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<1>
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.

<2>
Accession Number
620852204
Title
Comparison between Optical COherence tomography guidance and Angiography
guidance in percutaneous coronary intervention (COCOA): Study protocol for
a randomized controlled trial.
Source
Journal of Cardiology. 72 (2) (pp 170-175), 2018. Date of Publication:
August 2018.
Author
Kubo T.; Shinke T.; Okamura T.; Hibi K.; Nakazawa G.; Morino Y.; Shite J.;
Ino Y.; Kitabata H.; Shimokawa T.; Akasaka T.
Institution
(Kubo, Ino, Kitabata, Akasaka) Department of Cardiovascular Medicine,
Wakayama Medical University, Wakayama, Japan
(Shinke) Department of Internal Medicine, Division of Cardiovascular
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
(Okamura) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Nakazawa) Division of Cardiology, Tokai University School of Medicine,
Isehara, Japan
(Morino) Division of Cardiology, Iwate Medical University, Morioka, Japan
(Shite) Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka,
Japan
(Ino, Kitabata) Department of Cardiovascular Imaging and Dynamics,
Wakayama Medical University, Wakayama, Japan
(Shimokawa) Clinical Research Center, Wakayama Medical University,
Wakayama, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Optical coherence tomography (OCT) is increasingly used as an
adjunct to coronary angiography for guiding percutaneous coronary
intervention (PCI). The current consensus on PCI is that the large final
stent area offers the best chance of a good late clinical outcome. Since
OCT provides more accurate information about the coronary artery and
implanted stents, OCT-guided stent implantation is expected to achieve
greater stent expansion than angiography guidance alone. Therefore, we
designed the COCOA (Comparison between Optical COherence tomography
guidance and Angiography guidance in percutaneous coronary intervention)
study to evaluate whether OCT-guided stent implantation would result in a
minimum stent area greater than that achieved with angiography guidance
alone. Methods and design: The COCOA study is a large-scale, multicenter,
single country (Japan), prospective randomized controlled, open-label,
parallel group, superiority study comparing OCT-guided PCI with
angiography-guided PCI. The eligible patients (n = 550) are randomly
allocated in a 1:1 ratio to receive either OCT-guided PCI or
angiography-guided PCI. PCI is performed using the everolimus-eluting
stent in accordance with certain criteria of OCT or angiography for
optimal stent implantation. Following the stent optimization guided by OCT
or angiography alone, OCT is performed in both groups. The primary
endpoint is minimum stent area at post-PCI with allocated imaging
guidance. Conclusion(s): When completed, the COCOA study will
contribute to define the clinical value of the OCT guidance in
PCI. Copyright © 2018 Japanese College of Cardiology

<3>
Accession Number
2000640419
Title
Midterm outcome of transcatheter versus surgical aortic valve replacement
in low to intermediate risk patients: A meta-analysis of randomized
controlled trials.
Source
Journal of Cardiology. 71 (6) (pp 534-539), 2018. Date of Publication:
June 2018.
Author
Wang Y.; Zhou Y.; Zhang L.; Zhu J.
Institution
(Wang) Department of Cardiology, Ningbo Medical Treatment Center Lihuili
Hospital, Ningbo, China
(Zhou, Zhang, Zhu) Department of Cardiology, The First Affiliated
Hospital, Zhejiang University, School of Medicine, Hangzhou, China
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Current guidelines recommend transcatheter aortic valve
replacement (TAVR) in patients with severe symptomatic aortic stenosis
(AS) who are not suitable for conventional surgical aortic valve
replacement (SAVR). In light of the recent trend in performing TAVR in
patients with lower risk profile, we assessed the midterm outcome
comparing TAVR and SAVR for the treatment of patients with severe AS at
low to intermediate risk. Method(s): PubMed, EBSCO, and Cochrane
CENTRAL were systematically searched for randomized controlled trials that
reported the clinical outcomes of TAVR versus SAVR in patients at low to
intermediate surgical risk with at least 2 years of follow-up. Clinical
endpoints including death, acute kidney injury, myocardial infarction,
stroke, permanent pacemaker implantation, and life-threatening bleeding
events were assessed. Result(s): From 2000 to 2017, 4 clinical
studies comprising 4355 patients were identified. At 2-year follow-up,
TAVR was associated with similar rate of death from any cause (RR 0.86;
95%CI: 0.67-1.10), cardiovascular death (RR 0.88; 95%CI: 0.73-1.06), and
stroke (RR 0.97; 95%CI: 0.81-1.15). TAVR reduced incidence of bleeding
events (RR 0.45; 95%CI: 0.28-0.73) and acute kidney injury (RR 0.48;
95%CI: 0.25-0.93). However, TAVR was associated with higher rate of
permanent pacemaker implantation (RR 3.01; 95%CI: 1.04-8.72).
 Conclusion(s): In patients at low to intermediate surgical risk,
midterm clinical outcomes of TAVR were similar to SAVR in survival and
stroke rate, superior in reducing life-threatening bleeding, acute kidney
injury, and new-onset atrial fibrillation, but inferior in increasing
permanent pacemaker implantation. Copyright © 2018 Japanese
College of Cardiology

<4>
Accession Number
620932281
Title
Transcarotid transcatheter aortic valve implantation: A systematic review.
Source
Journal of Cardiology. 71 (6) (pp 525-533), 2018. Date of Publication:
June 2018.
Author
Wee I.J.Y.; Stonier T.; Harrison M.; Choong A.M.T.L.
Institution
(Wee, Stonier, Harrison, Choong) SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
(Wee) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Stonier) Princess Alexandra Hospital, Harlow, London, United Kingdom
(Harrison) Department of General Surgery, Sir Charles Gairdner Hospital,
Perth, Australia
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The carotid artery is a novel access route for transcatheter
aortic valve implantation (TAVI), especially useful in patients unsuitable
for traditional access routes including transfemoral (TF), subclavian,
transapical (TAp), and aortic (TAo). This systematic review summarizes the
evidence on TAVI via the carotid artery for its efficacy and safety.
 Method(s): A systematic review was conducted as per the Preferred
Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA)
guidelines on three online databases: Medline (via Pubmed), SCOPUS, and
Cochrane Database. Result(s): There were 8 non-randomized controlled
trials identified comprising 650 patients in four TAVI vascular access
sites: transcarotid (TC) (N = 364), TF (N = 100), TAp (N = 151), TAo (N =
35). The 30-day rates of mortality and neurological complications for TC
TAVI were 6.5% and 3.8%, respectively, with 1 incidence of myocardial
infarction. Other complications included vascular complications (7.7%),
insertion of new pacemaker (17.4%), atrial fibrillation (5.2%), and acute
kidney injury (6.9%), bleeding episodes (14.3%), of which 13 (3.6%) cases
were life-threatening; 5 (1.4%) were major; and 35 (9.3%) were minor
cases. Follow-up to 1 year showed 19 further deaths. There were no
significant differences in terms of mortality rates [risk ratio (RR) =
0.31, 95%CI 0.05-1.79; p = 0.19] and onset of dialysis treatment (RR =
2.53, 95%CI 0.31-19.78; p = 0.38) between the TC and TAp groups.
 Conclusion(s): The available data on TC TAVI show comparable
technical feasibility with other traditional access routes, representing a
viable alternative. However, the paucity of data warrants the need for
larger randomized controlled trials to establish a firm
conclusion. Copyright © 2018 Japanese College of Cardiology

<5>
Accession Number
626538998
Title
Rationale and design of PASSAT - Patients' satisfaction with local or
general anaesthesia in video-assisted thoracoscopic surgery: Study
protocol for a randomised controlled trial with a non-randomised side arm.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 149. Date of
Publication: 27 Feb 2019.
Author
Galetin T.; Bretzke P.; Lopez-Pastorini A.; Schieren M.; Koryllos A.;
Kosse N.; Schnell J.; Defosse J.M.; Wappler F.; Stoelben E.
Institution
(Galetin, Lopez-Pastorini, Koryllos, Stoelben) University Witten/Herdecke,
Department of Thoracic Surgery, Alfred-Herrhausen-Str. 50, Witten D-58448,
Germany
(Schieren, Defosse, Wappler) University Witten/Herdecke, Department of
Anaesthesiology and Intensive Care Medicine, Alfred-Herrhausen-Str. 50,
Witten D-58448, Germany
(Galetin, Lopez-Pastorini, Koryllos, Kosse, Schnell, Stoelben) University
Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Thoracic
Surgery, Ostmerheimer Str. 200, Cologne D-51109, Germany
(Schieren, Defosse, Wappler) University Witten/Herdecke, Medical Centre
Cologne-Merheim, Department of Anaesthesiology and Intensive Care
Medicine, Ostmerheimer Str. 200, Cologne D-51109, Germany
(Bretzke) Sana IT Services GmbH, Burger Strase 211, Remscheid 42859,
Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Although general anaesthesia (GA) with one-lung ventilation is
the current standard of care, minor thoracoscopic surgery, i.e. treatment
of pleural effusions, biopsies and small peripheral pulmonary wedge
resections, can also be performed using local anaesthesia (LA),
analgosedation and spontaneous breathing. Whilst the feasibility and
safety of LA have been demonstrated, its impact on patient satisfaction
remains unclear. Most studies evaluating patient satisfaction lack control
groups or do not meet psychometric criteria. We report the design of the
PASSAT trial (PAtientS' SATisfaction in thoracic surgery - general vs.
local anaesthesia), a randomised controlled trial with a non-randomised
side arm. Method(s): Patients presenting for minor thoracoscopic
surgery and physical eligibility for GA and LA are randomised to surgery
under GA (control group) or LA (intervention group). Those who refuse to
be randomised are asked to attend the study on the basis of their own
choice of anaesthesia (preference arm) and will be analysed separately.
The primary endpoint is patient satisfaction according to a
psychometrically validated questionnaire; secondary endpoints are
complication rates, capnometry, actual costs and cost effectiveness. The
study ends after inclusion of 54 patients in each of the two randomised
study groups. Discussion(s): The PASSAT study is the first randomised
controlled trial to systematically assess patients' satisfaction depending
on LA or GA. The study follows an interdisciplinary approach, and its
results may also be applicable to other surgical disciplines. It is also
the first cost study based on randomised samples. Comparison of the
randomised and the non-randomised groups may contribute to satisfaction
research. Trial registration: German Clinical Trials Register,
DRKS00013661. Registered on 23 March 2018. Copyright © 2019 The
Author(s).

<6>
Accession Number
2001407955
Title
Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary
Review of 103 Published Cases.
Source
Clinical Lung Cancer. 20 (2) (pp e152-e157), 2019. Date of Publication:
March 2019.
Author
McGehee E.; Gerber D.E.; Reisch J.; Dowell J.E.
Institution
(McGehee, Gerber, Dowell) Department of Internal Medicine, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Gerber, Reisch) Department of Clinical Sciences, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Gerber, Dowell) Harold C. Comprehensive Cancer Center, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Dowell) Veterans Affairs, North Texas Health Care System, Dallas, TX,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Primary pericardial mesothelioma (PPM) is a rare cancer for which there is
no consensus on treatment. We evaluated and summarized a large
contemporary population of published PPM cases to characterize risk
factors, treatment patterns, and clinical outcomes. Using Ovid and PubMed,
literature published from 2000 through 2016 was searched using the terms
"primary pericardial mesothelioma," "pericardial mesothelioma," and
"malignant pericardial mesothelioma." We identified 6 case series and 84
case reports for a total of 103 PPM cases published from 2000 through
2016. The median age at diagnosis was 55 years, and the median overall
survival was 6 months. In univariate analyses of clinical characteristics
including gender, asbestos exposure, tobacco use, prior radiation
exposure, histologic subtype, and metastasis and/or mediastinal spread,
only the presence of metastasis and/or mediastinal spread was a
significant predictor of decreased survival (P = .015). Surgery did not
provide a statistically significant survival benefit (P = .12). A survival
benefit was noted in those who received chemotherapy (median survival, 13
months vs. 0.5 months, P = .002), specifically chemotherapy with a
platinum agent with or without pemetrexed. In multivariate analysis, only
the receipt of chemotherapy was associated with improved survival. PPM
remains a rare and poorly understood malignancy with unclear etiology and
a poor prognosis. In this retrospective systematic review, a survival
benefit was seen in patients who received chemotherapy. Copyright
© 2018 Elsevier Inc.

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

<8>
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Accession Number
628389794
Title
Percutaneous coronary intervention or coronary artery bypass graft in left
main coronary artery disease: A comprehensive meta-analysis of adjusted
observational studies and randomized controlled trials.
Source
Journal of Cardiovascular Medicine. 19 (10) (pp 554-563), 2018. Date of
Publication: 2018.
Author
Bertaina M.; De Filippo O.; Iannaccone M.; Colombo A.; Stone G.; Serruys
P.; Mancone M.; Omede P.; Conrotto F.; Pennone M.; Kimura T.; Kawamoto H.;
Zoccai G.B.; Sheiban I.; Templin C.; Benedetto U.; Cavalcante R.; D'Amico
M.; Gaudino M.; Moretti C.; Gaita F.; D'Ascenzo F.
Institution
(De Filippo, Iannaccone, Omede, Conrotto, Pennone, D'Amico, Moretti,
Gaita, D'Ascenzo) Division of Cardiology, Citta Della Salute e della
Scienza, Molinette Hospital, Turin, Italy
(Colombo, Kawamoto) Interventional Cardiology, Cardio-Thoracic-Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Stone) Cardiovascular Research and Education Columbia University Medical
Center, Presbyterian Hospital, New York, United States
(Serruys, Cavalcante) Department of Interventional Cardiology, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mancone) Department of Cardiovascular, Respiratory, Nephrology,
Anesthesiology and Geriatric Sciences, University 'La Sapienza' of Rome,
Rome, Italy
(Kimura) Department of Cardiovascular Medicine, Kyoto University, Japan
(Zoccai) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Latina, Italy
(Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli,
Italy
(Sheiban) Cardiology Department, Pederzoli Hospital, Verona, Italy
(Templin) University Heart Center, Department of Cardiology, University
Hospital Zurich, Zurich, Switzerland
(Benedetto, Gaudino) Bristol Heart Institute, University of Bristol,
School of Clinical Sciences, Bristol, United Kingdom
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medical
College, New York, NY, United States
(Bertaina) Division of Cardiology, CItta della salute e della Scienza,
Molinette Hospital, University of Turin, Italy
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Treatment of patients with ULMCA (unprotected left main
coronary artery disease) with percutaneous coronary intervention (PCI) has
been compared with coronary artery bypass graft (CABG), without conclusive
results. Method(s): All randomized controlled trials (RCTs) and
observational studies with multivariate analysis comparing PCI and CABG
for ULMCA were included. Major cardiovascular events (MACEs, composite of
all-cause death, MI, definite or probable ST, target vessel
revascularization and stroke) were the primary end points, whereas its
single components were the secondary ones, along with stent thrombosis,
graft occlusion and in-hospital death and stroke. Subgroup analyses were
performed according to Syntax score. Result(s): Six RCTs (4717
patients) and 20 observational studies with multivariate adjustment (14
597 patients) were included. After 5 (3 - 5.5) years, MACE rate was higher
for PCI [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07 - 1.14],
without difference in death, whereas more relevant risk of MI was because
of observational studies. Coronary stenting increased risk of
revascularization (OR 1.52; 95% CI 1.34 - 1.72). At meta-regression,
performance of PCI was improved by use of intra-coronary imaging and
worsened by first generation stents, whereas two arterial grafts increased
benefit of CABG. For patients with Syntax score less than 22, MACE rates
did not differ, whereas for higher values, CABG reduced MACE because of
lower risk of revascularization. Incidence of graft occlusion was 3.24%
(2.25-4.23), whereas 2.13% (1.28-2.98: all CI 95%) of patients experienced
stent thrombosis. Conclusion(s): Surgical revascularization reduces
risk of revascularization for ULMCA patients, especially for those with
Syntax score greater than 22, with a higher risk of in-hospital death.
Intra-coronary imaging and use of arterial grafts improved performance of
revascularization strategies. Copyright © 2018 Italian Federation
of Cardiology - I.F.C. All rights reserved.

<9>
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

<10>
Accession Number
626372663
Title
Effect of iloprost inhalation on postoperative outcome in high-risk
cardiac surgical patients: a prospective randomized-controlled multicentre
trial (ILOCARD).
Source
Canadian Journal of Anesthesia. 66 (8) (pp 907-920), 2019. Date of
Publication: 15 Aug 2019.
Author
Winterhalter M.; Rex S.; Stoppe C.; Kienbaum P.; Muller H.-H.; Kaufmann
I.; Kuppe H.; Dongas A.; Zwissler B.
Institution
(Winterhalter) Klinik fur Anasthesiologie und Schmerztherapie, Klinikum
Bremen-Mitte gGmbH, Bremen, Germany
(Winterhalter, Kienbaum) Klinik fur Anasthesiologie, Universitatsklinikum
Dusseldorf, Dusseldorf, Germany
(Rex) Department of Anesthesiology & Department of Cardiovascular
Sciences, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven
3000, Belgium
(Rex, Stoppe) Klinik fur Anasthesiologie, Universitatsklinikum der RWTH
Aachen, Aachen, Germany
(Muller) Klinische Forschung, IBE - Institut fur Medizinische
Informationsverarbeitung, Biometrie und Epidemiologie,
Ludwig-Maximilians-Universitat Munchen, Munich, Germany
(Muller) Institut fur Medizinische Biometrie und Epidemiologie,
Philipps-Universitat Marburg, Marburg, Germany
(Kaufmann, Zwissler) Klinik fur Anasthesiologie, LMU Klinikum der
Universitat Munchen, Munich, Germany
(Kaufmann) Klinik fur Anasthesiologie, Operative Intensivmedizin und
Schmerztherapie, Stadtisches Klinikum Munchen, Neuperlach, Munich, Germany
(Kuppe) Institut fur Anasthesiologie, Deutsches Herzzentrum Berlin,
Berlin, Germany
(Dongas) Institut fur Anasthesiologie, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Dongas) Klinik fur Anasthesiologie und operative Intensivmedizin,
Franziskus Hospital Bielefeld, Bielefeld, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Perioperative right ventricular (RV) failure due to pressure
overload from pulmonary hypertension (PH) worsens postoperative outcomes
after cardiac surgery. Inhaled iloprost is a potent pulmonary vasodilator
improving RV performance, ameliorating myocardial and pulmonary
ischemia-reperfusion injury and attenuating inflammation. We hypothesized
that the prophylactic inhalation of iloprost would reduce postoperative
ventilation times after cardiac surgery. Method(s): In this phase
III, multicentre, randomized, double-blind, placebo-controlled trial, we
randomly assigned 253 cardiac surgical patients at high risk of
perioperative RV failure to the prophylactic inhalation of 20 micro g
iloprost or placebo before and during weaning from extracorporeal
circulation. The primary endpoint was the duration of postoperative
ventilation. Secondary endpoints included perioperative hemodynamics,
intensive care unit and hospital length of stay, and 90-day mortality.
Safety was assessed by the incidence of adverse events. Result(s):
Iloprost had no significant effect on the median [interquartile range]
duration of postoperative ventilation compared with placebo (720
[470-1170] min vs 778 [541-1219] min, respectively; median decrease, 65
min; 95% confidence interval [CI], - 77 to 210; P = 0.37). While the
nebulization of iloprost decreased RV afterload and improved cardiac
index, major secondary endpoints were not significantly affected.
Ninety-day mortality occurred in 14% of the iloprost patients compared
with 14% of the placebo patients (hazard ratio, 0.97; 95% CI, 0.50 to
1.89; P = 0.93). The incidence of adverse events was comparable in both
groups. Conclusion(s): The prophylactic inhalation of iloprost did
not meaningfully improve the outcome in high-risk cardiac surgical
patients. Trial registration: www.clinicaltrials.gov (NCT00927654);
registered 25 June, 2009. Copyright © 2019, Canadian
Anesthesiologists' Society.

<11>
Accession Number
2001326374
Title
Antiplatelet effects of ticagrelor versus clopidogrel after coronary
artery bypass graft surgery: A single-center randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (2) (pp 430-437.e4),
2019. Date of Publication: August 2019.
Author
Xu F.; Feng W.; Zhou Z.; Zhang Y.; Diao X.; Hu S.; Zheng Z.
Institution
(Xu, Feng, Hu, Zheng) Department of Cardiovascular Surgery, Fuwai
Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical
College, Beijing, China
(Zhou, Zhang) Center of Laboratory Medicine, Beijing Key Laboratory for
Molecular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences,
and Peking Union Medical College, Beijing, China
(Diao) Biostatistical Unit, Fuwai Hospital, Chinese Academy of Medical
Sciences, and Peking Union Medical College, Beijing, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to compare the onset of platelet
inhibition (inhibition of platelet aggregation) between ticagrelor 90 mg
twice per day and clopidogrel 75 mg once per day in patients receiving
coronary artery bypass grafting. Method(s): In a single-center,
randomized, open-label study, 140 patients receiving coronary artery
bypass grafting were randomly assigned to the aspirin + ticagrelor group
or the aspirin + clopidogrel group in a 1:1 ratio. Participants in the
aspirin + ticagrelor group took aspirin 100 mg once per day and ticagrelor
90 mg twice per day. Participants in the aspirin + clopidogrel group took
aspirin 100 mg once per day and clopidogrel 75 mg once per day. Platelet
function was determined before study treatment (0 hours); at 2 hours, 8
hours, 24 hours, and 72 hours after medication; and during follow-up at 30
days after surgery. Result(s): Inhibition of platelet aggregation at
2 hours after the first drug administration was greater for the aspirin +
ticagrelor group than for the aspirin + clopidogrel group (34.2%
[interquartile range, 9.1-66.0] vs 5.3% [interquartile range, -14.3-22.0],
P <.001) and at all times in the study period (P <.001). More patients
reached inhibition of platelet aggregation maximum within 24 hours in the
aspirin + ticagrelor group than in the aspirin + clopidogrel group (52.9%
vs 27.5%, P =.006). The average inhibition of platelet aggregation maximum
from 2 to 24 hours was still greater in the aspirin + ticagrelor group
than in the aspirin + clopidogrel group (72.3% +/- 15.4% vs 49.2% +/-
46.8%, P <.001). There were no differences in terms of bleeding or major
adverse cardiac events between the 2 groups. Conclusion(s): In
patients receiving coronary artery bypass grafting, the onset of action
was faster and the peak inhibition of platelet aggregation was higher with
ticagrelor than with clopidogrel. Copyright © 2018 The American
Association for Thoracic Surgery

<12>
Accession Number
627528426
Title
Risk factors for surgical site infection in neonates: A systematic review
of the literature and meta-analysis.
Source
Frontiers in Pediatrics. 7 (MAR) (no pagination), 2019. Article Number:
101. Date of Publication: 2019.
Author
Catania V.D.; Boscarelli A.; Lauriti G.; Morini F.; Zani A.
Institution
(Catania, Zani) Division of General and Thoracic Surgery, The Hospital for
Sick Children, University of Toronto, Toronto, ON, Canada
(Boscarelli, Morini) Neonatal Surgery Unit, Department of Medical and
Surgical Neonatology, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
(Lauriti) Department of Pediatric Surgery, Spirito Santo Hospital and G.
d'Annunzio University of Chieti and Pescara, Chieti, Italy
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Purpose: Surgical site infections (SSI) contribute to postoperative
morbidity and mortality in children. Our aim was to evaluate the
prevalence and identify risk factors for SSI in neonates. Method(s):
Using a defined strategy, three investigators searched articles on
neonatal SSI published since 2000. Studies on neonates and/or patients
admitted to neonatal intensive care unit following
cervical/thoracic/abdominal surgery were included. Risk factors were
identified from comparative studies. Meta-analysis was conducted according
to PRISMA guidelines using RevMan 5.3. Data are (mean +/- SD) prevalence.
 Result(s): Systematic review-of 885 abstracts screened, 48 studies
(27,760 neonates) were included. The incidence of SSI was 5.6% (1,564
patients). SSI was more frequent in males (61.8%), premature babies
(77.4%), and following gastrointestinal surgery (95.4%). Meta-analysis-10
comparative studies (16,442 neonates; 946 SSI 5.7%) showed that predictive
factors for SSI development were gestational age, birth weight, age at
surgery, length of surgical procedure, number of procedure per patient,
length of preoperative hospital stay, and preoperative sepsis. Conversely,
preoperative antibiotic use was not significantly associated with
development of SSI. Conclusion(s): Younger neonates and those
undergoing abdominal procedures are at higher risk for SSI. Given the lack
of evidence-based literature, prospective studies may help determine the
risk factors for SSI in neonates. Copyright © 2019 Catania,
Boscarelli, Lauriti, Morini and Zani.

<13>
Accession Number
2001210787
Title
Cardiovascular Outcomes in Patients With Previous Myocardial Infarction
and Mild Diabetes Mellitus Following Treatment With Pioglitazone: Reports
of a Randomised Trial From The Japan Working Group for the Assessment
Whether Pioglitazone Protects DM Patients Against Re-Infarction (PPAR
Study).
Source
EClinicalMedicine. 4-5 (pp 10-24), 2018. Date of Publication: October -
November 2018.
Author
Asakura M.; Kim J.; Asanuma H.; Nakama Y.; Tsukahara K.; Higashino Y.;
Ishikawa T.; Koba S.; Tsujimoto M.; Himeno H.; Maruyama Y.; Ookusa T.;
Yoda S.; Suzuki H.; Okubo S.; Shimizu M.; Hashimoto Y.; Satake K.; Fujino
S.; Uzui H.; Nagai Y.; Kohno T.; Mizuno S.; Nakahama M.; Kanaya H.;
Murohara T.; Fukui K.; Takase H.; Ohte N.; Shiono T.; Fukunami M.; Endo
T.; Sawada R.; Fujii K.; Takeuchi M.; Ikeda S.; Mizuno K.; Uematsu M.;
Matsubara T.; Yano S.; Takahashi J.; Ueda K.; Kinoshita Y.; Tamita K.;
Hayashi H.; Hamasaki T.; Kitakaze M.
Institution
(Asakura, Kim, Kitakaze) Department of Clinical Medicine and Development,
National Cerebral and Cardiovascular Center, Osaka, Japan
(Asakura, Kitakaze) Department of Cardiovascular Medicine, National
Cerebral and Cardiovascular Center, Osaka, Japan
(Asanuma) Department of Internal Medicine, Meiji University of Integrative
Medicine, Kyoto, Japan
(Nakama) Department of Cardiology, Hiroshima City Hospital, Hiroshima,
Japan
(Tsukahara) Division of Cardiology, Yokohama City University Medical
Center, Kanagawa, Japan
(Higashino) Department of Cardiology, Higashi Takarazuka Satoh Hospital,
Hyogo, Japan
(Ishikawa) Department of Cardiology, Saitama Prefecture Cardiovascular and
Respiratory Center, Saitama, Japan
(Koba) Division of Cardiology, Department of Medicine, Showa University
Hospital, Tokyo, Japan
(Tsujimoto) Department of Cardiology, Cardiovascular Center, Veritas
Hospital, Hyogo, Japan
(Himeno) Division of Cardiology, Fujisawa City Hospital, Kanagawa, Japan
(Maruyama) Department of Cardiology, Iwatsuki-Minami Hospital, Saitama,
Japan
(Ookusa) Department of Cardiology, Hokko Memorial Hospital, Hokkaido,
Japan
(Yoda) Division of Cardiology, Department of Internal Medicine, Nihon
University School of Medicine, Tokyo, Japan
(Suzuki) Division of Cardiology, Showa University Fujigaoka Hospital,
Kanagawa, Japan
(Okubo) Department of Cardiovascular Medicine, Tokyo Medical University
Ibaraki Medical Center, Ibaraki, Japan
(Shimizu) Department of Cardiology, International Goodwill Hospital,
Kanagawa, Japan
(Hashimoto) Department of Cardiology, Kameda Medical Center, Chiba, Japan
(Satake) Department of Cardiology, Fukui General Clinic, Fukui, Japan
(Fujino) Department of Cardiology, Fukui Prefectural Hospital, Fukui,
Japan
(Uzui) Department of Cardiology, University of Fukui Hospital, Fukui,
Japan
(Nagai) Department of Cardiology, Rinku General Medical Center, Osaka,
Japan
(Kohno) Department of Cardiology, Tokyo Rinkai Hospital, Tokyo, Japan
(Mizuno) Department of Internal Medicine, Fukui Cardiovascular Center,
Fukui, Japan
(Nakahama) Department of Cardiology, Fukuyama City Hospital, Hiroshima,
Japan
(Kanaya) Division of Cardiology, Ishikawa Prefectural Central Hospital,
Ishikawa, Japan
(Murohara) Department of Cardiology, Nagoya University, Aichi, Japan
(Fukui) Department of Cardiology, Kanagawa Cardiovascular and Respiratory
Center, Kanagawa, Japan
(Takase) Department of Internal Medicine, Enshu Hospital, Shizuoka, Japan
(Ohte) Department of Cardio-Renal Medicine and Hypertension, Nagoya City
University Graduate School of Medical Sciences, Aichi, Japan
(Shiono) Department of Cardiology, Kitasato University Medical Center,
Saitama, Japan
(Fukunami) Division of Cardiology, Osaka General Medical Center, Osaka,
Japan
(Endo) Department of Cardiology, Saiseikai Yokohama City Southern
Hospital, Kanagawa, Japan
(Sawada) Department of Cardiology, Hadano Red Cross Hospital, Kanagawa,
Japan
(Fujii) Department of Cardiology, Fukui Prefectural Hospital, Fukui, Japan
(Takeuchi) Department of Internal Medicine, Takeuchi Clinic, Hyogo, Japan
(Ikeda) Division of Cardiology, Uwajima City Hospital, Ehime, Japan
(Mizuno) Department of Cardiology, Kawasaki Municipal Tama Hospital,
Kanagawa, Japan
(Uematsu) Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
(Matsubara) Department of Cardiovascular Medicine, Shinrakuen Hospital,
Niigata, Japan
(Yano) Department of Cardiovascular Medicine, Almeida Memorial Hospital,
Oita, Japan
(Takahashi) Department of Cardiovascular Medicine, Tohoku University
Graduate School of Medicine, Miyagi, Japan
(Ueda) Division of Cardiology, Komatsu Municipal Hospital, Ishikawa, Japan
(Kinoshita) Department of Cardiology, Kinoshita Clinic, Hiroshima, Japan
(Tamita) Department of Cardiology, Nishinomiya Watanabe Cardiovascular
Center, Hyogo, Japan
(Hayashi) Department of Internal Medicine, Hoetsu Hospital, Tokushima,
Japan
(Hamasaki) Department of Data Science, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Asakura) Department of Cardiovascular Division, Hyogo College of
Medicine, Hyogo, Japan
(Kim) Kim Cardiovascular Clinic, Osaka, Japan
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Secondary prevention in patients with myocardial infarction
(MI) is critically important to prevent ischaemic heart failure and reduce
social burden. Pioglitazone improves vascular dysfunction and prevents
coronary atherosclerosis, mainly via anti-inflammatory and antiatherogenic
effects by enhancing adiponectin production in addition to
antihyperglycemic effects, thus suggesting that pioglitazone attenuates
cardiovascular events in patients with mild (HbA1c levels < 6.5%) diabetes
mellitus (DM). Therefore, we evaluated the effects of pioglitazone on
cardiovascular events in patients with both previous MI and mild DM.
 Method(s): In this multicentre, prospective, randomised, open,
blinded-endpoint trial, we randomly assigned 630 patients with mild DM
with a history of MI to undergo either DM therapy with (pioglitazone
group) or without (control group) pioglitazone. DM was diagnosed using the
75-g oral glucose tolerance test, and mild DM was defined if HbA1c level
was < 6.5%. The primary endpoint was the composite of cardiovascular death
and hospitalisation caused by acute MI, unstable angina, coronary
revascularisation (including percutaneous coronary intervention and
cardiac bypass surgery), and stroke. Finding(s): HbA1C levels were
5.9 and 5.8% (p = 0.71) at baseline and 6.0 and 5.8% (p < 0.01) at 2 years
for the control and pioglitazone groups, respectively. The primary
endpoint was observed in 14.2% and 14.1% patients in the control and
pioglitazone groups during two years (95% confidential interval
(CI):0.662-1.526, p = 0.98), respectively; the incidence of MI and
cerebral infarction was 0.3% and 2.2% (95%CI: 0.786-32.415, p = 0.09) and
1.0% and 0.3% (95%CI: 0.051-3.662, p = 0.44), respectively. Post-hoc
analyses of the 7-year observation period showed that these trends were
comparable (21.9% and 19.2% in the control and pioglitazone groups, 95%CI:
0.618-1.237, p = 0.45). Interpretation(s): Pioglitazone could not
reduce the occurrence of cardiovascular events in patients with mild DM
and previous MI. Copyright © 2018

<14>
Accession Number
628515007
Title
Gravity Venous Drainage and the 3/8-Inch Venous Line: What Would
Poiseuille Do?.
Source
The journal of extra-corporeal technology. 51 (2) (pp 78-82), 2019. Date
of Publication: 01 Jun 2019.
Author
Datt B.; Pourmoghadam K.K.; Munro H.M.; DeCampli W.M.
Institution
(Datt) Children's Hospital of New Orleans, New Orleans, LA, United States
(Pourmoghadam, Munro, DeCampli) The Heart Center, Arnold Palmer Hospital
for Children, Orlando, Florida; and
(Munro, DeCampli) University of Central Florida College of Medicine,
Orlando, FL, United States
Publisher
NLM (Medline)
Abstract
The 1/2 venous line has long been the drainage tubing diameter of choice
for adult patients undergoing cardiac surgery. However, several programs
use a smaller diameter venous line when used in conjunction with
kinetic-assisted venous drainage or vacuum-assisted venous drainage. In
2014, our perfusion team made an institution-wide effort to miniaturize
the cardiopulmonary bypass (CPB) circuit for children. One of our changes
was the transition to a 3/8 diameter venous line for drainage, even in our
larger patients (up to 80 kg). We reviewed the current literature on this
topic and delineated the various parameters required to be able to use the
3/8 venous line with gravity drainage with the aim of using it on patients
up to 115 kg with the appropriate venous reservoir. We have successfully
used the 3/8 venous line in more than 40 of our larger patients (35-90 kg)
without the need for assisted venous drainage. We were able to reduce CPB
prime from 625 +/- 118 to 425 +/- 52 mL before retrograde autologous
priming (RAP)/venous autologous priming (VAP). The prime was further
reduced to 325 +/- 66 mL after RAP/VAP. Homologous blood utilization was
reduced from 217 +/- 311 mL to 27 +/- 77 mL. Both results were
statistically significant. We hypothesize that taking into account two of
the parameters of Poiseuille's law, namely length and diameter, it is
possible to safely drain large children and mid-size adults via gravity
venous drainage and the 3/8 venous line. This technique allows reducing
prime volume, simplifies CPB circuits with increased safety and
potentially reduces the need for homologous blood transfusion.

<15>
Accession Number
628450745
Title
Randomised controlled trial to investigate the effectiveness of thoracic
epidural and paravertebral blockade in reducing chronic post-thoracotomy
pain (TOPIC): A pilot study to assess feasibility of a large multicentre
trial.
Source
BMJ Open. 9 (7) (no pagination), 2019. Article Number: e023679. Date of
Publication: 01 Jul 2019.
Author
Yeung J.; Middleton L.; Tryposkiadis K.; Kerr A.; Daniels J.; Naidu B.;
Melody T.; Goebel A.; Wilson M.; Kumar S.; Szentgyorgyi L.; Flanagan S.;
Shah R.; Worrall A.; Gao F.
Institution
(Yeung) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
(Yeung, Melody, Kumar, Worrall, Gao) Academic Department of Anaesthesia,
Critical Care, Pain and Resuscitation, Birmingham Heartlands Hospital,
University Hospital Birmingham NHS Foundation Trust, Birmingham, United
Kingdom
(Middleton) School of Health and Population Sciences, University of
Birmingham, Birmingham, United Kingdom
(Tryposkiadis) Birmingham Clinical Trials Unit, University of Birmingham,
Birmingham, United Kingdom
(Kerr, Naidu) Department of Thoracic Surgery, Birmingham Heartlands
Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham,
United Kingdom
(Daniels) Nottingham Clinical Trials Unit, University of Nottingham,
Nottingham, United Kingdom
(Naidu, Gao) Institute of Inflammation and Ageing, College of Medical and
Dental Sciences, University of Birmingham, Birmingham, United Kingdom
(Goebel) University of Liverpool, Institute of Translational Medicine,
Liverpool, United Kingdom
(Wilson) Health Services Research, University of Sheffield, Sheffield,
United Kingdom
(Szentgyorgyi) Department of Anaesthesia, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
(Flanagan) Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
(Shah) Department of Thoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Thoracotomy is considered one of the most painful surgical
procedures. The incidence of chronic post-thoracotomy pain (CPTP) is up to
50%. Paravertebral blockade (PVB) may be superior to thoracic epidural
blockade (TEB) in preventing CPTP. The specific objective of this pilot
study was to assess the feasibility of conducting a larger trial to
determine whether PVB at thoracotomy is more effective in reducing CPTP
compared with TEB. Design(s): A randomised, parallel, external pilot
study was conducted to assess whether a large randomised trial of TEB and
PVB with CPTP as the primary outcome is feasible. Setting(s): Two
adult thoracic centres in the UK. Participant(s): All adult patients
admitted for elective open thoracotomy. Participant(s): were excluded
if they were American Society of Anesthesiologists physical status IV or
V; or if there is contraindication to local anaesthetics; infection near
the proposed puncture site; coagulation/thoracic spine disorders; required
chest wall resection or emergency thoracic surgery or had a previous
thoracotomy. Result(s): All patients presenting for thoracotomy were
screened over a 12-month period with 194 found to be eligible. Of these,
69 (36%) were randomised (95% CI 29% to 42%). Discounting five
participants who died, 54 of 64 participants (84%) returned questionnaire
booklets at 6 months. The number of participants indicating at least a
moderate level of chest pain at 6 months was lower with PVB but with high
levels of uncertainty (RR: 0.7; 95% CI 0.3 to 1.7 for worst pain; RR: 0.3;
95% CI 0.0 to 2.8 for average pain). There were no safety concerns.
 Conclusion(s): A large, multicentre randomised controlled trial of
PVB versus TEB is feasible as it is possible to randomise and follow up
participants with high fidelity. Pain scores were lower on average with
PVB compared with TEB but a much larger trial is required to confirm this
reliably. Copyright © 2019 Author(s).

<16>
Accession Number
628436073
Title
Effects of non-statin lipid-modifying agents on cardiovascular morbidity
and mortality among statin-treated patients: A systematic review and
network meta-analysis.
Source
Frontiers in Pharmacology. 10 (MAY) (no pagination), 2019. Article Number:
547. Date of Publication: 2019.
Author
Chaiyasothi T.; Nathisuwan S.; Dilokthornsakul P.; Vathesatogkit P.;
Thakkinstian A.; Reid C.; Wongcharoen W.; Chaiyakunapruk N.
Institution
(Chaiyasothi, Nathisuwan) Department of Pharmacy, Faculty of Pharmacy,
Mahidol University, Bangkok, Thailand
(Chaiyasothi) Department of Clinical Pharmacy, Faculty of Pharmacy,
Srinakharinwirot University, Nakhon Nayok, Thailand
(Dilokthornsakul, Chaiyakunapruk) Department of Pharmacy Practice, Faculty
of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research,
Naresuan University, Phitsanulok, Thailand
(Vathesatogkit) Department of Medicine, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Thakkinstian) Section for Clinical Epidemiology and Biostatistics,
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand
(Reid) School of Epidemiology and Preventive Medicine, Monash University,
Melbourne, VIC, Australia
(Reid) School of Public Health, Curtin University, Perth, WA, Australia
(Wongcharoen) Division of Cardiology, Department of Internal Medicine,
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
(Chaiyakunapruk) School of Pharmacy, Monash University Malaysia, Bandar
Sunway, Selangor, Malaysia
(Chaiyakunapruk) School of Pharmacy, University of Wisconsin, Madison, WI,
United States
(Chaiyakunapruk) Asian Centre for Evidence Synthesis in Population,
Implementation and Clinical Outcomes, Health and Well-being Cluster,
Global Asia in the 21st Century (GA21) Platform, Monash University
Malaysia, Bandar Sunway, Malaysia
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: Currently, there is a lack of information on the comparative
efficacy and safety of non-statin lipid-lowering agents (NST) in
cardiovascular (CV) disease risk reduction when added to background statin
therapy (ST). This study determine the relative treatment effects of NST
on fatal and non-fatal CV events among statin-treated patients.
 Method(s): A network meta-analysis based on a systematic review of
randomized controlled trials (RCTs) comparing non-statin lipid-modifying
agents among statin-treated patients was performed. PubMed, EMBASE,
CENTRAL, and Clinicaltrial.gov were searched up to April 10, 2018. The
primary outcomes were CV and all-cause mortalities. Secondary CV outcomes
were coronary heart disease (CHD) death, non-fatal myocardial infarction
(MI), any stroke, and coronary revascularization. Risks of
discontinuations were secondary safety outcomes. Result(s):
Sixty-seven RCTs including 259,429 participants with eight interventions
were analyzed. No intervention had significant effects on the primary
outcomes (CV mortality and all-cause mortality). For secondary endpoints,
proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK) plus statin
(PCSK/ST) significantly reduced the risk of non-fatal MI (RR 0.82, 95% CI
0.72-0.93, p = 0.003), stroke (RR 0.74, 95% CI 0.65-0.85, p < 0.001),
coronary revascularization (RR 0.84, 95% CI 0.75-0.94, p = 0.003) compared
to ST. Combinations of ST and all NST except PCSK and ezetimibe showed
higher rate of discontinuation due to adverse events compared to ST.
 Conclusion(s): None of NST significantly reduced CV or all-cause
death when added to ST. PCSKs and to a lesser extent, ezetimibe may help
reduce cardiovascular events with acceptable tolerability profile among
broad range of patients. Copyright © 2019 Chaiyasothi,
Nathisuwan, Dilokthornsakul, Vathesatogkit, Thakkinstian, Reid,
Wongcharoen and Chaiyakunapruk. This is an open-access article distributed
under the terms of the Creative Commons Attribution License (CC BY). The
use, distribution or reproduction in other forums is permitted, provided
the original author(s) and the copyright owner(s) are credited and that
the original publication in this journal is cited, in accordance with
accepted academic practice. No use, distribution or reproduction is
permitted which does not comply with these terms.

<17>
Accession Number
613415547
Title
Impact of telmisartan on glomerular filtration in laparoscopic surgery. A
double blinded randomised controlled study.
Source
Cirugia y Cirujanos (English Edition). 85 (1) (pp 34-40), 2017. Date of
Publication: 01 Jan 2017.
Author
Fuentes-Reyes R.A.; Pacheco-Patino M.F.; Ponce-Escobedo A.N.;
Munoz-Maldonado G.E.; Hernandez-Guedea M.A.
Institution
(Fuentes-Reyes, Pacheco-Patino, Ponce-Escobedo, Munoz-Maldonado,
Hernandez-Guedea) Servicio de Cirugia General, Hospital Universitario Dr.
Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey,
Nuevo Leon, Mexico
Publisher
Mexican Academy of Surgery (E-mail: permanyer@permanyer.com)
Abstract
Background Laparoscopic surgery has begun to replace a great number of
procedures that were previously practiced using open or conventional
techniques. This is due to the minimal invasion, small incisions, and
short time recovery. However, it has come to knowledge, that the increase
in intra-abdominal pressure due to carbon dioxide pneumoperitoneum during
laparoscopic surgery causes cardiovascular, respiratory, endocrine, and
renal alterations. Objective To evaluate the nephroprotective effect of
telmisartan, an angiotensin II AT1 receptor antagonist, on glomerular
filtration in laparoscopic surgery. Material and methods Analytical
prospective, randomised, double-blind study was conducted on patients
undergoing elective laparoscopic cholecystectomy. They were randomised
into 2 groups, with the treatment group receiving a single dose of 40 mg
telmisartan orally 2 hours prior to surgery, and the placebo group.
Results There were 20 patients in each group (n = 40), with a mean age of
32.65 years in the treatment group. Plasma creatinine did not show any
significant change in the different time lapse in which blood samples were
taken, but creatinine clearance at the end of surgery (196.415 +/- 56.507
vs. 150.1995 +/- 75.081; p=0.034), and at 2 h postoperative period
(162.105 +/- 44.756 vs. 113.235 +/- 31.228; p <= 0.001) was statistically
significant, which supports an increase in renal function in the
telmisartan group. Conclusion The use of telmisartan, an angiotensin II
AT1 receptor antagonist, offers renal protection during laparoscopic
surgery. Copyright © 2016 Academia Mexicana de Cirugia A.C.

<18>
Accession Number
628521158
Title
Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic
Valve Implantation for Aortic Stenosis and Porcelain Aorta with a
Systematic Review of Transfemoral versus Transapical Approach.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2019. Date of
Publication: 26 Jun 2019.
Author
Useini D.; Haldenwang P.; Schlomicher M.; Christ H.; Naraghi H.;
Moustafine V.; Strauch J.
Institution
(Useini, Haldenwang, Schlomicher, Naraghi, Moustafine, Strauch) Department
of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum,
Germany
(Christ) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: We have aimed to analyze early and mid-term outcomes of
patients undergoing transapical/transfemoral transcatheter aortic valve
implantation (TA-/TF-TAVI) for aortic stenosis and porcelain aorta (PAo)
in our institution. Additionally, we postulated that the TA approach may
be associated with a more favorable neurological outcome than the TF
approach; hence, a systematic literature review was conducted.
 METHOD(S): Between 2011 and 2017, 15 patients with PAo underwent
TA-TAVI and 4 patients with PAo TF-TAVI at our institution. The assessment
of PAo was done either intraoperatively after aborted sternotomy or via
computed tomography for elective TAVI. We conducted mid-term follow-up.
Furthermore, a systematic review was performed to compare the mortality
and neurological outcomes of TF and TA-TAVI approaches. RESULT(S):
TA/TF-TAVIs were performed with 100% device success, without paravalvular
leakage>=2 and without procedural death. The 30-day mortality/stroke rates
were 6.6%/0% in TA-TAVI and 0%/25% in TF-TAVI, respectively. The 6-month,
1-year, and 2-year survival rates were in TA/TF-TAVI 93%/75%, 82%/66.6%,
and 50%/0%, respectively.The pooled results derived from the literature
review were as follows: The prevalence of PAo in the TAVI population is
9.74%; the mean logistic EuroSCORE is 41.9% in TA-TAVI versus 16.2% in
TF-TAVI; the mean 30-day mortality is 5.9% in TA-TAVI versus 6.3% in
TF-TAVI, and the mean stroke is 0.8% in TA-TAVI versus 9% in TF-TAVI.
 CONCLUSION(S): TA-TAVI shows promising early and mid-term outcomes
in patients with PAo. TF-TAVI performed in patients with PAo is likely to
be associated with higher rates of stroke than TA-TAVI. Copyright
Georg Thieme Verlag KG Stuttgart . New York.

<19>
Accession Number
628520090
Title
Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative
Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A
Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2019. Date
of Publication: 26 Jun 2019.
Author
Kiabi F.H.; Soleimani A.; Habibi M.R.
Institution
(Kiabi, Soleimani, Habibi) Mazandaran University of Medical Sciences
Faculty of Medicine Department of Anesthesiology Sari Iran Department of
Anesthesiology, Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The true influence of the low mean arterial pressure (low
MAP) during coronary artery bypass grafting (CABG) on the development of
postoperative cognitive deficit (POCD) remains controversial. We aimed to
perform a meta-analysis and meta-regression to determine the effect of low
MAP on POCD, as well as moderator variables between low MAP and POCD.
 METHOD(S): The Web of Science, PubMed database, Scopus and the
Cochrane Library database (up to June 2018) were searched and retrieved
articles systematically reviewed. Only randomized controlled trials (RCTs)
comparing maintenance of low MAP (<80 mmHg) and high MAP (>80 mmHg) during
cardiopulmonary bypass (CPB) were included in our final review.
Statistical analysis of the risk ratio (RR) and corresponding 95%
confidence interval (CI) was used to report the overall effect. The
overall effect and meta-regression analysis were done using
Mantel-Haenszel risk ratio (MHRR) and the corresponding 95% confidence
interval (CI). RESULT(S): A total of 731 patients in three RCTs were
included in this study. POCD occurred in 6.4% of all cases. Maintenance of
low MAP did not reduce the occurrence of POCD (MHRR 1.012 [95% CI
0.277-3.688]; Z=0.018; P=0.986; I2=66%). Shorter CPB time reduced the
occurrence of POCD regardless of group assignment (MH log risk ratio
-0.519 [95% CI -0.949 - -0.089]; Z= -2.367; P=0.017). CONCLUSION(S):
POCD is a common event among CABG patients. The neuroprotective effect of
low MAP on POCD was attenuated by the prolonged CPB time.

<20>
Accession Number
628519221
Title
Risk of stroke and other adverse outcomes in patients with perioperative
atrial fibrillation 1 year after non-cardiac surgery.
Source
European heart journal. (no pagination), 2019. Date of Publication: 25 Jun
2019.
Author
Conen D.; Alonso-Coello P.; Douketis J.; Chan M.T.V.; Kurz A.; Sigamani
A.; Parlow J.L.; Wang C.Y.; Villar J.C.; Srinathan S.K.; Tiboni M.; Malaga
G.; Guyatt G.; Sivakumaran S.; Rodriguez Funes M.-V.; Cruz P.; Yang H.;
Dresser G.K.; Alvarez-Garcia J.; Schricker T.; Jones P.M.; Drummond L.W.;
Balasubramanian K.; Yusuf S.; Devereaux P.J.
Institution
(Conen, Balasubramanian, Yusuf, Devereaux) Population Health Research
Institute, McMaster University, Hamilton, Canada
(Conen, Douketis, Tiboni, Guyatt, Yusuf, Devereaux) Department of
Medicine, McMaster University, 1280 Main St W, Hamilton, Canada
(Conen, Alonso-Coello, Guyatt, Yusuf, Devereaux) Department of Health
Research Methods, Evidence, Impact, McMaster University, 1280 Main St W,
Hamilton, Canada
(Alonso-Coello) Iberoamerican Cochrane Center, Biomedical Research
Institute Sant Pau (IIB Sant Pau-CIBERESP), Sant Antoni Maria Claret 167,
Barcelona, Spain
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong Special administrative Region, China
(Kurz) Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, United States
(Sigamani) Department of Clinical Research, Narayana Hrudayalaya Limited,
Bommasandra Industrial Area, Hosur Road, Bangalore, India
(Parlow) Department of Anesthesiology and Perioperative Medicine, Kingston
Health Sciences Centre and Queen's University, 76 Stuart St, Kingston, ON,
Canada
(Wang) Department of Anesthesiology, University of Malaya, Kuala Lumpur,
Malaysia
(Villar) Departamento de Investigaciones, Fundacion Cardioinfantil
-Instituto de Cardiologia and Facultad de Ciencias de la Salud,
Universidad Autonoma de Bucaramanga, Av. 42 ##48 - 11, Bucaramanga,
Santander, Colombia
(Srinathan) Department of Surgery, University of Manitoba, Rm. GE61, 820
Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
(Malaga) School of Medicine, Universidad Peruana Cayetano Heredia, Av.
Honorio Delgado 430, San Martin de Porres, Lima, Peru
(Sivakumaran) Department of Medicine, University of Alberta, 116 St & 85
Ave, Edmonton, AB, Canada
(Rodriguez Funes) Unidad de Investigacion Cientifica, Facultad de
Medicina, Universidad de El Salvador, Final 25 Ave norte, San Salvador, El
Salvador
(Cruz) Department of Anesthesia, Hospital General Universitario Gregorio
Maranon, Calle del Dr. Esquerdo 46, Madrid, Spain
(Yang, Jones) Department of Anesthesia & Perioperative Medicine,
University of Western Ontario, 1151 Richmond St, London, ON, Canada
(Dresser) Department of Medicine, London Health Sciences Centre, Victoria
Hospital, 800 Commissioners Rd E, London, ON, Canada
(Alvarez-Garcia) Department of Cardiology, Hospital de la Santa Creu i
Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau),
Universitat Autonoma de Barcelona, Carrer de Sant Quinti, 89, Barcelona,
Spain
(Schricker) Department of Anesthesia, McGill University Health Centre,
McGill University, 1001 Decarie Blvd, Montreal, QC, Canada
(Jones) Department of Epidemiology & Biostatistics, University of Western
Ontario, 1151 Richmond St, London, ON, Canada
(Drummond) Department of Anaesthesia, Nelson R Mandela School of Medicine,
University of KwaZulu-Natal, 719 Umbilo Road, South Africa
Publisher
NLM (Medline)
Abstract
AIMS: To determine the 1-year risk of stroke and other adverse outcomes in
patients with a new diagnosis of perioperative atrial fibrillation (POAF)
after non-cardiac surgery. METHODS AND RESULTS: The PeriOperative ISchemic
Evaluation (POISE)-1 trial evaluated the effects of metoprolol vs. placebo
in 8351 patients, and POISE-2 compared the effect of aspirin vs. placebo,
and clonidine vs. placebo in 10 010 patients. These trials included
patients with, or at risk of, cardiovascular disease who were undergoing
non-cardiac surgery. For the purpose of this study, we combined the POISE
datasets, excluding 244 patients who were in atrial fibrillation (AF) at
the time of randomization. Perioperative atrial fibrillation was defined
as new AF that occurred within 30days after surgery. Our primary outcome
was the incidence of stroke at 1year of follow-up; secondary outcomes were
mortality and myocardial infarction (MI). We compared outcomes among
patients with and without POAF using multivariable adjusted Cox
proportional hazards models. Among 18 117 patients (mean age 69years,
57.4% male), 404 had POAF (2.2%). The stroke incidence 1year after surgery
was 5.58 vs. 1.54 per 100 patient-years in patients with and without POAF,
adjusted hazard ratio (aHR) 3.43, 95% confidence interval (CI) 2.00-5.90;
P<0.001. Patients with POAF also had an increased risk of death (incidence
31.37 vs. 9.34; aHR 2.51, 95% CI 2.01-3.14; P<0.001) and MI (incidence
26.20 vs. 8.23; aHR 5.10, 95% CI 3.91-6.64; P<0.001). CONCLUSION(S):
Patients with POAF have a significantly increased risk of stroke, MI, and
death at 1 year. Intervention studies are needed to evaluate risk
reduction strategies in this high-risk population. 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.

<21>
Accession Number
2002296598
Title
Perioperative clinical utility of myocardial deformation imaging: a
narrative review.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Abuelkasem E.; Wang D.W.; Omer M.A.; Abdelmoneim S.S.; Howard-Quijano K.;
Rakesh H.; Subramaniam K.
Institution
(Abuelkasem, Wang, Howard-Quijano, Rakesh, Subramaniam) Department of
Anesthesiology and Perioperative Medicine, University of Pittsburgh School
of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Omer) Department of Cardiology, Saint-Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Abdelmoneim) Cardiovascular Ultrasound Imaging and Hemodynamic
Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, 200 First
Street SW, Rochester, MN, United States
(Abdelmoneim) Cardiology Department, Orman Heart Center Assiut University,
Assiut, Egypt
Publisher
Elsevier Ltd
Abstract
Preoperative cardiac function is an important predictor of postoperative
outcomes. Patients with heart failure are at higher risk of perioperative
morbidity and mortality. Left ventricular ejection fraction (LVEF),
derived by standard echocardiography, is most frequently used to assess
cardiac function in the intraoperative and postoperative periods.
Myocardial strain analysis, a measurement of myocardial deformation, can
provide additional information to LVEF estimation. Here, we provide an
overview of myocardial strain and different methods used to evaluate
strain, including speckle tracking echocardiography. Speckle tracking
echocardiography is an imaging modality that can analyse and track small
segments of the myocardium, which provides greater detail for assessing
global and regional cardiac motion and function. We further review the
literature to illustrate the value of speckle tracking
echocardiography-derived myocardial strain in describing cardiac function
and its association with adverse surgical outcomes in the perioperative
period, including low cardiac output states, need for inotropic support,
postoperative arrhythmias, subclinical myocardial ischaemia, and length of
hospital stay. Copyright © 2019 British Journal of Anaesthesia

<22>
Accession Number
2002266195
Title
Randomized clinical trial of an elastomeric sealant for hemostasis in
thoracic aortic surgery.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2019. Date
of Publication: 2019.
Author
Morita S.; Matsuda T.; Tashiro T.; Komiya T.; Ogino H.; Mukohara N.;
Tominaga R.
Institution
(Morita) Department of Thoracic and Cardiovascular Surgery, Clinical
Research Institute, National Hospital Organization Kyushu Medical Center,
1-8-1 Jigyohama, Fukuoka 810-8563, Japan
(Matsuda) Division of Biomedical Engineering, Graduate School of Medical
Science, Kyushu University, Fukuoka, Japan
(Tashiro) Department of Cardiovascular Surgery, University of Fukuoka
Medical School, Fukuoka, Japan
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Kurashiki, Okayama, Japan
(Ogino) Department of Cardiovascular Surgery, National Cardiovascular and
Research Center, Suita, Osaka, Japan
(Mukohara) Department of Cardiovascular Surgery, Hyogo Brain and Heart
Center, Himeji, Japan
(Tominaga) Division of Cardiovascular Surgery, Graduate School of Medical
Science, Kyushu University, Fukuoka, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objectives: This study aimed to demonstrate the efficacy and safety of a
newly developed elastomeric sealant, which does not require any blood
coagulation system to exert its effect, during thoracic aortic surgery.
 Method(s): This is a multicenter, randomized study conducted in six
hospitals in Japan. A total of 81 patients undergoing replacement surgery
of a thoracic aortic aneurysm using cardiopulmonary bypass were randomized
with a ratio of 2-:1 for those patients designated to receive the sealant
(Group S, 54 patients) or those without the usage of the sealant (Group C,
27 patients). The primary endpoints were bleeding from each anastomosis at
two time points: (1) immediately before applying protamine and (2) 15 min
after applying protamine. The patients were followed for 6 months.
 Result(s): The number of anastomoses checked for bleeding was 196 in
Group S and 117 in Group C. Before protamine sulfate administration,
complete hemostasis was obtained in 155 anastomoses (79%) in Group S
compared to 45 anastomoses (38%) in Group C (p < 0.001). Fifteen minutes
after the administration of protamine sulfate infusion, bleeding stopped
completely in 173 anastomoses (88%) in Group S and in 71 anastomoses (61%,
p < 0.001) in Group C. Between the two groups, there were no marked
differences in the patient background or in the incidence of major adverse
events. Conclusion(s): The sealant is effective in achieving
hemostasis, even under fully heparinized conditions. The novel sealant is
safe and effective in thoracic aortic surgery, one of the most demanding
surgical situations for hemostasis. Copyright © 2019, The
Author(s).

<23>
Accession Number
628508211
Title
Inspiratory Muscle Training after Heart Valve Replacement Surgery Improves
Inspiratory Muscle Strength, Lung Function, and Functional Capacity: A
RANDOMIZED CONTROLLED TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2019. Date of Publication: 2019.
Author
Cargnin C.; Karsten M.; Guaragna J.C.V.D.C.; Dal Lago P.
Institution
(Cargnin, Dal Lago) Programa de Pos-graduacao em Ciencias da Saude,
Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto
Alegre, Brazil
(Karsten, Dal Lago) Programa de Pos-graduacao em Ciencias da Reabilitacao
(UFCSPA), Porto Alegre, Brazil
(Karsten) Departamento de Fisioterapia, Universidade Do Estado de Santa
Catarina (UDESC), Florianopolis, Brazil
(Karsten) Programa de Pos-graduacao em Fisioterapia (UDESC),
Florianopolis, Brazil
(Guaragna, Dal Lago) Faculdade de Medicina, Pontificia Universidade
Catolica Do Rio Grande Do sul (PUCRS), Porto Alegre, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: The aim of this study was to analyze the effects of inspiratory
muscle training (IMT) as a therapeutic strategy after heart valve
replacement surgery (HVRS). Method(s): A double-blind, randomized,
clinical trial that included patients undergoing elective HVRS, without
post-operative complications, were allocated to 2 groups: IMT group
(IMT-G) and IMT placebo group (IMT-PG). The IMT started 3 d after surgery
and was performed twice daily for 4 wk. Lung function, maximum inspiratory
pressure (MIP) as a measure of inspiratory muscle strength, functional
capacity, and quality of life were assessed pre-operatively and at the end
of training. Result(s): The IMT-G recovered pre-operative MIP and
lung function values after 4 wk of training. This group also increased the
distance walked during the 6-min walk test (6MWD). In the IMT-PG, the
values of MIP were below those found pre-operatively, with impairment of
lung function and lower 6MWD in the final evaluation. At the end of IMT,
MIP was correlated with the 6MWD and with the spirometry variables.
 Conclusion(s): IMT performed for 4 wk after HVRS was effective in
restoring the values of inspiratory muscle strength and lung function to
the pre-operative level and increasing the functional capacity assessed by
the 6MWD. Furthermore, an association between lung function and functional
capacity was observed, demonstrating the clinical relevance of the use of
IMT in the rehabilitation process of these patients. Copyright ©
2019 The Academy of Geriatric Physical Therapy, APTA. Unauthorized
reproduction of this article is prohibited.

<24>
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.

<25>
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.

<26>
Accession Number
624062686
Title
Effects of different doses of ticagrelor on platelet aggregation and
endothelial function in diabetic patients with stable coronary artery
disease.
Source
Platelets. 30 (6) (pp 752-761), 2019. Date of Publication: 18 Aug 2019.
Author
He M.; Li D.; Zhang Y.; Sun D.; Liu G.; Pan Y.; Shi J.; Yin S.; Li Y.
Institution
(He, Li, Sun, Liu, Pan, Shi, Li, Yin, Li) Cardiovascular Department, the
First Affiliated Hospital of Harbin Medical University, Harbin,
Heilongjiang, China
(Zhang) Cardiovascular Department, Harbin Red Cross Central Hospital,
Harbin, Heilongjiang, China
Publisher
Taylor and Francis Ltd
Abstract
We performed this study to observe the effects of different doses of
ticagrelor and standard-dose clopidogrel on platelet reactivity and
endothelial function in diabetic patients with stable coronary artery
disease (CAD). Sixty type 2 diabetic patients were assigned to one-quarter
standard-dose ticagrelor, half standard-dose ticagrelor, standard-dose
ticagrelor and standard-dose clopidogrel groups. Light transmission
aggregometry (LTA) and VerifyNow assay were used to measure platelet
function. Endothelial function was assessed by measurement of
flow-mediated vasodilation (FMD) and plasma von Willebrand factor (VWF)
levels were detected. Enzyme-linked immunosorbent assay (ELISA) examined
the Interleukin-8(IL-8) and IL-10. The results suggested that the
one-quarter dose (34.0%+/- 14.7%), half-dose (26.9%+/- 11.6%) and
standard-dose (17.3%+/- 10.3%) ticagrelor showed lower platelet
aggregation rate than clopidogrel (52.8%+/- 18.3%; P 0.0001). PRU values
in three ticagrelor groups were lower than that in clopidogrel group (102
(76-184)75 (33-88)38 (11-52) versus 194 (138-271) andP 0.0001). FMD levels
were higher in ticagrelor groups compared with baseline levels while lower
in clopidogrel group after treatment. However, no significant differences
were found in the percentage increase in the FMD between ticagrelor groups
and clopidogrel group. The levels of VWF after treatment were lower than
the baseline levels, but there was no statistically significant difference
between ticagrelor group and clopidogrel group after treatment. The
concentration of IL-8 and IL-10 were decreased in patients with half and
standard-dose ticagrelor group. In conclusion, one-quarter standard-dose
ticagrelor produced similar inhibitory effects on platelet aggregation as
standard-dose clopidogrel in diabetic patients with stable CAD. The half
standard-dose ticagrelor had a similar inhibitory effect on platelet
inhibition as standard-dose ticagrelor, which was stronger than that of
clopidogrel. Moreover, the half-dose ticagrelor had equal protection of
endothelial function and inhibition of inflammatory factor as
standard-dose ticagrelor. Copyright © 2018, © 2018 Taylor &
Francis.

<27>
Accession Number
628200824
Title
Effects of catheter tip location on the spread of sensory block caused by
a continuous thoracic paravertebral block: A prospective, randomized,
controlled, double-blind study.
Source
BioMed Research International. 2019 (no pagination), 2019. Article Number:
1051629. Date of Publication: 2019.
Author
Yoshida T.; Watanabe Y.; Hashimoto T.; Ohta A.; Nakamoto T.
Institution
(Yoshida, Nakamoto) Department of Anesthesiology, Kansai Medical
University Hospital, Hirakata City, Osaka, Japan
(Watanabe) Department of Anesthesiology, Niigata City General Hospital,
Niigata City, Niigata, Japan
(Hashimoto) Department of Anesthesiology, Nagaoka Chuo General Hospital,
Nagaoka City, Niigata, Japan
(Ohta) Department of Radiology and Radiation Oncology, Niigata University
Graduate School of Medical and Dental Sciences, Niigata City, Niigata,
Japan
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Single injections in the anterior region of the thoracic paravertebral
space (TPVS) have been reported to generate a multisegmental longitudinal
spreading pattern more frequently than those in the posterior region of
the TPVS. In this trial, we examined the hypothesis that a continuous
thoracic paravertebral block (TPVB) administered through a catheter
inserted into the anterior region of the TPVS allows a wider sensory block
dispersion. Fifty consecutive patients undergoing video-assisted thoracic
surgery were enrolled. Before the surgery, an infusion catheter was
inserted into the TPVS through a needle placed adjacent to either the
parietal pleura (group A) or internal intercostal membrane (group P) using
an ultrasound-guided intercostal transverse approach according to a
randomized allocation schedule. A chest radiograph was obtained
postoperatively after injection of 10 mL of radiopaque dye through the
catheter. Thereafter, 20 mL of 0.375% levobupivacaine was injected via the
catheter, followed by commencement of continuous TPVB with 0.25%
levobupivacaine at 8 mL/h. The primary outcome was the number of blocked
dermatomes at 24 h after surgery. The secondary outcomes included
radiopaque dye spreading patterns, the number of segments reached by the
radiopaque dye, the number of blocked dermatomes at 2 h after surgery, and
pain scores. The median (interquartile range [range]) number of blocked
dermatomes 24 h after surgery was 3 (2.75-4 [1-6]) in group A (n = 22) and
2 (1.5-3 [0-7]) in group P (n = 25; p = 0.037). No significant differences
in the other outcomes were found between the groups. In conclusion, a
continuous TPVB administered using a catheter supposedly inserted into the
anterior region of the TPVS allows a wider sensory block dispersion than a
catheter inserted into the posterior region of the TPVS. This trial is
registered with the UMIN Clinical Trials Registry
(UMIN000018578). Copyright © 2019 Takayuki Yoshida et al.

<28>
Accession Number
2000859892
Title
A systematic review and meta-analysis of one-stage versus two-stage
brachiobasilic arteriovenous fistula creation.
Source
Journal of Vascular Surgery. 68 (1) (pp 285-297), 2018. Date of
Publication: July 2018.
Author
Jun Yan Wee I.; Mohamed I.H.; Patel A.; Choong A.M.T.L.
Institution
(Jun Yan Wee, Mohamed, Patel, Choong) SingVaSC, Singapore Vascular
Surgical Collaborative, Singapore
(Jun Yan Wee) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Mohamed) Renal Transplantation and Vascular Access Surgery, Royal London
Hospital, London, United Kingdom
(Patel) Stem Cell Transplantation and Cellular Therapy Unit, The
Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool,
Liverpool, United Kingdom
(Patel) Institute of Translational Medicine and School of Medicine,
University of Liverpool, Liverpool, United Kingdom
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
(Choong) Division of Vascular Surgery, National University Heart Centre,
Singapore
(Choong) Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Long-term patency of arteriovenous fistulas (AVFs) is critical
for hemodialysis vascular access. We compared the efficacy of a one-stage
vs two-stage approach to brachiobasilic AVF creation by primarily
investigating primary and secondary patency rates. We hypothesize that the
two-stage is superior to the one-stage procedure in terms of efficacy and
safety. Method(s): This review was performed as per the Preferred
Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
Searches were performed on MEDLINE, EMBASE, Google Scholar, and Cochrane
Database. Risk of bias and quality assessment scores were both performed
based on previously validated tool. Result(s): The systematic search
revealed a total of 242 publications for possible inclusion. On the basis
of title and abstract review, two randomized controlled trials and nine
case-cohort series fit our inclusion criteria. There were no statistically
significant differences in failure rates (pooled risk ratio [RR], 1.10;
95% confidence interval [CI], 0.79-1.55; P =.25), 1-year primary patency
rates (RR, 1.31; 95% CI, 0.83-2.06; P =.24), 1-year secondary patency
rates (RR, 0.97; 95% CI, 0.54-1.77) and 2-year secondary patency rates
(RR, 1.19; 95% CI, 0.54-2.63; P =.67) between both groups. However, the
two-stage procedure had significantly improved 2-year primary patency
rates (RR, 2.50; 95% CI, 1.66-3.74; P <.00001). There were no differences
in steal syndrome, hematoma, infection, pseudoaneuryms, or stenosis,
although there was a trend toward an increased incidence of postoperative
thrombosis (RR, 1.81; 95% CI, 0.95-3.45; P =.07) in one-stage procedures.
 Conclusion(s): With improved 2-year primary patency rates and the
absence of significant differences in complications, this study suggests
potential benefit of a two-stage over a one-stage procedure for
brachiobasilic AVF creation. However, rather than being a definitive
answer, our results merely highlight the continuing need for an adequately
powered, well-designed, randomized controlled trial to interrogate this
question further. Copyright © 2018 Society for Vascular Surgery

<29>
Accession Number
2001810201
Title
Endoscopic spine surgery: Past, present, and future.
Source
Bulletin of the Hospital for Joint Diseases. 77 (1) (pp 75-84), 2019. Date
of Publication: March 2019.
Author
Hasan S.; Hofstetter C.P.
Institution
(Hasan) Department of Orthopedic Surgery, The University of Washington,
Seattle, WA, United States
(Hofstetter) Department of Neurological Surgery, The University of
Washington, Seattle, WA, United States
Publisher
J. Michael Ryan Publishing Inc. (24 Crescent Drive North, Andover NJ
07821-4000, United States. E-mail: jcostello@jmichaelryan.com)

<30>
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.

<31>
Accession Number
2001191425
Title
Rationale and design of the Pemafibrate to Reduce Cardiovascular Outcomes
by Reducing Triglycerides in Patients with Diabetes (PROMINENT) study.
Source
American Heart Journal. 206 (pp 80-93), 2018. Date of Publication:
December 2018.
Author
Pradhan A.D.; Paynter N.P.; Everett B.M.; Glynn R.J.; Amarenco P.; Elam
M.; Ginsberg H.; Hiatt W.R.; Ishibashi S.; Koenig W.; Nordestgaard B.G.;
Fruchart J.-C.; Libby P.; Ridker P.M.
Institution
(Pradhan) Division of Cardiovascular Medicine, VA Boston Medical Center,
Boston, MA, United States
(Pradhan, Paynter, Everett, Glynn, Ridker) Division of Preventive
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Amarenco) Paris-Diderot Sorbonne University, Paris, France
(Elam) Division of Cardiovascular Medicine, VA Memphis Medical Center,
Memphis, TN, United States
(Ginsberg) Columbia University Vagellos College of Physicians and
Surgeons, New York, NY, United States
(Hiatt) University of Colorado School of Medicine, Division of Cardiology
and CPC Clinical Research, Aurora, CO, United States
(Ishibashi) Division of Endocrinology and Metabolism, Department of
Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen and
German Centre for Cardiovascular Research, Partner Site Munich Heart
Alliance, Munich, Germany
(Nordestgaard) Herlev and Gentofte Hospital, Copenhagen University
Hospital, University of Copenhagen, Copenhagen, Denmark
(Fruchart) The R3i Foundation, Basel, Switzerland
(Everett, Libby, Ridker) Division of Cardiovascular Medicine Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Observational, genetic, and experimental data indicate that triglyceride
rich lipoproteins (TRLs) likely participate causally in atherothrombosis.
Yet, robust clinical trial evidence that triglyceride (TG) lowering
therapy reduces cardiovascular events remains elusive. The selective
peroxisome proliferator-activated receptor alpha modulator (SPPARM-alpha),
pemafibrate, will be used to target residual cardiovascular risk remaining
after treatment to reduce low-density lipoprotein cholesterol (LDL-C) in
individuals with the dyslipidemia of type 2 diabetes mellitus (T2). The
PROMINENT study will randomly allocate approximately 10,000 participants
with T2D, mild-to-moderate hypertriglyceridemia (TG: 200- 499 mg/dl; 2.26-
5.64 mmol/l) and low high-density lipoprotein cholesterol levels (HDL-C:
<=40 mg/dl; 1.03 mmol/l) to either pemafibrate (0.2 mg twice daily) or
matching placebo with an average expected follow-up period of 3.75 years
(total treatment phase 5 years; 24 countries). At study entry,
participants must be receiving either moderate-to-high intensity statin
therapy or meet specified LDL-C criteria. The study population will be
one-third primary and two-thirds secondary prevention (established
cardiovascular disease). The primary endpoint is a composite of nonfatal
myocardial infarction, nonfatal ischemic stroke, hospitalization for
unstable angina requiring urgent coronary revascularization, and
cardiovascular death. This event-driven study will complete when 1092
adjudicated primary endpoints have accrued with at least 200 occurring in
women. Statistical power is at least 90% to detect an 18% reduction in the
primary endpoint. Pre-specified secondary and tertiary endpoints include
all-cause mortality, hospitalization for heart failure, new or worsening
peripheral artery disease, new or worsening diabetic retinopathy and
nephropathy, and change in biomarkers including select lipid and non-lipid
biomarkers, inflammatory and glycemic parameters. Copyright ©
2018

<32>
Accession Number
2001191290
Title
The East-West late lumen loss study: Comparison of angiographic late lumen
loss between Eastern and Western drug-eluting stent study cohorts.
Source
American Heart Journal. 206 (pp 61-71), 2018. Date of Publication:
December 2018.
Author
Harrison R.W.; Radhakrishnan V.; Allen J.C.; Lam P.S.; Allocco D.J.; Brar
S.; Fahy M.; Zhang Z.; Fisher R.; Ikeno F.; Genereux P.; Kimura T.; Liu
M.; Lye W.K.; Nagai H.; Suzuki Y.; White R.; Krucoff M.W.
Institution
(Harrison, Radhakrishnan, Fisher, White, Krucoff) Duke University Medical
Center/Duke Clinical Research Institute, Durham, NC, United States
(Allen, Lye) Duke-NUS Medical School Singapore, Singapore
(Lam, Allocco) Boston Scientific Corporation, Marlborough, MA, United
States
(Brar, Fahy, Liu) Medtronic, Inc., Santa Rosa, CA, United States
(Zhang) Abbott Vascular, Santa Clara, CA, United States
(Ikeno) Stanford University, Stanford, CA, United States
(Genereux) Cardiovascular Research Foundation, New York, NY, United States
(Kimura) Kyoto University, Kyoto, Japan
(Nagai) Terumo Corporation, Tokyo, Japan
(Suzuki) Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Regulatory decisions approving new coronary drug-eluting stent
(DES) require mechanistic observations of angiographic late lumen loss
(LLL). Patient safety and device approval times could be enhanced if
angiographic follow-up data were found to be generalizable across
jurisdictions and geographies. The objectives were to assess the
comparability of in-segment LLL in Eastern and Western DES populations
using the world's largest compilation of follow-up quantitative coronary
angiography data. Method(s): Data from 4 manufacturers involving 29
DES clinical trials in Eastern and Western hemispheres were compiled.
"East" and "West" cohorts were defined by trial location. Independent core
laboratories quantified in-segment LLL for all studies. East and West were
compared before and after adjustment for clinical and anatomic covariates
known to correlate with LLL via conditioning on propensity score
quintiles. An international panel of experts and regulators prospectively
established a clinically meaningful difference between East and West mean
in-segment LLL of +/-0.40 mm. Result(s): The data set comprised 2,047
East and 4,456 West patients. Unadjusted mean +/- SD for West and East
in-segment LLL (mm) was 0.25 +/- 0.46 and 0.12 +/- 0.42, respectively
(difference 0.13 mm; 95% CI 0.11-0.16). Propensity score-adjusted
in-segment LLL East and West least squares means were 0.11 and 0.26 mm,
respectively (difference 0.15 mm; 95% CI 0.13-0.18). Conclusion(s):
In the world's largest compilation of DES protocol 8- to 13-month
angiographic follow-up data, clinically meaningful comparability of
in-segment LLL by independent core laboratory quantitative coronary
angiography in East and West cohorts was demonstrated in both unadjusted
and adjusted comparisons. These findings suggest that DES LLL, once
characterized, could be generalized across regulatory jurisdictions over
the course of global registration efforts. Copyright © 2018
Elsevier Inc.

<33>
Accession Number
2001020237
Title
Serotonin Toxicity and Urinary Analgesics: A Case Report and Systematic
Literature Review of Methylene Blue-Induced Serotonin Syndrome.
Source
Psychosomatics. 59 (6) (pp 539-546), 2018. Date of Publication: November
2018.
Author
Zuschlag Z.D.; Warren M.W.; K. Schultz S.
Institution
(Zuschlag, Warren, K. Schultz) James A. Haley Veterans' Hospital, Mental
Health and Behavioral Sciences Service, University of South Florida,
Psychiatry and Behavioral Neurosciences, Tampa, FL, United States
(K. Schultz) University of Iowa Roy J and Lucille A Carver College of
Medicine, Psychiatry, Tampa, FL, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Serotonin syndrome (SS) is a potentially serious side effect
of serotonergic drugs. Cases of SS have been reported from the
administration of methylene blue (MB), an agent with monoamine oxidase
inhibiting properties. To date, the reported cases of MB-induced SS have
all been with MB given parenterally. We report a case induced by the
initiation of a MB-containing oral agent. Method(s): A case of SS
felt to be induced by the initiation of an MB-containing
orally-administered urinary analgesic, started in a patient concurrently
treated with multiple serotonergic drugs, is presented. A systematic
literature review of MB-induced SS follows. The review consisted of
searches in MEDLINE databases using the key terms "methylene blue" and
"serotonin syndrome". The authors read all abstracts, and articles related
to MB and serotonin toxicity; non-associated articles were discarded.
Results are summarized. Result(s): 23 manuscripts were identified,
resulting in 50 unique cases of MB-induced SS. The majority of cases were
related to peri-operative use of MB in parathyroidectomies or for the
treatment of vasoplegic shock. All cases were associated with MB given
parenterally. Concurrent treatment with serotonergic antidepressants was
described in all 50 cases. Symptoms of SS ranged from mild to severe. One
fatality was reported. Conclusion(s): Methylene blue can induce SS,
felt to be secondary to MAOI properties. Although previous reports have
exclusively been associated with MB given via parental administration, our
case suggests that SS can be induced by oral administration of
MB-containing agents. Copyright © 2018

<34>
Accession Number
628490513
Title
Does ex vivo perfusion lead to more or less intimal thickening in the
first-year post-heart transplantation?.
Source
Clinical Transplantation. (no pagination), 2019. Article Number: e13648.
Date of Publication: 2019.
Author
Sato T.; Azarbal B.; Cheng R.; Esmailian F.; Patel J.; Kittleson M.; Czer
L.; Thottam M.; Levine R.; Dimbil S.; Olymbios M.; Anzai T.; Hamilton
M.A.; Khayal T.; Kobashigawa J.A.
Institution
(Sato, Azarbal, Patel, Kittleson, Czer, Thottam, Levine, Dimbil, Olymbios,
Hamilton, Kobashigawa) Department of Cardiology, Cedars-Sinai Smidt Heart
Institute, Los Angeles, CA, United States
(Sato, Anzai) Department of Cardiovascular Medicine, Hokkaido University,
Sapporo, Japan
(Cheng, Esmailian) Cardiothoracic Surgery, Cedars-Sinai Smidt Heart
Institute, Los Angeles, CA, United States
(Khayal) TransMedics Inc., Andover, MA, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: The Organ Care System (OCS), an ex vivo heart perfusion
platform, represents an alternative to the current standard of cold organ
storage that sustains the donor heart in a near-physiologic state.
Previous reports showed that this system had significantly shortened the
cold ischemic time from standard cold storage (CS). However, the effect of
reduced ischemic injury against the coronary vascular bed has not been
examined by intravascular ultrasound (IVUS). Method(s): Between
August 2011 and February 2013, heart transplant (HTx) candidates enrolled
in the PROCEED 2 trial were randomized to either CS or OCS. IVUS was
performed at 4-6 weeks (baseline) and repeated 1 year after
transplantation. The change in maximal intimal thickness (MIT) and other
clinical outcomes were examined. Result(s): Thirty-nine patients were
randomized and underwent HTx by OCS (n=16) or CS (n=18). Of these, 18
patients (OCS: n=5, CS: n=13) with paired IVUS were examined. There were
no significant differences in the change of MIT and other clinical
outcomes between the groups. Conclusion(s): The incidence of cardiac
allograft vasculopathy in donor hearts preserved with the OCS versus CS
was similar. These results suggest that this ex vivo allograft perfusion
system is a promising and valid platform for donor heart
transportation. Copyright © 2019 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<35>
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.

<36>
Accession Number
2002148411
Title
Official Statement of the Spanish Society of Pulmonology and Thoracic
Surgery (SEPAR) on Electronic Cigarettes and IQOS.
Source
Archivos de Bronconeumologia. (no pagination), 2019. Date of Publication:
2019.
Author
Signes-Costa J.; de Granda-Orive J.I.; Ramos Pinedo A.; Camarasa Escrig
A.; de Higes Martinez E.; Rabade Castedo C.; Cabrera Cesar E.;
Jimenez-Ruiz C.A.
Institution
(Signes-Costa) Servicio de Neumologia, Hospital Clinico Universitario
INCLIVA, Universidad de Valencia, Valencia, Spain
(de Granda-Orive) Servicio de Neumologia, Hospital Universitario 12 de
Octubre, Universidad Complutense, Madrid, Spain
(Ramos Pinedo, de Higes Martinez) Unidad de Neumologia, Hospital
Universitario Fundacion Alcorcon, Universidad Rey Juan Carlos, Madrid,
Spain
(Camarasa Escrig) Unidad de Neumologia, Hospital Universitario del
Vinalopo, Elche, Spain
(Rabade Castedo) Servicio de Neumologia, Complejo Hospitalario de Santiago
de Compostela, Santiago de Compostela, Spain
(Cabrera Cesar) Servicio de Neumologia. Hospital Universitario Virgen de
la Victoria, Malaga, Spain
(Jimenez-Ruiz) Unidad Especializada en Tabaquismo, Hospital Clinico San
Carlos, Madrid, Spain
Publisher
Elsevier Doyma
Abstract
The use of novel tobacco products, particularly the electronic cigarette
(EC) and partial tobacco combustion devices (HnB systems: Heat not Burn),
has increased exponentially, particularly among adolescents and young
people. The health authorities and scientific societies have shown concern
about issues surrounding safety and effectiveness (as a method of smoking
cessation). A study of the available scientific evidence has concluded
that the safety of the vapor or fumes inhaled by the users of these
devices cannot be guaranteed. Contradictory results from various clinical
trials and meta-analyses also mean that these devices cannot be
recommended for their effectiveness in cessation, especially when safe and
effective treatments are available to help quit smoking (varenicline,
nicotine replacement therapy, and bupropion, combined with psychological
counseling). Copyright © 2019 SEPAR

<37>
Accession Number
2001916898
Title
CHANGES IN THE LIVER TESTS AFTER BARIATRIC SURGERY IN PATIENTS WITH
CIRRHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Gastroenterology. Conference: 2019 DDW. United States. 156 (6 Supplement
1) (pp S-1298-S-1299), 2019. Date of Publication: 2019.
Author
Rassameehiran S.; Tetangco E.P.; Tan G.; Bhagatwala J.; Kendrick K.; Hudgi
A.; Sridhar S.
Publisher
W.B. Saunders
Abstract
Background: Obesity has a strong association with metabolic syndrome,
non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease.
Bariatric surgery has been shown to improve obesity related comorbidities
including the liver histology in NASH patients, however, rapid weight loss
also has been shown to be a risk factor for fatty liver disease. Studies
on bariatrics surgery in patients with cirrhosis are limited. We conducted
a systematic review and meta-analysis of the published literature to
better understand the short-term effects of bariatrics surgery in
cirrhotic patients. Method(s): We searched EMBASE and MEDLINE from
the database inception to Nov 20, 2018. We used the following text words:
"bariatric surgery" and "cirrhosis" as search terms for the published
studies that assessed the short-term effects of bariatric surgery on the
liver tests in patients with cirrhosis. We excluded studies with less than
10 patients and studies which did not provide the liver tests results
within 3 years following post-surgery. Statistical analysis was conducted
with Review Manager (RevMan Version 5.3). The Chi2 test and I2 statistic
was used to address heterogeneity among the studies. The results of
studies were pooled, and an overall odds ratio (OR) with 95% confidence
intervals (CIs) was obtained using generic inverse variance weighting and
a random-effects method. Result(s): Four observational studies met
our inclusion criteria. 82 subjects cases were included in our analysis.
Characteristics of the studies are shown in Table 1. The results of the
study are shown in Figure 1. There was a statistically significant
decrease in the AST, ALT and albumin after bariatric surgery without
significant changes in the MELD scores or bilirubin. Pooled mean
difference in the ALT was -16.19 IU/L (95%CI = -29.66, -2.72). Pooled mean
difference in the AST was -13.68 IU/L (95%CI = -25.20, -2.17). Pooled mean
difference in the albumin was -0.19 g/dL (95%CI = - 0.35, -0.04). No
significant heterogeneity was present among the included studies.
 Conclusion(s): Our study demonstrated that the short-term effects of
bariatric surgery was is not associated with worsening the liver enzymes
or MELD scores in compensated cirrhotic patients. Slight A modest decrease
in albumin may be related to decreased calories intake and malnutrition
post following bariatric surgery and should be monitored closely. Further
prospective studies are warranted to assess the long-term effects of
bariatric surgery in cirrhotic patients. [Table Presented] [Table
Presented] Copyright © 2019 European Association for the Study of
the Liver. All rights reserved.

<38>
Accession Number
628499732
Title
Impact of surgical aortic root enlargement on the outcomes of aortic valve
replacement: a meta-analysis of 13174 patients.
Source
Interactive cardiovascular and thoracic surgery. 29 (1) (pp 74-82), 2019.
Date of Publication: 01 Jul 2019.
Author
Sa M.P.B.O.; Carvalho M.M.B.; Sobral Filho D.C.; Cavalcanti L.R.P.; Diniz
R.G.S.; Rayol S.C.; Soares A.M.M.N.; Sa F.B.C.A.; Menezes A.M.; Clavel
M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Diniz, Rayol, Soares, Sa, Menezes, Lima) Division of
Cardiovascular Surgery of Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Recife, Brazil
(Sa, Carvalho, Sobral Filho, Cavalcanti, Diniz, Rayol, Soares, Sa,
Menezes, Lima) University of Pernambuco - UPE, Recife, Brazil
(Sa, Carvalho, Sobral Filho, Lima) Nucleus of Postgraduate and Research in
Health Sciences of Faculty of Medical Sciences and Biological Sciences
Instituite - FCM/ICB, Recife, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie e de Pneumologie
du Quebec, Quebec City, QC, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study sought to evaluate the impact of surgical aortic
root enlargement (ARE) on the perioperative outcomes of aortic valve
replacement (AVR). METHOD(S): Databases were searched for studies
published until April 2018 to carry out a systematic review followed by
meta-analysis of results. RESULT(S): The search yielded 1468 studies
for inclusion. Of these, 10 articles were analysed and their data
extracted. A total of 13174 patients (AVR with ARE: 2819 patients; AVR
without ARE: 10 355 patients) were included from studies published from
2002 to 2018. The total rate of ARE was 21.4%, varying in the studies from
5.7% to 26.3%. The overall odds ratio (OR) [95% confidence interval (CI)]
for perioperative mortality showed a statistically significant difference
between the groups (among 10 studies), with a higher risk in the 'AVR with
ARE' group (OR 1.506, 95% CI 1.209-1.875; P<0.001), but not when adjusted
for isolated AVR+ARE without any concomitant procedures such as mitral
valve surgery, coronary artery bypass surgery, etc. (OR 1.625, 95% CI
0.968-2.726; P=0.066-among 6 studies). The 'AVR with ARE' group showed an
overall lower risk of significant patient-prosthesis mismatch among 9
studies (OR 0.472, 95% CI 0.295-0.756; P=0.002) and a higher overall
difference in means of indexed effective orifice area among 10 studies
(random-effect model: 0.06 cm2/m2, 95% CI 0.029-0.103; P<0.001).
 CONCLUSION(S): Surgical ARE seems to be associated with increased
perioperative mortality but with lower risk of patient-prosthesis
mismatch. 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
628496814
Title
Impact of pretransplant recipient body mass index on post heart transplant
mortality: A systematic review and meta-analysis.
Source
Clinical transplantation. 32 (8) (pp e13348), 2018. Date of Publication:
01 Aug 2018.
Author
Foroutan F.; Doumouras B.S.; Ross H.; Alba A.C.
Institution
(Foroutan, Doumouras, Ross, Alba) Heart Failure/Transplant Program,
Toronto General Hospital, University Health Network, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
The ISHLT's 2016 Guidelines on the selection of heart transplant (HT)
candidates recommends weight loss prior to listing for persons with body
mass (BMI) index greater than 35 kg/m2 . We conducted a systematic review
to assess the impact of BMI on all-cause mortality. We searched to
identify eligible observational studies that followed HT recipients. We
used the GRADE system to quantify absolute effects and quality of
evidence, and meta-analyzed survival curves to assess post-transplant
mortality across BMI categories. We found a significantly increased risk
of mortality in patients with BMI > 30 kg/m2 across all age categories,
independently of transplant era and study source (BMI 30-34.9: HR 1.10,
95% CI 1.04-1.17; BMI >= 35: HR 1.24, 95% CI 1.12-1.38). We also found an
increased risk of death in underweight (BMI < 18.5 kg/m2 ) candidates over
39 years of age (Age 40-65: HR 1.24, 95% CI 1.02-1.53; Age > 65: HR 1.70,
95% 1.13-2.57). We found obesity and underweight BMI to be associated with
mortality post-HT. The similar and overlapping increased risk of mortality
in patients with BMI 30-34.9 and BMI >= 35 does not support the recently
updated ISHLT guidelines. Future evidence in the form of randomized
controlled trials is required to assess effectiveness of interventions
targeting obesity-related comorbidities and weight
management. Copyright © 2018 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<40>
Accession Number
2002238444
Title
Meta-analysis of the impact on early and late mortality of TAVI compared
to surgical aortic valve replacement in high and low-intermediate surgical
risk patients.
Source
European Review for Medical and Pharmacological Sciences. 23 (12) (pp
5402-5412), 2019. Date of Publication: 2019.
Author
Sergi D.; Acconcia M.C.; Muscoli S.; Perrone M.A.; Cammalleri V.; Di
Luozzo M.; Marchei M.; Giannoni M.F.; Barilla F.; Gaudio C.; Chiocchi M.;
Romeo F.; Caretta Q.
Institution
(Sergi, Muscoli, Perrone, Cammalleri, Di Luozzo, Marchei, Romeo)
Department of Cardiovascular Disease, University of Rome Tor Vergata,
Rome, Italy
(Acconcia, Barilla, Gaudio) Department of Cardiovascular Disease,
University of Rome La Sapienza, Rome, Italy
(Giannoni) Department of Vascular Surgery Paride Stefanini, University of
Rome La Sapienza, Rome, Italy
(Chiocchi) Department of Diagnostic Imaging, Molecular Imaging
Interventional Radiology and Radiotherapy, University of Rome Tor Vergata,
Rome, Italy
(Caretta) Department of Experimental and Clinical Medicine, University of
Florence, Florence, Italy
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: We studied the impact of transcatheter aortic valve
implantation (TAVI) compared to the surgical aortic valve replacement
(SAVR) on 30-day and one-year mortality from randomized controlled trials
(RCTs) in patients with severe aortic stenosis at high or low-intermediate
surgical risk. MATERIALS AND METHODS: All RCTs were retrieved through
PubMed computerized database and the site https://www.clinicaltrials.gov
from January 2010 until March 31st, 2019. The absolute risk
reduction (RD) with the 95% confidence interval (CI) was used to assess
the effectiveness of the intervention under comparison. We evaluated
overall mortality rates at 30-day and one-year follow-up in the comparison
between TAVI vs. SAVR. We also evaluated the role played by the site
access for TAVI performed through the femoral or subclavian artery
(TV-TAVI) vs. SAVR, or transapically (TA-TAVI) vs. SAVR. RESULT(S):
In the "as-treated population" the overall 30-day mortality was
significantly lower in TAVI (p=0.03) with respect to SAVR. However, the
analysis for TAVI subgroups showed that 30-day mortality was (1)
significantly lower in TV-TAVI vs. SAVR (p=0.006), (2) increased, not
significantly, in TA-TAVI vs. SAVR (p=0.62). No significant differences
were found between TAVI vs. SAVR at one-year follow-up.
 CONCLUSION(S): The results of our meta-analysis suggest that TV-TAVI
is a powerful tool in the treatment of severe aortic stenosis at high or
low-intermediate surgical risk, with a significant lower mortality with
respect to SAVR. On the contrary, SAVR seems to provide better results
than TA-TAVI. Copyright © 2019 Verduci Editore s.r.l. All rights
reserved.

<41>
Accession Number
2002194815
Title
The effect of distraction with a loved one's voice on pain reduction while
extracting the chest tube after open heart surgery.
Source
Open Pain Journal. 12 (1) (pp 6-10), 2019. Date of Publication: 2019.
Author
Sheykhasadi H.; Abbaszadeh A.; Bonakdar H.; Salmani F.; Tavan A.; Sedri N.
Institution
(Sheykhasadi) Critical Care Nurse, Kerman University of Medical Sciences,
Kerman, Iran, Islamic Republic of
(Abbaszadeh) Department of Nursing and Midwifery, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bonakdar) Department of Anesthesia and Operating Room, Faculty of Nursing
and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Salmani) Department of Epidemiology and Biostatistics, Faculty of Health,
Birjand University of Medical Sciences, Birjand, Iran, Islamic Republic of
(Tavan) Shahid Sadughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Sedri) Zarand Nursing Faculty, Kerman University of Medical Sciences,
Kerman, Iran, Islamic Republic of
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: One of the forms of ost-operative care after open heart
surgery is controlling the pain resulting from chest tube insertion.
Management of pain is considered vital and requires the awareness of
health care providers. One of the main responsibilities of nurses is to
prepare patients for invasive procedures such as the removal of the chest
tube. This study was designed to analyze the impact of a loved one's voice
for distraction in patients undergoing open heart surgery. Method(s):
This study was a clinical trial. The research sample was randomly selected
from patients undergoing open heart surgery. In this study, the number of
samples for each group was considered to be 64 people, where the total
number of samples was 128 people. The data collection tools included
Visual Analog Scale (VAS) assessment tool and a researcher-made
questionnaire. After selecting the eligible samples and obtaining the
informed consent, each patient was randomly assigned to one of the two
groups (intervention group and control group). The pain was measured
before, immediately, and 10 minutes after removing the chest tube.
 Result(s): The findings of this study indicated that the two groups
had no statistically significant differences in pain before chest tube
removal. The mean pain during chest tube removal and 10 minutes later in
both groups indicated a significant difference based on Mann-Whitney test
(P<0.001). Conclusion(s): This study showed that a loved one's voice
is effective in reducing pain during chest tube removal after open heart
surgery. Copyright © 2019, Bentham Science Publishers B.V. All
rights reserved.

<42>
Accession Number
628492236
Title
Post-thoracotomy ipsilateral shoulder pain: What should be preferred to
optimize it - Phrenic nerve infiltration or paracetamol infusion?.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 291-296), 2019. Date of
Publication: July-September 2019.
Author
Manzoor S.; Khan T.; Zahoor S.; Wani S.; Rather J.; Yaqoob S.; Ali Z.;
Hakeem Z.; Dar B.
Institution
(Manzoor, Khan, Zahoor, Rather, Yaqoob, Dar) Department of
Anaesthesiology, Pain and Critical Care, Sher i Kashmir Institute of
Medical Sciences, Srinagar, Jammu and Kashmir, India
(Khan, Zahoor, Wani, Ali, Hakeem) Department of Radiation Oncology, Sher i
Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Post thoracotomy ipsilateral shoulder pain (PTISP) is a
distressing and highly prevalent problem after thoracic surgery and has
not received much attention despite the incidence as high as 85%.
 Objective(s): To study the effect of phrenic nerve infiltration with
Ropivacaine compared to paracetamol infusion on PTISP in thoracotomy
patients with epidural analgesia as standard mode of incisional analgesia
in both the groups. Study Design: Prospective Randomised and Double
Blind Study. Method(s): 126 adult patients were divided randomly into
2 groups, 'Group A (Phrenic Nerve Infiltration Group) received 10 mL of
0.2% Ropivacaine close to the diaphragm into the periphrenic fat pad' and
'Group B (Paracetamol Infusion Group) received 20mgkg paracetamol
infusion' 30 minutes prior to chest closure respectively. A blinded
observer assessed the patients PTISP using the VAS score at 1, 4, 8, 12
and 24 hours (h) postoperatively. The time and number of any rescue
analgesic medication were recorded. Result(s): PTISP was relieved
significantly in Group A (25.4) as compared to Group B (61.9), with
significantly higher mean duration of analgesia in Group A. The mean time
for first rescue analgesia was significantly higher in Group A (11.1 +/-
7.47 hours) than in Group B (7.40 +/- 5.30 hours). The number of rescue
analgesic required was less in Group A 1.6 +/- 1.16 as compared to Group B
2.9 +/- 1.37 (P value <0.5). Conclusion(s): Phrenic Nerve
Infiltration significantly reduced the incidence and delayed the onset of
PTISP as compared to paracetamol infusion and was not associated with any
adverse effects. Copyright © 2019 Annals of Cardiac Anaesthesia.

<43>
Accession Number
628492196
Title
A randomized, double-blinded trial comparing the effectiveness of
tranexamic acid and epsilon-aminocaproic acid in reducing bleeding and
transfusion in cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 265-272), 2019. Date of
Publication: July-September 2019.
Author
Leff J.; Rhee A.; Nair S.; Lazar D.; Sathyanarayana S.; Shore-Lesserson L.
Institution
(Leff) Montefiore Medical Center, New York, United States
(Rhee) Department of Anesthesiology, Icahn School of Medicine at Mount
Sinai, New York, United States
(Nair) Department of Anesthesiology, Montefiore Hospital and Medical
Center, New York, United States
(Lazar) Department of Anesthesiology, North Shore Long Island Jewish
Health System, New York, United States
(Sathyanarayana) Department of Anesthesiology, Lincoln Medical Centerc,
New York, United States
(Shore-Lesserson) Department of Anesthesiology, Hofstra University, North
Shore Long Island Jewish School of Medicine, New York, United States
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objectives: To compare the effectiveness of epsilon aminocaproic acid
(EACA) to tranexamic acid (TA) in reducing blood loss and transfusion
requirements in patients undergone cardiac surgery under cardiopulmonary
bypass. Design(s): Randomized, double blinded study. Outcome
variables collected included; baseline demographic characteristics, type
of surgery, amount of 24 hour chest tube drainage, amount of 24 hour blood
products administered, 30 day mortality and morbidity and length of stay.
We analyzed the data using parametric and non-parametric tests as
appropriate. Setting(s): Single center tertiary-care university
hospital setting. Participant(s): 114 patients who had undergone
cardiac surgery under cardiopulmonary bypass. Intervention(s):
Standard dose of intra-operative EACA or TA was compared in patients
undergone cardiac surgery under cardiopulmonary bypass. Result(s):
There was no statistically significant difference between groups when
analyzing chest tube drainage. However, there was a significant difference
in the administration of any transfusion (PRBC's, FFP, platelets)
intra-operatively to 24 hours postoperatively, with less transfusion in
patients receiving EACA compared to TA (25% vs. 44.8%, respectively P =
0.027). Additionally, there was no significant difference in terms of
adverse events during the one month follow up period. Conclusion(s):
The findings of this study suggest that EACA and TA have similar effects
on chest tube drainage but EACA is associated with fewer transfusions in
CABG alone surgeries. Our results suggest that EACA can be used in a
similar fashion to TA which may result in a cost and morbidity
advantage. Copyright © 2019 Annals of Cardiac Anaesthesia.

<44>
Accession Number
628492172
Title
The perioperative effect of magnesium sulfate in patients with concentric
left ventricular hypertrophy undergoing cardiac surgery: A double-blinded
randomized study.
Source
Annals of Cardiac Anaesthesia. 22 (3) (pp 246-253), 2019. Date of
Publication: July-September 2019.
Author
Soliman R.; Abukhudair W.
Institution
(Soliman) Department of Anesthesia, Cairo University, Cairo, Egypt
(Abukhudair) Department of Cardiac Surgery, Cardiac Center, King Fahd
Armed Forces Hospital, Jeddah, Saudi Arabia
Publisher
Wolters Kluwer Medknow Publications (B9, Kanara Business Centre, off Link
Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to assess the cardioprotective
effect of magnesium sulfate in patients with left ventricular concentric
hypertrophy undergoing cardiac surgery. Design(s): The study was a
double-blinded randomized study. Setting(s): This study was conducted
at a cardiac center. Patient(s): The study included 250 patients.
 Intervention(s): The study included two groups (each = 125): Group M
- the patients who received magnesium sulfate infusion (15 mgkgh). The
infusion was started 20 min before induction, during surgery, and the
first postoperative 24 h. Group C - the patients who received an equal
amount of normal saline. Measurements: The variables included troponin I
level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with
automatic ST-segment analysis (leads II and V), EA peak ratio,
end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood
pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and
systemic vascular resistances, and pharmacological and mechanical support.
 Main Result(s): The troponin I level, CK-MB, and ECG changes were
lower in Group M than Group C (P < 0.05). The EA peak ratio and
end-diastolic volume increased in Group M than Group C (P < 0.05). There
was a significant increase in the CI and a decrease in the heart rate,
mPAP, pulmonary vascular resistances, and pharmacological and mechanical
support in Group M compared to Group C (P < 0.05). There were minimal
changes in the MAP and systemic vascular resistance in Group M compared to
Group C (P < 0.05). Conclusion(s): The magnesium sulfate provides a
cardioprotective effect in patients with concentric ventricular
hypertrophy undergoing cardiac surgery. It decreases the incidence of
perioperative myocardial infarction and arrhythmia. Furthermore, it
decreases the requirement of pharmacological and mechanical
support. Copyright © 2019 Annals of Cardiac Anaesthesia.

<45>
Accession Number
628503652
Title
Preoperative anemia and outcomes in cardiovascular surgery: systematic
review and meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 21 Jun 2019.
Author
Padmanabhan H.; Siau K.; Curtis J.; Ng A.; Menon S.; Luckraz H.; Brookes
M.J.
Institution
(Padmanabhan, Siau, Menon, Brookes) Department of Gastroenterology, Heart
& Lung Centre, Wolverhampton WV10 0QP, United Kingdom
(Curtis) Department of Shrewsbury Health Library, Royal Shrewsbury
Hospital, Shrewsbury SY3 8XQ, United Kingdom
(Ng) Department of Cardiothoracic Anaesthesiology, Heart & Lung Centre,
Wolverhampton WV10 0QP, United Kingdom
(Luckraz) Department of Cardiothoracic Surgery Department, Heart Centre,
American Hospital Dubai, Dubai, United Arab Emirates
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pre-operative anemia is common in patients scheduled for
cardiac surgery. However, its effect on postoperative outcomes remains
controversial. This meta-analysis aimed to clarify the impact of anemia on
outcomes following cardiac surgery. METHOD(S): A literature search
was conducted on MEDLINE, Embase, Cochrane, and Web of Science databases.
The primary outcome was 30-day postoperative or in-hospital mortality.
Secondary outcomes included acute kidney injury (AKI), stroke, blood
transfusion, and infection. A meta-analytic model was used to determine
the differences in the above postoperative outcomes between anemic and
non-anemic patients. RESULT(S): Out of 1103 studies screened, 22 met
the inclusion criteria. A total of 23624 (20.6%) out of 114277 patients
were anemic. Anemia was associated with increased mortality (odds ratio
[OR] 2.74, 95% confidence interval [CI] 2.32-3.24; I2=69.6%; p<0001), AKI
(OR 3.13, 95% CI 2.37-4.12; I2=71.1%; p<0001), stroke (OR 1.46, 95% CI
1.24-1.72; I2=21.6%; p<0001), and infection (OR 2.65, 95% CI 1.98-3.55;
I2=46.7%; p<0001). More anemic patients were transfused than non-anemic
(33.3 versus 11.9%). No statistically significant association was found
between mortality and blood transfusion (OR 1.35, 95% CI 0.92-1.98;
I2=83.7%; p=0.12) but we were not able to compare mortality with or
without transfusion in those who were or were not anemic.
 CONCLUSION(S): Preoperative anemia is associated with adverse
outcomes following cardiac surgery. These findings support the addition of
preoperative anemia to future risk prediction models, and as a target for
risk modification. Copyright © 2019. Published by Elsevier Inc.

<46>
Accession Number
2002288970
Title
Meta-Analysis Comparing the Risk of Myocardial Infarction Following
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients With Multivessel or Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Lee P.H.; Park H.; Lee J.S.; Lee S.-W.; Lee C.W.
Institution
(Lee, Park, Lee, Lee) Division of Cardiology, Department of Internal
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
(Lee) Department of Clinical Epidemiology and Biostatistics, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
(Lee) Clinical Research Center, Asan Institute for Life Sciences, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
There is insufficient data regarding the comparative efficacy of coronary
artery bypass graft surgery (CABG) and percutaneous coronary intervention
(PCI) regarding myocardial infarction (MI). Our systematic review included
randomized controlled trials that compared CABG versus PCI with stents in
patients with multivessel or left main coronary artery disease (CAD).
Included trials should have had reported event number of MI and a clinical
follow-up of one or more years. Data were pooled using a random-effects
model. The primary end point was MI at the longest available follow-up in
the intention-to-treat population. Fifteen trials with a total of 13,592
patients treated with either CABG (n = 6,596) or PCI (n = 6,996) were
included. After a weighted follow-up of 4.5 years, patients treated with
CABG had a significantly lower risk of MI than those treated with PCI
(risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58 to 0.96, p =
0.024). The lower risk of MI with CABG as compared with PCI was more
evident during a longer duration of follow-up (>=3 years, RR 0.69, 95% CI
0.52 to 0.91, p = 0.008; >=5 years, RR 0.64, 95% CI 0.48 to 0.86, p =
0.003) and in the diabetic population (RR 0.55, 95% CI 0.44 to 0.70, p
<0.001). The magnitude of risk reduction was similar across patients with
multivessel (RR 0.72, 95% CI 0.53 to 0.99) and left main CAD (RR 0.74, 95%
CI 0.47 to 1.15). In conclusion, the present meta-analysis of studies
involving patients with multivessel or left main CAD suggests a
significant benefit of CABG over PCI concerning the risk of future
MI. Copyright © 2019 Elsevier Inc.

<47>
Accession Number
2002212409
Title
Perioperative dexmedetomidine reduces delirium in elderly patients after
non-cardiac surgery: a systematic review and meta-analysis of
randomized-controlled trials.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Pan H.; Liu C.; Ma X.; Xu Y.; Zhang M.; Wang Y.
Institution
(Pan, Liu, Ma, Xu, Zhang, Wang) Department of Anesthesiology, Shandong
Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu
Road, Jinan 250021, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Delirium is a frequent postoperative complication in elderly
patients after non-cardiac surgery. We performed this updated
meta-analysis to ascertain more precisely the efficacy of dexmedetomidine
(DEX) on the incidence of postoperative delirium (POD) in elderly patients
after non-cardiac surgery. Method(s): We searched PubMed, EMBASE, the
Cochrane Library, Web of Science, and the Cumulative Index of Nursing and
Allied Health Literature (CINAHL) from inception until February 24, 2019.
In this meta-analysis, we included randomized-controlled trials comparing
the effect of DEX vs normal saline (NS) or other anesthetic drugs on POD
incidence in elderly (either >= 60 or >= 65 yr old) patients undergoing
non-cardiac surgery. We performed subgroup analyses of the DEX dosing
strategy (starting time, dose, and duration of administration, with or
without loading dose) and the strategy of various control drugs. A
random-effects model was used for all analyses. Result(s): We
included 11 studies involving 2,890 patients in our meta-analysis. The
pooled results of these studies revealed that DEX significantly reduced
the incidence of POD (relative risk [RR], 0.47; 95% confidence interval
[CI], 0.38 to 0.58; P < 0.001) compared with the control group. Meanwhile,
the incidences of hypotension (RR, 1.20; 95% CI, 1.04 to 1.39; P = 0.01)
and bradycardia (RR, 1.33; 95% CI, 1.08 to 1.63; P = 0.007) were increased
in the DEX group. Subgroup analyses revealed a decrease in POD incidence
when DEX was administered intraoperatively (RR, 0.43; 95% CI, 0.33 to
0.57; P < 0.001) and postoperatively (RR, 0.38; 95% CI, 0.27 to 0.54; P <
0.001) with a loading dose (RR, 0.49; 95% CI, 0.36 to 0.69; P < 0.001)
compared with NS (RR, 0.49; 95% CI, 0.37 to 0.64; P < 0.001) and other
anesthetic drugs (RR, 0.40; 95% CI, 0.26 to 0.60; P < 0.001). There were
significant differences in the time to extubation (standardized mean
difference, -0.60; 95% CI, -1.17 to -0.03; P = 0.04) and the length of
hospital stay (mean difference, -0.50 days; 95% CI, -0.97 to -0.03; P =
0.04). The amount of data for the duration of mechanical ventilation and
length of intensive care unit stay were insufficient to perform a
meta-analysis. Conclusion(s): Perioperative dexmedetomidine reduces
the incidence of POD in elderly patients after non-cardiac surgery, but
this comes at the cost of an increased incidence of hypotension and
bradycardia. Copyright © 2019, Canadian Anesthesiologists'
Society.

<48>
Accession Number
628490917
Title
Rejuvenation of RBCs: validation of a manufacturing method suitable for
clinical use.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
Smethurst P.A.; Jolley J.; Braund R.; Proffitt S.; Lynes T.; Hazell M.;
Mellor P.; Ridgwell K.; Procter S.; Griffiths A.; Marinaki A.M.; New H.V.;
Murphy G.J.; Edmondson D.; Cardigan R.
Institution
(Smethurst, Jolley, Proffitt, Cardigan) Component Development Laboratory,
NHS Blood and Transplant, Cambridge, United Kingdom
(Braund, Mellor, Edmondson) Manufacturing & Development, NHS Blood and
Transplant, Bristol, United Kingdom
(Lynes, Hazell) Red Cell Immunohaematology, NHS Blood and Transplant,
Bristol, United Kingdom
(Ridgwell) IBGRL Protein Development & Production Unit, NHS Blood and
Transplant, Bristol, United Kingdom
(Procter) Quality Monitoring, NHS Blood and Transplant, London, United
Kingdom
(Griffiths) Clinical Trials Unit, NHS Blood and Transplant, Bristol,
United Kingdom
(Marinaki) Purine Research Laboratory, St Thomas' Hospital, London, United
Kingdom
(New) Clinical Directorate, NHS Blood and Transplant, London, United
Kingdom
(New) Department of Haematology, Imperial College London, London, United
Kingdom
(Murphy) Department of Cardiovascular Sciences and NIHR Leicester
Biomedical Research Centre, Glenfield General Hospital, University of
Leicester, Leicester, United Kingdom
(Cardigan) Department of Haematology, University of Cambridge, Cambridge,
United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Rejuvenation of stored red blood cells (RBCs) increases levels
of adenosine 5'-triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) to
those of fresh cells. This study aimed to optimize and validate the
US-approved process to a UK setting for manufacture and issue of
rejuvenated RBCs for a multicenter randomized controlled clinical trial in
cardiac surgery. STUDY DESIGN AND METHODS: Rejuvenation of leukoreduced
RBC units involved adding a solution containing pyruvate, inosine,
phosphate, and adenine (Rejuvesol, Zimmer Biomet), warming at 37degreeC
for 60 minutes, then "manual" washing with saline adenine glucose mannitol
solution. A laboratory study was conducted on six pools of ABO/D-matched
units made the day after donation. On Days 7, 21, and 28 of 4 +/- 2degreeC
storage, one unit per pool was rejuvenated and measured over 96 hours for
volume, hematocrit, hemolysis, ATP, 2,3-DPG, supernatant potassium,
lactate, and purines added (inosine) or produced (hypoxanthine) by
rejuvenation. Subsequently, an operational validation (two phases of 32
units each) was undertaken, with results from the first informing a trial
component specification applied to the second. Rejuvenation effects were
also tested on crossmatch reactivity and RBC antigen profiles.
 RESULT(S): Rejuvenation raised 2,3-DPG to, and ATP above, levels of
fresh cells. The final component had potassium and hemolysis values below
those of standard storage Days 7 and 21, respectively, containing 1.2%
exogenous inosine and 500 to 1900 mumoles/unit of hypoxanthine. The second
operational validation met compliance to the trial component
specification. Rejuvenation did not adversely affect crossmatch reactivity
or RBC antigen profiles. CONCLUSION(S): The validated rejuvenation
process operates within defined quality limits, preserving RBC
immunophenotypes, enabling manufacture for clinical trials. Copyright
© 2019 Crown copyright. Transfusion © 2019 AABB

<49>
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.

<50>
Accession Number
627110349
Title
Adiposity in relation to readmission and all-cause mortality following
coronary artery bypass grafting: A systematic review and meta-analysis.
Source
Obesity Reviews. 20 (8) (pp 1159-1183), 2019. Date of Publication: August
2019.
Author
Zhang K.; Wang J.; Yang Y.; An R.
Institution
(Zhang) Beijing Aortic Disease Center, Beijing Anzhen Hospital, Beijing,
Capital Medical University, Beijing, China
(Wang) Department of Physical Education, Dalian University of Technology,
Dalian, Liaoning, China
(Yang) Cabot Microelectronics, Aurora, IL, United States
(An) Guangzhou Sport University, Guangzhou, Guangdong, China
(An) Department of Kinesiology and Community Health, University of
Illinois at Urbana-Champaign, Champaign, IL, United States
(An) Brown School, Washington University, St. Louis, MO, United States
Publisher
Blackwell Publishing Ltd
Abstract
This study systemically reviewed evidence linking adiposity to readmission
and all-cause mortality in post-coronary artery bypass grafting (CABG)
patients. Keyword/reference search was performed in PubMed, Web of
Science, CINAHL, and Cochrane Library for articles published before June,
2018. Eligibility criteria included study designs:
experimental/observational studies; subjects: adult patients undergoing
CABG; and outcomes: hospital/clinic readmissions, and short-term (<=30
days) and mid-to-long-term (>30 days) all-cause mortality. Seventy-two
studies were identified. Meta-analysis showed that the odds of post-CABG
readmission among patients with overweight was 30% lower than their
normal-weight counterparts and the odds of mid-to-long-term post-CABG
mortality among patients with overweight were 20% lower than their
normal-weight counterparts. In contrast, no difference in post-CABG
readmission rate was found between patients with obesity and their
nonobese counterparts; no difference in short-term or in-hospital
post-CABG mortality rate was found between patients with overweight or
obesity and their normal-weight counterparts; and no difference in
mid-to-long-term post-CABG mortality rate was found between patients with
obesity and their normal-weight counterparts. In conclusion, patients with
overweight but not obesity had a lower readmission and mid-to-long-term
mortality rate following CABG relative to their normal-weight
counterparts. Preoperative weight loss may not be advised to patients with
overweight undergoing CABG. Copyright © 2019 World Obesity
Federation

<51>
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.

<52>
Accession Number
628433303
Title
Can human myocardium be remotely preconditioned? the results of a
randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 55 (6) (pp 1086-1094), 2019.
Date of Publication: 01 Jun 2019.
Author
Deja M.A.; Piekarska M.; Malinowski M.; Wiaderkiewicz R.; Czekaj P.;
Machej L.; Weglarzy A.; Kowalowka A.; Kolodziej T.; Czech E.; Plewka D.;
Mizia M.; Latusek T.; Szurlej B.
Institution
(Deja, Piekarska, Malinowski, Kowalowka, Latusek, Szurlej) Department of
Cardiac Surgery, School of Medicine in Katowice, Medical University of
Silesia, Katowice, Poland
(Deja, Piekarska, Malinowski, Kowalowka, Kolodziej) Department of Cardiac
Surgery, Upper-Silesian Heart Center, Katowice, Poland
(Wiaderkiewicz, Czekaj, Czech, Plewka) Department of Histology and
Embryology, School of Medicine in Katowice, Medical University of Silesia,
Katowice, Poland
(Machej) Department of Anesthesia and Intensive Care Nursing, School of
Health Sciences, Medical University of Silesia, Katowice, Poland
(Weglarzy) Department of Cardiac Anesthesia, Upper-Silesian Heart Center,
Katowice, Poland
(Mizia) Department of Cardiology, School of Medicine in Katowice, Medical
University of Silesia, Katowice, Poland
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
No experimental study has shown that the myocardium of a remotely
preconditioned patient is more resistant to a standardized
ischaemic/hypoxic insult. This was a single-centre randomized (1:1),
double-blinded, sham-controlled, parallel-group study. Patients referred
for elective coronary bypass surgery were allocated to either remote
ischaemic preconditioning (3 cycles of 5-min ischaemia/5-min reperfusion
of the right arm using a blood pressure cuff inflated to 200 mmHg) or sham
intervention. One hundred and thirty-four patients were recruited, of whom
10 dropped out, and 4 were excluded from the per-protocol analysis. The
right atrial trabecula harvested on cannulation for cardiopulmonary bypass
was subjected to 60 min of simulated ischaemia and 120 min of
reoxygenation in an isolated organ experiment. Postoperative troponin T
release and haemodynamics were assessed in an in vivo study. The atrial
trabeculae obtained from remotely preconditioned patients recovered 41.9%
(36.3 48.3) of the initial contraction force, whereas those from
non-preconditioned patients recovered 45.9% (39.1 53.7) (P = 0.399).
Overall, the content of cleaved poly (ADP ribose) polymerase in the right
atrial muscle increased from 9.4% (6.0 13.5) to 19.1% (13.2 23.8) (P
0.001) after 1 h of ischaemia and 2 h of reperfusion in vitro. The amount
of activated Caspase 3 and the number of terminal deoxynucleotidyl
transferase dUTP nick end labeling-positive cells also significantly
increased. No difference was observed between the remotely preconditioned
and sham-treated myocardium. In the in vivo trial, the area under the
curve for postoperative concentration of troponin T over 72 h was 16.4
ngh/ml (95% confidence interval 14.2 18.9) for the remote ischaemic
preconditioning and 15.5 ngh/ml (13.4 17.9) for the control group in the
intention-to-treat analysis. This translated into an area under the curve
ratio of 1.06 (0.86 1.30; P = 0.586). Remote ischaemic preconditioning
with 3 cycles of 5-min ischaemia/reperfusion of the upper limb before
cardiac surgery does not make human myocardium more resistant to
ischaemia/reperfusion injury.. Copyright © The Author(s) 2018.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<53>
Accession Number
2002252870
Title
Comparison of transcatheter versus surgical closure of perimembranous
ventricular septal defect in pediatric patients: A systematic review and
meta-analysis.
Source
Journal of the Saudi Heart Association. 31 (4) (pp 188-197), 2019. Date of
Publication: October 2019.
Author
El-Kadeem S.; El Nemr S.; El Amrousy D.; Zoair A.
Institution
(El-Kadeem, El Nemr, El Amrousy, Zoair) Pediatric Department, Faculty of
Medicine, Tanta University, Tanta, Egypt
(El-Kadeem, El Nemr, El Amrousy, Zoair) Tanta University Hospital, Tanta,
Egypt
Publisher
Elsevier B.V.
Abstract
Objective: Perimembranous ventricular septal defect (pmVSD) is a common
congenital heart disease (CHD) usually treated with either catheter or
surgical closure. Superiority of one procedure over the other in children
is still a matter of debate. We performed this meta-analysis to compare
the clinical outcomes and cost of transcatheter and surgical closure of
pmVSD in children. Material(s) and Method(s): We searched seven
databases (MEDLINE, PubMed, EMBASE, Google Scholar, CENTRAL, CINHAL, and
Cochrane library) and literature references for articles published in the
past 10 years (between January 2008 and January 2018) comparing closure of
pmVSD by both procedures in children. The outcomes of interest were
success rate, residual shunt, need for blood transfusion, complications
especially complete atrioventricular block, length of hospital stay, and
cost. Result(s): A total of 1750 articles were identified. However,
only five studies fulfilled the inclusion criteria. As regards success
rate, no significant difference was found between surgical and catheter
closure. Residual shunt was significantly lower in catheter closure than
surgical closure [risk ratio (RR) = 0.44; 95% confidence interval (CI),
0.23-0.83, p = 0.01). The need for blood transfusion and the length of
hospital stay were significantly lower in the catheter closure compared to
surgical closure (RR = 0.02; 95% CI, 0.01-0.08; p < 0.00001), (RR = -4.81;
95% CI, -7.76 to -1.86; p = 0.001), respectively. However, overall
complications, complete atrioventricular block, and the cost were
comparable in both procedures. Conclusion(s): Transcatheter closure
of pmVSD in children was as effective as surgical closure with a lower
residual shunt and need for blood transfusion, and shorter hospital
stay. Copyright © 2019 The Authors

<54>
Accession Number
2002273212
Title
PREDICTORS OF LONG-TERM ARRHYTHMIA-FREE SURVIVAL IN PATIENTS UNDERGOING
SURGICAL ABLATION FOR ATRIAL FIBRILLATION: FIVE-YEAR RESULTS FROM THE
PRAGUE-12 STUDY.
Source
Heart Rhythm. Conference: Heart Rhythm 2019: 40th Annual Heart Rhythm
Scientific Sessions. United States. 16 (5 Supplement) (pp 179), 2019. Date
of Publication: May 2019.
Author
Osmancik P.; Budera P.; Talavera D.; Hlavicka J.; Herman D.; Holy J.;
Cervinka P.; Smid J.; Rokyta R.; Hanak P.; Hatala R.; Widimsky P.
Institution
(Osmancik, Budera, Talavera, Hlavicka, Herman, Holy, Cervinka, Smid,
Rokyta, Hanak, Hatala, Widimsky) Cardiocenter, Charles University and
University Hospital Kralovske Vinohrady, Prague, Czech Republic;
Cardiocenter University Hospital Kralovske Vinohrady, Prague, Czech
Republic; Department of Cardiology, Masaryk Hospital, Usti Nad Labem,
Czech Republic; Cardiology Department, University Hospital and Faculty of
Medicine Pilsen, Pilsen, Czech Republic; Clinic of Cardiology, National
Cardiovascular Institute, Bratislava, Slovakia, Cardiocenter, University
Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles
University, Prague, Czech Republic
Publisher
Elsevier B.V.
Abstract
Background: Surgical ablation of atrial fibrillation (AF) is commonly
performed as a concomitant procedure during cardiac surgery indicated for
coronary artery disease or valve disease, and AF. However, the long-term
effect and predictors of successful surgical ablation of AF have not been
established in randomized trials. Objective(s): To assess predictors
associated with long-term AF-free survival after cardiac surgery.
 Method(s): PRAGUE-12 was a prospective, randomized, multicenter,
clinical trial assessing cardiac surgery with left atrial ablation for AF
vs. cardiac surgery alone. Patients with AF, and indicated for cardiac
surgery (coronary artery disease, valve surgery, or combinations), were
enrolled and randomized to cardiac surgery with or without concomitant
surgical AF ablation. All patients were followed for 5 years and the
recurrence of AF at five years and the variables associated with complete
long-term AF-free survival were studied. Result(s): Originally, 224
patients were enrolled at three university centers, with 207 patients
ultimately analyzed after 5 years (108 from the ablation group and 99 from
the control group). Thirty-two (29.6%) patients in the ablation group and
11 (11.1%) patients in the control (no ablation) group were AF-free at
five years. Using a multivariate logistic regression, factors associated
independently with a greater chance for long-term AF-free survival were
randomization to surgical ablation (odds ratio 3.9 [1.7-8.9], p<0.001),
age (OR 0.9 [0.87-0.96], p=0.001), left atrial diameter (OR 0.93
[0.87-0.98], p=0.015), and AF duration before surgery (OR 0.98
[0.97-0.99], p=0.03). Conclusion(s): Concomitant surgical ablation of
AF was significantly associated with long-term AF-free survival. The
chance for long-term sinus rhythm maintenance by means of surgery, but
without concomitant surgical ablation, is poor. Other variables associated
with an increased chance of AF-free survival were younger age, smaller
left atrial diameter, and a shorter history of AF before surgery and
ablation. Copyright © 2019. Published by Elsevier

<55>
Accession Number
2002272930
Title
RISK PREDICTION MODEL FOR PERMANENT PACEMAKER IMPLANTATION AFTER
TRANSCATHETER AORTIC VALVE IMPLANTATION: AN EXTRACTION AND INTERNAL
VALIDATION IN SINGLE HIGH VOLUME CENTER EXPERIENCE.
Source
Heart Rhythm. Conference: Heart Rhythm 2019: 40th Annual Heart Rhythm
Scientific Sessions. United States. 16 (5 Supplement) (pp 11), 2019. Date
of Publication: May 2019.
Author
Tsushima T.; Nadeem F.; Al-Kindi S.; Clevenger J.R.; Bansal E.J.; Kalra
A.; Attizzani G.; Sareyyupoglu B.; Elgudin Y.; Markowitz A.; Costa M.A.;
Simon D.I.; Arruda M.S.; Mackall J.A.; Thal S.G.
Institution
(Tsushima, Nadeem, Al-Kindi, Clevenger, Bansal, Kalra, Attizzani,
Sareyyupoglu, Elgudin, Markowitz, Costa, Simon, Arruda, Mackall, Thal)
Department of Medicine, University Hospitals Cleveland Medical Center,
Cleveland, OH; Division of Cardiology, Harrington Heart & Vascular
Institute, University Hospitals Cleveland Medical Center, Cleveland, OH;
Department of Cardiac Surgery, Harrington Heart & Vascular Institute,
University Hospitals Cleveland Medical Center, Cleveland, OH
Publisher
Elsevier B.V.
Abstract
Background: Atrioventricular block (AVB) requiring permanent pacemaker
(PPM) implantation remains a significant complication following
transcatheter aortic valve implantation (TAVI). Although pre-TAVI patient
characteristics, such as RBBB, have been associated with risk of AVB, the
ability to accurately identify patients at risk is challenging.
 Objective(s): The aim of this study was to develop and validate a
risk prediction model for AVB requiring PPM implantation after TAVI.
 Method(s): This is a single center retrospective study of consecutive
patients who underwent TAVI during March 2011 to October 2018. This cohort
sample was randomly divided into two groups. One was for extracting a risk
prediction model using multivariate logistic regression (group A) and the
other was for the internal validation (group B). Result(s): A total
of 1071 patients underwent TAVI during the study period and 889 cases
remained after excluding pre-existing PPM/ICD. They were divided into
group A: 507 and B: 382. With multivariate logistic regression in group A,
the final predictive covariates were extracted and the point assigned to
each variable equaled our regression coefficient. Predictive variables
were: AVB, self-expandable valve, hypertension (all 1 point), and RBBB (2
points). The resulting score was calculated from the total points. The
internal validation in group B showed a high predictive accuracy in
calibration plot (high R square: 0.933) and area under the curve: 0.693
(Figure B and C). Conclusion(s): Our prediction model accurately
predicted post-TAVI AVB and PPM. This prediction impacts patient
management as well as patient expectation. Prospective and external
validation should be undertaken. [Figure presented] Copyright ©
2019. Published by Elsevier

<56>
Accession Number
2002250605
Title
Association between depression and risk of triggering ventricular
arrhythmias: A meta-analysis.
Source
International Journal of Clinical Pharmacology and Therapeutics. 57 (6)
(pp 306-314), 2019. Date of Publication: 2019.
Author
Fu Y.; Shen X.; Huang W.
Institution
(Fu, Shen) First Affiliated Hospital of Sun Yat-Sen University, Guangzhou,
China
(Huang) Zhongshan Ophthalmic Center, State Key Laboratory of
Ophthalmology, Sun Yat-Sen University, Guangzhou, China
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Background: This meta-analysis aims to clarify the effects of depression
on the risk of ventricular arrhythmias. Material(s) and Method(s): A
systematic search was performed in PubMed, EMBASE, Web of Science, and the
Cochrane Library. Summary hazard ratios (HRs) and 95% confidence intervals
(CIs) were calculated employing random-effects models. Publication bias of
the literature was evaluated using Begg's funnel plots and Egger's test.
 Result(s): A total of nine prospective cohort studies were included
in this meta-analysis. Overall, participants with depression, as compared
to those who had no depression, experienced a significantly increased risk
of developing ventricular arrhythmia (combined HR, 1.33; 95% CI, 1.02 -
1.73; p = 0.037). In a subgroup analysis, a statistically-significant
relation between depression and risk of ventricular arrhythmia was
observed in coronary heart disease (CHD) patients and in studies with
adjustment for confounding factors, with pooled HR at a 95% CI of 1.78
(1.31 - 2.42) and 1.52 (1.11 - 2.08), respectively. No publication bias
was detected by Begg's funnel plot and Egger's test. Conclusion(s):
This meta-analysis suggests that depression in patients was associated
with increased risk of developing ventricular arrhythmias, especially in
patients with CHD. Cardiologists and psychiatrists should be alert to the
risk of ventricular arrhythmia in patients with depression. Moreover, the
antidepressant medications (e.g., tricyclic antidepressants and selective
serotonin reuptake inhibitors) that could affect heart rate variability
should be used carefully. Copyright ©2019 Dustri-Verlag Dr. K.
Feistle

<57>
Accession Number
2001061650
Title
Comparison of Health Related Quality of Life in Transcatheter Versus
Surgical Aortic Valve Replacement: A Meta-Analysis.
Source
Heart Lung and Circulation. 28 (8) (pp 1235-1245), 2019. Date of
Publication: August 2019.
Author
Ando T.; Takagi H.; Briasoulis A.; Grines C.L.; Afonso L.
Institution
(Ando, Afonso) Division of Cardiology, Wayne State University/Detroit
Medical Center, Detroit, MI, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Cardiology, University of Iowa Hospitals and
Clinics, IA, United States
(Grines) Division of Cardiology, North Shore University Hospital, Hofstra
Northwell School of Medicine, Manhasset, NY, United States
Publisher
Elsevier Ltd
Abstract
Background: Data on the effects of transcatheter aortic valve replacement
(TAVR) compared to surgical aortic valve replacement (SAVR) on
health-related quality of life (HRQOL) outcomes are limited. To assess the
comparative HRQOL outcomes between TAVR and SAVR, we performed a
systematic review and meta-analysis. Method(s): PubMed and EMBASE
databases were searched for articles that compared the HRQOL scores,
Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study
Short-Form Health Survey 12 or 36 (SF-12/36), or the EuroQoL 5 Dimension
score (EQ-5D) at 30 days and 1 year between TAVR and SAVR. Mean difference
(MD) and 95% confidence interval (CI) was calculated with inverse variance
statistical method and random-effects model. Result(s): A total of
four studies with 4,125 patients (1268 transfemoral [TF]-TAVR, 1261 Non-TF
TAVR [transsubclavian, transapical or transaortic], and 1,596 SAVR) were
included in the studies. KCCQ overall summary scores and its subscales,
SF-12/36, and EQ-5D were significantly higher in TF-TAVR compared to SAVR
but were similar in non-TF TAVR vs. SAVR at 30 days. At 1-year follow-up,
TF-TAVR and non-TF TAVR conferred similar HRQOL scores in KCCQ overall
summary and subscales scores, SF-12/36, and EQ-5D compared to SAVR.
 Conclusion(s): Transfermoral-TAVR achieved better HRQOL at 30 days
but similar HRQOL at 1 year compared to SAVR. Non-TF TAVR resulted in
similar improvements in HRQOL at both 30 days and 1 year compared with
SAVR. Copyright © 2018

<58>
Accession Number
2002113617
Title
A systematic review of the use of near-infrared fluorescence imaging in
patients with peripheral artery disease.
Source
Journal of Vascular Surgery. 70 (1) (pp 286-297.e1), 2019. Date of
Publication: July 2019.
Author
van den Hoven P.; Ooms S.; van Manen L.; van der Bogt K.E.A.; van Schaik
J.; Hamming J.F.; Vahrmeijer A.L.; van der Vorst J.R.; Mieog J.S.D.
Institution
(van den Hoven, Ooms, van Manen, van der Bogt, van Schaik, Hamming,
Vahrmeijer, van der Vorst, Mieog) Department of Surgery, Leiden University
Medical Center, Leiden, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: In the diagnosis of peripheral artery disease (PAD), the
ankle-brachial index plays an important role. However, results of the
ankle-brachial index are unreliable in patients with severe media
sclerosis. Near-infrared (NIR) fluorescence imaging using indocyanine
green (ICG) can provide information about tissue perfusion and has already
been studied in oncologic, reconstructive, and cardiac surgery. For
patients with PAD, this technique might give insight into skin perfusion
and thereby guide treatment. We performed a systematic review of the
literature on the use of NIR fluorescence imaging in patients with PAD.
 Method(s): PubMed, MEDLINE, Embase, and Cochrane were searched for
articles and abstracts on the application of NIR fluorescence imaging
using ICG as fluorescent dye in patients with PAD. Our search strategy
combined the terms "fluorescence," "ICG," or synonyms and "peripheral
artery disease" or synonyms. The extracted data included fluorescence
parameters and test characteristics for diagnosis of PAD. Result(s):
Twenty-three articles were found eligible for this review using 18
different parameters for evaluation of the fluorescence signal intensity.
NIR fluorescence imaging was used for four main indications: diagnosis,
quality control in revascularization, guidance in amputation surgery, and
visualization of vascular structures. For the diagnosis of PAD, NIR
fluorescence imaging yields a sensitivity ranging from 67% to 100% and a
specificity varying between 72% and 100%. Significant increases in
multiple fluorescence parameters were found in comparing patients before
and after revascularization. Conclusion(s): NIR fluorescence imaging
can be used for several indications in patients with PAD. NIR fluorescence
imaging seems promising in diagnosis of PAD and guidance of surgeons in
treatment, especially in patients in whom current diagnostic methods are
not applicable. Further standardization is needed to reliably use this
modality in patients with PAD. Copyright © 2018 Society for
Vascular Surgery

<59>
Accession Number
2002113612
Title
A systematic review and meta-analysis of bivalirudin application in
peripheral endovascular procedures.
Source
Journal of Vascular Surgery. 70 (1) (pp 274-284.e5), 2019. Date of
Publication: July 2019.
Author
Hu Y.; Liu A.Y.; Zhang L.; Wu X.; Shi S.; Elmore J.R.; Zhang X.
Institution
(Hu) Biomedical & Translational Informatics, Geisinger Medical Center,
Danville, Penn, United States
(Liu) Department of Cell and Systems Biology, University of Toronto,
Toronto, Ontario, Canada
(Zhang, Wu, Zhang) Division of Anesthesiology, Geisinger Medical Center,
Danville, Penn, United States
(Shi) Gillings School of Global Public Health, University of North
Carolina-Chapel Hill, Chapel Hill, NC, United States
(Elmore) Department of Vascular Surgery, Geisinger Medical Center,
Danville, Penn, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The direct thrombin inhibitor bivalirudin (BIV) was shown to be
superior to unfractionated heparin (UFH) in percutaneous coronary
interventions for reducing procedural blood loss. The aim of this study
was to compare outcome profiles of BIV and UFH in peripheral endovascular
procedures (PEPs) by synthesizing the currently available data.
 Method(s): Following the PRISMA statement, we conducted a
comprehensive literature search using Medline, Cochrane CENTRAL, PubMed,
EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We recruited
randomized, controlled trials and well-conducted observational studies
that compared UFH and BIV in PEPs requiring anticoagulation, excluding
endovascular cardiac procedures and coronary interventions. Random-effects
meta-analyses were conducted to compare the outcome profiles of these two
agents. Result(s): Thirteen articles containing 17 studies involving
a total of 21,057 patients were enrolled. Of these, 2 were randomized
controlled trials, 2 were prospective cohort studies, and 10 were
retrospective studies. There were no significant differences between BIV
and UFH in terms of procedural success rates, major and minor
perioperative bleeding, transfusion, perioperative transient ischemic
attack, or hemorrhagic strokes. However, compared with UFH, BIV had
significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58;
95% confidence interval [CI], 0.40-0.86), major adverse cardiovascular
events (OR, 0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR,
0.75; 95% CI, 0.63-0.88), perioperative myocardial infarction (OR, 0.73;
95% CI, 0.55-0.98), major vascular complications (OR, 0.59; 95% CI,
0.39-0.91), and minor vascular complications (OR, 0.58; 95% CI,
0.40-0.84). Conclusion(s): Compared with UFH, PEPs using BIV had
comparable procedural success rates and odds of perioperative transient
ischemic attack and hemorrhagic stroke. However, procedures with BIV had a
lower but nonsignificant odds of perioperative bleeding and transfusion.
Depending on the procedures conducted, the patients who received BIV will
have reduced or comparable odds of perioperative mortality, myocardial
infarction, major adverse cardiovascular events, net adverse clinical
events, and major and minor vascular complications. Therefore, BIV may be
chosen solely as an alternative procedural anticoagulant to UFH for
PEPs. Copyright © 2019 The Authors

<60>
Accession Number
614188784
Title
SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial.
Source
Journal of the American College of Cardiology. 69 (4) (pp 395-403), 2017.
Date of Publication: 31 Jan 2017.
Author
Ikeno F.; Brooks M.M.; Nakagawa K.; Kim M.-K.; Kaneda H.; Mitsutake Y.;
Vlachos H.A.; Schwartz L.; Frye R.L.; Kelsey S.; Waseda K.; Hlatky M.A.;
Detre K.M.; Orchard T.; Thomas S.B.; Tyrrell K.S.; Rana J.S.; Averbach F.;
MacGregor J.M.; O'Neal S.M.; Pitluga K.; Sansing V.; Tranchine M.; Crow
S.W.; Bertolet M.M.; Hardison R.; Kip K.; Lombardero M.; Lu J.;
Janiszewski S.; Protivnak D.; Reiser S.; Barton S.; Guo P.; Kushner Y.;
Michael O.; Martin J.P.; Kania C.; Kania M.; O'Donnell J.; Maxwell R.A.;
Goldberg S.; Rosenberg Y.; Desvigne-Nickens P.; Ershow A.; Gordon D.;
Paltoo D.; Jones T.L.Z.; Hueb W.; Ramires J.; Lopes N.; Wajchenberg B.L.;
Martinez E.E.; Oliveira S.A.; Ribeiro E.E.; Perin M.; Betti R.; Steiner
G.; Barolet A.; Groenewoud Y.; Mighton L.; Camelon K.; O'Rourke R.;
Blodgett J.; Sako E.; Nicastro J.; Prescott R.; Rihal C.; Kennedy F.;
Barsness G.; Basu A.; Clavell A.; Holmes D.R.; Lerman A.; Mullaney C.;
Reeder G.; Rizza R.; Schaff H.; Smith S.; Somers V.; Sundt T.; Ting H.;
Wright R.S.; Helgemoe P.; Lesmeister D.; Rolbiecki D.; Lepe-Montoya L.;
Escobedo J.; Barraza R.; Baleon R.; Campos A.; Garcia P.; Lezama C.;
Miramontes C.; Ocampo S.; Penafiel J.V.; Valdespino A.; Verdin R.;
Albarran H.; Ayala F.; Chavez E.; Murillo H.; Buitron L.V.; Rico-Verdin
B.; Angulo F.; Adler D.; Halle A.A.; Ismail-Beigi F.; Paranjape S.;
Mazzurco S.; Ridley K.; Solomon S.; Wall B.; Weinman D.; Touchstone T.;
Douglas L.; Bourassa M.; Tardif J.-C.; Chiasson J.-L.; Lavoie M.A.;
Rabasa-Lhoret R.; Langelier H.; Foucher S.; Trudel J.; Monrad S.; Srinivas
V.; Zonszein J.; Crandall J.; Duffy H.; Vartolomei E.; King S.; Jacobs C.;
Robertson D.; Porter M.; Eley M.; Nichols E.; LaCorte J.; Rogers W.;
Ovalle F.; Bell D.; Misra V.K.; Hillegass W.B.; Aqel R.; Pierce P.; Smith
M.; Saag L.; Vaughn A.; Smith D.; Grimes T.; Rolli S.; Hill R.; Barrett
B.D.; Morehead C.; Doss K.; Davidson C.J.; Molitch M.; Beohar N.; Massaro
E.; Goodreau L.; Arroyo F.; Neuzil P.; Pavlickova L.; Stehlikova S.;
Benedik J.; Coling L.; Davies R.; Glover C.; LeMay M.; Mesana T.; Ooi
T.C.; Silverman M.; Sorisky A.; Favreau C.; McClinton S.; Weiss M.; Weiss
I.; Saulle L.; Kannam H.; Kurylas J.C.; Vasi L.; Douglas J.; Ghazzal Z.;
Sperling L.; Dayamani P.; Gebhart S.; Basu S.; Helmy T.; Tangpricha V.;
Hyde P.; Jenkins M.; Grant B.P.; Kent K.; Suddath W.; Magee M.;
Julien-Williams P.; Reed V.; Nassar C.; Dagenais G.; Garceau C.; Auger D.;
Buller C.; Elliott T.; Ramanathan K.; Ricci D.; Fox R.; Kolesniak D.;
Attubato M.; Feit F.; Richardson S.; Sing I.P.; Slater J.; Amendola A.;
Vargas B.; Tsapatsaris N.; Woods B.; Cushing G.; Rutter M.; Singh P.;
DesRochers G.; Woodhead G.; Gannon D.; Campbell N.S.; Ragosta M.;
Sarembock I.; Powers E.; Barrett E.; Jahn L.; Murie K.; Das G.; Sigurdsson
G.; White C.; Bantle J.; Redmon J.B.; Kwong C.; Tamis-Holland J.; Albu J.;
Hochman J.S.; Wilentz J.; Frances S.; Tormey D.; Pepine C.; Smith K.;
Kennedy L.; Brezner K.; Curry T.; Bleyer F.; Albert S.; Mooradian A.;
Plummer S.; Fuentes F.; Robles R.; Lavis V.; Gomez J.; Iliescu C.;
Underwood C.; Fulton M.S.; Ramirez J.G.; Merta J.; Scott G.; Krishnaswami
A.; Dowdell L.; Berkheimer S.; Greenbaum A.; Whitehouse F.; Pangilinan R.;
Mann K.; Jacobs A.K.; Sternthal E.; Ebner S.; Nedeljkovic Z.; Beardsley
P.; Schneider D.; Pratley R.; Cefalu W.; Schnure J.; Rowen M.; Tilton L.;
Niederman A.; Mata C.; Kellerman T.; Farmer J.; Garber A.J.; Kleiman N.;
Howard N.; Nichols D.; Pool M.; Granger C.; Feinglos M.; Adams G.; Green
J.; Druken B.; Underwood D.; Stafford J.L.; Donner T.; Laskey W.; Beach
D.; Lopez J.; Davis A.; Faxon D.; Reutrakul S.; Bayer E.; Marroquin O.;
Cohen H.; Korytkowski M.; Koerbel G.; Baxendell L.; Rosenfelder D.; DeRiso
L.; Farrell C.; Vita T.; McGill J.; Krone R.; Bach R.; Recklein C.; Luepke
K.M.; Clifton M.J.; Farkouh M.E.; Kim M.C.; Smith D.A.; Guzman I.; Travis
A.; O'Keefe J.; Forker A.; Isley W.; Moe R.; Kennedy P.; Rosson M.; Long
A.; Bates E.; Herman W.; Pop-Busui R.; Duvernoy C.; Stevens M.; Luciano
A.; Majors C.; Gottlieb S.H.; Rodriguez A.; Herr M.; Williams D.; Smith
R.J.; Abbott J.D.; Laufgraben M.J.; Grogan M.; Muratori J.; Habib G.;
Marcelli M.; Mikati I.; Cordero E.; Caldwell G.; Schechter D.; Lorber D.;
August P.; Brown M.; Depree P.; Huber K.; Hanusch-Enserer U.; Jordanova
N.; Cilesiz D.; Vogel B.; McCallister B.; Kleerekoper M.; Mandagere K.;
Urbanic R.; Bengston J.; Kong B.K.; Pruitt A.; Sanfield J.; Carulli C.;
Churley-Strom R.; Magorien R.; Osei K.; Boyer C.C.; Lee R.; Palumbo P.;
Wisbey J.; Alderman E.; Michael Steffes A.S.; Nowicki M.; Bucksa J.;
Chaitman B.; Eckstein J.; Stocke K.; Boothroyd D.B.; Melsop K.A.; Sobel
B.E.; Neimane D.; Iskandrian A.E.; Schaaf M.B.; Genuth S.; Bongarno T.;
Nesto R.; Hultberg K.; Rosenhouse-Romeo H.; Pambianco G.; Mock M.; Ryan
T.; Lebovitz H.; Brown R.; Friesinger G.; Horton E.; Mason J.; Virmani R.;
Wechsler L.; Bairey-Merz C.N.; Kennedy J.W.; Antman E.; Colwell J.; Fowler
S.; Furberg C.; Goldman L.; Jennings B.; Rankin S.
Institution
(Ikeno, Nakagawa, Kim, Kaneda, Mitsutake, Waseda, Hlatky) Division of
Cardiovascular Medicine, Stanford University School of Medicine, Stanford,
California, United States
(Brooks, Vlachos, Kelsey) Department of Epidemiology, University of
Pittsburgh, Pittsburgh, Pennsylvania, United States
(Schwartz) Division of Cardiology, University Health Network-Toronto
General Hospital, Toronto, Ontario, Canada
(Frye) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
(Hlatky) Department of Health Research and Policy, Stanford University
School of Medicine, Stanford, California, United States
Publisher
Elsevier USA
Abstract
Background The extent of coronary disease affects clinical outcomes and
may predict the effectiveness of coronary revascularization with either
coronary artery bypass graft (CABG) surgery or percutaneous coronary
intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) score quantifies the extent
of coronary disease. Objectives This study sought to determine whether
SYNTAX scores predicted outcomes and the effectiveness of coronary
revascularization compared with medical therapy in the BARI-2D (Bypass
Angioplasty Revascularization Investigation 2 Diabetes) trial. Methods
Baseline SYNTAX scores were retrospectively calculated for BARI-2D
patients without prior revascularization (N = 1,550) by angiographic
laboratory investigators masked to patient characteristics and outcomes.
The primary outcome was major cardiovascular events (a composite of death,
myocardial infarction, and stroke) over 5 years. Results A mid/high SYNTAX
score (>=23) was associated with a higher risk of major cardiovascular
events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01).
Patients in the CABG stratum had significantly higher SYNTAX scores: 36%
had mid/high SYNTAX scores compared with 13% in the PCI stratum (p <
0.001). Among patients with low SYNTAX scores (<=22), major cardiovascular
events did not differ significantly between revascularization and medical
therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the
PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high
SYNTAX scores, however, major cardiovascular events were lower after
revascularization than with medical therapy in the CABG stratum (15.3% vs.
30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12).
Conclusions Among patients with diabetes and stable ischemic heart
disease, higher SYNTAX scores predict higher rates of major cardiovascular
events and were associated with more favorable outcomes of
revascularization compared with medical therapy among patients suitable
for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2
Diabetes; NCT00006305) Copyright © 2017 American College of
Cardiology Foundation

<61>
Accession Number
368825088
Title
Systematic review of the accuracy of dual-source cardiac CT for detection
of arterial stenosis in difficult to image patient groups.
Source
Radiology. 267 (2) (pp 387-395), 2013. Date of Publication: 01 Jan 2013.
Author
Westwood M.E.; Raatz H.D.I.; Misso K.; Burgers L.; Redekop K.; Lhachimi
S.K.; Armstrong N.; Kleijnen J.
Institution
(Westwood, Misso, Armstrong) Kleijnen Systematic Reviews Ltd, Escrick
Business Park, Escrick, York YO19 6FD, United Kingdom
(Raatz) Basel Institute of Clinical Epidemiology and Biostatistics,
University Hospital Basel, Basel, Switzerland
(Burgers, Redekop, Lhachimi) Institute of Health Policy and Management,
Erasmus University Rotterdam, Rotterdam, Netherlands
(Kleijnen) School for Public Health and Primary Care, Maastricht
University, Maastricht, Netherlands
Publisher
Radiological Society of North America Inc.
Abstract
Purpose: To assess the diagnostic performance of dual-source cardiac (DSC)
computed tomography (CT) newer-generation CT instruments for identifying
anatomically significant coronary artery disease (CAD) in patients who are
difficult to image by using 64-section CT. Material(s) and Method(s):
A literature search comprised bibliographic databases (January 1, 2000, to
March 22, 2011, with a pragmatic update on September 6, 2012), trial
registries, and conference proceedings. Only studies using invasive
coronary angiography as reference standard were included. Risk of bias was
assessed (QUADAS-2). Results were stratified according to patient group on
the basis of clinical characteristics. Summary estimates of sensitivity
and specificity of DSC CT for detecting 50% or greater arterial stenosis
were calculated by using a bivariate summary receiver operating
characteristic or random-effects model. Result(s): Twenty-five
studies reported accuracy of DSC CT for diagnosing CAD in difficult to
image patients; in 22 studies, one of two CT units of the same
manufacturer (Somatom Definition or Somatom Definition Flash) was used,
and in the remaining three, a different CT unit of another manufacturer
(Aquilion One) was used. The pooled, per-patient estimates of sensitivity
were 97.7% (95% confidence interval [CI]: 88.0%, 99.9%) and 97.7% (95% CI:
93.2%, 99.3%) for patients with arrhythmias and high heart rates,
respectively. The corresponding pooled estimates of specificity were 81.7%
(95% CI: 71.6%, 89.4%) and 86.3% (95% CI: 80.2%, 90.7%), respectively. All
data were acquired by using Somatom Definition. In two studies with
Somatom and one study with Aquilion One, sensitivity estimates of 90% or
greater were reported in patients with previous stent implantations;
specificities were 81.7% and 89.5% for Somatom and 81.0% for Aquilion One.
In patients with high coronary calcium scores, previous bypass grafts, or
obesity, only per-segment or per-artery data were available. Sensitivity
estimates remained high (.90% in all but one study), and specificities
ranged from 79.1% to 100%. All data were acquired by using Somatom
Definition. Conclusion(s): DSC CT may be sufficiently accurate to
diagnose clinically significant CAD in some or all difficult to image
patients. © RSNA, 2013.

<62>
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.

<63>
Accession Number
628251087
Title
Pressure support ventilation, sigh adjunct to pressure support
ventilation, and neurally adjusted ventilatory assist in infants after
cardiac surgery: A physiologic crossover randomized study.
Source
Pediatric Pulmonology. 54 (7) (pp 1078-1086), 2019. Date of Publication:
July 2019.
Author
Bonacina D.; Bronco A.; Nacoti M.; Ferrari F.; Fazzi F.; Bonanomi E.;
Bellani G.
Institution
(Bonacina, Nacoti, Ferrari, Fazzi, Bonanomi) Pediatric Intensive Care
Unit, A.S.S.T. Papa Giovanni XXIII, Bergamo, Italy
(Bronco, Bellani) Department of Emergency and Intensive Care, San Gerardo
Hospital, Monza, Italy
(Bellani) Department of Medicine and Surgery, University of Milan-Bicocca,
Monza, Italy
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We sought to compare gas exchange, respiratory mechanics, and
asynchronies during pressure support ventilation (PSV), sigh adjunct to
PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in
hypoxemic infants after cardiac surgery. Design(s): Prospective,
single-center, crossover, randomized physiologic study. Setting(s):
Tertiary-care pediatric intensive care unit. Patient(s): Fourteen
hypoxemic infants (median age 11.5 days [8.7-74]). Intervention(s):
The protocol begins with a 1 hour step of PSV, followed by two consecutive
steps in PSV SIGH and NAVA in random order, with a washout period of 30
minutes (PSV) between them. Main Result(s): Three infants presented
an irregular Eadi signal because of diaphragmatic paralysis and were
excluded from analysis. For the remaining 11 infants, PaO<inf>2</inf>/FiO
<inf>2</inf> and oxygenation index improved in PSV SIGH compared with PSV
(P < 0.05) but not in NAVA compared with PSV. PSV SIGH showed increased
tidal volumes and lower respiratory rate than PSV (P < 0.05), as well as a
significant improvement in compliance with respiratory system indexed to
body weight when compared with both PSV and NAVA (P < 0.01). No changes in
mean airway pressure was registered among steps. Inspiratory time resulted
prolonged for both PSV SIGH and NAVA than PSV (P < 0.05). NAVA showed the
higher coefficient of variability in respiratory parameters and a
significative decrease in asynchrony index when compared with both PSV and
PSV SIGH (P < 0.01). Conclusion(s): The adjunct of one SIGH per
minute to PSV improved oxygenation and lung mechanics while NAVA provided
the best patient-ventilator synchrony in infants after cardiac
surgery. Copyright © 2019 Wiley Periodicals, Inc.

<64>
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).

<65>
Accession Number
627200492
Title
Pentoxifylline, progression of chronic kidney disease (CKD) and
cardiovascular mortality: long-term follow-up of a randomized clinical
trial.
Source
Journal of Nephrology. 32 (4) (pp 581-587), 2019. Date of Publication: 01
Aug 2019.
Author
de Morales A.M.; Goicoechea M.; Verde E.; Carbayo J.; Barbieri D.; Delgado
A.; Verdalles U.; de Jose A.P.; Luno J.
Institution
(de Morales, Goicoechea, Verde, Carbayo, Barbieri, Delgado, Verdalles, de
Jose, Luno) Nephrology Department, Hospital General Universitario Gregorio
Maranon, C/Dr Esquerdo 46, Madrid 28007, Spain
(Goicoechea, Delgado, Luno) Spanish Kidney Research Network (REDINREN),
FEDER FUND, Madrid, Spain
Publisher
Springer International Publishing
Abstract
Background: Pentoxifylline could reduce proteinuria and slow renal disease
progression. We previously conducted a single-blind, randomized,
controlled trial that showed that pentoxifylline decreases inflammatory
markers and stabilizes renal function. Setting and Participants: 91
participants (46 in the pentoxifylline group and 45 in the control group)
followed up for 7 additional years. Study design: Post hoc analysis of a
long-term follow-up after completion of the 12-months trial.
 Intervention(s): Pentoxifylline treatment (400 mg/twice a day) or
standard treatment. Outcome(s): Renal event (defined as starting
dialysis therapy and/or doubling serum creatinine and/or >= 50% decrease
in estimated glomerular filtration rate) and cardiovascular mortality.
 Result(s): During follow-up, a renal event was recorded in 24
patients from control group (13 initiated dialysis therapy and serum
creatinine doubled in 11) and 11 patients from PTF group (7 initiated
dialysis and serum creatinine doubled in 4) (log Rank: 5.822, p = 0.016).
The possible protector effect of PTF was more significant in albuminuric
patients and was independently of diabetes mellitus presence. Treatment
with PTF reduced the renal events by 35% compared to the control group in
a Cox model adjusted for diabetes mellitus, albuminuria and basal renal
function (HR 0.65 (0.45-0.94), p = 0.022). Cardiovascular mortality was
significantly reduced in PTF treatment (2 patients vs. 10 in control
group) (log Rank 5.0977, p = 0.024). PTF treatment reduced cardiovascular
mortality in 55% adjusted for diabetes mellitus and age (HR 0.45
(0.21-0.98), p = 0.044) (Table 3). Limitation(s): Small sample size,
single center, not double blind and post hoc follow-up analysis.
 Conclusion(s): Long-term treatment with pentoxifylline may slow the
rate of progression of kidney disease and reduce cardiovascular
risk. Copyright © 2019, Italian Society of Nephrology.

<66>
Accession Number
628168717
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)

<67>
Accession Number
628283112
Title
Comparison between hemodynamic effects of propofol and thiopental during
general anesthesia induction with remifentanil infusion: a double-blind,
age-stratified, randomized study.
Source
Journal of Anesthesia. (no pagination), 2019. Date of Publication: 2019.
Author
Hino H.; Matsuura T.; Kihara Y.; Tsujikawa S.; Mori T.; Nishikawa K.
Institution
(Hino, Matsuura, Kihara, Tsujikawa, Mori, Nishikawa) Department of
Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7
Asahimachi, Abeno-ku, Osaka 545-8586, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: Propofol is commonly used with remifentanil for induction of
general anesthesia (GA); however, it often leads to hypotension.
Intraoperative hypotension is associated with postoperative adverse
events. By contrast, thiopental has less negative inotropic effects on
hemodynamics compared to propofol, which could be suitable to prevent
hypotension during GA induction. In the present age-stratified,
randomized, assessor-blinded study, using the ClearSight
system, we compared the hemodynamic effects of propofol and thiopental
during GA induction under remifentanil infusion in non-cardiac surgery.
 Method(s): Patients were divided into young (20-40 year), middle
(41-70 year), and elderly (> 70 year) groups (n = 20, each group). General
anesthesia was induced with remifentanil 0.3 mug/kg/min, followed by
propofol (2.0, 1.5, and 1.2 mg/kg) or thiopental (5.0, 4.0, and 3.0 mg/kg)
in the young, middle, and elderly groups, respectively. The primary
outcome was the difference in the decrease in mean arterial blood pressure
between patients receiving propofol and thiopental in each age group. The
secondary outcomes included other hemodynamic parameters and minimal
bispectral index values measured up to 10 min after tracheal intubation.
 Result(s): The decrease in mean arterial blood pressure was greater
in patients receiving propofol than those receiving thiopental (- 45.4 vs
- 26.6 mmHg and - 45.7 vs - 28.9 mmHg, P = 0.003 and 0.007, respectively),
whereas no significant difference was observed in the young age group (P =
0.96). Conclusion(s): Thiopental is a more suitable agent than
propofol for avoiding hypotension during GA induction under remifentanil
infusion in the middle and elderly patients. Copyright © 2019,
Japanese Society of Anesthesiologists.

<68>
Accession Number
2002142929
Title
High-Flow Therapy by Nasal Cannulae Versus High-Flow Face Mask in Severe
Hypoxemia After Cardiac Surgery: A Single-Center Randomized Controlled
Study-The HEART FLOW Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Vourc'h M.; Nicolet J.; Volteau C.; Caubert L.; Chabbert C.; Lepoivre T.;
Senage T.; Roussel J.-C.; Rozec B.
Institution
(Vourc'h, Nicolet, Caubert, Chabbert, Lepoivre, Rozec) Intensive Care Unit
of Cardiothoracic Surgery, Department of Anesthesia and Critical Care,
Hopital Laennec, University Hospital of Nantes, Nantes, France
(Volteau) Department of Methodology and Biostatistics, Department of
Research Promotion, University Hospital of Nantes, Nantes, France
(Senage, Roussel) Cardiovascular and Thoracic Surgery Unit, Hopital
Laennec, University Hospital of Nantes, Nantes, France
Publisher
W.B. Saunders
Abstract
Objective: To determine whether high-flow oxygen therapy by nasal cannulae
(HFNC) is more effective than a high-flow face mask (HFFM) in severe
hypoxemia. Design(s): Randomized, single-center, open-labeled,
controlled trial. Setting(s): University Hospital of Nantes, France.
 Participant(s): Cardiac surgery patients presenting oxygen saturation
<96% with Venturi mask 50%. Intervention(s): Oxygenation by HFNC (45
L/min, F<inf>I</inf>O<inf>2</inf> 100%) or Hudson RCI non-rebreather face
mask with a reservoir bag (15 L/min). Measurements and Main Results:
The co-primary outcomes were the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio at 1 and 24 hours. In the
intent-to-treat analysis (90 patients), the mean (standard deviation)
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratios were: after 1 hour,
113.4 (50.2) in HFFM versus 137.8 (57.0) in HFNC (mean difference 24.4, CI
97.5% [2.9-45.9], p = 0.03), and after 24 hours, 106.9 (62.6) in HFFM
versus 129.9 (54.0) in HFNC (mean difference 23.0, CI 97.5% [1.5-44.6], p
= 0.04). After adjustment on baseline
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf>, this difference persisted at
24 hours (p = 0.04). For secondary outcomes, the
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio after 6 hours was 108.7
(47.9) in HFFM versus 136.0 (45.2) in HFNC (p = 0.01), without difference
after 48 hours (p = 0.95). Refractory hypoxemia requiring noninvasive
ventilation occurred in 13 (28%) patients in HFNC versus 24 (56%) patients
in HFFM (p = 0.007). The HFNC improved satisfaction (p = 0.0002) and
reduced mucus dryness (p = 0.003) compared with HFFM. Conclusion(s):
In patients with severe hypoxemia after cardiac surgery,
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> at 1 and 24 hours were higher
and the use of noninvasive ventilation was reduced in HFNC compared with
HFFM. Copyright © 2019 Elsevier Inc.

<69>
Accession Number
2002138523
Title
Traditional Chinese Medicine Treatment as Adjuvant Therapy in Completely
Resected Stage IB-IIIA Non-Small-Cell Lung Cancer: Study Protocol for a
Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial.
Source
Clinical Lung Cancer. (no pagination), 2019. Date of Publication: 2019.
Author
Jiang Y.; Liu L.-S.; Shen L.-P.; Liu J.-X.; Jiang G.-N.; Gu A.-Q.; Li
H.-C.; Li Q.; Li H.-G.; Huang P.-X.
Institution
(Jiang, Liu, Shen, Liu, Li) Department of Oncology, Longhua Hospital,
Shanghai University of Traditional Chinese Medicine, Shanghai, China
(Li) Department of Oncology, Shuguang Hospital, Shanghai University of
Traditional Chinese Medicine, Shanghai, China
(Huang) Department of Health Statistics, Shanghai University of
Traditional Chinese Medicine, Shanghai, China
(Jiang) Department of Thoracic Surgery, Shanghai Pulmonary Hospital,
Tongji University, Shanghai, China
(Gu) Department of Respiratory Medicine, Shanghai Chest Hospital,
Shanghai, China
(Li) Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong
University, Shanghai, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Adjuvant chemotherapy (AC) has been proven to yield an approximately 5%
improvement in 5-year survival for patients with early-stage
non-small-cell lung cancer. With such small gains in survival, the optimal
treatment regimen remains to be established. Traditional Chinese medicine
(TCM) treatment in combination with AC is frequently used in China. The
efficacy and safety of this integrated approach should be scientifically
evaluated. We present the rationale and study design of the Combined
Adjuvant Chemotherapy and Traditional Chinese Medicine (ACTCM) trial
(ChiCTR-IPR-16009062). The ACTCM trial, a prospective multicenter
double-blind randomized placebo-controlled study, will recruit 312
patients overall from 5 clinical research centers in China. Within 6 weeks
of the thoracic surgery, eligible participants with stages IB-IIIA
non-small-cell lung cancer will be randomly assigned in a 1:1 ratio to
either the treatment or control group. Patients in the treatment group
will receive AC combined with TCM herbal treatment for 4 cycles, then TCM
herbal plus injection treatment for 4 cycles. Patients in the control
group will receive AC combined with TCM placebo for 4 cycles and then TCM
placebo for 4 cycles. Treatment will be discontinued if disease
progression or unacceptable toxicity occurs. The primary end point is
2-year disease-free survival. Secondary end points include disease-free
survival and quality of life. Other end points are TCM symptoms,
performance status, and safety of the regimens. Recruitment started in
October 2016 and is ongoing. Copyright © 2019 Elsevier Inc.

<70>
Accession Number
2002138087
Title
Incidence, determinants and impact of acute kidney injury in patients with
diabetes mellitus and multivessel disease undergoing coronary
revascularization: Results from the FREEDOM trial.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Arbel Y.; Fuster V.; Baber U.; Hamza T.H.; Siami F.S.; Farkouh M.E.
Institution
(Arbel) Department of Cardiology, Tel Aviv Medical Center, Affiliated with
the University of Tel Aviv, Tel Aviv, Israel
(Fuster, Baber) Icahn School of Medicine at Mount Sinai, New York, United
States
(Fuster, Baber) Centro Nacional de Investigaciones Cardiovasculares,
Madrid, Spain
(Hamza, Siami) New England Research Institute (NERI), United States
(Farkouh) Peter Munk Cardiac Centre, and Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background: The incidence and prognostic significance of acute kidney
injury (AKI) in patients with diabetes mellitus and multivessel coronary
artery disease undergoing coronary revascularization is not well known.
The current analysis included patients randomized to PCI vs. CABG as part
of the FREEDOM trial. We sought to examine the impact of AKI and its
predictors in diabetic patients with multivessel coronary artery disease
undergoing PCI vs. CABG. Method(s): We conducted a pre-specified
subgroup analysis of the FREEDOM trial to examine the incidence,
correlates and impact of AKI according to revascularization strategy. AKI
predictors were identified using multivariable logistic regression and
associations between AKI and outcomes were examined using Cox regression.
The primary endpoint was the composite occurrence of all-cause death,
stroke or myocardial infarction at 5 years of follow-up. Result(s):
KI occurred more frequently in patients following CABG (15.6%) compared
with PCI (9.1%) (p < 0.001). AKI was associated with a higher risk for
major cardiovascular events (MACE) at 5 years (34.6% vs. 20.5%, p <
0.001), an effect that remained large and significant irrespective of CABG
(HR = 2.18 95% CI 1.44-3.31, p <=0.001) or PCI (HR = 2.08 95% CI
1.35-3.21, p < 0.0001). There was a non-significant interaction (p-value =
0.89) between the revascularization method and AKI, supporting that AKI is
a significant risk factor in both revascularization methods.
 Conclusion(s): Although risk for AKI was higher in patients
undergoing CABG, the impact of AKI on MACE was substantial irrespective of
revascularization strategy. Preventive strategies to identify patients at
risk for AKI are warranted to mitigate the long-term effects of this
complication. Copyright © 2019

<71>
Accession Number
2002132642
Title
Prognostic value of coronary artery calcium score in symptomatic
individuals: A meta-analysis of 34,000 subjects.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Lo-Kioeng-Shioe M.S.; Rijlaarsdam-Hermsen D.; van Domburg R.T.; Hadamitzky
M.; Lima J.A.C.; Hoeks S.E.; Deckers J.W.
Institution
(Lo-Kioeng-Shioe, Rijlaarsdam-Hermsen, van Domburg, Hoeks, Deckers)
Department of Cardiology, Erasmus MC, University Medical Center,
Rotterdam, Netherlands
(Rijlaarsdam-Hermsen) Medical Center Haaglanden Bronovo, The Hague,
Netherlands
(Hadamitzky) Institut fur Radiologie und Nuklearmedizin, Hospital at the
Technische Universitat Munchen, Munich, Germany
(Lima) Department of Cardiology, Johns Hopkins Hospital and School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Coronary artery calcium (CAC) scanning has evolved into an
important subclinical prediction method for cardiovascular diseases in
asymptomatic subjects. However, the prognostic implication of CAC scanning
in symptomatic individuals is less clear. Objective(s): To assess the
prognostic utility of CAC in predicting risk of major adverse cardiac
events (MACE) in stable patients with suspected CAD. Method(s): We
did a systematic electronic literature search for studies presenting
original data in CAC score, and reporting cardiovascular events in stable,
symptomatic patients as primary outcome. Primary outcome of the
meta-analysis was the occurrence of MACE, a composite of late coronary
revascularization, hospitalization for unstable angina or heart failure,
nonfatal myocardial infarction, and cardiac death or all-cause mortality.
Using random effects models, we pooled relative risk ratios of CAC for
MACE, and adjusted hazard ratios (HR) of the associations between
different CAC strata (CAC 0-100,100-400, and >= 400, versus CAC = 0) and
incident MACE. Result(s): We included 19 observational studies (n =
34,041). In total, 1601 events were analyzed, of which 158 in patients
with CAC = 0. The pooled relative risk ratio was 5.71 (95%-CI: 3.98;8.19)
for subjects with CAC > 0. The pooled estimate of adjusted HRs
demonstrated increasing, positive associations, with the strongest
association for CAC > 400 (HR: 4.88; 95%-CI: 2.44;9.27).
 Conclusion(s): This meta-analysis demonstrated that increased levels
of CAC are strongly and independently associated with increased risk for
MACE in stable, symptomatic patients with suspected CAD, showing
increasing risk with greater CAC scores. Application of CAC scanning as a
prediction method could be useful for a considerable number of such
patients. Copyright © 2019

<72>
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. 40 (24) (pp 1930-1941), 2019. Date of Publication:
21 Jun 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, 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.

<73>
Accession Number
628455258
Title
Comparison with solid organ transplants reveals distinct face transplant
rejection gene signature that reflects the unique immunobiologyofskin.
Source
American Journal of Transplantation. Conference: 2019 American Transplant
Congress, ATC 2019. United States. 19 (Supplement 3) (pp 615), 2019. Date
of Publication: April 2019.
Author
Win T.; Dyring-Andersen B.; Lopdrap R.; Teague J.; Murakami N.; Chandraker
A.; Tullius S.G.; Pomahac B.; Riella L.V.; Clark R.A.
Institution
(Win, Dyring-Andersen, Lopdrap, Teague, Murakami, Chandraker, Tullius,
Pomahac, Riella, Clark) Brigham and Women's Hospital, Boston, MA, United
States
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Skin containing transplants, such as face transplants, are
immunologi-cally unique. We compared the gene expression profiles of acute
cellular rejection in human face transplants with solid organ transplants
to determine the unique molecular pathways. Method(s): We studied
skin biopsies (n=35) from seven face transplant patients collected during
rejection and non-rejection, using NanoString gene expression profiling,
histology and immunostaining. A combination of exploratory and supervised
bioinformatic methods was used to analyze the gene expression profiles.
 Result(s): Grade 1 rejection (n=6), defined by the Banff criteria,
did not differ significantly from non-rejection (n=10). Grade 2 rejection
(n=8) had evidence of inteferon-gamma signaling and upregulation of T cell
co-stimulatory as well as co-inhibitory molecules. Inteferon-gamma driven
cytotoxicity, tissue injury and robust upregulation of immunoregulatory
pathways were present in Grade 3 rejection (n=ll). Genes of interest were
validated at the protein level using immunofluores-cence staining of
biopsies. To compare the gene expression signatures of face and solid
organ transplants, we undertook a systematic review of the studies across
human kidney, liver and heart transplants. The majority (82%) of genes
unregulated in face transplant rejection were shared with those increased
in solid organ tarnsplant biopsies. Face transplant rejection was uniquely
associated with upregulation of immunoregulatory genes, including SOCS1,
and induction of lipid antigen-presenting CD1 proteins (Figure 1).
 Conclusion(s): As an epithelial barrier tissue, the skin is
constantly confronted by immunologic challenges and therefore, has
developed complex immunoregulatory networks to dampen inappropriate
inflammation and maintain homeostasis. Our data suggests that these
networks are activated in face transplant rejection and could be leveraged
as therapeutic strategy to reduce rejection. [Figure Presented] Figure 1.
Comparison between human face and solid organ transplant rejection.

<74>
Accession Number
628465459
Title
Does Ex Vivo Perfusion Lead to More or Less Intimal Thickening in the
First-year Post-Heart Transplantation?.
Source
Clinical transplantation. (pp e13648), 2019. Date of Publication: 23 Jun
2019.
Author
Sato T.; Azarbal B.; Cheng R.; Esmailian F.; Patel J.; Kittleson M.; Czer
L.; Thottam M.; Levine R.; Dimbil S.; Olymbios M.; Anzai T.; Hamilton
M.A.; Khayal T.; Kobashigawa J.
Institution
(Sato, Azarbal, Patel, Kittleson, Czer, Thottam, Levine, Dimbil, Olymbios,
Hamilton, Kobashigawa) Cardiology, Los Angeles, CA, United States
(Sato, Anzai) Department of Cardiovascular Medicine, Hokkaido University,
Sapporo, Japan
(Cheng, Esmailian) Cardiothoracic Surgery, Los Angeles, CA, United States
(Khayal) TransMedics Inc, Andover, MA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Organ Care System (OCS), an ex-vivo heart perfusion
platform, represents an alternative to the current standard of cold organ
storage that sustains the donor heart in a near-physiologic state.
Previous reports showed that this system had significantly shortened the
cold ischemic time from standard cold storage (CS). However, the effect of
reduced ischemic injury against the coronary vascular bed has not been
examined by intravascular ultrasound (IVUS). METHOD(S): Between
August 2011 and February 2013, heart transplant (HTx) candidates enrolled
in the PROCEED 2 trial were randomized to either CS or OCS. IVUS was
performed at 4-6 weeks (baseline) and repeated 1 year after
transplantation. The change in maximal intimal thickness (MIT) and other
clinical outcomes were examined. RESULT(S): Thirty-nine patients were
randomized and underwent HTx by OCS (n=16) or CS (n=18). Of these, 18
patients (OCS: n=5, CS: n=13) with paired IVUS were examined. There were
no significant differences in the change of MIT and other clinical
outcomes between the groups. CONCLUSION(S): The incidence of cardiac
allograft vasculopathy in donor hearts preserved with the OCS versus CS
was similar. These results suggest that this ex-vivo allograft perfusion
system is a promising and valid platform for donor heart transportation.
This article is protected by copyright. All rights reserved.

<75>
Accession Number
628462578
Title
Cadaveric simulation training in cardiothoracic surgery: A systematic
review.
Source
Anatomical sciences education. (no pagination), 2019. Date of Publication:
24 Jun 2019.
Author
Robinson D.A.; Piekut D.T.; Hasman L.; Knight P.A.
Institution
(Robinson, Knight) Division of Cardiac Surgery, Department of Surgery,
School of Medicine and Dentistry, University of Rochester, Rochester, NY,
United States
(Piekut) Department of Neuroscience, School of Medicine and Dentistry,
University of Rochester, Rochester, NY, United States
(Hasman) Division of Research and Clinical Information Services,
University of Rochester, Rochester, NY, United States
Publisher
NLM (Medline)
Abstract
Simulation training has become increasingly relevant in the educational
curriculum of surgical trainees. The types of simulation models used,
goals of simulation training, and an objective assessment of its utility
and effectiveness are highly variable. The role and effectiveness of
cadaveric simulation in cardiothoracic surgical training has not been well
established. The objective of this study was to evaluate the current
medical literature available on the utility and effectiveness of cadaveric
simulation in cardiothoracic surgical residency training. A literature
search was performed using PubMed, Cochrane Library, Embase, Scopus, and
CINAHL from inception to February 2019. Of the 362 citations obtained, 23
articles were identified and retrieved for full review, yielding 10
eligible articles that were included for analysis. One additional study
was identified and included in the analysis. Extraction of data from the
selected articles was performed using predetermined data fields, including
study design, study participants, simulation task, performance metrics,
and costs. Most of these studies were only descriptive of a cadaveric or
perfused cadaveric simulation model that could be used to augment clinical
operative training in cardiothoracic surgery. There is a paucity of
evidence in the literature that specifically evaluates the utility and
efficacy of cadavers in cardiothoracic surgery training. Of the few
studies that have been published in the literature, cadaveric simulation
does seem to have a role in cardiothoracic surgery training beyond simply
learning basic skills. Additional research in this area is needed. This
article is protected by copyright. All rights reserved.

<76>
Accession Number
628462408
Title
Annual case volume on mortality after coronary artery bypass grafting: a
dose-response meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 23 Jun 2019.
Author
Tie H.-T.; Shi R.; Zhou Q.; Wang K.; Zheng X.-Q.; Wu Q.-C.
Institution
(Tie, Wu) Department of Cardiothoracic Surgery, First Affiliated Hospital
of Chongqing Medical University, Chongqing, China
(Shi) Department of Cardiology, First Affiliated Hospital of Chongqing
Medical University, Chongqing, China
(Zhou) Department of Science and Education, First People's Hospital of
Changde City, Hunan, China
(Wang) Department of Endocrine and Breast Surgery, First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
(Zheng) Department of Chemical Biology, School of Pharmaceutical Science,
Peking University Health Science Center, Beijing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study evaluated the effect of both hospital and surgeon
annual case volumes on patient mortality following coronary artery bypass
grafting (CABG). METHOD(S): PubMed and Embase databases were searched
for clinical studies on CABG. The outcome was mortality, including
operative mortality, in-hospital mortality and 30-day mortality.
 RESULT(S): Twenty-five studies involving 3492101 participants and
143951 deaths were included for hospital volume, and 4 studies involving
108356 participants and 2811 deaths were included for surgeon volume. The
pooled estimate revealed that both hospital and surgeon annual case
volumes were inversely associated with mortality in patients after CABG
[odds ratio (OR) for hospital: 0.62, 95% confidence interval (CI)
0.56-0.69; P<0.001; OR for surgeon: 0.51, 95% CI 0.31- 0.83; P<0.001] with
high heterogeneity (hospital: I2=90.6%, Pheterogeneity<0.001; surgeon:
I2=86.8%, Pheterogeneity<0.001). The relationship remained consistent and
robust in most subgroup and sensitivity analyses. Our meta-regression
analysis of time suggested that the strength of the negative associations
between volume and mortality for both hospitals and surgeons remained
unattenuated over time even though the CABG mortality gradually decreased
over time. The dose-response analysis suggested a non-linear relationship
between both hospital and surgeon annual case volumes and mortality (both
Pnon-linearity=0.001). CONCLUSION(S): Both higher hospital and
surgeon annual case volumes are associated with lower mortality in
patients undergoing CABG, and the negative associations remain
unattenuated over time. (The study was registered at PRESPERO as
CRD42017067912.). CLINICAL REGISTRATION NUMBER: The study was registered
at PRESPERO as CRD4201706. Copyright © The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<77>
Accession Number
628460008
Title
Association between marfan syndrome and oral health status: A systematic
review and meta-analysis.
Source
Medicina oral, patologia oral y cirugia bucal. (no pagination), 2019. Date
of Publication: 24 Jun 2019.
Author
Galletti C.; Camps-Font O.; Teixido-Tura G.; Llobet-Poal I.; Gay-Escoda C.
Institution
(Galletti) Faculty of Medicine and Health Sciences University of Barcelona
Campus de Bellvitge Faculty of Medicine and Health Sciences Surgery and
Oral Implantology C/ Feixa Llarga, s/n; Pavello Govern, 2da planta 08907
L'Hospitalet de Llobregat; Barcelona (Spain)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose was to identify and assess the existing scientific
evidence from epidemiologic, non-experimental, observational studies of
associations between Marfan's syndrome and oral diseases. MATERIAL AND
METHODS: Electronic literature searches in MEDLINE (OVID), The Cochrane
Library, Scopus and the Web of Science were conducted to identify all
relevant articles. Eligibility was based on inclusion criteria, and
quality assessments were conducted. The outcome variables were probing
depth, gingival margin, clinical attachment level, bleeding on probing,
gingival status, periodontal status, tooth mobility, furcation involvement
and decayed, missing and filled teeth index. After extracting data,
meta-analyses were carried out. RESULT(S): Out of 527 potentially
eligible papers, 3 cross-sectional studies were included. No statistically
significant differences were found in the number of sites with bleeding on
probing (OR: 1.26; 95% CI: 0.47 to 3.42; P = 0.65; I2: 0%), probing depth
(MD: -0.14 mm; 95% CI: -0.24 to 0.53; P = 0.46; I2: 93%), periodontal
status (WMD: 0.68 points; 95% CI: -0.48 to 1.83; P = 0.25; I2: 98%) nor
number of decayed, missing and filled teeth index score (MD: 1.08 points.;
95% CI: -1.27 to 3.42; P = 0.37; I2: 0%). CONCLUSION(S): Patients
diagnosed with Marfan's syndrome do not seem to have worsened oral health
status. Due to the high number of patients with Marfan's syndrome that
have prosthetic heart valves, an adequate dental monitoring as well as a
strict maintenance therapy program should be implemented.

<78>
Accession Number
2002249474
Title
Hands-On Surgical Simulation in Congenital Heart Surgery: Literature
Review and Future Perspective.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Hussein N.; Honjo O.; Haller C.; Hickey E.; Coles J.G.; Williams W.G.; Yoo
S.-J.
Institution
(Hussein, Honjo, Haller, Hickey, Coles, Williams, Yoo) Division of
Cardiology, Department of Paediatrics, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
(Hussein, Honjo, Haller, Hickey, Coles, Williams) Division of
Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
(Yoo) Department of Diagnostic Imaging, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
Publisher
W.B. Saunders
Abstract
Congenital heart surgery is a technically demanding specialty resulting in
a prolonged training period. With the growing expectation of perfect
patient outcomes, there is a need for improved training methods by
implementing simulation. We assess the utilization of simulation in the
training of congenital heart surgeons and discuss its future implications.
A keyword-based PubMed literature search was conducted for hands-on
surgical simulation in congenital heart surgery. The abstracts/titles of
the search were reviewed and papers using simulation specific to
congenital cardiac surgery were selected. Studies that did not include
surgeons operating on the simulator, or did not incorporate assessment
methods were excluded. Analysis included the problem addressed,
simulator-type, methodology, assessment methods, results,
benefits/limitations, and reproducibility. Five papers fulfilled our
selection criteria of hands-on surgical simulation in congenital heart
surgery with an assessment of the simulator or procedural performance. One
simulation used animal models and 4 utilized 3D-printed models. Simulators
covered either single or multiple complex procedures. All studies
highlight usefulness of simulation; however, only 1 study has been
replicated with >10 participants. The studies demonstrate how hands-on
surgical simulation is possible within congenital heart surgery. Although
primarily proof of concept studies, the next step would involve using a
greater number of participants and demonstrate how repetition and
deliberate practice will improve outcomes. Congenital heart surgery is one
of the most technically demanding surgical specialties; therefore, we
should lead the way in utilizing simulation to complement the training of
our surgeons as we face the challenges ahead. Copyright © 2019

<79>
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.

<80>
Accession Number
626669510
Title
Outcomes following surgical revascularization with single versus bilateral
internal thoracic arterial grafts in patients with left main coronary
artery disease undergoing coronary artery bypass grafting: Insights from
the EXCEL trial.
Source
European Journal of Cardio-thoracic Surgery. 55 (3) (pp 501-509), 2019.
Date of Publication: 01 Mar 2019.
Author
Thuijs D.J.F.M.; Head S.J.; Stone G.W.; Puskas J.D.; Taggart D.P.; Serruys
P.W.; Dressler O.; Crowley A.; Brown W.M.; Horkay F.; Boonstra P.W.;
Bogats G.; Noiseux N.; Sabik J.F.; Kappetein A.P.
Institution
(Thuijs, Head, Kappetein) Department of Cardiothoracic Surgery, Erasmus
MC, University Medical Centre, 230, PO Box 2040, Rotterdam 3000,
Netherlands
(Stone) Department of Cardiology, Columbia University Medical Center, New
York-Presbyterian Hospital, Cardiovascular Research Foundation, New York,
NY, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's,
New York, NY, United States
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Dressler, Crowley) Cardiovascular Research Foundation, New York, NY,
United States
(Brown) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, GA, United States
(Horkay) Department of Cardiology, National Institute of Cardiology,
Budapest, Hungary
(Boonstra) Department of Cardiothoracic Surgery, Medical Center
Leeuwarden, Leeuwarden, Netherlands
(Bogats) Department of Cardiac Surgery, University of Szeged, Szeged,
Hungary
(Noiseux) Department of Surgery, FacultCrossed D Signde MCrossed D
Signdecine, UniversitCrossed D Sign de MontrCrossed D Signal, Montreal,
QC, Canada
(Sabik) Department of Cardiovascular Surgery, University Hospitals,
Cleveland, OH, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Observational data suggest that the use of a single internal thoracic
artery (SITA) may result in inferior outcomes compared with bilateral
internal thoracic artery (BITA) use for coronary artery bypass grafting
(CABG) - A finding not yet supported by randomized trial outcomes.
However, the optimal number of internal thoracic artery grafts in patients
with left main coronary artery disease has not been investigated.
 METHOD(S): The EXCEL trial randomized 1905 patients with left main
coronary artery disease to percutaneous coronary intervention with
everolimus-eluting stents versus CABG. Among the 905 patients undergoing
CABG, 688 (76.0%) received SITA and 217 (24.0%) received BITA. Differences
in clinical event rates were estimated using the Kaplan-Meier method and
compared with the log-rank test. Multivariable Cox regression was used to
adjust for differences in baseline covariates. RESULT(S): Compared to
SITA, patients treated with BITA were younger (66.1 9.5 vs 64.5 9.3 years,
P = 0.020), were less likely female (24.3% vs 14.3%, P = 0.002) and
diabetic (28.8% vs 15.2%, P < 0.001), and had a lower prevalence of
peripheral vessel disease (10.2% vs 5.5%, P = 0.040). The unadjusted
3-year composite primary endpoint of death, stroke or myocardial
infarction (MI) occurred in 15.6% of SITA vs 11.6% of BITA patients (P =
0.17). The SITA group tended to have a higher 3-year rate of all-cause
death compared with the BITA group (6.7% vs 3.3%; P = 0.070). Stroke, MI
and ischaemia-driven revascularization outcomes were not significantly
different between groups. After adjusting for baseline differences,
neither the composite of death, stroke or MI [hazard ratio (HR) 1.12, 95%
confidence interval (CI) 0.71-1.78; P = 0.62] nor mortality (HR 1.36, 95%
CI 0.60-3.12; P = 0.46) was significantly higher with SITA. The
rehospitalization rate after 3 years was higher in the SITA group (35.8%
vs 26.0%, P = 0.008), a difference which was no longer present after
multivariable adjustment (HR 1.27, 95% CI 0.93-1.74; P = 0.13). Sternal
wound dehiscence within 30 days did not occur more often in the BITA group
compared to the SITA group (1.8% vs 2.2%, P>0.99). CONCLUSION(S): In
the EXCEL trial, there were no clinical differences at 3 years between
SITA or BITA revascularization in patients with left main coronary artery
disease. Copyright © 2018. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.

<81>
[Use Link to view the full text]
Accession Number
627473689
Title
Therapeutic challenges in patients with noncardioembolic acute ischemic
stroke in need of double antiplatelet therapy for coronary artery disease.
Source
American Journal of Therapeutics. 26 (2) (pp E213-E221), 2019. Date of
Publication: 01 Mar 2019.
Author
Oana Darabont R.; Stoicescu C.; Tiu C.
Institution
(Oana Darabont, Stoicescu) Discipline of Internal Medicine and Cardiology,
University Emergency Hospital Bucharest, University of Medicine and
Pharmacy Carol Davila, 169 Splaiul Independentei, 5th District, Bucharest
050098, Romania
(Tiu) Discipline of Neurology, University Emergency Hospital Bucharest,
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:The risk of ischemic stroke (IS) is significant within 6-12
months from the myocardial revascularization for an acute cardiac event.
Consequently, we can expect to have patients with an acute IS occurring
right in the time frame of dual antiplatelet therapy (DAPT) imposed by the
coronary heart disease (CHD).Areas of Uncertainty:Until present, there are
no evidence-based guidelines for the management of patients with acute IS
in need of DAPT for ischemic heart disease. The aim of this article was to
go through the available data and to depict the appropriate therapeutic
strategy for this category of patients. Data Sources:We have
performed a systematic review of the literature through June 2018, using
Medline/PubMed database.Therapeutic Advances:DAPT (aspirin and only
clopidogrel among all P2Y<inf>12</inf> inhibitors) might be maintained or
initiated for CHD in patients with minor acute stroke and high-risk
transient ischemic attack patient with IS attributable to an important
intracranial stenosis, as long as this drug combination proved to be safe
for them in the prevention of stroke recurrence. In patients with IS
receiving thrombolysis, with increased size of infarction or high National
Institute of Health Stroke Score (NIHSS), the risk of hemorrhagic
transformation under DAPT must be weighed against the risk of stent
thrombosis in the coronary arteries, which, on its turn, depends on the
clinical form for which myocardial revascularization was performed, the
time interval from the complexity of a certain interventional procedure.
 Conclusion(s):In the acute phase of an IS, maintenance or initiation
of DAPT therapy imposed by CHD relies, on one hand, on the risk of
hemorrhagic transformation of the brain injury and, on the other hand, on
the risk of stent thrombosis in the coronary arteries. The management of
these patients must be carried on by a vascular team, on an individualized
basis. Copyright © 2019 Wolters Kluwer Health, Inc. All rights
reserved.

<82>
Accession Number
2002187411
Title
Prevalence of Infective Endocarditis in Enterococcus faecalis Bacteremia.
Source
Journal of the American College of Cardiology. 74 (2) (pp 193-201), 2019.
Date of Publication: 16 July 2019.
Author
Dahl A.; Iversen K.; Tonder N.; Hoest N.; Arpi M.; Dalsgaard M.; Chehri
M.; Soerensen L.L.; Fanoe S.; Junge S.; Hoest U.; Valeur N.; Lauridsen
T.K.; Fosbol E.; Hoi-Hansen T.; Bruun N.E.
Institution
(Dahl, Iversen, Dalsgaard, Soerensen, Lauridsen, Hoi-Hansen, Bruun)
Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen,
Denmark
(Dahl, Hoest, Valeur) Department of Cardiology, Bispebjerg Hospital,
Copenhagen, Denmark
(Tonder) Department of Cardiology, Nordsjaellands Hospital, Hillerod,
Denmark
(Arpi) Department of Clinical Microbiology, Herlev Gentofte University
Hospital, Copenhagen, Denmark
(Chehri) Department of Clinical Microbiology, Hvidovre University
Hospital, Hvidovre, Denmark
(Fanoe, Fosbol) Department of Cardiology, Hvidovre University Hospital,
Hvidovre, Denmark
(Junge, Hoest) Department of Cardiology, University Hospital Glostrup,
Glostrup, Denmark
(Fosbol) Department of Cardiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Bruun) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Bruun) Clinical Institute, Copenhagen University, Copenhagen, Denmark
(Bruun) Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
Publisher
Elsevier USA
Abstract
Background: Enterococcus faecalis is the third most frequent cause of
infective endocarditis (IE). Despite this, no systematic prospective
echocardiography studies have examined the prevalence of IE in patients
with E. faecalis bacteremia. Objective(s): This study sought to
determine the prevalence of IE in patients with E. faecalis bacteremia.
The secondary objective was to identify predictors of IE. Method(s):
From January 1, 2014, to December 31, 2016, a prospective multicenter
study was conducted with echocardiography in consecutive patients with E.
faecalis bacteremia. Predictors of IE were assessed using multivariate
logistic regression with backward elimination. Result(s): A total of
344 patients with E. faecalis bacteremia were included, all examined using
echocardiography, including transesophageal echocardiography in 74% of the
cases. The patients had a mean age of 74.2 years, and 73.5% were men.
Definite endocarditis was diagnosed in 90 patients, resulting in a
prevalence of 26.1 +/- 4.6% (95% confidence interval [CI]). Risk factors
for IE were prosthetic heart valve (odds ratio [OR]: 3.93; 95% CI: 1.76 to
8.77; p = 0.001), community acquisition (OR: 3.35; 95% CI: 1.74 to 6.46; p
< 0.001), >=3 positive blood culture bottles (OR: 3.69; 95% CI: 1.88 to
7.23; p < 0.001), unknown portal of entry (OR: 2.36; 95% CI: 1.26 to 4.40;
p = 0.007), monomicrobial bacteremia (OR: 2.73; 95% CI: 1.23 to 6.05; p =
0.013), and immunosuppression (OR: 2.82; 95% CI: 1.20 to 6.58; p = 0.017).
 Conclusion(s): This study revealed a high prevalence of 26% definite
IE in patients with E. faecalis bacteremia, suggesting that
echocardiography should be considered in all patients with E. faecalis
bacteremia. Copyright © 2019 American College of Cardiology
Foundation

<83>
Accession Number
628284000
Title
Effects of dexamethasone on post-operative cognitive dysfunction and
delirium in adults following general anaesthesia: A meta-analysis of
randomised controlled trials.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 113.
Date of Publication: 29 Jun 2019.
Author
Li L.-Q.; Wang C.; Fang M.-D.; Xu H.-Y.; Lu H.-L.; Zhang H.-Z.
Institution
(Li, Wang, Fang, Xu, Lu, Zhang) Department of Anesthesiology, Jilin
University Second Hospital, No. 218 Ziqiang street, Changchun, Jilin
130021, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Several studies have investigated the effects of dexamethasone
on post-operative cognitive dysfunction (POCD) or post-operative delirium
(POD); however, their conclusions have been inconsistent. Thus, we
conducted a meta-analysis to determine the effects of dexamethasone on
POCD and POD in adults following general anaesthesia. Method(s): The
Cochrane Central Register of Controlled Trials (2018, Issue 11 of 12) in
the Cochrane Library (searched 17 November 2018), MEDLINE OvidSP (1946 to
16 November 2018) and Embase OvidSP (1974 to 16 November 2018) were
searched for randomised controlled trials that evaluated the incidence of
POCD and POD following dexamethasone administration in adults (age >= 18
years) under general anaesthesia. We used the Grading of Recommendations,
Assessment, Development and Evaluations framework to assess the quality of
the evidence. Result(s): Five studies were included (three studies
with 855 participants in the dexamethasone group and 538 participants in
the placebo group for the incidence of POCD, and two studies with 410
participants in the dexamethasone group and 420 participants in the
placebo group for the incidence of POD). There was no significant
difference between the dexamethasone group and the placebo group in terms
of the incidence of POCD 30 days after surgery (RR [relative risk] 1.00;
95% CI [confidence interval: 0.51, 1.96], P = 1.00, I 2 = 77%)
or the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I
2 = 0%). However, both analyses had some limitations because of
limited evidence and clinical heterogeneity, and we considered the quality
of the evidence for the post-operative incidence of POCD and POD to be
very low. Conclusion(s): This meta-analysis revealed that
prophylactic dexamethasone did not reduce the incidence of POCD and POD.
Trials of alternative preventive strategies for POCD and POD, as well as a
better understanding of the pathophysiology of those complex syndromes,
are still needed to make progress in this field. Trial registrationr: This
study is registered with PROSPERO, 23 October 2018, number CRD42018114552.
Available from
https://www.crd.york.ac.uk/PROSPERO/#recordDetails. Copyright ©
2019 The Author(s).

<84>
[Use Link to view the full text]
Accession Number
628131553
Title
Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent
Persistent Pain after Cardiac Surgery.
Source
Anesthesiology. 131 (1) (pp 119-131), 2019. Date of Publication: 01 Jul
2019.
Author
Anwar S.; Cooper J.; Rahman J.; Sharma C.; Langford R.
Institution
(Anwar) From the Department of Perioperative Medicine, Barts Heart Centre,
United Kingdom (S.A.) National Institutes of Health Research Biomedical
Research Centre at Barts, J.C.) Pain and Anaesthesia Research Centre,
United Kingdom (S.A., J.R., C.S., St. Bartholomew's Hospital, London,
Canada
Publisher
NLM (Medline)
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Cardiac surgery is associated with
a significant rate of chronic postoperative painFew proven strategies
exist to reduce chronic postoperative pain WHAT THIS ARTICLE TELLS US THAT
IS NEW: The administration of pregabalin (14 days) with or without
ketamine (2 days) postoperatively reduced the prevalence of pain at 3 and
6 monthsSide effects from pregabalin and ketamine administration were
generally mild BACKGROUND:: Persistent postsurgical pain is common and
affects quality of life. The hypothesis was that use of pregabalin and
ketamine would prevent persistent pain after cardiac surgery.
 METHOD(S): This randomized, double-blind, placebo-controlled trial
was undertaken at two cardiac surgery centers in the United Kingdom.
Adults without chronic pain and undergoing any elective cardiac surgery
patients via sternotomy were randomly assigned to receive either usual
care, pregabalin (150mg preoperatively and twice daily for 14
postoperative days) alone, or pregabalin in combination with a 48-h
postoperative infusion of intravenous ketamine at 0.1mg . kg . h. The
primary endpoints were prevalence of clinically significant pain at 3 and
6 months after surgery, defined as a pain score on the numeric rating
scale of 4 or higher (out of 10) after a functional assessment of three
maximal coughs. The secondary outcomes included acute pain, opioid use,
and safety measures, as well as long-term neuropathic pain, analgesic
requirement, and quality of life. RESULT(S): In total, 150 patients
were randomized, with 17 withdrawals from treatment and 2 losses to
follow-up but with data analyzed for all participants on an
intention-to-treat basis. The prevalence of pain was lower at 3
postoperative months for pregabalin alone (6% [3 of 50]) and in
combination with ketamine (2% [1 of 50]) compared to the control group
(34% [17 of 50]; odds ratio = 0.126 [0.022 to 0.5], P = 0.0008; and 0.041
[0.0009 to 0.28], P < 0.0001, respectively) and at 6 months for pregabalin
alone (6% [3 of 50]) and in combination with ketamine 0% (0 of 5) compared
to the control group (28% [14 of 50]; odds ratio = 0.167 [0.029 to 0.7], P
= 0.006; and 0.000 [0 to 0.24], P < 0.0001). Diplopia was more common in
both active arms. CONCLUSION(S): Preoperative administration of 150mg
of pregabalin and postoperative continuation twice daily for 14 days
significantly lowered the prevalence of persistent pain after cardiac
surgery.

<85>
Accession Number
628437876
Title
Hands-on surgical simulation in congenital heart surgery: Literature
review and future perspective.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2019.
Date of Publication: 17 Jun 2019.
Author
Hussein D.N.; Honjo D.O.; Haller D.C.; Hickey D.E.; Coles D.J.G.; Williams
D.W.G.; Yoo D.S.-J.
Institution
(Hussein, Honjo, Haller, Hickey, Coles, Williams) Division of Cardiology,
Department of Paediatrics and Division of Cardiovascular Surgery,
Department of Surgery, Hospital for Sick Children, University of Toronto,
Toronto, ON, Canada
(Yoo) Department of Diagnostic Imaging and Division of Cardiology,
Department of Paediatrics Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Congenital heart surgery is a technically demanding
speciality resulting in a prolonged training period. With the growing
expectation of perfect patient outcomes there is a need for improved
training methods by implementing simulation. We assess the utilization of
simulation in the training of congenital heart surgeons and discuss its
future implications. METHOD(S): A keyword-based PubMed literature
search was conducted for hands-on surgical simulation in congenital heart
surgery. The abstracts/titles of the search were reviewed and papers using
simulation specific to congenital cardiac surgery were selected. Studies
that did not include surgeons operating on the simulator, or did not
incorporate assessment methods were excluded. Analysis included: the
problem addressed, simulator-type, methodology, assessment methods,
results, benefits/limitations and reproducibility. RESULT(S): 5
papers fulfilled our selection criteria of hands-on surgical simulation in
congenital heart surgery with an assessment of the simulator or procedural
performance. One simulation used animal models and four utilized
3D-printed models. Simulators covered either single or multiple complex
procedures. All studies highlight usefulness of simulation, however only
one study has been replicated with >10 participants. CONCLUSION(S):
The studies demonstrate how hands-on surgical simulation is possible
within congenital heart surgery. Although primarily proof of concept
studies, the next step would involve using a greater number of
participants and demonstrate how repetition and deliberate practice will
improve outcomes. Congenital heart surgery is one of the most technically
demanding surgical specialities, therefore we should lead the way in
utilizing simulation to complement the training of our surgeons as we face
the challenges ahead. Copyright © 2019. Published by Elsevier
Inc.

<86>
Accession Number
627577767
Title
Remote ischaemic preconditioning in isolated aortic valve and coronary
artery bypass surgery: a randomized trial+.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 55 (5) (pp 905-912),
2019. Date of Publication: 01 May 2019.
Author
Moscarelli M.; Fiorentino F.; Suleiman M.-S.; Emanueli C.; Reeves B.C.;
Punjabi P.P.; Angelini G.D.
Institution
(Moscarelli, Suleiman, Reeves, Angelini) Faculty of Health Sciences,
Bristol Heart Institute, Bristol Medical School, University of Bristol,
Bristol, United Kingdom
(Fiorentino, Emanueli, Punjabi) Imperial College, National Heart and Lung
Institute, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This trial was designed and patients were recruited at a time
when the benefits of remote ischaemic preconditioning during open-heart
surgery were still controversial. We focused on a homogeneous patient
population undergoing either isolated aortic valve replacement or coronary
artery bypass grafting (CABG) surgery by investigating cardiac injury,
metabolic stress and inflammatory response. METHOD(S): A 2-centre
randomized controlled trial recruited a total of 124 patients between
February 2013 and April 2015. Of them, 64 patients underwent CABG and 60
patients underwent aortic valve replacement. Patients were randomized to
either sham or preconditioning. Remote ischaemic preconditioning was
applied following anaesthesia and before sternotomy. Myocardial injury and
inflammatory response were assessed by serially measuring cardiac troponin
I, and interleukin-6, 8, 10 and the tumour necrosis factor (TNF-alpha).
Biopsies from the left and the right ventricles were harvested after
ischaemic reperfusion injury for nucleotides analysis. RESULT(S):
Application of remote ischaemic preconditioning did not alter the degree
of troponin I release, levels of inflammatory markers and cardiac
energetics in both the CABG and the aortic valve replacement groups.
 CONCLUSION(S): Preconditioning did not confer any additional
cardioprotection in terms of reducing the levels of troponin I and
inflammatory markers and preserving left and right ventricle energy
metabolites in patients undergoing isolated CABG or aortic valve surgery.
CLINICAL TRIAL REGISTRATION NUMBER: International Standard Randomized
Controlled Trial Number (ISRCTN) registry ID 33084113 (doi:
10.1186/ISRCTN33084113) and UK controlled randomized trial number (UKCRN)
registry ID 13672. Copyright © The Author(s) 2018. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<87>
Accession Number
2001384178
Title
Heparin-Induced Thrombocytopenia and Cardiac Surgery.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2018.
Date of Publication: 2018.
Author
Solanki J.; Shenoy S.; Downs E.; Palkimas S.; Goldman S.; Sharma A.M.
Institution
(Solanki) Department of Medicine, University of Virginia, Charlottesville,
VA, United States
(Shenoy) Division of Cardiovascular Medicine, University of Arizona,
Tuscan, AZ, United States
(Downs) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
(Palkimas, Goldman) Department of Pharmacy, University of Virginia,
Charlottesville, VA, United States
(Sharma) Division of Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
Publisher
W.B. Saunders
Abstract
Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition
characterized by thrombocytopenia with possible arterial and/or venous
thrombosis. The overall incidence of HIT is low but ranges from 0.1% to
5%.1,2 The incidence can be as high as 3% in patients
undergoing cardiac surgery. The use of unfractionated heparin (UFH) is
ubiquitous in patients who undergo cardiac procedures and carries a
10-fold higher incidence of HIT over low molecular weight heparin.
Patients undergoing cardiac surgery thus form a unique group that warrants
specific attention to this clinicopathologic entity considering the
relatively high incidence and associated morbidity and mortality with a
delay in diagnosis. In this article, we will discuss 5 clinical aspects
pertinent to the diagnosis and management of HIT in cardiac surgery
patients and review the current literature. Copyright © 2018

<88>
Accession Number
628438135
Title
Mid-term results of a randomized trial of tricuspid annuloplasty for
less-than-severe functional tricuspid regurgitation at the time of mitral
valve surgery+.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 55 (5) (pp 851-858),
2019. Date of Publication: 01 May 2019.
Author
Pettinari M.; De Kerchove L.; Lazam S.; Pasquet A.; Gerber B.;
Vanoverschelde J.-L.; El-Khoury G.
Institution
(Pettinari) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk,
Belgium
(De Kerchove, El-Khoury) Cardiac Surgery Department, Universitair Clinique
St. Luc, Brussel, Belgium
(Lazam, Pasquet, Gerber, Vanoverschelde) Cardiology Department,
Universitair Clinique St. Luc, Brussel, Belgium
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The optimal management of functional tricuspid regurgitation
(FTR) in the setting of mitral valve operations remains controversial. The
current practice is both centre specific and surgeon specific with
guidelines based on non-randomized data. A prospective randomized trial
was performed to evaluate the worth of less-than-severe FTR repair during
mitral valve procedures. METHOD(S): A single-centre randomized study
was designed to allocate patients with less-than-severe FTR undergoing
mitral valve surgery to be prophylactically treated with or without
tricuspid valve annuloplasty (TVP- or TVP+). These patients were analysed
using longitudinal cardiopulmonary exercise capacity, echocardiographic
follow-up and cardiac magnetic resonance. The primary outcome was freedom
from more than or equal to moderate tricuspid regurgitation with vena
contracta >=4mm. Secondary outcomes were maximal oxygen uptake and right
ventricular (RV) dimension and function. RESULT(S): A total of 53
patients were allocated to receive concomitant TVP+, and 53 patients were
treated conservatively (TVP-). At 5 years, tricuspid regurgitation was
observed to be greater than mild in 10 patients in the TVP- group and no
patients in the TVP+ group (P<0.01). Maximal oxygen uptake, RV basal
diameter, end-diastolic diameter and end-systolic diameter and fractional
area changes were similar in both groups. Cardiac magnetic resonance
confirmed no differences in RV end-diastolic volume, RV end-systolic
volume and RV ejection fraction. CONCLUSION(S): This single-centre
prospective randomized trial demonstrated that prophylactic tricuspid
annuloplasty irrespective of annular dilatation at the time of mitral
surgery reduced the recurrence of moderate or severe FTR at 5-year
follow-up and reduced the pulmonary pressure. Nevertheless, the functional
capacity, the RV function and the RV dimension remained
similar. Copyright © The Author(s) 2018. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<89>
Accession Number
628442503
Title
Safety of a Restrictive versus Liberal Approach to Red Blood Cell
Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery:
A Randomized Clinical Trial.
Source
Journal of the American Society of Nephrology : JASN. (no pagination),
2019. Date of Publication: 20 Jun 2019.
Author
Garg A.X.; Badner N.; Bagshaw S.M.; Cuerden M.S.; Fergusson D.A.; Gregory
A.J.; Hall J.; Hare G.M.T.; Khanykin B.; McGuinness S.; Parikh C.R.;
Roshanov P.S.; Shehata N.; Sontrop J.M.; Syed S.; Tagarakis G.I.; Thorpe
K.E.; Verma S.; Wald R.; Whitlock R.P.; Mazer C.D.
Institution
(Garg) Division of Nephrology, Department of Medicine, London Health
Sciences Centre and Western University, London, Ontario, Canada;
(Badner) Department of Anesthesia & Clinical Pharmacology, University of
British Columbia, Kelowna, BC, Canada
(Bagshaw) Department of Critical Care Medicine, University of Alberta,
Edmonton, AB, Canada
(Cuerden, Sontrop) Division of Nephrology, Department of Medicine, London
Health Sciences Centre and Western University, London, ON, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
University of Calgary, Calgary, AB, Canada
(Hall, Hare, Thorpe, Verma, Wald, Mazer) Li Ka Shing Knowledge Institute,
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Khanykin) Cardiothoracic Anesthesiology Department, Copenhagen University
Hospital, Copenhagen, Denmark
(McGuinness) Cardiothoracic and Vascular Intensive Care and High
Dependency Unit, Auckland City Hospital, Auckland, New Zealand
(Parikh) Division of Nephrology, Department of Medicine, Johns Hopkins
School of Medicine, Baltimore, MD, United States
(Roshanov, Syed, Whitlock) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Shehata) Department of Medicine, Mount Sinai Hospital, University of
Toronto, Toronto, Ontario, Canada; and
(Tagarakis) Department of Cardiothoracic Surgery, Aristotle University
Hospital of Thessaloniki, Thessaloniki, Greece
Publisher
NLM (Medline)
Abstract
BACKGROUND: Safely reducing red blood cell transfusions can prevent
transfusion-related adverse effects, conserve the blood supply, and reduce
health care costs. Both anemia and red blood cell transfusion are
independently associated with AKI, but observational data are insufficient
to determine whether a restrictive approach to transfusion can be used
without increasing AKI risk. METHOD(S): In a prespecified kidney
substudy of a randomized noninferiority trial, we compared a restrictive
threshold for red blood cell transfusion (transfuse if hemoglobin<7.5
g/dl, intraoperatively and postoperatively) with a liberal threshold
(transfuse if hemoglobin<9.5 g/dl in the operating room or intensive care
unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied
4531 patients undergoing cardiac surgery with cardiopulmonary bypass who
had a moderate-to-high risk of perioperative death. The substudy's primary
outcome was AKI, defined as a postoperative increase in serum creatinine
of >=0.3 mg/dl within 48 hours of surgery, or >=50% within 7 days of
surgery. RESULT(S): Patients in the restrictive-threshold group
received significantly fewer transfusions than patients in the
liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer
transfusions in the restricted-threshold group compared with the
liberal-threshold group; P<0.001). AKI occurred in 27.7% of patients in
the restrictive-threshold group (624 of 2251) and in 27.9% of patients in
the liberal-threshold group (636 of 2280). Similarly, among patients with
preoperative CKD, AKI occurred in 33.6% of patients in the
restrictive-threshold group (258 of 767) and in 32.5% of patients in the
liberal-threshold group (252 of 775). CONCLUSION(S): Among patients
undergoing cardiac surgery, a restrictive transfusion approach resulted in
fewer red blood cell transfusions without increasing the risk of
AKI. Copyright © 2019 by the American Society of Nephrology.

<90>
Accession Number
628439265
Title
Reported outcomes after aortic valve resuspension for acute type A aortic
dissection: a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 10 Apr 2019.
Author
Chen S.-K.; Qiu Z.-H.; Fang G.-H.; Wu X.-J.; Chen L.-W.
Institution
(Chen, Qiu, Fang, Wu, Chen) Department of Cardiac Surgery, Union Hospital,
Fujian Medical University, Fuzhou, Fujian, China
Publisher
NLM (Medline)
Abstract
In the majority of patients presenting with acute type A aortic dissection
(AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can
be preserved by AV resuspension. A meta-analysis was performed to
investigate the outcomes following AV resuspension for AAD. A systematic
literature search for publications reporting outcomes after AV
resuspension in AAD published between January 1998 and June 2018 was
conducted. Early outcome events and linearized occurrence rates for late
outcome events were derived. The retrieval process yielded 18 unique
studies involving 3295 patients with a total of 17 532 patient-years
(pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95%
CI) 11.5-19.4%, I2 = 91.9%], and the linearized late mortality rate was
3.21%/pt-yrs (95% CI 2.49-3.77, I2 = 29%). The linearized occurrence rates
for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88-1.79, I2 =
48%); for recurrent significant aortic valve insufficiency (>2+), it was
1.12%/pt-yrs (95% CI 0.79-1.45, I2 = 68%); and for endocarditis, it was
0.01%/pt-yrs (95% CI 0-0.04, I2 = 7%). The composite rate of
thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18-2.63, I2 =
82%). A more recent surgical period was associated with a decreased hazard
of reoperation on the aortic root (P<0.001). Requirement of AV
resuspension alone in AAD is a risk factor for mortality. The long-term
durability of AV resuspension is excellent, with low rates of endocarditis
and thromboembolism and bleeding. Root reoperation hazard has become
acceptable in recent years. Preoperative aortic valve insufficiency grade
exceeding 2+ is a predictor for root reoperation. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<91>
Accession Number
628428105
Title
Minimally invasive surgical approaches to left main and left anterior
descending coronary artery revascularization are superior compared to
first- and second-generation drug-eluting stents: a network meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 20 Jun 2019.
Author
Indja B.; Woldendorp K.; Black D.; Bannon P.G.; Wilson M.K.; Vallely M.P.
Institution
(Indja, Woldendorp, Bannon) Sydney Medical School, University of Sydney,
Camperdown, NSW, Australia
(Woldendorp, Bannon) Baird Institute of Applied Heart & Lung Surgical
Research, Sydney, Australia
(Woldendorp, Bannon) Department of Cardiothoracic Surgery, Royal Prince
Alfred Hospital, Camperdown, Sydney, NSW, Australia
(Black) Faculty of Health Sciences, University of Sydney, Camperdown, NSW,
Australia
(Wilson, Vallely) Sydney Heart and Lung Surgeons, Camperdown, NSW,
Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: There are a number of minimally invasive approaches to
revascularization of coronary artery disease that involve the left main or
proximal left anterior descending artery; however, studies to date provide
mixed results. METHOD(S): A Bayesian network meta-analysis was
performed to compare early and late postoperative outcomes between
percutaneous coronary intervention with first- and second-generation
drug-eluting stents (DESs), off-pump coronary artery bypass and minimally
invasive direct coronary artery bypass (MIDCAB) in patients with
involvement of left main or left anterior descending disease.
 RESULT(S): A total of 37 studies with 31 728 patients were included
in the analysis. There were no significant differences in early mortality
rates, strokes or myocardial infarctions (MIs). The long-term all-cause
mortality rate was equivalent between the groups. Patients who had
off-pump coronary artery bypass had fewer late MI compared with those who
had first-generation DES (DES1) [odds ratio (OR) 0.38, 95% confidence
interval (CI) 0.20-0.72] and MIDCAB (OR 0.41, 95% CI 0.17-0.97) and
reduced late target vessel revascularization compared with DES1 (OR 0.17,
95% CI 0.09-0.32) and second-generation DES (DES2) (OR 0.32, 95% CI
0.14-0.72). The rate of late major adverse cardiac events was lower with
off-pump coronary artery bypass compared with that with DES1 (OR 0.33, 95%
CI 0.26-0.43) and DES2 (OR 0.62, 95% CI 0.45-0.90). The rate of late major
adverse cardiac events with MIDCAB was lower than that with DES1 (OR 0.43,
95% CI 0.31-0.62) as was that with DES2 compared with DES1 (OR 0.53, 95%
CI 0.39-0.70). CONCLUSION(S): Surgical approaches to left main or
proximal left anterior descending disease remain superior to first- or
second-generation DES in terms of long-term freedom from MI and target
vessel revascularization as well as improved overall long-term survival.
Conflicting rates of late MI and target vessel revascularization in
patients who underwent MIDCAB suggest disease in alternate vessels that
may best be approached via hybrid techniques. Copyright © The
Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<92>
Accession Number
628429793
Title
Impact of cell saver during cardiac surgery on blood transfusion
requirements: a systematic review and meta-analysis.
Source
Vox Sanguinis. (no pagination), 2019. Date of Publication: 2019.
Author
Al Khabori M.; Al Riyami A.; Siddiqi M.S.; Sarfaraz Z.K.; Ziadinov E.; Al
Sabti H.
Institution
(Al Khabori, Al Riyami) Department of Hematology, Sultan Qaboos University
Hospital, Muscat, Oman
(Siddiqi, Sarfaraz, Ziadinov, Al Sabti) Department of Cardiac Surgery,
Sultan Qaboos University Hospital, Muscat, Oman
(Al Sabti) Oman Medical Specialty Board, Muscat, Oman
Publisher
Blackwell Publishing Ltd
Abstract
Objective: We performed a systematic review and meta-analysis of
randomized clinical trials on adult patients undergoing cardiac surgery
and compared the rates of red blood cell (RBC), platelet and fresh frozen
plasma (FFP) transfusion between the cell saver (CS) and the standard of
care groups. Method(s): MEDLINE , The Cochrane Central Register of
Controlled Trials (CENTRAL), American Society of Hematology (ASH) and
bibliographies of relevant studies were searched. We used random-effect
model. Result(s): Our search strategy returned 624 citations, of
which 15 studies were selected. The use of CS did not decrease the rate of
RBC transfusion (odds ratio [OR]: 0.69; 95% CI: 0.48-1.00), albeit with a
substantial heterogeneity (I2 = 60%). The year of publication
explained most of the heterogeneity (P for subgroup effect <0.001).
Although the rate of platelet transfusion was lower in the CS group, the
difference was not statistically significant (OR: 0.83; 95% CI: 0.57-1.2;
I2 = 0%). The rate of FFP transfusion was numerically higher in
the CS group; however, this difference did not reach statistical
significance (OR: 1.26; 95% CI: 0.82-1.94; I2 = 15%). Only two
studies scored five on the Jadad score. There was no indication of a
publication bias using the funnel plot and Egger test (P = 0.34, 0.87, and
0.62 for RBC, platelet and FFP, respectively). Conclusion(s): The use
of CS during cardiac surgery does not have an impact on the rates of RBC,
platelet and FFP transfusion; however, this should be interpreted in the
light of the study limitations. Copyright © 2019 International
Society of Blood Transfusion

<93>
Accession Number
628442109
Title
Generalizing causal inferences from individuals in randomized trials to
all trial-eligible individuals.
Source
Biometrics. (no pagination), 2018. Date of Publication: 29 Nov 2018.
Author
Dahabreh I.J.; Robertson S.E.; Tchetgen E.J.; Stuart E.A.; Hernan M.A.
Institution
(Dahabreh, Robertson) Center for Evidence Synthesis in Health, Brown
University School of Public Health, Providence, RI, United States
(Dahabreh) Departments of Health Services, Policy & Practice and
Epidemiology, Brown University, Providence, RI, United States
(Dahabreh, Hernan) Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, MA, United States
(Tchetgen) Department of Statistics, University of Pennsylvania, Wharton
Business School, Philadelphia, PA, United States
(Stuart) Departments of Mental Health, Biostatistics, Health Policy and
Management, Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, United States
(Hernan) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Hernan) Harvard-MIT Division of Health Sciences and Technology, Boston,
MA, United States
Publisher
NLM (Medline)
Abstract
We consider methods for causal inference in randomized trials nested
within cohorts of trial-eligible individuals, including those who are not
randomized. We show how baseline covariate data from the entire cohort,
and treatment and outcome data only from randomized individuals, can be
used to identify potential (counterfactual) outcome means and average
treatment effects in the target population of all eligible individuals. We
review identifiability conditions, propose estimators, and assess the
estimators' finite-sample performance in simulation studies. As an
illustration, we apply the estimators in a trial nested within a cohort of
trial-eligible individuals to compare coronary artery bypass grafting
surgery plus medical therapy vs. medical therapy alone for chronic
coronary artery disease. Copyright © 2019 The International
Biometric Society.

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