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<1>
Accession Number
2002169111
Title
Accelerated Allograft Vasculopathy With Rituximab After Cardiac
Transplantation.
Source
Journal of the American College of Cardiology. 74 (1) (pp 36-51), 2019.
Date of Publication: 9 July 2019.
Author
Starling R.C.; Armstrong B.; Bridges N.D.; Eisen H.; Givertz M.M.;
Kobashigawa J.; Ikle D.; Morrison Y.; Pinney S.; Stehlik J.; Tripathi S.;
Sayegh M.H.; Chandraker A.; Gus B.; Keslar K.; Magyar B.; Petrich J.; Tang
W.H.W.; Brooks K.; Givertz M.; Kelly C.; Klein K.; Crisalli K.; DeBronkart
S.; Madsen J.; Semigran M.; Vetrano J.; DeMarco T.; Fields S.; Maguire C.;
Gordon R.; Anderson A.; Regalado J.; Warzecha A.; Goldberg L.; Olt C.;
Rockwell K.; Harris A.; Johnston S.; Roginski C.; Ahmed R.; Cohen I.;
Peace D.; Yao T.; Araujo G.; Bhimaraj A.; Karanga E.; Patel V.; Chait J.;
Deng M.; Fonarow G.; Shin C.; Gibbs C.; Hunt J.; Johnson M.; Worley T.;
Gibbs J.; Kirk J.; Redd W.; Bryan J.; French A.; Kfoury A.G.; Konery K.;
Feller E.; Lee M.; Pierson R.; Young C.; Hollifield T.; Porter K.; Schulz
M.; VanBakel A.; Khush K.; Luikart H.; Nguyen S.; Pham M.; DeNofrio D.;
O'Kelly R.; Garcia L.; Sana S.; Starks B.; Thottam M.; Yi A.; Cabuay B.;
Olson R.; Tucker L.; Uppgaard L.; Lai D.; Poisker C.; Dragicevic K.;
Kelner H.; Luke D.; Nelson J.; Raveendran G.; Kleissas N.; Murali S.; Rayl
K.; Sherry S.; Cosgrove M.
Institution
(Starling) Department of Medicine, Cleveland Clinic Foundation, Cleveland,
OH, United States
(Armstrong, Ikle) Rho Federal Systems Division, Chapel Hill, NC, United
States
(Bridges, Morrison) National Institute of Allergy and Infectious Diseases,
Bethesda, MD, United States
(Eisen) Department of Medicine, Drexel University College of Medicine,
Philadelphia, PA, United States
(Givertz, Tripathi, Sayegh, Chandraker) Transplantation Research Center,
Renal Division, Brigham and Women's Hospital, Boston, MA, United States
(Kfoury) Department of Medicine, Intermountain Medical Center, Murray, UT,
United States
(Kobashigawa) Department of Medicine, Cedars Sinai Medical Center, Los
Angeles, CA, United States
(Pinney) Department of Medicine, Mount Sinai School of Medicine, New York,
NY, United States
(Stehlik) Department of Medicine, University of Utah, Salt Lake City, UT,
United States
Publisher
Elsevier USA
Abstract
Background: The CTOT-11 (Prevention of Cardiac Allograft Vasculopathy
Using Rituximab Therapy in Cardiac Transplantation [Clinical Trials in
Organ Transplantation-11]) study was a randomized, placebo-controlled,
multicenter, double-blinded clinical trial in nonsensitized primary heart
transplant (HTX) recipients. Objective(s): The study sought to
determine whether B cell depletion therapy would attenuate the development
of cardiac allograft vasculopathy. Method(s): A total of 163 HTX
recipients were randomized to rituximab 1,000 mg intravenous or placebo on
days 0 and 12 post-transplant. Primary outcome was change in percent
atheroma volume (PAV) from baseline to 1 year measured by intravascular
ultrasound. Secondary outcomes included treated episodes of acute
rejection, de novo anti-HLA antibodies (including donor-specific
antibodies), and phenotypic differentiation of B cells. Result(s):
There were no significant differences at study entry between the rituximab
and placebo groups. Paired intravascular ultrasound measures were
available at baseline and 1 year in 86 subjects (49 rituximab, 37
placebo). The mean +/- SD change in PAV at 12 months was +6.8 +/- 8.2%
rituximab versus +1.9 +/- 4.4% placebo (p = 0.0019). Mortality at 12
months was 3.4% rituximab versus 6.8% placebo (p = 0.47); there were no
retransplants or post-transplant lymphoproliferative disorder. The rate of
treated rejection was 24.7% rituximab versus 32.4% placebo (p = 0.28).
Rituximab therapy effectively eliminated CD20+/CD19+
B cells followed by a gradual expansion of a CD19- cell
population in the rituximab-treated group. Conclusion(s): A marked,
unexpected increase in coronary artery PAV with rituximab was observed
during the first year in HTX recipients. One-year mortality was not
impacted; however, longer-term follow-up and mechanistic explanations are
required. (Prevention of Cardiac Allograft Vasculopathy Using Rituximab
[Rituxan] Therapy in Cardiac Transplantation; NCT01278745) Copyright
© 2019 American College of Cardiology Foundation

<2>
Accession Number
628492245
Title
Perioperative takotsubo cardiomyopathy: Implications for anesthesiologist.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 309-315), 2019. Date of
Publication: July-September 2019.
Author
Agarwal S.; Sanghvi C.; Odo N.; Castresana M.
Institution
(Agarwal, Sanghvi, Odo, Castresana) Department of Anesthesiology and
Perioperative Medicine, Medical College of Georgia, Augusta University,
Augusta, GA, United States
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular
dysfunction in the absence of obstructive coronary artery disease that may
be triggered by an acute medical illness or intense physical or emotional
stress. TCM is often confused with acute myocardial infarction given the
similar electrocardiographic changes, cardiac enzymes, hemodynamic
perturbations, and myocardial wall motion abnormalities. In the
perioperative setting, the clinical picture may be more confusing because
of the effect of anesthesia as well as hemodynamic changes related to the
surgery itself. However, awareness of various other diagnostic modalities
may enable clinicians to distinguish between the two, more systematically
and with greater certainty. Despite the large body of literature, there
still seems to be an overall paucity in our understanding of the
etiopathogenesis, clinical characteristics, natural history, and
management of this syndrome, especially in the perioperative setting. This
narrative review seeks to present and synthesize the most recent
literature on TCM and to identify gaps in current knowledge which can
become the basis for future research. Copyright © 2019 Annals of
Cardiac Anaesthesia.

<3>
Accession Number
628492236
Title
Post-thoracotomy ipsilateral shoulder pain: What should be preferred to
optimize it - Phrenic nerve infiltration or paracetamol infusion?.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 291-296), 2019. Date of
Publication: July-September 2019.
Author
Manzoor S.; Khan T.; Zahoor S.; Wani S.; Rather J.; Yaqoob S.; Ali Z.;
Hakeem Z.; Dar B.
Institution
(Manzoor, Khan, Zahoor, Rather, Yaqoob, Dar) Department of
Anaesthesiology, Pain and Critical Care, Sher i Kashmir Institute of
Medical Sciences, Srinagar, Jammu and Kashmir, India
(Khan, Zahoor, Wani, Ali, Hakeem) Department of Radiation Oncology, Sher i
Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Post thoracotomy ipsilateral shoulder pain (PTISP) is a
distressing and highly prevalent problem after thoracic surgery and has
not received much attention despite the incidence as high as 85%.
 Objective(s): To study the effect of phrenic nerve infiltration with
Ropivacaine compared to paracetamol infusion on PTISP in thoracotomy
patients with epidural analgesia as standard mode of incisional analgesia
in both the groups. Study Design: Prospective Randomised and Double
Blind Study. Method(s): 126 adult patients were divided randomly into
2 groups, 'Group A (Phrenic Nerve Infiltration Group) received 10 mL of
0.2% Ropivacaine close to the diaphragm into the periphrenic fat pad' and
'Group B (Paracetamol Infusion Group) received 20mgkg paracetamol
infusion' 30 minutes prior to chest closure respectively. A blinded
observer assessed the patients PTISP using the VAS score at 1, 4, 8, 12
and 24 hours (h) postoperatively. The time and number of any rescue
analgesic medication were recorded. Result(s): PTISP was relieved
significantly in Group A (25.4) as compared to Group B (61.9), with
significantly higher mean duration of analgesia in Group A. The mean time
for first rescue analgesia was significantly higher in Group A (11.1 +/-
7.47 hours) than in Group B (7.40 +/- 5.30 hours). The number of rescue
analgesic required was less in Group A 1.6 +/- 1.16 as compared to Group B
2.9 +/- 1.37 (P value <0.5). Conclusion(s): Phrenic Nerve
Infiltration significantly reduced the incidence and delayed the onset of
PTISP as compared to paracetamol infusion and was not associated with any
adverse effects. Copyright © 2019 Annals of Cardiac Anaesthesia.

<4>
Accession Number
628492196
Title
A randomized, double-blinded trial comparing the effectiveness of
tranexamic acid and epsilon-aminocaproic acid in reducing bleeding and
transfusion in cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 265-272), 2019. Date of
Publication: July-September 2019.
Author
Leff J.; Rhee A.; Nair S.; Lazar D.; Sathyanarayana S.; Shore-Lesserson L.
Institution
(Leff) Montefiore Medical Center, New York, United States
(Rhee) Department of Anesthesiology, Icahn School of Medicine at Mount
Sinai, New York, United States
(Nair) Department of Anesthesiology, Montefiore Hospital and Medical
Center, New York, United States
(Lazar) Department of Anesthesiology, North Shore Long Island Jewish
Health System, New York, United States
(Sathyanarayana) Department of Anesthesiology, Lincoln Medical Centerc,
New York, United States
(Shore-Lesserson) Department of Anesthesiology, Hofstra University, North
Shore Long Island Jewish School of Medicine, New York, United States
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objectives: To compare the effectiveness of epsilon aminocaproic acid
(EACA) to tranexamic acid (TA) in reducing blood loss and transfusion
requirements in patients undergone cardiac surgery under cardiopulmonary
bypass. Design(s): Randomized, double blinded study. Outcome
variables collected included; baseline demographic characteristics, type
of surgery, amount of 24 hour chest tube drainage, amount of 24 hour blood
products administered, 30 day mortality and morbidity and length of stay.
We analyzed the data using parametric and non-parametric tests as
appropriate. Setting(s): Single center tertiary-care university
hospital setting. Participant(s): 114 patients who had undergone
cardiac surgery under cardiopulmonary bypass. Intervention(s):
Standard dose of intra-operative EACA or TA was compared in patients
undergone cardiac surgery under cardiopulmonary bypass. Result(s):
There was no statistically significant difference between groups when
analyzing chest tube drainage. However, there was a significant difference
in the administration of any transfusion (PRBC's, FFP, platelets)
intra-operatively to 24 hours postoperatively, with less transfusion in
patients receiving EACA compared to TA (25% vs. 44.8%, respectively P =
0.027). Additionally, there was no significant difference in terms of
adverse events during the one month follow up period. Conclusion(s):
The findings of this study suggest that EACA and TA have similar effects
on chest tube drainage but EACA is associated with fewer transfusions in
CABG alone surgeries. Our results suggest that EACA can be used in a
similar fashion to TA which may result in a cost and morbidity
advantage. Copyright © 2019 Annals of Cardiac Anaesthesia.

<5>
Accession Number
628492172
Title
The perioperative effect of magnesium sulfate in patients with concentric
left ventricular hypertrophy undergoing cardiac surgery: A double-blinded
randomized study.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 246-253), 2019. Date of
Publication: July-September 2019.
Author
Soliman R.; Abukhudair W.
Institution
(Soliman) Department of Anesthesia, Cairo University, Cairo, Egypt
(Abukhudair) Department of Cardiac Surgery, Cardiac Center, King Fahd
Armed Forces Hospital, Jeddah, Saudi Arabia
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to assess the cardioprotective
effect of magnesium sulfate in patients with left ventricular concentric
hypertrophy undergoing cardiac surgery. Design(s): The study was a
double-blinded randomized study. Setting(s): This study was conducted
at a cardiac center. Patient(s): The study included 250 patients.
 Intervention(s): The study included two groups (each = 125): Group M
- the patients who received magnesium sulfate infusion (15 mgkgh). The
infusion was started 20 min before induction, during surgery, and the
first postoperative 24 h. Group C - the patients who received an equal
amount of normal saline. Measurements: The variables included troponin I
level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with
automatic ST-segment analysis (leads II and V), EA peak ratio,
end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood
pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and
systemic vascular resistances, and pharmacological and mechanical support.
 Main Result(s): The troponin I level, CK-MB, and ECG changes were
lower in Group M than Group C (P < 0.05). The EA peak ratio and
end-diastolic volume increased in Group M than Group C (P < 0.05). There
was a significant increase in the CI and a decrease in the heart rate,
mPAP, pulmonary vascular resistances, and pharmacological and mechanical
support in Group M compared to Group C (P < 0.05). There were minimal
changes in the MAP and systemic vascular resistance in Group M compared to
Group C (P < 0.05). Conclusion(s): The magnesium sulfate provides a
cardioprotective effect in patients with concentric ventricular
hypertrophy undergoing cardiac surgery. It decreases the incidence of
perioperative myocardial infarction and arrhythmia. Furthermore, it
decreases the requirement of pharmacological and mechanical
support. Copyright © 2019 Annals of Cardiac Anaesthesia.

<6>
Accession Number
628450957
Title
Protocol of a randomised controlled trial in cardiac surgical patients
with endothelial dysfunction aimed to prevent postoperative acute kidney
injury by administering nitric oxide gas.
Source
BMJ Open. 9 (7) (no pagination), 2019. Article Number: e026848. Date of
Publication: 01 Jul 2019.
Author
Marrazzo F.; Spina S.; Zadek F.; Lama T.; Xu C.; Larson G.; Rezoagli E.;
Malhotra R.; Zheng H.; Bittner E.A.; Shelton K.; MelnitchoUK S.; Roy N.;
Sundt T.M.; Riley W.D.; Williams P.; Fisher D.; Kacmarek R.M.; Thompson
T.B.; Bonventre J.; Zapol W.; Ichinose F.; Berra L.
Institution
(Marrazzo, Spina, Zadek, Lama, Xu, Larson, Rezoagli, Bittner, Shelton,
Zapol, Ichinose, Berra) Department of Anesthesia, Critical Care and Pain
Medicine, Massachusetts General Hospital, Boston, MA, United States
(Malhotra) Department of Medicine, Cardiology Division, Massachusetts
General Hospital, Boston, MA, United States
(Zheng) Department of Medicine, Massachusetts General Hospital, Boston,
MA, United States
(MelnitchoUK, Roy, Sundt) Department of Cardiac surgery, Massachusetts
General Hospital, Boston, MA, United States
(Riley) Department of Surgery, Cardiac Surgery, Perfusion Services,
Massachusetts General Hospital, Boston, MA, United States
(Williams) Respiratory Care Services, Massachusetts General Hospital,
Boston, MA, United States
(Fisher) Respiratory Care Services, Boston Medical Center, Boston, MA,
United States
(Kacmarek) Department of Respiratory Care, Massachusetts General Hospital,
Boston, United States
(Kacmarek) Department of Anesthesiology, Harvard University, Boston,
United States
(Thompson) Department of Medicine Pulmonary and Critical Care Unit,
Massachusetts General Hospital, Boston, MA, United States
(Bonventre) Department of Medicine, Division of Renal Medicine, Brigham
and Women's Hospital, Department of Medicine, Boston, MA, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Postoperative acute kidney injury (AKI) is a common
complication in cardiac surgery. Levels of intravascular haemolysis are
strongly associated with postoperative AKI and with prolonged (>90 min)
use of cardiopulmonary bypass (CPB). Ferrous plasma haemoglobin released
into the circulation acts as a scavenger of nitric oxide (NO) produced by
endothelial cells. Consequently, the vascular bioavailability of NO is
reduced, leading to vasoconstriction and impaired renal function. In
patients with cardiovascular risk factors, the endothelium is
dysfunctional and cannot replenish the NO deficit. A previous clinical
study in young cardiac surgical patients with rheumatic fever, without
evidence of endothelial dysfunction, showed that supplementation of NO gas
decreases AKI by converting ferrous plasma haemoglobin to ferric
methaemoglobin, thus preserving vascular NO. In this current trial, we
hypothesised that 24 hours administration of NO gas will reduce AKI
following CPB in patients with endothelial dysfunction. Methods This is a
single-centre, randomised (1:1) controlled, parallel-arm superiority trial
that includes patients with endothelial dysfunction, stable kidney
function and who are undergoing cardiac surgery procedures with an
expected CPB duration >90 min. After randomisation, 80 parts per million
(ppm) NO (intervention group) or 80 ppm nitrogen (N 2, control group) are
added to the gas mixture. Test gases (N 2 or NO) are delivered during CPB
and for 24 hours after surgery. The primary study outcome is the
occurrence of AKI among study groups. Key secondary outcomes include AKI
severity, occurrence of renal replacement therapy, major adverse kidney
events at 6 weeks after surgery and mortality. We are recruiting 250
patients, allowing detection of a 35% AKI relative risk reduction,
assuming a two-sided error of 0.05. Ethics and dissemination The Partners
Human Research Committee approved this trial. Recruitment began in
February 2017. Dissemination plans include presentations at scientific
conferences, scientific publications and advertising flyers and posters at
Massachusetts General Hospital. Trial registration number
NCT02836899. Copyright © 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.

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

<8>
[Use Link to view the full text]
Accession Number
628579926
Title
Impact of smoking on all-cause mortality and cardiovascular events in
patients after coronary revascularization with a percutaneous coronary
intervention or coronary artery bypass graft: A systematic review and
meta-analysis.
Source
Coronary Artery Disease. 30 (5) (pp 367-376), 2019. Date of Publication:
01 Aug 2019.
Author
Ma W.-Q.; Wang Y.; Sun X.-J.; Han X.-Q.; Zhu Y.; Yang R.; Liu N.-F.
Institution
(Ma, Wang, Sun, Han, Zhu, Liu) Department of Cardiology, Zhongda Hospital,
School of Medicine, Southeast University, 87 Dingjiaqiao, Nanjing 210009,
China
(Yang) B Department of Pharmaceutical, Qianfoshan Hospital, Jinan,
People's Republic of China, China
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Although cigarette smoking is an independent risk factor for
cardiovascular disease, inconsistent results have been published in the
literature on its impacts on the cardiovascular health of patients after
coronary revascularization with a percutaneous coronary intervention (PCI)
or coronary artery bypass graft (CABG). We performed a comprehensive
electronic database search through July 2018. Studies reporting the risk
estimates of all-cause mortality and cardiovascular outcomes in patients
after coronary revascularization with PCI or CABG on the basis of smoking
status were selected. Multivariate-adjusted relative risks (RRs) and 95%
confidence intervals (CIs) were pooled using random-effects models with
inverse variance weighting. Data from 37 records including 126 901
participants were finally collected. Overall, the pooled RR (95% CI)
associated with cigarette smoking was 1.26 (95% CI: 1.09-1.47) for
all-cause mortality, 1.08 (95% CI: 0.92-1.28) for major adverse
cardiovascular events, 0.96 (95% CI: 0.69-1.35) for cardiovascular
mortality and 1.15 (95% CI: 0.81-1.64) for myocardial infarction. The
increased risk of all-cause mortality was also observed in former smokers
compared with those who had never smoked (RR: 1.19; 95% CI: 1.03-1.38).
Furthermore, the negative effects of cigarette smoking on all-cause
mortality were also observed in most subgroups. Cigarette smoking has been
shown to increase the likelihood of all-cause mortality in patients after
coronary revascularization with PCI or CABG. Smoking cessation is
essential for PCI or CABG patients to manage their coronary artery
disease. Copyright © 2019 Wolters Kluwer Health, Inc. All rights
reserved.

<9>
Accession Number
627110349
Title
Adiposity in relation to readmission and all-cause mortality following
coronary artery bypass grafting: A systematic review and meta-analysis.
Source
Obesity Reviews. 20 (8) (pp 1159-1183), 2019. Date of Publication: August
2019.
Author
Zhang K.; Wang J.; Yang Y.; An R.
Institution
(Zhang) Beijing Aortic Disease Center, Beijing Anzhen Hospital, Beijing,
Capital Medical University, Beijing, China
(Wang) Department of Physical Education, Dalian University of Technology,
Dalian, Liaoning, China
(Yang) Cabot Microelectronics, Aurora, IL, United States
(An) Guangzhou Sport University, Guangzhou, Guangdong, China
(An) Department of Kinesiology and Community Health, University of
Illinois at Urbana-Champaign, Champaign, IL, United States
(An) Brown School, Washington University, St. Louis, MO, United States
Publisher
Blackwell Publishing Ltd
Abstract
This study systemically reviewed evidence linking adiposity to readmission
and all-cause mortality in post-coronary artery bypass grafting (CABG)
patients. Keyword/reference search was performed in PubMed, Web of
Science, CINAHL, and Cochrane Library for articles published before June,
2018. Eligibility criteria included study designs:
experimental/observational studies; subjects: adult patients undergoing
CABG; and outcomes: hospital/clinic readmissions, and short-term (<=30
days) and mid-to-long-term (>30 days) all-cause mortality. Seventy-two
studies were identified. Meta-analysis showed that the odds of post-CABG
readmission among patients with overweight was 30% lower than their
normal-weight counterparts and the odds of mid-to-long-term post-CABG
mortality among patients with overweight were 20% lower than their
normal-weight counterparts. In contrast, no difference in post-CABG
readmission rate was found between patients with obesity and their
nonobese counterparts; no difference in short-term or in-hospital
post-CABG mortality rate was found between patients with overweight or
obesity and their normal-weight counterparts; and no difference in
mid-to-long-term post-CABG mortality rate was found between patients with
obesity and their normal-weight counterparts. In conclusion, patients with
overweight but not obesity had a lower readmission and mid-to-long-term
mortality rate following CABG relative to their normal-weight
counterparts. Preoperative weight loss may not be advised to patients with
overweight undergoing CABG. Copyright © 2019 World Obesity
Federation

<10>
Accession Number
2002344100
Title
In Search of the Ideal Valve: Optimizing Genetic Modifications to Prevent
Bioprosthetic Degeneration.
Source
Annals of Thoracic Surgery. 108 (2) (pp 624-635), 2019. Date of
Publication: August 2019.
Author
Smood B.; Hara H.; Cleveland D.C.; Cooper D.K.C.
Institution
(Smood, Hara, Cooper) Xenotransplantation Program, Department of Surgery,
University of Alabama at Birmingham, Birmingham, AL, United States
(Cleveland) Division of Pediatric Cardiovascular Surgery, University of
Alabama at Birmingham, Birmingham, AL, United States
Publisher
Elsevier USA
Abstract
Background: Bioprosthetic heart valves undergo structural degeneration and
calcification. Similarities exist in the histopathologic features of
explanted bioprosthetic valves and rejected pig tissues and organs after
xenotransplantation into nonhuman primates. The development of more
durable bioprosthetic valves, namely from genetically modified pigs, could
negate the need for the insertion of mechanical prostheses in children and
young adults with the requirement for life-long anticoagulation and might
avoid the need for reoperation in elderly patients. Method(s): We
reviewed the literature (MedlinePlus, PubMed, Google Scholar) through
September 1, 2018, under four key terms: (1) bioprosthetic heart valves,
(2) xenograft antigens, (3) immunologic responses to bioprosthetic valves,
and (4) genetic modification of xenografts. Result(s): Advances in
tissue and organ xenotransplantation have elucidated important immunologic
barriers that provide innovative approaches to prevent structural
degeneration of bioprosthetic heart valves. The current evidence suggests
that bioprosthetic valves derived from genetically modified pigs lacking
xenogeneic antigens (namely Gal, Neu5Gc, and Sda), termed triple-knockout
pigs, would function considerably longer than current wild-type
(genetically unmodified) porcine valves in human recipients.
 Conclusion(s): Preclinical and clinical studies to determine the
safety and efficacy of triple-knockout porcine bioprosthetic valves will
likely establish that they are more resistant to human immune responses
and thus less susceptible to structural degeneration. Copyright ©
2019 The Society of Thoracic Surgeons

<11>
Accession Number
628598791
Title
Early versus delayed stroke after cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 8 (13) (no pagination), 2019.
Article Number: e012447. Date of Publication: 01 Jul 2019.
Author
Gaudino M.; Rahouma M.; Di Mauro M.; Yanagawa B.; Abouarab A.; Demetres
M.; Di Franco A.; Arisha M.J.; Ibrahim D.A.; Baudo M.; Girardi L.N.;
Fremes S.
Institution
(Gaudino, Rahouma, Di Mauro, Abouarab, Di Franco, Ibrahim, Baudo, Girardi)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York,
NY, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Yanagawa) Division of Cardiac Surgery, St. Michael's Hospital, University
of Toronto, Canada
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Canada
(Arisha) Internal Medicine Department, West Virginia University Charleston
Division, Charleston Area Medical Center, Charleston, WV, United States
Publisher
American Heart Association Inc.
Abstract
Background-Although it is traditionally regarded as a single entity,
perioperative stroke comprises 2 separate phenomena (early/intraoperative
and delayed/postoperative stroke). We aimed to systematically evaluate
incidence, risk factors, and clinical outcome of early and delayed stroke
after cardiac surgery. Methods and Results-A systematic review (MEDLINE,
EMBASE, Cochrane Library) was performed to identify all articles reporting
early (on awakening from anesthesia) and delayed (after normal awakening
from anesthesia) stroke after cardiac surgery. End points were pooled
event rates of stroke and operative mortality and incident rate of late
mortality. Thirty-six articles were included (174 969 patients). The
pooled event rate for early stroke was 0.98% (95% CI 0.79% to 1.23%) and
was 0.93% for delayed stoke (95% CI 0.77% to 1.11%; P=0.68). The pooled
event rate of operative mortality was 28.8% (95% CI 17.6% to 43.4%) for
early and 17.9% (95% CI 14.0% to 22.7%) for delayed stroke, compared with
2.4% (95% CI 1.9% to 3.1%) for patients without stroke (P<0.001for early
versus delayed, and for perioperative stroke, early stroke, and delayed
stroke versus no stroke). At a mean follow-up of 8.25 years, the incident
rate of late mortality was 11.7% (95% CI 7.5% to 18.3%) for early and 9.4%
(95% CI 5.9% to 14.9%) for delayed stroke, compared with 3.4% (95% CI 2.4%
to 4.8%) in patients with no stroke. Meta-regression demonstrated that
off-pump was inversely associated with early stroke (beta=-0.009, P=0.01),
whereas previous stroke (beta=0.02, P<0.001) was associated with delayed
stroke. Conclusions-Early and delayed stroke after cardiac surgery have
different risk factors and impacts on operative mortality as well as on
long-term survival. Copyright © 2019 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<12>
Accession Number
2001839223
Title
Risk factors for death or heart transplantation in single-ventricle
physiology (tricuspid atresia, pulmonary atresia, and heterotaxy): A
systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 38 (7) (pp 739-747), 2019. Date
of Publication: July 2019.
Author
Kulkarni A.; Patel N.; Singh T.P.; Mossialos E.; Mehra M.R.
Institution
(Kulkarni) London School of Economics and Political Science, London,
United Kingdom
(Patel, Mossialos) Department of Health Policy, London School of Economics
and Political Science, London, United Kingdom
(Singh) Department of Cardiology, Boston Children's Hospital, Boston, MA,
United States
(Mehra) Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
Publisher
Elsevier USA
Abstract
BACKGROUND: In this study we sought to evaluate risk factors (RFs) for
death or heart transplantation (D-HT) in single-ventricle (SV) physiology
due to tricuspid atresia (TA), pulmonary atresia-intact ventricular septum
(PA-IVS), and heterotaxy with SV (HX), clinical conditions for which
outcome data are limited. METHOD(S): To conduct a systematic review,
we included citations that evaluated occurrence of D-HT in SV physiology
of TA, PA-IVS, and HX in English articles published between January 1998
and December 2017 based on inclusion and exclusion criteria, following the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
(PRISMA) guidelines. The Cochrane Risk of Bias in Non-Randomized
Studies-Interventions (ROBINS-I) tool for non-randomized studies was used
to assess the risk of bias. Meta-analysis was performed if RF data were
available in more than 3 studies. RESULT(S): Of 11,629 citations
reviewed, 30 met inclusion criteria. All 30 were observational,
retrospective studies. In all, 1,770 patients were included, 481 died and
21 underwent HT (63 lost to follow-up); 723 patients reached Fontan
completion. We found that systemic ventricular dysfunction (odds ratio
[OR] 20.7, confidence interval [CI] 10.0-42.5, I2 = 0%) and
atrioventricular valve regurgitation (AVR) were associated with risk of
D-HT (OR 3.7, CI 1.9-6.9, I2 = 14%). RF associations with D-HT
could not be derived for right ventricle-dependent coronary circulation,
pulmonary arteriovenous malformations, total anomalous pulmonary venous
return, arrhythmias, and pulmonary atresia. CONCLUSION(S): This
systematic review and meta-analysis has identified a high mortality rate
in children born with non-HLHS SV heart disease and points to potential
under-utilization of HT. Systemic ventricular dysfunction and AVR were
identified as RFs for D-HT in this subset of patients SV with TA, PA-IVS,
and HX. Copyright © 2019 International Society for Heart and Lung
Transplantation

<13>
Accession Number
2002209086
Title
Non-Transfemoral Transcatheter Aortic Valve Replacement Approach is
Associated with a Higher Risk of New-Onset Atrial Fibrillation: A
Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Angsubhakorn N.; Kittipibul V.; Prasitlumkum N.; Kewcharoen J.;
Cheungpasitporn W.; Ungprasert P.
Institution
(Angsubhakorn) Department of Medicine, University of Minnesota Medical
School, Minneapolis, MN, United States
(Kittipibul) Department of Internal Medicine, University of Miami Miller
School of Medicine, Miami, FL, United States
(Prasitlumkum, Kewcharoen) University of Hawaii Internal Medicine
Residency Program, Honolulu, HI, United States
(Cheungpasitporn) Division of Nephrology, University of Mississippi
Medical Center, Jackson, MS, United States
(Ungprasert) Clinical Epidemiology Unit, Department of Research and
Development, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Publisher
Elsevier Ltd
Abstract
Background: New-onset atrial fibrillation (NOAF) is a frequent arrhythmic
complication following transcatheter aortic valve replacement (TAVR).
Choice of access routes for TAVR could be a factor that determines the
risk of NOAF although the data is still not well-characterised. We aimed
to assess the association between different access routes for TAVR
(transfemoral versus non-transfemoral) and the risk of NOAF.
 Method(s): A comprehensive literature review was performed through
September 2018 using EMBASE and Medline. Eligible studies must compare the
incidence of NOAF in patients without pre-existing atrial fibrillation who
underwent TAVR. Relative risk (RR) and 95% confidence intervals (CI) were
extracted from each study and combined together using the random-effects
model, generic inverse variance method of DerSimonian and Laird.
 Result(s): Seven (7) retrospective studies with 18,425 patients who
underwent TAVR (12,744 with the transfemoral approach and 5,681 with the
non-transfemoral approach) met the eligibility criteria. After the
procedures, 2,205 (12.0%) patients developed NOAF (656 [5.1%] patients in
the transfemoral group and 1,549 [27.3%] patients in the non-transfemoral
group). There was a significant association between the non-transfemoral
approach and an increased risk of NOAF with the pooled RR of 2.94 (95%CI,
2.53-3.41; p < 0.00001). Subgroup analysis showed the highest risk of NOAF
in the transapical subgroup with the pooled RR of 3.20 (95% CI, 2.69-3.80;
I2 33%). Conclusion(s): A significantly increased risk of
NOAF following TAVR among those who underwent a non-transfemoral approach
compared with transfemoral approach was observed in this
meta-analysis. Copyright © 2019 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<14>
Accession Number
2002205235
Title
Modality Selection for the Revascularization of Left Main Disease.
Source
Canadian Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Tam D.Y.; Bakaeen F.; Feldman D.N.; Kolh P.; Lanza G.A.; Ruel M.; Piccolo
R.; Fremes S.E.; Gaudino M.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Department of Surgery, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario, Canada
(Bakaeen) Departments of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institutes, Cleveland Clinic, Cleveland, OH, United States
(Feldman) Division of Cardiology, Weill Cornell Medical College, New York,
NY, United States
(Kolh) Department of Biomedical and Preclinical Sciences, University of
Liege, Liege, Belgium
(Lanza, Gaudino) Fondazione Policlinico Universitario A. Gemelli IRCCS,
Universita Cattolica del Sacro Cuore and Department of Cardiovascular and
Thoracic Diseases, Rome, Italy
(Ruel) Division of Cardiac Surgery, Department of Surgery, University of
Ottawa, Ottawa, Ontario, Canada
(Piccolo) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The management of severe left main (LM) disease remains controversial and
continues to evolve as new evidence emerges. Patient selection for
coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI) relies on both predicting mortality with CABG from
clinical characteristics using the Society of Thoracic Surgeons (STS) risk
score and anatomical complexity, using the Synergy Between Percutaneous
Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score. LM
stenting techniques continue to evolve; for bifurcation lesions, the use
of the double-kiss crush technique may reduce the incidence of late target
vessel revascularization. In patients with acute coronary syndrome (ACS)
complicated by cardiogenic shock, PCI is likely the first-line option in
those with anatomically amenable disease, whereas all other stable
non-ST-elevated ACS should be treated similar to stable ischemic heart
disease. Outcomes comparing CABG and PCI have been recently examined in 2
large randomized clinical trials. In general, early outcomes of
periprocedural myocardial infarction and stroke favoured PCI or were not
different from outcomes with CABG. However, the conclusions of both trials
are at present discordant with respect to late major adverse cardiac and
cerebral events; additional follow-up of the trial patients is important
for informed patient decision making. The appropriate mode of
revascularization should be selected according to patient clinical
characteristics and the complexity of the coronary lesions according to
European and American guidelines. In those with low or intermediate SYNTAX
scores, particularly with high surgical risk, PCI may be preferred to CABG
in most other scenarios. A multidisciplinary heart team is recommended to
help individualize revascularization decisions. Copyright © 2018
Canadian Cardiovascular Society

<15>
Accession Number
627205268
Title
Effect of an Incentive Spirometer Patient Reminder after Coronary Artery
Bypass Grafting: A Randomized Clinical Trial.
Source
JAMA Surgery. 154 (7) (pp 579-588), 2019. Date of Publication: July 2019.
Author
Eltorai A.E.M.; Baird G.L.; Eltorai A.S.; Healey T.T.; Agarwal S.;
Ventetuolo C.E.; Martin T.J.; Chen J.; Kazemi L.; Keable C.A.; Diaz E.;
Pangborn J.; Fox J.; Connors K.; Sellke F.W.; Elias J.A.; Daniels A.H.
Institution
(Eltorai, Baird, Healey, Agarwal, Ventetuolo, Martin, Chen, Kazemi,
Keable, Diaz, Pangborn, Fox, Connors, Sellke, Elias, Daniels) Warren
Alpert Medical School, Brown University, 222 Richmond St, Providence, RI
02903, United States
(Eltorai) Yale University School of Medicine, New Haven, CT, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Incentive spirometers (ISs) were developed to reduce
atelectasis and are in widespread clinical use. However, without IS use
adherence data, the effectiveness of IS cannot be determined.
 Objective(s): To evaluate the effect of a use-tracking IS reminder on
patient adherence and clinical outcomes following coronary artery bypass
grafting (CABG) surgery. Design, Setting, and Participant(s): This
randomized clinical trial was conducted from June 5, 2017, to December 29,
2017, at a tertiary referral teaching hospital and included 212 patients
who underwent CABG, of whom 160 participants were randomized (intent to
treat), with 145 completing the study per protocol. Participants were
stratified by surgical urgency (elective vs nonelective) and sex (men vs
women). Intervention(s): A use-tracking, IS add-on device
(SpiroTimer) with an integrated use reminder bell recorded and timestamped
participants' inspiratory breaths. Patients were randomized by hourly
reminder "bell on" (experimental group) or "bell off" (control group).
 Main Outcomes and Measures: Incentive spirometer use was recorded for
the entire postoperative stay and compared between groups. Radiographic
atelectasis severity (score, 0-10) was the primary clinical outcome.
Secondary respiratory and nonrespiratory outcomes were also evaluated.
 Result(s): A total of 145 per-protocol participants (112 men [77%];
mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective
procedure) were evaluated, with 74 (51.0%) in the bell off group and 71
(49.0%) in the bell on group. The baseline medical and
motivation-to-recover characteristics of the 2 groups were similar. The
mean number of daily inspiratory breaths was greater in bell on (35; 95%
CI, 29-43 vs 17; 95% CI, 13-23; P <.001). The percentage of recorded hours
with an inspiratory breath event was greater in bell on (58%; 95% CI,
51-65 vs 28%; 95% CI, 23-32; P <.001). Despite no differences in the first
postoperative chest radiograph mean atelectasis severity scores (2.3; 95%
CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P =.48), the mean atelectasis
severity scores for the final chest radiographs conducted before discharge
were significantly lower for bell on than bell off group (1.5; 95% CI,
1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P =.04). Of those with early
postoperative fevers, fever duration was shorter for bell on (3.2 hours;
95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P =.04). Having the bell
turned on reduced noninvasive positive pressure ventilation use rates
(37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P =.03) for
participants undergoing nonelective procedures. Bell on reduced the median
postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7;
P =.048) and the intensive care unit length of stay for patients
undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI,
3-4; P =.02). At 6 months, the bell off mortality rate was higher than
bell on (9% vs 0%, P =.048) for participants undergoing nonelective
procedures. Conclusions and Relevance: The incentive spirometer
reminder improved patient adherence, atelectasis severity, early
postoperative fever duration, noninvasive positive pressure ventilation
use, ICU and length of stay, and 6-month mortality in certain patients.
With the reminder, IS appears to be clinically effective when used
appropriately. Trial Registration: ClinicalTrials.gov identifier:
NCT02952027. Copyright © 2019 American Medical Association. All
rights reserved.

<16>
Accession Number
2002198071
Title
Concomitant vs staged orthotopic liver transplant after cardiac surgical
procedures.
Source
Transplantation Reviews. (no pagination), 2019. Date of Publication: 2019.
Author
Reddy H.G.; Choi J.H.; Maynes E.J.; Carlson L.A.; Gordon J.S.; Horan D.P.;
Khan J.; Weber M.P.; Bodzin A.S.; Morris R.J.; Massey H.T.;
Tchantchaleishvili V.
Institution
(Reddy, Choi, Maynes, Carlson, Gordon, Horan, Khan, Weber, Morris, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Bodzin) Division of Transplant Surgery, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
W.B. Saunders
Abstract
Background: In patients who require orthotopic liver transplant (OLT),
cardiac surgery may be needed to optimize preoperative cardiac status for
OLT. The aim of this systematic review was to evaluate patient
characteristics and outcomes of those undergoing staged versus concomitant
cardiac procedures with OLT. Method(s): An electronic search was
performed to identify all case reports and series, from which
patient-level data was extracted regarding cardiac procedures associated
with OLT. After assessment for inclusion and exclusion criteria, 26
articles were pooled for systematic review. Result(s): Overall, 49
patients were included in the analysis, of whom 12 (24%) underwent staged
procedures and 37 (76%) underwent concomitant procedures. The median age
was lower in the staged group [staged: 51 (IQR, 43.8-59.2) years vs.
concomitant: 60 (IQR, 55.0-64.0) years, p = .02]. Other baseline
characteristics were comparable between the two groups. For staged
procedures, the median time between heart procedures and OLT was 2 (IQR,
1.0-3.5) months. The most commonly reported cardiac procedures were
coronary artery bypass graft (CABG) [staged: 4/12 (33.3%) vs. concomitant:
21/37 (56.8%), p = .28], aortic valve replacement (AVR) [staged: 3/12
(25.0%) vs. concomitant: 19/37 (51.2%), p = .21], and transcatheter aortic
valve replacement (TAVR) [staged: 4/12 (33.3%) vs. concomitant: 0/37 (0%),
p = .002]. Regarding outcomes, there was a significantly shorter post-OLT
hospital stay for those who had staged procedures versus those who had
concomitant procedures [staged: 8 (IQR, 5-13) days vs. concomitant: 17
(IQR, 14-24) days, p = .007]. However, both groups had similar in-hospital
mortality rates [staged: 1/12 (8.3%) vs. concomitant: 4/37 (10.8%), p =
1.0]. Overall survival stratified between the two groups was comparable.
 Conclusion(s): Patients who underwent the staged approach had a
shorter post-transplant hospital stay, but comparable survival with
respect to those who underwent concomitant cardiac procedures and
OLT. Copyright © 2019 Elsevier Inc.

<17>
Accession Number
628014780
Title
Effect of the PCSK9 Inhibitor Evolocumab on Total Cardiovascular Events in
Patients with Cardiovascular Disease: A Prespecified Analysis from the
FOURIER Trial.
Source
JAMA Cardiology. 4 (7) (pp 613-619), 2019. Date of Publication: July 2019.
Author
Murphy S.A.; Pedersen T.R.; Gaciong Z.A.; Ceska R.; Ezhov M.V.; Connolly
D.L.; Jukema J.W.; Toth K.; Tikkanen M.J.; Im K.; Wiviott S.D.; Kurtz
C.E.; Honarpour N.; Giugliano R.P.; Keech A.C.; Sever P.S.; Sabatine M.S.
Institution
(Murphy, Im, Wiviott, Giugliano, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, 60 Fenwood Rd, Ste
7022, Boston, MA 02115, United States
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Diseases, Medical University of Warsaw, Warsaw, Poland
(Ceska) Center for Preventive Cardiology, 3rd Internal Medicine Clinic,
University General Hospital, Charles University, 1st Medical Faculty,
Prague, Czechia
(Ezhov) National Cardiology Research Center, Moscow, Russian Federation
(Connolly) Birmingham City and Sandwell Hospitals and the Institute of
Cardiovascular Sciences, University of Birmingham, Birmingham, United
Kingdom
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Toth) First Department of Medicine, University of Pecs, Medical School,
Pecs, Hungary
(Tikkanen) Folkhalsan Research Center, University of Helsinki, Helsinki,
Finland
(Kurtz, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) Imperial College London, London, United Kingdom
(Sabatine) JAMA Cardiology
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The PCSK9 inhibitor evolocumab reduced low-density lipoprotein
cholesterol and first cardiovascular events in the Further Cardiovascular
Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk
(FOURIER) trial, but patients remain at high risk of recurrent
cardiovascular events. Objective(s): To evaluate the effect of
evolocumab on total cardiovascular events, given the importance of total
number of cardiovascular events to patients, clinicians, and health
economists. Design, Setting, and Participant(s): Secondary analysis
of a randomized, double-blind clinical trial. The FOURIER trial compared
evolocumab or matching placebo and followed up patients for a median of
2.2 years. The study included 27564 patients with stable atherosclerotic
disease receiving statin therapy. Data were analyzed between May 2017 and
February 2019. Main Outcomes and Measures: The primary end point
(PEP) was time to first cardiovascular death, myocardial infarction,
stroke, hospitalization for unstable angina, or coronary
revascularization; the key secondary end point was time to first
cardiovascular death, myocardial infarction, or stroke. In a prespecified
analysis, total cardiovascular events were evaluated between treatment
arms. Result(s): The mean age of patients was 63 years, 69% of
patients were taking high-intensity statin therapy, and the median LDL-C
at baseline was 92 mg/dL (to convert to millimoles per liter, multiply by
0.0259). There were 2907 first PEP events and 4906 total PEP events during
the trial. Evolocumab reduced total PEP events by 18% (incidence rate
ratio [RR], 0.82; 95% CI, 0.75-0.90; P <.001) including both first events
(hazard ratio, 0.85; 95% CI, 0.79-0.92; P <.001) and subsequent events
(RR, 0.74; 95% CI, 0.65-0.85). There were 2192 total primary events in the
evolocumab group and 2714 total events in the placebo group. For every
1000 patients treated for 3 years, evolocumab prevented 22 first PEP
events and 52 total PEP events. Reductions in total events were driven by
fewer total myocardial infarctions (RR, 0.74; 95% CI, 0.65-0.84; P <.001),
strokes (RR, 0.77; 95% CI, 0.64-0.93; P =.007), and coronary
revascularizations (RR, 0.78; 95% CI, 0.71-0.87; P <.001).
 Conclusions and Relevance: The addition of the PCSK9 inhibitor
evolocumab to statin therapy improved clinical outcomes, with significant
reductions in total PEP events, driven by decreases in myocardial
infarction, stroke, and coronary revascularization. More than double the
number of events were prevented with evolocumab vs placebo as compared
with the analysis of only first events. These data provide further support
for the benefit of continuing aggressive lipid-lowering therapy to prevent
recurrent cardiovascular events. Trial Registration: ClinicalTrials.gov
identifier: NCT01764633. Copyright © 2019 American Medical
Association. All rights reserved.

<18>
Accession Number
628429793
Title
Impact of cell saver during cardiac surgery on blood transfusion
requirements: a systematic review and meta-analysis.
Source
Vox Sanguinis. (no pagination), 2019. Date of Publication: 2019.
Author
Al Khabori M.; Al Riyami A.; Siddiqi M.S.; Sarfaraz Z.K.; Ziadinov E.; Al
Sabti H.
Institution
(Al Khabori, Al Riyami) Department of Hematology, Sultan Qaboos University
Hospital, Muscat, Oman
(Siddiqi, Sarfaraz, Ziadinov, Al Sabti) Department of Cardiac Surgery,
Sultan Qaboos University Hospital, Muscat, Oman
(Al Sabti) Oman Medical Specialty Board, Muscat, Oman
Publisher
Blackwell Publishing Ltd
Abstract
Objective: We performed a systematic review and meta-analysis of
randomized clinical trials on adult patients undergoing cardiac surgery
and compared the rates of red blood cell (RBC), platelet and fresh frozen
plasma (FFP) transfusion between the cell saver (CS) and the standard of
care groups. Method(s): MEDLINE , The Cochrane Central Register of
Controlled Trials (CENTRAL), American Society of Hematology (ASH) and
bibliographies of relevant studies were searched. We used random-effect
model. Result(s): Our search strategy returned 624 citations, of
which 15 studies were selected. The use of CS did not decrease the rate of
RBC transfusion (odds ratio [OR]: 0.69; 95% CI: 0.48-1.00), albeit with a
substantial heterogeneity (I2 = 60%). The year of publication
explained most of the heterogeneity (P for subgroup effect <0.001).
Although the rate of platelet transfusion was lower in the CS group, the
difference was not statistically significant (OR: 0.83; 95% CI: 0.57-1.2;
I2 = 0%). The rate of FFP transfusion was numerically higher in
the CS group; however, this difference did not reach statistical
significance (OR: 1.26; 95% CI: 0.82-1.94; I2 = 15%). Only two
studies scored five on the Jadad score. There was no indication of a
publication bias using the funnel plot and Egger test (P = 0.34, 0.87, and
0.62 for RBC, platelet and FFP, respectively). Conclusion(s): The use
of CS during cardiac surgery does not have an impact on the rates of RBC,
platelet and FFP transfusion; however, this should be interpreted in the
light of the study limitations. Copyright © 2019 International
Society of Blood Transfusion

<19>
Accession Number
2002307387
Title
Hemadsorption during cardiopulmonary bypass reduces interleukin 8 and
tumor necrosis factor alpha serum levels in cardiac surgery: A randomized
controlled trial.
Source
Minerva Anestesiologica. 85 (7) (pp 715-723), 2019. Date of Publication:
2019.
Author
Garau I.; Marz A.; Sehner S.; Reuter D.A.; Reichenspurner H.; Zollner C.;
Kubitz J.C.
Institution
(Garau, Zollner, Kubitz) Department of Anesthesiology, Center of
Anesthesiology and Intensive Care Medicine, University Hospital
Hamburg-Eppendorf, Hamburg, Germany
(Marz, Reuter) Department of Anesthesiology, Rostock University Medical
Center, University of Rostock, Rostock, Germany
(Sehner) Department of Medical Biometry and Epidemiology, University
Medical Center, Hamburg-Eppendorf, Hamburg, Germany
(Reichenspurner) Department of Cardiothoracic Surgery, University Heart
Center, Hamburg-Eppendorf, Hamburg, Germany
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Surgical trauma and cardiopulmonary bypass (CPB) are
associated with the liberation of pro-inflammatory cytokines. With
hemadsorption (Cytosorb) during CPB, pro-inflammatory cytokines
may be reduced and the inflammatory response may be decreased.
 METHOD(S): In this prospective, randomized single center study, serum
cytokine levels of interleukin 8 (Il-8), interleukin 6 (Il-6) and
tumor-necrosis-factor alpha (TNFalpha) were assessed in elective on-pump
cardiac surgery patients with hemadsorption on CPB (study group [SG],
N.=20) and without (control group [CG], N.=20). Cytokine levels were
assessed prior to CPB, at the end of CPB, and 6 hours (h) and 24 h after
the end of CPB, together with a hemodynamic assessment. Cardiac-Index (CI)
was assessed with transcardiopulmonary thermodilution. RESULT(S): For
Il-8, significantly lower serum levels were observed in the SG compared to
the CG at the end of CPB (P=0.008). In the SG, TNFalpha levels were also
below those in the CG at both the end of and 6h after CPB (P=0.034). After
24 hours, TNFalpha levels were at baseline in both groups. No significant
differences were found for Il-6. The CI was significantly higher in the SG
at the end of CPB (P=0.025). However, there was no difference between both
groups 6 h after CPB. CONCLUSION(S): This prospective study shows a
significant reduction in pro-inflammatory cytokine levels of Il-8 and
TNFalpha with hemadsorption in on-pump cardiac surgery whilst also
demonstrating safety in its applications. However, the differences in
cytokine levels and CI between patients treated with hemadsorption and
those without were minor and of short duration. Copyright © 2018
EDIZIONI MINERVA MEDICA

<20>
[Use Link to view the full text]
Accession Number
627568554
Title
Ultrasound-Guided Femoral Arterial Cannulation in Neonates Undergoing
Cardiac Surgery or Catheterization: Comparison of 0.014-Inch Floppy Versus
0.019-Inch Straight Guidewire.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 20 (7) (pp 608-613), 2019. Date of Publication: 01 Jul
2019.
Author
Polat T.B.
Institution
(Polat) Department of Pediatric Cardiology, Altinbas University School of
Medicine, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Percutaneous femoral artery cannulation can be technically
challenging in small infants. DESIGN: We designed a prospective randomized
trial to compare the use of two different guidewires for femoral arterial
cannulation in neonates undergoing cardiac surgery or catheterization.
SETTINGS: Cardiac ICU in a university hospital. PATIENTS: One-hundred
twenty-four children were enrolled in this prospective study, with 64
being randomized to the 0.019-inch straight guidewire group and 60 to the
0.014-inch floppy guidewire group. INTERVENTIONS: Femoral artery
cannulation. MEASUREMENTS AND MAIN RESULTS: The study period was limited
to 10 minutes at the first site of arterial puncture. The time to complete
cannulation, number of successful cannulation on first attempt, number of
attempts, and number of successful cannulations were compared. The number
of successful cannulations and successful cannulations on first attempt
were higher in 0.014-inch floppy guidewire group (p = 0.001; p = 0.002,
respectively). The time to complete cannulation was significantly shorter,
and the number of attempts was lower in 0.014-inch floppy guidewire group
(p = 0.001). Among the neonates less than 2000g, the number of attempts
and time to complete cannulation were significantly lower (p < 0.001), and
number of successful cannulation on first attempt and number of successful
cannulations were significantly higher (p < 0.028; p < 0.001,
respectively) in the 0.014-inch floppy guidewire CONCLUSION(S)::
Using 0.014-inch floppy guidewire for femoral arterial cannulation in
particularly very small neonates provides significant improvement in first
attempt success, number of successful cannulations, number of attempts,
time to complete cannulation.

<21>
Accession Number
2002358732
Title
Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass:
Randomized Controlled Trial.
Source
Journal of the American College of Cardiology. 74 (5) (pp 659-668), 2019.
Date of Publication: 6 August 2019.
Author
Graham E.M.; Martin R.H.; Buckley J.R.; Zyblewski S.C.; Kavarana M.N.;
Bradley S.M.; Alsoufi B.; Mahle W.T.; Hassid M.; Atz A.M.
Institution
(Graham, Martin, Buckley, Zyblewski, Kavarana, Bradley, Hassid, Atz)
Medical University of South Carolina, Charleston, SC, United States
(Alsoufi, Mahle) Children's Healthcare of Atlanta and Emory University,
Atlanta, Georgia
Publisher
Elsevier USA
Abstract
Background: The efficacy of intraoperative corticosteroids to improve
outcomes following congenital cardiac operations remains controversial.
 Objective(s): The purpose of this study was to determine whether
intraoperative methylprednisolone improves post-operative recovery in
neonates undergoing cardiac surgery. Method(s): Neonates undergoing
cardiac surgery with cardiopulmonary bypass at 2 centers were enrolled in
a double-blind randomized controlled trial of methylprednisolone (30
mg/kg) or placebo after the induction of anesthesia. The primary outcome
was a previously validated morbidity-mortality composite that included any
of the following events following surgery before discharge: death,
mechanical circulatory support, cardiac arrest, hepatic injury, renal
injury, or rising lactate level (>5 mmol/l). Result(s): Of the 190
subjects enrolled, 176 (n = 81 methylprednisolone, n = 95 placebo) were
included in this analysis. A total of 27 (33%) subjects in the
methylprednisolone group and 40 (42%) in the placebo group reached the
primary study endpoint (odds ratio [OR]: 0.63; 95% confidence interval
[CI]: 0.31 to 1.3; p = 0.21). Methylprednisolone was associated with
reductions in vasoactive inotropic requirements and in the incidence of
the composite endpoint in subjects undergoing palliative operations (OR:
0.38; 95% CI: 0.15 to 0.99; p = 0.048). There was a significant
interaction between treatment effect and center. In this analysis,
methylprednisolone was protective at 1 center, with an OR: 0.35 (95% CI:
0.15 to 0.84; p = 0.02), and not so at the other center, with OR: 5.13
(95% CI: 0.85 to 30.90; p = 0.07). Conclusion(s): Intraoperative
methylprednisolone failed to show an overall significant benefit on the
incidence of the composite primary study endpoint. There was, however, a
benefit in patients undergoing palliative procedures and a significant
interaction between treatment effect and center, suggesting that there may
be center or patient characteristics that make prophylactic
methylprednisolone beneficial. Copyright © 2019 American College
of Cardiology Foundation

<22>
Accession Number
628614478
Title
Aortic or Pulmonary Valved Homograft Right Ventricle to Pulmonary Artery
Conduit in the Norwood Procedure.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 10 (4) (pp
499-501), 2019. Date of Publication: 01 Jul 2019.
Author
Nasirov T.; Maeda K.; Reinhartz O.
Institution
(Nasirov, Maeda, Reinhartz) Department of Cardiothoracic Surgery, Stanford
University School of Medicine, Palo Alto, CA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Several modifications of the Norwood procedure utilizing
valved right ventricle to pulmonary artery conduits have recently been
reported. Our group has been using aortic or pulmonary valved homografts
combined with PTFE tube grafts for now 16 years. Method(s): In this
report, we review our technique in detail and describe any changes that
have occurred over the years. We provide detailed illustrations of our
preferred surgical technique, report outcome data, and compare it to the
other conduit options available. Result(s): Between 2006 and 2015,
130 stage I Norwood procedures were performed at our institution, 100 of
them using valved conduits. Our technique is described and illustrated in
detail. Early mortality was 15%. Postoperative percutaneous intervention
on the conduit was required in 29% of cases. Conclusion(s): While a
randomized trial comparing different valved conduits is lacking, we
believe a composite conduit made from homograft aortic or pulmonary valves
and PTFE tube grafts is an excellent choice in stage I Norwood
procedure. Copyright © The Author(s) 2019.

<23>
Accession Number
628626085
Title
The 100 most cited manuscripts in coronary artery bypass grafting.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 03
Jul 2019.
Author
Chan J.; Mak T.L.A.; Chu T.S.M.; Hui T.L.Y.; Kwan L.Y.A.
Institution
(Chan) Department of Cardiothoracic Surgery, Morriston Hospital, Swansea,
United Kingdom
(Mak, Kwan) Institute of Medical and Biomedical Education, University of
London, St George's, London, United Kingdom
(Chu) School of Medical Education, Newcastle University, Newcastle upon
Tyne, United Kingdom
(Hui) College of Medicine and Health, University of Exeter Medical School,
Exeter, United Kingdom
Publisher
NLM (Medline)
Abstract
INTRODUCTION: To gain a better understanding of the progression of
coronary artery bypass grafting (CABG) and its impact on clinical
practice, bibliometric citation analysis can be performed. Bibliometric
citation analysis is a method of determining the most influential papers
on a topic based on several citations and impact factor. METHOD(S): A
search of the Thomson Reuters Web of Science citation indexing database
and research platform was completed using the terms "CABG," "Coronary
artery bypass graft," "Coronary artery," "bypass," and/or "bypass
grafting." The returned dataset was sorted by the number of citations.
 RESULT(S): The search yielded a total of 11560 papers which were
ranked in order of citations. New England Journal of Medicine published
the most papers in the top 100 and generated the most significant number
of citations with 20 papers in total followed by Journal of the American
College of Cardiology. It also has the highest impact factor and 5-year
impact fact in 2007 of 79.26 and 67.513, respectively. CONCLUSION(S):
The most cited manuscripts by Serruys et al described a randomised trial
comparing percutaneous coronary intervention and CABG for treating severe
coronary artery disease. This work provides the most influential
references related to CABG and serves as a guide as to the area of focus
in CABG. Copyright © 2019 Wiley Periodicals, Inc.

<24>
Accession Number
628623364
Title
Systematic review and meta-analysis of staged vs simultaneous coronary
artery bypass grafting surgery and carotid endarterectomy.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 03
Jul 2019.
Author
Chan J.S.K.; Shafi A.M.A.; Grafton-Clarke C.; Singh S.; Harky A.
Institution
(Chan, Singh) Faculty of Medicine, Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong, China
(Chan) Division of Cardiology, Department of Medicine and Therapeutics,
Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
(Shafi) Department of Cardiothoracic Surgery, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Grafton-Clarke) Department of Surgery, Northampton General Hospital,
Northampton, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To systematically compare outcomes between patients with
asymptomatic carotid artery diseases (>80% stenosis) that had undergone
staged carotid endarterectomy (CEA) before coronary artery bypass grafting
(CABG) vs simultaneous CEA and CABG. METHOD(S): A comprehensive
electronic search of MEDLINE, Scopus, EMBASE, and Ovid from their
inception up till August 2018 was performed to identify all studies
comparing staged CEA followed by CABG to simultaneous CEA and CABG.
Primary outcome measure was postoperative stroke, and secondary measures
were myocardial infarction (MI) and 30-day mortality rates.
 RESULT(S): A total of 67953 patients were analyzed from 11 articles.
There was higher rate of previous stroke in the staged cohort (2.64% vs
2.32%; odds ratio [OR], 0.81; 95% confidence interval [CI; 0.66, 0.99];
P=.040). There was no difference in previous MI (P=.57) or unstable angina
(P=.08) among both cohorts. Postoperatively, there were higher stroke
rates (3.64% vs 2.83%; OR, 0.72; 95% CI [0.62-0.89]; P<.0001), operative
mortality (4.32% vs 3.58%; OR, 0.90; 95% CI [0.83-0.98]; P=.02), and
30-day mortality (4.40% vs 3.58%; OR, 0.86; 95% CI [0.78-0.96]; P=.006) in
the simultaneous cohort. However, length of stay was significantly shorter
in the simultaneous cohort (11.9 days vs 12.6 days; weighted mean
difference 3.14 [0.77-5.51]; P=.009). There were no significant
differences in 1-year mortality (P=.33), MI rates (P=.08), and rates of
transient neurological deficits (P=.06). CONCLUSION(S): The results
from this study favors staged CEA with CABG with lower incidence of
postoperative stroke, operative, and 30-day mortality. A larger study,
ideally a randomized controlled trial, is required to address the
superiority of each technique. Copyright © 2019 Wiley
Periodicals, Inc.

<25>
Accession Number
628621846
Title
The Effect of Levosimendan Versus Milrinone on the Occurrence Rate of
Acute Kidney Injury Following Congenital Heart Surgery in Infants: A
Randomized Clinical Trial.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. (no pagination), 2019. Date of Publication: 03 Jul 2019.
Author
Thorlacius E.M.; Suominen P.K.; Wahlander H.; Keski-Nisula J.; Vistnes M.;
Ricksten S.-E.; Synnergren M.; Romlin B.S.; Castellheim A.
Institution
(Thorlacius, Ricksten, Romlin, Castellheim) Department of Anesthesiology
and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg
and Queen Silvia Children's Hospital, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Suominen, Keski-Nisula) Department of Anesthesia and Intensive Care,
Children's Hospital, Helsinki University Central Hospital, Helsinki,
Finland
(Wahlander) Department of Pediatric Cardiology, Sahlgrenska Academy,
University of Gothenburg and Queen Silvia Children's Hospital, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Vistnes) Department of Internal Medicine, Diakonhjemmet Hospital and
Institute for Experimental Medical Research, Oslo University Hospital and
University of Oslo, Oslo, Norway
(Synnergren) Department of Pediatric Thoracic Surgery, Queen Silvia
Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
OBJECTIVES: It has been shown that, in contrast to other inotropic agents,
levosimendan improves glomerular filtration rate after adult cardiac
surgery. The aim of this study was to investigate the efficacy of
levosimendan, compared with milrinone, in preventing acute kidney
dysfunction in infants after open-heart surgery with cardiopulmonary
bypass. DESIGN: Two-center, double-blinded, prospective, randomized
clinical trial. SETTING: The study was performed in two tertiary pediatric
centers, one in Sweden (Gothenburg) and one in Finland (Helsinki).
PATIENTS: Infants between 1 and 12 months old, diagnosed with Tetralogy of
Fallot, complete atrioventricular septal defect or nonrestrictive
ventricular septal defect, undergoing total corrective cardiac surgery
with cardiopulmonary bypass. INTERVENTIONS: Seventy-two infants were
randomized to receive a perioperative infusion of levosimendan (0.1
micro g/kg/min) or milrinone (0.4 micro g/kg/min). The infusion
was initiated at the start of cardiopulmonary bypass and continued for 26
hours. MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was the
absolute value of serum creatinine data on postoperative day 1. Secondary
outcomes included the following: 1) acute kidney injury according to the
serum creatinine criteria of the Kidney Diseases: Improving Global
Outcomes; 2) acute kidney injury with serum creatinine corrected for fluid
balance; 3) plasma neutrophil gelatinase-associated lipocalin; 4) cystatin
C; 5) urea; 6) lactate; 7) hemodynamic variables; 8) use of diuretics in
the PICU; 9) need of dialysis; 10) length of ventilator therapy; and 11)
length of PICU stays. There was no significant difference in postoperative
serum creatinine between the treatment groups over time (p = 0.65). The
occurrence rate of acute kidney injury within 48 hours was 46.9% in the
levosimendan group and 39.5% in the milrinone group (p = 0.70). There were
no significant differences in other secondary outcome variables between
the groups. CONCLUSION(S): Levosimendan compared with milrinone did
not reduce the occurrence rate of acute kidney injury in infants after
total corrective heart surgery for atrioventricular septal defect,
ventricular septal defect, or Tetralogy of Fallot.

<26>
Accession Number
628619331
Title
Efficacy and safety of alirocumab and evolocumab: a systematic review and
meta-analysis of randomized controlled trials.
Source
European heart journal. (no pagination), 2019. Date of Publication: 03 Jul
2019.
Author
Guedeney P.; Giustino G.; Sorrentino S.; Claessen B.E.; Camaj A.; Kalkman
D.N.; Vogel B.; Sartori S.; De Rosa S.; Baber U.; Indolfi C.; Montalescot
G.; Dangas G.D.; Rosenson R.S.; Pocock S.J.; Mehran R.
Institution
(Guedeney, Giustino, Sorrentino, Claessen, Camaj, Kalkman, Vogel, Sartori,
Baber, Dangas, Rosenson, Mehran) Center for Interventional Cardiovascular
Research, The Zena and Michael A. Weiner Cardiovascular Institute, The
Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box
1030, New York, NY 10029, USA
(Guedeney, Montalescot) Department of Cardiology, Sorbonne Universite,
ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie (AP-HP),
hopital Pitie Salpetriere, Paris, France
(Sorrentino, De Rosa, Indolfi) Division of Cardiology, Department of
Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
(Kalkman) Department of Cardiology, Academic Medical Center - University
of Amsterdam, Amsterdam, Netherlands
(Pocock) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
Publisher
NLM (Medline)
Abstract
AIMS: The effect of low-density lipoprotein cholesterol-lowering therapy
with alirocumab or evolocumab on individual clinical efficacy and safety
endpoints remains unclear. We aimed to evaluate the efficacy and safety of
alirocumab and evolocumab in patients with dyslipidaemia or
atherosclerotic cardiovascular disease. METHODS AND RESULTS: We performed
a review of randomized controlled trials (RCTs) comparing treatment with
alirocumab or evolocumab vs. placebo or other lipid-lowering therapies up
to March 2018. Primary efficacy endpoints were all-cause death,
cardiovascular death, myocardial infarction (MI), and stroke. We estimated
risk ratios (RR) and 95% confidence intervals (CI) using random effect
models. We included 39 RCTs comprising 66 478 patients of whom 35 896 were
treated with proprotein convertase subtilisin-kexin type 9 (PCSK9)
inhibitors (14 639 with alirocumab and 21 257 with evolocumab) and 30 582
with controls. Mean weighted follow-up time across trials was 2.3years
with an exposure time of 150 617 patient-years. Overall, the effects of
PCSK9 inhibition on all-cause death and cardiovascular death were not
statistically significant (P=0.15 and P=0.34, respectively). Proprotein
convertase subtilisin-kexin type 9 inhibitors were associated with lower
risk of MI (1.49 vs. 1.93 per 100 patient-year; RR 0.80, 95% CI 0.74-0.86;
I2 = 0%; P<0.0001), ischaemic stroke (0.44 vs. 0.58 per 100 patient-year;
RR 0.78, 95% CI 0.67-0.89; I2 = 0%; P=0.0005), and coronary
revascularization (2.16 vs. 2.64 per 100 patient-year; RR 0.83, 95% CI
0.78-0.89; I2 = 0%; P<0.0001), compared with the control group. Use of
these PCSK9 inhibitors was not associated with increased risk of
neurocognitive adverse events (P=0.91), liver enzymes elevations (P=0.34),
rhabdomyolysis (P=0.58), or new-onset diabetes mellitus (P=0.97).
 CONCLUSION(S): Proprotein convertase subtilisin-kexin type 9
inhibition with alirocumab or evolocumab was associated with lower risk of
MI, stroke, and coronary revascularization, with favourable safety
profile. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2019. For
permissions, please email: journals.permissions@oup.com.

<27>
Accession Number
628616888
Title
Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT)
Feasibility of a Pilot Randomized Controlled Trial.
Source
Journal of cardiac failure. (no pagination), 2019. Date of Publication: 02
Jul 2019.
Author
Grady K.L.; Andrei A.-C.; Shankel T.; Chinnock R.; Miyamoto S.D.;
Ambardekar A.V.; Anderson A.; Addonizio L.; Latif F.; Lefkowitz D.;
Goldberg L.R.; Hollander S.A.; Pham M.; Van't Hof K.; Weissberg-Benchell
J.; Yancy C.; Liu M.; Melody N.; Pahl E.
Institution
(Grady, Andrei, Liu) Department of Surgery, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Shankel, Chinnock) Department of Medicine, Loma Linda University
Children's Hospital, Loma Linda, CA, United States
(Miyamoto) Department of Medicine, Children's Hospital Colorado, Aurora,
CO, United States
(Ambardekar) Department of Medicine, University of Colorado, Aurora, CO,
United States
(Anderson, Yancy) Department of Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Addonizio, Latif) Department of Medicine, Columbia University Medical
Center, New York, NY
(Lefkowitz) Department of Psychiatry, Children's Hospital of Philadelphia,
Philadelphia, PA, United States
(Goldberg) Department of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Hollander, Pham) Department of Medicine, Stanford University, Palo Alto,
CA, United States
(Van't Hof, Pahl) Department of Medicine, Ann & Robert H. Lurie Children's
Hospital of Chicago, Chicago, IL, United States
(Weissberg-Benchell) Department of Psychiatry, Ann & Robert H. Lurie
Children's Hospital of Chicago, Chicago, IL, United States
(Melody) Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Young adult heart transplant (HT) recipients transferring to
adult care are at risk for poor health outcomes. We conducted a pilot
randomized controlled trial to determine feasibility and test a transition
intervention for young adults who underwent HT as children and transferred
to adult care. METHOD(S): Participants were randomized to the
transition intervention (4 months long, focused on HT knowledge,
self-care, self-advocacy, and social support) or usual care. Self-report
questionnaires and medical records data were collected at baseline and 3
and 6 months after the initial adult clinic visit. Longitudinal analyses
comparing outcomes over time were performed using generalized estimating
equations and linear mixed models. RESULT(S): Transfer to adult care
was successful and feasible (i.e., excellent participation rates). The
average patient standard deviation of mean tacrolimus levels was similar
over time in both study arms and < 2.5, indicating adequate adherence.
There were no between group and within group differences in percent of
tacrolimus bioassays within target range (>50%). Average overall adherence
to treatment was similarly good for both groups. Rates of appointment
keeping through 6 months after transfer declined over time in both groups.
 CONCLUSION(S): Feasibility of the study was demonstrated. Our
transition intervention did not improve outcomes. Copyright ©
2019. Published by Elsevier Inc.

<28>
Accession Number
628628965
Title
Nontraumatic tension pneumopericardium in nonventilated pediatric
patients: a review.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 03
Jul 2019.
Author
Bonardi C.M.; Spadini S.; Fazio P.C.; Galiazzo M.; Voltan E.; Coscini N.;
Padalino M.; Daverio M.
Institution
(Bonardi, Spadini, Fazio, Galiazzo, Voltan, Daverio) Department of Woman's
and Child's Health, Pediatric Intensive Care Unit, University Hospital of
Padua, Padua, Italy
(Coscini) Department for Community Child Health, Royal Children's
Hospital, Melbourne, Australia
(Padalino) Department of Cardiac, Thoracic and Vascular Sciences,
Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua,
Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIMS: Pneumopericardium is a rare air leak syndrome caused
by the abnormal presence of air in the pericardial sac, with a high risk
of morbidity and mortality. It is clinically divided into nontension and
tension pneumopericardium, with the latter resulting in a decreased
cardiac output and circulatory failure. There are limited data regarding
nontraumatic pneumopericardium in nonventilated pediatric patients.
Therefore, we aimed to describe a case of tension pneumopericardium and
review the available literature. METHOD(S): Case report and
literature review of nontraumatic pneumopericardium in nonventilated
pediatric patients. RESULT(S): A 2-month-old infant developed cardiac
tamponade secondary to tension pneumopericardium 11 days after cardiac
surgery promptly resolved with pericardium drainage. We reviewed the
literature on this topic and retrieved 50 cases, of which 72% were
nontension whereas a minority were tension pneumopericardium (28%).
Patients with tension pneumopericardium were mostly neonates (35.7% vs
22.2%), presented with an isolated air leak (64.3% vs 36.1%), and had a
history of surgery (28.6% vs 8.3%) or hematological disease (28.6% vs
11.1%). In all nontension cases, treatment was conservative, whilst in all
other cases, pericardiocentesis/pericardium drainage was carried out.
There was a high survival rate (86.0%), which was lower in patients with
tension pneumopericardium (71.4% vs 91.6%). CONCLUSION(S):
Pneumopericardium is a rare condition with a higher mortality rate in
patients with tension pneumopericardium, which requires immediate
diagnosis and treatment. In nonventilated patients, tension
pneumopericardium occurred more frequently in neonates, as an isolated air
leak, and in those with a history of surgery or hematological
disease. Copyright © 2019 Wiley Periodicals, Inc.

<29>
Accession Number
2001453938
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Chronic Kidney Disease: A Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (8) (pp 2221-2230),
2019. Date of Publication: August 2019.
Author
Cheng X.; Hu Q.; Zhao H.; Qin S.; Zhang D.
Institution
(Cheng, Qin, Zhang) Department of Cardiology, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Hu) Department of Clinical Laboratory, Chongqing General Hospital,
Chongqing, China
(Zhao) Department of Cardiology, People's Hospital of Chongqing Banan,
Chongqing, China
Publisher
W.B. Saunders
Abstract
Objective: The aim of this meta-analysis was to compare the clinical
outcomes of transcatheter aortic valve replacement (TAVR) with those of
surgical aortic valve replacement (SAVR) in patients with chronic kidney
disease (CKD). Design(s): Meta-analysis of 10 observational studies.
 Setting(s): Hospital. Participant(s): Patients with CKD (9,619)
undergoing aortic valve replacement. Intervention(s): None.
 Measurements and Main Results: The Medline, Cochrane Library, and
Embase databases were searched for clinical studies published from January
2000 to October 2018. Studies that fulfilled the predefined inclusion
criteria were included. The primary clinical outcomes included early
all-cause mortality and postoperative stroke. Random-effects modeling was
used to calculate odds ratio (OR) and 95% CI. After a literature search of
the major databases, 10 observational cohort studies with a total of 9,619
patients were identified. Pooled analysis indicated that, when compared
with SAVR, TAVR was associated with a lower risk of early all-cause
mortality (6.1% v 10.2%; OR: 0.71; 95% CI: 0.51-0.98) and stroke (1.1% v
2.2%; OR: 0.53; 95% CI: 0.37-0.75). Although TAVR increased the risk of
pacemaker implantation (OR: 2.06; 95% CI: 1.16-3.66), it reduced the risk
of blood transfusion (OR: 0.50; 95% CI: 0.39-0.65), infection (OR: 0.30;
95% CI: 0.13-0.70), acute kidney injury (AKI) (OR: 0.46; 95% CI:
0.38-0.55), and AKI requiring dialysis (OR: 0.66; 95% CI: 0.58-0.75).
There were not significant differences in the incidence rates of cardiac
tamponade (OR: 0.60; 95% CI: 0.26-1.36) and major vascular damage (OR:
1.12; 95% CI: 0.81-1.55) between the 2 groups. Conclusion(s):
Transcatheter aortic valve replacement might be a preferable approach to
SAVR in patients with CKD. A large, prospective, randomized controlled
trial is warranted. Copyright © 2018 Elsevier Inc.

<30>
Accession Number
2001446157
Title
The Role of Tolvaptan Administration After Cardiac Surgery: A
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (8) (pp 2170-2179),
2019. Date of Publication: August 2019.
Author
Bellos I.; Iliopoulos D.C.; Perrea D.N.
Institution
(Bellos, Iliopoulos, Perrea) Laboratory of Experimental Surgery and
Surgical Research N.S. Christeas, Athens University Medical School,
National and KaPOD istrian University of Athens, Athens, Greece
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the efficacy and safety of tolvaptan in fluid
management after cardiac surgery compared with conventional diuretic
treatment. Design(s): Systematic review of the literature with
meta-analyses. Setting(s): The Medline, Scopus, Cochrane Central
Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar
databases were searched from inception to July 30, 2018.
 Participant(s): The study comprised 759 patients undergoing cardiac
surgery. Intervention(s): Tolvaptan administration (n = 397) or
standard diuretic therapy (n = 398). Measurements and Main Results:
Ten studies were included in the present meta-analysis. Tolvaptan
administration was associated with a significantly faster return to
preoperative body weight (mean difference [MD)] -1.48 d, 95% confidence
interval [CI] -1.92 to 1.03), shorter duration of hospital stay (MD -2.58
d, 95% CI -5.09 to -0.07), lower incidence of acute kidney injury (odds
ratio 0.34, 95% CI 0.16-0.69), and greater urine output (MD 0.47 L/d, 95%
CI 0.25-0.69) and sodium levels (MD 2.85 mEq/L, 95% CI 1.90-3.80). No
significant differences were present regarding duration of intensive care
unit stay (MD -0.09 d, 95% CI -0.33 to 0.15), arrhythmia incidence (odds
ratio 0.58, 95% CI 0.33-1.02), and serum creatinine values (MD -0.08
mg/dL, 95% CI -0.20 to 0.04). Conclusion(s): The outcomes of the
present meta-analysis suggest the promising role of tolvaptan
administration in the management of fluid retention in patients after
cardiac surgery. Future large-scale clinical trials should be conducted to
fully elucidate its efficacy and to assess the optimal treatment protocol
to be applied in the clinical setting. Copyright © 2018 Elsevier
Inc.

<31>
Accession Number
2000461878
Title
Atorvastatin prevents postoperative atrial fibrillation in patients
undergoing cardiac surgery.
Source
Hellenic Journal of Cardiology. 60 (1) (pp 40-47), 2019. Date of
Publication: January - February 2019.
Author
Sai C.; Li J.; Ruiyan M.; Yingbin X.
Institution
(Sai, Li, Ruiyan, Yingbin) Department of Cardiovascular Surgery, Xinqiao
Hospital, Third Military Medical University, Chongqing, China
Publisher
Hellenic Cardiological Society
Abstract
Background: Observational studies have suggested that statins might reduce
postoperative atrial fibrillation (AF) in patients undergoing cardiac
surgery. However, a number of retrospective studies have shown equivocal
results. We aimed to evaluate whether different statins can reduce the
risk for AF at different doses. Method(s): We searched PubMed,
EMBASE, and the Cochrane Database for all published randomized controlled
trials (RCTs) that examined the effects of statin therapy on AF up to June
2016. A random-effects model was used when there was substantial
heterogeneity. Result(s): Eighteen published studies that included
4003 statin-naive patients (2009 receiving satins and 1994 receiving
regime) with sinus rhythm before cardiac surgeries were identified for
inclusion in the analysis. Thirteen studies investigated the prevention of
AF by atorvastatin, two studies investigated the prevention of AF by
rosuvastatin, two studies investigated the prevention of AF by
simvastatin, and one study investigated the prevention of AF by
pravastatin. The remaining two studies compared the effects of different
doses of atorvastatin on the prevention of AF in patients undergoing
coronary artery bypass grafting (CABG). Overall, statin therapy was
associated with a significant decrease in the risk for AF (relative risk
[RR]: 0.57, 95% confidence interval [CI]: 0.45-0.73, P = 0.000). However,
subgroup analyses showed that only atorvastatin reduced the risk for
new-onset AF in patients after cardiac surgery (RR: 0.53, 95% CI:
0.41-0.69, P = 0.000). Patients undergoing CABG possibly received more
benefits from statin therapy (RR: 0.52, 95% CI: 0.39-0.68).Statin therapy
in a moderate dose may be optimal (RR: 0.42, 95% CI: 0.28-0.64).
 Conclusion(s): This meta-analysis suggests that statin therapy has an
overall protective effect against postoperative AF, among which
atorvastatin in a moderate dose was significantly associated with a
decreased risk for new-onset AF in patients after CABG. Moreover,
simvastatin may also exert a significant protective effect against the AF
recurrences in patients undergoing cardiac surgeries; hence, further
prospective studies are warranted. Copyright © 2018 Hellenic
Society of Cardiology

<32>
Accession Number
2001563242
Title
Cardiac Prehabilitation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (8) (pp 2255-2265),
2019. Date of Publication: August 2019.
Author
McCann M.; Stamp N.; Ngui A.; Litton E.
Institution
(McCann, Stamp, Ngui, Litton) Fiona Stanley Hospital, Perth, WA, Australia
(Litton) St John of God Hospital, Subiaco, Perth, WA, Australia
Publisher
W.B. Saunders
Abstract
The care of patients undergoing cardiac surgery is becoming more complex,
in part owing to the increasing burden of comorbid disease, frailty, and
psychosocial issues. Many risk factors for postoperative morbidity and
mortality are potentially modifiable if identified and treated in a timely
fashion before surgery. Cardiac prehabilitation, draws from strategies
currently undertaken in cardiac rehabilitation but implements them
proactively rather than reactively. There is substantial evidence that in
multiple domains, including aerobic conditioning, respiratory muscle
training, lifestyle modification, diabetic control, sleep, and
psychoeducation, selected interventions before cardiac surgery may improve
outcomes. However, the optimal preoperative program remains unclear and
there is an unmet need for a comprehensive evaluation of the range of
interventions specifically targeted at modifiable perioperative risk
factors that may reduce adverse outcomes after cardiac
surgery. Copyright © 2019 Elsevier Inc.

<33>
Accession Number
620607562
Title
Long-term outcome of consecutive patients with previous coronary bypass
surgery, treated with newer-generation drug-eluting stents.
Source
Journal of the American Heart Association. 7 (3) (no pagination), 2018.
Article Number: e007212. Date of Publication: 01 Feb 2018.
Author
van der Heijden L.C.; Kok M.M.; Zocca P.; Sen H.; Lowik M.M.; Mariani S.;
de Man F.H.A.F.; Hartmann M.; Stoel M.G.; Gert van Houwelingen K.;
Louwerenburg J.H.W.; Linssen G.C.M.; Doggen C.J.M.; Grandjean J.G.; von
Birgelen C.
Institution
(van der Heijden, Kok, Zocca, Sen, Lowik, de Man, Hartmann, Stoel, Gert
van Houwelingen, Louwerenburg, von Birgelen) Department of Cardiology,
Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
(Mariani, Grandjean) Department of Cardiothoracic Surgery, Thoraxcentrum
Twente, Medisch Spectrum Twente, Enschede, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo and
Hengelo, Netherlands
(Doggen, von Birgelen) Department of Health Technology and Services
Research, MIRA-Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
Publisher
American Heart Association Inc.
Abstract
Background--Percutaneous coronary intervention (PCI) in patients with
previous coronary artery bypass grafting (CABG) is associated with adverse
clinical events. Although newer generation drug-eluting stents showed
favorable short-term safety profiles, there is a lack of long-term outcome
data. We evaluated the impact of previous CABG on 5-year clinical outcomes
of patients treated with PCI using newer-generation drug-eluting stents.
Methods and Results--In this patient-level pooled analysis of the
prospective TWENTE (The Real-World Endeavor Resolute versus Xience V
Drug-Eluting Stent Study in Twente) trial and nonenrolled TWENTE registry,
we assessed a consecutive series of patients who underwent PCI with
newer-generation drug-eluting stents for non-ST-segment-elevation acute
coronary syndromes or stable angina. Of all 1709 patients, 202 (11.8%) had
a history of CABG. Patients with previous CABG had significantly higher
5-year rates of cardiac death (10.4% versus 4.3%; P < 0.001) and target
vessel revascularization (25.0% versus 8.1%; P < 0.001). These differences
remained statistically significant after adjustment for differences in
baseline characteristics. Landmark analysis revealed that from 1- to
5-year follow-up, the rates of cardiac death (8.1% versus 3.2%; P < 0.001)
and target vessel revascularization (17.1% versus 5.9%; P < 0.001) were
significantly higher in patients with previous CABG. Among patients with a
history of CABG, PCI of an obstructed vein graft was associated with a
higher rate of 5-year target vessel revascularization (P=0.003).
Conclusions--At 5-year follow-up after PCI with newer-generation
drug-eluting stents, the risk of cardiac death and target vessel
revascularization was significantly higher in patients with previous CABG.
The target vessel revascularization rate was highest in patients who
underwent PCI of obstructed vein grafts. Copyright © 2018 The
Authors.

<34>
Accession Number
617399337
Title
Effect of anesthesia methods on postoperative major adverse cardiac events
and mortality after non-cardiac surgeries: A systematic review and
meta-analysis.
Source
Minerva Anestesiologica. 83 (7) (pp 749-761), 2017. Date of Publication:
July 2017.
Author
An R.; Pang Q.-Y.; Chen B.; Liu H.-L.
Institution
(An, Pang, Chen, Liu) Department of Anesthesiology, Chongqing Cancer
Institute, Hospital Cancer Center, Hanyu Road, 181, Shapingba District,
Chongqing City 400030, China
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Postoperative major adverse cardiac events (MACEs) are the
main cause of postoperative mortality, and controversies exist regarding
the effects of anesthesia methods on postoperative MACEs and mortality in
high-risk cardiac patients after non-cardiac surgeries. EVIDENCE
ACQUISITION: A Meta-analysis about the effect of anesthesia methods on
postoperative MACEs and mortality in high-risk cardiac patients undergoing
intermediate- or high-risk non-cardiac surgeries was conducted; Chinese
databases (SinoMed, CNKI, Wanfang, and VIP) and English databases
(Medline, EMBASE, PubMed, Springer, Ovid, the Cochrane Library, and Google
scholar) were searched. EVIDENCE SYNTHESIS: Twenty-seven randomized
controlled trials (RCTs) were included and 35340 patients were involved.
The cardiac troponin I level (cTnI) on postoperative day 1 (MD: -0.39, 95%
CI: -0.45-0.34, P<0.00001) and the incidence of myocardial ischaemia (OR:
0.43, 95% CI: 0.27-0.68, P=0.0004) within 3 postoperative days were
significantly lower after sevoflurane anesthesia than propofol anesthesia.
There were no differences in postoperative MACEs or in mortality within
either 30 days or 1 year between sevoflurane and propofol anesthesia, or
between N2O and non-N2O anesthesia. The cTnI on postoperative day 3 was
significantly lower from epidural anesthesia combined with general
anesthesia (GA) than from GA alone (MD: -0.61, 95% CI: -0.75-0.47,
P<0.00001). However, there were no differences in myocardial infarction or
mortality between epidural anesthesia combined with GA and GA alone, or
between spinal anesthesia alone and GA alone. CONCLUSION(S):
Sevoflurane anesthesia, or epidural combined with general anesthesia can
provide short-term myocardial protective effect in high-risk cardiac
patients undergoing intermediate- or high-risk non-cardiac
surgeries. Copyright © 2016 EDIZIONI MINERVA MEDICA.

<35>
Accession Number
2002321419
Title
Bone disease following solid organ transplantation: A narrative review and
recommendations for management from The European Calcified Tissue Society.
Source
Bone. 127 (pp 401-418), 2019. Date of Publication: October 2019.
Author
Anastasilakis A.D.; Tsourdi E.; Makras P.; Polyzos S.A.; Meier C.;
McCloskey E.V.; Pepe J.; Zillikens M.C.
Institution
(Anastasilakis) Department of Endocrinology, 424 General Military
Hospital, Thessaloniki 54638, Greece
(Tsourdi) Department of Medicine III, Technische Universitat Dresden
Medical Center, Dresden, Germany
(Tsourdi) Center for Healthy Aging, Technische Universitat Dresden Medical
Center, Dresden, Germany
(Makras) Department of Endocrinology and Diabetes, 251 Hellenic Force & VA
General Hospital, Athens, Greece
(Polyzos) First Department of Pharmacology, Medical School, Aristotle
University of Thessaloniki, Thessaloniki, Greece
(Meier) Division of Endocrinology, Diabetology and Metabolism, University
Hospital and University of Basel, Switzerland
(McCloskey) Centre for Metabolic Bone Diseases, University of Sheffield,
Sheffield, United Kingdom
(McCloskey) Centre for Integrated research in Musculoskeletal Ageing
(CIMA), Mellanby Centre for Bone Research, University of Sheffield,
Sheffield, United Kingdom
(Pepe) Department of Internal Medicine and Medical Disciplines, "Sapienza"
University, Rome, Italy
(Zillikens) Bone Center, Department of Internal Medicine, Erasmus MC,
Rotterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Solid organ transplantation is an established therapy for
end-stage organ failure. Both pre-transplantation bone disease and
immunosuppressive regimens result in rapid bone loss and increased
fracture rates. Method(s): The European Calcified Tissue Society
(ECTS) formed a working group to perform a systematic review of existing
literature on the consequences of end-stage kidney, liver, heart, and lung
disease on bone health. Moreover, we assessed the characteristics of
post-transplant bone disease and the skeletal effects of immunosuppressive
agents and aimed to provide recommendations for the prevention and
treatment of transplantation-related osteoporosis. Result(s):
Characteristics of bone disease may differ depending on the organ that
fails, but patients awaiting solid organ transplantation frequently depict
a wide spectrum of bone and mineral abnormalities. Common features are a
decreased bone mass and impaired bone strength with consequent high
fracture risk, all of which are aggravated in the early
post-transplantation period. Conclusion(s): Both the underlying
disease leading to end-stage organ failure and the immunosuppression
regimens implemented after successful organ transplantation have
detrimental effects on bone mass, quality and strength. Given existing
ample data confirming the high frequency of bone disease in patients
awaiting solid organ transplantation, we recommend that all transplant
candidates should be assessed for osteoporosis and fracture risk and, if
indicated, treated before and after transplantation. Since bone loss in
the early post-transplantation period occurs in virtually all solid organ
recipients and is associated with glucocorticoid administration, the goal
should be to use the lowest possible dose and to taper and withdraw
glucocorticoids as early as possible. Copyright © 2019 Elsevier
Inc.

<36>
Accession Number
628305793
Title
Clinical outcomes of polyvalent immunoglobulin use in solid organ
transplant recipients: A systematic review and meta-analysis - Part II:
Non-kidney transplant.
Source
Clinical Transplantation. 33 (7) (no pagination), 2019. Article Number:
e13625. Date of Publication: July 2019.
Author
Bourassa-Blanchette S.; Patel V.; Knoll G.A.; Hutton B.; Fergusson N.;
Bennett A.; Tay J.; Cameron D.W.; Cowan J.
Institution
(Bourassa-Blanchette, Patel) Division of General Internal Medicine,
Department of Medicine, University of Ottawa, Ottawa, ON, Canada
(Knoll, Hutton, Fergusson, Bennett, Cameron, Cowan) Clinical Epidemiology
Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Knoll) Renal Transplantation, Division of Nephrology, Department of
Medicine, University of Ottawa, Ottawa, ON, Canada
(Tay) Blood and Marrow Transplant Program, Alberta Health Sciences,
Calgary, AB, Canada
(Cameron, Cowan) Division of Infectious Diseases, Department of Medicine,
University of Ottawa, Ottawa, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Immunoglobulin (IG) is commonly used to desensitize and treat
antibody-mediated rejection in solid organ transplant (SOT) recipients.
The impact of IG on other outcomes such as infection, all-cause mortality,
graft rejection, and graft loss is not clear. We conducted a similar
systematic review and meta-analysis to our previously reported Part I
excluding kidney transplant. A comprehensive literature review found 16
studies involving the following organ types: heart (6), lung (4), liver
(4), and multiple organs (2). Meta-analysis could only be performed on
mortality outcome in heart and lung studies due to inadequate data on
other outcomes. There was a significant reduction in mortality (OR 0.34
[0.17-0.69]; 4 studies, n = 455) in heart transplant with
hypogammaglobulinemia receiving IVIG vs no IVIG. Mortality in lung
transplant recipients with hypogammaglobulinemia receiving IVIG was
comparable to those of no hypogammaglobulinemia (OR 1.05 [0.49, 2.26]; 2
studies, n = 887). In summary, IVIG targeted prophylaxis may decrease
mortality in heart transplant recipients as compared to those with
hypogammaglobulinemia not receiving IVIG, or improve mortality to the
equivalent level with those without hypogammaglobulinemia in lung
transplant recipients, but there is a lack of data to support physicians
in making decisions around using immunoglobulins in all SOT recipients for
infection prophylaxis. Copyright © 2019 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd

<37>
Accession Number
628510097
Title
Custom patient-specific three-dimensional printed mitral valve models for
pre-operative patient education enhance patient satisfaction and
understanding.
Source
Journal of Medical Devices, Transactions of the ASME. 13 (3) (no
pagination), 2019. Article Number: 034501. Date of Publication: 01 Sep
2019.
Author
Hung K.S.; Paulsen M.J.; Wang H.; Hironaka C.; Woo Y.J.
Institution
(Hung, Paulsen, Wang, Hironaka, Woo) Department of Cardiothoracic Surgery,
Stanford University, 870 Quarry Road Extension, Palo Alto, CA 94304,
United States
Publisher
American Society of Mechanical Engineers (ASME) (E-mail:
infocentral@asme.org)
Abstract
In recent years, advances in medical imaging and three-dimensional (3D)
additive manufacturing techniques have increased the use of 3D-printed
anatomical models for surgical planning, device design and testing,
customization of prostheses, and medical education. Using 3D-printing
technology, we generated patient-specific models of mitral valves from
their pre-operative cardiac imaging data and utilized these custom models
to educate patients about their anatomy, disease, and treatment. Clinical
3D transthoracic and transesophageal echocardiography images were acquired
from patients referred for mitral valve repair surgery and segmented using
3D modeling software. Patient-specific mitral valves were 3D-printed using
a flexible polymer material to mimic the precise geometry and tissue
texture of the relevant anatomy. 3D models were presented to patients at
their pre-operative clinic visit and patient education was performed using
either the 3D model or the standard anatomic illustrations. Afterward,
patients completed questionnaires assessing knowledge and satisfaction.
Responses were calculated based on a 1-5 Likert scale and analyzed using a
nonparametric Mann-Whitney test. Twelve patients were presented with a
patient-specific 3D-printed mitral valve model in addition to standard
education materials and twelve patients were presented with only standard
educational materials. The mean survey scores were 64.2 (+/-1.7) and 60.1
(+/-5.9), respectively (p = 0.008). The use of patient-specific anatomical
models positively impacts patient education and satisfaction, and is a
feasible method to open new opportunities in precision
medicine. Copyright © 2019 by ASME.

<38>
Accession Number
2001981999
Title
The risk of infective endocarditis following interventional pulmonary
valve implantation: A meta-analysis.
Source
Journal of Cardiology. 74 (3) (pp 197-205), 2019. Date of Publication:
September 2019.
Author
Lehner A.; Haas N.A.; Dietl M.; Jakob A.; Schulze-Neick I.; Dalla Pozza
R.; Rodriguez S.F.; Fischer M.
Institution
(Lehner, Haas, Dietl, Jakob, Schulze-Neick, Dalla Pozza, Rodriguez,
Fischer) Department for Pediatric Cardiology and Intensive Care, Medical
Hospital of the University of Munich, LMU Ludwig Maximilians University
Munich, Bavaria, Germany
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Interventional percutaneous pulmonary valve implantation
(PPVI) was first reported in 2000. Today, two different valves are
certified for this procedure [i.e. Medtronic Melody valve
(Medtronic, Dublin, Ireland) and Edwards SapienTM valve (Edwards
Lifesciences, Irvine, CA, USA)]. For a decade, studies have reported an
increasing risk of infective endocarditis (IE) after PPVI; as patients for
PPVI are usually younger, even a low annual incidence of IE is important.
However, the overall incidence and potential differences between the
valves remain unclear. Method(s): A systematic literature search was
performed in the databases Medline, Cochrane Library, and Embase including
the clinical trials register. The aim was to summarize and compare the
cumulative incidence of IE after PPVI. Using a sensitivity analysis we set
the incidence rates of the two valve types in ratio with a normal
population. Result(s): A total of 967 publications were identified
searching for "pulmonary valve implantation," "PPVI," and 47 publications
were used for final analysis. A total 3616 patients with Melody
valves and 501 with SapienTM valves were included. IE after PPVI occurred
in 214 patients with Melody valves and in 5 patients only with
SapienTM valves. The pooled incidence for Melody and SapienTM
valves was 4.9% (95% CI: 3.6-6.2) and 1.3% (95% CI: 0.3-2.3),
respectively. Chi-square test was significant. The sensitivity analysis
showed that the incidence rate ratio was 252.1 (95% CI: 187.6-338.6) for
Melody valves and for SapienTM valves 2.7 (95% CI: 0.8-9.2).
 Conclusion(s): At present, there is an important difference for the
risk of IE after PPVI. To reduce the risk of post PPVI endocarditis, a
careful valve selection in favor of the SapienTM valves seems to be
beneficial. Copyright © 2019 Japanese College of Cardiology

<39>
[Use Link to view the full text]
Accession Number
628563159
Title
Unselected use of ultrathin strut biodegradable polymer sirolimus-eluting
stent versus durable polymer everolimus-eluting stent for coronary
revascularization.
Source
Circulation: Cardiovascular Interventions. 11 (9) (no pagination), 2018.
Article Number: e006741. Date of Publication: 2018.
Author
Yamaji K.; Zanchin T.; Zanchin C.; Stortecky S.; Koskinas K.C.; Hunziker
L.; Praz F.; Blochlinger S.; Moro C.; Moschovitis A.; Seiler C.;
Valgimigli M.; Billinger M.; Pilgrim T.; Heg D.; Windecker S.; Raber L.
Institution
(Yamaji, Zanchin, Zanchin, Stortecky, Koskinas, Hunziker, Praz,
Blochlinger, Moro, Moschovitis, Seiler, Valgimigli, Billinger, Pilgrim,
Windecker, Raber) Swiss Cardiovascular Center Bern, Department of
Cardiology, Bern University Hospital, Bern 3010, Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Switzerland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Biodegradable polymer sirolimus-eluting stents (BP-SESs) have
been reported to be noninferior compared with durable polymer
everolimus-eluting stents (DP-EES) in a randomized clinical trial. We
sought to compare the efficacy and safety of an ultrathin strut BP-SES
with a DP-EES in an all-comers population. METHODS AND RESULTS: Among 7640
consecutive patients who underwent percutaneous coronary intervention
between March 2011 and June 2015, 4638 patients were exclusively treated
with BP-SES (N=1896; 3137 lesions) or DP-EES (N=2742; 4468 lesions). After
propensity score matching within strata of clinical indications, the final
study population consisted of 2902 matched patients (BP-SES 2406 lesions
and DP-EES 2368 lesions). The primary device-oriented composite end point
(DOCE) included cardiac death, target vessel myocardial infarction, and
target lesion revascularization at 1 year. BP-SES (6.9%) was noninferior
to DP-EES (8.0%) with respect to device-oriented composite end point
(hazard ratio [HR], 0.85; 95% CI, 0.65-1.11; P for noninferiority <0.001;
P for superiority=0.24). No differences in cardiac death (BP-SES, 2.3%
versus DP-EES, 3.0%; HR, 0.76; 95% CI, 0.49-1.20; P=0.25), myocardial
infarction (BP-SES, 4.6% versus DP-EES, 4.6%; HR, 1.00; 95% CI, 0.71-1.40;
P=0.99), or target lesion revascularization (BP-SES, 2.8% versus DP-EES,
2.5%; HR, 1.11; 95% CI, 0.71-1.74; P=0.65) were observed. The rate of
periprocedural myocardial infarction was comparable between the 2 groups
(2.1% versus 2.2%; HR, 0.97; 95% CI, 0.59-1.58; P=0.89). The rate of
definite stent thrombosis was similarly low throughout 1 year (BP-SES,
0.8% versus DP-EES, 0.8%; HR, 1.00; 95% CI, 0.45-2.22; P=1.00).
 CONCLUSION(S): In a consecutively enrolled percutaneous coronary
intervention population reflecting routine clinical practice, BP-SES was
noninferior to DP-EES for device-oriented composite end point at 1
year. Copyright © 2018 American Heart Association, Inc.

<40>
[Use Link to view the full text]
Accession Number
628563131
Title
Benefit and risk of prolonged DAPT after coronary stenting in women:
Results from the DAPT study.
Source
Circulation: Cardiovascular Interventions. 11 (8) (no pagination), 2018.
Article Number: e005308. Date of Publication: 2018.
Author
Berry N.C.; Kereiakes D.J.; Yeh R.W.; Gabriel Steg P.; Cutlip D.E.; Jacobs
A.K.; Dawn Abbott J.; Hsieh W.-H.; Massaro J.M.; Mauri L.
Institution
(Berry, Mauri) Division of Cardiovascular Medicine, Department of
Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St,
Boston, MA 02115, United States
(Berry, Yeh, Cutlip, Mauri) Harvard Medical School, Boston, MA, United
States
(Berry, Yeh, Cutlip, Hsieh, Massaro, Mauri) Baim Institute for Clinical
Research, Boston, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Cutlip) Division of Cardiology, Department of Medicine, United States
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Gabriel Steg) Universite Paris-Diderot, Sorbonne Paris Cite, INSERM
Unite-1148, Departement Hospitalo-Universitaire Fibrosis Inflammation
Remodeling, Hopital Bichat, Assistance Publique-Hopitaux de Paris, France
(Gabriel Steg) National Heart and Lung Institute, Institute of
Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial
College, London, United Kingdom
(Massaro) Boston University School of Public Health, MA, United States
(Jacobs) Boston University School of Medicine, Boston, MA, United States
(Dawn Abbott) Rhode Island Hospital, Brown University School of Medicine,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Women may derive differential benefit from prolonged DAPT
(dual antiplatelet therapy) after coronary stenting than men. We assessed
whether the risks/benefits of prolonged DAPT differ between women and men.
METHODS AND RESULTS: The DAPT study was a randomized double-blind,
placebo-controlled trial comparing continued thienopyridine versus placebo
beyond 12 months after coronary stenting. We compared rates of myocardial
infarction, stent thrombosis, major adverse cardiovascular and
cerebrovascular events, and bleeding by sex and randomized treatment. Of
11648 patients, women (N=2925) were older, with higher prevalence of
diabetes mellitus and lower rates of acute coronary syndrome than men. At
12 to 30 months, women had similar adjusted ischemic and bleeding events
as men. The effects of continued thienopyridine therapy did not differ
significantly by sex for stent thrombosis (women: hazard ratio [HR], 0.54;
95% confidence interval [CI], 0.22-1.36; men: HR, 0.26; 95% CI, 0.15-0.44;
interaction P=0.17), myocardial infarction (women: HR, 0.75; 95% CI,
0.50-1.14; men: HR, 0.46; 95% CI, 0.36-0.60; interaction P=0.052), major
adverse cardiovascular and cerebrovascular events (women: HR, 0.87; 95%
CI, 0.62-1.22; men: HR, 0.70; 95% CI, 0.58-0.85; interaction P=0.26), and
bleeding (women: HR, 1.45; 95% CI, 0.88-2.40; men: HR, 1.78; 95% CI,
1.28-2.49; interaction P=0.50). CONCLUSION(S): Women had similar late
risks of ischemia and bleeding as men after coronary stent
procedures. Copyright © 2018 American Heart Association, Inc.

<41>
[Use Link to view the full text]
Accession Number
628563068
Title
Subgroup analysis comparing ultrathin, bioresorbable polymer
sirolimus-eluting stents versus thin, durable polymer everolimus-eluting
stents in acute coronary syndrome patients: Bioflow v acute coronary
syndromes subgroup.
Source
Circulation: Cardiovascular Interventions. 11 (10) (no pagination), 2018.
Article Number: e007331. Date of Publication: 2018.
Author
Roguin A.; Kandzari D.E.; Marcusohn E.; Koolen J.J.; Doros G.; Massaro
J.M.; Garcia-Garcia H.M.; Bennett J.; Gharib E.G.; Cutlip D.E.; Waksman R.
Institution
(Roguin, Marcusohn) Division of Invasive Cardiology, Rambam Medical
Center, Bat-Galim, Haifa 31096, Israel
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Doros) Baim Institute for Clinical Research, Boston, MA, United States
(Massaro) Department of Biostatistics and Epidemiology, Boston University,
School of Public Health, MA, United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center, DC,
United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Belgium
(Gharib) Charleston Area Medical Center, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Presentation with acute coronary syndromes (ACS) constitutes a
high-risk subset of patients with worse outcome after percutaneous
coronary intervention. We report clinical outcomes in subjects with ACS
from the BIOFLOW V trial (BIOTRONIK - A Prospective Randomized Multicenter
Study to Assess the Safety and Effectiveness of the Orsiro Sirolimus
Eluting Coronary Stent System in the Treatment of Subjects With up to
Three De Novo or Restenotic Coronary Artery Lesions) comparing an
ultrathin strut (60 mum) bioresorbable polymer sirolimus-eluting stent
(BP-SES) with a thin strut (81 mum) durable polymer everolimus-eluting
stent (DP-EES). METHODS AND RESULTS: Among 1334 patients randomized to 2:1
treatment with either BP-SES or DP-EES, 677 (50.7%) ACS patients without
ST-segment-elevation myocardial infarction (MI; 454 BP-SES and 223 DP-EES)
were identified in the retrospective post hoc analysis. The primary end
point of 12-month target lesion failure, individual component end points,
and stent thrombosis were evaluated. Recurrent MI was defined as a >=50%
increase of creatine kinase-myocardial band or in the absence of creatine
kinase-myocardial band, troponin >50% increase over previous level and >3x
the upper limit of normal). All events were adjudicated by a blinded
independent clinical events committee. Overall, baseline clinical,
angiographic, and procedural characteristics of the ACS population were
similar between the 2 treatment groups. At 12 months, target lesion
failure occurred in 5.6% (24/426) of BP-SES patients versus 11.0% (23/209)
in DP-EES patients (P=0.02); target lesion failure composite components
were cardiac death, 0% versus 1.0% (P=0.11); target vessel-related MI,
3.5% versus 9.7% (P=0.003); and clinically driven target lesion
revascularization, 2.8% versus 3.4% (P=0.80). Spontaneous target vessel MI
was 0.5% (2/425) for BP-SES versus 2.4% (5/206) for DP-EES (P=0.041).
Stent thrombosis rates at 1 year were similar (0.5% versus 1.0%; P=0.601).
 CONCLUSION(S): In the ACS subgroup population of the BIOFLOW V study,
treatment with BP-SES compared with DP-EES was associated with a
significantly lower rate of 12-month target lesion failure, a difference
driven by significantly lower periprocedural MI and spontaneous MI. These
findings support treatment with an ultrathin strut BP-SES in ACS patients
undergoing percutaneous coronary intervention. CLINICAL TRIAL
REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT02389946. Copyright © 2018 American Heart Association, Inc.

<42>
[Use Link to view the full text]
Accession Number
628520793
Title
Periprocedural myocardial injury predicts short- And long-term mortality
in patients undergoing transcatheter aortic valve replacement.
Source
Circulation: Cardiovascular Interventions. 11 (11) (no pagination), 2018.
Article Number: e007106. Date of Publication: 2018.
Author
Michail M.; Cameron J.N.; Nerlekar N.; Ihdayhid A.R.; McCormick L.M.;
Gooley R.; Niccoli G.; Crea F.; Montone R.A.; Brown A.J.
Institution
(Michail, Nerlekar, Ihdayhid, McCormick, Gooley, Brown) Monash
Cardiovascular Research Centre, Monash University, MonashHeart, Monash
Health, 246 Clayton Rd, Clayton, Melbourne, VIC 3168, Australia
(Michail) Institute of Cardiovascular Science, University College London,
United Kingdom
(Cameron) St George's University of London, United Kingdom
(Niccoli, Crea, Montone) Department of Cardiovascular and Thoracic
Sciences, Fondazione Policlinico A. Gemelli IRCCS, Catholic University of
the Sacred Heart, Rome, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The aim was to assess whether periprocedural myocardial injury
(PPMI) predicts outcomes in patients undergoing transcatheter aortic valve
replacement (TAVR). PPMI is a strong predictor of outcomes following
coronary intervention, but its impact in the context of TAVR remains
unclear. We performed a systematic review and meta-analysis to ascertain
the association between PPMI and short- or long-term outcomes. METHODS AND
RESULTS: Electronic searches identified studies reporting PPMI following
TAVR. Primary end point was 30-day all-cause mortality, with secondary end
points, including 1-year all-cause mortality, neurological events,
post-TAVR pacemaker implantation, and aortic regurgitation. Analyses were
performed using random effects modeling and reported as summary odds ratio
(OR) with 95% CI. Nine studies comprising 3442 patients (mean age
81.0+/-6.6 years, 51.2% female) were included. PPMI occurred in 25.5% of
patients following TAVR. The pooled all-cause mortality at 30-days and
1-year was 5.2% and 18.6%, respectively. The occurrence of PPMI following
TAVR was associated with significantly increased risk of both 30-day (OR,
4.23; CI, 1.95-9.19; P<0.001) and 1-year all-cause mortality (OR, 1.77;
CI, 1.05-2.99; P<0.001). Similarly, PPMI was associated with post-TAVR
neurological events (OR, 2.72; CI, 1.69-4.37; P<0.001) and post-TAVR
permanent pacing (OR, 1.43; CI, 1.02-2.00; P=0.04) but not with a
statistically significant increase in aortic regurgitation post-TAVR (OR,
1.39; CI, 0.93-2.08; P=0.11). CONCLUSION(S): PPMI is common following
TAVR and is strongly associated with 30-day and 1-year mortality.
Detection of PPMI has potential to identify TAVR patients at highest risk
of subsequent adverse events. Copyright © 2018 American Heart
Association, Inc.

<43>
Accession Number
620867060
Title
Scandinavian SSAI clinical practice guideline on choice of inotropic agent
for patients with acute circulatory failure.
Source
Acta Anaesthesiologica Scandinavica. 62 (4) (pp 420-450), 2018. Date of
Publication: April 2018.
Author
Moller M.H.; Granholm A.; Junttila E.; Haney M.; Oscarsson-Tibblin A.;
Haavind A.; Laake J.H.; Wilkman E.; Sverrisson K.O.; Perner A.
Institution
(Moller, Granholm, Perner) Department of Intensive Care 4131, Copenhagen
University Hospital, Rigshospitalet, Copenhagen, Denmark
(Junttila) Department of Anaesthesiology, Tampere University Hospital,
Tampere, Finland
(Haney) Anaesthesiology and Intensive Care Medicine, Umea University,
Umea, Sweden
(Oscarsson-Tibblin) Department of Anaesthesiology and Intensive Care,
Department of Medicine and Health, Linkoping University, Linkoping, Sweden
(Haavind) Department of Anaesthesiology and Intensive Care, University
Hospital Northern Norway, Tromso, Norway
(Laake) Division of Critical Care, Oslo University Hospital, Oslo, Norway
(Wilkman) Division of Intensive Care Medicine, Department of
Perioperative, Intensive Care and Pain Medicine, Helsinki University
Hospital, University of Helsinki, Helsinki, Finland
(Sverrisson) Department of Anesthesia & Critical Care, Landspitali
University Hospital of Iceland, Reykjavik, Iceland
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Adult critically ill patients often suffer from acute
circulatory failure and those with low cardiac output may be treated with
inotropic agents. The aim of this Scandinavian Society of Anaesthesiology
and Intensive Care Medicine guideline was to present patient-important
treatment recommendations on this topic. Method(s): This guideline
was developed according to GRADE. We assessed the following subpopulations
of patients with shock: (1) shock in general, (2) septic shock, (3)
cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery,
and (6) other types of shock, including vasodilatory shock. We assessed
patient-important outcome measures, including mortality and serious
adverse reactions. Result(s): For all patients, we suggest against
the routine use of any inotropic agent, including dobutamine, as compared
to placebo/no treatment (very low quality of evidence). For patients with
shock in general, and in those with septic and other types of shock, we
suggest using dobutamine rather than levosimendan or epinephrine (very low
quality of evidence). For patients with cardiogenic shock and in those
with shock after cardiac surgery, we suggest using dobutamine rather than
milrinone (very low quality of evidence). For the other clinical
questions, we refrained from giving any recommendations or suggestions.
 Conclusion(s): We suggest against the routine use of any inotropic
agent in adult patients with shock. If used, we suggest using dobutamine
rather than other inotropic agents for the majority of patients, however,
the quality of evidence was very low, implying high uncertainty on the
balance between the benefits and harms of inotropic agents. Copyright
© 2018 The Authors. Acta Anaesthesiologica Scandinavica published by
John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica
Foundation

<44>
Accession Number
2002212409
Title
Perioperative dexmedetomidine reduces delirium in elderly patients after
non-cardiac surgery: a systematic review and meta-analysis of
randomized-controlled trials.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Pan H.; Liu C.; Ma X.; Xu Y.; Zhang M.; Wang Y.
Institution
(Pan, Liu, Ma, Xu, Zhang, Wang) Department of Anesthesiology, Shandong
Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu
Road, Jinan 250021, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Delirium is a frequent postoperative complication in elderly
patients after non-cardiac surgery. We performed this updated
meta-analysis to ascertain more precisely the efficacy of dexmedetomidine
(DEX) on the incidence of postoperative delirium (POD) in elderly patients
after non-cardiac surgery. Method(s): We searched PubMed, EMBASE, the
Cochrane Library, Web of Science, and the Cumulative Index of Nursing and
Allied Health Literature (CINAHL) from inception until February 24, 2019.
In this meta-analysis, we included randomized-controlled trials comparing
the effect of DEX vs normal saline (NS) or other anesthetic drugs on POD
incidence in elderly (either >= 60 or >= 65 yr old) patients undergoing
non-cardiac surgery. We performed subgroup analyses of the DEX dosing
strategy (starting time, dose, and duration of administration, with or
without loading dose) and the strategy of various control drugs. A
random-effects model was used for all analyses. Result(s): We
included 11 studies involving 2,890 patients in our meta-analysis. The
pooled results of these studies revealed that DEX significantly reduced
the incidence of POD (relative risk [RR], 0.47; 95% confidence interval
[CI], 0.38 to 0.58; P < 0.001) compared with the control group. Meanwhile,
the incidences of hypotension (RR, 1.20; 95% CI, 1.04 to 1.39; P = 0.01)
and bradycardia (RR, 1.33; 95% CI, 1.08 to 1.63; P = 0.007) were increased
in the DEX group. Subgroup analyses revealed a decrease in POD incidence
when DEX was administered intraoperatively (RR, 0.43; 95% CI, 0.33 to
0.57; P < 0.001) and postoperatively (RR, 0.38; 95% CI, 0.27 to 0.54; P <
0.001) with a loading dose (RR, 0.49; 95% CI, 0.36 to 0.69; P < 0.001)
compared with NS (RR, 0.49; 95% CI, 0.37 to 0.64; P < 0.001) and other
anesthetic drugs (RR, 0.40; 95% CI, 0.26 to 0.60; P < 0.001). There were
significant differences in the time to extubation (standardized mean
difference, -0.60; 95% CI, -1.17 to -0.03; P = 0.04) and the length of
hospital stay (mean difference, -0.50 days; 95% CI, -0.97 to -0.03; P =
0.04). The amount of data for the duration of mechanical ventilation and
length of intensive care unit stay were insufficient to perform a
meta-analysis. Conclusion(s): Perioperative dexmedetomidine reduces
the incidence of POD in elderly patients after non-cardiac surgery, but
this comes at the cost of an increased incidence of hypotension and
bradycardia. Copyright © 2019, Canadian Anesthesiologists'
Society.

<45>
Accession Number
2001970386
Title
The association between postoperative cognitive dysfunction and cerebral
oximetry during cardiac surgery: a secondary analysis of a randomised
trial.
Source
British Journal of Anaesthesia. 123 (2) (pp 196-205), 2019. Date of
Publication: August 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.
 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. 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. 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 goal is to prevent POCD.
Clinical trial registration: NCT 02185885. Copyright © 2019
British Journal of Anaesthesia

<46>
Accession Number
628460008
Title
Association between Marfan syndrome and oral health status: A systematic
review and meta-analysis.
Source
Medicina oral, patologia oral y cirugia bucal. 24 (4) (pp e473-e482),
2019. Date of Publication: 01 Jul 2019.
Author
Galletti C.; Camps-Font O.; Teixido-Tura G.; Llobet-Poal I.; Gay-Escoda C.
Institution
(Galletti) Faculty of Medicine and Health Sciences, University of
Barcelona, Campus de Bellvitge, Surgery and Oral Implantology, C/ Feixa
Llarga, s/n; Pavello Govern, 2da planta, 08907 L'Hospitalet de Llobregat;
Barcelona, (Spain),
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose was to identify and assess the existing scientific
evidence from epidemiologic, non-experimental, observational studies of
associations between Marfan's syndrome and oral diseases. MATERIAL AND
METHODS: Electronic literature searches in MEDLINE (OVID), The Cochrane
Library, Scopus and the Web of Science were conducted to identify all
relevant articles. Eligibility was based on inclusion criteria, and
quality assessments were conducted. The outcome variables were probing
depth, gingival margin, clinical attachment level, bleeding on probing,
gingival status, periodontal status, tooth mobility, furcation involvement
and decayed, missing and filled teeth index. After extracting data,
meta-analyses were carried out. RESULT(S): Out of 527 potentially
eligible papers, 3 cross-sectional studies were included. No statistically
significant differences were found in the number of sites with bleeding on
probing (OR: 1.26; 95% CI: 0.47 to 3.42; P = 0.65; I2: 0%), probing depth
(MD: -0.14 mm; 95% CI: -0.24 to 0.53; P = 0.46; I2: 93%), periodontal
status (WMD: 0.68 points; 95% CI: -0.48 to 1.83; P = 0.25; I2: 98%) nor
number of decayed, missing and filled teeth index score (MD: 1.08 points.;
95% CI: -1.27 to 3.42; P = 0.37; I2: 0%). CONCLUSION(S): Patients
diagnosed with Marfan's syndrome do not seem to have worsened oral health
status. Due to the high number of patients with Marfan's syndrome that
have prosthetic heart valves, an adequate dental monitoring as well as a
strict maintenance therapy program should be implemented.

<47>
Accession Number
2001998265
Title
Systematic review and consensus definitions for the Standardised Endpoints
in Perioperative Medicine initiative: clinical indicators.
Source
British Journal of Anaesthesia. 123 (2) (pp 228-237), 2019. Date of
Publication: August 2019.
Author
Fleisher L.A.; Grocott M.P.W.; Myles P.S.; Myles P.; Grocott M.; Biccard
B.; Blazeby J.; Boney O.; Chan M.; Diouf E.; Fleisher L.; Kalkman C.; Kurz
A.; Moonesinghe R.; Wijeysundera D.; Gan T.J.; Peyton P.; Sessler D.;
Tramer M.; Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.; Botti
M.; Haller G.; Cook T.; Neuman M.; Story D.; Gruen R.; Bampoe S.; Evered
L.; Scott D.; Silbert B.; van Dijk D.; Grocott H.; Eckenhoff R.; Rasmussen
L.; Eriksson L.; Beattie S.; Landoni G.; Leslie K.; Howell S.; Nagele P.;
Richards T.; Lamy A.; Lalu M.; Pearse R.; Mythen M.; Canet J.; Moller A.;
Gin T.; Schultz M.; Pelosi P.; Gabreu M.; Futier E.; Creagh-Brown B.;
Abbott T.; Klein A.; Corcoran T.; Jamie Cooper D.; Dieleman S.; McIlroy
D.; Bellomo R.; Shaw A.; Prowle J.; Karkouti K.; Billings J.; Mazer D.;
Jayarajah M.; Murphy M.; Bartoszko J.; Sneyd R.; Morris S.; George R.;
Shulman M.; Lane-Fall M.; Nilsson U.; Stevenson N.; Cooper J.D.J.; van
Klei W.; Cabrini L.; Miller T.; Pace N.; Jackson S.; Buggy D.; Short T.;
Riedel B.; Gottumukkala V.; Alkhaffaf B.; Johnson M.
Institution
(Haller) Department of Anaesthesiology, Geneva University Hospitals,
Geneva, Switzerland
(Haller, Myles) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Bampoe) Centre for Perioperative Medicine, University College London,
United Kingdom
(Cook) Department of Anaesthesia and Intensive Care, Royal United
Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
(Fleisher, Neuman) Departments of Anesthesiology and Critical Care and
Medicine, Perelman School of Medicine of the University of Pennsylvania,
Philadelphia, PA, United States
(Grocott) Integrative Physiology and Critical Illness Group, Clinical and
Experimental Sciences, Faculty of Medicine, University Hospital
Southampton, Southampton, United Kingdom
(Grocott) Anaesthesia, Perioperative and Critical Care Research Group,
Southampton NIHR Biomedical Research Centre, University Hospital
Southampton, Southampton, United Kingdom
(Story) Centre for Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Myles) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Clinical indicators are powerful tools to quantify the safety
and quality of patient care. Their validity is often unclear and
definitions extremely heterogeneous. As part of the International
Standardised Endpoints in Perioperative Medicine (StEP) initiative, this
study aimed to derive a set of standardised and valid clinical outcome
indicators for use in perioperative clinical trials. Method(s): We
identified clinical indicators via a systematic review of the anaesthesia
and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane
Library). We performed a three-stage Delphi consensus-gaining process that
involved 54 clinician-researchers worldwide. Indicators were first
shortlisted and the most suitable definitions for evaluation of quality
and safety interventions determined. Indicators were then assessed for
validity, reliability, feasibility, and clarity. Result(s): We
identified 167 clinical outcome indicators. Participation in the three
Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A
final list of eight outcome indicators was generated: surgical site
infection at 30 days, stroke within 30 days of surgery, death within 30
days of coronary artery bypass grafting, death within 30 days of surgery,
admission to the intensive care unit within 14 days of surgery,
readmission to hospital within 30 days of surgery, and length of hospital
stay (with or without in-hospital mortality). They were rated by the
majority of experts as valid, reliable, easy to use, and clearly defined.
 Conclusion(s): These clinical indicators can be confidently used as
endpoints in clinical trials measuring quality, safety, and improvement in
perioperative care. Registration: PROSPERO 2016 CRD42016042102
(http://www.crd.york.ac.uk/PROSPERO/display_record.php?
ID=CRD42016042102). Copyright © 2019 British Journal of
Anaesthesia

<48>
Accession Number
628053778
Title
Different Effects of Thiazolidinediones on In-Stent Restenosis and Target
Lesion Revascularization after PCI: A Meta-Analysis of Randomized
Controlled Trials.
Source
Scientific reports. 7 (1) (pp 14464), 2017. Date of Publication: 31 Oct
2017.
Author
Zhou X.; Chen S.; Zhu M.; Hua J.; Dai J.; Xu X.; Qiu Y.; Mao W.
Institution
(Zhou, Chen, Zhu, Hua, Dai, Xu, Qiu, Mao) Department of Cardiology, First
Affiliated Hospital of Zhejiang Chinese Medical University,
Hangzhou310006, Zhejiang, China
Publisher
NLM (Medline)
Abstract
In-stent restenosis (ISR) remains the leading problem encountered after
percutaneous coronary intervention (PCI). Thiazolidinediones (TZDs) has
been shown to be associated with reduced ISR and target lesion
revascularization (TLR); however, the results are inconsistent, especially
between rosiglitazone and pioglitazone. In this study, fourteen RCTs with
a total of 1350 patients were finally included through a systematical
literature search of Embase, Pubmed, the Cochrane Library, and
ClinicalTrials.gov from inception to January 31, 2017. The follow-up
duration of the included trials ranged from 6 months to 18 months. The
results demonstrated that TZDs treatment is associated with significantly
reduced risk of TLR (RR:0.45, 95%CI 0.30 to 0.67 for pioglitazone,
RR:0.68, 95%CI 0.46 to 1.00 for rosiglitazone). Pioglitazone is associated
with significantly reduced risks of ISR (RR:0.47, 95%CI 0.27 to 0.81),
major adverse cardiac events (MACE) (RR:0.44, 95%CI 0.30 to 0.64) and
neointimal area (SMD: -0.585, 95%CI -0.910 to -0.261). No significant
relationship was observed between rosiglitazone and ISR (RR:0.91, 95%CI
0.39 to 2.12), MACE (RR:0.73, 95%CI 0.53 to 1.00) and neointimal area
(SMD: -0.164, 95%CI -1.146 to 0.818). This meta-analysis demonstrated that
TZDs treatment is associated with significant reduction in ISR, TLR and
MACE for patients after PCI. Pioglitazone treatment seems to have more
beneficial effects than rosiglitazone and no significantly increased
cardiovascular risk was detected for both agents.

<49>
Accession Number
627594326
Title
New-Onset Atrial Fibrillation After Coronary Artery Bypass Graft and
Long-Term Risk of Stroke: A Meta-Analysis.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Date of Publication: 22 Dec 2017.
Author
Megens M.R.; Churilov L.; Thijs V.
Institution
(Megens, Churilov, Thijs) Florey Institute of Neuroscience and Mental
Health, University of Melbourne, Melbourne, Victoria, Australia
(Megens, Churilov) School of Sciences, RMIT University, Melbourne,
Victoria, Australia
(Thijs) Department of Neurology, Austin Health, Heidelberg, Victoria,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: New-onset atrial fibrillation (NOAF) after coronary artery
bypass graft is related to an increased short-term risk of stroke and
mortality. We investigated whether the long-term risk of stroke is
increased. METHODS AND RESULTS: We performed a systematic review and
meta-analysis of studies that included patients who had coronary artery
bypass graft and who afterwards developed NOAF during their index
admission; these patients did not have previous atrial fibrillation. The
primary outcome was risk of stroke at 6 months or more in patients who
developed NOAF compared with those who did not. Odds ratios, relative
risk, and hazard ratios were considered equivalent; outcomes were pooled
on the log-ratio scale using a random-effects model and reported as
exponentiated effect-sizes. We included 16 studies, comprising 108 711
participants with a median follow-up period of 2.05 years. Average
participant age was 66.8 years, with studies including an average of 74.8%
males. There was an increased long-term risk of stroke in the presence of
NOAF (unadjusted studies effect-sizes=1.36, 95% confidence interval,
1.12-1.65, P=0.001, adjusted studies effect-sizes=1.25, 95% confidence
interval, 1.09-1.42, P=0.001). There was evidence of moderate effect
variation because of heterogeneity in studies reporting unadjusted
(P=0.021, I2=49.8%) and adjusted data (P=0.081, I2=49.1%), and publication
bias in the latter group (Egger's test, P=0.031). Sensitivity analysis on
unadjusted data by study quality, design, and surgery did not alter the
effect direction. CONCLUSION(S): Presence of NOAF in patients
post-coronary artery bypass graft is associated with increased long-term
risk of stroke compared with patients without NOAF. Further studies may
show whether the increased risk is mediated by atrial fibrillation and
whether anticoagulation reduces risk. Copyright © 2017 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

<50>
Accession Number
628594688
Title
Test drives, TAVRs, bedsavers and Intensive Care Unit lifesavers: The many
uses of the temporary-permanent pacemaker-a single center experience.
Source
Journal of Interventional Cardiac Electrophysiology. Conference: 15th
Annual Congress of the European Cardiac Arrhythmia Society, ECAS 2019.
France. 55 (Supplement 1) (pp S59), 2019. Date of Publication: June 2019.
Author
Adeola O.; Ward C.; Roy S.D.; Mentias A.; Giudici M.
Institution
(Adeola, Ward, Roy, Mentias, Giudici) University of Iowa, Iowa City,
United States
Publisher
Springer New York LLC
Abstract
Introduction: Temporary-Permanent (T-P) Pacemakers are transvenous
percutaneously inserted leads connected to a non-sterile generator placed
under a waterproof dressing on the chest. They have better lead stability
over a longer period compared to temporary transvenous pacemakers while
also providing hemodynamic benefits of pacing similar to a permanent
device but without the risks or burden related to the full implant
procedure. We provide a review of our experience with these T-P pacemakers
and their clinical utility in patient care. Method(s): 155
consecutive patients [102 M/53 F, mean age 71 years (19-101 years)]
underwent implantation of T-P Pacemakers between 2015 and 2018.
Indications include pocket/lead infections in pacemaker dependent patients
after lead extraction, periprocedural following transcatheter aortic valve
replacement (TAVR) or cardiac surgery with associated bradycardia,
intensive care unit (ICU)/emergency setting with uncontrolled atrial
tachyarrhythmia with ongoing sepsis requiring rate control, and pacemaker
"test drives" in patients with asymptomatic bradycardia as a therapeutic
trial when the patient or provider isn't completely convinced of the
benefit of permanent pacemaker implant. Result(s): of 155 patients,
17 (10.9%) had pacemaker test drives, 16 (10.3%) were implanted for
pocket/lead infection, 30 (19.4%) implanted periprocedural following
cardiac or valve surgeries and 92 (59.4%) implanted in ICU/emergency
setting. Mean implant procedure duration was 46.7 +/- 37.2 min and device
was retained for a mean duration of 16.4 +/- 25.6 days. 7 out of 17 (41%)
patients of the pacemaker test drives and 15 out of 30 (50%)
periprocedural implants eventually did not require permanent pacing and
were explanted. No procedure related complications were noted.
 Conclusion(s): T-P Pacemakers can be safely utilized in selected
patients for multiple indications to provide durable pacing support when
the need for a permanent device is not yet clearly established.

<51>
Accession Number
628600912
Title
Influence of preoperative information support on anxiety, pain and
satisfaction with postoperative analgesia in children and adolescents
after thoracic surgery: A randomized double blind study.
Source
Biomedical papers of the Medical Faculty of the University Palacky,
Olomouc, Czechoslovakia. 163 (2) (pp 172-178), 2019. Date of Publication:
01 Jun 2019.
Author
Tomaszek L.; Cepuch G.; Fenikowski D.
Institution
(Tomaszek, Fenikowski) Department of Thoracic Surgery, Institute for
Tuberculosis and Lung Diseases, Pediatric Division, Rabka-Zdroj, Poland
(Cepuch) Collegium Medicum, Faculty of Health Sciences, Jagiellonian
University, Poland Corresponding author: Lucyna Tomaszek, Krakow, Poland
Publisher
NLM (Medline)
Abstract
AIMS/BACKGROUND: The proportion of patients who experience anxiety prior
to planned surgery, even a minimally invasive one, is estimated at 50-70%.
Thoracic surgery, causes significant preoperative anxiety, especially in
children. The aim of this study was to determine the effect of an
important component of psychological preparation for a surgery as
information support on levels of anxiety, pain and satisfaction with
postoperative analgesia. METHOD(S): The randomized double blind study
including patients aged 9-18 years qualified for lateral thoracotomy or
Ravitch procedure. The subjects were randomized to the control group
(n=56) provided with a routine preoperative information by a nurse, and
the experimental group (n=56) offered additional psychological
consultation. Data were collected via the State-Trait Anxiety Inventory.
 RESULT(S): In the experimental group, the level of state anxiety at
48 h post-surgery was significantly lower than prior to the procedure, but
only in subjects with preoperative trait anxiety Conclusion(s):
Information support from a psychologist offered prior to a thoracic
surgery decrease the level of postoperative state anxiety solely in
children with lower levels of trait anxiety. Higher level of postoperative
state anxiety negatively affect patients' satisfaction with post-surgical
analgesia. TRIAL REGISTRATION: ClinicalTrials.gov; Influence of
Preoperative Support on Anxiety, Pain and Satisfaction With Postoperative
Analgesia; NCT03488459,
https://clinicaltrials.gov/ct2/show/record/NCT03488459?cntry=PL&city=Rabka
-Zdr%C3%B3j&rank=1.

<52>
Accession Number
628600933
Title
Perioperative dental screening and treatment in patients undergoing
cardio-thoracic surgery and interventional cardiovascular procedures. A
consensus report based on RAND/UCLA methodology.
Source
International journal of cardiology. (no pagination), 2019. Date of
Publication: 17 Jun 2019.
Author
Cotti E.; Cairo F.; Bassareo P.P.; Fonzar F.; Venturi M.; Landi L.;
Parolari A.; Franco V.; Fabiani C.; Barili F.; Di Lenarda A.; Gulizia M.;
Borzi M.; Campus G.; Musumeci F.; Mercuro G.
Institution
(Cotti) Department of Conservative Dentistry and Endodontics, University
of Cagliari, Italy
(Cairo) Research Unit in Periodontology and Periodontal Medicine,
University of Florence, Italy
(Bassareo) University College of Dublin, Mater Misericordiae University
Teaching Hospital, Dublin, Ireland
(Fonzar) Private practice, Udine, Italy
(Venturi) Private practice, Bologna, Italy
(Landi) Private practice, Verona, Roma, Italy
(Parolari) Unit of Cardiac Surgery and Translational Researh, IRCCS
Policlinico S. Donato, San Donato, Italy
(Franco, Fabiani) Private practice, Roma, Italy
(Barili) Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
(Di Lenarda) Cardiovascular Center ASS1, Trieste, Italy
(Gulizia) Division of Cardiology, Hospital "Garibaldi-Nesima", Catania,
Italy
(Borzi) Department of Cardiovascular Disease, University of Rome Tor
Vergata, Rome, Italy
(Campus) Department of Surgery, Microsurgery and Medicine Sciences,
University of Sassari, Italy
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Roma, Italy
(Mercuro) Department of Cardiology, University of Cagliari, Italy
Publisher
NLM (Medline)
Abstract
AIM: To reach a consensus on a consistent strategy to adopt when screening
patients for dental/periodontal infections, and on the feasibility of
providing dental treatment before cardiothoracic surgery, cardiovascular
surgery or other cardiovascular invasive procedures. METHODOLOGY: A panel
of experts from six Italian scientific societies was created. The
deliberations of the panel were based on the RAND method. From an initial
systematic literature review, it became clear that a consensually
validated protocol for the reproducible dental screening of patients
awaiting cardiac interventions was considered mandatory by professionals
with expertise in the dental, cardiologic and cardiac surgery areas.
However, systematic review also concluded that the treatment options to be
provided, their prognosis and timing in relation to the physical condition
of patients had never been defined. Following the systematic review
several fundamental questions were generated. The panel was divided into
two working groups each of which produced documents that addressed the
topic and which were subsequently used to generate a questionnaire. Each
member of the panel completed the questionnaire independently and then a
panel discussion was held to reach a consensus on how best to manage
patients with dental/periodontal infections who were awaiting invasive
cardiac procedures. RESULT(S): A high level of agreement was reached
regarding all the items on the questionnaire, and each of the clinical
questions formulated were answered. Three tables were created which can be
used to generate a useful tool to provide standardized dental/periodontal
screening of patients undergoing elective cardiovascular interventions,
and to summarize both the possible oral and cardiovascular conditions of
the patient and the timing available for the procedures considered.
 CONCLUSION(S): Upon publication of this consensus document, the
dissemination of the information to a wide dental and cardiac audience
should commence. The authors hope that this consensus can become a model
for the development of a dedicated protocol, ideally usable by heart and
dental teams in the pre-interventional preparation phase. Copyright
© 2019 Elsevier B.V. All rights reserved.

<53>
Accession Number
2002344172
Title
Adherence to lifestyle changes after coronary artery bypass graft: Outcome
of preoperative peer education.
Source
Patient Education and Counseling. (no pagination), 2019. Date of
Publication: 2019.
Author
Golaghaie F.; Esmaeili-Kalantari S.; Sarzaeem M.; Rafiei F.
Institution
(Golaghaie) Department of Community Health Nursing, Arak University of
Medical Sciences, Arak, Iran, Islamic Republic of
(Esmaeili-Kalantari) Student Research Committee, Arak University of
Medical Sciences, Arak, Iran, Islamic Republic of
(Sarzaeem) Department of Cardiovascular Surgery, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Rafiei) Department of Biostatistics & Epidemiology, School of health,
Scientific Research Center, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Elsevier Ireland Ltd
Abstract
Objective: This study was done to investigate the effect of preoperative
peer education on patients' adherence to medication and lifestyle changes
after Coronary Artery Bypass Graft (CABG). Method(s): In this
randomized clinical trial, the peers of CABG patients conducted
preoperative educational sessions at the ward in groups of 4-5 (n = 36)
while the control group (n = 34) received routine education by a nurse.
Adherence of both groups to medication and recommendations for lifestyle
modification including physical activity, smoking, and diet was measured
one and two months after discharge. Result(s): A multivariate
analysis of co-variance showed the significant effect of peer education on
adherence (F = 32.586, p < 0.001; eta2 = 0.671). Univariate
ANCOVA revealed a significant difference in adherence to diet between the
two groups (F = 62.316, p = 0 0.0001; eta2 = 0.482). Based on
the repeated measures ANOVA, peer education significantly improved the
CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total
adherence (F = 9.911, p = 0.002) compared to the control group.
 Conclusion(s): Preoperative peer education had a significant effect
on improving CABG patients' adherence to lifestyle changes after hospital
discharge. Practice implication: Peer education can be used as an
effective method to improve the CABG patients ' adherence to lifestyle
changes. Copyright © 2019 Elsevier B.V.

<54>
Accession Number
2002323830
Title
Diabetes, dysglycemia, and vascular surgery.
Source
Journal of Vascular Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Duwayri Y.; Jordan W.D.
Institution
(Duwayri, Jordan) Division of Vascular Surgery and Endovascular Therapies,
Emory University School of Medicine, Atlanta, Ga, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Abnormalities in glucose metabolism are common in patients
with arterial disease. Chronic hyperglycemia and insulin resistance
contribute to the complexity of vascular disorders. They also overlap with
the effects of perioperative hyperglycemia on adverse perioperative
outcomes. We provide an overview of the pathophysiologic consequences of
dysglycemia and the evidence behind glycemic control in patients
undergoing vascular surgery. Method(s): We searched the literature
for major studies evaluating the pathophysiology of hyperglycemia in
microvascular and macrovascular beds, randomized trials in perioperative
populations, and meta-analyses. The literature was summarized to guide
therapy in the population of vascular patients and for the perioperative
period. Result(s): National standards for glycemic control after
vascular interventions were not identified. Mounting evidence exists for
the long-term consequences of poor glycemic control on the progression of
vascular disease. Similarly, there is a large body of evidence supporting
tight control of hyperglycemia after general and cardiac surgery during
the critical perioperative period. The absolute glucose target remains
controversial. Randomized controlled studies are lacking in vascular
surgery patients, but the current evidence can be extrapolated to guide
management after vascular interventions. Glycated hemoglobin is a
biomarker for increased mortality and vascular morbidity after vascular
surgery. Conclusion(s): Hyperglycemia contributes to poor outcome in
the vascular patient. Further vascular focused studies are required to
determine the proper perioperative serum glucose target and the long-term
glycated hemoglobin range. Copyright © 2019 Society for Vascular
Surgery

<55>
Accession Number
2002303566
Title
Feasibility and acceptability of continuous postoperative pericardial
flushing for blood loss reduction in patients undergoing coronary artery
bypass grafting.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2019. Date
of Publication: 2019.
Author
Kara H.; Erden T.
Institution
(Kara) Department of Cardiovascular Surgery, Giresun Ada Hospital,
Giresun, Turkey
(Erden) Department of Cardiovascular Surgery, Faculty of Medicine,
Karadeniz Technical University, Trabzon, Turkey
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Introduction: Postoperative bleeding requires blood transfusion and
surgical re-exploration that can affect the short- and long-term
postoperative outcomes. Interventions that can be used in the
postoperative period to reduce blood loss should be developed. Continuous
postoperative pericardial flushing (CPPF) with an irrigation solution may
reduce blood loss by preventing the accumulation of clots. This study
examined the feasibility and acceptability of CPPF for reducing bleeding
after coronary artery bypass surgery. Method(s): This pilot study
adopted a prospective and group comparison design. Between January and
April 2018, 42 patients who underwent isolated coronary artery bypass
surgery received CPPF from sternal closure up to 8 h postoperative. The
mean actual blood loss in the CPPF group was compared to the mean of
retrospectively group (n = 58). In the CPPF group, an extra infusion
catheter was inserted through one of the tube incision holes and an
irrigation solution (0.9% NaCl at 38 degreeC) was delivered to the
pericardial cavity by using a volumetric pump. Safety aspects, feasibility
issues, and complications were documented. The primary outcome was blood
loss, and it was assessed 18 h after the surgery. Result(s): CPPF was
successfully completed in 40 patients (95.24%). Method-related
complications were not observed. Feasibility was good in this experimental
setting. Blood loss was lower in the CPPF group (257.24 mL) than non-CPPF
group (p < 0.001). Conclusion(s): CPPF after coronary artery bypass
grafting surgery is safe, effective, feasible, and acceptable. However,
standardized randomized clinical trials are necessary to draw definitive
conclusions. Copyright © 2019, The Japanese Association for
Thoracic Surgery.

<56>
Accession Number
613085809
Title
Mechanical dyssynchrony according to validated cut-off values using gated
SPECT myocardial perfusion imaging.
Source
Journal of Nuclear Cardiology. 25 (3) (pp 999-1008), 2018. Date of
Publication: 01 Jun 2018.
Author
Aguade-Bruix S.; Romero-Farina G.; Candell-Riera J.; Pizzi M.N.;
Garcia-Dorado D.
Institution
(Aguade-Bruix) Department of Nuclear Medicine, Hospital Universitari Vall
d'Hebron, Institut de Recerca (VHIR), Universitat Autonoma de Barcelona,
Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain
(Romero-Farina, Candell-Riera, Pizzi, Garcia-Dorado) Cardiology
Department, Hospital Universitari Vall d'Hebron, Institut de Recerca
(VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The aim of this study was to establish different degrees of
mechanical dyssynchrony according to validated cut-off (CO) values of
myocardial perfusion gated SPECT phase analysis parameters (SD, standard
deviation; B, bandwidth; S, skewness; K, kurtosis). Method(s): Using
Emory Cardiac ToolboxTM, we prospectively analyzed 408 patients (mean age
64.1 years, 26.7% female), divided into a control group of 150 normal
subjects and a validation group of 258 patients (left bundle branch block:
17.8%, right bundle branch block: 8.9%. atrial fibrillation: 16.3%,
coronary revascularization: 30%, dilated cardiomyopathy: 7.4%.
valvulopathies: 2.7%, ischemic test: 45.3%) with ischemic and non-ischemic
cardiac diseases, by means of phase analysis. Result(s): Agreement of
CO values (SD > 18.4degree; B > 51degree; S <= 3.2; K <= 9.3) used to
discriminate between normal subjects and patients was strong (c-statistic
0.9; 95% CI 0.98-0.99). Four degrees of dyssynchrony were found according
to the number of abnormal phase parameters. All patients with mechanical
and electrical criteria for cardiac resynchronization therapy (CCRT) (n:
82) had Grade 2 to 4 (two to four abnormal phase parameters). Agreement of
CO values (SD > 40.2degree; B > 132degree; S <= 2.3; K <= 4.6) used to
discriminate between patients with and without CCRT was strong
(c-statistic 0.8; 95% CI 0.79-0.87) but 12% of patients with CCRT did not
have any of these abnormal phase parameters. Conclusion(s): The
discriminatory capacity of gated SPECT phase analysis parameters between
normal subjects and patients, and between patients with and without CCRT,
is very good, making it possible to define different degrees of mechanical
dyssynchrony. Copyright © 2016, American Society of Nuclear
Cardiology.

<57>
Accession Number
623793755
Title
Study protocol of the randomised placebo-controlled GLOBE trial: GL P-1 f
o r b ridging of hyperglyca e mia during cardiac surgery.
Source
BMJ Open. 8 (6) (no pagination), 2018. Article Number: e022189. Date of
Publication: 01 Jun 2018.
Author
Hulst A.H.; Visscher M.J.; Godfried M.B.; Thiel B.; Gerritse B.M.; Scohy
T.V.; Bouwman R.A.; Willemsen M.G.A.; Hollmann M.W.; Devries J.H.; Preckel
B.; Hermanides J.
Institution
(Hulst, Visscher, Hollmann, Preckel, Hermanides) Department of
Anaesthesiology, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Godfried, Thiel) Department of Anaesthesiology, Onze Lieve Vrouwe
Gasthuis, Amsterdam, Netherlands
(Gerritse, Scohy) Department of Anaesthesiology, Amphia Ziekenhuis, Breda,
Netherlands
(Bouwman, Willemsen) Department of Anaesthesiology, Catharina
Ziekenhuisen, Eindhoven, Netherlands
(Devries) Department of Endocrinology, Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Perioperative hyperglycaemia is common during cardiac surgery
and associated with postoperative complications. Although intensive
insulin therapy for glycaemic control can reduce complications, it carries
the risk of hypoglycaemia. GLP-1 therapy has the potential to lower
glucose without causing hypoglycaemia. We hypothesise that preoperative
liraglutide (a synthetic GLP-1 analogue) will reduce the number of
patients requiring insulin to achieve glucose values<8 mmol l -1 in the
intraoperative period. Methods and analysis We designed a multi-centre
randomised parallel placebo-controlled trial and aim to include 274
patients undergoing cardiac surgery, aged 18-80 years, with or without
diabetes mellitus. Patients will receive 0.6 mg liraglutide or placebo on
the evening before, and 1.2 mg liraglutide or placebo just prior to
surgery. Blood glucose is measured hourly and controlled with an insulin
bolus algorithm, with a glycaemic target between 4-8 mmol l a -1. The
primary outcome is the percentage of patients requiring insulin
intraoperatively. Ethics and dissemination This study protocol has been
approved by the medical ethics committee of the Academic Medical Centre
(AMC) in Amsterdam and by the Dutch competent authority. The study is
investigator-initiated and the AMC, as sponsor, will remain owner of all
data and have all publication rights. Results will be submitted for
publication in a peer-reviewed international medical journal. Trial
registration number NTR6323; Pre-results. Copyright © Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2018.

<58>
Accession Number
2000568333
Title
Impact of ticagrelor versus aspirin on graft patency after CABG: Rationale
and design of the TARGET (ticagrelor antiplatelet therapy to reduce graft
events and thrombosis) randomized controlled trial (NCT02053909).
Source
Contemporary Clinical Trials. 68 (pp 45-51), 2018. Date of Publication:
May 2018.
Author
Kulik A.; Abreu A.M.; Boronat V.; Kouchoukos N.T.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital, Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, FL, United States
(Kouchoukos) Division of Cardiovascular and Thoracic Surgery, Missouri
Baptist Medical Center, BJC Healthcare, St. Louis, MO, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rationale: Saphenous vein graft disease remains a major limitation of
coronary artery bypass graft surgery (CABG). Up to 20% of vein grafts will
occlude within the first year after CABG despite standard aspirin
antiplatelet therapy. However, more potent postoperative platelet
inhibition with ticagrelor may improve graft patency. The goal of this
study will be to evaluate the efficacy of ticagrelor, as compared to
aspirin, for the prevention of saphenous vein graft occlusion following
CABG. Study design: The Ticagrelor Antiplatelet Therapy to Reduce Graft
Events and Thrombosis (TARGET) study is a multi-center double-blind
randomized controlled trial enrolling patients who have undergone
multi-vessel CABG with at least one saphenous vein graft. Patients are
being randomized to receive either aspirin 81 mg twice per day or
ticagrelor 90 mg twice per day for 2 years starting within 7 days after
surgery. The projected enrollment is 150 patients in each arm (300 total
patients). Patients will undergo computed tomography (CT) coronary
angiography at 1 and 2 years after surgery to assess the incidence of vein
graft occlusion and stenosis. Conclusion(s): To our knowledge, this
trial is the first prospective study to evaluate the impact of early
postoperative ticagrelor on 1- and 2-year graft patency after CABG.
Furthermore, it is also the first trial to use a novel antiplatelet agent
as a standalone, without aspirin, after CABG. Should ticagrelor reduce the
incidence of postoperative graft occlusion, the results of this study will
redefine modern antiplatelet management following coronary bypass surgery
(ClinicalTrials.gov NCT02053909). Copyright © 2018 Elsevier Inc.

<59>
[Use Link to view the full text]
Accession Number
622871276
Title
A Qualitative Study of Experiences of Participants in Cardiac
Rehabilitation.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 38 (4) (pp
E6-E9), 2018. Date of Publication: 01 Jul 2018.
Author
Yates B.C.; Vazquez Hernandez M.L.; Rowland S.A.; Bainter D.E.; Schulz P.;
Hanson C.K.
Institution
(Yates, Rowland) College of Nursing, University of Nebraska Medical Center
(UNMC), Omaha, NE 68198, United States
(Vazquez Hernandez) CHI Health Creighton University Medical Center Bergan
Mercy, Omaha, NE, United States
(Bainter) Cardiopulmonary Rehabilitation, Nebraska Methodist Health
System, Omaha, United States
(Schulz) College of Nursing, UNMC, Lincoln, United States
(Hanson) College of Allied Health Professions, UNMC, Omaha, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Maintenance of lifestyle changes after cardiac rehabilitation
(CR) is suboptimal. In addition, partners of cardiac patients are invited
to participate in CR educational sessions and implicitly expected to
assist patients with their lifestyle changes. The purpose of this study
was to qualitatively examine patient and partner perceptions of phase 2 CR
3 mo after completion of the program. Method(s): A purposive sample
of 11 couples (patients post-heart surgery and their spouses) was
interviewed following completion of CR. Semistructured, in-person
interviews were conducted with patients and spouses separately. Data were
analyzed using line-by-line coding to identify themes. Result(s):
Themes were identified in relation to program elements of CR. Exercise
themes were as follows: (1) benefitted from exercise and (2) felt held
back. Education themes were as follows: (1) received basic education and
(2) needed more personalized information. CR environment themes were as
follows: (1) developed confidence; (2) made social comparisons; and (3)
helped to have partner there. Conclusion(s): Overall, participant
perceptions of exercise, education, and the CR environment were very
positive. Nevertheless, there is a need to improve educational efforts
within CR to rely less on "canned" presentations and more on participants
developing their own self-management methods to maintain a healthy
lifestyle after CR. Copyright © 2018 Lippincott Williams and
Wilkins. All rights reserved.

<60>
Accession Number
628280529
Title
Efficacy of different analgesic or sedative drug therapies in pediatric
patients with congenital heart disease undergoing surgery: a network
meta-analysis.
Source
World Journal of Pediatrics. 15 (3) (pp 235-245), 2019. Date of
Publication: 01 Jun 2019.
Author
Liu R.-Z.; Li B.-T.; Zhao G.-Q.
Institution
(Liu, Zhao) Department of Anesthesiology, China-Japan Union Hospital of
Jilin University, Changchun 130000, China
(Li) Department of Rheumatology and Immunology, China-Japan Union Hospital
of Jilin University, Changchun 130000, China
Publisher
Institute of Pediatrics of Zhejiang University (E-mail: wjpch@zju.edu.cn)
Abstract
Background: Surgery is an effective therapy for congenital heart disease
(CHD) and the management after surgery poses challenges for the clinical
workers. We performed this network meta-analysis to enhance the
corresponding evidence with respect to the relative efficacy of different
drug treatments applied after the CHD surgery. Method(s): Embase and
PubMed were systematically retrieved to identify all published controlled
trials investigating the effectiveness of drugs for patients up to 25
August, 2018. Mean differences (MD), odds ratios and their 95% credible
intervals (CrIs) were used to evaluate multi-aspect comparisons. Surface
under cumulative ranking curve (SUCRA) was used to analyze the relative
ranking of different treatments in each endpoint. Result(s): Compared
to saline, all the drugs achieved better preference under the efficacy
endpoints except fentanyl in JET. As for ventilator time, all drugs were
more effective than saline while only the difference of dexmedetomidine
was statistically obvious (MD = 6.92, 95% CrIs 1.77-12.54). Under the
endpoint of ICU time, dexmedetomidine was superior to saline as well (MD =
1.26, 95% CrIs 0.11-2.45). When all the endpoints were taken into
consideration and with the help of ranking probabilities and SUCRA values,
fentanyl combined with dexmedetomidine was one of the recommended drugs
due to its shorter time on ventilator and stay in hospital as well as
lower mortality. Conclusion(s): Overall, based on the comprehensive
consideration of all the endpoints, fentanyl combined with dexmedetomidine
was considered to be the best-recommended clinical interventions among all
the methods. Copyright © 2019, Children's Hospital, Zhejiang
University School of Medicine.

<61>
Accession Number
626372663
Title
Effect of iloprost inhalation on postoperative outcome in high-risk
cardiac surgical patients: a prospective randomized-controlled multicentre
trial (ILOCARD).
Source
Canadian Journal of Anesthesia. 66 (8) (pp 907-920), 2019. Date of
Publication: 15 Aug 2019.
Author
Winterhalter M.; Rex S.; Stoppe C.; Kienbaum P.; Muller H.-H.; Kaufmann
I.; Kuppe H.; Dongas A.; Zwissler B.
Institution
(Winterhalter) Klinik fur Anasthesiologie und Schmerztherapie, Klinikum
Bremen-Mitte gGmbH, Bremen, Germany
(Winterhalter, Kienbaum) Klinik fur Anasthesiologie, Universitatsklinikum
Dusseldorf, Dusseldorf, Germany
(Rex) Department of Anesthesiology & Department of Cardiovascular
Sciences, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven
3000, Belgium
(Rex, Stoppe) Klinik fur Anasthesiologie, Universitatsklinikum der RWTH
Aachen, Aachen, Germany
(Muller) Klinische Forschung, IBE - Institut fur Medizinische
Informationsverarbeitung, Biometrie und Epidemiologie,
Ludwig-Maximilians-Universitat Munchen, Munich, Germany
(Muller) Institut fur Medizinische Biometrie und Epidemiologie,
Philipps-Universitat Marburg, Marburg, Germany
(Kaufmann, Zwissler) Klinik fur Anasthesiologie, LMU Klinikum der
Universitat Munchen, Munich, Germany
(Kaufmann) Klinik fur Anasthesiologie, Operative Intensivmedizin und
Schmerztherapie, Stadtisches Klinikum Munchen, Neuperlach, Munich, Germany
(Kuppe) Institut fur Anasthesiologie, Deutsches Herzzentrum Berlin,
Berlin, Germany
(Dongas) Institut fur Anasthesiologie, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Dongas) Klinik fur Anasthesiologie und operative Intensivmedizin,
Franziskus Hospital Bielefeld, Bielefeld, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Perioperative right ventricular (RV) failure due to pressure
overload from pulmonary hypertension (PH) worsens postoperative outcomes
after cardiac surgery. Inhaled iloprost is a potent pulmonary vasodilator
improving RV performance, ameliorating myocardial and pulmonary
ischemia-reperfusion injury and attenuating inflammation. We hypothesized
that the prophylactic inhalation of iloprost would reduce postoperative
ventilation times after cardiac surgery. Method(s): In this phase
III, multicentre, randomized, double-blind, placebo-controlled trial, we
randomly assigned 253 cardiac surgical patients at high risk of
perioperative RV failure to the prophylactic inhalation of 20 micro g
iloprost or placebo before and during weaning from extracorporeal
circulation. The primary endpoint was the duration of postoperative
ventilation. Secondary endpoints included perioperative hemodynamics,
intensive care unit and hospital length of stay, and 90-day mortality.
Safety was assessed by the incidence of adverse events. Result(s):
Iloprost had no significant effect on the median [interquartile range]
duration of postoperative ventilation compared with placebo (720
[470-1170] min vs 778 [541-1219] min, respectively; median decrease, 65
min; 95% confidence interval [CI], - 77 to 210; P = 0.37). While the
nebulization of iloprost decreased RV afterload and improved cardiac
index, major secondary endpoints were not significantly affected.
Ninety-day mortality occurred in 14% of the iloprost patients compared
with 14% of the placebo patients (hazard ratio, 0.97; 95% CI, 0.50 to
1.89; P = 0.93). The incidence of adverse events was comparable in both
groups. Conclusion(s): The prophylactic inhalation of iloprost did
not meaningfully improve the outcome in high-risk cardiac surgical
patients. Trial registration: www.clinicaltrials.gov (NCT00927654);
registered 25 June, 2009. Copyright © 2019, Canadian
Anesthesiologists' Society.

<62>
Accession Number
625513473
Title
Low-level laser therapy versus trunk stabilization exercises on sternotomy
healing after coronary artery bypass grafting: a randomized clinical
trial.
Source
Lasers in Medical Science. 34 (6) (pp 1115-1124), 2019. Date of
Publication: 01 Aug 2019.
Author
Helmy Z.M.; Mehani S.H.M.; El-Refaey B.H.; Al-Salam E.H.A.; Felaya
E.-S.E.E.-S.
Institution
(Helmy, El-Refaey, Felaya) Department of Physical Therapy for Internal
Medicine, Faculty of Physical Therapy, Cairo University, Giza, Egypt
(Mehani) Department of Physical Therapy for Internal Medicine, Faculty of
Physical Therapy, Beni-Suef University, Benisuef Elgadata, Street No. 18,
Beni-Suef governorate 62511, Egypt
(Al-Salam) Department of Diagnostic Imaging, National Heart Institute,
Giza, Egypt
Publisher
Springer London
Abstract
The aim of this study was to investigate the effects of low-level laser
therapy (LLLT) versus trunk stabilization exercises on sternotomy healing
following coronary artery bypass grafting (CABG) surgery. Forty-five male
patients who had acute sternal instability post-CABG surgery in the age
range of 45-65 years were divided randomly into three equal groups (n =
15). The laser group received LLLT, while the exercise group received
trunk stabilization exercises. The control group only received a routine
cardiac rehabilitation programme, which was also provided to both the
laser and the exercise groups. All groups were offered 12 sessions over 4
weeks. Sternal separation, median sternotomy photographic analysis, pain
and activities of daily living (ADL) performance were evaluated pre- and
post-treatment. Statistical significance was set at P < 0.05. There was a
significant decrease among the laser group in upper-sternal separation,
while the exercise and control groups showed a non-significant decrease.
In terms of mid-sternal separation, laser and exercise groups showed a
significant decrease while the control group showed a non-significant
decrease. In terms of lower-sternal separation, the exercise group showed
a significant decrease, while the laser and control groups showed a
non-significant decrease. Post-treatment between-groups analysis showed a
significant difference only among the laser and control groups with regard
to upper-sternal separation, while analysis of the laser, exercise and
control groups in the case of upper-sternal separation and the
between-groups comparison in terms of mid- and lower-sternal separation
revealed no significant differences. LLLT and trunk stabilization
exercises were found to be the most effective methods for sternotomy
healing post-CABG surgery, with LLLT offering superior performance in the
case of the upper sternum while trunk stabilization exercises were more
effective for the lower sternum. Copyright © 2019,
Springer-Verlag London Ltd., part of Springer Nature.

<63>
Accession Number
628436073
Title
Effects of non-statin lipid-modifying agents on cardiovascular morbidity
and mortality among statin-treated patients: A systematic review and
network meta-analysis.
Source
Frontiers in Pharmacology. 10 (MAY) (no pagination), 2019. Article Number:
547. Date of Publication: 2019.
Author
Chaiyasothi T.; Nathisuwan S.; Dilokthornsakul P.; Vathesatogkit P.;
Thakkinstian A.; Reid C.; Wongcharoen W.; Chaiyakunapruk N.
Institution
(Chaiyasothi, Nathisuwan) Department of Pharmacy, Faculty of Pharmacy,
Mahidol University, Bangkok, Thailand
(Chaiyasothi) Department of Clinical Pharmacy, Faculty of Pharmacy,
Srinakharinwirot University, Nakhon Nayok, Thailand
(Dilokthornsakul, Chaiyakunapruk) Department of Pharmacy Practice, Faculty
of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research,
Naresuan University, Phitsanulok, Thailand
(Vathesatogkit) Department of Medicine, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Thakkinstian) Section for Clinical Epidemiology and Biostatistics,
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand
(Reid) School of Epidemiology and Preventive Medicine, Monash University,
Melbourne, VIC, Australia
(Reid) School of Public Health, Curtin University, Perth, WA, Australia
(Wongcharoen) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
(Chaiyakunapruk) School of Pharmacy, Monash University Malaysia, Bandar
Sunway, Selangor, Malaysia
(Chaiyakunapruk) School of Pharmacy, University of Wisconsin, Madison, WI,
United States
(Chaiyakunapruk) Asian Centre for Evidence Synthesis in Population,
Implementation and Clinical Outcomes, Health and Well-being Cluster,
Global Asia in the 21st Century (GA21) Platform, Monash University
Malaysia, Bandar Sunway, Malaysia
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: Currently, there is a lack of information on the comparative
efficacy and safety of non-statin lipid-lowering agents (NST) in
cardiovascular (CV) disease risk reduction when added to background statin
therapy (ST). This study determine the relative treatment effects of NST
on fatal and non-fatal CV events among statin-treated patients.
 Method(s): A network meta-analysis based on a systematic review of
randomized controlled trials (RCTs) comparing non-statin lipid-modifying
agents among statin-treated patients was performed. PubMed, EMBASE,
CENTRAL, and Clinicaltrial.gov were searched up to April 10, 2018. The
primary outcomes were CV and all-cause mortalities. Secondary CV outcomes
were coronary heart disease (CHD) death, non-fatal myocardial infarction
(MI), any stroke, and coronary revascularization. Risks of
discontinuations were secondary safety outcomes. Result(s):
Sixty-seven RCTs including 259,429 participants with eight interventions
were analyzed. No intervention had significant effects on the primary
outcomes (CV mortality and all-cause mortality). For secondary endpoints,
proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK) plus statin
(PCSK/ST) significantly reduced the risk of non-fatal MI (RR 0.82, 95% CI
0.72-0.93, p = 0.003), stroke (RR 0.74, 95% CI 0.65-0.85, p < 0.001),
coronary revascularization (RR 0.84, 95% CI 0.75-0.94, p = 0.003) compared
to ST. Combinations of ST and all NST except PCSK and ezetimibe showed
higher rate of discontinuation due to adverse events compared to ST.
 Conclusion(s): None of NST significantly reduced CV or all-cause
death when added to ST. PCSKs and to a lesser extent, ezetimibe may help
reduce cardiovascular events with acceptable tolerability profile among
broad range of patients. Copyright © 2019 Chaiyasothi,
Nathisuwan, Dilokthornsakul, Vathesatogkit, Thakkinstian, Reid,
Wongcharoen and Chaiyakunapruk. This is an open-access article distributed
under the terms of the Creative Commons Attribution License (CC BY). The
use, distribution or reproduction in other forums is permitted, provided
the original author(s) and the copyright owner(s) are credited and that
the original publication in this journal is cited, in accordance with
accepted academic practice. No use, distribution or reproduction is
permitted which does not comply with these terms.

<64>
[Use Link to view the full text]
Accession Number
627370813
Title
Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial.
Source
Anesthesiology. 130 (3) (pp 385-393), 2019. Date of Publication: 01 Mar
2019.
Author
Park M.; Ahn H.J.; Kim J.A.; Yang M.; Heo B.Y.; Choi J.W.; Kim Y.R.; Lee
S.H.; Jeong H.; Choi S.J.; Song I.S.
Institution
(Park, Ahn, Kim, Yang, Heo, Choi, Kim, Lee, Jeong, Choi, Song) Department
of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Park) Kangwon National University, School of Graduate Medicine in
Chuncheon, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Editor's Perspective What We Already Know about This Topic Driving
pressure (plateau minus end-expiratory airway pressure) is a target in
patients with acute respiratory distress syndrome, and is proposed as a
target during general anesthesia for patients with normal lungs. It has
not been reported for thoracic anesthesia where isolated, inflated lungs
may be especially at risk. What This Article Tells Us That Is New In a
double-blinded, randomized trial (292 patients), minimized driving
pressure compared with standard protective ventilation was associated with
less postoperative pneumonia or acute respiratory distress syndrome.
 Background(s): Recently, several retrospective studies have suggested
that pulmonary complication is related with driving pressure more than any
other ventilatory parameter. Thus, the authors compared driving
pressure-guided ventilation with conventional protective ventilation in
thoracic surgery, where lung protection is of the utmost importance. The
authors hypothesized that driving pressure-guided ventilation decreases
postoperative pulmonary complications more than conventional protective
ventilation. Method(s): In this double-blind, randomized, controlled
study, 292 patients scheduled for elective thoracic surgery were included
in the analysis. The protective ventilation group (n = 147) received
conventional protective ventilation during one-lung ventilation: tidal
volume 6 ml/kg of ideal body weight, positive end-expiratory pressure
(PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n =
145) received the same tidal volume and recruitment, but with
individualized PEEP which produces the lowest driving pressure (plateau
pressure-PEEP) during one-lung ventilation. The primary outcome was
postoperative pulmonary complications based on the Melbourne Group Scale
(at least 4) until postoperative day 3. Result(s): Melbourne Group
Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving
pressure group, as compared with 18 of 147 (12.2%) in the protective
ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The
number of patients who developed pneumonia or acute respiratory distress
syndrome was less in the driving pressure group than in the protective
ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio
0.42; 95% CI, 0.19 to 0.92). Conclusion(s): Application of driving
pressure-guided ventilation during one-lung ventilation was associated
with a lower incidence of postoperative pulmonary complications compared
with conventional protective ventilation in thoracic
surgery. Copyright © 2019, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<65>
Accession Number
2001341598
Title
Impact of frailty on outcomes in surgical patients: A systematic review
and meta-analysis.
Source
American Journal of Surgery. 218 (2) (pp 393-400), 2019. Date of
Publication: August 2019.
Author
Panayi A.C.; Orkaby A.R.; Sakthivel D.; Endo Y.; Varon D.; Roh D.; Orgill
D.P.; Neppl R.L.; Javedan H.; Bhasin S.; Sinha I.
Institution
(Panayi, Sakthivel, Roh, Orgill, Sinha) Division of Plastic Surgery,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
(Orkaby) Geriatric Research, Education, and Clinical Center, VA Boston
Healthcare System, Boston, MA, United States
(Orkaby) Division of Aging, Brigham and Women's Hospital, Harvard Medical
School, Boston, MA, United States
(Endo) Division of Pathology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Varon) University of Michigan Medical School, Ann Arbor, MI, United
States
(Neppl) Department of Orthopedic Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Javedan) Division of Gerontology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Bhasin) Division of Endocrinology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Importance: Age has historically been used to predict negative
post-surgical outcomes. The concept of frailty was introduced to explain
the discrepancies that exist between patients' chronological and
physiological age. The efficacy of the modified frailty index (mFI) to
predict surgical risk is not clear. Objective(s): We sought to
synthesize the current literature to quantify the impact of frailty as a
prognostic indicator across all surgical specialties. Data sources: Pubmed
and Cochrane databases were screened from inception to 1 January 2018.
Study selection: Studies utilizing the modified Frailty Index (mFI) as a
post-operative indicator of any type of surgery. The mFI was selected
based on a preliminary search showing it to be the most commonly applied
index in surgical cohorts. Data extraction and synthesis: Articles were
selected via a two-stage process undertaken by two reviewers (AP and DS).
Statistical analysis was performed in Revman (Review manager V5.3). The
random-effects model was used to calculate the Risk Ratios (RR). Main
outcome(s) and measure(s): The primary outcomes: post-operative
complications, re-admission, re-operation, discharge to a skilled care
facility, and mortality. Result(s): This meta-analysis of 16 studies
randomizes 683,487 patients, 444,885 frail, from gastrointestinal,
vascular, orthopedic, urogenital, head and neck, emergency, neurological,
oncological, cardiothoracic, as well as general surgery cohorts. Frail
patients were more likely to experience complications (RR 1.48, 95%CI
1.35-1.61; p < 0.001), major complications (RR 2.03, 95%CI 1.26-3.29; p =
0.004), and wound complications (RR 1.52, 95%CI 1.47-1.57; p < 0.001).
Furthermore, frail patients had higher risk of readmission (RR 1.61, 95%CI
1.44-1.80; p < 0.001) and discharge to skilled care (RR 2.15, 95%CI
1.92-2.40; p < 0.001). Notably, the risk of mortality was 4.19 times more
likely in frail patients (95% CI 2.96-5.92; p < 0.001).
 Conclusion(s): and Relevance: This study is the first to synthesize
the evidence across multiple surgical specialties and demonstrates that
the mFI is an underappreciated prognostic indicator that strongly
correlates with the risk of post-surgical morbidity and mortality. This
supports that formal incorporation of pre-operative frailty assessment
improves surgical decision-making. Copyright © 2018 Elsevier Inc.

<66>
Accession Number
626733921
Title
Comparison of outcomes between fractional-flow-reserve- and
angiography-directed intervention in non-ST elevation acute coronary
syndrome.
Source
Journal of the College of Physicians and Surgeons Pakistan. 29 (3) (pp
268-273), 2019. Date of Publication: 01 Mar 2019.
Author
Jianjun Y.; Xiaohua P.; Xuemei T.; Gang H.; Hailong W.
Institution
(Jianjun, Xiaohua, Xuemei, Hailong) Department of Cardiology, Heart
Center, Chongqing Three Gorges Central Hospital, 165# Xincheng Road,
Wanzhou, Chongqing 404000, China
(Gang) Department of Cardiology, Suining Central Hospital, Suining,
Sichuan 629000, China
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Among the sick patients suffering from non-ST segment elevation acute
coronary syndrome (NSTEACS), the accuracy of fractional flow reserve
(FFR)-directed percutaneous coronary intervention (PCI) or coronary artery
bypass grafting (CABG) is still ambiguous. Studies were obtained from
PubMed, Embase, Wanfang Data, and Cochrane Library electronic statistics
from their initiation up to April 2018, to explore the differences between
the FFR-directed approach and the coronary angiography (CA)/stress
perfusion scintigraphy (SPS)-directed approach in the outcomes of NSTACS
patients. Odds ratio was determined for individual studies, quality
assessments, heterogeneity, and publishing bias analyses. In total, there
were 5 studies involving 1,366 patients (606 FFR patients and 760 CA
patients). Compared with CA, the collection of the studies indicated that
FFR had a lower incidence of myocardial infarction (MI) (OR, 0.61; 95% CI:
0.39-0.96; p <0.05). However, none showed important disparities in main
adverse cardiovascular events (MACE, OR, 0.74; 95% CI: 0.53-1.03; p=0.07),
all-cause death rate (OR, 0.83; 95% CI: 0.45-1.54; p = 0.56), and major
bleeding (OR, 1.00; 95%CI: 0.25-4.03; p=1). The FFR-directed management of
patients with NSTEACS had a close relationship with the serious decrease
in incidence of MI without statistical significance. Future large-scale
research, which is carried out at random and with a control, is needed to
confirm these conclusions. Copyright © 2019 Dustri-Verlag Dr.
Karl Feistle. All Rights Reserved.

<67>
Accession Number
628572983
Title
Changes in Physical Performance and Their Association with Health-Related
Quality of Life in a Mixed Nonischemic Cardiac Population That
Participates in Rehabilitation.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2019. Date of Publication: 2019.
Author
Tang L.H.; Zwisler A.-D.; Doherty P.; Oldridge N.; Berg S.K.; Christensen
J.
Institution
(Tang, Zwisler) National Centre for Rehabilitation and Palliative Care,
University of Southern Denmark, Odense University Hospital, Nyborg,
Denmark
(Tang) Department of Physiotherapy and Occupational Therapy,
Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
(Doherty) Department of Health Sciences, University of York, England,
United Kingdom
(Oldridge) College of Health Sciences, University of Wisconsin-Milwaukee,
United States
(Berg) Department of Cardiology, Heart Centre, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Christensen) Department of Occupational Therapy and Physiotherapy,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: Exercise-based cardiac rehabilitation improves physical
performance and health-related quality of life (HRQoL). However, whether
improvements in physical performance are associated with changes in HRQoL
has not been adequately investigated in a nonischemic cardiac population.
 Method(s): Patients who were ablated for atrial fibrillation, who
underwent heart valve surgery or who were treated for infective
endocarditis, and who participated in 1 of 3 randomized controlled
rehabilitation trials were eligible for the current study. Change in
physical performance and HRQoL were measured before and after a 12-wk
exercise intervention. Physical performance was assessed using a
cardiopulmonary exercise test, a 6-min walk test, and a sit-to-stand test.
Health-related quality of life was assessed using the generic 36-Item
Short Form Health Survey and the disease-specific HeartQoL questionnaire.
Spearman correlation coefficient (rho) and linear regressions quantified
the association between changes in physical outcome measures and changes
in HRQoL. Result(s): A total of 344 patients were included (mean age:
60.8 +/- 11.6 yr and 77% males). Associations between changes in physical
outcome measures and HRQoL ranged from very weak to weak (rho = -0.056 to
0.228). The observed associations were more dominant within physical
dimensions of the HRQoL compared with mental or emotional dimensions.
After adjusting for sex, age, and diagnosis, changes in physical
performance explained no more than 20% of the variation in the HRQoL.
 Conclusion(s): The findings show that the positive improvement in
HRQoL from exercise-based cardiac rehabilitation cannot simply be
explained by an improvement in physical performance. Copyright ©
2019 National Association of Neonatal Nurses. Unauthorized reproduction of
this article is prohibited.

<68>
[Use Link to view the full text]
Accession Number
627842586
Title
Revascularization strategies in cardiogenic shock after acute myocardial
infarction.
Source
Current opinion in critical care. 25 (4) (pp 379-383), 2019. Date of
Publication: 01 Aug 2019.
Author
Desch S.
Institution
(Desch) Department of Internal Medicine/Cardiology, Heart Center Leipzig
at the University of Leipzig, Leipzig, Germany
(Desch) Deutsches Zentrum fur Herz-Kreislauf-Forschung (DZHK), partner
site Hamburg/Kiel/Lubeck, Lubeck, Germany
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Coronary revascularization compared with medical
treatment alone leads to improved survival in patients with myocardial
infarction (MI) and cardiogenic shock. Percutaneous coronary intervention
(PCI) is the predominant mode of revascularization in clinical practice.
This review discusses several aspects relevant to mechanical
revascularization such as general indication, the roles of PCI and bypass
surgery, percutaneous access site choice, strategy in multivessel disease
and adjunctive antithrombotic therapy. RECENT FINDINGS: The recently
published CULPRIT-SHOCK trial provided the first randomized evidence that
in the vast majority of patients with infarct-related cardiogenic shock
PCI should be confined to the culprit lesion, whereas nonculprit lesions
should not be routinely treated in the emergency setting. Although
randomized data are not available, a primary radial access for PCI is
becoming more popular in the shock population. Cardiac surgery plays an
indispensable, yet quantitatively only minor role in the management of
infarct-related cardiogenic shock. SUMMARY: Coronary revascularization
remains the cornerstone in the early management of patients with acute MI
and cardiogenic shock. In patients with multivessel disease, a strategy of
culprit lesion only PCI is the default approach.

<69>
Accession Number
628442503
Title
Safety of a Restrictive versus Liberal Approach to Red Blood Cell
Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery:
A Randomized Clinical Trial.
Source
Journal of the American Society of Nephrology : JASN. 30 (7) (pp
1294-1304), 2019. Date of Publication: 01 Jul 2019.
Author
Garg A.X.; Badner N.; Bagshaw S.M.; Cuerden M.S.; Fergusson D.A.; Gregory
A.J.; Hall J.; Hare G.M.T.; Khanykin B.; McGuinness S.; Parikh C.R.;
Roshanov P.S.; Shehata N.; Sontrop J.M.; Syed S.; Tagarakis G.I.; Thorpe
K.E.; Verma S.; Wald R.; Whitlock R.P.; Mazer C.D.
Institution
(Garg) Division of Nephrology, Department of Medicine, London Health
Sciences Centre and Western University, London, Ontario, Canada;
(Badner) Department of Anesthesia & Clinical Pharmacology, University of
British Columbia, Kelowna, BC, Canada
(Bagshaw) Department of Critical Care Medicine, University of Alberta,
Edmonton, AB, Canada
(Cuerden, Sontrop) Division of Nephrology, Department of Medicine, London
Health Sciences Centre and Western University, London, ON, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
University of Calgary, Calgary, AB, Canada
(Hall, Hare, Thorpe, Verma, Wald, Mazer) Li Ka Shing Knowledge Institute,
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Khanykin) Cardiothoracic Anesthesiology Department, Copenhagen University
Hospital, Copenhagen, Denmark
(McGuinness) Cardiothoracic and Vascular Intensive Care and High
Dependency Unit, Auckland City Hospital, Auckland, New Zealand
(Parikh) Division of Nephrology, Department of Medicine, Johns Hopkins
School of Medicine, Baltimore, MD, United States
(Roshanov, Syed, Whitlock) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Shehata) Department of Medicine, Mount Sinai Hospital, University of
Toronto, Toronto, Ontario, Canada; and
(Tagarakis) Department of Cardiothoracic Surgery, Aristotle University
Hospital of Thessaloniki, Thessaloniki, Greece
Publisher
NLM (Medline)
Abstract
BACKGROUND: Safely reducing red blood cell transfusions can prevent
transfusion-related adverse effects, conserve the blood supply, and reduce
health care costs. Both anemia and red blood cell transfusion are
independently associated with AKI, but observational data are insufficient
to determine whether a restrictive approach to transfusion can be used
without increasing AKI risk. METHOD(S): In a prespecified kidney
substudy of a randomized noninferiority trial, we compared a restrictive
threshold for red blood cell transfusion (transfuse if hemoglobin<7.5
g/dl, intraoperatively and postoperatively) with a liberal threshold
(transfuse if hemoglobin<9.5 g/dl in the operating room or intensive care
unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied
4531 patients undergoing cardiac surgery with cardiopulmonary bypass who
had a moderate-to-high risk of perioperative death. The substudy's primary
outcome was AKI, defined as a postoperative increase in serum creatinine
of >=0.3 mg/dl within 48 hours of surgery, or >=50% within 7 days of
surgery. RESULT(S): Patients in the restrictive-threshold group
received significantly fewer transfusions than patients in the
liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer
transfusions in the restricted-threshold group compared with the
liberal-threshold group; P<0.001). AKI occurred in 27.7% of patients in
the restrictive-threshold group (624 of 2251) and in 27.9% of patients in
the liberal-threshold group (636 of 2280). Similarly, among patients with
preoperative CKD, AKI occurred in 33.6% of patients in the
restrictive-threshold group (258 of 767) and in 32.5% of patients in the
liberal-threshold group (252 of 775). CONCLUSION(S): Among patients
undergoing cardiac surgery, a restrictive transfusion approach resulted in
fewer red blood cell transfusions without increasing the risk of
AKI. Copyright © 2019 by the American Society of Nephrology.

<70>
[Use Link to view the full text]
Accession Number
628170863
Title
Inotropes and vasopressors use in cardiogenic shock: when, which and how
much?.
Source
Current opinion in critical care. 25 (4) (pp 384-390), 2019. Date of
Publication: 01 Aug 2019.
Author
Levy B.; Buzon J.; Kimmoun A.
Institution
(Levy, Buzon, Kimmoun) Service de Reanimation Medicale Brabois, CHRU Nancy
(Levy, Buzon, Kimmoun) INSERM U1116, Faculte de Medecine
(Levy, Buzon, Kimmoun) Universite de Lorraine, Nancy, France
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Data and interventional trials regarding vasopressor
and inotrope use during cardiogenic shock are scarce. Their use is limited
by their side-effects and the lack of solid evidence regarding their
effectiveness in improving outcomes. In this article, we review the
current use of vasopressor and inotrope agents during cardiogenic shock.
RECENT FINDINGS: Two recent Cochrane analyses concluded that there was not
sufficient evidence to prove that any one vasopressor or inotrope was
superior to another in terms of mortality. A recent RCT and a
meta-analysis on individual data suggested that norepinephrine may be
preferred over epinephrine in patients with cardiogenic shock . For
inotrope agents, when norepinephrine fails to restore perfusion,
dobutamine represents the first-line agent. Levosimendan is a calcium
sensitizer agent, which improves acute hemodynamics, albeit with uncertain
effects on mortality. SUMMARY: When blood pressure needs to be restored,
norepinephrine is a reasonable first-line agent. Dobutamine is the
first-line inotrope agent wheraes levosimendan can be used as a
second-line agent or preferentially in patients previously treated with
beta-blockers. Current information regarding comparative effective
outcomes is nonetheless sparse and their use should be limited as a
temporary bridge to recovery, mechanical circulatory support or heart
transplantation.

<71>
Accession Number
628561569
Title
Heterogeneity of cardiac macrophages in patients with of ischemic ADHF.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp
40-41), 2019. Date of Publication: May 2019.
Author
Ekaterina Kruchinkina E.V.; Rogovskaya Y.V.; Batalov R.E.; Ryabov V.V.
Institution
(Ekaterina Kruchinkina, Batalov) Cardiology Research Institute Tomsk
National Research Medical Center Russian Academy of Sciences, Tomsk,
Russian Federation
(Rogovskaya) National Research Tomsk State University, Tomsk, Russian
Federation
(Ryabov) Siberian State Medical University, Tomsk, Russian Federation
Publisher
John Wiley and Sons Ltd
Abstract
The role of the infammatory reaction in the pathogenesis of HF is a
well-known fact. However, there are no methods that affect myocardial
infammation. This is due to the lack of laboratory and clinical criteria
for the phenotyping of HF. Macrophages play an important role in the
infammation. Identification of macrophage subpopu-lations in different
types of infammation in patients with HF will allow flling the lack of
knowledge. Aim(s): To study the heterogeneity of cardiac macrophages
in patients with cute decompensation of ischemic chronic heart failure
(ADHF). Method(s): This open-label, nonrandomized, single-center,
prospective trial was registered at clinicaltrials.gov (#NCT02649517).
This trial included 25 patients (84% men, left ventricular ejection
fraction 29.17+/-9.4%) with ADHF and ischemic systolic dysfunction.
Inclusion criteria were ADHF not earlier than six months after optimal
surgery (percutaneous coronary intervention or/and coronary artery bypass
graft) and optimal drug treatment for ADHF according to ESC guidelines.
All patients underwent invasive angiography and endomyocardial biopsy with
immunohisto-chemistry (n=25) and immunofuorescent analysis (n=21).
Immunohistochemical criteria of myocarditis were at least 14 leukocytes
per sq. mm in the myocardium including up to 4 monocytes and 7 or more
CD3+ T lymphocytes per sq. mm. After that they were divided into four
groups: group 1 (viral and autoimmune infamma-tion), group 2 (viral
infammation), group 3 (cardiotropic virus without infammation), group 4
(cardiotropic virus with antibodies to cardiomyocytes without
infammation). We used CD68 as a marker for the cells of the macrophage
lineage, while CD80 was considered as M1-like macrophage and CD163, CD206,
stabilin-1 were considered as M2-like macrophage biomarkers. We used CD19,
Cq1, MHL II as a marker for autoimmune process. Result(s): The most
common phenotype of infammation according to the results of
immunohistochemical analysis is viral infammation (40%). Cardiotropic
virus without signs of infammation in the myocardium was revealed in 16%
of patients. Viral and autoimmune infammation and a cardiotropic virus
with antibodies to cardiomyocytes were found in 12% and 8% of cases,
respectively. The number of CD68+CD80+ cells in group 1 was significantly
higher than in group 2 (p=0.0429). In addition, we observed an increased
number of macrophages CD68+CD206+ in group 2 compared with group 3
(p=0.0085). We noted a slight increase stabilin-1 in group 4.
 Conclusion(s): We found the heterogeneity of cardiac macrophages in
patients with ADHF. It was revealed the predominance of CD68+CD80+ cells
in patients with viral and autoimmune infammation and CD163-CD206+ cells
predominate in patients with viral infammation.

<72>
Accession Number
628561512
Title
Meta-analysis on MitraClip implantation for functional mitral
regurgitation.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp 523),
2019. Date of Publication: May 2019.
Author
Noutsias M.; Matiakis M.; Ali M.; Abate E.; Melnyk H.; Bigalke B.;
Rigopoulos A.G.
Institution
(Noutsias, Matiakis, Ali, Abate, Melnyk, Rigopoulos) University Clinic
Halle (Saale), Mid-German Heart Center, Department of Internal Medicine
III (KIM-III), Division of Cardiology, Halle, Germany
(Bigalke) Charite-Campus Benjamin Franklin, Berlin, Germany
Publisher
John Wiley and Sons Ltd
Abstract
In patients with heart failure reduced left ventricular ejection fraction
(HFrEF), moderate-to-severe or severe functional mitral regurgitation
(FMR) may is associated with high rate of hospitalizations for heart
failure and with increased mortality. Transcatheter mitral valve repair
(TMVR) by MitraClip implantation may effectively reduce severe MR;
however, the long-term clinical effects of this procedure are not well
defned. Aim(s): We analyzed outcomes for rehospitalization and
survival in heart failure patients with moderate-to-severe or severe
functional mitral regurgitation (FMR) treated by either medical treatment
(MT) only versus transcatheter mitral valve repair (TMVR) by MitraClip
implantation + MT by meta-analysis. Methods & Results: By systematic
search of bibliographic databases, we evaluated publications comparing
heart failure patients with FMR treated by MT only versus treatment by MT
combined with TMVR (by Mitraclip implantation). Studies with a minimum of
25 enrolled patients and a follow/up period of at least 12 months were
deemed eligible for this meta-analysis. We identified n=8 studies
enrolling 2,960 HFrEF patients, divided into two study arms: MTVR by
MitraClip implantation and MT (n=1,692), versus FMR patients receiving MT
only (n=1,268). At 12 months, there was a significant reduction in
all-cause mortality favoring TMVR+MT (OR: 0.67; CI 95% 0.55-0.81), as well
as a reduction of unplanned rehospitalizations (OR: 0.64; 95%; CI
0.54-0.77), compared with the MT only patients. At 24 months, there was a
significant reduction of all-cause mortality in the TMVR+MT patient group
(OR: 0.50; CI: 95%: 0.38-0.66; p<0.001). TMVR+MT was associated with
significantly lower rates of unplanned re-admissions for heart failure
compared with MT only at 12 months (OR: 0.69; 95% CI: 0.53-0.89; p<0.001)
and at 24 months (OR: 0.53; 95% CI: 0.39-0.71; p<0.001).
 Conclusion(s):This meta-analysis on n=2,960 patients with
moderate-to-severe or severe FMR reveals that TMVR+MT, as compared with MT
alone, is associated with a significant reduction of rehospitalizations
and improvement of survival. These data imply additional evidence for TMVR
by Mitraclip in eligible heart failure patients with relevant FMR, which
might be important for an update of the corresponding guidelines.

<73>
Accession Number
628561744
Title
Anti-thymocyte globulin induction therapy usage is not associated with
short and long-term survival differences in heart transplant patients.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp 280),
2019. Date of Publication: May 2019.
Author
Jia S.; Nagpal D.; Goldraich L.; Davey R.A.; McKelvie R.; De S.; Smith
S.J.
Institution
(Jia) University of Western Ontario, Schulich School of Medicine and
Dentistry, London, Canada
(Nagpal) London Health Sciences Centre, Cardiac Surgery, London, Canada
(Goldraich, Davey, McKelvie, De, Smith) London Health Sciences Centre,
Cardiology, London, Canada
Publisher
John Wiley and Sons Ltd
Abstract
Purpose: The use of induction therapy for heart transplant remains in
debate. Additionally, agent choice is a major consideration for centers
and may infuence survival outcomes. It is important to have evidence-based
justification for the usage of induction therapy agents due to costs and
risks. Method(s): A retrospective analysis of heart transplant
patients who received anti-thymocyte globulin (ATG), anti-lymphocyte
globulin (ALG), and muromonab-CD3 (OKT3) at a tertiary academic center was
conducted. Patients who received cyclosporine (CyA) alone served as
control. Baseline characteristics were collected for each group. Survival
at 3 months, 1 year, and 10-year post transplant were compared.
 Result(s): A total of 513 patients receiving induction therapy or CyA
between April 1981 and September 2007 were included. Mean baseline
characteristics of the three groups are detailed in Table 1. At 3-months
post transplant ATG, ALG, OKT3, and CyA had survival rates of 78.7, 81.6,
85.1, and 61.9 percent, respectively. The survival 1-year post transplant
for ATG, ALG, OKT3, and CyA were 74.5, 76.4, 81.1, and 61.9 percent,
respectively. After 10-years post transplant 56.4, 53.6, 47.3, and 33.3
percent of ATG, ALG, OKT3, and CyA receiving patients survived,
respectively. P>0.5 for all intervals. Conclusion(s): Anti-thymocyte
globulin is not significantly associated with short and long-term survival
differences in heart transplant patients compared to no induction and
off-market induction agents. Further controlled trials are needed to
provide additional evidence for current use.

<74>
Accession Number
628560753
Title
Outcomes of left atrial appendage occlusion using the atriclip device-the
evidence to date.
Source
European Stroke Journal. Conference: 5th European Stroke Organisation
Conference, ESOC 2019. Italy. 4 (Supplement 1) (pp 734-735), 2019. Date of
Publication: May 2019.
Author
Toale C.; Fitzmaurice G.J.; Eaton D.; Lyne J.; Redmond K.
Institution
(Toale, Fitzmaurice, Eaton, Redmond) Mater Misericordiae University
Hospital Dublin, Department of Thoracic Surgery, Dublin, Ireland
(Lyne) Blackrock Clinic Dublin, Department of Cardiology, Dublin, Ireland
Publisher
SAGE Publications Ltd
Abstract
Background and Aims: The recent development of occlusion devices such as
the Atriclip device (AtriCure, Mason, USA) enables safe and reproducible
epicardial clipping of the left atrial appendage (LAA) during both open
and thoracoscopic surgery, representing an evolution in the surgical
management of atrial fibrillation. This review sought to assess outcomes
of (LAA) clipping using the Atriclip device. Method(s): A systematic
review was performed in May 2018, based on the PRISMA guidelines, using
the keyword 'Atriclip'. A total of 68 papers were identified and reviewed;
12 studies met the inclusion criteria. Data was extracted from each study
including patient demographics, patient medical history, indication for
intervention, and intervention (s) performed. Further data on
peri-procedural outcomes and follow-up was assessed and analyzed.
 Result(s): 956 patients were identified (69.9% male) with a weighted
mean age of 68.2 (62.6 - 74). Complete LAA occlusion was achieved in 936
out of 956 patients (97.9%), as assessed by intra-operative
echocardiogram. In 14 patients, a residual LAA stump of >1cm was observed
post clip placement (1.5%). No device-related serious adverse events were
reported across the studies. The incidence of stroke/TIA post-clip
placement was 1 in 165.6 patient-years. No late deaths attributable to the
Atriclip device were reported. The 3-month success rate of clip placement
was 98.4% (428 of 435 patients) and 399 of 674 patients (59.2%) ceased
anticoagulant/ antiplatelet medication. Conclusion(s): The Atriclip
occlusion device is safe and effective in the management of patients with
Atrial Fibrillation, either as an adjunct in patients undergoing cardiac
surgery or as a stand-alone thoracoscopic procedure.

<75>
Accession Number
628581352
Title
Effect of mediterranean diet on the blood fatty acid profile of patients
with coronary disease.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2019.
Portugal. 26 (Supplement 1) (pp S72), 2019. Date of Publication: June
2019.
Author
Manuela Amato M.; Giroli M.G.; Cavalca V.; Werba J.P.; Bonomi A.; Vigo L.;
Rise P.; Tremoli E.; Veglia F.
Institution
(Manuela Amato, Giroli, Cavalca, Werba, Bonomi, Vigo, Tremoli, Veglia)
Cardiology Center Monzino IRCCS, Milan, Italy
(Rise) University of Milan, Department of Pharmacological and Biomolecular
Sciences, Milan, Italy
Publisher
SAGE Publications Inc.
Abstract
Introduction: Observational and interventional studies showed a possible
role of the Mediterranean diet (MD) in the prevention of cardiovascular
disease; the blood fatty acid (FA) profile has been associated with
cardiovascular risk and its modification, induced by diet, could be a
mediator of the positive effects of MD. Purpose(s): To assess whether
MD is able to favorably modify the blood FA profile in patients with
coronary heart disease (CHD). Method(s): RISMeD (Randomized
Intervention Study on Mediterranean Diet): Parallel groups, open-label
study. Intervention(s): Intensive MD vs. conventional low-fat diet
(LFD) for 3 months. 130 patients (30-75 years) with a recent history of
coronary revascularization were randomized after clinical stabilization
(>60 days after coronary bypass or stenting). At baseline and after 3
months of treatment, anthropometric data, routine biochemical variables,
C-reactive protein (hs- CRP) and blood fatty acid percent composition were
determined. MD adherence was assessed by the Mediterranean Diet Adherence
Screener (MEDAS), a 14-item tool developed and validated for the Spanish
PREDIMED trial. Result(s): 120 patients (58 MD, 62 LFD) completed the
study. After 3 months of treatment many FA varied significantly (Table)
and both diets significantly reduced the blood concentration of saturated
FA (p<.0001). Putative favorable changes of blood omega3 (p=.026) and of
the unsaturation index (p=.032) were significantly larger with MD than
with LFD; notably, the results were not modified after adjustment for
weight loss. Also 20:4n-6 (arachidonic acid) increased more with MD than
with LFD (p=.049) but this change was not paralleled by an increase of
hs-CRP. The change of MEDAS score correlated with changes of many FA:
inversely with 16:0 (R= -0.21, p=.02), and with 22:5 n-6 (R= -0.25
p=.007), and positively with total omega3 (R= 0.19, p=.03) and 20:5 n-3
(R=0.28, p=.002). Conclusion(s): In summary, MD modifies the blood
fatty acids profile of patients with CHD more effectively than LFD, and MD
adherence correlates with the increase of total omega3. (Table Presented)
.

<76>
Accession Number
628580228
Title
Exercise training with selected loads in the rehabilitation of patients
after coronary artery bypass grafting.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2019.
Portugal. 26 (Supplement 1) (pp S159-S160), 2019. Date of Publication:
June 2019.
Author
Anastasia Inozemtseva A.A.; Argunova Y.A.; Pomeshkina S.A.; Barbarash O.L.
Institution
(Anastasia Inozemtseva, Argunova, Pomeshkina, Barbarash) Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian
Federation
Publisher
SAGE Publications Inc.
Abstract
Purpose: To assess the effectiveness of the fast-track exercise trainings
using cycle spiroergometry parameters in patients after coronary artery
bypass grafting (CABG). Method(s): 50 patients after CABG were
included in the study and randomly assigned to two groups. The mean age
was 61.1 +/- 9.1 years (44 men (88%), 6 women (12%). Group 1 patients
(n=25) underwent treadmill exercises of different intensity estimated by
the cardiopulmonary test in addition to the 6-day standard rehabilitation
program. Group 2 patients (n=25) underwent the standard cardiac
rehabilitation program, including dosed walking and dosed exercise
trainings. The inclusion criteria were as follows: isolated CABG and the
presence of written informed consent. The exclusion criteria included
severe concomitant somatic pathology, limiting the patient's physical
activity. All patients underwent routine examination, including clinical
and laboratory tests, cycle spiroergometry on days 6 and 16 after CABG
with the estimation of VO2peak and the anaerobic threshold. There were no
cases of complications. Exercise trainings were performed 5 times a week
(an average of 9 trainings) lasting for 20 minutes: 5 minutes - warm-up,
10 minutes - workout, 5 minutes-cool down. Statistic analysis was
performed using the software package STATISTICA 8.0 (StatSoft).
Quantitative variables were assessed using the Mann-Whitney test. The mean
values are presented as medians and the interquartile ranges. The null
hypothesis was rejected at p <0.05. Result(s): There were no
significant differences found in cycle spiroergometry parameters on day 6
between the study groups. It confirmed the comparability of the study
groups. On day 16, exercise tolerance increased in both groups from 50 to
75 W (p = 0.1). On day 16 after CABG, VO2peak was significantly higher >
59 [51; 69]% in the group with the fast track exercise trainings compared
with the control group, 49 [40; 56]% (p = 0.04) and higher than that on
day 6 after CABG (49 [45, 55]%). The anaerobic threshold was similar in
both groups, but with a tendency towards to its increase in the group with
the fast track exercise trainings, as compared to the control group - 46
[38, 55]% vs 39 [32; 47]% (p = 0,12), and that on day 6 - 38 [30; 43]% (p
= 0.09). Conclusion(s): Alternative rehabilitation programs allowed
improving exercise tolerance in both groups. However, the fast track
exercise trainings with selected loads were more beneficial for improving
the functional capacity of the bronchopulmonary system.

<77>
Accession Number
628579915
Title
Effect of mediterranean diet on inflammatory markers and classical risk
factors in patients with coronary heart disease.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2019.
Portugal. 26 (Supplement 1) (pp S136), 2019. Date of Publication: June
2019.
Author
Giroli M.G.; Amato M.; Cavalca V.; Werba J.P.; Di Minno A.; Porro B.;
Bonomi A.; Vigo L.; Tremoli E.; Veglia F.
Institution
(Giroli, Amato, Cavalca, Werba, Di Minno, Porro, Bonomi, Vigo, Tremoli,
Veglia) Cardiology Center Monzino IRCCS, Milan, Italy
Publisher
SAGE Publications Inc.
Abstract
Introduction: Several studies documented a role of the Mediterranean diet
(MD) in the prevention of cardiovascular diseases, possibly through the
reduction of risk factors and inflammation. Consequently, a change in
dietary habits, induced by the adoption of a MD, could have positive
effects on coronary patients in secondary prevention. Purpose(s): The
purpose of the study was to assess whether the MD was able to modify
markers of inflammation and classical risk factors in patients with overt
coronary heart disease (CHD) on top of poly-therapy with drugs known to
influence these factors. Method(s): RISMeD: Randomized Intervention
Study on Mediterranean Diet, open-label in parallel groups.
 Intervention(s): 130 patients (30-75 years) with a recent history of
coronary revascularization were randomized 1:1 after clinical
stabilization (>60 days) to intensive MD vs. conventional low-fat diet
(LFD) for 3 months; 120 patients (58 MD, 62 LFD) completed the study. At
baseline and after 3 months of diet, anthropometric data, routine
biochemical variables, lipid profile, high sensitivity C-reactive protein
(hs-CRP), white blood cells (WBC) and differential count were determined.
MD adherence was assessed in all the patients using the Mediterranean Diet
Adherence Screener (MEDAS), a 14-item tool developed and validated for the
Spanish PREDIMED trial. Result(s): In all patients, the change of
MEDAS score after 3 months of treatment correlated negatively with changes
of hs-CRP (R=-0.22, p=.01), total cholesterol (R=-0.41, p<.0001),
LDL-cholesterol (R=-0.37, p<.0001), triglycerides (R=-0.26, p=.005), BMI
(R=-0.34, p=.0001) and waist circumference (R=-0.25, p=.005). No
significant correlation was observed between MD adherence and WBC
(R=-0.045, p=.62) or differential count. Conclusion(s): An increased
MD adherence is associated with reduction of metabolic risk factors and
inflammatory markers even in patients on poly-therapy with drugs known to
favorably modify these factors.

<78>
Accession Number
628579778
Title
Derivation and validation of a new scoring system to stratify
post-surgical valvular patients during cardiovascular rehabilitation.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2019.
Portugal. 26 (Supplement 1) (pp S61-S62), 2019. Date of Publication: June
2019.
Author
Maranta F.; Pistoni A.; Cartella I.; Cianfanelli L.; Cianflone D.
Institution
(Maranta) San Raffaele Scientific Institute, Cardiac Rehabilitation Unit,
Milan, Italy
(Pistoni, Cartella, Cianfanelli, Cianflone) University Vita-Salute San
Raffaele, Milan, Italy
Publisher
SAGE Publications Inc.
Abstract
Background: Guidelines emphasise the importance of Cardiovascular
Rehabilitation (CR) in post-surgical valvular patients both for the
functional recovery and complications-monitoring. However, indicators to
better categorise their risk and to identify the real probability of
recovery are lacking. Purpose(s): To propose and validate a scoring
system to appropriately stratify post-surgical valvular patients in order
to individualise CR programmes. Method(s): We conducted a
retrospective study on 1480 (902M-578 F; median age of 64 years, IQR
53-73) consecutive post-surgical valvular patients hospitalised in our CR
Unit. 485 patients underwent single heart valve repair, 408 single heart
valve replacement, 237 single heart valve surgery with additional
interventions, 249 multiple valve interventions and 101 multiple heart
valves with additional interventions. Subjects were randomised in two
groups for data analysis: a Derivation (D; n = 1000) and a Validation (V;
n = 480) group. Initially, we assessed the predictive value of anamnestic,
clinical and laboratory variables for major complications and functional
recovery in group D. We created two scoring systems for these outcomes
and, subsequently, we validated them on group V. Finally, we interlaced
them in an operative algorithm. Result(s): Chronic kidney disease (OR
2.588; 95%CI 1.232-5.436; p=0.012), sternal surgical resynthesis (OR
7.757; 95%CI 2.042-29.471; p=0.003), post-surgical transfusions (OR 2.419;
95%CI 1.407-4.161; p=0.001) and Troponin T peak > 1400 mug/L (OR 2.441;
95%CI 1.418- 4.200; p=0.001) were independent predictors for the
occurrence of major complications in group D. Age (OR 0.958; 95%CI
0.9339-0.977; p<0.001), post- surgical transfusions (OR 1.981; 95%CI
1.160-3.380; p<0.001) and METS at admission (OR 0.032; 95%CI 0.017-0.061;
p<0.001) were independent predictors of a higher functional recovery in
group D. When the two scoring systems were validated on group V, we
obtained a z score of 0.07 (p=0.941) for the major complications risk
score and a z score of 1.23 (p=0.219) for the functional recovery
stratification system, respectively, indicating a very reliable model. We
proceeded to build an operative algorithm to stratify patients and propose
personalised CR strategies. Conclusion(s): We identified predictors
to stratify the risk of complications and to define the probability of
recovery in post-surgical valvular patients undergoing CR. The proposed
final operative algorithm may be a unique tool to support the cardiologist
to tailor rehabilitation programmes. This may lead to better outcomes and
reduction of healthcare expenditure with optimisation in the use of
available resources.

<79>
Accession Number
628579589
Title
Comparison of selected health indices in Irish and Belgian participants
commencing a home-based, technology enabled cardiac rehabilitation
program.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2019.
Portugal. 26 (Supplement 1) (pp S40-S41), 2019. Date of Publication: June
2019.
Author
Mcdermott C.; Mccormack C.M.; Mcdermott L.; O'shea O.; Kelly S.M.;
Mccarren A.; Claes J.; Buys R.; O'connor N.; Mccaffrey N.; Susta D.; Woods
C.; Cornelissen V.; Moran K.; Moyna N.M.
Institution
(Mcdermott, Mccormack, Mcdermott, O'shea, Kelly, Mccaffrey, Susta, Moran,
Moyna) Dublin City University (DCU), School of Health and Human
Performance, Dublin, Ireland
(Mccarren) Dublin City University (DCU), School of Computing, Dublin,
Ireland
(Claes, Buys, Cornelissen) KU Leuven, Department of Cardiovascular
Sciences, Leuven, Belgium
(O'connor) Dublin City University (DCU), School of Electronic Engineering,
Dublin, Ireland
(Woods) University of Limerick, Department of Physical Education and
Sports Science, Limerick, Ireland
Publisher
SAGE Publications Inc.
Abstract
Background/Introduction: Despite strong evidence for cardiac
rehabilitation (CR) in secondary prevention of CVD, both uptake and
long-term adherence is low. Innovative, patientcentered and cost-effective
delivery models based on advances in digital technology/communications
have the potential to increase both uptake and long-term adherence to CR.
PATHway is an individualized self-management home-based CR program
involving an internet- enabled, sensor-based platform designed for men and
women with CVD living in Ireland and Belgium. Purpose(s): The purpose
of this study was to compare selected health indices of Irish and Belgian
participants entering the PATHway program. Method(s): In a
multicentre randomized controlled pilot trial, 120 patients (men = 82%),
ranging in age from 40-80 yr, completing a hospital-based CR program in
Belgium or Ireland were randomized (1:1) to PATHway or standard care.
Anthropometric measures, vascular health, cardiorespiratory fitness (CRF),
strength, physical activity and blood parameters were assessed using
identical protocol in both the Irish and Belgian centres. Result(s):
The study participants (mean age+/-SD = 60.3+/-9.2 yr) were classified as
overweight (BMI=28.2+/-4.0 kg/m2). Two thirds (n=81) of the
participants were referred to CR following percutaneous coronary
intervention, 16 following coronary artery bypass graft, 6 following valve
surgery and 17 for other cardiac conditions. The Irish participants
expended more calories per day (p = 0.001) than their Belgium counterparts
(1871.2+/-688.9 kcal/d vs. 1456.0+/-427.8 kcal/d). Cardiorespiratory
fitness level was significantly higher (p <0.01) in the Belgian
(25.5+/-6.3 ml/kg/min vs. 22.7+/-6.1 ml/min/kg) than the Irish
participants. Measures of upper and lower body strength were significantly
higher in the Belgian than the Irish participants. Conclusion(s): The
Irish cohort were significantly more active than the Belgian group.
However, the Belgian group had higher levels of CRF and both upper and
lower body strength than their Irish counterparts.

<80>
Accession Number
628579141
Title
Cardioprotective effects of exercise trainings prior to coronary artery
bypass grafting.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2019.
Portugal. 26 (Supplement 1) (pp S37), 2019. Date of Publication: June
2019.
Author
Yulia Argunova Y.; Pomeshkina S.A.; Kokov A.N.; Barbarash O.L.
Institution
(Yulia Argunova, Pomeshkina, Kokov, Barbarash) Research Institute for
Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
Publisher
SAGE Publications Inc.
Abstract
Purpose: To evaluate cardioprotective effects of high intensity
prehabilitation for patients with coronary artery disease (CAD) prior to
elective on-pump coronary artery bypass grafting (CABG). Method(s):
38 male patients with stable CAD referred to on-pump CABG were randomized
into two groups based on the prehabilitation program. Group 1 patients (n
= 20, the mean age 57.9+/-7.15 years) underwent high intensity treadmill
exercises. Group 2 patients (n = 18, the mean age 60.4+/-7.01 years)
underwent routine preoperative management without prehabilitation. Group 1
patients underwent exercise trainings under hemodynamic control and ECG
monitoring (30 minute workouts per 1 day for 7 days). The training power
of workout was calculated based on cardiopulmonary exercise test performed
before preoperative exercises, and was estimated as 80% of the maximal
oxygen consumption obtained during the exercise test. Adenosine loading
single-photon emission computed tomography (SPECT) was used to measure
myocardial perfusion before preoperative exercises and on days 5-7 after
CABG in both study groups. Myocardial perfusion was assessed using the QPS
program (Cedars Sinai Medical Center (USA)) with the construction of 17
segment polar map. All patients underwent direct myocardial
revascularization under extracorporeal circulation. Statistical analysis
was performed using the Statistica 10.0 software packages (Statsoft, USA).
 Result(s): Both study groups were comparable in the main clinical and
demographic as well as main intraoperative clinical. Moreover, the
parameters of the cardiopulmonary exercise test and SPECT were similar in
both study groups. There were no cases of complications during
prehabilitation. All patients had good exercise tolerance. The following
parameters were assessed: the rate of accumulation of radiopharmaceutical
in each sector (%), as well as integral indices of myocardial damage: SRS
(Summed Rest Score) - the sum of individual scores during rest, SSS
(Summed Stress Score) - the sum of scores characterizing the extent and
severity of stress perfusion abnormality, SDS (Summed Difference Score) -
the sum of scores representing the extent and severity of stress-induced
ischemia. The analysis of myocardial perfusion parameters demonstrated
that patients who had undergone preabilitation had significantly higher
accumulation of radiopharmaceutical than those in the control group in
basal segments (74.9+/-3.98% vs. 70.3+/-7.40% p = 0.04), middle
(86.7+/-5.24% vs. 79.6+/-10.43%, p = 0.03) and apical (85.8+/-5.03% vs.
79.0+/-8,67%, p = 0.02) myocardium. The stress-induced ischemia (SDS) was
less pronounced in Group 1 compared to Group 2 (0 scores and 0.9+/-0.53
scores, respectively, p = 0.04). Conclusion(s): High intensity
preoperative exercises in the routine preoperative management of patients
referred to elective CABG improves myocardial perfusion in the
postoperative period.

<81>
Accession Number
628578991
Title
Effects of prehabilitation program on quality of life and adherence to
therapy in patients undergoing coronary artery bypass grafting.
Source
European Journal of Preventive Cardiology. Conference: EuroPrevent 2019.
Portugal. 26 (Supplement 1) (pp S35), 2019. Date of Publication: June
2019.
Author
Yulia Argunova Y.; Pomeshkina S.A.; Moskin E.G.; Sogoyan N.; Barbarash
O.L.
Institution
(Yulia Argunova, Pomeshkina, Moskin, Barbarash) Research Institute for
Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Sogoyan) Federal State Budgetary Educational Institution of Higher
Education, Kemerovo State University, Kemerovo, Russian Federation
Publisher
SAGE Publications Inc.
Abstract
Aim: To evaluate clinical efficacy of high-intensity exercise training
included in the prehabilitation program for elective coronary artery
bypass grafting (CABG). Method(s): 38 male patients were included in
the study before on-pump CABG. After fulfilling the inclusion/exclusion
criteria, patients were randomized into two groups: Group 1 patients (n =
20) underwent supervised treadmill exercise, and Group 2 patients (n = 18)
were referred to surgery without any exercise training. Patients underwent
a 7-day exercise training with daily measurements of hemodynamic
parameters and electrocardiogram (ECG) monitoring. The load intensity was
measured with cardiopulmonary exercise testing and accounted for 80% of
the maximal oxygen uptake. Postoperative complications were recorded in
the in-hospital period and analyzed. Quality of life indicators were
measured by the SF-36 standard version 7-10 days prior to surgery and on
days 7-10 of the postoperative period. Adherence to drug and non-drug
therapy was assessed during the 6-month follow-up. Result(s): There
was a significantly lower incidence of postoperative complications during
the in-hospital period in patients undergoing prehabilitation program with
supervised high-intensity exercise training, compared with patients
without any exercise training (p = 0.002). Group 1 patients had reliably
better mental health (MH) scores compared with Group 2 patients
(48.9+/-7.60 vs. 39.1+/-6.80 scores, respectively; p = 0.03) on days 7-10
after CABG. Six months after the CABG, patients who underwent
prehabilitation exercise training were less likely to resume smoking than
patients without any exercise training (p = 0.04). The tendency towards
improved adherence to drug therapy and compensation in arterial
hypertension has been determined among Group 1 patients.
 Conclusion(s): Exercise training included in the prehabilitation
program proved to be safe and effective in terms of improved clinical
outcomes after CABG, quality of life and adherence to treatment in this
group of patients.

<82>
Accession Number
628562332
Title
Exercise oscillatory ventilation improves the performance of prognosis
scores currently used for heart failure.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp 350),
2019. Date of Publication: May 2019.
Author
Francisco Gama F.; Freitas P.; Aguiar C.; Ferreira A.; Tralhao A.; Strong
C.; Ventosa A.; Ferreira J.; Mendes M.
Institution
(Francisco Gama, Freitas, Aguiar, Ferreira, Tralhao, Strong, Ventosa,
Ferreira, Mendes) Hospital de Santa Cruz, Lisbon, Portugal
Publisher
John Wiley and Sons Ltd
Abstract
Background and aim: Several prognostic risk scores are available for heart
failure with reduced ejection fraction (HFrEF), and are used, together
with other criteria, to help decide the ideal timing for listing
candidates for a heart transplant. The detection of an oscillatory
ventilatory pattern (OVP) during cardiopulmonary exercise testing (CPET)
has been associated with more advanced HF and a worse prognosis, but was
not considered in the development of all the current risk scores. We
evaluated whether OVP adds significant prognostic information to four
contemporary HF scores. Method(s): Single-centre retrospective cohort
study of consecutive HFrEF patients undergoing CPET for functional and
prognostic assessment from October 1996 till May 2018. The Heart Failure
Survival Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-analysis
Global Group in Chronic Heart Failure (MAGGIC) and Metabolic Exercise
Cardiac Kidney Index (MECKI) were obtained in each patient. Cox model was
ft with time to death or urgent transplant (whichever came frst within 2
years) as the dependent variable and OVP and respective HF score as the
independent variables. We further assessed the added discriminative power
by performing ROC curve comparisons. Result(s): We studied 387
patients, median age 58 (IQR 49; 65) years, and 77% were male. The most
common HFrEF aetiology was ischemic heart disease (54%). Median peak
oxygen consumption was 15,7 mL/kg/min (IQR 12,8; 20,0). OVP was present in
150 (39%) patients. Over the 2-year follow-up period, 48 patients died,
and 52 underwent heart transplantation (of which 25 were urgent). HFSS
showed the weakest (c-statistic 0,625; 95% [CI] 0,54-0,71) and MECKI score
the strongest (c-statistic 0,819; 95% [CI] 0,76-0,88) discriminatory
ability. The presence of OVP predicted the study endpoint independently of
the HF prognosis score used (see table). Adding the occurrence of OVP to
the HFSS and the MAGGIC scores significantly improved their prognostic
performance (see Table). Conclusion(s): An OVP is a common fnding in
HFrEF patients undergoing CPET and adds prognostic information to
contemporary HF prognosis scores. Systematic evaluation of this easily
available criterion may assist the decision on the appropriate timing for
heart transplantation listing. [Table Presented].

<83>
Accession Number
628558023
Title
Changes in hemodynamic profile in patients with severe systolic
dysfunction treated with sacubitril-valsartan.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp 422),
2019. Date of Publication: May 2019.
Author
Corazza F.; Ceccarelli A.; Vitale G.; Boschi S.; Giovannini L.; Masetti
M.; Russo A.; Luciano Potena L.
Institution
(Corazza, Ceccarelli, Vitale, Boschi, Giovannini, Masetti, Russo, Luciano
Potena) Bologna University Hospital, Bologna, Italy
Publisher
John Wiley and Sons Ltd
Abstract
Background. Post-capillary pulmonary hypertension (PC-PH) is a frequent
complication and prognostic marker in patients with advanced heart failure
(HF). No specifc treatments are available for PC-PH other than optimal HF
therapy. In this context, we tested the hypothesis that therapy
optimization with sacubitril-valsartan (LCZ), known to reduce the risk of
death and hospitalizations for HF, could improve the hemodynamic profle of
patients with HF and PC-PH. Methods. Among the patients included in our
institutional prospective HF Registry, we included in this analysis those
who underwent two right heart catheterizations (RHC) and started LCZ in
between, in the period July 2017 to December 2018. All patients were
evaluated for heart transplantation and RHC is part of our routine
clinical practice as follow-up strategy in these patients. Baseline and
follow-up RHC were compared by paired T-test. Changes in guideline
directed therapy (GDT) were also assessed. Results. 35 patients (86%
males; aged 53.3 +/- 8.4y, 10(29%) with ischemic etiology, and 12 (34%) in
NYHA class III-IV) with severe left ventricular dysfunction (ejection
fraction: 25.6+/-7.5%) underwent two RHC at 187+/-85 days interval. All
patients were receiving therapy with diuretics (187+/-85mg/day),
ACE-i/ARBs (43+/-27% of GDT dose), and beta-blockers (57+/-33% of GDT
dose) at the time of baseline RHC. LCZ was started at a median of
21(0-116) days after the baseline RHC. By comparing baseline with
follow-up RHC in a matched paired fashion, we observed significant
reduction of mean pulmonary artery pressure (from 31+/-11 to 26+/-9 mmHg;
P<0.01), pulmonary capillary wedge pressure (from 21+/-7 to 18+/-8 mmHg;
P<0.01) and pulmonary vascular resistances (from 2.8+/-1.7 to 2.0+/-1.0
WU; P<0.01), associated with a significant increased of cardiac index
(from 2.1+/-0.4 to 2.3+/-0.6 l/min/m2; P=0.03). Conversely, systolic
systemic pressure did not change significantly (from 110+/-12 to 107+/-12
mmHg; P=0.16). Of note, diuretics and beta-blockers dose did not change
significantly between the two RHC. Conclusions. In the context of stable
and optimized at the maximal tolerated dose of GDT, this pilot experience
suggests that LCZ may improve the management of PC-PH in patients with
severe LV dysfunction. The changes in hemodynamic profle, including the
increase in cardiac index, provide a pathophysiological Background of the
clinical benefits observed in the LCZ randomized trial.

<84>
Accession Number
628562472
Title
Repetitive levosimendan infusions for patients with advanced chronic heart
failure in the vulnerable post-discharge period: The LeoDOR Trial.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp 331),
2019. Date of Publication: May 2019.
Author
Gerhard Polzl G.; Comin-Colet J.; Delgado J.F.; Fiedele F.;
Garcia-Gonzales M.J.; Gustafsson F.; Masip J.F.; Papp Z.; Stoerk S.; Ulmer
H.; Vrtovec B.; Wikstroem G.; Altenberger J.F.
Institution
(Gerhard Polzl) Department of Internal Medicine III-Cardiology, Innsbruck,
Austria
(Comin-Colet) University Hospital of Bellvitge, Cardiology, Barcelona,
Spain
(Delgado) University Hospital 12 de Octubre, Cardiology, Madrid, Spain
(Fiedele) Sapienza University of Rome, Cardiovascular Science, Rome, Italy
(Garcia-Gonzales) University Hospital Canarias, Cardiology, San Cristobal,
Spain
(Gustafsson) University of Copenhagen, Cardiology, Copenhagen, Denmark
(Masip) University of Barcelona, Intensive Care, Barcelona, Spain
(Papp) University of Debrecen, Cardiology, Debrecen, Hungary
(Stoerk) University Hospital Wurzburg, Wuerzburg, Germany
(Ulmer) Innsbruck Medical University, Innsbruck, Austria
(Vrtovec) University Medical Centre of Ljubljana, Cardiology, Ljubljana,
Slovenia
(Wikstroem) Uppsala University Hospital, Uppsala, Sweden
(Altenberger) Centre for Cardiac Rehabilitation Grossgmain, Grossgmain,
Austria
Publisher
John Wiley and Sons Ltd
Abstract
Background Readmission and mortality rates are high during the vulnerable
period following an episode of acute heart failure. Experience in several
clinical studies has indicated that administration of intravenous
levosimendan in intermittent cycles may be effective in patients with
advanced HF. We here describe the rationale and protocol of the LeoDOR
study that will assess the effcacy and safety of intermittent levosimendan
therapy during the vulnerable phase after a recent hospitalisation for
acute HF in advanced HFrEF patients. The overarching hypothesis is that,
compared with placebo, repetitive administration of levosimendan during
the post-acute phase will be associated with greater clinical stability
over a follow-up period of 14 weeks. Methods The LeoDOR study is a
randomised, double-blind, placebo-controlled, three-armed trial designed
to evaluate the effcacy and safety of intermittent lev-osimendan therapy,
administered in addition to standard therapy for a period of 12 weeks
either as a 6-h continuous infusion at a rate of 0.2 g/kg/min every 2
weeks or as a 24-h continuous infusion at a rate of 0.1 g/kg/min every 3
weeks. The primary endpoint will be evaluated after 14 weeks. Information
on safety events will be obtained after 6 months. The study that was
started in March 2018 intends to include 264 patients in 30 centres in
nine European countries. The primary effcacy assessment will be made using
a global rank endpoint in which all participants are ranked across three
hierarchical groups: (i) time to death or urgent heart transplantation or
implantation of a ventricular assist device (VAD); (ii) time to non-fatal
HF requiring i.v. vasoactive therapy; and (iii) time-averaged proportional
change in N-terminal pro-brain natriuretic peptide (NT-proBNP) from
baseline to week 14 with (i) as the most important event. Secondary
effcacy end-points include individual components of the primary endpoint
at short-(14 weeks) and intermediate-term (26 weeks) follow-up, as well as
changes in functional status. Conclusion The LeoDOR trial will test
effcacy and safety of intermittent levosi-mendan therapy in patients with
"very" advanced but not acute heart failure with the highest short-and
long-term mortality and rehospitalisation rates. The study is configured
to examine evidence of effcacy of an intensified therapy using clinically
relevant endpoints for severely ill patients managed on an outpatient
basis.

<85>
Accession Number
628561341
Title
Platelet aggregation test with adenosine diphosphate in prevention of
early coronary stent thrombosis.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp 555),
2019. Date of Publication: May 2019.
Author
Ekaterina Gitelzon E.; Faybushevich A.; Gitelson D.; Baranovich V.;
Veretnik G.; Maximkin D.
Institution
(Ekaterina Gitelzon, Faybushevich, Gitelson, Baranovich, Veretnik,
Maximkin) Peoples Friendship University of Russia (PFUR), Moscow, Russian
Federation
Publisher
John Wiley and Sons Ltd
Abstract
The coronary artery stenting is a common and effective endovascular
treatment for various forms of coronary artery disease. In most cases
prescribed dual antiplatelet therapy helps prevent stent thrombosis.
However, the effectiveness of dual antiplatelet therapy is rarely
monitored. Despite there are 0.6-2% chances in the frst year of having
stent thrombosis with high mortality rate after coronary artery stenting.
 Aim(s): to study the effectiveness of platelet aggregation management
in early coronary stent thrombosis prevention in patients with unstable
angina.Materials and methods. The study included 215 patients with
unstable angina. All patients were randomized in II groups. There were 112
patients in group I and 103 patients-in group II. Group I had the platelet
aggregation managment based on platelet aggregation test with adenosine
diphosphate and group II had not. Percutaneous coronary intervention with
stenting perfomed in both groups. The odds ratio for the development of
early coronary stent thrombosis in patients with unstable angina with
platelet aggregation management compared with the patients without
platelet aggregation management is 3.36 (p <0.05).Conclusion. The study
shows the importance of platelet aggregation management in the prevention
of early coronary stent thrombosis in patients with unstable angina.

<86>
Accession Number
628558429
Title
Combination immunosuppressive therapy with prednisone and azathioprine for
virus-negative inflammatory cardiomyopathy: Meta-analysis of all available
evidence.
Source
European Journal of Heart Failure. Conference: Heart Failure 2019 and the
World Congress on Acute Heart Failure. Greece. 21 (Supplement 1) (pp 458),
2019. Date of Publication: May 2019.
Author
Philippe Timmermans P.H.T.; Barradas-Pires A.; Ali O.; Henkens M.; Heymans
S.; Negishi K.
Institution
(Philippe Timmermans) Jessa Hospital, Rehabilitation and Health Centre,
Heart Centre, Hasselt, Belgium
(Barradas-Pires) Royal Brompton Hospital, Cardiology, London, United
Kingdom
(Ali) Wayne State University, Cardiology, Detroit, United States
(Henkens, Heymans) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
(Negishi) Menzies Research Institute, Hobart, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Combination immune suppression with prednisolone and
azathio-prine (IPA) is used to treat heart failure due to chronic
non-fulmintant non-viral myocarditis. However, there has been
inconsistency in the effects of immunosup-pression treatment. A systematic
review and meta-analysis of trials using (IPA) to treat HF refractory to
OMT caused by chronic non-fulminant virus negative or "autoimmune"
myocarditis was conducted to demonstrate the effect on LV EF and the
combined clinical endpoint of cardiovascular mortality and/or HTx-free
survival. Methods and Results: All trials with using IPA versus OMT
were searched using OVID Medline and ClinicalTrials.gov, following the
PRISMA guidelines. Missing clinical outcome data was retrieved after
contacting the corresponding authors. All data was reviewed and analysed
using and standard meta-analysis methods. A random effect model was used
to pool the effect sizes. A total of 4 trials were identified. Two were
published RCT, one was an aborted RCT without publication but randomised
and treated 20 patients and one was a published registry with a
corresponding control group, resulting in a total of 369 patients. IPA on
top of OMT did not improve LVEF (mean difference 9.9% [95% confdence
interval-1.8, 21.7]). Because of the significant heterogeneity (I296.8%,
p<0.001) we performed a subanalysis of this result. First, the studies
were divided by whether RCT or not, where I2values remained similar
(96.9%). Then, they were sub-grouped by whether published or not, which
did not reduce I2-values but the pooled estimates of the change in LVEF
became significantly positive with 14% [1.4, 26.6]. A trend towards a
benefit in the combined endpoint of cardiovascular mortality and/or heart
transplantation-free survival was observed with the intervention but did
not reach clinical significance (risk ratio 0.34 [0.08, 1.51]). Because of
a moderate heterogeneity (I2= 60%), we again performed a subgroup
analyses. When categorised by RCT or not, heterogeneity significantly
dropped close to low level (32%) with no difference in the pooled RR of
the RCTs. Sub-grouping by publication status increased heterogeneity to
almost high category (I2=72.9%). Conclusion(s): At the moment, there
is insuffcient evidence supporting functional and prognostic benefits of
IPA added to OMT in virus negative infammatory positive cardiomyopathy.
There is a potential positive effect on both LV EF and the combined
endpoint of cardiovascular mortality or HTx-free survival. Significant
heterogeneity exist among individual publications regarding diagnosis,
dose regime, duration of therapy, study design and quality of the data.
More research is needed to elucidate the exact impact of this treatment.
Further adequate-powered well-designed prospective RCTs should be
warranted to explore the potential effects of adding immunosup-pressive
therapy to OMT.

<87>
Accession Number
628557003
Title
Factors that influence oncology nutrition efficacy in breast cancer
patients under antiestrogenic treatment.
Source
Annals of Oncology. Conference: 43rd Congress of European Society for
Medical Oncology, ESMO 2018. Germany. 29 (Supplement 8) (pp
viii603-viii604), 2018. Date of Publication: October 2018.
Author
Artene D.V.; Blidaru A.
Institution
(Artene) Oncology, Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania
(Blidaru) Surgical Oncology, Alexandru Trestioreanu Oncology Institute,
Bucharest, Romania
Publisher
Oxford University Press
Abstract
Background: Many breast cancer patients gain weight during treatment
increasing recurrence, metastasis and mortality risks. The diagnosis
overthrows patients' lifestyle aggravating sedentariness and any
pre-existing weight gain causes like insulin and leptin resistance, sleep
disturbances and hedonic eating. Method(s): To test the efficacy of
an at-home oncology nutrition intervention meant to stop weight gain
during antiestrogenic treatment we proposed a diet based on foods
naturally high in proteins, omega-3 fatty acids, calcium, probiotics and
prebiotics. 331 patients were randomly assigned to the control group, with
no oncology nutrition advice besides the physician recommendation to avoid
weight gain. 283 patients were randomly assigned to the intervention group
and asked to follow the proposed diet. We measured weight and body
composition and we compared results at 24 months between intervention and
control groups. Then we analysed the results based on the administered
oncology treatment type and patients' age, comorbidities, lifestyle
characteristics. Result(s): At 24 months, patients within the
intervention group reached a modest but statistically significant weight
loss and fat loss with no sarcopenia (2.44kg weight loss, 2.37%
subcutaneous fat loss, 0.65% visceral fat loss, 1,24% muscle mass
increase), while those in the control group maintained weight, increased
fat and lost muscle (0.35kg weight loss, 0.34% subcutaneous fat increase,
0.4% visceral fat increase, 0.42 muscle mass decrease). Efficacy was
influenced by: age - 31-40 yo patients having worse results than 41-50 yo
patients and than 51-80 yo patients; AET type - patients on letrozole
having best results; De novo thyroidal disease - lowered fat loss;
depression - lowered fat loss; statins - when co-administrated throughout
exemestane treatment - lowered fat loss; sleep disturbances - increased
sarcopenia. Efficacy was not influenced by: chemotherapy or radiotherapy
administration, type of surgery, cardiovascular disease, smoking or by the
dieting history. Conclusion(s): Oncology nutrition interventions can
counteract sarcopenic obesity during antiestrogenic treatment, but the
efficacy of the intervention can be influenced by patients' age and
comorbidities.

<88>
Accession Number
628451850
Title
Prognostic value of lipoprotein (a) level in patients with coronary artery
disease: A meta-analysis.
Source
Lipids in Health and Disease. 18 (1) (no pagination), 2019. Article
Number: 150. Date of Publication: 08 Jul 2019.
Author
Wang Z.; Zhai X.; Xue M.; Cheng W.; Hu H.
Institution
(Wang, Xue, Cheng, Hu) Department of Cardiology, Shandong Provincial
Qianfoshan Hospital, First Hospital Affiliated with Shandong First Medical
University, NO. 16766, Jingshi Road, Jinan city, Jinan Shandong Province
250014, China
(Zhai) Department of Geriatrics, Municipal Hospital of Zibo City, Zibo
City Shandong Province 255000, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Elevated lipoprotein (a) is recognized as a risk factor for
incident cardiovascular events in the general population and established
cardiovascular disease patients. However, there are conflicting findings
on the prognostic utility of elevated lipoprotein (a) level in patients
with coronary artery disease (CAD).Thus, we performed a meta-analysis to
evaluate the prognostic value of elevated lipoprotein (a) level in CAD
patients. Methods and Results: A systematic literature search of
PubMed and Embase databases was conducted until April 16, 2019.
Observational studies reporting the prognostic value of elevated
lipoprotein (a) level for cardiac events (cardiac death and acute coronary
syndrome), cardiovascular events (death, stroke, acute coronary syndrome
or coronary revascularisation), cardiovascular death, and all-cause
mortality in CAD patients were included. Pooled multivariable adjusted
risk ratio (RR) and 95% confidence interval (CI) for the highest vs. the
lowest lipoprotein (a) level were utilized to calculate the prognostic
value. Seventeen studies enrolling 283,328 patients were identified.
Meta-analysis indicated that elevated lipoprotein (a) level was
independently associated with an increased risk of cardiac events (RR
1.78; 95% CI 1.31-2.42) and cardiovascular events (RR 1.29; 95% CI
1.17-1.42) in CAD patients. However, elevated lipoprotein (a) level was
not significantly associated with an increased risk of cardiovascular
mortality (RR 1.43; 95% CI 0.94-2.18) and all-cause mortality (RR 1.35;
95% CI 0.93-1.95). Conclusion(s): Elevated lipoprotein (a) level is
an independent predictor of cardiac and cardiovascular events in CAD
patients. Measurement of lipoprotein (a) level has potential to improve
the risk stratification among patients with CAD. Copyright © 2019
The Author(s).

<89>
Accession Number
628578019
Title
Comparison of Major Adverse Cardiac Events between Instantaneous Wave-Free
Ratio and Fractional Flow Reserve-Guided Strategy in Patients with or
Without Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical
Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Lee J.M.; Choi K.H.; Koo B.-K.; Dehbi H.-M.; Doh J.-H.; Nam C.-W.; Shin
E.-S.; Cook C.M.; Al-Lamee R.; Petraco R.; Sen S.; Malik I.S.; Nijjer
S.S.; Mejia-Renteria H.; Alegria-Barrero E.; Alghamdi A.; Altman J.;
Baptista S.B.; Bhindi R.; Bojara W.; Brugaletta S.; Silva P.C.; Di Mario
C.; Erglis A.; Gerber R.T.; Going O.; Harle T.; Hellig F.; Indolfi C.;
Janssens L.; Jeremias A.; Kharbanda R.K.; Khashaba A.; Kikuta Y.;
Krackhardt F.; Laine M.; Lehman S.J.; Matsuo H.; Meuwissen M.; Niccoli G.;
Piek J.J.; Ribichini F.; Samady H.; Sapontis J.; Seto A.H.; Sezer M.;
Sharp A.S.P.; Singh J.; Takashima H.; Talwar S.; Tanaka N.; Tang K.; Van
Belle E.; Van Royen N.; Vinhas H.; Vrints C.J.; Walters D.; Yokoi H.;
Samuels B.; Buller C.; Patel M.R.; Serruys P.; Escaned J.; Davies J.E.
Institution
(Lee, Choi) Samsung Medical Center, Sungkyunkwan University, School of
Medicine, Seoul, South Korea
(Koo) Seoul National University Hospital, Institute on Aging, Seoul
National University, Seoul, South Korea
(Dehbi) Cancer Research UK, University College London Cancer Trials
Centre, University College London, London, United Kingdom
(Doh) Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea
(Nam) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Shin) Ulsan Hospital, Ulsan, South Korea
(Cook, Al-Lamee, Petraco, Sen, Malik, Nijjer, Serruys, Davies) Hammersmith
Hospital, Imperial College London, London, United Kingdom
(Mejia-Renteria, Escaned) Hospital Clinico San Carlos, IDISSC, Universidad
Complutense de Madrid, Madrid, Spain
(Alegria-Barrero) Hospital Universitario de Torrejon, Universidad
Francisco de Vitoria, Madrid, Spain
(Alghamdi) King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi
Arabia
(Altman) Colorado Heart and Vascular, Lakewood, CO, United States
(Baptista) Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal
(Bhindi) Royal North Shore Hospital, Sydney, Australia
(Bojara) Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz,
Germany
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
(Silva) Hospital Santa Maria, Lisbon, Portugal
(Di Mario) Royal Brompton Hospital, Imperial College London, London,
United Kingdom
(Di Mario) University of Florence, Florence, Italy
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
(Gerber) Conquest Hospital, St Leonards-on-Sea, United Kingdom
(Going) Sana Klinikum Lichtenberg, Lichtenberg, Germany
(Harle) Klinikum Oldenburg, European Medical School, Carl von Ossietzky
University, Oldenburg, Germany
(Hellig) Sunninghill Hospital, Johannesburg, South Africa
(Indolfi) University Magna Graecia, Catanzaro, Italy
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Jeremias) Stony Brook University Medical Center, New York, NY, United
States
(Kharbanda) John Radcliffe Hospital, Oxford University Hospitals
Foundation Trust, Oxford, United Kingdom
(Khashaba) Ain Shams University, Cairo, Egypt
(Kikuta) Fukuyama Cardiovascular Hospital, Fukuyama, Japan
(Krackhardt) Charite Campus Virchow Klinikum, Universitaetsmedizin,
Berlin, Germany
(Laine) Helsinki University Hospital, Helsinki, Finland
(Lehman) Flinders University, Adelaide, SA, Australia
(Matsuo) Gifu Heart Center, Gifu, Japan
(Meuwissen) Amphia Hospital, Breda, Netherlands
(Niccoli) Catholic University of the Sacred Heart, Rome, Italy
(Piek) AMC Heart Center, Academic Medical Center, Amsterdam, Netherlands
(Ribichini) University Hospital Verona, Verona, Italy
(Samady) Emory University, Atlanta, GA, United States
(Sapontis) Monash Heart, Monash University, Melbourne, VIC, Australia
(Seto) Veterans Affairs Long Beach Healthcare System, Long Beach, CA,
United States
(Sezer) Istanbul University, Istanbul Faculty of Medicine, Istanbul,
Turkey
(Sharp) Royal Devon and Exeter Hospital, Exeter, United Kingdom
(Sharp) University of Exeter, Exeter, United Kingdom
(Singh) Washington University School of Medicine in St Louis, St Louis,
MO, United States
(Takashima) Aichi Medical University Hospital, Aichi, Japan
(Talwar) Royal Bournemouth General Hospital, Bournemouth, United Kingdom
(Tanaka) Tokyo Medical University, Tokyo, Japan
(Tang) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Tang) Anglia Ruskin University, Chelmsford, United Kingdom
(Van Belle) Institut Coeur Poumon, Lille University Hospital, Lille,
France
(Van Belle) INSERM Unite 1011, Lille, France
(Van Royen) VU University Medical Center, Amsterdam, Netherlands
(Vinhas) Hospital Garcia de Horta, Lisbon, Portugal
(Vrints) Antwerp University Hospital, Antwerp, Belgium
(Walters) Prince Charles Hospital, Brisbane, QLD, Australia
(Yokoi) Fukuoka Sannou Hospital, Fukuoka, Japan
(Samuels) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Buller) St Michaels Hospital, Toronto, ON, Canada
(Patel) Duke University, Durham, NC, United States
(Shin) Ulsan University Hospital, University of Ulsan, College of
Medicine, Ulsan, South Korea
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Invasive physiologic indices such as fractional flow reserve
(FFR) and instantaneous wave-free ratio (iFR) are used in clinical
practice. Nevertheless, comparative prognostic outcomes of iFR-guided and
FFR-guided treatment in patients with type 2 diabetes have not yet been
fully investigated. Objective(s): To compare 1-year clinical outcomes
of iFR-guided or FFR-guided treatment in patients with and without
diabetes in the Functional Lesion Assessment of Intermediate Stenosis to
Guide Revascularization (DEFINE-FLAIR) trial. Design, Setting, and
Participant(s): The DEFINE-FLAIR trial is a multicenter, international,
randomized, double-blinded trial that randomly assigned 2492 patients in a
1:1 ratio to undergo either iFR-guided or FFR-guided coronary
revascularization. Patients were eligible for trial inclusion if they had
intermediate coronary artery disease (40%-70% diameter stenosis) in at
least 1 native coronary artery. Data were analyzed between January 2014
and December 2015. Intervention(s): According to the study protocol,
iFR of 0.89 or less and FFR of 0.80 or less were used as criteria for
revascularization. When iFR or FFR was higher than the prespecified
threshold, revascularization was deferred. Main Outcomes and
Measures: The primary end point was major adverse cardiac events (MACE),
defined as the composite of all-cause death, nonfatal myocardial
infarction, or unplanned revascularization at 1 year. The incidence of
MACE was compared according to the presence of diabetes in iFR-guided and
FFR-guided groups. Result(s): Among the total trial population (2492
patients), 758 patients (30.4%) had diabetes. Mean age of the patients was
66 years, 76% were men (1868 of 2465), and 80% of patients presented with
stable angina (1983 of 2465). In the nondiabetes population (68.5%; 1707
patients), iFR guidance was associated with a significantly higher rate of
deferral of revascularization than the FFR-guided group (56.5% [n = 477 of
844] vs 46.6% [n = 402 of 863]; P <.001). However, it was not different
between the 2 groups in the diabetes population (42.1% [n = 161 of 382] vs
47.1% [n = 177 of 376]; P =.15). At 1 year, the diabetes population showed
a significantly higher rate of MACE than the nondiabetes population (8.6%
vs 5.6%; adjusted hazard ratio [HR], 1.88; 95% CI, 1.28-2.64; P <.001).
However, there was no significant difference in MACE rates between
iFR-guided and FFR-guided groups in both the diabetes (10.0% vs 7.2%;
adjusted HR, 1.33; 95% CI, 0.78-2.25; P =.30) and nondiabetes population
(4.7% vs 6.4%; HR, 0.83; 95% CI, 0.51-1.35; P =.45) (interaction P =.25).
 Conclusions and Relevance: The diabetes population showed
significantly higher risk of MACE than the nondiabetes population, even
with the iFR-guided or FFR-guided treatment. The iFR-guided and FFR-guided
treatment showed comparable risk of MACE and provided equal safety in
selecting revascularization target among patients with diabetes. Trial
Registration: ClinicalTrials.gov identifier: NCT02053038. Copyright
© 2019 American Medical Association. All rights reserved.

<90>
Accession Number
628573832
Title
Effect of Simvastatin-Ezetimibe Compared with Simvastatin Monotherapy
after Acute Coronary Syndrome among Patients 75 Years or Older: A
Secondary Analysis of a Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Bach R.G.; Cannon C.P.; Giugliano R.P.; White J.A.; Lokhnygina Y.; Bohula
E.A.; Califf R.M.; Braunwald E.; Blazing M.A.
Institution
(Bach) Cardiovascular Division, Department of Medicine, Washington
University, School of Medicine, St Louis, MO, United States
(Cannon, Giugliano, Bohula, Braunwald) TIMI Study Group, Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA, United States
(White, Lokhnygina, Califf, Blazing) Duke Clinical Research Institute,
Division of Cardiology, Department of Medicine, Duke University, Durham,
NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Limited evidence is available regarding the benefit and hazard
of higher-intensity treatment to lower lipid levels among patients 75
years or older. As a result, guideline recommendations differ for this age
group compared with younger patients. Objective(s): To determine the
effect on outcomes and risks of combination ezetimibe and simvastatin
compared with simvastatin monotherapy to lower lipid levels among patients
75 years or older with stabilized acute coronary syndrome (ACS). Design,
Setting, Participants: In this prespecified secondary analysis of the
global, multicenter, prospective clinical randomized Improved Reduction of
Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), outcomes and
risks were compared by age among patients 50 years or older after a
hospitalization for ACS. Data were collected from October 26, 2005,
through July 8, 2010, with the database locked October 21, 2014. Data were
analyzed May 29, 2015, through March 13, 2018, using Kaplan-Meier curves
and Cox proportional hazards models. Intervention(s): Double-blind
randomized assignment to combined simvastatin and ezetimibe or simvastatin
and placebo with follow-up for a median of 6 years (interquartile range,
4.3-7.1 years). Main Outcomes and Measures: The primary composite end
point consisted of death due to cardiovascular disease, myocardial
infarction (MI), stroke, unstable angina requiring hospitalization, and
coronary revascularization after 30 days. Individual adverse ischemic and
safety end points and lipid variables were also analyzed. Result(s):
Of 18144 patients enrolled (13 728 men [75.7%]; mean [SD] age, 64.1 [9.8]
years), 5173 (28.5%) were 65 to 74 years old, and 2798 (15.4%) were 75
years or older at randomization. Treatment with simvastatin-ezetimibe
resulted in lower rates of the primary end point than simvastatin-placebo,
including 0.9% for patients younger than 65 years (HR, 0.97; 95% CI,
0.90-1.05) and 0.8% for patients 65 to 74 years of age (hazard ratio [HR],
0.96; 95% CI, 0.87-1.06), with the greatest absolute risk reduction of
8.7% for patients 75 years or older (HR, 0.80; 95% CI, 0.70-0.90) (P =.02
for interaction). The rate of adverse events did not increase with
simvastatin-ezetimibe vs simvastatin-placebo among younger or older
patients. Conclusions and Relevance: In IMPROVE-IT, patients
hospitalized for ACS derived benefit from higher-intensity therapy to
lower lipid levels with simvastatin-ezetimibe compared with simvastatin
monotherapy, with the greatest absolute risk reduction among patients 75
years or older. Addition of ezetimibe to simvastatin was not associated
with any significant increase in safety issues among older patients. These
results may have implications for guideline recommendations regarding
lowering of lipid levels in the elderly. Trial Registration:
ClinicalTrials.gov identifier: NCT00202878. Copyright © 2019
American Medical Association. All rights reserved.

<91>
Accession Number
628556366
Title
Is the Glasses-Free 3-Dimensional Display System More Effective for
Complex Video-Assisted Thoracic Surgery? A Self-Controlled Study Ex Vivo.
Source
Surgical Innovation. (no pagination), 2019. Date of Publication: 2019.
Author
Liu J.; Li J.; Liang H.; Cui F.; Wang W.; Huang J.; Peng G.; Huang W.;
Wang Y.; He K.; Pan Q.; He J.
Institution
(Liu, Li, Liang, Cui, Wang, Huang, Peng, Huang, Wang, He) The First
Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
(Liu, Li, Liang, Cui, Wang, Huang, Peng, Huang, He) Guangzhou Institute of
Respiratory Health (GIRH), Guangzhou, China
(Liu, Li, Liang, Cui, Wang, Huang, Peng, Huang, He) State Key Laboratory
of Respiratory Disease, National Clinical Research Center for Respiratory
Diseases, Guangzhou, China
(He) The Affiliated Hospital of Southwest Medical University, Luzhou,
China
(Pan) The Affiliated Tumor Hospital of Guangxi Medical University,
Nanning, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective. Considering the demerits of a high-definition 2-dimensional
(HD-2D) system, with its lack of stereopsis, and a conventional
3-dimensional (C-3D) system, which results in a dimmed image, we have
recently developed a glasses-free 3-dimensional (GF-3D) display system for
reconstruction surgeries such as video-assisted thoracic surgery (VATS)
for tracheal reconstruction. Methods. Thoracic surgeons were invited to
complete thoracoscopic continuous suture of a transected porcine trachea
using the HD-2D, C-3D, and GF-3D systems on separate mornings in
randomized order. The duration, numbers of stitches, and distance between
every 2 stitches were recorded for every procedure. The surgeons'
spontaneous eye blink rate was recorded for 5 minutes before the procedure
and the last 5 minutes of the procedure. Results. Fifteen volunteers
successfully completed the tracheal reconstruction procedures in this
study. Both C-3D (0.403 +/- 0.064 stitch/min, P <.001) and GF-3D (0.427
+/- 0.079 stitch/min, P <.001) showed significant advantages in speed
compared with HD-2D (0.289 +/- 0.065 stitch/min). Both C-3D (2.536 +/-
2.223 mm, P <.001) and GF-3D (2.603 +/- 2.159 mm, P <.001) showed
significant advantages in accuracy compared with HD-2D (3.473 +/- 3.403
mm). Both HD-2D (1.240 +/- 0.642, P <.001) and GF-3D (1.307 +/- 0.894, P
<.001) showed significant advantages in eye fatigue compared with C-3D
(3.333 +/- 1.44). Conclusions. All 3 available display systems are
efficient for complex VATS. With the help of stereopsis, surgeons can
achieve faster operation using C-3D and GF-3D systems in a thoracoscopic
simulated setting. GF-3D may be a more effective display system for VATS
reconstruction in terms of speed, accuracy, and eye fatigue during
operations. Copyright © The Author(s) 2019.

<92>
Accession Number
628284000
Title
Effects of dexamethasone on post-operative cognitive dysfunction and
delirium in adults following general anaesthesia: A meta-analysis of
randomised controlled trials.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 113.
Date of Publication: 29 Jun 2019.
Author
Li L.-Q.; Wang C.; Fang M.-D.; Xu H.-Y.; Lu H.-L.; Zhang H.-Z.
Institution
(Li, Wang, Fang, Xu, Lu, Zhang) Department of Anesthesiology, Jilin
University Second Hospital, No. 218 Ziqiang street, Changchun, Jilin
130021, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Several studies have investigated the effects of dexamethasone
on post-operative cognitive dysfunction (POCD) or post-operative delirium
(POD); however, their conclusions have been inconsistent. Thus, we
conducted a meta-analysis to determine the effects of dexamethasone on
POCD and POD in adults following general anaesthesia. Method(s): The
Cochrane Central Register of Controlled Trials (2018, Issue 11 of 12) in
the Cochrane Library (searched 17 November 2018), MEDLINE OvidSP (1946 to
16 November 2018) and Embase OvidSP (1974 to 16 November 2018) were
searched for randomised controlled trials that evaluated the incidence of
POCD and POD following dexamethasone administration in adults (age >= 18
years) under general anaesthesia. We used the Grading of Recommendations,
Assessment, Development and Evaluations framework to assess the quality of
the evidence. Result(s): Five studies were included (three studies
with 855 participants in the dexamethasone group and 538 participants in
the placebo group for the incidence of POCD, and two studies with 410
participants in the dexamethasone group and 420 participants in the
placebo group for the incidence of POD). There was no significant
difference between the dexamethasone group and the placebo group in terms
of the incidence of POCD 30 days after surgery (RR [relative risk] 1.00;
95% CI [confidence interval: 0.51, 1.96], P = 1.00, I 2 = 77%)
or the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I
2 = 0%). However, both analyses had some limitations because of
limited evidence and clinical heterogeneity, and we considered the quality
of the evidence for the post-operative incidence of POCD and POD to be
very low. Conclusion(s): This meta-analysis revealed that
prophylactic dexamethasone did not reduce the incidence of POCD and POD.
Trials of alternative preventive strategies for POCD and POD, as well as a
better understanding of the pathophysiology of those complex syndromes,
are still needed to make progress in this field. Trial registrationr: This
study is registered with PROSPERO, 23 October 2018, number CRD42018114552.
Available from
https://www.crd.york.ac.uk/PROSPERO/#recordDetails. Copyright ©
2019 The Author(s).

<93>
Accession Number
52008191
Title
Preoperative carbohydrate loading for elective surgery: A systematic
review and meta-analysis.
Source
Surgery Today. 42 (7) (pp 613-624), 2012. Date of Publication: July 2012.
Author
Li L.; Wang Z.; Ying X.; Tian J.; Sun T.; Yi K.; Zhang P.; Jing Z.; Yang
K.
Institution
(Li, Wang, Tian, Yi, Zhang, Jing, Yang) Evidence-Based Medicine Center,
School of Basic Medical Sciences, Lanzhou University, Dong Gang West Road
No. 199, Lanzhou 730000, Gansu, China
(Li, Yi, Zhang, Yang) First Clinical College of Lanzhou University,
Lanzhou 730000, Gansu, China
(Wang, Ying) Second Clinical College of Lanzhou University, Lanzhou
730000, Gansu, China
(Sun) Shanghai Jiao-Tong University, School of Medicine Ren-ji Hospital,
Shanghai 20000, China
(Jing) Institute of Science and Technology Information of Gansu, Lanzhou
730000, China
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background and objective It is unclear whether the preoperative
administration of oral carbohydrates (CHO) is safe and effective, and
therefore we herein evaluated the efficacy and adverse events associated
with CHO for elective surgery. Methods Comprehensive searches were
conducted to identify randomized controlled trials (RCTs), which evaluated
preoperative CHO for elective surgery. Two reviewers independently
selected the trials, extracted data, and assessed the methodological
qualities and evidence levels. The data were analyzed by the RevMan 5.0
software program. Result CHO increased the insulin and glucose levels on
the first day after surgery higher than those in overnight fasting group
(fifteen RCTs) and i.v. glucose infusion group (three RCTs). The pooled
results of thirteen RCTs showed greater declines in the insulin level at
the induction of anesthesia and a smaller increase in the glucose level at
the end of surgery, and fewer decreases in the postoperative insulin
sensitivity index in the CHO group were observed as compared to the
placebo group. No aspiration was observed in any of the included studies.
Conclusion CHO appears to be safe, and may attenuate postoperative insulin
resistance as compared to placebo. However, the quality of most of the
published trials has been poor, and the evidence levels for most outcomes
were low, so rigorous and larger RCTs are needed in the future. ©
Springer 2012.

<94>
Accession Number
2002194815
Title
The effect of distraction with a loved one's voice on pain reduction while
extracting the chest tube after open heart surgery.
Source
Open Pain Journal. 12 (1) (pp 6-10), 2019. Date of Publication: 2019.
Author
Sheykhasadi H.; Abbaszadeh A.; Bonakdar H.; Salmani F.; Tavan A.; Sedri N.
Institution
(Sheykhasadi) Critical Care Nurse, Kerman University of Medical Sciences,
Kerman, Iran, Islamic Republic of
(Abbaszadeh) Department of Nursing and Midwifery, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bonakdar) Department of Anesthesia and Operating Room, Faculty of Nursing
and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Salmani) Department of Epidemiology and Biostatistics, Faculty of Health,
Birjand University of Medical Sciences, Birjand, Iran, Islamic Republic of
(Tavan) Shahid Sadughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Sedri) Zarand Nursing Faculty, Kerman University of Medical Sciences,
Kerman, Iran, Islamic Republic of
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: One of the forms of ost-operative care after open heart
surgery is controlling the pain resulting from chest tube insertion.
Management of pain is considered vital and requires the awareness of
health care providers. One of the main responsibilities of nurses is to
prepare patients for invasive procedures such as the removal of the chest
tube. This study was designed to analyze the impact of a loved one's voice
for distraction in patients undergoing open heart surgery. Method(s):
This study was a clinical trial. The research sample was randomly selected
from patients undergoing open heart surgery. In this study, the number of
samples for each group was considered to be 64 people, where the total
number of samples was 128 people. The data collection tools included
Visual Analog Scale (VAS) assessment tool and a researcher-made
questionnaire. After selecting the eligible samples and obtaining the
informed consent, each patient was randomly assigned to one of the two
groups (intervention group and control group). The pain was measured
before, immediately, and 10 minutes after removing the chest tube.
 Result(s): The findings of this study indicated that the two groups
had no statistically significant differences in pain before chest tube
removal. The mean pain during chest tube removal and 10 minutes later in
both groups indicated a significant difference based on Mann-Whitney test
(P<0.001). Conclusion(s): This study showed that a loved one's voice
is effective in reducing pain during chest tube removal after open heart
surgery. Copyright © 2019, Bentham Science Publishers B.V. All
rights reserved.

<95>
Accession Number
628342762
Title
Short-Term Versus Long-Term Adverse Cardiovascular Outcomes Post
Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2
Diabetes Mellitus: A Simple Meta-Analysis.
Source
Diabetes Therapy. 10 (4) (pp 1487-1497), 2019. Date of Publication: 01 Aug
2019.
Author
Lu H.; Tang B.; Zhou Y.; Xu C.; Bundhun P.K.; Tang Z.; Bao H.
Institution
(Lu, Tang, Xu) Department of Cardiology, Jingzhou Central Hospital, The
Second Clinical Medical College, Yangtze University, Jingzhou, Hubei,
China
(Zhou) Department of Hematology, Jingzhou First People's Hospital, The
First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
(Bundhun) Department of Internal Medicine, The First Affiliated Hospital
of Guangxi Medical University, Nanning, Guangxi, China
(Tang) Department of Cardiovascular Diseases, Xiangya Hospital, Central
South University, Changsha, Hunan, China
(Bao) Jiangling County People's Hospital of Cardiology, Jingzhou, Hubei,
China
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: Type 2 diabetes mellitus (T2DM) is a major health issue,
especially in patients with coexisting coronary artery disease (CAD).
Patients with insulin-treated T2DM (ITDM) have worse outcomes than those
with non-insulin-treated T2DM. Very few studies have compared short-term
to long-term adverse cardiovascular outcomes following percutaneous
coronary intervention (PCI) in patients on insulin therapy. Therefore, in
this meta-analysis, we systematically compared short-term to long-term
adverse cardiovascular outcomes in a population of patients with ITDM
following PCI. Method(s): We searched for English-language
publications focusing on PCI in patients with ITDM using specific search
terms/phrases. All the participants accepted for inclusion in this
meta-analysis were treated with a drug-eluting stent. Post-intervention
adverse cardiovascular outcomes observed during short-term and long-term
follow-up periods were assessed and compared. Statistical analysis was
carried out using the popular RevMan 5.3 software. Odd ratios (OR) with
95% confidence intervals (CI) were calculated. Result(s): Six studies
comprising 1568 participants with ITDM in total were included in this
simple meta-analysis. Patient enrollment periods varied but enrollment
occurred during the years 1993-2012. When a fixed-effects statistical
model was used, post-PCI adverse cardiovascular outcomes-such as major
adverse cardiac events (MACEs) (OR 3.33, 95% CI 2.64-4.21; P = 0.00001),
all-cause mortality (OR 5.73, 95% CI 3.37-9.73; P = 0.00001), myocardial
infarction (MI) (OR 1.47, 95% CI 1.05-2.07; P = 0.02), and repeated
revascularization (OR 4.78, 95% CI 3.29-6.94; P = 0.00001)-were found to
be significantly more likely during the long-term follow-up period. A
similar result was observed with a random-effects statistical model.
 Conclusion(s): Adverse cardiovascular outcomes post PCI were
significantly more likely during the long-term follow-up period than
during the short-term follow-up period in these patients with T2DM on
insulin therapy. This hypothesis requires confirmation via new comparative
trials that consider short-term and long-term follow-up
periods. Copyright © 2019, The Author(s).

<96>
Accession Number
2002219471
Title
Inferior Caval Valve Implantation Versus Optimal Medical Therapy for
Severe Tricuspid Regurgitation.
Source
Journal of the American College of Cardiology. 74 (3) (pp 473-475), 2019.
Date of Publication: 23 July 2019.
Author
Laule M.; Mattig I.; Schobel C.; Knebel F.; Lauten A.; Lembcke A.; Thoenes
M.; Grubitzsch H.; Stangl K.; Dreger H.
Publisher
Elsevier USA

<97>
Accession Number
628515386
Title
Effects of curcuminoids on myocardial injury after percutaneous coronary
intervention.
Source
Journal of Medicinal Food. 22 (7) (pp 680-684), 2019. Date of Publication:
July 2019.
Author
Phrommintikul A.; Chanchai R.; Wongcharoen W.
Institution
(Phrommintikul, Chanchai, Wongcharoen) Division of Cardiology, Department
of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110,
Sriphoom, Muang, Chiang Mai 50200, Thailand
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
The rise of cardiac troponin post-percutaneous coronary intervention (PCI)
is associated with a high risk of long-term cardiovascular events.
Previous studies have shown that curcuminoids decreased myocardial injury
post-coronary bypass graft surgery through anti-oxidant and
anti-inflammatory effects. We sought to examine whether curcuminoids could
prevent PCI-related myocardial injury. One-hundred enrolled patients
receiving elective PCI were randomized to obtain curcuminoids or placebo 4
g/day at least 1 day before and after the scheduled PCI. Cardiac
troponin-T and 12-lead electrocardiogram were evaluated before PCI and at
24 and 48 h post-PCI. The definitions of PCI-related myocardial injury and
myocardial infarction were in line with the third universal definition of
myocardial infarction. Baseline characteristics of patients and procedures
did not differ between the curcuminoids and placebo groups. The mean age
was 63.9 +/- 10.8 years. The incidence of PCI-related myocardial injury
was not different between curcuminoids and placebo groups (32% vs. 38%, P
= .675). The peak high-sensitive cardiac troponin T levels after PCI were
not different between the curcuminoids and placebo groups (201.0 +/- 547.0
ng/L vs. 187.0 +/- 703.9 ng/L respectively, P = .912). Further, the
high-sensitive C-reactive protein levels post-PCI were similar in patients
receiving curcuminoids and placebo (7.2 +/- 18.8 mg/dL vs. 6.6 +/- 17.5
mg/dL, respectively, P = .873). We found that short-term treatment with
curcuminoids did not reduce the occurrence of PCI-related myocardial
injury. We did not observe the role of anti-oxidative and
anti-inflammatory effects of curcuminoids in the PCI-related myocardial
injury. © Copyright 2019, Mary Ann Liebert, Inc., publishers, and
Korean Society of Food Science and Nutrition 2019.

<98>
Accession Number
628019094
Title
Sex-mismatched red blood cell transfusions and mortality: A systematic
review and meta-analysis.
Source
Vox Sanguinis. 114 (5) (pp 505-516), 2019. Date of Publication: July 2019.
Author
Zeller M.P.; Rochwerg B.; Jamula E.; Li N.; Hillis C.; Acker J.P.;
Runciman R.J.R.; Lane S.J.; Ahmed N.; Arnold D.M.; Heddle N.M.
Institution
(Zeller, Jamula, Li, Hillis, Runciman, Lane, Ahmed, Arnold, Heddle)
McMaster Centre for Transfusion Research, McMaster University, Hamilton,
ON, Canada
(Zeller) Canadian Blood Services, Medical Office, Hamilton, ON, Canada
(Zeller, Arnold, Heddle) Division of Hematology and Thromboembolism,
Department of Medicine, McMaster University, Hamilton, ON, Canada
(Rochwerg) Division of Critical Care, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Rochwerg) Department of Health Research Methods, Evidence & Impact,
McMaster University, Hamilton, ON, Canada
(Hillis) Department of Oncology, McMaster University, Hamilton, ON, Canada
(Acker) Department of Laboratory Medicine and Pathology, University of
Alberta, Edmonton, AB, Canada
(Acker) Centre for Innovation, Canadian Blood Services, Edmonton, AB,
Canada
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: Selection of a compatible red blood cell (RBC)
unit does not include matching for donor sex. This systematic review and
meta-analysis aims to summarize the evidence examining the impact of
sex-mismatched RBC transfusion on recipient mortality. Material(s)
and Method(s): Ovid MEDLINE, Ovid EMBASE, CINAHL, PubMed, Web of Science
and the Cochrane Database of Systematic Reviews were searched from
inception up to 23 November 2018. Randomized controlled trials and
observational studies were included in the search. Eligible studies
reported on the impact of sex-matched compared to sex-mismatched RBC
transfusion on recipient mortality. Two investigators independently
extracted data and assessed study quality. A three-level meta-analytic
model was applied to emphasize the unknown dependence among the effect
sizes. Result(s): Five retrospective observational studies (n = 86
737) were included; no RCTs were found. Sex-mismatched RBC transfusions
were associated with a higher risk of death compared with sex-matched
transfusions (pooled hazard ratio [HR]: 1.13; 95% confidence interval
[CI]: 1.02-1.24). In the subgroup of cardiovascular surgery (n = 57 712),
there was no significant increase in mortality with sex-mismatched
transfusions (pooled HR: 1.08; 95% CI: 0.95-1.22). The data were prone to
confounding, selection bias and reporting bias. Certainty of the evidence
was very low. Conclusion(s): Sex-mismatched RBC transfusions were
associated with an increased risk of death in this pooled analysis.
However, the certainty of the evidence was very low from observational
studies. The need to match donor and recipient sex for transfusions
requires further investigation because of the potential widespread
impact. Copyright © 2019 International Society of Blood
Transfusion

<99>
Accession Number
628374481
Title
Prognostic factors of mortality after surgery in infective endocarditis:
systematic review and meta-analysis.
Source
Infection. (no pagination), 2019. Date of Publication: 2019.
Author
Varela Barca L.; Navas Elorza E.; Fernendez-Hidalgo N.; Moya Mur J.L.;
Muriel Garcia A.; Fernandez-Felix B.M.; Miguelena Hycka J.; Rodriguez-Roda
J.; Lopez-Menendez J.
Institution
(Varela Barca, Miguelena Hycka, Rodriguez-Roda, Lopez-Menendez) Department
of Cardiovascular Surgery, University Hospital Ramon y Cajal, Ctra.
Colmenar Viejo, km. 9.100, Madrid 28034, Spain
(Navas Elorza) Department of Infectology, University Hospital Ramon y
Cajal, Madrid, Spain
(Fernendez-Hidalgo) Department of Infectious Diseases, University Hospital
Vall d'Hebron, Barcelona, Spain
(Moya Mur) Department of Cardiology, University Hospital Ramon y Cajal,
Madrid, Spain
(Muriel Garcia, Fernandez-Felix) Clinical Biostatistics Unit, Hospital
Ramon y Cajal (IRYCIS), Madrid, Spain
(Fernandez-Felix) CIBER Epidemiology and Public Health (CIBERESP), Madrid,
Spain
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Purpose: There is a lack of consensus about which endocarditis-specific
preoperative characteristics have an actual impact over postoperative
mortality. Our objective was the identification and quantification of
these factors. Method(s): We performed a systematic review of all the
studies which reported factors related to in-hospital mortality after
surgery for acute infective endocarditis, conducted according to PRISMA
recommendations. A search string was constructed and applied on three
different databases. Two investigators independently reviewed the
retrieved references. Quality assessment was performed for identification
of potential biases. All the variables that were included in at least two
validated risk scores were meta-analyzed independently, and the pooled
estimates were expressed as odds ratios (OR) with their confidence
intervals (CI). Result(s): The final sample consisted on 16 studies,
comprising a total of 7484 patients. The overall pooled OR were
statistically significant (p < 0.05) for: age (OR 1.03, 95% CI 1.00-1.05),
female sex (OR 1.56, 95% CI 1.35-1.81), urgent or emergency surgery (OR
2.39 95% CI 1.91-3.00), previous cardiac surgery (OR 2.19, 95% CI
1.84-2.61), NYHA >= III (OR 1.84, 95% CI 1.33-2.55), cardiogenic shock (OR
4.15, 95% CI 3.06-5.64), prosthetic valve (OR 1.98, 95% CI 1.68-2.33),
multivalvular affection (OR 1.35, 95% CI 1.01-1.82), renal failure (OR
2.57, 95% CI 2.15-3.06), paravalvular abscess (OR 2.39, 95% CI 1.77-3.22)
and S. aureus infection (OR 2.27, 95% CI 1.89-2.73). Conclusion(s):
After a systematic review, we identified 11 preoperative factors related
to an increased postoperative mortality. The meta-analysis of each of
these factors showed a significant association with an increased
in-hospital mortality after surgery for active infective endocarditis.
Graphic abstract: Graph summary of the Pooled Odds Ratios of the 11
preoperative factors analyzed after the systematic review and
meta-analysis.[Figure not available: see fulltext.]. Copyright ©
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<100>
Accession Number
628341413
Title
Detection of gastric inflation using transesophageal echocardiography
after different level of pressure-controlled mask ventilation: a
prospective randomized trial.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2019. Date
of Publication: 2019.
Author
Zeng J.; Jia Z.-J.; Peng L.; Wei W.
Institution
(Zeng, Peng, Wei) Department of Anesthesiology, West China Hospital,
Sichuan University, 37# GuoXue Xiang, Chengdu, Sichuan 610041, China
(Jia) Department of Anesthesiology, The First Affiliated Hospital of
XinXiang Medical University, Henan 453100, China
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
This study aimed to assess the technique of using transesophageal
echocardiography (TEE) to detect gastric inflation and to determine the
optimal level of inspiratory pressure during face mask ventilation (FMV).
In this prospective and randomized trial, seventy-five adults scheduled
for cardiac surgery were enrolled to one of the three groups
(P<inf>12</inf>, P<inf>15</inf>, P<inf>20</inf>) defined by the applied
inspiratory pressure during FMV. After induction, mask ventilation was
performed with the corresponding level of pressure-control ventilation for
2 min in each patient. Respiratory and hemodynamic parameters were
recorded every 15 s. Arterial blood gases were tested before induction and
at the time of intubation. Gastric cross-section area was detected using
transesophageal echocardiography after intubation. The gastric
cross-section areas were 3.1 +/- 0.81, 3.8 +/- 1.37 and 4.8 +/- 2.29
cm2 respectively. It statistically increased in group
P<inf>20</inf> compared with group P<inf>12</inf> and P<inf>15</inf>.
PaCO<inf>2</inf> before intubation statistically increased compared with
the baseline in groups P<inf>12</inf> and P<inf>15</inf>, while decreased
in group P<inf>20</inf>. The mean values of PaCO<inf>2</inf> equaled to
44.4 mmHg (40-51.5), 42.9 mmHg (34-50.5) and 36.9 mmHg (30.9-46)
respectively in three groups. Peak airway pressure of 12-20
cmH<inf>2</inf>O could provide acceptable sufficient ventilation during
mask ventilation, but 20 cmH<inf>2</inf>O result in higher incidence of
gastric inflation. TEE is useful to detect the gastric inflation related
to the entry of air into the stomach during pressure-controlled face mask
ventilation. Trial Registration Number ChiCTR-IOR-14005325. Copyright
© 2019, Springer Nature B.V.

<101>
Accession Number
628536025
Title
Sternal complication rates and healing with wire closure using a 90-day
global period: Pooled analysis from 3 randomized trials.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S162), 2018. Date of Publication: October
2018.
Author
Allen K.B.; Raman J.S.; Scherman J.; Thourani V.H.; Naka Y.; Gerdisch
M.W.; Grubb K.J.; Grehan J.F.
Institution
(Allen) St. Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Raman) Oregon Health and Science University, Portland, OR, United States
(Scherman) University of Cape Town, Cape Town, South Africa
(Thourani) Medstar Heart and Vascular Institute, Washington, DC, United
States
(Naka) Columbia University Medical Center, New York, NY, United States
(Gerdisch) Franciscan St. Francis Health, Indianapolis, IN, United States
(Grubb) University of Louisville, Louisville, KY, United States
(Grehan) Allina Health, Saint Paul, MN, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: Sternal complication rates with wire cerclage (WC) may be
underreported using a traditional 30-day model for deep sternal wound
infection (DSWI). We evaluated all sternal complications and sternal
healing prospectively in the context of a 90-day global model from 3
randomized trials. Method(s): Pooled analysis of cardiac surgery
patients from 3 randomized controlled trials (RCTs) (clinicaltrials.gov
00819286, 01783483, and 02686099) randomized to WC (n = 214) at 19 centers
was performed. The studies tracked overall sternal complication rates
(DSWI and superficial sternal wound infection), evaluated sternal healing,
and assessed sternal pain for 90 days. Sternal healing was analyzed based
on computed tomography as determined by an independent radiological core
laboratory using validated methods. Sternal healing scores (0-5 scale,
higher scores represent better healing) and percentage of patients with
sternal union (defined a priori as scores >= 3) were determined.
 Result(s): In a 90-day global model, the overall sternal complication
rate was 3.8% (8/209; 95% CI 1.7%-7.4%; Table D55-1) with 25% (2/8) of
complications occurring after the traditional 30-day reporting period.
Sternal complications through 90 days resulted in 16 reoperations in 8
patients. At 30 days, the DSWI rate was 1.4% (3/209; 95% CI 0.3%-4.1%),
and the overall sternal complication rate was 2.9% (6/209; 95% CI
1.1%-6.1%). Only 14.8% (22/149; 95% CI 9.5%-21.5%) of patients exhibited
sternal union based on CT criteria at 90 days. Mean CT scan scores were
1.7 (95% CI 1.6-1.9), indicating only minimal or early healing, well below
the criteria for sternal union. Stepwise regression indicated older age (P
= 0.001) and higher body mass index (P = 0.02), and chronic obstructive
pulmonary disease (P = 0.05) predicted lower sternal healing scores.
Logistic regression established a significant correlation between sternal
healing and pain (Table D55-1). At 90 days, 40% (48/120) of patients
without sternal union reported pain at rest (95% CI 31.2%-48.3%) and 52%
(62/120) reported pain after coughing (95% CI 42.4%-60.9%). As sternal
healing improved, the probability of being pain free increased both at
rest (OR = 1.8; 95% CI 1.2-2.5; P = 0.001) and after coughing (OR = 1.7;
95% CI 1.2-2.5; P = 0.004). Conclusion(s): The traditionally reported
30-day DSWI rate underreports sternal complications. When prospectively
evaluated in a 90-day global model, sternotomy closure with WC resulted in
a higher sternal complication rate than generally appreciated and a high
percentage of patients without sternal union. (Table Presented) .

<102>
Accession Number
628535952
Title
Long-term results of minimally invasive mitral valve repair and aortic
valve replacement.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S190), 2018. Date of Publication: October
2018.
Author
Glauber M.
Institution
(Glauber) Istituto Clinico Sant'Ambrogio'Gruppo Ospedaliero San Donato,
Milan, Italy
Publisher
SAGE Publications Ltd
Abstract
The term minimally invasive refers to a small incision in the chest wall
that does not include a full sternotomy. This approach is being used with
increasing frequency to reduce the 'invasiveness' of the surgical
procedure while maintaining the same efficacy, quality, and safety of the
conventional approach. Compared with conventional surgery, minimally
invasive mitral valve (MV) surgery has been shown to reduce postoperative
mortality and morbidity; to provide faster recovery, shorter hospital
stay, and better cosmetics results; and to require fewer rehabilitation
resources and therefore a reduction in costs. Despite these excellent
results, many criticisms still remain regarding minimally invasive MV
surgery. Traditionalists have claimed that minimally invasiveMV surgery is
technicallymore complex, is associated with a lower rate of MV repair,
requires a longer learning curve, and is associated with higher costs. My
long-term experience has shown that minimally invasiveMV repair is
associated with excellent early and long-term outcomes, with an overall
mortality rate of less than 1%, a 95% rate ofMV repair in the setting of
degenerative MV disease, and freedom from reoperation of 94% at 10 years.
Despite the well-known benefit of a minimally invasive approach, minimally
invasive aortic valve replacelment is limited by the longer cross-clamp
and cardiopulmonary bypass times, which have raised some concerns in
fragile and high-risk patients. However, with the introduction of
sutureless, fast deployment valves, operative times have been dramatically
reduced by 35-40%, standardizing this procedure. In our 10-year
experience, more than 500 patients had a right minithoracotomy. Results
have been outstanding: We have an overall mortality rate of 1.5% and 1.5
days median stay in the intensive care unit. At a mean follow-up of 32
months (1531 cumulative patientyears), 95% survival was observed. In
conclusion, minimally invasive cardiac surgery is a safe procedure, with
low perioperative morbidity and low rates of reoperation and death at late
follow-up. Prospective randomized trials are required to confirm this
observation.

<103>
Accession Number
628535801
Title
A novel device for sternal closure: Clinical outcomes from a prospective,
randomized, first-in-man pilot study.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S113), 2018. Date of Publication: October
2018.
Author
Scherman J.; Pennel T.; Da Silva N.; Keshaw P.; Moodley A.; Zilla P.
Institution
(Scherman, Pennel, Da Silva, Keshaw, Moodley, Zilla) Chris Barnard
Division of Cardiothoracic Surgery, University of Cape Town, Cape Town,
South Africa
Publisher
SAGE Publications Ltd
Abstract
Objective: Whereas rigid fixation is standard in other disciplines,
cardiac surgeons still use wire cerclage (WC) for sternal closure. WC
provides good reduction of the sternal halves but does not provide optimal
approximation or rigid fixation. Combining rigid fixation with cerclage
may help improve sternal healing and recovery time. Our goalwas to report
a pilot, first-in-man, prospective, randomized, single-blinded study
evaluating sternal healing, complications, and pain after sternal closure
using either WC or a device combining a cerclage band for reduction with
rigid plate fixation for stabilization (360). Method(s): Patients
undergoing elective cardiac surgery were randomized to either 360 (n = 26)
or WC (n = 24). Independent radiologists evaluated 3- and 6-month
postoperative computed tomographic scans for sternal healing. Healing
scores and rate of sternal union were evaluated along with pain,
complications, and proportion of pain-free patients for up to 6 months.
Logistic regression was used to explore the relationship between healing
and pain. Result(s): At 3 months, sternal healing was greater with
360 compared to WC (69.2% vs. 25.0%; P = 0.002) and remained higher at 6
months, though the difference was not significant (96.2% vs. 87.5%; P =
0.340). Mean (+/- SD) computed tomographic scores at 3 months were 3.32
+/- 0.85 for 360 and 2.23 +/- 0.96 for WC (P < 0.001, Fig. P29-1A); at 6
months, the mean scores were 4.32 +/- 0.47 for 360 and 3.88 +/- 1.00 for
WC (P = 0.055). At 1 month, sternal pain after forced coughing was 59%
lower with 360 compared to WC (0.81 +/- 1.02 vs. 2.17 +/- 1.95; P =
0.004). Pain scores at both 3 and 6 months were not significantly
different between the groups. Logistic regression demonstrated that
improved healing led to a higher probability of being pain-free after
exertion (odds ratio = 2.5; 95% CI 1.2-5.1; P = 0.005; Fig. P29-1B).
Sternal complications resulting in reoperation occurred in 8.3% (2/24) and
3.8% (1/26) of patients with WC and 360, respectively (P = 0.6).
 Conclusion(s): The results of this study show that sternal closure
using rigid fixation with cerclage results in improved sternal healing at
3 months; a significant correlation between improved healing and the
absence of postoperative pain; and no device-related complications.
Additional studies to further evaluate the utility of this method for
sternal closure are warranted.

<104>
Accession Number
628535741
Title
Myocardial protection of del nido versus St. Thomas cardioplegia in adult
patients undergoing minimally invasive valve replacement surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S112), 2018. Date of Publication: October
2018.
Author
Devenraj V.; Pandey A.K.; Singh S.K.; Kumar S.; Devenraj N.
Institution
(Devenraj, Pandey, Singh, Kumar, Devenraj) King George's Medical
University, Lucknow, India
Publisher
SAGE Publications Ltd
Abstract
Objective: St. Thomas cold blood cardioplegia is the most commonly used
cardioplegia. It requires repeated administration at intervals of 18 to 23
minutes and is a hyperkalemic solution. In comparison, Del Nido
cardioplegia, which is administered at intervals of 60 to 90 minutes,
leads to less frequent dosing and volume, is less hyperkalemic, and has a
different chemical composition. Our goal was to compare the effect of Del
Nido cardioplegia solution with that of St. Thomas cold blood cardioplegia
for myocardial protection in adult patients undergoing minimally invasive
valve replacement surgery. Method(s): A single-center, prospective,
randomized case control study was done in our Department of CardioThoracic
and Vascular Surgery. Sixty patients were divided into 2 groups: group 1
received Del Nido cardioplegia and group 2 received St. Thomas
cardioplegia. We analyzed the total cardiopulmonary bypass time (CPB), the
aortic crossclamp time, the volume and quantity of cardioplegia solution
used, the time to wean the patient off CPB, the intraoperative
defibrillation requirement, and the quantities of the postoperative
myocardial biochemical markers CPKMB, Trop T, and NT-Pro BNP.
 Result(s): The Del Nido group was associated with significantly (P <
0.05) shorter CPB (121.34 +/- 17.86 min vs. 159.3 +/- 24.37 min) and
aortic cross-clamp times (84.2 +/- 20.8 min vs. 122.8 +/- 24.76 min).
Lesser cardioplegia volume and fewer applications were required with the
Del Nido group (1368.4 +/- 70 ml vs. 2765.6 +/- 56.3 ml and 1.4 +/- 0.6
vs. 3.9 +/- 1.5), respectively. The requirement for defibrillation was
less in the Del Nido group (0.4 vs. 1.9), and the time to wean the
patients off CPB was comparable (24.45 +/- 4.32 min vs. 25.26 +/- 3.34
min). The postoperative rise in the level of NT-Pro BNP was significantly
more in the St. Thomas cardioplegia group. Conclusion(s):Del Nido
cardioplegia provides equal or better myocardial protection than St.
Thomas cold blood cardioplegia solution in patients undergoing minimally
invasive valve replacement surgery under CPB.

<105>
Accession Number
628535576
Title
Minimally invasive mitral valve repair.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S186), 2018. Date of Publication: October
2018.
Author
Glauber M.
Institution
(Glauber) Istituto Clinico Sant'Ambrogio'Gruppo Ospedaliero San Donato,
Milan, Italy
Publisher
SAGE Publications Ltd
Abstract
The term minimally invasive refers to a small incision in the chest wall
that does not include a full sternotomy. The most common minimally
invasive mitral valve surgery (MIMVS) approach is the right
minithoracotomy, followed by the lower ministernotomy. Potential benefits
of theMIMVS approach are less surgical trauma and postoperative pain,
better respiratory function due to the preservation of the sternum, faster
recovery, and better cosmesis. Several meta-analyses have shown that MIMVS
is associated with a low mortality rate and excellent postoperative
outcomes compared with the conventional procedure. Specifically, MIMVS has
the advantage of reducing bleeding, quantity of blood products transfused,
atrial fibrillation, sternal wound infection, ventilation times, length of
stay in the intensive care unit and the hospital, and the time to return
to normal activity. Mitral valve repair is now considered the standard of
care for most mitral valve diseases because a number of studies have
demonstrated its superiority over replacement in terms of mortality,
morbidities, and long-term results, while reducing the risk of infective
endocarditis, thromboembolic events, and bleeding complications related to
anticoagulation. MIMVS allows excellent mitral valve repair in terms of
early and long-term outcomes. Inmy 15 years of experience with more than
1600 patients undergoing MIMVS for mitral valve repair, the overall
mortality rate was less than 1%, the rate of mitral valve repairs in the
setting of degenerative mitral valve disease was 95%, and freedom from
reoperation at 10 years was 94%.

<106>
Accession Number
628537085
Title
Prospective randomized comparison of 2 different endoscopic devices for
harvesting the radial artery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S84), 2018. Date of Publication: October
2018.
Author
Van Linden A.; Hecker F.; Arsalan M.; Richter M.; Matzke B.; Beckers J.;
Holubec T.; Van Linden S.; Walther T.
Institution
(Van Linden, Hecker, Richter, Beckers, Holubec, Van Linden) Kerckhoff
Klinik, Bad Nauheim, Germany
(Arsalan, Walther) University Frankfurt, Frankfurt, Germany
(Matzke) Max-Planck Institut, Bad Nauheim, Germany
Publisher
SAGE Publications Ltd
Abstract
Objective: Endoscopic radial artery harvesting (ERAH) is routine during
coronary artery bypass grafting using different devices with different
energy sources. Thermal spread and potential graft damage are themost
common concerns. The aim of this study was a prospectively randomized
comparison of the MiFusion TLS2 system (Endotrust, Nettetal, Germany) with
the direct heat technique and the LigaSure Maryland system (Medtronic,
Inc., Minneapolis, MN, USA) with the advanced bipolar technique.
 Method(s): A total of 100 consecutive all-comer patients with
coronary artery bypass grafts undergoing ERAH were prospectively included
and randomized 1:1 to either the TLS2 or the LigaSure group. ERAH was
performed in a standard nonsealed fashion. The proximal ends of the grafts
were analyzed using immunofluorescence microscopy with a focus on graft
integrity. In addition, harvesting time, graft sealing, and subjective
impression of freedom from blood in the harvesting situs were compared.
 Result(s): The mean age was 67 +/- 8 years with 14% women. The mean
harvesting time was 26.5 +/- 9 minutes for the TLS2 and 23.2 +/- 8 minutes
for the LigaSure (P = 0.049). The endothelial graft integrity was
comparable in both groups. The graft integrity was significantly better in
the internal elastic layer in the LigaSure group (scale 0-3; 3 = best)
with 2.5 +/- 0.6 for TLS2 and 2.8 +/- 0.4 for LigaSure (P = 0.031). Graft
sealing (scale 0-2; 0 = best) and freedom from residual bleeding (scale
1-5; 1 = best) were favorable for LigaSure with 0.6 +/- 0.7 versus 1.0 +/-
0.6 (P = 0.006) and 1.4 +/- 0.6 versus 2.0 +/- 0.9 (P < 0.001).
 Conclusion(s): This study demonstrates excellent results with ERAH
with generally good graft integrity (Fig. CMP27-1) and quick, safe
harvesting. In direct comparison, the LigaSure device is faster and
results in better graft integrity in the elastica interna, with better
sealing. (Figure Presented).

<107>
Accession Number
628536461
Title
Systemic review: Are outcomes of aortic valve repair "a beneficial
alternative" for patients with aortic valve insufficiency?.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S147), 2018. Date of Publication: October
2018.
Author
Malik S.
Institution
(Malik) Orebro University, Orebro, Sweden
Publisher
SAGE Publications Ltd
Abstract
Objective: Young adult patients with aortic valve insufficiency who
undergo aortic valve replacement (AVR) are forced to take anticoagulation
medications for the rest of their lives because of the prosthetic valve.
This fact leads to many postoperative complications and drastic outcomes.
The in vogue alternative of aortic valve repair (AVr) is available and
more beneficial in the long term. The aim of this study was to learn if
the outcomes of AVr are a beneficial alternative in the long term for
patients suffering from aortic valve insufficiency. Method(s):
Internet searches using standard key words of "Aortic Valve Repair and
Outcomes" were done on February 28, 2017 to find the white literature in
PubMed, Google Scholar database, Cochrane Library, Ovid, and DARE and on
March 4, 2017 to find the grey literature with human, adult, English
language, and studies published after January 1, 2007 as limitations.
Inclusion criteria were adult patients with aortic insufficiency with
aortic valve repair as intervention with outcomes at least greater than 5
years. All the datawere extracted usingMicrosoft Excel for Windows and
were analyzed using GraphPad Prisma (GraphPad Software, La Jolla, CAUSA).
 Result(s):A total of 20 studies comprising 5369 patientswere included
in this systemic review, which included 2 randomized control trials, 6
clinical prospective studies, 8 retrospective studies, and 4 observational
studies. Conclusion(s): We found that AVr is a beneficial long-term
alternative available for young adults suffering from aortic valve
insufficiency.

<108>
Accession Number
628536326
Title
Intubated versus nonintubated general anesthesia for minimally invasive
video-assisted thoracic surgery in octogenarians.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 19th International Society for Minimally Invasive
Cardiothoracic Surgery Annual Scientific Meeting, ISMICS 2019. United
States. 13 (Supplement 3) (pp S98), 2018. Date of Publication: October
2018.
Author
Ilic N.; Ilic D.; Juricic J.; Krnic D.; Orsulic D.; Simundza I.; Ilic
N.F.; Karanovic N.
Institution
(Ilic, Juricic, Krnic, Orsulic, Simundza) University Surgical Hospital,
Split, Croatia
(Ilic, Karanovic) Anesthesiology Department, Clinical Hospital, Split,
Croatia
(Ilic) Policlinic Cito, Split, Croatia
Publisher
SAGE Publications Ltd
Abstract
Objective: In recent years, nonintubated video-assisted thoracic surgery
(VATS) has gained popularity worldwide, especially in elderly patients
with lung diseases. The main goal of this surgical practice was to achieve
an overall improvement in patient management and outcome by avoiding the
side effects related to general anesthesia (GA) and single-lung
ventilation. In this study, we compared a nonintubated general anesthetic
technique with an intubated general anesthetic technique for VATS.
 Method(s): Sixty patients aged 80 or more years scheduled for VATS
lung surgery were allocated randomly into 2 groups with 30 patients each.
The first group received a standard general anesthesia with a double-lumen
tube. The second group had a nonintubated anesthetic technique. Heart
rate, mean arterial pressure, end-tidal CO<inf>2</inf> values, and the
visual analog pain score (VAS) were recorded during the operation and for
24 hours postoperatively. Both groups received an ultrasound-guided
paravertebral block before surgery with a single injection of 20 ml of
0.25% levobupivacaine. VATS lung biopsy and sublobar or lobar resection
were equally distributed in both groups of patients. Result(s): The
time for anesthetic procedure was shorter in the nonintubated group. VATS
was performed in the usual manner in all patients without any
intraoperative complications. Final surgical outcome was similar for both
groups. The visual analog pain scores in the first 24 hours were
comparable.We found significantly shorter recovery times, reduced oxygen
requirements, and shorter hospital stays in the nonintubated group. There
were no significant differences in intraoperative blood loss, operation
times, or postoperative complications between the nonintubated and the
intubated group of patients. Conclusion(s): Our experience has shown
that nonintubated VATS is a safe and feasible surgical procedure for
elderly patients with lung cancer with certain advantages for the patients
undergoing VATS. Our results indicated that we can achieve 1-day surgery
for selected patients. Further clinical studies should be carried out to
improve surgical outcomes in elderly patients with lung cancer.

<109>
Accession Number
628547533
Title
Ultrasound Guidance in Femoral Artery Catheterization: A Systematic Review
and a Meta-Analysis of Randomized Controlled Trials.
Source
The Journal of invasive cardiology. 31 (7) (pp E192-E198), 2019. Date of
Publication: 01 Jul 2019.
Author
Rashid M.K.; Sahami N.; Singh K.; Winter J.; Sheth T.; Jolly S.S.
Institution
(Jolly) Cardiology Division, Hamilton Health Sciences, Hamilton General
Hospital Site, Population Health Research Institute (PHRI), McMaster
University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: During percutaneous cardiac procedures, the use of radial
access is growing, but femoral access remains needed for large-bore,
high-risk procedures. Methods are needed to make femoral access safer. In
this systematic review and meta-analysis of randomized-controlled trials
(RCTs), we assess whether ultrasound guidance is associated with a
decreased risk of vascular complications during femoral artery
catheterization. METHOD(S): Medline, Embase, and Cochrane Central
were searched from inception to April 2018. RCTs assessing the use of
ultrasound among adult patients undergoing a femoral artery
catheterization were included. The primary outcome was vascular-access
related complications. Secondary outcomes included major and minor
vascular access bleeding, success rate, venipuncture, number of attempts,
and successful placement into the common femoral artery. RESULT(S):
Five RCTs (n = 1553) met the inclusion criteria, with two trials using
blinded outcome assessment. Ultrasound use was associated with a reduction
in the rate of vascular-access related complications (1.9% vs 4.3%; odds
ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81; P<.01). This
was primarily driven by a reduction in local hematomas; once hematomas
were excluded, the association was no longer significant (0.6% vs 1.7%;
OR, 0.39; 95% CI, 0.15-1.07; P=.07). There was no significant reduction in
major bleeding (0.3% vs 1.3%; OR, 0.28; 95% CI, 0.07-0.1.16; P=.08) or
minor bleeding (1.4% vs 2.8%; OR, 0.50; 95% CI, 0.24-1.05; P=.07).
 CONCLUSION(S): Ultrasound guidance during femoral artery
catheterization is associated with a decreased risk of vascular
complications, primarily driven by a reduction in local hematomas. Larger
trials are needed to determine the effect of ultrasound on major bleeding
and vascular complications (excluding hematomas).

<110>
Accession Number
628532320
Title
Verification of meta-analysis and propensity-matched analysis comparing
stereotactic body radiation therapy versus surgery for early stage lung
cancer.
Source
Journal of Thoracic Disease. 11 (6) (pp 2201-2204), 2019. Date of
Publication: 01 Jun 2019.
Author
Onishi H.
Institution
(Onishi) Department of Radiology, School of Medicine, University of
Yamanashi, 1110 Shimokato, Chuo, Yamanashi 4093898, Japan
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Stereotactic body radiation therapy (SBRT) has been recognized as a
standard radical treatment for medically inoperable patients with stage I
non-small cell lung cancers (NSCLCs). However, evaluation of SBRT in
medically operable patients has shown widely varying results.
Evidence-based guidelines published by the American Society for Radiation
Oncology (ASTRO) in 2017 (1) prudently expressed that SBRT is not
recommended as an alternative to surgery outside of a clinical trial
setting. Contrastingly, the National Comprehensive Cancer Network (NCCN)
guidelines published in 2018 (2) presented that SBRT is recommended for
patients who are medically inoperable or who refused to undergo surgery
after thoracic surgery evaluation. SBRT has been reported to achieve
primary tumor control and overall survival (OS) rates that are comparable
to those achieved with lobectomy by nonrandomized and population-based
comparative studies involving older patients. SBRT is an appropriate
option for patients with high surgical risk [those able to tolerate
sublobar resection but not lobectomy (e.g., age >=75 years, poor lung
function)]. Additionally, a combined analysis of two randomized trials
that compared SBRT with lobectomy in operable patients (3) was ignored in
the ASTRO guidelines but was referred to in the NCCN guidelines. How are
physicians and patients meant to interpret these guidelines? Copyright
© Journal of Thoracic Disease. All rights reserved.

<111>
Accession Number
628545849
Title
Does prehabilitation improve outcomes in cardiac surgical patients?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 30 Jun 2019.
Author
Sandhu M.S.; Akowuah E.F.
Institution
(Sandhu, Akowuah) Department of Cardiothoracic Surgery, James Cook
University Hospital, Middlesbrough, United Kingdom
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, 'Does prehabilitation
improve outcomes in cardiac surgical patients?'. Altogether more than 483
papers were found using the reported search, of which 10 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. Four meta-analyses
concluded that prehabilitation reduced postoperative pulmonary
complications (PPCs). The 6 randomized controlled trials (RCT) included,
differed significantly in the type of prehabilitation delivered. There was
replication of some RCTs across the meta-analyses. The consensus across
the meta-analyses was a reduction in PPCs and 3 of 4 meta-analyses finding
a reduction in length of stay (LOS). There were no adverse events or
difference in mortality found. Two small RCTs showed feasibility and
modest improvements in physiological parameters. Three RCTs demonstrated a
reduction in LOS and a reduction in PPCs. One RCT found no difference in
quality of life scores, LOS or postoperative atrial fibrillation. None of
the RCTs found negative evidence of prehabilitation interventions. We
conclude that the prehabilitation is a positive preoperative intervention,
most favourably in older patients and in those who are at risk of PPCs.
Specifically inspiratory muscle training is the intervention with most
favourable evidence. Copyright © The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<112>
Accession Number
628544334
Title
Chinese patients with heart valve replacement do not benefit from warfarin
pharmacogenetic testing on anticoagulation outcomes.
Source
Therapeutic drug monitoring. (no pagination), 2019. Date of Publication:
26 Jun 2019.
Author
Hao Y.; Yang J.; Zheng X.; Hu Y.; Yan X.; Zhang L.
Institution
(Hao, Yang, Yan, Zhang) Department of ClinicalLaboratory, Wuhan Asia Heart
Hospital, Wuhan University, Wuhan 420022, China
(Zheng, Hu) Laboratory of Molecular Cardiology, Wuhan Asia Heart Hospital,
WuhanUniversity, Wuhan 420022, China
Publisher
NLM (Medline)
Abstract
BACKGROUD: Genotype-guided warfarin dosing has been shown in some
randomized trials to improve anticoagulation outcomes in individuals of
European ancestry, yet its utility in Chinese patients with heart valve
replacement remains unresolved. METHOD(S): A total of 2264 patients
who underwent heart valve replacement at Wuhan Asia Heart Hospital were
enrolled in this study. Patients were randomly divided into two groups,
namely, a genotype-guided and a traditionally clinical guided warfarin
dosing group. In the genotype-guided group (n=1134), genotyping for CYP2C9
and VKORC1 (-1639G->A) was performed using TaqMan genotyping assay.
Warfarin doses were predicted with the International Warfarin
Pharmacogenetics Consortium (IWPC) algorithm. Patients in the control
group (n=1130) were clinically guided. The primary outcome was to compare
the incidence of adverse events (major bleeding and thrombotic) during a
90-day follow-up period between two groups. Secondary objectives were to
describe effects of the pharmacogenetic intervention on the first
therapeutic-target-achieving (TTA) time, the stable maintenance dose and
the hospitalization days. RESULT(S): A total of 2245 patients were
included in the analysis. Forty-nine events occurred during follow-up.
Genotype-guided dosing strategy did not result in a reduction in major
bleeding (0.26% vs 0.63%; hazard ratio [HR], 0.44; 95% confidence interval
[CI], 0.13-1.53; p=0.20), thrombotic events (0.89% vs 1.61%; HR, 0.56; 95%
CI, 0.27-1.17; p=0.12) compared with clinical dosing group. Compared with
traditional dosing, patients in the genotype-guided group reached their
therapeutic INR in a shorter time (3.8+/-2.0 days vs 4.4+/-2.0 days,
P<0.001). There was no difference in hospitalization days (P=0.28).
 CONCLUSION(S): Warfarin pharmacogenetic testing according to the IWPC
algorithm cannot improve anticoagulation outcomes in Chinese patients with
heart valve replacement.

<113>
Accession Number
2002314631
Title
Percutaneous mitral valve repair vs. stand-alone medical therapy in
patients with functional mitral regurgitation and heart failure.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Benito-Gonzalez T.; Estevez-Loureiro R.; Villablanca P.A.; Armeni P.;
Iglesias-Garriz I.; Minguito C.; Garrote C.; de Prado A.P.; Tundidor-Sanz
E.; Gualis J.; Fernandez-Vazquez F.
Institution
(Benito-Gonzalez, Estevez-Loureiro, Iglesias-Garriz, Minguito, Garrote, de
Prado, Tundidor-Sanz, Fernandez-Vazquez) Department of Cardiology,
University Hospital of Leon, Leon, Spain
(Villablanca) Department of Cardiology, Center for Structural Heart
Disease, Henry Ford Hospital, Detroit, United States
(Armeni) SDA Bocconi School of Management/CERGAS SDA Bocconi, Italy
(Gualis) Department of Cardiac Surgery, University Hospital of Leon, Leon,
Spain
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Functional mitral regurgitation (FMR) is a common finding
among patients with heart failure (HF) and it is related to adverse
events. Outcomes in patients undergoing transcatheter mitral valve repair
(TMVR) are still a matter of debate. We performed a meta-analysis to
assess mid- and long-term outcomes of patients with FMR treated with
MitraClip compared to medical management. Method(s): We conducted an
electronic database search of all published data PubMed Central, Embase,
the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov,
and Google Scholar databases. The primary end-point was all-cause
mortality. The secondary end-points were hospitalizations for HF, need for
heart transplantation or left ventricular assist device, unplanned mitral
valve surgery, myocardial infarction and stroke. Result(s): Five
studies (n = 1513 patients) were included in the analysis. The summary
estimate including all the available studies showed a statistically
significant reduction in all-cause mortality favoring MitraClip (HR 0.56,
CI 95% [0.38-0.84]) and HF hospitalizations (HR 0.65; CI 95% [0.46-0.92]).
A significant reduction in the indication for advanced HF therapies (OR
0.48; CI 95% [0.25-0.90]) or the need for unplanned mitral valve surgery
(OR 0.20; CI 95% [0.07-0.57]) was also found in the group of patients that
underwent TMVR. No differences in the incidence of myocardial infarction
or stroke were found between both groups of treatment. No publication bias
was detected. Conclusion(s): TMVR with MitraClip system was related
to a significant reduction in all-cause mortality, hospitalizations for HF
and the need for HF transplant, left ventricular assist device or
unplanned surgery beyond 1-year follow up. Copyright © 2019
Elsevier Inc.

<114>
Accession Number
2002311153
Title
Early outcomes for low-risk pediatric heart transplant recipients and
steroid avoidance: A multicenter cohort study (Clinical Trials in Organ
Transplantation in Children - CTOTC-04).
Source
Journal of Heart and Lung Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Lamour J.M.; Mason K.L.; Hsu D.T.; Feingold B.; Blume E.D.; Canter C.E.;
Dipchand A.I.; Shaddy R.E.; Mahle W.T.; Zuckerman W.A.; Bentlejewski C.;
Armstrong B.D.; Morrison Y.; Diop H.; Ikle D.N.; Odim J.; Zeevi A.; Webber
S.A.
Institution
(Lamour, Hsu) Division of Pediatric Cardiology, Children's Hospital at
Montefiore, Bronx, New York, NY, United States
(Mason, Armstrong, Morrison, Diop, Ikle) Rho Federal Systems Division,
Chapel Hill, NC, United States
(Feingold) Departments of Pediatrics and Clinical and Translational
Science, University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
(Blume) Department of Pediatric Cardiology, Boston Children's Hospital,
Boston, MA, United States
(Canter) Division of Pediatric Cardiology, Washington University School of
Medicine, St. Louis, MO, United States
(Dipchand) Department of Paediatrics, Labatt Family Heart Center, Hospital
for Sick Children, Toronto, Ontario, Canada
(Shaddy) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mahle) Division of Pediatric Cardiology, Children's Healthcare of
Atlanta, Atlanta, Georgia, Georgia
(Zuckerman, Bentlejewski) Division of Pediatric Cardiology, Columbia
University Medical Center, New York, NY, United States
(Odim) Transplantation Branch, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, MD, United
States
(Zeevi) Department of Pathology, University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
(Webber) Department of Pediatrics, Vanderbilt University School of
Medicine, Nashville, TN, United States
Publisher
Elsevier USA
Abstract
BACKGROUND: Immunosuppression strategies have changed over time in
pediatric heart transplantation. Thus, comorbidity profiles may have
evolved. Clinical Trials in Organ Transplantation in Children-04 is a
multicenter, prospective, cohort study assessing the impact of
pre-transplant sensitization on outcomes after pediatric heart
transplantation. This sub-study reports 1-year outcomes among recipients
without pre-transplant donor-specific antibodies (DSAs). METHOD(S):
We recruited consecutive candidates (<21 years) at 8 centers.
Sensitization status was determined by a core laboratory.
Immunosuppression was standardized as follows: Thymoglobulin induction
with tacrolimus and/or mycophenolate mofetil maintenance. Steroids were
not used beyond 1 week. Rejection surveillance was by serial biopsy.
 RESULT(S): There were 240 transplants. Subjects for this sub-study (n
= 186) were non-sensitized (n = 108) or had no DSAs (n = 78). Median age
was 6 years, 48.4% were male, and 38.2% had congenital heart disease.
Patient survival was 94.5% (95% confidence interval, 90.1-97.0%). Freedom
from any type of rejection was 67.5%. Risk factors for rejection were
older age at transplant and presence of non-DSAs pre-transplant. Freedom
from infection requiring hospitalization/intravenous anti-microbials was
75.4%. Freedom from rehospitalization was 40.3%. New-onset diabetes
mellitus and post-transplant lymphoproliferative disorder (PTLD) occurred
in 1.6% and 1.1% of subjects, respectively. There was no decline in renal
function over the first year. Corticosteroids were used in 14.5% at 1
year. CONCLUSION(S): Pediatric heart transplantation recipients
without DSAs at transplant and managed with a steroid avoidance regimen
have excellent short-term survival and a low risk of first-year diabetes
mellitus and PTLD. Rehospitalization remains common. These contemporary
observations allow for improved caregiver and/or patient counseling and
provide the necessary outcomes data to help design future randomized
controlled trials. Copyright © 2019 International Society for
Heart and Lung Transplantation

<115>
Accession Number
2002290748
Title
Oral Triiodothyronine Supplementation Decreases Low Cardiac Output
Syndrome After Pediatric Cardiac Surgery.
Source
Pediatric Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Marwali E.M.; Caesa P.; Darmaputri S.; Sani A.A.; Roebiono P.S.; Fakhri
D.; Djer M.M.; Munasir Z.M.; Batubara J.R.L.; Satroasmoro S.; Portman
M.A.; Haas N.A.
Institution
(Marwali, Caesa, Darmaputri, Sani) Pediatric Cardiac Intensive Care Unit,
National Cardiovascular Center Harapan Kita, Let Jend S Parman Road, Kav
87, Slipi, Jakarta 11420, Indonesia
(Marwali, Roebiono) Department of Cardiology, Faculty of Medicine,
Universitas Indonesia, Jakarta, Indonesia
(Roebiono) Pediatric Cardiology Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Department of Cardio-Thoracic-Vascular Surgery, Faculty of
Medicine, Universitas Indonesia, Jakarta, Indonesia
(Djer, Munasir, Batubara, Satroasmoro) Department of Pediatrics, Cipto
Mangunkusumo Hospital and Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
(Portman) Seattle Children's Hospital, University of Washington, Seattle,
WA, United States
(Haas) Department of Pediatric Cardiology and Pediatric Intensive Care,
Medical Hospital of the University of Munich, Munich, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The oral triiodothyronine for infants and children undergoing
cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3)
supplementation improved hemodynamic and clinical outcome parameters. We
tested the validity of low cardiac output syndrome (LCOS), derived using
clinical parameters and laboratory data, by comparing the LCOS diagnosis
with objective parameters commonly measured in a cardiac intensive care
unit (CCU) setting. OTICC, a randomized, placebo-controlled trial included
children younger than 3 years with an Aristotle score between 6 and 9. We
used the existing trial data set to compare the LCOS diagnosis with
echocardiographic hemodynamic parameters. Additionally, we determined if
LCOS, prospectively assigned during a clinical trial, served as an early
predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after
cross-clamp release later showed significantly lower pulse pressure,
stroke volume and cardiac output, and higher systemic vascular resistance.
These LCOS patients also had significantly longer time to extubation (TTE)
and higher mortality rate. LCOS incidence was significantly lower in the
T3 treatment group [n = 86 vs. 66, respectively, p < 0.001; OR (95% CI)
0.43 (0.36-0.52)] particularly at 6 h. Also, LCOS patients in the placebo
group had significantly lower FT3 serum levels over time. These analyses
confirm that early clinically defined LCOS successfully predicts cardiac
dysfunction determined later by objective hemodynamic echocardiographic
parameters. Furthermore, early LCOS significantly impacts TTE and
mortality. Finally, the data support prior clinical trial data, showing
that oral T3 supplementation decreases early LCOS in concordance with
reducing TTE. Copyright © 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<116>
Accession Number
364760481
Title
Outcomes of PCI at hospitals with or without on-site cardiac surgery.
Source
New England Journal of Medicine. 366 (19) (pp 1792-1802), 2012. Date of
Publication: 10 May 2012.
Author
Aversano T.; Lemmon C.C.; Liu L.
Institution
(Aversano, Lemmon) Johns Hopkins University, Baltimore, United States
(Liu) Clinical Trials and Surveys, Owings Mills, MD, United States
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Performance of percutaneous coronary intervention (PCI) is
usually restricted to hospitals with cardiac surgery on site. We conducted
a noninferiority trial to compare the outcomes of PCI performed at
hospitals without and those with on-site cardiac surgery.
 METHOD(S):We randomly assigned participants to undergo PCI at a
hospital with or without on-site cardiac surgery. Patients requiring
primary PCI were excluded. The trial had two primary end points: 6-week
mortality and 9-month incidence of major adverse cardiac events (the
composite of death, Q-wave myocardial infarction, or target-vessel
revascularization). Noninferiority margins for the risk difference were
0.4 percentage points for mortality at 6 weeks and 1.8 percentage points
for major adverse cardiac events at 9 months. RESULT(S):A total of
18,867 patients were randomly assigned in a 3:1 ratio to undergo PCI at a
hospital without on-site cardiac surgery (14,149 patients) or with on-site
cardiac surgery (4718 patients). The 6-week mortality rate was 0.9% at
hospitals without on-site surgery versus 1.0% at those with on-site
surgery (difference, -0.04 percentage points; 95% confidence interval
[CI], -0.31 to 0.23; P = 0.004 for noninferiority). The 9-month rates of
major adverse cardiac events were 12.1% and 11.2% at hospitals without and
those with on-site surgery, respectively (difference, 0.92 percentage
points; 95% CI, 0.04 to 1.80; P = 0.05 for noninferiority). The rate of
target-vessel revascularization was higher in hospitals without on-site
surgery (6.5% vs. 5.4%, P = 0.01). CONCLUSION(S): We found that PCI
performed at hospitals without on-site cardiac surgery was non-inferior to
PCI performed at hospitals with on-site cardiac surgery with respect to
mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded
by the Cardiovascular Patient Outcomes Research Team [C-PORT]
participating sites; ClinicalTrials.gov number, NCT00549796.) Copyright
© 2012 Massachusetts Medical Society.

<117>
Accession Number
355113031
Title
The Thrombin Receptor Antagonist for Clinical Event Reduction in Acute
Coronary Syndrome (TRA*CER) trial: study design and rationale.
Source
American Heart Journal. 158 (3) (pp 327-334.e4), 2009. Date of
Publication: September 2009.
Author
Anonymous
Publisher
Mosby Inc.
Abstract
Background: The protease-activated receptor 1 (PAR-1), the main platelet
receptor for thrombin, represents a novel target for treatment of arterial
thrombosis, and SCH 530348 is an orally active, selective, competitive
PAR-1 antagonist. We designed TRA*CER to evaluate the efficacy and safety
of SCH 530348 compared with placebo in addition to standard of care in
patients with non-ST-segment elevation (NSTE) acute coronary syndromes
(ACS) and high-risk features. Trial design: TRA*CER is a prospective,
randomized, double-blind, multicenter, phase III trial with an original
estimated sample size of 10,000 subjects. Our primary objective is to
demonstrate that SCH 530348 in addition to standard of care will reduce
the incidence of the composite of cardiovascular death, myocardial
infarction (MI), stroke, recurrent ischemia with rehospitalization, and
urgent coronary revascularization compared with standard of care alone.
Our key secondary objective is to determine whether SCH 530348 will reduce
the composite of cardiovascular death, MI, or stroke compared with
standard of care alone. Secondary objectives related to safety are the
composite of moderate and severe GUSTO bleeding and clinically significant
TIMI bleeding. The trial will continue until a predetermined minimum
number of centrally adjudicated primary and key secondary end point events
have occurred and all subjects have participated in the study for at least
1 year. The TRA*CER trial is part of the large phase III SCH 530348
development program that includes a concomitant evaluation in secondary
prevention. Conclusion(s): TRA*CER will define efficacy and safety of
the novel platelet PAR-1 inhibitor SCH 530348 in the treatment of
high-risk patients with NSTE ACS in the setting of current treatment
strategies. © 2009 Mosby, Inc. All rights reserved.

<118>
Accession Number
2002092069
Title
Computed tomography-guided platinum microcoil lung surgery: A
cross-sectional study.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (2) (pp 594-600),
2019. Date of Publication: August 2019.
Author
McGuire A.L.; Vieira A.; Grant K.; Mayo J.; Sedlic T.; Choi J.; Yee J.
Institution
(McGuire, Mayo, Yee) Vancouver Coastal Health Research Institute,
Vancouver General Hospital, Vancouver, British Columbia, Canada
(McGuire, Vieira, Grant, Choi, Yee) Department of Surgery, Division of
Thoracic Surgery, University of British Columbia, Vancouver, British
Columbia, Canada
(Mayo, Sedlic) Thoracic Service, Department of Diagnostic Medical Imaging,
University of British Columbia, Vancouver, British Columbia, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to provide a 5-year update on our
tertiary-level institutional experience with computed tomography-guided
platinum microcoil lung surgery. Method(s): A retrospective
cross-sectional study was conducted. All patients admitted to the Thoracic
Service at Vancouver General Hospital to undergo computed
tomography-guided microcoil lung surgery were included. Key primary
outcome variables were successful nodule localization and severity of
adverse events associated with placement. Secondary outcomes included
nodule characteristics on preoperative computed tomography chest and
nodule surgical pathology. Continuous variables were reported as mean (+/-
standard deviation), and counts were reported as proportions n (%).
 Result(s): A total of 97 lung nodules were resected in 92 patients.
Mean age was 65.3 (+/-10.6) years, and 59 (61%) were female. All 97
nodules (100%) were successfully localized using video-assisted thoracic
surgery wedge resection. There were 59 cases (60.8%) of placement-related
events noted on computed tomography of the chest. All were minor and
self-limited in nature and did not require treatment: pneumothorax 45
(46.4%), lung hematoma 18 (18.6%), dislodgement 4 (4.1%), and hemoptysis 2
(2.1%). Mean nodule diameter was 13.2 mm (+/-6.7). Density was nonsolid in
27 (27.8%) and semi-solid in 27 (27.8%). There was a single case of
positive surgical margin, and 4 (4.1%) went on to completion lobectomy.
Non-small lung cancer was identified in 66 nodules. Conclusion(s):
Computed tomography-guided platinum microcoil lung surgery is safe with a
favorable clinical adverse event profile and is suitable for poor-risk
patients. The method is efficient, yielding 100% diagnostic localization
in our 5-year update. It eliminates the need for thoracotomy and palpation
to localize worrisome subpleural tiny nodules. It is ideal for the
management of changing nodules concerning for early lung cancer and
diagnosis of small indeterminate lung nodules or metastases. Copyright
© 2019

<119>
[Use Link to view the full text]
Accession Number
628358044
Title
Baseline significant tricuspid regurgitation is associated with higher
mortality in transcatheter aortic valve replacement: Systemic review and
meta-analysis.
Source
Journal of Cardiovascular Medicine. 20 (7) (pp 477-486), 2019. Date of
Publication: July 2019.
Author
Prasitlumkum N.; Kittipibul V.; Tokavanich N.; Kewcharoen J.; Rattanawong
P.; Angsubhakorn N.; Mao M.A.; Gillaspie E.A.; Cheungpasitporn W.
Institution
(Prasitlumkum, Kewcharoen, Rattanawong) Department of Internal Medicine,
University of Hawaii Internal Medicine Residency Program, Honolulu, HI,
United States
(Kittipibul) Department of Internal Medicine, Jackson Memorial Hospital
Internal Medicine Residency Program, Miami, FL, United States
(Tokavanich) Department of Cardiology, Chulalongkorn University, Bangkok,
Thailand
(Rattanawong) Faculty of Medicine Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
(Angsubhakorn) Department of Medicine, University of Minnesota,
Minneapolis, United States
(Mao) Division of Internal Medicine, Mayo Clinic, Rochester, MN, United
States
(Gillaspie) Department of Thoracic Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Cheungpasitporn) Department of Medicine, University of Mississippi
Medical Center, Jackson, MS, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction Significant tricuspid regurgitation is a well recognized
indicator of right ventricular dysfunction. Recent studies have shown that
significant tricuspid regurgitation is potentially associated with
increased mortality in patients with severe aortic stenosis who underwent
transcatheter aortic valve replacement (TAVR). However, data remained
sparse and inconclusive. Thus, we performed a systematic review and
meta-analysis of the literature to assess the association between
significant tricuspid regurgitation and mortality in post TAVR patients.
Hypothesis Significant tricuspid regurgitation is predictive for higher
mortality in patients undergoing TAVR. Methods We comprehensively searched
the databases of MEDLINE and EMBASE from inception to October 2018.
Included studies were published observational studies that reported
multivariate analysis of the effects of significant tricuspid
regurgitation on all-cause mortality among patients undergoing TAVR. Data
from each study were combined utilizing the random-effects, generic
inverse variance method of DerSimonian and Laird to calculate odds ratios
(ORs) and 95% confidence intervals (CIs). Results Nine cohort studies from
August 2011 to May 2018 consisting of 27 614 patients with severe aortic
stenosis undergoing TAVR (6255 with and 21 359 without significant
tricuspid regurgitation) were included in this meta-analysis. The presence
of significant tricuspid regurgitation was associated with higher
all-cause mortality (pooled OR = 2.26, 95% CI: 1.45 - 3.52, P < 0.001). We
found that all-cause mortality remained statistically substantial in all
subgroups (30-day all-cause mortality: OR = 2.05, 95% CI: 1.20 - 3.49, P =
0.009; midterm all-cause mortality: OR = 9.67, 95% CI: 2.44 - 38.31, P =
0.001; and long-term all-cause mortality: OR = 1.48, 95% CI: 1.19 - 1.85,
P < 0.001). Funnel plots and Egger's regression asymmetry test were
performed and showed no publication bias. Conclusion Significant tricuspid
regurgitation increased risk of mortality by up to two-fold among patients
with severe aortic stenosis undergoing TAVR. Our study suggests that
significant tricuspid regurgitation should be considered a component of
risk stratification tools. Copyright © 2019 Italian Federation of
Cardiology - I.F.C. All rights reserved.

<120>
Accession Number
2002231325
Title
Decompensated congestive heart failure - treatment with levosimendan.
Source
Revista da Associacao Medica Brasileira. 65 (4) (pp 524-529), 2019. Date
of Publication: 2019.
Author
Ferreira Buzzini R.; Silvinato A.; Floriano I.; Bernardo W.M.; De Almeida
G.R.
Institution
(Ferreira Buzzini, Silvinato, Floriano, Bernardo, De Almeida) Brazilian
Medical Association, Rua Sao Carlos do Pinhal, 324, Bela Vista, Sao Paulo
- SP, Brazil
Publisher
Associacao Medica Brasileira
Abstract
Levosimendan has been extensively evaluated for the treatment of acute
heart failure (AHF) and in various other clinical situations characterized
by impaired cardiac performance, including heart surgery and
sepsis.1 Among the drugs generally classified as inotropic,
levosimendan was the agent most widely researched over the past 20
years.2 It is a drug that belongs to the class of calcium
sensitizers and has been commercially available in Brazil since 2002.
Through sensitizing action of troponin C to calcium, levosimendan has the
potential to improve the cardiac contractility during systole without
harming the relaxation during the diastole. It could also have a
va-sodilating action, which would result in a significant, dose-dependent,
improvement of cardiac output (CO) without increasing myocardial oxygen
demand. Other hemodynamic effects of the drug on heart failure include
increased systolic volume and reduced pulmonary wedge pressure (PWP) and
pulmonary arterial pressure.3-5 These effects are observed
immediately after the beginning of the continued intravenous therapy
(I.V.) for 24 hs with levosimendan and persist (up to = 10 days) after the
interruption of perfusion, through the action of the long-acting active
metabolite OR-1896.3-6. Copyright © 2019 Associacao
Medica Brasileira. All rights reserved.

<121>
Accession Number
2001326374
Title
Antiplatelet effects of ticagrelor versus clopidogrel after coronary
artery bypass graft surgery: A single-center randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (2) (pp 430-437.e4),
2019. Date of Publication: August 2019.
Author
Xu F.; Feng W.; Zhou Z.; Zhang Y.; Diao X.; Hu S.; Zheng Z.
Institution
(Xu, Feng, Hu, Zheng) Department of Cardiovascular Surgery, Fuwai
Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical
College, Beijing, China
(Zhou, Zhang) Center of Laboratory Medicine, Beijing Key Laboratory for
Molecular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences,
and Peking Union Medical College, Beijing, China
(Diao) Biostatistical Unit, Fuwai Hospital, Chinese Academy of Medical
Sciences, and Peking Union Medical College, Beijing, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to compare the onset of platelet
inhibition (inhibition of platelet aggregation) between ticagrelor 90 mg
twice per day and clopidogrel 75 mg once per day in patients receiving
coronary artery bypass grafting. Method(s): In a single-center,
randomized, open-label study, 140 patients receiving coronary artery
bypass grafting were randomly assigned to the aspirin + ticagrelor group
or the aspirin + clopidogrel group in a 1:1 ratio. Participants in the
aspirin + ticagrelor group took aspirin 100 mg once per day and ticagrelor
90 mg twice per day. Participants in the aspirin + clopidogrel group took
aspirin 100 mg once per day and clopidogrel 75 mg once per day. Platelet
function was determined before study treatment (0 hours); at 2 hours, 8
hours, 24 hours, and 72 hours after medication; and during follow-up at 30
days after surgery. Result(s): Inhibition of platelet aggregation at
2 hours after the first drug administration was greater for the aspirin +
ticagrelor group than for the aspirin + clopidogrel group (34.2%
[interquartile range, 9.1-66.0] vs 5.3% [interquartile range, -14.3-22.0],
P <.001) and at all times in the study period (P <.001). More patients
reached inhibition of platelet aggregation maximum within 24 hours in the
aspirin + ticagrelor group than in the aspirin + clopidogrel group (52.9%
vs 27.5%, P =.006). The average inhibition of platelet aggregation maximum
from 2 to 24 hours was still greater in the aspirin + ticagrelor group
than in the aspirin + clopidogrel group (72.3% +/- 15.4% vs 49.2% +/-
46.8%, P <.001). There were no differences in terms of bleeding or major
adverse cardiac events between the 2 groups. Conclusion(s): In
patients receiving coronary artery bypass grafting, the onset of action
was faster and the peak inhibition of platelet aggregation was higher with
ticagrelor than with clopidogrel. Copyright © 2018 The American
Association for Thoracic Surgery

<122>
Accession Number
628450745
Title
Randomised controlled trial to investigate the effectiveness of thoracic
epidural and paravertebral blockade in reducing chronic post-thoracotomy
pain (TOPIC): A pilot study to assess feasibility of a large multicentre
trial.
Source
BMJ Open. 9 (7) (no pagination), 2019. Article Number: e023679. Date of
Publication: 01 Jul 2019.
Author
Yeung J.; Middleton L.; Tryposkiadis K.; Kerr A.; Daniels J.; Naidu B.;
Melody T.; Goebel A.; Wilson M.; Kumar S.; Szentgyorgyi L.; Flanagan S.;
Shah R.; Worrall A.; Gao F.
Institution
(Yeung) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
(Yeung, Melody, Kumar, Worrall, Gao) Academic Department of Anaesthesia,
Critical Care, Pain and Resuscitation, Birmingham Heartlands Hospital,
University Hospital Birmingham NHS Foundation Trust, Birmingham, United
Kingdom
(Middleton) School of Health and Population Sciences, University of
Birmingham, Birmingham, United Kingdom
(Tryposkiadis) Birmingham Clinical Trials Unit, University of Birmingham,
Birmingham, United Kingdom
(Kerr, Naidu) Department of Thoracic Surgery, Birmingham Heartlands
Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham,
United Kingdom
(Daniels) Nottingham Clinical Trials Unit, University of Nottingham,
Nottingham, United Kingdom
(Naidu, Gao) Institute of Inflammation and Ageing, College of Medical and
Dental Sciences, University of Birmingham, Birmingham, United Kingdom
(Goebel) University of Liverpool, Institute of Translational Medicine,
Liverpool, United Kingdom
(Wilson) Health Services Research, University of Sheffield, Sheffield,
United Kingdom
(Szentgyorgyi) Department of Anaesthesia, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
(Flanagan) Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
(Shah) Department of Thoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Thoracotomy is considered one of the most painful surgical
procedures. The incidence of chronic post-thoracotomy pain (CPTP) is up to
50%. Paravertebral blockade (PVB) may be superior to thoracic epidural
blockade (TEB) in preventing CPTP. The specific objective of this pilot
study was to assess the feasibility of conducting a larger trial to
determine whether PVB at thoracotomy is more effective in reducing CPTP
compared with TEB. Design(s): A randomised, parallel, external pilot
study was conducted to assess whether a large randomised trial of TEB and
PVB with CPTP as the primary outcome is feasible. Setting(s): Two
adult thoracic centres in the UK. Participant(s): All adult patients
admitted for elective open thoracotomy. Participant(s): were excluded
if they were American Society of Anesthesiologists physical status IV or
V; or if there is contraindication to local anaesthetics; infection near
the proposed puncture site; coagulation/thoracic spine disorders; required
chest wall resection or emergency thoracic surgery or had a previous
thoracotomy. Result(s): All patients presenting for thoracotomy were
screened over a 12-month period with 194 found to be eligible. Of these,
69 (36%) were randomised (95% CI 29% to 42%). Discounting five
participants who died, 54 of 64 participants (84%) returned questionnaire
booklets at 6 months. The number of participants indicating at least a
moderate level of chest pain at 6 months was lower with PVB but with high
levels of uncertainty (RR: 0.7; 95% CI 0.3 to 1.7 for worst pain; RR: 0.3;
95% CI 0.0 to 2.8 for average pain). There were no safety concerns.
 Conclusion(s): A large, multicentre randomised controlled trial of
PVB versus TEB is feasible as it is possible to randomise and follow up
participants with high fidelity. Pain scores were lower on average with
PVB compared with TEB but a much larger trial is required to confirm this
reliably. Copyright © 2019 Author(s).

<123>
Accession Number
2002296152
Title
TRANSESOPHAGEAL ECHOCARDIOGRAPHY VS. INTRACARDIAC ECHOCARDIOGRAPHY FOR
LEFT ATRIAL APPENDAGE OCCLUSION.
Source
Heart Rhythm. Conference: Heart Rhythm 2019: 40th Annual Heart Rhythm
Scientific Sessions. United States. 16 (5 Supplement) (pp 499-500), 2019.
Date of Publication: May 2019.
Author
Gopinathannair R.; Sharma S.P.; Palle S.; Atkins D.; Pope T.; Marcum J.;
Bangalore D.; Krauthammer Y.S.; Kondur A.K.; Eshcol J.; Chilappa K.;
Natale A.; Lakkireddy D.R.
Institution
(Gopinathannair, Sharma, Palle, Atkins, Pope, Marcum, Bangalore,
Krauthammer, Kondur, Eshcol, Chilappa, Natale, Lakkireddy) Kansas City
Heart Rhythm Institute, Overland Park, KS, USA; Kansas City Heart Rhythm
Institute, KS, USA; Kansas City Heart Rhythm Institute, Olathe, KS, USA;
HCA Healthcare, Overland Park, KS, USA; Kansas City Heart Rhythm
Institute, Kansas City, MO, USA; Wayne State Univ, DMC, Detroit, MI, USA;
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin,
TX, USA; The Kansas City Heart Rhythm Institute at HCA Midwest Health,
Leawood, KS, USA
Publisher
Elsevier B.V.
Abstract
Background: Left Atrial Appendage Occlusion (LAAO) is traditionally done
under transesophageal echocardiography (TEE) guidance. TEE needs use of
general anesthesia and a second operator. By the use of Intracardiac
echocardiography (ICE) LAAO might be done under local anesthesia and it
may have advantages over TEE-guided LAAO. A few studies on ICE-guided LAAO
have been published. Objective(s): We attempted to compare the
efficacy and safety of ICE-guided versus TEE-guided LAAO by meta-analytic
technique. Method(s): We searched PubMed, EMBASE, CINAHL and Cochrane
CENTRAL for any study comparing TEE-guided versus ICE-guided LAAO since
inception till July 20, 2018 and used random effects model for analysis.
The outcomes analyzed were procedural time, fluoroscopy time, device
embolization, TIA/Stroke and cardiac tamponade. Result(s): We
included 4 non-randomized studies with a total of 1040 patients with 369
in ICE-guided group and 671 in TEE-guided group. Devices used for LAAO
were Watchman, Amplatzer Cardiac Plug and Amulet. Average CHADS2Vasc and
HASBLED scores were similar in both arms. 90% of patient in ICE arm and
50% in TEE arm had pre-procedure imaging with Cardiac CT or TEE. There was
no difference in procedural [Std. mean difference -0.73 min (-3 to
1.5);p=0.5, I2 = 99%] and fluoroscopic time [SMD -0.15min (-0.8 to
0.5);p=0.6,I2 = 95%] between ICE-guided and TEE-guided LAAO procedures
(Figure 1). We did not find significant difference between two approaches
in occurrence of TIA/Stroke (0.5% vs. 0.4%, OR 1.0; CI 0.1-6.5;p=0.9, I2 =
0) and device embolization (0.5% vs. 1%, OR 0.5;CI 0.1-2.6;p=0.4, I2 = 0).
Similarly, there was no difference in cardiac tamponade (1.3% vs.1.3%, OR
1.07; CI 0.34-3.3;p=0.9, I2 = 0) between two groups. Conclusion(s):
ICE-guided LAAO with appropriate preprocedural imaging is comparable to
TEE-guided LAAO with no difference in procedural or fluoroscopic time and
similar adverse events rate of Stroke/TIA, device embolization and cardiac
tamponade. Copyright © 2019. Published by Elsevier.

<124>
Accession Number
2002295648
Title
UTILIZATION AND INHOSPITAL ADVERSE OUTCOMES ASSOCIATED WITH WATCHMAN
DEVICE.
Source
Heart Rhythm. Conference: Heart Rhythm 2019: 40th Annual Heart Rhythm
Scientific Sessions. United States. 16 (5 Supplement) (pp 404-405), 2019.
Date of Publication: May 2019.
Author
Deshmukh A.J.; Arora S.; Mehra N.; Tripathi B.; Vaidya V.; Deshmukh A.;
Badheka A.; Friedman P.A.; Munger T.M.; Holmes D.R.
Institution
(Deshmukh, Arora, Mehra, Tripathi, Vaidya, Deshmukh, Badheka, Friedman,
Munger, Holmes) Mayo Clinic, Rochester, MN, USA; Mount Sinai St Luke's
Roosevelt Hospital, NY, NY, USA; Mount Sinai St. Luke's-West hospital, NY,
NY, USA; University of Miami, Miami, FL, USA
Publisher
Elsevier B.V.
Abstract
Background: The FDA approval of Watchman device [percutaneous left atrial
appendage occlusion (LAAO)] has resulted in widespread use of this
procedure in many centers across United States Objective: We sought to
estimate the nationwide utilization and frequency of adverse outcomes
associated with this procedure. Method(s): The National Inpatient
Sample (NIS) was queried for all adult patients (pts) with primary
diagnosis of atrial fibrillation or flutter during the year 2016 who had
percutaneous LAAO during the same admission. (ICD 10 code - 02L73DK)The
incidence of peri-procedural complications including mortality, stroke,
major bleeding requiring blood transfusion, pericardial effusions and
vascular access complications was assessed. We also compared the
complication rates with the published randomized control trials and the
European registry. Result(s): Estimated 5175 LAAO procedures were
performed in 2016. Majority of the patients were male (59.1%), age > 75
years (58.6%), Caucasians (83%). The overall complication rate was 1.93%.
The in hospital mortality was 0.29%. Pericardial effusion requiring
pericardiocentesis was the most frequent complication (0.6%).Bleeding
requiring transfusion was noted in 0.1% of implants. The rates of ischemic
stroke, hemorrhagic stroke and systemic embolism were 0.1%, 0.29% and
0.29% respectively. Table1 shows comparison of complication rates between
NIS data, PROTECT AF, PREVAIL, CAP registry and the EWOLUTION cohort.
 Conclusion(s): Percutaneous LAAO using the Watchman device in the US
is associated with low in-hospital complications and similar safety
profile to a recently published EWOLUTION cohort and lower than the RCTs.
[Table presented] Copyright © 2019. Published by Elsevier.

<125>
Accession Number
2002295647
Title
PROPHYLACTIC LEFT ATRIAL APPENDAGE EXCLUSION REDUCES STROKE INCIDENCE IN
HIGH RISK CARDIAC SURGERY PATIENTS: RESULTS FROM THE ATLAS RANDOMIZED
CONTROLLED TRIAL.
Source
Heart Rhythm. Conference: Heart Rhythm 2019: 40th Annual Heart Rhythm
Scientific Sessions. United States. 16 (5 Supplement) (pp 404), 2019. Date
of Publication: May 2019.
Author
William. Gerdisch M.; Garrett H.E.; Mumtaz M.; Grehan J.; Ramlawi B.
Institution
(William. Gerdisch, Garrett, Mumtaz, Grehan, Ramlawi) Franciscan St
Francis Health, Indianapolis, IN, USA; Cardiovascular Surgery Clinic,
Memphis, TN, USA; Pinnacle Health Cardiovascular Institute, Harrisburg,
PA, USA; Allina Health Clinic, St Paul, MN, USA; Valley Health System -
Heart & Vascular Center, Winchester, VA, USA
Publisher
Elsevier B.V.
Abstract
Background: Patients without history of AF undergoing cardiac surgery (CS)
have a high incidence of new onset post-operative AF (POAF). While POAF is
typically transient, it may occur several days after surgery and is a
predictor of recurrent AF, which may go undetected. Since AF is a stroke
risk, there may be an indication to manage patients prophylactically. As
clots in AF arise frequently in the LAA, LAA exclusion (LAAE) during
cardiac surgery may reduce strokes in high risk patients.
 Objective(s): ATLAS, a prospective, multicenter, randomized trial was
conducted to determine the cerebrovascular event rate (CVA, stroke + TIA)
in CS patients without AF history, but with elevated AF stroke and
bleeding risk (CHA2DS2-VASc=>2, HASBLED=>2) undergoing concomitant LAAE vs
without LAAE. Method(s): 562 patients were randomized 2:1 to LAAE Vs
No-LAAE. LAAE was done using epicardial AtriClip©. Both arms received
institutional standard treatment on POAF detection. As POAF incidence is
highest in early post-operative period, an analysis of CVA rates at 3
months post-procedure was done. The adverse events (AEs) were adjudicated
by an independent medical reviewer. Patients are followed to 12 months,
which is underway. Result(s): The baseline characteristics in both
arms were similar. Intraoperatively 99% patients had no flow between LAA
and LA, 98.4% had LAA remnant < =10 mm. No major device or procedural AEs
were attributed to LAAE. [Table presented] Conclusion(s): At 3
months, prophylactic LAAE in cardiac surgery patients with elevated
CHADS2VASc and HASBLED resulted in significantly lower CVA incidence,
without increase in AEs. Further trials to evaluate the long-term effects
of LAAE during cardiac surgery are needed. Copyright © 2019.
Published by Elsevier.

<126>
Accession Number
2002295553
Title
DOES ATRIAL FIBRILLATION BURDEN PREDICT CLINICAL OUTCOME AFTER ATRIAL
FIBRILLATION INTERVENTIONAL THERAPY: POOLED ANALYSIS OF TWO RANDOMIZED
STUDIES USING CONTINUOUS RHYTHM MONITORING.
Source
Heart Rhythm. Conference: Heart Rhythm 2019: 40th Annual Heart Rhythm
Scientific Sessions. United States. 16 (5 Supplement) (pp 363), 2019. Date
of Publication: May 2019.
Author
Romanov A.B.; Pokushalov E.; Ponomarev D.; Shabanov V.; Losik D.; Elesin
D.; Syenin I.; Mikheenko I.; Zhizhov R.; Peregudov I.; Steinberg J.S.
Institution
(Romanov, Pokushalov, Ponomarev, Shabanov, Losik, Elesin, Syenin,
Mikheenko, Zhizhov, Peregudov, Steinberg) E. Meshalkin National Medical
Research Center, Novosibirsk, Russian Federation; Heart Research Follow-up
Program, University of Rochester School of Medicine & Dentistry,
Rochester, NY, USA
Publisher
Elsevier B.V.
Abstract
Background: There is preliminary evidence that measurement of atrial
fibrillation (AF) burden rather than other AF or clinical variables can be
a more accurate predictor of clinical outcome in patients who undergo AF
treatment Objective: To test the value of AF burden detected by continuous
rhythm monitoring for the prediction of a clinically relevant composite
outcome (death, stroke, hospitalization) in patients who participated in 2
randomized clinical trials of interventions to prevent AF Methods: The
pooled analysis included data from 2 randomized studies (n=110): PREVENT
AF I using pulmonary vein isolation to prevent AF in patients with atrial
flutter; and Botulinum toxin injections during open-chest cardiac surgery
to prevent postoperative AF in patient undergoing CABG. All patients
underwent implantation of cardiac monitors for continuous rhythm capture
and were followed for 36 months. Receiver operating characteristic (ROC)
analysis was employed to assess predictive properties. The threshold value
was found as the best sum of sensitivity + specificity. Additionally,
positive (PPV) and negative (NPV) predictive values were calculated.
 Result(s): Over the 36 months of follow-up, 4 (3.6%) strokes, 24
(21.8%) hospitalizations for reasons other than stroke and 2 (1.8%) deaths
occurred in the 2 studies, thus comprising 30 (27.2%) primary endpoints.
The independent predictors of composite endpoint were type of AF prior to
procedure and AF burden post procedure, such that 1% increase in AF burden
was associated with a 10% increase in the risk of composite endpoint. With
the area under the ROC curve of 0.87 (95% confidence interval 0.83 to
0.86). At the threshold value of 1.0%, AF burden had 84.5% accuracy, 86.6%
sensitivity and 83.7% specificity to predict stroke, hospitalization or
death. The PPV of 66.6% indicated the probability of composite endpoint
occurring among those with AF burden above 1%. The NPV of 94.3%
corresponds to the probability of the event not occurring among those with
AF burden below 1%. Conclusion(s): Post-proceduralAF burden detected
by ICM can provide strong independent discrimination to predict death,
hospitalization and/or stroke among patients undergoing interventions for
AF prevention. Copyright © 2019. Published by Elsevier.

<127>
Accession Number
2002307373
Title
Inhalation versus intravenous anesthesia for adults undergoing heart valve
surgery: A systematic review and meta-analysis.
Source
Minerva Anestesiologica. 85 (6) (pp 665-675), 2019. Date of Publication:
2019.
Author
Ren S.-F.; Guo Y.-Q.; Yu H.
Institution
(Ren, Guo) Department of Cardiovascular Surgery, West China Hospital of
Sichuan University, Chengdu, China
(Ren, Yu, Yu) Department of Anesthesiology, West China Hospital of Sichuan
University, Chengdu, China
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Many studies have found that volatile anesthetics are
associated with improved clinical outcomes for adults undergoing coronary
artery bypass grafting. However, the effect of volatile anesthetics for
adults after heart valve surgery has been unclear. So we conducted a
meta-analysis of randomized controlled trials (RCTs) to explore whether
the choice of an anesthetic regimen might influence patients' outcomes
after valve surgery. EVIDENCE ACQUISITION: PubMed, Embase, and Cochrane
Library were searched from inception to June 2018. We included eligible
research comparing inhalation anesthesia with total intravenous anesthesia
(TIVA) in adult patients undergoing valve surgery. The major endpoints
involved mortality, postoperative arrhythmia, acute kidney injury,
pulmonary complications, neurological events, myocardial infarction,
reoperation for bleeding. The postoperative peak troponin release,
hospital stay, Intensive Care Unit (ICU) stay and ventilation time were
also analyzed. EVIDENCE SYNTHESIS: After screening through 243 potentially
relevant articles, we included 13 RCTs with 962 patients. The inhalation
anesthesia group revealed comparable mortality (inhalation group 12/249
[4.8%] vs. TIVA group 13/247 [5.3%], RR=0.97; 95% CI: 0.45 to 2.09;
P=0.93; P for heterogeneity=0.66, I2=0%) and other
postoperative complications with no heterogeneity. The postoperative peak
troponin release, hospital/ICU stay and ventilation time were comparable
between two groups with considerable heterogeneity. CONCLUSION(S):
Among patients undergoing heart valve surgery, the use of inhalation
anesthesia compared with TIVA failed to demonstrate superiority for
survival and major postoperative complications, and the evidence was
insufficient to draw firm conclusions due to the limited sample size. A
determination of equivalence or superiority between these two anesthetic
regimens requires further researches. Copyright © 2019 EDIZIONI
MINERVA MEDICA

<128>
Accession Number
2002311391
Title
Meta-Analysis for Impact of Statin on Mortality After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To determine whether statin (hydroxymethylglutaryl-CoA reductase
inhibitor) therapy is associated with better midterm survival after
transcatheter aortic valve implantation (TAVI), the first meta-analysis of
currently available studies was performed. To identify all observational
comparative studies and randomized controlled trials (RCTs) of statin
versus control (no statin) therapy or cohort studies investigating statin
treatment as one of covariates in patients undergoing TAVI, PubMed, Web of
Science, and Google Scholar were searched through March 2019. Adjusted (if
unavailable, unadjusted) hazard ratios (HRs) with their confidence
interval (CIs) of midterm (>=1 year) all-cause mortality after TAVI for
statin therapy were extracted from each study. Study-specific estimates
were combined by means of inverse variance-weighted averages of
logarithmic HRs in the random-effects model. Eight eligible studies with a
total of 5,170 TAVI patients were identified and included in the present
meta-analysis. The primary meta-analysis (including HRs for high intensity
statin from 3 studies together with other HRs) demonstrated that statin
treatment was associated with significantly lower midterm mortality (HR,
0.74; 95% CI, 0.60 to 0.91; p = 0.005). The secondary meta-analysis
(including HRs for low/moderate intensity statin from 3 studies together
with other HRs) also indicated an association of statin therapy with
significantly lower midterm mortality (HR, 0.80; 95% CI, 0.69 to 0.93; p =
0.005). No funnel plot asymmetry for the primary meta-analysis (p = 0.64)
was identified, which suggested probably no publication bias. In
conclusion, statin therapy is associated with better midterm survival
after TAVI. Copyright © 2019 Elsevier Inc.

<129>
Accession Number
2002284403
Title
Postoperative shared-care for patients undergoing non-cardiac surgery: a
systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Mazzarello S.; McIsaac D.I.; Montroy J.; Fergusson D.A.; Yateem D.;
Devereaux P.J.; Lalu M.M.
Institution
(Mazzarello, McIsaac, Montroy, Fergusson, Lalu) Clinical Epidemiology
Program, Blueprint Translational Research Group, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Mazzarello, McIsaac, Fergusson) School of Epidemiology and Public Health,
University of Ottawa, Ottawa, ON, Canada
(McIsaac, Yateem, Lalu) Department of Anesthesiology and Pain Medicine,
The Ottawa Hospital Research Institute, Room B307, 1053 Carling Ave, Mail
Stop 249, Ottawa, ON K1Y 4E9, Canada
(Fergusson) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
(Devereaux) Population Health Research Institute, David Braley Cardiac,
Vascular, and Stroke Research Institute, McMaster University, Hamilton,
ON, Canada
(Lalu) Regenerative Medicine Program, The Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Lalu) Department of Cellular and Molecular Medicine, University of
Ottawa, Ottawa, ON, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Collaborative ("shared-care") models of postoperative care
improve outcomes in patients undergoing surgery for hip fracture. Despite
being widely adopted, it is unclear if similar benefits of shared-care
models exist for other at-risk surgical patient populations. Thus, we
performed a systematic review to understand the impact of shared-care
models. Method(s): EMBASE, MEDLINE, CINAHL, and Cochrane Central
Register databases were searched for prospective studies examining an
in-hospital shared-care approach to postoperative management of adult
non-cardiac surgery patients. The primary outcome was a composite of
in-hospital mortality and mortality of up to 30 days. Secondary outcomes
were long-term mortality (> 90 days) and hospital length of stay. Tertiary
outcomes included quality of life and health utility measures. Risk of
bias was assessed using Cochrane Collaboration tools. Result(s): Six
thousand eight hundred and ninety-six citations were reviewed and four
studies (n = 987 patients) met the inclusion criteria-two
randomized-controlled trials (RCT, n = 729 patients) and two
non-randomized-controlled trials (NRCT, n = 258 patients). All studies
were conducted in the elective surgical setting. There was no association
between shared-care and control groups for in-hospital mortality (Peto
odds ratio, 1.76; 95% confidence interval [CI], 0.65 to 4.80), or hospital
length of stay (mean difference, -1.41; 95% CI, -3.18 to 0.35). Reporting
of other outcomes was limited. Both RCTs were judged to be at high risk of
bias for blinding and both NRCTs were judged to be at moderate risk of
bias for reported outcomes. Conclusion(s): Overall, there was limited
high-quality evidence to evaluate the effect of postoperative shared-care.
Well-designed interventional studies, perhaps targeting higher risk
surgical populations, are needed. Registration: PROSPERO (CRD42018094943);
registered 16 May, 2018. Copyright © 2019, Canadian
Anesthesiologists' Society.

<130>
Accession Number
628528012
Title
A randomized, controlled pilot clinical trial of cryopreserved platelets
for perioperative surgical bleeding: the CLIP-I trial.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
Faulke D.J.; Fraser J.F.; Holley A.D.; Irving D.O.; Pearse B.L.; Royse
A.G.; Bellomo R.; Weinberg L.; Eastwood G.; Peck L.; Young H.;
Sidiropoulos S.; Baulch S.; Dalyell A.; Kolar D.; Martinelli T.; Reidy Y.;
Caldwell N.; Royse A.; Tivendale L.; Bisignano M.; Hausler M.; Williams
Z.; Dong N.; Gattas D.J.; Buhr H.; Bannon P.; Cartwright B.; Turner L.;
Gibson J.; Blayney B.; Beattie L.; Hutch D.; Wun Jennifer Coles J.; Pearse
B.; Faulke D.; Zeigenfuss M.; Tesar P.; Fraser J.; Perel J.; Kahn C.;
Vincent B.; O'Brien D.; Reade M.C.; Deans R.; Holley A.; Marks D.C.;
Johnson L.; Wong J.; Irving D.
Institution
(Reade) Joint Health Command, Australian Defence Force, Canberra, ACT,
Australia
(Reade, Deans, Holley) University of Queensland, Brisbane, QLD, Australia
(Marks, Irving, Johnson, Wong) Australian Red Cross Blood Service, Sydney,
NSW, Australia
(Bellomo) Austin Hospital, Melbourne, VIC, Australia
(Faulke, Fraser, Pearse) The Prince Charles Hospital, Brisbane, QLD,
Australia
(Gattas) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Royse) Royal Melbourne Hospital, Melbourne, VIC, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Cryopreservation extends platelet (PLT) shelf life from 5 to 7
days to 2 to 4 years. However, only 73 patients have been transfused
cryopreserved PLTs in published randomized controlled trials (RCTs),
making safety data insufficient for regulatory approval. STUDY DESIGN AND
METHODS: The Cryopreserved vs. Liquid Platelet (CLIP) study was a
double-blind, pilot, multicenter RCT involving high-risk cardiothoracic
surgical patients in four Australian hospitals. The objective was to test,
as the primary outcome, the feasibility and safety of the protocol.
Patients were allocated to study group by permuted block randomization,
with patients and clinicians blinded by use of an opaque shroud placed
over each study PLT unit. Up to 3 units of cryopreserved or liquid-stored
PLTs were administered per patient. No other aspect of patient care was
affected. Adverse events were actively sought. RESULT(S): A total of
121 patients were randomized, of whom 23 received cryopreserved PLTs and
18 received liquid-stored PLTs. There were no differences in blood loss
(median, 715 mL vs. 805 mL at 24 hr; difference between groups 90 mL [95%
CI, -343.8 to 163.8 mL], p = 0.41), but the Bleeding Academic Research
Consortium criterion for significant postoperative hemorrhage in cardiac
surgery composite bleeding endpoint occurred in nearly twice as many
patients in the liquid-stored group (55.6% vs. 30.4%, p = 0.10). Red blood
cell transfusion requirements were a median of 3 units in the
cryopreserved group versus 4 units with liquid-stored PLTs (difference
between groups, 1 unit [95% CI, -3.1 to 1.1 units]; p = 0.23). Patients in
the cryopreserved group were more likely to be transfused fresh-frozen
plasma (78.3% vs. 27.8%, p = 0.002) and received more study PLT units
(median, 2 units vs. 1 unit; difference between groups, 1 unit [95% CI,
-0.03 to 2.0 units]; p = 0.012). There were no between-group differences
in potential harms including deep venous thrombosis, myocardial
infarction, respiratory function, infection, and renal function. No
patient had died at 28 days, and postoperative length of stay was similar
in each group. CONCLUSION(S): In this pilot RCT, compared to
liquid-stored PLTs, cryopreserved PLTs were associated with no evidence of
harm. A definitive study testing safety and hemostatic effectiveness is
warranted. Copyright © 2019 AABB

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