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<1>
Accession Number
2002284403
Title
Postoperative shared-care for patients undergoing non-cardiac surgery: a
systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. 66 (9) (pp 1095-1105), 2019. Date of
Publication: 15 Sep 2019.
Author
Mazzarello S.; McIsaac D.I.; Montroy J.; Fergusson D.A.; Yateem D.;
Devereaux P.J.; Lalu M.M.
Institution
(Mazzarello, McIsaac, Montroy, Fergusson, Lalu) Clinical Epidemiology
Program, Blueprint Translational Research Group, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Mazzarello, McIsaac, Fergusson) School of Epidemiology and Public Health,
University of Ottawa, Ottawa, ON, Canada
(McIsaac, Yateem, Lalu) Department of Anesthesiology and Pain Medicine,
The Ottawa Hospital Research Institute, Room B307, 1053 Carling Ave, Mail
Stop 249, Ottawa, ON K1Y 4E9, Canada
(Fergusson) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
(Devereaux) Population Health Research Institute, David Braley Cardiac,
Vascular, and Stroke Research Institute, McMaster University, Hamilton,
ON, Canada
(Lalu) Regenerative Medicine Program, The Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Lalu) Department of Cellular and Molecular Medicine, University of
Ottawa, Ottawa, ON, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Collaborative ("shared-care") models of postoperative care
improve outcomes in patients undergoing surgery for hip fracture. Despite
being widely adopted, it is unclear if similar benefits of shared-care
models exist for other at-risk surgical patient populations. Thus, we
performed a systematic review to understand the impact of shared-care
models. Method(s): EMBASE, MEDLINE, CINAHL, and Cochrane Central
Register databases were searched for prospective studies examining an
in-hospital shared-care approach to postoperative management of adult
non-cardiac surgery patients. The primary outcome was a composite of
in-hospital mortality and mortality of up to 30 days. Secondary outcomes
were long-term mortality (> 90 days) and hospital length of stay. Tertiary
outcomes included quality of life and health utility measures. Risk of
bias was assessed using Cochrane Collaboration tools. Result(s): Six
thousand eight hundred and ninety-six citations were reviewed and four
studies (n = 987 patients) met the inclusion criteria-two
randomized-controlled trials (RCT, n = 729 patients) and two
non-randomized-controlled trials (NRCT, n = 258 patients). All studies
were conducted in the elective surgical setting. There was no association
between shared-care and control groups for in-hospital mortality (Peto
odds ratio, 1.76; 95% confidence interval [CI], 0.65 to 4.80), or hospital
length of stay (mean difference, -1.41; 95% CI, -3.18 to 0.35). Reporting
of other outcomes was limited. Both RCTs were judged to be at high risk of
bias for blinding and both NRCTs were judged to be at moderate risk of
bias for reported outcomes. Conclusion(s): Overall, there was limited
high-quality evidence to evaluate the effect of postoperative shared-care.
Well-designed interventional studies, perhaps targeting higher risk
surgical populations, are needed. Registration: PROSPERO (CRD42018094943);
registered 16 May, 2018. Copyright © 2019, Canadian
Anesthesiologists' Society.

<2>
Accession Number
2002367816
Title
Characteristics and prognosis of IgG4-related periaortitis/periarteritis:
A systematic literature review.
Source
Autoimmunity Reviews. 18 (9) (no pagination), 2019. Article Number:
102354. Date of Publication: September 2019.
Author
Akiyama M.; Kaneko Y.; Takeuchi T.
Institution
(Akiyama, Kaneko, Takeuchi) Division of Rheumatology, Department of
Internal Medicine, Keio University School of Medicine, Japan
Publisher
Elsevier B.V.
Abstract
Objective: Immunoglobulin G4 (IgG4)-related disease is a systemic chronic
fibroinflammatory disease that can affect almost every organ of the body.
IgG4-related periaortitis/periarteritis is a newly recognized subset of
IgG4-related disease, and its characteristics and prognosis remain
unclear. We investigated the clinical characteristics and prognosis of
IgG4-related periaortitis/periarteritis. Method(s): We performed a
systematic literature review of IgG4-related periaortitis/periarteritis.
Additionally, we have summarized the characteristics and prognosis of
IgG4-related coronary arteritis. Result(s): We investigated 248
patients with IgG4-related periaortitis/periarteritis. All studies
reported the condition in elderly patients, and male predominance was
observed. The infra-renal abdominal aorta and iliac arteries were the most
commonly affected sites. Most reports showed the serum C-reactive protein
elevation in this disease entity, in contrast to non-vascular IgG4-related
disease. Based on radiological findings observed in 27 patients with
IgG4-related coronary arteritis, vasculitic lesions were classified into 3
types: stenotic (67% of patients), aneurysmal (42%), and diffuse wall
thickening type (92%). Serum IgG4 level, but not C-reactive protein level,
was associated with the number of affected organs in IgG4-related coronary
arteritis. Corticosteroid treatment with or without cardiac surgery or
percutaneous coronary intervention was effective in most patients with
IgG4-related coronary arteritis; however, 33% of patients showed an
unfavorable clinical course including disease progression, relapse, or
death. Pre-treatment stenosis and/or aneurysms were associated with
progression of stenosis or aneurysm after corticosteroid treatment.
 Conclusion(s): Most clinical characteristics were similar between the
IgG4-related periaortitis/periarteritis and the non-vascular IgG4-related
disease groups; however, serum C-reactive protein level elevation was
observed only in the former. Although corticosteroid treatment was
effective, this disease can be life-threatening secondary to myocardial
infarction, aortic dissection, and aneurysmal rupture. Pre-treatment
evaluation of stenosis or aneurysms is important for predicting
progression of stenosis or aneurysm after corticosteroid
treatment. Copyright © 2019 Elsevier B.V.

<3>
Accession Number
627429233
Title
Computed tomographic coronary angiography in risk stratification prior to
non-cardiac surgery: a systematic review and meta-analysis.
Source
Heart. 105 (17) (pp 1335-1342), 2019. Date of Publication: 01 Sep 2019.
Author
Koshy A.N.; Ha F.J.; Gow P.J.; Han H.-C.; Amirul-Islam F.M.; Lim H.S.; Teh
A.W.; Farouque O.
Institution
(Koshy, Ha, Han, Lim, Teh, Farouque) Department of Cardiology, Austin
Health, Melbourne, VIC, Australia
(Koshy, Gow, Han, Lim, Teh, Farouque) Austin Health Clinical School,
University of Melbourne, Parkville, Melbourne, VIC, Australia
(Koshy, Gow) Victorian Liver Transplant Unit, Austin Health, Melbourne,
VIC, Australia
(Amirul-Islam) Department of Statistics, Data Science and Epidemiology,
Swinburne University of Technology, Melbourne, VIC, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Utility of CT coronary angiography (CTA) and coronary artery
calcium (CAC) scoring in risk stratification prior to non-cardiac surgery
is unclear. Although current guidelines recommend stress testing in
intermediate-high risk individuals, over one-third of perioperative major
adverse cardiovascular events (MACE) occur in patients with a negative
study. This systematic review and meta-analysis evaluates the value of CTA
and CAC score in preoperative risk prognostication prior to non-cardiac
surgery. Methods MEDLINE, PubMed and EMBASE databases were searched for
articles published up to June 2018. Summary ORs for degree of coronary
artery disease (CAD) and perioperative MACE were pooled using a
random-effects model. Results Eleven studies were included. Two hundred
and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of perioperative
MACE rose with the severity and extent of CAD on CTA (no CAD 2.0%;
non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive
multivessel 23.1%, p<0.001). Multivessel disease (MVD) demonstrated the
greatest risk (OR 8.9, 95% CI 5.1 to 15.3, p<0.001). Increasing CAC score
was associated with higher perioperative MACE (CAC score: >=100 OR 5.1,
>=1000 OR 10.4, both p<0.01). In a cohort deemed high risk by established
clinical indices, absence of MVD on CTA demonstrated a negative predictive
value of 96% (95% CI 92.8 to 98.4) for predicting freedom from MACE.
Conclusions Severity and extent of CAD on CTA conferred incremental risk
for perioperative MACE in patients undergoing non-cardiac surgery. The
'rule-out' capability of CTA is comparable to other non-invasive imaging
modalities and offers a viable alternative for risk stratification of
patients undergoing non-cardiac surgery. Trial registration number
CRD42018100883. Copyright © Author(s) (or their employer(s))
2019.

<4>
Accession Number
2002288694
Title
Comparative study between insulin bolus regimen and glucose insulin
infusion regimen on effectiveness of intraoperative blood glucose control
in patients with type 2 diabetes mellitus undergoing non-cardiac surgery.
Source
Sri Lankan Journal of Anaesthesiology. 27 (2) (pp 110-114), 2019. Date of
Publication: 2019.
Author
Krishna H.M.
Institution
(Krishna) Kasturba Medical College, Manipal, Manipal Academy of Higher
Education, India
Publisher
College of Anaesthesiologists of Sri Lanka (44/5A, Gnanartha
Pradeepaya,Mawatha, Colombo 8, Sri Lanka)
Abstract
Background: The surgical rates are comparatively greater among diabetic
patients. Surgery, a period of stress, mandates fasting and anti-diabetic
medications are skipped on the morning of the procedure. High blood
glucose levels in the peri-operative period can lead to ischaemia,
infection, acute kidney injury and electrolyte disturbances. Hence,
control of blood glucose levels during the peri-operative period becomes
important and there are various regimens described. We compared two of the
existing regimens, intravenous insulin bolus and glucose insulin infusion
regimen, for their effectiveness of intraoperative blood glucose control.
 Method(s): In this randomized, prospective controlled study, 120
patients were enrolled with 60 patients in bolus group and 60 in infusion
group. Capillary blood glucose was measured every hour during the
intra-operative period. The primary outcome measure was proportion of
patients in the target glucose levels between 100 mg/dL and 180 mg/dL and
proportion of intra-operative surgery time (in minutes) during which
patient was in the target range. Secondary outcome measure was serum
potassium levels pre-operatively and postoperatively. Result(s): The
proportion of patients in the target range in the bolus group was 39 out
of 60 as compared to 31 out of 60 in the infusion group (P=0.13). Also,
proportion of intraoperative surgery time (in minutes) during which
patient was in the target glycaemic range was 41.57% in bolus group when
compared to 27.22% in the infusion group (P < 0.05). No hypoglycaemic
episodes were seen in any of the patients in the two groups.
 Conclusion(s): As compared with infusion regimen, bolus regimen
provides better glycaemic control measured in terms of target blood
glucose levels and duration for which the patient remained in the target
range. Copyright © 2019, College of Anaesthesiologists of Sri
Lanka. All rights reserved.

<5>
Accession Number
627537910
Title
Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery
after Surgery Society Recommendations.
Source
JAMA Surgery. 154 (8) (pp 755-766), 2019. Date of Publication: August
2019.
Author
Engelman D.T.; Ben Ali W.; Williams J.B.; Perrault L.P.; Reddy V.S.; Arora
R.C.; Roselli E.E.; Khoynezhad A.; Gerdisch M.; Levy J.H.; Lobdell K.;
Fletcher N.; Kirsch M.; Nelson G.; Engelman R.M.; Gregory A.J.; Boyle E.M.
Institution
(Engelman) Heart and Vascular Program, Baystate Medical Center, 759
Chestnut St, Springfield, MA 01199, United States
(Ben Ali, Perrault) Montreal Heart Institute, Montreal, Canada
(Williams) WakeMed Health and Hospitals, Raleigh, NC, United States
(Reddy) Centennial Heart and Vascular Center, Nashville, TN, United States
(Arora) St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
(Roselli) Cleveland Clinic, Cleveland, OH, United States
(Khoynezhad) MemorialCare Heart and Vascular Institute, Los Angeles, CA,
United States
(Gerdisch) Franciscan Health Heart Center, Indianapolis, IN, United States
(Levy) Duke University School of Medicine, Durham, NC, United States
(Lobdell) Atrium Health, Department of Cardiovascular and Thoracic
Surgery, NC, United States
(Fletcher) St Georges University of London, London, United Kingdom
(Kirsch) Centre Hospitalier Universitaire Vaudois Cardiac Surgery Centre,
Lausanne, Switzerland
(Nelson, Gregory) University of Calgary, Calgary, AB, Canada
(Boyle) Department of Cardiac Surgery, St Charles Medical Center, Bend,
OR, United States
(Arora) Now with Department of Surgery, Max Rady College of Medicine,
University of Manitoba, Winnipeg, Canada
(Engelman) Department of Surgery, Baystate Medical Center, Springfield,
MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Enhanced Recovery After Surgery (ERAS) evidence-based protocols for
perioperative care can lead to improvements in clinical outcomes and cost
savings. This article aims to present consensus recommendations for the
optimal perioperative management of patients undergoing cardiac surgery. A
review of meta-analyses, randomized clinical trials, large nonrandomized
studies, and reviews was conducted for each protocol element. The quality
of the evidence was graded and used to form consensus recommendations for
each topic. Development of these recommendations was endorsed by the
Enhanced Recovery After Surgery Society. Copyright © 2019
American Medical Association. All rights reserved.

<6>
Accession Number
2002602786
Title
A meta-analysis of randomized and observational studies: Aspirin protects
from cardiac surgery-associated acute kidney injury.
Source
Heart Surgery Forum. 22 (4) (pp E301-E307), 2019. Date of Publication:
2019.
Author
Liu H.; Li J.; Chen M.; Yang T.; Ruan Z.; Su J.; Xing Y.
Institution
(Liu, Li, Chen, Yang, Ruan) Department of Department of Critical Care
Medicine, Zhongshan City People's Hospital, Zhongshan City 528403, China
(Su) Department of Neurosurgery, Zhongshan City People's Hospital,
Zhongshan City, Guangdong Province 528403, China
(Xing) Department of Gynecology, Sun Yat-sen Memorial Hospital, Guangzhou
5105120, China
Publisher
Forum Multimedia Publishing LLC (E-mail: motis@cjp.com)
Abstract
Background: Antiplatelet therapy is critical in the management of coronary
artery diseases. For patients undergoing cardiac surgeries, including
coronary artery bypass graft (CABG) and valve replacement, controversy
remains in preoperative antiplatelet therapy concerning risk of bleeding.
For safety concern, aspirin is recommended to be withdrawn 5 to 10 days
before a cardiac surgery. Recent studies, however, indicate that
preoperative aspirin may have a protective effect on cardiac
surgery-associated acute kidney injury (CSA-AKI). Objective(s): To
estimate the efficacy of preoperative aspirin in preventing CSA-AKI.
 Methods and Results: Eligible studies included randomized controlled
trials (RCTs) and observational studies (OSs) of patients, who had
undergone CABG, valve replacement, or combined surgery. These studies
compared preoperative aspirin with placebo/no aspirin and reported the
least incidence of CSA-AKI. One RCT and five OSs met the inclusion
criteria. Data retrieved suggested that aspirin prescribed within five
days before cardiac surgery decreased post-operative renal failure [odds
ratio (OR), 0.67; 95% confidence interval (CI), 0.50-0.89; P < 0.01] and
30-day mortality (OR, 0.64; 95% CI, 0.53-0.77; P < 0.01). One RCT and
three OSs suggested aspirin protected from major adverse cardiocerebral
events (MACE) (OR, 0.88; 95% CI, 0.76-1.01; P = 0.07). One RCT and two OSs
suggested aspirin did not increase risk of re-exploration for bleeding
(OR, 1.01; 95% CI, 0.76-1.34; P = 0.95). Conclusion(s): Preoperative
low-dose aspirin decreases postoperative CSA-AKI, mortality, and MACE
without increasing the risk of re-exploration. But most of the studies are
observational. They lack a uniformed standard on prescription of aspirin
and outcomes measurement. No stratification analysis is performed
concerning different types of surgical procedures and comorbidities. More
randomized controlled trials are necessary to confirm the efficacy and
safety of preoperative aspirin prescription. Copyright © 2019
Forum Multimedia Publishing, LLC.

<7>
Accession Number
2002467081
Title
Impact of telephone follow-up and 24/7 hotline on 30-day readmission rates
following aortic valve replacement -A randomized controlled trial.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Danielsen S.O.; Moons P.; Sandvik L.; Leegaard M.; Solheim S.; Tonnessen
T.; Lie I.
Institution
(Danielsen, Lie) Center for Patient-centered Heart and Lung Research,
Department of Cardiothoracic Surgery, Division of Cardiovascular and
Pulmonary Diseases, Oslo University Hospital, Ulleval, Oslo, Norway
(Danielsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Danielsen, Moons) KU Leuven Department of Public Health and Primary Care,
KU Leuven-University of Leuven, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Moons) Department of Paediatrics and Child Health, University of Cape
Town, South Africa
(Sandvik) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ulleval,
Oslo, Norway
(Solheim) Center for Clinical Heart Research, Department of Cardiology,
Division of Medicine, Oslo University Hospital, Ulleval, Oslo, Norway
(Leegaard) Department of Nursing and Health Promotion, Faculty of Health
Sciences, Oslo Metropolitan University, Oslo, Norway
Publisher
Elsevier Ireland Ltd
Abstract
Background: Thirty-day all-cause readmissions are high after aortic valve
replacement (AVR). We aimed to assess the effectiveness of a structured
telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause
readmission (30-DACR) after AVR, on reducing symptoms of anxiety and
depression and on improving perceived health state. Method(s): A
prospective randomized controlled trial was conducted. Patients (n = 288)
were randomly allocated to either post-discharge usual care or to care
that provided TFU and access to a 24/7 hotline after AVR. Ancillary
endpoints were time-to-event (readmission), proportion of avoidable versus
unavoidable readmissions after AVR, and predictors of 30-DACR after AVR.
 Result(s): 30-DACR was 22.3%. The structured TFU and 24/7 hotline
intervention failed to reduce 30-DACR rates after AVR (P = 0.274).
Symptoms of anxiety were significantly reduced 30 days after surgery (P =
0.031), an effect that did not persist one year after surgery (P = 0.108).
Most readmissions occurred before 15 days post-discharge, and 75% of them
were deemed to be unavoidable. Pleural drainage before hospital discharge
(P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were
predictors of 30-DACR after AVR. Conclusion(s): The TFU and 24/7
hotline had no effect on reducing 30-DACR after AVR. However, we did
measure reduced symptoms of anxiety the first month after AVR. Anxiety
reduction appeared to be an important target for intervention, because we
found it to be a risk factor for readmission. Future research should focus
on the effectiveness of interventions to prevent avoidable unplanned
readmissions. Trial registration: ClinicalTrial.gov,
NCT02522663. Copyright © 2019 Elsevier B.V.

<8>
Accession Number
2002586563
Title
Management of patients with concomitant coronary and carotid artery
disease.
Source
Expert Review of Cardiovascular Therapy. 17 (8) (pp 575-583), 2019. Date
of Publication: 2019.
Author
Drakopoulou M.; Oikonomou G.; Soulaidopoulos S.; Toutouzas K.; Tousoulis
D.
Institution
(Drakopoulou, Oikonomou, Soulaidopoulos, Toutouzas, Tousoulis) First
Department of Cardiology, Medical School of Athens University,
Hippokration Hospital, Athens, Greece
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Ideal management of concomitant carotid and coronary artery
occlusive disease remains under investigation. Although researchers have
advocated the potential benefits of varying treatment strategies based on
either concomitant or staged surgical treatment, there is no consensus in
treatment guidelines. With emerging data suggesting favorable outcome of
carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) in
patients with critical coronary artery disease, physicians must consider
these diverging therapeutic options. Areas covered: This review presents
current evidence regarding the prevalence of carotid stenosis in patients
with coronary artery disease, the common pathophysiologic links with an
emphasis on the diverse mechanisms of stroke in the coronary artery bypass
grafting (CABG) setting and discusses the contemporary registries and
observational studies comparing outcomes of various revascularization
strategies in high-risk patients. Authors conducted a literature search in
two bibliographic databases including papers published from 1983 until
2018 (PubMed, Scopus). Expert opinion: Symptoms should drive the need to
intervene on carotid stenosis in patients undergoing coronary
revascularization. Carotid artery stenting has gained significant ground,
especially among those individuals considered of high surgical risk. PCI
may be considered as an alternative option for the management of severe
concurrent coronary disease. Copyright © 2019, © 2019
Informa UK Limited, trading as Taylor & Francis Group.

<9>
Accession Number
2002416232
Title
New-onset atrial fibrillation after percutaneous coronary intervention or
coronary artery bypass grafting for left main disease.
Source
Medicinski Glasnik. 16 (2) (pp 249-256), 2019. Date of Publication: August
2019.
Author
Avdagic H.; Iveljic I.; Jahic E.; Sijercic S.; Krdzalic A.; Skakic A.;
Radovic J.; Ahmetasevic E.
Institution
(Avdagic, Jahic, Krdzalic, Skakic) Clinic for Cardiovascular Surgery,
Bosnia and Herzegovina
(Iveljic, Radovic) Clinic for Invasive Cardiology, Bosnia and Herzegovina
(Sijercic) Clinic for Anesthesiology, Bosnia and Herzegovina
(Ahmetasevic) Clinic for Surgery, University Clinical Center Tuzla, Bosnia
and Herzegovina
Publisher
Medical Association of Zenica-Doboj Canton (E-mail: selma_kamb@yahoo.com)
Abstract
Aim To determine the prevalence of new-onset atrial fibrillation (NOAF)
following percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) for left main coronary artery disease (LMCAD) and
its effect on 6-month cardiovascular outcomes. Methods This prospective
study included 40 patients diagnosed with LMCAD, in the period from 2017
to 2018. The patients with LMCAD and low or intermediate SYNTAX score were
randomized to PCI with zotarolimus-eluting stents versus CABG. Outcomes
were analyzed according to the development of NOAF during the initial
hospitalization following revascularization. Results Among 40 patients
without atrial fibrillation on presentation, NOAF developed 3.1+/-1.3 days
during hospitalization in three CABG treated patients, and one PCI treated
patient. One patient that was CABG treated developed NOAF after two
months. Patients with versus patients without NOAF had a significantly
longer duration of hospitalization, probably because they were discharged
on anticoagulant therapy. Myocardial infarction was presented in one CABG
treated patient after 3 months, and also in one PCI treated patient after
4 months. One patient died 2 months after the operation, and one developed
stroke 5 months after the CABG operation. Conclusion The NOAF was common
after CABG, but extremely rare after PCI, and it occurred almost
exclusively following CABG. There was a clear statistical tendency for
all-cause death, cardiovascular death and stroke at 6-month follow-up
period. Copyright © 2017, Medical Association of Zenica-Doboj
Canton. All rights reserved.

<10>
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Accession Number
629036869
Title
Fentanyl-based intravenous patient-controlled analgesia with low dose of
ketamine is not inferior to thoracic epidural analgesia for acute
post-Thoracotomy pain following video-Assisted thoracic surgery: A
randomized controlled study.
Source
Medicine (United States). 98 (28) (no pagination), 2019. Article Number:
e16403. Date of Publication: 01 Jul 2019.
Author
Tseng W.-C.; Lin W.-L.; Lai H.-C.; Huang T.-W.; Chen P.-H.; Wu Z.-F.
Institution
(Tseng, Lin, Lai, Chen, Wu) Department of Anesthesiology, No. 901,
Zhonghua Road, Tainan 71004, Taiwan (Republic of China)
(Huang) Division of Chest Surgery, Department of Surgery, Tri-Service
General Hospital and National Defense Medical Center, Taiwan (Republic of
China)
(Chen) Graduate Institute of Public Health, National Defense Medical
Center, Taiwan (Republic of China)
(Wu) D Department of Anesthesiology, Chi Mei Medical Center, Tainan,
Taiwan, R.O.C., Taiwan (Republic of China)
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Thoracic epidural analgesia is the preferred method for
postoperative analgesia following thoracic surgery. However, intravenous
patient-controlled analgesia (IVPCA) may be an effective alternative. This
study was conducted because few scientific reports exist comparing
fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with
thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment
of postoperative pain after video-Assisted thoracic surgery (VATS).
 Method(s):This prospective, and randomized study included 70 patients
randomized into fk-IVPCA and t-PCEA groups. Pain at rest and during
movement, successful and unsuccessful triggers after pressing the PCA
device button, the need for rescue analgesia, drug-related adverse events,
and patient satisfaction were recorded for 48hours postoperatively.
 Result(s):No significant differences in the intensity of pain at rest
or during movement were observed between the 2 groups within 48hours
postoperatively. The number of unsuccessful PCA triggers in the t-PCEA
group 0 to 4hours after surgery was significantly higher than that in the
fk-IVPCA group. However, the numbers of successful PCA triggers in the
fk-IVPCA group at 4 to 12 and 0 to 24hours after surgery were
significantly higher than those in the t-PCEA group. The incidence of
analgesic-related side effects and patient satisfaction were similar in
both groups. Conclusion(s):Compared with t-PCEA, the addition of a
subanesthetic dose of ketamine to fentanyl-based IVPCA resulted in similar
pain control after VATS with no increase in the incidence of drug-related
adverse effects. The results confirm that both multimodal intravenous
analgesia and epidural analgesia can provide sufficient pain control and
are safe strategies for treating acute post-Thoracotomy
pain. Copyright © 2019 the Author(s).

<11>
[Use Link to view the full text]
Accession Number
628951438
Title
Effects of Pre-Cardiopulmonary Bypass Administration of Dexmedetomidine on
Cardiac Injuries and the Inflammatory Response in Valve Replacement
Surgery With a Sevoflurane Postconditioning Protocol: A Pilot Study.
Source
Journal of cardiovascular pharmacology. 74 (2) (pp 91-97), 2019. Date of
Publication: 01 Aug 2019.
Author
Zhou H.; Zhou D.; Lu J.; Wu C.; Zhu Z.
Institution
(Zhou) Department of Anesthesiology, Second Affiliated Hospital of Jiaxing
University, Jiaxing City, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Preventing myocardial ischemia-reperfusion injury in on-pump
cardiac surgeries remains an enormous challenge. Sevoflurane
postconditioning has been effective at overcoming this challenge by
modulating inflammatory mediators and ameliorating antioxidative stress.
Dexmedetomidine (DEX) is a commonly used medication for cardiac patients
with organ-protective properties that lead to positive outcomes. Whether
DEX also has cardiac-protective properties and the associated mechanism in
sevoflurane postconditioning-based valve replacement surgeries are
unknown. OBJECTIVE(S): This study was conducted to observe the effect
of DEX administration before cardiopulmonary bypass (CPB) on myocardial
injury, oxidative stress, and inflammatory response indicators in the
peripheral blood. METHOD(S): Twenty-eight eligible cardiac patients
who underwent valve replacement surgery with standard sevoflurane
postconditioning were included in the study. The patients were randomly
divided into a DEX group and a non-DEX group according to whether DEX
(0.5-micro g/kg overload dose for 10 minutes and a 0.5-mug/kg/h
maintenance dose) or saline was administered from induction to the
beginning of CPB. The primary outcome was the cardiac troponin I
concentration (cTnI) in the blood 24 hours after CPB. The levels of
malondialdehyde (MDA), superoxide dismutase, tumor necrosis factor-alpha
(TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) were also
measured. RESULT(S): The mean cTnI at 24 hours after CPB was clearly
decreased in the DEX group compared with that in the non-DEX group (4.16
+/- 1.58 vs. 6.90 +/- 3.73, P < 0.05). TNF-alpha levels were lower in the
DEX group after CPB (T1-T5), with a significant difference found at 1-6
hours after CPB (1 hour, 19.03 vs. 28.09; 6 hours, 20.74 vs. 30.94, P <
0.05). The IL-6 and IL-8 concentrations in the DEX group were dramatically
increased at 6 hours after CPB (P < 0.05). The MDA content and superoxide
dismutase activity were comparable between the 2 groups. A lower
proportion of anemia cases were noted after CPB in the DEX group than in
the non-DEX group (non-DEX, 10% vs. DEX, 5%, P < 0.05).
 CONCLUSION(S): In valve replacement surgery with sevoflurane
postconditioning, pre-CPB administration of DEX can reduce the cTnI level
at 24 hours after CPB and brings synergic benefits of the inflammatory
response.

<12>
[Use Link to view the full text]
Accession Number
624600751
Title
Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination on
Cardiac Allograft Vasculopathy in De Novo Heart Transplant Recipients.
Source
Circulation. Heart failure. 11 (9) (pp e004050), 2018. Date of
Publication: 01 Sep 2018.
Author
Arora S.; Andreassen A.K.; Karason K.; Gustafsson F.; Eiskjaer H.; Botker
H.E.; Radegran G.; Gude E.; Ioanes D.; Solbu D.; Dellgren G.; Ueland T.;
Aukrust P.; Gullestad L.
Institution
(Arora, Andreassen, Gude, Gullestad) Department of Cardiology, Oslo
University Hospital, E.G., Rikshospitalet
(Arora) Center for Heart Failure Research, University of Oslo and Faculty
of Medicine, University of Oslo, Norway
(Karason, Ioanes) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Germany
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer, Botker) Department of Cardiology, Aarhus University Hospital,
Sweden
(Radegran) Section for Heart Failure and Valvular Disease, VO Heart and
Lung Medicine, Skane University Hospital and Department of Clinical
Sciences, Lund University, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Germany
(Ueland, Aukrust) Research Institute of Internal Medicine, Oslo University
Hospital, Rikshospitalet, Norway
(Ueland, Aukrust) K.G. Jebsen Inflammatory Research Center, Faculty of
Medicine, University of Oslo, Norway
(Ueland, Aukrust) K. G. Jebsen Thrombosis Research and Expertise Center,
University of Tromso
(Ueland, Aukrust, Gullestad) Faculty of Medicine, University of Oslo, P.A,
Norway
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital, Rikshospitalet, Norway
Publisher
NLM (Medline)
Abstract
Background Cardiac allograft vasculopathy (CAV) limits survival after
heart transplantation, and the effect of different immunosuppressive
regimens on CAV is not fully understood. The randomized SCHEDULE trial
(Scandinavian Heart Transplant Everolimus De Novo Study With Early
Calcineurin Inhibitors Avoidance) evaluated whether initiation of the
proliferation signal inhibitor everolimus and early cyclosporine
elimination can reduce CAV development. Methods and Results The SCHEDULE
trial was a multicenter Scandinavian trial, where 115 de novo heart
transplantation recipients were randomized to everolimus with complete
cyclosporine withdrawal 7 to 11 weeks after heart transplantation or
standard cyclosporine-based immunosuppression. Seventy-six (66%) patients
had matched intravascular ultrasound examinations at baseline and 12 and
36 months. Intravascular ultrasound analysis evaluated maximal intimal
thickness, percent atheroma volume, and total atheroma volume. Qualitative
plaque analysis using virtual histology assessed fibrous, fibrofatty, and
calcified tissue as well as necrotic core. Serum inflammatory markers were
measured in parallel. The everolimus group (n=37) demonstrated
significantly reduced CAV progression as compared with the cyclosporine
group (n=39) at 36 months (DELTA maximal intimal thickness, 0.09+/-0.05
versus 0.15+/-0.16 mm [ P=0.03]; DELTA percent atheroma volume, 5.3+/-2.8%
versus 7.6+/-5.9% [ P=0.03]; and DELTA total atheroma volume, 33.9+/-71.2
versus 54.2+/-96.0 mm3 [ P=0.34], respectively]. At 36 months the number
of everolimus patients with rejection graded >=2R was 15 (41%) as compared
with 5 (13%) in the cyclosporine group ( P=0.01). Everolimus did not
affect CAV morphology or immune marker activity during the follow-up
period. Conclusions The SCHEDULE trial demonstrates that everolimus
initiation and early cyclosporine elimination significantly reduces CAV
progression at 12 months, and this beneficial effect is clearly sustained
at 36 months. Clinical trial registration URL:
https://www.clinicaltrials.gov . Unique identifier: NCT01266148.

<13>
Accession Number
627329750
Title
Anesthesia with propofol and sevoflurane on postoperative cognitive
function of elderly patients undergoing general thoracic surgery.
Source
Pakistan journal of pharmaceutical sciences. 30 (3) (pp 1107-1110), 2017.
Date of Publication: 01 May 2017.
Author
Yu W.
Institution
(Yu) Fudan University, Shanghai, China
Publisher
NLM (Medline)
Abstract
This study is to analyze the effects and variations on cognitive function
for elderly patients undergoing general thoracic surgery, who accepted the
anesthesia with propofol and sevoflurane. A total of 500 elderly general
thoracic surgical patients were selected randomly, all receiving the
propofol anesthesia (Propofol group). Meanwhile, another totality of 500
patients in the same condition and period were selected and accepted the
sevoflurane anesthesia (Sevoflurane group). Mini-mental state examination
(MMSE) and recovery quality after anesthesia were compared among the
patients in both groups respectively at the time of pre-operation and 1 h,
6 h and 12 h after surgery. There was no statistic difference in
preoperative MMES of patients in both two groups (P<0.05); while the
results of postoperative MMSE showed that both Propofol group and
Sevoflurane group had a certain statistical difference, and that in
Propofol group was larger compared that in Sevoflurane group. Moreover,
P<0.05 was obtained on comparing the MMSE at the time of 1h, 6h and 12h
after surgery and that at pre-operation, revealing statistical
significance. Either propofol or sevoflurane, to certain extent, can
affect patients' cognitive function when they are applied in the general
thoracic surgery for elderly patients. However, the influence of propofol
on cognitive function is relatively smaller, which presents a better
application value.

<14>
Accession Number
2002424161
Title
Comparative efficacy of bortezomib and carfilzomib desensitization
protocols in highly sensitized cardiac transplant candidates.
Source
Human Immunology. Conference: ASHI/BANFF Joint Scientific Meeting 2019.
David L. Lawrence Convention Center, United States. 80 (Supplement) (pp
107), 2019. Date of Publication: September 2019.
Author
Sobanian M.; Saltarrelli J.; Weeks P.; Nathan S.; Radovancevic R.; Kar B.;
Gregoric I.
Institution
(Sobanian, Weeks) Memorial Hermann Hospital, Houston, TX, United States
(Saltarrelli, Nathan, Radovancevic, Kar, Gregoric) University of Texas
McGovern Medical School/Memorial Hermann Hospital, Houston, TX, United
States
Publisher
Elsevier Inc.
Abstract
Aim: At our center, patients who are deemed highly sensitized may undergo
a proteasome inhibitor-based desensitization protocol to shorten organ
wait time and improve the probability of finding an acceptable donor. The
purpose of this study is to evaluate the comparative effects on detectable
anti-HLA antibodies between our center's bortezomib-based and
carfilzomib-based protocol in sensitized patients awaiting heart
transplantation. Method(s): This was a retrospective cohort study.
Highly sensitized patients awaiting cardiac transplant who underwent the
desensitization protocol between April 2013 and February 2017 were
included in the study. Protocol included either a bortezomib or
carfilzomib-based regimen with multiple plasmapheresis sessions and a
single dose of rituximab. Efficacy of these two desensitization regimens
was evaluated by comparing trends in pre- and post-protocol positive (mean
fluorescence intensity (MFI) greater than 500) anti-HLA antibody allele
specificities. Result(s): Of the 19 patients who underwent a
desensitization protocol, 8 patients received a bortezomib-based regimen
and 11 patients a carfilzomib-based regimen. When comparing trends in both
HLA class I and class II antibodies pre- and post- desensitization
protocol, patients who received a bortezomib-based regimen experienced a
greater reduction (p < 0.0001) in the detection of both class I and class
II alloantibodies compared to those that received carfilzomib (Table 1).
 Conclusion(s): In our observed cohort, bortezomib-based
desensitization protocol was associated with a greater percent reduction
of anti-HLA antibody alleles with MFI > 500 compared to the
carfilzomib-based desensitization protocol. Larger, prospective randomized
studies are needed to confirm these results. [Figure
presented] Copyright © 2019

<15>
Accession Number
629023395
Title
Use and Outcomes Associated With Perioperative Amiodarone in Cardiac
Surgery.
Source
Journal of the American Heart Association. 8 (15) (pp e009892), 2019. Date
of Publication: 06 Aug 2019.
Author
Atreya A.R.; Priya A.; Pack Q.R.; Pekow P.S.; Stefan M.; Lagu T.; Lotfi
A.S.; Lindenauer P.K.
Institution
(Atreya) Section of Electrophysiology, Samuel and Jean Frankel
Cardiovascular Center University of Michigan Ann Arbor MI
(Priya, Pack, Pekow, Stefan, Lagu, Lindenauer) Institute for Healthcare
Delivery and Population Science University of Massachusetts Medical
School-Baystate Springfield MA
(Priya, Pekow) School of Public Health and Health Sciences University of
Massachusetts Amherst MA
(Pack, Stefan, Lagu, Lotfi, Lindenauer) Department of Medicine University
of Massachusetts Medical School-Baystate Springfield MA
(Pack, Lotfi) Division of Cardiology University of Massachusetts Medical
School-Baystate Springfield MA
(Lindenauer) Department of Quantitative and Population Health Sciences
University of Massachusetts Medical School Worcester MA
Publisher
NLM (Medline)
Abstract
Background In randomized controlled trials, perioperative administration
of amiodarone has been shown to reduce the incidence of postoperative
atrial arrhythmias and length of stay (LOS) among patients undergoing
coronary bypass surgery. However, little is known about the use or
effectiveness of perioperative amiodarone in routine clinical practice.
Methods and Results We studied patients >=18 years old without a previous
history of atrial or ventricular arrhythmias who underwent elective
coronary bypass surgery between 2013 and 2014 within a network of 235 US
hospitals. Perioperative amiodarone was defined as receipt of amiodarone
either on the day of or the day preceding surgery. We used
covariate-adjusted modeling and instrumental variable methods to examine
the association between receipt of amiodarone and the development of
atrial arrhythmias, in-hospital mortality, readmission, LOS, and cost. Of
12 758 patients, 2195 (17.2%) received perioperative amiodarone, 3330
(26.1%) developed atrial arrhythmias postoperatively, and the average LOS
was 6.4 days (+/-2.6 days). Instrumental variable analysis showed that
receipt of perioperative amiodarone was associated with lower risk of
atrial arrhythmias (risk difference -11 percentage points, 95% CI -19 to
-4 percentage points; P=0.002) and a shorter LOS (-0.7 day, 95% CI -1.39
to -0.01 days; P=0.048). There was no association between receipt of
perioperative amiodarone and in-hospital mortality, cost, or readmission.
Conclusions Among patients undergoing coronary bypass surgery without
previous arrhythmias, perioperative amiodarone is associated with a lower
risk of atrial arrhythmias and shorter LOS. These findings are consistent
with previous randomized trials and lend support to current guideline
recommendations.

<16>
Accession Number
629030842
Title
A Risk Prediction Model in Asymptomatic Patients with Severe Aortic
Stenosis: CURRENT-AS risk score.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2019. Date of Publication: 06 Aug 2019.
Author
Minamino-Muta E.; Kato T.; Morimoto T.; Taniguchi T.; Ando K.; Kanamori
N.; Murata K.; Kitai T.; Kawase Y.; Miyake M.; Izumi C.; Mitsuoka H.; Kato
M.; Hirano Y.; Matsuda S.; Nagao K.; Murakami T.; Takeuchi Y.; Yamane K.;
Toyofuku M.; Ishii M.; Inoko M.; Ikeda T.; Ishii K.; Hotta K.; Jinnai T.;
Kato Y.; Inuzuka Y.; Maeda C.; Morikami Y.; Saito N.; Minatoya K.; Kimura
T.
Institution
(Minamino-Muta, Kato, Taniguchi, Matsuda, Saito, Kimura) Department of
Cardiovascular Medicine, Kyoto University Graduate School of Medicine,
Kyoto, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Ando) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Kanamori) Division of Cardiology, Shimada Municipal Hospital, Shimada,
Japan
(Murata) Department of Cardiology, Shizuoka City Shizuoka Hospital,
Shizuoka, Japan
(Kitai) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Kobe, Japan
(Kawase) Department of Cardiovascular Medicine, Kurashiki Central
Hospital, Kurashiki, Japan
(Miyake) Department of Cardiology, Tenri Hospital, Tenri, Japan
(Izumi) Division of Heart Failure, National Cerebral and Cardiovascular
Center, Suita, Japan
(Mitsuoka) Division of Cardiology, Nara Hospital, Kinki University Faculty
of Medicine, Ikoma, Japan
(Kato) Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
(Hirano) Department of Cardiology, Kinki University Hospital, Osakasayama,
Japan
(Nagao) Department of Cardiovascular Center, Osaka Red Cross Hospital,
Osaka, Japan
(Murakami) Department of Cardiology, Koto Memorial Hospital, Japan
(Takeuchi) Department of Cardiology, Shizuoka General Hospital, Shizuoka,
Japan
(Yamane) Department of Cardiology, Nishikobe Medical Center, Kobe, Japan
(Toyofuku) Department of Cardiology, Japanese Red Cross Wakayama Medical
Center, Wakayama, Japan
(Ishii) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
(Inoko) Cardiovascular Center, Tazuke Kofukai Medical Research Institute,
Kitano Hospital, Osaka, Japan
(Ikeda) Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan
(Ishii) Department of Cardiology, Kansai Electric Power Hospital, Osaka,
Japan
(Hotta) Department of Cardiology, Hyogo Prefectural Amagasaki General
Medical Center, Amagasaki, Japan
(Jinnai) Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu,
Japan
(Kato) Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan
(Inuzuka) Department of Cardiology, Shiga Medical Center for Adults,
Moriyama, Japan
(Maeda) Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu,
Japan
(Morikami) Department of Cardiology, Hirakata Kohsai Hospital, Hirakata,
Japan
(Minatoya) Department of Cardiovascular Surgery, Kyoto University Graduate
School of Medicine, Kyoto, Japan
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Early aortic valve replacement (AVR) might be beneficial in
selected high-risk asymptomatic patients with severe aortic stenosis (AS),
considering their poor prognosis when managed conservatively. This study
aimed to develop and validate a clinical scoring system to predict
AS-related events within 1-year after diagnosis in asymptomatic severe AS
patients. METHOD(S): We analysed 1274 asymptomatic severe AS patients
derived from a retrospective multicentre registry enrolling consecutive
patients with severe AS in Japan (CURRENT AS registry), who were managed
conservatively and completed 1-year follow-up without AVR. From a randomly
assigned derivation set (N=849), we developed CURRENT AS risk score for
the AS-related event (a composite of AS-related death and heart failure
hospitalization) within 1-year using a multivariable logistic regression
model. RESULT(S): The risk score comprised independent risk
predictors including left ventricular ejection fraction <60%, hemoglobin
<=11.0g/dl, chronic lung disease (2 points), diabetes mellitus,
hemodialysis, and any concomitant valve disease (1 point). The predictive
accuracy of the model was good with the area under the curve of 0.79 and
0.77 in the derivation and validation sets (N=425). In the validation set,
the 1-year incidence of AS-related events was much higher in patients with
score >=2 than in patients with score <=1 (Score 0: 2.2%, Score 1: 1.9%,
Score 2: 13.4%, Score 3: 14.3%, and Score >=4: 22.7%, P<0.001).
 CONCLUSION(S): The CURRENT-AS risk score integrating clinical and
echocardiographic factors well predicted the risk of AS-related events at
1-year in asymptomatic patients with severe AS, and was validated
internally. 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.

<17>
Accession Number
2002440903
Title
Early Complete Revascularization in Hemodynamically Stable Patients With
ST-Segment Elevation Myocardial Infarction and Multivessel Disease.
Source
Canadian Journal of Cardiology. 35 (8) (pp 1047-1057), 2019. Date of
Publication: August 2019.
Author
Fortuni F.; Crimi G.; Angelini F.; Leonardi S.; D'Ascenzo F.; Ferlini M.;
Rolando M.; Raisaro A.; Oltrona Visconti L.; Ferrario M.; Gnecchi M.; De
Ferrari G.M.
Institution
(Fortuni, Leonardi, Rolando, Gnecchi, De Ferrari) Coronary Care Unit and
Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Fortuni, Leonardi, Rolando, Gnecchi, De Ferrari) Department of Molecular
Medicine, University of Pavia, Pavia, Italy
(Crimi, Ferlini, Raisaro, Oltrona Visconti, Ferrario) Division of
Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Angelini, D'Ascenzo) Division of Cardiology, University of Torino, Citta
della Salute e della Scienza Hospital, Turin, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The optimal strategy and timing of revascularization in
hemodynamically stable patients with ST-segment elevation myocardial
infarction and multivessel disease is unknown. We performed a systematic
review and meta-analysis to explore the comparative efficacy and safety of
early complete revascularization vs culprit-only or staged
revascularization in this setting. Method(s): We searched the
literature for randomized clinical trials that assessed this issue. Early
complete revascularization was defined as a complete revascularization
achieved during the index procedure or within 72 hours. Efficacy outcomes
were major adverse cardiovascular events, myocardial infarction, repeat
revascularization, and all-cause mortality. Safety outcomes were all
bleeding events, stroke, and contrast-induced acute kidney injury.
 Result(s): Nine randomized clinical trials with a total of 2837
patients were included; 1254 received early complete revascularization and
1583 were treated with other revascularization strategies. After a mean
follow-up of 15.3 +/- 9.4 months early complete revascularization was
associated with a lower risk of major adverse cardiovascular events
(relative risk [RR], 0.51; 95% confidence interval [CI], 0.41-0.62; P <
0.00001; number needed to treat = 8), myocardial infarction (RR, 0.59; 95%
CI, 0.40-0.87), and repeat revascularization (RR, 0.39; 95% CI, 0.28-0.55)
without any difference in all-cause mortality and in safety outcomes
compared with culprit-only or staged revascularization. Moreover,
fractional flow reserve-guided complete revascularization reduced the
incidence of repeat revascularization compared with angiography-guided
procedure (chi2 = 4.36; P = 0.04). Conclusion(s): Early
complete revascularization should be considered in hemodynamically stable
patients with ST-segment elevation myocardial infarction and multivessel
disease deemed suitable for percutaneous interventions. Fractional flow
reserve-guided complete revascularization might be superior to
angiography-guided procedures in reducing need for further
interventions. Copyright © 2019 Canadian Cardiovascular Society

<18>
Accession Number
2002440902
Title
Optimal Duration of Dual Antiplatelet Therapy Following Percutaneous
Coronary Intervention: An Umbrella Review.
Source
Canadian Journal of Cardiology. 35 (8) (pp 1039-1046), 2019. Date of
Publication: August 2019.
Author
Elliott J.; Kelly S.E.; Bai Z.; Liu W.; Skidmore B.; Boucher M.; So
D.Y.F.; Wells G.A.
Institution
(Elliott, Kelly, Bai, Liu, Wells) Cardiovascular Research Methods Centre,
University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Skidmore) Independent Information Specialist, Ottawa, Ontario, Canada
(Boucher) Canadian Agency for Drugs and Technologies in Health (CADTH),
Ottawa, Ontario, Canada
(So) Division of Cardiology, University of Ottawa Heart Institute, Ottawa,
Ontario, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The optimal duration of dual antiplatelet therapy (DAPT) after
percutaneous coronary intervention with stenting requires consideration of
patient characteristics, and decision makers require a comprehensive
overview of the evidence. Method(s): We performed an umbrella review
of systematic reviews (SRs) of randomized controlled trials of extended
DAPT (> 12 months) compared with DAPT for 6 to 12 months after
percutaneous coronary intervention with stenting. Outcomes of interest
were death, myocardial infarction (MI), stroke, stent thrombosis, major
adverse cardiac and cerebrovascular events, bleeding, and urgent
revascularization. We aimed to assess the evidence of benefits and harms
among clinically important subgroups (eg, elderly patients, those with
diabetes, prior MI, acute coronary syndrome). We assessed the quality of
the included reviews by use of A Measurement Tool to Assess Systematic
Reviews (AMSTAR). Result(s): Sixteen SRs involving 8 randomized
controlled trials were included. Most scored 7 or more points on the
AMSTAR checklist. There was no significant difference in outcomes with
extended DAPT compared with 6 months of DAPT in most SRs, with the
exception of an increased risk of major bleeding. Compared with 12 months,
extended DAPT may reduce the risk of MI and stent thrombosis; however, the
findings were not consistent across all reviews. There have been
conflicting reports of an increased risk of death with extended DAPT. Few
SRs assessed outcomes among patient subgroups. Conclusion(s):
Extended DAPT may reduce the risk of MI and stent thrombosis but increase
the risk of major bleeding and death. Whether the effects of extended DAPT
are consistent across patient subgroups is unclear, and future SRs should
address this knowledge gap. Copyright © 2019 Canadian
Cardiovascular Society

<19>
Accession Number
628792365
Title
Long-term clinical outcomes in patients with untreated non-culprit
intermediate coronary lesion and evaluation of predictors by using virtual
histology-intravascular ultrasound; A prospective cohort study.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 187. Date of Publication: 05 Aug 2019.
Author
Seo Y.H.; Kim Y.-K.; Song I.G.; Kim K.-H.; Kwon T.-G.; Bae J.-H.
Institution
(Seo, Kim, Song, Kim, Kwon, Bae) Division of Cardiology, Heart Center,
Konyang University Hospital, 158, Gwanjeodong-Ro, Seo-Gu, Daejeon 35365,
South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: It is uncertain whether the coronary lesion with intermediate
stenosis is more likely to cause cardiovascular events than a normal or
minimal lesion. We conducted a single-center, prospective cohort study to
identify long-term clinical outcomes of patients with untreated
non-culprit intermediate lesion and evaluate its predictor of
cardiovascular events by using virtual histology-intravascular ultrasound
(VH-IVUS). Method(s): Subjects with non-culprit intermediate lesion
underwent VH-IVUS were prospectively registered after percutaneous
coronary intervention at the culprit lesion. Intermediate lesion was
defined as 30 to 70% stenosis in coronary angiography and primary outcome
was an occurrence of major adverse cardiovascular events (MACE) defined as
all-cause death, intermediate lesion revascularization (InLR), minimal
lesion revascularization (MnLR, unplanned revascularization elsewhere in
the target vessel or in other coronary arteries which looked normal or
minimal stenosis), cerebrovascular events, or non-fatal myocardial
infarction (MI). The mean follow-up period was 4.2 years. Result(s):
Total 25 MACE, approximately 7% incidence annually, were identified during
a follow-up period in 86 patients with 89 intermediate lesions. InLR (n =
13) was a most common event followed by MnLR (n = 6), non-fatal MI (n =
4), all-cause death (n = 3), and cerebrovascular events (n = 1). Diameter
stenosis (OR 1.07, 95% CI 1.01-1.12, p = 0.015), plaque burden (PB, OR
1.07, 95% CI 1.00-1.15, p = 0.040), fibrofatty area (FFA, OR 1.61, 95% CI
1.10-2.38, p = 0.016), PB >= 70% (OR 3.93, 95% CI 1.28-12.07, p = 0.018),
and area stenosis >= 50% (OR 2.94, 95% CI 1.01-8.56, p = 0.042) showed
significant relationships with an occurrence of MACE. In multivariable
Cox-proportional hazard analysis, FFA in intermediate lesion was an only
independent predictor of MACE (HR 1.36, 95% CI 1.05-1.77, p = 0.019).
 Conclusion(s): Untreated intermediate lesions had a significantly
higher chance for requiring revascularization compared with a normal or
minimal lesion. And also, a large FFA in intermediate lesion was a
significant predictor of cardiovascular events and which finding was
mainly driven by coronary-related events, in particularly intermediate
lesion progression. Copyright © 2019 The Author(s).

<20>
Accession Number
621864972
Title
Use of Viral load as a surrogate marker in clinical studies of
cytomegalovirus in solid organ transplantation: A systematic review and
meta-analysis.
Source
Clinical Infectious Diseases. 66 (4) (pp 617-631), 2018. Date of
Publication: 15 Feb 2018.
Author
Natori Y.; Alghamdi A.; Tazari M.; Miller V.; Husain S.; Komatsu T.;
Griffiths P.; Ljungman P.; Orchanian-Cheff A.; Kumar D.; Humar A.
Institution
(Natori, Alghamdi, Tazari, Husain, Kumar, Humar) Multi-Organ Transplant
Program, University Health Network, 585 University Ave, 11-PMB-175,
Toronto, ON M5G 2N2, Canada
(Alghamdi) King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
(Miller) Forum for Collaborative Research, University of California,
Berkeley, United States
(Komatsu) Division of Antiviral Products, Center for Drug Evaluation and
Research, Food and Drug Administration, Silver Spring, MD, United States
(Griffiths) Institute for Immunity and Transplantation, University College
London, Medical School, United Kingdom
(Ljungman) Division of Hematology, Department of Medicine Huddigne,
Karolinksa Institutet, Stockholm, Sweden
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, ON, Canada
Publisher
Oxford University Press
Abstract
Symptomatic cytomegalovirus (CMV) disease has been the standard endpoint
for clinical trials in organ transplant recipients. Viral load may be a
more relevant endpoint due to low frequency of disease. We performed a
meta-analysis and systematic review of the literature. We found several
lines of evidence to support the validity of viral load as an appropriate
surrogate end-point, including the following: (1) viral loads in CMV
disease are significantly greater than in asymptomatic viremia (odds
ratio, 9.3 95% confidence interval, 4.6-19.3); (2) kinetics of viral
replication are strongly associated with progression to disease; (3)
pooled incidence of CMV viremia and disease is significantly lower during
prophylaxis compared with the full patient follow-up period (viremia
incidence: 3.2% vs 34.3%; P <.001) (disease incidence: 1.1% vs 13.0%; P
<.001); (4) treatment of viremia prevented disease; and (5) viral load
decline correlated with symptom resolution. Based on the analysis, we
conclude that CMV load is an appropriate surrogate endpoint for CMV trials
in organ transplant recipients. Copyright © The Author(s) 2017.

<21>
Accession Number
2000715217
Title
The Effects of an Open-Lung Approach During One-Lung Ventilation on
Postoperative Pulmonary Complications and Driving Pressure: A Descriptive,
Multicenter National Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2665-2672),
2018. Date of Publication: 01 Dec 2018.
Author
Belda J.; Ferrando C.; Garutti I.; Pozo N.; Soro M.; Suarez-Sipmann F.;
Tusman G.; Unzueta C.; Villar J.; Bermejo S.; Callejo A.; Coves S.;
Gallego-Ligorit L.; Granell M.; Jimenez M.J.; Lluch A.; Martinez J.A.; de
la Matta M.; Planas A.; Aguirre P.; Rodriguez A.; Sastre J.A.; Arocas B.;
Barcena E.; Belmonte L.; Carbonell J.; Carrizo J.; Charco P.; Cuervo J.;
Del Rio E.; Florea R.; Gutierrez A.; Jurado A.; Lascorz L.; Navarro J.M.;
Martinez S.; Monleon B.; Parra M.J.; Perez S.; Sancho L.; Serralta F.;
Villena A.; Cruz P.; de la Gala F.; Olmedilla L.; Pineiro P.;
Sanchez-Pedrosa G.; Alday E.; Munoz M.; Ramasco F.; Diaz R.; Parera A.;
Cabrera S.; Guerra E.; Morales L.; Gallart L.; Perez A.; Calderon A.;
Guerrero M.; Kadaoui S.-D.; Levstek M.; Real M.I.; Pintor J.; Barrado P.;
Cotera I.; Izquierdo B.; Lacosta L.; Molinos I.; Rubio B.; Puertolas M.;
Sanjuan-Villareal A.; Valles-Torres J.; Tres E.; Viguera L.; Biosca E.;
Broseta A.; Hernandez J.; Morales J.; Navarro-Ripoll R.; Femenia X.;
Minguez L.; Lopez A.; Esteve I.; Llacer E.; Blanco L.; Ceresuela R.;
Orallo M.A.; Pereira D.; Prieto M.P.; Otero T.
Institution
(Belda, Ferrando) Hospital Clinico de Valencia, Valencia, Spain
(Ferrando) CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos
III, Madrid, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain
(Belda, Ferrando, Pozo, Soro) Hospital Clinico de Valencia, Valencia,
Spain
(Ferrando, Suarez-Sipmann, Villar) CIBER de Enfermedades Respiratorias,
Instituto de Salud Carlos III, Madrid, Spain
(Garutti) Hospital Gregorio Maranon de Madrid, Madrid, Spain
(Suarez-Sipmann, Planas) La Princesa de Madrid, Madrid, Spain
(Tusman) Hospital Privado Mar de Plata, La Plata, Argentina
(Unzueta) Hospital San Pau i Santa Creu de Barcelona, Barcelona, Spain
(Villar, Rodriguez) Hospital Dr. Negrin de Las Palmas, Las Palmas, Spain
(Bermejo) Hospital Parc de Salut Mar de Barcelona, Barcelona, Spain
(Callejo) Hospital 12 de Octubre de Madrid, Madrid, Spain
(Coves) Hospital de Vinalopo de Elche, Alicante, Spain
(Gallego-Ligorit) Hospital Miguel Servet de Zaragoza, Zaragoza, Spain
(Granell) Hospital Consorcio General de Valencia, Valencia, Spain
(Jimenez) Hospital Clinic de Barcelona, Barcelona, Spain
(Lluch) Hospital La Fe de Valencia, Valencia, Spain
(Martinez) Hospital Mutua de Terrassa, Terrassa, Spain
(de la Matta) Hospital Virgen del Rocio de Sevilla, Sevilla, Spain
(Aguirre) Hospital Alvaro Cunqueiro de Vigo, Vigo, Spain
(Sastre) Hospital Clinico de Salamanca, Salamanca, Spain
(Ferrando, Arocas, Barcena, Belmonte, Carbonell, Carrizo, Charco, Cuervo,
Del Rio, Florea, Gutierrez, Jurado, Lascorz, Navarro, Martinez, Monleon,
Parra, Perez, Sancho, Serralta, Villena) Hospital Clinico de Valencia,
Spain
(Cruz, de la Gala, Olmedilla, Pineiro, Sanchez-Pedrosa) Hospital Gregorio
Maranon de Madrid, Spain
(Alday, Munoz, Ramasco) Hospital La Princesa de Madrid, Spain
(Diaz, Parera) Hospital Sant Pau i Santa Creu de Barcelona, Spain
(Cabrera, Guerra, Morales) Hospital Dr. Negrin de Las Palmas, Spain
(Gallart, Perez) Hospital Parc de Salut Mar de Barcelona, Spain
(Calderon, Guerrero, Kadaoui, Levstek, Real) Hospital 12 de Octubre de
Madrid, Spain
(Pintor) Hospital de Vinalopo de Elche, Spain
(Barrado, Cotera, Izquierdo, Lacosta, Molinos, Rubio, Puertolas,
Sanjuan-Villareal, Valles-Torres, Tres, Viguera) Hospital Miguel Servet de
Zaragoza, Spain
(Biosca, Broseta, Hernandez, Morales) Hospital Consorcio General de
Valencia, Spain
(Navarro-Ripoll) Hospital Clinic de Barcelona, Spain
(Femenia, Minguez, Lopez) Hospital La Fe de Valencia, Spain
(Esteve, Llacer) Hospital Mutua de Terrassa, Spain
(Blanco, Ceresuela, Orallo, Pereira, Prieto, Otero) Hospital Alvaro
Cunqueiro de Vigo, Spain
Publisher
W.B. Saunders
Abstract
Objective: Thoracic surgical procedures are associated with an increased
risk of postoperative pulmonary complications (PPCs), which seem to be
related directly to intraoperative driving pressure. The authors conducted
this study to describe the incidence of PPCs in patients in whom an
individualized open-lung approach was applied during one-lung ventilation.
 Design(s): This was a prospective, multicenter, national descriptive
study. Setting(s): Thoracic surgery patients undergoing one-lung
ventilation. Participant(s): Eligible participants were included
consecutively from October 1, 2016, to September 30, 2017. A total of 690
patients were included. Intervention(s): An individualized open-lung
approach that consisted of an alveolar recruitment maneuver followed by a
positive end-expiratory pressure adjusted to best respiratory system
compliance was performed in all patients. Measurements and Main
Results: Preoperative and intraoperative data were recorded; the primary
outcome was a description of the incidence of PPCs in these patients
during the first 7 postoperative days. The patients were mainly male, and
half of them had a high risk of PPCs (ARISCAT score exceeding 44). Eleven
percent of participants developed a PPC within the first postoperative
week. The mean open lung positive end-expiratory pressure was 8 +/- 3
cmH<inf>2</inf>O. When compared with pre-open lung approach values, the
open-lung approach significantly decreased the driving pressure (14 +/- 4
cmH<inf>2</inf>O v 11 +/- 3 cmH<inf>2</inf>O; p < 0.001) and increased
dynamic compliance (30 +/- 10 mL/cmH<inf>2</inf>O v 43 +/-15
mL/cmH<inf>2</inf>O; p < 0.001). Conclusion(s): The low incidence of
PPCs in patients who underwent an open-lung approach during one-lung
ventilation compared with that reported for other thoracic surgery series
and the decrease in the driving pressure in these patients justify an
additional randomized controlled trial to compare the open-lung approach
with the standard protective strategy of low tidal volume and low positive
end-expiratory pressure. Copyright © 2018 Elsevier Inc.

<22>
Accession Number
2001217197
Title
Randomized Controlled Trial of Heparin Versus Bivalirudin Anticoagulation
in Acyanotic Children Undergoing Open Heart Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2633-2640),
2018. Date of Publication: December 2018.
Author
Hasija S.; Talwar S.; Makhija N.; Chauhan S.; Malhotra P.; Chowdhury U.K.;
Krishna N.S.; Sharma G.
Institution
(Hasija, Makhija, Chauhan, Malhotra, Krishna) Department of Cardiac
Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
(Talwar, Chowdhury) Department of Cardiothoracic Vascular Surgery, All
India Institute of Medical Sciences, New Delhi, India
(Sharma) Department of Perfusion Technology, All India Institute of
Medical Sciences, New Delhi, India
Publisher
W.B. Saunders
Abstract
Objective: To determine the safety and efficacy of bivalirudin as an
anticoagulant for pediatric open heart surgery (OHS) and to determine its
appropriate dosage for this purpose. Design(s): Prospective,
randomized controlled trial. Setting(s): Tertiary care hospital.
 Participant(s): Fifty acyanotic children aged 1-12 years undergoing
OHS. Intervention(s): The children were randomized to receive either
4 mg/kg of heparin (n = 25, group H) or 1 mg/kg of bivalirudin bolus
followed by 2.5 mg/kg/h infusion (n = 25, group B) as the anticoagulant.
The doses were adjusted to maintain activated clotting time (ACT) above
480 seconds. At the conclusion of surgery, protamine (1.3 mg/100 U of
heparin) was administered to children in group H. Measurements and
Main Results: The children were comparable in both groups with regard to
demographic characteristics. The mean age and weight were 51.5 months and
13.4 kg in group H, and 59.3 months and 13.4 kg in group B. The dose of
anticoagulant required was 4.0 +/- 0.2 mg/kg in group H and 1.7 +/- 0.2
mg/kg followed by 3.0 +/- 0.7 mg/kg/h infusion in group B (p < 0.001). One
child in group H required an additional dose compared to 13 (54.2%)
children in group B. Intraoperatively, the ACT achieved was higher in
group H compared to group B (p < 0.05). The ACT returned to baseline value
after protamine administration in group H, but it remained elevated for 2
hours after termination of cardiopulmonary bypass (CPB) in group B (p <
0.01). The ACT was higher in group B compared to group H for 6 hours after
termination of CPB (p < 0.05). Heparin prolonged the onset of clotting,
decreased the rate and strength of thrombus formation, and inhibited
platelet function to a greater extent than bivalirudin on viscoelastic
coagulation testing. The total duration of surgery was prolonged in group
B. The postoperative chest tube drainage was similar in group B (4.9
mL/kg) as in group H (5.9 mL/kg) in spite of higher ACT. The transfusion
requirements were similar. No adverse event occurred in any patient.
 Conclusion(s): Bivalirudin is a safe and effective anticoagulant for
pediatric OHS. Though it is not suitable as a routine anticoagulant for
this purpose, it may be used as a heparin alternative in instances when
heparin cannot be used. The dose required to maintain ACT for more than
480 seconds was 1.7 +/- 0.2 mg/kg followed by 3.0 +/- 0.7 mg/kg/h
infusion. The ACT remained elevated for 2 hours after stopping the
infusion. Bivalirudin did not increase postoperative bleeding and
transfusion requirement. Copyright © 2018 Elsevier Inc.

<23>
Accession Number
628014780
Title
Effect of the PCSK9 Inhibitor Evolocumab on Total Cardiovascular Events in
Patients with Cardiovascular Disease: A Prespecified Analysis from the
FOURIER Trial.
Source
JAMA Cardiology. 4 (7) (pp 613-619), 2019. Date of Publication: July 2019.
Author
Murphy S.A.; Pedersen T.R.; Gaciong Z.A.; Ceska R.; Ezhov M.V.; Connolly
D.L.; Jukema J.W.; Toth K.; Tikkanen M.J.; Im K.; Wiviott S.D.; Kurtz
C.E.; Honarpour N.; Giugliano R.P.; Keech A.C.; Sever P.S.; Sabatine M.S.
Institution
(Murphy, Im, Wiviott, Giugliano, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, 60 Fenwood Rd, Ste
7022, Boston, MA 02115, United States
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Diseases, Medical University of Warsaw, Warsaw, Poland
(Ceska) Center for Preventive Cardiology, 3rd Internal Medicine Clinic,
University General Hospital, Charles University, 1st Medical Faculty,
Prague, Czechia
(Ezhov) National Cardiology Research Center, Moscow, Russian Federation
(Connolly) Birmingham City and Sandwell Hospitals and the Institute of
Cardiovascular Sciences, University of Birmingham, Birmingham, United
Kingdom
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Toth) First Department of Medicine, University of Pecs, Medical School,
Pecs, Hungary
(Tikkanen) Folkhalsan Research Center, University of Helsinki, Helsinki,
Finland
(Kurtz, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) Imperial College London, London, United Kingdom
(Sabatine) JAMA Cardiology
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The PCSK9 inhibitor evolocumab reduced low-density lipoprotein
cholesterol and first cardiovascular events in the Further Cardiovascular
Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk
(FOURIER) trial, but patients remain at high risk of recurrent
cardiovascular events. Objective(s): To evaluate the effect of
evolocumab on total cardiovascular events, given the importance of total
number of cardiovascular events to patients, clinicians, and health
economists. Design, Setting, and Participant(s): Secondary analysis
of a randomized, double-blind clinical trial. The FOURIER trial compared
evolocumab or matching placebo and followed up patients for a median of
2.2 years. The study included 27564 patients with stable atherosclerotic
disease receiving statin therapy. Data were analyzed between May 2017 and
February 2019. Main Outcomes and Measures: The primary end point
(PEP) was time to first cardiovascular death, myocardial infarction,
stroke, hospitalization for unstable angina, or coronary
revascularization; the key secondary end point was time to first
cardiovascular death, myocardial infarction, or stroke. In a prespecified
analysis, total cardiovascular events were evaluated between treatment
arms. Result(s): The mean age of patients was 63 years, 69% of
patients were taking high-intensity statin therapy, and the median LDL-C
at baseline was 92 mg/dL (to convert to millimoles per liter, multiply by
0.0259). There were 2907 first PEP events and 4906 total PEP events during
the trial. Evolocumab reduced total PEP events by 18% (incidence rate
ratio [RR], 0.82; 95% CI, 0.75-0.90; P <.001) including both first events
(hazard ratio, 0.85; 95% CI, 0.79-0.92; P <.001) and subsequent events
(RR, 0.74; 95% CI, 0.65-0.85). There were 2192 total primary events in the
evolocumab group and 2714 total events in the placebo group. For every
1000 patients treated for 3 years, evolocumab prevented 22 first PEP
events and 52 total PEP events. Reductions in total events were driven by
fewer total myocardial infarctions (RR, 0.74; 95% CI, 0.65-0.84; P <.001),
strokes (RR, 0.77; 95% CI, 0.64-0.93; P =.007), and coronary
revascularizations (RR, 0.78; 95% CI, 0.71-0.87; P <.001).
 Conclusions and Relevance: The addition of the PCSK9 inhibitor
evolocumab to statin therapy improved clinical outcomes, with significant
reductions in total PEP events, driven by decreases in myocardial
infarction, stroke, and coronary revascularization. More than double the
number of events were prevented with evolocumab vs placebo as compared
with the analysis of only first events. These data provide further support
for the benefit of continuing aggressive lipid-lowering therapy to prevent
recurrent cardiovascular events. Trial Registration: ClinicalTrials.gov
identifier: NCT01764633. Copyright © 2019 American Medical
Association. All rights reserved.

<24>
[Use Link to view the full text]
Accession Number
626207605
Title
Donor-specific Cell-free DNA as a Biomarker in Solid Organ
Transplantation. A Systematic Review.
Source
Transplantation. 103 (2) (pp 273-283), 2019. Date of Publication: 01 Feb
2019.
Author
Knight S.R.; Thorne A.; Lo Faro M.L.
Institution
(Knight, Thorne, Lo Faro) Nuffield Department of Surgical Sciences,
University of Oxford, Oxford, United Kingdom
(Knight) Centre for Evidence in Transplantation, Clinical Effectiveness
Unit, Royal College of Surgeons of England, London, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background There is increasing interest in the use of noninvasive
biomarkers to reduce the risks posed by invasive biopsy for monitoring of
solid organ transplants (SOTs). One such promising marker is the presence
of donor-derived cell-free DNA (dd-cfDNA) in the urine or blood of
transplant recipients. Methods We systematically reviewed the published
literature investigating the use of cfDNA in monitoring of graft health
after SOT. Electronic databases were searched for studies relating cfDNA
fraction or levels to clinical outcomes, and data including measures of
diagnostic test accuracy were extracted. Narrative analysis was performed.
Results Ninety-five articles from 47 studies met the inclusion criteria
(18 kidneys, 7 livers, 11 hearts, 1 kidney-pancreas, 5 lungs, and 5
multiorgans). The majority were retrospective and prospective cohort
studies, with 19 reporting diagnostic test accuracy data. Multiple
techniques for measuring dd-cfDNA were reported, including many not
requiring a donor sample. dd-cfDNA falls rapidly within 2 weeks, with
baseline levels varying by organ type. Levels are elevated in the presence
of allograft injury, including acute rejection and infection, and return
to baseline after successful treatment. Elevation of cfDNA levels is seen
in advance of clinically apparent organ injury. Discriminatory power was
greatest for higher grades of T cell-mediated and antibody-mediated acute
rejection, with high negative predictive values. Conclusions Cell-free DNA
is a promising biomarker for monitoring the health of SOTs. Future studies
will need to define how it can be used in routine clinical practice and
determine clinical benefit with routine prospective
monitoring. Copyright © 2019 Wolters Kluwer Health, Inc. All
rights reserved.

<25>
Accession Number
2001675387
Title
High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A
meta-analysis.
Source
Journal of Clinical Anesthesia. 57 (pp 57-62), 2019. Date of Publication:
November 2019.
Author
Rong L.Q.; Kamel M.K.; Rahouma M.; Naik A.; Mehta K.; Abouarab A.A.; Di
Franco A.; Demetres M.; Mustapich T.L.; Fitzgerald M.M.; Pryor K.O.;
Gaudino M.
Institution
(Rong, Mustapich, Fitzgerald, Pryor) Department of Anesthesiology, Weill
Cornell Medicine/New York Presbyterian, NY, NY, United States
(Kamel, Rahouma, Naik, Mehta, Abouarab, Di Franco, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, NY,
NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective. We performed a systematic comparison of high-dose and
low-dose opioid anesthesia in cardiac surgery. Design(s): Systematic
review and meta-analysis of randomized controlled trials (RCTs).
 Setting(s): Operating room. Patient(s): 1400 adult patients
undergoing cardiac surgery using general anesthesia. Intervention(s):
All RCTs comparing the effects of various doses of intravenous opioids
(morphine, fentanyl, sufentanil, and remifentanil) during adult cardiac
surgery using general anesthesia published until May 2018 (full-text
English articles reporting data from human subjects) were included.
Measurements: Primary outcome was intensive care unit (ICU) length of stay
(LOS). Secondary outcomes were ventilation time, use of vasopressors,
perioperative myocardial infarction, perioperative stroke, and hospital
LOS. Main Result(s): Eighteen articles were included (1400 patients).
There was no difference in ICU LOS between studies using high or low dose
of opioids (both short-acting and long-acting) (standard mean difference
[SMD]-0.02, 95%CI: -0.15-0.11, P = 0.74). Similarly, there was no
difference in secondary outcomes of ventilation time (SMD-0.27, 95%CI:
-0.63-0.09, P = 0.14), use of vasopressors (OR 0.61, 95%CI: 0.29-1.30, P =
0.20), myocardial infarction (risk difference 0.00, 95% CI: -0.02-0.03, P
= 0.70), stroke (RD 0.00, 95% CI: -0.01-0.01, P = 0.92) and hospital LOS
(SMD 0.03, 95% CI: -0.26-0.33, P = 0.84). At meta-regression, there was no
effect of age, gender, or type of opioid on the difference between groups.
 Conclusion(s): Our data suggest that low-dose opioids, both short
acting and long acting, are safe and effective to use in adult cardiac
surgery patients, independent of the clinical characteristics of the
patients and the type of opioid used. In view of the current opioid
epidemic, low-dose opioid anesthesia should be considered for cardiac
surgery patients. Copyright © 2019 Elsevier Inc.

<26>
Accession Number
627205268
Title
Effect of an Incentive Spirometer Patient Reminder after Coronary Artery
Bypass Grafting: A Randomized Clinical Trial.
Source
JAMA Surgery. 154 (7) (pp 579-588), 2019. Date of Publication: July 2019.
Author
Eltorai A.E.M.; Baird G.L.; Eltorai A.S.; Healey T.T.; Agarwal S.;
Ventetuolo C.E.; Martin T.J.; Chen J.; Kazemi L.; Keable C.A.; Diaz E.;
Pangborn J.; Fox J.; Connors K.; Sellke F.W.; Elias J.A.; Daniels A.H.
Institution
(Eltorai, Baird, Healey, Agarwal, Ventetuolo, Martin, Chen, Kazemi,
Keable, Diaz, Pangborn, Fox, Connors, Sellke, Elias, Daniels) Warren
Alpert Medical School, Brown University, 222 Richmond St, Providence, RI
02903, United States
(Eltorai) Yale University School of Medicine, New Haven, CT, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Incentive spirometers (ISs) were developed to reduce
atelectasis and are in widespread clinical use. However, without IS use
adherence data, the effectiveness of IS cannot be determined.
 Objective(s): To evaluate the effect of a use-tracking IS reminder on
patient adherence and clinical outcomes following coronary artery bypass
grafting (CABG) surgery. Design, Setting, and Participant(s): This
randomized clinical trial was conducted from June 5, 2017, to December 29,
2017, at a tertiary referral teaching hospital and included 212 patients
who underwent CABG, of whom 160 participants were randomized (intent to
treat), with 145 completing the study per protocol. Participants were
stratified by surgical urgency (elective vs nonelective) and sex (men vs
women). Intervention(s): A use-tracking, IS add-on device
(SpiroTimer) with an integrated use reminder bell recorded and timestamped
participants' inspiratory breaths. Patients were randomized by hourly
reminder "bell on" (experimental group) or "bell off" (control group).
 Main Outcomes and Measures: Incentive spirometer use was recorded for
the entire postoperative stay and compared between groups. Radiographic
atelectasis severity (score, 0-10) was the primary clinical outcome.
Secondary respiratory and nonrespiratory outcomes were also evaluated.
 Result(s): A total of 145 per-protocol participants (112 men [77%];
mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective
procedure) were evaluated, with 74 (51.0%) in the bell off group and 71
(49.0%) in the bell on group. The baseline medical and
motivation-to-recover characteristics of the 2 groups were similar. The
mean number of daily inspiratory breaths was greater in bell on (35; 95%
CI, 29-43 vs 17; 95% CI, 13-23; P <.001). The percentage of recorded hours
with an inspiratory breath event was greater in bell on (58%; 95% CI,
51-65 vs 28%; 95% CI, 23-32; P <.001). Despite no differences in the first
postoperative chest radiograph mean atelectasis severity scores (2.3; 95%
CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P =.48), the mean atelectasis
severity scores for the final chest radiographs conducted before discharge
were significantly lower for bell on than bell off group (1.5; 95% CI,
1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P =.04). Of those with early
postoperative fevers, fever duration was shorter for bell on (3.2 hours;
95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P =.04). Having the bell
turned on reduced noninvasive positive pressure ventilation use rates
(37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P =.03) for
participants undergoing nonelective procedures. Bell on reduced the median
postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7;
P =.048) and the intensive care unit length of stay for patients
undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI,
3-4; P =.02). At 6 months, the bell off mortality rate was higher than
bell on (9% vs 0%, P =.048) for participants undergoing nonelective
procedures. Conclusions and Relevance: The incentive spirometer
reminder improved patient adherence, atelectasis severity, early
postoperative fever duration, noninvasive positive pressure ventilation
use, ICU and length of stay, and 6-month mortality in certain patients.
With the reminder, IS appears to be clinically effective when used
appropriately. Trial Registration: ClinicalTrials.gov identifier:
NCT02952027. Copyright © 2019 American Medical Association. All
rights reserved.

<27>
Accession Number
627239022
Title
Visit-to-Visit Blood Pressure Variability, Coronary Atheroma Progression,
and Clinical Outcomes.
Source
JAMA Cardiology. 4 (5) (pp 437-443), 2019. Date of Publication: May 2019.
Author
Clark D.; Nicholls S.J.; St John J.; Elshazly M.B.; Ahmed H.M.; Khraishah
H.; Nissen S.E.; Puri R.
Institution
(Clark) Division of Cardiology, Department of Medicine, University of
Mississippi Medical Center, Jackson, United States
(Nicholls) Monash Cardiovascular Research Centre, Monash University,
Melbourne, Australia
(St John, Ahmed, Nissen, Puri) Department of Cardiovascular Medicine,
Cleveland Clinic Coordinating Center for Clinical Research, Cleveland
Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States
(Elshazly) Division of Cardiology, Department of Medicine, Weill Cornell
Medical College-Qatar, Education City, Doha, Qatar
(Khraishah) Division of Cardiology, Department of Medicine, Beth Israel
Deaconess Medical Center, Boston, MA, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Visit-to-visit blood pressure variability (BPV) is associated
with cardiovascular events, but mechanisms and therapeutic implications
underlying this association are not well understood. Objective(s): To
examine the association of intraindividual BPV, coronary atheroma
progression, and clinical outcomes using serial intravascular
ultrasonography. Design, Setting, and Participant(s): Post hoc
patient-level analysis of 7 randomized clinical trials conducted from 2004
to 2016 involving 3912 patients in multicenter, international,
clinic-based primary and tertiary care centers. Adult patients with
coronary artery disease who underwent serial intravascular ultrasonography
in the setting of a range of medical therapies were included. Data were
analyzed between November 2017 and March 2019. Exposures: Visit-to-visit
BPV measured using intraindividual standard deviation over 3, 6, 12, 18,
and 24 months. Main Outcomes and Measures: Percent atheroma volume
(PAV) progression and major adverse cardiovascular events (defined as
death, myocardial infarction, stroke, urgent revascularization for acute
coronary syndrome, and hospitalization for unstable angina).
 Result(s): Of 3912 patients, the mean (SD) age was 58 (9) years, 1093
(28%) were women, and 3633 (93%) were white. Continuous change in PAV was
significantly associated with systolic BPV (beta,049; 95% CI, 0.021-0.078;
P =.001), diastolic BPV (beta,031; 95% CI, 0.002-0.059; P =.03), and pulse
pressure variability (beta,036; 95% CI, 0.006-0.067; P =.02), without a
signal for differential effect greater than or less than a mean BP of
140/90 mm Hg. The PAV progression as a binary outcome was significantly
associated with systolic BPV (odds ratio, 1.09; 95% CI, 1.01-1.17; P =.02)
but not diastolic BPV (odds ratio, 1.04; 95% CI, 0.97-1.11; P =.30) or
pulse pressure variability (odds ratio, 1.03; 95% CI, 0.96-1.10; P =.47).
Survival curves revealed a significant stepwise association between
cumulative major adverse cardiovascular events and increasing quartiles of
systolic BPV (Kaplan-Meier estimates for quartiles 1-4: 6.1% vs 8.5% vs
10.1% vs 12.0%, respectively; log-rank P <.001). These distinct stepwise
associations were not seen with diastolic BPV or pulse pressure
variability. Conclusions and Relevance: Greater BPV, particularly
systolic BPV, is significantly associated with coronary atheroma
progression and adverse clinical outcomes. These data suggest maintaining
stable blood pressure levels may be important to further improve outcomes
in patients with coronary disease.. Copyright © 2019 American
Medical Association. All rights reserved.

<28>
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

<29>
Accession Number
2002488807
Title
Prolonged versus brief balloon inflation during arterial angioplasty for
de novo atherosclerotic disease: a systematic review and meta-analysis.
Source
CVIR Endovascular. 2 (1) (no pagination), 2019. Article Number: 29. Date
of Publication: 01 Dec 2019.
Author
Rockley M.; Jetty P.; Radonjic A.; Rockley K.; Wells G.; Fergusson D.
Institution
(Rockley, Jetty, Radonjic, Rockley) Division of Vascular and Endovascular
Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital
- Civic Campus, Ottawa K1Y4E9, Canada
(Wells) Cardiovascular Research Methods Centre, University of Ottawa Heart
Institute, Ottawa K1Y4W7, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa K1H8L6, Canada
Publisher
Springer
Abstract
Objective: Angioplasty is a fundamental treatment for atherosclerotic
disease and may be performed as the sole therapy in small vessel disease.
However, the ideal duration of balloon inflation has not yet been
identified. Our study investigated whether prolonged inflation of at least
1-min duration, when compared with brief inflation, affects residual
stenosis after arterial angioplasty. Data sources and methods: Two
independent reviewers conducted a systematic review of EMBASE, MEDLINE,
CENTRAL, trial registries and grey literature, using pre-specified search
syntax. Data abstraction and quantitative analysis was performed
independently, according to pre-specified criteria. The primary outcome
was residual stenosis after initial angioplasty, in addition to other
pre-specific clinical and radiographic outcomes. All analyses were
stratified by coronary, cerebrovascular, and peripheral territory. The
study protocol is published and registered on PROSPERO (CRD42018092702).
 Result(s): Six relevant articles were identified, of which one
investigated peripheral vascular angioplasty and five investigated
coronary artery angioplasty, encompassing 1496 procedures. The studies
were at moderate risk of bias. Minimal heterogeneity within coronary
studies allowed for subgroup meta-analysis. Prolonged inflation was
significantly associated with lower risk of residual stenosis
post-inflation in the pooled coronary trials (RR 1.76 [95% CI 1.46-2.12],
I2 = 0%, p < 0.001) in addition to approaching significance in
the peripheral vascular trial (RR 2.40 [95% CI 0.94-6.13], p = 0.07).
Prolonged inflation was associated with less risk of arterial dissection
and need for adjunctive procedures such as stenting. Following adjunctive
procedures, less residual stenosis was still observed in the prolonged
angioplasty group in the reported coronary studies. Follow-up data did not
reveal a significant difference in the presence of restenosis, however
there was a long-term benefit of prolonged inflation in reducing overall
severity of stenosis. Discussion(s): This is the first review
investigating outcomes related to duration of balloon inflation. Both
coronary and peripheral vascular evidence are in agreement that prolonged
angioplasty balloon inflation greater than 60 s appears to be associated
with improved immediate post-inflation results. However, long-term data is
heterogeneous and inconsistently reported. We propose further
investigation to address outstanding long-term outcomes, particularly in
small vessel territories such as tibial vessels where angioplasty is often
used as the only endovascular therapy. Trial registration: This protocol
has been registered with the International Prospective Register of
Systematic Reviews (PROSPERO: CRD42018092702) prior to conduct of the
review. Copyright © 2019, The Author(s).

<30>
Accession Number
2002467574
Title
Comparison of the effect of 80 vs 40 mg atorvastatin in patients with
isolated coronary artery bypass graft surgery: A randomized clinical
trial.
Source
Journal of Cardiac Surgery. 34 (8) (pp 670-675), 2019. Date of
Publication: 2019.
Author
Shekari A.; Forouzannia S.K.; Davarpasand T.; Talasaz A.H.; Jalali A.;
Gorabi A.M.; Lotfi-Tokaldany M.; Bagheri J.
Institution
(Shekari, Forouzannia, Davarpasand, Talasaz, Jalali, Gorabi,
Lotfi-Tokaldany, Bagheri) Department of Cardiovascular Research, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Atorvastatin can decrease cardiac injury after coronary artery
bypass graft (CABG) surgery. We compared the effects of 80 and 40 mg of
atorvastatin per day on the levels of cardiac troponin T (cTnT) and
creatine kinase-MB (CK-MB) after an isolated CABG. Method(s): This
randomized single-blind parallel clinical trial enrolled 125 patients
(mean age = 60.59 +/- 8.37 years) who were candidates for elective
isolated CABG at the Tehran Heart Center between May 2017 and December
2017. Patients were randomly allocated into two groups to receive either
80 mg (n = 62) or 40 mg of atorvastatin (n = 63) per day, 5 days before
surgery. The levels of cTnT and CK-MB, used as myocardial injury markers,
were measured at baseline and then at 8 and 24 hours after CABG.
 Result(s): The levels of CK-MB and cTnT at baseline and at 8 and 24
hours following CABG were not significantly different between the two
groups. Our repeated measures analysis of variance showed that the levels
of CK-MB and cTnT increased significantly over time (P <.001). No
significant interaction was observed between time and the atorvastatin
dosage on the levels of either CK-MB (P =.159) or cTnT (P =.646). In
addition, the between-group effects were not significant for CK-MB (P
=.632) and cTnT (P =.126). Conclusion(s): The higher dose of
atorvastatin (80 mg) did not exert a more protective effect than the
standard dose of atorvastatin (40 mg) after CABG surgery. Copyright
© 2019 Wiley Periodicals, Inc.

<31>
Accession Number
2002349038
Title
Efficacy and safety of robot-assisted thoracic surgery (RATS) compare with
video-assisted thoracoscopic surgery (VATS) for lung lobectomy in patients
with non-small cell lung cancer.
Source
Combinatorial Chemistry and High Throughput Screening. 22 (3) (pp
169-178), 2019. Date of Publication: 2019.
Author
Hu X.; Wang M.
Institution
(Hu) Department of Thoracic Surgery, The Second Hospital of Jiaxing,
Jiaxing, Zhejiang 314000, China
(Wang) Department of Thoracic Surgery, Shulan (Hangzhou) Hospital,
Hangzhou, Zhejiang, China
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: In the past decade, many researchers focused on
Robotic-Assisted Thoracoscopic Surgery (RATS), which has been introduced
as an alternative minimally invasive approach, versus VideoAssisted
Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small
cell lung cancer. However, the advantage of RVATS compared to VATS is
still under investigation. The results are unclear. Aim(s): The aim
of this study is to compare the efficacy and safety of Robot-assisted
Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery
(VATS) for lobectomy in patients with NonSmall Cell Lung Cancer (NSCLC).
 Method(s): A systematic electronic search of online electronic
databases: Pubmed, Embase, Cochrane library updated in June 2017. The
meta-analysis was performed including the studies are designed as
randomized or non-randomized controlled. Result(s): Twenty
retrospective cohort studies met our inclusion criteria. The pooled
analysis of mortality showed that RATS lobectomy significantly reduced the
mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 -
0.76; P = 0.0005). With the pooled result of duration of surgery indicated
that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI
0.23- 0.81; P < 0.0004=). However, the meta-analysis on the median length
of hospital stay (MD =0.00, 95% CI-0.03 - 0.03; P = 0.91), number of
dissected lymph nodes station (SMD =0.39, 95% CI-0.60 - 1.38; P = 0.44),
the number of removed lymph nodes (SMD =0.98, 95% CI-0.61 - 2.56; P =
0.23), mean duration of drainage (SMD =0.29, 95% CI-0.15 - 0.73; P =
0.20), prolonged air leak (RR =1.01, 95% CI 0.84 - 1.21; P = 0.93),
arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia
(RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR
=0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90
- 1.23; P = 0.055) all showed no significant differences between RATS and
VATS lobectomy. Conclusion(s): RATS result in better mortality as
compared with VATS. However, robotics seems to have longer operative time
and higher hospital costs, without superior advantages in morbidity rates
and oncologic efficiency. Since the advantages of RATS has been performed
in some area, the continuation of a comparative investigation with VATS
may be necessary. And some efforts need to be taken into consideration to
reduce the operative time and cost. Copyright © 2019 Bentham
Science Publishers.

<32>
Accession Number
2002634958
Title
Effects of Alirocumab on Cardiovascular Events After Coronary Bypass
Surgery.
Source
Journal of the American College of Cardiology. 74 (9) (pp 1177-1186),
2019. Date of Publication: 3 September 2019.
Author
Goodman S.G.; Aylward P.E.; Szarek M.; Chumburidze V.; Bhatt D.L.; Bittner
V.A.; Diaz R.; Edelberg J.M.; Hanotin C.; Harrington R.A.; Jukema J.W.;
Kedev S.; Letierce A.; Moryusef A.; Pordy R.; Ramos Lopez G.A.; Roe M.T.;
Viigimaa M.; White H.D.; Zeiher A.M.; Steg P.G.; Schwartz G.G.
Institution
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada and St. Michael's Hospital, University of Toronto,
Toronto, Ontario, Canada
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, South Australia, Australia
(Szarek) State University of New York, Downstate School of Public Health,
Brooklyn, NY, United States
(Chumburidze) Chapidze Emergency Cardiology Center, Tbilisi, Georgia
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
(Diaz) Estudios Cardiologicos Latinoamerica, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Edelberg, Moryusef) Sanofi, Bridgewater, NJ, United States
(Hanotin, Letierce) Sanofi, Chilly-Mazarin, France
(Harrington) Stanford Center for Clinical Research, Department of
Medicine, Stanford University, Stanford, CA, United States
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Kedev) University Clinic of Cardiology, Skopje, Macedonia
(Pordy) Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
(Ramos Lopez) Medical Office, Guadalajara, Jalisco, Mexico
(Roe) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Roe) Division of Cardiology, Department of Medicine, Duke University
School of Medicine, Durham, NC, United States
(Viigimaa) SA Pohja-Eesti Regionaalhaigla, Tallinn, Estonia
(White) Green Lane Cardiovascular Services Auckland City Hospital,
Auckland, New Zealand
(Zeiher) Department of Medicine III, Goethe University, Frankfurt am Main,
Germany
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, Aurora, CO, United States
Publisher
Elsevier USA
Abstract
Background: Patients with acute coronary syndrome (ACS) and history of
coronary artery bypass grafting (CABG) are at high risk for recurrent
cardiovascular events and death. Objective(s): This study sought to
determine the clinical benefit of adding alirocumab to statins in ACS
patients with prior CABG in a pre-specified analysis of ODYSSEY OUTCOMES
(Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome
During Treatment With Alirocumab). Method(s): Patients (n = 18,924) 1
to 12 months post-ACS with elevated atherogenic lipoprotein levels despite
high-intensity statin therapy were randomized to alirocumab or placebo
subcutaneously every 2 weeks. Median follow-up was 2.8 years. The primary
composite endpoint of major adverse cardiovascular events (MACE) comprised
coronary heart disease death, nonfatal myocardial infarction, ischemic
stroke, or unstable angina requiring hospitalization. All-cause death was
a secondary endpoint. Patients were categorized by CABG status: no CABG (n
= 16,896); index CABG after qualifying ACS, but before randomization (n =
1,025); or CABG before the qualifying ACS (n = 1,003). Result(s): In
each CABG category, hazard ratios (95% confidence intervals) for MACE (no
CABG 0.86 [0.78 to 0.95], index CABG 0.85 [0.54 to 1.35], prior CABG 0.77
[0.61 to 0.98]) and death (0.88 [0.75 to 1.03], 0.85 [0.46 to 1.59], 0.67
[0.44 to 1.01], respectively) were consistent with the overall trial
results (0.85 [0.78 to 0.93] and 0.85 [0.73 to 0.98], respectively).
Absolute risk reductions (95% confidence intervals) differed across CABG
categories for MACE (no CABG 1.3% [0.5% to 2.2%], index CABG 0.9% [-2.3%
to 4.0%], prior CABG 6.4% [0.9% to 12.0%]) and for death (0.4% [-0.1% to
1.0%], 0.5% [-1.9% to 2.9%], and 3.6% [0.0% to 7.2%]). Conclusion(s):
Among patients with recent ACS and elevated atherogenic lipoproteins
despite intensive statin therapy, alirocumab was associated with large
absolute reductions in MACE and death in those with CABG preceding the ACS
event. (ODYSSEY OUTCOMES: Evaluation of Cardiovascular Outcomes After an
Acute Coronary Syndrome During Treatment With Alirocumab;
NCT01663402) Copyright © 2019 American College of Cardiology
Foundation

<33>
Accession Number
623904994
Title
A method for addressing right upper lobe obstruction with right-sided
double-lumen endobronchial tubes during surgery: A randomized controlled
trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 130.
Date of Publication: 18 Sep 2018.
Author
Yu W.; Wang Z.; Gao D.; Zhang W.; Jin W.; Ma X.; Qi S.
Institution
(Yu, Wang, Gao, Zhang, Jin, Ma, Qi) Department of Anaesthesiology, Fourth
Affiliated Hospital, Harbin Medical University, 37 Yiyuan Road, Harbin
Heilongjiang Province 150001, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A right-sided double-lumen tube (R-DLT) tends to obstruct the
right upper lobe intraoperatively due to anatomical distortion during
surgery. If the R-DLT is poorly matched with the patient's airway anatomy,
it will not be possible to correctly replace the tube with a fiberoptic
bronchoscope (FOB). In our study, we aimed to explore an efficient method
for difficult repositioning caused by right upper lobe occlusion during
surgery: repositioning the R-DLT from the right main bronchus into the
left main bronchus. The current study was designed to assess the efficacy
and safety of this method. Method(s): Sixty adult patients scheduled
to undergo left-sided thoracic surgery were randomly assigned to two
groups. With the patient in the right lateral position during surgery, the
R-DLT was pulled back to the trachea while being rotated 90degree
clockwise; it was then either rotated 90degree clockwise for placement
into the left main bronchus (Group L) or rotated 90degree anticlockwise
and returned to the right main bronchus (Group R) using FOB guidance. The
primary outcomes included clinical performance, which was measured by
intubation time, and the quality of lung collapse. A secondary outcome was
safety, which was determined according to bronchial injury and vocal cord
injury. Result(s): The median intubation time (IQR [range]) required
for placement of a R-DLT into the left main bronchus was shorter than the
time required for placement into the right main bronchus (15.0 s [IQR,
12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups
showed comparable overall results for the quality of lung collapse during
the total period of one-lung ventilation (P = 1.000). The numbers of
patients with bronchial injuries or vocal cord injuries were also
comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for
bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal
cord injuries). Conclusion(s): Repositioning a R-DLT from the right
main bronchus into the left main bronchus had good clinical performance
without causing additional injury. This may be an efficient method for the
difficult repositioning of a R-DLT due to right upper lobe occlusion
during surgery. Trial registration: Chinese Clinical Trial Registry,
ChiCTR-IPR-15006933, registered on 15 August 2015. Copyright ©
2018 The Author(s).

<34>
Accession Number
2000644715
Title
Feasibility of initiating early enteral nutrition after congenital heart
surgery in neonates and infants.
Source
Clinical Nutrition ESPEN. 25 (pp 100-102), 2018. Date of Publication: June
2018.
Author
Kalra R.; Vohra R.; Negi M.; Aggarwal N.; Aggarwal M.; Joshi R.
Institution
(Kalra, Vohra, Negi, Joshi, Aggarwal, Aggarwal, Joshi) Pediatric Cardiac
Sciences, Sir Ganga Ram Hospital, New Delhi 110060, India
Publisher
Elsevier Ltd
Abstract
Objective: To assess the feasibility of initiating enteral nutrition
support with first 24 h of congenital heart repairs in neonates and
Infants and its impact on outcomes following surgery. Design(s): It
is a prospective randomized control single blind study. Setting(s):
It is a single centre prospective study carried out in a tertiary care
centre at Pediatric cardiac intensive care unit. Patient(s): All
patients with the cyanotic congenital heart disease with increase
pulmonary blood flow, weighing less than 5 kg and undergoing congenital
heart repair during the study period were included in the study. Patients
with single ventricle status, those undergoing palliative procedures (PA
band), open chest, requiring ECMO before leaving operating room, having
any other contraindication for starting enteral feeding or those who
refuse for consent were excluded from study. Intervention(s): The
patients were randomized into two groups. Group 1 received trophic feeds
(10-20 ml/kg/day) starting 4-6 h after surgery while feeds children in
group 2 were kept NPO and received feeds after 48 h after surgery.
 Measurements and Main Results: 15 children enrolled in both the
groups. Both pre-operative and intraoperative variables were comparable in
both the groups. There was no complication (vomiting, diarrhea, NEC, bowel
necrosis) noted in the children who received feeds after surgery. Mean
duration of mechanical ventilation in the feeds group was 58.2 +/- 4.71 h,
which was less then significantly less than those in the NPO group (P
value 0.05). Similarly, duration of ICU stay was only 179.04 +/- 41.28 h
in feeds group as compared to 228.72 +/- 85.44 h in the NPO group.
 Conclusion(s): Neonates and Infants tolerate feeds immediately
following congenital heart repairs. Moreover, feeds appear to decrease
duration of mechanical ventilation and duration of ICU stay. Copyright
© 2018 European Society for Clinical Nutrition and Metabolism

<35>
Accession Number
624279160
Title
Effect of Shenmai injection on cognitive function after cardiopulmonary
bypass in cardiac surgical patients: A randomized controlled trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 142.
Date of Publication: 11 Oct 2018.
Author
Chen L.; Wang L.; Zhuo Q.; Zhang Q.; Chen F.; Li L.; Lin L.
Institution
(Chen, Wang, Zhang, Chen, Li, Lin) Department of Anesthesiology, First
Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang
Province, China
(Zhuo) Wenzhou People's Hospital, Wenzhou, Zhejiang Province, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common
complication after cardiac surgery that influences the clinical outcomes
and quality of life of patients. This study aimed to evaluate the effects
of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve
replacement under cardiopulmonary bypass (CPB). Method(s): This
prospective, randomized, controlled trial was conducted from September
2014 to January 2017. Eighty-eight patients receiving cardiac valve
replacement under CPB were randomized into the control (C) or the SMI (S)
group. SMI (0.6 mL/kg) was administered intravenously from the time of
anesthesia induction to the beginning of CPB. Cognitive function was
assessed at 3 days before surgery and 3 days, 7 days, and 1 month after
surgery using the Beijing version of the Montreal Cognitive Assessment
(MoCA-BJ) score. The serum levels of neuroglobin (Ngb), hypoxia-inducible
factor-1alpha (HIF-1alpha), and neuron-specific enolase (NSE) were
measured at 30 min after induction (T<inf>0</inf>), immediately after the
endonasal temperature rewarmed to 36 degreeC (T<inf>1</inf>), and 1 h
(T<inf>2</inf>), 6 h (T<inf>3</inf>), 24 h (T<inf>4</inf>), 48 h
(T<inf>5</inf>), and 72 h (T<inf>6</inf>) after CPB. Result(s):
Compared with the baseline values at T<inf>0</inf>, the serum Ngb levels
in group C were significantly decreased at T<inf>1-2</inf> and then
increased at T<inf>3-6</inf>, while the levels in group S were decreased
at T<inf>1-2</inf> and increased at T<inf>4-6</inf>, compared to group C
(p < 0.05). The serum HIF-1alpha levels at T<inf>1-4</inf> and the serum
NSE levels at T<inf>1-6</inf> were significantly increased in both groups
(p < 0.05). The serum levels of Ngb at T<inf>3</inf>, HIF-1alpha at
T<inf>1-3</inf>, and NSE at T<inf>3-4,6</inf> were lower in group S,
compared to group C (p < 0.01). The MoCA-BJ scores were decreased at 3 and
7 days after surgery in both groups, and the MoCA-BJ scores in group S
were higher than those in group C at 3 and 7 days after surgery (p <
0.01). Conclusion(s): Cognitive function is impaired postoperatively
in patients who have undergone cardiac valve replacement under CPB. In
addition, treatment with the traditional Chinese medicine SMI decreases
the serum levels of Ngb, HIF-1alpha, and NSE as well as attenuates
cognitive dysfunction. Trial registration: This trial was registered with
Clinicaltrials.gov as ChiCTR-TRC-14004373 on March 11, 2014. Copyright
© 2018 The Author(s).

<36>
Accession Number
628217160
Title
Current perspective on the use of opioids in perioperative medicine: An
evidence-based literature review, national survey of 70,000 physicians,
and multidisciplinary clinical appraisal.
Source
Pain Medicine (United States). 19 (9) (pp 1710-1719), 2018. Date of
Publication: September 2018.
Author
Jahr J.S.; Bergese S.D.; Sheth K.R.; Bernthal N.M.; Ho H.S.; Stoicea N.;
Apfel C.C.
Institution
(Jahr) Department of Anesthesiology and Perioperative Care, David Geffen
School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los
Angeles, CA, United States
(Bergese, Stoicea) Departments of Anesthesiology and Neurological Surgery,
Ohio State University, Columbus, OH, United States
(Sheth) Division of General Surgery, Cambridge Health Alliance, Cambridge,
MA, United States
(Sheth) Harvard Medical School, Boston, MA, United States
(Bernthal) Department of Orthopedic Surgery, David Geffen School of
Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA,
United States
(Ho) Department of Surgery, UC Davis Medical Center, Davis, CA, United
States
(Apfel) Clinical Research Consultants LLC, Larkspur, CA, United States
(Apfel) University of California, San Francisco School of Medicine, San
Francisco, CA, United States
Publisher
Oxford University Press
Abstract
Objective. Opioids represent an important analgesic option for physicians
managing acute pain in surgical patients. Opioid management is not without
its drawbacks, however, and current trends suggest that opioids might be
overused in the United States. An expert panel was convened to conduct a
clinical appraisal regarding the use of opioids in the perioperative
setting. Methods. The clinical appraisal consisted of the review,
presentation, and assessment of current published evidence as it relates
to the statement "Opioids are not overused in the United States, even
though opioid adjunct therapy achieves greater pain control with less
risk." The authors' evaluation of this statement was also compared with
the results of a national survey of surgeons and anesthesiologists in the
United States. Results. We report the presented literature and proceedings
of the panel discussion. The national survey revealed a wide range of
opinions regarding opioid overuse in the United States. Current published
evidence provides support for the efficacy of opioid therapy in surgical
patients; however, it is not sufficient to conclude unequivocally that
opioids are - or are not - overused in the management of acute surgical
pain in the United States. Conclusions. Opioids remain a key component of
multimodal perioperative analgesia, and strategic opioid use based on
clinical considerations and patient-specific needs represents an
opportunity to support improved postoperative outcomes and satisfaction.
Future studies should focus on identifying optimal procedure-specific and
patient-centered approaches to multimodal perioperative
analgesia. Copyright © 2018 Oxford University Press. All rights
reserved.

<37>
[Use Link to view the full text]
Accession Number
627079999
Title
Intravenous heme arginate induces HO-1 (heme oxygenase-1) in the human
Heart randomized, placebo-controlled, safety, and feasibility
pharmacokinetic study-brief report.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 38 (11) (pp
2755-2762), 2018. Date of Publication: 2018.
Author
Andreas M.; Oeser C.; Kainz F.-M.; Shabanian S.; Aref T.; Bilban M.;
Messner B.; Heidtmann J.; Laufer G.; Kocher A.; Wolzt M.
Institution
(Andreas, Oeser, Kainz, Shabanian, Aref, Messner, Heidtmann, Laufer,
Kocher) Department of Cardiac Surgery, Medical University of Vienna,
Austria
(Bilban) Department of Laboratory Medicine, Medical University of Vienna,
Austria
(Bilban, Wolzt) Department of Clinical Pharmacology, Medical University of
Vienna, Austria
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective-HO-1 (heme oxygenase-1) induction may prevent or reduce
ischemia-reperfusion injury. We previously evaluated its in vivo induction
after a single systemic administration of heme arginate in peripheral
blood mononuclear cells. The current trial was designed to assess the
pharmacological tissue induction of HO-1 in the human heart with heme
arginate in vivo. Approach and Results-Patients planned for conventional
aortic valve replacement received placebo (n=8), 1 mg/kg (n=7) or 3 mg/kg
(n=9) heme arginate infused intravenously 24 hours before surgery. A
biopsy of the right ventricle was performed directly before aortic
cross-clamping and after cross-clamp release. In addition, the right
atrial appendage was partially removed for analysis. HO-1 protein and mRNA
concentrations were measured in tissue samples and in peripheral blood
mononuclear cells before to and up to 72 hours after surgery. No study
medication-related adverse events occurred. A strong, dose-dependent
effect on myocardial HO-1 mRNA levels was observed (right ventricle:
7.9+/-5.0 versus 88.6+/-49.1 versus 203.6+/-148.7; P=0.002 and right
atrium: 10.8+/-8.8 versus 229.8+/-173.1 versus 392.7+/-195.7; P=0.001).
This was paralleled by a profound increase of HO-1 protein concentration
in atrial tissue (8401+/-3889 versus 28 585+/-10 692 versus 29 022+/-8583;
P<0.001). Surgery and heme arginate infusion significantly increased HO-1
mRNA concentration in peripheral blood mononuclear cells (P<0.001). HO-1
induction led to a significant increase of postoperative carboxyhemoglobin
(1.7% versus 1.4%; P=0.041). No effect on plasma HO-1 protein levels could
be detected. Conclusions-Myocardial HO-1 mRNA and protein can be
dose-dependently induced by heme arginate. Protective effects of this
therapeutic strategy should be evaluated in upcoming clinical
trials. Copyright © 2018 American Heart Association, Inc.

<38>
Accession Number
623771658
Title
Maintaining intraoperative normothermia reduces blood loss in patients
undergoing major operations: A pilot randomized controlled clinical trial.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 126.
Date of Publication: 08 Sep 2018.
Author
Yi J.; Liang H.; Song R.; Xia H.; Huang Y.
Institution
(Yi, Liang, Song, Xia, Huang) Chinese Academy of Medical Science,
Department of Anesthesia, Peking Union Medical College Hospital, 1
Shuaifuyuan, Dongcheng District, Beijing 100730, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Inadvertent intraoperative hypothermia (core
temperature<36degreeC) is a common but preventable adverse event. This
study aimed to determine whether active intraoperative warming reduced
bleeding in patients undergoing major operations: open thoracic surgery
and hip replacement surgery. Methods/Design: The study was a pilot,
prospective, parallel two-arm randomized controlled trial. Eligible
patients were randomly allocated to two groups: passive warming (PW), with
application of a cotton blanket (thermal insulation), or active warming
(AW), with a forced-air warming system. The primary endpoint was
intraoperative blood loss, and secondary endpoints were surgical-site
infection, cardiovascular events, and length of stay in the
post-anesthesia care unit, intensive care unit, and hospital.
 Result(s): Sixty-two patients were enrolled. Forced-air active
warming maintained intraoperative normothermia in all AW subjects, whereas
intraoperative hypothermia occurred in 21/32 (71.8%) of PW patients
(p=0.000). The volume of blood loss was more in the PW group (682+/-426ml)
than in the AW group (464+/-324ml) (p<0.021), and the perioperative
hemoglobin value declined more in the PW group (28.6+/-17.5g/L) than in
the AW group (21.0+/-9.9g/L) (p=0.045). However, there were no difference
in other clinical outcomes between two groups. Conclusion(s):
Intraoperative active warming is associated with less blood loss than
passive warming in open thoracic and hip replacement operations in this
pilot study. Copyright © 2018 The Author(s).

<39>
Accession Number
2002448855
Title
Bilateral or unilateral antegrade cerebral perfusion during surgery for
acute type A dissection.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Angleitner P.; Stelzmueller M.-E.; Mahr S.; Kaider A.; Laufer G.; Ehrlich
M.
Institution
(Angleitner, Stelzmueller, Mahr, Laufer, Ehrlich) Division of Cardiac
Surgery, Department of Surgery, Medical University of Vienna, Vienna,
Austria
(Kaider) Center for Medical Statistics, Informatics, and Intelligent
Systems, Medical University of Vienna, Vienna, Austria
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to investigate outcomes associated with
the application of bilateral or unilateral antegrade cerebral perfusion
during surgery for acute type A dissection. Method(s): Patients who
underwent surgery for type A dissection with the application of antegrade
cerebral perfusion between 2009 and 2017 at the Division of Cardiac
Surgery, Medical University of Vienna were analyzed retrospectively
(bilateral antegrade cerebral perfusion: n = 91, 49.5%; unilateral
antegrade cerebral perfusion: n = 93, 50.5%). The primary outcome variable
was overall survival. Subgroup analyses were performed in patients
requiring antegrade cerebral perfusion durations of 50 minutes or more and
less than 50 minutes. Secondary outcome variables were 30-day mortality,
adverse outcome, permanent and temporary neurologic deficits, renal
replacement therapy, prolonged ventilation, intensive care unit stay, and
hospital stay. Result(s): Multivariable Cox proportional hazards
analysis demonstrated no significant association of bilateral antegrade
cerebral perfusion with overall survival (hazard ratio, 0.63; 95%
confidence interval, 0.34-1.14, P = .126). Propensity score modeling using
the method of inverse probability of treatment weighting confirmed this
result (hazard ratio, 0.73; 95% confidence interval, 0.33-1.60, P = .428).
Bilateral antegrade cerebral perfusion was associated with significantly
improved overall survival in patients requiring antegrade cerebral
perfusion durations of 50 minutes or more (P = .017). The bilateral
antegrade cerebral perfusion and unilateral antegrade cerebral perfusion
groups showed comparable rates of secondary outcome variables.
 Conclusion(s): In the present study, bilateral antegrade cerebral
perfusion and unilateral antegrade cerebral perfusion are associated with
comparable outcomes after surgery for type A dissection. Subgroup analyses
suggest that bilateral antegrade cerebral perfusion is associated with
superior overall survival in patients requiring antegrade cerebral
perfusion durations of 50 minutes or more. An adequately powered
prospective randomized controlled trial is required to validate these
results. Copyright © 2019 The American Association for Thoracic
Surgery

<40>
Accession Number
628856684
Title
Surgical site infections in Eastern Mediterranean region: a systematic
review and meta-analysis.
Source
Infectious Diseases. 51 (10) (pp 719-729), 2019. Date of Publication:
2019.
Author
Maleknejad A.; Dastyar N.; Badakhsh M.; Balouchi A.; Rafiemanesh H.; Al
Rawajfah O.; Rezaie Keikhaie K.; Sheyback M.
Institution
(Maleknejad) Department of General Surgery, Clinical Immunology Research
Center, Ali-Ebne Abitaleb Hospital, Zahedan University of Medical
Sciences, Zahedan, Iran, Islamic Republic of
(Dastyar) Department of Midwifery, Jiroft University of Medical Sciences,
Jiroft, Iran, Islamic Republic of
(Badakhsh) Department of Midwifery, School of Nursing and Midwifery, Zabol
University of Medical Sciences, Zabol, Iran, Islamic Republic of
(Balouchi) Student Research Committee, Nursing and Midwifery School, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Rafiemanesh) Department of Epidemiology, Student Research Committee,
School of Public Health and Safety, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Al Rawajfah) College of Nursing, Sultan Qaboos University, Muscat, Oman
(Rezaie Keikhaie) Zabol Medicinal Plants Research Center, Zabol University
of Medical Sciences, Zabol, Iran, Islamic Republic of
(Sheyback) Bushehr University of Medical Sciences, Bushehr, Iran, Islamic
Republic of
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background: Surgical site infections (SSIs) are the most common and costly
type of hospital-acquired infections (HAIs) worldwide. Despite individual
studies, there is also no clear statistics on the SSI prevalence rate in
the East Mediterranean region. The aim of this study was to investigate
the prevalence of SSI in the Eastern Mediterranean region. Method(s):
This systematic review and meta-analysis were performed by searching three
international databases (Web of Science, PubMed and Scopus) from 1 January
2001 to 31 December 2018. The keywords used included 'Prevalence' OR
'incidence' OR 'surgical site infection' OR 'wound infection' OR
'Postoperative Wound Infections' and 'Middle east'. The Hoy et al.'s tool
was used to evaluate the quality of the articles. Result(s): Out of
889 initial studies, 40 studies from 12 countries of the Eastern
Mediterranean region were included in the final stage of the study. Based
on the results of random effect method, the overall prevalence of SSI in
137,452 patients was 7.9% (95% Confidence Interval (CI): 7.1, 8.8;
I2=96.7%). The prevalence of SSI in cardiac surgery and general
surgery wards was 10 and 9.2%, respectively. The prevalence of SSI was
lower in women than in males, although this difference was related to
caesarean section. Conclusion(s): Considering the high prevalence of
SSI in the Eastern Mediterranean region, timely diagnosis, proper
prevention and postoperative control are necessary in the region using the
same international guides in all countries. Copyright © 2019,
© 2019 Society for Scandinavian Journal of Infectious Diseases.

<41>
Accession Number
2002385596
Title
Surgical Treatment for Ischemic Heart Failure (STICH) trial: A review of
outcomes.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Hassanabad A.F.; MacQueen K.T.; Ali I.
Institution
(Hassanabad, MacQueen, Ali) Section of Cardiac Surgery, Department of
Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of
Medicine, University of Calgary, Calgary, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Coronary artery disease (CAD) is a significant source of morbidity and
mortality in developed countries. The landmark Surgical Treatment for
Ischemic Heart Failure (STICH) trial has provided greatly needed evidence
in the management of patients with severe left ventricle (LV) dysfunction
(LVEF <= 35%) and CAD amenable to revascularization. The trial
investigated two primary hypotheses: (i) that coronary artery bypass
grafting (CABG) with optimal medical therapy (OMT) was superior to OMT
alone, and (ii) that CABG with surgical ventricular reconstruction (SVR)
would be superior to CABG alone. The results of the 10-year follow-up
demonstrated significant long-term benefits with the addition of CABG to
OMT. However, the second hypothesis yielded controversial results as the
study found no difference between CABG with SVR and SVR alone. The STICH
trial, and the numerous subanalyses that followed have reinforced and
challenged a number of widely held beliefs regarding the management of
patients with severe LV dysfunction and ischemic heart failure. The
purpose of this comprehensive review is to outline the published data from
the STICH trial and its substudies while providing a balanced assessment
of the evidence-based conclusions and criticisms that have
followed. Copyright © 2019 Wiley Periodicals, Inc.

<42>
Accession Number
2002380213
Title
Defining the learning curve of robotic thoracic surgery: what does it
take?.
Source
Surgical Endoscopy. (no pagination), 2019. Date of Publication: 2019.
Author
Power A.D.; D'Souza D.M.; Moffatt-Bruce S.D.; Merritt R.E.; Kneuertz P.J.
Institution
(Power, D'Souza, Moffatt-Bruce, Merritt, Kneuertz) Division of Thoracic
Surgery, Department of Surgery, The Ohio State University Wexner Medical
Center, 410 West 10th Avenue; N846a Doan Hall, Columbus, OH 43210, United
States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Controversy exists as to what constitutes a learning curve to
achieve competency, and how the initial learning period of robotic
thoracic surgery should be approached. Method(s): We conducted a
systematic review of the literature published prior to December 2018 using
PubMed/MEDLINE for studies of surgeons adopting the robotic approach for
anatomic lung resection or thymectomy. Changes in operating room time and
outcomes based on number of cases performed, type of procedure, and
existing proficiency with video-assisted thoracoscopic surgery (VATS) were
examined. Result(s): Twelve observational studies were analyzed,
including nine studies on robotic lung resection and three studies on
thymectomy. All studies showed a reduction in operative time with an
increasing number of cases performed. A steep learning curve was described
for thymectomy, with a decrease in operating room time in the first 15
cases and a plateau after 15-20 cases. For anatomic lung resection, the
number of cases to achieve a plateau in operative time ranged between
15-20 cases and 40-60 cases. All but two studies had at least some VATS
experience. Six studies reported on experience of over one hundred cases
and showed continued gradual improvements in operating room time.
 Conclusion(s): The learning curve for robotic thoracic surgery
appears to be rapid with most studies indicating the steepest improvement
in operating time occurring in the initial 15-20 cases for thymectomy and
20-40 cases for anatomic lung resection. Existing data can guide a
standardized robotic curriculum for rapid adaptation, and aid
credentialing and quality monitoring for robotic thoracic surgery
programs. Copyright © 2019, Springer Science+Business Media, LLC,
part of Springer Nature.

<43>
Accession Number
2002311391
Title
Meta-Analysis for Impact of Statin on Mortality After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. 124 (6) (pp 920-925), 2019. Date of
Publication: 15 September 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To determine whether statin (hydroxymethylglutaryl-CoA reductase
inhibitor) therapy is associated with better midterm survival after
transcatheter aortic valve implantation (TAVI), the first meta-analysis of
currently available studies was performed. To identify all observational
comparative studies and randomized controlled trials (RCTs) of statin
versus control (no statin) therapy or cohort studies investigating statin
treatment as one of covariates in patients undergoing TAVI, PubMed, Web of
Science, and Google Scholar were searched through March 2019. Adjusted (if
unavailable, unadjusted) hazard ratios (HRs) with their confidence
interval (CIs) of midterm (>=1 year) all-cause mortality after TAVI for
statin therapy were extracted from each study. Study-specific estimates
were combined by means of inverse variance-weighted averages of
logarithmic HRs in the random-effects model. Eight eligible studies with a
total of 5,170 TAVI patients were identified and included in the present
meta-analysis. The primary meta-analysis (including HRs for high intensity
statin from 3 studies together with other HRs) demonstrated that statin
treatment was associated with significantly lower midterm mortality (HR,
0.74; 95% CI, 0.60 to 0.91; p = 0.005). The secondary meta-analysis
(including HRs for low/moderate intensity statin from 3 studies together
with other HRs) also indicated an association of statin therapy with
significantly lower midterm mortality (HR, 0.80; 95% CI, 0.69 to 0.93; p =
0.005). No funnel plot asymmetry for the primary meta-analysis (p = 0.64)
was identified, which suggested probably no publication bias. In
conclusion, statin therapy is associated with better midterm survival
after TAVI. Copyright © 2019 Elsevier Inc.

<44>
Accession Number
2002376256
Title
Total arterial revascularization strategies: A meta-analysis of propensity
score-matched observational studies.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Urso S.; Sadaba R.; Gonzalez J.M.; Nogales E.; Pettinari M.; Tena M.A.;
Paredes F.; Portela F.
Institution
(Urso, Tena, Paredes, Portela) Cardiac Surgery Department, Hospital
Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Cardiac Surgery Department, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Nogales) Cardiology Department, Hospital Universitario Insular, Las
Palmas de Gran Canaria, Spain
(Pettinari) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk,
Belgium
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: We explored the current evidence
available on total arterial revascularization (TAR) carrying out a
meta-analysis of propensity score-matched studies comparing TAR versus
non-TAR strategy. Method(s): PubMed, EMBASE, and Google Scholar were
searched for propensity score-matched studies comparing TAR vs non-TAR.
The generic inverse variance method was used to compute the combined
hazard ratio (HR) of long-term mortality. The Der-Simonian and Laird
method were used to compute the combined risk ratio (RR) of 30-day
mortality, deep sternal wound infection, and reoperation for bleeding.
 Result(s): Eighteen TAR vs non-TAR matched populations were included.
Meta-analysis showed a significant benefit in terms of long-term survival
of the TAR group over the non-TAR group (HR: 0.73; 95% confidence interval
[CI]: 0.68-0.78). Better long-term survival over non-TAR strategy was
confirmed by both subgroups: TAR with the bilateral internal mammary
artery (BIMA) and TAR without BIMA. Meta-regression suggests that TAR may
offer a higher protective survival effect in diabetic patients
(coefficient: -0.0063; 95% CI: -0.01 to 0.0006), when carried out with
BIMA (coefficient: -0.15; 95% CI: -0.27 to -0.03) or using three arterial
conduits (coefficient: -0.12; 95% CI: -0.25 to 0.007). A TAR strategy
carried out using BIMA, differently from TAR without BIMA, increases the
risk of deep sternal infection (RR: 1.44; 95% CI: 1.17-1.77).
 Conclusion(s): TAR provides a long-term survival benefit compared
with the non-TAR strategy. Also, compared with TAR without BIMA, TAR with
BIMA may offer a higher protective long-term survival effect at the
expense of a higher risk of sternal deep wound infection. Copyright
© 2019 Wiley Periodicals, Inc.

<45>
Accession Number
624725597
Title
Peep titration based on the open lung approach during one lung ventilation
in thoracic surgery: a physiological study.
Source
BMC anesthesiology. 18 (1) (pp 156), 2018. Date of Publication: 31 Oct
2018.
Author
Rauseo M.; Mirabella L.; Grasso S.; Cotoia A.; Spadaro S.; D'Antini D.;
Valentino F.; Tullo L.; Loizzi D.; Sollitto F.; Cinnella G.
Institution
(Rauseo, Mirabella, Cotoia, D'Antini, Valentino, Tullo, Cinnella)
Department of Anesthesia and Intensive care, University of Foggia, Viale
Pinto, Foggia, Italy
(Rauseo) Interdepartmental Division of Critical Care Medicine, University
of Toronto, Toronto, ON, Canada
(Grasso) Department of Anesthesia and Intensive care, University of Bari,
Bari, Italy
(Spadaro) Department of Anesthesia and Intensive care, University of
Ferrara, Ferrara, Italy
(Loizzi, Sollitto) Department of Thoracic Surgery, University of Foggia,
Foggia, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: During thoracic surgery in lateral decubitus, one lung
ventilation (OLV) may impair respiratory mechanics and gas exchange. We
tested a strategy based on an open lung approach (OLA) consisting in lung
recruitment immediately followed by a decremental positive-end expiratory
pressure (PEEP) titration to the best respiratory system compliance (CRS)
and separately quantified the elastic properties of the lung and the chest
wall. Our hypothesis was that this approach would improve gas exchange.
Further, we were interested in documenting the impact of the OLA on
partitioned respiratory system mechanics. METHOD(S): In thirteen
patients undergoing upper left lobectomy we studied lung and chest wall
mechanics, transpulmonary pressure (PL), respiratory system and
transpulmonary driving pressure (DELTAPRS and DELTAPL), gas exchange and
hemodynamics at two time-points (a) during OLV at zero end-expiratory
pressure (OLVpre-OLA) and (b) after the application of the open-lung
strategy (OLVpost-OLA). RESULT(S): The external PEEP selected through
the OLA was 6+/-0.8 cmH2O. As compared to OLVpre-OLA, the PaO2/FiO2 ratio
went from 205+/-73 to 313+/-86 (p=.05) and CL increased from 56+/-18
ml/cmH2O to 71+/-12 ml/cmH2O (p=.0013), without changes in CCW. Both
DELTAPRS and DELTAPL decreased from 9.2+/-0.4 cmH2O to 6.8+/-0.6 cmH2O and
from 8.1+/-0.5 cmH2O to 5.7+/-0.5 cmH2O, (p=.001 and p=.015 vs
OLVpre-OLA), respectively. Hemodynamic parameters remained stable
throughout the study period. CONCLUSION(S): In our patients, the OLA
strategy performed during OLV improved oxygenation and increased CL and
had no clinically significant hemodynamic effects. Although our study was
not specifically designed to study DELTAPRS and DELTAPL, we observed a
parallel reduction of both after the OLA. TRIAL REGISTRATION: TRN:
ClinicalTrials.gov , NCT03435523 , retrospectively registered, Feb 14
2018.

<46>
Accession Number
2002518902
Title
Pain control with ultrasound-guided ilioinguinal-iliohypogastric nerve
block compared with local infiltration anesthesia in patients undergoing
transfemoral transcatheter aortic valve implantation: a prospective
randomized trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S86-S87), 2019. Date
of Publication: September 2019.
Author
Hasak L.; Jagielak D.; Lango R.; Formella D.M.; Pepiorka-Broniecka M.;
Ciecwierz D.; Koska A.
Institution
(Hasak, Koska) University Clinical Centre - Department of Cardiac
Anaesthesia, Gdansk, Poland
(Jagielak, Formella, Pepiorka-Broniecka) University Clinical Centre -
Department of Cardiovascular Surgery, Gdansk, Poland
(Lango) Medical University - Department of Cardiac Anaesthesiology,
Gdansk, Poland
(Ciecwierz) University Clinical Centre - Department of Cardiology, Gdansk,
Poland
Publisher
W.B. Saunders
Abstract
Introduction: Ilioinguinal-ilioinguinal nerve block is frequently
performed for analgesia in inguinal surgery. The authors hypothesized that
preoperative ultrasound-guided ilioinguinal-iliohypogastric (II-IH) nerve
block produce better intraoperative analgesia and less analgesic
requirement in comparison to commonly used local infiltration anesthesia
in patients undergoing transfemoral transcatheter aortic valve
implantation (TF-TAVI). Method(s): 87 elderly patients scheduled for
TF-TAVI were randomized to receive either II-IH nerve block (Group A) or
local infiltration anesthesia (Group B) between July 2018 and April 2019
(ClinicalTrials.gov; ID: NCT03863899). In patients in group A
ultrasound-guided II-IH nerve block was performed preoperatively by
anesthesiologist. Patients in group B received local anesthetic
infiltration of the operative area performed by surgeon. Pain intensity
was assessed using numeric rating scale (NRS 0-10; 0 = no pain; 10 = the
worth pain imaginable) in five time-points intraoperatively (femoral
artery cannulation (1), aortic valve system introduction (2), aortic valve
system removal (3), vessel closure devices insertion (4), the end of the
operation (5)). When NRS was <4, paracetamol was given intravenously. If
NRS was >4, fentanyl was given. The need for additional analgesics was
also evaluated during the procedure. Result(s): After exclusion of 10
patients the analysis was performed in 77 patients: 40 in group A and 37
patients in group B. In time points (1-4) pain intensity was lower in
group A than in group B (p<0.0003 for all comparisons). Pain intensity at
time point (5) did not differ between the groups (p = 0.52). The need for
supplementary fentanyl administration was lower in group A in comparison
to group B (p = 0.02). Time from arrival in operation room to start
surgery was longer in group A than in group B (median: 60 min. vs. 50
min., respectively; p = 0.01). Discussion(s): Ultrasound-guided II-IH
nerve block produce better intraoperative analgesia and less analgesic
consumption than local infiltration anesthesia in patients undergoing
TF-TAVI, at the cost of slightly longer patient's preparation to
surgery. Copyright © 2019

<47>
Accession Number
2002518898
Title
Liraglutide for perioperative management of hyperglycaemia in cardiac
surgery patients - A multicentre, prospective, randomised superiority
trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S89), 2019. Date of
Publication: September 2019.
Author
Hulst A.; Visscher M.; Godfried M.; Thiel B.; Gerritse B.; Scohy T.;
Bouwman A.; Willemsen M.; Hollmann M.; Preckel B.; DeVries H.; Hermanides
J.
Institution
(Hulst, Visscher, Hollmann, Preckel, DeVries, Hermanides) Amsterdam UMC,
Amsterdam, Netherlands
(Godfried, Thiel) OLVG, Amsterdam, Netherlands
(Gerritse, Scohy) Amphia Hospital, Breda, Netherlands
(Bouwman, Willemsen) Catharina Hospitals, Eindhoven, Netherlands
Publisher
W.B. Saunders
Abstract
Introduction: Most cardiac surgery patients, with or without diabetes,
develop perioperative hyperglycaemia, for which intravenous insulin is the
only therapeutic option. This is labour-intensive and carries a risk of
hypoglycaemia. We hypothesised that preoperative administration of the
glucagon-like peptide-1 receptor agonist liraglutide reduces the number of
patients requiring insulin for glycaemic control during cardiac surgery.
 Method(s): In this randomised, blinded, placebo-controlled,
parallel-group, balanced (1:1), multicentre randomised, superiority trial,
adult patients undergoing cardiac surgery in four Dutch tertiary hospitals
were randomised to receive 0.6 mg subcutaneous liraglutide on the evening
before surgery and 1.2 mg after induction of anaesthesia or matching
placebo. Blood glucose was measured hourly and controlled using an
insulin-bolus-algorithm. The primary outcome was insulin administration
for blood glucose above 8.0 mmol/L in the operating theatre. Research
pharmacists used centralised, stratified, variable-block, randomisation
software. Patients, care providers, and study personnel were blinded to
treatment allocation. Result(s): Between June 2017 and August 2018,
278 patients were randomised to liraglutide (139) or placebo (139). All
patients receiving at least one study drug injection were included in the
intention-to-treat analyses (129 in the liraglutide group, 132 in the
placebo group). In the liraglutide group 55 (43%) patients required
additional insulin compared to 80 (61%) patients in the placebo group,
absolute difference: 18% (95% CI 5.9-30.0, p = 0.003). Dose and number of
insulin injections and mean blood glucose were all significantly lower in
the liraglutide group, see figure. We observed no difference in the
incidence of hypoglycaemia, nausea and vomiting, mortality, or
postoperative complications. Discussion(s): Preoperative liraglutide,
compared to placebo, reduces insulin requirements while improving
peri-operative glycaemic control during cardiac surgery. Copyright
© 2019

<48>
Accession Number
2002508348
Title
Hyperalgesia and fentanyl dosing in on-pump coronary artery bypass
grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S153), 2019. Date of
Publication: September 2019.
Author
Priem H.; Vandenheuvel M.
Institution
(Priem, Vandenheuvel) University Hospital Ghent, Department of
Anesthesiology and Perioperative Medicine, Ghent, Belgium
Publisher
W.B. Saunders
Abstract
Introduction: Opioids have many known side-effects. However opioid-induced
hyperalgesia (OIH), as a result of central sensitization, remains more
obscure. The increase in hyperalgesia is dose-related and postoperatively
an increased secondary wound hyperalgesia may be a factor in the
development of chronic or persistent pain. This prospective, randomized
and double-blind clinical trial aims to investigate the effects of
fentanyl on secondary wound hyperalgesia in patients undergoing on-pump
coronary artery bypass grafting. Method(s): Secondary wound
hyperalgesia was investigated between two study-groups, respectively a low
dose bolus group (n = 14, 3mcg/ kg) and a continuous infusion group (n =
17, Shibutani). The primary endpoint of this study was the area of
secondary wound hyperalgesia after 24 hours. The area was measured using a
Von Frey filament (256mN). Additionally we looked at hyperalgesia after 48
hours and we investigated following secondary endpoints: time to
extubation, ICU/hospital length of stay, PONV, pain scores, the need for
additional analgesia and the total dose of opioids administered 24 and 48
hours after surgery. This study is a subgroup analysis of a larger study,
in which the possible association between the area of secondary wound
hyperalgesia and persistent pain at 3, 6 and 12 months after surgery will
be investigated. Result(s): The examination of preliminary results
showed no statistically significant difference for the area of secondary
wound hyperalgesia after 24 hours (p = 0.3268). However the results became
significant after 48 hours, where the area of secondary wound hyperalgesia
was smaller in the low dose bolus group (p = 0.0389). No significant
differences were found for the other secondary endpoints.
 Discussion(s): There was less secondary wound hyperalgesia in the low
dose bolus group after 48 hours, although at 24 hours this was not
statistically significant. These findings are the result of preliminary
data. We need to wait for the definitive results of hyperalgesia and for
the results regarding chronic pain to draw any conclusions about the
clinical significance of OIH. Copyright © 2019

<49>
Accession Number
2002508333
Title
A comparison of the extent of hemolysis and leukocyte activation induced
by conventional versus miniaturized cardiopulmonary bypass during coronary
artery bypass surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S118), 2019. Date of
Publication: September 2019.
Author
Hoogzaad D.; Engst E.; Daane R.; Rohoman N.; Jansma J.; Bulder I.; Idema
R.; Gerritse B.; Scohy T.; Luken B.
Institution
(Hoogzaad, Engst, Daane) Amphia Hospital - Department of Extracorporeal
Circulation, Breda, Netherlands
(Rohoman) Amphia Hospital - Department of Cardiothoracic surgery, Breda,
Netherlands
(Jansma, Idema) Amphia Hospital - Laboratory for Clinical Chemistry and
Hematology, Breda, Netherlands
(Bulder, Luken) Sanquin Research and Landsteiner Laboratory of the AMC,
University of Amsterdam - Department of Immunopathology, Amsterdan,
Netherlands
(Gerritse, Scohy) Amphia Hospital - Department of Anaesthesiology, Breda,
Netherlands
Publisher
W.B. Saunders
Abstract
Introduction: It is known that blood contact with the components of the
cardiopulmonary bypass system induces hemolysis and cell activation.
Minimized extracorporeal circulation systems (MiECC) were designed to
reduce these effects and to maintain higher hemoglobin levels compared to
a conventional extracorporeal circulation system (CECC). However, the
differences in the extent of hemolysis and cell activation are not fully
known. The aim of this study was to examine whether differences exist in
the extent of hemolysis and leukocyte activation induced by CECC and
MiECC. Method(s): We have initiated a prospective randomized pilot
study. The patients included underwent CABG surgery and were maintained
with cardiopulmonary bypass. The study included two groups of patients
wherein we compared 20 patients in the CECC group to 20 patients in the
MiECC group. Blood samples were collected at six different points in time;
prior to surgery, 5 minutes after the start of ECC, 30 minutes after the
start of ECC, 10 minutes after clamp removal, 5 minutes after protamine
administration (post ECC) and lastly in the ICU. Parameters that were
measured included hemoglobin, hematocrit, lactate dehydrogenase, cell free
hemoglobin, neutrophil elastase-alpha1-antitrypsin complexes, nucleosomes
and myeloperoxidase-nucleosome complexes. Result(s): The hemoglobin
levels in patients maintained by MiECC remained higher during ECC compared
to CECC. However, the samples which were collected in the ICU showed
comparable hemoglobin levels. The CECC system showed increased levels of
lactate dehydrogenase, cell free hemoglobin, neutrophil
elastase-alpha1-antitrypsin complexes, nucleosomes and
myeloperoxidase-nucleosome complexes, compared to the MiECC system. In
patients maintained by the MiECC system the cell free hemoglobin levels
remained unaffected over time. Discussion(s): The MiECC system
induced less hemodilution of the patient's blood during ECC compared to
the CECC system. An absence of hemolysis was observed in MiECC, whereas a
significant extent of hemolysis was observed in CECC. Together with the
increased levels of neutrophil elastase-alpha1-antitrypsin complexes,
nucleosomes and myeloperoxidase-nucleosome complexes in CECC, we consider
the use of MiECC in relation to cell preservation superior to the use of
CECC during CABG surgery. Copyright © 2019

<50>
Accession Number
2002508320
Title
Meta-analysis of associations of sleep disordered breathing with outcomes
after cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S141), 2019. Date of
Publication: September 2019.
Author
Zhang F.; Zhao B.; Zhou B.; Zhuang P.; Liu J.; Deng W.; Liu K.
Institution
(Zhang, Zhao, Zhou, Zhuang, Liu, Deng, Liu) Department of Anesthesiology,
Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N,
Guangzhou, China
Publisher
W.B. Saunders
Abstract
Introduction: Sleep disordered breathing (SDB) is a chronic disorder
characterized by repeated upper airway collapse during sleep with a high
prevalence in patients undergoing cardiac surgery. Although patients with
SDB are considered to be at increased risk for postoperative complications
after noncardiac surgery, the impact of SDB on postoperative outcomes
after cardiac surgery remains obscure. Result(s): Nineteen eligible
studies including 3992 patients were identified. SDB was significantly
associated with postoperative all-cause mortality (OR 2.44, 95% CI
1.08-5.49), atrial fibrillation (OR 2.15, 95% CI 1.67-2.77), pulmonary
complications (OR 2.02, 95% CI 1.20-3.39), acute kidney injury (OR 2.82,
95% CI 1.19-6.66), delirium (OR 6.4, 95% CI 2.6-15.4), and long-term major
adverse cardiovascular events (MACE) (OR 3.44, 95% CI 1.43-8.25), but not
short-term MACE (OR 1.64, 95% CI 0.57-4.74) or infection (OR 1.50, 95% CI
0.75-3.01). Increasing severity of SDB might be associated with worsened
outcomes. Discussion(s): SDB is associated with increased risk of
mortality and morbidity after cardiac surgery. Future studies need to
explore the optimal screening methods and interventions for SDB in the
perioperative period. Copyright © 2019

<51>
Accession Number
2002508314
Title
Encephalography guidance of anesthesia to alleviate geriatric syndromes
(Engages-Canada) study in cardiac surgery patients: a pragmatic,
randomized clinical trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S157-S158), 2019.
Date of Publication: September 2019.
Author
Palermo J.; Overbeek C.; Dumont A.; Jacobson E.; El-Gabalwy R.; Kavosh M.;
Saha T.; Tanzola R.; Dumertonshore D.; Avidan M.; Oberhaus J.; Mickle A.;
Djaiani G.; Deschamps A.
Institution
(Palermo, Overbeek, Dumont, Deschamps) Universite de Montreal, Montreal,
Canada
(Jacobson, El-Gabalwy, Kavosh) University of Manitoba, Winnipeg, Canada
(Saha, Tanzola, Dumertonshore) Queen's University, Kingston, Canada
(Avidan, Oberhaus, Mickle) Washington University, Saint-Louis, MA, United
States
(Djaiani) University of Toronto, Toronto, Canada
Publisher
W.B. Saunders
Abstract
Introduction: Postoperative delirium (POD) is a syndrome characterized by
an acute onset of fluctuating confusion, disorganization and inattention.
POD is frequent in the cardiac surgery population (incidence between
11-50%), and associated to complications such as increased risk of falls,
prolonged hospital stay, functional decline and increased morbidity and
mortality. Risk factors for POD are often non-modifiable, such as age,
male sex, underlying cognitive or psychiatric conditions, while risk
factors more specific to the cardiac surgery population include the type
of surgery, cardiopulmonary bypass time, transfusions, and mechanical
ventilation time15-18. Recent studies suggest that the use of a processed
EEG for titration of anesthesia may reduce the incidence of POD. Burst
suppression, or the pathological patterns of high-voltage electrical
activity alternating with periods of quiescence may be associated with
POD. Our primary objective is to demonstrate whether guiding anesthesia
depth using an EEG monitor to avoid episodes burst suppression can result
in a decreased incidence and severity of delirium in the cardiac surgery
population. Secondly, we want to examine contributing risk factors and
sequelae of delirium. Method(s): ENGAGES-Canada is an ongoing
multi-center, double-blinded, randomized controlled trial across 4
Canadian sites. Patients included are those over the age of 60 scheduled
for elective cardiac surgery with cardiopulmonary bypass. Exclusion
criteria are pre-operative delirium, illiteracy, history of awareness, and
planned surgery within five days of index surgery. Using an anesthesia
protocol for EEG-guided anesthesia to avoid burst suppression, patients
are randomized to the intervention or the control group (non-utilization
of the monitor). The primary outcome is defined as the incidence of
postoperative delirium, assessed using the Confusion Assessment Method
(CAM) or CAM-ICU, coupled with chart review from day 1 to 5. Secondary
outcomes include the effect of known risk factors on the incidence of
delirium and 30-day and 1-year patient-reported outcomes of health-related
quality of life and prevention of falls. Result(s): Current
enrollment includes 600 patients, out of a target population of 1200. An
interim analysis was performed at 570 patients. The incidence of delirium
across all subjects was 17.5% when considering CAM alone. Patients in the
EEG-blinded group spent more cumulative time in burst suppression than
those guided by EEG: median 317 seconds versus 136 seconds in the blind
and guided groups respectively. Discussion(s): ENGAGES-CANADA is the
first RCT to examine whether avoidance of burst suppression using EEG
guidance can decrease the incidence and severity of delirium in a cardiac
surgery population. Copyright © 2019

<52>
Accession Number
2002508307
Title
The role of preoperative endocrine parameters in prediction of
postoperative complication in adult patients undergoing elective heart
surgery - Preliminary study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S145-S146), 2019.
Date of Publication: September 2019.
Author
Szabo A.; Nagy A.; Holndonner-Kirst E.; Sandor A.; Domokos D.; Eke C.;
Lendvai M.; Szecsi B.; Czobor N.; Merkely B.; Gal J.; Szekely A.
Institution
(Szabo, Nagy, Holndonner-Kirst, Sandor, Eke, Lendvai, Szecsi, Czobor, Gal,
Szekely) Semmelweis University Department of Anesthesiology and Intensive
Therapy, Budapest, Hungary
(Domokos, Merkely) Semmelweis University Heart and Vascular Center,
Budapest, Hungary
Publisher
W.B. Saunders
Abstract
Introduction: The correct cost-benefit estimation and the more accurately
perioperative risk evaluation is one of the more difficult task in the
perioperative medicine. We wanted to study more than the obvious
parameters, so we looked for less studied predictors, such as different
peripherial hormone levels. Every hormone molecule acts a complex pathway,
so we truely believe that the insufficient function or decreased serum
level of these mediators could be heavy influence for the perioperative
adverse events. Method(s): Our single center prospective,
observational study approved by the IRB and registered at
clinicaltrials.gov (NCT03736499). We enrolled 89 patients between
25.01.2019 and 30.04.2019 who underwent elective cardiac surgical
procedure. In the preoperative period we measured different hormone levels
in serum (TSH, free T3 and T4, prolactine and testosterone) and collected
the demographic parameters. We corrigated the normal hormone levels for
age and gender. We recorded the length of postoperative intensive care
unit stay, length of mechanical ventilation, dose of different vasopressor
and inotropic agents, fluid balance, blood transfusion and bleeding. The
adverse outcomes were also collected. The primary outcome was the
all-cause mortality. Secondary outcome were the length of ICU stay, length
of mechanical ventilation and the frequency of different adverse events.
We performed descriptive statistics, chi square test and Mann-Whitney U
test using the IBM-SPSS 22.0 statistic software. Result(s): Median
age was 66.0 years (IQR: 59.0-73.0), 64.04% of the patients were male,
median of BMI was 28.22 (IQR: 25.44-31.44). The median of EuroSCOREII was
1.94 (IQR: 1.17-3.05). The mean follow up time was 52.8+/-20.68 days. 8
patients (8.98%) died during the follow up time, the median length of ICU
stay was 45 hours (IQR: 22.0-92.0), the median length of mechanical
ventilation was 9 hours (IQR: 5.0-19.0). In univariable Cox regression
serum free T3 was correlated with all cause mortality (OR: 0.266, CI 95%:
0.096-0.735, p = 0.011) and the abnormal level of free T3 was associated
with higher infection rate (OR: 6.052, CI 95%: 1.271-28.832, p = 0.024).
Using nonparametric tests we found association between abnormal serum
prolactine level and postoperative arrhythmias (p = 0.017) and between
abnormal serum testosterone level and prolonged length of ICU stay (p =
0.002). Discussion(s): The evaluation of serum hormone levels could
help to make more precise estimation of perioperative risk in adult
patients waiting heart surgery. Further examination should be performed,
to establish stronger correlation between fine hormonal dysregulation and
postoperation complications. Copyright © 2019

<53>
Accession Number
2002508289
Title
Sustained high-dose thiamine supplementation in high-risk cardiac patients
undergoingsurgery under cardiopulmonary bypass (apply trial): a pilot
study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: EACTA
Annual Congress 2019. Belgium. 33 (Supplement 2) (pp S162-S163), 2019.
Date of Publication: September 2019.
Author
Moroz G.; Lomivorotov V.; Ismoilov S.; Efremov S.; Landoni G.; Lembo R.;
Bellomo R.
Institution
(Moroz, Lomivorotov, Ismoilov) Meshalkin National Medical Research Center,
Novosibirsk, Russian Federation
(Efremov) St. Petersburg University hospital, St. Petersburg, Russian
Federation
(Landoni, Lembo) IRCCS San Raffaele Scientific Institute, Milan, Italy
(Bellomo) University of Melbourne, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Introduction: Numerous studies showed that relative thiamine depletion in
critically ill patients and in patients undergoing cardiac surgery may
contribute to cardiac dysfunction and hyperlactatemia leading to adverse
outcomes. Thus, in preparation for a larger trial, we performed a pilot,
randomized, placebo-controlled feasibility trial of sustained thiamine
supplementation in high-risk patients undergoing cardiac surgery under
CPB. Method(s): Forty patients who underwent high-risk cardiac
surgery under CPB were randomly assigned to receive either 200 mg of
Thiamine or placebo intravenously after anesthesia induction; after CPB;
on the evening of the day of surgery; on three postoperative days (twice a
day). Primary endpoints were successful compliance with protocol and
successful recruitment of patients. Secondary endpoints included:
vasoinotropic score and norepinephrine equivalent dose, postoperative peak
lactate and creatinine levels, incidence of acute kidney injury, daily
SOFA score, rate of postoperative complications, incidence of adverse
events, 7-day and 30-day mortality. Result(s): The mean recruitment
rate was 6.6 patients per month (1.6 patients per week). Compliance with
protocol was excellent as all patients enrolled into the study received
all assigned intervention. No patients develop allergic reactions to the
study drug. All patients completed the 30-day follow-up. There were no
differences in secondary endpoints. Statistical analysis performed with
the Stata Statistical Software using Mann-Whitney U test, T test of
Student and ANOVA. Discussion(s): The rationale for thiamine
administration in patients undergoing cardiac surgery comes from results
of several studies that showed a high incidence of thiamine deficiency
postoperatively. Our study implies that it is feasible to achieve an
acceptable recruitment rate in a typical tertiary institution with full
compliance with the protocol and it's not associated with major safety
concerns in patients receiving complex cardiac surgery. Copyright
© 2019

<54>
Accession Number
629017647
Title
Effects of pulsatile minimal invasive extracorporeal circulation on
fibrinolysis and organ protection in adult cardiac surgery - A prospective
randomized trial.
Source
Journal of Thoracic Disease. 11 (Supplement10) (pp S1453-S1463), 2019.
Date of Publication: 01 Jun 2019.
Author
Grassler A.; Bauernschmitt R.; Guthoff I.; Kunert A.; Hoenicka M.;
Albrecht G.; Liebold A.
Institution
(Grasler, Bauernschmitt, Guthoff, Kunert, Hoenicka, Albrecht, Liebold)
Department of Cardiothoracic and Vascular Surgery, University of Ulm
Medical Center, Ulm, Germany
(Grasler) RoMed Clinical Center Rosenheim, Department of Internal Medicine
III, Rosenheim, Germany
(Bauernschmitt) MediClin Herzzentrum, Department of Cardiothoracic and
Vascular Surgery, Lahr, Germany
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Minimal invasive extracorporeal circulation (MiECC) reduces
the impact of cardiopulmonary bypass during cardiac surgery on
inflammation and hemostasis. Pulsatile perfusion may enhance organ
perfusion and help to prevent renal and neuronal damage. The present study
investigated the impact of pulsatile MiECC in low-risk coronary artery
bypass grafting (CABG) patients. Method(s): CABG patients were
prospectively randomized for non-pulsatile (np: n=19) and pulsatile (p:
n=21) MiECC. Blood and urine samples were collected at several time points
until 72 h post-operative and analyzed for biochemical markers of
fibrinolytic capacity, renal damage, and neuronal damage. Result(s):
Although intraoperative tissue plasminogen activator (tPA) levels tended
to be higher in the p group, none of the fibrinolysis markers including
plasminogen activator inhibitor (PAI-1) and the PAI-1/ tPA ratio were
significantly affected by pulsation. Hemolysis and markers of renal and
neuronal damage were comparable between groups. Intraoperative urinary
excretion [np: 400 mL (355 to 680) vs. p: 530 mL (360 to 900)] and
cumulative 24 h volume intake [np: 7,090 mL (5,492 to 7,544) vs. p: 7,155
mL (6,682 to 8,710)] were increased by pulsation whereas blood losses up
to 12 h post-operative [np: 365 mL (270 to 515) vs. p: 310 mL (225 to
470)] and up to 24 h post-operative [np: 760 mL (555 to 870) vs. p: 520 mL
(460 to 670)] were attenuated. Conclusion(s): The present study did
not find evidence for a beneficial effect of pulsation on markers of
fibrinolysis, renal damage, and neuronal damage. However, pulsatile
perfusion increased intraoperative urinary secretion and reduced
post-operative blood losses. Copyright © Journal of Thoracic
Disease. All rights reserved.

<55>
Accession Number
2002630344
Title
Comparison of efficacy and tolerability of pentoxifylline and cilostazole
on peripheral arterial disease.
Source
JK Practitioner. 22 (3-4) (pp 30-35), 2017. Date of Publication: 2017.
Author
Singh S.; WaheedMir A.; Singh G.
Institution
(Singh) Department of Clinical Pharmacology, SKIMS, Soura, Srinagar, India
(WaheedMir) Department of Anesthesiology and Critical Care, SKIMS, Soura
Srinagar, India
(Singh) Department of Cardiothoracic and Vascular Surgery, Govt. Medical
College Associated Hospital Jammu, India
Publisher
JK Practitioner
Abstract
Aim:To compare the efficacy and tolerability of cilostazole and
pentoxifylline in patients with moderately severe peripheral arterial
disease. Material(s) and Method(s):It is a prospective, randomized,
open label parallel study conducted in Postgraduate Department of
Pharmacology and Therapeutics in collaboration with Cardiothoracic and
Vascular Surgery Department, Govt. Medical College Jammu for a period of
one year. Result(s):out of 53 patientswith grade I chronic limb
ischemia, 26 patients were assigned pentoxifylline 400mg, and 28 patients
were given cilostazole 100mg. Both pentoxifylline as well as cilostazole
raised initial as well as absolute claudication distances significantly
from baseline, but on comparison, cilostazole was significantly more
effective compared to pentoxifylline. Cilostazole also had significant
beneficial effect on lipid profile (decreasing triglycerides and raising
HDL-Cholesterol), whereas pentoxifylline was lacking such effect. There
were no differences in patient's assessment, physician's assessment as
well as side effects between two groups. Conclusion(s):cilostazole is
found to be an effective treatment for patients of peripheral arterial
disease with intermittent claudication. It also has favorable effect on
lipid profile.However, long term randomized trials are required to further
substantiate our findings. Copyright © 2017 JK Practitioner. All
rights reserved.

<56>
Accession Number
2002358732
Title
Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass:
Randomized Controlled Trial.
Source
Journal of the American College of Cardiology. 74 (5) (pp 659-668), 2019.
Date of Publication: 6 August 2019.
Author
Graham E.M.; Martin R.H.; Buckley J.R.; Zyblewski S.C.; Kavarana M.N.;
Bradley S.M.; Alsoufi B.; Mahle W.T.; Hassid M.; Atz A.M.
Institution
(Graham, Martin, Buckley, Zyblewski, Kavarana, Bradley, Hassid, Atz)
Medical University of South Carolina, Charleston, SC, United States
(Alsoufi, Mahle) Children's Healthcare of Atlanta and Emory University,
Atlanta, Georgia
Publisher
Elsevier USA
Abstract
Background: The efficacy of intraoperative corticosteroids to improve
outcomes following congenital cardiac operations remains controversial.
 Objective(s): The purpose of this study was to determine whether
intraoperative methylprednisolone improves post-operative recovery in
neonates undergoing cardiac surgery. Method(s): Neonates undergoing
cardiac surgery with cardiopulmonary bypass at 2 centers were enrolled in
a double-blind randomized controlled trial of methylprednisolone (30
mg/kg) or placebo after the induction of anesthesia. The primary outcome
was a previously validated morbidity-mortality composite that included any
of the following events following surgery before discharge: death,
mechanical circulatory support, cardiac arrest, hepatic injury, renal
injury, or rising lactate level (>5 mmol/l). Result(s): Of the 190
subjects enrolled, 176 (n = 81 methylprednisolone, n = 95 placebo) were
included in this analysis. A total of 27 (33%) subjects in the
methylprednisolone group and 40 (42%) in the placebo group reached the
primary study endpoint (odds ratio [OR]: 0.63; 95% confidence interval
[CI]: 0.31 to 1.3; p = 0.21). Methylprednisolone was associated with
reductions in vasoactive inotropic requirements and in the incidence of
the composite endpoint in subjects undergoing palliative operations (OR:
0.38; 95% CI: 0.15 to 0.99; p = 0.048). There was a significant
interaction between treatment effect and center. In this analysis,
methylprednisolone was protective at 1 center, with an OR: 0.35 (95% CI:
0.15 to 0.84; p = 0.02), and not so at the other center, with OR: 5.13
(95% CI: 0.85 to 30.90; p = 0.07). Conclusion(s): Intraoperative
methylprednisolone failed to show an overall significant benefit on the
incidence of the composite primary study endpoint. There was, however, a
benefit in patients undergoing palliative procedures and a significant
interaction between treatment effect and center, suggesting that there may
be center or patient characteristics that make prophylactic
methylprednisolone beneficial. Copyright © 2019 American College
of Cardiology Foundation

<57>
Accession Number
623047623
Title
Serum Calcification Propensity and Fetuin-A: Biomarkers of Cardiovascular
Disease in Kidney Transplant Recipients.
Source
American Journal of Nephrology. 48 (1) (pp 21-31), 2018. Date of
Publication: 01 Aug 2018.
Author
Bostom A.; Pasch A.; Madsen T.; Roberts M.B.; Franceschini N.; Steubl D.;
Garimella P.S.; Ix J.H.; Tuttle K.R.; Ivanova A.; Shireman T.; Gohh R.;
Merhi B.; Jarolim P.; Kusek J.W.; Pfeffer M.A.; Liu S.; Eaton C.B.
Institution
(Bostom, Roberts, Eaton) Center for Primary Care and Prevention, Memorial
Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, United
States
(Pasch) University of Bern, Bern, Switzerland
(Madsen) Department of Emergency Medicine, Rhode Island Hospital,
Providence, RI, United States
(Franceschini, Ivanova) Department of Epidemiology, Gillings School of
Public Health, University of North Carolina at Chapel Hill, Chapel Hill,
NC, United States
(Steubl) Klinikum Rechts der Isar, Technische Universitat, Munich, Germany
(Garimella, Ix) Department of Medicine, Division of
Nephrology-Hypertension, University of California, San Diego, CA, United
States
(Tuttle) Providence Medical Research Center, University of Washington,
Spokane, WA, United States
(Shireman) Center for Gerontology and Healthcare Research, Brown
University, Providence, RI, United States
(Gohh, Merhi) Department of Medicine, Division of Hypertension and Kidney
Diseases, Rhode Island Hospital, Providence, RI, United States
(Jarolim) Department of Pathology, Brigham and Women's Hospital, Boston,
MA, United States
(Kusek) National Institute of Diabetes, Digestive, and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Pfeffer) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Liu) Department of Epidemiology, School of Public Health, Brown
University, Providence, RI, United States
(Eaton) Department of Family Medicine, Warren Alpert Medical School, Brown
University, Providence, RI, United States
Publisher
S. Karger AG
Abstract
Background: "T50," shortened transformation time from primary to secondary
calciprotein particles may reflect deranged mineral metabolism
predisposing to vascular calcification and cardiovascular disease (CVD).
The glycoprotein fetuin-A is a major T50 determinant. Method(s): The
Folic Acid For Vascular Outcome Prevention In Transplantation (FAVORIT)
cohort is a completed, large, multiethnic controlled clinical trial cohort
of chronic, stable kidney transplant recipients (KTRs). We conducted a
longitudinal case-cohort analysis using a randomly selected subcohort of
patients, and all individual cases who developed CVD. Serum T50 and
fetuin-A were determined in this total of n = 685 FAVORIT trial
participants at randomization. Result(s): During a median
surveillance of 2.18-years, 311 incident or recurrent CVD events occurred.
Shorter T50 (minutes) or reduced fetuin-A concentrations (g/L) were
associated with CVD after adjustment for treatment assignment, systolic
blood pressure, age, sex, race, preexisting CVD and diabetes, smoking,
body mass index, total cholesterol/HDL cholesterol, kidney allograft
vintage and type, calcineurin inhibitor, or lipid-lowering drug use,
estimated glomerular filtration rate, and urinary albumin/creatinine:
tertile 1 (lowest) to tertile 3 (highest) comparisons, T50, (hazard ratio
[HR] 1.86; 95% CI 1.20-2.89); fetuin-A, (HR 2.25; 95% CI 1.38-3.69).
Elevated high sensitivity c-reactive protein (hsCRP) was an effect
modifier of both these associations. Conclusion(s): Shortened T50, as
well as reduced fetuin-A levels, ostensible promoters of vascular
calcification, remained associated with greater risk for CVD outcomes,
after adjustment for major CVD risk factors, measures of kidney function
and damage, and KTR clinical characteristics and demographics, in a large,
multiethnic cohort of long-term KTRs. Increased hsCRP was an effect
modifier of these CVD risk associations. © 2018 S. Karger AG,
Basel. Copyright: All rights reserved.

<58>
Accession Number
2000968232
Title
Maternal and Fetal Outcome After Cardiac Operations During Pregnancy: A
Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (2) (pp 618-626), 2018. Date of
Publication: August 2018.
Author
Jha N.; Jha A.K.; Chand Chauhan R.; Chauhan N.S.
Institution
(Jha, Chauhan) Department of Obstetrics and Gynecology, Pondicherry
Institute of Medical Sciences, Puducherry, India
(Jha) Department of Anesthesiology and Critical Care, Jawaharlal Institute
of Postgraduate Medical Education and Research, Puducherry, India
(Chand Chauhan) Department of Community and Family Medicine, All India
Institute of Medical Sciences, Bhubaneswar, India
Publisher
Elsevier USA
Abstract
Background: In the past, cardiac surgical procedures during pregnancy have
been associated with a high risk of adverse maternal and fetal outcomes.
Therefore, this meta-analysis of more recent studies was done to assess
the fetomaternal risk after cardiac operations during pregnancy using
cardiopulmonary bypass. Method(s): The MEDLINE, Embase, and Cochrane
library were searched to find studies from January 1, 1990, to July 31,
2016, without language restriction. We selected studies that included at
least 4 women to report fetomaternal outcomes after a cardiac operation
using cardiopulmonary bypass during pregnancy. Two authors independently
extracted data from the selected studies. The studies were assessed for
methodological qualities using the Newcastle-Ottawa Scale. The primary
outcomes included maternal death and any pregnancy loss. The secondary
outcomes were maternal complications and neonatal complications. Primary
analysis calculated absolute risks and 95% confidence intervals (CIs) for
pregnancy outcomes using the DerSimonian-Laird random effects model.
Heterogeneity was assessed by I2 statistic and visual plot.
 Result(s): Ten studies, including 154 women, were eligible for
inclusion in this study. The patients underwent cardiac operations during
pregnancy involving cardiopulmonary bypass. As calculated per 100
pregnancies, the pooled unadjusted estimate of maternal mortality was 11.2
(95% CI, 6.8 to 17.8), pregnancy loss was 33.1 (95% CI, 25.1 to 41.2),
maternal complications were 8.8 (95% CI, 2.8 to 24.2), and neonatal
complications were 10.8 (95% CI, 4.2 to 25.2). The risks of preterm labor
and cesarean delivery were 28 per 100 pregnancies (95% CI, 15.6 to 45) and
33.8 per 100 pregnancies (95% CI, 19.1 to 52.4), respectively.
 Conclusion(s): The fetomaternal mortality and morbidity after a
cardiac operation during pregnancy are higher than that reported in the
earlier literature (PROSPERO No. CRD42016047093). Copyright ©
2018 The Society of Thoracic Surgeons

<59>
Accession Number
624108235
Title
Angiotensin receptor neprilysin inhibitor in Japanese patients with heart
failure and reduced ejection fraction: Baseline characteristics and
treatment of PARALLEL-HF trial.
Source
Circulation Journal. 82 (10) (pp 2575-2583), 2018. Date of Publication:
2018.
Author
Tsutsui H.; Momomura S.-I.; Saito Y.; Ito H.; Yamamoto K.; Ohishi T.;
Okino N.; Kitamura T.; Guo W.
Institution
(Tsutsui) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan
(Momomura) Cardiovascular Division, Jichi Medical University, Saitama
Medical Center, Saitama, Japan
(Saito) First Department of Internal Medicine, Nara Medical University,
Kashihara, Japan
(Ito) Department of Cardiovascular Medicine, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
(Yamamoto) Department of Molecular Medicine and Therapeutics, Tottori
University, Yonago, Japan
(Ohishi, Okino, Kitamura) Novartis Pharma K.K., Tokyo, Japan
(Guo) Novartis Pharmaceutical Corporation, East Hanover, NJ, United States
Publisher
Japanese Circulation Society
Abstract
Background: The objective of the present analyses was to describe the
baseline characteristics and treatment of the Japanese patients with HFrEF
in THE PARALLEL-HF study. Methods and Results: Key demographic,
clinical and laboratory findings, along with treatment, were reported and
compared with patients enrolled in the PARADIGM-HF trial and other
contemporary randomized clinical trials and registries of Japanese
patients with HFrEF. In addition, the MAGGIC and EMPHASIS-HF risk scores
were calculated. A total of 225 Japanese patients were randomized in
PARALLEL-HF with a mean age of 67.9 years and the majority of the patients
being male (85.8%) and in NYHA Class II (93.8%). Key baseline
characteristics in PARALLEL-HF were generally comparable with PARADIGM-HF,
and other contemporary clinical trials and registries of Japanese HFrEF
patients. Patients enrolled in PARALLEL-HF were well treated with
conventional evidence-based therapy at baseline (angiotensin-converting
enzyme inhibitor inhibitor/angiotensin receptor blocker, 62.7%/37.3%;
beta-blockers, 94.7%; mineralocorticoid receptor antagonist, 59.1%).
Despite the evidence-based treatment and most patients being in NYHA Class
II, these patients had a low LVEF (mean 28.1%) and were at high risk of
cardiovascular mortality and morbidity as assessed by the MAGGIC and
EMPHASIS-HF risk scores. Conclusion(s): Overall, the patients in
PARALLEL-HF were largely representative of contemporary ambulatory
patients with HFrEF who are well treated with evidence-based therapies.
PARALLEL-HF will determine whether sacubitril/valsartan provides similar
improvements in clinical outcomes in Japanese HFrEF patients as observed
in the PARADIGM-HF study. Copyright © 2018, Japanese Circulation
Society. All rights reserved.

<60>
Accession Number
616834912
Title
Intraoperative dexamethasone does not increase the risk of postoperative
wound infection: A propensity score-matched post hoc analysis of the
ENIGMA-II trial (EnDEX).
Source
British Journal of Anaesthesia. 118 (2) (pp 190-199), 2017. Date of
Publication: 01 Feb 2017.
Author
Corcoran T.; Kasza J.; Short T.G.; Chan M.T.V.; Forbes A.; Myles P.;
Wallace S.; Galagher W.; Farrington C.; Ditoro A.; Peyton P.; Baulch S.;
Sidiropoulos S.; Bulach R.; Bryant D.; O'Loughlin E.; Mitteregger V.;
Bolsin S.; Osborne C.; McRae R.; Backstrom M.; Leslie K.; Cotter R.; Paech
M.; March S.; Silbert B.; Said S.; Halliwell R.; Cope J.; Fahlbusch D.;
Crump D.; Thompson G.; Jefferies A.; McCulloch T.; Reeves M.; Buckley N.;
Tidyl T.; Schricker T.; Lattermann R.; Iannuzzi D.; Beattie S.; Carroll
J.; Jacka M.; Bryden C.; Badner N.; Chan M.; Tsang M.; Cheng B.; Fong A.;
Chu L.; Koo E.; Mohd N.; Ming L.E.; Yin Wang C.; Campbell D.; McAllister
D.; Walker S.; Olliff S.; Kennedy R.; Eldawlatly A.; Alzahrani T.; Chua
N.; Haller G.; Pichon I.; Sneyd R.; McMillan H.; Parkinson I.; Rousseau
G.; Brennan A.; Balaji P.; Cupitt J.; Nightingale J.; Kunst G.; Dickinson
M.; Saran T.; Subramaniam B.; Banner-Godspeed V.; Sessler D.; Liu J.; Kurz
A.; Hesler B.; Fu A.; Egan C.; Fiffick A.; Hutcherson M.; Turan A.; Naylor
A.; Obal D.; Cooke E.
Institution
(Corcoran, Paech) Department of Anaesthesia and Pain Medicine, Royal Perth
Hospital, Perth, WA, Australia
(Corcoran, O'Loughlin, Paech) School of Medicine and Pharmacology,
University of Western Australia, Perth, WA, Australia
(Corcoran) Western Australia Health Department, Perth, WA, Australia
(Corcoran, Kasza, Leslie, Forbes, Myles) Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, Park Road,
Grafton, Auckland, New Zealand
(O'Loughlin) Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Perth, WA, Australia
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong Special Administrative Region, Hong Kong
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Leslie) Anaesthesia Perioperative and Pain Medicine Unit, Department of
Pharmacology and Therapeutics, University of Melbourne, Melbourne, VIC,
Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Wallace, Galagher, Farrington, Ditoro) AustinAustralia
(Peyton, Baulch, Sidiropoulos) DandenongAustralia
(Bulach, Bryant) Fremantle, Australia
(O'Loughlin, Mitteregger) Geelong Hospital, Australia
(Bolsin, Osborne) Monash Medical Centre, Australia
(McRae, Backstrom) Royal Melbourne Hospital, Australia
(Leslie, Cotter) Royal Perth Hospital, Australia
(Paech, March) St Vincent's Hospital, Australia
(Silbert, Said) Westmead Hospital, Australia
(Halliwell, Cope) Calvary WakefieldAustralia
(Fahlbusch, Crump) Peter MacCallum Cancer Centre, Australia
(Thompson) Western Hospital, Australia
(Jefferies) Royal Prince Alfred, Australia
(McCulloch) North West Regional Hosptial, Australia
(Reeves) McMaster University, Canada
(Buckley, Tidyl) Royal Victoria Hospital, Canada
(Schricker, Lattermann, Iannuzzi) Toronto General Hospital, Canada
(Beattie, Carroll) University of Alberta Hospital, Canada
(Jacka, Bryden) London Health Sciences, Canada
(Badner) Prince of Wales, Hong Kong
(Chan) ANZCA Trials Group Member, Hong Kong
(Tsang) Tuen Mun Hospital, Hong Kong
(Cheng, Fong) ACM Fong, Hong Kong
(Chu, Koo) Nethersole Eastern Hospital, Hong Kong
(Mohd, Ming) Hospital Kuala Lumpur, Malaysia
(Yin Wang) Malaya Medical Centre, Malaysia
(Campbell, McAllister) Auckland Hospital, New Zealand
(Walker, Olliff) Middlemore Hospital, New Zealand
(Kennedy) Christchurch Hospital, New Zealand
(Eldawlatly, Alzahrani) King Saud University Hospital, Saudi Arabia
(Chua) Tan Tock Seng Hospital, Singapore
(Haller, Pichon) Geneva University Hospital, Switzerland
(Sneyd, McMillan) Plymouth NHS Trust, France
(Parkinson) Royal Lancaster Infirmary, United Kingdom
(Rousseau) North Devon District Hospital, United Kingdom
(Brennan) Bradford Teaching Hospital, United Kingdom
(Balaji) Hull Royal Infirmary, United Kingdom
(Cupitt) Blackpool Victoria Hospital, United Kingdom
(Nightingale) Portsmouth Hospital, United Kingdom
(Kunst) King's College Hospital, United Kingdom
(Dickinson) Royal Surrey County Hospital, United Kingdom
(Saran) University Hospitals, Coventry and Warwickshire, United Kingdom
(Subramaniam, Banner-Godspeed) Beth Israel Deaconess Medical Center,
United States
(Sessler, Liu, Kurz, Hesler, Fu, Egan, Fiffick, Hutcherson, Turan, Naylor)
Cleveland Clinic, United States
(Obal, Cooke) Louisville Medical Centre, United States
Publisher
Oxford University Press
Abstract
Background. In a post hoc analysis of the ENIGMA-II trial, we sought to
determine whether intraoperative dexamethasone was associated with adverse
safety outcomes. Methods. Inverse probability weighting with estimated
propensity scores was used to determine the association of dexamethasone
administration with postoperative infection, quality of recovery, and
adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects
enrolled in ENIGMA-II. Results. Dexamethasone was administered to 2178
(40%) of the 5499 subjects included in this analysis and was not
associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity
score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI)
0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242
(7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30;
P=0.59], quality of recovery score [median 14, interquartile range (IQR)
12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the
postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0
(1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main
trial. Dexamethasone administration was associated with a decrease in
fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74;
P<0.001] and shorter lengths of stay in hospital [propensity
score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001].
Neither diabetes mellitus nor surgical wound contamination status altered
these outcomes. Conclusion. Dexamethasone administration to high-risk
non-cardiac surgical patients did not increase the risk of postoperative
wound infection or other adverse events up to day 30, and appears to be
safe in patients either with or without diabetes mellitus. Clinical trial
registration. NCT00430989. Copyright © 2017 The Author.

<61>
[Use Link to view the full text]
Accession Number
612357996
Title
Insights into Timing, Risk Factors, and Outcomes of Stroke and Transient
Ischemic Attack after Transcatheter Aortic Valve Replacement in the
PARTNER Trial (Placement of Aortic Transcatheter Valves).
Source
Circulation: Cardiovascular Interventions. 9 (9) (no pagination), 2016.
Article Number: e002981. Date of Publication: 01 Sep 2016.
Author
Kapadia S.; Agarwal S.; Miller D.C.; Webb J.G.; MacK M.; Ellis S.;
Herrmann H.C.; Pichard A.D.; Tuzcu E.M.; Svensson L.G.; Smith C.R.;
Rajeswaran J.; Ehrlinger J.; Kodali S.; Makkar R.; Thourani V.H.;
Blackstone E.H.; Leon M.B.
Institution
(Kapadia, Agarwal, Ellis, Tuzcu, Svensson, Rajeswaran, Ehrlinger,
Blackstone) Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United
States
(Miller) Stanford University, Medical School, CA, United States
(Webb) St. Paul's Hospital, University of British Columbia, Canada
(MacK) Baylor Scott and White Health, Plano, TX, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia,
United States
(Pichard) MedStar Washington Hospital Center, DC, United States
(Smith, Kodali, Leon) Columbia University, Medical Center, New
York-Presbyterian Hospital, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Thourani) Emory University, Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Prior studies of stroke and transient ischemic attack (TIA)
after transcatheter aortic valve replacement (TAVR) are limited by
reporting and follow-up variability. This is a comprehensive analysis of
time-related incidence, risk factors, and outcomes of these events.
Methods and Results-From April 2007 to February 2012, 2621 patients, aged
84+/-7.2 years, underwent transfemoral (TF; 1521) or transapical (TA;
1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves;
as-treated), including the continued access registry. Stroke and TIA were
identified by protocol and adjudicated by a Clinical Events Committee.
Within 30 days of TAVR, 87 (3.3%) patients experienced a stroke (TF 58
[3.8%]; TA 29 [2.7%]; P=0.09), 85% within 1 week. Instantaneous stroke
risk peaked on day 2, then fell to a low prolonged risk of 0.8% by 1 to 2
weeks. Within 30 days, 13 (0.50%) patients experienced a TIA (TF 10
[0.67%]; TA 3 [0.27%]; P>0.17). Stroke and TIA were associated with lower
1-year survival than expected (TF 47% after stroke versus 82%, and 64%
after TIA versus 83%; TA 53% after stroke versus 80%, and 64% after TIA
versus 83%). Risk factors for early stroke after TA-TAVR included more
postdilatations, pure aortic stenosis without regurgitation, and possibly
more pacing runs, earlier date of procedure, and no dual antiplatelet
therapy; high pre-TAVR aortic peak gradient was a risk factor for stroke
early after TF-TAVR. Conclusions-Risk of stroke or TIA is highest early
after TAVR and is associated with increased 1-year mortality.
Modifications of TAVR, emboli-prevention devices, and better
intraprocedural pharmacological protection may mitigate this risk.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00530894.

<62>
Accession Number
2002385056
Title
Intravascular ultrasound-guided drug-eluting stent implantation for
patients with unprotected left main coronary artery lesions: A
single-center randomized trial.
Source
Anatolian Journal of Cardiology. 21 (2) (pp 83-90), 2019. Date of
Publication: February 2019.
Author
Liu X.-M.; Yang Z.-M.; Liu X.-K.; Zhang Q.; Liu C.-Q.; Han Q.-L.; Sun
J.-H.
Institution
(Liu) Departments of General Practice, Hebei Medical University, Tangshan,
China
(Liu, Liu, Zhang, Liu, Han, Sun) Departments of Cardiology, Tangshan
Gongren Hospital, Hebei Medical University, Tangshan, China
(Yang) Department of Orthopedic Trauma, Tangshan Second Hospital,
Tangshan, China
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Intravascular ultrasound (IVUS) has developed as a preferable
choice for optimizing the stenting procedures mainly because it will have
good access to vessel size, lesion length, or severity accurately.
However, it still remains unclear about the benefits of IVUS guidance in
drug-eluting stent (DES) implantation for patients with unprotected left
main coronary artery (ULMCA) stenosis. The aim of the present study was to
evaluate the clinical outcomes with respect to IVUS-guided DES
implantation for these patients. Method(s): A total of 336
consecutive patients from December 2010 to December 2015 were enrolled in
the study. The patients were then randomly assigned into two groups:
IVUS-guided group (n=167) and control group (n=169). The primary endpoint
was the incidence of composite major adverse cardiac events (MACEs),
including cardiac death, myocardial infarction (MI), and target vessel
revascularization (TVR). The risk of stent thrombosis (ST) was chosen as
the safety endpoint. Result(s): After a 1-year follow-up, the
occurrence of composite MACE in the IVUS-guided group was significantly
lower than that in the control group (13.2% vs. 21.9%, p=0.031), which
might mainly result from the significant reduction in the risk of cardiac
death (1.8% vs. 5.9%, p=0.048). Dramatically, the risk of MI did not
differ significantly between the two groups (11.4% vs. 13.6%, p=0.478),
though a tended reduction in TVR was observed under IVUS guidance (4.2%
vs. 8.9%, p=0.068). There was no statistical significance between the two
groups with respect to the risk of target lesion revascularization
(IVUS-guided vs. control: 1.2% vs. 3.0%, p=0.239) and ST (IVUS-guided vs.
control: 1.2% vs. 3.0%, p=0.246). Conclusion(s): The possible
feasibility of IVUS-guided DES implantation for patients with ULMCA
stenosis was supported by the present study. Larger and more powerful
randomized trials were still warranted to research the whole benefits of
IVUS guidance for these patients. (Anatol J Cardiol 2019; 21:
83-90). © Copyright 2018 by Turkish Society of Cardiology.

<63>
Accession Number
625556086
Title
Effects of patient-controlled analgesia with hydromorphone or sufentanil
on postoperative pulmonary complications in patients undergoing thoracic
surgery: A quasi-experimental study 11 Medical and Health Sciences 1103
Clinical Sciences.
Source
BMC Anesthesiology. 18 (1) (no pagination), 2018. Article Number: 192.
Date of Publication: 19 Dec 2018.
Author
Yan G.; Chen J.; Yang G.; Duan G.; Du Z.; Yu Z.; Peng J.; Liao W.; Li H.
Institution
(Yan, Chen, Yang, Duan, Du, Peng, Liao, Li) Department of Anesthesiology,
Anesthesiology of Xinqiao Hospital of Third Military Medical University,
Shapingba District, Chongqing 400037, China
(Yu) Department of Anesthesiology, Xinqiao Hospital, Thoracic Surgery of
Xinqiao Hospital of Third Military Medical University, Shapingba District,
Chongqing 400037, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Objective: To compare the analgesic effects of patient-controlled
intravenous analgesia (PCA) with hydromorphone and sufentanil after
thoracic surgery on postoperative pulmonary complications (PPCs).
 Method(s): A total of 142 patients who were scheduled for thoracic
surgery were randomly allocated to receive PCA with hydromorphone (group
A: experimental group): hydromorphone 0.2 mg/kg + dezocine 0.5 mg/kg +
ramosetron 0.6 mg diluted with normal saline to 200 mL; or with sufentanil
(group B: control group): sufentanil 3.0mug/kg + dezocine 0.5 mg/kg +
ramosetron 0.6 mg diluted with normal saline to 200 mL. The parameters of
intravenous analgesia pump were set as background dose 4 ml/h, PCA dose 1
mL, locking time 15 min. Pain NRS (numerical rating scale), Ramsay
sedation score, nausea or vomiting score were evaluated at 0 h, 6 h, 12 h,
24 h, 48 h after operation. The cases of PPCs (atelectasis, pulmonary
infection, respiratory failure), CRP (C-reaction protein) and inflammatory
cells (white cell count and percentage of neutrophils) and blood gas
analysis at 12 h after operation, length of ICU and postoperative stay
were recorded for each patient. Result(s): Data of 136 patients were
analyzed. Compared with group B (4[IQR:2,2]), the pain NRS in group A
(2[IQR:4,4]) was significantly lower at 6 h after operation (P = 0.000).
The CRP in group A (69.79 +/- 32.13 mg/L) were lower than group B (76.76
+/- 43.42 mg/L) after operation, but the difference was not significant (P
= 0.427). No difference of nausea or vomiting was found between group A
(7.3%) and group B (5.8%) postoperatively (P = 0.999). The PPCs were
happened in 11 patients in group A (16.2%) and 22 patients in group B
(32.4%) and the difference between two groups was significant (P = 0.027).
Seven patients in group A (10.3%) and eighteen patients in group B (26.5%)
had clinical evidence of pneumonia and the difference between two groups
was significant (P = 0.014). The length of ICU and postoperative stay in
group A were 2.73 h and 1.82 days less than group B respectively but the
differences were not significant (P = 0.234, P = 0.186 respectively).
 Conclusion(s): Compared with sufentanil, hydromorphone may provide
better postoperative analgesic effect with less pulmonary complications
for patients undergoing thoracic surgery, and it may accelerate patients'
rehabilitation. Trial registration: Randomized Controlled Trials
ChiCTR1800014282c. Registered 3 January 2018. Copyright © 2018
The Author(s).

<64>
Accession Number
2002213850
Title
Five-year outcomes in cardiac surgery patients with atrial fibrillation
undergoing concomitant surgical ablation versus no ablation. The long-term
follow-up of the PRAGUE-12 Study.
Source
Heart Rhythm. 16 (9) (pp 1334-1340), 2019. Date of Publication: September
2019.
Author
Osmancik P.; Budera P.; Talavera D.; Hlavicka J.; Herman D.; Holy J.;
Cervinka P.; Smid J.; Hanak P.; Hatala R.; Widimsky P.
Institution
(Osmancik, Herman, Widimsky) Cardiocenter, IIIrd Internal -
Cardiology Clinic, Third Faculty of Medicine, Charles University and
University Hospital Kralovske Vinohrady, Prague, Czechia
(Budera, Talavera, Hlavicka) Cardiocenter, Dept. of Cardiac Surgery, Third
Faculty of Medicine, Charles University and University Hospital Kralovske
Vinohrady, Prague, Czechia
(Holy, Cervinka) Department of Cardiology, Masaryk Hospital in Usti nad
Labem, Krajska Zdravotni and UJEP in Usti na Labem, Usti nad Labem,
Czechia
(Smid) Cardiology Department, University Hospital and Faculty of Medicine
Pilsen, Pilsen, Czechia
(Hanak, Hatala) Department of Arrhythmias and Cardiac Pacing, National
Institute for Cardiovascular Disease, Bratislava, Slovakia
Publisher
Elsevier B.V.
Abstract
Background: The long-term effect of concomitant surgical ablation (SA) on
clinical outcomes in an unselected population of patients has not been
sufficiently reported in randomized studies. Objective(s): The aim of
this study was to assess clinical outcomes of the SA after 5 years of
follow-up. Method(s): The PRAGUE-12 study was a prospective,
randomized clinical trial assessing cardiac surgery with ablation for AF
vs cardiac surgery alone. Patients with AF who were also indicated for
cardiac surgery (coronary artery disease [CAD], valve surgery) were
randomized to SA or control (no ablation) group. All patients were
followed for 5 years. The primary endpoint was a composite of
cardiovascular death, stroke, hospitalization for heart failure, or severe
bleeding. Secondary endpoint was a recurrence of AF. Result(s): A
total of 207 patients were analyzed (SA group = 108 patients, control
group = 99 patients). Both groups were similar relative to important
clinical characteristics except for CAD, which was more common in the
control group. Cumulative incidence curves showed a higher incidence of
the primary endpoint in the control group (P = .024, Gray's test).
However, after adjusting for all covariables, the difference between
groups was not significant (subhazard ratio [SHR] 0.69 [0.47-1.02], P =
.068). The incidence of stroke and AF recurrences were significantly
reduced in the SA group, and remained significant even after adjustment
for all covariables, including CAD (stroke: SHR 0.32 [0.12-0.84], P = .02,
AF recurrences: SHR 0.44 [0.31-0.62], P < .001). Conclusion(s):
Concomitant SA of AF is associated with a greater likelihood of
maintaining sinus rhythm and a decreased risk of stroke. Copyright
© 2019 Heart Rhythm Society

<65>
Accession Number
2002374072
Title
Cost-effectiveness comparison of routine transfusion with restrictive and
liberal transfusion strategies for surgical patients in China.
Source
Vox Sanguinis. (no pagination), 2019. Date of Publication: 2019.
Author
Yu X.; Wang Z.; Huang Y.; Xin S.; Sun H.; Zhang X.; Wang Y.; Han W.; Xue
F.; Wang L.; Hu Y.; Xu M.; Li L.; He J.; Jiang J.
Institution
(Yu, Wang, Huang, Xu) Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences, Beijing, China
(Wang, Han, Xue, Wang, Hu, Jiang) Department of Epidemiology and
Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing, China
(Xin, Zhang, Li) First Hospital of China Medical University, Shenyang,
China
(Sun, Wang, He) Xiangya Hospital, Central South University, Changsha,
China
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: A health industry standard recommending
restrictive transfusion is to be in effect in China in April 2019. We aim
to explore its potential economic and clinical impacts among surgical
patients. Material(s) and Method(s): A decision tree model was
applied to compare cost-effectiveness of current routine transfusion in
China, a restrictive (transfusion at Hb < 8 g/dl or ischaemic symptoms)
and a liberal (transfusion at Hb < 10 g/dl) strategy. Parameters were
estimated from empirical data of 25 227 surgical inpatients aged >=30
years in a multicenter study and supplemented by meta-analysis when
necessary. Results are shown for cardio-cerebral-vascular (CCV) surgery
and non-CCV (orthopaedics, general, thoracic) surgery separately.
 Result(s): Per 10 000 patients in routine, restrictive, liberal
transfusion scenarios, total spending (transfusion and length of stay
related) was 7.67, 7.58 and 9.39 million CNY (1 CNY x 0.157 = 1 US dollar)
for CCV surgery and 6.35, 6.70 and 8.09 million CNY for non-CCV surgery;
infectious and severe complications numbered 354, 290, and 290 (CCV) and
315, 286, and 330 (non-CCV), respectively. Acceptability curves showed
high probabilities for restrictive strategy to be cost-effective across a
wide range of willingness-to-pay values. Such findings were mostly
consistent in sensitivity and subgroup analyses except for patients with
cardiac problems. Conclusion(s): We showed strong rationale,
succeeding previous findings only in cardiac or joint procedures, to
comply with the new standard as restrictive transfusion has high potential
to save blood, secure safety, and is cost-effective for a wide spectrum of
surgical patients. Experiences should be further summarized to pave the
way towards individualized transfusion. Copyright © 2019
International Society of Blood Transfusion

<66>
Accession Number
628429793
Title
Impact of cell saver during cardiac surgery on blood transfusion
requirements: a systematic review and meta-analysis.
Source
Vox Sanguinis. 114 (6) (pp 553-565), 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

<67>
Accession Number
2002681661
Title
Randomized Comparison of Clinical Effectiveness of Pharmacologic SPECT and
PET MPI in Symptomatic CAD Patients.
Source
JACC: Cardiovascular Imaging. 12 (9) (pp 1821-1831), 2019. Date of
Publication: September 2019.
Author
Patel K.K.; Al Badarin F.; Chan P.S.; Spertus J.A.; Courter S.; Kennedy
K.F.; Case J.A.; McGhie A.I.; Heller G.V.; Bateman T.M.
Institution
(Patel, Al Badarin, Chan, Spertus, McGhie, Bateman) Department of
Cardiology, University of Missouri-Kansas City, Kansas City, MO, United
States
(Patel, Al Badarin, Chan, Spertus, Kennedy, McGhie, Bateman) Department of
Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Courter, Case) Cardiovascular Imaging Technologies, Kansas City, MO,
United States
(Heller) Department of Cardiology, Gagnon Cardiovascular Institute,
Morristown Medical Center, Morristown, NJ, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study compared the clinical effectiveness of
pharmacologic stress myocardial perfusion imaging (MPI) plus positron
emission tomography (PET) with single-photon emission computed tomography
(SPECT) in patients with known coronary artery disease (CAD) presenting
with symptoms suggestive of ischemia. Background(s): Although PET MPI
has been shown to have higher diagnostic accuracy in detecting
hemodynamically significant CAD than SPECT MPI, whether this impacts
downstream management has not been formally evaluated in randomized
trials. Method(s): This study consisted of a single-center trial in
which patients with known CAD and suspected ischemia were randomized to
undergo PET or attenuation-corrected SPECT MPI between June 2009 and
September 2013. Post-test management was at the discretion of the
referring physician, and patients were followed for 12 months. The primary
endpoint was diagnostic failure, defined as unnecessary angiography
(absence of >=50% stenosis in >=1 vessel) or additional noninvasive
testing within 60 days of the MPI. Secondary endpoints were post-test
escalation of antianginal therapy, referral for angiography, coronary
revascularization, and health status at 3, 6, and 12 months.
 Result(s): A total of 322 patients with an evaluable MPI were
randomized (n = 161 in each group). At baseline, 88.8% of patients were
receiving aspirin therapy, 76.7% were taking beta-blockers, and 77.3% were
taking statin therapy. Diagnostic failure within 60 days occurred in only
7 patients (2.2%) (3 [1.9%] in the PET group and 4 [2.5%] in the SPECT
group; p = 0.70). There were no significant differences between the 2
groups in subsequent rates of coronary angiography, coronary
revascularization, or health status at 3, 6, and 12 months of follow-up
(all p values >=0.20); however, when subjects were stratified by findings
on MPI in a post hoc analysis, those with high-risk MPI on PET testing had
higher rates of angiography and revascularization on follow-up than those
who had SPECT MPI, whereas those undergoing low-risk PET studies had lower
rates of both procedures than those undergoing SPECT (interaction between
randomized modality *high-risk MPI for 12-month catheterization [p =
0.001] and 12-month revascularization [p = 0.09]). Conclusion(s): In
this contemporary cohort of symptomatic CAD patients who were optimally
medically managed, there were no discernible differences in rates of
diagnostic failure at 60 days, subsequent coronary angiography,
revascularization, or patient health status at 1 year between patients
evaluated by pharmacologic PET compared with those evaluated by SPECT MPI.
Downstream invasive testing rates with PET MPI were more consistent with
high-risk features than those with SPECT MPI. (Effectiveness Study of
Single Photon Emission Computed Tomography [SPECT] Versus Positron
Emission Tomography [PET] Myocardial Perfusion Imaging;
NCT00976053) Copyright © 2019 American College of Cardiology
Foundation

<68>
Accession Number
2001912740
Title
Selected 2018 Highlights in Congenital Cardiac Anesthesia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (10) (pp 2833-2842),
2019. Date of Publication: October 2019.
Author
Nasr V.G.; Gottlieb E.A.; Adler A.C.; Evans M.A.; Sawardekar A.; DiNardo
J.A.; Mossad E.B.; Mittnacht A.J.C.
Institution
(Nasr, DiNardo) Department of Anesthesiology, Critical Care and Pain
Medicine, Boston Children's Hospital, Boston, MA, United States
(Gottlieb) Department of Anesthesiology, Dell Medical School, University
of Texas in Austin, Austin, TX, United States
(Adler, Mossad) Division of Pediatric Cardiovascular Anesthesia, Baylor
College of Medicine, Texas Children's Hospital, Houston, TX, United States
(Evans, Sawardekar) Department of Anesthesiology, Northwestern
University's Feinberg School of Medicine, Chicago, IL, United States
(Mittnacht) Department of Anesthesiology, Perioperative and Pain Medicine,
The Icahn School of Medicine at Mount Sinai, New York, NY, United States
Publisher
W.B. Saunders
Abstract
THIS ARTICLE IS a review of the highlights of pertinent literature
published during the 12 months of 2018 that is of interest to the
congenital cardiac anesthesiologist. During a search of the US National
Library of Medicine PubMed database, several topics that displayed
significant contributions to the field in 2018 emerged. The authors of the
present review consider the following topics noteworthy: the patient with
high-risk congenital heart disease (CHD) presenting for noncardiac
surgery, cardiopulmonary resuscitation in infants and children with CHD,
dexmedetomidine use in pediatric patients, point-of-care lung ultrasound,
and regional anesthesia in pediatric cardiac surgery. Copyright ©
2019 Elsevier Inc.

<69>
Accession Number
2001920356
Title
Development and Validation of a Score to Identify Cardiac Surgery Patients
at High Risk of Prolonged Mechanical Ventilation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (10) (pp 2709-2716),
2019. Date of Publication: October 2019.
Author
Hessels L.; Coulson T.G.; Seevanayagam S.; Young P.; Pilcher D.; Marhoon
N.; Bellomo R.
Institution
(Hessels, Marhoon, Bellomo) Data Analytics, Research and Evaluation
Centre, Austin Hospital, University of Melbourne, Melbourne, Australia
(Hessels, Bellomo) Department of Intensive Care, Austin Hospital,
Melbourne, Australia
(Hessels) Department of Critical Care, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
(Coulson) Department of Anaesthesia, Austin Hospital, Melbourne, Australia
(Seevanayagam) Department of Cardiac Surgery, Austin Hospital, Melbourne,
Australia
(Young) Medical Research Institute of New Zealand, Wellington, New Zealand
(Young) Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
(Pilcher) Department of Intensive Care, Alfred Hospital, Melbourne,
Australia
(Pilcher) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Bellomo) Centre of Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Publisher
W.B. Saunders
Abstract
Objective: To develop and validate a score for the early identification of
cardiac surgery patients at high risk of prolonged mechanical ventilation
(MV) who may be suitable targets for interventional trials.
 Design(s): Retrospective analysis. Setting(s): Tertiary
intensive care unit. Participant(s): Cardiac surgery patients.
 Intervention(s): Observational study. Measurements and Main
Results: The study comprised 1,994 patients. Median age was 67 years, and
1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A
total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for >=24,
>=36, and >=48 hours, respectively. In-hospital mortality was 13%, 15%,
and 17%, respectively. For the study model, all preoperative,
intraoperative, and early (first 4 hours) postoperative variables were
considered. A multivariable logistic regression model was developed, and a
predictive scoring system was derived. Using MV >=24 hours as the primary
outcome, the model performance in the development set was good with a
c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score
of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948),
Brier's score was 0.059, and the model remained well calibrated.
 Conclusion(s): The authors developed a simple score to predict
prolonged MV after cardiac surgery. This score, if externally validated,
is potentially suitable for identifying a high-risk target population for
future randomized controlled trials of postoperative care after cardiac
surgery. Copyright © 2019 Elsevier Inc.

<70>
Accession Number
2002366932
Title
A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular
Velocities in TEE.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (10) (pp 2636-2644),
2019. Date of Publication: October 2019.
Author
Mauermann E.; Vandenheuvel M.; Francois K.; Bouchez S.; Wouters P.
Institution
(Mauermann, Vandenheuvel, Bouchez, Wouters) Department for Anesthesiology
and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
(Mauermann) Department for Anesthesiology, Surgical Intensive Care,
Prehospital Emergency Medicine, and Pain Therapy, Basel University
Hospital, Basel, Switzerland
(Francois) Department of Cardiac Surgery, Ghent University Hospital,
Ghent, Belgium
Publisher
W.B. Saunders
Abstract
Objectives: A novel speckle-tracking-based option for measuring tricuspid
annular velocities in the midesophageal 4-chamber view (ME4C) was compared
with velocities measured by tissue Doppler in the apical-4 chamber view
(AP4C). Because this method was based on a modified speckle-tracking-based
measurement of tricuspid annular plane systolic excursion (TAPSE), the
authors also compared TAPSE by speckle tracking in the ME4C with TAPSE by
M-mode in the AP4C. The authors hypothesized that velocities measured by
speckle tracking in transesophageal echocardiography (TEE) would be
similar, correlate, and agree with those measured by tissue Doppler in
transthoracic echocardiography (TTE). Design(s): Prospective
diagnostic study with randomization of the order of post-induction
echocardiography views by TTE (AP4C) and TEE (ME4C). Images were both
acquired and analyzed by 2 echocardiographers independently. The primary
outcome was S'; secondary outcomes were E', A', and TAPSE.
 Setting(s): Single university hospital. Participant(s):
Consecutive adult patients undergoing cardiac surgery (mainly coronary
artery bypass grafting). Intervention(s): None. Main Result(s):
Complete data was available in 24 of 25 patients. For the primary outcome,
S' measured by speckle tracking in the ME4C correlated and agreed with S'
measured by tissue Doppler in the AP4C (S'<inf>STE</inf> =
0.87S<inf>TDI</inf> + 0.60, p < 0.001, r = 0.78; mean bias -0.6 cm/s, 95%
limits of agreement (LoA) -3.5 to 2.4 cm/s). Similarly results were found
for E', but not A' (E'<inf>STE</inf> = 0.69E'<inf>TDI</inf> + 2.37, p <
0.001, r = 0.71; mean bias 0.1 cm/s, 95%LoA -2.5 to 2.8cm/s;
A'<inf>STE</inf> = 0.15A'<inf>TDI</inf> + 11.17, p = 0.629). TAPSE
measurements by the authors' modified speckle-tracking-based technique
were similar to TAPSE by M-mode (18.2 +/- 5.5 mm and 17.1 +/- 3.9 mm,
respectively). Conclusion(s): Tricuspid annular velocities
(S'<inf>STE</inf>, E'<inf>STE</inf>) determined by speckle tracking in TEE
seem to be promising surrogates for velocities measured in TTE. This may
be important for perioperative assessment of the right
ventricle. Copyright © 2019 Elsevier Inc.

<71>
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. 293 (pp 197-202), 2019. Date of
Publication: 15 October 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 Elsevier B.V.

<72>
Accession Number
2001543550
Title
Trends and Updates on Cardiopulmonary Bypass Setup in Pediatric Cardiac
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (10) (pp 2804-2813),
2019. Date of Publication: October 2019.
Author
Medikonda R.; Ong C.S.; Wadia R.; Goswami D.; Schwartz J.; Wolff L.;
Hibino N.; Vricella L.; Nyhan D.; Barodka V.; Steppan J.
Institution
(Medikonda) Johns Hopkins School of Medicine, Baltimore, MD, United States
(Ong, Wolff, Hibino, Vricella) Department of Surgery, Johns Hopkins
University, Baltimore, MD, United States
(Wadia, Goswami, Schwartz, Nyhan, Barodka, Steppan) Department of
Anesthesiology and Critical Care Medicine, Johns Hopkins University,
Baltimore, MD, United States
Publisher
W.B. Saunders
Abstract
Perfusion strategies for cardiopulmonary bypass have direct consequences
on pediatric cardiac surgery outcomes. However, inconsistent study results
and a lack of uniform evidence-based guidelines for pediatric
cardiopulmonary bypass management have led to considerable variability in
perfusion practices among, and even within, institutions. Important
aspects of cardiopulmonary bypass that can be optimized to improve
clinical outcomes of pediatric patients undergoing cardiac surgery include
extracorporeal circuit components, priming solutions, and additives. This
review summarizes the current literature on circuit components and priming
solution composition with an emphasis on crystalloid, colloid, and
blood-based primes, as well as mannitol, bicarbonate, and
calcium. Copyright © 2019 Elsevier Inc.

<73>
Accession Number
2001913331
Title
A Systematic Review and International Web-Based Survey of Randomized
Controlled Trials in the Perioperative and Critical Care Setting:
Interventions Increasing Mortality.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (10) (pp 2685-2694),
2019. Date of Publication: October 2019.
Author
Sartini C.; Lomivorotov V.; Pisano A.; Riha H.; Baiardo Redaelli M.;
Lopez-Delgado J.C.; Pieri M.; Hajjar L.; Fominskiy E.; Likhvantsev V.;
Cabrini L.; Bradic N.; Avancini D.; Wang C.Y.; Lembo R.; Novikov M.;
Paternoster G.; Gazivoda G.; Alvaro G.; Roasio A.; Wang C.; Severi L.;
Pasin L.; Mura P.; Musu M.; Silvetti S.; Votta C.D.; Belletti A.; Corradi
F.; Brusasco C.; Tama S.; Ruggeri L.; Yong C.-Y.; Pasero D.; Mancino G.;
Spadaro S.; Conte M.; Lobreglio R.; Di Fraja D.; Saporito E.; D'Amico A.;
Sardo S.; Ortalda A.; Yavorovskiy A.; Riefolo C.; Monaco F.; Bellomo R.;
Zangrillo A.; Landoni G.
Institution
(Sartini, Baiardo Redaelli, Pieri, Fominskiy, Cabrini, Lembo, Votta,
Belletti, Tama, Ruggeri, Ortalda, Riefolo, Monaco, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Lomivorotov) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Pisano, Di Fraja) Division of Cardiac Anesthesia and Intensive Care Unit,
AORN dei Colli - Monaldi Hospital, Naples, Italy
(Riha) Institute for Clinical and Experimental Medicine, Prague, Czechia
(Lopez-Delgado) Hospital Universitari de Bellvitge, Barcelona, Spain
(Hajjar) Instituto do Coracao do Hospital das Clinicas, Sao Paulo, Brazil
(Likhvantsev, Yavorovskiy) Department of Anesthesiology and Intensive
Care, Sechenov First Moscow State Medical University, Moscow Regional
Clinical and Research Institute, Moscow, Russian Federation
(Bradic) Department of Cardiovascular Anesthesiology and Cardiac Intensive
Medicine, University Hospital Dubrava, Zagreb, Croatia
(Avancini) San Raffaele Telethon Institute for Gene Therapy (SR-Tiget),
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Wang) Anaesthesia and Intensive Care, University of Malaya, Kuala Lumpur,
Malaysia
(Novikov) Saint Petersburg State University, Saint Petersburg, Russian
Federation
(Paternoster) Anaesthesia and Intensive Care, San Carlo Hospital, Potenza,
Italy
(Gazivoda) Institute of Cardiovascular Diseases "Dedinje", Belgrade,
Serbia
(Alvaro, Saporito, D'Amico) AOU Mater Domini Germaneto, Catanzaro, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Wang) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Severi) Anesthesia and Intensive Care, Azienda Ospedaliera San Camillo
Forlanini, Rome, Italy
(Pasin) S. Antonio Hospital, Padova, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU, Cagliari, Italy
(Musu, Sardo) Department of Medical Sciences and Public Health, University
of Cagliari, Monserrato, Italy
(Silvetti) IRCCS Istituto Giannina Gaslini, Ospedale Pediatrico, Genoa,
Italy
(Corradi, Brusasco) E.O. Ospedali Galliera, Genova, Italy and Universita
degli Studi di Pisa, Italy
(Yong) Anaesthesia and Intensive Care, Hospital Pulau Pinang, Georgetown,
Malaysia
(Pasero) Department of Anesthesia and Intensive Care, A.O.U. Cittadella
Salute e della Scienza, Turin, Italy
(Mancino) Hospital Santa Chiara, Pisa, Italy
(Spadaro) Department Morphology, Surgery and Experimental Medicine,
Intensive Care Unit, University of Ferrara, Italy
(Conte) Mater Dei Hospital, Bari, Italy
(Lobreglio) Anesthesia and Intensive Care A.O.U Citta della salute e della
Scienza, Turin, Italy
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Melbourne, Australia
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
W.B. Saunders
Abstract
Objective: Reducing mortality is a key target in critical care and
perioperative medicine. The authors aimed to identify all nonsurgical
interventions (drugs, techniques, strategies) shown by randomized trials
to increase mortality in these clinical settings. Design(s): A
systematic review of the literature followed by a consensus-based voting
process. Setting(s): A web-based international consensus conference.
 Participant(s): Two hundred fifty-one physicians from 46 countries.
 Intervention(s): The authors performed a systematic literature search
and identified all randomized controlled trials (RCTs) showing a
significant increase in unadjusted landmark mortality among surgical or
critically ill patients. The authors reviewed such studies during a
meeting by a core group of experts. Studies selected after such review
advanced to web-based voting by clinicians in relation to agreement,
clinical practice, and willingness to include each intervention in
international guidelines. Measurements and Main Results: The authors
selected 12 RCTs dealing with 12 interventions increasing mortality:
diaspirin-crosslinked hemoglobin (92% of agreement among web voters),
overfeeding, nitric oxide synthase inhibitor in septic shock, human growth
hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute
respiratory distress syndrome, plasma-derived protein C concentrate,
aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in
meningitis, methylprednisolone in traumatic brain injury, and albumin in
traumatic brain injury (72% of agreement). Overall, a high consistency
(ranging from 80% to 90%) between agreement and clinical practice was
observed. Conclusion(s): The authors identified 12 clinical
interventions showing increased mortality supported by randomized
controlled trials with nonconflicting evidence, and wide agreement upon
clinicians on a global scale. Copyright © 2019 Elsevier Inc.

<74>
Accession Number
2000968229
Title
Meta-Analysis of Repeat Revascularization of Off-Pump and On-Pump Coronary
Artery Bypass Surgery.
Source
Annals of Thoracic Surgery. 106 (2) (pp 526-531), 2018. Date of
Publication: August 2018.
Author
Zhou P.; Zhu P.; Xiao Z.; Lin X.; Xu R.; Zheng S.
Institution
(Zhou, Zhu, Xiao, Lin, Xu, Zheng) Department of Cardiovascular Surgery,
Nanfang Hospital, Southern Medical University, Guangzhou, China
Publisher
Elsevier USA
Abstract
Background: There is an ongoing debate focusing on clinical outcomes after
off-pump coronary artery bypass graft surgery (OPCABG) and on-pump
coronary artery bypass graft surgery (ONCABG). The objective of the
present meta-analysis is to update and compare repeat revascularization
rates between OPCABG and ONCABG procedures. Method(s): Data sources
including PubMed, EMBASE, Cochrane Library, and ISI Web of Knowledge were
searched between 1966 and October 2017. Studies considered for inclusion
should conform to the following criteria: prospective randomized clinical
trials comparing OPCABG and ONCABG. Outcome should include repeat
revascularization rate at the time of 1-month, 1-year, or 5-year
follow-up. Result(s): A literature search yielded 11 randomized
controlled trials, and a total of 11,246 patients were randomly allocated
to OPCABG or ONCABG procedures. Pooled analysis demonstrated a
statistically significant 53% increase in repeat revascularization rate at
1-year follow-up with OPCABG relative to ONCABG in the fixed effects model
(odds ratio 1.53, 95% confidence interval: 1.17 to 2.00, p = 0.002),
whereas there was no significant difference in repeat revascularization
rate at 5-year follow-up between OPCABG and ONCABG in the fixed effects
model (OR 1.16, 95% confidence interval: 0.95 to 1.41, p = 0.14). In
general, exclusion of any single trial did not affect repeat
revascularization rate at 1-year and 5-year follow-up. There was no
evidence of significant publication bias. Conclusion(s): The result
of our meta-analysis suggests that compared with ONCABG, OPCABG increases
repeat revascularization rate at 1-year follow-up, but does not affect
that of 5-year follow-up. Copyright © 2018 The Society of
Thoracic Surgeons

<75>
Accession Number
629003579
Title
Have you seen liver enzymes this high in congestive hepatopathy: A case
report.
Source
Journal of General Internal Medicine. Conference: 2019 Annual Meeting of
the Society of General Internal Medicine, SGIM 2019. United States. 34 (2
Supplement) (pp S543), 2019. Date of Publication: May 2019.
Author
Numan L.; Elkafrawy A.A.; Tomaw A.; Abuamr K.
Institution
(Numan, Elkafrawy, Tomaw, Abuamr) University of Missouri-Kansas City,
Kansas City, MO, United States
Publisher
Springer New York LLC
Abstract
Learning Objective #1: Recognize that congestive hepatopathy can present
with liver enzymes higher than three times the normal levels. Learning
Objective #2: Treat as soon asthe etiology is identified to avoid
irreversible damage to the liver, and trend the liver enzymes to assess
the response. CASE: A 33-year-old male previously healthy presented to the
emergency department with epigastric pain of two weeks duration. At the
same time, he noticed yellowish discoloration of his eyes. He denied
acetaminophen use. On review of systems, he was complaining of increased
shortness of breath and new lower limbs swelling. He denied any illicit
drug use, excessive alcohol intake, recent travel, or mushrooms
consumption. On physical examination, he had scleral icterus, bilateral
crackles on auscultation, and lower limns pitting edema. On labs, his
liver function test was trending up: AST(U/L) 883 > 2251, ALT (U/L) 1334 >
2527, and total bilirubin (mg/dL) 3.2 > 3.6. Acetaminophen level was
negative at presentation and 4 hours after presentation. International
randomized ratio (INR) was trending up as well: 3.2 > 3.6. Chest X-ray
showed cardiomegaly. Computed tomography (CT) of the abdomen with contrast
showed volume overload with small right pleural effusion, ascites and
anasarca. There were no signs of liver ischemia or infarct on CT scan.
Ultrasound Doppler of the liver showed patent vasculature and congestion
of the inferior vena cava. Throughout his hospitalization, he remained
normotensive. Hepatology team recommended to trend his liver enzymes, INR
and to do neuro checks every 2 hours. Given his fluid overload, an
echocardiogram was done, and it showed severely dilated left ventricle,
ejection fraction of less than 20%, severe global hypokinesis of the left
and right ventricles, severe aortic regurgitation and bicuspid aortic
valve. Cardiology team recommended to start the patient on intravenous
furosemide twice daily, and then he underwent left heart catheterization
which showed normal coronary arteries. After the first dose of furosemide,
his liver enzymes and INR started trending down till they reached normal
levels. He was diagnosed with congestive hepatopathy that was due to
congestive heart failure secondary to severe aortic insufficiency. The
patient improved and was discharged on Spironolactone, Carvedilol, and
Torsemide. He was scheduled for an outpatient aortic valve replacement.
IMPACT/DISCUSSION: Congestive hepatopathy is common with congestive heart
failure, especially with right-sided heart failure. Typically, the liver
enzymes will be elevated but not higher than three times the normal value.
It is rare for congestive hepatopathy to presents with liver enzymes as
high as this case. However, you always have to rule out other causes of
acute transaminitis. Conclusion(s): Identifying the cause of acute
transaminitis is time sensitive, as the outcome could be catastrophic. Do
not exclude congestive hepatopathy if the liver enzymes are very high,
think about it if other physical signs of congestive heart failure are
present.

<76>
Accession Number
629002988
Title
Don't forget the steroids! management of a rare etiology of pericardial
effusion.
Source
Journal of General Internal Medicine. Conference: 2019 Annual Meeting of
the Society of General Internal Medicine, SGIM 2019. United States. 34 (2
Supplement) (pp S520-S521), 2019. Date of Publication: May 2019.
Author
Lee C.; Nguyen S.; Patel S.; Bergquist H.; Ostrzega E.
Institution
(Lee, Bergquist, Nguyen, Patel, Ostrzega) University of Southern
California, La Crescenta, CA, United States
(Bergquist) University of Southern California, Los Angeles, CA, United
States
Publisher
Springer New York LLC
Abstract
Learning Objective #1: Recognize a rare etiology of pericardial effusions
and possible treatment modalities CASE: A 65-year-old male with a history
of hypertension presented with 2 weeks of shortness of breath and dyspnea
on exertion along with orthopnea and a dry cough. He denied any chest
pain, weight loss, fevers, or night sweats. On examination, vital signs
were stable and he was saturating well on room air. He had jugular venous
distension, distant heart sounds, and lower extremity edema. Laboratory
values were within normal with the exception of alkaline phosphatase 558
U/L, AST 137 U/L, ALT 88 U/L, T Bili 1.4 mg/dL, D Bili 0.7 mg/dL, and a
mildly elevated pro-BNP to 804 pg/ml. HIV and hepatitis panel was
negative. Electrocardiogram revealed normal sinus rhythm with low voltages
on the limb leads and chest X-ray showed cardiomegaly without evidence of
pulmonary edema. Transthoracic echocardiogram showed a large
circumferential pericardial effusion measuring 3.3 cm with early tamponade
physiology. Right heart catheterization revealed elevated right and
left-sided pressures (right atrial mean 17, right ventricular pressure
43/13, right ventricular end-diastolic pressure 17, pulmonary artery
pressure 42/23, pulmonary capillary wedge pressure 22) with a pericardial
pressure of 13 mmHg. Pericardiocentesis was performed with removal of 700
cc of serous fluid, resulting in improvement of filling pressures. Fluid
analysis showed an exudative effusion with 2,035 nucleated cells with a
58% lymphocytic predominance and adenosine deaminase elevated to 118.1 U/L
(normal less than 9.2 U/L). He was empirically treated with a four-drug
anti-tuberculous regimen and subsequent pericardial fluid and
induced-sputum cultures grew Mycobacterium tuberculosis. He was continued
on anti-tuberculous antibiotics but unfortunately, eventually succumbed to
his disease 9 months later. IMPACT/DISCUSSION: Although a more common
diagnosis in developing countries, tuberculous pericardial effusions are
rare in developed countries and are usually limited to immunocompromised
individuals. Treatment involves anti-tuberculous antibiotic therapy with
possible ad-junctive glucocorticoid use. Pericardiocentesis may also be
performed. Studies regarding adjunctive glucocorticoid use have yielded
mixed Results but data from meta-analyses have shown that corticosteroids
may reduce death from all causes in HIV-negative patients, which usually
result from complications of pericardial constriction. However regardless
of treatment, mortality rates remain high. Conclusion(s): This case
demonstrates the importance of having a broad differential when working up
pericardial effusions. Although tuberculosis is a rare etiology of
pericardial effusions, rapid recognition and intervention with antibiotics
and corticosteroids are important in management.

<77>
Accession Number
628992853
Title
Evaluating topical vancomycin to reduce surgical-site infections in
craniotomies: Interim analysis of a randomized controlled trial.
Source
Journal of Neurosurgery. Conference: 2019 Annual Scientific Meeting of the
American Association of Neurological Surgeons, AANS 2019. United States.
131 (1) (pp 51), 2019. Date of Publication: July 2019.
Author
Ruan D.T.; Ulene S.; Christophe B.; Clarke A.; Connolly E.
Institution
(Ruan) New YorkNYUnited States
Publisher
American Association of Neurological Surgeons
Abstract
Introduction: Surgical site infections (SSIs) following craniotomy
procedures are associated with worse outcomes and higher costs.
Application of topical vancomycin prior to wound closure has decreased SSI
rates in spine, cardiac, and ophthalmologic procedures, while minimizing
systemic exposure to vancomycin. Here, we assess the efficacy of topical
vancomycin in reducing SSIs in craniotomy patients. Method(s): As of
August 1st, 2018, 970 craniotomy patients at New York
Presbyterian-Columbia and Cornell were enrolled and 758 interviewed in
this ongoing multi-center, patient-blinded randomized controlled trial.
Subjects were randomized to Cohort I, which received IV cefazolin, or to
Cohort II, which received IV cefazolin and 2 g topical vancomycin.
Follow-up phone interviews were conducted to screen for SSIs within 30 and
90-days post-operation (POD). Primary outcomes were defined as antibiotic
prescription for suspected SSI (probable) or positive skin culture
with/without SSI-related hospital readmission (confirmed). Result(s):
Among 378 Cohort I subjects (50.1%) interviewed at POD 30, SSI rates were
1.85% probable and 0.8% confirmed. The 367 Cohort II patients (49.9%)
interviewed at POD 30 had rates of 0.53% probable and 1.1% confirmed (RR
1.05; 0.27, 4.19, p=0.9399; NNT=1,775). Of 123 Cohort I subjects (50.6%)
interviewed at POD 90, SSI rates were 0.8% probable and 0.8% confirmed.
Among the 120 Cohort II subjects (49.4%) interviewed at POD 90, SSI rates
were 0% probable and 0.8% confirmed SSIs (RR 1.03; 0.06, 16.20, p=0.986;
NNT=4,920). Conclusion(s): Both POD 30 and 90 follow-up data show no
significant difference in confirmed SSIs between the two cohorts, which
may be attributable to low baseline infection rates at the study sites
relative to centers included in published literature. While the trial is
ongoing, initial analysis suggests a larger cohort and greater site
diversity may be necessary to observe a significant decrease in craniotomy
SSIs following prophylactic application of topical vancomycin.

<78>
Accession Number
629005143
Title
Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions
in Patients With ST-Segment-Elevation Myocardial Infarction: A Systematic
Review and Meta-Analysis.
Source
Journal of the American Heart Association. 7 (8) (no pagination), 2018.
Date of Publication: 13 Apr 2018.
Author
Villablanca P.A.; Olmedo W.; Weinreich M.; Gupta T.; Mohananey D.;
Albuquerque F.N.; Kassas I.; Briceno D.; Sanina C.; Brevik T.A.; Ong E.;
Ramakrishna H.; Attubato M.; Menegus M.; Wiley J.; Kalra A.
Institution
(Villablanca, Kassas, Attubato) Division of Cardiology, Department of
Medicine, New York University School of Medicine, New York, NY
(Olmedo, Weinreich, Gupta, Sanina, Brevik, Ong, Menegus, Wiley) Division
of Cardiology, Department of Medicine, Montefiore Medical Center/Albert
Einstein College of Medicine, New York, NY
(Mohananey) Department of Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Albuquerque) Division of Cardiology, Department of Medicine, University
of Miami Miller School of Medicine, Miami, FL, United States
(Briceno) Division of Cardiology, Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, United
States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic, Phoenix, AZ, United States
(Kalra) Division of Cardiovascular Medicine, Department of Medicine, Case
Western Reserve University School of Medicine, Cleveland, OH, United
States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Studies have shown that chronic total occlusion (CTO) in a
noninfarct-related artery in patients with ST-segment-elevation myocardial
infarction is linked to increased mortality. It remains unclear whether
staged revascularization of a noninfarct-related artery CTO in patients
with ST-segment-elevation myocardial infarction translates to improved
outcomes. We performed a meta-analysis to compare outcomes between
patients presenting with ST-segment-elevation myocardial infarction with
concurrent CTO who underwent percutaneous coronary intervention of
noninfarct-related artery CTO versus those who did not. METHOD AND
RESULTS: We conducted an electronic database search of all published data.
The primary end point was major adverse cardiovascular events. Secondary
end points were all-cause mortality, cardiovascular mortality, myocardial
infarction, repeat revascularization with either percutaneous coronary
intervention or coronary artery bypass grafting, stroke, and heart failure
readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were
computed. Random effects model was used and heterogeneity was considered
if I2 >25. Six studies (n=1253 patients) were included in the analysis.
There was a significant difference in major adverse cardiovascular events
(OR, 0.54; 95% CI, 0.32-0.91), cardiovascular mortality (OR, 0.43; 95% CI,
0.20-0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36-0.89),
favoring the patients in the CTO percutaneous coronary intervention group.
No significant differences were observed between the 2 groups for
all-cause mortality (OR, 0.47; 95% CI, 0.22-1.00), myocardial infarction
(OR, 0.78; 95% CI, 0.41-1.46), repeat revascularization (OR, 1.13; 95% CI,
0.56-2.27), and stroke (OR, 0.51; 95% CI, 0.20-1.33). CONCLUSION(S):
In this meta-analysis, CTO percutaneous coronary intervention of the
noninfarct-related artery in patients presenting with ST-segment-elevation
myocardial infarction was associated with a significant reduction in major
adverse cardiovascular events, cardiovascular mortality, and heart failure
readmissions. Copyright © 2018 The Authors. Published on behalf
of the American Heart Association, Inc., by Wiley.

<79>
Accession Number
2002660818
Title
Effectiveness of polypill for primary and secondary prevention of
cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial.
Source
The Lancet. 394 (10199) (pp 672-683), 2019. Date of Publication: 24 - 30
August 2019.
Author
Roshandel G.; Khoshnia M.; Poustchi H.; Hemming K.; Kamangar F.; Gharavi
A.; Ostovaneh M.R.; Nateghi A.; Majed M.; Navabakhsh B.; Merat S.;
Pourshams A.; Nalini M.; Malekzadeh F.; Sadeghi M.; Mohammadifard N.;
Sarrafzadegan N.; Naemi-Tabiei M.; Fazel A.; Brennan P.; Etemadi A.;
Boffetta P.; Thomas N.; Marshall T.; Cheng K.K.; Malekzadeh R.
Institution
(Roshandel, Khoshnia, Poustchi, Gharavi, Ostovaneh, Nateghi, Majed,
Navabakhsh, Pourshams, Nalini, Malekzadeh, Malekzadeh) Digestive Disease
Research Center, Digestive Disease Research Institute, Shariati Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Poustchi, Pourshams, Malekzadeh) Digestive Oncology Research Center,
Digestive Disease Research Institute, Shariati Hospital, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Merat, Malekzadeh) Liver and Pancreaticobiliary Disease Research Center,
Digestive Disease Research Institute, Shariati Hospital, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Roshandel, Khoshnia, Naemi-Tabiei, Fazel) Golestan Research Center of
Gastroenterology and Hepatology, Golestan University of Medical Sciences,
Gorgan, Iran, Islamic Republic of
(Hemming, Thomas, Marshall, Cheng) Institute of Applied Health Research,
University of Birmingham, Birmingham, United Kingdom
(Kamangar) Department of Biology, School of Computer, Mathematical, and
Natural Sciences, Morgan State University, Baltimore, MD, United States
(Sadeghi) Cardiac Rehabilitation Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Mohammadifard) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Sarrafzadegan) Heart Failure Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Brennan) Section of Genetics, International Agency for Research on
Cancer, WHO, Lyon, France
(Etemadi) Division of Cancer Epidemiology and Genetics, National Cancer
Institute, National Institutes of Health, Bethesda, MD, United States
(Boffetta) Tisch Cancer Institute, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Boffetta) Department of Medical and Surgical Sciences, University of
Bologna, Italy
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: A fixed-dose combination therapy (polypill strategy) has been
proposed as an approach to reduce the burden of cardiovascular disease,
especially in low-income and middle-income countries (LMICs). The PolyIran
study aimed to assess the effectiveness and safety of a four-component
polypill including aspirin, atorvastatin, hydrochlorothiazide, and either
enalapril or valsartan for primary and secondary prevention of
cardiovascular disease. Method(s): The PolyIran study was a
two-group, pragmatic, cluster-randomised trial nested within the Golestan
Cohort Study (GCS), a cohort study with 50 045 participants aged 40-75
years from the Golestan province in Iran. Clusters (villages) were
randomly allocated (1:1) to either a package of non-pharmacological
preventive interventions alone (minimal care group) or together with a
once-daily polypill tablet (polypill group). Randomisation was stratified
by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the
unit of randomisation. We used a balanced randomisation algorithm,
considering block sizes of 20 and balancing for cluster size or natural
log of the cluster size (depending on the skewness within strata).
Randomisation was done at a fixed point in time (Jan 18, 2011) by
statisticians at the University of Birmingham (Birmingham, UK),
independent of the local study team. The non-pharmacological preventive
interventions (including educational training about healthy lifestyle-eg,
healthy diet with low salt, sugar, and fat content, exercise, weight
control, and abstinence from smoking and opium) were delivered by the
PolyIran field visit team at months 3 and 6, and then every 6 months
thereafter. Two formulations of polypill tablet were used in this study.
Participants were first prescribed polypill one (hydrochlorothiazide 12.5
mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants
who developed cough during follow-up were switched by a trained study
physician to polypill two, which included valsartan 40 mg instead of
enalapril 5 mg. Participants were followed up for 60 months. The primary
outcome-occurrence of major cardiovascular events (including
hospitalisation for acute coronary syndrome, fatal myocardial infarction,
sudden death, heart failure, coronary artery revascularisation procedures,
and non-fatal and fatal stroke)-was centrally assessed by the GCS
follow-up team, who were masked to allocation status. We did
intention-to-treat analyses by including all participants who met
eligibility criteria in the two study groups. The trial was registered
with ClinicalTrials.gov, number NCT01271985. Finding(s): Between Feb
22, 2011, and April 15, 2013, we enrolled 6838 individuals into the
study-3417 (in 116 clusters) in the minimal care group and 3421 (in 120
clusters) in the polypill group. 1761 (51.5%) of 3421 participants in the
polypill group were women, as were 1679 (49.1%) of 3417 participants in
the minimal care group. Median adherence to polypill tablets was 80.5%
(IQR 48.5-92.2). During follow-up, 301 (8.8%) of 3417 participants in the
minimal care group had major cardiovascular events compared with 202
(5.9%) of 3421 participants in the polypill group (adjusted hazard ratio
[HR] 0.66, 95% CI 0.55-0.80). We found no statistically significant
interaction with the presence (HR 0.61, 95% CI 0.49-0.75) or absence of
pre-existing cardiovascular disease (0.80; 0.51-1.12;
p<inf>interaction</inf>=0.19). When restricted to participants in the
polypill group with high adherence, the reduction in the risk of major
cardiovascular events was even greater compared with the minimal care
group (adjusted HR 0.43, 95% CI 0.33-0.55). The frequency of adverse
events was similar between the two study groups. 21 intracranial
haemorrhages were reported during the 5 years of follow-up-ten
participants in the polypill group and 11 participants in the minimal care
group. There were 13 physician-confirmed diagnoses of upper
gastrointestinal bleeding in the polypill group and nine in the minimal
care group. Interpretation(s): Use of polypill was effective in
preventing major cardiovascular events. Medication adherence was high and
adverse event numbers were low. The polypill strategy could be considered
as an additional effective component in controlling cardiovascular
diseases, especially in LMICs. Funding(s): Tehran University of
Medical Sciences, Barakat Foundation, and Alborz Darou. Copyright
© 2019 World Health Organization. Published by Elsevier Ltd/Inc/BV.
All rights reserved.

<80>
Accession Number
2002663111
Title
Transcatheter aortic valve replacement in low-risk patients: A
meta-analysis of randomized controlled trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Al-Abdouh A.; Upadhrasta S.; Fashanu O.; Elias H.; Zhao D.; Hasan R.K.;
Michos E.D.
Institution
(Al-Abdouh, Upadhrasta, Fashanu, Elias) Department of Medicine, Saint
Agnes Hospital, Baltimore, MD, United States
(Fashanu, Michos) The Ciccarone Center for the Prevention of
Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD,
United States
(Zhao, Michos) Department of Epidemiology, Johns Hopkins University,
Baltimore, MD, United States
(Hasan, Michos) Division of Cardiology, Johns Hopkins School of Medicine,
Baltimore, MD, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has become the
standard treatment option for patients with symptomatic severe aortic
stenosis (AS) with high surgical risk and a reasonable option for
intermediate surgical risk as an alternative to surgical aortic valve
replacement (SAVR). The role of TAVR in lower risk patients is less
established but has been the focus of recent randomized controlled trials
(RCTs). We performed a meta-analysis of RCTs to assess TAVR outcomes among
low surgical risk patients. Methods and Results: Systematic search of
RCTs was done using PubMed, EMBASE, and Cochrane Library databases.
Statistical analysis was performed with RevMan v5.3 software using a
random effects model to report risk ratio (RR) with 95% confidence
interval (CI). A total of three RCTs including 2698 patients (1375 TAVR
and 1323 SAVR) were analyzed. Compared to SAVR, TAVR was not associated
with all-cause mortality [RR 0.86 (95% CI 0.61-1.19); P = 0.36;
I2 = 8%] or stroke [RR 0.82 (0.48-1.43); P = 0.49;
I2 = 42%]. However, TAVR was significantly associated with
lower risk of acute kidney injury [RR 0.27 (0.13-0.54); P = 0.0002;
I2 = 0%], new-onset atrial fibrillation [RR 0.26 (0.18-0.39); P
< 0.00001; I2 = 80%], and life-threatening or disabling
bleeding [RR 0.35 (0.22-0.55); P < 0.00001; I2 = 57%], but a
higher risk of moderate-severe paravalvular leak [RR 4.40 (1.22-15.86); P
= 0.02; I2 = 26%] and permanent pacemaker insertion [RR 2.73
(1.41-5.28); P = 0.003; I2 = 83%]. Conclusion(s): There is
no difference in all-cause mortality or stroke between TAVR and SAVR, but
TAVR is associated with lower risk of other perioperative complications
except for moderate-severe paravalvular leak and the need for permanent
pacemaker implantation. Copyright © 2019

<81>
Accession Number
2002659429
Title
Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis,
Meta-Regression, and Trial Sequential Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Meco M.; Montisci A.; Giustiniano E.; Greco M.; Pappalardo F.; Mammana L.;
Panisi P.; Roscitano C.; Cirri S.; Donatelli F.; Albano G.
Institution
(Meco, Panisi, Roscitano, Albano) Anesthesia and Intensive Care
Department, Humanitas Gavazzeni Clinic, Bergamo, Italy
(Montisci, Cirri) Department of Anesthesia and Intensive Care,
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milano, Italy
(Montisci, Donatelli) Cardiac Surgery, University of Milan, Milano, Italy
(Giustiniano, Greco) Department of Anesthesia and Intensive Care, IRCCS
Humanitas Clinical and Research Center, Rozzano, Italy
(Pappalardo) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute and Vita-Salute San Raffaele University,
Milano, Italy
(Mammana, Donatelli) Department of Cardiac Surgery, Cardiothoracic Center,
Istituto Clinico Sant'Ambrogio, Milano, Italy
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative hemorrhage in cardiac surgery is a significant
cause of morbidity and mortality. Standard laboratory tests fail as
predictors for bleeding in the surgical setting. The use of viscoelastic
(VE) hemostatic assays thromboelastography (TEG) and rotational
thromboelastometry (ROTEM) could be an advantage in patients undergoing
cardiac surgery. The objective of this meta-analysis was to analyze the
effects (benefits and harms) of VE-guided transfusion practice in cardiac
surgery patients. Design(s): A meta-analysis of randomized trials.
 Setting(s): For this study, PubMed, EMBASE, Scopus, and the Cochrane
Collaboration database were searched, and only randomized controlled
trials were included. A systematic review and meta-analysis were performed
in accordance with the standards set forth by the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement, using a
random-effects model. Participant(s): The study comprised adult
cardiac surgery patients. Intervention(s): VE-hemostatic assays
transfusion algorithm compared with transfusion algorithms based on
clinicians' discretion. Measurements and Main Results: Seven
comparative randomized controlled trials were considered, including a
total of 1,035 patients (522 patients in whom a TEG- or ROTEM-based
transfusion algorithm was used). In patients treated according to
VE-guided algorithms, red blood cell (odds ratio 0.61; 95% confidence
interval [CI]: 0.37-0.99; p: 0.04; I2: 66%) and fresh frozen
plasma transfusions (risk difference 0.22; 95% CI: 0.11-0.33; p < 0.0001;
I2: 79%) use was reduced; platelets transfusion was not reduced
(odds ratio 0.61; 95% CI: 0.32-1.15; p: 0.12; I2 74%).
 Conclusion(s): This study demonstrated that the use of VE assays in
cardiac surgical patients is effective in reducing allogenic blood
products exposure, postoperative bleeding at 12 and 24 hours after
surgery, and the need for redo surgery unrelated to surgical
bleeding. Copyright © 2019 Elsevier Inc.

<82>
Accession Number
2002549390
Title
Regional analgesia for minimally invasive cardiac surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Yu S.; Valencia M.B.; Roques V.; Aljure O.D.
Institution
(Yu, Aljure) Department of Anesthesiology, Jackson Memorial
Hospital/University of Miami, Miami, FL, United States
(Valencia) Department of Cardiac and Transplant Anesthesiology, London
Health Sciences Centre, London, ON, Canada
(Roques) Department of Intensive Care and Chronic Pain Treatment,
University Hospital Virgen de la Arrixaca, Murcia, Spain
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Minimally invasive cardiac surgery (MICS) has expanded during
the recent years due to interest in improved patient satisfaction and
decreased stay in the hospital. To assist in these interests,
postoperative pain control is aimed at decreasing opioid usage but
maintaining adequate pain control. Regional anesthesia has the ability to
provide these goals. This review article will describe different regional
anesthesia techniques and discuss the evidence of their use in MICS.
 Method(s): A literature search was conducted in MEDLINE (PubMed) and
EMBASE with keywords and narrowed to publications between 1998 and 2018.
The results are reviewed, analyzed, and discussed in this paper.
 Result(s): Thoracic epidurals provide improved pain control and
decreased stay in the intensive care unit. Thoracic paravertebral blocks
are as effective as thoracic epidurals for postoperative pain control.
Serratus anterior plane block provides adequate pain control but does not
control pain as well as paravertebral blocks. Intrapleural blocks provide
sufficient pain control and can be placed by the surgeon. Pectoral fascial
blocks, intercostal blocks, and erector spinae plane blocks described in
case reports seem to be viable options for postoperative pain control.
 Conclusion(s): As cardiac surgery moves toward smaller incisions and
MICS with the goal of enhanced recovery, multimodal analgesic techniques
should be explored for postoperative pain control. The regional techniques
discussed in this article show a trend toward improved pain control and
decreased stay in the intensive care unit. Copyright © 2019 Wiley
Periodicals, Inc.

<83>
Accession Number
628760814
Title
Postoperative sore throat and subglottic injury after McGrath MAC
videolaryngoscopic intubation with versus without a stylet in patients
with a high Mallampati score: A randomized controlled trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 137.
Date of Publication: 31 Jul 2019.
Author
Yoon H.-K.; Lee H.-C.; Oh H.; Jun K.; Park H.-P.
Institution
(Yoon, Lee, Oh, Jun, Park) Department of Anesthesiology and Pain Medicine,
Seoul National University College of Medicine, Seoul National University
Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A tracheal tube stylet can be used to assist successful
tracheal intubation, especially during videolaryngoscopic intubation
because videolaryngoscopes with a Macintosh-type blade such as McGrath MAC
videolaryngoscope have more acute angle than conventional Macintosh
laryngoscope. However, the use of a stylet during tracheal intubation can
raise concerns about stylet-induced postoperative airway complications,
such as sore throat, subglottic injury, and hoarseness. In this study, we
compared the incidence of postoperative airway complications after McGrath
MAC videolaryngoscopic intubation with versus without a stylet in patients
with a high Mallampati score. Method(s): In 104 patients with
Mallampati score III or IV and who were scheduled for lumbar or thoracic
spine surgery, McGrath MAC videolaryngoscopic intubation was performed
either with a stylet (group S, n = 52) or without a stylet (group N, n =
52). The primary outcome measure was the incidences of sore throat
evaluated at 1 and 24 h postoperatively. Secondary outcome measures were
the incidences of subglottic injury and postoperative hoarseness.
 Result(s): The incidence of CL grade III in group S and N was 3.8 and
5.8%, respectively. No patient showed CL grade IV. The incidences of sore
throat at 1 (26.9 vs 19.2%, P = 0.485) and 24 h (17.3 vs 13.5%, P = 0.786,
respectively) postoperatively were not significantly different between the
group S and N. However, the incidence of subglottic injury was
significantly higher in the group S, compared with the group N (65.4 vs
42.3%, P = 0.030). The incidence of postoperative hoarseness did not
differ significantly between the two groups. Conclusion(s): The use
of a stylet during McGrath MAC videolaryngoscopic intubation did not have
a significant impact on the incidence of postoperative sore throat in
patients with a high Mallampati score. Avoiding the use of a stylet during
intubation with McGrath MAC videolaryngoscope may reduce the incidence of
subglottic injury in such patients. Copyright © 2019 The
Author(s).

<84>
Accession Number
614517308
Title
Coronary Artery Bypass Grafting With and Without Manipulation of the
Ascending Aorta: A Network Meta-Analysis.
Source
Journal of the American College of Cardiology. 69 (8) (pp 924-936), 2017.
Date of Publication: 28 Feb 2017.
Author
Zhao D.F.; Edelman J.J.; Seco M.; Bannon P.G.; Wilson M.K.; Byrom M.J.;
Thourani V.; Lamy A.; Taggart D.P.; Puskas J.D.; Vallely M.P.
Institution
(Zhao, Edelman, Seco, Bannon, Byrom, Vallely) Sydney Medical School, The
University of Sydney, Sydney, New South Wales, Australia
(Zhao, Edelman, Seco, Bannon, Wilson, Byrom, Vallely) Baird Institute of
Applied Heart and Lung Surgical Research, Sydney, New South Wales,
Australia
(Edelman, Seco, Bannon, Wilson, Byrom, Vallely) Cardiothoracic Surgical
Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
(Bannon, Byrom, Vallely) Institute of Academic Surgery, Royal Prince
Alfred Hospital, Sydney, New South Wales, Australia
(Bannon, Wilson, Byrom, Vallely) Sydney Heart and Lung Surgeons, Sydney,
New South Wales, Australia
(Thourani) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, United States
(Lamy) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Puskas) Department of Cardiac Surgery, Mt. Sinai Hospital, New York, New
York, United States
Publisher
Elsevier USA
Abstract
Background Coronary artery bypass grafting (CABG) remains the standard of
treatment for 3-vessel and left main coronary disease, but is associated
with an increased risk of post-operative stroke compared to percutaneous
coronary intervention. It has been suggested that CABG techniques that
eliminate cardiopulmonary bypass and reduce aortic manipulation may reduce
the incidence of post-operative stroke. Objectives A network meta-analysis
was performed to compare post-operative outcomes between all CABG
techniques, including anaortic off-pump CABG (anOPCABG), off-pump with the
clampless Heartstring device (OPCABG-HS), off-pump with a partial clamp
(OPCABG-PC), and traditional on-pump CABG with aortic cross-clamping.
Methods A systematic search of 6 electronic databases was performed to
identify all publications reporting the outcomes of the included
operations. Studies reporting the primary endpoint, 30-day post-operative
stroke rate, were included in a Bayesian network meta-analysis. Results
There were 13 included studies with 37,720 patients. At baseline, anOPCABG
patients had higher previous stroke than did the OPCABG-PC (7.4% vs. 6.5%;
p = 0.02) and CABG (7.4% vs. 3.2%; p = 0.001) patients. AnOPCABG was the
most effective treatment for decreasing the risk of post-operative stroke
(-78% vs. CABG, 95% confidence interval [CI]: 0.14 to 0.33; -66% vs.
OPCABG-PC, 95% CI: 0.22 to 0.52; -52% vs. OPCABG-HS, 95% CI: 0.27 to
0.86), mortality (-50% vs. CABG, 95% CI: 0.35 to 0.70; -40% vs. OPCABG-HS,
95% CI: 0.38 to 0.94), renal failure (-53% vs. CABG, 95% CI: 0.31 to
0.68), bleeding complications (-48% vs. OPCABG-HS, 95% CI: 0.31 to 0.87;
-36% vs. CABG, 95% CI: 0.42 to 0.95), atrial fibrillation (-34% vs.
OPCABG-HS, 95% CI: 0.49 to 0.89; -29% vs. CABG, 95% CI: 0.55 to 0.87; -20%
vs. OPCABG-PC, 95% CI: 0.68 to 0.97), and shortening the length of
intensive care unit stay (-13.3 h; 95% CI: -19.32 to -7.26; p < 0.0001).
Conclusions Avoidance of aortic manipulation in anOPCABG may decrease the
risk of post-operative stroke, especially in patients with higher stroke
risk. In addition, the elimination of cardiopulmonary bypass may reduce
the risk of short-term mortality, renal failure, atrial fibrillation,
bleeding, and length of intensive care unit stay. Copyright ©
2017 American College of Cardiology Foundation

<85>
Accession Number
618525524
Title
Effects of anacetrapib in patients with atherosclerotic vascular disease.
Source
New England Journal of Medicine. 377 (13) (pp 1217-1227), 2017. Date of
Publication: 28 Sep 2017.
Author
Bowman L.; Hopewell J.C.; Chen F.; Wallendszus K.; Stevens W.; Collins R.;
Wiviott S.D.; Cannon C.P.; Braunwald E.; Sammons E.; Landray M.J.; Jiang
L.; Armitage J.; Haynes R.; Maggioni A.P.; Angermann C.E.; Ertl G.; Wanner
C.; Pedersen T.; Goto S.; Teramoto T.; Baigent C.; Barter P.; Chen Y.;
Chen Z.; Gray A.; Mihaylova B.; Sleight P.; Tobert J.; Blaustein R.;
DeLucca P.; Mitchel Y.; van Leijenhorst G.; Sandercock P.; DeMets D.;
Kjekshus J.; Neuberger J.; Tonkin A.; Emberson J.; Granger C.; Colhoun H.;
Barton J.; Bray C.; Dayanandan R.; Knott C.; Lay M.; Murphy K.; Wincott
E.; Achiri P.; Barry S.; Bateman S.; Brewster A.; Briggs S.; Brown R.;
Burke A.; Butler E.; Cobb L.; Collet A.; Crowther J.; Cureton L.;
Danesh-Pour S.; Fathers S.; Fletcher L.; Frederick K.; Gordon T.; Gray M.;
Heineman J.; Howard S.; Jackson D.; Lam N.; Lee R.; Machin O.; Madgwick
Z.; Matthewson M.; Nolan J.; Nunn M.; Panicker A.; Pank L.; Pearson-Burton
E.; Pickworth S.; Qiao Y.; Radley A.; Roby K.; Sayer J.; Shah S.; Taylor
K.; Thorne H.; Timadjer A.; Vandenberg K.; Wickman M.; Willett M.; Woods
J.; Yu H.; Aung T.; Bulbulia R.; Clarke R.; Herrington W.; Judge P.; Lewis
D.; Llewellyn-Bennett R.; Mafham M.; Preiss D.; Reith C.; Storey B.;
Tomson J.; Waters E.; Baxter A.; Goodenough R.; Ait-Sadi R.; Arnold M.;
Barton I.; Berry C.; Blower G.; Booth J.; Brown E.; Bu Y.; Cleverley P.;
Coates G.; Cox J.; Craig M.; Cui G.; Dalton P.; Danel L.; Daniels C.; Dawe
C.; Field A.; Gilbert S.; Harding P.; Jayne K.; Kurien R.; Lancaster G.;
Maskill A.; McDougall A.; Mostefai Y.; Mulay S.; Munday A.; Murawska A.;
Prajapati N.; Ramesh S.; Reid R.; Syed S.; Todd H.; Young A.; Zhu W.;
Parish S.; Valdes-Marquez E.; Hill M.; Clark S.; Emmens K.; McClean G.;
Radley M.; Wintour J.; Allworth M.; Beneat A.M.; Bird C.; Boggs L.; Casey
A.; Chavagnon T.; Chung K.; Chung R.; Cockram L.; Cox R.; Douglas J.;
Finnegan L.; French H.; Goodwin N.; Gordon A.; Gordon J.; Guest C.; Hazim
S.; Hill J.; Hrusecka R.; Lacey M.; Luker N.; Mulligan S.; Obrero M.E.;
Plunkett N.; Sansom L.; Shellard R.; Taylor J.; Taylor P.; Tyler J.;
Weaving L.; Wheeler J.; Williams T.; Yeung M.; Beebe S.; Bowsher-Brown K.;
Dabrowski J.; Henderson J.; James J.; Lochhead H.; Toghill V.; Wright L.;
Young L.; Hundei W.; Liu J.; Qu J.; Zhang H.; Dai H.; Feng F.; Hou L.; Li
J.; Ma L.; Niu S.; Tang R.; Wang S.; Wei X.; Xie M.; Yan X.; Yang M.;
Zhang Y.; Zhang L.; Zhang A.; Zhang S.; Zhao L.; Zhong H.; Chen L.; Gao
Y.; Li L.; Yang H.; Zhang J.; Brenner S.; Heldmann M.; Kraus B.; Meyer B.;
Fajardo-Moser M.; Hartner C.; Knoppe A.; Pop-Marschall D.; Renner J.;
Saemann U.; Fabbri G.; Lorimer A.; Lucci D.; Bartolomei Mecatti B.; Ceseri
M.; Baldini E.; Benoni S.; Bianchini F.; Ferruzzi P.; Miccoli M.; Musio
S.; Ramani F.; Gorini M.; Orsini G.; Kato E.; Tawara K.; Tomita A.;
Kitamura S.; Saitoh Y.; Shimizu M.; Shiozaki S.; Soeda K.; Tanaka A.;
Eisen A.; Steen D.; Fish P.; MacDonnell S.; Kent J.; McCagg A.; Greene E.;
Klements D.; Washington K.; Davis A.; Goeres M.; Joyce J.; Koen J.;
Colicchia J.; Domercant J.; Foster V.; Fox C.; Gennusa C.; Hollis R.;
Kassa Y.; Kelley A.; Magloire V.; Owens C.; Yeh N.; Arnesson K.; Mosegaard
S.; Andersen K.; Haywood S.; Osmanagic A.; Pilgaard Madsen C.; Rebnord E.;
Serup-Hansen K.; Tarras Wahlberg M.; Hannibal K.; Johansen T.; Rasmussen
L.; Sloth A.; Kiuru P.; Lauronen M.; Leinonen A.S.; Mononen T.; Vuola M.;
Wiik S.; Hovdal H.; Lien C.; Svingen S.; Singh P.; Thorsby I.; Westerheim
E.; Bergsten P.; Bergvall L.; Castedal H.; Cederholm A.C.; Froberg L.;
Johansson A.; Jonsson L.; Martin P.; Rasmusson T.; Wiik-Karu S.; Diget H.;
Moll O.; Snejbjerg S.; Sorensen G.; Eronen S.; Roine S.; Vaine T.;
Bjorhovde V.; Edvardsen L.; Saether S.; Blechert A.; Ek I.; Hedlof L.;
Levin J.; Vlaheli D.; Genest J.; Gupta M.; Burgess A.; Dela Cruz C.;
Harnden S.; Hirjikaka S.; Mallari E.; Thevakumaran Y.; Pandey A.; Lake J.;
Pandey M.; Wang C.; Sabbah E.; Chausse I.; Deslongchamp F.; Lavoie J.;
Sabe-Affaki G.; Fontaine S.; Gosselin G.; David M.; Drouin K.; Lachance
N.; Masson C.; Pashko M.; Tremblay C.; Constance C.; Gauthier M.; Kouz S.;
Fleury C.; Lemay-Chretien V.; Roberge N.; Roy M.; Hoag G.; Standring R.;
Warke L.; Pearce S.; Breakwell L.; Cleveland T.; Kastanis D.; Bhargava R.;
Stafford C.; Stata C.; Anderson T.; Brown D.; Madden B.; Pajevic M.;
Ramadan D.; Smith B.; Cha J.; Otis J.; Zadra R.; Harwood A.; McPherson C.;
Rackham C.; Bakbak A.; Baghiana S.; Gibney K.; Swailes L.; Nault P.; Audet
K.; Roy C.; St-Amour E.; Tremblay I.; Chehayeb R.; Lepage C.; Vizel S.;
Fox B.; Yu Q.; Chi L.; Liu F.; Zhao R.; Li X.; Qian Y.; Wang J.; Yang X.;
Chen M.; Lin X.; Zhang F.; Fang X.; Su W.; Zhu X.; Huang L.; Ye G.; Zhao
Y.; Yang P.; He M.; Li B.; Zhi Y.; Sun L.; Xiao L.; Yuan Y.; Guo R.; Wang
Q.; Wang Y.; Guo Y.; Zhai M.; Yang Y.; Song J.; Zheng Z.; Wang X.; Zhao
C.; Wang Z.; Li C.; Cui Z.; Zhang X.; Su H.; Huang X.; Zhang R.; Ge Z.;
Liu D.; Liu Q.; Han Y.; He W.; Qian D.; Liu L.; Yao X.; Du Y.; Song L.;
Che H.; Li D.; Sun C.; Bai H.; Chen W.; Liu Z.; Yang J.; Li Z.; Bai J.;
Wang F.; Xing C.; Yao Y.; Jiang X.; Dong Y.; Wu G.; Zhang B.; Wu Z.; Chu
Y.; Gu X.; Chai X.; Sun S.; Tong L.; Ma S.; Li H.; Liu X.; Shi J.; Xiao
R.; Wu R.; Meng X.; Shao B.; Zhang T.; Chen X.; Feng T.; Huo L.; Shang X.;
Zhou C.; Guo M.; Li P.; Pei H.; Han D.; Cheng C.; Huang M.; Wu W.; Xu T.;
Xia J.; Zhao S.; Ding S.; Guo L.; Li N.; Diao Q.; Wang H.; Qi G.; Jia Z.;
Meng Y.; Wu C.; Liu B.; Bian X.; Li W.; Jing J.; Sun Y.; Wu S.; Xu Y.; Lv
F.; Guo C.; Long J.; Huang Z.; Fu X.; Yao H.; Zheng Y.; Liu C.; Tong Q.;
Wang G.; Cheng Y.; Gang X.; Guo W.; He G.; Han Q.; Bian H.; Duan L.; Jin
C.; Xing W.; Xu J.; Jin Y.; Lin Y.; Zhou X.; Li Y.; Guan X.; Liu H.; Pan
H.; Fan P.; Ma R.; Wang P.; Cui R.; Sun G.; Xie R.; Qu P.; Li G.; Mei J.;
Wang L.; Yang Q.; Zhang C.; Yu B.; Cao W.; Du W.; Luan Y.; Wang W.; Zhu
Y.; Jiao H.; Qu Y.; Yang Z.; Du N.; Liang B.; Wang D.; Zhao P.; Xu B.;
Zong D.; Tang X.; Zong C.; Mo Z.; Jin P.; Xiong J.; Cong H.; Guo X.; Liang
R.; Zhou J.; Liu Y.; Sun Z.; Wan Z.; Bian B.; Zhang W.; Yao Z.; Wang R.;
Chen G.; Ma C.; Jiang J.; Ni L.; Yan H.; Su X.; Cai J.; Ma J.; Zhong R.;
Gu Y.; Hu L.; Wu X.; Feng J.; Huang H.; Ouyang F.; Zhou Y.; Yang T.; Deng
X.; Peng L.; Su S.; Fu Q.; Zong X.; Shang Y.; Sun H.; Guo S.; He Y.; Cha
L.; Lu Y.; Egstrup K.; Berg Schmidt E.; Dinesen P.; Gammelmark A.; Nielsen
M.; Rix T.; Vadmann H.; Christensen B.; Hessing Kobbelgaard L.; Mikkelsen
B.; Storgaard M.; Nyvad O.; Rohold A.; Thomsen K.; Hummelshoj J.;
Svenningsen A.; Tanggaard L.; Gislason G.; Torp Pedersen C.; von Jessen
G.; Larsen J.; Sandberg Madsen J.; Iversen H.; Nielsen C.; Obionu J.;
Simonsen S.; Kjaergaard Dano M.; Hornslet P.; Veng-Olsen T.; May O.;
Madsen L.; Engbjerg Andersen M.; Jensen L.; Lynggaard V.; Sondergaard S.;
Vester S.; Roseva-Nielsen N.; Sorensen V.; Skjodeberg Christensen K.; Bang
Hansen M.; Mollerup H.; Voigt S.; Jepsen J.; Gesla J.; Johansen L.;
Zeuthen E.; Bjerge Kaspersen B.; Felthaus B.; Lokke M.; Holm Pedersen L.;
Schrader A.; Schmidt Thomsen L.; Stender S.; Brink-Kjaer T.; Jonsson H.;
Sykulski R.; Thorsen J.; Osterby Elin P.; Stage Jensen B.; Ralfkier N.;
Gottschalck H.; Bloksgaard Nilesen S.; Lytken Larsen M.; Mickley H.;
Hosbond S.; Saaby L.; Ronn M.; Rosenlund I.; Clemmensen P.; Grande P.;
Kober L.; Andersson H.; Wiberg S.; Graversen K.; Hedgaard L.; Melchior T.;
Larsen C.; Heinsvig S.; Larsen I.; Perret-Gentil V.; Frost L.; Christensen
A.; Arp H.; Mortensen M.; Odgaard A.; Wiggers H.; Poulsen S.; Udsen G.;
Lomholt J.; Niemann K.; Ridderstrale M.; Tarnow L.; Boesgaard T.; Hansen
T.; Safai N.; Andersen M.; Hansen S.; Pedersen M.; Auscher S.; Sheta H.;
Vinter K.; Hindsgaul L.; Lundgaard M.; Moltrup L.; Klausen I.; Haastrup
B.; Hedegaard B.; Gudmundsdottir S.; Kesaniemi A.; Hussi E.; Valpas S.;
Taurio J.; Airaksinen A.; Luukkonen S.; Uusitalo S.; Strandberg T.;
Ronkainen E.; Sarti C.; Tilvis R.; Aaltonen M.; Landstrom E.; Punkka A.;
Lakka T.; Savonen K.; Kastarinen H.; Koskinen N.; Tuominen M.L.; Haaraoja
A.; Laukkanen J.; Hadjikov A.; Hellsten S.; Hiltunen P.; Perhonen M.;
Valtonen M.; Moilanen M.; Varakas M.; Eloranta E.; Ukkola O.; Ojala P.;
Ukkola L.; Pihlman S.; Mononen M.; Hyttinen K.; Lipponen S.; Kotila M.;
Pollanen A.; Rajala A.; Kantola I.; Kiviniemi T.; Strandberg M.; Raali J.;
Roine E.; Appel K.F.; Appel S.; Utech A.; Becker P.; Chmilewski S.;
Kuehnert J.; Pietsch I.; Reinemann A.; Werner S.; Mentz G.; Drexler M.;
Muller-Wittlich I.; Drexler A.; Hobrack S.; Tajouaout K.; Dungen H.D.;
Bekfani T.; Cherian G.; Fritschka M.; Musial-Bright L.; Trippel T.;
Tscholl V.; Baltic A.; Inkrot S.; Maiwald A.; Pinta A.; Sacirovic M.;
Saewe Y.; Stolz R.; Boelmans K.; Breunig M.; Hammer F.; Hofmann U.; Judex
J.; Richter C.; Voehringer H.; Lianopoulos E.; Opitz C.; Buchholz M.;
Gebhardt S.; Helms S.; Horacek T.; Kahrmann G.; Stobbe O.; Fink P.;
Gunesli A.; Richtstein J.; Wilke K.; Weiss N.; Jabs N.; Mahlmann A.; Werth
S.; Brilloff S.; Dechert M.; Festerling E.; Leistner M.; Sehr B.; Weise
I.; Jeserich M.; Haggenmiller S.; Kimmel S.; Schoengart H.O.; Cakir M.;
Eichinger G.; Rupprecht M.; Graf K.; Thieme R.; Tummos E.; Ausner J.;
Fischer L.; Braun-Dullaeus R.; Bonigk H.; Meissler S.; Schmeisser A.;
Schulz H.; Uslar S.; Weigt D.; Gebauer R.; Roeder S.; Schafer K.; Silber
S.; Basler M.; Matt C.; Styllou P.; Bosnjak B.; Huth M.; Schmid A.; Senger
C.; Camerer M.; Drosch H.; Stromer H.; Heid J.; Wilsch R.; Voller H.;
Jawari A.; Stiehl S.; Salzwedel A.; Stolze K.; Mitrovic V.; Gaede L.; Peil
A.; Shaker M.; Stellbrink C.; Drephal C.; Elberg B.; Junge J.; Stellbrink
E.; Weber T.; Brettschneider B.; Gruhne C.; Iselt M.; Kube J.; Lehmann U.;
Potthast C.; Watson S.; Brachmann J.; Held M.; Mahnkopf C.; Saleh A.;
Sallam A.; Schertel-Gruenler B.; Schnupp S.; Goebel U.; Rube S.; Truthan
K.; Kadel C.; Lahiri K.; Moellinger H.; Pagitz M.; Reusch J.; Stadler A.;
Zulauf N.; Anuschek V.; Beissner S.; Buerger M.; Hagmanns M.; Hickmann E.;
Klinger C.; Rahn G.; Schemann J.; Tu E.; Wolfl C.; Schaechinger V.;
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Schwimmbeck P.; Fahrig A.; Hautmann M.; Oner A.; Weidmann B.; Wenzel I.;
Czihal M.; Hausleiter K.; Kress K.; Kreuzpointner R.; Kuhlencordt P.;
Rieber S.; Nuerbchen J.; Roth-Zetzsche S.; Kaab S.; Franz W.; Feldmann C.;
Grabmaier U.; Sinner M.; Bongartz A.; Gross C.; Halter B.; Sakic J.;
Bauersachs J.; Bavendiek U.; Pirr J.; Sonnenschein K.;
Hohenleitner-Luhrssen K.; Juergens A.; Schaefer N.; Bosiljanoff P.; Betzl
G.; Bosiljanoff E.; Feger J.; Kinateder A.; Sechtem U.; Egenrieder S.;
Karagianni A.; Schaufele T.; Voehringer M.; Gruensfelder S.; Hoffmann L.;
Wenzelburger I.; Dengler T.; Loges C.; Neatu C.; Lindner C.; Pfau C.;
Heuer H.; Bourhaial H.; Dulea I.; Guerocak O.; Halberstadt S.; Kemala E.;
Peterek J.; Philips H.; Dieckheuer U.; Euler K.; Laschewski B.; Maas M.;
Peda J.; Schaper F.; Henkel E.; Teige M.; Schrapel C.; Waetzold K.;
Isermann B.; Westphal S.; Borucki K.; Schulze M.; West K.; Trenk D.;
Hochholzer W.; Leggewie S.; Stratz C.; Schiebeling-Romer A.; Siefer M.;
Werner N.; Schueler R.; Sedaghat A.; Sinning J.M.; Twelker K.; Jones U.;
Lauterborn M.; Lennarz M.; Lubnau S.; Meier A.; Streuber-Bouhksas T.;
Blankenberg S.; Adam M.; Alternburg C.; Huemmelgen M.; Jagodzinski A.;
Karaks M.; Koopmann K.; Schafer S.; Schuler H.; Sydow K.; Thomas C.;
Tigges E.; De Boer I.; Hermes M.; Nebel J.; Schlesner C.; Schluter J.;
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Centofante L.; Kremerskothen R.; Beilker J.; Muller S.; Schlosser E.;
Birner C.; Luchner A.; Egresits J.; Jungbauer C.; Resch M.; Schmid P.;
Buesing M.; Liebl C.; Sulflow S.; Weil J.; Brueggemann B.; Graf T.;
Moeller C.; Miodek M.; Ince H.; Andresen D.; Seidel A.; Sprenger C.;
Stoeckicht Y.; Ziefle S.; Forster S.; Ort J.; Szczesnak S.; Midi P.;
Felici A.; Caranzetti F.; Tomassini L.; Sicuro M.; Aillon C.; Gianonatti
C.; Bare C.; Dona P.; Caldarola P.; Resta M.; Ruggiero M.; Galietti M.; Di
Pasquale G.; Filippini E.; Riva L.; Zagnoni S.; Piccinni G.; Perrone C.;
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Paradiso G.; Signore S.; Baggiore C.; Crescenti C.; Leopardi A.; Pini P.;
Di Biase M.; D'Antuono C.; Ieva R.; Monaco I.; Montrone D.; Mandorla S.;
Buccolieri M.; Capponi E.; Martinelli S.; Piccioni N.; Regni O.;
Iaquaniello A.; Malvestiti A.; Pieroni Minciaroli S.; Olivieri C.; Chiodi
R.; Masciotra A.; Poletti F.; De Servi S.; Affinito S.; Di Donato A.;
Messina S.; Stefanin C.; Casolo G.; Robiglio L.; Vivaldi F.; Buono A.;
Urbani C.; Alberti A.; Giagnoni E.; Pupilella T.; Biondi A.; Lazzari A.;
Montagna L.; Chirio C.; Salvetti I.; Perrelli M.; Baldin M.G.; Cesanelli
R.; Boccati S.; Duri G.; Priori S.; Ceresa M.; Zambelli M.; Savino G.;
Piovaccari G.; Grosseto D.; Testa P.; Gaviani P.; Girardi A.; Manzo I.;
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C.; Fattore L.; Morello G.; Nave C.; Petacchi R.; Bertoli D.; Filorizzo
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Fresco C.; Andrioli V.; Biundo V.; Giannuzzi P.; Gattone M.; Bolzani V.;
Di Ruocco M.; Temporelli B.; Mihara B.; Okada Y.; Vingsnes T.; Sirnes H.;
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Stodle R.; Nygard O.; Berge C.; Schartum Hansen H.; Kask A.; Loland K.;
Svingen G.; Tuseth N.; Vavik V.; Wilberg Rebnord E.; Gjellefall B.;
Hovland S.; Nordgaard Thorsen S.; Kjaernli T.; Erstad O.; Grodal K.; Nybo
S.; Royset C.; Stadsnes S.; Hovland A.; Lappegard K.; Sandvik J.; Carlsen
H.; Enebakk T.; Thunhaug H.; Solnor L.; Holmstrom P.; Risberg K.; Hansen
H.; Kulseng B.; Lauglo K.; Tevik Bjoru H.; Langeng T.; Salater S.; Scott
Munk P.; Singsaas E.; Larsen A.G.; Moen S.; Nilsen J.; Larsen T.; Turkerud
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Hysing J.; Thalamus J.; Flagstad E.; Rosland H.; Klemsdal T.; Bergengen
L.; Kleve R.; Skogsholm A.; Larsby K.; Holde I.; Jonassen R.; Nilsen M.;
Berg-Johansen J.; Tisthammer Antonsen H.; Jonasson L.; Ohlsson A.; Bastani
L.; Delgado T.; Gunvarsdotter S.; Lof P.; Persson L.; Larsdotter-Damm T.;
Skoglund K.; Lindholm C.; Thulin J.; Assarsson E.; Broberg M.; Torstensson
I.; Lager I.; Harsmar K.; Knutsson A.; Hjelmaeus L.; Zlatewa R.; Lindemann
E.; McLain I.; Larnefeldt H.; Eld M.; Bjorkman-Larnefeldt M.; Hardhammar
P.; Johansson P.A.; Karlsson A.C.; Lingman M.; Lofgren M.; Tabandeh A.;
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C.; Thott O.; Hedin U.; Montan C.; Nilsson O.; Lenquist M.; Nilsson L.;
Wodlin P.; Borjesson M.; Raschberger A.; Ekholm L.; Svensson K.A.; Agardh
A.; Algotsson L.; Bergstrom M.L.; Randers F.; Klintberg L.; Axelsson U.;
Mostrom P.A.; Mourtzinis G.; Paren P.; Persson B.; Risenfors M.; Moodh J.;
Mossmark M.; Ohrtgren L.; Ahlstrom P.; Tornqvist A.; Rosenqvist U.;
Grandas M.; Karlsson G.; Ottander P.; Eriksson A.; Backlund M.; Johansson
M.; Sundholm C.; Kempe A.; Salomonsson S.; Larsson J.; Forsberg K.; Sjodin
A.; Mathiesen U.; Carlsson M.; Keppel E.; Fehling K.; Robertsson U.;
Jansson J.H.; Boman K.; Lundmark L.M.; Norrfors B.; Weiderman A.; Jasinska
E.; Lundvall M.; Eriksson K.; Kjellberg-Eriksson J.; Larsson U.; Vasko P.;
Anderson G.; Bergstrom O.; Johansson S.; Nystrom T.; Uggeldahl I.; Webster
J.; Herd V.; Wilson E.; Mir F.; Blackwood S.; Watts M.; Khan W.; Tahir N.;
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Gallivan A.; Jones A.; Andrews L.; Jewkes C.; Lindsay S.; Rees K.; Wilson
A.; Bayly G.; Chambers J.; George S.; Halestrap M.; Bellamy C.; Evans S.;
Pritchard E.; Stockport J.; Wynne S.; Fulton J.; Simmonds J.; Stewart C.;
West C.; Chidambara H.; Msimanga T.; Moore B.; Roberts G.; Edwards T.;
Breakspear S.; Fleming N.; Newby D.; Fraser E.; Marshall L.; Nailon H.;
Parkin D.; Edwards M.; Mitchell C.; Mahabir N.; Griffiths H.; Mitchell K.;
Appleyard D.; Farr S.; Lloyd-Mostyn R.; Hardingham S.; Sewell T.; Lynch
M.; Burog W.; Dhaliwal M.; Mfuko C.; Travill C.; Gent S.; Norris B.;
Edgell R.; Lake T.; Taylor Bennett A.; Hartland A.; Walton E.; Murphy J.;
Brennan G.; Cawley P.; Dixon L.; Rees E.; Andrews R.; Brownlow T.; Crouch
S.; Mills H.; Nixon M.; Salter N.; Pringle S.; Hutcheon S.; Waldie H.;
Swan J.; McSorland D.; Curless R.; Armstrong M.; Ashbrook-Raby C.; Bunn
D.; Gour R.; Herriott C.; Robson C.; Tanney C.; Davey P.; Campey L.; Smith
K.; Tanqueray E.; Munir A.; Pereira O.; Khalifa M.; Capps N.; Donaldson
D.; Miller C.; Tonks L.; Reynolds T.; Basvi P.; Reynolds J.; Wilcox L.;
Mansell P.; Babington G.; Barnes E.; Beck S.; Craig S.; Patterson L.;
Selby A.; Woodford C.; Watkins H.; Bowsher Brown K.; Robertson J.;
Muthusamy R.; Lawan M.; Weston C.; Orr W.; Foxton J.; Hallett S.; Hilltout
P.; Jones L.; King J.; Ramtoola S.; Grimes Y.; Hutchesson A.; Cummings J.;
Morris K.; Fleming S.; Ludlow K.; Parrett M.; Pellow S.; Quinn L.; James
M.; Green E.; Keenan S.; Reckless J.; Robinson A.; Andrews G.; McLenaghan
A.; ul Haq I.; Albers C.; Labib M.; Higginson E.; Fitchet A.;
Darrel-Asherel E.; Green J.; Healey M.; Sexton D.; Hughes E.; Chackathayil
J.; Willetts S.; Shearman C.; Pal N.; Lewis A.; Pasinabo M.; Trevithick
C.; Tyler D.; Watkins B.; Papouchado M.; Bertram W.; Binley E.; Hierons
S.; Kandola S.; Mann C.; Whitney K.; Wilcox H.; Bibi A.; Fuller J.;
Jackson S.; Kalra P.; Howe S.; Hudson K.; Suttling A.; Turner C.; Wong Y.;
Clayton-Evans L.; Moore S.; Stearn S.; Lewis P.; Cochrane H.; Curtis J.;
Holland M.; Junejo S.; Dungca E.; Robson T.; Smith A.; Carey C.; Felmeden
L.; Summerhayes A.; Sutton J.; Butler R.; Creamer J.; Bellaby J.;
Castro-Foskett K.; Griffiths M.; Machin J.; Massey I.; Sellars E.; Wain
J.; McDowell I.; Davies L.; Davies M.; Dyer H.; Odam M.; Waters A.; Been
M.; Ansell V.; Campbell A.; Davies D.; De Burca B.; Jones J.; Musa A.;
Roberts D.; Brady R.; Dickinson C.; Lane L.; Pickervance S.; Francis M.;
Bryson V.; Clements M.; Ashton L.; George A.; Markwell K.; Walker E.;
Orugun O.; Poultney U.; Lie F.; Taneja A.; Badal B.; Conteh V.; Jones M.;
Montemayor M.; Trevelyan J.; Byng-Hollander E.; Doughty A.; Signy M.;
Dunne A.; Fox H.; Wheatley K.; Price S.; Ray S.; Golledge S.; Murmu M.;
Nicholas A.; Brigden G.; Board J.; Buckley C.; Vickers C.; Albert M.;
Baillargeon G.; Harman D.; Mahal S.; Kaur J.; Padkowsky S.; Walker M.;
Yandamuri S.; Dietrich D.; Armstrong L.; Casey M.; Schaefer V.; Bretton
E.; Hsi D.; Kovach J.; Troy J.; Asbill B.; Brown L.; Cauthren T.; Hull A.;
Lim O.; Tompkins J.; Vaughn J.; Perlman R.; Connors D.; Hoopes D.; Palazzo
D.; Prosser A.; Serrano-Rawls M.; Tedder B.; Johnson E.; Pearson T.;
Rubino K.; Williams P.; Singh N.; Brown M.; Dubal S.; Hall E.; Logwood D.;
Mazahir U.; Raynes K.; Gammon R.; Bauman A.; Hatch J.; Mock P.; Tilton N.;
Abide W.; Gudeman D.; Minor S.; Shipwash T.; Korn D.; Korn A.; Awasty V.;
Baldwin E.; Hunt G.; Kaiser V.; McMurray C.; Khan T.; Al-Jumaily J.;
Foster T.; Holbrook V.; Nambi V.; Ballantyne C.; Jackson M.; Jones P.;
Morris B.; Techmanski M.; Tran A.; Eshaghian S.; Mirshkarlo H.; Zineldine
A.; Bies J.; Hockett D.; Kimball L.; Thakkar M.; Varma S.;
Barkley-Daughtry S.; Collins S.; Evans-Gay S.; Martin L.; McKinley A.;
Murray L.; Noel L.; Prasada S.; Robinson R.; Wheeler S.; Andreo J.;
Bansilal S.; Bergmark B.; Bohula May E.; Cavender M.; Cyr J.; Desai N.;
Fanola C.; Fantony N.; Giugliano R.; Gutierrez J.; Kazanjian P.;
Marti-Bernier J.; Mega J.; Mesa R.; O'Donoghue M.; Scirica B.; Silverman
M.; Williams L.; Meckel C.; Orosco C.; Saalfeld R.; Thompson N.; Wiechert
C.; Kozlowski L.; Cooke B.; Corbelli J.; Galla A.; Stock R.; Benton R.;
Carroll A.; Leeper C.; Orvis E.; Shah P.; Kasson A.; Lieberman J.;
O'Malley A.; Rider J.; Loomis B.; Schantz M.; Heiman M.; Sadowski K.;
Scierka L.; Sclafani J.; Strubberg K.; Mania D.; Del Mastro E.; Jumper R.;
Bukoski K.; Eiben P.; Keegan R.; Kelley E.; Sekerak E.; Weisberger J.;
Serra A.; Augenbraun C.; Jumper S.; Stuart A.; Archer A.; Malak T.; Velky
J.; Spencer R.; Lane B.; Lehmann J.; Henderson D.; Crandall L.; Easterling
A.; Lizama A.; Millard D.; Gelernt M.; Billings C.; Cockrell D.; Anderson
E.; Pavlides A.; Davis M.; Viswanath D.; Kinder M.; Jeffers H.; Manga S.;
Shaw P.; Jones S.; Stover T.; Reeves R.; Frew S.; Menuet R I.I.; Veerina
K.; Domingue N.; Huffman L.; Leach Y.; Rideaux T.; Smith J.; Soileau L.;
Karlsberg R.; Bhatia; Gomez A.; Levi L.; Lopez D.; Treasure C.; Michaelis
L I.I.; Parker M.; Robertson C.; Treasure L.; Erickson B.; Amundson A.;
Humbert J.; Madden H.; Desai V.; Lemmertz K.; Zoghbi J.; Malone M.;
Mullinax K.; Schenks R.; Goldscher D.; Fisher M.; Latteri J.; Goldstein
M.; Lutz H.; Peichert D.; Haskel E.; Powell J.; Yashinski C.; Amin J.;
Bashton D.; Burns S.; Davidson A.; DeSousa C.; Humberger C.; McGee R.;
Zelenka J.; Ferguson D.; Manuel C.; Quinn J.; Zelik J.; Nukta E.; Bittel
B.; Dettmer M.; Palmer C.; Boulware W.; Cooper L.; Freeman R.; Banks K.;
Hall L.; Hall C.; Riser K.; Vaz S.; Winstead J.; Womack L.; Dy J.; Fox L.;
Landers E.; Raby B.; Whisnant T.; Isserman S.; Annas T.; Kirby K.; Lail
J.; Moore C.; Cohen R.; Bossaers J.; Heaney L.; Hislop A.; Moreiras L.;
Ocampo M.; Jetty P.; Allen T.; Custer C.; Key A.; Lipps S.; Banerjee S.;
Carlos S.; Garza A.; Sutton R.; Tobiansky J.; Gluck J.; Tofstad C.; Kmetzo
J.; Brown J.; Carter L.; Riley R.; Scott D.; Seger P.; Taylor D.; Wood D.;
Ahmad A.; Ahmed M.; Ayub H.; Contreras S.; Iqbal S.; Martinez S.; Martinez
M.; Donahoe S.; Dalal P.; Defraia C.; DeStefano R.; Lederman S.; Lorme D.;
Ruhani M.; Acheatel R.; Biggers J.; Emery P.; Kim C.; Barnes D.; Behm K.;
Dziekonski A.; Karunaratne H.; Stastny C.; Bittar N.; Lehmann S.; Spatola
M.; Wilson P.; Staniloae C.; Homberg-Pinassi E.; Hermany P.; Batchlett K.;
Gibson A.; Meissner-Dengler S.; Rosenfeld J.; Seidner M.; Sosonkin K.;
Pollock S.; Johnson S.; Salazar J.; Hovland R.; Jordan J.; Karas S.;
Peacock T.; Schechtmann N.; Tischner G.; Vicari R.; Warren K.; Ghitis A.;
Cusner H.; Klaus Clark M.; Zebrack J.; Christensen S.; Evenson C.;
Fullerton D.; Hartley J.; Broadway K.; Eskridge L.; Raymond D.;
Kizhakekuttu T.; Hillis S.; Klundt R.; McElroy D.; House K.; Begg R.; Acon
J.; Flores A.; Hobbs-Williams J.; Schidemantle E.; Cooper M.; Campbell E.;
Corcoran B.; Hughes S.; Miller N.; Steingard S.; Einhorn D.; Berry M.;
Dawkins Hughes S.; Gilbert L.; Lasala E.; Loeck A.; Mills N.; Oppenheim
J.; O'Dea D.; Brian S.; Gerber G.; Landi T.; Ling J.; Rimmey S.; Gilmore
R.; Bruney C.; Gabbert E.; Hays R.; Stawecki L.; Trahan J.; Winey-Ward D.;
Baker S.; Gervasio B.; Labodin J.; Taheri H.; Brooks J.; Delozier A.;
Jayashekaramurthy J.; Khachab S.; Machineni P.; Morgan K.; Cathcart C.;
Ciampanelli E.; Ervin W.; Soule K.; Stinson J.; Bhargava A.; Borg L.;
Carver A.; Koren M.; West A.; Jenkins R.; Barnett S.; Caro H.; Mooney J.;
Janout M.; Bjergo J.; Passey L.; Sather K.; Hage-Korban E.; Carrington M.;
Childs A.; Harrington A.; Manns D.; Phelan T.; Stuckey T.; Lord S.; Milks
S.; Bays H.; Bushong D.; Keiran S.; Moore M.; Weiter K.; Morris F.; Dignon
C.; Downing J.; Lowry D.; Metcalf A.; Claxton E.; Weiss R.; Dumais S.;
Bernstein R.; Singh C.; Colfer H.; Teklinski A.; Antonishen D.; Antonishen
M.; Ronquist M.; Shaw C.; Hall J.; Hanzich C.; Gessler A.; Skatrud L.;
Collins J.; Bitzer V.; Fruge A.; Gauthier T.; Hernandez M.; Kayner K.;
Michon C.; Naessens L.; Felten W.; Cryderman A.; Lagalo M.; Mostek K.;
Cluley C.; Prior J.; Lader E.; Meyer M.; Alford C.; Bryan S.; Gilley J.;
Levin P.; Bromberger L.; Guerra D.; Brandon P.; Burton C.; Ebert J.;
Garrison K.; Goetz C.; Harris S.; Lumsden C.; Quinn D.; Graf R.; Scott J.;
Ayers S.; Beasley T.; Finney; Gordon R.; Hoekstra J.; Jeter W.; Young C.;
Dionisopoulos P.; Godfrey C.; Holcomb R.; Krenk S.; Randhawa P.; Agarwal
S.; Almond E.; Capstraw E.; Geraldo-Abache A.; Kuchipudi S.; Pasupuleti
L.; Sangiovanni C.; Sheena H.; Vargas B.; Hendrix E.; Crews C.; McNeese
J.; Traboulssi M.; Bohn A.; Humphrey K.; Walton A.; Lupovitch S.; Bellini
S.; Clemens L.; Galindo M.; Piszkiewicz V.; Soni A.; Lash J.; Abell T.;
Flanery V.; Hanrahan J.; Mudd D.; Pasquini J.; Morton V.; Nikitin J.;
Richards P.; Sander C.; Voelkers M.; Hamroff G.; Bentivenga L.;
Fuerst-Carter K.; Hametz C.; Hollenweger L.; Pankovic C.; Solomon A.;
Prashad R.; Colacone T.; Green M.; Lightcap P.; McDonough C.; Metivier E.;
Miller D.; Alton M.; Grimwood-Fidler D.; Heins G.; Looney A.; Orr L.;
Clark W.; Dolan M.; Dugan B.; Feest K.; Foley J.; Perlmutter N.; Aviles
R.; Doucette W.; Fortney T.; Garceau J.; Heywood J.; Kanegae K.; Kozlowski
C.; LeDoux D.; Leggett J.; Mahan A.; McKinney E.; Ostergard S.; Wagoner
S.; Yedinak S.; Zilz N.; Kahn B.; Coombs V.; Phelps J.; Sheridan E.;
Steinberg M.; Littlefield R.; Baty J.; Clark A.; Cooper J.; Hames E.;
Collis W.; Needham J.; Srivastava S.; Bilazarian S.; Ketis C.; Roach K.;
Boccalandro F.; Bryan A.; Krantzler J.; McClelland N.; Muhlenberg T.;
Pickett S.; Rink L.; Brooks-Wolfe A.; Litz B.; Mobley D.; Knutson T.;
Belanger B.; Hermans P.; Quinnell C.; Hack T.; Fisher E.; Morelli L.;
Sullivan S.; Landau C.; Hilts T.; Eisenberg D.; Babar G.; Fam M.; Fernando
D.; Gallegos D.; Kenegos G.; Reed K.; Danish Rizvi M.; Erie G.; Eubanks
C.; Foster B.; Kline J.; Nelson W.; Tami L.; Abdur Rahman M.; Viera Moreno
J.; Krichmar P.; Ferreira J.; Marquez D.; Sanchez-Lacayo H.; Yunes R.;
Hunter J.; Battistelli E.; Cook T.; Iverson R.; Suarez M.; Kandath D.;
Frank S.; Kostedt G.; Nelson J.; Hamburg C.; Diaz L.; Hernandez E.;
Roberts J.; Shatsky K.; Torres E.; Tahirkheli N.; Adams T.; Springer K.;
Springer W.; Talano J.; Ficarra R.; Leo L.; Nolen J.; Perez M.; Rappley
G.; Szalanski N.; Peart B.; Ford-Tarlton M.; Peart K.; Stephens J.;
Schlager D.; Schramm E.; Rabalais M.; Williamson C.; DeSantis J.;
Benedetto K.; Bursey E.; Harting T.; Muller R.; Phang R.; Roccario E.;
Schaummann-Boyle P.; Zuchelkowski A.; Katopodis J.; Gearld K.; Knap P.;
Liebrich S.; Lieber I.; Ferree L.; Stowe F.; Sutton M.; Wiseman D.; Vogel
C.; Aggarwal R.; Baroni C.; Beck P.; Blake J.; Dagher E.; Gryl A.; Johnson
M.; Smith M.; Kereiakes D.; DeFosse C.; Schwartz J.; Ervin J.; Edwards S.;
Gorman C.; Gorsuch A.; Pomeroy S.; Huehnergarth K.; Davis K.; Harder M.;
Lim M.; Schrenker M.; Robinson J.; Cayler J.; Cherrico M.; Chun-Furlong
D.; De La Garza J.; Pothula A.; Antonio-Drabek C.; Bradley A.; Buresh R.;
Hass T.; Lopez C.; Strader J.; Donlin A.; Ensminger E.; Garcia H.;
Gneiting A.; Graf E.; Greenberg D.; Rogers W.; Arora P.; Morgan T.; Saag
L.; Thorington S.; Jerome S.; Black L.; Gupta A.; Aggarwal K.; Belew K.;
Burkhardt V.; Holland Clasby S.; Lau-Sieckman A.; Cebe J.; Calhoun E.;
Kissam C.; Major L.; Butman S.; Bescak K.; Bescak D.; Bigelow A.; Brown
T.; Davidson S.; Haddad T.; Alexander T.; Jain J.; McClain S.; Myhera T.;
Overbeck D.; Torre B.; Wotorson L.; Canto J.; Corneal C.; Donley B.;
McGowan N.; Prisoc K.; Sharrett M.; Kaster S.; Akers J.; Darlington H.;
Gault J.; Horner J.; Roozen C.; Loh I.; Anderson R.; Call T.; Esaki J.;
Patel P.; Plocky J.; Raymond J.; Rideaux C.; Sprafka L.; Stich M.; Andres
C.; Brown C.; Buda M.; Ciuica S.; Minker B.; Perry S.; McCullum K.; Doty
B.; Gates S.; Hutcheson K.
Institution
(Bowman, Hopewell, Chen, Wallendszus, Stevens, Collins) Clinical Trial
Service Unit, University of Oxford, Oxford, United Kingdom
(Wiviott, Cannon, Braunwald) Thrombolysis in Myocardial Infarction Study
Group, Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
(Sammons, Landray) Clinical Trial Service Unit, Medical Research Council
Population Health Research Unit, University of Oxford, Oxford, United
Kingdom
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Patients with atherosclerotic vascular disease remain at high
risk for cardiovascular events despite effective statin-based treatment of
low-density lipoprotein (LDL) cholesterol levels. The inhibition of
cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL
cholesterol levels and increases high-density lipoprotein (HDL)
cholesterol levels. However, trials of other CETP inhibitors have shown
neutral or adverse effects on cardiovascular outcomes. METHOD(S): We
conducted a randomized, double-blind, placebo-controlled trial involving
30,449 adults with atherosclerotic vascular disease who were receiving
intensive atorvastatin therapy and who had a mean LDL cholesterol level of
61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol
level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL
cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The
patients were assigned to receive either 100 mg of anacetrapib once daily
(15,225 patients) or matching placebo (15,224 patients). The primary
outcome was the first major coronary event, a composite of coronary death,
myocardial infarction, or coronary revascularization. RESULT(S):
During the median follow-up period of 4.1 years, the primary outcome
occurred in significantly fewer patients in the anacetrapib group than in
the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224
patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97;
P=0.004). The relative difference in risk was similar across multiple
prespecified subgroups. At the trial midpoint, the mean level of HDL
cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the
anacetrapib group than in the placebo group (a relative difference of
104%), and the mean level of non-HDL cholesterol was lower by 17 mg per
deciliter (0.44 mmol per liter), a relative difference of -18%. There were
no significant between-group differences in the risk of death, cancer, or
other serious adverse events. CONCLUSION(S): Among patients with
atherosclerotic vascular disease who were receiving intensive statin
therapy, the use of anacetrapib resulted in a lower incidence of major
coronary events than the use of placebo. Copyright © 2017
Massachusetts Medical Society.

<86>
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. 20 (5) (pp e541-e547), 2019. Date of Publication:
September 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.

<87>
Accession Number
2002290748
Title
Oral Triiodothyronine Supplementation Decreases Low Cardiac Output
Syndrome After Pediatric Cardiac Surgery.
Source
Pediatric Cardiology. 40 (6) (pp 1238-1246), 2019. Date of Publication: 15
Aug 2019.
Author
Marwali E.M.; Caesa P.; Darmaputri S.; Sani A.A.; Roebiono P.S.; Fakhri
D.; Djer M.M.; Munasir Z.M.; Batubara J.R.L.; Satroasmoro S.; Portman
M.A.; Haas N.A.
Institution
(Marwali, Caesa, Darmaputri, Sani) Pediatric Cardiac Intensive Care Unit,
National Cardiovascular Center Harapan Kita, Let Jend S Parman Road, Kav
87, Slipi, Jakarta 11420, Indonesia
(Marwali, Roebiono) Department of Cardiology, Faculty of Medicine,
Universitas Indonesia, Jakarta, Indonesia
(Roebiono) Pediatric Cardiology Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Department of Cardio-Thoracic-Vascular Surgery, Faculty of
Medicine, Universitas Indonesia, Jakarta, Indonesia
(Djer, Munasir, Batubara, Satroasmoro) Department of Pediatrics, Cipto
Mangunkusumo Hospital and Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
(Portman) Seattle Children's Hospital, University of Washington, Seattle,
WA, United States
(Haas) Department of Pediatric Cardiology and Pediatric Intensive Care,
Medical Hospital of the University of Munich, Munich, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The oral triiodothyronine for infants and children undergoing
cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3)
supplementation improved hemodynamic and clinical outcome parameters. We
tested the validity of low cardiac output syndrome (LCOS), derived using
clinical parameters and laboratory data, by comparing the LCOS diagnosis
with objective parameters commonly measured in a cardiac intensive care
unit (CCU) setting. OTICC, a randomized, placebo-controlled trial included
children younger than 3 years with an Aristotle score between 6 and 9. We
used the existing trial data set to compare the LCOS diagnosis with
echocardiographic hemodynamic parameters. Additionally, we determined if
LCOS, prospectively assigned during a clinical trial, served as an early
predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after
cross-clamp release later showed significantly lower pulse pressure,
stroke volume and cardiac output, and higher systemic vascular resistance.
These LCOS patients also had significantly longer time to extubation (TTE)
and higher mortality rate. LCOS incidence was significantly lower in the
T3 treatment group [n = 86 vs. 66, respectively, p < 0.001; OR (95% CI)
0.43 (0.36-0.52)] particularly at 6 h. Also, LCOS patients in the placebo
group had significantly lower FT3 serum levels over time. These analyses
confirm that early clinically defined LCOS successfully predicts cardiac
dysfunction determined later by objective hemodynamic echocardiographic
parameters. Furthermore, early LCOS significantly impacts TTE and
mortality. Finally, the data support prior clinical trial data, showing
that oral T3 supplementation decreases early LCOS in concordance with
reducing TTE. Copyright © 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<88>
Accession Number
2001509347
Title
Causes of death in intermediate-risk patients: The Randomized Surgical
Replacement and Transcatheter Aortic Valve Implantation Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (3) (pp 718-728.e3),
2019. Date of Publication: September 2019.
Author
Amrane H.; Deeb G.M.; Popma J.J.; Yakubov S.J.; Gleason T.G.; Van Mieghem
N.M.; Reardon M.J.; Williams M.R.; Mumtaz M.; Kappetein A.P.; Serruys
P.W.; Tadros P.; Zorn G.L.; Boonstra P.W.; van Boven A.; Li S.
Institution
(Amrane) Department of Cardiac and Thoracic Surgery, Medisch Centrum
Leeuwarden, Netherlands
(Deeb) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, Mich, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Mass, United States
(Yakubov) Department of Interventional Cardiology; Riverside
Methodist-Ohio Health, Columbus, OH, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, Pa, United States
(Van Mieghem) Department of Interventional Cardiology, Eramus Medical
Center, Rotterdam, Netherlands
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart & Vascular Center, Houston, Tex, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Examine the causes and timing of death in the Surgical
Replacement and Transcatheter Aortic Valve Implantation intermediate-risk
randomized trial for transcatheter aortic valve replacement (TAVR) and
surgical aortic valve replacement (SAVR). Method(s): Causes of death
were adjudicated by an independent clinical event committee and by
post-hoc hierarchical classification. Causes of death were evaluated and
characteristics and procedural parameters compared between patients who
died and survivors for 3 time periods: early (0-30 days), recovery (31-120
days), and late (121-365 days). Result(s): All-cause mortality at 1
year was 6.5% after TAVR and 6.7% after SAVR. There were no differences in
mortality rates between TAVR and SAVR for any of the 3 time periods. Early
mortality was primarily due to technical, procedure-related problems in
TAVR and due to complications in SAVR. For TAVR and SAVR, most deaths
during recovery were caused by complications. Other causes, including
comorbid conditions, accounted for most late deaths. Conclusion(s):
Mortality rates were similar for patients treated with TAVR or SAVR at any
time period including at 1 year. Early cause of death was more commonly
technical failure after TAVR and due to complications after SAVR. Recovery
phase cause of death was dominated by complications from TAVR and SAVR.
Late cause of death appeared to be independent of the procedure in both
groups. Copyright © 2018 The American Association for Thoracic
Surgery

<89>
Accession Number
2002288325
Title
Total intravenous anesthesia maintained the degree of pre-existing mitral
regurgitation better than isoflurane anesthesia in cardiac surgery: A
randomized controlled trial.
Source
Journal of Clinical Medicine. 8 (8) (no pagination), 2019. Article Number:
1104. Date of Publication: August 2019.
Author
Ahn J.H.; Ahn H.J.; Yi J.-W.
Institution
(Ahn) Department of Anesthesiology and Pain Medicine, Kangbuk Samsung
Hospital, Sungkyunkwan University, School of Medicine, Seoul 03181, South
Korea
(Ahn) Department of Anesthesiology and Pain Medicine, College of Medicine,
Graduate School, Kyung Hee University, Seoul 02447, South Korea
(Ahn) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul 06351, South
Korea
(Yi) Department of Anesthesiology and Pain Medicine, College of Medicine,
Kyung Hee, University, Seoul 02447, South Korea
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Accurate assessment of mitral regurgitation (MR) is critical during mitral
valve repair surgery. However, anesthesia may influence the degree of
mitral regurgitation by changing pre-and after-load or cardiac
contractility. Therefore, we compared changes in mitral regurgitation by
total intravenous anesthesia (TIVA) and inhalation anesthesia in patients
with pre-existing mitral regurgitation. This was a double-blind randomized
controlled study conducted at a tertiary care center in 2018. Fifty-four
mitral regurgitation patents undergoing elective cardiac surgery were
randomly assigned to receive TIVA or isoflurane. Primary endpoint was
change of regurgitation volume by anesthesia. The reduction of
regurgitation volume by anesthesia was greater in the isoflurane group
than in the TIVA group (mean (95% confidence interval CI): -0.20 (-6.15,
5.75) vs. -9.66 (-15.77, -3.56), mL.beat-1, p = 0.0266) and
this phenomenon was more prominent with severe mitral regurgitation (grade
3 or 4) (mean (95% CI): -0.33 (-9.10, 8.44) vs. -16.20 (-24.22, -8.18),
mL.beat-1, p = 0.0079). Among patients with MR grade 3 or 4,
94% remained the same with TIVA during anesthesia compared to 56% with
isoflurane. In conclusion, TIVA maintained the pre-anesthetic state of
mitral regurgitation relatively well, while the severity of mitral
regurgitation tended to decrease with isoflurane anesthesia. Copyright
© 2019 by the authors. Licensee MDPI, Basel, Switzerland.

<90>
Accession Number
2001390378
Title
Long-term outcomes of mechanical versus biological aortic valve
prosthesis: Systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (3) (pp 706-714.e18),
2019. Date of Publication: September 2019.
Author
Diaz R.; Hernandez-Vaquero D.; Alvarez-Cabo R.; Avanzas P.; Silva J.;
Moris C.; Pascual I.
Institution
(Diaz, Hernandez-Vaquero, Alvarez-Cabo, Avanzas, Silva, Moris, Pascual)
Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
(Diaz, Hernandez-Vaquero, Avanzas, Moris, Pascual) Instituto de
Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain
(Silva, Moris) Department of Medicine, University of Oviedo, Oviedo, Spain
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: In recent years, the use of surgically implanted biological
aortic valves has been favored over mechanical prosthesis in patients
between 50 and 70 years of age. However, outcomes on long-term survival
are contradictory. The objective of this study was to determine if
patients with mechanical valves have worse long-term survival than
patients with biological prostheses. Method(s): We systematically
searched published studies that: (1) were propensity score-matched or
randomized controlled trials; (2) provided survival data with a minimum
follow-up of 5 years; and (3) included patients older than 50 and younger
than 70 years of age. Review articles, case reports, and editorials were
excluded. We conducted a meta-analysis on the basis of 2 types of
analysis. A reconstruction of the database of each study to simulate a
patient-level meta-analysis was performed. Log rank test of Kaplan-Meier
curves was recalculated. Hazard ratio (HR) was calculated using a
univariate Cox regression. In addition, we calculated a pooled HR using
the fixed-effect inverse variance method. Result(s): Four propensity
score-matched studies and 1 randomized controlled trial met the inclusion
criteria. Data of 4686 patients were analyzed. Survival rates for
mechanical versus biological valves at 10 and 15 years of follow-up were:
76.78% (95% confidence interval [CI], 74.72%-78.69%) versus 74.09% (95%
CI, 71.96%-76.08%), and 61.58% (95% CI, 58.29%-64.69%) versus 58.04% (95%
CI, 54.57%-61.35%). Log rank test was statistically significant (P =.012)
and the pooled HR was 0.86 (95% CI, 0.76-0.97; P =.01).
 Conclusion(s): Compared with biological aortic valves, mechanical
valves are associated with a long-term survival benefit for patients
between 50 and 70 years. Copyright © 2018 The American
Association for Thoracic Surgery

<91>
Accession Number
2002582943
Title
A systematic review and meta-analysis of risk factors for and incidence of
30-day readmission after revascularization for peripheral artery disease.
Source
Journal of Vascular Surgery. 70 (3) (pp 996-1006.e7), 2019. Date of
Publication: September 2019.
Author
Smith S.L.; Matthews E.O.; Moxon J.V.; Golledge J.
Institution
(Smith, Moxon, Golledge) Queensland Research Centre for Peripheral
Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Australia
(Matthews, Golledge) Department of Vascular and Endovascular Surgery, The
Townsville Hospital, Townsville, Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Readmission to the hospital after revascularization for
peripheral artery disease (PAD) is frequently reported. No consensus
exists as to the exact frequency and risk factors for readmission. This
review aimed to determine the incidence of and risk factors for 30-day
readmission after revascularization for PAD. Method(s):
PubMed/Medline (Ovid), Scopus, Web of Science, the Cochrane Library, and
CINAHL were searched systematically from inception until May 20, 2018.
Studies were eligible for inclusion if they included patients with
diagnosed PAD undergoing revascularization and reported the readmission
rate and a statistical evaluation of the association of at least one risk
factor with readmission. Studies were excluded if data for other
procedures could not be distinguished from revascularization. Two authors
undertook study selection independently with the final inclusion decision
resolved through consensus. The PRISMA and Meta-analyses of Observational
Studies in Epidemiology guidelines were followed regarding data extraction
and quality assessment, which was performed by two authors independently.
Data were pooled using a random effects model. Result(s): The primary
outcome was readmission within 30 days of revascularization. Fourteen
publications reporting the outcomes of 526,008 patients were included.
Reported readmission rates ranged from 10.9% to 30.0% with a mean of 16.4%
(95% confidence interval [CI], 15.1%-17.9%). Meta-analyses suggested the
following risk factors had a significant association with readmission:
female sex (odds ratio [OR], 1.13; 95% CI, 1.05-1.21), black race (OR,
1.36; 95% CI, 1.28-1.46), dependent functional status (OR, 1.72; 95% CI,
1.43-2.06), critical limb ischemia (OR, 2.12; 95% CI, 1.72-2.62),
emergency admission (OR, 1.75; 95% CI, 1.43-2.15), hypertension (OR, 1.39;
95% CI, 1.26-1.54), heart failure (OR, 1.82; 95% CI, 1.50-2.20), chronic
pulmonary disease (OR, 1.19; 95% CI, 1.08-1.32), diabetes (OR, 1.47; 95%
CI, 1.32-1.63), chronic kidney disease (OR, 1.93; 95% CI, 1.62-2.31),
dialysis dependence (OR, 2.08; 95% CI, 1.75-2.48), smoking (OR, 0.83; 95%
CI, 0.78-0.89), postoperative bleeding (OR, 1.70; 95% CI, 1.23-2.35), and
postoperative sepsis (OR, 4.13; 95% CI, 2.02-8.47). Conclusion(s):
Approximately one in six patients undergoing revascularization for PAD are
readmitted within 30 days of their procedure. This review identified
multiple risk factors predisposing to readmission, which could potentially
serve as a way to target interventions to reduce
readmissions. Copyright © 2019

<92>
Accession Number
627731878
Title
Native kidney BK virus nephropathy, a systematic review.
Source
Transplant Infectious Disease. 21 (4) (no pagination), 2019. Article
Number: e13083. Date of Publication: 2019.
Author
Shah A.; Kumar V.; Palmer M.B.; Trofe-Clark J.; Laskin B.; Sawinski D.;
Hogan J.J.
Institution
(Shah, Trofe-Clark, Sawinski, Hogan) Division of Nephrology, University of
Pennsylvania, Philadelphia, PA, United States
(Kumar, Palmer, Trofe-Clark, Laskin, Sawinski, Hogan) Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Palmer) Department of Pathology, University of Pennsylvania,
Philadelphia, PA, United States
(Trofe-Clark) Department of Pharmacy Services, Hospital of the University
of Pennsylvania, University of Pennsylvania, Philadelphia, PA, United
States
(Laskin) Division of Nephrology, Children's Hospital of Philadelphia,
University of Pennsylvania, Philadelphia, PA, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: There is a growing base of literature describing BK
nephropathy (BKVN) in patients outside of the setting of kidney
transplant. Previous systematic reviews of the literature have been
limited by methodology or by the scope of patients included. Study Design
and Methods: Systematic Review (Prospero # CRD42018088524). Setting &
Population: Patients without kidney transplant who had biopsy-proven BKVN.
Selection Criteria for Studies: Full-text articles that describe native
BKVN patient cases. Analytical Approach: Descriptive synthesis.
 Result(s): The search identified 630 unique articles of which 51 were
included in the final review. Sixty-five cases (including two new cases
presented in this review) were identified, all but one occurred in the
setting of known immunosuppression. Limitation(s): The primary
limitation was the exclusion of studies that did not fulfill the stringent
review criteria. We excluded reports with only a clinical diagnosis of
BKVN, such as those with viruria and/or viremia without biopsy.
 Conclusion(s): As of May 2018, there are 65 reported cases of BKVN in
native kidneys. This represents the most comprehensive description of
biopsy-proven BKVN in native kidneys to date. Evaluation for BK
nephropathy should be considered in immunocompromised patients who exhibit
unexplained renal failure. Copyright © 2019 John Wiley & Sons
A/S. Published by John Wiley & Sons Ltd

<93>
[Use Link to view the full text]
Accession Number
628946813
Title
Post percutaneous coronary interventional outcomes on proximal vs
non-proximal lesions of the left and right coronary arteries: A systematic
review and meta-analysis.
Source
Medicine (United States). 98 (33) (no pagination), 2019. Article Number:
e16905. Date of Publication: 01 Aug 2019.
Author
Tang B.; Yang H.; Bil J.
Institution
(Tang, Yang) Department of Cardiology, Jingzhou Central Hospital, Second
Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020,
China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:The prognosis of patients with coronary artery disease is
mainly related to the extent of myocardium at risk. Proximal coronary
arteries, especially the proximal left anterior descending coronary artery
(LAD), supply a large part of the myocardium. In this analysis, we aimed
to systematically compare the post percutaneous coronary interventional
(PCI) outcomes observed with proximal vs non-proximal lesions of the left
and right coronary arteries. Method(s):MEDLARS Online, Excerpta
Medica database, www.ClinicalTrials.gov, and the Cochrane databases were
searched for relevant studies comparing the post PCI outcomes reported on
proximal vs non-proximal lesions of the coronary arteries. RevMan software
version 5.3 was used to analyze the data to generate respective results.
Odds ratios (OR) and 95% confidence intervals (CI) were derived to
represent the results appropriately. Result(s):Six studies with a
total number of 11,109 participants who were enrolled between 1990 and
2015 were included in this analysis. The current results showed major
adverse cardiac events (MACEs) (OR: 1.28, 95% CI: 1.14-1.45; P =.0001) and
mortality (OR: 1.70, 95% CI: 1.43-2.03; P = .00001) to be significantly
higher with proximal compared to non-proximal coronary lesions
irrespective of the follow-up time periods. However, re-infarction (OR:
1.05, 95% CI: 0.80-1.38; P = .71), repeated revascularization (OR: 1.08,
95% CI: 0.92-1.27; P = .35) and stent thrombosis (OR: 0.59, 95% CI:
0.27-1.31; P = .20) were not significantly different.When patients
specifically with LAD lesions were compared with associated non-proximal
lesions, mortality was still significantly higher with proximal lesions
(OR: 2.26, 95% CI: 1.52-3.36; P = .0001). However, when patients with
right proximal coronary artery lesions were compared with the
corresponding non-proximal lesions, no significant difference was observed
in mortality. Conclusion(s):In-hospital and long-term MACEs and
mortality were significantly higher in patients with proximal compared to
non-proximal coronary lesions following PCI. In addition, mortality was
significantly higher in patients with proximal LAD lesions whereas no
significant difference was observed in patients with right proximal
coronary artery lesions. Larger trials should further confirm these
hypotheses. Copyright © 2019 the Author(s).

<94>
Accession Number
2002540093
Title
Comparison of pressure volume loop closure with just to seal technique to
guide endotracheal tube cuff inflation and to assess the incidence of sore
throat, cough and hoarseness of voice - A prospective randomized
controlled trial.
Source
Anestezi Dergisi. 27 (3) (pp 174-179), 2019. Date of Publication: 2019.
Author
Narayan A.; Dhanasekaran R.; Krishnasamy T.S.
Institution
(Dhanasekaran) No 1, Ramachandra Nagar, Porur, Chennai 600116, India
(Narayan, Krishnasamy) Department of Anesthesiology and Pain Medicine, Sri
Ramachandra Institute of Higher Education and Research, Chennai, India
Publisher
Anestezi Dergisi (E-mail: arud@arss.org)
Abstract
Objective: Several methods of endotracheal cuff (ETT) inflation methods
were investigated to ensure proper cuff inflation to avoid short, and long
term airway morbidities. Pressure Volume Loop (PV-L) closure was found to
be a new technique to guide ETT cuff inflation with a lower cuff
pressures. Hence, we assessed whether PV-L was a useful guide in inflating
the ETT with adequate cuff pressure when compared to Just to Seal (JS)
technique. Method(s): A prospective randomized double-blinded study
was done with eighty-four patients undergoing surgeries under general
anesthesia using endotracheal tubes. The ETT cuffs were inflated using
PV-L closure in PV-L group and using stethoscope in JS group. The cuff
pressure was measured as the primary outcome of the study. The cuff
volume, postoperative sore throat, cough and hoarseness of voice were
assessed as secondary outcomes. Result(s): In our study, PV-L group
had statistically significantly lower post-intubation (24.5+/-4.97 cm of
H<inf>2</inf>O in PV-L group, 28.6+/-6.39 cm of H<inf>2</inf>O in group
JS, p-0.002) and pre- extubation cuff pressures (24.9+/-4.923 cm of
H<inf>2</inf>O in Group PV-L, 29.0+/-5.624 cm of H<inf>2</inf>O in Group
JS, p-0.001) when compared with the JS method. Conclusion(s):
Pressure Volume Loop-guided endotracheal tube cuff inflation was an
effective way to seal the airway with lower cuff pressures and was
associated with a lower incidence of postoperative ETT cuff-related
complications when compared with Just to Seal method. Copyright ©
2019 Anesthesiology and Reanimation Specialists' Society.

<95>
Accession Number
2002560975
Title
Comparison of early and delayed invasive strategies in short-medium term
among patients with non-ST segment elevation acute coronary syndrome: A
systematic review and meta-analysis.
Source
PLoS ONE. 14 (8) (no pagination), 2019. Article Number: e0220847. Date of
Publication: 2019.
Author
Zhang M.-B.; Guo C.; Li M.; Lv Y.-H.; Fan Y.-D.; Wang Z.-L.
Institution
(Zhang, Guo, Li, Lv, Wang) First Medical Clinical College of Lanzhou
University, Lanzhou, China
(Fan) Department of Cardiology, Emergency General Hospital, Beijing, China
(Wang) Department of Cardiology, First Hospital of Lanzhou University,
Lanzhou, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background and objectives An invasive approach is recommended as the
treatment of patients with non-ST elevated acute coronary syndromes
(NSTE-ACS). However, it remains unclear that the optimal time of
angiography and intervention for patients with NSTE-ACS at present. This
study was designed to compare the effect of early and delayed invasive
strategies on short-medium term prognosis in patients with those. Methods
Pubmed, Cochrane Library and Embase were searched up to Dec-30-2018.
Randomized clinical trials comparing an early versus a delayed invasive
strategy in patients with NSTEACS were included. The primary endpoint
(all-cause death and recurrent myocardial infarction) and secondary
endpoint (major bleeding and recurrent revascularization), as well as
composite endpoint were assessed by random or fixed effected meta-analysis
with software RevMan 5.3 version after short-medium term follow up. Result
A total of six randomized clinical trials involving 4,277 early or delayed
invasive strategies patients with NSTE-ACS were included in the
meta-analysis. Time to coronary angiography varied from 0.5 to 24 h in the
early invasive strategy and from 18.6 to 72 h in the delayed invasive
strategy. There was a statistical difference in the primary endpoint of
all-cause death among patients with NSTE-ACS between early and delayed
invasive strategies (4.6% vs 6%; OR:0.76; 95% CI:0.58 to 1.00; P = 0.05;
I2 = 0%), but not for recurrent myocardial infarction (6.0% vs 6.3%; OR:
0.94; 95% CI: 0.55 to 1.61; P = 0.82; I2 = 60%). The major bleeding in
patients with NSTE-ACS was similar between both invasive strategies (2.7%
vs 3.1%; OR:0.88; 95% CI:0.59 to 1.31; P = 0.54; I2 = 0%). However, the
composite endpoint in the early invasive strategy patients with NSTE-ACS
was significantly lower than that of the delayed invasive strategy (10.9%
vs 13.9%; OR:0.76; 95% CI:0.63 to 0.92; P = 0.006; I2 = 0%), and the
recurrent revascularization between both strategies was just the opposite
(8.7% vs 5.9%; OR:1.5; 95%CI:1.15 to 1.97; P = 0.003; I2 = 0%). Conclusion
The systematic review and meta-analysis demonstrated that the early
invasive strategy had a beneficial trend on all-cause death and
significantly reduced the composite endpoint in patients with NSTE-ACS,
but increased the rate of revascularization. These data could provide a
solution for patients with those. Copyright © 2019 Zhang et al.

<96>
Accession Number
2002349811
Title
Video-assisted thoracoscopic surgery versus thoracotomy for non-small cell
lung cancer: A meta-analysis.
Source
Combinatorial Chemistry and High Throughput Screening. 22 (3) (pp
187-193), 2019. Date of Publication: 2019.
Author
Ye B.; Wang M.
Institution
(Ye) Department of Thoracic Surgery, Hangzhou Red Cross Hospital,
Hangzhou, Zhejiang, China
(Wang) Department of Thoracic Surgery, Shulan (Hangzhou) Hospital,
Hangzhou, Zhejiang, China
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Patients undergoing surgery for non-small cell lung cancer
(NSCLC) are often elderly and have co-morbidity conditions and decreased
performance status. Compared with open thoracotomy, video-assisted
thoracoscopic lobectomy is associated with fewer postoperative
complications. Despite encouraging results for patients with NSCLC who
underwent VATS, the procedure is still not widely accepted, and large
retrospective studies have yielded conflicting results. Objective(s):
In video-assisted lobectomy for NSCLC, it has remained controversial
whether mediastinal lymphadenectomy can be performed as effectively as an
open procedure via thoracotomy. To deal with inherent biases in any
non-randomized comparison, we analyzed propensity-matched studies and
randomized controlled trials. The aim of this study was to evaluate the
treatment outcomes of VATS and open thoracotomy for NSCLC patients.
 Method(s): We collected publications on comparison of VATS versus
open thoracotomy for NSCLC patients from 2007 to 2017. All trials analyzed
the summary Hazard Ratios (HRs) of the endpoints of interest, including
perioperative mortality and morbidity, and individual postoperative
complications. Revman 5.3 software was used to analyze the combined pooled
HRs using fixed-or random-effects models according to heterogeneity.
 Result(s): A systematic literature search was conducted including 15
studies. The results indicated that VATS was associated with lower
postoperative morbidity and mortality, and significantly lower rates of
prolonged pneumonia, atrial arrhythmias and renal failure.
 Conclusion(s): Compared with lobectomy by thoracotomy, thoracoscopic
lobectomy is associated with a lower incidence of major complications,
including lower rates of prolonged pneumonia, atrial arrhythmias and renal
failure. Lobectomy via VATs may be the preferred strategy for
appropriately selected NSCLC patients. The determinants of this advantage
should be analyzed to improve the safety and outcomes of other thoracic
procedures. Copyright © 2019 Bentham Science Publishers.

<97>
Accession Number
2002329811
Title
Preemptive alveolar recruitment maneuver followed by PEEP in obese
patients undergoing laparoscopic gastric banding. Does it make a
difference? a randomized controlled clinical study.
Source
Open Anesthesiology Journal. 13 (1) (pp 31-39), 2019. Date of Publication:
2019.
Author
Elokda S.A.; Farag H.M.
Institution
(Elokda, Farag) Department of Anesthesia, Intensive Care, and Pain
Management, Ain Shams University, Cairo, Egypt
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Impaired respiratory functions during general anesthesia are
commonly caused by lung atelectasis more in morbidly obese patients. This
occurs more frequently with laparoscopic surgery due to trendelenburg
position and pneumoperitoneum. Preemptive recruitment maneuver + PEEP
results in the prevention of these changes. Aim(s): To quantitate the
effects of RM and PEEP on intraoperative hypoxemia and respiratory
mechanics during laparoscopic gastric banding in obese patients.
 Study Design: A randomized, double-blinded, controlled study. Method
and Materials: Fifty adults ASA I-II, BMI (40-50 kg/m2) for
elective laparoscopic gastric banding were randomized into, groups C, and
RM, 25 patients each. Group C patients received standard ventilation, VT 6
ml/kg, I: E ratio 1: 2 PEEP 5 cm H<inf>2</inf> O, and respiratory rate
10-12 breaths/ min. RM patients received standard ventilation with one
alveolar recruitment maneuver after mechanical ventilation with PEEP of 15
cm H<inf>2</inf> O till the end of the surgery. Heart rate, mean blood
pressure, respiratory mechanical parameters: peak airway pressure, plateau
pressure and end-expiratory lung volume, PaO<inf>2</inf>,
PaO<inf>2</inf>/FiO<inf>2</inf> and (SpO<inf>2</inf>) were assessed.
 Result(s): PaO<inf>2</inf> and PaO<inf>2</inf> /FiO<inf>2</inf> ratio
increased significantly in the RM group after RM from T2 (before
pneumoperitoneum) to T6 (end of surgery) compared with group C (P <
0.001). Peak and plateau airway pressures increased significantly in group
C from T2 till T5 (60 min after pneumoperitoneum) compared with the RM
group (P < 0.001). End-expiratory lung volume increased significantly in
the RM group after RM compared with group C (P<0.001). Conclusion(s):
Preemptive RM with PEEP of 15 cm H<inf>2</inf> O was effective in
preventing pneumoperitoneum-induced intraoperative hypoxemia and
respiratory mechanics changes. Copyright © 2019 Elokda and Farag.

<98>
Accession Number
2002482077
Title
Peritoneal Dialysis Vs Diuretics in Children After Congenital Heart
Surgery.
Source
Annals of Thoracic Surgery. 108 (3) (pp 806-812), 2019. Date of
Publication: September 2019.
Author
Flores S.; Loomba R.S.; Elhoff J.J.; Bronicki R.A.; Mery C.M.; Alsaied T.;
Alahdab F.
Institution
(Flores, Elhoff, Bronicki) Section of Critical Care Medicine and
Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX, United States
(Loomba) Advocate Children's Heart Institute/Advocate Children's Hospital,
Oak Lawn, IL, United States
(Mery) Section of Congenital Heart Surgery, Department of Surgery, Texas
Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Alsaied) Department of Pediatrics, Cincinnati Children's Hospital Heart
Institute, University of Cincinnati, Cincinnati, OH, United States
(Alahdab) Mayo Evidence-based Practice Center, Mayo Clinic, Rochester, MN,
United States
Publisher
Elsevier USA
Abstract
Background: This study sought to evaluate outcomes of patients undergoing
congenital heart surgery who underwent peritoneal dialysis (PD) vs a
diuretic regimen. Method(s): This study conducted a comprehensive
search in Medline, EMBASE, Scopus, the Cochrane Central Register of
Controlled Trials, and the Cochrane Database of Systematic Reviews from
the databases' inception through April 24, 2018. Independent reviewers
selected studies and extracted data. A random effects meta-analysis was
performed to pool the outcomes of interest across studies. Result(s):
A total of 8 studies (2 prospective studies, 2 randomized clinical trials,
and 4 retrospective studies) with 507 patients were included in this
review. A total of 204 (40%) patients underwent PD, whereas the remaining
patients underwent fluid removal with diuretics. The analyses demonstrated
a significantly shorter time of mechanical ventilation in those patients
who underwent PD (mean difference, -1.25 days; 95% confidence interval,
-2.18 to -0.33; P =.008) and increased odds of mortality (odds ratio,
2.27; 95% confidence interval, 1.13 to 4.56; P =.02) compared with the
diuretic group. No differences were identified in terms of incidence of
negative fluid balance by postoperative day 1, presence of peritonitis,
and intensive care unit length of stay. Conclusion(s): The
meta-analysis did not identify differences between the 2 groups with
regard to negative fluid balance after postoperative day 1, incidence of
peritonitis, or length of intensive care unit stay. There is a need for
large, prospective, multicenter studies to evaluate the benefits and
complications associated with PD use further in selected children after
congenital heart surgery. Because some of the outcomes were present in
only 2 studies, results from the pooled analysis may be
underpowered. Copyright © 2019 The Society of Thoracic Surgeons

<99>
Accession Number
2002365716
Title
Epicardial Application of Hydrogel with Amiodarone for Prevention of
Postoperative Atrial Fibrillation in Patients After Coronary Artery Bypass
Grafting.
Source
Journal of Cardiovascular Translational Research. (no pagination), 2019.
Date of Publication: 2019.
Author
Bockeria O.L.; Kanametov T.N.; Shvartz V.A.; Sokolskaya M.A.; Zhuginisov
D.S.; Sanakoev M.K.; Bockeria L.A.
Institution
(Bockeria, Kanametov, Shvartz, Sokolskaya, Zhuginisov, Sanakoev, Bockeria)
Bakulev National Medical Research Center for Cardiovascular Surgery,
Moscow, Russian Federation
(Bockeria, Kanametov, Shvartz, Sokolskaya, Zhuginisov, Sanakoev, Bockeria)
Department of Surgical Treatment for Interactive Pathology, Bakulev
National Medical Research Center for Cardiovascular Surgery, Moscow,
Russian Federation
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The objective of this study was to assess the safety and efficacy of local
epicardial application of amiodarone-releasing hydrogel for prevention of
postoperative atrial fibrillation (POAF) in patients after coronary artery
bypass grafting. Patients were randomized into two groups: with the
application of amiodarone-releasing hydrogel and the control group. It
included 60 patients (47 males, 13 females) (mean age of 62 +/- 8.5). POAF
incidence differences were statistically significant between two groups:
in the study group, the POAF incidence was 3.3%, while in the control
group, the POAF incidence was 37% (p < 0.001). Statistically significant
differences were revealed in the PQ interval duration. The risk of POAF
incidence was calculated using the Cox regression model: the age and the
application of amiodarone-releasing hydrogel application were
statistically significant. Hospital length of stay in two groups was also
different (p < 0.001). The age and the application of amiodarone-releasing
hydrogel were statistically significant for POAF incidence. Copyright
© 2019, Springer Science+Business Media, LLC, part of Springer
Nature.

<100>
Accession Number
2002643172
Title
Incidence of cardiovascular events among tildrakizumab-treated patients
with moderate to severe plaque psoriasis: Pooled data from 3 large
randomized clinical trials.
Source
Journal of the American Academy of Dermatology. Conference: American
Academy of Dermatology 2019 Annual Meeting. United States. 81 (4
Supplement 1) (pp AB79), 2019. Date of Publication: October 2019.
Author
Anonymous
Publisher
Mosby Inc.
Abstract
Introduction: Observational studies suggest that patients with moderate to
severe plaque psoriasis may have increased risk of major adverse
cardiovascular events (MACE). We assessed the incidence of cardiovascular
(CV) events during phase 2 and 3 trials of tildrakizumab (TIL), a
high-affinity, humanized, immunoglobulin G1kappa, anti-interleukin-23p19
antibody for moderate to severe chronic plaque psoriasis. Method(s):
This pooled analysis included data from patients in P05495 (phase 2b;
NCT01225731) and reSURFACE 1 and 2 (phase 3; NCT01722331 and NCT01729754)
who were treated with placebo (PBO), TIL 100 mg, or TIL 200 mg at Week 0,
Week 4, and every 12 weeks thereafter and followed up to Week 52
(P05495/reSURFACE 2) or Week 64 (reSURFACE 1). reSURFACE 2 included an
etanercept (ETN) 50-mg arm administered 2x/wk for 12 weeks, then 1x/wk up
to Week 28. PBO controls were included up to Week 16 (P05495) or Week 12
(reSURFACE 1 and 2). We analyzed safety data from the full-trial periods
and Year 1 of the extensions. For this safety pool, patients with multiple
treatments were counted in each assigned treatment group after starting
different treatment. Extensions to phase 3 studies are ongoing. MACE
comprised nonfatal myocardial infarction (MI), stroke, and CV deaths
confirmed as CV or sudden. Confirmed composite-adjudicated CV (CACV)
events included MACE, unstable angina, coronary revascularization,
resuscitated cardiac arrest, and fatal or nonfatal thrombotic, embolic, or
ischemic CV events. Result(s): The pooled safety population included
588 patients treated with PBO, 1083 with TIL 100 mg, 1041 with TIL 200 mg,
and 313 with ETN. The numbers of patients with CACV events
(exposure-adjusted rate, measured as the number of patients with
events/100 patient-years) were comparable for the TIL 100-mg (4 [0.40])
and 200-mg (8 [0.86]) groups vs PBO (1 [0.46]) and ETN (1 [0.65]). Three
deaths were adjudicated as MACE unrelated to study treatment, all in
patients with preexistent CV risk factors (eg, hypertension): aneurysm
(TIL 200 mg), respiratory arrest and MI (both TIL 100 mg). In the
extension, across TIL-100 and 200-mg groups (n = 1237), only 7 patients
had CACV events (0.60%); no deaths were due to CV events.
 Conclusion(s): In the TIL clinical program, the incidences of CV
events were low and comparable across TIL treatment groups and vs the PBO
and ETN groups. Supported by Sanofi and Regeneron Pharmaceuticals, Inc.
Medical writing/editorial assistance provided by Luke Shelton, PhD, of
Excerpta Medica, funded by Sanofi Genzyme and Copyright © 2019

<101>
Accession Number
628978042
Title
Intensive Care Society State of the Art 2018 Abstracts.
Source
Journal of the Intensive Care Society. Conference: Intensive Care Society
State of the Art Meeting, ICS 2018. United Kingdom. 20 (2 Supplement) (no
pagination), 2019. Date of Publication: May 2019.
Author
Anonymous
Publisher
SAGE Publications Inc.
Abstract
The proceedings contain 320 papers. The topics discussed include: computed
tomography measurement of skeletal muscle mass in adults receiving
veno-venous extracorporeal membrane oxygenation; a review of deaths within
forty-eight hours of ICU admission using the Royal College of Physicians
structured judgment review method; post-traumatic stress disorder and
debriefing after in-hospital cardiac arrests; acetate versus lactate
buffered balanced infusates on hemodynamic stability in patients
undergoing cardiac surgery a randomized controlled double-blind trial;
opioid-induced constipation in intensive care how big is the problem?;
successful utilization of a computer-based prompt to reduce the incidence
of hyperoxaemia within a university hospital general critical care unit;
and the one year follow up outcomes of all critical care referrals, and
the association between frail and non-frail, accepted and declined
referrals: a single-centre long-term prospective study.

<102>
Accession Number
628977939
Title
Acetate versus lactate buffered balanced infusates on hemodynamic
stability in patients undergoing cardiac surgery-a randomized controlled
double-blind trial.
Source
Journal of the Intensive Care Society. Conference: Intensive Care Society
State of the Art Meeting, ICS 2018. United Kingdom. 20 (2 Supplement) (pp
4-6), 2019. Date of Publication: May 2019.
Author
Pfortmueller C.; Faeh L.; Muller M.; Eberle B.; Jenni H.; Zante B.; Prazak
J.; Englberger L.; Takala J.; Jakob S.M.
Institution
(Pfortmueller, Faeh, Prazak, Takala, Jakob) Department for Intensive Care
Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
(Muller) Institute of Health Economics and Clinical Epidemiology,
University Hospital of Cologne, Cologne, Germany
(Muller) Department for Emergency Medicine, Bern University Hospital,
University of Bern, Bern, Switzerland
(Eberle) Department of Anesthesiology and Pain Medicine, Bern University
Hospital, University of Bern, Bern, Switzerland
(Jenni, Zante, Englberger) Department of Cardiovascular Surgery, Bern
University Hospital, University of Bern, Bern, Switzerland
Publisher
SAGE Publications Inc.
Abstract
Patients undergoing cardiac surgery require several hours of hemodynamic
support. Recent evidence suggests that the type of crystalloid fluid used
perioperatively might influence the need for vasoactive agents. Acetate
instead of lactate as a buffer molecule has been controversially discussed
for many years, with vasodilatation and metabolic alkalosis as the main
arguments against its use (1). However, recently two investigations by our
group pointed towards acetate-buffered infusions being more beneficial for
hemodynamic stabilization in patients undergoing major surgical procedures
than 0.9% saline (3). We therefore hypothesized that use of an
acetate-based balanced crystalloid solution for perioperative fluid
replacement in patients undergoing cardiac surgery results in a lower dose
of inopressors, in a shorter total time on inopressors, and in a lesser
amount of fluid needed to achieve hemodynamic stability, than use of a
lactate-buffered crystalloid solution. Using a randomized controlled
double blind design, we compared acetated Ringer's (RA) to lactated
Ringer's (RL) with respect to the cumulative dose of inopressors
administered until postoperative hemodynamic stabilization. Secondary
outcomes were the duration of inopressor administration, the total fluid
volume administered, and changes in acid-base homeostasis. Patients
undergoing elective valvular +/- bypass surgery were included. Patients
with severe cardiac (EF<30%), renal (eGFR<30 ml/min/1.73m2),
liver dysfunction (bilirubin >3 mg/dl), florid endocarditis or chronic
inflammatory disease were excluded from the analysis. Seventy-five
patients were randomly allocated to the RA arm, 73 to RL. Groups were
comparable with in respect to age (median 67.5, IQR 58.0-72.5), sex
(males=111, 75.7%), or ASA (ASA IV=145, 98.0%). Table 1. Multivariable
analysis for ICU mortality. Odds Ratio [95% CI] p-value Average
time-weighted PaO<inf>2</inf> (kPa) 0.81 [0.66, 0.99] 0.05 Age (years)
1.04 [1.02, 1.06] 0.001 Lactate (mmol/L) 1.19 [0.99, 1.45] 0.08
Non-respiratory SOFA 1.08 [0.97, 1.19] 0.15 PEEP (cmH<inf>2</inf>O) 0.89
[0.78, 1.01] 0.08 4 Journal of the Intensive Care Society 20(2) State of
the Art Abstracts Supplement In the RL-group more patients underwent a
composite graft operation whereas in the RA-group more patients received a
single valve replacement (p=0.024). The groups did not differ in respect
to the cumulative dose 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), see table 1. The evolution of blood
pressure, peripheral temperature and urinary output was similar in the
acetated Ringer's and the lactated Ringer's group. Sensitivity analysis of
inopressors showed that all patients received norepinephrine infusions
(n=148, 100%) and 41 (27.7%) of all patients received epinephrine
infusions at some time during the perioperative period (for both p>0.05
between groups). The total norepinephrine dose per hour on norepinephrine
did not differ between the RA and the RL group (median 4.1 mcg/kg/h, IQR
1.1-11.7, respectively median 3.7 mcg/kg/h, IQR 1.5-9.5, p=0.907).
However, patients in the RL-group received significantly higher dose of
epinephrine per hour of epinephrine when compared to the RA-group (median
4.5 mug/kg/h, IQR 0.4-33.0 vs. median 0.2 mug/kg/h, IQR 0.1-9.3, p=0.047).
If considered only for the period in the ICU, more patients in the
lactated Ringer's group received epinephrine infusions (14 (19.2%) vs. 6
(8.0%), p=0.047). However, the cumulative dose of epinephrine per hour on
epinephrine during the perioperative period was significantly higher in
the composite graft group (median 0.1mug/Kg/h, IQR 0.0-0.6 vs median
0.0mug/Kg/h, IQR 0.0-0.0, p=0.008) as were as were the incidence of aortic
insufficiency (p=0.0001) and the duration of hypothermic cardiac arrest
(p=0.0001). The 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. Specifically, there was no occurrence of
metabolic alkalosis, see Figure 1. The main finding of this study is that
for use in perioperative fluid management of elective cardiac surgical
patients, acetate-buffered balanced Ringer's solution does not differ
significantly from lactate-buffered Ringer's with respect to postoperative
hemodynamic stability and pharmacological support with inotropic agents.
Also, we observed no difference in the cumulative amount of perioperative
iv fluids necessary, or in acidbase profiles. More epinephrine use was
noted in the group with acetate-buffered infusion, which was however
related to a significantly larger proportion of patients with valvular
aortic regurgitation and hypothermic cardiac arrests in this group,
receiving more composite graft procedures. Based on this study's results,
we now reject our hypothesis that acetate-buffered is superior to lactated
Ringer's solution with respect to perioperative hemodynamic stability. It
is therefore likely that the effect seen in previous studies is due to
normal saline-induced excessive chloride load and related acidosis.
Chloride excess was linked to adverse hemodynamic outcomes in several
previous human and experimental studies (2, 3) have been correct in
implying excess chloride as the culprit responsible for hemodynamic
instability, it appears logical that this study, comparing two
chloridereduced balanced solutions, did not observe a difference in this
regard. The hemodynamic effects of acetate are controversially discussed.
However, most of this evidence originates from investigations of either
sodium-acetate infusion or acetate-buffered dialysis, where the acetate
load is much higher than in fluid replacement with acetate- buffered
Ringer's solution. Therefore such findings are not generalizable to
populations receiving perioperative fluid therapy with acetate-buffered
infusions (5). In this study, the hemodynamic profile of patient groups
receiving either RA or RL did not differ significantly, even though large
quantities of iv fluid were administered. RA therefore appears as a
feasible alternative to RL for fluid resuscitation in the critically ill
from a hemodynamic viewpoint. Another feared side effect of
acetate-buffered infusion solutes is the occurrence of metabolic
alkalosis. Our study shows that even in patients undergoing cardiac
surgery who receive large quantities of intravenous fluid within a short
time period, the use of an acetatebuffered infusion solution did not
result in metabolic alkalosis. This is in accordance with a recent
systematic review by our group on studies comparing acetate buffered
solution to other crystalloids were major increases in bicarbonate with
acetate buffered solutions were rarely observed (5). In summary,
acetate-buffered and lactated-buffered infusion solutions are equal for
early hemodynamic stabilization in patients undergoing cardiac surgery.
(Figure Presented).

<103>
Accession Number
628977905
Title
An audit of the administration of rFVIIa (Novo Seven) as an emergency
haemostatic agent for intractable bleeding in cardiac surgery at a
cardiothoracic quaternary centre.
Source
Journal of the Intensive Care Society. Conference: Intensive Care Society
State of the Art Meeting, ICS 2018. United Kingdom. 20 (2 Supplement) (pp
79), 2019. Date of Publication: May 2019.
Author
Miller L.; Besser M.; Webb S.
Institution
(Miller) West Suffolk NHS Foundation Trust, Bury St Edmunds, United
Kingdom
(Besser) Addenbrooke's Hospital, Cambridge, United Kingdom
(Webb) Royal Papworth Hospital, Papworth Everard, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Activated recombinant factor VII (rFVIIa) is increasingly used off-license
as an effective haemostatic agent for refractive bleeding from cardiac
surgery. Its use has also been linked to increased prevalence of
thromboembolic events. Moderate to severe haemorrhage is a common
postoperative complication in cardiothoracic surgery. Treatment for
intractable bleeding from cardiothoracic procedures is usually
re-exploration surgery and large quantities of resuscitation fluids
(including packed red blood cells, platelets, fibrinogen, and
cryoprecipitate) and licensed haemostatic agents. Activated recombinant
factor VII (rFVIIa) (NovoSeven), a synthetic haemostatic agent licensed
for treatment of haemophilia, has increasingly been used off-licence to
control refractory haemorrhage post cardiothoracic surgery. Despite
reports of success, a link between use of Novo Seven and increased
morbidity has also been raised. Adverse outcomes include increased
mortality, renal failure and thromboembolic events. Meta analyses focusing
on use of Novo Seven for treatment of bleeding in cardiac surgery have
found a significantly increased rated of stroke following administration
of rFVIIa. A proposed link between cardiothoracic surgery and the
development of DIC has been hypothesised, leading to increased risk of
thromboembolic events following administration of Novo Seven. Given this
hypothesis, it is essential that Novo Seven is administered according to
clinical guidelines. This paper presents the results of an audit of the
administration of Novo Seven compared to the stated trust guidelines. 20
patients were given Novo Seven at a leading cardiothoracic quaternary
centre due to intractable bleeding during cardiac surgery. Systematic
analysis of patient pre-administration prothrombin time, activated partial
thromboplastin time and platelet numbers were undertaken and compared to
the guidelines.

<104>
Accession Number
628707210
Title
Timing of clopidogrel loading dose on peripheral blood endothelial
progenitor cells, SDF-1alpha and neointimal hyperplasia in carotid
stenting.
Source
Clinical Hemorheology and Microcirculation. 72 (1) (pp 23-38), 2019. Date
of Publication: 2019.
Author
Di Stolfo G.; Mastroianno S.; Ruggieri M.; Fontana A.; Marinucci R.;
Copetti M.; Minervini M.M.; Savino L.; Mastroianno M.; Savino M.; Pacilli
M.A.; Di Mauro L.; Potenza D.R.; Cascavilla N.; Paroni G.; Russo A.
Institution
(Di Stolfo, Mastroianno, Pacilli, Potenza, Russo) Cardiology Unit,
Cardiovascular Department, Fondazione IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo (FG), Italy
(Ruggieri, Marinucci, Paroni) Vascular Surgery Unit, Cardiolovascular
Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni
Rotondo (FG), Italy
(Fontana, Copetti) Unit of Biostatistics, Fondazione IRCCS Casa Sollievo
della Sofferenza, San Giovanni Rotondo (FG), Italy
(Minervini, Savino, Cascavilla) Hematology Unit, Onco-hematology
Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni
Rotondo (FG), Italy
(Mastroianno) Unit of Information Systems and Innovation Research,
Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
(FG), Italy
(Savino, Di Mauro) Transfusion Medicine Unit and Laboratory of Clinical
Chemistry, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni
Rotondo (FG), Italy
Publisher
IOS Press (Nieuwe Hemweg 6B, Amsterdam 1013 BG, Netherlands)
Abstract
BACKGROUND: Carotid stenting stimulates intimal proliferation through
platelet and stem cell activation. OBJECTIVE(S): The aim of this
study is to evaluate whether the administration before or after carotid
stenting of clopidogrel loading dose may play a role on circulating
endothelial progenitor cells, stromal cell-derived factor-1alpha
(SDF-1alpha) and neointimal hyperplasia. METHOD(S): We recruited 13
patients (aged 74.52+/-7.23) with indication of carotid revascularization
and in therapy with salicylic acid and statin. We blindly randomized them
in two groups: pre-carotid angioplasty with stent (Pre-CAS group)
receiving 300 mg of clopidogrel before stenting, and post-carotid
angioplasty with stent (Post-CAS group) receiving 300 mg after stenting.
At the admission, we valued endothelial progenitor cells, SDF-1alpha and
prospectively we repeated blood samples and measured intima-media
thickness to estimate neointimal hyperplasia on the stent at 3, 6 and 12
months. RESULT(S): In the days following the CAS, we found a lower,
statistically not significant, trend of endothelial progenitor cells in
Pre-CAS group. The SDF-1alpha concentration tended to be lower at baseline
in the pre-CAS group than in the post-CAS group and it did not show an
increase in the observed time. On the contrary, in the Post-CAS group we
observed a peak at six hours with a significant reduction (p < 0.001) at
one day after stenting. The intima-media thickness was significantly lower
in the Pre-CAS group than the Post-CAS group both at six months and 12
months after stenting. CONCLUSION(S): Pre-stenting clopidogrel
loading dose leaded to short-time modification of endothelial progenitor
cells and platelets and to long-term a minor neointimal
hyperplasia. Copyright © 2019 - IOS Press and the authors. All
rights reserved.

<105>
Accession Number
622467437
Title
Use rate and outcome in bilateral internal thoracic artery grafting:
Insights From a systematic review and meta-analysis.
Source
Journal of the American Heart Association. 7 (11) (no pagination), 2018.
Article Number: e009361. Date of Publication: 01 Jun 2018.
Author
Gaudino M.; Bakaeen F.; Benedetto U.; Rahouma M.; Di Franco A.; Tam D.Y.;
Iannaccone M.; Schwann T.A.; Habib R.; Ruel M.; Puskas J.D.; Sabik J.;
Girardi L.N.; Taggart D.P.; Fremes S.E.
Institution
(Gaudino, Rahouma, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY, United States
(Bakaeen) Cleveland Clinic, Cleveland, OH, United States
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, United Kingdom
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Science, University
of Toronto, ON, Canada
(Iannaccone) Citta della Scienza e della Salute, Department of Cardiology,
University of Turin, Torino, Italy
(Schwann) University of Toledo Medical Center, Toledo, OH, United States
(Habib) The Society of Thoracic Surgeons Research Center, Chicago, IL,
United States
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Sabik) University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Taggart) University of Oxford, United Kingdom
Publisher
American Heart Association Inc.
Abstract
Background--This meta-analysis was designed to assess whether center
experience affects the short- and long-term results and the relative
benefits of bilateral internal thoracic artery grafting (BITA) for
coronary artery bypass grafting. Methods and Results--MEDLINE and EMBASE
were searched to identify all articles reporting the outcome of BITA in
patients undergoing coronary artery bypass grafting. The BITA center
experience was gauged according to the percentage use of BITA in the
institutional overall coronary artery bypass grafting population (%BITA).
The primary outcome was long-term all-cause mortality. Secondary outcomes
were operative mortality, perioperative myocardial infarction,
perioperative stroke, deep sternal wound infections (DSWIs), and major
postoperative adverse event. The rates of the primary and secondary
outcomes were calculated after adjusting for %BITA. Primary and secondary
outcomes were also compared between the BITA and the single internal
thoracic artery arms in the adjusted studies. Meta-regression was used to
evaluate the effect of %BITA on the primary and secondary outcomes.
Thirty-four studies (27 894 patients undergoing BITA) were included. In
the pooled analysis, the incidence rate for long-term mortality was 2.83%
(95% confidence interval, 2.21%-3.61%). %BITA was significantly and
inversely associated with long-term mortality and the rate of DSWI. In the
pairwise comparison, %BITA was significantly and inversely associated with
the risk of longterm mortality and DSWI in the group undergoing BITA.
Conclusions--BITA series with higher %BITA report significantly lower
long-term mortality and DSWI rate as well as higher longterm survival
advantage and lower relative risk of DSWI in their BITA cohort. These
findings suggest that a specific volume-outcome relationship exists for
BITA grafting. Copyright © 2018 The Authors.

<106>
Accession Number
622178592
Title
Cerebral protection during transcatheter aortic valve implantation: An
updated systematic review and meta-analysis.
Source
Journal of the American Heart Association. 7 (10) (no pagination), 2018.
Article Number: e008463. Date of Publication: 15 May 2018.
Author
Testa L.; Latib A.; Casenghi M.; Gorla R.; Colombo A.; Bedogni F.
Institution
(Testa, Casenghi, Gorla, Bedogni) Department of Cardiology, IRCCS Pol. S.
Donato, S. Donato Milanese, Milan, Italy
(Latib, Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, EMO-GVM Centro Cuore Columbus, Milan, Italy
Publisher
American Heart Association Inc.
Abstract
Background--The use of embolic protection devices (EPD) may theoretically
reduce the occurrence of cerebral embolic lesions during transcatheter
aortic valve implantation. Available evidence from single studies is
inconclusive. The aim of the present metaanalysis was to assess the safety
and efficacy profile of current EPD. Methods and Results--Major medical
databases were searched up to December 2017 for studies that evaluated
patients undergoing transcatheter aortic valve implantation with or
without EPD. End points of interest were 30-day mortality, 30-day stroke,
the total number of new lesions, the ischemic volume per lesion, and the
total volume of lesions. Eight studies involving 1285 patients were
included. The EPD delivery success rate was reported in all studies and
was achieved in 94.5% of patients. The use of EPD was not associated with
significant differences in terms of 30-day mortality (odds ratio 0.43
[0.18-1.05], P=0.3) but it was associated with a lower rate of 30-day
stroke (odds ratio 0.55 [0.31-0.98], P=0.04). No differences were detected
with respect to the number of new lesions (standardized mean difference
-0.19 [-0.71 to 0.34], P=0.49). The use of EPD was associated with a
significantly smaller ischemic volume per lesion (standardized mean
difference, -0.52 [-0.85 to -0.20], P=0.002) and smaller total volume of
lesions (standardized mean difference, -0.23 [-0.42 to -0.03], P=0.02).
Conclusions--The use of EPD is not associated with a reduced rate of
mortality and new ischemic cerebral lesions. The use of EPD during
transcatheter aortic valve implantation seems to be associated with a
lower 30-day stroke rate, although this result is driven by a single
nonrandomized study. The use of EPD is associated with a smaller volume of
ischemic lesions, and smaller total volume of ischemic
lesions. Copyright © 2018 The Authors.

<107>
Accession Number
2000770869
Title
Inhibition of Interleukin-1beta by Canakinumab and Cardiovascular Outcomes
in Patients With Chronic Kidney Disease.
Source
Journal of the American College of Cardiology. 71 (21) (pp 2405-2414),
2018. Date of Publication: 29 May 2018.
Author
Ridker P.M.; MacFadyen J.G.; Glynn R.J.; Koenig W.; Libby P.; Everett
B.M.; Lefkowitz M.; Thuren T.; Cornel J.H.
Institution
(Ridker, MacFadyen, Glynn, Everett) Center for Cardiovascular Disease
Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Ridker, Libby, Everett) Cardiovascular Division, Brigham and Women's
Hospital, Harvard Medical School, Boston, Massachusetts, United States
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
DZHK (German Centre for Cardiovascular Research), partner site Munich
Heart Alliance, Munich, Germany
(Koenig) University of Ulm Medical Center, Department of Internal Medicine
II-Cardiology, Ulm, Germany
(Lefkowitz, Thuren) Novartis Pharmaceutical Corporation, East Hanover, New
Jersey, United States
(Lefkowitz, Thuren) Novartis Pharmaceutical Corporation, Basel,
Switzerland
(Cornel) Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
Publisher
Elsevier USA
Abstract
Background: Inflammation contributes to chronic kidney disease (CKD), in
part mediated through activation of interleukin (IL)-1beta by the NLRP3
inflammasome within the kidney. This process also likely contributes to
the accelerated atherosclerosis associated with nephropathy.
 Objective(s): The authors hypothesized that canakinumab, a human
monoclonal antibody targeting IL-1beta, might reduce cardiovascular event
rates and improve renal function among post-myocardial infarction patients
with CKD. Method(s): Stable post-myocardial infarction patients with
high-sensitivity C-reactive protein (hsCRP) >= 2mg/l were randomly
allocated to placebo or to 1 of 3 doses of canakinumab (50, 150, or 300
mg) given subcutaneously once every 3 months. Participants were followed
for incident myocardial infarction, stroke, hospitalization for unstable
angina requiring urgent revascularization, cardiovascular death, or death
from any cause over a median follow-up period of 3.7 years (maximum 5
years). All patients additionally had serial monitoring of estimated
glomerular filtration rate (eGFR), creatinine, the urine albumin to
creatinine ratio (uACR), and were monitored for adverse renal and urinary
events. Result(s): Of 10,061 participants, 1,875 (18.6%) had baseline
eGFR <60 ml/min/1.73 m2. These moderate CKD patients had higher
incidence rates for major adverse vascular events compared with those with
eGFR >=60 ml/min/1.73 m2 (6.92 vs. 4.13 per 100 person-years; p
< 0.0001). Random allocation to canakinumab reduced the risk of major
adverse cardiovascular events among those with CKD (hazard ratio: 0.82;
95% confidence interval: 0.68 to 1.00; p = 0.05) with the largest
cardiovascular benefits accruing among those who achieved on-treatment
hsCRP levels below 2 mg/l measured after taking the first dose (hazard
ratio: 0.68; 95% confidence interval: 0.53 to 0.86; p = 0.0015).
Comparable effects were observed among those with baseline albuminuria or
diabetes. Canakinumab had neither clinically meaningful benefits nor
substantive harms with respect to serial measures of eGFR, creatinine, the
uACR, or reported adverse renal events during trial follow-up.
 Conclusion(s): IL-1beta inhibition with canakinumab reduces major
adverse cardiovascular event rates among high-risk atherosclerosis
patients with CKD, particularly among those with a robust
anti-inflammatory response to initial treatment. These cardiovascular
benefits accrued with no adverse clinical renal events. (Canakinumab
Anti-inflammatory Thrombosis Outcomes Study [CANTOS];
NCT01327846) Copyright © 2018 American College of Cardiology
Foundation

<108>
[Use Link to view the full text]
Accession Number
624068322
Title
Impact of Cardiac Progenitor Cells on Heart Failure and Survival in Single
Ventricle Congenital Heart Disease.
Source
Circulation Research. 122 (7) (pp 994-1005), 2018. Date of Publication: 30
Mar 2018.
Author
Sano T.; Ousaka D.; Goto T.; Ishigami S.; Hirai K.; Kasahara S.; Ohtsuki
S.; Sano S.; Oh H.
Institution
(Sano, Ousaka, Goto, Kasahara) Department of Cardiovascular Surgery,
Okayama University Graduate School of Medicine, Dentistry, and
Pharmaceutical Sciences, Japan
(Hirai, Ohtsuki) Department of Pediatrics, Okayama University Graduate
School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
(Oh) Department of Regenerative Medicine, Center for Innovative Clinical
Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama
700-8558, Japan
(Ishigami, Sano) Department of Pediatric Cardiothoracic Surgery,
University of California, San Francisco, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Intracoronary administration of cardiosphere-derived cells
(CDCs) in patients with single ventricles resulted in a short-term
improvement in cardiac function. Objective(s): To test the hypothesis
that CDC infusion is associated with improved cardiac function and reduced
mortality in patients with heart failure. Methods and Results: We
evaluated the effectiveness of CDCs using an integrated cohort study in
101 patients with single ventricles, including 41 patients who received
CDC infusion and 60 controls treated with staged palliation alone. Heart
failure with preserved ejection fraction (EF) or reduced EF was stratified
by the cardiac function after surgical reconstruction. The main outcome
measure was to evaluate the magnitude of improvement in cardiac function
and all-cause mortality at 2 years. Animal studies were conducted to
clarify the underlying mechanisms of heart failure with preserved EF and
heart failure with reduced EF phenotypes. At 2 years, CDC infusion
increased ventricular function (stage 2: +8.4+/-10.0% versus +1.6+/-6.4%,
P=0.03; stage 3: +7.9+/-7.5% versus -1.1+/-5.5%, P<0.001) compared with
controls. In all available follow-up data, survival did not differ between
the 2 groups (log-rank P=0.225), whereas overall patients treated by CDCs
had lower incidences of late failure (P=0.022), adverse events (P=0.013),
and catheter intervention (P=0.005) compared with controls. CDC infusion
was associated with a lower risk of adverse events (hazard ratio, 0.411;
95% CI, 0.179-0.942; P=0.036). Notably, CDC infusion reduced mortality
(P=0.038) and late complications (P<0.05) in patients with heart failure
with reduced EF but not with heart failure with preserved EF. CDC-treated
rats significantly reversed myocardial fibrosis with differential collagen
deposition and inflammatory responses between the heart failure
phenotypes. Conclusion(s): CDC administration in patients with single
ventricles showed favorable effects on ventricular function and was
associated with reduced late complications except for all-cause mortality
after staged procedures. Patients with heart failure with reduced EF but
not heart failure with preserved EF treated by CDCs resulted in
significant improvement in clinical outcome. Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01273857 and
NCT01829750. Copyright © 2018 American Heart Association, Inc.

<109>
[Use Link to view the full text]
Accession Number
624093793
Title
Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A
Randomized Controlled Trial.
Source
Anesthesiology. 128 (4) (pp 718-727), 2018. Date of Publication: 01 Apr
2018.
Author
Song I.-K.; Kim E.-H.; Lee J.-H.; Kang P.; Kim H.-S.; Kim J.-T.
Institution
(Song) Department of Anesthesiology and Pain Medicine, Asan Medical
Center, University of Ulsan, College of Medicine, Seoul, South Korea
(Kim, Lee, Kang, Kim, Kim) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University College of
Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Pediatric cardiac patients are at risk for perioperative
respiratory insufficiency. The objective of this study was to assess the
utility of perioperative lung ultrasound examination in pediatric cardiac
surgery. Method(s): In this randomized, controlled trial, children (5
yr old or younger) undergoing cardiac surgery were allocated into a
control (n = 61) or intervention (n = 61) group. The control group
received only lung ultrasound examinations at the end of surgery and 6 to
12 h after surgery. The intervention group received lung ultrasound
examinations and an ultrasound-guided recruitment maneuver depending on
ultrasound findings after inducing anesthesia, at the end of surgery, and
6 to 12 h after surgery. Primary outcomes were incidences of intra-and
postoperative desaturation, and postoperative pulmonary complications.
Multiple comparisons were corrected (P <= 0.017) in the primary outcome
analysis. Result(s): Of the 120 children included in the analysis,
postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR],
0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The
incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR,
0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications
(12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar
between the groups. Lung ultrasound scores were better in the intervention
group than in the control group. Duration of mechanical ventilation was
longer in the control group than in the intervention group (38 +/- 43 vs.
26 +/- 25 h; 95% CI of mean difference, 0 to 25; P = 0.048).
 Conclusion(s): Perioperative lung ultrasound examination followed by
ultrasound-guided recruitment maneuver helped decrease postoperative
desaturation events and shorten the duration of mechanical ventilation in
pediatric cardiac patients. Copyright © 2018, the American
Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights
Reserved.

<110>
[Use Link to view the full text]
Accession Number
624093791
Title
Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent
Postoperative Decreases in Renal Function: A Randomized Clinical Trial.
Source
Anesthesiology. 128 (4) (pp 710-717), 2018. Date of Publication: 01 Apr
2018.
Author
Ederoth P.; Dardashti A.; Grins E.; Bronden B.; Metzsch C.; Erdling A.;
Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson L.; Jovinge
S.; Bjursten H.
Institution
(Ederoth, Dardashti, Grins, Bronden, Metzsch, Erdling, Algotsson)
Departments of Anesthesiology and Intensive Care, Sweden
(Nozohoor, Mokhtari, Bjursten) Departments of Cardiothoracic Surgery,
Clinical Sciences, Lund University, Skane University Hospital, Lund 221
85, Sweden
(Hansson, Elmer) Department of Mitochondrial Medicine Clinical Sciences,
Lund University, Lund, Sweden
(Jovinge) Frederik Meijer Heart and Vascular Institute, Spectrum Health,
Grand Rapids, MI, United States
(Jovinge) Van Andel Institute, Grand Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Stanford, CA,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Acute kidney injury is a common complication after cardiac
surgery, leading to increased morbidity and mortality. One suggested cause
for acute kidney injury is extracorporeal circulation-induced
ischemia-reperfusion injury. In animal studies, cyclosporine has been
shown to reduce ischemia-reperfusion injury in the kidneys. We
hypothesized that administering cyclosporine before extracorporeal
circulation could protect the kidneys in patients undergoing cardiac
surgery. Method(s): The Cyclosporine to Protect Renal Function in
Cardiac Surgery (CiPRICS) study was an investigator-initiated,
double-blind, randomized, placebo-controlled, single-center study. The
primary objective was to assess if cyclosporine could reduce acute kidney
injury in patients undergoing coronary artery bypass grafting surgery with
extracorporeal circulation. In the study, 154 patients with an estimated
glomerular filtration rate of 15 to 90 ml . min-1 . 1.73
m-2 were enrolled. Study patients were randomized to receive
2.5 mg/kg cyclosporine or placebo intravenously before surgery. The
primary endpoint was relative plasma cystatin C changes from the
preoperative day to postoperative day 3. Secondary endpoints included
biomarkers of kidney, heart, and brain injury. Result(s): All
enrolled patients were analyzed. The cyclosporine group (136.4 +/- 35.6%)
showed a more pronounced increase from baseline plasma cystatin C to day 3
compared to placebo (115.9 +/- 30.8%), difference, 20.6% (95% CI, 10.2 to
31.2%, P < 0.001). The same pattern was observed for the other renal
markers. The cyclosporine group had more patients in Risk Injury Failure
Loss End-stage (RIFLE) groups R (risk), I (injury), or F (failure; 31% vs.
8%, P < 0.001). There were no differences in safety parameter distribution
between groups. Conclusion(s): Administration of cyclosporine did not
protect coronary artery bypass grafting patients from acute kidney injury.
Instead, cyclosporine caused a decrease in renal function compared to
placebo that resolved after 1 month. Copyright © 2018, the
American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
All Rights Reserved.

<111>
Accession Number
617044344
Title
Meta-analysis to assess the effectiveness of topically used vancomycin in
reducing sternal wound infections after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (4) (pp 1320-1323.e3),
2017. Date of Publication: October 2017.
Author
Kowalewski M.; Raffa G.M.; Szwed K.A.; Anisimowicz L.
Institution
(Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr Antoni Jurasz
Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK, Bydgoszcz,
Poland
(Szwed) Department of Clinical Neuropsychology, Collegium Medicum UMK,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<112>
Accession Number
617317261
Title
Overexpression of microRNA-30a contributes to the development of aortic
dissection by targeting lysyl oxidase.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (6) (pp 1862-1869),
2017. Date of Publication: December 2017.
Author
Yu Y.; Shi E.; Gu T.; Tang R.; Gao S.; Wang Y.; Liu H.
Institution
(Yu, Shi, Gu, Tang, Gao, Wang) Department of Cardiac Surgery, First
Affiliated Hospital, Shenyang, China
(Liu) Department of Health Statistics, School of Public Health, China
Medical University, Shenyang, China
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To explore the role of microRNA (miR)-30a in the development of
aortic dissection. Methods Human aortic specimens of aortic dissections
and aneurysms were harvested. Aortic specimens from donors for heart
transplantation served as controls. Rat aortic vascular smooth muscle
cells (VSMCs) were transfected with agomiR-30a or antagomiR-30a, and
control cells were incubated with empty vectors. Rats were pretreated with
agomiR-30a or antagomiR-30a (5 x 107 transfection units every 3
days for 4 weeks), and empty vectors were infused to controls. Acute
aortic dissection was induced by subcutaneous infusion of angiotensin II
(1 mug . kg-1 . min-1 for 24 hours). Protein
expressions of lysyl oxidase (LOX) and elastin and gene expression of
miR-30a were measured in VSMCs and human and rat aortic specimens by
Western blot analysis and quantitative real-time polymerase chain
reaction. Results Gene expression of miR-30a was much higher, and protein
abundance of LOX and elastin was significantly lower, in the aortic
dissection specimens (P <.05 vs controls). Transfection of agomiR-30a
markedly decreased the luciferase activity of LOX in VSMCs of wild type,
but not of LOX 3'-UTR mutant (P =.002). In cultured VSMCs, transfection of
agomiR-30a dramatically enhanced the gene expression of miR-30a and
down-regulated the protein abundance of LOX and elastin (P <.05 vs
controls). Pretreatment with agomiR-30a in vivo enhanced miR-30a
expression and down-regulated the protein abundance of LOX and elastin in
rat aortas (P <.05 vs controls). The rate of dissection was significantly
higher in rats pretreated with agomiR-30a (P =.003 vs controls).
Conclusions Overexpression of miR-30a contributes to the development of
aortic dissection, possibly by targeting LOX. Copyright © 2017
The American Association for Thoracic Surgery

<113>
Accession Number
619282830
Title
Pre-existing psychological depression confers increased risk of adverse
cardiovascular outcomes following cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (5) (pp 1578-1586.e1),
2017. Date of Publication: November 2017.
Author
Flaherty L.B.; Wood T.; Cheng A.; Khan A.R.
Institution
(Flaherty) Department of Psychological and Brain Sciences, University of
Louisville School of Arts and Sciences, Louisville, Ky, United States
(Wood, Khan) Division of Cardiovascular Medicine, University of Louisville
School of Medicine, Louisville, Ky, United States
(Cheng) Division of Cardiothoracic Surgery, Washington University School
of Medicine, St Louis, Mo, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<114>
Accession Number
618389718
Title
A prognostic tool to predict outcomes in children undergoing the Norwood
operation.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (6) (pp 2030-2037.e2),
2017. Date of Publication: December 2017.
Author
Gupta P.; Chakraborty A.; Gossett J.M.; Rettiganti M.
Institution
(Gupta) Division of Pediatric Cardiology, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital,
Little Rock, Ark, United States
(Chakraborty) Department of Mathematical Sciences, University of Arkansas,
Fayetteville, Ark, United States
(Gossett, Rettiganti) Biostatistics Program, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital
Research Institute, Little Rock, Ark, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To create and validate a prediction model to assess outcomes
associated with the Norwood operation. Methods The public-use dataset from
a multicenter, prospective, randomized single-ventricle reconstruction
trial was used to create this novel prediction tool. A Bayesian lasso
logistic regression model was used for variable selection. We used a
hierarchical framework by representing discrete probability models with
continuous latent variables that depended on the risk factors for a
particular patient. Bayesian conditional probit regression and Markov
chain Monte Carlo simulations were then used to estimate the effects of
the predictors on the means of these latent variables to create a score
function for each of the study outcomes. We also devised a method to
calculate the risk of outcomes associated with the Norwood operation
before the actual heart operation. The 2 study outcomes evaluated were
in-hospital mortality and composite poor outcome. Results The training
dataset used 520 patients to generate the prediction model. The model
included patient demographics, baseline characteristics, cardiac
diagnosis, operation details, site volume, and surgeon experience. An
online calculator for the tool can be accessed at
https://soipredictiontool.shinyapps.io/NorwoodScoreApp/. Model validation
was performed on 520 observations using an internal 10-fold
cross-validation approach. The prediction model had an area under the
curve of 0.77 for mortality and 0.72 for composite poor outcome on the
validation dataset. Conclusions Our new prognostic tool is a promising
first step in creating real-time risk stratification in children
undergoing a Norwood operation; this tool will be beneficial for the
purposes of benchmarking, family counseling, and research. Copyright
© 2017 The American Association for Thoracic Surgery

<115>
Accession Number
628018996
Title
Topical application of magnesium to prevent intubation-related sore throat
in adult surgical patients: a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. 66 (9) (pp 1082-1094), 2019. Date of
Publication: 15 Sep 2019.
Author
Kuriyama A.; Maeda H.; Sun R.
Institution
(Kuriyama) Emergency and Critical Care Center, Kurashiki Central Hospital,
Miwa, Kurashiki, Okayama 710-8602, Japan
(Maeda) Department of Emergency Medicine, Sugita Genpaku Memorial Obama
Municipal Hospital, Fukui, Japan
(Sun) Department of Anesthesiology, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Hubei, China
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Postoperative sore throat negatively affects patient
satisfaction and recovery. We conducted a systematic review and
meta-analysis to examine the efficacy of preoperative topical
administration of magnesium sulfate in preventing postoperative sore
throat in adult patients. Method(s): We searched Medline, EMBASE,
China National Knowledge Infrastructure, and the Cochrane Central Register
of Controlled Trials from inception to 6 October, 2018. We included
randomized-controlled trials that assessed the efficacy and safety of
topical application of magnesium preoperatively in adult patients who
underwent endotracheal intubation for general anesthesia. We then pooled
the data using a random-effects model and conducted a trial sequential
analysis on the incidence of sore throat. Our primary outcome was the
incidence of sore throat at 24 hr after surgery/extubation. Our secondary
outcomes included the severity of sore throat at 24 hr after
surgery/extubation and adverse events. Result(s): Eleven
randomized-controlled trials involving 1,096 patients were included in
this study. Topical application of magnesium was associated with reduced
incidence of postoperative sore throat (risk ratio, 0.31; 95% confidence
interval [CI], 0.21 to 0.45) as well as reduced severity of postoperative
sore throat (standardized mean difference, - 2.66; 95% CI, - 3.89 to -
1.43). Three studies reported that significant adverse events were not
associated with topical magnesium. The trial sequential analysis suggested
that there is adequate evidence supporting the efficacy of topical
magnesium in preventing postoperative sore throat. Conclusion(s): Our
study suggests that preoperative topical magnesium can effectively prevent
postoperative sore throat. Trial registration: PROSPERO (CRD42018110019);
registered 26 September, 2018. Copyright © 2019, Canadian
Anesthesiologists' Society.

<116>
Accession Number
2002431288
Title
Percutaneous Coronary Intervention Versus Medical Therapy for Chronic
Total Occlusion of Coronary Arteries: A Systematic Review and
Meta-Analysis.
Source
Current Atherosclerosis Reports. 21 (10) (no pagination), 2019. Article
Number: 42. Date of Publication: 01 Oct 2019.
Author
Li K.H.C.; Wong K.H.G.; Gong M.; Liu T.; Li G.; Xia Y.; Ho J.;
Nombela-Franco L.; Sawant A.C.; Eccleshall S.; Tse G.; Vassiliou V.S.
Institution
(Li, Wong, Tse) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong
(Li, Wong, Ho, Tse) Li Ka Shing Institute of Health Sciences, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong
(Li) Faculty of Medicine, Newcastle University, Newcastle, United Kingdom
(Gong, Liu, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211,
China
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Ho) Department of Microbiology, The Chinese University of Hong Kong, Hong
Kong
(Nombela-Franco) Cardiology Department, Instituto Cardiovascular, Hospital
Clinico San Carlos, IdISSC, Madrid, Spain
(Sawant) Division of Interventional Cardiology, Banner University Medical
Center, Phoenix, AZ, United States
(Eccleshall, Vassiliou) Norfolk and Norwich University Hospital and
Norwich Medical School, University of East Anglia, Norwich, United Kingdom
(Vassiliou) Royal Brompton Hospital and Imperial College London, London,
United Kingdom
(Vassiliou) Bob Champion Research and Education, Second Floor, University
of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Chronic total occlusion (CTO) of the coronary arteries
is a significant clinical problem and has traditionally been treated by
medical therapy or coronary artery bypass grafting. Recent studies have
examined percutaneous coronary intervention (PCI) as an alternative
option. Recent Findings: This systematic review and meta-analysis compared
medical therapy to PCI for treating CTOs. Summary: PubMed and Embase
were searched from their inception to March 2019 for studies that compared
medical therapy and PCI for clinical outcomes in patients with CTOs.
Quality of the included studies was assessed by Newcastle-Ottawa scale.
The results were pooled by DerSimonian and Laird random- or fixed-effect
models as appropriate. Heterogeneity between studies and publication bias
was evaluated by I2 index and Egger's regression, respectively.
Of the 703 entries screened, 17 studies were included in the final
analysis. This comprised 11,493 participants. Compared to PCI, medical
therapy including randomized and observational studies was significantly
associated with higher risk of all-cause mortality (risk ratio (RR) 1.99,
95% CI 1.38-2.86), cardiac mortality (RR 2.36 (1.97-2.84)), and major
adverse cardiac event (RR 1.25 (1.03-1.51)). However, no difference in the
rate of myocardial infarction and repeat revascularization procedures was
observed between the two groups. Univariate meta-regression demonstrated
multiple covariates as independent moderating factors for myocardial
infarction and repeat revascularization but not cardiac death and
all-cause mortality. However, when only randomized studies were included,
there was no difference in overall mortality or cardiac death. In CTO,
when considering randomized and observational studies, medical therapy
might be associated with a higher risk of mortality and myocardial
infarction compared to PCI treatment. Copyright © 2019, The
Author(s).

<117>
Accession Number
620365390
Title
Early treatment of intrapericardial teratoma: a case presentation and
systematic literature review.
Source
Journal of Maternal-Fetal and Neonatal Medicine. 32 (13) (pp 2262-2268),
2019. Date of Publication: 03 Jul 2019.
Author
Cavalcante C.T.D.M.B.; Pinto Junior V.C.; Pompeu R.G.; Ferrer J.V.C.C.;
Cavalcante M.B.; Araujo Junior E.; Peixoto A.B.; Castello Branco K.M.
Institution
(Cavalcante, Pinto Junior, Pompeu, Ferrer, Castello Branco) Department of
Cardiology and Pediatric Cardiovascular Surgery, Carlos Alberto Studart
Gomes Hospital, Fortaleza, Brazil
(Cavalcante) Department of Pediatrics, Fortaleza University (UNIFOR),
Fortaleza, Brazil
(Cavalcante) Department of Obstetrics and Gynecology, Fortaleza University
(UNIFOR), Fortaleza, Brazil
(Araujo Junior) Department of Obstetrics, Paulista School of Medicine,
Federal University of Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
(Peixoto) Mario Palmerio University Hospital, University of Uberaba
(UNIUBE), Uberaba, Brazil
(Peixoto) Discipline of Obstetrics and Gynecology, Federal University of
Triangulo Mineiro (UFTM), Uberaba, Brazil
(Castello Branco) Post graduation Program in Organ Transplantation, State
University of Ceara (UECE), Fortaleza, Brazil
Publisher
Taylor and Francis Ltd
Abstract
Objective: To present a case of an early treatment of cardiac
intraperitoneal teratoma (IPT) in a newborn and its associated systematic
literature review. Method(s): We presented a case of a newborn with
IPT but without hydrops and having a good perinatal outcome after cardiac
surgery. Using the PubMed database, we conducted a systematic literature
review of articles regarding cases with cardiac IPT diagnosed and treated
in the neonatal period and published in English from 2004 onward. We
excluded cases that involved fetal death or interrupted gestation events.
 Result(s): In total, 38 cases of IPT from 31 articles were included.
The mean +/- standard deviation of the gestational age at diagnosis and
delivery were 27.9 +/- 5.7 and 33.0 +/- 3.5 weeks, respectively, and that
of birth weight was 2373 +/- 834.5 g. The majority of fetuses (42.1%) were
males. Pericardial effusion was the most common symptom (60.5%) followed
by hydrops (42.1%) and respiratory distress (42.1%). Intrauterine
procedure was not performed in 63.1% of cases, and 71.0% of newborns were
alive. Conclusion(s): IPT in newborns is usually associated with a
good prognosis without the need for intrauterine procedures. Cases with
IPT-related death are associated with hemodynamic impairment in fetuses
with hydrops. Copyright © 2018, © 2018 Informa UK Limited,
trading as Taylor & Francis Group.

<118>
Accession Number
626668069
Title
Cardioplegia in paediatric cardiac surgery: A systematic review of
randomized controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (1) (pp 144-150),
2019. Date of Publication: 01 Jan 2019.
Author
Drury N.E.; Yim I.; Patel A.J.; Oswald N.K.; Chong C.-R.; Stickley J.;
Jones T.J.
Institution
(Drury, Yim, Patel, Oswald, Stickley, Jones) Department of Paediatric
Cardiac Surgery, Birmingham Children's Hospital, Steelhouse Lane,
Birmingham B4 6NH, United Kingdom
(Drury) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Chong) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
OBJECTIVES: Cardioplegia is the primary method for myocardial protection
during cardiac surgery. We conducted a systematic review of randomized
controlled trials of cardioplegia in children to evaluate the current
evidence base. METHOD(S): We searched MEDLINE, CENTRAL and LILACS and
manually screened retrieved references and systematic reviews to identify
all randomized controlled trials comparing cardioplegia solutions or
additives in children undergoing cardiac surgery published in any
language; secondary publications and those reporting inseparable adult
data were excluded. Two or more reviewers independently screened studies
for eligibility and extracted data; the Cochrane Risk of Bias tool was
used to assess for potential biases. RESULT(S): We identified 26
trials randomizing 1596 children undergoing surgery; all were
single-centre, Phase II trials, recruiting few patients (median 48,
interquartile range 30-99). The most frequent comparison was blood versus
crystalloid in 10 (38.5%) trials, and the most common end points were
biomarkers of myocardial injury (17, 65.4%), inotrope requirements (15,
57.7%) and length of stay in the intensive care unit (11, 42.3%). However,
the heterogeneity of patients, interventions and reported outcome measures
prohibited metaanalysis. Overall risk of bias was high in 3 (11.5%)
trials, unclear in 23 (88.5%) and low in none. CONCLUSION(S): The
current literature on cardioplegia in children contains no late phase
trials. The small size, inconsistent use of end points and low quality of
reported trials provide a limited evidence base to inform practice. A core
outcome set of clinically important, standardized, validated end points
for assessing myocardial protection in children should be developed to
facilitate the conduct of highquality, multicentre trials. Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<119>
Accession Number
625357028
Title
Hybrid Coronary Revascularization vs Complete Coronary Artery Bypass
Grafting for Multivessel Coronary Artery Disease: A Systematic Review and
Meta-Analysis.
Source
Journal of Invasive Cardiology. 30 (12) (pp E131-E149), 2018. Date of
Publication: December 2018.
Author
Nolan S.; Filion K.B.; Atallah R.; Moss E.; Reynier P.; Eisenberg M.J.
Institution
(Nolan, Filion, Atallah, Reynier, Eisenberg) Centre for Clinical
Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill
University, 3755 Cote Ste-Catherine Road, Montreal, QC H3T 1E2, Canada
(Nolan, Filion, Moss, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Filion) Department of Medicine, McGill University, Montreal, QC, Canada
(Moss) Division of Cardiac Surgery, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
Publisher
HMP Communications
Abstract
BACKGROUND: Hybrid coronary revascularization (HCR) has emerged as a
potential alternative to complete coronary artery bypass graft (CABG)
surgery. However, the efficacy and safety of HCR vs CABG remain unclear.
We therefore conducted a systematic review and meta-analysis to compare
these interventions. Methods. We systematically searched PubMed, MEDLINE
(via Ovid), EMBASE (via Ovid), Cochrane Library of Clinical Trials, and
the Web of Science for studies comparing HCR to CABG in patients with
multivessel coronary artery disease. The primary outcome was major adverse
cardiovascular and cerebrovascular events (MACCE) and its components
(myocardial infarction, stroke, mortality, and target-vessel
revascularization [TVR]) at >=1 year. Secondary outcomes included MACCE at
<=30 days, its components, and postoperative safety outcomes (renal
failure, blood transfusion, new-onset atrial fibrillation, and infection).
 RESULT(S): One randomized controlled trial and 9 cohort studies were
included in our systematic review. Pooled results indicate that HCR is
associated with a lower risk for postoperative blood transfusion (odds
ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68) and infection
(OR, 0.19; 95% CI, 0.04-0.98), and a shorter hospital stay (6.0 days for
HCR vs 7.8 days for CABG) and intensive care unit (ICU) stay (25.4 hours
for HCR vs 45.7 hours for CABG). Long-term outcome data showed an
association between HCR and long-term TVR (OR, 3.10; 95% CI, 1.39-6.90).
 CONCLUSION(S): Our results suggest that compared to CABG, HCR is
associated with a lower risk of postoperative blood transfusion and
infection, as well as a shorter ICU stay and hospital stay. HCR was also
associated with a higher risk of long-term TVR. Copyright © 2018
HMP Communications.

<120>
Accession Number
621589228
Title
International Normalized Ratio Targets for Left-Sided Mechanical Valve
Replacement.
Source
Thrombosis and Haemostasis. 118 (5) (pp 906-913), 2018. Article Number:
170712. Date of Publication: 01 May 2018.
Author
Gupta S.; Belley-Cote E.P.; Sarkaria A.; Pandey A.; Spence J.; McClure G.;
Panchal P.; Jaffer I.H.; An K.; Eikelboom J.; Whitlock R.P.
Institution
(Gupta, Jaffer, Whitlock) Department of Surgery, McMaster University,
Hamilton, ON, Canada
(Gupta, Belley-Cote, Spence, McClure, Whitlock) Department of Health
Research Methods, Evidence and Impact, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote, Eikelboom, Whitlock) Perioperative and Surgery Program,
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
ON, Canada
(Sarkaria) Department of Medicine, School of Medicine, Queen's University,
Kingston, ON, Canada
(Pandey, Jaffer) Experimental Thrombosis and Atherosclerosis Program,
Thrombosis and Atherosclerosis Research Institute, Hamilton Health
Sciences, Hamilton, ON, Canada
(Pandey, Panchal) Department of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
(McClure, An) Michael DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Whitlock) David Braley Cardiac, Vascular and Stroke Research Institute,
237 Barton Street East, Hamilton, ON L8L 2X2, Canada
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Background Guidelines recommend higher international normalized ratio
(INR) targets for patients with mechanical valves believed to be at higher
risk for thromboembolism. Higher INR targets are associated with increased
bleeding risk. We performed a systematic review and meta-analysis
assessing effects of lower and higher INR targets on thromboembolic and
bleeding risk in patients with mechanical heart valves. Methods We
searched Cochrane CENTRAL, MEDLINE and EMBASE for randomized controlled
trials (RCTs) evaluating lower versus higher INR targets for adults with
bileaflet mechanical valves. We performed title and abstract screening,
full-text review, risk of bias evaluation and data collection
independently and in duplicate. We pooled data using a random effects
model and used the Grading of Recommendations Assessment, Development and
Evaluation framework to evaluate overall quality of evidence. Results We
identified six RCTs (n = 5,497). Lower INR targets were associated with
significantly less bleeding--22% versus 40% (relative risk [RR]: 0.54, 95%
confidence interval [CI]: 0.31, 0.93, p = 0.03, very low quality). There
was no difference in thromboembolism--2% in both groups (RR: 1.28, 95% CI:
0.88, 1.85, p = 0.20, very low quality) or mortality--5.5% with lower INR
targets versus 8.5% (RR: 1.00, 95% CI: 0.82, 1.21, p = 0.47, moderate
quality). Conclusion In patients with mechanical valves, higher INR
targets are not supported by current evidence, which is of very low
quality. In fact, our systematic review suggests that lower INR targets
offer significantly lower bleeding risks with no significant difference in
thromboembolic risk. Copyright © 2018 Schattauer.

<121>
Accession Number
621862076
Title
Treatment of malignant pleural mesothelioma: American society of clinical
oncology clinical practice guideline.
Source
Journal of Clinical Oncology. 36 (13) (pp 1343-1373), 2018. Date of
Publication: 01 May 2018.
Author
Kindler H.L.; Ismaila N.; Armato S.G.; Bueno R.; Hesdorffer M.; Jahan T.;
Jones C.M.; Miettinen M.; Pass H.; Rimner A.; Rusch V.; Sterman D.; Thomas
A.; Hassan R.
Institution
(Kindler, Armato) University of Chicago, Chicago, IL, United States
(Ismaila) American Society of Clinical Oncology, Alexandria, VA, United
States
(Hesdorffer) Mesothelioma Applied Research Foundation, Alexandria, VA,
United States
(Bueno) Harvard Medical School, Boston, MA, United States
(Jahan) University of California San Francisco, San Francisco, CA, United
States
(Jones) Baptist Cancer Center Physicians Foundation, Memphis, TN, United
States
(Miettinen, Thomas, Hassan) Center for Cancer Research, National Cancer
Institute, Bethesda, MD, United States
(Pass, Sterman) New York University Langone Medical Center, New York, NY,
United States
(Rimner, Rusch) Memorial Sloan Kettering Cancer Center, New York, NY,
United States
Publisher
American Society of Clinical Oncology (E-mail: jcoservice@asco.org)
Abstract
Purpose To provide evidence-based recommendations to practicing physicians
and others on the management of malignant pleural mesothelioma. Methods
ASCO convened an Expert Panel of medical oncology, thoracic surgery,
radiation oncology, pulmonary, pathology, imaging, and advocacy experts to
conduct a literature search, which included systematic reviews,
meta-analyses, randomized controlled trials, and prospective and
retrospective comparative observational studies published from 1990
through 2017. Outcomes of interest included survival, disease-free or
recurrence-free survival, and quality of life. Expert Panel members used
available evidence and informal consensus to develop evidence-based
guideline recommendations. Results The literature search identified 222
relevant studies to inform the evidence base for this guideline.
Recommendations Evidence-based recommendations were developed for
diagnosis, staging, chemotherapy, surgical cytoreduction, radiation
therapy, and multimodality therapy in patients with malignant pleural
mesothelioma. Copyright © 2018 American Society of Clinical
Oncology. All rights reserved.

<122>
Accession Number
628825341
Title
Review of available evidence supporting different transfusion thresholds
in different patient groups with anemia.
Source
Annals of the New York Academy of Sciences. (no pagination), 2019. Date of
Publication: 2019.
Author
Chai K.L.; Cole-Sinclair M.
Institution
(Chai, Cole-Sinclair) Department of Haematology, St Vincent's Hospital,
Melbourne, VIC, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
In patients with anemia, transfusion of red blood cells (RBCs) can save
lives and improve quality of life. The choice to transfuse should be
cautiously made owing to risks of transfusion, economic costs, and
limitations on the blood supply. Until the 1980s, the decision for RBC
transfusion was guided by Hb threshold, with the aim of maintaining the
patient's blood Hb level over 100 grams per liter. Since then, multiple
randomized controlled trials and key systematic reviews have provided
evidence-based guidelines as to appropriate transfusion thresholds in a
number of clinical settings. Here, we aimed to address the outcome of
defining different anemia criteria in specific clinical populations
exclusively on the basis of the need for RBC transfusion based on Hb
concentration. We focused on the patient populations, where there were the
most available data on differing transfusion thresholds, which looked at
transfusing to a higher or liberal transfusion threshold in comparison
with a lower or restrictive transfusion threshold. These included patients
in intensive care with or without septic shock, hip fracture surgery,
cardiovascular surgery, and upper gastrointestinal bleeding, the pediatric
population, and also those with malaria, by reviewing key randomized
controlled trials and systematic reviews. Twenty-four randomized
controlled studies and 12 systematic reviews have been included, and these
are discussed below. Copyright © 2019 New York Academy of
Sciences.

<123>
Accession Number
2002392296
Title
The del Nido versus cold blood cardioplegia in aortic valve replacement: A
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Sanetra K.; Gerber W.; Shrestha R.; Domaradzki W.; Krzych L.; Zembala M.;
Cisowski M.
Institution
(Sanetra, Gerber, Shrestha, Domaradzki, Cisowski) 1st Department of
Cardiac Surgery, American Heart of Poland, Bielsko-Biala, Poland
(Sanetra, Gerber, Shrestha, Domaradzki, Cisowski) Center for
Cardiovascular Research and Development, American Heart of Poland,
Bielsko-Biala, Poland
(Krzych) Department of Anesthesiology and Intensive Therapy, Medical
University of Silesia, Katowice, Poland
(Zembala, Cisowski) Department of Cardiac, Vascular and Endovascular
Surgery and Transplantology, Zabrze, Poland
(Zembala, Cisowski) Medical University of Silesia, Katowice, Poland
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To compare the cardioprotective efficacy of a solution that
requires only a single infusion at the start of the ischemic duration
versus a solution that requires multiple infusions. Method(s): Aortic
valve replacement was performed for 150 patients, who were randomized into
the del Nido (DN) cardioplegia group or the cold blood (CB) cardioplegia
group. The DN cardioplegia was delivered every 90 minutes and the CB
cardioplegia was delivered every 20 to 30 minutes, or whenever cardiac
activity was observed. The primary endpoints were electrical cardiac
activity during crossclamp, ventricular fibrillation during reperfusion,
and postoperative troponin and creatine kinase (CK-MB isoenzyme) at 24 and
48 hours. Result(s): Electrical activity during crossclamp occurred
in 29 (39.7%) patients in the DN group versus 34 (45.3%) patients in the
CB group (adjusted P = 1.0). The number of procedures with ventricular
fibrillation after removing the crossclamp was 41 (54.7%) in the CB group
versus 17 (22.7%) in the DN group (adjusted P = .001; relative risk,
2.41). Troponin values appeared to be lower in the DN group (median,
223.10; interquartile range, 168.35-364.77 pg/mL vs 285.5; 196.20-419.45
pg/mL at 24 hours and 159.60; 125.42-217.20 pg/mL vs 201.60; 160.62-268.45
pg/mL at 48 hours) and CK-MB (median, 14.94; interquartile range,
12.16-20.39 ng/mL vs 17.43; 13.66-22.43 ng/mL at 24 hours and 6.19;
4.41-7.63 ng/mL vs 7.38; 4.74-10.20 ng/mL at 48 hours), but no
significance was found. Conclusion(s): The del Nido cardioplegia
protocol is an acceptable alternative for cold blood cardioplegia in
patients undergoing aortic valve replacement. Copyright © 2019
The American Association for Thoracic Surgery

<124>
Accession Number
2002354633
Title
Integrin s1 polymorphisms and bleeding risk after coronary artery
stenting.
Source
Molecular Biology Reports. (no pagination), 2019. Date of Publication:
2019.
Author
Thienel M.; Lusebrink E.; Kastrati A.; Dannenberg L.; Polzin A.; Schulz
C.; Massberg S.; Petzold T.
Institution
(Thienel, Lusebrink, Schulz, Massberg, Petzold) Medizinische Klinik und
Poliklinik I, Klinikum der Universitat Munchen, Marchioninistrase 15,
Munich 81377, Germany
(Kastrati) Klinik fur Herz- und Kreislauferkrankungen, Deutsches
Herzzentrum Munchen, Munich, Germany
(Thienel, Lusebrink, Kastrati, Schulz, Massberg, Petzold) DZHK (German
Centre for Cardiovascular Research), partner site Munich Heart Alliance,
Munich, Germany
(Dannenberg, Polzin) Klinik fur Kardiologie, Pneumologie und Angiologie,
Universitatsklinikum Dusseldorf, Dusseldorf, Germany
(Dannenberg, Polzin) CARID (Cardiovascular Research Institute Dusseldorf),
Dusseldorf, Germany
Publisher
Springer Netherlands (E-mail: rbk@louisiana.edu)
Abstract
Bleeding complications following percutaneous coronary intervention
associate with increased mortality. However, the underlying molecular
mechanisms are insufficiently understood. Platelet recruitment and
activation at sites of vascular injury depends on the function of integrin
adhesion receptors. Besides GPIIbIIIa as the most abundant integrin
receptor, platelets relevantly express s1 integrins. Experimental evidence
from in vivo studies suggests a significant role of s1 integrins in
primary haemostasis. However, little is known about the clinical impact of
genetic alterations of the beta1 subunit, which might contribute to
bleeding complications in patients. In this study, we performed DNA
sequencing of patients suffering from bleeding complications after
coronary artery stenting according to TIMI or BARC classification. We
isolated DNA samples from 741 patients out of a cohort from 14,160
patients recruited in seven randomized clinical trials between June 2000
and May 2011. Subsequently, Sanger sequencing was performed covering the
beta1 integrin cytoplasmic activation domain (exon16) and its non-coding
upstream region. Out of 764 patients suffering from bleeding
complications, 741 DNA samples were successfully sequenced. Genotype
variation was detected for SNP rs2153875 located within the non-coding
upstream region with following allele frequency in study population: CC
(7.3%), CA (35%) and AA (57.8%), which is similar to a general population
cohort. Further, genotype variation in SNP rs2153875 do not associate with
the frequency of TIMI or BARC classified access or non-access site
bleedings. Genotype variations of the beta1 integrin activation domain do
not associate with bleeding risk after PCI. Copyright © 2019,
Springer Nature B.V.

<125>
Accession Number
625207455
Title
Quality of life is not improved after mitral valve surgery combined with
epicardial left atrial cryoablation as compared with mitral valve surgery
alone: a substudy of the double blind randomized SWEDish Multicentre
Atrial Fibrillation study (SWEDMAF).
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. 20 (FI3)
(pp f343-f350), 2018. Date of Publication: 01 Nov 2018.
Author
Bagge L.; Probst J.; Jensen S.M.; Blomstrom P.; Thelin S.; Holmgren A.;
Blomstrom-Lundqvist C.
Institution
(Bagge, Probst, Blomstrom, Blomstrom-Lundqvist) Departments of Cardiology
and Medical Science, Uppsala University, Sweden
(Jensen) Faculty of Medicine, Department of Public Health and Clinical
Medicine (Heart centre) Umea University, SE-901 87 Umea, Sweden
(Thelin) Department of Cardiothoracic Surgery, Uppsala University, Uppsala
SE-751 85, Sweden
(Holmgren) Faculty of Medicine, Department of Public Health and Clinical
Medicine, Cardiology, Umea University, SE-901 87 Umea, Sweden
Publisher
NLM (Medline)
Abstract
Aims: Concomitant surgical ablation of atrial fibrillation (AF) in
patients undergoing mitral valve surgery (MVS) has almost become routine
despite lack of convincing information about improved quality-of-life
(QOL) and clinical benefit. Quality-of-life was therefore assessed after
MVS with or without epicardial left atrial cryoablation. Methods and
Results: Sixty-five patients with permanent AF randomized to MVS with or
without left atrial cryoablation, in the double-blinded multicentre
SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12months
follow-up. The QOL scores at 12month follow-up did not differ
significantly between patients undergoing MVS combined with cryoablation
vs. those undergoing MVS alone regarding Physical Component Summary mean
42.8 (95% confidence interval 38.3-47.3) vs. mean 44.0 (40.1-47.7),
P=0.700 or Mental Component Summary mean 53.1 (49.7-56.4) vs. mean 48.4
(44.6-52.2), P=0.075. All patients, irrespective of allocated procedure,
reached the same QOL after surgery as an age-matched Swedish general
population. The Physical Component Summary in patients with sinus rhythm
did also not differ from those in AF at 12months; mean 45.4 (42.0-48.7)
vs. mean 40.5 (35.5-45.6), P=0.096) nor was there a difference in Mental
Component Summary; mean 51.0 (48.0-54.1) vs. mean 49.6 (44.6-54.5),
P=0.581). Conclusion(s): Left atrial cryoablation added to MVS does
not improve health-related QOL in patients with permanent AF, a finding
that raises concerns regarding recommendations made for this combined
procedure.

<126>
Accession Number
2002634003
Title
Postoperative Adjuvant Chemotherapy or Chemoradiation versus Surgery alone
for Thoracic Pathological Node Positive Esophageal Cancer: A Propensity
Score-Matched Analysis (APEC Study 2).
Source
International Journal of Radiation Oncology Biology Physics. Conference:
The Amercian Society for Radiation Oncology 61st Annual Meeting. United
States. 105 (1 Supplement) (pp S129), 2019. Date of Publication: 1
September 2019.
Author
Wang Q.; Li T.; Han Y.; Li Q.; Peng L.; Xie T.; Fang Q.; Yang X.; Zhuang
X.; Dai W.; Jiang Y.; Wang Y.; Lv J.; Wu L.; Cao B.; Lang J.
Institution
(Wang, Li, Wang, Lv, Wu, Cao, Lang) Department of Radiation Oncology,
Sichuan Cancer Hospital& Institution, Sichuan Cancer Center, School of
Medicine, University of Electronic Science and Technology of China,
Chengdu, China
(Han, Li, Peng, Xie, Fang, Yang, Zhuang, Dai, Jiang) Thoracic Surgery
Department, Sichuan Cancer hospital institute/Sichuan Cancer Center/School
of Medicine, University of Electronic Science and Technology of China,
Chengdu, China
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): No completed randomized controlled trial has
compared long-term survival outcomes of patients receiving postoperative
adjuvant chemotherapy (POCT group) and chemoradiation therapy (POCRT
group) compare with surgery alone (S group) directly for Pathological node
positive Thoracic Esophageal Squamous cell cancer (N+ TESCC).
Materials/Methods: Patients with N+ TESCC receiving either adjuvant
chemotherapy or chemoradiation after esophagectomy were identified at
Sichuan Cancer Hospital from January 2009 to December 2017. Univariate
analysis compared patient, tumor, and postoperative outcome
characteristics. Kaplan-Meier analysis was performed to compare overall
survival (OS) and disease free survival (DFS) by adjuvant therapy type.
Propensity score matching was used to create patient groups that were
balanced across several covariates (n= 281 in each group). Finally, a Cox
proportional hazards model was fitted to identify variables associated
with increased mortality hazard. Result(s): From 2009 to 2017, a
total of 1490 of N+ TESCC patients received operation whereas 283(19.0%)
received POCRT, 563 (37.8%) received POCT, 644(43.2%) received Surgery
alone. Patients who received POCRT and POCT were more likely to achieve a
longer 5-year OS (38.8% and 30.0% versus 27.3%, p = 0.005) and DFS (36.4%
and 27.5% versus 25.2%, p = 0.089). These data were confirmed in the
matched samples (5-year OS, 38.1% and 30.9 % versus 20.5% [p = 0.006];
DFS, 35.9% and 28.2% versus 19.6% [p = 0.017]). Multivariate Cox analyses
in the matched samples revealed that postoperative POCRT and POCT were
independently associated with longer OS (hazard ratio = 0.878, 95%
confidence interval: 0.818 - 0.942, p < 0.001) and longer DFS (hazard
ratio = 0.931, 95% confidence interval: 0.869-0.997, p = 0.042 ) than
resection alone. Subgroup analysis found: for N1-2 patients, POCRT and
POCT have longer 5-year OS (p=0.001) and DFS (p=0.034) than S group. For
N3 patients, postoperative adjuvant therapy cannot prolong the OS and DFS
than resection alone. Conclusion(s): Postoperative adjuvant
chemoradiation therapy and chemotherapy are strongly associated with
improved OS and DFS in patients with N positive TESCC. A multicenter,
randomized phase III clinical trial is warranted to confirm these
findings. Copyright © 2019

<127>
Accession Number
2002479920
Title
Comparison Of Remote And Regular Monitoring In Patients After Coronary
Stenting.
Source
Atherosclerosis. Conference: 87th EAS Congress. Netherlands. 287 (pp
e156-e157), 2019. Date of Publication: August 2019.
Author
Osokina A.; Filatova A.; Potekhina A.; Noeva E.; Masenko V.; Arefieva T.;
Provatorov S.
Institution
(Osokina, Potekhina, Noeva) National Medical Research Center of Cardiology
of the Ministry of Healthcare of Russian Federation, Department of
Pulmonary Hypertension and Heart Diseases of Institute of Clinical
Cardiology, Moscow, Russian Federation
(Filatova, Arefieva) National Medical Research Center of Cardiology of the
Ministry of Healthcare of Russian Federation, Laboratory of Cell
Immunology of Institute of Experimental Cardiology, Moscow, Russian
Federation
(Masenko) National Medical Research Center of Cardiology of the Ministry
of Healthcare of Russian Federation, Laboratory of Neurohumoral Regulation
of Cardiovascular Diseases of Institute of Clinical Cardiology, Moscow,
Russian Federation
(Provatorov) Provatorov Sergey, Department of Pulmonary Hypertension and
Heart Diseases of Institute of Clinical Cardiology of National Medical
Research Center of Cardiology of the Ministry of Healthcare of Russian
Federation, semaver@yandex.ru, Provatorov Sergey, Department of Pulmonary
Hypertension and Heart Diseases of Institute of Clinical Cardiology of
National Medical Research Center of Cardiology of the Ministry of
Healthcare of Russian Federation, semaver@yandex.ru, Moscow, Russian
Federation
Publisher
Elsevier Ireland Ltd
Abstract
Background and Aims: The low adherence to cardiovascular treatment is a
well known problem. We aimed to investigate the LDL and hsCRP blood level
dynamics in patients after coronary stenting (CS) receiving remote
monitoring or care with outpatient visits. Method(s): We enrolled 134
patients (98 men, 62 (54; 67) years), with stable angina, who underwent
CS. The patients were randomized into groups of care with regular
outpatient visits (Group 1, n=74) or to remote monitoring (Group 2, n=60).
The patients were receiving conventional treatment with LDL-based statin
regimen. The visits (cardio exam and blood testing for LDL, hsCRP,
transaminases and creatinkinase) and remote monitoring (76%
videoconference\ 24% telephone care and blood tests interpretation) were
performed at 1, 3 and 6 months after CS. Result(s): The
baseline/1mo/3mo/6mo LDL blood levels (mmol/l) in group 1 were
2,4(1,8;2,8) /1,9(1,6;2,4) /1,8 (1,3;2,0)/ 1,8 (1,3; 1,9) (p<0,05 baseline
vs. 3mo). The LDL blood levels (mmol/l) in group 2 were 2,3 (1,8;2,7)/ 2,1
(1,8;2,8)/ 1,9 (1,7;2,7)/ 1,8 (1,6;2,1), respectively. The
baseline/1mo/3mo/6mo hsCRP blood levels (mg/dl) in group 1 were 0,9
(0,6;1,4)/ 0,8 (0,4;1,6)/ 0,9 (0,6;1,4)/0,8 (0,4;1,6) ((p<0,05 baseline
vs. 3mo). The hsCRP blood levels (mg/dl) in group 2 were 1,0 (0,8;2,0) /
0,8 (0,7;1,4) / 0,3 (0,04;0,7). Conclusion(s): The groups of care
with outpatient visits and remote monitoring after CS showed the same
trend of LDL and hsCRP blood level decline with no differences between
groups. The remote monitoring is a safe strategy for improving and
maintaining the adherence to treatment in patients after CS. Copyright
© 2019

<128>
Accession Number
628967248
Title
Clinical observation of modified gastric tube in middle and lower thoracic
esophageal carcinoma surgery.
Source
Journal of cardiothoracic surgery. 14 (1) (pp 146), 2019. Date of
Publication: 30 Jul 2019.
Author
Liu B.; Wang W.; Liang T.
Institution
(Liu, Wang, Liang) Department of Thoracic Surgery, First Affiliated
Hospital of Anhui University of Chinese Medicine, No.117 Meishan Road,
Hefei, Anhui 230031, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: A clinical case-control study was conducted to analyze the
short-term efficacy of modified gastric tube in surgery for middle (mid)-
and lower- thoracic esophageal carcinoma compared with the conventional
gastric tube and its effect on postoperative pulmonary function.
 METHOD(S): A total of 70 patients with mid- and lower-thoracic
esophageal cancer who underwent esophagectomy between October 2012 and
September 2018 in our hospital were recruited in the study. They were
randomly divided into a modified gastric tube group (n=35) and a
conventional gastric tube group (n=35). The operation time, intraoperative
blood loss, number of intraoperative lymph node dissection,
gastrointestinal decompression time and postoperative hospital stay were
recorded. The operation results and complications were recorded, and the
pulmonary function was recorded at 3days before surgery and 6weeks after
surgery. RESULT(S): The operation time in the modified gastric tube
group was significantly lower than that in the gastric tube group
(P<0.05). There were no anastomotic leakage or death occurred in the
modified gastric tube group. There was 1 case of anastomotic leakage in
the conventional gastric tube group. The pulmonary function in both groups
was improved at 6weeks after surgery, but there was no significant
difference between both groups (P>0.05). CONCLUSION(S): Modified
gastric tube has a good clinical application value compared with gastric
tube for patients with mid- and lower-thoracic esophageal cancer. It is
easy and safe, and can shorten the operation time without aggravation of
pulmonary function after surgery.

<129>
[Use Link to view the full text]
Accession Number
628962362
Title
Invasive Versus Medical Management in Patients With Prior Coronary Artery
Bypass Surgery With a Non-ST Segment Elevation Acute Coronary Syndrome.
Source
Circulation. Cardiovascular interventions. 12 (8) (pp e007830), 2019. Date
of Publication: 01 Aug 2019.
Author
Lee M.M.Y.; Petrie M.C.; Rocchiccioli P.; Simpson J.; Jackson C.E.;
Corcoran D.S.; Mangion K.; Brown A.; Cialdella P.; Sidik N.P.; McEntegart
M.B.; Shaukat A.; Rae A.P.; Hood S.H.M.; Peat E.E.; Findlay I.N.; Murphy
C.L.; Cormack A.J.; Bukov N.B.; Balachandran K.P.; Oldroyd K.G.; Ford I.;
Wu O.; McConnachie A.; Barry S.J.E.; Berry C.
Institution
(Lee, Petrie, Rocchiccioli, Simpson, Jackson, Corcoran, Mangion,
Cialdella, Sidik, McEntegart, Shaukat, Rae, Hood, Peat, Oldroyd, Berry)
Department of Cardiology, West of Scotland Heart and Lung Centre, Golden
Jubilee National Hospital, Glasgow, United Kingdom (M.M.Y.L., M.C.P.,
P.R., J.S., C.E.J., D.S.C., K.M., P.C., N.P.S., M.B.M., A.S., A.P.R.,
S.H.M.H., E.E.P., K.G.O., C.B.)
(Lee, Petrie, Rocchiccioli, Simpson, Jackson, Corcoran, Mangion, Brown,
McEntegart, Shaukat, Rae, Berry) British Heart Foundation Glasgow
Cardiovascular Research Centre, Institute of Cardiovascular and Medical
Sciences (M.M.Y.L., M.C.P., P.R., D.S.C., University of Glasgow, K.M.,
A.S, A.B, United Kingdom
(Lee, Brown, McEntegart, Berry) Department of Cardiology, Western
Infirmary, Glasgow, United Kingdom (M.M.Y.L., A.B., M.B.M., C.B.)
(Lee, Hood, Peat, Findlay, Murphy, Cormack) Department of Cardiology,
Royal Alexandra Hospital, United Kingdom (M.M.Y.L., E.E.P., I.N.F.,
C.L.M., Paisley, United Kingdom
(Lee, Petrie, Rocchiccioli, Shaukat, Rae) Department of Cardiology,
Glasgow Royal Infirmary, United Kingdom (M.C.P., P.R., A.S., A.P.R.,
M.M.Y.L.)
(Bukov, Balachandran) Department of Cardiology, Royal Blackburn Hospital,
United Kingdom (N.B.B.
(Ford, McConnachie) Robertson Centre for Biostatistics (I.F., University
of Glasgow, United Kingdom
(Wu) Health Economics and Health Technology Assessment (O.W.), University
of Glasgow, United Kingdom
(Barry) Department of Mathematics and Statistics, University of
Strathclyde, United Kingdom (S.J.E.B.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The benefits of routine invasive management in patients with
prior coronary artery bypass grafts presenting with non-ST elevation acute
coronary syndromes are uncertain because these patients were excluded from
pivotal trials. METHOD(S): In a multicenter trial, non-ST elevation
acute coronary syndromes patients with prior coronary artery bypass graft
were prospectively screened in 4 acute hospitals. Medically stabilized
patients were randomized to invasive management (invasive group) or
noninvasive management (medical group). The primary outcome was adherence
with the randomized strategy by 30 days. A blinded, independent Clinical
Event Committee adjudicated predefined composite outcomes for efficacy
(all-cause mortality, rehospitalization for refractory ischemia/angina,
myocardial infarction, hospitalization because of heart failure) and
safety (major bleeding, stroke, procedure-related myocardial infarction,
and worsening renal function). RESULT(S): Two hundred seventeen
patients were screened and 60 (mean+/-SD age, 71+/-9 years, 72% male) were
randomized (invasive group, n=31; medical group, n=29). One-third (n=10)
of the participants in the invasive group initially received percutaneous
coronary intervention. In the medical group, 1 participant crossed over to
invasive management on day 30 but percutaneous coronary intervention was
not performed. During 2-years' follow-up (median [interquartile range],
744 [570-853] days), the composite outcome for efficacy occurred in 13
(42%) subjects in the invasive group and 13 (45%) subjects in the medical
group. The composite safety outcome occurred in 8 (26%) subjects in the
invasive group and 9 (31%) subjects in the medical group. An efficacy or
safety outcome occurred in 17 (55%) subjects in the invasive group and 16
(55%) subjects in the medical group. Health status (EuroQol 5 Dimensions)
and angina class in each group were similar at 12 months.
 CONCLUSION(S): More than half of the population experienced a serious
adverse event. An initial noninvasive management strategy is feasible. A
substantive health outcomes trial of invasive versus noninvasive
management in non-ST elevation acute coronary syndromes patients with
prior coronary artery bypass grafts appears warranted. CLINICAL TRIAL
REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT01895751.

<130>
Accession Number
2002384549
Title
Amiodarone in the treatment of atrial fibrillation of patients with
rheumatic heart disease after valve replacement.
Source
Pakistan Journal of Medical Sciences. 35 (4) (pp 918-922), 2019. Date of
Publication: July-August 2019.
Author
Chen K.; Qin L.; Lu X.; Xia T.; Gu Q.
Institution
(Chen, Qin, Lu, Xia, Gu) Department of Cardiovascular Surgery, Taian
Central Hospital, Shandong 271000, China
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objectives: To explore the efficacy of amiodarone in the treatment of
atrial fibrillation for patients with rheumatic heart disease after valve
replacement. Method(s): Eighty-six patients with rheumatic heart
disease who were hospitalized between June 2016 and June 2017 and
developed atrial fibrillation after valvular heart valve replacement were
randomly divided into a control group and an observation group, 42 cases
in each group. The control group was treated with routine medical
treatment, while the observation group was given amiodarone on the basis
of routine treatment. The cardiac function of the two groups were observed
and recorded. Postoperative atrial fibrillation conversion rate, sinus
rhythm maintenance rate, intensive care unit (ICU) monitoring time and
hospital stay were compared between the two groups. Result(s):
Compared with the control group, the improvement of cardiac function
indexes of the observation group was better, and the difference was
statistically significant (P<0.05). The atrial fibrillation conversion
rate and the maintenance rate of sinus rhythm of the observation group
were 76.2% and 47.6% respectively, which were significantly higher than
57.1% and 33.3% of the control group; the differences had statistical
significance (P<0.05). The ICU monitoring time and hospitalization time of
the patients in the observation group were (1.69+/-0.91) d and
(10.24+/-1.11) d respectively, which were significantly shorter than
(2.83+/-0.95) d and (14.07+/-1.17) d in the control group (P<0.05); the
differences were statistically significant (P<0.05). Conclusion(s):
Amiodarone can effectively treat valve replacement associated atrial
fibrillation of patients with rheumatic heart disease. It can
significantly improve the heart function, prevent the recurrence of atrial
fibrillation, maintain sinus rhythm after operation, and shorten the time
of ICU monitoring and hospitalization. Copyright © 2019,
Professional Medical Publications. All rights reserved.

<131>
Accession Number
628958029
Title
Quality of life in patients with advanced heart failure and an implanted
left ventricular assist device: an umbrella review protocol.
Source
JBI database of systematic reviews and implementation reports. (no
pagination), 2019. Date of Publication: 29 Jul 2019.
Author
Abrams D.; McNair M.
Institution
(Abrams, McNair) School of Nursing, University of Mississippi Medical
Center, Jackson, United States
(Abrams, McNair) Mississippi Centre for Evidence Based Practice: a Joanna
Briggs Institute Centre of Excellence
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This review aims to evaluate the effectiveness of implanted
left ventricular assist devices on quality of life in patients with
advanced heart failure. INTRODUCTION: Approximately 500,000 patients
worldwide are diagnosed with advanced heart failure. The preferred
treatment for patients who remain symptomatic after standard medical
treatment is heart transplantation. However, due to the shortage of donor
organs, left ventricular assist devices are increasingly used as an
alternative. This umbrella review is necessary to advice clinicians so
they may provide patients and families with clear information on standard
medical treatment, implanted left ventricular assist devices and heart
transplantation. INCLUSION CRITERIA: This umbrella review will consider
research syntheses that include patients 16 years or over with advanced
heart failure and an implanted left ventricular assist device. The primary
outcome is quality of life, and secondary outcomes include patient
survival rates and the New York Heart Association functional
classification changes. METHOD(S): An initial search of PubMed and
CINAHL has been undertaken to identify articles and create a search
strategy. Retrieved articles will be screened against the inclusion
criteria. Included studies will be critically appraised for methodological
quality according to Joanna Briggs Institute (JBI) umbrella review
methodology, and data will be extracted using the standardized JBI data
extraction tool. The results will be presented in a Summary of Evidence,
and a GRADE Summary of Findings will be produced for grading the quality
of the evidence.

<132>
Accession Number
628956257
Title
Frequency and impact of incidental findings on computed tomography during
work-up for transcatheter aortic valve implantation: single centre
experience and review of the literature.
Source
The British journal of radiology. (pp 20190344), 2019. Date of
Publication: 30 Jul 2019.
Author
Hinton J.; Gough S.; Ahmed H.; Gabara L.; Rawlins J.; Calver A.; Shah
B.N.; Rakhit D.; Shambrook J.; Harden S.; Peebles C.; Abbas A.; Curzen N.
Institution
(Hinton, Gough, Ahmed, Gabara, Rawlins, Calver, Shah, Rakhit, Curzen)
Coronary Research Group, University Hospital Southampton NHS Foundation
Trust, United Kingdom
(Hinton, Curzen) Faculty of Medicine, University of Southampton, United
Kingdom
(Shambrook, Harden, Peebles, Abbas) Cardiothoracic Radiology, University
Hospital Southampton NHS Foundation Trust, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess the frequency and impact of incidental findings (IF)
on CT during work-up for transcatheter aortic valve intervention (TAVI).
 METHOD(S): A consecutive cohort of patients referred for
consideration of TAVI who underwent a CT scan between 2009 and 2018 were
studied retrospectively. CT reports were reviewed for the presence of IFs
and categorised based upon their clinical significance: (a)
insignificant-findings that did not require specific treatment or
follow-up; (b) intermediate-findings that did not impact on the
decision-making process but required follow-up; (c) significant-findings
that either required urgent investigation or meant that TAVI was
clinically inappropriate. RESULT(S): A total of 652 patients were
included, whose median age was 82 years. One or more insignificant IF was
found in 95.6% of patients. Intermediate IFs were documented in 5.4%. 91
(14%) patients had at least one significant IF. These included possible
malignancy in 67 (74%). The ultimate decision to offer aortic valve
intervention was only changed by the presence of an IF in 3.5% of cases.
 CONCLUSION(S): Clinically significant IFs are detected in more than 1
in 10 of patients undergoing CT as part of a TAVI work-up, although just
over half of these patients still receive aortic valve intervention.
ADVANCES IN KNOWLEDGE: This study is the largest UK cohort, which, when
combined with a review of existing literature, provides a clear picture of
the frequency and clinical impact of IFs found at CT for TAVI assessment.

<133>
Accession Number
628954670
Title
Long-term and short-term duration of thienopyridine therapy after coronary
stenting in patients with chronic kidney disease a meta-analysis of
literature studies.
Source
Platelets. (pp 1-7), 2019. Date of Publication: 29 Jul 2019.
Author
Wu Y.; Song Y.; Pan Y.; Gong Y.; Zhou Y.
Institution
(Wu, Gong, Zhou) Department of Nephrology, Beijing Tiantan hospital,
Capital Medical University, Beijing, China
(Song) School of Economics, Central University of Finance and Economics,
Beijing, China
(Pan) Department of Epidemiology and Health Statistics, School of Public
Health, Capital Medical University, Beijing, China
(Pan) China National Clinical Research Center for Neurological Diseases
(NCRC-ND), Beijing, China
Publisher
NLM (Medline)
Abstract
The study aimed to compare the efficacy and safety outcome associated with
a short and a prolonged duration of thienopyridine therapy in patients
with chronic kidney disease (CKD) after coronary stenting. We
systematically searched PubMed, EMBASE and the Cochrane Library from their
inception to 1 January 2019 for studies comparing short and prolonged
thienopyridine therapy in patients with CKD. Ischemic and bleeding events
were considered as the clinical endpoints in this analysis. Odds Ratios
(OR) with 95% confidence intervals (CIs) were used as estimates of effect
size in random-effect models. Seven studies comprising a total of 17,628
CKD patients were included in the evaluation. Prolonged duration of
thienopyridine use, when compared to short-term thienopyridine, was
associated with reduced risk of all-cause mortality (odds ratio 0.75, 95%
confidence interval: 0.70-0.81, P< .001) and stent thrombosis (OR: 0.54,
95% CI 0.32 to 0.89; P< .001), but the odds of myocardial infarction (OR:
0.91, 95% CI: 0.77-1.07; P = .23) and stroke (OR: 0.91, 95% CI 0.73 to
1.13; P = .38) did not differ according to different duration of
thienopyridine. As for bleeding events, long-term thienopyridine therapy
did not significantly increase the bleeding (OR: 0.95, 95% CI 0.79 to
1.14; P = .58). In these patients with CKD following PCI, prolonged
thienopyridine therapy compared with short-term therapy, was associated
with reduced all-cause mortality and stent thrombosis, without any
significant difference in myocardial infarction, stroke, and bleeding.
Thienopyridine prolongation decisions for CKD patients should be
individualized after careful consideration of the benefit-risk balance.

<134>
Accession Number
2002637677
Title
Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk
Patients.
Source
American Journal of Medicine. (no pagination), 2019. Date of Publication:
2019.
Author
Kheiri B.; Osman M.; Bakhit A.; Radaideh Q.; Barbarawi M.; Zayed Y.;
Golwala H.; Zahr F.; Stone G.W.; Bhatt D.L.
Institution
(Kheiri, Barbarawi, Zayed, Golwala, Zahr) Knight Cardiovascular Institute,
Oregon Health & Science University, Portland, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, United States
(Bakhit) Division of Cardiology, Saint Vincent Hospital, Worcester, Mass,
United States
(Radaideh) Midwest Cardiovascular Research Foundation, Davenport, IA,
United States
(Stone) NewYork-Presbyterian Hospital/Columbia University Medical Center,
New York, NY; Cardiovascular Research Foundation, New York, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, Mass, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose: This study evaluated the efficacy and safety of transcatheter
aortic valve replacement (TAVR) compared with surgical aortic valve
replacement (SAVR) in low surgical risk patients. Method(s): An
electronic database search was conducted for randomized controlled trials
(RCTs). We calculated hazard ratios (HRs) and 95% confidence intervals
(CIs) using a random-effects model. Result(s): Five RCTs were
identified with a total of 3,072 patients (mean age 74.5 +/- 6.1 and 64.8%
male). Compared with SAVR, TAVR was associated with a significantly
reduced rate of death or disabling stroke (HR = 0.52; 95% CI = 0.27-0.99;
P =.049), atrial-fibrillation (HR = 0.28; 95% CI = 0.18-0.46; P <.01), and
post-procedure bleeding (HR = 0.38; 95% CI = 0.31-0.46; P <.01), along
with a significantly improved quality-of-life at 1-year. However, TAVR was
associated with significantly increased rates of paravalvular leak (HR =
4.09; 95% CI = 1.92-8.69; P <.01) and pacemaker insertion (HR = 2.81; 95%
CI = 1.85-4.28; P <.01) compared with SAVR. Conclusion(s): Among
older low-risk patients with severe aortic stenosis, TAVR is associated
with a lower rate of death or disabling stroke compared with SAVR.
Transcatheter aortic valve replacement is also associated with improved
quality-of-life, reduced bleeding and atrial fibrillation, but higher
paravalvular leak and pacemaker implantation rates. Copyright ©
2019 Elsevier Inc.

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