EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
613014842
Title
Contemporary outcomes after surgical aortic valve replacement with
bioprostheses and allografts:a systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 605-616), 2016.
Date of Publication: 09 Nov 2016.
Author
Huygens S.A.; Mokhles M.M.; Hanif M.; Bekkers J.A.; Bogers A.J.J.C.;
Rutten-van Molken M.P.M.H.; Takkenberg J.J.M.
Institution
(Huygens, Mokhles, Hanif, Bekkers, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Huygens, Rutten-van Molken) Institute for Medical Technology Assessment,
Erasmus University, Rotterdam, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and Management,
Erasmus University, Rotterdam, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Many observational studies have reported outcomes after surgical aortic
valve replacement (AVR), but there are no recent systematic reviews and
meta-analyses including all available bioprostheses and allografts. The
objective of this study is to provide a comprehensive and up-to-date
overview of the outcomes after AVR with bioprostheses and allografts
reported in the last 15 years. We conducted a systematic literature review
(PROSPERO register: CRD42015017041) of studies published between 2000-15.
Inclusion criteria were observational studies or randomized controlled
trials reporting on outcomes of AVR with bioprostheses (stented or
stentless) or allografts, with or without coronary artery bypass grafting
(CABG) or valve repair procedure, with study population size n >= 30 and
mean follow-up length >=5 years. Fifty-four bioprosthesis studies and 14
allograft studies were included, encompassing 55 712 and 3872 patients and
349 840 and 32 419 patient-years, respectively. We pooled early mortality
risk and linearized occurrence rates of valve-related events,
reintervention and late mortality in a random-effects model. Sensitivity,
meta-regression and subgroup analyses were performed to investigate the
influence of outliers on the pooled estimates and to explore sources of
heterogeneity. Funnel plots were used to investigate publication bias.
Pooled early mortality risks for bioprostheses and allografts were 4.99%
(95% confidence interval [CI], 4.44-5.62) and 5.03% (95% CI, 3.61-7.01),
respectively. The late mortality rate was 5.70%/patient-year (95% CI,
4.99-5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23-2.28)
for allografts. Pooled reintervention rates for bioprostheses and
allografts were 0.75%/patient-year (95% CI, 0.61-0.91) and
1.87%/patient-year (95% CI, 1.52-2.31), respectively. There was
substantial heterogeneity in most outcomes. Meta-regression analyses
identified covariates that could explain the heterogeneity: implantation
period, valve type, patient age, gender, pre-intervention New York Heart
Association class III/IV, concomitant CABG, study design and follow-up
length. There is possible publication bias in all outcomes. This
comprehensive systematic review and meta-analysis provides an overview of
the outcomes after AVR with bioprostheses and allografts reported during
the last 15 years. The results of this study can support patients and
doctors in the prosthetic valve choice and can be used in microsimulation
models to predict patient outcomes and estimate the cost-effectiveness of
AVR with bioprostheses or allografts compared with current and future
heart valve prostheses.<br/>Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<2>
Accession Number
355677383
Title
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients
With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and
2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary
Intervention (Updating the 2005 Guideline and 2007 Focused Update).
Source
Journal of the American College of Cardiology. 54 (23) (pp 2205-2241),
2009. Date of Publication: 01 Dec 2009.
Author
Kushner F.G.; Hand M.; Smith Jr. S.C.; King III S.B.; Anderson J.L.;
Antman E.M.; Bailey S.R.; Bates E.R.; Blankenship J.C.; Casey Jr. D.E.;
Green L.A.; Hochman J.S.; Jacobs A.K.; Krumholz H.M.; Morrison D.A.;
Ornato J.P.; Pearle D.L.; Peterson E.D.; Sloan M.A.; Whitlow P.L.;
Williams D.O.
Publisher
Elsevier USA

<3>
Accession Number
628237729
Title
Can postoperative massage therapy reduce pain and anxiety in cardiac
surgery patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (5) (pp 716-721),
2019. Date of Publication: 2019.
Author
Grafton-Clarke C.; Grace L.; Roberts N.; Harky A.
Institution
(Grafton-Clarke) School of Medicine, Department of Life Sciences,
University of Liverpool, Liverpool, United Kingdom
(Grace, Roberts) Department of Cardiac Surgery, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Harky) Department of Vascular Surgery, Countess of Chester, Chester,
United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, 'In patients undergoing
cardiac surgery, is postoperative massage therapy effective in reducing
pain, anxiety and physiological parameters?' Altogether, 287 papers were
found using the reported search, of which 7 papers represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and the results of these papers are tabulated. The specific
therapy protocols widely varied between studies, with differences in
frequency, specific timing in the postoperative period, techniques used
and experience of therapy provider. These variations limit the
generalization and transferability of the conclusions. The effect of
massage therapy on anxiety levels was reported in 5 studies. All but one
demonstrated a significant improvement in anxiety. Pain was also reported
in 5 studies, with significant improvement demonstrated in 4 studies.
Importantly, a number of these studies failed to report on analgesic
requirements nor demonstrate a reduction in opioid requirements, thus
limiting the validity of the drawn conclusions. There is significant
heterogeneity in randomized trials reporting on the effects of massage
therapy. Although there is evidence to suggest that massage therapy
reduces pain and anxiety following cardiac surgery, there are often
caveats to the conclusions drawn with other studies reporting no
significant difference. Therefore, in light of this, it would not be
logical to recommend massage therapy as an effective therapy. There is no
current evidence to suggest that massage therapy improves physiological
parameters, including the onset of atrial fibrillation
postoperatively.<br/>Copyright &#xa9; 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<4>
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. <br/>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. <br/>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).
<br/>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.<br/>Copyright &#xa9; 2018 Hellenic
Society of Cardiology

<5>
Accession Number
2002089443
Title
Different strategies in simultaneous coronary and carotid artery
revascularization - a single center experience.
Source
Archives of Iranian Medicine. 22 (3) (pp 132-136), 2019. Date of
Publication: March 2019.
Author
Zhang J.; Dong Z.; Liu P.; Fan X.; Chen J.; Zheng X.; Ma B.; Ye Z.
Institution
(Zhang, Liu, Fan, Chen, Zheng, Ma, Ye) Department of Cardiovascular
Surgery, China-Japan Friendship Hospital, Beijing 100029, China
(Dong) Department of Vascular Surgery, Daqing Oilfield General Hospital,
Daqing 16300, China
Publisher
Academy of Medical Sciences of I.R. Iran
Abstract
Background: The optimal management for patients with concomitant severe
coronary artery disease (CAD) and carotid artery stenosis (CAS) remains
controversial. We reported our preliminary experience on a synchronous
hybrid strategy. <br/>Method(s): Seven patients with synchronous
percutaneous coronary intervention (PCI)/carotid endarterectomy
(CEA)/coronary artery bypass grafting (CABG) and 36 patients with
synchronous CEA/CABG were enrolled. Then we analyzed the demographics,
risk factors and 30-day results of the 2 groups, retrospectively.
<br/>Result(s): The 2 groups were comparable in demographics. The
operation time was 312.14 +/- 40.08 minutes for synchronous PCI/CEA/CABG
and 294.58 +/- 47.62 minutes for synchronous CEA/CABG (P = 0.367). The
intraoperative blood loss was 814.29+/-195.18 mL for synchronous
PCI/CEA/CABG and 769.44 +/- 330.21 mL for synchronous CEA/CABG (P =
0.731). There was no death in the 2 groups within 30 days. The incidence
of primary endpoint [stroke, myocardial infarction (MI) and death] was
14.29% (1/7) in synchronous PCI/CEA/CABG group and 5.56% (2/36) in
synchronous CEA/CABG group. The difference between the 2 groups was not
statistically significant (P = 0.421). <br/>Conclusion(s): Synchronous
PCI, CEA and CABG may be safe and effective in the management of patients
with concomitant CAS and complicated multi-vessel CAD. The current data
suggested that more studies and randomized controlled trials may be
necessary to define whether this strategy is suitable for these
patients.<br/>Copyright &#xa9; 2019 The Author(s).

<6>
Accession Number
626131720
Title
In-hospital outcomes after emergency or prophylactic veno-arterial
extracorporeal membrane oxygenation during transcatheter aortic valve
implantation: a comprehensive review of the literature.
Source
Perfusion (United Kingdom). 34 (5) (pp 354-363), 2019. Date of
Publication: 01 Jul 2019.
Author
Raffa G.M.; Kowalewski M.; Meani P.; Follis F.; Martucci G.; Arcadipane
A.; Pilato M.; Maessen J.; Lorusso R.; Turrisi M.; Gandolfo C.; Montalbano
G.; Cannata S.; Coco V.L.; Armaro A.; Stringi V.; Romano G.; Falletta C.;
Delnoij T.; Gilbers M.; Heuts S.; Schreurs R.; Jiritano F.; Matteucci M.;
Fina D.
Institution
(Raffa, Maessen, Lorusso) Cardio-Thoracic Surgery Department, Heart and
Vascular Centre, Maastricht University Medical Centre, Maastricht,
Netherlands
(Raffa, Follis, Martucci, Arcadipane, Pilato) Department for the Treatment
and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation
and Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto
Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo,
Italy
(Kowalewski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Poland
(Kowalewski) Cardiothoracic Research Centre, Collegium Medicum, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Meani) Intensive Care Unit, Heart and Vascular Centre, Maastricht
University Medical Centre, Maastricht, Netherlands
(Meani) Cardiology Departments, Heart and Vascular Centre, Maastricht
University Medical Centre, Maastricht, Netherlands
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used
to deal with life-threatening complications as well as back-up or active
cardiovascular support during high-risk procedures in patients undergoing
transcatheter aortic valve implantation (TAVI). PubMed and MEDLINE
electronic databases were searched in order to identify studies with
emergency or prophylactic V-A ECMO application in association with TAVI
procedures. From November 2012 to November 2017, 14 relevant studies were
identified that included 5,115 TAVI patients of whom 102 (2%) required V-A
ECMO (22 prophylactically, 66 as an emergency and 14 without a reported
indication). The reason for emergency V-A ECMO institution was detailed in
64 patients: left ventricle free wall rupture (n = 14), haemodynamic
instability (n = 12), ventricular arrhythmias (n = 7), aortic annulus
rupture (n = 6), coronary obstruction (n = 6), low left ventricular output
(ejection fraction <35%) (n = 5), uncontrollable bleeding (n = 5), severe
aortic regurgitation (n = 4), prosthesis embolisation (n = 3), aortic
dissection (n = 1) and respiratory failure (n = 1). Femoral arterial and
vein cannulation was the most common access technique for V-A ECMO
institution. Major bleeding (n = 7) and vascular access complications (n =
7) were reported after ECMO institution. The overall in-hospital survival
was 73% (61% in the emergency vs. 100% in the prophylactic group). V-A
ECMO support should be available at any centre performing TAVI and
provides effective mechanical circulatory support in an emergency setting.
We present an algorithm to aid decisions about prophylactic circulatory
assistance with V-A ECMO and it should form part of the heart team
discussion before a TAVI procedure is undertaken.<br/>Copyright &#xa9; The
Author(s) 2019.

<7>
Accession Number
2001934144
Title
Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: A
Systematic Review.
Source
European Journal of Vascular and Endovascular Surgery. 58 (1) (pp
130-140), 2019. Date of Publication: July 2019.
Author
Waskowski J.; Pfortmueller C.A.; Erdoes G.; Buehlmann R.; Messmer A.S.;
Luedi M.M.; Schmidli J.; Schefold J.C.
Institution
(Waskowski, Pfortmueller, Messmer, Schefold) Department of Intensive Care
Medicine, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Waskowski, Erdoes, Luedi) Department of Anaesthesiology and Pain
Medicine, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Buehlmann, Schmidli) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background: Post-operative acute kidney injury (AKI) is a
frequent peri-operative complication that negatively affects morbidity and
mortality. Mannitol is frequently used peri-operatively for renal
protection, although evidence for its use is ambiguous. A systematic
review was conducted to clarify whether there is evidence supporting
peri-operative mannitol administration for the prevention of
post-operative AKI. <br/>Method(s): A systematic literature search was
performed in MEDLINE/Pubmed, Embase, the Cochrane Library, Clinical Trials
registry, and the Cochrane Central Register of Controlled Trials
(CENTRAL). Eligibility criteria were (i) population (studies involving
adult patients undergoing surgery or a related intervention); (ii)
intervention (intravenous mannitol administered in either the pre- or
intra-operative period with comparison to controls); and (iii) predefined
outcomes (post-operative AKI or respective renal end points/surrogates).
<br/>Result(s): In total, 1,538 articles published between January 1990
and October 2018 were identified. After checking for eligibility, 22
studies, including 17 prospective and/or randomised controlled trials and
five retrospective studies, were included. The investigations involved
various fields of surgery, such as aortic surgery, cardiac surgery with
cardiopulmonary bypass, and urological procedures, including partial
nephrectomy. Significant heterogeneity, limited sample size, and mostly
short follow up periods were noted. <br/>Conclusion(s): Given the
available evidence, the peri-operative use of mannitol to prevent AKI
cannot be considered an evidence based intervention in cardiac surgery,
partial nephrectomy, and/or other major surgery. Further research is
required with a focus on patients at high risk of post-operative
AKI.<br/>Copyright &#xa9; 2019 European Society for Vascular Surgery

<8>
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). <br/>Design(s): Meta-analysis of 10 observational studies.
<br/>Setting(s): Hospital. <br/>Participant(s): Patients with CKD (9,619)
undergoing aortic valve replacement. <br/>Intervention(s): None.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<9>
Accession Number
625925229
Title
The effect of methylprednisolone prophylaxis on inflammatory monocyte
subsets and suppressive regulatory T cells of patients undergoing
cardiopulmonary bypass.
Source
Perfusion (United Kingdom). 34 (5) (pp 364-374), 2019. Date of
Publication: 01 Jul 2019.
Author
Hao X.; Han J.; Zeng H.; Wang H.; Li G.; Jiang C.; Xing Z.; Hao Y.; Yang
F.; Hou X.
Institution
(Hao, Wang, Jiang, Xing, Yang, Hou) Center for Cardiac Intensive Care,
Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Han, Zeng, Li, Hao) Institute of Infectious Diseases, Beijing Ditan
Hospital, Capital Medical University, Beijing, China
(Han, Zeng, Li, Hao) Beijing Key Laboratory of Emerging Infectious
Diseases, Beijing, China
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardiopulmonary bypass (CPB) during open-heart surgery
triggers an inflammatory response that can cause significant morbidity and
mortality. Human monocytes and regulatory T (Treg) cells are
phenotypically and functionally heterogeneous and have been shown to play
a significant role in the inflammatory dysfunction triggered by CPB.
Glucocorticoids (GCs) have been widely administered for decades in
patients undergoing CPB to reduce this inflammatory response. However, it
has not been clearly established how routine prophylactic administration
of glucocorticoids (GCs) affects monocyte and Treg subsets.
<br/>Method(s): Thirty-six patient who underwent heart surgery with CPB
were randomly assigned to a methylprednisolone group (MG, N = 18; 500 mg
in the CPB priming) and a non-methylprednisolone group (NMG, N = 18). The
circulating monocyte and Treg subsets were analyzed by flow cytometry.
<br/>Result(s): The MG and NMG groups had comparable percentages of
monocyte subsets and similar expression levels of HLA-DR, CD86, CD64 and
toll-like receptor 4 (TLR4). Remarkably, methylprednisolone increased the
percentage of CD4+CD25+ Treg cells among CD4+ T cells in patients
undergoing CPB, but did not increase the proportion of suppressive Treg
cells, either resting or activated, in these patients undergoing CPB.
<br/>Conclusion(s): Our results showed that prophylactic administration of
methylprednisolone neither decreased the percentages and counts of
inflammatory monocyte subsets nor did it induce the expansion of
suppressive Treg cells in patients undergoing CPB. These results clarified
the effects of GCs on cell-mediated immune responses and provided
additional evidence in practice. Trial registration: Clinicaltrials.gov:
NCT01296074. Registered 14 February 2011.<br/>Copyright &#xa9; The
Author(s) 2019.

<10>
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. (no pagination), 2019. Article Number: e13625.
Date of Publication: 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.<br/>Copyright &#xa9; 2019 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd

<11>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2019, Children's Hospital, Zhejiang
University School of Medicine.

<12>
Accession Number
2002179521
Title
SUN-112 POSTOPERATIVE OUTCOMES IN RENAL TRANSPLANT RECIPIENTS: A
META-ANALYSIS OF 11 STUDIES AND 18, 655 PATIENTS.
Source
Kidney International Reports. Conference: ISN World Congress of Nephrology
(WCN). Australia. 4 (7 Supplement) (pp S204), 2019. Date of Publication:
July 2019.
Author
Palamuthusingm D.; Kuhan K.; David W J.; Carmel H.; Elaine P.; Magid F.
Institution
(Palamuthusingm, David W, Carmel, Magid) Princess Alexandra Hospital,
Nephrology, Brisbane, Australia
(Kuhan) Sunshine Coast Hospital, Medicine, Birtinya, Australia
(Elaine) University of Queensland, Centre for Health Services Research-
Faculty of Medicine, Brisbane, Australia
Publisher
Elsevier Inc.
Abstract
Introduction: Kidney transplantation affords patients with end-stage
kidney disease (ESKD) an improved survival and quality of life compared to
dialysis treatment, but their absolute and relative risk of postoperative
complications is unclear. The aim of this study was to estimate the risks
of fatal and non-fatal postoperative outcomes in renal transplant (RTx)
patients undergoing major elective surgery. <br/>Method(s): Two authors
performed a systematic review of observational studies indexed in Embase
and MEDLINE till March 2018 that reported postoperative outcomes in RTx
patients and patients with normal renal function undergoing major,
elective surgery. All included studies must report at least a single
postoperative complication or mortality. Summary level data on study
characteristics, type of surgical procedure, patient demographics and
comorbidity were extracted. The primary outcome was death (30-day or
in-hospital mortality); secondary outcomes were acute kidney injury.
Random effects meta-analysis was performed to derive summary risk
estimates and meta-regression was performed to explore heterogeneity.
<br/>Result(s): 11 studies involving 18,655 RTx patients and 6,021,582
non-RTx patients undergoing orthopaedic, cardiothoracic, and general
surgical procedures were included. Summary, unadjusted risk estimates
showed increased risks of postoperative mortality (9 studies, 9791
patients, 5.0% vs. 3.5%, OR 1.8, 95%CI 1.4-2.4, I²78%), sepsis
or surgical site infection (7 studies, 12597 patients, 5.8% vs. 4.4%, OR
1.9, 95% CI 1.2- 3.0, I²95%) and acute kidney injury (9
studies, 9785 patients, 4.7% vs. 4.5%, OR 5.7, 95% CI 3.6-8.9,
I²98%) in RTx patients compared to non-RTx patients
irrespective of surgical discipline. Adjustment for age and comorbidity
attenuated the risks of postoperative death (3 studies, 9590 patients, OR
1.3, 95% CI 0.8-1.8 I²0%) and acute kidney injury (4 studies,
6347 patients, OR 2.6, 95% CI 2.1-3.0, I²76.3[DP1] %).
Univariate metaregression of neither the weighted mean age nor ischemic
heart disease prevalence demonstrated an effect on mortality risk.
However, a significant effect was associated with increasing prevalence of
diabetes (slope 0.03, p<0.04). Weighted univariate metaregression did not
identify factors that affect the risk of acute kidney injury. The
relationship between level of renal transplant function and outcomes was
not able to be assessed by metaregression due to inadequate study data.
<br/>Conclusion(s): This review suggests a functioning renal transplant is
not an independent risk factor for postoperative mortality. However, they
have substantially increased risks of non-fatal postoperative
complications following major elective surgery.<br/>Copyright &#xa9; 2019

<13>
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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<14>
Accession Number
628307275
Title
The Effect of Modified Cardiac Rehabilitation on Erectile Dysfunction and
Coping with Stress in Men Undergoing Coronary Artery Bypass Graft (CABG):
A Clinical Trial.
Source
Sexuality and Disability. (no pagination), 2019. Date of Publication:
2019.
Author
Kaikhosro Doulatyari P.; Gholami M.; Toulabi T.; Birjandi M.; Abdi A.
Institution
(Kaikhosro Doulatyari) Student Research Committee, Lorestan University of
Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Gholami, Toulabi) School of Nursing and Midwifery, Social Determinants of
Health Research Center, Lorestan University of Medical Sciences,
Khorramabad, Iran, Islamic Republic of
(Birjandi) Biostatistics Department, School of Health, Lorestan University
of Medical Sciences, Khorramabad, Iran, Islamic Republic of
(Abdi) School of Nursing and midwifery, Student Research Committee,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Erectile dysfunction and stress are among common post-CABG surgery
complications. The present study was conducted to assess the effect of
modified cardiac rehabilitation on "erectile dysfunction" and "coping with
stress". In the present clinical trial study, 126 male patients undergoing
CABG surgery were randomly assigned to treatment (63 patients) and control
(63 patients) groups. Control group received conventional cardiac
rehabilitation program over 26 sessions. Treatment group received modified
cardiac rehabilitation program, including Kegel exercise and training on
stress coping strategies in the first four sessions of their
rehabilitation program. Patients were assessed before and after cardiac
rehabilitation program using the International Index of Erectile
Dysfunction (IIEF-5) questionnaire and Endler and Parker Coping with
Stress Scale. Data were analyzed in SPSS using ANOVA, T, and Chi square
tests. Mean erectile function score significantly increased in both
treatment and control groups, but the difference in mean scores for
improvement in erectile function was greater in treatment group (P <
0.001). Analysis showed no significant difference in mean differences
between two groups in all subscales of stress coping. Intragroup analysis
showed significant differences in both groups between mean differences
before and after intervention in task-oriented styles {treatment group (P
< 0.002), control group (P < 0.001)}, and social diversion-oriented. The
results showed that conventional and modified cardiac rehabilitation can
be effective in improving erectile dysfunction and stress coping in
task-oriented and social diversion-oriented styles in the men patients
with left ventricular ejection fraction over 30% following CABG surgery.
However, modified cardiac rehabilitation has greater benefits for
improving erectile dysfunction.<br/>Copyright &#xa9; 2019, Springer
Science+Business Media, LLC, part of Springer Nature.

<15>
Accession Number
624062686
Title
Effects of different doses of ticagrelor on platelet aggregation and
endothelial function in diabetic patients with stable coronary artery
disease.
Source
Platelets. 30 (6) (pp 752-761), 2019. Date of Publication: 18 Aug 2019.
Author
He M.; Li D.; Zhang Y.; Sun D.; Liu G.; Pan Y.; Shi J.; Yin S.; Li Y.
Institution
(He, Li, Sun, Liu, Pan, Shi, Li, Yin, Li) Cardiovascular Department, the
First Affiliated Hospital of Harbin Medical University, Harbin,
Heilongjiang, China
(Zhang) Cardiovascular Department, Harbin Red Cross Central Hospital,
Harbin, Heilongjiang, China
Publisher
Taylor and Francis Ltd
Abstract
We performed this study to observe the effects of different doses of
ticagrelor and standard-dose clopidogrel on platelet reactivity and
endothelial function in diabetic patients with stable coronary artery
disease (CAD). Sixty type 2 diabetic patients were assigned to one-quarter
standard-dose ticagrelor, half standard-dose ticagrelor, standard-dose
ticagrelor and standard-dose clopidogrel groups. Light transmission
aggregometry (LTA) and VerifyNow assay were used to measure platelet
function. Endothelial function was assessed by measurement of
flow-mediated vasodilation (FMD) and plasma von Willebrand factor (VWF)
levels were detected. Enzyme-linked immunosorbent assay (ELISA) examined
the Interleukin-8(IL-8) and IL-10. The results suggested that the
one-quarter dose (34.0%+/- 14.7%), half-dose (26.9%+/- 11.6%) and
standard-dose (17.3%+/- 10.3%) ticagrelor showed lower platelet
aggregation rate than clopidogrel (52.8%+/- 18.3%; P 0.0001). PRU values
in three ticagrelor groups were lower than that in clopidogrel group (102
(76-184)75 (33-88)38 (11-52) versus 194 (138-271) andP 0.0001). FMD levels
were higher in ticagrelor groups compared with baseline levels while lower
in clopidogrel group after treatment. However, no significant differences
were found in the percentage increase in the FMD between ticagrelor groups
and clopidogrel group. The levels of VWF after treatment were lower than
the baseline levels, but there was no statistically significant difference
between ticagrelor group and clopidogrel group after treatment. The
concentration of IL-8 and IL-10 were decreased in patients with half and
standard-dose ticagrelor group. In conclusion, one-quarter standard-dose
ticagrelor produced similar inhibitory effects on platelet aggregation as
standard-dose clopidogrel in diabetic patients with stable CAD. The half
standard-dose ticagrelor had a similar inhibitory effect on platelet
inhibition as standard-dose ticagrelor, which was stronger than that of
clopidogrel. Moreover, the half-dose ticagrelor had equal protection of
endothelial function and inhibition of inflammatory factor as
standard-dose ticagrelor.<br/>Copyright &#xa9; 2018, &#xa9; 2018 Taylor &
Francis.

<16>
Accession Number
628200824
Title
Effects of catheter tip location on the spread of sensory block caused by
a continuous thoracic paravertebral block: A prospective, randomized,
controlled, double-blind study.
Source
BioMed Research International. 2019 (no pagination), 2019. Article Number:
1051629. Date of Publication: 2019.
Author
Yoshida T.; Watanabe Y.; Hashimoto T.; Ohta A.; Nakamoto T.
Institution
(Yoshida, Nakamoto) Department of Anesthesiology, Kansai Medical
University Hospital, Hirakata City, Osaka, Japan
(Watanabe) Department of Anesthesiology, Niigata City General Hospital,
Niigata City, Niigata, Japan
(Hashimoto) Department of Anesthesiology, Nagaoka Chuo General Hospital,
Nagaoka City, Niigata, Japan
(Ohta) Department of Radiology and Radiation Oncology, Niigata University
Graduate School of Medical and Dental Sciences, Niigata City, Niigata,
Japan
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Single injections in the anterior region of the thoracic paravertebral
space (TPVS) have been reported to generate a multisegmental longitudinal
spreading pattern more frequently than those in the posterior region of
the TPVS. In this trial, we examined the hypothesis that a continuous
thoracic paravertebral block (TPVB) administered through a catheter
inserted into the anterior region of the TPVS allows a wider sensory block
dispersion. Fifty consecutive patients undergoing video-assisted thoracic
surgery were enrolled. Before the surgery, an infusion catheter was
inserted into the TPVS through a needle placed adjacent to either the
parietal pleura (group A) or internal intercostal membrane (group P) using
an ultrasound-guided intercostal transverse approach according to a
randomized allocation schedule. A chest radiograph was obtained
postoperatively after injection of 10 mL of radiopaque dye through the
catheter. Thereafter, 20 mL of 0.375% levobupivacaine was injected via the
catheter, followed by commencement of continuous TPVB with 0.25%
levobupivacaine at 8 mL/h. The primary outcome was the number of blocked
dermatomes at 24 h after surgery. The secondary outcomes included
radiopaque dye spreading patterns, the number of segments reached by the
radiopaque dye, the number of blocked dermatomes at 2 h after surgery, and
pain scores. The median (interquartile range [range]) number of blocked
dermatomes 24 h after surgery was 3 (2.75-4 [1-6]) in group A (n = 22) and
2 (1.5-3 [0-7]) in group P (n = 25; p = 0.037). No significant differences
in the other outcomes were found between the groups. In conclusion, a
continuous TPVB administered using a catheter supposedly inserted into the
anterior region of the TPVS allows a wider sensory block dispersion than a
catheter inserted into the posterior region of the TPVS. This trial is
registered with the UMIN Clinical Trials Registry
(UMIN000018578).<br/>Copyright &#xa9; 2019 Takayuki Yoshida et al.

<17>
Accession Number
628180981
Title
Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review
and Meta-Analysis.
Source
Journal of the American Heart Association. 8 (9) (no pagination), 2019.
Article Number: e010920. Date of Publication: 07 May 2019.
Author
Indja B.; Woldendorp K.; Vallely M.P.; Grieve S.M.
Institution
(Indja, Grieve) Sydney Translational Imaging Laboratory, Heart Research
Institute, Charles Perkins Centre, The University of Sydney, Camperdown,
Sydney, NSW, Australia
(Indja, Woldendorp, Vallely, Grieve) Sydney Medical School, The University
of Sydney, Camperdown, Sydney, NSW, Australia
(Vallely) Sydney Heart and Lung Surgeons, Camperdown, Sydney, NSW,
Australia
(Woldendorp) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Camperdown, Sydney, NSW, Australia
(Grieve) Department of Radiology, Royal Prince Alfred Hospital,
Camperdown, Sydney, NSW, Australia
Publisher
American Heart Association Inc.
Abstract
Background: Silent brain infarcts (SBI) are increasingly being recognized
as an important complication of cardiac procedures as well as a potential
surrogate marker for studies on brain injury. The extent of subclinical
brain injury is poorly defined. <br/>Methods and Results: We conducted a
systematic review and meta-analysis utilizing studies of SBIs and focal
neurologic deficits following cardiac procedures. Our final analysis
included 42 studies with 49 separate intervention groups for a total of
2632 patients. The prevalence of SBIs following transcatheter aortic valve
implantation was 0.71 (95% CI 0.64-0.77); following aortic valve
replacement 0.44 (95% CI 0.31-0.57); in a mixed cardiothoracic surgery
group 0.39 (95% CI 0.28-0.49); coronary artery bypass graft 0.25 (95% CI
0.15-0.35); percutaneous coronary intervention 0.14 (95% CI 0.10-0.19);
and off-pump coronary artery bypass 0.14 (0.00-0.58). The risk ratio of
focal neurologic deficits to SBI in aortic valve replacement was 0.22 (95%
CI 0.15-0.32); in off-pump coronary artery bypass 0.21 (95% CI 0.02-2.04);
with mixed cardiothoracic surgery 0.15 (95% CI 0.07-0.33); coronary artery
bypass graft 0.10 (95% CI 0.05-0.18); transcatheter aortic valve
implantation 0.10 (95% CI 0.07-0.14); and percutaneous coronary
intervention 0.06 (95% CI 0.03-0.14). The mean number of SBIs per patient
was significantly higher in the transcatheter aortic valve implantation
group (4.58 +/- 2.09) compared with both the aortic valve replacement
group (2.16 +/- 1.62, P=0.03) and the percutaneous coronary intervention
group (1.88 +/- 1.02, P=0.03). <br/>Conclusion(s): SBIs are a very common
complication following cardiac procedures, particularly those involving
the aortic valve. The high frequency of SBIs compared with strokes
highlights the importance of recording this surrogate measure in cardiac
interventional studies. We suggest that further work is required to
standardize reporting in order to facilitate the use of SBIs as a routine
outcome measure.<br/>Copyright &#xa9; 2019 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<18>
Accession Number
2002151066
Title
Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary
Arterial Hypertension: A Systematic Review and Meta-Analysis.
Source
Chest. 156 (1) (pp 53-63), 2019. Date of Publication: July 2019.
Author
Khan M.S.; Memon M.M.; Amin E.; Yamani N.; Khan S.U.; Figueredo V.M.; Deo
S.; Rich J.D.; Benza R.L.; Krasuski R.A.
Institution
(Khan, Yamani) Department of Internal Medicine, John H. Stroger, Jr.
Hospital of Cook County, Chicago, IL, United States
(Memon, Amin) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Khan) West Virginia University, Morgantown, WV, United States
(Figueredo) St Mary Medical Center, Langhorne, PA, United States
(Deo) Division of Cardiovascular Surgery, University Hospitals, Cleveland,
OH, United States
(Rich) Department of Medicine, Division of Cardiology, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Benza) Cardiovascular Institute, Allegheny Health Network, Pittsburgh,
PA, United States
(Krasuski) Department of Cardiovascular Medicine, Duke University Health
System, Durham, NC, United States
Publisher
Elsevier Inc
Abstract
Background: Despite the use and purported benefits of balloon atrial
septostomy (BAS), its safety, efficacy, and therapeutic role in the
setting of advanced pulmonary arterial hypertension (PAH) are not well
defined. <br/>Objective(s): The goal of this study was to conduct a
systematic review and meta-analysis to better determine the evidence
supporting the use of BAS in PAH. <br/>Method(s): MEDLINE, Scopus,
Cochrane Library, and Clinicaltrials.gov were searched from inception
through May 2018 for original studies reporting outcomes with PAH prior to
and following BAS. Studies comparing BAS vs other septostomy procedures
were excluded. Weighted mean differences and 95% CIs were pooled by using
a random effects model. <br/>Result(s): Sixteen studies comprising 204
patients (mean age, 35.8 years; 73.1% women) were included. Meta-analysis
revealed significant reductions in right atrial pressure (-2.77 mm Hg [95%
CI, -3.50, -2.04]; P < .001) and increases in cardiac index (0.62
L/min/m² [95% CI, 0.48, 0.75]; P < .001) and left atrial
pressure (1.86 mm Hg [95% CI, 1.24, 2.49]; P < .001) following BAS, along
with a significant reduction in arterial oxygen saturation (-8.45% [95%
CI, -9.93, -6.97]; P < .001). The pooled incidence of procedure-related
(48 h), short-term (<= 30 day), and long-term (> 30 days up to a mean
follow-up of 46.5 months) mortality was 4.8% (95% CI, 1.7%, 9.0%), 14.6%
(95% CI, 8.6%, 21.5%), and 37.7% (95% CI, 27.9%, 47.9%), respectively.
<br/>Conclusion(s): The present analysis suggests that BAS is relatively
safe in advanced PAH, with beneficial hemodynamic effects. The relatively
high postprocedural and short-term survival with less impressive long-term
survival suggest a bridging role for BAS; its contribution to this change
needs to be verified by using a comparator group.<br/>Copyright &#xa9;
2019 American College of Chest Physicians

<19>
Accession Number
2002143440
Title
Effect of a new sternal sealant on marrow bleeding and blood product use
after adult cardiac surgery.
Source
American Surgeon. 85 (5) (pp E257-E259), 2019. Date of Publication: May
2019.
Author
Hasaniya N.W.; Bansal N.R.; John M.M.; Miller V.L.A.; Floridia R.; Razzouk
A.J.; Rabkin D.G.
Institution
(Hasaniya, Bansal, John, Miller, Floridia, Razzouk, Rabkin) Department of
Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman
Pavilion, 11175 Campus Street, Loma Linda, CA 92354, United States
(Hasaniya) Kaiser Permanente Fontana Medical Center, 9961 Sierra Avenue,
Fontana, CA 92335, United States
Publisher
Southeastern Surgical Congress (E-mail: SESC@sesc.org)

<20>
Accession Number
628227010
Title
Utility of preoperative exercise therapy in reducing postoperative
morbidity after surgery; a clinical overview of current evidence.
Source
Expert Review of Cardiovascular Therapy. 17 (6) (pp 395-412), 2019. Date
of Publication: 03 Jun 2019.
Author
Topal B.; Smelt H.J.M.; Van Helden E.V.; Celik A.; Verseveld M.; Smeenk
F.; Pouwels S.
Institution
(Topal) Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Smelt) Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
(Van Helden, Verseveld, Pouwels) Department of Surgery, Franciscus
Gasthuis & Vlietland, Rotterdam/Schiedam, Netherlands
(Celik) Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli,
Istanbul, Turkey
(Smeenk) Department of Respiratory Medicine, Catharina Hospital,
Eindhoven, Netherlands
(Smeenk) SHE School of Health Professions Education, Maastricht
University, Maastricht, Netherlands
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Surgery is a major stressor especially for older patients
that are prone for postoperative complications and mortality.
Hospitalization due to surgery and illness can be major life events, and
the age-related impairments in physiological function and the decreased
ability to respond to metabolic and hormonal perturbations in response to
surgery often lead to a longer convalescence. Areas covered: This article
gives an overview of the effects of PET in various surgical fields and
also what to account for and expect of PET after various types of surgery.
A comprehensive literature search was performed in Pubmed, Embase,
Medline, Cochrane Library, and PEDro database (from the earliest date of
each database to March 2019) using search words 'Preoperative Exercise
Therapy', 'Physical Therapy' and 'surgery'. Secondly, the literature
searches were modified depending on the surgical specialty. Expert
opinion: Evidence is growing that preoperative exercise therapy in various
surgical specialties is well tolerated and effective, with by far the most
evidence in the cardiac surgical field. Future improvements in standards
of care and optimal pre-operative preparation should not only focus on the
surgical team and the hospital organization but also on incorporating the
active role of the patient.<br/>Copyright &#xa9; 2019, &#xa9; 2019 Informa
UK Limited, trading as Taylor & Francis Group.

<21>
Accession Number
628151645
Title
The effect of low- dose tranexamic acid on postoperative blood loss in
patients treated with clopidogrel and aspirin.
Source
Caspian Journal of Internal Medicine. 10 (2) (pp 156-161), 2019. Date of
Publication: 2019.
Author
Banihashem N.; Khorasani M.; Vaffai H.; Naziri F.; Khafri S.; Seyfi S.
Institution
(Banihashem, Khorasani, Vaffai, Naziri) Clinical Research Development Unit
of Ayatollah Rouhani Hospital, Babol University of Medical Sciences,
Babol, Iran, Islamic Republic of
(Banihashem, Seyfi) Department of Anesthesiology, School of Medicine,
Babol University of Medical Sciences, Babol, Iran, Islamic Republic of
(Khorasani, Vaffai) Department of Surgery, School of Medicine, Babol
University of Medical Sciences, Babol, Iran, Islamic Republic of
(Khafri) Infertility and Health Reproductive Research Center, Health
Research Institute, Babol University of Medical Sciences, Babol, Iran,
Islamic Republic of
Publisher
Babol University of Medical Sciences (Journal office,Ganj Afrooz Avenue,
Babol 4717641367, Iran, Islamic Republic of)
Abstract
Background: Clopidogrel in combination with aspirin increases bleeding,
allogeneic red cell transfusion and reoperation rates after CABG.
Tranexamic acid, an antifibrinolytic agent, has been approved for use in
cardiac surgery to reduce bleeding. In the present study, we evaluated the
impact of tranexamic acid on the transfusion and post-operative blood loss
after CABG in patients treated with clopidogrel less than 5 days before
surgery. <br/>Method(s): This study was a prospective, randomized,
double-blinded clinical trial. Patients undergoing on-pump CABG with their
last dose of clopidogrel and aspirin less than 5 days preoperatively were
randomly assigned to receive tranexamic acid (10 mg/kg before surgical
incision and 10 mg/kg after protamine neutralization) or a corresponding
volume of saline solution. The incidence of allogeneic red cell
transfusion and 48h postoperative blood loss were recorded.
<br/>Result(s): The average volume of blood loss was 776.92+/-459.81mL for
the TXA group and 1075.00+/-670.91mL for the control group (P=0.03) in the
patients with clopidogrel exposure within 48 h before surgery. The average
volume of blood loss was not different between two groups in the patients
with clopidogrel exposure within 5 days before surgery and also
transfusion rate. <br/>Conclusion(s): The result of this study shows that
tranexamic acid reduced blood loss in the patients with clopidogrel
exposure within 48 h before surgery. So, it is better that we use
tranexamic acid before surgery in all patients.<br/>Copyright &#xa9; 2019
Babol University of Medical Sciences. All rights reserved.

<22>
Accession Number
619183443
Title
Effects of monoclonal antibodies against PCSK9 on clinical cardiovascular
events: A meta-analysis of randomized controlled trials.
Source
Herz. 44 (4) (pp 336-346), 2019. Date of Publication: 01 Jun 2019.
Author
Zhu Y.; Shen X.; Jiang Q.; Wang Z.; Dong X.; Li J.; Han Q.; Zhao J.; Wang
B.; Liu L.
Institution
(Zhu, Wang, Wang, Dong, Li, Han, Zhao, Wang, Liu) Dongzhimen Hospital,
Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,
Beijing 100700, China
(Shen) Cardiovascular Department of Dongzhimen Hospital, Dongzhimen
Hospital Affiliated to Beijing University of Chinese Medicine, Beijing
100700, China
(Jiang) ICU Department of Dongzhimen Hospital, Beijing University of
Chinese Medicine, Beijing 100700, China
(Shen) No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029,
China
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: The present meta-analysis was designed to improve statistical
power and review the effects of monoclonal antibodies against PCSK9 on
clinical cardiovascular events. <br/>Method(s): PubMed, Embase, Web of
Science, and the Cochrane Library were searched from inception to May
2017. Studies considered to be eligible were randomized controlled trials
about the effects of monoclonal antibodies against PCSK9 on clinical
cardiovascular events. The primary endpoint was positively adjudicated
cardiovascular events; the secondary endpoint comprised cardiac mortality,
myocardial infarction (MI), coronary revascularization, stroke, and
hospitalization for unstable angina. <br/>Result(s): We included 20
randomized controlled trials involving 67,934 patients. Monoclonal
antibodies against PCSK9 were associated with a significant reduction in
positively adjudicated cardiovascular events (relative risk [RR] = 0.87;
95% confidence interval [CI] = 0.81-0.93; z = 4.03; p = 0.000), MI (RR =
0.78; 95% CI = 0.71-0.86; z = 4.96; p = 0.000), coronary revascularization
(RR = 0.81, 95% CI = 0.75-0.88; z = 4.93; p = 0.000), and stroke (RR =
0.76, 95% CI = 0.65-0.89; z = 3.47; p = 0.001). Monoclonal antibodies
against PCSK9 did not reduce hospitalization rates due to unstable angina.
The results of subgroup analysis showed that evolocumab was associated
with a lower risk of positively adjudicated cardiovascular events, MI,
coronary revascularization, and stroke without reducing cardiac mortality.
Alirocumab reduced the incidence of cardiac mortality but not of other
cardiovascular events, while bococizumab was associated with a reduced
risk of stroke. <br/>Conclusion(s): Monoclonal antibodies against PCSK9
were associated with a lower risk of positively adjudicated cardiovascular
events, MI, coronary revascularization, and stroke.<br/>Copyright &#xa9;
2017, Springer Medizin Verlag GmbH.

<23>
Accession Number
628251087
Title
Pressure support ventilation, sigh adjunct to pressure support
ventilation, and neurally adjusted ventilatory assist in infants after
cardiac surgery: A physiologic crossover randomized study.
Source
Pediatric Pulmonology. 54 (7) (pp 1078-1086), 2019. Date of Publication:
July 2019.
Author
Bonacina D.; Bronco A.; Nacoti M.; Ferrari F.; Fazzi F.; Bonanomi E.;
Bellani G.
Institution
(Bonacina, Nacoti, Ferrari, Fazzi, Bonanomi) Pediatric Intensive Care
Unit, A.S.S.T. Papa Giovanni XXIII, Bergamo, Italy
(Bronco, Bellani) Department of Emergency and Intensive Care, San Gerardo
Hospital, Monza, Italy
(Bellani) Department of Medicine and Surgery, University of Milan-Bicocca,
Monza, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We sought to compare gas exchange, respiratory mechanics, and
asynchronies during pressure support ventilation (PSV), sigh adjunct to
PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in
hypoxemic infants after cardiac surgery. <br/>Design(s): Prospective,
single-center, crossover, randomized physiologic study. <br/>Setting(s):
Tertiary-care pediatric intensive care unit. <br/>Patient(s): Fourteen
hypoxemic infants (median age 11.5 days [8.7-74]). <br/>Intervention(s):
The protocol begins with a 1 hour step of PSV, followed by two consecutive
steps in PSV SIGH and NAVA in random order, with a washout period of 30
minutes (PSV) between them. <br/>Main Result(s): Three infants presented
an irregular Eadi signal because of diaphragmatic paralysis and were
excluded from analysis. For the remaining 11 infants, PaO<inf>2</inf>/FiO
<inf>2</inf> and oxygenation index improved in PSV SIGH compared with PSV
(P < 0.05) but not in NAVA compared with PSV. PSV SIGH showed increased
tidal volumes and lower respiratory rate than PSV (P < 0.05), as well as a
significant improvement in compliance with respiratory system indexed to
body weight when compared with both PSV and NAVA (P < 0.01). No changes in
mean airway pressure was registered among steps. Inspiratory time resulted
prolonged for both PSV SIGH and NAVA than PSV (P < 0.05). NAVA showed the
higher coefficient of variability in respiratory parameters and a
significative decrease in asynchrony index when compared with both PSV and
PSV SIGH (P < 0.01). <br/>Conclusion(s): The adjunct of one SIGH per
minute to PSV improved oxygenation and lung mechanics while NAVA provided
the best patient-ventilator synchrony in infants after cardiac
surgery.<br/>Copyright &#xa9; 2019 Wiley Periodicals, Inc.

<24>
[Use Link to view the full text]
Accession Number
628250019
Title
The effect of Vitamin C on clinical outcome in critically ill patients: A
systematic review with meta-analysis of randomized controlled trials.
Source
Critical Care Medicine. 47 (6) (pp 774-783), 2019. Date of Publication:
June 2019.
Author
Putzu A.; Daems A.-M.; Lopez-Delgado J.C.; Giordano V.F.; Landoni G.
Institution
(Putzu, Daems) Division of Anesthesiology, Department of Anesthesiology,
Pharmacology and Intensive Care Medicine, Geneva University Hospitals,
Geneva, Switzerland
(Lopez-Delgado) Intensive Care Department, Hospital Universitari de
Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
(Lopez-Delgado) Institut d'Investigacio Biomedica Bellvitge (IDIBELL),
L'Hospitalet de Llobregat, Barcelona, Spain
(Giordano, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: The effects of vitamin C administration on clinical outcome in
critically ill patients remain controversial. <br/>Data Sources: Online
databases were searched up to October 1, 2018. Study Selection: We
included randomized controlled trials on the use of vitamin C (any
regimen) in adult critically ill patients versus placebo or no therapy.
<br/>Data Extraction: Risk ratio for dichotomous outcome and standardized
mean difference for continuous outcome with 95% CI were calculated using
random-effects model meta-analysis. <br/>Data Synthesis: Forty-four
randomized studies, 16 performed in ICU setting (2,857 patients) and 28 in
cardiac surgery (3,598 patients), published between 1995 and 2018, were
included in the analysis. In ICU patients, vitamin C administration was
not associated with a difference in mortality (risk ratio, 0.90; 95% CI,
0.74-1.10; p = 0.31), acute kidney injury, ICU or hospital length of stay
compared with control. In cardiac surgery, vitamin C was associated to a
reduction in postoperative atrial fibrillation (risk ratio, 0.64; 95% CI,
0.52-0.78; p < 0.0001), ICU stay (standardized mean difference, -0.28 d;
95% CI, -0.43 to -0.13 d; p = 0.0003), and hospital stay (standardized
mean difference, -0.30 d; 95% CI, -0.49 to -0.10 d; p = 0.002).
Furthermore, no differences in postoperative mortality, acute kidney
injury, stroke, and ventricular arrhythmia were found. <br/>Conclusion(s):
In a mixed population of ICU patients, vitamin C administration is
associated with no significant effect on survival, length of ICU or
hospital stay. In cardiac surgery, beneficial effects on postoperative
atrial fibrillation, ICU or hospital length of stay remain unclear.
However, the quality and quantity of evidence is still insufficient to
draw firm conclusions, not supporting neither discouraging the systematic
administration of vitamin C in these populations. Vitamin C remains an
attractive intervention for future investigations aimed to improve
clinical outcome.<br/>Copyright &#xa9; 2019 by the Society of Critical
Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<25>
Accession Number
628249912
Title
Effects of programmed intermittent thoracic paravertebral bolus of
levobupivacaine on the spread of sensory block: A randomized, controlled,
double-blind study.
Source
Regional Anesthesia and Pain Medicine. 44 (3) (pp 326-332), 2019. Date of
Publication: 01 Mar 2019.
Author
Hida K.; Murata H.; Ichinomiya T.; Inoue H.; Sato S.; Hara T.
Institution
(Hida, Murata, Ichinomiya, Inoue, Hara) Department of Anesthesiology,
Nagasaki University, School of Medicine, Nagasaki 852-8501, Japan
(Sato) Clinical Research Center, Nagasaki University Hospital, Nagasaki,
Japan
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background and objectives This randomized, controlled, double-blind trial
compared the effectiveness of levobupivacaine delivery of a programmed
intermittent paravertebral bolus with a continuous paravertebral infusion.
Methods Thirty-two consecutively enrolled patients who underwent
unilateral video-assisted thoracic surgery were randomized to receive
either a programmed intermittent paravertebral bolus of 10 mL of 0.2%
levobupivacaine every 2 hours (Bolus group, n=16) or a continuous
paravertebral infusion of 0.2% levobupivacaine at 5 mL/hour (Infusion
group, n=16) after the operation. Postoperatively, after injection of 20
mL of 0.25% levobupivacaine through the paravertebral catheter, a
mechanical infusion pump was set depending on the assigned group. The
primary efficacy outcome was the number of anesthetized dermatomes 24
hours after the initial bolus of levobupivacaine. The secondary efficacy
outcomes included the number of anesthetized dermatomes at other time
points, pain at rest and coughing, additional analgesic use and patient
acceptance of the analgesic technique. Arterial levobupivacaine
concentration was measured to ensure safety. P<0.05 was considered
statistically significant. Results The mean (95% CI) number of
anesthetized dermatomes 24 hours after the initial bolus of
levobupivacaine was significantly larger among subjects receiving
programmed intermittent bolus (n=16) compared with those receiving
continuous infusion (n=16; 6.8 (5.7-7.9) vs 3.1 (2.0-4.2); p<0.001). The
arterial levobupivacaine concentration did not reach a toxic level.
Conclusions The programmed intermittent paravertebral bolus of
levobupivacaine provided a wider dermatomal spread of sensory block than
continuous paravertebral infusion with an identical hourly dose of
levobupivacaine. Trial registration number UMIN000022532.<br/>Copyright
&#xa9; 2019 American Society of Regional Anesthesia & Pain Medicine.

<26>
Accession Number
2002169397
Title
Quality appraisal of systematic reviews, and meta-analysis of the
hospital/surgeon-linked volume-outcome relationship of carotid
revascularization procedures.
Source
Journal of Cardiovascular Surgery. 60 (3) (pp 354-363), 2019. Date of
Publication: June 2019.
Author
Kallmayer M.A.; Salvermoser M.; Knappich C.; Trenner M.; Karlas A.; Wein
F.; Eckstein H.-H.; Kuehnl A.
Institution
(Kallmayer, Salvermoser, Knappich, Trenner, Karlas, Wein, Eckstein,
Kuehnl) Department of Vascular and Endovascular Surgery, Klinikum rechts
der Isar, Technical University of Munich, Ismaninger Str. 22, Munich
81675, Germany
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Several systematic reviews and meta-analyses of primary
studies have been published on the relationship between annual case load
of carotid endarterectomy (CEA) and carotid artery stenting (CAS)
performed at hospital level or by individual surgeons, and perioperative
outcomes. Many studies on volume-outcome relationship have already been
published and high-quality systematic reviews are crucial for further
guideline development. EVIDENCE ACQUISITION: Systematic reviews and
meta-analyses on the relationship between hospital or surgeon CEA/CAS
volume and periprocedural outcomes were identified through a systematic
literature search of Medline, Web of Science, and the Cochrane Database of
Systematic Reviews. Methodological quality of the systematic reviews was
appraised using the AMSTAR2 tool independently by two authors. Systematic
reviews were aggregated in their volume-outcome findings. Quantitative
data from primary studies included in the systematic reviews were
synthesized. Additionally, volume definitions and the time point of
outcome assessment used in primary studies were analyzed. EVIDENCE
SYNTHESIS: In total, five systematic reviews published between 2000 and
2018 were identified, each comprising 11-25 primary studies.
Methodological quality appraisal of these reviews revealed high quality
for only the most recent review, low quality for three reviews, and
critically low quality in one review. Aggregation of the systematic
reviews revealed a significant inverse relationship between
hospital/operator volume and the periprocedural risk of death or stroke
following CEA. For CAS, high operator volume was associated with lower
outcome rates. Regarding hospital volume, an inverse but non-significant
relationship between CAS hospital volume and outcome rate was found. In
our synthesis of primary studies from these systematic reviews an inverse
CEA hospital and operator volume relationship was present for stroke or
death and for CAS for hospital volume, respectively. A high heterogeneity
regarding the definitions of volume categories, and of time points
assessing outcomes was apparent. <br/>CONCLUSION(S): For CEA, high quality
aggregated evidence revealed an inverse relationship between
hospital/surgeon CEA volume and periprocedural rate of stroke or death.
The same was true for operator linked CAS volume. Regarding hospital
linked CAS volume, no unequivocal evidence was found. Additionally,
heterogeneity was found regarding volume definition, and time of outcome
assessment. Thus, future studies should aim to harmonize volume
definitions and outcome time points.<br/>Copyright &#xa9; 2019 EDIZIONI
MINERVA MEDICA.

<27>
Accession Number
626924657
Title
Hospital costs associated with intraoperative hypotension among
non-cardiac surgical patients in the US: a simulation model.
Source
Journal of Medical Economics. 22 (7) (pp 645-651), 2019. Date of
Publication: 03 Jul 2019.
Author
Keuffel E.L.; Rizzo J.; Stevens M.; Gunnarsson C.; Maheshwari K.
Institution
(Keuffel) Health Finance & Access Initiative, Bryn Mawr, PA, United States
(Rizzo) Stony Brook University Medical Center, Stony Brook University (New
York), Stony Brook, NY, United States
(Stevens) Edwards Lifesciences, Irvine, CA, United States
(Gunnarsson) Gunnarsson Consulting, Jupiter, FL, United States
(Maheshwari) Cleveland Clinic, Cleveland, OH, United States
Publisher
Taylor and Francis Ltd
Abstract
Objective: Recent studies indicate intraoperative hypotension, common in
non-cardiac surgical patients, is associated with myocardial injury, acute
kidney injury, and mortality. This study extends on these findings by
quantifying the association between intraoperative hypotension and
hospital expenditures in the US. <br/>Method(s): Monte Carlo simulations
(10,000 trial per simulation) based on current epidemiological and cost
outcomes literature were developed for both acute kidney injury (AKI) and
myocardial injury in non-cardiac surgery (MINS). For AKI, three models
with different epidemiological assumptions (two models based on
observational studies and one model based on a randomized control trial
[RCT]) estimate the marginal probability of AKI conditional on
intraoperative hypotension status. Similar models are also developed for
MINS (except for the RCT case). Marginal probabilities of AKI and MINS
sequelae (myocardial infarction, congestive heart failure, stroke, cardiac
catheterization, and percutaneous coronary intervention) are multiplied by
marginal cost estimates for each outcome to evaluate costs associated with
intraoperative hypotension. <br/>Result(s): The unadjusted (adjusted)
model found hypotension control lowers the absolute probability of AKI by
2.2% (0.7%). Multiplying these probabilities by the marginal cost of AKI,
the unadjusted (adjusted) AKI model estimated a cost reduction of $272
[95% CI = $223-$321] ($86 [95% CI = $47-$127]) per patient. The AKI model
based on relative risks from the RCT had a mean cost reduction estimate of
$281 (95% CI = -$346-$750). The unadjusted (adjusted) MINS model yielded a
cost reduction of $186 [95% CI = $73-$393] ($33 [95% CI = $10-$77]) per
patient. <br/>Conclusion(s): The model results suggest improved
intraoperative hypotension control in a hospital with an annual volume of
10,000 non-cardiac surgical patients is associated with mean cost
reductions ranging from $1.2-$4.6 million per year. Since the magnitude of
the RCT mean estimate is similar to the unadjusted observational model,
the institutional costs are likely at the upper end of this
range.<br/>Copyright &#xa9; 2019, &#xa9; 2019 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<28>
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. <br/>Design(s): Systematic review of the literature with
meta-analyses. <br/>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.
<br/>Participant(s): The study comprised 759 patients undergoing cardiac
surgery. <br/>Intervention(s): Tolvaptan administration (n = 397) or
standard diuretic therapy (n = 398). <br/>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). <br/>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.<br/>Copyright &#xa9; 2018 Elsevier
Inc.

<29>
Accession Number
2002187093
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: 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, Roma, Verona, 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
Elsevier Ireland Ltd
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. <br/>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.
<br/>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.<br/>Copyright
&#xa9; 2019 Elsevier B.V.

<30>
Accession Number
628294190
Title
The risk of bacterial endocarditis after percutaneous pulmonary valve
implantation-a meta-analysis of the currently available valves.
Source
Thoracic and Cardiovascular Surgeon. Conference: 51st Annual Meeting
German Society for Pediatric Cardiology. Germany. 67 (Supplement 2) (no
pagination), 2019. Date of Publication: January 2019.
Author
Haas N.; Lehner A.; Jakob A.; Fernandez S.; Dietl M.; Dalla-Pozza R.;
Fischer M.
Institution
(Haas, Lehner, Jakob, Fernandez, Dietl, Dalla-Pozza, Fischer)
Kinderkardiologie und Padiatrische Intensivmedizin, LMU Munchen, Munchen,
Germany
Publisher
Georg Thieme Verlag
Abstract
Background: Interventional percutaneous pulmonary valve implantation
(PPVI) was first reported in 2000; today, two different valves are
certified for this procedure (Medtronic Melody valve and Edwards Sapien
valves). For a decade, studies have reported an increasing risk of
bacterial endocarditis after PPVI; the published incidence however remains
unclear. <br/>Method(s): A systematic literature search in the databases
Medline, Cochrane Library, and Embase including Google Scholar was
performed until December 2017. The aim was to summarize and compare the
incidence of endocarditis after percutaneous pulmonary valve replacement.
<br/>Result(s): A total of 741 publications were identified searching for
"percutaneous pulmonary valve implantation and PPVI," 38 publications were
used for final analysis. The follow-up time was between 2 and 108 months,
2,972 patients with melody valves and 321 with Sapien valves were
included. Endocarditis after percutaneous pulmonary valve replacement
occurred in 151 patients with Melody valves and in 5 patients with Sapien.
The pooled incidence for Melody and Sapien was 4.2% (95% CI: 3.1-5.5) and
2.0 (95% CI: 0.5-3.4), respectively. <br/>Conclusion(s): In general,
systematic reviews proved an increasing number of endocarditis after PPVI
especially for the Melody valve. To reduce the risk of post-PPVI
endocarditis, the Sapien valves seem to be beneficial. The reason for this
finding may be explained by the different manufacturing process reducing
the risk of bacterial adherence in Sapien valves.

<31>
Accession Number
628291515
Title
Aortic involvement in relapsing polychonditis: A systematic review.
Source
Rheumatology (United Kingdom). Conference: 19th International Vasculitis
and ANCA Workshop. United States. 58 (Supplement 2) (no pagination), 2019.
Date of Publication: March 2019.
Author
Erdogan M.; Esatoglu S.N.; Hatemi G.; Hamuryudan V.
Publisher
Oxford University Press
Abstract
Background: Purpose: Aortic involvement (AI) occurs in up to 10% of
relapsing polychondritis (RP) patients. We performed a systematic
literature review (SLR) for AI in RP. <br/>Method(s): A PubMed search was
done by related terms by 2 investigator. <br/>Result(s): The SLR revealed
352 papers of which 281 were discarded because of language or irrelevant
content. Six papers were reporting duplicate cases and were also excluded.
Thus, 70 patients from 68 case reports (34 females, 35 males; median age
at the first symptom of RP: 32 years; IQR: 24-46 years, median age at
diagnosis of RP: 36 years; IQR: 28-51 years; median age at diagnosis of
AI: 37.5 years; IQR: 30-52.5 years) and 30 patients from 4 cohorts were
included. Mean delay between first RP symptom and AI diagnosis was 5 [IQR:
1-8] years and mean delay between RP diagnosis and AI was 1 [IQR: 0-3]
year.AI was in thoracic aorta in 68% of patients and in abdominal aorta in
21%. The most frequent extra-aortic arterial involvement was coronary
artery (CA) in 14 (Table). The most common symptom was dyspnea [37
patients; 53%] whereas 21 patients were asymptomatic. Diagnosis of AI was
made during surgery in 4 patients, with computed tomography (CT) in 25,
with echocardiography in 20, with chest X-Ray in 11, with MRI in 10 and
with PET-CT in 8 patients. CT was the most frequently used diagnostic tool
(performed in 27 patients). It failed to diagnose 2 patients who received
their diagnosis with MRI and PET-CT, respectively. Outcome information was
available for 81 patients. Twenty-five (31%) patients died after a median
follow up of 24 [IQR: 12-48] months and the most frequent cause of death
was aortic discetion (n = 6). Corticosteroids were the most frequently
used drugs (76 patients) followed by immunosuppressive (51 patients),
cyclophosphamide (29 patients), infiiximab (14 patients), tocilizumab (6
patients) and, adalimumab (3 patients). Sixty-three patients underwent
surgeries including aortic graft, coronary by-pass, aortic valve or mitral
valve replacement operations. <br/>Conclusion(s): AI occurs after a median
5 years after the first symptom and 1 year after RP diagnosis; whether it
is an early but overlooked involvement or a late onset involvement is not
clear. Some patients were asymptomatic (21%). Most patients underwent
vascular surgeries related to AI. Thirteen patients had coronary artery
involvement (CAI) and 5 of them died after a median 13.5 months follow-up
time. Screening for AI in RP and for CAI when AI is present may be useful.

<32>
Accession Number
2002029758
Title
Aortic Root Enlargement Is Safe and Reduces the Incidence of
Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes.
Source
Canadian Journal of Cardiology. 35 (6) (pp 782-790), 2019. Date of
Publication: June 2019.
Author
Yu W.; Tam D.Y.; Rocha R.V.; Makhdoum A.; Ouzounian M.; Fremes S.E.
Institution
(Yu, Tam, Makhdoum, Fremes) Division of Cardiac Surgery, Department of
Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Ontario, Canada
(Tam, Fremes) Institute of Health Policy, Management and Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Rocha, Ouzounian) Division of Cardiac Surgery, Department of Surgery,
Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, Ontario, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Aortic root enlargement (ARE)may be an important adjunct to
aortic valve replacement (AVR)to prevent patient-prosthesis mismatch and
facilitate future valve-in-valve transcatheter AVR (TAVR). However, the
early safety and late benefits of adding surgical ARE to AVR remain
controversial. <br/>Method(s): MEDLINE and EMBASE were searched from 1946
to 2018 for articles comparing patients undergoing AVR+ARE with those
undergoing AVR alone. A random-effects meta-analysis was performed to
compare early and late clinical outcomes. <br/>Result(s): A total of 2570
AVR+ARE and 5,991 AVR patients were included from 9 observational studies.
There was no difference in early mortality (relative risk [RR]1.21; 95%
confidence interval [CI], 0.94-1.54; P = 0.13). Both cardiopulmonary
bypass (mean difference [MD]20 minutes; 95% CI, 15-25; P < 0.01)and aortic
cross-clamp time (MD 14 minutes; 95% CI, 11-17, P < 0.01)were higher
following AVR+ARE. There was no difference in the risk of permanent
pacemaker implantation (RR 1.02; 95% CI, 0.83-1.25; P = 0.86), reoperation
for bleeding (RR 1.05; 95% CI, 0.84-1.32; P = 0.64), or stroke (RR 0.93;
95% CI, 0.68-1.27; P = 0.65). The risk of moderate (indexed effective
orifice area [iEOA]< 0.85 cm²/m²)and severe (iEOA <
0.65 cm²/m²)patient-prosthesis mismatch (PPM)was
lower with AVR+ARE (RR 0.65; 95% CI, 0.51-0.83; P < 0.01)and RR 0.36; 95%
CI, 0.16-0.82; P = 0.01, respectively). There was no difference in late
mortality (incidence rate ratio [IRR]1.05; 95% CI, 0.87-1.27; P = 0.59)at
mean 7.8-year follow-up in 5 studies. <br/>Conclusion(s): Surgical ARE is
a safe adjunct to AVR in selected patients that does not increase early
adverse events and results in less patient-prosthesis mismatch. This
strategy allows for a larger valve size at the time of implantation, an
important consideration for potential future valve-in-valve procedures in
the era of TAVR.<br/>Copyright &#xa9; 2019 Canadian Cardiovascular Society

<33>
Accession Number
2002159992
Title
Left lateral intercostal region versus subxiphoid position for pleural
drain during elective coronary artery bypass graft surgery: Randomized
clinical trial.
Source
Sao Paulo Medical Journal. 137 (1) (pp 66-74), 2019. Date of Publication:
January-February 2019.
Author
Simon S.; Coronel C.; de Almeida A.S.; Marcadenti A.
Institution
(Simon) Instituto de Cardiologia, Fundacao Universitaria de Cardiologia
(IC/FUC), Porto Alegre, RS, Brazil
(Simon) Cardiology and Cardiac Surgery Services, Hospital Nossa Senhora da
Conceicao Hospital (HNSC), Porto Alegre, RS, Brazil
(Coronel) Instituto de CardiologiaFundacao, Universitaria de Cardiologia
(IC/ FUC), Porto Alegre, RS, Brazil
(Coronel) La Salle University (Unilasalle Canoas), Canoas, RS, Brazil
(de Almeida) Hospital Nossa Senhora da Conceicao Hospital (HNSC), Porto
Alegre, RS, Brazil
(Marcadenti) Instituto de Cardiologia, Fundacao Universitaria de
Cardiologia (IC/ FUC), Porto Alegre, RS, Brazil
(Marcadenti) Universidade Federal de Ciencias da Saude de Porto Alegre
(UFCSPA), Porto Alegre, RS, Brazil
(Marcadenti) Instituto de Pesquisa do Hospital do Coracao (HCor), Sao
Paulo, SP, Brazil
Publisher
Associacao Paulista de Medicina (E-mail: revistas@apm.org.br)
Abstract
BACKGROUND: The pleural drain insertion site after coronary artery bypass
graft (CABG) surgery may alter lung function, especially respiratory
muscle strength. The main objective of this study was to compare the
effectiveness and safety of use of the left lateral intercostal region
versus the subxiphoid position for pleural drainage during elective CABG
surgery using extracorporeal circulation (ECC). DESIGN AND SETTING:
Randomized trial conducted in a tertiary-level hospital in Porto Alegre,
Brazil. <br/>METHOD(S): 48 patients were assigned to group 1 (pleural
drain in the left lateral intercostal region) or group 2 (pleural drain in
the subxiphoid position). Respiratory muscle strength was measured in
terms of maximal inspiratory pressure (MIP) and maximal expiratory
pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24
and 72 hours after drain removal and before discharge from hospital. Pain
and dyspnea scales, presence of infections, pleural effusion and
atelectasis, duration of drain use, drainage volumes and surgical
reinterventions were also evaluated. <br/>RESULT(S): After adjustments,
there were no significant differences between the groups at the end of the
study (before discharge), in predicted percentages either for MIP (delta
group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP
(delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). There
were no differences between the groups in relation to other outcomes.
<br/>CONCLUSION(S): There was no difference in maximal respiratory
pressures in relation to the pleural drain insertion site among patients
who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc
V1111.1159.4447.<br/>Copyright &#xa9; 2019 by Associacao Paulista de
Medicina.

<34>
Accession Number
628283112
Title
Comparison between hemodynamic effects of propofol and thiopental during
general anesthesia induction with remifentanil infusion: a double-blind,
age-stratified, randomized study.
Source
Journal of Anesthesia. (no pagination), 2019. Date of Publication: 2019.
Author
Hino H.; Matsuura T.; Kihara Y.; Tsujikawa S.; Mori T.; Nishikawa K.
Institution
(Hino, Matsuura, Kihara, Tsujikawa, Mori, Nishikawa) Department of
Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7
Asahimachi, Abeno-ku, Osaka 545-8586, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: Propofol is commonly used with remifentanil for induction of
general anesthesia (GA); however, it often leads to hypotension.
Intraoperative hypotension is associated with postoperative adverse
events. By contrast, thiopental has less negative inotropic effects on
hemodynamics compared to propofol, which could be suitable to prevent
hypotension during GA induction. In the present age-stratified,
randomized, assessor-blinded study, using the ClearSight
system, we compared the hemodynamic effects of propofol and thiopental
during GA induction under remifentanil infusion in non-cardiac surgery.
<br/>Method(s): Patients were divided into young (20-40 year), middle
(41-70 year), and elderly (> 70 year) groups (n = 20, each group). General
anesthesia was induced with remifentanil 0.3 mug/kg/min, followed by
propofol (2.0, 1.5, and 1.2 mg/kg) or thiopental (5.0, 4.0, and 3.0 mg/kg)
in the young, middle, and elderly groups, respectively. The primary
outcome was the difference in the decrease in mean arterial blood pressure
between patients receiving propofol and thiopental in each age group. The
secondary outcomes included other hemodynamic parameters and minimal
bispectral index values measured up to 10 min after tracheal intubation.
<br/>Result(s): The decrease in mean arterial blood pressure was greater
in patients receiving propofol than those receiving thiopental (- 45.4 vs
- 26.6 mmHg and - 45.7 vs - 28.9 mmHg, P = 0.003 and 0.007, respectively),
whereas no significant difference was observed in the young age group (P =
0.96). <br/>Conclusion(s): Thiopental is a more suitable agent than
propofol for avoiding hypotension during GA induction under remifentanil
infusion in the middle and elderly patients.<br/>Copyright &#xa9; 2019,
Japanese Society of Anesthesiologists.

<35>
Accession Number
628044046
Title
The effect of implementing an aseptic practice bundle for anaesthetists to
reduce postoperative infections, the Anaesthetists Be Cleaner (ABC) study:
Protocol for a stepped wedge, cluster randomised, multi-site trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 342. Date of
Publication: 10 Jun 2019.
Author
Merry A.F.; Gargiulo D.A.; Bissett I.; Cumin D.; English K.; Frampton C.;
Hamblin R.; Hannam J.; Moore M.; Reid P.; Roberts S.; Taylor E.; Mitchell
S.J.; Chapman I.; Denison T.; Hopley L.; Jackson L.; Jones R.; Kruger C.;
Lindsay H.; Love A.; McGuinness S.; Milsom P.; Munro J.; Panduri G.; Pitto
R.; Sheridan J.; Sidhu N.; Stapelberg F.; Sweetman C.; Torrie J.; Walker
S.; Walsh C.; Willcox T.; Wiles S.; Young S.
Institution
(Merry, Gargiulo, Cumin, Moore, Mitchell) Department of Anaesthesiology,
School of Medicine, University of Auckland, Private Bag 92019, Auckland
1142, New Zealand
(Merry, English, Mitchell) Department of Anaesthesia, Auckland City
Hospital, PO Box 92024, Auckland 1142, New Zealand
(Bissett) Department of Surgery, School of Medicine, University of
Auckland, Private Bag 92019, Auckland 1142, New Zealand
(Bissett) Department of Surgery, Auckland City Hospital, Private Bag
92019, Auckland 1142, New Zealand
(Frampton) Department of Psychological Medicine, University of Otago, PO
Box 4345, Christchurch 8140, New Zealand
(Hamblin) Health Quality and Safety Commission, PO Box 25496, Wellington
6146, New Zealand
(Hannam) Department of Pharmacology and Clinical Pharmacology, University
of Auckland, Private Bag 92019, Auckland 1142, New Zealand
(Reid) Te Kupenga Hauora Maori, University of Auckland, Private Bag 92019,
Auckland 1142, New Zealand
(Roberts) LabPLUS, Auckland City Hospital, PO Box 110031, Auckland 1070,
New Zealand
(Taylor) Starship Children's Health, Auckland District Health Board, PO
Box 9389, Auckland 1149, New Zealand
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative infection is a serious problem in New Zealand
and internationally with considerable human and financial costs. Also, in
New Zealand, certain factors that contribute to postoperative infection
are more common in Maori and Pacific populations. To date, most efforts to
reduce postoperative infection have focussed on surgical aspects of care
and on antibiotic prophylaxis, but recent research shows that anaesthesia
providers may also have an impact on infection transmission. These
providers sometimes exhibit imperfect hand hygiene and frequently transfer
the blood or saliva of their patients to their work environment. In
addition, intravenous medications may become contaminated whilst being
drawn up and administered to patients. Working with relevant practitioners
and other experts, we have developed an evidence-informed bundle to
improve key aseptic practices by anaesthetists with the aim of reducing
postoperative infection. The key elements of the bundle are the filtering
of compatible drugs, context-relevant hand hygiene practices and enhanced
maintenance of clean work surfaces. <br/>Method(s): We will seek support
for implementation of the bundle from senior anaesthesia and hospital
leadership and departmental "champions". Anaesthetic teams and recovery
room staff will be educated about the bundle and its potential benefits
through presentations, written material and illustrative videos. We will
implement the bundle in operating rooms where hip or knee arthroplasty or
cardiac surgery procedures are undertaken in a five-site, stepped wedge,
cluster randomised, quality improvement design. We will compare outcomes
between approximately 5000 cases before and 5000 cases after
implementation of our bundle. Outcome data will be collected from existing
national and hospital databases. Our primary outcome will be days alive
and out of hospital to 90 days, which is expected to reflect all serious
postoperative infections. Our secondary outcome will be the rate of
surgical site infection. Aseptic practice will be observed in sampled
cases in each cluster before and after implementation of the bundle.
<br/>Discussion(s): If effective, our bundle may offer a practical
clinical intervention to reduce postoperative infection and its associated
substantial human and financial costs. Trial registration: Australian New
Zealand Clinical Trials Registry, ACTRN12618000407291. Registered on 21
March 2018.<br/>Copyright &#xa9; 2019 The Author(s).

<36>
Accession Number
628044461
Title
Bilateral thoracic paravertebral block combined with general anesthesia
vs. general anesthesia for patients undergoing off-pump coronary artery
bypass grafting: A feasibility study.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 101.
Date of Publication: 12 Jun 2019.
Author
Sun L.; Li Q.; Wang Q.; Ma F.; Han W.; Wang M.
Institution
(Sun, Li, Wang, Ma, Wang) Department of Anesthesiology, Qingdao Municipal
Hospital, Qingdao, Shandong 266011, China
(Han) Department of Respiratory Medicine, Qingdao Municipal Hospital, 1
Jiaozhou Road, Qingdao, Shandong 266011, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Whether thoracic paravertebral block (PVB) is useful in
patients undergoing off-pump coronary artery bypass grafting (OPCABG)
remains unknown. This study aimed to investigate the feasibility of
bilateral PVB combined with general anesthesia (GA) in patients undergoing
OPCABG. <br/>Method(s): This feasibility study assessed 60 patients
scheduled for OPCABG at the Qingdao Municipal Hospital in 2016-2017.
Patients were randomly assigned to receive nerve stimulator-guided
bilateral PVB combined with GA (PVB + GA) or GA alone (n = 30/group).
Patients were asked to rate rest and cough pain hourly after the surgery.
The primary endpoint was the visual analogue scale (VAS) pain score within
48 h postoperatively. Secondary endpoints were rescue analgesia and
morphine consumption, fentanyl dose within 48 h postoperatively, as well
as operative time, time to extubation, intensive care unit (ICU) stay,
hospital stay and other postoperative adverse events. <br/>Result(s): Both
rest and cough pains were lower in the PVB + GA group at 12, 24, 36, and
48 h after surgery compared with the GA group. There were fewer patients
who needed rescue analgesia in the PVB + GA group at 12 and 24 h than in
the GA group. Morphine consumptions at 24 and 48 h were lower in the PVB +
GA group compared with the GA group. Time to extubation (P = 0.035) and
ICU stay (P = 0.028) were shorter in the PVB + GA group compared with the
GA group. AEs showed no differences between the two groups.
<br/>Conclusion(s): Nerve stimulator-guided bilateral thoracic PVB
combined with GA in OPCABG is associated with a reduced rescue analgesia
and morphine consumption, compared to GA.<br/>Copyright &#xa9; 2019 The
Author(s).

<37>
Accession Number
624066358
Title
Impact of the MitraClip Procedure on Left Atrial Strain and Strain Rate.
Source
Circulation: Cardiovascular Imaging. 11 (3) (no pagination), 2018. Article
Number: 006553. Date of Publication: 01 Mar 2018.
Author
Ipek E.G.; Singh S.; Viloria E.; Feldman T.; Grayburn P.; Foster E.; Qasim
A.
Institution
(Ipek, Singh, Viloria, Foster, Qasim) Department of Cardiology, University
of California San Francisco Medical Center, 720 W Oak St, 505 Parnassus
Avenue, San Francisco, CA 94143, United States
(Feldman) Department of Cardiology, Evanston Hospital, IL, United States
(Grayburn) Department of Cardiology, Baylor Heart and Vascular Institute,
Dallas, TX, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Although reverse remodeling of the left atrium (LA) has been
shown after MitraClip placement in degenerative mitral regurgitation (MR),
changes in LA strain and strain rate have not been evaluated in these
patients or compared with surgical mitral valve repair. Methods and
Results - We included 87 subjects (mean age 59.7+/-12.3 years) with
degenerative MR enrolled in the randomized EVEREST II trial (Endovascular
Valve Edge-to-Edge Repair Study II). Baseline peak positive LA strain ()
and strain rates along with longitudinal left ventricular strain (LV )
were compared with 12-month follow-up measures. At 12 months, all 38
mitral valve repair subjects had <=2+ MR, and 31 of the 49 MitraClip had
<=2+ MR. Baseline LA strain and strain rate values were similar in
MitraClip and mitral valve repair groups. Of the strain rate measures,
only peak early diastolic strain rate was consistently decreased in all
treatment arms. In patients with reduced baseline LA , no significant
change in LA occurred in either the MitraClip or mitral valve repair
group despite significant MR and LA volume reduction. However, in patients
with normal or high baseline , successful MR reduction by either method
resulted in return of LA to normative values. There was a significant
correlation between LA , LV values, and change in LA and LV over time.
Conclusions - Changes seen in LA seem to depend on baseline LA and LV
function. Changes in LA after MR reduction may reflect a decrease in LA
expansion but may also be influenced by the degree of pre-existing LA
dysfunction.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<38>
Accession Number
2001061078
Title
EdoxabaN Versus standard of care and theIr effectS on clinical outcomes in
pAtients havinG undergonE Transcatheter Aortic Valve Implantation in
Atrial Fibrillation-Rationale and design of the ENVISAGE-TAVI AF trial.
Source
American Heart Journal. 205 (pp 63-69), 2018. Date of Publication:
November 2018.
Author
Van Mieghem N.M.; Unverdorben M.; Valgimigli M.; Mehran R.; Boersma E.;
Baber U.; Hengstenberg C.; Shi M.; Chen C.; Saito S.; Veltkamp R.; Vranckx
P.; Dangas G.D.
Institution
(Van Mieghem) Department of Cardiology, Thoraxcenter, Erasmus Medical
Center, Rotterdam, Netherlands
(Unverdorben, Chen) Global Medical Affairs, Daiichi Sankyo, Inc, Basking
Ridge, NJ, United States
(Valgimigli, Boersma) Swiss Cardiovascular Center, Inselspital, Bern,
Switzerland
(Mehran, Baber, Dangas) Zena and Michael A. Wiener Cardiovascular
Institute, Mount Sinai Hospital, New York, NY, United States
(Hengstenberg) Division of Cardiology, Department of Internal Medicine II,
Medical University of Vienna, Vienna, Austria
(Shi) Biostatistics, Daiichi Sankyo Pharma Development, Basking Ridge, NJ,
United States
(Saito) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kanagawa, Japan
(Veltkamp) Imperial College, London, United Kingdom
(Veltkamp) Department of Neurology, Alfried-Krupp Krankenhaus, Essen,
Germany
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Transcatheter aortic valve implantation, also called transcatheter aortic
valve replacement (TAVR), is the treatment of choice for patients with
severe aortic stenosis and intermediate to high operative risk. A
significant portion of TAVR patients have atrial fibrillation (AF)
requiring chronic oral anticoagulation. In moderate- to high-risk AF
patients, the direct factor Xa inhibitor edoxaban is noninferior to
vitamin K antagonists (VKAs) for prevention of stroke or systemic embolism
with less bleeding and cardiovascular deaths. ENVISAGE-TAVI AF
(NCT02943785) is a multinational, multicenter, prospective, randomized,
open-label, blinded end point evaluation study comparing edoxaban to
VKA-based therapy in approximately 1,400 patients with an indication for
chronic oral anticoagulation after successful transfemoral TAVR. The
coprimary end points are to assess the differential effects of the 2
treatments (a) on net adverse clinical events (the composite of all-cause
death, myocardial infarction, ischemic stroke, systemic thromboembolism,
valve thrombosis, and major bleeding events) and (b) on major bleeding.
Twelve hours to 5 days after successful TAVR, patients will be randomized
to 60 mg daily oral edoxaban or any VKA (international normalized ratio:
2.0-3.0 or 1.6-2.6 [numbers inclusive] in Japan if age >= 70 years).
Antiplatelet therapy may be administered per physician's discretion.
Randomization will be stratified by edoxaban dose reduction (per local
label). Treatment duration will be up to 36 months. The study is powered
(80%) to detect noninferiority (margin for the hazard ratio: 1.38) for the
composite primary end points, followed by superiority
testing.<br/>Copyright &#xa9; 2018

<39>
[Use Link to view the full text]
Accession Number
622578241
Title
Design and Rationale of the RIPCORD 2 Trial (Does Routine Pressure Wire
Assessment Influence Management Strategy at Coronary Angiography for
Diagnosis of Chest Pain?): A Randomized Controlled Trial to Compare
Routine Pressure Wire Assessment with Conventional Angiography in the
Management of Patients with Coronary Artery Disease.
Source
Circulation: Cardiovascular Quality and Outcomes. 11 (2) (no pagination),
2018. Article Number: e004191. Date of Publication: 01 Feb 2018.
Author
Elguindy M.; Stables R.; Nicholas Z.; Kemp I.; Curzen N.
Institution
(Elguindy, Stables, Kemp) Institute of Cardiovascular Medicine and
Science, London, United Kingdom
(Elguindy, Stables, Kemp) Liverpool Heart and Chest Hospital NHS
Foundation Trust, United Kingdom
(Nicholas, Curzen) Wessex Cardiothoracic Centre, University Hospital
Southampton NHS Foundation Trust, Department of Cardiology, E Level N
Wing, Tremona Rd, Southampton SO16 6YD, United Kingdom
(Curzen) Faculty of Medicine, University of Southampton, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Investigation of anginal chest pain has traditionally involved
either assessment of the coronary anatomy by angiography or noninvasive
testing for reversible ischemia. Invasive pressure wire assessment at the
time of angiography offers information on both anatomy and physiology.
Fractional flow reserve-guided percutaneous coronary intervention is
associated with lower resource utilization and improved clinical outcome
compared with angiographic guidance alone. However, the value of routine
fractional flow reserve of all major coronary vessels at the time of
diagnostic angiography has not been established in a randomized trial
despite persuasive observational data. A change in practice to routine
fractional flow reserve assessment of all major vessels during diagnostic
angiography would require evidence not just of clinical benefit but also
of cost effectiveness. This randomized trial aims to test that strategy.
<br/>Methods and Results: RIPCORD 2 (Does Routine Pressure Wire Assessment
Influence Management Strategy at Coronary Angiography for Diagnosis of
Chest Pain?) is an 1100 patient prospective, multicenter, randomized
trial. Participants are randomized, after initial coronary angiography,
and in equal proportion, to assessment and management according to (1)
conventional angiography only or (2) additional routine pressure wire
assessment in all epicardial vessels of sufficient size to be amenable to
revascularization. The primary economic outcome measure will be a
comparison of healthcare costs at 1 year. The primary quality-of-life
outcome measure analysis will compare patient-reported quality-of-life
scores at 1 year. Secondary outcome measures include clinical events at 1
year, management strategy (optimal medical therapy with or without
revascularization), and angina status at 1 year according to Canadian
Cardiovascular Society angina grade. <br/>Conclusion(s): The aim of the
RIPCORD 2 trial is to assess whether a strategy of routine fractional flow
reserve-guided assessment and management of all major coronary arteries
will be associated with more effective resource utilization, improved
quality of life, and better clinical outcome, compared with angiographic
guidance alone.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<40>
[Use Link to view the full text]
Accession Number
622261069
Title
Interventional Treatment of Severe Tricuspid Regurgitation.
Source
Circulation: Cardiovascular Interventions. 11 (2) (no pagination), 2018.
Article Number: e006061. Date of Publication: 01 Feb 2018.
Author
Lauten A.; Figulla H.R.; Unbehaun A.; Fam N.; Schofer J.; Doenst T.;
Hausleiter J.; Franz M.; Jung C.; Dreger H.; Leistner D.; Alushi B.;
Stundl A.; Landmesser U.; Falk V.; Stangl K.; Laule M.
Institution
(Lauten, Dreger, Leistner, Alushi, Landmesser, Falk, Stangl, Laule)
Charite - Universitatsmedizin Berlin, Charite Campus Mitte and Campus
Benjamin Franklin, Berlin, Germany
(Lauten, Unbehaun, Dreger, Leistner, Alushi, Landmesser, Falk, Stangl,
Laule) Deutsches Zentrum fur Herz-Kreislauf-Forschung (DZHK), Berlin,
Germany
(Figulla, Doenst, Franz) Friedrich-Schiller-Universitaet Jena, Germany
(Stundl) Department of Medicine II, Heart Center Bonn, University Hospital
Bonn, Germany
(Unbehaun, Falk) German Heart Center Berlin, St. Michaels Hospital,
Toronto, Canada
(Fam) Division of Cardiology, St. Michaels Hospital, Toronto, Canada
(Schofer) Albertinen Heart Center, Hamburg, Germany
(Hausleiter) Medizinische Klinik und Poliklinik i,
Ludwig-Maximilians-Universitat Munchen, Munich, Germany
(Jung) Medical Faculty, Division of Cardiology, Pulmonology and Vascular
Medicine, University Dusseldorf, Germany
(Landmesser) Berlin Institute of Health, Germany
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Transcatheter caval valve implantation is under evaluation as
a treatment option for inoperable patients with severe tricuspid
regurgitation (TR). The procedure involves the catheter-based implantation
of bioprosthetic valves in the inferior vena cava and superior vena cava
to treat symptoms associated with TR. This study is the first to evaluate
the feasibility, safety, and efficacy of this interventional concept.
Methods and Results - Twenty-five patients (mean age, 73.9+/-7.6 years;
women, 52.0%) with severe symptomatic TR despite optimal medical treatment
deemed unsuitable for surgery were treated with caval valve implantation
under a compassionate clinical use program. Technical feasibility defined
as procedural success, hemodynamic effect defined as venous pressure
reduction, and safety defined as periprocedural adverse events were
evaluated, with clinical follow-up at discharge and up to 12 months. The
functional impact was evaluated by assessment of New York Heart
Association class at the time of hospital discharge. The total number of
valves implanted in the caval position was 31. Patients were treated with
single (inferior vena cava-only; n=19; 76.0%) or bicaval valve
implantation (inferior vena cava+superior vena cava; n=6; 24.0%). Either
balloon-expandable valves (Sapien XT/3: n=18; 72.0%) or self-expandable
valves (TricValve: n=6; 24.0%; Directflow: n=1; 4.0%) were used.
Procedural success was achieved in 96% (n=24). Early and late valve
migration requiring surgical intervention occurred in 1 patient each.
Thirty-day and in-hospital mortality were 8% (2 of 25) and 16% (4 of 25).
Causes of in-hospital mortality included respiratory (n=1) or multiple
organ failure (n=3) and were not linked to the procedure. Mean overall
survival in the study cohort was 316+/-453 days (14-1540 days).
Conclusions - Caval valve implantation for the treatment of severe TR and
advanced right ventricular failure is associated with a high procedural
success rate and seems safe and feasible in an excessive-risk cohort. The
study demonstrates hemodynamic efficacy with consistent elimination of
TR-associated venous backflow and initial clinical improvement. These
results encourage further trials to determine which patients benefit most
from this interventional approach.<br/>Copyright &#xa9; 2018 American
Heart Association, Inc.

<41>
[Use Link to view the full text]
Accession Number
622261043
Title
Prior Percutaneous Coronary Intervention and Mortality in Patients
Undergoing Surgical Myocardial Revascularization.
Source
Circulation: Cardiovascular Interventions. 11 (2) (no pagination), 2018.
Article Number: e005650. Date of Publication: 01 Feb 2018.
Author
Mariscalco G.; Rosato S.; Serraino G.F.; Maselli D.; Dalen M.; Airaksinen
J.K.E.; Reichart D.; Zanobini M.; Onorati F.; De Feo M.; Gherli R.;
Santarpino G.; Rubino A.S.; Gatti G.; Nicolini F.; Santini F.; Perrotti
A.; Bruno V.D.; Ruggieri V.G.; Biancari F.
Institution
(Mariscalco, Serraino) Department of Cardiovascular Sciences, University
of Leicester, Glenfield Hospital, Clinical Science Wing, Leicester LE39QP,
United Kingdom
(Rosato) National Center for Epidemiology, Surveillance and Health
Promotion, Istituto Superiore di Sanita, Rome, Italy
(Serraino) Cardiac Surgery Unit, Magna Graecia University of Catanzaro,
Italy
(Maselli) Department of Cardiac Surgery, St. Anna Hospital, Catanzaro,
Italy
(Dalen) Department of Molecular Medicine and Surgery, Karolinska
Institutet, Karolinska University Hospital, Stockholm, Sweden
(Dalen) Department of Cardiothoracic Surgery and Anesthesiology,
Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
(Airaksinen, Biancari) Heart Center, Turku University Hospital, University
of Turku, Finland
(Biancari) Department of Surgery, University of Turku, Finland
(Reichart) Hamburg University Heart Center, Germany
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Italy
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Italy
(De Feo) Division of Cardiac Surgery, Department of Cardiothoracic
Sciences, Second University of Naples, Italy
(Gherli) Department of Cardiovascular Sciences, Cardiac Surgery Unit, S.
Camillo-Forlanini Hospital, Rome, Italy
(Santarpino) Citta di Lecce Hospital, GVM Care and Research, Italy
(Santarpino) Cardiovascular Center, Paracelsus Medical University,
Nuremberg, Germany
(Rubino) Centro Clinico Diagnostico G.B. Morgagni, Centro Cuore, Pedara,
Italy
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Nicolini) Division of Cardiac Surgery, University of Parma, Italy
(Santini) Division of Cardiac Surgery, University of Genoa, Italy
(Perrotti) Department of Thoracic and Cardiovascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Bruno) Heart Centre, Bristol University, United Kingdom
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Biancari) Department of Surgery, Oulu University Hospital, Finland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The clinical impact of prior percutaneous coronary
intervention (PCI) in patients requiring coronary artery bypass grafting
(CABG) remains unsettled. We sought to determine whether prior PCI is
associated with adverse outcome after CABG. Methods and Results - Data
from the prospective E-CABG (European Multicenter Study on Coronary Artery
Bypass Grafting) conducted between January 2015 and March 2016 at 16
European centres were analyzed using propensity weighted methodology to
adjust for confounding. A parallel systematic review/meta-analysis
(MEDLINE, Embase, SCOPUS, and Cochrane Library) through September 2017 was
accomplished. Of a total of 3641 adult patients included in the E-CABG
study, 685 (19%) patients had a history of PCI. At multivariable level,
prior PCI was not associated with an increased hospital mortality in both
unweighted and weighted patient groups (odds ratio, 0.73; 95% confidence
interval, 0.29-1.38; P=0.33 and odds ratio, 0.90; 95% confidence interval,
0.39-2.08; P=0.81, respectively). Subgroup analyses confirmed that prior
PCI had no impact on hospital mortality and morbidity, including
reexploration for bleeding, blood transfusion, hospital resource use, and
neurological, renal, and cardiac complications. The systematic review
provided a total of 71 366 individuals and showed a trend toward higher
in-hospital/30-day mortality (adjusted odds ratio, 1.30; 95% confidence
interval, 0.99-1.70; I 2 =43.1%) in patients with prior PCI. Conclusions -
Our prospective multicenter study showed that prior PCI was not associated
with an increased risk of mortality or other adverse outcomes in patients
undergoing CABG. In light of a trend toward increased mortality observed
in the meta-analysis, further studies are needed to ascertain the
prognostic impact of prior PCI in the outcome after CABG.<br/>Copyright
&#xa9; 2018 American Heart Association, Inc.

<42>
Accession Number
620922720
Title
A Meta-Analysis Comparing Percutaneous Coronary Intervention With
Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected
Left Main Disease.
Source
American Journal of Cardiology. 121 (8) (pp 924-933), 2018. Date of
Publication: 15 April 2018.
Author
Kodumuri V.; Balasubramanian S.; Vij A.; Siddamsetti S.; Sethi A.;
Khalafallah R.; Khosla S.
Institution
(Kodumuri, Balasubramanian, Vij, Siddamsetti) Division of Cardiology, John
H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States
(Sethi) Department of Cardiology, Chicago Cardiology Institute,
Schaumberg, Illinois, United States
(Khalafallah) Department of Biology, Loyola University Health System,
Maywood, Illinois, United States
(Khosla) Department of Cardiology, Rosalind Franklin University of
Medicine and Sciences, North Chicago, Illinois, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Coronary artery bypass grafting (CABG) is the preferred revascularization
strategy for unprotected left main disease (UPLMD). Multiple small-scale
trials and registry data showed that percutaneous coronary intervention
(PCI) with drug-eluting stents (DES) is a noninferior strategy with a
Class IIa American College of Cardiology/American Heart Association
recommendation in patients with high surgical risk and favorable anatomy.
However, 2 recent large-scale randomized trials showed conflicting
evidence. We conducted a meta-analysis of the existing data to compare
outcomes of PCI with DES versus CABG for UPLMD. Four randomized and 8
nonrandomized trials involving 10,284 patients were included. Primary end
point was composite of death, stroke, or myocardial infarction (MI) at 3
years or longer. Secondary end points were MACCE (Major Adverse Cardiac
and Cerebrovascular Events) and its individual components (death, stroke,
MI, or repeat revascularization). Mantel-Haenszel random effects model was
used to calculate combined odds ratio for outcomes. A separate analysis of
randomized data was also performed. There was no significant difference in
primary composite outcome between PCI and CABG. However, MACCE was
significantly higher in PCI, primarily driven by significantly high repeat
revascularization. A subgroup analysis stratified by Synergy between PCI
with Taxus and Cardiac Surgery (SYNTAX) score showed that MACCE and repeat
revascularization were not significantly different between PCI and CABG in
low to intermediate SYNTAX score (<33), whereas they were significantly
higher in PCI with higher SYNTAX score. Thus, although CABG remains the
preferred method of treatment in UPLMD, PCI with DES can be considered as
a reasonable alternative in patients with favorable anatomy and high
surgical risk.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<43>
Accession Number
2000600177
Title
Long-term efficacy and safety of proprotein convertase subtilisin/kexin 9
monoclonal antibodies: A meta-analysis of 11 randomized controlled trials.
Source
Journal of Clinical Lipidology. 12 (2) (pp 277-291.e3), 2018. Date of
Publication: March - April 2018.
Author
Bai J.; Gong L.-L.; Li Q.-F.; Wang Z.-H.
Institution
(Bai, Gong, Li, Wang) Department of Endocrinology, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
Publisher
Elsevier Ltd
Abstract
Background: Monoclonal antibodies targeting proprotein convertase
subtilisin/kexin type 9 (PCSK9) have been shown to significantly reduce
low-density lipoprotein cholesterol (LDL-C) levels. <br/>Objective(s): The
purpose of this study was to assess the long-term efficacy and safety of
PCSK9 antibodies. <br/>Method(s): PubMed, EMBASE, the Cochrane Library,
and ClinicalTrials.gov were searched for relevant studies. <br/>Result(s):
A total of 11 studies including 38,235 participants who were treated for
at least 48 weeks were included in this meta-analysis. The results
suggested that PCSK9 antibody treatment significantly decreased LDL-C
levels (mean difference, -50.23% [95% confidence interval {CI}, -56.65% to
-43.82%]) compared with no PCSK9 antibody treatment and also decreased
other atherogenic lipid fractions. PCSK9 antibody treatment also elicited
a significant reduction in cardiovascular event rates compared with no
antibody treatment (relative risk [RR], 0.86 [95% CI, 0.81-0.92]). This
reduction consisted of separate significant reductions in the rates of
myocardial infarction (RR, 0.73 [95% CI, 0.65-0.82]), coronary
revascularization (RR, 0.79 [95% CI, 0.73-0.87]), and stroke (RR, 0.81
[95% CI, 0.68-0.96]). There were no clear differences in the incidences of
treatment-emergent adverse events (TEAEs), serious TEAEs, or TEAEs of
interest between the 2 groups; moreover, no differences between the 2
groups were found for other laboratory parameters. <br/>Conclusion(s):
PCSK9 antibodies have significant effects on reducing LDL-C levels and
improve cardiovascular outcomes. These antibodies have a satisfactory
safety profile, which suggests that they are suitable for use as a
long-term treatment.<br/>Copyright &#xa9; 2018 National Lipid Association

<44>
Accession Number
620524701
Title
Relation of Bleeding Events to Mortality in Patients With ST-Segment
Elevation Myocardial Infarction Treated by Percutaneous Coronary
Intervention (a DANAMI-3 Substudy).
Source
American Journal of Cardiology. 121 (7) (pp 781-788), 2018. Date of
Publication: 01 Apr 2018.
Author
Sadjadieh G.; Engstrom T.; Helqvist S.; Hofsten D.E.; Kober L.; Pedersen
F.; Laursen P.N.; Nepper-Christensen L.; Clemmensen P.; Moller-Helgestad
O.K.; Sorensen R.; Ravkilde J.; Terkelsen C.J.; Jorgensen E.; Saunamaki
K.; Tilsted H.-H.; Kelbaek H.; Holmvang L.
Institution
(Sadjadieh, Engstrom, Helqvist, Hofsten, Kober, Pedersen, Laursen,
Nepper-Christensen, Sorensen, Jorgensen, Saunamaki, Tilsted, Holmvang)
Department of Cardiology, Rigshospitalet-Copenhagen University Hospital,
Denmark
(Clemmensen) Department of General and Interventional Cardiology,
University Heart Center Hamburg, Universitatsklinikum Hamburg-Eppendorf,
Hamburg, Germany
(Clemmensen) Department of Medicine, Nykobing F Hospital, Nykobing F,
Denmark
(Clemmensen, Moller-Helgestad) Department of Cardiology, University of
Southern Denmark, Odense, Denmark
(Ravkilde) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Terkelsen) Department of Cardiology, Skejby-Aarhus University Hospital,
Aarhus, Denmark
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Bleeding events in relation to treatment of ST-segment elevation
myocardial infarction (STEMI) have previously been associated with
mortality. In this study, we investigated the incidence and prognosis of,
and variables associated with serious bleedings within 30 days after
primary percutaneous coronary intervention in patients from The Third
Danish Study of Optimal Acute Treatment of Patients with ST-Segment
Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts
were read within 30 days postadmission to assess bleeding events using
thrombolysis in myocardial infarction (TIMI) and Bleeding Academic
Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in
59 patients (2.7%). Variables associated with TMMB were female gender
(hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p
<0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to
3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2
to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2,
p = 0.001). Undergoing 2 in-hospital procedures were not associated with
increased risk of TMMB. TMMB was strongly associated with 30-day mortality
in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not
with mortality days 31 to 365. When excluding fatal bleedings from the
analysis, a TMMB was no longer associated with 30-day mortality. In
conclusion, we found that in a contemporary STEMI-population, the
incidence of 30-day TMMB was low. A TMMB was strongly associated with
30-day mortality but not with mortality days 31 to 365. If patients
survived a serious bleeding, their short- and long-term prognoses were not
affected.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<45>
[Use Link to view the full text]
Accession Number
623945707
Title
Impact of coronary artery revascularization completeness on outcomes of
patients with coronary artery disease undergoing transcatheter aortic
valve replacement a meta-analysis of studies using the residual syntax
score (synergy between PCI with taxus and cardiac surgery).
Source
Circulation: Cardiovascular Interventions. 11 (3) (no pagination), 2018.
Article Number: e006000. Date of Publication: 01 Mar 2018.
Author
Witberg G.; Zusman O.; Codner P.; Assali A.; Kornowski R.
Institution
(Witberg, Zusman, Codner, Assali, Kornowski) Sackler Faculty of Medicine,
Tel-Aviv University, Israel
(Witberg, Zusman, Codner, Assali, Kornowski) Department of Cardiology,
Rabin Medical Center, 100 Jabutinski St, Petah Tikva 98100, Israel
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Coronary artery disease (CAD) is highly prevalent in patients
undergoing transcatheter aortic valve replacement. In the overall CAD
population, complete revascularization or reasonable incomplete
revascularization (ICR) is associated with improved outcomes; whether the
same applies for the transcatheter aortic valve replacement population is
still a matter of debate. Methods and Results-We conducted a systematic
review and meta-analysis of studies that examined the prognostic effect of
revascularization completeness in patients undergoing transcatheter aortic
valve replacement using the residual SYNTAX score (Synergy Between PCI
With Taxus and Cardiac Surgery) to separate between reasonable ICR and ICR
(using the individual threshold used by each study). Six studies with a
total of 3107 patients were included. The duration of follow-up ranged
from 0.7 to 3 years. Overall, ICR was associated with an increased risk
for mortality. This was true when comparing ICR patients to those with no
CAD (odds ratio, 1.85; 95% confidence interval, 1.42-2.40; P<0.01), to
those with reasonable ICR (odds ratio, 1.69; 95% confidence interval,
1.26-2.28; P<0.001), or to both groups combined (odds ratio, 1.71; 95%
confidence interval, 1.36-2.16; P<0.001). On the contrary, patients in the
reasonable ICR category did not show an increased risk for mortality when
compared with those with no CAD (odds ratio, 1.11; 95% confidence
interval, 0.89-1.39; P=0.33). Conclusions-Our results suggest that for
patients with CAD undergoing transcatheter aortic valve replacement, a
residual SYNTAX score-guided revascularization strategy may carry
significant benefits in terms of mortality. Adequate revascularization may
offer a unique and valuable opportunity to improve the prognosis of these
patients.<br/>Copyright &#xa9; 2018 American Heart Association, Inc.

<46>
Accession Number
615137717
Title
Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients
with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A
Randomized, Placebo-Controlled Trial.
Source
Annals of Nutrition and Metabolism. 70 (2) (pp 106-110), 2017. Date of
Publication: 01 Apr 2017.
Author
Da Silva Guimaraes S.; De Souza Cruz W.; Da Silva L.; MacIel G.; Huguenin
A.B.; De Carvalho M.; Costa B.; Da Silva G.; Da Costa C.; D'Ippolito J.A.;
Colafranceschi A.; Scalco F.; Boaventura G.
Institution
(Da Silva Guimaraes, De Souza Cruz, MacIel, Huguenin, De Carvalho, Costa,
Da Silva, Da Costa, Boaventura) Experimental Nutrition Laboratory, College
of Nutrition, Fluminense Federal University, Rio de Janeiro 24020-140,
Brazil
(Colafranceschi) National Institute of Cardiology, Department of Surgical
Procedures, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
(De Souza Cruz, Scalco) Laboratory of Inborn Errors of Metabolism
(LABEIM), Rio de Janeiro Federal University, Rio de Janeiro, Brazil
(De Souza Cruz) College of Medicine, Rio de Janeiro Federal University,
Rio de Janeiro, Brazil
(Da Silva) Istitute of Mathematics, Fluminense Federal University, Rio de
Janeiro, Brazil
(D'Ippolito) Clinical Pathology Service, Fluminense Federal University,
Rio de Janeiro, Brazil
Publisher
S. Karger AG
Abstract
During cardiac failure, cardiomyocytes have difficulty in using the
substrates to produce energy. L-carnitine is a necessary nutrient for the
transport of fatty acids that are required for generating energy. Coronary
artery graft surgery reduces the plasma levels of L-carnitine and
increases the oxidative stress. This study demonstrates the effect of
L-carnitine supplementation on the reverse remodeling of patients
undergoing coronary artery bypass graft. Patients with ischemic heart
failure who underwent coronary graft surgery were randomized to group A -
supplemented with L-carnitine or group B controls. Left ventricular
ejection fraction, left ventricular systolic and diastolic diameters were
assessed preoperatively, 60 and 180 days after surgery. Our study included
28 patients (26 [93.0%] males) with a mean age +/- SD of 58.1 +/- 10.5
years. The parameters for the evaluation of reverse remodeling did not
improve after 60 and 180 days of coronary artery bypass grafting in
comparison between groups (p > 0.05). Evaluation within the L-carnitine
group showed a 37.1% increase in left ventricle ejection fraction (p =
0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and
diastolic diameters, respectively. L-carnitine supplementation at a dose
of 50 mg/kg combined with artery bypass surgery did not demonstrate any
additional benefit in reverse remodeling. However, evaluation within the
L-carnitine group may indicate a clinical benefit of L-carnitine
supplementation.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<47>
Accession Number
373203852
Title
Effects of propofol and midazolam infusions on serum lipid and glucose
levels in hyperlipidemic patients undergoing coronary artery bypass
surgery.
Source
Turkiye Klinikleri Journal of Medical Sciences. 34 (2) (pp 267-272), 2014.
Date of Publication: 2014.
Author
Acarturk H.; Oztekin I.; Oztek S.D.; Issever H.; Canik S.
Institution
(Acarturk, Canik) Department of Anesthesiology and Reanimation, Siyami
Ersek Heart Surgery Hospital, Istanbul, Turkey
(Oztekin) Department of Anesthesiology and Reanimation, Trakya University,
Edirne, Turkey
(Oztek) Department of Surgical Nursing, Istanbul University Florence
Nightingale Highschool of Nursing, Turkey
(Issever) Department of Public Health, Istanbul University, Istanbul,
Turkey
Publisher
Turkiye Klinikleri
Abstract
Objective: Propofol has been accused for increasing plasma lipid levels
during continuous infusion due to its lipid content. We aimed to show the
effect and the risk of propofol infusion on plasma lipid and glucose
levels in patients with hyperlipidemia undergoing coronary artery bypass
graft surgery (CABG), and to compare them with a midazolam used control
group. <br/>Material(s) and Method(s): In this randomized controlled
study, 15 patients in the propofol group had anesthesia induction with
intravenous propofol 1%, 2 mg/kg, fentanyl 10-15 mcg/kg, pancuronium 0.1
mg/kg, and the anesthesia was maintained with 1% 2-5 mg/kg/h propofol
infusion, fentanyl 5-10 mcg/kg/hr, and an hourly pancuronium dose of 0.03
mg/kg The anesthetia management of 15 patients in midazolam group included
induction with midazolam 0.1 mg/kg, fentanyl 10-15 mcg/kg, pancuronium 0.1
mg/kg, and infusion of midazolam 0.05-0.07 mg/kg/hr, fentanyl 5-10
mcg/kg/hr, and an hourly pancuronium dose of 0.03 mg/kg Plasma lipid
[total cholesterol (CHL), triglyceride (TRG), high density lipoprotein
(HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL)]
and glucose concentrations were measured in both groups perioperatively,
at seven different time points until 72 hours after the operation.
<br/>Result(s): The decreases of TRG and HDL levels were statistically
significant in the midazolam group. There were no significant differences
for the decreases in CHL, LDL and VLDL levels between the groups. In both
groups, plasma glucose levels increased significantly, independent from
the propofol and midazolam infusions. <br/>Conclusion(s): We observed that
propofol and midazolam anesthesia used in patients with hyperlipidemia
undergoing to CABG did not have any effect on plasma lipid or glucose
levels. &#xa9; 2014 by Turkiye Klinikleri.

<48>
Accession Number
369142732
Title
The efficacy of vitamin E in the prevention of lung ischemia-reperfusion
injury after cardiopulmonary bypass in open heart surgery.
Source
Turkiye Klinikleri Journal of Medical Sciences. 33 (3) (pp 777-784), 2013.
Date of Publication: 2013.
Author
Acipayam M.; Sunar H.; Canbaz S.; Huseyinova G.; Erbas H.; Erten O.; Duran
E.
Institution
(Acipayam) Department of Cardiovascular Surgery, Mustafa Kemal University,
Hatay, Turkey
(Sunar) Clinic of Cardiovascular Surgery, Kartal Kosuyolu Yuksek Ihtisas
Training and Research Hospital, Istanbul, Turkey
(Canbaz, Duran) Department of Cardiovascular Surgery, Trakya University,
Edirne, Turkey
(Huseyinova) Department of Pathology, Trakya University, Edirne, Turkey
(Erbas) Department of Biochemistry, Trakya University, Edirne, Turkey
(Erten) Clinic of Biochemistry, Uzunkopru State Hospital, Trabzon, Turkey
Publisher
Turkiye Klinikleri
Abstract
Objective: The purpose of the study was to investigate the effects of
vitamin E in the protection of the lung from potential
ischemia-reperfusion injury during elective coronary artery bypass graft
surgery. <br/>Material(s) and Method(s): This controlled randomized
single-center study included patients who underwent elective coronary
bypass grafting (CABG) operation. Forty-nine patients were randomly
divided into 2 groups. Water soluble Vitamin E (100 mg) in tepid saline
(n=25) or tepid saline alone (n=24) was administered via the jugular vein
before the aortic cross clamping. Serum total antioxidant capacity (TAC)
levels and serum malonedialdehyde levels (MDA) were measured. Pulmonary
biopsies were obtained before the aortic cross clamping and 60 minutes
after removing the cross clamp. Biopsies were examined histopathologically
under electron microscopy. <br/>Result(s): Serum MDA levels at T1 (15
minutes after removal of the cross clamp) and T2 (30 minutes after removal
of the cross clamp) were higher in the control group compared to the
Vitamin group. Serum TAC levels at T1, T2 and T3 (60 minutes after removal
of the cross clamp) were higher in the Vitamin E group compared to the
control group. Histopathologic injury grade was lower in the Vitamin E
group than in the control group. <br/>Conclusion(s): Vitamin E was found
to be protective against reperfusion induced oxidative injury in the early
operative period. &#xa9; 2013 by Turkiye Klinikleri.

<49>
Accession Number
368463986
Title
Effects of epidural bupivacaine on the doses of propofol, alfentanil,
vecuronium, and neuromuscular block: A prospective randomized,
single-blind clinical study.
Source
Turkiye Klinikleri Journal of Medical Sciences. 33 (2) (pp 306-313), 2013.
Date of Publication: 2013.
Author
Karlilar B.; Tunc M.; Gunal Sazak H.; Telatar A.; Savkilioglu E.;
Karabulut E.
Institution
(Karlilar) Clinic of Anesthesiology and Reanimation, Umut Surgical Medical
Center, Mersin, Turkey
(Tunc, Gunal Sazak, Savkilioglu) Anesthesiology and Reanimation, Ataturk
Pulmonary Diseases and Surgery Training and Research Hospital, Ankara,
Turkey
(Telatar) Anesthesiology and Reanimation, Sinop State Hospital, Sinop,
Turkey
(Karabulut) Department of biostatistics, Hacettepe University, Faculty of
Medicine, Ankara, Turkey
Publisher
Turkiye Klinikleri
Abstract
Objective: This study was planned to ascertain the effects of epidural
bupivacaine on the doses of propofol, alfentanil and vecuronium used for
the maintenance for general anesthesia in patients receiving thoracic
epidural anesthesia (TEA) combined with total intravenous anesthesia
(TIVA) in thoracic surgery. In addition, the impacts of TEA on duration,
intensity, reversal and the characteristics of residual block related to
vecuronium-induced neuromuscular blockade was investigated.
<br/>Material(s) and Method(s): Thirty patients scheduled for thoracic
surgery were randomly assigned into two groups. Group 1 received TIVA
combined with TEA, whereas Group 2 obtained TIVA solely. Epidural
bupivacaine (0.375%) was given 6 mL/h following 1.5 mL/segment bupivacaine
(0.5%) bolus in Group 1. General anesthesia was provided with propofol,
alfentanil and vecuronium in both groups. Propofol dose was adjusted to
maintain bispectral index (BIS) value between 45 and 60, whereas
alfentanil dose was titrated according to the hemodynamic parameters.
Following neuromuscular monitoring and stabilization of response to the
neuromuscular stimulus, 0.1 mg/kg vecuronium was injected intravenously in
5 seconds. The responses to train of four (TOF) stimulation (TOF1 and
TOF2), posttetanic count (PTC), and TOF rate (TOFR) values were recorded.
The neuromuscular blockade was reversed after closure of surgical incision
and the fourth response to TOF during recovery. The residual block was
assessed in surgical intensive care unit for 30 minutes. <br/>Result(s):
Alfentanil amount used in the maintenance was significantly less in Group
1 compared to Group 2 (p<0.05), whereas there was no difference between
the groups for propofol and vecuronium doses (p>0.05). There was no
statistically significant difference between the groups with respect to
the onset time of vecuronium, TOF1 time following induction, and duration
of the clinical effects of vecuronium used for induction and maintenance
(p>0.05). <br/>Conclusion(s): It was demonstrated that epidural
bupivacaine decreased the requirement of alfentanil without alterations in
propofol and vecuronium doses in patients undergoing thoracic surgery in
our study. We also suggest that in the present dose, epidural bupivacaine
has no effect on duration, intensity, reversal or the characteristics of
residual block related to vecuronium-induced neuromuscular blockade.
&#xa9; 2013 by Turkiye Klinikleri.

<50>
Accession Number
627200492
Title
Pentoxifylline, progression of chronic kidney disease (CKD) and
cardiovascular mortality: long-term follow-up of a randomized clinical
trial.
Source
Journal of Nephrology. 32 (4) (pp 581-587), 2019. Date of Publication: 01
Aug 2019.
Author
de Morales A.M.; Goicoechea M.; Verde E.; Carbayo J.; Barbieri D.; Delgado
A.; Verdalles U.; de Jose A.P.; Luno J.
Institution
(de Morales, Goicoechea, Verde, Carbayo, Barbieri, Delgado, Verdalles, de
Jose, Luno) Nephrology Department, Hospital General Universitario Gregorio
Maranon, C/Dr Esquerdo 46, Madrid 28007, Spain
(Goicoechea, Delgado, Luno) Spanish Kidney Research Network (REDINREN),
FEDER FUND, Madrid, Spain
Publisher
Springer International Publishing
Abstract
Background: Pentoxifylline could reduce proteinuria and slow renal disease
progression. We previously conducted a single-blind, randomized,
controlled trial that showed that pentoxifylline decreases inflammatory
markers and stabilizes renal function. Setting and Participants: 91
participants (46 in the pentoxifylline group and 45 in the control group)
followed up for 7 additional years. Study design: Post hoc analysis of a
long-term follow-up after completion of the 12-months trial.
<br/>Intervention(s): Pentoxifylline treatment (400 mg/twice a day) or
standard treatment. <br/>Outcome(s): Renal event (defined as starting
dialysis therapy and/or doubling serum creatinine and/or >= 50% decrease
in estimated glomerular filtration rate) and cardiovascular mortality.
<br/>Result(s): During follow-up, a renal event was recorded in 24
patients from control group (13 initiated dialysis therapy and serum
creatinine doubled in 11) and 11 patients from PTF group (7 initiated
dialysis and serum creatinine doubled in 4) (log Rank: 5.822, p = 0.016).
The possible protector effect of PTF was more significant in albuminuric
patients and was independently of diabetes mellitus presence. Treatment
with PTF reduced the renal events by 35% compared to the control group in
a Cox model adjusted for diabetes mellitus, albuminuria and basal renal
function (HR 0.65 (0.45-0.94), p = 0.022). Cardiovascular mortality was
significantly reduced in PTF treatment (2 patients vs. 10 in control
group) (log Rank 5.0977, p = 0.024). PTF treatment reduced cardiovascular
mortality in 55% adjusted for diabetes mellitus and age (HR 0.45
(0.21-0.98), p = 0.044) (Table 3). <br/>Limitation(s): Small sample size,
single center, not double blind and post hoc follow-up analysis.
<br/>Conclusion(s): Long-term treatment with pentoxifylline may slow the
rate of progression of kidney disease and reduce cardiovascular
risk.<br/>Copyright &#xa9; 2019, Italian Society of Nephrology.

<51>
Accession Number
625381088
Title
Variations on classification of main types of myocardial infarction: a
systematic review and outcome meta-analysis.
Source
Clinical Research in Cardiology. 108 (7) (pp 749-762), 2019. Date of
Publication: 01 Jul 2019.
Author
Vargas K.G.; Haller P.M.; Jager B.; Tscharre M.; Binder R.K.; Mueller C.;
Lindahl B.; Huber K.
Institution
(Vargas, Haller, Jager, Tscharre, Huber) 3rd Department of Medicine,
Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna,
Austria
(Vargas, Haller, Jager, Tscharre, Huber) Ludwig Boltzmann Cluster for
Cardiovascular Research, Vienna, Austria
(Binder) Department of Cardiology and Intensive Care, Klinikum
Wels-Grieskirchen, Wels, Austria
(Mueller) Department of Cardiology and Cardiovascular Research Institute
Basel (CRIB), University Hospital Basel, Basel, Switzerland
(Lindahl) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Huber) Sigmund Freud Private University, Medical School, Vienna, Austria
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Objective: Classifying myocardial infarction into type 1 (T1MI) or type 2
(T2MI) remains a challenge in clinical practice. We aimed to identify
factors contributing to variation in the classifications of MI into type 1
or type 2. In addition, pooled analyses of long-term mortality and
reinfarction outcomes were performed. <br/>Method(s): We searched Medline,
Embase and Web of Science through January 2018 for observational studies
or clinical trials classifying patients as either T1MI or T2MI. Studies
with baseline characteristics allowing a comparison between both groups
were included. Inverse variance random-effects models were used to pool
risk ratios (RR). <br/>Result(s): Overall, 93,194 patients from 20
included observational studies were classified as T1MI and 9291 as T2MI;
corresponding to 87.9% and 8.8% of all patients diagnosed with MI.
Inclusion of ST-elevation MI patients was inconsistent among studies.
Coronary angiography was performed in 77.7% and 31.5% of all patients with
T1MI and T2MI, respectively. From a subgroup of 11 studies, percutaneous
coronary intervention was performed in 79.2% of all patients classified as
T1MI (range 44.2-93.0%) and 40.2% of all T2MI patients (range 0-87.5%). A
meta-analysis of 6 studies (44,366 in total) on 2-year mortality showed
worse outcome among T2MI patients (RR: 1.52, CI 1.07-2.17, P = 0.02;
I² = 92%). Risk of reinfarction at 1.6 years was higher among
T2MI patients (RR: 1.68, CI 1.22-2.31, P = 0.001; I² = 9%).
<br/>Conclusion(s): Classification of T1MI and T2MI varies widely among
studies. A standardized approach with clear definitions is needed to avoid
misclassification and ensure appropriate patient management.<br/>Copyright
&#xa9; 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

<52>
Accession Number
625339148
Title
Outcomes of the Tryton-dedicated bifurcation stent for the treatment of
true coronary bifurcations: Individual-patient-data pooled analysis.
Source
Catheterization and Cardiovascular Interventions. 93 (7) (pp 1255-1261),
2019. Date of Publication: 01 Jun 2019.
Author
Konigstein M.; Srdanovic I.; Gore A.K.; Rahim H.M.; Genereux P.;
Ben-Yehuda O.; Kumsars I.; Lesiak M.; Kini A.; Fontos G.; Slagboom T.;
Ungi I.; Christopher Metzger D.; Crowley A.; Leon M.B.; Ali Z.A.
Institution
(Konigstein, Srdanovic, Genereux, Ben-Yehuda, Crowley, Leon, Ali) Clinical
Trials Center, Cardiovascular Research Foundation, New York, NY, United
States
(Gore, Rahim, Ben-Yehuda, Leon, Ali) Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Kumsars) Latvian Center of Cardiology, Paul Stradins Clinical University
Hospital, Riga, Latvia
(Lesiak) 1st Department of Cardiology, University of Medical Sciences,
Poznan, Poland
(Kini) Mount Sinai Medical Center, New York, NY, United States
(Fontos) Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
(Slagboom) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Ungi) 2nd Department of Medicine and Cardiology Center, University of
Szeged, Szeged, Hungary
(Christopher Metzger) Wellmont CVA Heart Institute, Kingsport, TN, United
States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to evaluate the safety and efficacy of the dedicated
Tryton side branch (SB) stent for the treatment of true bifurcations
involving large SBs. <br/>Background(s): Bifurcation lesions are
associated with lower procedural success and a higher risk of adverse
cardiac events. Provisional stenting (PS) is currently the default
approach for the treatment of bifurcation lesions. The Tryton stent is a
dedicated bifurcation stent system for the treatment of true bifurcation
lesions. <br/>Method(s): We performed an individual-patient-data pooled
post-hoc analysis of the Tryton Pivotal randomized controlled trial and
post-approval Confirmatory Study. Only patients with true bifurcations
involving a SB >= 2.25 mm in diameter were included. The primary endpoint
was non-inferiority of Tryton compared with PS for target vessel failure
(TVF) at 1 year. <br/>Result(s): Of the 411 patients meeting the criteria
for enrolment, 287 patients were treated with the Tryton stent and 124
with PS. Procedural success was higher in the Tryton group (95.4 versus
82.3%, P < 0.0001). TVF at 1 year was 8.1% in the Tryton group and 9.7% in
the PS group, meeting the pre-specified criteria for non-inferiority
established for the randomized controlled trail
(p<inf>non-inferiority</inf> = 0.02). At 9-month angiographic follow-up,
SB diameter stenosis was significantly lower in the Tryton group (29.3 +/-
21.9 versus 41.1 +/- 17.5, P = 0.0008) and in-segment binary restenosis
(diameter stenosis >= 50%) was higher in the PS group (19.0 versus 34.2%,
respectively, P = 0.052). <br/>Conclusion(s): In patients with true
bifurcations involving a large SB, treatment with the Tryton SD Stent was
clinically non-inferior to PS and showed favorable angiographic
outcomes.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<53>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2019 International Society for Heart and Lung
Transplantation

<54>
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. <br/>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. <br/>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. <br/>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). <br/>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)<br/>Copyright
&#xa9; 2019

<55>
Accession Number
2001983601
Title
Effect of perioperative administration of dexmedetomidine on delirium
after cardiac surgery in elderly patients: A double-blinded, multi-center,
randomized study.
Source
Clinical Interventions in Aging. 14 (pp 571-575), 2019. Date of
Publication: 2019.
Author
Shi C.; Jin J.; Qiao L.; Li T.; Ma J.; Ma Z.
Institution
(Shi, Jin, Qiao, Li, Ma, Ma) Department of Anesthesiology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong
264000, China
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Objective: Postoperative delirium (POD) is a serious complication in
elderly patients undergoing cardiac surgery. This study was aimed at
investigating the effect of perioperative administration of
dexmedetomidine for general anesthesia maintenance on occurrence and
duration of POD in elderly patients after cardiac surgery. <br/>Method(s):
One hundred and sixty-four patients were enrolled after cardiac surgery
between June 2009 and December 2016. Patients were assigned by a
computer-generated randomization sequence in a 1:1 ratio to receive
dexmedetomidine general anesthesia maintenance or propofol general
anesthesia maintenance. POD was assessed every day with confusion
assessment method for intensive care units (ICU) during the first 5
postoperative days. <br/>Result(s): There was no significance in incidence
of POD between the dexmedetomidine group and the propofol group
(P=0.0758). In patients treated with dexmedetomidine, the median onset
time of delirium was delayed (second day vs first day) and the duration of
delirium reduced (2 days vs 3 days) when compared with propofol-treated
patients. The dexmedetomidine-treated patients also displayed a lower VAS
score and less opiate analgesic consumption. No difference was observed in
respect to other postoperative outcomes. <br/>Conclusion(s): For elderly
patients, perioperative administration of dexmedetomidine reduced
incidence, delayed onset and shortened duration of POD after cardiac
surgery.<br/>Copyright &#xa9; 2019 Shi et al.

<56>
Accession Number
628150846
Title
Multicentre, open-label, randomised, controlled clinical trial comparing
2% chlorhexidine-70% isopropanol and 5% povidone iodine-69% ethanol for
skin antisepsis in reducing surgical-site infection after cardiac surgery:
The CLEAN 2 study protocol.
Source
BMJ Open. 9 (6) (no pagination), 2019. Article Number: e026929. Date of
Publication: 01 Jun 2019.
Author
Boisson M.; Corbi P.; Kerforne T.; Camilleri L.; Debauchez M.; Demondion
P.; Eljezi V.; Flecher E.; Lepelletier D.; Leprince P.; Nesseler N.; Nizou
J.Y.; Roussel J.C.; Rozec B.; Ruckly S.; Lucet J.-C.; Timsit J.-F.; Mimoz
O.
Institution
(Boisson, Kerforne) Anaesthesia and Intensive Care Unit, Centre
Hospitalier Universitaire de Poitiers, Poitiers, France
(Boisson, Mimoz) INSERM U1070, Universite de Poitiers UFR Medecine et
Pharmacie, Poitiers, France
(Corbi) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de
Poitiers, Poitiers, France
(Camilleri) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire
de Clermont-Ferrand, Clermont-Ferrand, France
(Debauchez) Cardiothoracic Surgery Unit, Institut Mutualiste Montsouris,
Paris, France
(Demondion, Leprince) Cardiothoracic Surgery Unit, Hopitaux Universitaires
Pitie, Alpetriere-Charles Foix, Paris, France
(Eljezi) Anaesthesia and Intensive Care Unit, Centre Hospitalier
Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
(Flecher) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de
Rennes, Rennes, France
(Lepelletier) Infection Control Unit, Centre Hospitalier Universitaire de
Nantes, Nantes, France
(Nesseler) Anaesthesia and Intensive Care Unit, Centre Hospitalier
Universitaire de Rennes, Rennes, France
(Nizou) Infection Control Unit, Institut Mutualiste Montsouris, Paris,
France
(Roussel) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de
Nantes, Nantes, France
(Rozec) Anesthesia and Intensive Care Unit, Centre Hospitalier
Universitaire de Nantes, Nantes, France
(Ruckly, Timsit) INSERM UMR 1137, Universite Paris Diderot UFR de Medecine
Site Xavier-Bichat, Paris, France
(Lucet) Infection Control Unit, Hopital Bichat - Claude-Bernard, Paris,
France
(Lucet) Iame, INSERM, Paris, France
(Timsit) Medical and Infectious Diseases Intensive Care Unit, Hopital
Bichat - Claude-Bernard, Paris, France
(Mimoz) Emergency Department and Prehospital Care, Centre Hospitalier
Universitaire de Poitiers, Poitiers, France
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Surgical-site infection (SSI) is the second most frequent
cause of healthcare-associated infection worldwide and is associated with
increased morbidity, mortality and healthcare costs. Cardiac surgery is
clean surgery with low incidence of SSI, ranging from 2% to 5%, but with
potentially severe consequences. Perioperative skin antisepsis with an
alcohol-based antiseptic solution is recommended to prevent SSI, but the
superiority of chlorhexidine (CHG)-alcohol over povidone iodine
(PVI)-alcohol, the two most common alcohol-based antiseptic solutions used
worldwide, is controversial. We aim to evaluate whether 2% CHG-70%
isopropanol is more effective than 5% PVI-69% ethanol in reducing the
incidence of reoperation after cardiac surgery. Methods and analysis The
CLEAN 2 study is a multicentre, open-label, randomised, controlled
clinical trial of 4100 patients undergoing cardiac surgery. Patients will
be randomised in 1:1 ratio to receive either 2% CHG-70% isopropanol or 5%
PVI-69% ethanol for perioperative skin preparation. The primary endpoint
is the proportion of patients undergoing any re-sternotomy between day 0
and day 90 after initial surgery and/or any reoperation on saphenous
vein/radial artery surgical site between day 0 and day 30 after initial
surgery. Data will be analysed on the intention-to-treat principle. Ethics
and dissemination This protocol has been approved by an independent ethics
committee and will be carried out according to the principles of the
Declaration of Helsinki and the Good Clinical Practice guidelines. The
results of this study will be disseminated through presentation at
scientific conferences and publication in peer-reviewed journals. Trial
registration number EudraCT 2017-005169-33 and NCT03560193.<br/>Copyright
&#xa9; 2019 BMJ Publishing Group Limited.

<57>
Accession Number
2002055392
Title
Randomized Trial of Miniaturized Versus Standard Extracorporeal
Circulation in Aortic Valve Surgery.
Source
Annals of Thoracic Surgery. 108 (1) (pp 37-44), 2019. Date of Publication:
July 2019.
Author
Halfwerk F.R.; Knol K.; Mariani S.; Grandjean J.G.; Mecozzi G.
Institution
(Halfwerk, Knol, Mariani, Grandjean, Mecozzi) Department of
Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente
Hospital, Enschede, Netherlands
(Halfwerk, Grandjean) Department of Biomechanical Engineering, Faculty of
Engineering Technology, University of Twente, Enschede, Netherlands
(Mecozzi) Department of Cardio-Thoracic Surgery, University Medical Center
Groningen, Groningen, Netherlands
Publisher
Elsevier USA
Abstract
Background: Complications related to extracorporeal circulation remain
serious. Although a minimal invasive extra corporeal circulation (MiECC)
system was developed to cope with these complications, its effectivity on
patient-related outcomes such as blood loss remain uncertain. Therefore,
the aim of this study is to compare MiECC to an advanced standard system
with respect to blood loss. <br/>Method(s): A total of 128 adult patients
undergoing elective isolated aortic valve replacement were enrolled in a
randomized clinical trial. Patients who had undergone previous heart
surgery and with preexisting kidney failure were excluded. The primary end
point was postoperative blood loss after 12 hours and at drain removal.
Secondary end points included intensive care and total length of stay and
intubation time. At 1 hour and 12 hours after surgery, clinical laboratory
data were determined. Early clinical outcomes and long-term survival were
determined. <br/>Result(s): MiECC patients (n = 63) had a significant
lower blood loss (230 mL, 95% confidence interval: 203 to 261 mL) than
regular patients (n = 62) after 12 hours (288 mL, 95% confidence interval:
241 to 344 mL, p = 0.04). A preservation of hemoglobin levels 1 hour and
12 hours after surgery in the MiECC group were observed (p < 0.001). No
difference was found in early clinical outcomes and long-term survival.
<br/>Conclusion(s): This randomized controlled trial compares MiECC and an
advanced system for aortic valve replacement with blood loss as primary
end point. We conclude that using MiECC is clinically equal for short- and
long-term follow-up regarding blood loss. Clinical trial registration:
NTR3378.<br/>Copyright &#xa9; 2019 The Society of Thoracic Surgeons

<58>
Accession Number
624319300
Title
Pre-hospital administration of ticagrelor in diabetic patients with
ST-elevation myocardial infarction undergoing primary angioplasty: A
sub-analysis of the ATLANTIC trial.
Source
Catheterization and Cardiovascular Interventions. 93 (7) (pp E369-E377),
2019. Date of Publication: 01 Jun 2019.
Author
Fabris E.; van't Hof A.; Hamm C.W.; Lapostolle F.; Lassen J.F.; Goodman
S.G.; ten Berg J.M.; Bolognese L.; Cequier A.; Chettibi M.; Hammett C.J.;
Huber K.; Janzon M.; Merkely B.; Storey R.F.; Zeymer U.; Cantor W.J.;
Kerneis M.; Diallo A.; Vicaut E.; Montalescot G.
Institution
(Fabris, van't Hof) Cardiology Department, Isala Heart Center, Zwolle,
Netherlands
(Fabris) Cardiovascular Department, University of Trieste, Trieste, Italy
(van't Hof) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
(van't Hof) Department of Cardiology, Zuyderland Hospital, Heerlen,
Netherlands
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Lapostolle) SAMU 93 Hopital Avicenne, Bobigny, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Aarhus,
Denmark
(Goodman) Canadian Heart Research Centre, Division of Cardiology, St.
Michael's Hospital, University of Toronto, Toronto, Canada
(ten Berg) Department of Cardiology, St. Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, Spain
(Chettibi) Centre Hospito-universitaire Frantz Fanon, Blida, Algeria
(Hammett) Department of Cardiology, Royal Brisbane and Women's Hospital,
Brisbane, QLD, Australia
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminen hospital and Sigmund Freud University, Medical
School, Vienna, Austria
(Janzon) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Zeymer) Klinikum Ludwigshafen and Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Cantor) Southlake Regional Health Centre, University of Toronto, ON,
Canada
(Kerneis, Montalescot) Sorbonne Universite, ACTION Study Group, Hospital
Pitie-Salpetriere (AP-HP), Paris, France
(Diallo, Vicaut) Hospital Lariboisiere, ACTION Study Group, Paris, France
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We investigated, in the contemporary era of ST-elevation
myocardial infarction (STEMI) treatment, the influence of diabetes
mellitus (DM) on cardiovascular outcomes, and whether pre-hospital
administration of ticagrelor may affect these outcomes in a subgroup of
STEMI patients with DM. <br/>Background(s): DM patients have high platelet
reactivity and a prothrombotic condition which highlight the importance of
an effective antithrombotic regimen in this high-risk population.
<br/>Method(s): In toal 1,630 STEMI patients enrolled in the ATLANTIC
trial who underwent primary percutaneous coronary intervention (PCI) were
included. Multivariate analysis was used to explore the association of DM
with outcomes and potential treatment-by-diabetes interaction was tested.
<br/>Result(s): A total of 214/1,630 (13.1%) patients had DM. DM was an
independent predictor of poor myocardial reperfusion as reflected by less
frequent ST-segment elevation resolution (>=70%) after PCI (OR 0.59, 95%
CI 0.43-0.82, P < 0.01) and was an independent predictor of the composite
30-day outcomes of death/new myocardial infarction (MI)/urgent
revascularization/definite stent thrombosis (ST) (OR 2.80, 95% CI
1.62-4.85, P < 0.01), new MI or definite acute ST (OR 2.46, 95% CI
1.08-5.61, P = 0.03), and definite ST (OR 10.00, 95% CI 3.54-28.22, P <
0.01). No significant interaction between pre-hospital ticagrelor vs
in-hospital ticagrelor administration and DM was present for the clinical,
electrocardiographic and angiographic outcomes as well as for thrombolysis
in myocardial infarction major bleeding. <br/>Conclusion(s): DM remains
independently associated with poor myocardial reperfusion and worse 30-day
clinical outcomes. No significant interaction was found between
pre-hospital vs in-hospital ticagrelor administration and DM status.
Further approaches for the treatment of DM patients are needed. CLINICAL
TRIAL REGISTRATION: clinicaltrials.gov identifier:
NCT01347580.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<59>
Accession Number
2002135653
Title
Does left atrial appendage closure reduce mortality? A vital status
analysis of the randomized protect AF and PREVAIL clinical trials.
Source
Journal of Atrial Fibrillation. 11 (4) (no pagination), 2018. Date of
Publication: December 2018.
Author
Whang W.; Holmes D.R.; Miller M.A.; Langan M.-N.; Choudry S.; Sofi A.;
Koruth J.S.; Dukkipati S.R.; Reddy V.Y.
Institution
(Whang, Miller, Langan, Choudry, Sofi, Koruth, Dukkipati, Reddy) Icahn
School of Medicine at Mount Sinai, Box 1030, New York, NY, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
Publisher
CardioFront LLC (E-mail: editors.office@jafib.com)
Abstract
Compared with warfarin, left atrial appendage closure (LAAC) reduced
mortality in an analysis of the PROTECT AF and PREVAIL trials. However,
these data were limited by patient drop-out.We sought to estimate the
mortality benefit with LAAC using updated vital status information.In
PROTECT AF and PREVAIL, 227 of 1114 randomized subjects failed to complete
5-year follow-up. Centers were manually queried for updated vital status
on 76 subjects (33%). During median follow-up 5.0 years (interquartile
range 3.8, 5.1), 112 of 732 LAAC subjects (15.3%) and 79 of 382 controls
(20.7%) died. The hazard ratio for all-cause mortality with LAAC compared
with warfarin was 0.70 (95% CI 0.53-0.94, p=0.017).Subgroup analyses
suggested that subjects <75 years and those with higher CHA2DS2-VASc
score, history of transient ischemic attack or stroke, and permanent AF
derived particular benefit, although interaction terms were not
significant.The number needed to treat(NNT) with LAAC to prevent one death
over 5 years was 16 (95% CI 10-82). Despite competing mortality risks in
this elderly cohort, updated vital status data from PROTECT AF and PREVAIL
revealed that LAAC was associated with 30% improved survival compared with
warfarin, with an NNT of 16.<br/>Copyright &#xa9; 2018 CardioFront LLC.
All rights reserved.

<60>
Accession Number
628206345
Title
Effects and Tolerance of Protein and Energy-Enriched Formula in Infants
Following Congenital Heart Surgery: A Randomized Controlled Trial.
Source
Journal of Parenteral and Enteral Nutrition. 42 (1) (pp 196-204), 2018.
Date of Publication: January 2018.
Author
Cui Y.; Li L.; Hu C.; Shi H.; Li J.; Gupta R.K.; Liang H.; Chen X.; Gong
S.
Institution
(Cui, Gupta, Gong) The First Affiliated Hospital of Jinan University,
Guangzhou, China
(Cui, Li, Hu, Li, Chen) Cardiac Intensive Care Unit, Heart Center,
Guangzhou Women and Children's Medical Center, Guangzhou Medical
University, Guangzhou, China
(Shi, Liang) Institute of Pediatrics, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
(Gong) Department of Gastroenterology, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Nutrition support is important for clinical management to
improve outcomes of infants following congenital heart surgery.
Protein-enriched and energy-enriched formula (PE-formula) may help provide
adequate nutrition and promote wound healing. However, the effects and
tolerance of increased protein and energy intakes of these infants have
not been well defined. <br/>Objective(s): To evaluate nutrition effects
and tolerance of a PE-formula compared with the standard formula
(S-formula) in infants in the first 5 days after congenital heart surgery.
<br/>Method(s): Fifty infants were randomly assigned to S-formula
(S-group, n = 24) or PE-formula (PE-group, n = 26). Daily nutrient intakes
and tolerance were recorded. Plasma amino acid concentrations were
measured. Cumulative energy balance and nitrogen balance were calculated.
<br/>Result(s): Nutrient intakes were significantly higher in the PE-group
after day 1, and all met the adequate intakes as early as day 2. Nitrogen
balance in the PE-group met positive balance from day 2, whereas in the
S-group, this was not until day 5. The PE-group also had a significantly
higher increase in many essential amino acids. With the exception of
tolerable diarrhea (multivariate adjusted hazard ratio, 3.16; 95%
confidence interval, 1.24-8.01), the PE-group did not have a significantly
higher incidence of intolerable events. <br/>Conclusion(s): In infants
during the early postoperative period after congenital heart surgery,
early administration of PE-formula was as well tolerated as S-formula and
effective in achieving higher nutrition intakes and earlier nitrogen
balance. Further research is warranted to support the use of PE-formula in
this special group of infants.<br/>Copyright &#xa9; 2017 American Society
for Parenteral and Enteral Nutrition

<61>
Accession Number
628179107
Title
ACTH-producing thymic neuroendocrine tumor initially presenting as
psychosis: A case report and literature review.
Source
Thoracic Cancer. (no pagination), 2019. Date of Publication: 2019.
Author
Okumura T.; Takayama S.; Nishio S.-I.; Miyakoshi T.; Noguchi T.; Kobayashi
T.; Fukushima T.; Sekiguchi N.; Otsuki T.; Komatsu M.; Koizumi T.
Institution
(Okumura) Second Department of Internal Medicine, Shinshu University
School of Medicine, Asahi Matsumoto, Japan
(Okumura, Noguchi, Kobayashi, Fukushima, Sekiguchi, Koizumi) Department of
Comprehensive Cancer Therapy, Shinshu University School of Medicine, Asahi
Matsumoto, Japan
(Takayama, Nishio, Miyakoshi, Komatsu) Fourth Department of Internal
Medicine, Shinshu University School of Medicine, Asahi Matsumoto, Japan
(Otsuki) Department of Central Laboratory, Shinshu University School of
Medicine, Asahi Matsumoto, Japan
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
A 32-year-old woman was referred to our hospital because of severe
psychosis and was found to have an ectopic ACTH-producing thymic
neuroendocrine tumor. Laboratory data revealed an elevated serum cortisol
and plasma ACTH level, hypokalemia, and metabolic alkalosis. Chest
computed tomography (CT) revealed an anterior mediastinal mass and
multiple pulmonary nodules. As the patient was unable to communicate
because of her consciousness disturbance, she was managed with artificial
ventilation and deep sedation. Metyrapone and potassium supplementation
were administered, and steroid psychosis gradually improved. Thoracic
surgery was performed and the histopathological diagnosis was thymic
neuroendocrine tumor with positive anti-ACTH immunohistochemical staining.
Here we present details of the case and review the
literature.<br/>Copyright &#xa9; 2019 The Authors. Thoracic Cancer
published by China Lung Oncology Group and John Wiley & Sons Australia,
Ltd

<62>
Accession Number
2002085401
Title
Cryptococcus endocarditis: A case report and review of the literature.
Source
Journal of Infection and Chemotherapy. (no pagination), 2019. Date of
Publication: 2019.
Author
Nakajima T.; Oba Y.; Takashima J.; Ueno K.; Kikuchi A.; Yamada T.;
Fukunami M.
Institution
(Nakajima) Division of General Internal Medicine, Akashi Medical Center,
743-33, Okubocho-Yagi, Akashi City, Hyogo 674-0063, Japan
(Oba) Department of General Internal Medicine, Osaka General Medical
Center, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
(Takashima) Department of Respiratory Medicine, Sakai City Medical Center,
1-1-1, Eharaji, Nishi-ku, Sakai City, Osaka 593-8304, Japan
(Ueno) Department of Respiratory Medicine, Osaka General Medical Center,
3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
(Kikuchi, Yamada, Fukunami) Department of Cardiology, Osaka General
Medical Center, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
Publisher
Elsevier B.V.
Abstract
Introduction: Cryptococcus neoformans is known to be a cause of
meningitis. However, as cryptococcal endocarditis is rare, it is not well
understood. Here, we describe a case with Implantable Cardioverter
Defibrillator associated endocarditis and meningitis caused by
Cryptococcus neoformans and we review the literature associated
cryptococcal endocarditis. Case presentation: A 72 years old Japanese male
presented in emergency department with non-productive cough and
respiratory discomfort. His past medical history was ischemic heart
disease four years ago and ICD was implanted. Physical examination was
unremarkable. Chest computer tomography revealed ground glass opacity in
the right lung. He received a diagnosis of amiodarone-induced interstitial
pneumonitis and high dose steroid pulse therapy. Septic shock and acute
respiratory failure occurred after steroid therapy. Cryptococcus
neoformans was identified by blood culture and cerebral spinal fluid.
Intravenous liposomal Amphotericin B and oral flucytosine were initiated.
Transesophageal echocardiography revealed vegetation on the lead of the
ICD. Diagnosis of cryptococcal endocarditis was made. The patient died
despite antifungal therapy was continued. <br/>Discussion(s): We analyzed
our case and 8 cases of cryptococcal endocarditis in the literature for 40
years. Almost all of the patients had previous valve replacement surgery
or immunocompromised state. Three cases had meningitis. Surgery performed
in 3 cases. The overall mortality rate were 44.4%. <br/>Conclusion(s):
Cryptococcal endocarditis is rare and carries a high mortality. Almost all
of the patients had underlying diseases. Diagnosis needs repeating blood
culture and echocardiogram, sometimes. Cryptococcal endocarditis needs
lumber puncture for rule out meningitis.<br/>Copyright &#xa9; 2019
Japanese Society of Chemotherapy and The Japanese Association for
Infectious Diseases

<63>
Accession Number
628034977
Title
--Statins in the perioperative period.
Source
F1000Research. 8 (no pagination), 2019. Date of Publication: 2019.
Author
Mohebi R.; Rosenson R.
Institution
(Mohebi, Rosenson) Department of Medicine (Cardiology), Icahn school of
Medicine at Mount Sinai, NY 10029, United States
Publisher
NLM (Medline)
Abstract
In this review, we discuss clinical evidence-based data regarding the
potential benefit of statin therapy in the perioperative period of
non-cardiac surgery. Results from meta-analyses of prospective
observational studies have provided conflicting evidence. Moreover,
comparison among studies is complicated by varying data sources, outcome
definitions, types of surgery, and preoperative versus perioperative
statin therapy. However, results of two recent large prospective cohort
studies showed that statin use on the day of or the day after non-cardiac
surgery (or both) is associated with lower 30-day all-cause mortality and
reduction in a variety of postoperative complications, predominantly
cardiac, compared with non-use during this period. There is a paucity of
data from randomized controlled trials assessing the benefit of statin
therapy in non-cardiac surgery. No randomized controlled trials have shown
that initiating a statin in statin-naive patients may reduce the risk of
cardiovascular complications in non-cardiac surgeries. One randomized
clinical trial demonstrated that the use of a preoperative statin in
patients with stable coronary heart disease treated with long-term statin
therapy had a significant reduction in the incidence of myocardial
necrosis and major adverse cardiovascular events after non-cardiac
surgery. In conclusion, it is important that all health-care professionals
involved in the care of the surgical patient emphasize the need to resume
statin therapy, particularly in patients with established atherosclerotic
cardiovascular disease. However, initiating a statin in statin-naive
patients undergoing non-cardiac surgery needs more evidence-based data.

<64>
[Use Link to view the full text]
Accession Number
628259781
Title
Heart Transplantation for Hepatitis C Virus Non-Viremic Recipients From
Hepatitis C Virus Viremic Donors.
Source
Cardiology in review. 27 (4) (pp 179-181), 2019. Date of Publication: 01
Jul 2019.
Author
Frager S.Z.; Dhand A.; Gass A.; Levine A.; Spielvogel D.; Nog R.; Wolf
D.C.; Bodin R.I.
Institution
(Frager) From the Department of Medicine, Division of Gastroenterology and
Hepatobiliary Disease
(Dhand, Nog) Department of Medicine, Division of Infectious Diseases,
Mexico
(Gass, Levine) Department of Medicine, Division of Cardiology, India
(Spielvogel) Department of Surgery, Cardiothoracic Surgery, Finland
(Wolf, Bodin) Department of Surgery, Division of Transplant Hepatology,
New York Medical College, Westchester Medical Center, Valhalla, NY, United
States
Publisher
NLM (Medline)
Abstract
Multiple strategies have been implemented to increase the donor pool to
avoid transplant wait-list mortality. The approval of highly effective
direct-acting antiviral regimens for the treatment of hepatitis C virus
(HCV) has enabled expansion of the donor pool by allowing the
transplantation of organs from HCV-viremic donors to HCV-negative
recipients. Multiple centers have recently published data on outcomes of
heart transplantation from HCV-viremic heart donors to HCV-negative
recipients, with acceptable posttransplant outcomes. However, areas of
uncertainty remain, particularly in the long-term risks of intentional HCV
transmission, as well as the possibility that sustained virologic response
may not be achieved. In this article, we review the literature
illustrating both the risks and benefits of transplantation of organs from
HCV-viremic donors to HCV-negative recipients. We also present the data
collected at our institution regarding this special patient population.

<65>
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. <br/>Objective(s): The study sought to
determine whether B cell depletion therapy would attenuate the development
of cardiac allograft vasculopathy. <br/>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. <br/>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. <br/>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)<br/>Copyright
&#xa9; 2019 American College of Cardiology Foundation

<66>
Accession Number
628270032
Title
Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation in
Patients Aged >=70 Years.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 08 Jun 2019.
Author
Biancari F.; Saeed D.; Fiore A.; Dalen M.; Ruggieri V.G.; Jonsson K.;
Gatti G.; Zipfel S.; Dell'Aquila A.M.; Chocron S.; Bounader K.; Amr G.;
Settembre N.; Palve K.; Loforte A.; Gabrielli M.; Livi U.; Lechiancole A.;
Pol M.; Netuka I.; Spadaccio C.; Pettinari M.; De Keyzer D.; Reichart D.;
Ragnarsson S.; Alkhamees K.; Lichtenberg A.; Fux T.; El Dean Z.;
Fiorentino M.; Mariscalco G.; Jeppsson A.; Welp H.; Perrotti A.
Institution
(Biancari) Heart Center, Turku University Hospital and University of
Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu,
Finland
(Saeed, Lichtenberg) Cardiovascular Surgery, University Hospital of
Duesseldorf, Dusseldorf, Germany
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Dalen, Fux) Department of Molecular Medicine and Surgery, Department of
Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
(Ruggieri, Amr) Division of Cardiothoracic and Vascular Surgery, Robert
Debre University Hospital, Reims, France
(Jonsson, Jeppsson) Department of Cardiac Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Gatti, Gabrielli) Division of Cardiac Surgery, Ospedali Riuniti, Trieste,
Italy
(Zipfel, Reichart) Hamburg University Heart Center, Hamburg, Germany
(Dell'Aquila, Welp) Department of Cardiothoracic Surgery, Munster
University Hospital, Munster, Germany
(Chocron, Perrotti) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Bounader) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Settembre) Department of Vascular Surgery, Nancy University Hospital,
University of Lorraine, Nancy, France
(Palve) Heart Center, Turku University Hospital and University of Turku,
Turku, Finland
(Loforte, Fiorentino) Department of Cardiothoracic, Transplantation and
Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna,
Italy
(Livi, Lechiancole) Cardiothoracic Department, University Hospital of
Udine, Udine, Italy
(Pol, Netuka) Institute of Clinical and Experimental Medicine, Prague,
Czechia
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Pettinari, De Keyzer) Department of Cardiovascular Surgery, Ziekenhuis
Oost-Limburg, Genk, Belgium
(Ragnarsson) Department of Cardiothoracic Surgery, University of Lund,
Lund, Sweden
(Alkhamees) Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
(El Dean, Mariscalco) Department of Cardiac Surgery, University Hospitals
of Leicester, Glenfield Hospital, Leicester, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is uncertainty whether venoarterial extracorporeal
membrane oxygenation (VA-ECMO) should be used in the elderly with
cardiopulmonary failure after cardiac surgery. <br/>METHOD(S): This is a
retrospective multicenter study on 781 patients who required
postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac
surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel
systematic review and meta-analysis of the literature was performed.
<br/>RESULT(S): The hospital mortality in the overall PC-ECMO series was
64.4%. Two-hundred and fifty-five patients were >=70 years old (32.7%) and
their hospital mortality was significantly higher than younger patients
(76.1% vs. 58.7%, adjusted OR 2.199, 95%CI 1.536-3.149). Arterial lactate
>6 mmol/L before starting VA-ECMO was the only predictor of hospital
mortality among patients >=70 years old in univariate analysis (82.6% vs.
70.4%, p=0.029). Meta-analysis of the current and prior studies showed
that early mortality after postcardiotomy VA-ECMO was significantly higher
in patients aged >=70 years compared with younger patients (OR 2.09, 95%CI
1.59-2.75, five studies including 1547 patients, I2 5.9%). The pooled
early mortality rate among patients aged >=70 years was 78.8% (95%CI
74.1-83.5, six studies including 617 patients, I2 41.8%). Two studies
reported 1-year mortality (including hospital mortality) of 79.9% and
75.6%, respectively, in patients >=70 years old. <br/>CONCLUSION(S):
Advanced age should not be considered a contraindication for
postcardiotomy VA-ECMO. However, in view of the high risk of early
mortality, a meaningful scrutiny is needed before using VA-ECMO after
cardiac surgery in the elderly.<br/>Copyright &#xa9; 2019. Published by
Elsevier Inc.

<67>
Accession Number
628266884
Title
Stent versus Coronary Artery Bypass Surgery in Multi-Vessel and Left Main
Coronary Artery Disease: A Meta-Analysis of Randomized Trials with
Subgroups Evaluation.
Source
Arquivos brasileiros de cardiologia. (no pagination), 2019. Date of
Publication: 21 Feb 2019.
Author
Andrade P.J.N.; Falcao J.L.A.A.; Falcao B.A.A.; Rocha H.A.L.
Institution
(Andrade, Falcao, Falcao, Rocha) Hospital Dr. Carlos Alberto Studart Gomes
de Messejana, Fortaleza, Brazil
(Andrade, Falcao, Falcao, Rocha) Universidade Federal do Ceara, Fortaleza,
Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: Comparison between percutaneous coronary intervention (PCI)
using stents and Coronary Artery Bypass Grafting (CABG) remains
controversial. <br/>OBJECTIVE(S): To conduct a systematic review with
meta-analysis of PCI using Stents versus CABG in randomized controlled
trials. <br/>METHOD(S): Electronic databases were searched to identify
randomized trials comparing PCI using Stents versus CABG for multi-vessel
and unprotected left main coronary artery disease (LMCAD). 15 trials were
found and their results were pooled. Differences between trials were
considered significant if p < 0.05. <br/>RESULT(S): In the pooled data (n
= 12,781), 30 days mortality and stroke were lower with PCI (1% versus
1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference
in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus
6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p =
0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In
diabetics (n = 3,274) long term mortality favored CABG (13.7% versus
10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no
difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year
mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus
8.1%) between PCI and CABG; the incidence of stroke was lower with PCI
(0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the
subgroups that influenced more adversely the results of PCI.
<br/>CONCLUSION(S): Compared with CABG, PCI using Stents showed lower 30
days mortality, higher late mortality and lower incidence of stroke.
Diabetes and a high SYNTAX were the subgroups that influenced more
adversely the results of PCI.

<68>
Accession Number
628249329
Title
Surgical Outcomes in Syndromic Tetralogy of Fallot: A Systematic Review
and Evidence Quality Assessment.
Source
Pediatric Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Athanasiadis D.I.; Mylonas K.S.; Kasparian K.; Ziogas I.A.; Vlachopoulou
D.; Sfyridis P.G.; Schizas D.; Spartalis E.; Nikiteas N.; Hemmati P.;
Kalangos A.; Avgerinos D.V.
Institution
(Athanasiadis, Mylonas, Kasparian, Ziogas) Pediatric Cardiac Surgery and
Pediatric Cardiology Working Group, Society of Junior Doctors, Athens,
Greece
(Athanasiadis) Department of Surgery, Indiana University School of
Medicine, Indianapolis, IN, United States
(Mylonas, Sfyridis, Kalangos) Department of Pediatric Cardiac Surgery,
Mitera Children'S Hospital, Athens, Greece
(Mylonas, Spartalis, Nikiteas) Laboratory of Experimental Surgery and
Surgical Research, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
(Kasparian, Ziogas, Vlachopoulou) School of Medicine, Aristotle University
of Thessaloniki, Thessaloniki, Greece
(Schizas) 1st Department of Surgery, Laikon University General Hospital,
School of Medicine, National and Kapodistrian University of Athens,
Athens, Greece
(Hemmati) Department of Surgery, Mayo Clinic, Rochester, MN, United States
(Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York Presbyterian Hospital, New York City, NY, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital
heart defects. We sought to summarize all available data regarding the
epidemiology and perioperative outcomes of syndromic ToF patients. A
PRISMA-compliant systematic literature review of PubMed and Cochrane
Library was performed. Twelve original studies were included. The
incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent
genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4-52.2) and
trisomy 21 (41.9%; 95% CI 37.7-46.3). Complete surgical repair was
performed in 75.2% of the patients (n = 161/214; 95% CI 69.0-80.1) and
staged repair in 24.8% (n = 53/214; 95 CI 19.4-30.9). Relief of RVOT
obstruction was performed with transannular patch in 64.7% (n = 79/122;
95% CI 55.9-72.7) of the patients, pulmonary valve-sparing technique in
17.2% (n = 21/122; 95% CI 11.5-24.9), and RV-PA conduit in 18.0% (n =
22/122; 95% CI 12.1-25.9). Pleural effusions were the most common
postoperative complications (n = 28/549; 5.1%; 95% CI 3.5-7.3).
Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9-6.4) of the
patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5-12.7).
Genetic syndromes are seen in approximately 15% of ToF patients. Long-term
survival exceeds 90%, suggesting that surgical management should be
dictated by anatomy regardless of genetics.<br/>Copyright &#xa9; 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<69>
Accession Number
2002156789
Title
PMD6 THE ACIST I CVI VARIABLE RATE CONTRAST DELIVERY SYSTEM
REDUCES COSTS OF CORONARY CATHETERIZATIONS COMPARED WITH MANUAL INJECTION.
Source
Value in Health. Conference: ISPOR 2019: Rapid. Disruptive. Innovative: A
New Era in HEOR. United States. 22 (Supplement 2) (pp S217), 2019. Date of
Publication: May 2019.
Author
Wright G.; Ferko N.; Knox K.; Wolf B.; Brutlag B.
Institution
(Wright, Ferko) Cornerstone Research Group Inc., Burlington, ON, Canada
(Knox, Wolf, Brutlag) ACIST Medical Systems, Inc., Eden Prairie, MN,
United States
Publisher
Elsevier Ltd
Abstract
Objectives: The clinical and economic burden associated with
contrast-induced acute kidney injury (CIAKI) from contrast injected for
coronary catheterization is high. Meta-analyses have demonstrated
significant reductions in CIAKI incidence and contrast volume utilization
with automated contrast injection compared with manual injection. This
study performed a budget impact analysis comparing costs of automated
contrast injection, using the ACIST I CVI variable rate
contrast delivery system, and manual contrast injection, from a U.S.
hospital perspective. <br/>Method(s): An economic model was developed to
assess the use of the ACIST I CVI systems for contrast
injection. Current practice assumed that all procedures were performed
using manual injection switching completely to the ACIST I CVI
systems for future practice. The annual cohort analyzed 3,500 patients.
Key model parameters included in the base-case analysis were contrast use,
CIAKI incidence rates, contrast costs, and product acquisition costs.
Model input values were primarily informed by meta-analyses, randomized
trials, and costing studies. Sensitivity analyses also additionally
considered vascular closure device (VCD) use and complications avoided
with automated contrast injection. <br/>Result(s): The analysis predicted
that switching from manual injection to the ACIST I CVI systems
would lead to institutional savings of $566,303 for the annual cohort
based on the base-case assumptions. <br/>Result(s): of the sensitivity
analyses predicted further annual cohort cost savings with the ACIST I
CVI systems, ranging from $891,103 to $992,771.
<br/>Conclusion(s): This economic analysis predicted that automated
contrast injection with the ACIST I CVI system can lead to
important institutional cost savings due to avoided contrast and
complication related resource use. Automated contrast injectors should be
considered as part of a comprehensive approach to reduce CIAKI and the
costs of cardiac catheterization procedures. Future study should consider
the budget impact of automated contrast injection in peripheral
catheterization procedures.<br/>Copyright &#xa9; 2019

<70>
Accession Number
628239987
Title
Post-operative cardiovascular complications and time to recurrence in
meningioma patients treated with versus without pre-operative
embolization: A retrospective cohort study of 741 patients.
Source
Neuro-Oncology. Conference: 13th Meeting of the European Association of
Neurooncology. Sweden. 20 (Supplement 3) (pp iii317), 2018. Date of
Publication: September 2018.
Author
Wirsching H.
Institution
(Wirsching) University Hospital Zurich, Zurich, Switzerland
Publisher
Oxford University Press
Abstract
BACKGROUND: Preoperative embolization of radiographically suspected
meningiomas is often performed to facilitate subsequent tumor resection.
Its effects on the post-operative course of operated meningiomas have not
been studied in detail and randomized trials are lacking. The objective of
this study was to explore associations of preoperative meningioma
embolization with postoperative outcome. <br/>PATIENTS AND METHODS:
Patients undergoing resection of an intracranial meningioma at a single
tertiary center 2000-2013 (N=741) were reviewed for the inclusion of
pre-operative embolization in the management strategy. Annotations
included demographics, radiographic, surgical, histological and
hematological parameters, cardiovascular risk factors, pre- and
postoperative neurological function and gene methylation-based
classification. Binary regression and Cox proportional hazards models were
applied to determine factors associated with outcome. <br/>RESULT(S):
Pre-operative embolization was performed in 337 patients (42%).
Cardiovascular events after surgery comprised mostly deep vein thrombosis
(N=39) and pulmonary embolisms (N=64). On multivariate analyses of
post-operative cardiovascular adverse events controlling for established
risk factors, there were associations with embolization (OR 2.38, 95% CI
1.37-4.00), and with female gender (OR 2.18, 95% CI 1.17-4.08).
Recurrence-free survival (RFS) of embolized patients was less favorable
among patients with WHO grade II or grade III meningiomas (median RFS: 4.3
versus 7.0 years, P=.029) or in patients with intermediate or malignant
gene methylation subtype meningiomas (median RFS: 2.0 versus 8.2 years,
P=.005), including in a multivariate Cox regression model that controlled
for established risk factors. <br/>CONCLUSION(S): Pre-operative meningioma
embolization may cause adverse surgical outcomes. Randomized trials to
determine beneft-risk ratios are warranted to clarify the role of
pre-operative embolization for meningioma surgery.

<71>
Accession Number
628237732
Title
Music therapy following cardiac surgery-is it an effective method to
reduce pain and anxiety?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (5) (pp 722-727),
2019. Date of Publication: 2019.
Author
Grafton-Clarke C.; Grace L.; Harky A.
Institution
(Grafton-Clarke) School of Medicine, University of Liverpool, Liverpool,
United Kingdom
(Grace) Department of Cardiac Surgery, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In patients undergoing
cardiac surgery, is postoperative music therapy effective in reducing pain
and anxiety? Altogether, 153 papers were found using the reported search
method, of which 7 represented the best evidence to answer the clinical
question. Six of the included studies were randomized trials, with 1
further non-randomized trial. The specific music protocols utilized widely
varied, ranging from 1 short session on day 1 postoperatively to multiple
sessions per day over a 72-h period. Most therapies involved music of a
relaxing type, typically between 50 and 60 dB. All 7 studies reported on
pain, with 4 demonstrating significant differences in pain score; however,
3 of these were not associated with reduction in analgesia requirements.
Five studies reported on anxiety, with 2 demonstrating a statistically
significant improvement in levels of anxiety. These results need to be
contextualized by the small number of participants within each study and
the heterogeneity in the therapy protocols utilized. The current best
available evidence fails to support the benefits of music therapy as an
effective non-pharmacological option in reducing pain and anxiety
following open-heart surgery. While there is scarce evidence demonstrating
efficacy, the current literature contains very small-sample-sized studies
in utilizing music therapy protocols which in turn have wide range of
variability in terms of duration, frequency, timing in the postoperative
period and specific choice of music utilized in each
protocol.<br/>Copyright &#xa9; 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.