
A.; de Higes Martinez E.; Rabade Castedo C.; Cabrera Cesar E.;
Jimenez-Ruiz C.A.
Institution
(Signes-Costa) Servicio de Neumologia, Hospital Clinico Universitario
INCLIVA, Universidad de Valencia, Valencia, Spain
(de Granda-Orive) Servicio de Neumologia, Hospital Universitario 12 de
Octubre, Universidad Complutense, Madrid, Spain
(Ramos Pinedo, de Higes Martinez) Unidad de Neumologia, Hospital
Universitario Fundacion Alcorcon, Universidad Rey Juan Carlos, Madrid,
Spain
(Camarasa Escrig) Unidad de Neumologia, Hospital Universitario del
Vinalopo, Elche, Spain
(Rabade Castedo) Servicio de Neumologia, Complejo Hospitalario de Santiago
de Compostela, Santiago de Compostela, Spain
(Cabrera Cesar) Servicio de Neumologia. Hospital Universitario Virgen de
la Victoria, Malaga, Spain
(Jimenez-Ruiz) Unidad Especializada en Tabaquismo, Hospital Clinico San
Carlos, Madrid, Spain
Publisher
Elsevier Doyma
Abstract
The use of novel tobacco products, particularly the electronic cigarette
(EC) and partial tobacco combustion devices (HnB systems: Heat not Burn),
has increased exponentially, particularly among adolescents and young
people. The health authorities and scientific societies have shown concern
about issues surrounding safety and effectiveness (as a method of smoking
cessation). A study of the available scientific evidence has concluded
that the safety of the vapor or fumes inhaled by the users of these
devices cannot be guaranteed. Contradictory results from various clinical
trials and meta-analyses also mean that these devices cannot be
recommended for their effectiveness in cessation, especially when safe and
effective treatments are available to help quit smoking (varenicline,
nicotine replacement therapy, and bupropion, combined with psychological
counseling). Copyright © 2019 SEPAR

<59>
Accession Number
2002142929
Title
High-Flow Therapy by Nasal Cannulae Versus High-Flow Face Mask in Severe
Hypoxemia After Cardiac Surgery: A Single-Center Randomized Controlled
Study-The HEART FLOW Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Vourc'h M.; Nicolet J.; Volteau C.; Caubert L.; Chabbert C.; Lepoivre T.;
Senage T.; Roussel J.-C.; Rozec B.
Institution
(Vourc'h, Nicolet, Caubert, Chabbert, Lepoivre, Rozec) Intensive Care Unit
of Cardiothoracic Surgery, Department of Anesthesia and Critical Care,
Hopital Laennec, University Hospital of Nantes, Nantes, France
(Volteau) Department of Methodology and Biostatistics, Department of
Research Promotion, University Hospital of Nantes, Nantes, France
(Senage, Roussel) Cardiovascular and Thoracic Surgery Unit, Hopital
Laennec, University Hospital of Nantes, Nantes, France
Publisher
W.B. Saunders
Abstract
Objective: To determine whether high-flow oxygen therapy by nasal cannulae
(HFNC) is more effective than a high-flow face mask (HFFM) in severe
hypoxemia. Design(s): Randomized, single-center, open-labeled,
controlled trial. Setting(s): University Hospital of Nantes, France.
 Participant(s): Cardiac surgery patients presenting oxygen saturation
<96% with Venturi mask 50%. Intervention(s): Oxygenation by HFNC (45
L/min, F<inf>I</inf>O<inf>2</inf> 100%) or Hudson RCI non-rebreather face
mask with a reservoir bag (15 L/min). Measurements and Main Results:
The co-primary outcomes were the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio at 1 and 24 hours. In the
intent-to-treat analysis (90 patients), the mean (standard deviation)
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratios were: after 1 hour,
113.4 (50.2) in HFFM versus 137.8 (57.0) in HFNC (mean difference 24.4, CI
97.5% [2.9-45.9], p = 0.03), and after 24 hours, 106.9 (62.6) in HFFM
versus 129.9 (54.0) in HFNC (mean difference 23.0, CI 97.5% [1.5-44.6], p
= 0.04). After adjustment on baseline
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf>, this difference persisted at
24 hours (p = 0.04). For secondary outcomes, the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio after 6 hours was 108.7
(47.9) in HFFM versus 136.0 (45.2) in HFNC (p = 0.01), without difference
after 48 hours (p = 0.95). Refractory hypoxemia requiring noninvasive
ventilation occurred in 13 (28%) patients in HFNC versus 24 (56%) patients
in HFFM (p = 0.007). The HFNC improved satisfaction (p = 0.0002) and
reduced mucus dryness (p = 0.003) compared with HFFM. Conclusion(s):
In patients with severe hypoxemia after cardiac surgery,
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> at 1 and 24 hours were higher
and the use of noninvasive ventilation was reduced in HFNC compared with
HFFM. Copyright © 2019 Elsevier Inc.

<60>
Accession Number
2002138523
Title
Traditional Chinese Medicine Treatment as Adjuvant Therapy in Completely
Resected Stage IB-IIIA Non-Small-Cell Lung Cancer: Study Protocol for a
Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial.
Source
Clinical Lung Cancer. (no pagination), 2019. Date of Publication: 2019.
Author
Jiang Y.; Liu L.-S.; Shen L.-P.; Liu J.-X.; Jiang G.-N.; Gu A.-Q.; Li
H.-C.; Li Q.; Li H.-G.; Huang P.-X.
Institution
(Jiang, Liu, Shen, Liu, Li) Department of Oncology, Longhua Hospital,
Shanghai University of Traditional Chinese Medicine, Shanghai, China
(Li) Department of Oncology, Shuguang Hospital, Shanghai University of
Traditional Chinese Medicine, Shanghai, China
(Huang) Department of Health Statistics, Shanghai University of
Traditional Chinese Medicine, Shanghai, China
(Jiang) Department of Thoracic Surgery, Shanghai Pulmonary Hospital,
Tongji University, Shanghai, China
(Gu) Department of Respiratory Medicine, Shanghai Chest Hospital,
Shanghai, China
(Li) Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong
University, Shanghai, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Adjuvant chemotherapy (AC) has been proven to yield an approximately 5%
improvement in 5-year survival for patients with early-stage
non-small-cell lung cancer. With such small gains in survival, the optimal
treatment regimen remains to be established. Traditional Chinese medicine
(TCM) treatment in combination with AC is frequently used in China. The
efficacy and safety of this integrated approach should be scientifically
evaluated. We present the rationale and study design of the Combined
Adjuvant Chemotherapy and Traditional Chinese Medicine (ACTCM) trial
(ChiCTR-IPR-16009062). The ACTCM trial, a prospective multicenter
double-blind randomized placebo-controlled study, will recruit 312
patients overall from 5 clinical research centers in China. Within 6 weeks
of the thoracic surgery, eligible participants with stages IB-IIIA
non-small-cell lung cancer will be randomly assigned in a 1:1 ratio to
either the treatment or control group. Patients in the treatment group
will receive AC combined with TCM herbal treatment for 4 cycles, then TCM
herbal plus injection treatment for 4 cycles. Patients in the control
group will receive AC combined with TCM placebo for 4 cycles and then TCM
placebo for 4 cycles. Treatment will be discontinued if disease
progression or unacceptable toxicity occurs. The primary end point is
2-year disease-free survival. Secondary end points include disease-free
survival and quality of life. Other end points are TCM symptoms,
performance status, and safety of the regimens. Recruitment started in
October 2016 and is ongoing. Copyright © 2019 Elsevier Inc.

<61>
Accession Number
2002138087
Title
Incidence, determinants and impact of acute kidney injury in patients with
diabetes mellitus and multivessel disease undergoing coronary
revascularization: Results from the FREEDOM trial.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Arbel Y.; Fuster V.; Baber U.; Hamza T.H.; Siami F.S.; Farkouh M.E.
Institution
(Arbel) Department of Cardiology, Tel Aviv Medical Center, Affiliated with
the University of Tel Aviv, Tel Aviv, Israel
(Fuster, Baber) Icahn School of Medicine at Mount Sinai, New York, United
States
(Fuster, Baber) Centro Nacional de Investigaciones Cardiovasculares,
Madrid, Spain
(Hamza, Siami) New England Research Institute (NERI), United States
(Farkouh) Peter Munk Cardiac Centre, and Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: The incidence and prognostic significance of acute kidney
injury (AKI) in patients with diabetes mellitus and multivessel coronary
artery disease undergoing coronary revascularization is not well known.
The current analysis included patients randomized to PCI vs. CABG as part
of the FREEDOM trial. We sought to examine the impact of AKI and its
predictors in diabetic patients with multivessel coronary artery disease
undergoing PCI vs. CABG. Method(s): We conducted a pre-specified
subgroup analysis of the FREEDOM trial to examine the incidence,
correlates and impact of AKI according to revascularization strategy. AKI
predictors were identified using multivariable logistic regression and
associations between AKI and outcomes were examined using Cox regression.
The primary endpoint was the composite occurrence of all-cause death,
stroke or myocardial infarction at 5 years of follow-up. Result(s):
KI occurred more frequently in patients following CABG (15.6%) compared
with PCI (9.1%) (p < 0.001). AKI was associated with a higher risk for
major cardiovascular events (MACE) at 5 years (34.6% vs. 20.5%, p <
0.001), an effect that remained large and significant irrespective of CABG
(HR = 2.18 95% CI 1.44-3.31, p <=0.001) or PCI (HR = 2.08 95% CI
1.35-3.21, p < 0.0001). There was a non-significant interaction (p-value =
0.89) between the revascularization method and AKI, supporting that AKI is
a significant risk factor in both revascularization methods.
 Conclusion(s): Although risk for AKI was higher in patients
undergoing CABG, the impact of AKI on MACE was substantial irrespective of
revascularization strategy. Preventive strategies to identify patients at
risk for AKI are warranted to mitigate the long-term effects of this
complication. Copyright © 2019

<62>
Accession Number
628179107
Title
ACTH-producing thymic neuroendocrine tumor initially presenting as
psychosis: A case report and literature review.
Source
Thoracic Cancer. (no pagination), 2019. Date of Publication: 2019.
Author
Okumura T.; Takayama S.; Nishio S.-I.; Miyakoshi T.; Noguchi T.; Kobayashi
T.; Fukushima T.; Sekiguchi N.; Otsuki T.; Komatsu M.; Koizumi T.
Institution
(Okumura) Second Department of Internal Medicine, Shinshu University
School of Medicine, Asahi Matsumoto, Japan
(Okumura, Noguchi, Kobayashi, Fukushima, Sekiguchi, Koizumi) Department of
Comprehensive Cancer Therapy, Shinshu University School of Medicine, Asahi
Matsumoto, Japan
(Takayama, Nishio, Miyakoshi, Komatsu) Fourth Department of Internal
Medicine, Shinshu University School of Medicine, Asahi Matsumoto, Japan
(Otsuki) Department of Central Laboratory, Shinshu University School of
Medicine, Asahi Matsumoto, Japan
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
A 32-year-old woman was referred to our hospital because of severe
psychosis and was found to have an ectopic ACTH-producing thymic
neuroendocrine tumor. Laboratory data revealed an elevated serum cortisol
and plasma ACTH level, hypokalemia, and metabolic alkalosis. Chest
computed tomography (CT) revealed an anterior mediastinal mass and
multiple pulmonary nodules. As the patient was unable to communicate
because of her consciousness disturbance, she was managed with artificial
ventilation and deep sedation. Metyrapone and potassium supplementation
were administered, and steroid psychosis gradually improved. Thoracic
surgery was performed and the histopathological diagnosis was thymic
neuroendocrine tumor with positive anti-ACTH immunohistochemical staining.
Here we present details of the case and review the
literature. Copyright © 2019 The Authors. Thoracic Cancer
published by China Lung Oncology Group and John Wiley & Sons Australia,
Ltd

<63>
Accession Number
628083868
Title
Hypertonic saline for fluid resuscitation after cardiac surgery
(HERACLES): Study protocol for a preliminary randomised controlled
clinical trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 357. Date of
Publication: 14 Jun 2019.
Author
Pfortmueller C.A.; Messmer A.S.; Hess B.; Reineke D.; Jakob L.; Wenger S.;
Waskowski J.; Zuercher P.; Stoehr F.; Erdoes G.; Luedi M.M.; Jakob S.M.;
Englberger L.; Schefold J.C.
Institution
(Pfortmueller, Messmer, Hess, Jakob, Wenger, Waskowski, Zuercher, Stoehr,
Jakob, Schefold) Department of Intensive Care Medicine, Inselspital, Bern
University Hospital, University of Bern, Freiburgstrasse 18, Bern CH-3010,
Switzerland
(Erdoes, Luedi) Department of Anaesthesiology and Pain Medicine,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Reineke, Englberger) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intraoperative and postoperative management of cardiac surgery
patients is complex, involving the application of differential
vasopressors and volume therapy. It has been shown that a positive fluid
balance has a major impact on postoperative outcome. Today, the advantages
and disadvantages of buffered crystalloid solutes are a topic of
controversy, with no consensus being reached so far. The use of hypertonic
saline (HS) has shown promising results with respect to lower total fluid
balance and postoperative weight gain in critically ill patients in
preliminary studies. However, collection of more data on HS in critically
ill patients seems warranted. This preliminary study aims to investigate
whether fluid resuscitation using HS in patients following cardiac surgery
results in less total fluid volume being administered. Method(s): In
a prospective double-blind randomised controlled clinical trial, we aim to
recruit 96 patients undergoing elective cardiac surgery for ischaemic
and/or valvular heart disease. After postoperative admission to the
intensive care unit (ICU), patients will be randomly assigned to receive 5
ml/kg ideal body weight HS (7.3% NaCl) or normal saline (NS, 0.9% NaCl)
infused within 60 min. Blood and urine samples will be collected
preoperatively and postoperatively up to day 6 to assess changes in renal,
cardiac, inflammatory, acid-base, and electrolyte parameters.
Additionally, we will perform renal ultrasonography studies to assess
renal blood flow before, during, and after infusion, and we will measure
total body water using preoperative and postoperative body composition
analysis (bioimpedance). Patients will be followed up for 90 days.
 Discussion(s): The key objective of this study is to assess the
cumulative amount of fluid administered in the intervention (HS) group
versus control (NS) group during the ICU stay. In this preliminary,
prospective, randomised controlled clinical trial we will test the
hypothesis that use of HS results in less total fluids infused and less
postoperative weight gain when compared to the standard of intensive care
in cardiac surgery patients. Trial registration: ClinicalTrials.gov,
NCT03280745. Registered on 12 September 2017. Copyright © 2019
The Author(s).

<64>
Accession Number
628083447
Title
Recommendations for the management of MPS IVA: Systematic evidence- A nd
consensus-based guidance.
Source
Orphanet Journal of Rare Diseases. 14 (1) (no pagination), 2019. Article
Number: 137. Date of Publication: 13 Jun 2019.
Author
Akyol M.U.; Alden T.D.; Amartino H.; Ashworth J.; Belani K.; Berger K.I.;
Borgo A.; Braunlin E.; Eto Y.; Gold J.I.; Jester A.; Jones S.A.; Karsli
C.; Mackenzie W.; Marinho D.R.; McFadyen A.; McGill J.; Mitchell J.J.;
Muenzer J.; Okuyama T.; Orchard P.J.; Stevens B.; Thomas S.; Walker R.;
Wynn R.; Giugliani R.; Harmatz P.; Hendriksz C.; Scarpa M.
Institution
(Akyol) Department of Otolaryngology, Hacettepe University, Ankara, Turkey
(Alden) Department of Neurosurgery, Ann and Robert H. Lurie Children's
Hospital of Chicago, Northwestern University, Feinberg School of Medicine,
Chicago, IL, United States
(Amartino) Child Neurology Department, Hospital Universitario Austral,
Buenos Aires, Argentina
(Ashworth) Department of Paediatric Ophthalmology, Manchester Royal Eye
Hospital, Manchester University NHS Foundation Trust, Manchester, United
Kingdom
(Belani) Department of Anesthesiology, University of Minnesota,
Minneapolis, MN, United States
(Berger) Departments of Medicine and Neuroscience and Physiology, New York
University School of Medicine, Andre Cournand Pulmonary Physiology
Laboratory, Bellevue Hospital, New York, NY, United States
(Borgo) Orthopaedics Clinic, Padova University Hospital, Padova, Italy
(Braunlin) Division of Pediatric Cardiology, University of Minnesota,
Minneapolis, MN, United States
(Eto) Advanced Clinical Research Centre, Institute of Neurological
Disorders, Kanagawa, Japan
(Gold) Keck School of Medicine, Departments of Anesthesiology, Pediatrics,
and Psychiatry and Behavioural Sciences, Children's Hospital Los Angeles,
Department of Anesthesiology Critical Care Medicine, 4650 Sunset
Boulevard, Los Angeles, CA, United States
(Jester) Hand and Upper Limb Service, Department of Plastic Surgery,
Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
(Jones) Willink Biochemical Genetic Unit, Manchester Centre for Genomic
Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust,
Manchester, United Kingdom
(Karsli) Department of Anesthesiology and Pain Medicine, Hospital for Sick
Children, Toronto, Canada
(Mackenzie) Department of Orthopedics, Nemours/Alfred I, Dupont Hospital
for Children, Wilmington, DE, United States
(Marinho) Department of Ophthalmology, UFRGS, Ophthalmology Service, HCPA,
Porto Alegre, Brazil
(McFadyen) Isaac Foundation, Campbellford, ON, Canada
(McGill) Department of Metabolic Medicine, Queensland Children's Hospital,
Brisbane, Australia
(Mitchell) Division of Pediatric Endocrinology, Montreal Children's
Hospital, Montreal, QC, Canada
(Muenzer) Department of Pediatrics, School of Medicine, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States
(Okuyama) Department of Clinical Laboratory Medicine, National Centre for
Child Health and Development, Tokyo, Japan
(Orchard) Division of Blood and Marrow Transplantation, Department of
Pediatrics, University of Minnesota, Minneapolis, MN, United States
(Stevens, Thomas) MPS Society, Amersham, Buckinghamshire, United Kingdom
(Walker) Department of Paediatric Anaesthesia, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Wynn) Department of Paediatric Haematology, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Giugliani) Department of Genetics, UFRGS, Medical Genetics Service, HCPA,
Porto Alegre, Brazil
(Harmatz) UCSF Benioff Children's Hospital Oakland, Oakland, CA, United
States
(Hendriksz) Steve Biko Academic Hospital, University of Pretoria,
Pretoria, South Africa
(Scarpa) Center for Rare Diseases at Host Schmidt Kliniken, Wiesbaden,
Germany
(Eto) Department of Paediatrics/Gene Therapy, Tokyo Jikei University
School of Medicine, Tokyo, Japan
(Scarpa) Department of Paediatrics, University of Padova, Padova, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: Mucopolysaccharidosis (MPS) IVA or Morquio A syndrome is an
autosomal recessive lysosomal storage disorder (LSD) caused by deficiency
of the N-acetylgalactosamine-6-sulfatase (GALNS) enzyme, which impairs
lysosomal degradation of keratan sulphate and chondroitin-6-sulphate. The
multiple clinical manifestations of MPS IVA present numerous challenges
for management and necessitate the need for individualised treatment.
Although treatment guidelines are available, the methodology used to
develop this guidance has come under increased scrutiny. This programme
was conducted to provide evidence-based, expert-agreed recommendations to
optimise management of MPS IVA. Method(s): Twenty six international
healthcare professionals across multiple disciplines, with expertise in
managing MPS IVA, and three patient advocates formed the Steering
Committee (SC) and contributed to the development of this guidance.
Representatives from six Patient Advocacy Groups (PAGs) were interviewed
to gain insights on patient perspectives. A modified-Delphi methodology
was used to demonstrate consensus among a wider group of healthcare
professionals with experience managing patients with MPS IVA and the
manuscript was evaluated against the validated Appraisal of Guidelines for
Research and Evaluation (AGREE II) instrument by three independent
reviewers. Result(s): A total of 87 guidance statements were
developed covering five domains: (1) general management principles; (2)
recommended routine monitoring and assessments; (3) disease-modifying
interventions (enzyme replacement therapy [ERT] and haematopoietic stem
cell transplantation [HSCT]); (4) interventions to support respiratory and
sleep disorders; (5) anaesthetics and surgical interventions (including
spinal, limb, ophthalmic, cardio-thoracic and ear-nose-throat [ENT]
surgeries). Consensus was reached on all statements after two rounds of
voting. The overall guideline AGREE II assessment score obtained for the
development of the guidance was 5.3/7 (where 1 represents the lowest
quality and 7 represents the highest quality of guidance).
 Conclusion(s): This manuscript provides evidence- A nd
consensus-based recommendations for the management of patients with MPS
IVA and is for use by healthcare professionals that manage the holistic
care of patients with the intention to improve clinical- A nd
patient-reported outcomes and enhance patient quality of life. It is
recognised that the guidance provided represents a point in time and
further research is required to address current knowledge and evidence
gaps. Copyright © 2019 The Author(s).

<65>
Accession Number
2002013505
Title
Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated
With Primary Percutaneous Coronary Intervention.
Source
Journal of the American College of Cardiology. 73 (22) (pp 2832-2842),
2019. Date of Publication: 11 June 2019.
Author
Mathias W.; Tsutsui J.M.; Tavares B.G.; Fava A.M.; Aguiar M.O.D.; Borges
B.C.; Oliveira M.T.; Soeiro A.; Nicolau J.C.; Ribeiro H.B.; Chiang H.P.;
Sbano J.C.N.; Morad A.; Goldsweig A.; Rochitte C.E.; Lopes B.B.C.; Ramirez
J.A.F.; Kalil Filho R.; Porter T.R.
Institution
(Mathias, Tsutsui, Tavares, Aguiar, Borges, Oliveira, Soeiro, Nicolau,
Ribeiro, Chiang, Sbano, Rochitte, Lopes, Ramirez, Kalil Filho) Heart
Institute (InCor), University of Sao Paulo, Medical School, Sao Paulo,
Brazil
(Fava, Goldsweig, Porter) University of Nebraska Medical Center, Omaha,
NE, United States
(Morad) University of Kansas Medical Center, Kansas City, KS, United
States
Publisher
Elsevier USA
Abstract
Background: Preclinical studies have demonstrated that high mechanical
index (MI)impulses from a diagnostic ultrasound transducer during an
intravenous microbubble infusion (sonothrombolysis)can restore epicardial
and microvascular flow in acute ST-segment elevation myocardial infarction
(STEMI). Objective(s): This study tested the clinical effectiveness
of sonothrombolysis in patients with STEMI. Method(s): Patients with
their first STEMI were prospectively randomized to either diagnostic
ultrasound-guided high MI impulses during an intravenous Definity
(Lantheus Medical Imaging, North Billerica, Massachusetts)infusion before,
and following, emergent percutaneous coronary intervention (PCI), or to a
control group that received PCI only (n = 50 in each group). A reference
first STEMI group (n = 203)who arrived outside the randomization window
was also analyzed. Angiographic recanalization before PCI, ST-segment
resolution, infarct size by magnetic resonance imaging, and systolic
function (LVEF)at 6 months were compared. Result(s): ST-segment
resolution occurred in 16 (32%)high MI PCI versus 2 (4%)PCI-only patients
before PCI, and angiographic recanalization was 48% in high MI/PCI versus
20% in PCI only and 21% in the reference group (p < 0.001). Infarct size
was reduced (29 +/- 22 g high MI/PCI vs. 40 +/- 20 g PCI only; p = 0.026).
LVEF was not different between groups before treatment (44 +/- 11% vs. 43
+/- 10%), but increased immediately after PCI in the high MI/PCI group (p
= 0.03), and remained higher at 6 months (p = 0.015). Need for implantable
defibrillator (LVEF <=30%)was reduced in the high MI/PCI group (5% vs. 18%
PCI only; p = 0.045). Conclusion(s): Sonothrombolysis added to PCI
improves recanalization rates and reduces infarct size, resulting in
sustained improvements in systolic function after STEMI. (Therapeutic Use
of Ultrasound in Acute Coronary Artery Disease;
NCT02410330). Copyright © 2019 American College of Cardiology
Foundation

<66>
Accession Number
2002053513
Title
Completeness of Revascularization as a Determinant of Outcome: A
Contemporary Review and Clinical Perspectives.
Source
Canadian Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Kwon O.; Park D.-W.; Park S.-J.
Institution
(Kwon, Park, Park) Division of Cardiology, Department of Internal
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
It has been debated whether patients with multivessel coronary artery
disease should undergo complete revascularization (CR). The benefit of CR
is biologically plausible, and numerous studies and large meta-analyses
suggested that CR achievement was associated with a substantial reduction
of mortality and future coronary events. In patients with multivessel
coronary artery disease, the aim of myocardial revascularization is to
minimize residual ischemia. Therefore, CR of all significant coronary
lesions has been proposed as the first priority in decision-making for
myocardial revascularization between coronary artery bypass grafting and
percutaneous coronary intervention (PCI). Reflecting the contemporary
practice of ischemia-based revascularization, a physiological/functional
approach, such as measurement of fractional flow reserve or instantaneous
wave-free ratio, is considered more reasonable and should be encouraged
for appropriate CR. In patients who present with acute ST-elevation
myocardial infarction, current evidence suggests that an immediate or
staged CR strategy might be equivalent or superior to culprit-only
revascularization. There is still uncertainty on when and how to perform
CR in ST-elevation myocardial infarction patients; comprehensive studies
dedicated to this issue are required. Hybrid coronary revascularization
includes the advantages of minimally invasive bypass grafting for the left
anterior descending artery and PCI for non-left anterior descending
arteries and has been proposed as a viable alternative for coronary artery
bypass grafting or PCI only for achieving CR. In clinical practice, the
extent of revascularization and strategy for CR should be individualized,
taking account of different aspects of the patients, lesions, and treating
physicians. Collaboration of coronary heart teams would confer balanced
decision-making and advanced therapeutic capabilities. Copyright
© 2019 Canadian Cardiovascular Society

<67>
Accession Number
628160662
Title
Outcomes of percutaneous coronary intervention versus coronary artery
bypass graft surgery at >10-year follow-up in patients with unprotected
left main coronary artery disease: An analysis of 3,904 patients.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S102-S103), 2019. Date
of Publication: May 2019.
Author
Khan M.R.; Manan M.; Ahmad W.; Hamzeh I.; Virani S.S.; Birnbaum Y.; Lakkis
N.M.; Alam M.
Institution
(Khan) McLaren Flint - Michigan State University, United States
(Manan) King Edward Medical University, Pakistan
(Ahmad) Nishtar Medical College, Pakistan
(Hamzeh, Virani, Birnbaum, Lakkis, Alam) Baylor College of Medicine,
United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: There is a paucity of data comparing long-term outcomes of
unprotected left main coronary artery (ULMCA) revascularization with
Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass
Grafting. Method(s): We performed aggregate data meta-analyses of
clinical outcomes [all-cause mortality, stroke, non-fatal myocardial
infarction (MI), repeat revascularization and a composite of death, MI and
stroke (MACCE)] in studies reporting a minimum of 7-year outcomes of PCI
versus CABG for ULMCA disease. An extensive literature search (to December
31, 2018) identified 5 studies (all observational). Effect size for
individual clinical outcomes were estimated with odds ratio (OR) and 95%
confidence intervals (CI) using a random-effects model. Result(s): A
total of 3,904 patients were included in this analysis. Baseline
demographic and clinical characteristics were comparable between the two
groups. A weighted mean follow-up of 10.2 years was available. At the
longest available follow-up, patients in the PCI and CABG groups were
comparable in terms of all-cause mortality (OR 0.78, CI 0.59-1.03) and
MACCE (OR 0.90, CI 0.74-1.10). However, patients in the PCI group had a
significant advantage in terms of reduced risk of stroke (OR 0.38, CI
0.25-0.59) but higher rates of repeat revascularization (OR 2.60, CI
1.35-5.03) and non-fatal MI (OR 1.50, CI 1.04- 2.16) (table 1).
 Conclusion(s): At a weighted mean follow up of 10.2 years, PCI is
comparable to CABG in terms of MACCE and all-cause mortality. PCI was
however associated with significantly lower risk of stroke and higher risk
of repeat revascularization and non-fatal MI. (Table Presented).

<68>
Accession Number
628160657
Title
Transcatheter versus surgical aortic valve replacement in low surgical
risk patients: A meta-analysis of randomized controlled trials and
observational studies.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S235-S236), 2019. Date
of Publication: May 2019.
Author
Chen K.; Pino J.E.; Alrifai A.; Kabach M.; Donath E.; Chait R.
Institution
(Chen, Alrifai, Kabach, Chait) University of Miami, Palm Beach Regional
Campus, United States
(Pino, Donath) University of Miami, JFK Medical Center Palm Beach Regional
Consortium, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an effective
treatment for patients with severe aortic stenosis at intermediate to high
surgical risk. The use of TAVR in low risk patients is also on the rise.
However, the efficacy and safety profile in this population is still
unclear. Method(s): We conducted a meta-analysis of both randomized
controlled trials (RCTs) and observational studies comparing TAVR and
surgical aortic valve replacement (SAVR) in low surgical risk patients.
Comprehensive and systematic search of PubMed, Scopus and Embase was
performed. 3 RCTs and 5 observational studies were included. The primary
outcomes are 30-day mortality, 1-year mortality, and periprocedural
complications. Result(s): Total of 4657 patients were included in
eight studies with follow up between 3 months to 3 years. The 30-day
mortality was similar between TAVR and SAVR, (RR 0.86, 95% CI 0.55-1.34)
using fixed effect model. The 1-year mortality was significantly higher in
TAVR than SAVR, (RR 1.30, 95% CI 1.04-1.61). Patients underwent TAVR had
less acute kidney injury (RR 0.34, 95% CI 0.24-0.49) and major bleeding
(RR 0.47, 95% CI 0.37-0.59), more pacemaker implantation (RR 4.22, 95% CI
3.25-5.47) and vascular complications (RR 12.11, 95% CI 6.28-23.34). There
was no significant difference between cerebrovascular accident (RR 0.76,
95% CI 0.47-1.24) or myocardial infarction (RR 0.60, 95% CI 0.27-1.32).
 Conclusion(s): Among lower surgical risk patients, TAVR appear to
have higher 1-year mortality. More studies are needed to further
investigate long term outcomes in this population.

<69>
Accession Number
628160632
Title
Clinical outcomes of percutaneous coronary intervention for unprotected
left main bifurcation disease versus coronary artery bypass grafting at
intermediate follow-up: A meta-analysis of 3,470 patients.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S63-S64), 2019. Date
of Publication: May 2019.
Author
Alam M.; Khan M.R.; Ahmad W.; Virani S.S.; Hamzeh I.; Birnbaum Y.; Lakkis
N.M.
Institution
(Alam, Virani, Hamzeh, Birnbaum, Lakkis) Baylor College of Medicine,
United States
(Khan) McLaren Flint - Michigan State University, United States
(Ahmad) Nishtar Medical College, Pakistan
Publisher
John Wiley and Sons Inc.
Abstract
Background: There is a need for additional evidence comparing Percutaneous
Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) for
unprotected left main bifurcation disease (LMBD) as PCI for LMBD is
procedurally complex and requires technical expertise. Method(s): A
comprehensive literature search to January 2019 identified 4 studies (2
Randomized, 2 Observational) with 3470 patients. Aggregate data
meta-analyses of clinical outcomes [allcause mortality, non-fatal
myocardial infarction (MI), repeat revascularization and a composite
outcome of major adverse cardiac and cerebrovascular events (MACCE)]
comparing PCI and CABG for LMBD were performed. Odds Ratios (OR) and 95%
confidence intervals (CI) were estimated using random-effects model.
 Result(s): We included a total of 3,470 patients in this analysis.
Baseline characteristics were comparable between the two groups. At an
average follow-up of 4.3 years, PCI and CABG groups experienced comparable
all-cause mortality (OR 0.84, CI 0.51-1.39), stroke (OR 0.27, CI
0.06-1.24, Absolute Risk Reduction 5.6%), MI (OR 0.77, CI 0.45-1.33) and
MACCE (OR 1.18, 0.93-1.51) events. Repeat revascularization rates were
higher in the PCI group (OR 2.72, CI 1.59- 4.65) compared to CABG (Table
1). Conclusion(s): At an intermediate term follow-up, PCI for
unprotected LMBD is a safe alternative compared to CABG with no increased
risk of all-cause mortality, MI or MACCE. The disparity between ARR and OR
of stroke between the two groups might be secondary to sample size and
event rate. However, consistent with published data, PCI is associated
with higher rates of repeat revascularization. (Figure Presented).

<70>
Accession Number
628160605
Title
Comparison of clinical outcomes of transcatheter aortic valve replacement
through transcarotid and transthoracic approaches: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S231-S232), 2019. Date
of Publication: May 2019.
Author
Ndunda P.M.; Vindhyal M.; Khayyat S.; Muutu T.M.; Fanari Z.
Institution
(Ndunda, Vindhyal, Khayyat, Muutu) University of Kansas, School of
Medicine-Wichita, United States
(Fanari) Wesley Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transthoracic transcatheter aortic valve replacement (TT-TAVR)
approaches (transaortic and transapical) have been the most commonly used
alternative access routes in the US. TT-TAVR may be associated with poorer
outcomes compared with transfemoral TAVR. We conducted a systematic review
and meta-analysis comparing outcomes of transcarotid transcatheter aortic
valve replacement (TC-TAVR) and TT-TAVR. Method(s): We
comprehensively searched four online databases for controlled randomized
and non-randomized studies. Data was presented using Mantel-Haenszel odds
ratios (95% confidence intervals) and measured heterogeneity using
Higgins' I2. Result(s): Sixteen observational studies on transcarotid
TAVR were included in the qualitative analysis; 5 studies compared TC-TAVR
vs TT-TAVR and were included in the meta-analysis. The mean age and STS
score for patients undergoing TC-TAVR were 80 years and 7.6 respectively.
For TT-TAVR patients, the mean age and STS score were 79.7 years and 8.7
respectively. Compared with TTTAVR, TC-TAVR patients had lower odds of
30-day MACE [7.8% vs 13.7%; OR 0.54 (95% CI 0.29-0.99, P = 0.05) I2 = 0%]
and major or life-threatening bleeding [4.0% vs 14.2%; OR 0.25 (95% CI
0.09-0.67, P = 0.006) I2 = 0%]. There was no statistically significant
difference in 30-day: mortality [5.0% vs 8.6%; OR 0.61 (95% CI 0.29-1.30,
P = 0.20) I2 = 0%], stroke or transient ischemic attack [2.8% vs 4.0%; OR
0.65 (95% CI 0.25-1.73, P = 0.39) I2 = 0%] and moderate or severe aortic
valve regurgitation [5.0% vs 4.6%; OR 1.14. (95% CI 0.52-2.52, P = 0.75)
I2 = 0%]. There was a trend towards fewer major vascular complications in
TC-TAVR compared with TT-TAVR [3.0% vs 7.8%; OR 0.42 (95% CI 0.16-1.12, P
= 0.08) I2 = 0%]. Conclusion(s): TC-TAVR may have a lower risk of
30-day: MACE, major or life-threatening bleeding and a trend towards fewer
major vascular complications, compared to TT-TAVR.

<71>
Accession Number
628160604
Title
Now or later: Multi-vessel versus culprit-vessel PCI in patients with
NSTEMI or unstable angina-a meta-analysis of 171,805 patients.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S61-S62), 2019. Date
of Publication: May 2019.
Author
Borgaonkar S.; Siebert V.; Nguyen H.L.; Jia X.; Birnbaum Y.; Lakkis N.M.;
Alam M.
Institution
(Borgaonkar, Siebert, Nguyen, Jia, Birnbaum, Lakkis, Alam) Baylor College
of Medicine, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Among patients with non-ST elevation myocardial infarction
(NSTEMI) or unstable angina (UA), it is unclear whether multi-vessel (MVR)
percutaneous coronary intervention (PCI) improves clinical outcomes when
compared to culprit-only (CVR) intervention. Method(s): A systematic
review using PubMed and EMBASE identified 16 studies comparing MVR versus
CVR in patients with NSTEMI or UA. Meta-analyses were conducted to
estimate the effect size (odds ratio with 95% confidence intervals) using
random-effects model at short-term (<30 days), mid-term (1 year), and
long-term (>2 years) follow-up for the following variables: major adverse
cardiovascular events (MACE), myocardial infarction (MI), all-cause death,
repeat PCI, coronary artery bypass graft (CABG) surgery, and
cerebrovascular accidents (CVA). Result(s): A total of 171,805
patients were included (MVR = 58,539 and CVR = 113,266). CVR had lower
rates of short-term MACE, MI and CVA and higher rates of CABG compared
with MVR. However, MVR was associated with lower rates of mid-term MACE
(OR 0.70, 95% CI 0.49-0.98) and all-cause death (OR 0.65, 95% CI
0.51-0.83) with no significant differences in MI, repeat PCI, and CABG.
Longterm outcomes were limited by the number of studies, but there were no
significant differences between MVR and CVR although a trend was observed
towards lower rates of MI and repeat PCI with MVR (Table 1).
 Conclusion(s): While CVR resulted in fewer short-term adverse cardiac
events, this was offset by significantly lower rates of MACE and mortality
with MVR at one-year. A strategy of multi-vessel PCI for NSTEMI and UA can
be safely considered and may be advantageous for patient outcomes. (Table
Presented).

<72>
Accession Number
628160603
Title
Outcomes of trans-catheter aortic valve replacement among patients with
low gradient severe aortic stenosis: Pairwise and network meta-analysis
with trial sequential analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S197-S198), 2019. Date
of Publication: May 2019.
Author
Osman M.; Abdulghaffar Y.; Foster T.; Alqahtani F.; Osman K.; Shah K.;
Kheiri B.; Alkhouli M.
Institution
(Osman) West Virginia University Medical Center, United States
(Abdulghaffar, Foster, Alqahtani, Osman, Shah, Alkhouli) WVU Heart and
Vascular Institute, United States
(Kheiri) Michigan State University, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Trans-catheter aortic valve replacement (TAVR) has emerged as
an effective therapy for severe aortic stenosis. Data is conflicting
regarding comparison of TAVR outcomes among patients with low gradient
(LG) vs high gradient (HG) severe aortic stenosis. Method(s): We
conducted a literature search of PubMed, Embase, and Cochrane library.
Studies reporting outcomes of TAVR in patients with severe aortic stenosis
and low gradient were included. The primary endpoint was all-cause
mortality. Secondary endpoints included cardiovascular and periprocedural
mortality. Result(s): A total of 19 studies; with 27,204 patients
were included in the current analysis. The HG group had less
periprocedural, allcause and cardiovascular mortality compared to the LG
group, 6% vs 7.5%; OR 0.76 (95% CI 0.66,0.87); I2 = 18%, 21% vs 29%; OR
0.59 (95% CI 0.52,0.67); I2 = 62%, 12.6% vs 18.7%; OR 0.61 (95%
CI0.49,0.76); I2 = 62%, respectively, p < 0.0001 for all. The network
meta-analysis revealed that the best all-cause mortality outcomes were
seen in the HG group followed by the paradoxical low gradient group (PLG)
with worse outcomes in the classical low gradient (CLG) group. (Figure)
The cumulative Z-curve of the trial sequential analysis successfully
crossed the conventional test boundary as well as the trial sequential
monitoring boundary for all the outcomes, indicating firm evidence for
better outcomes in the HG group compared to the LG group.
 Conclusion(s): Patients with HG severe aortic stenosis have better
periprocedural mortality, all-cause mortality and cardiovascular mortality
compared to low gradient patients post TAVR. (Table Presented).

<73>
Accession Number
628160594
Title
A meta-analysis on the outcomes of blood transfusion in patients
undergoing transcatheter aortic valve replacement (TAVR).
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S196-S197), 2019. Date
of Publication: May 2019.
Author
Apala D.R.; Jhand A.; Thandra A.; Gundepalli S.G.; Alla V.M.
Institution
(Apala, Jhand, Thandra, Gundepalli, Alla) Creighton University, United
States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Previously, studies have shown packed red blood cell (PRBC)
transfusion peri-procedurally during TAVR is associated with poor
outcomes. We conducted a meta-analysis to assess the above.
 Method(s): PubMed, Cochrane and Web of Science databases were
systematically searched. Outcomes of interest were mortality, length of
stay (LOS), stroke and Acute kidney injury (AKI). The analysis was
performed using DerSimonian and Laird random effect model. Result(s):
Five studies met the inclusion criteria with a total of 2397 patient
undergoing TAVR of which 819 patients received PRBC transfusion and 1578
did not receive any transfusion. There was no statistically significant
difference in preoperative risk assessment between two groups as compared
by log Euroscore (Std. mean difference: 0.36; 95% CI -0.12 to 0.84, p =
0.14). When compared with patients who did not receive any RBC, patients
who received RBC transfusion had significantly higher All cause 30day
mortality (OR: 3.95; 95% CI: 1.6 to 9.6, p = 0.0002), 1 year mortality,
In-hospital mortality, ICU length of stay and Hospital length of stay
(Std. mean difference: 1.67; 95% CI 1.1 to 2.2, p = 0.000001). Also,
incidence of stroke and AKI was higher but no significant difference in
incidence ofMI. See the image attached for all Odds ratios with 95% CI.
 Conclusion(s): This meta-analysis shows, PRBC transfusion during TAVR
is associated with poor outcomes which includes higher mortality rates,
longer hospital LOS, stroke and AKI.

<74>
Accession Number
628160592
Title
Reduced ejection fraction is associated with increased cardiovascular
mortality after transcatheter aortic valve replacement: insights from a
large single center cohort.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S231), 2019. Date of
Publication: May 2019.
Author
Kumar S.; Akkanti B.; Mahmoud M.S.; Hussain R.; Jumean M.; Patel J.A.; De
Armas I.S.; Rajagopal K.; Akay M.H.; Patel M.; Basra S.; Radovancevic R.;
Sauer R.M.; Gregoric I.; Kar B.
Institution
(Kumar, Akkanti, Mahmoud) University of Texas Medical Center, Houston,
United States
(Hussain, Jumean, Patel, De Armas, Rajagopal, Akay, Patel, Basra,
Radovancevic, Sauer, Gregoric, Kar) University of Texas, Health McGovern
Medical School Houston, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Indications and outcomes from Trans-catheter Valve Replacement
(TAVR) continue to increase and improve. It is unclear if the survival in
patients with low ejection fraction are the same. Method(s): We
performed a retrospective analysis of our institutional data from December
2011 to April 2018. We examined 1884 patients, 555 out of them had low EF
(defined as <50%). Patient and procedural factors were identified and
examined. The rate and outcomes of survival at 30 days were analyzed.
 Result(s): Our results indicate that survival in patients with low
LVEF < 50% are lower than those with LVEF > 50% (95.8% vs 97.5%, p = 0.05)
at 30 days. Majority of patients were Male (67%), Caucasians (89%) with
Median age of 79. Among non-survivors in patients with low LVEF, patients
were more likely to have cardiac arrest (9% vs 1%, p = 0.002), and
Cardiogenic shock (5% vs 22%, p = 0.001). Length of stay was shorter in
survivors vs. non-survivors (6 days versus 14, P = 0.0078). Urgent and
emergent TAVR procedures had lower rates of survival than those done
electively. Non-survivors tend to stay in ICU for > 72 hours compared to
survivors (P < 0.0001). Mean AV gradient post valve deployment was not
statistically different. Conclusion(s): TAVR in low LVEF patients
appears to carry a higher morbidity and mortality. Post procedural mean
gradients do not impact the short-term mortality. Mortality in low EF
cohort is independent of the degree of LV dysfunction. However, long term
randomized data is warranted in this meaningful cohort of patients. (Table
Presented).

<75>
Accession Number
628160584
Title
Outcomes of transcarotid versus transfemoral transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S195-S196), 2019. Date
of Publication: May 2019.
Author
Ndunda P.M.; Vindhyal M.; Khayyat S.; Muutu T.M.; Fanari Z.
Institution
(Ndunda, Vindhyal, Khayyat, Muutu, Fanari) University of Kansas, School of
Medicine, Wichita, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Between 13-25% of patients undergo transcatheter aortic valve
replacement (TAVR) via access sites other than the femoral artery. Studies
on transcarotid access route are small and showed varied outcomes. We
conducted a systematic review and meta-analysis comparing outcomes of
transcarotid TAVR (TC-TAVR) and transfemoral TAVR (TF-TAVR).
 Method(s): We searched for controlled randomized and non-randomized
studies from 4 online databases: MEDLINE, Cochrane Library, Web of Science
and Google Scholar. We presented data using odds ratios (95% confidence
intervals) and measured heterogeneity using Higgins' I2. Result(s):
Sixteen observational studies on transcarotid TAVR were included in the
analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS
score for patients undergoing TC-TAVR were 80 years and 7.6 respectively.
For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5
respectively. There was no difference between patients undergoing TC-TAVR
and TF-TAVR in the following 30-day outcomes: MACE [8.4% vs 6.7%; OR 1.32
(95% CI 0.71-2.46 p = 0.38) I2 = 0%], mortality [5.6% vs 4.0%; OR 0.42
(95% CI 0.60-3.37, P = 0.42) I2 = 0%] and stroke [0.7% vs 2.3%; OR 0.49
(95% CI 0.09-2.56, P = 0.40) I2 = 0%]. There was no difference in 30-day
major vascular complications [0.7% vs 3%; OR 0.55 (95% CI 0.06-5.29, P =
0.61) I2 = 39%], major bleeding [0.7% vs 3.8%; OR 0.39 (95% CI 0.09-1.67,
P = 0.21) I2 = 0%], and moderate or severe aortic valve regurgitation
[8.6% vs 9.9%; OR 0.89 (95% CI 0.48-1.65, P = 0.72) I2 = 0%].
 Conclusion(s): There was no significant difference between patients
undergoing TC-TAVR and TF-TAVR in 30-day: MACE, mortality, stroke, major
vascular complications, major bleeding, and aortic regurgitation. (Table
Presented).

<76>
Accession Number
628160539
Title
Fractional flow reserve versus angiographically-guided coronary
revascularization: A meta-analysis of randomized clinical trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S95), 2019. Date of
Publication: May 2019.
Author
Naz A.; Michalopulos M.; Butt A.K.; Jagadish P.S.; Latham S.; Hesterberg
K.; Shah R.
Institution
(Naz) Sir Syed College of Medical Sciences for Girls, Pakistan
(Michalopulos, Jagadish) University of Tennessee Health Science Center,
United States
(Butt) UTHSC, United States
(Latham) UTHSC, Cardiology, United States
(Hesterberg) University of Tennessee Health Science Center, Memphis, TN,
United States
(Shah) VA Hospital UT Memphis, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: When non-invasive studies for ischemia are not conclusive or
are unavailable, assessment of fractional flow reserve (FFR) is the
standard of care for intermediate-severity coronary lesions before
undertaking revascularization. However, recent randomized clinical trials
(RCTs) have suggested that FFR-guided revascularization might not be
superior to angiographically-guided revascularization (e.g., the FARGO
trial) and might even be potentially harmful (e.g., the FUTURE trial).
Therefore, we performed an updated comprehensive metaanalysis of clinical
trials to compare the efficacy and safety of FFRguided coronary
revascularization versus angiographically-guided revascularization.
 Method(s): Scientific databases were searched for RCTs, and pooled
risk ratios (RRs) were determined using both a random effects model and a
fixed effects model. Result(s): Data from 2029 patients were
analyzed. The risks for MACEs (RR, 0.85; 95% CI, 0.66-1.10; p = 0.23), MI
(RR, 0.82; 95% CI, 0.56- 1.18; p = 0.82), and all-cause death (RR, 0.99;
95% CI, 0.29-3.34; p = 0.99) for FFR-guided revascularization were similar
to those for angiographically-guided revascularization. The risk for
recurrent revascularization was numerically lower with FFR-guided
revascularization but did not reach statistical significance (RR, 0.76;
95% CI, 0.57-1.01; p = 0.060). Results from the fixed effects model were
consistent with those from the random effects model. Conclusion(s):
This updated meta-analysis of RCTs seems to suggest that FFR-guided
revascularization is not superior to angiographicallyguided
revascularization. However, the majority of included trials were small;
therefore, ongoing larger trials (i.e., the GRAFFITI and FAME-3 trials)
will provide additional insight on this subject.

<77>
Accession Number
628160537
Title
Percutaneous coronary intervention for chronic total occlusion in patients
aged <75 years versus >75 years: A systematic review.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S56-S57), 2019. Date
of Publication: May 2019.
Author
Ahsan M.J.; Lateef N.; Fazeel H.M.; Yousaf A.; Mirza M.
Institution
(Ahsan) CHI Health Creighton University Medical Center, United States
(Lateef) Creighton University, School of Medicine, Pakistan
(Fazeel) Services Institute of Medical Sciences, Pakistan
(Yousaf) Hamad General Hospital, Qatar
(Mirza) CHI health Creighton University Medical Center, Pakistan
Publisher
John Wiley and Sons Inc.
Abstract
Background: In younger patients, advancements in percutaneous coronary
intervention (PCI) has significantly improved survival in chronic total
occlusion (CTO) of coronary arteries but its significance in elderly (>75
years) is not well established. Method(s): PubMed, Ovid Embase and
Web of science databases were searched up to August 2018. Only original
studies reporting the comparative use of PCI in CTO for younger and
elderly patients were included. Result(s): Seven studies including
7717 patients with an overall follow up period of 1.5 to 5 years were
included in our review. The baseline characteristics were not
significantly different between the two groups in majority of studies,
except for BMI, history of stroke and coronary artery bypass graft (CABG)
surgery which were reported higher in elderly patients. The angiographic
characteristics showed a higher percentage of LAD disease (27.6% vs.
43.4%) in older patients as compared to LCX disease (30% vs. 27.8%) and
RCA disease (44.8% vs. 42.8%). CTO PCI was similarly successful in younger
and older patients (82%, n = 4744 vs. 86.5%, n = 1039). The short-term
all-cause mortality was not significantly different between the two
cohorts, however, long-term mortality, cardiac mortality and long term
major adverse cardiovascular events (MACE) were lower in younger age
group. Conclusion(s): CTO-PCI can be a good alternative to CABG in
select elderly CAD patients owing to its good efficacy and a procedural
success equivalent to younger populations. Further studies are required to
delineate any potential survival benefit associated with the procedure in
elderly population. (Table Presented).

<78>
Accession Number
628160509
Title
Transthyretin cardiac amyloidosis and aortic stenosis: What is the
connection and therapeutic Implications? A Systematic Review and
Metanalysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S225-S226), 2019. Date
of Publication: May 2019.
Author
Penalver J.; Ambrosino M.; Jeon H.D.; Stempel J.; Agrawal A.; Ram P.;
Amanullah A.
Institution
(Penalver, Ambrosino, Jeon, Stempel, Agrawal, Ram, Amanullah) Albert
Einstein Medical Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: There is growing interest in the observed incidence of
transthyretin cardiac amyloidosis (TTR-CA) in elderly patients with aortic
stenosis (AS). Approximately 16% of patients with severe AS undergoing
aortic valve replacement (AVR) have TTR-CA. Outcomes after aortic valve
replacement appear worse in patients with concomitant TTR-CA.
 Method(s): Publications in PubMed, Cochrane Library, and Embase
databases were systematically searched from January 2010 to September 2018
using the Keywords transthyretin, amyloidosis, and aortic stenosis. All
studies published in English that reported the prevalence, association and
outcomes of TTR-CA in patients with AS were included in the metanalysis.
 Result(s): A total of 7 retrospective and prospective studies (n =
765) met inclusion criteria. A total of 103 patients had concomitant AS
and TTR-CA. Five studies included 578 patients (mean age 79.7 years) with
AS of which 60 patients had TTR-CA. The prevalence of TTR-CA was 10% (95%
CI 0.05-0.15) I^2 = 74.6%. Four studies addressed clinical outcomes after
AVR in patients with TTR-CA. The mean follow-up was 21 months, the mean
age was 76 years, and the pooled mortality was 37% (95% CI 0.25-0.49), I^2
= 0%. Conclusion(s): The relationship between AS and TTR-CA is not
well understood. This systematic review and metanalysis suggests that
TTR-CA is common in elderly patients with AS and these patients tend to
have high mortality rates after AVR. The significant incidence of the two
diseases occurring simultaneously warrants further investigation to
improve management strategies in the future. (Table Presented).

<79>
Accession Number
628160494
Title
Second generation drug eluting stents (SDES) vs coronary artery bypass
surgery (CABG) for left main vessel coronary artery disease: Meta-analysis
of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S53-S54), 2019. Date
of Publication: May 2019.
Author
Nalluri N.; Atti V.; Seetharam K.; Anugu V.R.; Kumar V.; Patel N.J.; Patel
M.; Kandov R.; Royzman R.Y.; Hassid B.; Kim M.C.; Singh V.P.
Institution
(Nalluri, Anugu, Kandov, Royzman) Staten Island University Hospital,
United States
(Atti) Michigan State University, United States
(Seetharam) Zucker School of Medicine at Hofstra/Northwell-Lenox Hill
Hospital, United States
(Kumar) St. Luke's-Roosevelt Hospital Center, United States
(Patel) Mount Sinai Medical Center, United States
(Patel) University of Florida, United States
(Hassid, Kim, Singh) Lenox Hill Heart and Vascular Institute of New York,
United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: The European and American consensus recommend coronary artery
bypass surgery (CABG) for left main coronary artery disease (LMCAD).
Second generation drug eluting stents (SDES) has been evaluated as
alternative in randomized controlled trials (RCT). However, efficacy and
safety remain uncertain. Method(s): We performed a comprehensive
literature search through December 31, 2018 for all eligible trials
comparing SDES and CABG in PubMed, EMBASE, SCOPUS, Google Scholar, and
ClinicalTrials.gov. Clinical outcomes comprised of all-cause mortality,
cardiovascular mortality, major adverse cardiovascular events (MACE),
myocardial infarction (MI), stent thrombosis, and target vessel
revascularization (TVR) Results: Four randomized controlled trials were
eligible and included 4575 patients, 2312 were randomized to SDES and 2263
were randomized to CABG. The follow up period ranged from 18 to 60 months.
There was no statistically significant difference between SDES and CABG
for all-cause mortality (RR 1.14, 95% CI .88-1.48; P = 0.32),
cardiovascular mortality (RR 1, 95% CI 0.72- 1.39, P = 0.98), myocardial
infarction (RR = 1.07 95% CI = 0.82-1.39, P = 0.62) MACE (RR = 0.96 95% CI
= 0.79-1.17, P = 0.72). CABG was associated with lower risk of ST (RR =
2.03, 95% CI 1.12-3.71, P = 0.02) and TVR (RR = 1.70 95% CI = 1.36- 2.13,
P = < 0.00001) Conclusion(s): Our results showed that CABG was
associated with lower risk of ST and TVR compared with SDES among patients
with LMCAD. There was no difference in risk of all-cause mortality,
cardiovascular mortality, MACE and MI. (Table Presented).

<80>
Accession Number
628160487
Title
Clinical outcomes of incidental findings in initial body computed
tomography prior to transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S92), 2019. Date of
Publication: May 2019.
Author
Tan J.L.; Lee J.Z.; Fong H.K.; Ali M.U.; Lee K.S.; Raza M.
Institution
(Tan, Ali, Raza) Crozer-Chester Medical Center, United States
(Lee) Mayo Clinic, United States
(Fong) University of Missouri Columbia, United States
(Lee) University of Arizona Sarver Heart Center, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is increasingly
performed in patient with severe symptomatic aortic valve stenosis and
intermediate/high surgical risk. The aim of this meta-analysis is to
identify the outcomes of clinically significant incidental finding (CSIF)
on computed tomography angiography (CTA) prior to TAVR in this patient
population. Method(s): A systematic literature search was performed
in accordance to PRISMA guidelines using PubMed, EMBASE, Web of Science,
CINAHL, ClinicalTrials.gov, and the Cochrane Library databases for studies
comparing long-term outcomes of patients with and without CSIF on CTA
prior to TAVR. Result(s): Data from 6 studies (n = 2269 patients)
were analyzed. The overall prevalence of CSIF (e.g. aortic aneurysm &
pulmonary or kidney mass) and highly suspicious malignant findings were
23.4% and 3.3%, respectively. Analysis of 1-year mortality in TAVR
patients (n = 2269 patients) showed no significant difference between
patients with CSIF and without CSIF (RR: 0.97; 95% CI, 0.69-1.37; p =
0.87). There was no significant difference in the mean time from CTA
scanning to therapeutic decision (TAVR) in patients with CSIF and without
CSIF (mean difference: 2.35; 95% CI, -0.91-5.62; p = 0.16). Among patients
with CSIF evaluated for TAVR, TAVR was associated with lower 1-year
mortality compared to no TAVR (17% vs 49%, p < 0.0001).
 Conclusion(s): There was no significant difference in 1-year
mortality in patients with and without CSIF undergoing TAVR. This
suggested that CSIF detected during TAVR evaluation should not be an
absolute contraindication for TAVR.

<81>
Accession Number
628160481
Title
Device based mitral valve repair vs. medical therapy for functional mitral
regurgitation: An updated Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S189-S190), 2019. Date
of Publication: May 2019.
Author
Vij A.; Akhtar T.; Siddamsetti S.; Kodumuri V.K.
Institution
(Vij, Akhtar, Siddamsetti) John H Stroger Jr Hospital of Cook County,
United States
(Kodumuri) John Stroger Hospital of Cook County, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Functional mitral regurgitation from left ventricular
dilatation in patients with heart failure has been associated with
frequent hospitalizations, decreased quality of life and increased
mortality. Treatment is predominantly aimed at medical management with
unclear benefit from surgical repair/replacement. Several studies have
looked at outcomes from device based mitral valve repair with conflicting
results. We conducted a meta-analysis of all studies comparing outcomes in
functional mitral regurgitation with percutaneous mitral valve repair vs.
medical therapy alone. Method(s): We searched PubMed, Medline and
Embase for relevant studies. Two RCT's and Five observational studies that
compared MitraClip to optimal medical therapy only for treatment of
functional mitral regurgitation were included. Mantel- Haenszel random
effects model was used to calculate odds ratio (OR) and 95% confidence
intervals (CI). Outcomes analyzed were death from any cause and hospital
readmission rates. Result(s): Our meta-analysis shows statistically
significant mortality benefit in patients undergoing device based mitral
valve repair compared to medical therapy alone {OR = 0.46 (0.29-0.73), p
<0.05} and a statistically significant reduction in readmissions in the
device closure group {OR = 0.29 (0.11-0.72), p < 0.05}.
 Conclusion(s): Device based mitral valve repair with MitraClip has
mortality benefit and reduces risk of re-admissions as compared to medical
therapy alone. (Table Presented).

<82>
Accession Number
628160292
Title
Sex-based differences in patients undergoing percutaneous mitral valve
repair: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S183-S184), 2019. Date
of Publication: May 2019.
Author
Pandya B.; Spagnola J.; Anugu V.R.; Biglari D.; Gramze N.; Hurst T.;
Centorino L.; Gopalan R.; Arabia F.; Fang K.; Su W.; Kalya A.; Abbas F.;
Patel N.; Gellert G.; Butman S.M.; Gulati M.; Verma D.R.
Institution
(Pandya, Spagnola, Anugu) Staten Island University Hospital, United States
(Biglari) Phoenix Veterans Affairs Health Care System, United States
(Gramze, Hurst, Centorino, Gopalan, Arabia, Fang, Su, Kalya, Abbas, Patel,
Gellert, Gulati, Verma) Banner University Medical Center Phoenix, United
States
(Butman) HEART and VASCULAR CENTER OF NORTHERN ARIZONA, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Female patients are more frail and have a distinct risk
profile compared to males. Sex-based differences in patients undergoing
percutaneous mitral valve repair with MitraClip have not been studied
Methods: PubMed, EMBASE and Google Scholar databases were queried for all
trials about MitraClip. Trials reporting sex-based outcomes were included
Results: This meta-analysis of 5 trials included 1587 patients, of whom
609 (38%) were females, undergoing MitraClip procedure. Female patients
compared to males had similar acute procedural success (OR 0.99, 95% CI
0.60-1.64), numerically females were more likely to get a single clip but
differences were not statistically significant (OR 1.24, 95% CI
0.35-4.40). NYHA functional class improvement was similar for both females
and males after MitraClip (OR 0.86, 95% CI 0.63-1.18). Conclusion(s):
In this meta-analysis, female patients, compared to males, had similar
acute procedural success and NYHA functional class improvement after
transcatheter mitral valve repair with MitraClip device. This analysis
supports percutaneous mitral valve repair for symptomatic females when
appropriate (Table Presented).

<83>
Accession Number
628160202
Title
Remote ischemic preconditioning for renal protection in patients
undergoing transcatheter aortic valve interventions.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S114-S115), 2019. Date
of Publication: May 2019.
Author
Fuller B.; O'Neill W.; Szymanski T.; Guruswamy J.; Taylor A.
Institution
(Fuller) Henry Ford Hospital, United States
(O'Neill, Szymanski, Guruswamy, Taylor) Henry Ford Health System, United
States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Severe aortic stenosis remains a major source of morbidity and
mortality of the elderly with an estimated nearly 27,000 patients becoming
candidates for transcatheter aortic valve interventions (TAVI) annually.
Pre-procedural CT scans are routinely performed for planning. Despite use
of pre-hydration strategies, contrast induced nephropathy (CIN) remains a
major source of concern particularly in this aging population with
baseline renal dysfunction. We sought to evaluate the effects of remote
ischemic preconditioning (RIPc) on prevention of CIN post TAVI.
 Method(s): Single center, randomized controlled trial enrolling 46
patients from February 2018 to October 2018. Selected patients had an
estimated glomerular filtration rate (eGFR) less than 60ml/min indicating
advanced chronic kidney disease stage 3 based on the modified diet in
renal disease (MDRD) equation. Following procedural sedation RIPc was
initiated and completed prior to valve implantation. The control group
received the sham with manual blood pressure cuff inflations to 40 mmHg
for 5 minutes, followed by 5 minutes of reperfusion for a total of 4
cycles. The intervention group received manual blood pressure cuff
inflations to 200 mmHg for 5 minutes, followed by 5 minutes of reperfusion
for a total of 4 cycles. Labs were ordered for 48-72 hours post procedure.
CIN was defined as a serum rise in creatinine (Cr) of 0.5 mg/dl or a 25%
relative rise in Cr 48-72 hours after contrast exposure. Result(s):
Of the 46 patients enrolled, 26 were randomized to the intervention group
and 20 to the control group. The average age of study participants was 80.
In the intervention group, the average eGFR was 43 ml/min, average Cr was
1.39 mg/dl, and average contrast load was 120 mL. In the control group,
the average eGFR was 41 ml/min, average Cr was 1.49 mg/dl, and average
contrast was load 99 ml. One patient developed CIN in the intervention
group however, they did not require renal replacement therapy. Otherwise,
there was no change or a decrease in measured Cr post intervention.
 Conclusion(s): This study was designed as a pilot study to evaluate
the effects of RIPc on renal function post TAVI. In this study, there was
no trend towards benefit and no signals towards harm however, a larger
sample size is needed.

<84>
Accession Number
628160078
Title
Antiplatelet therapy after coronary artery bypass surgery: An updated
network meta-analysis of randomized clinical trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S142), 2019. Date of
Publication: May 2019.
Author
Naz A.; Hesterberg K.; Latham S.; Botta V.; Michalopulos M.; Shah R.
Institution
(Naz) Sir Syed College of Medical Sciences for Girls, Pakistan
(Hesterberg, Latham, Botta) University of Tennessee, Health Science
Center, Memphis, TN, United States
(Michalopulos) University of Tennessee, Health Science Center, United
States
(Shah) VA hospital UT Memphis, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Recently, several trials have suggested that adding a p2y12
inhibitor (p2y12i) to aspirin (ASA) therapy can improve outcomes after
CABG. However, it is not clear which P2Y12i is best and if ASA+p2y12i is
more effective than a p2y12i alone. In recent months, results of the TICAB
trial (the largest trial in this field) have been reported. Therefore, we
performed an updated network metaanalysis of the clinical trials.
 Method(s): Scientific databases were searched, and a Bayesian network
meta-analysis was performed using a random effects model. Because
follow-up durations varied across trials, standardized event rates were
converted to events/per 100,000 patient-days. Result(s): Data from 12
trials including 4964 patients were analyzed. Both ASA+ Clopidogrel and
ASA+clopidogrel were associated with significantly lower MACE rates
compared to ASA or ticagrelor alone, but no difference between ASA+
clopidogrel and ASA +ticagrelor was found (Figure). Additionally,
ASA+ticagrelor was associated with a significantly higher rate of major
bleeding compared to ASA alone and ASA+ clopidogrel (Figure). Conversely,
ASA+ clopidogrel was associated with a numerically higher risk of major
bleeding compared to ASA alone, but the difference does not reach
statistical significance. Finally, the rate of SVG occlusion was
significantly lower for ASA+ clopidogrel compared to ASA alone, but it did
not differ between ASA+ clopidogrel and ASA +ticagrelor (Figure).
 Conclusion(s): After CABG, patients given ASA+ clopidogrel l as
antiplatelet therapy seem to achieve the best net efficacy and safety
profiles.

<85>
Accession Number
628160070
Title
A meta-analysis of transradial versus transfemoral approach for secondary
vascular access in transfemoral-transcatheter aortic valve implantation.
Source
Catheterization and Cardiovascular Interventions. Conference: 41st Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Interventions. United States. 93 (Supplement 2) (pp S243-S244), 2019. Date
of Publication: May 2019.
Author
Apala D.R.; Jhand A.; Gundepalli S.G.; Freeman W.; Alla V.M.
Institution
(Apala, Jhand, Gundepalli, Freeman, Alla) Creighton University, United
States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transradial approach (TRA) has emerged as an alternative to
Transfemoral approach (TFA) for secondary access in Transfemoral
Transcatheter Aortic Valve Replacement (TF-TAVR). We conducted this
meta-analysis to evaluate the efficacy and safety of TRA as a secondary
access site compared to TFA for TF-TAVR. Method(s): PubMed, Cochrane
and Web of Science databases were systematically searched. Outcomes of
interest were procedural success rates and 30-day complications according
to VARC-2 criteria. The analysis was performed using DerSimonian and Laird
random effect model. OR and 95% CI were calculated. Result(s): Four
studies met our inclusion criteria with a total of 898 patients (TRA: 496;
TFA: 402). There was no statistically significant difference in
preoperative risk assessment between two groups as compared by STS score
(Stand. mean diff:-0.07; 95% CI-0.22 to 0.07, p = 0.32) and log Euroscore
(Stand. mean diff:-0.17;95%CI-0.72 to 0.38, p = 0.54). Procedural success
rates, procedure time and contrast volume used were comparable between the
two groups. When compared with TFA, TRA had significantly lower incidence
of major bleeding events (OR: 0.48; 95% CI: 0.29 to 0.79, p = 0.004),
access site complications (OR: 0.45; 95% CI: 0.29 to 0.68, p = 0.0002);
and stroke (OR: 0.28; 95% CI: 0.10 to 0.74, p = 0.01). No statistically
significant difference was observed in the incidence of AKI, MI and
all-cause 30-day mortality. Conclusion(s): Our analysis shows that
TRA is an effective and safe alternative to TFA for secondary vascular
access in TF-TAVR with significantly lower rates of major bleeding events,
access site complications and incidence of stroke. (Table Presented).

<86>
Accession Number
628159950
Title
Updates on cardiac transplant and LVAD implants across the UK and Europe.
Source
Heart Asia. Conference: 2nd Asia Pacific Advanced Heart Failure Forum,
APAHFF 2018. Hong Kong. 11 (Supplement 1) (pp A2), 2019. Date of
Publication: April 2019.
Author
Tsui S.S.L.
Institution
(Tsui) Department of Cardiothoracic Surgery, Royal Papworth Hospital,
Cambridge, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Whilst there has recently been unprecedented growth in heart transplants
(HTx) in North America, the number has been static or falling in most
European countries. These have resulted in significant increases in the
waiting times. In the UK, an Urgent Heart Allocation Scheme has been in
existence since 2001. With a growing number of heart failure patients on
temporary mechanical circulatory support (MCS) devices, a Super Urgent
category was introduced in 2016. So far, ~15% of HTx in the UK are
performed under this new category and the median waiting time has been >>7
days. Post-transplant 30 day survival has been reassuring. However,
ongoing monitoring will be required to ensure effectiveness. The other
major development has been donation after circulatory death (DCD) HTx. To
date, ~100 DCD HTx have been performed worldwide, with 70 of these being
in the UK. Growing waiting lists have led to increased implantation of
bridge-to-transplant left ventricular assist devices (LVAD). However, the
extended waiting times for donor hearts in stable patients mean that
patients being bridged are effectively having destination therapy by
default. Whilst destination therapy is approved in some countries, the
available evidence has not been accepted by other countries. The Swedish
Evaluation of LVAD as Permanent Treatment in End-stage Heart Failure
(SweVAD) is a prospective randomised study comparing LVAD therapy with
optimal medical therapy. Recruitment commenced in 2016 with the aim of
randomising 74 patients. Outcomes and adverse events associated with
implantable MCS will further improve as new devices using novel pumping
mechanisms with lower shear stress are in development to address inherent
limitations of current devices.

<87>
Accession Number
2002132642
Title
Prognostic value of coronary artery calcium score in symptomatic
individuals: A meta-analysis of 34,000 subjects.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Lo-Kioeng-Shioe M.S.; Rijlaarsdam-Hermsen D.; van Domburg R.T.; Hadamitzky
M.; Lima J.A.C.; Hoeks S.E.; Deckers J.W.
Institution
(Lo-Kioeng-Shioe, Rijlaarsdam-Hermsen, van Domburg, Hoeks, Deckers)
Department of Cardiology, Erasmus MC, University Medical Center,
Rotterdam, Netherlands
(Rijlaarsdam-Hermsen) Medical Center Haaglanden Bronovo, The Hague,
Netherlands
(Hadamitzky) Institut fur Radiologie und Nuklearmedizin, Hospital at the
Technische Universitat Munchen, Munich, Germany
(Lima) Department of Cardiology, Johns Hopkins Hospital and School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Coronary artery calcium (CAC) scanning has evolved into an
important subclinical prediction method for cardiovascular diseases in
asymptomatic subjects. However, the prognostic implication of CAC scanning
in symptomatic individuals is less clear. Objective(s): To assess the
prognostic utility of CAC in predicting risk of major adverse cardiac
events (MACE) in stable patients with suspected CAD. Method(s): We
did a systematic electronic literature search for studies presenting
original data in CAC score, and reporting cardiovascular events in stable,
symptomatic patients as primary outcome. Primary outcome of the
meta-analysis was the occurrence of MACE, a composite of late coronary
revascularization, hospitalization for unstable angina or heart failure,
nonfatal myocardial infarction, and cardiac death or all-cause mortality.
Using random effects models, we pooled relative risk ratios of CAC for
MACE, and adjusted hazard ratios (HR) of the associations between
different CAC strata (CAC 0-100,100-400, and >= 400, versus CAC = 0) and
incident MACE. Result(s): We included 19 observational studies (n =
34,041). In total, 1601 events were analyzed, of which 158 in patients
with CAC = 0. The pooled relative risk ratio was 5.71 (95%-CI: 3.98;8.19)
for subjects with CAC > 0. The pooled estimate of adjusted HRs
demonstrated increasing, positive associations, with the strongest
association for CAC > 400 (HR: 4.88; 95%-CI: 2.44;9.27).
 Conclusion(s): This meta-analysis demonstrated that increased levels
of CAC are strongly and independently associated with increased risk for
MACE in stable, symptomatic patients with suspected CAD, showing
increasing risk with greater CAC scores. Application of CAC scanning as a
prediction method could be useful for a considerable number of such
patients. Copyright © 2019

<88>
Accession Number
628159081
Title
Oral anticoagulants in atrial fibrillation with valvular heart disease and
bioprosthetic heart valves.
Source
Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Malik A.H.; Yandrapalli S.; Aronow W.S.; Panza J.A.; Cooper H.A.
Institution
(Malik) Department of Medicine, New York Medical College, Westchester
Medical Center Health Network, Valhalla, NY 10595, United States
(Yandrapalli, Aronow, Panza, Cooper) Department of Cardiology, New York
Medical College, Valhalla, NY, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: Current guidelines endorse the use of non-vitamin K antagonist
oral anticoagulants (NOACs) in patients with atrial fibrillation (AF).
However, little is known about their safety and efficacy in valvular heart
disease (VHD). Similarly, there is a paucity of data regarding NOACs use
in patients with a bioprosthetic heart valve (BPHV). We, therefore,
performed a network meta-analysis in the subgroups of VHD and
meta-analysis in patients with a BPHV. Method(s): PubMed, Cochrane
and Embase were searched for randomised controlled trials. Summary effects
were estimated by the random-effects model. The outcomes of interest were
a stroke or systemic embolisation (SSE), myocardial infarction (MI),
all-cause mortality, major adverse cardiac events, major bleeding and
intracranial haemorrhage (ICH). Result(s): In patients with VHD,
rivaroxaban was associated with more ICH and major bleeding than other
NOACs, while edoxaban 30 mg was associated with least major bleeding. Data
combining all NOACs showed a significant reduction in SSE, MI and ICH
(0.70, [0.57 to 0.85; p<0.001]; 0.70 [0.50 to 0.99; p<0.002]; and 0.46
[0.24 to 0.86; p<0.01], respectively). Analysis of 280 patients with AF
and a BPHV showed similar outcomes with NOACs and warfarin.
 Conclusion(s): NOACs performed better than warfarin for a reduction
in SSE, MI and ICH in patients with VHD. Individually NOACs performed
similarly to each other except for an increased risk of ICH and major
bleeding with rivaroxaban and a reduced risk of major bleeding with
edoxaban 30 mg. In patients with a BPHV, results with NOACs seem similar
to those with warfarin and this needs to be further explored in larger
studies. Copyright © Author(s) (or their employer(s)) 2019. No
commercial re-use. See rights and permissions. Published by BMJ.

<89>
Accession Number
626424309
Title
Association of Elevated Plasma Homocysteine Level with Restenosis and
Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic
Review and Meta-analysis.
Source
Cardiovascular Drugs and Therapy. 33 (3) (pp 353-361), 2019. Date of
Publication: 15 Jun 2019.
Author
Zhang Z.; Xiao S.; Yang C.; Ye R.; Hu X.; Chen X.
Institution
(Zhang, Yang, Ye, Hu, Chen) Department of Cardiology, West China Hospital,
Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province
610041, China
(Xiao) Department of Day Surgery Center, West China Hospital, Sichuan
University, Chengdu 610041, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: We conducted this systemic review and meta-analysis to
investigate the association between elevated plasma homocysteine (Hcy)
levels and recurrent restenosis and clinical outcomes after percutaneous
coronary intervention (PCI). Method(s): PubMed, EMBASE, and Web of
Science were systematically searched prior to May 2018. Studies evaluating
the association between plasma Hcy levels and the occurrence of
restenosis, major adverse cardiac events (MACE), all-cause mortality,
cardiac death, non-fatal myocardial infarction (MI), and target lesion
revascularization were identified. Result(s): A total of 19 articles
with 4340 participants were identified. Higher Hcy levels were not
associated with an increased risk of restenosis (relative risk (RR) =
1.10, 95% CI 0.90-1.33). Hcy levels in the restenosis group were not
significantly higher than in the non-restenosis group (weighted mean
difference = 0.70, 95% CI - 0.23-1.63). Subgroup analysis revealed that
higher Hcy levels were not associated with restenosis after stenting but
appeared to increase the risk of restenosis after angioplasty. Elevated
Hcy levels increased the risk of all-cause mortality by an average of
3.19-fold (RR = 3.19, 95% CI 1.90-5.34, P = 0.000), the risk of MACE by
1.51-fold (RR = 1.51, 95% CI 1.23-1.85, P = 0.000), and the risk of
cardiac death by 2.76-fold (RR = 2.76, 95% CI 1.44-5.32, P = 0.000) but
appeared not to increase the risk of non-fatal MI (RR = 1.36, 95% CI
0.89-2.09). Conclusion(s): Our meta-analysis suggests that although
there is no clear association between higher Hcy levels and restenosis
following stent implantation, higher Hcy levels appeared to increase the
risk of restenosis after coronary angioplasty and also increased the risk
of all-cause mortality, MACE, and cardiac death after PCI. Registration
Details: The protocol of this meta-analysis was registered on PROSPERO
(CRD42018096466).
(http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018096466).
 Copyright © 2019, Springer Science+Business Media, LLC, part of
Springer Nature.

<90>
Accession Number
2002013558
Title
Current Smoking and Prognosis After Acute ST-Segment Elevation Myocardial
Infarction: New Pathophysiological Insights.
Source
JACC: Cardiovascular Imaging. 12 (6) (pp 993-1003), 2019. Date of
Publication: June 2019.
Author
Haig C.; Carrick D.; Carberry J.; Mangion K.; Maznyczka A.; Wetherall K.;
McEntegart M.; Petrie M.C.; Eteiba H.; Lindsay M.; Hood S.; Watkins S.;
Davie A.; Mahrous A.; Mordi I.; Ahmed N.; Teng Yue May V.; Ford I.;
Radjenovic A.; Welsh P.; Sattar N.; Oldroyd K.G.; Berry C.
Institution
(Haig, Wetherall, Ford) Robertson Centre for Biostatistics, University of
Glasgow, Glasgow, United Kingdom
(Carrick, Carberry, Mangion, Maznyczka, Mordi, Ahmed, Teng Yue May,
Radjenovic, Welsh, Sattar, Oldroyd, Berry) British Heart Foundation
Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, United Kingdom
(Carrick, Carberry, Mangion, Maznyczka, McEntegart, Petrie, Eteiba,
Lindsay, Hood, Watkins, Davie, Mahrous, Mordi, Ahmed, Teng Yue May,
Oldroyd, Berry) West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Clydebank, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to mechanistically investigate
associations among cigarette smoking, microvascular pathology, and longer
term health outcomes in patients with acute ST-segment elevation
myocardial infarction (MI). Background(s): The pathophysiology of
myocardial reperfusion injury and prognosis in smokers with acute
ST-segment elevation MI is incompletely understood. Method(s):
Patients were prospectively enrolled during emergency percutaneous
coronary intervention. Microvascular function in the culprit artery was
measured invasively. Contrast-enhanced magnetic resonance imaging
(1.5-T)was performed 2 days and 6 months post-MI. Infarct size and
microvascular obstruction were assessed using late gadolinium enhancement
imaging. Myocardial hemorrhage was assessed with T2* mapping.
Pre-specified endpoints included: 1)all-cause death or first heart failure
hospitalization; and 2)cardiac death, nonfatal MI, or urgent coronary
revascularization (major adverse cardiovascular events). Binary logistic
regression (odds ratio [OR]with 95% confidence interval [CI])with smoking
status was used. Result(s): In total, 324 patients with ST-segment
elevation MI were enrolled (mean age 59 years, 73% men, 60% current
smokers). Current smokers were younger (age 55 +/- 11 years vs. 65 +/- 10
years, p < 0.001), with fewer patients with hypertension (52 +/- 27% vs.
53 +/- 41%, p = 0.007). Smokers had better TIMI (Thrombolysis In
Myocardial Infarction)flow grade (>=2 vs. <=1, p = 0.024)and ST-segment
resolution (none vs. partial vs. complete, p = 0.010)post-percutaneous
coronary intervention. On day 1, smokers had higher circulating C-reactive
protein, neutrophil, and monocyte levels. Two days post-MI, smoking
independently predicted infarct zone hemorrhage (OR: 2.76; 95% CI: 1.42 to
5.37; p = 0.003). After a median follow-up period of 4 years, smoking
independently predicted all-cause death or heart failure events (OR: 2.20;
95% CI: 1.07 to 4.54)and major adverse cardiovascular events (OR: 2.79;
95% CI: 2.30 to 5.99). Conclusion(s): Smoking is associated with
enhanced inflammation acutely, infarct-zone hemorrhage subsequently, and
longer term adverse cardiac outcomes. Inflammation and irreversible
myocardial hemorrhage post-MI represent mechanistic drivers for adverse
long-term prognosis in smokers. (Detection and Significance of Heart
Injury in ST Elevation Myocardial Infarction. [BHF MR-MI];
NCT02072850) Copyright © 2019 The Authors

<91>
Accession Number
2002067777
Title
A systematic review and meta-analysis of supplemental education in
patients treated with oral anticoagulation.
Source
Blood Advances. 3 (10) (pp 1638-1646), 2019. Date of Publication: 28 May
2019.
Author
Paquette M.; Witt D.M.; Holbrook A.; Skov J.; Ansell J.; Schunemann H.J.;
Wiercioch W.; Nieuwlaat R.
Institution
(Paquette, Schunemann, Wiercioch, Nieuwlaat) Department of Health Research
Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
(Paquette) Department of Medicine, Boehringer Ingelheim, Ltd, Burlington,
ON, Canada
(Witt) Department of Pharmacotherapy, University of Utah College of
Pharmacy, Salt Lake City, UT, United States
(Holbrook) Division of Clinical Pharmacology and Toxicology, McMaster
University, Hamilton, ON, Canada
(Holbrook, Schunemann) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Skov) Unit for Health Promotion Research, Department of Public Health,
University of Southern Denmark, Esbjerg, Denmark
(Ansell) Zucker School of Medicine, Hofstra Northwell, Hempstead, NY,
United States
Publisher
American Society of Hematology (E-mail: publishing@hematology.org)
Abstract
Oral anticoagulants (OACs) are indicated for treatment and prevention of
thromboembolic diseases. Supplemental patient education (education) has
been proposed to improve outcomes, and this systematic review assesses the
effect of education on mortality, thromboembolic events (TEEs) including
venous thromboembolism (VTE), and bleeding in patients taking OACs.
Randomized controlled trials were included, and 2 authors independently
screened articles and assessed risk of bias. In 9 trials (controls, n 5
720; intervention group patients, n 5 646), 4 assessed critical outcomes
of mortality, TEEs (VTE, stroke, and systemic embolism), and bleeding to
estimate absolute risk ratios. When comparing education with usual care,
in 1000 patients, there may be 12 fewer deaths (95% confidence interval
[CI], 19 fewer to 154 more) and 16 fewer bleeding events (95% CI, 34 fewer
to 135 more), but this evidence is uncertain; the evidence also suggests 6
fewer VTEs (95% CI, 10 fewer to 16 more) and 8 fewer TEEs (95% CI, 16
fewer to 18 more). The mean difference in time in therapeutic range may be
2.4% higher in the education group compared with usual care (95% CI, 2.79%
lower to 7.58% higher). We also found very low certainty of evidence for a
large increase in knowledge scores (standardized mean difference, 0.84
standard deviation units higher; 95% CI, 0.51-1.16). Overall, the
certainty of evidence was low to very low because of serious risk of bias
and serious imprecision. Additional sufficiently powered trials or
different approaches to education are required to better assess
supplemental education effects on outcomes in patients taking
OACs. Copyright © 2019 by The American Society of Hematology

<92>
Accession Number
621361839
Title
Impact of upper respiratory tract infections on perioperative outcomes of
children undergoing therapeutic cardiac catheterisation.
Source
Acta Anaesthesiologica Scandinavica. 62 (7) (pp 915-923), 2018. Date of
Publication: August 2018.
Author
Zhang S.; Ding S.; Cai M.; Bai J.; Zhang M.; Huang Y.; Zheng J.
Institution
(Zhang, Cai, Zhang, Huang, Zheng) Pediatric Clinical Pharmacology
Laboratory, Shanghai Children's Medical Center, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
(Zhang, Bai, Zhang, Huang, Zheng) Department of Anesthesiology, Shanghai
Children's Medical Center, School of Medicine, Shanghai Jiao Tong
University, Shanghai, China
(Ding) Department of Anesthesiology, The People's Hospital of Gansu
Province, Lanzhou, China
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Recent upper respiratory tract infection (URI) is associated
with increased incidence of perioperative complications in children
undergoing open heart surgery. As a result, surgery is often postponed.
However, the effect of recent URI on the incidence of perioperative
complications in children undergoing therapeutic cardiac catheterisation
is unknown. We investigated the perioperative outcomes of congenital heart
disease (CHD) children with recent URI who underwent elective therapeutic
catheterisation. Method(s): We prospectively included children
treated for CHD. Before surgery, parents or legal guardians were
interviewed to complete a questionnaire on the child's demographics,
history of asthma and passive smoking, and URI symptoms. Recorded
perioperative respiratory adverse events (PRAEs) included laryngospasm,
bronchospasm, breath holding, oxygen desaturation, and severe cough.
Information on postoperative dysphoria, fever, copious sputum, and
vomiting was obtained by telephone 24 h after surgery. Result(s): Of
363 included children, 169 had recently (within 2 weeks) had a URI. The
URI did not affect the incidence of laryngospasm, bronchospasm, breath
holding, fever, or vomiting. The incidence of desaturation, severe cough,
dysphoria, and copious sputum were significantly increased. Independent
risk factors for PRAEs in children with a recent URI included age, passive
smoking, and presence of rhinorrhoea or moist cough. The lengths of stay
in the hospital and intensive care unit were not significantly different
between groups. Conclusion(s): Although recent URI increased the
incidence of PRAEs in children undergoing therapeutic cardiac
catheterisation, most CHD patients with recent URI can undergo elective
therapeutic cardiac catheterisation without serious adverse events or
prolonged hospitalisation. Copyright © 2018 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<93>
Accession Number
622903400
Title
POFA trial study protocol: A multicentre, double-blind, randomised,
controlled clinical trial comparing opioid-free versus opioid anaesthesia
on postoperative opioid-related adverse events after major or intermediate
non-cardiac surgery.
Source
BMJ Open. 8 (6) (no pagination), 2018. Article Number: e020873. Date of
Publication: 01 Jun 2018.
Author
Beloeil H.; Laviolle B.; Menard C.; Paugam-Burtz C.; Garot M.; Asehnoune
K.; Minville V.; Cuvillon P.; Oger S.; Nadaud J.; Lecoeur S.; Chanques G.;
Futier E.
Institution
(Beloeil) CHU Rennes, CIC, Universite de Rennes, Rennes, France
(Laviolle) Univ Rennes, Centre d'Investigation Clinique de Rennes, Service
de Pharmacologie Clinique, Rennes, France
(Menard) CHU de Rennes, Rennes, France
(Menard) INSERM, UMR, Universite Rennes, EFS Bretagne, Rennes, France
(Paugam-Burtz) Departement Anesthesie Reanimation, Hopitaux Universitaires
Paris Nord Val de Seine, Universite Paris Diderot, Clichy, France
(Garot) Centre Hospitalier Universitaire, Pole Anesthesie Reanimation,
Lille, France
(Asehnoune) Department of Anesthesiology and Critical Care Medicine,
Centre Hospitalier Universitaire, Nantes, France
(Minville) Departement d'Anesthesie et de Reanimation, Centre Hospitalier,
Universitaire de Toulouse, Toulouse, France
(Cuvillon) Service Anesthesie, Pole Anesthesie Reanimation Douleur
Urgence, Centre Hospitalier Universitaire Caremeau, Nimes, France
(Oger) Centre Hospitalier de Perigueux, Pole Bloc Anesthesie Chirurgie,
Perigueux, France
(Nadaud) Centre Hospitalier Metz Thionville, Pole Anesthesie Reanimation,
Metz, France
(Lecoeur) Centre Hospitalier Yves le Foll, Pole Anesthesie Reanimation,
Saint-Brieuc, France
(Chanques) Department of Anaesthesia and Critical Care Medicine,
University of Montpellier, Saint Eloi Hospital, Montpellier, France
(Futier) Departement de Medecine Perioperatoire, Universite Clermont
Auvergne, CNRS, Centre Hospitalier Universitaire, Clermont-Ferrand, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Reducing opioid consumption during and after surgery has been
recommended for more than 10 years. Opioid-free anaesthesia (OFA) is a
multimodal anaesthesia associating hypnotics, NMDA antagonists, local
anaesthetics, anti-inflammatory drugs and alpha-2 agonists. Proofs of the
effect of OFA on reducing opioid-related adverse effects after major or
intermediate non-cardiac surgery are still scarce. We hypothesised that
the reduced opioid consumption allowed by OFA compared with standard of
care will be associated with a reduction of postoperative opioid-related
adverse events. Methods/analysis The POFA trial is a prospective,
randomised, parallel, single-blind, multicentre study of 400 patients
undergoing elective intermediate or major non-cardiac surgery. Patients
will be randomly allocated to receive either a standard anaesthesia
protocol or an OFA. The primary outcome measure is the occurrence of a
severe postoperative opioid-related adverse event within the first 48
hours after extubation defined as: Postoperative hypoxaemia or
postoperative ileus or postoperative cognitive dysfunction. In addition,
each component of the primary outcome measure will be analysed separately.
Data will be analysed on the intention-to-treat principle and a
per-protocol basis. Ethics and dissemination The POFA trial has been
approved by an independent ethics committee for all study centres.
Participant recruitment begins in November 2017. Results will be published
in international peer-reviewed medical journals. Trial registration number
NCT03316339; Pre-results. Copyright © 2018 author(s).

<94>
Accession Number
625700087
Title
Caudal and epidural blocks in infants and small children: Historical
perspective and ultrasound-guided approaches.
Source
Korean Journal of Anesthesiology. 71 (6) (pp 430-439), 2018. Date of
Publication: December 2018.
Author
Kil H.K.
Institution
(Kil) Department of Anesthesiology and Pain Medicine, Severance Hospital,
Yonsei University Health System, Seoul, South Korea
Publisher
Korean Society of Anesthesiologists
Abstract
In infants and small children, ultrasound (US) guidance provides ample
anatomical information to perform neuraxial blocks. We can measure the
distance from the skin to the epidural space in the US image and can refer
to it during needle insertion. We may also visualize the needle or a
catheter during real-time US-guided epidural catheterization. In cases
where direct needle or catheter visualization is difficult, US allows
predicting successful puncture and catheterization using surrogate
markers, such as dura mater displacement, epidural space widening due to
drug injection, or mass movement of the drug within the caudal space.
Although many experienced anesthesiologists still prefer to use
conventional techniques, prospective randomized controlled trials using US
guidance are providing increasing evidence of its advantages. The use of
US-guided regional block will gradually become widespread in infants and
children. Copyright © The Korean Society of Anesthesiologists,
2018.

<95>
Accession Number
622942127
Title
Perioperative hyperoxia and post-operative cardiac complications in adults
undergoing non-cardiac surgery: Systematic review protocol.
Source
Acta Anaesthesiologica Scandinavica. 62 (7) (pp 1014-1019), 2018. Date of
Publication: August 2018.
Author
Petersen C.; Wetterslev J.; Meyhoff C.S.
Institution
(Petersen, Meyhoff) Department of Anaesthesia and Intensive Care,
Bispebjerg and Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Oxygen therapy is used liberally for all patients undergoing
anaesthesia. Recent studies have raised concerns that it may not be
without complications when arterial oxygen concentrations reach
supranormal concentrations (hyperoxia). Studies of oxygen therapy have
raised concerns that the risk of myocardial injury and infarction is
elevated in patients with hyperoxia due to vasoconstriction and formation
of reactive oxygen species. Due to lack of symptoms or silent ischaemia,
post-operative myocardial injury may be missed clinically. In some
studies, perioperative hyperoxia has been linked to increased long-term
mortality, but cardiac complications are sparsely evaluated. The aim of
this review is to summarize current evidence to assess the risk and
benefits of perioperative hyperoxia on post-operative cardiac
complications. Method(s): This systematic review will include
meta-analyses and Trial Sequential Analyses. We will include randomized
clinical trials with patients undergoing non-cardiac surgery if the
allocation separates patients into a target of either higher (above 0.60)
or lower (below 0.40) inspired oxygen fraction. To minimize the risk of
systematic error, we will assess the risk of bias of the included trials
using the Cochrane Risk of Bias Tool. The overall quality of evidence for
each outcome will be assessed with the Grading of Recommendation,
Assessment, Development and Evaluation (GRADE). Discussion(s): This
systematic review will provide data on a severe, albeit rare, potential
risk of oxygen therapy. We will do a trial sequential analysis to assess
the robustness of results as well as help estimate the required patient
size for future clinical trials. Copyright © 2018 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<96>
Accession Number
622228591
Title
Functional capacity and health-related quality of life outcomes post
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Age and Ageing. 47 (3) (pp 478-482), 2018. Date of Publication: 01 May
2018.
Author
Straiton N.; Jin K.; Bhindi R.; Gallagher R.
Institution
(Straiton, Jin, Gallagher) Sydney Nursing School, University of Sydney,
Sydney, NSW, Australia
(Straiton, Bhindi) Department of Cardiology, Royal North Shore Hospital,
Sydney, NSW, Australia
(Bhindi) The University of Sydney, Sydney, NSW, Australia
Publisher
Oxford University Press
Abstract
Background: transcatheter aortic valve replacement (TAVR) provides
prognostic benefit for high surgical-risk patients with severe aortic
stenosis (AS), yet the impact to patient outcomes is far less understood.
 Method(s): we performed a systematic review and meta-analysis to
evaluate functional capacity and health-related quality of life (HRQoL)
outcomes for patients up to 12 months post TAVR. A total of 20 eligible
publications, comprising randomised-controlled trials, observational
studies and a registry study were identified from electronic databases,
including MEDLINE, EMBASE, Cochrane Library and others (inception to
February 2017). Result(s): the total sample was 2,775 with a mean age
of 81.8 +/- 2.1 years, more than half (52%) were female and high surgical
risk 9.6 +/- 4.3% mean STS (Society of Thoracic Surgeons risk model). Post
TAVR, patients had significant improvement in functional capacity of > 40
m in the 6-minute walk test (6MWT) (95% confidence interval (CI)
9.69-73.28) and a clinically meaningful increase in ability to perform
daily physical-based tasks (Duke Activity Status Index (DASI), mean
difference (MD) increase 5.42 points, 95% CI 3.16-7.68). HRQoL improved
consistently following TAVR regardless of measure used. Significant
increases occurred in the physical component summary scores (PCS) of the
short form (SF) health surveys (MD increase 10.45 (SF36) and 10.14 (SF12)
points). Conclusion(s): functional capacity and HRQoL improved
substantially following TAVR, despite evolving patient selection criteria,
thus TAVR continues to provide a directly beneficial option for severe AS
patients. Copyright © The Author 2017. Published by Oxford
University Press on behalf of the British Geriatrics Society. All rights
reserved.

<97>
Accession Number
2002101577
Title
Estrogen replacement therapy is not a recommended therapy for
postmenopausal women with coronary heart disease: A meta-analysis.
Source
Clinical and Experimental Obstetrics and Gynecology. 46 (2) (pp 219-226),
2019. Date of Publication: 2019.
Author
Zheng Y.; Zhang H.; Lu W.; Liu Z.; Niu G.
Institution
(Zheng, Zhang, Liu) Department of Drug Branch, Liaocheng People's
Hospital, Liaocheng, Shandong, China
(Niu) Department of Endocrinology, Liaocheng People's Hospital, Liaocheng,
Shandong, China
(Lu) Department of Obstetrics and Gynecology, Liaocheng People's Hospital,
Liaocheng, Shandong, China
Publisher
S.O.G. CANADA Inc. (4900 Cote St-Luc Apt#212, Montreal, Quebec, Alberta
H3W 2H3, Canada. E-mail: irog.canada@gmail.com)
Abstract
Aim: This study was to investigate the effect of estrogen replacement
therapy (ERT) on clinical outcomes for postmenopausal women with
established coronary heart disease (CHD). Material(s) and Method(s):
The authors conducted a meta-analysis using 12 eligible studies. The
overall odds ratios (OR) or standardized mean difference (SMD) and their
corresponding 95% confidence interval (CI) were calculated.
 Result(s): For the incidence of adverse events, significant
difference was observed in the occurrence rates of CHD death (OR = 1.166,
95% CI: 1.000-1.360, p = 0.050) and death of any cause (OR = 1.221, 95%
CI: 1.057-1.410, p = 0.007) in postmenopausal women with CHD between ERT
and placebo groups, whereas there was no significant difference (p > 0.05)
in the occurrence rates of CHD events, myocardial infarction (MI),
revascularization, unstable angina (UA), venous thromboembolic event,
stroke/transient ischemic attack, and congestive heart failure between two
groups. With respect to the alterations of other clinical outcomes, the
SMD for the alteration of TC level was -0.192 (95% CI: -0.346-0.047, p =
0.015), and a significant difference was detected between the two groups,
whereas there was no significant difference (p > 0.05) in the alterations
of MLD and TG in patients between the two groups. Additionally, patients
treated with ERT had lower LDL and higher HDL levels. Conclusion(s):
This meta-analysis suggests that postmenopausal women with CHD receiving
ERT are more likely to suffer from CHD death, death of any cause, lower
LDL, and higher HDL and TC levels. Therefore, ERT should not be
recommended to postmenopausal women with CHD for the secondary prevention
of cardiovascular disease (CVD) clinically. Copyright © 2019
S.O.G. CANADA Inc.. All rights reserved.

<98>
Accession Number
2002096732
Title
Rational and design of the INtentional COronary revascularization versus
conservative therapy in patients undergOing successful peripheRAl arTEry
revascularization due to critical limb ischemia trial (INCORPORATE trial).
Source
American Heart Journal. 214 (pp 107-112), 2019. Date of Publication:
August 2019.
Author
Toth G.; Brodmann M.; Barbato E.; Mangiacapra F.; Schneller L.; Orias V.;
Gil R.; Bil J.; Bartus S.; Ruzsa Z.
Institution
(Toth) Division of Cardiology, Department of Medicine, Medical University
of Graz, Austria
(Brodmann) Division of Angiology, Department of Medicine, Medical
University of Graz, Austria
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Mangiacapra) Unit of Cardiovascular Science, Department of Medicine,
Campus Bio-Medico University, Rome, Italy
(Orias, Ruzsa) Division of Invasive Cardiology and Angiology, Bacs-Kiskun
County Hospital, Kecskemet, Hungary
(Orias, Ruzsa) Semmelweis University, Cardiac and Vascular Center,
Budapest, Hungary
(Gil, Bil) Department of Invasive Cardiology, Central Clinical Hospital of
the Ministry of Interior and Administration, Warsaw, Poland
(Bartus) 2nd Department of Cardiology, Jagiellonian University,
Krakow, Poland
(Schneller) Division of Cardiology, Department of Medicine, Medical
University of Graz, Graz, Austria
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Critical limb ischemia is associated with excessively high risk for
cardiovascular events, including myocardial infarction and death.
Additionally, in this patient population non-invasive evaluation of
coronary artery disease is limited due to (1) inability of exercise
testing, (2) frequent occurrence of balanced ischemia and (3) frequent
occurrence of diffuse coronary calcification. Intentional Coronary
Revascularization Versus Conservative Therapy in Patients Undergoing
Peripheral Artery Revascularization Due to Critical Limb Ischemia trial
(INCORPORATE trial) is a multicentric international randomized open label
clinical trial. Trial will recruit patients, who underwent successful
peripheral artery revascularization due to critical limb ischemia and
randomize 1:1 to conservative medical therapy versus an immediate invasive
strategy to investigate and treat coronary artery disease. The objective
is to evaluate whether intentional invasive strategy with ischemia
targeted reasonably complete coronary revascularization is superior as
compared to conventional primarily conservative approach in terms of
spontaneous myocardial infarction and overall survival at 12 months
follow-up. The trial is registered at clinicaltrials.gov
(NCT03712644). Copyright © 2019 Elsevier Inc.

<99>
Accession Number
2002018703
Title
Post cardiovascular surgery atrial fibrillation. Biomarkers determining
prognosis.
Source
Current Medicinal Chemistry. 26 (5) (pp 916-924), 2019. Date of
Publication: 2019.
Author
Manfrini O.; Cenko E.; Ricci B.; Bugiardini R.
Institution
(Manfrini, Cenko, Ricci, Bugiardini) Department of Experimental,
Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: New onset of atrial fibrillation (AF) after cardiovascular
surgery is associated with increased risk of complications and length of
hospital stay. Identification of patients at high risk of post-operative
AF (POAF) may help to act with preventive strategies having clinical and
economic relevance. Objective(s): The focus of this review is to
summarize findings on biomarkers of myocardial fibrosis (PICP and PIIINP),
profibrotic mediators (TGF-beta1), extracellular matrix remodeling
(MMP-9), myocardial stretch (BNP and NTpro-BNP), inflammation
(interleukins, C-reactive protein and sCD40L), and myocardial necrosis
(high-sensitivity troponin T), biomarkers, that can be used in clinical
practice to stratify patients at risk for POAF. Method(s): We
searched English-language studies on MEDLINE and PubMed. Evidence
synthesis was based on cohort studies, clinical trials and meta-analysis
data. International clinical practice guidelines were reviewed, as well.
 Result(s): Factors such as cardiac remodelling, atrial pressure,
surgery trauma, inflammation, oxidative stress, and
sympathetic/parasympathetic activation have been implicated in the
development of POAF. On the basis of multifactorial mechanism underlying
the onset of POAF, several studies have investigated the predictive value
of some serum biomarkers. To date, there are promising preliminary data on
the clinical utility of PICP, PIINP, TGF-beta1 and sCD40L, whereas data on
NT-proBNP, BNP, CRP, IL- 6, and hs-cTnT are controversial.
 Conclusion(s): Although some studies have shown promising results,
there is a need for future larger studies with longer follow-up, before
applying biomarkers as tools for POAF risk-stratification into clinical
practice. Copyright © 2019 Bentham Science Publishers.

<100>
Accession Number
2001810201
Title
Endoscopic spine surgery: Past, present, and future.
Source
Bulletin of the Hospital for Joint Diseases. 77 (1) (pp 75-84), 2019. Date
of Publication: March 2019.
Author
Hasan S.; Hofstetter C.P.
Institution
(Hasan) Department of Orthopedic Surgery, The University of Washington,
Seattle, WA, United States
(Hofstetter) Department of Neurological Surgery, The University of
Washington, Seattle, WA, United States
Publisher
J. Michael Ryan Publishing Inc. (24 Crescent Drive North, Andover NJ
07821-4000, United States. E-mail: jcostello@jmichaelryan.com)

<101>
Accession Number
628092077
Title
Transcatheter versus surgical aortic valve replacement in low and
intermediate risk patients with severe aortic stenosis: Systematic review
and meta-analysis of randomized controlled trials and propensity score
matching observational studies.
Source
Journal of Thoracic Disease. 11 (5) (pp 1945-1962), 2019. Date of
Publication: 2019.
Author
Fu J.; Popal M.S.; Li Y.; Li G.; Qi Y.; Fang F.; Kwong J.S.W.; You B.;
Meng X.; Du J.
Institution
(Fu, Popal, Li, Li, Qi, Fang, You, Meng, Du) Beijing Anzhen Hospital,
Capital Medical University, No. 2 Anzhen Road, Beijing 100029, China
(Kwong) Jockey Club School of Public Health and Primary Care, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: To compare the outcome of transcatheter aortic valve
replacement (TAVR) with surgical aortic valve replacement (SAVR) in low
and intermediate risk patients with severe aortic stenosis (AS).
Randomized controlled trials (RCT) and propensity score matching (PSM)
studies compare TAVR with SAVR in patients at low and intermediate
surgical risk. Method(s): Two authors searched relevant literature
independently, then extracted data from the included studies, and assessed
risk of bias and quality of study separately according to different study
designs, besides that, the extracted data was analyzed via utilization of
GRADE system to evaluate the quality of evidence separately.
 Result(s): Overall 15 studies (5 RCTs, 10 PSM studies) with total
12,057 patients were selected. Mortality and disabling stroke during
follow-up period were comparable between TAVR and SAVR (RR 1.09, 95% CI:
0.81 to 1.46; RR 0.7, 95% CI: 0.45 to 1.07, respectively), TAVR revealed
to be superior to SAVR regarding acute kidney injury (AKI), and onset of
new atrial fibrillation (AF) (RCT: high certainty; AKI in PSM: moderate
certainty, AF in PSM: low certainty). These results of RCT and PSM studies
are consistent. In RCT review, SAVR was better in the following aspects:
aortic valve (AV) re-intervention (high certainty), vascular
complications, pacemaker implantation (moderate certainty), but comparable
in the following aspects: myocardial infarction (MI), aortic insufficient
(AI) (moderate certainty), major bleeding (low certainty). In PSM review,
SAVR revealed a better result in AI and vascular complications (high
certainty), but in the aspects of AV re-intervention, pacemaker
implantation, major bleeding and MI (low certainty), it was comparable.
 Conclusion(s): TAVR is comparable to SAVR in terms of mortality and
disabling stroke in severe AS patients at low and intermediate risk, but
higher proportion of AV re-intervention observed in TAVR. Those results
should encourage caution when extending the indications of TAVR into low
risk patients, especially for young low risk patients. Copyright
© Journal of Thoracic Disease. All rights reserved.

<102>
Accession Number
628091168
Title
Clinical factors affecting the survival of patients diagnosed with
non-small cell lung cancer and metastatic malignant pleural effusion,
treated with hyperthermic intrathoracic chemotherapy or chemical talc
pleurodesis: A monocentric, prospective, randomized trial.
Source
Journal of Thoracic Disease. 11 (5) (pp 1788-1798), 2019. Date of
Publication: 2019.
Author
Sioga A.; Pandria N.; Barbetakis N.; Lazopoulos A.; Katsikas I.; Asteriou
C.; Paliouras D.; Kamperis E.; Ikonomou D.; Papamitsou T.; Filippou D.;
Destouni C.; Ikonomou L.; Zarogoulidis K.; Papagiannopoulos K.; Kleontas
A.
Institution
(Ikonomou, Filippou, Kleontas) Department of Thoracic Surgery, European
Interbalkan Medical Center of Thessaloniki, 10 Asclepiou Str., Pylaia
Thessaloniki 57001, Greece
(Sioga, Papamitsou, Ikonomou) Laboratory of Histology-Embryology, Greece
(Pandria) Laboratory of Medical Physics, Medical School of Aristotle
University of Thessaloniki, Thessaloniki, Greece
(Barbetakis, Lazopoulos, Paliouras) Department of Thoracic Surgery,
"Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
(Katsikas) Department of Anesthesiology, Polyclinique Du Val De Loire,
Nevers, France
(Asteriou) Department of Thoracic Surgery, Euromedica General Clinic of
Thessaloniki, Thessaloniki, Greece
(Kamperis) Department of Radiotherapy, "Papageorgiou" General Hospital of
Thessaloniki, Thessaloniki, Greece
(Destouni) Laboratory of Cytology, "Theagenio" Cancer Hospital of
Thessaloniki, Thessaloniki, Greece
(Zarogoulidis) Department of Pulmonary, "Papanikolaou" General Hospital of
Thessaloniki, Thessaloniki, Greece
(Papagiannopoulos) Department of Thoracic Surgery, St' James' University
Hospital, Bexley Wing, Leeds, United Kingdom
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: There is a plethora of treatment algorithms for managing
patients with malignant pleural effusions (MPEs), sharing many common
points and principles. Our study aims to compare hyperthermic intrapleural
chemotherapy (HITHOC) and talc pleurodesis (TALC), as treatment options
for patients with non-small cell lung cancer (NSCLC) and metastatic MPE.
 Method(s): This prospective, randomized trial was conducted at a
single thoracic surgery center, the "Theagenio" Cancer Institute, in
Greece, under the identification code NCT01409551 and was completed. All
40 patients enrolled were adults with histologically proven metastatic,
unilateral, MPE caused by NSCLC. Exclusion criteria included patients >80
years, trapped lung, and major comorbidities. Patients were randomly and
equally assigned 1:1 to either HITHOC (group A) or TALC (group B) by video
assisted thoracic surgery (VATS). The primary outcome was the median
overall survival (OS) from trial intervention to death, while secondary
outcome was the identification of clinical factors affecting the survival.
 Result(s): The patients were followed up for 45 months. The OS of the
full group was 8 months (95% CI: 7.046-8.954). Participants who underwent
HITHOC had an OS of 8 months (95% CI: 7.141-8.859), whereas the
participants of TALC had an OS of 9 months (95% CI: 7.546-10.454), with no
significant difference between groups. Among fifty-four factors that were
tested for their effects on survival, only TNM stage and creatinine values
both preoperatively and 7 days postoperatively could be regarded as
risk-factors for survival. Other recorded parameters, which had
significant variance between the two groups, were urea levels, C-reactive
protein, white blood cells and total in hospital length of stay (LOS).
 Conclusion(s): Both HITHOC and TALC are equally effective and safe
therapeutic options in treating patients with MPE and NSCLC with
acceptable survival. The study revealed independent clinical risk factors
influencing survival, which could be utilized as starting points for
larger clinical studies. Copyright © Journal of Thoracic Disease.
All rights reserved.

<103>
Accession Number
2001788177
Title
Skeletonized versus pedicled internal mammary artery: A systematic review.
Source
Cirugia Cardiovascular. 26 (3) (pp 162-168), 2019. Date of Publication:
May - June 2019.
Author
Urso S.; Sadaba R.; Tena M.A.; Bellot R.; Rios L.; Martinez-Comendador
J.M.; Abad C.; Portela F.
Institution
(Urso, Tena, Bellot, Rios, Abad, Portela) Servicio de Cirugia Cardiaca,
Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Servicio de Cirugia Cardiaca, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Martinez-Comendador) Servicio de Cirugia Cardiaca, Hospital Universitario
de Leon, Leon, Spain
Publisher
Elsevier Doyma
Abstract
The European Society of Cardiology (ESC) and European Association for
Cardio-Thoracic Surgery (EACTS) 2018 guidelines state "skeletonised
internal mammary artery (IMA) dissection is recommended in patients with a
high risk of sternal wound infection". This indication does not clarify in
which type of patients the IMA skeletonisation technique should be
applied. For this reason, review is presented. A Medline search was
conducted up to November 2018. The inclusion criteria were: studies
published in English, conducted on humans, those that compared
skeletonised versus pedicled IMA, and published at least one of the
following results: flow, permeability, length and graft calibre, and
incidence or risk of sternal wound infection. A total of 208 articles were
found, of which 30 were included. Most of the studies included in the
present systematic review show that IMA skeletonisation provides a
significant benefit in terms of lower risk of sternal infection, and
increase in length, calibre, and flow of the graft, in comparison with
pedicled IMA. The clinical benefits of skeletonisation are evident,
especially, but not exclusively, in patients undergoing double IMA surgery
and in diabetic patients. In conclusion, IMA skeletonisation should be
recommended in patients undergoing surgery with the use of double IMA and
in diabetic patients. The clinical benefits of skeletonisation in patients
undergoing surgery with the use of a single IMA are not supported by solid
evidence. Copyright © 2019 Sociedad Espanola de Cirugia
Toracica-Cardiovascular

<104>
Accession Number
2001744272
Title
Does prior coronary angioplasty affect outcomes of surgical coronary
revascularization? Insights from the STICH trial.
Source
International Journal of Cardiology. 291 (pp 36-41), 2019. Date of
Publication: 15 September 2019.
Author
Nicolau J.C.; Stevens S.R.; Al-Khalidi H.R.; Jatene F.B.; Furtado R.H.M.;
Dallan L.A.O.; Lisboa L.A.F.; Desvigne-Nickens P.; Haddad H.; Jolicoeur
E.M.; Petrie M.C.; Doenst T.; Michler R.E.; Ohman E.M.; Maddury J.; Ali
I.; Deja M.A.; Rouleau J.L.; Velazquez E.J.; Hill J.A.
Institution
(Nicolau, Jatene, Furtado, Dallan, Lisboa) Instituto do Coracao (InCor),
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, SP, Brazil
(Stevens, Al-Khalidi, Ohman) Duke Clinical Research Institute and
Department of Biostatistics and Bioinformatics, Duke University School of
Medicine, Durham, NC, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
(Haddad) Department of Medicine, University of Saskatchewan, Saskatoon,
Saskatchewan, Canada
(Jolicoeur, Rouleau) Montreal Heart Institute, Universite de Montreal,
Quebec, Canada
(Petrie) BHF Cardiovascular Research Centre, University of Glasgow,
Glasgow, United Kingdom
(Doenst) Department of Cardiothoracic Surgery, University of Jena, Jena,
Germany
(Michler) Department of Cardiothoracic Surgery, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Maddury) Department of Cardiology, Nizams Institute of Medical Sciences,
Hyderabad, India
(Ali) Libin Cardiovascular Institute of Alberta, University of Calgary,
Foothills Medical Centre, Calgary, Alberta, Canada
(Deja) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Velazquez) Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Hill) Department of Medicine, University of Florida, Gainesville, FL,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The STICH trial showed superiority of coronary artery bypass
plus medical treatment (CABG) over medical treatment alone (MED) in
patients with left ventricular ejection fraction (LVEF) <=35%. In previous
publications, percutaneous coronary intervention (PCI) prior to CABG was
associated with worse prognosis. Objective(s): The main purpose of
this study was to analyse if prior PCI influenced outcomes in STICH.
 Methods and Results: Patients in the STICH trial (n = 1212), followed
for a median time of 9.8 years, were included in the present analyses. In
the total population, 156 had a prior PCI (74 and 82, respectively, in the
MED and CABG groups). In those with vs. without prior PCI, the adjusted
hazard-ratios (aHRs) were 0.92 (95% CI = 0.74-1.15) for all-cause
mortality, 0.85 (95% CI = 0.64-1.11) for CV mortality, and 1.43 (95% CI =
1.15-1.77) for CV hospitalization. In the group randomized to CABG without
prior PCI, the aHRs were 0.82 (95% CI = 0.70-0.95) for all-cause
mortality, 0.75 (95% CI = 0.62-0.90) for CV mortality and 0.67 (95% CI =
0.56-0.80) for CV hospitalization. In the group randomized to CABG with
prior PCI, the aHRs were 0.76 (95% CI = 0.50-1.15) for all-cause
mortality, 0.81 (95% CI = 0.49-1.36) for CV mortality and 0.61 (95% CI =
0.41-0.90) for CV hospitalization. There was no evidence of interaction
between randomized treatment and prior PCI for any endpoint (all adjusted
p > 0.05). Conclusion(s): In the STICH trial, prior PCI did not
affect the outcomes of patients whether they were treated medically or
surgically, and the superiority of CABG over MED remained unchanged
regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov;
Identifier: NCT00023595 Copyright © 2019 Elsevier B.V.

<105>
Accession Number
628044046
Title
The effect of implementing an aseptic practice bundle for anaesthetists to
reduce postoperative infections, the Anaesthetists Be Cleaner (ABC) study:
Protocol for a stepped wedge, cluster randomised, multi-site trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 342. Date of
Publication: 10 Jun 2019.
Author
Merry A.F.; Gargiulo D.A.; Bissett I.; Cumin D.; English K.; Frampton C.;
Hamblin R.; Hannam J.; Moore M.; Reid P.; Roberts S.; Taylor E.; Mitchell
S.J.; Chapman I.; Denison T.; Hopley L.; Jackson L.; Jones R.; Kruger C.;
Lindsay H.; Love A.; McGuinness S.; Milsom P.; Munro J.; Panduri G.; Pitto
R.; Sheridan J.; Sidhu N.; Stapelberg F.; Sweetman C.; Torrie J.; Walker
S.; Walsh C.; Willcox T.; Wiles S.; Young S.
Institution
(Merry, Gargiulo, Cumin, Moore, Mitchell) Department of Anaesthesiology,
School of Medicine, University of Auckland, Private Bag 92019, Auckland
1142, New Zealand
(Merry, English, Mitchell) Department of Anaesthesia, Auckland City
Hospital, PO Box 92024, Auckland 1142, New Zealand
(Bissett) Department of Surgery, School of Medicine, University of
Auckland, Private Bag 92019, Auckland 1142, New Zealand
(Bissett) Department of Surgery, Auckland City Hospital, Private Bag
92019, Auckland 1142, New Zealand
(Frampton) Department of Psychological Medicine, University of Otago, PO
Box 4345, Christchurch 8140, New Zealand
(Hamblin) Health Quality and Safety Commission, PO Box 25496, Wellington
6146, New Zealand
(Hannam) Department of Pharmacology and Clinical Pharmacology, University
of Auckland, Private Bag 92019, Auckland 1142, New Zealand
(Reid) Te Kupenga Hauora Maori, University of Auckland, Private Bag 92019,
Auckland 1142, New Zealand
(Roberts) LabPLUS, Auckland City Hospital, PO Box 110031, Auckland 1070,
New Zealand
(Taylor) Starship Children's Health, Auckland District Health Board, PO
Box 9389, Auckland 1149, New Zealand
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative infection is a serious problem in New Zealand
and internationally with considerable human and financial costs. Also, in
New Zealand, certain factors that contribute to postoperative infection
are more common in Maori and Pacific populations. To date, most efforts to
reduce postoperative infection have focussed on surgical aspects of care
and on antibiotic prophylaxis, but recent research shows that anaesthesia
providers may also have an impact on infection transmission. These
providers sometimes exhibit imperfect hand hygiene and frequently transfer
the blood or saliva of their patients to their work environment. In
addition, intravenous medications may become contaminated whilst being
drawn up and administered to patients. Working with relevant practitioners
and other experts, we have developed an evidence-informed bundle to
improve key aseptic practices by anaesthetists with the aim of reducing
postoperative infection. The key elements of the bundle are the filtering
of compatible drugs, context-relevant hand hygiene practices and enhanced
maintenance of clean work surfaces. Method(s): We will seek support
for implementation of the bundle from senior anaesthesia and hospital
leadership and departmental "champions". Anaesthetic teams and recovery
room staff will be educated about the bundle and its potential benefits
through presentations, written material and illustrative videos. We will
implement the bundle in operating rooms where hip or knee arthroplasty or
cardiac surgery procedures are undertaken in a five-site, stepped wedge,
cluster randomised, quality improvement design. We will compare outcomes
between approximately 5000 cases before and 5000 cases after
implementation of our bundle. Outcome data will be collected from existing
national and hospital databases. Our primary outcome will be days alive
and out of hospital to 90 days, which is expected to reflect all serious
postoperative infections. Our secondary outcome will be the rate of
surgical site infection. Aseptic practice will be observed in sampled
cases in each cluster before and after implementation of the bundle.
 Discussion(s): If effective, our bundle may offer a practical
clinical intervention to reduce postoperative infection and its associated
substantial human and financial costs. Trial registration: Australian New
Zealand Clinical Trials Registry, ACTRN12618000407291. Registered on 21
March 2018. Copyright © 2019 The Author(s).

<106>
Accession Number
624399324
Title
Does oesophageal stenosis have any impact on survival of oesophageal
cancer patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (3) (pp 384-386),
2018. Date of Publication: 2018.
Author
Deng H.-Y.; Li G.; Luo J.
Institution
(Deng) Lung Cancer Center, West China Hospital, Sichuan University, No. 37
Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng, Li, Luo) Department of Thoracic Surgery, West China Hospital,
Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does oesophageal stenosis
have any impact on survival of oesophageal cancer patients?'. A total of
542 papers were found using the reported search, of which 8 cohort studies
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
Most of these studies defined stenosis as failure to cross the tumour at
endoscopic ultrasonography. Seven studies demonstrated that oesophageal
cancer patients with stenosis had significantly poorer survival than those
without, while 2 studies found that oesophageal stenosis was also a
predictor of poor recurrence-free survival. We conclude that oesophageal
stenosis is a predictor of poor prognosis in patients with oesophageal
cancer. Copyright © 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<107>
Accession Number
620674692
Title
Adherence to Mediterranean and low-fat diets among heart and lung
transplant recipients: A randomized feasibility study.
Source
Nutrition Journal. 17 (1) (no pagination), 2018. Article Number: 22. Date
of Publication: 14 Feb 2018.
Author
Entwistle T.R.; Green A.C.; Fildes J.E.; Miura K.
Institution
(Entwistle, Fildes) Transplant Centre, University Hospital of South
Manchester, Manchester M23 9LT, United Kingdom
(Green, Miura) Cancer and Population Studies Group, QIMR Berghofer Medical
Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
(Green) CRUK Manchester Institute, University of Manchester, Wilmslow
Road, Manchester, United Kingdom
(Fildes) Manchester Collaborative Centre for Inflammation Research,
University of Manchester, Manchester, United Kingdom
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Heart and lung transplant recipients are at a substantially
increased risk of cardiovascular disease (CVD). Since both low-fat and
Mediterranean diets can reduce CVD in immunocompetent people at high risk,
we assessed adherence among thoracic transplant recipients allocated to
one or other of these diets for 12 months. Method(s): Forty-one
transplant recipients (20 heart; 21 lung) randomized to a Mediterranean or
a low-fat diet for 12 months received diet-specific education at baseline.
Adherence was primarily assessed by questionnaire: 14-point Mediterranean
diet (score 0-14) and 9-point low-fat diet (score 0-16) respectively, high
scores indicating greater adherence. Median scores at baseline, 6 months,
12 months, and 6-weeks post-intervention were compared by dietary group.
We further assessed changes in weight, body mass index (BMI) and serum
triglycerides from baseline to 12 months as an additional indicator of
adherence. Result(s): In those randomized to a Mediterranean diet,
median scores increased from 4 (range 1-9) at baseline, to 10 (range 6-14)
at 6-months and were maintained at 12 months, and also at 6-weeks
post-intervention (median 10, range 6-14). Body weight, BMI and serum
triglycerides decreased over the 12-month intervention period (mean weight
- 1.8 kg, BMI -0.5 kg/m2, triglycerides - 0.17 mmol/L). In the
low-fat diet group, median scores were 11 (range 9-14) at baseline;
slightly increased to 12 (range 9-16) at 6 months, and maintained at 12
months and 6 weeks post-intervention (median 12, range 8-15). Mean changes
in weight, BMI and triglycerides were - 0.2 kg, 0.0 kg/m2 and -
0.44 mmol/L, respectively. Conclusion(s): Thoracic transplant
recipients adhered to Mediterranean and low-fat dietary interventions. The
change from baseline eating habits was notable at 6 months; and this
change was maintained at 12 months and 6 weeks post-intervention in both
Mediterranean diet and low-fat diet groups. Dietary interventions based on
comprehensive, well-supported education sessions targeted to both patients
and their family members are crucial to success. Such nutritional
strategies can help in the management of their substantial CVD risk. Trial
registration: The IRAS trial registry (ISRCTN63500150). Date of
registration 27 July 2016. Retrospectively registered. Copyright
© 2018 The Author(s).

<108>
Accession Number
624181533
Title
Advanced image processing with fusion and calcification enhancement in
transcatheter aortic valve implantation: Impact on radiation exposure.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (4) (pp 512-519),
2018. Date of Publication: 01 Oct 2018.
Author
Overtchouk P.; Sudre A.; Delhaye C.; Juthier F.; Van Belle E.; Coisne A.;
Koussa M.; Mylotte D.; Modine T.
Institution
(Overtchouk, Sudre, Delhaye, Juthier, Van Belle, Coisne, Koussa, Modine)
Department of Cardiology and Cardiovascular Surgery, Institut Coeur
Poumon, Centre Hospitalier Regional et Universitaire de Lille (CHRU de
Lille), 2 Avenue Oscar Lambret, Lille 59037, France
(Juthier, Van Belle, Coisne) INSERM UMR 1011, Lille, France
(Juthier, Van Belle, Coisne) Faculte de Medecine, Universite de Lille 2,
Lille, France
(Coisne) Institut Pasteur de Lille, Lille, France
(Coisne) European Genomic Institute for Diabetes (E.G.I.D), Lille, France
(Coisne) CHU Lille, Department of Clinical Physiology and
Echocardiography, Lille, France
(Mylotte) Department of Cardiology, Galway University Hospital, Galway,
Ireland
Publisher
Oxford University Press
Abstract
OBJECTIVES Radiation exposure is a concern for both patients and operators
during transcatheter aortic valve implantation (TAVI). Efforts to reduce
radiation dose are warranted. We aimed at investigating if per-operative
advanced image processing can reduce patient and operator irradiation use
during TAVI. METHODS We performed a prospective single-centre
observational study comparing patient and operator radiation exposure
using standard fluoroscopy (control group) or a novel technology of live
advanced fluoroscopic image processing (test group) among consecutive
patients undergoing TAVI between August 2015 and April 2016. Patient
irradiation (dose-area product, effective dose and air kerma), contrast
media volume and clinical outcomes were assessed. RESULTS Among 152
elderly [median age (interquartile range): 83 (78-87)] patients (n = 76
per group) undergoing TAVI, baseline clinical characteristics were similar
between the control and test groups, except for a higher median EuroSCORE
II (2.8% vs 2.3%, P = 0.02) and higher rate of TAVI for failing surgical
bioprosthesis (11.8% vs 2.6%, P = 0.03) in the control group. The
dose-area product was reduced in the test group: mean reduction of -27.5
Gy x cm2 [95% confidence intervals (CIs): 15.9-39.1, P <
0.001]. Furthermore, effective dose [mean reduction -6.5 (95% CI: 5.9-7.2)
mSv, P < 0.001] and air kerma [mean reduction -167.5 (95% CI 163.4-177.3)
mGy, P < 0.001] were lower in the test group. Fluoroscopy time, contrast
volume and clinical outcomes were similar. CONCLUSIONS Patient radiation
exposure was significantly reduced using a novel live advanced fluoroscopy
image processing with calcification enhancement and fusion of the virtual
aortic annulus without compromising patient safety. Copyright ©
The Author(s) 2018. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<109>
Accession Number
624181500
Title
Is administration of dual-antiplatelet therapy beneficial for patients
following off-pump coronary artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (4) (pp 548-554),
2018. Date of Publication: 01 Oct 2018.
Author
Peksa M.; Aboul-Hassan S.S.; Marczak J.; Cichon R.
Institution
(Peksa, Aboul-Hassan, Marczak) Department of Cardiac Surgery, MEDINET
Heart Center Ltd., Chalubinskiego 7 street, Nowa Sol 67-100, Poland
(Marczak) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Cichon) Department of Cardiac Surgery, Warsaw Medical University, Warsaw,
Poland
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether administration of
dual-antiplatelet therapy (DAPT) following off-pump coronary artery bypass
grafting (OPCAB) would improve postoperative clinical outcomes or minimize
the incidence of postoperative graft failure. In total, 101 papers were
found using the reported search, 14 of which represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. One meta-analysis and 3 randomized
controlled trials showed that DAPT following OPCAB is associated with
decreased incidence of saphenous vein graft occlusion. One randomized
controlled trial and 4 observational studies showed no effect of DAPT on
mortality following OPCAB, whereas 3 observational studies showed that
DAPT decreased mortality. One meta-analysis and 4 observational studies
showed that DAPT reduced the incidence of cardiac events following OPCAB.
One randomized controlled trial and 4 observational studies showed that
DAPT did not increase the incidence of major or minor bleeding
complications following OPCAB. The results presented suggest that
administration of DAPT in patients following OPCAB for at least 3 months
improves saphenous vein graft patency and could be protective against
recurrence of cardiac events, especially acute coronary syndrome, in
comparison with aspirin monotherapy. The administration of DAPT following
OPCAB is safe and is not associated with increased incidence of major or
minor bleeding complications when compared with aspirin
alone. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<110>
Accession Number
624513621
Title
Diabetes mellitus is an independent prognostic factor for mid-term and
long-term survival following transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (2) (pp 159-168),
2018. Date of Publication: August 2018.
Author
Lv W.; Li S.; Zhao Z.; Liao Y.; Li Y.; Chen M.; Feng Y.
Institution
(Li) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Lv, Zhao, Liao, Li, Chen, Feng) Department of Cardiology, West China
Hospital, Sichuan University, Guoxue Alley No. 37, Chengdu, China
Publisher
Oxford University Press
Abstract
Prior studies have proposed the unfavourable roles of diabetes mellitus
(DM) in surgical populations. For patients who underwent transcatheter
aortic valve implantation, the prognostic value of DM remains
controversial. This review summarizes the effects of DM on short-term,
mid-term and long-term prognosis in patients who undergo transcatheter
aortic valve implantation. We searched the PubMed database to identify
eligible articles. The odds ratio and hazard ratio with the corresponding
95% confidence interval were adopted for synthesizing short-term and
medium- to long-term survival outcomes, respectively. The heterogeneity
level and publication bias between studies were also estimated. Finally,
20 observational studies enrolling 19 260 patients met the eligibility
criteria and, thus, were included in this review. An overall analysis
identified that DM was significantly associated with the poor medium- to
long-term overall survival (hazard ratio 1.21, 95% confidence interval
1.03-1.41; P = 0.019). However, no significant impact of DM on 30-day
mortality was observed (odds ratio 1.10, 95% confidence interval
0.86-1.41; P = 0.46) in patients undergoing transcatheter aortic valve
implantation. Further subgroup analyses indicated that the prognostic
value of DM for medium- to long-term overall survival Remained significant
in the subgroups of multivariable origins of incorporated data, duration
of follow-ups (1-year/<_2-year follow-up), Western populations and
insulin-dependent diabetes mellitus. This meta-analysis demonstrates that
DM is a strongly independent predictor for poor medium- to long-term
overall survival but shows no significant effect of DM on 30-day
mortality. Our findings need to be further verified and modified by more
worldwide studies. Copyright © The Author(s) 2018.

<111>
Accession Number
624751005
Title
Effect of physical exercise on weight loss and physical function following
bariatric surgery: A meta-analysis of randomised controlled trials.
Source
BMJ Open. 8 (10) (no pagination), 2018. Article Number: e023208. Date of
Publication: 2018.
Author
Ren Z.-Q.; Lu G.-D.; Zhang T.-Z.; Xu Q.
Institution
(Ren, Zhang, Xu) School of Nursing, Nanjing Medical University, Nanjing,
China
(Lu) Department of Interventional Radiology, First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives We performed a meta-analysis of all of the available randomised
controlled trials (RCTs) to investigate whether physical exercise
contributes to weight loss or physical function improvement in adults
receiving bariatric surgery. Methods We searched PubMed, Embase, the
Cochrane Library, OVID and the CINAHL up through May 2018. RCTs that
assigned adults with obesity to either an exercise training group or a
no-exercise group after bariatric surgery were included. The primary
outcomes were weight loss and physical function. Study bias was assessed
using the Cochrane risk of bias tool, and the quality of evidence was
assessed using GRADEpro. Results A total of eight studies met the
inclusion criteria (n=347 participants). Most of the studies carried a low
risk of bias due to randomisation and blinding. Compared with those
without exercise intervention after surgery, patients engaging in physical
exercise were associated with greater weight loss (weighted mean
difference (WMD) -1.94 kg; 95% CI -3.18 to -0.69; n=8) and longer 6 min
walk distance (6MWD; WMD29.67 m; 95% CI 25.97 to 33.37; n=2) during
follow-up. By subgroup analyses, the additional weight loss in exercise
group was related to the starting time and type of exercise: patients
engaging in exercise 1 year or more after surgery and patients received
aerobic-resistance exercise experienced more weight loss. Besides,
patients in exercise training group also had lower systolic blood pressure
and resting heart rate after surgery. The quality of evidence for these
outcomes was moderate to very low. Conclusions Physical exercise after
bariatric surgery provides 1.94 kg additional weight loss and 29.67 m
longer 6MWD compared with surgery alone. Moreover, engaging in exercise 1
year or more after surgery, and a combined aerobic and resistance training
programme may result in greater weight loss. Copyright © 2018
Author(s) (or their employer(s)).

<112>
Accession Number
625947688
Title
Perioperative statin administration with decreased risk of postoperative
atrial fibrillation, but not acute kidney injury or myocardial infarction:
A meta-analysis.
Source
Scientific reports. 7 (1) (pp 10091), 2017. Date of Publication: 30 Aug
2017.
Author
Zhen-Han L.; Rui S.; Dan C.; Xiao-Li Z.; Qing-Chen W.; Bo F.
Institution
(Zhen-Han, Bo) Department of Metabolism and Endocrinology, Shanghai East
Hospital, Tongji University School of Medicine, Shanghai 200120, China
(Rui, Xiao-Li) Department of Cardiology, First Affiliated Hospital of
Chongqing Medical University, Chongqing 400016, China
(Dan, Qing-Chen) Department of Cardiothoracic Surgery, First Affiliated
Hospital of Chongqing Medical University, Chongqing 400016, China
Publisher
NLM (Medline)
Abstract
A controversy effect of perioperative statin use for preventing
postoperative atrial fibrillation (POAF) and acute kidney injury (AKI)
after cardiac surgery still remains. We thus performed current systematic
review and meta-analysis to comprehensively evaluate effects of statin in
cardiac surgery. 22 RCTs involving 5243 patients were included.
Meta-analysis of 18 randomized controlled trials with 3995 participants
suggested that perioperative statin use could decrease the risk of POAF
(relative risk [RR] 0.69, 95%CI 0.56 to 0.86, P=0.001), with a moderate
heterogeneity (I 2=65.7%, P H <0.001). And the beneficial effect was found
only in patients receiving coronary artery bypass graft (CABG), but not in
patients undergoing valve surgery. However, perioperative statin use was
not associated with lower risks of AKI (RR 0.98, 95%CI 0.70 to 1.35,
P=0.884, I 2=33.9%, P H =0.157) or myocardial infarction (MI) (RR 0.84,
95%CI 0.58 to 1.23, P=0.380, I 2=0%, P H =0.765), and even an increased
trend of AKI was observed in patients with valve surgery. Perioperative
statin use could decrease the inflammation response with no impact on
clinical outcomes. In conclusion, perioperative statin use is useful in
preventing POAF, particularly in patients with CABG, and ameliorate
inflammation, while it has no effect on AKI and MI after cardiac surgery.

<113>
Accession Number
628127909
Title
Association of Preoperative Renin-Angiotensin System Inhibitors With
Prevention of Postoperative Atrial Fibrillation and Adverse Events: A
Systematic Review and Meta-analysis.
Source
JAMA network open. 2 (5) (pp e194934), 2019. Date of Publication: 03 May
2019.
Author
Chen S.; Acou W.-J.; Kiuchi M.G.; Meyer C.; Sommer P.; Martinek M.;
Schratter A.; Andrea B.R.; Ling Z.; Liu S.; Yin Y.; Hindricks G.;
Purerfellner H.; Krucoff M.W.; Schmidt B.; Chun K.R.J.
Institution
(Chen, Schmidt, Chun) Cardioangiologisches Centrum Bethanien, Medizinische
Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
(Acou) Department of Cardiology, AZ Delta, Roeselare, Belgium
(Kiuchi) School of Medicine, Royal Perth Hospital Unit, University of
Western Australia, Perth, Australia
(Meyer) Klinik fur Kardiologie mit Schwerpunkt Elektrophysiologie,
Universitares Herzzentrum Hamburg, Universitatsklinikum Hamburg-Eppendorf,
Hamburg, Germany
(Meyer) German Centre for Cardiovascular Research, Partner Site
Hamburg/Kiel/Lubeck, Germany
(Sommer) Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitatsklinik
der Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Sommer, Hindricks) Abteilung der Elektrophysiologie, Herzzentrum
Universitat Leipzig, Leipzig, Germany
(Martinek, Purerfellner) Abteilung der Kardiologie, Akademisches
Lehrkrankenhaus der Elisabethinen, Ordensklinikum Linz Elisabethinen,
Linz, Austria
(Schratter) Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing
Wien, Vienna, Austria
(Andrea) Department of Cardiology, Sul Fluminense University Hospital,
Vassouras, Brazil
(Ling, Yin) Department of Cardiology, Second Affiliated Hospital of
Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic
Service Center, Chongqing, China
(Liu) Department of Cardiology, Shanghai General Hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Krucoff) Department of Medicine and Cardiology, Duke University Medical
Center and Duke Clinical Research Institute, Durham, NC, United States
Publisher
NLM (Medline)
Abstract
Importance: Postoperative atrial fibrillation (POAF) is a well-known
complication after cardiac surgery. Renin-angiotensin system inhibitors
(RASIs) have been suggested as an upstream therapy for selected patients
with AF; however, evidence in the surgical setting is limited.
 Objective(s): To evaluate the role of preoperative RASIs in
prevention of POAF and adverse events for patients undergoing cardiac
surgery. Data Sources: The PubMed database and the Cochrane Library
from inception until December 31, 2018, were searched by using the
keywords renin-angiotensin system inhibitors OR angiotensin-converting
enzyme inhibitors OR angiotensin receptor blocker OR aldosterone
antagonist AND cardiac surgery. ClinicalTrials.gov was searched from
inception until December 31, 2018, by using the keywords postoperative
atrial fibrillation. Study Selection: Randomized clinical trials (RCTs)
and observational studies comparing the association between preoperative
RASI treatment vs no preoperative RASI treatment (control group) and the
incidence of POAF were identified. Eleven unique studies met the selection
criteria. Data Extraction and Synthesis: Pooled analysis was performed
using a random-effects model. Sensitivity and subgroup analyses of RCTs
were performed to test the stability of the overall effect. Metaregression
was conducted to explore potential risk of bias. Main Outcomes and
Measures: The primary outcome was POAF, and the secondary outcomes
included rates of stroke and mortality and duration of hospitalization.
 Result(s): Eleven unique studies involving 27 885 unique patients
(74.4% male; median age, 65 years [range, 58.5-74.5 years]) were included.
Compared with the control group, the RASI group did not have a
significantly reduced risk of POAF (odds ratio [OR], 1.04; 95% CI,
0.91-1.19; P=.55; z=0.60), stroke (OR, 0.86; 95% CI, 0.62-1.19; P=.37;
z=0.90; without significant heterogeneity, P=.11), death (OR, 1.07; 95%
CI, 0.85-1.35; P=.56; z=0.59; without significant heterogeneity, P=.12),
composite adverse cardiac events (OR, 1.04; 95% CI, 0.91-1.18; P=.58;
z=0.56), or a reduced hospital stay (weighted mean difference, -0.04; 95%
CI, -1.05 to 0.98; P=.94; z=0.07) using a random-effects model. Pooled
analysis focusing on RCTs showed consistent results. The primary overall
effect was maintained in sensitivity and subgroup analyses. Metaregression
showed that male sex was significantly associated with POAF (tau2=0.0065;
z=3.47; Q=12.047; P<.001) and that use of beta-blockers was associated
with a significantly reduced risk in developing POAF (tau2=0.018; z=-2.24;
Q=5.0091; P=.03). Conclusions and Relevance: The findings from this
study suggest that preoperative RASI treatment does not offer additional
benefit in reducing the risk of POAF, stroke, death, and hospitalization
in the setting of cardiac surgery. The results provide no support for
conventional use of RASIs for the possible prevention of POAF and adverse
events in patients undergoing cardiac surgery; further randomized data,
particularly among those patients with heart failure, are needed.

<114>
Accession Number
628142517
Title
Women's Health Initiative clinical trials: potential interactive effect of
calcium and vitamin D supplementation with hormonal therapy on
cardiovascular disease.
Source
Menopause (New York, N.Y.). (no pagination), 2019. Date of Publication: 15
May 2019.
Author
Jiang X.; Nudy M.; Aragaki A.K.; Robbins J.A.; Manson J.E.; Stefanick
M.L.; O'Sullivan D.M.; Shikany J.M.; LeBlanc E.S.; Kelsey A.M.; Cauley J.;
Martin L.W.; Payne M.E.; Johnson K.C.; Howard B.; Schnatz P.F.
Institution
(Jiang, O'Sullivan, Schnatz) Department of ObGyn, Reading Hospital,
Reading, PA, United States
(Jiang, Schnatz) Department of ObGyn, Sidney Kimmel Medical College at
Thomas Jefferson University, Philadelphia, PA, United States
(Nudy) Department of Internal Medicine, Penn State Hershey Medical Center,
Hershey, PA, United States
(Aragaki) Division of Public Health Sciences, Fred Hutchinson Cancer
Research Center, Seattle, WA, United States
(Robbins) UC Davis Medical Center, Sacramento, CA, United States
(Manson) Division of Preventive Medicine, Brigham and Women's
Hospital/Harvard Medical School, Boston, MA, United States
(Stefanick) Department of Medicine, Stanford Prevention Research Center,
Stanford University School of Medicine, Stanford University, Stanford, CA,
United States
(Shikany) Division of Preventive Medicine, School of Medicine, University
of Alabama at Birmingham, Birmingham, AL, United States
(LeBlanc) Kaiser Permanente Center for Health Research NW, Portland, OR,
United States
(Kelsey) Division of Cardiology, Saint Francis Hospital and Medical
Center, Hartford, CT, United States
(Cauley) Department of Epidemiology, Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, PA, United States
(Martin) Division of Cardiology, Department of Internal Medicine, George
Washington University School of Medicine and Health Sciences, WA, United
States
(Payne) Office of Research Development, Duke University School of
Medicine, Durham, NC, United States
(Johnson) Department of Preventive Medicine, University of Tennessee
Health Science Center, Memphis, TN, United States
(Howard) MedStar Health Research Institute and Georgetown/Howard
Universities Center for Clinical and Translational Science, WA, United
States
(Schnatz) Department of Internal Medicine, Reading Hospital, Reading, PA,
United States
(Schnatz) Department of Internal Medicine, Sidney Kimmel Medical College
at Thomas Jefferson University, Philadelphia, PA, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Data in humans and nonhuman primates have suggested a possible
synergistic effect of vitamin D and calcium (CaD) and estrogen on the
cardiovascular disease (CVD) risk factors. Using randomized trial data we
explored whether the effect of menopausal hormone therapy (HT) on CVD
events is modified by CaD supplementation. METHOD(S): A prospective,
randomized, double-blind, placebo-controlled trial was implemented among
postmenopausal women in the Women's Health Initiative. A total of 27,347
women were randomized to the HT trials (0.625 mg/d of conjugated equine
estrogens [CEE] alone for women without a uterus vs placebo; or 0.625 mg
of CEE in addition to 2.5 mg of medroxyprogesterone acetate daily [CEE +
MPA] for women with a uterus vs placebo). After 1 year, 16,089 women in
the HT trial were randomized to the CaD trial and received either 1,000 mg
of elemental calcium carbonate and 400 IU of vitamin D3 daily or placebo.
The mean (SD) duration of follow-up after CaD randomization was 6.2 (1.3)
years for the CEE trial and 4.6 (1.1) years for the CEE + MPA trial. CVD
and venous thromboembolism events evaluated in this subgroup analysis
included coronary heart disease, stroke, pulmonary embolism, all-cause
mortality, plus select secondary endpoints (total myocardial infarction,
coronary revascularization, deep venous thrombosis, cardiovascular death,
and all CVD events). Time-to-event methods were used and models were fit
with a Cox proportional hazards regression model. RESULT(S): In the
CEE trial, CaD significantly modified the effect of CEE on stroke (P
interaction = 0.04). In the CaD-placebo group, CEE's effect on stroke was
harmful (hazard ratio [95% confidence interval] = 2.19[1.34-3.58]);
however, it was neutral in the CaD-supplement group (hazard ratio [95%
confidence interval] = 1.07[0.66-1.73]). We did not observe significant
CEE-CaD interactions for coronary heart disease, total CVD events, or any
of the remaining endpoints. In the CEE + MPA trial, there was no evidence
that the effect of CEE + MPA on any of CVD endpoints was modified by CaD
supplementation. CONCLUSION(S): CaD did not consistently modify the
effect of CEE therapy or CEE + MPA therapy on CVD events. However, the
increased risk of stroke due to CEE therapy appears to be mitigated by CaD
supplementation. In contrast, CaD supplementation did not influence the
risk of stroke due to CEE + MPA.

<115>
Accession Number
628139499
Title
Randomized trial of ticagrelor vs. aspirin in patients after coronary
artery bypass grafting: the TiCAB trial.
Source
European heart journal. (no pagination), 2019. Date of Publication: 30 May
2019.
Author
Schunkert H.; Boening A.; von Scheidt M.; Lanig C.; Gusmini F.; de Waha
A.; Kuna C.; Fach A.; Grothusen C.; Oberhoffer M.; Knosalla C.; Walther
T.; Danner B.C.; Misfeld M.; Zeymer U.; Wimmer-Greinecker G.; Siepe M.;
Grubitzsch H.; Joost A.; Schaefer A.; Conradi L.; Cremer J.; Hamm C.;
Lange R.; Radke P.W.; Schulz R.; Laufer G.; Grieshaber P.; Pader P.;
Attmann T.; Schmoeckel M.; Meyer A.; Ziegelhoffer T.; Hambrecht R.;
Kastrati A.; Sandner S.E.
Institution
(Schunkert, von Scheidt, Lanig, Gusmini, de Waha, Kuna, Lange, Kastrati)
Department of Cardiology, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstrasse 36, Munich 80636, Germany
(Schunkert, von Scheidt, Lange, Kastrati) DZHK (German Center for
Cardiovascular Research), partner site Munich Heart Alliance, Munich,
Germany
(Boening, Grieshaber) Department of Cardiovascular Surgery, Justus-Liebig
University Giesen, Ludwigstrase 23, Germany
(Fach, Pader, Hambrecht) Department of Cardiology and Angiology, Klinikum
Links der Weser, Senator-Wesling-Strase 1, Bremen 28277, Germany
(Grothusen, Cremer, Attmann) Department of Cardiovascular Surgery,
University Hospital of Schleswig-Holstein, Arnold-Heller-Strase 3, Kiel
24105, Germany
(Oberhoffer, Schmoeckel) Department of Cardiac Surgery, Asklepios Klinik
St. Georg ,Lohmuhlenstrase 5, Hamburg 20099, Germany
(Knosalla, Meyer) Department of Cardiothoracic and Vascular Surgery,
German Heart Institute Berlin, Augustenburger Platz 1, Berlin 13353,
Germany
(Knosalla, Meyer) DZHK (German Center for Cardiovascular Research),
partner site Berlin, Berlin, Germany
(Walther, Ziegelhoffer) Department of Cardiac Surgery, Kerckhoff Heart and
Thorax Center, Benekestrase 2-8, Bad Nauheim 61231, Germany
(Danner) Department of Thoracic and Cardiovascular Surgery, University
Medical Center, Robert-Koch-Strase 40, 37075 Gottingen, Germany
(Misfeld) University Department of Cardiac Surgery, Leipzig Heart Center,
Strumpellstrase 39, Leipzig 04289, Germany
(Zeymer) Bremserstrase 79, Ludwigshafen 6706, Germany
(Wimmer-Greinecker) Department for Cardiothoracic Surgery, Heart and
Vessel Center Bad Bevensen, Bad Bevensen 2954, Germany
(Siepe) Department of Cardiovascular Surgery, Heart Centre Freiburg
University, University of Freiburg, Hugstetter Strase 55, Freiburg 79106,
Germany
(Grubitzsch) Department of Cardiovascular Surgery, Charite
Universitatsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
(Joost) Department of Cardiology, Angiology and Intensive Care Medicine,
University Hospital Schleswig-Holstein, Medical Clinic IIRatzeburger Allee
160, 23538 Lubeck, Germany
(Schaefer, Conradi) Department of Cardiovascular Surgery, University Heart
Center Hamburg, Hamburg, Germany
(Hamm) Justus-Liebig University Giesen, Kerckhoff Campus ,Ludwigstrase 23,
Germany
(Hamm) DZHK (German Center for Cardiovascular Research), Rhein-Main,
partner site Rhein-Main, Germany
(Radke) Department of Internal Medicine-Cardiology, Schon Klinik Neustadt
SE & Co. KG, Am Kiebitzberg 10, Neustadt 23730, Germany
(Schulz) Institute of Physiology, Justus-Liebig University Giesen, Aulweg
129, Germany
(Laufer, Sandner) Division of Cardiac Surgery, Medical University Vienna,
Spitalgasse 23, Wien 1090, Austria
Publisher
NLM (Medline)
Abstract
AIMS: The antiplatelet treatment strategy providing optimal balance
between thrombotic and bleeding risks in patients undergoing coronary
artery bypass grafting (CABG) is unclear. We prospectively compared the
efficacy of ticagrelor and aspirin after CABG. METHODS AND RESULTS: We
randomly assigned in double-blind fashion patients scheduled for CABG to
either ticagrelor 90mg twice daily or 100mg aspirin (1:1) once daily. The
primary outcome was the composite of cardiovascular death, myocardial
infarction (MI), repeat revascularization, and stroke 12 months after
CABG. The main safety endpoint was based on the Bleeding Academic Research
Consortium classification, defined as BARC >=4 for periprocedural and
hospital stay-related bleedings and BARC >=3 for post-discharge bleedings.
The study was prematurely halted after recruitment of 1859 out of 3850
planned patients. Twelve months after CABG, the primary endpoint occurred
in 86 out of 931 patients (9.7%) in the ticagrelor group and in 73 out of
928 patients (8.2%) in the aspirin group [hazard ratio 1.19; 95%
confidence interval (CI) 0.87-1.62; P=0.28]. All-cause mortality
(ticagrelor 2.5% vs. aspirin 2.6%, hazard ratio 0.96, CI 0.53-1.72;
P=0.89), cardiovascular death (ticagrelor 1.2% vs. aspirin 1.4%, hazard
ratio 0.85, CI 0.38-1.89; P=0.68), MI (ticagrelor 2.1% vs. aspirin 3.4%,
hazard ratio 0.63, CI 0.36-1.12, P=0.12), and stroke (ticagrelor 3.1% vs.
2.6%, hazard ratio 1.21, CI 0.70-2.08; P=0.49), showed no significant
difference between the ticagrelor and aspirin group. The main safety
endpoint was also not significantly different (ticagrelor 3.7% vs. aspirin
3.2%, hazard ratio 1.17, CI 0.71-1.92; P=0.53). CONCLUSION(S): In
this prematurely terminated and thus underpowered randomized trial of
ticagrelor vs. aspirin in patients after CABG no significant differences
in major cardiovascular events or major bleeding could be demonstrated.
CLINICALTRIALS.GOV IDENTIFIER: NCT01755520. Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. ©
The Author(s) 2019. For permissions, please email:
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<116>
Accession Number
628131553
Title
Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent
Persistent Pain after Cardiac Surgery.
Source
Anesthesiology. (no pagination), 2019. Date of Publication: 27 May 2019.
Author
Anwar S.; Cooper J.; Rahman J.; Sharma C.; Langford R.
Institution
(Anwar) From the Department of Perioperative Medicine, Barts Heart Centre,
United Kingdom (S.A.) National Institutes of Health Research Biomedical
Research Centre at Barts, J.C.) Pain and Anaesthesia Research Centre,
United Kingdom (S.A., J.R., C.S., St. Bartholomew's Hospital, London,
Canada
Publisher
NLM (Medline)
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Cardiac surgery is associated with
a significant rate of chronic postoperative painFew proven strategies
exist to reduce chronic postoperative pain WHAT THIS ARTICLE TELLS US THAT
IS NEW: The administration of pregabalin (14 days) with or without
ketamine (2 days) postoperatively reduced the prevalence of pain at 3 and
6 monthsSide effects from pregabalin and ketamine administration were
generally mild BACKGROUND:: Persistent postsurgical pain is common and
affects quality of life. The hypothesis was that use of pregabalin and
ketamine would prevent persistent pain after cardiac surgery.
 METHOD(S): This randomized, double-blind, placebo-controlled trial
was undertaken at two cardiac surgery centers in the United Kingdom.
Adults without chronic pain and undergoing any elective cardiac surgery
patients via sternotomy were randomly assigned to receive either usual
care, pregabalin (150 mg preoperatively and twice daily for 14
postoperative days) alone, or pregabalin in combination with a 48-h
postoperative infusion of intravenous ketamine at 0.1 mg . kg . h. The
primary endpoints were prevalence of clinically significant pain at 3 and
6 months after surgery, defined as a pain score on the numeric rating
scale of 4 or higher (out of 10) after a functional assessment of three
maximal coughs. The secondary outcomes included acute pain, opioid use,
and safety measures, as well as long-term neuropathic pain, analgesic
requirement, and quality of life. RESULT(S): In total, 150 patients
were randomized, with 17 withdrawals from treatment and 2 losses to
follow-up but with data analyzed for all participants on an
intention-to-treat basis. The prevalence of pain was lower at 3
postoperative months for pregabalin alone (6% [3 of 50]) and in
combination with ketamine (2% [1 of 50]) compared to the control group
(34% [17 of 50]; odds ratio = 0.126 [0.022 to 0.5], P = 0.0008; and 0.041
[0.0009 to 0.28], P < 0.0001, respectively) and at 6 months for pregabalin
alone (6% [3 of 50]) and in combination with ketamine 0% (0 of 5) compared
to the control group (28% [14 of 50]; odds ratio = 0.167 [0.029 to 0.7], P
= 0.006; and 0.000 [0 to 0.24], P < 0.0001). Diplopia was more common in
both active arms. CONCLUSION(S): Preoperative administration of 150
mg of pregabalin and postoperative continuation twice daily for 14 days
significantly lowered the prevalence of persistent pain after cardiac
surgery.

<117>
Accession Number
628131406
Title
Cardiopulmonary Bypass Priming with Hydroxyethyl Starch 6% 130/0.4 or
Sodium Chloride 0.9%: A Preliminary Double-Blind Randomized Controlled
Study in Cardiac Surgery.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2019.
Date of Publication: 10 May 2019.
Author
Schweizer R.; Lameche M.; Coelembier C.; Portran P.; Fornier W.; Colombet
B.; Grinberg D.; Pozzi M.; Jacquet-Lagreze M.; Fellahi J.-L.
Institution
(Schweizer, Lameche, Coelembier, Portran, Fornier, Jacquet-Lagreze)
Service d'Anesthesie-Reanimation, Hopital Louis Pradel, Hospices Civils de
Lyon, Lyon, France
(Colombet) Service de Pharmacie Hospitaliere, Hopital Louis Pradel,
Hospices Civils de Lyon, Lyon, France
(Grinberg, Pozzi) Service de Chirurgie Cardiaque, Vasculaire et
Thoracique, Hopital Louis Pradel, Hospices Civils de Lyon, Lyon, France
(Fellahi) Service d'Anesthesie-Reanimation, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France; IHU OPERA Cardioprotection, Universite
Claude Bernard Lyon 1, Lyon, France
Publisher
NLM (Medline)

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