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<1>
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. Copyright
© 2019 BMJ Publishing Group Limited.

<2>
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. 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). 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%).
 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. Copyright
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

<3>
[Use Link to view the full text]
Accession Number
623156174
Title
Does goal-directed haemodynamic and fluid therapy improve peri-operative
outcomes?.
Source
European Journal of Anaesthesiology. 35 (7) (pp 469-483), 2018. Date of
Publication: 01 Jul 2018.
Author
Chong M.A.; Wang Y.; Berbenetz N.M.; McConachie I.
Institution
(Chong, Wang, McConachie) Department of Anesthesia and Perioperative
Medicine, Western University, University Hospital, London Health Sciences
Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
(Berbenetz) Department of Medicine, Western University, London, ON, Canada
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Much uncertainty exists as to whether peri-operative
goal-directed therapy is of benefit. OBJECTIVES To discover if
peri-operative goal-directed therapy decreases mortality and morbidity in
adult surgical patients. DESIGN An updated systematic review and random
effects meta-analysis of randomised controlled trials. DATA SOURCES
Medline, Embase and the Cochrane Library were searched up to 31 December
2016. ELIGIBILITY CRITERIA Randomised controlled trials enrolling adult
surgical patients allocated to receive goal-directed therapy or standard
care were eligible for inclusion. Trauma patients and parturients were
excluded. Goal-directed therapy was defined as fluid and/or vasopressor
therapy titrated to haemodynamic goals [e.g. cardiac output (CO)].
Outcomes included mortality, morbidity and hospital length of stay. Risk
of bias was assessed using Cochrane methodology. RESULTS Ninety-five
randomised trials (11659 patients) were included. Only four studies were
at low risk of bias. Modern goal-directed therapy reduced mortality
compared with standard care [odds ratio (OR) 0.66; 95% confidence interval
(CI) 0.50 to 0.87; number needed to treat=59; N = 52; I 2 =0.0%]. In
subgroup analysis, there was no mortality benefit for fluid-only
goal-directed therapy, cardiac surgery patients or nonelective surgery.
Contemporary goal-directed therapy also reduced pneumonia (OR 0.69; 95%
CI, 0.51 to 0. 92; number needed to treat=38), acute kidney injury (OR 0.
73; 95% CI, 0.58 to 0.92; number needed to treat=29), wound infection (OR
0.48; 95% CI, 0.37 to 0.63; number needed to treat=19) and hospital length
of stay (days) (-0.90; 95% CI, -1.32 to -0.48; I 2 =81. 2%). No important
differences in outcomes were found for the pulmonary artery catheter
studies, after accounting for advances in the standard of care. CONCLUSION
Peri-operative modern goal-directed therapy reduces morbidity and
mortality. Importantly, the quality of evidence was low to very low (e.g.
Grading of Recommendations, Assessment, Development and Evaluation
scoring), and there was much clinical heterogeneity among the
goal-directed therapy devices and protocols. Additional well designed and
adequately powered trials on peri-operative goal-directed therapy are
necessary. Copyright © 2018 European Society of Anaesthesiology.

<4>
Accession Number
2001098703
Title
Reduced Stroke After Transcatheter Patent Foramen Ovale Closure: A
Systematic Review and Meta-analysis.
Source
American Journal of the Medical Sciences. 356 (2) (pp 103-113), 2018. Date
of Publication: August 2018.
Author
Alvarez C.; Siddiqui W.J.; Aggarwal S.; Hasni S.F.; Hankins S.; Eisen H.
Institution
(Alvarez) Internal Medical Department, Seton Hall University, St. Francis
Medical Center, Trenton, New Jersey, United States
(Siddiqui, Aggarwal, Hasni, Hankins, Eisen) Department of Cardiology,
Drexel University College of Medicine, Philadelphia, Pennsylvania, United
States
(Siddiqui, Aggarwal, Hasni, Hankins, Eisen) Department of Cardiology,
Hahnemann University Hospital, Philadelphia, Pennsylvania, United States
Publisher
Elsevier B.V.
Abstract
Background: Recent randomized control trials (RCTs) have suggested benefit
with transcatheter patent foramen ovale (PFO) closure plus antiplatelet
therapy over medical treatment alone for secondary stroke prevention.
 Material(s) and Method(s): Data sources: we searched PubMed and Ovid
MEDLINE from the inception until November 10, 2017 for RCTs comparing TPFO
closure to medical therapy in patients with a PFO and a history of
cryptogenic stroke. Result(s): Five RCTs with 3,627 patients (TPFO
closure = 1,829 versus medical therapy =1,798) were included. There was a
decreased number of post-TPFO closure strokes compared to the medical
therapy arm; 53 versus 80 strokes (odds ratio [OR] = 0.61, CI: 0.39-0.94,
P = 0.03, I2 = 17%). Transient ischemic attacks occurred in 43
patients after TPFO closure versus 60 patients in the medical therapy
group (OR = 0.80, CI: 0.53-1.19, P = 0.26, I2 = 0%). There was
a higher incidence of atrial fibrillation in the TPFO closure group, which
occurred in 75 patients, compared to 12 patients in the medical therapy
group (OR = 5.23, CI: 2.17-12.59, P = 0.0002, I2 = 43%). There
was a trend toward a decreased number of neuropsychiatric events in the
TPFO closure closure group compared to the medical therapy group; 42
versus 67 neuropsychiatric events (OR = 0.71, CI: 0.48-1.06, P = 0.09,
I2 = 0%). Conclusion(s): TPFO closure plus antiplatelet
therapy is superior to medical therapy in patients with a PFO and
cryptogenic stroke. PFO closure is associated with new-onset atrial
fibrillation and a trend toward reduced neuropsychiatric
events. Copyright © 2018 Southern Society for Clinical
Investigation

<5>
Accession Number
354277424
Title
Percutaneous coronary interventions for non-acute coronary artery disease:
a quantitative 20-year synopsis and a network meta-analysis.
Source
The Lancet. 373 (9667) (pp 911-918), 2009. Date of Publication:
20090314/20.
Author
Trikalinos T.A.; Alsheikh-Ali A.A.; Tatsioni A.; Nallamothu B.K.; Kent
D.M.
Institution
(Trikalinos, Alsheikh-Ali, Tatsioni, Kent) Institute for Clinical Research
and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
(Alsheikh-Ali) Division of Cardiology, Department of Medicine, Tufts
Medical Center, Boston, MA, United States
(Nallamothu) VA Health Services Research, Development Center of
Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI, United States
Publisher
Elsevier Limited
Abstract
Background: Over the past 20 years, percutaneous transluminal balloon
coronary angioplasty (PTCA), bare-metal stents (BMS), and drug-eluting
stents (DES) succeeded each other as catheter-based treatments for
coronary artery disease. We undertook a systematic overview of randomised
trials comparing these interventions with each other and with medical
therapy in patients with non-acute coronary artery disease.
 Method(s): We searched Medline for trials contrasting at least two of
the four interventions (PTCA, BMS, DES, and medical therapy). Eligible
outcomes were death, myocardial infarction, coronary artery bypass
grafting, target lesion or vessel revascularisation, and any
revascularisation. Random effects meta-analyses summarised head-to-head
(direct) comparisons, and network meta-analyses integrated direct and
indirect evidence. Finding(s): 61 eligible trials (25 388 patients)
investigated four of six possible comparisons between the four
interventions; no trials directly compared DES with medical therapy or
PTCA. In all direct or indirect comparisons, succeeding advancements in
percutaneous coronary intervention did not produce detectable improvements
in deaths or myocardial infarction. The risk ratio (RR) for indirect
comparisons between DES and medical therapy was 0.96 (95% CI 0.60-1.52)
for death and 1.15 (0.73-1.82) for myocardial infarction. By contrast, we
recorded sequential significant reductions in target lesion or vessel
revascularisation with BMS compared with PTCA (RR 0.68 [0-60.0.77]) and
with DES compared with BMS (0.44 [0.35-0.56]). The RR for the indirect
comparison between DES and PTCA for target lesion or vessel
revascularisation was 0.30 (0.17-0.51). Interpretation(s): Sequential
innovations in the catheter-based treatment of non-acute coronary artery
disease showed no evidence of an effect on death or myocardial infarction
when compared with medical therapy. These results lend support to present
recommendations to optimise medical therapy as an initial management
strategy in patients with this disease. Funding(s): US National
Institutes of Health. © 2009 Elsevier Ltd. All rights reserved.

<6>
Accession Number
50625882
Title
Otamixaban for the treatment of patients with non-ST-elevation acute
coronary syndromes (SEPIA-ACS1 TIMI 42): a randomised, double-blind,
active-controlled, phase 2 trial.
Source
The Lancet. 374 (9692) (pp 787-795), 2009. Date of Publication:
20090905/11.
Author
Sabatine M.S.; Antman E.M.; Widimsky P.; Ebrahim I.O.; Kiss R.G.; Saaiman
A.; Polasek R.; Contant C.F.; McCabe C.H.; Braunwald E.
Institution
(Sabatine, Antman, Contant, McCabe, Braunwald) TIMI Study Group, Division
of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA,
United States
(Widimsky) Cardiocentre, 3rd Faculty of Medicine, Charles University,
Prague, Czechia
(Ebrahim) Unitas Hospital, Pretoria, South Africa
(Kiss) Research Group for Inflammation Biology and Immunogenomics,
Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
(Saaiman) Kuils River Heart Unit, Cape Town, South Africa
(Polasek) Department of Cardiology, District Hospital Liberec, Liberec,
Czechia
Publisher
Elsevier Limited
Abstract
Background: Otamixaban is an intravenous direct factor Xa inhibitor. We
aimed to assess its efficacy and safety in non-ST-elevation acute coronary
syndromes and to identify the optimum dose range for further assessment in
a phase 3 study. Method(s): In this double-blind, phase 2 trial
undertaken in 196 sites in 36 countries, 3241 patients with
non-ST-elevation acute coronary syndromes were randomly assigned via a
central, telephone-based interactive voice response system to one of five
doses of otamixaban (0.08 mg/kg bolus followed by infusions of 0.035
[n=125], 0.070 [676], 0.105 [662], 0.140 [658], or 0.175 [671] mg/kg/h) or
to a control of unfractionated heparin (60 IU/kg intravenous bolus
followed by an infusion of 12 IU/kg/h) plus eptifibatide (180 mug/kg
intravenous bolus followed by an infusion of 1.0-2.0 mug/kg/min [n=449]).
Both investigators and patients were unaware of treatment allocation.
Enrolment into the lowest dose group was stopped early at the
recommendation of the Data Monitoring Committee. The primary efficacy
endpoint was a composite of death, myocardial infarction, urgent
revascularisation, or bailout glycoprotein IIb/IIIa inhibitor use up to 7
days. The primary safety endpoint was TIMI major or minor bleeding not
related to coronary-artery bypass grafting. Efficacy analyses were by
intention to treat; safety analyses were in treated patients. This study
is registered with ClinicalTrials.gov, number NCT00317395.
 Finding(s): Rates of the primary efficacy endpoint in the five
otamixaban doses were 7.2% (nine of 125) with 0.035 mg/kg/h, 4.6% (31/676)
with 0.070 mg/kg/h, 3.8% (25/662) with 0.105 mg/kg/h, 3.6% (24/658) with
0.140 mg/kg/h, and 4.3% (29/671) with 0.175 mg/kg/h (p=0.34 for trend). In
the control group, the rate was 6.2% (28/449), yielding relative risks for
the five otamixaban doses of 1.16 (95% CI 0.56-2.38), 0.74 (0.45-1.21),
0.61 (0.36-1.02), 0.58 (0.34-1.00), and 0.69 (0.42-1.15), respectively.
Rates of the primary safety endpoint in the five otamixaban doses were
1.6% (two of 122), 1.6% (11/669), 3.1% (20/651), 3.4% (22/651), and 5.4%
(36/664), respectively (p=0.0001 for trend); the rate in the control group
was 2.7% (12/448). Interpretation(s): In patients with
non-ST-elevation acute coronary syndromes, otamixaban infusions of
0.100-0.140 mg/kg/h might reduce ischaemic events and have a safety
profile similar to unfractionated heparin plus eptifibatide. Further
testing in a phase 3 trial is warranted. Funding(s): Sanofi-Aventis.
© 2009 Elsevier Ltd. All rights reserved.

<7>
Accession Number
355802458
Title
Safety and Effectiveness of the Endeavor Zotarolimus-Eluting Stent in
Real-World Clinical Practice. 12-Month Data From the E-Five Registry.
Source
JACC: Cardiovascular Interventions. 2 (12) (pp 1227-1235), 2009. Date of
Publication: December 2009.
Author
Lotan C.; Meredith I.T.; Mauri L.; Liu M.; Rothman M.T.
Institution
(Lotan) Heart Institute, Hadassah-Hebrew University Medical Center,
Jerusalem, Israel
(Meredith) Monash Heart Medical Centre, Melbourne, Australia
(Mauri) Brigham and Women's Hospital, Harvard Clinical Research Institute,
Boston, MA, United States
(Liu) Medtronic CardioVascular, Santa Rosa, CA, United States
(Rothman) The London Chest Hospital, Barts, The London NHS Trust, London,
United Kingdom
Publisher
Elsevier Inc.
Abstract
Objectives: The E-Five registry was designed to evaluate the safety and
effectiveness of the Endeavor zotarolimus-eluting stent (ZES) (Medtronic
CardioVascular, Santa Rosa, California) for the treatment of coronary
artery stenosis across a wide range of patients treated in real-world
clinical practice settings. Background(s): Early clinical trials with
the Endeavor ZES have demonstrated low rates of target lesion
revascularization with a favorable safety profile including low late stent
thrombosis with up to 4 years of follow-up. A clinical registry was
designed to complement controlled trial data by examining a large patient
population, including high-risk patient subsets. Method(s): The
E-Five registry is a prospective, nonrandomized, multicenter global
registry conducted at 188 centers worldwide. Adult patients (n = 8,314)
with coronary artery disease who underwent single-vessel or multivessel
percutaneous coronary intervention were enrolled. The primary end point
was the rate of major adverse cardiac events (MACE) at 12 months. A
secondary analysis stratified patients by standard versus extended-use
clinical and lesion characteristics. Result(s): Overall 12-month
outcome rates were MACE 7.5%; cardiac death 1.7%; myocardial infarction
(all) 1.6%; target lesion revascularization 4.5%; and stent thrombosis
(Academic Research Consortium definite and probable) 1.1%. The 12-month
MACE rates were 4.3% and 8.6% for standard- and extended-use patients,
respectively (p < 0.001). Conclusion(s): This large, international
multicenter registry provides important information regarding the
long-term safety and efficacy of the Endeavor ZES across standard and
extended-use patients in the real-world setting. Rates of MACE and
measures of safety including cardiac death, myocardial infarction, and
stent thrombosis were low and consistent with pooled results of clinical
trials. (E-Five Registry: A World-Wide Registry With The Endeavor
Zotarolimus Eluting Coronary Stent [eFive Registry]; NCT00623441). ©
2009 American College of Cardiology Foundation.

<8>
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. Copyright © 2019, © 2019 Informa
UK Limited, trading as Taylor & Francis Group.

<9>
Accession Number
628371346
Title
Sodium tanshinone IIA sulfonate prevents the adverse left ventricular
remodelling: Focus on polymorphonuclear neutrophil-derived granule
components.
Source
Journal of Cellular and Molecular Medicine. 23 (7) (pp 4592-4600), 2019.
Date of Publication: July 2019.
Author
Mao S.; Taylor S.; Chen Q.; Zhang M.; Hinek A.
Institution
(Mao, Zhang) Key Discipline of Integrated Chinese and Western Medicine,
Second Clinical College, Guangzhou University of Chinese Medicine,
Guangzhou, China
(Mao, Taylor) Cardiovascular Institute, Stanford University School of
Medicine, Stanford, CA, United States
(Chen) Biological Resource Center, Guangdong Provincial Hospital of
Chinese Medicine, Guangzhou, China
(Hinek) Translational Medicine, Hospital for Sick Children, Toronto,
Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aims: The aims of this study were to evaluate the effects of sodium
tanshinone IIA sulfonate (STS) on left ventricular (LV) remodelling after
for ST-elevated myocardial infarction (STEMI). Methods and Results:
In this prospective, randomized clinical trial, 101 patients with the
ST-elevated MI (STEMI) and a successful reperfusion were immediately
randomized to receive STS (80 mg qd for 7 days) or saline control, along
with standard therapy. The primary effectiveness endpoint is the % change
in LV end diastolic volumes index (% LVEDVi) as measured by
echocardiography from baseline to 6 months. Secondary effectiveness
endpoints include 6-month period for major adverse cardiac events (MACE),
including the occurrence of recurrent myocardial infarction, death,
hospitalization for heart failure and malignant arrhythmia. The 6-month
changes in % LVEDVi were significantly smaller in the STS group than in
the control group [-5.05% vs 3.32%; P < 0.001]. With respect to MACE,
there was a significant difference between those who received STS (8.16%)
and those patients on control (26.00%) (P = 0.019). Meaningfully, results
of parallel tests aimed at mechanistic explanation of the reported
clinical effects, revealed a significantly reduced levels of
neutrophils-derived granule components in the blood of STS treated
patients. Conclusion(s): We found that short-term treatment with STS
reduced progressive left ventricular remodelling and subsequent better
clinical outcome that could be mechanistically linked to the inhibition of
the ultimate damage of infarcted myocardium by infiltrating
neutrophils. Copyright © 2019 The Authors. Journal of Cellular
and Molecular Medicine published by John Wiley & Sons Ltd and Foundation
for Cellular and Molecular Medicine.

<10>
Accession Number
2001861188
Title
I-level positive airway pressure ventilation for patients with hypoxemia
after coronary artery bypass grafting.
Source
Journal of Biological Regulators and Homeostatic Agents. 33 (2) (pp
403-408), 2019. Date of Publication: March/April 2019.
Author
Cai W.W.; Hu J.; Wang H.; Zhu G.J.; Chen S.; Chen X.
Institution
(Cai, Hu, Wang, Zhu, Chen, Chen) Luoyang Central Hospital Affiliated to
Zhengzhou University, Luoyang, China
Publisher
Biolife s.a.s. (E-mail: biolife_sas@yahoo.it)
Abstract
Coronary artery bypass grafting (CABG) is an effective scheme for
treatment of myocardial ischemia. Hypoxemia is a common complication of
CABG, which can affect surgical effect and prognosis and even induce
multiple organ failure. To explore the clinical efficacy of bi-level
positive airway pressure ventilation in the treatment of CABG-associated
hypoxemia, 216 patients who were admitted to our hospital between August
2015 and April 2017 and developed CABG-associated hypoxemia were selected
and randomly divided into 2 groups, an observation group (n=108) and a
control group (n=108). Patients in the control group were given
conventional treatment including continuous oxygen inhalation through
nasal tube, antiinfection, bronchodilation, phlegm resolving, nutrition
support, analgesia, cardiac function maintenance, coronary dilatation,
anticoagulation and maintenance of stable internal environment, while
patients in the observation group were given positive airway pressure
ventilation via a breathing machine or nasal mask besides the conventional
treatment. The arterial blood gas indexes and blood circulation indexes of
patients in the two groups were detected before and after treatment, the
number of cases of reintubation was recorded, and the curative effects
were analyzed. The results demonstrated that the arterial gas indexes and
blood circulation indexes of patients in the observation group improved
after treatment, and the improvement of the observation group was
significantly superior to that of the control group (P<0.05). The
intensity of hypoxia of the observation group was higher, and the number
of cases of reintubation of the observation group was lower than that of
the control group (P<0.05). Thus bi-level positive airway pressure
ventilation is an effective non-invasive ventilation mode for treating
CABG-associated hypoxemia because it can improve p(O2), reduce p(CO2) in a
short time, relieve blood circulation, and reduce the rate of
reintubation. Patients who develop hypoxemia after removal of tracheal
intubation are advised to undergo bi-level positive airway pressure in the
early stage. Copyright © by BIOLIFE, s.a.s.

<11>
Accession Number
628179828
Title
Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or
low birth weight infants.
Source
Cochrane Database of Systematic Reviews. 2019 (6) (no pagination), 2019.
Article Number: CD004213. Date of Publication: 21 Jun 2019.
Author
Ohlsson A.; Shah S.S.
Institution
(Ohlsson) Departments of Paediatrics, Obstetrics and Gynaecology,
Institute of Health Policy, Management and Evaluation, University of
Toronto, Toronto, Canada
(Shah) Department of Pediatrics, Surya Hospital for Women and Children,
Pune, India
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background Patent ductus arteriosus (PDA) complicates the clinical course
of preterm infants and increases the risk of adverse outcomes.
Indomethacin has been the standard treatment to close a PDA but is
associated with renal, gastrointestinal, and cerebral side effects.
Ibuprofen has less effect on blood flow velocity to important organs.
Objectives Primary objectives To determine the effectiveness and safety of
ibuprofen compared to placebo/no intervention, or other cyclo-oxygenase
inhibitor drugs in the prevention of PDA in preterm infants. Search
methods We used the standard search strategy of Cochrane Neonatal to
search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018,
Issue 10), MEDLINE via PubMed (1966 to 17 October 2018), Embase (1980 to
17 October 2018), and CINAHL; 1982 to 17 October 2018). We searched
clinical trials databases, conference proceedings, and the reference lists
of retrieved articles for randomised controlled trials and
quasi-randomised trials. Selection criteria Randomised and
quasi-randomised controlled trials comparing ibuprofen with placebo/no
intervention or other cyclo-oxygenase inhibitor drugs to prevent PDA in
preterm or low birth weight infants. Data collection and analysis We
extracted outcomes data including presence of PDA on day three or four of
life (after 72 hours of treatment), need for surgical ligation or rescue
treatment with cyclo-oxygenase inhibitors, mortality, cerebral, renal,
pulmonary, and gastrointestinal complications. We performed meta-analyses
and reported treatment estimates as typical mean difference (MD), risk
ratio (RR), risk difference (RD) and, if statistically significant, number
needed to treat to benefit (NNTB) or to harm (NNTH), along with their 95%
confidence intervals (CI). We assessed between-study heterogeneity by the
I-squared test (I2). We used the GRADE approach to assess the
quality of evidence. Main results In this updated analysis, we included
nine trials (N = 1070 infants) comparing prophylactic ibuprofen (IV or
oral) with placebo/no intervention or indomethacin. Ibuprofen (IV or oral)
probably decreases the risk of PDA on day 3 or 4 (typical RR 0.39, 95% CI
0.31 to 0.48; typical RD -0.26, 95% CI -0.31 to -0.21; NNTB 4, 95% CI 3 to
5; 9 trials; N = 1029) (moderate-quality evidence). In the control group,
the spontaneous closure rate was 58% by day 3 to 4 of age. In addition,
ibuprofen probably decreases the need for rescue treatment with
cyclo-oxygenase inhibitors (typical RR 0.17, 95% CI 0.11 to 0.26; typical
RD -0.27, 95% CI -0.32 to -0.22; NNTB 4; 95% CI 3 to 5),and the need for
surgical ductal ligation (typical RR 0.46, 95% CI 0.22 to 0.96; typical RD
-0.03, 95% CI -0.05 to -0.00; NNTB 33, 95% CI 20 to infinity; 7 trials; N
= 925) (moderate-quality evidence). There was a possible decrease in the
risk of grade 3 or 4 intraventricular haemorrhage (IVH) in infants
receiving prophylactic ibuprofen (typical RR 0.67, 95% CI 0.45 to 1.00;
I2 = 34%; typical RD -0.04, 95% CI -0.08 to- 0.00;
I2 = 60%; 7 trials; N = 925) (moderate-quality evidence). High
quality evidence showed increased risk for oliguria (typical RR 1.45, 95%
CI 1.04 to 2.02; typical RD 0.06, 95% CI 0.01 to 0.11; NNTH 17, 95% CI 9
to 100; 4 trials; N = 747). Low quality results from four studies (N =
202) showed that administering oral ibuprofen may decrease the risk of PDA
(typical RR 0.47, 95% CI 0.30 to 0.74) and may increase risk of
gastrointestinal bleeding (NNTH 7, 95% CI 4 to 25). No evidence of a
difference was identified for mortality, any intraventricular haemorrhage
(IVH), or chronic lung disease. Authors conclusions This review shows that
prophylactic use of ibuprofen, compared to placebo or no intervention,
probably decreases the incidence of patent ductus arteriosus, the need for
rescue treatment with cyclo-oxygenase inhibitors, and for surgical ductal
closure. Adverse effects associated with ibuprofen (IV or oral) included
increased risks for oliguria, increase in serum creatinine levels, and
increased risk of gastrointestinal haemorrhage. There was a reduced risk
for intraventricular haemorrhage (grade III - IV) but no evidence of a
difference in mortality, chronic lung disease, necrotising enterocolitis,
or time to reach full feeds. In the control group, the patent ductus
arteriosus had closed spontaneously by day 3 or 4 in 58% of neonates.
Prophylactic treatment exposes a large proportion of infants unnecessarily
to a drug that has important side effects without conferring any important
short-term benefits. Current evidence does not support the use of
ibuprofen for prevention of patent ductus arteriosus. Until long-term
follow-up results of the trials included in this review have been
published, no further trials of prophylactic ibuprofen are recommended. A
new approach to patent ductus arteriosus management is an early targeted
treatment based on echocardiographic criteria within the first 72 hours of
life, that have a high sensitivity for diagnosing a patent ductus
arteriosus that is unlikely to close spontaneously. Such trials are
currently ongoing in many parts of the world. Results of such trials will
be included in updates of our "Ibuprofen for treatment of PDA"
review. Copyright © 2019 The Cochrane Collaboration. Published by
JohnWiley & Sons, Ltd.

<12>
Accession Number
626366127
Title
Right minithoracotomy versus median sternotomy for reoperative mitral
valve surgery: A systematic review and meta-analysis of observational
studies.
Source
European Journal of Cardio-thoracic Surgery. 54 (5) (pp 817-825), 2018.
Date of Publication: 2018.
Author
Daemen J.H.T.; Heuts S.; Olsthoorn J.R.; Maessen J.G.; Nia P.S.
Institution
(Heuts, Maessen, Nia) Faculty of Health, Medicine and Life Sciences,
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Daemen, Heuts, Olsthoorn, Maessen, Nia) Department of Cardiothoracic
Surgery, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25,
Maastricht 6229 HX, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Reoperative mitral valve surgery (MVS) through a median sternotomy
(ST-MVS) can be particularly challenging due to dense adhesions and is
known to carry a substantial risk of injuries to vascular structures.
These injuries occur in 7-9% of cases and are associated with increased
mortality rates. A valid alternative that could avoid the risks associated
with redo ST-MVS is the right anterolateral minithoracotomy (MT-MVS)
approach. The aim of this study was to quantify the effects of MT-MVS
compared with those of ST-MVS on morbidity and mortality among patients
who underwent prior cardiac surgery through a sternotomy. The MEDLINE and
EMBASE databases were searched through 1 November 2017. Data regarding
mortality, stroke, reoperation for bleeding and length of hospital stay
were extracted and submitted to a meta-analysis using random effects
modelling and the I2-test for heterogeneity. Six retrospective
observational studies were included, enrolling a total of 777 patients. In
a pooled analysis, MT-MVS demonstrated reduced mortality rates compared to
a standard sternotomy [odds ratio (OR) 0.41, 95% confidence interval (CI)
0.18-0.96; P = 0.04]. MT-MVS was, moreover, associated with reduced length
of hospital stay [difference between the means was -3.81, 95% CI -5.53 to
-2.08; P < 0.0001) and reoperation for bleeding (OR 0.32, 95% CI
0.10-0.99; P = 0.0488). The incidence of stroke was similar (OR 1.51, 95%
CI 0.65-3.54; P = 0.34), all in the absence of heterogeneity. In
conclusion, reoperative minimally invasive MVS through a minithoracotomy
is a safe alternative to standard sternotomy, with reduced mortality
rates, length of hospital stay and reoperations for bleeding and a
comparable risk of stroke. However, because the existing literature
provided limited, low-quality evidence, more methodologically rigorous
randomized controlled trials are needed. Copyright © The
Author(s) 2018.

<13>
Accession Number
627090096
Title
Impact of large periprocedural myocardial infarction on mortality after
percutaneous coronary intervention and coronary artery bypass grafting for
left main disease: an analysis from the EXCEL trial.
Source
European heart journal. (no pagination), 2019. Date of Publication: 28 Mar
2019.
Author
Ben-Yehuda O.; Chen S.; Redfors B.; McAndrew T.; Crowley A.; Kosmidou I.;
Kandzari D.E.; Puskas J.D.; Morice M.-C.; Taggart D.P.; Leon M.B.; Lembo
N.J.; Brown W.M.; Simonton C.A.; Dressler O.; Kappetein A.P.; Sabik J.F.;
Serruys P.W.; Stone G.W.
Institution
(Ben-Yehuda, Chen, Redfors, McAndrew, Crowley, Kosmidou, Leon, Lembo,
Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
(Ben-Yehuda, Leon, Lembo, Stone) Division of Cardiology,
NewYork-Presbyterian Hospital, Columbia University Medical Center, New
York, NY, USA
(Kosmidou) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Kandzari, Brown) Piedmont Heart Institute, Atlanta, GA, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY, USA
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Taggart) Department Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
NLM (Medline)
Abstract
AIMS: The prognostic implications of periprocedural myocardial infarction
(PMI) after percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) remain controversial. We examined the 3-year rates
of mortality among patients with and without PMI undergoing left main
coronary artery intervention randomized to PCI with everolimus-eluting
stents vs. CABG in the large-scale, multicentre, prospective, randomized
EXCEL trial. METHODS AND RESULTS: By protocol, PMI was defined using an
identical threshold for PCI and CABG [creatinine kinase-MB (CK-MB)
elevation >10x the upper reference limit (URL) within 72h post-procedure,
or >5x URL with new Q-waves, angiographic vessel occlusion, or loss of
myocardium on imaging]. Cox proportional hazards modelling was performed
controlling for age, sex, hypertension, diabetes mellitus, left
ventricular ejection fraction, SYNTAX score, and chronic obstructive
pulmonary disease (COPD). A total of 1858 patients were treated as
assigned by randomization. Periprocedural MI occurred in 34/935 (3.6%) of
patients in the PCI group and 56/923 (6.1%) of patients in the CABG group
[odds ratio 0.61, 95% confidence interval (CI) 0.40-0.93; P=0.02].
Periprocedural MI was associated with SYNTAX score, COPD, cross-clamp
duration and total procedure duration, and not using antegrade
cardioplegia. By multivariable analysis, PMI was associated with
cardiovascular death and all-cause death at 3years [adjusted hazard ratio
(HR) 2.63, 95% CI 1.19-5.81; P=0.02 and adjusted HR 2.28, 95% CI
1.22-4.29; P=0.01, respectively]. The effect of PMI was consistent for PCI
and CABG for cardiovascular death (Pinteraction = 0.56) and all-cause
death (Pinteraction = 0.59). Peak post-procedure CK-MB >=10x URL strongly
predicted mortality, whereas lesser degrees of myonecrosis were not
associated with prognosis. CONCLUSION(S): In the EXCEL trial, PMI was
more common after CABG than PCI, and was strongly associated with
increased 3-year mortality after controlling for potential confounders.
Only extensive myonecrosis (CK-MB >=10x URL) was prognostically
important. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2019. For
permissions, please email: journals.permissions@oup.com.

<14>
Accession Number
628223195
Title
Comparison of Outcomes after Transcatheter vs Surgical Aortic Valve
Replacement among Patients at Intermediate Operative Risk with a History
of Coronary Artery Bypass Graft Surgery: A Post Hoc Analysis of the
SURTAVI Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Reardon M.J.; Heijmen R.H.; Van Mieghem N.M.; Williams M.R.; Yakubov S.J.;
Watson D.; Kleiman N.S.; Conte J.; Chawla A.; Hockmuth D.; Petrossian G.;
Robinson N.; Kappetein A.P.; Li S.; Popma J.J.
Institution
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Heijmen) St Antonius Hospital, Nieuwegein, Netherlands
(Van Mieghem) Erasmus University Medical Center, Rotterdam, Netherlands
(Williams) NYU Langone Medical Center, New York, NY, United States
(Yakubov, Watson) OhioHeath Riverside Methodist Hospital, Columbus, OH,
United States
(Conte) Johns Hopkins University, Baltimore, MD, United States
(Chawla, Hockmuth) Iowa Heart Center, Des Moines, United States
(Petrossian, Robinson) St Francis Hospital, Roslyn, NY, United States
(Kappetein, Li) Medtronic, Minneapolis, MN, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Surgical aortic valve replacement (SAVR) has increased risk
for patients with aortic stenosis (AS) and a history of coronary artery
bypass graft (CABG) surgery. Transcatheter aortic valve replacement (TAVR)
may be an alternative. Objective(s): To compare TAVR with SAVR
outcomes in patients at intermediate operative risk with prior CABG
surgery. Design, Setting, and Participant(s): In this post hoc
analysis of the Surgical Replacement and Transcatheter Aortic Valve
Implantation (SURTAVI) noninferiority randomized clinical trial, patients
with severe, symptomatic AS at intermediate operative risk were enrolled
from 87 centers across the United States, Europe, and Canada from June
2012 to June 2016 and followed-up with up to July 2017. Those with a
history of CABG surgery were considered for analysis. Data were analyzed
from September to December 2017. Intervention(s): A total of 1746
patients were enrolled and randomized 1:1 to self-expanding TAVR or SAVR.
An implant was attempted in 1660 patients, of whom 273 had prior CABG
surgery, including 136 who underwent attempted TAVR and 137 who underwent
attempted SAVR. Main Outcomes and Measures: The primary outcome was
all-cause mortality or disabling stroke at 1-year follow-up. Efficacy
outcomes included quality of life, measured using the Kansas City
Cardiomyopathy Questionnaire at 30 days, 6 months, and 1 year, and
distance walked in 6 minutes, measured using the 6-minute walk test at 30
days and 1 year. Result(s): Of the 136 patients in the TAVR cohort,
111 (81.6%) were male, and the mean (SD) age was 76.9 (6.5) years; of the
137 in the SAVR cohort, 117 (85.4%) were male, and the mean (SD) age was
76.6 (6.5) years. The mean (SD) Society of Thoracic Surgeons Predicted
Risk of Mortality score was 5.0% (1.6%) in the TAVR cohort and 5.2% (1.7%)
in the SAVR cohort. All-cause mortality or disabling stroke at 1-year
follow-up was 8.9% (95% CI, 5.2-15.2) in the TAVR cohort and 6.7% (95% CI,
3.5-12.8) in the SAVR cohort (log-rank P =.53). Compared with patients
receiving SAVR, the mean (SD) Kansas City Cardiomyopathy Questionnaire
summary score was significantly better among patients receiving TAVR at 30
days (81.4 [19.2] vs 69.7 [22.6]; P <.001); treatments were similar at 1
year (85.7 [14.6] vs 82.8 [18.4]; P =.19). Compared with patients in the
SAVR cohort, those in the TAVR cohort showed greater mean (SD) improvement
in distance walked at 1 year (48.3 [120.6] m vs 16.8 [88.7] m; P =.04).
 Conclusions and Relevance: Both TAVR and SAVR were safe for
intermediate-risk patients with AS and prior CABG surgery. The
transcatheter approach facilitated faster improvement in quality of life
and better exercise capacity at 1-year follow-up. Trial Registration:
ClinicalTrials.gov identifier: NCT01586910. Copyright © 2019
American Medical Association. All rights reserved.

<15>
Accession Number
628179107
Title
ACTH-producing thymic neuroendocrine tumor initially presenting as
psychosis: A case report and literature review.
Source
Thoracic Cancer. 10 (7) (pp 1648-1653), 2019. Date of Publication: July
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. Copyright © 2019 The Authors. Thoracic Cancer
published by China Lung Oncology Group and John Wiley & Sons Australia,
Ltd

<16>
Accession Number
2002016982
Title
Meta-Analysis of Outcomes of Transcatheter Aortic Valve Implantation Among
Patients With Low Gradient Severe Aortic Stenosis.
Source
American Journal of Cardiology. 124 (3) (pp 423-429), 2019. Date of
Publication: 1 August 2019.
Author
Osman M.; Ghaffar Y.A.; Foster T.; Osman K.; Alqahtani F.; Shah K.; Kheiri
B.; Alkhouli M.
Institution
(Osman, Ghaffar, Foster, Alqahtani, Shah, Alkhouli) Division of
Cardiology, West Virginia University School of Medicine, Morgantown, WV,
United States
(Kheiri) Hurley Medical Center, Michigan State University, Flint, MI,
United States
(Osman) Michigan Health Specialist, Michigan State University, Flint, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an effective
therapy for patients with severe aortic stenosis (AS). However, data on
TAVI outcomes in patients with low gradient (LG) AS are limited. We
performed a meta-analysis of studies comparing TAVI outcomes between
patients with classic high gradient (HG) and LG AS through November 2018.
The 30-day mortality, mid-term all-cause, and cardiovascular mortality at
maximum follow-up were compared between patients with HG and LG AS
(Pairwise meta-analysis), and between the three distinct groups of AS
including HG, paradoxical low-flow low-gradient and low gradient with
reduced ejection fraction (rEF-LG) (Network meta-analysis). Nineteen
studies (n = 27,204 patients) met the inclusion criteria. The HG group had
less 30-day, mid-term all-cause and cardiovascular mortality compared with
the low-gradient AS group overall, (6% vs 7.5%, OR 0.76, 95% CI 0.66 to
0.87, I2 = 18%), (21% vs 29%, OR 0.59, 95% CI 0.52 to 0.67,
I2 = 62%), and (12.6% vs 18.7%, OR 0.61, 95% CI 0.49 to 0.76,
I2 = 62%), respectively, p <0.0001. These outcomes were
confirmed in a trial sequential analysis in which the cumulative Z-curve
crossed the conventional test boundary as well as the trial sequential
monitoring boundary for all outcomes. The network meta-analysis revealed
that patients with rEF-LG had similar outcomes to those with pLFLG, and
both had worse outcomes than patients with classic HG AS. In conclusion
patients with classic HG have better 30-day mortality, mid-term all-cause
and cardiovascular mortality compared with LG patients following TAVI.
Among patients with LG severe AS, TAVI outcomes were similar in patients
with rEF-LG and pLFLG. Copyright © 2019 Elsevier Inc.

<17>
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. Copyright © 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<18>
[Use Link to view the full text]
Accession Number
624244811
Title
Simvastatin Treatment Protects Myocardium in Noncoronary Artery Cardiac
Surgery by Inhibiting Apoptosis Through miR-15a-5p Targeting.
Source
Journal of cardiovascular pharmacology. 72 (4) (pp 176-185), 2018. Date of
Publication: 01 Oct 2018.
Author
Zhou L.; Liu X.; Wang Z.-Q.; Li Y.; Shi M.-M.; Xu Z.; Ou Z.-J.; Li H.-M.;
Cheng T.-P.; Jian Y.-P.; Zhang W.; Liu C.; Zhang X.; Quon M.J.; Zhang
C.-X.; Xu Y.-Q.; Wang Z.-P.; Ou J.-S.
Institution
(Zhou, Liu, Wang, Li, Shi, Xu, Li, Cheng, Jian, Zhang, Zhang, Xu, Wang,
Ou) Division of Cardiac Surgery, Heart Center, First Affiliated Hospital
of Sun Yat-sen University, Guangzhou, China
(Zhou, Liu, Wang, Li, Shi, Xu, Ou, Li, Cheng, Jian, Zhang, Liu, Zhang, Xu,
Wang, Ou) Key Laboratory of Assisted Circulation, Ministry of Health,
Guangzhou, China
(Liu, Wang, Li, Shi, Ou, Li, Cheng, Jian, Liu, Ou) National and Guangdong
Province Joint Engineering Laboratory for Diagnosis and Treatment of
Vascular Diseases, Guangzhou, China
(Ou) Division of Hypertension and Vascular Diseases, Heart Center, First
Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
(Liu) Department of Cardiology, Heart Center, First Affiliated Hospital of
Sun Yat-sen University, Guangzhou, China
(Quon) Division of Endocrinology, Diabetes, Nutrition, University of
Maryland School of Medicine, Baltimore, MD, United States
(Zhang) Department of Biomedical Engineering, School of Medicine,
University of Alabama at Birmingham, Birmingham, AL, United States
(Ou) Guangdong Provincial Key Laboratory of Brain Function and Disease,
Guangzhou, China
Publisher
NLM (Medline)
Abstract
Simvastatin treatment is cardioprotective in patients undergoing
noncoronary artery cardiac surgery. However, the mechanisms by which
simvastatin treatment protects the myocardium under these conditions are
not fully understood. Seventy patients undergoing noncoronary cardiac
surgery, 35 from a simvastatin treatment group and 35 from a control
treatment group, were enrolled in our clinical study. Simvastatin (20
mg/d) was administered preoperatively for 5-7 days. Myocardial tissue
biopsies were taken before and after surgery. Apoptosis was detected by
TUNEL staining. The expressions of Bcl-2 and Bak in myocardial tissue were
detected by immunoblotting. The expressions of miRNA and Bcl-2 mRNA were
detected by quantitative real-time polymerase chain reaction assays.
Cardiomyocytes were isolated from rat and cultured cells. MiR-15a-5p mimic
was transfected into cardiomyocytes, and the Bcl-2 was detected by
immunoblotting. TUNEL staining showed significantly less myocardial
apoptosis in the simvastatin treatment group when compared with the
control treatment group. Protein expression of Bcl-2 was increased in the
simvastatin treatment group before surgery, and Bak expression was
increased in the control treatment group after surgery. Further
comparisons showed that Bcl-2/Bak ratios were reduced in the control
treatment group but were not significantly changed in the simvastatin
treatment group after surgery. Furthermore, microarray assays revealed
that miR-15a-5p was significantly decreased by simvastatin treatment. This
was validated by quantitative real-time polymerase chain reaction
analysis. MiR-15a-5p was predicted to target Bcl-2 mRNA at nucleotide
positions 2529-2536. This was validated by luciferase binding assays.
Coincident with the change in miR-15a-5p, the mRNA expression of Bcl-2 was
increased in the simvastatin treatment group. MiR-15a-5p mimic
significantly inhibited Bcl-2 expression in cardiomyocytes. Our findings
strongly suggest that simvastatin treatment preoperatively protected the
myocardium in patients undergoing noncoronary artery cardiac surgery, at
least in part, by inhibiting apoptosis via suppressing miR-15a-5p
expression, leading to increasing expression of Bcl-2 and decreasing
expression of Bak.

<19>
Accession Number
628422113
Title
Management of anti coagulation in patients with metastatic
castration-resistant prostate cancer receiving abiraterone + prednisone.
Source
Supportive Care in Cancer. Conference: 2019 Joint Meeting of the
Multinational Association of Supportive Care in Cancer, MASCC and the
International Society of Oral Oncology, ISOO. United States. 27 (1
Supplement) (pp S117-S118), 2019. Date of Publication: June 2019.
Author
Dubinsky S.; Thawer A.; McLeod A.; Emmenegger U.; McFarlane T.
Institution
(Dubinsky) University of Waterloo, Pharmacy, Kitchener, Canada
(Thawer, Emmenegger, McFarlane) Sunnybrook Health Sciences Centre, Odette
Cancer Centre, Toronto, Canada
(McLeod) Sunnybrook Health Sciences Centre, Division of Medicine and
Hematology, Toronto, Canada
Publisher
Springer Verlag
Abstract
Introduction Abiraterone is an effective agent used in the management of
metastatic castration-resistant prostate cancer, significantly improving
overall and progression free survival. Due to the pharmacodynamic and
pharmacokinetic properties of abiraterone, concurrent use with
anticoagulation may pose a challenge for clinicians. Thrombosis within the
cancer setting continues to increase patient mortality therefore
appropriate anticoagulation management can reduce adverse events and
increase quality of life. Clinician guidance is needed on the safe and
effective use of anticoagulants with abiraterone and prednisone. Methods A
systematic review of the literature was preformed to identify relevant
randomized controlled trials, meta-analyses and retrospective studies.
Studies including oncology patients and an active intervention were
considered relevant. Major society guidelines were reviewed to further aid
in developing algorithms for the use of anticoagulants with abiraterone.
Results Our review identified abiraterone can pose a challenge for
patients receiving concurrent anticoagulation due to PK and PD
interference. We describe the potential interactions between abiraterone
and various anticoagulants, and provide management strategies based on the
most recent literature for atrial fibrillation, venous thromboembolism and
mechanical heart valves (Figures 1.0-3.0). Conclusions Abiraterone therapy
has become a mainstay of the management of advanced prostate cancer, and
is often used over prolonged years. In this review we summarize a
framework of how to use abiraterone inmen with prostate cancer on
anticoagulants. Evidence available to date suggests that patients with an
indication for anticoagulation such as atrial fibrillation, VTE and
mechanical heart-valves can be treated safely with abiraterone with
appropriate monitoring.

<20>
Accession Number
628414868
Title
Early Versus Delayed Stroke After Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Heart Association. 8 (13) (pp e012447), 2019. Date
of Publication: 02 Jul 2019.
Author
Gaudino M.; Rahouma M.; Di Mauro M.; Yanagawa B.; Abouarab A.; Demetres
M.; Di Franco A.; Arisha M.J.; Ibrahim D.A.; Baudo M.; Girardi L.N.;
Fremes S.
Institution
(Gaudino, Rahouma, Di Mauro, Abouarab, Di Franco, Ibrahim, Baudo, Girardi)
Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
(Yanagawa) Division of Cardiac Surgery St. Michael's Hospital University
of Toronto Canada
(Demetres) 2 Samuel J. Wood Library & C.V. Starr Biomedical Information
Center Weill Cornell Medicine New York NY, France
(Arisha) Internal Medicine Department West Virginia University Charleston
Division Charleston Area Medical Center Charleston WV
(Fremes) Schulich Heart Centre Sunnybrook Health Sciences Centre
University of Toronto Canada
Publisher
NLM (Medline)
Abstract
Background Although it is traditionally regarded as a single entity,
perioperative stroke comprises 2 separate phenomena (early/intraoperative
and delayed/postoperative stroke). We aimed to systematically evaluate
incidence, risk factors, and clinical outcome of early and delayed stroke
after cardiac surgery. Methods and Results A systematic review ( MEDLINE ,
EMBASE , Cochrane Library) was performed to identify all articles
reporting early (on awakening from anesthesia) and delayed (after normal
awakening from anesthesia) stroke after cardiac surgery. End points were
pooled event rates of stroke and operative mortality and incident rate of
late mortality. Thirty-six articles were included (174 969 patients). The
pooled event rate for early stroke was 0.98% (95% CI 0.79% to 1.23%) and
was 0.93% for delayed stoke (95% CI 0.77% to 1.11%; P=0.68). The pooled
event rate of operative mortality was 28.8% (95% CI 17.6% to 43.4%) for
early and 17.9% (95% CI 14.0% to 22.7%) for delayed stroke, compared with
2.4% (95% CI 1.9% to 3.1%) for patients without stroke ( P<0.001 for early
versus delayed, and for perioperative stroke, early stroke, and delayed
stroke versus no stroke). At a mean follow-up of 8.25 years, the incident
rate of late mortality was 11.7% (95% CI 7.5% to 18.3%) for early and 9.4%
(95% CI 5.9% to 14.9%) for delayed stroke, compared with 3.4% (95% CI 2.4%
to 4.8%) in patients with no stroke. Meta-regression demonstrated that
off-pump was inversely associated with early stroke (beta=-0.009, P=0.01),
whereas previous stroke (beta=0.02, P<0.001) was associated with delayed
stroke. Conclusions Early and delayed stroke after cardiac surgery have
different risk factors and impacts on operative mortality as well as on
long-term survival.

<21>
Accession Number
628419297
Title
Hyperbaric oxygen in patients with ischemic stroke following cardiac
surgery: a retrospective observational trial.
Source
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric
Medical Society, Inc. 44 (5) (pp 377-385), 2017. Date of Publication: 01
Sep 2017.
Author
Weixler V.H.-M.; Yates A.E.; Puchinger M.; Zirngast B.; Pondorfer P.;
Ratzenhofer-Komenda B.; Amegah-Sakotnik A.; Smolle-Juettner F.-M.; Dapunt
O.
Institution
(Weixler, Yates, Zirngast, Pondorfer, Dapunt) Division of Cardiac Surgery,
Medical University of Graz, Austria
(Puchinger) Division of Surgery and Medical Biotechnology, Medical
University of Graz, Austria
(Ratzenhofer-Komenda, Amegah-Sakotnik) Division of Anesthesiology for
Cardiovascular and Thoracic Surgery and Intensive Care Medicine, Medical
University of Graz, Austria
(Smolle-Juettner) Division of Thoracic and Hyperbaric Surgery, Medical
University of Graz, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: Hyperbaric oxygenation (HBO2) involves breathing 100% oxygen
under elevated ambient pressure in a hyperbaric chamber, thereby
dissolving oxygen in the plasma. This results in an increase of arterial
partial pressure of oxygen (pO2). Though well established in experimental
studies, HBO2 treatment for ischemic stroke is still under discussion.
 METHOD(S): From 2002-2014 HBO2 (2.2 bar, 90 minutes one/day; average
number per patient: 4.7) was applied in 49 consecutive patients (32 males,
17 females, mean age: 68.8 years, range 31.2 - 83.9) with acute
neurological deficit following cardiac surgery (CABG 15; combined surgery
14; valve surgery 11; aneurysm repair 8; malformation 1). Patients'
history including TIA or stroke and carotid artery pathology were
documented. Both degree and type of neurological deficit was evaluated by
a scoring system (0-4) before and after HBO2 treatment. RESULT(S):
Before HBO2 therapy, the average motor deficit score was 2.45 and the
average speech disorder score was 0.55, as compared with an average motor
deficit of 1.12 and an average speech disorder of 0.27 afterward
(alpha=0.0001, alpha=0.009). The majority of patients had an overall
improvement of 2 score-points after HBO2 therapy (n=23 patients). Probit
analysis showed that for a 50% response/probability (LC50) of having an
overall outcome of >=2 scoring points, an estimate of 4.3 HBO2 therapy
sessions is necessary. CONCLUSION(S): HBO22 therapy was associated
with significant improvement in patients with acute neurological deficits
due to ischemic stroke following cardiac surgery. Though this fact
suggests gas embolism as the most likely cause of stroke in this
collective, other underlying pathologies cannot be ruled out. Randomized
studies are needed for further evaluation.

<22>
Accession Number
2002237747
Title
Transcatheter or Surgical Aortic Valve Replacement for Low Surgical Risk
Patients: Meta-Analysis of Randomized Trials.
Source
JACC: Cardiovascular Interventions. 12 (14) (pp 1399-1401), 2019. Date of
Publication: 22 July 2019.
Author
Elgendy I.Y.; Mahmoud A.N.; Gad M.M.; Elbadawi A.; Rivero F.; Alfonso F.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<23>
Accession Number
628420147
Title
Ultrasound-guided radial artery cannulation using dynamic needle tip
positioning versus conventional long-axis in-plane techniques in cardiac
surgery patients: a randomised, controlled trial.
Source
Minerva anestesiologica. (no pagination), 2019. Date of Publication: 17
Jun 2019.
Author
Nam K.; Jeon Y.; Yoon S.; Kwon S.M.; Kang P.; Cho Y.J.; Kim T.K.
Institution
(Nam, Jeon, Yoon, Cho) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: A novel ultrasound imaging technique, dynamic needle tip
positioning (DNTP), enables continuous visualisation of the needle tip
during ultrasound-guided cannulation. The purpose of this study was to
compare the rate of successful first-attempt radial artery cannulations
between DNTP and the conventional long-axis in-plane (LAX-IP) technique.
 METHOD(S): Adult patients undergoing cardiac surgery requiring radial
artery cannulation were included and randomly allocated into either a DNTP
or LAX-IP group. Radial artery cannulation was performed by a single
experienced practitioner. The primary outcome was the first-attempt
success rate of radial artery cannulation. Secondary outcomes included the
length of time needed for cannulation and overall incidence of
complications. RESULT(S): A total of 136 patients were studied. The
first-attempt success rate of cannulation was 94% in the DNTP group (n=70)
and 68% in the LAX-IP group (n=66; OR 7.70, 95% CI 2.48-24.94, P <0.001).
The total procedure time was also shorter in the DNTP group (median [IQR];
87 [72-108] seconds) versus the LAX-IP group (118 [93-182] seconds; P
<0.001). During cannulation, vasospasm occurred less often in the DNTP
(4%) group compared to the LAX-IP group (17%; P =0.018).
 CONCLUSION(S): The DNTP technique had a greater first-attempt success
rate of radial artery cannulation compared to the conventional LAX-IP
technique. Also, DNTP required significantly less time for cannulation and
had fewer complications.

<24>
Accession Number
628418786
Title
Comparison of the effect of 80 vs 40mg atorvastatin in patients with
isolated coronary artery bypass graft surgery: A randomized clinical
trial.
Source
Journal of cardiac surgery. (no pagination), 2019. Date of Publication: 18
Jun 2019.
Author
Shekari A.; Forouzannia S.K.; Davarpasand T.; Talasaz A.H.; Jalali A.;
Gorabi A.M.; Lotfi-Tokaldany M.; Bagheri J.
Institution
(Shekari, Forouzannia, Davarpasand, Talasaz, Jalali, Gorabi,
Lotfi-Tokaldany, Bagheri) Department of Cardiovascular Research, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Atorvastatin can decrease cardiac injury after coronary artery
bypass graft (CABG) surgery. We compared the effects of 80 and 40mg of
atorvastatin per day on the levels of cardiac troponin T (cTnT) and
creatine kinase-MB (CK-MB) after an isolated CABG. METHOD(S): This
randomized single-blind parallel clinical trial enrolled 125 patients
(mean age=60.59+/-8.37 years) who were candidates for elective isolated
CABG at the Tehran Heart Center between May 2017 and December 2017.
Patients were randomly allocated into two groups to receive either 80mg
(n=62) or 40mg of atorvastatin (n=63) per day, 5 days before surgery. The
levels of cTnT and CK-MB, used as myocardial injury markers, were measured
at baseline and then at 8 and 24hours after CABG. RESULT(S): The
levels of CK-MB and cTnT at baseline and at 8 and 24hours following CABG
were not significantly different between the two groups. Our repeated
measures analysis of variance showed that the levels of CK-MB and cTnT
increased significantly over time (P< .001). No significant interaction
was observed between time and the atorvastatin dosage on the levels of
either CK-MB (P= .159) or cTnT (P= .646). In addition, the between-group
effects were not significant for CK-MB (P= .632) and cTnT (P= .126).
 CONCLUSION(S): The higher dose of atorvastatin (80mg) did not exert a
more protective effect than the standard dose of atorvastatin (40mg) after
CABG surgery. Copyright © 2019 Wiley Periodicals, Inc.

<25>
Accession Number
628417462
Title
Clinical guidelines for perioperative hemodynamic management of non
cardiac surgical adult patients.
Source
Minerva anestesiologica. (no pagination), 2019. Date of Publication: 17
Jun 2019.
Author
Brienza N.; Biancofiore G.; Cavaliere F.; Corcione A.; De Gasperi A.; De
Rosa R.C.; Fumagalli R.; Giglio M.T.; Locatelli A.; Lorini F.L.; Romagnoli
S.; Scolletta S.; Tritapepe L.
Institution
(Brienza) Sezione di Anestesia e Rianimazione, Dipartimento delle
Emergenze e Trapianti d'Organo, Universita degli Studi Aldo Moro di Bari,
Bari, Italy
(Biancofiore) UO Anestesia e Rianimazione Trapianti, Universita degli
Studi di Pisa, Pisa, Italy
(Cavaliere) UOC Cardio-Anestesia e Terapia Intensiva Cardiochirurgica,
Universita Cattolica del Sacro Cuore, Policlinico Universitario A.
Gemelli, Rome, Italy
(Corcione, De Rosa) Dipartimento di Area Critica UOC Anestesia e TIPO,
AORN dei Colli-Monaldi, Naples, Italy
(De Gasperi) UOC Anestesia e Rianimazione II, Ospedale Niguarda Ca'
Granda, Milan, Italy
(Fumagalli) UOC Anestesia e Rianimazione I, Ospedale Niguarda Ca' Granda,
Universita degli Studi Milano Bicocca, Milan, Italy
(Giglio) Sezione di Anestesia e Rianimazione, Dipartimento delle Emergenze
e Trapianti d'Organo, Universita degli Studi Aldo Moro di Bari, Bari,
Italy
(Locatelli) Servizio Di Anestesia e Terapia Intensiva Cardiovascolare,
Dipartimento di Emergenza ed Aree Critiche, Azienda Ospedaliera Santa
Croce e Carle, Cuneo, Italy
(Lorini) Dipartimento Emergenza, Urgenza e Area Critica, Bergamo, Italy
(Romagnoli) Dipartimento di Scienze della Salute, Universita di Firenze,
Florence, Italy
(Romagnoli) Dipartimento di Anestesia e Rianimazione, Azienda
Ospedaliero-Universitaria Careggi, Florence, Italy
(Scolletta) UOC Rianimazione e Medicina Critica, Dipartimento di Scienze
Mediche, Chirurgiche e Neuroscienze, Azienda Ospedaliera Universitaria
Senese, Siena, Italy
(Tritapepe) DAI Emergenza e Accettazione, Anestesia ed Aree Critiche, UOD
Anestesia e Terapia Intensiva in Cardiochirurgia, , Policlinico Umberto I,
Sapienza Universita di Roma, Rome, Italy
Publisher
NLM (Medline)
Abstract
Perioperative hemodynamic management, through monitoring and intervention
on physiological parameters to improve Cardiac Output and Oxygen Delivery
(Goal-directed therapy, GDT), may improve outcome. However, an Italian
survey has revealed that hemodynamic protocols are applied by only 29,1%
of anesthesiologists. Aim of this paper is to provide clinical guidelines
for a rationale use of perioperative hemodynamic management in non cardiac
surgical adult patients, oriented for Italy and updated with most recent
studies. Guidelines were elaborated according to NICE (National Institute
for Health and Care Excellence) and GRADE system (Grading of
Recommendations of Assessment Development and Evaluations). Key questions
were formulated according to PICO system (Population, Intervention,
Comparators, Outcome). Guidelines and systematic reviews were identified
on main research databases and strategy was updated to June 2018. There is
not enough good quality evidence to support the adoption of a GDT protocol
in order to reduce mortality, although it may be useful in high risk
patients. Perioperative GDT protocol to guide fluid therapy is recommended
to reduce morbidity. Continuous monitoring of arterial pressure may help
to identify short periods of hemodynamic instability and hypotension.
Fluid strategy should aim to a near zero balance in normovolemic patients
at the beginning of surgery, and a slight positive fluid balance may be
allowed to protect renal function. Drugs such as inotropes,
vasocostrictors, and vasodilatator should be used only when fluids alone
are not sufficient to optimize hemodynamics. Perioperative GDT protocols
are associated with a reduction in costs, although no economic study has
been performed in Italy.

<26>
Accession Number
2002239196
Title
Reducing red blood cell transfusion in orthopedic and cardiac surgeries
with Antifibrinolytics: A laboratory medicine best practice systematic
review and meta-analysis.
Source
Clinical Biochemistry. (no pagination), 2019. Date of Publication: 2019.
Author
Derzon J.H.; Clarke N.; Alford A.; Gross I.; Shander A.; Thurer R.
Institution
(Derzon) RTI International, Research Triangle Park, NC, United States
(Clarke) Pharmerit International, Bethesda, MD, United States
(Alford) National Network of Public Health Institutes, Washington, DC,
United States
(Gross) Acumen Inc., San Diego, CA, United States
(Shander) Englewood Hospital and Medical Center, NJ, United States
(Thurer) Gauss Surgical, Los Altos, CA, United States
(Clarke) Vector Oncology, Memphis, TN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: To evaluate the effectiveness of antifibrinolytics tranexamic
acid (TA), epsilon-aminocaproic acid (EACA), and aprotinin to decrease
overuse of red blood cell transfusions in adult surgical and non-surgical
patients. Method(s): This review followed the Centers for Disease
Control and Prevention (CDC) Laboratory Medicine Best Practice (LMBPTM)
Systematic Review (A-6) method. Eligible studies were assessed for
evidence of effectiveness of TA or EACA in reducing the number of patients
transfused or the number of whole blood transfusions. Result(s):
Seventy-two articles met LMBPTM inclusion criteria. Fifty-six studies
assessed Topical, Intra-articular Injection, or Intravenous TA, 4 studied
EACA, and 12 studied the effectiveness of aprotinin. The overall strength
of the body of evidence of effectiveness for each of these practices was
rated as high. Conclusion(s): LMBPTM recommends the use of topical,
intra-articular injection, or intravenous tranexamic acid and the use of
epsilon-aminocaproic acid for reducing overuse of red blood cell
transfusion. Copyright © 2019 The Canadian Society of Clinical
Chemists

<27>
Accession Number
628150880
Title
Dual antiplatelet therapy following percutaneous coronary intervention:
Protocol for a systematic review.
Source
BMJ Open. 9 (6) (no pagination), 2019. Article Number: e022271. Date of
Publication: 01 Jun 2019.
Author
Elliott J.; Kelly S.E.; Bai Z.; Skidmore B.; Boucher M.; So D.Y.F.; Wells
G.A.
Institution
(Elliott, Kelly, Bai, Skidmore, So, Wells) Cardiovascular Research Methods
Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
(Elliott, Kelly, Wells) School of Epidemiology and Public Health,
University of Ottawa, Ottawa, ON, Canada
(Boucher) Program and Policy Development, Canadian Agency for Drugs and
Technologies in Health (CADTH), Ottawa, ON, Canada
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Dual antiplatelet therapy (DAPT) is routinely given to
patients after percutaneous coronary intervention (PCI) with stenting;
however, there is ongoing debate about the optimal duration, especially in
specific patient groups. In the proposed systematic review, we intend to
assess the optimal duration of DAPT following PCI with stenting, with a
focus on clinically relevant patient subgroups. Methods and analysis: We
will perform a comprehensive search of the published literature for
randomised controlled trials (RCTs) assessing the benefits and harms of
extended DAPT (>12 months) compared with short-term DAPT (6-12 months)
following PCI with stenting (bare metal or drug eluting).
ClinicalTrials.gov and ICTRP will also be searched to identify ongoing and
completed clinical trials. Two independent reviewers will select studies
for inclusion, and the risk of bias will be assessed by use of Cochrane's
Risk of Bias tool. The primary outcome of interest is death (all-cause,
cardiovascular, non-cardiovascular). Secondary outcomes are bleeding
(major, minor, gastrointestinal), urgent target vessel revascularisation,
major adverse cardiovascular events, myocardial infarction, stroke and
stent thrombosis. Subgroup data will be sought for patients with prior
myocardial infarction, acute coronary syndrome at presentation and
diabetes, and based on smoking status and age group. Data will be analysed
by random-effects meta-analysis, and separate analyses will be performed
for patient subgroups. Bayesian network meta-analysis will be performed to
investigate the effect of individual P2Y12 inhibitors at different DAPT
durations longer than 6 months. Ethics and dissemination: This review will
provide a comprehensive overview of the available evidence of the benefits
and harms associated with extending DAPT beyond 12 months following PCI
with stenting and the effects on clinically important subgroups. The
results of this review will inform clinical and policy decisions regarding
the optimal treatment duration of DAPT following PCI with
stenting. Copyright © 2019 Author(s).

<28>
[Use Link to view the full text]
Accession Number
627472092
Title
ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols
Eliminate Testing Disparities in Patients With Chest Pain.
Source
Critical Pathways in Cardiology. 18 (1) (pp 5-9), 2019. Date of
Publication: 01 Mar 2019.
Author
Miller C.D.; Stopyra J.P.; Mahler S.A.; Case L.D.; Vasu S.; Bell R.A.;
Hundley W.G.
Institution
(Miller, Stopyra, Mahler) Department of Emergency Medicine, Wake Forest
School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157,
United States
(Case) Department of Internal Medicine/Cardiology, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Vasu, Hundley) Department of Biostatistical Sciences, Wake Forest School
of Medicine, Winston-Salem, NC, United States
(Bell) Department of Epidemiology and Prevention, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Bell) Maya Angelou Center for Health Equity, Wake Forest School of
Medicine, Winston-Salem, NC, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Patients from racial and ethnic minority groups presenting to
the Emergency Department (ED) with chest pain experience lower odds of
receiving stress testing compared with nonminorities. Studies have
demonstrated that care pathways administered within the ED can reduce
health disparities, but this has yet to be studied as a strategy to
increase stress testing equity. Method(s): A secondary analysis from
3 randomized clinical trials involving ED patients with acute chest pain
was performed to determine whether a care pathway, ACES (Accelerated Chest
pain Evaluation with Stress imaging), reduces the racial disparity in
index visit cardiac testing between African American (AA) and White
patients. Three hundred thirty-four participants with symptoms and
findings indicating intermediate to high risk for acute coronary syndrome
were enrolled in 3 clinical trials. Major exclusions were ST-segment
elevation, initial troponin elevation, and hemodynamic instability.
Participants were randomly assigned to receive usual inpatient care, or
ACES. The ACES care pathway includes placement in observation for serial
cardiac markers, with an expectation for stress imaging. The primary
outcome was index visit objective cardiac testing, compared among AA and
White participants. Result(s): AA participants represented 111/329
(34%) of the study population, 80/220 (36%) of the ACES group and 31/109
(28%) of the usual care group. In usual care, objective testing occurred
less frequently among AA (22/31, 71%) than among White (69/78, 88%, P =
0.027) participants, primarily driven by cardiac catheterization (3% vs.
24%; P = 0.012). In ACES, testing rates did not differ by race [AA 78/80
(98%) vs. White 138/140 (99%); P = 0.623]. At 90 days, death, MI, and
revascularization did not differ in either group between AA and White
participants. Conclusion(s): A care pathway with the expectation for
stress imaging eliminates the racial disparity among AA and White
participants with chest pain in the acquisition of index-visit
cardiovascular testing. Copyright © 2018 Wolters Kluwer Health,
Inc.

<29>
Accession Number
626512976
Title
Restrictive versus liberal red blood cell transfusion for cardiac surgery:
a systematic review and meta-analysis of randomized controlled trials.
Source
Journal of Thrombosis and Thrombolysis. 47 (2) (pp 179-185), 2019. Date of
Publication: 15 Feb 2019.
Author
Kheiri B.; Abdalla A.; Osman M.; Haykal T.; Chintalapati S.; Cranford J.;
Sotzen J.; Gwinn M.; Ahmed S.; Hassan M.; Bachuwa G.; Bhatt D.L.
Institution
(Kheiri, Haykal, Chintalapati, Cranford, Sotzen, Ahmed, Hassan, Bachuwa)
Department of Internal Medicine, Hurley Medical Center/Michigan State
University, Flint, MI 48503, United States
(Abdalla) Division of Hematology & Oncology, Ascension St. John Hospital,
Grosse Pointe Woods, MI 48236, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV 26506, United States
(Gwinn) Michigan State University-College of Human Medicine, Flint, MI
48502, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, 75 Francis Street, Boston, MA 02115, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Patients undergoing cardiac surgery are among the most common recipients
of allogeneic red blood cell (RBC) transfusions. However, whether
restrictive RBC transfusion strategies for cardiac surgery achieve a
similar clinical outcome in comparison with liberal strategies remains
unclear. We searched electronic databases from inception to December 2017
for randomized controlled trials (RCTs). We calculated the risk ratios
(RRs) and weighted-mean difference (MD) using a random-effects model. We
included 9 RCTs with a total of 9005 patients. There was no significant
difference in mortality between groups [RR 1.03; 95% confidence interval
(CI) 0.74-1.45; P = 0.86]. In addition, there were no significant
differences between groups in the clinical outcomes of infections (RR
1.09; 95% CI 0.94-1.26; P = 0.26), stroke (RR 0.98; 95% CI 0.72-1.35; P =
0.91), respiratory morbidity (RR 1.05; 95% CI 0.89-1.24; P = 0.58), renal
morbidity (RR 1.02; 95% CI 0.94-1.09; P = 0.68), myocardial infarction (RR
1.00; 95% CI 0.80-1.24; P = 0.99), cardiac arrhythmia (RR 1.05; 95% CI
0.88-1.26; P = 0.56), gastrointestinal morbidity (RR 1.93; 95% CI
0.81-4.63; P = 0.14), or reoperation (RR 0.90; 95% CI 0.67-1.20; P =
0.46). There was a significant difference in the intensive care unit
length of stay (h) (MD 4.29; 95% CI 2.19-6.39, P < 0.01) favoring the
liberal group. However, there was no significant difference in the
hospital length of stay (days) (MD 0.15; 95% CI - 0.18 to 0.48; P = 0.38).
In conclusion, this meta-analysis showed that restrictive strategies for
RBC transfusion are as safe as liberal strategies in patients undergoing
cardiac surgery with regards to short-term clinical
outcomes. Copyright © 2018, Springer Science+Business Media, LLC,
part of Springer Nature.

<30>
Accession Number
624628505
Title
Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary
Intervention in ST-Segment Elevation Myocardial Infarction:
ATLANTIC-Morphine.
Source
American Journal of Cardiovascular Drugs. 19 (2) (pp 173-183), 2019. Date
of Publication: 08 Apr 2019.
Author
Lapostolle F.; van't Hof A.W.; Hamm C.W.; Stibbe O.; Ecollan P.; Collet
J.-P.; Silvain J.; Lassen J.F.; Bolognese L.; Cantor W.J.; Cequier A.;
Chettibi M.; Goodman S.G.; Hammett C.J.; Huber K.; Janzon M.; Merkely B.;
Storey R.F.; ten Berg J.; Zeymer U.; Licour M.; Tsatsaris A.; Bougherbal
R.; Bouafia M.T.; Nibouche D.; Moklati A.; Benalia A.; Kaid O.; Krim M.;
Hammett C.; Garraby P.; Jayasinghe R.; Rashford S.; Neunteufl T.; Brussee
H.; Alber H.; Weidinger F.; Brunner M.; Sipoetz J.; Prause G.; Baubin M.;
Sebald D.; Cantor W.; Vijayaraghavan R.; Bata I.; Lavoie A.; Ravkilde J.;
Jensen L.O.; Christensen A.M.; Toftegaard M.; Kohler D.; Montalescot G.;
Ducrocq G.; Danchin N.; Henry P.; Livarek B.; Berthier R.; Hovasse T.;
Garot P.; Payot L.; Benamer H.; Esteve J.B.; Elhadad S.; Teiger E.; Bonnet
J.L.; Paganelli F.; Cottin Y.; Schiele F.; Thuaire C.; Cayla G.; Coste P.;
Ohlmann P.; Cudraz E.B.; Lantelme P.; Perret T.; Tron C.; De Labriolle A.;
Aptecar E.; Beliard O.; Varenne O.; Mahmoud R.E.; Filippi-Codaccioni E.;
Angoulvant D.; Peycher P.; Poitrineau O.; Tabone X.; Broche C.; Lambert
Y.; Briole N.; Beruben A.; Porcher N.; Auffray J.-P.; Freysz M.; Depardieu
F.; Poubel D.; De La Cousaye J.-E.; Bartier J.-C.; Jardel B.; Boulanger
B.; Labourel H.; Soulat L.-C.; Julie V.; Thicoipe M.; Capel O.; Carli P.;
Tazarourte K.; Alcouffe F.; Aboucaya D.; Aubert G.; Kierzek G.;
Cahun-Giraud S.; Hamm C.; Dengler T.; Prondzinsky R.; Biever P.M.; Schafer
A.; Seyfarth M.; Lemke B.; Werner G.; Nef H.; Steiger H.; Leschke M.;
Munzel T.; Orto M.C.D.; Loges C.; Schinke M.; Koberne F.; Reiffen H.P.;
Tiroch K.; Wierich D.; Kneussel M.; Little S.; Sauer H.;
Laufenberg-Feldmann R.; Ungi I.; Horvath I.; Edes I.; Martai I.; Berti S.;
Chiarella F.; Calabria P.; Fineschi M.; Galvani M.; Valgimigli M.; Moretti
L.; Tespili M.; Mando M.; Bermano F.; Biagioni R.; Fabbri A.; Ricciardelli
A.; Petroni M.R.; Vatteroni U.R.; Palumbo F.; Willems F.F.; mafragi A.A.;
Heestermans T.A.A.C.M.; Van Eck M.J.; Heutz W.M.J.M.; Meppelder H.H.; Jong
A.R.-D.; Van de Pas H.; Fillat A.C.; Tenas M.S.; Ferrer J.M.; Penaranda
A.S.; Ferrer J.A.; Del Blanco B.G.; Guardiola F.M.; Nodar J.M.R.; Romo
A.I.; Gonzalez N.V.; Nouche R.T.; De La Llera L.D.; Garcia J.M.H.;
Rivero-Crespo F.; Hernandez F.H.; Gomez J.L.Z.; Farega X.J.; Fernandez
G.A.; Toboso J.L.; Carrasco M.; Barreiro V.; Vazquez J.A.I.; del Mar Ruiz
Montero M.; Ortiz F.R.; Escudero G.G.; Ingelmo V.S.-B.; Garcia A.L.;
Oldgren J.; Calais F.; Kastberg R.; Bergsten P.-A.; Blomberg H.; Thorn K.;
Skoog G.; Zaman A.; Gerber R.; Ryding A.; Spence M.; Swanson N.; Been M.;
Grosser K.; Schofield P.; Mackin D.; Fell P.; Foster T.Q.T.; McManus D.;
Carson A.
Institution
(Lapostolle) SAMU 93 - UF Recherche-Enseignement-Qualite, Universite Paris
13, Sorbonne Paris Cite, Inserm U942, Hopital Avicenne, 125, rue de
Stalingrad, Bobigny 93009, France
(van't Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Stibbe) Service Medical d'Urgence, Brigade de Sapeurs-Pompiers de Paris,
Paris, France
(Ecollan, Collet, Silvain, Montalescot) Sorbonne Universite, ACTION Study
Group, Hopital Pitie-Salpetriere (AP-HP), 47 boul de l'Hopital, Paris
75013, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus N, Denmark
(Heutz) Regionale Ambulance Voor ziening Gelderland-Midden, Arnhem,
Netherlands
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Cantor) Southlake Regional Health Centre, University of Toronto,
Newmarket, ON, Canada
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
(Chettibi) Centre Hospito-universitaire Frantz Fanon, Blida, Algeria
(Goodman) Division of Cardiology, Canadian Heart Research Centre, St
Michael's Hospital, University of Toronto, Toronto, Canada
(Hammett) Department of Cardiology, Royal Brisbane and Women's Hospital,
Brisbane, QLD, Australia
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, 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
(ten Berg) Department of Cardiology, St Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Zeymer) Klinikum Ludwigshafen and Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Licour, Tsatsaris) AstraZeneca, Rueil Malmaison, France
(van't Hof) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
Publisher
Springer International Publishing
Abstract
Background: Morphine adversely impacts the action of oral adenosine
diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial
infarction (STEMI) patients, and is possibly associated with differing
patient characteristics. This retrospective analysis investigated whether
interaction between morphine use and pre-percutaneous coronary
intervention (pre-PCI) ST-segment elevation resolution in STEMI patients
in the ATLANTIC study was associated with differences in patient
characteristics and management. Method(s): ATLANTIC was an
international, multicenter, randomized study of treatment in the acute
ambulance/hospital setting where STEMI patients received ticagrelor 180 mg
+/- morphine. Patient characteristics, cardiovascular history, risk
factors, management, and outcomes were recorded. Result(s): Opioids
(97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were
no significant differences in age, sex or cardiovascular history, but more
morphine-treated patients had anterior myocardial infarction and left-main
disease. Time from chest pain to electrocardiogram and ticagrelor loading
was shorter with morphine (both p = 0.01) but not total ischemic time.
Morphine-treated patients more frequently received glycoprotein IIb/IIIa
inhibitors (p = 0.002), thromboaspiration and stent implantation (both p <
0.001). No significant difference between the two groups was found
regarding pre-PCI >= 70% ST-segment elevation resolution, death,
myocardial infarction, stroke, urgent revascularization and definitive
acute stent thrombosis. More morphine-treated patients had an absence of
pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow (85.8% vs.
79.7%; p = 0.001) and more had TIMI major bleeding (1.1% vs. 0.1%; p =
0.02). Conclusion(s): Morphine-treatment was associated with
increased GP IIb/IIIa inhibitor use, less pre-PCI TIMI 3 flow, and more
bleeding. Judicious morphine use is advised with non-opioid analgesics
preferred for non-severe acute pain. Trial Registration:
clinicaltrials.gov identifier: NCT01347580. Copyright © 2018,
Springer Nature Switzerland AG.

<31>
Accession Number
620513169
Title
Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive
Care.
Source
Journal of Intensive Care Medicine. 34 (8) (pp 652-661), 2019. Date of
Publication: 01 Aug 2019.
Author
Asmussen S.; Przkora R.; Maybauer D.M.; Fraser J.F.; Sanfilippo F.;
Jennings K.; Adamzik M.; Maybauer M.O.
Institution
(Asmussen, Adamzik) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University
Bochum, Bochum, Germany
(Asmussen, Przkora, Maybauer, Jennings, Maybauer) Departments of
Anesthesiology and Epidemiology and Biostatistics, The University of Texas
Medical Branch, Galveston, TX, United States
(Asmussen, Fraser, Maybauer) Critical Care Research Group, Prince Charles
Hospital, The University of Queensland, Brisbane, QLD, Australia
(Przkora) Department of Anesthesiology, College of Medicine, University of
Florida, Gainesville, FL, United States
(Maybauer, Maybauer) Department of Cardiothoracic Anaesthesia and Critical
Care, St George's Hospital, London, United Kingdom
(Sanfilippo) Department of Anesthesia and Intensive Care, IRCCS-ISMETT
(Istituto Mediterraneo per i Trapianti e Terapie ad Alta
Specializzazione), Palermo, Italy
(Sanfilippo) Department of Anaesthesiology and Intensive Care, Philipps
University, Marburg, Germany
(Maybauer) Cardiothoracic Anaesthesia and Intensive Care, Central
Manchester University Hospitals NHS Foundation Trust, Manchester Royal
Infirmary, University of Manchester, United Kingdom
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Acupuncture treatment has been employed in China for over 2500
years and it is used worldwide as analgesia in acute and chronic pain.
Acupuncture is also used in general anesthesia (GA). The aim of this
systematic review and meta-analysis was to assess the efficacy of
electroacupuncture (EA) in addition to GA in patients undergoing cardiac
surgery. Method(s): We searched 3 databases (Pubmed, Cochrane
Library, and Web of Science-from 1965 until January 31, 2017) for
randomized controlled trials (RCTs) including patients undergoing cardiac
surgery and receiving GA alone or GA + EA. As primary outcomes, we
investigated the association between GA + EA approach and the dosage of
intraoperative anesthetic drugs administered, the duration of mechanical
ventilation (MV), the postoperative dose of vasoactive drugs, the length
of intensive care unit (ICU) and hospital stay, and the levels of troponin
I and cytokines. Result(s): The initial search yielded 477 citations,
but only 7 prospective RCTs enrolling a total of 321 patients were
included. The use of GA + EA reduced the dosage of intraoperative
anesthetic drugs (P <.05), leading to shorter MV time (P <.01) and ICU
stay (P <.05) as well as reduced postoperative dose of vasoactive drugs (P
<.001). In addition, significantly lower levels of troponin I (P <.01) and
tumor necrosis factor alpha (P <.01) were observed. Conclusion(s):
The complementary use of EA for open-heart surgery reduces the duration of
MV and ICU stay, blunts the inflammatory response, and might have
protective effects on the heart. Our findings stimulate future RCT to
provide definitive recommendations. Copyright © The Author(s)
2017.

<32>
[Use Link to view the full text]
Accession Number
628315394
Title
Transcathether aortic valve implantation with the new repositionable
self-expandable Medtronic Evolut R vs. CoreValve system: Evidence on the
benefit of a meta-analytical approach.
Source
Journal of Cardiovascular Medicine. 20 (4) (pp 226-236), 2019. Date of
Publication: April 2019.
Author
Kowalewski M.; Gozdek M.; Raffa G.M.; Slomka A.; Zielinski K.; Kubica J.;
Anisimowicz L.; Kowalewski J.; Landes U.; Kornowski R.; Lorusso R.;
Suwalski P.
Institution
(Kowalewski, Suwalski) Clinical Department of Cardiac Surgery, Central
Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
(Kowalewski, Gozdek) Cardiothoracic Research Centre, Innovative Medical
Forum, Bydgoszcz, Poland
(Kowalewski, Raffa, Lorusso) Cardio-Thoracic Surgery Department, Heart and
Vascular Centre, Maastricht University Medical Centre, Maastricht,
Netherlands
(Gozdek, Kubica) Department of Cardiology and Internal Medicine, Collegium
Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Slomka) Department of Pathophysiology, Collegium Medicum UMK in
Bydgoszcz, Bydgoszcz, Poland
(Zielinski) Medical University of Warsaw, Warsaw, Poland
(Anisimowicz) Department of Cardiac Surgery, Collegium Medicum, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum, Nicolaus Copernicus University, Torun, Poland
(Landes, Kornowski) Department of Cardiology, Institute of Interventional
Cardiology, Rabin Medical Center, Petach Tikva and, Tel Aviv University,
Tel Aviv, Israel
(Suwalski) Department of Cardiac Surgery, Centre of Postgraduate Medical
Education, Warsaw, Poland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims To compare transcatheter aortic valve replacement TAVR with
self-expandable first-generation Medtronic CoreValve with new-generation
Evolut R devices in patients with aortic stenosis. Methods Multiple
databases were screened for all available reports directly or indirectly
comparing CoreValve vs Evolut R. Primary endpoint was device success.
Procedural, functional and clinical outcomes were assessed as well.
Results Ten retrospective series including 12 294 pts. were found. Overall
device success rate was 95.5% and was statistically higher in the Evolut R
treated patients as compared with CoreValve: 96.6 vs. 94.8%, respectively;
RR (risk ratio) 95%CIs (confidence intervals): 1.02 (1.00-1.04); P U 0.01.
There were no statistical differences with regard to postoperative mean
aortic gradients 8.5 R/- 5.3 vs 7.9 R/- 4.6 with Evolut R and CoreValve.
Evolut R valve demonstrated nearly 50% reduction of the risk for
moderate-to-severe paravalvilar leak 0.55 (0.39-0.79); P U 0.001; 60%
statistically significant lower risk of developing myocardial injury 0.40
(0.22-0.72); P U 0.002 and numerical reductions in the risk of acute
kidney injury, vascular complications and bleeding. Together with
significantly reduced risk of permanent pacemaker implantation (0.80
[0.67-0.96]; P U 0.02) the above benefits were associated with 40%
reduction in the risk of 30-day all-cause mortality with Evolut R as
compared to CoreValve: 0.60 (0.37-1.00); P U 0.05. Conclusions The use of
new-generation Evolut R was associated with improved procedural,
functional and clinical outcomes compared with the CoreValve
device. Copyright © 2019 Italian Federation of Cardiology -
I.F.C. All rights reserved.

<33>
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. 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. 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. 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. Copyright © 2019, © 2019 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<34>
Accession Number
623488501
Title
Intravenous ivabradine versus placebo in patients with low cardiac output
syndrome treated by dobutamine after elective coronary artery bypass
surgery: A phase 2 exploratory randomized controlled trial.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 193. Date of
Publication: 17 Aug 2018.
Author
Nguyen L.S.; Squara P.; Amour J.; Carbognani D.; Bouabdallah K.; Thierry
S.; Apert-Verneuil C.; Moyne A.; Cholley B.
Institution
(Nguyen, Squara) Critical Care Medicine, CMC Ambroise Pare,
Neuilly-sur-Seine, France
(Amour) Hopital de la Pitie-Salpetriere, AP-HP, Universite Pierre et Marie
Curie, Anesthesiology and Critical Care Medicine, Paris, France
(Carbognani, Bouabdallah) Institut Mutualiste Monsouris, Anesthesiology
and Critical Care Medicine, Paris, France
(Thierry) Centre Cardiologique du Nord, Anesthesiology and Critical Care
Medicine, Saint-Denis, France
(Apert-Verneuil, Moyne) Institut de Recherches Internationales Servier,
Suresnes, France
(Cholley) Hopital Europeen Georges Pompidou, AP-HP, Universite Paris
Descartes-Sorbonne Paris Cite, Anesthesiology and Critical Care Medicine
Department, Paris, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Low cardiac output syndrome (LCOS) is a severe condition which
can occur after cardiac surgery, especially among patients with
pre-existing left ventricular dysfunction. Dobutamine, its first-line
treatment, is associated with sinus tachycardia. This study aims to assess
the ability of intravenous ivabradine to decrease sinus tachycardia
associated with dobutamine infused for LCOS after coronary artery bypass
graft (CABG) surgery. Method(s): In a phase 2, multi-center,
single-blind, randomized controlled trial, patients with left ventricular
ejection fraction below 40% presenting sinus tachycardia of at least 100
beats per minute (bpm) following dobutamine infusion for LCOS after CABG
surgery received either intravenous ivabradine or placebo (three
ivabradine for one placebo). Treatment lasted until dobutamine weaning or
up to 48 h. The primary endpoint was the proportion of patients achieving
a heart rate (HR) in the 80- to 90-bpm range. Secondary endpoints were
invasive and non-invasive hemodynamic parameters and arrhythmia events.
 Result(s): Nineteen patients were included. More patients reached the
primary endpoint in the ivabradine than in the placebo group (13 (93%)
versus 2 (40%); P = 0.04). Median times to reach target HR were 1.0 h in
the ivabradine group and 5.7 h in the placebo group. Ivabradine decreased
HR (112 to 86 bpm, P <0.001) while increasing cardiac index (P = 0.02),
stroke volume (P <0.001), and systolic blood pressure (P = 0.03). In the
placebo group, these parameters remained unchanged from baseline. In the
ivabradine group, five patients (36%) developed atrial fibrillation (AF)
and one (7%) was discontinued for sustained AF; two (14%) were
discontinued for bradycardia. Conclusion(s): Intravenous ivabradine
achieved effective and rapid correction of sinus tachycardia in patients
who received dobutamine for LCOS after CABG surgery. Simultaneously,
stroke volume and systolic blood pressure increased, suggesting a
beneficial effect of this treatment on tissue perfusion. Copyright
© 2018 The Author(s).

<35>
Accession Number
619465272
Title
Efficacy and safety of bivalirudin in coronary artery disease patients
with mild to moderate chronic kidney disease: Meta-analysis.
Source
Journal of Cardiology. 71 (5) (pp 494-504), 2018. Date of Publication: May
2018.
Author
Zeng X.; Lincoff A.M.; Schulz-Schupke S.; Steg P.G.; Elbez Y.; Mehran R.;
Stone G.W.; McAndrew T.; Lin J.; Zhang X.; Shi W.; Lei H.; Jing Z.; Huang
W.
Institution
(Zeng, Zhang, Shi, Lei, Huang) Department of Cardiology, The First
Affiliated Hospital, Chongqing Medical University, Chongqing, China
(Lincoff) Cleveland Clinic Foundation, Cleveland, OH, United States
(Schulz-Schupke) ISA Research Center, Deutsches Herzzentrum, Technische
Universitat, Munich, Germany
(Schulz-Schupke) German Center for Cardiovascular Research (DZHK), Partner
Site Munich Heart Alliance, France
(Steg, Elbez) French Alliance for Cardiovascular Clinical Trials (FACT),
DHU-FIRE, Hopital Bichat (Assistance Publique-Hopitaux de Paris),
Universite Paris-Diderot, Sorbonne-Paris Cite and INSERM U-1148, Paris,
France
(Mehran) Department of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, United States
(Stone) Department of Cardiology, New York-Presbyterian Hospital/Columbia
University Medical Center, New York, United States
(McAndrew) Clinical Trials Center, Cardiovascular Research Foundation, New
York, United States
(Lin) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield Medical School, Sheffield, United Kingdom
(Jing) State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital,
Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing, China
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Patients with chronic kidney disease (CKD) have elevated
bleeding and ischemic outcomes. We aim to assess the short- and long-term
efficacy and safety of bivalirudin compared to heparin plus glycoprotein
IIb/IIIa inhibitors (GPIs) in coronary artery disease (CAD) patients with
CKD. Method(s): Randomized trials were searched in PubMed, Cochrane,
and Embase databases up to January 2017. Among the trials retrieved,
efficacy endpoints were defined as mortality, myocardial infarction (MI),
repeat revascularization, stent thrombosis, and major adverse cardiac
events (MACEs). Safety endpoints were reported as non-coronary artery
bypass grafting (CABG) related major bleeding and thrombolysis in
myocardial infarction (TIMI) major bleeding. Risk ratio (RR) and 95%
confidence interval (CI) were calculated for each outcome using a fixed
effect model. Result(s): Five studies with a total of 3796 patients
were included. In short-term follow up (30 days), bivalirudin
significantly reduced non-CABG related major bleeding (p = 0.0004) and
TIMI major bleeding (p = 0.007) compared to heparin plus GPIs. No
significant differences were observed in rates of mortality, MI, repeat
revascularization, stent thrombosis, and MACEs between the two groups in
short- and long-term follow up (6 months to 3 years). In patients with ST
elevated myocardial infarction (STEMI) with concurrent CKD, the decreased
non-CABG related major bleeding (p = 0.04) without increasing ischemic
events was also observed after short-term follow up. Conclusion(s):
(1) Bivalirudin is safer than and as effective as heparin plus GPIs in CAD
patients with CKD. (2) Impaired renal function does not affect the safety
benefits of bivalirudin. (3) Similar efficacy profiles were identified
between the two groups after both short- and long-term follow up in the
CAD patients with CKD. Copyright © 2017 Japanese College of
Cardiology

<36>
Accession Number
2002111967
Title
Resistance Training Following Median Sternotomy: A Systematic Review and
Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Pengelly J.; Pengelly M.; Lin K.-Y.; Royse C.; Royse A.; Bryant A.;
Williams G.; El-Ansary D.
Institution
(Pengelly, El-Ansary) Department of Health Professions, Swinburne
University of Technology, Melbourne, Vic, Australia
(Pengelly) Independent Researcher, Melbourne, Vic, Australia
(Lin) Department of Physiotherapy, School of Primary and Allied Health
Care, Faculty of Medicine, Nursing and Health Science, Monash University,
Melbourne, Vic, Australia
(Royse, Royse, El-Ansary) Department of Surgery, University of Melbourne,
Melbourne, Vic, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Vic, Australia
(Bryant, Williams) Department of Physiotherapy, University of Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Objective: Despite no evidence to support weight limitations following
median sternotomy, sternal precautions continue to be routinely
prescribed. Moreover, international cardiac rehabilitation guidelines lack
sufficient detail for the implementation of resistance training. This
systematic review and meta-analysis aimed to determine what the literature
defines as resistance training; how resistance training is applied,
progressed and evaluated; and, whether resistance training improves
physical and functional recovery postoperatively in the cardiac surgical
population. Data Sources: Five (5) electronic databases were searched
from inception to 28 September 2018 for studies published in English that
investigated the effects of a resistance training intervention on physical
and functional recovery following median sternotomy. Result(s):
Eighteen (18) trials (n = 3,462) met eligibility criteria and were
included in the analysis. Seven (7) randomised controlled trials shared
common outcome measures, allowing meta-analysis. The performance of
resistance training appears to be safe and feasible, and resulted in
similar improvements in both cardiopulmonary capacity and anthropometry,
when compared to aerobic training alone. However, the definition and
application of resistance training is frequently a lower intensity and
volume than recommended by the American College of Sports Medicine.
Furthermore, sternal precautions are not reflective of the kinematics and
weights used when performing many activities of daily living. For this
reason, resistance training needs to be task-specific, reflecting
functional tasks to promote recovery. Conclusion(s): Resistance
training, in isolation or when combined with aerobic training, may lead to
greater improvements in physical and functional recovery following cardiac
surgery via median sternotomy; however, further research is required to
inform clinical guidelines. Copyright © 2019 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<37>
Accession Number
628403466
Title
What is the best graft to supplement the bilateral internal thoracic
artery to the left coronary system? A meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (1) (pp 21-29), 2019.
Date of Publication: 01 Jul 2019.
Author
Di Mauro M.; Lorusso R.; Di Franco A.; Foschi M.; Rahouma M.; Soletti G.;
Calafiore A.M.; Gaudino M.
Institution
(Di Mauro, Foschi) Heart Department, SS Annunziata Hospital, Chieti, Italy
(Lorusso) Cardiac Surgery Department, Maastricht University Medical
Center, Maastricht, Netherlands
(Di Franco, Rahouma, Soletti, Gaudino) Cardiothoracic Surgery Department,
New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
(Calafiore) Cardiac Surgery Department, Campobasso, Italy
Publisher
NLM (Medline)
Abstract
This meta-analysis was designed to assess the effect of the use of
arterial conduits (ACs) versus great saphenous vein (GSV) grafts as a
third conduit for revascularization of the right coronary artery system,
in addition to the bilateral internal mammary artery on the left coronary
artery. PubMed and OVID's version of MEDLINE were searched from January
2000 to September 2017 for relevant publications. The primary end point
was the long-term mortality rate. The secondary end point was early
mortality, defined as either in-hospital death or death within 30days
after the operation. Meta-regression was used to evaluate the effect of
female gender and diabetes on the primary and secondary outcomes. A total
of 10 studies (4121 patients) were selected for the systematic review and
meta-analysis comparing ACs (1619) versus the GSV (2502), 6 (2548)
comparing the GSV (2548) versus the right gastroepiploic artery (1023) and
5 comparing the GSV (2548) versus the radial artery (596). The pooled
analysis did not show any difference between ACs and the GSV in terms of
long-term mortality rates [hazard ratio (HR) = 0.75, 95% confidence
interval (CI) = 0.56-1.01; P=0.061]. When using the leave-one-out
analysis, after the exclusion of 1 study (outlier), ACs were significantly
associated with lower long-term mortality rates (HR=0.67, 95%
CI=0.54-0.83; P<0.001). When the results were stratified according to the
type of study, no differences with regard to long-term results were found
between ACs and the GSV, either in the pooled analysis of the 6 propensity
score-matched studies (HR=0.69, 95% CI=0.43-1.08; P=0.107) or in the
pooled analysis of the 4 non-propensity score-matched studies (HR=0.88,
95% CI=0.62-1.23; P=0.438). Again, when the outlier was excluded, the
pooled analysis of the propensity score-matched studies confirmed that ACs
were associated with lower long-term mortality rates (HR=0.58, 95%
CI=0.43-0.80; P<0.001). Comparisons between the GSV and either the right
gastroepiploic artery or the radial artery showed similar results. No
publication bias was found. This meta-analysis is the first to compare the
GSV to the radial artery and the right gastroepiploic artery for right
coronary artery grafting in patients receiving a bilateral internal
mammary artery to left coronary artery. The choice of a third AC seems to
be preferable in order to achieve better long-term survival. Copyright
© The Author(s) 2019. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<38>
Accession Number
628397871
Title
Surgical aortic valve replacement and patient-prosthesis mismatch: a
meta-analysis of 108182 patients.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 56 (1) (pp 44-54), 2019.
Date of Publication: 01 Jul 2019.
Author
Sa M.P.B.O.; de Carvalho M.M.B.; Sobral Filho D.C.; Cavalcanti L.R.P.;
Rayol S.D.C.; Diniz R.G.S.; Menezes A.M.; Clavel M.-A.; Pibarot P.; Lima
R.C.
Institution
(Sa, Cavalcanti, Rayol, Diniz, Menezes, Lima) Division of Cardiovascular
Surgery of Pronto Socorro Cardiologico de Pernambuco-PROCAPE, Recife,
Brazil
(Sa, de Carvalho, Sobral Filho, Cavalcanti, Rayol, Diniz, Menezes, Lima)
University of Pernambuco-UPE, Recife, Brazil
(Sa, de Carvalho, Sobral Filho, Lima) Nucleus of Postgraduate and Research
in Health Sciences of Faculty of Medical Sciences and Biological Sciences
Institute-FCM/ICB, Recife, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie et de Pneumologie
de Quebec, Universite Laval, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study sought to evaluate the impact of patient-prosthesis
mismatch (PPM) on the risk of perioperative, early-, mid- and long-term
mortality rates after surgical aortic valve replacement. METHOD(S):
Databases were searched for studies published until March 2018. The main
outcomes of interest were perioperative mortality, 1-year mortality,
5-year mortality and 10-year mortality. RESULT(S): The search yielded
3761 studies for inclusion. Of these, 70 articles were analysed, and their
data were extracted. The total number of patients included was 108 182 who
underwent surgical aortic valve replacement. The incidence of PPM after
surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066
without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95%
confidence interval (CI) 1.302-1.707; P<0.001], 1-year mortality (OR
1.465, 95% CI 1.277-1.681; P<0.001), 5-year mortality (OR 1.358, 95% CI
1.218-1.515; P<0.001) and 10-year mortality (OR 1.534, 95% CI 1.290-1.825;
P<0.001) were increased in patients with PPM. Both severe PPM and moderate
PPM were associated with increased risk of perioperative mortality, 1-year
mortality, 5-year mortality and 10-year mortality when analysed together
and separately, although we observed a higher risk in the group with
severe PPM. CONCLUSION(S): Moderate/severe PPM increases
perioperative, early-, mid- and long-term mortality rates proportionally
to its severity. The findings of this study support the implementation of
surgical strategies to prevent PPM in order to decrease mortality
rates. Copyright © The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<39>
Accession Number
628399534
Title
On-Pump Coronary Artery Bypass Graft: The State of the Art.
Source
Reviews on recent clinical trials. 14 (2) (pp 106-115), 2019. Date of
Publication: 2019.
Author
Cuminetti G.; Bonadei I.; Vizzardi E.; Sciatti E.; Lorusso R.
Institution
(Cuminetti, Bonadei, Vizzardi, Sciatti) Cardiology Unit, Department of
Experimental and Applied Medicine, University of Brescia, Brescia, Italy
(Lorusso) Cardio-Thoracic Surgery Department, Heart & Vascular Centre,
Maastricht University Medical Centre, Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) remains the standard of
care for patients with coronary artery disease (CAD). Debate exists
concerning several factors, which include percutaneous coronary
intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts,
radial artery vs. saphenous vein grafts, right internal mammary artery vs.
radial artery grafts, endoscopic vs. open vein-graft harvesting, and
on-pump vs. off- pump surgery. Moreover, challenging is the management of
diabetic patients with CAD undergoing CABG. This review reports current
indications, practice patterns, and outcomes of CABG. METHOD(S):
Randomized controlled trials comparing CABG to other therapeutical
strategies for CAD were searched through MEDLINE, EMBASE, Cochrane
databases, and proceedings of international meetings. RESULT(S):
Large multicenter randomized and observational studies (SYNTAX, BEST,
PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with
always fewer rates of operative mortality and major morbidity, than PCI.
The 10-year follow-up of ARTS II trial showed no difference between single
and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials
showed that CABG is the best choice for diabetic patients.
 CONCLUSION(S): CABG still represents one of the most widespread major
surgeries, with well-known benefits on symptoms and prognosis in patients
with CAD. However, further studies and follow-up data are needed to
validate these evidences. Copyright© Bentham Science Publishers;
For any queries, please email at epub@benthamscience.net.

<40>
[Use Link to view the full text]
Accession Number
628399515
Title
Personalized Versus Protocolized Fluid Management Using Noninvasive
Hemodynamic Monitoring (Clearsight System) in Patients Undergoing
Moderate-Risk Abdominal Surgery.
Source
Anesthesia and analgesia. 129 (1) (pp e8-e12), 2019. Date of Publication:
01 Jul 2019.
Author
Joosten A.; Raj Lawrence S.; Colesnicenco A.; Coeckelenbergh S.; Vincent
J.L.; Van der Linden P.; Cannesson M.; Rinehart J.
Institution
(Joosten, Raj Lawrence, Colesnicenco, Coeckelenbergh) From the Department
of Anesthesiology, Cliniques Universitaires de Bruxelles (CUB) Erasme,
Universite Libre de Bruxelles, Brussels, Belgium
(Vincent) Department of Intensive Care, CUB Erasme, Universite Libre de
Bruxelles, Brussels, Belgium
(Van der Linden) Department of Anesthesiology, Centre
Hospitalo-Universitaire (CHU) Brugmann, Universite Libre de Bruxelles,
Brussels, Belgium
(Cannesson) Department of Anesthesiology and Perioperative Medicine,
University of California Los Angeles, David Geffen School of Medicine, Los
Angeles, CA, United States
(Rinehart) Department of Anesthesiology and Perioperative Care, University
of California Irvine, Orange, CA, United States
Publisher
NLM (Medline)
Abstract
Advances in noninvasive hemodynamic monitoring systems allow delivery of
goal-directed fluid therapy and could therefore be used in less-invasive
surgical procedures. In this randomized controlled trial, we compared
closed-loop-assisted goal-directed fluid therapy using a noninvasive
cardiac output (Clearsight system) monitor (personalized approach) to a
protocolized fluid therapy approach in 40 patients undergoing
moderate-risk laparoscopic abdominal surgery. Cardiac output and stroke
volume variations were not significantly different in both groups and
remained within predefined target values >90% of the study time.
Personalized fluid therapy does not seem to offer any hemodynamic
advantage over a protocolized approach in this population.

<41>
Accession Number
628283744
Title
Effects of remote ischemic preconditioning in patients undergoing off-pump
coronary artery bypass graft surgery.
Source
Frontiers in Physiology. 10 (APR) (no pagination), 2019. Article Number:
495. Date of Publication: 2019.
Author
Wang H.; Lyu Y.; Liao Q.; Jin L.; Xu L.; Hu Y.; Yu Y.; Guo K.
Institution
(Wang, Liao, Jin, Xu, Hu, Yu, Guo) Department of Anesthesiology, Zhongshan
Hospital, Fudan University, Shanghai, China
(Lyu) Department of Anesthesiology, Yunnan Baoshan Anli Hospital, Baoshan,
China
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Purpose: This study aimed to evaluate effects of remote ischemic
preconditioning (RIPC) on myocardial injury in patients undergoing
off-pump coronary artery bypass graft surgery (OPCABG). Method(s):
Sixty-five patients scheduled for the OPCABG were randomly assigned to
control (n = 32) or RIPC group (n = 33). All patients received general
anesthesia. Before the surgical incision, RIPC was induced on an upper
limb with repeated 5-min ischemia and 5-min reperfusion for four times.
Blood samples were collected from right internal jugular vein. Plasma
levels of IL-6, IL-8, IL-10, TNF-alpha, cTnT, HFABP, IMA, and MDA were
detected at pre-operatively and 0, 6, 18, 24, 48, 72, and 120 h after the
surgery. Left internal mammary artery (LIMA) and great saphenous vein
(GSV) was cut into 2-3 mm for Western blot analysis of Hif-1alpha.
 Result(s): In the present study, RIPC treatment significantly reduced
plasma levels of cardiac troponin T (p < 0.05), heart-type fatty acid
binding protein (p < 0.05), ischemia modified albumin (p < 0.05),
malondialdehyde (p < 0.05), as well as plasma levels of pro-inflammatory
cytokines including IL-6, IL-8, and TNF-alpha (P < 0.05, respectively).
RIPC treatment significantly increased hypoxia-inducible factor-1alpha (p
< 0.05) expression as well. Mechanical ventilation time for postoperative
patients was shortened in RIPC group than those in control group (17.4 +/-
3.8 h vs. 19.7 +/- 2.9 h, respectively, p < 0.05). Conclusion(s):
RIPC by upper limb ischemia shortens mechanical ventilation time in
patients undergoing OPCABG. RIPC treatment reduces postoperative
myocardial enzyme expression and pro-inflammatory cytokine production.
RIPC is a protective therapeutic approach in the coronary artery bypass
graft surgery. Copyright © 2019 Frontiers Media S.A. All Rights
Reserved.

<42>
Accession Number
2002159713
Title
Protective effect of dexmedetomidine combined with ulinastatin on
myocardium in patients undergoing valve replacement.
Source
Farmacia. 67 (3) (pp 437-441), 2019. Date of Publication: 2019.
Author
Zhan Y.; Zhang H.; Han Z.
Institution
(Zhan, Zhang) Department of Anesthesiology, The Third Affiliated Hospital
of Qiqihar Medical University, Qiqihar City 161000, China
(Han) Department of Cardiothoracic Surgery, The Third Affiliated Hospital
of Qiqihar Medical University, Qiqihar City 161000, China
Publisher
Romanian Society for Pharmaceutical Sciences (Str. Traian Vuia 6, sector
2, Bucharest 020956, Romania)
Abstract
The aim of the study was to evaluate the myocardial protective effect of
dexmedetomidine (Dex) combined with ulinastatin in patients undergoing
heart valve replacement (HVR). Thirty-six patients undergoing
cardiopulmonary bypass (CPB) were randomly divided into control group
(group C), Dex group (group D), ulinastatin group (group U), and Dex
combined with ulinastatin group (group B), 9 patients per group.
Hemodynamic changes were monitored in all patients. From each patient 3 mL
of blood was collected from the internal jugular vein at 30 minutes after
anaesthesia induction, 30 minutes after rewarming, 30 minutes, 4 hours and
24 hours after stopping anaesthesia. The concentrations of tumour necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6), plasma S100beta protein
and malondialdehyde (MDA) were measured. The results showed that there was
no significant difference in regional arterial blood pressure, central
venous blood pressure, heart rate and oxygen saturation between the four
groups (p > 0.05). The concentrations of TNF-alpha, IL-6, MDA and S100beta
in blood had no significant difference immediately after anaesthesia
induction (p> 0.05); 30 minutes after anaesthesia induction, 30 minutes
after rewarming, 30 minutes, 4 hours and 24 hours after stopping
anaesthesia, the concentration of TNF-alpha, IL-6, MDA and S100beta in
group D and U were significantly lower than those in group C, while those
in group B were significantly lower than those in groups D and U (p <
0.05). In conclusion, Dex combined with ulinastatin can alleviate
myocardial injury in patients undergoing cardiopulmonary bypass valve
replacement, and has good myocardial protection, superior to the
dexmedetomidine or ulinastatin alone. Copyright © 2019, Romanian
Society for Pharmaceutical Sciences. All rights reserved.

<43>
Accession Number
2002064813
Title
CHEST 2019 Regional Congress Abstracts.
Source
Chest. Conference: CHEST 2019 Regional Congress. Greece. 155 (6
Supplement) (pp A327-A388), 2019. Date of Publication: June 2019.
Author
Anonymous
Publisher
Elsevier Inc.
Abstract
The proceedings contains 61 papers. The topics discussed include: SESTRINS
IN COPD;MULTIDISCIPLINARY APPROACH TO TB DIAGNOSTICS;HYDATID CYST OF THE
LUNG IN PREGNANCY: A RARE CASE PRESENTATION;WET LAB AS A TOOL FOR TEACHING
CARDIO THORACIC SURGERY RESIDENT: WHAT WOULD HALSTED SAY?;LEFT VENTRICULAR
MYXOMA: RECURRENCE AND RISK OF EMBOLISM;ROBOTIC THORACIC SURGERY:
OVERRATED OR EVOLUTION?;A MODIFIED TECHNIQUE FOR CHEST WALL
RECONSTRUCTION: TEN YEARS OF A SINGLE-INSTITUTE EXPERIENCE;MEDIASTINAL
MALIGNANT TRITON TUMOR: RARE CASE SERIES;REAL LIFE EARLY EXPERIENCE WITH
THE AVALUS AORTIC BIOPROSTHESIS;LEFT VENTRICULAR ASSIST DEVICE
IMPLANTATION IN NONCOMPACTION CARDIOMYOPATHY: IS AN AGGRESSIVE SURGICAL
APPROACH MANDATORY FOR EVENT FREE SURVIVAL?;CORRELATION BETWEEN
HISTOLOGICAL SUBTYPES AND PROGNOSIS IN PATIENTS WITH EARLY STAGE LUNG
ADENOCARCINOMA;SMALL DOSES OF STRENGTH TRAINING ARE MORE CARDIOPROTECTIVE
THAN AEROBIC ACTIVITY THROUGHOUT ADULTHOOD;CAUTION WITH THE USE OF
PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH SPONTANEOUS CORONARY
ARTERY DISSECTION;PREDICTORS OF REVERSE MYOCARDIAL REMODELING IN HEART
FAILURE PATIENTS UNDERGOING AEROBIC EXERCISE, DESIGNED WITH INDIVIDUALIZED
METHOD BASED ON LACTATE THRESHOLD DEFINITION;AVERAGE VOLUME ASSURED
PRESSURE SUPPORT AUTO-TITRATING EPAP MODE IN SEVERE PNEUMONIA
PATIENTS;VALIDITY OF PLEURAL FLUID PROTEIN IN DIFFERENTIATING TB FROM
MALIGNANT PLEURAL EFFUSION;THE MANAGEMENT OF RUPTURED HEPATIC HYDATID
CYSTS IN THE THORAX: ABOUT 33 CASES;VASCULAR DEMENTIA IN CHRONIC
CRITICALLY ILL PATIENTS WITH INVASIVE MECHANICAL VENTILATION: A
PROSPECTIVE, RANDOMIZED AND CONTROLLED STUDY;DEXMEDETOMIDINE AS ADJUVANT
THERAPY IN MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME IN ICU: RETROSPECTIVE
COHORT STUDY;PLASMA FIBRINOGEN AS A BIOCHEMICAL MARKER FOR ARDS AMONG
PATIENTS WITH SEVERE PNEUMONIA IN A PHILIPPINE TERTIARY HOSPITAL;A
COMBINED RHEUMATOLOGY/INTERSTITIAL LUNG DISEASES SERVICE: THE
WOLVERHAMPTON EXPERIENCE;EXPERIENCE WITH NINTEDANIB IN A NORTHERN GREECE
CENTER;TRACHEOESOPHAGEAL FISTULA AFTER CHEMOTHERAPY IN PRIMARY MEDIASTINAL
B-CELL LYMPHOMA;OSA IN OBESE PATIENTS

<44>
Accession Number
2001644179
Title
REPORTING OF CARDIOVASCULAR EVENTS IN CLINICAL TRIALS SUPPORTING
FDA-APPROVAL OF CONTEMPORARY CANCER DRUGS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1879), 2019. Date of Publication: 12 March
2019.
Author
Addison D.; Bonsu J.; Charles L.; Guha A.; Baker B.; Woyach J.; Awan F.;
Rogers K.; Lustberg M.; Reinbolt R.; Brammer J.; Miller E.; Jneid H.;
Paskett E.
Institution
(Addison, Bonsu, Charles, Guha, Baker, Woyach, Awan, Rogers, Lustberg,
Reinbolt, Brammer, Miller, Jneid, Paskett) Ohio State University,
Columbus, OH, United States
Publisher
Elsevier USA
Abstract
Background: Cardiovascular disease (CVD) is a leading cause of morbidity
and mortality among patients treated with anticancer therapies. In the US,
novel cancer therapy trials are required to report concerning adverse
events prior to Food and Drug Administration (FDA) approval. Yet, the
pattern and reported incidence of CVD events in these pivotal clinical
trials is unknown. Method(s): From the Drugs@FDA database, MEDLINE,
clinicaltrial.gov, and publicly available FDA reviews we identified all
pivotal (phase II and III) clinical trials tied to anticancer drug
approvals from 1998-2018. The primary outcome was the report of major
adverse cardiovascular events (MACE), defined as incident myocardial
infarction (MI), stroke, heart failure (HF), coronary or peripheral
revascularization, atrial fibrillation (AF) and CVD death, irrespective of
treatment arm. Pooled reported annualized incidence-rates of MACE were
compared to reported rates in a large contemporary similar-aged general
population using relative risks (RR). Population risk difference (RD) for
MACE was estimated. Differences in drug efficacy using pooled binary
endpoint hazard ratios (HR), based on the presence or absence of reported
MACE events were also assessed. Result(s): Overall, there were 189
trials, linked to 123 drugs, enrolling 97,365 participants (58.5+/-5
years, 46.0% female, 80.4% on biologic, targeted or immune-based
therapies) with 148,138 person-years of follow-up. Over a median follow-up
of 18 months, 954 cases of incident MACE (370 HF, 65 MI, 179 stroke, 29
revascularizations, 65 AF and 246 CVD deaths; 680 in the intervention vs
274 control arm; P<0.01) were reported, from the 48.7% of trials noting
any CVD. The overall weighted average incidence was 644 events per 100,000
person-years (777 per 100,000 in the intervention arm), compared to a
reported incidence of 1,408 among similar aged non-cancer trial subjects
(RR 0.46, P<0.01), translating into an RD of 764. There was no association
between reporting CVD events and drug efficacy (HR 0.60 vs 0.65; P =0.22).
 Conclusion(s): Among pivotal clinical trials linked to contemporary
FDA-approved cancer drugs, reported CVD event rates dramatically trail
reported population rates. Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<45>
Accession Number
2001644149
Title
NEGATIVE CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY PREDICTS LOW RISK OF
MAJOR ADVERSE CARDIOVASCULAR EVENTS FOLLOWING NON-CARDIAC SURGERY.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1510), 2019. Date of Publication: 12 March
2019.
Author
Bajwa M.T.; Mathew S.; Pakala A.
Institution
(Bajwa, Mathew, Pakala) University of Oklahoma Health Sciences Center,
Oklahoma City, OK, United States
Publisher
Elsevier USA
Abstract
Background: Pre-operative cardiac risk stratification is an integral part
of surgical planning; stress testing and invasive coronary angiography
have not accurately predicted perioperative risk. Diagnostic accuracy of
coronary computed tomography angiography (CCTA) in this setting is not
well-established. Herein we aim to conduct a review of available
literature on CCTA in patients undergoing non-cardiac surgery (NCS).
 Method(s): Medline, Embase, and PubMed were systematically searched
for studies of CCTA to risk stratify the patients prior to a NCS. A
positive CCTA was defined as at least 50% coronary artery stenosis. The
primary outcome measure was major adverse cardiovascular events (MACE) at
3-6 months post-NCS. Result(s): A total of 7 observational studies
with 2549 (n) patients were included in the analysis. The negative
predictive value of CCTA was 97%, suggesting that a negative CCTA was
associated with a very low risk of MACE following NCS. The positive
predictive value of CCTA was 12%, suggesting that a positive CCTA may not
be associated with increased perioperative MACE. Conclusion(s): Our
study suggests that negative CCTA is associated with reduced risk of MACE
following NCS. This negative predictive value in the setting of NCS
correlates with that observed for CCTA in non-surgical patients. Low
positive predictive value of CCTA for peri-operative risk is likely
related to the high false positive rate of CCTA in detecting significant
coronary artery stenosis. Our analysis suggests that CCTA may have a
significant role in predicting MACE in patients undergoing NCS; randomized
controlled trials for CCTA and CCTA-FFR in the setting of NCS are needed.
Our study was limited by the fact that all the included studies were
observational studies rather than randomized controlled trials; location
of the lesion and peri-operative management was not clearly described in
the studies. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<46>
Accession Number
2001643918
Title
INITIAL RESULTS FROM A NEWLY ESTABLISHED SOLID STATE SPECT MYOCARDIAL FLOW
QUANTIFICATION PROGRAM.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1658), 2019. Date of Publication: 12 March
2019.
Author
Nieves R.; Dietz J.; Soman P.
Institution
(Nieves, Dietz, Soman) University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
Publisher
Elsevier USA
Abstract
Background: We report data from our first twelve months of experience with
flow quantification with CZT SPECT Methods: Patients referred for
vasodilator stress MPI were randomly selected for dynamic imaging on a
DSPECT camera. The patient population was reflective of referral patterns
for MPI or post-heart transplant (HT)evaluation. Patient positioning was
accomplished with a hand-injected 1mCi Tc-99m sestamibi (MIBI) pre-scan.
Vasodilator stress, and rest/ stress MIBI injection using an automated
syringe pump, were performed with the patient under the camera. The
protocol consists of 9mCi and 30mCi of MIBI in 2ml saline followed by a 40
mL saline flush for the rest and stress studies, respectively, with the
tracer injection performed 50s after Regadenoson stress. Data acquired in
list mode were processed on the INVIA 4DM platform. Significant manual
adjustments were made to the blood pool and tissue ROI positions for input
and myocardial activity curve derivation. Result(s): Of 104
non-transplant patients, 83 had normal MPI. Global myocardial flow reserve
(MFR), peak stress flow (PSF) and rest flow (RF) were compared between
patients with normal and abnormal MPI (2.17 vs 1.89, p = .16; 2.91 vs
1.91, p= .00; and 1.5 vs 1.1, p= .028, respectively). Among patients with
normal MPI, MFR (2.1 vs 2.01, p= .287), PSF (3.1 vs 2.7, p= .044), and RF
(1.6 vs 1.5, p=.48) were compared between men and women. Among 16 HT
patients the RF was higher compared to non-transplant patients (1.8 vs
1.4, p=.032) while MF and PSF were similar. Conclusion(s): Myocardial
flow quantification with dynamic SPECT is feasible in the clinical setting
and provides physiologically tenable values. Further studies are needed to
evaluate its additive value to relative perfusion imaging. Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<47>
Accession Number
2001643837
Title
ANTITHROMBOTIC THERAPY AND CARDIOVASCULAR RISK IN PATIENTS WITH ATRIAL
FIBRILLATION AT HIGH RISK FOR THROMBOEMBOLIC EVENTS AFTER TRANSCATHETER
AORTIC VALVE REPLACEMENT: FROM THE PARTNER 2 TRIAL.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1036), 2019. Date of Publication: 12 March
2019.
Author
Kosmidou I.; Madhavan M.; Liu Y.; Alu M.; Biviano A.; Chakravarty T.;
Makkar R.; Thourani V.; Kodali S.; Leon M.
Institution
(Kosmidou, Madhavan, Liu, Alu, Biviano, Chakravarty, Makkar, Thourani,
Kodali, Leon) Cardiovascular Research Foundation, New York, NY, United
States
Publisher
Elsevier USA
Abstract
Background: We sought to determine patterns of antithrombotic therapy use
and impact on clinical outcomes in patients with AF and
CH<inf>2</inf>ADS<inf>2</inf>-VASc<inf>2</inf> score >= 2 undergoing
transcatheter aortic valve replacement (TAVR). Method(s): In the
randomized PARTNER 2 trial and associated registries, 1662 patients with
history of AF and CH<inf>2</inf>ADS<inf>2</inf>-VASc<inf>2</inf> score >=
2 comprised the study cohort. Outcomes at 2yrs were analyzed according to
antithrombotic therapy at discharge. Result(s): During the enrollment
period, 947 patients (47.7%) were discharged on oral anticoagulant therapy
(OAT) [793 (47.4%) on warfarin and 154 (9.3%) on Non-Vitamin K
antagonists]. Antiplatelet therapy (APT) was used for at least 6 months or
until an endpoint event in 364/793 (38.4%) of patients on OAT and 272/715
(38%) of patients not on OAT. At 2 yrs, the rate of the composite outcome
of death or stroke was similar in patients on OAT alone compared to no
therapy (31.5% vs 36.6%, p=0.18) but OAT plus APT significantly reduced
the rate of death or stroke compared to no therapy (21.8% vs 36.6%,
p<0.0001). By multivariable analyses, OAT alone conferred a similar
adjusted risk of death or stroke compared to no therapy. However, OAT plus
APT was associated with a significantly lower risk of death or stroke
compared to no therapy (HR 0.42, 95% CI 0.30-0.59, p<0.0001).
 Conclusion(s): In patients with AF and an absolute indication for OAT
undergoing TAVR for severe AS, OAT significantly reduced the risk of death
or stroke at 2 yrs only when used concomitantly with antiplatelet therapy.
[Figure presented] Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<48>
Accession Number
2001643702
Title
NON-TRANSFEMORAL TRANSCATHETER AORTIC VALVE REPLACEMENT APPROACH IS
ASSOCIATED WITH A HIGHER RISK OF NEW-ONSET ATRIAL FIBRILLATION: A
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1258), 2019. Date of Publication: 12 March
2019.
Author
Angsubhakorn N.; Kittipibul V.; Prasitlumkum N.; Kewcharoen J.; Ungprasert
P.
Institution
(Angsubhakorn, Kittipibul, Prasitlumkum, Kewcharoen, Ungprasert)
University of Minnesota Medical School, Minneapolis, MN, United States
Publisher
Elsevier USA
Abstract
Background: New-onset atrial fibrillation (NOAF) is a frequent
complication of Transcatheter Aortic Valve Replacement (TAVR). Choice of
access routes for TAVR could be a factor that determines the risk of NOAF
although the data is not well-characterized. We aimed to assess the
association between different access routes for TAVR (transfemoral versus
non-transfemoral) and the risk of NOAF. Method(s): A comprehensive
literature review was performed through September 2018 using EMBASE and
MEDLINE. Eligible studies must compare the incidence of NOAF in patients
without pre-existing atrial fibrillation who underwent TAVR. Relative risk
(RR) and 95% confidence intervals (CI) were extracted from each study and
combined together using the random-effects model, generic inverse variance
method of DerSimonian and Laird. Result(s): Seven retrospective
studies with 18,425 patients who underwent TAVR (12,744 with transfemoral
approach, 5,681 with non-transfemoral approach) met the eligibility
criteria. After the procedures, 2,205 (12.0%) patients developed NOAF (656
(5.1%) patients in transfemoral group and 1,549 (27.3%) patients in
non-transfemoral group). There was a significant association between
non-transfemoral approach and the increased risk of NOAF with the pooled
RR of 2.94 (95%CI = 2.53-3.41, p < 0.00001). Conclusion(s): A
significantly increased risk of NOAF following TAVR among those underwent
non-transfemoral approach compared with transfemoral approach was observed
in this meta-analysis. [Figure presented] Copyright 2019 American
College of Cardiology Foundation. All rights reserved.

<49>
Accession Number
2001643613
Title
IMPACT OF MODERATE/SEVERE MITRAL REGURGITATION ON 2-YEAR OUTCOMES AFTER
TRANSCATHETER AORTIC VALVE REPLACEMENT IN THE REPRISE III RANDOMIZED
CONTROLLED TRIAL.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1347), 2019. Date of Publication: 12 March
2019.
Author
Little S.; Vannan M.; Singh S.; Khandheria B.; Allocco D.; Feldman T.;
Weissman N.; Asch F.
Institution
(Little, Vannan, Singh, Khandheria, Allocco, Feldman, Weissman, Asch)
Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
Publisher
Elsevier USA
Abstract
Background: Mitral (MR) and tricuspid regurgitation (TR) often coexist
with aortic stenosis. The impact of preoperative MR and TR on outcomes and
changes in MR and TR after transcatheter aortic valve replacement (TAVR)
were assessed. Method(s): Patients (pts, n=912) with high/extreme
risk and severe, symptomatic aortic stenosis were randomized to receive
either the Lotus or CoreValve (2:1) in REPRISE III. Relevant imaging
parameters were collected and echocardiograms were analyzed by an
independent core laboratory. MR and TR were graded as none/trace, mild,
moderate, or severe. Echocardiographic and clinical results were evaluated
at 2 years. Result(s): In REPRISE III, 11% of patients had baseline
>=moderate MR or >=moderate TR. MR and TR severity improved or was
unchanged in most pts 2 years post-TAVR (MR: 30% improved, 35% unchanged,
7% worsened; TR: 22%, 36%, 18%, respectively). Outcomes at 2 years were
worse in pts with baseline >=moderate MR or TR; rates of hospitalization
and death/hospitalization were significantly worse in pts with baseline
>=moderate MR or TR compared to those without (Table). Bleeding and repeat
procedures were more common in pts with >=moderate MR than without
(Table). Predictors of improvement and impact of persistent MR and TR on
outcomes will be available for the presentation. [Table presented]
 Conclusion(s): Preoperative >=moderate MR or TR contribute to poorer
outcomes in pts undergoing TAVR. Moderate/severe MR and TR were associated
with more frequent hospitalization and
death/hospitalization. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<50>
Accession Number
2001643581
Title
OPTIMAL MEDICAL THERAPY USE AND LONG-TERM OUTCOMES IN CABG-ELIGIBLE HEART
FAILURE PATIENTS: INSIGHTS FROM THE STICH TRIAL.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 45), 2019. Date of Publication: 12 March
2019.
Author
Farsky P.S.; White J.; Sueta C.; Dabrowski R.; Djokovic L.; Drazner M.;
Haddad H.; Ali I.; Keltai M.; Naik A.; Sopko G.; Golba K.; Andersson B.;
Carson P.; Kukulski T.; Al-Khalidi H.; Rouleau J.; Velazquez E.
Institution
(Farsky, White, Sueta, Dabrowski, Djokovic, Drazner, Haddad, Ali, Keltai,
Naik, Sopko, Golba, Andersson, Carson, Kukulski, Al-Khalidi, Rouleau,
Velazquez) Christopher O'Connor, Instituto Dante Pazzanese de Cardiologia,
Sao Paulo, Brazil; Duke Clinical Research Institute, Durhan, NC, USA
Publisher
Elsevier USA
Abstract
Background: Coronary Artery Bypass Grafting (CABG) reduces mortality in
Heart Failure (HF) and coronary artery disease (CAD) patients (pts). There
is a paucity of data on the utilization of optimal medical therapy (OMT)
in HF and CAD pts after revascularization and the impact on long term
outcomes. We evaluate the impact of baseline use of OMT versus Non-OMT on
long-term clinical outcomes in pts receiving CABG compared to patients
with Medical treatment alone (MED). Method(s): The STICH trial
randomized 1212 pts with CAD and left ventricular ejection fraction (LVEF)
<= 35% to CABG + MED versus MED alone. OMT was defined as a combination of
4 drugs: ACEI/ARB, BB, statin, and at least one antiplatelet drug at
baseline, with a median follow up over 9.8 years. Result(s): At
baseline, 58.7% of the pts were on OMT (CABG 56.1%; MED 61.5%), remaining
stable or increasing similarly for both groups during follow up, for
example, at 1 year, CABG 73.2% and Med 74.3%. Age, gender, diabetes were
similar. OMT pts had less atrial fibrillation, lower angina score class,
less advance heart failure class and better renal function. There were no
differences in LVEF and end systolic and diastolic volume index. OMT use
at baseline was associated with a significantly lower all-cause mortality
compared to Non-OMT pts (58.8% vs 67.6%, log-rank P<0.001), lower
cardiovascular mortality (40.3% vs 51.4%, log-rank P<0.001) and lower HF
death, 11.2% vs 15.6%, log-rank P<0.001). Sudden death was not different
(21.5% vs 23.4%, P=0.058). In a multivariable Cox model, OMT was
associated with a lower All-cause mortality (HR 0.78, 95%CI 0.66-0.91
P=0.001). The effect of OMT was similar for both CABG and MED only pts for
these outcomes (p=0.189 for interaction). Hospitalization for HF was not
reduced with OMT. Conclusion(s): OMT is associated with lower
all-cause mortality in CABG eligible HF pts, regardless of the lower
baseline risk among OMT pts and the performance of CABG. OMT should be
strongly considered for all pts with ischemic cardiomyopathy regardless of
whether CABG is performed. Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<51>
Accession Number
2001643293
Title
EFFICACY AND SAFETY OF TRANSCAROTID TRANSCATHETER AORTIC VALVE REPLACEMENT
IN 495 PATIENTS: A SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1374), 2019. Date of Publication: 12 March
2019.
Author
Bob-Manuel T.; Nanda A.; Anunobi C.I.; Soto J.T.; Jenkins J.; Ibebuogu U.
Institution
(Bob-Manuel, Nanda, Anunobi, Soto, Jenkins, Ibebuogu) University of
Tennessee Health Science Center, Memphis, TN, USA; Ochsner Clinic
Foundation, New Orleans, LA, USA
Publisher
Elsevier USA
Abstract
Background: In patients who are unsuitable for traditional access routes
for transcatheter aortic valve replacement (TAVR) due to severe peripheral
vascular disease (PVD), carotid artery (CA) access is an emerging route
for TAVR. This study represents the most up to date outcomes on carotid
access TAVR. Method(s): A systematic review was conducted as per the
Preferred Reporting Instructions for Systematic Reviews and Meta-analysis
(PRISMA). We performed a thorough electronic search through Pubmed, SCOPUS
and Embase databases. Studies including case series and original articles
published between 2012 and 2018 with regards to Transcarotid access TAVR
were included. Only studies reporting data on demographic and procedural
characteristics, management and follow up outcomes were analyzed. Data
were analyzed using the SPSS version 23 (SPSS Inc., Chicago, Illinois).
 Result(s): A total of 11 studies were included in this systematic
review comprising of 495 patients that received CA TAVR. The mean age of
included patients was 80.15 +/- 8.2 and 59% were male. The mean STS score
was 7.7 +/- 4.6. 16% had prior stroke or TIA. 82% of patients had severe
PVD. Mean AVA pre-TAVR was 0.62 +/-0.31. Left Carotid access was used in
85% of patients (n =270), 72% received Self-expanding valves while 28%
received Balloon-Expanding valves (BEV). Device success was achieved in
93% of cases (n=318) Periprocedural mortality occured in 1.6% of cases,
30-day and 1-yr mortality was 5.4% and 10.1% respectively. Major bleeding
and vascular complications occurred in 3.6% and 6.4% of patients
respectively. 18.7% of patients required new pacemaker implantation.
In-hospital stroke or TIA occurred in 3.6% of cases, 30 day stroke or TIA
occurred 4.48% of cases. There were no hemorrhagic strokes. Mean time to
discharge was 10.3 +/- 6.4 days. Conclusion(s): The most contemporary
data on Carotid access TAVR shows impressive device success, low rates of
stroke and pacemaker implantation and an acceptable 30-day and 1-year
mortality. Copyright 2019 American College of Cardiology Foundation.
All rights reserved.

<52>
Accession Number
2001643265
Title
TEMPORAL TRENDS IN 30-DAY AND 1-YEAR MORTALITY RATES AFTER TRANSCATHETER
AORTIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND META-REGRESSION
ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1091), 2019. Date of Publication: 12 March
2019.
Author
Mattke S.; Schneider S.; Orr P.; Lakdawalla D.; Goldman D.
Institution
(Mattke, Schneider, Orr, Lakdawalla, Goldman) University of Southern
California, Los Angeles, CA, United States
Publisher
Elsevier USA
Abstract
Background: Anecdotal evidence suggests that risk-adjusted mortality rates
after TAVR have been declining over the years as the procedure became more
routinized and device technology improved. Confirming this finding with a
systematic assessment of the evidence could have substantial implications
for the choice between TAVR and surgical valve replacements in patients
who are eligible for both approaches. Method(s): We conducted a
systematic review of the published literature up to June 20, 2018 and
extracted data on 30-day and 1-year mortality rates, surgical risk, device
type, study design, and the proportion of procedures that used a
transapical approach. We used meta-regression techniques to test whether
risk-adjusted 30-day and 1-year mortality rates declined over time.
 Result(s): We identified 145 studies, which yielded 179 subsamples
for the analyses, once results for separately reported subgroups were
broken out. Of these, 160 subsamples (89%) representing 137 studies and
91,652 patients contained information on 30-day mortality, and 93
subsamples (52%) representing 84 studies and 40,765 patients information
on 1-year mortality. The adjusted 30-day mortality rate after TAVR fell
from 10.48% (95% CI 7.97-11.65%) in 2007 to 2.27% (95% CI 1.14-4.49%) in
2016, corresponding to a relative decrease of 78% over 10 years. The
adjusted mortality rate within one year after TAVR was 30.24% (95% CI
24.53-36.65%) in 2007 and fell to 11.35% (95% CI 8.32-15.31%) in 2014,
corresponding to a relative decrease of 63% over 8 years.
 Conclusion(s): The results suggest that near-term survival after TAVR
has improved substantially within the short period of time after the
procedure was introduced and support the increasing utilization of
TAVR. Copyright 2019 American College of Cardiology Foundation. All
rights reserved.

<53>
Accession Number
2001643228
Title
AN OUTCOME COMPARISON OF PERCUTANEOUS CORONARY INTERVENTION VERSUS
CORONARY ARTERY BYPASS GRAFTING IN ELDERLY PATIENT WITH MULTI-VESSEL
CORONARY ARTERY DISEASE.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 43), 2019. Date of Publication: 12 March
2019.
Author
Alkhawam H.; Muskula P.R.; Ghrair F.; Windish S.; Ampadu J.; Kichura A.;
Lieber J.; Lim M.; Helmy T.
Institution
(Alkhawam, Muskula, Ghrair, Windish, Ampadu, Kichura, Lieber, Lim, Helmy)
Saint Louis University School of Medicine, St. Louis, MO, USA; Icahn
School of Medicine at Mount Sinai (Elmhurst), Elmhurst, NY, USA
Publisher
Elsevier USA
Abstract
Background: Elderly patients have classically been inadequately
represented in clinical trials. As such, the outcomes of coronary
revascularization strategy (coronary artery bypass grafting [CABG] or
percutaneous coronary intervention [PCI]) in older adults with
multi-vessel coronary artery disease (MVCAD) is unknown. Method(s):
We performed a retrospective analysis of consecutive patients who
underwent cardiac catheterization between 2005-2015. We included the
patients aged 75-89 years old with MVCAD and underwent for
revascularization. Result(s): Out of 9,034 patients underwent cardiac
catheterization, 884 (9.8%) patients were 75-89 years old. Of 884 pts, 45%
found to have MVCAD. Out of 415 pts with MVCAD, 41.7% underwent PCI and
58.3% underwent CABG. Baseline characteristics between both groups were
similar (table 1). Pts who underwent CABG had a higher length of stay
(0.01). The 30-day readmission rate did not differ between both groups
(p=0.2) while the 6-month and 1-year readmission rates were higher in PCI
group (0.004 and 0.007, respectively). No difference between both groups
in term of in-hospital or 30-day post-discharge mortality (0.7 and 0.3,
respectively). Conclusion(s): In our observation study, pts between
75 and 89 years old with MVCAD who underwent CABG had lower 6-month and
1-year readmission rates compared to PCI group. No difference in
short-term mortality between PCI and CABG groups. Randomized trials are
warranted to assess the long-term outcomes among this high-risk
population. [Figure presented] Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<54>
Accession Number
2001643194
Title
IMPACT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON TRANSCATHETER AND
SURGICAL AORTIC VALVE REPLACEMENT: FROM THE PARTNER 2 COHORT A TRIAL.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1200), 2019. Date of Publication: 12 March
2019.
Author
Ando T.; Dvir D.; Nazif T.; Chen S.; Briasoulis A.; Kirtane A.; Afonso L.;
Takagi H.; Crowley A.; Alu M.; Leon M.; Kodali S.
Institution
(Ando, Dvir, Nazif, Chen, Briasoulis, Kirtane, Afonso, Takagi, Crowley,
Alu, Leon, Kodali) Columbia University Medical Center, New York, NY, USA;
Wayne State Medical Center, Detroit, MI, USA
Publisher
Elsevier USA
Abstract
Background: The impact of chronic obstructive pulmonary disease (COPD), an
independent risk factor for worse outcomes after surgery, in patients at
intermediate surgical risk undergoing transcatheter aortic valve
replacement (TAVR) versus surgical aortic valve replacement (SAVR) has not
been investigated in detail. Method(s): Patients in the transfemoral
(TF) cohort of the PARTNER 2A Trial (intermediate surgical risk)
randomized to TF-TAVR or SAVR were analyzed according to COPD status at
baseline. The primary endpoint was 2-year all-cause mortality. Secondary
endpoints were 2-year cardiovascular mortality, composite of all-cause
mortality or re-hospitalization, and changes in Kansas City Cardiomyopathy
Questionnaire overall score (KCCQ-OS). Result(s): A total of 1,542
patients (771 TF-TAVR and 771 SAVR) were included in the analysis. Stroke
was observed less in TF-TAVR (P<inf>interaction</inf> = 0.01) but other
major complications were similar between TF-TAVR and SAVR at 30-days.
Two-year mortality with vs without COPD was 17.5% vs 12.9%, p=0.10, in the
TF-TAVR arm and 17.4% vs 17.3%, p=0.91 in the SAVR arm. In fully adjusted
models*, the primary endpoint for both TF-TAVR (HR 1.52, 95 %CI 0.97-2.39)
and SAVR (HR 0.91, 95% CI 0.55-1.51) was not affected by the presence of
COPD, and no significant interaction was observed between treatment arm
and COPD status (p=0.13). For secondary endpoints, the relative
effectiveness of TF-TAVR vs. SAVR was similar in patients with or without
COPD (all P<inf>interaction</inf> >0.05). The degree of improvement in
KCCQ-OS in both TF-TAVR and SAVR arms was lower in patients with COPD
compared with non-COPD (TAVR: adjusted mean difference [aMD] -5.7, 95% CI
-9.9 to -1.6; SAVR: aMD -4.0, 95% CI -8.6 to 0.5), P<inf>interaction</inf>
= 0.57). *Variables in the regression models included age, sex, STS score,
diabetes mellitus, renal insufficiency, congestive heart failure, 15-foot
walk test >7 seconds, serum albumin < 3.5 mg/dl, LVEF, and moderate or
severe RV dysfunction at baseline. Conclusion(s): Outcomes of
intermediate surgical risk patients who underwent TF-TAVR or SAVR were not
significantly affected by the presence of COPD, and both treatment
modalities conferred similar outcomes in COPD patients. Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<55>
Accession Number
2001643143
Title
BASELINE SIGNIFICANT TRICUSPID REGURGITATION INCREASES RISK OF MORTALITY
IN POST TRANSCATHETER AORTIC VALVE REPLACEMENT: SYSTEMIC REVIEW AND
META-ANALYSIS OF MULTIVARIABLE ADJUSTED OBSERVATIONAL STUDIES.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1198), 2019. Date of Publication: 12 March
2019.
Author
Prasitlumkum N.; Kewcharoen J.; Kittipibul V.; Angsubhakorn N.; Tokavanich
N.; Vutthikraivit W.; Cheungpasitporn W.
Institution
(Prasitlumkum, Kewcharoen, Kittipibul, Angsubhakorn, Tokavanich,
Vutthikraivit, Cheungpasitporn) University of Hawaii Internal Medicine
Residency, Honolulu, HI, United States
Publisher
Elsevier USA
Abstract
Background: Significant tricuspid regurgitation (TR) is a well-recognized
indicator of right ventricular dysfunction. Recent studies showed that
significant TR is potentially associated with increased mortality in
patients with severe aortic stenosis (AS) who underwent Transcatheter
aortic valve replacement (TAVR). However, data remained sparse and
inconclusive. Thus, we assessed the association between significant TR and
mortality in patients undergoing TAVR by a systematic review of the
literature and a meta-analysis. Method(s): We comprehensively
searched the databases of MEDLINE and EMBASE from inception to October
2018. Included studies were published observational studies that evaluated
the effects of significant TR and mortality among patients undergoing
TAVR. Data from each study were combined using the random-effects, generic
inverse variance method of DerSimonian and Laird to calculate risk ratios
and 95% confidence intervals (CIs). Result(s): Eight cohort studies
from August 2011 to May 2018 were included in this meta-analysis involving
27,154 subjects with severe AS undergoing TAVR (6,180 with 20,974 without
significant TR). The presence of significant TR was associated with higher
mortality (pooled risk ratio=2.15, 95 % CI: 1.30-3.57, p = 0.003,
I2=90.4 %). Conclusion(s): Significant TR increased risk
of mortality up to 2-fold among patients with severe AS undergoing TAVR.
Our study suggests that the significant TR should be considered as a part
of risk stratification tools. [Figure presented] Copyright 2019
American College of Cardiology Foundation. All rights reserved.

<56>
Accession Number
2001643060
Title
IN-HOSPITAL OUTCOMES OF ORBITAL VERSUS ROTATIONAL ATHERECTOMY
INTERVENTIONS FOR TREATMENT OF CORONARY ARTERY DISEASE.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1155), 2019. Date of Publication: 12 March
2019.
Author
Mansour A.; Allaham H.; Alahdab F.; Yasar S.; Aggarwal K.; Abdullah O.
Institution
(Mansour, Allaham, Alahdab, Yasar, Aggarwal, Abdullah) University of
Missouri-Columbia, Columbia, MO, United States
Publisher
Elsevier USA
Abstract
Background: Rotational (RA) and Orbital atherectomy (OA) are the most
widely used devices as an adjunct therapy to conventional angioplasty with
or without stenting. The role of their use is controversial. We evaluated
short-term safety outcomes of RA in comparison with OA in coronary
interventions. Method(s): PubMed, Elsevier, EBSCO, Spring databases
and Cochrane Library were queried from 1985 through 2018. Two independent
reviewers selected and appraised studies and extracted data in duplicate.
Patients were divided into OA group and RA group. Primary safety endpoints
included, the rate of in-hospital Major Adverse Cardiac Events (MACE),
myocardial infarction (MI), cardiac and all-cause mortality, stroke,
target vessel revascularization (TVR) and target lesion revascularization
(TLR). Two independent reviewers selected and appraised studies and
extracted data in duplicate. Random-effects meta-analysis was used to pool
outcomes across studies. Result(s): A total of 4569 patients were
included from 13 studies. There was no significant difference between both
modalities in terms of cardiac and all-cause mortality, stroke, target
lesion and vessel revascularization and rate of emergent coronary artery
bypass (CABG). There was a trend for a higher rate of in-hospital major
adverse cardiac events (MACE) with OA 9.8% (95% CI, 7.5% - 12.1%) versus
5.5% (95% CI, 2% - 9.1%) with RA, and myocardial infarction (STEMI and
NSTEMI) with OA 9.5% (95% CI, 7.2% - 11.7%) versus 5.2% (95% CI, 2.2% -
8.2%) with RA use. Conclusion(s): In patients undergoing percutaneous
coronary interventions (PCI), Orbital and Rotational atherectomy have
yielded similar outcomes in terms of cardiac and all-cause mortality,
stroke, target lesion and vessel revascularization and rate of emergent
coronary artery bypass (CABG). Orbital atherectomy was associated with
higher major adverse cardiac events (MACE) and myocardial infarction when
compared with Rotational atherectomy. Copyright 2019 American College
of Cardiology Foundation. All rights reserved.

<57>
Accession Number
2001643056
Title
VESSEL PREPARATION IMPROVES DRUG ELUTING STENT (DES) EXPANSION PARAMETERS
VERSUS DIRECT CORONARY STENTING IN NON-COMPLEX LESIONS AS ASSESSED BY
HIGH-RESOLUTION OPTICAL COHERENCE TOMOGRAPHY (OCT).
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1154), 2019. Date of Publication: 12 March
2019.
Author
Bharmal M.I.; Marginean A.; Lloyd J.; Matsukage H.; Hashim F.; Brummel K.;
Kanelidis A.; Blair J.; Paul J.; Shah A.; Nathan S.
Institution
(Bharmal, Marginean, Lloyd, Matsukage, Hashim, Brummel, Kanelidis, Blair,
Paul, Shah, Nathan) University of Chicago, Chicago, IL, United States
Publisher
Elsevier USA
Abstract
Background: DES may be deployed with or without vessel prep in uncalcified
CAD. It is unknown if vessel prep improves DES expansion/apposition vs.
high-pressure direct stenting and if the architecture of individual DES
platforms impacts expansion. High-resolution OCT is an ideal tool for
measuring DES sizing/expansion. Method(s): We randomized 20 PCI
patients with de novo, minimally calcified (ACC/AHA Type A/B1) lesions to
3 DES implant strategies: semi-compliant PTCA- vs AngioSculpt-predilation
(nominal pressures) followed by DES implant vs direct stenting. Resolute
(R), Promus (P), or Xience (X) DES selection was per operator choice.
Illumien Optis OCT (54 mm pullback, 10 frames/mm) was performed before and
after each prep/implant step. Stent expansion was analyzed every 10 frames
(n = 417 frames) for stent expansion deficit (SED,
observed:bench-predicted expansion), stent-to-vessel ratio (SV), stent
symmetry and expansion (SSE, [diameter<inf>max</inf> -
diameter<inf>min</inf>]/diameter<inf>max</inf>), and strut malapposition
(>=0.3mm strut to intimal vessel wall). Metrics were averaged for prep
strategy and DES type. Result(s): Predilated (PTCA+AngioSculpt) vs
direct stented lesions showed significant differences for SSE (0.13+/-0.01
vs 0.11+/-0.01; p<0.01) but not for malapposition (20/296 frames, 6.6% vs
13/121, 10.7%; p=1.87). AngioSculpt vs PTCA showed significant differences
in SED (0.78+/-0.02 vs 0.87+/-0.02; p<0.01) and SSE (0.15+/-0.01 vs
0.12+/-0.01; p<0.01), but not for malapposition (9/146 frames, 6.2% vs
11/150, 7.3%; p=0.16). DES type predicted SED (0.83+/-0.27 X vs
0.88+/-0.03 R vs 0.78+/-0.01 P, p=0.03) and malapposition (3/131 frames,
2.3% X vs 15/139, 10.8% R; p<0.01 and 3/131 frames, 2.3% X vs 15/147,
10.2% P; p<0.01). Conclusion(s): Even simple coronary lesions
predilated with PTCA or AngioSculpt evidenced better DES expansion vs
direct stenting despite high pressure deployment (16-18 atm).
Malapposition differed by DES type (but not prep strategy), perhaps due to
differences in stent architecture, challenging the belief that same sized
DES from different manufacturers yield identical dimensions. Future
analyses will focus on the interaction between the 3 strategies and DES
type, stratified by stent size. Copyright 2019 American College of
Cardiology Foundation. All rights reserved.

<58>
Accession Number
2001642986
Title
META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS COMPARING MECHANICALLY
EXPANDABLE VERSUS SELF EXPANDABLE VALVES FOR PATIENTS UNDERGOING
TRANSCATHETER AORTIC VALVE IMPLANTATION.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1381), 2019. Date of Publication: 12 March
2019.
Author
Parekh J.; Kanmanthareddy A.; Saadi A.; Pandya J.
Institution
(Parekh, Kanmanthareddy, Saadi, Pandya) Creighton University Medical
Center, Omaha, NE, United States
Publisher
Elsevier USA
Abstract
Background: Mechanically expandable (MEV) and self expandable (SEV) valves
are the two major types utilized for Transcatheter Aortic Valve
Implantation (TAVI). There are two previous meta-analysis published but
only one Randomized Controlled Trial (RCT) was included in both analysis.
Previous registry and observational studies have found conflicting
results. We performed a meta-analysis of RCTs published till date to
compare their safety and efficacy. Method(s): PubMed, Medline and
Google Scholar databases were searched for available RCTs. Analysis was
performed using random effects model. The analyzed outcomes were all-cause
mortality, stroke, new permanent pacemaker (PPM) implantation and moderate
aortic regurgitation (AR) at follow up. Result(s): A total of 3 RCTs
with 1591 patients were included in the analysis. MEV and SEV were used
for TAVI in 947 and 644 patients respectively. The MEV include Edwards
Sapiens XT, Lotus valve system and Sapiens 3 while SEV include
commercially available CoreValve Classic or EvoluteR. There was no
difference in the all-cause mortality with the use of either valve types
(RR 0.94, 95 % CI 0.51 to 1.71). There was no difference in the risk of
stroke (RR 2.16, 95 % CI 0.71 to 6.54), PPM (RR 0.92, 95 % CI 0.43 to
1.97) and AR (RR 0.29, 95 % CI 0.02 to 4.18). Conclusion(s): Compared
to MEV, SEV implantation was associated with a similar risk of all-cause
mortality, stroke, PPM and moderate AR. Due to small sample sizes, larger
RCTs may be needed in the future to show significant differences. [Figure
presented] Copyright 2019 American College of Cardiology Foundation.
All rights reserved.

<59>
Accession Number
2001642484
Title
SURGICAL OUTCOMES IN PATIENTS WITH ANOMALOUS AORTIC ORIGIN OF CORONARY
ARTERY: A SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 625), 2019. Date of Publication: 12 March
2019.
Author
Chakraborty A.; Sandhu S.
Institution
(Chakraborty, Sandhu) University of Miami, Miami, FL, United States
Publisher
Elsevier USA
Abstract
Background: Anomalous Aortic origin of Coronary Artery (AAOCA) can be life
threatening and surgical intervention maybe indicated. A systematic review
was done to assess symptoms and the risk of sudden cardiac death (SCD) pre
and post-surgery Methods: A review of articles from 1998-2018 was done
with key words AAOCA, Anomalous Right Coronary Artery (ARCA), Anomalous
Left Coronary Artery (ALCA) and the MeSH term coronary vessel anomaly.
Presenting and residual symptoms, coronary artery anatomy, type of
surgery, ischemia on stress test and coronary stenosis on CT scan were
recorded. Statistical analysis was done with STATA software Results: There
were 691 patients with a mean age of 21.6 +14.2yrs. ARCA was present in
74% and ALCA in 25%. The vessel course was interarterial in 97.7% and
intramural in 91.5%. Surgical intervention was unroofing in 84% and
reimplantation in 13.5%. Symptoms were present in 70% at presentation and
decreased to 20.5% following surgery (Fig I): chest pain decreased from
47% to 11.1% (p<0.001), syncope/presyncope from 21% to 1.6% (p<0.001),
palpitations from 5% to 2.2% (p=0.003) and dyspnea from 7% to 1%
(p=<0.001). Following surgery coronary artery stenosis by CT scan was
present in 2.2% and a positive stress test in 3.5 % of the patients.
Aborted SCD in 28 patients prior to surgery and in 5 following surgery
(p<0.00001). Conclusion(s): Symptoms and risk of SCD decreased after
surgery for AAOCA. Residual coronary artery stenosis after AAOCA surgery
continues to be a risk factor for SCD. [Figure presented] Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<60>
Accession Number
2001642478
Title
COMPARISON OF PERCUTANEOUS MITRAL VALVE REPAIR AND OPTIMAL MEDICAL THERAPY
VERSUS OPTIMAL MEDICAL THERAPY ALONE FOR PATIENTS WITH SEVERE FUNCTIONAL
MITRAL REGURGITATION: AN UPDATED META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1132), 2019. Date of Publication: 12 March
2019.
Author
Rivera M.; Olarte N.; Knijnik L.; Toirac A.; Fernandes A.; Fernandes G.
Institution
(Rivera, Olarte, Knijnik, Toirac, Fernandes, Fernandes) University of
Miami Miller School of Medicine, Miami, FL, United States
Publisher
Elsevier USA
Abstract
Background: The efficacy of percutaneous mitral valve repair (pMVR) for
severe functional mitral regurgitation (FMR) has been a subject of debate
for many years. New evidence derived from well-designed randomized
controlled trials has shown conflicting results. We conducted a
meta-analysis including high quality observational studies and recently
published randomized controlled trials to investigate further the role of
pMVR for this indication. Method(s): PubMed, EMBASE and Cochrane
library were searched for randomized studies and high quality
retrospective cohorts comparing pMVR plus optimal medical therapy (OMT)
and OMT alone for severe FMR. Odds-ratios (OR) were calculated using
random effect models based on I2 statistics. Result(s):
Pooled analysis of 7 studies (3,440 participants) showed that pMVR + OMT
was associated with better survival than OMT alone (OR 0.48 [95% CI, 0.34
to 0.68]); as well as with a reduction in unplanned heart failure
hospitalizations, (OR 0.52 [95% CI, 0.28-0.98]). Egger's regression test
showed no evidence of publication bias (p=0.245). Conclusion(s): Our
meta-analysis demonstrates that pMVR for subjects with severe FMR already
on optimal medical therapy, led to a significant mortality reduction and
less unplanned hospital admissions. [Figure presented] Copyright 2019
American College of Cardiology Foundation. All rights reserved.

<61>
Accession Number
2001642388
Title
PRIOR EXPOSURE TO A CONVENTIONAL RENIN-ANGIOTENSIN SYSTEM ANTAGONIST AND
ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITION IN ACUTE DECOMPENSATED HEART
FAILURE: A PRESPECIFIED SUBGROUP ANALYSIS OF THE PIONEER-HF TRIAL.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1020), 2019. Date of Publication: 12 March
2019.
Author
Ambrosy A.P.; DeVore A.; Morrow D.; Braunwald E.; Duffy C.; McCague K.;
Rocha R.; Velazquez E.
Institution
(Ambrosy, DeVore, Morrow, Braunwald, Duffy, McCague, Rocha, Velazquez)
Department of Cardiology, The Permanente Medical Group, San Francisco, CA,
USA; Division of Research, Kaiser Permanente Northern California, Oakland,
CA, USA
Publisher
Elsevier USA
Abstract
Background: There are limited data on the efficacy, safety, and
tolerability of sacubitril/valsartan (S/V) in heart failure with a reduced
ejection fraction (HFrEF) patients not previously treated with an
angiotensin converting-enzyme inhibitor (ACEi)/angiotensin receptor
blocker (ARB). Method(s): The PIONEER-HF trial was a prospective,
multicenter, double-blind, active-controlled, randomized clinical trial
which enrolled 887 patients at 129 sites in the United States. Medically
stable patients >18 years of age with an EF <40% and a NT-proBNP >=1600
pg/mL or BNP >=400 pg/mL were eligible for participation no earlier than
24 hours and up to 10 days while still hospitalized for acute
decompensated HF (ADHF). Patients were randomly assigned 1:1 to
in-hospital initiation of S/V titrated to 97/103 mg vs. enalapril titrated
to 10 mg both by mouth twice daily. The primary endpoint was the
time-averaged proportional change in NT-proBNP from baseline to week 8.
Safety endpoints included the incidence of worsening renal function,
hyperkalemia, and hypotension. Exploratory endpoints included death from
any cause, all-cause and HF hospitalizations, left ventricular assist
device implantation, and listing for cardiac transplantation.
 Result(s): Between May 26, 2016 and May 1, 2018, 881 patients (99.3%)
were randomly assigned to S/V (N = 440) or enalapril (N = 441) and
received at least one dose of study drug. Patients were enrolled a median
(25th, 75th) of 68 hours (48, 98) hours from initial
presentation. The mean age was 61+14 years, 72% (N = 635) were male, and
36% (N = 316) were self-reported black. At the time of enrollment, 52% (N
= 459) of patients were not currently being treated with an ACEi/ARB. This
analysis will describe clinical characteristics based on prior ACEi/ARB
exposure and assess the interaction between previous treatment with an
ACEi/ARB and the effects of S/V vs. enalapril on change in NT-proBNP
levels, the incidence of adverse events, and clinical outcomes.
 Conclusion(s): This pre-specified subgroup analysis will provide the
first opportunity to explore the potential benefits of S/V, compared to
enalapril, in HFrEF patients not previously tolerating at least a moderate
dose of an ACEi/ARB. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<62>
Accession Number
2001642313
Title
THE EFFECT OF PLATELET INHIBITON BY CANGRELOR AMONG OBESE PATIENTS
UNDERGOING CORONARY STENTING: INSIGHTS FROM THE CHAMPION TRIALS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1333), 2019. Date of Publication: 12 March
2019.
Author
Peterson B.; Harrington R.; Stone G.; Steg P.G.; Gibson C.M.; Hamm C.;
Price M.; Lopes R.; Leonardi S.; Prats J.; Deliargyris E.; Mahaffey K.;
White H.; Bhatt D.L.
Institution
(Peterson, Harrington, Stone, Steg, Gibson, Hamm, Price, Lopes, Leonardi,
Prats, Deliargyris, Mahaffey, White, Bhatt) Brigham and Women's Hospital,
Boston, MA, United States
Publisher
Elsevier USA
Abstract
Background: In clinical trials, cangrelor reduced periprocedural ischemic
events related to percutaneous coronary stenting (PCI) without increasing
bleeding. However, some antiplatelet agents have shown a differential
treatment effect by body mass index (BMI). Method(s): Patients from
the three CHAMPION trials who were randomized to cangrelor vs control
during PCI were included for analysis and stratified by BMI. The primary
endpoint was a composite of death, myocardial infarction, ischemia-driven
revascularization, or stent thrombosis within 48 hours. The principal
safety outcome was GUSTO severe bleeding at 48 hours. Result(s):
There were 24,893 patients, with 8979 (36.1%) having BMI of >= 30. There
was no significant difference in the primary endpoint among obese vs
non-obese patients (4.3% vs 4.2%; OR 1.02; 95% CI, 0.89-1.15; p=0.82).
There was a consistent benefit in the primary endpoint in patients who
received cangrelor who were obese (3.9% vs 4.7%, OR 0.82; 95% CI,
0.67-1.01; P=0.06) and not obese (3.8% vs 4.7%; OR 0.80; 95% CI,
0.68-0.93; p=0.004); interaction p-value=0.81. There was no difference in
severe bleeding among patients who received cangrelor who were obese (0.1%
vs 0.2%; OR 0.66; 95% CI, 0.23-1.85; p=0.42) or non-obese (0.3% vs 0.2%;
OR 1.7; 95% CI, 0.85-3.37; p=0.13); interaction p-value=0.13.
 Conclusion(s): There was no difference in short term efficacy or
bleeding between obese and non-obese patients. Cangrelor at the time of
PCI is an attractive antiplatelet agent, irrespective of BMI. [Figure
presented] Copyright 2019 American College of Cardiology Foundation.
All rights reserved.

<63>
Accession Number
2001642004
Title
CARDIAC STRUCTURAL CHANGES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
(TAVR): SYSTEMATIC REVIEW AND META-ANALYSIS OF MAGNETIC RESONANCE IMAGING
(MRI) STUDIES.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1543), 2019. Date of Publication: 12 March
2019.
Author
Mehdipoor G.; Chen S.; Chatterjee S.; Torkian P.; Ben-Yehuda O.; Stone G.;
Prince M.
Institution
(Mehdipoor, Chen, Chatterjee, Torkian, Ben-Yehuda, Stone, Prince)
Cardiovascular Research Foundation, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is increasingly
used to treat patients with severe aortic stenosis (AS). We sought to
assess the impact of TAVR on ventricular volumes, mass and function.
 Method(s): Using Meta-analysis of Observational Studies in
Epidemiology (MOOSE) guidelines, we searched PubMed and Embase for studies
reporting cardiac magnetic resonance imaging (MRI) findings before and at
least 1 month after TAVR. Main factors of interest were LV end-diastolic
volume index (LVEDVi), LV end-systolic volume index (LVESVi), LV mass
index (LVMi), and left and right ventricular ejection fraction (LVEF and
RVEF). Standardized mean differences (SMD) were pooled by random effects
meta-analytic techniques. Result(s): We screened 453 publications, 15
of which reported cardiac changes post-TAVR. After excluding studies with
duplicate data, 10 studies (published between 2012-2018) were included for
meta-analysis. A total of 305 patients completed pre- and post-TAVR
follow-up cardiac MRI (163 male (53.4%), age range 78.6-85 years, MRI
follow-up range 6-15 months). TAVR resulted in a significant reduction in
LVEDVi (SMD: -0.25, 95% CI: -0.43 to -0.07, P=0.006), LVESVi (SMD: -0.24,
95% CI: -0.44 to -0.05, P=0.01), LVMi (SMD: -0.82, 95% CI: -1.0 to -0.63,
P<0.001) and a significant increase in LVEF (SMD: 0.22, 95% CI: 0.06 to
0.38, P=0.006). RVEF was not significantly changed after TAVR (SMD: 0.11,
95% CI: -0.15 to 0.38, P=0.40). There was no evidence of heterogeneity
across the included studies (I2: 0%, P<inf>heterogeneity</inf>
>0.05 for all). Across the included studies, the median average reduction
was 4ml/m2 (IQR: 3.1 to 8.2) for LVEDVi, 5ml/m2
(IQR: 3.9 to 5.5) for LVESVi, and 15.1g/m2 (IQR: 11.8 to 18.3)
for LVMi. The median average improvement in LVEF was 3.4% (IQR: 1.0 to
4.6). Conclusion(s): LV reverse remodeling occurred within 6-15
months after TAVR, with reduction in LVEDVi, LVESVi and LVMi. As a result
LVEF improved, with no significant changes observed in RVEF. Copyright
2019 American College of Cardiology Foundation. All rights reserved.

<64>
Accession Number
2001641147
Title
MITRAL REGURGITATION BEFORE TRANSCATHETER AORTIC VALVE IMPLANTATION FOR
AORTIC STENOSIS AND MORTALITY: A META-ANALYSIS AND SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1239), 2019. Date of Publication: 12 March
2019.
Author
Sethi A.; Kodumuri V.; Singbal Y.; Prasad V.; Chaudhary A.; Kassotis J.
Institution
(Sethi, Kodumuri, Singbal, Prasad, Chaudhary, Kassotis) Rutgers Robert
Wood Johnson Medical School, New Brunswick, NJ, United States
Publisher
Elsevier USA
Abstract
Background: Mitral regurgitation (MR) is commonly encountered in patients
with severe aortic stenosis. However, its impact on mortality, as an
independent risk factor, in patients undergoing transcatheter aortic valve
implantation (TAVI) has not been established. Method(s): We performed
a systematic search of electronic databases for studies reporting
characteristics and outcomes of patients with and without significant MR
and/or the adjusted mortality risk associated with MR. We conducted a
random effect meta-analysis. Result(s): Seventeen studies, a total of
20,717 patients, compared outcomes and group characteristics. Twenty-one
studies, a total of 32,257 patients, reported odds of mortality associated
with significant MR adjusting for other variables. The difference in group
characteristics are shown below. The patients with significant MR had a
higher unadjusted short-term (RR = 1.46 95% CI 1.30-1.65) and long-term
mortality (RR = 1.40 95% CI 1.18 - 1.65). Sixteen out of twenty-one
studies with 27,777 patients found no association between MR and mortality
after adjusting for baseline variables. Greater than half of the patients
(0.56 95% CI 0.45 - 0.66) with MR improved by at least a grade upon follow
up. Conclusion(s): The patients with pre-procedural MR undergoing
TAVI have a higher burden of risk factors; however, in our analysis we
found no evidence that patients with MR, after adjusting for other
factors, exhibited a higher mortality. In fact, MR tends to improve in the
majority of patients post TAVI. [Figure presented] Copyright 2019
American College of Cardiology Foundation. All rights reserved.

<65>
Accession Number
2001640400
Title
A META-ANALYSIS OF EFFICACY AND SAFETY OF TRANSRADIAL VERSUS TRANSFEMORAL
ACCESS FOR PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL OCCLUSIONS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1283), 2019. Date of Publication: 12 March
2019.
Author
Apala D.R.; Jhand A.; Thandra A.; Ahsan M.
Institution
(Apala, Jhand, Thandra, Ahsan) Toufik Mahfood Haddad, Venkata Alla,
Creighton University School of Medicine, Omaha, NE, United States
Publisher
Elsevier USA
Abstract
Background: Transradial access (TRA) is now increasingly used for
percutaneous coronary intervention (PCI) of chronic total occlusions (CTO)
vis-a-vis Transfemoral access (TFA). We conducted a meta-analysis to
evaluate the efficacy and safety of TRA compared to TFA for CTO-PCI.
 Method(s): PubMed, Cochrane and Web of Science databases were
systematically searched for studies comparing TRA with TFA for CTO-PCI.
Outcomes of interest were procedural success, technical success and
complications. Odds ratios (OR) and 95% Confidence Intervals (CI) were
calculated. The analysis was performed using DerSimonian and Laird random
effect model. Result(s): Six studies met our inclusion criteria with
a total of 3733 patients (TRA group: 1593 and TFA group: 2140). There was
no statistically significant difference in lesion complexity as calculated
by the J-CTO score (standardized mean difference: -0.16; 95% CI: -0.56 -
0.25, p= 0.45). Procedural and technical success rates were similar in
both the groups. No statistically significant difference was observed in
terms of early complications of death, myocardial infarction, stroke,
major bleeding, pericardial tamponade and urgent coronary artery bypass
surgery. Rates of access site complications were lower in TRA as compared
to TFA (OR: 0.38; 95% CI: 0.19 - 0.75, p= 0.005) (figure1). [Figure
presented] Conclusion(s): Our analysis shows that TRA is as effective
and safe as TFA for CTO-PCI with lower rates of access site
complications. Copyright 2019 American College of Cardiology
Foundation. All rights reserved.

<66>
Accession Number
2001638527
Title
GETTING THE LEAD OUT OF RV PACING: MICRA ACCORDING TO MAUDE.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 527), 2019. Date of Publication: 12 March
2019.
Author
Rousseau L.A.; Henien S.; Sharma E.; McCauley B.; Wu M.; Chu A.
Institution
(Rousseau, Henien, Sharma, McCauley, Wu, Chu) Brown University,
Providence, RI, United States
Publisher
Elsevier USA
Abstract
Background: Leadless pacing has promised to reduce lead- and
pocket-related complications when compared with traditional permanent
transvenous pacing. Early data from the leadless transcatheter pacemaker
Micra has demonstrated safety and efficacy. Observed short-term
complication rates of leadless pacing (4.8%), however, are higher than
conventional single-chamber permanent pacing (4.1%). To further
characterize this phenomenon, we performed a systematic review of
real-world complications reported from the Manufacturer and User Facility
Device Experience (MAUDE) database involving the Micra TPS leadless
pacemaker. Method(s): We performed a systematic review of published
clinical studies comparing the rates of complications from leadless pacing
(Medtronic Micra TPS system) versus historical transvenous permanent
pacing. Observational studies of adverse event rates were identified using
the Cochrane Library, EMBASE, and PubMed. This data was compared with the
MAUDE database reporting Micra adverse events. Result(s): A total of
740 adverse reported events were reviewed from the MAUDE database. Of
these adverse events, a total of 132 pericardial effusions (17.8%) and 50
deaths (6.7%) were reported. 98 of the 132 (74.2%) pericardial effusions
required pericardiocentesis. 24 patients required further surgical
intervention due to failed pericardiocentesis. 25 of 50 deaths were linked
to procedural complications of cardiac tamponade and/or cardiac
perforation. Difficulty in sheath manipulation at the tricuspid valve and
right ventricle as well as kinking of the delivery sheath were cited as
procedural related issues preceding the development of pericardial
effusion. Conclusion(s): MAUDE database adverse events rates for
Micra include the development of pericardial effusions in 17.8% of
patients. 74.2% of these patients required pericardiocentesis. In
addition, 25 of 50 deaths (3.4%) were linked to procedural cardiac
perforation and effusion. The reported rate of cardiac perforation for
leadless pacing in clinical studies is 1.52%. This data suggests that
cardiac perforation remains a significant driver of morbidity and
mortality with leadless pacemaker Micra. Copyright 2019 American
College of Cardiology Foundation. All rights reserved.

<67>
Accession Number
2001638471
Title
SEX-BASED DIFFERENCES IN OUTCOMES AFTER MITRAL VALVE SURGERY FOR SEVERE
ISCHEMIC MITRAL REGURGITATION: FROM THE CARDIOTHORACIC SURGICAL TRIALS
NETWORK.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1951), 2019. Date of Publication: 12 March
2019.
Author
Giustino G.; Overbey J.; Taylor D.; Ailawadi G.; Kirkwood K.; Gillinov A.;
Dagenais F.; Mayer M.-L.; Gelijns A.; Moskowitz A.; Bagiella E.; Miller
M.; Smith P.; O'Gara P.; Acker M.; Lala-Trindade A.A.; Hung J.
Institution
(Giustino, Overbey, Taylor, Ailawadi, Kirkwood, Gillinov, Dagenais, Mayer,
Gelijns, Moskowitz, Bagiella, Miller, Smith, O'Gara, Acker, Lala-Trindade,
Hung) Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier USA
Abstract
Background: Sex-based differences in outcomes after cardiac interventions
have become a major focus of research. However, there is little known
about such differences after mitral valve surgery. The objective of this
analysis was to investigate sex-based differences in clinical and
patient-centered outcomes among patients undergoing mitral valve (MV)
surgery for severe ischemic mitral regurgitation (MR). Method(s): We
evaluated the outcomes of women and men enrolled in a randomized trial
comparing MV replacement versus MV repair for severe ischemic MR. Patients
were followed for 2 years. Endpoints were all-cause death, treatment
failure (defined as the composite of death, MV reoperation, or moderate or
severe recurrent MR), quality of life (QOL) scores and percentage change
in left ventricular end-systolic volume index (LVESVI) from baseline
through 2 years assessed by an echo core-lab. Multiple regression models
were used for analysis Results: Of 251 patients enrolled in the trial, 96
(38.2%) were women. While there was no significant difference in age
between women and men (68.8+/-9.6 vs. 68.2+/-9.7; p=0.60), at baseline
women had a higher burden of diabetes, hypertension and thyroid disease.
Women had higher risk of mortality at 2 years (27.1% vs. 17.4%; absolute
risk increase [ARI]: +9.7%; adjusted hazard ratio: 1.86; 95% CI:
1.05-3.29; p=0.03), and a trend toward higher risk of treatment failure
(57.0% vs. 43.2%; ARI: +13.8%; adjusted odds ratio: 1.78; 95% CI:
0.98-3.23; p=0.06). Adjusting for baseline QOL scores, at 2 years women
had lower median European QOL-5 Dimensions score (75.0 vs. 77.0; adjusted
beta: -7.82; 95% CI: -14.04 to -1.6; p=0.01) and higher (i.e., worse)
median Minnesota Living with Heart Failure score (24.0 vs. 11.0; adjusted
beta: 8.61; 1.85 to 15.37; p=0.01). There was no significant difference
between women and men in the median percentage change in LVESVI from
baseline through 2 years (-15.8% vs. -11.1%; adjusted beta: -10.71%; 95%
CI: -22.97 to 1.55; p=0.09). Conclusion(s): Our analysis suggests
that there are important outcome differences between women and men after
surgery for severe ischemic MR. Women had lower survival and worse QOL
scores at 2 years compared with men. Copyright 2019 American College
of Cardiology Foundation. All rights reserved.

<68>
Accession Number
2001638435
Title
TRANSTHORACIC ECHOCARDIOGRAPHY VERSUS CARDIAC MAGNETIC RESONANCE FOR THE
ASSESSMENT OF AORTIC REGURGITATION AFTER TRANSCATHETER AORTIC VALVE
REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 1182), 2019. Date of Publication: 12 March
2019.
Author
Jonnalagadda A.K.; Papanastasiou C.A.; Kokkinidis D.; Oikonomou E.; Garcia
M.; Karamitsos T.
Institution
(Jonnalagadda, Papanastasiou, Kokkinidis, Oikonomou, Garcia, Karamitsos)
MedStar Washington Hospital Center, Washington, DC, United States
Publisher
Elsevier USA
Abstract
Background: Residual aortic regurgitation (AR) is a major complication
after transcatheter aortic valve replacement (TAVR). Our aim is to review
the level of agreement between two-dimensional transthoracic
echocardiography (2D TTE) and CMR on grading the severity of AR after
TAVR, and determine the accuracy of 2D TTE in detecting moderate or severe
AR. Method(s): Electronic databases were searched in order to
identify studies comparing 2D TTE to CMR for post-TAVR AR assessment.
Kappa coefficient was used to determine the level of agreement between the
two imaging modalities. CMR was used as the reference standard in order to
assess the diagnostic accuracy of 2D TTE. Result(s): Seven studies
were included in this systematic review. Six studies reported a low
correlation between 2D TTE and CMR (kappa coefficient ranging from -0.02
to 0.41), while one study showed good agreement with a kappa coefficient
of 0.72. Given the heterogeneity among the included studies the diagnostic
accuracy of TTE was evaluated by estimating the hierarchical summary
receiver operator characteristic curve. The area under the curve (AUC) for
detection of moderate or severe AR with TTE was 0.83 (95% CI: 0.79 to
0.86). Conclusion(s): Despite the reported significant disconcordance
between TTE and CMR grading of AR, 2D TTE has sufficient ability to
discriminate moderate or severe AR from mild or none AR after TAVR in the
clinical setting [Figure presented] Copyright 2019 American College
of Cardiology Foundation. All rights reserved.

<69>
Accession Number
2001638430
Title
MITRACLIP PLUS OPTIMAL MEDICAL THERAPY VERSUS OPTIMAL MEDICAL THERAPY
ALONE FOR FUNCTIONAL MITRAL REGURGITATION: A META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: 68th Annual
Scientific Session of the American College of Cardiology: ACC.19. United
States. 73 (9 Supplement 1) (pp 814), 2019. Date of Publication: 12 March
2019.
Author
Goel S.; Teja R.; Wats K.; Zakin E.; Chava S.; Ayzenberg S.; Malik B.;
Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Teja, Wats, Zakin, Chava, Ayzenberg, Malik, Frankel, Shani,
Gidwani) Maimonides Medical Center, Brooklyn, NY, USA; Icahn School of
Medicine at Mount Sinai, New York, NY, USA
Publisher
Elsevier USA
Abstract
Background: Functional mitral regurgitation (FMR) caused by left
ventricular dysfunction is associated with poor prognosis. Whether
MitraClip improves clinical outcomes in this patient population remains
controversial. The purpose of this meta-analysis is to compare the
efficacy of MitraClip plus optimal medical therapy (OMT) versus OMT alone
in patients with FMR Methods: We conducted an electronic database search
of all published data for studies that compared Mitraclip plus OMT with
OMT alone for patients with FMR and reported on subsequent mortality,
re-hospitalizations and other outcomes of interest. Event rates were
compared using a Forest plot of relative risk using a random-effects model
assuming interstudy heterogeneity Results: A total of 5 studies (n= 1513,
Mitraclip= 796, OMT= 717) were included in the final analysis. Mitraclip
compared to OMT was associated with a significant reduction in overall
mortality (RR = 0.66, 95% CI = 0.44-0.99, P = 0.04) and re-hospitalization
rates for heart failure (RR = 0.57, 95% CI = 0.36-0.91, P = 0.02). There
was reduced need for heart transplantation or mechanical support
requirement (RR = 0.48, 95% CI = 0.25-0.91, P = 0.02) and unplanned mitral
valve surgery (RR = 0.21, 95% CI = 0.07-0.61, P = 0.004) in the Mitraclip
group. No effect was observed on cardiac mortality (P = 0.42) and the 6
minute walking distance (P=0.22) between two groups Conclusion(s):
Mitraclip improves overall mortality and reduces re-hospitalization rates
in patients with FMR [Figure presented] Copyright 2019 American
College of Cardiology Foundation. All rights reserved.

<70>
Accession Number
2000873413
Title
A double-blind, randomized controlled trial of gabapentin vs. placebo for
acute pain management in critically ill patients with rib fractures.
Source
Injury. 49 (9) (pp 1693-1698), 2018. Date of Publication: September 2018.
Author
Moskowitz E.E.; Garabedian L.; Harden K.; Perkins-Pride E.; Asfaw M.;
Preslaski C.; Liasia K.N.; Lawless R.; Burlew C.C.; Pieracci F.
Institution
(Moskowitz, Garabedian, Harden, Perkins-Pride, Asfaw, Preslaski, Liasia,
Lawless, Burlew, Pieracci) Denver Health Medical Center, University of
Colorado School of Medicine, United States
Publisher
Elsevier Ltd
Abstract
Introduction: Achieving adequate pain control for rib fractures remains
challenging; prescription of alternatives to narcotics is imperative to
curtail the current opioid epidemic. Although gabapentin has shown promise
following elective thoracic procedures, its efficacy in patients with rib
fractures remains unstudied. We hypothesized that gabapentin, as compared
to placebo, would both improve acute pain control and decrease narcotic
use among critically ill patients with rib fractures. Material(s) and
Method(s): Adult patients admitted to the trauma surgery service from
November 2016 - November 2017 at an urban, Level I trauma center with one
or more rib fractures were randomized to either gabapentin 300 mg thrice
daily or placebo for one month following their injury. Daily numeric pain
scores, opioid consumption, oxygen requirement, respiratory rate, and
incentive spirometry recordings during the index admission, as well as and
one-month quality of life survey data were abstracted. Result(s):
Forty patients were randomized. The groups were well matched with respect
to age, gender, prior narcotic use, tobacco use, and prior respiratory
disease. Although the median RibScore did not differ between groups, the
gabapentin group had a higher median number of ribs fractured as compared
to the placebo group (7 vs. 5, respectively). Degree of pulmonary
contusion and injury severity score were similar between groups. Use of
loco-regional anesthetic modalities did not differ between groups. Daily
numeric pain scores, opioid consumption, oxygen requirement, respiratory
rate, and incentive spirometry recordings were similar between both
groups. No benefit was observed when adding gabapentin to a multi-modal
analgesic regimen for rib fractures. There were no instances of pneumonia,
respiratory failure, or mortality in either group. Hospital and intensive
care unit length of stay were similar between groups. Both overall and
chest-specific quality of life was equivalent between groups at one month
follow-up. Conclusion(s): In this group of critically ill patients
with rib fractures, gabapentin did not improve acute outcomes for up to
one month of treatment. Copyright © 2018 Elsevier Ltd

<71>
Accession Number
355461492
Title
Patterns of management of atrial fibrillation complicating coronary artery
bypass grafting: Results from the PRoject of Ex-vivo Vein graft
ENgineering via Transfection IV (PREVENT-IV) Trial.
Source
American Heart Journal. 158 (5) (pp 792-798), 2009. Date of Publication:
November 2009.
Author
Al-Khatib S.M.; Hafley G.; Harrington R.A.; Mack M.J.; Ferguson T.B.;
Peterson E.D.; Califf R.M.; Kouchoukos N.T.; Alexander J.H.
Institution
(Al-Khatib, Hafley, Harrington, Peterson, Califf, Alexander) Duke Clinical
Research Institute, Duke University Medical Center, Durham, NC, United
States
(Al-Khatib, Harrington, Peterson, Califf, Alexander) Division of
Cardiology, Duke University Medical Center, Durham, NC, United States
(Mack) Cardiopulmonary Research Science and Technology Institute, Dallas,
TX, United States
(Ferguson) East Carolina University, Greenville, NC, United States
(Kouchoukos) Missouri Baptist Medical Center, St. Louis, MO, United States
Publisher
Mosby Inc.
Abstract
Background: Current practice related to the management of atrial
fibrillation (AF) complicating coronary artery bypass grafting (CABG) is
uncertain. Method(s): We examined management of post-CABG AF in the
PREVENT-IV trial, and we explored patterns of use of postoperative rhythm
versus rate control and anticoagulation for AF by geographic region and
type of site. We also compared outcomes of patients who developed
post-CABG AF (663) with those who did not (2,131). Result(s): The
incidence of AF was 24%. Post-CABG AF was treated with a rhythm control
strategy in 81% of patients and with warfarin in 23% of patients. Although
there were significant variations across sites in the management of
post-CABG AF, patterns of use of postoperative rhythm versus rate control
and anticoagulation did not differ by geographic region or by whether or
not the enrolling site was an academic institution. Mortality was higher
in patients with post-CABG AF than patients without AF at 30 days (1.5% vs
0.7%, P = .01) but not at 3 years (6.9% vs 4.9%, P = .41). There was a
trend toward a higher risk of mortality or stroke at 30 days in patients
with AF (2.4% vs 1.9%, P = .08). Conclusion(s): Although a rhythm
control strategy was used in most of the patients in this trial and the
overall rate of use of warfarin was low, the significance of these
findings is uncertain because of the lack of data from randomized clinical
trials. The substantial variations in the management of post-CABG AF
across sites are likely because of definitive data on the most effective
therapies, highlighting the need for clinical trials on rate versus rhythm
control and on anticoagulation for AF in this setting. © 2009 Mosby,
Inc. All rights reserved.

<72>
Accession Number
354194133
Title
Meta-Analysis of On-Pump and Off-Pump Coronary Arterial Revascularization.
Source
Annals of Thoracic Surgery. 87 (3) (pp 757-765), 2009. Date of
Publication: March 2009.
Author
Feng Z.-Z.; Shi J.; Zhao X.-W.; Xu Z.-F.
Institution
(Feng, Zhao, Xu) Department of Thoracic Surgery, Shanghai Changzheng
Hospital, Second Military Medical University, Shanghai, China
(Shi) Department of Gastroenterology, Shanghai Changzheng Hospital, Second
Military Medical University, Shanghai, China
Publisher
Elsevier USA
Abstract
Background: There is no agreement whether off-pump coronary artery bypass
(OPCAB) can reduce mortality, rates of stroke, myocardial infarction, or
revascularization when compared with conventional coronary artery bypass
(CCAB). We performed a meta-analysis comparing off-pump coronary artery
bypass with conventional coronary artery bypass in randomized controlled
trials. Method(s): We comprehensively retrieved randomized controlled
studies according to predetermined criteria. We performed meta-analyses
for each outcome and empirically determined whether potential biases that
might result from differences in study design or patient characteristics
actually biased the results of a study. We also conducted sensitivity
analyses and tested for publication bias. Result(s): We undertook a
meta-analysis of ten randomized trials (2,018 patients) of OPCAB surgery
versus CCAB surgery. No significant differences were found for 1-year
mortality (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.75 to
1.33), myocardial infarction (OR, 0.61; 95% CI, 0.44 to 0.84), stroke (OR,
0.56; 95% CI, 0.34 to 0.91), or revascularization (OR, 1.38; 95% CI, 1.00
to 1.92). Therefore, this meta-analysis demonstrates that mortality,
stroke, myocardial infarction, and revascularization were not reduced in
OPCAB. Conclusion(s): In conclusion, OPCAB did not significantly
reduce 1-year mortality, stroke, myocardial infarction, and
revascularization compared with CCAB. © 2009 The Society of Thoracic
Surgeons.

<73>
Accession Number
628323230
Title
Percutaneous left ventricular assist device support during ablation of
ventricular tachycardia: A meta-analysis of current evidence.
Source
Journal of Cardiovascular Electrophysiology. 30 (6) (pp 886-895), 2019.
Date of Publication: June 2019.
Author
Luni F.K.; Zungsontiporn N.; Farid T.; Malik S.A.; Khan S.; Daniels J.; Wu
R.; Link M.S.; Joglar J.A.
Institution
(Luni, Zungsontiporn, Daniels, Wu, Link, Joglar) Department of Cardiology,
UT Southwestern Medical Center, Dallas, TX, United States
(Farid, Khan) Department of Cardiology, University of Louisville,
Louisville, KY, United States
(Malik) Department of Neurology, University of Michigan, Ann Arbor, MI,
United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Catheter ablation of ventricular tachycardia (VT) can be an
effective therapy to reduce VT burden, but often it is limited by the
potential for hemodynamic instability. Percutaneous left ventricular
assist devices (pLVADs) have been used to maintain hemodynamic support
during VT ablation but the evidence regarding its clinical impact has been
inconclusive. Methods and Results: We sought to assess the clinical
impact of pLVAD when used in VT ablation by conducting a meta-analysis of
the current evidence. We searched Pubmed and found nine observational
studies that compared clinical outcomes of VT ablation in patients with
pLVAD support to controls with no pLVAD support. The pooled data did not
show a significant difference in mortality between both groups, nor a
difference in acute procedural success or in recurrence of VT. There was
also no difference in the number of patients receiving a cardiac
transplant or being enrolled in the transplant list. Although there was no
difference in the ablation time between the groups, patients in the pLVAD
group had a longer total procedural time and more procedure-related
adverse effects. Conclusion(s): This meta-analysis did not show
clinical benefits from using pLVAD support during VT ablation, whereas it
was associated with longer procedure times and more complications. This
study was, however, limited by the observational nature of the data. In
view of these data, the risk and benefit of pLVAD support during VT
ablation should be considered on an individual basis. Copyright ©
2019 Wiley Periodicals, Inc.

<74>
Accession Number
628323015
Title
The effect of continuous propofol versus dexmedetomidine infusion on
regional cerebral tissue oxygen saturation during cardiopulmonary bypass.
Source
Romanian Journal of Anaesthesia and Intensive Care. 26 (1) (pp 17-23),
2019. Date of Publication: 01 Apr 2019.
Author
Metry A.A.; Hussain N.S.; Nakhla G.M.; Ragaei M.Z.; Wahba R.M.
Institution
(Metry, Hussain, Nakhla, Ragaei, Wahba) Anaesthesia Department, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
Publisher
Editura Clasium (E-mail: iacalovschi@hotmail.com)
Abstract
Background: Cerebral oxygen desaturation can arise during various
durations of cardiopulmonary bypass (CBP), thus continuous monitoring is
necessary. This desaturation may account for distinct neuropsychological
deficits. Near-infrared spectrophotometry (NIRS) is a non-invasive method
that offers many advantages for monitoring cerebral oxygenation.
 Objective(s): The aim of this study was to compare the outcome of
propofol and dexmedetomidine on cerebral regional oxygen saturation
(rScO<inf>2</inf> ) during CPB and on postoperative cognitive dysfunction.
 Patients and Methods: 50 patients anticipated for open heart
surgeries were encompassed in the study. Patients were divided into 2
groups, group P (receiving propofol) and group D (receiving
dexmedetomidine) during CPB. Both groups were studied for variations in
right and left rScO<inf>2</inf> as well as postoperative cognitive
dysfunction using the Mini Mental State Examination Score (MMSE) test.
 Result(s): The results showed no significant difference in both
groups of the study, with an increase in rScO<inf>2</inf> on the right and
left side in T1 compared to T0 and maximum increase in T3-4-5, then a
decrease in T6-7. With regard to the cognitive dysfunction there was a
decrease in the values at 1 h in both groups without significant
difference; after 1 week MMSE values returned to baseline values.
 Conclusion(s): Propofol and dexmedetomidine infusion used during CPB
preserve the rScO<inf>2</inf> and do not affect the neurological
outcome. Copyright © 2019, Editura Clasium. All rights reserved.

<75>
[Use Link to view the full text]
Accession Number
628316223
Title
Drug-eluting compared to bare metal stents in patients with end-stage
renal disease on dialysis: A meta-analysis.
Source
Journal of Cardiovascular Medicine. 20 (5) (pp 313-320), 2019. Date of
Publication: May 2019.
Author
Galiffa V.A.; Crimi G.; Gritti V.; Scotti V.; Ferrario M.; Repetto A.;
Ferlini M.; Marinoni B.; De Ferrari G.M.; De Servi S.; Bongo A.S.;
Visconti L.O.; Klersy C.
Institution
(Galiffa, Crimi, Gritti, Ferrario, Repetto, Ferlini, Marinoni, Visconti)
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
(Galiffa, Bongo) Coronary Care Unit and Catheterization Laboratory, A.O.U.
Maggiore della Carita, Novara, Italy
(Scotti) Center for Scientific Documentation, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
(De Ferrari) Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo,
Pavia, Italy
(De Servi) IRCCS Multimedica, UO Cardiologia, Sesto San Giovanni, Milan,
Italy
(Klersy) Service of Clinical Epidemiology and Biostatistic, Fondazione
IRCCS Policlinico San Matteo, Pavia, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims To systematically review literature comparing bare metal stent (BMS)
to drug-eluting stent (DES) in end-stage renal disease (ESRD) patients on
dialysis. ESRD patients on dialysis often suffer from accelerated
atherosclerosis and higher rate of stent-related complications including
major adverse cardiovascular events. Because dialysis usually qualifies
ineligibility for randomized clinical trials, an evidenced-based stent
choice for these patients is scarce. Methods PUBMED, CINHAL, COCHRANE,
EMBASE and WEB OF SCIENCE were searched for studies comparing BMS vs. DES
outcome in ESRD patients on dialysis. Results Twenty studies including 64
232 patients were considered. The use of DES was significantly associated
with a reduction in all-cause mortality [odds ratio (OR) 0.83, 95%
confidence interval (CI) 0.76 - 0.89], death from a cardiovascular cause
(OR 0.80, 95% CI 0.76 - 0.84) and target lesion revascularization/target
vessel revascularization (OR 0.73, 95% CI 0.53 - 1.00). No significant
difference was found in stent thrombosis (OR 1.08, 95% CI 0.50 - 2.33) and
myocardial infarction incidence (OR 0.91, 95% CI 0.69 - 1.20). Conclusions
Our meta-analysis shows a significant reduction in all-cause and
cardiovascular mortality with the use of DES over BMS in dialyzed
patients. Despite the lack of randomized studies, systematic use of DES in
these high-risk patients should thus reasonably be considered as a first
option in percutaneous coronary intervention candidates. Copyright
© 2019 Italian Federation of Cardiology - I.F.C. All rights reserved.

<76>
[Use Link to view the full text]
Accession Number
628315378
Title
Meta-analysis of impact of liver disease on mortality after transcatheter
aortic valve implantation.
Source
Journal of Cardiovascular Medicine. 20 (4) (pp 237-244), 2019. Date of
Publication: April 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims To evaluate whether liver disease is associated with increased
mortality after transcatheter aortic valve implantation (TAVI) and whether
TAVI is associated with decreased mortality compared to surgical aortic
valve replacement (SAVR) in patients with liver disease, we performed
meta-analyses of currently available studies. Methods Studies reporting
mortality in TAVI patients with liver disease versus those without liver
disease and mortality after TAVI versus SAVR in patients with liver
disease were eligible to be included. A relative risk (RR) or hazard ratio
of mortality for TAVI patients with versus without liver disease and
mortality for TAVI versus SAVR in patients with liver disease was
extracted from each individual study. Study-specific estimates were
combined in the random-effects model. Results We identified nine studies
of TAVI patients with versus without liver disease and four studies of
TAVI versus SAVR in patients with liver cirrhosis. Pooled analyses
demonstrated no association of liver disease with early
(in-hospital/30-day) mortality (P = 0.28), but a statistically significant
association of liver disease with increases midterm (1 - 2-year) mortality
(hazard ratio 1.87, P < 0.00001) in TAVI patients, and no statistically
significant difference in in-hospital mortality between TAVI and SAVR in
patients with cirrhosis (RR 0.60, P = 0.12). Conclusion There may be no
impact of liver disease on early mortality in TAVI patients, negative
impact of liver disease on mid-term mortality in TAVI patients, and no
difference in in-hospital mortality between TAVI and SAVR in patients with
liver cirrhosis. Copyright © 2019 Italian Federation of
Cardiology - I.F.C. All rights reserved.

<77>
Accession Number
2002219762
Title
Hemoadsorption to Reduce Plasma-Free Hemoglobin During Cardiac Surgery:
Results of REFRESH I Pilot Study.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Gleason T.G.; Argenziano M.; Bavaria J.E.; Kane L.C.; Coselli J.S.;
Engelman R.M.; Tanaka K.A.; Awad A.; Sekela M.E.; Zwischenberger J.B.
Institution
(Gleason) University of Pittsburgh Medical Center, Department of
Cardiothoracic Surgery, Pittsburgh, PA, United States
(Argenziano) Columbia University Medical Center-New York Presbyterian
Hospital, Department of Surgery, New York, NY, United States
(Bavaria) Hospital of the University of Pennsylvania, Department of
Surgery, Philadelphia, PA, United States
(Kane) Texas Children's Hospital, Department of Surgery, Houston, TX,
United States
(Coselli) Texas Heart Institute, Department of Surgery, Houston, TX,
United States
(Engelman) Baystate Medical Center, Department of Surgery, Springfield,
MA, United States
(Tanaka) University of Maryland School of Medicine, Department of
Anesthesiology, Baltimore, MD, United States
(Awad) Cooper University Hospital, Camden, NJ, United States
(Sekela, Zwischenberger) University of Kentucky College of Medicine,
Department of Surgery, Lexington, KY, United States
Publisher
W.B. Saunders
Abstract
Generation of plasma-free hemoglobin (pfHb) and activated complement
during complex cardiac surgery contributes to end-organ dysfunction. This
prospective, multicenter REFRESH I (REduction in FREe Hemoglobin)
randomized controlled trial evaluated the safety and feasibility of
CytoSorb hemoadsorption therapy to reduce these factors during prolonged
cardiopulmonary bypass (CPB). Eligible patients underwent elective,
nonemergent complex cardiac surgery with expected CPB duration >=3 hours.
Exclusions included single procedures including primary coronary artery
bypass graft, single valves, transplant, and left ventricular assist
device extraction. TREATMENT used 2 parallel 300 mL CytoSorb
hemoadsorption cartridges in a side circuit during CPB. CONTROL was
standard of care. Of 52 enrolled patients, 46 underwent surgery (Safety
group, n = 23 vs Control, n = 23), and 38 were evaluated for pfHb
reduction (EFFICACY group, n = 18 vs CONTROL, n = 20). Type and number of
serious adverse events (44 vs 43 CONTROL) were similar, as was 30-day
mortality. Transient reduction in platelets during CPB was observed in
both groups, especially TREATMENT, but returned to pretreatment levels
after CPB without bleeding. Peak pfHb was positively correlated with CPB
length (P = 0.01) but the high variability of pfHb, due to the broad
surgical procedure mix, prevented detection of changes in pfHb in the
overall EFFICACY population. However, the valve replacement surgery
subgroup (8 vs 10 CONTROL) had the highest peak pfHb levels, and TREATMENT
demonstrated significant pfHb reductions vs CONTROL (P <= 0.05) in CPB >=3
hours. In the EFFICACY group, C3a and C5a were significantly reduced by
treatment throughout surgery. Intraoperative hemoadsorption with CytoSorb
was safe and feasible in this randomized, controlled pilot study during
complex cardiac surgery. Treatment with CytoSorb resulted in significant
reductions in pfHb during valve replacement surgery and reductions in C3a
and C5a in the overall EFFICACY group. Future studies will target complex
cardiac surgery patients with prolonged CPB to assess hemoadsorption
effect on end-organ dysfunction and outcomes. Copyright © 2019

<78>
Accession Number
628377657
Title
Dynamics of serum biomarkers depending on myocardial inflammation in
patients with acute decompensation of ischemic heart failure.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2019. Spain. 8 (Supplement 1) (pp 196), 2019. Date of
Publication: April 2019.
Author
Kruchinkina E.V.; Ryabov V.V.; Rogovskaya Y.U.V.; Gusakova A.M.; Ogurkova
O.N.; Suslova T.E.
Institution
(Kruchinkina, Gusakova, Ogurkova, Suslova) Cardiology Research Institute
Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk,
Russian Federation
(Ryabov) Siberian State Medical University, Tomsk, Russian Federation
(Rogovskaya) National Research Tomsk State University, Tomsk, Russian
Federation
Publisher
SAGE Publications Inc.
Abstract
Aim: To conduct a comparative analysis and to assess the dynamics of serum
biomarkers depending on morphological characteristics of myocardial
inflammation in patients with acute decompensation of ischemic heart
failure (ADHF). Method(s): This open-label nonrandomized
single-center prospective trial was registered at clinicaltrials.gov
(#NCT02649517). This trial included 25 patients (84% men; average age of
60.12 +/- 9.3 years; LVEF of 27.5 +/- 13.0%) with ADHF and ischemic
systolic dysfunction. Inclusion criterion was ADHF not earlier than six
months after optimal surgery (percutaneous coronary intervention or/and
coronary artery bypass graft) with optimal drug treatment for ADHF
according to ESC guidelines. All patients underwent angiography and
endomyocardial biopsy with immunohistochemistry. Patients were divided
into two groups: group 1 comprised patients with morphological diagnosis
of myocarditis; group 2 comprised patients without myocarditis.
Immunohistochemical criteria of myocarditis were at least 14 leukocytes
per sq. mm in the myocardium including up to 4 monocytes and 7 or more
CD3+ T lymphocytes per sq. mm. On admission and at one-year follow up,
serum levels of interleukin (IL)-1beta, IL-6, IL-10, highly sensitive
C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-alpha),
troponin I, interferon gamma (IFN-gamma), plasma brain natriuretic peptide
(BNP), and N-terminal fragment of precursor protein brain-type natriuretic
peptide (NT-proBNP) were measured using multiplex immunoassays; serum
levels of insulin-like growth factor 1 receptor (IGF-1R), heat-shock
proteins (HSP60), and placental-like growth factor (PLGF) were measured
using the FLEXMAP 3D Luminex Corporation system and the Human
Cardiovascular Disease Panel 1 and Panel 5. Result(s): Serum
biomarkers did not differ between groups on admission. After a year, all
patients had significant increases in PLGF (p = 0.0455), IGF-IR (p =
0.0269), sST2 (p = 0.0455) and decrease in IL-10 (p = 0.0389), IFN-gamma
(p = 0.0003), and NT-proBNP (p = 0.0020). Also there were decreases in
IFN-gamma (p = 0.0233) and IL-1beta (p = 0.0233) in group 1 and in
IFN-gamma (p = 0.0133) in group 2. The associations were found between
myocardial inflammation and HSP60 (p = 0.0367) and IGF-1R (p = 0.02116).
 Conclusion(s): We did not find any differences in serum biomarkers
between patients with and without myocardial inflammation. After one year,
we also observed a decrease in IL-1beta in patients with myocardial
inflammation compared with a group without myocardial inflammation. The
associations between myocardial inflammation and HSP60 and IGF-1R were
found.

<79>
Accession Number
628377113
Title
Early complete revascularization in acute coronary syndrome: An updated
meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2019. Spain. 8 (Supplement 1) (pp 377-378), 2019. Date
of Publication: April 2019.
Author
Fortuni F.; Angelini F.; Crimi G.; Leonardi S.; D'Ascenzo F.; Ferlini M.;
Raisaro A.; Rolando M.; Oltrona Visconti L.; Ferrario M.; Gnecchi M.; De
Ferrari G.M.
Institution
(Fortuni, Crimi, Ferlini, Raisaro, Rolando, Oltrona Visconti, Ferrario)
IRCCS Policlinico San Matteo., Division of Cardiology, Pavia, Italy
(Angelini) University of Turin, Division of Cardiology, Torino, Italy
(Leonardi, Gnecchi, De Ferrari) Fondazione IRCCS Policlinico San Matteo.,
Coronary Care Unit, Pavia, Italy
(D'Ascenzo) Hospital 'Citta della Salute e della Scienza di Torino',
Division of Cardiology, Turin, Italy
Publisher
SAGE Publications Inc.
Abstract
Aims: The optimal revascularization strategy in hemodynamically stable
patients with Acute Coronary Syndrome (ACS) and multivessel disease is
unknown. A systematic review and meta-analysis was performed to explore
the comparative safety and efficacy of early complete revascularization
versus culprit-only or staged revascularization. Methods and Results:
We searched the literature for Randomized Clinical Trials (RCTs) assessing
this issue. Early complete revascularization was defined as a complete
revascularization achieved during the index procedure or during the same
hospitalization within 72 hours. 10 RCTs with a total of 3373 patients
were included, 1527 received early complete revascularization and 1846
were treated with other revascularization strategies. As shown in the
figure, after a mean follow up of 14.9} 8.9 months early complete
revascularization was associated with a lower risk of Major Adverse
Cardiovascular Events (RR 0.52, 95% CI 0.43-0.62; P < 0.00001-Number
Needed to Treat: 7, Absolute Risk Reduction: 15.1%), all-cause mortality
(RR 0.72, 95% CI 0.52-0.99), myocardial infarction (RR 0.60, 95% CI
0.42-0.86) and repeat revascularization (RR 0.41, 95% CI 0.30-0.56)
without any difference in stroke, total bleedings and Contrast Induced
Acute Kidney Injury compared with culprit-only or staged
revascularization. Conclusion(s): Early complete revascularization
should be considered in ACS hemodynamically stable patients with
multivessel disease if patient has no high risk feature, percutaneous
coronary revascularization is feasible and it is not complex. Further
studies are needed to confirm the safety of early complete
revascularization as our study was not adequately powered to detect a
difference in safety outcomes.

<80>
Accession Number
628376849
Title
Upstream therapy using preoperative renin-angiotensin system inhibitors in
prevention of postoperative atrial fibrillation and adverse events: A
collaborative pooled-analysis over 27,000 patients.
Source
Europace. Conference: 43rd Annual Meeting of the European Working Group on
Cardiac Cellular Electrophysiology, EWGCCE 2019. Portugal. 21 (Supplement
2) (pp ii861), 2019. Date of Publication: March 2019.
Author
Chen S.; Schmidt B.; Sommer P.; Liu S.; Krucoff M.; Kiuchi M.; Andrea B.;
Acou W.; Schratter A.; Nagase T.; Ling Z.; Yin Y.; Hindricks G.;
Puererfellner H.; Chun J.
Institution
(Chen, Schmidt, Nagase, Chun) Cardiology Centre Bethanien (CCB), Frankfurt
am Main, Germany
(Sommer, Hindricks) Heart Center of Leipzig, Leipzig, Germany
(Liu) Shanghai Jiao Tong University Affiliated First People's Hospital,
Shanghai, China
(Krucoff) Duke Clinical Research Institute, Durham, United States
(Kiuchi, Andrea) Universidade Federal Fluminense, Rio de Janeiro, Brazil
(Acou) AZ Delta, Roeselare, Belgium
(Schratter) Hietzing Hospital, Vienna, Austria
(Ling, Yin) Second Affiliated Hospital, Chongqing Medical University,
Chongqing, China
(Puererfellner) Elisabethinen University Teaching Hospital, Cardiology,
Linz, Austria
Publisher
Oxford University Press
Abstract
Background: Renin-angiotensin-system inhibitors (RASIs) have been
suggested as an upstream therapy for atrial fibrillation (AF); however,
the evidence in surgical setting is limited. Purpose(s): We aimed to
evaluate the role of preoperative RASIs in prevention of postoperative
atrial fibrillation (POAF) and adverse events for patients undergoing
cardiac surgery. Method(s): This is a collaborative pooled-analysis
of both randomized and nonrandomized controlled trials comparing
preoperative RASIs with no preoperative RASIs treatment on the incidence
of POAF. Pooled-analysis was performed using a random-effect model.
Sensitivity and subgroup analyses of RCTs were performed to test the
stability of the overall-effect, and meta-regression to explore the
potential risk of bias. The primary outcome was 30-day POAF, and the
secondary outcomes included rate of stroke, mortality and duration of
hospitalization. Result(s): Eleven trials involving 27885 patients
(male 74%, median age 65yrs) were included. As compared to the control
group, preoperative RASIs did not significantly reduce the risk of POAF
(OR: 1.04, 95%CI: 0.91-1.19), stroke (OR: 0.86, 95%CI: 0.62-1.19), death
(OR: 1.07, 95%CI: 0.85-1.35), composite adverse cardiac events (OR: 1.04,
95%CI: 0.91-1.18), and hospital stay (WMD: -0.04, 95%CI: -1.05-0.98).
Pooled-analysis of randomized trials showed consistent results. The
primary overall-effect was maintained in sensitivity analyses.
Multi-regression analysis showed that male-gender was a significant
risk-factor of POAF and use of Beta-blockers was associated with a
significantly reduced risk in developing POAF. Conclusion(s): This
comprehensive pooled-analysis demonstrates that preoperative RASIs do not
offer additional benefit in reducing the acute risk of postoperative AF,
stroke, death and hospitalization in patients undergoing cardiac surgery.

<81>
Accession Number
628376662
Title
Concomitant anti-platelet therapy in warfarin-treated patients undergoing
cardiac rhythm device implantation: A secondary analysis of the BRUISE
CONTROL trial.
Source
Europace. Conference: 43rd Annual Meeting of the European Working Group on
Cardiac Cellular Electrophysiology, EWGCCE 2019. Portugal. 21 (Supplement
2) (pp ii897), 2019. Date of Publication: March 2019.
Author
Essebag V.; Alturki A.; Proietti R.; Healey J.S.; Wells G.A.; Birnie D.
Institution
(Essebag, Alturki) McGill University Health Centre, Cardiology, Montreal,
Canada
(Proietti) University of Padova, Cardiac, Thoracic and Vascular Sciences,
Padua, Italy
(Healey) Population Health Research Institute, Hamilton, Canada
(Wells, Birnie) University of Ottawa Heart Institute, Ottawa, Canada
Publisher
Oxford University Press
Abstract
Background: Concomitant anti-platelet therapy is commonly used in patients
receiving oral anticoagulation and may increase bleeding risk among
patients undergoing cardiac implantable electronic device (CIED) surgery.
 Purpose(s): To assess the proportion of patients undergoing CIED
surgery who are receiving anti-platelet therapy, the proportion in whom
usage is guideline-indicated, and the risk of clinically significant
hematoma (CSH). Method(s): A secondary analysis of the Bridge or
Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE
CONTROL). Patients who were receiving warfarin, had an annual predicted
risk of thromboembolism of 5% or more and were scheduled to receive
undergo non-emergent CIED surgery (implantation of a new device,
pulse-generator change, lead replacement, or pocket revision) were
included. Participants were randomized to continued warfarin versus
heparin bridging. In the current analysis, patients were divided into
those receiving anti-platelet therapy and those not receiving
anti-platelet therapy. The proportion of patients on unnecessary and
potentially interruptible antiplatelet therapy was estimated. Unnecessary
(not indicated) concomitant antiplatelet therapy was defined as the
absence of a percutaneous coronary intervention (PCI) or coronary artery
bypass grafting (CABG) within the preceding 12 months, as well as the
absence of any mechanical valves The incidence of CSH was compared in both
groups and within the randomization sub-groups. Result(s): All 681
patients enrolled in BRUISE CONTROL were included, of whom 280 received
and 401 did not receive anti-platelet therapy. Anti-platelet therapy
increased the risk of CSH (relative risk, 1.72; 95% confidence interval
(CI), 1.09 to 2.72; P = 0.02). Regarding anti-platelet therapy, most
patients were receiving aspirin (268; 95.7%), including 18 (6.4%) who were
receiving dual anti-platelet therapy (DAPT), while the remaining 12 were
receiving clopidogrel alone. There were no patients receiving ticagrelor
or prasugrel. Of the 280 patients receiving anti-platelet therapy, 97
(34.6%) had no guideline indication for concomitant anti-platelet therapy
and an additional 146 (52.1%) were on anti-platelet therapy that could
potentially have been interrupted around CIED surgery. Conclusion(s):
Concomitant anti-platelet therapy in patients receiving anticoagulation is
associated with a significant risk of CSH. The majority of concomitant
anti-platelet therapy is unnecessary or interruptible.

<82>
Accession Number
628305377
Title
Fluid management in patients undergoing cardiac surgery: Effects of an
acetate- versus lactate-buffered balanced infusion solution on hemodynamic
stability (HEMACETAT).
Source
Critical Care. 23 (1) (no pagination), 2019. Article Number: 159. Date of
Publication: 06 May 2019.
Author
Pfortmueller C.A.; Faeh L.; Muller M.; Eberle B.; Jenni H.; Zante B.;
Prazak J.; Englberger L.; Takala J.; Jakob S.M.
Institution
(Pfortmueller, Faeh, Zante, Prazak, Takala, Jakob) Department of Intensive
Care Medicine, Inselspital, Bern University Hospital, University of Bern,
Freiburgstrasse 10, Bern 3010, Switzerland
(Muller) Institute of Health Economics and Clinical Epidemiology,
University Hospital of Cologne, Cologne, Germany
(Muller) Department of Emergency Medicine, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Eberle) Department of Anaesthesiology and Pain Medicine, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
(Jenni, Englberger) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recent evidence suggests that acetate-buffered infusions
result in better hemodynamic stabilization than 0.9% saline in patients
undergoing major surgery. The choice of buffer in balanced crystalloid
solutions may modify their hemodynamic effects. We therefore compared the
inopressor requirements of Ringer's acetate and lactate for perioperative
fluid management in patients undergoing cardiac surgery. Method(s):
Using a randomized controlled double-blind design, we compared Ringer's
acetate (RA) to Ringer's lactate (RL) with respect to the average rate of
inopressor administered until postoperative hemodynamic stabilization was
achieved. Secondary outcomes were the cumulative dose of inopressors, the
duration of inopressor administration, the total fluid volume
administered, and the changes in acid-base homeostasis. Patients
undergoing elective valvular cardiac surgery were included. Patients with
severe cardiac, renal, or liver disease were excluded from the study.
 Result(s): Seventy-five patients were randomly allocated to the RA
arm, 73 to the RL. The hemodynamic profiles were comparable between the
groups. The groups did not differ with respect to the average rate of
inopressors (RA 2.1 mcg/kg/h, IQR 0.5-8.1 vs. RL 1.7 mcg/kg/h, IQR
0.7-8.2, p = 0.989). Cumulative doses of inopressors and time on
individual and combined inopressors did not differ between the groups. No
differences were found in acid-base parameters and their evolution over
time. Conclusion(s): In this study, hemodynamic profiles of patients
receiving Ringer's lactate and Ringer's acetate were comparable, and the
evolution of acid-base parameters was similar. These study findings should
be evaluated in larger, multi-center studies. Trial registration:
Clinicaltrials.gov NCT02895659. Registered 16 September
2016. Copyright © 2019 The Author(s).

<83>
Accession Number
628374630
Title
Outcomes of Vocal Fold Motion Impairment and Dysphagia after Pediatric
Cardiothoracic Surgery: A Systematic Review.
Source
Otolaryngology - Head and Neck Surgery (United States). (no pagination),
2019. Date of Publication: 2019.
Author
Orzell S.; Joseph R.; Ongkasuwan J.; Bedwell J.; Shin J.; Raol N.
Institution
(Orzell) Department of Otolaryngology, SUNY Upstate Medical Center,
Syracuse, NY, United States
(Joseph) School of Medicine, Emory University, Atlanta, GA, United States
(Ongkasuwan, Bedwell) Department of Otolaryngology, Baylor College of
Medicine, Houston, TX, United States
(Shin) Department of Otolaryngology, Harvard Medical School, Boston, MA,
United States
(Raol) Department of Otolaryngology-Head and Neck Surgery, School of
Medicine, Emory University, Atlanta, GA, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: The objective of this study was to systematically review the
literature regarding vocal fold motion impairment (VFMI), respiratory
outcomes, and swallowing outcomes in children following congenital heart
surgery (CHS). Data Sources: PubMed, Embase, Medline, and CINAHL
databases. Review Methods: Data sources were searched from inception to
November 30, 2018. Studies that described recovery of VFMI and swallowing
function following CHS were included, and a qualitative analysis was
performed. Result(s): A total of 1371 studies were identified, of
which 8 met inclusion criteria for VFMI and 5 met inclusion criteria for
swallowing outcomes. Studies including patients who underwent isolate
patent ductus arteriosus ligation were excluded. VFMI was present in 8% to
59% of subjects, and rates of recovery ranged from 9% to 96% at 6 months
to 6 years of follow-up. Inability to maintain an oral diet occurred in
14% to 100% of subjects with VFMI and 11% to 61% without VFMI following
surgery. Tolerance of an oral diet without tube feeding was present in 66%
to 75% of subjects with VFMI and 88% to 100% without VFMI at 24 days to
3.2 years of follow-up. Limited data suggest that time to extubation is
longer in VFMI subjects, but overall hospital length of stay and mortality
may not be affected by VFMI status. Conclusion(s): Data evaluating
dysphagia and VFMI after CHS are limited. Most studies suggest significant
improvement in swallowing function, while rate of recovery of VFMI is
variable. Future prospective studies with standardized screening and
follow-up are needed to better elucidate outcomes to help develop
algorithms for identification and management of VFMI after
CHS. Copyright © American Academy of Otolaryngology-Head and Neck
Surgery Foundation 2019.

<84>
Accession Number
628374481
Title
Prognostic factors of mortality after surgery in infective endocarditis:
systematic review and meta-analysis.
Source
Infection. (no pagination), 2019. Date of Publication: 2019.
Author
Varela Barca L.; Navas Elorza E.; Fernendez-Hidalgo N.; Moya Mur J.L.;
Muriel Garcia A.; Fernandez-Felix B.M.; Miguelena Hycka J.; Rodriguez-Roda
J.; Lopez-Menendez J.
Institution
(Varela Barca, Miguelena Hycka, Rodriguez-Roda, Lopez-Menendez) Department
of Cardiovascular Surgery, University Hospital Ramon y Cajal, Ctra.
Colmenar Viejo, km. 9.100, Madrid 28034, Spain
(Navas Elorza) Department of Infectology, University Hospital Ramon y
Cajal, Madrid, Spain
(Fernendez-Hidalgo) Department of Infectious Diseases, University Hospital
Vall d'Hebron, Barcelona, Spain
(Moya Mur) Department of Cardiology, University Hospital Ramon y Cajal,
Madrid, Spain
(Muriel Garcia, Fernandez-Felix) Clinical Biostatistics Unit, Hospital
Ramon y Cajal (IRYCIS), Madrid, Spain
(Fernandez-Felix) CIBER Epidemiology and Public Health (CIBERESP), Madrid,
Spain
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Purpose: There is a lack of consensus about which endocarditis-specific
preoperative characteristics have an actual impact over postoperative
mortality. Our objective was the identification and quantification of
these factors. Method(s): We performed a systematic review of all the
studies which reported factors related to in-hospital mortality after
surgery for acute infective endocarditis, conducted according to PRISMA
recommendations. A search string was constructed and applied on three
different databases. Two investigators independently reviewed the
retrieved references. Quality assessment was performed for identification
of potential biases. All the variables that were included in at least two
validated risk scores were meta-analyzed independently, and the pooled
estimates were expressed as odds ratios (OR) with their confidence
intervals (CI). Result(s): The final sample consisted on 16 studies,
comprising a total of 7484 patients. The overall pooled OR were
statistically significant (p < 0.05) for: age (OR 1.03, 95% CI 1.00-1.05),
female sex (OR 1.56, 95% CI 1.35-1.81), urgent or emergency surgery (OR
2.39 95% CI 1.91-3.00), previous cardiac surgery (OR 2.19, 95% CI
1.84-2.61), NYHA >= III (OR 1.84, 95% CI 1.33-2.55), cardiogenic shock (OR
4.15, 95% CI 3.06-5.64), prosthetic valve (OR 1.98, 95% CI 1.68-2.33),
multivalvular affection (OR 1.35, 95% CI 1.01-1.82), renal failure (OR
2.57, 95% CI 2.15-3.06), paravalvular abscess (OR 2.39, 95% CI 1.77-3.22)
and S. aureus infection (OR 2.27, 95% CI 1.89-2.73). Conclusion(s):
After a systematic review, we identified 11 preoperative factors related
to an increased postoperative mortality. The meta-analysis of each of
these factors showed a significant association with an increased
in-hospital mortality after surgery for active infective endocarditis.
Graphic abstract: Graph summary of the Pooled Odds Ratios of the 11
preoperative factors analyzed after the systematic review and
meta-analysis.[Figure not available: see fulltext.]. Copyright ©
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<85>
Accession Number
627234012
Title
Checkpoint inhibitor therapy for cancer in solid organ transplantation
recipients: An institutional experience and a systematic review of the
literature.
Source
Journal for ImmunoTherapy of Cancer. 7 (1) (no pagination), 2019. Article
Number: 106. Date of Publication: 16 Apr 2019.
Author
Abdel-Wahab N.; Safa H.; Abudayyeh A.; Johnson D.H.; Trinh V.A.; Zobniw
C.M.; Lin H.; Wong M.K.; Abdelrahim M.; Gaber A.O.; Suarez-Almazor M.E.;
Diab A.
Institution
(Abdel-Wahab, Suarez-Almazor) Section of Rheumatology and Clinical
Immunology, Department of General Internal Medicine, University of Texas,
MD Anderson Cancer Center, Houston, TX, United States
(Abdel-Wahab) Department of Rheumatology and Rehabilitation, Faculty of
Medicine, Assiut University Hospitals, Assiut, Egypt
(Safa, Johnson, Trinh, Zobniw, Wong, Diab) Department of Melanoma Medical
Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX,
United States
(Abudayyeh) Section of Nephrology, Division of Internal Medicine,
University of Texas, MD Anderson Cancer Center, Houston, TX, United States
(Lin) Department of Biostatistics, University of Texas, MD Anderson Cancer
Center, Houston, TX, United States
(Abdelrahim, Gaber) Houston Methodist Hospital, Houston, TX, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Checkpoint inhibitors (CPIs) have revolutionized the treatment
of cancer, but their use remains limited by off-target inflammatory and
immune-related adverse events. Solid organ transplantation (SOT)
recipients have been excluded from clinical trials owing to concerns about
alloimmunity, organ rejection, and immunosuppressive therapy. Thus, we
conducted a retrospective study and literature review to evaluate the
safety of CPIs in patients with cancer and prior SOT. Method(s): Data
were collected from the medical records of patients with cancer and prior
SOT who received CPIs at The University of Texas MD Anderson Cancer Center
from January 1, 2004, through March 31, 2018. Additionally, we
systematically reviewed five databases through April 2018 to identify
studies reporting CPIs to treat cancer in SOT recipients. We evaluated the
safety of CPIs in terms of alloimmunity, immune-related adverse events,
and mortality. We also evaluated tumor response to CPIs. Result(s):
Thirty-nine patients with allograft transplantation were identified. The
median age was 63 years (range 14-79 years), 74% were male, 62% had
metastatic melanoma, 77% received anti-PD-1 agents, and 59% had prior
renal transplantation, 28% hepatic transplantation, and 13% cardiac
transplantation. Median time to CPI initiation after SOT was 9 years
(range 0.92-32 years). Allograft rejection occurred in 41% of patients
(11/23 renal, 4/11 hepatic, and 1/5 cardiac transplantations), at similar
rates for anti-CTLA-4 and anti-PD-1 therapy. The median time to rejection
was 21 days (95% confidence interval 19.3-22.8 days). There were no
associations between time since SOT and frequency, timing, or type of
rejection. Overall, 31% of patients permanently discontinued CPIs because
of allograft rejection. Graft loss occurred in 81%, and death was reported
in 46%. Of the 12 patients with transplantation biopsies, nine (75%) had
acute rejection, and five of these rejections were T cell-mediated. In
melanoma patients, 36% responded to CPIs. Conclusion(s): SOT
recipients had a high allograft rejection rate that was observed shortly
after CPI initiation, with high mortality rates. Further studies are
needed to optimize the anticancer treatment approach in these
patients. Copyright © 2019 The Author(s).

<86>
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. 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. 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. Conclusion(s): Monoclonal antibodies against PCSK9
were associated with a lower risk of positively adjudicated cardiovascular
events, MI, coronary revascularization, and stroke. Copyright ©
2017, Springer Medizin Verlag GmbH.

<87>
Accession Number
2002096732
Title
Rational and design of the INtentional COronary revascularization versus
conservative therapy in patients undergOing successful peripheRAl arTEry
revascularization due to critical limb ischemia trial (INCORPORATE trial).
Source
American Heart Journal. 214 (pp 107-112), 2019. Date of Publication:
August 2019.
Author
Toth G.; Brodmann M.; Barbato E.; Mangiacapra F.; Schneller L.; Orias V.;
Gil R.; Bil J.; Bartus S.; Ruzsa Z.
Institution
(Toth) Division of Cardiology, Department of Medicine, Medical University
of Graz, Austria
(Brodmann) Division of Angiology, Department of Medicine, Medical
University of Graz, Austria
(Barbato) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Mangiacapra) Unit of Cardiovascular Science, Department of Medicine,
Campus Bio-Medico University, Rome, Italy
(Orias, Ruzsa) Division of Invasive Cardiology and Angiology, Bacs-Kiskun
County Hospital, Kecskemet, Hungary
(Orias, Ruzsa) Semmelweis University, Cardiac and Vascular Center,
Budapest, Hungary
(Gil, Bil) Department of Invasive Cardiology, Central Clinical Hospital of
the Ministry of Interior and Administration, Warsaw, Poland
(Bartus) 2nd Department of Cardiology, Jagiellonian University,
Krakow, Poland
(Schneller) Division of Cardiology, Department of Medicine, Medical
University of Graz, Graz, Austria
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Critical limb ischemia is associated with excessively high risk for
cardiovascular events, including myocardial infarction and death.
Additionally, in this patient population non-invasive evaluation of
coronary artery disease is limited due to (1) inability of exercise
testing, (2) frequent occurrence of balanced ischemia and (3) frequent
occurrence of diffuse coronary calcification. Intentional Coronary
Revascularization Versus Conservative Therapy in Patients Undergoing
Peripheral Artery Revascularization Due to Critical Limb Ischemia trial
(INCORPORATE trial) is a multicentric international randomized open label
clinical trial. Trial will recruit patients, who underwent successful
peripheral artery revascularization due to critical limb ischemia and
randomize 1:1 to conservative medical therapy versus an immediate invasive
strategy to investigate and treat coronary artery disease. The objective
is to evaluate whether intentional invasive strategy with ischemia
targeted reasonably complete coronary revascularization is superior as
compared to conventional primarily conservative approach in terms of
spontaneous myocardial infarction and overall survival at 12 months
follow-up. The trial is registered at clinicaltrials.gov
(NCT03712644). Copyright © 2019 Elsevier Inc.

<88>
Accession Number
628083868
Title
Hypertonic saline for fluid resuscitation after cardiac surgery
(HERACLES): Study protocol for a preliminary randomised controlled
clinical trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 357. Date of
Publication: 14 Jun 2019.
Author
Pfortmueller C.A.; Messmer A.S.; Hess B.; Reineke D.; Jakob L.; Wenger S.;
Waskowski J.; Zuercher P.; Stoehr F.; Erdoes G.; Luedi M.M.; Jakob S.M.;
Englberger L.; Schefold J.C.
Institution
(Pfortmueller, Messmer, Hess, Jakob, Wenger, Waskowski, Zuercher, Stoehr,
Jakob, Schefold) Department of Intensive Care Medicine, Inselspital, Bern
University Hospital, University of Bern, Freiburgstrasse 18, Bern CH-3010,
Switzerland
(Erdoes, Luedi) Department of Anaesthesiology and Pain Medicine,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Reineke, Englberger) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intraoperative and postoperative management of cardiac surgery
patients is complex, involving the application of differential
vasopressors and volume therapy. It has been shown that a positive fluid
balance has a major impact on postoperative outcome. Today, the advantages
and disadvantages of buffered crystalloid solutes are a topic of
controversy, with no consensus being reached so far. The use of hypertonic
saline (HS) has shown promising results with respect to lower total fluid
balance and postoperative weight gain in critically ill patients in
preliminary studies. However, collection of more data on HS in critically
ill patients seems warranted. This preliminary study aims to investigate
whether fluid resuscitation using HS in patients following cardiac surgery
results in less total fluid volume being administered. Method(s): In
a prospective double-blind randomised controlled clinical trial, we aim to
recruit 96 patients undergoing elective cardiac surgery for ischaemic
and/or valvular heart disease. After postoperative admission to the
intensive care unit (ICU), patients will be randomly assigned to receive 5
ml/kg ideal body weight HS (7.3% NaCl) or normal saline (NS, 0.9% NaCl)
infused within 60 min. Blood and urine samples will be collected
preoperatively and postoperatively up to day 6 to assess changes in renal,
cardiac, inflammatory, acid-base, and electrolyte parameters.
Additionally, we will perform renal ultrasonography studies to assess
renal blood flow before, during, and after infusion, and we will measure
total body water using preoperative and postoperative body composition
analysis (bioimpedance). Patients will be followed up for 90 days.
 Discussion(s): The key objective of this study is to assess the
cumulative amount of fluid administered in the intervention (HS) group
versus control (NS) group during the ICU stay. In this preliminary,
prospective, randomised controlled clinical trial we will test the
hypothesis that use of HS results in less total fluids infused and less
postoperative weight gain when compared to the standard of intensive care
in cardiac surgery patients. Trial registration: ClinicalTrials.gov,
NCT03280745. Registered on 12 September 2017. Copyright © 2019
The Author(s).

<89>
Accession Number
628083573
Title
The safety and efficiency of intravenous administration of tranexamic acid
in coronary artery bypass grafting (CABG): A meta-analysis of 28
randomized controlled trials.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 104.
Date of Publication: 14 Jun 2019.
Author
Zhang Y.; Bai Y.; Chen M.; Zhou Y.; Yu X.; Zhou H.; Chen G.
Institution
(Zhang, Bai, Chen, Zhou, Yu, Zhou, Chen) Department of Anesthesiology, Sir
Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
310020, China
(Bai) Department of Anesthesiology, Fifth People's Hospital of Yuhang
District, Hangzhou 311100, China
(Chen) Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou
310008, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The safety and efficiency of intravenous administration of
tranexamic acid (TXA) in coronary artery bypass grafting (CABG) remains
unconfirmed. Therefore, we conducted a meta-analysis on this topic.
 Method(s): We searched the Cochrane Central Register of Controlled
Trials (CENTRAL), PUBMED and EMBASE for randomized controlled trials on
the topic. The results of this work are synthetized and reported in
accordance with the PRISMA statement. Result(s): Twenty-eight studies
met our inclusion criteria. TXA reduced the incidence of postoperative
reoperation of bleeding (relative risk [RR], 0.46; 95% confidence interval
[CI]; 0.31-0.68), the frequency of any allogeneic transfusion (RR, 0.64;
95% CI, 0.52-0.78) and the postoperative chest tube drainage in the first
24 h by 206 ml (95% CI - 248.23 to - 164.15). TXA did not significantly
affect the incidence of postoperative cerebrovascular accident (RR, 0.93;
95%CI, 0.62-1.39), mortality (RR, 0.82; 95%CI, 0.53-1.28), myocardial
infarction (RR, 0.90; 95%CI, 0.78-1.05), acute renal insufficiency (RR,
1.01; 95%CI, 0.77-1.32). However, it may increase the incidence of
postoperative seizures (RR, 6.67; 95%CI, 1.77-25.20). Moreover, the
subgroup analyses in on-pump and off-pump CABG, the sensitivity analyses
in trials randomized more than 99 participants and sensitivity analyses
that excluded the study with the largest number of participants further
strengthened the above results. Conclusion(s): TXA is effective to
reduce reoperation for bleeding, blood loss and the need for allogeneic
blood products in patients undergoing CABG without increasing
prothrombotic complication. However, it may increase the risk of
postoperative seizures. Copyright © 2019 The Author(s).

<90>
Accession Number
628083447
Title
Recommendations for the management of MPS IVA: Systematic evidence- A nd
consensus-based guidance.
Source
Orphanet Journal of Rare Diseases. 14 (1) (no pagination), 2019. Article
Number: 137. Date of Publication: 13 Jun 2019.
Author
Akyol M.U.; Alden T.D.; Amartino H.; Ashworth J.; Belani K.; Berger K.I.;
Borgo A.; Braunlin E.; Eto Y.; Gold J.I.; Jester A.; Jones S.A.; Karsli
C.; Mackenzie W.; Marinho D.R.; McFadyen A.; McGill J.; Mitchell J.J.;
Muenzer J.; Okuyama T.; Orchard P.J.; Stevens B.; Thomas S.; Walker R.;
Wynn R.; Giugliani R.; Harmatz P.; Hendriksz C.; Scarpa M.
Institution
(Akyol) Department of Otolaryngology, Hacettepe University, Ankara, Turkey
(Alden) Department of Neurosurgery, Ann and Robert H. Lurie Children's
Hospital of Chicago, Northwestern University, Feinberg School of Medicine,
Chicago, IL, United States
(Amartino) Child Neurology Department, Hospital Universitario Austral,
Buenos Aires, Argentina
(Ashworth) Department of Paediatric Ophthalmology, Manchester Royal Eye
Hospital, Manchester University NHS Foundation Trust, Manchester, United
Kingdom
(Belani) Department of Anesthesiology, University of Minnesota,
Minneapolis, MN, United States
(Berger) Departments of Medicine and Neuroscience and Physiology, New York
University School of Medicine, Andre Cournand Pulmonary Physiology
Laboratory, Bellevue Hospital, New York, NY, United States
(Borgo) Orthopaedics Clinic, Padova University Hospital, Padova, Italy
(Braunlin) Division of Pediatric Cardiology, University of Minnesota,
Minneapolis, MN, United States
(Eto) Advanced Clinical Research Centre, Institute of Neurological
Disorders, Kanagawa, Japan
(Gold) Keck School of Medicine, Departments of Anesthesiology, Pediatrics,
and Psychiatry and Behavioural Sciences, Children's Hospital Los Angeles,
Department of Anesthesiology Critical Care Medicine, 4650 Sunset
Boulevard, Los Angeles, CA, United States
(Jester) Hand and Upper Limb Service, Department of Plastic Surgery,
Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
(Jones) Willink Biochemical Genetic Unit, Manchester Centre for Genomic
Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust,
Manchester, United Kingdom
(Karsli) Department of Anesthesiology and Pain Medicine, Hospital for Sick
Children, Toronto, Canada
(Mackenzie) Department of Orthopedics, Nemours/Alfred I, Dupont Hospital
for Children, Wilmington, DE, United States
(Marinho) Department of Ophthalmology, UFRGS, Ophthalmology Service, HCPA,
Porto Alegre, Brazil
(McFadyen) Isaac Foundation, Campbellford, ON, Canada
(McGill) Department of Metabolic Medicine, Queensland Children's Hospital,
Brisbane, Australia
(Mitchell) Division of Pediatric Endocrinology, Montreal Children's
Hospital, Montreal, QC, Canada
(Muenzer) Department of Pediatrics, School of Medicine, University of
North Carolina at Chapel Hill, Chapel Hill, NC, United States
(Okuyama) Department of Clinical Laboratory Medicine, National Centre for
Child Health and Development, Tokyo, Japan
(Orchard) Division of Blood and Marrow Transplantation, Department of
Pediatrics, University of Minnesota, Minneapolis, MN, United States
(Stevens, Thomas) MPS Society, Amersham, Buckinghamshire, United Kingdom
(Walker) Department of Paediatric Anaesthesia, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Wynn) Department of Paediatric Haematology, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Giugliani) Department of Genetics, UFRGS, Medical Genetics Service, HCPA,
Porto Alegre, Brazil
(Harmatz) UCSF Benioff Children's Hospital Oakland, Oakland, CA, United
States
(Hendriksz) Steve Biko Academic Hospital, University of Pretoria,
Pretoria, South Africa
(Scarpa) Center for Rare Diseases at Host Schmidt Kliniken, Wiesbaden,
Germany
(Eto) Department of Paediatrics/Gene Therapy, Tokyo Jikei University
School of Medicine, Tokyo, Japan
(Scarpa) Department of Paediatrics, University of Padova, Padova, Italy
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: Mucopolysaccharidosis (MPS) IVA or Morquio A syndrome is an
autosomal recessive lysosomal storage disorder (LSD) caused by deficiency
of the N-acetylgalactosamine-6-sulfatase (GALNS) enzyme, which impairs
lysosomal degradation of keratan sulphate and chondroitin-6-sulphate. The
multiple clinical manifestations of MPS IVA present numerous challenges
for management and necessitate the need for individualised treatment.
Although treatment guidelines are available, the methodology used to
develop this guidance has come under increased scrutiny. This programme
was conducted to provide evidence-based, expert-agreed recommendations to
optimise management of MPS IVA. Method(s): Twenty six international
healthcare professionals across multiple disciplines, with expertise in
managing MPS IVA, and three patient advocates formed the Steering
Committee (SC) and contributed to the development of this guidance.
Representatives from six Patient Advocacy Groups (PAGs) were interviewed
to gain insights on patient perspectives. A modified-Delphi methodology
was used to demonstrate consensus among a wider group of healthcare
professionals with experience managing patients with MPS IVA and the
manuscript was evaluated against the validated Appraisal of Guidelines for
Research and Evaluation (AGREE II) instrument by three independent
reviewers. Result(s): A total of 87 guidance statements were
developed covering five domains: (1) general management principles; (2)
recommended routine monitoring and assessments; (3) disease-modifying
interventions (enzyme replacement therapy [ERT] and haematopoietic stem
cell transplantation [HSCT]); (4) interventions to support respiratory and
sleep disorders; (5) anaesthetics and surgical interventions (including
spinal, limb, ophthalmic, cardio-thoracic and ear-nose-throat [ENT]
surgeries). Consensus was reached on all statements after two rounds of
voting. The overall guideline AGREE II assessment score obtained for the
development of the guidance was 5.3/7 (where 1 represents the lowest
quality and 7 represents the highest quality of guidance).
 Conclusion(s): This manuscript provides evidence- A nd
consensus-based recommendations for the management of patients with MPS
IVA and is for use by healthcare professionals that manage the holistic
care of patients with the intention to improve clinical- A nd
patient-reported outcomes and enhance patient quality of life. It is
recognised that the guidance provided represents a point in time and
further research is required to address current knowledge and evidence
gaps. Copyright © 2019 The Author(s).

<91>
Accession Number
628083739
Title
Efficacy of programmed intermittent bolus epidural analgesia in thoracic
surgery: A randomized controlled trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 107.
Date of Publication: 15 Jun 2019.
Author
Higashi M.; Shigematsu K.; Nakamori E.; Sakurai S.; Yamaura K.
Institution
(Higashi, Nakamori, Sakurai, Yamaura) Department of Anesthesiology,
Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka
814-0180, Japan
(Shigematsu) Operation Rooms, Fukuoka University Hospital, Fukuoka, Japan
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Continuous epidural infusion (CEI) has some disadvantages,
such as increased local anesthetic consumption and limited area of
anesthetic distribution. Programmed intermittent bolus (PIB) is a
technique of epidural anesthesia in which boluses of local anesthetic are
automatically injected into the epidural space. The usefulness of PIB in
thoracic surgery remains unclear. In this study, we aimed to compare the
efficacies of PIB epidural analgesia and CEI in patients undergoing
thoracic surgery. Method(s): This randomized prospective study was
approved by the Institutional Review Board. The study included 42
patients, who were divided into CEI (n = 21) and PIB groups (n = 21). In
the CEI group, patients received continuous infusion of the local
anesthetic at a rate of 5.1 mL/90 min. In the PIB group, a pump delivered
the local anesthetic at a dose of 5.1 mL every 90 min. The primary
endpoints were the frequency of patient-controlled analgesia (PCA) and the
total dose of local anesthetic until 36 h following surgery. Student's
t-test, the chi-square test, and the Mann-Whitney U test were used for
statistical analyses. Result(s): The mean number of PCA
administrations and total amount of local anesthetic were not
significantly different between the two groups up to 24 h following
surgery. However, the mean number of PCA administrations and total amount
of local anesthetic at 24-36 h after surgery were significantly lower in
the PIB group than in the CEI group (median [lower-upper quartiles]: 0
[0-2.5] vs. 2 [0.5-5], P = 0.018 and 41 [41-48.5] vs. 47 [43-56], P =
0.035, respectively). Hypotension was significantly more frequent in the
PIB group than in the CEI group at 0-12 h and 12-24 h (3.3% vs. 0.5%, P =
0.018 and 7.9% vs. 0%, P = 0.017, respectively). Conclusion(s): PIB
can reduce local anesthetic consumption in thoracic surgery. However, it
might result in adverse events, such as hypotension. Trial registration:
This randomized prospective study was approved by the Institutional Review
Board (IRB No. 15-9-06) of the Fukuoka University Hospital, Fukuoka,
Japan, and was registered in the clinical trials database UMIN (ID
000019904) on 24 November 2015. Written informed consent was obtained from
all patients. Copyright © 2019 The Author(s).

<92>
Accession Number
628043357
Title
Transcatheter versus surgical aortic valve replacement in low- and
intermediate-risk patients: an updated systematic review and
meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. 34 (3) (pp 216-225), 2019.
Date of Publication: 16 Jul 2019.
Author
Ueshima D.; Fovino L.N.; D'Amico G.; Brener S.J.; Esposito G.; Tarantini
G.
Institution
(Ueshima, Fovino, D'Amico, Tarantini) Cardiology Unit, Department of
Cardiac, Thoracic and Vascular Sciences, University of Padua Medical
School, Padua, Italy
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, NY, United States
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples Federico II, Naples, Italy
(Tarantini) Clinica Cardiologica, Ospedale di Padova, Centro Cardiologico
Gallucci, Via Giustiniani, 2, Padua 35128, Italy
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Transcatheter aortic valve replacement (TAVR) has been recognized as a
well-established alternative to surgical aortic valve replacement (SAVR)
for symptomatic aortic stenosis with high surgical risk. With this updated
systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low-
and intermediate-risk subjects. Studies comparing TAVR and SAVR in
low-risk patients (defined as STS <= 8% or EuroSCORE <= 20%) were
identified with electronic searches. The principal endpoint was all-cause
mortality at short term (< 3 months), 1, and 2 years. Other outcomes of
interest were cardiac mortality, neurological events, paravalvular leakage
(PVL), myocardial infarction (MI), major bleeding, acute kidney injury
(AKI), vascular complications, and new pacemaker (PM) implantation.
Seventeen articles including 9805 (4956 TAVR and 4849 SAVR) patients were
eligible. There was no significant difference in all-cause mortality at
short term [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.63-1.09],
1 year (OR 1.01, 95% CI 0.86-1.20) and 2 years (OR 0.86, 95% CI 0.64-1.16)
between treatment groups. Subgroup analyses stratified by surgical risk
score (low-risk subgroup: STS < 4% or EuroSCORE < 10%, intermediate-risk
subgroup: the others) did not show interaction on primary endpoints.
Compared to SAVR, TAVR had similar rates of neurological events,
significantly lower risk of MI and AKI, but higher risk of vascular
complications, new PM implantation and moderate/severe PVL. In low- and
intermediate-risk patients, TAVR and SAVR have similar short- and mid-term
all-cause mortality. Compared to SAVR, TAVR carries higher rates of
vascular complications, PM implantation and moderate/severe PVL, but lower
risk of MI and AKI. Copyright © 2018, Japanese Association of
Cardiovascular Intervention and Therapeutics.

<93>
Accession Number
622228015
Title
Propensity Score-Based Methods in Comparative Effectiveness Research on
Coronary Artery Disease.
Source
American Journal of Epidemiology. 187 (5) (pp 1064-1078), 2018. Date of
Publication: 01 May 2018.
Author
Ellis A.G.; Trikalinos T.A.; Wessler B.S.; Wong J.B.; Dahabreh I.J.
Institution
(Ellis, Trikalinos, Dahabreh) Center for Evidence Synthesis in Health,
School of Public Health, Brown University, 121 South Main Street,
Providence, RI 02912, United States
(Ellis, Trikalinos, Dahabreh) Department of Health Services, Policy and
Practice, Brown University, Providence, RI, United States
(Wessler) Predictive Analytics and Comparative Effectiveness Center, Tufts
Medical Center, Boston, MA, United States
(Wong) Department of Cardiology, Tufts Medical Center, Boston, MA, United
States
(Wong) Division of Clinical Decision Making, Department of Medicine, Tufts
Medical Center, Boston, MA, United States
(Dahabreh) Department of Epidemiology, School of Public Health, Brown
University, Providence, RI, United States
Publisher
Oxford University Press
Abstract
This review examines the conduct and reporting of observational studies
using propensity score-based methods to compare coronary artery bypass
grafting (CABG), percutaneous coronary intervention (PCI), or medical
therapy for patients with coronary artery disease. A systematic selection
process identified 48 studies: 20 addressing CABG versus PCI; 21
addressing bare-metal stents versus drug-eluting stents; 5 addressing CABG
versus medical therapy; 1 addressing PCI versusmedical therapy; and 1
addressing drug-eluting stents versus balloon angioplasty.Of 32 studies
reporting information on variable selection, 7 relied exclusively on
statistical criteria for the association of covariates with treatment, and
5 used such criteria to determine whether product or nonlinear terms
should be included in the propensity score model. Twenty-five (52%)
studies reported assessing covariate balance using the estimated
propensity score, but only 1 described modifications to the propensity
score model based on this assessment. The over 400 variables used in the
48 propensity scoremodels were classified into 12 categories and 60
subcategories; only 17 subcategories were represented in at least half of
the propensity score models. Overall, reporting of propensity score-based
methods in observational studies comparing CABG, PCI, and medical therapy
was incomplete; when adequately described, the methods used were often
inconsistent with current methodological standards. Copyright ©
2018 The Author(s).

<94>
Accession Number
2000624198
Title
Myocardial Infarction Subtypes in Patients With Type 2 Diabetes Mellitus
and the Effect of Liraglutide Therapy (from the LEADER Trial).
Source
American Journal of Cardiology. 121 (12) (pp 1467-1470), 2018. Date of
Publication: 15 June 2018.
Author
Marso S.P.; Nauck M.A.; Monk Fries T.; Rasmussen S.; Treppendahl M.B.;
Buse J.B.
Institution
(Marso) HCA Midwest Health Heart & Vascular Institute, Kansas City,
Missouri, United States
(Nauck) Diabetes Center Bochum-Hattingen, St. Josef Hospital,
Ruhr-University Bochum, Bochum, Germany
(Monk Fries, Rasmussen, Treppendahl) Novo Nordisk A/S, Soborg, Denmark
(Buse) Department of Medicine, University of North Carolina School of
Medicine, Chapel Hill, North Carolina, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Diabetes mellitus (DM) is a known risk factor for myocardial infarction
(MI); however, data regarding MI subtypes in people with diabetes are
limited. In the Liraglutide Effect and Action in Diabetes: Evaluation of
Cardiovascular Outcome Results (LEADER) trial (n = 9,340), liraglutide
significantly reduced the risk of major adverse cardiovascular (CV) events
(composite of CV death, nonfatal MI, or nonfatal stroke) versus placebo in
patients with type 2 DM and high CV risk. Liraglutide also reduced risk of
first MI (292 events with liraglutide vs 339 with placebo). This post hoc
analysis characterized MIs (first and recurrent) occurring in LEADER, by
treatment arm and regarding incidence, outcome, subtype, and troponin
levels. A total of 780 MIs (first and recurrent) were reported, with fewer
in the liraglutide-treatment group than in the placebo-treatment group
(359 vs 421, p = 0.022). Numerically fewer MIs were associated with CV
death with liraglutide than with placebo (17 vs 28 fatal MIs, p = 0.28).
Symptomatic MIs in both arms were mainly non-ST-segment elevation MI
(555/641) and spontaneous MI (518/641). Numerically greater proportions of
symptomatic MIs were associated with troponin levels <=5x or <=10x the
upper reference limit with liraglutide versus placebo (p = 0.16 and p =
0.42, respectively). At baseline, more liraglutide-treated patients than
placebo-treated patients with MI during the trial had a history of
coronary artery bypass graft (p = 0.008), and fewer had peripheral
arterial disease in the lower extremities (p = 0.005) and >50% stenosis of
the coronary artery, the carotid artery, or other arteries (p = 0.044). In
conclusion, this analysis showed that liraglutide reduces the incidence of
MIs in patients with type 2 DM at high CV risk and may impact the clinical
outcomes of MI. Copyright © 2018 The Author(s)

<95>
Accession Number
620228197
Title
Unmeasured confounders in observational studies comparing bilateral versus
single internal thoracic artery for coronary artery bypass grafting: A
meta-analysis.
Source
Journal of the American Heart Association. 7 (1) (no pagination), 2018.
Article Number: e008010. Date of Publication: 01 Jan 2018.
Author
Gaudino M.; Di Franco A.; Rahouma M.; Tam D.Y.; Iannaccone M.; Deb S.;
D'Ascenzo F.; Abouarab A.A.; Girardi L.N.; Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Di Franco, Rahouma, Abouarab, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Tam, Deb, Fremes) Schulich Heart Centre, Sunnybrook Health Science,
University of Toronto, Toronto, ON, Canada
(Iannaccone, D'Ascenzo) Department of Cardiology, Citta della Scienza e
della Salute, University of Turin, Torino, Italy
(Taggart) University of Oxford, Oxford, United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background--Observational studies suggest a survival advantage with
bilateral single internal thoracic artery (BITA) versus single internal
thoracic artery grafting for coronary surgery, whereas this conclusion is
not supported by randomized trials. We hypothesized that this
inconsistency is attributed to unmeasured confounders intrinsic to
observational studies. To test our hypothesis, we performed a
meta-analysis of the observational literature comparing BITA and single
internal thoracic artery, deriving incident rate ratio for mortality at
end of follow-up and at 1 year. We postulated that BITA would not affect
1-year survival based on the natural history of coronary artery bypass
occlusion, so that a difference between groups at 1 year could not be
attributed to the intervention. Methods and Results--We searched MEDLINE
and Pubmed to identify all observational studies comparing the outcome of
BITA versus single internal thoracic artery. One-year and long-term
mortality for BITA and single internal thoracic artery were compared in
the propensity-score-matched (PSM) series, that is, the form of
observational evidence less prone to confounders. Thirty-eight
observational studies (174 205 total patients) were selected for final
comparison. In the 12 propensity-score- matched series (34 019 patients),
the mortality reduction for BITA was similar at 1 year and at the end of
follow-up (incident rate ratio, 0.70; 95% confidence interval, 0.60-0.82
versus 0.77; 95% confidence interval, 0.70-0.85; P for subgroup
difference=0.43). Conclusions--Unmeasured confounders, rather than
biological superiority, may explain the survival advantage of BITA in
observational series. Copyright © 2017 The Authors.

<96>
Accession Number
622748473
Title
Protective effect of remote ischemic preconditioning on myocardial damage
after percutaneous coronary intervention in stable angina patients with
complex coronary lesions - Subanalysis of a randomized controlled trial.
Source
Circulation Journal. 82 (7) (pp 1788-1796), 2018. Date of Publication:
2018.
Author
Ejiri K.; Miyoshi T.; Kohno K.; Nakahama M.; Doi M.; Munemasa M.; Murakami
M.; Takaishi A.; Nakamura K.; Ito H.
Institution
(Ejiri, Miyoshi, Kohno, Nakamura, Ito) Department of Cardiovascular
Medicine, Okayama University Graduate School of Medicine, Density and
Pharmaceutical Sciences, Okayama, Japan
(Nakahama) Department of Cardiology, Fukuyama City Hospital, Hiroshima,
Japan
(Doi) Department of Cardiology, Kagawa Prefectural Central Hospital,
Kagawa, Japan
(Munemasa) Department of Cardiology, Okayama Medical Center, Okayama,
Japan
(Murakami) Department of Cardiology, Okayama Heart Clinic, Okayama, Japan
(Takaishi) Department of Cardiology, Mitoyo General Hospital, Kagawa,
Japan
Publisher
Japanese Circulation Society
Abstract
Background: The effect of remote ischemic preconditioning (RIPC) on
periprocedural myocardial damage (pMD) in patients undergoing percutaneous
coronary intervention (PCI) is controversial. The aim of this study was to
investigate the effect of RIPC or intravenous nicorandil on pMD following
elective PCI in a subgroup of patients with complex coronary lesions from
a multicenter randomized controlled trial. Methods and Results:
Patients with stable angina who underwent elective PCI were assigned to 3
groups: control, upper-limb RIPC or intravenous nicorandil. The major
outcome was pMD incidence following PCI, with pMD defined as an elevated
level of high-sensitivity cardiac troponin T or creatine kinase myocardial
band at 12 or 24 h after PCI. A total of 171 patients with complex
coronary lesions (ACC-AHA coronary classification type B2 or C) were
analyzed. The incidence of pMD following PCI was significantly lower in
the RIPC group than in the control group (44.4% vs. 66.1%; P=0.023). The
adjusted odds ratio (95% confidence interval) for pMD in the RIPC vs. the
controls was 0.41 (0.18-0.94). The incidence of pMD in the nicorandil
group was not significantly reduced compared with the control groups.
 Conclusion(s): This substudy suggested that RIPC prior to PCI
prevented pMD in patients with complex coronary lesions. Further
investigation in a multicenter prospective study is needed to confirm
these results. Copyright © 2018, Japanese Circulation Society.
All rights reserved.

<97>
Accession Number
624065560
Title
Incidence, Predictors, and Outcomes Associated with Hypotensive Episodes
among Heart Failure Patients Receiving Sacubitril/Valsartan or Enalapril:
The PARADIGM-HF Trial (Prospective Comparison of Angiotensin Receptor
Neprilysin Inhibitor with Angiotensin-Converting Enzyme Inhibitor to
Determine Impact on Global Mortality and Morbidity in Heart Failure).
Source
Circulation: Heart Failure. 11 (4) (no pagination), 2018. Article Number:
e004745. Date of Publication: 01 Apr 2018.
Author
Vardeny O.; Claggett B.; Kachadourian J.; Pearson S.M.; Desai A.S.; Packer
M.; Rouleau J.; Zile M.R.; Swedberg K.; Lefkowitz M.; Shi V.; McMurray
J.J.V.; Solomon S.D.
Institution
(Vardeny) Minneapolis VA Health Care System, University of Minnesota,
United States
(Pearson) University of Colorado, Aurora, United States
(Claggett, Desai, Solomon) Brigham and Women's Hospital, Harvard
University, Cardiovascular Division, 75 Francis St, Boston, MA 02115,
United States
(Kachadourian, Lefkowitz, Shi) Novartis Pharmaceuticals Corporation, East
Hanover, NJ, United States
(McMurray) University of Glasgow, United Kingdom
(Packer) Baylor University Medical Center, Dallas, TX, United States
(Rouleau) Universite de Montreal, Canada
(Zile) Medical University of South Carolina, Charleston, United States
(Swedberg) University of Gothenburg, Sweden
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: In PARADIGM-HF (Prospective Comparison of Angiotensin Receptor
Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to
Determine Impact on Global Mortality and Morbidity in Heart Failure),
heart failure treatment with sacubitril/valsartan reduced the primary
composite outcome of cardiovascular death or heart failure hospitalization
compared with enalapril but resulted in more symptomatic hypotension.
Concern on hypotension may be limiting use of sacubitril/valsartan in
appropriate patients. Methods and Results: We characterized patients
in PARADIGM-HF by whether they reported hypotension during study run-in
periods (enalapril, followed by sacubitril/valsartan) and after
randomization and assessed whether hypotension modified the efficacy of
sacubitril/valsartan. Of the 10 513 patients entering the enalapril
run-in, 136 (1.3%) experienced hypotension and 93 (68%) were unable to
continue to the next phase; of 9419 patients entering the
sacubitril/valsartan run-in period, 228 (2.4%) patients experienced
hypotension and 51% were unable to successfully complete the run-in. After
randomization, 388 (9.2%) participants had 501 hypotensive events with
enalapril, and 588 (14.0%) participants had 803 hypotensive events with
sacubitril/valsartan (P<0.001). There was no difference between randomized
treatment groups in the number of participants who discontinued therapy
because of hypotension. Individuals with a hypotensive event in either
group were older, had lower blood pressure at randomization, and were more
likely to have an implantable cardioverter defibrillator. Participants
with hypotensive events during run-in who were ultimately randomized
derived similar efficacy from sacubitril/valsartan compared with enalapril
as those without hypotensive events (P interaction>0.90).
 Conclusion(s): Hypotension was more common with sacubitril/valsartan
relative to enalapril in PARADIGM-HF but did not differentially affect
permanent discontinuations. Patients with hypotension during run-in
derived similar benefit from sacubitril/valsartan compared with enalapril
as those who did not experience hypotension. Copyright © 2018
American Heart Association, Inc.

<98>
Accession Number
606426494
Title
Perioperative statin therapy in patients at high risk for cardiovascular
morbidity undergoing surgery: A review.
Source
British Journal of Anaesthesia. 114 (1) (pp 44-52), 2015. Date of
Publication: 03 Sep 2014.
Author
De Waal B.A.; Buise M.P.; Van Zundert A.A.J.
Institution
(De Waal) Department of Anesthesiology, Maastricht University Medical
Centre, P. Debyelaan 25, HX Maastricht 6229, Netherlands
(Buise) Department of Anesthesiology, Catharina Hospital, Postbus 1350, ZA
Eindhoven 5602, Netherlands
(Van Zundert) Discipline of Anesthesiology, University of Queensland,
Faculty of Medicine and Biomedical Sciences, Royal Brisbane and Women's
Hospital, Herston Campus, Brisbane, QLD 4029, Australia
Publisher
Oxford University Press
Abstract
Statins feature documented benefits for primary and secondary prevention
of cardiovascular disease and are thought to improve perioperative
outcomes in patients undergoing surgery. To assess the clinical outcomes
of perioperative statin treatment in statin-naive patients undergoing
surgery, a systematic review was performed. Studies were included if they
met the following criteria: randomized controlled trials, patients aged
A18 yr undergoing surgery, patients not already on long-term statin
treatment, reported outcomes including at least one of the following:
mortality, myocardial infarction, atrial fibrillation, stroke, and length
of hospital stay. The following randomized clinical trials were excluded:
retrospective studies, trials without surgical procedure, trials without
an outcome of interest, studies with patients on statin therapy before
operation, or papers not written in English. The literature search
revealed 16 randomized controlled studies involving 2275 patients. Pooled
results showed a significant reduction in (i) mortality [risk ratio (RR)
0.53, 95% confidence interval (CI) 0.30.0.94, P=0.03], (ii) myocardial
infarction (RR 0.54, 95% CI 0.38.0.76, P<0.001), (iii) perioperative
atrial fibrillation (RR 0.53, 95% CI 0.43.0.66, P<0.001), and (iv) length
of hospital stay (days, mean difference 20.58, 95% CI -0.79 to -0.37,
P<0.001) in patients treated with a statin. Subgroup analysis in patients
undergoing non-cardiac surgery showed a decrease in the perioperative
incidence of mortality and myocardial infarction. Consequently,
anaesthetists should consider prescribing a standarddose statin before
operation to statin-naive patients undergoing cardiac surgery. However,
there are insufficient data to support final recommendations on
perioperative statin therapy for patients undergoing non-cardiac
surgery. Copyright © The Author 2014. Published by Oxford
University Press on behalf of the British Journal of Anaesthesia. All
rights reserved.

<99>
Accession Number
628228241
Title
Cangrelor versus Ticagrelor in Patients Treated with Primary Percutaneous
Coronary Intervention: Impact on Platelet Activity, Myocardial
Microvascular Function and Infarct Size: A Randomized Controlled Trial.
Source
Thrombosis and Haemostasis. 119 (7) (pp 1171-1181), 2019. Date of
Publication: 2019.
Author
Ubaid S.; Ford T.J.; Berry C.; Murray H.M.; Wrigley B.; Khan N.; Thomas
M.R.; Armesilla A.L.; Townend J.N.; Khogali S.S.; Munir S.; Martins J.;
Hothi S.S.; McAlindon E.J.; Cotton J.M.
Institution
(Ubaid, Wrigley, Khan, Khogali, Munir, Martins, Hothi, McAlindon, Cotton)
Heart and Lung Centre, New Cross Hospital, Wolverhampton WV10 0QP, United
Kingdom
(Ford, Berry) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Ford, Berry) British Heart Foundation, Glasgow Cardiovascular Research
Centre, University of Glasgow, Glasgow, United Kingdom
(Murray) Robertson Centre for Biostatistics, Institute of Health and
Wellbeing, University of Glasgow, Glasgow, United Kingdom
(Thomas) Institute of Cardiovascular Sciences, College of Medical and
Dental Sciences, University of Birmingham, Birmingham, United Kingdom
(Armesilla, Cotton) School of Pharmacy, University of Wolverhampton,
Wolverhampton, United Kingdom
(Townend) Queen Elizabeth Hospital, Birmingham, United Kingdom
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Oral P2Y12 inhibitors take more than 2 hours to achieve full
effect in healthy subjects and this action is further delayed in patients
with acute myocardial infarction. Intravenous P2Y12 inhibition might lead
to more timely and potent anti-platelet effect in the context of emergency
primary angioplasty, improving myocardial recovery. Objectives This
article compares the efficacy of intravenous cangrelor versus ticagrelor
in a ST-elevation myocardial infarction (STEMI) population treated with
primary percutaneous coronary intervention (PPCI). Materials and Methods
In an open-label, prospective, randomized controlled trial, 100 subjects
with STEMI were assigned 1:1 to intravenous cangrelor or oral ticagrelor.
The co-primary endpoints were platelet P2Y12 inhibition at infarct vessel
balloon inflation time, 4 and 24 hours. Secondary endpoints included
indices of coronary microcirculatory function: index of microvascular
resistance (IMR), initial infarct size (troponin at 24 hours) and final
infarct size at 12 weeks (cardiac magnetic resonance). Secondary endpoints
included indices of coronary microcirculatory function (index of
microvascular resistance [IMR]), initial infarct size (troponin at 24
hours), final infarct size at 12 weeks (cardiac magnetic resonance),
corrected thrombolysis in myocardial infarction (TIMI) frame count, TIMI
flow grade, myocardial perfusion grade, and ST-segment resolution
(ClinicalTrials.gov NCT02733341). Results P2Y12 inhibition at first
balloon inflation time was significantly greater in cangrelor-treated
patients (cangrelor P2Y12 reaction unit [PRU] 145.2 +/- 50.6 vs.
ticagrelor 248.3 +/- 55.1). There was no difference in mean PRU at 4 and
24 to 36 hours post-dosing. IMR, final infarct size, angiographic and
electrocardiographic measures of reperfusion were all similar between
groups. Conclusion Cangrelor produces more potent P2Y12 inhibition at the
time of first coronary balloon inflation time compared with ticagrelor.
Despite this enhanced P2Y12 inhibition, coronary microvascular function
and final infarct size did not differ between groups. Copyright ©
2019 Georg Thieme Verlag KG Stuttgart - New York.

<100>
Accession Number
2002169111
Title
Accelerated Allograft Vasculopathy With Rituximab After Cardiac
Transplantation.
Source
Journal of the American College of Cardiology. 74 (1) (pp 36-51), 2019.
Date of Publication: 9 July 2019.
Author
Starling R.C.; Armstrong B.; Bridges N.D.; Eisen H.; Givertz M.M.;
Kobashigawa J.; Ikle D.; Morrison Y.; Pinney S.; Stehlik J.; Tripathi S.;
Sayegh M.H.; Chandraker A.; Gus B.; Keslar K.; Magyar B.; Petrich J.; Tang
W.H.W.; Brooks K.; Givertz M.; Kelly C.; Klein K.; Crisalli K.; DeBronkart
S.; Madsen J.; Semigran M.; Vetrano J.; DeMarco T.; Fields S.; Maguire C.;
Gordon R.; Anderson A.; Regalado J.; Warzecha A.; Goldberg L.; Olt C.;
Rockwell K.; Harris A.; Johnston S.; Roginski C.; Ahmed R.; Cohen I.;
Peace D.; Yao T.; Araujo G.; Bhimaraj A.; Karanga E.; Patel V.; Chait J.;
Deng M.; Fonarow G.; Shin C.; Gibbs C.; Hunt J.; Johnson M.; Worley T.;
Gibbs J.; Kirk J.; Redd W.; Bryan J.; French A.; Kfoury A.G.; Konery K.;
Feller E.; Lee M.; Pierson R.; Young C.; Hollifield T.; Porter K.; Schulz
M.; VanBakel A.; Khush K.; Luikart H.; Nguyen S.; Pham M.; DeNofrio D.;
O'Kelly R.; Garcia L.; Sana S.; Starks B.; Thottam M.; Yi A.; Cabuay B.;
Olson R.; Tucker L.; Uppgaard L.; Lai D.; Poisker C.; Dragicevic K.;
Kelner H.; Luke D.; Nelson J.; Raveendran G.; Kleissas N.; Murali S.; Rayl
K.; Sherry S.; Cosgrove M.
Institution
(Starling) Department of Medicine, Cleveland Clinic Foundation, Cleveland,
OH, United States
(Armstrong, Ikle) Rho Federal Systems Division, Chapel Hill, NC, United
States
(Bridges, Morrison) National Institute of Allergy and Infectious Diseases,
Bethesda, MD, United States
(Eisen) Department of Medicine, Drexel University College of Medicine,
Philadelphia, PA, United States
(Givertz, Tripathi, Sayegh, Chandraker) Transplantation Research Center,
Renal Division, Brigham and Women's Hospital, Boston, MA, United States
(Kfoury) Department of Medicine, Intermountain Medical Center, Murray, UT,
United States
(Kobashigawa) Department of Medicine, Cedars Sinai Medical Center, Los
Angeles, CA, United States
(Pinney) Department of Medicine, Mount Sinai School of Medicine, New York,
NY, United States
(Stehlik) Department of Medicine, University of Utah, Salt Lake City, UT,
United States
Publisher
Elsevier USA
Abstract
Background: The CTOT-11 (Prevention of Cardiac Allograft Vasculopathy
Using Rituximab Therapy in Cardiac Transplantation [Clinical Trials in
Organ Transplantation-11]) study was a randomized, placebo-controlled,
multicenter, double-blinded clinical trial in nonsensitized primary heart
transplant (HTX) recipients. Objective(s): The study sought to
determine whether B cell depletion therapy would attenuate the development
of cardiac allograft vasculopathy. Method(s): A total of 163 HTX
recipients were randomized to rituximab 1,000 mg intravenous or placebo on
days 0 and 12 post-transplant. Primary outcome was change in percent
atheroma volume (PAV) from baseline to 1 year measured by intravascular
ultrasound. Secondary outcomes included treated episodes of acute
rejection, de novo anti-HLA antibodies (including donor-specific
antibodies), and phenotypic differentiation of B cells. Result(s):
There were no significant differences at study entry between the rituximab
and placebo groups. Paired intravascular ultrasound measures were
available at baseline and 1 year in 86 subjects (49 rituximab, 37
placebo). The mean +/- SD change in PAV at 12 months was +6.8 +/- 8.2%
rituximab versus +1.9 +/- 4.4% placebo (p = 0.0019). Mortality at 12
months was 3.4% rituximab versus 6.8% placebo (p = 0.47); there were no
retransplants or post-transplant lymphoproliferative disorder. The rate of
treated rejection was 24.7% rituximab versus 32.4% placebo (p = 0.28).
Rituximab therapy effectively eliminated CD20+/CD19+
B cells followed by a gradual expansion of a CD19- cell
population in the rituximab-treated group. Conclusion(s): A marked,
unexpected increase in coronary artery PAV with rituximab was observed
during the first year in HTX recipients. One-year mortality was not
impacted; however, longer-term follow-up and mechanistic explanations are
required. (Prevention of Cardiac Allograft Vasculopathy Using Rituximab
[Rituxan] Therapy in Cardiac Transplantation; NCT01278745) Copyright
© 2019 American College of Cardiology Foundation

<101>
Accession Number
2002145752
Title
The value of F-18-fluorodeoxyglucose positron emission tomography
(FDG-PET/CT) in the intensive care unit: A review.
Source
Netherlands Journal of Critical Care. 27 (3) (pp 108-114), 2019. Date of
Publication: May 2019.
Author
van Hulst A.M.; van Rijk M.C.; Bavelaar-Croon C.D.L.; Tjan D.H.T.
Institution
(van Hulst) Princess Maxima Center for Paediatric Oncology, Utrecht,
Netherlands
(van Rijk) Department of Nuclear Medicine, Radboud UMC, Nijmegen,
Netherlands
(Bavelaar-Croon) Department of Nuclear Medicine, Gelderse Vallei Hospital,
Ede, Netherlands
(van Hulst, Tjan) Department of Intensive Care, Gelderse Vallei Hospital,
Ede, Netherlands
Publisher
Netherlands Society of Intensive Care
Abstract
Background: Despite intensive diagnostic testing, a septic focus might
prove difficult to detect in intensive care unit (ICU) patients. Yet it is
essential to identify the source of infection in order to consider all
source control options. An advanced diagnostic procedure to establish the
septic focus is a positron emission tomography / computed tomography
(FDG-PET/CT) scan. The purpose of this review is to explore the diagnostic
value of FDG-PET/CT in ICU patients. Method(s): A systematic search
was performed to identify all relevant evidence. Titles and abstracts were
screened using predefined criteria. Result(s): Ten articles were
included. No major multicentre prospective studies are available. The
current evidence shows results with sensitivities between 85% and 100% and
a specificity between 50% and 79% in finding a focus of infection. A
change of therapy due to the results of a FDG-PET/CT scan is reported in
15-71% of all cases. Conclusion(s): FDG-PET/CT could be a helpful
examination to determine the focus in sepsis of unknown origin. However,
several pitfalls and precautions should be taken into
consideration. Copyright © 2019, Netherlands Society of Intensive
Care. All rights reserved.

<102>
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. Copyright © The
Author(s) 2019.

<103>
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.
 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.
 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.
 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. Copyright © The
Author(s) 2019.

<104>
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. 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).
 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. 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. Copyright © 2019 European Society for Vascular Surgery

<105>
Accession Number
2001563242
Title
Cardiac Prehabilitation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (8) (pp 2255-2265),
2019. Date of Publication: August 2019.
Author
McCann M.; Stamp N.; Ngui A.; Litton E.
Institution
(McCann, Stamp, Ngui, Litton) Fiona Stanley Hospital, Perth, WA, Australia
(Litton) St John of God Hospital, Subiaco, Perth, WA, Australia
Publisher
W.B. Saunders
Abstract
The care of patients undergoing cardiac surgery is becoming more complex,
in part owing to the increasing burden of comorbid disease, frailty, and
psychosocial issues. Many risk factors for postoperative morbidity and
mortality are potentially modifiable if identified and treated in a timely
fashion before surgery. Cardiac prehabilitation, draws from strategies
currently undertaken in cardiac rehabilitation but implements them
proactively rather than reactively. There is substantial evidence that in
multiple domains, including aerobic conditioning, respiratory muscle
training, lifestyle modification, diabetic control, sleep, and
psychoeducation, selected interventions before cardiac surgery may improve
outcomes. However, the optimal preoperative program remains unclear and
there is an unmet need for a comprehensive evaluation of the range of
interventions specifically targeted at modifiable perioperative risk
factors that may reduce adverse outcomes after cardiac
surgery. Copyright © 2019 Elsevier Inc.

<106>
Accession Number
628332655
Title
No significant association between immunosuppression in solid organ
transplantation and prostate cancer risk: A meta-analysis of cohort
studies.
Source
Translational Cancer Research. 8 (3) (pp 939-949), 2019. Date of
Publication: 01 Jun 2019.
Author
Bao J.-M.; Zhu H.-L.; Yang G.-S.; Chen P.-L.; Dang Q.; Chen X.-X.; Tang
K.-Q.; Zhu Y.-T.; Hong X.-W.; Tan W.-L.
Institution
(Bao) Department of Urology, Third Affiliated Hospital of Southern Medical
University, Guangzhou 510630, China
(Bao) Academy of Orthopedics, Guangdong Province, Guangdong Provincial Key
Laboratory of Bone and Joint Degenerative Diseases, Third Affiliated
Hospital of Southern Medical University, Guangzhou 510630, China
(Zhu) Department of Nephrology, Nanfang Hospital, Southern Medical
University, Guangzhou 510515, China
(Yang) Department of Urology, Guangdong Second Provincial General
Hospital, Southern Medical University, Guangzhou510310, China
(Chen, Dang, Tan) Department of Urology, Nanfang Hospital, Southern
Medical University, Guangzhou 510515, China
(Chen) Department of Urology, Zhuhai Hospital of Jinan University, Zhuhai
People's Hospital, Zhuhai 519000, China
(Tang) Department of Urology, First Affiliated Hospital of Guangxi Medical
University, Nanning 530021, China
(Zhu) Department of Obstetrics and Gynecology, Center for Reproductive
Medicine, Southern Medical University, Guangzhou 510515, China
(Hong) Department of Urology, Shantou Central Hospital, Shantou 515031,
China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: It is known that organ transplant recipients have a
significantly higher risk for developing cancers, but the association
between immunosuppression in organ transplantation and the risk for
prostate cancer (PCa) remains unclear. We aimed to assess the evidence
regarding the association of solid organ transplantation with PCa risk.
 Method(s): A literature search of the PubMed, Embase, and Web of
Science databases was performed up to March 2019. Combined relative risks
(RRs) and 95% confidence intervals (CIs) were calculated by using a
fixed-effect or random-effect model. Result(s): In total, 26 articles
including 33 independent population-based cohort studies with 556,812
recipients and 2,438 PCa cases were identified and included in this
meta-analysis. PCa risk in the solid organ transplant recipients did not
increase compared with the general population (RR=1.04; 95% CI:
0.90-1.18). Independent analysis of different kinds of organ replacements
further indicated immune inhibition in the transplantation of kidney,
liver, heart, and lung, and was not associated with elevated PCa risk
(RR=0.89; 95% CI: 0.83-0.95; RR=0.61, 95% CI: 0.21-1.02; RR=1.70, 95% CI:
0.88-2.52; RR=0.87, 95% CI: 0.57-1.16, respectively). Conclusion(s):
This study demonstrated that immunosuppression in solid organ transplant
recipients was not associated with higher PCa risk. Copyright ©
Translational Cancer Research. All rights reserved.

<107>
Accession Number
2001453938
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Chronic Kidney Disease: A Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (8) (pp 2221-2230),
2019. Date of Publication: August 2019.
Author
Cheng X.; Hu Q.; Zhao H.; Qin S.; Zhang D.
Institution
(Cheng, Qin, Zhang) Department of Cardiology, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Hu) Department of Clinical Laboratory, Chongqing General Hospital,
Chongqing, China
(Zhao) Department of Cardiology, People's Hospital of Chongqing Banan,
Chongqing, China
Publisher
W.B. Saunders
Abstract
Objective: The aim of this meta-analysis was to compare the clinical
outcomes of transcatheter aortic valve replacement (TAVR) with those of
surgical aortic valve replacement (SAVR) in patients with chronic kidney
disease (CKD). Design(s): Meta-analysis of 10 observational studies.
 Setting(s): Hospital. Participant(s): Patients with CKD (9,619)
undergoing aortic valve replacement. Intervention(s): None.
 Measurements and Main Results: The Medline, Cochrane Library, and
Embase databases were searched for clinical studies published from January
2000 to October 2018. Studies that fulfilled the predefined inclusion
criteria were included. The primary clinical outcomes included early
all-cause mortality and postoperative stroke. Random-effects modeling was
used to calculate odds ratio (OR) and 95% CI. After a literature search of
the major databases, 10 observational cohort studies with a total of 9,619
patients were identified. Pooled analysis indicated that, when compared
with SAVR, TAVR was associated with a lower risk of early all-cause
mortality (6.1% v 10.2%; OR: 0.71; 95% CI: 0.51-0.98) and stroke (1.1% v
2.2%; OR: 0.53; 95% CI: 0.37-0.75). Although TAVR increased the risk of
pacemaker implantation (OR: 2.06; 95% CI: 1.16-3.66), it reduced the risk
of blood transfusion (OR: 0.50; 95% CI: 0.39-0.65), infection (OR: 0.30;
95% CI: 0.13-0.70), acute kidney injury (AKI) (OR: 0.46; 95% CI:
0.38-0.55), and AKI requiring dialysis (OR: 0.66; 95% CI: 0.58-0.75).
There were not significant differences in the incidence rates of cardiac
tamponade (OR: 0.60; 95% CI: 0.26-1.36) and major vascular damage (OR:
1.12; 95% CI: 0.81-1.55) between the 2 groups. Conclusion(s):
Transcatheter aortic valve replacement might be a preferable approach to
SAVR in patients with CKD. A large, prospective, randomized controlled
trial is warranted. Copyright © 2018 Elsevier Inc.

<108>
Accession Number
2001446157
Title
The Role of Tolvaptan Administration After Cardiac Surgery: A
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (8) (pp 2170-2179),
2019. Date of Publication: August 2019.
Author
Bellos I.; Iliopoulos D.C.; Perrea D.N.
Institution
(Bellos, Iliopoulos, Perrea) Laboratory of Experimental Surgery and
Surgical Research N.S. Christeas, Athens University Medical School,
National and KaPOD istrian University of Athens, Athens, Greece
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the efficacy and safety of tolvaptan in fluid
management after cardiac surgery compared with conventional diuretic
treatment. Design(s): Systematic review of the literature with
meta-analyses. Setting(s): The Medline, Scopus, Cochrane Central
Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar
databases were searched from inception to July 30, 2018.
 Participant(s): The study comprised 759 patients undergoing cardiac
surgery. Intervention(s): Tolvaptan administration (n = 397) or
standard diuretic therapy (n = 398). Measurements and Main Results:
Ten studies were included in the present meta-analysis. Tolvaptan
administration was associated with a significantly faster return to
preoperative body weight (mean difference [MD)] -1.48 d, 95% confidence
interval [CI] -1.92 to 1.03), shorter duration of hospital stay (MD -2.58
d, 95% CI -5.09 to -0.07), lower incidence of acute kidney injury (odds
ratio 0.34, 95% CI 0.16-0.69), and greater urine output (MD 0.47 L/d, 95%
CI 0.25-0.69) and sodium levels (MD 2.85 mEq/L, 95% CI 1.90-3.80). No
significant differences were present regarding duration of intensive care
unit stay (MD -0.09 d, 95% CI -0.33 to 0.15), arrhythmia incidence (odds
ratio 0.58, 95% CI 0.33-1.02), and serum creatinine values (MD -0.08
mg/dL, 95% CI -0.20 to 0.04). Conclusion(s): The outcomes of the
present meta-analysis suggest the promising role of tolvaptan
administration in the management of fluid retention in patients after
cardiac surgery. Future large-scale clinical trials should be conducted to
fully elucidate its efficacy and to assess the optimal treatment protocol
to be applied in the clinical setting. Copyright © 2018 Elsevier
Inc.

<109>
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. 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. 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.
 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. Copyright © 2019 by Associacao Paulista de
Medicina.

<110>
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. Method(s): MEDLINE and EMBASE were searched from 1946
to 2018 for articles comparing patients undergoing AVR+ARE with those
undergoing AVR alone. A random-effects meta-analysis was performed to
compare early and late clinical outcomes. Result(s): A total of 2570
AVR+ARE and 5,991 AVR patients were included from 9 observational studies.
There was no difference in early mortality (relative risk [RR]1.21; 95%
confidence interval [CI], 0.94-1.54; P = 0.13). Both cardiopulmonary
bypass (mean difference [MD]20 minutes; 95% CI, 15-25; P < 0.01)and aortic
cross-clamp time (MD 14 minutes; 95% CI, 11-17, P < 0.01)were higher
following AVR+ARE. There was no difference in the risk of permanent
pacemaker implantation (RR 1.02; 95% CI, 0.83-1.25; P = 0.86), reoperation
for bleeding (RR 1.05; 95% CI, 0.84-1.32; P = 0.64), or stroke (RR 0.93;
95% CI, 0.68-1.27; P = 0.65). The risk of moderate (indexed effective
orifice area [iEOA]< 0.85 cm2/m2)and severe (iEOA <
0.65 cm2/m2)patient-prosthesis mismatch (PPM)was
lower with AVR+ARE (RR 0.65; 95% CI, 0.51-0.83; P < 0.01)and RR 0.36; 95%
CI, 0.16-0.82; P = 0.01, respectively). There was no difference in late
mortality (incidence rate ratio [IRR]1.05; 95% CI, 0.87-1.27; P = 0.59)at
mean 7.8-year follow-up in 5 studies. Conclusion(s): Surgical ARE is
a safe adjunct to AVR in selected patients that does not increase early
adverse events and results in less patient-prosthesis mismatch. This
strategy allows for a larger valve size at the time of implantation, an
important consideration for potential future valve-in-valve procedures in
the era of TAVR. Copyright © 2019 Canadian Cardiovascular Society

<111>
Accession Number
2001744272
Title
Does prior coronary angioplasty affect outcomes of surgical coronary
revascularization? Insights from the STICH trial.
Source
International Journal of Cardiology. 291 (pp 36-41), 2019. Date of
Publication: 15 September 2019.
Author
Nicolau J.C.; Stevens S.R.; Al-Khalidi H.R.; Jatene F.B.; Furtado R.H.M.;
Dallan L.A.O.; Lisboa L.A.F.; Desvigne-Nickens P.; Haddad H.; Jolicoeur
E.M.; Petrie M.C.; Doenst T.; Michler R.E.; Ohman E.M.; Maddury J.; Ali
I.; Deja M.A.; Rouleau J.L.; Velazquez E.J.; Hill J.A.
Institution
(Nicolau, Jatene, Furtado, Dallan, Lisboa) Instituto do Coracao (InCor),
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, SP, Brazil
(Stevens, Al-Khalidi, Ohman) Duke Clinical Research Institute and
Department of Biostatistics and Bioinformatics, Duke University School of
Medicine, Durham, NC, United States
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
(Haddad) Department of Medicine, University of Saskatchewan, Saskatoon,
Saskatchewan, Canada
(Jolicoeur, Rouleau) Montreal Heart Institute, Universite de Montreal,
Quebec, Canada
(Petrie) BHF Cardiovascular Research Centre, University of Glasgow,
Glasgow, United Kingdom
(Doenst) Department of Cardiothoracic Surgery, University of Jena, Jena,
Germany
(Michler) Department of Cardiothoracic Surgery, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Maddury) Department of Cardiology, Nizams Institute of Medical Sciences,
Hyderabad, India
(Ali) Libin Cardiovascular Institute of Alberta, University of Calgary,
Foothills Medical Centre, Calgary, Alberta, Canada
(Deja) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Velazquez) Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, United States
(Hill) Department of Medicine, University of Florida, Gainesville, FL,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The STICH trial showed superiority of coronary artery bypass
plus medical treatment (CABG) over medical treatment alone (MED) in
patients with left ventricular ejection fraction (LVEF) <=35%. In previous
publications, percutaneous coronary intervention (PCI) prior to CABG was
associated with worse prognosis. Objective(s): The main purpose of
this study was to analyse if prior PCI influenced outcomes in STICH.
 Methods and Results: Patients in the STICH trial (n = 1212), followed
for a median time of 9.8 years, were included in the present analyses. In
the total population, 156 had a prior PCI (74 and 82, respectively, in the
MED and CABG groups). In those with vs. without prior PCI, the adjusted
hazard-ratios (aHRs) were 0.92 (95% CI = 0.74-1.15) for all-cause
mortality, 0.85 (95% CI = 0.64-1.11) for CV mortality, and 1.43 (95% CI =
1.15-1.77) for CV hospitalization. In the group randomized to CABG without
prior PCI, the aHRs were 0.82 (95% CI = 0.70-0.95) for all-cause
mortality, 0.75 (95% CI = 0.62-0.90) for CV mortality and 0.67 (95% CI =
0.56-0.80) for CV hospitalization. In the group randomized to CABG with
prior PCI, the aHRs were 0.76 (95% CI = 0.50-1.15) for all-cause
mortality, 0.81 (95% CI = 0.49-1.36) for CV mortality and 0.61 (95% CI =
0.41-0.90) for CV hospitalization. There was no evidence of interaction
between randomized treatment and prior PCI for any endpoint (all adjusted
p > 0.05). Conclusion(s): In the STICH trial, prior PCI did not
affect the outcomes of patients whether they were treated medically or
surgically, and the superiority of CABG over MED remained unchanged
regardless of prior PCI. Clinical trial registration: Clinicaltrials.gov;
Identifier: NCT00023595 Copyright © 2019 Elsevier B.V.

<112>
Accession Number
2001761535
Title
Smaller brain volumes at two years of age in patients with hypoplastic
left heart syndrome - Impact of surgical approach.
Source
International Journal of Cardiology. 291 (pp 42-44), 2019. Date of
Publication: 15 September 2019.
Author
Knirsch W.; Heye K.N.; Tuura R.O.; Hahn A.; Wetterling K.; Latal B.;
Schranz D.; Reich B.
Institution
(Knirsch, Heye) Pediatric Cardiology, Pediatric Heart Center, University
Children's Hospital, Zurich, Switzerland
(Knirsch, Heye, Tuura, Latal) Children's Research Center, University
Children's Hospital, Zurich, Switzerland
(Heye, Tuura) Diagnostic Imaging, MR-Center, University Children's
Hospital, Zurich, Switzerland
(Hahn) Pediatric Neurology, University Hospital Giessen,
Justus-Liebig-University, Giessen, Germany
(Wetterling) Child Development Center, SPZ Frankfurt Mitte,
Frankfurt/Main, Germany
(Latal) Child Development Center, University Children's Hospital, Zurich,
Switzerland
(Schranz, Reich) Pediatric Heart Center, University Hospital Giessen,
Justus-Liebig-University, Giessen, Germany
Publisher
Elsevier Ireland Ltd
Abstract
Background: Brain growth in hypoplastic left heart syndrome (HLHS) is
reduced before and after birth. Little is known about further brain growth
until two years of age before Fontan procedure and the potential impact of
type of surgery. Method(s): In a prospective, two-center study 29
patients with HLHS and variants were treated by Norwood (n = 5) or Hybrid
procedure (n = 24). At two years of age a cerebral MRI was performed and
brain volumes (total gray, deep gray, white matter) and cerebrospinal
fluid volume were calculated using FreeSurfer image analysis suite and
compared to a healthy control group (n = 8). Result(s): The total
brain volumes in patients with HLHS were smaller compared to controls
(HLHS: 893 +/- 76 ml vs. controls: 1015 +/- 148 ml, p = 0.005). This
difference was found in all three brain compartments after Norwood
procedure, whereas patients after Hybrid procedure had total and deep gray
volumes comparable to controls. When comparing Norwood to Hybrid patients,
deep gray matter volume reduction was more pronounced (Norwood: 38.4 +/-
4.1 ml vs. Hybrid: 44.4 +/- 3.9 ml, p = 0.005) than white matter reduction
(Norwood: 255 +/- 19 ml vs. Hybrid: 285 +/- 31 ml, p = 0.032).
 Conclusion(s): Smaller total and regional brain volumes were found
two years after Norwood or Hybrid procedure in children with HLHS. The
brain volume reduction was more distinct after Norwood than after Hybrid
procedure. Longitudinal studies are needed to identify impact of early
staged-surgeries on brain development and may become part of the
decision-making process in individual patients. Copyright © 2019
Elsevier B.V.

<113>
Accession Number
628280529
Title
Efficacy of different analgesic or sedative drug therapies in pediatric
patients with congenital heart disease undergoing surgery: a network
meta-analysis.
Source
World Journal of Pediatrics. 15 (3) (pp 235-245), 2019. Date of
Publication: 01 Jun 2019.
Author
Liu R.-Z.; Li B.-T.; Zhao G.-Q.
Institution
(Liu, Zhao) Department of Anesthesiology, China-Japan Union Hospital of
Jilin University, Changchun 130000, China
(Li) Department of Rheumatology and Immunology, China-Japan Union Hospital
of Jilin University, Changchun 130000, China
Publisher
Institute of Pediatrics of Zhejiang University (E-mail: wjpch@zju.edu.cn)
Abstract
Background: Surgery is an effective therapy for congenital heart disease
(CHD) and the management after surgery poses challenges for the clinical
workers. We performed this network meta-analysis to enhance the
corresponding evidence with respect to the relative efficacy of different
drug treatments applied after the CHD surgery. Method(s): Embase and
PubMed were systematically retrieved to identify all published controlled
trials investigating the effectiveness of drugs for patients up to 25
August, 2018. Mean differences (MD), odds ratios and their 95% credible
intervals (CrIs) were used to evaluate multi-aspect comparisons. Surface
under cumulative ranking curve (SUCRA) was used to analyze the relative
ranking of different treatments in each endpoint. Result(s): Compared
to saline, all the drugs achieved better preference under the efficacy
endpoints except fentanyl in JET. As for ventilator time, all drugs were
more effective than saline while only the difference of dexmedetomidine
was statistically obvious (MD = 6.92, 95% CrIs 1.77-12.54). Under the
endpoint of ICU time, dexmedetomidine was superior to saline as well (MD =
1.26, 95% CrIs 0.11-2.45). When all the endpoints were taken into
consideration and with the help of ranking probabilities and SUCRA values,
fentanyl combined with dexmedetomidine was one of the recommended drugs
due to its shorter time on ventilator and stay in hospital as well as
lower mortality. Conclusion(s): Overall, based on the comprehensive
consideration of all the endpoints, fentanyl combined with dexmedetomidine
was considered to be the best-recommended clinical interventions among all
the methods. Copyright © 2019, Children's Hospital, Zhejiang
University School of Medicine.

<114>
Accession Number
628217160
Title
Current perspective on the use of opioids in perioperative medicine: An
evidence-based literature review, national survey of 70,000 physicians,
and multidisciplinary clinical appraisal.
Source
Pain Medicine (United States). 19 (9) (pp 1710-1719), 2018. Date of
Publication: September 2018.
Author
Jahr J.S.; Bergese S.D.; Sheth K.R.; Bernthal N.M.; Ho H.S.; Stoicea N.;
Apfel C.C.
Institution
(Jahr) Department of Anesthesiology and Perioperative Care, David Geffen
School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los
Angeles, CA, United States
(Bergese, Stoicea) Departments of Anesthesiology and Neurological Surgery,
Ohio State University, Columbus, OH, United States
(Sheth) Division of General Surgery, Cambridge Health Alliance, Cambridge,
MA, United States
(Sheth) Harvard Medical School, Boston, MA, United States
(Bernthal) Department of Orthopedic Surgery, David Geffen School of
Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA,
United States
(Ho) Department of Surgery, UC Davis Medical Center, Davis, CA, United
States
(Apfel) Clinical Research Consultants LLC, Larkspur, CA, United States
(Apfel) University of California, San Francisco School of Medicine, San
Francisco, CA, United States
Publisher
Oxford University Press
Abstract
Objective. Opioids represent an important analgesic option for physicians
managing acute pain in surgical patients. Opioid management is not without
its drawbacks, however, and current trends suggest that opioids might be
overused in the United States. An expert panel was convened to conduct a
clinical appraisal regarding the use of opioids in the perioperative
setting. Methods. The clinical appraisal consisted of the review,
presentation, and assessment of current published evidence as it relates
to the statement "Opioids are not overused in the United States, even
though opioid adjunct therapy achieves greater pain control with less
risk." The authors' evaluation of this statement was also compared with
the results of a national survey of surgeons and anesthesiologists in the
United States. Results. We report the presented literature and proceedings
of the panel discussion. The national survey revealed a wide range of
opinions regarding opioid overuse in the United States. Current published
evidence provides support for the efficacy of opioid therapy in surgical
patients; however, it is not sufficient to conclude unequivocally that
opioids are - or are not - overused in the management of acute surgical
pain in the United States. Conclusions. Opioids remain a key component of
multimodal perioperative analgesia, and strategic opioid use based on
clinical considerations and patient-specific needs represents an
opportunity to support improved postoperative outcomes and satisfaction.
Future studies should focus on identifying optimal procedure-specific and
patient-centered approaches to multimodal perioperative
analgesia. Copyright © 2018 Oxford University Press. All rights
reserved.

<115>
Accession Number
628159081
Title
Oral anticoagulants in atrial fibrillation with valvular heart disease and
bioprosthetic heart valves.
Source
Heart. (no pagination), 2019. Date of Publication: 2019.
Author
Malik A.H.; Yandrapalli S.; Aronow W.S.; Panza J.A.; Cooper H.A.
Institution
(Malik) Department of Medicine, New York Medical College, Westchester
Medical Center Health Network, Valhalla, NY 10595, United States
(Yandrapalli, Aronow, Panza, Cooper) Department of Cardiology, New York
Medical College, Valhalla, NY, United States
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: Current guidelines endorse the use of non-vitamin K antagonist
oral anticoagulants (NOACs) in patients with atrial fibrillation (AF).
However, little is known about their safety and efficacy in valvular heart
disease (VHD). Similarly, there is a paucity of data regarding NOACs use
in patients with a bioprosthetic heart valve (BPHV). We, therefore,
performed a network meta-analysis in the subgroups of VHD and
meta-analysis in patients with a BPHV. Method(s): PubMed, Cochrane
and Embase were searched for randomised controlled trials. Summary effects
were estimated by the random-effects model. The outcomes of interest were
a stroke or systemic embolisation (SSE), myocardial infarction (MI),
all-cause mortality, major adverse cardiac events, major bleeding and
intracranial haemorrhage (ICH). Result(s): In patients with VHD,
rivaroxaban was associated with more ICH and major bleeding than other
NOACs, while edoxaban 30 mg was associated with least major bleeding. Data
combining all NOACs showed a significant reduction in SSE, MI and ICH
(0.70, [0.57 to 0.85; p<0.001]; 0.70 [0.50 to 0.99; p<0.002]; and 0.46
[0.24 to 0.86; p<0.01], respectively). Analysis of 280 patients with AF
and a BPHV showed similar outcomes with NOACs and warfarin.
 Conclusion(s): NOACs performed better than warfarin for a reduction
in SSE, MI and ICH in patients with VHD. Individually NOACs performed
similarly to each other except for an increased risk of ICH and major
bleeding with rivaroxaban and a reduced risk of major bleeding with
edoxaban 30 mg. In patients with a BPHV, results with NOACs seem similar
to those with warfarin and this needs to be further explored in larger
studies. Copyright © Author(s) (or their employer(s)) 2019. No
commercial re-use. See rights and permissions. Published by BMJ.

<116>
Accession Number
2002106080
Title
Single-dose cardioplegia protects myocardium as well as traditional
repetitive dosing: A noninferiority randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Vivacqua A.; Robinson J.; Abbas A.E.; Altshuler J.M.; Shannon F.L.;
Podolsky R.H.; Sakwa M.P.
Institution
(Vivacqua, Abbas, Altshuler, Shannon, Sakwa) Department of Cardiovascular
Surgery, Beaumont Hospital, Royal Oak, Mich, United States
(Robinson) Wayne State University School of Medicine, Detroit, Mich,
United States
(Podolsky) Beaumont Research Institute, Royal Oak, Mich, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The present prospective noninferiority randomized trial was
designed to demonstrate the safety and efficacy of a single dose of
Custodiol histidine-tryptophan-ketoglutarate compared with repetitive
cold-blood cardioplegia. Method(s): From October 2012 to May 2014,
110 patients were randomly assigned to 1 of 2 groups: Group 1 (55
patients) received repetitive cold-blood cardioplegia, and group 2 (55
patients) received single-dose Custodiol
histidine-tryptophan-ketoglutarate. Isolated aortic valve replacement,
isolated mitral valve replacement, and multivalve procedures represented
the most frequent operations, with 39 cases (71%) in group 1 and 49 cases
(89%) in group 2. There was no difference in cardiopulmonary bypass time
(102 +/- 26 minutes vs 99 +/- 19 minutes, P =.70) or aortic crossclamp
time (77 +/- 19 minutes vs 74 +/- 17 minutes, P =.33). All patients
underwent preoperative electrocardiogram and determination of creatine
kinase-MB, troponin I, left ventricular ejection fraction, and regional
wall motion. Postoperative cardiac biomarkers were checked at 7, 24, and
48 hours, and an echocardiogram was obtained to check for left ventricular
function abnormalities. Result(s): There was no difference in cardiac
biomarkers release between the 2 groups at baseline and 7, 24, and 48
hours postoperatively (creatine kinase, P =.18, troponin P =.23). Left
ventricular function was similar between groups preoperatively and at 24
hours after surgery. No death or myocardial infarction was observed in
either group. There were no differences in intensive care unit length of
stay, incidence of atrial fibrillation, use of inotropes or vasopressors
support, time of intubation, or creatinine levels. Conclusion(s): A
single dose of Custodiol histidine-tryptophan-ketoglutarate cardioplegia
is not inferior to repeated cold-blood cardioplegia during elective
cardiac surgery. Copyright © 2019 The American Association for
Thoracic Surgery

<117>
Accession Number
2002213850
Title
Five-year outcomes in cardiac surgery patients with atrial fibrillation
undergoing concomitant surgical ablation versus no ablation. The long-term
follow-up of the PRAGUE-12 Study.
Source
Heart Rhythm. (no pagination), 2019. Date of Publication: 2019.
Author
Osmancik P.; Budera P.; Talavera D.; Hlavicka J.; Herman D.; Holy J.;
Cervinka P.; Smid J.; Hanak P.; Hatala R.; Widimsky P.
Institution
(Osmancik, Herman, Widimsky) Cardiocenter, IIIrd Internal -
Cardiology Clinic, Third Faculty of Medicine, Charles University and
University Hospital Kralovske Vinohrady, Prague, Czechia
(Budera, Talavera, Hlavicka) Cardiocenter, Dept. of Cardiac Surgery, Third
Faculty of Medicine, Charles University and University Hospital Kralovske
Vinohrady, Prague, Czechia
(Holy, Cervinka) Department of Cardiology, Masaryk Hospital in Usti nad
Labem, Krajska Zdravotni and UJEP in Usti na Labem, Usti nad Labem,
Czechia
(Smid) Cardiology Department, University Hospital and Faculty of Medicine
Pilsen, Pilsen, Czechia
(Hanak, Hatala) Department of Arrhythmias and Cardiac Pacing, National
Institute for Cardiovascular Disease, Bratislava, Slovakia
Publisher
Elsevier B.V.
Abstract
Background: The long-term effect of concomitant surgical ablation (SA) on
clinical outcomes in an unselected population of patients has not been
sufficiently reported in randomized studies. Objective(s): The aim of
this study was to assess clinical outcomes of the SA after 5 years of
follow-up. Method(s): The PRAGUE-12 study was a prospective,
randomized clinical trial assessing cardiac surgery with ablation for AF
vs cardiac surgery alone. Patients with AF who were also indicated for
cardiac surgery (coronary artery disease [CAD], valve surgery) were
randomized to SA or control (no ablation) group. All patients were
followed for 5 years. The primary endpoint was a composite of
cardiovascular death, stroke, hospitalization for heart failure, or severe
bleeding. Secondary endpoint was a recurrence of AF. Result(s): A
total of 207 patients were analyzed (SA group = 108 patients, control
group = 99 patients). Both groups were similar relative to important
clinical characteristics except for CAD, which was more common in the
control group. Cumulative incidence curves showed a higher incidence of
the primary endpoint in the control group (P = .024, Gray's test).
However, after adjusting for all covariables, the difference between
groups was not significant (subhazard ratio [SHR] 0.69 [0.47-1.02], P =
.068). The incidence of stroke and AF recurrences were significantly
reduced in the SA group, and remained significant even after adjustment
for all covariables, including CAD (stroke: SHR 0.32 [0.12-0.84], P = .02,
AF recurrences: SHR 0.44 [0.31-0.62], P < .001). Conclusion(s):
Concomitant SA of AF is associated with a greater likelihood of
maintaining sinus rhythm and a decreased risk of stroke. Copyright
© 2019 Heart Rhythm Society

<118>
Accession Number
628330701
Title
Effects of Exercise after Percutaneous Coronary Intervention on Cardiac
Function and Cardiovascular Adverse Events in Patients with Coronary Heart
Disease: Systematic Review and Meta-Analysis.
Source
Journal of sports science & medicine. 18 (2) (pp 213-222), 2019. Date of
Publication: 01 Jun 2019.
Author
Zhang H.; Chang R.
Institution
(Zhang) Department of Cardiology, China-Japan Friendship Hospital,
Beijing, China
(Chang) Department of Cardiology, Qinghai Provincial People's Hospital,
Xining, Qinghai Province, China
Publisher
NLM (Medline)
Abstract
Exercise program has been associated with improved cardiovascular outcomes
in patients sustaining coronary artery disease. However, little is known
about the role of exercise after percutaneous coronary intervention (PCI).
Published literature was searched from Embase, PubMed, Wanfang Data,
Cochrane Database of Systematic Reviews, China National Knowledge
Infrastructure (CNKI) and Central Database. Exercise versus no exercise
following PCI in the patients with coronary heart disease (CHD) was
investigated in randomized trials. Left ventricular end diastolic diameter
(LVEDD), left ventricular ejection fraction (LVEF), 6-minute walking
distance (6MWD), cardiac death, myocardial infarction, coronary
angioplasty, coronary artery bypass surgery (CABG), and angina pectoris or
restenosis per randomized patients were analyzed by meta-analytic
procedure to compare the curative effect of exercise program with
exclusive exercise program after PCI. Ten randomized controlled trials
including 1274 subjects (636 in exercise group and 638 in control group)
were analyzed. The meta-analysis demonstrated that LVEF was significantly
improved in exercise group (MD = 2.82, 95% CI [1.50, 4.14], p < 0.05). In
contrast, the incidence rate of cardiac death (RR = 0.24, 95% CI [007,
0.76], p = 0.02), myocardial infarction (RR = 0.23, 95% CI [0.09, 0.57], p
= 0.002), coronary angioplasty (RR = 0.47, 95% CI [0.26, 0.84], p = 0.01),
angina pectoris (RR = 0.39, 95% CI [0.24, 0.64], p = 0.0002) and
restenosis (RR = 0.36, 95% CI [0.16, 0.83], p = 0.02) were significantly
lower in exercise group. LVEDD (MD = -2.01, 95% CI [-4.72, 0.70]), 6MWD
(MD = 50.85, 95% CI [-13.24, 114.94]), and CABG (RD = -0.01, 95% CI
[-0.05, 0.03]) were not significantly different in the patients with or
without exercise (p = 0.71). Trial sequential analysis reflected
traditional meta-analysis might generate a false positive conclusion for
MI and cardiac death. There was no firm evidence to support the beneficial
effects of exercise after PCI for the CHD patients to improve heart
function or to reduce the incidence of adverse cardiovascular events.

<119>
[Use Link to view the full text]
Accession Number
628330088
Title
Evaluation and Management of Right-Sided Heart Failure: A Scientific
Statement From the American Heart Association.
Source
Circulation. 137 (20) (pp e578-e622), 2018. Date of Publication: 15 May
2018.
Author
Konstam M.A.; Kiernan M.S.; Bernstein D.; Bozkurt B.; Jacob M.; Kapur
N.K.; Kociol R.D.; Lewis E.F.; Mehra M.R.; Pagani F.D.; Raval A.N.; Ward
C.
Publisher
NLM (Medline)
Abstract
BACKGROUND AND PURPOSE: The diverse causes of right-sided heart failure
(RHF) include, among others, primary cardiomyopathies with right
ventricular (RV) involvement, RV ischemia and infarction, volume loading
caused by cardiac lesions associated with congenital heart disease and
valvular pathologies, and pressure loading resulting from pulmonic
stenosis or pulmonary hypertension from a variety of causes, including
left-sided heart disease. Progressive RV dysfunction in these disease
states is associated with increased morbidity and mortality. The purpose
of this scientific statement is to provide guidance on the assessment and
management of RHF. METHOD(S): The writing group used systematic
literature reviews, published translational and clinical studies, clinical
practice guidelines, and expert opinion/statements to summarize existing
evidence and to identify areas of inadequacy requiring future research.
The panel reviewed the most relevant adult medical literature excluding
routine laboratory tests using MEDLINE, EMBASE, and Web of Science through
September 2017. The document is organized and classified according to the
American Heart Association to provide specific suggestions,
considerations, or reference to contemporary clinical practice
recommendations. RESULT(S): Chronic RHF is associated with decreased
exercise tolerance, poor functional capacity, decreased cardiac output and
progressive end-organ damage (caused by a combination of end-organ venous
congestion and underperfusion), and cachexia resulting from poor
absorption of nutrients, as well as a systemic proinflammatory state. It
is the principal cause of death in patients with pulmonary arterial
hypertension. Similarly, acute RHF is associated with hemodynamic
instability and is the primary cause of death in patients presenting with
massive pulmonary embolism, RV myocardial infarction, and postcardiotomy
shock associated with cardiac surgery. Functional assessment of the right
side of the heart can be hindered by its complex geometry. Multiple
hemodynamic and biochemical markers are associated with worsening RHF and
can serve to guide clinical assessment and therapeutic decision making.
Pharmacological and mechanical interventions targeting isolated acute and
chronic RHF have not been well investigated. Specific therapies promoting
stabilization and recovery of RV function are lacking. CONCLUSION(S):
RHF is a complex syndrome including diverse causes, pathways, and
pathological processes. In this scientific statement, we review the causes
and epidemiology of RV dysfunction and the pathophysiology of acute and
chronic RHF and provide guidance for the management of the associated
conditions leading to and caused by RHF. Copyright © 2018
American Heart Association, Inc.

<120>
[Use Link to view the full text]
Accession Number
628358044
Title
Baseline significant tricuspid regurgitation is associated with higher
mortality in transcatheter aortic valve replacement: Systemic review and
meta-analysis.
Source
Journal of Cardiovascular Medicine. 20 (7) (pp 477-486), 2019. Date of
Publication: July 2019.
Author
Prasitlumkum N.; Kittipibul V.; Tokavanich N.; Kewcharoen J.; Rattanawong
P.; Angsubhakorn N.; Mao M.A.; Gillaspie E.A.; Cheungpasitporn W.
Institution
(Prasitlumkum, Kewcharoen, Rattanawong) Department of Internal Medicine,
University of Hawaii Internal Medicine Residency Program, Honolulu, HI,
United States
(Kittipibul) Department of Internal Medicine, Jackson Memorial Hospital
Internal Medicine Residency Program, Miami, FL, United States
(Tokavanich) Department of Cardiology, Chulalongkorn University, Bangkok,
Thailand
(Rattanawong) Faculty of Medicine Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
(Angsubhakorn) Department of Medicine, University of Minnesota,
Minneapolis, United States
(Mao) Division of Internal Medicine, Mayo Clinic, Rochester, MN, United
States
(Gillaspie) Department of Thoracic Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Cheungpasitporn) Department of Medicine, University of Mississippi
Medical Center, Jackson, MS, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction Significant tricuspid regurgitation is a well recognized
indicator of right ventricular dysfunction. Recent studies have shown that
significant tricuspid regurgitation is potentially associated with
increased mortality in patients with severe aortic stenosis who underwent
transcatheter aortic valve replacement (TAVR). However, data remained
sparse and inconclusive. Thus, we performed a systematic review and
meta-analysis of the literature to assess the association between
significant tricuspid regurgitation and mortality in post TAVR patients.
Hypothesis Significant tricuspid regurgitation is predictive for higher
mortality in patients undergoing TAVR. Methods We comprehensively searched
the databases of MEDLINE and EMBASE from inception to October 2018.
Included studies were published observational studies that reported
multivariate analysis of the effects of significant tricuspid
regurgitation on all-cause mortality among patients undergoing TAVR. Data
from each study were combined utilizing the random-effects, generic
inverse variance method of DerSimonian and Laird to calculate odds ratios
(ORs) and 95% confidence intervals (CIs). Results Nine cohort studies from
August 2011 to May 2018 consisting of 27 614 patients with severe aortic
stenosis undergoing TAVR (6255 with and 21 359 without significant
tricuspid regurgitation) were included in this meta-analysis. The presence
of significant tricuspid regurgitation was associated with higher
all-cause mortality (pooled OR = 2.26, 95% CI: 1.45 - 3.52, P < 0.001). We
found that all-cause mortality remained statistically substantial in all
subgroups (30-day all-cause mortality: OR = 2.05, 95% CI: 1.20 - 3.49, P =
0.009; midterm all-cause mortality: OR = 9.67, 95% CI: 2.44 - 38.31, P =
0.001; and long-term all-cause mortality: OR = 1.48, 95% CI: 1.19 - 1.85,
P < 0.001). Funnel plots and Egger's regression asymmetry test were
performed and showed no publication bias. Conclusion Significant tricuspid
regurgitation increased risk of mortality by up to two-fold among patients
with severe aortic stenosis undergoing TAVR. Our study suggests that
significant tricuspid regurgitation should be considered a component of
risk stratification tools. Copyright © 2019 Italian Federation of
Cardiology - I.F.C. All rights reserved.

<121>
Accession Number
628364389
Title
Association between urinary dickkopf-3, acute kidney injury, and
subsequent loss of kidney function in patients undergoing cardiac surgery:
an observational cohort study.
Source
Lancet (London, England). (no pagination), 2019. Date of Publication: 12
Jun 2019.
Author
Schunk S.J.; Zarbock A.; Meersch M.; Kullmar M.; Kellum J.A.; Schmit D.;
Wagner M.; Triem S.; Wagenpfeil S.; Grone H.-J.; Schafers H.-J.; Fliser
D.; Speer T.; Zewinger S.
Institution
(Schunk, Schmit, Wagner, Triem, Fliser, Speer) Department of Internal
Medicine 4, Nephrology and Hypertension, Saarland University Medical
Centre, Homburg, Germany
(Zarbock, Meersch, Kullmar) Department of Anaesthesiology, Intensive Care
Medicine and Pain Medicine, University Hospital Munster, Munster, Germany
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Wagenpfeil) Institute of Medical Biometry, Epidemiology and Medical
Informatics, Saarland University, Homburg, Germany
(Grone) Department of Cellular and Molecular Pathology, German Cancer
Research Centre, Heidelberg, Germany
(Schafers) Department of Thoracic and Cardiovascular Surgery, Saarland
University Medical Centre, Homburg, Germany
(Zewinger) Department of Internal Medicine 4, Nephrology and Hypertension,
Saarland University Medical Centre, Homburg, Germany; Department of
Nephrology, Hopitaux Robert Schuman, Hopital Kirchberg, Luxembourg,
Luxembourg
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac surgery is associated with a high risk of
postoperative acute kidney injury (AKI) and subsequent loss of kidney
function. We explored the clinical utility of urinary dickkopf-3 (DKK3), a
renal tubular stress marker, for preoperative identification of patients
at risk for AKI and subsequent kidney function loss. METHOD(S): This
observational cohort study included patients who had cardiac surgery in a
derivation cohort and those who had cardiac surgery in a validation cohort
(RenalRIP trial). The study comprised consecutive patients who had
elective cardiac surgery at the Saarland University Medical Centre
(Homburg, Germany; derivation cohort) and those undergoing elective
cardiac surgery (selected on the basis of a Cleveland Clinical Foundation
score of 6 or higher) who were enrolled in the prospective RenalRIP
multicentre trial (validation cohort) and who were randomly assigned to
remote ischaemic preconditioning or a sham procedure. The association
between the ratio of preoperative urinary concentrations of DKK3 to
creatinine (DKK3:creatinine) and postoperative AKI, defined according to
the Kidney Disease Improving Global Outcomes criteria, and subsequent
kidney function loss, as determined by estimated glomerular filtration
rate, was assessed. FINDINGS: In the 733 patient in the derivation cohort,
urinary concentrations of DKK3 to creatinine that were higher than 471
pg/mg were associated with significantly increased risk for AKI (odds
ratio [OR] 1.65, 95% CI 1.10-2.47, p=0.015), independent of baseline
kidney function. Compared with clinical and other laboratory measurements,
urinary concentrations of DKK3:creatinine significantly improved AKI
prediction (net reclassification improvement 0.32, 95% CI 0.23-0.42,
p<0.0001). High urinary DKK3:creatinine concentrations were independently
associated with significantly lower kidney function at hospital discharge
and after a median follow-up of 820 days (IQR 733-910). In the RenalRIP
trial, preoperative urinary DKK3:creatinine concentrations higher than 471
pg/mg were associated with a significantly higher risk for AKI (OR 1.94,
95% CI 1.08-3.47, p=0.026), persistent renal dysfunction (OR 6.67,
1.67-26.61, p=0.0072), and dialysis dependency (OR 13.57, 1.50-122.77,
p=0.020) after 90 days compared with DKK3:creatinine concentrations of 471
pg/mg or less. Urinary DKK3:creatinine concentrations higher than 471
pg/mg were associated with significantly higher risk for AKI (OR 2.79, 95%
CI 1.45-5.37) and persistent renal dysfunction (OR 3.82, 1.32-11.05) only
in patients having a sham procedure, but not remote ischaemic
preconditioning (AKI OR 1.35, 0.76-2.39 and persistent renal dysfunction
OR 1.05, 0.12-9.45). INTERPRETATION: Preoperative urinary DKK3 is an
independent predictor for postoperative AKI and for subsequent loss of
kidney function. Urinary DKK3 might aid in the identification of patients
in whom preventive treatment strategies are effective. FUNDING: No study
funding. Copyright © 2019 Elsevier Ltd. All rights reserved.

<122>
Accession Number
628364161
Title
Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve
Replacement.
Source
JACC. Cardiovascular interventions. (no pagination), 2019. Date of
Publication: 06 Jun 2019.
Author
Jochheim D.; Barbanti M.; Capretti G.; Stefanini G.G.; Hapfelmeier A.;
Zadrozny M.; Baquet M.; Fischer J.; Theiss H.; Todaro D.; Chieffo A.;
Presbitero P.; Colombo A.; Massberg S.; Tamburino C.; Mehilli J.
Institution
(Jochheim, Baquet, Massberg, Mehilli) Department of Cardiology, Munich
University Clinic, Ludwig-Maximilians University, Munich, Germany; German
Centre for Cardiovascular Research, partner site Munich Heart Alliance,
Munich, Germany
(Barbanti, Todaro, Tamburino) Department of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Capretti, Chieffo, Colombo) Department of Cardiology, Universita
Vita-Salute San Raffaele, Milano, Italy
(Stefanini, Presbitero) Department of Cardiology, Istituto Clinico
Humanitas, Rozzano, Italy
(Hapfelmeier) Institute of Medical Informatics, Statistics and
Epidemiology, Technical University Munich, Munich, Germany
(Zadrozny, Fischer, Theiss) Department of Cardiology, Munich University
Clinic, Ludwig-Maximilians University, Munich, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The purpose of the study was to investigate the impact of oral
anticoagulation (OAC) type on clinical outcomes 1 year after transcatheter
aortic valve replacement (TAVR). BACKGROUND: Non-vitamin K oral
anticoagulant (NOACs) are superior to vitamin K antagonists (VKAs) in
nonvalvular atrial fibrillation (AF), while their comparative performance
among patients in need of OAC undergoing TAVR is underinvestigated.
 METHOD(S): The study enrolled 962 consecutive patients who underwent
TAVR in 4 tertiary European centers and were discharged on either NOACs (n
= 326) or VKAs (n = 636). By using propensity scores for inverse
probability of treatment weighting (IPTW), the comparison of treatment
groups was adjusted to correct for potential confounding. RESULT(S):
Mean age and Society of Thoracic Surgeons score of the population were
81.3 +/- 6.3 years and 4.5% (interquartile range: 3.0% to 7.3%); 52.5%
were women and a balloon-expandable valve was used in 62.7% of cases. The
primary outcome of interest, combined incidence of all-cause mortality,
myocardial infarction, and any cerebrovascular event at 1-year after TAVR,
was 21.2% with NOACs versus 15.0% with VKAs (hazard ratio [HR], 1.44; 95%
confidence interval [CI], 1.00 to 2.07; p = 0.050, IPTW-adjusted). The
1-year incidence of any Bleeding Academic Research Consortium bleeds and
all-cause mortality were comparable between the NOAC and VKA groups, 33.9%
versus 34.1% (HR, 0.97; 95% CI, 0.74 to 1.26; p = 0.838, IPTW-adjusted)
and 16.5% versus 12.2% (HR, 1.36; 95% CI, 0.90 to 2.06; p = 0.136,
IPTW-adjusted), respectively. CONCLUSION(S): Chronic use of both
NOACs and VKAs among patients in need of OAC after TAVR are comparable
regarding 1-year bleeding risk. The higher ischemic event rate observed
with NOACs needs to be evaluated in large randomized trials. Copyright
© 2019 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<123>
Accession Number
626790824
Title
Additional effects of psychological interventions on subjective and
objective outcomes compared with exercise-based cardiac rehabilitation
alone in patients with cardiovascular disease: A systematic review and
meta-analysis.
Source
European Journal of Preventive Cardiology. 26 (10) (pp 1035-1049), 2019.
Date of Publication: 01 Jul 2019.
Author
Albus C.; Herrmann-Lingen C.; Jensen K.; Hackbusch M.; Munch N.; Kuncewicz
C.; Grilli M.; Schwaab B.; Rauch B.
Institution
(Albus, Munch) Department of Psychosomatics and Psychotherapy, University
of Cologne, Germany
(Herrmann-Lingen, Kuncewicz) Department of Psychosomatic Medicine and
Psychotherapy, University of Gottingen Medical Centre, Germany
(Herrmann-Lingen) German Centre for Cardiovascular Research, partner site
Gottingen, Germany
(Jensen, Hackbusch) Institute of Medical Biometry and Informatics,
University of Heidelberg, Germany
(Grilli) Library of the Medical Faculty, University of Mannheim, Germany
(Schwaab) Curschmann Klinik, Timmendorfer Strand, Germany
(Rauch) IHF-Institut fur Herzinfarktforschung, Ludwigshafen am Rhein,
Germany
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Exercise-based cardiac rehabilitation (ebCR) often includes
various psychological interventions for lifestyle change or distress
management. However, the additional benefit of specific psychological
interventions on depression, anxiety, quality of life, cardiac morbidity
and cardiovascular or total mortality is not well investigated.
 Design(s): Systematic review and meta-analysis. Method(s):
Randomized controlled trials and controlled cohort trials published
between January 1995 and October 2017 comparing ebCR with or without
pre-specified psychosocial interventions were selected and evaluated on
the basis of predefined inclusion and outcome criteria. Result(s):
Out of 15,373 records, 20 studies were identified, including 4450 patients
with coronary artery disease (88.5%) or congestive heart failure (11.5%),
respectively. Studies were of low to moderate quality and methodological
heterogeneity was high. As compared with ebCR alone, additional
psychological interventions for lifestyle change or distress management
showed a trend to reduce depressive symptoms (standardized mean difference
-0.13, 95% confidence interval (CI) -0.30; 0.05). Furthermore, during a
follow-up of five years, distress management was associated with a trend
to reduce cardiac morbidity (risk ratio 0.74, 95% CI 0.51; 1.07). There
was no evidence for an additional impact of either psychological lifestyle
change interventions or distress management on anxiety, quality of life,
cardiovascular or total mortality. Conclusion(s): Specific
psychological interventions offered during ebCR may contribute to a
reduction of depressive symptoms and cardiac morbidity, but there remains
considerable uncertainty under which conditions these interventions exert
their optimal effects. (CRD42015025920). Copyright © The European
Society of Cardiology 2019.

<124>
Accession Number
2001411245
Title
The Intrarater and Interrater Reliability of Measures Derived from
Cardiopulmonary Exercise Testing in Patients with Abdominal Aortic
Aneurysms.
Source
Annals of Vascular Surgery. 56 (pp 175-182), 2019. Date of Publication:
April 2019.
Author
Harwood A.E.; Pymer S.; Hitchman L.; Totty J.; Wallace T.; Smith G.E.;
Carradice D.; Carroll S.; Chetter I.C.
Institution
(Harwood, Pymer, Hitchman, Totty, Wallace, Smith, Carradice, Chetter)
Academic Vascular Surgical Unit, Hull York Medical School, Hull Royal
Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom
(Harwood) Thermal Ergonomics Laboratory, University of Sydney, Cumberland
Campus, Lidcombe, New South Wales, Australia
(Carroll) School of Sport and Exercise Science, University of Hull,
Cottingham Road, Hull HU6 7RX, United Kingdom
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Patients with abdominal aortic aneurysms (AAAs) often have low
exercise tolerance due to comorbidities and advanced age. Cardiopulmonary
exercise testing (CPET) is predictive of postoperative morbidity and
mortality in patients with AAA. We aimed to assess the intrarater and
interrater reliability of both treadmill-based and cycle ergometer-based
CPET variables. Method(s): Patients with an AAA (>3.5 cm) were
randomized to a treadmill or bike CPET. Patients were asked to perform two
separate CPETs seven days apart after a familiarization protocol. All
CPETs were carried out using a ramp cycle or modified Bruce treadmill
protocol with breath-by-breath gas analysis. Result(s): Twenty-two
male and 2 female patients, aged 73.6 +/- 6.0 years, completed the study.
Intrarater analysis (intraclass correlation coefficients) demonstrated
high reliability on both the treadmill and bike for ventilatory anaerobic
threshold (r = 0.834 and r = 0.975, respectively). All other CPET
variables demonstrated high intrarater reliability on both modalities, bar
the highest point for the ventilatory slope of oxygen (VE/VO<inf>2</inf>)
on the treadmill (substantial agreement r = 0.755). Furthermore,
interrater reliability demonstrated high agreement for ventilatory
anaerobic threshold on both the treadmill and cycle (r = 0.983 and r =
0.905, respectively). All other CPET variables demonstrated high
intrarater reliability on both modalities, with the exception of
VO<inf>2Peak</inf> on the cycle ergometer (fair agreement r = 0.400).
 Conclusion(s): CPET in patients with AAAs is a reliable tool test and
among CPET test reviewers for common testing modalities/protocols. These
findings provide further support for the use of CPET, especially treadmill
walking, as a clinical measure of perioperative cardiorespiratory fitness
in patients with AAAs. Copyright © 2018 Elsevier Inc.

<125>
Accession Number
626519353
Title
The effect of hyperoxia on mortality in critically ill patients: A
systematic review and meta analysis.
Source
BMC Pulmonary Medicine. 19 (1) (no pagination), 2019. Article Number:
0810. Date of Publication: 26 Feb 2019.
Author
Ni Y.-N.; Wang Y.-M.; Liang B.-M.; Liang Z.-A.
Institution
(Ni, Liang, Liang) Department of Respiratory and Critical Care, West China
School of Medicine and West China Hospital, Sichuan University, No.37
Guoxue Alley, Chengdu 610041, China
(Wang) Department of Respiratory Medicine, Sichuan Second Hospital of
Traditional Chinese Medicine, Chengdu, Sichuan 610031, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Studies investigating the role of hyperoxia in critically ill
patients have reported conflicting results. We did this analysis to reveal
the effect of hyperoxia in the patients admitted to the intensive care
unit (ICU). Method(s): Electronic databases were searched for all the
studies exploring the role of hyperoxia in adult patients admitted to ICU.
The primary outcome was mortality. Random-effect model was used for
quantitative synthesis of the adjusted odds ratio (aOR). Result(s):
We identified 24 trials in our final analysis. Statistical heterogeneity
was found between hyperoxia and normoxia groups in patients with
mechanical ventilation (I2 = 92%, P < 0.01), cardiac
arrest(I2 = 63%, P = 0.01), traumatic brain injury
(I2 = 85%, P < 0.01) and post cardiac surgery (I2 =
80%, P = 0.03). Compared with normoxia, hyperoxia was associated with
higher mortality in overall patients (OR 1.22, 95% CI 1.12~1.33), as well
as in the subgroups of cardiac arrest (OR 1.30, 95% CI 1.08~1.57) and
extracorporeal life support (ELS) (OR 1.44, 95% CI 1.03~2.02).
 Conclusion(s): Hyperoxia would lead to higher mortality in critically
ill patients especially in the patients with cardiac arrest and
ELS. Copyright © 2019 The Author(s).

<126>
Accession Number
624224548
Title
Zero-Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and
Improves the Respiratory Function in Infants After Cardiopulmonary Bypass:
A Randomized Controlled Trial.
Source
Artificial Organs. 43 (2) (pp 167-172), 2019. Date of Publication:
Februaryy 2019.
Author
Gholampour Dehaki M.; Niknam S.; Azarfarin R.; Bakhshandeh H.; Mahdavi M.
Institution
(Gholampour Dehaki, Niknam, Azarfarin, Bakhshandeh, Mahdavi) Rajaie
Cardiovascular, Medical & Research Center-Perfusion, Tehran Province,
Tehran, Iran, Islamic Republic of
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and
infants to avoid exceeding hemodilution; however, transfusion-related
inflammation affects post-CPB outcomes in infant open-heart surgery.
Procalcitonin, a newly detected inflammatory moderator and a sensitive
parameter for predicting pulmonary dysfunction secondary to CPB, rises
after CPB. We hypothesized that the hemofiltration of priming blood before
CPB might decrease inflammatory mediators in the blood and post-CPB
inflammatory replications, thereby improving the respiratory function
after CPB in infants. Sixty infants with a weight below 10 kg were divided
randomly into two equal groups of CPB with the zero-balance
ultrafiltration (Z-BUF) of priming blood and CPB without it. The
procalcitonin level was measured before anesthesia, after admission to the
intensive care unit (ICU), and 24 h afterward. The respiratory index and
pulmonary compliance were measured after anesthesia, at the end of CPB,
and 2 h after admission to the ICU. Additionally, time to extubation was
recorded. The Z-BUF of priming blood maintained electrolytes within a
physiologic level, and procalcitonin had a slighter rise in the Z-BUF
Group at 24 h after admission to the ICU (P = 0.05). The respiratory index
was decreased in the Z-BUF Group, but the difference with the control
group did not reach statistical significance (P > 0.05). The change in
pulmonary compliance was significantly increased in the cyanotic patients
in the intervention group, but there was no significant difference between
the two groups. The time to extubation and the ICU stay were shorter in
the Z-BUF Group (P < 0.05). A positive correlation was found between the
peak procalcitonin concentration and the time to extubation directly and
pulmonary compliance reversely. These results suggest that the Z-BUF of
priming blood may have some beneficial clinical effects such as improved
respiratory function and attenuated procalcitonin. Copyright ©
2018 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<127>
Accession Number
626389708
Title
Statins for the Primary Prevention of Coronary Heart Disease.
Source
BioMed Research International. 2019 (no pagination), 2019. Article Number:
4870350. Date of Publication: 2019.
Author
Li M.; Wang X.; Li X.; Chen H.; Hu Y.; Zhang X.; Tang X.; Miao Y.; Tian
G.; Shang H.
Institution
(Li, Wang, Li, Chen, Hu, Zhang, Tang, Tian, Shang) Key Laboratory of
Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen
Hospital, Beijing University of Chinese Medicine, Beijing, China
(Miao) First Teaching Hospital of Tianjin University of Traditional
Chinese Medicine, Tianjin, China
(Shang) Institute of Integration of Traditional Chinese and Western
Medicine, Guangzhou Medical University, Guangzhou, China
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Object. The purpose of this study was to fully assess the role of statins
in the primary prevention of coronary heart disease (CHD). Methods. We
searched six databases (PubMed, the Cochrane Library, Web of Science,
China National Knowledge Infrastructure, Wanfang Database, and Chinese
Scientific Journal Database) to identify relevant randomized controlled
trials (RCTs) from inception to 31 October 2017. Two review authors
independently assessed the methodological quality and analysed the data
using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95%
CI) were pooled using fixed/random-effects models. Funnel plots and Begg's
test were conducted to assess publication bias. The quality of the
evidence was evaluated using the Grading of Recommendations Assessment,
Development and Evaluation (GRADE) approach. Results. Sixteen RCTs with
69159 participants were included in this review. Statins can effectively
decrease the occurrence of angina (RR=0.70, 95% CI: 0.580.85,
I2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI:
0.510.69, I2 =14%), fatal MI (RR=0.49, 95% CI: 0.240.98,
I2 =0%), any MI (RR=0.53, 95% CI: 0.420.67, I2 =0%),
any coronary heart events (RR=0.73, 95% CI: 0.680.78, I2=0%),
coronary revascularization (RR=0.66, 95% CI: 0.550.78, I2 =
0%), and any cardiovascular events (RR=0.77, 95% CI: 0.7282, I2
= 0%). However, based on the current evidence, there were no significant
differences in CHD deaths (RR=0.82, 95% CI: 0.661.02, I2=0%)
and all-cause mortality (RR=0.88, 95% CI: 0.76 1.01, I2 =58%)
between the two groups. Additionally, statins were more likely to result
in diabetes (RR=1.21, 95% CI: 1.051.39, I2 =0%). There was no
evidence of publication biases, and the quality of the evidence was
considered moderate. Conclusion. Statins seemed to be beneficial for the
primary prevention of CHDs but have no effect on CHD death and all-cause
mortality. Copyright © 2019 Min Li et al.

<128>
Accession Number
626231183
Title
Liberal transfusion strategy to prevent mortality and anaemia-associated,
ischaemic events in elderly non-cardiac surgical patients - The study
design of the LIBERAL-Trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 101. Date of
Publication: 04 Feb 2019.
Author
Meybohm P.; Lindau S.; Treskatsch S.; Francis R.; Spies C.; Velten M.;
Wittmann M.; Gueresir E.; Stoppe C.; Kowark A.; Coburn M.; Selleng S.;
Baschin M.; Jenichen G.; Meersch M.; Ermert T.; Zarbock A.; Kranke P.;
Kredel M.; Helf A.; Laufenberg-Feldmann R.; Ferner M.; Wittenmeier E.;
Gurtler K.-H.; Kienbaum P.; De Abreu M.G.; Sander M.; Bauer M.; Seyfried
T.; Gruenewald M.; Choorapoikayil S.; Mueller M.M.; Seifried E.; Brosteanu
O.; Bogatsch H.; Hasenclever D.; Zacharowski K.; Baron D.; Grottke O.;
Hill A.; Van Waesberghe J.; Ziemann S.; Tingart M.; Van Essen J.; Spring
O.; Pirzer R.; Jaschinski U.; Heller A.R.; Ertmer M.; Falk E.; Pickerodt
P.; Schiemann A.; Schmidt K.; Tafelski S.; Trauzeddel R.-F.; Perka C.;
Ehrentraut H.; Fingehut L.; Hopf A.; Guttenthaler V.; Neumann C.;
Osberghaus I.; Schuss P.; Winkler A.; Kohlhof H.; Wirtz D.C.; Kalb R.;
Hinterberg J.; Schafer M.; Koch T.; Piekarski F.; Tanner L.; Berg K.;
Wiedenbeck C.; Maushagen I.; Zeisset D.; Fuellenbach C.; Westphal S.;
Pfeiffer S.; Schnitzbauer A.; Marzi I.; Becker A.; Ghanaati S.;
Schmitz-Rixen T.; Brixner V.; Geisen C.; Herrmann E.; Edinger F.; Koch C.;
Kunzemann C.; Leicht D.; Markmann M.; Ruhrmann S.; Schneck E.; Schulte D.;
Grundling M.; Brenig I.; Gerber M.; Selleng K.; Wodrig S.; Bloos F.; Bloos
P.; Haucke A.; Knuhr-Kohlberg K.; Kolanos S.; Schwope K.; Thomas D.;
Buchholz C.; Heller B.; Renner J.; Schulz-Ruhtenberg N.; Elke G.; Fischer
S.; Hofbauer S.; Straub P.; Zimmer S.; Kullmar M.; Rosenow N.; Massoth C.;
Weiss R.; Bitzinger D.; Pfister K.; Guzman I.; Kranke E.-M.; Roewer N.;
Woeckel A.; Helmer P.
Institution
(Meybohm, Lindau, Choorapoikayil, Zacharowski) Department of
Anaesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
(Treskatsch, Francis, Spies) Department of Anesthesiology, Operative
Intensive Care Medicine, Berlin Institute of Health, Charite -
Universitatsmedizin Berlin, Freie Universitat Berlin, Humboldt-Universitat
zu Berlin, Campus Charite Mitte, Campus Virchow Klinikum, Berlin, Charite,
Germany
(Velten, Wittmann) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Gueresir) Department of Neurosurgery, University Hospital Bonn, Bonn,
Germany
(Stoppe) Department of Intensive Care Medicine, RWTH University Aachen,
Pauwelstrasse 30, Aachen 52074, Germany
(Kowark, Coburn) Department of Anesthesiology, RWTH University Aachen,
Pauwelstrasse 30, Aachen 52074, Germany
(Selleng, Baschin, Jenichen) Department of Anesthesiology, University
Hospital Greifswald, Greifswald, Germany
(Meersch, Ermert, Zarbock) Department of Anaesthesiology, Intensive Care
and Pain Therapy, University Hospital Munster, Munster, Germany
(Kranke, Kredel, Helf) Department of Anaesthesia and Critical Care,
University Hospital of Wurzburg, Wuerzburg, Germany
(Laufenberg-Feldmann, Ferner, Wittenmeier) Department of Anaesthesiology,
Intensive Care Medicine, University Hospital Mainz, Main, Germany
(Gurtler) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Augsburg, Augsburg, Germany
(Kienbaum) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Dusseldorf, Dusseldorf, Germany
(De Abreu) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Dresden, Dresden, Germany
(Sander) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Giessen-Marburg, Giessen, Germany
(Bauer) Department of Anaesthesiology, Intensive Care Medicine, University
Hospital Jena, Jena, Germany
(Seyfried) Department of Anaesthesiology, Intensive Care Medicine,
University Hospital Regensburg, Regensburg, Germany
(Gruenewald) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Mueller, Seifried) Institute for Transfusion Medicine and
Immunohaematology Frankfurt/ Main, German Red Cross Blood Transfusion
Service Baden-Wuerttemberg - Hessen, Frankfurt, Germany
(Brosteanu, Bogatsch) Clinical Trial Centre Leipzig, University Leipzig,
Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University Leipzig, Leipzig, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Perioperative anaemia leads to impaired oxygen supply with a
risk of vital organ ischaemia. In healthy and fit individuals, anaemia can
be compensated by several mechanisms. Elderly patients, however, have less
compensatory mechanisms because of multiple co-morbidities and age-related
decline of functional reserves. The purpose of the study is to evaluate
whether elderly surgical patients may benefit from a liberal red blood
cell (RBC) transfusion strategy compared to a restrictive transfusion
strategy. Method(s): The LIBERAL Trial is a prospective, randomized,
multicentre, controlled clinical phase IV trial randomising 2470 elderly
(>= 70 years) patients undergoing intermediate- or high-risk non-cardiac
surgery. Registered patients will be randomised only if Haemoglobin (Hb)
reaches <=9 g/dl during surgery or within 3 days after surgery either to
the LIBERAL group (transfusion of a single RBC unit when Hb <= 9 g/dl with
a target range for the post-transfusion Hb level of 9-10.5 g/dl) or the
RESTRICTIVE group (transfusion of a single RBC unit when Hb <= 7.5 g/dl
with a target range for the post-transfusion Hb level of 7.5-9 g/dl). The
intervention per patient will be followed until hospital discharge or up
to 30 days after surgery, whichever occurs first. The primary efficacy
outcome is defined as a composite of all-cause mortality, acute myocardial
infarction, acute ischaemic stroke, acute kidney injury (stage III), acute
mesenteric ischaemia and acute peripheral vascular ischaemia within 90
days after surgery. Infections requiring iv antibiotics with
re-hospitalisation are assessed as important secondary endpoint. The
primary endpoint will be analysed by logistic regression adjusting for
age, cancer surgery (y/n), type of surgery (intermediate- or high-risk),
and incorporating centres as random effect. Discussion(s): The
LIBERAL-Trial will evaluate whether a liberal transfusion strategy reduces
the occurrence of major adverse events after non-cardiac surgery in the
geriatric population compared to a restrictive strategy within 90 days
after surgery. Trial registration: ClinicalTrials.gov (identifier:
NCT03369210). Copyright © 2019 The Author(s).

<129>
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. 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. Copyright © 2019 EDIZIONI
MINERVA MEDICA.

<130>
Accession Number
627429112
Title
The combined effect of surgeon and hospital volume on health outcomes: A
systematic review.
Source
Clinica Terapeutica. 170 (2) (pp E148-E161), 2019. Date of Publication: 01
Mar 2019.
Author
Saulle R.; Vecchi S.; Cruciani F.; Mitrova Z.; Amato L.; Davoli M.
Institution
(Saulle, Vecchi, Cruciani, Mitrova, Amato, Davoli) Department of
Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112,
Rome 00147, Italy
Publisher
Societa Editrice Universo (E-mail: amministrazione@seu-roma.it)
Abstract
Objectives. To explore the interaction between surgeon volumes (SVs) and
hospital volumes (HVs) on health outcomes. Materials and Methods. We
searched MEDLINE, Embase, CINAHL, Web of Science as of May 2017. We
included studies investigating the interaction between high or low SVs
operating in high or low HVs. Review process follows the PRISMA
guidelines. We assessed the methodological quality of the included studies
using validated critical appraisal checklists. Results. Sixteen studies
were included. Due to the heterogeneity of studies, it was not possible to
perform a quantitative analysis. Heath outcome are worse when high SV
operating in low HV vs high HV, for the majority of the conditions
(colorectal cancer, cystectomy, liver resection, mitral valve surgery,
pancreatico-duodenectomy). Results for low SV are better when operating in
high HV vs low HV for patients undergoing pancreatic-duodenectomy for
mortality, 30 days complications and length of stay. Results for low SV
are worse vs high SV when operating in high HV for most considered
conditions. Results were in favour of higher SV vs low SV when operating
in low HV for digital replantation success after injuries, 30 days
mortality and complications after pancreatic-duodenectomy. Conclusion. The
available evidence is limited. It is necessary to increase the monitoring
of the association between surgeons volumes and hospitals volumes in which
they operate, to ensure fairness and accuracy of care for better health
outcomes. Copyright © 2019 Societa Editrice Universo. All Rights
Reserved.

<131>
Accession Number
621304862
Title
Metabolic syndrome and the risk of adverse cardiovascular events after an
acute coronary syndrome.
Source
European Journal of Preventive Cardiology. 25 (8) (pp 830-838), 2018. Date
of Publication: 01 May 2018.
Author
Cavallari I.; Cannon C.P.; Braunwald E.; Goodrich E.L.; Im K.A.; Lukas
M.A.; O'Donoghue M.L.
Institution
(Cavallari, Cannon, Braunwald, Goodrich, Im, O'Donoghue) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
United States
(Cavallari) Department of Cardiovascular Science, Campus Bio-Medico
University of Rome, Italy
(Lukas) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Philadelphia, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The incremental prognostic value of assessing the metabolic
syndrome has been disputed. Little is known regarding its prognostic value
in patients after an acute coronary syndrome. Design and methods: The
presence of metabolic syndrome (2005 International Diabetes Federation)
was assessed at baseline in SOLID-TIMI 52, a trial of patients within 30
days of acute coronary syndrome (median follow-up 2.5 years). The primary
endpoint was major coronary events (coronary heart disease death,
myocardial infarction or urgent coronary revascularization).
 Result(s): At baseline, 61.6% (n = 7537) of patients met the
definition of metabolic syndrome, 34.7% (n = 4247) had diabetes and 29.3%
had both (n = 3584). The presence of metabolic syndrome was associated
with increased risk of major coronary events (adjusted hazard ratio
(adjHR) 1.29, p < 0.0001) and recurrent myocardial infarction (adjHR 1.30,
p < 0.0001). Of the individual components of the definition, only diabetes
(adjHR 1.48, p < 0.0001) or impaired fasting glucose (adjHR 1.21, p =
0.002) and hypertension (adjHR 1.46, p < 0.0001) were associated with the
risk of major coronary events. In patients without diabetes, metabolic
syndrome was numerically but not significantly associated with the risk of
major coronary events (adjHR 1.13, p = 0.06). Conversely, diabetes was a
strong independent predictor of major coronary events in the absence of
metabolic syndrome (adjHR 1.57, p < 0.0001). The presence of both diabetes
and metabolic syndrome identified patients at highest risk of adverse
outcomes but the incremental value of metabolic syndrome was not
significant relative to diabetes alone (adjHR 1.07, p = 0.54).
 Conclusion(s): After acute coronary syndrome, diabetes is a strong
and independent predictor of adverse outcomes. Assessment of the metabolic
syndrome provides only marginal incremental value once the presence or
absence of diabetes is established. Copyright © 2018, © The
European Society of Cardiology 2018.

<132>
Accession Number
621375589
Title
Long-term effect of exercise training in patients after transcatheter
aortic valve implantation: Follow-up of the SPORT:TAVI randomised pilot
study.
Source
European Journal of Preventive Cardiology. 25 (8) (pp 794-801), 2018. Date
of Publication: 01 May 2018.
Author
Pressler A.; Forschner L.; Hummel J.; Haller B.; Christle J.W.; Halle M.
Institution
(Pressler, Forschner, Hummel, Christle, Halle) Department of Prevention,
Rehabilitation and Sports Medicine, Technische Universitat Munchen,
Germany
(Haller) Institute for Medical Statistics and Epidemiology, Technische
Universitat Munchen, Germany
(Christle) Department of Medicine, Stanford University, United States
(Halle) DZHK (German Center for Cardiovascular Research), partner site
Munich Heart Alliance, Germany
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Increased exercise capacity favourably influences clinical
outcomes after transcatheter aortic valve implantation. In our SPORT:TAVI
randomised pilot trial, eight weeks of endurance and resistance training
(training group, TG) shortly after transcatheter aortic valve implantation
resulted in significantly improved exercise capacity, muscular strength
and quality of life compared to usual care (UC). However, the long-term
clinical benefits of such an intervention are unknown. Design(s): A
randomised controlled trial. Method(s): SPORT:TAVI participants
underwent reassessment of trial endpoints 24 +/- 6 months after baseline:
maximal oxygen uptake (VO<inf>2</inf>peak) and anaerobic threshold
(VO<inf>2</inf>AT) were assessed with cardiopulmonary exercise testing,
muscular strength with one-repetition maximum testing, quality of life
with the Kansas City cardiomyopathy and medical outcomes study 12-item
short-form health survey questionnaires, and prosthetic aortic valve
function with echocardiography. Result(s): Of 27 original
participants (TG 13; UC 14; age 81 +/- 6 years), more patients had died
during follow-up in UC (n = 5) than in TG (n = 2; P = 0.165); three
further patients (TG 1; UC 2) were unavailable for other reasons. In the
remaining patients (TG 10; UC 7), a significant between-group difference
in favour of TG was observed for change in VO<inf>2</inf>AT from baseline
(2.7 ml/min/kg (95% confidence interval 0.8-4.6); P = 0.008), but not for
change in VO<inf>2</inf>peak (2.1 ml/min/kg (-1.1-5.4); P = 0.178).
Changes in muscular strength and quality of life did not differ between
groups over time. Overall, prosthetic valve function remained intact in
both groups. Conclusion(s): Eight weeks of exercise training shortly
after transcatheter aortic valve implantation resulted in preserved
long-term improvements in VO<inf>2</inf>AT, but not VO<inf>2</inf>peak,
muscular strength or quality of life compared to usual care. The findings
emphasise the importance of ongoing exercise interventions following
transcatheter aortic valve implantation to maintain initial improvements
long term. Clinical Trial Registration (original trial):
Clinicaltrials.gov NCT01935297. Copyright © 2018, © The
European Society of Cardiology 2018.

<133>
Accession Number
622975188
Title
A meta-analysis of the efficacy of allopurinol in reducing the incidence
of myocardial infarction following coronary artery bypass grafting.
Source
BMC Cardiovascular Disorders. 18 (1) (no pagination), 2018. Article
Number: 143. Date of Publication: 11 Jul 2018.
Author
Singh T.P.; Skalina T.; Nour D.; Murali A.; Morrison S.; Moxon J.V.;
Golledge J.
Institution
(Singh, Skalina, Nour, Murali, Morrison, Moxon, Golledge) James Cook
University, Queensland Research Centre for Peripheral Vascular Disease,
College of Medicine and Dentistry, Townsville, QLD 4811, Australia
(Singh, Golledge) The Townsville Hospital, The Department of Vascular and
Endovascular Surgery, Townsville, QLD, Australia
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The xanthine oxidase inhibitor allopurinol that is commonly
used to treat gout, has been suggested to have pleiotropic effects that
are likely to reduce the incidence of myocardial infarction (MI) in at
risk individuals. The aim of this meta-analysis was to assess the efficacy
of allopurinol treatment in reducing the incidence of MI. Method(s):
MEDLINE, Scopus, Web of Science, and Cochrane Library databases were
searched for randomised controlled trials examining the efficacy of
allopurinol in reducing the incidence of MI. The quality of study
methodology was assessed by two independent reviewers using the Cochrane
Collaboration's tool for assessing risk of bias. This meta-analysis was
conducted using a fixed-effects model, and heterogeneity was assessed with
the I2 index. Result(s): One thousand one hundred
twenty-three citations were screened and only six studies satisfied the
inclusion criterion. Published between 1988 and 1995, all studies examined
the cardioprotective efficacy of allopurinol in the setting of coronary
artery bypass graft (CABG). From a total pooled sample size of 229, MI was
reported in 2 (1.77%) allopurinol and 14 (12.07%) control patients. A
fixed-effects meta-analysis (I2 = 0%) identified a
statistically significant reduced incidence of myocardial infarction (RR
0.21, 95% CI: 0.06, 0.70, p = 0.01) in patients allocated to allopurinol.
However, in the leave-one-out sensitivity analyses, the treatment effect
became non-significant with the removal of one of the studies.
 Conclusion(s): Based on the limited evidence available, allopurinol
appears to reduce the incidence of perioperative MI following CABG.
Further research is required to confirm these findings. Copyright
© 2018 The Author(s).

<134>
Accession Number
623324833
Title
Platelet storage duration and its clinical and transfusion outcomes: A
systematic review.
Source
Critical Care. 22 (1) (no pagination), 2018. Article Number: 185. Date of
Publication: 05 Aug 2018.
Author
Aubron C.; Flint A.W.J.; Ozier Y.; McQuilten Z.
Institution
(Aubron) Centre Hospitalier et Universitaire de Brest - Universite de
Bretagne Occidentale, The Medical Intensive Care Unit, Bvd Tanguy Prigent,
Brest Cedex 29609, France
(Aubron, Flint, McQuilten) Monash University, The Australian and New
Zealand Intensive Care Research Centre, Department of Epidemiology and
Preventive Medicine, Melbourne, Australia
(McQuilten) Monash University, The Transfusion Research Unit, Department
of Epidemiology and Preventive Medicine, Melbourne, Australia
(Flint) Royal Australian Navy, Australian Defence Force, Canberra,
Australia
(Ozier) Centre Hospitalier et Universitaire de Brest - Universite de
Bretagne Occidentale, The Department of Anesthesiology, Brest, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Platelets (PLTs) are usually stored for up to 5days prior to
transfusion, although in some blood services the storage period is
extended to 7days. During storage, changes occur in both PLT and storage
medium, which may lead to PLT activation and dysfunction. The clinical
significance of these changes remains uncertain. Method(s): We
performed a systematic review to assess the association between PLT
storage time and clinical or transfusion outcomes in patients receiving
allogeneic PLT transfusion. We searched studies published in English
between January 2000 and July 2017 identified from MEDLINE, Embase, PubMed
and the Cochrane Libraries. Result(s): Of the 18 studies identified,
five included 4719 critically ill patients (trauma, post-cardiac surgery
and a heterogeneous population of critically ill patients) and 13 included
8569 haematology patients. The five studies in critically ill patients
were retrospective and did not find any association between PLT storage
time when PLTs were stored for up to 5days and mortality. There was also
no association between older PLTs and sepsis in the two largest studies
(n=4008 patients). Of the 13 studies in haematology patients, seven
analysed prolonged storage time up to 6.5 or 7days. Administration of
fresh PLTs (less than 2 or 3days) was associated with a significant
increase in corrected count increment (CCI) compared to older PLTs in
seven of the eight studies analysing this outcome. One single centre
retrospective study found an increase in bleeding events in patients
receiving older PLTs. Conclusion(s): PLT storage time does not appear
to be associated with clinical outcomes, including bleeding, sepsis or
mortality, in critically ill patients or haematology patients. The
freshest PLTs (less than 3days) were associated with a better CCI,
although there was no impact on bleeding events, questioning the clinical
significance of this association. However, there is an absence of evidence
to draw definitive conclusions, especially in critically ill
patients. Copyright © 2018 The Author(s).

<135>
Accession Number
624056769
Title
Amiodarone plus Ranolazine for Conversion of Post-Cardiac Surgery Atrial
Fibrillation: Enhanced Effectiveness in Reduced Versus Preserved Ejection
Fraction Patients.
Source
Cardiovascular Drugs and Therapy. 32 (6) (pp 559-565), 2018. Date of
Publication: 01 Dec 2018.
Author
Simopoulos V.; Hevas A.; Hatziefthimiou A.; Dipla K.; Skoularigis I.;
Tsilimingas N.; Aidonidis I.
Institution
(Simopoulos, Hevas, Tsilimingas) Department of Thoracic & Cardiovascular
Surgery, University Hospital of Larissa, Larissa, Greece
(Hatziefthimiou, Aidonidis) Department of Physiology, School of Medicine,
University of Thessaly, Larissa Medical School, Larissa 41500, Greece
(Dipla) Department of Physical Education and Sports Science at Serres,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Skoularigis) Department of Cardiology, University General Hospital of
Larissa, Larissa, Greece
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Ranolazine (RAN) added to amiodarone (AMIO) has been shown to
accelerate termination of postoperative atrial fibrillation (POAF)
following coronary artery bypass surgery in patients without heart failure
(HF). This study aimed to investigate if treatment efficacy with AMIO or
AMIO + RAN differs between patients with concomitant HF with reduced or
preserved ejection fraction (HFrEF or HFpEF). Method(s): Patients
with POAF and HFrEF (n = 511, 446 males; 65 +/- 9 years) and with HFpEF (n
= 301, 257 males; 66 +/- 10 years) were enrolled. Onset of AF occurred
2.15 +/- 1.0 days after cardiac surgery, and patients within each group
were randomly assigned to receive either AMIO monotherapy (300 mg in 30
min + 1125 mg in 36 h iv) or AMIO+RAN combination (500 mg po + 375 mg,
after 6 h and 375 mg twice daily thereafter). Primary endpoint was the
time to conversion of POAF within 36 h after initiation of treatment.
 Result(s): AMIO restored sinus rhythm earlier in HFrEF vs. in HFpEF
patients (24.3 +/- 4.6 vs. 26.8 +/- 2.8 h, p < 0.0001). AMIO + RAN
converted POAF faster than AMIO alone in both HFrEF and HFpEF groups, with
conversion times 10.4 +/- 4.5 h in HFrEF and 12.2 +/- 1.1 h in HFpEF
patients (p < 0.0001). Left atrial diameter was significantly greater in
HFrEF vs. HFpEF patients (48.2 +/- 2.6 vs. 35.2 +/- 2.9 mm, p < 0.0001).
No serious adverse drug effects were observed during AF or after
restoration to sinus rhythm in any of the patients enrolled.
 Conclusion(s): AMIO alone or in combination with RAN converted POAF
faster in patients with reduced EF than in those with preserved EF. Thus,
AMIO + RAN seems to be a valuable alternative treatment for terminating
POAF in HFrEF patients. Copyright © 2018, Springer
Science+Business Media, LLC, part of Springer Nature.

<136>
Accession Number
624183007
Title
Amaze: A randomized controlled trial of adjunct surgery for atrial
fibrillation.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 729-737), 2018.
Date of Publication: 01 Oct 2018.
Author
Nashef S.A.M.; Fynn S.; Abu-Omar Y.; Spyt T.J.; Mills C.; Everett C.C.;
Fox-Rushby J.; Singh J.; Dalrymple-Hay M.; Sudarshan C.; Codispoti M.;
Braidley P.; Wells F.C.; Sharples L.D.
Institution
(Nashef, Abu-Omar, Sudarshan, Codispoti, Wells) Department of Surgery,
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
(Fynn) Department of Cardiology, Papworth Hospital, Cambridge, United
Kingdom
(Spyt) Department of Cardiothoracic Surgery, Glenfield Hospital,
Leicester, United Kingdom
(Mills) Research and Development, Papworth Hospital, Cambridge, United
Kingdom
(Everett) Clinical Trials Unit, University of Leeds, Leeds, United Kingdom
(Fox-Rushby, Singh) Department of Health Economics, Brunel University,
London, United Kingdom
(Dalrymple-Hay) Department of Cardiothoracic Surgery, Plymouth Hospital,
Derriford Hospital, Plymouth, United Kingdom
(Braidley) Department of Cardiothoracic Surgery, Northern General
Hospital, Sheffield, United Kingdom
(Sharples) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Atrial fibrillation (AF) reduces survival and quality of life
(QoL). It can be treated at the time of major cardiac surgery using
ablation procedures ranging from simple pulmonary vein isolation to a full
maze procedure. The aim of this study is to evaluate the impact of adjunct
AF surgery as currently performed on sinus rhythm (SR) restoration,
survival, QoL and cost-effectiveness. METHODS In a multicentre, Phase III,
pragmatic, double-blinded, parallel-armed randomized controlled trial, 352
cardiac surgery patients with >3 months of documented AF were randomized
to surgery with or without adjunct maze or similar AF ablation between
2009 and 2014. Primary outcomes were SR restoration at 1 year and
quality-adjusted life years at 2 years. Secondary outcomes included SR at
2 years, overall and stroke-free survival, medication, QoL,
cost-effectiveness and safety. RESULTS More ablation patients were in SR
at 1 year [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.20-3.54; P
= 0.009]. At 2 years, the OR increased to 3.24 (95% CI 1.76-5.96).
Quality-adjusted life years were similar at 2 years (ablation - control
-0.025, P = 0.6319). Significantly fewer ablation patients were
anticoagulated from 6 months postoperatively. Stroke rates were 5.7%
(ablation) and 9.1% (control) (P = 0.3083). There was no significant
difference in stroke-free survival [hazard ratio (HR) = 0.99, 95% CI
0.64-1.53; P = 0.949] nor in serious adverse events, operative or overall
survival, cardioversion, pacemaker implantation, New York Heart
Association, EQ-5D-3L and SF-36. The mean additional ablation cost per
patient was 3533 (95% CI 1321-5746). Cost-effectiveness was not
demonstrated at 2 years. CONCLUSIONS Adjunct AF surgery is safe and
increases SR restoration and costs but not survival or QoL up to 2 years.
A continued follow-up will provide information on these outcomes in the
longer term. Study registration ISRCTN82731440 (project number
07/01/34). Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<137>
Accession Number
624182982
Title
Left ventricular assist device implantation with and without concomitant
tricuspid valve surgery: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 644-651), 2018.
Date of Publication: 01 Oct 2018.
Author
Veen K.M.; Muslem R.; Soliman O.I.; Caliskan K.; Kolff M.E.A.; Dousma D.;
Manintveld O.C.; Birim O.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Veen, Muslem, Kolff, Dousma, Birim, Bogers, Takkenberg) Thoraxcenter,
Department of Cardiothoracic Surgery, Erasmus University Medical Centre,
Rotterdam, Netherlands
(Muslem, Soliman, Caliskan, Manintveld) Thoraxcenter, Department of
Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Moderate-to-severe tricuspid regurgitation is common in
end-stage heart disease and is associated with an impaired survival after
left ventricular assist device (LVAD) surgery. Controversy remains whether
concomitant tricuspid valve surgery (TVS) during LVAD implantation is
beneficial. We aimed to provide a contemporary overview of outcomes in
patients who underwent LVAD surgery with or without concomitant TVS.
METHODS A systematic literature search was performed for articles
published between January 2005 and March 2017. Studies comparing patients
undergoing isolated LVAD implantation and LVAD + TVS were included. Early
outcomes were pooled in risk ratios using random effects models, and late
survival was visualized by a pooled Kaplan-Meier curve. RESULTS Eight
publications were included in the meta-analysis, including 562 undergoing
isolated LVAD implantation and 303 patients with LVAD + TVS. Patients
undergoing LVAD + TVS had a higher tricuspid regurgitation grade, central
venous pressure and bilirubin levels at baseline and were more often
female. We found no significant differences in early mortality and late
mortality, early right ventricular failure and late right ventricular
failure, acute kidney failure, early right ventricular assist device
implantation or length of hospital stay. Cardiopulmonary bypass time was
longer in patients undergoing additional TVS [mean difference +35 min 95%
confidence interval (16-55), P = 0.001]. CONCLUSIONS Adding TVS during
LVAD implantation is not associated with worse outcome. Adding TVS,
nevertheless, may be beneficial, as baseline characteristics of patients
undergoing LVAD + TVS were suggestive of a more progressive underlying
disease, but with comparable short-term outcome and long-term outcome with
patients undergoing isolated LVAD. Copyright © The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<138>
Accession Number
624182978
Title
Systematic bilateral internal mammary artery grafting: Lessons learned
from the CATHolic University EXtensive BIMA Grafting Study.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 702-707), 2018.
Date of Publication: 01 Oct 2018.
Author
Gaudino M.; Glieca F.; Luciani N.; Pragliola C.; Tsiopoulos V.; Bruno P.;
Farina P.; Bonalumi G.; Pavone N.; Nesta M.; Cammertoni F.; Munjal M.; Di
Franco A.; Massetti M.
Institution
(Gaudino, Glieca, Luciani, Pragliola, Tsiopoulos, Bruno, Farina, Bonalumi,
Pavone, Nesta, Cammertoni, Di Franco, Massetti) Department of
Cardiovascular Sciences, Catholic University, Rome, Italy
(Munjal) Department of Cardiothoracic Surgery, Cornell Medicine, New York,
NY, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES Despite claims of feasibility, to date no study has examined
the effect of systematic bilateral internal mammary artery (BIMA) use in a
large cohort of real-world unselected patients. The CATHolic University
EXtensive BIMA Grafting Study (CATHEXIS) registry was designed to assess
the feasibility and safety of systematic BIMA grafting. METHODS The
CATHEXIS was a single-centre, prospective, observational,
propensity-matched study. The study was supposed to include 2 arms of 500
patients each: a prospective arm and a retrospective arm. The prospective
arm included almost all patients referred for coronary artery bypass
grafting (CABG) at our institution after the start of the CATHEXIS with
very few exceptions. BIMA would have been used in all these patients. The
retrospective arm included patients submitted to CABG before the start of
the CATHEXIS and propensity matched to the prospective group (average BIMA
use 50%; the radial artery was extensively used). Safety analyses were
scheduled after enrolment of 200, 300 and 400 BIMA patients. RESULTS After
the first 226 patients, the BIMA use percentage was 88.5% (200 of 226). In
178 (89%) patients, mammary arteries were used as Y graft. Postoperative
mortality was 2%, and incidence of perioperative myocardial infarction,
graft failure and sternal complications were 3.5%, 3% and 5.5%,
respectively. No perioperative stroke occurred. The incidence of major
adverse cardiac events (particularly graft failure and sternal
complications) in the BIMA arm were significantly higher than those in the
propensity-matched cohort; the study was stopped for safety. CONCLUSIONS
In a real world setting the systematic use of BIMA was associated with a
higher incidence of perioperative adverse events (particularly sternal
complications). Individualization of the revascularization strategy and
use of alternative arterial conduits are probably preferable to systematic
use of BIMA. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<139>
Accession Number
624182891
Title
Prospective multicentre evaluation of a novel, low-profile transapical
delivery system for self-expandable transcatheter aortic valve
implantation: 6-month outcomes.
Source
European Journal of Cardio-thoracic Surgery. 54 (4) (pp 762-767), 2018.
Date of Publication: 01 Oct 2018.
Author
Conradi L.; Hilker M.; Kempfert J.; Borgermann J.; Treede H.; Holzhey
D.M.; Schrofel H.; Kim W.-K.; Schaefer U.; Walther T.
Institution
(Conradi) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg 20251, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Center
Regensburg, Regensburg, Germany
(Kempfert) Department of Cardiac Surgery, German Heart Center, Berlin,
Germany
(Borgermann) Clinic for Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
(Treede) Department of Cardiac Surgery, Mid-German Heart Center,
University Hospital Halle, Halle, Germany
(Holzhey) Department of Cardiac Surgery, Heart Center Leipzig University,
Leipzig, Germany
(Schrofel) Department of Cardiovascular Surgery, Heart Center Freiburg,
Bad Krozingen, Germany
(Kim) Department of Cardiology, Kerckhoff Heart and Lung Center, Bad
Nauheim, Germany
(Kim, Walther) Department of Cardiac Surgery, Kerckhoff Heart and Lung
Center, Bad Nauheim, Germany
(Schaefer) Department of Cardiology, University Heart Center Hamburg,
Hamburg, Germany
(Walther) Department of Thoracic and Cardiovascular Surgery, University
Hospital Frankfurt, Frankfurt am Main, Germany
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES We assessed the safety and efficacy of a novel low-profile,
22-Fr transapical delivery system together with the ACURATE neoTM
resheathable transcatheter heart valve. METHODS This prospective,
single-arm, multicentre study enrolled 60 patients with severe symptomatic
aortic stenosis and high surgical risk ineligible for transfemoral access.
Primary end points were 6-month mortality and procedural success. RESULTS
The mean age of patients was 79.8 +/- 4.7 years, and the patients had
severe comorbidities including coronary artery disease (71.7%), diabetes
(38.3%), atrial fibrillation (30.0%) and chronic obstructive pulmonary
disease (21.7%); logistic EuroSCORE-I, -II and the Society of Thoracic
Surgeons (STS) scores were 20.9 +/- 8.9%, 6.1 +/- 5.0% and 4.3 +/- 2.9%,
respectively. A non-rib spreading approach using soft tissue retractors
only was used in 88.3% of patients (n = 53). Resheathing and repositioning
of transcatheter heart valve were performed in 6.7% of cases (n = 4); the
device implantation time was 3 +/- 2 min. Apical access site complications
occurred in 1.7% (n = 1). Procedural success was 98.3% (n = 59), and
procedural success in the absence of major adverse cardiac and
cerebrovascular events at 30 days was 90.0% (n = 54). At 30 days,
cardiovascular and overall mortality were 8.3% (n = 5), stroke rate was
1.7% (n = 1), and 17.2% of patients (n = 10) received a permanent
pacemaker implant. No paravalvular leakage >=2+ was observed, and the mean
transvalvular gradient was 5.9 +/- 2.7 mmHg. At 6 months, survival was
84.3% with sustained haemodynamic results. CONCLUSIONS This study
indicates safety and efficacy of transapical aortic valve implantation
using a novel low-profile delivery system. High procedural success, short
implantation times and a low rate of apical access site complications
underline the favourable safety profile and ease of use. Clinical trial
registration ClinicalTrials.gov: NCT02950428. Copyright © The
Author(s) 2018. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<140>
Accession Number
622127401
Title
Aortic centres should represent the standard of care for acute aortic
syndrome.
Source
European Journal of Preventive Cardiology. 25 (1_suppl) (pp 3-14), 2018.
Date of Publication: 01 Jun 2018.
Author
Mariscalco G.; Maselli D.; Zanobini M.; Ahmed A.; Bruno V.D.; Benedetto
U.; Gherli R.; Gherli T.; Nicolini F.
Institution
(Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Glenfield Hospital, Leicester, United Kingdom
(Maselli) Department of Cardiac Surgery, St. Anna Hospital, Catanzaro,
Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Italy
(Ahmed) Department of Anaesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Bruno, Benedetto) Heart Centre, Bristol University, Bristol, United
Kingdom
(Gherli) Department of Cardiovascular Sciences, Cardiac Surgery Unit, San
Camillo Hospital, Rome, Italy
(Gherli, Nicolini) Division of Cardiac Surgery, University of Parma,
Parma, Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Existing evidence suggests that patients affected by acute
aortic syndromes (AAS) may benefit from treatment at dedicated specialized
aortic centres. The purpose of the present study was to perform a
meta-analysis to evaluate the impact aortic service configuration has in
clinical outcomes in AAS patients. Method(s): The design was a
quantitative and qualitative review of observational studies. We searched
PubMed/MEDLINE, EMBASE, and Cochrane Library from inception to the end of
December 2017 to identify eligible articles. Areas of interest included
hospital and surgeon volume activity, presence of a multidisciplinary
thoracic aortic surgery program, and a dedicated on-call aortic team.
Participants were patients undergoing repair for AAS, and odds ratios
(ORs) with corresponding 95% confidence intervals (CIs) were adopted for
synthesizing hospital/30-day mortality. Result(s): A total of 79,131
adult patients from a total of 30 studies were obtained. No randomized
studies were identified. Pooled unadjusted ORs showed that patients
treated in high-volume centres or by high-volume surgeons were associated
with lower mortality rates (OR 0.51; 95% CI 0.46-0.56, and OR 0.41, 95% CI
0.25-0.66, respectively). Pooled adjusted estimates for both high-volume
centres and surgeons confirmed these survival benefits (adjusted OR, 0.56;
95% CI 0.45-0.70, respectively). Patients treated in centres that
introduced a specific multidisciplinary aortic program and a dedicated
on-call aortic team also showed a significant reduction in mortality (OR
0.31; 95% CI 0.19-0.5, and OR 0.37; 95% CI 0.15-0.87, respectively).
 Conclusion(s): We found that specialist aortic care improves outcomes
and decreases mortality in patients affected by AAS. Copyright ©
2018, © The European Society of Cardiology 2018.

<141>
Accession Number
622127391
Title
The use of RemoweLL oxygenator-integrated device in the prevention of the
complications related to aortic valve surgery in the elderly patient:
Preliminary results.
Source
European Journal of Preventive Cardiology. 25 (1_suppl) (pp 59-65), 2018.
Date of Publication: 01 Jun 2018.
Author
Molardi A.; Di Chicco M.V.; Carino D.; Goldoni M.; Ricci M.; Borrello B.;
Gripshi F.; Gherli T.; Nicolini F.
Institution
(Molardi, Borrello) Department of General and Specialized Surgery, Cardiac
Surgery Unit, University Hospital of Parma, Italy
(Di Chicco, Carino, Goldoni, Ricci, Gripshi, Gherli, Nicolini) Department
of Medicine and Surgery, University Medical School, University of Parma,
Italy
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The effects of fat microembolization due to cardiopulmonary
bypass are well known in cardiac surgery. Our aim is to evaluate the use
of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic
valve replacement in elderly patients (>70 years old) to rate its
biochemical and clinical effects. The RemoweLL device is an
oxygenator-integrated reservoir which combines two strategies for fat
emboli and leucocytes removal: filtration and supernatant elimination.
 Method(s): Forty-four elderly patients were enrolled and assigned
randomly to a Group A (standard device) and a Group B (RemoweLL).
Biochemical effects were evaluated by blood samples, which were tested for
white blood cells, neutrophils, protein SP-100 and interleukin 6 besides
standard lab tests. Our clinical endpoints were any type of neurological,
cardiac, respiratory, gastrointestinal or renal complications, and length
of stay in the intensive care unit. Statistical analysis was carried out
with chi square test for non-parametric data; t test and analysis of
variance for repeated measures were used for parametric data.
 Result(s): Group B showed lower levels of white blood cells,
neutrophils, interleukin 6 and protein SP-100 immediately and 24 hours
after the operation. Group B also showed a lower amount of neurocognitive
type II dysfunction even if the length of stay in the ICU did not change.
 Conclusion(s): The RemoweLL system is safe and effective in reducing
inflammatory response to cardiopulmonary bypass and it could be a useful
tool in minimizing negative effects of cardiopulmonary bypass; however, it
does not seem to have any effect on elderly patients' hospital
stay. Copyright © 2018, © The European Society of Cardiology
2018.

<142>
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. 112 (5) (pp 511-523), 2019. Date of
Publication: 01 May 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. OBJECTIVE(S): To conduct a systematic review with
meta-analysis of PCI using Stents versus CABG in randomized controlled
trials. 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. 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.
 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.

<143>
Accession Number
627182683
Title
Usefulness of skeletal muscle area detected by computed tomography to
predict mortality in patients undergoing transcatheter aortic valve
replacement: a meta-analysis study.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2019.
Date of Publication: 2019.
Author
Soud M.; Alahdab F.; Ho G.; Kuku K.O.; Cejudo-Tejeda M.; Hideo-Kajita A.;
de Araujo Goncalves P.; Teles R.C.; Waksman R.; Garcia-Garcia H.M.
Institution
(Soud, Ho, Kuku, Cejudo-Tejeda, Hideo-Kajita, Waksman, Garcia-Garcia)
Section of Interventional Cardiology, MedStar Washington Hospital Center,
110 Irving St NW, Washington, DC 20010, United States
(Alahdab) Mayo Clinic Evidence-based Practice Center, Mayo Clinic,
Rochester, MN, United States
(de Araujo Goncalves) Hospital da Luz, Luz-Saude. Av. Lusiada 100, Lisbon
1500-650, Portugal
(de Araujo Goncalves, Teles) Hospital de Santa Cruz - Centro Hospitalar de
Lisboa Ocidental, Carnaxide, Lisbon, Portugal
(de Araujo Goncalves) Chronic Diseases Research Center - Nova Medical
School, Lisbon, Portugal
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Measures of sarcopenia, such as low muscle mass measured from the readily
available preoperative computed tomography (CT) images, have been recently
suggested as a predictor of outcomes in patients undergoing transcatheter
aortic valve replacement (TAVR). However, results of these studies are
variable and, therefore, we performed a systematic review of current
literature to evaluate sarcopenia as a predictor of outcome post TAVR. The
search was carried out in electronic databases between 2008 and 2018. We
identified studies that reported CT-derived skeletal muscle area (SMA) and
survival outcomes post TAVR. Studies were evaluated for the incidence of
early (<= 30 days) and late all-cause mortality (> 30 days) post TAVR.
Eight studies with 1881 patients were included (mean age of 81.8 years +/-
12, 55.9% men). Mean body mass index was (28.2 kg/m2 +/- 1.1),
mean Society of Thoracic Surgeons risk score (7.0 +/- 0.6), and mean
albumin level was (3.8 g/dL +/- 0.1). Higher SMA was associated with lower
long-term mortality [odds ratio (OR) 0.49, 95% confidence interval (CI)
0.28-0.83, p = 0.049], compared with low SMA. Also, higher SMA was
associated with lower early mortality but was not statistically
significant (OR 0.72; 95% CI 0.44-1.18; p = 0.285). CT-derived SMA
provides value in predicting post-TAVR long-term outcomes for patients
undergoing TAVR. This is a simple risk assessment tool that may help in
making treatment decisions and help identifying and targeting high-risk
patients with interventions to improve muscle mass prior to and following
the procedures. Copyright © 2019, Springer Nature B.V.

<144>
Accession Number
627074419
Title
Prosthesis-Patient Mismatch Negatively Affects Outcomes after Mitral Valve
Replacement: Meta-Analysis of 10,239 Patients.
Source
Brazilian journal of cardiovascular surgery. 34 (2) (pp 203-212), 2019.
Date of Publication: 01 Mar 2019.
Author
Sa M.P.B.O.; Cavalcanti L.R.P.; Rayol S.D.C.; Diniz R.G.S.; Menezes A.M.;
Clavel M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Rayol, Diniz, Menezes, Lima) Department of Cardiovascular
Surgery at the Pronto Socorro Cardiologico de Pernambuco (PROCAPE),
Recife, PE, Brazil
(Sa, Cavalcanti, Rayol, Diniz, Menezes, Lima) Universidade de Pernambuco
(UPE), Recife, PE, Brazil
(Sa, Lima) Nucleus of Postgraduate Studies and Research in Health Sciences
at Faculdade de Ciencias Medicas and Instituto de Ciencias Biologicas
(FCM/ICB), Recife, PE, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie et de Pneumologie
du Quebec, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This study sought to evaluate the impact of prosthesis-patient
mismatch on the risk of perioperative and long-term mortality after mitral
valve replacement. METHOD(S): Databases were researched for studies
published until December 2018. Main outcomes of interest were
perioperative and 10-year mortality and echocardiographic parameters.
 RESULT(S): The research yielded 2,985 studies for inclusion. Of
these, 16 articles were analyzed, and their data extracted. The total
number of patients included was 10,239, who underwent mitral valve
replacement. The incidence of prosthesis-patient mismatch after mitral
valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and
4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI
1.194-1.931, P<0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P<0.001)
mortality was increased in patients with prosthesis-patient mismatch.
Patients with prosthesis-patient mismatch after mitral valve replacement
had higher systolic pulmonary artery pressure and transprosthethic
gradient and lower indexed effective orifice area and left ventricle
ejection fraction. CONCLUSION(S): Prosthesis-patient mismatch
increases perioperative and long-term mortality. Prosthesis-patient
mismatch is also associated with pulmonary hypertension and depressed left
ventricle systolic function. The findings of this study support the
implementation of surgical strategies to prevent prosthesis-patient
mismatch in order to decrease mortality rates.

<145>
Accession Number
627074074
Title
Benefits of Fasting Abbreviation with Carbohydrates and Omega-3 Infusion
During CABG: a Double-Blind Controlled Randomized Trial.
Source
Brazilian journal of cardiovascular surgery. 34 (2) (pp 125-135), 2019.
Date of Publication: 01 Mar 2019.
Author
Feguri G.R.; Lima P.R.L.; Franco A.C.; Cruz F.R.H.; Borges D.C.; Toledo
L.R.; Segri N.J.; Aguilar-Nascimento J.E.
Institution
(Feguri, Lima, Borges) Department of Cardiology and Cardiovascular
Surgery, Hospital Geral Universitario, Universidade de Cuiaba (HGU-UNIC),
Cuiaba, MT, Brazil
(Franco, Cruz) Department of Cardiovascular Surgery, Hospital Geral
Universitario, Universidade de Cuiaba (HGU-UNIC), Cuiaba, MT, Brazil
(Toledo) Department of Physical Therapy, Hospital Geral Universitario,
Universidade de Cuiaba (HGU-UNIC), Cuiaba, MT, Brazil
(Segri) Department of Statistics, Universidade Federal do Mato Grosso
(UFMT), Cuiaba, MT, Brazil
(Aguilar-Nascimento) Universidade Federal do Mato Grosso (UFMT), Cuiaba,
MT, Brazil
(Aguilar-Nascimento) Universidade de Varzea Grande (UNIVAG), MT, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess postoperative clinical data considering the
association of preoperative fasting with carbohydrate (CHO) loading and
intraoperative infusion of omega-3 polyunsaturated fatty acids (omega-3
PUFA). METHOD(S): 57 patients undergoing coronary artery bypass
grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200
mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before
anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before
anesthesia) plus intraoperative infusion of omega-3 PUFA (0.2 g/kg),
(CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus
intraoperative infusion of omega-3 PUFA (0.2 g/kg), (W3, n=14). The need
for vasoactive drugs was analyzed, in addition to postoperative
inflammation and metabolic control. RESULT(S): There were two deaths
(3.5%). Patients in CHO groups presented a lower incidence of hospital
infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive
drugs during surgery and ICU stay (P<0.05); and had better blood glucose
levels in the first six hours of recovery (P=0.015), requiring less
exogenous insulin (P=0.018). Incidence of postoperative atrial
fibrillation (POAF) varied significantly among groups (P=0.009). Subjects
who receive omega-3 PUFA groups had fewer occurrences of POAF (RR=4.83,
95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower
ultrasensitive-CRP levels at 36 h postoperatively (P=0.008).
Interleukin-10 levels varied among groups (P=0.013), with the highest
levels observed in the postoperative of patients who received
intraoperative infusion of omega-3 PUFA (P=0.049). CONCLUSION(S):
Fasting abbreviation with carbohydrate loading and intraoperative infusion
of omega-3 PUFA is safe and supports faster postoperative recovery in
patients undergoing on-pump CABG.

<146>
Accession Number
627072861
Title
Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic
Review and Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. 34 (2) (pp 213-221), 2019.
Date of Publication: 01 Mar 2019.
Author
Harky A.; Chan J.S.; Bithas C.; Hof A.; Sharif M.; Froghi S.; Bashir M.
Institution
(Harky, Bithas) Department of Vascular Surgery, Countess of Chester,
United Kingdom of Great Britain and Northern Ireland, Chester, Canada
(Chan) Faculty of Medicine, Chinese University of Hong Kong, Region of the
People's Republic of China, Hong Kong
(Hof) Department of Cardiovascular Surgery, Heinrich-Heine-University,
Medical Faculty, Germany
(Sharif) School of Medicine, University of Liverpool, United Kingdom of
Great Britain and Northern Ireland, Liverpool, Australia
(Froghi) Department of Surgery, Imperial College NHS Trust, Hammersmith
Hospital, Du Cane Rd London, United Kingdom of Great Britain and Northern
Ireland
(Bashir) Manchester Royal Infirmary, United Kingdom of Great Britain and
Northern Ireland
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate whether axillary artery cannulation has
supremacy over innominate artery cannulation in thoracic aortic surgery.
 METHOD(S): A comprehensive search was undertaken among the four major
databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to
identify all randomized and nonrandomized controlled trials comparing
axillary to innominate artery cannulation in thoracic aortic surgery.
Databases were evaluated and assessed up to March 2017. RESULT(S):
Only three studies fulfilled the criteria for this meta-analysis,
including 534 patients. Cardiopulmonary bypass time was significantly
shorter in the innominate group (P=0.004). However, the innominate group
had significantly higher risk of prolonged intubation > 48 hours (P=0.04)
than the axillary group. Further analysis revealed no significant
difference between the innominate and axillary groups for deep hypothermic
circulatory arrest time (P=0.06). The relative risks for temporary and
permanent neurological deficits as well as in-hospital mortality were not
significantly different for both groups (P=0.90, P=0.49, and P=0.55,
respectively). Length of hospital stay was similar for both groups.
 CONCLUSION(S): There is no superiority of axillary over innominate
artery cannulation in thoracic aortic surgery in terms of perioperative
outcomes; however, as the studies were limited, larger scale comparative
studies are required to provide a solid evidence base for choosing optimal
arterial cannulation site.

<147>
Accession Number
2002098737
Title
Ultrasound Assessment of Respiratory Workload With High-Flow Nasal Oxygen
Versus Other Noninvasive Methods After Chest Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Laverdure F.; Genty T.; Rezaiguia-Delclaux S.; Herve P.; Stephan F.
Institution
(Laverdure) Department of Anesthesiology, Marie Lannelongue Hospital, Le
Plessis Robinson, France
(Laverdure, Genty, Rezaiguia-Delclaux, Stephan) Intensive Care Unit, Marie
Lannelongue Hospital, Le Plessis Robinson, France
(Herve) Department of Thoracic Surgery, Marie Lannelongue Hospital, Le
Plessis Robinson, France
Publisher
W.B. Saunders
Abstract
Objective: To compare the respiratory workload using the diaphragm
thickening fraction (DTf) determined by sonography during high-flow nasal
oxygen (HFNO), standard oxygen therapy (SOT), and noninvasive bilevel
positive airway pressure support (BIPAP) in patients with acute
respiratory failure (ARF) after cardiothoracic surgery. Design(s):
Prospective controlled clinical trial. Setting(s): A French 23-bed
cardiothoracic surgical intensive care unit. Participant(s):
Nonintubated patients with ARF after cardiothoracic surgery or while
awaiting lung transplantation. Intervention(s): HFNO (50 L/min), SOT
via a standard facemask, and BIPAP (pressure support, 4 cmH<inf>2</inf>O;
positive end-expiratory pressure [PEEP], 4 cmH<inf>2</inf>O), with
F<inf>I</inf>O<inf>2</inf> kept constant were successively applied and
compared. With BIPAP, pressure support or PEEP increments up to 8
cmH<inf>2</inf>O were compared with baseline settings. Each measurement
was made after stable breathing for 5 minutes. Measurements and Main
Results: Fifty patients aged 60.0 +/- 12.2 years were enrolled, including
14 (28%) with obesity. Mean PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> was
153 +/- 55 mmHg. DTf was lower with HFNO and BIPAP than with SOT
(respectively 21.2% +/- 15.1% v 30.9% +/- 21.1% and 17.8% +/- 19.1% v
30.9% +/- 21.1%, p < 0.001) and was not different with HFNO versus BIPAP
(p = 0.22). With BIPAP, increasing pressure support to 8 cmH<inf>2</inf>O
decreased DTf (21.0% +/- 14.3% v 28.8% +/- 19.8%, p = 0.009), whereas
increasing PEEP to 8 cmH<inf>2</inf>O did not (25.2% +/- 17.2% v 28.8% +/-
19.8%, p = 0.79). Tidal volume increased to 10.6 +/- 3.4 mL/kg with 8
cmH<inf>2</inf>O pressure support v 8.8 +/- 2.7 mL/kg with 4
cmH<inf>2</inf>O pressure support (p < 0.001). Conclusion(s): HFNO
provides a comparable respiratory workload decrease compared with BIPAP at
lower levels of pressure support and PEEP compared with SOT. Increasing
BIPAP pressure support may provide higher levels of assistance but carries
a risk of overdistension. Copyright © 2019 Elsevier Inc.

<148>
Accession Number
2002097938
Title
Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve
Implantation Versus Surgical Aortic Valve Replacement in
Low-to-Intermediate Surgical Risk Cohort.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Ando T.; Ashraf S.; Villablanca P.; Kuno T.; Pahuja M.; Shokr M.; Afonso
L.; Grines C.; Briasoulis A.; Takagi H.
Institution
(Ando, Ashraf, Pahuja, Shokr, Afonso) Division of Cardiology, Wayne State
University/Detroit Medical Center, Detroit, MI, United States
(Villablanca) Henry Ford Hospital, Detroit, MI, United States
(Kuno) Mount Sinai Beth Israel, New York, NY, United States
(Grines) North Shore University Hospital, Hofstra Northwell School of
Medicine, Manhasset, NY, United States
(Briasoulis) University of Iowa Hospitals and Clinics, Iowa, IA, United
States
(Takagi) Shizuoka Medical Center, Shizuoka, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) has been used to treat high
surgical risk cohorts but has been expanded to treat low-to-intermediate
risk cohort as well. We performed a systematic review and meta-analysis to
compare the outcomes between TAVI and surgical aortic valve replacement
(SAVR) in low-to-intermediate risk cohort. We queried PUBMED, EMBASE, and
ClinicalTrial.gov for relevant articles. Randomized controlled trials that
compared at least one of the outcomes of interest between TAVI and SAVR
were included. Risk ratio (RR) and 95% confidence interval (CI) were
pooled with a random-effects model to compare the risk of the primary
outcome between the 2 procedures. The primary outcome was a composite of
all-cause mortality or disabling/major stroke at 1 year. Seven studies
with a total of 7,143 patients (3,665 TAVI) were included. All-cause
mortality or disabling/major stroke at 30 days (6 studies, RR 0.71, 95% CI
0.49 to 1.03) was similar between TAVI and SAVR but was significantly
lower in TAVI at 1 year (5 studies, RR 0.81, 95% CI 0.67 to 0.98).
All-cause mortality was similar at both 30 days (7 studies, RR 0.90, 95%
CI 0.67 to 1.21) and 1 year (6 studies, RR 0.89, 95% CI 0.76 to 1.04).
Disabling/major stroke was similar between the 2 procedures (6 studies, RR
0.69, 95% CI 0.42 to 1.12) at 30 days but was significantly lower in TAVI
at 1 year (5 studies RR 0.71, 95% CI 0.51 to 0.98). Age, gender, diabetes,
and surgical risk score did not modulate the primary outcome. TAVI had a
significantly lower composite of all-cause mortality or disabling/major
stroke at 1 year compared with SAVR in low-to-intermediate surgical risk
cohort. Copyright © 2019 Elsevier Inc.

<149>
Accession Number
2002097221
Title
Interventions for secondary mitral regurgitation in patients with heart
failure: A network meta-analysis of randomized controlled comparisons of
surgery, medical therapy & transcatheter intervention.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Kheiri B.; Zayed Y.; Barbarawi M.; Osman M.; Chahine A.; Ahmed S.; Bachuwa
G.; Hassan M.; Alkhouli M.; Feldman T.; Bhatt D.L.
Institution
(Kheiri, Zayed, Barbarawi, Chahine, Ahmed, Bachuwa, Hassan) Department of
Internal Medicine, Hurley Medical Center/Michigan State University, Flint,
MI, United States
(Osman, Alkhouli) Division of Cardiology, West Virginia University School
of Medicine, Morgantown, WV, United States
(Feldman) Evanston Hospital, NorthShore University Health System,
Evanston, IL, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Mitral regurgitation (MR) in heart failure (HF) notoriously
carries a poor prognosis. While there are multiple interventional options
for treatment, the optimal intervention remains controversial. Therefore,
we aimed to evaluate the efficacy and safety of surgery, medical therapy,
and transcatheter intervention in secondary MR. Method(s): A
systematic database search was performed to identify all randomized
controlled trials (RCTs) that evaluate various interventions for secondary
MR. We performed a Bayesian network meta-analysis to calculate odd ratios
(ORs) and 95% credible intervals (CIs). The primary endpoint was all-cause
mortality. Secondary endpoints were moderate-severe MR,
HF-hospitalizations, and freedom from severe HF symptoms. Result(s):
We identified 12 RCTs (2316 total patients; age 67.6 +/- 11; 63% males,
and 74% with ischemic cardiomyopathy). There was a significant reduction
of mortality at 24-months with transcatheter leaflet repair compared with
medical therapy (OR = 0.57; 95% CI = 0.34-0.96). However, there were no
significant differences among the competing treatments in all-cause
mortality at the earlier time points of 30-days or 12-months (P > 0.05).
Recurrent moderate-severe MR was significantly less with valvular
interventions compared with medical therapy (P < 0.05), but there were no
differences in the rates of HF-hospitalizations or persistent severe HF
symptoms between the competing interventions (P > 0.05).
 Conclusion(s): Among patients with HF and secondary MR, transcatheter
leaflet repair was associated with significantly reduced 24-month
mortality compared with medical therapy. Valvular interventions were
associated with lower rates of recurrent moderate-severe MR, but
non-significant improvements in clinical outcomes. Further long-term
studies are needed to identify the best route of intervention for
secondary MR. Copyright © 2019 Elsevier Inc.

<150>
Accession Number
2002091179
Title
Spontaneous coronary artery dissection in a pregnant woman associated with
fetal complication: A case report and review of literature.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Ya'qoub L.
Institution
(Ya'qoub) Department of Cardiology, Louisiana State University,
Shreveport, LA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Spontaneous Coronary Artery Dissection (SCAD) is an important cause of
Acute Coronary Syndrome (ACS), especially in pregnant women. SCAD has
angiographic appearance that might mimic atherosclerotic coronary artery
disease (CAD). SCAD in pregnancy can be associated with both maternal and
fetal complications. The best management approach of such cases may be
achieved by a multi-disciplinary team, including an obstetrician, an
interventional cardiologist and a cardiothoracic surgeon. We present a
very interesting case of SCAD involving the left anterior descending (LAD)
artery with two different angiographic appearances in a pregnant woman
which was associated with fetal heart deceleration requiring urgent
cesarean section and later coronary artery bypass graft (CABG)
surgery. Copyright © 2019 Elsevier Inc.

<151>
Accession Number
628133345
Title
Effect of a New Sternal Sealant on Marrow Bleeding and Blood Product Use
after Adult Cardiac Surgery.
Source
The American surgeon. 85 (5) (pp e257-e259), 2019. Date of Publication: 01
May 2019.
Author
Hasaniya N.W.; Bansal N.R.; John M.M.; Ayer Miller V.L.; Floridia R.;
Razzouk A.J.; Rabkin D.G.
Publisher
NLM (Medline)

<152>
Accession Number
624656768
Title
The Efficacy of Ultrasound-Guided Paravertebral Block in Laparoscopic
Cholecystectomy.
Source
Medicina (Kaunas, Lithuania). 54 (5) (no pagination), 2018. Date of
Publication: 23 Oct 2018.
Author
Aydin G.; Aydin O.
Institution
(Aydin) Department of Anesthesiology and Reanimation, Kirikkale University
School of Medicine, Kirikkale 71450-, Turkey
(Aydin) Department of General Surgery, Kirikkale University School of
Medicine, Kirikkale 71450-, Turkey
Publisher
NLM (Medline)
Abstract
Background and objectives: Despite its wide use in thoracic procedures, to
date, few studies have assessed the effectiveness of paravertebral block
(PVB) in laparoscopic cholecystectomy (LC) in an adult population. In
these studies, PVB was performed bilaterally using nerve stimulator
guidance. To the best of our knowledge, the effectiveness of unilateral
preoperative and postoperative ultrasound-guided PVB has not been
evaluated in patients undergoing elective LC. The aim of this study was to
evaluate the efficacy of single-dose unilateral paravertebral block (PVB)
in patients undergoing laparoscopic cholecystectomy (LC) under general
anesthesia. Material(s) and Method(s): Patients undergoing LC were
randomly separated into control, preoperative block, and postoperative
block groups. PVB was performed unilaterally using bupivacaine under
ultrasound guidance. Postoperative pain within the first 24 h, side
effects, intraoperative opioid and postoperative analgesic requirements
were noted. Evaluation was made of a total of 90 patients (25 males, 65
females) with a mean age of 45.78 +/- 14.0 years (range, 19-74 years).
 Result(s): Opioid and additional analgesic needs and nausea/vomiting
rates were significantly reduced in the preoperative block group compared
to the other groups (p < 0.05). Visual Analog Scale (VAS) scores were
significantly lower in the preoperative and postoperative block groups
compared to the control group (p < 0.05 for all). When the VAS scores were
compared between the preoperative and postoperative block groups, a
significant difference in favor of the preoperative group was observed in
terms of the zero minute-, 1st and 2nd h assessments (p < 0.05 for all).
 Conclusion(s): Ultrasound-guided PVB is a useful and safe approach
for pain management during and after LC. Preoperative block can also
reduce the rate of requirement for intraoperative opioid and postoperative
analgesia.

<153>
Accession Number
2002089572
Title
ANZSCTS Annual Scientific Meeting 2018.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 3) (pp S67-S130), 2019. Date of
Publication: 2019.
Author
Anonymous
Publisher
Elsevier Ltd
Abstract
The proceedings contains 175 papers. The topics discussed include:
Drug-Eluting Stents Versus Bare-Metal Stents for Saphenous Vein Grafts
Lesions;Congenital Cardiac Surgery in the Modern Era: A 30-Year New
Zealand Experience;Patient Safety and Current Practice During Chest Drain
Insertion;Early Discharge From Intensive Care After Cardiac Surgery is
Feasible With an Adequate Fast Track, Stepdown Unit: Waikato
Experience;Stuck Between a Rock and a Hard Place: "Kokeshi
Phenomenon";Hybrid Repair of Aneurysms of Aortic Arch: Is This the Future
Treatment Modality;Surgical Management of Pulmonary Atresia With
Ventricular Septal Defects and Major Aorta Pulmonary Collaterals;Reduction
Ascending Aortoplasty Suitability of Waist Coat Aortoplasty Egyptian
Experience With Reference to the Gold Coast Experience;Learning Curve for
Aortic Valve Replacement Via Right Anterior Thoracotomy;Mandatory
Ultrasound-Guided Pleural Drain and Vascular Cannulation Training Program
for Cardiothoracic Trainees: A Scalable Solution;Carbon Dioxide
Insufflation Reduces Airborne Contamination in a Cardiac Wound Cavity
Model;Network Meta-Analysis of Antiplatelet Therapy Following Coronary
Artery Bypass Grafting: None Versus One Versus Two Antiplatelet
Agents;Outcome of Paracorporeal Biventricular Assist Device in INTERMACS
Profile 1 and 2 Patients: A Quaternary Referral Centre
Experience;Predicting Unexpected Postoperative Air Leak in Thoracic
Surgery Using Digital Chest Drains;Where Are They Now? An Update on the
First Australian Case of Mycobacterium chimaera Infection Following
Cardiac Surgery;Australia-Wide Experience With Tissue-Engineered Bovine
Pericardium (CardioCel) for the Repair of Congenital Heart Defects;What
Exercise Prescription Maximises Cognitive and Functional Recovery During
Phase II Cardiac Rehabilitation? A Systematic Review With Meta-analysis;A
Novel Method of Cardioprotection Via Inhibition of Acid-Sensing Ion
Channel 1a;Prehabilitation for Individuals Having Lung Cancer
Surgery;Challenges Faced in the Learning Curve of Uniportal Video-Assisted
Thoracoscopy

<154>
Accession Number
2002075770
Title
Abstracts for the Cardiac Society of Australia and New Zealand Annual
Scientific Meeting (New Zealand) 2019.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2018. Australia. 28 (Supplement 1) (pp S1-S38), 2019. Date of Publication:
2019.
Author
Anonymous
Publisher
Elsevier Ltd
Abstract
The proceedings contains 88 papers. The topics discussed include: A
Cross-Over Study of Hyperventilation Anxiety in Stress Cardiomyopathy and
Control Patients;Platelet Toll-Like Receptor Expression and Toll-Like
Receptor-Mediated Platelet Responses in Healthy and Acute Myocardial
Infarction Subjects;Clinical Applications for Artificial Intelligence on a
Multidimensional Cardiology Dataset;Review of Intravenous Amiodarone
Administration to Reduce the Occurrence of Phlebitis;Audit of Management
Post-Acute Coronary Syndrome With At Least Moderate Left Ventricular
Impairment in Counties Manukau: Room for Improvement;Catheter Ablation of
Cavotricuspid Isthmus-Dependent Atrial Flutter: Initial Experience With
the 8-mm IntellaTip MiFi Catheter;Cardiac Rehabilitation in Wellington:
Influence of a Comprehensive Exercise-Based 12-week Course on Key
Indicators (2017-2019);Progression of Acute Rheumatic Fever to Recurrence,
Rheumatic Heart Disease, and Death in New Zealand Children and Youth: A
Cohort Study;Performance of Risk Models Predicting Cardiac Complications
in Pregnant Women With Congenital Heart Disease: A Meta-Analysis;Serial
Right Heart Catheterisations in the Assessment of Portopulmonary
Hypertension;Dual Antiplatelet Therapy in High-Risk Clinically Stable
Coronary Artery Disease: A Randomised Controlled Trial;Borderline Coronary
Physiology: Outcomes of Patients With Negative Instantaneous Wave-Free
Ratio;Antithrombotic Strategy for Patients With Anticoagulation Indication
Undergoing Percutaneous Coronary Intervention: Meta-analysis of Randomised
Controlled Trials;Acute Coronary Syndrome Incidence, Procedures, and
Mortality Outcomes in New Zealand 2006-2016: ANZACS-QI 27 Nationwide Data
Linkage Study;Contemporary Audit of Prescribing Patterns Following
Coronary Artery Bypass Grafting;Long-Term Outcomes of Very Elderly
Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary
Syndrome;Shockwave Intravascular Lithotripsy for Calcified Coronary
Lesions: First Real-World Experience;Frailty in Very Elderly Patients
Undergoing Percutaneous Coronary Intervention for Acute Coronary
Syndromes;Acute Coronary Syndromes Complicated by Cardiogenic Shock:
Wellington Hospital Outcomes to One Year

<155>
[Use Link to view the full text]
Accession Number
628334259
Title
Integrating Quality of Life and Survival Outcomes Cardiovascular Clinical
Trials.
Source
Circulation. Cardiovascular quality and outcomes. 12 (6) (pp e005420),
2019. Date of Publication: 01 Jun 2019.
Author
Spertus J.V.; Hatfield L.A.; Cohen D.J.; Arnold S.V.; Ho M.; Jones P.G.;
Leon M.; Zuckerman B.; Spertus J.A.
Institution
(Spertus) Department of Statistics, University of California, United
States
(Hatfield) Department of Health Care Policy, Harvard Medical School,
Boston, United Kingdom
(Cohen, Arnold, Jones, Spertus) Saint Luke's Mid America Heart Institute,
S.V.A.
(Cohen, Arnold, Spertus) Department of Biomedical and Health Informatics,
University of Missouri - Kansas City, S.V.A.
(Ho, Zuckerman) Center for Devices and Radiologic Health, Food and Drug
Administration, Bethesda MD (M.H., Argentina
(Leon) Division of Cardiology, Columbia University, NY, United States
Publisher
NLM (Medline)
Abstract
Background Survival and health status (eg, symptoms and quality of life)
are key outcomes in clinical trials of heart failure treatment. However,
health status can only be recorded on survivors, potentially biasing
treatment effect estimates when there is differential survival across
treatment groups. Joint modeling of survival and health status can address
this bias. Methods and Results We analyzed patient-level data from the
PARTNER 1B trial (Placement of Aortic Transcatheter Valves) of
transcatheter aortic valve replacement versus standard care. Health status
was quantified with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at
randomization, 1, 6, and 12 months. We compared hazard ratios for survival
and mean differences in KCCQ scores at 12 months using several models: the
original growth curve model for KCCQ scores (ignoring death), separate
Bayesian models for survival and KCCQ scores, and a Bayesian joint
longitudinal-survival model fit to either 12 or 30 months of survival
follow-up. The benefit of transcatheter aortic valve replacement on
12-month KCCQ scores was greatest in the joint-model fit to all survival
data (mean difference, 33.7 points; 95% credible intervals [CrI],
24.2-42.4), followed by the joint-model fit to 12 months of survival
follow-up (32.3 points; 95% CrI, 22.5-41.5), a Bayesian model without
integrating death (30.4 points; 95% CrI, 21.4-39.3), and the original
growth curve model (26.0 points; 95% CI, 18.7-33.3). At 12 months, the
survival benefit of transcatheter aortic valve replacement was also
greater in the joint model (hazard ratio, 0.50; 95% CrI, 0.32-0.73) than
in the nonjoint Bayesian model (0.54; 95% CrI, 0.37-0.75) or the original
Kaplan-Meier estimate (0.55; 95% CI, 0.40-0.74). Conclusions In patients
with severe symptomatic aortic stenosis and prohibitive surgical risk, the
estimated benefits of transcatheter aortic valve replacement on survival
and health status compared with standard care were greater in joint
Bayesian models than other approaches.

<156>
Accession Number
628337902
Title
Antithrombotic pharmacotherapy after transcatheter aortic valve
implantation: an update.
Source
Expert review of cardiovascular therapy. (no pagination), 2019. Date of
Publication: 14 Jun 2019.
Author
Greco A.; Capranzano P.; Barbanti M.; Tamburino C.; Capodanno D.
Institution
(Greco, Capranzano, Barbanti, Tamburino, Capodanno) Division of
Cardiology, University of Catania, Catania, Italy
Publisher
NLM (Medline)
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is the
treatment of choice for a large proportion of patients with severe aortic
stenosis. Despite numerous technological and clinical advances, TAVI
remains associated with thrombotic complications requiring antithrombotic
pharmacotherapy, which exposes to the risk of bleeding, especially in
elderly individuals. The optimal antithrombotic regimen following TAVI is
uncertain and several investigations are ongoing. Areas covered: Clinical
guidelines are mostly driven by observational trials and experts'
opinions, thus resulting into low-grade level of evidence. The aim of the
current review is to critically explore the epidemiology, pathophysiology
and prognostic value of thrombotic and bleeding events after TAVI, and to
review the current literature on antithrombotic strategies following the
procedure. Expert opinion: Thrombotic and bleeding events remain major
complications occurring in the frail population that is currently offered
TAVI. Waiting for upcoming evidence from ongoing randomized clinical
trials, tailoring antithrombotic therapies based on patients'
characteristics, values and circumstances is a preferable approach.

<157>
Accession Number
628325494
Title
Outcomes of Chronic Total Occlusions in Coronary Arteries According to
Three Therapeutic Strategies: A Meta-analysis with 6985 Patients from 8
Published Observational Studies.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2019. Date
of Publication: 13 Jun 2019.
Author
Zheng Y.-Y.; Gao Y.; Chen Y.; Wu T.-T.; Ma Y.-T.; Zhang J.-Y.; Xie X.
Institution
(Zheng, Zhang) Zhengzhou University First Affiliated Hospital Department
of Cardiology Zhengzhou People's Republic of China Department of
Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou,
China
(Gao) Xinjiang Medical University First Affiliated Hospital Department of
Cadre Ward Urumqi Xinjiang People's Republic of China Department of Cadre
Ward, First Affiliated Hospital of Xinjiang Medical University, Urumqi,
Xinjiang, China
(Chen, Wu, Ma, Xie) Xinjiang Medical University First Affiliated Hospital
Heart Center Urumqi Xinjiang People's Republic of China Heart Center,
First Affiliated Hospital of Xinjiang Medical University, Urumqi,
Xinjiang, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To perform a systematic review and meta-analysis of studies
comparing coronary artery bypass grafting (CABG), percutaneous coronary
intervention (PCI), and medical treatment (MT) in patients with chronic
total occlusions (CTOs). METHOD(S): We identified eligible
observational studies published in the China National Knowledge
Infrastructure database, PubMed, Excerpta Medica database, Google Scholar,
Cochrane Library, Web of Science, and "Clinical trials" registration from
1999 to October 2018. Main outcome measures were all-cause mortality,
cardiac death, major adverse cardiac events (MACEs), and myocardial
infarction (MI). RESULT(S): There were eight observational studies
including 6985 patients. Patients' mean age was 64.4 years. Mean follow-up
time was 4.3 years. Comparing with MT (2958 patients), PCI (3157 patients)
presented decreased all-cause mortality (odd ratio [OR]: 0.46, 95%
confidence interval [CI]: 0.36-0.60; P<0.001), cardiac death (OR: 0.40,
95% CI: 0.31-0.52; P<0.001), MACE (OR: 0.55, 95% CI: 0.43-0.71; P<0.001),
and MI (OR: 0.40, 95% CI: 0.26-0.62; P<0.001). Comparing with MT, CABG
(613 patients) presented lower all-cause mortality (OR: 0.50, 95% CI:
0.36-0.69; P<0.001) and MACE (OR: 0.50, 95% CI: 0.26-0.96; P=0.04), but
not lower MI (OR: 0.23, 95% CI: 0.03-1.54; P=0.13) and cardiac death (OR:
0.83, 95% CI: 0.51-1.35). Comparing with CABG, PCI did not present
decreased risk for those outcomes. CONCLUSION(S): PCI or CABG was
associated with better clinical outcome in patients with CTO than MT. PCI
is not better than CABG in decreasing mortality, MI, cardiac death, and
MACE in coronary CTO patients.

<158>
Accession Number
2002209086
Title
Non-Transfemoral Transcatheter Aortic Valve Replacement Approach is
Associated with a Higher Risk of New-Onset Atrial Fibrillation: A
Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2019. Date of Publication:
2019.
Author
Angsubhakorn N.; Kittipibul V.; Prasitlumkum N.; Kewcharoen J.;
Cheungpasitporn W.; Ungprasert P.
Institution
(Angsubhakorn) Department of Medicine, University of Minnesota Medical
School, Minneapolis, MN, United States
(Kittipibul) Department of Internal Medicine, University of Miami Miller
School of Medicine, Miami, FL, United States
(Prasitlumkum, Kewcharoen) University of Hawaii Internal Medicine
Residency Program, Honolulu, HI, United States
(Cheungpasitporn) Division of Nephrology, University of Mississippi
Medical Center, Jackson, MS, United States
(Ungprasert) Clinical Epidemiology Unit, Department of Research and
Development, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Publisher
Elsevier Ltd
Abstract
Background: New-onset atrial fibrillation (NOAF) is a frequent arrhythmic
complication following transcatheter aortic valve replacement (TAVR).
Choice of access routes for TAVR could be a factor that determines the
risk of NOAF although the data is still not well-characterised. We aimed
to assess the association between different access routes for TAVR
(transfemoral versus non-transfemoral) and the risk of NOAF.
 Method(s): A comprehensive literature review was performed through
September 2018 using EMBASE and Medline. Eligible studies must compare the
incidence of NOAF in patients without pre-existing atrial fibrillation who
underwent TAVR. Relative risk (RR) and 95% confidence intervals (CI) were
extracted from each study and combined together using the random-effects
model, generic inverse variance method of DerSimonian and Laird.
 Result(s): Seven (7) retrospective studies with 18,425 patients who
underwent TAVR (12,744 with the transfemoral approach and 5,681 with the
non-transfemoral approach) met the eligibility criteria. After the
procedures, 2,205 (12.0%) patients developed NOAF (656 [5.1%] patients in
the transfemoral group and 1,549 [27.3%] patients in the non-transfemoral
group). There was a significant association between the non-transfemoral
approach and an increased risk of NOAF with the pooled RR of 2.94 (95%CI,
2.53-3.41; p < 0.00001). Subgroup analysis showed the highest risk of NOAF
in the transapical subgroup with the pooled RR of 3.20 (95% CI, 2.69-3.80;
I2 33%). Conclusion(s): A significantly increased risk of
NOAF following TAVR among those who underwent a non-transfemoral approach
compared with transfemoral approach was observed in this
meta-analysis. Copyright © 2019 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<159>
Accession Number
2002205235
Title
Modality Selection for the Revascularization of Left Main Disease.
Source
Canadian Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Tam D.Y.; Bakaeen F.; Feldman D.N.; Kolh P.; Lanza G.A.; Ruel M.; Piccolo
R.; Fremes S.E.; Gaudino M.
Institution
(Tam, Fremes) Division of Cardiac Surgery, Schulich Heart Centre,
Department of Surgery, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario, Canada
(Bakaeen) Departments of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institutes, Cleveland Clinic, Cleveland, OH, United States
(Feldman) Division of Cardiology, Weill Cornell Medical College, New York,
NY, United States
(Kolh) Department of Biomedical and Preclinical Sciences, University of
Liege, Liege, Belgium
(Lanza, Gaudino) Fondazione Policlinico Universitario A. Gemelli IRCCS,
Universita Cattolica del Sacro Cuore and Department of Cardiovascular and
Thoracic Diseases, Rome, Italy
(Ruel) Division of Cardiac Surgery, Department of Surgery, University of
Ottawa, Ottawa, Ontario, Canada
(Piccolo) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, New York, NY, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The management of severe left main (LM) disease remains controversial and
continues to evolve as new evidence emerges. Patient selection for
coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI) relies on both predicting mortality with CABG from
clinical characteristics using the Society of Thoracic Surgeons (STS) risk
score and anatomical complexity, using the Synergy Between Percutaneous
Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score. LM
stenting techniques continue to evolve; for bifurcation lesions, the use
of the double-kiss crush technique may reduce the incidence of late target
vessel revascularization. In patients with acute coronary syndrome (ACS)
complicated by cardiogenic shock, PCI is likely the first-line option in
those with anatomically amenable disease, whereas all other stable
non-ST-elevated ACS should be treated similar to stable ischemic heart
disease. Outcomes comparing CABG and PCI have been recently examined in 2
large randomized clinical trials. In general, early outcomes of
periprocedural myocardial infarction and stroke favoured PCI or were not
different from outcomes with CABG. However, the conclusions of both trials
are at present discordant with respect to late major adverse cardiac and
cerebral events; additional follow-up of the trial patients is important
for informed patient decision making. The appropriate mode of
revascularization should be selected according to patient clinical
characteristics and the complexity of the coronary lesions according to
European and American guidelines. In those with low or intermediate SYNTAX
scores, particularly with high surgical risk, PCI may be preferred to CABG
in most other scenarios. A multidisciplinary heart team is recommended to
help individualize revascularization decisions. Copyright © 2018
Canadian Cardiovascular Society

<160>
Accession Number
628341593
Title
Effect of pre-operative fluid therapy on hemodynamic stability during
anesthesia induction, a randomized study.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 2019.
Author
Myrberg T.; Lindelof L.; Hultin M.
Institution
(Myrberg, Lindelof, Hultin) Department of Surgical and Perioperative
Sciences, Anesthesiology and Intensive Care Medicine, Sunderby Research
Unit, Umea University, Umea, Sweden
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Preserving perfusion pressure during anesthesia induction is
crucial. Standardized anesthesia methods, alert fluid therapy and
vasoactive drugs may help maintain adequate hemodynamic conditions
throughout the induction procedure. In this randomized study, we
hypothesized that a pre-operative volume bolus based on lean body weight
would decrease the incidence of significant blood pressure drops (BPD)
after induction with target-controlled infusion (TCI) or rapid sequence
induction (RSI). Method(s): Eighty individuals scheduled for
non-cardiac surgery were randomized to either a pre-operative colloid
fluid bolus of 6 ml kg-1 lean body weight or no bolus, and then
anesthetized by means of TCI or RSI. The main outcome measure was blood
pressure drops below the mean arterial pressure 65 mm Hg during the first
20 minutes after anesthesia induction. ClinicalTrials.com Identifier:
NCT03394833. Result(s): Pre-operative fluid therapy decreased the
incidence of BPDs fivefold, from 23 of 40 (57.5%) individuals without
fluids to 5 of 40 (12.5%) with fluid management, P <.001. The mean BPD was
greater in the groups without pre-operative fluids compared to the groups
with fluid management; 53 +/- 18 mm Hg vs 43 +/- 14 mm Hg, P =.007. The
overall mean volume of pre-operative fluid bolus infused was 387 +/- 52
ml. There was no difference in hemodynamic stability between TCI and RSI.
No correlation was shown between incidence of BPDs and increasing age,
medication, hypertension, diabetes, renal failure, or low physical
capacity. Conclusion(s): Pre-operative fluid bolus decreased the
incidence of significant blood pressure drops during TCI and RSI induction
of general anesthesia. Copyright © 2019 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<161>
Accession Number
628341413
Title
Detection of gastric inflation using transesophageal echocardiography
after different level of pressure-controlled mask ventilation: a
prospective randomized trial.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2019. Date
of Publication: 2019.
Author
Zeng J.; Jia Z.-J.; Peng L.; Wei W.
Institution
(Zeng, Peng, Wei) Department of Anesthesiology, West China Hospital,
Sichuan University, 37# GuoXue Xiang, Chengdu, Sichuan 610041, China
(Jia) Department of Anesthesiology, The First Affiliated Hospital of
XinXiang Medical University, Henan 453100, China
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
This study aimed to assess the technique of using transesophageal
echocardiography (TEE) to detect gastric inflation and to determine the
optimal level of inspiratory pressure during face mask ventilation (FMV).
In this prospective and randomized trial, seventy-five adults scheduled
for cardiac surgery were enrolled to one of the three groups
(P<inf>12</inf>, P<inf>15</inf>, P<inf>20</inf>) defined by the applied
inspiratory pressure during FMV. After induction, mask ventilation was
performed with the corresponding level of pressure-control ventilation for
2 min in each patient. Respiratory and hemodynamic parameters were
recorded every 15 s. Arterial blood gases were tested before induction and
at the time of intubation. Gastric cross-section area was detected using
transesophageal echocardiography after intubation. The gastric
cross-section areas were 3.1 +/- 0.81, 3.8 +/- 1.37 and 4.8 +/- 2.29
cm2 respectively. It statistically increased in group
P<inf>20</inf> compared with group P<inf>12</inf> and P<inf>15</inf>.
PaCO<inf>2</inf> before intubation statistically increased compared with
the baseline in groups P<inf>12</inf> and P<inf>15</inf>, while decreased
in group P<inf>20</inf>. The mean values of PaCO<inf>2</inf> equaled to
44.4 mmHg (40-51.5), 42.9 mmHg (34-50.5) and 36.9 mmHg (30.9-46)
respectively in three groups. Peak airway pressure of 12-20
cmH<inf>2</inf>O could provide acceptable sufficient ventilation during
mask ventilation, but 20 cmH<inf>2</inf>O result in higher incidence of
gastric inflation. TEE is useful to detect the gastric inflation related
to the entry of air into the stomach during pressure-controlled face mask
ventilation. Trial Registration Number ChiCTR-IOR-14005325. Copyright
© 2019, Springer Nature B.V.

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