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<1>
Accession Number
622171559
Title
EQ-5D studies in cardiovascular diseases in eight Central and Eastern
European countries: A systematic review of the literature.
Source
Kardiologia Polska. 76 (5) (pp 860-870), 2018. Date of Publication: 11 May
2018.
Author
Batog P.; Rencz F.; Pentek M.; Gulacsi L.; Filipiak K.J.; Rupel V.P.;
Simon J.; Brodszky V.; Baji P.; Zavada J.; Petrova G.; Rotar A.; Golicki
D.
Institution
(Batog) Department of Experimental and Clinical Pharmacology, Medical
University of Warsaw, Warsaw, Poland
(Rencz, Pentek, Gulacsi, Brodszky, Baji) Corvinus University of Budapest,
Department of Health Economics, Budapest, Hungary
(Rencz) Hungarian Academy of Sciences, Premium Postdoctoral Research
Programme, Budapest, Hungary
(Filipiak) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Rupel) Institute for Economic Research, Ljubljana, Slovenia
(Simon) Department of Health Economics, Centre for Public Health, Medical
University of Vienna, Vienna, Austria
(Zavada) Institute of Rheumatology, Prague, Czechia
(Petrova) Department of Social Pharmacy and Pharmacoeconomics, Faculty of
Pharmacy, Medical University, Sofia, Bulgaria
(Rotar) Department of Social Medicine, University of Amsterdam, Amsterdam,
Netherlands
(Golicki) Department of Experimental and Clinical Pharmacology, Medical
University of Warsaw, ul. Banacha 1B, Warszawa 02-097, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: The measurement of health-related quality of life (HRQoL) by
validated generic instruments, such as EQ-5D, has become an increasingly
important tool for the assessment of health care in a wide range of
diagnoses. <br/>Aim(s): We aimed to systematically review EQ-5D literature
on cardiovascular diseases in eight Central and Eastern European (CEE)
countries. <br/>Method(s): A structured literature search was conducted in
MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, Cochrane Library, and
the EuroQol website up to November 2016. Original cardiovascular-related
studies that reported EQ-5D results were included. <br/>Result(s): Of the
36 papers, 17 reported EQ-5D index scores. Most studies were performed in
Poland (n = 24, 67%). The most common diagnosis regarding the number of
publications and population size was ischaemic heart disease (n = 13, N =
6394), followed by atrial fibrillation (n = 4, N = 1052). The average
EQ-5D index scores ranged from 0.61 to 0.88 and from 0.66 to 0.95 for
patients before and after cardiac procedure/surgery, respectively
(including angioplasty, coronary artery bypass grafting, ablation,
surgical correction of septal defects, transcatheter aortic valve
implantation [TAVI]). In all studies baseline scores were lower than the
repeated assessments after the procedure, with the most substantial
improvement of 0.24 in high-risk elderly patients after TAVI. Studies
which did not assess invasive treatment reported mean EQ-5D index scores
ranging from 0.18 to 0.80. <br/>Conclusion(s): The number of
cardiovascular-related studies reporting HRQoL using EQ-5D has
consistently increased in CEE countries over the past decade and is
outstanding compared with other clinical fields. The EQ-5D index and EQ
VAS scores varied based on the disease severity, patient characteristics,
and treatment protocol.<br/>Copyright &#xa9; Polish Cardiac Society 2018.

<2>
Accession Number
622526446
Title
Antiplatelet therapy for patients undergoing coronary artery bypass
surgery.
Source
Kardiologia Polska. 76 (6) (pp 945-952), 2018. Date of Publication: 11 Jun
2018.
Author
DeStephan C.M.; Schneider D.J.
Institution
(DeStephan, Schneider) Department of Medicine, Cardiovascular Research
Institute, University of Vermont, 308 S. Park Drive, Colchester, VT 05446,
United States
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Considerable variation in the use and duration of antiplatelet medications
during the perioperative and postoperative care of patients undergoing
coronary artery bypass grafting (CABG) reflects the limited number of
studies focused directly on these patients as well as the variation in the
results reported. In this review we highlight the incidence and mechanisms
of graft closure as well as the evidence in support of antiplatelet
therapy that is balanced by the impact of antiplatelet therapy on the risk
of bleeding to provide recommendations for the use of this therapy in
patients undergoing CABG. Low-dose acetylsalicylic acid (ASA; <= 160 mg
daily) reduces the incidence of perioperative myocardial infarction, acute
renal injury, and mortality without increasing the risk of bleeding and so
is recommended both before and after CABG. The use of dual antiplatelet
therapy with ASA plus a P2Y12 antagonist adds a greater risk of bleeding.
While additional studies are required, we can make the following
recommendations: Because of increased bleeding and mortality when patients
are treated with clopidogrel preoperatively, CABG should be delayed for
five days. Because of increased bleeding when patients are treated with
ticagrelor preoperatively, CABG should be delayed for three days. Because
of increased bleeding when patients are treated with prasugrel
preoperatively, CABG should be delayed for seven days. For patients who
had a coronary stent placed preoperatively or had an acute coronary
syndrome preoperatively, resumption of therapy with their P2Y12 antagonist
postoperatively for 12 months reduces the subsequent incidence of
cardiovascular events.<br/>Copyright &#xa9; Polish Cardiac Society 2018.

<3>
Accession Number
620405045
Title
Remote Ischaemic PrEconditioning of Human Myocardium (RIPE): Study
protocol for a double-blinded randomised controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 136-143), 2018. Date of Publication: 2018.
Author
Deja M.A.; Wiaderkiewicz R.; Czekaj P.; Czech E.; Malinowski M.; Machej
L.; Weglarzy A.; Kowalowka A.; Piekarska M.; Szurlej B.; Latusek T.
Institution
(Deja, Malinowski, Kowalowka, Piekarska, Szurlej, Latusek) Department of
Cardiac Surgery, School of Medicine in Katowice, Medical University of
Silesia, Katowice, Poland
(Deja, Malinowski, Kowalowka, Piekarska) Department of Cardiac Surgery,
Upper-Silesian Heart Centre, Katowice, Poland
(Wiaderkiewicz, Czekaj, Czech) Department of Histology and Embryology,
School of Medicine in Katowice, Medical University of Silesia, ul. Medykow
18, Katowice 40-752, Poland
(Machej) Department of Anaesthesia and Intensive Care Nursing, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Weglarzy) Department of Cardiac Anaesthesia, Upper-Silesian Heart Centre,
Katowice, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Remote preconditioning has been shown to be a potent
protective phenomenon in many animals. Several studies aimed to
demonstrate it was feasible in humans by trying to show its protective
effect during cardiac surgery. Of these, some small studies and one larger
trial were positive while two other bigger studies showed no effectiveness
of remote preconditioning as assessed by levels of postoperatively
released cardiac markers. Recently, two large clinical trials also failed
to prove the benefit of remote preconditioning in cardiac surgery. No
study showed that remote preconditioning actually increases resistance of
human myocardium to standardised ischaemic and reperfusion stimulus in
experimental settings. In animal studies, remote preconditioning was shown
to improve mitochondrial function and structure, but such data on human
myocardium are scarce. <br/>Aim(s): The aim of the study is to determine
whether remote preconditioning protects human myocardium against
ischaemia-reperfusion injury in both in vivo and in vitro conditions.
<br/>Method(s): The trial is designed as a single-centre, double-blinded,
sham-controlled trial of 120 patients. We randomise (1:1) patients
referred for coronary artery bypass grafting for stable coronary artery
disease to remote preconditioning or "sham" intervention. The remote
preconditioning is obtained by three cycles of 5 min inflation and 5 min
deflation of a blood pressure cuff on the right arm. Postoperative course
including myocardial enzymes profile will be analysed. Moreover, in the
in-vitro arm the clinically preconditioned myocardium will be assessed for
function, mitochondria structure, and mitochondria-dependent apoptosis.
The informed consent of all patients is obtained before enrolment into the
study by the investigator. The study conforms to the spirit and the letter
of the declaration of Helsinki. <br/>Result(s) and Conclusion(s): In case
the effect of remote preconditioning is not measurable in ex-vivo
assessment, any future attempt at implementing this phenomenon in clinical
practice may be futile and should not be continued until the effect can be
confirmed in a controlled experimental setting. The study might therefore
indicate future directions in trials of clinical implementation of remote
preconditioning. Trial Registration: Clinical Trials Register
(Clinicaltrials.gov) identifier: NCT01994707. The study was approved by
Institutional Review Board of the Medical University of Silesia
(KNW/0022/KB1/160/12).<br/>Copyright &#xa9; Polskie Towarzystwo
Kardiologiczne 2018.

<4>
Accession Number
620405039
Title
Haematological indices as predictors of atrial fibrillation following
isolated coronary artery bypass grafting, valvular surgery, or combined
procedures: A systematic review with meta-analysis.
Source
Kardiologia Polska. 76 (1) (pp 107-118), 2018. Date of Publication: 2018.
Author
Weymann A.; Ali-Hasan-Al-Saegh S.; Popov A.-F.; Sabashnikov A.;
Mirhosseini S.J.; Liu T.; Tse G.; Lotfaliani M.; Ghanei A.; Testa L.;
D'Ascenzo F.; Benedetto U.; Dehghan H.; Roever L.; De Oliveira Sa M.P.B.;
Baker W.L.; Yavuz S.; Zeriouh M.; Mashhour A.; Nombela-Franco L.; Jang
J.-S.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.; Linde C.; Filipiak
K.J.; Biondi-Zoccai G.; Calkins H.; Stone G.W.
Institution
(Weymann, Mashhour) Department of Cardiac Surgery, University Hospital
Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky
University Oldenburg, Oldenburg, Germany
(Weymann, Popov, Sabashnikov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield Middlesex, United Kingdom
(Ali-Hasan-Al-Saegh, Popov, Sabashnikov, Mirhosseini) Cardiovascular
Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran, Islamic Republic of
(Popov, Sabashnikov) Department of Thoracic and Cardiovascular Surgery,
University Hospital Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov) Department of Cardiothoracic Surgery, University Hospital of
Cologne, Cologne, Germany
(Liu, Meng, Gong) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Ghanei) Department of Internal Medicine, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco (PROCAPE), Recife, Brazil
(De Oliveira Sa) University of Pernambuco (UPE), Recife, Brazil
(De Oliveira Sa) Nucleus of Postgraduate and Research in Health Sciences
of Faculty of Medical Sciences and Biological Sciences Institute
(FCM/ICB), Recife, Brazil
(Baker) University of Connecticut/Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(Jang) Department of Cardiology, Busan Paik Hospital, Inje University
College of Medicine, Jin-gu, Busan, South Korea
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institutet, Stockholm, Sweden
(Filipiak) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: New postoperative atrial fibrillation (POAF) is one of the
most critical and common complications after cardiovascular surgery
precipitating early and late morbidities. Complete blood count (CBC) is an
imperative blood test in clinical practice, routinely used in the
examination of cardiovascular diseases. <br/>Aim(s): This systematic
review with meta-analysis aimed to determine the strength of evidence for
evaluating the association of haematological indices in CBC tests with
atrial fibrillation following isolated coronary artery bypass graft
(CABG), isolated valvular surgery, or a combination of these treatments.
<br/>Method(s): We conducted a meta-analysis of studies evaluating pre-
and postoperative haematological indices in patients with POAF. A
comprehensive subgroup analysis was performed to explore potential sources
of heterogeneity. <br/>Result(s): A literature search of all major
databases retrieved 732 studies. After screening, 22 studies were analysed
including a total of 6098 patients. Pooled analysis showed preoperative
platelet count (PC) (weighted mean difference [WMD] = -7.07 x
10⁹/L and p < 0.001), preoperative mean platelet volume (MPV)
(WMD = 0.53 FL and p < 0.001), preoperative white blood cell count (WBC)
(WMD = 0.130 x 10⁹/L and p < 0.001), preoperative
neutrophil-to-lymphocyte ratio (NLR) (WMD = 0.33 and p < 0.001),
preoperative red blood cell distribution width (RDW) (WMD = 0.36% and p <
0.001), postoperative WBC (WMD = 1.36 x 10⁹/L and p < 0.001),
and postoperative NLR (WMD = 0.74 and p < 0.001) as associated factors
with POAF. <br/>Conclusion(s): Haematological indices may predict the risk
of POAF before surgery. These easily-performed tests should definitely be
taken into account in patients undergoing isolated CABG, valvular surgery,
or combined procedures.<br/>Copyright &#xa9; Polskie Towarzystwo
Kardiologiczne 2018.

<5>
Accession Number
620405038
Title
The effect of intravenous N-acetylcysteine on prevention of atrial
fibrillation after coronary artery bypass graft surgery: A double-blind,
randomised, placebo-controlled trial.
Source
Kardiologia Polska. 76 (1) (pp 99-106), 2018. Date of Publication: 2018.
Author
Soleimani A.; Habibi M.R.; Kiabi F.H.; Alipour A.; Habibi V.; Azizi S.;
Zeydi A.E.; Sohrabi F.B.
Institution
(Soleimani, Habibi, Kiabi) Department of Anaesthesiology, Imam Khomeini
Hospital, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Alipour) Department of Epidemiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Azizi) Department of Pathology, Faculty of Paramedicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Sohrabi) Mazandaran Heart Centre, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Atrial fibrillation (AF) is one of the most frequently
occurring dysrhythmias after coronary artery bypass graft (CABG) surgery.
<br/>Aim(s): The aim of this study was to evaluate the effect of
intravenous N-acetylcysteine (NAC) on the prevention of AF after CABG
surgery. <br/>Method(s): In a double-blind, randomised controlled trial, a
total of 150 patients who were scheduled for on-pump CABG surgery were
randomly assigned into two groups. In group A, patients received an
intravenous NAC infusion (50 mg/kg) after induction of anaesthesia. These
patients additionally received two intravenous doses of NAC on
postoperative days 1 and 2. Patients in group B received normal saline (as
a placebo) with the same volume, during the same time interval. During the
first three days after surgery, postoperative AF (POAF) was assessed by
continuous electrocardiogram monitoring; serum high-sensitivity C-reactive
protein (hsCRP) level was also assessed before and three days after
surgery. <br/>Result(s): During follow-up, 17 patients (17/141, 12.1%)
developed POAF. POAF occurred in four (5.6%) patients in the NAC group and
13 (18.8%) patients in the placebo group (OR 0.23; 95% CI 0.08-0.82; p =
0.02). In the multivariable logistic regression analysis, the only
predictor of AF after CABG surgery was the use of NAC (OR 0.21; 95% CI
0.06-0.73; p = 0.01). Also, the hsCRP level trend in the NAC group was
different from the trend in the control group (group time interaction or
interaction effect) (p < 0.001). <br/>Conclusion(s): It seems that
perioperative intravenous NAC therapy can be effectively used to reduce
inflammation and the incidence of POAF after CABG surgery.<br/>Copyright
&#xa9; Polskie Towarzystwo Kardiologiczne 2018.

<6>
Accession Number
620743485
Title
Baseline and postoperative levels of C-reactive protein and interleukins
as inflammatory predictors of atrial fibrillation following cardiac
surgery: A systematic review and meta-analysis.
Source
Kardiologia Polska. 76 (2) (pp 440-451), 2018. Date of Publication: 16 Feb
2018.
Author
Weymann A.; Popov A.-F.; Sabashnikov A.; Ali-Hasan-Al-Saegh S.; Ryazanov
M.; Tse G.; Mirhosseini S.J.; Liu T.; Lotfaliani M.; Sedaghat M.; Baker
W.L.; Ghanei A.; Yavuz S.; Zeriouh M.; Izadpanah P.; Dehghan H.; Testa L.;
Nikfard M.; De Oliveira Sa M.P.B.; Mashhour A.; Nombela-Franco L.;
Rezaeisadrabadi M.; D'Ascenzo F.; Zhigalov K.; Benedetto U.; Najafi S.A.;
Szczechowicz M.; Roever L.; Meng L.; Gong M.; Deshmukh A.J.; Palmerini T.;
Linde C.; Filipiak K.J.; Stone G.W.; Biondi-Zoccai G.; Calkins H.
Institution
(Weymann, Mashhour, Zhigalov, Szczechowicz) Department of Cardiac Surgery,
University Hospital Oldenburg, European Medical School
Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg,
Germany
(Popov, Sabashnikov, Zeriouh) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, Harefield Hospital, Harefield-Middlesex, United Kingdom
(Popov) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Goethe University Frankfurt, Frankfurt, Germany
(Sabashnikov, Zeriouh) Department of Cardiothoracic Surgery, University
Hospital of Cologne, Cologne, Germany
(Ali-Hasan-Al-Saegh, Mirhosseini) Cardiovascular Research Centre, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ali-Hasan-Al-Saegh, Mirhosseini, Dehghan) Consult. Ctr. for Secdry. Res.,
Data Mining, and Knowledge Transfer in Health and Medical Sciences, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Ryazanov) CVS Centre at Nizhny Novgorod, Nizhny Novgorod, Russian
Federation
(Tse) Department of Medicine and Therapeutics, Li Ka Shing Institute of
Health Sciences, Faculty of Medicine, Chinese University of Hong Kong,
Shatin, Hong Kong
(Liu, Meng, Gong) Department of Cardiology, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Lotfaliani) Faculty of Pharmacy, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Sedaghat, Ghanei, Rezaeisadrabadi) Department of Internal Medicine,
Shahid Beheshti University of Medical Sciences, Yazd, Tehran, Iran,
Islamic Republic of
(Baker) University of Connecticut, Hartford Hospital Evidence-Based
Practice Centre, Hartford, CT, United States
(Yavuz) Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas
Training and Research Hospital, Bursa, Turkey
(Izadpanah) Department of Interventional Cardiology, Cardiovascular
Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Dehghan) Department of Health Technology Assessment, Shahid Sadoughi
University of Medical Sciences and Health Services, Yazd, Iran, Islamic
Republic of
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, S. Donato
Milanese, Milan, Italy
(Nikfard) International Relations Office, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(De Oliveira Sa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil
(De Oliveira Sa) University of Pernambuco - UPE, Recife, Brazil
(De Oliveira Sa) Nucleus of Postgrad. and Res. in Hlth. Sci. of Fac. of
Med. Sci. and Biol. Sci. Institute (FCM/ICB), Recife, Brazil
(Nombela-Franco) Instituto Cardiovascular, Hospital Universitario Clinico
San Carlos, Madrid, Spain
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences, Citta
della Salute e della Scienza Hospital, University of Turin, Turin, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Najafi) Department of Cardiology and Internal Medicine, Sankt Katharinen
Hospital, Frankfurt am Main, Germany
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Uberlandia, Brazil
(Deshmukh) Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Italy
(Linde) Department of Cardiology, Karolinska University Hospital,
Karolinska Institute, Stockholm, Sweden
(Filipiak) Department of Cardiology, Medical University of Warsaw, Warsaw,
Poland
(Stone) New York Presbyterian Hospital, Columbia University Medical
Centre, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Calkins) Department of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, MD, United States
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a leading
arrhythmia with high incidence and serious clinical implications after
cardiac surgery. Cardiac surgery is associated with systemic inflammatory
response including increase in cytokines and activation of endothelial and
leukocyte responses. Aim This systematic review and meta-analysis aimed to
determine the strength of evidence for evaluating the association of
inflammatory markers, such as C-reactive protein (CRP) and interleukins
(IL), with POAF following isolated coronary artery bypass grafting (CABG),
isolated valvular surgery, or a combination of these procedures.
<br/>Method(s): We conducted a meta-analysis of studies evaluating
measured baseline (from one week before surgical procedures) and
postoperative levels (until one week after surgical procedures) of
inflammatory markers in patients with POAF. A comprehensive search was
performed in electronic medical databases (Medline/PubMed, Web of Science,
Embase, Science Direct, and Google Scholar) from their inception through
May 2017 to identify relevant studies. A comprehensive subgroup analysis
was performed to explore potential sources of heterogeneity.
<br/>Result(s): A literature search of all major databases retrieved 1014
studies. After screening, 42 studies were analysed including a total of
8398 patients. Pooled analysis showed baseline levels of CRP (standard
mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD
0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p <
0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001),
postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and
postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant
inflammatory parameters significantly associated with POAF.
<br/>Conclusion(s): Perioperative inflammation is proposed to be involved
in the pathogenesis of POAF. Therefore, perioperative assessment of CRP,
IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and
monitoring for POAF.<br/>&#xa9; Copyright 2018 Polskie Towarzystwo
Kardiologiczne.

<7>
Accession Number
625551530
Title
Hybrid versus traditional cardiac rehabilitation models: A systematic
review and meta-analysis.
Source
Kardiologia Polska. 76 (12) (pp 1717-1724), 2018. Date of Publication:
2018.
Author
Wu C.; Li Y.; Chen J.
Institution
(Wu, Chen) Department of Healthcare Centre, People's Hospital of Hainan
Province, 43 Renmin Ave, Meilan Qu, Haikou Shi, Hainan Sheng, China
(Li) Department of Emergency Medicine, Orthopaedics, and Diabetes,
Hospital of Haikou City, Haikou, China
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: The common drawbacks of standard cardiac rehabilitation (CR)
models include low participation rate, high cost, and dependence on
on-site exercise sessions. Therefore, hybrid CR protocols have been
developed. <br/>Aim(s): We aimed to test whether hybrid CR models are
superior or equivalent to the traditional CR models in patients after
myocardial infarction, heart failure, and cardiac surgery, using a
meta-analysis framework. <br/>Method(s): Data from relevant original
studies indexed in the Medline, Scopus, Cochrane Central, and Web of
Science databases were extracted and analysed. The standardised mean
difference (SMD) was used as a summary effect estimate, along with 95%
confidence interval (CI). <br/>Result(s): Based on data from 1195
patients, the summary effect size showed similar improvement in functional
capacity in hybrid and standard CR programmes (SMD = -0.04, 95% CI -0.18
to 0.09, p = 0.51). No significant difference was detected between the two
models in terms of changes in exercise duration (SMD = -0.14, 95% CI -0.51
to 0.24, p = 0.47), systolic (SMD = -0.01, 95% CI -0.14 to 0.12, p =
0.91), and diastolic (SMD = -0.03, 95% CI -0.16 to 0.11, p = 0.7) blood
pressure, or health-related quality of life (SMD = -0.08, 95% CI -0.23 to
0.07, p = 0.27). In terms of blood lipids, no significant difference was
noted between hybrid and traditional CR models in all assessed lipid
profile parameters, except for triglycerides (favouring the traditional CR
model). <br/>Conclusion(s): Hybrid CR protocols showed comparable efficacy
to the traditional model. Further well-designed studies are required to
validate these findings, especially regarding the long-term
outcomes.<br/>Kardiologia Polska Copyright &#xa9; Polish Cardiac Society
2018.

<8>
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.

<9>
Accession Number
619592387
Title
Quality-of-Life After Everolimus-Eluting Stents or Bypass Surgery for
Left-Main Disease: Results From the EXCEL Trial.
Source
Journal of the American College of Cardiology. 70 (25) (pp 3113-3122),
2017. Date of Publication: 26 December 2017.
Author
Baron S.J.; Chinnakondepalli K.; Magnuson E.A.; Kandzari D.E.; Puskas
J.D.; Ben-Yehuda O.; van Es G.-A.; Taggart D.P.; Morice M.-C.; Lembo N.J.;
Brown W.M.; Banning A.; Simonton C.A.; Kappetein A.P.; Sabik J.F.; Serruys
P.W.; Stone G.W.; Cohen D.J.
Institution
(Baron, Chinnakondepalli, Magnuson, Cohen) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City School of Medicine, Kansas
City, Missouri, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Puskas, Lembo, Brown) Mount Sinai Medical Center, New York, New York,
United States
(Ben-Yehuda, Stone) Cardiovascular Research Foundation, New York, New
York, United States
(van Es) Cardialysis, Rotterdam, Netherlands
(Taggart, Banning) Oxford University Hospitals, Oxford, United Kingdom
(Morice) Ramsay Generale de Sante, Hospital Prive Jacques Cartier, Massy,
France
(Simonton) Abbott Vascular Inc., Abbott Park, Illinois, United States
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Cleveland Clinic Foundation, Cleveland, Ohio, United States
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, New York, United States
Publisher
Elsevier USA
Abstract
Background The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) trial compared
outcomes in patients with unprotected left main coronary artery disease
(LMCAD) treated with coronary artery bypass graft (CABG) or percutaneous
coronary intervention (PCI) using everolimus-eluting stents. Whereas rates
of death, stroke, and myocardial infarction were similar at 36 months,
event timing and repeat revascularization rates differed by treatment
group. Objectives To understand the effects of revascularization strategy
from the patient's perspective, a prospective quality of life (QoL)
substudy was performed alongside the EXCEL trial. Methods Between
September 2010 and March 2014, 1,905 patients with LMCAD were randomized
to undergo CABG or PCI, of whom 1,788 participated in the QoL substudy.
QoL was assessed at baseline and 1, 12, and 36 months using the Seattle
Angina Questionnaire, the 12-Item Short Form Health Survey, the Rose
Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D.
Differences between PCI and CABG were assessed using longitudinal
random-effect growth curve models. Results Over 36 months, both PCI and
CABG were associated with significant improvements in QoL compared with
baseline. At 1 month, PCI was associated with better QoL than CABG. By 12
months though, these differences were largely attenuated, and by 36
months, there were no significant QoL differences between PCI and CABG.
Conclusions Among selected patients with LMCAD, both PCI and CABG result
in similar QoL improvement through 36 months, although a greater early
benefit is seen with PCI. Taken together with the 3-year clinical results
of EXCEL, these findings suggest that PCI and CABG provide similar
intermediate-term outcomes for patients with LMCAD. (Evaluation of Xience
Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization [EXCEL]; NCT01205776)<br/>Copyright &#xa9; 2017 American
College of Cardiology Foundation

<10>
Accession Number
618001156
Title
The short-term effect of atorvastatin plus ezetimibe therapy versus
atorvastatin monotherapy on clinical outcome in acute coronary syndrome
patients by gender.
Source
Kardiologia Polska. 75 (8) (pp 770-778), 2017. Date of Publication: 18 Aug
2017.
Author
Japaridze L.; Sadunishvili M.
Institution
(Japaridze, Sadunishvili) Amtel Hospital First Clinical, Centre of
Vascular and Heart Diseases, Tbilisi State Medical University, Chapidze
Heart Centre, Chachava str.#1, Tbilisi 0159, Georgia
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Atorvastatin reduces low-density lipoprotein cholesterol
(LDL-C) levels and the risk of cardiovascular events, but whether the
addition of ezetimibe (EZE), a non-statin drug that reduces intestinal
cholesterol absorption, can reduce the rate of cardiovascular events
further, and if there any sex differences, is not known. <br/>Aim(s): To
evaluate the effects of atorvastatin and EZE combination in acute coronary
syndrome (ACS) patients on the incidence of composite endpoint in
short-term follow-up and to assess differences according their gender.
<br/>Method(s): We conducted a 16-week, single-centre, prospective,
randomised, open-label clinical trial involving 323 patients who had been
hospitalised for an ACS within the preceding 14 days. They received
atorvastatin 20 mg for 28 days, and after that 292 patients who had LDL-C
levels >= 1.81 mmol/L were randomised to EZE 10 mg/day co-administered
with atorvastatin therapy (EZE + statin) or double their current
atorvastatin dose. The primary endpoint was a composite of cardiovascular
death, nonfatal myocardial infarction, unstable angina requiring
rehospitalisation, coronary revascularisation (>= 30 days after
randomisation), or nonfatal stroke. <br/>Result(s): The Kaplan-Meier
event-free survival rate at 16 weeks was 88.1% in the EZE + statin group
patients and 77.0% in the atorvastatin monotherapy group (absolute risk
reduction: 11.1 percentage points; hazard ratio: 2.099; 95% confidence
interval: 1.165-3.781; p = 0.014). The log rank test indicated that there
was not a statistically significant difference between male and female
survival rates in both treatment groups (p = 0.897). <br/>Conclusion(s):
The results of our study demonstrated that when added to statin therapy,
EZE resulted in improved cardiovascular outcomes, and the response to
atorvastatin and EZE combination was similar for both men and
women.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2017.

<11>
Accession Number
620117342
Title
Peripheral A Rtery Atherosclerotic DIsease and Sleep disordered breathing
(PARADISE) trial-protocol for an observational cohort study.
Source
Kardiologia Polska. 75 (12) (pp 1332-1338), 2017. Date of Publication: 15
Dec 2017.
Author
Szymanski F.M.; Galazka Z.; Platek A.E.; Gorko D.; Ostrowski T.;
Adamkiewicz K.; Legosz P.; Rys A.; Semczuk-Kaczmarek K.; Celejewski K.;
Filipiak K.J.
Institution
(Szymanski, Platek, Adamkiewicz, Rys, Semczuk-Kaczmarek, Filipiak) 1st
Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A,
Warszawa 02-097, Poland
(Galazka, Gorko, Ostrowski, Celejewski) Department of General and
Endocrinological Surgery, Medical University of Warsaw, Warsaw, Poland
(Platek) Department of General and Experimental Pathology, Centre for
Preclinical Research and Technology (CEPT), Medical University of Warsaw,
Warsaw, Poland
(Gorko) Cardiology Department, Regional Hospital, Kolobrzeg, Poland
(Legosz) Department of Orthopaedics and Traumatology, Medical University
of Warsaw, Warsaw, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Peripheral arterial disease (PAD) is in fact a group of
disease entities with different symptoms and course but a common
underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be
aggravated by several cardiovascular risk factors, including obstructive
sleep apnoea (OSA). <br/>Aim(s): Following paper is a protocol for the
Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing
(PARADISE) trial, which aims to describe the prevalence of OSA in PAD
patients scheduled for revascularisation, and to determine the effect of
OSA on the procedure outcomes. <br/>Method(s): The PARADISE study is an
observational cohort trial. It plans to include 200 consecutive patients
hospitalised for revascularisation due to PAD. In every patient an
overnight sleep study will be performed to diagnose sleep disorders.
According to the results of the test, patients will be divided into two
groups: Group A - patients with OSA, and group B - patients without OSA
(control group). All patients will also be screened for classical and
non-classical cardiovascular risk factors. In some of the patients, during
surgery, a fragment of atherosclerotic plaque will be collected for
further testing. Patients will be followed for one year for adverse events
and end-points. Primary end-point of the study will be the failure of
revascularisation defined as recurrence or new onset of the symptoms of
ischaemia from the treated region, a need for re-operation or procedure
revision, or recurrence of ischaemia signs on the imaging tests.
<br/>Discussion(s): The data obtained will help determine the incidence of
OSA in the population of patients with PAD. The authors expect to show
that, as with other cardiovascular diseases associated with
atherosclerosis, also in patients with PAD the incidence of undiagnosed
OSA is high and its presence is associated with elevated cholesterol,
inflammatory markers, and higher prevalence of arterial hypertension and
poor control of other cardiovascular risk factors. In addition, due to
increased oxidative stress and vascular endothelial injury associated with
OSA, patients afflicted with this condition will not only have more
advanced atherosclerotic lesions, but also in their histopathological
examination their atherosclerotic plaque will exhibit evidence of greater
instability and adverse morphology. We also expect to show that in
patients with OSA, achieving correct control of cardiovascular risk
factors will be more difficult. The study may improve PAD control through
assuring better multispecialty care in PAD patients.<br/>Copyright &#xa9;
Polskie Towarzystwo Kardiologiczne 2017.

<12>
Accession Number
618256232
Title
Transcatheter aortic valve implantation. Expert Consensus of the
Association of Cardiovascular Interventions of the Polish Cardiac Society
and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board
of the Polish Cardiac Society and National Consultants in Cardiology and
Cardiac Surgery.
Source
Kardiologia Polska. 75 (9) (pp 937-964), 2017. Date of Publication: 08 Sep
2017.
Author
Parma R.; Zembala M.O.; Dabrowski M.; Jagielak D.; Witkowski A.; Suwalski
P.; Dudek D.; Olszowka P.; Wojakowski W.; Przybylski R.; Gil R.;
Kusmierczyk M.; Lesiak M.; Sadowski J.; Dobrzycki S.; Ochala A.; Hoffman
P.; Kapelak B.; Kazmierczak J.; Jasinski M.; Stepinska J.; Szymanski P.;
Hryniewiecki T.; Kochman J.; Grygier M.; Zembala M.; Legutko J.; Rozanski
J.
Institution
(Parma, Wojakowski, Ochala) Division of Cardiology and Structural Heart
Diseases, SMK in Katowice, Medical University of Silesia, Katowice, Poland
(Zembala, Przybylski, Zembala) Department of Cardiac, Vascular and
Endovascular Surgery and Transplantology, Silesian Centre for Heart
Diseases, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
(Dabrowski, Witkowski) Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland
(Jagielak) Department of Cardiovascular Surgery, Medical University of
Gdansk, Gdansk, Poland
(Suwalski) Department of Cardiac Surgery, Central Clinical Hospital of the
Ministry of the Interior and Administration, Warsaw, Poland
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
Krakow, Poland
(Olszowka) Department of Cardiac Surgery, District Hospital 2, Rzeszow,
Poland
(Gil) Department of Invasive Cardiology, Central Clinical Hospital of the
Ministry of Interior and Administration, Warsaw, Poland
(Kusmierczyk, Rozanski) Department of Cardiac Surgery and Transplantology,
Institute of Cardiology, Warsaw, Poland
(Lesiak, Grygier) Department of Cardiology, Poznan University of Medical
Science, Poznan, Poland
(Sadowski, Kapelak) Department of Cardiovascular Surgery and
Transplantology, Jagiellonian University Medical College, Krakow, Poland
(Dobrzycki) Department of Invasive Cardiology, Medical University of
Bialystok, Bialystok, Poland
(Hoffman) Department of Congenital Cardiac Defects, Institute of
Cardiology, Warsaw, Poland
(Kazmierczak) Department of Cardiology, Pomeranian Medical University in
Szczecin, Poland
(Jasinski) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Stepinska) Department of Intensive Cardiac Care Clinic, Institute of
Cardiology, Warsaw, Poland
(Szymanski, Hryniewiecki) Department of Acquired Cardiac Defects,
Institute of Cardiology, Warsaw, Poland
(Kochman) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Legutko) 2nd Department of Cardiology, Jagiellonian University Medical
College, ul. Kopernika 17, Krakow 31-501, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Patients with severe symptomatic aortic stenosis have a poor prognosis
with medical management alone, and surgical aortic valve replacement can
improve symptoms and survival. In recent years, transcatheter aortic valve
implantation (TAVI) has been demonstrated to improve survival in
inoperable patients and to be an alternative treatment in patients in whom
the risk of surgical morbidity or mortality is high or intermediate. A
representative expert committee, summoned by the Association of
Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the
Polish Society of Cardio-Thoracic Surgeons, developed this Consensus
Statement in transcatheter aortic valve implantation. It endorses the
important role of a multi-disciplinary "TAVI team" in selecting patients
for TAVI and defines operator and institutional requirements fundamental
to the establishment of a successful TAVI programme. The article
summarises current evidence and provides specific recommendations on
organisation and conduct of transcatheter treatment of patients with
aortic valve disease in Poland.<br/>&#xa9; Copyright Polskie Towarzystwo
Kardiologiczne 2017.

<13>
Accession Number
611147882
Title
The effect of sedation during transoesophageal echocardiography on heart
rate variability: A comparison of hypnotic sedation with medical sedation.
Source
Kardiologia Polska. 74 (6) (pp 591-597), 2016. Date of Publication: 15 Jun
2016.
Author
Dogan Y.; Eren G.A.; Tulubas E.; Oduncu V.; Sahin A.; Ciftci S.
Institution
(Dogan, Oduncu, Sahin, Ciftci) Department of Cardiology, Fatih Medical
Park Hospital, Bahcesehir Medical University, Istanbul, Turkey
(Eren, Tulubas) Bakirkoy Dr. Sadi Konuk Education and Research Hospital,
Department of Anaesthesiology and Intensive Care, Istanbul, Turkey
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: There is no ideal sedation technique that can be used during
transoesophageal echocardiography (TEE), and the data concerning the
effects of available sedation techniques on heart rate variability (HRV)
are limited. <br/>Aim(s): To compare the effects of sedation through
hypnotherapy with medical sedation achieved by midazolam on HRV.
<br/>Method(s): We recruited 76 patients with an indication of TEE; the
age range was 18-83 years. In Group T there were 26 patients who had the
procedure under topical pharyngeal anaesthesia, in Group D there were 23
patients who received midazolam, and in Group H there were 27 patients
receiving hypnosis. All patients had an IV access; throughout the
procedure heart rate, rhythm electrocardiography, and peripheric O2
saturation were monitored with a non-invasive monitor, and blood pressure
measurements were taken every 3 min. Rhythm Holter recordings were
obtained from all patients and TEE was performed. <br/>Result(s): When
time domain parameters for HRV were compared in all three groups, the
hypnosis group had significant increases in pNN50 and RMSSD compared to
Groups D and T (p < 0.05). As concerns frequency domain parameters, there
were no significant differences between groups where low frequency (LF)
was decreased in hypnosis group and high frequency (HF) was increased (p >
0.05). However, LF/HF was decreased statistically significantly (p < 0.05)
when compared with the midazolam group. <br/>Conclusion(s): Contrary to
standard sedation in TEE patients, when hypnosis is used autonomic cardiac
tone is modified to a significant extent. Hypnotic sedation achieves this
by increasing the parasympathetic activity, decreasing the sympathetic
activity, and changing the sympathovagal interaction
balance.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2016.

<14>
Accession Number
608521295
Title
Appropriate bolus administration of glycoprotein IIb/IIIa inhibitors for
patients with acute coronary syndromes undergoing percutaneous coronary
intervention: Intracoronary or intravenous? A comprehensive and updated
meta-analysis and systematic review.
Source
Kardiologia Polska. 74 (2) (pp 104-118), 2016. Date of Publication: 2016.
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Shahidzadeh A.; Rahimizadeh E.;
Sarrafan-Chaharsoughi Z.; Ghodratipour Z.; Lotfaliani M.; Rezaeisadrabadi
M.; Dehghan H.R.; Bireta C.; Weymann A.; Sabashnikov A.; Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Shahidzadeh, Rahimizadeh,
Sarrafan-Chaharsoughi, Ghodratipour, Lotfaliani, Rezaeisadrabadi)
Cardiovascular Research Centre, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Dehghan) Dept. of Hlth. Technol. Assess. and Bio-statistics, Shahid
Sadoughi Univ. of Medical Sciences, Yazd, Iran, Islamic Republic of
(Bireta) Department of Thoracic and Cardiovascular Surgery, University
Hospital Goettingen, Goettingen, Germany
(Weymann, Sabashnikov, Popov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
This systematic review with meta-analysis sought to compare the efficacy
and safety of intracoronary (IC) vs. intravenous (IV) administration of
glycoprotein (GP) IIb/IIIa receptor inhibitors on clinical outcomes
following percutaneous coronary intervention in patients with acute
coronary syndromes (ST-segment elevation myocardial infarction or
non-ST-segment-elevation acute coronary syndrome). <br/>Method(s):
Medline, Embase, Elsevier, and Sciences online databases as well as Google
Scholar literature were used to select appropriate studies with randomised
controlled design. The primary end-points were mortality and target vessel
revascularisation (TVR), whereas the secondary end points were incidence
of thrombolysis in myocardial infarction score 3 flow (TIMI 3 flow means
complete perfusion in distal coronary artery bed), re-myocardial
infarction (re-MI), major bleeding, stent thrombosis left ventricular
ejection fraction (LVEF), and heart failure (HF). The literature search of
all major databases retrieved 1006 studies. After screening, a total of 18
trials (5812 patients) were identified with reported outcomes.
<br/>Result(s): Pooled analysis showed IC administration of GP IIb/IIIa
receptor inhibitors can significantly increase LVEF (WMD 4.97; 95% CI
3.34-6.60; p = 0.000) and the incidence of TIMI 3 flow (OR of 0.77; 95% CI
0.64-0.92; p = 0.005), and significantly decrease in incidence of HF (OR
of 1.927; 95% CI 1.189-3.124; p = 0.008). Incidences of TVR, re-MI, major
bleeding, stent thrombosis, and mortality showed no significant
differences between the IC and IV groups. <br/>Conclusion(s): Overall, the
most appropriate route of administration of GP IIb/IIIa inhibitors for
patients with acute coronary syndromes appeared to be an IC injection that
could increase LVEF and TIMI 3 flow and decrease the incidence of HF.
Furthermore, the IC administration was not associated with increased
adverse event rates when compared to IV injection.<br/>Copyright &#xa9;
2016 Polskie Towarzystwo Kardiologiczne.

<15>
Accession Number
610008229
Title
Outcomes of percutaneous coronary intervention in Patients after previous
coronary artery bypass surgery.
Source
Kardiologia Polska. 74 (4) (pp 322-330), 2016. Date of Publication: 2016.
Author
Zajac P.; Zycinski P.; Qawoq H.; Jankowski L.; Peruga J.; Wcislo T.;
Pagorek P.; Peruga J.Z.; Kasprzak J.D.; Plewka M.
Institution
(Zajac, Zycinski, Qawoq, Jankowski, Wcislo, Pagorek, Peruga, Kasprzak,
Plewka) Department and Chr. of Cardiology, Medical University of Lodz, ul.
Kniaziewicza 1/5, Lodz 91-347, Poland
(Peruga) Cardiology Service, Ludwik Perzyna Regional Specialist Hospital,
Kalisz, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Patients after previous coronary artery bypass grafting (CABG)
often require repeat percutaneous revascularisation due to poor patency
rates of saphenous vein grafts (SVG) and higher risk of re-CABG. Few data
are available to evaluate different percutaneous revascularisation
strategies in patients after previous CABG. <br/>Aim(s): To evaluate
outcomes of percutaneous coronary intervention (PCI) in patients after
previous CABG, including the effect of treatment on the quality of life
and symptoms, and secondly to assess the relation between angiographic
factors and treatment outcomes Methods: This was a prospective
observational study which included 78 patients after previous CABG.
Following coronary angiography, the patients were assigned to one of three
groups: group A (n = 20), PCI of a SVG (PCI SVG); group B (n = 29), PCI of
a native coronary artery (PCI NA); group C (n = 29), control group that
received medical treatment (MT) only. Duration of follow-up was 12 months.
<br/>Result(s): Compared to MT patients, patients treated with PCI had
significantly higher Canadian Cardiovascular Society (CCS) class (2.75 vs.
2.41, p = 0.03) and more frequently had coronary angiography performed due
to unstable angina (57% vs. 31%, p = 0.04). Patients in the PCI SVG group
had significantly older SVG conduits compared to the PCI NA group (13.4
years vs. 8.2 years, p = 0.005). At 12 months of follow-up, we found a
significant improvement in the EQ-5D index of the quality of life, and a
significant reduction in CCS class in the PCI SVG group (0.66 vs. 0.7, p =
0.0003, and 2.75 vs. 1.9, p < 0.001, respectively) and in the PCI NA group
(0.65 vs. 0.72, p < 0.001, and 2.75 vs. 2.17, p < 0.001, respectively),
but no improvement in the MT group. Treatment outcomes did not differ
significantly between the three groups (combined endpoint rate 20% vs. 13%
vs. 27.5%, p = 0.37). In multivariate analysis, SVG age > 11 years was
identified as a significant predictor of poor outcomes in patients treated
with PCI after previous CABG. <br/>Conclusion(s): PCI in patients after
previous CABG does not improve prognosis but significantly improves the
quality of life and reduces symptom severity.<br/>Copyright &#xa9; Polskie
Towarzystwo Kardiologiczne 2016.

<16>
Accession Number
372510382
Title
Intracoronary adenosine administered during aortocoronary vein graft
interventions may reduce the incidence of no-reflow phenomenon. A pilot
randomised trial.
Source
Kardiologia Polska. 72 (2) (pp 126-133), 2014. Date of Publication: 2014.
Author
Grygier M.; Araszkiewicz A.; Lesiak M.; Grajek S.
Institution
(Grygier, Araszkiewicz, Lesiak, Grajek) First Department of Cardiology,
Poznan University of Medical Sciences, ul. Dluga 1/2, 61-848 Poznan,
Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: The results of percutaneous coronary intervention (PCI) for
saphenous vein graft (SVG) disease are limited by distal embolisation and
no-reflow which occurs in 10-43% of cases. <br/>Aim(s): To examine the
role of a new protocol of adenosine administration during PCI in SVG on
immediate angiographic results and clinical course. <br/>Method(s): A
prospective, single-centre, randomised placebo-controlled pilot trial in
32 consecutive patients after coronary artery bypass graft (aged 71 +/- 12
years, 22 male) with stable and unstable angina (CCS II-IV), who were
admitted to our hospital for SVG PCI, was conducted. Patients were
randomised to two groups. Group A (16 patients) received two times
adenosine (2 mg + 2 mg) to the SVG during PCI procedure, and Group B (16
patients) received a placebo. <br/>Result(s): No reflow was observed in
one (6.25%) patient in the adenosine group and six (37.5%) patients in the
placebo group (p = 0.0325). TIMI 3 flow (94% vs. 63%; p = 0.0322) and
corrected TIMI frame count < 28 (94% vs. 63%; p = 0.0322) at the end of
the procedure were better in patients who received adenosine. Myocardial
blush grade 2 and 3 at the end of the procedure was observed in 15
patients in the adenosine group and ten patients in the placebo group (p =
0.083). A trend toward a lower rate of myocardial infarctions in the
adenosine group was observed (6% vs. 25%; p = 0.144). <br/>Conclusion(s):
Adenosine injections may be effective in preventing no-reflow in the
setting of PCI of SVG. Adenosine administration seems to be associated
with a more favourable clinical course. &#xa9; Polskie Towarzystwo
Kardiologiczne.

<17>
Accession Number
363156985
Title
The effects of intracoronary delivery of mononuclear bone marrow cells in
patients with myocardial infarction: A two year follow-up results.
Source
Kardiologia Polska. 69 (12) (pp 1234-1240), 2011. Date of Publication:
2011.
Author
Plewka M.; Krzeminska-Pakula M.; Peruga J.Z.; Lipiec P.; Kurpesa M.;
Wierzbowska-Drabik K.; Korycka-Wolowiec A.; Kasprzak J.D.
Institution
(Plewka, Krzeminska-Pakula, Peruga, Kurpesa, Wierzbowska-Drabik, Kasprzak)
Department of Cardiology, Medical University of Lodz, ul. Kniaziewicza
1/5, 91-347 Lodz, Poland
(Lipiec) Department of Rapid Cardiac Diagnostics, Medical University of
Lodz, Lodz, Poland
(Korycka-Wolowiec) Department of Haematology, Medical University of Lodz,
Lodz, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Transplantation of bone marrow stem cells (BMSC) is a new
method of prevention of left ventricular (LV) remodelling in
post-infarction patients. Studies published to date point to LV systolic
and diastolic function improvement following this therapy however only a
few studies assessed the long-term effects of BMSC. <br/>Aim(s): To assess
the 2 year prognosis in patients with anterior myocardial infarction (MI)
treated with BMSC transplantation in the acute phase. <br/>Method(s): The
study group consisted of 60 patients with first anterior ST-segment
elevation MI (STEMI), treated with primary percutaneous angioplasty, with
baseline LV ejection fraction (LVEF) < 40%, who were randomly assigned to
undergo BMSC transplantation on day 7 of the STEMI (40 patients, BMSC
group) or to receive standard treatment (20 patients, control group). In
all the patients echocardiography was performed at baseline and after 1,
3, 6, 12 and 24 months. The composite end-point (death, MI, admission for
heart failure or repeat revascularisation) was assessed after 2 years of
follow-up. <br/>Result(s): Absolute increase of LVEF compared to baseline
values was higher in the BMSC group than in the control group. The LVEF
increase in BMSC group at 1 month was 7.1% (95% CI 3.1-11.1%), at 6 months
- 9.3% (95% CI 5.3-13.3%), at 12 months - 11.0% (95% CI 6.2-13.3%) and at
24 months - 10% (95% CI 7.2-12.1%). In the control group, LVEF increase
was 3.7% (95% CI 2.3-9.7%) at 1 month, 4.7% (95% CI 1.2-10.6%) at 6
months, 4.8% (95% CI 1.5-11.0%) at 12 months and 4.7% (95% CI 1.4-10.7%)
at 24 months. The composite end-point occurred significantly more
frequently in the control group (55%) than in the BMSC group (23%): OR
2.72; 95% CI 1.06-7.02, p = 0.015. <br/>Conclusion(s): Treatment with
mononuclear bone marrow cells on day 7 of the first anterior MI in
patients with significant baseline systolic dysfunction improves 2-year
outcome. Copyright &#xa9; Polskie Towarzystwo Kardiologiczne.

<18>
Accession Number
362380518
Title
Radial vs femoral approach with StarClose clip placement for primary
percutaneous coronary intervention in patients with ST-elevation
myocardial infarction. RADIAMI II: A prospective, randomised, single
centre trial.
Source
Kardiologia Polska. 69 (8) (pp 763-771), 2011. Date of Publication: 2011.
Author
Chodor P.; Kurek T.; Kowalczuk A.; Swierad M.; Was T.; Honisz G.;
Swiatkowski A.; Streb W.; Kalarus Z.
Institution
(Chodor, Kurek, Swierad, Was, Honisz, Swiatkowski, Streb, Kalarus)
Department of Cardiology, Medical University of Silesia, Silesian Centre
for Heart Diseases, ul. Szpitalna 2, 44-100 Zabrze, Poland
(Kowalczuk) Department and Clinical Ward of Cardiac Surgery and
Transplantology, Medical University of Silesia, Katowice, Silesian Centre
for Heart Diseases, Zabrze, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Compared to the transfemoral approach (TFA), the transradial
approach (TRA) for primary percutaneous coronary intervention (PCI) is
associated with less risk of access site complications, greater patient
comfort and faster mobilisation. Using vascular closure devices during TFA
can offer similar advantages. <br/>Aim(s): To compare the results of TRA
and TFA using a StarClose device for primary PCI in patients with
ST-elevation myocardial infarction (STEMI). <br/>Method(s): Patients were
randomised to PCI using TRA (n = 49) or PCI using TFA and StarClose (n =
59). <br/>Result(s): Door-to-balloon inflation time was 67.4 +/- 17.1 vs
57.5 +/- 17.5 min (p = 0.009) in the TRA and TFA groups respectively.
Procedural success rate was 100% and 98.3%, respectively (NS). There were
no significant differences in the incidence of major adverse cardiac
events (MACE) or bleeding complications between the groups: 2.1% and 8.2%
in the TRA group vs 1.7% and 10.2% in the TFA group (NS). Time to resume
an upright position and time to full mobility was comparable in both
groups. <br/>Conclusion(s): The TRA for PCI in patients with STEMI is
related to a significantly longer door to balloon time compared to the
TFA. This had no influence on the incidence of MACE. The duration and
efficacy of PCI were comparable in both groups. Using StarClose after PCI
performed via the TFA resulted in an incidence of access site and bleeding
complications comparable to that found when using TRA. Copyright &#xa9;
Polskie Towarzystwo Kardiologiczne.

<19>
Accession Number
361838980
Title
Percutaneous transvenous mitral commissurotomy: With or without heparin? A
randomised double blind study.
Source
Kardiologia Polska. 69 (5) (pp 445-450), 2011. Date of Publication: 2011.
Author
Ghaffari S.; Sohrabi B.; Aslanabadi N.; Mogadam A.R.S.; Sepehrvand N.;
Pourafkari L.; Ghaffari R.; Akbarzadeh F.; Yaghoubi A.
Institution
(Ghaffari, Sohrabi, Aslanabadi, Mogadam, Sepehrvand, Pourafkari, Ghaffari,
Akbarzadeh, Yaghoubi) Cardiovascular Research Department, Madani Heart
Centre, Tabriz, Iran, Islamic Republic of
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Percutaneous transvenous mitral commissurotomy (PTMC) is an
alternative approach to open heart surgery in patients with symptomatic
mitral stenosis (MS). <br/>Aim(s): To compare the outcome of performing
PTMC with or without heparin administration. <br/>Method(s): In this
randomised clinical trial, 480 patients with symptomatic MS were randomly
allocated to one of two groups, with or without heparin administration as
part of the procedure. Echocardiographic and clinical outcomes of PTMC
assessed before the procedure, during hospitalisation, and after the
one-month follow-up, were compared between the two groups. <br/>Result(s):
Baseline demographic and clinical characteristics were similar in the 240
patients with heparin administration (the Hep [+] group) and the 240
patients without heparin administration (the Hep [-] group) during the
procedure. In the whole study group mitral valve area (MVA) was 0.94 +/-
0.03 cm² prior to PTMC, and increased to 1.85 +/- 0.06 cm
² after the procedure (p = 0.0001). The mean increase in MVA
was 0.85 +/- 0.27 cm² in the Hep (+) group and 0.88 +/- 0.2 cm
² in the Hep (-) group (NS). During the procedure, or
immediately after PTMC, embolic events were recorded in two (0.83%) Hep
(+) patients and one (0.42%) Hep (-) patient (NS). The frequency of
haematoma at puncture site (three [1.25%] Hep [+] vs two [0.83%] Hep [-]),
and the need for urgent surgery (two [0.83%] Hep [+] vs five [2.1%] Hep
[-]), were similar in both groups. There were no embolic events after
discharge or during the one month follow-up period. <br/>Conclusion(s):
Our study revealed that in high volume centres and in selected patients
without left atrial thrombus, heparin administration during PTMC is not
associated with any additional protective effect against embolic events
during short-term follow-up. Copyright &#xa9; Polskie Towarzystwo
Kardiologiczne.

<20>
Accession Number
361843948
Title
Prospective randomised pilOt study evaLuating the safety and efficacy of
hybrid revascularisation in MultI-vessel coronary artery DisEaSe
(POLMIDES) - Study design.
Source
Kardiologia Polska. 69 (5) (pp 460-466), 2011. Date of Publication: 2011.
Author
Tajstra M.; Zembala M.; Filipiak K.; Knapik P.; Hrapkowicz T.; Gierlotka
M.; Hawranek M.; Polonski L.; Gasior M.
Institution
(Zembala, Zembala, Filipiak, Hrapkowicz) Department of Cardiac Surgery and
Transplantology, Silesian Centre for Heart Diseases, Medical University of
Silesia, Zabrze, Poland
(Tajstra, Gierlotka, Hawranek, Polonski, Gasior) 3rd Department of
Cardiology, Silesian Centre for Heart Diseases, Medical University of
Silesia, Zabrze, Poland
(Knapik) Department of Cardiac Anaesthesia and Intensive Therapy, Silesian
Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: Hybrid coronary artery revascularisation (HCR) is a
combination of minimally invasive left internal mammary artery bypass
grafting to the left anterior descending artery (LAD) and percutaneous
coronary interventions (PCI) with drug eluting stent implantation to other
coronary arteries. Due to the paucity of data from large, prospective
randomised trials comparing HCR to standard surgical revascularisation,
the POLMIDES study has been designed to assess the safety and efficacy of
HCR in patients with multivessel coronary artery disease (CAD) referred
for standard coronary artery bypass grafting (CABG). <br/>Aim(s): The
primary objective is evaluating the feasibility and safety of HCR.
<br/>Method(s): Feasibility has been defined by means of the percentage of
patients with a complete hybrid procedure according to the study protocol
and a percentage of conversion to standard CABG. Safety has been defined
as the occurrence of major adverse cardiac events such as death,
myocardial infarction, stroke, repeat revascularisation and major bleeding
within the 12 month period after randomisation. All consecutive patients
with angiographically confirmed multivessel CAD involving LAD and a
critical (> 70%) lesion in at least one major epicardial vessel (except
LAD) amenable to both PCI and CABG referred for conventional surgical
revascularisation, will be randomised in a 1:1 fashion for HCR or standard
surgical revascularisation. <br/>Conclusion(s): The POLMIDES is a
prospective, randomised pilot trial designed to determine whether HCR in
patients with multivessel CAD referred for conventional CABG is safe,
feasible and efficacious (ClinicalTrials.gov number, NCT01035567).
Copyright &#xa9; Polskie Towarzystwo Kardiologiczne.

<21>
Accession Number
361371765
Title
Effect of gender on efficacy of preoperative intra-aortic balloon pump in
high risk patients undergoing surgical coronary revascularisation.
Source
Kardiologia Polska. 68 (12) (pp 1361-1368), 2010. Date of Publication:
2010.
Author
Wilczynski M.; Krzych L.J.; Bis J.; Szmagala P.; Ulczok R.; Bochenek A.
Institution
(Wilczynski, Krzych, Bis, Szmagala, Ulczok, Bochenek) 1st Department of
Cardiac Surgery, Medical University of Silesia, GCM, ul. Ziolowa 45/47,
40-635 Katowice, Poland
Publisher
Via Medica (E-mail: sekretariat@mp.pl)
Abstract
Background: There is no strong evidence supporting the use of preoperative
intra-aortic balloon pump (IABP) in high-risk patients undergoing coronary
artery bypass grafting (CABG). This issue has only been investigated in
small studies which analysed the general population of patients, without
focusing on specific subgroups, including gender. <br/>Aim(s): We sought
to determine if there is any benefit from preoperative IABP in high-risk
patients undergoing CABG with the analysis of its determinants including
gender. <br/>Method(s): We randomly assigned 502 high-risk patients (351
men, 151 women) to the group receiving preoperative IABP support or to the
control group with no preoperative IABP. Primary end-point was a major
adverse cardiac or cerebrovascular event (MACCE), defined as death from
any cause, myocardial infarction, cerebrovascular accident or repeat
revascularisation within 30 days post-surgery. <br/>Result(s): A
significant reduction of MACCE rate in patients with the preoperative IABP
counterpulsation in comparison to controls was noticed in the total
population of high risk patients (p = 0.001) and in the female subgroup (p
= 0.005). After adjustment for baseline characteristics, the hazard ratio
for MACCE was 0.7 (p = 0.005) in the total population; 0.6 (p = 0.01) for
females and 0.8 (p = 0.1) for males. <br/>Conclusion(s): There is a
beneficial effect of preoperative IABP use in high-risk patients
undergoing CABG, particularly in women and patients with co-morbidities
(diabetes, obesity, and peripheral vascular disease). Copyright &#xa9; Via
Medica.

<22>
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.

<23>
Accession Number
2001979453
Title
Prognostic impact of MitraClip in patients with left ventricular
dysfunction and functional mitral valve regurgitation: A comprehensive
meta-analysis of RCTs and adjusted observational studies.
Source
International Journal of Cardiology. 290 (pp 70-76), 2019. Date of
Publication: 1 September 2019.
Author
Bertaina M.; Galluzzo A.; D'Ascenzo F.; Conrotto F.; Grosso Marra W.; Frea
S.; Alunni G.; Crimi G.; Moretti C.; Montefusco A.; D'Amico M.; Perl L.;
Rinaldi M.; Giustetto C.; De Ferrari G.M.
Institution
(Bertaina, Galluzzo, D'Ascenzo, Conrotto, Grosso Marra, Frea, Alunni,
Moretti, Montefusco, D'Amico, Rinaldi, Giustetto, De Ferrari) Cardiology
Department, Citta della Salute e della Scienza, Molinette Hospital, Turin,
Italy
(Crimi) Cardiology Department, IRCCS Policlinico San Matteo, Pavia, Italy
(Perl) Cardiology Department, Rabin Medical Center, Petach-tikva, Israel
(Perl) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Publisher
Elsevier Ireland Ltd
Abstract
The real prognostic impact of MitraClip in patients with significant
functional mitral regurgitation (FMR) and left ventricular (LV)
dysfunction remains to be elucidated. Two randomized controlled trials
(RCTs) with conflicting results have been recently published. We conducted
a comprehensive meta-analysis of all RCTs and adjusted observational
studies to evaluate the clinical impact of percutaneous mitral valve
repair when compared with optimal medical therapy (OMT) alone, in patients
with symptomatic FMR and LV dysfunction. Death from any cause and heart
failure rehospitalizations at the longest available follow-up were the
primary endpoints. Cardiac death, one year and short-term death were the
secondary ones. 2255 patients (1207 for MitraClip and 1048 for OMT-only)
from 8 studies (2 RCTs and 6 observational studies) were included. At a
median (mid-term) follow-up of 438 days (IQR 360-625) MitraClip was
associated with a significant reduction of all-cause death (odds Ratio
[OR] 0.55, 95%CI 0.41-0.73, p < 0.001; [ORadj] 0.66, 95%CI 0.49-0.90, p =
0.009) and rehospitalization (OR 0.49, 95%CI 0.24-1.00, p = 0.05 and ORadj
0.63, 95%CI 0.43-0.94, p = 0.02). At one year, adjusted analysis
demonstrated a trend favoring the experimental cohort (ORadj 0.73, 95%CI
0.53-1.02, p = 0.07). Meta-regression suggested that benefit of MitraClip
on mid-term survival persists even after accounting for the prevalence of
implanted CRT, burden of comorbidities, NYHA class, cardiomyopathy
etiology and LV function and dimensions. In conclusion, MitraClip for FMR
in patients with LV dysfunction is associated with a considerable
reduction of death and HF hospitalization at mid-term follow-up. Further
ongoing RCTs are needed to strengthen present results.<br/>Copyright
&#xa9; 2019 Elsevier B.V.

<24>
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

<25>
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

<26>
Accession Number
2002055719
Title
Current Readings on Outcomes After Off-Pump Coronary Artery Bypass
Grafting.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Patel V.; Unai S.; Gaudino M.; Bakaeen F.
Institution
(Patel, Unai, Bakaeen) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
Publisher
W.B. Saunders
Abstract
Off-pump coronary artery bypass grafting (CABG) gained popularity in the
1990s through early 2000s as surgeons sought to mitigate the purported
adverse effects of cardiopulmonary bypass and reduce the risk of
neurologic events from aortic manipulation. Since then, results of several
large randomized controlled trials and meta-analyses have failed to
demonstrate an advantage of off-pump CABG over traditional on-pump CABG
and have even raised concerns about potential suboptimal outcomes. The
modern debate about off- vs on-pump CABG centers around long-term
outcomes, the role of surgeon experience, identification of specific
patient populations for which off-pump CABG is most appropriate, and
identification of novel techniques and technologies to improve long-term
outcomes. We review the key findings of 5 contemporary papers that address
these issues and provide a current perspective on the status of off-pump
CABG.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<27>
[Use Link to view the full text]
Accession Number
627110359
Title
Aortic valve repair or replacement in patients with aortic regurgitation:
A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 34 (6) (pp 377-384), 2019. Date of
Publication: June 2019.
Author
Wong C.H.M.; Chan J.S.K.; Sanli D.; Rahimli R.; Harky A.
Institution
(Wong, Chan) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Sanli) Gundogmus National Town Hospital, Antalya, Turkey
(Rahimli) Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
(Harky) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To systematically compare clinical outcomes between aortic
valve repair and replacement in patients with aortic regurgitation.
<br/>Method(s): A comprehensive literature search was undertaken among the
four major databases (PubMed, Embase, Scopus, and Ovid) to identify all
published data comparing clinical outcomes of aortic valve repair vs
replacement. Database searched from inception to November 2018.
<br/>Result(s): A total of 1071 patients were analyzed in eight articles.
Mean age was similar in both groups of patients (47.2 +/- 12.8 vs 48.3 +/-
12.7 years, P = 0.83, aortic valve repair and replacement, respectively).
The preoperative left ventricular ejection fraction was better in the
repair group (56.7% +/- 4.8 vs 53.3% +/- 4.2, P = 0.005). The rate of
moderate-to-severe regurgitation and bicuspid aortic valve were similar in
both cohorts (81% vs 78%, P = 0.90% and 58% vs 55%, P = 0.46). In-hospital
and 1-year mortality was lower in repair cohort, although not reaching
statistical significance (1.3% vs 3.6%, P = 0.12; 5.9% vs 9.3%, P = 0.77).
Reoperation rate was higher in repair patients at 1 year (8.8% vs 3.7%, P
= 0.03). <br/>Conclusion(s): Aortic valve repair offers comparable
perioperative outcomes to aortic valve replacement in aortic regurgitation
patients at the expense of higher late reintervention rate. Larger trials
with long-term follow-up are required to confirm the long-term benefits of
aortic valve repair.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<28>
Accession Number
627799686
Title
Herbal medications for anxiety, depression, pain, nausea and vomiting
related to preoperative surgical patients: A systematic review and
meta-analysis of randomised controlled trials.
Source
BMJ Open. 9 (5) (no pagination), 2019. Article Number: e023729. Date of
Publication: 01 May 2019.
Author
Arruda A.P.N.; Zhang Y.; Gomaa H.; Bergamaschi C.D.C.; Guimaraes C.C.;
Righesso L.A.R.; Paglia M.D.G.; Barberato-Filho S.; Lopes L.C.; Ayala
Melendez A.P.; De Oliveira L.D.; Paula-Ramos L.; Johnston B.; El Dib R.
Institution
(Arruda) Department of Surgery and Orthopedics, UNESP - Universidade
Estadual Paulista, Faculty of Medicine, Botucatu, Sao Paulo, Brazil
(Zhang) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Gomaa) Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
(Bergamaschi, Barberato-Filho, Lopes) Pharmaceutical Sciences, University
of Sorocaba, Sorocaba, Sao Paulo, Brazil
(Guimaraes) Terapeutica, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
(Righesso) Oral and Maxillofacial Surgery, University Medical Center
Mainz, Mainz, Germany
(Paglia) Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao
Paulo, Brazil
(Ayala Melendez) Gerstein Science Information Centre, University of
Toronto, Toronto, ON, Canada
(De Oliveira, Paula-Ramos, El Dib) Department of Biosciences and Oral
Diagnosis, UNESP - Universidade Estadual Paulista, Institute of Science
and Technology, Sao Jose Dos Campos, Brazil
(Johnston) Community Health and Epidemiology, Dalhousie University Faculty
of Medicine, Halifax, NS, Canada
(El Dib) St. Joseph's Healthcare, McMaster University, Institute of
Urology, Hamilton, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To summarise the effects of herbal medications for the
prevention of anxiety, depression, pain, and postoperative nausea and
vomiting (PONV) in patients undergoing laparoscopic,
obstetrical/gynaecological or cardiovascular surgical procedures. Methods
Searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled
Trials and LILACS up until January 2018 were performed to identify
randomised controlled trials (RCTs). We included RCTs or quasi-RCTs
evaluating any herbal medication among adults undergoing laparoscopic,
obstetrical/gynaecological or cardiovascular surgeries. The primary
outcomes were anxiety, depression, pain and PONV. We used the Grading of
Recommendations Assessment, Development and Evaluation approach to rate
overall certainty of the evidence for each outcome. Results Eleven trials
including 693 patients were eligible. Results from three RCTs suggested a
statistically significant reduction in vomiting (relative risk/risk ratio
(RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96)
with the use of Zingiber officinale (ginger) compared with placebo in both
laparoscopic and obstetrical/gynaecological surgeries. Results suggested a
non-statistically significantly reduction in the need for rescue
medication for pain (RR 0.52; 95% CI 0.13 to 2.13) with Rosa damascena
(damask rose) and ginger compared with placebo in laparoscopic and
obstetrical/gynaecological surgery. None of the included studies reported
on adverse events (AEs). Conclusions There is very low-certainty evidence
regarding the efficacy of both Zingiber officinale and Rosa damascena in
reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer),
nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for
rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752
more) in patients undergoing either laparoscopic or
obstetrical/gynaecological surgeries. Among our eligible studies, there
was no reported evidence on AEs. PROSPERO registration number
CRD42016042838.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<29>
Accession Number
628019094
Title
Sex-mismatched red blood cell transfusions and mortality: A systematic
review and meta-analysis.
Source
Vox Sanguinis. (no pagination), 2019. Date of Publication: 2019.
Author
Zeller M.P.; Rochwerg B.; Jamula E.; Li N.; Hillis C.; Acker J.P.;
Runciman R.J.R.; Lane S.J.; Ahmed N.; Arnold D.M.; Heddle N.M.
Institution
(Zeller, Jamula, Li, Hillis, Runciman, Lane, Ahmed, Arnold, Heddle)
McMaster Centre for Transfusion Research, McMaster University, Hamilton,
ON, Canada
(Zeller) Canadian Blood Services, Medical Office, Hamilton, ON, Canada
(Zeller, Arnold, Heddle) Division of Hematology and Thromboembolism,
Department of Medicine, McMaster University, Hamilton, ON, Canada
(Rochwerg) Division of Critical Care, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Rochwerg) Department of Health Research Methods, Evidence & Impact,
McMaster University, Hamilton, ON, Canada
(Hillis) Department of Oncology, McMaster University, Hamilton, ON, Canada
(Acker) Department of Laboratory Medicine and Pathology, University of
Alberta, Edmonton, AB, Canada
(Acker) Centre for Innovation, Canadian Blood Services, Edmonton, AB,
Canada
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: Selection of a compatible red blood cell (RBC)
unit does not include matching for donor sex. This systematic review and
meta-analysis aims to summarize the evidence examining the impact of
sex-mismatched RBC transfusion on recipient mortality. <br/>Material(s)
and Method(s): Ovid MEDLINE, Ovid EMBASE, CINAHL, PubMed, Web of Science
and the Cochrane Database of Systematic Reviews were searched from
inception up to 23 November 2018. Randomized controlled trials and
observational studies were included in the search. Eligible studies
reported on the impact of sex-matched compared to sex-mismatched RBC
transfusion on recipient mortality. Two investigators independently
extracted data and assessed study quality. A three-level meta-analytic
model was applied to emphasize the unknown dependence among the effect
sizes. <br/>Result(s): Five retrospective observational studies (n = 86
737) were included; no RCTs were found. Sex-mismatched RBC transfusions
were associated with a higher risk of death compared with sex-matched
transfusions (pooled hazard ratio [HR]: 1.13; 95% confidence interval
[CI]: 1.02-1.24). In the subgroup of cardiovascular surgery (n = 57 712),
there was no significant increase in mortality with sex-mismatched
transfusions (pooled HR: 1.08; 95% CI: 0.95-1.22). The data were prone to
confounding, selection bias and reporting bias. Certainty of the evidence
was very low. <br/>Conclusion(s): Sex-mismatched RBC transfusions were
associated with an increased risk of death in this pooled analysis.
However, the certainty of the evidence was very low from observational
studies. The need to match donor and recipient sex for transfusions
requires further investigation because of the potential widespread
impact.<br/>Copyright &#xa9; 2019 International Society of Blood
Transfusion

<30>
Accession Number
2001951616
Title
Hemorrhagic cardiac tamponade associated with Apixaban: A case report and
systematic review of literature.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Asad Z.U.A.; Ijaz S.H.; Chaudhary A.M.D.; Khan S.U.; Pakala A.
Institution
(Asad, Ijaz, Pakala) University of Oklahoma Health Sciences Center,
Oklahoma City, United States
(Chaudhary) Nishtar Medical College, Multan, Pakistan
(Khan) West Virginia University, Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Hemorrhagic cardiac tamponade (HCT)is characterized by rapid
accumulation of blood in the pericardium causing hemodynamic collapse. We
report a case of HCT due to Apixaban use in a patient with renal cell
carcinoma, supplemented with a systematic review of pericardial tamponade
associated with the use of direct oral anticoagulants (DOACs). Case
report: A 62-year-old African American male with a history of metastatic
renal cell carcinoma presented with dyspnea while taking Apixaban. He was
diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion
was drained. The pericardial fluid analysis was negative for malignancy
and suggestive of HCT. He had a complicated hospital course and died
several days later. <br/>Method(s): We searched MEDLINE, EMBASE and other
sources for published cases of pericardial tamponade associated with
DOACs. Our outcomes of interest included patient characteristics, risk
factors, timing from the start of anticoagulation to tamponade, treatment
and mortality. Simple descriptive statistics using percentages for
categorical variables were used to describe the included cases.
<br/>Result(s): A total of 26 cases were included in the final systematic
review after searching MEDLINE, EMBASE and other sources. The mean age was
70 years (range 43-88)with 19 (73%)males. Twelve cases (46%)were
associated with Rivaroxaban, 9 (37%)with Dabigatran and 5(19%)with
Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine.
Only 2 patients died but 24 had to undergo pericardiocentesis.
<br/>Conclusion(s): Cardiac tamponade is rarely associated with DOACs and
elderly male patients with renal and coagulation abnormalities appear to
have the highest risk.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<31>
Accession Number
628003411
Title
Optimal timing of surgical antimicrobial prophylaxis with cefuroxim:
Challenging the who guidelines with 121,000 prospectively followed
patients.
Source
Open Forum Infectious Diseases. Conference: ID Week 2017. United States. 4
(Supplement 1) (pp S647-S648), 2017. Date of Publication: September 2017.
Author
Widmer A.F.; Troillet N.; Thurneysen M.; Atkinson A.; Dangel M.; Kuster
S.P.; Marschall J.
Institution
(Widmer) Infectious Diseases, University of Basel Hospitals and Clinics,
Basel, Switzerland
(Troillet) Infectious Disease Hospital Epidemiology, Valais hospital,
Sion, Switzerland
(Thurneysen) Division of Infectious Disease and Hospital Epidemiology,
University of Basel, Basel, Switzerland
(Atkinson) Infectious Disease Hospital Epidemiology, University of Bern,
Bern, Switzerland
(Dangel) University Hospital Basel, Basel, Switzerland
(Kuster) Infectious Diseases and Hospital Epidemiology, University
Hospital Zurich, Zurich, Switzerland
(Marschall) Infectious Diseases and Hospital Epidemiology, Bern University
Hospital, University of Bern, Bern, United States
Publisher
Oxford University Press
Abstract
Background. Surgical antimicrobial prophylaxis (SAP) is standard of care
in clean surgery involving implants and in clean-contaminated surgical
procedures. Timing of application of the antibiotic remains a debate: WHO
recently extended the time prior to incision from 60 to 120 minutes, while
CDC considers the availabdata insufficient to provide evidence-based
guideline for timing. In addition, studies to date included different
types of antibiotics with different T . Therefore, we prospectively
followed 250'000 patients to further define the optimal timing for SAP
Methods. The Swiss national center for infection prevention
(www.swissnoso.ch) started surveillance for surgical site infection (SSI)
in 2009. Currently, 172 institutions participate throughout Switzerland,
with routine postdicharge surveillance (adherence >90%) and on-site
quality audits by a physician or infection control practitioner. The data
collection includes age, sex, type of surgery, timing of SAP in minutes
prior to incision, BMI, ASA score, antimicrobial agent. Inclusion criteria
for this study were: adult patients undergoing cardiac surgery, orthopedic
or abdominal surgery, antimicrobial prophylaxis with cefuroxime only
(+metronidazole for abdominal surgery) and pathogen identified in cases of
SSI was cefuroxime-susceptible. Data were analyzed using a generalized
additive model (GAM) to allow non-parametric fits with relaxed assumptions
on the actual relationship between response and predictor Results. Of the
258'481 patients in the national SSI surveillance database 121'645
fulfilled the inclusion criteria (38% of patients did not require SAP, 18%
had surgery with contaminated or dirty wounds, 2.7% were <18 years and
data on timing and class of antibiotic were missing in 5.7%). The lowest
risk of SSI was observed with application of SAP 0-30min prior incision,
even after adjustment for age, sex, ASA score, type of surgery, BMI, and
T1/2. (Figure, CI95 in blue area) Conclusion. Timing of SAP (with
cefuroxime) 0-30 minutes prior to incision was associated with the lowest
risk of SSI, challenging a previous randomized controlled trial and recent
WHO guidelines. (Figure Presented) .

<32>
[Use Link to view the full text]
Accession Number
628003485
Title
Serratia and surgical site infections: Risk factors and epidemiology.
Source
Open Forum Infectious Diseases. Conference: ID Week 2017. United States. 4
(Supplement 1) (pp S650), 2017. Date of Publication: September 2017.
Author
O'Horo J.; Mahler S.B.; Gardner B.; Berbari E.F.
Institution
(O'Horo) Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN,
United States
(O'Horo) Infectious Diseases, Mayo Clinic, Rochester, MN, United States
(Mahler, Gardner) Mayo Clinic, Rochester, MN, United States
(Berbari) Division of Infectious Diseases, Mayo Clinic, Rochester, MN,
United States
Publisher
Oxford University Press
Abstract
Background. Serratia spp. have been associated with surgical site
infection (SSI) outbreaks associated with specific providers, topical
creams and contaminated saline products. Patient risk factors for
developing infection with this organism have not been extensively studied.
We sought to evaluate risk factors for Serratia SSI. Methods. Cases of
Serratia SSI occurring between 2012 and 2016 were identified via an
infection control surveillance program. SSI was defined by National
Healthcare Safety Network (NHSN) criteria. Controls were randomly selected
individuals undergoing similar procedures during the same time frame
without identified Serratia SSI. Data was analyzed using partitioning,
student T test and chi-square analysis to identify risk factors for
Serratia SSI. Results. During the study period, 17 cases and 34 controls
were identified, all of whom were cardiac or vascular surgery patients.
Males were afflicted far more often than females (Relative risk 4.9, 95%
CI 0.72-33.37, P = 0.04) Cases were older (mean age [standard error]
55.1[3.40] vs. 66.3[4.92] years, P = 0.04), had longer operative times
(238.1[19.1] vs. 212.5[28.2] minutes, P = 0.04), and a similar American
Society of Anesthesiologist preoperative risk score (3.8[0.07] vs.
3.1[0.1], P = 0.83). We did not observe significant differences in body
mass index, cardiopulmonary comorbidities, preoperative catheterization,
or malignancy. In partition analysis, gender, (incision time >180 minutes
and age >62) was all highly predictive of Serratia SSI risk (receiver
operator characteristic 0.81). Other risk factors screened, including
types of vascular access, specific surgeon(s) performing procedures,
reoperation, open chest procedures and antecedent cardiac catheterization,
were not significantly associated with an increased risk of serratia
SSI's. Serratia SSI's were associated with a 29% 30-day mortality rate,
compared with 5.8% seen in controls (P = 0.02). Conclusion. Gender,
operative time and age are associated with an increase in Serratia SSI
risk. Serratia SSI is associated with a high mortality rate. Providers
should be vigilant for this organism, particularly in older male patients
undergoing complex cardiovascular surgical procedures.

<33>
Accession Number
627863404
Title
Quantification of Ischemia As a Prognostic Mandate for Coronary
Revascularization in Asymptomatic Patients: How Much Is Enough?.
Source
Critical pathways in cardiology. 18 (2) (pp 98-101), 2019. Date of
Publication: 01 Jun 2019.
Author
Shabbir A.; Fan L.; Fraser G.; Cassar M.P.; Swinburn J.
Institution
(Shabbir, Fan, Fraser) From the John Radcliffe Hospital, Oxford University
Hospital NHS Foundation Trust, Oxford, United Kingdom
(Shabbir, Cassar, Swinburn) Royal Berkshire NHS Foundation Trust, Reading,
United Kingdom
Publisher
NLM (Medline)
Abstract
The aim of this study was to investigate whether asymptomatic patients
with known coronary artery disease and demonstrable myocardial ischemia
warrant revascularization on prognostic grounds. A Medline and PubMed
search was performed, including 7 trials with data discussed and concise
reviews of prominent articles in the field. The magnitude of inducible
ischemia in those with known coronary disease correlates closely with poor
cardiovascular outcomes in terms of death, myocardial infarction,
hospitalization, and revascularization. Patients with >=10% inducible
ischemia experience a survival advantage when revascularized with a
reduction in mortality of greater than 50% regardless of symptoms (P <
0.00001). Evidence also suggests that left ventricular function remains
preserved in those who are revascularized when compared with medical
therapy alone; left ventricular ejection fraction 53.9% versus 48.8% (P <
0.001). Silent ischemia is a useful prognostic marker in those with known
coronary disease. It is recommended that asymptomatic patients with known
coronary disease be revascularized on prognostic grounds if >=10% ischemia
can be demonstrated on nuclear or myocardial perfusion scan, >=3 segments
of regional wall motion abnormality on stress echocardiography/cardiac
magnetic resonance imaging, or >=2 segments with perfusion deficits on
stress perfusion cardiac magnetic resonance imaging.

<34>
Accession Number
627869099
Title
The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A
Systematic Review With Meta-Analysis of Randomized Controlled Trials.
Source
Critical care medicine. 47 (6) (pp 774-783), 2019. Date of Publication: 01
Jun 2019.
Author
Putzu A.; Daems A.-M.; Lopez-Delgado J.C.; Giordano V.F.; Landoni G.
Institution
(Putzu, Daems) Division of Anesthesiology, Department of Anesthesiology,
Pharmacology & Intensive Care Medicine, Geneva University Hospitals,
Geneva, Switzerland
(Lopez-Delgado) Intensive Care Department, Hospital Universitari de
Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
(Lopez-Delgado) Institut d'Investigacio Biomedica Bellvitge (IDIBELL),
L'Hospitalet de Llobregat, Barcelona, Spain
(Giordano, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The effects of vitamin C administration on clinical outcome in
critically ill patients remain controversial. DATA SOURCES: Online
databases were searched up to October 1, 2018. STUDY SELECTION: We
included randomized controlled trials on the use of vitamin C (any
regimen) in adult critically ill patients versus placebo or no therapy.
DATA EXTRACTION: Risk ratio for dichotomous outcome and standardized mean
difference for continuous outcome with 95% CI were calculated using
random-effects model meta-analysis. DATA SYNTHESIS: Forty-four randomized
studies, 16 performed in ICU setting (2,857 patients) and 28 in cardiac
surgery (3,598 patients), published between 1995 and 2018, were included
in the analysis. In ICU patients, vitamin C administration was not
associated with a difference in mortality (risk ratio, 0.90; 95% CI,
0.74-1.10; p = 0.31), acute kidney injury, ICU or hospital length of stay
compared with control. In cardiac surgery, vitamin C was associated to a
reduction in postoperative atrial fibrillation (risk ratio, 0.64; 95% CI,
0.52-0.78; p < 0.0001), ICU stay (standardized mean difference, -0.28 d;
95% CI, -0.43 to -0.13 d; p = 0.0003), and hospital stay (standardized
mean difference, -0.30 d; 95% CI, -0.49 to -0.10 d; p = 0.002).
Furthermore, no differences in postoperative mortality, acute kidney
injury, stroke, and ventricular arrhythmia were found. <br/>CONCLUSION(S):
In a mixed population of ICU patients, vitamin C administration is
associated with no significant effect on survival, length of ICU or
hospital stay. In cardiac surgery, beneficial effects on postoperative
atrial fibrillation, ICU or hospital length of stay remain unclear.
However, the quality and quantity of evidence is still insufficient to
draw firm conclusions, not supporting neither discouraging the systematic
administration of vitamin C in these populations. Vitamin C remains an
attractive intervention for future investigations aimed to improve
clinical outcome.

<35>
Accession Number
627991894
Title
Left ventricular reconstruction surgery in ischemic heart disease: a
systematic review of the past two decades.
Source
The Journal of cardiovascular surgery. 60 (3) (pp 422-430), 2019. Date of
Publication: 01 Jun 2019.
Author
Doulamis I.P.; Perrea D.N.; Chloroyiannis I.A.
Institution
(Doulamis) Laboratory for Experimental Surgery and Surgical Research, N.S.
Christeas School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
(Perrea) Laboratory for Experimental Surgery and Surgical Research, N.S.
Christeas School of Medicine, National and Kapodistrian University of
Athens, Athens, Greece
(Chloroyiannis) Department of Cardiac Surgery, Euroclinic of Athens,
Athens, Greece
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The aim of this paper is to systematically review the
existing literature reporting on patients recruited during the past twenty
years regarding the role of left ventricular (LV) reconstruction in
ischemic cardiomyopathy in terms of efficacy and mortality and provide an
updated overview of the current evidence. EVIDENCE ACQUISITION: The PubMed
and Cochrane bibliographical databases were thoroughly searched for the
following MeSH terms: "ventricular reconstruction" OR ventriculoplasty OR
"ventricular aneurysm" OR "ventricular restoration." Original studies
-recruiting patients during the past twenty years- on LV reconstruction
surgery in more than five cases and reporting on the associated peri- or
postoperative mortality were deemed eligible. EVIDENCE SYNTHESIS:
Twenty-seven studies were included and provided data for 3220 patients
with a mean age of 61 years. Angina was present in 66.6% (510/766) of the
patients, while nine out of ten (635/699) had a history of myocardial
infarction. Average preoperative ejection fraction was 29.9% and
end-systolic volume index was 93.6 mL/m2. With respect to complications,
low cardiac output syndrome and the need for intra-aortic balloon pump
were prevalent in 9.3% (79/850) and 18.8% (334/1773), respectively.
Thirty-day mortality was 7.1% (230/3220) and late-mortality (mean
follow-up of 36.9 months) was 19.6% (548/2791), while the rate of MACCE
was 40.1% (367/915). Five-year mortality was 29% (340/1171).
<br/>CONCLUSION(S): Our findings provide a current perspective of the role
of LV reconstruction in the treatment of ischemic cardiomyopathy
suggesting its benefit in survival. Taking into consideration the existing
debate, further studies are required so that a solid conclusion to be
made.

<36>
Accession Number
628024479
Title
Pharmacological Prophylaxis of Atrial Fibrillation After Surgical
Myocardial Revascularization.
Source
Medical archives (Sarajevo, Bosnia and Herzegovina). 73 (1) (pp 19-22),
2019. Date of Publication: 01 Feb 2019.
Author
Osmanovic E.; Ostojic M.; Avdic S.; Djedovic S.; Delic A.; Kadric N.;
Terzic A.; Avdic-Salihovic A.
Institution
(Osmanovic, Avdic, Djedovic, Kadric, Terzic, Avdic-Salihovic) Heart Center
BH Tuzla, Tuzla, Bosnia and Herzegovina
(Ostojic) School of Medicine University of Belgrade, Serbia
(Delic) SarajevoBosnia and Herzegovina
Publisher
NLM (Medline)
Abstract
Introduction: Postoperative Atrial Fibrillation (POAF) is associated with
a higher rate of postoperative complications and mortality, as well as
with longer hospitalization and increased treatment costs. We have
designed and performed a randomized, trial of pharmacological prophylaxis
in which the event of interest is POAF. <br/>Aim(s): The aim of this study
is to reduce the risk of postoperative, complications associated with this
arrhythmia. <br/>Method(s): We included 240 stable patients with a
coronary heart disease, who were referred to elective surgical
revascularization of the myocardium. The patients were assigned into three
groups of 80 patients each: group A (BB, beta blocker, comparator), group
B (BB+ Amiodarone) and group C (BB + Rosuvastatin). The goal was to
establish whether intervention by combination therapy was more useful than
a comparator. <br/>Result(s): An event of interest (POAF) has occurred in
66 of the total 240 patients. Number of new POAF cases is the lowest in
Group B, 14 (17.5%) compared to 25 (31.25%) new cases in the comparator
group, and 27 new cases (33.75%) in group C. Absolute risk reduction was
13.75%, =14% less POAF in group B compared to comparator. Relative risk
reduction was 56% (RR 0.56, p = 0.04). Number Needed to Treat was 7.27. In
group C, 33.75% of patients developed POAF. Absolute risk was
insignificantly higher in group C (2.5%, NS) compared to the comparator
.The number needed to harm was high, 40. <br/>Conclusion(s): The results
of our research show that prophylaxis of POAF with combined therapy BB +
Amiodarone was the most efficient one.

<37>
Accession Number
627864646
Title
Impact of 2 Distinct Levels of Mean Arterial Pressure on Near-Infrared
Spectroscopy During Cardiac Surgery: Secondary Outcome From a Randomized
Clinical Trial.
Source
Anesthesia and analgesia. 128 (6) (pp 1081-1088), 2019. Date of
Publication: 01 Jun 2019.
Author
Holmgaard F.; Vedel A.G.; Lange T.; Nilsson J.C.; Ravn H.B.
Institution
(Holmgaard, Vedel, Nilsson, Ravn) From the Department of Cardiothoracic
Anesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Lange) Section of Biostatistics, University of Copenhagen, Copenhagen,
Denmark
(Lange) Center for Statistical Science, Peking University, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Near-infrared spectroscopy (NIRS) is used worldwide to monitor
regional cerebral oxygenation (rScO2) during cardiopulmonary bypass (CPB).
Intervention protocols meant to mitigate cerebral desaturation advocate to
increase mean arterial pressure (MAP) when cerebral desaturation occurs.
However, the isolated effect of MAP on rScO2 is uncertain. The aim of the
present study was in a randomized, blinded design to elucidate the effect
of 2 distinct levels of MAP on rScO2 values during CPB.We hypothesized
that a higher MAP would be reflected in higher rScO2 values, lower
frequency of patients with desaturation, and a less pronounced cerebral
desaturation load. <br/>METHOD(S): This is a substudy of the Perfusion
Pressure Cerebral Infarct trial, in which we investigated the impact of
MAP levels during CPB on ischemic brain injury after cardiac surgery.
Deviation in rScO2 was a predefined outcome in the Perfusion Pressure
Cerebral Infarct trial. Patients were randomized to low MAP (LMAP; 40-50
mm Hg) or high MAP (HMAP; 70-80 mm Hg) during CPB. CPB pump flow was fixed
at 2.4 L/min/m, and MAP levels were targeted using norepinephrine.
Intraoperatively, NIRS monitoring was performed in a blinded fashion, with
sensors placed on the left and right side of the patient's forehead. NIRS
recordings were extracted for offline analysis as the mean value of left
and right signal during prespecified periods. Mean rScO2 during CPB was
defined as the primary outcome in the present study. <br/>RESULT(S): The
average MAP level during CPB was 67 mm Hg +/- SD 5.0 in the HMAP group (n
= 88) and 45 mm Hg +/- SD 4.4 in the LMAP group (n = 88). Mean rScO2 was
significantly lower in the HMAP group during CPB (mean difference, 3.5;
95% confidence interval, 0.9-6.1; P = .010). There was no difference in
rScO2 values at specified time points during the intraoperative period
between the 2 groups. Significantly more patients experienced desaturation
below 10% and 20% relative to rScO2 baseline in the HMAP group (P = .013
and P = .009, respectively), and the cerebral desaturation load below 10%
relative to rScO2 baseline was more pronounced in the HMAP group (P =
.042). <br/>CONCLUSION(S): In a randomized blinded study, we observed that
a higher MAP induced by vasopressors, with a fixed CPB pump flow, leads to
lower mean rScO2 and more frequent and pronounced cerebral desaturation
during CPB. The mechanism behind these observations is not clear. We
cannot exclude extracranial contamination of the NIRS signal as a possible
explanation. However, we cannot recommend increasing MAP by
vasoconstrictors during cerebral desaturation because this is not
supported by the findings of the present study.

<38>
Accession Number
628001740
Title
A high-efficiency MUF method benefits postoperative hemodynamic stability
and oxygen delivery in neonates with transposition of great arteries.
Source
Journal of Cardiac Surgery. 34 (6) (pp 468-473), 2019. Date of
Publication: June 2019.
Author
Shen J.; Wang W.; Zhang W.; Jiang L.; Yang Y.Y.
Institution
(Shen, Wang, Zhang, Jiang, Yang) Department of Cardiothoracic Surgery,
School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To minimize the postoperative hemodynamic changes in neonates
with transposition of great arteries (TGA) by modifying the circuit and
efficiency of traditional modified ultrafiltration (MUF). <br/>Method(s):
Ninety-one patients (<5 kg) underwent arterial switch operations, which
were randomized to a traditional MUF (tMUF) group (N = 38) or a modified
MUF (mMUF) group (N = 53). MUF of both the groups lasted for 8 to 12
minutes, during which the near-infrared spectroscopy was used to monitor
cerebral tissue oxygenation parameters. <br/>Result(s): The cerebral
oxygenation was significantly improved after MUF in both groups. The
tissue hemoglobin concentration index (THI) was proportional to the total
cerebral hemoglobin during MUF. The ascending velocity of THI was faster
in the mMUF group. The mean change range in the mMUF group was 0.90 +/-
0.44 mM/cm, while that in the tMUF group was 0.51 +/- 0.35 mM/cm (P =
0.028). Quantitative changes in the cerebral concentration of oxygenated
hemoglobin increased faster in the mMUF group, in which a nadir of low
efficacy MUF was not observed. The rising velocity of the tissue
oxygenation index was faster in the mMUF group. All mMUF cases had stable
hemodynamics during MUF. The tMUF was aborted in two patients because of
unstable hemodynamics. At the end of MUF, hematocrit was significantly
greater in the mMUF group than in the tMUF group (40.33 +/- 5.43% vs 34.41
+/- 5.11%; P < 0.01). <br/>Conclusion(s): The mMUF circuit is more
miniaturized and less prime, which leads to more efficient
ultrafiltration. It benefits postoperative hemodynamic stability and
oxygen delivery in neonates with TGA.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<39>
Accession Number
628001512
Title
The role of ministernotomy in aortic valve surgery-A prospective
randomized study.
Source
Journal of Cardiac Surgery. 34 (6) (pp 435-439), 2019. Date of
Publication: June 2019.
Author
Vukovic P.M.; Milojevic P.; Stojanovic I.; Micovic S.; Zivkovic I.; Peric
M.; Milicic M.; Milacic P.; Milojevic M.; Bojic M.
Institution
(Vukovic, Milojevic, Stojanovic, Micovic, Zivkovic, Peric, Milicic,
Milacic, Milojevic, Bojic) Department of Cardiac Surgery, Dedinje
Cardiovascular Institute, Belgrade, Serbia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aims: The purpose of this prospective randomized study was
to compare the early and midterm outcomes of aortic valve replacement
(AVR) through upper ministernotomy with conventional AVR through median
sternotomy. <br/>Method(s): One hundred patients undergoing elective AVR
were randomized into two groups: the M group (upper ministernotomy group,
n = 50) and the C group (conventional sternotomy group, n = 50). The
operative data, major adverse outcomes, and postoperative variables were
compared between the two groups of patients. A cross-sectional follow-up
was performed 24.9 +/- 5.8 months after surgery. <br/>Result(s): The
aortic cross-clamp time and cardiopulmonary bypass time were significantly
longer in the M group. Similar incidences of major cardiac, neurologic and
renal complications were recorded in both groups. Two patients (4%) in the
C group developed wound infections. The length of ICU stay was similar in
both groups. The patients in the M group had a shorter hospital stay
compared with the patients in the C group (7.6 +/- 2 days vs 9.3 +/- 4.8
days; P = 0.022). Follow-up revealed that the time period needed to reach
full recovery was significantly shorter in the ministernotomy group (1.7
+/- 1.2 months vs 2.8 +/- 1.6 months; P = 0.001). Morbidity and mortality
data did not differ between the two groups. <br/>Conclusion(s): There was
no difference in the major outcomes between the patients who underwent
upper ministernotomy and those who underwent full sternotomy. The benefits
of the minimally invasive approach were the shorter hospital stay and
significantly faster recovery of patients after discharge from the
hospital.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<40>
Accession Number
628001382
Title
Low-frequency ventilation during cardiopulmonary bypass for lung
protection: A randomized controlled trial.
Source
Journal of Cardiac Surgery. 34 (6) (pp 385-399), 2019. Date of
Publication: June 2019.
Author
Fiorentino F.; Jaaly E.A.; Durham A.L.; Adcock I.M.; Lockwood G.; Rogers
C.; Ascione R.; Reeves B.C.; Angelini G.D.
Institution
(Fiorentino, Lockwood) Department of Surgery & Cancer, Imperial College
London, London, United Kingdom
(Jaaly, Rogers, Ascione, Reeves, Angelini) Department of Cardiac Surgery,
Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary,
Bristol, United Kingdom
(Durham, Adcock) Department of Cardiac Surgery, National Heart & Lung
Institute, Imperial College London, London, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: Pulmonary dysfunction is a common complication in patients
undergoing heart surgery. Current clinical practice does not include any
specific strategy for lung protection. To compare the anti-inflammatory
effects of low-frequency ventilation (LFV), as measured by nuclear factor
kappa-light-chain-enhancer of activated B cells (NF-kappaB) p65 pathway
activation, for the entire cardiopulmonary bypass (CPB) vs both lungs left
collapsed in patients undergoing coronary artery bypass grafting (CABG).
<br/>Method(s): Two groups parallel randomized controlled trial. The
primary outcome was inflammation measured by NF-kappaB p65 activation in
pre- and post-CPB lung biopsies. Secondary outcomes were additional
inflammatory markers in both biopsy tissue and blood. <br/>Result(s):
Thirty-seven patients were randomly allocated to LFV (18) and to both
lungs left collapsed (19). The mean concentration of NF-kappaB p65 in the
biopsies before chest closure (adjusted for pre-CPB concentration) was
higher in the LFV group compared to both lungs left collapsed group but
this was not significant (0.102, 95% confidence interval, -0.022 to 0.226,
P = 0.104). There were no significant differences between groups in the
other inflammatory markers measured in tissue and blood.
<br/>Conclusion(s): In patients undergoing elective CABG, the use of LFV
during CPB when compared to both lungs left collapsed does not seem to
reduce inflammation in lung biopsies and blood.<br/>Copyright &#xa9; 2019
Wiley Periodicals, Inc.

<41>
Accession Number
627947529
Title
Effect of ultrafiltration on extravascular lung water assessed by lung
ultrasound in children undergoing cardiac surgery: A randomized
prospective study.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 93. Date
of Publication: 04 Jun 2019.
Author
Elayashy M.; Madkour M.A.; Mahmoud A.A.A.; Hosny H.; Hussein A.; Nabih A.;
Lofty A.; Hamza H.M.; Hassan P.; Wagih M.; Mohamed A.K.
Institution
(Elayashy, Madkour, Hosny, Hussein, Nabih, Lofty, Hamza, Hassan, Wagih,
Mohamed) Department of Anesthesia and Intensive Care, Kasr Al Ainy Faculty
of Medicine, Cairo University, 7 Elshishiny St., El Maryotia, Faysal, Giza
12131, Egypt
(Mahmoud) Department of Anesthesia, Faculty of Medicine, Beni-Suef
University, Beni-Suef, Egypt
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Increased lung water and the resultant atelectasis are
significant pulmonary complications after cardiopulmonary bypass (CPB) in
children undergoing cardiac surgery; these complications are observed
after CPB than after anaesthesia alone. Ultrafiltration has been shown to
decrease total body water and postoperative blood loss and improve the
alveolar to arterial oxygen gradient and pulmonary compliance. This study
investigated whether conventional ultrafiltration during CPB in paediatric
heart surgeries influences post-bypass extravascular lung water (EVLW)
assessed by lung ultrasound (LUS). <br/>Method(s): This randomized
controlled study included 60 patients with congenital heart disease (ASA
II-III), aged 1 to 48 months, with a body weight > 3 kg. Conventional
ultrafiltration targeting a haematocrit (HCT) level of 28% was performed
on the ultrafiltration group, while the control group did not receive
ultrafiltration. LUS scores were recorded at baseline and at the end of
surgery. The PaO2/FiO2 ratio (arterial oxygen tension divided by the
fraction of inspired oxygen), urine output, and haemodynamic parameters
were also recorded. <br/>Result(s): LUS scores were comparable between the
two groups both at baseline (p = 0.92) and at the end of surgery (p =
0.95); however, within the same group, the scores at the end of surgery
significantly differed from their baseline values in both the
ultrafiltration (p = 0.01) and non-ultrafiltration groups (p = 0.02). The
baseline PaO2/FiO2 ratio was comparable between both groups. at the end of
surgery, The PaO2/FiO2 ratio increased in the ultrafiltration group
compared to that in the non-ultrafiltration group, albeit insignificant (p
= 0.16). no correlation between the PaO2/FiO2 ratio and LUS score was
found at baseline (r = - 0.21, p = 0.31). On the other hand, post-surgical
measurements were negatively correlated (r = - 0.41, p = 0.045).
<br/>Conclusion(s): Conventional ultrafiltration did not alter the EVLW
when assessed by LUS and oxygenation state. Similarly, ultrafiltration did
not affect the urea and creatinine levels, intensive care unit (ICU)
stays, ventilation days, or mortality. Trial registration:
Clinicaltrials.gov Identifier: NCT03146143 registered on
29-April-2017.<br/>Copyright &#xa9; 2019 The Author(s).

<42>
Accession Number
628014780
Title
Effect of the PCSK9 Inhibitor Evolocumab on Total Cardiovascular Events in
Patients with Cardiovascular Disease: A Prespecified Analysis from the
FOURIER Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Murphy S.A.; Pedersen T.R.; Gaciong Z.A.; Ceska R.; Ezhov M.V.; Connolly
D.L.; Jukema J.W.; Toth K.; Tikkanen M.J.; Im K.; Wiviott S.D.; Kurtz
C.E.; Honarpour N.; Giugliano R.P.; Keech A.C.; Sever P.S.; Sabatine M.S.
Institution
(Murphy, Im, Wiviott, Giugliano, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, 60 Fenwood Rd, Ste
7022, Boston, MA 02115, United States
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(Gaciong) Department of Internal Medicine Hypertension and Vascular
Diseases, Medical University of Warsaw, Warsaw, Poland
(Ceska) Center for Preventive Cardiology, 3rd Internal Medicine Clinic,
University General Hospital and Charles University 1st Medical Faculty,
Prague, Czechia
(Ezhov) National Cardiology Research Center, Moscow, Russian Federation
(Connolly) Birmingham City and Sandwell Hospitals and the Institute of
Cardiovascular Sciences, University of Birmingham, Birmingham, United
Kingdom
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Toth) First Department of Medicine, University of Pecs, Medical School,
Pecs, Hungary
(Tikkanen) Folkhalsan Research Center, University of Helsinki, Helsinki,
Finland
(Kurtz, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) Imperial College London, London, United Kingdom
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The PCSK9 inhibitor evolocumab reduced low-density lipoprotein
cholesterol and first cardiovascular events in the Further Cardiovascular
Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk
(FOURIER) trial, but patients remain at high risk of recurrent
cardiovascular events. <br/>Objective(s): To evaluate the effect of
evolocumab on total cardiovascular events, given the importance of total
number of cardiovascular events to patients, clinicians, and health
economists. <br/>Design, Setting, and Participant(s): Secondary analysis
of a randomized, double-blind clinical trial. The FOURIER trial compared
evolocumab or matching placebo and followed up patients for a median of
2.2 years. The study included 27564 patients with stable atherosclerotic
disease receiving statin therapy. Data were analyzed between May 2017 and
February 2019. <br/>Main Outcomes and Measures: The primary end point
(PEP) was time to first cardiovascular death, myocardial infarction,
stroke, hospitalization for unstable angina, or coronary
revascularization; the key secondary end point was time to first
cardiovascular death, myocardial infarction, or stroke. In a prespecified
analysis, total cardiovascular events were evaluated between treatment
arms. <br/>Result(s): The mean age of patients was 63 years, 69% of
patients were taking high-intensity statin therapy, and the median LDL-C
at baseline was 92 mg/dL (to convert to millimoles per liter, multiply by
0.0259). There were 2907 first PEP events and 4906 total PEP events during
the trial. Evolocumab reduced total PEP events by 18% (incidence rate
ratio [RR], 0.82; 95% CI, 0.75-0.90; P <.001) including both first events
(hazard ratio, 0.85; 95% CI, 0.79-0.92; P <.001) and subsequent events
(RR, 0.74; 95% CI, 0.65-0.85). There were 2192 total primary events in the
evolocumab group and 2714 total events in the placebo group. For every
1000 patients treated for 3 years, evolocumab prevented 22 first PEP
events and 52 total PEP events. Reductions in total events were driven by
fewer total myocardial infarctions (RR, 0.74; 95% CI, 0.65-0.84; P <.001),
strokes (RR, 0.77; 95% CI, 0.64-0.93; P =.007), and coronary
revascularizations (RR, 0.78; 95% CI, 0.71-0.87; P <.001).
<br/>Conclusions and Relevance: The addition of the PCSK9 inhibitor
evolocumab to statin therapy improved clinical outcomes, with significant
reductions in total PEP events, driven by decreases in myocardial
infarction, stroke, and coronary revascularization. More than double the
number of events were prevented with evolocumab vs placebo as compared
with the analysis of only first events. These data provide further support
for the benefit of continuing aggressive lipid-lowering therapy to prevent
recurrent cardiovascular events.<br/>Copyright &#xa9; 2019 American
Medical Association. All rights reserved.

<43>
Accession Number
628021464
Title
Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery
Bypass Grafting with or without Surgical Ventricular Reconstruction in the
Surgical Treatment for Ischemic Heart Failure (STICH) Trial.
Source
Structural Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Tsang M.Y.C.; She L.; Miller F.A.; Choi J.-O.; Michler R.E.; Grayburn
P.A.; Bonow R.O.; Menicanti L.; Deja M.A.; Castelvecchio S.; Rao V.; Smith
P.K.; Kukulski T.; Sopko G.; Prior D.L.; Velazquez E.J.; Lee K.L.; Oh J.K.
Institution
(Tsang, Miller, Choi, Oh) Division of Cardiovascular Diseases,
Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN, United
States
(Tsang) Division of Cardiology, Department of Medicine, University of
British Columbia, Vancouver, BC, Canada
(She, Smith, Lee) Duke Clinical Research Institute and Departments of
Surgery (PKS), Medicine (EJV), and Biostatistics and Bioinformatics (KLL),
Duke University School of Medicine, Durham, NC, United States
(Choi, Oh) Division of Cardiology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Michler) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, New York City, NY,
United States
(Grayburn) Department of Internal Medicine, Cardiology Section, Baylor
University Medical Center, Dallas, TX, United States
(Bonow) Cardiology Division, Department of Medicine, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Menicanti, Castelvecchio) Department of Cardiac Surgery, IRCCS
Policlinico San Donato, Milan, Italy
(Deja) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Rao) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, ON, Canada
(Kukulski) Department of Cardiology, Congenital Heart Disease and
Electrotherapy, Medical University of Silesia, Silesian Center for Heart
Diseases, Zabrze, Poland
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Prior) Department of Medicine, St. Vincent's Hospital, University of
Melbourne, Melbourne, Australia
(Velazquez) Section of Cardiovascular Medicine, Yale School of Medicine,
Hew Haven, CT, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: This study examined the impact of mitral valve repair (MVRe)
on survival of patients with moderate or severe (>=2+) MR and ischemic
cardiomyopathy randomized to coronary artery bypass grafting (CABG) versus
CABG+surgical ventricular reconstruction (SVR) in the STICH trial.
<br/>Method(s): Among patients with moderate or severe MR and ischemic
cardiomyopathy undergoing CABG or CABG+SVR, the impact of MVRe on
mortality between the two treatment arms was compared. <br/>Result(s):
Among 867 patients with assessment of baseline MR severity, 211 had
moderate or severe MR. After excluding 7 patients who underwent mitral
valve replacement, 50, 44, 62, and 48 patients underwent CABG, CABG+MVRe,
CABG+SVR, and CABG+SVR+MVRe, respectively. Four-year mortality rates were
lower following CABG+MVRe than CABG alone (16% vs. 55%; adjusted hazard
ratio [HR] 0.30; 95% CI 0.13-0.71). In contrast, the CABG+SVR+MVRe and
CABG+SVR groups had similar 4-year mortality of 39% vs. 39% (adjusted HR
0.88; 95% CI 0.46-1.70). MVRe had a more favorable effect on survival in
patients undergoing CABG alone compared to CABG+SVR (p =.013). Baseline MR
severity was similar between patients that received CABG+MVRe and those
that underwent CABG+SVR+MVRe. A larger proportion of patients demonstrated
a reduction in MR between 4 and 24 months after CABG+MVRe compared to
CABG+SVR+MVRe (50.0% versus 25.0%, p =.023). <br/>Conclusion(s): In
patients with moderate or severe MR and ischemic cardiomyopathy undergoing
CABG, MVRe appears to have a favorable effect on survival. The addition of
SVR to CABG may attenuate the anticipated benefits of MVRe by limiting the
long-term reduction of MR with MVRe.<br/>Copyright &#xa9; 2019, &#xa9;
2019 Cardiovascular Research Foundation.

<44>
Accession Number
627998047
Title
Case report and systematic review of iatrogenic left atrial dissection in
different cardiovascular specialties: A common treatment for an uncommon
complication?.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2019.
Date of Publication: 2019.
Author
Cereda A.F.; De Luca F.; Lanzone A.M.; Cottini M.; Pastori L.; Sangiorgi
G.
Institution
(Cereda) Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo,
Italy
(De Luca) Department of Cardiothoracic Surgery, Humanitas Gavazzeni
Hospital, Bergamo, Italy
(Lanzone, Pastori, Sangiorgi) Cardiac Cath Laboratory, Humanitas Gavazzeni
Hospital, Bergamo, Italy
(Cottini) Department of Cardiac Surgery and Heart Transplantation, De
Gasperis Center, Niguarda Hospital, Milan, Italy
(Sangiorgi) Department of Systemic Medicine, Division of Cardiology,
University of Rome Tor Vergata, Rome, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Left atrial dissection (LatD) is a rare and heterogeneous
condition affecting many cardiovascular areas. The present article, by the
means of personal case report illustration and systemic review of
different clinical management, is aimed to give to clinicians further
knowledge on this controversial topic. <br/>Background(s): LatD is an
exceedingly rare but potentially fatal complication of cardiac surgery or
catheter-based interventional procedures. Most of the cases are iatrogenic
and its incidence is expected to grow due to an increase in the number of
percutaneous coronary intervention and structural heart disease
procedures. The management of this complication is controversial, and it
may depend on related etiologies. <br/>Method(s): We have reported our
single-case experience and review of the scientific literature, focusing
on the decision-making process and the strategical approach by
multimodality imaging techniques. <br/>Result(s): Our case of LatD with
initial hemodynamic instability was surgically treated. Conservative
approach is often employed in literature despite the fact that
conservative versus surgical approach is debatable, depending on clinical
presentation, hemodynamic stability, multimodal imaging findings, and
personal experience of the center. <br/>Conclusion(s): According to
systematic literature review, a watchful-waiting strategy supported by
multimodality imaging could be a safe and effective management in stable
LatD.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<45>
Accession Number
627872681
Title
Randomized comparison between epidural waveform analysis through the
needle versus the catheter for thoracic epidural blocks.
Source
Regional anesthesia and pain medicine. (no pagination), 2019. Date of
Publication: 14 May 2019.
Author
Tangjitbampenbun A.; Layera S.; Arnuntasupakul V.; Apinyachon W.; Venegas
K.; Godoy J.; Aliste J.; Bravo D.; Blanch A.; Webar J.; Saadawi M.; Owen
A.; Finlayson R.J.; Tran Q.
Institution
(Tangjitbampenbun, Arnuntasupakul, Apinyachon) Anesthesia, Mahidol
University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
(Layera, Venegas, Godoy, Aliste, Bravo, Blanch) Anesthesia, University of
Chile, Santiago, Metropolitan, Chile
(Webar, Saadawi, Owen, Finlayson) Anesthesia, McGill University, Montreal,
QC, Canada
(Tran) Anesthesia, St Mary's Hospital, Montreal, QC, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Epidural waveform analysis (EWA) provides a simple
confirmatory adjunct for loss of resistance (LOR): when the
needle/catheter tip is correctly positioned inside the epidural space,
pressure measurement results in a pulsatile waveform. Epidural waveform
analysis can be carried out through the tip of the needle (EWA-N) or the
catheter (EWA-C). In this randomized trial, we compared the two methods.
We hypothesized that, compared with EWA-C, EWA-N would result in a shorter
performance time. <br/>METHOD(S): One hundred and twenty patients
undergoing thoracic epidural blocks for thoracic or abdominal surgery were
randomized to EWA-N or EWA-C. In the EWA-N group, LOR was confirmed by
connecting the epidural needle to a pressure transducer. After obtaining a
satisfactory waveform, the epidural catheter was advanced 5cm beyond the
needle tip. In the EWA-C group, the epidural catheter was first advanced
5cm beyond the needle tip after the occurrence of LOR. Subsequently, the
catheter was connected to the pressure transducer to detect the presence
of waveforms. In both study groups, the block procedure was repeated at
different intervertebral levels until positive waveforms could be obtained
(through the needle or catheter as per the allocation) or until a
predefined maximum of three intervertebral levels had been reached.
Subsequently, the operator administered a 4 mL test dose of lidocaine 2%
with epinephrine 5micro&#32;g/mL through the catheter. An investigator
present during the performance of the block recorded the performance time
(defined as the temporal interval between skin infiltration and local
anesthetic administration through the epidural catheter). Fifteen minutes
after the test dose, a blinded investigator assessed the patient for
sensory block to ice. Success was defined as a bilateral block in at least
two dermatomes. Furthermore, postoperative pain scores, local anesthetic
consumption, and breakthrough analgesic consumption were recorded.
<br/>RESULT(S): No intergroup differences were found in terms of
performance time, success rate, postoperative pain, local anesthetic
requirement, and breakthrough analgesic consumption. <br/>CONCLUSION(S):
EWA can be carried out through the needle or through the catheter with
similar efficiency (performance time) and efficacy (success rate,
postoperative analgesia). TRIAL REGISTRATION NUMBER:
NCT03603574.<br/>Copyright &#xa9; American Society of Regional Anesthesia
& Pain Medicine 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<46>
Accession Number
627872330
Title
Meta-analysis of prognostic impact of blood transfusion on survival after
transcatheter aortic valve implantation.
Source
The Journal of cardiovascular surgery. (no pagination), 2019. Date of
Publication: 08 May 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(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, USA
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)

<47>
Accession Number
372982234
Title
The odyssey of chronic cardiac mechanical support.
Source
Journal of the American College of Cardiology. 63 (17) (pp 1758-1760),
2014. Date of Publication: 06 May 2014.
Author
Drakos S.G.
Institution
(Drakos) Division of Cardiovascular Medicine and Cardiac Mechanical
Support Program, University of Utah, Utah Transplantation Affiliated
Hospitals (UTAH), 30 North 1900 East, Salt Lake City, UT 84132, United
States
Publisher
Elsevier USA

<48>
Accession Number
52502538
Title
Systematic review of outcomes of combined proximal stent grafting with
distal bare stenting for management of aortic dissection.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (6) (pp 1431-1438),
2013. Date of Publication: June 2013.
Author
Canaud L.; Patterson B.O.; Peach G.; Hinchliffe R.; Loftus I.; Thompson
M.M.
Institution
(Canaud, Patterson, Peach, Hinchliffe, Loftus, Thompson) Department of
Outcomes Research, St. George's Vascular Institute, London, United Kingdom
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Available data on outcomes of combined proximal stent grafting
with distal bare stenting for management of aortic dissection are limited.
This is a systematic review of outcomes of this approach. <br/>Method(s):
Studies involving combined proximal stent grafting with distal bare
stenting for management of aortic dissection were systematically searched
and reviewed. <br/>Result(s): A total of 4 studies were included, with 108
patients treated for acute (n = 54) and chronic (n = 54) aortic
dissection. Technical success rate was 95.3% (range, 84-100). The 30-day
mortality was 2.7% (range, 0%-5%). Morbidity rate within 30 days was 51.8%
(range, 0%-65%) and included stroke (2.7%), paraplegia (2.7%), retrograde
dissection (1.8%), renal failure (14.8%), severe cardiopulmonary
complications (5.5%), and bowel ischemia (0.9%). Incidence of type I
endoleak was 9.2% (10/108). During follow-up, 5 patient deaths (4.6%) were
related to aortic rupture or aortic repair. Reintervention rate was from
12.9%. Two cases of delayed retrograde type A dissection (1.9%) and 1 case
of aortobronchial fistula (0.9%) were reported. Most common delayed
complication was thoracic stent-graft migration (4.7%). Device failure
rate was 9.2%. Favorable aortic remodeling was observed: studies reporting
midterm follow-up of the true lumen demonstrated high rates of false-lumen
regression and true-lumen expansion. At 12 months, complete false-lumen
thrombosis was observed at the thoracic level in 70.4% and at the
abdominal level in 13.5%. <br/>Conclusion(s): Combined proximal stent
grafting with distal bare stenting for management of aortic dissection
appears to be a reasonable approach for type B aortic dissection, clearly
improved true-lumen perfusion and diameter although failing to suppress
false-lumen patency completely. Contemporary information on this approach
is mainly provided by small series with a wide range of results. &#xa9;
2013 by The American Association for Thoracic Surgery.

<49>
Accession Number
52064189
Title
Implications and management of anemia in cardiac surgery: Current state of
knowledge.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp 538-546),
2012. Date of Publication: September 2012.
Author
Loor G.; Koch C.G.; Sabik III J.F.; Li L.; Blackstone E.H.
Institution
(Loor, Sabik III, Blackstone) Cleveland Clinic, Department of
Cardiothoracic Anesthesia, 9500 Euclid Avenue/Desk J4-331, Cleveland, OH
44195, United States
(Koch) Department of Cardiothoracic Anesthesia, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Li, Blackstone) Department of Quantitative Health Sciences, Research
Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<50>
Accession Number
52014426
Title
Redo laparoscopic repair of benign esophageal disease.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp S71-S73),
2012. Date of Publication: September 2012.
Author
Wee J.O.
Institution
(Wee) Division of Thoracic Surgery, Brigham and Women's Hospital, 75
Francis St, Boston, MA 02115, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Laparoscopic fundoplication for gastroesophageal reflux disease has been
associated with excellent symptom control. Compared with medical
treatment, laparoscopic Nissen fundoplication has shown favorable control
of typical reflux symptoms. However, in approximately 2% to 17% of
patients, surgical treatment fails. The role of reoperative repair for
reflux disease and the factors that contribute to it are examined.
Copyright &#xa9; 2012 by The American Association for Thoracic Surgery.

<51>
Accession Number
52083996
Title
One-port (uniportal) video-assisted thoracic surgical resections - A clear
advance.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (3) (pp S27-S31),
2012. Date of Publication: September 2012.
Author
Rocco G.
Institution
(Rocco) Department of Thoracic Surgery and Oncology, National Cancer
Institute, Pascale Foundation, Naples, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
One-port (uniportal) video-assisted thoracic surgery (VATS) consists of
approaching an intrathoracic target lesion through a sagittal,
craniocaudal plane through 1 single-port incision. The use of articulating
instruments inserted parallel to the videothoracoscope enables the surgeon
to mimic inside the chest the maneuvers that are usually performed during
open surgery. Through this VATS approach, several thoracic conditions can
be addressed, including lung cancer in selected patients. Unlike
conventional, 3-port VATS, the uniportal VATS technique enables the
surgeon to bring the operative fulcrum inside the chest when the target
lunge lesion is approached through a sagittal plan, thanks to articulating
instruments. Uniportal wedge VATS resections of peripheral nodules can
help in solving diagnostic dilemmas, be of therapeutic benefit, and
provide tissue for biomolecular studies. Copyright &#xa9; 2012 by The
American Association for Thoracic Surgery.

<52>
Accession Number
51436377
Title
Patient blood management during cardiac surgery: Do we have enough
evidence for clinical practice?.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (2) (pp
249.e1-249.e32), 2011. Date of Publication: August 2011.
Author
Ranucci M.; Aronson S.; Dietrich W.; Dyke C.M.; Hofmann A.; Karkouti K.;
Levi M.; Murphy G.J.; Sellke F.W.; Shore-Lesserson L.; Von Heymann C.
Institution
(Ranucci) Department of Cardiothoracic-vascular Anesthesia and Intensive
Care, IRCCS Policlinico S. Donato, Via Morandi 30, San Donato Milanese,
Milan, 20097, Italy
(Aronson) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
(Dietrich) Working Group on Perioperative Hemostasis, Department of
Anaesthesia, Ludwig Maximilian University Muenchen, Munich, Germany
(Dyke) SouthEast Texas Cardiovascular Surgery Associates, PA, Houston, TX,
United States
(Hofmann) Centre for Population Health Research, Curtin Health Innovation
Research Institute (CHIRI), Curtin University, Perth, WA, Australia
(Hofmann) Medical Society for Blood Management, Laxenburg, Austria
(Karkouti) Department of Anesthesia, Toronto General Hospital, University
Health Network, Toronto, ON, Canada
(Levi) Department of Vascular Medicine and Internal Medicine, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Murphy) Bristol Heart Institute, University of Bristol, Bristol Royal
Infirmary, Bristol, United Kingdom
(Sellke) Division of Cardiothoracic Surgery, Alpert Medical School of
Brown University, Rhode Island Hospital, Providence, RI, United States
(Shore-Lesserson) Department of Anesthesiology, Cardiothoracic
Anesthesiology, Montefiore Medical Center, Bronx, NY, United States
(Von Heymann) Department of Anaesthesiology and Intensive Care Medicine,
Charite-Universitatsmedizin Berlin, Berlin, Germany
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<53>
Accession Number
627731671
Title
Thromboelastography-guided therapy improves patient blood management and
certain clinical outcomes in elective cardiac and liver surgery and
emergency resuscitation: A systematic review and analysis.
Source
Journal of Thrombosis and Haemostasis. 17 (6) (pp 984-994), 2019. Date of
Publication: June 2019.
Author
Dias J.D.; Sauaia A.; Achneck H.E.; Hartmann J.; Moore E.E.
Institution
(Dias) Haemonetics S.A., Signy, Switzerland
(Sauaia) Department of Health Systems Management and Policy, University of
Colorado Denver, Denver, CO, United States
(Achneck, Hartmann) Haemonetics Corporation, Braintree, MA, United States
(Moore) Department of Surgery, University of Colorado Denver, Denver, CO,
United States
Publisher
Blackwell Publishing Ltd
Abstract
Essentials TEG-guided therapy has been shown to be valuable in a number of
surgical settings. This systematic review and analysis specifically
evaluated the effects of TEG-guided therapy. TEG-guided therapy can
improve blood product utilization and enhance resource management. Use of
TEG improved key patient outcomes, including bleed rate, length of stay
and mortality. <br/>Background(s): Thromboelastography (TEG 5000 and 6s
Thrombelastograph Hemostasis Analyzer; Haemonetics) is a point-of-care
system designed to monitor and analyze the entire coagulation process in
real time. TEG-guided therapy has been shown to be valuable in a variety
of surgical settings. <br/>Objective(s): To conduct an analysis of
published clinical trials to evaluate the effects of TEG-guided
transfusion for the management of perioperative bleeding on patient
outcomes. Patients/Methods: We searched MEDLINE (PubMed) and EMBASE for
original articles reporting studies using TEG vs controls in a
perioperative setting for inclusion in this systematic review. We
identified nine eligible randomized controlled trials (RCTs) in two
elective surgery settings (cardiac surgery and liver surgery), but only
one RCT in the emergency setting. <br/>Result(s): In the elective surgery
study meta-analysis, platelet (P = 0.004), plasma (P < 0.001) and red
blood cell transfusion (P = 0.14), operating room length of stay (LoS) (P
= 0.005), intensive care unit LoS (P = 0.04) and bleeding rate (P = 0.002)
were reduced with TEG-guided transfusion vs controls. Although blood
product use was reduced, rates of mortality remained comparable between
the TEG group and control group. In the emergency setting evaluation, the
RCT reported lower mortality in the TEG group than in the control group (P
= 0.049). In addition, there were significant reductions in platelet and
plasma transfusion (P = 0.04 and P = 0.02, respectively), and the number
of ventilator-free days increased, in the TEG group as compared with the
control group (P = 0.10). <br/>Conclusion(s): This systematic review and
analysis indicate that TEG-guided hemostatic therapy can enhance blood
product management and improve key patient outcomes, including LoS,
bleeding rate, and mortality.<br/>Copyright &#xa9; 2019 The Authors.
Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc.
on behalf of International Society on Thrombosis and Haemostasis

<54>
Accession Number
627599270
Title
Comparison of the New Oral Anticoagulants and Warfarin in Patients with
Atrial Fibrillation and Valvular Heart Disease: Systematic Review and
Meta-Analysis.
Source
Drugs in R and D. 19 (2) (pp 117-126), 2019. Date of Publication: 01 Jun
2019.
Author
de Souza Lima Bitar Y.; Neto M.G.; Filho J.A.L.; Pereira L.V.; Travassos
K.S.O.; Akrami K.M.; Roever L.; Duraes A.R.
Institution
(de Souza Lima Bitar, Duraes) Medical School of Federal University of
Bahia, UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus,
Salvador, Bahia 40025-010, Brazil
(Neto, Pereira) Federal University of Bahia, UFBA, Salvador, Brazil
(Filho, Duraes) General Hospital Roberto Santos, Salvador, Bahia, Brazil
(Travassos) Bahian School of Medicine and Public Health, BAHIANA,
Salvador, Brazil
(Akrami) Department of Medicine, University of California San Diego, San
Diego, United States
(Roever) Federal University of Uberlandia, Uberlandia, Minas Gerais,
Brazil
Publisher
Springer International Publishing
Abstract
Introduction: New oral anticoagulants (NOACs) are approved for use in
nonvalvular atrial fibrillation (AF). <br/>Objective(s): This study aimed
to evaluate the efficacy and safety of NOACs compared with warfarin in AF
and valvular heart disease (VHD). <br/>Method(s): We identified randomized
controlled trials (RCTs) and post-hoc analyses comparing NOACs and
warfarin in AF and VHD, including biological and mechanical heart valves
(MHV). Through systematic review and meta-analysis, with the aid of the
"Rev Man" program 5.3, the primary effectiveness endpoints were stroke and
systemic embolism (SE). The primary safety outcome was major bleeding, and
the secondary outcome included intracranial hemorrhage. Data were analyzed
using risk ratios (RRs) and 95% confidence intervals (CIs), and
heterogeneity was assessed using the I² statistic.
<br/>Result(s): Six RCTs were included, involving 13,850 patients with AF
and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95%
CI 0.66-0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI
0.33-0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95%
CI 0.58-1.02; P = 0.07) compared with warfarin. <br/>Conclusion(s): The
efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are
similar to those of warfarin.<br/>Copyright &#xa9; 2019, The Author(s).

<55>
Accession Number
2001956172
Title
Myocardial Blood Flow and Coronary Flow Reserve During 3 Years Following
Bioresorbable Vascular Scaffold Versus Metallic Drug-Eluting Stent
Implantation: The VANISH Trial.
Source
JACC: Cardiovascular Interventions. 12 (10) (pp 967-979), 2019. Date of
Publication: 27 May 2019.
Author
Stuijfzand W.J.; Schumacher S.P.; Driessen R.S.; Lammertsma A.A.; Bakker
A.L.; Rijnierse M.T.; van Rossum A.C.; van de Ven P.M.; Nap A.; Appelman
Y.; van Royen N.; van Leeuwen M.A.; Lemkes J.S.; Raijmakers P.G.; Knaapen
P.
Institution
(Stuijfzand, Schumacher, Driessen, Bakker, Rijnierse, van Rossum, Nap,
Appelman, Lemkes, Knaapen) Department of Cardiology, Amsterdam UMC,
Location VU University Medical Center, Amsterdam, Netherlands
(Lammertsma, Raijmakers) Department of Radiology and Nuclear Medicine,
Amsterdam UMC, Location VU University Medical Center, Amsterdam,
Netherlands
(van de Ven) Department of Epidemiology and Biostatistics, Amsterdam UMC,
Location VU University Medical Center, Amsterdam, Netherlands
(van Royen) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(van Leeuwen) Department of Cardiology, Isala Heart Center, Zwolle,
Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The randomized clinical VANISH (Impact of Vascular Reparative
Therapy on Vasomotor Function and Myocardial Perfusion: A Randomized
[¹⁵O]H<inf>2</inf>O PET/CT Study) trial was conducted to assess
quantitative myocardial blood flow (MBF) during resting, hyperemia, and
cold pressor testing (CPT) with positron emission tomographic perfusion
imaging after the implantation of a bioresorbable everolimus-eluting
scaffold compared with a drug-eluting stent. <br/>Background(s): Long-term
resorption of the bioresorbable everolimus-eluting scaffold reinstates
normal vessel geometry, allowing natural regeneration of the newly formed
endothelium with revival of vasomotor function. <br/>Method(s): Sixty
patients (18 to 65 years of age) with single-vessel disease and type A or
B1 lesions were randomized in a 1-to-1 fashion. Approximately 1 month, 1
year, and 3 years after device implantation, patients underwent
[¹⁵O]H<inf>2</inf>O cardiac positron emission tomography. The
primary endpoint was the interaction of device type and evolution over
time of hyperemic MBF, coronary flow reserve, or CPT reserve. At 3-year
follow-up, control invasive coronary angiography with optical coherence
tomography was performed. <br/>Result(s): Fifty-nine (98%), 56 (93%), and
51 (85%) patients successfully completed 1-month, 1-year, and 3-year
follow-up positron emission tomography, respectively, and no culprit
vessel events were registered during follow-up time. The primary study
endpoint (i.e., interaction between device type and time) was
nonsignificant for hyperemic MBF, CPT reserve, and coronary flow reserve
(p > 0.05 for all). In all patients, hyperemic MBF decreased from 1 to 3
years (p = 0.02), while coronary flow reserve was lower at 3-year
follow-up compared with 1-month and 1-year follow-up (p = 0.03 for both).
After 3 years, percentage area stenosis measured with optical coherence
tomography was higher within the bioresorbable everolimus-eluting scaffold
compared with the drug-eluting stent (p = 0.03). <br/>Conclusion(s): The
hypothesized beneficial effects of scaffold resorption did not translate
to improved MBF during maximal hyperemia or endothelium-dependent
vasodilation by CPT.<br/>Copyright &#xa9; 2019 American College of
Cardiology Foundation

<56>
Accession Number
2002065626
Title
Spironolactone and perioperative atrial fibrillation occurrence in cardiac
surgery patients: Rationale and design of the ALDOCURE trial.
Source
American Heart Journal. 214 (pp 88-96), 2019. Date of Publication: August
2019.
Author
Alexandre J.; Ollitrault P.; Fischer M.-O.; Fellahi J.-L.; Rozec B.;
Cholley B.; Dolladille C.; Chequel M.; Allouche S.; Legallois D.; Saplacan
V.; Buklas D.; Beygui F.; Parienti J.-J.; Milliez P.
Institution
(Alexandre, Dolladille) Department of Pharmacology, CHU de Caen, Caen
F-14000, France
(Alexandre, Fischer, Allouche, Legallois, Beygui, Milliez) Universite Caen
Normandie, Medical School, UNICAEN, CHU Caen, 4650, Signalisation,
electrophysiologie et imagerie des lesions d'ischemie-reperfusion
myocardique, Caen, EA F-14000, France
(Ollitrault, Dolladille, Chequel, Legallois, Beygui, Milliez) Department
of Cardiology, CHU de Caen, Caen F-14000, France
(Fischer) Pole Reanimations Anesthesie SAMU/SMUR, CHU de Caen, Caen
F-14000, France
(Fellahi) Service d'Anesthesie-Reanimation, Hopital Cardiologique Louis
Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, Lyon Cedex 03, France
(Rozec) Service d'Anesthesie-Reanimation, Hopital Laennec, Hospitalier
Universitaire, Nantes, Centre, France
(Cholley) Anesthesiology and Critical Care Medicine Department, Hopital
Europeen Georges Pompidou, AP-, Universite Paris Descartes-Sorbonne Paris
Cite, Paris, HP, France
(Allouche) Department of Biochemistry, CHU de Caen, Caen F-14000, France
(Saplacan, Buklas) Department of Cardiac Surgery, CHU de Caen, Caen
F-14000, France
(Parienti) Department of Biostatistics and Clinical Research, CHU de Caen,
Caen F-14000, France
(Parienti) Medical School, Universite Caen Normandie, UNICAEN, CHU, EA2656
Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Caen, Caen
F-14000, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: After artery bypass grafting (CABG), the presence of
perioperative AF (POAF) is associated with greater short- and long-term
cardiovascular morbidity. Underlying POAF mechanisms are complex and
include the presence of an arrhythmogenic substrate, cardiac fibrosis and
electrical remodeling. Aldosterone is a key component in this process. We
hypothesize that perioperative mineralocorticoid receptor (MR) blockade
may decrease the POAF incidence in patients with a left ventricular
ejection fraction (LVEF) >=50% who are referred for CABG with or without
aortic valve replacement (AVR). Study design: The ALDOCURE trial
(NCT03551548) will be a multicenter, randomized, double-blind,
placebo-controlled trial testing the superiority of a low-cost MR
antagonist (MRA, spironolactone) on POAF in 1500 adults referred for
on-pump elective CABG surgery with or without AVR, without any history of
heart failure or atrial arrhythmia. The primary efficacy end point is the
occurrence of POAF from randomization to within 5 days after surgery,
assessed in a standardized manner. The main secondary efficacy end points
include the following: postoperative AF occurring within 5 days after
cardiac surgery, perioperative myocardial injury, major cardiovascular
events and death occurring within 30 days of surgery, hospital and
intensive care unit length of stay, need for readmission, LVEF at
discharge and significant ventricular arrhythmias within 5 days after
surgery. Safety end points, including blood pressure, serum potassium
levels and renal function, will be monitored regularly throughout the
trial duration. <br/>Conclusion(s): The ALDOCURE trial will assess the
effectiveness of spironolactone in addition to standard therapy for
reducing POAF in patients undergoing CABG. Clinical trial registration:
NCT03551548<br/>Copyright &#xa9; 2019 Elsevier Inc.

<57>
Accession Number
626424309
Title
Association of Elevated Plasma Homocysteine Level with Restenosis and
Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic
Review and Meta-analysis.
Source
Cardiovascular Drugs and Therapy. 33 (3) (pp 353-361), 2019. Date of
Publication: 15 Jun 2019.
Author
Zhang Z.; Xiao S.; Yang C.; Ye R.; Hu X.; Chen X.
Institution
(Zhang, Yang, Ye, Hu, Chen) Department of Cardiology, West China Hospital,
Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province
610041, China
(Xiao) Department of Day Surgery Center, West China Hospital, Sichuan
University, Chengdu 610041, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: We conducted this systemic review and meta-analysis to
investigate the association between elevated plasma homocysteine (Hcy)
levels and recurrent restenosis and clinical outcomes after percutaneous
coronary intervention (PCI). <br/>Method(s): PubMed, EMBASE, and Web of
Science were systematically searched prior to May 2018. Studies evaluating
the association between plasma Hcy levels and the occurrence of
restenosis, major adverse cardiac events (MACE), all-cause mortality,
cardiac death, non-fatal myocardial infarction (MI), and target lesion
revascularization were identified. <br/>Result(s): A total of 19 articles
with 4340 participants were identified. Higher Hcy levels were not
associated with an increased risk of restenosis (relative risk (RR) =
1.10, 95% CI 0.90-1.33). Hcy levels in the restenosis group were not
significantly higher than in the non-restenosis group (weighted mean
difference = 0.70, 95% CI - 0.23-1.63). Subgroup analysis revealed that
higher Hcy levels were not associated with restenosis after stenting but
appeared to increase the risk of restenosis after angioplasty. Elevated
Hcy levels increased the risk of all-cause mortality by an average of
3.19-fold (RR = 3.19, 95% CI 1.90-5.34, P = 0.000), the risk of MACE by
1.51-fold (RR = 1.51, 95% CI 1.23-1.85, P = 0.000), and the risk of
cardiac death by 2.76-fold (RR = 2.76, 95% CI 1.44-5.32, P = 0.000) but
appeared not to increase the risk of non-fatal MI (RR = 1.36, 95% CI
0.89-2.09). <br/>Conclusion(s): Our meta-analysis suggests that although
there is no clear association between higher Hcy levels and restenosis
following stent implantation, higher Hcy levels appeared to increase the
risk of restenosis after coronary angioplasty and also increased the risk
of all-cause mortality, MACE, and cardiac death after PCI. Registration
Details: The protocol of this meta-analysis was registered on PROSPERO
(CRD42018096466).
(http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018096466).
<br/>Copyright &#xa9; 2019, Springer Science+Business Media, LLC, part of
Springer Nature.

<58>
Accession Number
2002067777
Title
A systematic review and meta-analysis of supplemental education in
patients treated with oral anticoagulation.
Source
Blood Advances. 3 (10) (pp 1638-1646), 2019. Date of Publication: 28 May
2019.
Author
Paquette M.; Witt D.M.; Holbrook A.; Skov J.; Ansell J.; Schunemann H.J.;
Wiercioch W.; Nieuwlaat R.
Institution
(Paquette, Schunemann, Wiercioch, Nieuwlaat) Department of Health Research
Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
(Paquette) Department of Medicine, Boehringer Ingelheim, Ltd, Burlington,
ON, Canada
(Witt) Department of Pharmacotherapy, University of Utah College of
Pharmacy, Salt Lake City, UT, United States
(Holbrook) Division of Clinical Pharmacology and Toxicology, McMaster
University, Hamilton, ON, Canada
(Holbrook, Schunemann) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Skov) Unit for Health Promotion Research, Department of Public Health,
University of Southern Denmark, Esbjerg, Denmark
(Ansell) Zucker School of Medicine, Hofstra Northwell, Hempstead, NY,
United States
Publisher
American Society of Hematology (E-mail: publishing@hematology.org)
Abstract
Oral anticoagulants (OACs) are indicated for treatment and prevention of
thromboembolic diseases. Supplemental patient education (education) has
been proposed to improve outcomes, and this systematic review assesses the
effect of education on mortality, thromboembolic events (TEEs) including
venous thromboembolism (VTE), and bleeding in patients taking OACs.
Randomized controlled trials were included, and 2 authors independently
screened articles and assessed risk of bias. In 9 trials (controls, n 5
720; intervention group patients, n 5 646), 4 assessed critical outcomes
of mortality, TEEs (VTE, stroke, and systemic embolism), and bleeding to
estimate absolute risk ratios. When comparing education with usual care,
in 1000 patients, there may be 12 fewer deaths (95% confidence interval
[CI], 19 fewer to 154 more) and 16 fewer bleeding events (95% CI, 34 fewer
to 135 more), but this evidence is uncertain; the evidence also suggests 6
fewer VTEs (95% CI, 10 fewer to 16 more) and 8 fewer TEEs (95% CI, 16
fewer to 18 more). The mean difference in time in therapeutic range may be
2.4% higher in the education group compared with usual care (95% CI, 2.79%
lower to 7.58% higher). We also found very low certainty of evidence for a
large increase in knowledge scores (standardized mean difference, 0.84
standard deviation units higher; 95% CI, 0.51-1.16). Overall, the
certainty of evidence was low to very low because of serious risk of bias
and serious imprecision. Additional sufficiently powered trials or
different approaches to education are required to better assess
supplemental education effects on outcomes in patients taking
OACs.<br/>Copyright &#xa9; 2019 by The American Society of Hematology

<59>
Accession Number
2001970862
Title
Ultrasound-guided serratus anterior plane block for analgesia after
thoracic surgery.
Source
Journal of Pain Research. 12 (pp 953-960), 2019. Date of Publication:
2019.
Author
Semyonov M.; Fedorina E.; Grinshpun J.; Dubilet M.; Refaely Y.; Ruderman
L.; Koyfman L.; Friger M.; Zlotnik A.; Klein M.; Brotfain E.
Institution
(Semyonov, Fedorina, Dubilet, Koyfman, Zlotnik, Klein, Brotfain)
Department of Anesthesiology and Critical Care, General Intensive Care
Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer
Sheva, Israel
(Grinshpun, Friger) Department of Public Health, Faculty of Health
Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
(Refaely, Ruderman) Department of Cardiothoracic Surgery, Soroka Medical
Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Patients who undergo surgical procedures that impair the
integrity of the chest wall frequently experience extremely severe
postoperative pain. Opiates and weaker analgesics, such as nonsteroidal
anti-inflammatory drugs (NSAIDs), are not sufficiently effective in
achieving control of severe pain and might cause respiratory and
gastrointestinal complications. In the past decade, there has been an
increased interest in the use of regional nerve blocks for
post-thoracoscopy and post-thoracotomy analgesia. <br/>Method(s): This is
a prospective, randomized, double-blind and single-center study. We
recruited 104 patients who underwent elective thoracoscopy. Prior to
surgery, the participating patients were randomized into one of two study
groups: Group 1-the "standard control group" that received standard
postoperative pain control with intravenous opioids, NSAIDs and
acetaminophen (paracetamol) and Group 2-the "block group" that was treated
by ultrasound-guided serratus anterior plane (SAP) block (a single
injection of 0.25% bupivacaine hydrochloride 2 mg/kg plus dexamethasone 8
mg) with standard postoperative pain control regimen. We compared the
clinical, laboratory, and postoperative pain assessment data of both
groups. <br/>Result(s): Patients in the SAP block Group 2 reported
significantly lower levels of pain after thoracic surgery as assessed by
their visual analog scale scores, as compared to the patients in the
standard pain control Group 1 (P<0.001). The total dosage of morphine and
tramadol required for pain relief during the first hours after surgery was
significantly lower in the patients who received SAP block. Also, the
incidence of vomiting after surgery was significantly lower among the
patients who received SAP block than among the patients who received
standard pain control. <br/>Conclusion(s): The results of the present
study suggest that SAP block is an effective adjuvant treatment option for
post-thoracic surgery analgesia. Compared to the current methods used for
post-thoracic surgery pain relief, SAP block has some significant merits,
particularly its ease of use and its low potential for side
effects.<br/>Copyright &#xa9; 2019 Semyonov et al.

<60>
Accession Number
623156245
Title
Adjusted calculation model of heparin management during cardiopulmonary
bypass in obese patients.
Source
European Journal of Anaesthesiology. 35 (8) (pp 613-620), 2018. Date of
Publication: 01 Aug 2018.
Author
Vienne M.; Haas E.; Wipf T.; Grunebaum L.; Levy F.; Sattler L.; Minh T.H.;
Severac F.; Tacquard C.; Collange O.; Mertes P.-M.; Steib A.
Institution
(Vienne, Haas, Wipf, Levy, Tacquard, Collange, Mertes, Steib) Department
of Anesthesiology and Intensive Care, University Hospital, Nouvel Hopital
Civil, 1 Place de L'hopital, Strasbourg Cedex 67091, France
(Grunebaum, Sattler) Laboratory of Haemostasis, University Hospital,
Strasbourg, France
(Minh) Department of Cardiac Surgery, NHC, University Hospital,
Strasbourg, France
(Severac) Department of BioStatistics, Federation de Medecine
Translationelle, University Hospital, Strasbourg, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Anticoagulation during cardiopulmonary bypass (CPB) is usually
adapted to total body weight (TBW). This may be inaccurate in obese
patients and lead to heparin overdose with a risk of bleeding. OBJECTIVES
To validate the efficacy and safety of an adjusted calculation model of
heparin dosing based on ideal body weight (IBW) rather than TBW in obese
CPB patients, with an expected target mean plasma heparin concentration of
4.5IUml -1 after onset of CPB in the experimental group. DESIGN Randomised
controlled study. SETTING University hospital. PATIENTS Sixty obese
patients (BMI>=30kgm -2) scheduled for CPB were included from January to
June 2016. INTERVENTIONS Patients received a bolus dose of unfractionated
heparin of either 300IUkg -1 of TBW or 340IUkg -1 of IBW before onset of
CPB. Additional adjusted boluses were injected to maintain an activated
clotting time (ACT) of at least 400s. MAIN OUTCOME MEASURES Plasma heparin
concentration and ACT were measured at different time points. Total
heparin doses and transfusion requirements were recorded. RESULTS The
target heparin concentration of 4.5IUml -1 was reached in the IBW group at
the onset of CPB and maintained at all time points during CPB. Heparin
concentrations were significantly higher in the TBW group after the bolus
(6.52+/-0.97 vs. 4.54+/-1.13IUml -1, P<0.001) and after cardioplegia
(5.10+/-1.03 vs. 4.31+/-1.00IUml -1, P=0.02). Total heparin doses were
significantly higher in the TBW group. Mean ACT was significantly lower in
the IBW group but remained over 400s during CPB. The correlation between
heparin and ACT was poor. Peri-operative bleeding and transfusion
requirements were comparable. No thrombotic event occurred in the CPB
circuit. CONCLUSION The current IBW-adjusted regimen of heparin
administration may be used efficiently in obese CPB patients, thereby
avoiding overdose which cannot be accurately assessed by ACT monitoring
alone. TRIAL REGISTRATION ClinicalTrials.gov identifier:
NCT02675647.<br/>Copyright &#xa9; 2018 European Society of
Anaesthesiology. All rights reserved.

<61>
Accession Number
624836981
Title
Adding sufentanil to ropivacaine in continuous thoracic paravertebral
block fails to improve analgesia after video-assisted thoracic surgery: A
randomised controlled trial.
Source
European Journal of Anaesthesiology. 35 (10) (pp 766-773), 2018. Date of
Publication: 2018.
Author
Bauer C.; Pavlakovic I.; Mercier C.; Maury J.-M.; Koffel C.; Roy P.;
Fellahi J.-L.
Institution
(Bauer, Maury) Hospices Civils de Lyon, Hopital de la Croix Rousse,
Service d'Anesthesie-Reanimation, 103 Grande Rue de la Croix-Rousse, Lyon
69004, France
(Pavlakovic, Koffel, Fellahi) Hospices Civils de Lyon, Hopital
Cardiologique et Pneumologique Louis Pradel, Service
d'Anesthesie-Reanimation, Lyon, France
(Mercier, Roy) Hospices Civils de Lyon, Service de Biostatistique -
Bioinformatique, Lyon, France
(Koffel, Roy, Fellahi) Faculte de Medecine, Universite Claude Bernard Lyon
1, Lyon, France
(Koffel, Roy) CNRS UMR5558, Laboratoire de Biometrie et Biologie
Evolutive, Departement Biostatistiques et Modelisation pour la Sante et
l'Environnement, Equipe Biostatistique-Sante, Lyon, France
(Fellahi) Hospices Civils de Lyon, Hopital Cardiologique et Pneumologique
Louis Pradel, Service de Chirurgie Thoracique, Lyon, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND: The benefit of adding opioid to a local anaesthetic for
continuous thoracic paravertebral analgesia after video-assisted thoracic
surgery (VATS) is unclear. <br/>OBJECTIVE(S): To analyse the analgesic
efficacy of ropivacaine and sufentanil in combination compared with
ropivacaine alone after VATS. DESIGN: A randomised, double-blinded,
single-centre clinical trial. SETTING: A tertiary university hospital
between March 2010 and April 2014. PATIENTS: Ninety patients were
recruited, two were not included leaving 88 randomised into two groups.
Eighteen patients were excluded from analysis and 70 completed the study.
INTERVENTION: To receive thoracic paravertebral analgesia with either 2 mg
m^-1 ropivacaine and 0.25 mug m^-1 sufentanil
(ropivacaine R sufentanil group) or 2 mg m^-1 ropivacaine alone
(ropivacaine group) for 48 h postoperatively. Infusion rate was set at
0.15 ml kg^-1 h^-1 in both groups. MAIN OUTCOME
MEASURES: The primary endpoint was the mean total amount of
self-administered morphine by the patients in each group at 48 h
postoperatively. <br/>RESULT(S): The mean +/- SD total amount of
self-administered morphine was not significantly different between groups
(53.1+/-27.2mg in the ropivacaine R sufentanil group vs. 58.8+/- 34.3 mg
in the ropivacaine group; P=0.72). No significant differences were found
between the two groups in either pain scores at rest or during movement,
in opioid-related adverse reactions, in patient satisfaction or length of
hospital stay. <br/>CONCLUSION(S): Adding 0.25 mugm^-1
sufentanil to 2 mg m^-1 ropivacaine in continuous thoracic
paravertebral analgesia for VATS did not reduce morphine consumption or
pain scores when compared with ropivacaine alone. We cannot recommend its
use for routine clinical practice. Further studies analysing different
concentrations and infusion rates of sufentanil are needed before a lack
of efficacy can be confirmed.<br/>Copyright &#xa9; 2018 European Society
of Anaesthesiology. All rights reserved.

<62>
Accession Number
627079468
Title
Peri-operative oral caffeine does not prevent postoperative atrial
fibrillation after heart valve surgery with cardiopulmonary bypass: A
randomised controlled clinical trial.
Source
European Journal of Anaesthesiology. 35 (12) (pp 911-918), 2018. Date of
Publication: 2018.
Author
Lagier D.; Nee L.; Guieu R.; Kerbaul F.; Fenouillet E.; Roux N.; Giorgi
R.; Theron A.; Grisoli D.; Gariboldi V.; Collart F.; Bruder N.; Velly L.;
Guidon C.
Institution
(Lagier, Nee, Kerbaul, Bruder, Velly, Guidon) Department of Anaesthesia
and Intensive Care Medicine, La Timone University Hospital, Aix-Marseille
University, Marseille, France
(Guieu, Fenouillet) Department of Biochemistry, La Timone University
Hospital, Aix-Marseille University, Marseille, France
(Roux, Giorgi) Department of Biostatistics, La Timone University Hospital,
Aix-Marseille University, Marseille, France
(Theron, Grisoli, Gariboldi, Collart) Department of Cardiac Surgery, La
Timone University Hospital, Aix-Marseille University, Marseille, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND: Raised plasma levels of endogenous adenosine after cardiac
surgery using cardiopulmonary bypass (CPB) have been related to the
incidence of postoperative atrial fibrillation (POAF). <br/>OBJECTIVE(S):
We wished to assess if caffeine, an adenosine receptor antagonist could
have a beneficial effect on the incidence of POAF. DESIGN A randomised
controlled study. SETTING: Single University Hospital. PATIENTS: One
hundred and ten patients scheduled for heart valve surgery with CPB.
INTERVENTIONS: We randomly assigned patients to receive peri-operative
oral caffeine (400mg every 8 h for 2 days) or placebo. Adenosine plasma
concentrations and caffeine pharmacokinetic profile were evaluated in a
subgroup of 50 patients. MAIN OUTCOME MEASURES: The primary endpoint was
the rate of atrial fibrillation during postoperative hospital stay.
RESULTS The current study was stopped for futility by the data monitoring
board after an interim analysis. The incidence of atrial fibrillation was
similar in the caffeine and in the placebo group during hospital stay (33
vs. 29%, P=0.67) and the first 3 postoperative days (18 vs. 15%; P=0.60).
Basal and postoperative adenosine plasma levels were significantly
associated with the primary outcome. Adenosine plasma levels were similar
in the two treatment groups. Caffeine administration was associated with a
higher incidence of postoperative nausea and vomiting (27 vs. 7%,
P=0.005). <br/>CONCLUSION(S): Oral caffeine does not prevent POAF after
heart valve surgery with CPB but increased the incidence of postoperative
nausea and vomiting.<br/>Copyright &#xa9; 2018 European Society of
Anaesthesiology. All rights reserved.

<63>
Accession Number
2001957489
Title
The effect of EDTA-based chelation on patients with diabetes and
peripheral artery disease in the Trial to Assess Chelation Therapy (TACT).
Source
Journal of Diabetes and its Complications. 33 (7) (pp 490-494), 2019. Date
of Publication: July 2019.
Author
Ujueta F.; Arenas I.A.; Escolar E.; Diaz D.; Boineau R.; Mark D.B.; Golden
P.; Lindblad L.; Kim H.; Lee K.L.; Lamas G.A.
Institution
(Ujueta, Lamas) Department of Medicine, Mount Sinai Medical Center, 4300
Alton Road, Miami Beach, FL, United States
(Arenas, Escolar, Diaz, Lamas) Columbia University Division of Cardiology,
Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, United
States
(Boineau) National Center of Complementary and Integrative Health (NCCIH),
Bethesda, MD, United States
(Mark, Lindblad, Kim, Lee) Duke Clinical Research Institute, Durham, NC,
United States
(Golden) The Golden Center for Integrative Medicine, Fresno, CA, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: Approximately 1 in 7 US adults have diabetes; and over 60% of
deaths in patients with diabetes have cardiac disease as a principal or
contributing cause. Both coronary and peripheral artery disease (PAD)
identify high-risk cohorts among patients with diabetes. We have
previously demonstrated improved cardiovascular outcomes with edetate
disodium-based chelation in post-MI patients with diabetes, enrolled in
the Trial to Assess Chelation Therapy (TACT). In these analyses we further
studied the effect size of patients with diabetes and severe disease in 2
vascular beds; coronaries, and lower extremity arteries. We questioned
whether greater atherosclerotic burden would attenuate the observed
beneficial effect of edetate disodium infusions. Research design and
methods: The multicenter TACT used a double blind, placebo controlled, 2 x
2 factorial design with 1708 participants, randomly assigned to receive
edetate disodium-based chelation, or placebo and high dose oral vitamins
or placebo. There were 162 (9.5% of 1708) post-MI patients with a
diagnosis of diabetes mellitus and PAD for this post hoc analysis.
Patients received up to 40 double-blind intravenous infusions of edetate
disodium-based chelation, or placebo. The composite primary endpoint of
TACT consisted of death from any cause, myocardial infarction, stroke,
coronary revascularization and hospitalization for angina. <br/>Result(s):
The median age was 66 years, 15% female, 5% non-Caucasian, and BMI was 31.
Insulin was used by 32% of patients. Active infusions significantly
reduced the primary endpoint compared with placebo infusions (HR, 0.52;
95% CI, 0.30-0.92; P = 0.0069), with a 30% absolute risk reduction in the
primary endpoint. There was a marked reduction in total mortality from 24%
to 11%, although of borderline significance (P = 0.052).
<br/>Conclusion(s): Atherosclerotic disease in multiple vascular beds did
not attenuate the beneficial effect of edetate disodium infusions in post
MI patients with diabetes. Studies now in progress will prospectively test
this post hoc finding.<br/>Copyright &#xa9; 2019 The Authors

<64>
Accession Number
2001986702
Title
Efficacy of an Ultrasound-Guided Erector Spinae Plane Block for
Postoperative Analgesia Management After Video-Assisted Thoracic Surgery:
A Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Ciftci B.; Ekinci M.; Celik E.C.; Tukac I.C.; Bayrak Y.; Atalay Y.O.
Institution
(Ciftci, Ekinci, Tukac, Atalay) Istanbul Medipol University, School of
Medicine, Mega Medipol University Hospital, Department of Anesthesiology
and Reanimation, Istanbul, Turkey
(Celik) Erzurum Regional Training and Research Hospital, Department of
Anesthesiology and Reanimation, Yakutiye, Erzurum, Turkey
(Bayrak) Istanbul Medipol University, Mega Medipol University Hospital,
Department of Thoracic Surgery, Istanbul, Turkey
Publisher
W.B. Saunders
Abstract
Objectives: Investigate whether an ultrasound-guided erector spinae plane
block (ESPB) can be used to manage postoperative pain in video-assisted
thoracic surgery (VATS) patients. <br/>Design(s): Prospective, randomized
study. <br/>Setting(s): Single institution, academic university hospital.
<br/>Participant(s): Adult patients who underwent VATS under general
anesthesia between September 2018 and March 2019. <br/>Intervention(s):
This study was an interventional study. <br/>Measurements and Main
Results: A total of 60 patients were randomly assigned into 2 groups (n =
30 per group): an ESPB group and a control group. In the ESPB group, a
single-shot ultrasound-guided ESPB was administered preoperatively. The
control group received no such intervention. All of the patients received
intravenous patient-controlled postoperative analgesia, and they were
assessed using visual analogue scale (VAS) scores, opioid consumption, and
adverse events. There were no statistically significant intergroup
differences with respect to the age, sex, weight, American Society of
Anesthesiologists status, anesthesia duration, and surgery length (p >
0.05 for each). The opioid consumption at 1, 2, 4, 8, 16, and 24 hours and
the active and passive VAS scores at 0, 2, 4, 8, 16, and 24 hours were
statistically lower in the ESPB group at all of the time periods when
compared with the control group (p < 0.05). In the control group, the
nausea and itching rates were higher, but there were no intergroup
differences in terms of other adverse effects. <br/>Conclusion(s): A
preemptive single-shot ESPB may provide effective analgesia management
after VATS.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<65>
Accession Number
2002051672
Title
Mortality Following Off-Pump Versus On-Pump Coronary Artery Bypass
Grafting at Five-Year Follow-Up: A Meta-Analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S106), 2019. Date of Publication:
2019.
Author
Zhao D.F.; Edelman J.J.; Seco M.; Bannon P.G.; Vallely M.P.
Institution
(Zhao, Edelman, Seco, Bannon, Vallely) The Baird Institute, Sydney,
Australia
Publisher
Elsevier Ltd
Abstract
Purpose: Long-term mortality following off-pump vs on-pump coronary artery
bypass grafting (CABG) remains controversial, despite recent randomised
controlled trials. A systematic review and meta-analysis were performed to
assess mortality risk at 5-year follow-up. Methodology: A comprehensive
search from six electronic databases was performed from their inception to
March 2017. Randomised controlled trials comparing mortality following
off-pump vs on-pump CABG at 5-year follow-up were included for analysis.
Odds ratio (OR) and hazard ratio (HR) analyses were performed to test for
model consistency. <br/>Result(s): There were six included studies with
8,142 patients. The random-effects model demonstrated no difference in
5-year mortality between OPCAB and CABG (13.9% vs 12.2%, OR 1.19, 95% CI
0.89-1.58, I2 = 56%). Aggregated HR demonstrated no difference in 5-year
mortality between OPCAB and CABG (HR 1.06, 95% CI 0.94-1.20, I2 = 0%).
<br/>Conclusion(s): This meta-analysis suggested that off-pump and on-pump
CABG may be associated with similar risk of mortality at 5-year follow-up.
Future randomised trials with longer follow-up are required for more
definitive conclusions on long-term outcomes following off-pump vs on-pump
CABG.<br/>Copyright &#xa9; 2019

<66>
Accession Number
2002051628
Title
Thirty-Day Stroke Risk After Anaortic Off-Pump Coronary Artery Bypass
Grafting Versus Percutaneous Coronary Intervention: A Network
Meta-Analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S117), 2019. Date of Publication:
2019.
Author
Zhao D.F.; Edelman J.J.; Seco M.; Bannon P.G.; Vallely M.P.
Institution
(Zhao, Edelman, Seco, Bannon, Vallely) The Baird Institute, Newtown,
Australia
Publisher
Elsevier Ltd
Abstract
Purpose: There are no studies comparing 30-day stroke risk following
anaortic off-pump coronary artery bypass grafting (anOPCABG) vs
percutaneous coronary intervention (PCI). A network meta-analysis was
performed to indirectly compare 30-day stroke risk following anOPCABG vs
PCI. Methodology: A comprehensive search from six electronic databases was
performed from their inception to July 2018. Randomised controlled trials
comparing 30-day stroke rate following PCI vs coronary artery bypass
grafting were included in a Bayesian network meta-analysis to indirectly
compare against observational trials of anOPCABG. <br/>Result(s): There
were 27 included studies with 63,837 patients. There was no difference in
30-day stroke risk when comparing anOPCAB with PCI (OR 0.92, 95% CI
0.47-1.78). Compared with CABG, anOPCAB (OR 0.28, 95% CI 0.20-0.38) and
PCI (OR 0.31, 95% CI 0.17-0.55) were associated with 72% and 69%
reductions in 30-day stroke risk, respectively. <br/>Conclusion(s): These
results suggest that anOPCAB and PCI may have similar rates of
periprocedural stroke and comparable efficacy in stroke reduction relative
to CABG. Anaortic OPCAB may be considered for reducing stroke risk in
patient groups known to benefit most from surgical revascularisation
compared with PCI.<br/>Copyright &#xa9; 2019

<67>
Accession Number
2002051627
Title
The SEcReT Study: Supervised Early Resistance Training Following Median
Sternotomy: Protocol for a Randomised Controlled Pilot Study.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S119), 2019. Date of Publication:
2019.
Author
Pengelly J.; Royse C.; El-Ansary D.; Royse A.; Tivendale L.; Bryant A.;
Williams G.; Dettmann T.; Canty D.
Institution
(Pengelly, Royse, El-Ansary, Royse, Tivendale, Bryant, Williams, Dettmann,
Canty) Swinburne University of Technology, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Purpose: The incidence of mild cognitive impairment is significantly
higher in the post-surgical cardiac population. It is reported to be up to
40% at >=3 months after surgery compared with 10% in the general
population?>[1,2]. The prevalence is even higher in the elderly cardiac
population, which is significant as mild cognitive impairment is
considered a precursor to dementia and significantly impacts quality of
life. Exercise may help to mediate the effects of cognitive decline
through improved neurogenesis, synaptic plasticity, and inflammatory and
neurotrophic factor pathways. However, the effects of resistance training
alone on improving cognition and patient-reported recovery have not been
investigated in the elderly cardiac population. This pilot study aimed to
determine the feasibility and efficacy of moderate-intensity resistance
training during cardiac rehabilitation. Methodology: Adults aged >=65
years (n = 100) undergoing elective coronary artery bypass grafting via
median sternotomy were recruited. Recruitment was from two hospitals in
Melbourne, Australia. Prospective randomisation was in dynamic blocks of
4-6, with 1:1 concealed allocation to either the moderate-intensity
resistance training group or standard care group. The Intervention group
will receive a 12-week moderate-intensity resistance training program,
twice weekly. The Standard care group will receive 1-3 weekly sessions of
light-intensity aerobic exercise and education for 6-10 weeks. Feasibility
will be assessed by recruitment and retention rates, intervention
compliance, group separation, and major adverse cardio-cerebral events.
The primary outcome measure will be the Alzheimer's Disease Assessment
Scale (ADAS-cog), assessed at baseline and 6-month follow-up.
<br/>Result(s): The results of this pilot study will be used to inform the
feasibility, methodological design, and power calculations of a future
definitive randomised controlled trial investigating the effectiveness of
resistance training as a primary prevention strategy for cognitive decline
following cardiac surgery. <br/>Conclusion(s): This study may add to the
evidence supporting early moderate-intensity exercise after cardiac
surgery.<br/>Copyright &#xa9; 2019

<68>
Accession Number
2002051608
Title
Is Custodiol Cardioplegia Superior to Blood Cardioplegia? A Systematic
Review and Meta-Analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S114), 2019. Date of Publication:
2019.
Author
Singh N.; Gimpel D.; Chan B.; McCormack D.J.; El-Gamel A.
Institution
(Singh, Gimpel, Chan, McCormack, El-Gamel) Waikato Cardiothoracic Unit,
Waikato Hospital, New Zealand
Publisher
Elsevier Ltd
Abstract
Purpose: Preference between the use of Custodiol or blood cardioplegia in
patients undergoing cardiopulmonary bypass varies from surgeon to surgeon.
This study aimed to review modern evidence to assess which type of
cardioplegia is superior for myocardial protection. Methodology: A search
of PubMed, CENTRAL and Science Direct databases was carried out for
randomised controlled trials (RCTs) published between 2008-2018 and that
investigated Custodiol vs blood cardioplegia in adult cardiac surgical
patients. Eligible studies needed to present myocardial injury markers
such as creatine kinase-MB (CK-MB) levels as outcome measures.
<br/>Result(s): Database searching yielded 1,616 results. Three RCTs met
inclusion criteria, with a total sample size of 243 patients. All included
studies were in patients receiving mitral valve surgery. There was no
difference in cross-clamp duration between Custodiol or blood cardioplegia
patients (mean difference -0.64 minutes, 95% CI -5.20 to 3.92). There was
a significantly higher incidence of post-clamp removal ventricular
fibrillation in patients receiving Custodiol cardioplegia (OR 14.64, 95%
CI 6.26-34.24). There were no differences in postoperative CK-MB levels
between Custodiol or blood cardioplegia in two studies, but one study
found higher CK-MB 6-hours postoperatively in patients receiving blood
cardioplegia. <br/>Conclusion(s): There is sparse contemporary randomised
literature that has investigated Custodiol vs blood cardioplegia for
myocardial protection. Current literature in this area considers mitral
valve surgery. Further studies are required in order to make confident
conclusions regarding the efficacy of either cardioplegia type for
myocardial protection.<br/>Copyright &#xa9; 2019

<69>
Accession Number
2002051587
Title
What Exercise Prescription Maximises Cognitive and Functional Recovery
During Phase II Cardiac Rehabilitation? A Systematic Review With
Meta-analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S73), 2019. Date of Publication:
2019.
Author
Pengelly J.; Pengelly M.; El-Ansary D.; Lin K.-Y.; Williams G.; Karri R.;
Royse C.; Royse A.; Bryant A.
Institution
(Pengelly, Pengelly, El-Ansary, Lin, Williams, Karri, Royse, Royse,
Bryant) Swinburne University of Technology, Melbourne, VIC, Australia
Publisher
Elsevier Ltd
Abstract
Aim: While cardiac surgery is associated with excellent outcomes, a third
of patients experience mild cognitive impairment that can accelerate
progression to dementia. This is more prevalent in the elderly population,
which is increasingly presenting for cardiac surgery. It is well
established that exercise elicits cognitive and physiological benefits.
However, it remains unknown which mode, intensity, and frequency of
exercise optimises cognitive recovery and postoperative outcomes in the
elderly cardiac population. <br/>Method(s): A primary search of relevant
key terms was conducted in the electronic databases of PubMed, CINAHL, and
Embase. All studies were assessed independently for relevance,
eligibility, and quality. Eleven studies evaluating the physiological and
cognitive effects of exercise in elderly (>=65 years) patients undergoing
coronary artery bypass grafting and/or valve replacement were included in
the qualitative analysis, with two suitable for meta-analysis.
<br/>Result(s): The qualitative analysis showed that programme duration
ranged from 1 week to 6 months, once weekly to daily sessions, for
anywhere between 30 and 120 minutes. All 11 studies included aerobic
training, typically performed at a light-to-moderate intensity, while
eight studies also reported the inclusion of resistance training. The
outcome measures used to measure intervention effect were varied, limiting
the meta-analysis to two randomised controlled trials. The meta-analysis
found that the addition of resistance exercises to traditional aerobic
programmes leads to more significant improvements in functional capacity,
than aerobic exercise alone. However, the impact of exercise on cognitive
recovery in this population was not reported in any of the included
studies and thus remains unknown. <br/>Conclusion(s): The physiological
benefits of aerobic exercise have been extensively researched; however,
there is a lack of evidence surrounding resistance training following
cardiac surgery, particularly regarding cognitive recovery. Given the
significant number of patients who experience permanent cognitive
impairment following cardiac surgery, cognitive assessment should be
undertaken prior to and following surgery. Resistance training may be more
effective in reducing cognitive decline after cardiac surgery compared
with conventional aerobic programmes; however, large controlled trials are
needed before more definite conclusions can be drawn.<br/>Copyright &#xa9;
2019

<70>
Accession Number
2002051582
Title
Minimally Invasive Aortic Valve Replacement: The Optimal Surgical
Alternative to Transcatheter Aortic Valve Replacement?.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S77), 2019. Date of Publication:
2019.
Author
Doyle M.; Woldendorp K.; Yan T.; Bannon P.
Institution
(Doyle, Woldendorp, Yan, Bannon) Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Elsevier Ltd
Abstract
Aim: Minimally invasive aortic valve replacement and transcatheter aortic
valve replacement (TAVI) provide aortic valve replacement by less invasive
methods than conventional full sternotomy, with each method of valve
replacement offering different benefits. This study aims to compare the
perioperative outcomes and short-term survival rates of MiAVR and TAVI.
<br/>Method(s): A systematic literature search was performed to include
all studies comparing MiAVR with TAVI. A meta-analysis was performed
comparing propensity-matched studies. Primary end points were
postoperative mortality and stroke. Secondary end points included new
aortic insufficiency (AI), new atrial fibrillation, need for permanent
pacemaker (PPM), major bleeding, conversion to sternotomy, intensive care
unit length of stay (LOS), and hospital LOS. <br/>Result(s): A total of
seven studies with 6,091 patients were included in the quantitative
analysis. Pooled analysis showed mortality was significantly lower after
MiAVR compared with TAVI (odds ratio [OR] 0.37, 95% confidence interval
[CI] 0.16-0.86; p = 0.02). Analysis of risk-matched patients showed MiAVR
had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29,
95% CI 0.16-0.52; p < 0.0001) and postoperative AI or paravalvular leak
(PVL) (OR 0.05, 95% CI 0.01-0.20; p < 0.0001) compared with TAVI, with no
difference in stroke (OR 0.42, 95% CI 0.13-1.29; p = 0.13), major bleeding
(OR 1.15, 95% CI 0.49-2.71; p = 0.74) or short-term mortality (relative
risk 0.76, 95% CI 0.37-1.54; p = 0.44). <br/>Conclusion(s): Minimally
invasive aortic valve replacement can be performed with lower
postoperative PPM requirement and new AI/PVL compared with patients of
equivalent surgical risk undergoing TAVI, with no difference in
perioperative stroke, major bleeding, or short-term
mortality.<br/>Copyright &#xa9; 2019

<71>
Accession Number
2002051581
Title
Systematic Review and Meta-Analysis on the Impact of Preoperative Atrial
Fibrillation on Short-Term and Long-Term Outcomes After Aortic Valve
Replacement.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S92-S93), 2019. Date of
Publication: 2019.
Author
Saxena A.; Virk S.; Bowman S.; Bannon P.
Institution
(Saxena, Virk, Bowman, Bannon) University of Sydney, Sydney, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: This systematic review and meta-analysis was performed to
evaluate the impact of preoperative atrial fibrillation (preAF) on early
and late outcomes after aortic valve replacement (AVR). <br/>Method(s):
Medline, EMBASE, and CENTRAL were systematically searched for studies that
reported AVR outcomes according to the presence or absence of preAF. Data
were independently extracted by two investigators; a meta-analysis was
conducted according to predefined clinical endpoints. Studies including
patients undergoing concomitant atrial fibrillation surgery were excluded.
<br/>Result(s): Six observational studies with eight distinct AVR cohorts
(AVR +/- concomitant surgery) met criteria for inclusion, including a
total of 6,693 patients. Of these, 1,014 (15%) presented with preAF.
Overall, perioperative mortality was increased in patients with preAF (OR
2.33, 95% CI 1.48-3.67, p < 0.001). Subgroup analysis of patients
undergoing isolated AVR also demonstrated preAF as a risk factor for
perioperative mortality (OR 2.49, 95% CI 1.57-3.95, p < 0.001). PreAF was
also associated with acute renal failure (OR 1.42, 95% CI 1.07-1.89, p =
0.02) but not stroke (OR 1.11, 95% CI 0.59-2.12, p = 0.74). Late mortality
was significantly higher in patients with preAF (HR 1.75, 95% CI
1.33-2.30, p < 0.001). This relationship remained true when only patients
who underwent isolated AVR were analysed (HR 1.97, 95% CI 1.11-3.51, p =
0.02). <br/>Conclusion(s): PreAF is associated with an increased risk of
early mortality and late mortality after AVR. These data support the more
widespread utilisation of concomitant AF ablation.<br/>Copyright &#xa9;
2019

<72>
Accession Number
2002051561
Title
What Constitutes "Resistance Training" and How is it Applied Following
Median Sternotomy? A Systematic Review With Meta-Analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S117-S118), 2019. Date of
Publication: 2019.
Author
Pengelly J.; Pengelly M.; El-Ansary D.; Lin K.-Y.; Williams G.; Royse C.;
Royse A.; Bryant A.
Institution
(Pengelly, Pengelly, El-Ansary, Lin, Williams, Royse, Royse, Bryant)
Swinburne University of Technology, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Purpose: Despite a lack of evidence, patients are routinely instructed to
follow arbitrary sternal precautions that restrict use of the upper limbs
and trunk to prevent sternal complications following median sternotomy.
However, bilateral upper limb and thoracic exercises have been shown to be
safe, facilitate recovery, reduce pain, and improve function following
surgery?>[1,2]. Furthermore, many daily activities require patients to
repetitively perform tasks and lift loads that exceed these precautions.
Progressive resistance training mediates the inflammatory and neurotrophic
factor pathways associated with cognitive decline and sarcopenia. This
review aimed to determine what the literature defines as "resistance
training" in the postsurgical cardiac population, and whether current
practice complies with national and international cardiac rehabilitation
guidelines. Methodology: A primary search of relevant key terms was
conducted in the electronic databases of PubMed, CINAHL and EMBASE. All
studies were independently assessed for relevance, eligibility, and
quality. Eighteen studies evaluating the effects of resistance exercise in
adults (>=18 years) undergoing coronary artery bypass grafting and or
valve replacement were included in the qualitative analysis, with seven
suitable for meta-analysis. <br/>Result(s): To date, there have been few
studies investigating the effects of resistance training alone following
cardiac surgery. The definition of resistance varies substantially, with
the majority of studies defining resistance training as calisthenic or
range of motion-type exercises. Meta-analysis determined that there is no
statistically significant improvement in VO2peak when comparing aerobic
and resistance training interventions; however, there is a trend toward
improvement in functional capacity with the addition of resistance
training to standard care. <br/>Conclusion(s): Resistance training
presents as a safe, feasible and time-efficient intervention that shows
potential in optimising patient recovery through improved neurogenesis,
neuromuscular control, and muscle activation patterns. Instead of
restricting movements and loads, the focus should be on educating patients
to safely and progressively return to activity. However, the limited
literature prevents more definitive conclusions from being
drawn.<br/>Copyright &#xa9; 2019

<73>
Accession Number
2002051544
Title
Heart Valve Surgery Performed by Trainee Surgeons: Meta-Analysis of
Clinical Outcomes.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S98), 2019. Date of Publication:
2019.
Author
Saxena A.; Virk S.; Bowman S.; Jeremy R.; Bannon P.
Institution
(Saxena, Virk, Bowman, Jeremy, Bannon) University of Sydney, Sydney,
Australia
Publisher
Elsevier Ltd
Abstract
Background: Cardiac surgical units must balance trainee education with a
duty to provide optimal patient care. This is particularly challenging
with valvular surgery, given the lower volume and increased complexity of
these procedures. The present meta-analysis was conducted to assess the
impact of trainee operator status on clinical outcomes following valvular
surgery. <br/>Method(s): Medline, Embase and CENTRAL databases were
systematically searched for studies reporting clinical outcomes according
to the training status of the primary operator (consultant or trainee).
Data were extracted and meta-analysed according to predefined endpoints.
<br/>Result(s): Eleven observational studies met inclusion criteria,
reporting on five patient cohorts undergoing mitral valve surgery (n =
3975), six undergoing aortic valve replacement (AVR) (n = 6236), and three
undergoing combined AVR and coronary artery bypass grafting (CABG) (n =
3495). Perioperative mortality was not significantly different between
trainee and consultant cases for mitral valve surgery (OR 0.92, 95% CI
0.62-1.37); AVR (OR 0.67, 95% CI 0.37-1.24), or combined AVR and CABG (OR
1.07, 95% CI 0.40-2.85). The incidences of perioperative stroke,
myocardial infarction, arrhythmias, acute renal failure, re-operation, or
wound infection were not significantly different between trainee and
consultant cases. There was a paucity of mid-term survival data.
<br/>Conclusion(s): Valvular surgery cases primarily performed by trainees
were not associated with adverse perioperative outcomes. These findings
suggest that the rigorous design of cardiac surgical trainee programs can
sufficiently mitigate trainee deficiencies. However, studies with longer
follow-up duration and echocardiographic data are required to assess
long-term durability and safety.<br/>Copyright &#xa9; 2019

<74>
Accession Number
2002051525
Title
Early Postoperative Outcomes for Aortic Valve Replacement Using Stented
Versus Sutureless Valves Via a Full Sternotomy or Minimally Invasive
Approach: A Network Meta-Analysis of Surgical Techniques.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S92), 2019. Date of Publication:
2019.
Author
Woldendorp K.; Doyle M.; Yan T.; Bannon P.
Institution
(Woldendorp, Doyle, Yan, Bannon) Royal Prince Alfred Hospital, Sydney,
Australia
Publisher
Elsevier Ltd
Abstract
Purpose: In the era of transcatheter aortic valve replacement, new
technologies such as sutureless prosthetic valves and improved access via
minimally invasive incisions offer a reduction in surgical trauma for
patients undergoing surgical aortic valve replacement. It remains unclear
whether a reduction in cardiopulmonary bypass and aortic cross-clamp
times, or avoiding complete sternotomy offer improved early postoperative
outcomes. A network meta-analysis was performed to compare minimally
invasive aortic valve replacement (MiAVR) with sutureless aortic valve
replacement (SuAVR), and full sternotomy aortic valve replacement (FAVR).
Methodology: A network meta-analysis was performed to compare early
postoperative outcomes between full sternotomy AVR (FAVR), minimally
invasive AVR (MiAVR), sutureless AVR (SuAVR) via full sternotomy, and
minimally invasive SuAVR (MiSuAVR). A comprehensive literature search was
conducted to identify all publications reporting matched outcomes of the
included procedures. Preliminary results are included in this report.
Results Twenty-two studies with 6,643 patients were identified. A signal
towards reduced early mortality, stroke, bleeding complications, sternal
infections, and acute kidney injury was noted in both sutureless and
minimally invasive techniques, but did not achieve significance. Minimally
invasive and sutureless procedures had significantly lower rates of new
postoperative atrial fibrillation (MiSuAVR vs FAVR OR 0.52, 95% CI
0.32-0.85 and MiAVR vs FAVR OR 0.74, 95% CI 0.61-0.89), and demonstrated a
trend towards shorter intensive care unit length of stay; however,
statistical significance was only noted with MiSuAVR (mean difference
-0.45 days, 95% CI -0.75 to -0.16). <br/>Conclusion(s): Minimally invasive
and sutureless techniques demonstrated equivalent early postoperative
outcomes to FAVR, and may reduce intensive care unit length of stay and
postoperative atrial fibrillation burden. Further benefits may be realised
after the acute postoperative period and in long-term
follow-up.<br/>Copyright &#xa9; 2019

<75>
Accession Number
2002051517
Title
Network Meta-Analysis of Antiplatelet Therapy Following Coronary Artery
Bypass Grafting: None Versus One Versus Two Antiplatelet Agents.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S71), 2019. Date of Publication:
2019.
Author
Chakos A.; Jbara D.; Singh K.; Yan T.; Tian D.
Institution
(Chakos, Jbara, Singh, Yan, Tian) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Aim: Numerous agents have been trialled following coronary artery bypass
grafting (CABG) to maintain long-term graft patency. While clear evidence
exists for the use of aspirin in maintaining graft patency, the role of
dual antiplatelet therapy (DAT) in CABG patients is not as well
established. This network meta-analysis aimed to compare post-CABG graft
patency beyond 3 months for patients with none, one, or two antiplatelet
agents. <br/>Method(s): Electronic databases were queried for randomised
controlled trials comparing CABG graft patency rates at 3 months and
beyond using various antiplatelet agents or placebo. Drug and graft
patency data were compared using a mixed-treatment comparison under a
Bayesian hierarchical framework. A random-effects consistency model was
applied. Direct and indirect comparisons were made between drugs and used
to determine the relative efficacy for graft patency. <br/>Result(s): The
literature search identified 16 papers fulfilling the inclusion criteria,
including a total of 3,133 patients with an average of 2.43 grafts per
patient (95% confidence interval [CI] 2.20-2.66) grafts per patient. Graft
types were incompletely reported; however, saphenous vein grafts (SVG)
were predominantly used (where specifically reported: 4,490 SVG; 1,226
internal mammary artery grafts). In all, five different agents and placebo
in various regimens were compared by results of angiographic follow-up
conducted at a mean of 10.4 months (95% CI 9.28-11.5). Compared with
placebo, aspirin alone (odds ratio [OR] 1.9, 95% CI 1.3-2.8), aspirin +
dipyridamole (OR 1.9, 95% CI 1.3-2.6), aspirin + clopidogrel (OR 2.9, 95%
CI 1.5-5.7), and aspirin + ticagrelor (OR 3.8, 95% CI 1.2-13.0)
significantly improved graft patency. When compared with aspirin
monotherapy, aspirin + clopidogrel (OR 1.6; 95% CI 0.86-2.7) and aspirin +
ticagrelor (OR 2.0, 95% CI 0.69-6.3) had ORs that suggested a trend
favouring patency versus aspirin monotherapy; however, these results did
not reach significance. Secondary end points of death, bleeding,
myocardial infarction, and cerebrovascular accident were incompletely
reported and were pooled but not compared between drug treatment arms.
<br/>Conclusion(s): Only aspirin monotherapy and DAT provided significant
all-graft patency benefit versus placebo at 3 months and beyond. A trend
existed for DAT to improving graft patency versus aspirin, although this
did not reach statistical significance. Further studies comparing aspirin
monotherapy with DAT are required to determine the utility of DAT in CABG
patients.<br/>Copyright &#xa9; 2019

<76>
Accession Number
2002033816
Title
Interventional Management of Indigenous Rheumatic Valvular Heart Disease
at TPCH.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 2) (pp S53), 2019. Date of Publication:
2019.
Author
Hlaing S.H.; Goh S.; Smith S.; Scalia G.; Pohlner P.
Institution
(Hlaing, Goh, Smith, Scalia, Pohlner) The Prince Charles Hospital,
Chermside, Australia
(Hlaing, Goh, Scalia, Pohlner) The University of Queensland, Brisbane,
Australia
Publisher
Elsevier Ltd
Abstract
Background: The incidence of rheumatic heart disease (RHD) in the
indigenous Australian population is the highest in the world. Review of
Queensland Patient Admitted Data Collection and TPCH cardiac clinical
databases between January 2005 to December 2017 identified 240 indigenous
patients undergoing any valve related interventional procedures at Metro
North HHS. Of these 75 were performed for rheumatic valves at TPCH.
<br/>Method(s): Chart review and electronic database procedural data was
analysed, with clinical follow up records, including echocardiography,
being collated to identify survival and cardiac status following these
interventions. <br/>Result(s): Rheumatic interventions were required over
an age range of 10-69 years dominantly female 75%. Percutaneous mitral
balloon valvuloplasty was performed in 15 patients, transcatheter aortic
valve implantation in 1 patient. Surgical valve repair of 11 isolated
mitral valves was achieved. Single valve replacement was possible in 10
with multiple valve repair/replacements required in the remaining 38
patients. Mechanical and tissue valves were utilized by 12 surgeons almost
equally during replacement. Valve failure due to mitral valve thrombus
formation, aortic prosthetic patient mismatch, and endocarditis required 7
reoperations. Hospital 30-day survival was 100%, 5year survival was 90%
and 12year survival was 85%, estimated from medical record review. One
reoperation following mitral valve repair has been required to date. Valve
function on late follow up with clinical and echo data remains
satisfactory. <br/>Conclusion(s): Mitral valve function is durable
following balloon valvuloplasty or surgical repair in RHD. Risk to
survival during all forms of intervention is low. The type of systemic
heart valve utilized for replacement requires close consideration of
patient geography, medical access and patient compliance.<br/>Copyright
&#xa9; 2019

<77>
Accession Number
2002004024
Title
Catheter Versus Thoracoscopic Ablation for Atrial Fibrillation:
Meta-Analysis of Randomised Trials.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 1) (pp S10-S11), 2019. Date of
Publication: 2019.
Author
Wang T.K.M.; Wang M.T.M.; Martin A.
Institution
(Wang, Wang, Martin) Auckland City Hospital, Auckland, New Zealand
(Wang) Middlemore Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Antiarrhythmic drugs and ablation are the two pillars for
rhythm control of atrial fibrillation (AF). Percutaneous catheter and
minimally invasive thoracoscopy are the two approaches for ablation, in
absence of concurrent cardiac surgery, but the optimal strategy remains
controversial. This study compared the efficacy and safety outcomes of
these two strategies by meta-analysis. <br/>Method(s): PubMed, Embase, and
Cochrane databases were searched from 1 January 1980 to 31 December 2018,
with two authors adjudicating randomised trials with both catheter and
thoracoscopic arms for inclusion, followed by data extraction and pooled
analysis. <br/>Result(s): There were 636 studies searched, 19 full-text
articles were reviewed, and six randomised trials with 465 patients (254
catheter and 211 thoracoscopic) were included for analyses. Overall mean
age was 56 +/- 8 years, 68% were male, and 85% had paroxysmal AF. Pooled
freedom of AF for percutaneous and thoracoscopic ablation at 6 months were
62% vs 81% (OR, 0.34; 0.19-0.61; p < 0.001) in three studies, and 54% vs
74% at 12 months (OR, 0.35; 0.16-0.76; p = 0.008) in six studies. Efficacy
differences were preserved in those with paroxysmal AF but not permanent
AF in pooling subgroup analyses reported by two studies. Thoracoscopic
ablation had longer procedural time, hospital stay, and total adverse
events, including pneumothorax and haemothorax, but no other
complications. <br/>Conclusion(s): Thoracosopic ablation was superior to
catheter endocardial ablation for maintaining freedom from AF up to 1
year, but had higher overall complication rates. Decisions for optimal
approach to AF ablation should be individualised and based on their
relative benefits and risks.<br/>Copyright &#xa9; 2019

<78>
Accession Number
2002003999
Title
Review of Intravenous Amiodarone Administration to Reduce the Occurrence
of Phlebitis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 1) (pp S2), 2019. Date of Publication:
2019.
Author
Seeney S.
Institution
(Seeney) Capital and Coast District Health Board, Wellington, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Intravenous (IV) amiodarone is regularly administered at the
current clinic unit for atrial fibrillation, including cardiology and
post-cardiac surgery patients. The unit noted an increase in chemical
phlebitis from the submission of reportable events. From this increase, a
systematic review of administration was performed. <br/>Method(s): A
literature review was performed of global administration guidelines - from
the National Health Service, Australia, Canada and United States of
America - and compared with current administration. The concentrations
were similar but it was noted that IV giving sets were not filtered at the
current centre. In partnership with IV therapy, correct filter IV giving
sets were replaced. A retrospective review was then performed of patients,
from the previous 3 months, who had received amiodarone via old IV giving
sets and 3-month review was performed of new IV giving sets; chemical
phlebitis rates were compared. <br/>Result(s): Aligning administration
with international standards saw a reduction in phlebitis by 30%. There
were no effects on cardioversion numbers due to increased filtration of
drugs and no increased cost to the District Health Board for change of
giving sets. <br/>Conclusion(s): Aligning administration guidelines with
international standards enabled a significant reduction in rates of
phlebitis. This reduced pain and infection risks for patients and reduced
length of stay; thus, reducing the cost of treatment.<br/>Copyright &#xa9;
2019

<79>
Accession Number
2002003981
Title
Percutaneous MitraClip Versus Mitral Valve Surgery for Severe Mitral
Regurgitation: Updated Meta-Analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 1) (pp S33), 2019. Date of Publication:
2019.
Author
Chatfield A.; Wang M.T.M.; Ruygrok P.; Wang T.K.M.
Institution
(Chatfield, Wang, Ruygrok, Wang) Auckland City Hospital, Auckland, New
Zealand
(Wang) Middlemore Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Mitral valve surgery (MVS) is the traditional gold standard
for treating severe symptomatic mitral regurgitation (MR). Percutaneous
mitral valve interventions starting with MitraClip offers another
dimension to its management, particularly in high-risk patients. We
compared the outcomes of MitraClip and MVS in this meta-analysis.
<br/>Method(s): PubMed, MEDLINE, Embase, Cochrane, and Scopus databases
were searched from 1 January 1980 to 31 December 2018 for original
studies. Three authors evaluated these studies for inclusion
independently, then extracted and pooled data using random-effects models.
<br/>Result(s): After screening 959 studies and reviewing 21 full-text
articles, nine studies, including one randomised trial, were included,
totalling 640 MitraClip and 531 MVS (91% valve repair) procedures.
MitraClip patients were significantly older, had a higher proportion of
previous cardiac surgery, higher EuroSCORE (all p<0.05), and functional
mitral regurgitation (MR) made up approximately 70% in both groups. Pooled
mortality rates were similar for MitraClip versus MVS (3% vs 5% [odds
ratio, 0.58; 95% confidence interval, 0.28-1.19] in-hospital or within 30
days; 12% vs 13% [odds ratio, 1.09; 95% confidence interval 0.71-1.68] at
1 year; 29% vs 35% [OR, 1.08; 95% confidence interval 0.72-0.163] at 3
years). MitraClip had higher rates of early and late significant MR and
more cardiovascular re-admissions, while MVS had higher rates of
in-hospital bleeding and pacemaker implantation (all p < 0.05).
<br/>Conclusion(s): Patients undergoing MitraClip had higher baseline risk
than MVS, but there were no significant differences in mortality in both
the short and long term. Use of a MitraClip had higher rates of
significant MR post-operatively and cardiovascular admissions, while MVS
had more procedural complications.<br/>Copyright &#xa9; 2019

<80>
Accession Number
2002003969
Title
Prognostic Utility of Risk Models for Percutaneous MitraClip Implantation:
A Meta-Analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 1) (pp S34-S35), 2019. Date of
Publication: 2019.
Author
Wang T.K.M.; Wang M.T.M.
Institution
(Wang, Wang) Auckland City Hospital, Auckland, New Zealand
(Wang) Middlemore Hospital, Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: The MitraClip is the most established percutaneous mitral
valve intervention indicated for severe mitral regurgitation at high or
prohibitive surgical risk. Risk stratification plays a critical role in
selecting the appropriate treatment modality in high-risk patients with
valve disease but have been rarely studied in this setting. We compared
the performance of risk scores at predicting mortality after MitraClip in
this meta-analysis. <br/>Method(s): The MEDLINE, Embase, and Cochrane
databases were searched from 1 January 1980 to 31 December 2018. Two
authors reviewed studies that reported the c-statistics of risk models to
predict mortality after MitraClip for inclusion, followed by data
extraction and pooled analyses. <br/>Result(s): Of 494 articles searched,
47 full-text articles were evaluated, and four studies totalling 879
MitraClip cases were included for analyses. Operative mortality was
reported at 3.3% - 7.4% in three studies, and 1-year mortality as 11.2% -
13.5% in two studies. C-statistics for operative mortality were EuroSCORE
0.66 (95% confidence interval [CI] 0.57-0.75), EuroSCORE II 0.72 (95% CI
0.60-0.85), and Society of Thoracic Surgery (STS) score 0.64 (95% CI
0.56-0.73). Respective Peto's odds ratios to assess calibration were
EuroSCORE 0.21 (95% CI 0.14-0.31), EuroSCORE II 0.43 (95% CI 0.24-0.76),
and STS score 0.36 (95% CI 0.21-0.61). C-statistics for 1-year mortality
were EuroSCORE II 0.64 (95% CI 0.57-0.70) and STS score (95% CI
0.58-0.64). <br/>Conclusion(s): All scores overestimated operative
mortality, and EuroSCORE II had the best moderate discrimination, while
the other two scores were only modestly prognostic. Development of
MitraClip-specific scores may improve accuracy of risk stratification for
this procedure to guide clinical decision-making.<br/>Copyright &#xa9;
2019

<81>
Accession Number
2002003956
Title
Mitral Valve Repair Versus Replacement for Infective Endocarditis: An
Updated Meta-Analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 1) (pp S34), 2019. Date of Publication:
2019.
Author
Wang T.K.M.; Haydock M.; Wang M.T.M.; Pemberton J.
Institution
(Wang, Haydock, Wang, Pemberton) Auckland City Hospital, Auckland, New
Zealand
(Wang) Middlemore Hospital, Auckland, New Zealand
(Pemberton) Dunedin Hospital, Dunedin, Dunedin, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Mitral valve repair has superior results to replacement for
severe degenerative mitral valve disease; however, in the infective
endocarditis setting, mixed results have been reported. We compared the
outcomes of mitral valve repair and replacement for infective endocarditis
in this meta-analysis. <br/>Method(s): The MEDLINE, Embase, and Cochrane
databases were searched from 1 January 1980 to 30 June 2018 for original
studies. Two authors evaluated these studies for inclusion independently,
then data were extracted and pooled. <br/>Result(s): A total of 4,527
papers were obtained from the search, 121 full-texts were reviewed, and 18
studies reporting both mitral valve repair and replacement patients
totalling 12,339 patients were included for analyses. Pooled rates and
odds ratios (OR) for operative mortality of repair versus replacement were
4.0% versus 10.5% (OR, 0.37; 95% confidence interval [CI], 0.29-0.48) in
17 studies. Other in-hospital complications of stroke and renal failure
were lower for repair than replacement (OR, 0.65 [95% CI 0.50-0.84] vs OR,
0.42 [95% CI 0.34-0.52]). Odds ratio for mortality at 1 year (n = 4) was
0.31 (95% CI 0.14-0.72), and at long-term follow-up (n = 12) was 0.50 (95%
CI 0.41-0.61). There were no differences in long-term stroke, recurrent
endocarditis, and redo operations (OR, 0.55-0.81; p = 0.21-0.66).
<br/>Conclusion(s): Mitral valve repair is associated with significant
reduction in mortality short and long term, as well was in-hospital stroke
and renal failure, with similar rates of long-term stroke, recurrent
endocarditis, and redo operation rates at the long-term follow-up compared
with replacement for endocarditis. It is therefore preferred when
feasible, similar to surgery for degenerative mitral valve
disease.<br/>Copyright &#xa9; 2019

<82>
Accession Number
2002077425
Title
Could Short-Term Perioperative High-Dose Atorvastatin Offer Antiarrhythmic
and Cardio-Protective Effects in Rheumatic Valve Replacement Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Allah E.A.; Kamel E.Z.; Osman H.M.; Abd-Elshafy S.K.; Nabil F.; Elmelegy
T.T.H.; Elkhayat H.; Ibrahim A.S.; Minshawy A.A.
Institution
(Allah, Kamel, Osman, Abd-Elshafy, Nabil, Ibrahim) Faculty of Medicine,
Assiut University, Assiut, Egypt
(Elmelegy) Clinical pathology department, Faculty of Medicine, Assiut
University, Assiut, Egypt
(Elkhayat, Minshawy) Cardiothoracic Surgery department, Faculty of
Medicine, Assiut, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate the role of prophylactic high-dose atorvastatin
for prevention of postoperative atrial fibrillation (POAF), inflammatory
response attenuation, and myocardial protection after valve replacement
cardiac surgery. <br/>Design(s): Randomized controlled trial.
<br/>Setting(s): Assiut University Hospitals. <br/>Participant(s):
Sixty-four adult patients undergoing cardiac valve replacement surgery.
<br/>Intervention(s): The participants were equally divided into 2 groups.
Group S received 80 mg of atorvastatin (oral tablets), 12 and 2 hours
preoperatively, and on the 2nd, 3rd, 4th, and 5th postoperative days.
Control group C received placebo at the same time periods. Measurements:
The incidence of POAF, postoperative white blood cell count, serum
C-reactive protein, interleukin 6, and troponin I. <br/>Main Result(s):
Group S patients showed a lower incidence of POAF compared with the
placebo group (p = 0.031). The white blood cell count showed significant
reductions in group S compared with group C on the second, third, fourth,
and fifth postoperative days. The C-reactive protein level showed
significant reductions on the third, fourth, and fifth postoperative days
in group S compared with group C (p = 0.001, 0.001, and 0.001,
respectively). The serum level of interleukin 6 showed a significant
reduction on the fifth postoperative day in group S compared with group C
(p = 0.001). There was no significant difference between the 2 groups
regarding the troponin I level and inotropic score. <br/>Conclusion(s):
Prophylactic use of high dose atorvastatin can decrease the incidence of
POAF and attenuate the inflammatory process in adult patients undergoing
isolated rheumatic cardiac valve replacement surgery.<br/>Copyright &#xa9;
2019 Elsevier Inc.

<83>
Accession Number
2002075752
Title
Prophylactic Intra-Aortic Balloon Counterpulsation in High Risk Cardiac
Surgery: The PINBALL Pilot Multicentre, Registry-Linked, Randomised,
Controlled Feasibility Trial.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Litton E.; Bass F.; Dickson C.; Hillis G.; Inskip D.; Jacques T.; McGiffin
D.; McGuiness S.; Miller J.; Parke R.; Playford H.; Reid C.; Smith J.;
Solman N.; Tran L.; Yarad E.; Delaney A.
Institution
(Litton) Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
(Litton, Hillis) School of Medicine, University of Western Australia,
Perth, WA, Australia
(Bass, Yarad, Delaney) Malcolm Fischer Department of Intensive Care
Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
(Dickson) Department of cardiothoracic surgery, Westmead Hospital, Sydney,
NSW, Australia
(Hillis) Department of Cardiology, Royal Perth Hospital, Perth, WA,
Australia
(Inskip, Jacques, Miller) Intensive Care Unit, The St George Hospital,
Sydney, NSW, Australia
(McGiffin, McGuiness) Department of Cardiothoracic Surgery, The Alfred
Hospital, Melbourne, Vic, Australia
(Parke) Cardiovascular Intensive Care Unit, Auckland City Hospital,
Auckland, New Zealand
(Playford) Department of Anaesthesia, Westmead Hospital, Sydney, NSW,
Australia
(Reid, Solman, Tran) School of Public Health and Preventive Medicine,
Monash University, Melbourne Vic, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Melbourne,
Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Prophylactic intra-aortic balloon counterpulsation (IABC) is
commonly used in selected patients undergoing coronary artery bypass graft
(CABG) surgery, but definitive evidence is lacking. The aim of the
multicentre PINBALL Pilot randomised controlled trial (RCT) was to assess
the feasibility of performing a definitive trial to address this question.
<br/>Method(s): Patients listed for CABG surgery with impaired left
ventricular function and at least one additional risk factor for
postoperative low cardiac output syndrome were eligible for inclusion if
the treating surgical team was uncertain as to the benefit of prophylactic
IABC. The primary outcome of feasibility was based on exceeding a
pre-specified recruitment rate, protocol compliance and follow-up.
<br/>Result(s): The recruitment rate of 0.5 participants per site per
month did not meet the feasibility threshold of two participants per site
per month and the study was stopped early after enrolment of 24 out of the
planned sample size of 40 participants. For 20/24 (83%) participants,
preoperative IABC use occurred according to study assignment. Six
(6)-month follow-up was available for all enrolled participants, [IABC 1
death (8%) vs. control 1 death (9%), p = 0.95]. <br/>Conclusion(s): The
PINBALL Pilot recruitment rate was insufficient to demonstrate feasibility
of a multicentre RCT of prophylactic IABC in high risk patients undergoing
CABG surgery.<br/>Copyright &#xa9; 2019

<84>
Accession Number
619070096
Title
Contribution of the straightening effect of the parent artery to decreased
recanalization in stent-assisted coiling of large aneurysms.
Source
Journal of Neurosurgery. 127 (5) (pp 1063-1069), 2017. Date of
Publication: November 2017.
Author
Ishii A.; Chihara H.; Kikuchi T.; Arai D.; Ikeda H.; Miyamoto S.
Institution
(Ishii, Chihara, Kikuchi, Arai, Ikeda, Miyamoto) Department of
Neurosurgery, Kyoto University, Graduate School of Medicine, 54
Kawahara-cho, Syogo-in, Sakyo-ku, Kyoto 606-8507, Japan
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE The durability of embolization of large aneurysms is enhanced by
use of the neck-bridging stent. However, it remains unclear what factors
contribute to decreased recanalization. The purpose of this study was to
demonstrate the contribution of the straightening effect of the parent
artery to the durability of stent-assisted coiling for large aneurysms.
METHODS Of the 182 aneurysms treated by embolization since the
introduction of the neurovascular stent, 82 consecutive unruptured
aneurysms with a diameter greater than 7 mm were selected. There were 52
aneurysms treated with a stent (Group S) and 30 treated without a stent
(Group NS). Occlusion status was evaluated 12 months after embolization
with digital subtraction angiography. The vascular angle of the parent
artery was measured before, immediately after, and 12 months after
embolization. The rates of recanalization were compared between Group S
and Group NS. In Group S, the rates of recanalization were further
compared between those aneurysms with and without a significant angle
change. RESULTS The rate of major recanalization was 9.6% in Group S and
26.7% in Group NS. The volume embolization ratio was 32.6% in Group S and
31.6% in Group NS, with no statistically significant difference. However,
the angulation change before and after coiling was significantly higher in
Group S (10.6degree) than in Group NS (0.9degree). The difference in the
angulation was more evident 12 months after coiling (19.1degree in Group S
and 1.5degree in Group NS). In Group S, recanalization was found in 14.3%
of 35 stented aneurysms without a significant angular change when a
significant angular change was defined as more than 20degree. In contrast,
all 17 aneurysms with >=20degree of angular change remained occluded.
CONCLUSIONS Significant angular change of >=20degree most likely leads to
decreased recanalization following stentassisted embolization of large
aneurysms.<br/>Copyright &#xa9; AANS, 2017.

<85>
Accession Number
606428481
Title
Viability, remodeling, and CABG another STICH in the shroud of
observation-based paradigm?.
Source
JACC: Cardiovascular Imaging. 8 (10) (pp 1130-1132), 2015. Date of
Publication: October 2015.
Author
Konstam M.A.
Institution
(Konstam) Cardio Vascular Center, Tufts Medical Center, Tufts University
School of Medicine, Box 108, 800 Washington Street, Boston, MA 02111,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<86>
Accession Number
601312957
Title
To bypass or stent' the changing rules of an advancing game.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (3) (pp 679-681),
2015. Date of Publication: 01 Mar 2015.
Author
Deb S.; Fremes S.E.
Institution
(Deb, Fremes) Schulich Heart Centre, University of Toronto, University of
Toronto, Toronto, ON, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<87>
Accession Number
52444495
Title
A systematic review on the quality of life benefits after aortic valve
replacement in the elderly.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (5) (pp 1173-1189),
2013. Date of Publication: May 2013.
Author
Shan L.; Saxena A.; McMahon R.; Wilson A.; Newcomb A.
Institution
(Shan, Newcomb) Department of Cardiothoracic Surgery, St Vincent's
Hospital Melbourne, Fitzroy, VIC, Australia
(Saxena, McMahon) Department of Medicine, South Eastern Sydney and
Illawarra Health Network, Cardiology Unit, Wollongong, NSW, Australia
(Wilson) Department of Cardiology, St Vincent's Hospital Melbourne,
Fitzroy, VIC, Australia
(Newcomb) University of Melbourne Department of Surgery, St Vincent's
Hospital Melbourne, Fitzroy, VIC, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Surgical aortic valve replacement is being increasingly
performed in elderly patients with good perioperative outcomes and
long-term survival. Evidence is limited on health-related quality of life
after aortic valve replacement, which is an important measure of operative
success in the elderly. <br/>Method(s): A systematic review of clinical
studies after January 2000 was performed to identify health-related
quality of life in the elderly after aortic valve replacement. Strict
inclusion and exclusion criteria were applied. Quality appraisal of each
study also was performed using predefined criteria. Health-related quality
of life results were synthesized through a narrative review with full
tabulation of the results of all included studies. <br/>Result(s):
Health-related quality of life improvements were shown across most or all
domains in different health-related quality of life instruments. Elderly
patients experienced marked symptomatic improvement. Health-related
quality of life was equivalent or superior to both an age-matched
population and younger patients undergoing identical procedures. There
were excellent functional gains after surgery, but elderly patients remain
susceptible to geriatric issues and mood problems. Concomitant coronary
artery bypass did not affect health-related quality of life. There was a
diverse range of study designs, methods, and follow-up times that limited
direct comparison between studies. <br/>Conclusion(s): Aortic valve
replacement results in significant health-related quality of life benefits
across a broad range of health domains in elderly patients. Age alone
should not be a precluding factor for surgery. Data are heterogeneous and
mostly retrospective. We recommend future studies based on consistent
guidelines provided in this systematic review. Copyright &#xa9; 2013 by
The American Association for Thoracic Surgery.

<88>
Accession Number
52106551
Title
Systematic review of clinical outcomes in hybrid procedures for aortic
arch dissections and other arch diseases.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (6) (pp 1286-1300.e2),
2012. Date of Publication: December 2012.
Author
Cao P.; De Rango P.; Czerny M.; Evangelista A.; Fattori R.; Nienaber C.;
Rousseau H.; Schepens M.
Institution
(Cao) Vascular Surgery, Ospedale San Camillo, Rome, Italy
(De Rango) Vascular Surgery, Ospedale S. Maria della Misericordia,
Perugia, Italy
(Czerny) Cardiovascular Surgery, Basel, Switzerland
(Evangelista) Cardiology, Hospital Val d'Hebron Barcelona, Barcelona,
Spain
(Fattori) Cardiovascular Radiology, San Salvatore Hospital, Pesaro, Italy
(Nienaber) Interventional Cardiology, University of Rostock, Rostock,
Germany
(Rousseau) Radiology, Toulouse, France
(Schepens) Cardiovascular Surgery, Brugge, Belgium
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Available data on clinical outcomes of hybrid aortic arch
repair are limited, especially for patients with aortic dissection. The
objective of this review was to provide pooled analysis of periprocedural
mortality and neurologic outcomes in hybrid procedures involving the
aortic arch for dissection and other aortic diseases. <br/>Method(s):
Studies involving hybrid aortic arch procedures (2002-2011) were
systematically searched and reviewed. End points were periprocedural
mortality, stroke, and spinal cord ischemia. <br/>Result(s): A total of 50
studies including 1886 patients were included. Perioperative mortality
ranged from 1.6% to 25.0% with a pooled event ratio of 10.8% (95%
confidence intervals [CI], 9.3-12.5). Perioperative stroke, regardless of
severity, ranged from 0.8% to 25.0% (pooled ratio 6.9%; 95% CI, 5.7%-8.4),
and spinal cord ischemia, including permanent and transitory events,
ranged from 1.0% to 25.0% (pooled ratio, 6.8%; 95% CI, 5.6-8.2).
Neurologic but no mortality risk was affected by timing and center volume
with decreased rates in more recent and higher volume studies. In
dissected aorta, perioperative mortality rate was 9.8% (95% CI, 7.7-12.4),
stroke 4.3% (95% CI, 3.0-6.3), and spinal cord ischemia 5.8% (95% CI,
4.2-7.9). Perioperative mortality was higher in diseases that extended to
the ascending aorta (15.1% vs 7.6%; odds ratio, 2.8; 95% CI, 1.17-6.7; P
=.021), whereas there were no significant differences in the neurologic
risks of stroke or spinal cord ischemia. <br/>Conclusion(s): Hybrid repair
of the aortic arch carries not negligible risks of perioperative mortality
and neurologic morbidity. Risk of neurologic complications has decreased
with timing and center volume and may be limited in dissection repairs.
However, contemporary information on aortic hybrid arch procedures is
mainly provided by small case series or retrospective studies with wide
range of results. Copyright &#xa9; 2012 by The American Association for
Thoracic Surgery.

<89>
Accession Number
51008919
Title
Visceral pain - Still an enigma?.
Source
Pain. 151 (2) (pp 239-240), 2010. Date of Publication: November 2010.
Author
Janig W.
Institution
(Janig) Department of Physiology, Christian-Albrechts-Universitat zu Kiel,
Physiologisches Institut, Olshausenstr. 40, 24098 Kiel, Germany
Publisher
Elsevier B.V. (E-mail: agents@lww.com)

<90>
Accession Number
2002062807
Title
The contribution of cardiac rehabilitation program in management of
diabetes mellitus: A systematic review.
Source
Obesity Medicine. 15 (no pagination), 2019. Article Number: 100103. Date
of Publication: September 2019.
Author
Chatziefstratiou A.A.; Fotos N.V.; Giakoumidakis K.; Brokalaki H.
Institution
(Chatziefstratiou) Cardiac Surgery Intensive Care Unit, General Pediatric
Hospital of Athens, Agia Sophia, Greece
(Fotos, Brokalaki) Faculty of Nursing, National and Kapodistrian
University of Athens, Athens, Greece
(Giakoumidakis) Department of Nursing, School of Health Sciences and
Welfare, University of West Attica, Greece
Publisher
Elsevier Ltd
Abstract
Aims: to determine the effectiveness of cardiac rehabilitation
(CR)programs in management of DM. <br/>Method(s): Pubmed database was
researched from June 2018 to July 2018 for randomized control trials and
cohort studies between 2013 and 2018. Data were extracted, and validity
was assessed by 2 reviewers and graded using the Cochrane Collaboration
tool for assessing risk of bias. <br/>Result(s): A total of 208 articles
were screened for relevance. Only 8 articles were deemed eligible for this
review, 4 retrospective and 4 prospective studies. Totally 23.415 people
with DM participated in CR, whereas the mean duration of CR programs was
12 weeks. The findings indicated a reduction in total mortality, length of
hospitalization and risk for cardiac surgery. Also, it was observed a
decrease in body weight, blood glycose, glycated hemoglobin, insulin
resistance and blood lipids. <br/>Conclusion(s): It is imperative the
increase of CR programs and people' participation with DM with the aim of
effective management of their disease and reduction of health care cost.
In addition, it is observed a gap in knowledge and more research is
needed.<br/>Copyright &#xa9; 2019

<91>
Accession Number
627898638
Title
Epidural analgesia versus paravertebral block in video-assisted
thoracoscopic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 404-406),
2019. Date of Publication: 2019.
Author
Harky A.; Clarke C.G.; Kar A.; Bashir M.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Liverpool Road, Chester CH2 1UL, United Kingdom
(Clarke) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Kar) Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's
Hospital, London, United Kingdom
(Bashir) Department of Aortovascular Surgery, Manchester Royal Infirmary,
Manchester, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In patients undergoing
video-assisted thoracoscopic surgery, is paravertebral block (PVB)
superior to epidural analgesia (EP) in terms of pain control and its
postoperative complication rates? Altogether, 153 papers were found using
the reporting search, of which 4 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. At present, there are a limited
number of studies directly comparing pain control and postoperative
outcomes between PVB and EP, and no large-scale randomized trials have
been reported. Three of the 4 papers are small prospective randomized
trials, with a small cohort study featuring as the final piece of
literature. There is no conclusive body of evidence to recommend either
route as more efficacious from a pain control perspective; one study
demonstrated significantly lower levels of pain with EP (P = 0.01), with a
second study demonstrating significantly better pain control with PVB (P <
0.01) and a third failing to demonstrate any significant difference (P =
0.899). The frequency of requiring supplemental analgesia was similar
between the PVB and EP cohorts (56% vs 48%, P = 0.26). PVB is associated
with lower rates of postoperative complications compared to EP,
specifically urinary retention (64% vs 34.6%, P = 0.0036) and hypotension
(32% vs 7%, P = 0.0031; 21% vs 3%, P = 0.02). In summary, PVBs appear to
offer an equivalent level of analgesic effect following video-assisted
thoracoscopic surgery, with a more favourable side-effect profile,
compared to EP. This does need to be contextualized in light of the
scarcity of published material, with the available studies each containing
a small number of participants.<br/>Copyright &#xa9; 2018 The Author(s).

<92>
Accession Number
627898630
Title
Do patients who require re-exploration for bleeding have inferior outcomes
following cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 613-618),
2019. Date of Publication: 2019.
Author
Ali J.M.; Wallwork K.; Moorjani N.
Institution
(Ali, Wallwork, Moorjani) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Do patients who require
return to theatre (RTT) for bleeding have inferior outcomes following
cardiac surgery? Altogether, 598 papers were found using the reported
search, of which 8 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. In summary, patients who bleed following cardiac surgery
and then RTT have increased mortality and experience greater morbidity,
including neurological, respiratory and renal complications, which result
in increased length of intensive care unit stay and hospital stay. It is
not easy to dissect the relative contribution of the blood loss and
consequent haemodynamic instability, the RTT and the increased blood
product consumption to the inferior outcomes observed, as there is
evidence that each is important. However, several studies have
demonstrated RTT to be an independent predictor of morbidity and
mortality, even when controlling for amount of transfusion. Patients who
bleed and RTT beyond 12 h postoperatively appear to have the poorest
outcomes, suggesting that the decision to RTT should not be delayed if
there are concerns over significant bleeding, to ensure the best patient
outcomes.<br/>Copyright &#xa9; 2018 The Author(s).

<93>
Accession Number
627895169
Title
Does the use of a hot-shot lead to improved outcomes following adult
cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 473-477),
2019. Date of Publication: 2019.
Author
Volpi S.; Ali J.M.; De Silva R.
Institution
(Volpi, Ali, De Silva) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Does the use of a
'hot-shot' (terminal warm blood cardioplegia) lead to improved outcomes
following adult cardiac surgery? Altogether, 567 papers were found using
the reported search, of which 9 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. We conclude that evidence
supporting the use of a hot-shot prior to weaning from cardiopulmonary
bypass is rather limited. All 8 of the randomized trials to date are small
studies which examine heterogeneous groups of patients, and unfortunately,
the conclusions are inconsistent, perhaps in part related to the inability
to demonstrate statistical significance with small group size. From the
evidence, it appears likely that the use of a hot-shot results in more
rapid biochemical, electrical and possibly functional myocardial recovery
from cardiopulmonary bypass. However, no study has been able to
demonstrate that this leads to improved clinical outcomes other than lower
incidence of atrial fibrillation.<br/>Copyright &#xa9; 2018 The Author.

<94>
Accession Number
627895167
Title
Is systematic lymph node dissection mandatory or is sampling adequate in
patients with stage I non-small-cell lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 550-554),
2019. Date of Publication: 2019.
Author
Mitsos S.; Panagiotopoulos N.; Patrini D.; George R.S.
Institution
(Mitsos, Panagiotopoulos, Patrini, George) Thoracic Surgery Department,
University College London Hospitals, NHS Foundation Trust, London, United
Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Is systematic lymph node
dissection (SLND) mandatory or is sampling adequate in stage I
non-small-cell lung cancer (NSCLC)? Two hundred and eleven papers were
identified, of which 12 papers represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and the results of
these papers are tabulated. There are 7 retrospective cohort reviews, 3
meta-analyses and 2 randomized controlled clinical trials (RCTs) to answer
the clinical question. Four of the 7 retrospective studies demonstrated
that the total number of resected lymph nodes and the number of lymph node
stations sampled affected the accuracy of staging in patients with
early-stage NSCLC and had an impact on overall survival and disease-free
survival. Two RCTs, 1 meta-analysis and 1 cohort study revealed no
significant benefit in overall survival and disease-free survival in
patients undergoing SLND. One meta-analysis, which contained only 1 RCT,
revealed significantly better 3- and 5-year survival with SLND. One
further metaanalysis revealed improved survival with SLND in cohort
studies but no significant difference in the 4 RCTs included. Two further
studies identified specific subgroups of patients in whom LN sampling
could be justified and SLND avoided. We conclude that there is no
significant difference in the recurrence rate when performing either SLND
or LN sampling in patients with stage I NSCLC. While retrospective cohort
studies implied survival benefit with SLND, this was not borne out in RCTs
and meta-analyses. However, there may be a potential survival benefit for
patients who are upstaged by SLND identifying mediastinal nodal
involvement.<br/>Copyright &#xa9; 2018 The Author.

<95>
Accession Number
627895159
Title
Intravenous iron does not effectively correct preoperative anaemia in
cardiac surgery: A pilot randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 447-454),
2019. Date of Publication: 2019.
Author
Padmanabhan H.; Siau K.; Nevill A.M.; Morgan I.; Cotton J.; Ng A.; Brookes
M.J.; Luckraz H.
Institution
(Padmanabhan, Siau, Brookes) Department of Gastroenterology, Royal
Wolverhampton NHS Trust, Wolverhampton WV10 0QP, United Kingdom
(Nevill) Faculty of Education, Health and Wellbeing, University of
Wolverhampton, Wolverhampton, United Kingdom
(Morgan, Luckraz) Department of Cardiothoracic Surgery, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Cotton) Department of Cardiology, Heart and Lung Centre, Wolverhampton,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart and Lung Centre,
Wolverhampton, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Preoperative anaemia is a strong predictor of blood
transfusion requirements and must be assessed for appropriate optimization
before elective surgery. Iron therapy is a transfusion-sparing approach
effective for increasing haemoglobin concentrations. However, its role in
elective cardiac surgery and the optimal route of administration remain
unknown. This single-centre, non-blinded, randomized, controlled trial
compared the effectiveness of intravenous ferric carboxymaltose therapy
with oral iron for anaemic patients undergoing elective cardiac surgery.
<br/>Method(s): Fifty anaemic patients scheduled for elective cardiac
surgery were randomized to receive either oral or intravenous iron therapy
3-8 weeks preoperatively. Changes in haemoglobin concentration were
measured. Blood transfusion and postoperative outcome data were collected.
<br/>Result(s): Preoperative median increases in haemoglobin were 1.0 g/l
(interquartile range -3.25 to 7.25 g/l) and 3.0 g/l (interquartile range
-1.25 to 6.25 g/l) for patients receiving intravenous and oral iron,
respectively (P = 0.42). The median first 12-h blood loss was
significantly higher in the intravenous group (655 ml; interquartile range
162-1540 ml) compared to the oral group (313 ml; interquartile range
150-1750 ml; P < 0.007). Median increments in serum ferritin were superior
for the intravenous group (median difference 313 mug/l; interquartile
range 228-496) compared to the oral group (median difference 5.5 mug/l;
interquartile range -1.4 to 19.4; P < 0.001). <br/>Conclusion(s):
Increases in ferritin after intravenous iron administration were
significantly greater than those after oral iron administration. There was
no significant difference in haemoglobin increments between groups.
Despite significantly higher intraoperative blood loss in the group
receiving intravenous iron, blood transfusion requirements for both groups
were not statistically different.<br/>Copyright &#xa9; The Author(s) 2018.

<96>
Accession Number
627895115
Title
Does the 'non-intubated' anaesthetic technique offer any advantage for
patients undergoing pulmonary lobectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 555-558),
2019. Date of Publication: 2019.
Author
Ali J.M.; Volpi S.; Kaul P.; Aresu G.
Institution
(Ali, Volpi, Kaul, Aresu) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: Do patients undergoing
pulmonary lobectomy using the non-intubated anaesthetic technique have
superior clinical outcomes? Altogether, 324 papers were found using the
reported search, of which 5 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. The nonintubated anaesthetic technique can be safely
used in patients undergoing video-assisted thoracic surgery lobectomy. Low
conversion rates to intubation are reported, and conversion has been
safely managed with no associated morbidity or mortality reported. The
technique has not been shown to impact on the incidence of postoperative
complications. However, studies consistently demonstrate improved
postoperative outcomes in terms of recovery from anaesthesia permitting
earlier oral intake and mobilization which is associated with a reduced
length of hospital stay.<br/>Copyright &#xa9; The Author(s) 2018.

<97>
Accession Number
627895110
Title
Randomized evaluation of fibrinogen versus placebo in complex
cardiovascular surgery: Post hoc analysis and interpretation of phase III
results.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 566-574),
2019. Date of Publication: 2019.
Author
Rahe-Meyer N.; Levy J.H.; Mazer C.D.; Schramko A.; Klein A.A.; Brat R.;
Okita Y.; Ueda Y.; Schmidt D.S.; Gill R.
Institution
(Rahe-Meyer) Department of Anaesthesiology and Critical Care, Franziskus
Hospital, Bielefeld, Germany
(Levy) Department of Anesthesiology and Critical Care, Duke University
School of Medicine, Durham, NC, United States
(Mazer) Department of Anesthesia, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Schramko) Department of Anesthesiology, Intensive Care and Pain Medicine,
Helsinki University Hospital, Helsinki, Finland
(Klein) Department of Anaesthesia and Intensive Care, Papworth Hospital,
Cambridge, United Kingdom
(Brat) Department of Cardiac Surgery, Faculty of Medicine, University of
Ostrava, Ostrava, Czechia
(Okita) Department of Cardiovascular Surgery, Kobe University Hospital,
Kobe, Japan
(Ueda) Department of Cardiac Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
(Schmidt) CSL Behring, Marburg, Germany
(Gill) Department of Anaesthesia, University Hospital of Southampton,
Southampton, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: In a multicentre, randomized-controlled, phase III trial in
complex cardiovascular surgery (Randomized Evaluation of Fibrinogen vs
Placebo in Complex Cardiovascular Surgery: REPLACE), single-dose human
fibrinogen concentrate (FCH) was associated with the transfusion of
increased allogeneic blood products (ABPs) versus placebo. Post hoc
analyses were performed to identify possible reasons for this result.
<br/>Method(s): We stratified REPLACE results by adherence to the
transfusion algorithm, pretreatment fibrinogen level (<=2 g/l vs >2 g/l)
and whether patients were among the first 3 treated at their centre.
<br/>Result(s): Patients whose treatment was adherent with the transfusion
algorithm [FCH, n = 47 (60.3%); placebo, n = 57 (77.0%); P = 0.036]
received smaller quantities of ABPs than those with non-adherent treatment
(P < 0.001). Among treatment-adherent patients with pretreatment plasma
fibrinogen <=2 g/l, greater reduction in 5-min bleeding mass was seen with
FCH versus placebo (median -22.5 g vs -15.5 g; P = 0.071). Considering
patients with the above conditions and not among the first 3 treated at
their centre (FCH, n = 15; placebo, n = 22), FCH was associated with
trends towards reduced transfusion of ABPs (median 2.0 vs 4.0 units; P =
0.573) and greater reduction in 5-min bleeding mass (median -21.0 g vs
-9.5 g; P = 0.173). Differences from a preceding single-centre phase II
study with positive outcomes included more patients with pretreatment
fibrinogen >2 g/l and fewer patients undergoing thoracoabdominal aortic
aneurysm repair. <br/>Conclusion(s): None of the patient stratifications
provided a clear explanation for the lack of efficacy seen for FCH in the
REPLACE trial versus the positive phase II outcomes. However, together,
the 3 factors demonstrated trends favouring FCH. Less familiarity with the
protocol and procedures and unavoidable differences in the study
populations may explain the differences seen between the phase II study
and REPLACE.<br/>Copyright &#xa9; The Author(s) 2018.

<98>
Accession Number
2001967121
Title
Long-term comparison of ethyl icosapentate vs. Omega-3-acid ethyl in
patients with cardiovascular disease and hypertriglyceridemia (DEFAT
Trial).
Source
Circulation Journal. 83 (6) (pp 1368-1376), 2019. Date of Publication:
2019.
Author
Sezai A.; Unosawa S.; Taoka M.; Osaka S.; Obata K.; Kanno S.; Sekino H.;
Tanaka M.
Institution
(Sezai, Taoka, Osaka, Tanaka) Department of Cardiovascular Surgery, Nihon
University School of Medicine, Japan
(Obata, Kanno, Sekino) Sekino Hospital, Tokyo, Japan
Publisher
Japanese Circulation Society
Abstract
Background: Numerous studies have demonstrated a reduction in
cardiovascular events when the low-density lipoprotein cholesterol (LDL)
level is decreased by statin therapy. However, despite good control of
LDL, cardiovascular events may increase if the triglyceride (TG) level is
high. We conducted a long-term comparison of treatment of
hypertriglyceridemia with ethyl icosapentate (EPA) vs. omega-3-acid ethyl
(EPA+docosahexaenoic acid [DHA]). <br/>Methods and Results: Cardiac
surgery patients with hypertriglyceridemia were randomized to an EPA group
(1.8 g t.i.d.) or an EPA+DHA group (2 g s.i.d.) and observed for 3 years.
The primary endpoints were the serum TG level and its percent change.
Secondary endpoints included lipid markers, fatty acid parameters, serum
creatinine, cystatin-C, oxidized LDL, high-sensitivity C-reactive protein,
and MACCE. An interview to assess study drug adherence was conducted 6
months after completing the study. TG levels were significantly lower in
the EPA+DHA group than in the EPA group. Levels of remnant-like
particles-cholesterol, oxidized LDL, and cystatin-C were also
significantly lower in the EPA+DHA group than in the EPA group. Compliance
with treatment was significantly worse in the EPA group.
<br/>Conclusion(s): Better results were obtained in the EPA+DHA group, but
more patients showed poor compliance with treatment in the EPA group,
making detailed comparison of the 2 groups difficult. Even so, TG were
reduced while EPA and DHA levels were increased in the EPA+DHA group,
together with a reduction in oxidative stress and remnant-like
particles-cholesterol. Decreased compliance with medication in the EPA
group significantly affected the results of this study, clearly indicating
the importance of good compliance.<br/>Copyright &#xa9; 2019, Japanese
Circulation Society. All rights reserved.

<99>
Accession Number
627937429
Title
Left lateral intercostal region versus subxiphoid position for pleural
drain during elective coronary artery bypass graft surgery: randomized
clinical trial.
Source
Sao Paulo medical journal = Revista paulista de medicina. 137 (1) (pp
66-74), 2019. Date of Publication: 08 May 2019.
Author
Simon S.; Coronel C.; Almeida A.S.; Marcadenti A.
Institution
(Simon) MSc. Registered Nurse, Graduate Program in Health Sciences
(Cardiology), Instituto de Cardiologia, Fundacao Universitaria de
Cardiologia (IC/FUC), Registered Nurse, Cardiology and Cardiac Surgery
Services, Hospital Nossa Senhora da Conceicao Hospital (HNSC), Porto
Alegre (RS), Brazil
(Coronel) MSc. Physiotherapist, Physical Therapy Service, Surgery Service,
Instituto de Cardiologia, Fundacao Universitaria de Cardiologia (IC/FUC),
Porto Alegre (RS), and Professor, La Salle University (Unilasalle Canoas),
Canoas (RS), Brazil
(Almeida) PhD. Physician and Cardiovascular Surgeon, Cardiology and
Cardiac Surgery Services, Hospital Nossa Senhora da Conceicao Hospital
(HNSC), Porto Alegre (RS), Brazil
(Marcadenti) PhD. Professor, Graduate Program in Health Sciences
(Cardiology), Instituto de Cardiologia, Fundacao Universitaria de
Cardiologia (IC/FUC), Porto Alegre (RS); Professor, Postgraduate Program
on Nutrition Sciences, Universidade Federal de Ciencias da Saude de Porto
Alegre (UFCSPA), Porto Alegre (RS); and Researcher, Instituto de Pesquisa
do Hospital do Coracao (HCor), Sao Paulo (SP), Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: The pleural drain insertion site after coronary artery bypass
graft (CABG) surgery may alter lung function, especially respiratory
muscle strength. The main objective of this study was to compare the
effectiveness and safety of use of the left lateral intercostal region
versus the subxiphoid position for pleural drainage during elective CABG
surgery using extracorporeal circulation (ECC). DESIGN AND SETTING:
Randomized trial conducted in a tertiary-level hospital in Porto Alegre,
Brazil. <br/>METHOD(S): 48 patients were assigned to group 1 (pleural
drain in the left lateral intercostal region) or group 2 (pleural drain in
the subxiphoid position). Respiratory muscle strength was measured in
terms of maximal inspiratory pressure (MIP) and maximal expiratory
pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24
and 72 hours after drain removal and before discharge from hospital.
Painand dyspnea scales, presence of infections, pleural effusion and
atelectasis, duration of drain use, drainage volumes and surgical
reinterventions were also evaluated. <br/>RESULT(S): After adjustments,
there were no significant differences between the groups at the end of the
study (before discharge), in predicted percentages either for MIP (delta
group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP
(delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere
no differences between the groups in relation to other outcomes.
<br/>CONCLUSION(S): There was no difference in maximal respiratory
pressures in relation to the pleural drain insertion site among patients
who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc
V1111.1159.4447.

<100>
Accession Number
627902377
Title
Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS): A protocol
for a randomized controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 312. Date of
Publication: 31 May 2019.
Author
O'Gara B.; Subramaniam B.; Shaefi S.; Mueller A.; Banner-Goodspeed V.;
Talmor D.
Institution
(O'Gara, Subramaniam, Shaefi, Mueller, Banner-Goodspeed, Talmor)
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave,
Boston, MA 02215, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients undergoing cardiac surgery with cardiopulmonary
bypass are at an increased risk of developing postoperative pulmonary
complications, potentially leading to excess morbidity and mortality. It
is likely that pulmonary ischemia-reperfusion (IR) injury during
cardiopulmonary bypass is a major contributor to perioperative lung
injury. Therefore, interventions that can minimize IR injury would be
valuable in reducing the excess burden of this potentially preventable
disease process. Volatile anesthetics including sevoflurane have been
shown in both preclinical and human trials to effectively limit pulmonary
inflammation in a number of settings including ischemia-reperfusion
injury. However, this finding has not yet been demonstrated in the cardiac
surgery population. The Anesthetics to Prevent Lung Injury in Cardiac
Surgery (APLICS) trial is a randomized controlled trial (RCT)
investigating whether sevoflurane anesthetic maintenance can modulate
pulmonary inflammation occurring during cardiac surgery with
cardiopulmonary bypass and whether this potential effect can translate to
a reduction in postoperative pulmonary complications. <br/>Method(s):
APLICS is a prospective RCT of adult cardiac surgical patients.
Participants will be randomized to receive intraoperative anesthetic
maintenance with either sevoflurane or propofol. Patients in both groups
will be ventilated according to protocols intended to minimize the
influences of ventilator-induced lung injury and hyperoxia.
Bronchoalveolar lavage (BAL) and blood sampling will take place after
anesthetic induction and 2-4 h after pulmonary reperfusion. The primary
outcome is a difference between groups in the degree of post-bypass lung
inflammation, defined by BAL concentrations of TNFalpha. Secondary
outcomes will include differences in additional relevant BAL and systemic
inflammatory markers and the incidence of postoperative pulmonary
complications. <br/>Discussion(s): APLICS investigates whether anesthetic
choice can influence lung inflammation and pulmonary outcomes following
cardiac surgery with cardiopulmonary bypass. A positive result from this
trial would add to the growing body of evidence describing the lung
protective properties of the volatile anesthetics and potentially reduce
unnecessary morbidity for cardiac surgery patients. Trial registration:
ClinicalTrials.gov, NCT02918877. Registered on 29 September
2016.<br/>Copyright &#xa9; 2019 The Author(s).

<101>
Accession Number
2001847654
Title
Evaluation of observational and behavioural pain assessment tools in
nonverbal intubated critically adult patients after open - Heart surgery:
A systematic review.
Source
Open Access Macedonian Journal of Medical Sciences. 7 (3) (pp 446-457),
2019. Date of Publication: 15 Feb 2019.
Author
Barzanji A.; Zareiyan A.; Nezamzadeh M.; Mazhari M.S.
Institution
(Barzanji) Nursing Faculty, AJA University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Barzanji) Department of Anesthesiology, Faculty of Paramedical, Kurdistan
University of Medical Sciences, Sanandaj, Iran, Islamic Republic of
(Zareiyan) Department of Community and Public Health, Nursing Faculty, AJA
University of Medical Science, Tehran, Iran, Islamic Republic of
(Nezamzadeh, Mazhari) Department of Medical-Surgical Nursing, Faculty of
Nursing, AJA University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Open Access Macedonian Journal of Medical Sciences (E-mail:
mspiroski@id-press.eu)
Abstract
BACKGROUND: Over 70% of patients hospitalised in an intensive care unit
(ICU) often experience moderate to severe pain due to pre-existing
diseases, trauma, surgery, aggressive procedures, and routine ICU care.
Many patients hospitalised in ICU are not able to speak and express their
pain due to various causes, including mechanical ventilation, reduced
consciousness, and administration of sedative drugs. Therefore, the use of
observational and behavioural pain tools is recommended in this group of
patients given their inability to express pain. AIM: To examine the
existing observational and behavioural tools for assessment of in
Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery.
<br/>METHOD(S): A systematic review of available observational and
behavioural tools for assessment of pain was undertaken using the COSMIN
checklist. A literature search was conducted using the following
databases: Ovid, Science Direct, Scopus, PubMed, and CINHAL databases,
Google Scholar search engine as well as Persian resources Sid, Magiran,
Iran doc, and IranMedex up to the end of 2017 were reviewed.
<br/>RESULT(S): A total of 47 studies that had examined five tools used in
intensive care units after cardiac surgery in patients under mechanical
ventilation were reviewed. Each of the five tools included behavioural and
observational items, and only one tool had physiological items. All the
tools had been evaluated regarding validity and reliability. In the three
tools, sensitivity, specificity, responsiveness, and satisfaction were
considered. <br/>CONCLUSION(S): Based on available evidence and
investigations, CPOT and BPS tools have good validity and reliability to
be used in pain assessment in Nonverbal Intubated Critically Adult
Patients after Open-Heart Surgery. The NVPS tool requires more studies to
be further confirmed before the assessment of pain in this group of
patients.<br/>Copyright &#xa9; 2019 Arvin Barzanji, Armin Zareiyan, Maryam
Nezamzadeh, Marjan Seyed Mazhari.

<102>
Accession Number
627837035
Title
Myectomy with mitral valve repair versus replacement in adult patients
with hypertrophic obstructive cardiomyopathy: a systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 465-472),
2019. Date of Publication: 2019.
Author
Afanasyev A.; Bogachev-Prokophiev A.; Lenko E.; Sharifulin R.; Ovcharov
M.; Kozmin D.; Karaskov A.
Institution
(Afanasyev, Bogachev-Prokophiev, Lenko, Sharifulin, Ovcharov, Karaskov)
National Medical Research Center, Rechkunovsky St. 15, Novosibirsk 630055,
Russian Federation
(Kozmin) Cardiac surgery department, Federal Center for Cardiovascular
Surgery, Astrakhan, Russian Federation
Publisher
Oxford University Press
Abstract
We evaluated the differences in mitral valve (MV) plasty (MVP) and MV
replacement (MVR) with respect to death, postoperative MV dysfunction,
reoperation rates and thromboembolic events (DFRE) in patients with
hypertrophic obstructive cardiomyopathy and systolic anterior motion of
the anterior mitral leaflet-mediated MV regurgitation (HOCM & MR). We
followed the Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines, searching PubMed, Cochrane library and
ClinicalTrials.gov for studies that evaluated DFRE in adults with HOCM &
MR after MVP/MVR. We used a risk of bias assessment tool for
non-randomized studies, and analyses were performed using Cochrane Review
Manager 5.3.5 for I² statistics, funnel plots and forest plot
and the generic inverse variance method for hazard ratios (HRs). We
developed qualitative and quantitative syntheses of 35 and 23 studies,
respectively, including levels of evidence of 1=2/3/4/5 = 3/1/11/11/9 and
1=2/3/4/5 = 0/1/11/11/0, respectively, from January 1980 to August 2017. A
statistically significant difference between MVP and MVR favoured MVP for
the prevention of DFRE in patients with HOCM & MR, on the basis of a
significant reduction of the HR for DFRE: HR = 0.68 (0.57, 0.82),
I² = 68% (P = 0.002). The findings were as follows: (i) MVP
should be the first-line treatment in patients with HOCM & MR (accuracy
LEVEL A) and (ii) MVR may be harmful if it is used as the first-line
treatment (accuracy LEVEL A).<br/>Copyright &#xa9; The Author(s) 2018.

<103>
Accession Number
627836200
Title
Is the modified single-patch repair superior to the double-patch repair of
complete atrioventricular septal defects?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 427-431),
2019. Date of Publication: 2019.
Author
Fong L.S.; Winlaw D.S.; Orr Y.
Institution
(Fong, Winlaw, Orr) University of Sydney Children's Hospital Westmead
Clinical School, Sydney, NSW, Australia
(Fong, Winlaw, Orr) Department of Cardiothoracic Surgery, Heart Centre for
Children, Children's Hospital at Westmead, Sydney, NSW, Australia
(Winlaw, Orr) Sydney Children's Hospital Network, Sydney, NSW, Australia
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, 'Is the modified
single-patch repair superior to the double-patch repair of complete
atrioventricular septal defects?'. A total of 634 papers were found using
the reported search, of which 9 represented the best evidence to answer
the clinical question, which included 1 meta-Analysis and 8 cohort
studies. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
were tabulated. There was limited high-quality evidence available, with
all the included studies being retrospective and observational in nature.
One meta-Analysis and 8 cohort studies provided evidence that there was no
significant difference in survival or other postoperative outcomes based
on a surgical technique during follow-up ranging from 6 months to 4.2
years. Surgical reintervention for development of left ventricular outflow
tract obstruction, left atrioventricular valve dysfunction or residual
septal defects after the initial repair of complete atrioventricular
septal defect was not significantly different between cohorts in almost
all studies. Cardiopulmonary bypass and aortic cross-clamp times were
significantly shorter with the modified single-patch repair compared to
the double-patch repair in all studies that examined these variables, but
this did not correspond to a difference in outcomes. We conclude, based on
the available evidence, that the modified single-patch repair of complete
atrioventricular septal defect is similar to the double-patch repair in
terms of postoperative outcomes. However, this conclusion is limited by
the retrospective nature of all studies, small cohort sizes and short
durations of follow-up in addition to lack of statistical analysis in 1
study.<br/>Copyright &#xa9; 2018 The Author(s).

<104>
Accession Number
627960289
Title
Effects of foot reflexology massage on pain and fatigue in patients
undergoing coronary artery bypass graft.
Source
Annals of Tropical Medicine and Public Health. 8 (Special Issue) (pp
S513), 2018. Date of Publication: 2018.
Author
Mohammadi S.; Pouladi S.; Ostovar A.; Ravanipour M.
Institution
(Mohammadi) Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
(Pouladi, Ravanipour) Department of Nursing, School of Nursing and
Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
(Ostovar) Department of Medicine, Bushehr University of Medical Sciences,
Bushehr, Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background and objectives: Pain and fatigue are of prevalent complaints
among patients following heart surgery. Hence, although the use of
analgesics is the most common intervention to reduce pain, but
nonpharmacologic approaches to alleviate pain could be useful due to the
side effects of excessive drug administration and high costs. The present
study was conducted to determine the effect of foot reflexology massage on
reducing pain and fatigue in patients undergoing coronary artery bypass
graft (CABG). <br/>Material(s) and Method(s): In this randomized
controlled trial (RCT),100 male and female patients over 18 years old
undergoing CABG in Cardiac Surgery ICU at medical centers in Shiraz, Iran,
were assigned to one of two intervention and control groups. In the
intervention group, the reflexology massage was carried out on the second
day after surgery for 30 minutes on foot (preferably the left foot), at
the end of the evening shift between the hours of 5 and 7 pm. In the
control group, the patient's foot was only rubbed for 30 minutes without
applying any pressure. The severity of pain and fatigue was measured using
Numeric Rating Scale (NRS) 10 minutes before and 10 minutes, 30 minutes
and 24 hours after the intervention, and then compared between the two
groups. <br/>Result(s): The severity of pain and fatigue in the first 10
minutes after intervention was lower in the group receiving reflexology
massage compared to control group (p=0.016). The severity of pain and
fatigue in 30 minutes and 24 hours after intervention showed no
statistically significant difference between the two groups.
<br/>Conclusion(s): According to our findings, the use of foot reflexology
massage in temporary reduction in the severity of pain and fatigue is
effective in patients, and can be useful as one of the non-invasive
nursing actions and non-pharmacological methods to reduce pain and
fatigue.<br/>Copyright &#xa9; 2018 Wolters Kluwer Medknow Publications.
All rights reserved.

<105>
Accession Number
627951852
Title
Forced diuresis with matched hydration during transcatheter aortic valve
implantation for Reducing Acute Kidney Injury: a randomized,
sham-controlled study (REDUCE-AKI).
Source
European heart journal. (no pagination), 2019. Date of Publication: 23 May
2019.
Author
Arbel Y.; Ben-Assa E.; Puzhevsky D.; Litmanowicz B.; Galli N.; Chorin E.;
Halkin A.; Sadeh B.; Konigstein M.; Bassat O.K.-B.; Steinvil A.; Bazan S.;
Banai S.; Finkelstein A.
Institution
(Arbel, Ben-Assa, Puzhevsky, Litmanowicz, Galli, Chorin, Halkin, Sadeh,
Konigstein, Steinvil, Bazan, Banai, Finkelstein) Department of Cardiology,
Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, 6 weizman st, Israel
(Bassat) Department of Nephrology, Tel-Aviv Medical Center Affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st, Israel
Publisher
NLM (Medline)
Abstract
AIMS: Acute kidney injury (AKI) is a common complication following
transcatheter aortic valve implantation (TAVI) and is associated with
increased risk for short- and long-term mortality. In patients undergoing
percutaneous coronary intervention (PCI), forced diuresis with matched
hydration has been shown to reduce the incidence of AKI by ~50%. The aim
of the present study was to evaluate whether forced diuresis with matched
intravenous hydration reduces AKI in patients undergoing TAVI. METHODS AND
RESULTS: Reducing Acute Kidney Injury (REDUCE-AKI) was a single-centre,
prospective, randomized, double-blind sham-controlled clinical trial,
designed to examine the effect of an automated matched saline infusion
with urine output for the prevention of AKI in patients undergoing TAVI. A
total of 136 TAVI patients were randomized, 68 in each group. Mean age was
83.9+/-5years and 41.2% were males. There were no differences in baseline
characteristics between the two groups. The rate of AKI was not
statistically different between the groups (25% in the active group vs.
19.1% in the sham group, P=0.408). There was a significant increase in
long-term mortality in the active group (27.9% vs. 13. 2% HR 3.744, 95% CI
1.51-9.28; P=0.004). The study was terminated prematurely by the Data
Safety Monitoring Board for futility and a possible signal of harm.
<br/>CONCLUSION(S): Unlike in PCI, forced diuresis with matched hydration
does not prevent AKI in patients undergoing TAVI, and might be associated
with increased long-term mortality. Future studies should focus on
understanding the mechanisms behind these findings. CLINICALTRIALS.GOV
REGISTRATION: NCT01866800, 30 April 2013.<br/>Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. &#xa9;
The Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<106>
Accession Number
627954922
Title
Delirium is associated with higher mortality in transcatheter aortic valve
replacement: systemic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2019. Date
of Publication: 2019.
Author
Prasitlumkum N.; Mekritthikrai R.; Kewcharoen J.; Kanitsoraphan C.; Mao
M.A.; Cheungpasitporn W.
Institution
(Prasitlumkum, Mekritthikrai, Kewcharoen, Kanitsoraphan) Internal Medicine
Residency Program, University of Hawaii, 1356 Lusitana St, Honolulu, HI
96813, United States
(Mao) Department of Internal Medicine, Mayo Clinic, Rochester, MN, United
States
(Cheungpasitporn) Department of Medicine, University of Mississippi
Medical Center, Jackson, MS, United States
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Post-operative delirium (POD) has been recognized as an independent risk
factor for mortality. Recent studies suggest that POD is associated with
higher mortality rates in patients undergoing transcatheter aortic valve
replacement (TAVR). However, a systematic review and meta-analysis of the
literature has not been performed. This study assessed the association
between POD and TAVR by performing a systematic review and meta-analysis
of the literature. We comprehensively searched the databases of MEDLINE
and EMBASE from inception to April 2018. Included studies were prospective
or retrospective cohort studies that compared mortality among patients
undergoing TAVR both with and without POD. Data from each study were
combined using the random-effects, generic inverse variance method of
DerSimonian and Laird to calculate risk ratios and 95% confidence
intervals. Seven studies consisting of 20,086 subjects undergoing TAVR
(1517 with POD and 18,569 without POD) were included in this
meta-analysis. POD demonstrated a trend towards higher all-cause mortality
(pooled odd ratio 1.52, 95% confidence interval 0.98-2.37, p = 0.062,
I² = 72%). POD was associated with a significant increased
long-term mortality (pooled odd ratio 2.11, 95% confidence interval
1.21-3.68, p = 0.009, I² = 62.5%). POD was associated with an
increased risk of long-term all-cause mortality in patients undergoing
TAVR. Our study suggests POD could be a potential risk factor of mortality
among patients undergoing TAVR. Further studies implementing preventative
and treatment strategies against delirium and its effect on POD and its
associated mortality are needed.<br/>Copyright &#xa9; 2019, Japanese
Association of Cardiovascular Intervention and Therapeutics.

<107>
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)

<108>
Accession Number
627158451
Title
A meta-analysis of randomized controlled trials to compare long-term
clinical outcomes of bioabsorbable polymer and durable polymer
drug-eluting stents.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 5 (2) (pp
105-113), 2019. Date of Publication: 01 Apr 2019.
Author
Mridha N.; Subhaharan D.; Niranjan S.; Rashid M.K.; Psaltis P.; Singh K.
Institution
(Mridha, Subhaharan, Niranjan, Singh) Department of Cardiology, Gold Coast
University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
(Mridha, Niranjan, Singh) Department of Medicine, Griffith University,
Parklands Dr, Southport, QLD 4215, Australia
(Mridha, Subhaharan, Niranjan, Singh) School of Medicine, Bond University,
14 University Dr, Robina, QLD 4226, Australia
(Rashid) Department of Medicine, Mc Master University, 1280 Main St W,
Hamilton, ON L8S 4L8, Canada
(Psaltis, Singh) Department of Medicine, University of Adelaide, North
Terrace, Adelaide, SA 5000, Australia
(Psaltis) Department of Medicine, South Australian Health and Medical
Research Institute, North Terrace, Adelaide, SA 5000, Australia
Publisher
Oxford University Press
Abstract
Aims The durable polymer (DP) of a drug-eluting stent (DES) serves no
function once drug elution is complete. To ascertain the benefits of
bioabsorbable polymer (BP) over DP-DESs requires a longer follow-up
period, to overcome the time taken for polymer absorption. The primary aim
of this meta-analysis was to compare the safety and efficacy of BP-DES
with the DP-DES over mid (2 years) to long-term (3-5 years) follow-up.
Methods and results A thorough computer-based search was performed using
Ovid MEDLINE, EMBASE, Google Scholar, and PubMed databases. We only
included randomized controlled studies comparing clinical outcomes between
BP-DESs and DP-DESs. Only studies where data were available for a minimum
of 2 years were included. A separate analysis of 2-year outcomes and 3- to
5-year outcomes were conducted. Data from 6 and 8 studies were included in
3- to 5-year and 2-year follow-up, respectively. There were no differences
between stent groups in cardiac mortality, stent thrombosis (ST), target
lesion revascularization, target vessel failure, and reinfarction rates
for either 2-year or 3- to 5-year follow-up. Subgroup analysis according
to strut thickness (<100 mum, >100 mum) of BP-DES demonstrated similar
results. The analyses of ST and very late ST favoured BP-DESs but did not
reach statistically significant level. Conclusion There were no
differences in clinical outcomes between BP-DESs and DP-DESs over mid- and
long-term follow-up.<br/>Copyright &#xa9; Published on behalf of the
European Society of Cardiology. All rights reserved.

<109>
Accession Number
2001871184
Title
Effect of ultra-short-term treatment of patients with iron deficiency or
anaemia undergoing cardiac surgery: a prospective randomised trial.
Source
The Lancet. 393 (10187) (pp 2201-2212), 2019. Date of Publication: 1 - 7
June 2019.
Author
Spahn D.R.; Schoenrath F.; Spahn G.H.; Seifert B.; Stein P.; Theusinger
O.M.; Kaserer A.; Hegemann I.; Hofmann A.; Maisano F.; Falk V.
Institution
(Spahn, Spahn, Stein, Kaserer, Hofmann) Institute of Anaesthesiology,
University of Zurich and University Hospital Zurich, Zurich, Switzerland
(Schoenrath, Falk) Department of Cardiothoracic and Vascular Surgery,
German Heart Centre Berlin, Berlin, Germany
(Schoenrath) German Centre for Cardiovascular Research, partner site
Berlin, Germany
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Switzerland
(Theusinger) Department of Anaesthesiology, University of Zurich and
University Hospital Balgrist, Zurich, Switzerland
(Hegemann) Division of Haematology, University of Zurich and Zurich
University Hospital, Zurich, Switzerland
(Hofmann) School of Surgery, University of Western Australia and School of
Public Health Research, Curtin University, Perth, Western Australia,
Australia
(Maisano) Department of Cardiovascular Surgery, University of Zurich and
University Hospital Zurich, Zurich, Switzerland
(Falk) German Centre for Cardiovascular Research, Berlin, Germany
(Falk) Department of Cardiothoracic Surgery, Charite - Universitatsmedizin
Berlin Universitat Berlin, Humboldt-Universitat zu Berlin, Berlin
Institute of Health, Berlin, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Anaemia and iron deficiency are frequent in patients scheduled
for cardiac surgery. This study assessed whether immediate preoperative
treatment could result in reduced perioperative red blood cell (RBC)
transfusions and improved outcome. <br/>Method(s): In this single-centre,
randomised, double-blind, parallel-group controlled study, patients
undergoing elective cardiac surgery with anaemia (n=253; haemoglobin
concentration (Hb) <120 g/L in women and Hb <130 g/L in men) or isolated
iron deficiency (n=252; ferritin <100 mcg/L, no anaemia) were enrolled.
Participants were randomly assigned (1:1) with the use of a
computer-generated range minimisation (allocation probability 0.8) to
receive either placebo or combination treatment consisting of a slow
infusion of 20 mg/kg ferric carboxymaltose, 40 000 U subcutaneous
erythropoietin alpha, 1 mg subcutaneous vitamin B12, and 5 mg oral folic
acid or placebo on the day before surgery. Primary outcome was the number
of RBC transfusions during the first 7 days. This trial is registered with
ClinicalTrials.gov, number NCT02031289. <br/>Finding(s): Between Jan 9,
2014, and July 19, 2017, 1006 patients were enrolled; 505 with anaemia or
isolated iron deficiency and 501 in the registry. The combination
treatment significantly reduced RBC transfusions from a median of one unit
in the placebo group (IQR 0-3) to zero units in the treatment group (0-2,
during the first 7 days (odds ratio 0.70 [95% CI 0.50-0.98] for each
threshold of number of RBC transfusions, p=0.036) and until postoperative
day 90 (p=0.018). Despite fewer RBC units transfused, patients in the
treatment group had a higher haemoglobin concentration, higher
reticulocyte count, and a higher reticulocyte haemoglobin content during
the first 7 days (p<=0.001). Combined allogeneic transfusions were less in
the treatment group (0 [IQR 0-2]) versus the placebo group (1 [0-3])
during the first 7 days (p=0.038) and until postoperative day 90
(p=0.019). 73 (30%) serious adverse events were reported in the treatment
group group versus 79 (33%) in the placebo group. <br/>Interpretation(s):
An ultra-short-term combination treatment with intravenous iron,
subcutaneous erythropoietin alpha, vitamin B12, and oral folic acid
reduced RBC and total allogeneic blood product transfusions in patients
with preoperative anaemia or isolated iron deficiency undergoing elective
cardiac surgery. <br/>Funding(s): Vifor Pharma and Swiss Foundation for
Anaesthesia Research.<br/>Copyright &#xa9; 2019 Elsevier Ltd

<110>
Accession Number
2002020620
Title
Determining which prosthetic to use during aortic valve replacement in
patients aged younger than 70 years: A systematic review of the
literature.
Source
Heart Surgery Forum. 22 (2) (pp E70-E81), 2019. Date of Publication: 2019.
Author
Borger P.; Charles E.J.; Smith E.D.; Hunter Mehaffey J.; Hawkins R.B.;
Kron I.L.; Ailawadi G.; Teman N.
Institution
(Borger) University of Virginia School of Medicine, Charlottesville, VA,
United States
(Smith) Department of Medicine, University of Michigan, Ann Arbor, MI,
United States
(Charles, Hunter Mehaffey, Hawkins, Kron, Ailawadi, Teman) University of
Virginia Health System, PO Box 800679, Charlottesville, VA 22908, United
States
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: The choice of bioprosthesis versus mechanical prosthesis in
patients aged less than 70 years undergoing aortic valve replacement (AVR)
remains controversial, with guidelines disparate in their recommendations.
The objective of this study was to explore outcomes after AVR for various
age ranges based on type of prosthesis. <br/>Method(s): A systematic
review was undertaken according to the Preferred Reporting Instructions
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using
Medline (PubMed), Cochrane, Web of Science, Embase, and Scopus databases.
Rates of long-term survival (primary outcome), reoperation, major
bleeding, thromboembolism, stroke, structural valve deterioration, and
endocarditis were compared between subjects receiving biologic and
mechanical prostheses. Findings were grouped into patients aged <60 years,
aged <=65 years, and finally aged <70 years. <br/>Result(s): A total of 19
studies met inclusion criteria. Seven evaluated patients aged <60 years, 4
of which found mechanical prosthesis patients to have higher long-term
survival, whereas the remaining studies found no difference. Eight
additional studies included patients aged 65 years or younger, and 9
studies included patients aged <70 years. The former found no difference
in survival between prosthesis groups, whereas the latter favored
mechanical prostheses in 3 studies. Bleeding, thromboembolism, and stroke
were more prevalent in patients with a mechanical prosthesis, whereas
reoperation was more common in those receiving a bioprosthesis.
<br/>Conclusion(s): Published literature does not preclude the use of
bioprostheses for AVR in younger patients. As new valves are developed,
the use of bioprosthetic aortic valves in younger patients will likely
continue to expand. Clinical trials are needed to provide surgeons with
more accurate guidelines.<br/>Copyright &#xa9; 2019 Forum Multimedia
Publishing LLC. All rights reserved.

<111>
Accession Number
624329304
Title
Comparison of graft patency following coronary artery bypass grafting in
the left versus the right coronary artery systems: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 221-228), 2018.
Date of Publication: 2018.
Author
Pinho-Gomes A.-C.; Azevedo L.; Antoniades C.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, John Radcliffe Hospital, Oxford OX39DU, United
Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences, Faculty of Medicine, Center for Health Technology and
Services Research, University of Porto, Porto, Portugal
(Antoniades, Taggart) Division of Cardiovascular Medicine, University of
Oxford, Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Although coronary artery bypass grafting has been the standard of care for
patients with complex coronary artery disease for over 50 years, the
evolution of graft patency over time in the left versus the right coronary
systems remains poorly documented. This systematic review and
meta-analysis aimed to characterize the evolution of graft patency over
time comparing the left (excluding left anterior descending artery) and
right coronary systems, with an emphasis on the comparison of venous
versus arterial grafts and symptomatic versus asymptomatic patients. We
searched the Cochrane Central Register of Controlled Trials (CENTRAL) and
MEDLINE from inception to August 2016. We also searched clinical trials
registers and reference lists of relevant studies. We included randomized
clinical trials and observational studies comparing graft patency in the
left versus the right coronary systems. Our outcome was graft patency
defined as a binary variable according to whether grafts were reported as
patent or failed at the time of angiogram. Data collection and analysis
were performed according to the methodological recommendations of the
Cochrane Collaboration. From a total 2275 papers, 52 studies were included
in the qualitative analysis and 48 studies (including 36 006 grafts) in
the meta-analysis. There was a 3.3% significant difference between the
left-sided and rightsided graft patency, and the difference appeared to
increase over time. Furthermore, patency of arterial grafts was higher in
the left coronary system, while venous grafts performed similarly
irrespective of the coronary circulation. Symptom recurrence also seemed
related to a higher failure rate in the right coronary circulation.
However, the high degree of heterogeneity precluded drawing definite
conclusions. This metaanalysis suggested that graft patency might be
better for left-sided vessels and that this difference might be driven by
the better performance of arterial grafts in the left coronary system.
However, evidence currently available is limited, and further research is
warranted to understand whether certain grafts achieve better patency in
the right versus the left coronary circulations.<br/>Copyright &#xa9; 2018
The Author(s).

<112>
Accession Number
625397345
Title
Prevention of Early Postoperative Decline (PEaPoD): Protocol for a
randomized, controlled feasibility trial.
Source
Trials. 19 (1) (no pagination), 2018. Article Number: 676. Date of
Publication: 11 Dec 2018.
Author
O'Gara B.; Marcantonio E.R.; Pascual-Leone A.; Shaefi S.; Mueller A.;
Banner-Goodspeed V.; Talmor D.; Subramaniam B.
Institution
(O'Gara, Shaefi, Mueller, Banner-Goodspeed, Talmor, Subramaniam)
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave,
Boston, MA 02215, United States
(Marcantonio) Division of General Medicine and Primary Care, Beth Israel
Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave,
Boston, MA 02215, United States
(Pascual-Leone) Division of Neurology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215,
United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is associated with a significantly increased risk of
postoperative morbidity and mortality. Furthermore, delirium has been
associated with an increased risk of prolonged cognitive deficits and
accelerated long-term cognitive decline. To date, experimental
interventions for delirium have mainly focused on alternative
pharmacologic and behavioral strategies in the postoperative period. Few
studies have examined whether proactive strategies started before surgery
can prevent delirium or reduce its sequelae. Neurocognitive training
programs such as Lumosity have been shown to be effective in increasing
cognitive performance in both elderly healthy volunteers and patients
suffering from a myriad of acute and chronic medical conditions. When
initiated in the preoperative period, such training programs may serve as
interesting and novel patient-led interventions for the prevention of
delirium and postoperative cognitive decline (POCD). We hypothesize that
perioperative neurocognitive training is feasible in the older cardiac
surgical population and are testing this hypothesis using a randomized
controlled design. <br/>Method(s): The Prevention of Early Postoperative
Decline (PEaPoD) study is a randomized, controlled trial with a target
enrollment of 45 elderly cardiac surgical patients. Subjects will be
randomized in a 1:1 ratio to undergo either at least 10 days of
preoperative neurocognitive training, continued for 4 weeks
postoperatively, or usual care control. The primary outcome, feasibility,
will be assessed by study recruitment and adherence to protocol. Secondary
outcomes will include potential differences in the incidence of
postoperative in-hospital delirium and POCD up to 6 months, as determined
by the Confusion Assessment Method and the Montreal Cognitive Assessment.
<br/>Discussion(s): PEaPoD will be the first trial investigating the use
of perioperative cognitive training to potentially reduce delirium and
POCD in the cardiac surgical population. Information gleaned from this
feasibility study will prove valuable in designing future efficacy studies
aimed at determining whether this low-risk, patient-led intervention can
reduce serious postoperative morbidity. Trial registration:
ClinicalTrials.gov, NCT02908464. Registered on 21 September
2016.<br/>Copyright &#xa9; 2018 The Author(s).

<113>
Accession Number
624377409
Title
Randomized trial of the Carpentier-Edwards supra-annular prosthesis versus
the Medtronic Mosaic aortic prosthesis: 10-year results.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 281-287), 2018.
Date of Publication: 2018.
Author
Zibdeh O.; Bugg I.; Patel S.; Twine G.; Unsworth-White J.
Institution
(Zibdeh, Bugg, Patel) Plymouth University, Peninsula School of Medicine,
Plymouth, United Kingdom
(Twine, Unsworth-White) South West Cardiothoracic Unit, Derriford
Hospital, Plymouth PL6 8DH, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We performed a prospective randomized study comparing the
clinical performance of the Carpentier-Edwards supraannular valve (CE-SAV)
(Edwards Lifesciences, Irvine, CA, USA) and the newer Mosaic (Medtronic
Corporation, Minneapolis, MN, USA) porcine bioprostheses in the aortic
position over a 10-year period. <br/>METHOD(S): Between January 2001 and
March 2005, 394 patients undergoing bioprosthetic aortic valve replacement
were randomized to receive either the CE-SAV (n = 191) or the Mosaic (n =
203) prosthesis. The preoperative demographics, EuroSCORE and
intraoperative characteristics concerning cardiopulmonary bypass of the 2
groups were comparable. All patients were followed annually for 10 years.
<br/>RESULT(S): There were 77 (40.3%) deaths in the CE-SAV group and 93
(45.8%) deaths in the Mosaic group. The 10-year survival rate in the 2
groups was 59.7% and 54.2%, respectively (P = 0.27). There were no
statistically significant differences between the 2 groups in terms of
structural valve deterioration (P = 0.08), endocarditis (P = 0.95),
thromboembolism (P = 0.06) and major bleeds (P = 0.09). However, the
incidence of paravalvular leaks and valve-related reoperations were higher
in the Mosaic group, with 5 leaks and 6 reoperations when compared to none
in the CE-SAV group, (P=0.02) and (P = 0.01) respectively.
<br/>CONCLUSION(S): At 10 years after implantation, freedom from
reoperation was greater in the CE-SAV group with no incidences of
paravalvular leaks. There were no other statistically significant
differences between CE-SAV and Mosaic aortic prostheses.<br/>Copyright
&#xa9; The Author(s) 2018.

<114>
Accession Number
623793281
Title
Resuming anticoagulants after anticoagulation-associated intracranial
haemorrhage: Systematic review and meta-analysis.
Source
BMJ Open. 8 (5) (no pagination), 2018. Article Number: e019672. Date of
Publication: 01 May 2018.
Author
Zhou Z.; Yu J.; Carcel C.; Delcourt C.; Shan J.; Lindley R.I.; Neal B.;
Anderson C.S.; Hackett M.L.
Institution
(Zhou) Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University,
Shanghai, China
(Zhou, Yu, Carcel, Delcourt, Lindley, Neal, Anderson, Hackett) George
Institute for Global Health, Faculty of Medicine, University of New South
Wales, Sydney, NSW, Australia
(Yu) Department of Cardiology, Peking University Third Hospital, Beijing,
China
(Carcel, Delcourt, Anderson) Department of Neurology, Royal Prince Alfred
Hospital, Sydney Health Partners, Sydney, NSW, Australia
(Carcel, Delcourt, Lindley, Hackett) Sydney Medical School, University of
Sydney, Sydney, NSW, Australia
(Shan) Department of Geriatrics, Ren Ji Hospital, Shanghai Jiao Tong
University, Shanghai, China
(Neal) Charles Perkins Centre, University of Sydney, Sydney, NSW,
Australia
(Neal) Department of Epidemiology and Biostatistics, Imperial College
London, London, United Kingdom
(Anderson) George Institute China, Peking University Health Science
Center, Beijing, China
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To determine the adverse outcomes following resumption of
anticoagulation in patients with anticoagulation-associated intracranial
haemorrhage (ICH). Design We performed a systematic review and
meta-analysis in this clinical population. The Preferred Reporting Items
for Systemic Reviews and Meta-Analyses statement was followed, and two
authors independently assessed eligibility of all retrieved studies and
extracted data. Data sources Medline, Embase and the Cochrane Central
Register of Controlled Trials, from inception to February 2017.
Eligibility criteria and outcomes Randomised controlled trials or cohort
studies that recruited adults who received oral anticoagulants at the time
of ICH occurrence and survived after the acute phase or hospitalisation
were searched. Primary outcomes, including long-term mortality, recurrent
ICH and thromboembolic events. Secondary outcomes were the frequency of
resuming anticoagulant therapy and related factors. Results We included 12
cohort studies (no clinical trials) involving 3431 ICH participants. The
pooled frequency of resuming anticoagulant therapy was 38% (95% CI 32% to
44%), but this was higher in participants with prosthetic heart valves,
subarachnoid haemorrhage or dyslipidaemia. There was no evidence that
resuming anticoagulant therapy was associated with higher long-term
mortality (pooled relative risk (RR) 0.60, 95% CI 0.30 to 1.19; p=0.14) or
ICH recurrence (pooled RR 1.14, 95% CI 0.72 to 1.80; p=0.57). Resumption
of anticoagulation was associated with significantly fewer thromboembolic
events (pooled RR 0.31, 95% CI 0.23 to 0.42; p<0.001). In a subgroup of
patients with atrial fibrillation, resuming anticoagulant therapy was
associated with fewer long-term mortality (pooled RR 0.27, 95% CI 0.20 to
0.37, p<0.001). Conclusions Based on these observational studies, resuming
anticoagulant therapy after anticoagulation-associated ICH has beneficial
effects on long-term complications. Clinical trials are needed to
substantiate these findings. PROSPERO registration number
CRD42017063827.<br/>Copyright &#xa9; Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2018.

<115>
Accession Number
626168450
Title
Perioperative Bridging With Glycoprotein IIb/IIIa Inhibitors Versus
Cangrelor: Balancing Efficacy and Safety.
Source
Annals of Pharmacotherapy. (no pagination), 2019. Date of Publication:
2019.
Author
Van Tuyl J.S.; Newsome A.S.; Hollis I.B.
Institution
(Van Tuyl) SSM Health St Louis University Hospital, MO, United States
(Van Tuyl) St Louis College of Pharmacy, MO, United States
(Newsome) The University of Georgia College of Pharmacy, Augusta, GA,
United States
(Newsome) Augusta University Medical Center, Augusta, GA, United States
(Hollis) University of North Carolina Medical Center, Chapel Hill, NC,
United States
(Hollis) UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review the efficacy and safety of perioperative
administration of intravenous (IV) antiplatelet agents as a substitute for
oral P2Y<inf>12</inf> inhibitors and to provide clinicians guidance on
optimal and cost-effective use of these medications. <br/>Data Sources: A
MEDLINE literature search (1950 to November 2018) was performed using the
key search terms abciximab, bridging, cangrelor, cardiac surgery, coronary
artery bypass surgery, eptifibatide, intravenous antiplatelet agent, and
tirofiban. Additional references were identified from a review of
literature citations. Study Selection and Data Extraction: In all, 18
original research reports and case reports/series were included in the
review. <br/>Data Synthesis: Prevention of postoperative bleeding is
critical to decrease morbidity and mortality after cardiac surgery. IV
antiplatelet medications have short half-lives and are frequently used to
substitute for oral P2Y<inf>12</inf> inhibitors to allow platelet function
recovery before procedures. Functional recovery of platelets is delayed
after abciximab discontinuation and increases postoperative bleeding risk.
Eptifibatide and tirofiban have similar pharmacokinetic/pharmacodynamic
properties and comparable efficacy and safety in the setting of
perioperative bridging. Cangrelor may be considered in patients with renal
insufficiency as decreased clearance of eptifibatide or tirofiban may
increase the risk of postoperative bleeding. Relevance to Patient Care and
Clinical Practice: Comparative studies of IV antiplatelet medications have
not been published. Appropriate use of IV antiplatelet medications can
prevent perioperative ischemic events and bleeding. <br/>Conclusion(s):
Eptifibatide, tirofiban, and cangrelor are preferred over abciximab as a
perioperative bridge. The choice of agent should be tailored to clinical
characteristics of the patient and institutional acquisition
costs.<br/>Copyright &#xa9; The Author(s) 2019.

<116>
Accession Number
627177127
Title
Effect of perioperative administration of dexmedetomidine on delirium
after cardiac surgery in elderly patients: a double-blinded, multi-center,
randomized study.
Source
Clinical interventions in aging. 14 (pp 571-575), 2019. Date of
Publication: 2019.
Author
Shi C.; Jin J.; Qiao L.; Li T.; Ma J.; Ma Z.
Institution
(Shi, Jin, Qiao, Li, Ma, Ma) Department of Anesthesiology, Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong
264000, China
Publisher
NLM (Medline)
Abstract
Objective: Postoperative delirium (POD) is a serious complication in
elderly patients undergoing cardiac surgery. This study was aimed at
investigating the effect of perioperative administration of
dexmedetomidine for general anesthesia maintenance on occurrence and
duration of POD in elderly patients after cardiac surgery. <br/>Method(s):
One hundred and sixty-four patients were enrolled after cardiac surgery
between June 2009 and December 2016. Patients were assigned by a
computer-generated randomization sequence in a 1:1 ratio to receive
dexmedetomidine general anesthesia maintenance or propofol general
anesthesia maintenance. POD was assessed every day with confusion
assessment method for intensive care units (ICU) during the first 5
postoperative days. <br/>Result(s): There was no significance in incidence
of POD between the dexmedetomidine group and the propofol group
(P=0.0758). In patients treated with dexmedetomidine, the median onset
time of delirium was delayed (second day vs first day) and the duration of
delirium reduced (2 days vs 3 days) when compared with propofol-treated
patients. The dexmedetomidine-treated patients also displayed a lower VAS
score and less opiate analgesic consumption. No difference was observed in
respect to other postoperative outcomes. <br/>Conclusion(s): For elderly
patients, perioperative administration of dexmedetomidine reduced
incidence, delayed onset and shortened duration of POD after cardiac
surgery.

<117>
Accession Number
627846661
Title
Effect of Targeting Mean Arterial Pressure during Cardiopulmonary Bypass
by Monitoring Cerebral Autoregulation on Postsurgical Delirium among Older
Patients: A Nested Randomized Clinical Trial.
Source
JAMA Surgery. (no pagination), 2019. Date of Publication: 2019.
Author
Brown C.H.; Neufeld K.J.; Tian J.; Probert J.; Laflam A.; Max L.; Hori D.;
Nomura Y.; Mandal K.; Brady K.; Hogue C.W.; Shah A.; Zehr K.; Cameron D.;
Conte J.; Bienvenu O.J.; Gottesman R.; Yamaguchi A.; Kraut M.
Institution
(Brown) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University, School of Medicine, Zayed 6208, 1800 Orleans St,
Baltimore, MD 21287, United States
(Neufeld) Department of Psychiatry, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Tian) Department of Biostatistics, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
(Probert) School of Medicine, New York University, New York, United States
(Laflam) Medical Stud., School of Medicine, Tufts University, Medford, MA,
United States
(Max) Department of Radiology, Massachusetts General Hospital, Boston,
United States
(Hori, Nomura) Department of Cardiovascular Surgery, Saitama Medical
Center, Jichi Medical University, Saitama, Japan
(Mandal, Conte) Division of Cardiac Surgery, Department of Surgery, Penn
State University Hershey Medical Center, Hershey, PA, United States
(Brady) Department of Anesthesiology, Northwestern University Feinberg,
School of Medicine, Chicago, IL, United States
(Hogue) Bluhm Cardiovascular Institute, Department of Anesthesiology,
Northwestern University Feinberg, School of Medicine, Chicago, IL, United
States
(Shah) Department of Cardiac Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Zehr) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
(Cameron) Division of Cardiac Surgery, Department of Surgery,
Massachusetts General Hospital, Boston, United States
(Bienvenu) Department of Psychiatry, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Gottesman) Department of Neurology, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Yamaguchi) Saitama Medical Center, Jichi Medical University, Saitama,
Japan
(Kraut) Department of Radiology and Radiological Sciences, Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Delirium occurs in up to 52% of patients after cardiac surgery
and may result from changes in cerebral perfusion. Using intraoperative
cerebral autoregulation monitoring to individualize and optimize cerebral
perfusion may be a useful strategy to reduce the incidence of delirium
after cardiac surgery. <br/>Objective(s): To determine whether targeting
mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral
autoregulation monitoring reduces the incidence of delirium compared with
usual care. <br/>Design, Setting, and Participant(s): This randomized
clinical trial nested within a larger trial enrolled patients older than
55 years who underwent nonemergency cardiac surgery at a single US
academic medical center between October 11, 2012, and May 10, 2016, and
had a high risk for neurologic complications. Patients, physicians, and
outcome assessors were masked to the assigned intervention. A total of
2764 patients were screened, and 199 were eligible for analysis in this
study. <br/>Intervention(s): In the intervention group, the patient's
lower limit of cerebral autoregulation was identified during surgery
before CPB. On CPB, the patient's mean arterial pressure was targeted to
be greater than that patient's lower limit of autoregulation. In the
control group, mean arterial pressure targets were determined according to
institutional practice. <br/>Main Outcomes and Measures: The main outcome
was any incidence of delirium on postoperative days 1 through 4, as
adjudicated by a consensus expert panel. <br/>Result(s): Among the 199
participants in this study, mean (SD) age was 70.3 (7.5) years and 150
(75.4%) were male. One hundred sixty-two (81.4%) were white, 26 (13.1%)
were black, and 11 (5.5%) were of other race. Of 103 patients randomized
to usual care, 94 were analyzed, and of 102 patients randomized to the
intervention 105 were analyzed. Excluding 5 patients with coma, delirium
occurred in 48 of the 91 patients (53%) in the usual care group compared
with 39 of the 103 patients (38%) in the intervention group (P =.04). The
odds of delirium were reduced by 45% in patients randomized to the
autoregulation group (odds ratio, 0.55; 95% CI, 0.31-0.97; P =.04).
<br/>Conclusions and Relevance: The results of this study suggest that
optimizing mean arterial pressure to be greater than the individual
patient's lower limit of cerebral autoregulation during CPB may reduce the
incidence of delirium after cardiac surgery, but further study is
needed.<br/>Copyright &#xa9; 2019 American Medical Association. All rights
reserved.

<118>
Accession Number
627922163
Title
Are Carbohydrate Drinks More Effective Than Preoperative Fasting: A
Systematic Review of Randomised Controlled Trials.
Source
Journal of clinical nursing. (no pagination), 2019. Date of Publication:
21 May 2019.
Author
Noba L.; Wakefield A.
Institution
(Noba) Department of Surgery, North Middlesex University Hospital NHS
Trust Sterling Way, London N18 1QX, Canada
(Wakefield) University of Manchester, Room 5.326 Jean McFarlane Building,
Oxford Road, Manchester M13 9PL, United Kingdom
Publisher
NLM (Medline)
Abstract
AIM AND OBJECTIVE: To evaluate current evidence to determine whether oral
preoperative carbohydrate drinks shorten hospital stays, reduce insulin
resistance and/or improve postoperative discomfort for patients undergoing
abdominal or cardiac surgery. BACKGROUND: Criticisms of standard
preoperative fasting have forced practitioners to explore new ways of
preparing patients for theatre. Consequently, the use of preoperative
carbohydrate drinks prior to elective surgery has gained momentum. Current
evidence regarding the efficacy of this treatment has been inconsistent
and contradictory which prompted a review of the current literature.
DESIGN: A systematic review of Randomised Clinical Trials (RCTs).
<br/>METHOD(S): In accordance with Prisma guidelines, the review
incorporated a systematic, comprehensive search of English language only
texts published between 2001-2018. The search focused on five databases
(MEDLINE, EMBASE, CINAHL, British Nursing Index and ASSIA). Reference
lists of relevant systematic reviews and studies located were also
hand-search for eligibility and further references. All randomised control
trials (RCTs) investigating the effect of preoperative carbohydrate drinks
on adult patients undergoing cardiac or abdominal surgery were included.
The review excluded RCTs conducted on patients with type 1 or 2 diabetes
mellitus and patients under the age of 18. <br/>RESULT(S): The review
included 22 RCT's with a total sample of 2065 patients across thirteen
countries. Nine different types of surgery were identified. No significant
reductions in hospital stay were noted in 8 of the ten trials.
Preoperative carbohydrate drinks significantly reduced insulin resistance
and improved postoperative discomfort especially in patients undergoing
laparoscopic cholecystectomy. No definite conclusion regarding the impact
of preoperative carbohydrate drinks on gastric volume and gastric pH were
noted. Similarly, no adverse events such as pulmonary aspiration were
reported. <br/>CONCLUSION(S): Preoperative carbohydrate drinks were found
to be safe and can be administered up to 2 hours before surgery. Such
drinks were also found to reduce insulin resistance and improve
postoperative discomfort especially in patients undergoing laparoscopic
cholecystectomy. However, there is insufficient evidence to definitively
conclude what impact they have on length of hospital stay. RELEVANCE TO
CLINICAL PRACTICE: Patients undergoing surgery are often required to fast
from midnight, while in some extreme cases patients are fasted for up to
24 hours prior to surgery. The main purpose of asking patients to undergo
this prolonged fasting is to reduce the risk of aspiration. However, there
is a general consensus that this traditional practice is out-of-date, and
it is often associated with postoperative complications. On the other
hand, current evidence suggests oral intake of fluids up to 90 - 180
minutes prior to surgery is safe and consumption of a preoperative
carbohydrate drinks does not delay gastric emptying or affect gastric
acidity. This article is protected by copyright. All rights reserved.

<119>
Accession Number
627871592
Title
Hemoadsorption to Reduce Plasma Free Hemoglobin during Cardiac Surgery:
Results of REFRESH I Pilot Study.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 11 May 2019.
Author
Gleason T.G.; Argenziano M.; Bavaria J.E.; Kane L.C.; Coselli J.S.;
Engelman R.M.; Tanaka K.A.; Awad A.; Sekela M.E.; Zwischenberger J.B.
Institution
(Gleason) University of Pittsburgh Medical Center, Dept. of Cardiothoracic
Surgery, Pittsburgh, PA, United States
(Argenziano) Columbia University Medical Center-New York Presbyterian
Hospital, Dept. of Surgery, New York, NY
(Bavaria) Hospital of the University of Pennsylvania, Dept. of Surgery,
Philadelphia, PA, United States
(Kane) Texas Children's Hospital, Dept. of Surgery, Houston, TX, United
States
(Coselli) Texas Heart Institute, Dept. of Surgery, Houston, TX, United
States
(Engelman) Baystate Medical Center, Dept. of Surgery, Springfield, MA,
United States
(Tanaka) University of Maryland School of Medicine, Dept. of
Anesthesiology, Baltimore, MD, United States
(Awad) Cooper University Hospital, Camden, NJ, United States
(Sekela) University of Kentucky College of Medicine, Dept. of Surgery,
Lexington, KY, United States
(Zwischenberger) University of Kentucky College of Medicine, Dept. of
Surgery, Lexington, KY, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Generation of plasma free hemoglobin (pfHb) and activated
complement during complex cardiac surgery contributes to end-organ
dysfunction. This prospective, multi-center REFRESH I (REduction in FREe
Hemoglobin) randomized controlled trial (RCT) evaluated the safety and
feasibility of CytoSorb hemoadsorption therapy to reduce these factors
during prolonged cardiopulmonary bypass (CPB). <br/>METHOD(S): Eligible
patients underwent elective, non-emergent complex cardiac surgery with
expected CPB duration >= 3h. Exclusions included single procedures
including primary CABG, single valves, transplant, and LVAD extraction.
TREATMENT used two parallel 300 ml CytoSorb hemoadsorption cartridges in a
side circuit during CPB. CONTROL was standard of care. <br/>RESULT(S): Of
52 enrolled patients, 46 underwent surgery (Safety group, n=23 vs Control,
n=23), and 38 were evaluated for pfHb reduction (EFFICACY group, n=18 vs
CONTROL, n=20). Type and number of SAEs (44 vs 43 CONTROL) were similar,
as was 30-day mortality. Transient reduction in platelets during CPB was
observed in both groups, especially TREATMENT, but returned to
pre-treatment levels after CPB without bleeding. Peak pfHb was positively
correlated with CPB length (p=0.01) but the high variability of pfHb, due
to the broad surgical procedure mix, prevented detection of changes in
pfHb in the overall EFFICACY population. However, the valve replacement
surgery subgroup (8 vs 10 CONTROL) had the highest peak pfHb levels, and
TREATMENT demonstrated significant pfHb reductions vs CONTROL (p<=0.05) in
CPB >= 3h. In the EFFICACY group, C3a and C5a were significantly reduced
by treatment throughout surgery. <br/>CONCLUSION(S): Intraoperative
hemoadsorption with CytoSorb was safe and feasible in this randomized,
controlled pilot study during complex cardiac surgery. Treatment with
CytoSorb resulted in significant reductions in pfHb during valve
replacement surgery and reductions in C3a and C5a in the overall EFFICACY
group. Future studies will target complex cardiac surgery patients with
prolonged CPB to assess hemoadsorption effect on end-organ dysfunction and
outcomes.<br/>Copyright &#xa9; 2019. Published by Elsevier Inc.

<120>
Accession Number
2002071922
Title
Exercise Parameters and Outcome Measures Used in Cardiac Rehabilitation
Programs Following Median Sternotomy in the Elderly: A Systematic Review
and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Pengelly J.; Pengelly M.; Lin K.-Y.; Royse C.; Karri R.; Royse A.; Bryant
A.; Williams G.; El-Ansary D.
Institution
(Pengelly, El-Ansary) Department of Health Professions, Swinburne
University of Technology, Melbourne, Vic, Australia
(Pengelly) Independent Researcher, Melbourne, Vic, Australia
(Lin) Department of Physiotherapy, School of Primary and Allied Health
Care, Faculty of Medicine, Nursing and Health Science, Monash University,
Melbourne, Vic, Australia
(Royse, Karri, Royse, El-Ansary) Department of Surgery, University of
Melbourne, Melbourne, Vic, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Vic, Australia
(Bryant, Williams) Department of Physiotherapy, University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Objective: The aim of this systematic review was to identify exercise
parameters and outcome measures used in cardiac rehabilitation programs
following median sternotomy, in the elderly cardiac population. <br/>Data
Sources: Five (5)electronic databases were searched for relevant studies
published in English after 1997. Study Selection: The screening process
was completed by two independent researchers, with a third independent
reviewer for overall agreement. Studies were selected if they included
only cardiac patients aged >=65 years who had undergone valve surgery
and/or coronary artery bypass grafting via median sternotomy, and who had
undertaken a postoperative cardiac rehabilitation exercise intervention
assessing physical function and/or cognitive recovery as outcomes.
<br/>Data Extraction: Two researchers independently completed the data
extraction and quality assessment. Quality was assessed using a modified
Downs and Black tool. <br/>Data Synthesis: In total, 11 articles were
included for appraisal with respect to the quality of the study. Only two
randomised controlled trials were suitable for meta-analysis. A higher
volume of exercise was shown to have a positive effect on functional
recovery, assessed using the 6-minute walk test (6MWT)(mean difference =
26.97 m; 95% confidence interval [CI], 6.96-46.97; p = 0.008;
I² = 0%). No significant improvement was shown between
additional exercise compared to standard care in improving
VO<inf>2peak</inf>, maximal power output or quality of life. No studies
evaluated the effect of exercise on cognitive recovery.
<br/>Conclusion(s): Exercise significantly improves functional recovery in
the post-surgical elderly cardiac population, however uncertainty still
exists with regard to which modes of exercise and their specific
parameters are most effective in improving cognitive
recovery.<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)

<121>
Accession Number
2002063597
Title
Clinical outcomes of sentinel cerebral protection system use during
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Ndunda P.M.; Vindhyal M.R.; Muutu T.M.; Fanari Z.
Institution
(Ndunda, Vindhyal, Muutu, Fanari) Internal Medicine, University of Kansas
School of Medicine - Wichita, 1010 N Kansas Street, Wichita, KS 67214,
United States
(Fanari) Heartland Cardiology/Wesley Medical Center, University of Kansas
School of Medicine - Wichita, 551 N. Hillside, Suite 520, Wichita, KS
67214, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To compare the clinical outcomes following transcatheter aortic
valve replacement (TAVR)with and without the use of the Sentinel Cerebral
Protection System (Sentinel CPS). <br/>Background(s): Stroke occurs in
2-5% of patients at 30 days after TAVR and increases mortality >3 fold.
The Sentinel CPS is the only FDA (Food and Drug Administration)approved
cerebral embolic protection device. <br/>Method(s): The Cochrane Library,
PubMed and Web of Science were searched for relevant studies for inclusion
in the meta-analysis. Two authors independently screened and included
studies comparing the clinical outcomes after TAVR with and without the
Sentinel CPS. Risk of bias was assessed using the Cochrane tools (RoB2.0
and ROBINS-I). <br/>Result(s): Four studies comparing 606 patients
undergoing TAVR with Sentinel CPS to 724 without any embolic protection
device were included. Sentinel CPS use was associated with lower rates of
30-day mortality [0.8% vs 2.7%; RR 0.34 (95% CI 0.12, 0.92)I² =
0%], 30-day symptomatic stroke [3.5% vs 6.1%; RR 0.51 (95% CI 0.29,
0.90)I² = 0]and major or life-threatening bleeding [3.3% vs
6.6%; RR 0.50 (0.26, 0.98)I² = 16%]. There was no significant
difference between the two arms in the incidence of acute kidney injury
[0.8% vs 1%; RR 0.85 (95% CI 0.22, 3.24)I² = 0%]and major
vascular complications [5.1% vs 6%; RR 0.74 (0.33, 1.67)I² =
45%]. <br/>Conclusion(s): The results suggest that Sentinel CPS use in
TAVR is associated with a lower risk of stroke, mortality and major or
life-threatening bleeding at 30 days.<br/>Copyright &#xa9; 2019 Elsevier
Inc.