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<1>
Accession Number
2001065927
Title
Levosimendan use in patients with preoperative low ejection fraction
undergoing cardiac surgery: A systematic review with meta-analysis and
trial sequential analysis.
Source
Journal of Clinical Anesthesia. 52 (pp 37-47), 2019. Date of Publication:
February 2019.
Author
Ng K.T.; Chan X.L.; Tan W.; Wang C.Y.
Institution
(Ng, Wang) Department of Anaesthesiology, Faculty of Medicine, University
of Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia
(Chan, Tan) School of Medicine, University of Bristol, Bristol, United
Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: Patients with preoperative low left ventricular ejection
fraction (LVEF) are known to be associated with high morbidities and
mortality in cardiac surgery. The primary aim of this review was to
examine the clinical outcomes of levosimendan versus placebo in patients
with preoperative low LVEF <= 50% undergoing cardiac surgery. Data
sources: MEDLINE, EMBASE, PubMed and CENTRAL were searched systematically
from their inception until June 2018. Review methods: All the randomised
clinical trials (RCTs) were included. Result(s): Twelve trials were
eligible (n = 1867) for inclusion in the data synthesis. In comparison to
the placebo cohort, the levosimendan cohort showed a significant reduction
in mortality (TSA = inconclusive; rho = 0.002; I2 = 0%; FEM: OR
0.56; 95% CI 0.39, 0.80), especially in the subgroups of preoperative
severe low LVEF <= 30% (rho = 0.003; OR 0.33; 95% CI 0.16, 0.69),
preoperative administering of levosimendan (rho = 0.001; OR 0.46; 95% CI
0.29, 0.74) and patients who had bolus followed by infusion of
levosimendan (rho = 0.005; OR 0.50; 95% CI 0.30, 0.81). However, the
effect on mortality was not significant in the subgroup analysis of high
quality trials (rho = 0.14; OR 0.73; 95% CI 0.47, 1.12). The levosimendan
cohort showed a significantly lower incidence of
low-cardiac-output-syndrome (rho < 0.001; OR 0.58; 95% CI 0.46, 0.74) and
lesser need for mechanical support of cardiac assist devices (rho = 0.02;
OR 0.39; 95% CI 0.18, 0.86). Conclusion(s): Given the low level of
evidence and inconclusive TSA, the results of this meta-analysis neither
support nor oppose the use of levosimendan in cardiac patients with
preoperative low LVEF <= 50%. Therefore, multi-centre, adequately powered,
randomised controlled trials are warranted. PROSPERO registration:
CRD42017067572. Copyright © 2018 Elsevier Inc.

<2>
Accession Number
625955291
Title
Cell therapy and left ventricular restoration for ischemic cardiomyopathy:
Long-term results of a perspective, randomized study.
Source
Minerva Cardioangiologica. 67 (1) (pp 64-72), 2019. Date of Publication:
February 2019.
Author
Stefanelli G.; Pirro F.; Olaru A.; Giovanardi P.; Meli M.; Concari M.;
Weltert P.L.
Institution
(Stefanelli, Pirro, Olaru, Meli, Concari) Department of Cardiac Surgery,
Hesperia Hospital, via Arqua 80, Modena, Italy
(Giovanardi) Department of Cardiology, University Hospital, Modena, Italy
(Weltert) Department of Cardiac Surgery, European Hospital, Rome, Italy
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Aim of this study is to verify the potential advantages and
benefits of bone-marrow derived autologous stem cells implantation
associated to surgical left ventricular restoration (SVR), to report a new
modality of cell delivery to myocardium, and to identify possible side
effects of this procedure. METHOD(S): Between March 2007 and March
2013, 30 patients affected by ischemic dilative cardiomyopathy who
received a SVR operation were enrolled in the study. The population was
divided in two groups:16 patients were randomly assigned to receive stem
cells therapy in addition to SVR (groupA), 14 patients received a placebo
(group B). The two groups were homogeneous in respect of age, gender,
preoperative NYHA class, mitral incompetence and left ventricular sizes
and volumes. The patients were evaluated by echo and pet-scan before
surgery and at 6 months follow-up, and by echo at subsequent follow-up.
 RESULT(S): Overall 30 days-in hospital mortality was 0 for the entire
cohort. At last follow-up ejection fraction increased from 25.3% before
surgery to 36.3% in group A, and from 31.8% to 45.6% in group B. Reduction
of LVEDD was 6% in group A, 9% in group B. ESLVV and EDLVD decreased more
significantly in patients receiving stem cells (55% vs. 35%). Late cardiac
mortality at 9 years follow-up was similar in the two groups of patients.
No early or late adverse reaction nor cases of infections were observed.
 CONCLUSION(S): Patients affected by ischemic cardiomyopathy have a
favourable outcome after SVR. Ahigher reduction of LVEDV and LVESV
assessed by CT-Scan evaluation in patients receiving cell therapy, when
compared to control group, encourages the evolution and refinement of
myocardial regenerative therapy added to SVR. Copyright © 2018
EDIZIONIMINERVAMEDICA.

<3>
Accession Number
2001775976
Title
Optimizing the vertical position of the brace thoracic pad: Apical rib or
apical vertebra?.
Source
Orthopaedics and Traumatology: Surgery and Research. 105 (4) (pp 727-731),
2019. Date of Publication: June 2019.
Author
Karam J.A.; Eid R.; Kreichati G.; Abiad R.; Kharrat K.; Ghanem I.B.
Institution
(Karam) Department of Orthopaedic Surgery, 835 S. Wolcott Ave, Room E-270,
University of Illinois at Chicago, Chicago, IL 60612, United States
(Eid, Kreichati, Abiad, Kharrat, Ghanem) Department of Orthopaedic
Surgery, Hotel-Dieu de France Hospital, Saint-Joseph University, Alfred
Naccache Street, Ashrafieh, Beirut, Lebanon
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction: The vertical position of the thoracic pad is a subject of
controversy in brace design. Traditional recommendations dictate a maximal
force applied at the level of the apical rib, about 2 levels below the
apical vertebra. We sought to evaluate the optimal vertical position of
the brace thoracic pad using fulcrum bending radiographs. Hypothesis: A
lateral force applied at the apical vertebra of a thoracic curve is more
efficient at correcting coronal deformity than a force placed the apical
rib. Patients and Methods: In this prospective study, we recruited
patients presenting with adolescent idiopathic scoliosis (AIS) and Risser
stage 0-2 over a period of 12 months. Patients with a history of spine or
thoracic surgery were excluded. Two fulcrum bending radiographs were
performed for each patient: one with the center of the fulcrum placed
under the most lateral part of the apical rib and another with the fulcrum
centered below the apical vertebra. Cobb angles were measured on each
fulcrum radiograph and compared using a paired t test. Result(s):
Fifty-two patients were included, with a mean age of 12.4 years and mean
thoracic Cobb angle of 39.4. Placing a fulcrum under the apical vertebra
reduced the Cobb angle to a mean of 11.5, which was significantly lower
than a fulcrum placed under the apical rib (14.3, p = 0.001). This
corresponded to a 20% relative loss in the absolute correction angle when
placing the fulcrum under the apical rib. The difference between the 2
Cobb angles was not significantly correlated to patient age (p = 0.896) or
curve apex (p = 0.813). Discussion(s): This is the first clinical
study addressing the vertical position of the thoracic pad in braces for
AIS. A lateral force applied at the level of the apical vertebra was
significantly more efficient at reducing thoracic curve deformities than
one applied at the apical rib. Our results provide clinical support to
finite element studies that refute traditional recommendations of brace
design, advocating for a revision of these guidelines to optimize
non-operative treatment of AIS. Level of Evidence: II, prospective
comparative study. Copyright © 2019 Elsevier Masson SAS

<4>
Accession Number
627526730
Title
Transcatheter aortic-valve replacement with a self-expanding valve in
low-risk patients.
Source
New England Journal of Medicine. 380 (18) (pp 1706-1715), 2019. Date of
Publication: 02 May 2019.
Author
Popma J.J.; Michael Deeb G.; Yakubov S.J.; Mumtaz M.; Gada H.; O'Hair D.;
Bajwa T.; Heiser J.C.; Merhi W.; Kleiman N.S.; Askew J.; Sorajja P.; Rovin
J.; Chetcuti S.J.; Adams D.H.; Teirstein P.S.; Zorn G.L.; Forrest J.K.;
Tchetche D.; Resar J.; Walton A.; Piazza N.; Ramlawi B.; Robinson N.;
Petrossian G.; Gleason T.G.; Oh J.K.; Boulware M.J.; Qiao H.; Mugglin
A.S.; Reardon M.J.
Institution
(Popma) Interventional Cardiology, Beth Israel Deaconess Medical Center,
185 Pilgrim Rd., Boston, MA 02215, United States
(Michael Deeb, Chetcuti) University of Michigan Hospitals, Ann Arbor, MI,
United States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, MI, United States
(Yakubov) Riverside Methodist, Ohio Health, Columbus, United States
(Mumtaz, Gada) University of Pittsburgh Medical Center Pinnacle Health,
Harrisburg, PA, United States
(Gleason) University of Pittsburgh, Pittsburgh, PA, United States
(O'Hair, Bajwa) Pennsylvania; Aurora-Saint Luke's Medical Center,
Milwaukee, United States
(Kleiman) Houston Methodist Debakey Heart and Vascular Center, Houston,
United States
(Askew, Sorajja) Abbott Northwestern Hospital, MN, United States
(Boulware, Qiao) Medtronic, MN, United States
(Oh) Minneapolis, Mayo Clinic, Rochester, MN, United States
(Mugglin) Paradigm Biostatistics, Anoka, MN, United States
(Rovin) Morton PlantHospital, Clearwater, FL, United States
(Adams) Mount Sinai Health System, New York, NY, United States
(Robinson, Petrossian) Saint Francis Hospital, Roslyn, NY, United States
(Teirstein) Scripps Clinic and Research Foundation, San Diego, CA, United
States
(Zorn) University of Kansas Hospital, Kansas City, United States
(Forrest) Yale New Haven Hospital, New Haven, CT, United States
(Tchetche) Clinique Pasteur, Toulouse, France
(Resar) Johns Hopkins Hospital, Baltimore, United States
(Walton) Alfred Hospital, Melbourne, VIC, Australia
(Piazza) McGill University Health Centre, Montreal, Canada
(Ramlawi) Winchester Medical Center, Winchester, VA, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) is an alternative
to surgery in patients with severe aortic stenosis who are at increased
risk for death from surgery; less is known about TAVR in low-risk
patients. METHODS We performed a randomized noninferiority trial in which
TAVR with a self-expanding supraannular bioprosthesis was compared with
surgical aortic-valve replacement in patients who had severe aortic
stenosis and were at low surgical risk. When 850 patients had reached
12-month follow-up, we analyzed data regarding the primary end point, a
composite of death or disabling stroke at 24 months, using Bayesian
methods. RESULTS Of the 1468 patients who underwent randomization, an
attempted TAVR or surgical procedure was performed in 1403. The patients'
mean age was 74 years. The 24-month estimated incidence of the primary end
point was 5.3% in the TAVR group and 6.7% in the surgery group
(difference, -1.4 percentage points; 95% Bayesian credible interval for
difference, -4.9 to 2.1; posterior probability of noninferiority >0.999).
At 30 days, patients who had undergone TAVR, as compared with surgery, had
a lower incidence of disabling stroke (0.5% vs. 1.7%), bleeding
complications (2.4% vs. 7.5%), acute kidney injury (0.9% vs. 2.8%), and
atrial fibrillation (7.7% vs. 35.4%) and a higher incidence of moderate or
severe aortic regurgitation (3.5% vs. 0.5%) and pacemaker implantation
(17.4% vs. 6.1%). At 12 months, patients in the TAVR group had lower
aortic-valve gradients than those in the surgery group (8.6 mm Hg vs. 11.2
mm Hg) and larger effective orifice areas (2.3 cm2vs. 2.0
cm2). CONCLUSIONS In patients with severe aortic stenosis who
were at low surgical risk, TAVR with a self-expanding supraannular
bioprosthesis was noninferior to surgery with respect to the composite end
point of death or disabling stroke at 24 months. Copyright © 2019
Massachusetts Medical Society.

<5>
Accession Number
625375867
Title
A process for academic societies to develop scientific statements and
white papers: Experience of the Pediatric Cardiac Intensive Care Society.
Source
Cardiology in the Young. 29 (2) (pp 174-177), 2019. Date of Publication:
01 Feb 2019.
Author
Reddy S.; Polito A.; Staveski S.; Dalton H.
Institution
(Reddy) Department of Pediatrics (Cardiology), Stanford University, 750
Welch Road, Palo Alto, CA 94305, United States
(Polito) Pediatric and Neonatal Intensive Care Unit, Department of
Pediatrics, University Hospital of Geneva, Geneva, Switzerland
(Staveski) Research in Patient Services and the Heart Institute,
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United
States
(Dalton) Department of Pediatrics, Adult and Pediatric ECMO, INOVA Fairfax
Medical Center, Falls Church, VA, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
There are substantial knowledge gaps, practice variation, and paucity of
controlled trials owing to the relatively small number of patients with
critical heart disease. The Pediatric Cardiac Intensive Care Society has
recognised this knowledge gap as an area needing a more comprehensive and
evidence-based approach to the management of the critically ill child with
heart disease. To address this, the Pediatric Cardiac Intensive Care
Society created a scientific statements and white papers committee.
Scientific statements and white papers will present the current
state-of-the-art in areas where controversy exists, providing clinicians
with guidance in diagnostic and therapeutic strategies, particularly where
evidence-based data are lacking. This paper provides a template for other
societies and organisations faced with the task of developing scientific
statements and white papers. We describe the methods used to perform a
systematic literature search and evidence rating that will be used by all
scientific statements and white papers emerging from the Pediatric Cardiac
Intensive Care Society. The Pediatric Cardiac Intensive Care Society aims
to revolutionise the care of children with heart disease by shifting our
efforts from individual institution-based practices to national
standardised protocols and to lay the ground work for multicentre
high-impact research directions. Copyright © 2018 Cambridge
University Press.

<6>
Accession Number
625997810
Title
The Portico transcatheter aortic valve for the treatment of severe aortic
stenosis.
Source
Future Cardiology. 15 (1) (pp 31-37), 2019. Date of Publication: January
2019.
Author
Taramasso M.; Miura M.; Gavazzoni M.; Andreas M.; Saccocci M.; Gulmez G.;
Puri R.; Maisano F.
Institution
(Taramasso, Miura, Gavazzoni, Saccocci, Gulmez, Maisano) Cardiovascular
Surgical Department, Heart Valve Clinic, University of Zurich, Zurich,
Switzerland
(Andreas) Department of Surgery, Division of Cardiac Surgery, Medical
University of Vienna, Vienna, Austria
(Puri) Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland,
OH, United States
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
The Portico TAVI system (Abbott Vascular, Santa Clara, CA, USA) has been
specifically designed to mitigate some of the complications associated
with first-generation valves. Most of the data generated from randomized
studies comparing transcatheter aortic valve implantation with surgery
stem from reported experiences with first generation transcatheter heart
valve devices. The aim of this review is to describe the repositionable
and retrievable Portico system and its implantation technique, coupled
with our single-center experience and to provide a review of the clinical
results reported so far in the literature. Copyright © 2018 2018
Future Medicine Ltd.

<7>
Accession Number
620125977
Title
Is 300 Seconds ACT Safe and Efficient during MiECC Procedures?.
Source
Thoracic and Cardiovascular Surgeon. 67 (3) (pp 191-202), 2019. Date of
Publication: 2019.
Author
Bauer A.; Hausmann H.; Schaarschmidt J.; Szlapka M.; Scharpenberg M.;
Eberle T.; Hasenkam J.M.
Institution
(Bauer, Schaarschmidt) Department of Cardiovascular Perfusion, MediClin
Heart Center Coswig, Lerchenfeld 1, Coswig, Saxony-Anhalt 06869, Germany
(Bauer, Hasenkam) Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Aarhus, Denmark
(Bauer, Hasenkam) Department of Clinical Medicine, Aarhus University,
Aarhus, Denmark
(Hausmann, Szlapka) Department of Cardiothoracic and Vascular Surgery,
MediClin Heart Center Coswig, Coswig, Saxony-Anhalt, Germany
(Scharpenberg) Competence Center for Clinical Trials Bremen, University of
Bremen, Bremen, Germany
(Eberle) Department of Anesthesia and Intensive Care Medicine, MediClin
Heart Center Coswig, Coswig, Saxony-Anhalt, Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Introduction The recommended minimum activated clotting time (ACT) level
for cardiopulmonary bypass (CPB) of 480 seconds originated from
investigations with bubble oxygenators and uncoated extracorporeal
circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are
completely closed circuits containing a membrane oxygenator and a
tip-to-tip surface coating. We hypothesized that surface coating and the
closed-loop design allow the MiECC to safely run with lower ACT levels and
that an ACT level of 300 seconds can be safely applied without
thromboembolic complications. The aim of this study was to investigate the
potential risks during application of reduced heparin levels in patients
undergoing coronary surgery. Methods In this study, 68 patients undergoing
coronary artery bypass grafting with MiECC were randomized to either the
study group with an ACT target of 300 seconds or the control group with an
ACT of 450 seconds. All other factors of MiECC remained unchanged. Results
The study group received significantly less heparin and protamine (heparin
[international units] median [min-max], Red-AC: 32,800 [23,000-51,500] vs.
Full-AC: 50,000 [35,000-65,000] p < 0.001; protamine [international
units], Red-AC: 18,000 [10,000-35,000] vs. Full-AC: 30,000 [20,000-45,000]
p < 0.001). The ACT in the study group was significantly lower at the
start of MiECC (mean +/- standard deviation: study group 400 +/- 112 vs.
control group 633 +/- 177; p < 0.0001). Before termination of CPB the ACT
levels were: study group 344 +/- 60 versus control group 506 +/- 80. In
both groups, the values of the endogenous thrombin potential (ETP)
decreased simultaneously. None of the study participants experienced
thromboembolic complications. Conclusion Since no evidence of increased
thrombin formation (ETP) was found from a laboratory standpoint, we
concluded that the use of MiECC with a reduced anticoagulation strategy
seems possible. This alternative anticoagulation strategy leads to
significant reduction in dosages of both heparin and protamine. We can
confidently move forward with investigating this anticoagulation concept.
However, to establish clinical safety of ACT below 300 seconds, we need
larger clinical studies. Copyright © 2019 Georg Thieme Verlag KG
Stuttgart. New York.

<8>
Accession Number
2001110854
Title
Intraoperative hypotension is not associated with postoperative cognitive
dysfunction in elderly patients undergoing general anesthesia for surgery:
results of a randomized controlled pilot trial.
Source
Journal of Clinical Anesthesia. 52 (pp 111-118), 2019. Date of
Publication: February 2019.
Author
Langer T.; Santini A.; Zadek F.; Chiodi M.; Pugni P.; Cordolcini V.;
Bonanomi B.; Rosini F.; Marcucci M.; Valenza F.; Marenghi C.; Inglese S.;
Pesenti A.; Gattinoni L.
Institution
(Langer, Zadek, Chiodi, Pugni, Cordolcini, Valenza, Pesenti, Gattinoni)
Department of Pathophysiology and Transplantation, University of Milan,
Milan, Italy
(Langer, Santini, Valenza, Marenghi, Pesenti, Gattinoni) Department of
Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Milan, Italy
(Bonanomi, Rosini, Marcucci, Inglese) Geriatric Unit, Department of
Medical Sciences and Community Health, University of Milan, Italy
(Marcucci) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Rosini, Marcucci, Inglese) Fondazione IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Milan, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To assess the effect of different intraoperative blood
pressure targets on the development of POCD and test the feasibility of a
larger trial. Design(s): Randomized controlled pilot trial.
 Setting(s): Perioperative care in a tertiary care teaching hospital
with outpatient follow-up. Patient(s): One hundred one patients aged
>=75 years with ASA physical status <4, undergoing elective, non-cardiac
surgery under general anesthesia and 33 age-matched healthy controls.
 Intervention(s): Randomization to a personalized intraoperative blood
pressure target, mean arterial pressure (MAP) >= 90% of preoperative
values (Target group), or to a more liberal intraoperative blood pressure
management (No-Target group). Strategies to reach intraoperative blood
pressure target were at discretion of anesthesiologists. Measurements: An
experienced neuropsychologist performed a validated battery of
neurocognitive tests preoperatively and 3 months after surgery. Incidence
of POCD at three months and postoperative delirium were assessed.
Intraoperative time spent with MAP >= 90% of preoperative values,
recruitment and drop-out rate at 3 months were feasibility outcomes.
 Main Result(s): The Target group spent a higher percentage of
intraoperative time with MAP >=90% of preoperative values (65 +/- 25% vs.
49 +/- 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52;
95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk,
0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No
correlation was found between intraoperative hypotension and postoperative
cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate
was of 6 patients/month (95% confidential interval (CI), 5 to 7) and
drop-out rate at 3 months was 24% (95% CI, 14 to 33%). Conclusion(s):
Intraoperative hypotension did not correlate with postoperative cognitive
dysfunction or delirium occurrence in elderly patients undergoing general
anesthesia for non-cardiac surgery. A multicenter randomized controlled
trial is needed in order to confirm the effect of intraoperative blood
pressure on the development of POCD. Trial registration number:
NCT02428062 www.clinicaltrials.gov. Copyright © 2018

<9>
Accession Number
624414720
Title
Intra-coronary morphine versus placebo in the treatment of acute
ST-segment elevation myocardial infarction: The MIAMI randomized
controlled trial.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 193. Date of Publication: 19 Oct 2018.
Author
Le Corvoisier P.; Gallet R.; Lesault P.-F.; Audureau E.; Paul M.; Ternacle
J.; Ghostine S.; Champagne S.; Arrouasse R.; Bitari D.; Mouillet G.;
Dubois-Rande J.-L.; Berdeaux A.; Ghaleh B.; Deux J.-F.; Teiger E.
Institution
(Le Corvoisier, Arrouasse, Bitari) Department VERDI, Inserm, CIC1430,
AP-HP, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny,
Creteil F-94010, France
(Le Corvoisier, Gallet, Dubois-Rande, Berdeaux, Ghaleh, Teiger) Inserm,
U955 Team 3, Creteil F-94010, France
(Gallet, Lesault, Ternacle, Champagne, Mouillet, Teiger) Interventional
Cardiology Unit, AP-HP, Henri Mondor Hospital, Creteil F-94010, France
(Audureau) Department of Public Health and CEPIA EA7376, AP-HP, Henri
Mondor Hospital, Creteil F-94010, France
(Paul) Department of Pharmacy, AP-HP, Henri Mondor Hospital, Creteil
F-94010, France
(Ghostine) Department of Cardiology, Marie-Lannelongue Hospital, Le
Plessis-Robinson F-92350, France
(Dubois-Rande) Department of Cardiology, AP-HP, Henri Mondor Hospital,
Creteil F-94010, France
(Deux) Department of Radiology, AP-HP, Henri Mondor Hospital, Creteil
F-94010, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Experimental studies suggest that morphine may protect the
myocardium against ischemia-reperfusion injury by activating salvage
kinase pathways. The objective of this two-center, randomized,
double-blind, controlled trial was to assess potential cardioprotective
effects of intra-coronary morphine in patients with ST-segment elevation
myocardial infarction (STEMI) referred for primary percutaneous
intervention. Method(s): Ninety-one patients with STEMI were randomly
assigned to intracoronary morphine (1 mg) or placebo at reperfusion of the
culprit coronary artery. The primary endpoint was infarct size/left
ventricular mass ratio assessed by magnetic resonance imaging on day 3-5.
Secondary endpoints included the areas under the curve (AUC) for troponin
T and creatine kinase over three days, left ventricular ejection fraction
assessed by echocardiography on days 1 and 6, and clinical outcomes.
 Result(s): Infarct size/left ventricular mass ratio was not
significantly reduced by intracoronary morphine compared to placebo (27.2%
+/- 15.0% vs. 30.5% +/- 10.6%, respectively, p = 0.28). Troponin T and
creatine kinase AUCs were similar in the two groups. Morphine did not
improve left ventricular ejection fraction on day 1 (49.7 +/- 10.3% vs.
49.3 +/- 9.3% with placebo, p = 0.84) or day 6 (48.5 +/- 10.2% vs. 49.0
+/- 8.5% with placebo, p = 0.86). The number of major adverse cardiac
events, including stent thrombosis, during the one-year follow-up was
similar in the two groups. Conclusion(s): Intracoronary morphine at
reperfusion did not significantly reduce infarct size or improve left
ventricular systolic function in patients with STEMI. Presence of
comorbidities in some patients may contribute to explain these results.
Trial registration: ClinicalTrials.gov, NCT01186445 (date of registration:
August 23, 2010). Copyright © 2018 The Author(s).

<10>
Accession Number
625534090
Title
Bioactive scaffolds in stem-cell-based therapies for cardiac repair:
Protocol for a meta-analysis of randomized controlled preclinical trials
in animal myocardial infarction models 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Systematic Reviews. 7 (1) (no pagination), 2018. Article Number: 225. Date
of Publication: 05 Dec 2018.
Author
Khan K.; Gasbarrino K.; Mahmoud I.; Makhoul G.; Yu B.; Dufresne L.;
Daskalopoulou S.S.; Schwertani A.; Cecere R.
Institution
(Khan, Makhoul, Yu, Dufresne, Schwertani, Cecere) Division of Cardiology
and Cardiac Surgery, McGill University Health Centre, Montreal, QC, Canada
(Gasbarrino, Daskalopoulou) Division of Experimental Medicine, Department
of Medicine, Faculty of Medicine, McGill University Health Centre,
Montreal, QC, Canada
(Mahmoud) McConnell Resource Centre, McGill University Health Centre,
Montreal, QC, Canada
(Cecere) Glen Campus-The Royal Victoria Hospital, 1001 Decarie Blvd,
Montreal, QC H4A 3J1, Canada
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute myocardial infarction (MI) remains one of the leading
causes of death worldwide with no curative therapy available. Stem cell
therapies have been gaining interest as a means to repair the cardiac
tissue after MI and prevent the onset of heart failure. Many in vivo
reports suggest that the use of stem cells is promising, yet clinical
trials suggest that the cells fail to integrate into the native tissue,
resulting in limited improvements in cardiac function and repair. To
battle this limitation, the combination of using stem cells embedded in a
bioactive scaffold that promotes cell retention is growing in interest.
Yet, a systematic review of the literature on the use of stem cells
embedded in bioactive scaffolds for cardiac repair has not yet been
performed. In this protocol, we outline a systematic review and
meta-analysis of preclinical trials in animal MI models that utilize stem
cell-embedded scaffolds for cardiac repair and compare their effects to
stem cell-treated animals without the use of a scaffold. Methods/design:
We will search the following electronic databases: Cochrane Library,
MEDLINE, Embase, PubMed, Scopus and Web of Science, and gray literature:
Canadian Agency for Drugs and Technologies in Health and Google Scholar.
We will only include randomly controlled preclinical trials that have
directly investigated the effects of stem cells embedded in a scaffold for
cardiac repair in an animal MI model. Two investigators will independently
review each article included in the final analysis. The primary endpoint
that will be investigated is left ventricular ejection fraction. Secondary
endpoints will include infarct size, end systolic volume, end diastolic
volume, fractional shortening and left ventricular wall thickness. Pooled
analyses will be conducted using the DerSimonian-Laird random effects and
Mantel-Haenszel fixed-effect models. Between-studies heterogeneity will be
quantified and determined using the Tau2 and I 2
statistics. Publication bias will be assessed using visual inspection of
funnel plots and complemented by Begg's and Egger's statistical tests.
Possible sources of heterogeneity will be assessed using subgroup-meta
analysis and meta-regression. Discussion(s): To date, the use of
scaffolds in myocardial repair has not yet been systematically reviewed.
The results of this meta-analysis will aid in determining the efficacy of
stem cell-embedded scaffolds for cardiac repair and help bring this
therapy to the clinic. Copyright © 2018 The Author(s).

<11>
Accession Number
624377360
Title
A systemic review and meta-analysis: Long-term results of the Bentall
versus the David procedure in patients with Marfan syndrome.
Source
European Journal of Cardio-thoracic Surgery. 54 (3) (pp 411-419), 2018.
Date of Publication: 2018.
Author
Burgstaller J.M.; Held U.; Mosbahi S.; Stak D.; Steurer J.; Eckstein F.;
Berdajs D.A.
Institution
(Burgstaller, Held, Steurer) Horten Center for Patient-Oriented Research
and Knowledge Transfer, University of Zurich, Zurich, Switzerland
(Mosbahi) Department of General Surgery, County Hospital Freiburg,
Freiburg im Breisgau, Switzerland
(Stak) Department of Cardiac Surgery, Triemli City Hospital, Zurich,
Switzerland
(Eckstein, Berdajs) Department of Cardiac Surgery, University Hospital
Basel, Spitalstrasse 21, Basel 4031, Switzerland
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This systemic review of the literature and meta-analysis aimed to evaluate
the current state of the evidence for and against reimplantation of the
aortic valve (RAV) versus the composite valve graft (CVG) intervention in
patients with Marfan syndrome. Random effects metaregression was performed
across the study arms with logit-transformed proportions of in-hospital
deaths as an outcome measure when possible. Results are presented as odds
ratios with 95% confidence intervals (CIs) and P-values. Other outcomes
are summarized with medians, interquartile ranges (IQR) and ranges and the
numbers of patients at risk. Twenty retrospective studies that included a
combined 2156 patients with long-term follow-up were identified for
analysis after a literature search. The in-hospital mortality rate
favoured the RAV procedure with an odds ratio of 0.23 [95% CI 0.09-0.55, P
= 0.001]. The survival rate at mid-term for the RAV cohort was 96.7% (CI
94.2-98.5) vs. 86.4% (CI 82.8-89.6) for the CVG group and 93.1% (CI
66.4-100) for the RAV group vs. 82.6% (CI 74.9-89.2) for the CVG group for
the long term. Freedom from valve-related reintervention (median
percentages) for the long term was 97.6% (CI 90.3-100%) for the RAV
procedure and 88.6% (CI 79.1-95.5) for a CVG. This systematic review of
the literature stresses the advantages of the RAV procedure in patients
with Marfan syndrome in regard to long- and short-term results as the
treatment of choice in aortic root surgery. The RAV procedure reduces
in-hospital as well as long-term deaths and protects against aortic valve
reintervention. Copyright © 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<12>
Accession Number
622219722
Title
Mitral Valve Interventions in Structural Heart Disease.
Source
Current Cardiology Reports. 20 (6) (no pagination), 2018. Article Number:
49. Date of Publication: 01 Jun 2018.
Author
Saccocci M.; Taramasso M.; Maisano F.
Institution
(Saccocci, Taramasso, Maisano) Heart Center University Hospital of Zurich,
Department of Cardiac Surgery - UniversitatsSpital Zurich, Ramistrasse
100, Zurich 8091, Switzerland
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of review: Analyze the current state of the art and the future
perspectives of mitral interventions in clinical setting. Recent Findings:
A systematic and critical review of the new mitral percutaneous therapies
and imaging technologies is the basis to adopt the right treatment for
each patient according to specific valve dysfunction and clinical
presentation, waiting for definitive guidelines. While surgical mitral
repair will remain the gold standard for low-risk healthy patients with
degenerative mitral regurgitation (DMR), transcatheter mitral valve repair
is becoming first line therapy in high risk patients with functional
mitral regurgitation (FMR). The introduction of transcatheter mitral valve
replacement will expand indications for advanced DMR and FMR in inoperable
patients. Summary: The introduction of transcatheter mitral
interventions is changing the mitral therapy scenario. Mitral
interventionalists might evolve into hybrid professional figures able to
offer a tailored approach for each patient, including surgical and
percutaneous approaches, depending on the anatomo-functional status of the
valve, to clinical conditions, and to the timing of the
intervention. Copyright © 2018, Springer Science+Business Media,
LLC, part of Springer Nature.

<13>
Accession Number
624430159
Title
Enhanced recovery after surgery pathway for patients undergoing cardiac
surgery: A randomized clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 54 (3) (pp 491-497), 2018.
Date of Publication: 2018.
Author
Li M.; Zhang J.; Gan T.J.; Qin G.; Wang L.; Zhu M.; Zhang Z.; Pan Y.; Ye
Z.; Zhang F.; Chen X.; Lin G.; Huang L.; Luo W.; Guo Q.; Wang E.
Institution
(Li, Zhang, Qin, Wang, Zhu, Zhang, Pan, Ye, Zhang, Guo, Wang) Department
of Anaesthesiology, Xiangya Hospital, Central South University, Changsha,
Hunan 410008, China
(Gan) Department of Anesthesiology, Stony Brook University, Stony Brook,
NY, United States
(Chen, Lin, Huang, Luo) Department of Cardiovascular Surgery, Xiangya
Hospital, Central South University, Changsha, Hunan, China
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Enhanced recovery after surgery (ERAS) pathways have not been
reported in cardiac surgery. The aim of this study was to evaluate the
clinical effectiveness and safety profile of ERAS pathways compared with
routine care for patients undergoing cardiac valvular surgery.
 METHOD(S): A randomized clinical trial was conducted between July
2015 and November 2016. A total of 226 patients who underwent elective
valvular surgery were randomly assigned to the ERAS pathway or routine
care (control) group. The ERAS protocol consisted of an evidence-based
systematic optimization approach for managing perioperative patients. The
control group received routine care. The primary end-point was readiness
for hospital discharge. The secondary outcomes were duration of intensive
care unit (ICU) stay, length of postoperative vasoactive drug support,
duration of mechanical ventilation, time to first bowel movement, removal
of surgical drain, overall medical costs and complication rate.
 RESULT(S): Postoperative time to readiness for discharge was
significantly shorter in the ERAS group (6.0 (2.014.0) days) than the
control group (7.0 (4.016.0) days, P = 0.01), and the duration of ICU stay
and duration of mechanical ventilation were significantly shorter in the
ERAS group (20.9 (13.569.3) h, 7.2 (0.022.3) h, respectively) than the
control group (22.0 (13.4212.3) h, P = 0.001; 8.8 (3.744.9) h,
respectively; P < 0.0001). The overall treatment cost of the ERAS group
(69202 (52089123823) CNY) was significantly lower than that of the control
group (77058 (51390144290) CNY, P = 0.002). CONCLUSION(S): ERAS
pathways reduce the length of ICU and hospital stay, postoperative
complications and cost for patients undergoing cardiac surgery. Clinical
trial registration: ClinicalTrials.gov: NCT02479581. Copyright ©
2018 The Author(s).

<14>
Accession Number
624544263
Title
Does No-Touch Technique Better than Conventional or Intermediate Saphenous
Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a
Systematic Review and Meta-analysis.
Source
Journal of Cardiovascular Translational Research. 11 (6) (pp 483-494),
2018. Date of Publication: 01 Dec 2018.
Author
Elshafay A.; Bendary A.H.; Vuong H.T.; Ahmed A.R.; Mokhtar M.A.; Soliman
A.L.; Vuong N.L.; bestawi I.A.E.; Abdallah N.A.; Vu V.T.; Hirayama K.; Huy
N.T.
Institution
(Elshafay, Bendary, Soliman, bestawi) Faculty of Medicine, Al-Azhar
University, Cairo 11884, Egypt
(Vuong) Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho
Chi Minh City 700000, Vietnam
(Ahmed) Faculty of Pharmacy, Tanta University, Gharbia 13741, Egypt
(Mokhtar) Faculty of Medicine, Sohag University, Sohag 82738, Egypt
(Vuong) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Vuong) Department of Medical statistic and Informatics, Faculty of Public
Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi
Minh City 70000, Vietnam
(Abdallah) Faculty of Medicine, Aswan University, Aswan 81543, Egypt
(Vu) Faculty of Public Health, University of Medicine and Pharmacy at Ho
Chi Minh City, Ho Chi Minh City 700000, Vietnam
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University,
1-12-4 Sakamoto, Nagasaki 852-8523, Japan
(Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Huy) Department of Clinical Product Development, Institute of Tropical
Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki
University, Nagasaki, Japan
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Saphenous vein (SV) is a common graft being used in coronary artery bypass
grafting (CABG). Conventional (CON), intermediate (I), and no-touch (NT)
are the most common harvesting techniques of SV for CABG. The aim of this
study is to systematically review the NT versus CON and I techniques in
harvesting SV for CABG. Twelve databases were searched for randomized
controlled trials comparing the CON, I, and NT techniques in harvesting SV
for CABG. Twelve reports of six RCTs were included. Our meta-analysis
showed that with NT technique, patency rate was significantly higher when
compared to I technique up to 18-month follow-up duration. In contrast,
this significant difference was not maintained in terms of minor
complications of leg wounds with both techniques. The NT has significantly
higher patency rate compared to I vein harvesting technique. However, more
RCTs are warranted to confirm these results. Copyright © 2018,
Springer Science+Business Media, LLC, part of Springer Nature.

<15>
Accession Number
628032521
Title
Effect of a New Sternal Sealant on Marrow Bleeding and Blood Product Use
after Adult Cardiac Surgery.
Source
The American surgeon. 85 (5) (pp e257-e259), 2019. Date of Publication: 01
May 2019.
Author
Hasaniya N.W.; Bansal N.R.; John M.M.; Ayer Miller V.L.; Floridia R.;
Razzouk A.J.; Rabkin D.G.
Publisher
NLM (Medline)

<16>
[Use Link to view the full text]
Accession Number
627643089
Title
Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent
Stroke and/or Mortality.
Source
Stroke. 50 (6) (pp 1364-1371), 2019. Date of Publication: 01 Jun 2019.
Author
Lin M.-H.; Kamel H.; Singer D.E.; Wu Y.-L.; Lee M.; Ovbiagele B.
Institution
(Lin, Lee) From the Department of Neurology, Chang Gung University College
of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (Republic of
China)
(Kamel) Department of Neurology, Weill Cornell Medical College, China
(Singer) Division of General Internal Medicine, Massachusetts General
Hospital and Harvard Medical School
(Wu) Institute of Population Health Sciences, National Health Research
Institutes, Miaoli County, Taiwan (Republic of China)
(Ovbiagele) Department of Neurology, University of California, San
Francisco (B.O.)
Publisher
NLM (Medline)
Abstract
Background and Purpose- Although believed to be transient and
self-limiting, new-onset perioperative/postoperative atrial fibrillation
(POAF) might be a risk factor for stroke and mortality. We conducted a
systematic review and meta-analysis to qualitatively and quantitatively
evaluate the relationship of POAF with early and late risks of mortality
and stroke. Methods- We searched Pubmed, EMBASE, and Cochrane Library
(1966 through March 2018) to identify cohort studies that reported stroke
and mortality associated with POAF. We computed a random-effects estimate
based on the Mantel-Haenszel method. Odds ratios with 95% CI were used as
a measure of the association between POAF and early (in-hospital or within
30 days of surgery) stroke and mortality, while hazard ratios (HR) were
used for long-term outcomes. Results- Our analysis included 35 studies
with 2458010 patients. Pooling the results from the random-effects model
showed that POAF was associated with increased risks of early stroke (odds
ratio, 1.62; 95% CI, 1.47-1.80), early mortality (odds ratios, 1.44; 95%
CI, 1.11-1.88), long-term stroke (HR, 1.37; 95% CI, 1.07-1.77), and
long-term mortality (HR, 1.37; 95% CI, 1.27-1.49). Analyses focusing on
high-quality studies obtained similar results. In subgroup analyses, POAF
was more strongly associated with stroke in patients undergoing noncardiac
surgery (HR, 2.00; 95% CI, 1.70-2.35) than in patients undergoing cardiac
surgery (HR, 1.20; 95% CI, 1.07-1.34). Conclusions- New-onset POAF is
associated with an increased risk of stroke and mortality, both in the
short-term and long-term. The best strategy to reduce stroke risk among
these patients needs to be determined.

<17>
Accession Number
2002016982
Title
Meta-Analysis of Outcomes of Transcatheter Aortic Valve Implantation Among
Patients With Low Gradient Severe Aortic Stenosis.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Osman M.; Ghaffar Y.A.; Foster T.; Osman K.; Alqahtani F.; Shah K.; Kheiri
B.; Alkhouli M.
Institution
(Osman, Ghaffar, Foster, Alqahtani, Shah, Alkhouli) Division of
Cardiology, West Virginia University School of Medicine, Morgantown, WV,
United States
(Kheiri) Hurley Medical Center, Michigan State University, Flint, MI,
United States
(Osman) Michigan Health Specialist, Michigan State University, Flint, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an effective
therapy for patients with severe aortic stenosis (AS). However, data on
TAVI outcomes in patients with low gradient (LG) AS are limited. We
performed a meta-analysis of studies comparing TAVI outcomes between
patients with classic high gradient (HG) and LG AS through November 2018.
The 30-day mortality, mid-term all-cause, and cardiovascular mortality at
maximum follow-up were compared between patients with HG and LG AS
(Pairwise meta-analysis), and between the three distinct groups of AS
including HG, paradoxical low-flow low-gradient and low gradient with
reduced ejection fraction (rEF-LG) (Network meta-analysis). Nineteen
studies (n = 27,204 patients) met the inclusion criteria. The HG group had
less 30-day, mid-term all-cause and cardiovascular mortality compared with
the low-gradient AS group overall, (6% vs 7.5%, OR 0.76, 95% CI 0.66 to
0.87, I2 = 18%), (21% vs 29%, OR 0.59, 95% CI 0.52 to 0.67,
I2 = 62%), and (12.6% vs 18.7%, OR 0.61, 95% CI 0.49 to 0.76,
I2 = 62%), respectively, p <0.0001. These outcomes were
confirmed in a trial sequential analysis in which the cumulative Z-curve
crossed the conventional test boundary as well as the trial sequential
monitoring boundary for all outcomes. The network meta-analysis revealed
that patients with rEF-LG had similar outcomes to those with pLFLG, and
both had worse outcomes than patients with classic HG AS. In conclusion
patients with classic HG have better 30-day mortality, mid-term all-cause
and cardiovascular mortality compared with LG patients following TAVI.
Among patients with LG severe AS, TAVI outcomes were similar in patients
with rEF-LG and pLFLG. Copyright © 2019 Elsevier Inc.

<18>
[Use Link to view the full text]
Accession Number
625705834
Title
Short- and long-term impact of remifentanil on thermal detection and pain
thresholds after cardiac surgery: A randomised controlled trial.
Source
European journal of anaesthesiology. 36 (1) (pp 32-39), 2019. Date of
Publication: 01 Jan 2019.
Author
de Hoogd S.; Valkenburg A.J.; van Dongen E.P.A.; Daeter E.J.; van Rosmalen
J.; Dahan A.; Tibboel D.; Knibbe C.A.J.
Institution
(de Hoogd) From the Department of Clinical Pharmacy, St. Antonius
Hospital, Nieuwegein (SdH, CAJK), Intensive Care and Department of
Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam
(AJV, DT, CAJK), Department of Anaesthesiology and Intensive Care (EPAvD),
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein
(EJD), Department of Biostatistics, Erasmus MC, Rotterdam (JvR),
Department of Anaesthesiology, Leiden University Medical Centre (AD) and
Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden
University, Leiden, The Netherlands (CAJK)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The clinical relevance of the suggested hyperalgesic effects
of remifentanil is still unclear, especially in the long term.
 OBJECTIVE(S): The current study evaluated the impact of remifentanil
on thermal thresholds 3 days and 12 months after surgery, measured with
Quantitative Sensory Testing. DESIGN: A single-blind, randomised
controlled trial. SETTING: A tertiary care teaching hospital in The
Netherlands, from 2014 to 2016. PATIENTS: A total of 126 patients aged
between 18 and 85 years, undergoing cardiothoracic surgery via sternotomy
(coronary artery bypass grafts and/or valve replacement) were included.
Exclusion criteria were BMI above 35 kg m, history of cardiac surgery,
chronic pain conditions, neurological conditions, allergy to opioids or
paracetamol, language barrier and pregnancy. INTERVENTIONS: Patients were
allocated randomly to receive intra-operatively either a continuous
remifentanil infusion or intermittent intra-operative fentanyl as needed
in addition to standardised anaesthesia with propofol and intermittent
intravenous fentanyl at predetermined time points. MAIN OUTCOME MEASURES:
Warm and cold detection and pain thresholds 3 days and 12 months after
surgery. In addition the use of remifentanil, presence of postoperative
chronic pain, age, opioid consumption and pre-operative quality of life
were tested as a predictor for altered pain sensitivity 12 months after
surgery. RESULT(S): Both warm and cold detection, and pain
thresholds, were not significantly different between the remifentanil and
fentanyl groups 3 days and 12 months after surgery (P > 0.05). No
significant predictors for altered pain sensitivity were identified.
 CONCLUSION(S): Earlier reports of increased pain sensitivity 1 year
after the use of remifentanil could not be confirmed in this randomised
study using Quantitative Sensory Testing. This indicates that remifentanil
plays a minor role in the development of chronic thoracic pain. Still, the
relatively high incidence of chronic thoracic pain and its accompanying
impact on quality of life remain challenging problems. TRIAL REGISTRATION:
The study was registered at EudraCT (ref: 2013-000201-23) and
ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02031016).

<19>
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. 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. 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. 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. 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. Copyright © 2019 Wiley Periodicals, Inc.

<20>
Accession Number
2001081212
Title
The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial
Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates
for Long-term Mechanical Circulatory Support.
Source
Psychosomatics. 59 (5) (pp 415-440), 2018. Date of Publication: September
- October 2018.
Author
Dew M.A.; DiMartini A.F.; Dobbels F.; Grady K.L.; Jowsey-Gregoire S.G.;
Kaan A.; Kendall K.; Young Q.-R.; Abbey S.E.; Butt Z.; Crone C.C.; De
Geest S.; Doligalski C.T.; Kugler C.; McDonald L.; Ohler L.; Painter L.;
Petty M.G.; Robson D.; Schloglhofer T.; Schneekloth T.D.; Singer J.P.;
Smith P.J.; Spaderna H.; Teuteberg J.J.; Yusen R.D.; Zimbrean P.C.
Institution
(Dew, DiMartini) University of Pittsburgh School of Medicine and Medical
Center, Pittsburgh, PA, United States
(Dobbels, De Geest) Katholieke Universiteit Leuven, Leuven, Belgium
(Grady, Butt) Northwestern University Feinberg School of Medicine,
Chicago, IL, United States
(Jowsey-Gregoire, Schneekloth) Mayo Clinic, Rochester, MN, United States
(Kaan, Young) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Kendall) Cleveland Clinic, Cleveland, OH, United States
(Abbey) University of Toronto and University Health Network, Toronto,
Ontario, Canada
(Crone) INOVA Hospitals, Fairfax, VA, United States
(De Geest) University of Basel, Basel, Switzerland
(Doligalski) Tampa General Hospital, Tampa, FL, United States
(Kugler) University of Freiburg, Freiburg, Germany
(McDonald) University of North Carolina, Chapel Hill, NC, United States
(Ohler) George Washington University, Washington, DC, United States
(Painter) Auckland City Hospital, Auckland, New Zealand
(Petty) University of Minnesota, Minneapolis, MN, United States
(Robson) St. Vincent's Hospital, Sydney, New South Wales, Australia
(Schloglhofer) Medical University of Vienna, Vienna, Austria
(Singer) University of California at San Francisco, San Francisco, CA,
United States
(Smith) Duke University, Durham, NC, United States
(Spaderna) Trier University, Trier, Germany
(Teuteberg) Stanford University, Stanford, CA, United States
(Yusen) Washington University, St. Louis, MO, United States
(Zimbrean) Yale University, New Haven, CT, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The psychosocial evaluation is well-recognized as an important component
of the multifaceted assessment process to determine candidacy for heart
transplantation, lung transplantation, and long-term mechanical
circulatory support (MCS). However, there is no consensus-based set of
recommendations for either the full range of psychosocial domains to be
assessed during the evaluation, or the set of processes and procedures to
be used to conduct the evaluation, report its findings, and monitor
patients' receipt of and response to interventions for any problems
identified. This document provides recommendations on both evaluation
content and process. It represents a collaborative effort of the
International Society for Heart and Lung Transplantation (ISHLT) and the
Academy of Psychosomatic Medicine, American Society of Transplantation,
International Consortium of Circulatory Assist Clinicians, and Society for
Transplant Social Workers. The Nursing, Health Science and Allied Health
Council of the ISHLT organized a Writing Committee composed of
international experts representing the ISHLT and the collaborating
societies. This Committee synthesized expert opinion and conducted a
comprehensive literature review to support the psychosocial evaluation
content and process recommendations that were developed. The
recommendations are intended to dovetail with current ISHLT guidelines and
consensus statements for the selection of candidates for cardiothoracic
transplantation and MCS implantation. Moreover, the recommendations are
designed to promote consistency across programs in the performance of the
psychosocial evaluation by proposing a core set of content domains and
processes that can be expanded as needed to meet programs' unique needs
and goals. Copyright © 2018 The Authors

<21>
Accession Number
628119523
Title
The effect of prophylactic cranial irradiation (PCI) for young stage III
NSCLC patients: Subgroup analyses of the NVALT-11/DLCRG-02 study.
Source
Annals of Oncology. Conference: European Lung Cancer Congress, ELCC 2019.
Switzerland. 30 (Supplement 2) (pp ii33-ii34), 2019. Date of Publication:
April 2019.
Author
Witlox W.J.A.; Ramaekers B.; Groen H.J.M.; Dingemans A.-M.C.; Praag J.;
Belderbos J.; Van der Noort V.; Van Tinteren H.; Joore M.A.; De Ruysscher
D.
Institution
(Witlox, Ramaekers, Joore) Clinical Epidemiology and Medical Technology
Assessment, Maastricht University Medical Center (MUMC), Maastricht,
Netherlands
(Groen) University Hospital Groningen (UMCG), Groningen, Netherlands
(Dingemans) Pulmonology, Maastricht University Medical Center (MUMC),
Maastricht, Netherlands
(Praag) Department of Radiation Oncology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Belderbos) Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital,
Amsterdam, Netherlands
(Van der Noort, Van Tinteren) Department of Biometrics, Het Nederlands
Kanker Instituut Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, Netherlands
(De Ruysscher) Radiation Oncology (Maastro Clinic), Maastricht University
Medical Centre (MUMC)-MAASTRO Clinic, Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
Background: The NVALT-11/DLCRG-02 phase III study compared PCI to
observation after chemo-radiotherapy (RT) for stage III NSCLC and showed a
significant decrease in the cumulative incidence of symptomatic brain
metastases (BM) in the PCI arm at two years (7% vs 27% [HR 0.23]). We here
performed exploratory subgroup analyses. Method(s): Two year
cumulative incidence rates were calculated and competing risk regression,
with death of any cause as competing risk, was used to examine the time to
symptomaticBM in the following subgroups: age, gender, performance status,
disease stage and tumour type, prior surgery, chemotherapy cycles,
thoracic RT dose and total concurrent chemo-RT treatment time. For
continuous variables, the median was used as a cut-off value. The effect
of PCI was only examined if the initial result was significant.
 Result(s): In total, 174 patients were analysed. The symptomatic BM
incidence was significantly lower in the subgroup of older (>61 years)
versus younger (=<61 years) patients (7% vs 26% [HR 0.25]). Stratified by
age, PCI only significantly reduced the symptomaticBM incidence in younger
patients (9% vs 42% [HR 0.18])(Table). Conclusion(s): The symptomatic
BM incidence was significantly lower in older (>61 years) compared to
younger (=<61 years) patients, likely due to higher numbers of
adenocarcinoma in the younger patients group. The effect of PCI was only
significant in younger patients. This study was randomized based on
treatment allocation and subgroups might be too small to detect
significant differences. Therefore, our results are hypothesis generating
and should be prospectively tested.

<22>
Accession Number
628120215
Title
Daily chlorhexidine bathing in general hospital units-results of the abate
infection trial (active bathing to eliminate infection).
Source
Open Forum Infectious Diseases. Conference: ID Week 2017. United States. 4
(Supplement 1) (pp S35-S37), 2017. Date of Publication: September 2017.
Author
Huang S.S.; Septimus E.; Kleinman K.; Moody J.; Hickok J.; Heim L.;
Gombosev A.; Avery T.; Hafenrefer K.; Shimelman L.; Hayden M.K.; Weinstein
R.A.; Spencer-Smith C.; Kaganov R.E.; Murphy M.V.; Forehand T.; Lankiewicz
J.; Coady M.H.; Portillo L.M.; Sarup J.P.; Jernigan J.A.; Perlin J.; Platt
R.
Institution
(Huang, Heim, Gombosev) Division of Infectious Diseases and Health Policy
Research Institute, University of California Irvine School of Medicine,
Irvine, CA, United States
(Septimus, Moody, Hickok, Spencer-Smith, Forehand, Perlin) Clinical
Services Group, HCA Inc., Nashville, TN, United States
(Kleinman) University of Massachusetts Amherst School of Public Health and
Health Sciences, Amherst, MA, United States
(Avery, Hafenrefer, Shimelman, Kaganov, Murphy, Lankiewicz, Coady, Platt)
Department of Population Medicine, Harvard Medical School and Harvard
Pilgrim Health Care Institute, Boston, MA, United States
(Hayden, Portillo, Sarup) Department of Internal Medicine, Division of
Infectious Diseases, Rush University Medical Center, Chicago, IL, United
States
(Weinstein) Cook County Health and Hospitals System, Chicago, IL, United
States
(Jernigan) Division of Healthcare Quality Promotion, Centers for Disease
Control and Prevention, Atlanta, GA, United States
Publisher
Oxford University Press
Abstract
Background. Universal decolonization with daily chlorhexidine (CHG)
bathing with and without nasal decolonization has significantly reduced
positive MRSA clinical cultures and bloodstream infections in adult ICUs
in several clinical trials. We evaluated whether decolonization was
similarly effective in a lower risk hospitalized population. Methods. We
conducted a 2 arm cluster-randomized trial involving a 1-year baseline
period (April 2013-March 2014) and a 21-month intervention period (June
2014-February 2016). All noncritical care units in a hospital were
assigned to the same strategy. These were (1) Routine Care: routine
bathing product and frequency and (2) Decolonization: CHG for routine
daily bathing (2% leave-on CHG) or showering (4% rinse-of CHG) for all
patients plus mupirocin for 5 days for known MRSA. Universal ICU
decolonization was in place in both arms by September 2013. Differences
between the arms in the outcome rates between the baseline and
intervention periods were assessed with proportional hazards models, using
shared frailties to account for clustering by hospital. The primary
analysis was as-randomized and unadjusted. Primary outcome was any MRSA or
VRE clinical isolate attributable to the unit. Secondary outcome was
all-cause bloodstream infections. Additional analyses adjusted for age,
gender, race, Medicaid insurer, surgery, and comorbidities. Results. We
randomized 53 hospitals in 15 states. There were 194 adult units with
189,616 admissions in the baseline period and 340,350 in the intervention
period. Common unit types included mixed medical surgical (30%), cardiac
(20%), step-down (11%), medical (10%), surgical (10%), and oncology (4%).
There were no significant Differences between arms in the relative hazards
for intervention vs. baseline for either outcome (Table and Figure).
Adjusted analyses yielded similar results. [Table Presented] [Figure
Presented] Conclusion. Universal daily CHG bathing or showering plus
targeted mupirocin for MRSA+ patients in non-critical care units did not
reduce the combination of positive MRSA and VRE clinical cultures or
bloodstream infections due to all pathogens. Further analyses to assess
for any differential effects in high-risk subpopulations will be
important.

<23>
Accession Number
628118438
Title
Rate of peri-procedural stroke observed with cerebral embolic protection
during transcatheter aortic valve replacement: A patient-level
propensity-matched analysis.
Source
European Heart Journal. 40 (17) (pp 1334-1339), 2019. Date of Publication:
01 May 2019.
Author
Seeger J.; Kapadia S.R.; Kodali S.; Linke A.; Wohrle J.; Haussig S.;
Makkar R.; Mehran R.; Rottbauer W.; Leon M.
Institution
(Seeger, Wohrle, Rottbauer) Department of Internal Medicine II -
Cardiology, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081,
Germany
(Kapadia) Cleveland Clinic, Department of Cardiology, 9500 Euclid Ave,
Cleveland, OH, United States
(Kodali, Leon) Columbia University Medical Centre, 161 Fort Washington
Ave, New York, NY, United States
(Linke, Haussig) Herzzentrum Dresden Universitatsklinik, Fetscherstrase
76, Dresden 01307, Germany
(Makkar) Cedars-Sinai Medical Centre, 8631 W 3rd St, Los Angeles, CA,
United States
(Mehran) Mount Sinai School of Medicine, 1190 5th Avenue, 1 South, New
York, NY, United States
Publisher
Oxford University Press
Abstract
Aims The role of cerebral embolic protection (CEP) in transcatheter aortic
valve replacement (TAVR) remains controversial. Randomized trials have not
been powered to demonstrate a reduction in stroke rates. The aim of this
patient level pooled analysis was to validate the impact of the
dual-filter CEP device (Claret Medical Inc., CA, USA) on peri-procedural
stroke in a large number of TAVR patients. Methods Patients from the
SENTINEL US IDE trial were combined with the CLEAN-TAVI and SENTINEL-Ulm
study in a and results patient level pooled analysis (N= 1306). Propensity
score matching was performed to adjust for possible confounders. The
primary endpoint was procedural stroke within 72 h post-TAVR according to
Valve Academic Research Consortium-2 criteria. The secondary endpoint was
the combination of all-cause mortality or all-stroke within 72 h after
TAVR. In the propensity-matched population, 533 patients underwent TAVR
without CEP and 533 patients underwent TAVR with CEP. TAVR patients
without vs. with CEP were similar with respect to baseline
characteristics, procedural approach, or valve type. In patients
undergoing TAVR with dual-filter CEP, procedural all-stroke was
significantly lower compared with unprotected procedures [1.88% vs. 5.44%,
odds ratio 0.35, 95% confidence interval (CI) 0.17-0.72, relative risk
reduction 65%, P = 0.0028]. In addition, all-cause mortality and
all-stroke were significantly lower (2.06% vs. 6.00%, odds ratio 0.34, 95%
CI 0.17-0.68, relative risk reduction 66%, P = 0.0013). Conclusion Our
findings suggest that TAVR with the dual-filter CEP device is associated
with a significant lower rate of periprocedural stroke compared with
unprotected procedures. However, randomized trials are still needed to
clarify this issue. All rights reserved. Copyright © The
Author(s) 2018.

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

<25>
Accession Number
628043357
Title
Transcatheter versus surgical aortic valve replacement in low- and
intermediate-risk patients: an updated systematic review and
meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. 34 (3) (pp 216-225), 2019.
Date of Publication: 16 Jul 2019.
Author
Ueshima D.; Fovino L.N.; D'Amico G.; Brener S.J.; Esposito G.; Tarantini
G.
Institution
(Ueshima, Fovino, D'Amico, Tarantini) Cardiology Unit, Department of
Cardiac, Thoracic and Vascular Sciences, University of Padua Medical
School, Padua, Italy
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, NY, United States
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Naples, Italy
(Tarantini) Clinica Cardiologica, Ospedale di Padova, Centro Cardiologico
Gallucci, Via Giustiniani, 2, Padua 35128, Italy
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Transcatheter aortic valve replacement (TAVR) has been recognized as a
well-established alternative to surgical aortic valve replacement (SAVR)
for symptomatic aortic stenosis with high surgical risk. With this updated
systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low-
and intermediate-risk subjects. Studies comparing TAVR and SAVR in
low-risk patients (defined as STS <= 8% or EuroSCORE <= 20%) were
identified with electronic searches. The principal endpoint was all-cause
mortality at short term (< 3 months), 1, and 2 years. Other outcomes of
interest were cardiac mortality, neurological events, paravalvular leakage
(PVL), myocardial infarction (MI), major bleeding, acute kidney injury
(AKI), vascular complications, and new pacemaker (PM) implantation.
Seventeen articles including 9805 (4956 TAVR and 4849 SAVR) patients were
eligible. There was no significant difference in all-cause mortality at
short term [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.63-1.09],
1 year (OR 1.01, 95% CI 0.86-1.20) and 2 years (OR 0.86, 95% CI 0.64-1.16)
between treatment groups. Subgroup analyses stratified by surgical risk
score (low-risk subgroup: STS < 4% or EuroSCORE < 10%, intermediate-risk
subgroup: the others) did not show interaction on primary endpoints.
Compared to SAVR, TAVR had similar rates of neurological events,
significantly lower risk of MI and AKI, but higher risk of vascular
complications, new PM implantation and moderate/severe PVL. In low- and
intermediate-risk patients, TAVR and SAVR have similar short- and mid-term
all-cause mortality. Compared to SAVR, TAVR carries higher rates of
vascular complications, PM implantation and moderate/severe PVL, but lower
risk of MI and AKI. Copyright © 2018, Japanese Association of
Cardiovascular Intervention and Therapeutics.

<26>
Accession Number
2002113617
Title
A systematic review of the use of near-infrared fluorescence imaging in
patients with peripheral artery disease.
Source
Journal of Vascular Surgery. 70 (1) (pp 286-297.e1), 2019. Date of
Publication: July 2019.
Author
van den Hoven P.; Ooms S.; van Manen L.; van der Bogt K.E.A.; van Schaik
J.; Hamming J.F.; Vahrmeijer A.L.; van der Vorst J.R.; Mieog J.S.D.
Institution
(van den Hoven, Ooms, van Manen, van der Bogt, van Schaik, Hamming,
Vahrmeijer, van der Vorst, Mieog) Department of Surgery, Leiden University
Medical Center, Leiden, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: In the diagnosis of peripheral artery disease (PAD), the
ankle-brachial index plays an important role. However, results of the
ankle-brachial index are unreliable in patients with severe media
sclerosis. Near-infrared (NIR) fluorescence imaging using indocyanine
green (ICG) can provide information about tissue perfusion and has already
been studied in oncologic, reconstructive, and cardiac surgery. For
patients with PAD, this technique might give insight into skin perfusion
and thereby guide treatment. We performed a systematic review of the
literature on the use of NIR fluorescence imaging in patients with PAD.
 Method(s): PubMed, MEDLINE, Embase, and Cochrane were searched for
articles and abstracts on the application of NIR fluorescence imaging
using ICG as fluorescent dye in patients with PAD. Our search strategy
combined the terms "fluorescence," "ICG," or synonyms and "peripheral
artery disease" or synonyms. The extracted data included fluorescence
parameters and test characteristics for diagnosis of PAD. Result(s):
Twenty-three articles were found eligible for this review using 18
different parameters for evaluation of the fluorescence signal intensity.
NIR fluorescence imaging was used for four main indications: diagnosis,
quality control in revascularization, guidance in amputation surgery, and
visualization of vascular structures. For the diagnosis of PAD, NIR
fluorescence imaging yields a sensitivity ranging from 67% to 100% and a
specificity varying between 72% and 100%. Significant increases in
multiple fluorescence parameters were found in comparing patients before
and after revascularization. Conclusion(s): NIR fluorescence imaging
can be used for several indications in patients with PAD. NIR fluorescence
imaging seems promising in diagnosis of PAD and guidance of surgeons in
treatment, especially in patients in whom current diagnostic methods are
not applicable. Further standardization is needed to reliably use this
modality in patients with PAD. Copyright © 2018 Society for
Vascular Surgery

<27>
Accession Number
2002113612
Title
A systematic review and meta-analysis of bivalirudin application in
peripheral endovascular procedures.
Source
Journal of Vascular Surgery. 70 (1) (pp 274-284.e5), 2019. Date of
Publication: July 2019.
Author
Hu Y.; Liu A.Y.; Zhang L.; Wu X.; Shi S.; Elmore J.R.; Zhang X.
Institution
(Hu) Biomedical & Translational Informatics, Geisinger Medical Center,
Danville, Penn, United States
(Liu) Department of Cell and Systems Biology, University of Toronto,
Toronto, Ontario, Canada
(Zhang, Wu, Zhang) Division of Anesthesiology, Geisinger Medical Center,
Danville, Penn, United States
(Shi) Gillings School of Global Public Health, University of North
Carolina-Chapel Hill, Chapel Hill, NC, United States
(Elmore) Department of Vascular Surgery, Geisinger Medical Center,
Danville, Penn, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The direct thrombin inhibitor bivalirudin (BIV) was shown to be
superior to unfractionated heparin (UFH) in percutaneous coronary
interventions for reducing procedural blood loss. The aim of this study
was to compare outcome profiles of BIV and UFH in peripheral endovascular
procedures (PEPs) by synthesizing the currently available data.
 Method(s): Following the PRISMA statement, we conducted a
comprehensive literature search using Medline, Cochrane CENTRAL, PubMed,
EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We recruited
randomized, controlled trials and well-conducted observational studies
that compared UFH and BIV in PEPs requiring anticoagulation, excluding
endovascular cardiac procedures and coronary interventions. Random-effects
meta-analyses were conducted to compare the outcome profiles of these two
agents. Result(s): Thirteen articles containing 17 studies involving
a total of 21,057 patients were enrolled. Of these, 2 were randomized
controlled trials, 2 were prospective cohort studies, and 10 were
retrospective studies. There were no significant differences between BIV
and UFH in terms of procedural success rates, major and minor
perioperative bleeding, transfusion, perioperative transient ischemic
attack, or hemorrhagic strokes. However, compared with UFH, BIV had
significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58;
95% confidence interval [CI], 0.40-0.86), major adverse cardiovascular
events (OR, 0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR,
0.75; 95% CI, 0.63-0.88), perioperative myocardial infarction (OR, 0.73;
95% CI, 0.55-0.98), major vascular complications (OR, 0.59; 95% CI,
0.39-0.91), and minor vascular complications (OR, 0.58; 95% CI,
0.40-0.84). Conclusion(s): Compared with UFH, PEPs using BIV had
comparable procedural success rates and odds of perioperative transient
ischemic attack and hemorrhagic stroke. However, procedures with BIV had a
lower but nonsignificant odds of perioperative bleeding and transfusion.
Depending on the procedures conducted, the patients who received BIV will
have reduced or comparable odds of perioperative mortality, myocardial
infarction, major adverse cardiovascular events, net adverse clinical
events, and major and minor vascular complications. Therefore, BIV may be
chosen solely as an alternative procedural anticoagulant to UFH for
PEPs. Copyright © 2019 The Authors

<28>
Accession Number
2001422044
Title
A systematic review of infected descending thoracic aortic grafts and
endografts.
Source
Journal of Vascular Surgery. 69 (6) (pp 1941-1951.e1), 2019. Date of
Publication: June 2019.
Author
Kahlberg A.; Grandi A.; Loschi D.; Vermassen F.; Moreels N.; Chakfe N.;
Melissano G.; Chiesa R.
Institution
(Kahlberg, Grandi, Loschi, Melissano, Chiesa) Department of Vascular
Surgery, Vita-Salute University School of Medicine, San Raffaele
Scientific Institute, Milan, Italy
(Vermassen, Moreels) Department of Vascular and Thoracic Surgery, Ghent
University Hospital, Ghent, Belgium
(Chakfe) Department of Vascular Surgery and Kidney Transplantation,
University Hospital of Strasbourg, Strasbourg, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The objective of this study was to collect and critically
analyze the current evidence on the modalities and results of treatment of
descending thoracic aortic surgical graft (SG) and endograft (EG)
infection, which represents a rare but dramatic complication after both
surgical and endovascular aortic repair. Method(s): A comprehensive
electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar,
and the Cochrane Library) identified all articles that were published up
to October 2017 reporting on thoracic aortic SG or EG infection.
Observational studies, multicenter reports, single-center series and case
reports, case-control studies, and guidelines were considered eligible if
reporting specific results of treatment of descending thoracic aortic SG
or EG infection. Comparisons of patients presenting with SG or EG
infection and between invasive and conservative treatment were performed.
Odds ratio (OR) meta-analyses were run when comparative data were
available. Result(s): Forty-three studies reporting on 233 patients
with infected SG (49) or EG (184) were included. Four were multicenter
studies including 107 patients, all with EG infection, associated with a
fistula in 91% of cases, with a reported overall survival at 2 years of
16% to 39%. The remaining 39 single-center studies included 49 patients
with SG infection and 77 with EG infection. Association with
aortoesophageal fistula was significantly more common with EG (60% vs 31%;
P = .01). In addition, time interval from index procedure to infection was
significantly shorter with EG (17 +/- 21 months vs 32 +/- 61 months; P =
.03). Meta-analysis showed a trend of increased 1-year mortality in
patients with SG infection compared with EG infection (pooled OR, 3.6; 95%
confidence interval, 0.9-14.7; P = .073). Surgical management with
infected graft explantation was associated with a trend toward lower
1-year mortality compared with graft preservation (pooled OR, 0.3; 95%
confidence interval, 0.1-1.0; P = .056). Conclusion(s): Thoracic
aortic EG infection is likely to occur more frequently in association with
aortoesophageal fistulas and in a shorter time compared with SG infection.
Survival is poor in both groups, especially in patients with SG infection.
Surgical treatment with graft explantation seems to be the preferable
choice in fit patients. Copyright © 2018 Society for Vascular
Surgery

<29>
Accession Number
622222736
Title
Survival after aortic valve replacement with bovine or porcine valve
prostheses: A systematic review and meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. 67 (4) (pp 282-290), 2019. Date of
Publication: 2019.
Author
Glaser N.; Jackson V.; Franco-Cereceda A.; Sartipy U.
Institution
(Glaser, Jackson, Franco-Cereceda, Sartipy) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm 17176, Sweden
(Glaser) Department of Cardiology, Stockholm South General Hospital,
Stockholm, Sweden
(Jackson, Franco-Cereceda, Sartipy) Department of Heart and Vascular
Theme, Karolinska University Hospital, Stockholm, Sweden
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Bovine and porcine bioprostheses are commonly used for surgical
aortic valve replacement. It is unknown if the long-term survival differs
between the two valve types. We performed a systematic review and
meta-analysis to compare survival in patients who underwent aortic valve
replacement and received a bovine or a porcine prosthesis. Methods We
performed a systematic search of Medline, Embase, Web of Science, and the
Cochrane Library. Cohort studies that compared survival between patients
who underwent aortic valve replacement and received either a bovine or a
porcine bioprosthesis and that reported overall long-term survival with
hazard ratio (HR) and 95% confidence interval (CI) were included. Two
authors independently reviewed articles considered for inclusion,
extracted the information from each study, and performed the quality
assessment. We performed a meta-analysis using a random effects model to
calculate the pooled HR (95% CI) for all-cause mortality. We did
sensitivity analyses to assess the robustness of our findings. Results
Seven studies published between 2010 and 2015 were included, and the
combined study population was 49,190 patients. Of these, 32,235 (66%)
received a bovine, and 16,955 (34%) received a porcine bioprosthesis.
There was no significant difference in all-cause mortality between
patients who received a bovine compared with a porcine bioprosthesis
(pooled HR 1.00, 95% CI: 0.92-1.09). Heterogeneity between studies was
moderate (55.8%, p = 0.04). Conclusions This systematic review and
meta-analysis suggest no difference in survival between patients who
received a bovine versus a porcine bioprosthesis after aortic valve
replacement. Our study provides valuable evidence for the continuing use
of both bovine and porcine bioprosthetic valves for surgical aortic valve
replacement. Copyright © 2019 Georg Thieme Verlag KG Stuttgart*
New York.

<30>
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). 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. 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).
 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. Copyright © 2019 The Author(s).

<31>
Accession Number
622011607
Title
Randomized (CO)mparison of (TRI)fecta and (P)erimount Magna ease
supraannular aortic Xenografts-COTRI.P study.
Source
Thoracic and Cardiovascular Surgeon. 67 (4) (pp 266-273), 2019. Date of
Publication: 2019.
Author
Van Linden A.; Arsalan M.; Korschgen T.; Blumenstein J.; Kempfert J.;
Hecker F.; Walther T.
Institution
(Van Linden, Arsalan, Hecker, Walther) Department of Cardiac Surgery,
Kerckhoff Klinik, Bad Nauheim, Germany
(Van Linden, Arsalan, Hecker, Walther) Department of Cardiac Surgery,
University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt D-60590,
Germany
(Korschgen) Department of Cardiology, Kerckhoff Klinik, Bad Nauheim,
Germany
(Blumenstein) Department of Cardiology, St. Johannes Hospital, Dortmund,
Germany
(Kempfert) Department of Cardiac Surgery, German Heart Center, Berlin,
Germany
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Modern supraannular aortic xenografts offer a special design,
thus providing maximized opening area for improved hemodynamics. The aim
of this study was a prospectively randomized comparison of the Trifecta
and the Perimount Magna Ease valves based on metric annulus sizing.
Methods A total of 100 patients with aortic stenosis undergoing aortic
valve replacement (AVR) with or without concomitant procedures were
prospectively included. After decalcification of the annulus, stratified
intraoperative randomization was performed. The diameter of the aortic
annulus was measured using metric Hegar dilators and randomization was
based on this metric annulus diameter. Exercise echocardiography was
performed at 10-month follow-up. Results Mean age was 69 years, with 36%
female. Predominant implanted valve sizes were 23 mm (39%) and 25 mm
(32%). Unadjusted mean pressure gradient was significantly lower and
effective orifice area larger for the Trifecta group (10.8 +/- 5 vs. 13.2
+/- 4 mm Hg, p = 0.02 and 1.93 +/- 0.39 vs. 1.70 +/- 0.30 cm 2,
p = 0.002) at discharge. In patients with small annuli, based on the
metric annulus size there were no significant differences in gradients or
the orifice area. At exercise echocardiography follow-up, there were no
significant hemodynamic differences between both prostheses. Conclusions
The Trifecta and the Perimount Magna Ease prostheses both show excellent
hemodynamic performance after AVR. In patients with larger annuli, the
Trifecta valve seems to be even superior to the Magna Ease, which may be
advantageous in obese patients. Copyright © 2019 Georg Thieme
Verlag KG Stuttgart * New York.

<32>
Accession Number
627945846
Title
Meta-analysis of valve-in-valve transcatheter versus redo surgical aortic
valve replacement.
Source
Thoracic and Cardiovascular Surgeon. 67 (4) (pp 243-250), 2019. Date of
Publication: 2019.
Author
Takagi H.; Mitta S.; Ando T.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, United
States
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Objective The objective of this study was to determine whether
valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) is
associated with better survival than redo surgical aortic valve
replacement (SAVR) in patients with degenerated aortic valve
bioprostheses, and we performed a meta-analysis of comparative studies.
Methods To identify all comparative studies of VIV-TAVI versus redo SAVR;
MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials
were searched through October 2017. For each study, data regarding
all-cause mortality in both the VIV-TAVI and redo SAVR groups were used to
generate odds ratios (ORs). To assess selection bias, we generated ORs and
(standardized) mean differences (MDs) for baseline characteristics.
Study-specific estimates were combined in the random-effects model.
Results Of 446 potentially relevant articles screened initially, 6 reports
of retrospective comparative studies enrolling a total of 498 patients
were identified. Pooled analyses of baseline characteristics demonstrated
no statistically significant differences in the proportion of women,
patients with diabetes mellitus, patients with coronary artery disease,
and patients with baseline New York Heart Association functional class of
>=III; baseline ejection fraction; and predicted mortality between the
VIV-TAVI and redo SAVR groups. Patients in the VIV-TAVI group, however,
were significantly older (MD, 4.20 years) and had undergone prior coronary
artery bypass grafting more frequently (OR, 2.19) than those in the redo
SAVR group. Main pooled analyses demonstrated no statistically significant
differences in early (30 days or in-hospital) (OR, 0.91; p = 0.83) and
midterm (180 days-3 years) all-cause mortalities (OR, 1.42; p = 0.21)
between the VIV-TAVI and redo SAVR groups. Conclusion In patients with
degenerated aortic valve bioprostheses, especially elderly or high-risk
patients, VIV-TAVI could be a safe, feasible alternative to redo SAVR. The
lack of randomized data and differences in baseline characteristics in the
present analysis emphasize the need for prospective randomized
trials. Copyright © 2019 Georg Thieme Verlag KG Stuttgart * New
York.

<33>
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.
 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.
 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). 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. Copyright © 2019 Wiley Periodicals, Inc.

<34>
Accession Number
627526727
Title
Transcatheter aortic-valve replacement with a balloon-expandable valve in
low-risk patients.
Source
New England Journal of Medicine. 380 (18) (pp 1695-1705), 2019. Date of
Publication: 02 May 2019.
Author
Mack M.J.; Leon M.B.; Thourani V.H.; Makkar R.; Kodali S.K.; Russo M.;
Kapadia S.R.; Chris Malaisrie S.; Cohen D.J.; Pibarot P.; Leipsic J.; Hahn
R.T.; Blanke P.; Williams M.R.; McCabe J.M.; Brown D.L.; Babaliaros V.;
Goldman S.; Szeto W.Y.; Genereux P.; Pershad A.; Pocock S.J.; Alu M.C.;
Webb J.G.; Smith C.R.
Institution
(Mack, Brown) Baylor Scott and White Health, Plano, TX, United States
(Leon, Kodali, Hahn, Alu, Smith) Columbia University Irving Medical
Center, New York-Presbyterian Hospital, New York, United States
(Williams) New York University Langone Medical Center, New York, United
States
(Thourani) Medstar Heart and Vascular Institute, Georgetown University,
Washington, DC, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, United States
(Russo) Robert Wood Johnson Medical School, Rutgers University, New
Brunswick, NJ, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Kapadia) Cleveland Clinic, Cleveland, United States
(Chris Malaisrie) Feinberg School of Medicine, Northwestern University,
Chicago, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec, QC,
Canada
(Leipsic, Blanke, Webb) St. Paul's Hospital, University of British
Columbia, Vancouver, Canada
(McCabe) University of Washington, Seattle, United States
(Babaliaros) Emory University Hospital, Atlanta, United States
(Goldman) Lankenau Medical Center, Wynnewood, PA, United States
(Szeto) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Pershad) Banner University Medical Center, Phoenix, AZ, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Among patients with aortic stenosis who are at intermediate or
high risk for death with surgery, major outcomes are similar with
transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve
replacement. There is insufficient evidence regarding the comparison of
the two procedures in patients who are at low risk. METHODS We randomly
assigned patients with severe aortic stenosis and low surgical risk to
undergo either TAVR with transfemoral placement of a balloon-expandable
valve or surgery. The primary end point was a composite of death, stroke,
or rehospitalization at 1 year. Both noninferiority testing (with a
prespecified margin of 6 percentage points) and superiority testing were
performed in the as-treated population. RESULTS At 71 centers, 1000
patients underwent randomization. The mean age of the patients was 73
years, and the mean Society of Thoracic Surgeons risk score was 1.9% (with
scores ranging from 0 to 100% and higher scores indicating a greater risk
of death within 30 days after the procedure). The Kaplan-Meier estimate of
the rate of the primary composite end point at 1 year was significantly
lower in the TAVR group than in the surgery group (8.5% vs. 15.1%;
absolute difference, -6.6 percentage points; 95% confidence interval [CI],
-10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI,
0.37 to 0.79; P=0.001 for superiority). At 30 days, TAVR resulted in a
lower rate of stroke than surgery (P=0.02) and in lower rates of death or
stroke (P=0.01) and new-onset atrial fibrillation (P<0.001). TAVR also
resulted in a shorter index hospitalization than surgery (P<0.001) and in
a lower risk of a poor treatment outcome (death or a low Kansas City
Cardiomyopathy Questionnaire score) at 30 days (P<0.001). There were no
significant between-group differences in major vascular complications, new
permanent pacemaker insertions, or moderate or severe paravalvular
regurgitation. CONCLUSIONS Among patients with severe aortic stenosis who
were at low surgical risk, the rate of the composite of death, stroke, or
rehospitalization at 1 year was significantly lower with TAVR than with
surgery. (Funded by Edwards Lifesciences; PARTNER 3 ClinicalTrials.gov
number, NCT02675114.) Copyright © 2019 Massachusetts Medical
Society.

<35>
Accession Number
627008689
Title
Comparative pharmacokinetics of tacrolimus in stable pediatric allograft
recipients converted from immediate-release tacrolimus to
prolonged-release tacrolimus formulation.
Source
Pediatric Transplantation. 23 (4) (no pagination), 2019. Article Number:
e13391. Date of Publication: June 2019.
Author
Rubik J.; Debray D.; Iserin F.; Vondrak K.; Sellier-Leclerc A.-L.; Kelly
D.; Czubkowski P.; Webb N.J.A.; Riva S.; D'Antiga L.; Marks S.D.; Rivet
C.; Tonshoff B.; Kazeem G.; Undre N.
Institution
(Rubik) Department of Nephrology, Kidney Transplantation and Hypertension,
The Children's Memorial Health Institute, Warsaw, Poland
(Debray) Pediatric Hepatology Unit, APHP-University Hospital Necker
Enfants Malades, Paris, France
(Iserin) Department of Pediatric Cardiology, University Hospital Necker
Enfants Malades, Paris, France
(Vondrak) Department of Pediatrics, University Hospital Motol, Second
School of Medicine, Charles University, Prague, Czechia
(Sellier-Leclerc) Department of Nephrology, Rheumatology, and Dermatology,
Center for Rare Diseases, Civil Hospice of Lyon, "Woman-Mother-Child"
Hospital, Bron, France
(Kelly) The Liver Unit, Birmingham Women's and Children's Hospital,
Birmingham, United Kingdom
(Czubkowski) Department of Gastroenterology, Hepatology, Nutritional
Disorders and Pediatrics, The Children's Memorial Health Institute,
Warsaw, Poland
(Webb) Department of Paediatric Nephrology and NIHR/Wellcome Trust
Manchester Clinical Research Facility, University of Manchester,
Manchester Academic Health Science Centre, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Riva) Department of Pediatrics, ISMETT-IRCCS, Palermo, Italy
(D'Antiga) Pediatric Hepatology, Gastroenterology and Transplantation,
Hospital Papa Giovanni XXIII, Bergamo, Italy
(Marks) Department of Paediatric Nephrology, Great Ormond Street Hospital
for Children, NHS Foundation Trust, London, United Kingdom
(Rivet) Pediatric Hepatology, Gastroenterology and Transplantation, Civil
Hospice of Lyon, Lyon, France
(Tonshoff) Department of Pediatrics I, University Children's Hospital
Heidelberg, Heidelberg, Germany
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kazeem) BENKAZ Consulting Ltd, Cambridge, United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
This study was a Phase II, open-label, multicenter, single-arm, cross-over
study comparing the pharmacokinetics (PK) of tacrolimus in stable
pediatric kidney, liver, or heart allograft recipients converted from
immediate-release tacrolimus (IR-T) to prolonged-release tacrolimus
(PR-T). In Days -30 to -1 of screening period, patients received their
IR-T-based regimen; during Days 1-7, patients received study IR-T (same
dose as screening). On Day 7, the first 24-hours PK profile was taken;
patients were then converted to PR-T (1 mg:1 mg), with a second 24-hours
PK profile taken on Day 14. The primary end-point was tacrolimus area
under the blood concentration-time curve over 24 hours (AUC<inf>24</inf>);
secondary end-points were maximum concentration C<inf>max</inf>and
concentration at 24 hours C<inf>24</inf>. The predefined similarity
interval for confidence intervals (CIs) of least squares mean (LSM) ratios
was 80%-125%. The PK analysis set comprised 74 pediatric transplant
recipients (kidney, n = 45; liver, n = 28; heart, n = 1). PR-T:IR-T LSM
ratio (90% CI) was similar overall for AUC<inf>24</inf>, <inf>max</inf>,
and C<inf>24</inf>, and for kidney and liver recipients for
AUC<inf>24</inf> (LSM ratio, kidney 91.8%; liver 104.1%) and
C<inf>24</inf> (kidney 90.5%; liver 89.9%). Linear relationship was
similar between AUC<inf>24</inf> and C<inf>24</inf>, and between PR-T and
IR-T (rho 0.89 and 0.84, respectively), suggesting that stable pediatric
transplant recipients can be converted from IR-T to PR-T at the same total
daily dose, using the same therapeutic drug monitoring
method. Copyright © 2019 The Authors. Pediatric Transplantation
published by Wiley Periodicals, Inc

<36>
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). 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. 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). 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. Copyright © 2019 Wiley
Periodicals, Inc.

<37>
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. 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. 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. 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. Copyright © 2019 Wiley Periodicals, Inc.

<38>
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).
 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. 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.
 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. Copyright © 2019
Wiley Periodicals, Inc.

<39>
Accession Number
626168912
Title
Comparison of clinical outcomes between intravascular ultrasound-guided
and angiography-guided drug-eluting stent implantation: A meta-analysis of
randomised control trials and systematic review.
Source
International Wound Journal. 16 (3) (pp 649-658), 2019. Date of
Publication: June 2019.
Author
Tan Y.-Y.; Man X.-X.; Liu L.-Y.; Xu H.
Institution
(Tan, Xu) Department of Echocardiography, The First Hospital of Jilin
University, Changchun, China
(Man) Department of Gynecologic Oncology, The First Hospital of Jilin
University, Changchun, China
(Liu) Department of Andrology, The First Hospital of Jilin University,
Changchun, China
Publisher
Blackwell Publishing Ltd
Abstract
This systematic review was designed to evaluate the overall efficacy of
angiography-guided drug-eluting stent (DES) implantation vs intravascular
ultrasound-guided (IVUS) implantation for percutaneous coronary
intervention. The electronic databases CENTRAL, PubMed, Cochrane, and
EMBASE were searched for systematic reviews to investigate
angiography-guided and IVUS-guided DES implantation. We measured the
following six parameters in each patient: cardiovascular death, stent
thrombosis, target lesion revascularisation (TLR), myocardial infarction
(MI), major adverse cardiac events (MACEs), and all-cause death. Twelve
studies involving 6268 subjects were included, with 2984 receiving
IVUS-guided DES implantation and 3284 using angiography-guided DES
implantation. With regard to MACEs, TLR, MI, cardiovascular death, and
all-cause death, the IVUS-guided DES implantation group had remarkably
improved clinical outcomes. However, there was no significant statistical
difference in stent thrombosis between the two groups. Dramatic decrease
in MACEs through IVUS guidance was presented by trial sequential analysis.
Remarkably improved clinical outcomes, including MACEs, cardiovascular
death, all-cause death, and TLR, were identified through IVUS-guided DES
implantation in comparison with angiography-guided DES implantation.
Nonetheless, the effect on stent thrombosis and MI required further
confirmation. In this meta-analysis, eligible randomised clinical trials
were warranted to verify the findings and to determine the beneficial
effect of IVUS guidance for patients. Copyright © 2019
Medicalhelplines.com Inc and John Wiley & Sons Ltd

<40>
Accession Number
627237536
Title
A Systematic Review of Direct Cardiovascular Event Costs: An International
Perspective.
Source
PharmacoEconomics. 37 (7) (pp 895-919), 2019. Date of Publication: 01 Jul
2019.
Author
Ryder S.; Fox K.; Rane P.; Armstrong N.; Wei C.-Y.; Deshpande S.; Stirk
L.; Qian Y.; Kleijnen J.
Institution
(Ryder, Armstrong, Wei, Deshpande, Stirk) Kleijnen Systematic Reviews Ltd,
Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD,
United Kingdom
(Fox) Strategic Healthcare Solutions LLC, 133 Cottonwood Creek Lane,
Aiken, SC 29803, United States
(Rane, Qian) Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA
91320-1799, United States
(Kleijnen) School for Public Health and Primary Care, Maastricht
University, Maastricht, Netherlands
Publisher
Springer International Publishing
Abstract
Introduction: There is a lack of comprehensive cost information for
cardiovascular events since 2013. Objective(s): A systematic review
on the contemporary cost of cardiovascular events was therefore
undertaken. Method(s): Methods complied with those recommended by the
Cochrane Collaboration and the Centre for Reviews and Dissemination.
Studies were unrestricted by language, were from 2013 to 23 December 2017,
and included cost-of-illness data in adults with the following
cardiovascular conditions: myocardial infarction (MI), stroke, transient
ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary
artery bypass graft (CABG), percutaneous coronary intervention (PCI), or
peripheral artery disease (PAD). Seven electronic databases were searched,
namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and
Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health
Technology Assessment (HTA) database, Cochrane Central Register of
Controlled Trials (CENTRAL), and PubMed. The included studies reported
data from a variety of years (sometimes prior to 2013), so costs were
inflated and converted to $US, year 2018 values, for standardization.
 Result(s): After de-duplication, 29,945 titles and abstracts and then
403 full papers were screened; 82 studies (88 papers) were extracted. Year
1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in
the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in
Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA),
UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to
$45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One
Swedish study reported PAD costs in a format convertible to $US, 2018
values, with a mean annual cost of $15,565. Conclusion(s): There was
considerable unexplained variation in contemporary costs for all major
cardiovascular events. One emerging theme was that average costs in the
USA were considerably higher than anywhere else. Copyright ©
2019, Springer Nature Switzerland AG.

<41>
Accession Number
625266952
Title
Effect of continuous local anesthetic in post-cardiac surgery patients: A
systematic review.
Source
Pain Medicine (United States). 19 (5) (pp 1077-1090), 2018. Date of
Publication: 01 May 2018.
Author
Hong S.S.; Milross M.A.; Alison J.A.
Institution
(Hong, Milross, Alison) Physiotherapy Department, Liverpool Hospital,
Sydney, NSW 2170, Australia
(Hong) Discipline of Physiotherapy and Discipline of Physiotherapy,
Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
(Alison) Physiotherapy Department, Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Oxford University Press
Abstract
Objective. The purpose of this review was to determine the effect of CLA
infusion post cardiac surgery on pain, time to ambulation, severe adverse
events, patient satisfaction, time to extubation, length of stay in the
intensive care unit and in the hospital, total narcotic consumption, and
pulmonary function. Design. Systematic review with meta-Analysis (PROSPERO
CRD42014010188). Methods. We searched the following electronic databases:
The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE;
EMBASE; CINAHL; Allied and Complementary Medicine (AMED); and PsycINFO; as
well as hand-searching cardiothoracic surgery and anesthetic journals and
meeting abstracts. Results. Ten eligible trials with a total of 546
participants were identified. Meta-Analyses showed that CLA infusion
significantly reduced the total mean visual analog pain score at 72 hours
(mean difference [MD] 5 ?14.31mm, 95% confidence interval [CI] 5 ?25.59 to
?3.03); time to ambulation (MD 5 ?2.81 hours, 95% CI 5 ?5.23 to ?0.4);
morphine requirement (MD 5 ?10.19 mg, 95% CI 5 ?11.80 to ?8.58) but did
not reduce time to ambulate to chair (MD 5 ?1.65 hours, 95% CI 5 ?4.04 to
0.74); time to extubation (MD 5 ?0.18 hours, 95% CI 5 ?1.24 to 0.89);
length of ICU stay (MD50.9 hours, 95% CI 5 ?2.96 to 4.75); and hospital
length of stay (MD 5 ?0.59 days, 95% CI 5 ?1.24 to 0.07). There were
insufficient data to perform a meta-Analysis on severe adverse events,
patient satisfaction, or pulmonary function. Conclusions. CLA infusion
after cardiac surgery reduces pain score at 72 hours, shortens time to
ambulation, and reduces morphine consumption at 48 hours. Copyright
© 2018 Oxford University Press. All Rights Reserved.

<42>
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. 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. 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). 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). 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. Kardiologia Polska Copyright © Polish Cardiac Society
2018.

<43>
Accession Number
620892214
Title
Transcatheter aortic valve implantation (TAVI) for native aortic valve
regurgitation - A systematic review -.
Source
Circulation Journal. 82 (3) (pp 895-902), 2018. Date of Publication: 2018.
Author
Yousef A.; MacDonald Z.; Simard T.; Russo J.J.; Feder J.; Froeschl M.V.;
Dick A.; Glover C.; Burwash I.G.; Latib A.; Rodes-Cabau J.; Labinaz M.;
Hibbert B.
Institution
(Yousef, MacDonald, Simard, Russo, Feder, Froeschl, Dick, Glover, Burwash,
Latib, Labinaz, Hibbert) CAPITAL Research Group, Division of Cardiology,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus and
San Raffaele Scientific Institute, Milan, Italy
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Simard, Hibbert) Department of Cellular and Molecular Medicine,
University of Ottawa, Ottawa, ON, Canada
Publisher
Japanese Circulation Society
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the
standard of care for management of high-risk patients with aortic
stenosis. Limited data is available regarding the performance of TAVI in
patients with native aortic valve regurgitation (NAVR). Methods and
Results: We performed a systematic review from 2002 to 2016. The primary
outcome was device success as per VARC-2 criteria. Secondary endpoints
included procedural complications, and 30-day and 1-year mortality rates.
A total of 175 patients were included from 31 studies. Device success was
reported in 86.3% of patients - with device failure driven by moderate
aortic regurgitation (AR >=3+) and/or need for a second device. Procedural
complications were rare, with no procedural deaths, myocardial infarctions
or annular ruptures reported. Procedural safety was acceptable with a low
30-day incidence of stroke (1.5%). The 30-day and 1-year overall mortality
rates were 9.6% and 20.0% (cardiovascular death, 3.8% and 10.1%,
respectively). Patients receiving 2nd-generation valves demonstrated
similar safety profiles with greater device success compared with
1st-generation valves (96.2% vs. 78.4%). This was driven by the higher
incidence of second-valve implantation (23.4% vs. 1.7%) and significant
paravalvular leak (8.3% vs. 0.0%). Conclusion(s): TAVI demonstrates
acceptable safety and efficacy in high-risk patients with severe NAVR.
Second-generation valves may afford a similar safety profile with improved
device success. Dedicated studies are needed to definitively establish the
efficacy of TAVI in this population. Copyright © 2018, Japanese
Circulation Society. All rights reserved.

<44>
Accession Number
626390306
Title
Acute and long-term efficacy and safety with a single cryoballoon
application as compared with the standard dual application strategy: A
prospective randomized study using the second-generation cryoballoon for
pulmonary vein isolation in patients with symptomatic atrial fibrillation.
Source
Europace. 20 (10) (pp 1598-1605), 2018. Date of Publication: 2018.
Author
Mortsell D.; Malmborg H.; Lonnerholm S.; Jansson V.; Blomstrom-Lundqvist
C.
Institution
(Malmborg, Lonnerholm, Jansson, Blomstrom-Lundqvist) Department of Medical
Sciences, Department of Cardiology, Uppsala University, Sjukhusvagen 85,
Uppsala SE 751 85, Sweden
Publisher
Oxford University Press
Abstract
Aims A single cryoballoon (CB) application per vein for pulmonary vein
isolation (PVI) in patients with atrial fibrillation (AF) could save time
and was therefore compared to the standard approach of two consecutive CB
applications for acute and long-term efficacy and safety. Methods Patients
with symptomatic AF were randomized to a single CB application per vein
guided by an Achieve catheter and results (Single cryo-arm) or to two CB
applications using a standard guidewire (Routine cryo-arm). The primary
endpoint was the rate of acute complete PVI. Secondary endpoints were
freedom from AF evaluated by electrocardiogram and 7 days Holter at 6 and
12 months, symptoms by Symptom Severity Questionnaires and EHRA score and
quality of life (QoL) by EQ5D-5L at 12 months. Among 140 patients
included, PVI was achieved in 271 (100%) veins in the Single cryo-arm and
in 269/271 (99.3%) veins in the Routine cryo-arm, P=0.25. The procedure
time was shorter in the Single cryo-arm, mean +/- standard deviation
99.4+/-33.3min vs. 118.4+/-34.3min, P=0.0015. Freedom from AF after one
procedure at 12 months did not differ; 73.9.0% (Single cryo) vs. 71.4%
(Routine), P=0.74. Symptoms and QoL did also not differ between the two
groups. There was a lower complication rate in the Single cryo-group, 2.9%
vs. 12.9%, P=0.03. Conclusion A single CB application shortens the
procedure time without affecting acute or long-term efficacy, as compared
to the routine two-application strategy, which with the lower complication
rates has important implications when defining standards for
PVI. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2018.

<45>
Accession Number
620124669
Title
Clinical efficacy and safety of evolocumab in high-risk patients receiving
a statin: Secondary analysis of patients with low LDL cholesterol levels
and in those already receiving a maximal-potency statin in a randomized
clinical trial.
Source
JAMA Cardiology. 2 (12) (pp 1385-1391), 2017. Date of Publication:
December 2017.
Author
Giugliano R.P.; Keech A.; Murphy S.A.; Huber K.; Tokgozoglu S.L.; Lewis
B.S.; Ferreira J.; Pineda A.L.; Somaratne R.; Sever P.S.; Pedersen T.R.;
Sabatine M.S.
Institution
(Giugliano, Murphy, Sabatine) TIMI (Thrombolysis in Myocardial Infarction)
Study Office, Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, 60 Fenwood Rd, Ste 7122, Boston, MA 02115, United
States
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Sydney, Australia
(Huber) Third Department of Medicine, Cardiology, and Intensive Care
Medicine, Faculty of Medicine, Sigmund Freud University, Vienna, Austria
(Tokgozoglu) Department of Cardiology, Hacettepe University Faculty of
Medicine, Ankara, Turkey
(Lewis) Cardiovascular Clinical Research Institute, Lady Davis Carmel
Medical Center, Haifa, Israel
(Ferreira) Department of Cardiology, Hospital de Santa Cruz, Lisbon,
Portugal
(Pineda, Somaratne) Amgen, Inc, Thousand Oaks, CA, United States
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Ulleval and Medical Faculty, Oslo University Hospital,
University of Oslo, Oslo, Norway
(Sabatine) JAMA Cardiology, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Current guidelines for atherosclerotic cardiovascular disease
focus on high-intensity statins and targeting or using a threshold
low-density lipoprotein cholesterol (LDL-C) level of less than 70mg/dL for
the highest-risk patients. Whether further reduction of LDL-C beyond these
boundaries would be beneficial is unknown. OBJECTIVE To compare outcomes
of evolocumab vs placebo in patients with stable atherosclerotic
cardiovascular disease and a baseline LDL-C of less than 70mg/dL and in
those receiving background treatment with a maximal-potency statin.
DESIGN, SETTING, AND PARTICIPANTS This secondary ad hoc analysis of the
Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects
With Elevated Risk (FOURIER) trial compared randomized treatments in 2
subgroups of patients with stable atherosclerotic cardiovascular disease
currently receiving statin. Patientswere classified by a baseline LDL-C of
less than 70 or at least 70mg/dL and by statin intensity (maximal:
atorvastatin calcium, 80mg/d, or rosuvastatin, 40mg/d; submaximal: all
other dosages). Patients with baseline LDL of less than 70mg/dL either had
a final screening LDL-C of at least 70mg/dL or a final screening
non-high-density lipoprotein cholesterol level of at least 100 mg/dL.
Datawere retrieved from 2013 to 2016 and analyzed in 2017 based on
intention to treat. MAIN OUTCOMES AND MEASURES The primary efficacy
endpointwas the composite of cardiovascular death,myocardial infarction,
stroke, hospitalization for unstable angina, or coronary
revascularization. The secondary efficacy endpoint was the composite of
cardiovascular death,myocardial infarction, or stroke. Safety outcomes
included adverse events and events of interest identified in the FOURIER
trial. Interaction testing was used to assess the consistency of results
in patients who did vs did not satisfy the above criteria. RESULTS A total
of 27 564 patients (75.4%men and 24.6%women; mean [SD] age, 62.5 [9.0]
years) were included in the analysis. Of 2034 patients (7.4%) who had a
baseline LDL-C of less than 70mg/dL, evolocumab reduced the risk for the
primary endpoint (hazard ratio [HR], 0.80; 95%CI, 0.60-1.07) to a similar
degree as in the 25 529 patients who had baseline LDL-C of at least
70mg/dL (HR 0.86; 95%CI, 0.79-0.92; P = .65 for interaction; 1 patient was
missing baseline LDL-C data). Of 7533 patients (27.3%) receiving
maximal-potency statins, evolocumab significantly reduced the primary
endpoint (HR, 0.86; 95%CI, 0.75-0.98) to a similar degree as in the 20 031
patients not receiving a maximal-potency statin (HR, 0.85; 95%CI,
0.78-0.93; P = .88 for interaction). The key secondary endpoint was
reduced to a similar degree in both analyses. No major safety concerns
were identified. CONCLUSIONS AND RELEVANCE Evolocumabwas equally effective
in reducing cardiovascular events in patients with stable atherosclerotic
cardiovascular disease regardless of whether the baseline LDL-C was less
than 70 or at least 70mg/dL and whether the background statin was of
maximal or submaximal potency. Copyright © 2017 American Medical
Association. All rights reserved.

<46>
Accession Number
619378690
Title
Longitudinal hemodynamics of transcatheter and surgical aortic valves in
the PARTNER Trial.
Source
JAMA Cardiology. 2 (11) (pp 1197-1206), 2017. Date of Publication:
November 2017.
Author
Douglas P.S.; Leon M.B.; Mack M.J.; Svensson L.G.; Webb J.G.; Hahn R.T.;
Pibarot P.; Weissman N.J.; Miller D.C.; Kapadia S.; Herrmann H.C.; Kodali
S.K.; Makkar R.R.; Thourani V.H.; Lerakis S.; Lowry A.M.; Rajeswaran J.;
Finn M.T.; Alu M.C.; Smith C.R.; Blackstone E.H.
Institution
(Douglas, Leon, Hahn) Duke University Medical Center, Durham, NC, United
States
(Leon, Hahn, Kodali, Finn, Alu, Smith) New York Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Svensson, Kapadia, Lowry, Rajeswaran, Blackstone) Cleveland Clinic,
Cleveland, OH, United States
(Webb) St Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Weissman, Miller) MedStar Washington Hospital Center, Washington, DC,
United States
(Miller) Stanford University, Stanford, CA, United States
(Herrmann) University of Pennsylvania Health System, Philadelphia, PA,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani, Lerakis) Emory University, Atlanta, GA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Use of transcatheter aortic valve replacement (TAVR) for
severe aortic stenosis is growing rapidly. However, to our knowledge, the
durability of these prostheses is incompletely defined. OBJECTIVE(S):
To determine the midterm hemodynamic performance of balloon-expandable
transcatheter heart valves. DESIGN, SETTING, AND PARTICIPANTS: In this
study, we analyzed core laboratory-generated data from echocardiograms of
all patients enrolled in the Placement of Aortic Transcatheter Valves
(PARTNER) 1 Trial with successful TAVR or surgical AVR (SAVR) obtained
preimplantation and at 7 days, 1 and 6 months, and 1, 2, 3, 4, and 5 years
postimplantation. Patients from continued access observational studies
were included for comparison. INTERVENTIONS: Successful implantation after
randomization to TAVR vs SAVR (PARTNER 1A; TAVR, n = 321; SAVR, n = 313),
TAVR vs medical treatment (PARTNER 1B; TAVR, n = 165), and continued
access (TAVR, n = 1996). Five-year echocardiogram data were available for
424 patients after TAVR and 49 after SAVR. MAIN OUTCOMES AND MEASURES:
Death or reintervention for aortic valve structural indications, measured
using aortic valve mean gradient, effective orifice area, Doppler velocity
index, and evidence of hemodynamic deterioration by reintervention,
adverse hemodynamics, or transvalvular regurgitation. RESULT(S): Of
2795 included patients, the mean (SD) age was 84.5 (7.1) years, and 1313
(47.0%) were female. Population hemodynamic trends derived from nonlinear
mixed-effects models showed small early favorable changes in the first few
months post-TAVR, with a decrease of -2.9 mm Hg in aortic valve mean
gradient, an increase of 0.028 in Doppler velocity index, and an increase
of 0.09 cm2 in effective orifice area. There was relative
stability at a median follow-up of 3.1 (maximum, 5) years. Moderate/severe
transvalvular regurgitation was noted in 89 patients (3.7%) after TAVR and
increased over time. Patients with SAVR showed no significant changes. In
TAVR, death/reintervention was associated with lower ejection fraction,
stroke volume index, and aortic valve mean gradient up to 3 years, with no
association with Doppler velocity index or valve area. Reintervention
occurred in 20 patients (0.8%) after TAVR and in 1 (0.3%) after SAVR and
became less frequent over time. Reintervention was caused by structural
deterioration of transcatheter heart valves in only 5 patients. Severely
abnormal hemodynamics on echocardiograms were also infrequent and not
associated with excess death or reintervention for either TAVR or SAVR.
CONCLUSIONS AND RELEVANCE: This large, core laboratory-based study of
transcatheter heart valves revealed excellent durability of the
transcatheter heart valves and SAVR. Abnormal findings in individual
patients, suggestive of valve thrombosis or structural deterioration, were
rare in this protocol-driven database and require further investigation.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00530894. Copyright © 2017 American Medical Association. All
rights reserved.

<47>
Accession Number
619032645
Title
Survival and cardiovascular outcomes of patients with secondary mitral
regurgitation: A systematic review and meta-analysis.
Source
JAMA Cardiology. 2 (10) (pp 1130-1139), 2017. Date of Publication: October
2017.
Author
Sannino A.; Smith R.L.; Schiattarella G.G.; Trimarco B.; Esposito G.;
Grayburn P.A.
Institution
(Sannino, Grayburn) Division of Cardiology, Department of Medicine, Baylor
University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX,
United States
(Sannino, Schiattarella) Division of Cardiology, Department of Medicine,
Universita Degli Studi di Napoli Federico II, Naples, Italy
(Smith) Department of Cardiothoracic Surgery, Heart Hospital Baylor Plano,
Plano, TX, United States
(Schiattarella) Division of Cardiology, Department of Medicine, University
of Texas Southwestern Medical Center, Dallas, United States
(Trimarco, Esposito) Division of Cardiology, Department of Medicine,
Universita Degli Studi di Napoli Federico II, Naples, Italy
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: The outcomes of patients with left ventricular (LV)
dysfunction and secondary mitral regurgitation (SMR) are still
controversial. OBJECTIVE(S): To clarify the role of SMR in the
outcomes of patients with ischemic or idiopathic cardiomyopathies. DATA
SOURCES: MEDLINE, ISI Web of Science, and Scopus databases were searched
for studies published up to March 2017. STUDY SELECTION: Studies reporting
data on outcomes in patients with SMR were included. Duplicate publication
data, studies lacking data on SMR grade and its correlation with outcomes,
mixed data on SMR and primary mitral regurgitation, studies not clearly
reporting the outcome of interest, and studies with fewer than 100
patients were excluded. Of the initial 3820 articles identified, 1.4% were
finally included. DATA EXTRACTION AND SYNTHESIS: The study met PRISMA
requirements. Two of us independently screened articles for fulfillment of
inclusion criteria. MAIN OUTCOMES AND MEASURES: The primary outcome, set
after data collection, was the incidence of all-cause mortality in
patients with and without SMR. Secondary outcomes included hospitalization
for heart failure (HF), cardiac mortality, and a composite end point of
death, HF hospitalization, and cardiac transplant. RESULT(S):
Fifty-three studies and 45 900 patients were included in the
meta-analysis. The mean (SD) length of follow-up was 40.8 (22.2) months.
In 26 of 36 studies reporting LV function by SMR grade, increasing SMR
severity was associated with worse LV function. When SMR was categorized
as present or absent, all-cause mortality was significantly higher in the
patients with SMR (17 studies, 26 359 patients; risk ratio [RR],1.79; 95%
CI, 1.47-2.18; P < .001, I2 = 85%); when SMR was qualitatively
graded, the incidence of all-cause mortality was significantly increased
in patients having any degree of SMR compared with patients not having SMR
(21 studies, 21 081 patients; RR, 1.96; 95% CI, 1.67-2.31; P < .001,
I2 = 74%). Finally, when SMR was quantitatively graded, it
remained associated with an increased all-cause mortality rate (9 studies,
3649 patients; RR, 1.97; 95% CI, 1.71-2.27; P < .001, I2 = 0%).
Moreover, SMR was associated with an increased risk of hospitalization for
HF (16 studies, 10 171 patients; RR, 2.26; 95% CI, 1.92-2.67; P < .001,
I2 = 41%), cardiac mortality (12 studies, 11 896 patients; RR,
2.62; 95% CI, 1.87-3.69; P < .001, I2 = 74%), and death, HF,
and transplant (11 studies, 8256 patients; RR, 1.63; 95% CI, 1.33-1.99; P
< .001, I2 = 78%). CONCLUSIONS AND RELEVANCE: To our knowledge,
this study is the first meta-analysis to date to demonstrate that SMR,
even when mild, correlates with adverse outcomes in patients with ischemic
or idiopathic cardiomyopathies. Because SMR is an intrinsic consequence of
LV dysfunction, causality between SMR and mortality should not be
implied. Copyright © 2017 American Medical Association. All
rights reserved.

<48>
Accession Number
619032639
Title
Percutaneous coronary intervention vs coronary artery bypass grafting in
patients with left main coronary artery stenosis: A systematic review and
meta-analysis.
Source
JAMA Cardiology. 2 (10) (pp 1079-1088), 2017. Date of Publication: October
2017.
Author
Giacoppo D.; Colleran R.; Cassese S.; Frangieh A.H.; Wiebe J.; Joner M.;
Schunkert H.; Kastrati A.; Byrne R.A.
Institution
(Giacoppo, Colleran, Cassese, Frangieh, Wiebe, Joner, Schunkert, Kastrati,
Byrne) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Joner, Schunkert, Kastrati, Byrne) German Centre for Cardiovascular
Research, Partner Site Munich Heart Alliance, Munich, Germany
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: In patients with left main coronary artery (LMCA) stenosis,
coronary artery bypass grafting (CABG) has been the standard therapy for
several decades. However, some studies suggest that percutaneous coronary
intervention (PCI) with drug-eluting stents may be an acceptable
alternative. OBJECTIVE(S): To compare the long-term safety of PCI
with drug-eluting stent vs CABG in patients with LMCA stenosis. DATA
SOURCES: PubMed, Scopus, EMBASE, Web of Knowledge, and ScienceDirect
databases were searched from December 18, 2001, to February 1, 2017.
Inclusion criteria were randomized clinical trial, patients with LMCA
stenosis, PCI vs CABG, exclusive use of drug-eluting stents, and clinical
follow-up of 3 or more years. DATA EXTRACTION AND SYNTHESIS: Trial-level
hazard ratios (HRs) and 95% CIs were pooled by fixed-effect and
random-effects models with inverse variance weighting. Time-to-event
individual patient data for the primary end point were reconstructed.
Sensitivity analyses according to drug-eluting stent generation and
coronary artery disease complexity were performed. MAIN OUTCOMES AND
MEASURES: The primary end point was a composite of all-cause death,
myocardial infarction, or stroke at long-term follow-up. Secondary end
points included repeat revascularization and a composite of all-cause
death, myocardial infarction, stroke, or repeat revascularization at
long-term follow-up. RESULTS: A total of 4 randomized clinical trials were
pooled; 4394 patients were included in the analysis. Of these, 3371
(76.7%) were men; pooled mean age was 65.4 years. According to Grading of
Recommendations, Assessment, Development and Evaluation, evidence quality
with respect to the primary composite end point was high. Percutaneous
coronary intervention and CABG were associated with a comparable risk of
all-cause death, myocardial infarction, or stroke both by fixed-effect
(HR, 1.06; 95% CI, 0.90-1.24; P = .48) and random-effects (HR, 1.06; 95%
CI, 0.85-1.32; P = .60) analysis. Sensitivity analyses according to low to
intermediate Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX)
score (random-effects: HR, 1.02; 95% CI, 0.74-1.41; P = .89) and
drug-eluting stent generation (first generation: HR, 0.90; 95% CI,
0.68-1.20; P = .49; second generation: HR, 1.19; 95% CI, 0.82-1.73; P =
.36) were consistent. Kaplan-Meier curve reconstruction did not show
significant variations over time between the techniques, with a 5-year
incidence of all-cause death, myocardial infarction, or stroke of 18.3%
(319 events) in patients treated with PCI and 16.9% (292 events) in
patients treated with CABG. However, repeat revascularization after PCI
was increased (HR, 1.70; 95% CI, 1.42-2.05; P < .001). Other individual
secondary end points did not differ significantly between groups. Finally,
pooled estimates of trials with LMCA stenosis tended overall to differ
significantly from those of trials with multivessel coronary artery
disease without left main LMCA stenosis. CONCLUSIONS AND RELEVANCE:
Percutaneous coronary intervention and CABG show comparable safety in
patients with LMCA stenosis and low to intermediate-complexity coronary
artery disease. However, repeat revascularization is more common after
PCI. Copyright © 2017 American Medical Association. All rights
reserved.

<49>
Accession Number
2001744272
Title
Does prior coronary angioplasty affect outcomes of surgical coronary
revascularization? Insights from the STICH trial.
Source
International Journal of Cardiology. 291 (pp 36-41), 2019. Date of
Publication: 15 September 2019.
Author
Nicolau J.C.; Stevens S.R.; Al-Khalidi H.R.; Jatene F.B.; Furtado R.H.M.;
Dallan L.A.O.; Lisboa L.A.F.; Desvigne-Nickens P.; Haddad H.; Jolicoeur
E.M.; Petrie M.C.; Doenst T.; Michler R.E.; Ohman E.M.; Maddury J.; Ali
I.; Deja M.A.; Rouleau J.L.; Velazquez E.J.; Hill J.A.
Institution
(Nicolau, Jatene, Furtado, Dallan, Lisboa) Instituto do Coracao (InCor),
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, SP, Brazil
(Stevens, Al-Khalidi, Ohman) Duke Clinical Research Institute and
Department of Biostatistics and Bioinformatics, Duke University School of
Medicine, Durham, NC, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
(Haddad) Department of Medicine, University of Saskatchewan, Saskatoon,
Saskatchewan, Canada
(Jolicoeur, Rouleau) Montreal Heart Institute, Universite de Montreal,
Quebec, Canada
(Petrie) BHF Cardiovascular Research Centre, University of Glasgow,
Glasgow, United Kingdom
(Doenst) Department of Cardiothoracic Surgery, University of Jena, Jena,
Germany
(Michler) Department of Cardiothoracic Surgery, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Maddury) Department of Cardiology, Nizams Institute of Medical Sciences,
Hyderabad, India
(Ali) Libin Cardiovascular Institute of Alberta, University of Calgary,
Foothills Medical Centre, Calgary, Alberta, Canada
(Deja) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Velazquez) Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Hill) Department of Medicine, University of Florida, Gainesville, FL,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The STICH trial showed superiority of coronary artery bypass
plus medical treatment (CABG) over medical treatment alone (MED) in
patients with left ventricular ejection fraction (LVEF) <=35%. In previous
publications, percutaneous coronary intervention (PCI) prior to CABG was
associated with worse prognosis. Objective(s): The main purpose of
this study was to analyse if prior PCI influenced outcomes in STICH.
 Methods and Results: Patients in the STICH trial (n = 1212), followed
for a median time of 9.8 years, were included in the present analyses. In
the total population, 156 had a prior PCI (74 and 82, respectively, in the
MED and CABG groups). In those with vs. without prior PCI, the adjusted
hazard-ratios (aHRs) were 0.92 (95% CI = 0.74-1.15) for all-cause
mortality, 0.85 (95% CI = 0.64-1.11) for CV mortality, and 1.43 (95% CI =
1.15-1.77) for CV hospitalization. In the group randomized to CABG without
prior PCI, the aHRs were 0.82 (95% CI = 0.70-0.95) for all-cause
mortality, 0.75 (95% CI = 0.62-0.90) for CV mortality and 0.67 (95% CI =
0.56-0.80) for CV hospitalization. In the group randomized to CABG with
prior PCI, the aHRs were 0.76 (95% CI = 0.50-1.15) for all-cause
mortality, 0.81 (95% CI = 0.49-1.36) for CV mortality and 0.61 (95% CI =
0.41-0.90) for CV hospitalization. There was no evidence of interaction
between randomized treatment and prior PCI for any endpoint (all adjusted
p > 0.05). Conclusion(s): In the STICH trial, prior PCI did not
affect the outcomes of patients whether they were treated medically or
surgically, and the superiority of CABG over MED remained unchanged
regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov;
Identifier: NCT00023595 Copyright © 2019 Elsevier B.V.

<50>
Accession Number
626168450
Title
Perioperative Bridging With Glycoprotein IIb/IIIa Inhibitors Versus
Cangrelor: Balancing Efficacy and Safety.
Source
Annals of Pharmacotherapy. 53 (7) (pp 726-737), 2019. Date of Publication:
01 Jul 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. 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. 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. 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. Copyright © The Author(s) 2019.

<51>
Accession Number
628110836
Title
Outcomes Following Balloon Aortic Valvuloplasty Versus Surgical Valvotomy
in Congenital Aortic Valve Stenosis: A Meta-Analysis.
Source
The Journal of invasive cardiology. 31 (6) (pp E133-E142), 2019. Date of
Publication: 01 Jun 2019.
Author
Saung M.T.; McCracken C.; Sachdeva R.; Petit C.J.
Institution
(Petit) Associate Professor of Pediatrics, Emory University School of
Medicine, 1405 Clifton Road, Atlanta
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal treatment for congenital aortic stenosis (AS) has
been debated over the past three decades of experience with both balloon
aortic valvuloplasty (BAV) and surgical aortic valvotomy (SAV). While BAV
has been the mainstay of therapy for children with AS in most centers,
recent single-center reports suggest superior results following SAV.
 METHOD(S): We queried Medline, EMBASE and Web of Science for eligible
studies. RESULT(S): A total of 18 studies were included in our
meta-analysis: SAV alone (n = 3), BAV alone (n = 10), and both (n = 5).
The mean follow-up duration of BAV patients was 6.5 years, while the mean
follow-up duration for SAV patients was 7.2 years. Mortality rates
following BAV and SAV were 11% (95% CI, 8-14) and 10% (95% CI, 7-15),
respectively. Reintervention following initial procedure for treatment of
AS was higher following BAV (37% [95% CI, 30-44]) compared with SAV (25%
[95% CI, 20-31]). The predominant reintervention for both the BAV and SAV
groups was surgery (SAV or aortic valve replacement [AVR]); the surgical
reintervention rate was 59% for BAV (95% CI, 51-66) and 75% for SAV (95%
CI, 48-91). Mean time to reintervention was shorter for BAV (2.7 years
[95% CI, 1.4-4.1]) compared with SAV (6.9 years [95% CI, 4.4-9.4]). AVR
following BAV was 20% (95% CI, 17-23) and following SAV was 17% (95% CI,
12-25). Long-term and mid-term follow-up in these studies showed moderate
to severe aortic insufficiency (AI) was present in 28% (95% CI, 20-37) and
19% (95% CI, 12-27) in BAV and SAV patients, respectively.
 CONCLUSION(S): The rate of reintervention following BAV is higher
than following SAV. However, survival rates, AVR, and development of late
AI following BAV and SAV are equivalent. The costs associated with the two
therapies in terms of hospital days and other morbidities should be
considered in future comparative studies.

<52>
Accession Number
628100889
Title
Initial results from a randomized trial in video-assisted versus open
thoracic surgery.
Source
Journal of Thoracic Disease. 11 (Supplement9) (pp S1317-S1319), 2019. Date
of Publication: 2019.
Author
Eklund A.; Sartipy U.
Institution
(Eklund, Sartipy) Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm, Sweden
(Eklund, Sartipy) Heart and Vascular Theme, Karolinska University
Hospital, Stockholm SE-171 76, Sweden
Publisher
AME Publishing Company (E-mail: info@amepc.org)

<53>
Accession Number
628044046
Title
The effect of implementing an aseptic practice bundle for anaesthetists to
reduce postoperative infections, the Anaesthetists Be Cleaner (ABC) study:
Protocol for a stepped wedge, cluster randomised, multi-site trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 342. Date of
Publication: 10 Jun 2019.
Author
Merry A.F.; Gargiulo D.A.; Bissett I.; Cumin D.; English K.; Frampton C.;
Hamblin R.; Hannam J.; Moore M.; Reid P.; Roberts S.; Taylor E.; Mitchell
S.J.; Chapman I.; Denison T.; Hopley L.; Jackson L.; Jones R.; Kruger C.;
Lindsay H.; Love A.; McGuinness S.; Milsom P.; Munro J.; Panduri G.; Pitto
R.; Sheridan J.; Sidhu N.; Stapelberg F.; Sweetman C.; Torrie J.; Walker
S.; Walsh C.; Willcox T.; Wiles S.; Young S.
Institution
(Merry, Gargiulo, Cumin, Moore, Mitchell) Department of Anaesthesiology,
School of Medicine, University of Auckland, Private Bag 92019, Auckland
1142, New Zealand
(Merry, English, Mitchell) Department of Anaesthesia, Auckland City
Hospital, PO Box 92024, Auckland 1142, New Zealand
(Bissett) Department of Surgery, School of Medicine, University of
Auckland, Private Bag 92019, Auckland 1142, New Zealand
(Bissett) Department of Surgery, Auckland City Hospital, Private Bag
92019, Auckland 1142, New Zealand
(Frampton) Department of Psychological Medicine, University of Otago, PO
Box 4345, Christchurch 8140, New Zealand
(Hamblin) Health Quality and Safety Commission, PO Box 25496, Wellington
6146, New Zealand
(Hannam) Department of Pharmacology and Clinical Pharmacology, University
of Auckland, Private Bag 92019, Auckland 1142, New Zealand
(Reid) Te Kupenga Hauora Maori, University of Auckland, Private Bag 92019,
Auckland 1142, New Zealand
(Roberts) LabPLUS, Auckland City Hospital, PO Box 110031, Auckland 1070,
New Zealand
(Taylor) Starship Children's Health, Auckland District Health Board, PO
Box 9389, Auckland 1149, New Zealand
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative infection is a serious problem in New Zealand
and internationally with considerable human and financial costs. Also, in
New Zealand, certain factors that contribute to postoperative infection
are more common in Maori and Pacific populations. To date, most efforts to
reduce postoperative infection have focussed on surgical aspects of care
and on antibiotic prophylaxis, but recent research shows that anaesthesia
providers may also have an impact on infection transmission. These
providers sometimes exhibit imperfect hand hygiene and frequently transfer
the blood or saliva of their patients to their work environment. In
addition, intravenous medications may become contaminated whilst being
drawn up and administered to patients. Working with relevant practitioners
and other experts, we have developed an evidence-informed bundle to
improve key aseptic practices by anaesthetists with the aim of reducing
postoperative infection. The key elements of the bundle are the filtering
of compatible drugs, context-relevant hand hygiene practices and enhanced
maintenance of clean work surfaces. Method(s): We will seek support
for implementation of the bundle from senior anaesthesia and hospital
leadership and departmental "champions". Anaesthetic teams and recovery
room staff will be educated about the bundle and its potential benefits
through presentations, written material and illustrative videos. We will
implement the bundle in operating rooms where hip or knee arthroplasty or
cardiac surgery procedures are undertaken in a five-site, stepped wedge,
cluster randomised, quality improvement design. We will compare outcomes
between approximately 5000 cases before and 5000 cases after
implementation of our bundle. Outcome data will be collected from existing
national and hospital databases. Our primary outcome will be days alive
and out of hospital to 90 days, which is expected to reflect all serious
postoperative infections. Our secondary outcome will be the rate of
surgical site infection. Aseptic practice will be observed in sampled
cases in each cluster before and after implementation of the bundle.
 Discussion(s): If effective, our bundle may offer a practical
clinical intervention to reduce postoperative infection and its associated
substantial human and financial costs. Trial registration: Australian New
Zealand Clinical Trials Registry, ACTRN12618000407291. Registered on 21
March 2018. Copyright © 2019 The Author(s).

<54>
Accession Number
2002107701
Title
The prospective randomized On-X valve Anticoagulation clinical trial
(PROACT): Lower is better, but is it good enough?.
Source
Global Cardiology Science and Practice. 2019 (1) (pp 1-8), 2019. Date of
Publication: 2019.
Author
Bouhout I.; El-Hamamsy I.
Institution
(Bouhout, El-Hamamsy) Department of Cardiac Surgery, Montreal Heart
Institute, Universite de Montreal, Quebec, Canada
Publisher
Bloomsbury Qatar Foundation Journals (E-mail: info@QScience.com)
Abstract
Due to their durability, mechanical prostheses are frequently used for
aortic valve replacement (AVR) in young adults. However, these valves are
thrombogenic and require lifelong anticoagulation. Over the last few
decades, efforts have been made towards the lowering of INR targets in an
effort to reduce bleeding events without influencing the thromboembolic
risk. The Prospective Randomized On-X Valve Anticoagulation Clinical Trial
(PROACT) was designed to compare standard versus low anticoagulation
targets in high-risk patients undergoing mechanical AVR with the ON-X
prosthesis. Copyright © 2019 The Author(s).

<55>
Accession Number
628113088
Title
Spontaneous Breathing Trial for Prediction of Extubation Success in
Pediatric Patients Following Congenital Heart Surgery: A Randomized,
Controlled Trial.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. (no pagination), 2019. Date of Publication: 31 May 2019.
Author
Ferreira F.V.; Sugo E.K.; Aragon D.C.; Carmona F.; Carlotti A.P.C.P.
Institution
(Ferreira) Department of Pediatrics, Division of Pediatric Critical Care,
Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto,
Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To evaluate the usefulness of a spontaneous breathing trial
for predicting extubation success in pediatric patients in the
postoperative period after cardiac surgery compared with a physician-led
weaning. STUDY DESIGN: Randomized, controlled trial. SETTING: PICU of a
tertiary-care university hospital. PATIENTS: A population of pediatric
patients following cardiac surgery for congenital heart disease.
INTERVENTIONS: Patients on mechanical ventilation for more than 12 hours
after surgery who were considered ready for weaning were randomized to the
spontaneous breathing trial group or the control group. The spontaneous
breathing trial was performed on continuous positive airway pressure with
the pressure support of 10 cmH2O, the positive end-expiratory pressure of
5 cmH2O, and the fraction of inspired oxygen less than or equal to 0.5 for
2 hours. Patients in the control group underwent ventilator weaning
according to clinical judgment. MEASUREMENTS AND MAIN RESULTS: The primary
endpoint was extubation success defined as no need for reintubation within
48 hours after extubation. Secondary outcomes were PICU length of stay,
hospital length of stay, occurrence rate of ventilator-associated
pneumonia, and mortality. One hundred ten patients with the median age of
8 months were included in the study: 56 were assigned to the spontaneous
breathing trial group and 54 were assigned to the control group.
Demographic and clinical data and Risk Adjustment for Congenital Heart
Surgery-1 classification were similar in both groups. Patients undergoing
the spontaneous breathing trial had greater extubation success (83% vs
68%, p = 0.02) and shorter PICU length of stay (median 85 vs 367 hr, p <
0.0001) compared with the control group, respectively. There was no
significant difference between groups in hospital length of stay,
occurrence rate of ventilator-associated pneumonia, and mortality.
 CONCLUSION(S): Pediatric patients with congenital heart disease
undergoing the spontaneous breathing trial postoperatively had greater
extubation success and shorter PICU length of stay compared with those
weaned according to clinical judgment.

<56>
Accession Number
628109894
Title
Clinical outcomes of polyvalent immunoglobulin use in solid organ
transplant recipients: a systematic review and meta-analysis. Part II:
Non-kidney transplant.
Source
Clinical transplantation. (pp e13625), 2019. Date of Publication: 04 Jun
2019.
Author
Bourassa-Blanchette S.; Patel V.; Knoll G.A.; Hutton B.; Fergusson N.;
Bennett A.; Tay J.; Cameron D.W.; Cowan J.
Institution
(Bourassa-Blanchette, Patel) Division of General Internal Medicine,
Department of Medicine, University of Ottawa, United Kingdom
(Knoll, Hutton, Fergusson, Bennett, Cameron, Cowan) Clinical Epidemiology
Program, Ottawa Hospital Research Institute, Ottawa, Canada
(Knoll) Renal Transplantation, Division of Nephrology, Department of
Medicine, University of Ottawa, Ottawa, Canada
(Tay) Blood and Marrow Transplant Program, Alberta Health Sciences,
Calgary, Canada
(Cameron, Cowan) Division of Infectious Diseases, Department of Medicine,
University of Ottawa, Ottawa, Canada
Publisher
NLM (Medline)
Abstract
Immunoglobulin (IG) is commonly used to desensitize and treat
antibody-mediated rejection in solid organ transplant (SOT) recipients.
The impact of IG on other outcomes such as infection, all-cause mortality,
graft rejection, and graft loss is not clear. We conducted a similar
systematic review and meta-analysis to our previously reported Part I
excluding kidney transplant. A comprehensive literature review found 16
studies involving the following organ types: heart (6), lung (4), liver
(4) and multiple organs (2). Meta-analysis could only be performed on
mortality outcome in heart and lung studies due to inadequate data on
other outcomes. There was a significant reduction in mortality (OR 0.34
[0.17-0.69]; 4 studies, n=455) in heart transplant with
hypogammaglobulinemia receiving IVIG versus no IVIG. Mortality in lung
transplant recipients with hypogammaglobulinemia receiving IVIG was
comparable to those of no hypogammaglobulinemia (OR 1.05 [0.49, 2.26]; 2
studies, n=887). In summary, IVIG targeted prophylaxis may decrease
mortality in heart transplant recipients as compared to those with
hypogammaglobulinemia not receiving IVIG, or improve mortality to the
equivalent level with those without hypogammaglobulinemia in lung
transplant recipients, but there is a lack of data to support physicians
in making decisions around using immunoglobulins in all SOT recipients for
infection prophylaxis. This article is protected by copyright. All rights
reserved.

<57>
Accession Number
628108163
Title
Perioperative dental screening and treatment in patients undergoing
cardio-thoracic surgery and interventional cardiovascular procedures. A
consensus report based on RAND/UCLA methodology.
Source
International endodontic journal. (no pagination), 2019. Date of
Publication: 04 Jun 2019.
Author
Cotti E.; Cairo F.; Bassareo P.P.; Fonzar F.; Venturi M.; Landi L.;
Parolari A.; Franco V.; Fabiani C.; Barili F.; Di Lenarda A.; Gulizia M.;
Borzi M.; Campus G.; Musumeci F.; Mercuro G.
Institution
(Cotti) Department of Conservative Dentistry and Endodontics, University
of Cagliari, Italy
(Cairo) Research Unit in Periodontology and Periodontal Medicine,
University of Florence, Italy
(Bassareo) University College of Dublin, Mater Misericordiae University
Teaching Hospital, Dublin, Ireland
(Fonzar) Private practice, Udine, Italy
(Venturi) Private practice, Bologna, Italy
(Landi) Private practice, Verona, Roma, Italy
(Parolari) Unit of Cardiac Surgery and Translational Researh, IRCCS
Policlinico S. Donato, San Donato, Italy
(Franco, Fabiani) Private practice, Roma, Italy
(Barili) Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
(Di Lenarda) Cardiovascular Center ASS1, Trieste, Italy
(Gulizia) Division of Cardiology, Hospital "Garibaldi-Nesima", Catania,
Italy
(Borzi) Department of Cardiovascular Disease, University of Rome Tor
Vergata, Rome, Italy
(Campus) Department of Surgery, Microsurgery and Medicine Sciences,
University of Sassari, Italy
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Roma, Italy
(Mercuro) Department of Cardiology, University of Cagliari, Italy
Publisher
NLM (Medline)
Abstract
AIM: To reach a consensus on a consistent strategy to adopt when screening
patients for dental/periodontal infections, and on the feasibility of
providing dental treatment before cardiothoracic surgery, cardivascular
surgery or other cardivascular invasive procedures. METHODOLOGY: A panel
of experts from six Italian scientific societies was created. The
deliberations of the panel were based on the RAND method. From an initial
systematic literature review, it became clear that a consensually
validated protocol for the reproducible dental screening of patients
awaiting cardiac interventions was considered mandatory by professionals
with expertise in the dental, cardiologic and cardiac surgery areas.
However, systematic review also concluded that the treatment options to be
provided, their prognosis and timing in relation to the physical condition
of patients had never been defined. Following the systematic review
several fundamental questions were generated. The panel was divided into
two working groups each of which produced documents that addressed the
topic and which were subsequently used to generate a questionnaire. Each
member of the panel completed the questionnaire independently and then a
panel discussion was held to reach a consensus on how best to manage
patients with dental/periodontal infections who were awaiting invasive
cardiac procedures. RESULT(S): A high level of agreement was reached
regarding all the items on the questionnaire, and each of the clinical
questions formulated were answered. Three tables were created which can be
used to generate a useful tool to provide standardized dental/periodontal
screening of patients undergoing elective cardiovascular interventions,
and to summarise both the possible oral and cardiovascular conditions of
the patient and the timing available for the procedures considered.
 CONCLUSION(S): Upon publication of this consensus document, the
dissemination of the information to a wide dental and cardiac audience
should commence. The authors hope that this consensus can become a model
for the development of a dedicated protocol, ideally usable by heart and
dental teams in the pre-interventional preparation phase. This article is
protected by copyright. All rights reserved.

<58>
Accession Number
2002106080
Title
Single-dose cardioplegia protects myocardium as well as traditional
repetitive dosing: A noninferiority randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Vivacqua A.; Robinson J.; Abbas A.E.; Altshuler J.M.; Shannon F.L.;
Podolsky R.H.; Sakwa M.P.
Institution
(Vivacqua, Abbas, Altshuler, Shannon, Sakwa) Department of Cardiovascular
Surgery, Beaumont Hospital, Royal Oak, Mich, United States
(Robinson) Wayne State University School of Medicine, Detroit, Mich,
United States
(Podolsky) Beaumont Research Institute, Royal Oak, Mich, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The present prospective noninferiority randomized trial was
designed to demonstrate the safety and efficacy of a single dose of
Custodiol histidine-tryptophan-ketoglutarate compared with repetitive
cold-blood cardioplegia. Method(s): From October 2012 to May 2014,
110 patients were randomly assigned to 1 of 2 groups: Group 1 (55
patients) received repetitive cold-blood cardioplegia, and group 2 (55
patients) received single-dose Custodiol
histidine-tryptophan-ketoglutarate. Isolated aortic valve replacement,
isolated mitral valve replacement, and multivalve procedures represented
the most frequent operations, with 39 cases (71%) in group 1 and 49 cases
(89%) in group 2. There was no difference in cardiopulmonary bypass time
(102 +/- 26 minutes vs 99 +/- 19 minutes, P =.70) or aortic crossclamp
time (77 +/- 19 minutes vs 74 +/- 17 minutes, P =.33). All patients
underwent preoperative electrocardiogram and determination of creatine
kinase-MB, troponin I, left ventricular ejection fraction, and regional
wall motion. Postoperative cardiac biomarkers were checked at 7, 24, and
48 hours, and an echocardiogram was obtained to check for left ventricular
function abnormalities. Result(s): There was no difference in cardiac
biomarkers release between the 2 groups at baseline and 7, 24, and 48
hours postoperatively (creatine kinase, P =.18, troponin P =.23). Left
ventricular function was similar between groups preoperatively and at 24
hours after surgery. No death or myocardial infarction was observed in
either group. There were no differences in intensive care unit length of
stay, incidence of atrial fibrillation, use of inotropes or vasopressors
support, time of intubation, or creatinine levels. Conclusion(s): A
single dose of Custodiol histidine-tryptophan-ketoglutarate cardioplegia
is not inferior to repeated cold-blood cardioplegia during elective
cardiac surgery. Copyright © 2019 The American Association for
Thoracic Surgery

<59>
Accession Number
2001485298
Title
A prospective 5-year study of exercise performance following Melody valve
implant.
Source
American Heart Journal. 209 (pp 47-53), 2019. Date of Publication: March
2019.
Author
Priromprintr B.; Silka M.J.; Rhodes J.; Batra A.S.
Institution
(Priromprintr, Silka) Children's Hospital Los Angeles, University of
Southern California, Los Angeles, CA, United States
(Priromprintr) Lucile Packard Children's Hospital at Stanford, Stanford
University Medical Center, Palo Alto, CA, United States
(Rhodes) Children's Hospital of Boston, Boston, MA, United States
(Batra) Children's Hospital of Orange County, University of California,
Irvine, CA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The long-term benefits of Melody valve implant for right
ventricular outflow tract conduit obstruction or insufficiency on exercise
capacity are undefined. Method(s): As part of the Melody valve
clinical trial, 136 patients with congenital heart disease underwent
serial cardiopulmonary exercise testing prior to, 6 months after, and
annually for up to 5 years postimplant. Result(s): Mean age at Melody
valve implantation was 22.4 +/- 0.9 years (range 7-53 years). The 95
patients who completed the study protocol provide the basis of this
report. An initial improvement in % predicted workload was present at 6
months postimplant; however, at the final (5 year) follow-up, sustained or
further improvements in workload were not demonstrated for the entire
cohort compared to baseline. By subgroup analysis, age <17 years at
implant and pulmonary regurgitation as the primary lesion were variables
associated with sustained improvement in exercise performance. There were
sustained improvements in the ventilatory equivalents for O<inf>2</inf>
(minute ventilation/O<inf>2</inf> intake, P =.01) and CO<inf>2</inf>
(minute ventilation/CO<inf>2</inf> output, P <.01) at the ventilatory
anaerobic threshold at the study conclusion. Improvements in forced vital
capacity were also observed during the study but not sustained at the
final follow-up. Conclusion(s): A cautious appraisal of the
cardiovascular benefits of Melody valve implant on sustained improvements
in exercise performance appears warranted. Although the observed changes
in pulmonary function suggest improved restrictive lung physiology and
more efficient gas exchange, after an initial increase in % predicted
performance, neither sustained nor further improvements in exercise
performance were observed, except in specific patient
subgroups. Copyright © 2018 Elsevier Inc.

<60>
Accession Number
607946178
Title
Evaluating Catheter-Based Mitral Valve Therapies Lessons Learned and
Future Directions.
Source
Journal of the American College of Cardiology. 66 (25) (pp 2855-2859),
2015. Date of Publication: 29 Dec 2015.
Author
Anyanwu A.C.; Adams D.H.
Institution
(Anyanwu, Adams) Department of Cardiovascular Surgery, Mount Sinai Medical
Center, 1190 Fifth Avenue, New York, NY 10029, United States
Publisher
Elsevier USA

<61>
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. Copyright
© 2019 Elsevier B.V.

<62>
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). Copyright © The Author(s) 2018.

<63>
Accession Number
2001788177
Title
Skeletonized versus pedicled internal mammary artery: A systematic review.
Source
Cirugia Cardiovascular. 26 (3) (pp 162-168), 2019. Date of Publication:
May - June 2019.
Author
Urso S.; Sadaba R.; Tena M.A.; Bellot R.; Rios L.; Martinez-Comendador
J.M.; Abad C.; Portela F.
Institution
(Urso, Tena, Bellot, Rios, Abad, Portela) Servicio de Cirugia Cardiaca,
Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Servicio de Cirugia Cardiaca, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Martinez-Comendador) Servicio de Cirugia Cardiaca, Hospital Universitario
de Leon, Leon, Spain
Publisher
Elsevier Doyma
Abstract
The European Society of Cardiology (ESC) and European Association for
Cardio-Thoracic Surgery (EACTS) 2018 guidelines state "skeletonised
internal mammary artery (IMA) dissection is recommended in patients with a
high risk of sternal wound infection". This indication does not clarify in
which type of patients the IMA skeletonisation technique should be
applied. For this reason, review is presented. A Medline search was
conducted up to November 2018. The inclusion criteria were: studies
published in English, conducted on humans, those that compared
skeletonised versus pedicled IMA, and published at least one of the
following results: flow, permeability, length and graft calibre, and
incidence or risk of sternal wound infection. A total of 208 articles were
found, of which 30 were included. Most of the studies included in the
present systematic review show that IMA skeletonisation provides a
significant benefit in terms of lower risk of sternal infection, and
increase in length, calibre, and flow of the graft, in comparison with
pedicled IMA. The clinical benefits of skeletonisation are evident,
especially, but not exclusively, in patients undergoing double IMA surgery
and in diabetic patients. In conclusion, IMA skeletonisation should be
recommended in patients undergoing surgery with the use of double IMA and
in diabetic patients. The clinical benefits of skeletonisation in patients
undergoing surgery with the use of a single IMA are not supported by solid
evidence. Copyright © 2019 Sociedad Espanola de Cirugia
Toracica-Cardiovascular

<64>
Accession Number
628077900
Title
Differential modulatory effects of Propofol and Sevoflurane anesthesia on
blood monocyte HLA-DR and CD163 expression during and after cardiac
surgery with cardiopulmonary bypass: a preliminary randomized flow
cytometry study.
Source
Perfusion (United Kingdom). (no pagination), 2019. Date of Publication:
2019.
Author
Sbrana S.; Nunziata A.; Storti S.; Haxhiademi D.; Mazzone A.; Leone M.;
Solinas M.; Del Sarto P.
Institution
(Sbrana) Flow Cytometry Laboratory, CNR Institute of Clinical Physiology,
Ospedale del Cuore, Massa, Italy
(Nunziata, Haxhiademi, Del Sarto) Department of Anesthesiology and
Intensive Care, Ospedale del Cuore, Fondazione Toscana Gabriele
Monasterio, Massa, Italy
(Storti) Unit of Laboratory Medicine, Ospedale del Cuore, Fondazione
Toscana Gabriele Monasterio, Massa, Italy
(Mazzone) Adult Cardiology Department, Ospedale del Cuore, Fondazione
Toscana Gabriele Monasterio, Massa, Italy
(Leone) Perfusion Unit, Cardiothoracic Department, Ospedale del Cuore,
Fondazione Toscana Gabriele Monasterio, Massa, Italy
(Solinas) Adult Cardiac Surgery Department, Ospedale del Cuore, Fondazione
Toscana Gabriele Monasterio, Massa, Italy
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: The increase of the anti-inflammatory
CD163highHLA-DRlow blood monocyte subset is one of
the mechanisms dampening inflammation during cardiac surgery with
cardiopulmonary bypass. We evaluated the effect of two different
anesthetic protocols, intravenous Propofol infusion or Sevoflurane-gas
administration, on the perioperative frequency of this subset.
 Method(s): Blood from patients (Propofol = 11, Sevoflurane = 13)
undergoing minimally invasive mitral valve surgery was drawn
preoperatively (T1), before declamping (T2), at 6 (T3), 24 (T4), 48 (T5),
and 72 hours (T6) after declamping. C-reactive protein, haptoglobin, and
lactate dehydrogenase were measured. A hemolytic index, as C-reactive
protein/haptoglobin ratio, was introduced. Monocyte expression of HLA-DR,
CD163, and the CD163highHLA-DRlow subset fraction
was quantified by flow cytometry. Baseline-referred variations of
plasmatic and cellular data at T2 were normalized for clamping times.
Subsequent time-point variations were normalized for the final
cardiopulmonary bypass times. Result(s): Variations of hemolytic
index and lactate dehydrogenase were higher with Propofol at T3 (p = 0.004
and p = 0.02, respectively) when compared with Sevoflurane. At T2, the
down-modulation of CD163 was higher with Propofol (p = 0.005). Starting
from T3, the up-regulatory trend of CD163 was basically higher with
Propofol, although not significantly. Propofol induced higher increments
of HLA-DR low fractions, at T2 (p = 0.04) and, to a lesser extent, at T4
(p = 0.06). Starting from T3, the CD163highHLA-DRlow
subset variations were higher with Propofol, especially at T4 and T6.
 Conclusion(s): Propofol seems to induce a higher postoperative
fraction of the CD163highHLA-DRlow monocyte subset.
This could represent either a compensatory mechanism dampening the higher
inflammatory condition observed with Propofol at T2 or a consequence of a
higher postoperative Propofol-induced hemolysis. Copyright © The
Author(s) 2019.

<65>
Accession Number
628069517
Title
Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after
Transcatheter Aortic Valve Replacement: a Systematic Review and
Meta-analysis.
Source
Scientific reports. 7 (1) (pp 15014), 2017. Date of Publication: 08 Nov
2017.
Author
Liao Y.-B.; Li Y.-J.; Jun-Li L.; Zhao Z.-G.; Wei X.; Tsauo J.-Y.; Xiong
T.-Y.; Xu Y.-N.; Feng Y.; Chen M.
Institution
(Liao, Li, Jun-Li, Zhao, Wei, Tsauo, Xiong, Xu, Chen) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu 610041, China
(Feng) Department of Cardiology, West China Hospital, Sichuan University,
37 Guoxue Street, Chengdu 610041, China
Publisher
NLM (Medline)
Abstract
The aim of this study was to investigate the incidence, predictors and
outcome of prosthesis-patient mismatch (PPM) following transcatheter
aortic valve replacement (TAVR). A total of 30 articles incorporating
4,691 patients were identified. The pooled incidences of overall, moderate
and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively.
Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%,
P<0.0001) and moderate (23% vs 32%, P<0.0001) than Edwards Sapien (ESV).
PPM was associated with a younger age, smaller annulus diameter and lower
left ventricular ejection fraction in comparison with those patients
without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p<0.001)
during TAVR would decrease the incidence of PPM. Although PPM was common
after TAVR, no significant differences were observed both in short- and
mid-term all-cause mortality (30day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2
year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those
without PPM. In conclusion, despite being common after TAVR, the incidence
of PPM was lower than that of surgical aortic valve replacement (SAVR) and
decreased with the experience accumulating, and PPM was not seen to impact
on short- and mid-term survival, regardless of its magnitude.

<66>
Accession Number
628092077
Title
Transcatheter versus surgical aortic valve replacement in low and
intermediate risk patients with severe aortic stenosis: Systematic review
and meta-analysis of randomized controlled trials and propensity score
matching observational studies.
Source
Journal of Thoracic Disease. 11 (5) (pp 1945-1962), 2019. Date of
Publication: 2019.
Author
Fu J.; Popal M.S.; Li Y.; Li G.; Qi Y.; Fang F.; Kwong J.S.W.; You B.;
Meng X.; Du J.
Institution
(Fu, Popal, Li, Li, Qi, Fang, You, Meng, Du) Beijing Anzhen Hospital,
Capital Medical University, No. 2 Anzhen Road, Beijing 100029, China
(Kwong) Jockey Club School of Public Health and Primary Care, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: To compare the outcome of transcatheter aortic valve
replacement (TAVR) with surgical aortic valve replacement (SAVR) in low
and intermediate risk patients with severe aortic stenosis (AS).
Randomized controlled trials (RCT) and propensity score matching (PSM)
studies compare TAVR with SAVR in patients at low and intermediate
surgical risk. Method(s): Two authors searched relevant literature
independently, then extracted data from the included studies, and assessed
risk of bias and quality of study separately according to different study
designs, besides that, the extracted data was analyzed via utilization of
GRADE system to evaluate the quality of evidence separately.
 Result(s): Overall 15 studies (5 RCTs, 10 PSM studies) with total
12,057 patients were selected. Mortality and disabling stroke during
follow-up period were comparable between TAVR and SAVR (RR 1.09, 95% CI:
0.81 to 1.46; RR 0.7, 95% CI: 0.45 to 1.07, respectively), TAVR revealed
to be superior to SAVR regarding acute kidney injury (AKI), and onset of
new atrial fibrillation (AF) (RCT: high certainty; AKI in PSM: moderate
certainty, AF in PSM: low certainty). These results of RCT and PSM studies
are consistent. In RCT review, SAVR was better in the following aspects:
aortic valve (AV) re-intervention (high certainty), vascular
complications, pacemaker implantation (moderate certainty), but comparable
in the following aspects: myocardial infarction (MI), aortic insufficient
(AI) (moderate certainty), major bleeding (low certainty). In PSM review,
SAVR revealed a better result in AI and vascular complications (high
certainty), but in the aspects of AV re-intervention, pacemaker
implantation, major bleeding and MI (low certainty), it was comparable.
 Conclusion(s): TAVR is comparable to SAVR in terms of mortality and
disabling stroke in severe AS patients at low and intermediate risk, but
higher proportion of AV re-intervention observed in TAVR. Those results
should encourage caution when extending the indications of TAVR into low
risk patients, especially for young low risk patients. Copyright
© Journal of Thoracic Disease. All rights reserved.

<67>
Accession Number
628091168
Title
Clinical factors affecting the survival of patients diagnosed with
non-small cell lung cancer and metastatic malignant pleural effusion,
treated with hyperthermic intrathoracic chemotherapy or chemical talc
pleurodesis: A monocentric, prospective, randomized trial.
Source
Journal of Thoracic Disease. 11 (5) (pp 1788-1798), 2019. Date of
Publication: 2019.
Author
Sioga A.; Pandria N.; Barbetakis N.; Lazopoulos A.; Katsikas I.; Asteriou
C.; Paliouras D.; Kamperis E.; Ikonomou D.; Papamitsou T.; Filippou D.;
Destouni C.; Ikonomou L.; Zarogoulidis K.; Papagiannopoulos K.; Kleontas
A.
Institution
(Ikonomou, Filippou, Kleontas) Department of Thoracic Surgery, European
Interbalkan Medical Center of Thessaloniki, 10 Asclepiou Str., Pylaia
Thessaloniki 57001, Greece
(Sioga, Papamitsou, Ikonomou) Laboratory of Histology-Embryology, Greece
(Pandria) Laboratory of Medical Physics, Medical School of Aristotle
University of Thessaloniki, Thessaloniki, Greece
(Barbetakis, Lazopoulos, Paliouras) Department of Thoracic Surgery,
"Theagenio" Cancer Hospital of Thessaloniki, Thessaloniki, Greece
(Katsikas) Department of Anesthesiology, Polyclinique Du Val De Loire,
Nevers, France
(Asteriou) Department of Thoracic Surgery, Euromedica General Clinic of
Thessaloniki, Thessaloniki, Greece
(Kamperis) Department of Radiotherapy, "Papageorgiou" General Hospital of
Thessaloniki, Thessaloniki, Greece
(Destouni) Laboratory of Cytology, "Theagenio" Cancer Hospital of
Thessaloniki, Thessaloniki, Greece
(Zarogoulidis) Department of Pulmonary, "Papanikolaou" General Hospital of
Thessaloniki, Thessaloniki, Greece
(Papagiannopoulos) Department of Thoracic Surgery, St' James' University
Hospital, Bexley Wing, Leeds, United Kingdom
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: There is a plethora of treatment algorithms for managing
patients with malignant pleural effusions (MPEs), sharing many common
points and principles. Our study aims to compare hyperthermic intrapleural
chemotherapy (HITHOC) and talc pleurodesis (TALC), as treatment options
for patients with non-small cell lung cancer (NSCLC) and metastatic MPE.
 Method(s): This prospective, randomized trial was conducted at a
single thoracic surgery center, the "Theagenio" Cancer Institute, in
Greece, under the identification code NCT01409551 and was completed. All
40 patients enrolled were adults with histologically proven metastatic,
unilateral, MPE caused by NSCLC. Exclusion criteria included patients >80
years, trapped lung, and major comorbidities. Patients were randomly and
equally assigned 1:1 to either HITHOC (group A) or TALC (group B) by video
assisted thoracic surgery (VATS). The primary outcome was the median
overall survival (OS) from trial intervention to death, while secondary
outcome was the identification of clinical factors affecting the survival.
 Result(s): The patients were followed up for 45 months. The OS of the
full group was 8 months (95% CI: 7.046-8.954). Participants who underwent
HITHOC had an OS of 8 months (95% CI: 7.141-8.859), whereas the
participants of TALC had an OS of 9 months (95% CI: 7.546-10.454), with no
significant difference between groups. Among fifty-four factors that were
tested for their effects on survival, only TNM stage and creatinine values
both preoperatively and 7 days postoperatively could be regarded as
risk-factors for survival. Other recorded parameters, which had
significant variance between the two groups, were urea levels, C-reactive
protein, white blood cells and total in hospital length of stay (LOS).
 Conclusion(s): Both HITHOC and TALC are equally effective and safe
therapeutic options in treating patients with MPE and NSCLC with
acceptable survival. The study revealed independent clinical risk factors
influencing survival, which could be utilized as starting points for
larger clinical studies. Copyright © Journal of Thoracic Disease.
All rights reserved.

<68>
Accession Number
628044461
Title
Bilateral thoracic paravertebral block combined with general anesthesia
vs. general anesthesia for patients undergoing off-pump coronary artery
bypass grafting: A feasibility study.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 101.
Date of Publication: 12 Jun 2019.
Author
Sun L.; Li Q.; Wang Q.; Ma F.; Han W.; Wang M.
Institution
(Sun, Li, Wang, Ma, Wang) Department of Anesthesiology, Qingdao Municipal
Hospital, Qingdao, Shandong 266011, China
(Han) Department of Respiratory Medicine, Qingdao Municipal Hospital, 1
Jiaozhou Road, Qingdao, Shandong 266011, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Whether thoracic paravertebral block (PVB) is useful in
patients undergoing off-pump coronary artery bypass grafting (OPCABG)
remains unknown. This study aimed to investigate the feasibility of
bilateral PVB combined with general anesthesia (GA) in patients undergoing
OPCABG. Method(s): This feasibility study assessed 60 patients
scheduled for OPCABG at the Qingdao Municipal Hospital in 2016-2017.
Patients were randomly assigned to receive nerve stimulator-guided
bilateral PVB combined with GA (PVB + GA) or GA alone (n = 30/group).
Patients were asked to rate rest and cough pain hourly after the surgery.
The primary endpoint was the visual analogue scale (VAS) pain score within
48 h postoperatively. Secondary endpoints were rescue analgesia and
morphine consumption, fentanyl dose within 48 h postoperatively, as well
as operative time, time to extubation, intensive care unit (ICU) stay,
hospital stay and other postoperative adverse events. Result(s): Both
rest and cough pains were lower in the PVB + GA group at 12, 24, 36, and
48 h after surgery compared with the GA group. There were fewer patients
who needed rescue analgesia in the PVB + GA group at 12 and 24 h than in
the GA group. Morphine consumptions at 24 and 48 h were lower in the PVB +
GA group compared with the GA group. Time to extubation (P = 0.035) and
ICU stay (P = 0.028) were shorter in the PVB + GA group compared with the
GA group. AEs showed no differences between the two groups.
 Conclusion(s): Nerve stimulator-guided bilateral thoracic PVB
combined with GA in OPCABG is associated with a reduced rescue analgesia
and morphine consumption, compared to GA. Copyright © 2019 The
Author(s).

<69>
Accession Number
2002111967
Title
Resistance Training Following Median Sternotomy: 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.; 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, 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: Despite no evidence to support weight limitations following
median sternotomy, sternal precautions continue to be routinely
prescribed. Moreover, international cardiac rehabilitation guidelines lack
sufficient detail for the implementation of resistance training. This
systematic review and meta-analysis aimed to determine what the literature
defines as resistance training; how resistance training is applied,
progressed and evaluated; and, whether resistance training improves
physical and functional recovery postoperatively in the cardiac surgical
population. Data Sources: Five (5) electronic databases were searched
from inception to 28 September 2018 for studies published in English that
investigated the effects of a resistance training intervention on physical
and functional recovery following median sternotomy. Result(s):
Eighteen (18) trials (n = 3,462) met eligibility criteria and were
included in the analysis. Seven (7) randomised controlled trials shared
common outcome measures, allowing meta-analysis. The performance of
resistance training appears to be safe and feasible, and resulted in
similar improvements in both cardiopulmonary capacity and anthropometry,
when compared to aerobic training alone. However, the definition and
application of resistance training is frequently a lower intensity and
volume than recommended by the American College of Sports Medicine.
Furthermore, sternal precautions are not reflective of the kinematics and
weights used when performing many activities of daily living. For this
reason, resistance training needs to be task-specific, reflecting
functional tasks to promote recovery. Conclusion(s): Resistance
training, in isolation or when combined with aerobic training, may lead to
greater improvements in physical and functional recovery following cardiac
surgery via median sternotomy; however, further research is required to
inform clinical guidelines. Copyright © 2019 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<70>
Accession Number
2002098737
Title
Ultrasound Assessment of Respiratory Workload With High-Flow Nasal Oxygen
Versus Other Noninvasive Methods After Chest Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Laverdure F.; Genty T.; Rezaiguia-Delclaux S.; Herve P.; Stephan F.
Institution
(Laverdure) Department of Anesthesiology, Marie Lannelongue Hospital, Le
Plessis Robinson, France
(Laverdure, Genty, Rezaiguia-Delclaux, Stephan) Intensive Care Unit, Marie
Lannelongue Hospital, Le Plessis Robinson, France
(Herve) Department of Thoracic Surgery, Marie Lannelongue Hospital, Le
Plessis Robinson, France
Publisher
W.B. Saunders
Abstract
Objective: To compare the respiratory workload using the diaphragm
thickening fraction (DTf) determined by sonography during high-flow nasal
oxygen (HFNO), standard oxygen therapy (SOT), and noninvasive bilevel
positive airway pressure support (BIPAP) in patients with acute
respiratory failure (ARF) after cardiothoracic surgery. Design(s):
Prospective controlled clinical trial. Setting(s): A French 23-bed
cardiothoracic surgical intensive care unit. Participant(s):
Nonintubated patients with ARF after cardiothoracic surgery or while
awaiting lung transplantation. Intervention(s): HFNO (50 L/min), SOT
via a standard facemask, and BIPAP (pressure support, 4 cmH<inf>2</inf>O;
positive end-expiratory pressure [PEEP], 4 cmH<inf>2</inf>O), with
F<inf>I</inf>O<inf>2</inf> kept constant were successively applied and
compared. With BIPAP, pressure support or PEEP increments up to 8
cmH<inf>2</inf>O were compared with baseline settings. Each measurement
was made after stable breathing for 5 minutes. Measurements and Main
Results: Fifty patients aged 60.0 +/- 12.2 years were enrolled, including
14 (28%) with obesity. Mean PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> was
153 +/- 55 mmHg. DTf was lower with HFNO and BIPAP than with SOT
(respectively 21.2% +/- 15.1% v 30.9% +/- 21.1% and 17.8% +/- 19.1% v
30.9% +/- 21.1%, p < 0.001) and was not different with HFNO versus BIPAP
(p = 0.22). With BIPAP, increasing pressure support to 8 cmH<inf>2</inf>O
decreased DTf (21.0% +/- 14.3% v 28.8% +/- 19.8%, p = 0.009), whereas
increasing PEEP to 8 cmH<inf>2</inf>O did not (25.2% +/- 17.2% v 28.8% +/-
19.8%, p = 0.79). Tidal volume increased to 10.6 +/- 3.4 mL/kg with 8
cmH<inf>2</inf>O pressure support v 8.8 +/- 2.7 mL/kg with 4
cmH<inf>2</inf>O pressure support (p < 0.001). Conclusion(s): HFNO
provides a comparable respiratory workload decrease compared with BIPAP at
lower levels of pressure support and PEEP compared with SOT. Increasing
BIPAP pressure support may provide higher levels of assistance but carries
a risk of overdistension. Copyright © 2019 Elsevier Inc.

<71>
Accession Number
2002097938
Title
Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve
Implantation Versus Surgical Aortic Valve Replacement in
Low-to-Intermediate Surgical Risk Cohort.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Ando T.; Ashraf S.; Villablanca P.; Kuno T.; Pahuja M.; Shokr M.; Afonso
L.; Grines C.; Briasoulis A.; Takagi H.
Institution
(Ando, Ashraf, Pahuja, Shokr, Afonso) Division of Cardiology, Wayne State
University/Detroit Medical Center, Detroit, MI, United States
(Villablanca) Henry Ford Hospital, Detroit, MI, United States
(Kuno) Mount Sinai Beth Israel, New York, NY, United States
(Grines) North Shore University Hospital, Hofstra Northwell School of
Medicine, Manhasset, NY, United States
(Briasoulis) University of Iowa Hospitals and Clinics, Iowa, IA, United
States
(Takagi) Shizuoka Medical Center, Shizuoka, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) has been used to treat high
surgical risk cohorts but has been expanded to treat low-to-intermediate
risk cohort as well. We performed a systematic review and meta-analysis to
compare the outcomes between TAVI and surgical aortic valve replacement
(SAVR) in low-to-intermediate risk cohort. We queried PUBMED, EMBASE, and
ClinicalTrial.gov for relevant articles. Randomized controlled trials that
compared at least one of the outcomes of interest between TAVI and SAVR
were included. Risk ratio (RR) and 95% confidence interval (CI) were
pooled with a random-effects model to compare the risk of the primary
outcome between the 2 procedures. The primary outcome was a composite of
all-cause mortality or disabling/major stroke at 1 year. Seven studies
with a total of 7,143 patients (3,665 TAVI) were included. All-cause
mortality or disabling/major stroke at 30 days (6 studies, RR 0.71, 95% CI
0.49 to 1.03) was similar between TAVI and SAVR but was significantly
lower in TAVI at 1 year (5 studies, RR 0.81, 95% CI 0.67 to 0.98).
All-cause mortality was similar at both 30 days (7 studies, RR 0.90, 95%
CI 0.67 to 1.21) and 1 year (6 studies, RR 0.89, 95% CI 0.76 to 1.04).
Disabling/major stroke was similar between the 2 procedures (6 studies, RR
0.69, 95% CI 0.42 to 1.12) at 30 days but was significantly lower in TAVI
at 1 year (5 studies RR 0.71, 95% CI 0.51 to 0.98). Age, gender, diabetes,
and surgical risk score did not modulate the primary outcome. TAVI had a
significantly lower composite of all-cause mortality or disabling/major
stroke at 1 year compared with SAVR in low-to-intermediate surgical risk
cohort. Copyright © 2019 Elsevier Inc.

<72>
Accession Number
626328701
Title
Antifibrinolytic agents for paediatric scoliosis surgery: a systematic
review and meta-analysis.
Source
European Spine Journal. 28 (5) (pp 1023-1034), 2019. Date of Publication:
01 May 2019.
Author
Karimi S.; Lu V.M.; Nambiar M.; Phan K.; Ambikaipalan A.; Mobbs R.J.
Institution
(Karimi) Faculty of Medicine, Melbourne School of Medicine, Melbourne
University, Melbourne, VIC, Australia
(Karimi) Department of Orthopaedic Surgery, Westmead Hospital, Westmead,
Sydney, NSW 2145, Australia
(Lu, Phan) Faculty of Medicine, University of Sydney, Sydney, NSW,
Australia
(Nambiar) Department of Surgery, The University of Melbourne, Melbourne,
VIC, Australia
(Nambiar, Ambikaipalan) Department of Orthopaedic Surgery, Box Hill
Hospital, Melbourne, Australia
(Phan, Mobbs) NeuroSpine Surgery Research Group, Prince of Wales Private
Hospital, Randwick, Sydney, NSW, Australia
(Phan, Mobbs) Department of Neurosurgery, Prince of Wales Public Hospital,
Randwick, Sydney, NSW, Australia
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Study design: Systematic review and meta-analysis of randomised controlled
trials. Objective(s): The purpose of this study is to perform a
systematic review and meta-analysis of antifibrinolytic agents for
paediatric spine surgery. Background(s): Bleeding is an important
consideration in paediatric scoliosis surgery; blood loss leads directly
to higher morbidity and mortality. Antifibrinolytics are an attractive
non-invasive method of reducing bleeding as evidenced in arthroplasty,
cardiac surgery and adult scoliosis surgery. Method(s): A thorough
database search of Medline, PubMed, EMBASE and Cochrane was performed
according to PRISMA guidelines, and a systematic review was performed.
 Result(s): Five randomised controlled trials were identified in this
meta-analysis, consisting of a total of 285 spine surgery patients with
subgroups of tranexamic acid (n = 101), epsilon aminocaproic acid (n = 61)
and control (n = 123). This meta-analysis found that antifibrinolytics
lead to statistically significant reductions in peri-operative blood loss
(MD - 379.16, 95% CI [- 579.76, - 178.57], p < 0.001), intra-operative
blood loss (MD - 516.42, 95% CI [- 1055.58, 22.74], p < 0.001), reduced
fresh frozen plasma requirements (MD - 307.77, 95% CI [- 369.66, -
245.88], p < 0.001) and reduced post-operative blood loss (MD - 185.95,
95% CI [- 336.04, - 35.87], p = 0.02). Conclusion(s): This
meta-analysis concludes that antifibrinolytics lead to statistically
significant reductions in peri-operative blood loss, intra-operative blood
loss, reduced fresh frozen plasma requirements and reduced post-operative
blood loss with TXA. Graphical abstract: These slides can be retrieved
under Electronic Supplementary Material.[Figure not available: see
fulltext.]. Copyright © 2019, Springer-Verlag GmbH Germany, part
of Springer Nature.

<73>
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. 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. 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. Copyright © 2019 The Author(s).

<74>
Accession Number
619415895
Title
Comparison of left atrial pressure monitoring with dedicated catheter
versus steerable guiding catheter during transcatheter mitral valve
repair.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 374-378),
2018. Date of Publication: 01 Aug 2018.
Author
Eleid M.F.; Reeder G.S.; Rihal C.S.
Institution
(Eleid, Reeder, Rihal) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The objective of this study was to determine the accuracy of
left atrial pressure (LAP) measurement through the manufacturer provided
steerable guiding catheter (SGC) during transcatheter mitral valve repair
(TMVR). Background(s): LAP measurement during TMVR has been shown to
be associated with clinical improvement when measured through a dedicated
catheter. Method(s): Simultaneous LAP was performed in consecutive
patients using an independent fluid-filled 4F multipurpose catheter and
compared to LAP waveforms measured through the manufacturer-provided
MitraClip SGC during TMVR (Abbott, Santa Clara, CA). Result(s): Mean
age of 10 consecutive subjects with primary mitral regurgitation
undergoing TMVR was 83 +/- 3 years (60% female). Left atrial v wave and
mean pressures through the dedicated catheter were 42 +/- 7 and 24 +/- 3
mmHg vs. 35 +/- 7 and 23 +/- 3 mmHg through the SGC (P < 0.001 and P =
0.23, respectively). Mean differences in v wave and mean LAP were 8 +/- 4
and 1.0 +/- 2.4 mmHg (percent difference 19 and 3%), respectively. SGC
waveform overdamping was observed in all cases. Conclusion(s): Left
atrial v wave pressure measurement through a dedicated catheter with
sideholes during TMVR has superior accuracy compared to the manufacturer
provided SGC, which results in waveform overdamping and a significant
underestimation of v wave pressure. These data have important implications
for clinical practice. Copyright © 2017 Wiley Periodicals, Inc.

<75>
[Use Link to view the full text]
Accession Number
624836881
Title
The impact of massage and reading on children's pain and anxiety after
cardiovascular surgery: A pilot study.
Source
Pediatric Critical Care Medicine. 19 (8) (pp 725-732), 2018. Date of
Publication: 2018.
Author
Staveski S.L.; Boulanger K.; Erman L.; Lin L.; Almgren C.; Journel C.;
Roth S.J.; Golianu B.
Institution
(Staveski, Lin) Cincinnati Children's Hospital Medical Center, Research in
Patient Services, Cincinnati, OH, United States
(Staveski) University of Cincinnati, College of Nursing, Cincinnati, OH,
United States
(Boulanger, Erman) Lucile Packard Children's Hospital Stanford, Massage
Therapy Service, Palo Alto, CA, United States
(Almgren, Journel) Lucile Packard Children's Hospital Stanford, Patient
Services - Advanced Practice Nursing, Palo Alto, CA, United States
(Roth) Department of Cardiology and Critical Care, Lucile Packard
Children's Hospital Stanford, Palo Alto, CA, United States
(Roth, Golianu) Department of Pediatrics, Stanford University, School of
Medicine, Palo Alto, CA, United States
(Golianu) Lucile Packard Children's Hospital Stanford, Anesthesiology and
Pain Service, Palo Alto, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: The purpose of this pilot study was three-fold: 1) to evaluate
the safety and feasibility of instituting massage therapy in the immediate
postoperative period after congenital heart surgery, 2) to examine the
preliminary results on effects of massage therapy versus standard of care
plus three reading visits on post-operative pain and anxiety, and 3) to
evaluate preliminary effects of opioid and benzodiazepine exposure in
patients receiving massage therapy compared with reading controls.
 Design(s): Prospective, randomized controlled trial. Setting(s):
An academic children's hospital. Subjects: Sixty pediatric heart surgery
patients between ages 6 and 18 years. Intervention(s): Massage
therapy and reading. Measurement and Main Results: There were no adverse
events related to massage or reading interventions in either group. Our
investigation found no statistically significant difference in Pain or
State-Trait Anxiety scores in the initial 24 hours after heart surgery
(T1) and within 48 hours of transfer to the acute care unit (T2) after
controlling for age, gender, and Risk Adjustment for Congenital Heart
Surgery 1 score. However, children receiving massage therapy had
significantly lower State-Trait Anxiety scores after receiving massage
therapy at time of discharge (T3; p = 0.0075) than children receiving
standard of care plus three reading visits. We found no difference in
total opioid exposure during the first 3 postoperative days between groups
(median [interquartile range], 0.80 mg/kg morphine equivalents
[0.29-10.60] vs 1.13 mg/kg morphine equivalents [0.72-6.14]). In contrast,
children receiving massage therapy had significantly lower total
benzodiazepine exposure in the immediate 3 days following heart surgery
(median [interquartile range], 0.002 mg/kg lorazepam equivalents [0-0.03]
vs 0.03 mg/kg lorazepam equivalents [0.02-0.09], p = 0.0253, Wilcoxon
rank-sum) and number of benzodiazepine PRN doses (0.5 [0-2.5] PRN vs 2
PRNs (1-4); p = 0.00346, Wilcoxon rank-sum). Conclusion(s): Our pilot
study demonstrated the safety and feasibility of implementing massage
therapy in the immediate postoperative period in pediatric heart surgery
patients. We found decreased State-Trait Anxiety scores at discharge and
lower total exposure to benzodiazepines. Preventing postoperative
complications such as delirium through nonpharmacologic interventions
warrants further evaluation. Copyright © 2018 by the Society of
Critical Care Medicine and the World Federation of Pediatric Intensive and
Critical Care Societies.

<76>
Accession Number
620454145
Title
Transcatheter versus surgical aortic valve replacement in patients at low
surgical risk: A meta-analysis of randomized trials and propensity score
matched observational studies.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 408-416),
2018. Date of Publication: 01 Aug 2018.
Author
Witberg G.; Lador A.; Yahav D.; Kornowski R.
Institution
(Witberg, Lador, Kornowski) Department of Cardiology, Rabin medical
center, Petach, Tikva, Israel
(Witberg, Lador, Yahav, Kornowski) Sackler Faculty of Medicine, Tel-Aviv
university, Tel, Aviv, Israel
(Yahav) Infectious diseases unit, Rabin medical center, Petach, Tikva,
Israel
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Although transcatheter aortic valve replacement (TAVR) is
officially indicated for high risk aortic stenosis (AS) patients, the
procedure is increasingly being performed in patients who are not at high
surgical risk, including a substantial number of low risk patients.
However, data on the benefit of TAVR in this patient population is
limited. Method(s): We conducted a systematic review and
meta-analysis of randomized controlled trials (RCTs) and observational
studies with propensity score matching (PSM) of TAVR versus surgical
aortic valve replacement (SAVR) in patients who are at low surgical risk.
The primary outcome was all-cause mortality. The secondary outcomes
included stroke, myocardial infarction, bleeding, and various procedural
complications. Result(s): Six studies (2 RCTs and 4 PSM studies)
totaling 3,484 patients were included. Follow-up ranged from 3 months to 3
years (median 2 years). The short-term mortality was similar with either
TAVR or SAVR (2.2% for TAVR and 2.6% for SAVR, RR 0.89, 95% CI 0.56-1.41,
P = 0.62), however, TAVR was associated with increased risk for
intermediate-term mortality (17.2% for TAVR and 12.7% for SAVR, RR 1.45,
95% CI 1.11-1.89, P = 0.006). In terms of periprocedural complications,
TAVR was associated with reduced risk for bleeding and renal failure and
an increase in vascular complications and Pacemaker implantation.
 Conclusion(s): In patients who are at low surgical risk, TAVR seems
to be associated with increased mortality risk. Until more data in this
population is available, SAVR should remain the treatment of choice for
these patients. Copyright © 2018 Wiley Periodicals, Inc.

<77>
Accession Number
620453952
Title
Long-term survival after transcatheter versus surgical aortic valve
replacement for aortic stenosis: A meta-analysis of observational
comparative studies with a propensity-score analysis.
Source
Catheterization and Cardiovascular Interventions. 92 (2) (pp 419-430),
2018. Date of Publication: 01 Aug 2018.
Author
Takagi H.; Mitta S.; Ando T.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To synthesize evidence regarding long-term survival after
transcatheter aortic valve implantation (TAVI) versus surgical aortic
valve replacement (SAVR) for severe aortic stenosis (AS) from real-world
clinical practice, we performed a meta-analysis of observational studies
with a propensity-score analysis and >=3-year follow-up. Method(s):
Databases including MEDLINE and EMBASE were searched through April 2017
using PubMed and OVID. Eligible studies were observational comparative
studies with a propensity-score analysis of TAVI versus SAVR enrolling
patients with severe AS and reporting >=3-year all-cause mortality as an
outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of
follow-up (including early) mortality for TAVI versus SAVR was extracted
from each individual study. Result(s): Our search identified 14
eligible studies enrolling a total of 4,197 patients. A pooled analysis of
all the 14 studies demonstrated a statistically significant 54% increase
in mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31-1.81; P
for effect < 0.00001; P for heterogeneity = 0.14; I2 = 30%).
Several sensitivity analyses did not substantially change the
statistically significant benefit for SAVR. There was no evidence of
significant publication bias. Conclusion(s): On the basis of a
meta-analysis of 14 observational comparative studies with a
propensity-score analysis including a total of >=4,000 patients, TAVI is
associated with worse >=3-year overall survival than SAVR. Copyright
© 2018 Wiley Periodicals, Inc.

<78>
Accession Number
2000844102
Title
Revascularization strategies in cardiogenic shock complicating acute
myocardial infarction: A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 19 (6) (pp 647-654), 2018. Date
of Publication: September 2018.
Author
Rahman H.; Khan S.U.; Lone A.N.; Kaluski E.
Institution
(Rahman, Khan, Lone, Kaluski) Guthrie Health System/Robert Packer
Hospital, Sayre, PA, United States
(Kaluski) Rutgers New Jersey Medical School, Newark, NJ, United States
(Kaluski) The Geisinger Commonwealth Medical College, Scranton, PA, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The optimal revascularization strategy in patients with
multi-vessel disease (MVD) presenting with acute myocardial infarction
(AMI) and cardiogenic shock (CS) remains unclear. Objective(s): To
investigate the comparative differences between culprit-only
revascularization (COR) versus instant multi-vessel revascularization
(IMVR) in AMI and CS. Method(s): 13 studies were selected using
MEDLINE, EMBASE and the CENTRAL (Inception - 31 November2017). Outcomes
were assessed at short-term (in-hospital or <=30 days duration) and
long-term duration (>=6 months). Estimates were reported as random effects
relative risk (RR) with 95% confidence interval (CI). Result(s): In
analysis of 7311 patients, COR significantly reduced the relative risk of
short-term all-cause mortality (RR: 0.87; 95% CI, 0.77-0.97; p = 0.01,
I2 = 50%) and renal failure (RR: 0.75; 95% CI, 0.61-0.94; p =
0.01, I2 = 7%) compared with IMVR. There were no significant
differences between both the strategies in terms of reinfarction (RR:
1.25; 95% CI, 0.59-2.63; p = 0.56, I2 = 0%), major bleeding
(RR: 0.88; 95% CI, 0.75-1.04; p = 0.14, I2 = 0%) and stroke
(RR: 0.77; 95% CI, 0.50-1.17; p = 0.22, I2 = 0%) at short term
duration. Similarly, no significant differences were observed between both
groups regarding all-cause mortality (RR; 1.01; 95% CI, 0.85-1.20; p =
0.93, I2 = 61%) and reinfarction (RR: 0.71; 95% CI, 0.34-1.47;
p = 0.35, I2 = 26%) at long term duration. Conclusion(s):
In MVD patients presenting with AMI and CS, IMVR was comparable to COR in
terms of all-cause mortality at long term follow up duration. These
results are predominantly derived from observational data and more
randomized controlled trials are required to validate this
impression. Copyright © 2018 Elsevier Inc.

<79>
Accession Number
2001137546
Title
Prevalence and Outcomes of Percutaneous Coronary Interventions for Ostial
Chronic Total Occlusions: Insights From a Multicenter Chronic Total
Occlusion Registry.
Source
Canadian Journal of Cardiology. 34 (10) (pp 1264-1274), 2018. Date of
Publication: October 2018.
Author
Tajti P.; Burke M.N.; Karmpaliotis D.; Alaswad K.; Jaffer F.A.; Yeh R.W.;
Patel M.; Mahmud E.; Choi J.W.; Doing A.H.; Datilo P.; Toma C.; Smith
A.J.C.; Uretsky B.; Holper E.; Garcia S.; Krestyaninov O.; Khelimskii D.;
Koutouzis M.; Tsiafoutis I.; Moses J.W.; Lembo N.J.; Parikh M.; Kirtane
A.J.; Ali Z.A.; Doshi D.; Jaber W.; Samady H.; Rangan B.V.; Xenogiannis
I.; Ungi I.; Banerjee S.; Brilakis E.S.
Institution
(Tajti, Burke, Xenogiannis, Brilakis) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Tajti, Ungi) University of Szeged, Division of Invasive Cardiology,
Department of Second Internal Medicine and Cardiology Center, Szeged,
Hungary
(Karmpaliotis, Moses, Lembo, Ali, Doshi) Columbia University, New York,
NY, United States
(Alaswad, Parikh, Kirtane) Henry Ford Hospital, Detroit, MI, United States
(Jaffer) Massachusetts General Hospital, Boston, MA, United States
(Yeh) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Patel, Mahmud) VA San Diego Healthcare System and University of
California San Diego, La Jolla, CA, United States
(Choi) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Doing, Datilo) Medical Center of the Rockies, Loveland, CO, United States
(Toma, Smith) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Uretsky) VA Central Arkansas Healthcare System, Little Rock, AR, United
States
(Holper) The Heart Hospital Baylor Plano, Plano, TX, United States
(Garcia) VA Minneapolis Healthcare System and University of Minnesota,
Minneapolis, MN, United States
(Krestyaninov, Khelimskii) Meshalkin Siberian Federal Biomedical Research
Center, Ministry of Health of Russian Federation, Novosibirsk, Russian
Federation
(Koutouzis, Tsiafoutis) Korgialeneio-Benakeio Hellenic Red Cross General
Hospital of Athens, Athens, Greece
(Jaber, Samady) Emory University Hospital Midtown, Atlanta, GA, United
States
(Rangan, Banerjee) VA North Texas Health Care System and University of
Texas Southwestern Medical Center, Dallas, TX, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Ostial chronic total occlusions (CTOs) can be challenging to
recanalize. Method(s): We sought to examine the prevalence,
angiographic presentation, and procedural outcomes of ostial (side-branch
ostial and aorto-ostial) CTOs among 1000 CTO percutaneous coronary
interventions (PCIs) performed in 971 patients between 2015 and 2017 at 14
centres in the US, Europe, and Russia. Result(s): Ostial CTOs
represented 16.9% of all CTO PCIs: 9.6% were aorto-ostial, and 7.3% were
side-branch ostial occlusions. Compared with nonostial CTOs, ostial CTOs
were longer (44 +/- 33 vs 29 +/- 19 mm, P < 0.001) and more likely to have
proximal-cap ambiguity (55% vs 33%, P < 0.001), moderate/severe
calcification (67% vs 45%, P < 0.001), a diffusely diseased distal vessel
(41% vs 26%, P < 0.001), interventional collaterals (64% vs 53%, P =
0.012), and previous coronary artery bypass graft surgery (CABG) (51% vs
27%, P < 0.001). The retrograde approach was used more often in ostial
CTOs (54% vs 29%, P < 0.001) and was more often the final successful
crossing strategy (30% vs 18%, P = 0.003). Technical (81% vs 84%, P =
0.280), and procedural (77% vs 83%, P = 0.112) success rates and the
incidence of in-hospital major complication were similar (4.8% vs 2.2%, P
= 0.108), yet in-hospital mortality (3.0% vs 0.5%, P = 0.010) and stroke
(1.2% vs 0.0%, P = 0.030) were higher in the ostial CTO PCI group. In
multivariable analysis, ostial CTO location was not independently
associated with higher risk for in-hospital major complications (adjusted
odds ratio 1.27, 95% confidence intervals 0.37 to 4.51, P = 0.694).
 Conclusion(s): Ostial CTOs can be recanalized with similar rates of
success as nonostial CTOs but are more complex, more likely to require
retrograde crossing and may be associated with numerically higher risk for
major in-hospital complications. Copyright © 2018 Canadian
Cardiovascular Society

<80>
Accession Number
620538852
Title
Incidence, predictors, and long term clinical outcome of angiographic
definite stent thrombosis in real world scenario - A prospective cohort
study.
Source
Cardiovascular Revascularization Medicine. 19 (6) (pp 666-670), 2018. Date
of Publication: September 2018.
Author
Singh B.; Ramesh B.; Rajendran R.; Singh Y.; Singla V.; Kolhari V.B.;
Goyal A.; Mohan B.; Aslam N.; Chhabra S.T.; Wander G.S.; Nanjappa M.C.
Institution
(Singh, Goyal, Mohan, Aslam, Chhabra, Wander) Department of Cardiology,
Dayanand Medical College and Hospital, Ludhiana, Punjab, India
(Ramesh, Rajendran, Singh, Singla, Kolhari, Nanjappa) Department of
Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research,
Karnataka, India
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The occurrence of stent thrombosis (ST) in real world scenario
is far different from that mentioned in the literature. Our study
identifies the various parameters of ST. Method(s): This is a
prospective observational-cohort study where-in consecutive patients who
received successful percutaneous transluminal angioplasty (PTCA) over the
study period of 1-year was included and were followed for 1-year from the
primary procedure. Result(s): The overall incidence of definite ST
was 1.4% and 1.7% at 30 days and 1 year respectively. The most common mode
of presentation of ST was ST-elevation myocardial infarction (82.6%). The
history of prior PTCA, multi-vessel disease, emergent PTCA, acute coronary
syndrome and type B2/C lesions were found to be the independent predictors
for definite ST. The incidence of late ST was significantly higher with
bare metal stent (BMS) than drug-eluting stent (DES) (OR-2.4, 95%
CI:1.3-4.5). At mean follow-up of 13.9 months after ST, the overall
mortality was 36.9%. The independent predictors of mortality after ST were
post-PTCA thrombolysis in myocardial infarction (TIMI) flow grade < 3, and
cardiogenic shock at the time of presentation. Conclusion(s): The
overall incidence of definite ST is high in the real world scenario and
the DES fared better than BMS. ST carries a bad prognosis especially so if
the patients present in cardiogenic shock, or unable to achieve TIMI-3
flow after PTCA. Copyright © 2018 Elsevier Inc.

<81>
Accession Number
609614423
Title
Contemporary extracorporeal membrane oxygenation therapy in adults:
Fundamental principles and systematic review of the evidence.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (1) (pp 20-32), 2016.
Date of Publication: 01 Jul 2016.
Author
Squiers J.J.; Lima B.; DiMaio J.M.
Institution
(Squiers, DiMaio) Baylor Research Institute, Baylor Scott and White
Health, 3310 Live Oak, Ste 501, Dallas, TX 75204, United States
(Lima, DiMaio) Department of Cardiac and Thoracic Surgery, Baylor
University Medical Center, Baylor Healthcare System, Dallas, TX, United
States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Extracorporeal membrane oxygenation (ECMO) provides days to weeks of
support for patients with respiratory, cardiac, or combined
cardiopulmonary failure. Since ECMO was first reported in 1974, nearly
70,000 runs of ECMO have been implemented, and the use of ECMO in adults
increased by more than 400% from 2006 to 2011 in the United States. A
variety of factors, including the 2009 influenza A epidemic, results from
recent clinical trials, and improvements in ECMO technology, have
motivated this increased use in adults. Because ECMO is increasingly
becoming available to a diverse population of critically ill patients, we
provide an overview of its fundamental principles and a systematic review
of the evidence basis of this treatment modality for a variety of
indications in adults. Copyright © 2016 The American Association
for Thoracic Surgery.

<82>
Accession Number
370332929
Title
Is the wearable cardioverter-defibrillator the answer for early
post-myocardial infarction patients at risk for sudden death?: Mind the
gap.
Source
Journal of the American College of Cardiology. 62 (21) (pp 2008-2009),
2013. Date of Publication: November 19-26, 2013.
Author
Zei P.C.
Institution
(Zei) Department of Medicine, Cardiac Electrophysiology, Stanford
University, 300 Pasteur Drive, Stanford, CA 94305, United States
Publisher
Elsevier USA

<83>
[Use Link to view the full text]
Accession Number
51807685
Title
Comparison between valsartan and amlodipine regarding cardiovascular
morbidity and mortality in hypertensive patients with glucose intolerance:
NAGOYA HEART study.
Source
Hypertension. 59 (3) (pp 580-586), 2012. Date of Publication: March 2012.
Author
Muramatsu T.; Matsushita K.; Yamashita K.; Kondo T.; Maeda K.; Shintani
S.; Ichimiya S.; Ohno M.; Sone T.; Ikeda N.; Watarai M.; Murohara T.
Institution
(Muramatsu, Matsushita, Yamashita, Kondo, Maeda, Shintani, Murohara)
Department of Cardiology, Nagoya University Graduate, School of Medicine,
65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
(Ichimiya, Ohno) Yokkaichi Municipal Hospital, Yokkaichi, Japan
(Shintani) Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
(Sone) Ogaki Municipal Hospital, Ogaki, Japan
(Ikeda) Chunichi Hospital, Nagoya, Japan
(Watarai) Anjo Kosei Hospital, Anjo, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
It has not been fully examined whether angiotensin II receptor blocker is
superior to calcium channel blocker to reduce cardiovascular events in
hypertensive patients with glucose intolerance. A prospective,
open-labeled, randomized, controlled trial was conducted for Japanese
hypertensive patients with type 2 diabetes mellitus or impaired glucose
tolerance. A total of 1150 patients (women: 34%; mean age: 63 years;
diabetes mellitus: 82%) were randomly assigned to receive either
valsartan- or amlodipine-based antihypertensive treatment. Primary outcome
was a composite of acute myocardial infarction, stroke, coronary
revascularization, admission attributed to heart failure, or sudden
cardiac death. Blood pressure was 145/82 and 144/81 mm Hg, and
glycosylated hemoglobin was 7.0% and 6.9% at baseline in the valsartan
group and the amlodipine group, respectively. Both of them were equally
controlled between the 2 groups during the study. The median follow-up
period was 3.2 years, and primary outcome had occurred in 54 patients in
the valsartan group and 56 in the amlodipine group (hazard ratio: 0.97
[95% CI: 0.66-1.40]; P=0.85). Patients in the valsartan group had a
significantly lower incidence of heart failure than in the amlodipine
group (hazard ratio: 0.20 [95% CI: 0.06-0.69]; P=0.01). Other components
and all-cause mortality were not significantly different between the 2
groups. Composite cardiovascular outcomes were comparable between the
valsartan- and amlodipine-based treatments in Japanese hypertensive
patients with glucose intolerance. Admission because of heart failure was
significantly less in the valsartan group. © 2012 American Heart
Association, Inc.

<84>
Accession Number
628008750
Title
Chest Wall Stabilization (CWS) in China: Current situation and prospect.
Source
Journal of Thoracic Disease. 11 (Supplement8) (pp S1044-S1048), 2019. Date
of Publication: 01 May 2019.
Author
He W.; Yang Y.; Wu W.; Zhao T.; Guo X.; Li Y.; Gao E.
Institution
(He, Yang, Wu, Zhao, Guo, Li, Gao) Department of Thoracic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
200233, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Rib fracture is the most common injury in chest trauma. Chest wall
stabilization (CWS) has been employed in China for 10 years and has been
recognized as a safe and practical technique for rib fracture therapy. A
survey entitled "Surgical Treatment for Rib Fractures" was launched at the
beginning of 2018 showing that 95.6% of the hospitals surveyed performed
CWS in over 30,000 cases in the past 2 years. Despite the large volume of
CWS performed in China, we discovered the following characteristics: lack
of large-scale clinical research, and standardized recognition of surgical
indications, high costs incurred for surgical consumables, and undefined
professional standard. We revealed that most of the researches on CWS in
China have room for improvement. The Shanghai Sixth People's Hospital has
conducted a series of CWS researches in patients with multi-rib fractures
whose results showed shorter therapeutic time, pain reduction, lower
morbidity, and improvement in lung function. Consequently, we formulated
our own surgical indications for CWS. Thoracoscopic-assisted minimally
invasive CWS surgery had been conducted in several hospitals in China.
Undoubtedly, the continuous improvement of equipment and surgical
techniques will inevitably lead to its further development. Researches on
materials with superior absorbability or tissue compatibility have been
successfully conducted in China. However, the lack of multi-center and
large-sample randomized controlled trials has been one of the key factors
that hampered the accurate evaluation of CWS. Accordingly, a nationwide
study entitled "Evaluation of the effectiveness of surgical fixation of
multiple rib fractures-a multi-center and ambispective cohort study" was
initiated in June 2018. It is believed that the result of this research
would considerably improve and enrich the clinical evidence on CWS in rib
fracture patients. Copyright © Journal of Thoracic Disease. All
rights reserved.

<85>
Accession Number
2001967251
Title
Efficacy and safety of alirocumab in japanese patients with diabetes
mellitus: Post-hoc subanalysis of ODYSSEY Japan.
Source
Journal of Atherosclerosis and Thrombosis. 26 (3) (pp 282-293), 2019. Date
of Publication: 2019.
Author
Teramoto T.; Usami M.; Takagi Y.; Baccara-Dinet M.T.
Institution
(Teramoto) Teikyo Academic Research Center, Teikyo University, Tokyo,
Japan
(Usami) Cardiovascular Medical, Sanofi, Tokyo, Japan
(Takagi) Clinical Sciences and Operations, Sanofi, Tokyo, Japan
(Baccara-Dinet) PCSK9 Development and Launch Unit, Sanofi, Montpellier,
France
Publisher
Japan Atherosclerosis Society
Abstract
Aim: To examine the efficacy and safety of alirocumab in Japanese patients
with dyslipidemia with or without diabetes mellitus (DM). Method(s):
Patients (n=216) with heterozygous familial hypercholesterolemia (heFH),
non-FH at high cardiovascular risk with coronary artery disease (CAD), or
category III (primary prevention) were enrolled; 148 (68.5%) patients had
a diagnosis of DM at baseline. Patients were randomized (2:1), with
stratification factor (heFH, non-FH), to alirocumab (75 mg every 2 weeks
[Q2W] with increase to 150 mg if week 8 LDL-C was above predefined limits)
or placebo subcutaneously for 52 weeks on top of stable statin therapy.
 Result(s): At Week 24, least square (LS) mean+/-standard error
changes in low-density lipoprotein cholesterol (LDL-C) concentration from
baseline in alirocumab-treated patients were -63.1+/-1.6% and -60.8+/-2.7%
in those with and without DM. These LDL-C reductions were maintained to
Week 52: -63.0+/-1.6% (LS mean difference vs placebo -62.4+/-3.0%;
P0.0001) with DM and -61.3+/-2.8% (LS mean difference vs placebo -
53.4+/-4.0%; P0.0001) without DM. The most common adverse events in the
alirocumab group were naso-pharyngitis, back pain, injection site
reaction, and fall. No particular safety signals or concerns were noted
between DM and non-DM groups at 52 weeks. A dose-increase in alirocumab
from 75 to 150 mg Q2W was necessary in two heFH patients, neither of whom
had DM. Conclusion(s): In high-cardiovascular-risk Japanese patients
with hypercholesterolemia on stable statin therapy, alirocumab produced
substantial and sustained LDL-C reductions throughout the 52-week study
regardless of DM status at baseline, with a similar safety profile to
placebo. Copyright © 2019 Japan Atherosclerosis Society.

<86>
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. 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. 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. 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). 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. Copyright © 2019 The Authors.
Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc.
on behalf of International Society on Thrombosis and Haemostasis

<87>
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. Copyright © 2019, Japanese
Association of Cardiovascular Intervention and Therapeutics.

<88>
Accession Number
2002010322
Title
Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve
Implantation for Pure Native Aortic Regurgitation.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Takagi H.; Hari Y.; Kawai N.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Ltd
Abstract
Aim: To assess outcomes of transcatheter aortic valve implantation (TAVI)
for pure native aortic regurgitation (AR) and to evaluate whether 30-day
all-cause mortality is modulated by patient characteristics, we performed
a meta-analysis and meta-regression of currently available studies.
 Method(s): Studies enrolling >=20 patients undergoing TAVI for AR
were considered for inclusion. Study-specific estimates (incidence rates
of outcomes) were combined using one-group meta-analysis in a
random-effects model. Subgroup meta-analysis of studies exclusively using
early-generation devices (EGD) and new-generation devices (NGD) and
stepwise random-effects multivariate meta-regression were also performed.
 Result(s): The search identified 11 eligible studies including a
total of 911 patients undergoing TAVI for AR. Pooled analysis demonstrated
an incidence of device success of 80.4% (NGD 90.2%, EGD 67.2%; p < 0.001),
moderate or higher paravalvular aortic regurgitation (PAR) of 7.4% (NGD
3.4%, EGD 17.3%; p < 0.001), 30-day all-cause mortality of 9.5% (NGD 6.1%,
EGD 14.7%; p < 0.001), mid-term (4 mo - 1 yr) all-cause mortality of 18.8%
(NGD 11.8%, EGD 32.2%; p < 0.001), life-threatening/major bleeding
complications (BC) 5.7% (NGD 3.5%, EGD 12.4%; p = 0.015), and major
vascular complications (MVC) of 3.9% (NGD 3.0%, EGD 6.2%; p = 0.041). All
coefficients in the multivariate meta-regression adjusting simultaneously
for the proportion of diabetes mellitus, chronic obstructive pulmonary
disease, peripheral arterial disease, concomitant moderate or higher
mitral regurgitation, and mean left ventricular ejection fraction (with
significant coefficients in the univariate meta-regression) were not
statistically significant. Conclusion(s): Thirty (30)-day all-cause
mortality after TAVI for AR was high (9.5%) with a high incidence of
moderate or higher PAR (7.4%). Compared with EGD, NGD was associated with
significantly higher device success rates and significantly lower rates of
second-valve deployment, moderate or higher PAR, 30-day/mid-term all-cause
mortality, serious BC, and MVC. Copyright © 2019 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<89>
Accession Number
2002085697
Title
Thyroid Hormone (Triiodothyronine) Therapy in Children After Congenital
Heart Surgery: A Meta-Analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Flores S.; Loomba R.S.; Checchia P.A.; Graham E.M.; Bronicki R.A.
Institution
(Flores, Checchia, Bronicki) Section of Critical Care and Cardiology,
Department of Pediatrics, Texas Children's Hospital, Baylor College of
Medicine, Houston, TX, United States
(Loomba) Division of Cardiology, Advocate Children's Hospital, Oak Lawn,
IL, United States
(Graham) Division of Cardiology, Department of Pediatrics, Medical
University of South Carolina, Charleston, SC, United States
Publisher
W.B. Saunders
Abstract
Thyroid hormone modifies metabolic, immune and cardiovascular functions
and has been administered perioperatively to treat a relative reduction of
thyroid function in children following cardiopulmonary bypass (CPB) for
correction of congenital heart disease. However, it remains unclear
whether its use is associated with improved outcomes. We performed a
meta-analysis of studies that evaluated the impact of thyroid hormone
supplementation on clinical outcomes in children undergoing repair of
congenital heart disease using CPB. A systematic review of published
trials was conducted to identify studies of children randomized to thyroid
hormone supplementation or placebo undergoing congenital heart surgery. A
meta-analysis was then conducted to determine the clinical impact of
thyroid hormone replacement on cardiac function and postoperative
characteristics. The following outcomes were included for the study:
duration of mechanical ventilation, duration of intensive care unit (ICU)
stay, duration of postoperative hospital stay, inotrope score, cardiac
index at 24 hours postoperatively, and inpatient mortality. A total of 9
studies with 711 patients were included in the analyses. All included
studies were prospective and patients were randomized to either thyroid
hormone or placebo. There was wide variation in thyroid hormone dosing,
ranging from 0.4 mug/kg up to 5 mug/kg over a 24-hour period, and duration
of therapy, ranging from a single dose after cessation of CPB to continued
thyroid hormone for the duration of the ICU stay. There was a significant
difference in the mean inotrope score between the 2 groups of -1.249 (95%
confidence interval -1.570 to -0.929, P < 0.001), with the inotrope score
being significantly lower in the thyroid group. There was no difference in
duration of mechanical ventilation, duration of ICU stay, duration of
hospital stay, cardiac index, and mortality between groups. In this
meta-analysis, routine thyroid hormone replacement with approximately 1-5
mug/kg administered over 24 hours does not significantly alter the
postoperative course in children following CPB. However, given a
clinically small but significant difference in respect to lower inotrope
score and shorter duration of ICU and hospital stays with higher thyroid
replacement additional studies are warranted. Copyright © 2019
Elsevier Inc.

<90>
Accession Number
2002018703
Title
Post cardiovascular surgery atrial fibrillation. Biomarkers determining
prognosis.
Source
Current Medicinal Chemistry. 26 (5) (pp 916-924), 2019. Date of
Publication: 2019.
Author
Manfrini O.; Cenko E.; Ricci B.; Bugiardini R.
Institution
(Manfrini, Cenko, Ricci, Bugiardini) Department of Experimental,
Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: New onset of atrial fibrillation (AF) after cardiovascular
surgery is associated with increased risk of complications and length of
hospital stay. Identification of patients at high risk of post-operative
AF (POAF) may help to act with preventive strategies having clinical and
economic relevance. Objective(s): The focus of this review is to
summarize findings on biomarkers of myocardial fibrosis (PICP and PIIINP),
profibrotic mediators (TGF-beta1), extracellular matrix remodeling
(MMP-9), myocardial stretch (BNP and NTpro-BNP), inflammation
(interleukins, C-reactive protein and sCD40L), and myocardial necrosis
(high-sensitivity troponin T), biomarkers, that can be used in clinical
practice to stratify patients at risk for POAF. Method(s): We
searched English-language studies on MEDLINE and PubMed. Evidence
synthesis was based on cohort studies, clinical trials and meta-analysis
data. International clinical practice guidelines were reviewed, as well.
 Result(s): Factors such as cardiac remodelling, atrial pressure,
surgery trauma, inflammation, oxidative stress, and
sympathetic/parasympathetic activation have been implicated in the
development of POAF. On the basis of multifactorial mechanism underlying
the onset of POAF, several studies have investigated the predictive value
of some serum biomarkers. To date, there are promising preliminary data on
the clinical utility of PICP, PIINP, TGF-beta1 and sCD40L, whereas data on
NT-proBNP, BNP, CRP, IL- 6, and hs-cTnT are controversial.
 Conclusion(s): Although some studies have shown promising results,
there is a need for future larger studies with longer follow-up, before
applying biomarkers as tools for POAF risk-stratification into clinical
practice. Copyright © 2019 Bentham Science Publishers.

<91>
Accession Number
628089282
Title
Therapeutic options and survival of patients with plastic bronchitis after
single ventricle palliation-a systematic review.
Source
Cardiology in the Young. Conference: 53rd Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC 2019.
Spain. 29 (Supplement 1) (pp S90), 2019. Date of Publication: April 2019.
Author
Harteveld L.M.; Blom N.A.; Hazekamp M.G.; Ten Harkel A.D.J.
Institution
(Harteveld, Blom, Hazekamp, Ten Harkel) Center for Congenital Heart
Disease Amsterdam-Leiden, Leiden, Netherlands
(Harteveld, Blom, Ten Harkel) Department of Pediatric Cardiology, Leiden
University Medical Center, Netherlands
(Blom) Department of Pediatric Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Hazekamp) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Netherlands
Publisher
Cambridge University Press
Abstract
Introduction: Plastic bronchitis (PB) is a rare complication in single
ventricle (SV) patients of which the exact pathophysiology, survival and
best treatment are still unclear. This study aims to systematically review
the literature to give insight into characteristics, survival and
management of SV patients with PB. Method(s): A systematic review was
conducted, using the PUBMED database, to find articles, published up to
August 2018, with SV patients and PB of which characteristics, treatment
and/or outcome were well described per case. [Figure Presented]
Kaplan-Meier curve of survival of patients withplastic bronchitis (PB)
based on period of diagnosis after Fontan palliation, diagnosis within 12
months (light grey dashed line) and after 12 months (dark grey solid line)
after Fontan palliation. Result(s): 576 articles were screened and 72
articles had sufficient data of 132 well described SV cases with PB. Most
cases had a Fontan palliation (n=125) with a median age at diagnosis of PB
of 60.0 months (IQR 41.0-85.3), median age at Fontan operation of 36.5
months (IQR 25.5-50.4), median interval between Fontan operation and
diagnosis of PB of 18.0 months (IQR 5.0-36.6) and a median follow-up after
diagnosis of PB of 18.0 months (IQR 6.5-36.8). Mortality was 15.2% (n=20)
with a median period of 3.5 months after diagnosis of PB. Patients were
treated with a combination of medical and interventional/surgical
treatment (n=101), only medical (n=13) or only interventional/surgical
treatment (n=11). Most reported drugs were fibrinolytics (n=75), most
described intervention was bronchoscopic cast extraction (n=61) and most
reported catheterization and/or surgical treatments were
ligation/embolization of thoracic duct (n=33), relief of arterial, venous
or intra-cardiac stenosis (n=26), creation, dilation or stenting of
fenestration (n=24), and occasionally Fontan takedown or heart
transplantation. Mortality was associated with diagnosis of PB within 12
months after Fontan palliation versus diagnosis after 12 months after
Fontan palliation (five-years survival of 56.1% within 12 months vs 94.7%
after 12 months, p=0.003; Figure) and a higher age at Fontan operation
(47.4 months in the mortality group vs 36.0 months in the survival group,
p=0.013). Conclusion(s): Most cases are diagnosed with PB one year
and a half after the Fontan palliation and around one-sixth of the cases
die after a short period after diagnosis. A negative outcome is associated
with diagnosis of PB within 12 months after Fontan palliation and a higher
age at Fontan operation.

<92>
Accession Number
628088744
Title
Optimal duration for clopidogrel suspension prior to cardiac surgery.
Source
Journal of Investigative Medicine. Conference: Eastern Regional Meeting
2019. United States. 67 (4) (pp 784), 2019. Date of Publication: April
2019.
Author
Cheema M.A.; Ghani A.R.; Ullah W.; Balaratna A.; Cohen M.
Institution
(Cheema, Ghani, Ullah) Internal Medicine, Abington Jefferson Health,
Horsham, RI, United States
(Balaratna, Cohen) Cardiology, Abington Jefferson Health, Horsham, PA,
United States
Publisher
BMJ Publishing Group
Abstract
Purpose of study Recent American College of Cardiology (ACC) guideline
suggests clopidogrel suspension five days before non-emergent cardiac
surgery (Class IIa, Level B).1 This puts patients with recent angioplasty
and ongoing ischemia at a high risk of stent thrombosis.1 We sought to
determine the bleeding risk in patients who stopped clopidogrel at three
or less than three days before cardiac surgery. Methods used A
retrospective single center study was performed, and a total of 90
patients were included. Forty patients were not on clopidogrel and hence
were used as a control group. Fifty of the remaining patients were
randomized into two groups. Group A included patients who had clopidogrel
stopped three or less than three days prior to the cardiac surgery and
group B included patients who followed the standard ACC guidelines and
clopidogrel was suspended five days before the coronary artery bypass
graft (CABG). The frequency of the included patients in each group is
shown in table 1. Postoperative hemoglobin drop was analyzed between
subgroups using IBM SPSS version 22. Summary of results The mean age of
the included population was 69.9 years (46-88) with 65% comprising of male
and 35% female patients. The mean hemoglobin (Hb) drop for patients in
group A was 2.42 in comparison with Hb drop of 2.51 for patients in group
B prior to the surgery. This is shown in figure 1. Conclusions Our study
concludes that there was no significant difference in the hemoglobin drop
of the patients who had clopidogrel stopped three days prior to the major
procedure like CABG in comparison to the patients who stopped clopidogrel
five days before surgery. We advocate, that early cessation of clopidogrel
is posing a threat of thrombosis in high risk patients with no additional
benefit of decreased bleeding risks. However, large population studies are
needed to validate the results. (Figure Presented).

<93>
Accession Number
628084799
Title
Serum proteomic analysis in thoracic surgery patients with delirium.
Source
Journal of Investigative Medicine. Conference: Midwest Clinical and
Translational Research Meeting 2019. United States. 67 (5) (pp 900), 2019.
Date of Publication: June 2019.
Author
Khan S.H.; Purpura R.; Perkins A.; Gao S.; Khan B.
Institution
(Khan, Purpura, Perkins, Gao, Khan) Indiana University, School of
Medicine, United States
Publisher
BMJ Publishing Group
Abstract
Background and objectives Delirium is a leading post-operative
complication in non-cardiac thoracic surgery patients, with an incidence
as high as 50%. The pathophysiology of delirium is not well defined. We
performed an exploratory proteomic analysis to identify serum proteins
associated with delirium in thoracic surgery patients. Methods Blood
samples were collected from 56 patients (28 with delirium, 28 without
delirium) enrolled in PEPOD, a randomized double-blind clinical trial.
Inclusion criteria of the parent trial were: English speaking, adults aged
18 or older, undergoing thoracic surgery at our tertiary-care academic
medical center. Exclusion criteria of the parent trial were history of
schizophrenia, Parkinson's, severe dementia, alcohol abuse, haloperidol
allergy, neuroleptic malignant syndrome. Blood samples were collected
pre-operatively, and on post-operative day 1. Trypsin-digested protein
samples were labeled with TMT 10plex isobaric labels, eluted with 3-hour
acetonitrile gradient with mass spectrometry. Bioinformatics analysis was
performed using Thermo Proteome Discoverer and STRING web-based tools.
Between-group differences in median abundance ratios were analyzed using
Kruskal-Wallis. Results Three proteins with greater increase in median
abundance ratio in the delirium group were identified: Coagulation factor
IX (delirium-negative: 1.13, IQR: 0.99-1.18, deliriumpositive: 1.18, IQR:
1.08-1.26, p=0.047), phospholipid transfer protein (delirium-negative:
0.94, IQR: 0.88-1.06, deliriumpositive: 1.05, IQR: 0.97-1.11, p=0.029),
and mannosyl-oligosaccharide 1,2-alpha-mannosidase (delirium-negative:
1.36, IQR: 1.34-1.44, delirium-positive: 1.48, IQR: 1.35-1.60, p=0.043).
Conclusions Our study identified three proteins with greater increase in
median abundance ratio in the delirium group. This hypothesis generating
study may guide further work in proteins associated with postoperative
delirium.

<94>
Accession Number
628084776
Title
Up to 7-year follow-up of bicuspid aortic valves (BAV) undergoing TAVI
versus surgical aortic valve replacement (SAVR).
Source
Thoracic and Cardiovascular Surgeon. Conference: 48th Annual Meeting
German Society for Thoracic, Cardiac, and Vascular Surgery. Germany. 67
(Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Josic T.; Koehne J.; Liebetrau C.; Schonburg M.; Kim K.W.; Doss M.
Institution
(Josic, Koehne, Schonburg, Doss) Kerckhoff-Klinik, Cardiac Surgery, Bad
Nauheim, Germany
(Liebetrau, Kim) Kerckhoff-Klinik, Cardiology, Bad Nauheim, Germany
Publisher
Georg Thieme Verlag
Abstract
Objectives: Recently many groups have reported their results with TAVI in
bicuspid aortic valves and have pointed out technical challenges in this
patient population. The aim of this study was to compare clinical outcomes
of bicuspid aortic valves; in TAVI vs. surgical aortic valve replacement
in an up to 7-year follow-up. Method(s): Between January 2011 and
December 2014, a total of 2,506 patients with aortic stenosis underwent
aortic valve replacement in our institution. 1,515 patients had a surgical
aortic valve replacement and 991 patients had a TAVI procedure. In this
cohort of patients, there were 104 bicuspid aortic valves (BAV) identified
(SAVR = 52 vs. TAVI = 52). The diagnosis of BAV was made preoperatively by
CT scan, echocardiography, or intraoperatively. Clinical endpoints were
procedural and postoperative complications. Mean follow-up was 5 +/- 2.82
years. Result(s): Postoperative complications with the need for a
secondary intervention were higher in the TAVI group 36.53% (n = 19) vs.
19.23% (n = 10) (vascular complications, pacemaker and conversion/
re-sternotomy). Significantly more patients in the TAVI group had a stroke
postoperatively; 25% (n = 13) vs. 7, 69% (n = 4); p = 0.011. Residual
aortic regurgitation > grade II was significantly higher in the TAVI group
(21.2 vs. 0%). Thirty-day mortality was lower in the SAVR group, 1.92% (n
= 1) vs. 7.69% (n = 4), also the 5-year follow-up was lower in the SAVR
group, 5.7% (n=3), then in the TAVI group, 46.30% (n = 24).
 Conclusion(s): Treatment of BAV with TAVI bears significant
procedural challenges. It may be an alternative treatment option for
high-risk patients with BAV. In our study TAVI had significantly higher
rates of mortality and procedural complications. Since the cohort was
small, a randomized trial would lead to more conclusive results.

<95>
Accession Number
628084705
Title
Preoperative intracranial hemorrhage affecting surgical decision making in
endocarditis patients: a literature review and a single-centre
retrospective study.
Source
Thoracic and Cardiovascular Surgeon. Conference: 48th Annual Meeting
German Society for Thoracic, Cardiac, and Vascular Surgery. Germany. 67
(Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Musleh R.; Diab M.; Guenther A.; Faerber G.; Lehmann T.; Tasar R.; Franz
M.; Witte W.O.; Doenst T.
Institution
(Musleh, Diab, Faerber, Tasar, Doenst) Department of Cardiothoracic
Surgery, Friedrich-Schiller-University Jena, Jena, Germany
(Guenther, Witte) Department of Neurology, Friedrich-Schiller-University
Jena, Jena, Germany
(Lehmann) Center of Clinical Studies, Friedrich-Schiller-University Jena,
Jena, Germany
(Franz) Department of Internal Medicine I, Friedrich-Schiller-University
Jena, Jena, Germany
Publisher
Georg Thieme Verlag
Abstract
Objectives: Cardiac surgery in infectious endocarditis (IE) patients with
preoperative intracranial hemorrhage (Pre-ICH) is considered a highly
debatable issue, and guidelines are still not well defined. Recent studies
suggest that the incidence of neurological exacerbations has decreased in
recent years. In this study, we aimed to investigate the effect of cardiac
surgery on clinical outcomes of IE patients accompanied by Pre-ICH.
 Method(s): Through using PubMed, EMBASE, and Cochrane databases, a
systematic review of the recent publications (1995-August 2018) was
conducted. Twenty-six articles were retrieved, but due to the lack of
controlled studies, only seven articles provided the best evidence to
answer our clinical question and thus were included. We also
retrospectively analyzed data from our own patients who were operated for
left-sided endocarditis between January 2007 and May 2018. A total of 525
patients were identified, but only 287 patients with preoperative brain
imaging were included in further analysis. Result(s): Literature
review illustrated a total of 133 cases of IE patients with Pre-ICH who
underwent cardiac surgery. A total of 112 patients (84.2%) reported no
postoperative neurological deterioration regardless of the timing of the
surgery; 12 patients (9.1%) had postoperative events (10 with new strokes
as cerebral infarcts or ICH; 2 with ectopic asymptomatic hemorrhages).
However, none of the observed events led to death. Nine patients (6.7%)
died, and one article confirmed the cause of mortality in four of nine
deaths as cardiac or multiorgan failure (MOF). As for our own
retrospective study, we identified a total of 34 patients with Pre-ICH who
were assigned to cardiac surgery. There was no significant difference in
hospital mortality between patients with Pre-ICH and without Pre-ICH (29.4
vs. 28.9%; p = 1.0). The rate of postoperative bleeding was higher in
patients with pre-ICH compared with those without pre-ICH, but the
difference was not statistically significant (17.5 vs. 7.5%; p = 0.095).
Out of six patients who presented with postoperative bleeding, three
showed resorption of the ICH on follow-up brain imaging.
 Conclusion(s): Recent studies report a low rate of neurological
deterioration and good survival in operated IE patients with Pre-ICH. The
results of our patient data and the literature review suggest that the
perception of preoperative ICH may be worse than it actually is. These
findings may facilitate decision making in endocarditis patients with
intracranial hemorrhage.

<96>
Accession Number
628084501
Title
Partial upper sternotomy versus full sternotomy for mitral valve surgery:
A propensity score matched analysis.
Source
Thoracic and Cardiovascular Surgeon. Conference: 48th Annual Meeting
German Society for Thoracic, Cardiac, and Vascular Surgery. Germany. 67
(Supplement 1) (no pagination), 2019. Date of Publication: January 2019.
Author
Oezpeker C.U.; Barbieri F.; Bonaros N.; Grimm M.; Hoefer D.; Mueller L.
Institution
(Oezpeker, Barbieri, Bonaros, Grimm, Hoefer, Mueller) Department of
Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
Publisher
Georg Thieme Verlag
Abstract
Objectives: Minimally invasive mitral valve surgery (MIMVS) through
anterolateral minithoracotomy (MT) has become the standard therapy for
isolated mitral valve disease in experienced centers. Multiple valve
disease or other anatomical and certain clinical conditions, however, make
this access not suitable for some patients and conventional full
sternotomy (FS) is the mostly preferred alternative approach. For those
patients, partial upper sternotomy (PS) can be used as a less invasive
access. Although FS has been widely investigated, there are not enough
insights to the PS approach for mitral valve surgery (MVS). Therefore, we
compared the data of both accesses. Method(s): This retrospective
analysis includes data on 1,639 patients who underwent either isolated or
combined primary MVS at our department from May 2011 to August 2017. Out
of these, 663 patients were operated via MT access and were excluded from
this analysis. Further 528 patients were excluded mainly due to
concomitant coronary artery bypass (CABG) surgery but also because of
re-do cases, concomitant aortic surgery or urgent/salvage MVS. Finally, 99
patients who had been judged suitable for PS had either isolated MVS (n =
47, 47.5%) or multivalve surgery (n = 52, 52.5%). In addition, 349
patients with FS for primary MVS were included in our study. To reduce the
possibility of selection bias a 1:1 propensity score match making was
performed which resulted in 98 pairs. For analysis of postoperative
survival Kaplan-Meier curves were calculated. Result(s): During a
median follow-up time of 1,491 days (478-2,186; PS 1,103 [331-1,806 days],
FS 2,180 days [8413,054]) all-cause mortality was 15.90% (70 of 439
patients). In the propensity score paired model, PS showed statistically
significant superior survival compared with FS at 30 days (p = 0.044,
hazard ratio [HR] 7.525, 95% confidence interval [CI] 1.06-53.56).
Furthermore, 90 and 365 days survival after surgery showed a similar
trend, but without reaching statistical significance (p = 0.096, HR 3.898,
95% CI 0.79-19.34; p = 0.077, HR 2.774, 95% CI 0.89-8.61). As secondary
end points, number of second pump runs and hospital length of stay were
significantly less (p = 0.016, p < 0.001) in PS patients.
 Conclusion(s): The less invasive PS approach for MVS seems to have
short- and long-term survival benefits. In patients who are not candidates
for MT PS seems a favorable approach although prospective
randomized-controlled trials are necessary for confirmation.

<97>
Accession Number
2002097221
Title
Interventions for secondary mitral regurgitation in patients with heart
failure: A network meta-analysis of randomized controlled comparisons of
surgery, medical therapy & transcatheter intervention.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Kheiri B.; Zayed Y.; Barbarawi M.; Osman M.; Chahine A.; Ahmed S.; Bachuwa
G.; Hassan M.; Alkhouli M.; Feldman T.; Bhatt D.L.
Institution
(Kheiri, Zayed, Barbarawi, Chahine, Ahmed, Bachuwa, Hassan) Department of
Internal Medicine, Hurley Medical Center/Michigan State University, Flint,
MI, United States
(Osman, Alkhouli) Division of Cardiology, West Virginia University School
of Medicine, Morgantown, WV, United States
(Feldman) Evanston Hospital, NorthShore University Health System,
Evanston, IL, 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)
Abstract
Background: Mitral regurgitation (MR) in heart failure (HF) notoriously
carries a poor prognosis. While there are multiple interventional options
for treatment, the optimal intervention remains controversial. Therefore,
we aimed to evaluate the efficacy and safety of surgery, medical therapy,
and transcatheter intervention in secondary MR. Method(s): A
systematic database search was performed to identify all randomized
controlled trials (RCTs) that evaluate various interventions for secondary
MR. We performed a Bayesian network meta-analysis to calculate odd ratios
(ORs) and 95% credible intervals (CIs). The primary endpoint was all-cause
mortality. Secondary endpoints were moderate-severe MR,
HF-hospitalizations, and freedom from severe HF symptoms. Result(s):
We identified 12 RCTs (2316 total patients; age 67.6 +/- 11; 63% males,
and 74% with ischemic cardiomyopathy). There was a significant reduction
of mortality at 24-months with transcatheter leaflet repair compared with
medical therapy (OR = 0.57; 95% CI = 0.34-0.96). However, there were no
significant differences among the competing treatments in all-cause
mortality at the earlier time points of 30-days or 12-months (P > 0.05).
Recurrent moderate-severe MR was significantly less with valvular
interventions compared with medical therapy (P < 0.05), but there were no
differences in the rates of HF-hospitalizations or persistent severe HF
symptoms between the competing interventions (P > 0.05).
 Conclusion(s): Among patients with HF and secondary MR, transcatheter
leaflet repair was associated with significantly reduced 24-month
mortality compared with medical therapy. Valvular interventions were
associated with lower rates of recurrent moderate-severe MR, but
non-significant improvements in clinical outcomes. Further long-term
studies are needed to identify the best route of intervention for
secondary MR. Copyright © 2019 Elsevier Inc.

<98>
Accession Number
2002091179
Title
Spontaneous coronary artery dissection in a pregnant woman associated with
fetal complication: A case report and review of literature.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Ya'qoub L.
Institution
(Ya'qoub) Department of Cardiology, Louisiana State University,
Shreveport, LA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Spontaneous Coronary Artery Dissection (SCAD) is an important cause of
Acute Coronary Syndrome (ACS), especially in pregnant women. SCAD has
angiographic appearance that might mimic atherosclerotic coronary artery
disease (CAD). SCAD in pregnancy can be associated with both maternal and
fetal complications. The best management approach of such cases may be
achieved by a multi-disciplinary team, including an obstetrician, an
interventional cardiologist and a cardiothoracic surgeon. We present a
very interesting case of SCAD involving the left anterior descending (LAD)
artery with two different angiographic appearances in a pregnant woman
which was associated with fetal heart deceleration requiring urgent
cesarean section and later coronary artery bypass graft (CABG)
surgery. Copyright © 2019 Elsevier Inc.

<99>
Accession Number
2002085401
Title
Cryptococcus endocarditis: A case report and review of the literature.
Source
Journal of Infection and Chemotherapy. (no pagination), 2019. Date of
Publication: 2019.
Author
Nakajima T.; Oba Y.; Takashima J.; Ueno K.; Kikuchi A.; Yamada T.;
Fukunami M.
Institution
(Nakajima) Division of General Internal Medicine, Akashi Medical Center,
743-33, Okubocho-Yagi, Akashi City, Hyogo 674-0063, Japan
(Oba) Department of General Internal Medicine, Osaka General Medical
Center, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
(Takashima) Department of Respiratory Medicine, Sakai City Medical Center,
1-1-1, Eharaji, Nishi-ku, Sakai City, Osaka 593-8304, Japan
(Ueno) Department of Respiratory Medicine, Osaka General Medical Center,
3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
(Kikuchi, Yamada, Fukunami) Department of Cardiology, Osaka General
Medical Center, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
Publisher
Elsevier B.V.
Abstract
Introduction: Cryptococcus neoformans is known to be a cause of
meningitis. However, as cryptococcal endocarditis is rare, it is not well
understood. Here, we describe a case with Implantable Cardioverter
Defibrillator associated endocarditis and meningitis caused by
Cryptococcus neoformans and we review the literature associated
cryptococcal endocarditis. Case presentation: A 72 years old Japanese male
presented in emergency department with non-productive cough and
respiratory discomfort. His past medical history was ischemic heart
disease four years ago and ICD was implanted. Physical examination was
unremarkable. Chest computer tomography revealed ground glass opacity in
the right lung. He received a diagnosis of amiodarone-induced interstitial
pneumonitis and high dose steroid pulse therapy. Septic shock and acute
respiratory failure occurred after steroid therapy. Cryptococcus
neoformans was identified by blood culture and cerebral spinal fluid.
Intravenous liposomal Amphotericin B and oral flucytosine were initiated.
Transesophageal echocardiography revealed vegetation on the lead of the
ICD. Diagnosis of cryptococcal endocarditis was made. The patient died
despite antifungal therapy was continued. Discussion(s): We analyzed
our case and 8 cases of cryptococcal endocarditis in the literature for 40
years. Almost all of the patients had previous valve replacement surgery
or immunocompromised state. Three cases had meningitis. Surgery performed
in 3 cases. The overall mortality rate were 44.4%. Conclusion(s):
Cryptococcal endocarditis is rare and carries a high mortality. Almost all
of the patients had underlying diseases. Diagnosis needs repeating blood
culture and echocardiogram, sometimes. Cryptococcal endocarditis needs
lumber puncture for rule out meningitis. Copyright © 2019
Japanese Society of Chemotherapy and The Japanese Association for
Infectious Diseases

<100>
Accession Number
623636713
Title
Comparison of propofol-based versus volatile-based anaesthesia and
postoperative sedation in cardiac surgical patients: A prospective,
randomized, study.
Source
Anaesthesiology Intensive Therapy. 50 (3) (pp 200-209), 2018. Date of
Publication: 17 Aug 2018.
Author
Wasowicz M.; Jerath A.; Luksun W.; Sharma V.; Mitsakakis N.; Meineri M.;
Katznelson R.; Yau T.; Rao V.; Beattie W.S.
Institution
(Wasowicz, Jerath, Luksun, Sharma, Meineri, Katznelson, Beattie)
Department of Anesthesia, University of Toronto, Toronto, Canada
(Mitsakakis) Institute for Health Policy, Management and Evaluation,
University of Toronto, Biostatistics Research Unit, University Health
Network, Toronto, Canada
(Yau, Rao) Division of Cardiac Surgery, Peter Munk Cardiac Centre,
University Health Network, Department of Surgery, University of Toronto,
Toronto, Canada
(Wasowicz, Jerath, Luksun, Sharma, Meineri, Katznelson, Beattie)
Department of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4,
Canada
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Clinical trials have shown conflicting results regarding the
use of volatile anaesthesia before or after an ischaemic insult in cardiac
surgical patients and its effect on myocardial injury. This may be
attributable to the failure of continuing volatile agents into the early
postoperative period. We hypothesised that combined volatile-based
anaesthesia and postoperative sedation would decrease the extent of
myocardial injury after coronary artery bypass grafting (CABG) when
compared with an intravenous, propofol-based approach. This study aimed to
assess the feasibility of the perioperative protocol and investigate
whether volatile anaesthesia provides cardioprotection in patients
undergoing CABG. Method(s): Randomized, controlled trial enrolling
157 patients with preserved left ventricular function scheduled for
elective or urgent on-pump CABG. Patients received either volatile- or
propofol-based anaesthesia and postoperative sedation. Volatile sedation
in the ICU was provided with the use of the AnaConDa device
(Sedana Medical, Uppsala, Sweden). The primary outcome was myocardial
injury measured by serial troponin measurement at the beginning of
surgery, 2, 4 and 12-16 h after ICU admission. The secondary outcome was
cardiac performance expressed as cardiac index (CI) and the need for
inotropic and vasopressor drug support. The peak postoperative troponin
level was defined as the highest level at any time in the first 16 h after
surgery. Result(s): 127 patients completed the study protocol, 60
patients in the volatile group and 67 patients in the propofol group.
Troponin levels were similar between groups at all of the measured time
points. There were no differences in cardiac index or vasoactive drug
support except for the immediate post- cardiopulmonary bypass (CPB) period
when patients in the volatile group had low systemic vascular resistance,
high CI and required more vasopressors. There was no difference in
postoperative kidney function, intensive care unit discharge or hospital
discharge time. Conclusion(s): The use of volatile-based anaesthesia
and postoperative sedation did not confer any cardioprotection compared
with propofol-based anaesthesia and sedation in patients who had good left
ventricular function and were undergoing CABG.

<101>
Accession Number
622276075
Title
Remote ischaemic preconditioning for renal and cardiac protection in adult
patients undergoing cardiac surgery with cardiopulmonary bypass:
Systematic review and meta-analysis of randomized controlled trials.
Source
Nephrology Dialysis Transplantation. 33 (5) (pp 813-824), 2018. Date of
Publication: 01 May 2018.
Author
Deferrari G.; Bonanni A.; Bruschi M.; Alicino C.; Signori A.
Institution
(Deferrari, Bonanni) Department of Cardionephrology, Istituto Clinico di
Alta Specialita (ICLAS) Rapallo (GE), Italy
(Deferrari) Department of Internal Medicine (Di.MI), University of Genoa,
Genoa, Italy
(Bonanni, Bruschi) Division of Nephrology, Dialysis and Transplantation
and Laboratory on Pathophysiology of Uremia, IRCCS Istituto Giannina
Gaslini, Genoa, Italy
(Alicino, Signori) Department of Health Science (Di.S.Sal), University of
Genoa, Genoa, Italy
Publisher
Oxford University Press
Abstract
Background. The main aim of this systematic review was to assess whether
remote ischaemic preconditioning (RIPC) protects kidneys and the heart in
cardiac surgery with cardiopulmonary bypass (CPB) and to investigate a
possible role of anaesthetic agents. Methods. Randomized clinical trials
(RCTs) on the effects of RIPC through limb ischaemia in adult patients
undergoing cardiac surgery with CPB were searched (1965-October 2016) in
PubMed, Cochrane Library and article reference lists. A random effects
model on standardized mean difference 0.97)]. In the volatile anaesthetic
group, RIPC significantly reduced AKI incidence [OR 0.57 (95% CI
0.41-0.79)] and marginally reduced ICU stay. Conversely, except for MIBs,
RIPC had fewer non-significant effects under propofol with or without
volatile anaesthetics. Conclusions. RIPC did not consistently reduce
morbidity and mortality in adults undergoing cardiac surgery with CPB. In
the subgroup on volatile anaesthetics only, RIPC markedly and
significantly reduced the incidence of AKI and composite endpoint as well
asmyocardial injury. Copyright © The Author 2017.

<102>
Accession Number
622996265
Title
Hypertonic saline-hydroxyethyl starch solution attenuates fluid
accumulation in cardiac surgery patients: A randomized controlled
double-blind trial.
Source
Anaesthesiology Intensive Therapy. 50 (2) (pp 122-127), 2018. Date of
Publication: 28 Jun 2018.
Author
Jarvela K.; Rantanen M.; Koobi T.; Huhtala H.; Sisto T.
Institution
(Koobi) Department of Clinical Physiology, Tampere University Hospital,
Tampere, Finland
(Huhtala) Faculty of Social Sciences, Tampere University, Tampere, Finland
(Jarvela, Rantanen, Sisto) Heart Centre Co. Tampere University Hospital,
PO Box 2000, Tampere FIN-33521, Finland
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Significant fluid retention is common after cardiac surgery
with the use of cardiopulmonary bypass (CPB). The aim of the study was to
evaluate the effects of hypertonic saline-hydroxyethyl starch (HS-HES)
solution on fluid accumulation in patients undergoing coronary artery
bypass grafting surgery (CABG). Method(s): Fifty adult male patients
undergoing coronary bypass surgery were enrolled in this interventional,
randomized, double-blinded study to compare HS-HES with saline solution.
The study fluid (250 mL) was given into the venous reservoir of the CPB
circuit at the time of aortic declamping. Result(s): Body mass change
from the baseline to the first postoperative morning was significantly
less in the HS-HES group compared with the control group (3.3 +/- 1.5 kg
vs. 4.4 +/- 1.5 kg, P = 0.022). In the extracellular water (ECW) or
ECW-balance, there were no significant differences between the groups. The
need for fluids and diuretic medication did not differ between the groups
during the perioperative period. Conclusion(s): Our study shows that
250 mL of HS-HES solution can reduce perioperative fluid accumulation to
some degree in patients undergoing CABG surgery with CPB. Copyright
© 2018 Via Medica. All rights reserved.

<103>
Accession Number
618838114
Title
Economic analysis of Apixaban therapy for patients with Atrial
Fibrillation from a us perspective: Results from the Aristotle randomized
clinical trial.
Source
JAMA Cardiology. 2 (5) (pp 525-534), 2017. Date of Publication: May 2017.
Author
Cowper P.A.; Sheng S.; Lopes R.D.; Anstrom K.J.; Stafford J.A.;
Davidson-Ray L.; Al-Khatib S.M.; Ansell J.; Dorian P.; Husted S.; McMurray
J.J.V.; Steg P.G.; Alexander J.H.; Wallentin L.; Granger C.B.; Mark D.B.
Institution
(Cowper, Sheng, Lopes, Anstrom, Stafford, Davidson-Ray, Al-Khatib,
Alexander, Granger, Mark) Duke Clinical Research Institute, Duke
University Medical Center, PO Box 17969, Durham, NC 27715, United States
(Ansell) Department of Medicine, Hofstra Northwell School of Medicine,
Hemstead, NY, United States
(Dorian) Division of Cardiology, University of Toronto, Toronto, ON,
Canada
(Husted) Aarhus University, Aarhus, Denmark
(McMurray) British Heart Foundation, Cardiovascular Research Centre,
University of Glasgow, Glasgow, United Kingdom
(Steg) Universite Paris-Diderot, Sorbonne Paris Cite, French Alliance for
Cardiovascular Clinical Trials, Departement Hospitalo-Universitaire
Fibrosis, Inflammation, Remodeling, Assistance-Publique-Hopitaux de Paris,
Institut National de la Sante et de la Recherche Medicale U-1148, Paris,
France
(Steg) National Heart and Lung Institute, Royal Brompton Hospital,
Imperial College, London, United Kingdom
(Wallentin) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The Apixaban for Reduction in Stroke and Other Thromboembolic
Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban
therapy was superior to warfarin therapy in preventing stroke and
all-cause death while causing significantly fewer major bleeds. To
establish the value proposition of substituting apixiban therapy for
warfarin therapy in patients with atrial fibrillation, we performed a
cost-effectiveness analysis using patient-level data from the ARISTOTLE
trial. Objective(s): To assess the cost and cost-effectiveness of
apixaban therapy compared with warfarin therapy in patients with atrial
fibrillation from the perspective of the US health care system.
 Design, Setting, and Participant(s): This economic analysis uses
patient-level resource use and clinical data collected in the ARISTOTLE
trial, a multinational randomized clinical trial that observed 18 201
patients (3417 US patients) for a median of 1.8 years between 2006 and
2011. Intervention(s): Apixaban therapy vs warfarin therapy.
 Main Outcomes and Measures: Within-trial resource use and costwere
compared between treatments, using externally derived US cost weights.
Life expectancies for US patients were estimated according to their
baseline risk and treatment using time-based and age-based survival models
developed using the overall ARISTOTLE population. Quality-of-life
adjustment factors were obtained from external sources. Cost-effectiveness
(incremental cost per quality-adjusted life-year gained) was evaluated
from a US perspective, and extensive sensitivity analyses were performed.
 Result(s): Of the 3417 US patients enrolled in ARISTOTLE, the mean
(SD) age was 71 (10) years; 2329 (68.2%) were male and 3264 (95.5%) were
white. After 2 years of anticoagulation therapy, health care costs
(excluding the study drug) of patients treated with apixaban therapy and
warfarin therapy were not statistically different (difference, -$60;
95%CI, -$2728 to $2608). Life expectancy, modeled from ARISTOTLE outcomes,
was significantly longer with apixaban therapy vs warfarin therapy (7.94
vs 7.54 quality-adjusted life years). The incremental cost, including cost
of anticoagulant and monitoring, of achieving these benefits was within
accepted US norms ($53 925 per quality-adjusted life year, with 98%
likelihood of meeting a $100 000 willingness-to-pay threshold). Results
were generally consistent when model assumptions were varied, with
lifetime cost-effectiveness most affected by the price of apixaban and the
time horizon. Conclusions and Relevance: Apixaban therapy for
ARISTOTLE-eligible patients with atrial fibrillation provides clinical
benefits at an incremental cost that represents reasonable value for money
judged using US benchmarks for cost-effectiveness. Copyright ©
2017 American Medical Association. All rights reserved.

<104>
Accession Number
618838054
Title
Effect of ischemic postconditioning during primary percutaneous coronary
intervention for patients with ST-segment elevation myocardial infarction:
A randomized clinical trial.
Source
JAMA Cardiology. 2 (5) (pp 490-497), 2017. Date of Publication: May 2017.
Author
Engstrom T.; Kelbaek H.; Helqvist S.; Hofsten D.E.; Klovgaard L.;
Clemmensen P.; Holmvang L.; Jorgensen E.; Pedersen F.; Saunamaki K.;
Ravkilde J.; Tilsted H.-H.; Villadsen A.; Aaroe J.; Jensen S.E.; Raungaard
B.; Botker H.E.; Terkelsen C.J.; Maeng M.; Kaltoft A.; Krusell L.R.;
Jensen L.O.; Veien K.T.; Kofoed K.F.; Torp-Pedersen C.; Kyhl K.;
Nepper-Christensen L.; Treiman M.; Vejlstrup N.; Ahtarovski K.; Lonborg
J.; Kober L.; Thygesen K.; Jeppesen J.; Galloe A.; Jensen G.B.; Gislasson
G.; Erlinge D.
Institution
(Engstrom, Helqvist, Hofsten, Klovgaard, Clemmensen, Holmvang, Jorgensen,
Pedersen, Saunamaki, Tilsted, Kofoed, Kyhl, Nepper-Christensen, Vejlstrup,
Ahtarovski, Lonborg, Kober) Department of Cardiology, Rigshospitalet,
University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
(Kelbaek, Galloe) Department of Cardiology, Roskilde Hospital, Roskilde,
Denmark
(Ravkilde, Villadsen, Aaroe, Jensen, Raungaard) Department of Cardiology,
Aalborg University Hospital, Aalborg, Denmark
(Botker, Terkelsen, Maeng, Kaltoft, Krusell) Department of Cardiology,
Skejby University Hospital, Skejby, Denmark
(Jensen, Veien) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Torp-Pedersen) Department of Clinical Epidemiology, Aalborg University
Hospital, Aalborg, Denmark
(Treiman) Department of Biomedical Sciences, Faculty of Health Sciences,
University of Copenhagen, Copenhagen, Denmark
(Thygesen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Jeppesen) Department of Medicine, Copenhagen University Hospital
Glostrup, Copenhagen, Denmark
(Jensen) Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark
(Gislasson) Department of Cardiology, Gentofte Hospital, Cohenhagen,
Denmark
(Erlinge) Department of Cardiology, Lund University, Lund, Sweden
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Ischemic postconditioning of the heart during primary
percutaneous coronary intervention (PCI) induced by repetitive
interruptions of blood flow to the ischemic myocardial region immediately
after reopening of the infarct-related arterymay limit myocardial damage.
 Objective(s): To determine whether ischemic postconditioning can
improve the clinical outcomes in patients with ST-segment
elevationmyocardial infarction (STEMI). Design, Setting, and
Participant(s): In this multicenter, randomized clinical trial, patients
with onset of symptoms within 12 hours, STEMI, and thrombolysis
inmyocardial infarction (TIMI) grade 0-1 flow in the infarct-related
artery at arrival were randomized to conventional PCI or postconditioning.
Inclusion began on March 21, 2011, through February 2, 2014, and follow-up
was completed on February 2, 2016. Analysis was based on intention to
treat. Intervention(s): Patients were randomly allocated 1:1 to
conventional primary PCI, including stent implantation, or
postconditioning performed as 4 repeated 30-second balloon occlusions
followed by 30 seconds of reperfusion immediately after opening of the
infarct-related artery and before stent implantation. Main Outcome and
Measures: A combination of all-cause death and hospitalization for heart
failure. Result(s): During the inclusion period, 1234 patients (975
men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent
randomization in the trial. Median follow-up was 38 months (interquartile
range, 24-58 months). The primary outcome occurred in 69 patients (11.2%)
who underwent conventional primary PCI and in 65 (10.5%) who underwent
postconditioning (hazard ratio, 0.93; 95%CI, 0.66-1.30; P = .66). The
hazard ratios were 0.75 (95%CI, 0.49-1.14; P = .18) for all-cause death
and 0.99 (95%CI, 0.60-1.64; P = .96) for heart failure. Conclusions
and Relevance: Routine ischemic postconditioning during primary PCI failed
to reduce the composite outcome of death from any cause and
hospitalization for heart failure in patients with STEMI and TIMI grade
0-1 flow at arrival. Copyright © 2017 American Medical
Association. All rights reserved.

<105>
Accession Number
618808940
Title
Health status benefits of transcatheter vs surgical aortic valve
replacement in patients with severe aortic stenosis at intermediate
surgical risk: Results from the PARTNER 2 randomized clinical trial.
Source
JAMA Cardiology. 2 (8) (pp 837-845), 2017. Date of Publication: August
2017.
Author
Baron S.J.; Arnold S.V.; Wang K.; Magnuson E.A.; Chinnakondepali K.;
Makkar R.; Herrmann H.C.; Kodali S.; Thourani V.H.; Kapadia S.; Svensson
L.; Brown D.L.; Mack M.J.; Smith C.R.; Leon M.B.; Cohen D.J.
Institution
(Baron, Arnold, Wang, Magnuson, Chinnakondepali, Smith, Cohen)
Saint-Luke's Mid America Heart Institute, School of Medicine, University
of Missouri, 4401Wornall Rd, Kansas City, MO 64111, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, California (Makkar),
United States
(Herrmann) Hospital of University of Pennsylvania, Philadelphia, United
States
(Kodali, Leon) Columbia University Medical Center, New York, New York,
United States
(Thourani) Emory University School of Medicine, Atlanta, Georgia, United
States
(Kapadia, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Brown) Baylor Scott and White Healthcare, Plano, Texas, United States
(Mack) Baylor Health Care System, Plano, Texas, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE In patients with severe aortic stenosis (AS) at intermediate
surgical risk treatment with transcatheter aortic valve replacement (TAVR)
or surgical aortic valve replacement (SAVR) results in similar 2-year
survival. The effect of TAVR vs SAVR on health status in patients at
intermediate surgical risk is unknown. OBJECTIVE To compare health-related
quality of life among intermediate-risk patients with severe AS treated
with either TAVR or SAVR. DESIGN, SETTING, AND PARTICIPANTS Between
December 2011 and November 2013, 2032 intermediate-risk patients with
severe AS were randomized to TAVR with the Sapien XT valve or SAVR in the
Placement of Aortic Transcatheter Valve 2 Trial and were followed up for 2
years. Data analysis was conducted between March 1, 2016, to April 30,
2017. MAIN OUTCOMES AND MEASURES Health status was assessed at baseline, 1
month, 1 year, and 2 years using the Kansas City Cardiomyopathy Quest
ionnaire (KCCQ) (23 items covering physical function, social function,
symptoms, self-efficacy and knowledge, and quality of life on a 0- to
100-point scale; higher scores indicate better quality of life), Medical
Outcomes Study Short Form-36 (36 items covering 8 dimensions of health
status as well as physical and mental summary scores; higher scores
represent better health status), and EuroQOL-5D (assesses 5 dimensions of
general health on a 3-level scale, with utility scores ranging from 0
[death] to 1 [ideal health]). Analysis of covariance was used to examine
changes in health status over time, adjusting for baseline status. RESULTS
Of the 2032 randomized patients, baseline health status was available for
1833 individuals (950 TAVR, 883 SAVR) who formed the primary analytic
cohort. A total of 1006 (54.9%) of the population were men; mean (SD) age
was 81.4 (6.8) years. Over 2 years, both TAVR and SAVR were associated
with significant improvements in both disease specific (16-22 points on
the KCCQ-OS scale) and generic health status (3.9-5.1 points on the SF-36
physical summary scale). At 1 month, TAVR was associated with better
health status than SAVR, but this difference was restricted to patients
treated via transfemoral access (mean difference in the KCCQ overall
summary [KCCQ-OS] score, 14.1 points; 95%CI, 11.7 to 16.4; P < .01) and
was not seen in patients treated via transthoracic access (mean difference
in KCCQ-OS, 3.5 points; 95%CI, -1.4 to 8.4; P < .01 for interaction).
There were no significant differences between TAVR and SAVR in any health
status measures at 1 or 2 years. CONCLUSIONS AND RELEVANCE Among
intermediate-risk patients with severe AS, health status improved
significantly with both TAVR and SAVR through 2 years of follow up. Early
health status improvement was greater with TAVR, but only among patients
treated via transfemoral access. Longer term follow-up is needed to assess
the durability of quality-of-life improvement with TAVR vs SAVR in this
population. Copyright © 2017 American Medical Association. All
rights reserved.

<106>
Accession Number
616540448
Title
Low-Level Vagus Nerve Stimulation Suppresses Post-Operative Atrial
Fibrillation and Inflammation: A Randomized Study.
Source
JACC: Clinical Electrophysiology. 3 (9) (pp 929-938), 2017. Date of
Publication: September 2017.
Author
Stavrakis S.; Humphrey M.B.; Scherlag B.; Iftikhar O.; Parwani P.; Abbas
M.; Filiberti A.; Fleming C.; Hu Y.; Garabelli P.; McUnu A.; Peyton M.; Po
S.S.
Institution
(Stavrakis, Humphrey, Scherlag, Iftikhar, Parwani, Abbas, Filiberti,
Fleming, Hu, Garabelli, McUnu, Peyton, Po) Heart Rhythm Institute,
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,
United States
Publisher
Elsevier Inc
Abstract
Objectives This study sought to examine the efficacy of low-level vagus
nerve stimulation (LLVNS) in suppressing post-operative atrial
fibrillation (POAF) and inflammatory cytokines in patients undergoing
cardiac surgery. Background POAF often complicates cardiac surgery.
Methods Patients undergoing cardiac surgery were randomized to active or
sham LLVNS. In all patients, a bipolar wire was sutured to the vagus nerve
pre-ganglionic fibers alongside the lateral aspect of the superior vena
cava. High-frequency (20 Hz) stimulation, 50% below the threshold for
slowing the heart rate, was delivered for 72 h in the LLVNS group. The
development of POAF was monitored continuously during the entire hospital
stay by use of telemetry. Blood was collected on arrival in the intensive
care unit and at 24 and 72 h for measurement of inflammatory cytokines.
Patients were followed up within 1 month after cardiac surgery. Results A
total of 54 patients were randomized to either active LLVNS (n = 26) or
sham control (n = 28). The baseline characteristics of the patients were
balanced in the 2 groups. POAF occurred in 3 patients (12%) in the LLVNS
group and 10 patients (36%) in the control group (hazard ratio: 0.28; 95%
confidence interval: 0.10 to 0.85; p = 0.027). None of the patients
developed any complications as a result of wire placement. At 72 h, serum
tumor necrosis factor-alpha and interleukin-6 levels were significantly
lower in the LLVNS group than in the control group. Conclusions These data
suggest that LLVNS suppresses POAF and attenuates inflammation in patients
undergoing cardiac surgery. Further studies are warranted. Copyright
© 2017 American College of Cardiology Foundation

<107>
Accession Number
627817512
Title
Optimal Timing of P2Y12 Inhibitor Loading in Patients Undergoing PCI: A
Meta-Analysis.
Source
Thrombosis and Haemostasis. 119 (6) (pp 1000-1020), 2019. Date of
Publication: 2019.
Author
Komosa A.; Lesiak M.; Krasinski Z.; Grygier M.; Siniawski A.; Skorupski
Wl.; Olasinska-Wisniewska A.; Pyda M.; Araszkiewicz A.; Mitkowski P.;
Grajek S.; Mularek-Kubzdela T.; Hengstenberg C.; Siller-Matula J.M.
Institution
(Komosa, Lesiak, Grygier, Siniawski, Skorupski, Olasinska-Wisniewska,
Pyda, Araszkiewicz, Mitkowski, Grajek, Mularek-Kubzdela, Siller-Matula)
1st Department of Cardiology, Poznan University of Medical Sciences,
Poznan, Poland
(Krasinski) Department of General and Vascular Surgery, Poznan University
of Medical Sciences, Poznan, Poland
(Hengstenberg, Siller-Matula) Division of Cardiology, Department of
Internal Medicine II, Medical University of Vienna, Waehringer Guertel
18-20, Vienna A-1090, Austria
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background and Aim The timing of P2Y12 inhibitor loading in patients
undergoing percutaneous coronary intervention (PCI) is a matter of debate.
The aim of our study was to compare the efficacy and safety of oral P2Y12
inhibitors: clopidogrel, ticagrelor and prasugrel administered at two
different time points in relation to PCI: early (> 2 hours pre-PCI) versus
late (< 2 hours pre-PCI or post-PCI). Methods This is a systematic review
and meta-analysis. Randomized controlled trials and non-randomized studies
were included. Outcomes evaluated were combined major adverse
cardiovascular events (MACEs), myocardial infarction (MI), target vessel
revascularization, death and bleeding complications. Summary estimates of
the relative risks with therapy were calculated. Results Twenty-three
studies met the selection criteria and included 60,907 patients. Early
P2Y12 inhibitor loading was associated with a 22% relative risk reduction
(RRR) of MACE (95% confidence interval [CI] = 0.68-0.89; p < 0.001). Early
clopidogrel loading was associated with a 25% RRR of MACE (95% CI =
0.65-0.85; p < 0.001), a 30% RRR of MI (95% CI = 0.6-0.82; p < 0.0001) and
25% RRR of death (95% CI = 0.64-0.87; p = 0.0002), without an impact on
major bleedings. In ST-elevation myocardial infarction as well as non-ST
elevation acute coronary syndrome (NSTE-ACS), early clopidogrel loading
resulted in 35 and 22% RRR in 30 days MACE (p < 0.001), respectively, with
no impact in elective PCI. Whereas early loading with prasugrel and
ticagrelor did not improve ischaemic outcomes, prasugrel administered
early increased bleeding risks in NSTE-ACS. Conclusion Early clopidogrel
loading is associated with a better efficacy and similar safety, whereas
timing of ticagrelor or prasugrel loading had no effects on ischaemic
events. Copyright © 2019 Georg Thieme Verlag KG Stuttgart . New
York.

<108>
Accession Number
2002013505
Title
Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated
With Primary Percutaneous Coronary Intervention.
Source
Journal of the American College of Cardiology. 73 (22) (pp 2832-2842),
2019. Date of Publication: 11 June 2019.
Author
Mathias W.; Tsutsui J.M.; Tavares B.G.; Fava A.M.; Aguiar M.O.D.; Borges
B.C.; Oliveira M.T.; Soeiro A.; Nicolau J.C.; Ribeiro H.B.; Chiang H.P.;
Sbano J.C.N.; Morad A.; Goldsweig A.; Rochitte C.E.; Lopes B.B.C.; Ramirez
J.A.F.; Kalil Filho R.; Porter T.R.
Institution
(Mathias, Tsutsui, Tavares, Aguiar, Borges, Oliveira, Soeiro, Nicolau,
Ribeiro, Chiang, Sbano, Rochitte, Lopes, Ramirez, Kalil Filho) Heart
Institute (InCor), University of Sao Paulo, Medical School, Sao Paulo,
Brazil
(Fava, Goldsweig, Porter) University of Nebraska Medical Center, Omaha,
NE, United States
(Morad) University of Kansas Medical Center, Kansas City, KS, United
States
Publisher
Elsevier USA
Abstract
Background: Preclinical studies have demonstrated that high mechanical
index (MI)impulses from a diagnostic ultrasound transducer during an
intravenous microbubble infusion (sonothrombolysis)can restore epicardial
and microvascular flow in acute ST-segment elevation myocardial infarction
(STEMI). Objective(s): This study tested the clinical effectiveness
of sonothrombolysis in patients with STEMI. Method(s): Patients with
their first STEMI were prospectively randomized to either diagnostic
ultrasound-guided high MI impulses during an intravenous Definity
(Lantheus Medical Imaging, North Billerica, Massachusetts)infusion before,
and following, emergent percutaneous coronary intervention (PCI), or to a
control group that received PCI only (n = 50 in each group). A reference
first STEMI group (n = 203)who arrived outside the randomization window
was also analyzed. Angiographic recanalization before PCI, ST-segment
resolution, infarct size by magnetic resonance imaging, and systolic
function (LVEF)at 6 months were compared. Result(s): ST-segment
resolution occurred in 16 (32%)high MI PCI versus 2 (4%)PCI-only patients
before PCI, and angiographic recanalization was 48% in high MI/PCI versus
20% in PCI only and 21% in the reference group (p < 0.001). Infarct size
was reduced (29 +/- 22 g high MI/PCI vs. 40 +/- 20 g PCI only; p = 0.026).
LVEF was not different between groups before treatment (44 +/- 11% vs. 43
+/- 10%), but increased immediately after PCI in the high MI/PCI group (p
= 0.03), and remained higher at 6 months (p = 0.015). Need for implantable
defibrillator (LVEF <=30%)was reduced in the high MI/PCI group (5% vs. 18%
PCI only; p = 0.045). Conclusion(s): Sonothrombolysis added to PCI
improves recanalization rates and reduces infarct size, resulting in
sustained improvements in systolic function after STEMI. (Therapeutic Use
of Ultrasound in Acute Coronary Artery Disease;
NCT02410330). Copyright © 2019 American College of Cardiology
Foundation

<109>
Accession Number
2001940389
Title
Mechanical efficiency of high versus moderatintensity aerobic exercise in
coronary heart disease patients: A randomized clinical trial.
Source
Cardiology Journal. 26 (2) (pp 130-137), 2019. Date of Publication: 26 Apr
2019.
Author
Villelabeitia-Jaureguizar K.; Campos D.V.; Senen A.B.; Jimenez V.H.;
Bautista L.R.; Garrido-Lestache M.E.B.; Chicharro J.L.
Institution
(Villelabeitia-Jaureguizar) Infanta Elena University Hospital, Valdemoro,
Madrid, Spain
(Campos) Facultad de Ciencias de la Salud, Universidad Francisco de
Vitoria, UFV, Polideportivo, Ctra. M-515 Pozuelo-Majadahonda km.1,800,
Pozuelo de Alarcon, Madrid 28223, Spain
(Senen) Virgen de la Salud University Hospital, Castilla La Mancha,
Toledo, Spain
(Jimenez, Bautista, Garrido-Lestache) Rey Juan Carlos University Hospital,
Madrid, Spain
(Chicharro) Grupo FEBIO, Universidad Complutense de Madrid, Spain
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Background: Mechanical efficiency (ME) refers to the ability of an
individual to transfer energy consumed by external work. A decreased ME,
could represent an increased energy cost during exercise and may,
therefore, be limited in terms of physical activity. This study aimed to
compare the influence of two different exercise protocols: moderate
continuous training (MCT) versus high intensity interval training (HIIT),
as part of a cardiac rehabilitation program on ME values among coronary
patients. Method(s): One hundred and ten coronary patients were
assigned to either HIIT or MCT groups for 8 weeks. Incremental exercise
tests in a cycle ergometer were performed to obtain VO<inf>2</inf>peak.
Net energy expenditure (EE) and ME were obtained at intensities
corresponding to the first (VT<inf>1</inf>) and second (VT<inf>2</inf>)
ventilatory thresholds, and at VO<inf>2</inf>peak. Result(s): Both
exercise programs significantly increase VO<inf>2</inf>peak with a higher
increase in the HIIT group (2.96 +/- 2.33 mL/kg/min vs. 3.88 +/- 2.40
mL/kg/min, for patients of the MCT and HIIT groups, respectively, p <
0.001). The ME at VO<inf>2</inf>peak and VT<inf>2</inf> only significantly
increased in the HIIT group. At VT<inf>1</inf>, ME significantly increased
in both groups, with a greater increase in the HIIT group (2.20 +/- +/-
6.25% vs. 5.52 +/- 5.53%, for patients of the MCT and HIIT groups,
respectively, p < 0.001). Conclusion(s): The application of HIIT to
patients with chronic ischemic heart disease of low risk resulted in a
greater improvement in VO<inf>2</inf>peak and in ME at VT<inf>1</inf>,
than when MCT was applied. Moreover, only the application of HIIT brought
about a significant increase in ME at VT<inf>2</inf> and at
VO<inf>2</inf>peak. Copyright © 2019 Via Medica.

<110>
Accession Number
2001967120
Title
Relative effect of current intensive lipid-lowering drugs on
cardiovascular outcomes in secondary prevention: A meta-analysis of 12
randomized trials.
Source
Circulation Journal. 83 (6) (pp 1356-1367), 2019. Date of Publication:
2019.
Author
Wang S.; Xiu J.; Liao W.; Liao Y.; Bin J.
Institution
(Wang, Xiu, Liao, Bin) Department of Cardiology, State Key Laboratory of
Organ Failure Research, Guangzhou, China
(Liao) Department of Oncology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
Publisher
Japanese Circulation Society
Abstract
Background: We aimed to investigate the comparative cardiovascular
benefits of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin
treatments in secondary prevention patients. Methods and Results: We
selected 12 randomized controlled trials (n=131,978 patients) using PubMed
and Embase (inception- June 1, 2018). Subgroup differences were explored
by meta-regression and Cochran Q test. The relative effects of high-dose
statin, ezetimibe-statin, and PCSK9 inhibitor-statin on major
cardiovascular events (MACE), and revascularization were varied and
decreased gradually, of which high-dose statin resulted in lower risk of
MACE and revascularization than PCSK9 inhibitor-statin per 1 mmol/L
reduction of low-density lipoprotein cholesterol (LDL-C): risk ratio (RR)
for MACE, 0.86 (95% confidence interval (CI), 0.81-0.90) for high-dose
statin, 0.90 (95% CI, 0.83-0.96) for ezetimibe-statin, and 0.94 (95% CI,
0.92-0.96) for PCSK9 inhibitor-statin; RR for revascularization, 0.84 (95%
CI, 0.77-0.90) for high-dose statin, 0.91 (95% CI, 0.81-1.00) for
ezetimibe-statin, and 0.94 (95% CI, 0.90-0.97) for PCSK9 inhibitor-statin.
Similar relative effects of intensive lipid-lowering treatment were also
observed in analyses of myocardial infarction and stroke, although no
significant difference between groups was identified. Conclusion(s):
In secondary prevention patients, the relative benefits of high-dose
statin, ezetimibe-statin, and PCSK9 inhibitor-statin treatments were
varied and decreased gradually, of which high-dose statin was
significantly superior to PCSK9 inhibitor-statin for improving MACE and
revascularization per 1 mmol/L reduction of LDL-C. Copyright ©
2019, Japanese Circulation Society. All rights reserved.

<111>
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.
 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.
 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. 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. Copyright © 2019 Arvin Barzanji, Armin Zareiyan, Maryam
Nezamzadeh, Marjan Seyed Mazhari.

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

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

<114>
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). 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. 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.
 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. Copyright © 2018 Wolters Kluwer Medknow Publications.
All rights reserved.

<115>
[Use Link to view the full text]
Accession Number
626183490
Title
Ultrasound-guided vs. palpation-guided techniques for radial arterial
catheterisation in infants: A randomised controlled trial.
Source
European journal of anaesthesiology. 36 (3) (pp 200-205), 2019. Date of
Publication: 01 Mar 2019.
Author
Min J.J.; Tay C.K.; Gil N.-S.; Lee J.-H.; Kim S.; Kim C.S.; Yang J.-H.;
Jun T.-G.
Publisher
NLM (Medline)
Abstract
BACKGROUND: The usefulness of ultrasound-guided techniques for radial
arterial catheterisation has been well identified; however, its usefulness
has not been completely evaluated in infants under 12 months of age, who
are generally considered the most difficult group for arterial
catheterisation. OBJECTIVE(S): We evaluated whether ultrasound
guidance would improve success rates and reduce the number of attempts at
radial arterial catheterisation in infants. DESIGN: A randomised,
controlled and patient-blinded study. SETTING: Single-centre trial, study
period from June 2016 to February 2017. PATIENTS: Seventy-four infants
undergoing elective cardiac surgery. INTERVENTION: Patients were allocated
randomly into either ultrasound-guided group (group US) or
palpation-guided group (group P) (each n=37) according to the technique
applied for radial arterial catheterisation. All arterial catheterisations
were performed by one of two experienced anaesthesiologists based on group
assignment and were recorded on video. MAIN OUTCOME MEASURES: The primary
endpoint was the first-pass success. The number of attempts and total
duration of the procedure until successful catheterisation were also
analysed. RESULT(S): The first-pass success rate was significantly
higher in the group US than in the group P (68 vs. 38%, P = 0.019). In
addition, fewer attempts were needed for successful catheterisation in the
group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P =
0.023). However, the median [IQR] procedural time (s) until successful
catheterisation in the two groups was not significantly different (102 [49
to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION(S): The current
study demonstrated that the ultrasound-guided technique for radial
arterial catheterisation in infants effectively improved first-pass
success rate and also reduced the number of attempts required. TRIAL
REGISTRATION: ClinicalTrials.gov NCT02795468.

<116>
Accession Number
627182683
Title
Usefulness of skeletal muscle area detected by computed tomography to
predict mortality in patients undergoing transcatheter aortic valve
replacement: a meta-analysis study.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2019.
Date of Publication: 2019.
Author
Soud M.; Alahdab F.; Ho G.; Kuku K.O.; Cejudo-Tejeda M.; Hideo-Kajita A.;
de Araujo Goncalves P.; Teles R.C.; Waksman R.; Garcia-Garcia H.M.
Institution
(Soud, Ho, Kuku, Cejudo-Tejeda, Hideo-Kajita, Waksman, Garcia-Garcia)
Section of Interventional Cardiology, MedStar Washington Hospital Center,
110 Irving St NW, Washington, DC 20010, United States
(Alahdab) Mayo Clinic Evidence-based Practice Center, Mayo Clinic,
Rochester, MN, United States
(de Araujo Goncalves) Hospital da Luz, Luz-Saude. Av. Lusiada 100, Lisbon
1500-650, Portugal
(de Araujo Goncalves, Teles) Hospital de Santa Cruz - Centro Hospitalar de
Lisboa Ocidental, Carnaxide, Lisbon, Portugal
(de Araujo Goncalves) Chronic Diseases Research Center - Nova Medical
School, Lisbon, Portugal
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Measures of sarcopenia, such as low muscle mass measured from the readily
available preoperative computed tomography (CT) images, have been recently
suggested as a predictor of outcomes in patients undergoing transcatheter
aortic valve replacement (TAVR). However, results of these studies are
variable and, therefore, we performed a systematic review of current
literature to evaluate sarcopenia as a predictor of outcome post TAVR. The
search was carried out in electronic databases between 2008 and 2018. We
identified studies that reported CT-derived skeletal muscle area (SMA) and
survival outcomes post TAVR. Studies were evaluated for the incidence of
early (<= 30 days) and late all-cause mortality (> 30 days) post TAVR.
Eight studies with 1881 patients were included (mean age of 81.8 years +/-
12, 55.9% men). Mean body mass index was (28.2 kg/m2 +/- 1.1),
mean Society of Thoracic Surgeons risk score (7.0 +/- 0.6), and mean
albumin level was (3.8 g/dL +/- 0.1). Higher SMA was associated with lower
long-term mortality [odds ratio (OR) 0.49, 95% confidence interval (CI)
0.28-0.83, p = 0.049], compared with low SMA. Also, higher SMA was
associated with lower early mortality but was not statistically
significant (OR 0.72; 95% CI 0.44-1.18; p = 0.285). CT-derived SMA
provides value in predicting post-TAVR long-term outcomes for patients
undergoing TAVR. This is a simple risk assessment tool that may help in
making treatment decisions and help identifying and targeting high-risk
patients with interventions to improve muscle mass prior to and following
the procedures. Copyright © 2019, Springer Nature B.V.

<117>
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. 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. 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. 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. Copyright © 2019 International Society of Blood
Transfusion

<118>
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. 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. 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. 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. 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).
 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. Copyright © 2019 American
Medical Association. All rights reserved.

<119>
Accession Number
627964740
Title
Engaging hospitalized patients with personalized health information: a
randomized trial of an inpatient portal.
Source
Journal of the American Medical Informatics Association. 26 (2) (pp
115-123), 2019. Date of Publication: 2019.
Author
Creber R.M.M.; Grossman L.V.; Ryan B.; Qian M.; Polubriaginof F.C.G.;
Restaino S.; Bakken S.; Hripcsak G.; Vawdrey D.K.
Institution
(Creber) Department of Healthcare Policy and Research, Division of Health
Informatics, Weill Cornell Medicine, New York, NY, United States
(Grossman, Polubriaginof, Hripcsak, Vawdrey) Department of Biomedical
Informatics, Columbia University, New York, NY, United States
(Ryan, Polubriaginof, Vawdrey) Value Institute at NewYork-Presbyterian
Hospital/Department of Biomedical Informatics, Columbia University, 622
West 168th St., New York, NY 10032, United States
(Qian) Department of Biostatistics, Columbia University, New York, NY,
United States
(Restaino) Columbia University Medical Center, New York, NY, United States
(Bakken) Department of Biomedical Informatics, School of Nursing, Data
Science Institute, Columbia University, New York, NY, United States
Publisher
Oxford University Press
Abstract
Objective: To determine the effects of an inpatient portal intervention on
patient activation, patient satisfaction, patient engagement with health
information, and 30-day hospital readmissions. Methods and Materials: From
March 2014 to May 2017, we enrolled 426 English-or Spanish-speaking
patients from 2 cardiac medical-surgical units at an urban academic
medical center. Patients were randomized to 1 of 3 groups: 1) usual care,
2) tablet with general Internet access (tablet-only), and 3) tablet with
an inpatient portal. The primary study outcome was patient activation
(Patient Activation Measure-13). Secondary outcomes included all-cause
readmission within 30 days, patient satisfaction, and patient engagement
with health information. Result(s): There was no evidence of a
difference in patient activation among patients assigned to the inpatient
portal intervention compared to usual care or the tablet-only group.
Patients in the inpatient portal group had lower 30-day hospital
readmissions (5.5% vs. 12.9% tablet-only and 13.5% usual care; P0.044).
There was evidence of a difference in patient engagement with health
information between the inpatient portal and tabletonly group, including
looking up health information online (89.6% vs. 51.8%; P<0.001).
Healthcare providers reported that patients found the portal useful and
that the portal did not negatively impact healthcare delivery.
 Conclusion(s): Access to an inpatient portal did not significantly
improve patient activation, but it was associated with looking up health
information online and with a lower 30-day hospital readmission rate.
These results illustrate benefit of providing hospitalized patients with
real-time access to their electronic health record data while in the
hospital. Copyright © The Author(s) 2018.

<120>
Accession Number
628046352
Title
Aortic Root Enlargement Is Safe and Reduces the Incidence of
Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes.
Source
The Canadian journal of cardiology. 35 (6) (pp 782-790), 2019. Date of
Publication: 01 Jun 2019.
Author
Yu W.; Tam D.Y.; Rocha R.V.; Makhdoum A.; Ouzounian M.; Fremes S.E.
Institution
(Yu, Makhdoum) Division of Cardiac Surgery, Department of Surgery,
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, ON, Canada
(Tam, Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, Ontario, Canada; Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, Ontario, Canada
(Rocha, Ouzounian) Division of Cardiac Surgery, Department of Surgery,
Peter Munk Cardiac Centre, University of Toronto, University Health
Network, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Aortic root enlargement (ARE) may be an important adjunct to
aortic valve replacement (AVR) to prevent patient-prosthesis mismatch and
facilitate future valve-in-valve transcatheter AVR (TAVR). However, the
early safety and late benefits of adding surgical ARE to AVR remain
controversial. METHOD(S): MEDLINE and EMBASE were searched from 1946
to 2018 for articles comparing patients undergoing AVR+ARE with those
undergoing AVR alone. A random-effects meta-analysis was performed to
compare early and late clinical outcomes. RESULT(S): A total of 2570
AVR+ARE and 5,991 AVR patients were included from 9 observational studies.
There was no difference in early mortality (relative risk [RR] 1.21; 95%
confidence interval [CI], 0.94-1.54; P = 0.13). Both cardiopulmonary
bypass (mean difference [MD] 20 minutes; 95% CI, 15-25; P < 0.01) and
aortic cross-clamp time (MD 14 minutes; 95% CI, 11-17, P < 0.01) were
higher following AVR+ARE. There was no difference in the risk of permanent
pacemaker implantation (RR 1.02; 95% CI, 0.83-1.25; P = 0.86), reoperation
for bleeding (RR 1.05; 95% CI, 0.84-1.32; P = 0.64), or stroke (RR 0.93;
95% CI, 0.68-1.27; P = 0.65). The risk of moderate (indexed effective
orifice area [iEOA] < 0.85 cm2/m2) and severe (iEOA < 0.65 cm2/m2)
patient-prosthesis mismatch (PPM) was lower with AVR+ARE (RR 0.65; 95% CI,
0.51-0.83; P < 0.01) and RR 0.36; 95% CI, 0.16-0.82; P = 0.01,
respectively). There was no difference in late mortality (incidence rate
ratio [IRR] 1.05; 95% CI, 0.87-1.27; P = 0.59) at mean 7.8-year follow-up
in 5 studies. CONCLUSION(S): Surgical ARE is a safe adjunct to AVR in
selected patients that does not increase early adverse events and results
in less patient-prosthesis mismatch. This strategy allows for a larger
valve size at the time of implantation, an important consideration for
potential future valve-in-valve procedures in the era of
TAVR. Copyright © 2019 Canadian Cardiovascular Society. Published
by Elsevier Inc. All rights reserved.

<121>
Accession Number
628054151
Title
Inhalation versus intravenous anesthesia for adults undergoing heart valve
surgery: a systematic review and meta-analysis.
Source
Minerva anestesiologica. 85 (6) (pp 665-675), 2019. Date of Publication:
01 Jun 2019.
Author
Ren S.-F.; Guo Y.-Q.; Yu H.
Institution
(Ren, Guo) Department of Cardiovascular Surgery, West China Hospital of
Sichuan University, Chengdu, China
(Ren, Yu) Department of Anesthesiology, West China Hospital of Sichuan
University, Chengdu, China
(Yu) Department of Anesthesiology, West China Hospital of Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Many studies have found that volatile anesthetics are
associated with improved clinical outcomes for adults undergoing coronary
artery bypass grafting. However, the effect of volatile anesthetics for
adults after heart valve surgery has been unclear. So we conducted a
meta-analysis of randomized controlled trials (RCTs) to explore whether
the choice of an anesthetic regimen might influence patients' outcomes
after valve surgery. EVIDENCE ACQUISITION: PubMed, Embase, and Cochrane
Library were searched from inception to June 2018. We included eligible
research comparing inhalation anesthesia with total intravenous anesthesia
(TIVA) in adult patients undergoing valve surgery. The major endpoints
involved mortality, postoperative arrhythmia, acute kidney injury,
pulmonary complications, neurological events, myocardial infarction,
reoperation for bleeding. The postoperative peak troponin release,
hospital stay, Intensive Care Unit (ICU) stay and ventilation time were
also analyzed. EVIDENCE SYNTHESIS: After screening through 243 potentially
relevant articles, we included 13 RCTs with 962 patients. The inhalation
anesthesia group revealed comparable mortality (inhalation group 12/249
[4.8%] vs. TIVA group 13/247 [5.3%], RR=0.97; 95% CI: 0.45 to 2.09;
P=0.93; P for heterogeneity=0.66, I2=0%) and other postoperative
complications with no heterogeneity. The postoperative peak troponin
release, hospital/ICU stay and ventilation time were comparable between
two groups with considerable heterogeneity. CONCLUSION(S): Among
patients undergoing heart valve surgery, the use of inhalation anesthesia
compared with TIVA failed to demonstrate superiority for survival and
major postoperative complications, and the evidence was insufficient to
draw firm conclusions due to the limited sample size. A determination of
equivalence or superiority between these two anesthetic regimens requires
further researches.

<122>
Accession Number
628051208
Title
Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for
Acute and Chronic Pain Prevention.
Source
Pain physician. 22 (3) (pp 271-280), 2019. Date of Publication: 01 May
2019.
Author
Abd-Elshafy S.K.; Abdallal F.; Kamel E.Z.; Edwar H.; Allah E.A.; Maghraby
H.H.M.; Sayed J.A.; Ali M.S.; Elkhayat H.; Mahran G.S.K.
Institution
(Abd-Elshafy) Department of Anesthesia, Intensive Care, Pain Management,
South Egypt Cancer Institute, Assiut University, Assiut, United Kingdom
(Abdallal, Edwar, Allah, Maghraby, Sayed, Ali) Department of Anesthesia,
Faculty of Medicine, Assiut University, Assiut, Egypt
(Kamel) Assiut University, Assiut, Egypt
(Elkhayat) Cardiothoracic surgery, Assiut University, Faculty of Medicine,
Assiut, Egypt
(Mahran) Department of Critical Care and Emergency Nursing, Faculty of
Nursing, Assiut University, Assiut, Egypt
Publisher
NLM (Medline)
Abstract
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is considered as
one of the minimally invasive surgeries. Early postoperative pain
alleviation is very important to avoid complications, at the same time,
proper early pain control is an established fact to decrease the incidence
of chronic pain. OBJECTIVE(S): To evaluate the efficacy of thoracic
paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture on
acute and chronic post-thoracoscopic surgery pain in patients undergoing
VATS. STUDY DESIGN: A randomized prospective double-blinded trial.
SETTING: Assiut University Hospitals, Orman Cardiology Hospital.
 METHOD(S): Sixty adult patients underwent elective VATS surgery under
general anesthesia randomly allocated into 2 groups; Group I received
thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II
received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and
dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough, and
with movement) was assessed through a visual analog scale (VAS) every 30
minutes in the first 2 hours, then at the second, fourth, eighth, and 24th
hours. Time to first analgesia request and consumption of intravenous
rescue analgesia (ketorolac tromethamine 30 mg/dose) was recorded.
Follow-up of the patients regarding the incidence of chronic
post-thoracoscopic pain by the end of the third and sixth months after the
procedure was reviewed through the Leeds Assessment of Neuropathic
Symptoms and Signs (LANSS) pain scale. RESULT(S): VAS score was
significantly lower in Group II during the early postoperative 90 minute
records. Pain with cough and with movement persisted to be significantly
lower in Group II up to the second postoperative hour. Time to first
analgesia requirement was significantly longer in Group II in comparison
to Group (P < 0.001). There was less ketorolac consumption in Group II
than in Group I (P = 0.002). At the third month, Group II showed
significantly lower incidence of LANSS pain scale than Group I (P = 0.04).
LIMITATIONS: There was the heterogeneity of surgical procedures in the
patients. CONCLUSION(S): Dexmedetomidine as an adjuvant to
bupivacaine PVB offers better pain relief during the early postoperative
hours, and it carries a favorable effect on chronic postoperative
pain.Clinical trial registry number: NCT03632161. KEY WORDS:
Dexmedetomidine, paravertebral block, video-assisted thoracoscopic
surgery, postoperative pain, chronic pain.

<123>
Accession Number
628053163
Title
Manual aspiration versus chest tube drainage in primary spontaneous
pneumothorax without underlying lung diseases: a meta-analysis of
randomized controlled trials.
Source
Interactive cardiovascular and thoracic surgery. 28 (6) (pp 936-944),
2019. Date of Publication: 01 Jun 2019.
Author
Zhu P.; Xia H.; Sun Z.; Zhu D.; Deng L.; Zhang Y.; Zhang H.; Wang D.
Institution
(Zhu, Xia, Sun, Zhu, Deng, Zhang, Zhang, Wang) Department of
Cardio-Thoracic Surgery, Tianjin Hospital, Tianjin, Hexi District, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Although primary spontaneous pneumothorax (PSP) is an
extremely frequent pathology, there is still no clear consensus on the
treatment for these patients. We performed a strict meta-analysis on the
effectiveness of manual aspiration (MA) compared to chest tube drainage
(CTD) for the treatment of PSP. METHOD(S): A literature search was
performed on PubMed, EMBASE and the Cochrane Library to identify
randomized controlled trials comparing MA with CTD for the treatment of
PSP. Independent reviewers evaluated the methodological quality of the
included randomized controlled trials. Statistical heterogeneity among
studies was quantitatively evaluated using the I-squared index.
 RESULT(S): Five randomized controlled trials were included, and a
total of 358 subjects were reported on. We found that MA was related to
significantly shorter hospital stays [in days; mean difference -1.70, 95%
confidence interval (CI) -2.36 to -1.04; P<0.00001, fixed effect model]
compared with CTD. However, no significant differences were found between
the 2 treatments for immediate success rate (risk ratio 1.15, 95% CI
0.73-1.81; P=0.54), 1-year recurrence rate, 1-week success rate, time of
recurrence, chest surgery rate or complication rate. Subgroup analysis
showed that MA can provide a significantly lower hospitalization rate than
CTD with a tube size of >12Fr or a water seal drainage system.
 CONCLUSION(S): On the basis of the currently available literature, MA
is advantageous in the treatment of PSP because of shorter hospital stays.
The subgroup analysis also indicates that MA can provide a lower
hospitalization rate than CTD with a tube size of >12Fr or a water seal
drainage system. However, there are no significant differences between the
2 interventions with respect to immediate success rate, 1-year recurrence
rate, 1-week success rate, time of recurrence, chest surgery rate or
complication rate. Copyright © The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<124>
Accession Number
628052118
Title
Risk factors for vasoplegia after cardiac surgery: a meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 28 (6) (pp 838-844),
2019. Date of Publication: 01 Jun 2019.
Author
Dayan V.; Cal R.; Giangrossi F.
Institution
(Dayan) Centro Cardiovascular Universitario, Hospital de Clinicas,
Montevideo, Uruguay
(Dayan, Cal, Giangrossi) Instituto Nacional de Cirugia Cardiaca,
Montevideo, Uruguay
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Postoperative vasoplegia (PV) is a common haemodynamic
disorder after cardiac surgery and is associated with high operative
mortality. Preventive and potent therapeutic measures are critical to
improve the outcome. Identification of risk factors for PV may increase
awareness and prompt therapeutic action. Our objective was to pool the
available evidence on the risk factors for PV in cardiac surgery and to
perform a meta-analysis. METHOD(S): PubMed, Embase, Ovid and Google
Scholar databases were searched for studies published between 1965 and
2017. Three investigators independently screened the studies and extracted
the data. Pooled estimates were obtained by a random effects model.
Preoperative and operative patient data were gathered to determine their
association with PV. RESULT(S): The search yielded 109 potential
studies for inclusion. Of these, 10 articles were analysed and their data
extracted. The total number of patients included was 30 035 patients (1524
with vasoplegia and 28 511 without vasoplegia). The only preoperative
variable that was significantly associated with PV was renal failure [odds
ratio (OR) 1.47; 95% confidence interval (CI) 1.17-1.86]. Patients with
isolated coronary artery bypass grafting had a lower risk for PV (OR 0.36;
95% CI 0.22-0.59), whereas previous cardiac surgery (OR 2.03; 95% CI
1.27-3.26) and combined procedures increased its incidence (OR 2.12; 95%
CI 1.82-2.47). PV increased with higher use of red blood cells (OR 2.12;
95% CI 1.82-2.47), longer aortic cross-clamp (mean difference 8.15min; 95%
CI 8.79-27.50min) and cardiopulmonary bypass (mean difference 25.72min;
95% CI 12.75-38.69min) duration. CONCLUSION(S): Patients with renal
failure, higher use of red blood cell, longer and combined cardiac surgery
procedures are at a higher risk for PV. Measures to promptly identify and
treat PV in these patients should be considered. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<125>
Accession Number
628034977
Title
--Statins in the perioperative period.
Source
F1000Research. 8 (no pagination), 2019. Date of Publication: 2019.
Author
Mohebi R.; Rosenson R.
Institution
(Mohebi, Rosenson) Department of Medicine (Cardiology), Icahn school of
Medicine at Mount Sinai, NY 10029, United States
Publisher
NLM (Medline)
Abstract
In this review, we discuss clinical evidence-based data regarding the
potential benefit of statin therapy in the perioperative period of
non-cardiac surgery. Results from meta-analyses of prospective
observational studies have provided conflicting evidence. Moreover,
comparison among studies is complicated by varying data sources, outcome
definitions, types of surgery, and preoperative versus perioperative
statin therapy. However, results of two recent large prospective cohort
studies showed that statin use on the day of or the day after non-cardiac
surgery (or both) is associated with lower 30-day all-cause mortality and
reduction in a variety of postoperative complications, predominantly
cardiac, compared with non-use during this period. There is a paucity of
data from randomized controlled trials assessing the benefit of statin
therapy in non-cardiac surgery. No randomized controlled trials have shown
that initiating a statin in statin-naive patients may reduce the risk of
cardiovascular complications in non-cardiac surgeries. One randomized
clinical trial demonstrated that the use of a preoperative statin in
patients with stable coronary heart disease treated with long-term statin
therapy had a significant reduction in the incidence of myocardial
necrosis and major adverse cardiovascular events after non-cardiac
surgery. In conclusion, it is important that all health-care professionals
involved in the care of the surgical patient emphasize the need to resume
statin therapy, particularly in patients with established atherosclerotic
cardiovascular disease. However, initiating a statin in statin-naive
patients undergoing non-cardiac surgery needs more evidence-based data.

<126>
Accession Number
628039054
Title
Association between transcatheter aortic valve replacement for bicuspid vs
tricuspid aortic stenosis and mortality or stroke.
Source
JAMA - Journal of the American Medical Association. 321 (22) (pp
2193-2202), 2019. Date of Publication: 11 Jun 2019.
Author
Makkar R.R.; Yoon S.-H.; Leon M.B.; Chakravarty T.; Rinaldi M.; Shah P.B.;
Skipper E.R.; Thourani V.H.; Babaliaros V.; Cheng W.; Trento A.;
Vemulapalli S.; Kapadia S.R.; Kodali S.; MacK M.J.; Tang G.H.L.; Kaneko T.
Institution
(Makkar, Yoon, Chakravarty, Cheng, Trento) Smidt Heart Institute,
Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048,
United States
(Leon, Kodali) Columbia University Medical Center, New York, NY, United
States
(Rinaldi, Skipper) Sanger Heart and Vascular Institute, Carolinas Medical
Center, Charlotte, NC, United States
(Shah, Kaneko) Brigham and Women's Hospital, Boston, MA, United States
(Thourani) Medstar Heart and Vascular Institute, Washington, DC, United
States
(Babaliaros) Emory University School of Medicine, Atlanta, GA, United
States
(Vemulapalli) Duke Clinical Research Institute, Durham, NC, United States
(Kapadia) Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(MacK) Baylor Scott and White Health, Plano, TX, United States
(Tang) Mount Sinai Health System, New York, NY, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Transcatheter aortic valve replacement (TAVR) indications are
expanding, leading to an increasing number of patients with bicuspid
aortic stenosis undergoing TAVR. Pivotal randomized trials conducted to
obtain US Food and Drug Administration approval excluded bicuspid anatomy.
 Objective(s): To compare the outcomes of TAVR with a
balloon-expandable valve for bicuspid vs tricuspid aortic stenosis.
 Design, Setting, and Participant(s): Registry-based prospective
cohort study of patients undergoing TAVR at 552 US centers. Participants
were enrolled in the Society of Thoracic Surgeons (STS)/American College
of Cardiology (ACC) Transcatheter Valve Therapies Registry from June 2015
to November 2018. Exposures: TAVR for bicuspid vs tricuspid aortic
stenosis. Main Outcomes and Measures: Primary outcomes were 30-day
and 1-year mortality and stroke. Secondary outcomes included procedural
complications, valve hemodynamics, and quality of life assessment.
 Result(s): Of 81822 consecutive patients with aortic stenosis (2726
bicuspid; 79096 tricuspid), 2691 propensity-score matched pairs of
bicuspid and tricuspid aortic stenosis were analyzed (median age, 74 years
[interquartile range {IQR}, 66-81 years]; 39.1%, women; mean [SD]
STS-predicted risk of mortality, 4.9% [4.0%] and 5.1% [4.2%],
respectively). All-cause mortality was not significantly different between
patients with bicuspid and tricuspid aortic stenosis at 30 days (2.6% vs
2.5%; hazard ratio [HR], 1.04, [95% CI, 0.74-1.47]) and 1 year (10.5% vs
12.0%; HR, 0.90 [95% CI, 0.73-1.10]). The 30-day stroke rate was
significantly higher for bicuspid vs tricuspid aortic stenosis (2.5% vs
1.6%; HR, 1.57 [95% CI, 1.06-2.33]). The risk of procedural complications
requiring open heart surgery was significantly higher in the bicuspid vs
tricuspid cohort (0.9% vs 0.4%, respectively; absolute risk difference
[RD], 0.5% [95% CI, 0%-0.9%]). There were no significant differences in
valve hemodynamics. There were no significant differences in moderate or
severe paravalvular leak at 30 days (2.0% vs 2.4%; absolute RD, 0.3% [95%
CI,-1.3% to 0.7%]) and 1 year (3.2% vs 2.5%; absolute RD, 0.7% [95%
CI,-1.3% to 2.7%]). At 1 year there was no significant difference in
improvement in quality of life between the groups (difference in
improvement in the Kansas City Cardiomyopathy Questionnaire overall
summary score,-2.4 [95% CI,-5.1 to 0.3]; P =.08). Conclusions and
Relevance: In this preliminary, registry-based study of propensity-matched
patients who had undergone transcatheter aortic valve replacement for
aortic stenosis, patients with bicuspid vs tricuspid aortic stenosis had
no significant difference in 30-day or 1-year mortality but had increased
30-day risk for stroke. Because of the potential for selection bias and
the absence of a control group treated surgically for bicuspid stenosis,
randomized trials are needed to adequately assess the efficacy and safety
of transcatheter aortic valve replacement for bicuspid aortic
stenosis. Copyright © 2019 American Medical Association. All
rights reserved.

<127>
Accession Number
628053646
Title
Concurrent presentation of a hemorrhagic pericardial effusion and venous
thromboembolism in malignancy: a systematic review of case studies.
Source
Journal of thrombosis and thrombolysis. (no pagination), 2019. Date of
Publication: 27 May 2019.
Author
Pabba K.; Rojas-Hernandez C.M.
Institution
(Pabba) Department of Internal Medicine, McGovern Medical School at The
University of Texas Health Science Center at Houston, Houston, TX, United
States
(Rojas-Hernandez) Section of Benign Hematology, University of Texas MD
Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, United
States
Publisher
NLM (Medline)
Abstract
The concurrent presentation of symptomatic malignant pericardial
hemorrhage and venous thromboembolism is a rare event that poses a
clinical dilemma. Existing VTE guidelines do not indicate when, or if,
anticoagulation therapy should be started after the treatment of the
pericardial bleed. We performed a systematic review to compile the
published clinical evidence on the occurrence of coexisting pericardial
hemorrhage and VTE in cancer patients and to describe the clinical
presentations and bleeding and thrombosis outcomes before and after
anticoagulation therapy. We studied published case reports on patients
with cancer who presented to the hospital with pericardial hemorrhage and
VTE through April 11, 2019. We found seven published case reports. All
patients had suffered from a pulmonary embolism and had pericardiocentesis
during hospitalization. Five patients (71%) had lung cancer. Four patients
(57%) were started on anticoagulation after pericardial drainage and
survived the index event. Two patients (29%) were not started on
anticoagulation after pericardiocentesis; only one of these patients
survived the hospitalization. Pericardial bleeding risk in cancer may be
inherent to malignancy, and it is unclear if anticoagulation use increases
the risk of recurrent pericardial bleeding. The management of pericardial
bleeding typically requires pericardiocentesis, and clinical registries,
prospective collaboration projects, and case adjudication are needed to
establish the safety of initiation of antithrombotic therapy in such
patients.

<128>
Accession Number
628046872
Title
Dilated Cardiomyopathy - From Epidemiologic to Genetic Phenotypes A
Translational Review of Current Literature.
Source
Journal of internal medicine. (no pagination), 2019. Date of Publication:
27 May 2019.
Author
Reichart D.; Magnussen C.; Zeller T.; Blankenberg S.
Institution
(Reichart, Magnussen, Zeller, Blankenberg) University Heart Center
Hamburg, Hamburg, Germany
Publisher
NLM (Medline)
Abstract
Dilated cardiomyopathy (DCM) is characterized by left ventricular
dilatation and, consecutively, contractile dysfunction. The causes of DCM
are heterogeneous. DCM often results from myocarditis, exposure to
alcohol, drugs or other toxins and metabolic or endocrine disturbances. In
about 35% of patients, genetic mutations can be identified that usually
involve genes responsible for cytoskeletal, sarcomere, and nuclear
envelope proteins. Due to its heterogeneity, a detailed diagnostic work-up
is necessary to identify the specific underlying cause and exclude other
conditions with phenotype overlap. Patients with DCM show typical systolic
heart failure symptoms, but, with progress of the disease, diastolic
dysfunction is present as well. Depending on the underlying pathology, DCM
patients also become apparent through arrhythmias, thromboembolic events
or cardiogenic shock. Disease progression and prognosis are mostly driven
by disease severity and reverse remodeling within the heart. The worst
prognosis is seen in patients with lowest ejection fractions or severe
diastolic dysfunction, leading to terminal heart failure with subsequent
need for left ventricular assist device implantation or heart
transplantation. Guideline-based heart failure medication and device
therapy reduces the frequency of heart failure hospitalizations and
improves survival. This article is protected by copyright. All rights
reserved.

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