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<1>
Accession Number
2002219471
Title
Inferior Caval Valve Implantation Versus Optimal Medical Therapy for
Severe Tricuspid Regurgitation.
Source
Journal of the American College of Cardiology. 74 (3) (pp 473-475), 2019.
Date of Publication: 23 July 2019.
Author
Laule M.; Mattig I.; Schobel C.; Knebel F.; Lauten A.; Lembcke A.; Thoenes
M.; Grubitzsch H.; Stangl K.; Dreger H.
Publisher
Elsevier USA

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

<3>
Accession Number
623779001
Title
Intraoperative ketamine administration to prevent delirium or
postoperative cognitive dysfunction: A systematic review and
meta-analysis.
Source
Acta Anaesthesiologica Scandinavica. 62 (9) (pp 1182-1193), 2018. Date of
Publication: October 2018.
Author
Hovaguimian F.; Tschopp C.; Beck-Schimmer B.; Puhan M.
Institution
(Hovaguimian, Tschopp, Beck-Schimmer) Institute of Anaesthesiology,
University of Zurich and University Hospital of Zurich, Zurich,
Switzerland
(Puhan) Epidemiology, Biostatistics and Prevention Institute, University
of Zurich, Zurich, Switzerland
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Postoperative cognitive complications are associated with
substantial morbidity and mortality. Ketamine has been suggested to have
neuroprotective effects in various settings. This systematic review
evaluates the effects of intraoperative ketamine administration on
postoperative delirium and postoperative cognitive dysfunction (POCD).
 Method(s): Medline, Embase and Central were searched to 4 March 2018
without date or language restrictions. We considered randomised controlled
trials (RCTs) comparing intraoperative ketamine administration versus no
intervention in adults undergoing surgery under general anaesthesia.
Primary outcomes were postoperative delirium and POCD. Non-cognitive
adverse events, mortality and length of stay were considered as secondary
outcomes. Data were independently extracted. The quality of the evidence
(GRADE approach) was assessed following recommendations from the Cochrane
collaboration. Risk ratios were calculated for binary outcomes, mean
differences for continuous outcomes. We planned to explore the effects of
age, specific anaesthesia regimen, depth of anaesthesia and intraoperative
haemodynamic events through subgroup analyses. Result(s): Six RCTs
were included. The incidence of postoperative delirium did not differ
between groups (4 trials, 557 patients, RR 0.83, 95% CI [0.25, 2.80]), but
patients receiving ketamine seemed at lower risk of POCD (3 trials, 163
patients, RR 0.34, 95% CI [0.15, 0.73]). However, both analyses presented
limitations. Therefore, the quality of the evidence (GRADE) was deemed low
(postoperative delirium) and very low (POCD). Conclusion(s): The
effect of ketamine on postoperative delirium remains unclear but its
administration may offer some protection towards POCD. Large,
well-designed randomised trials are urgently needed to further clarify the
efficacy of ketamine on neurocognitive outcomes. Copyright © 2018
The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd

<4>
Accession Number
628779598
Title
A systematic review of standardized methods for assessment of endograft
sealing on computed tomography angiography post-endovascular aortic
repair, and its influence on endograft-associated complications.
Source
Expert Review of Medical Devices. 16 (8) (pp 683-695), 2019. Date of
Publication: 03 Aug 2019.
Author
Schuurmann R.C.L.; De Rooy P.M.; Bastos Goncalves F.; Vos C.G.; De Vries
J.-P.P.M.
Institution
(Schuurmann, De Rooy, De Vries) Department of Surgery, Division of
Vascular Surgery, University Medical Centre Groningen, Groningen,
Netherlands
(Bastos Goncalves) Department of Vascular Surgery, Hospital de Santa
Marta, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal
(Vos) Department of Vascular Surgery, Martini Hospital Groningen,
Groningen, Netherlands
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Although there is much attention for proper sizing of
pre-operative anatomy before (thoracic) endovascular aneurysm repair
([T]EVAR), standardized assessment of endograft position and apposition at
postoperative imaging is seldom addressed in the international guidelines.
The highly detailed three-dimensional computed tomography angiography
(CTA) volumes contain valuable information about the apposition of the
endograft with the arterial wall and the position of the device relative
to anatomical landmarks in the proximal and distal landing zones, which is
currently hardly used. With proper assessment on CTA of the endograft
after EVAR, the risk for future endograft-related complications may be
determined, allowing patient-tailored, risk-stratified surveillance. Areas
covered: This systematic review identified three standardized methods for
assessing apposition or position of the endograft in the proximal or
distal landing zone on CTA after (T)EVAR. Quantification of apposition and
position, validation of measurement precision, and association with
endograft-related complications were extracted. Short (<10 mm apposition
length) and decreasing (>0 mm) apposition were associated with
endograft-associated complications. Expert commentary: Standardized
assessment of apposition and position of the endograft in the proximal and
distal landing zones on CTA should be incorporated in post-(T)EVAR
surveillance. A risk-stratified CTA surveillance protocol is
proposed. Copyright © 2019, © 2019 The Author(s). Published
by Informa UK Limited, trading as Taylor & Francis Group.

<5>
Accession Number
628775222
Title
Hemodynamics and reverse remodeling associated with Mosaic, Perimount and
Trifecta aortic bioprostheses.
Source
Expert Review of Medical Devices. 16 (8) (pp 743-751), 2019. Date of
Publication: 03 Aug 2019.
Author
Kalogerakos P.D.; Kontopodis N.; Ioannou C.V.; Kladou E.; Chalkiadakis G.;
Athanasiou T.; Lazopoulos G.
Institution
(Kalogerakos, Chalkiadakis, Lazopoulos) Cardiothoracic Surgery Division,
University Hospital of Heraklion, Crete, Greece
(Kontopodis, Ioannou) Vascular Surgery Division, University Hospital of
Heraklion, Crete, Greece
(Kladou) Internal Medicine Department, University Hospital of Heraklion,
Crete, Greece
(Athanasiou) Faculty of Medicine, Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
Publisher
Taylor and Francis Ltd
Abstract
Introduction: The implantation rate of aortic bioprostheses is increasing.
Their durability has improved to some extent over the years and they allow
for future transcatheter valve-in-valve deployment. In the lack of long
term follow up, their hemodynamic profile, i.e. transvalvular mean
pressure gradient and effective orifice area indexed, and the associated
left ventricular reverse remodeling indexed are useful surrogates for
clinical outcomes. Areas covered: A systematic review of the literature
was conducted by searching Medline, Cochrane, Scielo, Embase databases,
and grey literature until July 2018 for articles that perform comparisons
among the three most popular aortic bioprostheses. Six randomized and 12
non-randomized studies were included with 565 patients receiving a Mosaic,
1334 a Perimount and 557 a Trifecta valve. These articles are
heterogeneous but they allow the meta-analytic comparison of the
abovementioned outcomes. Expert opinion: Compared to the Perimount valve,
the Mosaic is hemodynamically inferior, while the Trifecta is superior.
Despite these statistically significant differences, the left ventricular
mass regression indexed, that is indicative of reverse remodeling, was
comparable in all groups. All patients were similarly benefited. The
predilection among these valves is fueled by their hemodynamic profile but
not supported by the comparable reverse remodeling. Copyright ©
2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

<6>
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)

<7>
Accession Number
624586004
Title
Effect of intraoperative dexmedetomidine on renal function after
cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A
randomized, placebo-controlled trial.
Source
International Journal of Hyperthermia. 36 (1) (pp 1-8), 2019. Date of
Publication: 01 Jan 2019.
Author
Song Y.; Kim D.-H.; Kwon T.D.; Han D.W.; Baik S.H.; Jung H.H.; Kim J.Y.
Institution
(Song, Kim, Kwon, Han, Jung, Kim) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Kim, Kwon, Han, Kim) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Baik) Department of Surgery, Yonsei University College of Medicine,
Seoul, South Korea
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal
chemotherapy (HIPEC) predispose to postoperative renal dysfunction.
Dexmedetomidine is an alpha<inf>2</inf> adrenoreceptor agonist, which has
renoprotective effects after cardiac surgery. Objective(s): To assess
the effect of dexmedetomidine on renal function after CRS and HIPEC.
Materials: Thirty-eight patients undergoing CRS and HIPEC were randomized
to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1
mug/kg over 20 min followed by infusion at 0.5 mug/kg/ h) or 0.9% sodium
chloride (control group, n = 19) during surgery. Creatinine clearance
(CrCl) was assessed daily until postoperative day 7. Urine neutrophil
gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1
were measured for 24 h after surgery. Result(s): There was no
difference in the lowest CrCl value during the first 7 days
postoperatively, but the % change from baseline to the lowest value was
lower in the dexmedetomidine group than in the control group (p =.037).
Urine NGAL and KIM-1 levels were increased over time in both groups, but
the increases were significantly less in the dexmedetomidine group (p
=.018 and 0.038, respect-ively). In the dexmedetomidine group, the length
of intensive care unit stay was shorter (p =.034). Conclusion(s):
Intraoperative dexmedetomidine infusion did not improve renal function in
terms of serum Cr-related indices following CRS and HIPEC. However, as the
decrease in CrCl was attenuated and early tubular-injury markers were
lower in the dexmedetomidine group, dexmedetomidine may have protective
effects against early tubular injury in CRS and HIPEC. Clinical Trials
Registry: http://clinicaltrials.gov (NCT02641938). Copyright ©
2018 The Author(s). Published by Informa UK Limited, trading as Taylor &
Francis Group.

<8>
Accession Number
2002220819
Title
Effect of pedometer-based walking interventions on long-term health
outcomes: Prospective 4-year follow-up of two randomised controlled trials
using routine primary care data.
Source
PLoS Medicine. 16 (6) (no pagination), 2019. Article Number: e1002836.
Date of Publication: June 2019.
Author
Harris T.; Limb E.S.; Hosking F.; Carey I.; Dewilde S.; Furness C.;
Wahlich C.; Ahmad S.; Kerry S.; Whincup P.; Victor C.; Ussher M.; Iliffe
S.; Ekelund U.; Fox-Rushby J.; Ibison J.; Cook D.G.
Institution
(Harris, Limb, Hosking, Carey, Dewilde, Furness, Wahlich, Ahmad, Whincup,
Ussher, Cook) Population Health Research Institute, St George's University
of London, Tooting, London, United Kingdom
(Kerry) Pragmatic Clinical Trials Unit, Queen Mary's University of London,
London, United Kingdom
(Victor) Gerontology and Health Services Research Unit, Brunel University,
London, United Kingdom
(Ussher) Institute for Social Marketing and Public Health, University of
Stirling, Stirling, United Kingdom
(Iliffe) Research Department of Primary Care and Population Health,
University College London, London, United Kingdom
(Ekelund) Department of Sport Medicine, Norwegian School of Sport
Sciences, Oslo, Norway
(Fox-Rushby) Department of Population Science, King's College London,
London, United Kingdom
(Ibison) Institute of Medical and Biomedical Education, St George's
University of London, Tooting, London, United Kingdom
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Data are lacking from physical activity (PA) trials with
long-term follow-up of both objectively measured PA levels and robust
health outcomes. Two primary care 12-week pedometer-based walking
interventions in adults and older adults (PACE-UP and PACE-Lift) found
sustained objectively measured PA increases at 3 and 4 years,
respectively. We aimed to evaluate trial intervention effects on long-term
health outcomes relevant to walking interventions, using routine primary
care data. Methods and findings Randomisation was from October 2012 to
November 2013 for PACE-UP participants from seven general (family)
practices and October 2011 to October 2012 for PACE-Lift participants from
three practices. We downloaded primary care data, masked to intervention
or control status, for 1,001 PACE-UP participants aged 45-75 years, 36%
(361) male, and 296 PACE-Lift participants, aged 60-75 years, 46% (138)
male, who gave written informed consent, for 4-year periods following
randomisation. The following new events were counted for all participants,
including those with preexisting diseases (apart from diabetes, for which
existing cases were excluded): nonfatal cardiovascular, total
cardiovascular (including fatal), incident diabetes, depression,
fractures, and falls. Intervention effects on time to first event
post-randomisation were modelled using Cox regression for all outcomes,
except for falls, which used negative binomial regression to allow for
multiple events, adjusting for age, sex, and study. Absolute risk
reductions (ARRs) and numbers needed to treat (NNTs) were estimated. Data
were downloaded for 1,297 (98%) of 1,321 trial participants. Event rates
were low (<20 per group) for outcomes, apart from fractures and falls. Cox
hazard ratios for time to first event post-randomisation for interventions
versus controls were nonfatal cardiovascular 0.24 (95% confidence interval
[CI] 0.07-0.77, p = 0.02), total cardiovascular 0.34 (95% CI 0.12-0.91, p
= 0.03), diabetes 0.75 (95% CI 0.42-1.36, p = 0.34), depression 0.98 (95%
CI 0.46-2.07, p = 0.96), and fractures 0.56 (95% CI 0.35-0.90, p = 0.02).
Negative binomial incident rate ratio for falls was 1.07 (95% CI
0.78-1.46, p = 0.67). ARR and NNT for cardiovascular events were nonfatal
1.7% (95% CI 0.5%-2.1%), NNT = 59 (95% CI 48- 194); total 1.6% (95% CI
0.2%-2.2%), NNT = 61 (95% CI 46-472); and for fractures 3.6% (95% CI
0.8%-5.4%), NNT = 28 (95% CI 19-125). Main limitations were that event
rates were low and only events recorded in primary care records were
counted; however, any underrecording would not have differed by
intervention status and so should not have led to bias. Conclusions
Routine primary care data used to assess long-term trial outcomes
demonstrated significantly fewer new cardiovascular events and fractures
in intervention participants at 4 years. No statistically significant
differences between intervention and control groups were demonstrated for
other events. Short-term primary care pedometer-based walking
interventions can produce long-term health benefits and should be more
widely used to help address the public health inactivity
challenge. Copyright © 2019 Harris et al.

<9>
Accession Number
628685968
Title
Short-term water-and land-based exercise training comparably improve
exercise capacity and vascular function in patients after a recent
coronary event: A pilot randomized controlled trial.
Source
Frontiers in Physiology. 10 (JUL) (no pagination), 2019. Article Number:
00903. Date of Publication: 2019.
Author
Vasic D.; Novakovic M.; Mijovski M.B.; Zagar B.B.; Jug B.
Institution
(Vasic, Jug) Faculty of Medicine, University of Ljubljana, Ljubljana,
Slovenia
(Vasic) Terme Krka, Smarjeske Toplice, Slovenia
(Novakovic, Jug) Department of Vascular Diseases, University Medical
Center, Ljubljana, Slovenia
(Mijovski) Laboratory for Haemostasis and Atherothrombosis, Department of
Vascular Diseases, University Medical Center, Ljubljana, Slovenia
(Zagar) KRKA, D.d., Novo Mesto, Slovenia
Publisher
Frontiers Media S.A. (E-mail: info@frontiersin.org)
Abstract
Background: We hypothesized that a 2-week twice daily aquatic endurance
plus calisthenics exercise training program: (i) increases aerobic
exercise capacity (peak oxygen uptake/V?O<inf>2</inf>peak), (ii) improves
endothelium-dependent flow-mediated vasodilation (FMD), and (iii) reduces
circulating markers of low-grade inflammation and hemostasis, as compared
to land-based endurance plus calisthenics exercise training or no exercise
in patients undergoing short-term residential cardiac rehabilitation after
a recent coronary artery disease (CAD) event. Method(s): Patients
with a recent myocardial infarction or revascularization procedure were
randomized into two interventional groups and a control group. The
interventional groups underwent supervised aerobic endurance plus
calisthenics exercise training either in thermo-neutral water or on land
at moderate intensity (60-80% of the peak heart rate achieved during
symptom-limited graded exercise testing) for 30 min twice daily for 2
weeks (i.e., 24 sessions). The control group was deferred from supervised
exercise training for the 2-week duration of the intervention, but was
advised low-to-moderate intensity physical activity at home while waiting.
At baseline and after the intervention period, all participants underwent
estimation of aerobic exercise capacity, brachial artery flow-mediated
dilatation (FMD, measured ultrasonographically at rest and during reactive
hyperemia after 4.5 min of forearm cuff inflation), markers of cardiac
dysfunction (NT-proBNP), inflammation (hsCRP, IL-6, IL-8,
IL-10), cell adhesion (ICAM, P-selectin), and hemostasis
(fibrinogen, D-dimer). Result(s): A total of 89 patients (mean age
59.9 +/- 8.2 years, 77.5% males, V.O<inf>2</inf>peak at baseline 14.8 +/-
3.5 ml kg-1 min-1) completed the study. Both
exercise modalities were safe (no significant adverse events recorded) and
associated with a significant improvement in V.O<inf>2</inf>peak as
compared to controls: age and baseline V.O<inf>2</inf>peak-adjusted
end-of-study V.O<inf>2</inf>peak increased to 16.7 (95% CI
16.0-17.4) ml kg-1 min-1 with land-based
training (p < 0.001 for change from baseline) and to 18.6 (95% CI
17.9-19.3) ml kg-1 min-1 with water-based
training (p < 0.001 for change from baseline), but not in controls (14.9
ml kg -1 min-1; 95% CI
14.2-15.6; p = 0.775 for change from baseline). FMD also
increased in both intervention groups (from 5.5 to 8.8%, p < 0.001 with
land-based, and from 7.2 to 9.2%, p < 0.001 with water-based training,
respectively), as compared to controls (p for change 0.629). No
significant changes were detected in biomarkers of inflammation, cell
adhesion or hemostasis, whereas levels of NT-proBNP (marker of cardiac
dysfunction) decreased in the water-based training group (p = 0.07 vs.
controls). Conclusion(s): Endurance plus calisthenics exercise
training in thermo-neutral water is safe, and improves aerobic exercise
capacity and vascular function in patients undergoing short-term
residential cardiac rehabilitation after a recent CAD event. Copyright
© 2007 - 2019 Frontiers Media S.A. All Rights Reserved.

<10>
Accession Number
626156786
Title
Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the
Critically Ill.
Source
Dysphagia. 34 (4) (pp 475-486), 2019. Date of Publication: 15 Aug 2019.
Author
Perren A.; Zurcher P.; Schefold J.C.
Institution
(Perren) Department of Physiotherapy, Inselspital, University Hospital of
Bern, Bern, Switzerland
(Zurcher, Schefold) Department of Intensive Care Medicine, Inselspital,
University Hospital of Bern, University of Bern, Freiburgstrasse 18, Bern
3010, Switzerland
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Swallowing disorders and respective consequences (including
aspiration-induced pneumonia) are often observed in extubated ICU patients
with data indicating that a large number of patients are affected. We
recently demonstrated in a large-scale analysis that the incidence of
post-extubation dysphagia (PED) is 12.4% in a general ICU population and
about 18% in emergency admissions to the ICU. Importantly, PED was mostly
sustained until hospital discharge and independently predicted 28- and
90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular
ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous
breathing, and gastrointestinal reflux, are all considered to contribute
to PED, little is known about the underlying pathomechanisms and risk
factors leading to PED in critically ill patients. Systematic screening of
all potential ICU patients for oropharyngeal dysphagia (OD) seems key for
early recognition and follow-up, as well as the design and testing of
novel therapeutic interventions. Today, screening methods and clinical
investigations for dysphagia differ considerably. In the context of a
recently proposed pragmatic screening algorithm introduced by us, we
provide a concise review on currently available non-instrumental
techniques that could potentially serve for non-instrumental OD assessment
in critically ill patients. Following systematic literature review, we
find that non-instrumental OD assessments were mostly tested in different
patient populations with only a minority of studies performed in
critically ill patients. Due to little available data on non-instrumental
dysphagia assessment in the ICU, future investigations should aim to
validate respective approaches in the critically ill against an
instrumental (gold) standard, for example, flexible endoscopic evaluation
of swallowing. An international expert panel is encouraged to addresses
critical illness-related definitions, screening and confirmatory
assessment approaches, treatment recommendations, and identifies optimal
patient-centered outcome measures for future clinical
investigations. Copyright © 2019, Springer Science+Business
Media, LLC, part of Springer Nature.

<11>
Accession Number
627340221
Title
Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Diabetic
Patients With Multivessel and/or Left Main Coronary Artery Disease: A
Meta-Analysis.
Source
Angiology. 70 (8) (pp 765-773), 2019. Date of Publication: 01 Sep 2019.
Author
Cui K.; Lyu S.; Song X.; Liu H.; Yuan F.; Xu F.; Wang W.; Zhang M.; Zhang
D.; Tian J.
Institution
(Cui, Lyu, Song, Liu, Yuan, Xu, Zhang, Wang, Zhang, Zhang, Tian)
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart, Lung and Blood Vessel Diseases,
Beijing, China
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
With the development of stent design and surgical techniques, the relative
benefit of percutaneous coronary intervention (PCI) versus coronary artery
bypass grafting (CABG) in patients with diabetes and complex coronary
artery disease are highly debated. This meta-analysis was conducted to
compare the outcomes of drug-eluting stent (DES) implantation and CABG in
these cohorts. A comprehensive search of PubMed, Embase, and Cochrane
Library up to January 4, 2018, was performed. Only randomized controlled
trials (RCTs), subgroup analysis from RCTs, or adjusted observational
studies were eligible. Five RCTs and 13 adjusted observational studies
involving 17 532 patients were included. Overall, PCI with DES was
significantly associated with higher risk of all-cause mortality (hazard
ratio [HR]: 1.16, 95% confidence interval [CI]: 1.05-1.29), myocardial
infarction (MI; HR: 1.69, 95% CI: 1.43-2.00), and repeat revascularization
(HR: 3.77, 95% CI: 2.76-5.16) compared with CABG. Nevertheless, the risk
of stroke was significantly lower in the DES group (HR: 0.67, 95% CI:
0.54-0.83). The incidence of the composite end point of death, MI, or
stroke was comparable between the 2 groups (HR: 0.99, 95% CI: 0.84-1.17).
Despite the higher risk of stroke, CABG was better than PCI with DES for
diabetic patients with multivessel and/or left main coronary artery
disease. Copyright © The Author(s) 2019.

<12>
Accession Number
2002296598
Title
Perioperative clinical utility of myocardial deformation imaging: a
narrative review.
Source
British Journal of Anaesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Abuelkasem E.; Wang D.W.; Omer M.A.; Abdelmoneim S.S.; Howard-Quijano K.;
Rakesh H.; Subramaniam K.
Institution
(Abuelkasem, Wang, Howard-Quijano, Rakesh, Subramaniam) Department of
Anesthesiology and Perioperative Medicine, University of Pittsburgh School
of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Omer) Department of Cardiology, Saint-Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Abdelmoneim) Cardiovascular Ultrasound Imaging and Hemodynamic
Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, 200 First
Street SW, Rochester, MN, United States
(Abdelmoneim) Cardiology Department, Orman Heart Center Assiut University,
Assiut, Egypt
Publisher
Elsevier Ltd
Abstract
Preoperative cardiac function is an important predictor of postoperative
outcomes. Patients with heart failure are at higher risk of perioperative
morbidity and mortality. Left ventricular ejection fraction (LVEF),
derived by standard echocardiography, is most frequently used to assess
cardiac function in the intraoperative and postoperative periods.
Myocardial strain analysis, a measurement of myocardial deformation, can
provide additional information to LVEF estimation. Here, we provide an
overview of myocardial strain and different methods used to evaluate
strain, including speckle tracking echocardiography. Speckle tracking
echocardiography is an imaging modality that can analyse and track small
segments of the myocardium, which provides greater detail for assessing
global and regional cardiac motion and function. We further review the
literature to illustrate the value of speckle tracking
echocardiography-derived myocardial strain in describing cardiac function
and its association with adverse surgical outcomes in the perioperative
period, including low cardiac output states, need for inotropic support,
postoperative arrhythmias, subclinical myocardial ischaemia, and length of
hospital stay. Copyright © 2019 British Journal of Anaesthesia

<13>
Accession Number
2002482077
Title
Peritoneal Dialysis Vs Diuretics in Children After Congenital Heart
Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Flores S.; Loomba R.S.; Elhoff J.J.; Bronicki R.A.; Mery C.M.; Alsaied T.;
Alahdab F.
Institution
(Flores, Elhoff, Bronicki) Section of Critical Care Medicine and
Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX, United States
(Loomba) Advocate Children's Heart Institute/Advocate Children's Hospital,
Oak Lawn, IL, United States
(Mery) Section of Congenital Heart Surgery, Department of Surgery, Texas
Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Alsaied) Department of Pediatrics, Cincinnati Children's Hospital Heart
Institute, University of Cincinnati, Cincinnati, OH, United States
(Alahdab) Mayo Evidence-based Practice Center, Mayo Clinic, Rochester, MN,
United States
Publisher
Elsevier USA
Abstract
Background: This study sought to evaluate outcomes of patients undergoing
congenital heart surgery who underwent peritoneal dialysis (PD) vs a
diuretic regimen. Method(s): This study conducted a comprehensive
search in Medline, EMBASE, Scopus, the Cochrane Central Register of
Controlled Trials, and the Cochrane Database of Systematic Reviews from
the databases' inception through April 24, 2018. Independent reviewers
selected studies and extracted data. A random effects meta-analysis was
performed to pool the outcomes of interest across studies. Result(s):
A total of 8 studies (2 prospective studies, 2 randomized clinical trials,
and 4 retrospective studies) with 507 patients were included in this
review. A total of 204 (40%) patients underwent PD, whereas the remaining
patients underwent fluid removal with diuretics. The analyses demonstrated
a significantly shorter time of mechanical ventilation in those patients
who underwent PD (mean difference, -1.25 days; 95% confidence interval,
-2.18 to -0.33; P =.008) and increased odds of mortality (odds ratio,
2.27; 95% confidence interval, 1.13 to 4.56; P =.02) compared with the
diuretic group. No differences were identified in terms of incidence of
negative fluid balance by postoperative day 1, presence of peritonitis,
and intensive care unit length of stay. Conclusion(s): The
meta-analysis did not identify differences between the 2 groups with
regard to negative fluid balance after postoperative day 1, incidence of
peritonitis, or length of intensive care unit stay. There is a need for
large, prospective, multicenter studies to evaluate the benefits and
complications associated with PD use further in selected children after
congenital heart surgery. Because some of the outcomes were present in
only 2 studies, results from the pooled analysis may be
underpowered. Copyright © 2019 The Society of Thoracic Surgeons

<14>
Accession Number
628797177
Title
Postoperative administration of tranexamic acid as approach to reduce
blood loss after open-heart surgery.
Source
Kardiovaskulare Medizin. Conference: Joint Annual Meeting 2019 of the
Swiss Society of Cardiology and the Swiss Society of Cardiac Surgery,
SSC-SSCS 2019. Switzerland. 22 (no pagination), 2019. Date of Publication:
2019.
Author
Meissner F.; Ploetze K.; Waldow T.
Institution
(Meissner, Ploetze, Waldow) Department of Cardiac Surgery, University
Heart Center Dresden, Dresden, Germany
(Meissner) Department of Cardiac Surgery, University Hospital Basel,
Basel, Switzerland
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Introduction: The administration of tranexamic acid (TXA) reduces blood
loss and transfusion requirements among patients undergoing open-heart
surgery. In contrast to its use before and during cardiopulmonary bypass,
the administration of TXA following open-heart surgery is scarcely
investigated. Furthermore, there are concerns about an increased risk of
thromboembolic events like my-ocardial infarction, stroke and acute kidney
injury. Method(s): In a retrospective cohort study at the University
Heart Center Dresden, patients who underwent elective or urgent on-pump
open-heart surgery and received regularly 1 g TXA before cardiopulmonary
bypass were included. Patients with postoperative administration of 1 g
TXA were compared to patients without. Primary endpoint was the
postoperative blood loss within 24 hours. Secondary endpoints included
transfusion requirements, reoperations, hospital mortality and adverse
events. Result(s): Among 2.179 patients undergoing open-heart surgery
at the University Heart Center Dresden between July 1, 2013 and October
31, 2014, 92 or 4.2% received TXA postoperatively. The logistic regression
revealed a highly significant correlation between postoperative blood loss
and use of TXA (p <0.00001). After coarsened exact and nearest neighbor
matching with replacement, 71 patients with postoperative administration
of TXA were compared to 71 without (n = 142). On the one hand,
postop-erative administration of TXA did not result in decreased blood
loss (MD 146.7 ml; p = 0.064), less red blood cell transfusions (RR 0.98
[0.77-1.24]; p >0.99) or lower risk for reoperation (RR 0.70 [0.38-1.27];
p = 0.325). On the other hand, there was no evidence of an increased risk
for thromboembolic complications like myocardial infarction (RR 1.00
[0.21-4.79]; p = 1.000), stroke (RR 1.00 [0.14-6.90]; p = 1.000), acute
kidney injury requiring dialysis (RR 1.00 [0.26-3.84]; p = 1.000) or
higher hospital mortality (RR 1.00 [0.26-3.84]; p = 1.000).
 Conclusion(s): The postoperative administration of TXA did neither
reduce blood loss nor transfusion requirements nor the rate of
reoperations. The use of TXA was shown to be safe in terms of
thromboembolic events and hospital mortality. It is recommended to carry
out a randomized controlled trial investigating the postoperative
administration of TXA. Unless there is no evidence, the postoperative use
of TXA should be restricted to patients with massive blood loss and signs
of hyperfibrinolysis only.

<15>
Accession Number
628796825
Title
10 versus 20 minutes treatment of human pericardium with glutaraldehyde in
OZAKI procedure.
Source
Kardiovaskulare Medizin. Conference: Joint Annual Meeting 2019 of the
Swiss Society of Cardiology and the Swiss Society of Cardiac Surgery,
SSC-SSCS 2019. Switzerland. 22 (no pagination), 2019. Date of Publication:
2019.
Author
Isu G.; Koechlin L.; Borisov V.; Eckstein F.S.; Marsano A.; Reuthebuch O.
Institution
(Isu) Department of Surgery and Biomedicine, University Hospital Basel,
Switzerland
(Koechlin, Borisov, Eckstein, Reuthebuch) Department of Surgery, Unispital
Basel, Basel, Switzerland
(Marsano) Department of Surgery and Biomedicine, Unispital Basel, Basel,
Switzerland
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Background: The aortic valve replacement/neocuspidiza-tion using
autologous pericardium (OZAKI technique) has gained popularity within the
last years. Before using the autologous pericardium to reconstruct the
valve, it is treated with glutaraldehyde (GA) for 10 minutes according the
Ozaki's original publication. However, it is unclear, if longer
intraoperative GA treatment (20 minutes) would enhance the pericardium
mechanical stability and strength. Method(s): After OZAKI valve
replacement, leftover pericardium in 6 patients (3 males and 3 females)
was bisected directly postoperatively and one half was treated for another
10 minutes (20 minutes in total). Strip samples of 25 x 5 mm2
were cut with randomized orientations to average the high tissue
anisotropy and used to evaluate the differences in strength and stability
performing standard uniaxial tensile tests (MTS Synergy). For each
specimen, thickness profiles were reconstructed and measured by in-house
developed image processing algorithms (Mat-lab 2017b, Mathworks) necessary
to calculate the resistant cross-section defined as the section at the
minimum thickness (width x minimum thickness). Thus, stress-strain curves
were elaborated and ultimate tensile strength (UTS), ultimate tensile
strain (uts) and collagen elastic modulus were calculated as engineering
stress at the minimum resistant cross-section. Two-tailed t-test was
performed to compare the two different experimental groups.
 Result(s): Uniaxial stretching generated elongations at rupture of 25
+/- 7% vs. 22 +/- 5% (10 vs. 20 min, p=0.05) corresponding to UTS values
reaching 5.16 +/- 2 and 6.54 +/- 3 MPa (p=0.59), respectively. The high
standard deviation values resulted from the highly anisotropy of the
tissue, which was averaged by randomizing sample orientation and from
gender differences (6.17 vs. 8.62 MPa, for males and 4.22 vs. 4.62 MPa for
females). Interestingly, the elastic modulus E representing the stiffness
properties of the collagen fibres showed similar values after treating the
pericardium for 10 or 20 mins with E values between 31.80 +/- 15.05 and
37.35 +/- 15.78 MPa (p=0.25,10 and 20 min, respectively).
 Conclusion(s): With this study we showed that doubling of fixation
time did not result in significantly different outcomes compared to the
operative procedure in regard to pericardium mechanical stability
quantified in terms of elastic modulus and ultimate tensile strength and
strain.

<16>
Accession Number
2002299372
Title
Comparison of the incidence and severity of delirium and biochemical
factors after coronary artery bypass grafting with dexmedetomidine: A
randomized double-blind placebo-controlled clinical trial study.
Source
ARYA Atherosclerosis. 15 (1) (pp 14-21), 2019. Date of Publication: 2019.
Author
Massoumi G.; Mansouri M.; Khamesipour S.
Institution
(Massoumi) Isfahan Cardiovascular Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Mansouri) Cardiovascular Anesthesia Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Khamesipour) Cardiac Rehabilitation Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: One of the most common postoperative problems, such as open
heart surgery, is delirium, which is responsible for increased mortality
and morbidity. Therefore, it is necessary to find a way to cure this
disease. The purpose of this study was to assess the effect of
dexmedetomidine administration on the prevention of delirium after
coronary artery bypass grafting (CABG) surgery. METHOD(S): This
randomized double-blind placebo-controlled clinical trial was performed on
88 patients (44 in the intervention group and 44 in the control group)
undertaking CABG surgery. The intervention group was subcutaneously
treated with doses of 1 mug/kg of dexmedetomidine for 10 minutes, and
0.2-0.7 mug/kg in hour infusion was applied. The control group underwent
normal saline infusion as a placebo. Chi-square and analysis of variance
(ANOVA) tests were used to compare the data. RESULT(S):
Administration of dexmedetomidine in intervention group significantly
decreased delirium (P = 0.040) and delirium intensity (P = 0.001).
Moreover, patients treated with dexmedetomidine had more stability in
laboratory variables and vital signs, and also the duration of
hospitalization in these patients was significantly lower than control
group (P = 0.002). CONCLUSION(S): Considering the efficacy of
dexmedetomidine on preventing the incidence and severity of delirium and
reducing mortality and morbidity, it is recommended that another study
with the larger sample size, with different doses and different
prescribing methods be conducted to better understand the effect of this
drug and achieve a safe dose with maximum efficacy. Copyright ©
2019, Isfahan University of Medical Sciences(IUMS). All rights reserved.

<17>
Accession Number
628802615
Title
Incidence, predictors and cerebrovascular consequences of leaflet
thrombosis after transcatheter aortic valve implantation: a systematic
review and meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2019.
Date of Publication: 10 Apr 2019.
Author
D'Ascenzo F.; Salizzoni S.; Saglietto A.; Cortese M.; Latib A.; Franzone
A.; Barbanti M.; Nietlispach F.; Holy E.W.; Burriesci G.; De Paoli A.;
Fonio P.; Atzeni F.; Moretti C.; Perl L.; D'Amico M.; Rinaldi M.; Conrotto
F.
Institution
(D'Ascenzo, Saglietto, Cortese, Moretti, D'Amico, Conrotto) Division of
Cardiology, Department of Medical Sciences, University of Turin, Citta
della Salute e della Scienza, Turin, Italy
(Salizzoni, Atzeni, Rinaldi) Division of Cardiac Surgery, Cardiovascular
and Thoracic Department, University of Turin, Citta della Salute e della
Scienza, Turin, Italy
(Latib) Interventional Cardiology Unit, Cardiothoracic and Vascular
Department, San Raffaele Scientific Institute, Milan, Italy
(Franzone) Department of Cardiology, Swiss Cardiovascular Center Bern,
Bern University Hospital, Bern, Switzerland
(Barbanti) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Nietlispach, Holy) Cardiology Clinic, University Hospital of Zurich,
Zurich, Switzerland
(Burriesci) UCL Mechanical Engineering, University College London, London,
United Kingdom
(Burriesci) Ri.MED Foundation, Palermo, Italy
(De Paoli, Fonio) Radiology Unit, Department of Surgical Science,
University of Turin, Turin, Italy
(Perl) Department of Cardiology, Rabin Medical Center, Petach-Tikva,
Israel
(Perl) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We examined the incidence, the impact of subsequent
cerebrovascular events and the clinical or procedural predictors of
leaflet thrombosis (LT) in patients undergoing transcatheter aortic valve
implantation (TAVI). METHOD(S): MEDLINE/PubMed was systematically
screened for studies reporting on LT in TAVI patients. Incidence [both
clinical and subclinical, i.e. detected with computed tomography (CT)] of
LT was the primary end point of the study. Predictors of LT evaluated at
multivariable analysis and impact of LT on stroke were the secondary ones.
 RESULT(S): Eighteen studies encompassing 11 124 patients evaluating
incidence of LT were included. Pooled incidence of LT was 0.43% per month
[5.16% per year, 95% confidence interval (CI) 0.21-0.72, I2 = 98%]. Pooled
incidence of subclinical LT was 1.36% per month (16.32% per year, 95% CI
0.71-2.19, I2=94%). Clinical LT was less frequent (0.04% per month, 0.48%
per year, 95% CI 0.00-0.19, I2=93%). LT increased the risk of stroke [odds
ratio (OR) 4.21, 95% CI 1.27-13.98], and was more frequent in patients
with a valve diameter of 28-mm (OR 2.89: 1.55-5.8), for balloon-expandable
(OR 8: 2.1-9.7) or after valve-in-valve procedures (OR 17.1: 3.1-84.9).
Oral anticoagulation therapy reduced the risk of LT (OR 0.43, 95% CI:
0.22-0.84, I2=64%), as well as the mean transvalvular gradient.
 CONCLUSION(S): LT represents an infrequent event after TAVI, despite
increasing risk of stroke. Given its full reversal with warfarin, in
high-risk patients (those with valve-in-valve procedures, balloon
expandable or large-sized devices), a protocol which includes a control CT
appears reasonable. Copyright © The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<18>
Accession Number
628800100
Title
A meta-analysis of impact of low-flow/low-gradient aortic stenosis on
survival after transcatheter aortic valve implantation.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2019. Date of Publication: 16 Jul 2019.
Author
Takagi H.; Hari Y.; Kawai N.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Kawai) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari) Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, NY,
United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
AIMS: To determine whether low-flow/low-gradient (LF/LG) aortic stenosis
affects survival after transcatheter aortic valve implantation (TAVI), we
performed a meta-analysis of currently available studies. METHOD(S):
MEDLINE and EMBASE were searched through January 2019 using PubMed and
OVID. Observational studies comparing all-cause mortality after TAVI for
patients with classical LF/LG (C/LF/LG) aortic stenosis versus
normal-flow/high-gradient (NF/HG) aortic stenosis, paradoxical LF/LG
(P/LF/LG) aortic stenosis versus NF/HG aortic stenosis, and (3) C/LF/LG
aortic stenosis versus P/LF/LG aortic stenosis were included.
Study-specific estimates, risk and hazard ratios of mortality, were
combined in the random-effects model. RESULT(S): Our search
identified nine eligible studies including a total of 5512 TAVI patients.
Pooled analysis demonstrated significantly higher early mortality in
C/LF/LG aortic stenosis than NF/HG aortic stenosis (risk ratio, 1.72; P =
0.02) and no statistically significant difference in early mortality
between P/LF/LG aortic stenosis and NF/HG aortic stenosis (P = 0.67) and
between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.51).
Midterm mortality in C/LF/LG (risk ratio/hazard ratio, 1.73; P = 0.0003)
and P/LF/LG aortic stenosis (risk ratio/hazard ratio, 1.48; P < 0.0001)
was significantly higher than that in NF/HG aortic stenosis. There was no
statistically significant difference in midterm mortality between C/LF/LG
aortic stenosis and P/LF/LG aortic stenosis (P = 0.63).
 CONCLUSION(S): After TAVI, C/LF/LG aortic stenosis is associated with
increased early mortality compared with NF/HG, and C/LF/LG and P/LF/LG
aortic stenosis is associated with increased midterm mortality compared
with NF/HG aortic stenosis despite no difference in early mortality
between P/LF/LG aortic stenosis and NF/HG aortic stenosis. There is no
difference in early and midterm mortality between C/LF/LG aortic stenosis
and P/LF/LG aortic stenosis.

<19>
Accession Number
628799355
Title
Aortic valvular imaging with cardiovascular magnetic resonance: seeking
for comprehensiveness.
Source
The British journal of radiology. (pp 20170868), 2019. Date of
Publication: 18 Jul 2019.
Author
De Rubeis G.; Galea N.; Ceravolo I.; Dacquino G.M.; Carbone I.; Catalano
C.; Francone M.
Institution
(De Rubeis, Galea, Ceravolo, Dacquino, Carbone, Catalano, Francone)
Department of Radiological, Oncological and Pathological Sciences,
"Sapienza" University of Rome, Rome, Italy
(Galea) Department of Experimental Medicine, "Sapienza" University of
Rome, Rome, Italy
Publisher
NLM (Medline)
Abstract
Cardiovascular magnetic resonance (CMR) has an emerging role in aortic
valve disease evaluation, becoming an all-in-one technique. CMR evaluation
of the anatomy and flow through the aortic valve has a higher
reproducibility than echocardiography. Its unique ability of invivo
myocardial tissue characterization, significantly improves the risk
stratification and management of patients. In addition, CMR is equivalent
to cardiac CT angiography for trans-aortic valvular implantation and
surgical aortic valve replacement planning; on the other hand, its role in
the evaluation of ventricular function improving and post-treatment
complications is undisputed. This review encompasses the existing
literature regarding the role of CMR in aortic valve disease, exploring
all the aspects of the disease, from diagnosis to prognosis.

<20>
Accession Number
2002467081
Title
Impact of telephone follow-up and 24/7 hotline on 30-day readmission rates
following aortic valve replacement -A randomized controlled trial.
Source
International Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Danielsen S.O.; Moons P.; Sandvik L.; Leegaard M.; Solheim S.; Tonnessen
T.; Lie I.
Institution
(Danielsen, Lie) Center for Patient-centered Heart and Lung Research,
Department of Cardiothoracic Surgery, Division of Cardiovascular and
Pulmonary Diseases, Oslo University Hospital, Ulleval, Oslo, Norway
(Danielsen, Tonnessen) Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Danielsen, Moons) KU Leuven Department of Public Health and Primary Care,
KU Leuven-University of Leuven, Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Moons) Department of Paediatrics and Child Health, University of Cape
Town, South Africa
(Sandvik) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ulleval,
Oslo, Norway
(Solheim) Center for Clinical Heart Research, Department of Cardiology,
Division of Medicine, Oslo University Hospital, Ulleval, Oslo, Norway
(Leegaard) Department of Nursing and Health Promotion, Faculty of Health
Sciences, Oslo Metropolitan University, Oslo, Norway
Publisher
Elsevier Ireland Ltd
Abstract
Background: Thirty-day all-cause readmissions are high after aortic valve
replacement (AVR). We aimed to assess the effectiveness of a structured
telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause
readmission (30-DACR) after AVR, on reducing symptoms of anxiety and
depression and on improving perceived health state. Method(s): A
prospective randomized controlled trial was conducted. Patients (n = 288)
were randomly allocated to either post-discharge usual care or to care
that provided TFU and access to a 24/7 hotline after AVR. Ancillary
endpoints were time-to-event (readmission), proportion of avoidable versus
unavoidable readmissions after AVR, and predictors of 30-DACR after AVR.
 Result(s): 30-DACR was 22.3%. The structured TFU and 24/7 hotline
intervention failed to reduce 30-DACR rates after AVR (P = 0.274).
Symptoms of anxiety were significantly reduced 30 days after surgery (P =
0.031), an effect that did not persist one year after surgery (P = 0.108).
Most readmissions occurred before 15 days post-discharge, and 75% of them
were deemed to be unavoidable. Pleural drainage before hospital discharge
(P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were
predictors of 30-DACR after AVR. Conclusion(s): The TFU and 24/7
hotline had no effect on reducing 30-DACR after AVR. However, we did
measure reduced symptoms of anxiety the first month after AVR. Anxiety
reduction appeared to be an important target for intervention, because we
found it to be a risk factor for readmission. Future research should focus
on the effectiveness of interventions to prevent avoidable unplanned
readmissions. Trial registration: ClinicalTrial.gov,
NCT02522663. Copyright © 2019 Elsevier B.V.

<21>
Accession Number
2002376256
Title
Total arterial revascularization strategies: A meta-analysis of propensity
score-matched observational studies.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Urso S.; Sadaba R.; Gonzalez J.M.; Nogales E.; Pettinari M.; Tena M.A.;
Paredes F.; Portela F.
Institution
(Urso, Tena, Paredes, Portela) Cardiac Surgery Department, Hospital
Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
(Sadaba) Cardiac Surgery Department, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
(Nogales) Cardiology Department, Hospital Universitario Insular, Las
Palmas de Gran Canaria, Spain
(Pettinari) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk,
Belgium
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: We explored the current evidence
available on total arterial revascularization (TAR) carrying out a
meta-analysis of propensity score-matched studies comparing TAR versus
non-TAR strategy. Method(s): PubMed, EMBASE, and Google Scholar were
searched for propensity score-matched studies comparing TAR vs non-TAR.
The generic inverse variance method was used to compute the combined
hazard ratio (HR) of long-term mortality. The Der-Simonian and Laird
method were used to compute the combined risk ratio (RR) of 30-day
mortality, deep sternal wound infection, and reoperation for bleeding.
 Result(s): Eighteen TAR vs non-TAR matched populations were included.
Meta-analysis showed a significant benefit in terms of long-term survival
of the TAR group over the non-TAR group (HR: 0.73; 95% confidence interval
[CI]: 0.68-0.78). Better long-term survival over non-TAR strategy was
confirmed by both subgroups: TAR with the bilateral internal mammary
artery (BIMA) and TAR without BIMA. Meta-regression suggests that TAR may
offer a higher protective survival effect in diabetic patients
(coefficient: -0.0063; 95% CI: -0.01 to 0.0006), when carried out with
BIMA (coefficient: -0.15; 95% CI: -0.27 to -0.03) or using three arterial
conduits (coefficient: -0.12; 95% CI: -0.25 to 0.007). A TAR strategy
carried out using BIMA, differently from TAR without BIMA, increases the
risk of deep sternal infection (RR: 1.44; 95% CI: 1.17-1.77).
 Conclusion(s): TAR provides a long-term survival benefit compared
with the non-TAR strategy. Also, compared with TAR without BIMA, TAR with
BIMA may offer a higher protective long-term survival effect at the
expense of a higher risk of sternal deep wound infection. Copyright
© 2019 Wiley Periodicals, Inc.

<22>
Accession Number
2002374072
Title
Cost-effectiveness comparison of routine transfusion with restrictive and
liberal transfusion strategies for surgical patients in China.
Source
Vox Sanguinis. (no pagination), 2019. Date of Publication: 2019.
Author
Yu X.; Wang Z.; Huang Y.; Xin S.; Sun H.; Zhang X.; Wang Y.; Han W.; Xue
F.; Wang L.; Hu Y.; Xu M.; Li L.; He J.; Jiang J.
Institution
(Yu, Wang, Huang, Xu) Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences, Beijing, China
(Wang, Han, Xue, Wang, Hu, Jiang) Department of Epidemiology and
Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing, China
(Xin, Zhang, Li) First Hospital of China Medical University, Shenyang,
China
(Sun, Wang, He) Xiangya Hospital, Central South University, Changsha,
China
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objectives: A health industry standard recommending
restrictive transfusion is to be in effect in China in April 2019. We aim
to explore its potential economic and clinical impacts among surgical
patients. Material(s) and Method(s): A decision tree model was
applied to compare cost-effectiveness of current routine transfusion in
China, a restrictive (transfusion at Hb < 8 g/dl or ischaemic symptoms)
and a liberal (transfusion at Hb < 10 g/dl) strategy. Parameters were
estimated from empirical data of 25 227 surgical inpatients aged >=30
years in a multicenter study and supplemented by meta-analysis when
necessary. Results are shown for cardio-cerebral-vascular (CCV) surgery
and non-CCV (orthopaedics, general, thoracic) surgery separately.
 Result(s): Per 10 000 patients in routine, restrictive, liberal
transfusion scenarios, total spending (transfusion and length of stay
related) was 7.67, 7.58 and 9.39 million CNY (1 CNY x 0.157 = 1 US dollar)
for CCV surgery and 6.35, 6.70 and 8.09 million CNY for non-CCV surgery;
infectious and severe complications numbered 354, 290, and 290 (CCV) and
315, 286, and 330 (non-CCV), respectively. Acceptability curves showed
high probabilities for restrictive strategy to be cost-effective across a
wide range of willingness-to-pay values. Such findings were mostly
consistent in sensitivity and subgroup analyses except for patients with
cardiac problems. Conclusion(s): We showed strong rationale,
succeeding previous findings only in cardiac or joint procedures, to
comply with the new standard as restrictive transfusion has high potential
to save blood, secure safety, and is cost-effective for a wide spectrum of
surgical patients. Experiences should be further summarized to pave the
way towards individualized transfusion. Copyright © 2019
International Society of Blood Transfusion

<23>
Accession Number
2002365716
Title
Epicardial Application of Hydrogel with Amiodarone for Prevention of
Postoperative Atrial Fibrillation in Patients After Coronary Artery Bypass
Grafting.
Source
Journal of Cardiovascular Translational Research. (no pagination), 2019.
Date of Publication: 2019.
Author
Bockeria O.L.; Kanametov T.N.; Shvartz V.A.; Sokolskaya M.A.; Zhuginisov
D.S.; Sanakoev M.K.; Bockeria L.A.
Institution
(Bockeria, Kanametov, Shvartz, Sokolskaya, Zhuginisov, Sanakoev, Bockeria)
Bakulev National Medical Research Center for Cardiovascular Surgery,
Moscow, Russian Federation
(Bockeria, Kanametov, Shvartz, Sokolskaya, Zhuginisov, Sanakoev, Bockeria)
Department of Surgical Treatment for Interactive Pathology, Bakulev
National Medical Research Center for Cardiovascular Surgery, Moscow,
Russian Federation
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The objective of this study was to assess the safety and efficacy of local
epicardial application of amiodarone-releasing hydrogel for prevention of
postoperative atrial fibrillation (POAF) in patients after coronary artery
bypass grafting. Patients were randomized into two groups: with the
application of amiodarone-releasing hydrogel and the control group. It
included 60 patients (47 males, 13 females) (mean age of 62 +/- 8.5). POAF
incidence differences were statistically significant between two groups:
in the study group, the POAF incidence was 3.3%, while in the control
group, the POAF incidence was 37% (p < 0.001). Statistically significant
differences were revealed in the PQ interval duration. The risk of POAF
incidence was calculated using the Cox regression model: the age and the
application of amiodarone-releasing hydrogel application were
statistically significant. Hospital length of stay in two groups was also
different (p < 0.001). The age and the application of amiodarone-releasing
hydrogel were statistically significant for POAF incidence. Copyright
© 2019, Springer Science+Business Media, LLC, part of Springer
Nature.

<24>
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. Copyright © 2019, © 2019
Informa UK Limited, trading as Taylor & Francis Group.

<25>
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. Method(s): This review article summarizes
different indications of plasma exchange for patients requiring cardiac
surgery based on reported case reports and case series. 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. 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. Copyright © 2018 Wiley Periodicals,
Inc.

<26>
Accession Number
2000717740
Title
The predictive value of baseline pulmonary hypertension in early and long
term cardiac and all-cause mortality after transcatheter aortic valve
implantation for patients with severe aortic valve stenosis: A systematic
review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. Part B. 19 (7) (pp 859-867),
2018. Date of Publication: October - November 2018.
Author
Kokkinidis D.G.; Papanastasiou C.A.; Jonnalagadda A.K.; Oikonomou E.K.;
Theochari C.A.; Palaiodimos L.; Karvounis H.I.; Armstrong E.J.; Faillace
R.T.; Giannakoulas G.
Institution
(Kokkinidis, Palaiodimos, Faillace) Department of Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine, Bronx, NY, United States
(Kokkinidis, Armstrong) Division of Cardiology, Denver VA Medical Center
and University of Colorado, Denver, United States
(Papanastasiou, Karvounis, Giannakoulas) 1st Cardiology Department, AHEPA
University Hospital, Aristotle University of Thessaloniki, Thessaloniki,
Greece
(Jonnalagadda) Division of Cardiology, Medstar, Washington Hospital
Center, DC, United States
(Oikonomou, Theochari) Cardiology Working Group, Society of Junior
Doctors, Athens, Greece
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a safe and
effective alternative to surgical aortic valve replacement (SAVR) for the
treatment of severe aortic valve stenosis (AS). The impact of concomitant
baseline elevated pulmonary artery pressures on outcomes after TAVI has
not been established, since different studies used different definitions
of pulmonary hypertension (PH). Objective(s): To determine the
association of PH with early and late cardiac and all-cause mortality
after TAVI. Method(s): We performed a meta-analysis of studies
comparing patients with elevated pulmonary artery pressures (defined as
pulmonary hypertension or not) versus patients without elevated pulmonary
artery pressures undergoing TAVI. We first performed stratified analyses
based on the different PH cut-off values utilized by the included studies
and subsequently pooled the studies irrespective of their cut-off values.
We used a random effects model for the meta-analysis and assessed
heterogeneity with I-square. Separate meta-analyses were performed for
studies reporting outcomes as hazards ratios (HRs) and relative risks
(RRs). Subgroup analyses were performed for studies published before and
after 2013. Meta-regression analysis in order to assess the effect of
chronic obstructive pulmonary disease and mitral regurgitation were
performed. Result(s): In total 22 studies were included in this
systematic review. Among studies presenting results as HR, PH was
associated with increased late cardiac mortality (HR: 1.8. 95% CI:
1.3-2.3) and late all-cause mortality (HR: 1.56; 95% CI: 1.1-2). The PH
cut-off value that was most likely to be associated with worst outcomes
among the different endpoints was pulmonary artery systolic pressure of 60
mm Hg (HR: 1.8; 95% CI: 1.3-2.3; I2 = 0, for late cardiac
mortality and HR: 1.52; 95% CI: 1-2.1; I2 = 85% for late
all-cause mortality). Conclusion(s): This systematic review and
meta-analysis emphasizes the importance of baseline PH in predicting
mortality outcomes after TAVI. Additional studies are needed to clarify
the association between elevated baseline pulmonary artery pressures and
outcomes after TAVI. Copyright © 2018 Elsevier Inc.

<27>
Accession Number
617003265
Title
Percutaneous Vascular Interventions Versus Bypass Surgeries in Patients
with Critical Limb Ischemia.
Source
Annals of Surgery. 267 (5) (pp 846-857), 2018. Date of Publication: 01 May
2018.
Author
Wang J.; Shu C.; Wu Z.; Zhao J.; Ma Y.; Huang B.; Yuan D.; Yang Y.; Bian
H.; He Y.; Wang Z.
Institution
(Wang, Shu, He) West China School of Medicine, West China Hospital,
Sichuan University, Chengdu, Sichuan Province, China
(Wang, Shu, Wu, Zhao, Ma, Huang, Yuan, Yang) Department of Vascular
Surgery, West China Hospital, Sichuan University, 37 Guo Xue Alley,
Chengdu, Sichuan Province 610041, China
(Bian) Department of Statistics, Population Health Research Institute,
McMaster University, Hamilton, ON, Canada
(He) Institute of Genetics and Molecular Medicine, Western General
Hospital, University of Edinburgh, Edinburgh, United Kingdom
(Wang) Department of Gastrointestinal Surgery, West China Hospital,
Sichuan University, 37 Guo Xue Alley, Chengdu, Sichuan Province 610041,
China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: The aim of our study was to compare percutaneous vascular
interventions (PVI) versus bypass surgeries (BSX) in patients with
critical limb ischemia (CLI). Background(s): Previous relevant
reviews with limited numbers of included studies did not strictly confine
the inclusion criteria to CLI, also involving patients with severe
claudication, which may introduce bias in the decision-making of CLI
revascularization. Current treatment strategies for CLI still remain
controversial. Method(s): We performed a meta-analysis of all
available randomized controlled trials and observational clinical studies
comparing PVI with BSX in CLI patients. Primary endpoints included overall
survival, amputation-free survival, 30-day mortality, and major adverse
cardiovascular and cerebrovascular events. Result(s): We identified
45 cohorts and 1 RCT in over 20,903 patients. In overall population, PVI
reduced the risks of 30-day mortality [odds ratio (OR) 0.69, 95%
confidence interval (CI) 0.51-0.95), major adverse cardiovascular and
cerebrovascular events (OR 0.42, 95% CI 0.29-0.61), and surgical site
infection (OR 0.31, 95% CI 0.19-0.51), but increased the risks of
long-term all-cause mortality [hazard ratio (HR) 1.16, 95% CI 1.05-1.27)
and primary patency failure (HR 1.31, 95% CI 1.08-1.58). When compared
with autogenous BSX, PVI was also associated with additional increased
risks of long-term death or amputation (HR 1.41, 95% CI 1.02-1.94) and
secondary patency failure (HR 1.51, 95% CI 1.17-1.95). In patients with
infrapopliteal lesions, we found PVI had inferior primary patency (HR
1.39, 95% CI 1.10-1.75) compared with BSX. Conclusion(s): For
patients in good physical condition with long life-expectancy, BSX may
represent a better choice compared with PVI, particularly when autogenous
bypass is available. While enhanced perioperative care for cardiovascular
events and surgical site should be considered in patients underwent BSX to
achieve comparable short-term outcomes provided by PVI. Copyright
© 2017 Wolters Kluwer Health, Inc. All rights reserved.

<28>
Accession Number
2000758454
Title
A meta-analysis of reduced leaflet motion for surgical and transcatheter
aortic valves: Relationship to cerebrovascular events and valve
degeneration.
Source
Cardiovascular Revascularization Medicine. Part B. 19 (7) (pp 868-873),
2018. Date of Publication: October - November 2018.
Author
Makki N.; Shreenivas S.; Kereiakes D.; Lilly S.
Institution
(Makki, Lilly) Department of Cardiology, Ohio State University Wexner
Medical Center, Columbus, OH 43210, United States
(Shreenivas, Kereiakes) Department Cardiology, The Christ Hospital,
Cincinnati, OH 45219, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Reduced leaflet motion (RLM) of transcatheter aortic valves
(TAV) is observed in up to 4% of cases with similar frequency in surgical
valves, with an overall incidence that differs based on prosthesis type
and size. This phenomenon likely represents subclinical leaflet
thrombosis. Herein we sought to analyze the existing reported literature
to assess whether or not RLM is associated with subsequent valve
degeneration or cerebrovascular events. Methods and Results: We
searched PubMed, and EMBASE (2008-2017) to identify relevant studies.
Studies with <1-year follow-up, studies not evaluating RLM, and/or
clinical outcomes were excluded. Our co-primary endpoints were the
incidence of cerebrovascular events (stroke and/or transient ischemic
attack-TIA) or structural valvular degeneration defined as moderate or
greater regurgitation and/or a mean gradient >=20 mm Hg. The literature
search yielded 30 potential studies. Of these, six observational studies
with a total population of 1704 patients met our selection criteria. RLM
was associated with an increased risk of stroke or TIA (adjusted OR 2.60,
95% CI 1.56 to 4.34, p = 0.004). At one year, RLM was associated with an
increased risk of structural valve degeneration (adjusted OR 2.51, 95% CI
1.47 to 4.30, p = 0.006). The association between RLM and clinical
endpoints remained even after limiting analysis to transcatheter aortic
valve replacement (TAVR) patients only. Conclusion(s): In patients
with bio prosthetic aortic valve, presence of RLM is associated with
increased risk of stroke or TIA as well as structural valvular
degeneration. These findings support ongoing surveillance efforts and
evaluation of pharmacotherapies to address RLM in effort to minimize
subsequent clinical events. Copyright © 2018 Elsevier Inc.

<29>
Accession Number
616541696
Title
Intraoperative ketamine for prevention of postoperative delirium or pain
after major surgery in older adults: an international, multicentre,
double-blind, randomised clinical trial.
Source
The Lancet. 390 (10091) (pp 267-275), 2017. Date of Publication: 15 Jul
2017.
Author
Avidan M.S.; Maybrier H.R.; Abdallah A.B.; Jacobsohn E.; Vlisides P.E.;
Pryor K.O.; Veselis R.A.; Grocott H.P.; Emmert D.A.; Rogers E.M.; Downey
R.J.; Yulico H.; Noh G.-J.; Lee Y.H.; Waszynski C.M.; Arya V.K.; Pagel
P.S.; Hudetz J.A.; Muench M.R.; Fritz B.A.; Waberski W.; Inouye S.K.;
Mashour G.A.; Apakama G.P.; Aquino K.G.; Dicks R.S.; Escallier K.E.;
Fardous H.; Funk D.J.; Gipson K.E.; Girardi L.N.; Gruber A.T.; Ivascu
N.S.; Jayant A.; Kashani H.H.; Kavosh M.S.; Kunkler B.S.; Lenze E.J.;
McKinney A.S.; McKinnon S.L.; Mickle A.M.; Monterola M.; Murphy M.R.;
Redko M.; Schmitt E.M.; Sivanesan L.; Steinkamp M.L.; Tellor B.; Thomas
S.; Upadhyayula R.T.
Institution
(Avidan, Maybrier, Abdallah, Emmert, Muench, Fritz) Department of
Anesthesiology, Washington University School of Medicine, Saint Louis, MO,
United States
(Jacobsohn) Department of Anesthesiology and Department of Internal
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Vlisides, Mashour) Department of Anesthesiology, University of Michigan,
Ann Arbor, MI, United States
(Pryor, Rogers) Department of Anesthesiology, Weill Cornell Medicine, New
York City, NY, United States
(Veselis) Department of Neuroanesthesiology, Memorial Sloan Kettering
Cancer Center, New York City, NY, United States
(Downey) Department of Surgery, Memorial Sloan Kettering Cancer Center,
New York City, NY, United States
(Yulico) Department of Anesthesiology, Memorial Sloan Kettering Cancer
Center, New York City, NY, United States
(Noh, Lee) Department of Anesthesiology, Asan Medical Center, Seoul, South
Korea
(Waszynski) Department of Medicine, Hartford Hospital, Hartford, CT,
United States
(Arya) Department of Anaesthesiology and Intensive Care, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
(Pagel, Hudetz) Department of Anesthesiology, Medical College of
Wisconsin, Milwaukee, WI, United States
(Waberski) Department of Anesthesiology, Hartford Hospital, Hartford,
Connecticut, United States
(Inouye) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife,
Boston, MA, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a common and serious postoperative complication.
Subanaesthetic ketamine is often administered intraoperatively for
postoperative analgesia, and some evidence suggests that ketamine prevents
delirium. The primary purpose of this trial was to assess the
effectiveness of ketamine for prevention of postoperative delirium in
older adults. Methods The Prevention of Delirium and Complications
Associated with Surgical Treatments [PODCAST] study is a multicentre,
international randomised trial that enrolled adults older than 60 years
undergoing major cardiac and non-cardiac surgery under general
anaesthesia. Using a computer-generated randomisation sequence we randomly
assigned patients to one of three groups in blocks of 15 to receive
placebo (normal saline), low-dose ketamine (0.5 mg/kg), or high dose
ketamine (1.0 mg/kg) after induction of anaesthesia, before surgical
incision. Participants, clinicians, and investigators were blinded to
group assignment. Delirium was assessed twice daily in the first 3
postoperative days using the Confusion Assessment Method. We did analyses
by intention-to-treat and assessed adverse events. This trial is
registered with clinicaltrials.gov, number NCT01690988. Findings Between
Feb 6, 2014, and June 26, 2016, 1360 patients were assessed, and 672 were
randomly assigned, with 222 in the placebo group, 227 in the 0.5 mg/kg
ketamine group, and 223 in the 1.0 mg/kg ketamine group. There was no
difference in delirium incidence between patients in the combined ketamine
groups and the placebo group (19.45% vs 19.82%, respectively; absolute
difference 0.36%, 95% CI -6.07 to 7.38, p=0.92). There were more
postoperative hallucinations (p=0.01) and nightmares (p=0.03) with
increasing ketamine doses compared with placebo. Adverse events
(cardiovascular, renal, infectious, gastrointestinal, and bleeding),
whether viewed individually (p value for each >0.40) or collectively
(36.9% in placebo, 39.6% in 0.5 mg/kg ketamine, and 40.8% in 1.0 mg/kg
ketamine groups, p=0.69), did not differ significantly across groups.
Interpretation A single subanaesthetic dose of ketamine did not decrease
delirium in older adults after major surgery, and might cause harm by
inducing negative experiences. Funding National Institutes of Health and
Cancer Center Support. Copyright © 2017 Elsevier Ltd

<30>
Accession Number
626602653
Title
Impact of renin-angiotensin system inhibitors continuation versus
discontinuation on outcome after major surgery: Protocol of a multicenter
randomized, controlled trial (STOP-or-NOT trial) 11 Medical and Health
Sciences 1103 Clinical Sciences 11 Medical and Health Sciences 1102
Cardiorespiratory Medicine and Haematology.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 160. Date of
Publication: 05 Mar 2019.
Author
Legrand M.; Futier E.; Leone M.; Deniau B.; Mebazaa A.; Plaud B.; Coriat
P.; Rossignol P.; Vicaut E.; Gayat E.
Institution
(Legrand, Deniau, Mebazaa, Plaud, Gayat) AP-HP, GH St-Louis-Lariboisiere,
Department of Anesthesiology and Critical Care and Burn Unit, St-Louis
Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
(Legrand, Deniau, Mebazaa, Plaud, Gayat) University Paris Diderot, Paris,
France
(Legrand, Deniau, Mebazaa, Plaud, Gayat) UMR INSERM 942, Institut National
de la Sante et de la Recherche Medicale (INSERM), Lariboisiere Hospital,
Paris, France
(Legrand, Mebazaa, Rossignol, Gayat) F-CRIN INI-CRCT Network, Nancy,
France
(Futier) Departement de Medecine Perioperatoire, Anesthesie Reanimation
Hopital Estaing, CHU Clermont-Ferrand and Universite Clermont Auvergne,
CNRS, Inserm, Clermont-Ferrand, France
(Leone) Service d'Anesthesie et de Reanimation, Hopital Nord, Aix
Marseille Universite, APHM, Marseille, France
(Coriat) Departement d'Anesthesie-Reanimation, La Pite-Salpetriere,
Universite Paris Descartes, Paris, France
(Rossignol) Inserm, Centre d'Investigations Cliniques-Plurithematique
14-33, Inserm U1116, CHRU Nancy, Universite de Lorraine, Nancy, France
(Vicaut) Unite de Recherche Clinique, GH St-Louis-Lariboisere-Fernand
Widal, Universite Paris Diderot, Paris, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Chronic treatment of hypertension or heart failure very often
includes an angiotensin-converting enzyme inhibitors (ACE-Is) or
angiotensin receptor blockers (ARBs) as renin-angiotensin system
inhibitors (RASi) treatments. To stop or not to stop these medications
before major surgery remains an unresolved issue. The lack of evidence
leads to conflicting guidelines with respect to RASi management before
major surgery. The purpose of this study is to evaluate the impact of a
strategy of RASi continuation or discontinuation on perioperative
complications in patients undergoing major non-cardiac surgery.
 Method(s): This is a multicenter, open-labeled randomized controlled
trial in > 30 French centers. In the experimental group, RASi will be
continued while the treatment will be stopped 48 h before the surgery in
the control arm. The primary endpoint is a composite endpoint of major
complications after surgery. An endpoint adjudication committee will
review clinical data and adjudicate efficacy endpoints while blinded to
the assigned study drug group. Main analysis will be by intention-to-treat
comparing the composite outcome measure at 28 days in the two groups. A
total of 2222 patients are planned to detect an absolute complications
difference of 5%. Discussion(s): The results of the trial should
provide robust evidence to anesthesiologists and surgeons regarding
management of RASi before major non-cardiac surgery. Trial registration:
ClinicalTrials.gov, NCT03374449. Registered on 11 December
2017. Copyright © 2019 The Author(s).

<31>
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.
 Method(s): Patients were divided into young (20-40 year), middle
(41-70 year), and elderly (> 70 year) groups (n = 20, each group). General
anesthesia was induced with remifentanil 0.3 mug/kg/min, followed by
propofol (2.0, 1.5, and 1.2 mg/kg) or thiopental (5.0, 4.0, and 3.0 mg/kg)
in the young, middle, and elderly groups, respectively. The primary
outcome was the difference in the decrease in mean arterial blood pressure
between patients receiving propofol and thiopental in each age group. The
secondary outcomes included other hemodynamic parameters and minimal
bispectral index values measured up to 10 min after tracheal intubation.
 Result(s): The decrease in mean arterial blood pressure was greater
in patients receiving propofol than those receiving thiopental (- 45.4 vs
- 26.6 mmHg and - 45.7 vs - 28.9 mmHg, P = 0.003 and 0.007, respectively),
whereas no significant difference was observed in the young age group (P =
0.96). Conclusion(s): Thiopental is a more suitable agent than
propofol for avoiding hypotension during GA induction under remifentanil
infusion in the middle and elderly patients. Copyright © 2019,
Japanese Society of Anesthesiologists.

<32>
Accession Number
626673983
Title
Optimal strategy of primary percutaneous coronary intervention for acute
myocardial infarction due to unprotected left main coronary artery
occlusion (OPTIMAL): Study protocol for a randomised controlled trial.
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 162. Date of
Publication: 08 Mar 2019.
Author
Gao Y.; Zhang F.; Li C.; Dai Y.; Yang J.; Qu Y.; Qian J.; Ge J.
Institution
(Gao, Zhang, Li, Dai, Yang, Qu, Qian, Ge) Department of Cardiology,
Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular
Diseases, 180 Fenglin Road, Shanghai 200032, China
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Primary percutaneous coronary intervention (PCI) for patients
presenting with acute myocardial infarction (AMI) caused by left main
coronary artery occlusion is associated with significantly higher
mortality and risks of major adverse cardiovascular events. Deferred stent
implantation may improve prognosis of primary PCI by reducing distal
embolization and no-reflow phenomenon. There is no randomized clinical
trial focusing on the effect and outcome of deferred stent implantation on
primary PCI for left main coronary artery occlusion in contrast with
conventional strategy. Method(s): The Optimal Strategy of Primary
Percutaneous Coronary Intervention for Acute Myocardial Infarction due to
Unprotected Left Main Coronary Artery Occlusion (OPTIMAL) study
(ClinicalTrials.gov Identifier: NCT03282773) is an open-label, randomized,
multicenter clinical trial in which 480 patients presenting with AMI
caused by left main coronary artery occlusion recruited from 30 hospitals
in mainland China will be randomly assigned 1:1 to immediate stenting or
deferred stenting (scheduled 4-10 days after primary angioplasty) groups.
The primary endpoint is a composite of all-cause mortality or recurrent
myocardial infarction at 30 days after randomization. The secondary
outcomes include all-cause mortality, cardiac death, recurrent myocardial
infarction, and unplanned target vessel revascularization at 30 days, 6
months, and 12 months. Discussion(s): The OPTIMAL study is designed
to compare the clinical performance of deferred stenting with that of
immediate stenting for AMI caused by left main coronary artery occlusion.
Trial registration: ClinicalTrials.gov Identifier: NCT03282773. Registered
on 10 September 2017. Copyright © 2019 The Author(s).

<33>
Accession Number
2002255358
Title
Advantages of using skeletonized ITA vs. Pedicled ITA in CABG.
Source
International Journal of Clinical and Experimental Medicine. 12 (6) (pp
7683-7691), 2019. Date of Publication: 2019.
Author
Khan A.; Zhang H.; Auchoybur M.L.; Xu Y.; Qin W.; Qiu Z.; Chen W.; Chen X.
Institution
(Khan, Zhang, Auchoybur, Xu, Qin, Qiu, Chen, Chen) Department of Thoracic
and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical
University, Jiangsu, China
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: Despite various observational studies having been performed
regarding the supposed advantages of skeletonization of the internal
thoracic artery (ITA), its impact, especially on reducing the microscopic
injury, remains unclear. Method(s): Sixty patients (45 males, mean
age 67.2 +/- 8.6 years) undergoing isolated CABG surgery were enrolled
into the study and randomized into skeletonized (n = 33) and pedicled (n =
37) groups. Intraoperatively, the left ITA was harvested according to the
group to which the patient was assigned to, and ITA free flow was assessed
directly with an ultrasonic flow meter both before and after anastomosis
was completed. ITA harvest time and conduit length were also recorded. A
blinded assessment of pain and dysesthesia was performed. Sternal
perfusion was assessed preoperatively and during the 6-month follow-up
using SPECT fusion imaging (n = 33), by measuring active microcirculation
in the Volume of Interest (VOI). Result(s): The harvest time was
longer for skeletonized ITA (27.1 versus 24.1 minutes; P = 0.06). There
was a trend toward increased ITA length in the skeletonized group (18.2
+/- 0.3 versus 17.7 +/- 0.3 cm; P = 0.09). In situ ITA flow was higher in
skeletonized arteries upon direct measurement (10.1 +/- 1.0 versus 7.4 +/-
0.9 mL/min; P = 0.01) upon harvesting, but not on post-anastomotic
ultrasonic flow meter measurement (7.1 +/- 0.8 versus 6.3 +/- 1.7 mL/min;
P = 0.19) after anastomosis was completed. Skeletonization was associated
with decreased pain at the 6-month follow-up (0.79 +/- 0.17 versus 1.47
+/- 0.25; P = 0.05) and a reduction in major sensory deficits at the
6-month follow-up (17% versus 50%; P = 0.002). There was no significant
difference between either group in the baseline adjusted sternal
perfusion. Conclusion(s): Skeletonization results in reduced
postoperative pain and dysesthesia, improved conduit free flow and graft
length, while significantly increasing the duration required for ITA
harvest. Additionally, there was no significant difference in the extent
of damage to the microcirculation of the sternum between both pedicled and
skeletonized groups, suggesting that skeletonization is not advantageous
for maintaining sternal circulation. Copyright © 2019, E-Century
Publishing Corporation. All rights reserved.

<34>
Accession Number
2002440903
Title
Early Complete Revascularization in Hemodynamically Stable Patients With
ST-Segment Elevation Myocardial Infarction and Multivessel Disease.
Source
Canadian Journal of Cardiology. 35 (8) (pp 1047-1057), 2019. Date of
Publication: August 2019.
Author
Fortuni F.; Crimi G.; Angelini F.; Leonardi S.; D'Ascenzo F.; Ferlini M.;
Rolando M.; Raisaro A.; Oltrona Visconti L.; Ferrario M.; Gnecchi M.; De
Ferrari G.M.
Institution
(Fortuni, Leonardi, Rolando, Gnecchi, De Ferrari) Coronary Care Unit and
Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Fortuni, Leonardi, Rolando, Gnecchi, De Ferrari) Department of Molecular
Medicine, University of Pavia, Pavia, Italy
(Crimi, Ferlini, Raisaro, Oltrona Visconti, Ferrario) Division of
Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Angelini, D'Ascenzo) Division of Cardiology, University of Torino, Citta
della Salute e della Scienza Hospital, Turin, Italy
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The optimal strategy and timing of revascularization in
hemodynamically stable patients with ST-segment elevation myocardial
infarction and multivessel disease is unknown. We performed a systematic
review and meta-analysis to explore the comparative efficacy and safety of
early complete revascularization vs culprit-only or staged
revascularization in this setting. Method(s): We searched the
literature for randomized clinical trials that assessed this issue. Early
complete revascularization was defined as a complete revascularization
achieved during the index procedure or within 72 hours. Efficacy outcomes
were major adverse cardiovascular events, myocardial infarction, repeat
revascularization, and all-cause mortality. Safety outcomes were all
bleeding events, stroke, and contrast-induced acute kidney injury.
 Result(s): Nine randomized clinical trials with a total of 2837
patients were included; 1254 received early complete revascularization and
1583 were treated with other revascularization strategies. After a mean
follow-up of 15.3 +/- 9.4 months early complete revascularization was
associated with a lower risk of major adverse cardiovascular events
(relative risk [RR], 0.51; 95% confidence interval [CI], 0.41-0.62; P <
0.00001; number needed to treat = 8), myocardial infarction (RR, 0.59; 95%
CI, 0.40-0.87), and repeat revascularization (RR, 0.39; 95% CI, 0.28-0.55)
without any difference in all-cause mortality and in safety outcomes
compared with culprit-only or staged revascularization. Moreover,
fractional flow reserve-guided complete revascularization reduced the
incidence of repeat revascularization compared with angiography-guided
procedure (chi2 = 4.36; P = 0.04). Conclusion(s): Early
complete revascularization should be considered in hemodynamically stable
patients with ST-segment elevation myocardial infarction and multivessel
disease deemed suitable for percutaneous interventions. Fractional flow
reserve-guided complete revascularization might be superior to
angiography-guided procedures in reducing need for further
interventions. Copyright © 2019 Canadian Cardiovascular Society

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

<36>
Accession Number
628775534
Title
Mediastinitis in open heart surgery: a systematic review and meta-analysis
of risk factors.
Source
Scandinavian Cardiovascular Journal. (no pagination), 2019. Date of
Publication: 2019.
Author
Abdelnoor M.; Sandven I.; Vengen O.; Risnes I.
Institution
(Abdelnoor) Centre of Clinical Heart Research, Oslo University Hospital,
Oslo, Norway
(Abdelnoor) Epidemiology and Biological Statistics, Independent Health
Research Unit, Oslo, Norway
(Sandven) Oslo Centre of Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Vengen, Risnes) Department of Cardiovascular Surgery, Oslo University
Hospital, Oslo, Norway
(Risnes) Department of Cardiovascular Surgery, LHL Hospital, Gardemoen,
Norway
Publisher
Taylor and Francis Ltd
Abstract
Objective. We aimed to summarize the evidence from observational studies
examining the risk factors of the incidence of mediastinitis in open heart
surgery. Design. The study was a systematic review and meta-analysis of
cohorts and case-control studies. Material and methods. 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. Results. 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. Conclusion. 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. Copyright © 2019, © 2019
Informa UK Limited, trading as Taylor & Francis Group.

<37>
Accession Number
628783614
Title
A Double-Blind Randomized Controlled Trial to Determine the Preventive
Effect of Hangekobokuto on Aspiration Pneumonia in Patients Undergoing
Cardiovascular Surgery.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2019. Date of Publication: 18 Jul 2019.
Author
Kawago K.; Nishibe T.; Shindo S.; Inoue H.; Motohashi S.; Akasaka J.;
Ogino H.
Institution
(Kawago, Shindo, Inoue, Motohashi, Akasaka) Department of Cardiovascular
Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji,
Tokyo, Japan
(Kawago, Nishibe, Ogino) Department of Cardiovascular Surgery, Tokyo
Medical University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aimed to assess whether hangekobokuto (HKT) can
prevent aspiration pneumonia in patients undergoing cardiovascular
surgery. METHOD(S): We performed a single-center, double-blinded,
randomized, placebo-controlled study of HKT in patients undergoing
cardiovascular surgery. JPS HKT extract granule (JPS-16) was used as HKT.
The primary endpoint was defined as the prevention of postoperative
aspiration pneumonia. The secondary endpoints included complete recovery
from swallowing and coughing disorders. RESULT(S): Between August
2014 and August 2015, a total of 34 patients were registered in this
study. The rate of subjects with postoperative aspiration pneumonia was
significantly lower in the HKT group than in the placebo group (p =
0.017). In high-risk patients for aspiration pneumonia, the rate was
significantly lower in the HKT group than in the placebo group (p =
0.015). The rate of subjects with swallowing disorders tended to be lower
in the HKT group than in the placebo group (p = 0.091), and in high-risk
patients, the rate was significantly lower in the HKT group than in the
placebo group (p = 0.038). CONCLUSION(S): HKT can prevent aspiration
pneumonia in patients undergoing cardiovascular surgery. In high-risk
patients for aspiration pneumonia, HKT can prevent aspiration pneumonia
and improve swallowing disorders.

<38>
Accession Number
621250003
Title
Preoperative short-term calorie restriction for prevention of acute kidney
injury after cardiac surgery: A randomized, controlled, open-label, pilot
trial.
Source
Journal of the American Heart Association. 7 (6) (no pagination), 2018.
Article Number: e008181. Date of Publication: 20 Mar 2018.
Author
Grundmann F.; Muller R.-U.; Reppenhorst A.; Hulswitt L.; Spath M.R.;
Kubacki T.; Scherner M.; Faust M.; Becker I.; Wahlers T.; Schermer B.;
Benzing T.; Burst V.
Institution
(Grundmann, Muller, Reppenhorst, Hulswitt, Spath, Kubacki, Schermer,
Benzing, Burst) Department II of Internal Medicine, Center for Molecular
Medicine Cologne, University of Cologne, Germany
(Muller, Schermer, Benzing) Cologne Excellence Cluster on Cellular Stress
Responses in Aging-Associated Diseases (CECAD), University of Cologne,
Germany
(Scherner, Faust, Wahlers) Department of Cardiothoracic Surgery,
University of Cologne, Germany
(Faust) Center for Endocrinology, Diabetes and Preventive Medicine,
University of Cologne, Germany
(Becker) Institute of Medical Statistics and Computational Biology,
University of Cologne, Germany
Publisher
American Heart Association Inc.
Abstract
Background--Acute kidney injury is a frequent complication after cardiac
surgery and is associated with adverse outcomes. Although short-term
calorie restriction (CR) has proven protective in rodent models of acute
kidney injury, similar effects have not yet been demonstrated in humans.
Methods and Results--CR_KCH (Effect of a Preoperative Calorie Restriction
on Renal Function After Cardiac Surgery) is a randomized controlled trial
in patients scheduled for cardiac surgery. Patients were randomly assigned
to receive either a formula diet containing 60% of the daily energy
requirement (CR group) or ad libitum food (control group) for 7 days
before surgery. In total, 82 patients were enrolled between April 16,
2012, and February 5, 2015. There was no between-group difference in the
primary end point of median serum creatinine increment after 24 hours
(control group: 0.0 mg/dL [-0.1 - (+0.2) mg/dL]; CR group: 0.0 mg/dL [-0.2
- (+0.2) mg/dL]; P=0.39). CR prevented a rise in median creatinine at 48
hours (control group: +0.1 mg/dL [0.0 - 0.3 mg/dL]; CR group: -0.1 mg/dL
[-0.2 - (+0.1) mg/dL]; P=0.03), with most pronounced effects observed in
male patients and patients with a body mass index > 25. This benefit
persisted until discharge: Median creatinine decreased by 0.1 mg/dL (-0.2
- 0.0 mg/dL) in the CR group, whereas it increased by 0.1 mg/dL (0.0 - 0.3
mg/dL; P=0.0006) in the control group. Incidence of acute kidney injury
was reduced by 5.8% (41.7% in the CR group compared with 47.5% in the
control group). Safety-related events did not differ between groups.
Conclusions--Despite disappointing results with respect to creatinine rise
within the first 24 hours, the benefits observed at later time points and
the subgroup analyses suggest the protective potential of short-term CR in
patients at risk for acute kidney injury, warranting further
investigation. Copyright © 2018 The Authors.

<39>
Accession Number
621249995
Title
Cognitive function before and after left heart catheterization.
Source
Journal of the American Heart Association. 7 (6) (no pagination), 2018.
Article Number: e008004. Date of Publication: 20 Mar 2018.
Author
Scott D.A.; Evered L.; Maruff P.; MacIsaac A.; Maher S.; Silbert B.S.
Institution
(Scott, Evered, Maher, Silbert) Centre for Anaesthesia and Cognitive
Function, Department of Anaesthesia and Acute Pain Medicine, St Vincent's
Hospital, Melbourne, Australia
(MacIsaac) Department of Cardiology, St Vincent's Hospital, Melbourne,
Australia
(Scott, Evered, Silbert) Anaesthesia, Perioperative and Pain Medicine
Unit, Melbourne Medical School, University of Melbourne, Australia
(MacIsaac) Department of Medicine, University of Melbourne, Australia
(Maruff) Florey Institute for Neuroscience and Mental Health, Parkville,
VIC, Australia
Publisher
American Heart Association Inc.
Abstract
Background--Hospital procedures have been associated with cognitive change
in older patients. This study aimed to document the prevalence of mild
cognitive impairment in individuals undergoing left heart catheterization
(LHC) before the procedure and the incidence of cognitive decline to 3
months afterwards. Methods and Results--We conducted a prospective,
observational, clinical investigation of elderly participants undergoing
elective LHC. Cognition was assessed using a battery of written tests and
a computerized cognitive battery before the LHC and then at 3 months
afterwards. The computerized tests were also administered at 24 hours (or
discharge) and 7 days after LHC. A control group of 51 community
participants was recruited to calculate cognitive decline using the
Reliable Change Index. Of 437 participants, mild cognitive impairment was
identified in 226 (51.7%) before the procedure. Computerized tests
detected an incidence of cognitive decline of 10.0% at 24 hours and 7.5%
at 7 days. At 3 months, written tests detected an incidence of cognitive
decline of 13.1% and computerized tests detected an incidence of 8.5%.
Cognitive decline at 3 months using written tests was associated with
increasing age, whereas computerized tests showed cognitive decline was
associated with baseline amnestic mild cognitive impairment, diabetes
mellitus, and prior coronary stenting. Conclusions--More than half the
patients aged > 60 years presenting for LHC have mild cognitive
impairment. LHC is followed by cognitive decline in 8% to 13% of
individuals at 3 months after the procedure. Subtle cognitive decline both
before and after LHC is common and may have important clinical
implications. Copyright © 2018 The Authors.

<40>
Accession Number
628707210
Title
Timing of clopidogrel loading dose on peripheral blood endothelial
progenitor cells, SDF-1alpha and neointimal hyperplasia in carotid
stenting.
Source
Clinical Hemorheology and Microcirculation. 72 (1) (pp 23-38), 2019. Date
of Publication: 2019.
Author
Di Stolfo G.; Mastroianno S.; Ruggieri M.; Fontana A.; Marinucci R.;
Copetti M.; Minervini M.M.; Savino L.; Mastroianno M.; Savino M.; Pacilli
M.A.; Di Mauro L.; Potenza D.R.; Cascavilla N.; Paroni G.; Russo A.
Institution
(Di Stolfo, Mastroianno, Pacilli, Potenza, Russo) Cardiology Unit,
Cardiovascular Department, Fondazione IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo (FG), Italy
(Ruggieri, Marinucci, Paroni) Vascular Surgery Unit, Cardiolovascular
Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni
Rotondo (FG), Italy
(Fontana, Copetti) Unit of Biostatistics, Fondazione IRCCS Casa Sollievo
della Sofferenza, San Giovanni Rotondo (FG), Italy
(Minervini, Savino, Cascavilla) Hematology Unit, Onco-hematology
Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni
Rotondo (FG), Italy
(Mastroianno) Unit of Information Systems and Innovation Research,
Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
(FG), Italy
(Savino, Di Mauro) Transfusion Medicine Unit and Laboratory of Clinical
Chemistry, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni
Rotondo (FG), Italy
Publisher
IOS Press (Nieuwe Hemweg 6B, Amsterdam 1013 BG, Netherlands)
Abstract
BACKGROUND: Carotid stenting stimulates intimal proliferation through
platelet and stem cell activation. OBJECTIVE(S): The aim of this
study is to evaluate whether the administration before or after carotid
stenting of clopidogrel loading dose may play a role on circulating
endothelial progenitor cells, stromal cell-derived factor-1alpha
(SDF-1alpha) and neointimal hyperplasia. METHOD(S): We recruited 13
patients (aged 74.52+/-7.23) with indication of carotid revascularization
and in therapy with salicylic acid and statin. We blindly randomized them
in two groups: pre-carotid angioplasty with stent (Pre-CAS group)
receiving 300 mg of clopidogrel before stenting, and post-carotid
angioplasty with stent (Post-CAS group) receiving 300 mg after stenting.
At the admission, we valued endothelial progenitor cells, SDF-1alpha and
prospectively we repeated blood samples and measured intima-media
thickness to estimate neointimal hyperplasia on the stent at 3, 6 and 12
months. RESULT(S): In the days following the CAS, we found a lower,
statistically not significant, trend of endothelial progenitor cells in
Pre-CAS group. The SDF-1alpha concentration tended to be lower at baseline
in the pre-CAS group than in the post-CAS group and it did not show an
increase in the observed time. On the contrary, in the Post-CAS group we
observed a peak at six hours with a significant reduction (p < 0.001) at
one day after stenting. The intima-media thickness was significantly lower
in the Pre-CAS group than the Post-CAS group both at six months and 12
months after stenting. CONCLUSION(S): Pre-stenting clopidogrel
loading dose leaded to short-time modification of endothelial progenitor
cells and platelets and to long-term a minor neointimal
hyperplasia. Copyright © 2019 - IOS Press and the authors. All
rights reserved.

<41>
Accession Number
625852777
Title
Post-transplant diabetes mellitus in patients with solid organ
transplants.
Source
Nature Reviews Endocrinology. 15 (3) (pp 172-188), 2019. Date of
Publication: 01 Mar 2019.
Author
Jenssen T.; Hartmann A.
Institution
(Jenssen, Hartmann) Department of Transplantation Medicine, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Jenssen, Hartmann) Institute of Clinical Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Solid organ transplantation (SOT) is a life-saving procedure and an
established treatment for patients with end-stage organ failure. However,
transplantation is also accompanied by associated cardiovascular risk
factors, of which post-transplant diabetes mellitus (PTDM) is one of the
most important. PTDM develops in 10-20% of patients with kidney
transplants and in 20-40% of patients who have undergone other SOT. PTDM
increases mortality, which is best documented in patients who have
received kidney and heart transplants. PTDM results from predisposing
factors (similar to type 2 diabetes mellitus) but also as a result of
specific post-transplant risk factors. Although PTDM has many
characteristics in common with type 2 diabetes mellitus, the prevention
and treatment of the two disorders are often different. Over the past 20
years, the lifespan of patients who have undergone SOT has increased, and
PTDM becomes more common over the lifespan of these patients. Accordingly,
PTDM becomes an important condition not only to be aware of but also to
treat. This Review presents the current knowledge on PTDM in patients
receiving kidney, heart, liver and lung transplants. This information is
not only for transplant health providers but also for endocrinologists and
others who will meet these patients in their clinics. Copyright ©
2018, Springer Nature Limited.

<42>
Accession Number
628694384
Title
Landscape of Cardiovascular Device Registries in the United States.
Source
Journal of the American Heart Association. 8 (11) (no pagination), 2019.
Article Number: e012756. Date of Publication: 04 Jun 2019.
Author
Rajan P.V.; Holtzman J.N.; Kesselheim A.S.; Yeh R.W.; Kramer D.B.
Institution
(Rajan, Holtzman, Yeh, Kramer) Richard A. and Susan F. Smith Center for
Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Rajan, Holtzman, Kesselheim, Yeh, Kramer) Harvard Medical School, Boston,
MA, United States
(Kesselheim) Program on Regulation, Therapeutics, and Law (PORTAL),
Department of Pharmacoepidemiology and Pharmacoeconomics, Brigham and
Women's Hospital, Boston, MA, United States
Publisher
American Heart Association Inc.
Abstract
Background: Regulators increasingly rely on registries for decision making
related to high-risk medical devices in the United States. However, the
limited uniform standards for registries may create substantial
variability in registry implementation and utility to regulators. We
surveyed the current landscape of US cardiovascular device registries and
chart the extent of inconsistency in goals, administration, enrollment
procedures, and approach to data access. Methods and Results: A
systematic review using Preferred Reporting Items for Systematic Reviews
and Meta-Analysis (PRISMA) guidelines identified studies (1995-2017)
referencing cardiovascular device registries with a US-based institution.
Registries were then evaluated by reviewing associated articles and
websites. Extracted data included device type, primary scientific aim(s),
funding, stewardship (eg, administration of registry procedures),
enrollment procedures, informed consent process, and mechanisms to access
data for research. The 138 cardiovascular device registries in the cohort
covered devices addressing interventional cardiology (65.9%), arrhythmias
(15.2%), heart failure (10.1%), and valvular disease (10.1%). While the
majority (55.8%) were industry-funded, stewardship was predominantly
overseen by academic centers (74.0%). Most registry participation was
voluntary (77.5%), but a substantial minority (19.7%) were required as a
condition of device implantation. Informed consent requirements varied
widely, with written consent required in only 55.1% of registries.
Registry data were primarily accessible only to stewards (84.1%), with
13.8% providing pathways for external applications. Conclusion(s):
The majority of cardiovascular device registries were funded privately
under the auspices of academic institutions, which set the rules for data
access. The substantial variation between cardiovascular device registries
suggests a role for regulators to further strengthen guidelines to improve
quality, consistency, and ethical standards. Copyright © 2019 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

<43>
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. Copyright ©
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).

<44>
Accession Number
628578019
Title
Comparison of Major Adverse Cardiac Events between Instantaneous Wave-Free
Ratio and Fractional Flow Reserve-Guided Strategy in Patients with or
Without Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical
Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Lee J.M.; Choi K.H.; Koo B.-K.; Dehbi H.-M.; Doh J.-H.; Nam C.-W.; Shin
E.-S.; Cook C.M.; Al-Lamee R.; Petraco R.; Sen S.; Malik I.S.; Nijjer
S.S.; Mejia-Renteria H.; Alegria-Barrero E.; Alghamdi A.; Altman J.;
Baptista S.B.; Bhindi R.; Bojara W.; Brugaletta S.; Silva P.C.; Di Mario
C.; Erglis A.; Gerber R.T.; Going O.; Harle T.; Hellig F.; Indolfi C.;
Janssens L.; Jeremias A.; Kharbanda R.K.; Khashaba A.; Kikuta Y.;
Krackhardt F.; Laine M.; Lehman S.J.; Matsuo H.; Meuwissen M.; Niccoli G.;
Piek J.J.; Ribichini F.; Samady H.; Sapontis J.; Seto A.H.; Sezer M.;
Sharp A.S.P.; Singh J.; Takashima H.; Talwar S.; Tanaka N.; Tang K.; Van
Belle E.; Van Royen N.; Vinhas H.; Vrints C.J.; Walters D.; Yokoi H.;
Samuels B.; Buller C.; Patel M.R.; Serruys P.; Escaned J.; Davies J.E.
Institution
(Lee, Choi) Samsung Medical Center, Sungkyunkwan University, School of
Medicine, Seoul, South Korea
(Koo) Seoul National University Hospital, Institute on Aging, Seoul
National University, Seoul, South Korea
(Dehbi) Cancer Research UK, University College London Cancer Trials
Centre, University College London, London, United Kingdom
(Doh) Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea
(Nam) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Shin) Ulsan Hospital, Ulsan, South Korea
(Cook, Al-Lamee, Petraco, Sen, Malik, Nijjer, Serruys, Davies) Hammersmith
Hospital, Imperial College London, London, United Kingdom
(Mejia-Renteria, Escaned) Hospital Clinico San Carlos, IDISSC, Universidad
Complutense de Madrid, Madrid, Spain
(Alegria-Barrero) Hospital Universitario de Torrejon, Universidad
Francisco de Vitoria, Madrid, Spain
(Alghamdi) King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi
Arabia
(Altman) Colorado Heart and Vascular, Lakewood, CO, United States
(Baptista) Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal
(Bhindi) Royal North Shore Hospital, Sydney, Australia
(Bojara) Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz,
Germany
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
(Silva) Hospital Santa Maria, Lisbon, Portugal
(Di Mario) Royal Brompton Hospital, Imperial College London, London,
United Kingdom
(Di Mario) University of Florence, Florence, Italy
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
(Gerber) Conquest Hospital, St Leonards-on-Sea, United Kingdom
(Going) Sana Klinikum Lichtenberg, Lichtenberg, Germany
(Harle) Klinikum Oldenburg, European Medical School, Carl von Ossietzky
University, Oldenburg, Germany
(Hellig) Sunninghill Hospital, Johannesburg, South Africa
(Indolfi) University Magna Graecia, Catanzaro, Italy
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Jeremias) Stony Brook University Medical Center, New York, NY, United
States
(Kharbanda) John Radcliffe Hospital, Oxford University Hospitals
Foundation Trust, Oxford, United Kingdom
(Khashaba) Ain Shams University, Cairo, Egypt
(Kikuta) Fukuyama Cardiovascular Hospital, Fukuyama, Japan
(Krackhardt) Charite Campus Virchow Klinikum, Universitaetsmedizin,
Berlin, Germany
(Laine) Helsinki University Hospital, Helsinki, Finland
(Lehman) Flinders University, Adelaide, SA, Australia
(Matsuo) Gifu Heart Center, Gifu, Japan
(Meuwissen) Amphia Hospital, Breda, Netherlands
(Niccoli) Catholic University of the Sacred Heart, Rome, Italy
(Piek) AMC Heart Center, Academic Medical Center, Amsterdam, Netherlands
(Ribichini) University Hospital Verona, Verona, Italy
(Samady) Emory University, Atlanta, GA, United States
(Sapontis) Monash Heart, Monash University, Melbourne, VIC, Australia
(Seto) Veterans Affairs Long Beach Healthcare System, Long Beach, CA,
United States
(Sezer) Istanbul University, Istanbul Faculty of Medicine, Istanbul,
Turkey
(Sharp) Royal Devon and Exeter Hospital, Exeter, United Kingdom
(Sharp) University of Exeter, Exeter, United Kingdom
(Singh) Washington University School of Medicine in St Louis, St Louis,
MO, United States
(Takashima) Aichi Medical University Hospital, Aichi, Japan
(Talwar) Royal Bournemouth General Hospital, Bournemouth, United Kingdom
(Tanaka) Tokyo Medical University, Tokyo, Japan
(Tang) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Tang) Anglia Ruskin University, Chelmsford, United Kingdom
(Van Belle) Institut Coeur Poumon, Lille University Hospital, Lille,
France
(Van Belle) INSERM Unite 1011, Lille, France
(Van Royen) VU University Medical Center, Amsterdam, Netherlands
(Vinhas) Hospital Garcia de Horta, Lisbon, Portugal
(Vrints) Antwerp University Hospital, Antwerp, Belgium
(Walters) Prince Charles Hospital, Brisbane, QLD, Australia
(Yokoi) Fukuoka Sannou Hospital, Fukuoka, Japan
(Samuels) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Buller) St Michaels Hospital, Toronto, ON, Canada
(Patel) Duke University, Durham, NC, United States
(Shin) Ulsan University Hospital, University of Ulsan, College of
Medicine, Ulsan, South Korea
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Invasive physiologic indices such as fractional flow reserve
(FFR) and instantaneous wave-free ratio (iFR) are used in clinical
practice. Nevertheless, comparative prognostic outcomes of iFR-guided and
FFR-guided treatment in patients with type 2 diabetes have not yet been
fully investigated. Objective(s): To compare 1-year clinical outcomes
of iFR-guided or FFR-guided treatment in patients with and without
diabetes in the Functional Lesion Assessment of Intermediate Stenosis to
Guide Revascularization (DEFINE-FLAIR) trial. Design, Setting, and
Participant(s): The DEFINE-FLAIR trial is a multicenter, international,
randomized, double-blinded trial that randomly assigned 2492 patients in a
1:1 ratio to undergo either iFR-guided or FFR-guided coronary
revascularization. Patients were eligible for trial inclusion if they had
intermediate coronary artery disease (40%-70% diameter stenosis) in at
least 1 native coronary artery. Data were analyzed between January 2014
and December 2015. Intervention(s): According to the study protocol,
iFR of 0.89 or less and FFR of 0.80 or less were used as criteria for
revascularization. When iFR or FFR was higher than the prespecified
threshold, revascularization was deferred. Main Outcomes and
Measures: The primary end point was major adverse cardiac events (MACE),
defined as the composite of all-cause death, nonfatal myocardial
infarction, or unplanned revascularization at 1 year. The incidence of
MACE was compared according to the presence of diabetes in iFR-guided and
FFR-guided groups. Result(s): Among the total trial population (2492
patients), 758 patients (30.4%) had diabetes. Mean age of the patients was
66 years, 76% were men (1868 of 2465), and 80% of patients presented with
stable angina (1983 of 2465). In the nondiabetes population (68.5%; 1707
patients), iFR guidance was associated with a significantly higher rate of
deferral of revascularization than the FFR-guided group (56.5% [n = 477 of
844] vs 46.6% [n = 402 of 863]; P <.001). However, it was not different
between the 2 groups in the diabetes population (42.1% [n = 161 of 382] vs
47.1% [n = 177 of 376]; P =.15). At 1 year, the diabetes population showed
a significantly higher rate of MACE than the nondiabetes population (8.6%
vs 5.6%; adjusted hazard ratio [HR], 1.88; 95% CI, 1.28-2.64; P <.001).
However, there was no significant difference in MACE rates between
iFR-guided and FFR-guided groups in both the diabetes (10.0% vs 7.2%;
adjusted HR, 1.33; 95% CI, 0.78-2.25; P =.30) and nondiabetes population
(4.7% vs 6.4%; HR, 0.83; 95% CI, 0.51-1.35; P =.45) (interaction P =.25).
 Conclusions and Relevance: The diabetes population showed
significantly higher risk of MACE than the nondiabetes population, even
with the iFR-guided or FFR-guided treatment. The iFR-guided and FFR-guided
treatment showed comparable risk of MACE and provided equal safety in
selecting revascularization target among patients with diabetes. Trial
Registration: ClinicalTrials.gov identifier: NCT02053038. Copyright
© 2019 American Medical Association. All rights reserved.

<45>
Accession Number
628573832
Title
Effect of Simvastatin-Ezetimibe Compared with Simvastatin Monotherapy
after Acute Coronary Syndrome among Patients 75 Years or Older: A
Secondary Analysis of a Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Bach R.G.; Cannon C.P.; Giugliano R.P.; White J.A.; Lokhnygina Y.; Bohula
E.A.; Califf R.M.; Braunwald E.; Blazing M.A.
Institution
(Bach) Cardiovascular Division, Department of Medicine, Washington
University, School of Medicine, St Louis, MO, United States
(Cannon, Giugliano, Bohula, Braunwald) TIMI Study Group, Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA, United States
(White, Lokhnygina, Califf, Blazing) Duke Clinical Research Institute,
Division of Cardiology, Department of Medicine, Duke University, Durham,
NC, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Limited evidence is available regarding the benefit and hazard
of higher-intensity treatment to lower lipid levels among patients 75
years or older. As a result, guideline recommendations differ for this age
group compared with younger patients. Objective(s): To determine the
effect on outcomes and risks of combination ezetimibe and simvastatin
compared with simvastatin monotherapy to lower lipid levels among patients
75 years or older with stabilized acute coronary syndrome (ACS). Design,
Setting, Participants: In this prespecified secondary analysis of the
global, multicenter, prospective clinical randomized Improved Reduction of
Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), outcomes and
risks were compared by age among patients 50 years or older after a
hospitalization for ACS. Data were collected from October 26, 2005,
through July 8, 2010, with the database locked October 21, 2014. Data were
analyzed May 29, 2015, through March 13, 2018, using Kaplan-Meier curves
and Cox proportional hazards models. Intervention(s): Double-blind
randomized assignment to combined simvastatin and ezetimibe or simvastatin
and placebo with follow-up for a median of 6 years (interquartile range,
4.3-7.1 years). Main Outcomes and Measures: The primary composite end
point consisted of death due to cardiovascular disease, myocardial
infarction (MI), stroke, unstable angina requiring hospitalization, and
coronary revascularization after 30 days. Individual adverse ischemic and
safety end points and lipid variables were also analyzed. Result(s):
Of 18144 patients enrolled (13 728 men [75.7%]; mean [SD] age, 64.1 [9.8]
years), 5173 (28.5%) were 65 to 74 years old, and 2798 (15.4%) were 75
years or older at randomization. Treatment with simvastatin-ezetimibe
resulted in lower rates of the primary end point than simvastatin-placebo,
including 0.9% for patients younger than 65 years (HR, 0.97; 95% CI,
0.90-1.05) and 0.8% for patients 65 to 74 years of age (hazard ratio [HR],
0.96; 95% CI, 0.87-1.06), with the greatest absolute risk reduction of
8.7% for patients 75 years or older (HR, 0.80; 95% CI, 0.70-0.90) (P =.02
for interaction). The rate of adverse events did not increase with
simvastatin-ezetimibe vs simvastatin-placebo among younger or older
patients. Conclusions and Relevance: In IMPROVE-IT, patients
hospitalized for ACS derived benefit from higher-intensity therapy to
lower lipid levels with simvastatin-ezetimibe compared with simvastatin
monotherapy, with the greatest absolute risk reduction among patients 75
years or older. Addition of ezetimibe to simvastatin was not associated
with any significant increase in safety issues among older patients. These
results may have implications for guideline recommendations regarding
lowering of lipid levels in the elderly. Trial Registration:
ClinicalTrials.gov identifier: NCT00202878. Copyright © 2019
American Medical Association. All rights reserved.

<46>
Accession Number
626999726
Title
American Society for Enhanced Recovery and Perioperative Quality
Initiative-4 Joint Consensus Statement on Persistent Postoperative Opioid
Use: Definition, Incidence, Risk Factors, and Health Care System
Initiatives.
Source
Anesthesia and analgesia. 129 (2) (pp 543-552), 2019. Date of Publication:
01 Aug 2019.
Author
Kent M.L.; Hurley R.W.; Oderda G.M.; Gordon D.B.; Mythen M.; Miller T.E.;
Shaw A.D.; Gan T.J.; Thacker J.K.M.; McEvoy M.D.; Argoff C.; Edwards D.A.;
Geiger T.M.; Grant M.C.; Grocott M.; Gulur P.; Gupta R.; Hah J.M.; Hedrick
T.L.; Holubar S.D.; Jayaram J.; King A.B.; Mythen M.G.; Sun E.; Wu C.L.
Institution
(Kent, Miller) From the Department of Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Hurley) Departments of Anesthesiology and Public Health Sciences, Wake
Forest University School of Medicine, Winston Salem, NC, United States
(Oderda) College of Pharmacy, University of Utah, Salt Lake City, UT,
United States
(Gordon) Department of Anesthesiology and Pain Medicine, University of
Washington, Seattle, WA, United States
(Sun) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University, Palo Alto, CA, United States
(Mythen) University College London National Institute of Health Research
(NIHR) Biomedical Research Centre, London, United Kingdom
(Shaw) Department of Anesthesiology and Pain Medicine, University of
Alberta, Edmonton, AB, Canada
(Gan) Department of Anesthesiology, Stony Brook School of Medicine, Stony
Brook, NY, United States
(Thacker) Division of Advanced Oncologic and Gastrointestinal Surgery,
Duke University Medical Center, Durham, NC, United States
(McEvoy) Department of Anesthesiology, Vanderbilt University Medical
Center, Nashville, TN, United States
Publisher
NLM (Medline)
Abstract
Persistent postoperative opioid use is thought to contribute to the
ongoing opioid epidemic in the United States. However, efforts to study
and address the issue have been stymied by the lack of a standard
definition, which has also hampered efforts to measure the incidence of
and risk factors for persistent postoperative opioid use. The objective of
this systematic review is to (1) determine a clinically relevant
definition of persistent postoperative opioid use, and (2) characterize
its incidence and risk factors for several common surgeries. Our approach
leveraged a group of international experts from the Perioperative Quality
Initiative-4, a consensus-building conference that included representation
from anesthesiology, surgery, and nursing. A search of the medical
literature yielded 46 articles addressing persistent postoperative opioid
use in adults after arthroplasty, abdominopelvic surgery, spine surgery,
thoracic surgery, mastectomy, and thoracic surgery. In opioid-naive
patients, the overall incidence ranged from 2% to 6% based on
moderate-level evidence. However, patients who use opioids preoperatively
had an incidence of >30%. Preoperative opioid use, depression, factors
associated with the diagnosis of substance use disorder, preoperative
pain, and tobacco use were reported risk factors. In addition, while
anxiety, sex, and psychotropic prescription are associated with persistent
postoperative opioid use, these reports are based on lower level evidence.
While few articles addressed the health policy or prescriber
characteristics that influence persistent postoperative opioid use,
efforts to modify prescriber behaviors and health system characteristics
are likely to have success in reducing persistent postoperative opioid
use.

<47>
Accession Number
2002288970
Title
Meta-Analysis Comparing the Risk of Myocardial Infarction Following
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients With Multivessel or Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Lee P.H.; Park H.; Lee J.S.; Lee S.-W.; Lee C.W.
Institution
(Lee, Park, Lee, Lee) Division of Cardiology, Department of Internal
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
(Lee) Department of Clinical Epidemiology and Biostatistics, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
(Lee) Clinical Research Center, Asan Institute for Life Sciences, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
There is insufficient data regarding the comparative efficacy of coronary
artery bypass graft surgery (CABG) and percutaneous coronary intervention
(PCI) regarding myocardial infarction (MI). Our systematic review included
randomized controlled trials that compared CABG versus PCI with stents in
patients with multivessel or left main coronary artery disease (CAD).
Included trials should have had reported event number of MI and a clinical
follow-up of one or more years. Data were pooled using a random-effects
model. The primary end point was MI at the longest available follow-up in
the intention-to-treat population. Fifteen trials with a total of 13,592
patients treated with either CABG (n = 6,596) or PCI (n = 6,996) were
included. After a weighted follow-up of 4.5 years, patients treated with
CABG had a significantly lower risk of MI than those treated with PCI
(risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58 to 0.96, p =
0.024). The lower risk of MI with CABG as compared with PCI was more
evident during a longer duration of follow-up (>=3 years, RR 0.69, 95% CI
0.52 to 0.91, p = 0.008; >=5 years, RR 0.64, 95% CI 0.48 to 0.86, p =
0.003) and in the diabetic population (RR 0.55, 95% CI 0.44 to 0.70, p
<0.001). The magnitude of risk reduction was similar across patients with
multivessel (RR 0.72, 95% CI 0.53 to 0.99) and left main CAD (RR 0.74, 95%
CI 0.47 to 1.15). In conclusion, the present meta-analysis of studies
involving patients with multivessel or left main CAD suggests a
significant benefit of CABG over PCI concerning the risk of future
MI. Copyright © 2019 Elsevier Inc.

<48>
Accession Number
627552625
Title
Effects of transthoracic device closure on ventricular septal defects and
reasons for conversion to open-heart surgery: A meta-analysis.
Source
Scientific reports. 7 (1) (pp 12219), 2017. Date of Publication: 22 Sep
2017.
Author
Zhou Y.; Liu L.-X.; Zhao F.; Tang S.-H.; Peng H.-L.; Jiang Y.-H.
Institution
(Zhou, Liu, Zhao, Tang, Peng) Department of Cardiothoracic Surgery,
People's Hospital of Leshan, Leshan, Sichuan Province 614000, China
(Jiang) Department of Cardiovascular Surgery, Xinqiao Hospital, Third
Military Medical University, Chongqing 400030, China
Publisher
NLM (Medline)
Abstract
Transthoracic device closure (TTDC) is thought to be a promising
technology for the repair of ventricular septal defects (VSDs). However,
there is considerable controversy regarding the efficacy and safety of
TTDC. The present study aimed to compare the benefits and safety of TTDC
with those of conventional open-heart surgery (COHS) and analyze the
associated factors causing complications, conversion to COHS and
reoperation. Electronic database searches were conducted in PubMed,
EMBASE, Cochrane Library, Clinicaltrials.gov and several Chinese
databases. A total of 5 randomized controlled trials (RCTs), 7 cohort
studies, 13 case-control studies, 129 case series and 13 case reports were
included. Compared to COHS, TTDC exhibited superior efficacy with a
significantly lower risk of post-operative arrhythmia; however, no
significant differences in other outcomes were identified. Meta-regression
analysis showed that perimembranous VSDs (pmVSDs), a smaller VSD, a
smaller occluder, and a median or subxiphoid approach lowered the relative
risk of several post-operative complications, conversion to COHS and
reoperation. The current evidence indicates that TTDC is associated with a
lower risk of post-operative arrhythmia and is not associated with an
increased risk of complications. PmVSDs, a smaller VSD and occluder, and a
median or subxiphoid approach correlate with better outcomes when using
TTDC.

<49>
Accession Number
2002432690
Title
Incidence and Predictors of Readmission with Gastrointestinal Bleeding in
Patients with Left Ventricular Assist Devices: A Nationwide 5-Year
Analysis.
Source
Gastroenterology. Conference: DDW 2018 - Digestive Disease Week. United
States. 154 (6 Supplement 1) (pp S-465-S-466), 2018. Date of Publication:
May 2018.
Author
Shah R.; Qayed E.S.
Publisher
W.B. Saunders
Abstract
Background: GI bleeding is a major comorbidity in patients with left
ventricular assist devices (LVAD). This study aims to evaluate the rate,
patterns, and predictors of GI bleeding readmissions in congestive heart
failure (CHF) patients post LVAD implantation using a nationally
representative sample. Method(s): We performed a retrospective
matched cohort study by analyzing data from the national readmission
database (NRD) from 2010 through 2014. We compared hospitalized adult
patients with CHF who underwent LVAD implantation, with CHF patients
without LVAD or heart transplant (controls). Three age and sex-matched
controls were randomly selected per one case. We excluded patients who
died during the hospitalization and those who were discharged in the month
of November and December. A multivariate Cox regression model was used to
compare the hazards of 60-day all-cause and GI bleeding readmission
between the groups, controlling for significant confounders.
 Result(s): A total of 3,293 hospitalized CHF patients who had LVAD
placement (cases) and 9,879 who did not have LVAD (controls) were included
in the study (Table 1). At 60 days, LVAD patients had a significantly
higher readmission rate with GI bleeding (8.7% vs. 2.3%, adjusted HR 4.45,
95% CI 3.71-5.33, p<.0001). The all-cause readmission rate was also higher
(43.3% vs. 35.7%, aHR 1.23, 1.12-1.34, p<.0001) (figure 1). The most
common etiology of bleeding in LVAD patients during readmissions were
gastroduodenal and small intestinal AVMs (28.6%). During bleeding
readmissions, LVAD patients were more likely to receive endoscopy (72.1%
vs. 33.5%, p<.0001), and packed RBC transfusion (62% vs 36.6%, p<.0001)
compared to controls. Independent risk factors for 60-day readmission with
GI bleeding in LVAD patients were increasing age (aHR 1.04, 1.03-1.05,
p<.0001) and GI bleeding during index admission (aHR 2.68, 1.95-3.7,
p<.0001). Conclusion(s): After LVAD implantation, CHF patients have
approximately 5-fold increased risk of readmission with GI bleeding within
60 days. Gastroduodenal and small intestinal AVMs are the most common
culprit lesions. Small bowel enteroscopy should be considered as the
initial test of choice in patients with suspected upper GI or small
intestinal bleeding. Further studies should evaluate the role of
aggressive risk factor modification in reducing the risk of GI bleeding
readmission, especially in older patients with bleeding during index
admission for LVAD placement. [Figure Presented] Copyright © 2018
AGA Institute

<50>
Accession Number
2002202151
Title
Ultrasound-guided continuous serratus anterior plane block:
Dexmedetomidine as an adjunctive analgesic with levobupivacaine for
post-thoracotomy pain. A prospective randomized controlled study.
Source
Journal of Pain Research. 12 (pp 1425-1431), 2019. Date of Publication:
2019.
Author
Abdallah N.M.; Bakeer A.H.; Youssef R.B.; Zaki H.V.; Abbas D.N.
Institution
(Abdallah) Department of Anesthesia and Pain Management, Surgical ICU,
Faculty of Medicine, Cairo University, Cairo, Egypt
(Bakeer, Abbas) Department of Anesthesia and Pain Management, National
Cancer Institute, Cairo University, Cairo, Egypt
(Youssef) Department of Anesthesia, Surgical ICU and Pain Management,
Faculty of Medicine, Helwan University, Cairo, Egypt
(Zaki) Department of Anesthesia, Surgical ICU and Pain Management, Faculty
of Medicine, Ain Shams University, Cairo, Egypt
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: The study aimed to evaluate the analgesic efficiency of
dexmedetomidine (DEX) when added to levobupivacaine in continuous
ultrasound-guided serratus anterior plane block (SAPB) performed at the
end of major thoracic surgery. Method(s): This randomized,
double-blind trial included 50 adults undergoing thoracic surgery.
Continuous SAPB was performed at the end of surgery. Patients were
randomized into two groups. Group L (n=25) received levobupivacaine only
while Group DL (n=25) received a mixture of levobupivacaine and DEX. All
patients received intravenous (IV) paracetamol every 8 hrs. Morphine IV
was given according to VAS score of pain as a 5 mg loading dose. The
primary outcome measure was postoperative pain intensity. Secondary
outcome measures were postoperative morphine consumption and adverse
effects. Result(s): Analgesia was satisfactory in the two groups up
to 24 hrs. VAS score was significantly lower in group DL compared to group
L between 6 and 24 hrs postoperatively. Total morphine consumption was
significantly lower in group DL compared to group L (p<0.001). Up to 12
hrs postoperatively, sedation score was significantly lower in group DL
compared to group L. Afterwards, all patients were fully alert. All values
of mean arterial pressure and heart rate were within the clinically
accepted ranges. There were no recorded cases of hypotension or
bradycardia in the whole studied group. Conclusion(s): Continuous
SAPB with levobupivacaine plus DEX seems to be a promising analgesic
alternative following thoracotomy. Combined with IV paracetamol, this
approach provided adequate analgesia and proper sedation. Copyright
© 2019 Abdallah et al.

<51>
Accession Number
2002448855
Title
Bilateral or unilateral antegrade cerebral perfusion during surgery for
acute type A dissection.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Angleitner P.; Stelzmueller M.-E.; Mahr S.; Kaider A.; Laufer G.; Ehrlich
M.
Institution
(Angleitner, Stelzmueller, Mahr, Laufer, Ehrlich) Division of Cardiac
Surgery, Department of Surgery, Medical University of Vienna, Vienna,
Austria
(Kaider) Center for Medical Statistics, Informatics, and Intelligent
Systems, Medical University of Vienna, Vienna, Austria
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to investigate outcomes associated with
the application of bilateral or unilateral antegrade cerebral perfusion
during surgery for acute type A dissection. Method(s): Patients who
underwent surgery for type A dissection with the application of antegrade
cerebral perfusion between 2009 and 2017 at the Division of Cardiac
Surgery, Medical University of Vienna were analyzed retrospectively
(bilateral antegrade cerebral perfusion: n = 91, 49.5%; unilateral
antegrade cerebral perfusion: n = 93, 50.5%). The primary outcome variable
was overall survival. Subgroup analyses were performed in patients
requiring antegrade cerebral perfusion durations of 50 minutes or more and
less than 50 minutes. Secondary outcome variables were 30-day mortality,
adverse outcome, permanent and temporary neurologic deficits, renal
replacement therapy, prolonged ventilation, intensive care unit stay, and
hospital stay. Result(s): Multivariable Cox proportional hazards
analysis demonstrated no significant association of bilateral antegrade
cerebral perfusion with overall survival (hazard ratio, 0.63; 95%
confidence interval, 0.34-1.14, P = .126). Propensity score modeling using
the method of inverse probability of treatment weighting confirmed this
result (hazard ratio, 0.73; 95% confidence interval, 0.33-1.60, P = .428).
Bilateral antegrade cerebral perfusion was associated with significantly
improved overall survival in patients requiring antegrade cerebral
perfusion durations of 50 minutes or more (P = .017). The bilateral
antegrade cerebral perfusion and unilateral antegrade cerebral perfusion
groups showed comparable rates of secondary outcome variables.
 Conclusion(s): In the present study, bilateral antegrade cerebral
perfusion and unilateral antegrade cerebral perfusion are associated with
comparable outcomes after surgery for type A dissection. Subgroup analyses
suggest that bilateral antegrade cerebral perfusion is associated with
superior overall survival in patients requiring antegrade cerebral
perfusion durations of 50 minutes or more. An adequately powered
prospective randomized controlled trial is required to validate these
results. Copyright © 2019 The American Association for Thoracic
Surgery

<52>
Accession Number
625513473
Title
Low-level laser therapy versus trunk stabilization exercises on sternotomy
healing after coronary artery bypass grafting: a randomized clinical
trial.
Source
Lasers in Medical Science. 34 (6) (pp 1115-1124), 2019. Date of
Publication: 01 Aug 2019.
Author
Helmy Z.M.; Mehani S.H.M.; El-Refaey B.H.; Al-Salam E.H.A.; Felaya
E.-S.E.E.-S.
Institution
(Helmy, El-Refaey, Felaya) Department of Physical Therapy for Internal
Medicine, Faculty of Physical Therapy, Cairo University, Giza, Egypt
(Mehani) Department of Physical Therapy for Internal Medicine, Faculty of
Physical Therapy, Beni-Suef University, Benisuef Elgadata, Street No. 18,
Beni-Suef governorate 62511, Egypt
(Al-Salam) Department of Diagnostic Imaging, National Heart Institute,
Giza, Egypt
Publisher
Springer London
Abstract
The aim of this study was to investigate the effects of low-level laser
therapy (LLLT) versus trunk stabilization exercises on sternotomy healing
following coronary artery bypass grafting (CABG) surgery. Forty-five male
patients who had acute sternal instability post-CABG surgery in the age
range of 45-65 years were divided randomly into three equal groups (n =
15). The laser group received LLLT, while the exercise group received
trunk stabilization exercises. The control group only received a routine
cardiac rehabilitation programme, which was also provided to both the
laser and the exercise groups. All groups were offered 12 sessions over 4
weeks. Sternal separation, median sternotomy photographic analysis, pain
and activities of daily living (ADL) performance were evaluated pre- and
post-treatment. Statistical significance was set at P < 0.05. There was a
significant decrease among the laser group in upper-sternal separation,
while the exercise and control groups showed a non-significant decrease.
In terms of mid-sternal separation, laser and exercise groups showed a
significant decrease while the control group showed a non-significant
decrease. In terms of lower-sternal separation, the exercise group showed
a significant decrease, while the laser and control groups showed a
non-significant decrease. Post-treatment between-groups analysis showed a
significant difference only among the laser and control groups with regard
to upper-sternal separation, while analysis of the laser, exercise and
control groups in the case of upper-sternal separation and the
between-groups comparison in terms of mid- and lower-sternal separation
revealed no significant differences. LLLT and trunk stabilization
exercises were found to be the most effective methods for sternotomy
healing post-CABG surgery, with LLLT offering superior performance in the
case of the upper sternum while trunk stabilization exercises were more
effective for the lower sternum. Copyright © 2019,
Springer-Verlag London Ltd., part of Springer Nature.

<53>
Accession Number
2001489272
Title
Intravenous amino acid therapy for kidney protection in cardiac surgery
patients: A pilot randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp 2356-2366),
2019. Date of Publication: June 2019.
Author
Pu H.; Doig G.S.; Heighes P.T.; Allingstrup M.J.; Wang A.; Brereton J.;
Pollock C.; Chesher D.; Bellomo R.
Institution
(Pu, Doig, Heighes, Allingstrup) Northern Clinical School Intensive Care
Research Unit, Sydney Medical School, University of Sydney, Sydney,
Australia
(Wang, Brereton, Pollock) Northern Clinical School, Sydney Medical School,
University of Sydney, Sydney, Australia
(Pu) Department of Critical Care Medicine, Sichuan Academy of Medical
Sciences & Sichuan Provincial People's Hospital, Chengdu, China
(Chesher) New South Wales Health, Pathology, St. Leonards, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To determine whether a continuous intravenous infusion of
standard amino acids could preserve kidney function after on-pump cardiac
surgery. Method(s): Adult patients scheduled to receive cardiac
surgery lasting longer than 1 hour on-pump were randomized to standard
care (n = 36) or an infusion of amino acids initiated immediately after
induction of anesthesia (n = 33). The study's primary outcome measurements
assessed renal function. These assessments included duration of renal
dysfunction, duration and severity of acute kidney injury (AKI), estimated
glomerular filtration rate (eGFR) over time, urine output, and use of
renal-replacement therapy. Complications and other measures of morbidity
were also assessed. Result(s): Sixty-nine patients (mean age 71.5
[standard deviation 9.2] years; 19 of 69 women) were enrolled and
randomized. Patients received coronary artery bypass graft surgery
(37/69), valve surgery (24/69), coronary artery bypass graft and valve
surgery (6/69), or other procedures (2/69). Mean on-pump time was 268
[standard deviation 136] minutes. Duration of renal dysfunction did not
differ between the groups (relative risk, 0.86; 95% confidence interval
[CI], 0.19-3.79, P = .84). However, patients who received the amino acid
infusion had a reduced duration of AKI (relative risk, 0.02; 95% CI,
0.005-0.11, P < .0001) and greater eGFR (+10.8%; 95% CI, 1.0%-20.8%, P =
.033). Daily mean urine output was also significantly greater in patients
who received the amino acid infusion (1.4 +/- 0.5 vs 1.7 +/- 0.9 L/d; P =
.046). Conclusion(s): Commencing an infusion of standard amino acids
immediately after the induction of anesthesia did not alter duration of
renal dysfunction; however, other key measures of renal function (duration
of AKI, eGFR and urine output) were significantly improved. These results
warrant replication in multicenter clinical trials. Copyright ©
2018 The American Association for Thoracic Surgery

<54>
Accession Number
2001326361
Title
Bioprosthetic aortic valve replacement in elderly patients: Meta-analysis
and microsimulation.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp
2189-2197.e14), 2019. Date of Publication: June 2019.
Author
Huygens S.A.; Etnel J.R.G.; Hanif M.; Bekkers J.A.; Bogers A.J.J.C.;
Rutten-van Molken M.P.M.H.; Takkenberg J.J.M.
Institution
(Huygens, Etnel, Hanif, Bekkers, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Huygens, Rutten-van Molken) Institute for Medical Technology Assessment,
Rotterdam/Erasmus School of Health Policy and Management, Erasmus
University, Rotterdam, Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To support decision-making in aortic valve replacement (AVR) in
elderly patients, we provide a comprehensive overview of outcome after AVR
with bioprostheses. Method(s): A systematic review was conducted of
studies reporting clinical outcome after AVR with bioprostheses in elderly
patients (mean age >=70 years; minimum age >=65 years) published between
January 1, 2000, to September 1, 2016. Reported event rates and
time-to-event data were pooled and entered into a microsimulation model to
calculate life expectancy and lifetime event risks. Result(s):
Forty-two studies reporting on 34 patient cohorts were included,
encompassing a total of 12,842 patients with 55,437 patient-years of
follow-up (pooled mean follow-up 5.0 +/- 3.3 years). Pooled mean age was
76.5 +/- 5.5 years. Pooled early mortality risk was 5.42% (95% confidence
interval [CI], 4.49-6.55), thromboembolism rate was 1.83%/year (95% CI,
1.28-3.61), and bleeding rate was 0.75%/year (95% CI, 0.50-1.11).
Structural valve deterioration (SVD) was based on pooled time to SVD data
(Gompertz; shape: 0.124, rate: 0.003). For a 75-year-old patient, this
translated to an estimated life expectancy of 9.8 years (general
population: 10.2 years) and lifetime risks of bleeding of 7%,
thromboembolism of 17%, and reintervention of 9%. Conclusion(s): The
low risks of SVD and reintervention support the use of bioprostheses in
elderly patients in need of AVR. The estimated life expectancy after AVR
was comparable with the general population. The results of this study
inform patients and clinicians about the expected outcomes after
bioprosthetic AVR and thereby support treatment decision-making.
Furthermore, our results can be used as a benchmark for long-term outcomes
after transcatheter aortic valve implantation in patients who were
eligible for surgery and other (future) alternative treatments (eg,
tissue-engineered heart valves). Copyright © 2018 The American
Association for Thoracic Surgery

<55>
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. 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.
 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.
 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. Copyright © 2019 The Author(s).

<56>
Accession Number
2001281375
Title
Nitric oxide provides myocardial protection when added to the
cardiopulmonary bypass circuit during cardiac surgery: Randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp 2328-2336.e1),
2019. Date of Publication: June 2019.
Author
Kamenshchikov N.O.; Mandel I.A.; Podoksenov Y.K.; Svirko Y.S.; Lomivorotov
V.V.; Mikheev S.L.; Kozlov B.N.; Shipulin V.M.; Nenakhova A.A.;
Anfinogenova Y.J.
Institution
(Kamenshchikov, Podoksenov, Svirko, Kozlov, Shipulin, Nenakhova,
Anfinogenova) Cardiology Research Institute, Tomsk National Research
Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
(Mandel) Federal State Autonomous Educational Institution of Higher
Education I. M. Sechenov First Moscow State Medical University of the
Ministry of Health of the Russian Federation (Sechenov University),
Moscow, Russian Federation
(Mandel) Federal Research and Clinical Center for Specialized Medical Care
and Medical Technologies, Federal Medico-Biological Agency, Moscow,
Russian Federation
(Podoksenov, Svirko, Kozlov, Shipulin) Siberian State Medical University,
Tomsk, Russian Federation
(Lomivorotov) E. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Mikheev) Federal State Autonomous Institution "Treatment and
Rehabilitation Center" of the Ministry of Healthcare of the Russian
Federation, Moscow, Russian Federation
(Anfinogenova) National Research Tomsk Polytechnic University, Tomsk,
Russian Federation
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The aim of this pilot study was to elucidate the effects of
exogenous nitric oxide (NO) supply to the extracorporeal circulation
circuit for cardioprotection against ischemia-reperfusion injury during
coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).
 Method(s): A total of 60 patients with coronary artery disease
scheduled for CABG with CPB were enrolled in a prospective randomized
study. Patients were allocated randomly to receive treatment according to
standard or modified CPB protocol where 40-ppm NO was added to the CPB
circuit during cardiac surgery. The primary endpoint was the measurement
of cardiac troponin I (cTnI). The secondary end points consisted in the
measurements of creatine kinase-muscle/brain fraction (CK-MB) and
vasoactive inotropic score (VIS). Result(s): NO delivered into the
CPB circuit had a cardioprotective effect. The level of cTnI was
significantly lower in NO-treated group compared with the control group 6
hours after surgery: 1.79 +/- 0.39 ng/mL versus 2.41 +/- 0.55 ng/mL,
respectively (P = .001). The CK-MB value was significantly lower in
NO-treated group compared with the control group 24 hours after surgery:
47.69 +/- 8.08 U/L versus 62.25 +/- 9.78 U/L, respectively (P = .001); and
the VIS was significantly lower in the NO-treated group 6 hours after the
intervention. Conclusion(s): NO supply to the CPB circuit during CABG
exerted a cardioprotective effect and was associated with lower levels of
VIS and cardiospecific blood markers cTnI and CK-MB. Copyright ©
2018 The American Association for Thoracic Surgery

<57>
Accession Number
2002321419
Title
Bone disease following solid organ transplantation: A narrative review and
recommendations for management from The European Calcified Tissue Society.
Source
Bone. 127 (pp 401-418), 2019. Date of Publication: October 2019.
Author
Anastasilakis A.D.; Tsourdi E.; Makras P.; Polyzos S.A.; Meier C.;
McCloskey E.V.; Pepe J.; Zillikens M.C.
Institution
(Anastasilakis) Department of Endocrinology, 424 General Military
Hospital, Thessaloniki 54638, Greece
(Tsourdi) Department of Medicine III, Technische Universitat Dresden
Medical Center, Dresden, Germany
(Tsourdi) Center for Healthy Aging, Technische Universitat Dresden Medical
Center, Dresden, Germany
(Makras) Department of Endocrinology and Diabetes, 251 Hellenic Force & VA
General Hospital, Athens, Greece
(Polyzos) First Department of Pharmacology, Medical School, Aristotle
University of Thessaloniki, Thessaloniki, Greece
(Meier) Division of Endocrinology, Diabetology and Metabolism, University
Hospital and University of Basel, Switzerland
(McCloskey) Centre for Metabolic Bone Diseases, University of Sheffield,
Sheffield, United Kingdom
(McCloskey) Centre for Integrated research in Musculoskeletal Ageing
(CIMA), Mellanby Centre for Bone Research, University of Sheffield,
Sheffield, United Kingdom
(Pepe) Department of Internal Medicine and Medical Disciplines, "Sapienza"
University, Rome, Italy
(Zillikens) Bone Center, Department of Internal Medicine, Erasmus MC,
Rotterdam, Netherlands
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Solid organ transplantation is an established therapy for
end-stage organ failure. Both pre-transplantation bone disease and
immunosuppressive regimens result in rapid bone loss and increased
fracture rates. Method(s): The European Calcified Tissue Society
(ECTS) formed a working group to perform a systematic review of existing
literature on the consequences of end-stage kidney, liver, heart, and lung
disease on bone health. Moreover, we assessed the characteristics of
post-transplant bone disease and the skeletal effects of immunosuppressive
agents and aimed to provide recommendations for the prevention and
treatment of transplantation-related osteoporosis. Result(s):
Characteristics of bone disease may differ depending on the organ that
fails, but patients awaiting solid organ transplantation frequently depict
a wide spectrum of bone and mineral abnormalities. Common features are a
decreased bone mass and impaired bone strength with consequent high
fracture risk, all of which are aggravated in the early
post-transplantation period. Conclusion(s): Both the underlying
disease leading to end-stage organ failure and the immunosuppression
regimens implemented after successful organ transplantation have
detrimental effects on bone mass, quality and strength. Given existing
ample data confirming the high frequency of bone disease in patients
awaiting solid organ transplantation, we recommend that all transplant
candidates should be assessed for osteoporosis and fracture risk and, if
indicated, treated before and after transplantation. Since bone loss in
the early post-transplantation period occurs in virtually all solid organ
recipients and is associated with glucocorticoid administration, the goal
should be to use the lowest possible dose and to taper and withdraw
glucocorticoids as early as possible. Copyright © 2019 Elsevier
Inc.

<58>
Accession Number
621915628
Title
Potential biomarkers of tissue hypoxia during acute hemodilutional anemia
in cardiac surgery: A prospective study to assess tissue hypoxia as a
mechanism of organ injury.
Source
Canadian Journal of Anesthesia. 65 (8) (pp 901-913), 2018. Date of
Publication: 01 Aug 2018.
Author
Hare G.M.T.; Han K.; Leshchyshyn Y.; Mistry N.; Kei T.; Dai S.Y.; Tsui
A.K.Y.; Pirani R.A.; Honavar J.; Patel R.P.; Yagnik S.; Welker S.L.; Tam
T.; Romaschin A.; Connelly P.W.; Beattie W.S.; Mazer C.D.
Institution
(Hare, Han, Leshchyshyn, Mistry, Kei, Dai, Tsui, Pirani, Yagnik, Mazer)
Department of Anesthesia, St. Michael's Hospital, University of Toronto,
30 Bond Street, Toronto, ON M5B 1W8, Canada
(Hare, Mazer) St. Michael's Hospital Center of Excellence for Patient
Blood Management, Toronto, ON, Canada
(Hare, Mazer) Department of Physiology, University of Toronto, 30 Bond
Street, Toronto, ON M5B 1W8, Canada
(Hare, Connelly, Mazer) Keenan Research Centre for Biomedical Research, Li
Ka Shing Knowledge Institute, Toronto, ON, Canada
(Honavar, Patel) Department of Pathology, Center for Free Radical Biology,
University of Alabama at Birmingham, Birmingham, AL, United States
(Welker, Tam) Department of Perfusion, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Romaschin, Connelly) Department of Laboratory Medicine and Pathobiology,
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Connelly) Department of Medicine, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Beattie) Department of Anesthesia, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hemodilutional anemia is associated with acute kidney injury
(AKI) and mortality in patients undergoing cardiac surgery by mechanisms
that may include tissue hypoxia. Our hypothesis was to assess if changes
in the potential hypoxic biomarkers, including methemoglobin and
erythropoietin, correlated with a decrease in hemoglobin (Hb)
concentration following hemodilution on cardiopulmonary bypass (CPB).
 Method(s): Arterial blood samples were taken from patients (n = 64)
undergoing heart surgery and CPB at baseline, during CPB, following CPB,
and in the intensive care unit (ICU). Potential hypoxic biomarkers were
measured, including methemoglobin, plasma Hb, and erythropoietin. Data
were analyzed by repeated measures one-way analysis of variance on ranks
and linear regression. Result(s): Hemoglobin levels decreased
following CPB and methemoglobin increased in the ICU (P < 0.001 for both).
No correlation was observed between the change in Hb and methemoglobin (P
= 0.23). By contrast, reduced Hb on CPB correlated with increased lactate,
reduced pH, and increased erythropoietin levels following CPB (P <= 0.004
for all). Increased plasma Hb (P < 0.001) also correlated with plasma
erythropoietin levels (P < 0.001). Conclusion(s): These data support
the hypothesis that erythropoietin rather than methemoglobin is a
potential biomarker of anemia-induced tissue hypoxia. The observed
relationships between decreased Hb during CPB and the increase in lactate,
reduced pH, and increase in erythropoietin levels suggest that early
changes in plasma erythropoietin may be a pragmatic early biomarker of
anemia-induced renal hypoxia. Further study is required to determine if
anemia-induced increases in erythropoietin may predict AKI in patients
undergoing cardiac surgery. Trial registration: www.clinicaltrials.gov
(NCT01883713). Registered 21 June 2013. Copyright © 2018,
Canadian Anesthesiologists' Society.

<59>
Accession Number
2000513205
Title
Bivalirudin or Heparin in Patients Undergoing Invasive Management of Acute
Coronary Syndromes.
Source
Journal of the American College of Cardiology. 71 (11) (pp 1231-1242),
2018. Date of Publication: 20 March 2018.
Author
Gargiulo G.; Carrara G.; Frigoli E.; Vranckx P.; Leonardi S.; Ciociano N.;
Campo G.; Varbella F.; Calabro P.; Garducci S.; Iannone A.; Briguori C.;
Ando G.; Crimi G.; Limbruno U.; Garbo R.; Sganzerla P.; Russo F.; Lupi A.;
Cortese B.; Ausiello A.; Ierna S.; Esposito G.; Zavalloni D.; Santarelli
A.; Sardella G.; Tresoldi S.; de Cesare N.; Sciahbasi A.; Zingarelli A.;
Tosi P.; van 't Hof A.; Omerovic E.; Brugaletta S.; Windecker S.;
Valgimigli M.
Institution
(Gargiulo, Frigoli, Windecker, Valgimigli) Department of Cardiology, Bern
University Hospital, Bern, Switzerland
(Gargiulo, Esposito) Department of Advanced Biomedical Sciences, Federico
II University of Naples, Naples, Italy
(Carrara) Advice Pharma Group S.r.l., Milan, Italy
(Vranckx, Crimi) Department of Cardiology and Critical Care Medicine,
Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life
Sciences Hasselt University, Hasselt, Belgium
(Leonardi) SC Terapia Intensiva Cardiologica, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
(Ciociano) EUSTRATEGY Association, Forli', Italy
(Campo) Cardiovascular Institute, Azienda Ospedaliero-Universitaria di
Ferrara, Cona (FE), Italy
(Campo) Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA),
Italy
(Varbella) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Calabro) Division of Cardiology, Department of Cardiothoracic Sciences,
University of Campania "Luigi Vanvitelli", Naples, Italy
(Garducci) Struttura complessa di Cardiologia ASST di Vimercate, Italy
(Iannone) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa,
Italy
(Briguori) Interventional Cardiology Unit, Clinica Mediterranea, Naples,
Italy
(Ando) Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino",
University of Messina, Messina, Italy
(Crimi) SC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
(Limbruno) UO Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
(Garbo) Interventional Cardiology Unit, Ospedale San Giovanni Bosco,
Turin, Italy
(Sganzerla) ASST Bergamo ovest, Ospedale di Treviglio (BG), Italy
(Russo) Cardiovascular Interventional Unit, Cardiology Department, S.Anna
Hospital, Como, Italy
(Lupi) University Hospital "Maggiore della Carita", Novara, Italy
(Cortese) ASST Fatebenefratelli-Sacco, Milan, Italy
(Cortese) Fondazione Monasterio-CNR-Regione Toscana, Toscana, Italy
(Ausiello) Casa di Cura Villa Verde, Taranto, Italy
(Ierna) Simple Departmental Emodynamic Structure, Ospedale Sirai-Carbonia,
Carbonia, Italy
(Zavalloni) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Santarelli) Cardiovascular Department, Infermi Hospital, Rimini, Italy
(Sardella) Department of Cardiovascular, Respiratory, Nephrologic,
Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza",
University of Rome, Rome, Italy
(Tresoldi) Struttura complessa di Emodinamica, ASST Monza, Ospedale di
Desio, Italy
(de Cesare) Policlinico San Marco, Zingonia, Italy
(Sciahbasi) Interventional Cardiology, Sandro Pertini Hospital, Rome,
Italy
(Zingarelli) Clinic of Cardiovascular Disease, IRCCS Policlinico San
Martino, Genoa, Italy
(Tosi) Mater Salutis Hospital-Legnago, Verona, Italy
(van 't Hof) Maastricht University Medical Center, Zuyderland MC,
Maastricht, Netherlands
(Omerovic) Sahlgrenska University Hospital, Goteborg, Sweden
(Brugaletta) Clinic Cardiovascular Institute, University Hospital Clinic,
IDIBAPS (Institut d'Investigacions Biomediques August Pi i Sunyer),
Barcelona, Spain
Publisher
Elsevier USA
Abstract
Background: Contrasting evidence exists on the comparative efficacy and
safety of bivalirudin and unfractionated heparin (UFH) in relation to the
planned use of glycoprotein IIb/IIIa inhibitors (GPIs). Objective(s):
This study assessed the efficacy and safety of bivalirudin compared with
UFH with or without GPIs in patients with acute coronary syndrome (ACS)
who underwent invasive management. Method(s): In the MATRIX
(Minimizing Adverse Haemorrhagic Events by Transradial Access Site and
Systemic Implementation of AngioX) program, 7,213 patients were randomly
assigned to receive either bivalirudin or UFH with or without GPIs at
discretion of the operator. The 30-day coprimary outcomes were major
adverse cardiovascular events (MACEs) (a composite of death, myocardial
infarction, or stroke), and net adverse clinical events (NACEs) (a
composite of MACEs or major bleeding). Result(s): Among 3,603
patients assigned to receive UFH, 781 (21.7%) underwent planned treatment
with GPI before coronary intervention. Bailout use of GPIs was similar
between the bivalirudin and UFH groups (4.5% and 5.4%) (p = 0.11). At 30
days, the 2 coprimary endpoints of MACEs and NACEs, as well as individual
endpoints of mortality, myocardial infarction, stent thrombosis or stroke
did not differ among the 3 groups after adjustment. Compared with the UFH
and UFH+GPI groups, bivalirudin reduced bleeding, mainly the most severe
bleeds, including fatal and nonaccess site-related events, as well as
transfusion rates and the need for surgical access site repair. These
findings were not influenced by the administered intraprocedural dose of
UFH and were confirmed at multiple sensitivity analyses, including the
randomly allocated access site. Conclusion(s): In patients with ACS,
the rates of MACEs and NACEs were not significantly lower with bivalirudin
than with UFH, irrespective of planned GPI use. However, bivalirudin
significantly reduced bleeding complications, mainly those not related to
access site, irrespective of planned use of GPIs. (Minimizing Adverse
Haemorrhagic Events by Transradial Access Site and Systemic Implementation
of AngioX [MATRIX]; NCT01433627) Copyright © 2018 American
College of Cardiology Foundation

<60>
Accession Number
622961049
Title
The impact of hyperoxia on outcomes after cardiac surgery: a systematic
review and narrative synthesis.
Source
Canadian Journal of Anesthesia. 65 (8) (pp 923-935), 2018. Date of
Publication: 01 Aug 2018.
Author
Heinrichs J.; Lodewyks C.; Neilson C.; Abou-Setta A.; Grocott H.P.
Institution
(Heinrichs, Grocott) Department of Anesthesia, Perioperative and Pain
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Lodewyks, Grocott) Department of Surgery, Section of Cardiac Surgery,
University of Manitoba, Winnipeg, MB, Canada
(Lodewyks, Abou-Setta) Department of Community Health Sciences, University
of Manitoba, Winnipeg, MB, Canada
(Neilson, Abou-Setta) George & Fay Yee Center for Healthcare Innovation,
University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB,
Canada
(Neilson) Neil John Maclean Health Sciences Library, University of
Manitoba, Winnipeg, MB, Canada
(Grocott) University of Manitoba, St. Boniface Hospital, CR3008 - 369
Tache Avenue, Winnipeg, MB R2H 2A6, Canada
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Historically, cardiac surgery patients have often been managed
with supraphysiologic intraoperative oxygen levels to protect against the
risks of cellular hypoxia inherent in the un-physiologic nature of surgery
and cardiopulmonary bypass. This may result in excessive reactive oxygen
species generation and exacerbation of ischemia-reperfusion injury. In
this review, we synthesize all available data from randomized controlled
trials (RCTs) to investigate the impact that hyperoxia has on
postoperative organ dysfunction, length of stay, and mortality during
adult cardiac surgery. Source: We searched Medline, Embase, Scopus, and
Cochrane Central Register of Controlled Trials databases using a
high-sensitivity strategy for RCTs that compared oxygenation strategies
for adult cardiac surgery. Our primary outcome was postoperative organ
dysfunction defined by postoperative increases in myocardial enzymes,
acute kidney injury, and neurologic dysfunction. Secondary outcomes were
mortality, ventilator days, and length of stay in the hospital and
intensive care unit. Principal findings: We identified 12 RCTs that met
our inclusion criteria. Risk of bias was unclear to high in all but one
trial. Significant heterogeneity in timing of the treatment period and the
oxygenation levels targeted was evident and precluded meta-analysis. The
large majority of trials found no difference between hyperoxia and
normoxia for any outcome. Two trials reported reduced postoperative
myocardial enzymes and one trial reported reduced mechanical ventilation
time in the normoxia group. Conclusion(s): Hyperoxia had minimal
impact on organ dysfunction, length of stay, and mortality in adult
cardiac surgery. The current evidence base is small, heterogeneous, and at
risk of bias. Trial registration: International Prospective Register of
Systematic Reviews (PROSPERO) (CRD42017074712). Registered 17 August
2017. Copyright © 2018, Canadian Anesthesiologists' Society.

<61>
Accession Number
628305793
Title
Clinical outcomes of polyvalent immunoglobulin use in solid organ
transplant recipients: A systematic review and meta-analysis - Part II:
Non-kidney transplant.
Source
Clinical Transplantation. 33 (7) (no pagination), 2019. Article Number:
e13625. Date of Publication: July 2019.
Author
Bourassa-Blanchette S.; Patel V.; Knoll G.A.; Hutton B.; Fergusson N.;
Bennett A.; Tay J.; Cameron D.W.; Cowan J.
Institution
(Bourassa-Blanchette, Patel) Division of General Internal Medicine,
Department of Medicine, University of Ottawa, Ottawa, ON, Canada
(Knoll, Hutton, Fergusson, Bennett, Cameron, Cowan) Clinical Epidemiology
Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Knoll) Renal Transplantation, Division of Nephrology, Department of
Medicine, University of Ottawa, Ottawa, ON, Canada
(Tay) Blood and Marrow Transplant Program, Alberta Health Sciences,
Calgary, AB, Canada
(Cameron, Cowan) Division of Infectious Diseases, Department of Medicine,
University of Ottawa, Ottawa, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Immunoglobulin (IG) is commonly used to desensitize and treat
antibody-mediated rejection in solid organ transplant (SOT) recipients.
The impact of IG on other outcomes such as infection, all-cause mortality,
graft rejection, and graft loss is not clear. We conducted a similar
systematic review and meta-analysis to our previously reported Part I
excluding kidney transplant. A comprehensive literature review found 16
studies involving the following organ types: heart (6), lung (4), liver
(4), and multiple organs (2). Meta-analysis could only be performed on
mortality outcome in heart and lung studies due to inadequate data on
other outcomes. There was a significant reduction in mortality (OR 0.34
[0.17-0.69]; 4 studies, n = 455) in heart transplant with
hypogammaglobulinemia receiving IVIG vs no IVIG. Mortality in lung
transplant recipients with hypogammaglobulinemia receiving IVIG was
comparable to those of no hypogammaglobulinemia (OR 1.05 [0.49, 2.26]; 2
studies, n = 887). In summary, IVIG targeted prophylaxis may decrease
mortality in heart transplant recipients as compared to those with
hypogammaglobulinemia not receiving IVIG, or improve mortality to the
equivalent level with those without hypogammaglobulinemia in lung
transplant recipients, but there is a lack of data to support physicians
in making decisions around using immunoglobulins in all SOT recipients for
infection prophylaxis. Copyright © 2019 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd

<62>
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. Copyright © 2019, Japanese Society of Anesthesiologists.

<63>
Accession Number
2002338803
Title
ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria
for Multimodality Imaging in the Assessment of Cardiac Structure and
Function in Nonvalvular Heart Disease: A Report of the American College of
Cardiology Appropriate Use Criteria Task Force, American Association for
Thoracic Surgery, American Heart Association, American Society of
Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm
Society, Society for Cardiovascular Angiography and Interventions, Society
of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic
Resonance, and the Society of Thoracic Surgeons.
Source
Journal of Nuclear Cardiology. 26 (4) (pp 1392-1413), 2019. Date of
Publication: 15 Aug 2019.
Author
Kort S.; Mehran R.; Soman P.; Schoenhagen P.; Bashore T.M.; Calnon D.A.;
Carabello B.; Conte J.; Dickfeld T.; Edmundowicz D.; Ferrari V.A.; Hall
M.E.; Ghoshhajra B.; Mehrotra P.; Naqvi T.Z.; Brett Reece T.; Starling
R.C.; Szerlip M.; Tzou W.S.; Wong J.B.; Doherty J.U.; Dehmer G.J.; Bailey
S.R.; Bhave N.M.; Brown A.S.; Daugherty S.L.; Dean L.S.; Desai M.Y.;
Duvernoy C.S.; Gillam L.D.; Hendel R.C.; Kramer C.M.; Lindsay B.D.;
Manning W.J.; Patel M.R.; Sachdeva R.; Samuel Wann L.; Winchester D.E.;
Wolk M.J.
Institution
(Doherty) American College of Cardiology, Washington, DC, United States
(Kort) American Society of Echocardiography, Morrisville, NC, United
States
(Mehran) Society for Cardiovascular Angiography and Interventions,
Washington, DC, United States
(Schoenhagen) Society of Cardiovascular Computed Tomography, Vienna, VA,
United States
(Soman) American Society of Nuclear Cardiology, Bethesda, MD, United
States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
This document is the second of 2 companion appropriate use criteria (AUC)
documents developed by the American College of Cardiology, American
Association for Thoracic Surgery, American Heart Association, American
Society of Echocardiography, American Society of Nuclear Cardiology, Heart
Rhythm Society, Society for Cardiovascular Angiography and Interventions,
Society of Cardiovascular Computed Tomography, Society for Cardiovascular
Magnetic Resonance, and Society of Thoracic Surgeons. The first document
(J Am Coll Cardiol 2017;70:1647-1672) addresses the evaluation and use of
multimodality imaging in the diagnosis and management of valvular heart
disease, whereas this document addresses this topic with regard to
structural (nonvalvular) heart disease. While dealing with different
subjects, the 2 documents do share a common structure and feature some
clinical overlap. The goal of the companion AUC documents is to provide a
comprehensive resource for multimodality imaging in the context of
structural and valvular heart disease, encompassing multiple imaging
modalities. Using standardized methodology, the clinical scenarios
(indications) were developed by a diverse writing group to represent
patient presentations encountered in everyday practice and included common
applications and anticipated uses. Where appropriate, the scenarios were
developed on the basis of the most current American College of
Cardiology/American Heart Association Clinical Practice Guidelines. A
separate, independent rating panel scored the 102 clinical scenarios in
this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a
modality is considered appropriate for the clinical scenario presented.
Midrange scores of 4 to 6 indicate that a modality may be appropriate for
the clinical scenario, and scores of 1 to 3 indicate that a modality is
considered rarely appropriate for the clinical scenario. The primary
objective of the AUC is to provide a framework for the assessment of these
scenarios by practices that will improve and standardize physician
decision making. AUC publications reflect an ongoing effort by the
American College of Cardiology to critically and systematically create,
review, and categorize clinical situations in which diagnostic tests and
procedures are utilized by physicians caring for patients with
cardiovascular diseases. The process is based on the current understanding
of the technical capabilities of the imaging modalities
examined. Copyright © 2019, American College of Cardiology
Foundation.

<64>
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. 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.
 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. Copyright
© 2019 Elsevier B.V.

<65>
Accession Number
2002367871
Title
Exercise Rehabilitation for Heart Failure: The Neglected Stepchild.
Source
JACC: Heart Failure. 7 (8) (pp 706-708), 2019. Date of Publication: August
2019.
Author
Fleg J.L.
Institution
(Fleg) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<66>
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. 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. 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. 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. Copyright © 2019 Janssen et
al.

<67>
Accession Number
2002290748
Title
Oral Triiodothyronine Supplementation Decreases Low Cardiac Output
Syndrome After Pediatric Cardiac Surgery.
Source
Pediatric Cardiology. (no pagination), 2019. Date of Publication: 2019.
Author
Marwali E.M.; Caesa P.; Darmaputri S.; Sani A.A.; Roebiono P.S.; Fakhri
D.; Djer M.M.; Munasir Z.M.; Batubara J.R.L.; Satroasmoro S.; Portman
M.A.; Haas N.A.
Institution
(Marwali, Caesa, Darmaputri, Sani) Pediatric Cardiac Intensive Care Unit,
National Cardiovascular Center Harapan Kita, Let Jend S Parman Road, Kav
87, Slipi, Jakarta 11420, Indonesia
(Marwali, Roebiono) Department of Cardiology, Faculty of Medicine,
Universitas Indonesia, Jakarta, Indonesia
(Roebiono) Pediatric Cardiology Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Department of Cardio-Thoracic-Vascular Surgery, Faculty of
Medicine, Universitas Indonesia, Jakarta, Indonesia
(Djer, Munasir, Batubara, Satroasmoro) Department of Pediatrics, Cipto
Mangunkusumo Hospital and Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
(Portman) Seattle Children's Hospital, University of Washington, Seattle,
WA, United States
(Haas) Department of Pediatric Cardiology and Pediatric Intensive Care,
Medical Hospital of the University of Munich, Munich, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The oral triiodothyronine for infants and children undergoing
cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3)
supplementation improved hemodynamic and clinical outcome parameters. We
tested the validity of low cardiac output syndrome (LCOS), derived using
clinical parameters and laboratory data, by comparing the LCOS diagnosis
with objective parameters commonly measured in a cardiac intensive care
unit (CCU) setting. OTICC, a randomized, placebo-controlled trial included
children younger than 3 years with an Aristotle score between 6 and 9. We
used the existing trial data set to compare the LCOS diagnosis with
echocardiographic hemodynamic parameters. Additionally, we determined if
LCOS, prospectively assigned during a clinical trial, served as an early
predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after
cross-clamp release later showed significantly lower pulse pressure,
stroke volume and cardiac output, and higher systemic vascular resistance.
These LCOS patients also had significantly longer time to extubation (TTE)
and higher mortality rate. LCOS incidence was significantly lower in the
T3 treatment group [n = 86 vs. 66, respectively, p < 0.001; OR (95% CI)
0.43 (0.36-0.52)] particularly at 6 h. Also, LCOS patients in the placebo
group had significantly lower FT3 serum levels over time. These analyses
confirm that early clinically defined LCOS successfully predicts cardiac
dysfunction determined later by objective hemodynamic echocardiographic
parameters. Furthermore, early LCOS significantly impacts TTE and
mortality. Finally, the data support prior clinical trial data, showing
that oral T3 supplementation decreases early LCOS in concordance with
reducing TTE. Copyright © 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<68>
Accession Number
628752415
Title
Are there real benefits to implanting cardiac devices in patients with
end-stage dilated dystrophinopathic cardiomyopathy? Review of literature
and personal results.
Source
Acta myologica : myopathies and cardiomyopathies : official journal of the
Mediterranean Society of Myology. 38 (1) (pp 1-7), 2019. Date of
Publication: 01 Jun 2019.
Author
Palladino A.; Papa A.A.; Morra S.; Russo V.; Ergoli M.; Rago A.; Orsini
C.; Nigro G.; Politano L.
Institution
(Palladino, Morra, Ergoli, Orsini, Politano) Cardiomyology and Medical
Genetics, Department of Experimental Medicine, University of Campania
"Luigi Vanvitelli", Naples, Italy
(Papa, Russo, Rago, Nigro) Arrhythmology Unit, Department of Translational
Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
Publisher
NLM (Medline)
Abstract
Cardiomyopathy associated with dystrophinopathies - Duchenne muscular
Dystrophy (DMD), Becker muscular dystrophy (BMD), X-linked dilated
cardiomyopathy (XL-CM) and cardiomyopathy of Duchenne/Becker (DMD/BMD
carriers - is an almost constant manifestation of these neuromuscular
disorders and contribute significantly to their morbidity and mortality.
Dystrophinopathic cardiomyopathy is the result of the dystrophin protein
deficiency at the myocardium level, parallel to that occurring at the
skeletal muscle level. Typically, cardiomyopathy begins as a
"presymptomatic" stage in the first decade of life and evolves in a
stepwise manner toward an end-stage dilated cardiomyopathy. Nearly
complete replacement of the myocardium by fibrous and fatty connective
tissue results in an irreversible cardiac failure, characterized by a
further reduction of ejection fraction (EF < 30%) and frequent episodes of
acute heart failure (HF). The picture of a severe dilated cardiomyopathy
with intractable heart failure is typical of dystrophinopathies. Despite
an appropriate pharmacological treatment, this condition is irreversible
because of the extensive loss of myocites. Heart transplantation is the
only curative therapy for patients with end-stage heart failure, who
remain symptomatic despite an optimal medical therapy. However there is a
reluctance to perform heart transplantation (HT) in these patients due to
the scarcity of donors and the concerns that the accompanying myopathy
will limit the benefits obtained through this therapeutic option.
Therefore the only possibility to ameliorate clinical symptoms, prevent
fatal arrhythmias and cardiac death in dystrophinopathic patients could be
the implantation of intracardiac device (ICD) or resynchronizing devices
with defibrillator (CRT-D). This overview reports the personal series of
patients affected by DMD and BMD and DMD carriers who received ICD or
CRT-D system, describe the clinical outcomes so far published and discuss
pro and cons in the use of such devices.

<69>
Accession Number
628752367
Title
Comparison of Effects of General Anesthesia and Combined Spinal/Epidural
Anesthesia for Cesarean Delivery on Umbilical Cord Blood Gas Values: A
Double-Blind, Randomized, Controlled Study.
Source
Medical science monitor : international medical journal of experimental
and clinical research. 25 (pp 5272-5279), 2019. Date of Publication: 16
Jul 2019.
Author
Chen Y.; Liu W.; Gong X.; Cheng Q.
Institution
(Chen, Liu, Gong) Department of Anesthesiology, First People's Hospital of
Jingzhou, First Affiliated Hospital of Yangtze University, Jingzhou,
Hubei, China
(Cheng) Department of Anesthesiology, Guangzhou Women and Children's
Medical Center, Guangzhou, Guangdong, China
Publisher
NLM (Medline)
Abstract
BACKGROUND The objective of this study was to analyze the effects of
general anesthesia in cesarean section on the umbilical cord blood gas
values and intraoperative hemodynamics of parturient women. MATERIAL AND
METHODS A total of 112 parturient women who received cesarean section were
eventually randomized into 2 groups, GA (general anesthesia) group (n=56),
and SE (combined spinal and epidural anesthesia) group (n=56). The
umbilical cord blood gas values, postpartum Apgar score, intraoperative
blood loss, mean arterial pressure, heart rate, total operative time, time
intervals from anesthesia to delivery and from skin incision to delivery,
the incidences of adverse reactions and neonatal asphyxia, and the
postoperative patient satisfaction were compared between the 2 groups.
RESULTS There were no significant differences between the 2 groups in
total operative time, Apgar score, neonatal asphyxia rate, umbilical
arterial and venous cord blood gas values, intraoperative blood loss, and
time interval from skin incision to delivery (all P>0.05). The GA group
was significantly shorter in the time interval from anesthesia to delivery
than the SE group (P<0.05). The incidences of nausea, vomiting, and chills
in the GA group were significantly lower than those in the SE group (all
P<0.05). The GA group was significantly higher in postoperative patient
satisfaction than the SE group (P<0.05). CONCLUSIONS General anesthesia
has little impact on the umbilical cord blood gas values and Apgar score,
and ensures better hemodynamic stability in cesarean section. Moreover,
general anesthesia is characterized by rapid induction and is therefore
valuable for use in clinical procedures.

<70>
Accession Number
628751700
Title
The Relationship between the Use of Cold and Isothermic Blood Cardioplegia
Solution for Myocardial Protection during Cardiopulmonary Bypass and the
Ischemia-Reperfusion Injury.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2019. Date of Publication: 12 Jul 2019.
Author
Sacli H.; Kara I.; Diler M.S.; Percin B.; Turan A.I.; Kirali K.
Institution
(Sacli, Kara, Kirali) Faculty of Medicine, Department of Cardiovascular
Surgery, Sakarya University, Turkey
(Diler, Percin, Turan) Department of Cardiovascular Surgery, Sakarya
University Education and Research Hospital, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: In this study, we aimed to assess myocardial protection and
ischemia-reperfusion injury in patients undergoing open heart surgery with
isothermic blood cardioplegia (IBC) or hypothermic blood cardioplegia
(HBC). MATERIALS AND METHODS: A total of 48 patients who underwent
isolated coronary artery bypass grafting or isolated mitral valve surgery
between March 2017 and October 2017 were evaluated as randomized
prospective study. Study groups (HBC: Group 1, IBC: Group 2) were compared
in terms of interleukin 6 (IL-6), IL-8, IL-10, and complement factor 3a
(C3a) levels, metabolic parameters, creatine kinase-muscle/brain (CK-MB)
and high-sensitivity Troponin I (hsTn-I), and clinical outcomes.
 RESULT(S): Comparison of the markers of ischemia-reperfusion injury
showed significantly higher levels of the proinflammatory cytokine IL-6 in
the early postoperative period as well as IL-8, in Group 2 (p <0.001),
whereas the anti-inflammatory cytokine IL-10 was significantly higher
during the X1 time period (p = 0.11) in Group 2, and subsequently it was
higher in Group 1. Using myocardial temperature probes, the target
myocardial temperatures were measured in the patients undergoing open
heart surgery with different routes of cardioplegia, and significant
differences were noted (p = 0.000). CONCLUSION(S): HBC for open heart
surgery is associated with less myocardial injury and intraoperative and
postoperative morbidity, indicating superior myocardial protection versus
IBC.

<71>
Accession Number
2001135853
Title
Comparing Combined Short-Axis and Long-Axis Ultrasound-Guided Central
Venous Catheterization With Conventional Short-Axis Out-of-Plane
Approaches.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 1029-1034),
2019. Date of Publication: April 2019.
Author
Takeshita J.; Nishiyama K.; Fukumoto A.; Shime N.
Institution
(Takeshita) Department of Intensive Care Medicine, Osaka Prefectural
Hospital Organization, Osaka Women's and Children's Hospital, Izumi,
Osaka, Japan
(Nishiyama) Department of Emergency and Critical Care Medicine, National
Hospital Organization, Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
(Fukumoto) Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital,
Yamashina-ku, Kyoto, Japan
(Shime) Department of Emergency and Critical Care Medicine, Institute of
Biomedical and Health Sciences, Hiroshima University, Minami-ku,
Hiroshima, Japan
Publisher
W.B. Saunders
Abstract
Objective: Visualizing the needle tip using the short-axis out-of-plane
(SA-OOP) ultrasound-guided central venous catheterization approach is
difficult and results in posterior wall puncture (PWP). To improve needle
tip visualization in the long-axis view, combining the SA-OOP and the
long-axis in-plane approaches has been suggested. The authors, who
previously reported on the utility of this technique using a manikin
model, examined the feasibility of this novel method (referred to as the
combined short-axis and long-axis [CSLA] approach) and compared the CSLA
approach with the SA-OOP approach in humans for the present study.
 Design(s): Prospective observational study. Setting(s): Single
institution, Rakuwakai Otowa Hospital. Participant(s): Patients
undergoing cardiac or vascular surgeries. Intervention(s): The CSLA
and SA-OOP approaches were used for ultrasound-guided right jugular venous
puncture. The puncturing procedures were determined arbitrarily
preoperatively without consideration of the patient's neck anatomy and
were based on the operator's preference without randomization.
 Measurements and Main Results: The study comprised 100 patients.
Successful guidewire insertion without PWP was performed in 48 patients
(96%) in the CSLA approach group and 33 (66%) in the SA-OOP approach
group; the rate was significantly higher in the CSLA approach group (p =
0.0001). The procedural durations were 27.5 (range 17.0-122.0) seconds in
the CSLA approach group and 25.0 (range 15.0-158.0) seconds in the SA-OOP
approach group (p = 0.19). Conclusion(s): This study showed that the
CSLA approach to ultrasound-guided central venous catheterization might
help prevent PWP. Copyright © 2018 Elsevier Inc.

<72>
Accession Number
2000971326
Title
The Edmonton Frail Scale Improves the Prediction of 30-Day Mortality in
Elderly Patients Undergoing Cardiac Surgery: A Prospective Observational
Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 945-952),
2019. Date of Publication: April 2019.
Author
Amabili P.; Wozolek A.; Noirot I.; Roediger L.; Senard M.; Donneau A.-F.;
Hubert M.B.; Brichant J.-F.; Hans G.A.
Institution
(Amabili, Wozolek, Noirot, Roediger, Senard, Hubert, Brichant, Hans)
Department of Anesthesia and Intensive Care Medicine, CHU of Liege, Liege,
Belgium
(Donneau) Department of Public Health, Biostatistics, University of Liege,
Liege, Belgium
Publisher
W.B. Saunders
Abstract
Objectives: To investigate whether the Edmonton Frail Scale (EFS), a
multidimensional frailty assessment tool, improves the prediction of
30-day or in-hospital mortality over the use of the European System for
Cardiac Outcome Risk Evaluation (EuroSCORE) II alone. Design(s):
Single-center prospective observational study. Setting(s): University
hospital. Participant(s): Patients aged 75 years or older undergoing
cardiac surgery between February 2014 and May 2017. Intervention(s):
No intervention was performed. The EFS was administered the day before
surgery. Measurements and Main Results: The primary endpoint was
30-day or in-hospital mortality. Secondary endpoints were times to
discharge from the intensive care unit (ICU) and from the hospital,
discharge to a health care facility, and ability to return home by
postoperative day 30. The EFS had a good discriminative ability for 30-day
mortality (area under the receiver operating characteristic curve = 0.69;
95% confidence interval [CI], 0.56-0.82). Adding frailty, defined by an
EFS >=8, to the EuroSCORE II significantly improved the prediction of
30-day (p = 0.04) mortality. The integrated discrimination index was 0.03
(95% CI, 0.01-0.06, p = 0.01), meaning that the difference in predicted
risk between patients who died and those who survived increased by 3% due
to the addition of frailty determined by the EFS to the EuroSCORE II.
Frailty also was associated significantly with a decreased cumulative
probability of discharge from the ICU (p = 0.02) and an increased
incidence of discharge to a health care facility (p = 0.01).
 Conclusion(s): The EFS has a good predictive ability for 30-day
mortality after cardiac surgery in elderly patients and improves the
prediction of 30-day mortality over the use of the EuroSCORE
II. Copyright © 2018 Elsevier Inc.

<73>
Accession Number
2001085516
Title
Calculation Algorithm Reduces Protamine Doses Without Increasing Blood
Loss or the Transfusion Rate in Cardiac Surgery: Results of a Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (4) (pp 985-992),
2019. Date of Publication: April 2019.
Author
Kjellberg G.; Holm M.; Fux T.; Lindvall G.; van der Linden J.
Institution
(Kjellberg) Department of Thoracic Surgery and Anesthesia, Academic
Hospital, Uppsala, Sweden
(Kjellberg, Holm, Fux, Lindvall, van der Linden) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Holm) Division of Perioperative Medicine and Intensive Care, Karolinska
University Hospital, Huddinge, Sweden
(Fux, Lindvall, van der Linden) Division of Perioperative Medicine and
Intensive Care, Section Cardiothoracic Surgery and Anesthesiology,
Karolinska University Hospital, Stockholm, Sweden
Publisher
W.B. Saunders
Abstract
Objectives: The aim of the study was to investigate whether the HeProCalc
algorithm affects heparin and protamine dosage, postoperative blood loss,
and transfusion rate. Design(s): Randomized controlled trial.
 Setting(s): University hospital. Participant(s): The study
comprised 210 cardiac surgery patients undergoing cardiac surgery with
cardiopulmonary bypass. Twenty patients were excluded because of
re-exploration for localized surgical bleeding (n = 9), violation of
protocol (n = 2), aprotinin use (n = 3 and nadir body temperature
<32degreeC (n = 6). Intervention(s): Study participants were randomly
assigned to either traditional heparin and protamine dosage based on body
weight only (control group) or dosage based on the HeProCalc algorithm
(intervention group). Measurements and Main Results: The initial
median heparin dose was 32,500 IU (interquartile range [IQR]
30,000-35,000) in the intervention group compared with 35,000 IU (IQR
30,000-37,500) (p = 0.025) in the control group. The total heparin dose in
the intervention group was 40,000 IU (IQR 32,500-47,500) compared with
42,500 IU (IQR 35,000-50,000) in the control group (p = 0.685). The total
protamine dose was 210 mg (IQR 190-240) in the intervention group compared
with 350 mg (IQR 300-380) (p < 0.001) in the control group. The ratio of
total protamine to initial dose of heparin in the intervention group was
0.62 compared with 1.0 (p < 0.001). The amount of chest tube bleeding
after 12 postoperative hours was 320 mL (IQR 250-460) in the intervention
group compared with 350 mL (IQR 250-450) (p = 0.754) in the control group.
Neither the transfusion rate nor postoperative blood loss differed
significantly between the 2 groups. Conclusion(s): Use of the
HeProCalc algorithm reduced protamine dosage and the protamine/heparin
ratio after cardiopulmonary bypass compared with conventional dosage based
on weight without significant effect on postoperative blood loss or the
transfusion rate. Copyright © 2018 Elsevier Inc.

<74>
Accession Number
622684080
Title
Factors associated with non-participation in and dropout from cardiac
rehabilitation programmes: a systematic review of prospective cohort
studies.
Source
European Journal of Cardiovascular Nursing. 18 (1) (pp 38-47), 2019. Date
of Publication: 01 Jan 2019.
Author
Resurreccion D.M.; Moreno-Peral P.; Gomez-Herranz M.; Rubio-Valera M.;
Pastor L.; Caldas de Almeida J.M.; Motrico E.
Institution
(Resurreccion, Motrico) Departamento de Psicologia, Universidad Loyola
Andalucia, Spain
(Moreno-Peral, Motrico) SAMSERAP Group, Primary Care Prevention and Health
Promotion Research Network (RedIAPP), Spain
(Moreno-Peral) SAMSERAP Group, Instituto de Investigacion Biomedica de
Malaga (IBIMA), Spain
(Gomez-Herranz) Departamento de psicologia experimental, Universidad de
Sevilla, Spain
(Rubio-Valera) Research and Development Unit, Institut de Recerca Sant
Joan de Deu, Spain
(Rubio-Valera) Grupo PRISMA, Centro de Investigacion Biomedica en Red
Epidemiologia y Salud Publica, Spain
(Pastor) Unidad Clinica de Cardiologia, Hospital Nuestra Senora de Valme,
Spain
(Caldas de Almeida) Mental Health Department, Universidade Nova de Lisboa,
Portugal
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although evidence exists for the efficacy of cardiac
rehabilitation programmes to reduce morbidity and mortality among patients
with cardiovascular disease, cardiac rehabilitation programmes are
underused. We aimed systematically to review the evidence from prospective
cohort studies on factors associated with non-participation in and/or
dropping out from cardiac rehabilitation programmes. Method(s):
MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for
relevant publications from inception to February 2018. Search terms
included (a) coronary heart disease and other cardiac conditions; (b)
cardiac rehabilitation and secondary prevention; and (c) non-participation
in and/or dropout. Databases were searched following the PRISMA statement.
Study selection, data extraction and the assessment of study quality were
performed in duplicate. Result(s): We selected 43 studies with a
total of 63,425 patients from 10 different countries that met the
inclusion criteria. Factors associated with non-participation in and
dropout from cardiac rehabilitation were grouped into six broad
categories: intrapersonal factors, clinical factors, interpersonal
factors, logistical factors, cardiac rehabilitation programme factors and
health system factors. We found that clinical factors, logistical factors
and health system factors were the main factors assessed for
non-participation in cardiac rehabilitation. We also found differences
between the factors associated with non-participation and dropout.
 Conclusion(s): Several factors were determinant for non-participation
in and dropout from cardiac rehabilitation. These findings could be useful
to clinicians and policymakers for developing interventions aimed at
improving participation and completion of cardiac rehabilitation, such as
E-health or home-based delivery programmes. Trial Registration:
International Prospective Register of Systematic Reviews (PROSPERO)
identifier: CRD42016032973. Copyright © The European Society of
Cardiology 2018.

<75>
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 g
iloprost (IL10 group), or 20 micro 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. Copyright © 2019 by the authors. Licensee MDPI, Basel,
Switzerland.

<76>
Accession Number
2002138123
Title
Design of CTP-PRO study (impact of stress Cardiac computed Tomography
myocardial Perfusion on downstream resources and PROgnosis in patients
with suspected or known coronary artery disease: A multicenter
international study).
Source
International Journal of Cardiology. 292 (pp 253-257), 2019. Date of
Publication: 1 October 2019.
Author
Pontone G.; De Cecco C.; Baggiano A.; Guaricci A.I.; Guglielmo M.; Leiner
T.; Lima J.; Maurovich-Horvat P.; Muscogiuri G.; Nance J.W.; Schoepf U.J.
Institution
(Pontone, Baggiano, Guglielmo, Muscogiuri) Centro Cardiologico Monzino,
IRCCS, Milan, Italy
(De Cecco) Department of Radiology and Imaging Sciences, Emory University
School of Medicine, Atlanta, GA, United States
(Guaricci) Institute of Cardiovascular Disease, Department of Emergency
and Organ Transplantation, University Hospital Policlinico, Bari, Italy
(Leiner) Department of Radiology, Utrecht University Medical Center,
Utrecht, Netherlands
(Lima) The Johns Hopkins Hospital, Baltimore, United States
(Maurovich-Horvat) MTA-SE Cardiovascular Imaging Research Group (CIRG)
Heart and Vascular Center, Semmelweis University, Budapest, Hungary
(Nance, Schoepf) Department of Radiology and Radiological Science, Medical
University of South Carolina, Charleston, SC, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: CT myocardial perfusion imaging (CTP) represents one of the
newly developed CT-based techniques but its cost-effectiveness in the
clinical pathway is undefined. The aim of the study is to evaluate the
usefulness of combined evaluation of coronary anatomy and myocardial
perfusion in intermediate to high-risk patients for suspected CAD or with
known disease in terms of clinical decision-making, resource utilization
and outcomes in a broad variety of geographic areas and patient subgroups.
 Method(s): CTP-PRO study is a cooperative, international,
multicentre, prospective, open-label, randomized controlled study
evaluating the cost-effectiveness of a CCTA+CTP strategy (Group A) versus
usual care (Group B) in intermediate-high risk patients with suspected or
known CAD who undergo clinically indicated diagnostic evaluation. A total
sample size of 2000 subjects will be enrolled and followed up for 24
months. The primary endpoint is the reclassification rate of CCTA in group
A due to the addition of CTP. The secondary endpoint will be the
comparison between groups in terms of non-invasive and invasive downstream
testing, prevalence of obstructive CAD at ICA, revascularization,
cumulative ED and overall cost during the follow-up at 1- and 2-years. The
tertiary endpoint will be the comparison between each group in terms of
MACE and cost-effectiveness at 1- and 2-years. Conclusion(s): The
study will provide information to patients, health care providers and
other stakeholders about which strategy could be more effective in the
diagnosis of suspected CAD in intermediate to high-risk patients or in the
symptomatic patients with known CAD and previous history of
revascularization. Copyright © 2019 Elsevier B.V.

<77>
Accession Number
2002236486
Title
The effects of ranolazine monotherapy on the incidence of atrial
fibrillation in heart disease: A meta-analysis of randomized controlled
trials.
Source
International Journal of Clinical and Experimental Medicine. 12 (6) (pp
6502-6511), 2019. Date of Publication: 2019.
Author
Li Z.; Han H.; Meng H.; Yu L.; Zhang Y.; Yin Z.; Wang H.
Institution
(Li, Han, Meng, Yu, Zhang, Yin, Wang) Department of Cardiovascular
Surgery, General Hospital of Shenyang Military Command, Shenyang, Liaoning
Province 110016, China
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
As the most common cardiac arrhythmia, atrial fibrillation (AF) increases
health-care costs and morbidity. Ranolazine, a novel anti-angina drug, has
unique antiarrhythmic properties, which have aroused interest in its use
in AF prevention. To evaluate the effects of ranolazine monotherapy on the
incidence of AF, randomized controlled trials (RCTs) that reported the
effects of monotherapy with ranolazine on the incidence of AF and that
were published up through May 2017 were searched in the Cochrane library,
PubMed, and EMBASE databases. Data are expressed as the odds ratio (OR)
with a 95% confidence interval (CI). Five RCTs involving 7003 patients
(3580 in the ranolazine group, 3423 in the controls group) were included
in the meta-analysis. Ranolazine monotherapy significantly reduced the
incidence of AF (OR 0.66, 95% CI 0.50 to 0.87; P<0.01) compared with the
controls, especially for postoperative (OR 0.33, 95% CI 0.13 to 0.79;
P<0.05) or non-surgical patients (OR 0.72, 95% CI 0.53 to 0.98; P<0.05).
Further analysis showed that a high dose of ranolazine could effectively
prevent AF (OR 0.68, 95% CI 0.50 to 0.93; P<0.05), but a low dose group
didn't have the effect of preventing AF (OR 0.46, 95% CI 0.14 to 1.56;
P=0.08). Ranolazine monotherapy may prove beneficial in AF prevention in
heart disease. However, not all doses of ranolazine can be effective in
the prevention of AF. Therefore, further studies with large RCTs are
warranted to confirm the effects of different doses of ranolazine
monotherapy in AF therapy. Copyright © 2019, E-Century Publishing
Corporation. All rights reserved.

<78>
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. Copyright ©
2019 Jannati and Attar.

<79>
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. Copyright © 2019 Elsevier Inc.

<80>
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. 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).
 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. Copyright
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

<81>
Accession Number
628635919
Title
The preventive role of selenium in inflammatory response during coronary
artery bypass graft surgery: A randomized, controlled clinical trial.
Source
Jundishapur Journal of Natural Pharmaceutical Products. 14 (1) (no
pagination), 2019. Article Number: e14158. Date of Publication: 2019.
Author
Sedighinejad A.; Imantalab V.; Mirmansouri A.; Jouryabi A.M.; Nabi B.N.;
Kanani G.; Atrkarroushan Z.; Biazar G.
Institution
(Sedighinejad, Imantalab, Mirmansouri, Jouryabi, Nabi, Biazar)
Anesthesiology Research Center, Guilan University of Medical Sciences
(GUMS), Rasht, Iran, Islamic Republic of
(Kanani) Department of Cardaic Surgery, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Atrkarroushan) Guilan University of Medical Sciences, Rasht, Iran,
Islamic Republic of
Publisher
Kowsar Medical Publishing Company (E-mail: editor@anesthpain.com)
Abstract
Background: Coronary artery bypass graft surgery (CABG) with
cardiopulmonary bypass (CPB) triggers a profound systemic inflammatory
response and sympathetic nervous system activation translated into
post-operative adverse outcomes. Objective(s): The current study
aimed at determining whether preparative use of selenium could reduce the
severity of inflammatory reaction to surgery. Method(s): The current
randomized, double-blind clinical trial was conducted at the Department of
Cardiac Surgery of Dr. Heshmat Hospital; a referral center affiliated to
Guilan University of Medical Sciences (GUMS), Rasht, Iran. From May 2015
to September 2015 one hundred and fourteen patients who were candidates
for elective CABG were randomly recruited to receive either an intravenous
bolus of 600 ?g Se before induction of anesthesia in the group S (n = 56)
or normal saline as placebo in the group C (n = 58). To measure white
blood cells (WBC) serum levels, blood samples were collected
preoperatively (T0) and three times after CPB initiation immediately after
the end of CPB (T1), as well as 24 (T2) and 48 hours (T3) after surgery.
Statistical tests including chi-square, the Kruskal-Wallis, and
independent t tests, as well as repeated measurement ANOVA were used to
analyze the data. Result(s): There was no significant difference
between the two groups regarding the baseline characteristics (P =
0.0512). There was no significant difference between the two groups in
other four time points; T0 (P = 0.0512), T1 (P = 0.571), T2 (P = 0.974),
and T3 (P = 0.215), although the trend of changes was statistically
significant in each group (P = 0.0001), the intergroup comparisons showed
no significant changes (P = 0.166). Conclusion(s): There was no
strong evidence that a single-dose of Se could reduce inflammation
following CABG surgery. Copyright © 2019, Jundishapur Journal of
Natural Pharmaceutical Products.

<82>
Accession Number
621363859
Title
Incidence and predictors of sudden cardiac death after heart
transplantation: A systematic review and meta-analysis.
Source
Clinical Transplantation. 32 (3) (no pagination), 2018. Article Number:
e13206. Date of Publication: March 2018.
Author
Alba A.C.; Foroutan F.; Ng Fat Hing N.K.V.; Fan C.-P.S.; Manlhiot C.; Ross
H.J.
Institution
(Alba, Foroutan, Ng Fat Hing, Ross) Heart Failure and Transplantation
Program, Toronto General Hospital, University Health Network, Toronto, ON,
Canada
(Fan, Manlhiot) The Hospital for Sick Children, University of Toronto,
Toronto, ON, Canada
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Sudden cardiac death (SCD) is an important post-transplant
problem being responsible for ~10% of deaths. We conducted a systematic
review and meta-analysis to evaluate incidence and predictors of
post-heart transplant SCD and the use of implantable cardiac defibrillator
(ICD). Method(s): Citations were identified in electronic databases
and references of included studies. Observational studies on adults
reporting on incidence and predictors of post-transplant SCD and ICD use
were selected. We meta-analyzed SCD in person-years using random effects
models. We qualitatively summarized predictors. Result(s): This study
includes 55 studies encompassing 47 901 recipients. The pooled incidence
rate of SCD was 1.30 per 100 person-years (95% CI: 1.08-1.52). Cardiac
allograft vasculopathy (CAV) was associated with higher SCD risk (2.40 per
100 patient-years, 95% CI: 1.46-3.34). Independent predictors of SCD
identified by two moderate-quality studies were older donor age, younger
recipient age, non-Caucasian race, reduced left ventricular ejection
fraction, rejection, infection, and cancer. Authors rarely reported on ICD
use. Conclusion(s): This meta-analysis found that post-transplant SCD
risk in heart transplant recipients is higher than that in the general
population. CAV was associated with increased SCD risk. Observational
studies reporting on absolute risk of SCD are needed to better identify
populations at a clinically significant increased risk. Copyright
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<83>
Accession Number
621398121
Title
Cerebrovascular autoregulation monitoring and patient-centred outcomes
after cardiac surgery: a systematic review.
Source
Acta Anaesthesiologica Scandinavica. 62 (5) (pp 588-599), 2018. Date of
Publication: May 2018.
Author
Chan B.; Butler E.; Frost S.A.; Chuan A.; Aneman A.
Institution
(Chan, Butler) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Frost, Aneman) Intensive Care Unit, Liverpool Hospital, Liverpool, NSW,
Australia
(Frost, Chuan, Aneman) Ingham Institute for Applied Medical Research,
Sydney, NSW, Australia
(Frost, Chuan, Aneman) South Western Sydney Clinical School, University of
New South Wales, Sydney, NSW, Australia
(Frost) Centre for Applied Nursing Research, Western Sydney University,
Sydney, NSW, Australia
(Chuan) Department of Anaesthesia, Liverpool Hospital, Liverpool, NSW,
Australia
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Impaired cerebrovascular autoregulation (CVAR) is observed in
up to 20% of cardiac surgical patients. This systematic review aims to
evaluate the association between impaired CVAR, measured by current
monitoring techniques, and patient-centred outcomes in adults following
cardiac surgery. Method(s): MEDLINE, EMBASE, PubMed, MEDLINE
In-Process and Cochrane Library were systematically searched through 8
December 2017. Studies were included if they assessed associations between
CVAR and patient-centred outcomes in the adult cardiac surgical
population. The primary outcome of this systematic review was mortality.
Secondary outcomes were stroke, delirium and acute kidney injury. Risk of
bias was systematically assessed, and the GRADE methodology was used to
evaluate the quality of evidence across outcomes. Result(s): Eleven
observational studies and no randomised controlled trials met the
inclusion criteria. Due to methodological heterogeneity, meta-analysis was
not possible. There was a high risk of bias within individual studies and
low quality of evidence across outcomes. Of the included studies, one
assessed mortality, five assessed stroke, four assessed delirium, and
three assessed acute kidney injury. No reliable conclusions can be drawn
from the one study assessing mortality. Interpretation of studies
investigating CVAR and stroke, delirium and acute kidney injury was
complicated by the lack of standardisation of monitoring techniques as
well as varying definitions of impaired CVAR. Conclusion(s): There is
a paucity of high quality evidence for CVAR monitoring and its
associations with outcome measures in post-cardiac surgical patients,
highlighting the need for future studies. Copyright © 2018 The
Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley &
Sons Ltd

<84>
Accession Number
623740753
Title
Randomized controlled trial of a self-administered five-day antiseptic
bundle versus usual disinfectant soap showers for preoperative eradication
of Staphylococcus aureus colonization.
Source
Infection Control and Hospital Epidemiology. 39 (9) (pp 1049-1057), 2018.
Date of Publication: 01 Sep 2018.
Author
Kline S.E.; Neaton J.D.; Lynfield R.; Ferrieri P.; Kulasingam S.; Dittes
K.; Glennen A.; Jawahir S.; Kaizer A.; Menk J.; Johnson J.R.
Institution
(Kline, Dittes, Johnson) University of Minnesota Medical School,
Department of Medicine, Division of Infectious Diseases, 420 Delaware St
SE, MMC# 250, Minneapolis, MN 55455, United States
(Neaton) Division of Biostatistics, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Lynfield, Glennen, Jawahir) Minnesota Department of Health, St Paul, MN,
United States
(Ferrieri) Department of Laboratory Medicine and Pathology, University of
Minnesota Medical School, Minneapolis, MN, United States
(Kulasingam) Division of Epidemiology, University of Minnesota School of
Public Health, Minneapolis, MN, United States
(Kaizer, Menk) Biostatistical Design and Analysis Center, University of
Minnesota, Minneapolis, MN, United States
(Johnson) Veterans Affairs Medical Center, Minneapolis, MN, United States
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective To determine the efficacy in eradicating Staphylococcus aureus
(SA) carriage of a 5-day preoperative decolonization bundle compared to 2
disinfectant soap showers, with both regimens self-administered at
home.Design Open label, single-center, randomized clinical trial.Setting
Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular,
and general surgery clinics at a tertiary-care referral center in the
United States.Participants Patients at the University of Minnesota Medical
Center planning to have elective surgery and not on antibiotics.Methods
Consenting participants were screened for SA colonization using nasal,
throat, axillary, and perianal swab cultures. Carriers of SA were
randomized, stratified by methicillin resistance status, to a
decolonization bundle group (5 days of nasal mupirocin, chlorhexidine
gluconate [CHG] bathing, and CHG mouthwash) or control group (2
preoperative showers with antiseptic soap). Colonization status was
reassessed preoperatively. The primary endpoint was absence of SA at all 4
screened body sites.Results Of 427 participants screened between August
31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers.
Of these, 121 were randomized and 110 were eligible for efficacy analysis
(57 decolonization bundle group, 53 control group). Overall, 90% of
evaluable participants had methicillin-susceptible SA strains. Eradication
of SA at all body sites was achieved for 41 of 57 participants (71.9%) in
the decolonization bundle group and for 13 of 53 participants (24.5%) in
the control group, a difference of 47.4% (95% confidence interval [CI],
29.1%-65.7%; P<.0001).Conclusion An outpatient preoperative antiseptic
decolonization bundle aimed at 4 body sites was significantly more
effective in eradicating SA than the usual disinfectant showers (ie, the
control).Trial Registration ClinicalTrials.gov identifier:
NCT02182115 Copyright © 2018 by The Society for Healthcare
Epidemiology of America. All rights reserved.

<85>
Accession Number
620142123
Title
Allogeneic mesenchymal stem cells for treatment of AKI after cardiac
surgery.
Source
Journal of the American Society of Nephrology. 29 (1) (pp 260-267), 2017.
Date of Publication: January 2018.
Author
Swaminathan M.; Stafford-Smith M.; Chertow G.M.; Warnock D.G.; Paragamian
V.; Brenner R.M.; Lellouche F.; Fox-Robichaud A.; Atta M.G.; Melby S.;
Mehta R.L.; Wald R.; Verma S.; Mazer C.D.; Lombard F.W.; Schroder J.;
Kurtzberg J.; Bisnar T.; Conte J.; Dodd-O J.; Rabb H.; Katz N.; Shah A.;
Huyette-Arrizza E.; Bellot C.; Kramer R.; Tolson B.; Solomon R.; Brooks
C.; Mora-Mangano C.; Wong J.; Kashani K.; Naka Y.; Umanath K.; Yee J.;
Kilic A.; Lecker S.; Frendl G.; MacKensen B.; Simon M.; Dagenais F.;
Ferland M.-C.; Bouchard P.-A.; Whitlock R.; Ainsworth C.; McDonald E.;
Curley G.; Yagnik S.; Crescini C.; Ferland A.; Maier K.; Denault A.; Ly
H.; Bainbridge D.; Bentall T.; Legare J.-F.; Grocott H.
Institution
(Swaminathan, Stafford-Smith) Division of Cardiothoracic Anesthesiology,
Department of Anesthesiology, Duke University School of Medicine, Durham,
NC, United States
(Chertow) Department of Medicine (Nephrology), Stanford University,
Stanford, CA, United States
(Warnock) Division of Nephrology, Department of Medicine, Birmingham, AB,
United States
(Paragamian, Brenner) Division of Cardiothoracic Surgery, Department of
Surgery, University of Alabama at Birmingham, Birmingham, AB, United
States
(Lellouche) AlloCure Inc., Burlington, MA, United States
(Fox-Robichaud) Department of Anesthesiology and Critical Care Medicine,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, Quebec City, QC, Canada
(Atta) Division of Critical Care, Department of Medicine and Thrombosis,
Atherosclerosis Research Institute, McMaster University and Hamilton
Health Sciences, Hamilton, ON, Canada
(Melby) Division of Nephrology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Mehta) Division of Nephrology, Department of Medicine, University of
California, San Diego, CA, United States
(Wald) Division of Nephrology, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Canada
(Verma) Department of Surgery, Division of Cardiac Surgery, Keenan
Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Canada
(Mazer) Department of Anesthesia, Keenan Research Centre for Biomedical
Science, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON
M5B 1W8, Canada
(Lombard, Schroder, Kurtzberg, Bisnar) Duke University, United States
(Conte, Dodd-O, Rabb, Katz, Shah, Huyette-Arrizza) Johns Hopkins
University, United States
(Bellot) University of Alabama, Birmingham, United States
(Kramer, Tolson) Maine Medical Center, United States
(Solomon) Fletcher Allen Health Care, United States
(Brooks) University of Virginia, United States
(Mora-Mangano, Wong) Stanford University, United States
(Kashani) Mayo Clinic, United States
(Naka) Columbia University, United States
(Umanath, Yee) Henry Ford Hospital, United States
(Kilic) Ohio State University, United States
(Lecker) Beth Israel Deaconess, Medical Center, United States
(Frendl) Brigham and Women's Hospital, United States
(MacKensen) University of Washington, United States
(Simon, Dagenais, Ferland, Bouchard) Institut Universitaire de Cardiologie
et de Pneumologie, Quebec, Canada
(Whitlock, Ainsworth, McDonald) McMaster-Hamilton General Hospital,
Thrombosis and Atherosclerosis Research Institute, Canada
(Curley, Yagnik, Crescini) St. Michael's Hospital, Canada
(Ferland, Maier) Libin Cardiovascular Institute of Alberta Foothills
Hospital, Canada
(Denault, Ly) Montreal Heart Institute, Canada
(Bainbridge, Bentall) London Health Sciences Centre, University Hospital,
Canada
(Legare) Capital District Health Authority, Queen Elizabeth II Health
Sciences Centre, Canada
(Grocott) St. Boniface Hospital, University of Manitoba, Canada
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
AKI after cardiac surgery remains strongly associated with mortality and
lacks effective treatment or prevention. Preclinical studies suggest that
cell-based interventions may influence functional recovery. We conducted a
phase 2, randomized, double-blind, placebo-controlled trial in 27 centers
across North America to determine the safety and efficacy of allogeneic
human mesenchymal stem cells (MSCs) in reducing the time to recovery from
AKI after cardiac surgery. We randomized 156 adult subjects undergoing
cardiac surgery with evidence of early AKI to receive intra-aortic MSCs
(AC607; n=67) or placebo (n=68). The primary outcome was the time to
recovery of kidney function defined as return of postintervention
creatinine level to baseline. The median time to recovery of kidney
function was 15 days with AC607 and 12 days with placebo (25th, 75th
percentile range, 10-29 versus 6-21, respectively; hazard ratio, 0.81; 95%
confidence interval, 0.53 to 1.24; P=0.32). We did not detect a
significant difference between groups in 30-day all-cause mortality (16.7%
with AC607; 11.8% with placebo) or dialysis (10.6% with AC607; 7.4% with
placebo). At follow-up, 12 patients who received AC607 and six patients
who received placebo had died. Rates of other adverse events did not
differ between groups. In these patients with AKI after cardiac surgery,
administration of allogeneic MSCs did not decrease the time to recovery of
kidney function. Our results contrast with those in preclinical studies
and provide important information regarding the potential effects of MSCs
in this setting. Copyright © 2018 by the American Society of
Nephrology.

<86>
Accession Number
2002266195
Title
Randomized clinical trial of an elastomeric sealant for hemostasis in
thoracic aortic surgery.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2019. Date
of Publication: 2019.
Author
Morita S.; Matsuda T.; Tashiro T.; Komiya T.; Ogino H.; Mukohara N.;
Tominaga R.
Institution
(Morita) Department of Thoracic and Cardiovascular Surgery, Clinical
Research Institute, National Hospital Organization Kyushu Medical Center,
1-8-1 Jigyohama, Fukuoka 810-8563, Japan
(Matsuda) Division of Biomedical Engineering, Graduate School of Medical
Science, Kyushu University, Fukuoka, Japan
(Tashiro) Department of Cardiovascular Surgery, University of Fukuoka
Medical School, Fukuoka, Japan
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Kurashiki, Okayama, Japan
(Ogino) Department of Cardiovascular Surgery, National Cardiovascular and
Research Center, Suita, Osaka, Japan
(Mukohara) Department of Cardiovascular Surgery, Hyogo Brain and Heart
Center, Himeji, Japan
(Tominaga) Division of Cardiovascular Surgery, Graduate School of Medical
Science, Kyushu University, Fukuoka, Japan
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objectives: This study aimed to demonstrate the efficacy and safety of a
newly developed elastomeric sealant, which does not require any blood
coagulation system to exert its effect, during thoracic aortic surgery.
 Method(s): This is a multicenter, randomized study conducted in six
hospitals in Japan. A total of 81 patients undergoing replacement surgery
of a thoracic aortic aneurysm using cardiopulmonary bypass were randomized
with a ratio of 2-:1 for those patients designated to receive the sealant
(Group S, 54 patients) or those without the usage of the sealant (Group C,
27 patients). The primary endpoints were bleeding from each anastomosis at
two time points: (1) immediately before applying protamine and (2) 15 min
after applying protamine. The patients were followed for 6 months.
 Result(s): The number of anastomoses checked for bleeding was 196 in
Group S and 117 in Group C. Before protamine sulfate administration,
complete hemostasis was obtained in 155 anastomoses (79%) in Group S
compared to 45 anastomoses (38%) in Group C (p < 0.001). Fifteen minutes
after the administration of protamine sulfate infusion, bleeding stopped
completely in 173 anastomoses (88%) in Group S and in 71 anastomoses (61%,
p < 0.001) in Group C. Between the two groups, there were no marked
differences in the patient background or in the incidence of major adverse
events. Conclusion(s): The sealant is effective in achieving
hemostasis, even under fully heparinized conditions. The novel sealant is
safe and effective in thoracic aortic surgery, one of the most demanding
surgical situations for hemostasis. Copyright © 2019, The
Author(s).

<87>
Accession Number
2001513139
Title
Are racial differences in hospital mortality after coronary artery bypass
graft surgery real? A risk-adjusted meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (6) (pp 2216-2225.e4),
2019. Date of Publication: June 2019.
Author
Benedetto U.; Kamel M.K.; Khan F.M.; Angelini G.D.; Caputo M.; Girardi
L.N.; Gaudino M.
Institution
(Benedetto, Angelini, Caputo) Bristol Heart Institute, University of
Bristol, School of Clinical Sciences, Bristol, United Kingdom
(Kamel, Khan, Girardi, Gaudino) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Despite several reports, there are still conflicting data on
the influence of ethnicity on mortality rates associated with coronary
artery bypass grafting (CABG). We aimed to get further insights into the
effect of race on mortality following CABG by performing a risk adjusted
meta-analysis. Method(s): Relevant studies were searched on PubMed,
Embase, BioMed Central, and the Cochrane Central register. Pairwise
meta-analysis was used to estimate the relative risk of hospital death of
black, Hispanic, and Asian patients using white patients as reference.
Risk adjusted meta-analytic estimates were obtained using generic inverse
variance methods with random effect model. Result(s): A total of 28
studies were selected for analysis. A total of 21 studies reported on
hospital mortality in black (n = 222,892) versus white (n = 3,884,043)
patients, 7 studies reported on Hispanic (n = 91,256) versus white (n =
1,458,524) and 9 studies reported on Asian (n = 27,820) versus white (n =
1,081,642). When compared with white patients, adjusted risk of hospital
death was significantly greater for black patients (adjusted odds ratio
[OR], 1.25; 95% confidence interval [CI], 1.13-1.39; P < .001), and not
statistically different for Asian (OR, 1.33; 95% CI, 0.99-1.77; P = .05)
and Hispanic patients (adjusted OR, 1.08; 95% CI, 0.94-1.23; P = .26).
Meta-regression showed a significant trend toward lower mortality rates in
most recent series in both black (P = .02) and white (P = .0007) and Asian
(P = .01) but not for Hispanic (P = .41). However, as mortality rates were
lower across the different races, the relative disadvantage between the
study groups persisted, which may explain the lack of interaction between
study period and race effect on mortality for black (adjusted P = .09),
Asian (adjusted P = .63), and Hispanic (adjusted P = .97) patients.
 Conclusion(s): The present meta-analysis showed that despite progress
is being made in lowering in-hospital mortality rates among the major
racial/ethnic groups, ethnical disparities in hospital mortality after
CABG remain. Copyright © 2018 The American Association for
Thoracic Surgery

<88>
Accession Number
628731687
Title
The value of routine serum C-reactive protein samples before elective
orthopaedic surgery in asymptomatic patients - A literature review.
Source
Swiss Medical Weekly. Conference: 79th Annual Meeting of the Swiss
Orthopaedics. Switzerland. 149 (Supplement 236) (pp 76S), 2019. Date of
Publication: June 2019.
Author
Uckay I.
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Objective: There are settings routinely performing pre-operative serum
C-reac-tive protein (CRP) samples before elective implant surgery, nota
bene before ar-throplasty. While this approach is valid for research
purposes, the clinical or preventive benefits are less clear.
 Method(s): We performed a survey in Switzerland and France, among
selected infectious diseases physicians and surgeons who are specialized
in orthopaedic infections; and reviewed existing literature and guidelines
we retrieved with the English MeSH terms "preoperative CRP" or "surgical
CRP" linked to "surgery" and "complications or "infection": We excluded
cases with a diagnostic use of CRP upon clinical suspicion of infection.
 Result(s): In Switzerland, one CRP determination costs 10 Francs. In
our survey, only a minority of Swiss and French settings seem to perform
preoperative CRP sampling routinely. International or national guidelines
do not recommend it either. According to the lecture of 85 specific
articles, the preoperative CRP might have panoply of reasons for being
slightly and transiently elevated and can be associated to postoperative
complications after cardiac or colorectal surgery; but is mostly a
surrogate of the underlying illness or stress. Regarding orthopaedic
surgery and traumatology, we identified three papers associating
preoperative CRP's with postoperative complications: one traumatology
article in the elderly; one paper on elective interventions without
case-mix adjustment, and one paper investigating the fate of arthroplasty
in patients with rheumatoid arthritis. In terms of outcome, no paper
proved that pre-operative routine CRP sampling modified the decisions of
the surgeons or the fate of the patient. Conclusion(s): The routine
pre-operative serum CRP sampling before elective orthopaedic surgery in
asymptomatic patients (besides the classic symptoms justifying the planned
surgery) doesn't justify the costs of measuring it.

<89>
Accession Number
628735130
Title
Fentanyl-based intravenous patient-controlled analgesia with low dose of
ketamine is not inferior to thoracic epidural analgesia for acute
post-thoracotomy pain following video-assisted thoracic surgery: A
randomized controlled study.
Source
Medicine. 98 (28) (pp e16403), 2019. Date of Publication: 01 Jul 2019.
Author
Tseng W.-C.; Lin W.-L.; Lai H.-C.; Huang T.-W.; Chen P.-H.; Wu Z.-F.
Institution
(Tseng, Lin, Lai, Chen, Wu) Department of Anesthesiology, Netherlands
(Huang) Division of Chest Surgery, Department of Surgery, Tri-Service
General Hospital and National Defense Medical Center
(Chen) Graduate Institute of Public Health, National Defense Medical
Center, Taiwan (Republic of China)
(Wu) Department of Anesthesiology, Chi Mei Medical Center, R.O.C, Tainan,
Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Thoracic epidural analgesia is the preferred method for
postoperative analgesia following thoracic surgery. However, intravenous
patient-controlled analgesia (IVPCA) may be an effective alternative. This
study was conducted because few scientific reports exist comparing
fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with
thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment
of postoperative pain after video-assisted thoracic surgery (VATS).
 METHOD(S): This prospective, and randomized study included 70
patients randomized into fk-IVPCA and t-PCEA groups. Pain at rest and
during movement, successful and unsuccessful triggers after pressing the
PCA device button, the need for rescue analgesia, drug-related adverse
events, and patient satisfaction were recorded for 48 hours
postoperatively. RESULT(S): No significant differences in the
intensity of pain at rest or during movement were observed between the 2
groups within 48 hours postoperatively. The number of unsuccessful PCA
triggers in the t-PCEA group 0 to 4 hours after surgery was significantly
higher than that in the fk-IVPCA group. However, the numbers of successful
PCA triggers in the fk-IVPCA group at 4 to 12 and 0 to 24 hours after
surgery were significantly higher than those in the t-PCEA group. The
incidence of analgesic-related side effects and patient satisfaction were
similar in both groups. CONCLUSION(S): Compared with t-PCEA, the
addition of a subanesthetic dose of ketamine to fentanyl-based IVPCA
resulted in similar pain control after VATS with no increase in the
incidence of drug-related adverse effects. The results confirm that both
multimodal intravenous analgesia and epidural analgesia can provide
sufficient pain control and are safe strategies for treating acute
post-thoracotomy pain.

<90>
Accession Number
628735481
Title
Management of patients with concomitant coronary and carotid artery
disease.
Source
Expert review of cardiovascular therapy. (no pagination), 2019. Date of
Publication: 15 Jul 2019.
Author
Drakopoulou M.; Oikonomou G.; Soulaidopoulos S.; Toutouzas K.; Tousoulis
D.
Institution
(Drakopoulou, Oikonomou, Soulaidopoulos, Toutouzas, Tousoulis) First
Department of Cardiology, Medical School of Athens University,
Hippokration Hospital, Athens, Greece
Publisher
NLM (Medline)
Abstract
Introduction: Ideal management of concomitant carotid and coronary artery
occlusive disease remains under investigation. Although researchers have
advocated the potential benefits of varying treatment strategies based on
either concomitant or staged surgical treatment, there is no consensus in
treatment guidelines among national or international clinical societies.
With emerging data suggesting favorable outcome of carotid artery stenting
(CAS) compared to carotid endarterectomy (CEA) in patients with critical
coronary artery disease, physicians must consider these diverging
therapeutic options when treating patients with concurrent carotid and
coronary disease. Areas covered: This review presents current evidence
regarding the prevalence of carotid stenosis in patients with coronary
artery disease, the common pathophysiologic links with an emphasis on the
diverse mechanisms of stroke in the coronary artery bypass grafting (CABG)
setting and discusses the contemporary registries and observational
studies comparing outcomes of various revascularization strategies in
high-risk patients. Authors conducted literature search in two
bibliographic databases including papers published from 1983 until 2018
(PubMed, Scopus). Expert Opinion: Symptoms should drive the need to
intervene on carotid stenosis in patients undergoing coronary
revascularization. Carotid artery stenting has gained significant ground,
especially among those individuals considered to be of high surgical risk.
PCI may be considered as an alternative option for the management of
severe concurrent coronary disease.

<91>
Accession Number
628732132
Title
Prevention of Stroke in Atrial Fibrillation After Coronary Stenting.
Source
Stroke. (pp STROKEAHA119026078), 2019. Date of Publication: 15 Jul 2019.
Author
Knijnik L.; Rivera M.; Blumer V.; Cardoso R.; Fernandes A.; Fernandes G.;
Ferreira T.; Romano J.G.; Lambrakos L.K.; Cohen M.G.
Institution
(Knijnik, Fernandes, Fernandes, Ferreira) From the Department of Internal
Medicine, University of Miami Miller School of Medicine, FL (L.K., A.F.
(Rivera) Cardiovascular Division, Washington University School of
Medicine, St. Louis, United States
(Blumer) Cardiovascular Division, Duke University Hospital, Durham, Canada
(Cardoso) Division of Cardiology, Johns Hopkins Medical Institutions,
Baltimore, Canada
(Romano) Department of Neurology, University of Miami Miller School of
Medicine, FL (J.G.R.)
(Lambrakos, Cohen) Cardiovascular Division, Department of Medicine,
University of Miami Miller School of Medicine, FL (L.K.L.
Publisher
NLM (Medline)
Abstract
Background and Purpose- The optimal antithrombotic strategy to balance
thromboembolic and bleeding events, especially acute stroke, for patients
with atrial fibrillation following coronary stenting remains a matter of
debate. We conducted a network meta-analysis to identify the
antithrombotic regimen associated with the lowest rate of bleeding and
thromboembolic events in atrial fibrillation after coronary stenting.
Methods- PubMed, Scopus, and Cochrane Central were searched for randomized
controlled trials and observational studies of patients with atrial
fibrillation after coronary stenting. The outcomes of interest were
stroke, myocardial infarction, major adverse cardiac events, mortality,
and major bleeding. A network meta-analysis was performed comparing the
available antithrombotic regimens in the literature. Results- Three
randomized and 15 observational studies were included, with a total of
23478 participants. Median follow-up was 2 years. Network meta-analysis
demonstrated that vitamin K antagonist plus single antiplatelet therapy or
direct-acting oral anticoagulant plus single antiplatelet therapy were the
most effective regimens in preventing stroke. Direct-acting oral
anticoagulant regimens were associated with lower major bleeding rates
than vitamin K antagonist regimens. Regimens with dual antiplatelet
therapy were associated with lower rates of myocardial infarction. Vitamin
K antagonist plus dual antiplatelet therapy was associated with a lower
mortality and low-dose direct-acting oral anticoagulants with decreased
major cardiovascular adverse events. Conclusions- Direct-acting oral
anticoagulant regimens were associated with less major bleeding and major
cardiovascular adverse events, but vitamin K antagonists were associated
with decreased mortality and stroke. These results suggest that the
decision of antithrombotic therapy in patients with atrial fibrillation
after percutaneous coronary intervention needs to be individualized.

<92>
Accession Number
628731886
Title
Meta-analysis of prognostic impact of peripheral arterial disease on
mortality after transcatheter aortic valve implantation.
Source
The Journal of cardiovascular surgery. (no pagination), 2019. Date of
Publication: 12 Jul 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Cardiovascular Surgery, Kitasato University School
of Medicine, Sagamihara, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, USA
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: To determine whether peripheral arterial disease (PAD) is an
independent predictor of mortality in patients who undergo transcatheter
aortic valve implantation (TAVI), we performed meta-analysis of currently
available studies. METHOD(S): MEDLINE and EMBASE were searched
through June 2018 using Web- based search engines (PubMed and OVID). We
included comparative studies of patients with PAD versus those without PAD
and cohort studies which investigated PAD as one of prognostic factors of
mortality, which used the multivariable analysis and reported an adjusted
odds and hazard ratio (OR/HR) for early (30-day or in-hospital) and late
(including early) mortality after TAVI. Study-specific estimates were
combined using inverse variance-weighted averages of logarithmic ORs/HRs
in the random-effects model. RESULT(S): The primary meta-analysis
which pooled all the ORs/HRs demonstrated that PAD was associated with a
statistically significant increase in both early (OR, 1.21; P = 0.02) and
midterm (1-year to 7-year) mortality (HR, 1.31; P < 0.00001). The
secondary meta-analysis which exclusively pooled
approach-adjusted/stratified ORs/HRs demonstrated that PAD was associated
with a strong trend toward (though statistically non-significant) an
increase in early mortality (OR, 1.18; P = 0.07) and a still statistically
significant increase in midterm mortality (OR, 1.24; P = 0.0001).
Meta-regression coefficients for the proportion of patients who underwent
transfemoral TAVI were not statistically significant (P for early/midterm
mortality = 0.24/0.52). CONCLUSION(S): The present meta-analysis
clearly highlighted that PAD was an independent predictor of both early
and midterm mortality in patients who underwent TAVI.

<93>
Accession Number
628714816
Title
The Neutrophil to Lymphocyte Ratio in Heart Failure: A Comprehensive
Review.
Source
Romanian journal of internal medicine = Revue roumaine de medecine
interne. (no pagination), 2019. Date of Publication: 12 Jul 2019.
Author
Delcea C.; Buzea C.A.; Dan G.A.
Institution
(Delcea, Buzea, Dan) Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania
(Delcea, Buzea, Dan) Cardiology Department, Colentina Clinical Hospital,
Bucharest, Romania
(Delcea, Dan) CDPC Cardiology Laboratory, Colentina Clinical Hospital,
Bucharest, Romania
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Heart failure (HF) and systemic inflammation are
interdependent processes that continuously potentiate each other. Distinct
pathophysiological pathways are activated, resulting in increased
neutrophil count and reduced lymphocyte numbers, making the neutrophil to
lymphocyte ratio (NLR) a potential indirect marker of severity. We
conducted this comprehensive review to characterize the role of NLR in HF.
 METHOD(S): We searched the PubMed (MEDLINE) database using the key
words neutrophil", "lymphocyte", "heart failure", "cardiomyopathy",
"implantable cardioverter defibrillator", "cardiac resynchronization
therapy" and "heart transplant". RESULT(S): We identified 241
publications. 31 were selected for this review, including 12107 patients.
NLR was correlated to HF severity expressed by clinical, biological, and
imaging parameters, as well as to short and long-term prognosis. Most
studies reported its survival predictive value. Elevated NLR (>2.1-7.6)
was an independent predictor of in-hospital mortality [adjusted HR
1.13(95%CI 1.01-1.27)-2.8(95%CI 1.43-5.53)] as well as long-term all-cause
mortality [adjusted HR 1.43(95%CI 1.1-1.85) -2.403(95%CI 1.076-5.704)].
Higher NLR levels also predicted poor functional capacity [NLR>2.26/2.74,
HR 3.93(95%CI 1.02-15.12)/3.085(95%CI 1.52-6.26)], hospital readmissions
[NLR>2.9/7.6, HR 1.46(95%CI 1.10-1.93)/3.46(95%CI 2.11-5.68)] cardiac
resynchronization therapy efficacy [NLR>3.45/unit increase, HR 12.22(95%CI
2.16-69.05)/1.51(95%CI 1.01-2.24)] and appropriate implantable
cardioverter defibrillator shocks (NLR>2.93), as well as mortality after
left ventricular assist device implantation [NLR>4.4/quartiles, HR 1.67
(95%CI 1.03-2.70)/1.22 (95%CI 1.01-1.47)] or heart transplant (NLR>2.41,
HR 3.403(95%CI 1.04-11.14)]. CONCLUSION(S): Increased NLR in HF
patients can be a valuable auxiliary biomarker of severity, and most of
all, of poor prognosis.

<94>
Accession Number
2002348198
Title
Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver
transplantation: a narrative review of cases and potential biochemical
mechanisms.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Charles F.-G.; Murray L.J.; Giordano C.; Spiess B.D.
Institution
(Charles, Giordano, Spiess) Department of Anesthesiology, University of
Florida College of Medicine, 1600 SW Archer Road, PO Box 100254,
Gainesville, FL 32610, United States
(Murray) Department of Chemistry, Center for Catalysis and Florida Center
for Heterocyclic Compounds, University of Florida, Gainesville, FL, United
States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hydroxocobalamin, or vitamin B12 (V-B12), is frequently used to
treat smoke inhalation and cyanide poisoning. Recent reports have also
described its use to treat vasoplegia in cardiac surgery and liver
transplantation. This narrative review discusses this "off-label"
indication for V-B12, focusing on the potential biochemical mechanisms of
its actions. Source: PubMed, Cochrane, and Web of Science databases were
searched for clinical reports on the use of V-B12 for vasoplegia in
cardiac surgery and liver transplantation, with the biochemical mechanisms
discussed being based on a survey of the related biochemistry literature.
Principal findings: Forty-four patients have been treated with V-B12 for
vasoplegia in various isolated case reports and one series. Although 75%
of patients have increased blood pressure in response to V-B12, there were
some "non-responders". The true efficacy remains unknown because clinical
trials have not been performed, and significant reporting bias likely
exists. Plausible biochemical explanations exist for the potential
beneficial effects of V-B12 in treating vasoplegia, including binding
nitric oxide and other gasotransmitters. Additional research is required
to clarify if and how these mechanisms are causally involved in effective
clinical responders and non-responders. Conclusion(s): Although
anecdotal reports utilizing V-B12 for vasoplegia are available, no
higher-level evidence exists. Future work is necessary to further
understand the dosing, timing, adverse events, and biochemical mechanisms
of V-B12 compared with other therapies such as methylene
blue. Copyright © 2019, Canadian Anesthesiologists' Society.

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