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<1>
Accession Number
2001944772
Title
Intraoperative fetal heart monitoring for non-obstetric surgery: A
systematic review.
Source
European Journal of Obstetrics and Gynecology and Reproductive Biology.
238 (pp 12-19), 2019. Date of Publication: July 2019.
Author
Po G.; Olivieri C.; Rose C.H.; Saccone G.; McCurdy R.; Berghella V.
Institution
(Po) Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of
Medical and Surgical Sciences, University of Modena and Reggio Emilia,
Modena, Italy
(Olivieri) Sapienza University of Rome, Rome, Italy
(Rose) Division of Maternal-Fetal Medicine, Department of Obstetrics and
Gynecology, Mayo Clinic, Rochester, MN, United States
(Saccone) Department of Neuroscience, Reproductive Science and Dentistry,
School of Medicine, University of Naples Federico II, Naples, Italy
(McCurdy, Berghella) Division of Maternal Fetal Medicine, Department of
Obstetrics and Gynecology, Thomas Jefferson University Hospital,
Philadelphia, PA, United States
Publisher
Elsevier Ireland Ltd
Abstract
Limited data are available on fetal monitoring during non-obstetric
surgery in pregnancy. We performed a systematic review to evaluate the
incidence of emergent cesarean delivery performed for non-reassuring fetal
heart rate patterns during non-obstetric surgery. Electronic databases
were searched from their inception until October 2018 without limit for
language. We included studies evaluating at least five cases of
intraoperative fetal heart rate monitoring -either with ultrasound or
cardiotocography- during non-obstetric surgery in pregnant women at >=22
weeks of gestation. The primary outcome was the incidence of
intraoperative cesarean delivery performed for non-reassuring fetal heart
rate monitoring. Non-reassuring fetal heart rate monitoring was defined by
attendant personnel, meeting NICHD criteria for category II or III
patterns. Data extracted regarded type of study, demographic
characteristics, maternal and perinatal outcomes. Statistical analysis was
performed for continuous outcomes by calculating mean and standard
deviations for appropriate variables. Of 120 studies identified, 4 with 41
cases of intraoperative monitoring met criteria for inclusion and were
analyzed. Most (66%)surgeries were indicated for neurological or abdominal
maternal issues and were performed under general anesthesia (88%)at a mean
gestational age of 28 weeks. Minimal or absent fetal heart variability was
noted in most cases and a 10-25 beats per minutes decrease in fetal heart
rate baseline was observed in cases with general anesthesia. No
intraoperative cesarean deliveries were needed. The incidence of
non-reassuring fetal heart rate monitoring was 4.9% (2/41)and were limited
to fetal tachycardia during maternal fever. Two (4.9%)cases of
non-reassuring fetal heart rate monitoring were noted within the immediate
48 h after surgery, necessitating cesarean delivery. A single case of
intrauterine fetal demise occurred four days postoperatively in a woman
who had neurosurgery and remained comatose. In conclusion, limited data
exist regarding the clinical application of fetal heart rate monitoring at
viable gestational ages during non-obstetric surgical procedures. Fetal
heart rate monitoring during non-obstetric surgery at >=22 weeks was not
associated with need for intraoperative cesarean delivery, but two
(4.9%)cesarean deliveries were performed for non-reassuring fetal heart
rate monitoring within 48 h after surgery.<br/>Copyright &#xa9; 2019
Elsevier B.V.

<2>
Accession Number
616368812
Title
Mitral valve surgery and coronary artery bypass grafting for
moderate-to-severe ischemic mitral regurgitation: Meta-analysis of
clinical and echocardiographic outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (1) (pp 127-136),
2017. Date of Publication: July 2017.
Author
Virk S.A.; Tian D.H.; Sriravindrarajah A.; Dunn D.; Wolfenden H.D.; Suri
R.M.; Munkholm-Larsen S.; Cao C.
Institution
(Virk, Tian, Sriravindrarajah, Dunn, Munkholm-Larsen, Cao) The
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Tian) Royal North Shore Hospital, Sydney, Australia
(Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Suri) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Cao) Department of Cardiothoracic Surgery, St George Hospital, Sydney,
Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective This meta-analysis was conducted to compare clinical and
echocardiographic outcomes following isolated coronary artery bypass
grafting (CABG) versus CABG and mitral valve (MV) surgery in patients with
moderate-to-severe ischemic mitral regurgitation (IMR). Methods Seven
databases were systematically searched to identify relevant studies. For
eligibility, studies were required to report on the primary endpoint of
perioperative or late mortality. Data were analyzed according to
predefined clinical endpoints. Results Four randomized controlled trials
(RCTs) (n = 505) and 15 observational studies (OS) (n = 3785) met the
criteria for inclusion. Compared with isolated CABG, concomitant CABG and
MV surgery was not associated with increased perioperative mortality
(RCTs: relative risk [RR] 0.89, 95% confidence interval [CI], 0.26-3.02;
OS: RR 1.40, 95% CI, 0.88-2.23). CABG and MV surgery was associated with
significantly lower incidence of moderate-to-severe MR at follow-up (RCTs:
RR 0.16, 95% CI, 0.04-0.75; OS: RR 0.20, 95% CI, 0.09-0.48). Late
mortality was similar between the surgical approaches in RCTs (hazard
ratio [HR] 1.20, 95% CI, 0.57-2.53) and OS (HR 0.99, 95% CI, 0.81-1.21).
There were no significant differences in echocardiographic outcomes. These
results remained consistent in subgroup analyses restricted to patients
with strictly moderate IMR. Conclusions In patients with
moderate-to-severe IMR, the addition of MV surgery to CABG was not
associated with increased perioperative mortality. Although concomitant MV
surgery reduced recurrence of moderate-to-severe MR at follow-up, this was
not associated with a reduction in late mortality. Larger trials with
longer follow-up duration are required to further assess long-term
survival and freedom from reintervention.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery

<3>
Accession Number
605122343
Title
Outcome of delirium in critically ill patients: Systematic review and
meta-analysis.
Source
BMJ (Online). 350 (pp 1-10), 2015. Article Number: h2538. Date of
Publication: 03 Jun 2015.
Author
Salluh J.I.F.; Wang H.; Schneider E.B.; Nagaraja N.; Yenokyan G.; Damluji
A.; Serafim R.B.; Stevens R.D.
Institution
(Salluh, Serafim) D'Or Institute for Research and Education, Rio de
Janeiro, Brazil
(Wang, Schneider, Nagaraja) Department of Surgery, Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
(Yenokyan) Department of Biostatistics, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
(Damluji) Cardiovascular Division, University of Miami, Miller School of
Medicine, Miami, United States
(Serafim) Department of Internal Medicine, Federal University of Rio de
Janeiro, Rio de Janeiro, Brazil
(Stevens) Department of Anesthesiology and Critical Care Medicine,
Neurology, Neurosurgery, and Radiology, Johns Hopkins University, School
of Medicine, Baltimore, MD 21287, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
OBJECTIVES: To determine the relation between delirium in critically ill
patients and their outcomes in the short term (in the intensive care unit
and in hospital) and after discharge from hospital. DESIGN: Systematic
review and meta-analysis of published studies. DATA SOURCES: PubMed,
Embase, CINAHL, Cochrane Library, and PsychINFO, with no language
restrictions, up to 1 January 2015. ELIGIBILITY CRITERIA FOR SELECTION
STUDIES: Reports were eligible for inclusion if they were prospective
observational cohorts or clinical trials of adults in intensive care units
who were assessed with a validated delirium screening or rating system,
and if the association was measured between delirium and at least one of
four clinical endpoints (death during admission, length of stay, duration
of mechanical ventilation, and any outcome after hospital discharge).
Studies were excluded if they primarily enrolled patients with a
neurological disorder or patients admitted to intensive care after cardiac
surgery or organ/tissue transplantation, or centered on sedation
management or alcohol or substance withdrawal. Data were extracted on
characteristics of studies, populations sampled, identification of
delirium, and outcomes. Random effects models and metaregression analyses
were used to pool data from individual studies. <br/>RESULT(S): Delirium
was identified in 5280 of 16 595 (31.8%) critically ill patients reported
in 42 studies. When compared with control patients without delirium,
patients with delirium had significantly higher mortality during admission
(risk ratio 2.19, 94% confidence interval 1.78 to 2.70; P<0.001) as well
as longer durations of mechanical ventilation and lengths of stay in the
intensive care unit and in hospital (standard mean differences 1.79 (95%
confidence interval 0.31 to 3.27; P<0.001), 1.38 (0.99 to 1.77; P<0.001),
and 0.97 (0.61 to 1.33; P<0.001), respectively). Available studies
indicated an association between delirium and cognitive impairment after
discharge. <br/>CONCLUSION(S): Nearly a third of patients admitted to an
intensive care unit develop delirium, and these patients are at increased
risk of dying during admission, longer stays in hospital, and cognitive
impairment after discharge.<br/>Copyright &#xa9; BMJ Publishing Group Ltd
2015.

<4>
Accession Number
601028239
Title
Incidence of mortality and morbidity related to postoperative lung injury
in patients who have undergone abdominal or thoracic surgery: A systematic
review and meta-analysis.
Source
The Lancet Respiratory Medicine. 2 (12) (pp 1007-1015), 2014. Date of
Publication: 01 Dec 2014.
Author
Neto A.S.; Hemmes S.N.T.; Barbas C.S.V.; Beiderlinden M.;
Fernandez-Bustamante A.; Futier E.; Hollmann M.W.; Jaber S.; Kozian A.;
Licker M.; Lin W.-Q.; Moine P.; Scavonetto F.; Schilling T.; Selmo G.;
Severgnini P.; Sprung J.; Treschan T.; Unzueta C.; Weingarten T.N.;
Wolthuis E.K.; Wrigge H.; de Abreu M.G.; Pelosi P.; Schultz M.J.
Institution
(Neto, Hemmes, Wolthuis, Schultz) Department of Intensive Care, Academic
Medical Centre, University of Amsterdam, Amsterdam, Netherlands
(Hemmes, Hollmann) Department of Anaesthesiology, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
(Schultz) Laboratory of Experimental Intensive Care and Anaesthesiology,
Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
(Neto, Sprung, Weingarten) Medical Intensive Care Unit, ABC Medical School
(FMABC), Santo Andre, Brazil
(Neto, Barbas) Department of Critical Care Medicine, Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(Beiderlinden, Treschan) Department of Anaesthesiology, Dusseldorf
University Hospital, Heinrich-Heine University, Dusseldorf, Germany
(Beiderlinden) Department of Anaesthesiology, Marienhospital Osnabruck,
Osnabruck, Germany
(Fernandez-Bustamante, Moine) Department of Anesthesiology, University of
Colorado, Aurora, CO, United States
(Futier) Department of Aneasthesiology and Critical Care Medicine, Estaing
University Hospital, Clermont-Ferrand, France
(Jaber) Department of Critical Care Medicine and Anaesthesiology (SAR B),
Saint Eloi University Hospital, Montpellier, France
(Kozian, Schilling) Department of Anaesthesiology and Intensive Care
Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
(Licker) Department of Anaesthesiology, Pharmacology and Intensive Care,
Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
(Lin) State Key Laboratory of Oncology of South China, Sun Yat-sen
University Cancer Center, Guangzhou, Guangdong, China
(Scavonetto) Department of Anesthesiology and Anesthesia Clinical Research
Unit, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United
States
(Selmo) Department of Anaesthesia, Azienda Ospedaliera Fondazione Macchi,
Ospedale di Circolo, Varese, Italy
(Severgnini) Department of Biotechnology and Life Sciences, University of
Insubria, Varese, Italy
(Unzueta) Department of Anaesthesiology, Hospital de Sant Pau, Barcelona,
Spain
(Wrigge) Department Anaesthesiology and Intensive Care Medicine,
University of Leipzig, Leipzig, Germany
(de Abreu) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Carl Gustav Carus, Dresden, Germany
(Pelosi) Department of Surgical Sciences and Integrated Diagnostics, IRCCS
San Martino IST, University of Genoa, Genoa, Italy
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Lung injury is a serious complication of surgery. We did a
systematic review and meta-analysis to assess whether incidence,
morbidity, and in-hospital mortality associated with postoperative lung
injury are affected by type of surgery and whether outcomes are dependent
on type of ventilation. <br/>Method(s): We searched MEDLINE, CINAHL, Web
of Science, and Cochrane Central Register of Controlled Trials for
observational studies and randomised controlled trials published up to
April, 2014, comparing lung-protective mechanical ventilation with
conventional mechanical ventilation during abdominal or thoracic surgery
in adults. Individual patients' data were assessed. Attributable mortality
was calculated by subtracting the in-hospital mortality of patients
without postoperative lung injury from that of patients with postoperative
lung injury. <br/>Finding(s): We identified 12 investigations involving
3365 patients. The total incidence of postoperative lung injury was
similar for abdominal and thoracic surgery (3.4% vs 4.3%, p=0.198).
Patients who developed postoperative lung injury were older, had higher
American Society of Anesthesiology scores and prevalence of sepsis or
pneumonia, more frequently had received blood transfusions during surgery,
and received ventilation with higher tidal volumes, lower positive
end-expiratory pressure levels, or both, than patients who did not.
Patients with postoperative lung injury spent longer in intensive care
(8.0 [SD 12.4] vs 1.1 [3.7] days, p<0.0001) and hospital (20.9 [18.1] vs
14.7 [14.3] days, p<0.0001) and had higher in-hospital mortality (20.3% vs
1.4% p<0.0001) than those without injury. Overall attributable mortality
for postoperative lung injury was 19% (95% CI 18-19), and differed
significantly between abdominal and thoracic surgery patients (12.2%, 95%
CI 12.0-12.6 vs 26.5%, 26.2-27.0, p=0.0008). The risk of in-hospital
mortality was independent of ventilation strategy (adjusted HR 0.71, 95%
CI 0.41-1.22). <br/>Interpretation(s): Postoperative lung injury is
associated with increases in in-hospital mortality and durations of stay
in intensive care and hospital. Attributable mortality due to
postoperative lung injury is higher after thoracic surgery than after
abdominal surgery. Lung-protective mechanical ventilation strategies
reduce incidence of postoperative lung injury but does not improve
mortality. <br/>Funding(s): None.<br/>Copyright &#xa9; 2014 Elsevier Ltd.

<5>
Accession Number
364664660
Title
Effect of transendocardial delivery of autologous bone marrow mononuclear
cells on functional capacity, left ventricular function, and perfusion in
chronic heart failure: The FOCUS-CCTRN trial.
Source
JAMA - Journal of the American Medical Association. 307 (16) (pp
1717-1726), 2012. Date of Publication: 25 Apr 2012.
Author
Perin E.C.; Willerson J.T.; Pepine C.J.; Henry T.D.; Ellis S.G.; Zhao
D.X.M.; Silva G.V.; Lai D.; Thomas J.D.; Kronenberg M.W.; Martin A.D.;
Anderson R.D.; Traverse J.H.; Penn M.S.; Anwaruddin S.; Hatzopoulos A.K.;
Gee A.P.; Taylor D.A.; Cogle C.R.; Smith D.; Westbrook L.; Chen J.;
Handberg E.; Olson R.E.; Geither C.; Bowman S.; Francescon J.; Baraniuk
S.; Piller L.B.; Simpson L.M.; Loghin C.; Aguilar D.; Richman S.; Zierold
C.; Bettencourt J.; Sayre S.L.; Vojvodic R.W.; Skarlatos S.I.; Gordon
D.J.; Ebert R.F.; Kwak M.; Moye L.A.; Simari R.D.
Institution
(Perin, Willerson, Silva, Smith, Westbrook, Chen) Texas Heart Institute,
St. Luke's Episcopal Hospital, Houston, TX, United States
(Pepine, Anderson, Cogle, Handberg) School of Medicine, University of
Florida, Gainesville, FL, United States
(Martin) College of Public Health and Health Professions, University of
Florida, Gainesville, FL, United States
(Henry, Traverse, Olson) Minneapolis Heart Institute, Abbott Northwestern
Hospital, Minneapolis, MN, United States
(Henry, Traverse, Taylor, Zierold) School of Medicine, University of
Minnesota, Minneapolis, MN, United States
(Ellis, Thomas, Geither) Cleveland Clinic Foundation, Cleveland, OH,
United States
(Zhao, Kronenberg, Hatzopoulos, Bowman, Francescon) School of Medicine,
Vanderbilt University, Nashville, TN, United States
(Lai, Baraniuk, Piller, Simpson, Bettencourt, Sayre, Vojvodic, Moye)
School of Public Health, University of Texas, Houston, TX, United States
(Loghin) School of Medicine, University of Texas, Houston, TX, United
States
(Penn) Northeast Ohio Medical University, Akron, OH, United States
(Anwaruddin) Penn Heart and Vascular Hospital, University of Pennsylvania,
Philadelphia, PA, United States
(Gee, Aguilar, Richman) College of Medicine, Baylor University, Houston,
TX, United States
(Skarlatos, Gordon, Ebert, Kwak) National Heart, Lung, and Blood
Institute, Bethesda, MD, United States
(Simari) Mayo Clinic, Rochester, MN, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Context: Previous studies using autologous bone marrow mononuclear cells
(BMCs) in patients with ischemic cardiomyopathy have demonstrated safety
and suggested efficacy. <br/>Objective(s): To determine if administration
of BMCs through transendocardial injections improves myocardial perfusion,
reduces left ventricular end-systolic volume (LVESV), or enhances maximal
oxygen consumption in patients with coronary artery disease or LV
dysfunction, and limiting heart failure or angina. Design, Setting, and
Patients: Aphase 2 randomized double-blind, placebo-controlled trial of
symptomatic patients (New York Heart Association classification II-III or
Canadian Cardiovascular Society classification II-IV) with a left
ventricular ejection fraction of 45% or less, a perfusion defect by
single-photon emission tomography (SPECT), and coronary artery
diseasenotam enable to revascularization who were receiving maximal
medical therapy at 5 National Heart, Lung, and Blood Institute-sponsored
Cardiovascular Cell Therapy Research Network (CCTRN) sites between April
29, 2009, and April 18, 2011. <br/>Intervention(s): Bone marrow aspiration
(isolation of BMCs using a standardized automated system performed
locally) and transendocardial injection of 100 million BMCs or placebo
(ratio of 2 for BMC group to 1 for placebo group). <br/>Main Outcome
Measure(s): Co-primary end points assessed at 6 months: changes in LVESV
assessed by echocardiography, maximal oxygen consumption, and
reversibility on SPECT. Phenotypic and functional analyses of the cell
product were performed by the CCTRN biorepository core laboratory.
<br/>Result(s): Of 153 patients who provided consent, a total of 92 (82
men; average age: 63 years) were randomized (n=61 in BMC group and n=31 in
placebo group). Changes in LVESV index (-0.9 mL/m2 [95% CI, -6.1 to 4.3];
P=.73), maximal oxygen consumption (1.0 [95% CI, -0.42 to 2.34]; P=.17),
and reversible defect (-1.2 [95% CI, -12.50 to 10.12]; P=.84) were not
statistically significant. There were no differences found in any of the
secondary outcomes, including percent myocardial defect, total defect
size, fixed defect size, regional wall motion, and clinical improvement.
<br/>Conclusion(s): Among patients with chronic ischemic heart failure,
transendocardial injection of autologous BMCs compared with placebo did
not improve LVESV, maximal oxygen consumption, or reversibility on SPECT.
Trial Registration: clinicaltrials.gov Identifier: NCT00824005. &#xa9;2012
American Medical Association. All rights reserved.

<6>
Accession Number
50878885
Title
Rationale and design of the NAGOYA HEART Study: Comparison between
valsartan and amlodipine regarding morbidity and mortality in patients
with hypertension and glucose intolerance.
Source
Journal of Cardiology. 56 (1) (pp 111-117), 2010. Date of Publication:
July 2010.
Author
Matsushita K.; Muramatsu T.; Kondo T.; Maeda K.; Shintani S.; Murohara T.
Institution
(Matsushita, Muramatsu, Kondo, Maeda, Shintani, Murohara) Department of
Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai,
Showa-ku, Nagoya 466-8550, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Inhibitors of the renin angiotensin system are recommended as
the first-line medications for diabetic hypertensive patients. However,
there is less evidence supporting this recommendation especially among
East Asians, a population with a unique distribution of cardiovascular
disease compared to the Western population. <br/>Methods and Results: The
NAGOYA HEART Study is a prospective randomized open-label blinded-endpoint
study to compare an angiotensin II receptor blocker, valsartan, and a
calcium channel blocker, amlodipine, regarding their efficacies on
cardiovascular morbidity and mortality in Japanese hypertensive patients
with glucose intolerance. Of 1168 eligible patients, we enrolled 1150
patients from October 2004 to January 2009. The participants will be
followed for more than a median follow-up period of 3 years. The primary
composite endpoint includes myocardial infarction, stroke, coronary
revascularization, and admission due to congestive heart failure or sudden
cardiac death. Any of these events are adjudicated by an independent
committee under blinded information regarding the treatment arm. Secondary
endpoints include all-cause mortality, changes in glucose tolerance
status, kidney function, left ventricular structure measured by
echocardiogram, and incident atrial fibrillation/flutter. The study was
registered at ClinicalTrials.gov NCT00129233. <br/>Conclusion(s): The
NAGOYA HEART Study will provide us with a relevant insight for appropriate
treatment of hypertension with glucose intolerance. &#xa9; 2010 Japanese
College of Cardiology.

<7>
Accession Number
2001848810
Title
Meta-analysis of transcatheter aortic valve implantation for bicuspid
versus tricuspid aortic valves.
Source
Journal of Cardiology. 74 (1) (pp 40-48), 2019. Date of Publication: July
2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: We performed meta-analysis and meta-regression of
transcatheter aortic valve implantation (TAVI)for the bicuspid aortic
valve (B-AV)versus the tricuspid aortic valve (T-AV). <br/>Method(s):
MEDLINE and EMBASE were searched through June 2018 using PubMed and OVID.
We included comparative studies of TAVI patients with B-AV versus T-AV
reporting at least one of postprocedural transcatheter valve regurgitation
(TVR)/pacemaker implantation (PMI)incidence and early (30-day or
in-hospital)/late (including early)mortality. For each study, crude
(unadjusted)data regarding TVR/PMI incidence and early/late mortality in
both the B-AV and T-AV groups were used to generate risk ratios (RRs).
Study-specific estimates were combined in the random-effects model. Using
meta-regression, we assessed potential confounders identified in
preliminary meta-analysis. <br/>Result(s): We identified 12 eligible
studies including a total of 1045 B-AV and 4069 T-AV patients. Pooled
analysis demonstrated an association of B-AV with a statistically
significant increase in TVR incidence (RR, 1.42; p = 0.006)but no
statistically significant difference in PMI incidence (p = 0.54)and 30-day
(p = 0.11)/midterm (1-year to 2-year)mortality (p = 0.99)between patients
with B-AV and those with T-AV. All meta-regression coefficients of 6
identified potential confounders (age, mean aortic valve gradient, aortic
valve area, left ventricular ejection fraction, aortic calcification, and
B-AV types)for the outcomes (TVR/PMI incidence and early/late
mortality)were statistically non-significant. <br/>Conclusion(s):
Postprocedural PMI incidence and 30-day/midterm (1-year to
2-year)mortality after TAVI may be similar between patients with B-AV and
those with T-AV despite the significant association of B-AV with increased
postprocedural TVR incidence.<br/>Copyright &#xa9; 2019 Japanese College
of Cardiology

<8>
Accession Number
627239022
Title
Visit-to-Visit Blood Pressure Variability, Coronary Atheroma Progression,
and Clinical Outcomes.
Source
JAMA Cardiology. 4 (5) (pp 437-443), 2019. Date of Publication: May 2019.
Author
Clark D.; Nicholls S.J.; St John J.; Elshazly M.B.; Ahmed H.M.; Khraishah
H.; Nissen S.E.; Puri R.
Institution
(Clark) Division of Cardiology, Department of Medicine, University of
Mississippi Medical Center, Jackson, United States
(Nicholls) Monash Cardiovascular Research Centre, Monash University,
Melbourne, Australia
(St John, Ahmed, Nissen, Puri) Department of Cardiovascular Medicine,
Cleveland Clinic Coordinating Center for Clinical Research, Cleveland
Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States
(Elshazly) Division of Cardiology, Department of Medicine, Weill Cornell
Medical College-Qatar, Education City, Doha, Qatar
(Khraishah) Division of Cardiology, Department of Medicine, Beth Israel
Deaconess Medical Center, Boston, MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Visit-to-visit blood pressure variability (BPV) is associated
with cardiovascular events, but mechanisms and therapeutic implications
underlying this association are not well understood. <br/>Objective(s): To
examine the association of intraindividual BPV, coronary atheroma
progression, and clinical outcomes using serial intravascular
ultrasonography. <br/>Design, Setting, and Participant(s): Post hoc
patient-level analysis of 7 randomized clinical trials conducted from 2004
to 2016 involving 3912 patients in multicenter, international,
clinic-based primary and tertiary care centers. Adult patients with
coronary artery disease who underwent serial intravascular ultrasonography
in the setting of a range of medical therapies were included. Data were
analyzed between November 2017 and March 2019. Exposures: Visit-to-visit
BPV measured using intraindividual standard deviation over 3, 6, 12, 18,
and 24 months. <br/>Main Outcomes and Measures: Percent atheroma volume
(PAV) progression and major adverse cardiovascular events (defined as
death, myocardial infarction, stroke, urgent revascularization for acute
coronary syndrome, and hospitalization for unstable angina).
<br/>Result(s): Of 3912 patients, the mean (SD) age was 58 (9) years, 1093
(28%) were women, and 3633 (93%) were white. Continuous change in PAV was
significantly associated with systolic BPV (beta,049; 95% CI, 0.021-0.078;
P =.001), diastolic BPV (beta,031; 95% CI, 0.002-0.059; P =.03), and pulse
pressure variability (beta,036; 95% CI, 0.006-0.067; P =.02), without a
signal for differential effect greater than or less than a mean BP of
140/90 mm Hg. The PAV progression as a binary outcome was significantly
associated with systolic BPV (odds ratio, 1.09; 95% CI, 1.01-1.17; P =.02)
but not diastolic BPV (odds ratio, 1.04; 95% CI, 0.97-1.11; P =.30) or
pulse pressure variability (odds ratio, 1.03; 95% CI, 0.96-1.10; P =.47).
Survival curves revealed a significant stepwise association between
cumulative major adverse cardiovascular events and increasing quartiles of
systolic BPV (Kaplan-Meier estimates for quartiles 1-4: 6.1% vs 8.5% vs
10.1% vs 12.0%, respectively; log-rank P <.001). These distinct stepwise
associations were not seen with diastolic BPV or pulse pressure
variability. <br/>Conclusions and Relevance: Greater BPV, particularly
systolic BPV, is significantly associated with coronary atheroma
progression and adverse clinical outcomes. These data suggest maintaining
stable blood pressure levels may be important to further improve outcomes
in patients with coronary disease..<br/>Copyright &#xa9; 2019 American
Medical Association. All rights reserved.

<9>
Accession Number
626537657
Title
Percutaneous closure of the patent ductus arteriosus: opportunities moving
forward.
Source
Congenital Heart Disease. 14 (1) (pp 95-99), 2019. Date of Publication:
January/Februaryy 2019.
Author
Mitchell C.C.; Rivera B.K.; Cooper J.N.; Smith C.V.; Berman D.P.;
Slaughter J.L.; Backes C.H.
Institution
(Mitchell, Rivera, Slaughter, Backes) Center for Perinatal Research, The
Research Institute at Nationwide Children's Hospital, Columbus, OH, United
States
(Cooper) Center for Surgical Outcomes Research, The Research Institute at
Nationwide Children's Hospital, Columbus, OH, United States
(Smith) Center for Integrated Brain Research, Seattle Children's Research
Institute, University of Washington School of Medicine, Seattle, WA,
United States
(Cooper, Berman, Slaughter, Backes) Department of Pediatrics, The Ohio
State University Wexner Medical Center, Columbus, OH, United States
(Berman, Backes) The Heart Center at Nationwide Children's Hospital,
Columbus, OH, United States
Publisher
Blackwell Publishing Ltd
Abstract
The optimal treatment method for infants with a patent ductus arteriosus
(PDA) necessitating closure remains a subject of controversy and debate.
While the risks associated with surgical PDA ligation are well described,
the available evidence base for alternative management strategies during
infancy, including percutaneous closure or conservative (nonintervention)
management, are not well explored. Among infants, the goals of this review
are to: (a) use rigorous systematic review methodology to assess the
quality and quantity of published reports on percutaneous closure vs
surgical ligation; (b) compare outcomes of percutaneous closure vs
conservative management; and (c) based on recommendations from the
International PDA symposium, to elucidate needs and opportunities for
future research and interdisciplinary collaboration. The available
evidence base, as well as on broad consensus reached at the International
PDA Symposium, suggests that a contemporary, pragmatic clinical trial
comparing PDA treatment strategies is warranted. Additionally, quality
assurance safeguards are necessary in the implementation of newer PDA
closure devices. Finally, to determine best approaches to treatment for
infants with PDA, tools for consistent data collection and reporting
across centers and disciplines are needed to minimize heterogeneity and
permit pooled analysis.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<10>
Accession Number
627732183
Title
Comparison of the effect of different degrees of passive leg raising on
the internal jugular vein cross-sectional area in patients before thoracic
surgery.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 78. Date
of Publication: 17 May 2019.
Author
Xie S.; Yu Q.; Li T.; Xu M.; Wu J.; Li Y.
Institution
(Xie, Yu, Li, Xu, Wu) Department of Anesthesiology, Shanghai Chest
Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West,
Shanghai, China
(Li) Department of Industrial Engineering and Management, School of
Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: This study investigated the effect of different degrees of
passive leg raising (PLR) on the internal jugular vein (IJV)
cross-sectional area (CSA) and on the success rate of IJV cannulation in
patients waiting for thoracic surgery, to analyze whether body mass index
(BMI), gender, age, fasting time and preoperative rehydration have any
impact on changes in the IJV CSA. <br/>Method(s): Eighty-two patients
scheduled for selective thoracic surgery were enrolled in this study.
Patients were randomly assigned based on a computer-generated
randomization sequence into 3 groups: 0, 30, and 50 degrees (n = 32, 25,
and 25 patients, respectively). The right IJV CSA in the sequence of
0-degree (supine position), 30-degree and 50-degree PLR positions was
recorded in all patients using an ultrasound probe. The relationship of
BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA
was analyzed. Then, each patient was returned to a supine position. After
waiting for at least 5 min, patients were placed in a PLR position at 0,
30, or 50 degrees, and then IJV cannulation was performed without
ultrasound guidance. The success rate of IJV catheterization at different
PLR angles was compared. <br/>Result(s): The average CSA of the right IJV
in the supine position, 30-degree PLR position and 50-degree PLR position
was 1.39 +/- 0.63 cm², 1.65 +/- 0.73 cm², and 1.68
+/- 0.71 cm², respectively. These results showed gradual
increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree
PLR) when compared to that in the supine position (P = 0.045 and 0.025,
respectively). However, only fasting time had a significant impact on the
increase in the right IJV CSA at different PLR angles (P = 0.026). Other
factors, such as BMI, gender, age and preoperative rehydration, had no
significant effects. The success rates of IJV catheterization at angles of
0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there
were no significant differences among the three groups (P = 0.674).
<br/>Conclusion(s): PLR increases the CSA of the right IJV, especially for
patients with long fasting times before thoracic surgery. The effect of
the 30-degree PLR position is similar to that of the 50-degree PLR
position. However, the success rate of right IJV catheterization was not
enhanced in this study using landmark-guided puncture, even though the CSA
of the right IJV was increased.<br/>Copyright &#xa9; 2019 The Author(s).

<11>
Accession Number
627732050
Title
Dexmedetomidine and sufentanil combination versus sufentanil alone for
postoperative intravenous patient-controlled analgesia: A systematic
review and meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 81. Date
of Publication: 18 May 2019.
Author
Feng M.; Chen X.; Liu T.; Zhang C.; Wan L.; Yao W.
Institution
(Feng, Chen, Liu, Zhang, Wan, Yao) Department of Anesthesiology, Tongji
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430030, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Previous studies have demonstrated that dexmedetomidine
improves the quality of postoperative analgesia. In the present study, we
performed a meta-analysis of randomized controlled trials to quantify the
effect of dexmedetomidine as an adjuvant to sufentanil for postoperative
patient-controlled analgesia (PCA). <br/>Method(s): PubMed, Embase, the
Cochrane Library, and Web of Science were systematically searched for
randomized controlled trials in which dexmedetomidine was used as an
adjuvant for PCA with sufentanil. In the retrieved studies, we
quantitatively analyzed pain intensity, sufentanil consumption, and
drug-related side effects. <br/>Result(s): Nine studies with 907 patients
were included in this meta-analysis. Compared with sufentanil alone,
dexmedetomidine-sufentanil for postoperative intravenous PCA reduced pain
intensity at 24 h (mean difference (MD) =-0.70points; 95% confidence
interval (CI):-1.01,-0.39; P < 0.00001) and 48 h postoperatively (MD
=-0.61points; 95% CI:-1.00,-0.22; P = 0.002). Moreover,
dexmedetomidine-sufentanil reduced sufentanil consumption during the first
24 h (MD =-13.77 mug; 95% CI:-18.56,-8.97; P < 0.00001) and 48 h
postoperatively (MD =-20.81 mug; 95% CI:-28.20,-13.42; P < 0.00001).
Finally, dexmedetomidine-sufentanil improved patient satisfaction without
increasing the incidence of side effects. <br/>Conclusion(s):
Dexmedetomidine as an adjuvant to sufentanil for postoperative PCA can
reduce postoperative pain score and sufentanil consumption.<br/>Copyright
&#xa9; 2019 The Author(s).

<12>
Accession Number
627725704
Title
PREhabilitation for improving QUality of recovery after ELective cardiac
surgery (PREQUEL) study: Protocol of a randomised controlled trial.
Source
BMJ Open. 9 (5) (no pagination), 2019. Article Number: e027974. Date of
Publication: 01 May 2019.
Author
Yau D.K.W.; Wong M.K.H.; Wong W.-T.; Gin T.; Underwood M.J.; Joynt G.M.;
Lee A.
Institution
(Yau, Wong, Gin, Joynt, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
(Wong) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, Shatin, New Territories, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Frailty is a multidimensional syndrome in which multiple
small physiological deficits accumulate gradually, resulting in a loss of
physiological reserve and adaptability, putting a patient that is exposed
to a stressor at a higher risk of adverse outcomes. Both pre-frailty and
frailty are associated with poor patient outcomes and higher healthcare
costs. The effect of a prehabilitation programme and standard care on the
quality of recovery in pre-frail and frail patients undergoing elective
cardiac surgery will be compared. Method and analysis A single-centre,
superiority, stratified randomised controlled trial with a blinded outcome
assessment and intention-to-treat analysis. Pre-frail and frail patients
awaiting elective coronary artery bypass graft, with or without valvular
repair/replacement, will be recruited. 164 participants will be randomly
assigned to either prehabilitation (intervention) or standard care (no
intervention) groups. The prehabilitation group will attend two
sessions/week of structured exercise (aerobic and resistance) training,
supervised by a physiotherapist, for 6-10 weeks before surgery with early
health promotion advice in addition to standard care. The standard care
group will receive the usual routine care (no prehabilitation). Frailty
will be assessed at baseline, hospital admission and at 1 and 3 months
after surgery. The primary outcomes will be participants' perceived
quality of recovery (15-item Quality of Recovery questionnaire) after
surgery (day 3), days at home within 30 days of surgery and the changes in
WHO Disability Assessment Schedule 2.0 score between baseline and at 1 and
3 months after surgery. Secondary outcomes will include major adverse
cardiac and cerebrovascular events, psychological distress levels,
health-related quality of life and healthcare costs. Ethics and
dissemination The Joint CUHK-NTEC Clinical Research Ethics Committee
approved the study protocol (CREC Ref. No. 2017.696 T). The findings will
be presented at scientific meetings, in peer-reviewed journals and to
study participants. Trial registration number ChiCTR1800016098;
Pre-results.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2018.

<13>
Accession Number
625445765
Title
Daytime variation of perioperative myocardial injury in non-cardiac
surgery and effect on outcome.
Source
Heart. 105 (11) (pp 826-833), 2019. Date of Publication: 01 Jun 2019.
Author
Du Fay De Lavallaz J.; Puelacher C.; Lurati Buse G.; Bolliger D.;
Germanier D.; Hidvegi R.; Walter J.E.; Twerenbold R.; Strebel I.;
Badertscher P.; Sazgary L.; Lampart A.; Espinola J.; Kindler C.;
Hammerer-Lercher A.; Thambipillai S.; Guerke L.; Rentsch K.; Buser A.;
Gualandro D.; Jakob M.; Mueller C.
Institution
(Du Fay De Lavallaz, Puelacher, Germanier, Hidvegi, Walter, Twerenbold,
Strebel, Badertscher, Sazgary, Thambipillai, Gualandro, Mueller)
Cardiovascular Research Institute Basel (CRIB) and Department of
Cardiology, University Hospital Basel, Basel, Switzerland
(Du Fay De Lavallaz, Puelacher, Germanier, Hidvegi, Walter, Sazgary)
Department of Internal Medicine, University Hospital Basel, University of
Basel, Basel, Switzerland
(Lurati Buse) Department of Anaesthesia, University Hospital Dusseldorf,
Dusseldorf, Germany
(Bolliger, Hidvegi, Lampart) Department of Anaesthesia, University
Hospital Basel, Basel, Switzerland
(Espinola, Kindler) Kantonsspital Aarau, Department of Anaesthesia, Aarau,
Switzerland
(Hammerer-Lercher) Department of Laboratory Medicine, Kantonsspital Aarau,
Aarau, Switzerland
(Guerke) Department of Vascular Surgery, University Hospital Basel,
University of Basel, Basel, Switzerland
(Rentsch) Department of Laboratory Medicine, University Hospital Basel,
University of Basel, Basel, Switzerland
(Buser) Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
(Buser) Department of Hematology, University Hospital Basel, University of
Basel, Basel, Switzerland, Switzerland
(Gualandro) Department of Cardiology, Instituto di Coracao, University of
Sao Paulo, Sao Paulo, Brazil, Brazil
(Jakob) Department of Traumatology and Orthopedics, Cardiovascular
Research Institute Basel (CRIB) and Department of Cardiology, University
Hospital Basel, University of Basel, Basel, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Recently, daytime variation in perioperative myocardial injury
(PMI) has been observed in patients undergoing cardiac surgery. We aim at
investigating whether daytime variation also occurs in patients undergoing
non-cardiac surgery. Methods In a prospective diagnostic study, we
evaluated the presence of daytime variation in PMI in patients at
increased cardiovascular risk undergoing non-cardiac surgery, as well as
its possible impact on the incidence of acute myocardial infarction (AMI),
and death during 1-year follow-up in a propensity score-matched cohort.
PMI was defined as an absolute increase in high-sensitivity cardiac
troponin T (hs-cTnT) concentration of >=14 ng/L from preoperative to
postoperative measurements. Results Of 1641 patients, propensity score
matching defined 630 with similar baseline characteristics, half
undergoing non-cardiac surgery in the morning (starting from 8:00 to
11:00) and half in the afternoon (starting from 14:00 to 17:00). There was
no difference in PMI incidence between both groups (morning: 50, 15.8%
(95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9),
p=0.94), nor if analysing hs-cTnT release as a quantitative variable
(median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon
group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the
incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries
versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected
HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p
log-rank=0.03), whereas no difference in mortality emerged (p=0.70).
Conclusions Although there is no daytime variation in PMI in patients
undergoing non-cardiac surgery, the incidence of AMI during follow-up is
increased in afternoon surgeries and requires further study. Clinical
trial registration NCT02573532;Results.<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<14>
[Use Link to view the full text]
Accession Number
627723424
Title
Prevention of low cardiac output syndrome after pediatric cardiac surgery:
A double-blind randomized clinical pilot study comparing dobutamine and
milrinone.
Source
Pediatric Critical Care Medicine. 19 (7) (pp 619-625), 2018. Date of
Publication: 2018.
Author
Cavigelli-Brunner A.; Hug M.I.; Dave H.; Baenziger O.; Buerki C.; Bettex
D.; Cannizzaro V.; Balmer C.
Institution
(Cavigelli-Brunner, Balmer) Department of Paediatric Cardiology,
University Children's Hospital Zurich, Zurich, Switzerland
(Cavigelli-Brunner, Hug, Dave, Baenziger, Buerki, Cannizzaro, Balmer)
Children's Research Centre, University Children's Hospital Zurich, Zurich,
Switzerland
(Hug, Baenziger, Cannizzaro) Department of Intensive Care Medicine and
Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
(Dave) Department of Congenital Cardiovascular Surgery, University
Children's Hospital Zurich, Zurich, Switzerland
(Buerki) Department of Anaesthesia, University Children's Hospital Zurich,
Zurich, Switzerland
(Bettex) Department of Anaesthesiology, University Hospital Zurich,
Zurich, Switzerland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Dobutamine and milrinone are commonly used after open-heart
surgery to prevent or treat low cardiac output syndrome. We sought to
compare efficacy and safety of these drugs in pediatric patients.
<br/>Design(s): Prospective, single-center, double-blinded, randomized
clinical pilot study. <br/>Setting(s): Tertiary-care university children's
hospital postoperative pediatric cardiac ICU. <br/>Patient(s): After
written consent, 50 consecutive patients (age, 0.2-14.2 yr; median, 1.2
yr) undergoing open-heart surgery for congenital malformations were
included. <br/>Intervention(s): After cardiopulmonary bypass, a continuous
infusion of either dobutamine or milrinone was administered for the first
36 postoperative hours. Maximum dose: dobutamine 6 micro&#32;g/kg/min,
milrinone 0.75 micro&#32;g/kg/min. <br/>Measurements and Main Results:
There were no significant differences in demographic data, complexity of
surgery, and intraoperative characteristics between the two study groups
(dobutamine vs milrinone). Efficacy was defined as need for additional
vasoactive support, which did not differ between groups (dobutamine 61% vs
milrinone 67%; p = 0.71). Sodium nitroprusside was used more often in the
dobutamine group (42% vs 13%; p = 0.019). Systolic blood pressure showed a
trend toward higher values in the dobutamine group, whereas both drugs
increased heart rate early postoperatively. Echocardiography demonstrated
a consistently good cardiac function in both groups. Central venous oxygen
saturation, serum lactate levels, urine output, time to chest tube
removal, length of mechanical ventilation, ICU, and hospital stay were
similar in both groups. Both drugs were well tolerated, no serious adverse
events occurred. <br/>Conclusion(s): Dobutamine and milrinone are safe,
well tolerated, and equally effective in prevention of low cardiac output
syndrome after pediatric cardiac surgery. The hemodynamic response of the
two drugs is comparable. In uncomplicated cases, a trend toward the more
cost-saving dobutamine might be anticipated; however, milrinone
demonstrated a trend toward higher efficacy in afterload
reduction.<br/>Copyright &#xa9; 2018 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.

<15>
Accession Number
623656274
Title
De novo NAD⁺ biosynthetic impairment in acute kidney injury in
humans.
Source
Nature Medicine. 24 (9) (pp 1351-1359), 2018. Date of Publication: 01 Sep
2018.
Author
Poyan Mehr A.; Tran M.T.; Ralto K.M.; Leaf D.E.; Washco V.; Messmer J.;
Lerner A.; Kher A.; Kim S.H.; Khoury C.C.; Herzig S.J.; Trovato M.E.;
Simon-Tillaux N.; Lynch M.R.; Thadhani R.I.; Clish C.B.; Khabbaz K.R.;
Rhee E.P.; Waikar S.S.; Berg A.H.; Parikh S.M.
Institution
(Poyan Mehr, Tran, Ralto, Washco, Messmer, Kher, Kim, Simon-Tillaux,
Lynch, Parikh) Division of Nephrology and Department of Medicine, Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
United States
(Ralto) Division of Pulmonary and Critical Care and Department of
Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA, United States
(Ralto) Division of Pulmonary and Critical Care, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, United States
(Leaf, Waikar) Division of Renal Medicine and Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
United States
(Lerner) Department of Anesthesia and Critical Care, Beth Israel Deaconess
Medical Center and Harvard Medical School, Boston, MA, United States
(Khoury, Thadhani, Rhee) Division of Nephrology and Department of
Medicine, Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
(Herzig) Division of General Medicine and Primary Care Medicine and
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard
Medical School, Boston, MA, United States
(Trovato, Khabbaz) Cardiovascular Institute and Department of Surgery,
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston,
MA, United States
(Clish, Rhee) Broad Institute of Harvard and MIT, Cambridge, MA, United
States
(Rhee) Endocrine Unit and Department of Medicine, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, United States
(Berg) Division of Clinical Chemistry and Department of Pathology, Beth
Israel Deaconess Medical Center and Harvard Medical School, Boston, MA,
United States
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Nicotinamide adenine dinucleotide (NAD⁺) extends longevity in
experimental organisms, raising interest in its impact on human health. De
novo NAD⁺ biosynthesis from tryptophan is evolutionarily
conserved yet considered supplanted among higher species by biosynthesis
from nicotinamide (NAM). Here we show that a bottleneck enzyme in de novo
biosynthesis, quinolinate phosphoribosyltransferase (QPRT), defends renal
NAD⁺ and mediates resistance to acute kidney injury (AKI).
Following murine AKI, renal NAD⁺ fell, quinolinate rose, and
QPRT declined. QPRT^+/- mice exhibited higher quinolinate, lower
NAD⁺, and higher AKI susceptibility. Metabolomics suggested an
elevated urinary quinolinate/tryptophan ratio (uQ/T) as an indicator of
reduced QPRT. Elevated uQ/T predicted AKI and other adverse outcomes in
critically ill patients. A phase 1 placebo-controlled study of oral NAM
demonstrated a dose-related increase in circulating NAD⁺
metabolites. NAM was well tolerated and was associated with less AKI.
Therefore, impaired NAD⁺ biosynthesis may be a feature of
high-risk hospitalizations for which NAD⁺ augmentation could be
beneficial.<br/>Copyright &#xa9; 2018, The Author(s).

<16>
Accession Number
2002013512
Title
Effects of Icosapent Ethyl on Total Ischemic Events: From REDUCE-IT.
Source
Journal of the American College of Cardiology. 73 (22) (pp 2791-2802),
2019. Date of Publication: 11 June 2019.
Author
Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Gregson J.; Pocock S.J.; Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), an F-CRIN
network, Departement Hospitalo-Universitaire FIRE, AP-HP, hopital Bichat,
Universite Paris-Diderot, INSERM U-1148, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, MD, United States
(Brinton) Utah Lipid Center, Salt Lake City, UT, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, Georgia
(Ketchum, Doyle, Juliano, Jiao, Granowitz) Amarin Pharma, Inc. (Amarin),
Bedminster, NJ, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal,
Quebec, Canada
(Gregson, Pocock) Department of Medical Statistics, London School of
Hygiene & Tropical Medicine, London, United Kingdom
(Ballantyne) Department of Medicine, Baylor College of Medicine; Center
for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
Publisher
Elsevier USA
Abstract
Background: In time-to-first-event analyses, icosapent ethyl significantly
reduced the risk of ischemic events, including cardiovascular death, among
patients with elevated triglycerides receiving statins. These patients are
at risk for not only first but also subsequent ischemic events.
<br/>Objective(s): Pre-specified analyses determined the extent to which
icosapent ethyl reduced total ischemic events. <br/>Method(s): REDUCE-IT
(Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention
Trial)randomized 8,179 statin-treated patients with triglycerides >=135
and <500 mg/dl (median baseline of 216 mg/dl)and low-density lipoprotein
cholesterol >40 and <=100 mg/dl (median baseline of 75 mg/dl), and a
history of atherosclerosis (71% patients)or diabetes (29% patients)to
icosapent ethyl 4 g/day or placebo. The main outcomes were total (first
and subsequent)primary composite endpoint events (cardiovascular death,
nonfatal myocardial infarction, nonfatal stroke, coronary
revascularization, or hospitalization for unstable angina)and total key
secondary composite endpoint events (cardiovascular death, nonfatal
myocardial infarction, or nonfatal stroke). As a pre-specified statistical
method, we determined differences in total events using negative binomial
regression. We also determined differences in total events using other
statistical models, including Andersen-Gill, Wei-Lin-Weissfeld (Li and
Lagakos modification), both pre-specified, and a post hoc joint frailty
analysis. <br/>Result(s): In 8,179 patients, followed for a median of 4.9
years, 1,606 (55.2%)first primary endpoint events and 1,303
(44.8%)subsequent primary endpoint events occurred (which included 762
second events, and 541 third or more events). Overall, icosapent ethyl
reduced total primary endpoint events (61 vs. 89 per 1,000 patient-years
for icosapent ethyl versus placebo, respectively; rate ratio: 0.70; 95%
confidence interval: 0.62 to 0.78; p < 0.0001). Icosapent ethyl also
reduced totals for each component of the primary composite endpoint, as
well as the total key secondary endpoint events (32 vs. 44 per 1,000
patient-years for icosapent ethyl versus placebo, respectively; rate
ratio: 0.72; 95% confidence interval: 0.63 to 0.82; p < 0.0001).
<br/>Conclusion(s): Among statin-treated patients with elevated
triglycerides and cardiovascular disease or diabetes, multiple statistical
models demonstrate that icosapent ethyl substantially reduces the burden
of first, subsequent, and total ischemic events. (Reduction of
Cardiovascular Events With Icosapent Ethyl-Intervention Trial [REDUCE-IT];
NCT01492361)<br/>Copyright &#xa9; 2019 The Authors

<17>
Accession Number
627799631
Title
Clinical and cost-effectiveness of the Ross procedure versus conventional
aortic valve replacement in young adults.
Source
Open Heart. 6 (1) (no pagination), 2019. Article Number: e001047. Date of
Publication: 01 May 2019.
Author
Thom H.; Visan A.C.C.; Keeney E.; Dorobantu D.M.; Fudulu D.; Sharabiani
M.T.A.; Round J.; Stoica S.C.
Institution
(Thom, Keeney) Bristol Medical School: Population Health Sciences,
University of Bristol, Bristol, United Kingdom
(Visan, Fudulu, Stoica) Cardiothoracic Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Visan) Department of Cardiothoracic Surgery, University Hospital
Southampton, Southampton, United Kingdom
(Dorobantu) Cardiac Surgery, Bristol Royal Hospital for Children, Bristol,
United Kingdom
(Dorobantu) Cardiology, Institutul de Urgenta pentru Boli Cardiovasculare
Prof Dr C C Iliescu, Bucuresti, Romania
(Sharabiani) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Round) Institute of Health Economics, Edmonton, AB, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives In young and middle-aged adults, there are three current
options for aortic valve replacement (AVR), namely mechanical AVR
(mechAVR), tissue AVR (biological AVR) and the Ross operation, with no
clear guidance on the best option. We aim to compare the clinical
effectiveness and cost-effectiveness of the Ross procedure with
conventional AVR in young and middle-aged adults. Methods This is a
systematic literature review and meta-analysis of AVR options. Markov
multistate model was adopted to compare cost-effectiveness. Lifetime
costs, quality-adjusted life years (QALYs), net monetary benefit (NMB),
population expected value of perfect information (EVPI) and expected value
of partial perfect information were estimated. Results We identified 48
cohorts with a total number of 12 975 patients (mean age 44.5 years, mean
follow-up 7.1 years). Mortality, bleeding and thromboembolic events over
the follow-up period were lowest after the Ross operation, compared with
mechAVR and biological AVR (p<0.001). Aortic reoperation rates were lower
after Ross compared with biological AVR, but slightly higher when compared
with mechAVR (p<0.001). At a willingness-to-pay threshold of 20effective.
At a willingness-to-pay threshold of 20, 000 per QALY000 per QALY, the
Ross procedure is more cost-effective compared the Ross procedure is more
cost-effective compared withwith conventional AVR, with a lifetime
incremental NMB of 60 conventional AVR, with a lifetime incremental NMB of
60 952 (952 (3030 236236 to to 7979 464). Incremental costs were 12464).
Incremental costs were 12 323 (323 (61086108 to to 1515 972) and
incremental QALYs 3.66 (1.81972) and incremental QALYs 3.66 (1.81 to to
4.76). The population EVPI indicates that a trial costing up to 2.03
million could be cost 4.76). The population EVPI indicates that a trial
costing up to 2.03 million could be cost - effective. At a
willingness-to-pay threshold of 20 000 per QALY, the Ross procedure is
more cost-effective compared with conventional AVR, with a lifetime
incremental NMB of 60 952 (30 236 to 79 464). Incremental costs were 12
323 (6108 to 15 972) and incremental QALYs 3.66 (1.81 to 4.76). The
population EVPI indicates that a trial costing up to 2.03 million could be
cost-effective. Conclusions In young and middle-aged adults with aortic
valve disease, the Ross procedure may confer greater quality of life and
be more cost-effective than conventional AVR. A high-quality randomised
trial could be warranted and cost-effective.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2019.

<18>
Accession Number
2002016982
Title
Meta-Analysis of Outcomes of Transcatheter Aortic Valve Implantation Among
Patients With Low Gradient Severe Aortic Stenosis.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Osman M.; Ghaffar Y.A.; Foster T.; Osman K.; Alqahtani F.; Shah K.; Kheiri
B.; Alkhouli M.
Institution
(Osman, Ghaffar, Foster, Alqahtani, Shah, Alkhouli) Division of
Cardiology, West Virginia University School of Medicine, Morgantown, WV,
United States
(Kheiri) Hurley Medical Center, Michigan State University, Flint, MI,
United States
(Osman) Michigan Health Specialist, Michigan State University, Flint, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an effective
therapy for patients with severe aortic stenosis (AS). However, data on
TAVI outcomes in patients with low gradient (LG) AS are limited. We
performed a meta-analysis of studies comparing TAVI outcomes between
patients with classic high gradient (HG) and LG AS through November 2018.
The 30-day mortality, mid-term all-cause, and cardiovascular mortality at
maximum follow-up were compared between patients with HG and LG AS
(Pairwise meta-analysis), and between the three distinct groups of AS
including HG, paradoxical low-flow low-gradient and low gradient with
reduced ejection fraction (rEF-LG) (Network meta-analysis). Nineteen
studies (n = 27,204 patients) met the inclusion criteria. The HG group had
less 30-day, mid-term all-cause and cardiovascular mortality compared with
the low-gradient AS group overall, (6% vs 7.5%, OR 0.76, 95% CI 0.66 to
0.87, I² = 18%), (21% vs 29%, OR 0.59, 95% CI 0.52 to 0.67,
I² = 62%), and (12.6% vs 18.7%, OR 0.61, 95% CI 0.49 to 0.76,
I² = 62%), respectively, p <0.0001. These outcomes were
confirmed in a trial sequential analysis in which the cumulative Z-curve
crossed the conventional test boundary as well as the trial sequential
monitoring boundary for all outcomes. The network meta-analysis revealed
that patients with rEF-LG had similar outcomes to those with pLFLG, and
both had worse outcomes than patients with classic HG AS. In conclusion
patients with classic HG have better 30-day mortality, mid-term all-cause
and cardiovascular mortality compared with LG patients following TAVI.
Among patients with LG severe AS, TAVI outcomes were similar in patients
with rEF-LG and pLFLG.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<19>
Accession Number
627827955
Title
Exclusion criteria and adverse events in perioperative trials of
tranexamic acid in cardiac surgery: a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Khair S.; Perelman I.; Yates J.; Taylor J.; Lampron J.; Tinmouth A.;
Saidenberg E.
Institution
(Khair, Perelman, Yates, Taylor, Lampron, Tinmouth, Saidenberg) Faculty of
Medicine, University of Ottawa, Ottawa, Canada
(Perelman, Lampron, Tinmouth, Saidenberg) Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, Canada
(Lampron, Tinmouth, Saidenberg) Ottawa Hospital, 501 Smyth Rd, Ottawa, ON
K1H 8L6, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Tranexamic acid (TXA) reduces perioperative blood loss and
transfusion requirement following cardiac surgery. Nevertheless, TXA
remains underutilized because of concerns regarding development of adverse
events. We conducted a systematic review to determine which patients are
commonly excluded from TXA cardiac surgery clinical trials to determine if
there are patient groups lacking safety data on TXA. <br/>Method(s): The
databases Medline, EMBASE, and the Cochrane Central Register of Controlled
Trials were searched until September 2017. Eligible studies were
randomized-controlled trials (RCTs) administering systemic TXA
perioperatively to patients undergoing any cardiac surgery. Our primary
outcome was the exclusion criteria for each RCT, and the secondary
endpoint was TXA safety. A descriptive synthesis was performed to analyze
the exclusion criteria. TXA safety was assessed with meta-analysis.
Principal findings: Seventy eligible RCTs were included. The most common
reasons for excluding patients from TXA cardiac surgery trials were major
hepatic, renal, or cardiac comorbidities (76% of studies). Meta-analysis
showed that TXA did not increase the risk of adverse events compared with
placebo or no intervention (risk ratio, 0.97; 95% confidence interval,
0.88 to 1.07), including thrombosis and seizure. <br/>Conclusion(s): We
found that systemic TXA is safe to use in cardiac surgery. Certain patient
groups are frequently excluded from TXA cardiac surgery trials, and may
consequently have limited efficacy and safety data on TXA. Further
research in these patient groups may be needed; nevertheless, for many
patient populations there are sufficient data to inform evidence-based
guidelines for TXA use in cardiac surgery. Trial registration: PROSPERO
(CRD42017060971); registered 4 April, 2017.<br/>Copyright &#xa9; 2019,
Canadian Anesthesiologists' Society.

<20>
Accession Number
627842795
Title
Female-to-Male Transgender Chest Contouring: A Systematic Review of
Outcomes and Knowledge Gaps.
Source
Annals of plastic surgery. (no pagination), 2019. Date of Publication: 10
May 2019.
Author
Cohen W.A.; Shah N.R.; Iwanicki M.; Therattil P.J.; Keith J.D.
Institution
(Cohen) From the Division of Plastic and Reconstructive Surgery, Rutgers
New Jersey Medical School, Newark, NJ, United States
Publisher
NLM (Medline)
Abstract
PURPOSE: The number of gender affirmation surgeries performed in the
United States is increasing. Frequently, chest contouring is the first
surgery for female-to-male transgender patients; it fosters assimilation
into the new gender role with a desired sense of masculinity. Creating an
aesthetic male chest requires adjustment of breast tissue volume, proper
nipple-areolar complex placement, and abolishment of the inframammary
fold. Although much has been published on various techniques and outcomes,
there is no consensus on how to approach transmale top surgery. We have
reviewed the most up-to-date literature and in so doing have uncovered
significant knowledge gaps. <br/>METHOD(S): An electronic literature
review was performed. PubMed search keywords included combinations of
"female-to-male," "transgender surgery," "chest contour," and
"nipple-areolar complex." Articles were included if the patients were
transgender female to male. <br/>RESULT(S): Our literature search yielded
67 unique articles, 22 of which met our inclusion criteria. A total of
2447 unique patients were analyzed. The articles discussed aspects of
chest surgery in female-to-male transsexuals including mastectomy and
nipple aesthetics. Relevant data trends were extracted and subsequently
investigated. DISCUSSION: Female-to-male transgender patients often
undergo chest contouring as their initial gender affirmation surgery. As
the surgical treatment of gender dysphoria continues to grow, it is
imperative for plastic surgeons to understand the surgical options and
associated outcomes for transmasculine top surgery. Future research is
needed to improve patient selection, surgical decision making, and
patient-reported outcomes for different chest contouring techniques. In
addition, there is a significant knowledge gap for the ideal
nipple-areolar complex shape, size, and location.

<21>
Accession Number
627842586
Title
Revascularization strategies in cardiogenic shock after acute myocardial
infarction.
Source
Current opinion in critical care. (no pagination), 2019. Date of
Publication: 10 May 2019.
Author
Desch S.
Institution
(Desch) Department of Internal Medicine/Cardiology, Heart Center Leipzig
at the University of Leipzig, Leipzig, Germany
(Desch) Deutsches Zentrum fur Herz-Kreislauf-Forschung (DZHK), partner
site Hamburg/Kiel/Lubeck, Lubeck, Germany
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Coronary revascularization compared with medical
treatment alone leads to improved survival in patients with myocardial
infarction (MI) and cardiogenic shock. Percutaneous coronary intervention
(PCI) is the predominant mode of revascularization in clinical practice.
This review discusses several aspects relevant to mechanical
revascularization such as general indication, the roles of PCI and bypass
surgery, percutaneous access site choice, strategy in multivessel disease
and adjunctive antithrombotic therapy. RECENT FINDINGS: The recently
published CULPRIT-SHOCK trial provided the first randomized evidence that
in the vast majority of patients with infarct-related cardiogenic shock
PCI should be confined to the culprit lesion, whereas nonculprit lesions
should not be routinely treated in the emergency setting. Although
randomized data are not available, a primary radial access for PCI is
becoming more popular in the shock population. Cardiac surgery plays an
indispensable, yet quantitatively only minor role in the management of
infarct-related cardiogenic shock. SUMMARY: Coronary revascularization
remains the cornerstone in the early management of patients with acute MI
and cardiogenic shock. In patients with multivessel disease, a strategy of
culprit lesion only PCI is the default approach.

<22>
Accession Number
627842340
Title
Five-year Outcomes in Cardiac Surgery Patients with Atrial Fibrillation
Undergoing Concomitant Surgical Ablation Versus No Ablation. The Long-term
Follow-up of the Prague-12 Study.
Source
Heart rhythm. (no pagination), 2019. Date of Publication: 06 May 2019.
Author
Osmancik P.; Budera P.; Talavera D.; Hlavicka J.; Herman D.; Holy J.;
Cervinka P.; Smid J.; Hanak P.; Hatala R.; Widimsky P.
Institution
(Osmancik, Herman, Widimsky) Cardiocenter, III(rd) internal - cardiology
clinic, Third Faculty of Medicine, Charles University and University
Hospital Kralovske Vinohrady, Prague, Czechia
(Budera, Talavera, Hlavicka) Cardiocenter, Dept. of cardiac surgery, Third
Faculty of Medicine, Charles University and University Hospital Kralovske
Vinohrady, Prague, Czechia
(Holy, Cervinka) Department of Cardiology, Masaryk hospital in Usti nad
Labem, Usti nad Labem, Czechia
(Smid) Cardiology Department, University Hospital and Faculty of Medicine
Pilsen, Pilsen, Czechia
(Hanak, Hatala) Department of arrhythmias and cardiac pacing, National
Institute for Cardiovascular Disease, Bratislava, Slovakia
Publisher
NLM (Medline)
Abstract
BACKGROUND: The long-term effect of concomitant surgical ablation (SA) on
clinical outcomes in unselected population of patients has not been
sufficiently reported in randomized studies. <br/>OBJECTIVE(S): The aim of
this study was to assess clinical outcomes of the SA after 5 years of
follow-up. <br/>METHOD(S): The PRAGUE-12 study was a prospective,
randomized clinical trial assessing cardiac surgery with ablation for AF
vs. cardiac surgery alone. Patients with AF who were also indicated for
cardiac surgery (coronary artery disease (CAD), valve surgery) were
randomized to group SA (surgical ablation) or Controls (control; no
ablation). All patients were followed for 5 years. The primary endpoint
was a composite of cardiovascular (CV) death, stroke, hospitalization for
heart failure (HFH) or severe bleeding. Secondary endpoint was a
recurrence of AF. <br/>RESULT(S): 207 patients were analyzed (group
SA=108, group Controls=99 patients). Both groups were similar relative to
important clinical characteristics except for CAD, which was more common
in the control group. Cumulative incidence curves showed a higher
incidence of the primary endpoint in the control group (p=0.024, Gray's
test). However, after adjusting for all covariables, the difference
between groups was not significant (subhazard ratio (SHR) 0.69
[0.47-1.02], p=0.068). The incidence of stroke and AF recurrences were
significantly reduced in the SA group, and remained significant even after
adjustment for all covariables incl. CAD (stroke: SHR 0.32 [0.12-0.84],
p=0.02, AF recurrences: SHR 0.44 [0.31-0.62], p<0.001).
<br/>CONCLUSION(S): Concomitant SA of AF is associated with a greater
likelihood of maintaining SR and a decreased risk of stroke.<br/>Copyright
&#xa9; 2019. Published by Elsevier Inc.

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

<24>
Accession Number
622978891
Title
Platelet reactivity in overweight and obese patients undergoing cardiac
surgery.
Source
Platelets. 30 (5) (pp 608-614), 2019. Date of Publication: 04 Jul 2019.
Author
Ranucci M.; Aloisio T.; Dedda U.D.; La Rovere M.T.; De Arroyabe B.M.L.;
Baryshnikova E.
Institution
(Ranucci, Aloisio, Dedda, Baryshnikova) Department of
Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico
San Donato, Milan, Italy
(La Rovere) Department of Cardiology, Fondazione Salvatore Maugeri, IRCCS
Istituto Scientifico di Montescano, Montescano, Italy
(De Arroyabe) Cardiac Anesthesia Unit, Department of Emergency Medicine,
University Hospital of Trieste, Trieste, Italy
Publisher
Taylor and Francis Ltd
Abstract
Body mass index (BMI) and specifically overweight and obesity have been
associated with an increased platelet reactivity in different series of
patients. This information is derived by different laboratory platelet
function tests (PFTs) like mean platelet volume (MPV), platelet
microparticles, thromboxane B2 metabolites, and others. Point-of-care PFT,
which are often used in cardiac surgery, are rarely addressed. The present
study aims to verify platelet reactivity using multiple-electrode
aggregometry (MEA) as a function of BMI in cardiac surgery patients.
One-hundred ninety-eight cardiac surgery patients free from the effects of
drugs acting on the P2Y<inf>12</inf> receptor and undergoing cardiac
surgery received MEA-PFT immediately before surgery. Platelet reactivity
was compared between normal weight and overweight-obese subjects. There
were 99 underweight/normal (BMI < 25), 60 overweight (BMI >= 25) and 39
obese (BMI >= 30) patients. Overweight-obese patients did not show higher
platelet counts nor a clear platelet hyper-reactivity, when tested with
MPV and MEA ADP test. At TRAPtest, the overweight/obese patients had a
significantly (P = 0.011) higher platelet reactivity (median 118,
interquartile range 106-136) than controls (median 112, interquartile
range 101-123) and a higher rate of platelet hyper-reactivity (odds ratio
2.19, 95% confidence interval 1.15-4.16, P = 0.016) in a multivariable
model. A minor association was found between the BMI and platelet
reactivity at TRAPtest, with a higher degree of activity for increasing
BMI. The BMI determines an increased thrombin-dependent platelet
reactivity in cardiac surgery patients. Thrombin is extensively formed
during cardiac surgery, and this may explain the lower postoperative
bleeding observed in obese patients in previous studies.<br/>Copyright
&#xa9; 2018, &#xa9; 2018 Taylor & Francis.

<25>
Accession Number
2001511372
Title
Effects of platelet-rich plasmapheresis during cardiovascular surgery: A
meta-analysis of randomized controlled clinical trials.
Source
Journal of Clinical Anesthesia. 56 (pp 88-97), 2019. Date of Publication:
September 2019.
Author
Zhai Q.; Wang Y.; Yuan Z.; Zhang R.; Tian A.
Institution
(Zhai, Wang, Yuan, Tian) Department of Anesthesiology, the First
Affiliated Hospital of China Medical University (CMU), Shenyang, Liaoning,
China
(Zhang) Department of Gerontology and Geriatrics, the First Affiliated
Hospital of China Medical University (CMU), Shenyang, Liaoning, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: This study aimed to explore the effects of platelet-rich
plasmapheresis (PRP) on the amount of postoperative blood loss and the
requirements for allogeneic fresh frozen plasma (FFP) and red blood cell
(RBC) transfusions during cardiovascular surgery. <br/>Method(s): A
literature search of 7 online databases was conducted. Randomized control
trials (RCT) comparing intraoperative PRP or appropriate control groups
were considered suitable for this current study. <br/>Result(s): Fifteen
RCTs enrolling a total of 1002 patients, including 501 patients who
received PRP and 501 control patients. Meta-analysis of the data from
these trials showed that PRP reduced the total volume of postoperative
blood loss (standardized mean difference [SMD], -0.74; 95% confidence
interval [CI], -1.18 to -0.31; P < 0.05), reduced postoperative fresh
frozen plasma (FFP) transfusion (SMD, -0.38; 95%CI, -0.69 to -0.08; P <
0.05), reduced postoperative RBCs transfusion (SMD, -0.44; 95%CI, -0.77 to
-0.10; P < 0.05), and reduced the proportion of patients receiving
postoperative allogeneic RBC transfusions (relative risk [RR], 0.44;
95%CI, 0.21-0.91, P < 0.05) during cardiovascular surgery.
<br/>Conclusion(s): Conducting PRP before cardiopulmonary bypass (CPB) and
transfusing autologous platelet-rich plasma (aPRP) after reversal of
heparin could reduce postoperative blood loss, the requirements for blood
products transfusion during cardiovascular surgery. A higher mean platelet
count in aPRP may improve the final outcome. However, there was a high
degree of undetermined heterogeneity among the analyzed trials, and larger
and more precise RCTs are needed to confirm these
conclusions.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<26>
Accession Number
615879106
Title
Four-wavelength near-infrared peripheral oximetry in cardiac surgery
patients: a comparison between EQUANOX and O3.
Source
Journal of Clinical Monitoring and Computing. 32 (2) (pp 253-259), 2018.
Date of Publication: 01 Apr 2018.
Author
Ferraris A.; Jacquet-Lagreze M.; Fellahi J.-L.
Institution
(Ferraris, Jacquet-Lagreze, Fellahi) Service d'Anesthesie-Reanimation,
Hopital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de
Lyon, 59 Boulevard Pinel, Lyon Cedex 69394, France
(Fellahi) Inserm U 1060, Universite Claude Bernard Lyon 1, Lyon, France
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Near-infrared spectroscopy (NIRS) is a continuous and noninvasive
technology that measures regional tissue oxygen saturation
(rSO<inf>2</inf>). A new 4-wavelength generation of NIRS monitors is now
available. We aimed to compare peripheral somatic rSO<inf>2</inf> values
given by the 4-wavelength EQUANOXTM 7600 device (Nonin Medical Inc.,
Plymouth, Mn) and O3TM device (Masimo Corporation, Irvine, CA). Twenty
adult patients scheduled for conventional elective cardiac surgery with
cardiopulmonary bypass over a 4-month period were included after local
Ethics Committee approval. For each patient, 2 NIRS sensors (EQUANOX and
O3) were placed over the medial part of the forearm. Thirteen couples of
measurements were performed at predefined intraoperative time points. We
compared 260 couples of absolute intraoperative rSO<inf>2</inf> values. No
significant difference was found between both monitors: EQUANOX median
rSO<inf>2</inf> 60% (95% CI 57-62) versus O3 median rSO<inf>2</inf> 62%
(95% CI 61-64), P = 0.103. Bias was 4.0% and limits of agreement were
+/-26.3%. Significant correlations were evidenced between EQUANOX and O3
rSO<inf>2</inf> absolute values: rho = 0.758 (95% CI 0.701-0.806), P
OpenSPiltSPi 0.0001, and rSO<inf>2</inf> percent maximum difference versus
baseline: rho = 0.582 (95% CI 0.188-0.815), P = 0.007. While absolute
values of rSO<inf>2</inf> given by both devices were equivalent and well
correlated, the clinical agreement is probably not acceptable, meaning
that EQUANOX and O3 are not interchangeable in routine
practice.<br/>Copyright &#xa9; 2017, Springer Science+Business Media
Dordrecht.

<27>
Accession Number
626424966
Title
A survey of anaesthetists' use of tranexamic acid in noncardiac surgery.
Source
Anaesthesia and Intensive Care. 47 (1) (pp 76-84), 2019. Date of
Publication: 2019.
Author
Painter T.W.; McIlroy D.; Myles P.S.; Leslie K.
Institution
(Painter) Department of Anaesthesia, Royal Adelaide Hospital, Adelaide,
Australia
(Painter) Discipline of Acute Care Medicine, Adelaide Medical School,
University of Adelaide, Adelaide, Australia
(McIlroy) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, Australia
(McIlroy) Monash University, Melbourne, Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
(Leslie) Royal Melbourne Hospital, Melbourne, Australia
(Leslie) Centre for Integrated Critical Care Medicine, University of
Melbourne, Melbourne, Australia
(Leslie) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Major bleeding in noncardiac surgery is common and associated with serious
complications. The antifibrinolytic agent tranexamic acid (TXA) reduces
bleeding and may reduce the risk of these complications. TXA also may have
immu-nomodulatory effects that could reduce surgical site infection.
Clinical trials of TXA in noncardiac surgery have been insufficiently
powered to evaluate its efficacy and safety. Therefore, large randomised
controlled trials of its use in noncardiac surgery are required. To ensure
that future clinical trials are feasible and acceptable, we undertook a
survey of Fellows of the Australian and New Zealand College of
Anaesthetists (ANZCA). Our aims were to ascertain current patterns of TXA
administration and to assess the acceptability of randomising patients to
intravenous TXA or placebo. A 12-item survey was electronically mailed to
1001 ANZCA Fellows. Two hundred and eighty nine responses were received
and analysed (response rate 29%). Ninety-eight percent of respondents had
used intravenous TXA in noncardiac surgery; 67% give TXA routinely for
lower limb arthroplasty, with smaller proportions giving TXA for spinal
surgery (40%) and other major orthopaedic surgery (28%). Almost half (49%)
give TXA routinely for major trauma surgery. Thirty-six percent indicated
that they did not give TXA for major vascular, abdominal, pelvic or
thoracic surgery. The majority administered TXA as a single, fixed dose.
Fifty-seven percent agreed that there is uncertainty about the relative
risks and benefits of perioperative TXA in noncardiac surgery and 87%
agreed that large definitive trials determining the safety and efficacy of
perioperative TXA in noncardiac surgery are required. These results
indicate that for ANZCA Fellows the use of TXA in noncardiac surgery is
highly variable, that there is uncertainty about the safety and efficacy
of TXA, and that a large trial would be acceptable.<br/>Copyright &#xa9;
The Author(s) 2019.

<28>
Accession Number
2001863154
Title
What Is the Potential of Tissue-Engineered Pulmonary Valves in Children?.
Source
Annals of Thoracic Surgery. 107 (6) (pp 1845-1853), 2019. Date of
Publication: June 2019.
Author
Huygens S.A.; Rutten-van Molken M.P.M.H.; Noruzi A.; Etnel J.R.G.; Corro
Ramos I.; Bouten C.V.C.; Kluin J.; Takkenberg J.J.M.
Institution
(Huygens, Noruzi, Etnel, Takkenberg) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Huygens, Rutten-van Molken) Erasmus School of Health Policy and
Management, Erasmus University, Rotterdam, Netherlands
(Huygens, Rutten-van Molken, Corro Ramos) Institute for Medical Technology
Assessment, Erasmus University, Rotterdam, Netherlands
(Bouten) Department of Biomedical Engineering, Eindhoven University of
Technology, Eindhoven, Netherlands
(Kluin) Department of Cardio-Thoracic Surgery, Academic Medical Centre,
Amsterdam, Netherlands
Publisher
Elsevier USA
Abstract
Background: As a living heart valve substitute with growth potential and
improved durability, tissue-engineered heart valves (TEHVs) may prevent
reinterventions that are currently often needed in children with
congenital heart disease. We performed early health technology assessment
to assess the potential cost-effectiveness of TEHVs in children requiring
right ventricular outflow tract reconstruction (RVOTR). <br/>Method(s): A
systematic review and meta-analysis was conducted of studies reporting
clinical outcome after RVOTR with existing heart valve substitutes in
children (mean age <=12 years or maximum age <=21 years) published between
January 1, 2000, and May 2, 2018. Using a patient-level simulation model,
costs and effects of RVOTR with TEHVs compared with existing heart valve
substitutes were assessed from a health care perspective applying a
10-year time horizon. Improvements in performance of TEHVs, divided in
durability, thrombogenicity, and infection resistance, were explored to
estimate quality-adjusted life year (QALY) gain, cost reduction, headroom,
and budget impact associated with TEHVs. <br/>Result(s): Five-year freedom
from reintervention after RVOTR with existing heart valve substitutes was
46.1% in patients less than or equal to 2 years of age and 81.1% in
patients greater than 2 years of age. Improvements in durability had the
highest impact on QALYs and costs. In the improved TEHV performance
scenario (durability >=5 years and -50% other valve-related events), QALY
gain was 0.074 and cost reduction was 10,378 per patient, translating to
maximum additional costs of 11,856 per TEHV compared with existing heart
valve substitutes. <br/>Conclusion(s): This study showed that there is
room for improvement in clinical outcomes in children requiring RVOTR. If
TEHVs result in improved clinical outcomes, they are expected to be
cost-effective compared with existing heart valve
substitutes.<br/>Copyright &#xa9; 2019 The Society of Thoracic Surgeons

<29>
Accession Number
2001422044
Title
A systematic review of infected descending thoracic aortic grafts and
endografts.
Source
Journal of Vascular Surgery. 69 (6) (pp 1941-1951.e1), 2019. Date of
Publication: June 2019.
Author
Kahlberg A.; Grandi A.; Loschi D.; Vermassen F.; Moreels N.; Chakfe N.;
Melissano G.; Chiesa R.
Institution
(Kahlberg, Grandi, Loschi, Melissano, Chiesa) Department of Vascular
Surgery, Vita-Salute University School of Medicine, San Raffaele
Scientific Institute, Milan, Italy
(Vermassen, Moreels) Department of Vascular and Thoracic Surgery, Ghent
University Hospital, Ghent, Belgium
(Chakfe) Department of Vascular Surgery and Kidney Transplantation,
University Hospital of Strasbourg, Strasbourg, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The objective of this study was to collect and critically
analyze the current evidence on the modalities and results of treatment of
descending thoracic aortic surgical graft (SG) and endograft (EG)
infection, which represents a rare but dramatic complication after both
surgical and endovascular aortic repair. <br/>Method(s): A comprehensive
electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar,
and the Cochrane Library) identified all articles that were published up
to October 2017 reporting on thoracic aortic SG or EG infection.
Observational studies, multicenter reports, single-center series and case
reports, case-control studies, and guidelines were considered eligible if
reporting specific results of treatment of descending thoracic aortic SG
or EG infection. Comparisons of patients presenting with SG or EG
infection and between invasive and conservative treatment were performed.
Odds ratio (OR) meta-analyses were run when comparative data were
available. <br/>Result(s): Forty-three studies reporting on 233 patients
with infected SG (49) or EG (184) were included. Four were multicenter
studies including 107 patients, all with EG infection, associated with a
fistula in 91% of cases, with a reported overall survival at 2 years of
16% to 39%. The remaining 39 single-center studies included 49 patients
with SG infection and 77 with EG infection. Association with
aortoesophageal fistula was significantly more common with EG (60% vs 31%;
P = .01). In addition, time interval from index procedure to infection was
significantly shorter with EG (17 +/- 21 months vs 32 +/- 61 months; P =
.03). Meta-analysis showed a trend of increased 1-year mortality in
patients with SG infection compared with EG infection (pooled OR, 3.6; 95%
confidence interval, 0.9-14.7; P = .073). Surgical management with
infected graft explantation was associated with a trend toward lower
1-year mortality compared with graft preservation (pooled OR, 0.3; 95%
confidence interval, 0.1-1.0; P = .056). <br/>Conclusion(s): Thoracic
aortic EG infection is likely to occur more frequently in association with
aortoesophageal fistulas and in a shorter time compared with SG infection.
Survival is poor in both groups, especially in patients with SG infection.
Surgical treatment with graft explantation seems to be the preferable
choice in fit patients.<br/>Copyright &#xa9; 2018 Society for Vascular
Surgery

<30>
Accession Number
620198489
Title
Letter regarding "Meta-analysis of 18F-FDG PET/CT in the diagnosis of
infective endocarditis".
Source
Journal of Nuclear Cardiology. 26 (3) (pp 939-940), 2019. Date of
Publication: 15 Jun 2019.
Author
Scholtens A.M.
Institution
(Scholtens) Meander Medical Center, Amersfoort, Netherlands
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)

<31>
Accession Number
2002001946
Title
Perioperative amiodarone reduces post-operative atrial fibrillation in
coronary artery bypass grafting patients.
Source
Pakistan Journal of Medical and Health Sciences. 13 (1) (pp 326-328),
2019. Date of Publication: January 2019.
Author
Khan I.A.; Ahmad A.; Qaisar A.M.
Institution
(Khan) Department of Cardiac Surgery, Sandeman Provincial Hospital,
Quetta, Pakistan
(Ahmad) Department of Cardiothoracic Surgery, ShaikhZayed Hospital Lahore,
Pakistan
(Qaisar) Department of Physiology, Niazi Medical and Dental College,
Sargodha, Pakistan
Publisher
Lahore Medical And Dental College (Lahore Medical & Dental College, Lahore
x, Pakistan. E-mail: nayyar_salam@yahoo.com)
Abstract
Aim: To examine the role of amiodarone in terms of reduction in the
postoperative atrial fibrillation in patients undergoing coronary artery
bypass grafting. <br/>Study Design: Prospectivestudy Place & Duration:
Department of Cardiac Surgery, Sandeman Provincial Hospital Quetta over a
period of 1 year from1^st June 2017 to 31^stMay2018.
<br/>Method(s): In this study 120 patients of both genders were included.
Patient'sages were ranging from30 to 80years. The patients weredivided
into twogroups, 60 patients in amiodarone (Group A) and 60 in control
(GroupB). Detailed medical history andinformed consent was taken from all
the patients.Patients with history of atrial fibrillation and
chronicobstructivepulmonary disease wereexcluded from the study. In
groupA, all the patients received oral amiodarone 400mg the night before
surgery, 400mg at 5 AM on the day of surgery and 400 mg PO/NGT BID for
four days post operatively .Group B 60 patients received placebo.
<br/>Result(s): In Group A 49(81.67%) patients were males while 11(18.33%)
patients were females with mean age 56.7+/-9.6 years. In Group B, 45(75%)
patients were males while 15(25%) patients were females with mean age
58.4+/-7.5 years. Post operative atrial fibrillation occurred in 7(11.67%)
patients in group A (amiodarone) while in placebo group 15(25%) patients
had atrial fibrillation (p-value 0.015).In group A (amiodarone) atrial
fibrillation duration was 11.7+/-5.8 hrs and in control group (Group B) it
was 35.8+/-26.6 hrs respectively. The maximum ventricular rate during
atrial fibrillation was slower in the amiodarone group than in the control
group (103.7+/-20.3 beats per minute and 128.0+/-16.5 beats per minutes
respectively.Group A patients had less hospital stay than that of Group B
(placebo). There was no difference found in term of mortality between two
groups (P value >0.05) <br/>Conclusion(s): Perioperative oral amiodarone
administration shows better results in terms of postoperative atrial
fibrillation. Amiodarone group had less hospital stay than control
group.<br/>Copyright &#xa9; 2019 Lahore Medical And Dental College. All
rights reserved.

<32>
Accession Number
2001911900
Title
Effects of intensive blood pressure control in patients with evident
cardiovascular disease: An investigation using the SPRINT study data.
Source
Current Vascular Pharmacology. 17 (3) (pp 298-306), 2019. Date of
Publication: 2019.
Author
Vlachopoulos C.; Terentes-Printzios D.; Aznaouridis K.; Ioakeimidis N.;
Xaplanteris P.; Lazaros G.; Tousoulis D.
Institution
(Vlachopoulos, Terentes-Printzios, Aznaouridis, Ioakeimidis, Xaplanteris,
Lazaros, Tousoulis) Hypertension and Cardiometabolic Unit, First
Department of Cardiology, Hippokration Hospital, Medical School, National
and Kapodistrian University of Athens, Athens, Greece
(Vlachopoulos, Terentes-Printzios, Aznaouridis, Ioakeimidis, Xaplanteris,
Lazaros, Tousoulis) st Department of Cardiology, National and Kapodistrian
University of Athens, Hippokration Hospital, Profiti Elia 24, Athens
14575, Greece
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Recent data advocate adoption of a more intensive treatment
strategy for management of blood pressure (BP). <br/>Objective(s): We
investigated whether the overall effects of the Systolic Blood Pressure
Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD)
patients. <br/>Method(s): In a post hoc analysis we analyzed data from
SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP)
target of <120 mmHg (intensive treatment) or <140 mmHg (standard
treatment). 1562 patients had clinically evident CVD (age=70.3+/-9.3
years, 24% females) at study entry and were followed for 3.1 years.
Further, we assessed the effect of low (<150 mmHg) baseline SBP on
outcome. <br/>Result(s): In CVD patients, there was no benefit from the
intensive treatment regarding all endpoints, except for a marginally
significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95%
confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there
was no increase in serious adverse events (SAE) in the intensive group,
there was increased risk for study-related SAE, acute renal failure and
electrolyte abnormalities. In patients with low baseline SBP there was a
beneficial effect on all-cause mortality (HR: 0.56; 95% CI: 0.33 to 0.96;
p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to
8.29; p=0.042). <br/>Conclusion(s): We confirm the beneficial effect of
the intensive strategy in SPRINT study on all-cause mortality and the
harmful effect on specific adverse outcomes in patients with CVD. However,
in patients with low baseline SBP stroke may increase.<br/>Copyright
&#xa9; 2019 Bentham Science Publishers.

<33>
Accession Number
2001932092
Title
Cognitive outcomes following coronary artery bypass grafting: A systematic
review and meta-analysis of 91,829 patients.
Source
International Journal of Cardiology. 289 (pp 43-49), 2019. Date of
Publication: 15 August 2019.
Author
Greaves D.; Psaltis P.J.; Ross T.J.; Davis D.; Smith A.E.; Boord M.S.;
Keage H.A.D.
Institution
(Greaves, Ross, Boord, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, School of Psychology, Social Work and Social
Policy, University of South Australia, Adelaide, Australia
(Psaltis) Vascular Research Centre, Heart Health Theme, South Australian
Health and Medical Research Institute, Adelaide, Australia and Adelaide
Medical School, University of Adelaide, Adelaide, Australia
(Davis) MRC Unit for Lifelong Health and Ageing Unit at University College
London, London, United Kingdom
(Smith) Alliance for Research in Exercise, Nutrition and Activity, School
of Health Sciences, University of South Australia, Adelaide, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Background: Cognitive impairments, including delirium, are common after
coronary artery bypass grafting (CABG) surgery, as described in over three
decades of research. Our aim was to pool estimates across the literature
for the first-time, relative to time (from pre- to post-CABG) and
diagnosis (cognitive impairment, delirium and dementia). <br/>Method(s): A
systematic search of four databases was undertaken. 215 studies
incorporating data from 91,829 patients were used to estimate the
prevalence of cognitive impairments pre- and post-CABG, including delirium
and dementia post-CABG, using random effects meta-analyses.
<br/>Result(s): Pre-surgical cognitive impairment was seen in 19% of
patients. Post-operatively, cognitive impairment was seen in around 43% of
patients acutely; this resolved to 19% at 4-6 months and then increased to
25% of patients between 6-months to 1-year post-operatively. In the long
term, between 1 and 5-years post-operatively, cognitive impairment
increased and was seen in nearly 40% of patients. Post-operative delirium
was apparent in 18% of CABG patients which increased to 24% when a
diagnostic instrument was utilized alongside clinical criteria. Dementia
was present in 7% of patients 5-7 years post-surgery. <br/>Conclusion(s):
The results of this meta-analysis demonstrate that cognitive impairment
and delirium are major issues in CABG patients which require specific
attention. It is imperative that appropriate methods for investigating
cognitive impairment, and screening for delirium using a diagnostic
instrument, occur in both pre-and post-CABG settings.<br/>Copyright &#xa9;
2019 The Authors

<34>
Accession Number
2001934144
Title
Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: A
Systematic Review.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2019. Date of Publication: 2019.
Author
Waskowski J.; Pfortmueller C.A.; Erdoes G.; Buehlmann R.; Messmer A.S.;
Luedi M.M.; Schmidli J.; Schefold J.C.
Institution
(Waskowski, Pfortmueller, Messmer, Schefold) Department of Intensive Care
Medicine, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Waskowski, Erdoes, Luedi) Department of Anaesthesiology and Pain
Medicine, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Buehlmann, Schmidli) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background: Post-operative acute kidney injury (AKI)is a
frequent peri-operative complication that negatively affects morbidity and
mortality. Mannitol is frequently used peri-operatively for renal
protection, although evidence for its use is ambiguous. A systematic
review was conducted to clarify whether there is evidence supporting
peri-operative mannitol administration for the prevention of
post-operative AKI. <br/>Method(s): A systematic literature search was
performed in MEDLINE/Pubmed, Embase, the Cochrane Library, Clinical Trials
registry, and the Cochrane Central Register of Controlled Trials
(CENTRAL). Eligibility criteria were (i)population (studies involving
adult patients undergoing surgery or a related intervention);
(ii)intervention (intravenous mannitol administered in either the pre- or
intra-operative period with comparison to controls); and (iii)predefined
outcomes (post-operative AKI or respective renal end points/surrogates).
<br/>Result(s): In total, 1,538 articles published between January 1990
and October 2018 were identified. After checking for eligibility, 22
studies, including 17 prospective and/or randomised controlled trials and
five retrospective studies, were included. The investigations involved
various fields of surgery, such as aortic surgery, cardiac surgery with
cardiopulmonary bypass, and urological procedures, including partial
nephrectomy. Significant heterogeneity, limited sample size, and mostly
short follow up periods were noted. <br/>Conclusion(s): Given the
available evidence, the peri-operative use of mannitol to prevent AKI
cannot be considered an evidence based intervention in cardiac surgery,
partial nephrectomy, and/or other major surgery. Further research is
required with a focus on patients at high risk of post-operative
AKI.<br/>Copyright &#xa9; 2019 European Society for Vascular Surgery

<35>
Accession Number
2001569043
Title
Depth of anesthesia measured by bispectral index and postoperative
mortality: A meta-analysis of observational studies.
Source
Journal of Clinical Anesthesia. 56 (pp 119-125), 2019. Date of
Publication: September 2019.
Author
Liu Y.-H.; Qiu D.-J.; Jia L.; Tan J.-T.; Kang J.-M.; Xie T.; Xu H.-M.
Institution
(Liu, Qiu, Jia, Tan, Kang, Xie, Xu) Department of Anesthesiology, Fourth
Hospital of Hebei Medical University, Shijiazhuang 050000, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Whether anesthesia depth affects postoperative mortality
remains uncertain. Measurements: Several databases were systematically
searched to identify all articles studying the relationship between depth
of anesthesia and postoperative mortality. Post hoc subgroup analyses were
conducted for follow-up period (30 days vs. longer than 90 days) and type
of surgery. <br/>Main Result(s): The analysis included 38,722 patients
from nine studies. We observed a significant relationship between low
bispectral index (BIS) and mortality (pooled aHR, 1.22;95% CI, 1.08 to
1.38; P = 0.001; I² = 85.4%). Post hoc subgroup analyses
indicated low BIS to be linked with significantly elevated mortality risk
in patients with >=90 days follow-up (pooled adjusted hazard ratio [aHR],
1.09; 95% CI, 1.00-1.19; P = 0.01; I² = 79.4%), but this
association did not achieve significance in those with a 30 day follow-up
duration (pooled aHR, 1.52; 95% CI, 0.97-2.38; P = 0.28; I² =
79.0%). In addition, this link between postoperative mortality and low BIS
was significant in those who had undergone cardiac surgery (pooled aHR,
1.30; 95% CI, 1.14 to 1.49; P < 0.001; I² = 0.0%), but not in
patients that had received other forms of surgery (pooled aHR, 1.06; 95%
CI, 0.98 to 1.14; P = 0.14; I² = 73.2%). <br/>Conclusion(s): We
observed a significant relationship between deep anesthesia and long-term
mortality, though this was not significant 30 days following surgery. In
patients who had received cardiac surgery, deep anesthesia may increase
mortality. However, this trend was not observed in patients who had
undergone other forms of surgery.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<36>
Accession Number
627806898
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
NLM (Medline)
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. <br/>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. <br/>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.
<br/>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.
<br/>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.<br/>Copyright&#xa9; Bentham Science Publishers; For any queries,
please email at epub@benthamscience.net.

<37>
Accession Number
2001935722
Title
Comparison of biological and mechanical prostheses for heart valve
surgery: A systematic review of randomized controlled trials.
Source
Arquivos Brasileiros de Cardiologia. 112 (3) (pp 292-301), 2019. Date of
Publication: March 2019.
Author
Kiyose A.T.; Suzumura E.A.; Laranjeira L.; Buehler A.M.; Santo J.A.E.;
Berwanger O.; Carvalho A.C.C.; de Paola A.A.; Moises V.A.; Cavalcanti A.B.
Institution
(Kiyose, Carvalho, de Paola, Moises) Universidade Federal de Sao Paulo
(UNIFESP), Sao Paulo, SP, Brazil
(Kiyose, Suzumura, Laranjeira, Buehler, Santo, Berwanger, Cavalcanti)
Hospital do Coracao (HCOR), Sao Paulo, SP, Brazil
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: The choice of a mechanical (MP) or biological prosthesis (BP)
for patients with valvular heart disease undergoing replacement is still
not a consensus. <br/>Objective(s): We aimed to determine the clinical
outcomes of MP or BP placement in those patients. <br/>Method(s): We
conducted a systematic review and meta-analysis of randomized controlled
trials (RCTs) that compared biological prostheses and mechanical
prostheses in patients with valvular heart diseases and assessed the
outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL,
SCOPUS and Web of Science (from inception to November 2014) databases.
Meta-analyses were performed using inverse variance with random effects
models. The GRADE system was used to rate the quality of the evidence. A
P-value lower than 0.05 was considered significant. <br/>Result(s): A
total of four RCTs were included in the meta-analyses (1,528 patients)
with follow up ranging from 2 to 20 years. Three used old generation
mechanical and biological prostheses, and one used contemporary
prostheses. No significant difference in mortality was found between BP
and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of
bleeding was significantly lower in BP patients than MP patients (RR =
0.64; 95% CI 0.52-0.78); however, reoperations were significantly more
frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no
statistically significant differences between BP and MP patients with
respect to systemic arterial embolisms and infective endocarditis (RR =
0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results
in the trials with modern and old prostheses were similar.
<br/>Conclusion(s): The mortality rate and the risk of thromboembolic
events and endocarditis were similar between BP and MP patients. The risk
of bleeding was approximately one third lower for BP patients than for MP
patients, while the risk of reoperations was more than three times higher
for BP patients.<br/>Copyright &#xa9; 2019, Arquivos Brasileiros de
Cardiologia. All rights reserved.

<38>
Accession Number
627729945
Title
Comparing clinical outcomes of NOACs with warfarin on atrial fibrillation
with Valvular heart diseases: A meta-analysis.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 113. Date of Publication: 15 May 2019.
Author
He Q.; Sze C.-Y.; Shum T.-Y.; Hao G.; Wong N.-Y.B.; Sin T.-H.; Wei W.; Xia
S.
Institution
(He, Sze, Shum, Wong, Sin) Clinical Medicine of International School,
Jinan University, Guangzhou, Guangdong 510632, China
(Wei, Xia) Department of Health Statistics, School of Medicine, Jinan
University, No.601 Huangpudadao, Guangzhou, Guangdong 510632, China
(Hao) Department of Epidemiology, School of Medicine, Jinan University,
Guangzhou, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Warfarin is the standard of care and NOAC (Novel oral
anticoagulants) are a group of newer drugs for such purposes. NOAC has a
generally better profile (Clear interaction, less side effect, require
less monitoring). However, its efficacy on valvular atrial fibrillation
remains unclear. <br/>Method(s): We researched literature articles from
Embase, Cochrane and PubMed. Then we meta-analysed these six articles to
assess pooled estimate of relative risk (RR) and 95% confidence intervals
(Cl) using random-effects model for stroke, systemic embolic event, major
bleeding and all-cause mortality. Heterogeneity across study was tested
with Cochran's Q Test and I² Test. The bias of studies was
first tested by examining the symmetry of Funnel Plot. Cochrane's
Collaboration Tool was also used to report any presented bias.
<br/>Result(s): We collected 496 articles in total and finally we included
six articles in our meta-analysis. For SSEE (Stroke, Systemic Embolic
Event), the pooled relative risk showed a significantly better clinical
outcome of NOAC (RR: 0.66; 95% CI: 0.46 to 0.95). However, there is no
significant difference in major bleeding (RR: 0.714, 95% CI:0.46 to 1.11)
and all-cause mortality (RR: 0.84, 95% CI: 0.58 to 1.21).
<br/>Conclusion(s): Compared to Warfarin, NOAC is significantly more
protective against the embolic event, but no significant difference in
lowering risk of major bleeding, all-cause mortality or all aspects of
post-TAVI (Trans-catheter aortic valve implantation).<br/>Copyright &#xa9;
2019 The Author(s).

<39>
Accession Number
627811904
Title
The impact of pre-existing peripheral artery disease on transcatheter
aortic valve implantation outcomes: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Ueshima D.; Barioli A.; Nai Fovino L.; D'Amico G.; Fabris T.; Brener S.J.;
Tarantini G.
Institution
(Ueshima, Barioli, Nai Fovino, D'Amico, Fabris, 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-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Peripheral arterial disease (PAD) plays a decisive role in the
preinterventional selection process of the optimal vascular access site in
patients undergoing transcatheter aortic valve implantation (TAVI).
However, the impact of PAD on mortality and vascular complications (VCs)
in TAVI-treated patients remains unclear. Accordingly, we aimed to assess
the outcomes of patients with and without PAD undergoing TAVI, by
performing a meta-regression analysis. <br/>Method(s): Studies published
between January 2002 and March 2018 and reporting outcomes according to
the presence of PAD in TAVI patients were identified. Outcome measures
analyzed were short-, mid- and long-term mortality, and peri-procedural
VC. The interaction between sheath size and PAD on outcomes was also
assessed. <br/>Result(s): A total of 26 studies (68,581 TAVI patients, of
whom 17,326 with preprocedural PAD) were included in the analysis.
Patients with PAD had higher risk of mortality at short- (HR 1.36, 95%
confidence interval [CI] 1.13-1.63, p =.0009), mid- (HR 1.18, 95% CI
1.08-1.30, p =.0005), and long-term (HR 1.36, 95% CI 1.24-1.48, p <.0001)
follow-up, and higher risk of VC (RR 1.55, 95% CI 1.27; 1.89, p <.0001).
Moreover, the adoption of smaller sheaths during TAVI procedures was
associated with fewer VC both in PAD and non-PAD patients, but the latter
group had a more pronounced benefit. <br/>Conclusion(s): Patients with
pre-existent PAD are at increased risk of all-cause mortality and VC after
TAVI. The adoption of smaller sheaths during the procedure seems to be
associated with fewer peri-procedural VC both in PAD and non-PAD
patients.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<40>
Accession Number
622338679
Title
Randomized prospective comparison of everolimus-eluting vs.
Sirolimus-eluting stents in patients undergoing percutaneous coronary
intervention - 3-year clinical outcomes of the EXCELLENT randomized trial.
Source
Circulation Journal. 82 (6) (pp 1566-1574), 2018. Date of Publication:
2018.
Author
Park K.W.; Rhee T.-M.; Kang H.-J.; Koo B.-K.; Gwon H.-C.; Yoon J.-H.; Lim
D.-S.; Chae I.-H.; Han K.-R.; Ahn T.; Jeong M.-H.; Jeon D.-W.; Jang Y.-S.;
Kim H.-S.
Institution
(Park, Rhee, Kang, Koo, Kim) Department of Internal Medicine and
Cardiovascular Center, Seoul National University Hospital, Seoul, South
Korea
(Gwon) Sung-Kyun-Kwan University Samsung Medical Center, Seoul, South
Korea
(Yoon) Yonsei University Wonju Severance Hospital, Wonju, South Korea
(Lim) Korea University Anam Hospital, Seoul, South Korea
(Chae) Seoul National University Bundang Hospital, Seongnam, South Korea
(Han) Kangdong Sacred Heart Hospital, Seoul, South Korea
(Ahn) Gachon University Gil Medical Center, Incheon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Jeon) NHIC Ilsan Hospital, Ilsan, South Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
Publisher
Japanese Circulation Society
Abstract
Background: Everolimus-eluting stents (EES) have equivalent short-term
angiographic and clinical outcomes to sirolimus-eluting stents (SES), but
EES may be superior to SES with regard to long-term clinical safety. We
report the 3-year clinical outcomes of EES and SES from the prospective
EXCELLENT Randomized Trial (NCT00698607). <br/>Methods and Results: We
randomly assigned 1,443 patients undergoing percutaneous coronary
intervention 3:1 to receive EES and SES, respectively. We investigated
endpoints including target lesion failure (TLF) and individual clinical
outcomes including stent thrombosis (ST) at 3 years. For EES and SES, the
TLF rate was 4.82% and 4.12% (risk ratio [RR], 1.16, 95% CI: 0.65-2.06,
P=0.62), respectively. Results were similar in other efficacy endpoints
including target lesion revascularization. For safety endpoints, rate of
all-cause death was significantly lower for EES (1.67%) than SES (3.57%;
RR, 0.46; 95% CI: 0.23-0.94, P=0.03), while the incidence of cardiac death
or myocardial infarction was numerically lower in EES. On 1-year landmark
analysis, rates of all-cause death and major adverse cardiovascular events
were significantly lower for EES than SES. Definite or probable ST was
numerically 3-fold higher for SES (1.37%) compared with EES (0.46%).
<br/>Conclusion(s): EES and SES had similar efficacy with regard to 3-year
outcomes in the EXCELLENT trial, while delayed safety events all trended
to favor EES.<br/>Copyright &#xa9; 2018, Japanese Circulation Society. All
rights reserved.

<41>
Accession Number
614094607
Title
Transcatheter Mitral Valve Replacement for Patients With Symptomatic
Mitral Regurgitation: A Global Feasibility Trial.
Source
Journal of the American College of Cardiology. 69 (4) (pp 381-391), 2017.
Date of Publication: 31 Jan 2017.
Author
Muller D.W.M.; Grayburn P.A.; Stoler R.C.; Scalia G.M.; Muller D.; Jansz
P.; Shaw M.; Conellan M.; Spina R.; Pedersen W.; Sorajja P.; Farivar R.S.;
Bae R.; Sun B.; Walters D.; Clarke A.; Scalia G.; Grayburn P.; Stoler R.;
Hebeler R.; Dahle G.; Rein K.A.; Fiane A.; Guerrero M.; Pearson P.;
Feldman T.; Salinger M.; Smart S.; Kapadia S.; Gillinov M.; Mick S.;
Krishnaswamy A.; Pichard A.; Corso P.; Chuang M.; Popma J.; Leipsic J.;
Blanke P.; Carroll J.; George I.; Missov E.; Kiser A.
Institution
(Muller, Jansz, Shaw) Departments of Cardiology and Cardiothoracic
Surgery, St. Vincent's Hospital, Sydney, Australia
(Farivar, Bae, Sorajja) Center for Valve and Structural Heart Disease and
Cardiothoracic Surgery Service, Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, Minnesota, United States
(Walters, Clarke, Scalia) Departments of Cardiology and Cardiothoracic
Surgery, Prince Charles Hospital, Brisbane, Australia
(Grayburn, Stoler) Divisions of Cardiology and Cardiothoracic Surgery,
Baylor University Medical Center, Dallas, Texas, United States
(Dahle, Rein) Departments of Cardiology and Cardiothoracic Surgery, Oslo
University Hospital, Oslo, Norway
(Guerrero, Pearson) Divisions of Cardiology and Cardiothoracic Surgery,
Evanston Hospital, Evanston, Illinois, United States
(Kapadia, Gillinov) Departments of Cardiovascular Medicine and
Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio,
United States
(Pichard, Corso) Division of Cardiology and Department of Cardiothoracic
Surgery, Medstar Washington Hospital Center, Washington DC, United States
(Popma, Chuang) Beth Israel Deaconness Medical Center, Boston,
Massachusetts, United States
(Blanke, Leipsic) St. Paul's Hospital, Vancouver, British Columbia, Canada
Publisher
Elsevier USA
Abstract
Background Symptomatic mitral regurgitation (MR) is associated with high
morbidity and mortality that can be ameliorated by surgical valve repair
or replacement. Despite this, many patients with MR do not undergo
surgery. Transcatheter mitral valve replacement (TMVR) may be an option
for selected patients with severe MR. Objectives This study aimed to
examine the effectiveness and safety of TMVR in a cohort of patients with
native valve MR who were at high risk for cardiac surgery. Methods
Patients underwent transcatheter, transapical delivery of a self-expanding
mitral valve prosthesis and were examined in a prospective registry for
short-term and 30-day outcomes. Results Thirty patients (age 75.6 +/- 9.2
years; 25 men) with grade 3 or 4 MR underwent TMVR. The MR etiology was
secondary (n = 23), primary (n = 3), or mixed pathology (n = 4). The
Society of Thoracic Surgeons Predicted Risk of Mortality was 7.3 +/- 5.7%.
Successful device implantation was achieved in 28 patients (93.3%). There
were no acute deaths, strokes, or myocardial infarctions. One patient died
13 days after TMVR from hospital-acquired pneumonia. Prosthetic leaflet
thrombosis was detected in 1 patient at follow-up and resolved after
increased oral anticoagulation with warfarin. At 30 days, transthoracic
echocardiography showed mild (1+) central MR in 1 patient, and no residual
MR in the remaining 26 patients with valves in situ. The left ventricular
end-diastolic volume index decreased (90.1 +/- 28.2 ml/m² at
baseline vs. 72.1 +/- 19.3 ml/m² at follow-up; p = 0.0012), as
did the left ventricular end-systolic volume index (48.4 +/- 19.7
ml/m² vs. 43.1 +/- 16.2 ml/m²; p = 0.18).
Seventy-five percent of the patients reported mild or no symptoms at
follow-up (New York Heart Association functional class I or II).
Successful device implantation free of cardiovascular mortality, stroke,
and device malfunction at 30 days was 86.6%. Conclusions TMVR is an
effective and safe therapy for selected patients with symptomatic native
MR. Further evaluation of TMVR using prostheses specifically designed for
the mitral valve is warranted. This intervention may help address an unmet
need in patients at high risk for surgery. (Early Feasibility Study of the
Tendyne Mitral Valve System [Global Feasibility Study];
NCT02321514)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<42>
Accession Number
604735376
Title
Antiplatelet therapy duration following bare metal or drug-eluting
coronary stents.
Source
JAMA - Journal of the American Medical Association. 313 (11) (pp
1113-1121), 2015. Date of Publication: 17 Mar 2015.
Author
Kereiakes D.J.; Yeh R.W.; Massaro J.M.; Driscoll-Shempp P.; Cutlip D.E.;
Steg P.G.; Gershlick A.H.; Darius H.; Meredith I.T.; Ormiston J.; Tanguay
J.F.; Windecker S.; Garratt K.N.; Kandzari D.E.; Lee D.P.; Simon D.I.;
Iancu A.C.; Trebacz J.; Mauri L.
Institution
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Kereiakes) Lindner Research Center, Cincinnati, OH, United States
(Yeh, Massaro, Driscoll-Shempp, Cutlip, Mauri) Harvard Clinical Research
Institute, Boston, MA, United States
(Yeh) Massachusetts General Hospital, Boston, United States
(Massaro) Boston University, Boston, MA, United States
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Steg) Universite Paris-Diderot, Paris, France
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat, Paris,
France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Gershlick) University Hospitals of Leicester, Leicester, United Kingdom
(Darius) Vivantes Neukoelln Medical Center, Berlin, Germany
(Meredith) Monash Heart, VIC, Australia
(Ormiston) Mercy Hospital, Auckland, New Zealand
(Tanguay) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Windecker) Bern University Hospital, Bern, Switzerland
(Garratt) Lenox Hill Hospital, New York, NY, United States
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Lee) Stanford University, Stanford, CA, United States
(Simon) University Hospitals Case Medical Center, Cleveland, OH, United
States
(Iancu) Heart Institute, Cluj-Napoca, Romania
(Trebacz) Jan Pawel II Hospital Krakow, Krakow, Poland
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Despite antirestenotic efficacy of coronary drug-eluting stents
(DES) compared with bare metal stents (BMS), the relative risk of stent
thrombosis and adverse cardiovascular events is unclear. Although dual
antiplatelet therapy (DAPT) beyond 1 year provides ischemic event
protection after DES, ischemic event risk is perceived to be less after
BMS, and the appropriate duration of DAPT after BMS is unknown. OBJECTIVE
To compare (1) rates of stent thrombosis and major adverse cardiac and
cerebrovascular events (MACCE; composite of death,myocardial infarction,
or stroke) after 30 vs 12 months of thienopyridine in patients treated
with BMS taking aspirin and (2) treatment duration effect within the
combined cohorts of randomized patients treated with DES or BMS as
prespecified secondary analyses. DESIGN, SETTING, AND PARTICIPANTS
International, multicenter, randomized, double-blinded, placebo-controlled
trial comparing extended (30-months) thienopyridine vs placebo in patients
taking aspirin who completed 12 months of DAPT without bleeding or
ischemic events after receiving stents. The study was initiated in August
2009 with the last follow-up visit in May 2014. INTERVENTIONS Continued
thienopyridine or placebo at months 12 through 30 after stent placement,
in 11 648 randomized patients treated with aspirin, of whom 1687 received
BMS and 9961 DES. MAIN OUTCOMES AND MEASURES Stent thrombosis, MACCE, and
moderate or severe bleeding. RESULTS Among 1687 patients treated with BMS
whowere randomized to continued thienopyridine vs placebo, rates of stent
thrombosiswere 0.5%vs 1.11% (n = 4 vs 9; hazard ratio [HR], 0.49; 95%CI,
0.15-1.64; P = .24), rates of MACCE were 4.04%vs 4.69%(n = 33 vs 38; HR,
0.92; 95%CI, 0.57-1.47; P = .72), and rates of moderate/severe bleeding
were 2.03%vs 0.90% (n = 16vs 7; P = .07), respectively. Among all 11 648
randomized patients (both BMS and DES), stent thrombosis rateswere 0.41%
vs 1.32%(n = 23 vs 74; HR, 0.31; 95%CI, 0.19-0.50; P < .001), rates of
MACCE were 4.29% vs 5.74%(n = 244 vs 323; HR, 0.73; 95%CI, 0.62-0.87; P <
.001), and rates of moderate/severe bleedingwere 2.45%vs 1.47%(n = 135 vs
80; P < .001). CONCLUSIONS AND RELEVANCE Among patients undergoing
coronary stent placement with BMS and who tolerated 12 months of
thienopyridine, continuing thienopyridine for an additional 18 months
compared with placebo did not result in statistically significant
differences in rates of stent thrombosis, MACCE, or moderate or severe
bleeding. However, the BMS subsetmay have been underpowered to identify
such differences, and further trials are suggested.<br/>Copyright &#xa9;
2015 American Medical Association. All rights reserved.

<43>
Accession Number
358850332
Title
Hydroxyethylstarch and gelatin solutions impair blood coagulation after
cardiac surgery: A prospective randomized trial.
Source
British Journal of Anaesthesia. 104 (6) (pp 691-697), 2010. Date of
Publication: June 2010.
Author
Schramko A.; Suojaranta-Ylinen R.; Kuitunen A.; Raivio P.; Kukkonen S.;
Niemi T.
Institution
(Schramko, Suojaranta-Ylinen, Kuitunen, Kukkonen, Niemi) Department of
Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital,
Meilahti Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland
(Raivio) Department of Cardiothoracic Surgery, Helsinki University
Hospital, Meilahti Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland
Publisher
Oxford University Press
Abstract
Background. Colloids are often used after cardiac surgery as intravascular
volume replacement therapy. Cardiac surgical patients have an increased
risk of bleeding. Both hydroxyethylstarch (HES) and gelatin solutions
impair haemostasis. We examined the impact and dose effect on coagulation
of HES 130/0.4, gelatin, or Ringer's acetate solutions after cardiac
surgery.Methods. Forty-five patients received three boluses (each 7 ml
kg^-1) of either 6% HES 130/0.4, 4% gelatin, or Ringer's acetate
solution after elective cardiac surgery. The infusion of study solution
was continued in the dose 7 ml kg ^-1 over the following 12 h.
The total dose of study solution was 28 ml kg^-1. Hypovolaemia
was treated with Ringer's acetate. Modified thromboelastometry was
performed to detect coagulation disorders.Results. Clot formation time was
prolonged and clot strength decreased after infusion of 7, 14, and 21 ml
kg^-1 of either colloid compared with the Ringer's acetate
group. After infusion of 14 and 21 ml kg^-1 of Ringer's acetate,
clot strength was slightly, but significantly, increased. On the first
postoperative morning, clot strength was still decreased in the gelatin
group in comparison with the Ringer's acetate group. Neither HES nor
gelatin induced fibrinolysis. Chest tube drainage was comparable between
all groups.Conclusions. Even a small dose of HES 130/0.4 or gelatin
impaired clot strength after cardiac surgery in a dose-dependent fashion,
but neither colloid increased blood loss. &#xa9; 2010 The Author.

<44>
Accession Number
2001784313
Title
Meta-analysis of Percutaneous Coronary Intervention Versus Medical Therapy
in the Treatment of Coronary Chronic Total Occlusion.
Source
American Journal of Cardiology. 123 (12) (pp 2060-2062), 2019. Date of
Publication: 15 June 2019.
Author
Barbarawi M.; Kheiri B.; Zayed Y.; Gakhal I.; Barbarawi O.; Rashdan L.;
Osman M.; Bachuwa G.; Alkotob M.L.; Bhatt D.L.
Institution
(Barbarawi, Kheiri, Zayed, Gakhal, Rashdan, Bachuwa) Department of
Internal Medicine, Hurley Medical Center/Michigan State University, Flint,
MI, United States
(Barbarawi) Department of Internal medicine, Mutah University, Al-Karak,
Jordan
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV, United States
(Alkotob) Division of cardiology, Hurley Medical Center/Michigan State
University, Flint, MI, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<45>
Accession Number
2001910728
Title
The Influence of Suction on Chest Drain Duration After Lobectomy Using
Electronic Chest Drainage.
Source
Annals of Thoracic Surgery. 107 (6) (pp 1621-1625), 2019. Date of
Publication: June 2019.
Author
Lijkendijk M.; Licht P.B.; Neckelmann K.
Institution
(Lijkendijk, Licht, Neckelmann) Department of Cardiothoracic Surgery,
Odense University Hospital, Odense, Denmark
Publisher
Elsevier USA
Abstract
Background: Management of chest drains after thoracic surgery remains an
area with little consensus. To optimize chest drainage algorithms with
electronic chest drainage systems, a randomized controlled trial comparing
low variable suction (-5 cm H<inf>2</inf>O) versus high variable suction
(-20 cm H<inf>2</inf>O) was conducted. <br/>Method(s): This was a
prospective open label randomized trial in patients undergoing lobectomy.
Sample size was calculated from a clinical relevant difference in chest
drain duration as 1 full day. End points were chest drain duration and
length of hospitalization. Data were analyzed by Kaplan-Meier survival
analysis and multivariate Cox proportional hazards regression.
<br/>Result(s): The study randomized 106 patients. There was no
statistical significant difference in chest drain duration and length of
stay between the low-suction and the high-suction groups: Median chest
drain duration and hospitalization were 25 hours (interquartile range
[IQR] 21 to 55 hours) versus 28 hours (IQR 23 to 77 hours; p = 0.97) and 5
days (IQR 3 to 6 days) versus 5 days (IQR 3 to 7 days; p = 0.75),
respectively. Multivariate analysis demonstrated that the diffusing
capacity of the lung for carbon monoxide was the only significant
predictor of chest drain duration (p = 0.015) and length of
hospitalization (p = 0.003). Complications requiring reinsertion of the
chest drain were significantly more frequent in the low-suction group (p =
0.03). <br/>Conclusion(s): There was no clinically relevant difference in
chest drain duration or length of hospitalization, but reinsertions of
chest drains were significantly more frequent in the low-suction group, a
finding suggesting that low suction levels should not be used after
lobectomy. Trial registry number is ISRCTN10408356.<br/>Copyright &#xa9;
2019 The Society of Thoracic Surgeons

<46>
[Use Link to view the full text]
Accession Number
621798694
Title
Complete revascularization for patients with ST-segment elevation
myocardial infarction and multivessel coronary artery disease: A
meta-analysis of randomized trials.
Source
Coronary Artery Disease. 29 (3) (pp 204-215), 2018. Date of Publication:
2018.
Author
Bajraktari G.; Jashari H.; Ibrahimi P.; Alfonso F.; Jashari F.; Ndrepepa
G.; Elezic S.; Heneina M.Y.
Institution
(Bajraktari, Jashari, Ibrahimi, Jashari, Elezic, Heneina) Department of
Public Health and Clinical Medicine, Umea University, Umea, Sweden
(Bajraktari, Jashari, Ibrahimi) Clinic of Cardiology, University Clinical
Centre of Kosova, Serbia
(Bajraktari, Jashari) Department of Internal Medicine, Medical Faculty,
University of Prishtina, Prishtina, Kosovo, Serbia
(Alfonso) Cardiac Department, La Princesa University Hospital, Institute
of Health Research, IIS-IP, University Autonoma of Madrid, Madrid, Spain
(Ndrepepa) Department of Adult Cardiology, German Heart Centre Munich,
Technical University of Munich, Munich, Germany
(Heneina) St George University, London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Introduction Despite the recent findings in randomized clinical trials
(RCTs) with limited sample sizes and the updates in clinical guidelines,
the current available data for the complete revascularization (CR) in
hemodynamically stable patients with ST-segment elevation myocardial
infarction (STEMI) at the time of primary percutaneous coronary
intervention (PCI) are still contradictory. Aim The aim of this
meta-analysis of the existing RCTs was to assess the efficacy of the CR
versus revascularization of infarct-related artery (IRA) only during
primary PCI in patients with STEMI and multivessel disease (MVD). Patients
and methods We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar,
Cochrane Central Register of Controlled Trials (CENTRAL), and
ClinicalTrials. gov databases aiming to find RCTs for patients with STEMI
and MVD which compared CR with IRA-only. Random effect risk ratios (RRs)
were calculated for efficacy and safety outcomes. Results Ten RCTs with
3291 patients were included. The median follow-up duration was 17.5
months. Major adverse cardiac events (RR=0.57; 0.43-0.76; P<0.0001),
cardiac mortality (RR=0.52; 0.31-0.87; P=0.014), and repeat
revascularization (RR=0.50; 0.30-0.84; P=0.009) were lower in CR compared
with IRA-only strategies. However, there was no significant difference in
the risk of all-cause mortality, recurrent nonfatal myocardial infarction,
stroke, major bleeding events, and contrast-induced nephropathy.
Conclusion For patients with STEMI and MVD undergoing primary PCI, the
current evidence suggests that the risk of major adverse cardiac events,
repeat revascularization, and cardiac death is reduced by CR. However, the
risk for all-cause mortality and PCI-related complications is not
different from the isolated culprit lesion-only treatment. Although these
findings support the cardiac mortality and safety benefit of CR in stable
STEMI, further large trials are required to provide better guidance for
optimum management of such patients.<br/>Copyright &#xa9; 2018 Wolters
Kluwer Health, Inc.

<47>
[Use Link to view the full text]
Accession Number
621798692
Title
A comparison of intracoronary treatment strategies for thrombus burden
removal during primary percutaneous coronary intervention: A COCTAIL II
substudy.
Source
Coronary Artery Disease. 29 (3) (pp 186-193), 2018. Date of Publication:
2018.
Author
Gatto L.; Di Landro A.; Romagnoli E.; Marco V.; Russo C.; Pawlowski T.;
Versaci F.; Limbruno U.; Castriota F.; Di Vito L.; Trivisonno A.; Prati F.
Institution
(Gatto, Romagnoli, Prati) Interventional Cardiology, San Giovanni
Addolorata Hospital, Via dell'Amba Aradam, 8, Rome 00184, Italy
(Gatto, Di Landro, Romagnoli, Marco, Russo, Di Vito, Prati) Centro per la
Lotta Contro L'Infarto, CLI Foundation, Rome, Italy
(Versaci) S. Maria Goretti Hospital, Latina, Italy
(Limbruno) Misericordia Hospital, Grosseto, Italy
(Castriota) Maria Cecilia Hospital, GVM Care and Research, Ettore
Sansavini Health Science Foundation, Cotignola, Italy
(Trivisonno) Ospedale A. Cardarelli, Campobasso, Italy
(Pawlowski) Central Clinical Hospital, Ministry of Interior, Warsaw,
Poland
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Manual thrombus aspiration and local drug delivery of abciximab
have been proposed as a strategy to reduce thrombus burden during
percutaneous coronary intervention in patients with ST elevation
myocardial infarction; however, the effectiveness of these approaches, is
uncertain. In this COCTAIL II substudy, we compared the effect of these
strategies on prestenting and poststenting thrombus burden assessed by
optical coherence tomography. Patients and methods COCTAIL II trial
enrolled patients with ST elevation myocardial infarction randomized to
intralesion (IL, by the ClearWay catheter) versus intracoronary (IC, by
the guide catheter) abciximab bolus with or without aspiration
thrombectomy (AT). The following parameters were used to quantify
atherothrombotic burden: thrombus volume (TVol), maximum thrombus area
(TA), and thrombus burden (TB). Primary endpoint was the comparison of
prestenting TVol after the use of local drug delivery (group IL+IL
abciximab plus AT) versus nonlocal drug delivery (group IC abciximab plus
AT+IC). Results The final population consisted of 59 patients undergoing
both prestenting and poststenting optical coherence tomography assessment.
The amount of thrombus was not significantly different in the groups with
local drug delivery of abciximab versus nonlocal drug delivery in both
prestenting (TVol: 18.87+/- 26.70 vs. 19.02 +/-18.45; TB: 26.73 +/-12.8
vs. 25.18 +/-13.25; and maximum TA: 59.25 +/- 18.84 vs. 53.34 +/- 19.30)
and poststenting (TVol: 8.46+/- 9.15 vs. 8.05 +/- 6.81; TB: 6.68 +/-3.54
vs. 6.24+/- 3.66; and maximum TA: 15.47 +/-7.61 vs. 16.52 +/-11.55)
evaluations. A good correlation between thrombus measurements after
thrombus removal techniques and intrastent thrombus was observed.
Conclusion Either local drug delivery of abciximab or manual thrombus
aspiration showed comparable results in terms of prestenting and
poststenting thrombus burden removal.<br/>Copyright &#xa9; 2018 Wolters
Kluwer Health, Inc.

<48>
Accession Number
627798405
Title
Myocardial ischemia presenting with hiccups.
Source
Journal of the College of Physicians and Surgeons Pakistan. 29 (5) (pp
469-473), 2019. Date of Publication: 01 May 2019.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, Division of Cardiac Surgery,
First Hospital of Putian, Teaching Hospital, Fujian Medical University,
Putian, Fujian Province, China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Myocardial infarction/ischemia can be an underlying etiology and a major
causative risk factor of cardiovascular hiccups. The objective of this
systematic review was to review the literature regarding clinical features
and treatments of hiccups of cardiac ischemia origin. PRISMA guidelines
were followed. In elderly patients with hiccups of uncertain causes,
electrocardiography is necessary to ensure the cardiogenic etiology. Both
symptomatic and etiologic treatments can be effective in terminating
hiccups. Of the therapeutic regimens, gabapentin is a second-line agent
alternative to baclofen in treating hiccups. It is especially helpful in
patients undergoing stroke rehabilitation or palliative care when
chlorpromazine is prohibited due to its adverse effects. Inferior
myocardial infarction is the most common cause of hiccups in this patient
setting. In addition to anti-myocardial ischemia agents and percutaneous
coronary intervention, coronary artery bypass grafting could be an
alternative to hiccups in such patients.<br/>Copyright &#xa9; 2019 College
of Physicians and Surgeons Pakistan. All rights reserved.

<49>
Accession Number
2001926871
Title
Patient Blood Management for Neonates and Children Undergoing Cardiac
Surgery: 2019 NATA Guidelines.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Faraoni D.; Meier J.; New H.V.; Van der Linden P.J.; Hunt B.J.
Institution
(Faraoni) Division of Cardiac Anesthesia, Department of Anesthesia and
Pain Medicine, The Hospital for Sick Children, University of Toronto,
Toronto, Canada
(Meier) Clinic of Anesthesiology and Critical Care Medicine, Kepler
University Clinic, Johannes Kepler University Linz, Linz, Austria
(New) NHS Blood and Transplant/Imperial College London, London, United
Kingdom
(Van der Linden) Department of Anesthesiology, Centre Hospital
Universitaire Brugmann, Hopital Universitaire Des Enfants Reine Fabiola,
Universite Libre de Bruxelles, Brussels, Belgium
(Hunt) Thrombosis & Haemophilia Centre, St Thomas' Hospital, London,
United Kingdom
Publisher
W.B. Saunders
Abstract
Pediatric cardiac surgery is associated with a substantial risk of
bleeding, frequently requiring the administration of allogeneic blood
products. Efforts to optimize preoperative hemoglobin, limit blood
sampling, improve hemostasis, reduce bleeding, correct coagulopathy, and
incorporate blood sparing techniques (including restrictive transfusion
practices) are key elements of patient blood management (PBM) programs,
and should be applied to the pediatric cardiac surgical population as
across other disciplines. Many guidelines for implementation of PBM in
adults undergoing cardiac surgery are available, but evidence regarding
the implementation of PBM in children is limited to systematic reviews and
specific guidelines for the pediatric cardiac population are missing. The
objective of the task force from the Network for the Advancement of
Patient Blood Management, Haemostasis and Thrombosis (NATA,
www.nataonline.com) is to provide evidence-based recommendations regarding
anemia management and blood transfusion practices in the perioperative
care of neonates and children undergoing cardiac surgery, and to highlight
potential areas where additional research is urgently
required.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<50>
Accession Number
2001926721
Title
Comparison of early and midterm outcomes after transsubclavian/axillary
versus transfemoral, transapical, or transaortic transcatheter aortic
valve implantation.
Source
Heart and Lung. (no pagination), 2019. Date of Publication: 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611,
Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Outcomes after transsubclavian/transaxillary
(TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been
unclear. <br/>Objective(s): To compare outcomes after TSc/TAx-TAVI versus
transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI,
we performed meta-analysis of currently available studies. <br/>Method(s):
Studies considered for inclusion met the following criteria: the study
population was patients undergoing TAVI; patients were assigned to
TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of
postprocedural early (30-day or in-hospital) or late (including early)
outcomes was reported. An odds or hazard ratio of each early or late
outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other
approach was extracted from each individual study and combined in the
random-effects model. <br/>Result(s): Our search identified 15 eligible
reports from 12 studies including 10,528 patients. Pooled analysis of
early all-cause mortality demonstrated a statistically significant
reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or
TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation
demonstrated a statistically significant increase after TSc/TAx-TAVI
compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled
analysis of midterm all-cause mortality demonstrated a statistically
significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007).
<br/>Conclusion(s): Early all-cause mortality was lower after TSc/TAx-TAVI
than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent
after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause
mortality was higher after TSc/TAx-TAVI than TF-TAVI.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<51>
Accession Number
2001926683
Title
Combined Approach Versus 2 Conventional Approaches in Ultrasound-Guided
Central Venous Catheterization: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Takeshita J.; Nishiyama K.; Fukumoto A.; Shime N.
Institution
(Takeshita) Department of Intensive Care Medicine, Osaka Prefectural
Hospital Organization, Osaka Women's and Children's Hospital, Izumi,
Osaka, Japan
(Nishiyama) Department of Emergency and Critical Care Medicine, National
Hospital Organization, Kyoto Medical Center, Mukaihata-cho, Fushimi-ku,
Kyoto, Japan
(Fukumoto) Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital,
Yamashina-ku, Kyoto, Japan
(Shime) Department of Emergency and Critical Care Medicine, Graduate
School of Biomedical & Health Sciences, Hiroshima University, Minami-ku,
Hiroshima, Japan
Publisher
W.B. Saunders
Abstract
Objective: The authors compared the occurrence of posterior wall puncture
using the short-axis out-of-plane and long-axis in-plane approaches with
that using the combined short-axis-and-long-axis approach that the authors
previously showed to be effective in observational and manikin studies.
<br/>Design(s): Randomized controlled study. <br/>Setting(s): Single
tertiary institution. <br/>Participant(s): One hundred twenty patients who
underwent cardiac or vascular surgery under general anesthesia.
<br/>Intervention(s): The patients were divided randomly into combined
short-axis-and-long-axis (n = 40), short-axis out-of-plane (SA-OOP) (n =
40), and long-axis in-plane (LA-IP) (n = 40) groups and received
ultrasound-guided central venous catheterization at the right internal
jugular vein. <br/>Measurements and Main Results: Successful guidewire
insertion without posterior wall puncture was performed in 40 patients
(100%) in the combined short-axis-and-long-axis approach group, 28 (70%)
in the short-axis out-of-plane approach group, and 38 (95%) in the LA-IP
approach group (combined short-axis-and-long-axis v SA-OOP, p = 0.0002
[relative risk = 1.43; 95% CI: 1.17-1.75]; combined
short-axis-and-long-axis v LA-IP, p = 0.49 [relative risk = 1.05; 95% CI:
0.98-1.13]). Procedure durations were 28.5 (24.1-36.4) seconds in the
combined short-axis-and-long-axis group, 31.7 (24.4-40.6) seconds in the
SA-OOP group, and 24.3 (20.8-32.1) seconds in the long-axis in-plane group
(combined short-axis-and-long-axis v SA-OOP, p = 0.53; combined
short-axis-and-long-axis v LA-IP, p = 0.044). <br/>Conclusion(s): The
combined short-axis-and-long-axis approach for ultrasound-guided central
venous catheterization had a lower posterior wall puncture rate than the
SA-OOP approach, but there was no significant difference with the
long-axis in-plane approach.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<52>
Accession Number
626486994
Title
Comparison of Del Nido and Intermittent Warm Blood Cardioplegia in
Coronary Artery Bypass Grafting Surgery.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (1) (pp
39-45), 2019. Date of Publication: 20 Feb 2019.
Author
Ucak H.A.; Uncu H.
Institution
(Ucak, Uncu) Department of Cardiovascular Surgery, University of Health
Sciences Adana City Hospital, Adana, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: In this study, we aim to investigate the efficacy and clinical
results of using Del Nido solution (DNS) in coronary artery bypass
grafting (CABG) surgery by comparing with intermittent warm blood
cardioplegia (IWBC). <br/>METHOD(S): Between March 2017 and February 2018,
297 adult patients who underwent primary isolated CABG surgery with
cardiopulmonary bypass (CPB) were included in the study. We used DNS in
112 patients and IWBC was used in 185 patients. We compared both the
clinical and the laboratory results. <br/>RESULT(S): Aortic cross-clamp
time, CPB time, and peak glucose level are lower with DNS. But we did not
observe any meaningful difference of clinical results between two methods
including postoperative myocardial enzyme release. <br/>CONCLUSION(S): Del
Nido cardioplegia was developed for immature heart and pediatric surgery.
But in our opinion, it is a good and useful alternative to CABG surgery
with similar results to IWBC.

<53>
Accession Number
626485308
Title
Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular
Injury and Oxidative Stress in Cardiovascular Surgery.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 25 (1) (pp
10-17), 2019. Date of Publication: 20 Feb 2019.
Author
Ulugol H.; Aksu U.; Kocyigit M.; Kilercik M.; Karduz G.; Okten M.; Toraman
F.
Institution
(Ulugol, Kocyigit, Toraman) Department of Anesthesiology and Reanimation,
Acibadem University, School of Medicine, Istanbul, Turkey
(Aksu, Karduz) Department of Biology, Science Faculty, Istanbul
University, Istanbul, Turkey
(Kilercik) Department of Clinical Laboratory, Acibadem Kadikoy Hospital,
Istanbul, Turkey
(Okten) Department of Cardiovascular Surgery, Acibadem University, School
of Medicine, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: The purpose of this study was to evaluate the effect of different
cardioplegic solutions on endothelial integrity and oxidative stress in
cardiovascular surgery. <br/>METHOD(S): In this randomized prospective
study, after ethics approval and informed consent, 60 surgical patients
were included. Patients undergoing coronary bypass surgery were randomized
into two groups as warm blood cardioplegia (n = 30) and cold crystalloid
cardioplegia (n = 30) following the cross-clamping. Measurements were
performed at three time points: before induction of anesthesia (T1), at
admission to intensive care unit (ICU) (T2) and at the 24th postoperative
hour (T3). Besides biochemical routine hemodynamic monitoring, patients
were assessed for the sialic acid (SA), ischemic-modified albumin (IMA),
advanced oxide protein products (AOPPs), total thiol (SH), and free
hemoglobin (fHb) level. <br/>RESULT(S): Neither crystalloid nor blood
cardioplegia led to significant changes in the AOPPs, T-SH, and SA level
(p >0.05). Crystalloid cardioplegia, however, increased IMA level compared
to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb
levels were transiently increased in both groups at the second-time point
(p <0.001). fHb level was lower in the crystalloid group compared to that
in the other group (p <0.05) at T2. <br/>CONCLUSION(S): Cardioplegia type
creates similar effects on glycocalyx integrity. However, myocardial
protection could be provided with warm blood cardioplegia.

<54>
Accession Number
627805092
Title
Comparison of the efects of succinated gelatine and hydroxy ethyl starch
(6% 130/0.4) on bleeding among cardiac surgery patients.
Source
Anaesthesiology Intensive Therapy. Conference: 6th International Fluid
Academy Days. Belgium. 51 (Supplement 1) (pp 9-10), 2019. Date of
Publication: 2019.
Author
Kavak E.K.O.; Aykac B.; Celik Z.; Kaya F.
Institution
(Kavak, Aykac, Kaya) Department of Anesthesiology, Cardiology Institute,
Istanbul University, Istanbul, Turkey
(Celik) Department of Anesthesiology and Reanimation, Yedikule Women and
Maternity Hospital, Istanbul, Turkey
Publisher
Via Medica
Abstract
Background: Volume therapy is often necessary to treat hypovolemia.
Especially for the cardiac surgery patients, volume defcit-replacement is
more important. There are several causes of hypovolemia and should be
treated according to the cause and defcit. Depends on the reason of
hypovolemia we can treat it with diferent fuids such as crystalloids,
colloids, blood, plasma. All kind of surgeries even the minor one
intravenous fuid replacement is necessary and done. But which solution it
should be done has controversies. Crystalloids or colloids? In our study
we compared two diferent colloid solutions and especially their efects on
bleeding for cardiac surgery patients. <br/>Objective(s): This study was
to compare the efects of HES 130/0.4 and Modifed Fluid Gelatine on
coagulation in patients undergoing cardiac surgery. <br/>Method(s):
Patients were randomized into 2 groups; group I (n:30) and group II
(n:30). Group I contains the patients who had modifed fuid gelatine
infusion and group II contains the patients who had HES 130/0.4 infusion.
Both groups had similar demographic characteristics. For both groups
patients charts checked and noted pre-op, post-op 1sth hour and postop
1^st day hgb, hct,plt, PT, aPTT, INR, BUN, Cr, ALT and AST
results. These results were analyzed SPSS statistic package. These two
diferent colloids efects on coagulation in cardiac surgery patients. We
measured the total hgb decrease to compare, and postop 1^st
hour; we observed that group II patients statistically signifcant hgb and
hct decrease. Apart from our study we also observed that group II patients
had statistically signifcant ALT and Cr abnormal test results which should
be discussed for another study. After all according to 1^st day
lab results hgb and hct were in normal range and there were no diferences
between HES 130/0.4 and modifed fuid gelatin on coagulation. Probably the
blood and plasma transfusion in ICU and also postop surgical bleeding
usually occurs in the 1^st-24 hour. <br/>Result(s): First 24
hours HES 130/0.4 caused coagulation impairment and signifcant Hgb and Hct
decrease among post cardiac surgery patients. We also found that HES
130/0.4 caused signifcant ALT and Cr abnormality which should be further
studied. <br/>Conclusion(s): Although postop 1^st hour HES
130/0.4 preparation caused more hgb and hct decrease in cardiac surgery
patients it was temporary, safe and not dangerous amount, and for the
volume replacement therapy new HES preparation was as safe as modifed fuid
gelatin. Acknowledgements: It is declared that there is no confict of
interest between the participants of this study. No fnancial aid has been
received for this study.

<55>
Accession Number
627805073
Title
6th International Fluid Academy Days.
Source
Anaesthesiology Intensive Therapy. Conference: 6th International Fluid
Academy Days. Belgium. 51 (Supplement 1) (no pagination), 2019. Date of
Publication: 2019.
Author
Anonymous
Publisher
Via Medica
Abstract
The proceedings contain 107 papers. The topics discussed include:
comparison of the effects of succinated gelatine and hydroxy ethyl starch
(6% 130/0.4) on bleeding among cardiac surgery patients; unintended fluid
load (UFLO) in elective coronary artery bypass surgery patients: a
retrospective analysis; clinibil: an open, monocentric, observational
study to investigate fluid and electrolyte balance in post cardiac-surgery
patients in the ICU; assessing the kidney's function in ICU-comparing
baseline parameters and impact of peri- and postoperative fluid
management; describing cardiac ICU patients' fluid transfer
characteristics using system analysis: a proof of concept; and crystalloid
vs. colloid for intraoperative goal-directed fluid therapy using a
closed-loop system: a randomized double blinded controlled trial in major
abdominal surgery.

<56>
Accession Number
627782924
Title
The mindful heart study: Results from a pilot randomized controlled trial
of mindfulness-based stress reduction for cardiac patients.
Source
Psychosomatic Medicine. Conference: 77th Annual Meeting of the American
Psychosomatic Society, APS 2019. Canada. 81 (4) (pp A168), 2019. Date of
Publication: May 2019.
Author
Everson-Rose S.A.; Nijjar P.S.; Lindquist R.; Kreitzer M.J.; Connett J.E.;
Brown R.Z.; Pergolski A.; Burt M.; Balaji P.; Wolfe A.; Chandiramani N.;
Yu X.
Institution
(Everson-Rose) Medicine, Minneapolis, MN, United States
(Nijjar) Cardiology, University of Minnesota Medical School, Minneapolis,
MN, United States
(Lindquist, Kreitzer) Nursing, University of Minnesota, School of Nursing,
Minneapolis, MN, United States
(Connett, Brown) Biostatistics, University of Minnesota, School of Public
Health, Minneapolis, MN, United States
(Pergolski, Burt) Cardiopulmonary Rehabilitation, Fairview Health
Services, Minneapolis, MN, United States
(Balaji, Wolfe, Chandiramani, Yu) Medicine, University of Minnesota
Medical School, Minneapolis, MN, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Secondary prevention strategies are crucial for millions who
experience myocardial infarction, heart failure, and interventional
cardiac procedures each year. Exercise-based cardiac rehab (CR) is the
standard of care but is underutilized and has mixed evidence of clinical
benefit. Mindfulness-based stress reduction (MBSR), which includes
meditation, yoga, and breathing practices, is a secondary prevention
strategy that may have psychosocial and cardiovascular (CV) benefits. Few
studies have rigorously evaluated MBSR in cardiac patients.
<br/>METHOD(S): The Mindful Heart Study (ClinicalTrials.gov #NCT02722213)
was a pilot RCT of MBSR in CR-eligible cardiac patients during their
initial recovery year. Goals were to test recruitment and retention
strategies, safety of MBSR, and to estimate treatment effects on
psychosocial measures, CV risk factors, heart rate variability and
health-related quality of life (HRQOL). Patients were recruited from a
university-affiliated hospital system, stratified by current CR enrollment
(yes/no), and randomly allocated 2:1 (intervention:control) to an 8-week
MBSR group intervention or usual care. Standard measures of depression,
anxiety, perceived stress, HRQOL, blood pressure, lipids, HbA1c, CRP and
24-hour Holter monitoring were obtained at baseline and 3- and 9-months
post-randomization. <br/>RESULT(S): A total of 47 patients [mean (SD) age,
58.6 (10.8) years; 38% female; 77% white] were enrolled in 2 cohorts over
15 weeks. Two 8-week MBSR groups were completed; 87% of MBSR patients
completed the intervention. All MBSR patients reported high satisfaction
with the intervention and improved stress coping. Study retention was >95%
at each follow-up visit. At 3 months, MBSR patients showed significant
improvements relative to controls in depression [adjusted difference (95%
CI), -2.69 (-4.70, -0.68) p=.01] and anxiety [-2.75 (-5.37, -0.13) p=.04]
with a similar trend in HRQOL [-3.93 (-8.04, 0.17) p=.06], but did not
differ on CV risk factors. At 9 months the MBSR group showed greater
improvement or less worsening of most CV risk factors. <br/>CONCLUSION(S):
This pilot RCT provides preliminary evidence of MBSR's potential to
improve psychosocial well-being in cardiac patients during their first
year of recovery. A fully-powered RCT is planned to evaluate effects of
MBSR on mental health and CV risk factors in a diverse patient population.

<57>
Accession Number
627783718
Title
"PTSD in patients with acute coronary syndromes and cardiovascular
disease: What comes first?".
Source
Psychosomatic Medicine. Conference: 77th Annual Meeting of the American
Psychosomatic Society, APS 2019. Canada. 81 (4) (pp A192), 2019. Date of
Publication: May 2019.
Author
Edmondson D.
Institution
(Edmondson) Behavioral Medicine, Columbia University, New York, NY, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The Enduring Somatic Threat (EST) model of posttraumatic
stress disorder (PTSD) due to life-threatening medical events suggests
that PTSD-like symptoms reflect, in large part, patients' sensitization to
cues of ongoing threat in the body. Meta-analyses suggest that 12-30% of
survivors of acute life-threatening cardiovascular disease (CVD) events
screen positive for PTSD due to the CVD event, and that CVD-induced PTSD
is associated with increased secondary CVD and mortality risk. Emergency
department (ED) factors such as overcrowding and poor clinician-patient
communication influence PTSD risk, but no study has tested whether CVD
management strategies influence PTSD risk. The EST model suggests that
perceived CVD recurrence risk is the core determinant of CVD-induced PTSD,
so interventions that reduce patients' perceived CVD risk may reduce PTSD.
Invasive coronary revascularization procedures are commonly used to reduce
secondary ACS risk, and may reduce patients' EST perceptions, as
revascularized patients are 4 times more likely to report being "cured"
compared to medically managed patients (i.e., no invasive procedure;
prescribed medications to reduce secondary CVD risk). <br/>Method(s): To
test the association of patients' threat perceptions during ED evaluation
and CVD management strategy with subsequent PTSD, we enrolled 143 patients
during ED evaluation for their first acute coronary syndrome (ACS; i.e.,
non-ST elevation myocardial infarction or unstable angina-colloquially,
"heart attack"). We assessed participants' initial threat perceptions
(e.g., fear of dying, feelings of vulnerability, lack of control) during
ED evaluation using the ED perceptions questionnaire (Cornelius et al., in
press), and followed them for 1 month for PTSD symptoms (PCL-specific for
ACS, by telephone). We compared PTSD symptoms in participants who were
revascularized (N = 65), catheterized but not revascularized (N = 35), or
medically managed (N = 43); abstracted from the electronic medical record.
Linear regression models were adjusted for age, sex, ACS type (NSTEMI vs
unstable angina), GRACE cardiac risk score, Charlson medical comorbidity
index, EDWIN ED crowding score, pre-existing PTSD due to pre-hospital
trauma by PCL-C, and pre-existing depression by PHQ-9. <br/>Result(s):
Unadjusted 1-month CVD-induced PTSD symptoms were lower for revascularized
versus medically managed participants, B =-5.32, 95% CI [-9.77,-0.87], p =
.020, and ED threat perceptions strongly predicted CVD-induced PTSD in the
full sample, B = 0.59, 95% CI [0.13, 1.05], p = .012. In a multiple
regression model adjusted for clinical and psychosocial covariates, the
interaction of threat perception in the emergency department (ED) and ACS
management group was significant (greater ED threat predicted greater
1-month PTSD symptoms only in medically managed participants).
<br/>Conclusion(s): Our findings offer further support for the EST model,
and suggest that psychological interventions to preempt patients'
development of EST (and thereby PTSD) should be considered in-hospital.
High resting state amygdala activation is associated with incident CVD
risk, partly through inflammatory pathways, and patients with PTSD evince
high rs-amygdala activation. Future studies should test whether
revascularization procedures reduce patients' secondary CVD risk
perceptions, and whether low risk perceptions are associated with reduced
rs-amygdala activation and secondary CVD risk.

<58>
Accession Number
627805373
Title
Vasopressin in diferent types of vasoplegic shock.
Source
Anaesthesiology Intensive Therapy. Conference: 6th International Fluid
Academy Days. Belgium. 51 (Supplement 1) (pp 85), 2019. Date of
Publication: 2019.
Author
Rehberg S.
Institution
(Rehberg) Department of Anaesthesiology, University Hospital of
Greifswald, Germany
Publisher
Via Medica
Abstract
Learning objectives: To briefy summarize current clinical evidence for the
use of vasopressin in the treatment of diferent types of vasoplegic shock.
<br/>Background(s): Vasopressin is recommended by current guidelines as
second-line vasopressor in septic shock. However, the optimal therapeutic
regime in respect to dose, time points of initiation and discontinuation
is still under investigation. In addition, the frst large randomized,
controlled study on frst-line vasopressin in patients with vasople-gic
shock following cardiac surgery suggests a superiority vs. norepinephrine
(VANCS). <br/>Discussion(s): New evidence on the use of vasopressin
reinforces the early start of treatment in septic shock patients [1]. Even
a frst-line approach tested in the VANISH trial was demonstrated to be as
safe and efective than the standard vasopressor norepinephrine [2]. In
addition, potential benefts of vasopressin on renal function in septic
shock require further investigation. Notably, retrospective data suggest
that contrary to current practice it may be benefcial to discontinue
vasopressin after norepinephrine to reduce the risk of haemodynamic
instability [3]. In vasoplegic shock following cardiac surgery, frst-line
vasopressin signifcantly reduced the composite endpoint of mortality and
severe complications as compared to frst-line norepinephrine [4].
Interestingly, both the VANISH and the VANCS trial used doses up to 0.06
U/min that are higher than currently recommended. Take home messages: The
role of Vasopressin as an efec-tive and safe vasopressor in septic shock
has been further reinforced by the VANISH trial and may become even more
relevant within the concept of decatecholaminisation. In vasoplegic shock
following cardiac surgery, frst randomized controlled trials emphasize the
potential beneft of vasopressin vs. norepinephrine even as frst-line
treatment. Confict of interest: The author received personal fees and
travel reimbursements from Amomed.

<59>
Accession Number
627805365
Title
The case for vasopressin.
Source
Anaesthesiology Intensive Therapy. Conference: 6th International Fluid
Academy Days. Belgium. 51 (Supplement 1) (pp 84), 2019. Date of
Publication: 2019.
Author
Rehberg S.
Institution
(Rehberg) Department of Anaesthesiology, University Hospital of
Greifswald, Germany
Publisher
Via Medica
Abstract
Learning objectives: To reinforce the use of vasopressin according to
current guidelines and to summarize additional recommendations based on
current clinical evidence. <br/>Background(s): Catecholamines can have
detrimental efects especially in high doses. These are associated with
increased mortality rates in certain patients. Therefore, non-adrener-gic
vasopressin receptor agonists represent alternatives with a potentially
lower risk profle, a higher efectivity in these shock patients and
potential additional benefts on organ function. <br/>Discussion(s): Two
large randomized controlled trials demonstrated that vasopressin as a
supplement to or substitution of norepinephrine has an equal efcacy and a
similar safety profle as norepinephrine in septic patients [1, 2]. Current
evidence suggests an early use of vasopressin and a titrated infusion
according to therapeutic goals rather than a last resort therapy and a
fxed infusion rate for hormone substitution. Subgroup analysis revealed
potential benefts over norepinephrine in respect to renal function. In
addition, vasopressin plays an important role to reduce catecholami-ne
doses as pointed out in the current sepsis guidelines. Of note, the highly
selective vasopressin 1a-receptor agonist selepressin not only stabilized
haemodynamics more efecti-vely than norepinephrine but also reduced
cumulative fuid balance in septic shock [3]. Furthermore, in vasoplegic
shock following cardiac surgery frst-line vasopressin improved clinical
outcome compared with standard treatment using norepinephrine in a recent
randomized, controlled study [4]. In addition, a study investigating the
use of vasopressin in haemorrhagic shock has been completed and the
results are expected shortly. Take home messages: Current guidelines
recommend va-sopressin as the second-line vasopressor in septic patients
with the indication to increase mean arterial pressure or to reduce
catecholamine doses. In addition to haemodymic management, there may be
additional benefts of vasopres-sin agonists in respect to renal function
and positive fuid balance. Notably, frst-line vasopressin maybe superior
to norepinephrine in vasoplegic shock following cardiac surgery. Confict
of interest: The author received personal fees and travel reimbursements
from Amomed.

<60>
Accession Number
627805474
Title
Meta-analysis of fuid overload.
Source
Anaesthesiology Intensive Therapy. Conference: 6th International Fluid
Academy Days. Belgium. 51 (Supplement 1) (pp 92-93), 2019. Date of
Publication: 2019.
Author
Silversides J.A.
Institution
(Silversides) Consultant in Critical Care and Anaesthesia, Belfast Health
and Social Care Trust, United Kingdom
Publisher
Via Medica
Abstract
Learning objectives: To review the current evidence for strategies to
prevent or treat fuid overload in critically ill patients. To discuss
future avenues for research in the prevention and management of fuid
overload. <br/>Background(s): Intravenous fuid administration, in the form
of fuid boluses, maintenance fuids, and diluents for medications, is
ubiquitous in critical care. In the context of increased capillary
permeability, endocrine infuences predisposing to sodium and water
retention, and acute kidney injury (AKI), all of which are common in
critical illness, the accumulation of large volumes of this fuid in the
interstitium is a frequent occurrence, and may impair oxygen delivery.
Numerous observational studies have demonstrated an association between
the accumulation of a positive fuid balance and adverse outcomes in
critically ill patients [1-3], and it has been suggested that strategies
aimed at prevention or treatment of fuid overload may be benefcial
following haemodynamic stabilisation [4, 5]. <br/>Discussion(s): We
undertook a systematic review and meta-analysis of the literature [6, 7],
aiming to evaluate the impact of a conservative fuid or active
deresuscitation strategy compared with standard care or a liberal fuid
strategy in critically ill adult or paediatric patients with sepsis,
systemic infammatory response syndrome (SIRS), or acute respiratory
distress syndrome (ARDS) on mortality and other clinical outcomes. We
searched Medline, Embase, and the Cochrane central register of controlled
trials, and manually searched conference proceedings for the last 5 years.
Two reviewers inde-pendently assessed publications. We included randomised
controlled trials comparing two or more fuid regimens in which fuid
balance difered, and observational studies investigating the relationship
between fuid volume administered or fuid balance achieved and patient
outcomes. We excluded studies published before 1980, studies of neonatal,
post-cardiac surgical, or heart failure patients, and observational
studies with fewer than 50 participants. Forty-nine studies were included,
of which eleven were randomised controlled trials. In a meta-analysis of
the randomised trials (2,051 patients) using a random efects model, there
was no signifcant diference in mortality with conservative or
deresuscitative strategies compared to a liberal strategy or usual care
(pooled risk ratio [RR] 0.92, 95% confdence interval [CI] 0.82-1.02,
I² = 0%). However, conservative or deresuscitative strategies
resulted in more ventilator-free days and reduced length of ICU stay
compared to a liberal strategy or standard care [8]. Marked clinical
heterogeneity was evident between trials, leaving considerable uncertainty
as to the optimum strategy to test in future trials, and demonstrating the
need for considerable further pilot work to defne optimal intervention
strategies before proceeding to large multicentre trials, which will
likely require several thousand patients. Take home messages: A
conservative or deresuscitative approach to fuid management improves some
outcomes in patients with sepsis and ARDS, although the efect on mortality
is uncertain and the level of evidence was low or very low for all
outcomes. A conservative or deresuscitative does not appear to increase
the incidence of acute kidney injury or renal replacement therapy.
Considerable pilot work remains to be done to optimise interventions to be
tested in large randomised trials comparing alternative fuid regimens.

<61>
Accession Number
627804984
Title
Long-term safety of tildrakizumab in patients with moderate-to-severe
psoriasis: Pooled analysis through 148 weeks from two phase 3 trials.
Source
Journal of the European Academy of Dermatology and Venereology.
Conference: 6th Congress of the Skin Inflammation and Psoriasis
International Network. France. 33 (Supplement 3) (pp 47-48), 2019. Date of
Publication: April 2019.
Author
Reich K.; Thaci D.; Pau-Charles I.; Igarashi A.; Ohtsuki M.; Lebwohl M.;
Cantrell W.; Rozzo S.; Blauvelt A.; Iversen L.
Institution
(Reich) Dermatologikum Berlin and SCIderm Research Institute, Hamburg,
Germany
(Thaci) University OfLubeck, Lubeck, Germany
(Pau-Charles) Almirall S.A., Barcelona, Spain
(Igarashi) NTT Medical Center Tokyo, Tokyo, Japan
(Ohtsuki) Jichi Medical University, Shimotsuke-shi, Japan
(Lebwohl) Icahn School of Medicine at Mount Sinai, New York, United States
(Cantrell) University of Alabama at Birmingham, Birmingham, United Kingdom
(Rozzo) Sun Pharmaceutical Industries, Princeton, United States
(Blauvelt) Oregon Medical Research Center, Portland, United States
(Iversen) Aarhus University Hospital, Aarhus, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Background: Tildrakizumab (TIL) is a high-affinity anti-IL-23p19
monoclonal antibody approved for the treatment of plaque psoriasis in the
USA and EU. <br/>Objective(s): To report 148-week (W) pooled safety
results in two phase 3 trials: reSURFACE 1/2 (NCT01722331/NCT01729754).
<br/>Method(s): Pooled analysis of adult patients with moderate-to-severe
plaque psoriasis from two 3-part, double-blinded, randomized controlled
trials: reSURFACE 1 (64W) and reSURFACE 2 (52W). Detailed methodology has
been previously published (Reich et al., 2017). Safety data over 148W
pooled across trials were included. Groups were placebo, etanercept (until
W28), TIL 100 mg (100 mg dose only in at least one part of the study), and
TIL 200 mg (200 mg dose only in at least one part of the study). Patients
were counted in each assigned treatment group after starting different
treatment. Exposure-adjusted incidence rates (EAIR) for adverse events
(AEs) of interest were reported. Severe infections were defined as any
infection meeting the regulatory definition of a serious adverse event
(SAE), or requiring intravenous antibiotics, irrespective of whether it
was reported as a SAE. Major adverse cardiovascular events (MACE) included
non-fatal myocardial infarction, non-fatal stroke, unstable angina,
coronary revascularization, resuscitated cardiac arrest, and
cardiovascular deaths that were confirmed as "cardiovascular" or "sudden".
<br/>Result(s): Overall, 928 patients on TIL 200 mg, 872 on TIL 100 mg,
543 on placebo, and 313 on etanercept were included. The EAIR of commonly
occurring (>5%) AEs was 27.70/100 subject-years of exposure with TIL 200
mg, 26.01 (TIL 100 mg), 82.81 (placebo), and 101.03 (etanercept). The EAIR
of severe infections was 1.12/100 subject-years of exposure with TIL 200
mg, 1.14 (TIL 100 mg), 0.97 (placebo), and 1.96 (etanercept). The EAIR of
malignancies (excluding non-melanoma skin cancer [NMSC]) was 0.39/100
subject-years of exposure with TIL 200 mg, 0.55 (TIL 100 mg), 0.0
(placebo), and 1.30 (etanercept). The EAIR of NMSC was 0.49/100
subject-years of exposure with TIL 200 mg, 0.50 (TIL 100 mg), 0.97
(placebo), and 1.30 (etanercept). The EAIR of confirmed MACE was 0.54/100
subject-years of exposure with TIL 200 mg, 0.40 (TIL 100 mg), 0.49
(placebo), and 0.65 (etanercept). The EAIR of SAE/drug-related SAE/SAE
leading to discontinuation/drug-related SAE leading to discontinuation was
5.47/0.54/0.78/0.20 per 100 subject-years of exposure with TIL 200 mg,
5.86/0.79/0.94/0.35 with TIL 100 mg, 6.33/0.97/0.49/0.00 with placebo, and
13.04/3.26/3.26/0.65 with etanercept. In conclusion, TIL was
well-tolerated with low rate of severe infections, malignancies, and MACE,
and with less than 1 patient with a drug-related SAE or discontinuation
due to drug-related SAE per 100 subject-years.

<62>
Accession Number
627804975
Title
Incidence of cardiovascular events in patients with moderate-to-severe
plaque psoriasis treated with tildrakizumab: Pooled analysis from a phase
2 and two phase 3 trials.
Source
Journal of the European Academy of Dermatology and Venereology.
Conference: 6th Congress of the Skin Inflammation and Psoriasis
International Network. France. 33 (Supplement 3) (pp 46-47), 2019. Date of
Publication: April 2019.
Author
Bissonnette R.; Fernandez-Penas P.; Puig L.; Peserico A.; Fumero E.;
Mendelsohn A.; Rozzo S.; Menter A.
Institution
(Bissonnette) Innovaderm Research, Montreal, Canada
(Fernandez-Penas) Westmead Hospital, Westmead, Australia
(Fernandez-Penas) University of Sidney, Sidney, Australia
(Puig) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Peserico) DIMED University of Padua, Padua, Italy
(Fumero) Almirall S.A., Barcelona, Spain
(Mendelsohn, Rozzo) Sun Pharmaceutical Industries, Princeton, United
States
(Menter) Texas A and M College of Medicine, Dallas, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: Tildrakizumab (TIL) is a high-affinity anti-IL-23p19
monoclonal antibody approved for the treatment of plaque psoriasis in the
USA and EU. Observational studies suggest that patients with
moderate-to-severe plaque psoriasis may have increased risk of major
adverse cardiovascular events (MACE) [1]. <br/>Objective(s): The objective
was to assess the incidence of cardiovascular (CV) events during phase 2
and 3 trials of TIL clinical program. <br/>Method(s): Pooled analysis of
adult patients with moderate-to-severe plaque psoriasis from P05495 (phase
2b trial; NCT01225731) [2] and reSURFACE 1 and 2 (phase 3 trials;
NCT01722331 and NCT01729754) [3] who were treated with placebo (PBO), TIL
100 mg, or TIL 200 mg at Week 0, Week 4, and every 12 weeks thereafter and
followed up to Week 52 (P05495/reS-URFACE 2) or Week 64 (reSURFACE 1). PBO
control groups were included up to Week 16 (P05495) or Week 12 (reSURFACE
1 and 2). The reSURFACE 2 trial included an etanercept (ETN) 50 mg arm
administered twice weekly for 12 weeks, then once weekly up to Week 28. We
analyzed safety data from the full-trial periods and Year 1 of the
extension periods. Patients with multiple treatments were counted in each
assigned treatment group after starting different treatment. Extensions to
phase 3 trials are ongoing. MACE comprised non-fatal myocardial infarction
(MI), stroke, and CV deaths confirmed as CV or sudden. Confirmed
composite-adjudicated CV (CACV) events included MACE, unstable angina,
coronary revascularization, resuscitated cardiac arrest, and fatal or
non-fatal thrombotic, embolic, or ischemic CV events. <br/>Result(s):
Overall, 1083 patients treated with TIL 100 mg, 1041 with TIL 200 mg, 588
with PBO, and 313 with ETN were included. The numbers of patients with
CACV events (exposure-adjusted rate, measured as the number of patients
with events/100 patient-years) were comparable for the TIL 100 mg (4
[0.40]) and TIL 200 mg (8 [0.86]) groups versus PBO (1 [0.46]) and ETN (1
[0.65]). Three deaths were adjudicated as MACE unrelated to study
treatment, all in patients with pre-existent CV risk factors (e.g.,
hypertension): aneurysm (TIL 200 mg), respiratory arrest and MI (both TIL
100 mg). In the extension, across TIL 100 mg and TIL 200 mg groups (n =
1237), only 7 patients had CACV events (0.60%); no deaths were due to CV
events. In conclusion, the incidence of CV events was low and comparable
across TIL 100 or 200 mg groups and versus the PBO and ETN groups.

<63>
Accession Number
627805180
Title
Austrian syndrome with quadruple valve infective endocarditis: A case
report and literature review of quadruple valve infective endocarditis.
Source
Open Forum Infectious Diseases. Conference: ID Week 2016. United States. 3
(Supplement 1) (no pagination), 2016. Date of Publication: September 2016.
Author
Zheng S.; Soh X.J.J.; Shafi H.
Institution
(Zheng, Soh) Department of Infectious Diseases, Singapore General
Hospital, Singapore, Singapore
(Shafi) Medicine, Infectious Disease, Changi General Hospital, Singapore,
Singapore
Publisher
Oxford University Press
Abstract
Background. The triad of pneumonia, meningitis and infective endocarditis
(IE) due to pneumococcus was first described in 1862.We present what we
believe to be the first reported case of Austrian syndrome with four-valve
involvement. Methods. A 54-year-old male presented with a two-week history
of fever, cough and headache. He had no medical history and denied
intravenous (IV) drug abuse. Examination revealed an early diastolic
murmur with basal crackles in the left lung. Chest radiograph showed
bronchopneumonia. He was started on IV antibiotics. Blood cultures were
non-yielding. Vegetations involving the mitral and aortic valves were seen
on transthoracic echocardiography. On the fourth hospitalization day, he
developed right arm weakness and seizures. Magnetic resonance imaging
revealed leptomeningeal enhancement, and cortical infarcts. A spinal tap
performed was consistent with meningitis but Gram stain and culture were
negative. Cerebrospinal fluid S. pneumoniae antigen was positive. A
diagnosis of Austrian syndrome with septic brain emboli was made.
Transesophageal echocardiography showed a ventricular septal defect and
quadruple-valve IE, complicated by aortic valvular perforation and
regurgitation. He developed multi-organ failure before surgery and passed
away. A PubMed search for English reports of quadruple valve IE was
conducted for the literature review. Results. A total of 19 cases were
available, including our patient. The mean age of presentation was 48.3
years, ranging from 7 to 82 years. There were more men (84.2%) than women
(15.8%). Four patients had a history of IV drug abuse, four had underlying
congenital heart disease and one had both. Two patients (10.5%) had two
pathogens isolated. S. aureus and S. viridans (three cases, 15.8% each)
were most commonly implicated. Heart failure was the commonest
complication, seen in eight patients (42.1%). The case fatality rate was
52.6%. Cardiac surgery was of borderline significance in predicting
survival (p = 0.054). IE was diagnosed only at post mortem in two cases
(10.5%). Conclusion. We report a case of quadruple valve IE due to S.
pneumoniae, presenting with Austrian triad in a patient with a newly
diagnosed ventricular septal defect. Risk factors for quadruple valve IE
include congenital heart disease and IV drug abuse. Clinicians need to
remain vigilant in the presence of these risk factors.

<64>
Accession Number
627786362
Title
Spontaneous Hemothorax in a Patient with von Recklinghausen's Disease: A
Case Report and Review of the Literature.
Source
The American journal of case reports. 20 (pp 674-678), 2019. Date of
Publication: 11 May 2019.
Author
Degbelo F.D.A.; Cito G.; Guendil B.; Christodoulou M.; Abbassi Z.
Institution
(Degbelo, Cito, Guendil) Department of Surgery, Sion Hospital, Sion,
Switzerland
(Christodoulou) Division of Thoracic Surgery, Department of Surgery, Sion
Hospital, Sion, Switzerland
(Abbassi) Department of Surgery, University Hospitals of Geneva, Geneva,
Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND Von Recklinghausen's disease, also known as Type 1
neurofibromatosis (NF1), is a genetic disorder characterized by skin
tumors, neurofibromas of multiple organs and vascular abnormalities.
Spontaneous thoracic hemorrhage is a rare but potentially fatal
consequence of this disorder. After a review of the literature over the
last 10 years and on the basis of a case study, the aim of this study was
to report the challenges of management of this pathology. CASE REPORT We
report a rare case of a 45-years-old male with a medical history of
neurofibromatosis who complained of a 3-day history of progressive
dyspnea. At his admission to the Emergency Department, the patient was
hemodynamically stable. A chest computed tomography (CT) scan showed a
large left hemothorax with mediastinal shift to the right without active
bleeding. A chest tube was introduced, and conservative treatment was
followed. Another CT scan performed 2 days later revealed a middle lobar
pulmonary embolism on the opposite side. A full treatment of
anticoagulation was administered, and the patient was released after 8
days of hospitalization. Three weeks later, a new chest CT scan indicated
the absence of vascular aneurysm or source for hemothorax. CONCLUSIONS Our
systematic literature review found 15 articles which were described as
early as 2005. To our knowledge, endovascular treatment produces the best
immediate successful result (100%) and may be used in adjunction with
video-assisted thorax surgery (VATS) or thoracic drainage to optimize
outcomes. In the present case, conservative treatment showed a good result
despite anticoagulation for pulmonary embolism. The endovascular approach
seems to be the most promising, but treatment needs to be tailored to each
individual patient.

<65>
Accession Number
627787457
Title
Aortic injury by thoracic pedicle screw. When is aortic repair required?
Literature review and three new cases.
Source
World neurosurgery. (no pagination), 2019. Date of Publication: 08 May
2019.
Author
Kayaci S.; Cakir T.; Dolgun M.; Cakir E.; Bozok S.; Temiz C.; Caglar Y.S.
Institution
(Kayaci) Associate Professor of Neurosurgery, Erzincan University, Faculty
of Medicine, Department of Neurosurgery, Erzincan, Turkey
(Cakir) Assistant Professor of Neurosurgery, Erzincan University, Faculty
of Medicine, Department of Neurosurgery, Erzincan, Turkey
(Dolgun) Specialist of Neurosurgery, Erzincan University, Faculty of
Medicine, Department of Neurosurgery, Erzincan, Turkey
(Cakir) Professor of Neurosurgery, Karadeniz Tecnical university, Faculty
of Medicine, Department of Neurosurgery, Trabzon, Turkey
(Bozok) Associate Professor of Cardiovascular Surgery, Usak University,
Faculty of Medicine, Department of Cardiovascular Surgery, Usak, Turkey
(Temiz) Professor of Neurosurgery, Celal Bayar University, Faculty of
Medicine, Department of Neurosurgery, Manisa, Turkey
(Caglar) Professor of Neurosurgery, Ankara University, Faculty of
Medicine, Department of Neurosurgery, Ankara, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: Aortic injury by pedicle screw is rare but can cause serious
complications. It has been clearly determined when aortic repair is
necessary in cases of screw impingement without perforation of the aortic
wall. In this article, we review the treatment and clinical course of
pedicle screw aortic impingement and attempt to clarify this issue.
<br/>METHOD(S): Cases of aortic injury during thoracic screw procedures
found using a MEDLINE search and analyzed together with three new cases
that we present. <br/>RESULT(S): Nineteen cases collected from the
literature and three new cases were included in the study. In seven of the
cases, aortic impingement by the pedicle screw was detected during
postoperative follow-up (day 1) radiological examinations. In the other
cases, time to presentation of aortic impingement ranged between 2
weeks-60 months after fixation. The main indications for thoracic spinal
fixation were post-traumatic vertebral fracture and kyphoscoliosis
/scoliosis. Repair of the aortic damage ranged from primary repair to
stent and tube graft placement by thoracic endovascular aortic repair
(TEVAR) method. <br/>CONCLUSION(S): In cases where the screw impinges less
than 5 mm into the aortic wall, hardware revision without aortic repair
may be sufficient if recognized early and there are no sign of aortic
leakage in vascular imaging. However, cases with more than 5 mm of screw
impingement should undergo aortic repair first, even in the absence of
aortic leakage, following by screw revision.<br/>Copyright Published by
Elsevier Inc.

<66>
Accession Number
2002010322
Title
Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve
Implantation for Pure Native Aortic Regurgitation.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Ltd
Abstract
Aim: To assess outcomes of transcatheter aortic valve implantation (TAVI)
for pure native aortic regurgitation (AR) and to evaluate whether 30-day
all-cause mortality is modulated by patient characteristics, we performed
a meta-analysis and meta-regression of currently available studies.
<br/>Method(s): Studies enrolling >=20 patients undergoing TAVI for AR
were considered for inclusion. Study-specific estimates (incidence rates
of outcomes) were combined using one-group meta-analysis in a
random-effects model. Subgroup meta-analysis of studies exclusively using
early-generation devices (EGD) and new-generation devices (NGD) and
stepwise random-effects multivariate meta-regression were also performed.
<br/>Result(s): The search identified 11 eligible studies including a
total of 911 patients undergoing TAVI for AR. Pooled analysis demonstrated
an incidence of device success of 80.4% (NGD 90.2%, EGD 67.2%; p < 0.001),
moderate or higher paravalvular aortic regurgitation (PAR) of 7.4% (NGD
3.4%, EGD 17.3%; p < 0.001), 30-day all-cause mortality of 9.5% (NGD 6.1%,
EGD 14.7%; p < 0.001), mid-term (4 mo - 1 yr) all-cause mortality of 18.8%
(NGD 11.8%, EGD 32.2%; p < 0.001), life-threatening/major bleeding
complications (BC) 5.7% (NGD 3.5%, EGD 12.4%; p = 0.015), and major
vascular complications (MVC) of 3.9% (NGD 3.0%, EGD 6.2%; p = 0.041). All
coefficients in the multivariate meta-regression adjusting simultaneously
for the proportion of diabetes mellitus, chronic obstructive pulmonary
disease, peripheral arterial disease, concomitant moderate or higher
mitral regurgitation, and mean left ventricular ejection fraction (with
significant coefficients in the univariate meta-regression) were not
statistically significant. <br/>Conclusion(s): Thirty (30)-day all-cause
mortality after TAVI for AR was high (9.5%) with a high incidence of
moderate or higher PAR (7.4%). Compared with EGD, NGD was associated with
significantly higher device success rates and significantly lower rates of
second-valve deployment, moderate or higher PAR, 30-day/mid-term all-cause
mortality, serious BC, and MVC.<br/>Copyright &#xa9; 2019 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<67>
Accession Number
608761473
Title
Novel Approaches in Primary Cardiovascular Disease Prevention: The HOPE-3
Trial Rationale, Design, and Participants' Baseline Characteristics.
Source
Canadian Journal of Cardiology. 32 (3) (pp 311-318), 2016. Date of
Publication: 01 Mar 2016.
Author
Lonn E.; Bosch J.; Pogue J.; Avezum A.; Chazova I.; Dans A.; Diaz R.;
Fodor G.J.; Held C.; Jansky P.; Keltai M.; Keltai K.; Kunti K.; Kim J.-H.;
Leiter L.; Lewis B.; Liu L.; Lopez-Jaramillo P.; Pais P.; Parkhomenko A.;
Peters R.J.G.; Piegas L.S.; Reid C.M.; Sliwa K.; Toff W.D.; Varigos J.;
Xavier D.; Yusoff K.; Zhu J.; Dagenais G.; Yusuf S.
Institution
(Lonn, Yusuf) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Lonn, Bosch, Pogue, Yusuf) Population Health Research Institute, Hamilton
Health Sciences and McMaster University, Hamilton, ON, Canada
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Chazova) Russian Cardiology Research Complex, Moscow, Russian Federation
(Dans) College of Medicine of the University of the Philippines, Manula,
Philippines
(Diaz) Fundacion ECLA, Rosario, Argentina
(Fodor) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Held) Department of Medical Sciences, Uppsala University, Uppsala, Sweden
(Jansky) University Hospital Motol, Prague, Czechia
(Keltai, Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Kunti) Diabetes Research Centre, University of Leicester, Leicester,
United Kingdom
(Kim) St. Paul's Hospital, The Catholic University of Korea, Seoul, South
Korea
(Leiter) Li Ka Shing Knowledge Institute and Keenan Research Centre for
Biomedical Science, St. Michael's Hospital, University of Toronto,
Toronto, ON, Canada
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
(Liu) Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China
(Lopez-Jaramillo) Fundacion Oftalmolgica de Santander (FOSCAL) and
Instituto Masira, Medical School, Universidad de Santander, Bucaramanga,
Colombia
(Pais, Xavier) Division of Clinical Research and Training, St. John's
Research Institute, Bangalore, India
(Parkhomenko) Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
(Peters) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Piegas) Hospital do Coracao, Sao Paulo, Brazil
(Reid, Varigos) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Sliwa) Hatter Institute for Cardiovascular Research in Africa, Department
of Medicine, University of Cape Town and Soweto Cardiovascular Research
Group, Johannesburg, South Africa
(Toff) Department of Cardiovascular Sciences, University of Leicester and
Leicester NIHR Biomedical Research Unit in Cardiovascular Disease,
Glenfield Hospital, Leicester, United Kingdom
(Yusoff) Universiti Teknologi MARA, Selangor, Malaysia
(Zhu) Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, China
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Universite Laval, QC, Canada
Publisher
Pulsus Group Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Cholesterol and blood pressure (BP) can be effectively and
safely lowered with statin drugs and BP-lowering drugs, reducing major
cardiovascular (CV) events by 20%-30% within 5 years in high-risk
individuals. However, there are limited data in lower-risk populations.
The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating
whether cholesterol lowering with a statin drug, BP lowering with low
doses of 2 antihypertensive agents, and their combination safely reduce
major CV events in individuals at intermediate risk who have had no
previous vascular events and have average cholesterol and BP levels.
<br/>Method(s): A total of 12,705 women 65 years or older and men 55 years
or older with at least 1 CV risk factor, no known CV disease, and without
any clear indication or contraindication to the study drugs were
randomized to rosuvastatin 10 mg/d or placebo and to
candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 x 2 factorial
design) and will be followed for a mean of 5.8 years. The coprimary study
outcomes are the composite of CV death, nonfatal myocardial infarction
(MI), and nonfatal stroke and the composite of CV death, nonfatal MI,
nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial
revascularization. <br/>Result(s): Participants were recruited from 21
countries in North America, South America, Europe, Asia, and Australia.
Mean age at randomization was 66 years and 46% were women.
<br/>Conclusion(s): The HOPE-3 trial will provide new information on
cholesterol and BP lowering in intermediate-risk populations with average
cholesterol and BP levels and is expected to inform approaches to primary
prevention worldwide (HOPE-3 ClinicalTrials.gov
NCT00468923).<br/>Copyright &#xa9; 2016 Canadian Cardiovascular Society.

<68>
[Use Link to view the full text]
Accession Number
603784511
Title
Conflicting results between randomized trials and observational studies on
the impact of proton pump inhibitors on cardiovascular events when
coadministered with dual antiplatelet therapy: Systematic review.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (1) (pp 47-55), 2015.
Date of Publication: 2015.
Author
Melloni C.; Washam J.B.; Jones W.S.; Halim S.A.; Hasselblad V.; Mayer
S.B.; Heidenfelder B.L.; Dolor R.J.
Institution
(Melloni, Jones, Halim, Hasselblad, Heidenfelder, Dolor) Duke Clinical
Research Institute, Duke University, Medical Center, Box 3850, Durham, NC
27710, United States
(Washam) Duke Heart Center, Duke University, Medical Center, Durham, NC,
United States
(Mayer) Division of Endocrinology and Metabolism, Department of Medicine,
Virginia Commonwealth University, Richmond, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Discordant results have been reported on the effects of
concomitant use of proton pump inhibitors (PPIs) and dual antiplatelet
therapy (DAPT) for cardiovascular outcomes. We conducted a systematic
review comparing the effectiveness and safety of concomitant use of PPIs
and DAPT in the postdischarge treatment of unstable
angina/non-ST-segment-elevation myocardial infarction patients.
<br/>Methods and Results: We searched for clinical studies in MEDLINE,
EMBASE, and the Cochrane Database of Systematic Reviews, from 1995 to
2012. Reviewers screened and extracted data, assessed applicability and
quality, and graded the strength of evidence. We performed meta-analyses
of direct comparisons when outcomes and follow-up periods were comparable.
Thirty-five studies were eligible. Five (4 randomized controlled trials
and 1 observational) assessed the effect of omeprazole when added to DAPT;
the other 30 (observational) assessed the effect of PPIs as a class when
compared with no PPIs. Random-effects meta-analyses of the studies
assessing PPIs as a class consistently reported higher event rates in
patients receiving PPIs for various clinical outcomes at 1 year (composite
ischemic end points, all-cause mortality, nonfatal MI, stroke,
revascularization, and stent thrombosis). However, the results from
randomized controlled trials evaluating omeprazole compared with placebo
showed no difference in ischemic outcomes, despite a reduction in upper
gastrointestinal bleeding with omeprazole. <br/>Conclusion(s): Large,
well-conducted observational studies of PPIs and randomized controlled
trials of omeprazole seem to provide conflicting results for the effect of
PPIs on cardiovascular outcomes when coadministered with DAPT. Prospective
trials that directly compare pharmacodynamic parameters and clinical
events among specific PPI agents in patients with unstable
angina/non-ST-segment-elevation myocardial infarction treated with DAPT
are warranted.<br/>Copyright &#xa9; 2015 American Heart Association, Inc.

<69>
Accession Number
627772810
Title
Innovative behavioral health screening and resilience building
intervention for pediatric heart transplant youth and families: The
focus-pedsht program.
Source
Pediatric Transplantation. Conference: 10th Congress of the International
Pediatric Transplant Association. Canada. 23 (Supplement 1) (no
pagination), 2019. Date of Publication: May 2019.
Author
Wijesekera K.; Aralis H.; Sinclair M.; Cosanella T.; Alejos J.; Lester P.
Institution
(Wijesekera, Aralis, Sinclair, Cosanella, Lester) UCLA Semel Institute for
Neuroscience and Human Behavior, UCLA, Los Angeles, CA, United States
(Alejos) UCLA Children's Heart Center, UCLA, Los Angeles, CA, United
States
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: Systematic behavioral health screening and preventive
interventions for pediatric heart transplant patients and their families
are lacking. This presentation aims to describe the delivery of the
Families OverComing Under Stress-Pediatric Heart Transplant (FOCUS-PedsHT)
program, which involves family-centered behavioral health screening (with
real-time feedback) paired to an in-home video teleconference (VTC) based
intervention designed to improve adherence and optimize the behavioral
health of pediatric heart transplant (HT) patients and their families.
<br/>Method(s): Eleven children with a heart transplant (ages 9-18) and
their families have been recruited thus far for the FOCUS-PedsHT pilot
study from the UCLA outpatient HT clinic and randomly assigned to: 1)
'intervention group', receiving 8-10 video-teleconferencing (VTC; n = 5),
or 2) treatment as usual (e.g. their usual clinic appointments; n = 6). At
baseline, all families completed screeners on an iPad measuring caregiver
and youth behavioral health symptoms and barriers to medication adherence.
Those randomized to the intervention group received VTC sessions that
focus on trauma-informed psychoeducation and developmental guidance,
narrative work, and resilience skills (Figure 1). <br/>Result(s): Youth
ratings revealed rates of clinically significant anxiety (45.5%),
post-traumatic stress symptoms (36.4%), and depression (9.1%). Caregiver
self-reports indicated clinically elevated post-traumatic stress symptoms
(55.6%), depression (50%), and anxiety (30%). Youth responses further
indicated that, having too many pills to take (45.5%) and disliking the
taste of medicine (54.5%) were the top two barriers for adherence. From
the caregiver perspective, two common barriers included having too many
pills to take (50%) and being tired of living with a medical condition
(50%). Of the 5 families in the intervention condition, 3 families are
actively engaged in the VTC sessions, 1 family has not been able to follow
through and schedule sessions, and 1 family stopped the program due to an
unexpected change in the child's medical status and lengthy
hospitalization. <br/>Conclusion(s): This presentation provides a valuable
behavioral health profile of HT youth and caregivers. Additionally,
web-based screening procedures and telehealth platforms appear to be a
promising format that could be implemented with HT youth and families seen
in an outpatient pediatric treatment setting.

<70>
Accession Number
2001990234
Title
IP149. A Literature Review of Iatrogenic Injury to Artery of Adamkiewcz
and Management of Injury or Occlusion.
Source
Journal of Vascular Surgery. Conference: 2019 Vascular Annual Meeting.
United States. 69 (6) (pp e150), 2019. Date of Publication: June 2019.
Author
GnanaDev R.; Makkar G.; Esiobu P.; Iwanaga J.; Oskouian R.; Loukas M.;
Tubbs R.S.
Institution
(GnanaDev, Makkar, Esiobu) Arrowhead Regional Medical Center, Colton,
Calif, United States
(Iwanaga, Oskouian, Tubbs) Seattle Science Foundation, Seattle, Wash,
United States
(Loukas) St. George's University School of Medicine, Latham, NY, United
States
Publisher
Mosby Inc.
Abstract
Objectives: While there are multiple radiculomedullary arteries derived
from the subclavian artery supplying oxygenated blood to the cervical
spinal cord, the caudal thoracic and lumbar regions of the spinal cord are
dependent on fewer, larger radiculomedullary arteries derived from the
aorta which collateralize with the anterior spinal artery. The most
prominent of these radiculomedullary arteries, typically derived between
the T8 and L2 vertebral segments, is the artery of Adamkiewicz (AKA).
Injury may lead to paraplegia, paralysis, and urinary or fecal
incontinence. This study reviews the literature on iatrogenic injury to
the AKA, and discusses known management techniques for injury or
occlusion. <br/>Method(s): A review of published literature on iatrogenic
injury of the AKA was performed from December 2018 to January 2019 on
following websites: Google, Google Books, Google Scholar, and PubMed.
Queries included various combinations of the terms "iatrogenic injury,"
"anterior spinal injury syndrome," "anterior spinal cord infarction,"
"artery of Adamkiewcz," "arteria radicularis magna," "great radicular
artery of Adamkiewcz," "major anterior segmental medullary artery,"
"artery of the lumbar enlargement," "great anterior radiculomedullary
artery," "great anterior segmental medullary artery," and
"thoracoabdominal aortic repair." Results: Iatrogenic injury of the AKA
has been documented in the following procedures: open or video-assisted
thoracic surgery, open or laparoscopic abdominal surgery with the reported
incidences ranging from less than 0.1% to 23.0% depending on the specific
procedure, transforaminal epidural steroid injections with fewer than 10
documented cases of AKA all related to variations from typical anatomy,
anterior and posterior spine surgeries including discectomies and repairs
of vertebral fractures with a documented incidence less than 1 in 2000,
and as a severe complication of bronchial artery thrombosis with an
overall incidence of 1.4% to 6.5%. With increasing resolution of computed
tomographic angiography and magnetic resonance imaging, visualization of
the AKA may also be considered before elective surgery. Of note, the
vascular surgery community has clear recommendations when the AKA is
expected to be occluded as seen in thoracoabdominal repair of aortic
aneurysms. Recommendations include optimizing collateral flow by
increasing mean arterial pressure, decreasing spinal cord pressures via a
cerebrospinal fluid drain placed preoperatively, and minimizing spinal
cord inflammation through selective spinal cord hypothermia and use of
various pharmaceuticals including steroids and naloxone.
<br/>Conclusion(s): This review is meant to emphasize the critical
importance of understanding of regional vascular anatomy for any physician
performing an invasive procedure in the territory of the AKA. Knowledge of
anatomical variations is vital to avoid potentially life-altering
complications.<br/>Copyright &#xa9; 2019

<71>
Accession Number
2001995659
Title
The top 100 manuscripts in emergency cardiac surgery. Potential role in
cardiothoracic training. A bibliometric analysis.
Source
Annals of Medicine and Surgery. 43 (pp 5-12), 2019. Date of Publication:
July 2019.
Author
Karsan R.B.; Powell A.G.; Nanjaiah P.; Mehta D.; Valtzoglou V.
Institution
(Karsan, Nanjaiah, Mehta, Valtzoglou) Department of Cardiothoracic
Surgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XW,
United Kingdom
(Powell) Division of Cancer and Genetics, Cardiff University, Heath Park,
Cardiff CF14 4XW, United Kingdom
(Powell) Department of Surgery, University Hospital of Wales, Heath Park,
Cardiff CF14 4XW, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Emergency Cardiac Surgery (ECS)is a component of
cardiothoracic training. Citations are considered to represent a papers
influence. Bibliometric analyses allow us to identify the most influential
work, and future research. We aim to highlight the key research themes
within ECS and determine their potential impact on cardiothoracic
training. <br/>Method(s): Thomas Reuters Web of Science was searched using
terms [Emergency AND Card* AND Surg*]. Results were ranked by citation and
reviewed by a panel of cardiac surgeons to identify the top 100 cited
papers relevant to ECS. Papers were analysed by topic, journal and impact.
Regression analysis was used to determine a link between impact factor and
scientific impact. <br/>Result(s): 3823 papers were identified. Median
citations for the top 100 was 88. The paper with the highest impact was by
Nashef et al. focusing on the use of EuroSCORE (2043 citations). The
Annals of Thoracic Surgery published most papers (n = 18:1778 citations).
The European Journal of Cardiothoracic Surgery coveted the most citations
(n = 2649). The USA published most papers (n = 55).The most ubiquitous
topics were; risk stratification, circulatory support and aortic surgery.
A positive relationship between journal impact fact and the scientific
impact of manuscripts in ECS (P = 0.043)was deduced. <br/>Conclusion(s):
This study is the first of its kind and identified the papers which are
likely to the contribute most to training and understanding of ECS. A
papers influence is partially determined by journal impact factor.
Bibliometric analysis is a potent tool to identify surgical training
needs.<br/>Copyright &#xa9; 2019 The Author(s)

<72>
Accession Number
627765556
Title
Transcatheter Mitral Valve Implantation with the Medtronic
Intrepid^TM Transcatheter Mitral Valve Replacement System.
Source
Future cardiology. (no pagination), 2019. Date of Publication: 10 May
2019.
Author
Koh J.Q.; Walton A.; Marasco S.; Duffy S.J.
Institution
(Koh, Walton, Duffy) Department of Cardiology, Alfred Hospital, Melbourne,
Victoria, Australia
(Marasco) Department of Cardiothoracic Surgery, Alfred Hospital,
Melbourne, Victoria, Australia
(Duffy) Centre of Cardiovascular Research & Education in Therapeutics,
Department of Epidemiology & Preventive Medicine, Monash University,
Melbourne, Victoria, Australia
Publisher
NLM (Medline)
Abstract
Mitral regurgitation is the most prevalent yet undertreated valvulopathy
despite its adverse prognosis. With the emergence of transcatheter mitral
interventions, the potential for this huge unmet disease burden to be
addressed may finally be realized. Medtronic IntrepidTM Transcatheter
Mitral Valve Replacement System represents one of several novel solutions.
Based on early data from the pilot study, its efficacy and clinical
utility is currently being tested against the mainstay treatment of
surgical mitral valve replacement in a randomized trial. While there
remain significant challenges before transcatheter mitral intervention can
become part of the routine treatment algorithm, the authors are optimistic
that transcatheter mitral valve repair and intervention have the potential
in revolutionizing the management of severe symptomatic mitral
regurgitation.

<73>
Accession Number
2002002348
Title
Risk of Ischemic Mitral Regurgitation Recurrence After Combined Valvular
and Subvalvular Repair.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Nappi F.; Lusini M.; Avtaar Singh S.S.; Santana O.; Chello M.; Mihos C.G.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Lusini, Chello) Department of Cardiovascular Surgery, University Campus
Bio-Medico of Rome, Rome, Italy
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Santana, Mihos) Echocardiography Laboratory, Columbia University Division
of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States
Publisher
Elsevier USA
Abstract
Background: Mitral valve repair (MVr) combined with papillary muscle
approximation (PMA) may improve repair durability in severe ischemic
mitral regurgitation (MR), when compared with MVr alone. We sought to
identify preoperative transthoracic echocardiographic markers associated
with MR recurrence after MVr with PMA. <br/>Method(s): A post-hoc analysis
was performed on patients with severe ischemic MR who underwent coronary
artery bypass graft surgery with MVr with PMA in the papillary muscle
approximation randomized trial. The PMA was performed utilizing a 4-mm
polytetrafluoroethylene graft placed around the papillary muscles. Linear
regression analyses and receiver-operating characteristic curves were used
to identify echocardiographic variables and diagnostic models associated
with recurrent MR. <br/>Result(s): There were 48 patients with a mean age
of 63 +/- 7 years, a left ventricular ejection fraction of 35% +/- 5%, and
a left ventricular end-diastolic diameter of 63 +/- 3 mm. Of these, 37
patients had baseline and 5-year follow-up echocardiograms, with
moderate-to-severe MR recurring in 27%. Linear regression analyses
revealed associations between preoperative pulmonary artery systolic
pressure (standardized beta coefficient, beta = 0.49/mm Hg, p = 0.002), MV
tenting area (beta = 0.47/cm², p = 0.004), a symmetric MV
tethering pattern (beta = 0.44, p = 0.007), and left ventricular
end-diastolic diameter (beta = 0.37/mm, p = 0.02) with follow-up MR grade.
The presence of both MV tenting area 3.1 cm² or greater (area
under the curve 0.822) and left ventricular end-diastolic diameter of 64
mm or greater (area under the curve 0.801) was the most robust
discriminative model for moderate-to-severe MR recurrence (specificity
92%, sensitivity 69%, area under the curve 0.804, p = 0.003).
<br/>Conclusion(s): In patients undergoing coronary artery bypass graft
surgery with MVr plus PMA, the extent of baseline MV apparatus and left
ventricle geometric remodeling identifies patients at increased risk for
MR recurrence.<br/>Copyright &#xa9; 2019

<74>
Accession Number
2001998265
Title
Systematic review and consensus definitions for the Standardised Endpoints
in Perioperative Medicine initiative: clinical indicators.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Fleisher L.A.; Grocott M.P.W.; Myles P.S.; Myles P.; Grocott M.; Biccard
B.; Blazeby J.; Boney O.; Chan M.; Diouf E.; Fleisher L.; Kalkman C.; Kurz
A.; Moonesinghe R.; Wijeysundera D.; Gan T.J.; Peyton P.; Sessler D.;
Tramer M.; Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.; Botti
M.; Haller G.; Cook T.; Neuman M.; Story D.; Gruen R.; Bampoe S.; Evered
L.; Scott D.; Silbert B.; van Dijk D.; Grocott H.; Eckenhoff R.; Rasmussen
L.; Eriksson L.; Beattie S.; Landoni G.; Leslie K.; Howell S.; Nagele P.;
Richards T.; Lamy A.; Lalu M.; Pearse R.; Mythen M.; Canet J.; Moller A.;
Gin T.; Schultz M.; Pelosi P.; Gabreu M.; Futier E.; Creagh-Brown B.;
Abbott T.; Klein A.; Corcoran T.; Jamie Cooper D.; Dieleman S.; McIlroy
D.; Bellomo R.; Shaw A.; Prowle J.; Karkouti K.; Billings J.; Mazer D.;
Jayarajah M.; Murphy M.; Bartoszko J.; Sneyd R.; Morris S.; George R.;
Shulman M.; Lane-Fall M.; Nilsson U.; Stevenson N.; Cooper J.D.J.; van
Klei W.; Cabrini L.; Miller T.; Pace N.; Jackson S.; Buggy D.; Short T.;
Riedel B.; Gottumukkala V.; Alkhaffaf B.; Johnson M.
Institution
(Haller) Department of Anaesthesiology, Geneva University Hospitals,
Geneva, Switzerland
(Haller, Myles) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Bampoe) Centre for Perioperative Medicine, University College London,
United Kingdom
(Cook) Department of Anaesthesia and Intensive Care, Royal United
Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
(Fleisher, Neuman) Departments of Anesthesiology and Critical Care and
Medicine, Perelman School of Medicine of the University of Pennsylvania,
Philadelphia, PA, United States
(Grocott) Integrative Physiology and Critical Illness Group, Clinical and
Experimental Sciences, Faculty of Medicine, University Hospital
Southampton, Southampton, United Kingdom
(Grocott) Anaesthesia, Perioperative and Critical Care Research Group,
Southampton NIHR Biomedical Research Centre, University Hospital
Southampton, Southampton, United Kingdom
(Story) Centre for Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Myles) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Clinical indicators are powerful tools to quantify the safety
and quality of patient care. Their validity is often unclear and
definitions extremely heterogeneous. As part of the International
Standardised Endpoints in Perioperative Medicine (StEP) initiative, this
study aimed to derive a set of standardised and valid clinical outcome
indicators for use in perioperative clinical trials. <br/>Method(s): We
identified clinical indicators via a systematic review of the anaesthesia
and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane
Library). We performed a three-stage Delphi consensus-gaining process that
involved 54 clinician-researchers worldwide. Indicators were first
shortlisted and the most suitable definitions for evaluation of quality
and safety interventions determined. Indicators were then assessed for
validity, reliability, feasibility, and clarity. <br/>Result(s): We
identified 167 clinical outcome indicators. Participation in the three
Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A
final list of eight outcome indicators was generated: surgical site
infection at 30 days, stroke within 30 days of surgery, death within 30
days of coronary artery bypass grafting, death within 30 days of surgery,
admission to the intensive care unit within 14 days of surgery,
readmission to hospital within 30 days of surgery, and length of hospital
stay (with or without in-hospital mortality). They were rated by the
majority of experts as valid, reliable, easy to use, and clearly defined.
<br/>Conclusion(s): These clinical indicators can be confidently used as
endpoints in clinical trials measuring quality, safety, and improvement in
perioperative care. Registration: PROSPERO 2016 CRD42016042102
(http://www.crd.york.ac.uk/PROSPERO/display_record.php?
ID=CRD42016042102).<br/>Copyright &#xa9; 2019 British Journal of
Anaesthesia

<75>
Accession Number
2001964124
Title
N-acetylcysteine use among patients undergoing cardiac surgery: A
systematic review and meta-analysis of randomized trials.
Source
PLoS ONE. 14 (5) (no pagination), 2019. Article Number: e0213862. Date of
Publication: May 2019.
Author
Pereira J.E.G.; Dib R.E.; Braz L.G.; Escudero J.; Hayes J.; Johnston B.C.
Institution
(Pereira, Braz) Department of Anesthesiology, Botucatu Medical School,
Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil
(Pereira) Department of Anesthesiology, EsSEx, Hospital Central do
Exercito, Rio de Janeiro, Rio de Janeiro, Brazil
(Pereira) Department of Anesthesiology, Santa Casa de Misericordia de
Barra Mansa, Barra Mansa, Rio de Janeiro, Brazil
(Dib, Johnston) Department of Community Health and Epidemiology, Dalhousie
University, Faculty of Medicine, Halifax, Canada
(Dib, Escudero) Institute of Science and Technology, Univ Estadual
Paulista, Sao Paulo, Sao Jose dos Campos, Brazil
(Dib) McMaster Institute of Urology, McMaster University, Hamilton, ON,
Canada
(Hayes) Department of Anesthesia and Pain Medicine, Hospital for Sick
Children, University of Toronto, Toronto, ON, Canada
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Cardiac surgeries are complex procedures aiming to re-establish
coronary flow and correct valvular defects. Oxidative stress, caused by
inflammation and ischemia-reperfusion injury, is associated with these
procedures, increasing the risk of adverse outcomes. N-acetylcysteine
(NAC) acts as an antioxidant by replenishing the glutathione stores, and
emerging evidence suggests that NAC may reduce the risk of adverse
perioperative outcomes. We conducted a systematic review and meta-analysis
to investigate the addition of NAC to a standard of care among adult
patients undergoing cardiac surgery. Methods We searched four databases
(PubMed, EMBASE, CENTRAL, LILACS) from inception to October 2018 and the
grey literaure for randomized controlled trials (RCTs) investigating the
effect of NAC on pre-defined outcomes including mortality, acute renal
insufficiency (ARI), acute cardiac insufficiency (ACI), hospital length of
stay (HLoS), intensive care unit length of stay (ICULoS), arrhythmia and
acute myocardial infarction (AMI). Reviewers independently screened
potentially eligible articles, extracted data and assessed the risk of
bias among eligible articles. We used the GRADE approach to rate the
overall certainty of evidence for each outcome. Results Twenty-nine RCTs
including 2,486 participants proved eligible. Low to moderate certainty
evidence demonstrated that the addition of NAC resulted in a
non-statistically significant reduction in mortality (Risk Ratio (RR)
0.71; 95% Confidence Interval (CI) 0.40 to 1.25), ARI (RR 0.92; 95% CI
0.79 to 1.09), ACI (RR 0.77; 95% CI 0.44 to 1.38), HLoS (Mean Difference
(MD) 0.21; 95% CI -0.64 to 0.23), ICULoS (MD -0.04; 95% CI -0.29 to 0.20),
arrhythmia (RR 0.79; 95% CI 0.52 to 1.20), and AMI (RR 0.84; 95% CI 0.48
to 1.48). Limitations Among eligible trials, we observed heterogeneity in
the population and interventions including patients with and without
kidney dysfunction and interventions that differed in route of
administration, dosage, and duration of treatment. This observed
heterogeneity was not explained by our subgroup analyses. Conclusions The
addition of NAC during cardiac surgery did not result in a statistically
significant reduction in clinical outcomes. A large randomized
placebo-controlled multi-centre trial is needed to determine whether NAC
reduces mortality.<br/>Copyright &#xa9; 2019 Pereira et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<76>
[Use Link to view the full text]
Accession Number
623482459
Title
Efficacy of ultrasound-guided serratus plane block on postoperative
quality of recovery and analgesia after video-assisted thoracic surgery: A
randomized, triple-blind, placebo-controlled study.
Source
Anesthesia and Analgesia. 126 (4) (pp 1353-1361), 2018. Date of
Publication: April 2018.
Author
Kim D.-H.; Oh Y.J.; Lee J.G.; Ha D.; Chang Y.J.; Kwak H.J.
Institution
(Kim, Oh) Departments of Anesthesiology and Pain Medicine, Anesthesia and
Pain Research Institute, South Korea
(Lee) Departments of Thoracic and Cardiovascular Surgery, South Korea
(Ha) Anesthesiology and Pain Medicine, Yonsei University College of
Medicine, Seoul, South Korea
(Chang, Kwak) Department of Anesthesiology and Pain Medicine, Gil Medical
Center, Gachon University, 1198 Guwol-dong, Namdong-gu, Incheon 405-760,
South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The optimal regional technique for analgesia and improved
quality of recovery after video-assisted thoracic surgery (a procedure
associated with considerable postoperative pain) has not been established.
The main objective in this study was to compare quality of recovery in
patients undergoing serratus plane block (SPB) with either ropivacaine or
normal saline on the first postoperative day. Secondary outcomes were
analgesic outcomes, including postoperative pain intensity and opioid
consumption. <br/>METHOD(S): Ninety patients undergoing video-assisted
thoracic surgery were randomized to receive ultrasound-guided SPB with 0.4
mL/kg of either 0.375% ropivacaine (SPB group) or normal saline (control
group) after anesthetic induction. The primary outcome was the 40-item
Quality of Recovery (QoR-40) score at 24 hours after surgery. The QoR-40
questionnaire was completed by patients the day before surgery and on
postoperative days 1 and 2. Pain scores, opioid consumption, and adverse
events were assessed for 2 days postoperatively. <br/>RESULT(S):
Eighty-five patients completed the study: 42 in the SPB group and 43 in
the control group. The global QoR-40 scores on both postoperative days 1
and 2 were significantly higher in the SPB group than in the control group
(estimated mean difference 8.5, 97.5% confidence interval [CI], 2.1-15.0,
and P = .003; 8.5, 97.5% CI, 2.0-15.1, and P = .004, respectively). The
overall mean difference between the SPB and control groups was 8.5 (95%
CI, 3.3-13.8; P = .002). Pain scores at rest and opioid consumption were
significantly lower up to 6 hours after surgery in the SPB group than in
the control group. Cumulative opioid consumption was significantly lower
up to 24 hours postoperatively in the SPB group. <br/>CONCLUSION(S):
Single-injection SPB with ropivacaine enhanced the quality of recovery for
2 days postoperatively and improved postoperative analgesia during the
early postoperative period in patients undergoing video-assisted thoracic
surgery.<br/>Copyright &#xa9; 2018 International Anesthesia Research
Society.

<77>
Accession Number
622224524
Title
Hybrid revascularization: A review.
Source
Cardiology (Switzerland). 140 (1) (pp 35-44), 2018. Date of Publication:
01 Jun 2018.
Author
Saha T.; Naqvi S.Y.; Goldberg S.
Institution
(Saha, Naqvi, Goldberg) Pennsylvania Hospital, University of Pennsylvania,
800 Spruce Street, Philadelphia, PA 19107, United States
Publisher
S. Karger AG
Abstract
Hybrid coronary revascularization (HCR) combines surgical bypass with
percutaneous coronary intervention (PCI) performed either during the same
procedure or in a staged approach within 60 days. Coronary artery bypass
grafting using the left internal mammary artery (LIMA) has shown excellent
long-term patency with improved patient survival. It remains the gold
standard treatment for the majority of patients with multivessel coronary
artery disease. However, saphenous vein grafts have poor long-term
patency. Advances in stent technology have resulted in reduced rates of
thrombosis and restenosis, making PCI a viable alternative to coronary
surgery in selected patients. HCR is attractive as a less invasive method
of coronary revascularization which preserves the benefits of the LIMA
performed with less invasive surgical techniques with the efficacy of
newer generation stents.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel.
All rights reserved.

<78>
[Use Link to view the full text]
Accession Number
623482183
Title
Myocardial protection by glucose-insulin-potassium in moderate-to
high-risk patients undergoing elective on-pump cardiac surgery: A
randomized controlled trial.
Source
Anesthesia and Analgesia. 126 (4) (pp 1133-1141), 2018. Date of
Publication: April 2018.
Author
Ellenberger C.; Sologashvili T.; Kreienbuhl L.; Cikirikcioglu M.; Diaper
J.; Licker M.
Institution
(Ellenberger, Diaper, Licker) Department of Anesthesiology, Pharmacology
and Intensive Care, University Hospital of Geneva, Faculty of Medicine,
Geneva CH-1206, Switzerland
(Sologashvili, Cikirikcioglu) Division of Cardiovascular Surgery,
University Hospital of Geneva, Geneva, Switzerland
(Kreienbuhl) Department of Anesthesiology and Intensive Care Medicine,
Campus Charite Mitte, Campus Virchow-Klinikum, Charite-Universitatsmedizin
Berlin, Berlin, Germany
(Licker) Faculty of Medicine, University of Geneva, Geneva, Switzerland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Low cardiac output syndrome is a main cause of death after
cardiac surgery. We sought to assess the impact of
glucose.insulin.potassium (GIK) to enhance myocardial protection in
moderate-to high-risk patients undergoing on-pump heart surgery.
<br/>METHOD(S): A randomized controlled trial was performed in adult
patients (Bernstein.Parsonnet score >7) scheduled for elective aortic
valve replacement and/or coronary artery bypass surgery. Patients were
randomized to GIK (20 IU of insulin, 10 mEq of potassium chloride in 50 mL
of glucose 40%) or saline infusion given over 60 minutes on anesthetic
induction. The primary end point was postcardiotomy ventricular
dysfunction (PCVD), defined as new/worsening left ventricular dysfunction
requiring inotropic support (>=120 minutes). Secondary end points were the
intraoperative changes in left ventricular function as assessed by
transoesophageal echocardiography, postoperative troponin levels,
cardiovascular and respiratory complications, and intensive care unit and
hospital length of stay. <br/>RESULT(S): From 224 randomized patients, 222
were analyzed (112 and 110 in the placebo and GIK groups, respectively).
GIK pretreatment was associated with a reduced occurrence of PCVD (risk
ratio [RR], 0.41; 95% confidence interval [CI], 0.25.0.66). In GIK-treated
patients, the left systolic ventricular function was better preserved
after weaning from bypass, plasma troponin levels were lower on the first
postoperative day (2.9 ng EmL.1 [interquartile range {IQR}, 1.5.6.6] vs
4.3 ng EmL.1 [IQR, 2.4.8.2]), and cardiovascular (RR, 0.69; 95% CI,
0.50.0.89) and respiratory complications (RR, 0.5; 95% CI, 0.38.0.74) were
reduced, along with a shorter length of stay in intensive care unit (3
days [IQR, 2.4] vs 3.5 days [IQR, 2.7]) and in hospital (14 days [IQR,
11.18.5] vs 16 days [IQR, 12.5.23.5]), compared with placebo-treated
patients. <br/>CONCLUSION(S): GIK pretreatment was shown to attenuate PCVD
and to improve clinical outcome in moderate-to high-risk patients
undergoing on-pump cardiac surgery.<br/>Copyright &#xa9; 2018
International Anesthesia Research Society.

<79>
Accession Number
620356117
Title
Angiotensin-Converting Enzyme Inhibitor Initiation and Dose Uptitration in
Children With Cardiovascular Disease: A Retrospective Review of Standard
Clinical Practice and a Prospective Randomized Clinical Trial.
Source
Journal of the American Heart Association. 5 (5) (no pagination), 2016.
Article Number: e003230. Date of Publication: May 2016.
Author
Roche S.L.; Timberlake K.; Manlhiot C.; Balasingam M.; Wilson J.; George
K.; Mccrindle B.W.; Kantor P.F.
Institution
(Roche, Manlhiot, Mccrindle, Kantor) Department of Medicine, University of
Toronto, Canada
(Timberlake) Faculty of Pharmacy, Univeristy of Toronto, Canada
(Roche, Timberlake, Manlhiot, Balasingam, Wilson, George, Mccrindle,
Kantor) The Labatt Family Heart Center, The Hospital for Sick Children,
Toronto, Canada
(Roche) Peter Munk Cardiac Centre, Toronto General Hospital, Toronto,
Canada
(Kantor) Stollery Children's Hospital, University of Alberta, Edmonton,
AB, Canada
Publisher
American Heart Association Inc.
Abstract
Background: Angiotensin-converting enzyme inhibitors (ACEIs) are a
mainstay of medical management in pediatric cardiology. However, there are
no data defining how best to initiate and uptitrate the dose of these
medications in children. <br/>Methods and Results: Retrospective chart
review revealed only 24% of our pediatric cardiology inpatients were
discharged on predefined optimal doses of ACEIs and few underwent further
dose uptitration in the 8 weeks after hospital discharge. Therefore, 2
alternative protocols for initiation of captopril were compared in a
prospective randomized clinical trial. A "rapid uptitration" protocol
reached an optimal dose on day 3, whereas the alternative, "prolonged
uptitration" protocol, reached an optimal dose on day 9. Forty-6 patients
(54% male) were recruited to the trial, with a median age of 0.7 year (IQR
0.5-2.3 years). Captopril was initiated while in intensive care in 39% of
patients and on the cardiology ward in 61%. There were no differences
between the protocols in episodes of hypotension, symptomatic hypotension,
or indices of renal function. Patients following the rapid protocol
reached higher doses of captopril (0.93+/-0.24 versus 0.57+/-0.38 mg/kg
per dose, P<0.0001) and were more likely to have achieved the predefined
target (88% versus 43%, P=0.002) and optimal ACEI doses (80% versus 29%,
P=0.001) before discharge. <br/>Conclusion(s): A protocol of rapid ACEI
dose uptitration for infants and children with cardiovascular disease can
be introduced safely, even in patients receiving intensive care therapy.
Compared with standard clinical practice or with a more prolonged
protocol, rapid ACEI dose uptitration achieves a higher dosage in this
population with no evident disadvantages.<br/>Copyright &#xa9; 2016 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley Blackwell.

<80>
Accession Number
610976838
Title
Association between severe hypoglycemia and cardiovascular disease risk in
japanese patients with type 2 diabetes.
Source
Journal of the American Heart Association. 5 (3) (no pagination), 2015.
Article Number: e002875. Date of Publication: 2015.
Author
Goto A.; Goto M.; Terauchi Y.; Yamaguchi N.; Noda M.
Institution
(Goto, Yamaguchi) Department of Public Health, Tokyo Women's Medical
University, Tokyo, Japan
(Goto, Goto, Noda) Department of Diabetes Research, Diabetes Research
Center, National Center for Global Health and Medicine, Tokyo, Japan
(Terauchi) Department of Endocrinology and Metabolism, Graduate School of
Medicine, Yokohama City University, Yokohama, Japan
(Noda) Department of Endocrinology and Diabetes, Saitama Medical
University, Saitama, Japan
Publisher
John Wiley and Sons Inc.
Abstract
Background: It remains unclear whether severe hypoglycemia is associated
with cardiovascular disease (CVD) in Asian populations with type 2
diabetes (T2D). Furthermore, no study in Japan, where the prescription
patterns differ from those in other countries, has examined this
association. <br/>Methods and Results: We retrospectively included 58 223
patients (18-74 years old) with T2D. First, we examined the potential
predictors of severe hypoglycemia. Then, we investigated the association
between severe hypoglycemia and CVD risk. Finally, we performed an updated
systematic review and meta-analysis to incorporate our findings and
recently published studies into the previous systematic review and
meta-analysis. During 134 597 person-years from cumulative observation
periods, 128 persons experienced severe hypoglycemia and 550 developed CVD
events. In a multivariate Cox proportional hazard model, severe
hypoglycemia was strongly and positively associated with the risk of CVD
(multivariate-adjusted adjusted hazard ratio, 3.39; 95% CI, 1.25-9.18). In
a propensity score-matched cohort that had similar baseline
characteristics for patients with severe hypoglycemia and those without,
severe hypoglycemia was more strongly associated with the risk of CVD. An
updated systematic review and meta-analysis that included 10 studies found
that severe hypoglycemia was associated with an =2-fold increased risk of
CVD (pooled relative risk, 1.91; 95% CI, 1.69-2.15). <br/>Conclusion(s):
Our results suggest that severe hypoglycemia is strongly associated with
an increased risk of CVD in Japanese patients with T2D, further supporting
the notion that avoiding severe hypoglycemia may be important in
preventing CVD in this patient population.<br/>Copyright &#xa9; 2016 The
Authors.

<81>
Accession Number
621876613
Title
Fish Oil-Containing Lipid Emulsions in Adult Parenteral Nutrition: A
Review of the Evidence.
Source
Journal of Parenteral and Enteral Nutrition. 43 (4) (pp 458-470), 2019.
Date of Publication: May 2019.
Author
Abbasoglu O.; Hardy G.; Manzanares W.; Pontes-Arruda A.
Institution
(Abbasoglu) Division of Nutrition Support, Department of General Surgery,
Faculty of Medicine, Hacettepe University, Ankara, Turkey
(Hardy) College of Health, Massey University, Auckland, New Zealand
(Manzanares) Intensive Care Unit, Department of Critical Care, Faculty of
Medicine, Universidad de la Republica, Montevideo, Uruguay
(Pontes-Arruda) Baxter Healthcare Corporation, Deerfield, IL, United
States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background. There is evidence from laboratory and animal studies that fish
oil-containing intravenous lipid emulsions (FOC-IVLEs) have a beneficial
effect on inflammation and the immune response, suggesting a possible
clinical benefit. Clinical studies of FOC-IVLEs have reported mixed
results. The aim of this review is to present findings from recent
randomized controlled clinical trials and other quality clinical studies
investigating the effects of administering intravenous fish oil alone or
as part of a multilipid emulsion and to examine the quality of these
studies in an objective, evidence-based manner. Methods. Studies comparing
FOC-IVLEs with other IVLEs in adults were included. Thirty-four clinical
studies were evaluated: 19 investigated levels of inflammatory and immune
markers as an endpoint; 13 investigated rates of infection or sepsis; 3
investigated clinical outcomes in septic patients; and 29 investigated
general clinical outcomes. Results. There was conflicting evidence for a
beneficial effect of fish oil on levels of inflammatory and immune markers
and some evidence that fish oil decreased the rate of postoperative atrial
fibrillation. Studies generally reported few statistical differences in
clinical outcomes and rates of infection and sepsis with FOC-IVLEs as
compared with other IVLEs. The quality of reporting was generally poor,
and the presented evidence for comparisons between FOC-IVLEs and other
IVLEs was inconclusive or weak. Conclusions. There is very little
high-quality evidence that FOC-IVLEs have a more beneficial effect than
other IVLEs on clinical outcomes in adult patients.<br/>Copyright &#xa9;
2017 American Society for Parenteral and Enteral Nutrition

<82>
Accession Number
619243123
Title
Comparison of postoperative analgesia with methadone versus morphine in
cardiac surgery.
Source
Brazilian Journal of Anesthesiology. 68 (2) (pp 122-127), 2018. Date of
Publication: March 2018.
Author
Carvalho A.C.; Sebold F.J.G.; Calegari P.M.G.; Oliveira B.H.D.;
Schuelter-Trevisol F.
Institution
(Carvalho) Universidade do Sul de Santa Catarina (Unisul), Curso de
Medicina, Campus Tubarao, Tubarao, SC, Brazil
(Sebold, Calegari, Oliveira) Hospital Nossa Senhora da Conceicao (HNSC),
Anestesiologia, Tubarao, SC, Brazil
(Schuelter-Trevisol) Universidade do Sul de Santa Catarina (Unisul),
Programa de Pos-Graduacao em Ciencias da Saude, Tubarao, SC, Brazil
(Schuelter-Trevisol) Hospital Nossa Senhora da Conceicao (HNSC), Centro de
Pesquisas Clinicas, Tubarao, SC, Brazil
Publisher
Elsevier Editora Ltda
Abstract
Background and objectives: Pain is an aggravating factor of postoperative
morbidity and mortality. The aim of this study was to compare the effects
of methadone versus morphine using the numerical rating scale of pain and
postoperative on-demand analgesia in patients undergoing myocardial
revascularization. <br/>Method(s): A randomized, double-blind, parallel
clinical trial was performed with patients undergoing coronary artery
bypass grafting. The subjects were randomly divided into two groups:
Morphine Group (MoG) and Methadone Group (MeG). At the end of cardiac
surgery, 0.1 mg.kg^-1 adjusted body weight of methadone or
morphine was administered intravenously. Patients were referred to the
ICU, where the following was assessed: extubation time, time to first
analgesic request, number of analgesic and antiemetic drug doses within 36
hours, numerical pain scale at 12, 24, and 36 hours postoperatively, and
occurrence of adverse effects. <br/>Result(s): Each group comprised 50
patients. Methadone showed 22% higher efficacy than morphine as it yielded
a number-needed-to-treat (NNT) score of 6 and number-needed-to-harm (NNH)
score of 16. The MeG showed a mean score of 1.9 +/- 2.2 according to the
numerical pain scale at 24 hours after surgery, whereas as the MoG showed
a mean score of 2.9 +/- 2.6 (p = 0.029). The MeG required less morphine
(29%) than the MoG (43%) (p = 0.002). However, the time to first analgesic
request in the postoperative period was 145.9 +/- 178.5 minutes in the
MeG, and 269.4 +/- 252.9 in the MoG (p = 0.005). <br/>Conclusion(s):
Methadone was effective for analgesia in patients undergoing coronary
artery bypass grafting without extracorporeal circulation.<br/>Copyright
&#xa9; 2017 Sociedade Brasileira de Anestesiologia

<83>
Accession Number
627668217
Title
Management of anticoagulation in patients with metastatic
castration-resistant prostate cancer receiving abiraterone + prednisone.
Source
Supportive Care in Cancer. (no pagination), 2019. Date of Publication:
2019.
Author
Dubinsky S.; Thawer A.; McLeod A.G.; McFarlane T.R.J.; Emmenegger U.
Institution
(Dubinsky, McFarlane) University of Waterloo School of Pharmacy, 10
Victoria St. S, Kitchener, ON, Canada
(Thawer, McFarlane, Emmenegger) Odette Cancer Centre, Sunnybrook Health
Sciences Centre, Toronto, ON, Canada
(McLeod) Department of Medicine, Division of Medical Oncology and
Hematology, Sunnybrook Hospital, University of Toronto, Toronto, ON,
Canada
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Abiraterone has been proven to be an effective agent used in the
management of metastatic castration-resistant prostate cancer,
significantly improving overall and progression-free survival. Due to the
pharmacodynamic and pharmacokinetic properties of abiraterone, concurrent
use with anticoagulation may pose a challenge for clinicians. Thrombosis
within the cancer setting continues to increase patient mortality;
therefore, appropriate anticoagulation through the use of a management
algorithm can reduce adverse events and increase quality of life.
<br/>Method(s): A review of the literature was preformed by a medical
oncologist, haematologist and pharmacists to identify relevant randomized
controlled trials, meta-analyses and retrospective studies. Major society
guidelines were reviewed to further aid in developing the anticoagulation
protocol for non-valvular atrial fibrillation and venous thromboembolism
within this patient population. After reviewing the literature, a clinical
framework was designed to aid clinicians in the management of those
patients receiving abiraterone concurrently with an anticoagulant.
<br/>Result(s): In this review, we describe the potential interactions
between abiraterone and various anticoagulants and provide management
strategies based on the most recent literature for atrial fibrillation,
venous thromboembolism and mechanical heart valves to avoid potential
drug-drug interactions. <br/>Conclusion(s): Abiraterone therapy has become
a mainstay of the management of advanced prostate cancer and is often used
over prolonged years. In this review, we have summarized a framework of
how to use abiraterone in men with prostate cancer on anticoagulants.
Evidence available to date suggests that patients with an indication for
anticoagulation such as atrial fibrillation, venous thromboembolism and
mechanical heart valves can be treated safely with abiraterone in the
appropriate setting, with appropriate monitoring.<br/>Copyright &#xa9;
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<84>
Accession Number
2001920368
Title
A Pilot Randomized Controlled Study of Mild Hypercapnia During Cardiac
Surgery With Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Chan M.J.; Lucchetta L.; Cutuli S.; Eyeington C.; Glassford N.J.;
Martensson J.; Angelopoulos P.; Matalanis G.; Weinberg L.; Eastwood G.M.;
Bellomo R.
Institution
(Chan, Lucchetta, Cutuli, Eyeington, Glassford, Martensson, Eastwood,
Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Angelopoulos) Department of Cardiac Perfusion, Austin Hospital,
Melbourne, Australia
(Matalanis) Department of Cardiac Surgery, Austin Hospital, Melbourne,
Australia
(Weinberg) Department of Anaesthesia, Austin Hospital, Melbournez,
Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
(Bellomo) Data Assessment Research Evaluation Centre, University of
Melbourne and Austin Hospital, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objectives: To test whether targeted therapeutic mild hypercapnia (TTMH)
would attenuate cerebral oxygen desaturation detected using near-infrared
spectroscopy during cardiac surgery requiring cardiopulmonary bypass
(CPB). <br/>Design(s): Randomized controlled trials. <br/>Setting(s):
Operating rooms and intensive care unit of tertiary hospital.
<br/>Participant(s): The study comprised 30 patients undergoing cardiac
surgery with CPB. <br/>Intervention(s): Patients were randomly assigned to
receive either standard carbon dioxide management (normocapnia) or TTMH
(target arterial carbon dioxide partial pressure between 50 and 55 mmHg)
throughout the intraoperative period and postoperatively until the onset
of spontaneous ventilation. <br/>Measurements and Main Results: Relevant
biochemical and hemodynamic variables were measured, and cerebral tissue
oxygen saturation (SctO<inf>2</inf>) was monitored with near-infrared
spectroscopy. Patients were followed-up with neuropsychological testing.
Patient demographics between groups were compared using the Fisher exact
and Mann-Whitney tests, and SctO<inf>2</inf> between groups was compared
using repeated measures analysis of variance. The median patient age was
67 years (interquartile range [IQR] 62-72 y), and the median EuroSCORE II
was 1.1. The median CPB time was 106 minutes. The mean intraoperative
arterial carbon dioxide partial pressure for each patient was
significantly higher with TTMH (52.1 mmHg [IQR 49.9-53.9 mmHg] v 40.8 mmHg
[IQR 38.7-41.7 mmHg]; p < 0.001) as was pulmonary artery pressure (23.9
mmHg [IQR 22.4-25.3 mmHg] v 18.5 mmHg [IQR 14.8-20.7 mmHg]; p = 0.004).
There was no difference in mean percentage change in SctO<inf>2</inf>
during CPB in the control group for both hemispheres (left: -6.7% v -2.3%;
p = 0.110; right: -7.9% v -1.0%; p = 0.120). Compliance with
neuropsychological test protocols was poor. However, the proportion of
patients with drops in test score >20% was similar between groups in all
tests. <br/>Conclusion(s): TTMH did not increase SctO<inf>2</inf>
appreciably during CPB but increased pulmonary artery pressures before and
after CPB. These findings do not support further investigation of TTMH as
a means of improving SctO<inf>2</inf> during and after cardiac surgery
requiring CPB.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<85>
Accession Number
2001920356
Title
Development and Validation of a Score to Identify Cardiac Surgery Patients
at High Risk of Prolonged Mechanical Ventilation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Hessels L.; Coulson T.G.; Seevanayagam S.; Young P.; Pilcher D.; Marhoon
N.; Bellomo R.
Institution
(Hessels, Marhoon, Bellomo) Data Analytics, Research and Evaluation
Centre, Austin Hospital, University of Melbourne, Melbourne, Australia
(Hessels, Bellomo) Department of Intensive Care, Austin Hospital,
Melbourne, Australia
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
(Coulson) Department of Anaesthesia, Austin Hospital, Melbourne, Australia
(Seevanayagam) Department of Cardiac Surgery, Austin Hospital, Melbourne,
Australia
(Young) Medical Research Institute of New Zealand, Wellington, New Zealand
(Young) Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
(Pilcher) Department of Intensive Care, Alfred Hospital, Melbourne,
Australia
(Pilcher) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Bellomo) Centre of Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Publisher
W.B. Saunders
Abstract
Objective: To develop and validate a score for the early identification of
cardiac surgery patients at high risk of prolonged mechanical ventilation
(MV) who may be suitable targets for interventional trials.
<br/>Design(s): Retrospective analysis. <br/>Setting(s): Tertiary
intensive care unit. <br/>Participant(s): Cardiac surgery patients.
<br/>Intervention(s): Observational study. <br/>Measurements and Main
Results: The study comprised 1,994 patients. Median age was 67 years, and
1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A
total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for >=24,
>=36, and >=48 hours, respectively. In-hospital mortality was 13%, 15%,
and 17%, respectively. For the study model, all preoperative,
intraoperative, and early (first 4 hours) postoperative variables were
considered. A multivariable logistic regression model was developed, and a
predictive scoring system was derived. Using MV >=24 hours as the primary
outcome, the model performance in the development set was good with a
c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score
of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948),
Brier's score was 0.059, and the model remained well calibrated.
<br/>Conclusion(s): The authors developed a simple score to predict
prolonged MV after cardiac surgery. This score, if externally validated,
is potentially suitable for identifying a high-risk target population for
future randomized controlled trials of postoperative care after cardiac
surgery.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<86>
Accession Number
627751710
Title
Impact of Early (<24h) Surgical Decompression on Neurological Recovery in
Thoracic Spinal Cord Injury: A Meta-Analysis.
Source
Journal of neurotrauma. (no pagination), 2019. Date of Publication: 09 May
2019.
Author
Ter Wengel P.V.; Martin E.; De Witt Hamer P.C.; Feller R.E.; van
Oortmerssen J.A.E.; van der Gaag N.A.; Oner F.C.; Vandertop W.P.
Institution
(Ter Wengel, Martin, De Witt Hamer, Feller, van Oortmerssen, Vandertop)
Neurosurgical Center Amsterdam, Amsterdam University Medical Center, VUmc,
Amsterdam, Netherlands
(Ter Wengel, van der Gaag) Department of Neurosurgery, Leiden University
Medical Center, Leiden, Netherlands
(van der Gaag) Department of Neurosurgery, HagaZiekenhuis, the Hague,
Netherlands
(Oner) Department of Orthopedic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Vandertop) Neurosurgical Center Amsterdam, Amsterdam University Medical
Center, AMC, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
The impact of surgical timing in neurological recovery in thoracic and
thoracolumbar traumatic spinal cord injury (tSCI) is still a subject of
discussion. While in cervical tSCI one may expect a beneficial effect of
early intervention within 24h, especially in complete cases, this has not
yet been demonstrated clearly for thoracic tSCI. This study addresses
neurological improvement after early and late surgery for thoracic and
thoracolumbar tSCI. A systematic search retrieved 14 publications of
observational studies reporting outcome measurements after surgery in 1075
patients with thoracic and thoracolumbar tSCI from PubMed and Embase
databases. Surgery was considered early within 24h and late thereafter. An
improvement of at least one and two grades on the American Spinal Injury
Association Impairment Scale (ASIA) was evaluated. The Meta-Analyses and
Systematic Reviews of Observational Studies guidelines were followed.
Improvement rates were summarized using individual patient data in a
Bayesian random effects model and compared for those with early and late
surgery. In the qualitative analysis, six of seven studies, which
investigated the effect of surgical timing, observed a significant effect
of early surgery on at least one ASIA grade improvement. Quantitative
analysis in 948 patients with thoracic and thoracolumbar tSCI data,
however, did not reveal a significant increase in odds of >=1 ASIA grade
recovery in early surgery (66.8% [95% confidence interval (CI):
45.0-87.8%] compared with late surgery (48.9% [95% CI: 25.1-70.7%; odds
ratio (OR) 2.2 (95% CI: 0.6-14.0]). This study did not observe a
significant beneficial effect of surgical decompression within 24h in
patients with thoracic and thoracolumbar tSCI.