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<1>
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.

<2>
Accession Number
2002299862
Title
Value of cardiogoniometry in diagnosis of coronary artery disease in
patients with suspected stable ischemic heart disease: A systematic review
and meta-analysis.
Source
International Heart Journal. 60 (3) (pp 527-538), 2019. Date of
Publication: 2019.
Author
Shamloo A.S.; Dinov B.; Bertagnolli L.; Sommer P.; Husser-Bollmann D.;
Bollmann A.; Hindricks G.; Arya A.
Institution
(Shamloo, Dinov, Bertagnolli, Sommer, Husser-Bollmann, Bollmann,
Hindricks, Arya) Department of Electrophysiology, Heart Center at
University of Leipzig, Leipzig, Germany
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
Cardiogoniometry (CGM) has been proposed as a new diagnostic tool for
coronary artery disease (CAD) in recent years. Although different studies
have evaluated the diagnostic value of CGM in CAD diagnosis, no pooled
analysis of its diagnostic accuracy has been performed so far. This study
aimed to assess the value of CGM in diagnosing CAD in patients with
suspected stable ischemic heart disease (SIHD). This was a systematic
review and meta-analysis conducted on available literature until May 2018.
Studies considered coronary angiography as the reference standard for CAD
diagnosis and reported CGM diagnostic value parameters were included. No
language and time restrictions for enrolling the studies were considered.
Statistical analysis was performed using Meta-DiSc software. The findings
of the 10 studies published in 9 articles were enrolled in the
meta-analysis. Overall pooled sensitivity was 71.7% (69.1 to 74.1;
Cochrane Q = 39.5; P < 0.00001; I2 = 77.3%), and pooled
specificity was 78.8% (76.3 to 81.1; Cochrane Q = 37.39; P < 0.00001;
I2 = 75.9%). Regarding Egger's regression test (P = 0.32),
there was no published bias in the studies. It seems that CGM, as an
easy-to-use and non-invasive modality, should be considered as a part of
risk stratifying strategies for CAD in patients with SIHD, mainly in
patients with contraindications for stress tests. However, further studies
with a high quality of methodology are still needed to assess the
diagnostic value of CGM for CAD in patients with suspected
SIHD. Copyright © 2019, International Heart Journal Association.
All rights reserved.

<3>
Accession Number
627125123
Title
Five-year costs from a randomised comparison of bilateral and single
internal thoracic artery grafts.
Source
Heart. 105 (16) (pp 1237-1243), 2019. Date of Publication: 01 Aug 2019.
Author
Little M.; Gray A.; Altman D.; Benedetto U.; Flather M.; Gerry S.; Lees
B.; Murphy J.; Campbell H.; Taggart D.
Institution
(Little) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Gray, Murphy, Campbell) Nuffield Department of Population Health,
University of Oxford Health Economics Research Centre, Oxford, United
Kingdom
(Altman) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Centre for Statistics in Medicine, University of
Oxford, Oxford, United Kingdom
(Benedetto) University of Bristol School of Clinical Science, Bristol,
Bristol, United Kingdom
(Flather) University of East Anglia Faculty of Medicine and Health
Sciences, Norwich-Norfolk, United Kingdom
(Flather) Norfolk and Norwich University Hospitals NHS Foundation Trust,
Norwich-Norfolk, United Kingdom
(Gerry) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Centre for Statistics in Medicine, Oxford,
United Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, Oxford, Oxfordshire, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: The use of bilateral internal thoracic arteries (BITA) for
coronary artery bypass grafting (CABG) may improve survival compared with
CABG using single internal thoracic arteries (SITA). We assessed the
long-term costs of BITA compared with SITA. Method(s): Between June
2004 and December 2007, 3102 patients from 28 hospitals in seven countries
were randomised to CABG surgery using BITA (n=1548) or SITA (n=1554).
Detailed resource use data were collected from the initial hospital
episode and annually up to 5 years. The associated costs of this resource
use were assessed from a UK perspective with 5 year totals calculated for
each trial arm and pre-selected patient subgroups. Result(s): Total
costs increased by approximately 1000 annually in each arm, with no
significant annual difference between trial arms. Cumulative costs per
patient at 5-year follow-up remained significantly higher in the BITA
group (18 629) compared with the SITA group (17 480; mean cost difference
1149, 95% CI 330 to 1968, p=0.006) due to the higher costs of the initial
procedure. There were no significant differences between the trial arms in
the cost associated with healthcare contacts, medication use or serious
adverse events. Conclusion(s): Higher index costs for BITA were still
present at 5-year follow-up mainly driven by the higher initial cost with
no subsequent difference emerging between 1 year and 5 years of follow-up.
The overall cost-effectiveness of the two procedures, to be assessed at
the primary endpoint of the 10-year follow-up, will depend on composite
differences in costs and quality-adjusted survival. Copyright ©
2019 Author(s).

<4>
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.

<5>
Accession Number
2002202114
Title
Combined ultrasound-guided Pecs II block and general anesthesia are
effective for reducing pain from modified radical mastectomy.
Source
Journal of Pain Research. 12 (pp 1353-1358), 2019. Date of Publication:
2019.
Author
Senapathi T.G.A.; Widnyana I.M.G.; Aribawa I.G.N.M.; Jaya A.A.G.P.S.;
Junaedi I.M.D.
Institution
(Senapathi, Widnyana, Aribawa, Jaya, Junaedi) Department of Anesthesiology
and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana
University, Denpasar, Bali, Indonesia
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Purpose: Combined regional and general anesthesia are often used for the
management of breast cancer surgery. Thoracic spinal block, thoracic
epidural block, thoracic paravertebral block, and multiple intercostal
nerve blocks are the regional anesthesia techniques which have been used
in breast surgery, but some anesthesiologists are not comfortable because
of the complication and side effects. In 2012, Blanco et al introduced
pectoralis nerve (Pecs) II block or modified Pecs block as a novel
approach to breast surgery. This study aims to determine the effectiveness
of combined ultrasound-guided Pecs II block and general anesthesia for
reducing intra- and postoperative pain from modified radical mastectomy.
 Patients and Methods: Fifty patients undergoing modified radical
mastectomy with general anesthesia were divided into two groups randomly
(n=25), to either Pecs (P) group or control (C) group. Ultrasound-guided
Pecs II block was done with 0.25% bupivacaine (P group) or 0.9% NaCl (C
group). Patient-controlled analgesia was used to control postoperative
pain. Intraoperative opioid consumption, postoperative visual analog scale
(VAS) score, and postoperative opioid consumption were measured.
 Result(s): Intraoperative opioid consumption was significantly lower
in P group (P<=0.05). VAS score at 3, 6, 12, and 24 hrs postoperative were
significantly lower in P group (P<=0.05). Twenty-four hours postoperative
opioid consumption was significantly lower in P group (P<=0.05). There are
no complications following Pecs block in both groups, including
pneumothorax, vascular puncture, and hematoma. Conclusion(s):
Combined ultrasound-guided Pecs II block and general anesthesia are
effective in reducing pain both intra- and postoperatively in patients
undergoing modified radical mastectomy. Ultrasound-guided Pecs II block is
a relatively safe peripheral nerve block. Copyright © 2019
Senapathi et al.

<6>
Accession Number
2002383281
Title
Pecs and Serratus Blocks: Current State of Chest Wall Analgesia.
Source
Current Anesthesiology Reports. 9 (3) (pp 308-313), 2019. Date of
Publication: 15 Sep 2019.
Author
Godlewski C.
Institution
(Godlewski) Department of Anesthesiology & Perioperative Medicine,
Division of Multispecialty Anesthesia, University of Alabama at
Birmingham, JT 923, 619 19th Street South, Birmingham, AL 35249-6810,
United States
Publisher
Springer
Abstract
Purpose of Review: This article seeks to provide a current review of
pertinent literature with regards to analgesia for chest wall
surgery-specifically Pecs and serratus blocks. Recent Findings:
Intermuscular plane blocks have been shown to be clinically efficacious in
the setting of chest wall surgery, especially in the setting of oncologic
breast surgery. Summary: Pecs and serratus blocks provide a safe and
effective alternative to neuraxial analgesia while avoiding many of the
associated technical difficulties and potential
complications. Copyright © 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<7>
Accession Number
2002344100
Title
In Search of the Ideal Valve: Optimizing Genetic Modifications to Prevent
Bioprosthetic Degeneration.
Source
Annals of Thoracic Surgery. 108 (2) (pp 624-635), 2019. Date of
Publication: August 2019.
Author
Smood B.; Hara H.; Cleveland D.C.; Cooper D.K.C.
Institution
(Smood, Hara, Cooper) Xenotransplantation Program, Department of Surgery,
University of Alabama at Birmingham, Birmingham, AL, United States
(Cleveland) Division of Pediatric Cardiovascular Surgery, University of
Alabama at Birmingham, Birmingham, AL, United States
Publisher
Elsevier USA
Abstract
Background: Bioprosthetic heart valves undergo structural degeneration and
calcification. Similarities exist in the histopathologic features of
explanted bioprosthetic valves and rejected pig tissues and organs after
xenotransplantation into nonhuman primates. The development of more
durable bioprosthetic valves, namely from genetically modified pigs, could
negate the need for the insertion of mechanical prostheses in children and
young adults with the requirement for life-long anticoagulation and might
avoid the need for reoperation in elderly patients. Method(s): We
reviewed the literature (MedlinePlus, PubMed, Google Scholar) through
September 1, 2018, under four key terms: (1) bioprosthetic heart valves,
(2) xenograft antigens, (3) immunologic responses to bioprosthetic valves,
and (4) genetic modification of xenografts. Result(s): Advances in
tissue and organ xenotransplantation have elucidated important immunologic
barriers that provide innovative approaches to prevent structural
degeneration of bioprosthetic heart valves. The current evidence suggests
that bioprosthetic valves derived from genetically modified pigs lacking
xenogeneic antigens (namely Gal, Neu5Gc, and Sda), termed triple-knockout
pigs, would function considerably longer than current wild-type
(genetically unmodified) porcine valves in human recipients.
 Conclusion(s): Preclinical and clinical studies to determine the
safety and efficacy of triple-knockout porcine bioprosthetic valves will
likely establish that they are more resistant to human immune responses
and thus less susceptible to structural degeneration. Copyright ©
2019 The Society of Thoracic Surgeons

<8>
Accession Number
2002112829
Title
Rate and predictors of permanent pacemaker implantation after
transcatheter aortic valve implantation: Current status.
Source
Current Cardiology Reviews. 15 (3) (pp 205-218), 2019. Date of
Publication: 2019.
Author
Russo E.; Potenza D.R.; Casella M.; Massaro R.; Russo G.; Braccio M.;
Russo A.D.; Cassese M.
Institution
(Russo, Braccio, Cassese) Department of Cardiovascular Disease, Division
of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni
Rotondo, Italy
(Russo, Potenza, Massaro) Department of Cardiovascular Disease, Division
of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo,
Italy
(Russo) Institute of Cardiology, Catholic University of the Sacred Heart,
Rome, Italy
(Casella, Russo) Cardiac Arrhythmia Research Center, Centro Cardiologico
Monzino IRCCS, Milan, Italy
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Transcather aortic valve implantation (TAVI) has become a safe and
indispensable treatment option for patients with severe symptomatic aortic
stenosis who are at high surgical risk. Recently, outcomes after TAVI have
improved significantly and TAVI has emerged as a qualified alternative to
surgical aortic valve replacement in the treatment of intermediate risk
patients and greater adoption of this procedure is to be expected in a
wider patients population, including younger patients and low surgical
risk patients. However since the aortic valve has close spatial proximity
to the conduction system, conduction anomalies are frequently observed in
TAVI. In this article, we aim to review the key aspects of
pathophysiology, current incidence, predictors and clinical association of
conduction anomalies following TAVI. Copyright © 2019 Bentham
Science Publishers.

<9>
Accession Number
628760814
Title
Postoperative sore throat and subglottic injury after McGrath MAC
videolaryngoscopic intubation with versus without a stylet in patients
with a high Mallampati score: A randomized controlled trial.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 137.
Date of Publication: 31 Jul 2019.
Author
Yoon H.-K.; Lee H.-C.; Oh H.; Jun K.; Park H.-P.
Institution
(Yoon, Lee, Oh, Jun, Park) Department of Anesthesiology and Pain Medicine,
Seoul National University College of Medicine, Seoul National University
Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A tracheal tube stylet can be used to assist successful
tracheal intubation, especially during videolaryngoscopic intubation
because videolaryngoscopes with a Macintosh-type blade such as McGrath MAC
videolaryngoscope have more acute angle than conventional Macintosh
laryngoscope. However, the use of a stylet during tracheal intubation can
raise concerns about stylet-induced postoperative airway complications,
such as sore throat, subglottic injury, and hoarseness. In this study, we
compared the incidence of postoperative airway complications after McGrath
MAC videolaryngoscopic intubation with versus without a stylet in patients
with a high Mallampati score. Method(s): In 104 patients with
Mallampati score III or IV and who were scheduled for lumbar or thoracic
spine surgery, McGrath MAC videolaryngoscopic intubation was performed
either with a stylet (group S, n = 52) or without a stylet (group N, n =
52). The primary outcome measure was the incidences of sore throat
evaluated at 1 and 24 h postoperatively. Secondary outcome measures were
the incidences of subglottic injury and postoperative hoarseness.
 Result(s): The incidence of CL grade III in group S and N was 3.8 and
5.8%, respectively. No patient showed CL grade IV. The incidences of sore
throat at 1 (26.9 vs 19.2%, P = 0.485) and 24 h (17.3 vs 13.5%, P = 0.786,
respectively) postoperatively were not significantly different between the
group S and N. However, the incidence of subglottic injury was
significantly higher in the group S, compared with the group N (65.4 vs
42.3%, P = 0.030). The incidence of postoperative hoarseness did not
differ significantly between the two groups. Conclusion(s): The use
of a stylet during McGrath MAC videolaryngoscopic intubation did not have
a significant impact on the incidence of postoperative sore throat in
patients with a high Mallampati score. Avoiding the use of a stylet during
intubation with McGrath MAC videolaryngoscope may reduce the incidence of
subglottic injury in such patients. Copyright © 2019 The
Author(s).

<10>
Accession Number
628249329
Title
Surgical Outcomes in Syndromic Tetralogy of Fallot: A Systematic Review
and Evidence Quality Assessment.
Source
Pediatric Cardiology. 40 (6) (pp 1105-1112), 2019. Date of Publication: 15
Aug 2019.
Author
Athanasiadis D.I.; Mylonas K.S.; Kasparian K.; Ziogas I.A.; Vlachopoulou
D.; Sfyridis P.G.; Schizas D.; Spartalis E.; Nikiteas N.; Hemmati P.;
Kalangos A.; Avgerinos D.V.
Institution
(Athanasiadis, Mylonas, Kasparian, Ziogas) Pediatric Cardiac Surgery and
Pediatric Cardiology Working Group, Society of Junior Doctors, Athens,
Greece
(Athanasiadis) Department of Surgery, Indiana University School of
Medicine, Indianapolis, IN, United States
(Mylonas, Sfyridis, Kalangos) Department of Pediatric Cardiac Surgery,
Mitera Children'S Hospital, Athens, Greece
(Mylonas, Spartalis, Nikiteas) Laboratory of Experimental Surgery and
Surgical Research, School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
(Kasparian, Ziogas, Vlachopoulou) School of Medicine, Aristotle University
of Thessaloniki, Thessaloniki, Greece
(Schizas) 1st Department of Surgery, Laikon University General Hospital,
School of Medicine, National and Kapodistrian University of Athens,
Athens, Greece
(Hemmati) Department of Surgery, Mayo Clinic, Rochester, MN, United States
(Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York Presbyterian Hospital, New York City, NY, United States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital
heart defects. We sought to summarize all available data regarding the
epidemiology and perioperative outcomes of syndromic ToF patients. A
PRISMA-compliant systematic literature review of PubMed and Cochrane
Library was performed. Twelve original studies were included. The
incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent
genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4-52.2) and
trisomy 21 (41.9%; 95% CI 37.7-46.3). Complete surgical repair was
performed in 75.2% of the patients (n = 161/214; 95% CI 69.0-80.1) and
staged repair in 24.8% (n = 53/214; 95 CI 19.4-30.9). Relief of RVOT
obstruction was performed with transannular patch in 64.7% (n = 79/122;
95% CI 55.9-72.7) of the patients, pulmonary valve-sparing technique in
17.2% (n = 21/122; 95% CI 11.5-24.9), and RV-PA conduit in 18.0% (n =
22/122; 95% CI 12.1-25.9). Pleural effusions were the most common
postoperative complications (n = 28/549; 5.1%; 95% CI 3.5-7.3).
Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9-6.4) of the
patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5-12.7).
Genetic syndromes are seen in approximately 15% of ToF patients. Long-term
survival exceeds 90%, suggesting that surgical management should be
dictated by anatomy regardless of genetics. Copyright © 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<11>
Accession Number
2002547975
Title
Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve
Replacement.
Source
JACC: Cardiovascular Interventions. 12 (16) (pp 1566-1576), 2019. Date of
Publication: 26 August 2019.
Author
Jochheim D.; Barbanti M.; Capretti G.; Stefanini G.G.; Hapfelmeier A.;
Zadrozny M.; Baquet M.; Fischer J.; Theiss H.; Todaro D.; Chieffo A.;
Presbitero P.; Colombo A.; Massberg S.; Tamburino C.; Mehilli J.
Institution
(Jochheim, Zadrozny, Baquet, Fischer, Theiss, Massberg, Mehilli)
Department of Cardiology, Munich University Clinic, Ludwig-Maximilians
University, Munich, Germany
(Jochheim, Baquet, Massberg, Mehilli) German Centre for Cardiovascular
Research, partner site Munich Heart Alliance, Munich, Germany
(Barbanti, Todaro, Tamburino) Department of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Capretti, Chieffo, Colombo) Department of Cardiology, Universita
Vita-Salute San Raffaele, Milano, Italy
(Stefanini, Presbitero) Department of Cardiology, Istituto Clinico
Humanitas, Rozzano, Italy
(Hapfelmeier) Institute of Medical Informatics, Statistics and
Epidemiology, Technical University Munich, Munich, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The purpose of the study was to investigate the impact of oral
anticoagulation (OAC) type on clinical outcomes 1 year after transcatheter
aortic valve replacement (TAVR). Background(s): Non-vitamin K oral
anticoagulants (NOACs) are superior to vitamin K antagonists (VKAs) in
nonvalvular atrial fibrillation (AF), while their comparative performance
among patients in need of OAC undergoing TAVR is underinvestigated.
 Method(s): The study enrolled 962 consecutive patients who underwent
TAVR in 4 tertiary European centers and were discharged on either NOACs (n
= 326) or VKAs (n = 636). By using propensity scores for inverse
probability of treatment weighting (IPTW), the comparison of treatment
groups was adjusted to correct for potential confounding. Result(s):
Mean age and Society of Thoracic Surgeons score of the population were
81.3 +/- 6.3 years and 4.5% (interquartile range: 3.0% to 7.3%); 52.5%
were women and a balloon-expandable valve was used in 62.7% of cases. The
primary outcome of interest, combined incidence of all-cause mortality,
myocardial infarction, and any cerebrovascular event at 1-year after TAVR,
was 21.2% with NOACs versus 15.0% with VKAs (hazard ratio [HR]: 1.44; 95%
confidence interval [CI]: 1.00 to 2.07; p = 0.050, IPTW-adjusted). The
1-year incidence of any Bleeding Academic Research Consortium bleeds and
all-cause mortality were comparable between the NOAC and VKA groups, 33.9%
versus 34.1% (HR: 0.97; 95% CI: 0.74 to 1.26; p = 0.838, IPTW-adjusted)
and 16.5% versus 12.2% (HR: 1.36; 95% CI: 0.90 to 2.06; p = 0.136,
IPTW-adjusted), respectively. Conclusion(s): Chronic use of both
NOACs and VKAs among patients in need of OAC after TAVR are comparable
regarding 1-year bleeding risk. The higher ischemic event rate observed
with NOACs needs to be evaluated in large randomized trials. Copyright
© 2019 American College of Cardiology Foundation

<12>
Accession Number
2002535919
Title
The Domino Procedure is a Viable Strategy with Acceptable Outcomes.
Source
Journal of Cardiac Failure. Conference: 23rd Annual Scientific Meeting:
Heart Failure Society of America. United States. 25 (8 Supplement) (pp
S166-S167), 2019. Date of Publication: August 2019.
Author
Maynes E.J.; Austin M.A.; Deb A.K.; Choi J.H.; Weber M.P.; Massey H.T.;
Daly R.C.; Tchantchaleishvili V.
Institution
(Maynes, Austin, Choi, Weber, Massey, Tchantchaleishvili) Thomas Jefferson
University, Philadelphia, PA, United States
(Deb) Philadelphia College of Osteopathic Medicine, Philadelphia, PA,
United States
(Daly) Mayo Clinic College of Medicine, Rochester, MN, United States
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: The domino-donor operation is a procedure applicable to
heart-lung transplantation (HLT) for septic or hypertensive lung disease.
Often a "conditioned" heart from the HLT recipient is transplanted (HT)
into a recipient with increased pulmonary vascular resistance. The
procedure is thought to maximize the number of donor organs but is very
rarely performed in the current era. The purpose of this systemic review
was to investigate the indications and outcomes associated with the domino
procedure. Method(s): An electronic search was performed to identify
all studies on the domino procedure in the English literature. Eight
studies reporting on a total of 183 HLT recipients and 266 HT recipients
were included for final analysis. Result(s): HLT indications included
cystic fibrosis in 58% (95%CI: 27-84) of recipients, primary pulmonary
hypertension in 17% (95%CI: 12-24), bronchiectasis in 5% (95%CI: 3-10),
emphysema in 5% (95%CI: 0-45), and Eisenmenger's syndrome in 4% (95%CI:
2-8). HT indications included ischemic heart disease in 40% (95%CI:
33-47), nonischemic disease in 39% (95%CI: 25-56), and retransplantation
in 10% (95%CI: 1-59). The pooled mean pulmonary vascular resistance (PVR)
in HT recipients was 3.05 Woods units (95%CI: 0.14-5.95). The overall
mortality in the HLT group was 28% (95%CI: 18-41) at an average follow-up
of 15.7 months (95%CI: 0.82-30.5), and 35% (95%CI: 17-58) in the HT group
at average follow-up of 37.3 months (95%CI: 6.7-67.8). Freedom from
rejection in HT was 94% (95%CI: 75-99) at 1 month, 77% (95%CI: 30-96) at 6
months, and 41% (95%CI: 33-50) at 1 year. A subgroup comparison between
HLT and HT groups demonstrated a significant difference in the age [mean
HLT age, 26.7 years (95%CI: 21.3-32.2) vs mean HT age, 40.4 years (95%CI:
32.2-48.6) p <= 0.01] and a trend towards significance in male sex [45%
males in HLT group (95%CI: 29-63), vs 68% males in the HT group (95%CI:
52-80) p=0.06]. Pooled survival over time for both groups is shown in the
figure. Conclusion(s): The domino procedure appears to be a viable
option in properly selected patients that can be performed safely with
acceptable outcomes. Copyright © 2019

<13>
Accession Number
2002535857
Title
Reversibility of Fixed Pulmonary Hypertension with LVADs as a Bridge to
Candidacy Strategy for Heart Transplantation: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiac Failure. Conference: 23rd Annual Scientific Meeting:
Heart Failure Society of America. United States. 25 (8 Supplement) (pp
S147), 2019. Date of Publication: August 2019.
Author
Acuna-Morin E.E.; Blumer V.; Rivera-Maza M.; Kittipibul V.; Maning J.;
Chaparro S.; Joyce E.
Institution
(Acuna-Morin, Kittipibul, Maning, Chaparro) University of Miami, Miami,
FL, United States
(Blumer) Duke University, Durham, NC, United States
(Rivera-Maza) Washington University, St. Louis, MO, United States
(Joyce) Mater Misericordiae University Hospital, Dublin, Ireland
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: Current guidelines recommend against listing for heart
transplantation (HTx) if there is evidence of fixed pulmonary hypertension
(fPH) given that these patients tend to have poor post-HTx outcomes. The
purpose of this study is to investigate the feasibility of left
ventricular assist device (LVAD) implantation as a bridge to candidacy
(BTC) in patients with fPH through a systematic review and meta-analysis
of published literature. Method(s): We systematically searched
Medline, Embase & the Cochrane library through December 31, 2018 for
studies reporting patients with fPH treated with LVADs as a BTC for HTx.
The primary outcome analyzed percentage of patients within each cohort
achieving reversibility of pulmonary hemodynamics and the secondary
endpoint was the time necessary to improve hemodynamics. Studies meeting
inclusion criteria were assessed with the Newcastle-Ottawa tool. We
performed a random-effects meta-analysis using pooled proportions and
heterogeneity was examined using I2 statistics. All statistical
analyses were carried out using Stata/IC 14.2. Result(s): A total of
8 studies (6 retrospective cohorts and 2 prospective cohorts) including
207 patients (89% male, mean age 49.46 years) formed part of our analysis.
Continuous flow LVADs were used in 176 patients (79%). Our meta-analysis
showed 97% reversal of fPH (95% CI, 88-100%) (Figure 1). The mean response
time was of 5.33 months (95% CI: 3.67-7.00). Out of the initial 207
patients, 80% (95% CI:61-98%) were effectively bridged to receive a HTx.
 Conclusion(s): Our findings show that in patients unable to be listed
for HTx due to fPH, a BTC strategy with LVAD implantation is associated
with improvement in pulmonary hemodynamics with a mean response time of
approximately 5 months. Further studies evaluating long-term outcomes in
these patients are warranted. Copyright © 2019

<14>
Accession Number
2002547974
Title
Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter
Aortic Valve Replacement in Patients With Atrial Fibrillation.
Source
JACC: Cardiovascular Interventions. 12 (16) (pp 1580-1589), 2019. Date of
Publication: 26 August 2019.
Author
Kosmidou I.; Liu Y.; Alu M.C.; Liu M.; Madhavan M.; Chakravarty T.; Makkar
R.; Thourani V.H.; Biviano A.; Kodali S.; Leon M.B.
Institution
(Kosmidou, Liu, Liu, Madhavan, Kodali, Leon) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Kosmidou, Alu, Madhavan, Biviano, Kodali, Leon) Department of Medicine,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Chakravarty, Makkar) Department of Medicine, Cedars-Sinai Medical Center,
Los Angeles, CA, United States
(Thourani) Department of Cardiac Surgery, Medstar Heart and Vascular
Institute/Georgetown University, Washington, DC, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: The study sought to determine the patterns of antithrombotic
therapy and association with clinical outcomes in patients with atrial
fibrillation (AF) and CHA<inf>2</inf>DS<inf>2</inf>-VASc (congestive heart
failure, hypertension, age >=75 years, diabetes mellitus, prior stroke or
transient ischemic attack or thromboembolism, vascular disease, age 65-74
years, sex category) score >=2 following transcatheter aortic valve
replacement (TAVR). Background(s): The impact of antithrombotic
regimens on clinical outcomes in patients with AF and severe aortic
stenosis treated with TAVR is unknown. Method(s): In the randomized
PARTNER II (Placement of Aortic Transcatheter Valve II) trial and
associated registries, 1,621 patients with prior AF and
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >=2 comprised the study cohort.
Outcomes were analyzed according to antithrombotic therapy.
 Result(s): During the 5-year enrollment period, 933 (57.6%) patients
were discharged on oral anticoagulant therapy (OAC). Uninterrupted
antiplatelet therapy (APT) for at least 6 months or until an endpoint
event was used in 544 of 933 (58.3%) of patients on OAC and 77.5% of
patients not on OAC. At 2 years, patients on OAC had a similar rate of
stroke (6.6% vs. 5.6%; p = 0.53) and the composite outcome of death or
stroke (29.7% vs. 31.8%; p = 0.33), compared with no OAC. OAC with APT was
associated with a reduced rate of stroke (5.4% vs. 11.1%; p = 0.03) and
death or stroke (29.7% vs. 40.1%; p = 0.01), compared with no OAC or APT.
Following adjustment, OAC with APT and APT alone were both associated with
reduced rates of stroke compared with no OAC or APT (hazard ratio for
OAC+APT: 0.43, 95% confidence interval: 0.22 to 0.85; p = 0.015; hazard
ratio for APT alone: 0.32, 95% confidence interval: 0.16 to 0.65; p =
0.002), while OAC alone was not. Conclusion(s): Among patients with
prior AF undergoing TAVR, antiplatelet with or without anticoagulant
therapy was associated with a reduced risk of stroke at 2 years,
implicating multifactorial stroke mechanisms in this
population. Copyright © 2019 American College of Cardiology
Foundation

<15>
Accession Number
2002326582
Title
The effect of pressure- and volume-controlled one -lung ventilation on
lung dynamics and plasma malondialdehyde level.
Source
Annals of Clinical and Analytical Medicine. 10 (3) (pp 325-329), 2019.
Date of Publication: May 2019.
Author
Yavuz O.; Kabukcu H.K.; Sahin N.; Ozdem S.; Erdogan A.; Titiz T.A.
Institution
(Yavuz, Kabukcu, Sahin, Titiz) Departments of Anesthesiology and
Reanimation, Akdeniz University, Antalya, Turkey
(Ozdem) Clinical Biochemistry, Akdeniz University, Antalya, Turkey
(Erdogan) Thoracic Surgery, Akdeniz University, Antalya, Turkey
Publisher
Derman Medical Publishing (E-mail: secretary@jcam.com.tr )
Abstract
Aim: The main purpose of the study was to assess the effects of modes of
volume-controlled ventilation (VCV) and pressure-controlled ventilation
(PCV) during one-lung ventilation (OLV) on serum malondialdehyde (MDA),
which is the end product of lipid peroxidation. Arterial blood gases,
respiratory dynamics, and hemodynamic values were also comparatively
investigated. Material(s) and Method(s): This study is a
single-center, prospective, randomized, controlled clinical study was
conducted in the Single-center, Thoracic Surgery Operating Room of
University Faculty of Medicine. Patients were randomly divided into two
groups: Group P (pressure controlled, 20 cases) and Group V
(volume-controlled, 20 cases). Following induction, a double-lumen
endotracheal tube was placed. Hemodynamics and respiratory parameters were
recorded during the operation. For MDA measurements, arterial blood
specimens were taken just before the operation (preoperative), after OLV,
and 6 hours after the operation. Result(s): The values of
hemodynamics were similar in both groups. Serum MDA measurements were
found similar in both groups at preoperative, end of OLV and 6 hours after
the operation. Discussion(s): During OLV the effects of PCV and VCV
on plasma MDA levels are not different from each other. Therefore we are
of the opinion that selection of PCV or VCV as respiratory mode created no
significant differences in oxidative stress. Copyright © 2019,
Derman Medical Publishing. All rights reserved.

<16>
Accession Number
2002288694
Title
Comparative study between insulin bolus regimen and glucose insulin
infusion regimen on effectiveness of intraoperative blood glucose control
in patients with type 2 diabetes mellitus undergoing non-cardiac surgery.
Source
Sri Lankan Journal of Anaesthesiology. 27 (2) (pp 110-114), 2019. Date of
Publication: 2019.
Author
Krishna H.M.
Institution
(Krishna) Kasturba Medical College, Manipal, Manipal Academy of Higher
Education, India
Publisher
College of Anaesthesiologists of Sri Lanka (44/5A, Gnanartha
Pradeepaya,Mawatha, Colombo 8, Sri Lanka)
Abstract
Background: The surgical rates are comparatively greater among diabetic
patients. Surgery, a period of stress, mandates fasting and anti-diabetic
medications are skipped on the morning of the procedure. High blood
glucose levels in the peri-operative period can lead to ischaemia,
infection, acute kidney injury and electrolyte disturbances. Hence,
control of blood glucose levels during the peri-operative period becomes
important and there are various regimens described. We compared two of the
existing regimens, intravenous insulin bolus and glucose insulin infusion
regimen, for their effectiveness of intraoperative blood glucose control.
 Method(s): In this randomized, prospective controlled study, 120
patients were enrolled with 60 patients in bolus group and 60 in infusion
group. Capillary blood glucose was measured every hour during the
intra-operative period. The primary outcome measure was proportion of
patients in the target glucose levels between 100 mg/dL and 180 mg/dL and
proportion of intra-operative surgery time (in minutes) during which
patient was in the target range. Secondary outcome measure was serum
potassium levels pre-operatively and postoperatively. Result(s): The
proportion of patients in the target range in the bolus group was 39 out
of 60 as compared to 31 out of 60 in the infusion group (P=0.13). Also,
proportion of intraoperative surgery time (in minutes) during which
patient was in the target glycaemic range was 41.57% in bolus group when
compared to 27.22% in the infusion group (P < 0.05). No hypoglycaemic
episodes were seen in any of the patients in the two groups.
 Conclusion(s): As compared with infusion regimen, bolus regimen
provides better glycaemic control measured in terms of target blood
glucose levels and duration for which the patient remained in the target
range. Copyright © 2019, College of Anaesthesiologists of Sri
Lanka. All rights reserved.

<17>
Accession Number
2002288325
Title
Total intravenous anesthesia maintained the degree of pre-existing mitral
regurgitation better than isoflurane anesthesia in cardiac surgery: A
randomized controlled trial.
Source
Journal of Clinical Medicine. 8 (8) (no pagination), 2019. Article Number:
1104. Date of Publication: August 2019.
Author
Ahn J.H.; Ahn H.J.; Yi J.-W.
Institution
(Ahn) Department of Anesthesiology and Pain Medicine, Kangbuk Samsung
Hospital, Sungkyunkwan University, School of Medicine, Seoul 03181, South
Korea
(Ahn) Department of Anesthesiology and Pain Medicine, College of Medicine,
Graduate School, Kyung Hee University, Seoul 02447, South Korea
(Ahn) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul 06351, South
Korea
(Yi) Department of Anesthesiology and Pain Medicine, College of Medicine,
Kyung Hee, University, Seoul 02447, South Korea
Publisher
MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: indexing@mdpi.com)
Abstract
Accurate assessment of mitral regurgitation (MR) is critical during mitral
valve repair surgery. However, anesthesia may influence the degree of
mitral regurgitation by changing pre-and after-load or cardiac
contractility. Therefore, we compared changes in mitral regurgitation by
total intravenous anesthesia (TIVA) and inhalation anesthesia in patients
with pre-existing mitral regurgitation. This was a double-blind randomized
controlled study conducted at a tertiary care center in 2018. Fifty-four
mitral regurgitation patents undergoing elective cardiac surgery were
randomly assigned to receive TIVA or isoflurane. Primary endpoint was
change of regurgitation volume by anesthesia. The reduction of
regurgitation volume by anesthesia was greater in the isoflurane group
than in the TIVA group (mean (95% confidence interval CI): -0.20 (-6.15,
5.75) vs. -9.66 (-15.77, -3.56), mL.beat-1, p = 0.0266) and
this phenomenon was more prominent with severe mitral regurgitation (grade
3 or 4) (mean (95% CI): -0.33 (-9.10, 8.44) vs. -16.20 (-24.22, -8.18),
mL.beat-1, p = 0.0079). Among patients with MR grade 3 or 4,
94% remained the same with TIVA during anesthesia compared to 56% with
isoflurane. In conclusion, TIVA maintained the pre-anesthetic state of
mitral regurgitation relatively well, while the severity of mitral
regurgitation tended to decrease with isoflurane anesthesia. Copyright
© 2019 by the authors. Licensee MDPI, Basel, Switzerland.

<18>
Accession Number
628862252
Title
A Systematic Review and Meta-Analysis of del Nido Versus Conventional
Cardioplegia in Adult Cardiac Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2019. Date of Publication: 2019.
Author
An K.R.; Rahman I.A.; Tam D.Y.; Ad N.; Verma S.; Fremes S.E.; Latter D.A.;
Yanagawa B.
Institution
(An, Rahman, Tam, Verma, Latter, Yanagawa) Division of Cardiac Surgery, Li
Ka Shing Knowledge Institute, St Michael's Hospital, University of
Toronto, ON, Canada
(Ad) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, United States
(Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
ON, Canada
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Del Nido cardioplegia (DC) has been used extensively in
pediatric cardiac surgery but the efficacy and safety in adults remains
uncertain. Our objective was to perform a systematic review and
meta-analysis comparing DC and blood cardioplegia (BC) in our primary
endpoint of 30-day or in-hospital mortality as well as other efficacy and
safety endpoints. Methods Both MEDLINE and EMBASE were searched from 1996
to 2017 for studies comparing DC and BC. Data were extracted by 2
independent investigators and aggregated in a random effects model.
 Result(s): One randomized controlled trial (n = 89), 7 adjusted (n =
1,104), and 5 unadjusted observational studies (n = 717) were included.
There was no difference in in-hospital mortality between DC and BC
(relative risk:0.67, 95% confidence interval [CI]: 0.22, 2.07; P = 0.49).
DC reduced cardioplegia volume requirements (mean difference [MD]:-1.1 L,
95% CI, -1.6, -0.6; P < 0.0001), aortic cross-clamp time (MD: -8 minutes,
95% CI, -12, -3; P = 0.0004), and cardiopulmonary bypass (CPB) times (MD:
-8 minutes, 95% CI, -14, -3; P = 0.03). DC reduced troponin release
(standardized MD: -0.3, 95% CI, -0.5, -0.1; P = 0.001). In-hospital
outcomes of stroke, atrial fibrillation, acute kidney injury/dialysis, low
cardiac output state, blood transfusion, reoperation rate, postoperative
left ventricular EF, intensive care unit length of stay (LOS), and
in-hospital LOS were comparable between groups. Conclusion(s): DC is
a safe alternative to BC in routine adult cardiac surgery. Its use is
associated with reduction in CPB and aortic cross-clamp times and may
potentially offer improved myocardial protection. Copyright © The
Author(s) 2019.

<19>
Accession Number
2002176422
Title
Paravertebral Dexmedetomidine in Video- Assisted Thoracic Surgeries for
Acute and Chronic Pain Prevention.
Source
Pain Physician. 22 (3) (pp 271-280), 2019. Date of Publication: May-June
2019.
Author
Abd-Elshafy S.K.; Abdallal F.; Kamel E.Z.; Edwar H.; Allah E.A.; Maghraby
H.H.M.; Sayed J.A.; Ali M.S.; Elkhayat H.; Mahran G.S.K.
Institution
(Abd-Elshafy, Abdallal, Kamel, Edwar, Allah, Maghraby, Sayed, Ali)
Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut,
Egypt
(Elkhayat) Cardiothoracic surgery, Assiut University, Faculty of Medicine,
Assiut, Egypt
(Mahran) Department of Critical Care and Emergency Nursing, Faculty of
Nursing, Assiut University, Assiut, Egypt
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) is considered as
one of the minimally invasive surgeries. Early postoperative pain
alleviation is very important to avoid complications, at the same time,
proper early pain control is an established fact to decrease the incidence
of chronic pain. Objective(s): To evaluate the efficacy of thoracic
paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture on
acute and chronic post-thoracoscopic surgery pain in patients undergoing
VATS. Study Design: A randomized prospective double-blinded trial.
 Setting(s): Assiut University Hospitals, Orman Cardiology Hospital.
 Method(s): Sixty adult patients underwent elective VATS surgery under
general anesthesia randomly allocated into 2 groups; Group I received
thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/ kg) and Group II
received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and
dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough, and
with movement) was assessed through a visual analog scale (VAS) every 30
minutes in the first 2 hours, then at the second, fourth, eighth, and 24th
hours. Time to first analgesia request and consumption of intravenous
rescue analgesia (ketorolac tromethamine 30 mg/dose) was recorded.
Follow-up of the patients regarding the incidence of chronic
post-thoracoscopic pain by the end of the third and sixth months after the
procedure was reviewed through the Leeds Assessment of Neuropathic
Symptoms and Signs (LANSS) pain scale. Result(s): VAS score was
significantly lower in Group II during the early postoperative 90 minute
records. Pain with cough and with movement persisted to be significantly
lower in Group II up to the second postoperative hour. Time to first
analgesia requirement was significantly longer in Group II in comparison
to Group (P < 0.001). There was less ketorolac consumption in Group II
than in Group I (P = 0.002). At the third month, Group II showed
significantly lower incidence of LANSS pain scale than Group I (P = 0.04).
 Limitation(s): There was the heterogeneity of surgical procedures in
the patients. Conclusion(s): Dexmedetomidine as an adjuvant to
bupivacaine PVB offers better pain relief during the early postoperative
hours, and it carries a favorable effect on chronic postoperative
pain. Copyright © 2019, American Society of Interventional Pain
Physicians. All rights reserved.

<20>
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.

<21>
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.

<22>
Accession Number
2001817942
Title
Efficacy of preoperative amino acid supplements on postoperative physical
function and complications in open heart surgery patients: A study
protocol for a randomized controlled trial.
Source
Journal of Cardiology. 74 (4) (pp 360-365), 2019. Date of Publication:
October 2019.
Author
Ogawa M.; Yoshida N.; Satomi-Kobayashi S.; Tsuboi Y.; Komaki K.; Wakida
K.; Gotake Y.; Inoue T.; Tanaka H.; Yamashita T.; Sakai Y.; Izawa K.P.;
Takahashi M.; Ogawa W.; Hirata K.-I.
Institution
(Ogawa, Tsuboi, Komaki) Division of Rehabilitation Medicine, Kobe
University Hospital, Kobe, Japan
(Ogawa, Izawa) Department of Public Health, Kobe University Graduate
School of Health Sciences, Kobe, Japan
(Yoshida, Satomi-Kobayashi, Yamashita, Hirata) Division of Cardiovascular
Medicine, Department of Internal Medicine, Kobe University Graduate School
of Medicine, Kobe, Japan
(Wakida, Takahashi, Ogawa) Department of Nutrition, Kobe University
Hospital, Kobe, Japan
(Gotake, Inoue, Tanaka) Division of Cardiovascular Surgery, Department of
Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
(Sakai) Division of Rehabilitation Medicine, Kobe University Graduate
School of Medicine, Kobe, Japan
(Takahashi, Ogawa) Division of Diabetes and Endocrinology, Department of
Internal Medicine, Kobe University Graduate School of Medicine, Kobe,
Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Elderly patients undergoing cardiac surgery often show poor
nutritional status, muscle wasting, and sarcopenia, which are reported to
affect postoperative functional recovery and incidence of complications.
Amino acids are essential in maintaining nutritional status, synthesizing
muscle protein, and promoting beneficial energy balance of the heart
muscle. beta-Hydroxy beta-methylbutyric acid (HMB) is a leucine metabolite
known to increase muscle protein synthesis and inhibit protein catabolism;
it has been used to more effectively support patients with muscle wasting
due to wearing diseases. However, the efficacy of amino acid
administration comprising HMB in patients undergoing open heart surgery
remains unclear. This study aims to examine whether preoperative
short-term aggressive amino acid administration helps support
postoperative recovery of physical function and prevent complications.
 Method(s): This is a single-center prospective randomized controlled
trial (UMIN000030490). Patients aged >=65 years who will be hospitalized
for medical examination before cardiac surgery will be recruited. The
participants will be randomly assigned to the experimental or control
group. The experimental group will be administered with an amino acid
supplement with HMB 1200 mg, L-glutamine 7000 mg, and L-arginine 7000 mg
once or twice per day depending on the degree of renal dysfunction, for
14-28 days preoperatively. The control group will not receive any
nutritional intervention. The main outcome will be a change in the 6-min
walking test distance pre- and postoperatively as a sign of functional
recovery. Secondary outcomes such as the incidence of complications;
physical, nutritional, and psychological states; mortality; and length of
hospital stay will also be evaluated. Conclusion(s): This clinical
study will determine the effects of preoperative short-term oral amino
acid supplementation with HMB, L-glutamine, and L-arginine on
postoperative physical function in elderly patients undergoing cardiac
surgery. Copyright © 2019

<23>
Accession Number
628848549
Title
Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: A
translational review of current literature.
Source
Journal of Internal Medicine. (no pagination), 2019. Date of Publication:
2019.
Author
Reichart D.; Magnussen C.; Zeller T.; Blankenberg S.
Institution
(Reichart, Magnussen, Zeller, Blankenberg) University Heart Center
Hamburg, Hamburg, Germany
Publisher
Blackwell Publishing Ltd
Abstract
Dilated cardiomyopathy (DCM) is characterized by left ventricular
dilatation and, consecutively, contractile dysfunction. The causes of DCM
are heterogeneous. DCM often results from myocarditis, exposure to
alcohol, drugs or other toxins and metabolic or endocrine disturbances. In
about 35% of patients, genetic mutations can be identified that usually
involve genes responsible for cytoskeletal, sarcomere and nuclear envelope
proteins. Due to its heterogeneity, a detailed diagnostic work-up is
necessary to identify the specific underlying cause and exclude other
conditions with phenotype overlap. Patients with DCM show typical systolic
heart failure symptoms, but, with progress of the disease, diastolic
dysfunction is present as well. Depending on the underlying pathology, DCM
patients also become apparent through arrhythmias, thromboembolic events
or cardiogenic shock. Disease progression and prognosis are mostly driven
by disease severity and reverse remodelling within the heart. The worst
prognosis is seen in patients with lowest ejection fractions or severe
diastolic dysfunction, leading to terminal heart failure with subsequent
need for left ventricular assist device implantation or heart
transplantation. Guideline-based heart failure medication and device
therapy reduces the frequency of heart failure hospitalizations and
improves survival. Copyright © 2019 The Association for the
Publication of the Journal of Internal Medicine

<24>
Accession Number
627135439
Title
Association between anaesthetic technique and unplanned admission to
intensive care after thoracic lung resection surgery: the second
Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC)
National Audit.
Source
Anaesthesia. 74 (9) (pp 1121-1129), 2019. Date of Publication: 2019.
Author
Shelley B.G.; McCall P.J.; Glass A.; Orzechowska I.; Klein A.A.; Hemming
A.E.; Knight T.; Jansen M.; Fogg K.J.; Bailey A.; Palomino P.R.; Lau G.;
Errico M.; Williams A.; Hurley R.; Petko M.; Giri R.; Nelapatla M.K.;
Auldin M.; Kumar S.; Hartley M.; Malpas C.; Agarwal S.; Lane B.; Irvine
M.; Elayaperumal A.K.; Easaw B.S.; Feddy L.; Heward S.; Ware M.; Abel R.;
Jooste R.; Fanning N.P.
Institution
(Shelley, McCall, Glass) University of Glasgow Academic Unit of
Anaesthesia, Pain and Critical Care Medicine, Glasgow, United Kingdom
(Orzechowska) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
Publisher
Blackwell Publishing Ltd
Abstract
Unplanned intensive care admission is a devastating complication of lung
resection and is associated with significantly increased mortality. We
carried out a two-year retrospective national multicentre cohort study to
investigate the influence of anaesthetic and analgesic technique on the
need for unplanned postoperative intensive care admission. All patients
undergoing lung resection surgery in 16 thoracic surgical centres in the
UK in the calendar years 2013 and 2014 were included. We defined critical
care admission as the unplanned need for either tracheal intubation and
mechanical ventilation or renal replacement therapy, and sought an
association between mode of anaesthesia (total intravenous anaesthesia vs.
volatile) and analgesic technique (epidural vs. paravertebral) and need
for intensive care admission. A total of 253 out of 11,208 patients
undergoing lung resection in the study period had an unplanned admission
to intensive care in the postoperative period, giving an incidence of
intensive care unit admission of 2.3% (95%CI 2.0-2.6%). Patients who had
an unplanned admission to intensive care unit had a higher mortality
(29.00% vs. 0.03%, p < 0.001), and hospital length of stay was increased
(26 vs. 6 days, p < 0.001). Across univariate, complete case and multiple
imputation (multivariate) models, there was a strong and significant
effect of both anaesthetic and analgesic technique on the need for
intensive care admission. Patients receiving total intravenous anaesthesia
(OR 0.50 (95%CI 0.34-0.70)), and patients receiving epidural analgesia (OR
0.56 (95%CI 0.41-0.78)) were less likely to have an unplanned admission to
intensive care after thoracic surgery. This large retrospective study
suggests a significant effect of both anaesthetic and analgesic technique
on outcome in patients undergoing lung resection. We must emphasise that
the observed association does not directly imply causation, and suggest
that well-conducted, large-scale randomised controlled trials are required
to address these fundamental questions. Copyright © 2019
Association of Anaesthetists

<25>
Accession Number
2001736909
Title
Rationale and Study Design for an Individualized Perioperative Open Lung
Ventilatory Strategy in Patients on One-Lung Ventilation (iPROVE-OLV).
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (9) (pp 2492-2502),
2019. Date of Publication: September 2019.
Author
Carraminana A.; Ferrando C.; Unzueta M.C.; Navarro R.; Suarez-Sipmann F.;
Tusman G.; Garutti I.; Soro M.; Pozo N.; Librero J.; Gallego L.; Ramasco
F.; Rabanal J.M.; Rodriguez A.; Sastre J.; Martinez J.; Coves S.; Garcia
P.; Aguirre-Puig P.; Yepes J.; Lluch A.; Lopez-Herrera D.; Leal S.; Vives
M.; Bellas S.; Socorro T.; Trespalacios R.; Salazar C.J.; Mugarra A.;
Cinnella G.; Spadaro S.; Futier E.; Ferrer L.; Cabrera M.; Ribeiro H.;
Celestino C.; Kucur E.; Cervantes O.; Morocho D.; Delphy D.; Ramos C.;
Villar J.; Belda J.
Institution
(Carraminana, Ferrando, Navarro) Department of Anesthesia and Critical
Care, Hospital Clinic i Provincial, Barcelona, Spain
(Ferrando, Suarez-Sipmann, Villar) CIBER de Enfermedades Respiratorias,
Instituto de Salud Carlos III, Madrid, Spain
(Unzueta) Department of Anesthesia and Critical Care, Hospital de la Santa
Creu i Sant Pau, Barcelona, Spain
(Suarez-Sipmann) Intensive Care Unit, Hospital de La Princesa, Madrid,
Spain
(Suarez-Sipmann) Hedenstierna Laboratory, Department of Surgical Sciences,
Uppsala University Hospital, Uppsala, Sweden
(Tusman) Department of Anesthesiology, Hospital Privado de Mar de Plata,
Mar de Plata, Argentina
(Garutti) Department of Anesthesia and Critical Care, Hospital
Universitario Gregorio Maranon, Madrid, Spain
(Soro, Mugarra, Belda) Department of Anesthesia and Critical Care,
Hospital Clinico of Valencia, Valencia, Spain
(Pozo) Institute INCLIVA, Hospital Clinico Universitario de Valencia,
Valencia, Spain
(Librero) Navarrabiomed-Fundacion Miguel Servet, Red de Investigacion en
Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
(Gallego) Department of Anesthesia and Critical Care, Hospital Miguel
Servet, Zaragoza, Spain
(Ramasco) Department of Anesthesiology and Critical Care, Hospital La
Princesa, Madrid, Spain
(Rabanal) Department of Anesthesia and Critical Care, Hospital Marques de
Valdecilla, Santander, Spain
(Rodriguez) Department of Anesthesiology, Hospital Universitario Dr.
Negrin, Las Palmas de Gran Canaria, Spain
(Sastre) Department of Anesthesia and Critical Care t, Hospital de
Salamanca, Salamanca, Spain
(Martinez) Department of Anesthesia and Critical Care, Hospital
Universitari Mutua of Terrassa, Terrassa, Spain
(Coves) Department of Anesthesia and Critical Care, Hospital Univeristari
de Vinalopo, Elche, Spain
(Garcia) Department of Anesthesia and Critical Care, Hospital 12 de
Octubre, Madrid, Spain
(Aguirre-Puig) Department of Anesthesia and Critical Care, Hospital Alvaro
Cunqueiro, Vigo, Spain
(Yepes) Department of Anesthesia and Critical Care, Clinica Universitaria
Pamplona, Spain
(Lluch) Department of Anesthesia and Critical Care, Hospital Universitario
La Fe, Valencia, Spain
(Lopez-Herrera) Department of Anesthesia and Critical Care, Hospital
Virgen del Rocio, Sevilla, Spain
(Leal) Department of Anesthesia and Critical Care, Hospital Povisa, Vigo,
Spain
(Vives) Department of Anesthesia and Critical Care, Hospital Dr. Josep
Trueta, Girona, Spain
(Bellas) Department of Anesthesia and Critical Care, Fundacion Jimenez
Diaz, Madrid, Spain
(Socorro) Department of Anesthesia, Complejo Universitario
Materno-Insular, Las Palmas, Spain
(Trespalacios) Department of Anesthesia and Critical Care, Hospital
Universitario Central de Asturias, Oviedo, Spain
(Salazar) Department of Anesthesia and Critical Care, Hospital
Universitario de Canarias, Tenerife, Spain
(Cinnella) Department of Anesthesia and Critical Care, Universita di
Foggia, Foggia, Italy
(Spadaro) Department of Anesthesia and Critical Care, Universita di
Ferrara, Ferrara, Italy
(Futier) Anesthesia and Critical Care, Centre Hospitalier Universitaire,
Clermont-Ferrand, France
(Ferrer) Department of Anesthesia, Universidad El Bosque, Bogota, Colombia
(Cabrera) Department of Anesthesia, Hospital Clinico de la Fuerza Aerea de
Chile, Las Condes, Chile
(Ribeiro) Department of Anesthesia and Critical Care, Centro Hospitalar
Sao Joao, Porto, Portugal
(Celestino) Department of Anesthesia and Critical Care, Centro Hospitalar
de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
(Kucur) Anesthesia and Critical Care, Medical Park Bahcelievler Hospital,
Istanbul, Turkey
(Cervantes) Department of Anesthesia and Critical Care, Hospital
Universitari Germans Trias i Pujol, Badalona, Spain
(Morocho) Critical Care Department, Hospital de especialidades Eugenio
Espejo, Quito, Ecuador
(Delphy) Department of Anesthesia, Alexandria University Hospital and
Kafrelsheikh University Hospital, Alexandria, Egypt
(Ramos) Department of Anesthesia and Critical Care, Hospital Universitario
Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain
(Villar) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
Publisher
W.B. Saunders
Abstract
Objective: The aim of this clinical trial is to examine whether it is
possible to reduce postoperative complications using an individualized
perioperative ventilatory strategy versus using a standard lung-protective
ventilation strategy in patients scheduled for thoracic surgery requiring
one-lung ventilation. Design(s): International, multicenter,
prospective, randomized controlled clinical trial. Setting(s): A
network of university hospitals. Participant(s): The study comprises
1,380 patients scheduled for thoracic surgery. Intervention(s): The
individualized group will receive intraoperative recruitment maneuvers
followed by individualized positive end-expiratory pressure (open lung
approach) during the intraoperative period plus postoperative ventilatory
support with high-flow nasal cannula, whereas the control group will be
managed with conventional lung-protective ventilation. Measurements
and Main Results: Individual and total number of postoperative
complications, including atelectasis, pneumothorax, pleural effusion,
pneumonia, acute lung injury; unplanned readmission and reintubation;
length of stay and death in the critical care unit and in the hospital
will be analyzed for both groups. The authors hypothesize that the
intraoperative application of an open lung approach followed by an
individual indication of high-flow nasal cannula in the postoperative
period will reduce pulmonary complications and length of hospital stay in
high-risk surgical patients. Copyright © 2019

<26>
Accession Number
2002508401
Title
Association between urinary dickkopf-3, acute kidney injury, and
subsequent loss of kidney function in patients undergoing cardiac surgery:
an observational cohort study.
Source
The Lancet. 394 (10197) (pp 488-496), 2019. Date of Publication: 10 - 16
August 2019.
Author
Schunk S.J.; Zarbock A.; Meersch M.; Kullmar M.; Kellum J.A.; Schmit D.;
Wagner M.; Triem S.; Wagenpfeil S.; Grone H.-J.; Schafers H.-J.; Fliser
D.; Speer T.; Zewinger S.
Institution
(Schunk, Schmit, Wagner, Triem, Fliser, Speer, Zewinger) Department of
Internal Medicine 4, Nephrology and Hypertension, Saarland University
Medical Centre, Homburg, Germany
(Zarbock, Meersch, Kullmar) Department of Anaesthesiology, Intensive Care
Medicine and Pain Medicine, University Hospital Munster, Munster, Germany
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Wagenpfeil) Institute of Medical Biometry, Epidemiology and Medical
Informatics, Saarland University, Homburg, Germany
(Grone) Department of Cellular and Molecular Pathology, German Cancer
Research Centre, Heidelberg, Germany
(Schafers) Department of Thoracic and Cardiovascular Surgery, Saarland
University Medical Centre, Homburg, Germany
(Zewinger) Department of Nephrology, Hopitaux Robert Schuman, Hopital
Kirchberg, Luxembourg, Luxembourg, Luxembourg
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Cardiac surgery is associated with a high risk of
postoperative acute kidney injury (AKI) and subsequent loss of kidney
function. We explored the clinical utility of urinary dickkopf-3 (DKK3), a
renal tubular stress marker, for preoperative identification of patients
at risk for AKI and subsequent kidney function loss. Method(s): This
observational cohort study included patients who had cardiac surgery in a
derivation cohort and those who had cardiac surgery in a validation cohort
(RenalRIP trial). The study comprised consecutive patients who had
elective cardiac surgery at the Saarland University Medical Centre
(Homburg, Germany; derivation cohort) and those undergoing elective
cardiac surgery (selected on the basis of a Cleveland Clinical Foundation
score of 6 or higher) who were enrolled in the prospective RenalRIP
multicentre trial (validation cohort) and who were randomly assigned to
remote ischaemic preconditioning or a sham procedure. The association
between the ratio of preoperative urinary concentrations of DKK3 to
creatinine (DKK3:creatinine) and postoperative AKI, defined according to
the Kidney Disease Improving Global Outcomes criteria, and subsequent
kidney function loss, as determined by estimated glomerular filtration
rate, was assessed. Finding(s): In the 733 patient in the derivation
cohort, urinary concentrations of DKK3 to creatinine that were higher than
471 pg/mg were associated with significantly increased risk for AKI (odds
ratio [OR] 1.65, 95% CI 1.10-2.47, p=0.015), independent of baseline
kidney function. Compared with clinical and other laboratory measurements,
urinary concentrations of DKK3:creatinine significantly improved AKI
prediction (net reclassification improvement 0.32, 95% CI 0.23-0.42,
p<0.0001). High urinary DKK3:creatinine concentrations were independently
associated with significantly lower kidney function at hospital discharge
and after a median follow-up of 820 days (IQR 733-910). In the RenalRIP
trial, preoperative urinary DKK3:creatinine concentrations higher than 471
pg/mg were associated with a significantly higher risk for AKI (OR 1.94,
95% CI 1.08-3.47, p=0.026), persistent renal dysfunction (OR 6.67,
1.67-26.61, p=0.0072), and dialysis dependency (OR 13.57, 1.50-122.77,
p=0.020) after 90 days compared with DKK3:creatinine concentrations of 471
pg/mg or less. Urinary DKK3:creatinine concentrations higher than 471
pg/mg were associated with significantly higher risk for AKI (OR 2.79, 95%
CI 1.45-5.37) and persistent renal dysfunction (OR 3.82, 1.32-11.05) only
in patients having a sham procedure, but not remote ischaemic
preconditioning (AKI OR 1.35, 0.76-2.39 and persistent renal dysfunction
OR 1.05, 0.12-9.45). Interpretation(s): Preoperative urinary DKK3 is
an independent predictor for postoperative AKI and for subsequent loss of
kidney function. Urinary DKK3 might aid in the identification of patients
in whom preventive treatment strategies are effective. Funding(s): No
study funding. Copyright © 2019 Elsevier Ltd

<27>
Accession Number
2002536068
Title
Impact of Left Ventricular Function on Patient-Prosthesis Mismatch Post
Transcatheter Aortic Valve Replacement.
Source
Journal of Cardiac Failure. Conference: 23rd Annual Scientific Meeting:
Heart Failure Society of America. United States. 25 (8 Supplement) (pp
S41), 2019. Date of Publication: August 2019.
Author
Chen K.; James T.M.; Rothenberg M.; Kapilla A.; Faber C.; Nores M.A.;
Stamou S.C.
Institution
(Chen, James) University of Miami Palm Beach Regional Campus, Atlantis,
FL, United States
(Rothenberg, Kapilla, Faber, Nores, Stamou) JFK Medical Center, Atlantis,
FL, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: There is limited data on whether development of
patient-prosthesis mismatch (PPM) depends on left ventricular function at
the time of TAVR, especially with newer generation transcatheter heart
valves (THVs). Our study sought to investigate the predictive value of
left ventricular ejection fraction (LVEF) on development of PPM, as well
as long-term clinical outcomes of PPM in patients with preserved,
mid-range, and reduced ejection fraction. Method(s): This is a
retrospective cohort study of patients with preserved (EF > 50%),
mid-range (EF 40-50%), and reduced (EF < 40%) ejection fraction that
underwent TAVR between April 2012 to Feb 2019 in a single cardiovascular
center. Evaluated outcomes were incidence of PPM, 30-day mortality, 1-year
mortality, length of stay (LOS) and vascular complications.
 Result(s): A total of 991 patients underwent TAVR. There were 423
(43%) females with median age of 85, STS score of 4.9 and LVEF of 60%.
There were 657 (66%) patients received Sapien 3 THVs and 60 (6%) received
Evolut R/Pro THVs. A total of 274 patients (28%) developed PPM. There were
58 (21%) patients with reduced EF, 38 (14%) patients with mid-range EF,
and 178 (65%) with preserved EF who developed PPM (p=0.92). Outcomes of
these patients are presented in Table 1. Reduced EF was significantly
associated with lower 5-year mortality (Figure 1). Conclusion(s): Our
study suggests that left ventricular function at the time of TAVR is not a
predictor for development of PPM. LVEF does not appear to have impact on
short-term clinical outcomes of PPM; however, it does appear to associate
with decreased long-term survival. Larger randomized controlled trials are
needed to further investigate the impact of LVEF. Copyright ©
2019

<28>
Accession Number
2002535935
Title
A Systematic Review of Cardiogenic Shock in the Setting of Severe Aortic
Stenosis: Prevalence, Management and Outcomes.
Source
Journal of Cardiac Failure. Conference: 23rd Annual Scientific Meeting:
Heart Failure Society of America. United States. 25 (8 Supplement) (pp
S51), 2019. Date of Publication: August 2019.
Author
Essa M.; Aneni E.; Bernardi C.; Fleming J.; Paredes M.; Frumento K.;
Abdelmessih M.; Sugeng L.; Bellumkonda L.
Institution
(Essa, Aneni, Bernardi, Fleming, Paredes, Frumento, Abdelmessih, Sugeng,
Bellumkonda) Yale School of Medicine, New Haven, CT, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Cardiogenic shock (CS) management has evolved over the recent
years especially after the development of mechanical circulatory support
devices (MCS). Aortic stenosis (AS) is the most common valvular heart
disease, yet little is known about the prevalence, management, and
mortality of the AS and CS combination. Method(s): A systematic
search was conducted to identify studies that included patients with
combined AS and CS using EMBASE, MEDLINE, and Scopus. Primary outcomes
included in-hospital, 30-day, and 1-year mortality. Additional outcomes
included procedure-related complications. The study protocol was
registered at PROSPERO (CRD42018112245). Result(s): A total of 10
studies representing 338 patients were included. Prevalence of AS
presenting with CS ranged from 3.5% to 12%. In-hospital mortality ranged
from 43% to 77% in patients treated with Balloon Aortic Valvuloplasty
(BAV), 0% and 11% in patients who underwent surgical valve replacement
(SAVR) and Transcatheter Aortic Valve Replacement (TAVR) respectively. In
patients undergoing BAV, 30-day mortality varied between 50% and 55%, and
between 19% and 33% in those treated with TAVR. Delaying valve
intervention for more than 48 hours was found to negatively impact
survival after BAV. There was limited evidence on the use of Mechanical
Circulatory Support (MCS). Conclusion(s): AS presenting with CS is a
fatal condition with no clarity of management strategy. Time to
intervention on the valve is critical. Valve replacement through either
SAVR or TAVR had better outcomes compared to BAV alone. There is limited
evidence on MCS as a management strategy in patients with AS complicated
by CS. Copyright © 2019

<29>
Accession Number
2002535768
Title
Can Posterior Pericardiotomy Reduce the Incidence of Postoperative Atrial
Fibrillation after Coronary Artery Bypass Grafting?.
Source
Journal of Cardiac Failure. Conference: 23rd Annual Scientific Meeting:
Heart Failure Society of America. United States. 25 (8 Supplement) (pp
S84), 2019. Date of Publication: August 2019.
Author
Gupta R.; Dhaduk K.; Harburger J.; Jacobson J.; Panza J.A.
Institution
(Gupta, Dhaduk, Harburger, Jacobson, Panza) Westchester Medical Center,
Valhalla, NY, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Posterior pericardiotomy (PP) is a simple surgical technique
that may reduce the risk of post-operative atrial fibrillation (POAF) by
allowing for drainage of pericardial fluid into the left pleural space,
reducing the incidence of pericardial effusion that may trigger POAF.
 Method(s): This systematic review sought to determine the impact of
posterior pericardiotomy on incidences of POAF, pericardial effusion, and
the length of hospital stay after coronary artery bypass grafting (CABG).
Electronic searches on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of
Science, and CINAHL databases from inception through December 15, 2018
were performed. The primary outcome of our study was reduction in POAF
following PP. Secondary outcomes were reductions in pericardial effusion
and length of hospital stay. A Mantel-Haenszel random effects model was
used to summarize data across treatment arms. Heterogeneity between
studies was assessed using the chi square test and was considered
significant for p values < 0.10 or I2> 50%. Result(s): A
total of 11 randomized controlled trials consisting of 2,462 patients
undergoing CABG were included in the meta-analysis. Patients who underwent
PP demonstrated significant reduction in POAF (OR 0.34; 95% CI 0.21-0.55,
p < 0.001) and pericardial effusion (OR 0.11; 95% CI 0.06-0.20, p < 0.001)
as compared to controls, respectively. However, heterogeneity between
studies was significant (I273% and 70%, respectively). No
difference was observed in terms of length of hospital stay (standard mean
difference -0.06; 95% CI -0.26 - 0.14, p = 0.56; heterogeneity
I262%, p = 0.02). Number needed to treat to prevent POAF was
6.6 (95% CI 5.38-8.39). Conclusion(s): Posterior pericardiotomy is a
simple intraoperative technique that can reduce the risk of post-operative
atrial fibrillation. These results should be interpreted with caution due
to heterogeneity between the studies. Copyright © 2019

<30>
Accession Number
2002535739
Title
Meta-Analysis of n-3 Polyunsaturated Fatty Acid Supplementation for the
Prevention of Post-Operative Atrial Fibrillation in Patients Undergoing
Coronary Artery Bypass Surgery.
Source
Journal of Cardiac Failure. Conference: 23rd Annual Scientific Meeting:
Heart Failure Society of America. United States. 25 (8 Supplement) (pp
S83), 2019. Date of Publication: August 2019.
Author
Gupta R.; Jacobson J.; Cooper H.A.; Lanier G.M.
Institution
(Gupta, Jacobson, Cooper, Lanier) Westchester Medical Center, Valhalla,
NY, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Several randomized clinical trials (RCTs) have evaluated
whether pre-operative supplementation of omega-3 (n-3) polyunsaturated
fatty acids (PUFA) protects against postoperative atrial fibrillation
(POAF) after coronary artery bypass surgery (CABG). However, the efficacy
of this intervention remains controversial. We performed a meta-analysis
to determine if PUFA supplementation prevents POAF. Method(s): A
systematic literature search was performed (through December 20, 2018)
using PubMed, EMBASE, Web of Science, and Cochrane Central Register of
Controlled Trials to identify RCTs evaluating PUFA supplementation for
post-CABG POAF prevention. The primary outcome was the incidence of POAF.
For each study, the incidence of AF in the intervention and placebo groups
was extracted to calculate odds ratio and 95% confidence intervals (CIs).
Mantel-Haenszel random effects model was used to summarize data across
treatment arms. Heterogeneity between the studies was assessed using the
chi square test and was considered significant if p values < 0.10 or
I2> 50%. Result(s): We identified 11 RCTs that included a
total of 3,127 participants (1,557 in the PUFA group and 1,570 in the
placebo group). Pooled analysis demonstrated a significant reduction in
POAF in patients treated with PUFA as compared to placebo (OR 0.66; 95%
CI, 0.48-0.90; p=0.008). The estimated number-needed-to-treat was 18 (95%
CI 11.53-45.67). The test of heterogeneity was significant
(I262%, p = 0.003). Conclusion(s): Preoperative
supplementation of omega-3 (n-3) polyunsaturated fatty acids reduces the
incidence of POAF in patients undergoing CABG surgery. Copyright
© 2019

<31>
Accession Number
2002535716
Title
Genetic Determinants of Allograft Hypertrophy- A Human Myocardial Biopsy
Study.
Source
Journal of Cardiac Failure. Conference: 23rd Annual Scientific Meeting:
Heart Failure Society of America. United States. 25 (8 Supplement) (pp
S110), 2019. Date of Publication: August 2019.
Author
Araujo-Gutierrez R.A.; Wang G.; Ali A.; Marcos-Abdala H.G.; Uribe C.;
Gonzalez-Bonilla H.M.; Senapati A.; Youker K.A.; Torre-Amione G.; Chen K.;
Bhimaraj A.
Institution
(Araujo-Gutierrez, Ali, Marcos-Abdala, Senapati, Youker, Torre-Amione,
Bhimaraj) Houston Methodist Hospital, Houston, TX, United States
(Wang) Houston Methodist Research Institute, Houston, TX, United States
(Uribe) University of Texas Rio Grande Valley, Brownsville, TX, United
States
(Gonzalez-Bonilla) Howard University Hospital, Washington, DC, United
States
(Chen) Houston Methodist Research Insititute, Houston, TX, United States
Publisher
Churchill Livingstone Inc.
Abstract
Background: Cardiac Allograft Hypertrophy (CAH) assessed by left
ventricular mass (LVM) on imaging at 1 year has been validated as an early
predictor of mortality and vasculopathy. The biology of such changes could
be starting much earlier in the life of the graft and reflect the
beginning of a continuum of remodeling of the transplanted heart that
finally leads to chronic rejection and graft failure. However, definitive
mechanisms and predictors have not been established. Therefore, we aimed
to study the molecular mechanisms of CAH characterized by abnormal echo
mass in heart transplant patients. We hypothesized there is a specific
genetic signature in the myocardium that can predict the morphological
mechanisms of CAH. Method(s): We used data from our heart transplant
biopsy repository where consented patients agree for an extra biopsy and
blood to be stored for research during their protocol visits. Biopsies are
stored at -80C in RNA later. We used samples from 6 month time-point in a
small cohort of randomly selected patients and performed full gene
expression profiling using Ilumina Beadarray Microarray Technology.
Additionally, clinical and echocardiogram parameters were collected at the
same time-point. LVM index and relative wall thickness at 6m from
transplant were used to define CAH according to ASE Guidelines.
 Result(s): A total of 16 patients were included in the analysis. 5
patients had normal LV geometry, 8 had concentric remodeling and 3
concentric hypertrophy (CH). Patients in the abnormal group were
significantly older than the patients in the normal group (53.4 vs 60.7
years, respectively, p=0.0478) while there were no other statistically
significant differences in the rest of the baseline and clinical
parameters. Gene expression data showed a distinct signature on the
heatmap for CH (Figure 1). There were 40 genes that were differentially
expressed in CH group compared to the rest. Conclusion(s): Only 31%
of the patients have a normal echo LVM by 6 months and there is a distinct
genetic signature for CH suggesting that there is a specific biological
change occurring in the heart as early as 6 months that contribute to
hypertrophy. We hope to elicit the biological basis of these changes so as
to create therapeutic interventions to temper these changes and promote
longevity of grafts. Copyright © 2019

<32>
Accession Number
628858779
Title
Successful treatment of pediatric cardioembolic stroke using thrombolysis
and thrombectomy in a patient with congenital heart disease.
Source
Haemophilia. Conference: 2019 Scientific Symposium of the Hemostasis and
Thrombosis Research Society and the North American Society on Thrombosis
and Hemostasis. United States. 25 (Supplement 2) (pp 50), 2019. Date of
Publication: July 2019.
Author
Olaiya O.; Goeden M.; Sharma M.
Institution
(Olaiya, Goeden, Sharma) Children's Mercy Hospital, Kansas City, MO,
United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: Pediatric arterial ischemic stroke (AIS) is rare but an
important cause of morbidity and mortality in neonates and children, often
with significant neurologic sequelae. Since presentation in children may
be subtle, diagnosis can unfortunately be delayed. Outcomes can be
significantly improved with early diagnosis, use of consensus based
guidelines involving a multidisciplinary approach. The reported incidence
of combined ischemic and hemorrhagic pediatric stroke ranges from 1.2 to
13 cases per 100,000 children under 18 years of age. Annual incidence
rates of arterial ischemic stroke (AIS) in infants and children range from
0.6 to 7.9/100,000 children per year. The reported incidence of stroke in
patients with Congenital Heart Disease (CHD) ranges from 8 to 9%
preoperatively and 16% to 21% postoperatively. The management of stroke in
children is largely extrapolated from the adult literature and is an area
for further research. Objective(s): Report a case of successful
treatment of embolic stroke in a pediatric CHD patient with thrombolysis
and thrombectomy using a multidisciplinary approach Methods: Case Report.
 Result(s): 7-Year-old female with single ventricle physiology with a
history of double outlet right ventricle, mitral stenosis, aortic
coarctation and ventricular septal defect status post failed fenestrated
Fontan who was admitted for cardiac dysfunction and end organ hepatic
failure. Her pertinent medications included aspirin. She suddenly
developed left sided hemiparesis, right gaze deviation, decreased level of
consciousness and was found to have a right MCA distribution embolic
stroke by MRI. After multidisciplinary discussions that included
neurology, critical care, hematology and interventional radiology, a plan
was determined. She received systemic alteplase within 4.5 hours of
symptom onset and underwent emergent thrombectomy with interventional
neuroradiology at a partner institution. She underwent thrombectomy 6
hours after symptom onset with complete recanalization of the right middle
cerebral artery. She was transferred back to the PICU for post procedure
care and continued to have improvement in left upper extremity strength,
facial asymmetry and gaze preference. Of note, a repeat MRI also noted
congenital absence of the left carotid artery and echo showed no
intracardiac thrombus. She was subsequently started on full
anticoagulation with low molecular weight heparin. She continued to
improve as she worked with physical therapy, speech therapy and
occupational therapy. She required ECMO support for 12 days and VAD
support for 35 days prior to heart transplant. She subsequently developed
a non-occlusive PICC associated right brachiocephalic thrombus 1 month
later for which she completed 3 months of anticoagulation. Given that she
underwent successful cardiac transplant, she is off anticoagulation as she
no longer has a cardiac defect or VAD that puts her at risk for recurrent
cardioembolic stroke. Conclusion(s): Strokes in children require a
high index of suspicion and an understanding of the risk factors leading
to stroke. There are no randomized clinical trials for treatment of
pediatric stroke, therefore creating evidenced based diagnostic and
treatment guidelines remain a challenge. Prompt action and a
multidisciplinary approach involving specialized physicians using best
available evidence can improve outcome. This case highlights the potential
for successful recovery from stroke using thrombolysis and thrombectomy
which is rarely used in the pediatric population.

<33>
Accession Number
628858493
Title
Inflammatory modulation during heart surgery: Study protocol for
randomized trial.
Source
Blood Purification. Conference: 2nd National Purification Therapies
Workshop - Ideas for Clinical Research. Italy. 47 (Supplement 4) (pp 13),
2019. Date of Publication: June 2019.
Author
Serraino G.F.; Longhini F.; Navalesi P.; Mastroroberto P.
Institution
(Serraino, Mastroroberto) Cardiac Surgery Unit, Department of Experimental
and Clinical Medicine, University Magna Graecia of Catanzaro
(Longhini, Navalesi) Anaesthesiology and Reanimation Unit, Department of
Medical and Surgical Sciences, University Magna Graecia of Catanzaro
Publisher
S. Karger AG
Abstract
Background/Aims: Chronic kidney disease (CKD) has consistently been found
to be an independent risk factor for the development of cardiovascular
disease, increasing the risk of mortality in patients undergoing cardiac
surgery. An elevated plasma IL-6 level is commonly observed in CKD
patients, which is largely caused by the increased generation resulting
from oxidative stress, chronic inflammation and fluid overload. Elevated
postoperative plasma concentrations of inflammatory cytokines are
associated with an increased mortality and morbidity and plasma IL-6 and
IL-10 concentrations predict long-term mortality in adults after cardiac
surgery. A novel extracorporeal sorbent haemoadsorption (HA) device
(CytoSorb) was recently developed for cytokine removal from the blood and
is now approved in the European Union. In this pilot trial we aim to
assess if intraoperative haemoadsorption with CytoSorb can significantly
reduce postoperative IL-6 serum levels in patients with CKD undergoing
on-pump cardiac surgery. Method(s): This will be a single-centre
randomised, two-arm, patient-blinded trial of the effects of
intraoperative HA on postoperative inflammatory response and organ
dysfunction in patients with chronic kidney disease undergoing on-pump
cardiac surgery. Subjects will be randomly allocated to receive either
intraoperative HA during cardiopulmonary bypass (CPB) or standard CPB
without HA. The HA device will be included in the CPB circuit between the
oxygenator and the venous reservoir. The study will be conducted at
University Hospital of Catanzaro (Italy). The primary outcome is the
difference in mean IL-6 serum levels between the two study groups on
admission to the ICU. Conclusion(s): we would like to demonstrate the
efficacy of intra- operative haemoadsorption with CytoSorb to remove
cytokines from circulation for prevention of surgical associated
inflammatory response and complications in patients with CKD.

<34>
Accession Number
2002117273
Title
Comparison between the effects of dexmedetomidine and midazolam on
postoperative cognitive impairment after coronary artery bypasses graft
surgery: A randomized clinical trial.
Source
Journal of Tehran University Heart Center. 14 (2) (pp 67-73), 2019. Date
of Publication: 14 Apr 2019.
Author
Rajaei M.; Tabari M.; Soltani G.; Alizadeh K.; Nazari A.; Noroozian M.;
Morovatdar N.
Institution
(Rajaei, Tabari, Soltani) Department of Anesthesiology, School of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Alizadeh) Department of Cardiac Surgery, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Nazari) Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Noroozian) Department of Psychiatry, School of Medicine, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Morovatdar) Clinical Research Unit, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Tehran Heart Center (E-mail: abbasi.hesam@gmail.com)
Abstract
Background: Postoperative cognitive decline is a common complication
observed frequently after general anesthesia in the immediate
postoperative phase. We studied the effects of dexmedetomidine versus
midazolam during coronary artery bypass graft (CABG) surgery on cognitive
and memory function. Method(s): In this clinical trial, 42 elective
on-pump CABG candidates under general anesthesia, aged between 40 and 65
years, were enrolled randomly in 2 groups. Group A received 0.05-0.1 mg/kg
of midazolam and Group B received 1 micro g/kg of dexmedetomidine. One
day before surgery, all the participants underwent the Persian version of
the Mini-Mental State Examination (MMSE) and the Persian version of the
Wechsler Memory Scale (WMS) test for a comparison of cognitive impairment
and memory functions. Both groups were given fentanyl and propofol for the
induction of anesthesia and muscle relaxants. The MMSE and WMS tests were
repeated 5 and 30 days after surgery. Result(s): The mean+/-SD of age
was 55.47+/-7.18 y in Group A and 55.39+/-6.08 y in Group B. Eighty
percent of the participants were men in both groups. There were no
significant differences between Group A and Group B in the MMSE and WMS
before surgery (89.04+/-14.30 vs. 97.10+/-18.10, respectively; P=0.059),
but the WMS was significantly different 30 days after surgery
(87.60+/-14.30 vs. 103.53+/-19.93, respectively; P=0.005). Group A showed
high cognitive impairment and low WMS scores compared with Group B
(P=0.005). Additionally, the MMSE results were not statistically different
between the 2 groups postoperatively (24.80+/-3.18 vs. 23.55+/-4.18,
respectively; P=0.394). Conclusion(s): Our results showed that
dexmedetomidine might have a lower impact on cognitive function than might
midazolam among patients undergoing CABG. Copyright © 2019,
Tehran Heart Center. All rights reserved.

<35>
Accession Number
2002320668
Title
Stent versus coronary artery bypass surgery in multi-vessel and left main
coronary artery disease: A meta-analysis of randomized trials with
subgroups evaluation.
Source
Arquivos Brasileiros de Cardiologia. 112 (5) (pp 511-523), 2019. Date of
Publication: May 2019.
Author
de Andrade P.J.N.; Falcao J.L.A.A.; Falcao B.A.A.; Rocha H.A.L.
Institution
(de Andrade, Falcao, Falcao, Rocha) Hospital Dr. Carlos Alberto Studart
Gomes de Messejana, Fortaleza, CE, Brazil
(de Andrade, Falcao, Falcao, Rocha) Universidade Federal do Ceara,
Fortaleza, CE, Brazil
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Comparison between percutaneous coronary intervention (PCI)
using stents and Coronary Artery Bypass Grafting (CABG) remains
controversial. Objective(s): To conduct a systematic review with
meta-analysis of PCI using Stents versus CABG in randomized controlled
trials. Method(s): Electronic databases were searched to identify
randomized trials comparing PCI using Stents versus CABG for multi-vessel
and unprotected left main coronary artery disease (LMCAD). 15 trials were
found and their results were pooled. Differences between trials were
considered significant if p < 0.05. Result(s): In the pooled data (n
= 12,781), 30 days mortality and stroke were lower with PCI (1% versus
1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference
in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus
6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p =
0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In
diabetics (n = 3,274) long term mortality favored CABG (13.7% versus
10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no
difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year
mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus
8.1%) between PCI and CABG; the incidence of stroke was lower with PCI
(0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the
subgroups that influenced more adversely the results of PCI.
 Conclusion(s): Compared with CABG, PCI using Stents showed lower 30
days mortality, higher late mortality and lower incidence of stroke.
Diabetes and a high SYNTAX were the subgroups that influenced more
adversely the results of PCI. (Arq Bras Cardiol. 2019;
112(5):511-523). Copyright © 2019, Arquivos Brasileiros de
Cardiologia. All rights reserved.

<36>
Accession Number
628838772
Title
Association of the coronary artery disease risk gene GUCY1A3 with
ischaemic events after coronary intervention.
Source
Cardiovascular research. 115 (10) (pp 1512-1518), 2019. Date of
Publication: 01 Aug 2019.
Author
Kessler T.; Wolf B.; Eriksson N.; Kofink D.; Mahmoodi B.K.; Rai H.;
Tragante V.; Akerblom A.; Becker R.C.; Bernlochner I.; Bopp R.; James S.;
Katus H.A.; Mayer K.; Munz M.; Nordio F.; O'Donoghue M.L.; Sager H.B.;
Sibbing D.; Solakov L.; Storey R.F.; Wobst J.; Asselbergs F.W.; Byrne
R.A.; Erdmann J.; Koenig W.; Laugwitz K.-L.; Ten Berg J.M.; Wallentin L.;
Kastrati A.; Schunkert H.
Institution
(Kessler, Wolf, Rai, Bopp, Mayer, Sager, Solakov, Wobst, Byrne, Koenig,
Kastrati, Schunkert) Klinik fur Herz- und Kreislauferkrankungen, Deutsches
Herzzentrum Munchen, Technische Universitat Munchen, Munich, Germany
(Kessler, Wolf, Sager, Sibbing, Wobst, Koenig, Laugwitz, Kastrati,
Schunkert) Deutsches Zentrum fur Herz-Kreislauf-Forschung (DZHK) e.V.,
Partner Site Munich Heart Alliance, Munich, Germany
(Eriksson, Akerblom, James, Wallentin) Uppsala Clinical Research Center,
Uppsala University, Uppsala, Sweden
(Kofink, Tragante, Asselbergs) Division of Heart and Lungs, Department of
Cardiology, University Medical Center Utrecht, University of Utrecht,
Netherlands
(Mahmoodi, Ten Berg) Cardiology Department, St. Antonius Hospital,
Nieuwegein, Netherlands
(Akerblom, James) Division of Cardiology, Department of Medical Sciences,
Uppsala University, Uppsala, Sweden
(Becker) Division of Cardiovascular Health and Disease, Lung & Vascular
Institute, University of Cincinnati Heart, Cincinnati, OH, United States
(Bernlochner, Laugwitz) I. Medizinische Klinik und Poliklinik, Klinikum
rechts der Isar, Technische Universitat Munchen, Munich, Germany
(Katus) Innere Medizin III: Kardiologie, Angiologie und Pneumologie,
Universitat Heidelberg, DZHK e.V., Partner Site Heidelberg, Heidelberg,
Germany
(Munz, Erdmann) University of Lubeck, Lubeck, Germany
(Munz, Erdmann) University Heart Center Lubeck, Lubeck, Germany
(Munz, Erdmann) DZHK e.V., Partner Site Hamburg/Kiel/Lubeck, Lubeck,
Germany
(Munz) Charite-University Medicine Berlin, Corporate Member of Freie
Universitat Berlin, Humboldt-Universitat zu Berlin, Berlin, Germany
(Munz) Department of Periodontology and Synoptic Dentistry, Berlin
Institute of Health, Institute for Dental and Craniofacial Sciences,
Berlin, Germany
(Nordio, O'Donoghue) TIMI Study Group, Brigham and Women's Hospital,
Boston, MA, United States
(Sibbing) Medizinische Klinik und Poliklinik I, Klinikum der Universitat
Munchen, Ludwig-Maximilians-Universitat, Munich, Germany
(Storey) Department of Infection, Immunity & Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Asselbergs) Institute of Cardiovascular Science, Faculty of Population
Health Sciences, London, United Kingdom
(Asselbergs) Health Data Research UK and Institute of Health Informatics,
University College London, London, United Kingdom
Publisher
NLM (Medline)
Abstract
AIM: A common genetic variant at the GUCY1A3 coronary artery disease locus
has been shown to influence platelet aggregation. The risk of ischaemic
events including stent thrombosis varies with the efficacy of aspirin to
inhibit platelet reactivity. This study sought to investigate whether
homozygous GUCY1A3 (rs7692387) risk allele carriers display higher
on-aspirin platelet reactivity and risk of ischaemic events early after
coronary intervention. METHODS AND RESULTS: The association of GUCY1A3
genotype and on-aspirin platelet reactivity was analysed in the genetics
substudy of the ISAR-ASPI registry (n=1678) using impedance aggregometry.
The clinical outcome cardiovascular death or stent thrombosis within
30days after stenting was investigated in a meta-analysis of substudies of
the ISAR-ASPI registry, the PLATO trial (n=3236), and the Utrecht Coronary
Biobank (n=1003) comprising a total 5917 patients. Homozygous GUCY1A3 risk
allele carriers (GG) displayed increased on-aspirin platelet reactivity
compared with non-risk allele (AA/AG) carriers [150 (interquartile range
91-209) vs. 134 (85-194) AUmin, P<0.01]. More homozygous risk allele
carriers, compared with non-risk allele carriers, were assigned to the
high-risk group for ischaemic events (>203AUmin; 29.5 vs. 24.2%, P=0.02).
Homozygous risk allele carriers were also at higher risk for
cardiovascular death or stent thrombosis (hazard ratio 1.70, 95%
confidence interval 1.08-2.68; P=0.02). Bleeding risk was not altered.
 CONCLUSION(S): We conclude that homozygous GUCY1A3 risk allele
carriers are at increased risk of cardiovascular death or stent thrombosis
within 30days after coronary stenting, likely due to higher on-aspirin
platelet reactivity. Whether GUCY1A3 genotype helps to tailor antiplatelet
treatment remains to be investigated. Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. © The
Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<37>
Accession Number
2002318795
Title
On-Pump coronary artery bypass graft: The state of the art.
Source
Reviews on Recent Clinical Trials. 14 (2) (pp 106-115), 2019. Date of
Publication: 2019.
Author
Cuminetti G.; Bonadei I.; Vizzardi E.; Sciatti E.; Lorusso R.
Institution
(Cuminetti, Bonadei, Vizzardi, Sciatti) Cardiology Unit, Department of
Experimental and Applied Medicine, University of Brescia, Brescia, Italy
(Lorusso) Cardio-Thoracic Surgery Department, Heart and Vascular Centre,
Maastricht University Medical Centre, Maastricht, Netherlands
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Coronary artery bypass grafting (CABG) remains the standard of
care for patients with coronary artery disease (CAD). Debate exists
concerning several factors, which include percutaneous coronary
intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts,
radial artery vs. saphenous vein grafts, right internal mammary artery vs.
radial artery grafts, endoscopic vs. open vein-graft harvesting, and
on-pump vs. off- pump surgery. Moreover, challenging is the management of
diabetic patients with CAD undergoing CABG. This review reports current
indications, practice patterns, and outcomes of CABG. Method(s):
Randomized controlled trials comparing CABG to other therapeutical
strategies for CAD were searched through MEDLINE, EMBASE, Cochrane
databases, and proceedings of international meetings. Result(s):
Large multicenter randomized and observational studies (SYNTAX, BEST,
PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with
always fewer rates of operative mortality and major morbidity, than PCI.
The 10-year follow-up of ARTS II trial showed no difference between single
and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials
showed that CABG is the best choice for diabetic patients.
 Conclusion(s): CABG still represents one of the most widespread major
surgeries, with well-known benefits on symptoms and prognosis in patients
with CAD. However, further studies and follow-up data are needed to
validate these evidences. Copyright © 2019 Bentham Science
Publishers.

<38>
Accession Number
2002281200
Title
Deep sternal wound infections: Evidence for prevention, treatment, and
reconstructive surgery.
Source
Archives of Plastic Surgery. 46 (4) (pp 291-302), 2019. Date of
Publication: July 2019.
Author
Schiraldi L.; Jabbour G.; Centofanti P.; Giordano S.; Abdelnour E.;
Gonzalez M.; Raffoul W.; Di Summa P.G.
Institution
(Schiraldi) Department of Surgery, Hospital du Valais, Sion, Switzerland
(Schiraldi, Jabbour, Raffoul, Di Summa) Department of Plastic and
Reconstructive Surgery, Lausanne University Hospital (CHUV), Lausanne,
Switzerland
(Jabbour) Department of Surgery, Hamad General Hospital, Doha, Qatar
(Centofanti) Department of Cardiac Surgery, Mauriziano Hospital, Turin,
Italy
(Giordano) Department of Plastic and General Surgery, Turku University
Hospital, Turku, Finland
(Abdelnour, Gonzalez) Department of Thoracic Surgery, Lausanne University
Hospital (CHUV), Lausanne, Switzerland
Publisher
Korean Society of Plastic and Reconstructive Surgeons (1355-3 Seocho-Dong,
Seocho-Gu, Seoul 137-070, South Korea)
Abstract
Median sternotomy is the most popular approach in cardiac surgery.
Post-sternotomy wound complications are rare, but the occurrence of a deep
sternal wound infection (DSWI) is a catastrophic event associated with
higher morbidity and mortality, longer hospital stays, and increased
costs. A literature review was performed by searching PubMed from January
1996 to August 2017 according to the guidelines in the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement. The following
keywords were used in various combinations: DSWI, post-sternotomy
complication, and sternal reconstruction. Thirty-nine papers were included
in our qualitative analysis, in which each aspect of the DSWI-related care
process was analyzed and compared to the actual standard of care. Plastic
surgeons are often involved too late in such clinical scenarios, when
previous empirical treatments have failed and a definitive reconstruction
is needed. The aim of this comprehensive review was to create an
up-to-date operative flowchart to prevent and properly treat sternal wound
infection complications after median sternotomy. Copyright © 2019
The Korean Society of Plastic and Reconstructive Surgeons.

<39>
Accession Number
2002155925
Title
Spontaneous hemothorax in a patient with von Recklinghausen's disease: A
case report and review of the literature.
Source
American Journal of Case Reports. 20 (pp 674-678), 2019. Date of
Publication: 2019.
Author
Degbelo F.D.A.; Cito G.; Guendil B.; Christodoulou M.; Abbassi Z.
Institution
(Degbelo, Cito, Guendil) Department of Surgery, Sion Hospital, Sion,
Switzerland
(Christodoulou) Division of Thoracic Surgery, Department of Surgery, Sion
Hospital, Sion, Switzerland
(Abbassi) Department of Surgery, University Hospitals of Geneva, Geneva,
Switzerland
Publisher
International Scientific Information, Inc. (E-mail:
iza.pranga@isl-science.com)
Abstract
Objective: Rare co-existance of disease or pathology Background: Von
Recklinghausen's disease, also known as Type 1 neurofibromatosis (NF1), is
a genetic disorder characterized by skin tumors, neurofibromas of multiple
organs and vascular abnormalities. Spontaneous thoracic hemorrhage is a
rare but potentially fatal consequence of this disorder. After a review of
the literature over the last 10 years and on the basis of a case study,
the aim of this study was to report the challenges of management of this
pathology. Case Report: We report a rare case of a 45-years-old male with
a medical history of neurofibromatosis who complained of a 3-day history
of progressive dyspnea. At his admission to the Emergency Department, the
patient was hemodynamically stable. A chest computed tomography (CT) scan
showed a large left hemothorax with mediastinal shift to the right without
active bleeding. A chest tube was introduced, and conservative treatment
was followed. Another CT scan performed 2 days later revealed a middle
lobar pulmonary embolism on the opposite side. A full treatment of
anticoagulation was administered, and the patient was released after 8
days of hospitalization. Three weeks later, a new chest CT scan indicated
the absence of vascular aneurysm or source for hemothorax.
 Conclusion(s): Our systematic literature review found 15 articles
which were described as early as 2005. To our knowledge, endovascular
treatment produces the best immediate successful result (100%) and may be
used in adjunction with video-assisted thorax surgery (VATS) or thoracic
drainage to optimize outcomes. In the present case, conservative treatment
showed a good result despite anticoagulation for pulmonary embolism. The
endovascular approach seems to be the most promising, but treatment needs
to be tailored to each individual patient. Copyright © Am J Case
Rep, 2019;.

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

<41>
Accession Number
626424966
Title
A survey of anaesthetists' use of tranexamic acid in noncardiac surgery.
Source
Anaesthesia and Intensive Care. 47 (1) (pp 76-84), 2019. Date of
Publication: 2019.
Author
Painter T.W.; McIlroy D.; Myles P.S.; Leslie K.
Institution
(Painter) Department of Anaesthesia, Royal Adelaide Hospital, Adelaide,
Australia
(Painter) Discipline of Acute Care Medicine, Adelaide Medical School,
University of Adelaide, Adelaide, Australia
(McIlroy) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, Australia
(McIlroy) Monash University, Melbourne, Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
(Leslie) Royal Melbourne Hospital, Melbourne, Australia
(Leslie) Centre for Integrated Critical Care Medicine, University of
Melbourne, Melbourne, Australia
(Leslie) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Major bleeding in noncardiac surgery is common and associated with serious
complications. The antifibrinolytic agent tranexamic acid (TXA) reduces
bleeding and may reduce the risk of these complications. TXA also may have
immu-nomodulatory effects that could reduce surgical site infection.
Clinical trials of TXA in noncardiac surgery have been insufficiently
powered to evaluate its efficacy and safety. Therefore, large randomised
controlled trials of its use in noncardiac surgery are required. To ensure
that future clinical trials are feasible and acceptable, we undertook a
survey of Fellows of the Australian and New Zealand College of
Anaesthetists (ANZCA). Our aims were to ascertain current patterns of TXA
administration and to assess the acceptability of randomising patients to
intravenous TXA or placebo. A 12-item survey was electronically mailed to
1001 ANZCA Fellows. Two hundred and eighty nine responses were received
and analysed (response rate 29%). Ninety-eight percent of respondents had
used intravenous TXA in noncardiac surgery; 67% give TXA routinely for
lower limb arthroplasty, with smaller proportions giving TXA for spinal
surgery (40%) and other major orthopaedic surgery (28%). Almost half (49%)
give TXA routinely for major trauma surgery. Thirty-six percent indicated
that they did not give TXA for major vascular, abdominal, pelvic or
thoracic surgery. The majority administered TXA as a single, fixed dose.
Fifty-seven percent agreed that there is uncertainty about the relative
risks and benefits of perioperative TXA in noncardiac surgery and 87%
agreed that large definitive trials determining the safety and efficacy of
perioperative TXA in noncardiac surgery are required. These results
indicate that for ANZCA Fellows the use of TXA in noncardiac surgery is
highly variable, that there is uncertainty about the safety and efficacy
of TXA, and that a large trial would be acceptable. Copyright ©
The Author(s) 2019.

<42>
Accession Number
2000932679
Title
Surgical closure of a ventricular septal defect in early childhood leads
to altered pulmonary function in adulthood: A long-term follow-up.
Source
International Journal of Cardiology. 274 (pp 100-105), 2019. Date of
Publication: 1 January 2019.
Author
Rex C.E.; Eckerstrom F.; Heiberg J.; Maagaard M.; Rubak S.; Redington A.;
Hjortdal V.E.
Institution
(Rex, Eckerstrom, Heiberg, Maagaard, Hjortdal) Dept. of Cardiothoracic and
Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard
99, Aarhus N 8200, Denmark
(Rubak) Dept. of Child and Adolescent Health, Danish Center of Pediatric
Pulmonology and Allergology, Aarhus University Hospital, Palle
Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
(Rex, Eckerstrom, Heiberg, Maagaard, Rubak, Hjortdal) Dept. of Clinical
Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99,
Aarhus N 8200, Denmark
(Redington) Dept. of Pediatrics, Cincinnati Children's Hospital, OH,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The long-term outlook after surgical closure of ventricular
septal defect (VSD) has traditionally been considered benign. However,
there is an increasing awareness of not only late cardiac dysfunction, but
also pulmonary abnormalities. The primary aim of this study was to
describe pulmonary function in adults with a surgically repaired VSD, and
secondarily to determine the effects of salbutamol on the potential
abnormalities. Method(s): All patients (operated for a VSD in early
childhood) and controls (age- and gender-matched) underwent static and
dynamic spirometry, impulse oscillometry, multiple breath washout,
diffusion capacity for carbon monoxide, and cardiopulmonary exercise
testing. In a double-blinded, cross-over study, participants were
randomized to inhalation of either 900 mug of salbutamol or placebo. The
primary outcome was forced expiratory volume in 1 s. Result(s): In
total, 30 participants with a surgically closed VSD and 30 healthy
controls were included. The VSD participants had a lower forced expiratory
volume in 1 s (99 +/- 13% vs. 111 +/- 13%), p < 0.001, impaired forced
vital capacity, (106 +/- 12% vs. 118 +/- 13%), p < 0.001, and lower peak
expiratory flow, (95 +/- 18% vs. 118 +/- 19%), p < 0.001, than the control
group. Also, the VSD group had a lower alveolar volume than the control
group, (92 +/- 10% vs. 101 +/- 11%), p < 0.001, but there were no
differences in the remaining pulmonary function parameters. Salbutamol
reduced airway resistances in both groups, but exercise performance was
not improved by salbutamol, however. Conclusion(s): Adults who have
undergone surgical closure of a VSD in early childhood have reduced
pulmonary function compared with controls, which is unaffected by
inhalation of salbutamol. Copyright © 2018 Elsevier B.V.

<43>
Accession Number
2001348031
Title
Deferred vs Immediate Stenting in Primary Percutaneous Coronary
Intervention: A Collaborative Meta-analysis of Randomized Trials With
Cardiac Magnetic Resonance Imaging Data.
Source
Canadian Journal of Cardiology. 34 (12) (pp 1573-1580), 2018. Date of
Publication: December 2018.
Author
Cassese S.; Belle L.; Ndrepepa G.; Bosson J.L.; Lonborg J.; Ahtarovski
K.A.; Kelbaek H.; Fusaro M.
Institution
(Cassese, Ndrepepa, Fusaro) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Belle) Departments of Cardiology and Radiology, Centre Hospitalier
Annecy-Genevois, Annecy, France
(Bosson) Clinical Investigation Centre, University Hospital of Grenoble,
Grenoble, France
(Fusaro) Department of Diagnostic and Interventional Radiology, Santa
Maria di Ca' Foncello Hospital, Treviso, Italy
(Lonborg) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Ahtarovski, Kelbaek) Department of Cardiology, Zealand University
Hospital, Roskilde, Denmark
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The role of deferred vs immediate stenting during primary
percutaneous coronary intervention (PCI) for patients with ST-segment
elevation myocardial infarction (STEMI) remains controversial.
 Method(s): We undertook a collaborative meta-analysis of study-level
data by searching electronic scientific databases for investigations of
primary PCI patients randomized to deferred or immediate stenting and
subsequent cardiac magnetic resonance imaging. Primary angiographic and
imaging outcomes were slow/no-reflow and microvascular obstruction (MVO),
respectively. Main secondary outcome was recurrent ischemia.
 Result(s): Among 4 trials, a total of 1570 patients with STEMI were
assigned to primary PCI with either deferred (n = 779) or immediate
stenting (n = 791). Of these, 797 participants had analyzable cardiac
magnetic resonance imaging examinations. Median clinical follow-up was 9
months. Patients treated with deferred stenting showed a lower risk of
developing slow/no-reflow in the culprit vessel (risk ratio [RR], 0.54
[95% confidence interval (CI), 0.41-0.72]; P < 0.001), a similar risk for
MVO (RR, 0.93 [95% CI, 0.76-1.14]; P = 0.51), and trended higher in the
risk of recurrent ischemia (RR, 2.42 [95% CI, 0.88-6.63]; P = 0.09)
compared with those treated with immediate stenting. The treatment effect
for slow/no-reflow and MVO correlated with a thrombus score grade > 3 at
the baseline angiography and with the total stent length implanted in the
culprit artery. Conclusion(s): A strategy of deferred stenting during
primary PCI improves angiographic but not imaging or clinical outcomes
compared with immediate stenting. The potential lower risk for myocardial
injury by deferred stenting in primary PCI patients with STEMI and high
thrombus burden requires a confirmation in adequately sized randomized
trials. Copyright © 2018 Canadian Cardiovascular Society

<44>
Accession Number
2001348018
Title
The Effect of Cardiac Rehabilitation Attendance on Sexual Activity
Outcomes in Cardiovascular Disease Patients: A Systematic Review.
Source
Canadian Journal of Cardiology. 34 (12) (pp 1590-1599), 2018. Date of
Publication: December 2018.
Author
Boothby C.A.; Dada B.R.; Rabi D.M.; Campbell T.S.; Tang K.L.
Institution
(Boothby, Dada, Rabi, Tang) Department of Community Health Sciences,
University of Calgary, Calgary, Alberta, Canada
(Rabi, Tang) Department of Medicine, University of Calgary, Calgary,
Alberta, Canada
(Rabi) Department of Cardiac Sciences, University of Calgary, Calgary,
Alberta, Canada
(Campbell) Department of Psychology, University of Calgary, Calgary,
Alberta, Canada
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Decreased sexual activity (SA) is a common problem in patients
with cardiovascular disease (CVD). Although there is evidence that cardiac
rehabilitation (CR) is effective in improving physical outcomes and
overall quality of life, its effects on SA remain unclear. In this
systematic review we assessed the association between CR attendance and SA
outcomes in adults with CVD. Method(s): Electronic databases
(MEDLINE, PsycINFO, EMBASE, CINAHL) were systematically searched in
January 2018. Original studies that compared attendance to CR vs no
attendance to CR in adults 18 years and older with diagnosed CVD that also
reported on SA outcomes were included. A narrative synthesis was conducted
because the data did not permit meta-analysis. Result(s): Fourteen
studies were identified: 6 randomized controlled trials, 5 nonrandomized
controlled trials, and 3 prospective cohort studies. All CR programs
included an exercise-based component and 4 included an SA-specific
component. Seven studies reported a significant benefit in SA outcomes in
the CR group, 1 study reported significant harm, and 11 studies reported a
nonsignificant difference. Conclusion(s): The effect of CR on SA
outcomes was generally reported to be equivocal or positive. CR showed
some promise in improving sexual functioning and frequency, with mixed
results with regard to sexual resumption and satisfaction. In conclusion,
it remains uncertain if CR consistently improves sexual outcomes in adults
with CVD but these data suggest that further exploration might be
justified. Copyright © 2018 Canadian Cardiovascular Society

<45>
[Use Link to view the full text]
Accession Number
628732132
Title
Prevention of Stroke in Atrial Fibrillation After Coronary Stenting.
Source
Stroke. 50 (8) (pp 2125-2132), 2019. Date of Publication: 01 Aug 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 (L.K., A.F., University of Miami Miller School of Medicine, FL,
United States
(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 (J.G.R.), University of Miami Miller
School of Medicine, FL, United States
(Lambrakos, Cohen) Cardiovascular Division, Department of Medicine
(L.K.L., University of Miami Miller School of Medicine, FL, United States
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.

<46>
Accession Number
2002500123
Title
Clinical Efficacy of a Medical Centre- and Home-based Cardiac
Rehabilitation Program for Patients With Coronary Heart Disease after
Coronary Bypass Graft Surgery.
Source
Archives of Medical Research. 50 (3) (pp 122-132), 2019. Date of
Publication: April 2019.
Author
Aronov D.; Bubnova M.; Iosseliani D.; Orekhov A.
Institution
(Aronov, Bubnova) Federal State Institution "National Medical Research
Center for Preventive Medicine", Petroverigskiy lane 10, Moscow, Russian
Federation
(Iosseliani) Center for Interventional Cardioangiology, I.M. Sechenov
First Moscow State Medical University, 8-2, Trubetskaya St., Moscow,
Russian Federation
(Orekhov) Laboratory of Angiopathology, Institute of General Pathology and
Pathophysiology, Moscow, Russian Federation
(Orekhov) Institute for Atherosclerosis Research, Skolkovo Innovative
Center, Moscow, Russian Federation
(Orekhov) Institute of Human Morphology, Moscow, Russian Federation
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Rehabilitation measures are crucial for maintaining clinical
benefits of coronary artery bypass grafting (CABG) surgery. We evaluated
the clinical efficacy of a medical centre- and home-based cardiac
rehabilitation (CR) for patients after CABG in an out-patient setting.
 Method(s): The study included 36 male patients 3-8 weeks after CABG
that were randomly assigned to either study or control group. Patients
from the study group performed a 60 min excercise in controlled setting 3
times a week for 4 months followed by home-based excercise later on, while
patients from the control group only received a recommendation to perform
the excercise at home in an uncontrolled setting. Total duration of the
follow-up was 12 months. Result(s): Physical endurance in the study
group increased by 32.6% (p <0.05) in comparison to baseline after 4
months, and was maintained at this level after 12 months, while in the
control group, an improvement of 9.8% (p <0.05) was observed after 12
months. Moreover, patients from the study group demonstrated a stable
level of such risk factors as blood total and low-density lipoprotein
cholesterol, while in the control group, these parameters increased by
10.2% (p < 0.05) and 15.6% (p < 0.05) respectively by the end of
follow-up. Controlled medical centre-based exercise resulted in
improvement of patients' quality of life and reduction of cardiovascular
complications (11.1% against 39.2% in the control group).
 Conclusion(s): The integral (medical centre and home-based) stage III
CR program after CABG helped reducing cardiovascular risk factors, and
improved clinical parameters and functional capacity of
patients. Copyright © 2019 IMSS

<47>
Accession Number
628831824
Title
Transcatheter aortic valve implantation vs. surgical aortic valve
replacement for treatment of symptomatic severe aortic stenosis: an
updated meta-analysis.
Source
European heart journal. (no pagination), 2019. Date of Publication: 23 Apr
2019.
Author
Siontis G.C.M.; Overtchouk P.; Cahill T.J.; Modine T.; Prendergast B.;
Praz F.; Pilgrim T.; Petrinic T.; Nikolakopoulou A.; Salanti G.;
Sondergaard L.; Verma S.; Juni P.; Windecker S.
Institution
(Siontis, Overtchouk, Praz, Pilgrim, Windecker) Department of Cardiology,
Bern University Hospital, Inselspital, University of Bern, Bern,
Switzerland
(Cahill) Department of Cardiology, Oxford Heart Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Modine) Service de Chirurgie Cardiovasculaire, Hopital Cardiologique,
CHRU de Lille ,2 Av Oscar Lambret, Lille 59037, France
(Prendergast) Department of Cardiology, St Thomas' Hospital ,Westminster
Bridge Rd, London, United Kingdom
(Petrinic) Cairns Library, Oxford University Hospitals NHS Foundation
Trust, Oxford, United Kingdom
(Nikolakopoulou, Salanti) Institute of Social and Preventive Medicine
(ISPM), University of Bern, Bern, Switzerland
(Sondergaard) Department of Cardiology, Heart Center, Rigshospitalet,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, Toronto, ON M5B 1W8, Canada
(Juni) Department of Medicine and Institute of Health Policy, Management
and Evaluation, Applied Health Research Centre, Li Ka Shing Knowledge
Institute of St Michael's Hospital, University of Toronto, 30 Bond Street,
Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
AIMS : Owing to new evidence from randomized controlled trials (RCTs) in
low-risk patients with severe aortic stenosis, we compared the collective
safety and efficacy of transcatheter aortic valve implantation (TAVI) vs.
surgical aortic valve replacement (SAVR) across the entire spectrum of
surgical risk patients. METHODS AND RESULTS : The meta-analysis is
registered with PROSPERO (CRD42016037273). We identified RCTs comparing
TAVI with SAVR in patients with severe aortic stenosis reporting at
different follow-up periods. We extracted trial, patient, intervention,
and outcome characteristics following predefined criteria. The primary
outcome was all-cause mortality up to 2years for the main analysis. Seven
trials that randomly assigned 8020 participants to TAVI (4014 patients)
and SAVR (4006 patients) were included. The combined mean STS score in the
TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low
surgical risk trials, respectively. Transcatheter aortic valve
implantation was associated with a significant reduction of all-cause
mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence
interval (CI) 0.78-0.99], P=0.030}; an effect that was consistent across
the entire spectrum of surgical risk (P-for-interaction=0.410) and
irrespective of type of transcatheter heart valve (THV) system
(P-for-interaction=0.674). Transcatheter aortic valve implantation
resulted in lower risk of strokes [HR 0.81 (95% CI 0.68-0.98), P=0.028].
Surgical aortic valve replacement was associated with a lower risk of
major vascular complications [HR 1.99 (95% CI 1.34-2.93), P=0.001] and
permanent pacemaker implantations [HR 2.27 (95% CI 1.47-3.64), P<0.001]
compared to TAVI. CONCLUSION : Compared with SAVR, TAVI is associated with
reduction in all-cause mortality and stroke up to 2years irrespective of
baseline surgical risk and type of THV system. Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. ©
The Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<48>
Accession Number
628822889
Title
A Prolonged Air Leak Score for Lung Cancer Resection: An Analysis of the
STS GTSD.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 16 Jul 2019.
Author
Seder C.W.; Basu S.; Ramsay T.; Rocco G.; Blackmon S.; Liptay M.J.;
Gilbert S.
Institution
(Seder, Liptay) Rush University Medical Center, Department of
Cardiovascular and Thoracic Surgery, Chicago, IL, United States
(Basu) Rush University Medical Center, Department of Internal Medicine,
Chicago, IL, United States
(Ramsay) University of Ottawa, Ottawa Health Research Institute, Ottawa,
ON, Canada
(Rocco) Memorial Sloan Kettering Cancer Center, New York, NY
(Blackmon) Mayo Clinic, Department of Surgery, Division of Thoracic
Surgery, Rochester, MN, United States
(Gilbert) University of Ottawa, Department of Surgery, Division of
Thoracic Surgery, Ottawa, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: The objective of this study was to create a simple
preoperative tool to assess the risk of prolonged air leak (PAL) using the
Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD).
 METHOD(S): The STS GTSD was queried for patients who underwent
elective lung cancer resection between 2009-2016. Exclusion criteria
included pneumonectomy, sleeve lobectomy, chest wall resection, bilateral
procedures, and patients with incomplete data sets. The primary outcome
was PAL > 5 days. Multivariable logistic regression was used to identify
risk factors for a PAL. Model coefficients were used to generate a PAL
score (PALS). The approach was cross-validated in 100 replications of a
training set consisting of randomly selected 2/3 of the cohort, and a
validation set of remaining patients. RESULT(S): A total of 52,198
patients from the STS GTSD met inclusion criteria, with an overall rate of
PAL of 10.4% (n=5,453). Final variables incorporated into the PALS
included BMI <= 25 kg/m2 (7 points), lobectomy or bilobectomy (6 points),
FEV1 <= 70% predicted (5 points), male gender (4 points), and right upper
lobe procedure (3 points). Using a cumulative PALS > 17 points, this tool
stratifies patients as high-risk or low-risk for PAL (19.6% vs. 9% rate of
PAL) with a cross-validated mean NPV of 91%, PPV of 19%, sensitivity of
30%, specificity of 85%, and correctly classifies 79% of patients.
 CONCLUSION(S): The PAL score (PALS) is a simple preoperative clinical
tool that can reliably risk stratify patients for PAL who are undergoing
lung cancer resection. Copyright © 2019. Published by Elsevier
Inc.

<49>
Accession Number
628822329
Title
Update on Cardiac Sarcoidosis.
Source
Annals of the American Thoracic Society. (no pagination), 2019. Date of
Publication: 19 Jul 2019.
Author
Ribeiro Neto M.L.; Jellis C.L.; Joyce E.; Callahan T.D.; Hachamovitch R.;
Culver D.A.
Institution
(Ribeiro Neto) Cleveland Clinic, Pulmonary Medicine, Cleveland, Ohio,
United States ; ribeirm@ccf.org
(Jellis, Callahan) Cleveland Clinic, Cardiovascular Medicine, Cleveland,
OH, United States
(Joyce) Mater Misericordiae University Hospital, Cardiology, Dublin,
Ireland
(Hachamovitch) Cleveland Clinic, Heart and Vascular Institute, Cleveland,
OH, United States
(Culver) Cleveland Clinic, Pulmonary and Critical Care Medicine,
Cleveland, OH, United States
Publisher
NLM (Medline)
Abstract
Increasing awareness of cardiac manifestations of sarcoidosis and the
widespread availability of advanced imaging tests have led to a tidal wave
of interest in a condition that was once considered rare. In this focused
review, we explore important clinical questions that may confront
specialists faced with possible cardiac involvement. In the absence of an
ideal reference standard, three main sets of clinical criteria exist: the
Japanese Ministry of Health and Welfare, the Heart Rhythm Society and the
World Association for Sarcoidosis and Other Granulomatous Disorders
criteria. Once cardiac sarcoidosis is suspected, clinicians should be
familiar with the prevalence of the disease in different clinical
scenarios. Before obtaining advanced cardiac imaging, electrocardiogram
(ECG), ambulatory ECG, echocardiogram, and b-type natriuretic peptide may
be useful. The available therapies for cardiac sarcoidosis include
immunosuppression, anti-arrhythmic medications, heart failure medications,
device therapy, ablation therapy and heart transplantation. Contemporary
data suggest that long-term survival in cardiac sarcoidosis is better than
previously thought. There is no randomized controlled trial demonstrating
benefits of screening, but screening is recommended based on observational
data.

<50>
Accession Number
628817223
Title
Randomized Comparison of Clinical Effectiveness of Pharmacologic SPECT and
PET MPI in Symptomatic CAD Patients.
Source
JACC. Cardiovascular imaging. (no pagination), 2019. Date of Publication:
11 Jul 2019.
Author
Patel K.K.; Al Badarin F.; Chan P.S.; Spertus J.A.; Courter S.; Kennedy
K.F.; Case J.A.; McGhie A.I.; Heller G.V.; Bateman T.M.
Institution
(Patel, Al Badarin, Chan, Spertus, McGhie, Bateman) Department of
Cardiology, University of Missouri-Kansas City, Kansas City, Missouri;
Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas
City, Missouri
(Courter, Case) Cardiovascular Imaging Technologies, Kansas City, United
States
(Kennedy) Department of Cardiology, Saint Luke's Mid America Heart
Institute, Kansas City, MO, United States
(Heller) Department of Cardiology, Gagnon Cardiovascular Institute,
Morristown Medical Center, Morristown, NJ, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study compared the clinical effectiveness of
pharmacologic stress myocardial perfusion imaging (MPI) plus positron
emission tomography (PET) with single-photon emission computed tomography
(SPECT) in patients with known coronary artery disease (CAD) presenting
with symptoms suggestive of ischemia. BACKGROUND: Although PET MPI has
been shown to have higher diagnostic accuracy in detecting hemodynamically
significant CAD than SPECT MPI, whether this impacts downstream management
has not been formally evaluated in randomized trials. METHOD(S): This
study consisted of a single-center trial in which patients with known CAD
and suspected ischemia were randomized to undergo PET or
attenuation-corrected SPECT MPI between June 2009 and September 2013.
Post-test management was at the discretion of the referring physician, and
patients were followed for 12 months. The primary endpoint was diagnostic
failure, defined as unnecessary angiography (absence of >=50% stenosis in
>=1 vessel) or additional noninvasive testing within 60 days of the MPI.
Secondary endpoints were post-test escalation of antianginal therapy,
referral for angiography, coronary revascularization, and health status at
3, 6, and 12 months. RESULT(S): A total of 322 patients with an
evaluable MPI were randomized (n = 161 in each group). At baseline, 88.8%
of patients were receiving aspirin therapy, 76.7% were taking
beta-blockers, and 77.3% were taking statin therapy. Diagnostic failure
within 60 days occurred in only 7 patients (2.2%) (3 [1.9%] in the PET
group and 4 [2.5%] in the SPECT group; p = 0.70). There were no
significant differences between the 2 groups in subsequent rates of
coronary angiography, coronary revascularization, or health status at 3,
6, and 12 months of follow-up (all p values >=0.20); however when subjects
were stratified by findings on MPI in a post hoc analysis, those with
high-risk MPI on PET testing had higher rates of angiography and
revascularization on follow-up than those who had SPECT MPI, whereas those
undergoing low-risk PET studies had lower rates of both procedures than
those undergoing SPECT (interaction between randomized modality *high-risk
MPI for 12-month catheterization [p = 0.001] and 12-month
revascularization [p = 0.09]). CONCLUSION(S): In this contemporary
cohort of symptomatic CAD patients who were optimally medically managed,
there were no discernible differences in rates of diagnostic failure at 60
days, subsequent coronary angiography, revascularization, or patient
health status at 1 year between patients evaluated by pharmacologic PET
compared with those evaluated by SPECT MPI. Downstream invasive testing
rates with PET MPI were more consistent with high-risk features than those
with SPECT MPI. (Effectiveness Study of Single Photon Emission Computed
Tomography [SPECT] Versus Positron Emission Tomography [PET] Myocardial
Perfusion Imaging; NCT00976053). Copyright © 2019 American
College of Cardiology Foundation. Published by Elsevier Inc. All rights
reserved.

<51>
Accession Number
2002503389
Title
The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An
Individual Patient Meta-Analysis of Two Randomized Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Whitlock R.P.; Dieleman J.M.; Belley-Cote E.; Vincent J.; Zhang M.;
Devereaux P.J.; Kalkman C.J.; van Dijk D.; Yusuf S.
Institution
(Whitlock, Belley-Cote, Vincent, Zhang, Devereaux, Yusuf) Population
Health Research Institute, Hamilton Health Sciences and McMaster
University, Hamilton, Ontario, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Whitlock, Devereaux) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, Ontario, Canada
(Belley-Cote, Devereaux, Yusuf) Department of Medicine, McMaster
University, Hamilton, Ontario, Canada
(Dieleman, Kalkman, van Dijk) University Medical Center, Utrecht,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Steroids suppress the inflammatory response to cardiopulmonary
bypass, but the impact on death at 30 days, myocardial infarction or
injury, stroke, renal failure, respiratory failure, new atrial
fibrillation, transfusion requirement, infection, and length of intensive
care unit (ICU) and hospital stays are uncertain. Design(s):
Patient-level data meta-analysis of 2 randomized trials. Setting(s):
Eighty-eight cardiac surgical centers in 19 countries.
 Participant(s): A total of 11,989 participants, from the Steroids in
Cardiac Surgery trial and the Dexamethasone in Cardiac Surgery study,
undergoing cardiac surgery with the use of cardiopulmonary bypass.
 Intervention(s): Participants were randomly assigned to steroid or
placebo. Measures and Main Results: Outcomes assessed were mortality at 30
days, myocardial infarction or injury, stroke, renal failure, respiratory
failure, new atrial fibrillation, transfusion requirement, infection, and
length of ICU and hospital stays. There was no significant difference in
death at 30 days between the steroid and placebo groups (odds ratio [OR],
0.87; 95% confidence interval [CI], 0.72-1.07). Myocardial infarction did
not differ significantly (OR, 1.17; 95% CI, 0.93-1.47); however,
myocardial injury was higher in the steroid group (OR, 1.25; 95% CI,
1.12-1.40). There were no significant differences for the outcomes of
stroke, renal failure, new atrial fibrillation, or transfusion. Steroids
significantly reduced respiratory failure (OR, 0.83; 95% CI, 0.75-0.99),
infection (OR, 0.80; 95% CI, 0.72-0.89), and length of ICU (p < 0.001) and
hospital stays (p = 0.006). Conclusion(s): This patient-level
meta-analysis does not support the routine use of steroids in cardiac
surgery. Steroid administration did not decrease the risk of death,
myocardial infarction, stroke, renal failure, new atrial fibrillation, or
transfusion. Steroids increased the risk of myocardial injury in both the
Steroids in Cardiac Surgery and Dexamethasone in Cardiac Surgery trials.
Finally, steroids lowered the risk of respiratory failure and infection,
and reduced length of ICU and hospital stay. Copyright © 2019
Elsevier Inc.

<52>
Accession Number
2002398580
Title
Addition of low-dose liraglutide to insulin therapy is useful for
glycaemic control during the peri-operative period: effect of
glucagon-like peptide-1 receptor agonist therapy on glycaemic control in
patients undergoing cardiac surgery (GLOLIA study).
Source
Diabetic Medicine. (no pagination), 2019. Date of Publication: 2019.
Author
Makino H.; Tanaka A.; Asakura K.; Koezuka R.; Tochiya M.; Ohata Y.;
Tamanaha T.; Son C.; Shimabara Y.; Fujita T.; Miyamoto Y.; Kobayashi J.;
Hosoda K.
Institution
(Makino, Tanaka, Koezuka, Tochiya, Ohata, Tamanaha, Son, Hosoda)
Departments of, Department of, Endocrinology and Metabolism, National
Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
(Asakura) Department of, Data Science, National Cerebral and
Cardiovascular Centre, Suita, Osaka, Japan
(Shimabara, Fujita, Kobayashi) Department of, Adult Cardiac Surgery,
National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
(Miyamoto) Department of, Preventive Cardiology, National Cerebral and
Cardiovascular Centre, Suita, Osaka, Japan
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To test the hypothesis that the addition of a glucagon-like peptide-1
receptor agonist that can decrease glucose levels without increasing the
hypoglycaemia risk will achieve appropriate glycaemic control during the
peri-operative period. Method(s): We studied 70 people with Type 2
diabetes who underwent elective cardiac surgery. Participants were
randomized to either an insulin-alone or an insulin plus liraglutide 0.6
mg/day group. We evaluated average M values, which indicated the proximity
index of the target glucose level from day 1 to day 10. Result(s):
The average M value in the liraglutide plus insulin group was
significantly lower than that in the insulin-alone group (liraglutide plus
insulin 5.8 vs insulin-alone 12.3; P < 0.001). The frequency of insulin
dose modification in the liraglutide plus insulin group was significantly
lower than that in the insulin-alone group (odds ratio 0.19, 95% CI
0.08-0.49; P < 0.001). The frequency of hypoglycaemia in the liraglutide
plus insulin group tended to be lower than that in the insulin-alone group
(odds ratio 0.57, 95% CI 0.15-2.23; P = 0.21). Conclusion(s): The
results of this study showed that the addition of low-dose liraglutide to
insulin achieved lower M values than insulin alone, suggesting that the
addition of low-dose liraglutide may achieve better glycaemic control
during the peri-operative period. (Clinical trials registry no.: UMIN
000008003). Copyright © 2019 Diabetes UK

<53>
Accession Number
628825341
Title
Review of available evidence supporting different transfusion thresholds
in different patient groups with anemia.
Source
Annals of the New York Academy of Sciences. (no pagination), 2019. Date of
Publication: 2019.
Author
Chai K.L.; Cole-Sinclair M.
Institution
(Chai, Cole-Sinclair) Department of Haematology, St Vincent's Hospital,
Melbourne, VIC, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
In patients with anemia, transfusion of red blood cells (RBCs) can save
lives and improve quality of life. The choice to transfuse should be
cautiously made owing to risks of transfusion, economic costs, and
limitations on the blood supply. Until the 1980s, the decision for RBC
transfusion was guided by Hb threshold, with the aim of maintaining the
patient's blood Hb level over 100 grams per liter. Since then, multiple
randomized controlled trials and key systematic reviews have provided
evidence-based guidelines as to appropriate transfusion thresholds in a
number of clinical settings. Here, we aimed to address the outcome of
defining different anemia criteria in specific clinical populations
exclusively on the basis of the need for RBC transfusion based on Hb
concentration. We focused on the patient populations, where there were the
most available data on differing transfusion thresholds, which looked at
transfusing to a higher or liberal transfusion threshold in comparison
with a lower or restrictive transfusion threshold. These included patients
in intensive care with or without septic shock, hip fracture surgery,
cardiovascular surgery, and upper gastrointestinal bleeding, the pediatric
population, and also those with malaria, by reviewing key randomized
controlled trials and systematic reviews. Twenty-four randomized
controlled studies and 12 systematic reviews have been included, and these
are discussed below. Copyright © 2019 New York Academy of
Sciences.

<54>
Accession Number
628577770
Title
Balloon-expandable transcatheter aortic valve implantation with or without
pre-dilation-results of a meta-analysis of 3 multicenter registries.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 172. Date of Publication: 19 Jul 2019.
Author
Ashauer J.O.; Bonaros N.; Kofler M.; Schymik G.; Butter C.; Romano M.;
Bapat V.; Strauch J.; Schrofel H.; Busjahn A.; Deutsch C.; Bramlage P.;
Kurucova J.; Thoenes M.; Baldus S.; Rudolph T.K.
Institution
(Ashauer, Baldus, Rudolph) Department of Cardiology, University of Cologne
Heart, Cologne, Germany
(Bonaros, Kofler) Department of Cardiac Surgery, Medical University
Innsbruck, Innsbruck, Austria
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital,
Karlsruhe, Germany
(Butter) Department of Cardiology, Immanuel Clinic Bernau, Heart Center
Brandenburg, Bernau, Germany
(Romano) Institut Hospitalier Jacques Cartier, Massy, France
(Bapat) Columbia University Medical, New York-Presbyterian Hospital, New
York, NY, United States
(Strauch) Clinic for Cardiosurgery and Thoracic Surgery,
Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil, Bochum,
Germany
(Schrofel) Department Cardiovascular Surgery, University Heart Center
Freiburg, Bad Krozingen, Germany
(Busjahn) Healthtwist GmbH, Berlin, Germany
(Deutsch, Bramlage) Institute for Pharmacology and Preventive Medicine,
Bahnhofstrasse 20, Cloppenburg 49661, Germany
(Kurucova) Edwards Lifesciences, Medical Affairs Professional Education,
Prague, Czechia
(Thoenes) Edwards Lifesciences, Medical Affairs Professional Education,
Nyon, Switzerland
(Rudolph) Department of Cardiology, Heart and Diabetes Center Bad
Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: To evaluate the outcomes of transcatheter aortic valve
implantation (TAVI) without balloon aortic valvuloplasty (BAV) in a
real-world setting through a patient-level meta-analysis. Method(s):
The meta-analysis included patients of three European multicenter,
prospective, observational registry studies that compared outcomes after
Edwards SAPIEN 3 or XT TAVI with (n = 339) or without (n = 355) BAV.
Unadjusted and adjusted pooled odds ratios (with 95% confidence intervals)
were calculated for procedural and 30-day outcomes. Result(s): Median
procedural time was shorter in the non-BAV group than in the BAV group (73
versus 93 min, p = 0.001), as was median fluoroscopy time (7 versus 11
min, p = 0.001). Post-delivery balloon dilation (15.5% versus 22.4%, p =
0.02) and catecholamine use (9.0% vs. 17.9%; p = 0.016) was required less
often in the non-BAV group than in the BAV group with the difference
becoming insignificant after multiple adjustment. There was a reduced risk
for periprocedural atrioventricular block during the intervention (1.4%
versus 4.1%, p = 0.035) which was non-significant after adjustment. The
rate of moderate/severe paravalvular regurgitation post-TAVI was 0.6% in
the no-BAV group versus 2.7% in the BAV group. There were no between-group
differences in the risk of death, stroke or other adverse clinical
outcomes at day 30. Conclusion(s): This patient-level meta-analysis
of real-world data indicates that TAVI performed without BAV is
advantageous as it has an adequate device success rate, reduced procedure
time and no adverse effects on short-term clinical outcomes. Copyright
© 2019 The Author(s).

<55>
Accession Number
2002323673
Title
Design and rationale of the COMPLETE trial: A randomized, comparative
effectiveness study of complete versus culprit-only percutaneous coronary
intervention to treat multivessel coronary artery disease in patients
presenting with ST-segment elevation myocardial infarction.
Source
American Heart Journal. 215 (pp 157-166), 2019. Date of Publication:
September 2019.
Author
Mehta S.R.; Wood D.A.; Meeks B.; Storey R.F.; Mehran R.; Bainey K.R.;
Nguyen H.; Bangdiwala S.I.; Cairns J.A.
Institution
(Mehta, Meeks, Nguyen, Bangdiwala) Population Health Research Institute,
Hamilton, Ontario, Canada
(Mehta, Bangdiwala) McMaster University, Hamilton, Ontario, Canada
(Mehta) Hamilton Health Sciences, Hamilton, Ontario, Canada
(Wood, Cairns) University of British Columbia, Vancouver, British
Columbia, Canada
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Mehran) The Zena A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Bainey) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Alberta, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
A significant proportion of patients with ST-segment elevation myocardial
infarction (STEMI) have multivessel coronary artery disease (CAD).
Following successful culprit lesion percutaneous coronary intervention
(PCI) for STEMI, the question of whether to routinely revascularize
non-culprit lesions or manage them conservatively with optimal medical
therapy (OMT) alone is a common dilemma facing clinicians. Method(s):
COMPLETE is a prospective, randomized, international, multicenter,
parallel group, open-label trial with blinded evaluation of outcomes.
Following successful PCI (contemporary drug eluting stents recommended) of
the culprit lesion for STEMI, a total of 4041 patients from 140 centers in
31 countries were randomized to receive either complete revascularization,
consisting of staged PCI of all suitable non-culprit lesions plus optimal
medical therapy (OMT), or to culprit lesion-only PCI, consisting of OMT
alone. OMT comprises evidence-based therapy for STEMI, including and dual
antiplatelet therapy with ticagrelor, HTN and lipid management. All
coronary angiograms in the trial are being evaluated in a central
angiographic core lab to assess quality and completeness of
revascularization. The co-primary outcomes are (1): the composite of CV
death or new non-fatal MI and (2 the composite of CV death, new non-fatal
MI or ischemia-driven revascularization at a median follow-up of 3 years.
 Conclusion(s): The COMPLETE trial is an international multicenter
randomized trial that will help determine whether complete
revascularization involving staged PCI of non-culprit lesions improves
outcomes in patients with STEMI and multivessel CAD. (clinicaltrials.gov
NCT01740479). Copyright © 2019 Elsevier Inc.

<56>
Accession Number
626727482
Title
Bilateral versus single internal thoracic artery for coronary artery
bypass grafting with end-stage renal disease: A systematic review and
meta-analysis.
Source
Journal of Cardiac Surgery. 34 (4) (pp 196-201), 2019. Date of
Publication: April 2019.
Author
Tam D.Y.; Rahouma M.; An K.R.; Gaudino M.F.L.; Karkhanis R.; Fremes S.E.
Institution
(Tam, An, Karkhanis, Fremes) Division of Cardiac Surgery, Schulich Heart
Centre, Department of Surgery, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Canada
(Gaudino) Department of Cardiovascular Sciences, Catholic University,
Rome, Italy
(Rahouma, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medical College, New York, NY, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The incidence of severe coronary artery disease (CAD) in
patients with end-stage renal disease (ESRD) on dialysis is high. Coronary
artery bypass grafting (CABG) is the preferred treatment in those with
severe CAD. Bilateral internal thoracic artery (BITA) vs single internal
thoracic artery (SITA) grafting has been shown to improve late survival in
other high-risk populations. In ESRD, comparative studies are limited by
sample size to detect outcome differences. We sought to determine the late
survival and early outcomes of BITA compared with SITA in patients with
ESRD. Method(s): MEDLINE and EMBASE were searched from inception to
2017 for studies directly comparing BITA to SITA in patients with ESRD
undergoing CABG. The primary outcome was late survival; secondary outcomes
were in-hospital/30-day mortality, stroke, and deep sternal wound
infection (DSWI). Kaplan-Meier curve reconstruction for late mortality was
performed. Result(s): Five studies (three adjusted [n = 197] and two
unadjusted observational studies [n = 231]) were included in the analysis.
Reported ITA skeletonization ranged from 83% to 100% (median: 100%). There
was no difference in in-hospital mortality (risk risk [RR], 0.84; 95%
confidence interval [95%CI], 0.36,1.98; P = 0.70), perioperative stroke
(RR, 1.97; 95%CI, 0.58,6.66; P = 0.28), and DSWI (RR, 1.56; 95%CI,
0.60,4.07; P = 0.36) between BITA and SITA. All studies reported adjusted
late mortality, which was similar between BITA and SITA (incident rate
ratio, 0.81; 95%CI, 0.59,1.11) at mean 3.7-year follow-up.
 Conclusion(s): BITA grafting is safe in patients with ESRD although
there was no survival benefit at 3.7 years. Additional studies with longer
follow-up are required to determine the potential late benefits of BITA
grafting in patients with ESRD. Copyright © 2019 Wiley
Periodicals, Inc.

<57>
Accession Number
2002255546
Title
Comparison of 3 blind brachial plexus block techniques during maintenance
of anesthesia and postoperative pain scores in dogs undergoing surgical
procedures of the thoracic limb.
Source
Canadian Journal of Veterinary Research. 83 (3) (pp 197-205), 2019. Date
of Publication: July 2019.
Author
Skelding A.; Valverde A.; Aguilera R.; Moens N.M.; Sinclair M.; Thomason
J.J.
Institution
(Skelding, Valverde, Aguilera, Moens, Sinclair) Department of Clinical
Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G
2W1, Canada
(Thomason) Department of Biomedical Sciences, Ontario Veterinary College,
University of Guelph, Guelph, ON N1G 2W1, Canada
Publisher
Canadian Veterinary Medical Association (339 Booth Street, Ottawa ONT K1R
7K1, Canada)
Abstract
The degree of analgesia provided by blind techniques for brachial plexus
blocks (BPBs) has not been compared in clinical cases undergoing surgery
of the thoracic limb. The objective of this study was to evaluate the
anesthetic conditions and postoperative analgesia resulting from 3
different BPB local anesthetic techniques in canine patients undergoing
such surgery. Twenty-four client-owned dogs received a standardized
premedication/induction protocol (hydromorphone and
acepromazine/propofol), maintained with isoflurane in oxygen using
mechanical ventilation, in a prospective, randomized, blinded clinical
trial. Before surgery, dogs received 1 of 3 anatomical BPB techniques:
traditional, perpendicular, or axillary, with 0.2 mL/kg body weight (BW)
of bupivacaine 0.5%. Cardiorespiratory variables and isoflurane end-tidal
concentrations were recorded throughout anesthesia. Scores for anesthetic
maintenance (0-best to 4-responsive), recovery quality (0-not responsive
to 3-responsive), and Glasgow pain scale were recorded for up to 24 h
postoperatively. All dogs recovered uneventfully from anesthesia and no
differences in the measured variables or scores were noted among groups,
during and after anesthesia. When thoracic limb amputations in each of the
3 groups (n = 9; 4 in traditional, 3 in perpendicular, 2 in axillary) were
compared to the other surgical procedures (n = 15); however, scores for
anesthetic maintenance were higher [0 (0 to 1) versus 0 (0 to 0); median
(interquartile range)], recovery [1 (0 to 2) versus 0 (0 to 0)], and pain
[2.4 (2.4 to 3.0) versus 1.6 (1.4 to 2.2)] in the first 3 h
post-extubation. Surgery times were also longer with amputations [115 min
(100 to 138 min) versus 50 min (41 to 90 min)]. The 3 BPB techniques
provided similar anesthesia and postoperative pain scores. Despite higher
pain scores in thoracic limb amputations than in less invasive surgeries,
the BPB appeared to provide significant comfort. Copyright ©
2019, Canadian Veterinary Medical Association. All rights reserved.

<58>
Accession Number
2002367816
Title
Characteristics and prognosis of IgG4-related periaortitis/periarteritis:
A systematic literature review.
Source
Autoimmunity Reviews. (no pagination), 2019. Article Number: 102354. Date
of Publication: 2019.
Author
Akiyama M.; Kaneko Y.; Takeuchi T.
Institution
(Akiyama, Kaneko, Takeuchi) Division of Rheumatology, Department of
Internal Medicine, Keio University School of Medicine, Japan
Publisher
Elsevier B.V.
Abstract
Objective: Immunoglobulin G4 (IgG4)-related disease is a systemic chronic
fibroinflammatory disease that can affect almost every organ of the body.
IgG4-related periaortitis/periarteritis is a newly recognized subset of
IgG4-related disease, and its characteristics and prognosis remain
unclear. We investigated the clinical characteristics and prognosis of
IgG4-related periaortitis/periarteritis. Method(s): We performed a
systematic literature review of IgG4-related periaortitis/periarteritis.
Additionally, we have summarized the characteristics and prognosis of
IgG4-related coronary arteritis. Result(s): We investigated 248
patients with IgG4-related periaortitis/periarteritis. All studies
reported the condition in elderly patients, and male predominance was
observed. The infra-renal abdominal aorta and iliac arteries were the most
commonly affected sites. Most reports showed the serum C-reactive protein
elevation in this disease entity, in contrast to non-vascular IgG4-related
disease. Based on radiological findings observed in 27 patients with
IgG4-related coronary arteritis, vasculitic lesions were classified into 3
types: stenotic (67% of patients), aneurysmal (42%), and diffuse wall
thickening type (92%). Serum IgG4 level, but not C-reactive protein level,
was associated with the number of affected organs in IgG4-related coronary
arteritis. Corticosteroid treatment with or without cardiac surgery or
percutaneous coronary intervention was effective in most patients with
IgG4-related coronary arteritis; however, 33% of patients showed an
unfavorable clinical course including disease progression, relapse, or
death. Pre-treatment stenosis and/or aneurysms were associated with
progression of stenosis or aneurysm after corticosteroid treatment.
 Conclusion(s): Most clinical characteristics were similar between the
IgG4-related periaortitis/periarteritis and the non-vascular IgG4-related
disease groups; however, serum C-reactive protein level elevation was
observed only in the former. Although corticosteroid treatment was
effective, this disease can be life-threatening secondary to myocardial
infarction, aortic dissection, and aneurysmal rupture. Pre-treatment
evaluation of stenosis or aneurysms is important for predicting
progression of stenosis or aneurysm after corticosteroid
treatment. Copyright © 2019

<59>
Accession Number
628653597
Title
Association between Stress Testing-Induced Myocardial Ischemia and
Clinical Events in Patients with Multivessel Coronary Artery Disease.
Source
JAMA Internal Medicine. (no pagination), 2019. Date of Publication: 2019.
Author
Garzillo C.L.; Hueb W.; Gersh B.; Rezende P.C.; Lima E.G.; Favarato D.;
Ramires J.A.F.; Filho R.K.
Institution
(Garzillo, Hueb, Rezende, Lima, Favarato, Ramires, Filho) Instituto Do
Coracao (InCor), Hospital das Clinicas, Faculdade de Medicina,
Universidade de Sao Paulo, Avenida Doutor Eneas de Carvalho Aguiar 44,
Cerqueira Cesar, SP 05403-000, Brazil
(Gersh) Department of Medicine, Mayo Clinic College of Medicine,
Rochester, MN, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The long-term prognostic implications of myocardial ischemia
documented during stress testing in patients with multivessel coronary
artery disease (CAD) are unclear. Objective(s): To assess whether
documented stress testing-induced myocardial ischemia is associated with
major adverse cardiovascular events or ventricular function changes in
patients with stable multivessel CAD. Design, Setting, and
Participant(s): A prospective cohort study was conducted using data from a
single-center randomized clinical trial (Medicine, Angioplasty, or Surgery
Study [MASS] II) to examine the association of myocardial ischemia
documented during stress testing at baseline with cardiovascular events
and ventricular function changes during follow-up. Participants were
previously randomized (May 1, 1995, to May 31, 2000) to medical therapy,
percutaneous coronary intervention with bare metal stents, or coronary
artery bypass grafting. Event-free survival was estimated by the
Kaplan-Meier method, and multivariable Cox regression models were
calculated to assess the association between ischemia and the primary
composite end point. The vital status was determined on February 28, 2011.
Data were analyzed from February 1, 2016, to April 1, 2017. Main
Outcomes and Measures: Cardiovascular events (overall mortality,
myocardial infarction, and revascularization for refractory angina) were
tracked from the time of randomization to the end of the 10-year follow-up
(mean [SD] duration, 11.4 [4.3] years). Myocardial ischemia was assessed
at baseline and at 1-year intervals by exercise stress testing, and
ventricular function (left ventricular ejection fraction) was assessed by
echocardiography at baseline and after 10 years. Patients with documented
ischemia were compared with those without ischemia regarding the outcomes
and changes in ventricular function. Result(s): Of 611 participants,
535 underwent exercise stress testing at baseline: 270 with documented
ischemia and 265 without. Of these 535 patients, 373 (69.7%) were men, and
the mean (SD) age for the entire cohort was 59.7 (9.2) years. No
association was found between the presence of ischemia at baseline and
survival free of combined cardiovascular events (hazard ratio, 1.00; 95%
CI, 0.80-1.27; P =.95) after multivariable adjustment that included CAD
initial randomized treatments. In addition, among 320 patients who
underwent echocardiographic evaluation, the slight decline in left
ventricular ejection fraction after 10 years was similar in both groups
(median [SD] difference, -4.9% [18.7%] vs -6.6% [20.0%], respectively, for
groups with and without ischemia; P =.97). Conclusions and Relevance:
In this study, regardless of the therapeutic strategy applied, the
presence of documented myocardial ischemia did not appear to be associated
with an increased occurrence of major adverse cardiovascular events or
changes in ventricular function in patients with multivessel CAD during a
long-term follow-up. Copyright © 2019 Garzillo CL et al.

<60>
Accession Number
2002323830
Title
Diabetes, dysglycemia, and vascular surgery.
Source
Journal of Vascular Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Duwayri Y.; Jordan W.D.
Institution
(Duwayri, Jordan) Division of Vascular Surgery and Endovascular Therapies,
Emory University School of Medicine, Atlanta, Ga, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Abnormalities in glucose metabolism are common in patients
with arterial disease. Chronic hyperglycemia and insulin resistance
contribute to the complexity of vascular disorders. They also overlap with
the effects of perioperative hyperglycemia on adverse perioperative
outcomes. We provide an overview of the pathophysiologic consequences of
dysglycemia and the evidence behind glycemic control in patients
undergoing vascular surgery. Method(s): We searched the literature
for major studies evaluating the pathophysiology of hyperglycemia in
microvascular and macrovascular beds, randomized trials in perioperative
populations, and meta-analyses. The literature was summarized to guide
therapy in the population of vascular patients and for the perioperative
period. Result(s): National standards for glycemic control after
vascular interventions were not identified. Mounting evidence exists for
the long-term consequences of poor glycemic control on the progression of
vascular disease. Similarly, there is a large body of evidence supporting
tight control of hyperglycemia after general and cardiac surgery during
the critical perioperative period. The absolute glucose target remains
controversial. Randomized controlled studies are lacking in vascular
surgery patients, but the current evidence can be extrapolated to guide
management after vascular interventions. Glycated hemoglobin is a
biomarker for increased mortality and vascular morbidity after vascular
surgery. Conclusion(s): Hyperglycemia contributes to poor outcome in
the vascular patient. Further vascular focused studies are required to
determine the proper perioperative serum glucose target and the long-term
glycated hemoglobin range. Copyright © 2019 Society for Vascular
Surgery

<61>
Accession Number
2002303566
Title
Feasibility and acceptability of continuous postoperative pericardial
flushing for blood loss reduction in patients undergoing coronary artery
bypass grafting.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2019. Date
of Publication: 2019.
Author
Kara H.; Erden T.
Institution
(Kara) Department of Cardiovascular Surgery, Giresun Ada Hospital,
Giresun, Turkey
(Erden) Department of Cardiovascular Surgery, Faculty of Medicine,
Karadeniz Technical University, Trabzon, Turkey
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Introduction: Postoperative bleeding requires blood transfusion and
surgical re-exploration that can affect the short- and long-term
postoperative outcomes. Interventions that can be used in the
postoperative period to reduce blood loss should be developed. Continuous
postoperative pericardial flushing (CPPF) with an irrigation solution may
reduce blood loss by preventing the accumulation of clots. This study
examined the feasibility and acceptability of CPPF for reducing bleeding
after coronary artery bypass surgery. Method(s): This pilot study
adopted a prospective and group comparison design. Between January and
April 2018, 42 patients who underwent isolated coronary artery bypass
surgery received CPPF from sternal closure up to 8 h postoperative. The
mean actual blood loss in the CPPF group was compared to the mean of
retrospectively group (n = 58). In the CPPF group, an extra infusion
catheter was inserted through one of the tube incision holes and an
irrigation solution (0.9% NaCl at 38 degreeC) was delivered to the
pericardial cavity by using a volumetric pump. Safety aspects, feasibility
issues, and complications were documented. The primary outcome was blood
loss, and it was assessed 18 h after the surgery. Result(s): CPPF was
successfully completed in 40 patients (95.24%). Method-related
complications were not observed. Feasibility was good in this experimental
setting. Blood loss was lower in the CPPF group (257.24 mL) than non-CPPF
group (p < 0.001). Conclusion(s): CPPF after coronary artery bypass
grafting surgery is safe, effective, feasible, and acceptable. However,
standardized randomized clinical trials are necessary to draw definitive
conclusions. Copyright © 2019, The Japanese Association for
Thoracic Surgery.

<62>
Accession Number
2002311391
Title
Meta-Analysis for Impact of Statin on Mortality After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Takagi H.; Hari Y.; Nakashima K.; Kuno T.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno) Department of Medicine, Mount Sinai Beth Israel Medical Center, New
York, NY, United States
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To determine whether statin (hydroxymethylglutaryl-CoA reductase
inhibitor) therapy is associated with better midterm survival after
transcatheter aortic valve implantation (TAVI), the first meta-analysis of
currently available studies was performed. To identify all observational
comparative studies and randomized controlled trials (RCTs) of statin
versus control (no statin) therapy or cohort studies investigating statin
treatment as one of covariates in patients undergoing TAVI, PubMed, Web of
Science, and Google Scholar were searched through March 2019. Adjusted (if
unavailable, unadjusted) hazard ratios (HRs) with their confidence
interval (CIs) of midterm (>=1 year) all-cause mortality after TAVI for
statin therapy were extracted from each study. Study-specific estimates
were combined by means of inverse variance-weighted averages of
logarithmic HRs in the random-effects model. Eight eligible studies with a
total of 5,170 TAVI patients were identified and included in the present
meta-analysis. The primary meta-analysis (including HRs for high intensity
statin from 3 studies together with other HRs) demonstrated that statin
treatment was associated with significantly lower midterm mortality (HR,
0.74; 95% CI, 0.60 to 0.91; p = 0.005). The secondary meta-analysis
(including HRs for low/moderate intensity statin from 3 studies together
with other HRs) also indicated an association of statin therapy with
significantly lower midterm mortality (HR, 0.80; 95% CI, 0.69 to 0.93; p =
0.005). No funnel plot asymmetry for the primary meta-analysis (p = 0.64)
was identified, which suggested probably no publication bias. In
conclusion, statin therapy is associated with better midterm survival
after TAVI. Copyright © 2019 Elsevier Inc.

<63>
Accession Number
2002314631
Title
Percutaneous mitral valve repair vs. stand-alone medical therapy in
patients with functional mitral regurgitation and heart failure.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2019. Date of
Publication: 2019.
Author
Benito-Gonzalez T.; Estevez-Loureiro R.; Villablanca P.A.; Armeni P.;
Iglesias-Garriz I.; Minguito C.; Garrote C.; de Prado A.P.; Tundidor-Sanz
E.; Gualis J.; Fernandez-Vazquez F.
Institution
(Benito-Gonzalez, Estevez-Loureiro, Iglesias-Garriz, Minguito, Garrote, de
Prado, Tundidor-Sanz, Fernandez-Vazquez) Department of Cardiology,
University Hospital of Leon, Leon, Spain
(Villablanca) Department of Cardiology, Center for Structural Heart
Disease, Henry Ford Hospital, Detroit, United States
(Armeni) SDA Bocconi School of Management/CERGAS SDA Bocconi, Italy
(Gualis) Department of Cardiac Surgery, University Hospital of Leon, Leon,
Spain
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Functional mitral regurgitation (FMR) is a common finding
among patients with heart failure (HF) and it is related to adverse
events. Outcomes in patients undergoing transcatheter mitral valve repair
(TMVR) are still a matter of debate. We performed a meta-analysis to
assess mid- and long-term outcomes of patients with FMR treated with
MitraClip compared to medical management. Method(s): We conducted an
electronic database search of all published data PubMed Central, Embase,
the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov,
and Google Scholar databases. The primary end-point was all-cause
mortality. The secondary end-points were hospitalizations for HF, need for
heart transplantation or left ventricular assist device, unplanned mitral
valve surgery, myocardial infarction and stroke. Result(s): Five
studies (n = 1513 patients) were included in the analysis. The summary
estimate including all the available studies showed a statistically
significant reduction in all-cause mortality favoring MitraClip (HR 0.56,
CI 95% [0.38-0.84]) and HF hospitalizations (HR 0.65; CI 95% [0.46-0.92]).
A significant reduction in the indication for advanced HF therapies (OR
0.48; CI 95% [0.25-0.90]) or the need for unplanned mitral valve surgery
(OR 0.20; CI 95% [0.07-0.57]) was also found in the group of patients that
underwent TMVR. No differences in the incidence of myocardial infarction
or stroke were found between both groups of treatment. No publication bias
was detected. Conclusion(s): TMVR with MitraClip system was related
to a significant reduction in all-cause mortality, hospitalizations for HF
and the need for HF transplant, left ventricular assist device or
unplanned surgery beyond 1-year follow up. Copyright © 2019
Elsevier Inc.

<64>
Accession Number
2002311153
Title
Early outcomes for low-risk pediatric heart transplant recipients and
steroid avoidance: A multicenter cohort study (Clinical Trials in Organ
Transplantation in Children - CTOTC-04).
Source
Journal of Heart and Lung Transplantation. (no pagination), 2019. Date of
Publication: 2019.
Author
Lamour J.M.; Mason K.L.; Hsu D.T.; Feingold B.; Blume E.D.; Canter C.E.;
Dipchand A.I.; Shaddy R.E.; Mahle W.T.; Zuckerman W.A.; Bentlejewski C.;
Armstrong B.D.; Morrison Y.; Diop H.; Ikle D.N.; Odim J.; Zeevi A.; Webber
S.A.
Institution
(Lamour, Hsu) Division of Pediatric Cardiology, Children's Hospital at
Montefiore, Bronx, New York, NY, United States
(Mason, Armstrong, Morrison, Diop, Ikle) Rho Federal Systems Division,
Chapel Hill, NC, United States
(Feingold) Departments of Pediatrics and Clinical and Translational
Science, University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
(Blume) Department of Pediatric Cardiology, Boston Children's Hospital,
Boston, MA, United States
(Canter) Division of Pediatric Cardiology, Washington University School of
Medicine, St. Louis, MO, United States
(Dipchand) Department of Paediatrics, Labatt Family Heart Center, Hospital
for Sick Children, Toronto, Ontario, Canada
(Shaddy) Division of Pediatric Cardiology, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mahle) Division of Pediatric Cardiology, Children's Healthcare of
Atlanta, Atlanta, Georgia, Georgia
(Zuckerman, Bentlejewski) Division of Pediatric Cardiology, Columbia
University Medical Center, New York, NY, United States
(Odim) Transplantation Branch, National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Bethesda, MD, United
States
(Zeevi) Department of Pathology, University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
(Webber) Department of Pediatrics, Vanderbilt University School of
Medicine, Nashville, TN, United States
Publisher
Elsevier USA
Abstract
BACKGROUND: Immunosuppression strategies have changed over time in
pediatric heart transplantation. Thus, comorbidity profiles may have
evolved. Clinical Trials in Organ Transplantation in Children-04 is a
multicenter, prospective, cohort study assessing the impact of
pre-transplant sensitization on outcomes after pediatric heart
transplantation. This sub-study reports 1-year outcomes among recipients
without pre-transplant donor-specific antibodies (DSAs). METHOD(S):
We recruited consecutive candidates (<21 years) at 8 centers.
Sensitization status was determined by a core laboratory.
Immunosuppression was standardized as follows: Thymoglobulin induction
with tacrolimus and/or mycophenolate mofetil maintenance. Steroids were
not used beyond 1 week. Rejection surveillance was by serial biopsy.
 RESULT(S): There were 240 transplants. Subjects for this sub-study (n
= 186) were non-sensitized (n = 108) or had no DSAs (n = 78). Median age
was 6 years, 48.4% were male, and 38.2% had congenital heart disease.
Patient survival was 94.5% (95% confidence interval, 90.1-97.0%). Freedom
from any type of rejection was 67.5%. Risk factors for rejection were
older age at transplant and presence of non-DSAs pre-transplant. Freedom
from infection requiring hospitalization/intravenous anti-microbials was
75.4%. Freedom from rehospitalization was 40.3%. New-onset diabetes
mellitus and post-transplant lymphoproliferative disorder (PTLD) occurred
in 1.6% and 1.1% of subjects, respectively. There was no decline in renal
function over the first year. Corticosteroids were used in 14.5% at 1
year. CONCLUSION(S): Pediatric heart transplantation recipients
without DSAs at transplant and managed with a steroid avoidance regimen
have excellent short-term survival and a low risk of first-year diabetes
mellitus and PTLD. Rehospitalization remains common. These contemporary
observations allow for improved caregiver and/or patient counseling and
provide the necessary outcomes data to help design future randomized
controlled trials. Copyright © 2019 International Society for
Heart and Lung Transplantation

<65>
Accession Number
628813405
Title
Resumption of anticoagulant therapy after anticoagulant-related bleeding:
A population-based cohort study.
Source
Research and Practice in Thrombosis and Haemostasis. Conference: 27th
Congress of the International Society on Thrombosis and Haemostasis.
Australia. 3 (Supplement 1) (pp 796-797), 2019. Date of Publication: July
2019.
Author
Little D.; Cerasuolo J.; Perez R.; Douketis J.; Holbrook A.; Sutradhar R.;
Paterson M.; Gomes T.; Siegal D.
Institution
(Little, Cerasuolo, Perez, Douketis, Holbrook, Siegal) McMaster
University, Hamilton, Canada
(Sutradhar, Paterson, Gomes) University of Toronto, Toronto, Canada
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Background : Oral anticoagulants (OACs) are often permanently discontinued
following a bleed. Existing data regarding the benefits and harms of
restarting OAC are derived primarily from observational studies of
warfarin- treated patients with few data on direct oral anticoagulants
(DOACs). Aims : To characterize OAC prescribing patterns after OAC-
related bleeding and compare the rates of thrombosis, bleeding, and
mortality in patients who resumed OAC versus those who did not. Methods :
We conducted a population- based, retrospective cohort study of adults
aged >=66 years hospitalized for bleeding while receiving OACs from April
1, 2012 to March 31, 2016 using administrative health data from Ontario,
Canada. Competing risk methods were used to calculate cause- specific
adjusted hazard ratios (aHR) for subsequent hospitalization for
thrombosis, bleeding, and mortality adjusting for known covariates.
Exposure to OAC was adjusted as a time- varying covariate. Cumulative
incidence function curves were generated for each outcome. Results : 5,408
patients (median age 82 years) with gastrointestinal (n=3,361, 62%),
intracranial (n=686,13%), or other bleeding (n=1,361, 25%) were included
in the study cohort. At cohort entry, 3,322 (61%) patients were on
warfarin and 2,086 (39%) patients were on a DOAC. The most common
indication for OAC was atrial fibrillation (n=4,423 [82%]) followed by
venous thromboembolism (n=1,090 [20%]) and prosthetic heart valves (n=200
[4%]). OAC was resumed in 3,737 (69%) patients at a median of 28 days
(interquartile range 60). Resuming OAC was associated with a reduced rate
of thrombosis (aHR 0.58; 95% CI 0.44- 0.75) and mortality (aHR 0.64; 95%
CI 0.54- 0.75), and an increased rate of bleeding (aHR 2.11; 95% CI 1.71-
2.60) (Table 1). The cumulative incidence of outcomes is shown in Figure
1. Conclusions : Results from this large cohort suggest that resuming OAC
is associated with a reduction in thrombosis and mortality, but an
increase in bleeding. Randomized trials evaluating OAC resumption
strategies are warranted. (Figure Presented) .

<66>
[Use Link to view the full text]
Accession Number
628809947
Title
The influence of exercise training on arterial blood pressure, QT
dispersion, cholesterol and physical exercise capacity in patience after
coronary artery bypass graft surgery.
Source
Journal of Hypertension. Conference: 29th European Meeting on Hypertension
and Cardiovascular Protection, ESH 2019. Italy. 37 (Supplement 1) (pp
e121-e122), 2019. Date of Publication: July 2019.
Author
Stoickov V.; Deljanin Ilic M.; Stoickov M.; Tasic I.; Stoickov I.; Saric
S.; Kostic S.; Mitic S.
Institution
(Stoickov, Deljanin Ilic, Tasic) University of Nis, Medical Faculty,
Institute of Cardiology Niska Banja, Nis, Serbia
(Stoickov, Saric, Kostic, Mitic) Institute of Cardiology, Niska Banja,
Nis, Serbia
(Stoickov) University of Nis, Medical Faculty, Nis, Serbia
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The aim of this study is to determine the impact of exercise
training on arterial blood pressure, QT dispersion, cholesterol and
physical exercise capacity in patients after coronary artery bypass graft
surgery (CABG). Design and method: 143 patients after CABG were involved
in the study. Patients were randomly divided into the exercise training
group (TG: 107 patients) and non-training group (NTG: 36 patients). The
patients performed the exercise test, after that the participants of TG
were involved in the exercise training. According to the results of the
exercise test, the TG of patients received certain degree of physical
activity (gymnastic exercises, using the bicycle ergometer and walking).
During the follow-up period, medication therapy was not changed. After the
observed follow-up period of 21 days, the exercise test were performed,
once again. Result(s): In TG of patients, after follow-up period,
there was a significant reduction of QTd from 48.2 +/- 15.9 to 42.1 +/-
14.2 ms (p < 0.005) and QTdc from 50.5 +/- 18.2 to 43.6 +/- 15.7 ms (p <
0.005). Also, in the TG, we have found significant reduction of systolic
blood pressure from 138.7 +/- 13.9 to 129.2 +/- 9.3 mmHg (p < 0.001), of
diastolic blood pressure from 88.5 +/- 8.4 to 83.6 +/- 5.9 mmHg (p <
0.001), of heart rate from 77.3 +/- 7.8 to 68.8 +/- 6.9 beats/min (p <
0.001), of double product from 11546.7 +/- 912.5 to 10227.6 +/- 628.4
beat/min x mmHg (p < 0.001), of total cholesterol from 5.1 +/- 1.6 to 4.7
+/- 1.2 mmol/L (p < 0.025) and of LDL cholesterol from 3.1 +/- 0.9 to 2.9
+/- 0.6 mmol/L (p < 0.05). After three weeks, TG patients in the exercise
test reached a significantly longer time (8.2 +/- 1.9 v.s. 5.3 +/- 1.4 min
(p < 0.001). In contrast, the non-training group showed no significant
changes. Conclusion(s): The study showed that exercise training led
to significant reduction in blood pressure, heart rate, double product,
cholesterol, as well as significantly improved physical exercise capacity,
which has a beneficial effect on the prognosis in patients after CABG.
Exercise training has favorable effects on QT dispersion in these
patients.

<67>
[Use Link to view the full text]
Accession Number
628809589
Title
A systematic review of superiority trials to elucidate the concept of
superiority margin.
Source
Journal of Hypertension. Conference: 29th European Meeting on Hypertension
and Cardiovascular Protection, ESH 2019. Italy. 37 (Supplement 1) (pp
e106), 2019. Date of Publication: July 2019.
Author
Gamad N.; Shafiq N.; Malhotra S.
Institution
(Gamad, Shafiq, Malhotra) Institute of Medical Education and Research,
Chandigarh, India
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Progress towards superiority trial design and analysis has been
slow. A statistically significant result may not be clinically relevant.
In this study, we aimed to show that overpowered trials show statistical
significance sans clinical relevance. Design and method: We did a
systematic review of all the superiority trials published in The New
England Journal of Medicine, NEJM between January 1st, 2015 to December
31st, 2018. Search was restricted to trial populations with specific
diseases such as cardiovascular diseases and diabetes mellitus. We
evaluated clinically significant difference used to calculate sample size
and compared with the findings. Result(s): Overall, 218,664
participants were included in the 16 trials that provided the quantitative
data for this review. Largely, the primary efficacy endpoint in these
trials was composite of cardiovascular death, nonfatal myocardial
infarction, unstable angina requiring rehospitalization, coronary
revascularization, fatal or nonfatal stroke. Overall effect estimate was
0.85 (95% CI 0.83-0.88) which was lower than the mean clinically
significant difference of 19.3 (range: 9.375 to 35) of these studies.
There was a wide 95% CI in these studies from 0.56 to 0.99. CI in most of
the studies was close to line of no difference. Absolute risk reduction
was very low (0.08 to 2.3%) translating to high number needed to treat
(mean: 70). Conclusion(s): The result of this systematic review
suggests that overpowered trials give statistically significant results
undermining clinical relevance. To avoid such misuse of current
statistical tools, there is a need to derive superiority margin. We hope
to generate debate on considering clinically significant difference, used
to calculate sample size, as superiority margin.

<68>
Accession Number
628191387
Title
Vascular outcomes in tavr v/s savr in end stage renal disease patients.
Source
Stroke. Conference: American Heart Association/American Stroke Association
2019 International Stroke Conference and State-of-the-Science Stroke
Nursing Symposium. United States. 50 (Supplement 1) (no pagination), 2019.
Date of Publication: February 2019.
Author
Vindhyal M.R.; Vindhyal S.; Ndunda P.; Khayyat S.; Fanari Z.
Institution
(Vindhyal, Vindhyal, Ndunda, Khayyat, Fanari) Internal Medicine,
KUSM-Wichita, Wichita, KS2Cardiology, KUSM-Wichita, Wichita, KS
Publisher
Lippincott Williams and Wilkins
Abstract
Background: End-stage renal disease patients undergoing dialysis have
higher stroke risk causing significant comorbidity and mortality in
patients undergoing cardiac surgery procedures. Transcatheter aortic valve
replacement(TAVR) has been approved by the Food and Drug Administration's
(FDA) as an alternative to surgical aortic valve replacement in patients
with intermediate and high-risk comorbidities. Several observational
studies have been published but very little data is available on outcomes
with both of these procedures in patients on dialysis. Method(s): We
performed a meta-analysis of the observational studies which have
transcatheter aortic valve replacement vascular outcomes in End-stage
renal disease patients on dialysis from three different databases.
Medline, Cochrane, and Web of Science were systematically searched for
relevant studies and were screened by two independent investigators.
Robins-I tool was used to analyze and assess the bias from the relevant
studies. Result(s): Five studies were included in the analysis (Three
of the studies were propensity-matched and the other two included cox
proportional hazard model) including 619 TAVR and 697 SAVR patients. The
overall risk of bias judgment for the propensity-matched studies was low
and for the two cox proportional hazard models were low to moderate in
bias due to confounding. TAVR patients on dialysis had similar major
stroke 2.1% vs 3.8% [0.58 (CI: 0.29, 1.14); P value = 0.93, I2 = 0%],
minor stroke rate of 2% vs 2% [1.0 (CI: 0.23, 4.43); P value = 0.37, I2 =
1%], major vascular complication rate of 4.2% vs 5.7% [0.73(CI: 0.38,
1.38); P value = 0.67, I2 = 0%], minor vascular complication rate of 8.4%
vs 9.9% [0.83(CI: 0.51, 1.35); P value =0.49, I2 = 0%], major bleeding
rate of 4.8% vs 6.5% [0.73(CI: 0.034, 1.60); P value = 0.58, I2 = 0%] and
pacemaker insertion rate of11.9% vs 6.5% [1.93(CI: 1.28, 2.90); P value =
0.43, I2 = 0%]. Conclusion(s): Although the available data from
observational studies show almost similar vascular outcomes in TAVR and
SAVR in dialysis patients. There is definitely a trend showing lower major
stroke rate, lower major and minor vascular complications but higher
pacemaker implantation rate in TAVR group when compared to the SAVR.

<69>
Accession Number
2002302132
Title
A cost-consequence analysis of parecoxib and opioids vs opioids alone for
postoperative pain: Chinese perspective.
Source
ClinicoEconomics and Outcomes Research. 11 (pp 169-177), 2019. Date of
Publication: 2019.
Author
Barra M.; Remak E.; Liu D.D.; Xie L.; Abraham L.; Sadosky A.B.
Institution
(Barra, Remak) Evidera, Budapest, Hungary
(Liu, Xie) Health Economics & Outcomes Research, Pfizer Investment Co.,
Ltd., Beijing, China
(Abraham) Health Economics & Outcomes Research, Pfizer Ltd, Tadworth,
United Kingdom
(Sadosky) Health Economics & Outcomes Research, Pfizer Inc, New York, NY,
United States
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Purpose: The use of parecoxib plus opioids for postoperative analgesia in
noncardiac surgical patients seems to be cost-saving in Europe due to a
reduction in opioid use and opioid-related adverse events. Given the lack
of information on postoperative analgesic use in Asia, this study assessed
the economic consequences of the addition of parecoxib to opioids vs
opioids alone to treat postsurgical pain in China. Method(s): A
cost-consequence economic evaluation assessed direct medical costs related
to opioid-related clinically meaningful events (CMEs) utilizing dosing
information and reported frequency of events from a Phase III, randomized,
double-blind, global clinical trial (PARA-0505-069) of parecoxib plus
opioids vs opioids alone for 3 days following major orthopedic, abdominal,
gynecologic, or noncardiac thoracic surgery requiring general or regional
anesthe-sia. The cost of CMEs was calculated using information on resource
utilization and unit costs provided by a panel of clinical experts in
China. Sensitivity analyses were performed to test the robustness of the
results. Result(s): Patients treated with parecoxib plus opioids
reported fewer CMEs (mean 0.62 vs 1.04 events per patient [P<0.0001])
compared with opioids alone for the 3-day postoperative period. This
suggested a potential savings of 356 Chinese yuan () per patient over the
3 days (total cost of 1,418 for parecoxib plus opioids vs 1,774 with
opioid use alone). Conclusion(s): Fewer CMEs with parecoxib plus
opioids suggest a reduction in medical resource utilization and reduced
costs compared to opioids alone when modeling analgesic use in non-cardiac
surgery patients in China. Copyright © 2019 Barra et al.

<70>
Accession Number
2002385596
Title
Surgical Treatment for Ischemic Heart Failure (STICH) trial: A review of
outcomes.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Hassanabad A.F.; MacQueen K.T.; Ali I.
Institution
(Hassanabad, MacQueen, Ali) Section of Cardiac Surgery, Department of
Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of
Medicine, University of Calgary, Calgary, Canada
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Coronary artery disease (CAD) is a significant source of morbidity and
mortality in developed countries. The landmark Surgical Treatment for
Ischemic Heart Failure (STICH) trial has provided greatly needed evidence
in the management of patients with severe left ventricle (LV) dysfunction
(LVEF <= 35%) and CAD amenable to revascularization. The trial
investigated two primary hypotheses: (i) that coronary artery bypass
grafting (CABG) with optimal medical therapy (OMT) was superior to OMT
alone, and (ii) that CABG with surgical ventricular reconstruction (SVR)
would be superior to CABG alone. The results of the 10-year follow-up
demonstrated significant long-term benefits with the addition of CABG to
OMT. However, the second hypothesis yielded controversial results as the
study found no difference between CABG with SVR and SVR alone. The STICH
trial, and the numerous subanalyses that followed have reinforced and
challenged a number of widely held beliefs regarding the management of
patients with severe LV dysfunction and ischemic heart failure. The
purpose of this comprehensive review is to outline the published data from
the STICH trial and its substudies while providing a balanced assessment
of the evidence-based conclusions and criticisms that have
followed. Copyright © 2019 Wiley Periodicals, Inc.

<71>
Accession Number
2002385539
Title
Rate of reoperation at 1 year for aortic repair vs replacement in aortic
regurgitation. A trial sequence analysis of published meta-analysis
results.
Source
Journal of Cardiac Surgery. (no pagination), 2019. Date of Publication:
2019.
Author
Kumar A.; Shariff M.
Institution
(Kumar, Shariff) Department of Critical Care Medicine, St John's Medical
College Hospital, Bangalore, India
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The pooled estimate of a recent meta-analysis concluded that rate of
reoperation at 1 year was significantly higher in Aortic valve repair
(8.82% vs 3.70%) as compared with aortic valve replacement in patients
with aortic regurgitation (odds ratio = 2.67, 95% confidence interval
[1.08, 3.62], P =.03). We performed a trial sequential analysis using the
published data of the meta-analysis and found the evidence is not strong
enough for the conclusion. Copyright © 2019 Wiley Periodicals,
Inc.

<72>
Accession Number
2002380213
Title
Defining the learning curve of robotic thoracic surgery: what does it
take?.
Source
Surgical Endoscopy. (no pagination), 2019. Date of Publication: 2019.
Author
Power A.D.; D'Souza D.M.; Moffatt-Bruce S.D.; Merritt R.E.; Kneuertz P.J.
Institution
(Power, D'Souza, Moffatt-Bruce, Merritt, Kneuertz) Division of Thoracic
Surgery, Department of Surgery, The Ohio State University Wexner Medical
Center, 410 West 10th Avenue; N846a Doan Hall, Columbus, OH 43210, United
States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Controversy exists as to what constitutes a learning curve to
achieve competency, and how the initial learning period of robotic
thoracic surgery should be approached. Method(s): We conducted a
systematic review of the literature published prior to December 2018 using
PubMed/MEDLINE for studies of surgeons adopting the robotic approach for
anatomic lung resection or thymectomy. Changes in operating room time and
outcomes based on number of cases performed, type of procedure, and
existing proficiency with video-assisted thoracoscopic surgery (VATS) were
examined. Result(s): Twelve observational studies were analyzed,
including nine studies on robotic lung resection and three studies on
thymectomy. All studies showed a reduction in operative time with an
increasing number of cases performed. A steep learning curve was described
for thymectomy, with a decrease in operating room time in the first 15
cases and a plateau after 15-20 cases. For anatomic lung resection, the
number of cases to achieve a plateau in operative time ranged between
15-20 cases and 40-60 cases. All but two studies had at least some VATS
experience. Six studies reported on experience of over one hundred cases
and showed continued gradual improvements in operating room time.
 Conclusion(s): The learning curve for robotic thoracic surgery
appears to be rapid with most studies indicating the steepest improvement
in operating time occurring in the initial 15-20 cases for thymectomy and
20-40 cases for anatomic lung resection. Existing data can guide a
standardized robotic curriculum for rapid adaptation, and aid
credentialing and quality monitoring for robotic thoracic surgery
programs. Copyright © 2019, Springer Science+Business Media, LLC,
part of Springer Nature.

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