EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 60

Results Generated From:
Embase <1980 to 2019 Week 23>
Embase (updates since 2019-05-31)

<1>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<2>
Accession Number
627732050
Title
Dexmedetomidine and sufentanil combination versus sufentanil alone for
postoperative intravenous patient-controlled analgesia: A systematic
review and meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 81. Date
of Publication: 18 May 2019.
Author
Feng M.; Chen X.; Liu T.; Zhang C.; Wan L.; Yao W.
Institution
(Feng, Chen, Liu, Zhang, Wan, Yao) Department of Anesthesiology, Tongji
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430030, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Previous studies have demonstrated that dexmedetomidine
improves the quality of postoperative analgesia. In the present study, we
performed a meta-analysis of randomized controlled trials to quantify the
effect of dexmedetomidine as an adjuvant to sufentanil for postoperative
patient-controlled analgesia (PCA). <br/>Method(s): PubMed, Embase, the
Cochrane Library, and Web of Science were systematically searched for
randomized controlled trials in which dexmedetomidine was used as an
adjuvant for PCA with sufentanil. In the retrieved studies, we
quantitatively analyzed pain intensity, sufentanil consumption, and
drug-related side effects. <br/>Result(s): Nine studies with 907 patients
were included in this meta-analysis. Compared with sufentanil alone,
dexmedetomidine-sufentanil for postoperative intravenous PCA reduced pain
intensity at 24 h (mean difference (MD) =-0.70points; 95% confidence
interval (CI):-1.01,-0.39; P < 0.00001) and 48 h postoperatively (MD
=-0.61points; 95% CI:-1.00,-0.22; P = 0.002). Moreover,
dexmedetomidine-sufentanil reduced sufentanil consumption during the first
24 h (MD =-13.77 mug; 95% CI:-18.56,-8.97; P < 0.00001) and 48 h
postoperatively (MD =-20.81 mug; 95% CI:-28.20,-13.42; P < 0.00001).
Finally, dexmedetomidine-sufentanil improved patient satisfaction without
increasing the incidence of side effects. <br/>Conclusion(s):
Dexmedetomidine as an adjuvant to sufentanil for postoperative PCA can
reduce postoperative pain score and sufentanil consumption.<br/>Copyright
&#xa9; 2019 The Author(s).

<3>
Accession Number
612433655
Title
Health-related quality-of-life after transapical transcatheter aortic
valve implantation.
Source
Scandinavian Cardiovascular Journal. 50 (5-6) (pp 377-382), 2016. Date of
Publication: 01 Nov 2016.
Author
Rex C.E.; Heiberg J.; Klaaborg K.-E.; Hjortdal V.E.
Institution
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Cardiothoracic & Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
Publisher
Taylor and Francis Ltd
Abstract
Purpose. Transcatheter aortic valve implantation (TA-TAVI) is a
well-established treatment for aortic valve stenosis in high-risk patients
and indications have been continuously expanding to also include
intermediate-risk patients. However, in low-risk patients, experiences are
still sparse and although clinical outcomes have been shown favorable
results, HRQoL has remained unexplored. The aim of this report was to
describe the long-term health-related quality-of-life (HRQoL) in low-risk
patients randomized to TA-TAVI or surgical aortic valve replacement
(SAVR). Methods. In a prospective, randomized trial, patients with aortic
valve stenosis were randomized to either TA-TAVI or SAVR. TA-TAVI was
performed through a mini thoracotomy with the introduction of prosthesis
via the apex of the heart and antegradely advancement over the pre-dilated
native valve. SAVR was performed during cardiopulmonary bypass with
resection of the native valve and replacement with a prosthesis valve
through a median sternotomy. Afterwards, patients were followed yearly
with echocardiography and HRQoL assessment. Results. A total of 58
patients were included; 29 patients for TA-TAVI and 29 patients for SAVR.
The only difference in HRQoL was found in the physical component summary
after 1 year; 44 +/- 9 in the TA-TAVI group compared with 36 +/- 9 in the
SAVR group, p =.03. There were no differences in any of the remaining
timepoints in neither physical nor mental component summary, p =.19 and p
=.98, respectively, and there were no differences in survival during the 5
years. Conclusions. In low-risk patients with aortic valve stenosis
undergoing TA-TAVI, no differences appeared in HRQoL compared with SAVR
during a 5-year follow-up period.<br/>Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group.

<4>
Accession Number
2001774394
Title
Pentraxin-3 in coronary artery disease: A meta-analysis.
Source
Cytokine. 119 (pp 197-201), 2019. Date of Publication: July 2019.
Author
Chu Y.; Teng J.; Feng P.; Liu H.; Wang F.; Li X.
Institution
(Chu, Teng, Feng, Liu, Wang, Li) Department of Cardiology, The Second
Affiliated Hospital of Air Force Medical University, Xi'an 710038, China
Publisher
Academic Press
Abstract
Aims: Studies on the prognostic significance of circulating pentraxin-3
level in patients with coronary artery disease (CAD) have yielded
conflicting results. The aim of this meta-analysis was to evaluate the
prognostic value of circulating pentraxin-3 level in CAD patients.
Materials/methods: We made a systematic literature search in Pubmed,
Embae, CNKI, Wanfang, and VIP database from their inception to January 10,
2019 for prospective cohort studies that investigated the association
between pentraxin-3 level and adverse outcomes in patients with CAD. The
outcome measures were all-cause mortality, cardiac death, and cardiac
events (cardiac death, nonfatal myocardial infarction, heart failure or
coronary revascularization). Multivariable-adjusted risk ratio (RR) with
95% confidence intervals (CI) was pooled for the highest versus the lowest
pentraxin-3 group to summarize the predictive value. <br/>Result(s): Nine
studies were included, enrolling 5,174 CAD patients. Overall, CAD patients
with the highest pentraxin-3 level had an increased risk of all-cause
mortality (RR 1.81; 95% CI 1.43-2.28), cardiac death (RR 1.77; 95% CI
1.38-2.26), and cardiac events (RR 1.61; 95% CI 1.16-2.25). However,
elevated pentraxin-3 level appeared to not significantly increase the risk
of cardiac events (RR 1.63; 95% CI 0.71-3.72) in stable CAD subgroup.
<br/>Conclusion(s): In CAD patients, elevated circulating pentraxin-3
level is possibly an independent predictor of all-cause mortality, cardiac
death, and cardiac events. However, interpretation of these findings
should be with caution due to the small number of studies
analyzed.<br/>Copyright &#xa9; 2019

<5>
Accession Number
2001970386
Title
The association between decrease in cerebral oxygen saturation during
cardiac surgery and postoperative cognitive dysfunction: secondary
analysis of a randomised trial.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Holmgaard F.; Vedel A.G.; Rasmussen L.S.; Paulson O.B.; Nilsson J.C.; Ravn
H.B.
Institution
(Holmgaard, Vedel, Nilsson, Ravn) Department of Cardiothoracic Anesthesia,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Vedel, Rasmussen) Department of Anesthesia, Centre of Head and
Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Paulson) Neurobiological Research Unit, The Neuro Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
Elsevier Ltd
Abstract
Background: Postoperative cognitive dysfunction (POCD)occurs commonly
after cardiac surgery. Near-infrared spectroscopy (NIRS)has been used to
monitor regional cerebral oxygen saturation (rScO<inf>2</inf>)in order to
minimise the occurrence of POCD by applying dedicated interventions when
rScO<inf>2</inf> decreases. However, the association between
rScO<inf>2</inf> intraoperatively and POCD has not been clarified.
<br/>Method(s): This is a secondary analysis of a randomised trial with
physician-blinded NIRS monitoring and cognitive testing at discharge from
hospital and at 3 months after surgery. The association between
intraoperative rScO<inf>2</inf> values and POCD at discharge from hospital
and at 3 months after surgery was investigated. The prespecified candidate
predictive variable of interest was cumulative time during surgery with
rScO<inf>2</inf> >=10% below its preoperative value. <br/>Result(s): One
hundred and fifty-three patients had complete NIRS data and neurocognitive
assessments at discharge, and 44 of these patients (29%)had POCD. At 3
months, 148 patients had complete data, and 12 (8%)of these patients had
POCD. The median time with rScO<inf>2</inf> >10% below preoperative values
did not differ for patients with and without POCD at discharge
(difference=0.0 min; Hodges-Lehmann 95% confidence interval, -3.11-1.47,
P=0.88). Other rScO<inf>2</inf> time thresholds that were assessed were
also not significantly different between those with and without POCD at
discharge. This applied both to absolute rScO<inf>2</inf> values and
relative changes from preoperative values. Similar results were found in
relation to POCD at 3 months. <br/>Conclusion(s): No significant
association was found between intraoperative rScO<inf>2</inf> values and
POCD. These findings bring into question the rationale for attempting to
avoid decreases in rScO<inf>2</inf> if the motivation is to prevent POCD.
Clinical trial registration: NCT 02185885.<br/>Copyright &#xa9; 2019
British Journal of Anaesthesia

<6>
Accession Number
627916636
Title
Preoperative anaemia: Consequences.
Source
Blood Transfusion. Conference: 6th International Multidisciplinary Course
on Iron Deficiency, IMCID 2018. Portugal. 17 (Supplement 1) (pp s5-s6),
2019. Date of Publication: March 2019.
Author
Gomez-Ramirez S.; Munoz M.
Institution
(Gomez-Ramirez) Internal Medicine, U.H. Virgen de la Victoria, Malaga,
Spain
(Munoz) Perioperative Transfusion Medicine, School of Medicine, Malaga,
Spain
Publisher
Edizioni SIMTI
Abstract
Background. Pre-operative anaemia (PA) is a frequent condition among
surgical patient, which has been usually regarded as no more than a
surrogated marker of the severity of the pathology requiring surgical
treatment, which does not entail an increase in patient's risk, and
therefore it is not always adequately treated before
surgery^1,2. Methods. A literature search on the consequences of
preoperative anaemia was performed. Results. The association between PA
and poor outcome has long been described, and a recent meta-analysis
including over 900,000 non-cardiac surgical patients showed that PA, even
if mild, is an independent risk factor for poorer post-operative
outcomes³. A sub-optimal haemoglobin (Hb <13 g/dL), is an
independent predictive factor of the need for perioperative red blood cell
transfusion (RBCT), though there exists a great inter-centre variability
in transfusion practice. In major elective surgery, perioperative blood
loss may lead to acute postoperative anaemia, especially in those with low
preoperative Hb. To avoid its deleterious effects, RBCT is usually
prescribed, as it produces a quick, albeit transient, increase of Hb
levels. However, RBCT carries its own risks of poor outcome^1,2.
Introduction of best practice alerts reduces transfusion requirements,
length of stay and mortality⁴. However, even using a
restrictive threshold, transfused patients have poorer clinical outcomes
when compared to non-transfused ones⁵. PA has also been shown
to potentiate the negative effects of major blood loss and transfusion on
mortality risk in cardiac surgical patients⁶, whereas in a
large series of patients undergoing colorectal cancer resection, severity
of PA was associated with progressive prolongation of hospital length of
stay⁷. Conclusion. In major elective surgery, patient may be
exposed to the effects of PA, blood loss and RBCT, all of which may
adversely influence post-operative infection rates, length of hospital
stay, and mortality (Figure 1). While there is not agreement on their
relative contributions on poor outcomes, their effects seem to be
synergistic. Stimulation of erythropoiesis to optimize pre-operative
haemoglobin and correction of iron and other haematinic deficiencies
constitute a fundamental pillar of multidisciplinary and multimodal
"Patient Blood Management" (PBM) programmes, aimed at insuring continuity
of care to improve clinical outcome¹. Therefore, despite the
lack of level-one evidence for improved outcomes, it is still recommended
as good clinical practice to treat all surgical patients with preoperative
anaemia, but especially those undergoing major surgery⁸.
However, this is probably the PBM strategy presenting more logistical
problems for its implementation, highlighting the difficulties that arise
in the process of moving from guideline recommendations to daily clinical
practice¹.

<7>
Accession Number
627913845
Title
Magnesium status and magnesium therapy in cardiac surgery: A systematic
review and meta-analysis focusing on arrhythmia prevention.
Source
Internal Medicine Journal. Conference: RACP Congress 2019, Impacting
Health Along the Life Course. New Zealand. 49 (Supplement 3) (pp 5), 2019.
Date of Publication: May 2019.
Author
Fairley J.L.; Zhang L.; Glassford N.J.; Bellomo R.
Institution
(Fairley) Alfred Hospital, Prahran, VIC 3004, Australia
(Fairley) School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC 3004, Australia
(Zhang, Glassford, Bellomo) Department of Intensive Care, Austin Hospital,
145 Studley Rd, Heidelberg, Melbourne, VIC 3084, Australia
(Zhang) Department of Nephrology, West China Hospital of Sichuan
University, Chengdu, Sichuan, China
(Glassford, Bellomo) Australian and New Zealand Intensive Care Research
Centre, School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC 3004, Australia
Publisher
Blackwell Publishing
Abstract
Purpose: To investigate magnesium as prophylaxis or treatment of
postoperative arrhythmias in cardiothoracic surgery (CTS) patients. To
assess the impact on biochemical and patient-centered outcomes.
<br/>Material(s) and Method(s): We searched MEDLINE, CENTRAL and EMBASE
electronic databases from 1975 to October 2015 using terms related to
magnesium and CTS. English-Language RCTs were included involving adults
undergoing CTS with parenterally administered magnesium to treat or
prevent arrhythmias, compared to control or standard antiarrythmics. We
extracted incidence of postoperative arrhythmias, termination following
magnesium administration and secondary outcomes (mortality, length of
stay, hemodynamic parameters, duration of mechanical ventilation and
biochemistry). <br/>Result(s): Thirty-five studies were included, with
significant methodological heterogeneity. Atrial fibrillation (AF) was
most commonly reported, followed by ventricular, supraventricular and
overall arrhythmia frequency. Magnesium appeared to reduce AF (RR 0.69,
95% confidence interval (CI) 0.56-0.86), particularly postoperatively (RR
0.51, 95% CI 0.34-0.77) for longer than 24 hours. Maximal benefit was seen
with bolus doses of up to 60mmol. Magnesium appeared to reduce ventricular
arrhythmias (RR = 0.46, 95% CI 0.24-0.89), with a trend to reduced overall
arrhythmias(RR = 0.80, 95% CI 0.57-1.12). We found no mortality effect or
significant increase in adverse events. <br/>Conclusion(s): Magnesium
administration post-CTS appears to reduce AF without significant adverse
events. There is limited evidence to support magnesium administration for
prevention of other arrhythmias.

<8>
Accession Number
627914029
Title
Positive effects of high intensity interval training (HIIT) in the post
heart transplant (HTx) population: A systematic review.
Source
Cardiopulmonary Physical Therapy Journal. Conference: Combined Sections
Meeting of the American Physical Therapy Association, CSM 2019. United
States. 30 (1) (pp e8-e9), 2019. Date of Publication: January 2019.
Author
Burkholder B.; Delahanty T.; Langer E.; Marceca N.; McCoy K.; Reiter K.;
Lefebvre K.M.
Institution
(Burkholder, Delahanty, Langer, Marceca, McCoy, Reiter, Lefebvre)
Institute for Physical Therapy Education, Widener University, Wilmington,
DE, United States
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE/HYPOTHESIS: Patients post heart transplant (HTx) experience
decreased quality of life, exercise capacity and overall function when
compared to the general population. The purpose of the systematic review
was to evaluate the effectiveness and safety of HITT in patients post HTx.
NUMBER OF SUBJECTS: One hundred ninety-six participants across 4
randomized controlled trials. Males represented a majority of participants
(65%) of the sample. The average age range was 47 to 56 and participants
ranged from 1 to 9 years post HTx. MATERIALS/METHODS: An electronic
database search of Medline, PubMed, Academic Search Premier, and
ScienceDirect was performed to gather articles that investigated the
relationship between high intensive interval training (HIIT) and moderate
intensity continuous training (MICT) in patients post heart transplant
(HTx). Peerreviewed studies published in the English language from January
1980 to October 2017 were retrieved using the keywords: 'heart or cardiac
transplantation' and 'high intensity interval training or HIIT or high
intensity interval exercise.' Inclusion criteria was defined as (1)
english language randomized controlled trials on humans (2) high intensity
interval exercise/training (HIIT) as an intervention (3) articles
comparing HIIT to MICT (4) population received a HTx (5) quality of life
measures utilized. Cut-off for acceptance of the RCTs when testing PEDro
scores was 6/11. Data extraction included: age, gender, sample size, post
HTx timeframe, types of interventions, frequency, outcome measures used,
and a summary of the main results from each study. <br/>RESULT(S): Four
randomized controlled trials met our inclusion criteria and qualified via
the Physiotherapy Evidence Database (PEDro) scoring. The studies all used
stable HTx recipients as the experimental groups. The frequency of
exercise across all studies was 2 to 33 per week. Intensity of the
exercise group (EG) ranged from 80% to 95% peak HR. Studies varied on use
of treadmill and or stationary bicycle for the method of intervention and
duration of the HIIT. Prominent findings included: HTx recipients'
exercise capacity improvement change (VO2 max improved 1 2.6-18.2
mL/Kg/min in HITT vs -2.8 to 12.6 in MICT group) without changes in
cardiac systolic/diastolic function, decrease in anxiety symptoms over
long-term application (HADS anxiety 2.3 in HITT vs 3.0 in MICT and
depression 1.8 in HITT vs 2.3 in MCIT). The positive results of HIIT on
cardiac transplantation can be lost if not maintained through intermittent
sessions throughout lifetime. No adverse events were reported across the
randomized controlled trials. <br/>CONCLUSION(S): HIIT should be
considered as a safe and effective treatment option for stable patients
post HTx.

<9>
Accession Number
627914012
Title
Abstracts for the RACP Congress 2019, Impacting Health Along the Life
Course.
Source
Internal Medicine Journal. Conference: RACP Congress 2019, Impacting
Health Along the Life Course. New Zealand. 49 (Supplement 3) (no
pagination), 2019. Date of Publication: May 2019.
Author
Anonymous
Publisher
Blackwell Publishing
Abstract
The proceedings contain 64 papers. The topics discussed include: magnesium
status and magnesium therapy in cardiac surgery: a systematic review and
meta-analysis focusing on arrhythmia prevention; changes in resting energy
expenditure with intermittent fasting versus continuous daily restriction
- a randomized controlled trial; aetiology and differentiating
characteristics of primary vs. secondary thrombocytosis - the clot
thickens; implementation of HFNO and reduction in the number of AECOPD
needing NIV in a rural hospital; postoperative outcomes in chronic
dialysis patients: a meta-analysis of 42 studies and 78,805 patients; and
predictors of longitudinal cardiac implantable electronic device (CIED)
dependency after open heart surgery (an Australian single center analysis
and practice).

<10>
Accession Number
627913920
Title
The effect of inspiratory muscle training on maximum inspiratory pressure,
postoperative pulmonary complications, and length of hospital stay in
patients undergoing coronary artery bypass graft surgery-systematic review
of randomized control trials.
Source
Cardiopulmonary Physical Therapy Journal. Conference: Combined Sections
Meeting of the American Physical Therapy Association, CSM 2019. United
States. 30 (1) (pp e5-e6), 2019. Date of Publication: January 2019.
Author
Elmarakby A.; Guay Z.; Kapic R.; Korogoda D.; Munro N.; Cappotelli J.
Institution
(Elmarakby, Guay, Kapic, Korogoda, Munro, Cappotelli) Doctor of Physical
Therapy Program, Utica College, Clinton, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE/HYPOTHESIS: Reduction in respiratory muscle strength has been
recognized as a common alteration after open heart surgery. During the
surgical procedure diaphragmatic paresis may be caused by one of the
following: reflex inhibition of the phrenic nerve during manipulation of
the viscera or thermal injury to the phrenic nerve after application of
cardiplegic solution. Diaphragmatic dysfunction changes the respiratory
mechanics leading to reduction in the ventilatory function and an increase
in respiratory workload, resulting in development of atelectasis. The high
incidence of atelectasis (54%-92%) has been considered problematic for
patient recovery, as it causes reduction in lung compliance and vital
capacity, deterioration of the gas exchange resulting in significant
hypoxemia and increase in the rate of postoperative pulmonary
complications (PPCs) such as pneumonia, and extended postoperative
hospital stay. Therefore, physical therapy rehabilitation is directed at
preventing and treating postoperative atelectasis by means of application
of chest physical therapy, and early mobilization. Studies have
investigated the efficacy of incorporating the inspiratory muscle training
(IMT) before or after cardiac surgery to minimize PPCs and the duration of
the hospital stay. The purpose of this systematic review was to synthesize
data from existing studies on the effect of IMT in the pre, post, or
perioperative periods on maximum inspiratory pressure MIP, PPCs, and
length of hospital stay in patients undergoing CABG. NUMBER OF SUBJECTS:
Five hundred thirty-one patients who were scheduled for CABG surgery and
were 45 years or older. MATERIALS/ METHODS: Databases utilized included
CINAHL, Medline, Cochrane between 2003 and 2018. Studies' quality tested
by Pedro scale. <br/>RESULT(S): Eight articles were included in this
review. Three articles studied the effect of IMT during postoperative
period. Three articles studied the effect of IMT during pre-operative
period. Two articles studied the effects of IMT peri-operatively. Seven
studies used threshold loading IMT and one study used flow dependent IMT.
All studies showed significant improvement in MIP. Four studies included
length of hospital stay in their outcomes. Only one study found a
significant difference in the length of hospital stay. Three articles
assessed the incidence of PPCs. Two studies showed reduction in PPCs in
the intervention groups. <br/>CONCLUSION(S): This systematic review
demonstrated that adding IMT to the cardiac rehabilitation improved the
MIP and reduced the incidence of PPCs after CABG surgery. Further studies
involving longer follow-up strategies are needed to study the effect of
IMT at home or in an outpatient setting on late PPCs such as pneumonia.

<11>
Accession Number
627905355
Title
Children's Heart Assessment Tool for Transplantation (CHAT) Score: A Novel
Risk Score Predicts Survival After Pediatric Heart Transplantation.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 10 (3) (pp
296-303), 2019. Date of Publication: 01 May 2019.
Author
Fraser C.D.; Grimm J.C.; Zhou X.; Lui C.; Giuliano K.; Suarez-Pierre A.;
Crawford T.C.; Magruder J.T.; Hibino N.; Vricella L.A.
Institution
(Fraser, Grimm, Zhou, Lui, Giuliano, Suarez-Pierre, Crawford, Magruder,
Hibino, Vricella) Division of Cardiac Surgery, The Johns Hopkins Hospital,
Baltimore, MD, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Given the shortage of donor organs in pediatric heart
transplantation (HTx), pretransplant risk stratification may assist in
organ allocation and recipient optimization. We sought to construct a
scoring system to preoperatively stratify a patient's risk of one-year
mortality after HTx. <br/>Method(s): The United Network for Organ Sharing
database was queried for pediatric (<18 years) patients undergoing HTx
between 2000 and 2016. The population was randomly divided in a 4:1
fashion into derivation and validation cohorts. A multivariable logistic
regression model for one-year mortality was constructed within the
derivation cohort. Points were then assigned to independent predictors (P
<.05) based on relative odds ratios (ORs). Risk groups were established
based on easily applicable, whole-integer score cutoffs. <br/>Result(s): A
total of 5,700 patients underwent HTx; one-year mortality was 10.7%. There
was a similar distribution of variables between derivation (n = 4,560) and
validation (n = 1,140) cohorts. Of the 12 covariates included in the final
model, nine were allotted point values. The low-risk (score 0-9),
intermediate-risk (10-20), and high-risk (>20) groups had a 5.18%, 10%,
and 28% risk of one-year mortality (P <.001), respectively. Both
intermediate-risk (OR = 2.46, 95% confidence interval [95% CI]: 1.93-3.15;
P <.001) and high-risk (OR = 9.24, 95% CI: 6.92-12.35; P <.001) scores
were associated with an increased risk of one-year mortality when compared
to the low-risk group. <br/>Conclusion(s): The Children's Heart Assessment
Tool for Transplantation score represents a pediatric-specific,
recipient-based system to predict one-year mortality after HTx. Its use
could assist providers in identification of patients at highest risk of
poor outcomes and may aid in pretransplant optimization of these
children.<br/>Copyright &#xa9; The Author(s) 2019.

<12>
Accession Number
627911121
Title
Can human myocardium be remotely preconditioned? The results of a
randomized controlled trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 55 (6) (pp 1086-1094),
2019. Date of Publication: 01 Jun 2019.
Author
Deja M.A.; Piekarska M.; Malinowski M.; Wiaderkiewicz R.; Czekaj P.;
Machej L.; Weglarzy A.; Kowalowka A.; Kolodziej T.; Czech E.; Plewka D.;
Mizia M.; Latusek T.; Szurlej B.
Institution
(Deja, Piekarska, Malinowski, Kowalowka, Latusek, Szurlej) Department of
Cardiac Surgery, School of Medicine in Katowice, Medical University of
Silesia, Katowice, Poland
(Deja, Piekarska, Malinowski, Kowalowka, Kolodziej) Department of Cardiac
Surgery, Upper-Silesian Heart Center, Katowice, Poland
(Wiaderkiewicz, Czekaj, Czech, Plewka) Department of Histology and
Embryology, School of Medicine in Katowice, Medical University of Silesia,
Katowice, Poland
(Machej) Department of Anesthesia and Intensive Care Nursing, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Weglarzy) Department of Cardiac Anesthesia, Upper-Silesian Heart Center,
Katowice, Poland
(Mizia) Department of Cardiology, School of Medicine in Katowice, Medical
University of Silesia, Katowice, Poland
Publisher
NLM (Medline)
Abstract
OBJECTIVES: No experimental study has shown that the myocardium of a
remotely preconditioned patient is more resistant to a standardized
ischaemic/hypoxic insult. <br/>METHOD(S): This was a single-centre
randomized (1:1), double-blinded, sham-controlled, parallel-group study.
Patients referred for elective coronary bypass surgery were allocated to
either remote ischaemic preconditioning (3 cycles of 5-min ischaemia/5-min
reperfusion of the right arm using a blood pressure cuff inflated to
200mmHg) or sham intervention. One hundred and thirty-four patients were
recruited, of whom 10 dropped out, and 4 were excluded from the
per-protocol analysis. The right atrial trabecula harvested on cannulation
for cardiopulmonary bypass was subjected to 60min of simulated ischaemia
and 120min of reoxygenation in an isolated organ experiment. Postoperative
troponin T release and haemodynamics were assessed in an in vivo study.
<br/>RESULT(S): The atrial trabeculae obtained from remotely
preconditioned patients recovered 41.9% (36.3-48.3) of the initial
contraction force, whereas those from non-preconditioned patients
recovered 45.9% (39.1-53.7) (P=0.399). Overall, the content of cleaved
poly (ADP ribose) polymerase in the right atrial muscle increased from
9.4% (6.0-13.5) to 19.1% (13.2-23.8) (P<0.001) after 1h of ischaemia and
2h of reperfusion in vitro. The amount of activated Caspase 3 and the
number of terminal deoxynucleotidyl transferase dUTP nick end
labeling-positive cells also significantly increased. No difference was
observed between the remotely preconditioned and sham-treated myocardium.
In the in vivo trial, the area under the curve for postoperative
concentration of troponin T over 72h was 16.4ngh/ml (95% confidence
interval 14.2-18.9) for the remote ischaemic preconditioning and
15.5ngh/ml (13.4-17.9) for the control group in the intention-to-treat
analysis. This translated into an area under the curve ratio of 1.06
(0.86-1.30; P=0.586). <br/>CONCLUSION(S): Remote ischaemic preconditioning
with 3 cycles of 5-min ischaemia/reperfusion of the upper limb before
cardiac surgery does not make human myocardium more resistant to
ischaemia/reperfusion injury. CLINICAL TRIAL REGISTRATION NUMBER:
NCT01994707.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<13>
Accession Number
627906177
Title
Impact of chronic obstructive pulmonary disease on prognosis after
percutaneous coronary intervention and bypass surgery for left main
coronary artery disease: an analysis from the EXCEL trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 55 (6) (pp 1144-1151),
2019. Date of Publication: 01 Jun 2019.
Author
Huang X.; Redfors B.; Chen S.; Liu Y.; Ben-Yehuda O.; Puskas J.D.;
Kandzari D.E.; Merkely B.; Horkay F.; van Boven A.J.; Boonstra P.W.; Sabik
J.F.; Serruys P.W.; Kappetein A.P.; Stone G.W.
Institution
(Huang, Redfors, Chen, Liu, Ben-Yehuda, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, USA
(Huang) Division of Cardiology, First Affiliated Hospital of Xi'an
Jiaotong University, Xi'an, Shaanxi, China
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Ben-Yehuda, Stone) Division of Cardiology, NewYork-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, USA
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY, USA
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Horkay) National Institute of Cardiology, Budapest, Hungary
(van Boven, Boonstra) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Percutaneous coronary intervention (PCI) is often favoured
over coronary artery bypass grafting (CABG) surgery for revascularization
in patients with chronic obstructive pulmonary disease (COPD). We studied
whether COPD affected clinical outcomes according to revascularization in
the Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization (EXCEL) trial, in which PCI
with everolimus-eluting stents was non-inferior to CABG for the treatment
of patients with left main coronary artery disease and low or intermediate
SYNTAX scores. <br/>METHOD(S): Patients with a history of COPD were
propensity score matched to those without COPD. Outcomes at 30days and
3years in both groups were compared in patients randomized to PCI versus
CABG. <br/>RESULT(S): COPD status was available for 1901 of 1905
randomized patients (99.8%), 148 of whom had COPD (7.8%). Propensity score
matching yielded 135 patients with COPD and 675 patients without COPD.
Patients with COPD had higher 3-year rates of the primary composite end
point of death, myocardial infarction or stroke (31.7% vs 14.5%,
P<0.0001), death (17.1% vs 7.5%, P=0.0005) and myocardial infarction
(18.3% vs 7.3%, P<0.0001), but not stroke (3.3% vs 2.9%, P=0.84). There
were no statistically significant interactions in the relative risks of
PCI versus CABG for the primary composite end point in patients with and
without COPD at 30days [hazard ratio (HR) 0.39, 95% confidence interval
(CI) 0.12-1.21 vs HR 0.55, 95% CI 0.29-1.06; Pinteraction=0.61] or at
3years (HR 0.85, 95% CI 0.46-1.56 vs HR 1.28, 95% CI 0.84-1.94;
Pinteraction=0.27). <br/>CONCLUSION(S): In the EXCEL trial, COPD was
independently associated with poor prognosis after left main coronary
artery disease revascularization. The relative risks of PCI versus CABG at
30days and 3years were consistent in patients with and without COPD.
CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov;
NCT01205776.<br/>Copyright &#xa9; The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<14>
Accession Number
627905540
Title
Percutaneous or surgical revascularization for left main stem disease:
NOBLE ideas, but do they EXCEL?.
Source
Expert Review of Cardiovascular Therapy. 17 (5) (pp 361-368), 2019. Date
of Publication: 04 May 2019.
Author
Kassimis G.; Raina T.; Kontogiannis N.; Krasopoulos G.; Gunn J.
Institution
(Kassimis, Raina, Kontogiannis) Department of Cardiology, Cheltenham
General Hospital, Gloucestershire Hospitals NHS Foundation Trust,
Cheltenham, United Kingdom
(Kassimis) Second Department of Cardiology, Hippokration Hospital, Medical
School, Aristotle University of Thessaloniki, Thessaloniki, Greece
(Krasopoulos) Oxford Heart Centre, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Gunn) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Although coronary artery bypass grafting (CABG) has
traditionally been the standard treatment for significant left main stem
(LMS) disease, percutaneous coronary intervention (PCI) using drug-eluting
stents (DES) is now considered an acceptable alternative. Areas covered:
This article aims to summarise the key findings of the landmark clinical
trials on LMS revascularization and the recently published ESC/EACTS
guidelines on myocardial revascularization related to LMS disease. Expert
opinion: It is unlikely that there will be a further large randomized
trial aimed at addressing the issue of the optimum method of
revascularization for LMS disease. Both PCI and CABG are reasonable
revascularization options for appropriately selected patients with LMS
disease. 'Heart Team' approach is vital to guide the management of
patients with LMS disease, when there is obvious clinical equipoise and a
mandate for complete revascularization. With an aging and increasing
co-morbid patient population, clinical equipoise may not always be
obvious, making extrapolation of clinical trial results to the 'real
world' difficult.<br/>Copyright &#xa9; 2019, &#xa9; 2019 Informa UK
Limited, trading as Taylor & Francis Group.

<15>
Accession Number
2002055719
Title
Current Readings on Outcomes After Off-Pump Coronary Artery Bypass
Grafting.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Patel V.; Unai S.; Gaudino M.; Bakaeen F.
Institution
(Patel, Unai, Bakaeen) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
Publisher
W.B. Saunders
Abstract
Off-pump coronary artery bypass grafting (CABG) gained popularity in the
1990s through early 2000s as surgeons sought to mitigate the purported
adverse effects of cardiopulmonary bypass and reduce the risk of
neurologic events from aortic manipulation. Since then, results of several
large randomized controlled trials and meta-analyses have failed to
demonstrate an advantage of off-pump CABG over traditional on-pump CABG
and have even raised concerns about potential suboptimal outcomes. The
modern debate about off- vs on-pump CABG centers around long-term
outcomes, the role of surgeon experience, identification of specific
patient populations for which off-pump CABG is most appropriate, and
identification of novel techniques and technologies to improve long-term
outcomes. We review the key findings of 5 contemporary papers that address
these issues and provide a current perspective on the status of off-pump
CABG.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<16>
Accession Number
2002055392
Title
Randomized Trial of Miniaturized Versus Standard Extracorporeal
Circulation in Aortic Valve Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Halfwerk F.R.; Knol K.; Mariani S.; Grandjean J.G.; Mecozzi G.
Institution
(Halfwerk, Knol, Mariani, Grandjean, Mecozzi) Department of
Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente
Hospital, Enschede, Netherlands
(Halfwerk, Grandjean) Department of Biomechanical Engineering, Faculty of
Engineering Technology, University of Twente, Enschede, Netherlands
(Mecozzi) Department of Cardio-Thoracic Surgery, University Medical Center
Groningen, Groningen, Netherlands
Publisher
Elsevier USA
Abstract
Background: Complications related to extracorporeal circulation remain
serious. Although a minimal invasive extra corporeal circulation (MiECC)
system was developed to cope with these complications, its effectivity on
patient-related outcomes such as blood loss remain uncertain. Therefore,
the aim of this study is to compare MiECC to an advanced standard system
with respect to blood loss. <br/>Method(s): A total of 128 adult patients
undergoing elective isolated aortic valve replacement were enrolled in a
randomized clinical trial. Patients who had undergone previous heart
surgery and with preexisting kidney failure were excluded. The primary end
point was postoperative blood loss after 12 hours and at drain removal.
Secondary end points included intensive care and total length of stay and
intubation time. At 1 hour and 12 hours after surgery, clinical laboratory
data were determined. Early clinical outcomes and long-term survival were
determined. <br/>Result(s): MiECC patients (n = 63) had a significant
lower blood loss (230 mL, 95% confidence interval: 203 to 261 mL) than
regular patients (n = 62) after 12 hours (288 mL, 95% confidence interval:
241 to 344 mL, p = 0.04). A preservation of hemoglobin levels 1 hour and
12 hours after surgery in the MiECC group were observed (p < 0.001). No
difference was found in early clinical outcomes and long-term survival.
<br/>Conclusion(s): This randomized controlled trial compares MiECC and an
advanced system for aortic valve replacement with blood loss as primary
end point. We conclude that using MiECC is clinically equal for short- and
long-term follow-up regarding blood loss. Clinical trial registration:
NTR3378.<br/>Copyright &#xa9; 2019 The Society of Thoracic Surgeons

<17>
Accession Number
52030946
Title
Early versus delayed percutaneous coronary intervention for patients with
non-ST segment elevation acute coronary syndrome: A meta-analysis of
randomized controlled clinical trials.
Source
Catheterization and Cardiovascular Interventions. 81 (2) (pp 223-231),
2013. Date of Publication: February 2013.
Author
Rajpurohit N.; Garg N.; Garg R.; Choudhary A.; Fresen J.; Boren S.;
Dellsperger K.C.; Webel R.; Aggarwal K.; Alpert M.A.
Institution
(Rajpurohit, Choudhary) Department of Internal Medicine, University of
Missouri, One Hospital Drive, Columbia, MO 65212, United States
(Garg, Garg, Dellsperger, Webel, Aggarwal, Alpert) Division of
Cardiovascular Medicine, University of Missouri, Columbia, MO, United
States
(Fresen) Department of Statistics, University of Missouri, Columbia, MO,
United States
(Boren) Department of Health Informatics and Management, University of
Missouri, Columbia, MO, United States
(Dellsperger) Center for Health Care Quality, University of Missouri,
Columbia, MO, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Studies assessing the timing of percutaneous coronary
interventions (PCI) in patients with Non-ST segment elevation Acute
Coronary Syndromes (NSTE-ACS) have failed to generate a consensus on how
early PCI should be performed in such patients. <br/>Purpose(s): This
meta-analysis compares clinical outcomes at 30 days in NSTE-ACS patients
undergoing PCI within 24 hours of presentation (early PCI) with those
receiving PCI more than 24 hours after presentation (delayed PCI).
<br/>Data Sources: Data were extracted from searches of MEDLINE
(1990-2010) and Google scholar and from scrutiny of abstract booklets from
major cardiology meetings (1990-2010). Study selection: Randomized
clinical trials (RCTs) that included the composite endpoint of death and
non-fatal myocardial infarction (MI) at 30 days after PCI were considered.
<br/>Data Extraction: Two independent reviewers extracted data using
standard forms. The effects of early and delayed PCI were analyzed by
calculating pooled estimates for death, non-fatal MI, bleeding, repeat
revascularization and the composite endpoint of death or non-fatal MI at
30 days. Univariate analysis of each of these variables was used to create
odds ratios. <br/>Data Synthesis: Seven studies with a total of 13,762
patients met the inclusion criteria. There was no significant difference
in the odds of the composite endpoint of death or non-fatal MI at 30 days
between patients undergoing early PCI and those receiving delayed PCI
(OR-0.83, 95%CI 0.62-1.10). Patients receiving delayed PCI experienced a
33% reduction in the odds of repeat revascularization at 30 days compared
to those undergoing early PCI (OR-1.33, 95%CI 1.14-1.56,
P=0.0004).Conversely, patients undergoing early PCI experienced lower odds
of bleeding than those receiving delayed PCI (OR-0.76, 95%CI 0.63-0.91, P
= 0.0003). <br/>Conclusion(s): In NSTE-ACS patients early PCI doesn't
reduce the odds of the composite endpoint of death or non-fatal MI at 30
day. This strategy is associated with lower odds of bleeding and higher
odds of repeat revascularization at 30 days than a strategy of delayed
PCI. Copyright &#xa9; 2012 Wiley Periodicals, Inc.

<18>
Accession Number
369199661
Title
Landiolol: A review of its use in intraoperative and postoperative
tachyarrhythmias.
Source
Drugs. 73 (9) (pp 959-977), 2013. Date of Publication: June 2013.
Author
Plosker G.L.
Institution
(Plosker) Adis, 41 Centorian Drive North Shore, 0754 Auckland, New Zealand
Publisher
Springer International Publishing
Abstract
Landiolol (Onoact) is an intravenously administered, ultra
short-acting beta<inf>1</inf>-blocker with an elimination half-life of 3-4
min and =8-fold greater cardioselectivity than esmolol in vitro. It is
approved in Japan for the treatment of intraoperative and postoperative
tachyarrhythmias, but in clinical practice is also used to prevent
postoperative tachyarrhythmias, such as atrial fibrillation after coronary
artery bypass grafting. Randomized controlled trials in patients
undergoing open-heart surgery demonstrated that various dosages of
landiolol (0.0005-0.04 mg/kg/min) [0.5-40 mug/kg/min] were more effective
than diltiazem in converting postoperative atrial fibrillation to normal
sinus rhythm during the first 8 h after surgery, and were more effective
than placebo (or no landiolol) in preventing the development of atrial
fibrillation during the first week after surgery (primary efficacy
endpoints). In patients undergoing surgical procedures, landiolol 0.125
mg/kg/min for 1 min followed by 0.04 mg/kg/min for 10 min was superior to
placebo in improving intraoperative tachycardia in randomized double-blind
trials. The beneficial effects of landiolol in attenuating adverse
haemodynamic or other changes that can occur during surgery or invasive
procedures (e.g. percutaneous coronary intervention) have been
demonstrated in a large number of randomized controlled trials. For
example, several studies showed that landiolol attenuated the increase in
heart rate associated with tracheal intubation, without adversely
affecting blood pressure or other haemodynamic parameters. Landiolol was
generally well tolerated in clinical trials, with a relatively low risk of
hypotension and bradycardia, although routine monitoring of cardiac
function during landiolol administration is important. In general, adverse
events such as reduced blood pressure resolve quickly after
discontinuation of landiolol. Thus, as an ultra short-acting
beta<inf>1</inf>-blocker with a rapid onset of action and readily
titratable and rapidly reversible effects, landiolol represents an
important agent for the management of intraoperative and postoperative
tachyarrhythmias. &#xa9; 2013 Springer International Publishing
Switzerland.

<19>
Accession Number
2002020633
Title
The effect of aspirin as an irreversible COX<inf>1</inf> inhibitor in
preventing non-valvular atrial fibrillation after coronary bypass surgery.
Source
Heart Surgery Forum. 22 (2) (pp E149-E154), 2019. Date of Publication:
2019.
Author
Erkut B.; Ates A.
Institution
(Erkut, Ates) Ataturk University, Medical Faculty, Department of
Cardiovascular Surgery, Erzurum, Turkey
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: We investigated whether the use of aspirin (irreversible COX1
inhibitor) in the preoperative period may prevent non-valvular atrial
fibrillation, which is the most common rhythm problem in the postoperative
period. Non-valvular atrial fibrillation after coronary surgery may lead
to an increase in hospital costs due to excessive drug use and long-term
hospitalization. <br/>Method(s): More than 1000 coronary artery bypass
grafting operations were performed between January 2011 to and Nov 2018.
The 572 patients were included in this study. Patients were divided into
two groups as medication (n=292) and medication-free group (n=280). In the
medication group, while patients received aspirin (300 mg daily) therapy
(up to 5 days) before the operation, the other group did not receive any
anti-aggregan treatment. The patients were followed up for the occurrence
of atrial fibrillation from the early postoperative period up to 3 months.
<br/>Result(s): While non-valvular atrial fibrillation was developed in 16
patients (5,5 %) in medication group, this rate was 24,3 % with 68
patients in medication-free group 3 month after operation (P < .05). In
addition to the intensive care unit and hospital stay, there was a
significant difference between the groups in terms of hospital costs (P <
.05). <br/>Conclusion(s): According to the results of our study, we found
that the aspirin used in preoperative period may prevent non-valvular
atrial fibrillation in the postoperative period. In relation to these
results; we found that hospital stay and hospital expenses
decreased.<br/>Copyright &#xa9; 2019 Forum Multimedia Publishing LLC. All
rights reserved.

<20>
Accession Number
2001932092
Title
Cognitive outcomes following coronary artery bypass grafting: A systematic
review and meta-analysis of 91,829 patients.
Source
International Journal of Cardiology. 289 (pp 43-49), 2019. Date of
Publication: 15 August 2019.
Author
Greaves D.; Psaltis P.J.; Ross T.J.; Davis D.; Smith A.E.; Boord M.S.;
Keage H.A.D.
Institution
(Greaves, Ross, Boord, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, School of Psychology, Social Work and Social
Policy, University of South Australia, Adelaide, Australia
(Psaltis) Vascular Research Centre, Heart Health Theme, South Australian
Health and Medical Research Institute, Adelaide, Australia and Adelaide
Medical School, University of Adelaide, Adelaide, Australia
(Davis) MRC Unit for Lifelong Health and Ageing Unit at University College
London, London, United Kingdom
(Smith) Alliance for Research in Exercise, Nutrition and Activity, School
of Health Sciences, University of South Australia, Adelaide, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Background: Cognitive impairments, including delirium, are common after
coronary artery bypass grafting (CABG) surgery, as described in over three
decades of research. Our aim was to pool estimates across the literature
for the first-time, relative to time (from pre- to post-CABG) and
diagnosis (cognitive impairment, delirium and dementia). <br/>Method(s): A
systematic search of four databases was undertaken. 215 studies
incorporating data from 91,829 patients were used to estimate the
prevalence of cognitive impairments pre- and post-CABG, including delirium
and dementia post-CABG, using random effects meta-analyses.
<br/>Result(s): Pre-surgical cognitive impairment was seen in 19% of
patients. Post-operatively, cognitive impairment was seen in around 43% of
patients acutely; this resolved to 19% at 4-6 months and then increased to
25% of patients between 6-months to 1-year post-operatively. In the long
term, between 1 and 5-years post-operatively, cognitive impairment
increased and was seen in nearly 40% of patients. Post-operative delirium
was apparent in 18% of CABG patients which increased to 24% when a
diagnostic instrument was utilized alongside clinical criteria. Dementia
was present in 7% of patients 5-7 years post-surgery. <br/>Conclusion(s):
The results of this meta-analysis demonstrate that cognitive impairment
and delirium are major issues in CABG patients which require specific
attention. It is imperative that appropriate methods for investigating
cognitive impairment, and screening for delirium using a diagnostic
instrument, occur in both pre-and post-CABG settings.<br/>Copyright &#xa9;
2019 The Authors

<21>
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. <br/>Objective(s): The purpose of this study is to perform a
systematic review and meta-analysis of antifibrinolytic agents for
paediatric spine surgery. <br/>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. <br/>Method(s): A thorough
database search of Medline, PubMed, EMBASE and Cochrane was performed
according to PRISMA guidelines, and a systematic review was performed.
<br/>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). <br/>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.].<br/>Copyright &#xa9; 2019, Springer-Verlag GmbH Germany, part
of Springer Nature.

<22>
Accession Number
627898638
Title
Epidural analgesia versus paravertebral block in video-assisted
thoracoscopic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 404-406),
2019. Date of Publication: 2019.
Author
Harky A.; Clarke C.G.; Kar A.; Bashir M.
Institution
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Liverpool Road, Chester CH2 1UL, United Kingdom
(Clarke) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Kar) Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's
Hospital, London, United Kingdom
(Bashir) Department of Aortovascular Surgery, Manchester Royal Infirmary,
Manchester, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In patients undergoing
video-assisted thoracoscopic surgery, is paravertebral block (PVB)
superior to epidural analgesia (EP) in terms of pain control and its
postoperative complication rates? Altogether, 153 papers were found using
the reporting search, of which 4 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. At present, there are a limited
number of studies directly comparing pain control and postoperative
outcomes between PVB and EP, and no large-scale randomized trials have
been reported. Three of the 4 papers are small prospective randomized
trials, with a small cohort study featuring as the final piece of
literature. There is no conclusive body of evidence to recommend either
route as more efficacious from a pain control perspective; one study
demonstrated significantly lower levels of pain with EP (P = 0.01), with a
second study demonstrating significantly better pain control with PVB (P <
0.01) and a third failing to demonstrate any significant difference (P =
0.899). The frequency of requiring supplemental analgesia was similar
between the PVB and EP cohorts (56% vs 48%, P = 0.26). PVB is associated
with lower rates of postoperative complications compared to EP,
specifically urinary retention (64% vs 34.6%, P = 0.0036) and hypotension
(32% vs 7%, P = 0.0031; 21% vs 3%, P = 0.02). In summary, PVBs appear to
offer an equivalent level of analgesic effect following video-assisted
thoracoscopic surgery, with a more favourable side-effect profile,
compared to EP. This does need to be contextualized in light of the
scarcity of published material, with the available studies each containing
a small number of participants.<br/>Copyright &#xa9; 2018 The Author(s).

<23>
Accession Number
627895167
Title
Is systematic lymph node dissection mandatory or is sampling adequate in
patients with stage I non-small-cell lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 550-554),
2019. Date of Publication: 2019.
Author
Mitsos S.; Panagiotopoulos N.; Patrini D.; George R.S.
Institution
(Mitsos, Panagiotopoulos, Patrini, George) Thoracic Surgery Department,
University College London Hospitals, NHS Foundation Trust, London, United
Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Is systematic lymph node
dissection (SLND) mandatory or is sampling adequate in stage I
non-small-cell lung cancer (NSCLC)? Two hundred and eleven papers were
identified, of which 12 papers represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and the results of
these papers are tabulated. There are 7 retrospective cohort reviews, 3
meta-analyses and 2 randomized controlled clinical trials (RCTs) to answer
the clinical question. Four of the 7 retrospective studies demonstrated
that the total number of resected lymph nodes and the number of lymph node
stations sampled affected the accuracy of staging in patients with
early-stage NSCLC and had an impact on overall survival and disease-free
survival. Two RCTs, 1 meta-analysis and 1 cohort study revealed no
significant benefit in overall survival and disease-free survival in
patients undergoing SLND. One meta-analysis, which contained only 1 RCT,
revealed significantly better 3- and 5-year survival with SLND. One
further metaanalysis revealed improved survival with SLND in cohort
studies but no significant difference in the 4 RCTs included. Two further
studies identified specific subgroups of patients in whom LN sampling
could be justified and SLND avoided. We conclude that there is no
significant difference in the recurrence rate when performing either SLND
or LN sampling in patients with stage I NSCLC. While retrospective cohort
studies implied survival benefit with SLND, this was not borne out in RCTs
and meta-analyses. However, there may be a potential survival benefit for
patients who are upstaged by SLND identifying mediastinal nodal
involvement.<br/>Copyright &#xa9; 2018 The Author.

<24>
Accession Number
627895159
Title
Intravenous iron does not effectively correct preoperative anaemia in
cardiac surgery: A pilot randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 447-454),
2019. Date of Publication: 2019.
Author
Padmanabhan H.; Siau K.; Nevill A.M.; Morgan I.; Cotton J.; Ng A.; Brookes
M.J.; Luckraz H.
Institution
(Padmanabhan, Siau, Brookes) Department of Gastroenterology, Royal
Wolverhampton NHS Trust, Wolverhampton WV10 0QP, United Kingdom
(Nevill) Faculty of Education, Health and Wellbeing, University of
Wolverhampton, Wolverhampton, United Kingdom
(Morgan, Luckraz) Department of Cardiothoracic Surgery, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Cotton) Department of Cardiology, Heart and Lung Centre, Wolverhampton,
United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart and Lung Centre,
Wolverhampton, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Preoperative anaemia is a strong predictor of blood
transfusion requirements and must be assessed for appropriate optimization
before elective surgery. Iron therapy is a transfusion-sparing approach
effective for increasing haemoglobin concentrations. However, its role in
elective cardiac surgery and the optimal route of administration remain
unknown. This single-centre, non-blinded, randomized, controlled trial
compared the effectiveness of intravenous ferric carboxymaltose therapy
with oral iron for anaemic patients undergoing elective cardiac surgery.
<br/>Method(s): Fifty anaemic patients scheduled for elective cardiac
surgery were randomized to receive either oral or intravenous iron therapy
3-8 weeks preoperatively. Changes in haemoglobin concentration were
measured. Blood transfusion and postoperative outcome data were collected.
<br/>Result(s): Preoperative median increases in haemoglobin were 1.0 g/l
(interquartile range -3.25 to 7.25 g/l) and 3.0 g/l (interquartile range
-1.25 to 6.25 g/l) for patients receiving intravenous and oral iron,
respectively (P = 0.42). The median first 12-h blood loss was
significantly higher in the intravenous group (655 ml; interquartile range
162-1540 ml) compared to the oral group (313 ml; interquartile range
150-1750 ml; P < 0.007). Median increments in serum ferritin were superior
for the intravenous group (median difference 313 mug/l; interquartile
range 228-496) compared to the oral group (median difference 5.5 mug/l;
interquartile range -1.4 to 19.4; P < 0.001). <br/>Conclusion(s):
Increases in ferritin after intravenous iron administration were
significantly greater than those after oral iron administration. There was
no significant difference in haemoglobin increments between groups.
Despite significantly higher intraoperative blood loss in the group
receiving intravenous iron, blood transfusion requirements for both groups
were not statistically different.<br/>Copyright &#xa9; The Author(s) 2018.

<25>
Accession Number
627895110
Title
Randomized evaluation of fibrinogen versus placebo in complex
cardiovascular surgery: Post hoc analysis and interpretation of phase III
results.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 566-574),
2019. Date of Publication: 2019.
Author
Rahe-Meyer N.; Levy J.H.; Mazer C.D.; Schramko A.; Klein A.A.; Brat R.;
Okita Y.; Ueda Y.; Schmidt D.S.; Gill R.
Institution
(Rahe-Meyer) Department of Anaesthesiology and Critical Care, Franziskus
Hospital, Bielefeld, Germany
(Levy) Department of Anesthesiology and Critical Care, Duke University
School of Medicine, Durham, NC, United States
(Mazer) Department of Anesthesia, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Schramko) Department of Anesthesiology, Intensive Care and Pain Medicine,
Helsinki University Hospital, Helsinki, Finland
(Klein) Department of Anaesthesia and Intensive Care, Papworth Hospital,
Cambridge, United Kingdom
(Brat) Department of Cardiac Surgery, Faculty of Medicine, University of
Ostrava, Ostrava, Czechia
(Okita) Department of Cardiovascular Surgery, Kobe University Hospital,
Kobe, Japan
(Ueda) Department of Cardiac Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
(Schmidt) CSL Behring, Marburg, Germany
(Gill) Department of Anaesthesia, University Hospital of Southampton,
Southampton, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: In a multicentre, randomized-controlled, phase III trial in
complex cardiovascular surgery (Randomized Evaluation of Fibrinogen vs
Placebo in Complex Cardiovascular Surgery: REPLACE), single-dose human
fibrinogen concentrate (FCH) was associated with the transfusion of
increased allogeneic blood products (ABPs) versus placebo. Post hoc
analyses were performed to identify possible reasons for this result.
<br/>Method(s): We stratified REPLACE results by adherence to the
transfusion algorithm, pretreatment fibrinogen level (<=2 g/l vs >2 g/l)
and whether patients were among the first 3 treated at their centre.
<br/>Result(s): Patients whose treatment was adherent with the transfusion
algorithm [FCH, n = 47 (60.3%); placebo, n = 57 (77.0%); P = 0.036]
received smaller quantities of ABPs than those with non-adherent treatment
(P < 0.001). Among treatment-adherent patients with pretreatment plasma
fibrinogen <=2 g/l, greater reduction in 5-min bleeding mass was seen with
FCH versus placebo (median -22.5 g vs -15.5 g; P = 0.071). Considering
patients with the above conditions and not among the first 3 treated at
their centre (FCH, n = 15; placebo, n = 22), FCH was associated with
trends towards reduced transfusion of ABPs (median 2.0 vs 4.0 units; P =
0.573) and greater reduction in 5-min bleeding mass (median -21.0 g vs
-9.5 g; P = 0.173). Differences from a preceding single-centre phase II
study with positive outcomes included more patients with pretreatment
fibrinogen >2 g/l and fewer patients undergoing thoracoabdominal aortic
aneurysm repair. <br/>Conclusion(s): None of the patient stratifications
provided a clear explanation for the lack of efficacy seen for FCH in the
REPLACE trial versus the positive phase II outcomes. However, together,
the 3 factors demonstrated trends favouring FCH. Less familiarity with the
protocol and procedures and unavoidable differences in the study
populations may explain the differences seen between the phase II study
and REPLACE.<br/>Copyright &#xa9; The Author(s) 2018.

<26>
Accession Number
2001957823
Title
A Randomized Controlled Trial of Surgical Rib Fixation in Polytrauma
Patients With Flail Chest.
Source
Journal of Surgical Research. 242 (pp 223-230), 2019. Date of Publication:
October 2019.
Author
Liu T.; Liu P.; Chen J.; Xie J.; Yang F.; Liao Y.
Institution
(Liu, Chen, Xie, Yang, Liao) Trauma Center, Department of Emergency and
Trauma Surgery, Tongji Hospital, Tongji Medical College of Huazhong
University of Science and Technology, Wuhan, China
(Liu) Department of Emergency Surgery, Wuhan Pu'ai Hospital, Tongji
Medical College of Huazhong University of Science and Technology, Wuhan,
China
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Flail chest (FC)is known to account for high mortality and
morbidity and is typically treated with conservative care. Operative
fixation of FC has been advocated as an alternative treatment choice. This
prospective randomized controlled trial aims to compare surgical and
nonsurgical management of FC in patients with severe polytrauma.
<br/>Method(s): Severe polytrauma patients with FC admitted between
January 2015 and July 2017 to our trauma center were investigated. The
enrolled patients were randomly assigned to the surgical or nonsurgical
group. Basic characteristics of injury and clinical outcomes were
compared. <br/>Result(s): Fifty patients entered final analysis, with 25
patients in each group. Operative rib fixation was associated with shorter
duration of mechanical ventilation (7 d [interquartile range {IQR}
6-10]versus 9 d [IQR 7-12], P = 0.012), shorter ICU stay (10 d [IQR
7-12]versus 12 d [IQR 9-15], P = 0.032), lower risk of adult respiratory
distress syndrome (28% versus 60%, P = 0.045), pneumonia (48% versus 80%,
P = 0.038), and thoracic deformity (8% versus 36%, P = 0.037)and less pain
while coughing (pain score 6 [IQR 3-8]versus 8 [IQR 4-9], P = 0.029)and
deep breathing (pain score 5 [IQR 3-9]versus 7 [IQR 3-9], P = 0.038).
Subgroup analysis was conducted by presence of pulmonary contusion.
Shorter time on the ventilator use and ICU stay associated with rib
surgery was not observed in patients with pulmonary contusion.
<br/>Conclusion(s): This study reveals that surgical rib fixation may
provide some critical care benefits for severe polytrauma patients with
FC, including less medical resource use and lower risk of complications.
Further studies should be designed to optimally identify patients who are
most likely to benefit from this surgery.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<27>
Accession Number
627732183
Title
Comparison of the effect of different degrees of passive leg raising on
the internal jugular vein cross-sectional area in patients before thoracic
surgery.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 78. Date
of Publication: 17 May 2019.
Author
Xie S.; Yu Q.; Li T.; Xu M.; Wu J.; Li Y.
Institution
(Xie, Yu, Li, Xu, Wu) Department of Anesthesiology, Shanghai Chest
Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West,
Shanghai, China
(Li) Department of Industrial Engineering and Management, School of
Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: This study investigated the effect of different degrees of
passive leg raising (PLR) on the internal jugular vein (IJV)
cross-sectional area (CSA) and on the success rate of IJV cannulation in
patients waiting for thoracic surgery, to analyze whether body mass index
(BMI), gender, age, fasting time and preoperative rehydration have any
impact on changes in the IJV CSA. <br/>Method(s): Eighty-two patients
scheduled for selective thoracic surgery were enrolled in this study.
Patients were randomly assigned based on a computer-generated
randomization sequence into 3 groups: 0, 30, and 50 degrees (n = 32, 25,
and 25 patients, respectively). The right IJV CSA in the sequence of
0-degree (supine position), 30-degree and 50-degree PLR positions was
recorded in all patients using an ultrasound probe. The relationship of
BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA
was analyzed. Then, each patient was returned to a supine position. After
waiting for at least 5 min, patients were placed in a PLR position at 0,
30, or 50 degrees, and then IJV cannulation was performed without
ultrasound guidance. The success rate of IJV catheterization at different
PLR angles was compared. <br/>Result(s): The average CSA of the right IJV
in the supine position, 30-degree PLR position and 50-degree PLR position
was 1.39 +/- 0.63 cm², 1.65 +/- 0.73 cm², and 1.68
+/- 0.71 cm², respectively. These results showed gradual
increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree
PLR) when compared to that in the supine position (P = 0.045 and 0.025,
respectively). However, only fasting time had a significant impact on the
increase in the right IJV CSA at different PLR angles (P = 0.026). Other
factors, such as BMI, gender, age and preoperative rehydration, had no
significant effects. The success rates of IJV catheterization at angles of
0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there
were no significant differences among the three groups (P = 0.674).
<br/>Conclusion(s): PLR increases the CSA of the right IJV, especially for
patients with long fasting times before thoracic surgery. The effect of
the 30-degree PLR position is similar to that of the 50-degree PLR
position. However, the success rate of right IJV catheterization was not
enhanced in this study using landmark-guided puncture, even though the CSA
of the right IJV was increased.<br/>Copyright &#xa9; 2019 The Author(s).

<28>
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.<br/>Copyright &#xa9; 2019 Georg Thieme Verlag KG Stuttgart . New
York.

<29>
Accession Number
627790645
Title
Cardiology fellows-in-training are exposed to relatively high levels of
radiation in the cath lab compared with staff interventional
cardiologists-insights from the RECAP trial.
Source
Netherlands Heart Journal. 27 (6) (pp 330-333), 2019. Date of Publication:
01 Jun 2019.
Author
Vlastra W.; Claessen B.E.; Beijk M.A.; Sjauw K.D.; Streekstra G.J.;
Wykrzykowska J.J.; Vis M.M.; Koch K.T.; de Winter R.J.; Piek J.J.;
Henriques J.P.S.; Delewi R.
Institution
(Vlastra, Claessen, Beijk, Sjauw, Wykrzykowska, Vis, Koch, de Winter,
Piek, Henriques, Delewi) Heart Center, Department of Clinical and
Experimental Cardiology, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
(Streekstra) Department of Biomedical Engineering and Physics, Amsterdam
UMC, University of Amsterdam, Amsterdam, Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background: Interventional cardiologists are inevitably exposed to
low-dose radiation, and consequently are at risk for radiation induced
diseases like cataract and left-sided brain tumours. Operator behaviour
may possibly be the largest influencer on radiation exposure. We
hypothesised that awareness regarding radiation exposure grows as skill
and the general experience in the catheterization laboratory increase.
<br/>Objective(s): In this study we determined the difference in the
relative radiation exposure of staff interventional cardiologists compared
with cardiology fellows-in-training. <br/>Method(s): During this
prospective trial the operator's radiation exposure (E in micro&#32;Sv)
was measured at chest height during 766 diagnostic catheterisations and
percutaneous coronary interventions. Also, the patient exposure (DAP in
mGy.cm²), representing the amount of radiation administered by
the operator per procedure, was collected. The primary outcome of this
study was the difference in relative exposure between staff interventional
cardiologists versus cardiology fellows-in-training (E/DAP).
<br/>Result(s): From January to May 2017, staff interventional
cardiologists performed 637 procedures and cardiology fellows-in-training
129 procedures. The performance of relatively complex procedures by staff
interventional cardiologists resulted in a 74% higher use of radiation
compared with fellows-in-training. Consequently, staff interventional
cardiologists were exposed to 50% higher levels of actual radiation
exposure. However, when correcting for the complexity of the procedure, by
comparing the relative operator exposure (E/DAP), fellows-in-training were
exposed to a 34% higher relative exposure compared with staff
interventional cardiologists (p= 0.025). <br/>Conclusion(s): In the
current study, when corrected for complexity, cardiology
fellows-in-training were exposed to significantly higher radiation levels
than staff interventional cardiologists during catheterisation
procedures.<br/>Copyright &#xa9; 2019, The Author(s).

<30>
Accession Number
627790633
Title
Five-year results of the complete versus culprit vessel percutaneous
coronary intervention in multivessel disease using drug-eluting stents II
(CORRECT II) study: a prospective, randomised controlled trial.
Source
Netherlands Heart Journal. 27 (6) (pp 310-320), 2019. Date of Publication:
01 Jun 2019.
Author
Fagel N.D.; van Nooijen F.C.; Maarse M.; Slagboom T.; Herrman J.P.; van
der Schaaf R.J.; Amoroso G.; Patterson M.S.; Laarman G.J.; Suttorp M.J.;
Vink M.A.
Institution
(Fagel, Maarse, Slagboom, Herrman, van der Schaaf, Amoroso, Patterson,
Vink) Department of Cardiology, OLVG Hospital, Amsterdam, Netherlands
(van Nooijen) Department of Cardiology, Waterland Hospital, Purmerend,
Netherlands
(Laarman) Department of Cardiology, Elisabeth-TweeSteden Hospital,
Tilburg, Netherlands
(Suttorp) Department of Cardiology, Sint Antonius Hospital, Nieuwegein,
Netherlands
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Objectives/background: In patients with multivessel coronary artery
disease (MVD) the decision whether to treat a single culprit vessel or to
perform multivessel revascularisation may be challenging. The purpose of
this study was to evaluate the long-term outcome of multivessel
percutaneous coronary intervention (MV-PCI) versus culprit vessel only
(CV-PCI) in patients with stable coronary artery disease or non-ST
elevation acute coronary syndrome. <br/>Method(s): In this dual-centre,
prospective, randomised study a total 215 patients with MVD were randomly
assigned to MV-PCI or CV-PCI. The primary endpoint was the occurrence of
major adverse cardiac events (MACE) including death, myocardial infarction
(MI), and repeat revascularisation. Secondary endpoints were the combined
endpoint of death or MI, the individual components of the primary
endpoint, and the occurrence of stent thrombosis. Patients were followed
up to 5 years after enrolment. <br/>Result(s): The occurrence of the
primary endpoint was similar at 28% versus 31% in the MV-PCI and CV-PCI
group, respectively (hazard ratio [HR] 0.87, 95% confidence interval [CI]:
0.53-1.44, p= 0.59). The rate of repeat revascularisation was 15% versus
24% (HR 0.59, 95% CI 0.32 to 1.11, p= 0.11), whereas definite or probable
stent thrombosis occurred in 2% versus 0% (p= 0.44). <br/>Conclusion(s):
In this randomised study comparing the strategies for MV-PCI and CV-PCI in
patients with MVD, no difference was found in the occurrence of MACE after
5 years. We observed a numerically higher rate of death or MI and a lower
rate of repeat revascularisation after MV-PCI, although these findings
were not statistically significant.<br/>Copyright &#xa9; 2019, The
Author(s).

<31>
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. <br/>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. <br/>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). <br/>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. <br/>Level of Evidence: II, prospective
comparative study.<br/>Copyright &#xa9; 2019 Elsevier Masson SAS

<32>
Accession Number
2001957489
Title
The effect of EDTA-based chelation on patients with diabetes and
peripheral artery disease in the Trial to Assess Chelation Therapy (TACT).
Source
Journal of Diabetes and its Complications. (no pagination), 2019. Date of
Publication: 2019.
Author
Ujueta F.; Arenas I.A.; Escolar E.; Diaz D.; Boineau R.; Mark D.B.; Golden
P.; Lindblad L.; Kim H.; Lee K.L.; Lamas G.A.
Institution
(Ujueta, Lamas) Department of Medicine, Mount Sinai Medical Center, 4300
Alton Road, Miami Beach, FL, United States
(Arenas, Escolar, Diaz, Lamas) Columbia University Division of Cardiology,
Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, United
States
(Boineau) National Center of Complementary and Integrative Health (NCCIH),
Bethesda, MD, United States
(Mark, Lindblad, Kim, Lee) Duke Clinical Research Institute, Durham, NC,
United States
(Golden) The Golden Center for Integrative Medicine, Fresno, CA, United
States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: Approximately 1 in 7 US adults have diabetes; and over 60% of
deaths in patients with diabetes have cardiac disease as a principal or
contributing cause. Both coronary and peripheral artery disease (PAD)
identify high-risk cohorts among patients with diabetes. We have
previously demonstrated improved cardiovascular outcomes with edetate
disodium-based chelation in post-MI patients with diabetes, enrolled in
the Trial to Assess Chelation Therapy (TACT). In these analyses we further
studied the effect size of patients with diabetes and severe disease in 2
vascular beds; coronaries, and lower extremity arteries. We questioned
whether greater atherosclerotic burden would attenuate the observed
beneficial effect of edetate disodium infusions. Research design and
methods: The multicenter TACT used a double blind, placebo controlled, 2 x
2 factorial design with 1708 participants, randomly assigned to receive
edetate disodium-based chelation, or placebo and high dose oral vitamins
or placebo. There were 162 (9.5% of 1708) post-MI patients with a
diagnosis of diabetes mellitus and PAD for this post hoc analysis.
Patients received up to 40 double-blind intravenous infusions of edetate
disodium-based chelation, or placebo. The composite primary endpoint of
TACT consisted of death from any cause, myocardial infarction, stroke,
coronary revascularization and hospitalization for angina. <br/>Result(s):
The median age was 66 years, 15% female, 5% non-Caucasian, and BMI was 31.
Insulin was used by 32% of patients. Active infusions significantly
reduced the primary endpoint compared with placebo infusions (HR, 0.52;
95% CI, 0.30-0.92; P = 0.0069), with a 30% absolute risk reduction in the
primary endpoint. There was a marked reduction in total mortality from 24%
to 11%, although of borderline significance (P = 0.052).
<br/>Conclusion(s): Atherosclerotic disease in multiple vascular beds did
not attenuate the beneficial effect of edetate disodium infusions in post
MI patients with diabetes. Studies now in progress will prospectively test
this post hoc finding.<br/>Copyright &#xa9; 2019 The Authors

<33>
Accession Number
627827955
Title
Exclusion criteria and adverse events in perioperative trials of
tranexamic acid in cardiac surgery: a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Khair S.; Perelman I.; Yates J.; Taylor J.; Lampron J.; Tinmouth A.;
Saidenberg E.
Institution
(Khair, Perelman, Yates, Taylor, Lampron, Tinmouth, Saidenberg) Faculty of
Medicine, University of Ottawa, Ottawa, Canada
(Perelman, Lampron, Tinmouth, Saidenberg) Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, Canada
(Lampron, Tinmouth, Saidenberg) Ottawa Hospital, 501 Smyth Rd, Ottawa, ON
K1H 8L6, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Tranexamic acid (TXA) reduces perioperative blood loss and
transfusion requirement following cardiac surgery. Nevertheless, TXA
remains underutilized because of concerns regarding development of adverse
events. We conducted a systematic review to determine which patients are
commonly excluded from TXA cardiac surgery clinical trials to determine if
there are patient groups lacking safety data on TXA. <br/>Method(s): The
databases Medline, EMBASE, and the Cochrane Central Register of Controlled
Trials were searched until September 2017. Eligible studies were
randomized-controlled trials (RCTs) administering systemic TXA
perioperatively to patients undergoing any cardiac surgery. Our primary
outcome was the exclusion criteria for each RCT, and the secondary
endpoint was TXA safety. A descriptive synthesis was performed to analyze
the exclusion criteria. TXA safety was assessed with meta-analysis.
Principal findings: Seventy eligible RCTs were included. The most common
reasons for excluding patients from TXA cardiac surgery trials were major
hepatic, renal, or cardiac comorbidities (76% of studies). Meta-analysis
showed that TXA did not increase the risk of adverse events compared with
placebo or no intervention (risk ratio, 0.97; 95% confidence interval,
0.88 to 1.07), including thrombosis and seizure. <br/>Conclusion(s): We
found that systemic TXA is safe to use in cardiac surgery. Certain patient
groups are frequently excluded from TXA cardiac surgery trials, and may
consequently have limited efficacy and safety data on TXA. Further
research in these patient groups may be needed; nevertheless, for many
patient populations there are sufficient data to inform evidence-based
guidelines for TXA use in cardiac surgery. Trial registration: PROSPERO
(CRD42017060971); registered 4 April, 2017.<br/>Copyright &#xa9; 2019,
Canadian Anesthesiologists' Society.

<34>
Accession Number
627868541
Title
Efficacy and safety of drug-eluting stenting compared with bypass grafting
in diabetic patients with multivessel and/or left main coronary artery
disease.
Source
Scientific reports. 9 (1) (pp 7268), 2019. Date of Publication: 13 May
2019.
Author
Xin X.; Wang X.; Dong X.; Fan Y.; Shao W.; Lu X.; Xiao P.
Institution
(Xin, Shao, Lu) Department of Cardiology, Affiliated Sir Run Run Hospital
of Nanjing Medical University, Nanjing, China
(Wang) Department of Geriatric Cardiology, First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
(Dong) Department of Biostatistics, School of Public Health, Southeast
University, Nanjing, China
(Fan) Clinical Metabolomics Center, School of Traditional Chinese
Pharmacy, China Pharmaceutical University, Nanjing, China
(Xiao) Department of Cardiology, Affiliated Sir Run Run Hospital of
Nanjing Medical University, Nanjing, China
Publisher
NLM (Medline)
Abstract
Although percutaneous coronary intervention (PCI) with drug-eluting stents
(DESs) and bypass grafting are generally believed to be superior
revascularization strategies in patients with coronary artery disease
(CAD), the optimal strategy for diabetic patients is still controversial.
This meta-analysis was performed to compare two methods of
revascularization for patients with diabetes mellitus with left main
coronary artery lesions or disease in multiple coronary arteries. Compared
with the coronary artery bypass grafting (CABG) group, those receiving
PCI-DES showed a greater risk of major adverse cardiovascular events
(MACEs) (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.01-1.25,
P=0.03), major adverse cardiac and cerebrovascular events (MACCEs) (HR:
1.85, 95% CI: 1.58-2.16; P<0.001), stroke (HR: 1.15, 95% CI: 1.02-1.29,
P=0.02), myocardial infarction (MI) (HR: 1.48, 95% CI: 1.04-2.09, P=0.03),
and repeat revascularization (HR: 3.23, 95% CI: 1.37-7.59, P=0.007). CABG
for diabetic patients with multivessel and/or left main CAD was superior
to PCI-DES with regard to MACEs, MACCEs, MI, repeat revascularization and
stroke, but there was no clear difference in all-cause mortality.

<35>
Accession Number
2002027352
Title
Outcomes of left main revascularization in patients with acute coronary
syndromes and stable ischemic heart disease: Analysis from the EXCEL
trial.
Source
American Heart Journal. 214 (pp 9-17), 2019. Date of Publication: August
2019.
Author
Doucet S.; Jolicoeur E.M.; Serruys P.W.; Ragosta M.; Kron I.L.; Scholtz
W.; Borgermann J.; Zhang Y.; McAndrew T.; Sabik J.F.; Kappetein A.P.;
Stone G.W.
Institution
(Doucet, Jolicoeur) Department of Medicine, Montreal Heart Institute,
Universite de Montreal, Canada
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Ragosta, Kron) University of Virginia Health System, Charlottesville, VA,
United States
(Scholtz, Borgermann) Clinic for Thoracic and Cardiovascular Surgery,
Heart and Diabetes Center NRW, University Hospital of the Ruhr-University
of Bochum, Bad Oeynhausen, Germany
(Zhang, McAndrew, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Stone) Center for Interventional Vascular Therapy, Division of
Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Prompt revascularization is often required in acute coronary
syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow
for more measured procedural planning. Whether the acuity of presentation
preferentially affects outcomes after coronary artery bypass grafting
(CABG) versus percutaneous coronary intervention (PCI) in patients with
left main coronary artery disease (LMCAD) is unknown. We investigated
whether the acuity of presentation discriminated patients who derived a
differential benefit from PCI versus CABG in the randomized Evaluation of
XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left
Main Revascularization (EXCEL) trial. <br/>Method(s): We used
multivariable Cox models to assess the interaction between the acuity of
presentation, type of revascularization and outcomes in patients with low
or intermediate SYNTAX scores enrolled in EXCEL. <br/>Result(s): At
baseline, 1151 patients (60.7%) presented with SIHD and 746 patients
(39.3%) presented with an ACS. The acuity of presentation was not
associated with the primary endpoint of all-cause death, MI, or stroke at
3 years (multivariable adjusted hazard ratio [HR] 0.94; 95% CI 0.70-1.26,
P = .64). The primary endpoint rate was similar in patients assigned to
PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95% CI
0.73-1.48]) or with ACS (HR 0.82; 95% CI 0.54-1.26)
(P<inf>interaction</inf> = .34). <br/>Conclusion(s): The acuity of
presentation did not predict outcomes in patients with LMCAD undergoing
revascularization, nor did it discriminate patients who derive greater
event-free survival from PCI versus CABG.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<36>
Accession Number
2002020648
Title
Decrease of perforin expressing lymphocytes after on-pump coronary artery
bypass grafting surgery irrespective of carbohydrate preoperative oral
feeding.
Source
Heart Surgery Forum. 22 (3) (pp E218-E224), 2019. Date of Publication:
2019.
Author
Sokolic J.; Knezevic D.; Kuharic J.; Medved I.; Sustic A.; Zupan Z.;
Laskarin G.; Tadin T.; Tokmadzic V.S.
Institution
(Sokolic, Knezevic, Kuharic, Sustic, Zupan, Tokmadzic) Departments of
Anesthesia, Resuscitation, Emergency and Intensive Care Medicine, Faculty
of Medicine, University of Rijeka, Rijeka, B. Branchetta 20 51000, Croatia
(Medved, Laskarin) Departments of Surgery, and Physiology and Immunology,
Faculty of Medicine, University of Rijeka, Croatia
(Laskarin) Division of Cardiology, Hospital for Medical Rehabilitation of
the Hearth and Lung Diseases and Rheumatism "Thalassotherapia-Opatija,",
Opatija, Croatia
(Tadin) Ultrasound Diagnostic Service, Health Centre Rijeka, Rijeka,
Croatia
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: Coronary artery bypass grafting (CABG) surgery continues to be
the gold standard for treating the patients with coronary artery disease.
CABG surgery can be performed on or off cardiopulmonary bypass, termed as
on-pump or off-pump CABG, respectively. It has been shown that CABG
surgery, preferably on-pump CABG surgery, leads to the changes of cell
immunity during perioperative and early postoperative period. The
mechanisms of regulation of the immune response in patients during and
early after surgical revascularization are not fully understood. The aim
of this study was to investigate the influence of carbohydrate
preoperative oral feeding on frequency and perforin expression in
peripheral blood lymphocytes in patients after on- or off-pump CABG
surgery in early postoperative period. <br/>Patients and Methods: In this
prospective clinical study, 80 patients scheduled for CABG surgery were
included in the study. The patients were randomly allocated into four
groups (20 in each group): patients in Group 1 underwent on-pump CABG and
did not receive carbohydrate preoperative oral feeding; patients in Group
2 underwent on-pump CABG and were preoperatively fed; patients in Group 3
underwent off-pump CABG and did not receive carbohydrate preoperative oral
feeding; while patients in Group 4 underwent off-pump CABG and received
carbohydrate preoperative oral feeding. Blood samples were collected
immediately before (T1), 24 (T2) and 72 (T3) hours after the surgery.
Peripheral blood mononuclear cells were isolated by gradient
centrifugation and simultaneously labelled by antigens using
fluorochrome-conjugated monoclonal antibodies. Frequency of T lymphocytes,
NK and NKT cells, their subsets as well as their perforin expression were
detected, and analyzed by flow cytometry. <br/>Result(s): There was
significant decrease in frequency of CD3+ and CD3+CD4⁺ cells,
as well as perforin expressing CD3+CD8+ cells in patients who underwent
on-pump CABG in comparison to patients who underwent off-pump CABG 24
hours after the surgery. Carbohydrate preoperative oral feeding did not
effect changes in lymphocytes subpopulations and perforin expression at
any time point. <br/>Conclusion(s): Decreases of CD3+ cells on account of
CD3+CD4⁺ subsets, and perforin expressing cells on account of
CD3+CD8⁺ perforin⁺ cells were found in patients who
had undergone on-pump CABG, but not in patients who had undergone off-pump
CABG surgery, irrespectively of carbohydrate preoperative oral
feeding.<br/>Copyright &#xa9; 2019 Forum Multimedia Publishing LLC. All
rights reserved.

<37>
Accession Number
2002020623
Title
Negative Pressure versus Conventional Sternal Wound Dressing in Coronary
Surgery Using Bilateral Internal Mammary Artery Grafts.
Source
Heart Surgery Forum. 22 (2) (pp E92-E96), 2019. Date of Publication: 2019.
Author
Ruggieri V.G.; Olivier M.-E.; Aludaat C.; Rosato S.; Marticho P.; Saade
Y.A.; Lefebvre A.; Poncet A.; Rubin S.; Biancari F.
Institution
(Ruggieri, Olivier, Aludaat, Marticho, Saade, Rubin) Division of
Cardiovascular and Thoracic Surgery, Robert Debre University Hospital,
Reims, France
(Poncet) Unite d'Anesthesie-Reanimation Cardio-Thoracique, Robert Debre
University Hospital, Reims, France
(Ruggieri, Rubin) Universite de Reims Champagne Ardenne (URCA), Reims,
France
(Rosato) Center for Global Health, Istituto Superiore di Sanita, Rome,
Italy
(Lefebvre) Equipe Operationnelle d'Hygiene, CHU Reims, Hopital Maison
Blanche, Reims, France
(Biancari) Heart Center, Turku University Hospital, Department of Surgery,
University of Turku, Turku, Finland
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: Sternal wound infection (SWI) is a major complication
occurring often after coronary artery bypass grafting (CABG) using
bilateral internal mammary artery (BIMA) grafts. The aim of this study is
to assess whether such a risk may be reduced by using incision negative
pressure wound therapy (INPWT). <br/>Method(s): Data on patients
undergoing isolated CABG using BIMA grafts at the Reims University
Hospital, France, from 2013 to 2016 without or with INPWT was
prospectively collected. <br/>Result(s): INPWT was used in 161 patients
and conventional sterile wound dressing was used in 266 patients.
Propensity score matching resulted in 128 pairs with similar
characteristics. SWIs were similarly distributed between the conventional
sterile wound dressing (10.9%) and the INPWT cohorts (10.2%) (P = 1.00).
Patients treated with INPWT had a lower rate of deep SWI/mediastinitis
than patients who had conventional sterile dressing (5.5% versus 10.2%, P
= .210), but the difference did not reach statistical significance. Tests
for interaction confirmed these findings in different patient subgroups.
<br/>Conclusion(s): The routine use of INPWT may not significantly reduce
the risk of SWI in patients undergoing BIMA grafting. In view of previous
reports showing a benefit with the use of this method, a large randomized
study is justified to assess the efficacy of INPWT in patients undergoing
cardiac surgery.<br/>Copyright &#xa9; 2019 Forum Multimedia Publishing
LLC. All rights reserved.

<38>
Accession Number
2002020620
Title
Determining which prosthetic to use during aortic valve replacement in
patients aged younger than 70 years: A systematic review of the
literature.
Source
Heart Surgery Forum. 22 (2) (pp E70-E81), 2019. Date of Publication: 2019.
Author
Borger P.; Charles E.J.; Smith E.D.; Hunter Mehaffey J.; Hawkins R.B.;
Kron I.L.; Ailawadi G.; Teman N.
Institution
(Borger) University of Virginia School of Medicine, Charlottesville, VA,
United States
(Smith) Department of Medicine, University of Michigan, Ann Arbor, MI,
United States
(Charles, Hunter Mehaffey, Hawkins, Kron, Ailawadi, Teman) University of
Virginia Health System, PO Box 800679, Charlottesville, VA 22908, United
States
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: The choice of bioprosthesis versus mechanical prosthesis in
patients aged less than 70 years undergoing aortic valve replacement (AVR)
remains controversial, with guidelines disparate in their recommendations.
The objective of this study was to explore outcomes after AVR for various
age ranges based on type of prosthesis. <br/>Method(s): A systematic
review was undertaken according to the Preferred Reporting Instructions
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using
Medline (PubMed), Cochrane, Web of Science, Embase, and Scopus databases.
Rates of long-term survival (primary outcome), reoperation, major
bleeding, thromboembolism, stroke, structural valve deterioration, and
endocarditis were compared between subjects receiving biologic and
mechanical prostheses. Findings were grouped into patients aged <60 years,
aged <=65 years, and finally aged <70 years. <br/>Result(s): A total of 19
studies met inclusion criteria. Seven evaluated patients aged <60 years, 4
of which found mechanical prosthesis patients to have higher long-term
survival, whereas the remaining studies found no difference. Eight
additional studies included patients aged 65 years or younger, and 9
studies included patients aged <70 years. The former found no difference
in survival between prosthesis groups, whereas the latter favored
mechanical prostheses in 3 studies. Bleeding, thromboembolism, and stroke
were more prevalent in patients with a mechanical prosthesis, whereas
reoperation was more common in those receiving a bioprosthesis.
<br/>Conclusion(s): Published literature does not preclude the use of
bioprostheses for AVR in younger patients. As new valves are developed,
the use of bioprosthetic aortic valves in younger patients will likely
continue to expand. Clinical trials are needed to provide surgeons with
more accurate guidelines.<br/>Copyright &#xa9; 2019 Forum Multimedia
Publishing LLC. All rights reserved.

<39>
Accession Number
2002053513
Title
Completeness of Revascularization as a Determinant of Outcome: A
Contemporary Review and Clinical Perspectives.
Source
Canadian Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Kwon O.; Park D.-W.; Park S.-J.
Institution
(Kwon, Park, Park) Division of Cardiology, Department of Internal
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Korea, South Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
It has been debated whether patients with multivessel coronary artery
disease should undergo complete revascularization (CR). The benefit of CR
is biologically plausible, and numerous studies and large meta-analyses
suggested that CR achievement was associated with a substantial reduction
of mortality and future coronary events. In patients with multivessel
coronary artery disease, the aim of myocardial revascularization is to
minimize residual ischemia. Therefore, CR of all significant coronary
lesions has been proposed as the first priority in decision-making for
myocardial revascularization between coronary artery bypass grafting and
percutaneous coronary intervention (PCI). Reflecting the contemporary
practice of ischemia-based revascularization, a physiological/functional
approach, such as measurement of fractional flow reserve or instantaneous
wave-free ratio, is considered more reasonable and should be encouraged
for appropriate CR. In patients who present with acute ST-elevation
myocardial infarction, current evidence suggests that an immediate or
staged CR strategy might be equivalent or superior to culprit-only
revascularization. There is still uncertainty on when and how to perform
CR in ST-elevation myocardial infarction patients; comprehensive studies
dedicated to this issue are required. Hybrid coronary revascularization
includes the advantages of minimally invasive bypass grafting for the left
anterior descending artery and PCI for non-left anterior descending
arteries and has been proposed as a viable alternative for coronary artery
bypass grafting or PCI only for achieving CR. In clinical practice, the
extent of revascularization and strategy for CR should be individualized,
taking account of different aspects of the patients, lesions, and treating
physicians. Collaboration of coronary heart teams would confer balanced
decision-making and advanced therapeutic capabilities.<br/>Copyright
&#xa9; 2019 Canadian Cardiovascular Society

<40>
Accession Number
627799631
Title
Clinical and cost-effectiveness of the Ross procedure versus conventional
aortic valve replacement in young adults.
Source
Open Heart. 6 (1) (no pagination), 2019. Article Number: e001047. Date of
Publication: 01 May 2019.
Author
Thom H.; Visan A.C.C.; Keeney E.; Dorobantu D.M.; Fudulu D.; Sharabiani
M.T.A.; Round J.; Stoica S.C.
Institution
(Thom, Keeney) Bristol Medical School: Population Health Sciences,
University of Bristol, Bristol, United Kingdom
(Visan, Fudulu, Stoica) Cardiothoracic Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Visan) Department of Cardiothoracic Surgery, University Hospital
Southampton, Southampton, United Kingdom
(Dorobantu) Cardiac Surgery, Bristol Royal Hospital for Children, Bristol,
United Kingdom
(Dorobantu) Cardiology, Institutul de Urgenta pentru Boli Cardiovasculare
Prof Dr C C Iliescu, Bucuresti, Romania
(Sharabiani) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Round) Institute of Health Economics, Edmonton, AB, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives In young and middle-aged adults, there are three current
options for aortic valve replacement (AVR), namely mechanical AVR
(mechAVR), tissue AVR (biological AVR) and the Ross operation, with no
clear guidance on the best option. We aim to compare the clinical
effectiveness and cost-effectiveness of the Ross procedure with
conventional AVR in young and middle-aged adults. Methods This is a
systematic literature review and meta-analysis of AVR options. Markov
multistate model was adopted to compare cost-effectiveness. Lifetime
costs, quality-adjusted life years (QALYs), net monetary benefit (NMB),
population expected value of perfect information (EVPI) and expected value
of partial perfect information were estimated. Results We identified 48
cohorts with a total number of 12 975 patients (mean age 44.5 years, mean
follow-up 7.1 years). Mortality, bleeding and thromboembolic events over
the follow-up period were lowest after the Ross operation, compared with
mechAVR and biological AVR (p<0.001). Aortic reoperation rates were lower
after Ross compared with biological AVR, but slightly higher when compared
with mechAVR (p<0.001). At a willingness-to-pay threshold of 20effective.
At a willingness-to-pay threshold of 20, 000 per QALY000 per QALY, the
Ross procedure is more cost-effective compared the Ross procedure is more
cost-effective compared withwith conventional AVR, with a lifetime
incremental NMB of 60 conventional AVR, with a lifetime incremental NMB of
60 952 (952 (3030 236236 to to 7979 464). Incremental costs were 12464).
Incremental costs were 12 323 (323 (61086108 to to 1515 972) and
incremental QALYs 3.66 (1.81972) and incremental QALYs 3.66 (1.81 to to
4.76). The population EVPI indicates that a trial costing up to 2.03
million could be cost 4.76). The population EVPI indicates that a trial
costing up to 2.03 million could be cost - effective. At a
willingness-to-pay threshold of 20 000 per QALY, the Ross procedure is
more cost-effective compared with conventional AVR, with a lifetime
incremental NMB of 60 952 (30 236 to 79 464). Incremental costs were 12
323 (6108 to 15 972) and incremental QALYs 3.66 (1.81 to 4.76). The
population EVPI indicates that a trial costing up to 2.03 million could be
cost-effective. Conclusions In young and middle-aged adults with aortic
valve disease, the Ross procedure may confer greater quality of life and
be more cost-effective than conventional AVR. A high-quality randomised
trial could be warranted and cost-effective.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2019.

<41>
Accession Number
627798405
Title
Myocardial ischemia presenting with hiccups.
Source
Journal of the College of Physicians and Surgeons Pakistan. 29 (5) (pp
469-473), 2019. Date of Publication: 01 May 2019.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, Division of Cardiac Surgery,
First Hospital of Putian, Teaching Hospital, Fujian Medical University,
Putian, Fujian Province, China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Myocardial infarction/ischemia can be an underlying etiology and a major
causative risk factor of cardiovascular hiccups. The objective of this
systematic review was to review the literature regarding clinical features
and treatments of hiccups of cardiac ischemia origin. PRISMA guidelines
were followed. In elderly patients with hiccups of uncertain causes,
electrocardiography is necessary to ensure the cardiogenic etiology. Both
symptomatic and etiologic treatments can be effective in terminating
hiccups. Of the therapeutic regimens, gabapentin is a second-line agent
alternative to baclofen in treating hiccups. It is especially helpful in
patients undergoing stroke rehabilitation or palliative care when
chlorpromazine is prohibited due to its adverse effects. Inferior
myocardial infarction is the most common cause of hiccups in this patient
setting. In addition to anti-myocardial ischemia agents and percutaneous
coronary intervention, coronary artery bypass grafting could be an
alternative to hiccups in such patients.<br/>Copyright &#xa9; 2019 College
of Physicians and Surgeons Pakistan. All rights reserved.

<42>
Accession Number
2002013558
Title
Current Smoking and Prognosis After Acute ST-Segment Elevation Myocardial
Infarction: New Pathophysiological Insights.
Source
JACC: Cardiovascular Imaging. 12 (6) (pp 993-1003), 2019. Date of
Publication: June 2019.
Author
Haig C.; Carrick D.; Carberry J.; Mangion K.; Maznyczka A.; Wetherall K.;
McEntegart M.; Petrie M.C.; Eteiba H.; Lindsay M.; Hood S.; Watkins S.;
Davie A.; Mahrous A.; Mordi I.; Ahmed N.; Teng Yue May V.; Ford I.;
Radjenovic A.; Welsh P.; Sattar N.; Oldroyd K.G.; Berry C.
Institution
(Haig, Wetherall, Ford) Robertson Centre for Biostatistics, University of
Glasgow, Glasgow, United Kingdom
(Carrick, Carberry, Mangion, Maznyczka, Mordi, Ahmed, Teng Yue May,
Radjenovic, Welsh, Sattar, Oldroyd, Berry) British Heart Foundation
Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow, United Kingdom
(Carrick, Carberry, Mangion, Maznyczka, McEntegart, Petrie, Eteiba,
Lindsay, Hood, Watkins, Davie, Mahrous, Mordi, Ahmed, Teng Yue May,
Oldroyd, Berry) West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Clydebank, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The aim of this study was to mechanistically investigate
associations among cigarette smoking, microvascular pathology, and longer
term health outcomes in patients with acute ST-segment elevation
myocardial infarction (MI). <br/>Background(s): The pathophysiology of
myocardial reperfusion injury and prognosis in smokers with acute
ST-segment elevation MI is incompletely understood. <br/>Method(s):
Patients were prospectively enrolled during emergency percutaneous
coronary intervention. Microvascular function in the culprit artery was
measured invasively. Contrast-enhanced magnetic resonance imaging
(1.5-T)was performed 2 days and 6 months post-MI. Infarct size and
microvascular obstruction were assessed using late gadolinium enhancement
imaging. Myocardial hemorrhage was assessed with T2* mapping.
Pre-specified endpoints included: 1)all-cause death or first heart failure
hospitalization; and 2)cardiac death, nonfatal MI, or urgent coronary
revascularization (major adverse cardiovascular events). Binary logistic
regression (odds ratio [OR]with 95% confidence interval [CI])with smoking
status was used. <br/>Result(s): In total, 324 patients with ST-segment
elevation MI were enrolled (mean age 59 years, 73% men, 60% current
smokers). Current smokers were younger (age 55 +/- 11 years vs. 65 +/- 10
years, p < 0.001), with fewer patients with hypertension (52 +/- 27% vs.
53 +/- 41%, p = 0.007). Smokers had better TIMI (Thrombolysis In
Myocardial Infarction)flow grade (>=2 vs. <=1, p = 0.024)and ST-segment
resolution (none vs. partial vs. complete, p = 0.010)post-percutaneous
coronary intervention. On day 1, smokers had higher circulating C-reactive
protein, neutrophil, and monocyte levels. Two days post-MI, smoking
independently predicted infarct zone hemorrhage (OR: 2.76; 95% CI: 1.42 to
5.37; p = 0.003). After a median follow-up period of 4 years, smoking
independently predicted all-cause death or heart failure events (OR: 2.20;
95% CI: 1.07 to 4.54)and major adverse cardiovascular events (OR: 2.79;
95% CI: 2.30 to 5.99). <br/>Conclusion(s): Smoking is associated with
enhanced inflammation acutely, infarct-zone hemorrhage subsequently, and
longer term adverse cardiac outcomes. Inflammation and irreversible
myocardial hemorrhage post-MI represent mechanistic drivers for adverse
long-term prognosis in smokers. (Detection and Significance of Heart
Injury in ST Elevation Myocardial Infarction. [BHF MR-MI];
NCT02072850)<br/>Copyright &#xa9; 2019 The Authors

<43>
Accession Number
620198489
Title
Letter regarding "Meta-analysis of 18F-FDG PET/CT in the diagnosis of
infective endocarditis".
Source
Journal of Nuclear Cardiology. 26 (3) (pp 939-940), 2019. Date of
Publication: 15 Jun 2019.
Author
Scholtens A.M.
Institution
(Scholtens) Meander Medical Center, Amersfoort, Netherlands
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)

<44>
Accession Number
2001457854
Title
Intraoperative Use of Nondepolarizing Neuromuscular Blocking Agents During
Cardiac Surgery and Postoperative Pulmonary Complications: A Prospective
Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1673-1681),
2019. Date of Publication: June 2019.
Author
Gerlach R.M.; Shahul S.; Wroblewski K.E.; Cotter E.K.H.; Perkins B.W.;
Harrison J.-H.; Ota T.; Jeevanandam V.; Chaney M.A.
Institution
(Gerlach, Shahul, Perkins, Harrison, Chaney) Department of Anesthesia and
Critical Care, University of Chicago Medicine, Chicago, IL, United States
(Wroblewski) Department of Public Health Sciences, University of Chicago,
Chicago, IL, United States
(Cotter) Department of Anesthesiology, University of Kansas Medical
Center, Kansas City, KS, United States
(Ota, Jeevanandam) Department of Cardiothoracic Surgery, University of
Chicago Medicine, Chicago, IL, United States
Publisher
W.B. Saunders
Abstract
Objective: Nondepolarizing neuromuscular blocking agents (NMBAs) are
associated with perioperative complications in noncardiac surgery;
however, little is known about their effect on cardiac surgery. This study
assessed the effect of neuromuscular blockade (NMB) on the incidence of
postoperative pulmonary complications (PPCs) after cardiac surgery and
operating conditions. <br/>Design(s): Prospective, randomized clinical
trial with blinded outcomes assessment. <br/>Setting(s): University
hospital, single institution. <br/>Participant(s): Adult patients having
cardiac surgery requiring cardiopulmonary bypass. <br/>Intervention(s):
One hundred patients were randomized to receive succinylcholine (group
SUX) for intubation with no further NMB administered or cisatracurium
(group CIS) for intubation and maintenance NMB. The primary outcome was a
composite incidence of PPCs in the 72 hours after elective cardiac
surgery. PPCs included failure to extubate within 24 hours, need for
reintubation, pneumonia, aspiration, unanticipated need for noninvasive
respiratory support, acute respiratory distress, and mortality from
respiratory arrest. The secondary outcome was the adequacy of operating
conditions as assessed by blinded surgeon survey (including a rating of
surgical conditions on a Likert scale from 1 = poor to 5 = excellent),
anesthesiologist report, and patient questionnaire. <br/>Measurements and
Main Results: The composite incidence of PPCs did not differ between
groups (8 of 50 patients in both groups; 16%). Mean surgeon rating of
surgical conditions was lower in the SUX group (4.65 +/- 0.85 v 4.96 +/-
0.20, p = 0.02). <br/>Conclusion(s): Although avoiding nondepolarizing
NMBA is feasible, doing so worsened operating conditions and did not
reduce the incidence of postoperative pulmonary
complications.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<45>
Accession Number
627725704
Title
PREhabilitation for improving QUality of recovery after ELective cardiac
surgery (PREQUEL) study: Protocol of a randomised controlled trial.
Source
BMJ Open. 9 (5) (no pagination), 2019. Article Number: e027974. Date of
Publication: 01 May 2019.
Author
Yau D.K.W.; Wong M.K.H.; Wong W.-T.; Gin T.; Underwood M.J.; Joynt G.M.;
Lee A.
Institution
(Yau, Wong, Gin, Joynt, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
(Wong) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, Shatin, New Territories, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Frailty is a multidimensional syndrome in which multiple
small physiological deficits accumulate gradually, resulting in a loss of
physiological reserve and adaptability, putting a patient that is exposed
to a stressor at a higher risk of adverse outcomes. Both pre-frailty and
frailty are associated with poor patient outcomes and higher healthcare
costs. The effect of a prehabilitation programme and standard care on the
quality of recovery in pre-frail and frail patients undergoing elective
cardiac surgery will be compared. Method and analysis A single-centre,
superiority, stratified randomised controlled trial with a blinded outcome
assessment and intention-to-treat analysis. Pre-frail and frail patients
awaiting elective coronary artery bypass graft, with or without valvular
repair/replacement, will be recruited. 164 participants will be randomly
assigned to either prehabilitation (intervention) or standard care (no
intervention) groups. The prehabilitation group will attend two
sessions/week of structured exercise (aerobic and resistance) training,
supervised by a physiotherapist, for 6-10 weeks before surgery with early
health promotion advice in addition to standard care. The standard care
group will receive the usual routine care (no prehabilitation). Frailty
will be assessed at baseline, hospital admission and at 1 and 3 months
after surgery. The primary outcomes will be participants' perceived
quality of recovery (15-item Quality of Recovery questionnaire) after
surgery (day 3), days at home within 30 days of surgery and the changes in
WHO Disability Assessment Schedule 2.0 score between baseline and at 1 and
3 months after surgery. Secondary outcomes will include major adverse
cardiac and cerebrovascular events, psychological distress levels,
health-related quality of life and healthcare costs. Ethics and
dissemination The Joint CUHK-NTEC Clinical Research Ethics Committee
approved the study protocol (CREC Ref. No. 2017.696 T). The findings will
be presented at scientific meetings, in peer-reviewed journals and to
study participants. Trial registration number ChiCTR1800016098;
Pre-results.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2018.

<46>
Accession Number
2001380210
Title
Postoperative Pain Management Strategies and Delirium After Transapical
Aortic Valve Replacement: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1668-1672),
2019. Date of Publication: June 2019.
Author
Strike E.; Arklina B.; Stradins P.; Cusimano R.J.; Osten M.; Horlick E.;
Styra R.; Poonawala H.; Carroll J.; Djaiani G.
Institution
(Strike, Arklina) Department of Anesthesiology, Paula Stradina University
Hospital, Riga, Latvia
(Stradins) Department of Cardiac Surgery, Paula Stradina University
Hospital, Riga, Latvia
(Cusimano) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, Canada
(Osten, Horlick) Department of Interventional Cardiology, Toronto General
Hospital, Toronto, Canada
(Styra) Department of Psychiatry, Toronto General Hospital, Toronto,
Canada
(Poonawala, Carroll, Djaiani) Department of Anesthesia and Pain
Management, Toronto General Hospital, Toronto, Canada
Publisher
W.B. Saunders
Abstract
Objective(s): This study was designed to compare 2 different perioperative
analgesia strategies with respect to the incidence of postoperative
delirium after a transapical approach for transcatheter aortic valve
replacement (TAVR). The authors hypothesized that perioperative thoracic
paravertebral analgesia with a local anesthetic would decrease opioid
consumption and in turn reduce the incidence of postoperative delirium
when compared with systemic opioid-based analgesia after a transapical
TAVR procedure. <br/>Design(s): Prospective, randomized controlled
clinical trial. <br/>Setting(s): Tertiary referral center, university
hospital. <br/>Participant(s): The study comprised 44 patients undergoing
a transapical TAVR procedure. Patients with a history of serious mental
illness, delirium, and severe dementia and/or patients with
contraindications to regional anesthesia were excluded.
<br/>Intervention(s): Patients were randomly assigned to either the
paravertebral group (perioperative continuous thoracic paravertebral block
with local anesthetic) or the patient-controlled analgesia group
(systemically administered opioids) using a computer-generated
randomization code in blocks of four patients. <br/>Measurements and Main
Results: Assessment of postoperative delirium was performed by trained
research staff using the confusion assessment method for intensive care
unit preoperatively and postoperatively every 12 hours or more often if
needed according to the patient's condition during the first 7
postoperative days or until discharge. Pain was assessed with a 10 cm
Visual Analog Scale pain score system during the 48 hours postoperatively.
The sedation level was assessed using the Sedation Agitation Scale during
the same period. Overall postoperative delirium was detected in 12/44
(27%) patients, with 7/22 (32%) in the patient-controlled analgesia and
5/22 (23%) in the paravertebral groups, respectively (p = 0.73). Both
groups were similar with respect to demographic data, preoperative
medications, and comorbidities. Paravertebral analgesia was associated
with an opioid-sparing effect during surgery and during the 48-hour
postoperative period. Sedation and pain scores were similar between the 2
groups. In addition, paravertebral analgesia was associated with earlier
extubation times; however, the overall morbidity and mortality were
similar between the 2 groups. <br/>Conclusion(s): Paravertebral analgesia
in patients undergoing transapical TAVR procedures appears to have an
opioid-sparing effect. However, it did not translate into a statistically
significant decrease in the rate of postoperative delirium.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<47>
Accession Number
625445765
Title
Daytime variation of perioperative myocardial injury in non-cardiac
surgery and effect on outcome.
Source
Heart. 105 (11) (pp 826-833), 2019. Date of Publication: 01 Jun 2019.
Author
Du Fay De Lavallaz J.; Puelacher C.; Lurati Buse G.; Bolliger D.;
Germanier D.; Hidvegi R.; Walter J.E.; Twerenbold R.; Strebel I.;
Badertscher P.; Sazgary L.; Lampart A.; Espinola J.; Kindler C.;
Hammerer-Lercher A.; Thambipillai S.; Guerke L.; Rentsch K.; Buser A.;
Gualandro D.; Jakob M.; Mueller C.
Institution
(Du Fay De Lavallaz, Puelacher, Germanier, Hidvegi, Walter, Twerenbold,
Strebel, Badertscher, Sazgary, Thambipillai, Gualandro, Mueller)
Cardiovascular Research Institute Basel (CRIB) and Department of
Cardiology, University Hospital Basel, Basel, Switzerland
(Du Fay De Lavallaz, Puelacher, Germanier, Hidvegi, Walter, Sazgary)
Department of Internal Medicine, University Hospital Basel, University of
Basel, Basel, Switzerland
(Lurati Buse) Department of Anaesthesia, University Hospital Dusseldorf,
Dusseldorf, Germany
(Bolliger, Hidvegi, Lampart) Department of Anaesthesia, University
Hospital Basel, Basel, Switzerland
(Espinola, Kindler) Kantonsspital Aarau, Department of Anaesthesia, Aarau,
Switzerland
(Hammerer-Lercher) Department of Laboratory Medicine, Kantonsspital Aarau,
Aarau, Switzerland
(Guerke) Department of Vascular Surgery, University Hospital Basel,
University of Basel, Basel, Switzerland
(Rentsch) Department of Laboratory Medicine, University Hospital Basel,
University of Basel, Basel, Switzerland
(Buser) Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
(Buser) Department of Hematology, University Hospital Basel, University of
Basel, Basel, Switzerland, Switzerland
(Gualandro) Department of Cardiology, Instituto di Coracao, University of
Sao Paulo, Sao Paulo, Brazil, Brazil
(Jakob) Department of Traumatology and Orthopedics, Cardiovascular
Research Institute Basel (CRIB) and Department of Cardiology, University
Hospital Basel, University of Basel, Basel, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Recently, daytime variation in perioperative myocardial injury
(PMI) has been observed in patients undergoing cardiac surgery. We aim at
investigating whether daytime variation also occurs in patients undergoing
non-cardiac surgery. Methods In a prospective diagnostic study, we
evaluated the presence of daytime variation in PMI in patients at
increased cardiovascular risk undergoing non-cardiac surgery, as well as
its possible impact on the incidence of acute myocardial infarction (AMI),
and death during 1-year follow-up in a propensity score-matched cohort.
PMI was defined as an absolute increase in high-sensitivity cardiac
troponin T (hs-cTnT) concentration of >=14 ng/L from preoperative to
postoperative measurements. Results Of 1641 patients, propensity score
matching defined 630 with similar baseline characteristics, half
undergoing non-cardiac surgery in the morning (starting from 8:00 to
11:00) and half in the afternoon (starting from 14:00 to 17:00). There was
no difference in PMI incidence between both groups (morning: 50, 15.8%
(95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9),
p=0.94), nor if analysing hs-cTnT release as a quantitative variable
(median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon
group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the
incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries
versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected
HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p
log-rank=0.03), whereas no difference in mortality emerged (p=0.70).
Conclusions Although there is no daytime variation in PMI in patients
undergoing non-cardiac surgery, the incidence of AMI during follow-up is
increased in afternoon surgeries and requires further study. Clinical
trial registration NCT02573532;Results.<br/>Copyright &#xa9; Author(s) (or
their employer(s)) 2019. No commercial re-use. See rights and permissions.
Published by BMJ.

<48>
Accession Number
2001490102
Title
Sildenafil for Pulmonary Hypertension in the Early Postoperative Period
After Mitral Valve Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (6) (pp 1648-1656),
2019. Date of Publication: June 2019.
Author
Ram E.; Sternik L.; Klempfner R.; Eldar M.; Goldenberg I.; Peled Y.;
Raanani E.; Kogan A.
Institution
(Ram, Sternik, Raanani, Kogan) Department of Cardiac Surgery, Sheba
Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Klempfner, Eldar, Goldenberg, Peled) Heart Institute, Sheba Medical
Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University,
Tel Aviv, Israel
Publisher
W.B. Saunders
Abstract
Objectives: The phosphodiesterase-5 inhibitor sildenafil was developed for
the treatment of pulmonary hypertension. The authors investigated the
efficacy and safety of sildenafil in the early postoperative period after
mitral valve surgery in patients with pulmonary hypertension.
<br/>Design(s): A double-blind, placebo-controlled randomized trial was
performed. <br/>Setting(s): The trial was performed in a single tertiary
referral center. <br/>Participant(s): Fifty consecutive patients who
experienced pulmonary hypertension and underwent mitral valve surgery.
<br/>Intervention(s): Patients were randomly assigned to the following 2
groups: 25 patients received 20 mg sildenafil every 8 hours, and the
remaining 25 patients received placebo during the same period. Hemodynamic
parameters were studied by using a pulmonary artery catheter at baseline
and every 6 hours up to 36 hours. <br/>Result(s): Patients who received
sildenafil showed a decrease in mean pulmonary pressure, from 32 +/- 7
mmHg at baseline to 26 +/- 3 mmHg after 36 hours, whereas no change was
seen in patients who received placebo (mean pulmonary pressure 34 +/- 6
mmHg at baseline and 35 +/- 5 mmHg after 36 h) (p < 0.001). No significant
changes in systemic hemodynamic and oxygenation were observed. Patients
who received sildenafil compared with those who received placebo had a
median mechanical lung ventilation time of 16 (10-31) hours versus 19
(13-41) hours (p = 0.431), intensive care unit stay of 74 (44-106) hours
versus 91 (66-141) hours (p = 0.410), and a total hospitalization stay of
7 (5-10) days versus 11 (7-15) days (p = 0.009). <br/>Conclusion(s): The
immediate postoperative administration of sildenafil after mitral valve
surgery is safe. Sildenafil demonstrates a favorable decreasing effect on
pulmonary vascular pressure without systemic hypotension and
ventilation-perfusion mismatch.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<49>
Accession Number
621876613
Title
Fish Oil-Containing Lipid Emulsions in Adult Parenteral Nutrition: A
Review of the Evidence.
Source
Journal of Parenteral and Enteral Nutrition. 43 (4) (pp 458-470), 2019.
Date of Publication: May 2019.
Author
Abbasoglu O.; Hardy G.; Manzanares W.; Pontes-Arruda A.
Institution
(Abbasoglu) Division of Nutrition Support, Department of General Surgery,
Faculty of Medicine, Hacettepe University, Ankara, Turkey
(Hardy) College of Health, Massey University, Auckland, New Zealand
(Manzanares) Intensive Care Unit, Department of Critical Care, Faculty of
Medicine, Universidad de la Republica, Montevideo, Uruguay
(Pontes-Arruda) Baxter Healthcare Corporation, Deerfield, IL, United
States
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background. There is evidence from laboratory and animal studies that fish
oil-containing intravenous lipid emulsions (FOC-IVLEs) have a beneficial
effect on inflammation and the immune response, suggesting a possible
clinical benefit. Clinical studies of FOC-IVLEs have reported mixed
results. The aim of this review is to present findings from recent
randomized controlled clinical trials and other quality clinical studies
investigating the effects of administering intravenous fish oil alone or
as part of a multilipid emulsion and to examine the quality of these
studies in an objective, evidence-based manner. Methods. Studies comparing
FOC-IVLEs with other IVLEs in adults were included. Thirty-four clinical
studies were evaluated: 19 investigated levels of inflammatory and immune
markers as an endpoint; 13 investigated rates of infection or sepsis; 3
investigated clinical outcomes in septic patients; and 29 investigated
general clinical outcomes. Results. There was conflicting evidence for a
beneficial effect of fish oil on levels of inflammatory and immune markers
and some evidence that fish oil decreased the rate of postoperative atrial
fibrillation. Studies generally reported few statistical differences in
clinical outcomes and rates of infection and sepsis with FOC-IVLEs as
compared with other IVLEs. The quality of reporting was generally poor,
and the presented evidence for comparisons between FOC-IVLEs and other
IVLEs was inconclusive or weak. Conclusions. There is very little
high-quality evidence that FOC-IVLEs have a more beneficial effect than
other IVLEs on clinical outcomes in adult patients.<br/>Copyright &#xa9;
2017 American Society for Parenteral and Enteral Nutrition

<50>
[Use Link to view the full text]
Accession Number
622140427
Title
No neurocognitive advantage for immediate antiretroviral treatment in
adults with greater than 500 CD4⁺ T-cell counts.
Source
AIDS. 32 (8) (pp 985-997), 2018. Date of Publication: 15 May 2018.
Author
Wright E.J.; Grund B.; Robertson K.R.; Cysique L.; Brew B.J.; Collins
G.L.; Poehlman-Roediger M.; Vjecha M.J.; Penalva De Oliveira A.C.;
Standridge B.; Carey C.; Avihingsanon A.; Florence E.; Lundgren J.D.;
Arenas-Pinto A.; Mueller N.J.; Winston A.; Nsubuga M.S.; Lal L.; Price
R.W.
Institution
(Wright) Department of Infectious Diseases Alfred Health, Monash
University, Burnet Institute, Peter Doherty Institute for Infection and
Immunity, Melbourne, VIC, Australia
(Grund) School of Statistics, University of Minnesota, Minneapolis, MN,
United States
(Robertson) Department of Neurology, University of North Carolina, NC,
United States
(Cysique) Neurosciences Research Australia, St. Vincent's Hospital Sydney,
Applied Medical Research Centre, Australia
(Brew) Neurosciences Program, Peter Duncan Neurosciences Unit, St
Vincent's Centre for Applied Medical Research, University of New South
Wales, Sydney, Australia
(Collins, Poehlman-Roediger) Division of Biostatistics, School of Public
Health, University of Minnesota, Minneapolis, MN, United States
(Vjecha) Institute for Clinical Research, Inc, Washington, DC, United
States
(Penalva De Oliveira) Instituto Emilio Ribas, Sao Paulo, Brazil
(Standridge) Veterans Affairs Medical Center, Washington, DC, United
States
(Carey) Kirby Institute, University of New South Wales, Sydney, Australia
(Avihingsanon) HIV-NAT Thai Red Cross AIDS Research Centre and Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand
(Florence) Department of Clinical Sciences, Institute of Tropical
Medicine, Antwerp, Belgium
(Lundgren) CHIP, Department of Infectious Diseases, Rigshospitalet,
University of Copenhagen, Denmark
(Arenas-Pinto) MRC Clinical Trials Unit at UCL, Institute of Clinical
Trials and Methodology, University College London, London, United Kingdom
(Mueller) Division of Infectious Diseases and Hospital Epidemiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland
(Winston) Division of Infectious Diseases, Department of Medicine,
Imperial College London, London, United Kingdom
(Nsubuga) People in Need Agency (PINA), Uganda
(Lal) Burnet Institute, Melbourne, Australia
(Price) Department of Neurology, University of California San Francisco,
San Francisco, CA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: To compare the effect of immediate versus deferred
antiretroviral treatment (ART) on neuropsychological test performance in
treatment-naive HIV-positive adults with more than 500 CD4 + cells/mul.
<br/>Design(s): Randomized trial. <br/>Method(s): The START parent study
randomized participants to commence immediate versus deferred ART until
CD4 + less than 350 cells/mul. The START Neurology substudy used eight
neuropsychological tests, at baseline, months 4, 8, 12 and annually, to
compare groups for changes in test performance. Test results were
internally standardized to z-scores. The primary outcome was the average
of the eight test z-scores (QNPZ-8). Mean changes in QNPZ-8 from baseline
were compared by intent-to-treat using longitudinal mixed models. Changes
from baseline to specific time points were compared using ANCOVA models.
<br/>Result(s): The 592 participants had a median age of 34 years; median
baseline CD4 + count was 629 cells/mul; the mean follow-up was 3.4 years.
ART was used for 94 and 32% of accrued person-years in the immediate and
deferred groups, respectively. There was no difference between the
immediate and deferred ART groups in QNPZ-8 change through follow-up
[-0.018 (95% CI -0.062 to 0.027, P = 0.44)], or at any visit. However,
QNPZ-8 scores increased in both arms during the first year, by 0.22 and
0.24, respectively (P < 0.001 for increase from baseline).
<br/>Conclusion(s): We observed substantial improvement in neurocognitive
test performance during the first year in both study arms, underlining the
importance of using a control group in studies assessing neurocognitive
performance over time. Immediate ART neither benefitted nor harmed
neurocognitive performance in individuals with CD4 + cell counts above 500
cells/mul.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc. All
rights reserved.

<51>
Accession Number
621323301
Title
Topical use of tranexamic acid in open heart surgery.
Source
Journal of the Pakistan Medical Association. 68 (4) (pp 538-542), 2018.
Date of Publication: April 2018.
Author
Chaudhary F.A.; Pervaz Z.; Ilyas S.; Niaz M.N.
Institution
(Chaudhary) Cardiothoracic Surgery, Rehmatul-lil-Alameen Institute of
Cardiology, PESSI, University of Lahore, Pakistan
(Pervaz) Cardiac Surgery, Sheikh Zayed Hospital, Lahore, Pakistan
(Ilyas) University of Lahore, Pakistan
(Niaz) Rehmatul-lil-Alameen Institute of Cardiology, PESSI, University of
Lahore, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objective: To determine the efficacy of topical pouring of tranexamic acid
in reducing post-operative mediastinal bleeding, requirement for blood
products and the rate of re-exploration for re-securing haemostasis or
relief of pericardial tamponade after open heart surgery. <br/>Method(s):
The prospective, randomised, placebo-controlled, double-blind comparative
study was conducted from March 2013 to September 2015 at
Rehmatul-lil-Alameen Institute of Cardiology, Punjab Employees Social
Security Institution, Lahore, and comprised patients scheduled for primary
isolated elective or urgent open heart surgery. The subjects were divided
into two equal groups. The hetranexamic acid group received cardiac bath
with 2gm of tranexamic acid diluted in 50mlof normal saline, while the
placebo group received cardiac bath without tranexamic acid. Before the
closure of sternum, the solution was poured into pericardial cavity as
cardiac bath while the chest tubes were temporarily clamped. Data was
entered into a pre-designed proforma. <br/>Result(s): Of the 100 subjects,
there were 50(50%) in each of the two groups. There was no difference in
surgical characteristics and perioperative complications in the groups
(p>0.05). After 48 post-operative hours, total blood loss was
significantly less in the tranexamic acid group compared to the placebo
group (p<0.05). Significantly less number of blood pints were transfused
in the acid group than the placebo group (p<0.05). No patient in the acid
group was re-explored for excessive bleeding compared to 4(8%) in the
placebo group. <br/>Conclusion(s): There was significant reduction in
post-operative blood drainage, need of blood products and rate of
re-exploration after topical use of tranexamic acid in open heart
surgery.<br/>Copyright &#xa9; 2018, Pakistan Medical Association. All
rights reserved.

<52>
Accession Number
620617939
Title
Meta-analysis of sutureless technology versus standard aortic valve
replacement and transcatheter aortic valve replacement.
Source
European Journal of Cardio-thoracic Surgery. 53 (2) (pp 463-471), 2018.
Article Number: ezx307. Date of Publication: 01 Feb 2018.
Author
Qureshi S.H.; Boulemden A.; Szafranek A.; Vohra H.
Institution
(Qureshi, Boulemden, Szafranek) Department of Cardiac Surgery, Trent
Cardiac Centre, Nottingham University Hospital, City Campus, Nottingham,
United Kingdom
(Vohra) Department of Cardiac Surgery, Bristol Heart Institute, Bristol
Royal Infirmary, Bristol, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic valve replacement (AVR) using sutureless technology is
a feasible alternative in surgical patients. Comparative evidence against
established strategies such as conventional AVR and transcatheter AVR is
lacking, limiting the assessment of safety and efficacy. <br/>METHOD(S):
Medline search for available evidence was undertaken. The outcomes
analysed were 30-day mortality, risk for stroke, myocardial infarction,
renal failure, paravalvular leak and need for permanent pacemaker. Odds
ratios were pooled using fixed- and randomeffect models. A trial
sequential analysis was undertaken to assess the statistical reliability
of cumulative evidence. <br/>RESULT(S): Twelve studies of moderate
methodological quality were included. Sutureless AVR was associated with
at least 30% reduction in 30-day mortality versus transcatheter AVR [odds
ratio (95% confidence interval) 0.40 (0.25, 0.62); P < 0.001] primarily in
the low- and intermediate-risk population and a similar reduction in the
risk for paravalvular leak [0.13 (0.09, 0.17); P < 0.001]. There was no
reduction in the risk for 30-day mortality versus conventional AVR [1.03
(0.56, 1.88); P = 0.93]. There was evidence in favour of conventional AVR
with at least 50% risk reduction in pacemaker implantation against
sutureless technology. There was absence of either benefit or harm
vis-a-vis risk for renal injury or stroke due to lack of required
information size. <br/>CONCLUSION(S): Current evidence suggests risk
reduction in 30-day mortality with sutureless AVR versus transcatheter AVR
but is inconclusive versus standard AVR in matched patients. Robust
randomized evidence is lacking to lend support to any potential
recommendation.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<53>
Accession Number
624320431
Title
Predictors of ischaemic mitral regurgitation recurrence in patients
undergoing combined surgery: Additional value of cardiovascular magnetic
resonance imaging.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (2) (pp 222-228),
2018. Date of Publication: August 2018.
Author
Glaveckaite S.; Uzdavinyte-Gateliene E.; Petrulioniene Z.; Palionis D.;
Valeviciene N.; Kalinauskas G.; Serpytis P.; Laucevicius A.
Institution
(Glaveckaite, Uzdavinyte-Gateliene, Petrulioniene, Serpytis, Laucevicius)
Clinic of Cardiovascular Diseases, Centre of Cardiology and Angiology,
Vilnius University, Vilnius, Lithuania
(Palionis, Valeviciene) Department of Radiology, Nuclear Medicine and
Medical Physics, Centre of Radiology and Nuclear Medicine, Vilnius,
Lithuania
(Kalinauskas) Clinic of Cardiovascular Diseases, Centre of Heart Surgery,
Vilnius University, Vilnius, Lithuania
Publisher
Oxford University Press
Abstract
OBJECTIVES: We aimed to evaluate (i) the effectiveness of combined surgery
(coronary artery bypass grafting with restrictive mitral valve
annuloplasty) and (ii) the late gadolinium enhancement cardiovascular
magnetic resonance-based predictors of ischaemic mitral regurgitation
(IMR) recurrence. <br/>METHOD(S): The prospective analysis included 40
patients with multivessel coronary artery disease, IMR >IIdegree and left
ventricular (LV) dysfunction undergoing combined surgery. The degree of
IMR and LV parameters were assessed preoperatively by transthoracic
echocardiography, 3D transoesophageal echocardiography and cardiovascular
magnetic resonance and postoperatively by transthoracic echocardiography.
The effective mitral valve repair group (n = 30) was defined as having
recurrent ischaemic mitral regurgitation (RIMR) <IIdegree at the end of
follow-up (25 +/- 11 months). <br/>RESULT(S): The surgery was effective:
freedom from RIMR >IIdegree at 1 and 2 years after surgery was 80% and
75%, respectively. Using multivariable logistic regression, 2 independent
predictors of RIMR >IIdegree were identified: >3 non-viable LV segments
(odds ratio 22, P = 0.027) and >1 non-viable segment in the LV posterior
wall (odds ratio 11, P = 0.026). Using classification trees, the best
combinations of cardiovascular magnetic resonance-based and 3D
transoesophageal echocardiography-based predictors for RIMR >IIdegree were
(i) posterior mitral valve leaflet angle >40degree and LV end-systolic
volume index >45 ml/m2 (sensitivity 100%, specificity 89%) and (ii) scar
transmurality >68% in the inferior LV wall and EuroSCORE II >8
(sensitivity 83%, specificity 78%). <br/>CONCLUSION(S): There is a clear
relationship between the amount of non-viable LV segments, especially in
the LV posterior and inferior walls, and the recurrence of IMR after the
combined surgery.<br/>Copyright &#xa9; The Author(s) 2018.

<54>
Accession Number
624633588
Title
Acute exercise is not cardioprotective and may induce apoptotic signalling
in heart surgery: A randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (1) (pp 95-101), 2018.
Date of Publication: 01 Jul 2018.
Author
Smenes B.T.; Baekkerud F.H.; Slagsvold K.H.; Hassel E.; Wohlwend M.; Pinho
M.; Hoydal M.; Wisloff U.; Rognmo O.; Wahba A.
Institution
(Smenes, Baekkerud, Hassel, Wohlwend, Wisloff, Rognmo, Wahba) Department
of Circulation and Medical Imaging, K.G. Jebsen Center of Exercise in
Medicine, Norwegian University of Science and Technology, Trondheim,
Norway
(Slagsvold, Wahba) Department of Cardiothoracic Surgery, St. Olav's
University Hospital, Norwegian University of Science and Technology,
Prinsesse Kristinas gate 3, Trondheim 7006, Norway
(Hassel) Clinic of Thoracic and Occupational Medicine, St. Olav's
University Hospital, Trondheim, Norway
(Pinho, Hoydal) Group of Molecular and Cellular Cardiology, Department of
Circulation and Medical Imaging, Norwegian University of Science and
Technology, Trondheim, Norway
(Wisloff) School of Human Movement and Nutrition Sciences, University of
Queensland, Australia
Publisher
Oxford University Press
Abstract
OBJECTIVES: During open-heart surgery, the myocardium experiences
ischaemia-reperfusion injury. A single bout of moderate, 30-min exercise
induces preconditioning and protects the heart from ischaemia-reperfusion
injury in rats, but this has never been investigated in humans. We aimed
to investigate whether 1 bout of moderate exercise 24 h prior to surgery
protects against mitochondrial and cardiac damage. <br/>METHOD(S):
Patients scheduled for elective coronary artery bypass were eligible for
this pilot study. Twenty were included and randomized to the treadmill
exercise group (the EX group, n = 10) 24 h preoperatively or to standard
presurgical procedures (control n = 10). Right atrial (RA) and left
ventricular (LV) biopsies were collected immediately before and as long as
possible after aortic cross-clamping to assess the primary outcome of
mitochondrial respiration by respirometry, in addition to reactive oxygen
species production by fluorometry and apoptotic transcripts. Cardiac
troponin T and creatine kinase myocardial brain were measured in plasma at
arrival, before surgery and 6 and 24 h postoperatively. <br/>RESULT(S):
Mitochondrial respiration was lower in the EX group after surgery in the
LV (Complex I -22%, P < 0.05 and maximal -23%, P < 0.05) and the right
atrium (Complex I -25%, P < 0.05). Transcript level of the
apoptosis-related marker caspase 3 was increased 1.5-fold in the LV prior
to surgery in the EX group when compared with the control group, P < 0.05.
Cardiac troponin T was 45% higher in the EX group than in the control
group 6 h postoperatively (P = 0.03), although not significant when
corrected for aortic cross-clamping time. <br/>CONCLUSION(S): Results
indicate that exercise did not precondition the heart against
surgery-related damage. Exercise may render the myocardium and
mitochondria more vulnerable to perioperative damage. Clinical trials
registration number: NCT00218985
(https://clinicaltrials.gov/ct2/show/NCT00218985).<br/>Copyright &#xa9;
2018 Oxford University Press. All rights reserved.

<55>
Accession Number
627729945
Title
Comparing clinical outcomes of NOACs with warfarin on atrial fibrillation
with Valvular heart diseases: A meta-analysis.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 113. Date of Publication: 15 May 2019.
Author
He Q.; Sze C.-Y.; Shum T.-Y.; Hao G.; Wong N.-Y.B.; Sin T.-H.; Wei W.; Xia
S.
Institution
(He, Sze, Shum, Wong, Sin) Clinical Medicine of International School,
Jinan University, Guangzhou, Guangdong 510632, China
(Wei, Xia) Department of Health Statistics, School of Medicine, Jinan
University, No.601 Huangpudadao, Guangzhou, Guangdong 510632, China
(Hao) Department of Epidemiology, School of Medicine, Jinan University,
Guangzhou, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Warfarin is the standard of care and NOAC (Novel oral
anticoagulants) are a group of newer drugs for such purposes. NOAC has a
generally better profile (Clear interaction, less side effect, require
less monitoring). However, its efficacy on valvular atrial fibrillation
remains unclear. <br/>Method(s): We researched literature articles from
Embase, Cochrane and PubMed. Then we meta-analysed these six articles to
assess pooled estimate of relative risk (RR) and 95% confidence intervals
(Cl) using random-effects model for stroke, systemic embolic event, major
bleeding and all-cause mortality. Heterogeneity across study was tested
with Cochran's Q Test and I² Test. The bias of studies was
first tested by examining the symmetry of Funnel Plot. Cochrane's
Collaboration Tool was also used to report any presented bias.
<br/>Result(s): We collected 496 articles in total and finally we included
six articles in our meta-analysis. For SSEE (Stroke, Systemic Embolic
Event), the pooled relative risk showed a significantly better clinical
outcome of NOAC (RR: 0.66; 95% CI: 0.46 to 0.95). However, there is no
significant difference in major bleeding (RR: 0.714, 95% CI:0.46 to 1.11)
and all-cause mortality (RR: 0.84, 95% CI: 0.58 to 1.21).
<br/>Conclusion(s): Compared to Warfarin, NOAC is significantly more
protective against the embolic event, but no significant difference in
lowering risk of major bleeding, all-cause mortality or all aspects of
post-TAVI (Trans-catheter aortic valve implantation).<br/>Copyright &#xa9;
2019 The Author(s).

<56>
[Use Link to view the full text]
Accession Number
626971919
Title
Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac
Surgery: A Randomized Controlled Trial.
Source
Anesthesiology. 130 (6) (pp 958-970), 2019. Date of Publication: 01 Jun
2019.
Author
Klinger R.Y.; Cooter M.; Bisanar T.; Terrando N.; Berger M.; Podgoreanu
M.V.; Stafford-Smith M.; Newman M.F.; Mathew J.P.; Blumenthal J.A.;
Karhausen J.A.; Kertai M.D.; Krishnamoorthy V.; Li Y.-J.; Swaminathan M.;
Warner D.S.; Funk B.L.; Brassard R.; Toulgoat-Dubois Y.; Waweru P.; Babyak
M.A.; Browndyke J.N.; Welsh-Bohmer K.A.; Sketch M.H.; Bennett E.R.;
Graffagnino C.; Laskowitz D.T.; Strittmatter W.J.; Collins K.; Smigla G.;
Shearer I.; D'Amico T.A.; Daneshmand M.A.; Gaca J.G.; Glower D.D.; Haney
J.; Harpole D.; Hartwig M.G.; Hughes G.C.; Klapper J.A.; Lin S.S.; Lodge
A.J.; Milano C.A.; Plichta R.P.; Schroeder J.N.; Smith P.K.; Tong B.C.
Institution
(Klinger) From the Department of Anesthesiology, Duke University Medical
Center, Durham, North Carolina (R.Y.K., M.C., T.B., N.T., M.B., M.V.P.,
M.S.-S., J.P.M.) the Department of Anesthesiology, University of Kentucky
School of Medicine, Lexington, Kentucky (M.F.N.)
Publisher
NLM (Medline)
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Preclinical and clinical studies
suggest that lidocaine might be neuroprotective, which could benefit
surgical patients at risk of neurologic compromise WHAT THIS ARTICLE TELLS
US THAT IS NEW: This multicenter trial of intravenous lidocaine
administered during and after cardiac surgery did not show an effect on
cognition at 6 weeks postoperatively BACKGROUND:: Cognitive decline after
cardiac surgery occurs frequently and persists in a significant proportion
of patients. Preclinical studies and human trials suggest that intravenous
lidocaine may confer protection in the setting of neurologic injury. It
was hypothesized that lidocaine administration would reduce cognitive
decline after cardiac surgery compared to placebo. <br/>METHOD(S): After
institutional review board approval, 478 patients undergoing cardiac
surgery were enrolled into this multicenter, prospective, randomized,
double-blinded, placebo-controlled, parallel group trial. Subjects were
randomized to lidocaine 1mg/kg bolus after the induction of anesthesia
followed by a continuous infusion (48 mug . kg . min for the first hour,
24 mug . kg . min for the second hour, and 10 mug . kg . min for the next
46h) or saline with identical volume and rate changes to preserve
blinding. Cognitive function was assessed preoperatively and at 6 weeks
and 1 yr postoperatively using a standard neurocognitive test battery. The
primary outcome was change in cognitive function between baseline and 6
weeks postoperatively, adjusting for age, years of education, baseline
cognition, race, and procedure type. <br/>RESULT(S): Among the 420
allocated subjects who returned for 6-week follow-up (lidocaine: N = 211;
placebo: N = 209), there was no difference in the continuous cognitive
score change (adjusted mean difference [95% CI], 0.02 (-0.05, 0.08); P =
0.626). Cognitive deficit (greater than 1 SD decline in at least one
cognitive domain) at 6 weeks occurred in 41% (87 of 211) in the lidocaine
group versus 40% (83 of 209) in the placebo group (adjusted odds ratio
[95% CI], 0.94 [0.63, 1.41]; P = 0.766). There were no differences in any
quality of life outcomes between treatment groups. At the 1-yr follow-up,
there continued to be no difference in cognitive score change, cognitive
deficit, or quality of life. <br/>CONCLUSION(S): Intravenous lidocaine
administered during and after cardiac surgery did not reduce postoperative
cognitive decline at 6 weeks.

<57>
Accession Number
2001951616
Title
Hemorrhagic cardiac tamponade associated with Apixaban: A case report and
systematic review of literature.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Asad Z.U.A.; Ijaz S.H.; Chaudhary A.M.D.; Khan S.U.; Pakala A.
Institution
(Asad, Ijaz, Pakala) University of Oklahoma Health Sciences Center,
Oklahoma City, United States
(Chaudhary) Nishtar Medical College, Multan, Pakistan
(Khan) West Virginia University, Morgantown, WV, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Hemorrhagic cardiac tamponade (HCT)is characterized by rapid
accumulation of blood in the pericardium causing hemodynamic collapse. We
report a case of HCT due to Apixaban use in a patient with renal cell
carcinoma, supplemented with a systematic review of pericardial tamponade
associated with the use of direct oral anticoagulants (DOACs). Case
report: A 62-year-old African American male with a history of metastatic
renal cell carcinoma presented with dyspnea while taking Apixaban. He was
diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion
was drained. The pericardial fluid analysis was negative for malignancy
and suggestive of HCT. He had a complicated hospital course and died
several days later. <br/>Method(s): We searched MEDLINE, EMBASE and other
sources for published cases of pericardial tamponade associated with
DOACs. Our outcomes of interest included patient characteristics, risk
factors, timing from the start of anticoagulation to tamponade, treatment
and mortality. Simple descriptive statistics using percentages for
categorical variables were used to describe the included cases.
<br/>Result(s): A total of 26 cases were included in the final systematic
review after searching MEDLINE, EMBASE and other sources. The mean age was
70 years (range 43-88)with 19 (73%)males. Twelve cases (46%)were
associated with Rivaroxaban, 9 (37%)with Dabigatran and 5(19%)with
Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine.
Only 2 patients died but 24 had to undergo pericardiocentesis.
<br/>Conclusion(s): Cardiac tamponade is rarely associated with DOACs and
elderly male patients with renal and coagulation abnormalities appear to
have the highest risk.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<58>
[Use Link to view the full text]
Accession Number
626908581
Title
Effectiveness of protection strategies for reducing radiation exposure in
proceduralists during cardiac catheterization procedures: a systematic
review protocol.
Source
JBI database of systematic reviews and implementation reports. 17 (5) (pp
660-666), 2019. Date of Publication: 01 May 2019.
Author
Fernandez R.; Ellwood L.; Barrett D.; Weaver J.
Institution
(Fernandez, Ellwood) Centre for Evidence Based Initiatives in Health Care:
a Joanna Briggs Centre of Excellence, Australia
(Fernandez, Ellwood) Centre for Research in Nursing and Health, St George
Hospital, Sydney, Australia
(Fernandez) School of Nursing, University of Wollongong, Sydney, Australia
(Barrett) Interventional Cardiology, St Andrews Private Hospital, Ipswich,
Australia
(Weaver) Cardiology Department, St George Hospital, Sydney, Australia
(Weaver) School of Medicine, University of New South Wales, Sydney,
Australia
Publisher
NLM (Medline)
Abstract
REVIEW QUESTION: What is the effectiveness of radiation protection
strategies for reducing the radiation dose received by the proceduralist
during cardiac catheterization procedures?

<59>
Accession Number
627799686
Title
Herbal medications for anxiety, depression, pain, nausea and vomiting
related to preoperative surgical patients: A systematic review and
meta-analysis of randomised controlled trials.
Source
BMJ Open. 9 (5) (no pagination), 2019. Article Number: e023729. Date of
Publication: 01 May 2019.
Author
Arruda A.P.N.; Zhang Y.; Gomaa H.; Bergamaschi C.D.C.; Guimaraes C.C.;
Righesso L.A.R.; Paglia M.D.G.; Barberato-Filho S.; Lopes L.C.; Ayala
Melendez A.P.; De Oliveira L.D.; Paula-Ramos L.; Johnston B.; El Dib R.
Institution
(Arruda) Department of Surgery and Orthopedics, UNESP - Universidade
Estadual Paulista, Faculty of Medicine, Botucatu, Sao Paulo, Brazil
(Zhang) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Gomaa) Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
(Bergamaschi, Barberato-Filho, Lopes) Pharmaceutical Sciences, University
of Sorocaba, Sorocaba, Sao Paulo, Brazil
(Guimaraes) Terapeutica, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
(Righesso) Oral and Maxillofacial Surgery, University Medical Center
Mainz, Mainz, Germany
(Paglia) Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao
Paulo, Brazil
(Ayala Melendez) Gerstein Science Information Centre, University of
Toronto, Toronto, ON, Canada
(De Oliveira, Paula-Ramos, El Dib) Department of Biosciences and Oral
Diagnosis, UNESP - Universidade Estadual Paulista, Institute of Science
and Technology, Sao Jose Dos Campos, Brazil
(Johnston) Community Health and Epidemiology, Dalhousie University Faculty
of Medicine, Halifax, NS, Canada
(El Dib) St. Joseph's Healthcare, McMaster University, Institute of
Urology, Hamilton, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To summarise the effects of herbal medications for the
prevention of anxiety, depression, pain, and postoperative nausea and
vomiting (PONV) in patients undergoing laparoscopic,
obstetrical/gynaecological or cardiovascular surgical procedures. Methods
Searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled
Trials and LILACS up until January 2018 were performed to identify
randomised controlled trials (RCTs). We included RCTs or quasi-RCTs
evaluating any herbal medication among adults undergoing laparoscopic,
obstetrical/gynaecological or cardiovascular surgeries. The primary
outcomes were anxiety, depression, pain and PONV. We used the Grading of
Recommendations Assessment, Development and Evaluation approach to rate
overall certainty of the evidence for each outcome. Results Eleven trials
including 693 patients were eligible. Results from three RCTs suggested a
statistically significant reduction in vomiting (relative risk/risk ratio
(RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96)
with the use of Zingiber officinale (ginger) compared with placebo in both
laparoscopic and obstetrical/gynaecological surgeries. Results suggested a
non-statistically significantly reduction in the need for rescue
medication for pain (RR 0.52; 95% CI 0.13 to 2.13) with Rosa damascena
(damask rose) and ginger compared with placebo in laparoscopic and
obstetrical/gynaecological surgery. None of the included studies reported
on adverse events (AEs). Conclusions There is very low-certainty evidence
regarding the efficacy of both Zingiber officinale and Rosa damascena in
reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer),
nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for
rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752
more) in patients undergoing either laparoscopic or
obstetrical/gynaecological surgeries. Among our eligible studies, there
was no reported evidence on AEs. PROSPERO registration number
CRD42016042838.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<60>
Accession Number
627846661
Title
Effect of Targeting Mean Arterial Pressure during Cardiopulmonary Bypass
by Monitoring Cerebral Autoregulation on Postsurgical Delirium among Older
Patients: A Nested Randomized Clinical Trial.
Source
JAMA Surgery. (no pagination), 2019. Date of Publication: 2019.
Author
Brown C.H.; Neufeld K.J.; Tian J.; Probert J.; Laflam A.; Max L.; Hori D.;
Nomura Y.; Mandal K.; Brady K.; Hogue C.W.; Shah A.; Zehr K.; Cameron D.;
Conte J.; Bienvenu O.J.; Gottesman R.; Yamaguchi A.; Kraut M.
Institution
(Brown) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University, School of Medicine, Zayed 6208, 1800 Orleans St,
Baltimore, MD 21287, United States
(Neufeld) Department of Psychiatry, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Tian) Department of Biostatistics, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
(Probert) School of Medicine, New York University, New York, United States
(Laflam) Medical Stud., School of Medicine, Tufts University, Medford, MA,
United States
(Max) Department of Radiology, Massachusetts General Hospital, Boston,
United States
(Hori, Nomura) Department of Cardiovascular Surgery, Saitama Medical
Center, Jichi Medical University, Saitama, Japan
(Mandal, Conte) Division of Cardiac Surgery, Department of Surgery, Penn
State University Hershey Medical Center, Hershey, PA, United States
(Brady) Department of Anesthesiology, Northwestern University Feinberg,
School of Medicine, Chicago, IL, United States
(Hogue) Bluhm Cardiovascular Institute, Department of Anesthesiology,
Northwestern University Feinberg, School of Medicine, Chicago, IL, United
States
(Shah) Department of Cardiac Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Zehr) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
(Cameron) Division of Cardiac Surgery, Department of Surgery,
Massachusetts General Hospital, Boston, United States
(Bienvenu) Department of Psychiatry, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Gottesman) Department of Neurology, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Yamaguchi) Saitama Medical Center, Jichi Medical University, Saitama,
Japan
(Kraut) Department of Radiology and Radiological Sciences, Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Delirium occurs in up to 52% of patients after cardiac surgery
and may result from changes in cerebral perfusion. Using intraoperative
cerebral autoregulation monitoring to individualize and optimize cerebral
perfusion may be a useful strategy to reduce the incidence of delirium
after cardiac surgery. <br/>Objective(s): To determine whether targeting
mean arterial pressure during cardiopulmonary bypass (CPB) using cerebral
autoregulation monitoring reduces the incidence of delirium compared with
usual care. <br/>Design, Setting, and Participant(s): This randomized
clinical trial nested within a larger trial enrolled patients older than
55 years who underwent nonemergency cardiac surgery at a single US
academic medical center between October 11, 2012, and May 10, 2016, and
had a high risk for neurologic complications. Patients, physicians, and
outcome assessors were masked to the assigned intervention. A total of
2764 patients were screened, and 199 were eligible for analysis in this
study. <br/>Intervention(s): In the intervention group, the patient's
lower limit of cerebral autoregulation was identified during surgery
before CPB. On CPB, the patient's mean arterial pressure was targeted to
be greater than that patient's lower limit of autoregulation. In the
control group, mean arterial pressure targets were determined according to
institutional practice. <br/>Main Outcomes and Measures: The main outcome
was any incidence of delirium on postoperative days 1 through 4, as
adjudicated by a consensus expert panel. <br/>Result(s): Among the 199
participants in this study, mean (SD) age was 70.3 (7.5) years and 150
(75.4%) were male. One hundred sixty-two (81.4%) were white, 26 (13.1%)
were black, and 11 (5.5%) were of other race. Of 103 patients randomized
to usual care, 94 were analyzed, and of 102 patients randomized to the
intervention 105 were analyzed. Excluding 5 patients with coma, delirium
occurred in 48 of the 91 patients (53%) in the usual care group compared
with 39 of the 103 patients (38%) in the intervention group (P =.04). The
odds of delirium were reduced by 45% in patients randomized to the
autoregulation group (odds ratio, 0.55; 95% CI, 0.31-0.97; P =.04).
<br/>Conclusions and Relevance: The results of this study suggest that
optimizing mean arterial pressure to be greater than the individual
patient's lower limit of cerebral autoregulation during CPB may reduce the
incidence of delirium after cardiac surgery, but further study is
needed.<br/>Copyright &#xa9; 2019 American Medical Association. All rights
reserved.