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<1>
Accession Number
626372663
Title
Effect of iloprost inhalation on postoperative outcome in high-risk
cardiac surgical patients: a prospective randomized-controlled multicentre
trial (ILOCARD).
Source
Canadian Journal of Anesthesia. 66 (8) (pp 907-920), 2019. Date of
Publication: 15 Aug 2019.
Author
Winterhalter M.; Rex S.; Stoppe C.; Kienbaum P.; Muller H.-H.; Kaufmann
I.; Kuppe H.; Dongas A.; Zwissler B.
Institution
(Winterhalter) Klinik fur Anasthesiologie und Schmerztherapie, Klinikum
Bremen-Mitte gGmbH, Bremen, Germany
(Winterhalter, Kienbaum) Klinik fur Anasthesiologie, Universitatsklinikum
Dusseldorf, Dusseldorf, Germany
(Rex) Department of Anesthesiology & Department of Cardiovascular
Sciences, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven
3000, Belgium
(Rex, Stoppe) Klinik fur Anasthesiologie, Universitatsklinikum der RWTH
Aachen, Aachen, Germany
(Muller) Klinische Forschung, IBE - Institut fur Medizinische
Informationsverarbeitung, Biometrie und Epidemiologie,
Ludwig-Maximilians-Universitat Munchen, Munich, Germany
(Muller) Institut fur Medizinische Biometrie und Epidemiologie,
Philipps-Universitat Marburg, Marburg, Germany
(Kaufmann, Zwissler) Klinik fur Anasthesiologie, LMU Klinikum der
Universitat Munchen, Munich, Germany
(Kaufmann) Klinik fur Anasthesiologie, Operative Intensivmedizin und
Schmerztherapie, Stadtisches Klinikum Munchen, Neuperlach, Munich, Germany
(Kuppe) Institut fur Anasthesiologie, Deutsches Herzzentrum Berlin,
Berlin, Germany
(Dongas) Institut fur Anasthesiologie, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Dongas) Klinik fur Anasthesiologie und operative Intensivmedizin,
Franziskus Hospital Bielefeld, Bielefeld, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Perioperative right ventricular (RV) failure due to pressure
overload from pulmonary hypertension (PH) worsens postoperative outcomes
after cardiac surgery. Inhaled iloprost is a potent pulmonary vasodilator
improving RV performance, ameliorating myocardial and pulmonary
ischemia-reperfusion injury and attenuating inflammation. We hypothesized
that the prophylactic inhalation of iloprost would reduce postoperative
ventilation times after cardiac surgery. <br/>Method(s): In this phase
III, multicentre, randomized, double-blind, placebo-controlled trial, we
randomly assigned 253 cardiac surgical patients at high risk of
perioperative RV failure to the prophylactic inhalation of 20 micro&#32;g
iloprost or placebo before and during weaning from extracorporeal
circulation. The primary endpoint was the duration of postoperative
ventilation. Secondary endpoints included perioperative hemodynamics,
intensive care unit and hospital length of stay, and 90-day mortality.
Safety was assessed by the incidence of adverse events. <br/>Result(s):
Iloprost had no significant effect on the median [interquartile range]
duration of postoperative ventilation compared with placebo (720
[470-1170] min vs 778 [541-1219] min, respectively; median decrease, 65
min; 95% confidence interval [CI], - 77 to 210; P = 0.37). While the
nebulization of iloprost decreased RV afterload and improved cardiac
index, major secondary endpoints were not significantly affected.
Ninety-day mortality occurred in 14% of the iloprost patients compared
with 14% of the placebo patients (hazard ratio, 0.97; 95% CI, 0.50 to
1.89; P = 0.93). The incidence of adverse events was comparable in both
groups. <br/>Conclusion(s): The prophylactic inhalation of iloprost did
not meaningfully improve the outcome in high-risk cardiac surgical
patients. Trial registration: www.clinicaltrials.gov (NCT00927654);
registered 25 June, 2009.<br/>Copyright &#xa9; 2019, Canadian
Anesthesiologists' Society.

<2>
Accession Number
626419169
Title
Effect of Intravenous Acetaminophen vs Placebo Combined with Propofol or
Dexmedetomidine on Postoperative Delirium among Older Patients Following
Cardiac Surgery: The DEXACET Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 321 (7) (pp 686-696),
2019. Date of Publication: 19 Feb 2019.
Author
Subramaniam B.; Shankar P.; Shaefi S.; Mueller A.; O'Gara B.;
Banner-Goodspeed V.; Gallagher J.; Gasangwa D.; Patxot M.; Packiasabapathy
S.; Mathur P.; Eikermann M.; Talmor D.; Marcantonio E.R.
Institution
(Subramaniam, Shankar, Shaefi, Mueller, O'Gara, Banner-Goodspeed,
Gasangwa, Patxot, Packiasabapathy, Mathur, Eikermann, Talmor) Department
of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, 375 Longwood Ave, W/MS-414,
Boston, MA 02215, United States
(Gallagher, Marcantonio) Department of Medicine, Division of Gerontology,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Postoperative delirium is common following cardiac surgery and
may be affected by choice of analgesic and sedative. <br/>Objective(s): To
evaluate the effect of postoperative intravenous (IV) acetaminophen
(paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on
postoperative delirium among older patients undergoing cardiac surgery.
<br/>Design, Setting, and Participant(s): Randomized, placebo-controlled,
factorial clinical trial among 120 patients aged 60 years or older
undergoing on-pump coronary artery bypass graft (CABG) surgery or combined
CABG/valve surgeries at a US center. Enrollment was September 2015 to
April 2018, with follow-up ending in April 2019. <br/>Intervention(s):
Patients were randomized to 1 of 4 groups receiving postoperative
analgesia with IV acetaminophen or placebo every 6 hours for 48 hours and
postoperative sedation with dexmedetomidine or propofol starting at chest
closure and continued for up to 6 hours (acetaminophen and
dexmedetomidine: n = 29; placebo and dexmedetomidine: n = 30;
acetaminophen and propofol: n = 31; placebo and propofol: n = 30).
<br/>Main Outcomes and Measures: The primary outcome was incidence of
postoperative in-hospital delirium by the Confusion Assessment Method.
Secondary outcomes included delirium duration, cognitive decline,
breakthrough analgesia within the first 48 hours, and ICU and hospital
length of stay. <br/>Result(s): Among 121 patients randomized (median age,
69 years; 19 women [15.8%]), 120 completed the trial. Patients treated
with IV acetaminophen had a significant reduction in delirium (10% vs 28%
placebo; difference, -18% [95% CI, -32% to -5%]; P =.01; HR, 2.8 [95% CI,
1.1-7.8]). Patients receiving dexmedetomidine vs propofol had no
significant difference in delirium (17% vs 21%; difference, -4% [95% CI,
-18% to 10%]; P =.54; HR, 0.8 [95% CI, 0.4-1.9]). There were significant
differences favoring acetaminophen vs placebo for 3 prespecified secondary
outcomes: delirium duration (median, 1 vs 2 days; difference, -1 [95% CI,
-2 to 0]), ICU length of stay (median, 29.5 vs 46.7 hours; difference,
-16.7 [95% CI, -20.3 to -0.8]), and breakthrough analgesia (median, 322.5
vs 405.3g morphine equivalents; difference, -83 [95% CI, -154 to -14]).
For dexmedetomidine vs propofol, only breakthrough analgesia was
significantly different (median, 328.8 vs 397.5g; difference, -69 [95% CI,
-155 to -4]; P =.04). Fourteen patients in both the
placebo-dexmedetomidine and acetaminophen-propofol groups (46% and 45%)
and 7 in the acetaminophen-dexmedetomidine and placebo-propofol groups
(24% and 23%) had hypotension. <br/>Conclusions and Relevance: Among older
patients undergoing cardiac surgery, postoperative scheduled IV
acetaminophen, combined with IV propofol or dexmedetomidine, reduced
in-hospital delirium vs placebo. Additional research, including comparison
of IV vs oral acetaminophen and other potentially opioid-sparing
analgesics, on the incidence of postoperative delirium is warranted. Trial
Registration: ClinicalTrials.gov Identifier: NCT02546765.<br/>Copyright
&#xa9; 2019 American Medical Association. All rights reserved.

<3>
Accession Number
2002187411
Title
Prevalence of Infective Endocarditis in Enterococcus faecalis Bacteremia.
Source
Journal of the American College of Cardiology. 74 (2) (pp 193-201), 2019.
Date of Publication: 16 July 2019.
Author
Dahl A.; Iversen K.; Tonder N.; Hoest N.; Arpi M.; Dalsgaard M.; Chehri
M.; Soerensen L.L.; Fanoe S.; Junge S.; Hoest U.; Valeur N.; Lauridsen
T.K.; Fosbol E.; Hoi-Hansen T.; Bruun N.E.
Institution
(Dahl, Iversen, Dalsgaard, Soerensen, Lauridsen, Hoi-Hansen, Bruun)
Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen,
Denmark
(Dahl, Hoest, Valeur) Department of Cardiology, Bispebjerg Hospital,
Copenhagen, Denmark
(Tonder) Department of Cardiology, Nordsjaellands Hospital, Hillerod,
Denmark
(Arpi) Department of Clinical Microbiology, Herlev Gentofte University
Hospital, Copenhagen, Denmark
(Chehri) Department of Clinical Microbiology, Hvidovre University
Hospital, Hvidovre, Denmark
(Fanoe, Fosbol) Department of Cardiology, Hvidovre University Hospital,
Hvidovre, Denmark
(Junge, Hoest) Department of Cardiology, University Hospital Glostrup,
Glostrup, Denmark
(Fosbol) Department of Cardiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Bruun) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Bruun) Clinical Institute, Copenhagen University, Copenhagen, Denmark
(Bruun) Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
Publisher
Elsevier USA
Abstract
Background: Enterococcus faecalis is the third most frequent cause of
infective endocarditis (IE). Despite this, no systematic prospective
echocardiography studies have examined the prevalence of IE in patients
with E. faecalis bacteremia. <br/>Objective(s): This study sought to
determine the prevalence of IE in patients with E. faecalis bacteremia.
The secondary objective was to identify predictors of IE. <br/>Method(s):
From January 1, 2014, to December 31, 2016, a prospective multicenter
study was conducted with echocardiography in consecutive patients with E.
faecalis bacteremia. Predictors of IE were assessed using multivariate
logistic regression with backward elimination. <br/>Result(s): A total of
344 patients with E. faecalis bacteremia were included, all examined using
echocardiography, including transesophageal echocardiography in 74% of the
cases. The patients had a mean age of 74.2 years, and 73.5% were men.
Definite endocarditis was diagnosed in 90 patients, resulting in a
prevalence of 26.1 +/- 4.6% (95% confidence interval [CI]). Risk factors
for IE were prosthetic heart valve (odds ratio [OR]: 3.93; 95% CI: 1.76 to
8.77; p = 0.001), community acquisition (OR: 3.35; 95% CI: 1.74 to 6.46; p
< 0.001), >=3 positive blood culture bottles (OR: 3.69; 95% CI: 1.88 to
7.23; p < 0.001), unknown portal of entry (OR: 2.36; 95% CI: 1.26 to 4.40;
p = 0.007), monomicrobial bacteremia (OR: 2.73; 95% CI: 1.23 to 6.05; p =
0.013), and immunosuppression (OR: 2.82; 95% CI: 1.20 to 6.58; p = 0.017).
<br/>Conclusion(s): This study revealed a high prevalence of 26% definite
IE in patients with E. faecalis bacteremia, suggesting that
echocardiography should be considered in all patients with E. faecalis
bacteremia.<br/>Copyright &#xa9; 2019 American College of Cardiology
Foundation

<4>
Accession Number
628615134
Title
Systematic literature review on the economic, humanistic, and societal
burden of heart failure in children and adolescents.
Source
Expert Review of Pharmacoeconomics and Outcomes Research. 19 (4) (pp
397-408), 2019. Date of Publication: 04 Jul 2019.
Author
Burch M.; Nallagangula T.K.; Nic Lochlainn E.; Severin T.; Thakur L.;
Jaecklin T.; George A.T.; Solar-Yohay S.; Rossano J.W.; Shaddy R.E.
Institution
(Burch) Cardiorespiratory Division, Great Ormond Street Hospital for
Children, London, United Kingdom
(Nallagangula, Thakur, George) Health Economics and Outcomes Research,
Novartis Healthcare Pvt. Ltd, Hyderabad, India
(Nic Lochlainn) Cardio-Metabolic Franchise, Novartis Pharma AG, Basel,
Switzerland
(Severin) Cardio-Metabolic Development Unit, Novartis Pharma AG, Basel,
Switzerland
(Jaecklin) Global Clinical Development, Mirum Pharmaceuticals AG, Basel,
Switzerland
(Solar-Yohay) Cardio-Metabolic Development Unit, Novartis Pharmaceuticals
Corporation, East Hanover, NJ, United States
(Rossano) Pediatric Cardiology, Children's Hospital of Philadelphia,
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,
United States
(Shaddy) Pediatric Cardiology, Children's Hospital Los Angeles and Keck
School of Medicine of USC, Los Angeles, CA, United States
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Unlike the adult heart failure (HF) patient population,
there is scarce information on the overall burden of HF in the pediatric
population across geographies and within different age groups. Areas
covered: A systematic review aims to describe and quantify the economic,
humanistic, and societal burden of pediatric (age <18 years) HF on
patients and caregivers. Eighteen published studies over a period of 10
years (1 January 2006-20 May 2016) were identified through Embase,
Medline, Cochrane Library and selected congresses. Studies from the US
reported higher HF-related hospitalization-rates in infants aged <1 year
(49.3%-63.9%) versus children aged 1-12 years (18.7%-30.9%) in HF
diagnosed patients. Across the studies, the average length of hospital
stay was 15 days, increasing to 26 days for infants. Average annual
hospital charges were higher for infants (US$176,000) versus children aged
1-10 years (US$132,000) in the US. In Germany, diagnosis-related group
(DRG)-based hospital-allowances per HF-case increased from 3,498 in 1995
to 4,250 in 2009. Expert opinion: To our knowledge, this is the first
systematic review, which provides valuable insights into the burden of HF
in children and adolescents, and strengthens current knowledge of
pediatric HF. However, there is a need for larger population-based studies
with wider geographical coverage.<br/>Copyright &#xa9; 2019, &#xa9; 2019
Informa UK Limited, trading as Taylor & Francis Group.

<5>
Accession Number
625786248
Title
Outcomes of multivessel vs culprit lesion-only percutaneous coronary
intervention in patients with acute myocardial infarction complicated by
cardiogenic shock: Evidence from an updated meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 94 (1) (pp 70-81), 2019.
Date of Publication: 01 Jul 2019.
Author
Kundu A.; Sardar P.; Kakouros N.; Malhotra R.; Kolte D.; Feldman D.N.;
Abbott J.D.; Fisher D.Z.
Institution
(Kundu, Kakouros, Malhotra, Fisher) Division of Cardiovascular Medicine,
University of Massachusetts Medical School, Worcester, MA, United States
(Sardar, Abbott) Division of Cardiovascular Medicine, Brown University,
Providence, RI, United States
(Kolte) Division of Cardiovascular Medicine, Massachusetts General
Hospital, Boston, MA, United States
(Feldman) Division of Cardiovascular Medicine, Weill Cornell Medical
College, New York, NY, United States
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This updated meta-analysis evaluated outcomes with
multi-vessel (MV-PCI) vs culprit lesion-only percutaneous coronary
intervention (CL-PCI), in patients with acute myocardial infarction (AMI)
complicated by cardiogenic shock (CS). <br/>Background(s): There is
considerable debate regarding the optimal revascularization strategy in
patients with AMI and CS, particularly regarding management of non-culprit
lesions. <br/>Method(s): Databases were searched for studies comparing
MV-PCI and CL-PCI in patients with AMI and CS. The primary outcome of
interest was short-term all-cause mortality. Secondary outcomes included
long-term mortality, repeat revascularization and myocardial reinfarction.
Safety outcomes were stroke, acute renal failure and major bleeding.
Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated
using random-effects models. <br/>Result(s): Our meta-analysis consisting
of 14 studies (13 observational, 1 RCT) involving 8,552 patients showed
that in comparison to CL-PCI, MV-PCI was associated with similar
short-term mortality (OR 1.14; 95% CI 0.9-1.43), as well as similar
long-term mortality (OR 0.94; 95% CI 0.68-1.28). There was no significant
difference in the risk of myocardial reinfarction (OR 1.19; 95% CI
0.76-1.86), or repeat revascularization (OR 0.79; 95% CI 0.41-1.55)
between the two groups. Compared to CL-PCI, MV-PCI was associated with a
similar risk of bleeding (OR 1.13; 95% CI 0.91-1.40) and stroke (OR 1.28;
95% CI 0.84-1.96), but a higher risk of developing renal failure (OR 1.32;
95% CI 1.05-1.65). <br/>Conclusion(s): Our meta-analysis suggests that
there is a higher risk of renal failure with no additional benefit in
efficacy outcomes with MV-PCI, compared to CL-PCI in patients with AMI and
CS.<br/>Copyright &#xa9; 2018 Wiley Periodicals, Inc.

<6>
Accession Number
628577770
Title
Balloon-expandable transcatheter aortic valve implantation with or without
pre-dilation-results of a meta-analysis of 3 multicenter registries.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 172. Date of Publication: 19 Jul 2019.
Author
Ashauer J.O.; Bonaros N.; Kofler M.; Schymik G.; Butter C.; Romano M.;
Bapat V.; Strauch J.; Schrofel H.; Busjahn A.; Deutsch C.; Bramlage P.;
Kurucova J.; Thoenes M.; Baldus S.; Rudolph T.K.
Institution
(Ashauer, Baldus, Rudolph) Department of Cardiology, University of Cologne
Heart, Cologne, Germany
(Bonaros, Kofler) Department of Cardiac Surgery, Medical University
Innsbruck, Innsbruck, Austria
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital,
Karlsruhe, Germany
(Butter) Department of Cardiology, Immanuel Clinic Bernau, Heart Center
Brandenburg, Bernau, Germany
(Romano) Institut Hospitalier Jacques Cartier, Massy, France
(Bapat) Columbia University Medical, New York-Presbyterian Hospital, New
York, NY, United States
(Strauch) Clinic for Cardiosurgery and Thoracic Surgery,
Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil, Bochum,
Germany
(Schrofel) Department Cardiovascular Surgery, University Heart Center
Freiburg, Bad Krozingen, Germany
(Busjahn) Healthtwist GmbH, Berlin, Germany
(Deutsch, Bramlage) Institute for Pharmacology and Preventive Medicine,
Bahnhofstrasse 20, Cloppenburg 49661, Germany
(Kurucova) Edwards Lifesciences, Medical Affairs Professional Education,
Prague, Czechia
(Thoenes) Edwards Lifesciences, Medical Affairs Professional Education,
Nyon, Switzerland
(Rudolph) Department of Cardiology, Heart and Diabetes Center Bad
Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: To evaluate the outcomes of transcatheter aortic valve
implantation (TAVI) without balloon aortic valvuloplasty (BAV) in a
real-world setting through a patient-level meta-analysis. <br/>Method(s):
The meta-analysis included patients of three European multicenter,
prospective, observational registry studies that compared outcomes after
Edwards SAPIEN 3 or XT TAVI with (n = 339) or without (n = 355) BAV.
Unadjusted and adjusted pooled odds ratios (with 95% confidence intervals)
were calculated for procedural and 30-day outcomes. <br/>Result(s): Median
procedural time was shorter in the non-BAV group than in the BAV group (73
versus 93 min, p = 0.001), as was median fluoroscopy time (7 versus 11
min, p = 0.001). Post-delivery balloon dilation (15.5% versus 22.4%, p =
0.02) and catecholamine use (9.0% vs. 17.9%; p = 0.016) was required less
often in the non-BAV group than in the BAV group with the difference
becoming insignificant after multiple adjustment. There was a reduced risk
for periprocedural atrioventricular block during the intervention (1.4%
versus 4.1%, p = 0.035) which was non-significant after adjustment. The
rate of moderate/severe paravalvular regurgitation post-TAVI was 0.6% in
the no-BAV group versus 2.7% in the BAV group. There were no between-group
differences in the risk of death, stroke or other adverse clinical
outcomes at day 30. <br/>Conclusion(s): This patient-level meta-analysis
of real-world data indicates that TAVI performed without BAV is
advantageous as it has an adequate device success rate, reduced procedure
time and no adverse effects on short-term clinical outcomes.<br/>Copyright
&#xa9; 2019 The Author(s).

<7>
Accession Number
628410483
Title
Impact of large periprocedural myocardial infarction on mortality after
percutaneous coronary intervention and coronary artery bypass grafting for
left main disease: An analysis from the EXCEL trial.
Source
European Heart Journal. 40 (24) (pp 1930-1941), 2019. Date of Publication:
21 Jun 2019.
Author
Ben-Yehuda O.; Chen S.; Redfors B.; McAndrew T.; Crowley A.; Kosmidou I.;
Kandzari D.E.; Puskas J.D.; Morice M.-C.; Taggart D.P.; Leon M.B.; Lembo
N.J.; Brown W.M.; Simonton C.A.; Dressler O.; Kappetein A.P.; Sabik J.F.;
Serruys P.W.; Stone G.W.
Institution
(Ben-Yehuda, Chen, Redfors, McAndrew, Crowley, Kosmidou, Leon, Lembo,
Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, 1700 Broadway, New York, NY, United States
(Ben-Yehuda, Leon, Lembo, Stone) Division of Cardiology,
NewYork-Presbyterian Hospital, Columbia University Medical Center, New
York, NY, United States
(Kosmidou) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Kandzari, Brown) Piedmont Heart Institute, Atlanta, GA, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY,
United States
(Morice) Ramsay GCrossed D SignnCrossed D Signrale de SantCrossed D Sign,
Hopital PrivCrossed D Sign Jacques Cartier, Massy, France
(Taggart) Department Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Aims The prognostic implications of periprocedural myocardial infarction
(PMI) after percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG) remain controversial. We examined the 3-year rates
of mortality among patients with and without PMI undergoing left main
coronary artery intervention randomized to PCI with everolimus-eluting
stents vs. CABG in the large-scale, multicentre, prospective, randomized
EXCEL trial.By protocol, PMI was defined using an identical threshold for
PCI and CABG [creatinine kinase-MB (CK-MB) elevation <10x the upper
reference limit (URL) within 72 h post-procedure, or <5x URL with new
Q-waves, angiographic vessel occlusion, or loss of myocardium on imaging].
Cox proportional hazards modelling was performed controlling for age, sex,
hypertension, diabetes mellitus, left ventricular ejection fraction,
SYNTAX score, and chronic obstructive pulmonary disease (COPD). A total of
1858 patients were treated as assigned by randomization. Periprocedural MI
occurred in 34/935 (3.6%) of patients in the PCI group and 56/923 (6.1%)
of patients in the CABG group [odds ratio 0.61, 95% confidence interval
(CI) 0.40-0.93; P = 0.02]. Periprocedural MI was associated with SYNTAX
score, COPD, cross-clamp duration and total procedure duration, and not
using antegrade cardioplegia. By multivariable analysis, PMI was
associated with cardiovascular death and all-cause death at 3 years
[adjusted hazard ratio (HR) 2.63, 95% CI 1.19-5.81; P = 0.02 and adjusted
HR 2.28, 95% CI 1.22-4.29; P = 0.01, respectively]. The effect of PMI was
consistent for PCI and CABG for cardiovascular death (Pinteraction = 0.56)
and all-cause death (Pinteraction = 0.59). Peak post-procedure CK-MB<10x
URL strongly predicted mortality, whereas lesser degrees of myonecrosis
were not associated with prognosis. In the EXCEL trial, PMI was more
common after CABG than PCI, and was strongly associated with increased
3-year mortality after controlling for potential confounders. Only
extensive myonecrosis (CK-MB <10x URL) was prognostically
important.<br/>Copyright &#xa9;The Author(s) 2019.

<8>
Accession Number
625381923
Title
Literature review of apheresis procedures performed perioperatively in
cardiac surgery for ASFA category indications.
Source
Journal of Clinical Apheresis. 34 (4) (pp 474-479), 2019. Date of
Publication: August 2019.
Author
Kanellopoulou T.; Kostelidou T.
Institution
(Kanellopoulou, Kostelidou) Department of Clinical Hematology - Blood Bank
and Hemostasis, Onassis Cardiac Surgery Center, Kallithea, Greece
Publisher
Wiley-Liss Inc. (E-mail: info@wiley.com)
Abstract
Background: Perioperative therapeutic plasma exchange in patients with
cardiovascular diseases poses several challenges, including alterations in
intravascular volume, serum electrolytes, the coagulation cascade, and
drug pharmacokinetics. <br/>Method(s): This review article summarizes
different indications of plasma exchange for patients requiring cardiac
surgery based on reported case reports and case series. <br/>Result(s):
The most common reported indication is plasma exchange for the management
of allosensitized cardiac transplant candidate patients in combination
with immunosuppressive regimens, which increases the likelihood of
obtaining a cross-match-negative allograft, improving post-transplant
clinical outcome. The second most common indication is for patients with a
history of heparin-induced thrombocytopenia syndrome that permits the use
of heparin in cardiopulmonary bypass in an urgent cardiac surgery. Less
common indications are restoration of clotting factors for patients with
congenital bleeding disorders or removal of cold agglutinins. No severe
complications were described in reported cases. <br/>Conclusion(s):
Therapeutic plasma exchange is an effective and safe procedure that could
be performed preoperatively and intraoperatively in urgent cardiac surgery
for the management of antibody-mediated disorders including allosensitized
cardiac transplant candidate patients or patients with heparin-induced
thrombocytopenia syndrome.<br/>Copyright &#xa9; 2018 Wiley Periodicals,
Inc.

<9>
Accession Number
628451850
Title
Prognostic value of lipoprotein (a) level in patients with coronary artery
disease: A meta-analysis.
Source
Lipids in Health and Disease. 18 (1) (no pagination), 2019. Article
Number: 150. Date of Publication: 08 Jul 2019.
Author
Wang Z.; Zhai X.; Xue M.; Cheng W.; Hu H.
Institution
(Wang, Xue, Cheng, Hu) Department of Cardiology, Shandong Provincial
Qianfoshan Hospital, First Hospital Affiliated with Shandong First Medical
University, NO. 16766, Jingshi Road, Jinan city, Jinan Shandong Province
250014, China
(Zhai) Department of Geriatrics, Municipal Hospital of Zibo City, Zibo
City Shandong Province 255000, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Elevated lipoprotein (a) is recognized as a risk factor for
incident cardiovascular events in the general population and established
cardiovascular disease patients. However, there are conflicting findings
on the prognostic utility of elevated lipoprotein (a) level in patients
with coronary artery disease (CAD).Thus, we performed a meta-analysis to
evaluate the prognostic value of elevated lipoprotein (a) level in CAD
patients. <br/>Methods and Results: A systematic literature search of
PubMed and Embase databases was conducted until April 16, 2019.
Observational studies reporting the prognostic value of elevated
lipoprotein (a) level for cardiac events (cardiac death and acute coronary
syndrome), cardiovascular events (death, stroke, acute coronary syndrome
or coronary revascularisation), cardiovascular death, and all-cause
mortality in CAD patients were included. Pooled multivariable adjusted
risk ratio (RR) and 95% confidence interval (CI) for the highest vs. the
lowest lipoprotein (a) level were utilized to calculate the prognostic
value. Seventeen studies enrolling 283,328 patients were identified.
Meta-analysis indicated that elevated lipoprotein (a) level was
independently associated with an increased risk of cardiac events (RR
1.78; 95% CI 1.31-2.42) and cardiovascular events (RR 1.29; 95% CI
1.17-1.42) in CAD patients. However, elevated lipoprotein (a) level was
not significantly associated with an increased risk of cardiovascular
mortality (RR 1.43; 95% CI 0.94-2.18) and all-cause mortality (RR 1.35;
95% CI 0.93-1.95). <br/>Conclusion(s): Elevated lipoprotein (a) level is
an independent predictor of cardiac and cardiovascular events in CAD
patients. Measurement of lipoprotein (a) level has potential to improve
the risk stratification among patients with CAD.<br/>Copyright &#xa9; 2019
The Author(s).

<10>
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.
<br/>Objective(s): The purpose of this study was to determine whether
intraoperative methylprednisolone improves post-operative recovery in
neonates undergoing cardiac surgery. <br/>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). <br/>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). <br/>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.<br/>Copyright &#xa9; 2019 American College
of Cardiology Foundation

<11>
Accession Number
628515386
Title
Effects of curcuminoids on myocardial injury after percutaneous coronary
intervention.
Source
Journal of Medicinal Food. 22 (7) (pp 680-684), 2019. Date of Publication:
July 2019.
Author
Phrommintikul A.; Chanchai R.; Wongcharoen W.
Institution
(Phrommintikul, Chanchai, Wongcharoen) Division of Cardiology, Department
of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110,
Sriphoom, Muang, Chiang Mai 50200, Thailand
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
The rise of cardiac troponin post-percutaneous coronary intervention (PCI)
is associated with a high risk of long-term cardiovascular events.
Previous studies have shown that curcuminoids decreased myocardial injury
post-coronary bypass graft surgery through anti-oxidant and
anti-inflammatory effects. We sought to examine whether curcuminoids could
prevent PCI-related myocardial injury. One-hundred enrolled patients
receiving elective PCI were randomized to obtain curcuminoids or placebo 4
g/day at least 1 day before and after the scheduled PCI. Cardiac
troponin-T and 12-lead electrocardiogram were evaluated before PCI and at
24 and 48 h post-PCI. The definitions of PCI-related myocardial injury and
myocardial infarction were in line with the third universal definition of
myocardial infarction. Baseline characteristics of patients and procedures
did not differ between the curcuminoids and placebo groups. The mean age
was 63.9 +/- 10.8 years. The incidence of PCI-related myocardial injury
was not different between curcuminoids and placebo groups (32% vs. 38%, P
= .675). The peak high-sensitive cardiac troponin T levels after PCI were
not different between the curcuminoids and placebo groups (201.0 +/- 547.0
ng/L vs. 187.0 +/- 703.9 ng/L respectively, P = .912). Further, the
high-sensitive C-reactive protein levels post-PCI were similar in patients
receiving curcuminoids and placebo (7.2 +/- 18.8 mg/dL vs. 6.6 +/- 17.5
mg/dL, respectively, P = .873). We found that short-term treatment with
curcuminoids did not reduce the occurrence of PCI-related myocardial
injury. We did not observe the role of anti-oxidative and
anti-inflammatory effects of curcuminoids in the PCI-related myocardial
injury.<br/>&#xa9; Copyright 2019, Mary Ann Liebert, Inc., publishers, and
Korean Society of Food Science and Nutrition 2019.

<12>
Accession Number
2001790781
Title
Vitamin C can shorten the length of stay in the ICU: A meta-analysis.
Source
Nutrients. 11 (4) (no pagination), 2019. Article Number: 708. Date of
Publication: April 2019.
Author
Hemila H.; Chalker E.
Institution
(Hemila) Department of Public Health, University of Helsinki, POB 41,
Helsinki FI-00014, Finland
(Chalker) School of Public Health, University of Sydney, Sydney 2006,
Australia
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
A number of controlled trials have previously found that in some contexts,
vitamin C can have beneficial effects on blood pressure, infections,
bronchoconstriction, atrial fibrillation, and acute kidney injury.
However, the practical significance of these effects is not clear. The
purpose of this meta-analysis was to evaluate whether vitamin C has an
effect on the practical outcomes: length of stay in the intensive care
unit (ICU) and duration of mechanical ventilation. We identified 18
relevant controlled trials with a total of 2004 patients, 13 of which
investigated patients undergoing elective cardiac surgery. We carried out
the meta-analysis using the inverse variance, fixed effect options, using
the ratio of means scale. In 12 trials with 1766 patients, vitamin C
reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%;
p = 0.00003). In six trials, orally administered vitamin C in doses of 1-3
g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p
= 0.003). In three trials in which patients needed mechanical ventilation
for over 24 hours, vitamin C shortened the duration of mechanical
ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the
insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth
exploring. The effects of vitamin C on ICU patients should be investigated
in more detail.<br/>Copyright &#xa9; 2019 by the authors. Licensee MDPI,
Basel, Switzerland.

<13>
Accession Number
2002236494
Title
Accuracy of urinary kidney injury molecule-1 in predicting acute kidney
injuries associated with cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 12 (6) (pp
6570-6578), 2019. Date of Publication: 2019.
Author
Wang H.; Wang W.-J.; Zhou C.-C.; Cen D.
Institution
(Wang, Zhou, Cen) Department of Laboratory Test, Yinzhou Second Hospital,
Ningbo, Zhejiang Province, China
(Wang) Ningbo College of Health Sciences, Ningbo, Zhejiang Province, China
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objectives: Urinary kidney injury molecule-1 (uKIM-1) is a very promising
diagnostic biomarker for acute kidney injuries (AKI), but its accuracy has
varied widely in different studies. The current study reviewed clinical
observation studies, investigating the accuracy of uKIM-1 in predicting
AKI associated with cardiac surgery. <br/>Method(s): Central, PubMed,
Embase, and Congress abstracts databases were searched for studies
reporting uKIM-1 levels predicting AKI after cardiac surgery. Standardized
data sheets were used to perform a meta-analysis of diagnostic studies.
Bivariate and hierarchical summary models were used to calculate
diagnostic odds ratios (DOR) and areas under the curve for the
receiver-operating characteristic (AUROC). <br/>Result(s): Analysis
included 15 observational studies in 7 countries, with a total of 4,120
patients. Of these, 983 (23.9%) developed AKI. The DOR of uKIM-1 was 2.4,
with a sensitivity of 0.76, specificity of 0.84, and an AUROC of 0.71.
Levels of uKIM-1 in adults (DOR: 3.7, AUROC: 0.79) and children (DOR: 2.6,
AUROC: 0.76) were predicted to be more accurate than those in infants
(DOR: 1.5, AUROC: 0.60). Moreover, the accuracy of using standardized
detection of uKIM-1 (DOR: 2.5, AUROC: 0.78) was significantly higher than
that of the research-based assay (DOR: 1.8, AUROC: 0.71).
<br/>Conclusion(s): Levels of uKIM-1 can be used to diagnose AKI
associated with cardiac surgery, with high sensitivity and
specificity.<br/>Copyright &#xa9; 2019, E-Century Publishing Corporation.
All rights reserved.

<14>
Accession Number
2000877776
Title
Improving informed consent in cardiac surgery by enhancing preoperative
education.
Source
Patient Education and Counseling. 101 (12) (pp 2047-2053), 2018. Date of
Publication: December 2018.
Author
Villanueva C.; Talwar A.; Doyle M.
Institution
(Villanueva, Talwar) Cardiothoracic Surgery Unit, Royal North Shore
Hospital, Sydney, Australia
(Villanueva) Conjoint Lecturer University of New South Wales, Sydney,
Australia
(Doyle) Cardiothoracic Surgery Unit, St George Hospital, Sydney, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To investigate the effect of enhancing preoperative education
in improving recall and understanding of a surgical procedure and its
application to the informed consent process in cardiac surgery.
<br/>Method(s): Four electronic database searches were performed from
January 2000 to August 2017. A total of 282 articles were identified from
which 22 prospective studies assessing an intervention were selected
according to predefined selection criteria. <br/>Result(s): Most articles
that used additional written information and all that used multimedia
presentations to enhance informed consent showed that their intervention
improved risk recall and patient's understanding of the procedure. A
single randomised controlled trial in cardiac surgery showed that
audiotaped consultations improved patient's knowledge of the operation.
<br/>Conclusion(s): Patient recall and understanding of pre-operative
information can significantly improve with a variety of educational tools.
Procedure-specific forms with or without illustrations as well as
interactive multimedia interventions enhance patient recall and
understanding of information. In cardiac surgery patients, interventions
need to meet patients' preferences, be repetitive on crucial points and
consider the nature of the procedure.<br/>Copyright &#xa9; 2018 Elsevier
B.V.

<15>
Accession Number
624732967
Title
A double-blind randomized controlled trial of the local application of
vancomycin versus ampicillin powder into the operative field for thoracic
and/or lumbar fusions.
Source
Journal of Neurosurgery: Spine. 29 (5) (pp 553-559), 2018. Date of
Publication: November 2018.
Author
Takeuchi M.; Wakao N.; Kamiya M.; Hirasawa A.; Murotani K.; Takayasu M.
Institution
(Takeuchi, Wakao, Kamiya, Hirasawa, Takayasu) Spine Center, Aichi Medical
University Hospital, Nagakute, Japan
(Takeuchi, Takayasu) Department of Neurological Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Wakao, Kamiya, Hirasawa) Department of Orthopedics Surgery, Aichi Medical
University Hospital, Nagakute, Japan
(Murotani) Division of Biostatistics, Clinical Research Center, Aichi
Medical University Hospital, Nagakute, Japan
(Takeuchi) Department of Spine Surgery, Aichi Spine Hospital, Inuyama,
Aichi, Japan
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE Retrospective studies have reported that the local application
of vancomycin (VCM) powder into the operative field decreases the
incidence of surgical site infection (SSI) in thoracic and/or lumbar
fusion. Authors of the present study prospectively evaluated the effects
of VCM in patients undergoing thoracic and/or lumbar fusion. METHODS In
this randomized double-blind trial, 230 patients undergoing thoracic
and/or lumbar fusion were randomly assigned to the local administration of
VCM (interventional group, 1 g) or ampicillin (AMP; control group, 1 g)
into the surgical field. The primary outcome was SSI results within 1 year
of surgery. RESULTS The trial was prematurely stopped according to
predetermined rules. The results showed one superficial infection (0.9%,
Staphylococcus aureus) and one deep infection (0.9%, S. aureus) in the VCM
group and two superficial infections (1.8%, Staphylococcus epidermidis and
culture negative) and one deep infection (0.9%, methicillin-resistant S.
aureus) in the AMP group. No significant differences in infection rates
were observed between the groups (p = 0.8). CONCLUSIONS This double-blind
randomized controlled trial demonstrated that the local application of VCM
or AMP powder into the operative field in short thoracic and/or lumbar
fusion procedures resulted in a similar incidence of SSI. CLASSIFICATION
OF EVIDENCE Type of question: therapeutic; study design: randomized
controlled trial; evidence: class III. Clinical trial registration no.:
UMIN000009377 (umin.ac.jp/ctr).<br/>Copyright &#xa9; AANS 2018.

<16>
Accession Number
628283112
Title
Comparison between hemodynamic effects of propofol and thiopental during
general anesthesia induction with remifentanil infusion: a double-blind,
age-stratified, randomized study.
Source
Journal of Anesthesia. 33 (4) (pp 509-515), 2019. Date of Publication: 20
Aug 2019.
Author
Hino H.; Matsuura T.; Kihara Y.; Tsujikawa S.; Mori T.; Nishikawa K.
Institution
(Hino, Matsuura, Kihara, Tsujikawa, Mori, Nishikawa) Department of
Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7
Asahimachi, Abeno-ku, Osaka 545-8586, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: Propofol is commonly used with remifentanil for induction of
general anesthesia (GA); however, it often leads to hypotension.
Intraoperative hypotension is associated with postoperative adverse
events. By contrast, thiopental has less negative inotropic effects on
hemodynamics compared to propofol, which could be suitable to prevent
hypotension during GA induction. In the present age-stratified,
randomized, assessor-blinded study, using the ClearSight
system, we compared the hemodynamic effects of propofol and thiopental
during GA induction under remifentanil infusion in non-cardiac surgery.
<br/>Method(s): Patients were divided into young (20-40 year), middle
(41-70 year), and elderly (> 70 year) groups (n = 20, each group). General
anesthesia was induced with remifentanil 0.3 mug/kg/min, followed by
propofol (2.0, 1.5, and 1.2 mg/kg) or thiopental (5.0, 4.0, and 3.0 mg/kg)
in the young, middle, and elderly groups, respectively. The primary
outcome was the difference in the decrease in mean arterial blood pressure
between patients receiving propofol and thiopental in each age group. The
secondary outcomes included other hemodynamic parameters and minimal
bispectral index values measured up to 10 min after tracheal intubation.
<br/>Result(s): The decrease in mean arterial blood pressure was greater
in patients receiving propofol than those receiving thiopental (- 45.4 vs
- 26.6 mmHg and - 45.7 vs - 28.9 mmHg, P = 0.003 and 0.007, respectively),
whereas no significant difference was observed in the young age group (P =
0.96). <br/>Conclusion(s): Thiopental is a more suitable agent than
propofol for avoiding hypotension during GA induction under remifentanil
infusion in the middle and elderly patients.<br/>Copyright &#xa9; 2019,
Japanese Society of Anesthesiologists.

<17>
Accession Number
2002368801
Title
Pre-operative stress testing in the evaluation of patients undergoing
non-cardiac surgery: A systematic review and meta-analysis.
Source
PLoS ONE. 14 (7) (no pagination), 2019. Article Number: e0219145. Date of
Publication: 2019.
Author
Kalesan B.; Nicewarner H.; Intwala S.; Leung C.; Balady G.J.
Institution
(Kalesan) Department of Medicine and Community Health Sciences, Boston
University, School of Medicine and Public Health, Boston, MA, United
States
(Nicewarner, Intwala, Leung, Balady) Department of Medicine, Boston
Medical Center, Boston University Medical Campus, Boston, MA, United
States
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Pre-operative stress testing is widely used to evaluate
patients for non-cardiac surgeries. However, its value in predicting
peri-operative mortality is uncertain. The objective of this study is to
assess the type and quality of available evidence in a comprehensive and
statistically rigorous evaluation regarding the effectiveness of
pre-operative stress testing in reducing 30-day post -operative mortality
following non -cardiac surgery. Methods The databases of MEDLINE, EMBASE,
and CENTRAL databases (from inception to January 27, 2016) were searched
for all studies in English. We included studies with pre-operative stress
testing prior to 10 different non-cardiac surgery among adults and
excluded studies with sample size<15. The data on study characteristics,
methodology and outcomes were extracted independently by two observers and
checked by two other observers. The primary outcome was 30-day mortality.
We performed random effects meta-analysis to estimate relative risk (RR)
and 95% confidence intervals (95% CI) in two-group comparison and pooled
the rates for stress test alone. Heterogeneity was assessed using I2 and
methodological quality of studies using Newcastle-Ottawa Quality
Assessment Scale. The predefined protocol was registered in PROSPERO
#CRD42016049212. Results From 1807 abstracts, 79 studies were eligible
(297,534 patients): 40 had information on 30- day mortality, of which 6
studies compared stress test versus no stress test. The risk of 30- day
mortality was not significant in the comparison of stress testing versus
none (RR: 0.79, 95% CI = 0.35-1.80) along with weak evidence for
heterogeneity. For the studies that evaluated stress testing without a
comparison group, the pooled rates are 1.98% (95% CI = 1.25- 2.85) with a
high heterogeneity. There was evidence of potential publication bias and
small study effects. Conclusions Despite substantial interest and research
over the past 40 years to predict 30-day mortality risk among patients
undergoing non-cardiac surgery, the current body of evidence is
insufficient to derive a definitive conclusion as to whether stress
testing leads to reduced perioperative mortality.<br/>Copyright &#xa9;
2019 Kalesan et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<18>
Accession Number
2002367508
Title
Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT):
Feasibility of a Pilot Randomized Controlled Trial.
Source
Journal of Cardiac Failure. (no pagination), 2019. Date of Publication:
2019.
Author
Grady K.L.; Andrei A.-C.; Shankel T.; Chinnock R.; Miyamoto S.D.;
Ambardekar A.V.; Anderson A.; Addonizio L.; Latif F.; Lefkowitz D.;
Goldberg L.R.; Hollander S.A.; Pham M.; Van't Hof K.; Weissberg-Benchell
J.; Yancy C.; Liu M.; Melody N.; Pahl E.
Institution
(Grady, Andrei, Liu) Department of Surgery, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Shankel, Chinnock) Department of Medicine, Loma Linda University
Children's Hospital, Loma Linda, CA, United States
(Miyamoto) Department of Medicine, Children's Hospital Colorado, Aurora,
CO, United States
(Ambardekar) Department of Medicine, University of Colorado, Aurora, CO,
United States
(Anderson, Yancy) Department of Medicine, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Addonizio, Latif) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Lefkowitz) Department of Psychiatry, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Goldberg) Department of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Hollander, Pham) Department of Medicine, Stanford University, Palo Alto,
CA, United States
(Van't Hof, Pahl) Department of Medicine, Ann & Robert H. Lurie Children's
Hospital of Chicago, Chicago, IL, United States
(Weissberg-Benchell) Department of Psychiatry, Ann & Robert H. Lurie
Children's Hospital of Chicago, Chicago, IL, United States
(Melody) Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL,
United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Young-adult heart transplant recipients transferring to adult
care are at risk for poor health outcomes. We conducted a pilot randomized
controlled trial to determine the feasibility of and to test a transition
intervention for young adults who underwent heart transplantation as
children and then transferred to adult care. <br/>Method(s): Participants
were randomized to the transition intervention (4 months long, focused on
heart-transplant knowledge, self-care, self-advocacy, and social support)
or usual care. Self-report questionnaires and medical records data were
collected at baseline and 3 and 6 months after the initial adult clinic
visit. Longitudinal analyses comparing outcomes over time were performed
using generalized estimating equations and linear mixed models.
<br/>Result(s): Transfer to adult care was successful and feasible (ie,
excellent participation rates). The average patient standard deviation of
mean tacrolimus levels was similar over time in both study arms and < 2.5,
indicating adequate adherence. There were no between-group or within-group
differences in percentage of tacrolimus bioassays within target range (>
50%). Average overall adherence to treatment was similarly good in both
groups. Rates of appointment keeping through 6 months after transfer
declined over time in both groups. <br/>Conclusion(s): The feasibility of
the study was demonstrated. Our transition intervention did not improve
outcomes.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<19>
Accession Number
628019094
Title
Sex-mismatched red blood cell transfusions and mortality: A systematic
review and meta-analysis.
Source
Vox Sanguinis. 114 (5) (pp 505-516), 2019. Date of Publication: July 2019.
Author
Zeller M.P.; Rochwerg B.; Jamula E.; Li N.; Hillis C.; Acker J.P.;
Runciman R.J.R.; Lane S.J.; Ahmed N.; Arnold D.M.; Heddle N.M.
Institution
(Zeller, Jamula, Li, Hillis, Runciman, Lane, Ahmed, Arnold, Heddle)
McMaster Centre for Transfusion Research, McMaster University, Hamilton,
ON, Canada
(Zeller) Canadian Blood Services, Medical Office, Hamilton, ON, Canada
(Zeller, Arnold, Heddle) Division of Hematology and Thromboembolism,
Department of Medicine, McMaster University, Hamilton, ON, Canada
(Rochwerg) Division of Critical Care, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Rochwerg) Department of Health Research Methods, Evidence & Impact,
McMaster University, Hamilton, ON, Canada
(Hillis) Department of Oncology, McMaster University, Hamilton, ON, Canada
(Acker) Department of Laboratory Medicine and Pathology, University of
Alberta, Edmonton, AB, Canada
(Acker) Centre for Innovation, Canadian Blood Services, Edmonton, AB,
Canada
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: Selection of a compatible red blood cell (RBC)
unit does not include matching for donor sex. This systematic review and
meta-analysis aims to summarize the evidence examining the impact of
sex-mismatched RBC transfusion on recipient mortality. <br/>Material(s)
and Method(s): Ovid MEDLINE, Ovid EMBASE, CINAHL, PubMed, Web of Science
and the Cochrane Database of Systematic Reviews were searched from
inception up to 23 November 2018. Randomized controlled trials and
observational studies were included in the search. Eligible studies
reported on the impact of sex-matched compared to sex-mismatched RBC
transfusion on recipient mortality. Two investigators independently
extracted data and assessed study quality. A three-level meta-analytic
model was applied to emphasize the unknown dependence among the effect
sizes. <br/>Result(s): Five retrospective observational studies (n = 86
737) were included; no RCTs were found. Sex-mismatched RBC transfusions
were associated with a higher risk of death compared with sex-matched
transfusions (pooled hazard ratio [HR]: 1.13; 95% confidence interval
[CI]: 1.02-1.24). In the subgroup of cardiovascular surgery (n = 57 712),
there was no significant increase in mortality with sex-mismatched
transfusions (pooled HR: 1.08; 95% CI: 0.95-1.22). The data were prone to
confounding, selection bias and reporting bias. Certainty of the evidence
was very low. <br/>Conclusion(s): Sex-mismatched RBC transfusions were
associated with an increased risk of death in this pooled analysis.
However, the certainty of the evidence was very low from observational
studies. The need to match donor and recipient sex for transfusions
requires further investigation because of the potential widespread
impact.<br/>Copyright &#xa9; 2019 International Society of Blood
Transfusion

<20>
Accession Number
628021464
Title
Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery
Bypass Grafting with or without Surgical Ventricular Reconstruction in the
Surgical Treatment for Ischemic Heart Failure (STICH) Trial.
Source
Structural Heart. 3 (4) (pp 302-308), 2019. Date of Publication: 04 Jul
2019.
Author
Tsang M.Y.C.; She L.; Miller F.A.; Choi J.-O.; Michler R.E.; Grayburn
P.A.; Bonow R.O.; Menicanti L.; Deja M.A.; Castelvecchio S.; Rao V.; Smith
P.K.; Kukulski T.; Sopko G.; Prior D.L.; Velazquez E.J.; Lee K.L.; Oh J.K.
Institution
(Tsang, Miller, Choi, Oh) Division of Cardiovascular Diseases,
Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN, United
States
(Tsang) Division of Cardiology, Department of Medicine, University of
British Columbia, Vancouver, BC, Canada
(She, Smith, Lee) Duke Clinical Research Institute and Departments of
Surgery (PKS), Medicine (EJV), and Biostatistics and Bioinformatics (KLL),
Duke University School of Medicine, Durham, NC, United States
(Choi, Oh) Division of Cardiology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Michler) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, New York City, NY,
United States
(Grayburn) Department of Internal Medicine, Cardiology Section, Baylor
University Medical Center, Dallas, TX, United States
(Bonow) Cardiology Division, Department of Medicine, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Menicanti, Castelvecchio) Department of Cardiac Surgery, IRCCS
Policlinico San Donato, Milan, Italy
(Deja) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Rao) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University of Toronto, Toronto, ON, Canada
(Kukulski) Department of Cardiology, Congenital Heart Disease and
Electrotherapy, Medical University of Silesia, Silesian Center for Heart
Diseases, Zabrze, Poland
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Prior) Department of Medicine, St. Vincent's Hospital, University of
Melbourne, Melbourne, Australia
(Velazquez) Section of Cardiovascular Medicine, Yale School of Medicine,
Hew Haven, CT, United States
Publisher
Taylor and Francis Inc. (E-mail: customerservice@taylorandfrancis.com)
Abstract
Background: This study examined the impact of mitral valve repair (MVRe)
on survival of patients with moderate or severe (>=2+) MR and ischemic
cardiomyopathy randomized to coronary artery bypass grafting (CABG) versus
CABG+surgical ventricular reconstruction (SVR) in the STICH trial.
<br/>Method(s): Among patients with moderate or severe MR and ischemic
cardiomyopathy undergoing CABG or CABG+SVR, the impact of MVRe on
mortality between the two treatment arms was compared. <br/>Result(s):
Among 867 patients with assessment of baseline MR severity, 211 had
moderate or severe MR. After excluding 7 patients who underwent mitral
valve replacement, 50, 44, 62, and 48 patients underwent CABG, CABG+MVRe,
CABG+SVR, and CABG+SVR+MVRe, respectively. Four-year mortality rates were
lower following CABG+MVRe than CABG alone (16% vs. 55%; adjusted hazard
ratio [HR] 0.30; 95% CI 0.13-0.71). In contrast, the CABG+SVR+MVRe and
CABG+SVR groups had similar 4-year mortality of 39% vs. 39% (adjusted HR
0.88; 95% CI 0.46-1.70). MVRe had a more favorable effect on survival in
patients undergoing CABG alone compared to CABG+SVR (p = 0.013). Baseline
MR severity was similar between patients that received CABG+MVRe and those
that underwent CABG+SVR+MVRe. A larger proportion of patients demonstrated
a reduction in MR between 4 and 24 months after CABG+MVRe compared to
CABG+SVR+MVRe (50.0% versus 25.0%, p = 0.023). <br/>Conclusion(s): In
patients with moderate or severe MR and ischemic cardiomyopathy undergoing
CABG, MVRe appears to have a favorable effect on survival. The addition of
SVR to CABG may attenuate the anticipated benefits of MVRe by limiting the
long-term reduction of MR with MVRe.<br/>Copyright &#xa9; 2019, &#xa9;
2019 Cardiovascular Research Foundation.

<21>
Accession Number
627519106
Title
The efficacy and safety of prophylactic use of levosimendan on patients
undergoing coronary artery bypass graft: a systematic review and
meta-analysis.
Source
Journal of Anesthesia. 33 (4) (pp 543-550), 2019. Date of Publication: 20
Aug 2019.
Author
Wang W.; Zhou X.; Liao X.; Liu B.; Yu H.
Institution
(Wang, Zhou, Liu, Yu) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu, Sichuan 610041, China
(Liao) Department of Urology, Institute of Urology, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Prophylactic use of levosimendan in cardiac surgery remains controversial
and no meta-analysis has been done exclusively about that in patients
undergoing coronary artery bypass graft (CABG) surgery. We conducted this
systematic review and meta-analysis of levosimendan in CABG using PubMed,
Embase, Scopus, and Cochrane Library (till April 20, 2018). Two-hundred
and forty manuscripts were identified and 21 randomized trials (1727
patients in total) investigating the effect of levosimendan on the
patients undergoing CABG surgery were finally included in this analysis.
We found that levosimendan was an effective, well-tolerated inotropic
agent in CABG, which was associated with a significantly reduced mortality
rate [odds ratio (OR) 0.43, 95% confidence interval (CI) (0.26, 0.71), p =
0.001, I² = 0%] and postoperative atrial fibrillation [OR 0.50,
95% CI (0.26, 0.97), p = 0.04, I² = 76%], but a higher
incidence of hypotension [OR 2.26, 95% CI (1.05, 4.85), p = 0.04,
I² = 79%]. Subgroup analyses revealed that such a benefit was
mainly observed in the isolated CABG, the preoperative administration,
with-bolus and on-pump subgroups. More high-quality and well-designed
prospective studies are needed to confirm or disprove our findings in
future.<br/>Copyright &#xa9; 2019, Japanese Society of Anesthesiologists.

<22>
Accession Number
627513114
Title
The effects of five days of intensive preoperative inspiratory muscle
training on postoperative complications and outcome in patients having
cardiac surgery: a randomized controlled trial.
Source
Clinical rehabilitation. 33 (5) (pp 913-922), 2019. Date of Publication:
01 May 2019.
Author
Chen X.; Hou L.; Zhang Y.; Shao B.; Yuan B.; Li J.; Li M.; Cheng H.; Teng
L.; Guo M.; Wang Z.; Chen T.; Liu J.; Liu Y.; Liu Z.; Liu X.; Guo Q.
Institution
(Chen, Hou, Zhang, Liu, Shao, Yuan, Li, Guo) Department of Rehabilitation
Medicine, TEDA International Cardiovascular Hospital, Cardiovascular
Clinical College of Tianjin Medical University, Tianjin, China
(Chen, Hou, Zhang, Guo) Department of Rehabilitation Medicine, Tianjin
Medical University, Tianjin, China
(Li, Cheng, Teng, Guo, Wang, Chen, Liu, Liu, Liu, Liu) Department of
Cardiac Surgery, TEDA International Cardiovascular Hospital,
Cardiovascular Clinical College of Tianjin Medical University, Tianjin,
China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine the prophylactic efficacy of short-term intensive
preoperative inspiratory muscle training on the incidence of postoperative
pulmonary complications in patients scheduled for cardiac surgery. DESIGN:
Single-blind, randomized controlled pilot study. SETTING: TEDA
International Cardiovascular Hospital, China. SUBJECTS: In total, 197
subjects aged 50years scheduled for cardiac surgery were selected.
INTERVENTION: The intervention group ( n=98) received five days of
preoperative inspiratory muscle training on top of the usual care received
by the patients in the control group ( n=99). MAIN MEASURES: The primary
outcome variable was the occurrence of postoperative pulmonary
complications. The secondary outcome variables were inspiratory muscle
strength, lung function and length of hospitalization. <br/>RESULT(S):
After cardiac surgery, a total of 10 (10.2%) of the 98 patients in the
intervention group and 27 (27.3%) of 99 patients in the control group had
postoperative pulmonary complications (risk ratio, 0.23; 95% confidence
interval (CI), 0.09-0.58, P=0.002). The study revealed that, compared with
the control group, the intervention group had a significant increase in
inspiratory muscle strength (by 10.48cmH2O, P<0.001), forced expiratory
volume in the first second of expiration (FEV1) %predicted (by 3.75%,
P=0.030), forced vital capacity (FVC) %predicted (by 4.15%, P=0.008) and
maximal voluntary ventilation (MVV) %predicted (by 6.44%, P=0.034). Length
of hospital stay was 7.51 (2.83) days in the intervention group and 9.38
(3.10) days in the control group ( P=0.039). <br/>CONCLUSION(S): A
five-day intensive pattern of preoperative inspiratory muscle training
reduced the incidence of postoperative pulmonary complications and
duration of postoperative hospitalization in patients undergoing cardiac
surgery.

<23>
Accession Number
2002097938
Title
Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve
Implantation Versus Surgical Aortic Valve Replacement in
Low-to-Intermediate Surgical Risk Cohort.
Source
American Journal of Cardiology. 124 (4) (pp 580-585), 2019. Date of
Publication: 15 August 2019.
Author
Ando T.; Ashraf S.; Villablanca P.; Kuno T.; Pahuja M.; Shokr M.; Afonso
L.; Grines C.; Briasoulis A.; Takagi H.
Institution
(Ando, Ashraf, Pahuja, Shokr, Afonso) Division of Cardiology, Wayne State
University/Detroit Medical Center, Detroit, MI, United States
(Villablanca) Henry Ford Hospital, Detroit, MI, United States
(Kuno) Mount Sinai Beth Israel, New York, NY, United States
(Grines) North Shore University Hospital, Hofstra Northwell School of
Medicine, Manhasset, NY, United States
(Briasoulis) University of Iowa Hospitals and Clinics, Iowa, IA, United
States
(Takagi) Shizuoka Medical Center, Shizuoka, Japan
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) has been used to treat high
surgical risk cohorts but has been expanded to treat low-to-intermediate
risk cohort as well. We performed a systematic review and meta-analysis to
compare the outcomes between TAVI and surgical aortic valve replacement
(SAVR) in low-to-intermediate risk cohort. We queried PUBMED, EMBASE, and
ClinicalTrial.gov for relevant articles. Randomized controlled trials that
compared at least one of the outcomes of interest between TAVI and SAVR
were included. Risk ratio (RR) and 95% confidence interval (CI) were
pooled with a random-effects model to compare the risk of the primary
outcome between the 2 procedures. The primary outcome was a composite of
all-cause mortality or disabling/major stroke at 1 year. Seven studies
with a total of 7,143 patients (3,665 TAVI) were included. All-cause
mortality or disabling/major stroke at 30 days (6 studies, RR 0.71, 95% CI
0.49 to 1.03) was similar between TAVI and SAVR but was significantly
lower in TAVI at 1 year (5 studies, RR 0.81, 95% CI 0.67 to 0.98).
All-cause mortality was similar at both 30 days (7 studies, RR 0.90, 95%
CI 0.67 to 1.21) and 1 year (6 studies, RR 0.89, 95% CI 0.76 to 1.04).
Disabling/major stroke was similar between the 2 procedures (6 studies, RR
0.69, 95% CI 0.42 to 1.12) at 30 days but was significantly lower in TAVI
at 1 year (5 studies RR 0.71, 95% CI 0.51 to 0.98). Age, gender, diabetes,
and surgical risk score did not modulate the primary outcome. TAVI had a
significantly lower composite of all-cause mortality or disabling/major
stroke at 1 year compared with SAVR in low-to-intermediate surgical risk
cohort.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<24>
Accession Number
627668217
Title
Management of anticoagulation in patients with metastatic
castration-resistant prostate cancer receiving abiraterone + prednisone.
Source
Supportive Care in Cancer. 27 (9) (pp 3209-3217), 2019. Date of
Publication: 01 Sep 2019.
Author
Dubinsky S.; Thawer A.; McLeod A.G.; McFarlane T.R.J.; Emmenegger U.
Institution
(Dubinsky, McFarlane) University of Waterloo School of Pharmacy, 10
Victoria St. S, Kitchener, ON, Canada
(Thawer, McFarlane, Emmenegger) Odette Cancer Centre, Sunnybrook Health
Sciences Centre, Toronto, ON, Canada
(McLeod) Department of Medicine, Division of Medical Oncology and
Hematology, Sunnybrook Hospital, University of Toronto, Toronto, ON,
Canada
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Abiraterone has been proven to be an effective agent used in the
management of metastatic castration-resistant prostate cancer,
significantly improving overall and progression-free survival. Due to the
pharmacodynamic and pharmacokinetic properties of abiraterone, concurrent
use with anticoagulation may pose a challenge for clinicians. Thrombosis
within the cancer setting continues to increase patient mortality;
therefore, appropriate anticoagulation through the use of a management
algorithm can reduce adverse events and increase quality of life.
<br/>Method(s): A review of the literature was preformed by a medical
oncologist, haematologist and pharmacists to identify relevant randomized
controlled trials, meta-analyses and retrospective studies. Major society
guidelines were reviewed to further aid in developing the anticoagulation
protocol for non-valvular atrial fibrillation and venous thromboembolism
within this patient population. After reviewing the literature, a clinical
framework was designed to aid clinicians in the management of those
patients receiving abiraterone concurrently with an anticoagulant.
<br/>Result(s): In this review, we describe the potential interactions
between abiraterone and various anticoagulants and provide management
strategies based on the most recent literature for atrial fibrillation,
venous thromboembolism and mechanical heart valves to avoid potential
drug-drug interactions. <br/>Conclusion(s): Abiraterone therapy has become
a mainstay of the management of advanced prostate cancer and is often used
over prolonged years. In this review, we have summarized a framework of
how to use abiraterone in men with prostate cancer on anticoagulants.
Evidence available to date suggests that patients with an indication for
anticoagulation such as atrial fibrillation, venous thromboembolism and
mechanical heart valves can be treated safely with abiraterone in the
appropriate setting, with appropriate monitoring.<br/>Copyright &#xa9;
2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<25>
Accession Number
2001445897
Title
Transcatheter versus surgical aortic valve replacement in low-risk
surgical patients: A meta-analysis of randomized clinical trials.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Kheiri B.; Osman M.; Abubakar H.; Subahi A.; Chahine A.; Ahmed S.; Bachuwa
G.; Alkotob M.L.; Hassan M.; Bhatt D.L.
Institution
(Kheiri, Chahine, Ahmed, Bachuwa) Department of Internal Medicine, Hurley
Medical Center, Michigan State University, Flint, MI, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV, United States
(Abubakar, Subahi) Department of Internal Medicine, Wayne State
University, Detroit, MI, United States
(Alkotob, Hassan) Division of Cardiology, Hurley Medical Center, Michigan
State University, Flint, MI, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a valid
option for patients with high or intermediate surgical risk. However,
clinical outcomes of TAVR in low-risk patients are lacking. Our aim was to
evaluate the efficacy and safety of TAVR versus surgical aortic valve
replacement (SAVR) in low-surgical-risk patients. <br/>Method(s):
Electronic database review was conducted for all randomized clinical
trials (RCTs) that compared TAVR versus SAVR in low-risk patients. We
calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a
random-effects model. <br/>Result(s): We included 3 RCTs totaling 604
patients (310 TAVR and 294 SAVR). Our results showed no significant
difference in mortality between TAVR compared with SAVR (RR = 0.71; 95% CI
= 0.22-2.30; P = 0.56), however, there was a significantly increased risk
of pacemaker implantation (RR = 7.28; 95% CI = 3.94-13.42; P < 0.01) and
moderate/severe paravalvular leakage (PVL) (RR = 6.74; 95% CI =
1.31-34.65; P = 0.02) with TAVR. Nevertheless, TAVR demonstrated a
significantly reduced risk of post-procedural bleeding (RR = 0.40; 95% CI
= 0.30-0.54; P < 0.01) and new-onset atrial fibrillation (RR = 0.36; 95%
CI = 0.27-0.47; P < 0.01). Other clinical outcomes were not significantly
different between the groups and included cardiovascular mortality,
stroke, transient ischemic attack, and myocardial infarction.
<br/>Conclusion(s): Among low-risk patients, TAVR offered comparable
efficacy outcomes and fewer bleeding events compared with SAVR. There were
increased risks of pacemaker implantation and PVL associated with TAVR,
though lower atrial fibrillation risks.<br/>Copyright &#xa9; 2018

<26>
Accession Number
2002187093
Title
Perioperative dental screening and treatment in patients undergoing
cardio-thoracic surgery and interventional cardiovascular procedures. A
consensus report based on RAND/UCLA methodology.
Source
International Journal of Cardiology. 292 (pp 78-86), 2019. Date of
Publication: 1 October 2019.
Author
Cotti E.; Cairo F.; Bassareo P.P.; Fonzar F.; Venturi M.; Landi L.;
Parolari A.; Franco V.; Fabiani C.; Barili F.; Di Lenarda A.; Gulizia M.;
Borzi M.; Campus G.; Musumeci F.; Mercuro G.
Institution
(Cotti) Department of Conservative Dentistry and Endodontics, University
of Cagliari, Italy
(Cairo) Research Unit in Periodontology and Periodontal Medicine,
University of Florence, Italy
(Bassareo) University College of Dublin, Mater Misericordiae University
Teaching Hospital, Dublin, Ireland
(Fonzar) Private practice, Udine, Italy
(Venturi) Private practice, Bologna, Italy
(Landi) Private practice, Roma, Verona, Italy
(Parolari) Unit of Cardiac Surgery and Translational Researh, IRCCS
Policlinico S. Donato, San Donato, Italy
(Franco, Fabiani) Private practice, Roma, Italy
(Barili) Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
(Di Lenarda) Cardiovascular Center ASS1, Trieste, Italy
(Gulizia) Division of Cardiology, Hospital "Garibaldi-Nesima", Catania,
Italy
(Borzi) Department of Cardiovascular Disease, University of Rome Tor
Vergata, Rome, Italy
(Campus) Department of Surgery, Microsurgery and Medicine Sciences,
University of Sassari, Italy
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Roma, Italy
(Mercuro) Department of Medical Sciences, Cagliari, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Aim: To reach a consensus on a consistent strategy to adopt when screening
patients for dental/periodontal infections, and on the feasibility of
providing dental treatment before cardiothoracic surgery, cardiovascular
surgery or other cardiovascular invasive procedures. Methodology: A panel
of experts from six Italian scientific societies was created. The
deliberations of the panel were based on the RAND method. From an initial
systematic literature review, it became clear that a consensually
validated protocol for the reproducible dental screening of patients
awaiting cardiac interventions was considered mandatory by professionals
with expertise in the dental, cardiologic and cardiac surgery areas.
However, systematic review also concluded that the treatment options to be
provided, their prognosis and timing in relation to the physical condition
of patients had never been defined. Following the systematic review
several fundamental questions were generated. The panel was divided into
two working groups each of which produced documents that addressed the
topic and which were subsequently used to generate a questionnaire. Each
member of the panel completed the questionnaire independently and then a
panel discussion was held to reach a consensus on how best to manage
patients with dental/periodontal infections who were awaiting invasive
cardiac procedures. <br/>Result(s): A high level of agreement was reached
regarding all the items on the questionnaire, and each of the clinical
questions formulated were answered. Three tables were created which can be
used to generate a useful tool to provide standardized dental/periodontal
screening of patients undergoing elective cardiovascular interventions,
and to summarize both the possible oral and cardiovascular conditions of
the patient and the timing available for the procedures considered.
<br/>Conclusion(s): Upon publication of this consensus document, the
dissemination of the information to a wide dental and cardiac audience
should commence. The authors hope that this consensus can become a model
for the development of a dedicated protocol, ideally usable by heart and
dental teams in the pre-interventional preparation phase.<br/>Copyright
&#xa9; 2019 Elsevier B.V.

<27>
Accession Number
628490917
Title
Rejuvenation of RBCs: validation of a manufacturing method suitable for
clinical use.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
Smethurst P.A.; Jolley J.; Braund R.; Proffitt S.; Lynes T.; Hazell M.;
Mellor P.; Ridgwell K.; Procter S.; Griffiths A.; Marinaki A.M.; New H.V.;
Murphy G.J.; Edmondson D.; Cardigan R.
Institution
(Smethurst, Jolley, Proffitt, Cardigan) Component Development Laboratory,
NHS Blood and Transplant, Cambridge, United Kingdom
(Braund, Mellor, Edmondson) Manufacturing & Development, NHS Blood and
Transplant, Bristol, United Kingdom
(Lynes, Hazell) Red Cell Immunohaematology, NHS Blood and Transplant,
Bristol, United Kingdom
(Ridgwell) IBGRL Protein Development & Production Unit, NHS Blood and
Transplant, Bristol, United Kingdom
(Procter) Quality Monitoring, NHS Blood and Transplant, London, United
Kingdom
(Griffiths) Clinical Trials Unit, NHS Blood and Transplant, Bristol,
United Kingdom
(Marinaki) Purine Research Laboratory, St Thomas' Hospital, London, United
Kingdom
(New) Clinical Directorate, NHS Blood and Transplant, London, United
Kingdom
(New) Department of Haematology, Imperial College London, London, United
Kingdom
(Murphy) Department of Cardiovascular Sciences and NIHR Leicester
Biomedical Research Centre, Glenfield General Hospital, University of
Leicester, Leicester, United Kingdom
(Cardigan) Department of Haematology, University of Cambridge, Cambridge,
United Kingdom
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Rejuvenation of stored red blood cells (RBCs) increases levels
of adenosine 5'-triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) to
those of fresh cells. This study aimed to optimize and validate the
US-approved process to a UK setting for manufacture and issue of
rejuvenated RBCs for a multicenter randomized controlled clinical trial in
cardiac surgery. STUDY DESIGN AND METHODS: Rejuvenation of leukoreduced
RBC units involved adding a solution containing pyruvate, inosine,
phosphate, and adenine (Rejuvesol, Zimmer Biomet), warming at 37degreeC
for 60 minutes, then "manual" washing with saline adenine glucose mannitol
solution. A laboratory study was conducted on six pools of ABO/D-matched
units made the day after donation. On Days 7, 21, and 28 of 4 +/- 2degreeC
storage, one unit per pool was rejuvenated and measured over 96 hours for
volume, hematocrit, hemolysis, ATP, 2,3-DPG, supernatant potassium,
lactate, and purines added (inosine) or produced (hypoxanthine) by
rejuvenation. Subsequently, an operational validation (two phases of 32
units each) was undertaken, with results from the first informing a trial
component specification applied to the second. Rejuvenation effects were
also tested on crossmatch reactivity and RBC antigen profiles.
<br/>RESULT(S): Rejuvenation raised 2,3-DPG to, and ATP above, levels of
fresh cells. The final component had potassium and hemolysis values below
those of standard storage Days 7 and 21, respectively, containing 1.2%
exogenous inosine and 500 to 1900 mumoles/unit of hypoxanthine. The second
operational validation met compliance to the trial component
specification. Rejuvenation did not adversely affect crossmatch reactivity
or RBC antigen profiles. <br/>CONCLUSION(S): The validated rejuvenation
process operates within defined quality limits, preserving RBC
immunophenotypes, enabling manufacture for clinical trials.<br/>Copyright
&#xa9; 2019 Crown copyright. Transfusion &#xa9; 2019 AABB

<28>
Accession Number
628556366
Title
Is the Glasses-Free 3-Dimensional Display System More Effective for
Complex Video-Assisted Thoracic Surgery? A Self-Controlled Study Ex Vivo.
Source
Surgical Innovation. (no pagination), 2019. Date of Publication: 2019.
Author
Liu J.; Li J.; Liang H.; Cui F.; Wang W.; Huang J.; Peng G.; Huang W.;
Wang Y.; He K.; Pan Q.; He J.
Institution
(Liu, Li, Liang, Cui, Wang, Huang, Peng, Huang, Wang, He) The First
Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
(Liu, Li, Liang, Cui, Wang, Huang, Peng, Huang, He) Guangzhou Institute of
Respiratory Health (GIRH), Guangzhou, China
(Liu, Li, Liang, Cui, Wang, Huang, Peng, Huang, He) State Key Laboratory
of Respiratory Disease, National Clinical Research Center for Respiratory
Diseases, Guangzhou, China
(He) The Affiliated Hospital of Southwest Medical University, Luzhou,
China
(Pan) The Affiliated Tumor Hospital of Guangxi Medical University,
Nanning, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective. Considering the demerits of a high-definition 2-dimensional
(HD-2D) system, with its lack of stereopsis, and a conventional
3-dimensional (C-3D) system, which results in a dimmed image, we have
recently developed a glasses-free 3-dimensional (GF-3D) display system for
reconstruction surgeries such as video-assisted thoracic surgery (VATS)
for tracheal reconstruction. Methods. Thoracic surgeons were invited to
complete thoracoscopic continuous suture of a transected porcine trachea
using the HD-2D, C-3D, and GF-3D systems on separate mornings in
randomized order. The duration, numbers of stitches, and distance between
every 2 stitches were recorded for every procedure. The surgeons'
spontaneous eye blink rate was recorded for 5 minutes before the procedure
and the last 5 minutes of the procedure. Results. Fifteen volunteers
successfully completed the tracheal reconstruction procedures in this
study. Both C-3D (0.403 +/- 0.064 stitch/min, P <.001) and GF-3D (0.427
+/- 0.079 stitch/min, P <.001) showed significant advantages in speed
compared with HD-2D (0.289 +/- 0.065 stitch/min). Both C-3D (2.536 +/-
2.223 mm, P <.001) and GF-3D (2.603 +/- 2.159 mm, P <.001) showed
significant advantages in accuracy compared with HD-2D (3.473 +/- 3.403
mm). Both HD-2D (1.240 +/- 0.642, P <.001) and GF-3D (1.307 +/- 0.894, P
<.001) showed significant advantages in eye fatigue compared with C-3D
(3.333 +/- 1.44). Conclusions. All 3 available display systems are
efficient for complex VATS. With the help of stereopsis, surgeons can
achieve faster operation using C-3D and GF-3D systems in a thoracoscopic
simulated setting. GF-3D may be a more effective display system for VATS
reconstruction in terms of speed, accuracy, and eye fatigue during
operations.<br/>Copyright &#xa9; The Author(s) 2019.

<29>
Accession Number
2002403999
Title
Meta-analysis of prognostic impact of blood transfusion on survival after
transcatheter aortic valve implantation.
Source
Journal of Cardiovascular Surgery. 60 (4) (pp 535-539), 2019. Date of
Publication: 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)

<30>
Accession Number
2002403993
Title
The long-term follow-up of large-diameter Dacron vascular
grafts in surgical practice: A review.
Source
Journal of Cardiovascular Surgery. 60 (4) (pp 501-513), 2019. Date of
Publication: 2019.
Author
Spadaccio C.; Rainer A.; Barbato R.; Trombetta M.; Chello M.; Meyns B.
Institution
(Rainer, Trombetta) CIR-Laboratory of Tissue Engineering, Campus
Bio-Medico University, Rome, Italy
(Barbato, Chello) Department of Cardiovascular Sciences, Campus Bio-Medico
University, Rome, Italy
(Spadaccio, Meyns) University Hospital UZ Leuven, Cardiovascular Diseases
and Cardiac Surgery Departments, Herestraat, Leuven 49B-3000, Belgium
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Synthetic grafts have been widely used in cardiac and vascular surgery
since the mid-1970s. Considering the relative lack of randomized clinical
trials or systematic analyses in the field of prosthetic large vessel
diameter replacement, we reviewed the literature on the long-term
performance and surgical management of complications of Dacron
grafts in both thoracic and abdominal aorta reconstruction and in the
pediatric population. MedLine, Embase and Cochrane Library databases were
searched for meta-analyses, reviews, clinical trials, and case reports
pertinent to the study object. Aortic replacement with Dacron
prostheses is widely performed with acceptable outcome and a relatively
low rate of graft-related and postimplantation complications, such as
rupture, infection and fistulization. However, progressive dilation and
mechanical failure of the grafts represent the most worrisome complication
in all the districts analyzed. The emerging concept of the mismatch in the
biomechanical properties between the prosthetic material and native aorta
is thought to be at the root of these complications leading to even more
daunting consequences when the ascending aorta is involved. Indeed
introduction of a non-compliant prosthesis in place of the native
ascending aorta can exert detrimental effects not only at the level of the
anastomosis, leading to pseudoaneurysm, but also can influence the optimal
performance of the aortic root complex with consequent valve dysfunction
and ventricular hypertrophy. Albeit confirming their overall successful
performance, this review launches a warning on the current liberal use of
non-compliant grafts in aortic position, remarking the need for
alternative vascular conduits mimicking the native artery
compliance.<br/>Copyright &#xa9; 2014 EDIZIONI MINERVA MEDICA

<31>
Accession Number
628450745
Title
Randomised controlled trial to investigate the effectiveness of thoracic
epidural and paravertebral blockade in reducing chronic post-thoracotomy
pain (TOPIC): A pilot study to assess feasibility of a large multicentre
trial.
Source
BMJ Open. 9 (7) (no pagination), 2019. Article Number: e023679. Date of
Publication: 01 Jul 2019.
Author
Yeung J.; Middleton L.; Tryposkiadis K.; Kerr A.; Daniels J.; Naidu B.;
Melody T.; Goebel A.; Wilson M.; Kumar S.; Szentgyorgyi L.; Flanagan S.;
Shah R.; Worrall A.; Gao F.
Institution
(Yeung) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
(Yeung, Melody, Kumar, Worrall, Gao) Academic Department of Anaesthesia,
Critical Care, Pain and Resuscitation, Birmingham Heartlands Hospital,
University Hospital Birmingham NHS Foundation Trust, Birmingham, United
Kingdom
(Middleton) School of Health and Population Sciences, University of
Birmingham, Birmingham, United Kingdom
(Tryposkiadis) Birmingham Clinical Trials Unit, University of Birmingham,
Birmingham, United Kingdom
(Kerr, Naidu) Department of Thoracic Surgery, Birmingham Heartlands
Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham,
United Kingdom
(Daniels) Nottingham Clinical Trials Unit, University of Nottingham,
Nottingham, United Kingdom
(Naidu, Gao) Institute of Inflammation and Ageing, College of Medical and
Dental Sciences, University of Birmingham, Birmingham, United Kingdom
(Goebel) University of Liverpool, Institute of Translational Medicine,
Liverpool, United Kingdom
(Wilson) Health Services Research, University of Sheffield, Sheffield,
United Kingdom
(Szentgyorgyi) Department of Anaesthesia, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
(Flanagan) Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
(Shah) Department of Thoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Thoracotomy is considered one of the most painful surgical
procedures. The incidence of chronic post-thoracotomy pain (CPTP) is up to
50%. Paravertebral blockade (PVB) may be superior to thoracic epidural
blockade (TEB) in preventing CPTP. The specific objective of this pilot
study was to assess the feasibility of conducting a larger trial to
determine whether PVB at thoracotomy is more effective in reducing CPTP
compared with TEB. <br/>Design(s): A randomised, parallel, external pilot
study was conducted to assess whether a large randomised trial of TEB and
PVB with CPTP as the primary outcome is feasible. <br/>Setting(s): Two
adult thoracic centres in the UK. <br/>Participant(s): All adult patients
admitted for elective open thoracotomy. <br/>Participant(s): were excluded
if they were American Society of Anesthesiologists physical status IV or
V; or if there is contraindication to local anaesthetics; infection near
the proposed puncture site; coagulation/thoracic spine disorders; required
chest wall resection or emergency thoracic surgery or had a previous
thoracotomy. <br/>Result(s): All patients presenting for thoracotomy were
screened over a 12-month period with 194 found to be eligible. Of these,
69 (36%) were randomised (95% CI 29% to 42%). Discounting five
participants who died, 54 of 64 participants (84%) returned questionnaire
booklets at 6 months. The number of participants indicating at least a
moderate level of chest pain at 6 months was lower with PVB but with high
levels of uncertainty (RR: 0.7; 95% CI 0.3 to 1.7 for worst pain; RR: 0.3;
95% CI 0.0 to 2.8 for average pain). There were no safety concerns.
<br/>Conclusion(s): A large, multicentre randomised controlled trial of
PVB versus TEB is feasible as it is possible to randomise and follow up
participants with high fidelity. Pain scores were lower on average with
PVB compared with TEB but a much larger trial is required to confirm this
reliably.<br/>Copyright &#xa9; 2019 Author(s).

<32>
Accession Number
2001869595
Title
Fifty shades of gradients: Does the pressure gradient in venous sinus
stenting for idiopathic intracranial hypertension matter? A systematic
review.
Source
Journal of Neurosurgery. 130 (3) (pp 999-1005), 2019. Date of Publication:
March 2019.
Author
McDougall C.M.; Ban V.S.; Beecher J.; Pride L.; Welch B.G.
Institution
(McDougall, Pride, Welch) Departments of Radiology, University of Texas
Southwestern, Dallas, TX, United States
(McDougall, Ban, Beecher, Welch) Departments of Neurosurgery, University
of Texas Southwestern, Dallas, TX, United States
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE The role of venous sinus stenting (VSS) for idiopathic
intracranial hypertension (IIH) is not well understood. The aim of this
systematic review is to attempt to identify subsets of patients with IIH
who will benefit from VSS based on the pressure gradients of their venous
sinus stenosis. METHODS MEDLINE/PubMed was searched for studies reporting
venous pressure gradients across the stenotic segment of the venous sinus,
pre- and post-stent pressure gradients, and clinical outcomes after VSS.
Findings are reported according to the PRISMA (Preferred Reporting Items
for Systematic Reviews and Meta-Analyses) guidelines. RESULTS From 32
eligible studies, a total of 186 patients were included in the analysis.
Patients who had favorable outcomes had higher mean pressure gradients
(22.8 +/- 11.5 mm Hg vs 17.4 +/- 8.0 mm Hg, p = 0.033) and higher changes
in pressure gradients after stent placement (19.4 +/- 10.0 mm Hg vs 12.0
+/- 6.0 mm Hg, p = 0.006) compared with those with unfavorable outcomes.
The post-stent pressure gradients between the 2 groups were not
significantly different (2.8 +/- 4.0 mm Hg vs 2.7 +/- 2.0 mm Hg, p =
0.934). In a multivariate stepwise logistic regression controlling for
age, sex, body mass index, CSF opening pressure, pre-stent pressure
gradient, and post-stent pressure gradient, the change in pressure
gradient with stent placement was found to be an independent predictor of
favorable outcome (p = 0.028). Using a pressure gradient of 21 as a
cutoff, 81/86 (94.2%) of patients with a gradient > 21 achieved favorable
outcomes, compared with 82/100 (82.0%) of patients with a gradient <= 21
(p = 0.022). CONCLUSIONS There appears to be a relationship between the
pressure gradient of venous sinus stenosis and the success of VSS in IIH.
A randomized controlled trial would help elucidate this relationship and
potentially guide patient selection.<br/>Copyright &#xa9; AANS 2019.

<33>
Accession Number
601554983
Title
Efficacy and safety of LDL-lowering therapy among men and women:
Meta-analysis of individual data from 174 000 participants in 27
randomised trials.
Source
The Lancet. 385 (9976) (pp 1397-1405), 2015. Date of Publication: 2015.
Author
Fulcher J.; O'Connell R.; Voysey M.; Mihaylova B.; Colhoun H.; Keech A.;
De Lemos J.; Blazing M.; Downs J.R.; Gotto A.; Clearfield M.; Gordon D.;
Davis B.; Koren M.; Dahlof B.; Poulter N.; Sever P.; Knopp R.H.; Fellstrom
B.; Holdaas H.; Jardine A.; Schmieder R.; Zannad F.; Goldbourt U.;
Kaplinsky E.; Colhoun H.M.; Betteridge D.J.; Durrington P.N.; Hitman G.A.;
Fuller J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.;
Hawkins C.M.; Wedel H.; Wikstrand J.; Barter P.; Tavazzi L.; Marchioli R.;
Tognoni G.; Franzosi M.G.; Maggioni A.; Bloomfield H.; Robins S.; Pedersen
T.R.; Ridker P.M.; Holman R.; Meade T.; MacMahon S.; Marschner I.; Tonkin
A.; Shaw J.; Serruys P.W.; Nakamura H.; Knatterud G.; Furberg C.; Byington
R.; Murphy M.; Blauw G.J.; Packard C.; Kjekshus J.; Pedersen T.;
Wilhelmsen L.; Braunwald E.; Cannon C.; Murphy S.; Armitage J.; Bowman L.;
Parish S.; Peto R.; Sleight P.; Landray M.; La Rosa J.; Rossouw J.;
Probstfield J.; Shepherd J.; Cobbe S.; Macfarlane P.; Ford I.; Flather M.;
Kastelein J.; Newman C.; Shear C.; Tobert J.; Varigos J.; White H.; Yusuf
S.; Barnes E.H.; Keech A.C.; Kirby A.; Simes J.; Baigent C.; Blackwell L.;
Collins R.; Emberson J.; Herrington W.G.; Holland L.E.; Reith C.
Institution
(Marschner, Barnes, Keech, Kirby, Simes) CTC, University of Sydney,
Australia
(Mihaylova, Baigent, Blackwell, Collins, Emberson, Herrington, Holland,
Reith) CTSU, University of Oxford, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Whether statin therapy is as effective in women as in men is
debated, especially for primary prevention. We undertook a meta-analysis
of statin trials in the Cholesterol Treatment Trialists' (CTT)
Collaboration database to compare the effects of statin therapy between
women and men. <br/>Method(s): We performed meta-analyses on data from 22
trials of statin therapy versus control (n=134 537) and five trials of
more-intensive versus less-intensive statin therapy (n=39 612). Effects on
major vascular events, major coronary events, stroke, coronary
revascularisation and mortality were weighted per 1.0 mmol/L reduction in
LDL cholesterol and effects in men and women compared with a Cox model
that adjusted for non-sex differences. For subgroup analyses, we used 99%
CIs to make allowance for the multiplicity of comparisons. Findings 46 675
(27%) of 174 149 randomly assigned participants were women. Allocation to
a statin had similar absolute effects on 1 year lipid concentrations in
both men and women (LDL cholesterol reduced by about 1.1 mmol/L in statin
vs control trials and roughly 0.5 mmol/L for more-intensive vs
less-intensive therapy). Women were generally at lower cardiovascular risk
than were men in these trials. The proportional reductions per 1.0 mmol/L
reduction in LDL cholesterol in major vascular events were similar overall
for women (rate ratio [RR] 0.84, 99% CI 0.78-0.91) and men (RR 0.78, 99%
CI 0.75-0.81, adjusted p value for heterogeneity by sex=0.33) and also for
those women and men at less than 10% predicted 5 year absolute
cardiovascular risk (adjusted heterogeneity p=0.11). Likewise, the
proportional reductions in major coronary events, coronary
revascularisation, and stroke did not differ significantly by sex. No
adverse effect on rates of cancer incidence or non-cardiovascular
mortality was noted for either sex. These net benefits translated into
all-cause mortality reductions with statin therapy for both women (RR
0.91, 99% CI 0.84-0.99) and men (RR 0.90, 99% CI 0.86-0.95; adjusted
heterogeneity p=0.43). Interpretation In men and women at an equivalent
risk of cardiovascular disease, statin therapy is of similar effectiveness
for the prevention of major vascular events.

<34>
Accession Number
52015679
Title
The effects of lowering LDL cholesterol with statin therapy in people at
low risk of vascular disease: Meta-analysis of individual data from 27
randomised trials.
Source
The Lancet. 380 (9841) (pp 581-590), 2012. Date of Publication: 01 Aug
2012.
Author
Mihaylova B.; Voysey M.; Gray A.; Baigent C.; De Lemos J.; Blazing M.;
Downs J.R.; Gotto A.; Clearfield M.; Gordon D.; Davis B.; Koren M.; Dahlof
B.; Poulter N.; Sever P.; Knopp R.H.; Fellstrom B.; Holdaas H.; Jardine
A.; Schmieder R.; Zannad F.; Goldbourt U.; Kaplinsky E.; Colhoun H.M.;
Betteridge D.J.; Durrington P.N.; Hitman G.A.; Fuller J.; Neil A.; Wanner
C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.; Hawkins C.M.; Wedel H.;
Wikstrand J.; Barter P.; Tavazzi L.; Marchioli R.; Tognoni G.; Franzosi
M.G.; Maggioni A.; Bloomfield H.; Robins S.; Pedersen T.R.; Ridker P.M.;
Holman R.; Meade T.; MacMahon S.; Marschner I.; Tonkin A.; Shaw J.;
Serruys P.W.; Nakamura H.; Knatterud G.; Furberg C.; Byington R.; Murphy
M.; Blauw G.J.; Packard C.; Kjekshus J.; Pedersen T.; Wilhelmsen L.;
Braunwald E.; Cannon C.; Murphy S.; Armitage J.; Bowman L.; Parish S.;
Peto R.; Sleight P.; Landray M.; La Rosa J.; Rossouw J.; Probstfi Eld J.;
Shepherd J.; Cobbe S.; MacFarlane P.; Ford I.; Flather M.; Kastelein J.;
Newman C.; Shear C.; Tobert J.; Varigos J.; White H.; Yusuf S.; Mellies
M.; McGovern M.; Barclay J.; Belder R.; Mitchel M.Y.; Musliner T.; Ansquer
J.-C.; Llewellyn B.M.; Pharma N.; Bortolini M.; Brandrup-Wognsen G.;
Bryzinski B.; Olsson G.; Pears J.; DeMicco D.; Barnes E.H.; Baxter A.;
Bhala N.; Blackwell L.; Buck G.; Collins R.; Emberson J.; Herrington W.G.;
Holland L.E.; Kearney P.M.; Keech A.; Kirby A.; Lewis D.A.; Pollicino C.;
Reith C.; Simes J.; Sourjina T.
Institution
(Baigent, Marschner, Barnes, Baxter, Bhala, Blackwell, Buck, Collins,
Emberson, Herrington, Holland, Kearney, Keech, Kirby, Lewis, Pollicino,
Reith, Simes, Sourjina) National Health and Medical Research Council
(NHMRC), Clinical Trial Centre, University of Sydney, Mallett Street
Campus M02, NSW 2006, Australia
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Statins reduce LDL cholesterol and prevent vascular events, but
their net effects in people at low risk of vascular events remain
uncertain. Methods This meta-analysis included individual participant data
from 22 trials of statin versus control (n=134 537; mean LDL cholesterol
difference 1.08 mmol/L; median follow-up 4.8 years) and five trials of
more versus less statin (n=39 612; difference 0.51 mmol/L; 5.1 years).
Major vascular events were major coronary events (ie, non-fatal myocardial
infarction or coronary death), strokes, or coronary revascularisations.
Participants were separated into five categories of baseline 5-year major
vascular event risk on control therapy (no statin or low-intensity statin)
(<5%, >=5% to <10%, >=10% to <20%, >=20% to <30%, >=30%); in each, the
rate ratio (RR) per 1.0 mmol/L LDL cholesterol reduction was estimated.
Findings Reduction of LDL cholesterol with a statin reduced the risk of
major vascular events (RR 0.79, 95% CI 0.77-0.81, per 1.0 mmol/L
reduction), largely irrespective of age, sex, baseline LDL cholesterol or
previous vascular disease, and of vascular and all-cause mortality. The
proportional reduction in major vascular events was at least as big in the
two lowest risk categories as in the higher risk categories (RR per 1.0
mmol/L reduction from lowest to highest risk: 0.62 [99% CI 0.47-0.81],
0.69 [99% CI 0.60-0.79], 0.79 [99% CI 0.74-0.85], 0.81 [99% CI 0.77-0.86],
and 0.79 [99% CI 0.74-0.84]; trend p=0.04), which reflected significant
reductions in these two lowest risk categories in major coronary events
(RR 0.57, 99% CI 0.36-0.89, p=0.0012, and 0.61, 99% CI 0.50-0.74,
p<0.0001) and in coronary revascularisations (RR 0.52, 99% CI 0.35-0.75,
and 0.63, 99% CI 0.51-0.79; both p<0.0001). For stroke, the reduction in
risk in participants with 5-year risk of major vascular events lower than
10% (RR per 1.0 mmol/L LDL cholesterol reduction 0.76, 99% CI 0.61-0.95,
p=0.0012) was also similar to that seen in higher risk categories (trend
p=0.3). In participants without a history of vascular disease, statins
reduced the risks of vascular (RR per 1.0 mmol/L LDL cholesterol reduction
0.85, 95% CI 0.77-0.95) and all-cause mortality (RR 0.91, 95% CI
0.85-0.97), and the proportional reductions were similar by baseline risk.
There was no evidence that reduction of LDL cholesterol with a statin
increased cancer incidence (RR per 1.0 mmol/L LDL cholesterol reduction
1.00, 95% CI 0.96-1.04), cancer mortality (RR 0.99, 95% CI 0.93-1.06), or
other non-vascular mortality. Interpretation In individuals with 5-year
risk of major vascular events lower than 10%, each 1 mmol/L reduction in
LDL cholesterol produced an absolute reduction in major vascular events of
about 11 per 1000 over 5 years. This benefi t greatly exceeds any known
hazards of statin therapy. Under present guidelines, such individuals
would not typically be regarded as suitable for LDL-lowering statin
therapy. The present report suggests, therefore, that these guidelines
might need to be reconsidered.

<35>
Accession Number
51141585
Title
Efficacy and safety of more intensive lowering of LDL cholesterol: A
meta-analysis of data from 170 000 participants in 26 randomised trials.
Source
The Lancet. 376 (9753) (pp 1670-1681), 2010. Date of Publication: 13 Nov
2010.
Author
De Lemos J.; Blazing M.; Downs J.R.; Gotto A.; Clearfield M.; Gordon D.;
Davis B.; Koren M.; Dahlof B.; Poulter N.; Sever P.; Knopp R.H.; Fellstrom
B.; Holdaas H.; Jardine A.; Schmieder R.; Zannad F.; Goldbourt U.;
Kaplinsky E.; Colhoun H.M.; Betteridge D.J.; Durrington P.N.; Hitman G.A.;
Fuller J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.;
Hawkins C.M.; Barter P.; Tavazzi L.; Marchioli R.; Tognoni G.; Franzosi
M.G.; Maggioni A.; Bloomfield H.; Robins S.; Pedersen T.R.; Ridker P.M.;
Holman R.; Meade T.; MacMahon S.; Marschner I.; Tonkin A.; Shaw J.;
Serruys P.W.; Nakamura H.; Knatterud G.; Furberg C.; Byington R.; Murphy
M.; Blauw G.J.; Packard C.; Kjekshus J.; Pedersen T.; Wilhelmsen L.;
Braunwald E.; Cannon C.; Murphy S.; Armitage J.; Bowman L.; Parish S.;
Peto R.; Sleight P.; Landray M.; La Rosa J.; Rossouw J.; Probstfield J.;
Shepherd J.; Cobbe S.; Macfarlane P.; Ford I.; Flather M.; Kastelein J.;
Newman C.; Shear C.; Tobert J.; Varigos J.; White H.; Yusuf S.; Mellies
M.; McGovern M.; Barclay J.; Belder R.; Mitchel Y.; Musliner T.; Ansquer
J.-C.; Llewellyn M.; Bortolini M.; Brandrup-Wognsen G.; Bryzinski B.;
Olsson G.; Pears J.; De Micco D.; Baxter A.; Baigent C.; Barnes E.H.;
Bhala N.; Blackwell L.; Buck G.; Collins R.; Emberson J.; Herrington W.G.;
Holland L.E.; Kearney P.M.; Keech A.; Kirby A.; Lewis D.A.; Pollicino C.;
Reith C.; Simes J.; Sourjina T.
Institution
(De Lemos, Braunwald, Blazing, Murphy) Phase Z, United States
(Downs, Gotto, Clearfield) AFCAPS/TEXCAPS (AirForce/Texas Coronary
Atherosclerosis Prevention Study), United States
(Holdaas) ALERT (Assessment of Lescol in Transplantation), United States
(Gordon, Davis) ALLHAT (Antihypertensive Lipid Lowering Heart Attack
Trial), United States
(Koren) ALLIANCE (Aggressive Lipid-Lowering Initiation Abates New Cardiac
Events), United States
(Dahlof, Poulter, Sever) ASCOT (Anglo-Scandinavian Cardiac Outcomes
Trial), United States
(Knopp) ASPEN, United States
(Fellstrom, Holdaas, Jardine, Schmieder, Zannad) AURORA, United States
(Goldbourt, Kaplinsky) BIP (Bezafibrate Infarction Prevention Study),
United States
(Colhoun, Betteridge, Durrington, Hitman, Fuller, Neil) CARDS
(Collaborative Atorvastatin Diabetes Study), United States
(Wanner, Krane) 4D (Die Deutsche Diabetes Dialyse Study), United States
(Sacks, Moye, Pfeffer) CARE (Cholesterol and Recurrent Events Study),
United States
(Keech, Barter) FIELD (Fenofibrate Intervention and Event Lowering in
Diabetes), United States
(Tavazzi, Maggioni) GISSI (Gruppo Italiano per Lo Studio della
Sopravvivenza nell'Infarto Miocardico)-Heart Failure, Italy
(Marchioli, Tognoni, Franzosi, Maggioni) GISSI-Prevention, Italy
(Bloomfield, Robins) HIT (Veteran Administration Low HDL Intervention
Trial), United States
(Keech, Collins, Armitage, Parish, Peto, Sleight) HPS (Heart Protection
Study), United States
(Pedersen) IDEAL (Incremental Decrease in Endpoints Through Aggressive
Lipid-lowering), United States
(Ridker) JUPITER, United States
(Holman) LDS (Lipids in Diabetes Study), United States
(Meade) LEADER (Lower Extremity Arterial Disease Event Reduction Trial),
United States
(Keech, Simes, MacMahon, Marschner, Tonkin, Shaw) LIPID (Long-term
Intervention with Pravastatin in Ischaemic Disease), United States
(Serruys) LIPS (Lescol Intervention Prevention Study), United States
(Nakamura) MEGA (Management of Elevated Cholesterol in the Primary
Prevention Group of Adult Japanese), United States
(Knatterud) Post-CABG (Post- Coronary Artery Bypass Graft Study), United
States
(Furberg, Byington) PPP (Pravastatin Pooling Project), United States
(Macfarlane, Cobbe, Ford, Murphy, Blauw, Packard, Shepherd) PROSPER
(Prospective Study of Pravastatin in the Elderly at Risk), United States
(Kjekshus, Pedersen, Wilhelmsen) 4S (Scandinavian Simvastatin Survival
Study), United States
(Braunwald, Cannon, Murphy) PROVE-IT (Pravastatin or Atorvastatin
Evaluation and Infection Therapy), United States
(Collins, Armitage, Bowman, Parish, Peto, Sleight) SEARCH (Study of
Effectiveness of Additional Reductions in Cholesterol and Homocysteine),
United States
(Baigent, Baxter, Collins, Landray) SHARP (Study of Heart and Renal
Protection), United States
(La Rosa) TNT (Testing New Targets), United States
(Rossouw, Probstfield) WHI (Women's Health Initiative), United States
(Shepherd, Cobbe, Macfarlane, Ford) WOSCOPS (West of Scotland Coronary
Prevention Study), United Kingdom
(Mellies, McGovern, Barclay, Belder) Bristol-Myers Squibb, United States
(Mitchel, Musliner) Merck, United States
(Ansquer) Laboratoires Fournier, United States
(Llewellyn) Bayer, United States
(Bortolini) Novartis Pharma, United States
(Brandrup-Wognsen, Bryzinski, Olsson, Pears) AstraZeneca, United States
(De Micco) Pfizer, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Lowering of LDL cholesterol with standard statin regimens reduces the risk
of occlusive vascular events in a wide range of individuals. We aimed to
assess the safety and efficacy of more intensive lowering of LDL
cholesterol with statin therapy. We undertook meta-analyses of individual
participant data from randomised trials involving at least 1000
participants and at least 2 years' treatment duration of more versus less
intensive statin regimens (five trials; 39 612 individuals; median
follow-up 5.1 years) and of statin versus control (21 trials; 129 526
individuals; median follow-up 4.8 years). For each type of trial, we
calculated not only the average risk reduction, but also the average risk
reduction per 1.0 mmol/L LDL cholesterol reduction at 1 year after
randomisation. In the trials of more versus less intensive statin therapy,
the weighted mean further reduction in LDL cholesterol at 1 year was 0.51
mmol/L. Compared with less intensive regimens, more intensive regimens
produced a highly significant 15 (95 CI 11-18; p<0.0001) further reduction
in major vascular events, consisting of separately significant reductions
in coronary death or non-fatal myocardial infarction of 13 (95 CI 7-19;
p<0.0001), in coronary revascularisation of 19 (95 CI 15-24; p<0.0001),
and in ischaemic stroke of 16 (95 CI 5-26; p=0.005). Per 1.0 mmol/L
reduction in LDL cholesterol, these further reductions in risk were
similar to the proportional reductions in the trials of statin versus
control. When both types of trial were combined, similar proportional
reductions in major vascular events per 1.0 mmol/L LDL cholesterol
reduction were found in all types of patient studied (rate ratio [RR]
0.78, 95 CI 0.76-0.80; p<0.0001), including those with LDL cholesterol
lower than 2 mmol/L on the less intensive or control regimen. Across all
26 trials, all-cause mortality was reduced by 10 per 1.0 mmol/L LDL
reduction (RR 0.90, 95 CI 0.87-0.93; p<0.0001), largely reflecting
significant reductions in deaths due to coronary heart disease (RR 0.80,
99 CI 0.74-0.87; p<0.0001) and other cardiac causes (RR 0.89, 99 CI
0.81-0.98; p=0.002), with no significant effect on deaths due to stroke
(RR 0.96, 95 CI 0.84-1.09; p=0.5) or other vascular causes (RR 0.98, 99 CI
0.81-1.18; p=0.8). No significant effects were observed on deaths due to
cancer or other non-vascular causes (RR 0.97, 95 CI 0.92-1.03; p=0.3) or
on cancer incidence (RR 1.00, 95 CI 0.96- 1.04; p=0.9), even at low LDL
cholesterol concentrations. Further reductions in LDL cholesterol safely
produce definite further reductions in the incidence of heart attack, of
revascularisation, and of ischaemic stroke, with each 1.0 mmol/L reduction
reducing the annual rate of these major vascular events by just over a
fifth. There was no evidence of any threshold within the cholesterol range
studied, suggesting that reduction of LDL cholesterol by 2-3 mmol/L would
reduce risk by about 40-50. UK Medical Research Council, British Heart
Foundation, European Community Biomed Programme, Australian National
Health and Medical Research Council, and National Heart
Foundation.<br/>Copyright &#xa9; 2010 Elsevier Ltd.

<36>
Accession Number
2002234833
Title
Computed Tomographic Coronary Angiography and Coronary Artery Calcium
Score as a Risk Stratification Tool Prior to Non-Cardiac Surgery: A
Meta-Analysis.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S242-S243), 2019. Date of Publication:
2019.
Author
Koshy A.; Ha F.; Gow P.; Han H.; Amirul-Islam F.; Cailes B.; Lim H.; Teh
A.; Farouque O.
Institution
(Koshy, Ha, Han, Amirul-Islam, Cailes, Lim, Teh, Farouque) Department of
Cardiology, Austin Health and University of Melbourne, Heidelberg,
Australia
(Gow) Victorian Liver Transplant Unit, Austin Health, Heidelberg,
Australia
Publisher
Elsevier Ltd
Abstract
Background: Current CSANZ guidelines are unclear about the role of
computed tomographic coronary angiography (CTA) and coronary artery
calcium score (CACS) in risk stratification prior to non-cardiac surgery
(NCS). We performed a systematic review and meta-analysis evaluating
perioperative risk prediction using these modalities in NCS.
<br/>Method(s): Electronic databases were used to identify studies of
preoperative CTA and CACS reporting 30-day perioperative major adverse
cardiovascular events (MACE). Summary odds ratios (OR) for degree of
coronary artery disease (CAD) and MACE were pooled using a random-effects
method. <br/>Result(s): Eleven studies were included. 246 (7.1%) MACE
occurred in 3480 patients. Risk of perioperative MACE rose with the
severity and extent of CAD on CTA (p < 0.001; Fig. 1 top). Multivessel
disease (>=2 vessels, >50% stenosis) demonstrated the greatest risk (OR
8.8 95% CI 5.1-15.3, p < 0.001; Fig. 1 bottom). Increasing CACS was also
associated with higher perioperative MACE (CACS: >=100 OR 5.1, p < 0.01).
In a cohort deemed high risk by established clinical indices, absence of
multivessel disease on CTA demonstrated a negative predictive value of 96%
(95% CI 92.8-98.4) for predicting freedom from MACE. <br/>Conclusion(s):
Severity and extent of CAD on CTA conferred incremental risk for
perioperative MACE post noncardiac surgery. The 'rule-out' capability of
CTA is comparable to other non-invasive modalities and may be a viable
alternative in perioperative risk stratification.<br/>Copyright &#xa9;
2019

<37>
Accession Number
2002234724
Title
Balloon Aortic Valvuloplasty in the Era of Transcatheter Aortic Valve
Implantation - A Review of Complications, Mortality and Destination
Therapy.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S386), 2019. Date of Publication: 2019.
Author
Mowbray A.; Ciofani J.; Soomro A.; Bhindi R.; De Silva K.; Asrress K.
Institution
(Mowbray, Ciofani, Soomro, Bhindi, Asrress) University Of Sydney, Sydney,
Australia
(Bhindi) Royal North Shore Hospital, Sydney, Australia
(De Silva) Bristol Heart Institute & University of Bristol, Bristol,
United Kingdom
(De Silva, Asrress) King's College London British Heart Foundation Centre
of Excellence, The Rayne Institute, St. Thomas' Hospital, London, United
Kingdom
(Asrress) Bankstown-Lidcombe Hospital, Sydney, Australia
Publisher
Elsevier Ltd
Abstract
Aims: To review the complications, mortality and destination therapy of
patients undergoing balloon aortic valvuloplasty (BAV) in the era of
transcatheter aortic valve implantation (TAVI). <br/>Method(s): A
systematic literature search identified journal articles reporting the
outcomes of adult patients undergoing BAV procedures. Cohorts of 50 or
more patients undergoing BAV between January 2002 and May 2018 were
included in the review. Patient baseline characteristics, surgical risk
scores, complications, short- and long-term mortality and reported
destination therapy were extracted and aggregated, with estimated mean and
standard deviation weighted by cohort size. <br/>Result(s): A total of 29
papers were included, describing the outcomes of 9,602 patients. The mean
age of the patient cohorts was 82.3 +/- 1.3 years. 51.6% of the patients
were female and the mean STS score was 12.3 +/- 3.2. The rates of stroke,
myocardial infarction, major vascular complications and greater than BARC
2 bleeding post-BAV were 1.2% +/- 0.7, 1.2% +/- 1.5, 2.4% +/- 1.1 and 8.9%
+/- 2.2 respectively. Periprocedural and intrahospital mortality rates
were 1.7% +/- 2.8 and 7.0% +/- 4.2. Mortality rates at 30 days and 12
months were 7.7% +/- 6.0 and 34.4% +/- 12.7. Reported rates of patients
undergoing TAVI, surgical aortic valve replacement or medical management
post-BAV were 17.2% +/- 12.1, 4.9% +/- 4.0 and 77.0% +/- 14.0.
<br/>Conclusion(s): Short and medium-term outcomes following BAV are
similar to contemporary cohorts undergoing TAVI. The vast majority of
patients do not proceed to further intervention, with BAV being their
destination therapy. The clinical and economic impact of such practice in
the era of TAVI requires further study.<br/>Copyright &#xa9; 2019

<38>
Accession Number
2002234698
Title
A Systematic Review of Transcatheter Mitral Valve-in-valve Replacement for
Failed Prosthesis.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S379-S380), 2019. Date of Publication:
2019.
Author
Hyasat K.; Markham R.; Raffel C.; Poon K.
Institution
(Hyasat, Markham, Raffel, Poon) The Prince Charles Hospital, Chermside,
Australia
Publisher
Elsevier Ltd
Abstract
Transcatheter mitral valve-in-valve (TMVIV) for failed bioprosthetic
valves is an emerging alternative to surgical re-operation in high risk
patients. In this systematic review, we assessed the outcomes of mitral
valve-in-valve replacement. <br/>Method(s): A thorough computer-based
search was performed using 4 major databases. We included studies
utilising TMVIV replacement in failed bioprosthetic valves, mitral ring
repairs and mitral clips. The 30-day and outcome of all-cause mortality,
stroke, major bleeding and reintervention was analysed. <br/>Result(s):
Seventeen observational studies were included in the analysis which
comprised of 558 patients (437 bioprosthetic mitral valves, 110 mitral
rings and 11 mitral clips). The mean age was 75 years with 39% of patients
being male. 42.7% (238 patients) had New York Heart Association class 3 or
4 symptoms. The mean Society of Thoracic Surgeons score was 12.5%. Mean
preoperative left ventricular ejection fraction was 55.5%. Patients with
underlying mitral valve disease included 13.1% (73 patients) with mitral
stenosis, 28% (158 patients) with mitral regurgitation and 10% (58
patients) with mixed mitral disease. Overall analysis demonstrated a low
30-day all-cause mortality of 2.5%. The rates of stroke and bleeding were
also low at 0.7% (4 patients) and 6.8% (38 patients) respectively. 2.7%
(16 patients) required reintervention with 0.4% (2 patients) needing
surgical replacement and 0.4% (2 patients) with further valve-in-valve
procedure. <br/>Conclusion(s): TMVIV is a safe and feasible option in
patients with failed mitral valve prosthesis who are high surgical risk
for re-operations.<br/>Copyright &#xa9; 2019

<39>
Accession Number
2002234597
Title
Surgical & Interventional Management of Rheumatic Valvular Heart Disease
at The Prince Charles Hospital from January 2005-December 2017.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S356), 2019. Date of Publication: 2019.
Author
Hlaing S.; Goh S.; Smith S.; Scalia G.; Pohlner P.
Institution
(Hlaing, Goh, Smith, Scalia, Pohlner) The Prince Charles Hospital,
Chermside, Australia
(Hlaing, Goh, Scalia, Pohlner) The Univesity of Queensland, Brisbane,
Australia
Publisher
Elsevier Ltd
Abstract
Background: The incidence of rheumatic heart disease (RHD) in the
indigenous Australian population is the highest in the world. 240
indigenous patients underwent any valve related surgical and
interventional procedures at Metro North HHS from January 2005-December
2017. Of these 75 were performed for rheumatic valves at TPCH.
<br/>Method(s): Chart review and electronic database procedural data was
analysed, with clinical follow up records, including echocardiography,
being collated to identify survival and cardiac status following these
interventions. <br/>Result(s): Rheumatic interventions were required over
an age range of 10-72 years dominantly female 82%. Percutaneous mitral
balloon valvuloplasty was performed in 15 patients, transcatheter aortic
valve implantation in 1 patient. Surgical valve repair of 11 isolated
mitral valves was achieved. Single valve replacement was done in 10 with
multiple valve repair/replacements required in the remaining 38 patients.
Mechanical and tissue valves were used almost equally during replacement.
Valve failure due to mitral valve thrombus formation, aortic prosthetic
patient mismatch, and endocarditis required 8 reoperations. One
reoperation following mitral valve repair has been required to date. Pre
and post procedure LVEF mean of 56% (range 33-80%) and 57% (range 28-75%)
respectively. 30-days hospital survival was 100%, 5 year was 88% and 12
year was 84%. Valve function on follow up with clinical and echo data
remains satisfactory. <br/>Conclusion(s): Mitral valve function is durable
following valvuloplasty or surgical repair in RHD. Risk to survival during
all forms of intervention is low. The type of systemic heart valve
utilised for replacement requires close consideration of patient
geography, medical access and patient compliance.<br/>Copyright &#xa9;
2019

<40>
Accession Number
2002234396
Title
New Atrial Fibrillation after Non-Cardiac Surgery Increases Risk of
Stroke: Results From a Meta-Analysis.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S219-S220), 2019. Date of Publication:
2019.
Author
Koshy A.; Thijs V.; Teh A.; Sajeev J.; Lim H.; Han H.; Weinberg L.; Gow
P.; Farouque O.
Institution
(Koshy, Teh, Sajeev, Lim, Han, Weinberg, Gow, Farouque) Department of
Cardiology & University of Melbourne, Austin Health, Heidelberg, Australia
(Thijs) Department of Neurology, Austin Health, Heidelberg, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: New-onset post-operative atrial fibrillation (POAF)
following non-cardiac surgery (NCS) has been associated with increased
length of stay, morbidity and mortality. However, it is unclear whether
POAF increases long-term risk of stroke, which may have implications for
anticoagulation use in POAF. <br/>Method(s): Electronic databases
(MEDLINE, PubMed) were systematically searched for studies of patients
undergoing NCS that reported incidence of new POAF and stroke. Studies of
patients with pre-existing AF were excluded. Event rates from individual
studies were pooled using a Der-Simonian and Laird random-effects model.
<br/>Result(s): Sixteen studies of 3,664,390 patients undergoing NCS were
included (mean age was 67 +/- 3 years). Majority were observational cohort
studies and follow-up ranged from 30-days to 3-years. Methods of cardiac
rhythm monitoring varied between studies. 29,307 (0.80%) patients
developed new POAF. On pooled analysis, POAF was associated with over a
two-fold increased risk of stroke (Relative Risk 2.1 95%CI 1.9-2.3, p <
0.001) with low heterogeneity (I² = 22%) between studies
(Figure 1 ). <br/>Conclusion(s): New POAF after NCS is associated with a
greater than two-fold increased risk of stroke. Future studies are needed
to assess whether anticoagulation can reduce the risk of stroke in this
cohort.<br/>Copyright &#xa9; 2019

<41>
Accession Number
2002234362
Title
Long-term Outcomes and Predictors of Mortality in Low Surgical Risk
Patients Undergoing Transcatheter Aortic Valve Implantation.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S411), 2019. Date of Publication: 2019.
Author
Mundisugih J.; Walton A.; Duffy S.; Stub D.; Stehli J.; Koh S.; Htun N.;
Johnston R.; Holland S.; Kaye D.; Nanayakkara S.
Institution
(Mundisugih, Walton, Duffy, Stub, Stehli, Koh, Htun, Johnston, Holland,
Kaye, Nanayakkara) Department of Cardiology, Alfred Hospital, Melbourne,
Australia
(Stub, Kaye, Nanayakkara) Heart Failure Research Group, Baker Heart and
Diabetes Research Institute, Melbourne, Australia
(Johnston, Holland) Faculty of Medicine, Nursing and Health Sciences,
Monash University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an
alternative treatment for severe symptomatic aortic stenosis (AS) in
patients at increased surgical risk. However, less is known about
long-term outcomes among patients with severe AS who are at low surgical
risk. <br/>Method(s): All patients who underwent TAVI at two centres
between August 2008 and December 2017 were reviewed and excluded if they
were lost to follow up. Patients were divided into three cohorts based on
the Society of Thoracic Surgery (STS) risk score (<4 = low, 4-8 =
intermediate, >8 = high). The primary endpoint was all-cause mortality.
[Figure presented] Results: A total of 593 patients were included, with
273 (46%) patients deemed low risk. Mean AV gradient was similar (49mmHg
vs. 50mmHg vs. 46mmHg, p = 0.10). The median follow-up was 861 days with a
maximum follow-up period of 10 years. Low-risk patients had lower 12-month
mortality (4% vs. 10% vs. 15%) and 5-year mortality (18% vs. 30% vs. 47%)
compared to moderate- and high-risk groups. In low-risk patients,
independent predictors of all-cause mortality were prior atrial
fibrillation (HR 4.15, 95%CI 1.26-13.66), pre-TAVI left ventricular
ejection fraction (HR 0.95, 95%CI 0.91-0.98), and frailty score (HR 2.05,
95%CI 1.07-3.91). <br/>Conclusion(s): Low-risk patients undergoing TAVI
display less than half of the mortality rates of higher-risk patients.
Long-term randomised studies are required to determine the safety of TAVI
in this cohort of patients compared with surgical aortic valve
replacement.<br/>Copyright &#xa9; 2019

<42>
Accession Number
2002234321
Title
Cryoablation Versus Radiofrequency Ablation for Maze Procedures.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S335), 2019. Date of Publication: 2019.
Author
Florisson D.; Conte S.; De Bono J.; Rahnavardi M.
Institution
(Florisson, De Bono, Rahnavardi) St Vincent's Hospital Melbourne, Fitzroy,
Australia
(Conte) St Vincent's Hospital Sydney, Darlinghurst, Australia
Publisher
Elsevier Ltd
Abstract
Background: The Cox-Maze IV procedure for the treatment of atrial
fibrillation (AF) is faster, less technically complex, portends fewer
complications, and results in lower morbidity compared to the traditional
cut-and-sew Cox-Maze III procedure. Cox-Maze IV is highly effective, with
recurrence rates of only 5-10%. The most studied energy sources are
radiofrequency and cryoablation. <br/>Method(s): A best evidence topic was
written according to a structured protocol addressing the question "for
patients undergoing maze procedure, do cryoablation and radiofrequency
ablation differ with respect to rate of recurrence of atrial
fibrillation?" Altogether, 480 papers were found searching Medline,
Embase, and Pubmed databases of which ten represented the best evidence to
answer the question. Randomised trials or cohort studies among adults
undergoing cardiac surgical procedures that included maze procedure were
included. <br/>Result(s): Rates of sinus rhythm or freedom from AF at
long-term follow-up (usually 12 months) ranged from 70-95% and 73-89% in
the radiofrequency and cryoablation groups respectively. Both methods were
much more effective at maintaining sinus rhythm compared to placebo. The
two groups were also evenly matched in terms of reported rates of
complications. Mortality, when reported, ranged from 0-2% in both groups.
<br/>Conclusion(s): We conclude that radiofrequency and cryoablation are
equiefficacious in terms of freedom from AF recurrence at long-term
follow-up. Rates of complications such as bleeding and cardiac tamponade
as well as mortality did not differ between groups. Choice of energy
source for Cox-Maze IV procedure does not appear to markedly affect
outcomes and should depend on centre and operator
experience.<br/>Copyright &#xa9; 2019

<43>
Accession Number
2002234294
Title
A Meta-Analysis of Cognitive Outcomes Including Delirium in Coronary
Artery Bypass Grafting Patients.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S333), 2019. Date of Publication: 2019.
Author
Greaves D.; Psaltis P.; Ross T.; Davis D.; Smith A.; Boord M.; Keage H.
Institution
(Greaves, Ross, Boord, Keage) Cognitive Ageing and Impairment
Neurosciences Laboratory, The University Of South Australia, Adelaide,
Australia
(Psaltis) Vascular Research Centre, Heart Health Theme, South Australian
Health and Medical Research Institute, Adelaide, Australia
(Davis) MRC Unit for Lifelong Health and Ageing at University College
London, London, United Kingdom
(Smith) Alliance for Research in Exercise, Nutrition and Activity,
University of South Australia, Adelaide, Australia
Publisher
Elsevier Ltd
Abstract
Background: Increasing numbers of adults are undergoing invasive
cardiothoracic surgeries, such as coronary artery bypass grafting (CABG).
CABG is known to improve cardiac vascularisation and mortality, however
cognitive impairments including delirium are common after CABG. Our aim
was to pool estimates across the literature for the first time, relative
to diagnosis (cognitive impairment and delirium) and time (from pre- to
post-CABG). <br/>Method(s): A systematic search of four databases was
undertaken. 213 studies incorporating data from 86,390 patients were used
to estimate the prevalence of cognitive impairments pre- and post-CABG,
including delirium post-CABG, using random effects meta-analyses.
<br/>Result(s): Pre-surgical cognitive impairment was seen in 19% of
patients. Post-operatively, cognitive impairment was seen in around 43% of
patients acutely; this resolved to 19% at 4-6 months and then increased to
25% of patients between 6-months to 1-year post-operatively. In the long
term, between 1 and 5-years post-operatively, cognitive impairment
increased and was seen in nearly 40% of patients. Post-operative delirium
was apparent in 18% of CABG patients which increased to 24% when a
diagnostic instrument was utilised alongside clinical criteria.
<br/>Conclusion(s): Cognitive impairment and delirium are major issues in
CABG patients. One in five patients have a cognitive impairment prior to
CABG, which raises questions regarding informed consent. One in four
patients have a delirium episode after CABG, which is associated with poor
long term outcomes. These data emphasise the importance of using
appropriate methods to investigate for cognitive impairment and screen for
delirium in both the pre-and post-CABG settings.<br/>Copyright &#xa9; 2019

<44>
Accession Number
2002234266
Title
Restrictive Versus Liberal Transfusion Strategies for Cardiac Surgery.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S339), 2019. Date of Publication: 2019.
Author
Conte S.; De Bono J.; Florisson D.; Vale P.
Institution
(Conte) St Vincent's Hospital Sydney, Darlinghurst, Australia
(De Bono, Florisson) St Vincent's Hospital Melbourne, Fitzroy, Australia
(Vale) Mater Hospital Sydney, Crows Nest, Australia
Publisher
Elsevier Ltd
Abstract
Background: Anaemia is an important complication affecting cardiac surgery
patients. Following cardiac surgery, transfusion of red blood cells is
often required for haemodynamic support. Traditionally, haemoglobin
cutoffs of 9-10 g/dL were used for to trigger transfusion. New randomised
trial evidence has recently bolstered support for restrictive protocols
with haemoglobin cutoffs of 7-8 g/dL. <br/>Method(s): A best evidence
topic was written addressing the question "does post-operative mortality
among adult patients undergoing cardiac surgery differ with restrictive
versus liberal transfusion strategies?" Altogether, ten randomised trials
representing 11,826 patients were identified searching Medline, Embase,
and Pubmed databases from 1980 to February 2019 which represented the best
evidence to answer the question. <br/>Result(s): Some older trials have
suggested a trend toward long-term mortality benefit with liberal
transfusion protocols: Hazard Ratio (HR) 0.7 [95% confidence interval (CI)
0.49-1.02, p = 0.06] from a meta-analysis summarising six trials. However,
more recent, larger, high-quality contemporary trials have demonstrated
noninferiority with regard to mortality for a restrictive strategy, with
the largest of which producing an odds ratio of 0.85 (95% CI 0.62-1.16)
for 28-day mortality and 1.02 (95% CI 0.87-1.18, p = 0.006) for 6-month
mortality. <br/>Conclusion(s): Among cardiac surgery patients, restrictive
and liberal transfusion strategies do not differ with respect to
mortality. Adverse outcomes such as stroke, nonfatal myocardial
infarction, and renal failure did not differ between the two groups.
Restrictive strategies result in fewer transfusions and less health care
expenditure.<br/>Copyright &#xa9; 2019

<45>
Accession Number
2002234253
Title
Renal Outcomes after Cardiac Surgery in Relation to Angiotensin Converting
Enzyme Inhibitor/Angiotensin II Receptor Blocker Use.
Source
Heart Lung and Circulation. Conference: 67th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting, the International Society for
Heart Research Australasian Section Annual Scientific Meeting and the 13th
Annual Australia and New Zealand Endovascular Therapies Meeting.
Australia. 28 (Supplement 4) (pp S338), 2019. Date of Publication: 2019.
Author
De Bono J.; Conte S.; Florisson D.; Vale P.
Institution
(De Bono, Florisson) St Vincent's Hospital Melbourne, Fitzroy, Australia
(Conte) St Vincent's Hospital Sydney, Darlinghurst, Australia
(Vale) Mater Hospital Sydney, Crows Nest, Australia
Publisher
Elsevier Ltd
Abstract
Background: Angiotensin converting enzyme inhibitors (ACEI) and
angiotensin II receptor blockers ARB) are first-line therapies in
hypertensive and heart failure. Their use in patients undergoing cardiac
surgery is common. Concern regarding renal outcomes exists for patients
administered these medications perioperatively, resulting in heterogeneous
practice. <br/>Method(s): A best evidence topic was written addressing the
question "in patients undergoing cardiac surgery, is long-term
preoperative ACEI/ARB therapy associated with postoperative renal
dysfunction?" Altogether, 11 studies representing 47,072 patients
comprised of two randomised trials, two prospective cohorts, and seven
retrospective cohorts with 811, 5,818, and 40,443 patients respectively
were identified searching Medline, Embase, and Pubmed databases from 1980
to February 2019. <br/>Result(s): Evidence is conflicting. The two
randomised trials showed that preoperative ACEI/ARB were protective
against the development of postoperative acute kidney injury (AKI). The
two prospective cohorts showed opposite results and of the seven
retrospective cohorts, four demonstrated increased risk, two no
difference, and one a protective effect against AKI in relation to
preoperative ACEI/ARB therapy. <br/>Conclusion(s): Most data are derived
from large cohort studies of moderate quality (average Newcastle Ottawa
Scale score of five) and overall suggest an increased risk of
postoperative AKI with preoperative ACEI/ARB. However, more recent, higher
quality, randomised studies have shown the opposite: preoperative ACEI/ARB
therapy reduces incidence of postoperative AKI; emphasizing the impact of
selection and confounders. Large randomised trials are necessary to
identify patients who may benefit from continued ACEI/ARB therapy in the
context of cardiac surgery.<br/>Copyright &#xa9; 2019

<46>
Accession Number
628679080
Title
Implementation of a systematic massive transfusion (MT) review process in
an australian tertiary hospital.
Source
Vox Sanguinis. Conference: 29th Regional Congress of the ISBT.
Switzerland. 114 (Supplement 1) (pp 84), 2019. Date of Publication: June
2019.
Author
Cole-Sinclair M.; Wynne A.; Walter C.; Walby A.; Ghani M.; McGlade D.
Institution
(Cole-Sinclair, Wynne, Walter) Haematology
(Walby) Emergency
(Ghani) Intensive Care
(McGlade) Anaesthesia, St Vincent's Hospital Melbourne, Melbourne,
Australia
Publisher
Blackwell Publishing Ltd
Abstract
Background: The National Blood Authority of Australia recommends that
institutions develop a MT Protocol (MTP) that includes the dose, timing
and ratio of blood component therapy for use in trauma patients with, or
at risk of, critical bleeding requiring massive transfusion' (Module 1 of
Patient Blood Management Guidelines, 2011). St Vincent's Hospital
Melbourne (SVHM), a tertiary hospital supporting medicine, surgery and
non-major trauma emergency and ITU services implemented a MTP in 2008.
Subsequent MTP reassessment has led to implementation of regular
multi-disciplinary review of all MTs to identify areas for improvement in
transfusion and other aspects of support for critically bleeding patients.
<br/>Aim(s): To implement a systematic service-wide stakeholder review of
MT events at SVHM aiming to identify deficiencies and implement
improvements in MT management. <br/>Method(s): A multi-disciplinary MT
review team was established as a subcommittee of the hospital Transfusion
Committee (TC) to update the organisational MTP in 2016 and subsequently
continued to meet quarterly as the MT review subcommittee (MTRS) of the
TC, systematically reviewing all aspects of MTs at SVHM. Instances where 4
or more red cell units are transfused in <4 h are identified from the
laboratory information system and reviewed by the MTRS which includes
representatives from Accident and Emergency, Intensive Care, Operating
Suite (OS) and Transfusion Laboratory staff; the Head of the patient's
treating unit is also invited to contribute. Reviews include:
demographics, clinical details, comorbidities, time from patient arrival
to pre-transfusion specimen collection/receipt, time from blood request to
release/transfusion, regularity of full blood examination
(FBE)/coagulation (coag) testing, timing of blood component transfusion,
total component provision/ratios, component waste, patient outcome, and
communication between various clinical areas and also the laboratory. A
discussion summary with actions/recommendations is provided to the TC and
some cases referred to the hospital Mortality/Clinical Review Committee.
<br/>Result(s): Cases reviewed: 65 from 10 treating units including
Cardiothoracic surgery (18) Hepatobiliary/Gastrointestinal/Colorectal
surgery (24), Vascular surgery (6), Neu-rosurgery (4), Orthopaedic surgery
(3), Endocrine (2) and "other" (encompassing General Surgery, Urology,
General Medicine and Oncology-8). Areas for monitoring/improvement
identified: transfusion documentation, regularity of FBE/coag specimen
submission, reducing time between patient arrival and specimen collection,
reducing specimen transport time, interfacing point of care blood-gas
analysers to the central pathology result management system as well as
component management/waste reduction and the introduction of
viscoelastometry assessment in the OS. 18 of 65 reviewed cases involved
the transfusion of emergency uncrossmatched O RhD negative red cell units.
The appropriateness of the use of this precious resource is also reviewed
by the MTRS. Summary/Conclusions: The SVHM MTRS meets regularly to review
MT events and formalise multidisciplinary collaboration in identifying
possible improvements to support these often critically ill patients.
Matters highlighted include communication issues, delays in specimen
delivery and blood component waste minimisation. Areas for further work
include minimising delay between MT events and review, and for-malisation
of key performance indicators for MTs.

<47>
Accession Number
628710029
Title
The effect of a virtual reality immersive experience upon anxiety levels
in patients undergoing cardiac catheterisation: The virtual CATH trial.
Source
Heart. Conference: British Cardiovascular Society Annual Conference
Digital Health Revolution. United Kingdom. 105 (Supplement 6) (pp
A50-A51), 2019. Date of Publication: May 2019.
Author
Morgan H.; Gallagher S.M.
Institution
(Morgan) Dr
(Gallagher) University Hospital of UK
Publisher
BMJ Publishing Group
Abstract
Introduction Patients undergoing cardiac catheterisation are
understandably anxious. This is due to a lack of familiarity with both the
hospital environment and the planned procedure. Anxiety may negatively
affect their patient experience. Appropriate patient information can help
improve understanding and reduce anxiety. In particular, video-based
patient information prior to cardiac catheterisation has been shown to
improve patient's knowledge and reduce peri-procedural anxiety. Generic
video-based patient information about the cardiac catheterisation
procedure is widely available. Ideally any patient information delivered
pre-cardiac catheterization would be specific to the hospital delivering
care. The use of virtual reality (VR) in healthcare is novel, but
expanding rapidly. The immersive nature of VR allows patients a unique
opportunity to prepare for the procedure and environment within which they
will be treated. To date, the use of VR to prepare patients for invasive
cardiac procedures has not been studied. Aim The aim of this study is to
assess whether the use of an immersive VR experience decreases
peri-procedural anxiety in patients undergoing cardiac catheterisation. We
will also assess whether the VR experience improves overall patient
satisfaction. Methods With the help of a local media company, a VR cardiac
catheterisation video was produced (figure 1 depicts a screenshot from the
VR video). The video is watched with a VR headset to create a 360
immersive experience. We are undertaking a single-centre randomised
control trial comparing the use of an immersive VR experience 1 week prior
to catheterisation with standard pre-procedural care. Pre procedural
anxiety levels and procedural knowledge are assessed by questionnaire,
using the validated six-item short-form of the Strait Trait Anxiety
Inventory (STAI). A satisfaction questionnaire is also completed before
the patient is discharged. Results Data collection is currently underway
and is due to finish in April 2019. Preliminary review of pilot results
shows trend towards reduced anxiety in VR cohort (n=45; 21C, 24VR; anxiety
scores 21.5 v 17.6) Informal feedback suggests patients enjoy the VR
experience and find it a helpful adjunct to the usual pre-procedure care.
Full data analysis will be completed by May 2019. Conclusion We aim to
assess whether the use of an immersive VR experience improves patient
familiarity with cardiac catheterisation, thereby reducing peri-procedural
anxiety. If confirmed, we plan to make the immersive VR experience
available to all patients undergoing angiography in our centre. Further
work includes expanding the VR resource to cover other cardiac procedures.
(Figure Presented) .

<48>
Accession Number
628666964
Title
Acceptance and commitment therapy (ACT) for parents of children with a
chronic medical condition: A systematic review.
Source
Paediatrics and Child Health (Canada). Conference: 96th Annual Conference
of the Canadian Paediatric Society, CPS 2019. Canada. 24 (Supplement 2)
(pp e10), 2019. Date of Publication: June 2019.
Author
Parmar A.; Morinis L.; Barreira L.; Miller D.; Major N.; Church P.; Cohen
E.; Orkin J.
Publisher
Oxford University Press
Abstract
BACKGROUND: Caring for a child with a chronic medical condition can
adversely affect parental health and well-being. Family-centered care
requires clinical teams to consider novel ways of providing holistic care
to the entire family by understanding the unique challenges of caring for
a child with a chronic medical condition. Addressing parental well-being
not only improves parental capacity to care for their child, but may also
optimize long-term health outcomes for the child themselves. Acceptance
and Commitment Therapy (ACT) is an established behavioural therapy that
has been used with caregivers in the paediatric setting. Through ACT,
individuals learn skills to increase psychological flexibility, cognitive
diffusion, and mindfulness. ACT aims to help with coping and adjustment,
but its impact has not been systematically appraised in parents of
children with chronic medical conditions. <br/>OBJECTIVE(S): To synthesize
available research evidence on the efficacy of ACT for parents of children
with medical conditions. DESIGN/METHODS: A comprehensive literature search
(December 2008 to October 2018) in PubMed, Cochrane Library, EMBASE, Web
of Science, and Google Scholar was conducted. Abstracts were included if:
1) they were original articles and 2) they assessed the efficacy and
outcomes of ACT on parents caring for children with chronic medical
conditions. <br/>RESULT(S): In total, 66 abstracts were identified. Nine
publications describing ACT as an intervention aimed at improving
parent-oriented outcomes met the final inclusion criteria. Five studies
were randomized control trials. Medical conditions included children with:
chronic pain (n=4), acquired brain injuries (n=2), autism spectrum
disorder (n=1), cerebral palsy (n=1), and life-threatening illness (cancer
or life-saving cardiac surgery) (n=1). All nine studies found improvements
in caregiver related outcomes following ACT treatment. Improvements were
seen in psychological flexibility (n=5), family functioning (n=3),
parenting (n=1), and depression (n=2). Significant, medium to large effect
sizes were found for measures of psychological flexibility, dysfunctional
parenting styles (laxness and over reactivity). A medium effect size was
found for family functioning. <br/>CONCLUSION(S): ACT improved outcomes
for parents caring for children with chronic medical conditions. The
majority of studies concentrated in paediatric patients with chronic pain
or neurologic conditions. Less is known about the efficacy of ACT in
improving parent-related outcomes in other paediatric disease groups
however, further research in this area is warranted.

<49>
Accession Number
2000753783
Title
ENDOSCOPIC EVALUATION OF UPPER GASTROINTESTINAL MUCOSAL INJURY IN PATIENTS
WITH DIFFERENT ANTIPLATELET THERAPIES AT 1 YEAR POST-CABG AND ANALYSIS OF
THE ASSOCIATED RISK FACTORS.
Source
Gastroenterology. Conference: DDW 2018 - Digestive Disease Week. United
States. 154 (6 Supplement 1) (pp S-703), 2018. Date of Publication: May
2018.
Author
Yu L.; Zhu Y.; Tang C.; Yang X.; Ye C.; Yang Y.; Zhong J.; Zhao Q.
Publisher
W.B. Saunders
Abstract
Background & Aim: The aim of our study is to observe potential upper
gastrointestinal (GI) mucosal injury in patients who received 1 year
different antiplatelet therapies after coronary artery bypass grafting
(CABG) surgery and explore the associated risk factors. <br/>Method(s):
Five hundred patients following CABG were randomly assigned into 3 groups,
including aspirin or ticagrelor monotherapy group and ticagrelor plus
aspirin group (DACAB, NCT 02201771). Among them, 272 patients enrolled in
Ruijin hospital would undergo esophagogastroduodenoscopy (EGD) with their
consent at 1 year. Helicobacter pylori (H. pylori) infection was detected
by ¹³C urea breath test. Major cardiovascular events (MACE)
were eventually assessed. Based on the modified Lanza score, a new
endoscopic evaluation system NEU-GD was developed to evaluate upper GI
mucosal injury. Mild injury was defined as level II or less, and severe
injury was from level III to V, which should be treated with proton pump
inhibitors (PPIs). <br/>Result(s): From August 2015 to December 2016, 261
of 272 patients finished the 1 year follow-up visit, 88.5% (231/261) of
whom underwent EGD. The incidence of MACE was 2.6% (7/272). According to
the PP principle, 230 patients were analyzed. The total rate of mucosal
injury from level III to V was 35.2% (81/230). It was 32.9% (23/70) in the
aspirin group, 28.8% (23/80) in the ticagrelor group and 43.6% (35/80) in
the ticagrelor plus aspirin group, respectively. All patients were
prescribed with 1-month PPIs. Among them, 56.5% (130/230) were treated
with PPIs for 3 months, only 8.3% (19/230) for more than 6 months.
Multivariate Logistic regression analysis showed that H. pylori positive
(adjusted OR= 5.790, 95%CI: 2.152, 15.579, p=0.001) and history of
myocardial infarction (MI) (adjusted OR=2.563, 95%CI: 1.003, 6.548,
p=0.049) were associated with severe mucosal injury of level V (11.7%.
27/230). A total of 87 patients (37.8%, 87/230) were H. pylori positive.
64.4% (56/87) of them were aspirin naive. However, only 1 finished
eradication treatment. Among the 56 patients with MI but no peptic ulcer
history (n=200), 27 patients (48.2%) were H. pylori positive, and 74.1%
(20/27) of whom were aspirin naive. The rate of mucosal injury from level
III to V in patients with H. pylori positive were remarkably higher as
compared to their H. pylori negative counterparts (44.4% (12/27) vs. 17.2%
(5/29)). <br/>Conclusion(s): The upper GI mucosal injury is much more
severe in the ticagrelor plus aspirin group, compared with that in aspirin
or ticagrelor monotherapy group, respectively. Patients with H. pylori
positive, especially in those of aspirin naive and with myocardial
infarction history, had a relatively higher rate of severe mucosal injury.
Chinese patients are rarely prescribed with both PPIs and antiplatelet
agents over 6 months after CABG.<br/>Copyright &#xa9; 2018 AGA Institute.
All rights reserved.

<50>
Accession Number
2000744944
Title
RISK OF GASTROINTESTINAL BLEEDING IN PATIENTS USING TICAGRELOR OR
CLOPIDOGREL: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Gastroenterology. Conference: DDW 2018 - Digestive Disease Week. United
States. 154 (6 Supplement 1) (pp S-782), 2018. Date of Publication: May
2018.
Author
Guo C.G.; Chen L.; Chan E.W.; Cheung K.S.; Wong I.C.; Leung W.K.
Publisher
W.B. Saunders
Abstract
Background: Ticagrelor is a novel oral reversible adenosine
diphosphate/P2Y<inf>12</inf> receptor inhibitor with rapid onset and more
pronounced platelet inhibition than clopidogrel. Several large-scale
randomized trials have confirmed the superiority of ticagrelor over
clopidogrel on various cardiovascular or cerebrovascular outcomes.
However, higher bleeding rates have also been reported with ticagrelor
uses and so far, no study has compared the risk of gastrointestinal
bleeding (GIB) in patients taking ticagrelor and clopidogrel.
<br/>Objective(s): To determine the risk of GIB and all non-CABG (coronary
artery bypass graft) bleeding in patients with acute coronary syndrome
(ACS) or other vascular diseases, including cerebrovascular and peripheral
vascular disease, using ticagrelor or clopidogrel. <br/>Method(s): We
systematically searched PubMed, Cochrane library and Web of Science to
identify randomized control trials (RCTs) comparing the efficacy and
safety of ticagrelor with clopidogrel published till September 2017. All
randomized patients or patients who received at least one dose of study
drug were included in the analysis. The primary end-point was the rate of
major or minor GIB based on the PLATO bleeding definition, expressed as
risk ratio (RR) and 95% confidence interval (CI). Subgroup analysis was
performed on follow-up duration and the subgroup involving Asian patients,
among which higher bleeding risk was reported. The rates of all non-CABG
related bleeding were also analyzed. <br/>Result(s): Twenty-three
full-text RCTs including 36,857 patients were identified. Analysis of all
major bleeding indicated that ticagrelor is associated with higher rate of
all major bleeding (RR 1.18, 95% CI 1.05 to 1.31) as compared with
clopidogrel (Fig. 1 A). This trend was also observed in the analysis for
all major and minor bleeding (RR 1.12, 95% CI 1.05 to 1.20) including 14
studies and 21,490 patients. Seven studies involving 2,296 patients
reported outcomes of GIB. In fixed effects model, ticagrelor use was not
associated with increased risk of major or minor GIB (RR 1.59, 95% CI 0.75
to 3.39) as compared with clopidogrel (Fig. 1 B). There was low
heterogeneity among the included studies (I² of 0%; 95% CI 0 to
52%). The result was consistent in subgroup analysis based on the duration
of follow-up, in which the RR of GIB in studies over 1 month or less than
1 month was 1.57 (95% CI 0.64 to 3.84) and 1.66 (95% CI 0.41 to 6.66),
respectively. The Asian trials subgroup analysis of GIB involving 1,111
patients showed the similar result (RR 1.55, 95% CI 0.58 to 4.17).
<br/>Conclusion(s): Based on currently available data, ticagrelor was
associated with higher risk of all major bleeding but did not appear to
increase the risk of GIB, when compared with clopidogrel. However, as most
relevant RCTs did not report GIB outcomes separately, further analyses
from the original data are needed. [Figure Presented]<br/>Copyright &#xa9;
2018 AGA Institute. All rights reserved.

<51>
[Use Link to view the full text]
Accession Number
628698933
Title
Improved Compliance and Comprehension of a Surgical Safety Checklist With
Customized Versus Standard Training: A Randomized Trial.
Source
Journal of patient safety. 14 (3) (pp 138-142), 2018. Date of Publication:
01 Sep 2018.
Author
Rakoff D.; Akella K.; Guruvegowda C.; Chhajwani S.; Seshadri S.; Sola S.
Institution
(Rakoff, Akella, Sola) From the Departments of Cardiology, Israel
(Guruvegowda) Cardiothoracic and Vascular Surgery, Germany
(Chhajwani) Anesthesia and Critical Care, Brazil
(Seshadri) Hospital Administration, Sri Sathya Sai Institute of Higher
Medical Sciences, Bangalore, Karnataka, India
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This study aimed to determine the effect of customized training
versus standard readily available training on surgical safety checklist
(SSCL) compliance and comprehension. BACKGROUND: The success of the SSCL
in reducing surgical mortality and morbidity depends largely on the degree
of compliance among health care workers with the checklist's components.
We hypothesized that a customized training program would improve
comprehension of the SSCL components among health care workers.
<br/>METHOD(S): We prospectively evaluated compliance and comprehension of
a locally modified SSCL among surgeons, anesthesiologists, nurses, and
perfusionists who were randomized to standard versus customized training
in the department of cardiac and thoracic surgery. Standard training
included videos, posters, and didactic sessions obtained from the World
Health Organization. Customized training consisted of a
department-specific orientation video (using local staff as actors),
locally made posters, and didactic sessions. Comprehension was assessed by
a written exam after each training program. Verbal and written compliance
with the SSCL was measured within the operating theater by trained
observers. <br/>RESULT(S): We observed a total of 244 surgeries for SSCL
compliance. Comprehension of the didactic material provided in the
training programs was higher in the customized versus the standard
training group (75% versus 30%; P < 0.0001). Verbal compliance was higher
in the customized versus standard training groups (87% versus 49%; P <
0.0001). Written compliance was 100% for both the customized and standard
training groups. <br/>CONCLUSION(S): A customized training program
improves verbal compliance and comprehension among health care workers
when implementing an SSCL, compared with standard readily available
training.

<52>
Accession Number
2002242214
Title
Prevention of postoperative delirium in elderly patients planned for
elective surgery: Systematic review and meta-analysis.
Source
Clinical Interventions in Aging. 14 (pp 1095-1117), 2019. Date of
Publication: 2019.
Author
Janssen T.L.; Alberts A.R.; Hooft L.; Mattace-Raso F.U.S.; Mosk C.A.; Van
Der Laan L.
Institution
(Janssen, Alberts, Mosk, Van Der Laan) Department of Surgery, Amphia
Hospital Breda, Breda, Netherlands
(Hooft) Cochrane Netherlands, Julius Centre for Health Sciences and
Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
(Mattace-Raso) Department of Geriatrics, Erasmus MC University Hospital
Rotterdam, Rotterdam, Netherlands
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Introduction: Vulnerable or "frail" patients are susceptible to the
development of delirium when exposed to triggers such as surgical
procedures. Once delirium occurs, interventions have little effect on
severity or duration, emphasizing the importance of primary prevention.
This review provides an overview of interventions to prevent postoperative
delirium in elderly patients undergoing elective surgery. <br/>Method(s):
A literature search was conducted in March 2018. Randomized controlled
trials (RCTs) and before-and-after studies on interventions with potential
effects on postoperative delirium in elderly surgical patients were
included. Acute admission, planned ICU admission, and cardiac patients
were excluded. Full texts were reviewed, and quality was assessed by two
independent reviewers. Primary outcome was the incidence of delirium.
Secondary outcomes were severity and duration of delirium. Pooled risk
ratios (RRs) were calculated for incidences of delirium where similar
intervention techniques were used. <br/>Result(s): Thirty-one RCTs and
four before-and-after studies were included for analysis. In 19 studies,
intervention decreased the incidences of postoperative delirium. Severity
was reduced in three out of nine studies which reported severity of
delirium. Duration was reduced in three out of six studies. Pooled
analysis showed a significant reduction in delirium incidence for
dexmedetomidine treatment, and bispectral index (BIS)-guided anaesthesia.
Based on sensitivity analyses, by leaving out studies with a high risk of
bias, multicomponent interventions and antipsychotics can also
significantly reduce the incidence of delirium. <br/>Conclusion(s):
Multicomponent interventions, the use of antipsychotics, BIS-guidance, and
dexmedetomidine treatment can successfully reduce the incidence of
postoperative delirium in elderly patients undergoing elective,
non-cardiac surgery. However, present studies are heterogeneous, and
high-quality studies are scarce. Future studies should add these
preventive methods to already existing multimodal and multidisciplinary
interventions to tackle as many precipitating factors as possible,
starting in the pre-admission period.<br/>Copyright &#xa9; 2019 Janssen et
al.

<53>
Accession Number
2002232708
Title
The effects of iloprost on oxygenation during one-lung ventilation for
lung surgery: A randomized controlled trial.
Source
Journal of Clinical Medicine. 8 (7) (no pagination), 2019. Article Number:
982. Date of Publication: July 2019.
Author
Choi H.; Jeon J.; Huh J.; Koo J.; Yang S.; Hwang W.
Institution
(Choi, Huh, Koo, Yang, Hwang) Department of Anesthesia and Pain Medicine,
Seoul St. Mary's Hospital, College of Medicine, The Catholic University of
Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, South Korea
(Jeon) Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, 93-6,
Jingwan-dong, Eunpyeong-gu, Seoul 122200, South Korea
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Hypoxemia can occur during one-lung ventilation (OLV) in thoracic surgery,
leading to perioperative complications. Inhaled iloprost is a selective
pulmonary vasodilator with efficacy in patients with pulmonary
hypertension. The purpose of this study was to evaluate the effects of
off-label inhaled iloprost on oxygenation during OLV in patients
undergoing lung surgery. Seventy-two patients who were scheduled for
elective video-assisted thoracoscopic lobectomy were assigned to receive
an inhaled nebulizer of distilled water (control group), 10 micro&#32;g
iloprost (IL10 group), or 20 micro&#32;g iloprost (IL20 group). Arterial
and venous blood gas and hemodynamic analyses were obtained. Changes in
partial pressure of oxygen in arterial blood (PaO<inf>2</inf>), after the
initiation of OLV and the resumption two-lung ventilation (TLV), were
similar in all three groups. However, PaO<inf>2</inf> in the IL10 group
was comparable to that in the control group, whereas PaO<inf>2</inf> in
the IL20 group was significantly higher than that in the control group at
10, 20, and 30 min after administration of iloprost (275.1 +/- 50.8 vs.
179.3 +/- 38.9, p < 0.0001; 233.9 +/- 39.7 vs. 155.1 +/- 26.5, p < 0.0001;
and 224.6 +/- 36.4 vs. 144.0 +/- 22.9, p < 0.0001, respectively). The
shunt fraction in the IL20 group was significantly higher than that in the
control group after administration of iloprost (26.8 +/- 3.1 vs. 32.2 +/-
3.4, p < 0.0001; 24.6 +/- 2.2 vs. 29.9 +/- 3.4, p < 0.0001; and 25.3 +/-
2.0 vs. 30.8 +/- 3.1, p < 0.0001, respectively). Administration of inhaled
iloprost during OLV improves oxygenation and decreases intrapulmonary
shunt.<br/>Copyright &#xa9; 2019 by the authors. Licensee MDPI, Basel,
Switzerland.

<54>
Accession Number
628688910
Title
Outcomes of left atrial appendage occlusion using the AtriClip device: a
systematic review.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2019.
Date of Publication: 10 Jul 2019.
Author
Toale C.; Fitzmaurice G.J.; Eaton D.; Lyne J.; Redmond K.C.
Institution
(Toale, Fitzmaurice, Eaton, Redmond) Department of Thoracic Surgery, Mater
Misericordiae University Hospital, Dublin, Ireland
(Lyne) Department of Cardiology, Blackrock Clinic, Dublin, Ireland
Publisher
NLM (Medline)
Abstract
Atrial fibrillation increases lifetime stroke risk. The left atrial
appendage (LAA) is thought to be the source of embolic strokes in up to
90% of cases, and occlusion of the LAA may be safer than the alternative
of oral anticoagulation. Occlusion devices, such as the AtriClipTM
(AtriCure, Mason, OH, USA) enable safe and reproducible epicardial
clipping of the LAA. A systematic review was performed in May 2018, based
on the Preferred Reporting Items for Systematic Reviews and Meta-analyses
guidelines, using the keyword 'AtriClip'. A total of 68 papers were
identified and reviewed; 11 studies were included. Data including
demographics, medical history intervention(s) performed, periprocedural
outcomes and follow-up were assessed and analysed. A total of 922 patients
were identified. LAA occlusion was achieved in 902 out of 922 patients
(97.8%). No device-related adverse events were reported across the
studies. The reported incidence of stroke or transient ischaemic attack
post-clip placement ranged from 0.2 to 1.5/100 patient-years. Four hundred
and seventy-seven of 798 patients (59.7%) had ceased anticoagulation on
follow-up. The AtriClip device is safe and effective in the management of
patients with atrial fibrillation, either as an adjunct in patients
undergoing cardiac surgery or as a stand-alone thoracoscopic
procedure.<br/>Copyright &#xa9; The Author(s) 2019. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<55>
Accession Number
628688204
Title
What is the role of preoperative breathing exercises in reducing
postoperative atelectasis after CABG?.
Source
Reviews on recent clinical trials. (no pagination), 2019. Date of
Publication: 10 Jul 2019.
Author
Moradian S.T.; Heydari A.A.; Mahmoudi H.
Institution
(Moradian) Atherosclerosis Research Center, Baqiyatallah University of
medical sciences, Tehran. Iran
(Heydari, Mahmoudi) Baqiyatallah University of medical sciences, Tehran.
Iran
Publisher
NLM (Medline)
Abstract
BACKGROUND: Atelectasis and hypoxemia are frequently reported after
coronary artery bypass graft surgery (CABG). Some studies confirm the
benefits of breathing exercises on pulmonary complications, but the
efficacy of preoperative breathing exercises in patients undergoing CABG
is controversial. In this study the effect of preoperative breathing
exercises on the incidence of atelectasis and hypoxemia in patients
candidate for CABG was examined. <br/>METHOD(S): In a single blinded
randomized clinical trial 100 patients who were undergoing coronary artery
bypass graft surgery were randomly allocated into two groups of
experimental and control, each consisted of 50 patients. Before the
operation, experimental group patients were enrolled in a protocol
including of the deep breathing, cough and incentive spirometer. In the
control group hospital routine physiotherapy was implemented. All the
patients received the hospital routine physiotherapy once a day for 2 to 3
minutes in the first four days postoperatively. Arterial blood gases and
atelectasis were compared between groups. <br/>RESULT(S): there was no
significant difference between groups in terms of atelectasis and
hypoxemia (p Value>0.05). <br/>CONCLUSION(S): preoperative breathing
exercise doesn't reduce the pulmonary complications in patients undergoing
CABG.<br/>Copyright&#xa9; Bentham Science Publishers; For any queries,
please email at epub@benthamscience.net.

<56>
Accession Number
628670135
Title
Radiation Exposure During Transcatheter Valve Replacement: What Cardiac
Surgeons Need to Know.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 06 Jul 2019.
Author
Aquino A.; Khiabani A.J.; Henn M.C.; Zajarias A.; Melby S.J.; Sintek M.;
Lasala J.; Kachroo P.; Novak E.; Maniar H.S.
Institution
(Aquino, Zajarias, Sintek, Lasala, Novak) Cardiovascular Division,
Department of Medicine, Washington University School of Medicine,
Barnes-Jewish Hospital, St. Louis, MO, United States
(Khiabani, Henn, Melby, Kachroo, Maniar) Division of Cardiothoracic
Surgery, Department of Surgery, Washington University School of Medicine,
Barnes-Jewish Hospital, St. Louis, MO, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter Aortic Valve Replacement(TAVR)and Transcatheter
Mitral Valve Replacement(TMVR) expose operators to radiation.These
procedures differ primarily in whether they are performed via a
transfemoral(TF)or an alternative access(AA)approach.This study compared
operator radiation exposure during transcatheter valve implantation when
performed via a TF versus an AA approach,when performed in a
catheterization lab versus a hybrid operating room(OR),and investigated
the potential benefit of disposable shielding. <br/>METHOD(S): Dosimeters
were worn during TAVR-TF(n=50) and TAVR-AA(n=31)procedures by
operators.All TAVR-AA procedures were performed in a hybrid OR while TF
procedures were performed in either catheterization labs(n=16) or a hybrid
OR(n=34).Disposable radiation shielding pads(RADPAD)or a placebo(SHAM-PAD)
were added in a randomized, blinded fashion. <br/>RESULT(S): Team
radiation exposure was higher following TAVR-AA vs TAVR-TF(median 15.1mRad
IQR[8.6, 32.4]vs5.5 mRad IQR[2.4, 9.8],p<0.001).TAVR-TF procedures
required the same amount of fluoroscopy time regardless of where they were
performed(20.3+/-7.4min in hybrid ORvs19.0+/-6.4min in cath
lab,p=0.55).However,radiation exposure for TAVR-TF remained higher when
performed in a hybrid OR(median 9.0mRad IQR[4.5,11.9]vs2.2mRad
IQR[1.3,2.8],p<0.001).Radiation exposure was greatest for TAVR-AA(median
15.1mRad IQR[8.6,32.4]).The use of RADPAD did not decrease radiation
exposure(median 9.0mRad IQR[4.5,14.7] vs 9.4mRad IQR[2.8,19.5],p=0.82).
<br/>CONCLUSION(S): Procedures performed in the hybrid OR were associated
with higher operator radiation exposure. In comparison to the TF approach,
AA cases had the highest levels of operator radiation. This is
particularly important in the cases of TMVR that can only be done via an
AA approach. The use of disposable radiation shielding in this series did
not attenuate operator radiation exposure. Radiation shielding within
hybrid ORs should be scrutinized in an effort to remain on par with that
found within catheterization labs.<br/>Copyright &#xa9; 2019. Published by
Elsevier Inc.

<57>
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. <br/>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. <br/>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. <br/>Conclusion(s): The del Nido cardioplegia
protocol is an acceptable alternative for cold blood cardioplegia in
patients undergoing aortic valve replacement.<br/>Copyright &#xa9; 2019
The American Association for Thoracic Surgery

<58>
Accession Number
2002370320
Title
Inter- and intrasite variability of mortality and stroke for sites
performing both surgical and transcatheter aortic valve replacement for
aortic valve stenosis in intermediate-risk patients.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Greason K.L.; Blackstone E.H.; Rajeswaran J.; Lowry A.M.; Svensson L.G.;
Webb J.G.; Tuzcu E.M.; Smith C.R.; Makkar R.R.; Mack M.J.; Thourani V.H.;
Kodali S.K.; Leon M.B.; Miller D.C.
Institution
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
Minn, United States
(Blackstone, Rajeswaran, Lowry, Svensson) Department of Thoracic and
Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, OH,
United States
(Blackstone, Rajeswaran, Lowry) Department of Quantitative Health Sciences
Cleveland Clinic, Research Institute, Cleveland, United States
(Svensson) Aorta Center, Heart and Vascular Institute, Cleveland, United
States
(Webb) Department of Cardiology, St. Paul's Hospital, Vancouver, British
Columbia, Canada
(Tuzcu) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, United States
(Smith) Department of Surgery, Columbia University Medical Center of New
York Presbyterian Hospital, New York, NY, United States
(Makkar) Department of Cardiovascular Diseases, Cedars-Sinai Medical
Center, Los Angeles, Calif, United States
(Mack) Cardiovascular Service Line, Baylor Scott & White Health, Plano,
Tex, United States
(Thourani) Department of Cardiac Surgery, MedStar Heart & Vascular
Institute, Georgetown University School of Medicine, Washington, DC,
United States
(Kodali, Leon) Structural Heart & Valve Center, Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Kodali, Leon) Center for Interventional Vascular Therapy, Division of
Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Miller) Department of Cardiovascular Surgery, Stanford University School
of Medicine, Stanford, Calif, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Multisite procedure-based randomized trials may be confounded
by performance variability and variability among sites. Therefore, we
studied variability in mortality and stroke after patients were randomized
to surgical (SAVR) or transcatheter aortic valve replacement (TAVR) in the
Placement of Aortic Transcatheter Valves-2A (PARTNER-2A) randomized trial.
<br/>Method(s): Patients at intermediate risk for SAVR were randomized to
SAVR (n = 1017) or TAVR (n = 1011) with a SAPIEN XT device (Edwards
Lifesciences, Irvine, Calif) at 54 sites. Patients were followed to 2
years. A mixed-effect model quantified variability at intersite and
intrasite levels. <br/>Result(s): There were 336 deaths (SAVR 170, TAVR
166) and 176 strokes (SAVR 85, TAVR 91). Intersite variability for
mortality was similar across sites for SAVR (hazard ratios ranging from
0.52-1.93 among sites) and TAVR (hazard ratios ranging from 0.49-2.03),
but intersite variability for stroke was greater for SAVR (hazard ratios
ranging from 0.44-2.26) than for TAVR (no detectable variability). Case
mix and lower site trial volume accounted for 37% of mortality intersite
variability for SAVR and 73% for TAVR, but only 14% for stroke for SAVR.
Intrasite mortality hazard ratios demonstrated all but 1 site's 95%
confidence interval overlapped 1.0, indicating generally similar SAVR and
TAVR mortalities within sites. <br/>Conclusion(s): Intersite variability
was similar for mortality in SAVR and TAVR, but variability for stroke was
greater for SAVR than for TAVR. Intrasite events were similar for both
SAVR and TAVR. These findings suggest that in performance-based trials,
site variability and its sources should be taken into account in analyzing
and interpreting trial results.<br/>Copyright &#xa9; 2019

<59>
Accession Number
2002367816
Title
Characteristics and prognosis of IgG4-related periaortitis/periarteritis:
A systematic literature review.
Source
Autoimmunity Reviews. (no pagination), 2019. Article Number: 102354. Date
of Publication: 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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2019

<60>
Accession Number
2002366932
Title
A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular
Velocities in TEE.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 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). <br/>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.
<br/>Setting(s): Single university hospital. <br/>Participant(s):
Consecutive adult patients undergoing cardiac surgery (mainly coronary
artery bypass grafting). <br/>Intervention(s): None. <br/>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). <br/>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.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<61>
Accession Number
2001369150
Title
Radial artery versus saphenous vein as the second conduit for coronary
artery bypass surgery: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (5) (pp
1819-1825.e10), 2019. Date of Publication: May 2019.
Author
Gaudino M.; Rahouma M.; Abouarab A.; Leonard J.; Kamel M.; Di Franco A.;
Demetres M.; Tam D.Y.; Tranbaugh R.; Girardi L.N.; Fremes S.E.
Institution
(Gaudino, Rahouma, Abouarab, Leonard, Kamel, Di Franco, Tranbaugh,
Girardi) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Demetres) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Individual studies may be limited by sample size to detect
differences in late survival between radial artery (RA) or saphenous vein
graft (SVG) as a second conduit for coronary artery bypass surgery. Here
we undertook a meta-analysis of the best evidence available on the
comparison of early and late clinical outcomes of the RA and the SVG.
<br/>Method(s): MEDLINE and EMBASE were searched for studies comparing use
of the RA versus SVG for isolated coronary artery bypass surgery.
Time-to-event outcomes for long-term mortality, repeat revascularization,
and myocardial infarction (MI) were extracted as incidence rate ratios
(IRR) with 95%confidence intervals (95% CI). Odds ratios (OR) were
extracted for perioperative mortality, stroke, and MI. A random effects
meta-analysis was performed. Sensitivity analyses included
leave-one-out-analyses and meta-regression. <br/>Result(s): Among 1201
articles, 14 studies (20,931 patients) were included (mean follow-up: 6.6
years). Operative mortality was 1.25% in the RA versus 1.33% in the SVG
group (OR, 0.93; 95% CI, 0.68-1.28). No difference in perioperative MI
(OR, 0.96; 95% CI, 0.59-1.56) or stroke (OR, 0.70; 95% CI, 0.43-1.13) was
found between RA and SVG. Long-term mortality (mean follow-up 6.6 years)
was 24.5% in RA versus 34.2% in SVG group (IRR, 0.74; 95% CI, 0.63-0.87, P
<.001). No difference in follow-up MI or repeat revascularization was
found (IRR, 0.76; 95% CI, 0.42-1.36 and IRR, 0.68; 95% CI, 0.42-1.09
respectively). At meta-regression, RA survival advantage was independent
of age, sex, diabetes, and ventricular function. <br/>Conclusion(s):
Compared with the SVG, using the RA as the second conduit is associated
with a 26% relative risk reduction in mortality at 6.6-year
follow-up.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<62>
Accession Number
2001594465
Title
Association of intraoperative circulating-brain injury biomarker and
neurodevelopmental outcomes at 1 year among neonates who have undergone
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (5) (pp 1996-2002),
2019. Date of Publication: May 2019.
Author
Graham E.M.; Martin R.H.; Atz A.M.; Hamlin-Smith K.; Kavarana M.N.;
Bradley S.M.; Alsoufi B.; Mahle W.T.; Everett A.D.
Institution
(Graham, Atz) Division of Pediatric Cardiology, Department of Pediatrics,
Medical University of South Carolina, Charleston, SC, United States
(Martin) Department of Public Health Sciences, Medical University of South
Carolina, Charleston, SC, United States
(Hamlin-Smith) Department of Pediatrics, Medical University of South
Carolina, Charleston, SC, United States
(Kavarana, Bradley) Department of Cardiothoracic Surgery, Medical
University of South Carolina, Charleston, SC, United States
(Alsoufi) Department of Cardiothoracic Surgery, Children's Healthcare of
Atlanta and Emory University, Atlanta, Ga, United States
(Mahle) Division of Pediatric Cardiology, Department of Pediatrics,
Children's Healthcare of Atlanta and Emory University, Atlanta, Ga, United
States
(Everett) Division of Cardiology, Department of Pediatrics, Johns Hopkins
University, Baltimore, Md, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Neurodevelopmental disability is the most significant
complication for survivors of infant surgery for congenital heart disease.
In this study we sought to determine if perioperative circulating brain
injury biomarker levels are associated with neurodevelopmental outcomes at
12 months. <br/>Method(s): A secondary analysis of a randomized controlled
trial of neonates who underwent cardiac surgery was performed. Glial
fibrillary acidic protein (GFAP) was measured: (1) before skin incision;
(2) immediately after bypass; (3) 4 and (4) 24 hours postoperatively.
Linear regression models were used to determine an association with the
highest levels of GFAP and Bayley Scales of Infant and Toddler Development
third edition (BSID) composite scores. <br/>Result(s): There were 97
subjects who had cardiac surgery at a mean age of 9 +/- 6 days and
completed a BSID at 12.5 +/- 0.6 months of age. Median (25th-75th
percentile) levels of GFAP were 0.01 (0.01-0.02), 0.85 (0.40-1.55), 0.07
(0.05-0.11), and 0.03 (0.02-0.04) ng/mL at the 4 time points,
respectively. In univariate analysis GFAP was negatively associated with
cognitive, language, and motor composite scores. GFAP levels immediately
after bypass differed between institutions; 1.57 (0.92-2.48) versus 0.77
(0.36-1.21) ng/mL (P =.01). After adjusting for center and potential
confounders, GFAP was independently associated with BSID motor score (P
=.04). <br/>Conclusion(s): Higher GFAP levels at the time of neonatal
cardiac operations were independently associated with decreased BSID motor
scores at 12 months. GFAP might serve as a diagnostic means to acutely
identify perioperative brain-specific injury and serve as a benchmark of
therapeutic efficacy for investigational treatments, discriminate
center-specific effects, and provide early prognostic information for
intervention.<br/>Copyright &#xa9; 2019 The American Association for
Thoracic Surgery

<63>
Accession Number
620758587
Title
Sutureless perceval aortic valve versus conventional stented
bioprostheses: Meta-analysis of postoperative and midterm results in
isolated aortic valve replacement.
Source
Journal of the American Heart Association. 7 (4) (no pagination), 2018.
Article Number: e006091. Date of Publication: 01 Feb 2018.
Author
Meco M.; Montisci A.; Miceli A.; Panisi P.; Donatelli F.; Cirri S.;
Ferrarini M.; Lio A.; Glauber M.
Institution
(Meco, Montisci, Miceli, Donatelli, Cirri, Ferrarini, Lio, Glauber)
Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo
Ospedaliero San Donato, Milan, Italy
(Donatelli) Chair of Cardiac Surgery, University of Milan, Milan, Italy
(Panisi) Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
Publisher
American Heart Association Inc.
Abstract
Background--Aortic stenosis is the most common valvular disease and has a
dismal prognosis without surgical treatment. The aim of this meta-analysis
was to quantitatively assess the comparative effectiveness of the Perceval
(LivaNova) valve versus conventional aortic bioprostheses. Methods and
Results--A total of 6 comparative studies were identified, including 639
and 760 patients who underwent, respectively, aortic valve replacement
with the Perceval sutureless valve (P group) and with a conventional
bioprosthesis (C group). Aortic cross-clamping and cardiopulmonary bypass
duration were significantly lower in the P group. No difference in
postoperative mortality was shown for the P and C groups (2.8% versus
2.7%, respectively; odds ratio [OR]: 0.99 [95% confidence interval (CI),
0.52-1.88]; P=0.98). Incidence of postoperative renal failure was lower in
the P group compared with the C group (2.7% versus 5.5%; OR: 0.45 [95% CI,
0.25-0.80]; P=0.007). Incidence of stroke (2.3% versus 1.7%; OR: 1.34 [95%
CI, 0.56-3.21]; P=0.51) and paravalvular leak (3.1% versus 1.6%; OR: 2.52
[95% CI, 0.60-1.06]; P=0.21) was similar, whereas P group patients
received fewer blood transfusions than C group patients (1.16+/-1.2 versus
2.13+/-2.2; mean difference: 0.99 [95% CI, -1.22 to -0.75]; P=0.001). The
incidence of pacemaker implantation was higher in the P than the C group
(7.9% versus 3.1%; OR: 2.45 [95% CI, 1.44-4.17]; P=0.001), whereas
hemodynamic Perceval performance was better (transvalvular gradient
23.42+/-1.73 versus 22.8+/-1.86; mean difference: 0.90 [95% CI,
0.62-1.18]; P=0.001), even during follow-up (10.98+/-5.7 versus
13.06+/-6.2; mean difference: -2.08 [95% CI, -3.96 to -0.21]; P=0.030). We
found no difference in 1-year mortality. Conclusions--The Perceval
bioprosthesis improves the postoperative course compared with conventional
bioprostheses and is an option for high-risk patients.<br/>Copyright
&#xa9; 2018 The Authors.

<64>
Accession Number
618266150
Title
Effects on the incidence of cardiovascular events of the addition of
pioglitazone versus sulfonylureas in patients with type 2 diabetes
inadequately controlled with metformin (TOSCA.IT): a randomised,
multicentre trial.
Source
The Lancet Diabetes and Endocrinology. 5 (11) (pp 887-897), 2017. Date of
Publication: November 2017.
Author
Vaccaro O.; Masulli M.; Nicolucci A.; Bonora E.; Del Prato S.; Maggioni
A.P.; Rivellese A.A.; Squatrito S.; Giorda C.B.; Sesti G.; Mocarelli P.;
Lucisano G.; Sacco M.; Signorini S.; Cappellini F.; Perriello G.; Lapolla
A.; Giordano C.; Buzzetti R.; Clemente G.; Di Cianni G.; Iannarelli R.;
Cordera R.; La Macchia O.; Zamboni C.; Scaranna C.; Boemi M.; Iovine C.;
Lauro D.; Leotta S.; Dall'Aglio E.; Cannarsa E.; Tonutti L.; Pugliese G.;
Bossi A.C.; Anichini R.; Dotta F.; Di Benedetto A.; Citro G.; Antenucci
D.; Ricci L.; Giorgino F.; Santini C.; Gnasso A.; De Cosmo S.; Zavaroni
D.; Vedovato M.; Consoli A.; Calabrese M.; di Bartolo P.; Fornengo P.;
Riccardi G.; D'Angelo F.; Giansanti R.; Tanase L.; Lanari L.; Testa I.;
Pancani F.; Ranchelli A.; Vagheggi P.; Scatona A.; Fontana L.; Laviola L.;
Tarantino L.; Ippolito C.; Gigantelli V.; Manicone M.; Conte E.; Trevisan
R.; Rota R.; Dodesini A.R.; Reggiani G.M.; Montesi L.; Mazzella N.;
Forlani G.; Caselli C.; Di Luzio R.; Mazzotti A.; Aiello A.; Barrea A.;
Musto A.; D'Amico F.; Sinagra T.; Longhitano S.; Trowpea V.; Sparti M.;
Italia S.; Lisi E.; Grasso G.; Pezzino V.; Insalaco F.; Carallo C.;
Scicchitano C.; De Franceschi M.S.; Calbucci G.; Ripani R.; Corsi L.;
Cuneo G.; Corsi S.; Romeo F.; Lesina A.; Comoglio M.; Bonetto C.; Robusto
A.; Nada E.; Asprino V.; Cetraro R.; Impieri M.; Lucchese G.; Donnarumma
G.; Tizio B.; Lenza L.; Paraggio P.; Tomasi F.; Dozio N.; Scalambra E.;
Mannucci E.; Lamanna C.; Cignarelli M.; Macchia O.L.; Fariello S.;
Sorrentino M.R.; Franzetti I.; Radin R.; Annunziata F.; Bonabello L.A.;
Durante A.; Dolcino M.; Gallo F.; Mazzucchelli C.; Aleo A.; Melga P.;
Briatore L.; Maggi D.; Storace D.; Cecoli F.; D'Ugo E.; Pupillo M.;
Baldassarre M.P.A.; Salvati F.; Minnucci A.; De Luca A.; Zugaro A.;
Santarelli L.; Bosco A.; Petrella V.; La Verghetta G.G.; D'Andrea S.;
Giuliani A.E.; Polidoro W.L.; Sperandio A.; Sciarretta F.; Pezzella A.;
Carlone A.; Venditti C.; Foffi C.; Carbone S.; Cipolloni L.; Moretti C.;
Leto G.; Serra R.; Petrachi F.; Romano I.; Lacaria E.; Russo L.; Goretti
C.; Sannino C.; Gregori G.; Dolci M.; Bruselli L.; Mori M.L.; Baccetti F.;
Del Freo M.; Cucinotta D.; Giunta L.; Ruffo M.C.; Cannizzaro D.; Pintaudi
B.; Perrone G.; Pata P.; Ragonese F.; Lettina G.; Mancuso T.; Coppolino
A.; Piatti P.M.; Monti L.; Stuccillo M.; Lucotti P.; Setola M.; Crippa
G.V.; Loi C.; Oldani M.; Bottalico M.L.; Pellegata B.; Bonomo M.;
Menicatti L.S.M.; Resi V.; Bertuzzi F.; Disoteo E.O.; Pizzi G.; Annuzzi
G.; Capaldo B.; Nappo R.; Auciello S.M.; Turco A.A.; Costagliola L.; Corte
G.D.; Vallefuoco P.; Nappi F.; Vitale M.; Cocozza S.; Ciano O.; Massimino
E.; Garofalo N.; Avogaro A.; Guarneri G.; Fedele D.; Sartore G.; Chilelli
N.C.; Burlina S.; Bonsembiante B.; Galluzzo A.; Torregrossa V.;
Mancastroppa G.; Arsenio L.; Cioni F.; Caronna S.; Papi M.; Santeusanio
F.; Calagreti G.; Timi A.; Tantucci A.; Marino C.; Ginestra F.; Di Biagio
R.; Taraborelli M.; Miccoli R.; Bianchi C.; Garofolo M.; Politi K.S.;
Penno G.; Livraga S.; Calzoni F.; Mancastroppa G.L.F.; Corsini E.;
Tedeschi A.; Gagliano M.S.; Ippolito G.; Salutini E.; Cervellino F.;
Natale M.; Salvatore V.; Zampino A.; Sinisi R.; Arcangeli A.; Zogheri A.;
Guizzotti S.; Longo R.; Pellicano F.; Scolozzi P.; Termine S.; Luberto A.;
Ballardini G.; Babini A.C.; Trojani C.; Mazzuca P.; Bruglia M.; Ciamei M.;
Genghini S.; Zannoni C.; Rangel G.; Salvi L.; Zappaterreno A.; Cordone S.;
Simonelli P.; Meggiorini M.; Frasheri A.; Di Pippo C.; Maglio C.;
Mazzitelli G.; Rinaldi M.E.; Galli A.; Romano M.; D'Angelo P.; Suraci C.;
Bacci S.; Palena A.P.; Genovese S.; Mancino M.; Rondinelli M.; Capone F.;
Calabretto E.; Bulgheroni M.; Bucciarelli L.; Ceccarelli E.; Fondelli C.;
Santacroce C.; Guarino E.; Nigi L.; Lalli C.; Di Vizia G.; Scarponi M.;
Montani V.; Di Bernardino P.; Romagni P.; Dolcetti K.; Forte E.;
Potenziani S.; Tamburo L.; Perin P.C.; Prinzis T.; Gruden G.; Bruno G.;
Zucco C.; Perotta M.; Marena S.; Monsignore S.; Panero F.; Ponzi F.;
Carpinteri R.; Casagrande M.L.; Coletti M.F.; Balini A.; Filopanti M.;
Madaschi S.; Pulcina A.; Grimaldi F.; Venturini G.; Agus S.; Pagnutti S.;
Guidotti F.; Cavarape A.; Cigolini M.; Pichiri I.; Brangani C.; Fainelli
G.; Tomasetto E.; Zoppini G.; Galletti A.; Perrone D.; Capra C.; Bianchini
F.; Ceseri M.; Di Nardo B.; Sasso E.; Bartolomei B.; Suliman I.; Fabbri
G.; Romano G.; Maturo N.; Nunziata G.; Capobianco G.; De Simone G.; Villa
V.; Rota G.; Pentangelo C.; Carbonara O.; Caiazzo G.; Cutolo M.;
Sorrentino T.; Mastrilli V.; Amelia U.; Masi S.; Corigliano G.; Gaeta I.;
Armentano V.; Calatola P.; Capuano G.; Angiulli B.; Auletta P.; Petraroli
E.; Iodice C.E.; Agrusta M.
Institution
(Vaccaro, Masulli, Rivellese, Riccardi) Department of Clinical Medicine
and Surgery, University of Naples Federico II, Naples, Italy
(Iovine) Diabetes Unit, University of Naples Federico II, Naples, Italy
(Nicolucci, Lucisano, Sacco) Center for Outcomes Research and Clinical
Epidemiology (CORESEARCH), Pescara, Italy
(Bonora) Division of Endocrinology, Diabetes and Metabolism, University
and Hospital Trust of Verona, Verona, Italy
(Del Prato) Department of Clinical & Experimental Medicine, University of
Pisa, Pisa, Italy
(Maggioni) National Association of Hospital Cardiologists (ANMCO) Research
Center, Florence, Italy
(Squatrito) Diabetes Unit, University Hospital Garibaldi-Nesima of
Catania, Catania, Italy
(Giorda) Diabetes Unit, Azienda Sanitaria Locale (ASL) Torino 5, Torino,
Italy
(Sesti) Department of Medical and Surgical Sciences, Magna Graecia
University of Catanzaro, Italy
(Gnasso) Department of Clinical and Experimental Medicine, Magna Graecia
University of Catanzaro, Italy
(Mocarelli, Signorini, Cappellini) University Department Laboratory
Medicine, Hospital of Desio, Monza, Italy
(Perriello) Endocrinology and Metabolism, University of Perugia, Perugia,
Italy
(Babini) Medical Division, Rimini Hospital, Rimini, Italy
(Lapolla) Dipartimento di Medicina, Universita di Padova, Padova, Italy
(Gregori) Diabetes Unit, Massa Carrara, Azienda Unita Sanitarie Locali
(USL) Toscana Nord Ovest, Carrara, Italy
(Giordano) Section of Endocrinology, Diabetology and Metabolic Diseases,
University of Palermo, Palermo, Italy
(Corsi) Diabetes Unit, ASL 4 Chiavarese, Chiavari, Italy
(Buzzetti) Department of Experimental Medicine, Sapienza University, Rome,
Italy
(Pugliese) Department of Clinical and Molecular Medicine, Sapienza
University, Rome, Italy
(Clemente) Institute for Research on Population and Social
Policies-National Research Council, Penta di Fisciano, Italy
(Di Cianni) Diabetes and Metabolism, Livorno Hospital, Livorno, Italy
(Iannarelli) Diabetes Unit, Department of Medicine, San Salvatore
Hospital, L'Aquila, Italy
(Cordera) Diabetes Unit, School of Medicine, University of Genova,
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino
Hospital, Genova, Italy
(La Macchia) Endocrinology, Azienda Ospedaliero Universitaria Ospedali
Riuniti, Foggia, Italy
(Zamboni) Diabetes Unit, University of Ferrara, Ferrara, Italy
(Scaranna) Endocrinology and Diabetology, Azienda Socio Sanitaria
Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
(Boemi) Diabetes and Metabolism Unit, IRCCS Istituto Nazionale Riposo e
Cura Anziani, Ancona, Italy
(Lauro) Department of Systems Medicine, University of Rome Tor Vergata,
Rome, Italy
(Leotta) UOC Diabetologia Ospedale Sandro Pertini, Rome, Italy
(Dall'Aglio) Clinical and Experimental Medicine, University of Parma,
Parma, Italy
(Cannarsa) Diabetes Unit, San Liberatore Hospital, Atri Teramo, Italy
(Tonutti) Endocrinology, Diabetes, Metabolism and Clinical Nutrition Unit,
Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
(Bossi) ASST Bergamo Ovest, Treviglio, Italy
(Anichini) Diabetes Unit, USL 3, Pistoia, Italy
(Dotta) Diabetes Unit, Department of Medicine, Surgery and Neurosciences,
University of Siena, Siena, Italy
(Di Benedetto) Department of Clinical and Experimental Medicine,
University of Messina, Messina, Italy
(Citro) Endocrinology and Diabetes Unit, Azienda Sanitaria Locale di
Potenza, Potenza, Italy
(Antenucci) Diabetes Unit, Renzetti Hospital, ASL 2 Abruzzo, Lanciano,
Italy
(Ricci) Diabetes Unit, USL Sud Est, Toscana, Italy
(Giorgino) Department of Emergency and Organ Transplantation,
Endocrinology and Metabolic Diseases, University of Bari Aldo Moro, Bari,
Apulia, Italy
(Santini) Department Endocrinology and Diabetology, Cesena Hospital,
Cesena, Italy
(De Cosmo) Unit of Internal Medicine, IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo, Italy
(Zavaroni) Diabetes Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
(Vedovato) Metabolism Unit, Azienda Ospedaliera di Padova, Padova, Italy
(Consoli) Department of Medicine and Aging Sciences, Aging and
Translational Medicine Research Center (CeSI-Met), D'Annunzio University,
Chieti-Pescara, Italy
(Calabrese) Diabetes Unit, USL Toscana Centro, Prato, Italy
(di Bartolo) Diabetes Unit, Ravenna Internal Medicine Department, Romagna
Local Health Unit, Ravenna, Italy
(Fornengo) Department of Medical Sciences, University of Turin, Turin,
Italy
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The best treatment option for patients with type 2 diabetes in
whom treatment with metformin alone fails to achieve adequate glycaemic
control is debated. We aimed to compare the long-term effects of
pioglitazone versus sulfonylureas, given in addition to metformin, on
cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT
was a multicentre, randomised, pragmatic clinical trial, in which patients
aged 50-75 years with type 2 diabetes inadequately controlled with
metformin monotherapy (2-3 g per day) were recruited from 57 diabetes
clinics in Italy. Patients were randomly assigned (1:1), by permuted
blocks randomisation (block size 10), stratified by site and previous
cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea
(5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in
accordance with local practice). The trial was unblinded, but event
adjudicators were unaware of treatment assignment. The primary outcome,
assessed with a Cox proportional-hazards model, was a composite of first
occurrence of all-cause death, non-fatal myocardial infarction, non-fatal
stroke, or urgent coronary revascularisation, assessed in the modified
intention-to-treat population (all randomly assigned participants with
baseline data available and without any protocol violations in relation to
inclusion or exclusion criteria). This study is registered with
ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008,
and Jan 15, 2014, 3028 patients were randomly assigned and included in the
analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas
(glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At
baseline, 335 (11%) participants had a previous cardiovascular event. The
study was stopped early on the basis of a futility analysis after a median
follow-up of 57.3 months. The primary outcome occurred in 105 patients
(1.5 per 100 person-years) who were given pioglitazone and 108 (1.5 per
100 person-years) who were given sulfonylureas (hazard ratio 0.96, 95% CI
0.74-1.26, p=0.79). Fewer patients had hypoglycaemias in the pioglitazone
group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0.0001).
Moderate weight gain (less than 2 kg, on average) occurred in both groups.
Rates of heart failure, bladder cancer, and fractures were not
significantly different between treatment groups. Interpretation In this
long-term, pragmatic trial, incidence of cardiovascular events was similar
with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as
add-on treatments to metformin. Both of these widely available and
affordable treatments are suitable options with respect to efficacy and
adverse events, although pioglitazone was associated with fewer
hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca,
and Italian Diabetes Society.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<65>
Accession Number
613651342
Title
Percutaneous coronary angioplasty versus coronary artery bypass grafting
in treatment of unprotected left main stenosis (NOBLE): a prospective,
randomised, open-label, non-inferiority trial.
Source
The Lancet. 388 (10061) (pp 2743-2752), 2016. Date of Publication: 03 Dec
2016.
Author
Makikallio T.; Holm N.R.; Lindsay M.; Spence M.S.; Erglis A.; Menown
I.B.A.; Trovik T.; Eskola M.; Romppanen H.; Kellerth T.; Ravkilde J.;
Jensen L.O.; Kalinauskas G.; Linder R.B.A.; Pentikainen M.; Hervold A.;
Banning A.; Zaman A.; Cotton J.; Eriksen E.; Margus S.; Sorensen H.T.;
Nielsen P.H.; Niemela M.; Kervinen K.; Lassen J.F.; Maeng M.; Oldroyd K.;
Berg G.; Walsh S.J.; Hanratty C.G.; Kumsars I.; Stradins P.; Steigen T.K.;
Frobert O.; Graham A.N.J.; Endresen P.C.; Corbascio M.; Kajander O.;
Trivedi U.; Hartikainen J.; Anttila V.; Hildick-Smith D.; Thuesen L.;
Christiansen E.H.
Institution
(Makikallio, Niemela, Kervinen) Department of Cardiology, Oulu University
Hospital, Oulu, Finland
(Holm, Lassen, Maeng, Christiansen) Department of Cardiology, Aarhus
University Hospital, Skejby, Aarhus, Denmark
(Lindsay, Oldroyd, Berg) Department of Cardiology, Golden Jubilee National
Hospital, Clydebank, United Kingdom
(Spence, Walsh, Hanratty, Graham) Belfast Heart Centre, Belfast Trust,
Belfast, Ireland
(Erglis, Kumsars, Stradins) Latvia Centre of Cardiology, Paul Stradins
Clinical Hospital, Riga, Latvia
(Menown) Craigavon Cardiac Centre, Craigavon, Ireland
(Trovik, Steigen) Department of Cardiology, University of Northern Norway,
Tromso, Norway
(Endresen) Department of Cardiovascular Surgery, University of Northern
Norway, Tromso, Norway
(Eskola, Kajander) Heart Hospital, Tampere University Hospital, Tampere,
Finland
(Romppanen, Hartikainen) Heart Center, Kuopio University Hospital, Kuopio,
Finland
(Kellerth, Frobert) Department of Cardiology, Orebro University Hospital,
Orebro, Sweden
(Ravkilde, Thuesen) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kalinauskas) Department of Cardiology, Vilnius University Hospital,
Vilnius, Lithuania
(Linder) Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
(Pentikainen) Heart and Lung Center, Helsinki University Hospital,
Helsinki, Finland
(Hervold) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Banning) Oxford Heart Centre, Oxford, United Kingdom
(Zaman) Department of Cardiology, Freeman Hospital and Institute of
Cellular Medicine, Newcastle, United Kingdom
(Cotton) Heart and Lung Centre, New Cross Hospital, Wolverhampton, United
Kingdom
(Eriksen) Department of Cardiology, Haukeland University Hospital, Bergen,
Norway
(Margus) Department of Cardiology, East Tallinn Hospital, Tallinn, Estonia
(Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
(Sorensen) Department of Health Research and Policy (Epidemiology),
Stanford University, Stanford, CA, United States
(Nielsen) Department of Cardiac Surgery, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Corbascio) Department of Cardiology, Karolinska University Hospital,
Huddinge, Stockholm, Sweden
(Anttila) Department of Cardiac Surgery, Oulu University Hospital, Finland
(Trivedi, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospital, Brighton, United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Coronary artery bypass grafting (CABG) is the standard
treatment for revascularisation in patients with left main coronary artery
disease, but use of percutaneous coronary intervention (PCI) for this
indication is increasing. We aimed to compare PCI and CABG for treatment
of left main coronary artery disease. Methods In this prospective,
randomised, open-label, non-inferiority trial, patients with left main
coronary artery disease were enrolled in 36 centres in northern Europe and
randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable
angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial
infarction. Exclusion criteria were ST-elevation myocardial infarction
within 24 h, being considered too high risk for CABG or PCI, or expected
survival of less than 1 year. The primary endpoint was major adverse
cardiac or cerebrovascular events (MACCE), a composite of all-cause
mortality, non-procedural myocardial infarction, any repeat coronary
revascularisation, and stroke. Non-inferiority of PCI to CABG required the
lower end of the 95% CI not to exceed a hazard ratio (HR) of 1.35 after up
to 5 years of follow-up. The intention-to-treat principle was used in the
analysis if not specified otherwise. This trial is registered with
ClinicalTrials.gov identifier, number NCT01496651. Findings Between Dec 9,
2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI
and 603 to CABG, and 592 in each group entered analysis by intention to
treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121
events) and 19% for CABG (81 events), HR 1.48 (95% CI 1.11-1.96),
exceeding the limit for non-inferiority, and CABG was significantly better
than PCI (p=0.0066). As-treated estimates were 28% versus 19% (1.55,
1.18-2.04, p=0.0015). Comparing PCI with CABG, 5 year estimates were 12%
versus 9% (1.07, 0.67-1.72, p=0.77) for all-cause mortality, 7% versus 2%
(2.88, 1.40-5.90, p=0.0040) for non-procedural myocardial infarction, 16%
versus 10% (1.50, 1.04-2.17, p=0.032) for any revascularisation, and 5%
versus 2% (2.25, 0.93-5.48, p=0.073) for stroke. Interpretation The
findings of this study suggest that CABG might be better than PCI for
treatment of left main stem coronary artery disease. Funding Biosensors,
Aarhus University Hospital, and participating sites.<br/>Copyright &#xa9;
2016 Elsevier Ltd

<66>
Accession Number
373395848
Title
Revascularisation versus medical treatment in patients with stable
coronary artery disease: Network meta-analysis.
Source
BMJ (Online). 348 (no pagination), 2014. Article Number: g3859. Date of
Publication: 23 Jun 2014.
Author
Windecker S.; Stortecky S.; Stefanini G.G.; DaCosta B.R.; Rutjes A.W.; Di
Nisio M.; Siletta M.G.; Maione A.; Alfonso F.; Clemmensen P.M.; Collet
J.-P.; Cremer J.; Falk V.; Filippatos G.; Hamm C.; Head S.; Kappetein
A.P.; Kastrati A.; Knuuti J.; Landmesser U.; Laufer G.; Neumann F.-J.;
Richter D.; Schauerte P.; Uva M.S.; Taggart D.P.; Torracca L.; Valgimigli
M.; Wijns W.; Witkowski A.; Kolh P.; Juni P.
Institution
(Windecker, Stortecky, Stefanini, DaCosta, Rutjes, Di Nisio, Siletta,
Maione, Juni) Department of Cardiology, University Hospital Bern, Bern
University Hospital, 3010 Bern, Switzerland
(Windecker, Stortecky, Stefanini, DaCosta, Rutjes, Di Nisio, Siletta,
Maione, Juni) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To investigate whether revascularisation improves prognosis
compared with medical treatment among patients with stable coronary artery
disease. <br/>Design(s): Bayesian network meta-analyses to combine direct
within trial comparisons between treatments with indirect evidence from
other trials while maintaining randomisation. Eligibility criteria for
selecting studies: A strategy of initial medical treatment compared with
revascularisation by coronary artery bypass grafting or Food and Drug
Administration approved techniques for percutaneous revascularization:
balloon angioplasty, bare metal stent, early generation paclitaxel eluting
stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent,
and new generation everolimus eluting stent, and zotarolimus eluting
(Resolute) stent among patients with stable coronary artery disease. Data
sources: Medline and Embase from 1980 to 2013 for randomised trials
comparing medical treatment with revascularisation. <br/>Main Outcome
Measure(s): All cause mortality. <br/>Result(s): 100 trials in 93 553
patients with 262 090 patient years of follow-up were included. Coronary
artery bypass grafting was associated with a survival benefit (rate ratio
0.80, 95% credibility interval 0.70 to 0.91) compared with medical
treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to
0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon
angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05),
or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12;
sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10)
were associated with improved survival compared with medical treatment.
Coronary artery bypass grafting reduced the risk of myocardial infarction
compared with medical treatment (0.79, 0.63 to 0.99), and everolimus
eluting stents showed a trend towards a reduced risk of myocardial
infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation
was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to
0.20) followed by new generation drug eluting stents (zotarolimus
(Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early
generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to
0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and
bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment.
<br/>Conclusion(s): Among patients with stable coronary artery disease,
coronary artery bypass grafting reduces the risk of death, myocardial
infarction, and subsequent revascularisation compared with medical
treatment. All stent based coronary revascularisation technologies reduce
the need for revascularisation to a variable degree. Our results provide
evidence for improved survival with new generation drug eluting stents but
no other percutaneous revascularisation technology compared with medical
treatment.

<67>
Accession Number
52893295
Title
Early postoperative prophylactic noninvasive ventilation after major lung
resection in COPD patients: A randomized controlled trial.
Source
Intensive Care Medicine. 40 (2) (pp 220-227), 2014. Date of Publication:
February 2014.
Author
Lorut C.; Lefebvre A.; Planquette B.; Quinquis L.; Clavier H.; Santelmo
N.; Hanna H.A.; Bellenot F.; Regnard J.-F.; Riquet M.; Magdeleinat P.;
Meyer G.; Roche N.; Huchon G.; Coste J.; Rabbat A.
Institution
(Lorut, Lefebvre, Roche, Huchon, Rabbat) Department of Respiratory and
Intensive Care Medicine, Cochin-Broca-Hotel, University Paris5, 27 rue du
Faubourg Saint Jacques, 75679 Paris cedex 14, France
(Regnard) Department of Thoracic Surgery, Cochin-Broca-Hotel-Dieu Hospital
Group, University Paris5, Paris, France
(Quinquis, Coste) Department of Biostatistics and Epidemiology, Hotel-Dieu
Hospital, University Paris5, Paris, France
(Planquette, Meyer) Department of Respiratory and Intensive Care Medicine,
European Georges Pompidou Hospital, University Paris5, Paris, France
(Riquet) Department of Thoracic Surgery, European Georges Pompidou
Hospital, University Paris5, Paris, France
(Clavier) Department of Intensive Care Medicine, Institut Montsouris
Hospital, Paris, France
(Magdeleinat) Department of Thoracic Surgery, Institut Montsouris
Hospital, Paris, France
(Santelmo) Department of Thoracic Surgery, University Hospital,
Strasbourg, France
(Hanna) Department of Thoracic Surgery, University Hospital, Dijon, France
(Bellenot) Department of Thoracic Surgery, University Hospital, Pontoise,
France
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To investigate whether prophylactic postoperative NIV prevents
respiratory complications following lung resection surgery in COPD
patients. <br/>Method(s): In seven thoracic surgery departments, 360 COPD
patients undergoing lung resection surgery were randomly assigned to two
groups: conventional postoperative treatment without (n = 179) or with (n
= 181) prophylactic NIV, applied intermittently during 6 h per day for 48
h following surgery. The primary endpoint was the rate of acute
respiratory events (ARE) at 30 days postoperatively (ITT analysis).
Secondary endpoints were acute respiratory failure (ARF), intubation rate,
mortality rate, infectious and non-infectious complications, and duration
of ICU and hospital stay. <br/>Measurements and Main Results: ARE rates
did not differ between the prophylactic NIV and control groups (57/181,
31.5 vs. 55/179, 30.7 %, p = 0.93). ARF rate was 18.8 % in the
prophylactic NIV group and 24.5 % in controls (p = 0.20). Re-intubation
rates were similar in the prophylactic NIV and control group [10/181 (5.5
%) and 13/179 (7.2 %), respectively, p = 0.53]. Mortality rates were 5 and
2.2 % in the control and prophylactic NIV groups, respectively (p = 0.16).
Infectious and non-infectious complication rates, and duration of ICU and
hospital stays were similar between groups. <br/>Conclusion(s):
Prophylactic postoperative NIV did not reduce the rate of ARE in COPD
patients undergoing lung resection surgery and did not influence other
postoperative complications rates, mortality rates, and duration of ICU
and hospital stay. &#xa9; 2013 Springer-Verlag Berlin Heidelberg and
ESICM.

<68>
Accession Number
373224384
Title
Kidney Function after off-pump or on-pump Coronary Artery Bypass Graft
Surgery: A randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 311 (21) (pp
2191-2198), 2014. Date of Publication: 2014.
Author
Garg A.X.; Devereaux P.J.; Yusuf S.; Cuerden M.S.; Parikh C.R.; Coca S.G.;
Walsh M.; Novick R.; Cook R.J.; Jain A.R.; Pan X.; Noiseux N.; Vik K.;
Stolf N.A.; Ritchie A.; Favaloro R.R.; Parvathaneni S.; Whitlock R.P.; Ou
Y.; Lawrence M.; Lamy A.
Institution
(Garg, Cuerden) Division of Nephrology, Department of Medicine, Western
University, London, ON, Canada
(Garg) Department of Epidemiology and Biostatistics, Western University,
London, ON, Canada
(Garg, Devereaux, Yusuf, Walsh) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(Devereaux, Yusuf, Walsh, Whitlock, Ou, Lawrence, Lamy) Population Health
Research Institute, Hamilton, ON, Canada
(Cuerden, Cook) Department of Statistics and Actuarial Science, University
of Waterloo, Waterloo, ON, Canada
(Parikh, Coca) Section of Nephrology, Yale University School of Medicine,
New Haven, CT, United States
(Novick) Division of Cardiac Surgery, Western University, London, ON,
Canada
(Jain) SAL Hospital and Medical Institute, Ahmadabad, India
(Pan) Department of Cardiovascular Surgery, Fuiwai Hospital, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing, China
(Noiseux) Department of Cardiac Surgery, Centre Hospitalier de
l'Universite de Montreal CHUM, Montreal, QC, Canada
(Vik) University Hospital Motol, Praha, Czechia
(Stolf) Instituto do Coracao do Hospital Das Clinicas da, Sao Paulo,
Brazil
(Ritchie) Essex Cardiothoracic Centre and Anglia Ruskin University, Essex,
United Kingdom
(Favaloro) Department of Cardiovascular Surgery, Hospital Universitario
Fundacion Favaloro, Buenos Aires, Argentina
(Parvathaneni) Mercy Hospital, Springfield, MO, United States
(Whitlock, Lamy) Division of Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Most acute kidney injury observed in the hospital is defined
by sudden mild or moderate increases in the serum creatinine
concentration, which may persist for several days. Such acute kidney
injury is associated with lower long-term kidney function. However, it has
not been demonstrated that an intervention that reduces the risk of such
acute kidney injury better preserves long-term kidney function.
<br/>OBJECTIVE(S): To characterize the risk of acute kidney injury with an
intervention in a randomized clinical trial and to determine if there is a
difference between the 2 treatment groups in kidney function 1 year later.
DESIGN, SETTING, AND PARTICIPANTS: The Coronary Artery Bypass Grafting
Surgery Off- or On-pump Revascularisation Study (CORONARY) enrolled 4752
patients undergoing first isolated coronary artery bypass graft (CABG)
surgery at 79 sites in 19 countries. Patients were randomized to receive
CABG surgery either with a beating-heart technique (off-pump) or with
cardiopulmonary bypass (on-pump). From January 2010 to November 2011, 2932
patients (from 63 sites in 16 countries) from CORONARY were enrolled into
a kidney function substudy to record serum creatinine concentrations
during the postoperative period and at 1 year. The last 1-year serum
creatinine concentration was recorded on January 18, 2013. MAIN OUTCOMES
AND MEASURES: Acute kidney injury within 30 days of surgery (>=50%
increase in serum creatinine concentration from prerandomization
concentration) and loss of kidney function at 1 year (>=20% loss in
estimated glomerular filtration rate from prerandomization level). RESULTS
Off-pump (n = 1472) vs on-pump (n = 1460) CABG surgery reduced the risk of
acute kidney injury (17.5%vs 20.8%, respectively; relative risk, 0.83
[95%CI, 0.72-0.97], P = .01); however, there was no significant difference
between the 2 groups in the loss of kidney function at 1 year (17.1%vs
15.3%, respectively; relative risk, 1.10 [95%CI, 0.95-1.29], P = .23).
Results were consistent with multiple alternate continuous and categorical
definitions of acute kidney injury or kidney function loss, and in the
subgroup with baseline chronic kidney disease. CONCLUSIONS AND RELEVANCE:
Use of off-pump compared with on-pump CABG surgery reduced the risk of
postoperative acute kidney injury, without evidence of better preserved
kidney function with off-pump CABG surgery at 1 year. In this setting, an
intervention that reduced the risk of mild to moderate acute kidney injury
did not alter longer-term kidney function. TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT00463294 Copyright 2014 American Medical
Association. All rights reserved.

<69>
Accession Number
373832196
Title
Vein graft preservation solutions, patency, and outcomes after coronary
artery bypass graft surgery: Follow-up from PREVENT IV randomized clinical
trail.
Source
JAMA Surgery. 149 (8) (pp 798-805), 2014. Date of Publication: August
2014.
Author
Harskamp R.E.; Alexander J.H.; Schulte P.J.; Brophy C.M.; Mack M.J.;
Peterson E.D.; Williams J.B.; Gibson C.M.; Califf R.M.; Kouchoukos N.T.;
Harrington R.A.; Ferguson Jr. T.B.; Lopes R.D.
Institution
(Harskamp, Alexander, Schulte, Peterson, Williams, Lopes) Department of
Medicine, Duke Clinical Research Institute, Duke University, 2400 Pratt
St, Durham, NC 27705, United States
(Harskamp) Heart Center, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Brophy) Division of Vascular Surgery, Vanderbilt University, Nashville,
TN, United States
(Mack) Cardiopulmonary Research Science and Technology Institute, Dallas,
TX, United States
(Gibson) PERFUSE Angiographic Laboratory, Boston, MA, United States
(Califf) Department of Medicine, Duke Translational Medicine Institute,
Duke University, Durham, NC, United States
(Kouchoukos) Heart Center, Missouri Baptist Medical Center, St Louis, MO,
United States
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Ferguson Jr.) Department of Cardiovascular Sciences, East Carolina
University, Greenville, NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE In vitro and animal model data suggest that intraoperative
preservation solutions may influence endothelial function and vein graft
failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical
studies to validate these findings are lacking. OBJECTIVE To evaluate the
effect of vein graft preservation solutions on VGF and clinical outcomes
in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS
Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection
IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind,
placebo-controlled trial that enrolled 3014 patients at 107 US sites from
August 1, 2002, through October 22, 2003, were used. Eligibility criteria
for the trial included CABG surgery for coronary artery disease with at
least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in
saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES
One-year angiographic VGF and 5-year rates of death, myocardial
infarction, and subsequent revascularization. RESULTS Most patients had
grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%])
and buffered saline (507 [16.8%]). Baseline characteristics were similar
among groups. One-year VGF rates were much lower in the buffered saline
group than in the saline group (patient-level odds ratio [OR], 0.59
[95%CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95%CI, 0.49-0.79; P <
.001]) or the blood group (patient-level OR, 0.62 [95%CI, 0.46-0.83; P =
.001]; graft-level OR, 0.63 [95%CI, 0.48-0.81; P < .001]). Use of buffered
saline solution also tended to be associated with a lower 5-year risk for
death,myocardial infarction, or subsequent revascularization compared with
saline (hazard ratio, 0.81 [95%CI, 0.64-1.02; P = .08]) and blood (0.81
[0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients
undergoing CABG whose vein grafts were preserved in a buffered saline
solution had lower VGF rates and trends toward better long-term clinical
outcomes compared with patients whose grafts were preserved in saline-or
blood-based solutions. Copyright 2014 American Medical Association. All
rights reserved.

<70>
Accession Number
372839038
Title
Culprit vessel only versus multivessel percutaneous coronary intervention
in patients presenting with ST-segment elevation myocardial infarction and
multivessel disease.
Source
PLoS ONE. 9 (3) (no pagination), 2014. Article Number: e92316. Date of
Publication: 20 Mar 2014.
Author
Zhang D.; Song X.; Lv S.; Yuan F.; Xu F.; Zhang M.; Li W.; Yan S.
Institution
(Zhang, Song, Lv, Yuan, Xu, Zhang, Li, Yan) Department of Cardiology,
Capital Medical University, Beijing Institute of Heart, Lung and Blood
Vessel Disease, Beijing, China
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: The best strategy for ST-segment elevation myocardial
infarction (STEMI) patients with multivessel disease (MVD), who underwent
primary percutaneous coronary intervention (PCI) in the acute phase, is
not well established. <br/>Objective(s): Our goal was to conduct a
meta-analysis comparing culprit vessel only percutaneous coronary
intervention (culprit PCI) with multivessel percutaneous coronary
intervention (MV-PCI) for treatment of patients with STEMI and MVD.
<br/>Method(s): Pubmed, Elsevier, Embase, and China National Knowledge
Infrastructure (CNKI) databases were systematically searched for
randomized and nonrandomized studies comparing culprit PCI and MV-PCI
strategies during the index procedure. A meta-analysis was performed using
Review Manager 5.1 (Cochrane Center, Denmark). <br/>Result(s): Four
randomized and fourteen nonrandomized studies involving 39,390 patients
were included. MV-PCI strategy is associated with an increased short-term
mortality (OR: 0.50, 95% CI: 0.32 to 0.77, p = 0.002), long-term mortality
(OR: 0.52, 95% CI: 0.36 to 0.74, p<0.001), and risk of renal dysfunction
(OR: 0.77, 95% CI: 0.61 to 0.97, p = 0.03) compared with culprit PCI
strategy, while it reduced the incidence of revascularization (OR: 2.65,
95% CI: 1.80 to 3.90, p<0.001). <br/>Conclusion(s): This meta-analysis
supports current guidelines which indicate that the non-culprit vessel
should not be treated during the index procedure. &#xa9; 2014 Zhang et al.

<71>
Accession Number
369793455
Title
In-hospital and 1-year mortality in patients undergoing early surgery for
prosthetic valve endocarditis.
Source
JAMA Internal Medicine. 173 (16) (pp 1495-1504), 2013. Date of
Publication: 09 Sep 2013.
Author
Lalani T.; Chu V.H.; Park L.P.; Cecchi E.; Corey G.R.; Durante-Mangoni E.;
Fowler Jr. V.G.; Gordon D.; Grossi P.; Hannan M.; Hoen B.; Munoz P.; Rizk
H.; Kanj S.S.; Selton-Suty C.; Sexton D.J.; Spelman D.; Ravasio V.;
Tripodi M.F.; Wang A.
Institution
(Lalani) Infectious Disease Clinical Research Program, Bethesda, MD,
United States
(Chu, Park, Corey, Fowler Jr.) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Cecchi) Maria Vittoria Hospital, Torino, Italy
(Durante-Mangoni, Tripodi) II Universita di Napoli, Naples, Italy
(Gordon) Flinders Medical Centre, Bedford Park, SA, Australia
(Grossi) Ospedale di Circolo Varese, Varese, Italy
(Hannan) Mater Misericordiae University Hospital, Dublin, Ireland
(Hoen) University Medical Center of Besancon, Besancon, France
(Munoz) Hospital General Universitario Gregorio Maranon, Madrid, Spain
(Rizk) Cairo University Medical School, Cairo, Egypt
(Kanj) American University of Beirut Medical Center, Beirut, Lebanon
(Selton-Suty) CHU Nancy-Brabois, Nancy, France
(Sexton, Wang) Department of Medicine, Duke University Medical Center,
Durham, NC, United States
(Spelman) Alfred Hospital, Melbourne, VIC, Australia
(Ravasio) Ospedali Riuniti di Bergamo, Bergamo, Italy
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: There are limited prospective, controlled data evaluating
survival in patients receiving early surgery vs medical therapy for
prosthetic valve endocarditis (PVE). <br/>OBJECTIVE(S): To determine the
in-hospital and 1-year mortality in patients with PVE who undergo valve
replacement during index hospitalization compared with patients who
receive medical therapy alone, after controlling for survival and
treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS: Participants
were enrolled between June 2000 and December 2006 in the International
Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a
prospective, multinational, observational cohort of patients with
infective endocarditis. Patients hospitalized with definite right- or
left-sided PVE were included in the analysis. We evaluated the effect of
treatment assignment on mortality, after adjusting for biases using a Cox
proportional hazards model that included inverse probability of treatment
weighting and surgery as a time-dependent covariate. The cohort was
stratified by probability (propensity) for surgery, and outcomes were
compared between the treatment groups within each stratum. INTERVENTIONS:
Valve replacement during index hospitalization (early surgery) vs medical
therapy. MAIN OUTCOMES AND MEASURES: In-hospital and 1-year mortality.
<br/>RESULT(S): Of the 1025 patients with PVE, 490 patients (47.8%)
underwent early surgery and 535 individuals (52.2%) received medical
therapy alone. Compared with medical therapy, early surgery was associated
with lower in-hospital mortality in the unadjusted analysis and after
controlling for treatment selection bias (in-hospital mortality: hazard
ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57
[95% CI, 0.49-0.67]). The lower mortality associated with surgery did not
persist after adjustment for survivor bias (in-hospital mortality: HR,
0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI,
0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality
with early surgery in the highest surgical propensity quintile (21.2% vs
37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery
was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs
50.0%; P = .007) quintiles of surgical propensity. CONCLUSIONS AND
RELEVANCE: Prosthetic valve endocarditis remains associated with a high
1-year mortality rate. After adjustment for differences in clinical
characteristics and survival bias, early valve replacement was not
associated with lower mortality compared with medical therapy in the
overall cohort. Further studies are needed to define the effect and timing
of surgery in patients with PVE who have indications for surgery.

<72>
Accession Number
51807685
Title
Comparison between valsartan and amlodipine regarding cardiovascular
morbidity and mortality in hypertensive patients with glucose intolerance:
NAGOYA HEART study.
Source
Hypertension. 59 (3) (pp 580-586), 2012. Date of Publication: March 2012.
Author
Muramatsu T.; Matsushita K.; Yamashita K.; Kondo T.; Maeda K.; Shintani
S.; Ichimiya S.; Ohno M.; Sone T.; Ikeda N.; Watarai M.; Murohara T.
Institution
(Muramatsu, Matsushita, Yamashita, Kondo, Maeda, Shintani, Murohara)
Department of Cardiology, Nagoya University Graduate, School of Medicine,
65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
(Ichimiya, Ohno) Yokkaichi Municipal Hospital, Yokkaichi, Japan
(Shintani) Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
(Sone) Ogaki Municipal Hospital, Ogaki, Japan
(Ikeda) Chunichi Hospital, Nagoya, Japan
(Watarai) Anjo Kosei Hospital, Anjo, Japan
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
It has not been fully examined whether angiotensin II receptor blocker is
superior to calcium channel blocker to reduce cardiovascular events in
hypertensive patients with glucose intolerance. A prospective,
open-labeled, randomized, controlled trial was conducted for Japanese
hypertensive patients with type 2 diabetes mellitus or impaired glucose
tolerance. A total of 1150 patients (women: 34%; mean age: 63 years;
diabetes mellitus: 82%) were randomly assigned to receive either
valsartan- or amlodipine-based antihypertensive treatment. Primary outcome
was a composite of acute myocardial infarction, stroke, coronary
revascularization, admission attributed to heart failure, or sudden
cardiac death. Blood pressure was 145/82 and 144/81 mm Hg, and
glycosylated hemoglobin was 7.0% and 6.9% at baseline in the valsartan
group and the amlodipine group, respectively. Both of them were equally
controlled between the 2 groups during the study. The median follow-up
period was 3.2 years, and primary outcome had occurred in 54 patients in
the valsartan group and 56 in the amlodipine group (hazard ratio: 0.97
[95% CI: 0.66-1.40]; P=0.85). Patients in the valsartan group had a
significantly lower incidence of heart failure than in the amlodipine
group (hazard ratio: 0.20 [95% CI: 0.06-0.69]; P=0.01). Other components
and all-cause mortality were not significantly different between the 2
groups. Composite cardiovascular outcomes were comparable between the
valsartan- and amlodipine-based treatments in Japanese hypertensive
patients with glucose intolerance. Admission because of heart failure was
significantly less in the valsartan group. &#xa9; 2012 American Heart
Association, Inc.

<73>
Accession Number
51420314
Title
A modified two-port thoracoscopic technique versus axillary
minithoracotomy for the treatment of recurrent spontaneous pneumothorax: A
prospective randomized study.
Source
Surgical Endoscopy. 26 (3) (pp 607-614), 2012. Date of Publication: March
2012.
Author
Foroulis C.N.; Anastasiadis K.; Charokopos N.; Antonitisis P.;
Halvatzoulis H.V.; Karapanagiotidis G.T.; Grosomanidis V.;
Papakonstantinou C.
Institution
(Foroulis, Anastasiadis, Charokopos, Antonitisis, Halvatzoulis,
Karapanagiotidis, Papakonstantinou) Department of Thoracic and
Cardiovascular Surgery, Aristotle University Medical School, AHEPA
University Hospital, Stilponos Kiriakidi Street, Thessaloniki 54636,
Greece
(Grosomanidis) Department of Anaesthesiology and Intensive Care, Aristotle
University Medical School, AHEPA University Hospital, Thessaloniki, Greece
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Currently, most thoracic surgeons perform surgical pleurodesis
for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic
surgery (VATS). However, the superiority of VATS over axillary
minithoracotomy is not been established in prospective studies to date. A
modified two-port VATS technique and axillary minithoracotomy were
prospectively evaluated for possible differences in the short- and
long-term outcome for patients. <br/>Method(s): In this study, 66
consecutive patients underwent surgical pleurodesis for RSP through either
a modified two-port VATS procedure (group A, 33 patients) or axillary
minithoracotomy (group B, 33 patients). According to the study design
(NCT01192217), the patients were randomly assigned to the two groups,
which were similar in terms of age and body mass index. One-lung
ventilation time, histology of the available lung parenchyma specimens,
early postoperative complications, length of chest tube drainage and
hospital stay, recurrence rate, and a score for patient satisfaction with
treatment based on the sum of postoperative pain, dependent-arm
mobilization, and return to full activity subscores were evaluated. The
follow-up period varied from 3 to 53 months (median, 30 months).
<br/>Result(s): The one-lung ventilation and operating times were
significantly longer (p < 0.001) in group A than in group B. The overall
detection of blebs, bulla, or both was 51.5% in group A and 63.8% in group
B. The recurrence rate, complication rate, postoperative chest tube
drainage duration, postoperative hospital stay, and incidence of chronic
pain did not differ between the two groups. The score for patient
satisfaction with treatment was significantly higher in group A than in
group B (p < 0.001) according the subscores for better dependent-arm
mobilization and return to full activity. <br/>Conclusion(s): Axillary
minithoracotomy and VATS are equally effective for the treatment of RSP,
although the rate for resection of blebs, bulla, or both is higher with
the axillary minithoracotomy procedure. Although VATS is more time
consuming, it offers to the patient more satisfaction with treatment.
&#xa9; 2011 Springer Science+Business Media, LLC.

<74>
Accession Number
361473740
Title
Comparison of the effect of 6% hydroxyethyl starch and gelatine on cardiac
and stroke volume index: A randomized, controlled trial after cardiac.
Source
Perfusion. 25 (5) (pp 283-291), 2010. Date of Publication: September 2010.
Author
Schramko A.A.; Suojaranta-Ylinen R.T.; Kuitunen A.H.; Raivio P.M.;
Kukkonen S.I.; Niemi T.T.
Institution
(Schramko, Suojaranta-Ylinen, Kuitunen, Kukkonen, Niemi) Department of
Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital,
Meilahti Hospital, PO Box 340, Helsinki, FI-00029 Hus, Finland
(Raivio) Department of Cardiothoracic Surgery, Helsinki University Central
Hospital, Meilahti Hospital, Helsinki, Finland
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background and aims: The objective of this study was to find out the
effect of various doses of hydroxyethyl starch (HES), gelatine or Ringer's
acetate on cardiac and stroke volume index after cardiac surgery.
<br/>Material(s) and Method(s): Three consecutive boluses (each 7 mL.kg-1)
of either 6% HES 130/0.4, 4% gelatine, or Ringer's acetate solutions were
administered to 45 patients postoperatively. The rate of infusions was
adjusted according to haemodynamic measurements. Thereafter, infusion of
the study solution (7 mL.kg-1) was continued for the following 12 hours.
The total dose of study solution was 28 mL. kg-1. <br/>Result(s) and
Conclusion(s): Mean (SD) cardiac and stroke volume indices were greater in
the HES group [2.8 L.min-1.m-2 (0.7), 34.1 (6.7) ml.m-2] than in the
gelatine group [2.2 L. min-1.m-2 (0.6), 25.8 (7.2) ml.m-2] after
completion of 7 mL. kg-1 of study solution. At this stage, the effect of
gelatine did not differ from Ringer's acetate. After completion of 14
mL.kg-1 and 21 mL.kg-1 of colloids, similar cardiac and stroke volume
indices were observed and the haemodynamic response was better in both
colloid groups than in the Ringer's acetate group. No differences between
groups were detected on the first postoperative morning. In the early
postoperative phase after cardiac surgery, the effect of a single dose of
HES solution on the haemodynamics was superior to the effect of gelatine
or Ringer's acetate. However, after repeated administration of the study
solutions, the haemodynamics in the two colloid groups appeared to be
similar, but superior to the Ringer's acetate group.

<75>
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.
<br/>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. <br/>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). <br/>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).
<br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2019 American Medical Association. All
rights reserved.

<76>
Accession Number
2001970386
Title
The association between postoperative cognitive dysfunction and cerebral
oximetry during cardiac surgery: a secondary analysis of a randomised
trial.
Source
British Journal of Anaesthesia. 123 (2) (pp 196-205), 2019. Date of
Publication: August 2019.
Author
Holmgaard F.; Vedel A.G.; Rasmussen L.S.; Paulson O.B.; Nilsson J.C.; Ravn
H.B.
Institution
(Holmgaard, Vedel, Nilsson, Ravn) Department of Cardiothoracic Anesthesia,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Vedel, Rasmussen) Department of Anesthesia, Centre of Head and
Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Paulson) Neurobiological Research Unit, The Neuro Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
Publisher
Elsevier Ltd
Abstract
Background: Postoperative cognitive dysfunction (POCD) occurs commonly
after cardiac surgery. Near-infrared spectroscopy (NIRS) has been used to
monitor regional cerebral oxygen saturation (rScO<inf>2</inf>) in order to
minimise the occurrence of POCD by applying dedicated interventions when
rScO<inf>2</inf> decreases. However, the association between
rScO<inf>2</inf> intraoperatively and POCD has not been clarified.
<br/>Method(s): This is a secondary analysis of a randomised trial with
physician-blinded NIRS monitoring and cognitive testing at discharge from
hospital and at 3 months after surgery. The association between
intraoperative rScO<inf>2</inf> values and POCD at discharge from hospital
and at 3 months after surgery was investigated. The prespecified candidate
predictive variable of interest was cumulative time during surgery with
rScO<inf>2</inf> >=10% below its preoperative value. <br/>Result(s): One
hundred and fifty-three patients had complete NIRS data and neurocognitive
assessments at discharge, and 44 of these patients (29%) had POCD. At 3
months, 148 patients had complete data, and 12 (8%) of these patients had
POCD. The median time with rScO<inf>2</inf> >10% below preoperative values
did not differ for patients with and without POCD at discharge
(difference=0.0 min; Hodges-Lehmann 95% confidence interval, -3.11-1.47,
P=0.88). Other rScO<inf>2</inf> time thresholds that were assessed were
also not significantly different between those with and without POCD at
discharge. This applied both to absolute rScO<inf>2</inf> values and
relative changes from preoperative values. Similar results were found in
relation to POCD at 3 months. <br/>Conclusion(s): No significant
association was found between intraoperative rScO<inf>2</inf> values and
POCD. These findings bring into question the rationale for attempting to
avoid decreases in rScO<inf>2</inf> if the goal is to prevent POCD.
Clinical trial registration: NCT 02185885.<br/>Copyright &#xa9; 2019
British Journal of Anaesthesia

<77>
Accession Number
2001998265
Title
Systematic review and consensus definitions for the Standardised Endpoints
in Perioperative Medicine initiative: clinical indicators.
Source
British Journal of Anaesthesia. 123 (2) (pp 228-237), 2019. Date of
Publication: August 2019.
Author
Fleisher L.A.; Grocott M.P.W.; Myles P.S.; Myles P.; Grocott M.; Biccard
B.; Blazeby J.; Boney O.; Chan M.; Diouf E.; Fleisher L.; Kalkman C.; Kurz
A.; Moonesinghe R.; Wijeysundera D.; Gan T.J.; Peyton P.; Sessler D.;
Tramer M.; Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.; Botti
M.; Haller G.; Cook T.; Neuman M.; Story D.; Gruen R.; Bampoe S.; Evered
L.; Scott D.; Silbert B.; van Dijk D.; Grocott H.; Eckenhoff R.; Rasmussen
L.; Eriksson L.; Beattie S.; Landoni G.; Leslie K.; Howell S.; Nagele P.;
Richards T.; Lamy A.; Lalu M.; Pearse R.; Mythen M.; Canet J.; Moller A.;
Gin T.; Schultz M.; Pelosi P.; Gabreu M.; Futier E.; Creagh-Brown B.;
Abbott T.; Klein A.; Corcoran T.; Jamie Cooper D.; Dieleman S.; McIlroy
D.; Bellomo R.; Shaw A.; Prowle J.; Karkouti K.; Billings J.; Mazer D.;
Jayarajah M.; Murphy M.; Bartoszko J.; Sneyd R.; Morris S.; George R.;
Shulman M.; Lane-Fall M.; Nilsson U.; Stevenson N.; Cooper J.D.J.; van
Klei W.; Cabrini L.; Miller T.; Pace N.; Jackson S.; Buggy D.; Short T.;
Riedel B.; Gottumukkala V.; Alkhaffaf B.; Johnson M.
Institution
(Haller) Department of Anaesthesiology, Geneva University Hospitals,
Geneva, Switzerland
(Haller, Myles) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Bampoe) Centre for Perioperative Medicine, University College London,
United Kingdom
(Cook) Department of Anaesthesia and Intensive Care, Royal United
Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
(Fleisher, Neuman) Departments of Anesthesiology and Critical Care and
Medicine, Perelman School of Medicine of the University of Pennsylvania,
Philadelphia, PA, United States
(Grocott) Integrative Physiology and Critical Illness Group, Clinical and
Experimental Sciences, Faculty of Medicine, University Hospital
Southampton, Southampton, United Kingdom
(Grocott) Anaesthesia, Perioperative and Critical Care Research Group,
Southampton NIHR Biomedical Research Centre, University Hospital
Southampton, Southampton, United Kingdom
(Story) Centre for Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Myles) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Clinical indicators are powerful tools to quantify the safety
and quality of patient care. Their validity is often unclear and
definitions extremely heterogeneous. As part of the International
Standardised Endpoints in Perioperative Medicine (StEP) initiative, this
study aimed to derive a set of standardised and valid clinical outcome
indicators for use in perioperative clinical trials. <br/>Method(s): We
identified clinical indicators via a systematic review of the anaesthesia
and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane
Library). We performed a three-stage Delphi consensus-gaining process that
involved 54 clinician-researchers worldwide. Indicators were first
shortlisted and the most suitable definitions for evaluation of quality
and safety interventions determined. Indicators were then assessed for
validity, reliability, feasibility, and clarity. <br/>Result(s): We
identified 167 clinical outcome indicators. Participation in the three
Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A
final list of eight outcome indicators was generated: surgical site
infection at 30 days, stroke within 30 days of surgery, death within 30
days of coronary artery bypass grafting, death within 30 days of surgery,
admission to the intensive care unit within 14 days of surgery,
readmission to hospital within 30 days of surgery, and length of hospital
stay (with or without in-hospital mortality). They were rated by the
majority of experts as valid, reliable, easy to use, and clearly defined.
<br/>Conclusion(s): These clinical indicators can be confidently used as
endpoints in clinical trials measuring quality, safety, and improvement in
perioperative care. Registration: PROSPERO 2016 CRD42016042102
(http://www.crd.york.ac.uk/PROSPERO/display_record.php?
ID=CRD42016042102).<br/>Copyright &#xa9; 2019 British Journal of
Anaesthesia

<78>
Accession Number
627061263
Title
Pharmacokinetics of ferric bepectate-a new intravenous iron drug for
treating iron deficiency.
Source
Basic and Clinical Pharmacology and Toxicology. 125 (2) (pp 133-141),
2019. Date of Publication: August 2019.
Author
Munoz M.; Olsen P.S.; Petersen T.S.; Manhart S.; Waldorff S.
Institution
(Munoz) Perioperative Transfusion Medicine, Department of Surgical
Specialties, Biochemistry and Immunology, School of Medicine, University
of Malaga, Malaga, Spain
(Olsen) Cardiothoracic Surgery and Transplantation, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Petersen) Department of Clinical Pharmacology, Bispebjerg Hospital,
Copenhagen, Denmark
(Manhart) Serumwerk Bernburg AG, Bernburg, Germany
(Waldorff) Iron4u, Holte, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
IV iron is indicated in clinical conditions, where rapid anaemia
alleviation and repletion of iron stores are required. The acute toxicity
of IV iron is ascribed to the presence of labile iron in plasma. Thus,
shorter plasma residence time might improve the safety profile, even for
compounds holding-on the iron tightly. In this single-centre, open-label,
single-dose escalation study, we evaluated the elimination kinetics of
ferric bepectate (FBP) compared to those of ferric carboxymaltose (FCM).
Thirty-three iron-depleted anaemic patients who had undergone cardiac
surgery were included and received 200, 500 or 1500 mg FBP or 500 mg FCM.
Plasma drug curves were subjected to model-free analysis. Because
saturation kinetics was found, a compartmental model with limited
elimination capacity was applied. Urinary iron excretion was also
analysed. The initial non-compartmental analysis revealed an increasing
AUC/dose ratio for FBP. For both drugs, the central distribution
compartment corresponded to plasma volume, and elimination followed
Michaelis-Menten saturation kinetics. Maximal elimination rates
(V<inf>max</inf>) were 224 mg/h and 81 mg/h for FBP 500 mg and FCM 500 mg,
respectively; drug concentrations at half V<inf>max</inf> (K<inf>m</inf>),
99 mg/L and 212 mg/L, respectively; and terminal plasma half-life (T1/2),
3.05 h and 8.96 h, respectively. Both drugs were equally effective in
eliciting an early ferritin rise. Urinary iron excretion was measurable in
all patients receiving FCM but not in those receiving FBP, which was well
tolerated. Intravenous iron drugs are subject to capacity-limited
elimination with different saturation thresholds. Urinary iron excretion
can be used as a surrogate for labile plasma iron.<br/>Copyright &#xa9;
2019 The Authors. Basic & Clinical Pharmacology & Toxicology published by
John Wiley & Sons Ltd on behalf of Nordic Association for the Publication
of BCPT (former Nordic Pharmacological Society).

<79>
Accession Number
2002307387
Title
Hemadsorption during cardiopulmonary bypass reduces interleukin 8 and
tumor necrosis factor alpha serum levels in cardiac surgery: A randomized
controlled trial.
Source
Minerva Anestesiologica. 85 (7) (pp 715-723), 2019. Date of Publication:
2019.
Author
Garau I.; Marz A.; Sehner S.; Reuter D.A.; Reichenspurner H.; Zollner C.;
Kubitz J.C.
Institution
(Garau, Zollner, Kubitz) Department of Anesthesiology, Center of
Anesthesiology and Intensive Care Medicine, University Hospital
Hamburg-Eppendorf, Hamburg, Germany
(Marz, Reuter) Department of Anesthesiology, Rostock University Medical
Center, University of Rostock, Rostock, Germany
(Sehner) Department of Medical Biometry and Epidemiology, University
Medical Center, Hamburg-Eppendorf, Hamburg, Germany
(Reichenspurner) Department of Cardiothoracic Surgery, University Heart
Center, Hamburg-Eppendorf, Hamburg, Germany
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Surgical trauma and cardiopulmonary bypass (CPB) are
associated with the liberation of pro-inflammatory cytokines. With
hemadsorption (Cytosorb) during CPB, pro-inflammatory cytokines
may be reduced and the inflammatory response may be decreased.
<br/>METHOD(S): In this prospective, randomized single center study, serum
cytokine levels of interleukin 8 (Il-8), interleukin 6 (Il-6) and
tumor-necrosis-factor alpha (TNFalpha) were assessed in elective on-pump
cardiac surgery patients with hemadsorption on CPB (study group [SG],
N.=20) and without (control group [CG], N.=20). Cytokine levels were
assessed prior to CPB, at the end of CPB, and 6 hours (h) and 24 h after
the end of CPB, together with a hemodynamic assessment. Cardiac-Index (CI)
was assessed with transcardiopulmonary thermodilution. <br/>RESULT(S): For
Il-8, significantly lower serum levels were observed in the SG compared to
the CG at the end of CPB (P=0.008). In the SG, TNFalpha levels were also
below those in the CG at both the end of and 6h after CPB (P=0.034). After
24 hours, TNFalpha levels were at baseline in both groups. No significant
differences were found for Il-6. The CI was significantly higher in the SG
at the end of CPB (P=0.025). However, there was no difference between both
groups 6 h after CPB. <br/>CONCLUSION(S): This prospective study shows a
significant reduction in pro-inflammatory cytokine levels of Il-8 and
TNFalpha with hemadsorption in on-pump cardiac surgery whilst also
demonstrating safety in its applications. However, the differences in
cytokine levels and CI between patients treated with hemadsorption and
those without were minor and of short duration.<br/>Copyright &#xa9; 2018
EDIZIONI MINERVA MEDICA

<80>
Accession Number
2002307373
Title
Inhalation versus intravenous anesthesia for adults undergoing heart valve
surgery: A systematic review and meta-analysis.
Source
Minerva Anestesiologica. 85 (6) (pp 665-675), 2019. Date of Publication:
2019.
Author
Ren S.-F.; Guo Y.-Q.; Yu H.
Institution
(Ren, Guo) Department of Cardiovascular Surgery, West China Hospital of
Sichuan University, Chengdu, China
(Ren, Yu, Yu) Department of Anesthesiology, West China Hospital of Sichuan
University, Chengdu, China
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Many studies have found that volatile anesthetics are
associated with improved clinical outcomes for adults undergoing coronary
artery bypass grafting. However, the effect of volatile anesthetics for
adults after heart valve surgery has been unclear. So we conducted a
meta-analysis of randomized controlled trials (RCTs) to explore whether
the choice of an anesthetic regimen might influence patients' outcomes
after valve surgery. EVIDENCE ACQUISITION: PubMed, Embase, and Cochrane
Library were searched from inception to June 2018. We included eligible
research comparing inhalation anesthesia with total intravenous anesthesia
(TIVA) in adult patients undergoing valve surgery. The major endpoints
involved mortality, postoperative arrhythmia, acute kidney injury,
pulmonary complications, neurological events, myocardial infarction,
reoperation for bleeding. The postoperative peak troponin release,
hospital stay, Intensive Care Unit (ICU) stay and ventilation time were
also analyzed. EVIDENCE SYNTHESIS: After screening through 243 potentially
relevant articles, we included 13 RCTs with 962 patients. The inhalation
anesthesia group revealed comparable mortality (inhalation group 12/249
[4.8%] vs. TIVA group 13/247 [5.3%], RR=0.97; 95% CI: 0.45 to 2.09;
P=0.93; P for heterogeneity=0.66, I²=0%) and other
postoperative complications with no heterogeneity. The postoperative peak
troponin release, hospital/ICU stay and ventilation time were comparable
between two groups with considerable heterogeneity. <br/>CONCLUSION(S):
Among patients undergoing heart valve surgery, the use of inhalation
anesthesia compared with TIVA failed to demonstrate superiority for
survival and major postoperative complications, and the evidence was
insufficient to draw firm conclusions due to the limited sample size. A
determination of equivalence or superiority between these two anesthetic
regimens requires further researches.<br/>Copyright &#xa9; 2019 EDIZIONI
MINERVA MEDICA

<81>
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. <br/>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. <br/>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. <br/>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. <br/>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).
<br/>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.<br/>Copyright &#xa9; 2019 American Medical
Association. All rights reserved.

<82>
Accession Number
2002323673
Title
Design and rationale of the COMPLETE trial: A randomized, comparative
effectiveness study of complete versus culprit-only percutaneous coronary
intervention to treat multivessel coronary artery disease in patients
presenting with ST-segment elevation myocardial infarction.
Source
American Heart Journal. 215 (pp 157-166), 2019. Date of Publication:
September 2019.
Author
Mehta S.R.; Wood D.A.; Meeks B.; Storey R.F.; Mehran R.; Bainey K.R.;
Nguyen H.; Bangdiwala S.I.; Cairns J.A.
Institution
(Mehta, Meeks, Nguyen, Bangdiwala) Population Health Research Institute,
Hamilton, Ontario, Canada
(Mehta, Bangdiwala) McMaster University, Hamilton, Ontario, Canada
(Mehta) Hamilton Health Sciences, Hamilton, Ontario, Canada
(Wood, Cairns) University of British Columbia, Vancouver, British
Columbia, Canada
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Mehran) The Zena A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Bainey) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Alberta, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
A significant proportion of patients with ST-segment elevation myocardial
infarction (STEMI) have multivessel coronary artery disease (CAD).
Following successful culprit lesion percutaneous coronary intervention
(PCI) for STEMI, the question of whether to routinely revascularize
non-culprit lesions or manage them conservatively with optimal medical
therapy (OMT) alone is a common dilemma facing clinicians. <br/>Method(s):
COMPLETE is a prospective, randomized, international, multicenter,
parallel group, open-label trial with blinded evaluation of outcomes.
Following successful PCI (contemporary drug eluting stents recommended) of
the culprit lesion for STEMI, a total of 4041 patients from 140 centers in
31 countries were randomized to receive either complete revascularization,
consisting of staged PCI of all suitable non-culprit lesions plus optimal
medical therapy (OMT), or to culprit lesion-only PCI, consisting of OMT
alone. OMT comprises evidence-based therapy for STEMI, including and dual
antiplatelet therapy with ticagrelor, HTN and lipid management. All
coronary angiograms in the trial are being evaluated in a central
angiographic core lab to assess quality and completeness of
revascularization. The co-primary outcomes are (1): the composite of CV
death or new non-fatal MI and (2 the composite of CV death, new non-fatal
MI or ischemia-driven revascularization at a median follow-up of 3 years.
<br/>Conclusion(s): The COMPLETE trial is an international multicenter
randomized trial that will help determine whether complete
revascularization involving staged PCI of non-culprit lesions improves
outcomes in patients with STEMI and multivessel CAD. (clinicaltrials.gov
NCT01740479).<br/>Copyright &#xa9; 2019 Elsevier Inc.

<83>
Accession Number
2002284403
Title
Postoperative shared-care for patients undergoing non-cardiac surgery: a
systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Mazzarello S.; McIsaac D.I.; Montroy J.; Fergusson D.A.; Yateem D.;
Devereaux P.J.; Lalu M.M.
Institution
(Mazzarello, McIsaac, Montroy, Fergusson, Lalu) Clinical Epidemiology
Program, Blueprint Translational Research Group, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Mazzarello, McIsaac, Fergusson) School of Epidemiology and Public Health,
University of Ottawa, Ottawa, ON, Canada
(McIsaac, Yateem, Lalu) Department of Anesthesiology and Pain Medicine,
The Ottawa Hospital Research Institute, Room B307, 1053 Carling Ave, Mail
Stop 249, Ottawa, ON K1Y 4E9, Canada
(Fergusson) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
(Devereaux) Population Health Research Institute, David Braley Cardiac,
Vascular, and Stroke Research Institute, McMaster University, Hamilton,
ON, Canada
(Lalu) Regenerative Medicine Program, The Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Lalu) Department of Cellular and Molecular Medicine, University of
Ottawa, Ottawa, ON, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Collaborative ("shared-care") models of postoperative care
improve outcomes in patients undergoing surgery for hip fracture. Despite
being widely adopted, it is unclear if similar benefits of shared-care
models exist for other at-risk surgical patient populations. Thus, we
performed a systematic review to understand the impact of shared-care
models. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2019, Canadian
Anesthesiologists' Society.

<84>
Accession Number
628528012
Title
A randomized, controlled pilot clinical trial of cryopreserved platelets
for perioperative surgical bleeding: the CLIP-I trial.
Source
Transfusion. (no pagination), 2019. Date of Publication: 2019.
Author
Faulke D.J.; Fraser J.F.; Holley A.D.; Irving D.O.; Pearse B.L.; Royse
A.G.; Bellomo R.; Weinberg L.; Eastwood G.; Peck L.; Young H.;
Sidiropoulos S.; Baulch S.; Dalyell A.; Kolar D.; Martinelli T.; Reidy Y.;
Caldwell N.; Royse A.; Tivendale L.; Bisignano M.; Hausler M.; Williams
Z.; Dong N.; Gattas D.J.; Buhr H.; Bannon P.; Cartwright B.; Turner L.;
Gibson J.; Blayney B.; Beattie L.; Hutch D.; Wun Jennifer Coles J.; Pearse
B.; Faulke D.; Zeigenfuss M.; Tesar P.; Fraser J.; Perel J.; Kahn C.;
Vincent B.; O'Brien D.; Reade M.C.; Deans R.; Holley A.; Marks D.C.;
Johnson L.; Wong J.; Irving D.
Institution
(Reade) Joint Health Command, Australian Defence Force, Canberra, ACT,
Australia
(Reade, Deans, Holley) University of Queensland, Brisbane, QLD, Australia
(Marks, Irving, Johnson, Wong) Australian Red Cross Blood Service, Sydney,
NSW, Australia
(Bellomo) Austin Hospital, Melbourne, VIC, Australia
(Faulke, Fraser, Pearse) The Prince Charles Hospital, Brisbane, QLD,
Australia
(Gattas) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Royse) Royal Melbourne Hospital, Melbourne, VIC, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Cryopreservation extends platelet (PLT) shelf life from 5 to 7
days to 2 to 4 years. However, only 73 patients have been transfused
cryopreserved PLTs in published randomized controlled trials (RCTs),
making safety data insufficient for regulatory approval. STUDY DESIGN AND
METHODS: The Cryopreserved vs. Liquid Platelet (CLIP) study was a
double-blind, pilot, multicenter RCT involving high-risk cardiothoracic
surgical patients in four Australian hospitals. The objective was to test,
as the primary outcome, the feasibility and safety of the protocol.
Patients were allocated to study group by permuted block randomization,
with patients and clinicians blinded by use of an opaque shroud placed
over each study PLT unit. Up to 3 units of cryopreserved or liquid-stored
PLTs were administered per patient. No other aspect of patient care was
affected. Adverse events were actively sought. <br/>RESULT(S): A total of
121 patients were randomized, of whom 23 received cryopreserved PLTs and
18 received liquid-stored PLTs. There were no differences in blood loss
(median, 715 mL vs. 805 mL at 24 hr; difference between groups 90 mL [95%
CI, -343.8 to 163.8 mL], p = 0.41), but the Bleeding Academic Research
Consortium criterion for significant postoperative hemorrhage in cardiac
surgery composite bleeding endpoint occurred in nearly twice as many
patients in the liquid-stored group (55.6% vs. 30.4%, p = 0.10). Red blood
cell transfusion requirements were a median of 3 units in the
cryopreserved group versus 4 units with liquid-stored PLTs (difference
between groups, 1 unit [95% CI, -3.1 to 1.1 units]; p = 0.23). Patients in
the cryopreserved group were more likely to be transfused fresh-frozen
plasma (78.3% vs. 27.8%, p = 0.002) and received more study PLT units
(median, 2 units vs. 1 unit; difference between groups, 1 unit [95% CI,
-0.03 to 2.0 units]; p = 0.012). There were no between-group differences
in potential harms including deep venous thrombosis, myocardial
infarction, respiratory function, infection, and renal function. No
patient had died at 28 days, and postoperative length of stay was similar
in each group. <br/>CONCLUSION(S): In this pilot RCT, compared to
liquid-stored PLTs, cryopreserved PLTs were associated with no evidence of
harm. A definitive study testing safety and hemostatic effectiveness is
warranted.<br/>Copyright &#xa9; 2019 AABB

<85>
Accession Number
626310170
Title
Transcatheter aortic valve replacement for pure aortic valve
regurgitation: "on-label" versus "off-label" use of TAVR devices.
Source
Clinical Research in Cardiology. 108 (8) (pp 921-930), 2019. Date of
Publication: 01 Aug 2019.
Author
Wernly B.; Eder S.; Navarese E.P.; Kretzschmar D.; Franz M.; Alushi B.;
Beckhoff F.; Jung C.; Lichtenauer M.; Datz C.; Schulze P.C.; Landmesser
U.; Hoppe U.C.; Falk V.; Lauten A.
Institution
(Wernly, Lichtenauer, Hoppe) Department of Cardiology, Clinic of Internal
Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
(Eder, Datz) Department of Internal Medicine, Hospital Oberndorf, Teaching
Hospital of Paracelsus Medical University Salzburg, Oberndorf, Austria
(Navarese) Interventional Cardiology and Cardiovascular Medicine Research,
Inova Center for Thrombosis Research and Drug Development, Inova Heart and
Vascular Institute, Falls Church, VA, United States
(Navarese) SIRIO MEDICINE Network, Evidence-Based Section, Falls Church,
VA, United States
(Navarese) Cardiovascular Institute, Ludwik Rydygier Collegium Medicum,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Kretzschmar, Franz, Schulze) Department of Cardiology, Clinic of Internal
Medicine I, Universitaetsherzzentrum Thuringen, Friedrich Schiller
University Jena, Jena, Germany
(Alushi, Beckhoff, Landmesser, Lauten) Department of Cardiology,
University Heart Center Berlin and Charite University Medicine Berlin,
Campus Benjamin-Franklin, Berlin, Germany
(Alushi, Beckhoff, Landmesser, Lauten) German Center for Cardiovascular
Research (DZHK), Site Berlin, Berlin, Germany
(Jung) Division of Cardiology, Pulmonology, and Vascular Medicine, Medical
Faculty, University Duesseldorf, Dusseldorf, Germany
(Landmesser) Berlin Institute of Health (BIH), Berlin, Germany
(Falk) Department of Cardiovascular Surgery, Charite Berlin, Berlin,
Germany
(Falk) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
(Falk) Department of Health Sciences and Technology, ETH Zurich, Zurich,
Switzerland
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has become the
mainstay of treatment for aortic stenosis in patients with high surgical
risk. Pure aortic regurgitation (PAR) is considered a relative
contraindication for TAVR; however, TAVR is increasingly performed in PAR
patients with unfavorable risk profile. Herein, we aim to summarize
available data on TAVR for PAR with special emphasis on "on-label" versus
"off-label" TAVR devices. <br/>Methods and Results: Pubmed was searched
for studies of patients undergoing TAVR for PAR. Primary outcome was 30
day-mortality. Pooled estimated event rates were calculated. Twelve
studies including a total of 640 patients were identified until December
2017. Among these, 208 (33%) patients were treated with devices with
CE-mark approval for PAR ("on-label"; JenaValve and J valve). Overall, the
procedural success rate was 89.9% (95% CI 81.1-96.1%; I² 80%).
Major bleeding was reported in 6.4% (95% CI 2.9-10.8%; I² 48%).
All-cause mortality at 30 days was 10.4% (95% CI 7.1-14.2%; I²
20%). Stroke occurred in 2.2% (95% CI 0.9-3.9%; I² 0%). A
permanent pacemaker was required in 10.7% (95% CI 7.3-14.6%; I²
23%). At 30 days after TAVR, >= moderate AR post-interventional was
observed in 11.5% (95% CI 2.9-23.6%; I² 90%). In the
"on-label"-group, success rate was 93.0% (95% CI 85.9-98.1%; I²
52%). 30-day-mortality was 9.1% (95% CI 3.7-16.0%; I² 36%).
More than trace AR was present in 2.8% (95% CI 0.1-7.6%; I²
0%). Compared to first-generation devices, second-generation devices were
associated with significantly lower 30-day-mortality (r = - 0.10; p =
0.02), and significantly higher procedural success rates (r = 0.28; p <
0.001). Compared to other second-generation devices, the use of J valve or
JenaValve was not associated with altered mortality (r = 0.04; p = 0.50),
rates of > trace residual AR (r = - 0.05; p = 0.65) but with a
significantly higher procedural success (r = 0.15; p = 0.042).
<br/>Conclusion(s): Based on this summary of available observational data
TAVR for PAR is feasible and safe in patients deemed inoperable.
First-generation TAVR devices are associated with inferior outcome and
should be avoided. The "on-label" use of PAR-certified TAVR devices is
associated with a significantly higher procedural success rate and might
be favorable compared to other second-generation devices.<br/>Copyright
&#xa9; 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<86>
Accession Number
600651808
Title
Remote ischemic preconditioning for pediatric patients undergoing
congenital cardiac surgery: A meta-analysis.
Source
International Journal of Cardiology. 177 (2) (pp 551-553), 2014. Date of
Publication: 15 Dec 2014.
Author
Tie H.-T.; Luo M.-Z.; Li Z.-H.; Wang Q.; Wu Q.-C.
Institution
(Tie, Wu) Department of Cardiothoracic Surgery, First Affiliated Hospital
of Chongqing Medical University, Chongqing 400016, China
(Luo) Children's Hospital of Chongqing Medical University, Chongqing
400016, China
(Li, Wang) First College of Clinical Medicine, Chongqing Medical
University, Chongqing 400016, China
Publisher
Elsevier Ireland Ltd

<87>
Accession Number
628650222
Title
Five-Year Outcomes of Transfemoral Transcatheter Aortic Valve Replacement
or Surgical Aortic Valve Replacement in a Real World Population.
Source
Circulation. Cardiovascular interventions. 12 (7) (pp e007825), 2019. Date
of Publication: 01 Jul 2019.
Author
Barbanti M.; Tamburino C.; D'Errigo P.; Biancari F.; Ranucci M.; Rosato
S.; Santoro G.; Fusco D.; Seccareccia F.
Institution
(Barbanti, Tamburino) Division of Cardiology, Policlinico-Vittorio
Emanuele Hospital, University of Catania, Italy
(D'Errigo, Rosato, Seccareccia) National Centre for Global Health-Istituto
Superiore di Sanita, S.R., Rome, Italy
(Biancari) Department of Surgery, University of Oulu, Finland (F.B.)
(Biancari) Heart Center, Turku University Hospital, Department of Surgery,
University of Turku, Finland (F.B.)
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia and
ICU-IRCCS Policlinico San Donato, San Donato Milanese (Milan)
(Santoro) Fondazione G.Monasterio CNR/Regione Toscana per la Ricerca
Medica e la Sanita Pubblica, Florence, Italy
(Fusco) Department of Epidemiology of Lazio Regional Health Service, Rome,
Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: The OBSERVANT study (Observational Study of Effectiveness of
SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment) showed that
mortality at 1 year is similar after transfemoral transcatheter aortic
valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for
real-world propensity-matched patients with aortic stenosis at low and
intermediate risk. We report the 5-year outcomes of the Italian OBSERVANT
study. METHODS AND RESULTS: The unadjusted enrolled population (N=7618)
between December 2010 and June 2012 included 5707 patients on SAVR and
1911 patients on TAVR. The propensity score method was applied to select 2
groups with similar baseline characteristics. All outcomes were
adjudicated through a linkage with administrative databases. The primary
end points of this analysis were death from any cause and major adverse
cardiac and cerebrovascular events at 5 years. The matched population had
a total of 1300 patients (650 per group). The propensity score method
generated a low and intermediate-risk population (mean logistic EuroSCORE
2: 5.1+/-6.2% versus 4.9+/-5.1%, SAVR versus transfemoral TAVR; P=0.485).
At 5 years, the rate of 5 death from any cause was 35.8% in the surgical
group and 48.3% in the transcatheter group (hazard ratio, 1.38; 95% CI,
1.12-1.69; P=0.002). Similarly, TAVR was associated with an increased risk
of major adverse cardiac and cerebrovascular events as compared with SAVR
(42.5% versus 54.0%; hazard ratio, 1.35; 95% CI, 1.11-1.63; P=0.003). The
cumulative incidence of cerebrovascular events, myocardial infarction, and
coronary revascularization were similar in the study groups at 5 years.
<br/>CONCLUSION(S): The present results suggest that at 5 years, in a
real-world population with severe aortic stenosis and at low and
intermediate risk, suggest that SAVR is associated in with lower mortality
and major adverse cardiac and cerebrovascular events rates than
transfemoral TAVR performed using first-generation devices. These data
need to be confirmed in randomized trials using new-generation TAVR
devices.

<88>
Accession Number
2002240064
Title
Analgesia and sedation post-coronary artery bypass graft surgery: A review
of the literature.
Source
Therapeutics and Clinical Risk Management. 15 (pp 773-781), 2019. Date of
Publication: 2019.
Author
Jannati M.; Attar A.
Institution
(Jannati) Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Attar) Cardiovascular Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
This review aimed to study the role of analgesia and sedation after
coronary artery bypass graft (CABG) surgery, regarding pain management,
assisted respiration, overall postoperative health care, and
hospitalization. Data were collected from Pubmed, Scopus, and Cochrane
databases. The following terms were used for the search: "analgesia",
"sedation", "coronary artery bypass grafting", CABG", and "opioids".
Articles between the years 1988 and 2018 were evaluated. Several opioid
and non-opioid analgesics used to relieve surgical pain are regarded as
critical risk factors for developing pulmonary and cardiovascular
complications in all kinds of thoracic surgery, especially CABG
procedures. Effective pain management in post-CABG patients is largely
dependent on effective pain assessment, type of sedatives and analgesics
administered, and evaluation of their effects on pain relief. A
significant challenge is to determine adequate amounts of administered
analgesics and sedatives for postoperative CABG patients, because patients
often order more sedatives and analgesics than needed. The pain management
process is deemed successful when patients feel comfortable after surgery,
with no negative side effects. However, postoperative pain management
patterns have not included many modern methods such as patient-controlled
analgesia, and postoperative pain management drugs are still limited to a
restricted range of opioid and non-opioid analgesics.<br/>Copyright &#xa9;
2019 Jannati and Attar.

<89>
Accession Number
628662554
Title
Mediastinitis in open heart surgery: a systematic review and meta-analysis
of risk factors.
Source
Scandinavian cardiovascular journal : SCJ. (pp 1-25), 2019. Date of
Publication: 10 Jul 2019.
Author
Abdelnoor M.; Sandven I.; Vengen O.; Risnes I.
Institution
(Abdelnoor) Centre of Clinical Heart Research, Oslo University Hospital,
Norway
(Abdelnoor) Epidemiology and Biological Statistics, Independent Health
Research Unit, Oslo, Norway
(Sandven) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Norway
(Vengen, Risnes) Department of Cardiovascular surgery, Oslo University
Hospital, Norway
(Risnes) Department of Cardiovascular Surgery, LHL Hospital, Norway
Publisher
NLM (Medline)
Abstract
Objective: We aimed to summarize the evidence from observational studies
examining the risk factors of the incidence of mediastinitis in open heart
surgery. <br/>Design(s): The study was a systematic review and
meta-analysis of cohorts and case-control studies. <br/>Material(s) and
Method(s): We searched the literature and 74 studies with at least one
risk factor were identified. Both fixed and random effects models were
used. Heterogeneity between studies was examined by subgroup and
meta-regression analysis. Publication bias or small study effects were
evaluated and corrected by limit meta-analysis. <br/>Result(s): When
correcting for small study effect, presence of obesity as estimated from
43 studies had Odds Ratio OR =2.26. (95% CI: 2.17-2.36). This risk was
increasing with decreasing latitude of study place. Presence of diabetes
mellitus from 63 studies carried an OR =1.90 (95% CI: 1.59-2.27). Presence
of Chronic Obstructive Pulmonary Disease (COPD) from 30 studies had an OR
=2.59 (95% CI: 2.22-2.85). Presence of bilateral intramammary graft (BIMA)
from 23 studies carried an OR =2.54 (95% CI: 2.07-3.13). This risk was
increasing with increasing frequency of female patients in the study
population. <br/>Conclusion(s): Evidence from this study showed the
robustness of the risk factors in the pathogenesis of mediastinitis.
Preventive measures can be implemented for reducing obesity, especially in
lower latitude countries. Furthermore, it is mandatory to monitor
perioperative hyperglycemias with continuous insulin infusion. Use of
skeletonized BIMA carries higher risk of mediastinitis especially in
female patients without evidence of beneficial effect on survival for the
time being.

<90>
Accession Number
628651374
Title
Outcomes after surgery for functional tricuspid regurgitation: a
systematic review and meta-analysis.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2019. Date of Publication: 08 Jul 2019.
Author
Veen K.M.; Etnel J.R.G.; Quanjel T.J.M.; Mokhles M.M.; Huygens S.A.;
Rasheed M.; Oei F.B.S.; Ten Cate F.J.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Veen, Etnel, Mokhles, Huygens, Oei, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Canada
(Ten Cate) Cardiology, Erasmus MC, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
INTRODUCTION: This study aims to provide a contemporary overview of
outcomes after tricuspid valve surgery for functional tricuspid
regurgitation(TR). <br/>METHOD(S): The literature was systematically
searched for papers published between January 2005 and December 2017
reporting on clinical/echocardiographic outcomes after tricuspid valve
surgery for functional TR. A random-effects meta-analysis was conducted
for outcome variables and late outcomes are visualized by pooled
Kaplan-Meier curves. Subgroup analyses were performed for studies with a
within-study comparison of suture vs. ring repair and flexible vs rigid
ring repair. <br/>RESULT(S): Eighty-seven publications were included,
encompassing 13,184 patients (mean age:62.1+/-11.8 years, 55% females). A
mitral valve procedure was performed in 92% of patients. Pooled mean
follow-up was 4.0+/-2.8 years. Pooled early mortality was
3.9%(95%CI:3.2-4.6), and late mortality rate was 2.7%/y(95%CI:2.0-3.5), of
which approximately half was cardiac-related 1.2%/y(95%CI:0.8-1.9). Pooled
risk of early moderate-to-severe TR at discharge was 9.4%(95%CI:7.0-12.1).
Late moderate-to-severe TR rate after discharge was 1.9%/y(95%CI:1.0-3.5).
Late reintervention rate was 0.3%/y(95%CI:0.2-0.4). Mortality and overall
(early and late) TR rate were comparable between suture vs. ring
annuloplasty (14 studies), whereas overall TR rate was higher after
flexible ring vs. rigid ring annuloplasty (6 studies) (7.5%/y vs 3.9%/y,
p=0.002). <br/>CONCLUSION(S): This study shows that patients undergoing
surgery for FTR have an acceptable early and late mortality. However, TR
remains prevalent after surgery. The results of this study can be used to
inform patients and clinicians about the expected outcome after surgery
for FTR and can results serve as a benchmark for the performance of
emerging transcatheter tricuspid valve interventions.<br/>Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. &#xa9; The Author(s) 2019. For permissions please email:
journals.permissions@oup.com.

<91>
Accession Number
628653597
Title
Association between Stress Testing-Induced Myocardial Ischemia and
Clinical Events in Patients with Multivessel Coronary Artery Disease.
Source
JAMA Internal Medicine. (no pagination), 2019. Date of Publication: 2019.
Author
Garzillo C.L.; Hueb W.; Gersh B.; Rezende P.C.; Lima E.G.; Favarato D.;
Ramires J.A.F.; Filho R.K.
Institution
(Garzillo, Hueb, Rezende, Lima, Favarato, Ramires, Filho) Instituto Do
Coracao (InCor), Hospital das Clinicas, Faculdade de Medicina,
Universidade de Sao Paulo, Avenida Doutor Eneas de Carvalho Aguiar 44,
Cerqueira Cesar, SP 05403-000, Brazil
(Gersh) Department of Medicine, Mayo Clinic College of Medicine,
Rochester, MN, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The long-term prognostic implications of myocardial ischemia
documented during stress testing in patients with multivessel coronary
artery disease (CAD) are unclear. <br/>Objective(s): To assess whether
documented stress testing-induced myocardial ischemia is associated with
major adverse cardiovascular events or ventricular function changes in
patients with stable multivessel CAD. <br/>Design, Setting, and
Participant(s): A prospective cohort study was conducted using data from a
single-center randomized clinical trial (Medicine, Angioplasty, or Surgery
Study [MASS] II) to examine the association of myocardial ischemia
documented during stress testing at baseline with cardiovascular events
and ventricular function changes during follow-up. Participants were
previously randomized (May 1, 1995, to May 31, 2000) to medical therapy,
percutaneous coronary intervention with bare metal stents, or coronary
artery bypass grafting. Event-free survival was estimated by the
Kaplan-Meier method, and multivariable Cox regression models were
calculated to assess the association between ischemia and the primary
composite end point. The vital status was determined on February 28, 2011.
Data were analyzed from February 1, 2016, to April 1, 2017. <br/>Main
Outcomes and Measures: Cardiovascular events (overall mortality,
myocardial infarction, and revascularization for refractory angina) were
tracked from the time of randomization to the end of the 10-year follow-up
(mean [SD] duration, 11.4 [4.3] years). Myocardial ischemia was assessed
at baseline and at 1-year intervals by exercise stress testing, and
ventricular function (left ventricular ejection fraction) was assessed by
echocardiography at baseline and after 10 years. Patients with documented
ischemia were compared with those without ischemia regarding the outcomes
and changes in ventricular function. <br/>Result(s): Of 611 participants,
535 underwent exercise stress testing at baseline: 270 with documented
ischemia and 265 without. Of these 535 patients, 373 (69.7%) were men, and
the mean (SD) age for the entire cohort was 59.7 (9.2) years. No
association was found between the presence of ischemia at baseline and
survival free of combined cardiovascular events (hazard ratio, 1.00; 95%
CI, 0.80-1.27; P =.95) after multivariable adjustment that included CAD
initial randomized treatments. In addition, among 320 patients who
underwent echocardiographic evaluation, the slight decline in left
ventricular ejection fraction after 10 years was similar in both groups
(median [SD] difference, -4.9% [18.7%] vs -6.6% [20.0%], respectively, for
groups with and without ischemia; P =.97). <br/>Conclusions and Relevance:
In this study, regardless of the therapeutic strategy applied, the
presence of documented myocardial ischemia did not appear to be associated
with an increased occurrence of major adverse cardiovascular events or
changes in ventricular function in patients with multivessel CAD during a
long-term follow-up.<br/>Copyright &#xa9; 2019 Garzillo CL et al.

<92>
Accession Number
2000592933
Title
Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting.
Source
Journal of the American College of Cardiology. 71 (9) (pp 983-991), 2018.
Date of Publication: 6 March 2018.
Author
Smart N.A.; Dieberg G.; King N.
Institution
(Smart, Dieberg) School of Science and Technology, University of New
England, Armidale, Australia, Australia
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth, United Kingdom
Publisher
Elsevier USA
Abstract
Background: When comparing effects of on- versus off-pump coronary artery
bypass grafting (CABG), it is important to assess the long-term clinical
outcomes. However, most research conducted thus far has concentrated on
short-term outcomes and ignored the long-term clinical outcomes,
especially the 5-year outcomes of the largest randomized controlled
trials. <br/>Objective(s): The aim of this systematic review and
meta-analysis was to investigate the long-term clinical outcomes of on-
versus off-pump CABG. <br/>Method(s): To identify potential studies
systematic searches were carried out using various databases. The search
strategy included the key concepts of cardiopulmonary bypass AND off-pump
AND long term OR 5-year outcomes. This was followed by a meta-analysis
investigating mortality, incidence of myocardial infarction, incidence of
angina, need for revascularization, and incidence of stroke.
<br/>Result(s): Six studies totaling 8,145 participants were analyzed. In
the on-pump group mortality was 12.3%, compared with 13.9% in the off-pump
group. The odds ratio (OR) for this comparison was 1.16 (95% confidence
interval [CI]: 1.02 to 1.32; p = 0.03; 13.9% vs. 12.3%). In contrast,
there were no differences in the incidence of myocardial infarction (OR:
1.06: 95% CI: 0.91 to 1.25; p = 0.45; 8.4% vs. 7.9%), incidence of angina
(OR: 1.09; 95% CI: 0.75 to 1.57; p = 0.65; 2.3% vs. 2.1%), need for
revascularization (OR: 1.15; 95% CI: 0.95 to 1.40; p = 0.16; 5.9% vs.
5.1%), and the incidence of stroke (OR: 0.78; 95% CI: 0.56 to 1.10; p =
0.16; 2.2% vs. 2.8%). <br/>Conclusion(s): Statistically, on-pump CABG
appeared to offer superior long-term survival, although the clinical
significance of this may be more uncertain.<br/>Copyright &#xa9; 2018
American College of Cardiology Foundation

<93>
Accession Number
2000586564
Title
Compliance With Guideline-Directed Medical Therapy in Contemporary
Coronary Revascularization Trials.
Source
Journal of the American College of Cardiology. 71 (6) (pp 591-602), 2018.
Date of Publication: 13 February 2018.
Author
Pinho-Gomes A.-C.; Azevedo L.; Ahn J.-M.; Park S.-J.; Hamza T.H.; Farkouh
M.E.; Serruys P.W.; Milojevic M.; Kappetein A.P.; Stone G.W.; Lamy A.;
Fuster V.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences (MEDCIDS) & Centre for Health Technology and Services
Research (CINTESIS), Faculty of Medicine, Porto University, Porto,
Portugal
(Ahn, Park) Asan Medical Center, University of Ulsan College of Medicine,
Ulsan, South Korea
(Hamza) New England Research Institutes, Watertown, Massachusetts, United
States
(Farkouh) Peter Munk Cardiac Centre and Heart & Stroke/Richard Lewar
Centre, University of Toronto, Toronto, Ontario, Canada
(Serruys, Milojevic) Imperial College of London, London, United Kingdom
(Kappetein) Department of Thoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Stone) The New York Presbyterian Hospital, Columbia University Medical
Center, Cardiovascular Research Foundation, New York, New York, United
States
(Lamy) Department of Surgery, Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
(Fuster) Mount Sinai Cardiovascular Institute, New York, New York, United
States
(Fuster) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
Publisher
Elsevier USA
Abstract
Background: Despite the well-established benefits of secondary
cardiovascular prevention, the importance of concurrent medical therapy in
clinical trials of coronary revascularization is often overlooked.
<br/>Objective(s): The goal of this study was to assess compliance with
guideline-directed medical therapy (GDMT) in clinical trials and its
potential impact on the comparison between percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG).
<br/>Method(s): The Cochrane Central Register of Controlled Trials and
MEDLINE were searched from 2005 to August 2017. Clinical trial registries
and reference lists of relevant studies were also searched. Randomized
controlled trials comparing PCI with drug-eluting stents versus CABG and
reporting medical therapy after revascularization were included. The study
outcome was compliance with GDMT, defined as the following: 1) any
antiplatelet agent plus beta-blocker plus statin (GDMT1); and 2) any
antiplatelet agent plus beta-blocker plus statin plus
angiotensin-converting enzyme inhibitor/angiotensin receptor blocker
(GDMT2). Data collection and analysis were performed according to the
methodological recommendations of The Cochrane Collaboration.
<br/>Result(s): From a total of 439 references, 5 trials were included
based on our inclusion and exclusion criteria. Overall, compliance with
GDMT1 was low and decreased over time from 67% at 1 year to 53% at 5
years. Compliance with GDMT2 was even lower and decreased from 40% at 1
year to 38% at 5 years. Compliance with both GDMT1 and GDMT2 was higher in
PCI than in CABG at all time points. Meta-regression suggested an
association between lower use of GDMT1 and adverse clinical outcomes in
PCI versus CABG at 5 years. <br/>Conclusion(s): Compliance with GDMT in
contemporary clinical trials remains suboptimal and is significantly lower
after CABG than after PCI, which may influence the comparison of clinical
trial endpoints between those study groups.<br/>Copyright &#xa9; 2018
American College of Cardiology Foundation

<94>
Accession Number
2002151066
Title
Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary
Arterial Hypertension: A Systematic Review and Meta-Analysis.
Source
Chest. 156 (1) (pp 53-63), 2019. Date of Publication: July 2019.
Author
Khan M.S.; Memon M.M.; Amin E.; Yamani N.; Khan S.U.; Figueredo V.M.; Deo
S.; Rich J.D.; Benza R.L.; Krasuski R.A.
Institution
(Khan, Yamani) Department of Internal Medicine, John H. Stroger, Jr.
Hospital of Cook County, Chicago, IL, United States
(Memon, Amin) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Khan) West Virginia University, Morgantown, WV, United States
(Figueredo) St Mary Medical Center, Langhorne, PA, United States
(Deo) Division of Cardiovascular Surgery, University Hospitals, Cleveland,
OH, United States
(Rich) Department of Medicine, Division of Cardiology, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Benza) Cardiovascular Institute, Allegheny Health Network, Pittsburgh,
PA, United States
(Krasuski) Department of Cardiovascular Medicine, Duke University Health
System, Durham, NC, United States
Publisher
Elsevier Inc
Abstract
Background: Despite the use and purported benefits of balloon atrial
septostomy (BAS), its safety, efficacy, and therapeutic role in the
setting of advanced pulmonary arterial hypertension (PAH) are not well
defined. <br/>Objective(s): The goal of this study was to conduct a
systematic review and meta-analysis to better determine the evidence
supporting the use of BAS in PAH. <br/>Method(s): MEDLINE, Scopus,
Cochrane Library, and Clinicaltrials.gov were searched from inception
through May 2018 for original studies reporting outcomes with PAH prior to
and following BAS. Studies comparing BAS vs other septostomy procedures
were excluded. Weighted mean differences and 95% CIs were pooled by using
a random effects model. <br/>Result(s): Sixteen studies comprising 204
patients (mean age, 35.8 years; 73.1% women) were included. Meta-analysis
revealed significant reductions in right atrial pressure (-2.77 mm Hg [95%
CI, -3.50, -2.04]; P < .001) and increases in cardiac index (0.62
L/min/m² [95% CI, 0.48, 0.75]; P < .001) and left atrial
pressure (1.86 mm Hg [95% CI, 1.24, 2.49]; P < .001) following BAS, along
with a significant reduction in arterial oxygen saturation (-8.45% [95%
CI, -9.93, -6.97]; P < .001). The pooled incidence of procedure-related
(48 h), short-term (<= 30 day), and long-term (> 30 days up to a mean
follow-up of 46.5 months) mortality was 4.8% (95% CI, 1.7%, 9.0%), 14.6%
(95% CI, 8.6%, 21.5%), and 37.7% (95% CI, 27.9%, 47.9%), respectively.
<br/>Conclusion(s): The present analysis suggests that BAS is relatively
safe in advanced PAH, with beneficial hemodynamic effects. The relatively
high postprocedural and short-term survival with less impressive long-term
survival suggest a bridging role for BAS; its contribution to this change
needs to be verified by using a comparator group.<br/>Copyright &#xa9;
2019 American College of Chest Physicians

<95>
Accession Number
2001967251
Title
Efficacy and safety of alirocumab in japanese patients with diabetes
mellitus: Post-hoc subanalysis of ODYSSEY Japan.
Source
Journal of Atherosclerosis and Thrombosis. 26 (3) (pp 282-293), 2019. Date
of Publication: 2019.
Author
Teramoto T.; Usami M.; Takagi Y.; Baccara-Dinet M.T.
Institution
(Teramoto) Teikyo Academic Research Center, Teikyo University, Tokyo,
Japan
(Usami) Cardiovascular Medical, Sanofi, Tokyo, Japan
(Takagi) Clinical Sciences and Operations, Sanofi, Tokyo, Japan
(Baccara-Dinet) PCSK9 Development and Launch Unit, Sanofi, Montpellier,
France
Publisher
Japan Atherosclerosis Society
Abstract
Aim: To examine the efficacy and safety of alirocumab in Japanese patients
with dyslipidemia with or without diabetes mellitus (DM). <br/>Method(s):
Patients (n=216) with heterozygous familial hypercholesterolemia (heFH),
non-FH at high cardiovascular risk with coronary artery disease (CAD), or
category III (primary prevention) were enrolled; 148 (68.5%) patients had
a diagnosis of DM at baseline. Patients were randomized (2:1), with
stratification factor (heFH, non-FH), to alirocumab (75 mg every 2 weeks
[Q2W] with increase to 150 mg if week 8 LDL-C was above predefined limits)
or placebo subcutaneously for 52 weeks on top of stable statin therapy.
<br/>Result(s): At Week 24, least square (LS) mean+/-standard error
changes in low-density lipoprotein cholesterol (LDL-C) concentration from
baseline in alirocumab-treated patients were -63.1+/-1.6% and -60.8+/-2.7%
in those with and without DM. These LDL-C reductions were maintained to
Week 52: -63.0+/-1.6% (LS mean difference vs placebo -62.4+/-3.0%;
P0.0001) with DM and -61.3+/-2.8% (LS mean difference vs placebo -
53.4+/-4.0%; P0.0001) without DM. The most common adverse events in the
alirocumab group were naso-pharyngitis, back pain, injection site
reaction, and fall. No particular safety signals or concerns were noted
between DM and non-DM groups at 52 weeks. A dose-increase in alirocumab
from 75 to 150 mg Q2W was necessary in two heFH patients, neither of whom
had DM. <br/>Conclusion(s): In high-cardiovascular-risk Japanese patients
with hypercholesterolemia on stable statin therapy, alirocumab produced
substantial and sustained LDL-C reductions throughout the 52-week study
regardless of DM status at baseline, with a similar safety profile to
placebo.<br/>Copyright &#xa9; 2019 Japan Atherosclerosis Society.

<96>
Accession Number
625195663
Title
Is surgical Apgar score an effective assessment tool for the prediction of
postoperative complications in patients undergoing oesophagectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (5) (pp 686-691),
2018. Date of Publication: 01 Nov 2018.
Author
Li S.; Zhou K.; Li P.; Che G.
Institution
(Li, Zhou, Li, Che) Department of Thoracic Surgery, West China Hospital,
Sichuan University, Guoxue Alley No.37, Chengdu 610041, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether the surgical Apgar
score (SAS) was an effective assessment tool for the prediction of
postoperative complications in patients undergoing oesophagectomy. In
total, 7 papers were identified using the reported search, of which 6
cohort studies represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. Five of 6 cohort studies demonstrated that a low SAS was
significantly associated with more postoperative complications in patients
undergoing oesophagectomy. The rates of major individual complications in
patients with a lower SAS were commonly higher than those in patients with
a higher SAS. Two cohort studies further reported that a low SAS was
significantly associated with the prolonged length of stay. The cut-off
value of the SAS that had the discriminative power for patients who were
considered at high morbidity risk, however, was not defined but was more
likely to be 6 or less. Current available evidence suggests that the SAS
system may serve as an effective assessment tool for the prediction of
morbidity risk after oesophagectomy.<br/>Copyright &#xa9; The Author(s)
2018. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<97>
Accession Number
625195334
Title
Levosimendan versus placebo in cardiac surgery: A systematic review and
meta-Analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (5) (pp 677-685),
2018. Date of Publication: 01 Nov 2018.
Author
Tena M.; Urso S.; Gonzalez J.M.; Santana L.; Sadaba R.; Juarez P.;
Gonzalez L.; Portela F.
Institution
(Tena, Urso, Portela) Department of Cardiac Surgery, Hospital
Universitario Dr. Negrin, Barranco de la Ballena, s/n, Las Palmas de Gran
Canaria 35010, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Santana) Department of Anesthesiology, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
(Sadaba) Department of Cardiac Surgery, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Juarez, Gonzalez) Intensive Care Unit, Hospital Universitario Dr. Negrin,
Las Palmas de Gran Canaria, Spain
Publisher
Oxford University Press
Abstract
The aim of this meta-Analysis was to review all published randomized
clinical trials comparing levosimendan versus placebo in patients
undergoing cardiac surgery. PubMed, EMBASE and the Cochrane library
database of clinical trials were searched for prospective randomized
clinical trials investigating the perioperative use of levosimendan versus
placebo in patients undergoing adult cardiac surgery from 1 May 2000 to 10
April 2017. Binary outcomes from individual studies were analysed to
compute individual and pooled risk ratios (RRs) with pertinent 95%
confidence intervals (CIs). Fourteen randomized clinical trials with a
total of 2243 patients were included in this review. Overall meta-Analysis
results demonstrated that levosimendan was associated with a significant
reduction in 30-day mortality (RR = 0.71, 95% CI = 0.53-0.95; P = 0.023).
Subgroup analysis showed that this benefit was confined to the moderate
and low ejection fraction studies (RR = 0.44, 95% CI = 0.27-0.70; P <
0.001), whereas no benefit was observed in the preserved ejection fraction
studies (RR = 1.06, 95% CI = 0.72-1.56; P = 0.78). Levosimendan also
reduced the risk of renal replacement therapy (RR = 0.66, 95% CI =
0.47-0.92; P = 0.015) and low cardiac output (RR = 0.40, 95% CI =
0.22-0.73; P = 0.003). No significant differences were detected, between
the levosimendan group and the placebo group, in terms of risk of
myocardial injury (RR = 0.90, 95% CI = 0.69-1.17; P = 0.44), intensive
care unit stay (weighted mean differences =-0.57, 95% CI =-1.15 to 0.01; P
= 0.055) and the use of ventricular assist device (RR = 0.42, 95% CI =
0.07-2.63; P = 0.35). In conclusion, levosimendan was associated with a
reduced risk of mortality, renal replacement therapy and low cardiac
output syndrome in patients undergoing cardiac surgery.<br/>Copyright
&#xa9; The Author(s) 2018. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<98>
Accession Number
2000720041
Title
Additional Physical Therapy Services Reduce Length of Stay and Improve
Health Outcomes in People With Acute and Subacute Conditions: An Updated
Systematic Review and Meta-Analysis.
Source
Archives of Physical Medicine and Rehabilitation. 99 (11) (pp 2299-2312),
2018. Date of Publication: November 2018.
Author
Peiris C.L.; Shields N.; Brusco N.K.; Watts J.J.; Taylor N.F.
Institution
(Peiris, Shields, Brusco, Taylor) La Trobe University, College of Science,
Health and Engineering, Department of Rehabilitation, Nutrition and Sport,
School of Allied Health(Physiotherapy), Melbourne, Australia
(Shields) Northern Health, Northern Centre for Health Education and
Research, Epping, United Kingdom
(Brusco) Cabrini Health, Physiotherapy, Malvern, United Kingdom
(Watts) Deakin University, School of Health and Social Development,
Faculty of Health, Burwood, Australia
(Taylor) Eastern Health, Eastern Health Clinical Research Office, Box
Hill, Australia
Publisher
W.B. Saunders
Abstract
Objective: To update a previous review on whether additional physical
therapy services reduce length of stay, improve health outcomes, and are
safe and cost-effective for patients with acute or subacute conditions.
<br/>Data Sources: Electronic database (AMED, CINAHL, EMBASE, MEDLINE,
Physiotherapy Evidence Database [PEDro], PubMed) searches were updated
from 2010 through June 2017. Study Selection: Randomized controlled trials
evaluating additional physical therapy services on patient health
outcomes, length of stay, or cost-effectiveness were eligible. Searching
identified 1524 potentially relevant articles, of which 11 new articles
from 8 new randomized controlled trials with 1563 participants were
selected. In total, 24 randomized controlled trials with 3262 participants
are included in this review. <br/>Data Extraction: Data were extracted
using the form used in the original systematic review. Methodological
quality was assessed using the PEDro scale, and the Grading of
Recommendation Assessment, Development, and Evaluation approach was
applied to each meta-analysis. Data synthesis: Postintervention data were
pooled with an inverse variance, random-effects model to calculate
standardized mean differences (SMDs) and 95% confidence intervals (CIs).
There is moderate-quality evidence that additional physical therapy
services reduced length of stay by 3 days in subacute settings (mean
difference [MD]=-2.8; 95% CI, -4.6 to -0.9; I²=0%), and
low-quality evidence that it reduced length of stay by 0.6 days in acute
settings (MD=-0.6; 95% CI, -1.1 to 0.0; I²=65%). Additional
physical therapy led to small improvements in self-care (SMD=.11; 95%
CI,.03-.19; I²=0%), activities of daily living (SMD=.13; 95%
CI,.02-.25; I²=15%), and health-related quality of life
(SMD=.12; 95% CI,.03-.21; I²=0%), with no increases in adverse
events. There was no significant change in walking ability. One trial
reported that additional physical therapy was likely to be cost-effective
in subacute rehabilitation. <br/>Conclusion(s): Additional physical
therapy services improve patient activity and participation outcomes while
reducing hospital length of stay for adults. These benefits are likely
safe, and there is preliminary evidence to suggest they may be
cost-effective.<br/>Copyright &#xa9; 2018 American Congress of
Rehabilitation Medicine

<99>
Accession Number
2002239196
Title
Reducing red blood cell transfusion in orthopedic and cardiac surgeries
with Antifibrinolytics: A laboratory medicine best practice systematic
review and meta-analysis.
Source
Clinical Biochemistry. (no pagination), 2019. Date of Publication: 2019.
Author
Derzon J.H.; Clarke N.; Alford A.; Gross I.; Shander A.; Thurer R.
Institution
(Derzon) RTI International, Research Triangle Park, NC, United States
(Clarke) Pharmerit International, Bethesda, MD, United States
(Alford) National Network of Public Health Institutes, Washington, DC,
United States
(Gross) Acumen Inc., San Diego, CA, United States
(Shander) Englewood Hospital and Medical Center, NJ, United States
(Thurer) Gauss Surgical, Los Altos, CA, United States
(Clarke) Vector Oncology, Memphis, TN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: To evaluate the effectiveness of antifibrinolytics tranexamic
acid (TA), epsilon-aminocaproic acid (EACA), and aprotinin to decrease
overuse of red blood cell transfusions in adult surgical and non-surgical
patients. <br/>Method(s): This review followed the Centers for Disease
Control and Prevention (CDC) Laboratory Medicine Best Practice (LMBPTM)
Systematic Review (A-6) method. Eligible studies were assessed for
evidence of effectiveness of TA or EACA in reducing the number of patients
transfused or the number of whole blood transfusions. <br/>Result(s):
Seventy-two articles met LMBPTM inclusion criteria. Fifty-six studies
assessed Topical, Intra-articular Injection, or Intravenous TA, 4 studied
EACA, and 12 studied the effectiveness of aprotinin. The overall strength
of the body of evidence of effectiveness for each of these practices was
rated as high. <br/>Conclusion(s): LMBPTM recommends the use of topical,
intra-articular injection, or intravenous tranexamic acid and the use of
epsilon-aminocaproic acid for reducing overuse of red blood cell
transfusion.<br/>Copyright &#xa9; 2019 The Canadian Society of Clinical
Chemists

<100>
Accession Number
628069517
Title
Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after
Transcatheter Aortic Valve Replacement: a Systematic Review and
Meta-analysis.
Source
Scientific reports. 7 (1) (pp 15014), 2017. Date of Publication: 08 Nov
2017.
Author
Liao Y.-B.; Li Y.-J.; Jun-Li L.; Zhao Z.-G.; Wei X.; Tsauo J.-Y.; Xiong
T.-Y.; Xu Y.-N.; Feng Y.; Chen M.
Institution
(Liao, Li, Jun-Li, Zhao, Wei, Tsauo, Xiong, Xu, Chen) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu 610041, China
(Feng) Department of Cardiology, West China Hospital, Sichuan University,
37 Guoxue Street, Chengdu 610041, China
Publisher
NLM (Medline)
Abstract
The aim of this study was to investigate the incidence, predictors and
outcome of prosthesis-patient mismatch (PPM) following transcatheter
aortic valve replacement (TAVR). A total of 30 articles incorporating
4,691 patients were identified. The pooled incidences of overall, moderate
and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively.
Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%,
P<0.0001) and moderate (23% vs 32%, P<0.0001) than Edwards Sapien (ESV).
PPM was associated with a younger age, smaller annulus diameter and lower
left ventricular ejection fraction in comparison with those patients
without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p<0.001)
during TAVR would decrease the incidence of PPM. Although PPM was common
after TAVR, no significant differences were observed both in short- and
mid-term all-cause mortality (30day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2
year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those
without PPM. In conclusion, despite being common after TAVR, the incidence
of PPM was lower than that of surgical aortic valve replacement (SAVR) and
decreased with the experience accumulating, and PPM was not seen to impact
on short- and mid-term survival, regardless of its magnitude.

<101>
Accession Number
628534297
Title
Different dose regimes and administration methods of tranexamic acid in
cardiac surgery: A meta-analysis of randomized trials.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 129.
Date of Publication: 15 Jul 2019.
Author
Guo J.; Gao X.; Ma Y.; Lv H.; Hu W.; Zhang S.; Ji H.; Wang G.; Shi J.
Institution
(Guo, Lv, Ji, Wang, Shi) Department of Anesthesiology, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, No.167 Beilishi Road, Xicheng
district Beijing, China
(Gao) Department of Blood Transfusion, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, No.167 Beilishi Road, Xicheng district Beijing, China
(Ma) Operating Room, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, Peking Union Medical
College, No.167 Beilishi Road, Xicheng district Beijing, China
(Hu) Department of Anesthesiology, 305th Hospital of the Chinese People's
Liberation Army, No.13 Wenjin Road, Xicheng district Beijing, China
(Zhang) Department of Anesthesiology, Wu'An First People's Hospital,
Kuangjian Road, Handan Hebei Province, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The efficacy of tranexamic acid (TXA) to reduce perioperative
blood loss and allogeneic blood transfusion in cardiac surgeries has been
proved in previous studies, but its adverse effects especially seizure has
always been a problem of concern. This meta-analysis aims to provide
information on the optimal dosage and delivery method which is effective
with the least adverse outcomes. <br/>Method(s): We searched Cochrane
Central Register of Controlled Trials, MEDLINE and EMBASE for all relevant
articles published before 2018/12/31. Inclusion criteria were adult
patients undergoing elective heart surgeries, and only randomized control
trials comparing TXA with placebo were considered. Two authors
independently assessed trial quality and extracted relevant data.
<br/>Result(s): We included 49 studies with 10,591 patients into analysis.
TXA significantly reduced transfusion rate (RR 0.71, 95% CI 0.65 to 0.78,
P<0.00001). The overall transfusion rate was 35%(1573/4477) for patients
using TXA and 49%(2190/4408) for patients in the control group.
Peri-operative blood loss (MD - 246.98 ml, 95% CI - 287.89 to - 206.06 ml,
P<0.00001) and re-operation rate (RR 0.62, 95% CI 0.49 to 0.79, P<0.0001)
were also reduced significantly. TXA usage did not increase risk of
mortality, myocardial infarction, stroke, pulmonary embolism and renal
dysfunction, but was associated with a significantly increase in seizure
attack (RR 3.21, 95% CI 1.04 to 9.90, P = 0.04).The overall rate of
seizure attack was 0.62%(21/3378) for patients using TXA and 0.15%(5/3406)
for patients in the control group. In subgroup analysis, TXA was effective
for both on-pump and off-pump surgeries. Topical application didn't reduce
the need for transfusion requirement, while intravenous delivery no matter
as bolus injection alone or bolus plus continuous infusion were effective.
Intravenous high-dose TXA didn't further decrease transfusion rate
compared with low-dose regimen, and increased the risk of seizure by 4.83
times. No patients in the low-dose group had seizure attack.
<br/>Conclusion(s): TXA was effective in reducing transfusion requirement
in all kinds of cardiac surgeries. Low-dose intravenous infusion was the
most preferable delivery method which was as effective as high-dose
regimen in reducing transfusion rate without increasing the risk of
seizure.<br/>Copyright &#xa9; 2019 The Author(s).

<102>
Accession Number
628648898
Title
The Use of Mannitol in Cardiopulmonary Bypass Prime Solution - Prospective
Randomized Double-blind Clinical Trial.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2019. Date of
Publication: 09 Jul 2019.
Author
Ljunggren M.; Skold A.; Dardashti A.; Hyllen S.
Institution
(Ljunggren, Skold, Dardashti, Hyllen) Department of Cardiothoracic
Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund,
Sweden
(Dardashti, Hyllen) Lund University, Department of Clinical Sciences,
Cardiothoracic Surgery, Lund, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal prime solution for the cardiopulmonary bypass
(CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol
is widely used in the priming solution for CPB despite the fact that there
is no clear consensus on the role of mannitol in cardiac surgery. The aim
of this study was to investigate the effect of mannitol in the CPB prime
solution. <br/>METHOD(S): This prospective, randomized, double-blind study
included forty patients with normal cardiac and renal functions, who
underwent coronary artery bypass grafting. One group received a prime
based on Ringer's acetate (n=20), and the other a prime consisting of
Ringer's acetate with 200 mL mannitol (n=20). Changes in osmolality,
acid-base status, electrolytes and renal- related parameters were
monitored. <br/>RESULT(S): No significant differences were found in
osmolality between the Ringer's acetate group and the mannitol group at
any time. The mannitol group showed a pronounced decrease in sodium, from
138.7+/-2.8 mmol/L at anesthesia onset, to 133.9+/-2.6 mmol/L after the
start of CPB (p <0.001). No differences were seen in the renal parameters
between the groups, apart from a short-term effect of mannitol on
peroperative urine production (p = 0.003). <br/>CONCLUSION(S): We observed
no effects on osmolality of a prime solution containing mannitol compared
to Ringer's acetate based prime in patients with normal cardiac and renal
function. The use of mannitol in the prime resulted in a short-term,
significant decrease in sodium level. This article is protected by
copyright. All rights reserved.