EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
628450745
Title
Randomised controlled trial to investigate the effectiveness of thoracic
epidural and paravertebral blockade in reducing chronic post-thoracotomy
pain (TOPIC): A pilot study to assess feasibility of a large multicentre
trial.
Source
BMJ Open. 9 (7) (no pagination), 2019. Article Number: e023679. Date of
Publication: 01 Jul 2019.
Author
Yeung J.; Middleton L.; Tryposkiadis K.; Kerr A.; Daniels J.; Naidu B.;
Melody T.; Goebel A.; Wilson M.; Kumar S.; Szentgyorgyi L.; Flanagan S.;
Shah R.; Worrall A.; Gao F.
Institution
(Yeung) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
(Yeung, Melody, Kumar, Worrall, Gao) Academic Department of Anaesthesia,
Critical Care, Pain and Resuscitation, Birmingham Heartlands Hospital,
University Hospital Birmingham NHS Foundation Trust, Birmingham, United
Kingdom
(Middleton) School of Health and Population Sciences, University of
Birmingham, Birmingham, United Kingdom
(Tryposkiadis) Birmingham Clinical Trials Unit, University of Birmingham,
Birmingham, United Kingdom
(Kerr, Naidu) Department of Thoracic Surgery, Birmingham Heartlands
Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham,
United Kingdom
(Daniels) Nottingham Clinical Trials Unit, University of Nottingham,
Nottingham, United Kingdom
(Naidu, Gao) Institute of Inflammation and Ageing, College of Medical and
Dental Sciences, University of Birmingham, Birmingham, United Kingdom
(Goebel) University of Liverpool, Institute of Translational Medicine,
Liverpool, United Kingdom
(Wilson) Health Services Research, University of Sheffield, Sheffield,
United Kingdom
(Szentgyorgyi) Department of Anaesthesia, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
(Flanagan) Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
(Shah) Department of Thoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester, United Kingdom
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Thoracotomy is considered one of the most painful surgical
procedures. The incidence of chronic post-thoracotomy pain (CPTP) is up to
50%. Paravertebral blockade (PVB) may be superior to thoracic epidural
blockade (TEB) in preventing CPTP. The specific objective of this pilot
study was to assess the feasibility of conducting a larger trial to
determine whether PVB at thoracotomy is more effective in reducing CPTP
compared with TEB. <br/>Design(s): A randomised, parallel, external pilot
study was conducted to assess whether a large randomised trial of TEB and
PVB with CPTP as the primary outcome is feasible. <br/>Setting(s): Two
adult thoracic centres in the UK. <br/>Participant(s): All adult patients
admitted for elective open thoracotomy. <br/>Participant(s): were excluded
if they were American Society of Anesthesiologists physical status IV or
V; or if there is contraindication to local anaesthetics; infection near
the proposed puncture site; coagulation/thoracic spine disorders; required
chest wall resection or emergency thoracic surgery or had a previous
thoracotomy. <br/>Result(s): All patients presenting for thoracotomy were
screened over a 12-month period with 194 found to be eligible. Of these,
69 (36%) were randomised (95% CI 29% to 42%). Discounting five
participants who died, 54 of 64 participants (84%) returned questionnaire
booklets at 6 months. The number of participants indicating at least a
moderate level of chest pain at 6 months was lower with PVB but with high
levels of uncertainty (RR: 0.7; 95% CI 0.3 to 1.7 for worst pain; RR: 0.3;
95% CI 0.0 to 2.8 for average pain). There were no safety concerns.
<br/>Conclusion(s): A large, multicentre randomised controlled trial of
PVB versus TEB is feasible as it is possible to randomise and follow up
participants with high fidelity. Pain scores were lower on average with
PVB compared with TEB but a much larger trial is required to confirm this
reliably.<br/>Copyright &#xa9; 2019 Author(s).

<2>
Accession Number
626602653
Title
Impact of renin-angiotensin system inhibitors continuation versus
discontinuation on outcome after major surgery: Protocol of a multicenter
randomized, controlled trial (STOP-or-NOT trial).
Source
Trials. 20 (1) (no pagination), 2019. Article Number: 160. Date of
Publication: 05 Mar 2019.
Author
Legrand M.; Futier E.; Leone M.; Deniau B.; Mebazaa A.; Plaud B.; Coriat
P.; Rossignol P.; Vicaut E.; Gayat E.
Institution
(Legrand, Deniau, Mebazaa, Plaud, Gayat) AP-HP, GH St-Louis-Lariboisiere,
Department of Anesthesiology and Critical Care and Burn Unit, St-Louis
Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
(Legrand, Deniau, Mebazaa, Plaud, Gayat) University Paris Diderot, Paris,
France
(Legrand, Deniau, Mebazaa, Plaud, Gayat) UMR INSERM 942, Institut National
de la Sante et de la Recherche Medicale (INSERM), Lariboisiere Hospital,
Paris, France
(Legrand, Mebazaa, Rossignol, Gayat) F-CRIN INI-CRCT Network, Nancy,
France
(Futier) Departement de Medecine Perioperatoire, Anesthesie Reanimation
Hopital Estaing, CHU Clermont-Ferrand and Universite Clermont Auvergne,
CNRS, Inserm, Clermont-Ferrand, France
(Leone) Service d'Anesthesie et de Reanimation, Hopital Nord, Aix
Marseille Universite, APHM, Marseille, France
(Coriat) Departement d'Anesthesie-Reanimation, La Pite-Salpetriere,
Universite Paris Descartes, Paris, France
(Rossignol) Inserm, Centre d'Investigations Cliniques-Plurithematique
14-33, Inserm U1116, CHRU Nancy, Universite de Lorraine, Nancy, France
(Vicaut) Unite de Recherche Clinique, GH St-Louis-Lariboisere-Fernand
Widal, Universite Paris Diderot, Paris, France
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Chronic treatment of hypertension or heart failure very often
includes an angiotensin-converting enzyme inhibitors (ACE-Is) or
angiotensin receptor blockers (ARBs) as renin-angiotensin system
inhibitors (RASi) treatments. To stop or not to stop these medications
before major surgery remains an unresolved issue. The lack of evidence
leads to conflicting guidelines with respect to RASi management before
major surgery. The purpose of this study is to evaluate the impact of a
strategy of RASi continuation or discontinuation on perioperative
complications in patients undergoing major non-cardiac surgery.
<br/>Method(s): This is a multicenter, open-labeled randomized controlled
trial in > 30 French centers. In the experimental group, RASi will be
continued while the treatment will be stopped 48 h before the surgery in
the control arm. The primary endpoint is a composite endpoint of major
complications after surgery. An endpoint adjudication committee will
review clinical data and adjudicate efficacy endpoints while blinded to
the assigned study drug group. Main analysis will be by intention-to-treat
comparing the composite outcome measure at 28 days in the two groups. A
total of 2222 patients are planned to detect an absolute complications
difference of 5%. <br/>Discussion(s): The results of the trial should
provide robust evidence to anesthesiologists and surgeons regarding
management of RASi before major non-cardiac surgery. Trial registration:
ClinicalTrials.gov, NCT03374449. Registered on 11 December
2017.<br/>Copyright &#xa9; 2019 The Author(s).

<3>
Accession Number
626416220
Title
Why does a point of care guided transfusion algorithm not improve blood
loss and transfusion practice in patients undergoing high-risk cardiac
surgery? A prospective randomized controlled pilot study.
Source
BMC Anesthesiology. 19 (1) (no pagination), 2019. Article Number: 24. Date
of Publication: 18 Feb 2019.
Author
Lehmann F.; Rau J.; Malcolm B.; Sander M.; Von Heymann C.; Moormann T.;
Geyer T.; Balzer F.; Wernecke K.D.; Kaufner L.
Institution
(Lehmann, Geyer, Balzer, Kaufner) Department of Anaesthesiology and
Intensive Care Medicine, Charite-Universitatsmedizin Berlin, Campus
Virchow-Klinikum and Campus Charite Mitte, Berlin, Germany
(Rau) Division of Medical Biotechnology, Paul-Ehrlich-Institut, Federal
Institute for Vaccines and Biomedicines, Langen Hessen, Germany
(Malcolm) Department of Internal Medicine, Hegau-Bodensee-Klinikum, Singen
Baden-Wurttemberg, Germany
(Sander) Department of Anaesthesiology Intensive Care Medicine and Pain
Therapy, University Hospital Giesen UKGM, Justus-Liebig-University
Giessen, Giessen Hessen, Germany
(Von Heymann) Department of Anaesthesia Intensive Care Medicine Emergency
Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin,
Germany
(Moormann) Department of Anaesthesiology and Intensive Care Medicine,
Martin-Luther-Krankenhaus, Berlin, Germany
(Wernecke) CRO SOSTANA GmbH and Charite, Universitatsmedizin Berlin,
Berlin, Germany
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Adult cardiac surgery is often complicated by elevated blood
losses that account for elevated transfusion requirements. Perioperative
bleeding and transfusion of blood products are major risk factors for
morbidity and mortality. Timely diagnostic and goal-directed therapies aim
at the reduction of bleeding and need for allogeneic transfusions.
<br/>Method(s): Single-centre, prospective, randomized trial assessing
blood loss and transfusion requirements of 26 adult patients undergoing
elective cardiac surgery at high risk for perioperative bleeding. Primary
endpoint was blood loss at 24 h postoperatively. Random assignment to
intra-and postoperative haemostatic management following either an
algorithm based on conventional coagulation assays (conventional group:
platelet count, aPTT, PT, fibrinogen) or based on point-of-care
(PoC-group) monitoring, i.e. activated rotational thromboelastometry
(ROTEM) combined with multiple aggregometry (Multiplate). Differences
between groups were analysed using nonparametric tests for independent
samples. <br/>Result(s): The study was terminated after interim analysis
(n = 26). Chest tube drainage volume was 360 ml (IQR 229-599 ml) in the
conventional group, and 380 ml (IQR 310-590 ml) in the PoC-group (p =
0.767) after 24 h. Basic patient characteristics, results of PoC
coagulation assays, and transfusion requirements of red blood cells and
fresh frozen plasma did not differ between groups. Coagulation results
were comparable. Platelets were transfused in the PoC group only.
<br/>Conclusion(s): Blood loss via chest tube drainage and transfusion
amounts were not different comparing PoC-and central lab-driven
transfusion algorithms in subjects that underwent high-risk cardiac
surgery. Routine PoC coagulation diagnostics do not seem to be beneficial
when actual blood loss is low. High risk procedures might not suffice as a
sole risk factor for increased blood loss. Trial registration:
NCT01402739, Date of registration July 26, 2011.<br/>Copyright &#xa9; 2019
The Author(s).

<4>
Accession Number
615771861
Title
Transcatheter vs. surgical aortic valve replacement and medical treatment:
Systematic review and meta-analysis of randomized and non-randomized
trials.
Source
Herz. 43 (4) (pp 325-337), 2018. Date of Publication: 01 Jun 2018.
Author
Ak A.; Porokhovnikov I.; Kuethe F.; Schulze P.C.; Noutsias M.; Schlattmann
P.
Institution
(Ak, Porokhovnikov, Schlattmann) Institute of Medical Statistics,
Informatics and Documentation (IMSID), Friedrich-Schiller University and
University Hospital Jena, Bachstrase 18, Jena 07743, Germany
(Kuethe, Schulze, Noutsias) Department of Internal Medicine I, Division of
Cardiology, Pneumology, Angiology and Intensive Medical Care, University
Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
the procedure of choice for patients with severe aortic stenosis (AS) and
high perioperative risk. We performed a meta-analysis to compare the
mortality related to TAVR with medical therapy (MT) and surgical aortic
valve replacement (SAVR). <br/>Method(s): A systematic literature search
was conducted by two independent investigators from the database inception
to 30 December 2014. Relative risk (RR) and odds ratio (OR) were
calculated and graphically displayed in forest plots. We used
I² for heterogeneity (meta-regression) and Egger's regression
test of asymmetry (funnel plots). <br/>Result(s): We included 24 studies
(n = 19 observational studies; n = 5 randomized controlled trials), with a
total of 7356 patients in this meta-analysis. Mean age had a substantial
negative impact on the long-term survival of AS patients (OR = 1.544; 95%
CI: 1.25-1.90). Compared with MT, TAVR showed a statistically significant
benefit for all-cause mortality at 12 months (OR = 0.68; 95% CI:
0.49-0.95). Both TAVR and SAVR were associated with better outcomes
compared with MT. TAVR showed lower all-cause mortality over SAVR at 12
months (OR = 0.81; 95% CI: 0.68-0.97). The comparison between SAVR and
TAVR at 2 years revealed no significant difference (OR = 1.09; 95% CI:
1.01-1.17). <br/>Conclusion(s): In AS, both TAVR and SAVR provide a
superior prognosis to MT and, therefore, MT is not the preferred treatment
option for AS. Furthermore, our data show that TAVR is associated with
lower mortality at 12 months compared with SAVR. Further studies are
warranted to compare the long-term outcome of TAVR versus SAVR beyond a
2-year follow-up period.<br/>Copyright &#xa9; 2017, Springer Medizin
Verlag GmbH.

<5>
Accession Number
628769945
Title
Effects of ischaemic conditioning on tissue oxygen saturation and heart
rate variability: an observational study.
Source
Journal of International Medical Research. 47 (7) (pp 3025-3039), 2019.
Date of Publication: 01 Jul 2019.
Author
Cho Y.J.; Lee H.-C.; Choi E.-K.; Park S.; Yu J.H.; Nam K.; Kim T.K.; Jeon
Y.
Institution
(Cho, Lee, Park, Yu, Nam, Jeon) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, Seoul, South Korea
(Choi) Department of Internal Medicine, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
(Kim) Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae
Medical Center, Seoul, South Korea
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Ischaemic conditioning (IC) has organ-protective effects, but
its clinical results have been inconsistent. Tissue oxygen saturation
(StO<inf>2</inf>) and heart rate variability (HRV) reflect peripheral
microcirculation and autonomic nervous system activity, but their changes
during IC have not been well documented. We assessed StO<inf>2</inf> and
HRV during IC in patients undergoing cardiac surgery and healthy
volunteers. <br/>Method(s): Ten patients undergoing cardiac surgery and 10
healthy male volunteers underwent remote IC (four 5-minute cycles of
ischaemia/reperfusion) applied to the upper arm. Changes in
StO<inf>2</inf> at the thenar eminence and HRV according to the R-R
intervals were recorded during IC. <br/>Result(s): The lowest
StO<inf>2</inf> during ischaemia significantly decreased in patients and
significantly increased in volunteers. Among the HRV parameters, the
low-frequency domain, which corresponds to sympathetic activity,
significantly increased after IC in volunteers but not in patients. Other
variables were similar between the groups. <br/>Conclusion(s): These
results suggest that the minimum tissue oxygen content is depleted during
ischaemia in patients and preserved in healthy volunteers. Sympathetic
nervous activity seems to increase after IC in healthy volunteers but
remains unaffected in patients. Thus, IC may act differently between
patients undergoing cardiac surgery and healthy subjects.<br/>Copyright
&#xa9; The Author(s) 2019.

<6>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2019,
Derman Medical Publishing. All rights reserved.

<7>
Accession Number
628779598
Title
A systematic review of standardized methods for assessment of endograft
sealing on computed tomography angiography post-endovascular aortic
repair, and its influence on endograft-associated complications.
Source
Expert Review of Medical Devices. 16 (8) (pp 683-695), 2019. Date of
Publication: 03 Aug 2019.
Author
Schuurmann R.C.L.; De Rooy P.M.; Bastos Goncalves F.; Vos C.G.; De Vries
J.-P.P.M.
Institution
(Schuurmann, De Rooy, De Vries) Department of Surgery, Division of
Vascular Surgery, University Medical Centre Groningen, Groningen,
Netherlands
(Bastos Goncalves) Department of Vascular Surgery, Hospital de Santa
Marta, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal
(Vos) Department of Vascular Surgery, Martini Hospital Groningen,
Groningen, Netherlands
Publisher
Taylor and Francis Ltd
Abstract
Introduction: Although there is much attention for proper sizing of
pre-operative anatomy before (thoracic) endovascular aneurysm repair
([T]EVAR), standardized assessment of endograft position and apposition at
postoperative imaging is seldom addressed in the international guidelines.
The highly detailed three-dimensional computed tomography angiography
(CTA) volumes contain valuable information about the apposition of the
endograft with the arterial wall and the position of the device relative
to anatomical landmarks in the proximal and distal landing zones, which is
currently hardly used. With proper assessment on CTA of the endograft
after EVAR, the risk for future endograft-related complications may be
determined, allowing patient-tailored, risk-stratified surveillance. Areas
covered: This systematic review identified three standardized methods for
assessing apposition or position of the endograft in the proximal or
distal landing zone on CTA after (T)EVAR. Quantification of apposition and
position, validation of measurement precision, and association with
endograft-related complications were extracted. Short (<10 mm apposition
length) and decreasing (>0 mm) apposition were associated with
endograft-associated complications. Expert commentary: Standardized
assessment of apposition and position of the endograft in the proximal and
distal landing zones on CTA should be incorporated in post-(T)EVAR
surveillance. A risk-stratified CTA surveillance protocol is
proposed.<br/>Copyright &#xa9; 2019, &#xa9; 2019 The Author(s). Published
by Informa UK Limited, trading as Taylor & Francis Group.

<8>
Accession Number
2002342222
Title
Respect or resect or resect with respect.
Source
Revista Argentina de Cardiologia. 87 (3) (pp 179-180), 2019. Date of
Publication: 2019.
Author
Falk V.
Institution
(Falk) Direktor der Klinik fur Herz-Thorax-Gefasschirurgie, Deutsches
Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany
Publisher
Sociedad Argentina de Cardiologia (E-mail: info@sac.org.ar)

<9>
Accession Number
621610469
Title
A Contemporary meta-Analysis of antegrade versus retrograde cerebral
perfusion for thoracic aortic surgery.
Source
Thoracic and Cardiovascular Surgeon. 67 (5) (pp 351-362), 2019. Date of
Publication: 06 Apr 2019.
Author
Takagi H.; Mitta S.; Ando T.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Objective To determine which of antegrade and retrograde cerebral
perfusion (ACP and RCP) surpasses for a reduction in postoperative
incidence of neurological dysfunction and all-cause death in thoracic
aortic surgery, we performed a meta-Analysis of contemporary comparative
studies. Methods MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials were searched from January 2010 to June 2017. For each
study, data regarding the endpoints in both the ACP and RCP groups were
used to generate odds ratios (ORs) and 95% confidence intervals (CIs).
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic ORs in the fixed-effect model. Results We
identified and included 19 eligible studies with a total of 15,365
patients undergoing thoracic aortic surgery by means of ACP (a total of
7,675 patients) or RCP (a total of 7,690 patients). Pooled analysis
demonstrated no statistically significant differences in postoperative
incidence of stoke (17 studies enrolling a total of 9,421 patients; OR,
0.92; 95% CI, 0.79-1.08; p = 0.32) and mortality (16 studies including a
total of 14,452 patients; OR, 1.07; 95% CI, 0.90-1.26; p = 0.46) between
ACP and RCP, whereas a trend toward a significant reduction in incidence
of temporary neurological dysfunction (TND) for ACP (12 studies enrolling
a total of 7922 patients; OR, 0.85; 95% CI, 0.69-1.04; p = 0.12) was
found. Conclusion In thoracic aortic surgery, postoperative incidence of
stroke and mortality was similar between ACP and RCP, whereas a trend
toward a reduction of TND incidence existed in ACP.<br/>Copyright &#xa9;
2019 Georg Thieme Verlag KG.

<10>
Accession Number
2002349038
Title
Efficacy and safety of robot-assisted thoracic surgery (RATS) compare with
video-assisted thoracoscopic surgery (VATS) for lung lobectomy in patients
with non-small cell lung cancer.
Source
Combinatorial Chemistry and High Throughput Screening. 22 (3) (pp
169-178), 2019. Date of Publication: 2019.
Author
Hu X.; Wang M.
Institution
(Hu) Department of Thoracic Surgery, The Second Hospital of Jiaxing,
Jiaxing, Zhejiang 314000, China
(Wang) Department of Thoracic Surgery, Shulan (Hangzhou) Hospital,
Hangzhou, Zhejiang, China
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: In the past decade, many researchers focused on
Robotic-Assisted Thoracoscopic Surgery (RATS), which has been introduced
as an alternative minimally invasive approach, versus VideoAssisted
Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small
cell lung cancer. However, the advantage of RVATS compared to VATS is
still under investigation. The results are unclear. <br/>Aim(s): The aim
of this study is to compare the efficacy and safety of Robot-assisted
Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery
(VATS) for lobectomy in patients with NonSmall Cell Lung Cancer (NSCLC).
<br/>Method(s): A systematic electronic search of online electronic
databases: Pubmed, Embase, Cochrane library updated in June 2017. The
meta-analysis was performed including the studies are designed as
randomized or non-randomized controlled. <br/>Result(s): Twenty
retrospective cohort studies met our inclusion criteria. The pooled
analysis of mortality showed that RATS lobectomy significantly reduced the
mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 -
0.76; P = 0.0005). With the pooled result of duration of surgery indicated
that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI
0.23- 0.81; P < 0.0004=). However, the meta-analysis on the median length
of hospital stay (MD =0.00, 95% CI-0.03 - 0.03; P = 0.91), number of
dissected lymph nodes station (SMD =0.39, 95% CI-0.60 - 1.38; P = 0.44),
the number of removed lymph nodes (SMD =0.98, 95% CI-0.61 - 2.56; P =
0.23), mean duration of drainage (SMD =0.29, 95% CI-0.15 - 0.73; P =
0.20), prolonged air leak (RR =1.01, 95% CI 0.84 - 1.21; P = 0.93),
arrhythmia (RR =1.06, 95% CI 0.88 - 1.26; P = 0.54) (P= 0.54), pneumonia
(RR =0.89, 95% CI 0.69 - 1.13; P = 0.33), the incidence of conversion (RR
=0.82, 95% CI 0.54 - 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90
- 1.23; P = 0.055) all showed no significant differences between RATS and
VATS lobectomy. <br/>Conclusion(s): RATS result in better mortality as
compared with VATS. However, robotics seems to have longer operative time
and higher hospital costs, without superior advantages in morbidity rates
and oncologic efficiency. Since the advantages of RATS has been performed
in some area, the continuation of a comparative investigation with VATS
may be necessary. And some efforts need to be taken into consideration to
reduce the operative time and cost.<br/>Copyright &#xa9; 2019 Bentham
Science Publishers.

<11>
Accession Number
628735130
Title
Fentanyl-based intravenous patient-controlled analgesia with low dose of
ketamine is not inferior to thoracic epidural analgesia for acute
post-thoracotomy pain following video-assisted thoracic surgery: A
randomized controlled study.
Source
Medicine. 98 (28) (pp e16403), 2019. Date of Publication: 01 Jul 2019.
Author
Tseng W.-C.; Lin W.-L.; Lai H.-C.; Huang T.-W.; Chen P.-H.; Wu Z.-F.
Institution
(Tseng, Lin, Lai, Chen, Wu) Department of Anesthesiology, Netherlands
(Huang) Division of Chest Surgery, Department of Surgery, Tri-Service
General Hospital and National Defense Medical Center
(Chen) Graduate Institute of Public Health, National Defense Medical
Center, Taiwan (Republic of China)
(Wu) Department of Anesthesiology, Chi Mei Medical Center, R.O.C, Tainan,
Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Thoracic epidural analgesia is the preferred method for
postoperative analgesia following thoracic surgery. However, intravenous
patient-controlled analgesia (IVPCA) may be an effective alternative. This
study was conducted because few scientific reports exist comparing
fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with
thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment
of postoperative pain after video-assisted thoracic surgery (VATS).
<br/>METHOD(S): This prospective, and randomized study included 70
patients randomized into fk-IVPCA and t-PCEA groups. Pain at rest and
during movement, successful and unsuccessful triggers after pressing the
PCA device button, the need for rescue analgesia, drug-related adverse
events, and patient satisfaction were recorded for 48 hours
postoperatively. <br/>RESULT(S): No significant differences in the
intensity of pain at rest or during movement were observed between the 2
groups within 48 hours postoperatively. The number of unsuccessful PCA
triggers in the t-PCEA group 0 to 4 hours after surgery was significantly
higher than that in the fk-IVPCA group. However, the numbers of successful
PCA triggers in the fk-IVPCA group at 4 to 12 and 0 to 24 hours after
surgery were significantly higher than those in the t-PCEA group. The
incidence of analgesic-related side effects and patient satisfaction were
similar in both groups. <br/>CONCLUSION(S): Compared with t-PCEA, the
addition of a subanesthetic dose of ketamine to fentanyl-based IVPCA
resulted in similar pain control after VATS with no increase in the
incidence of drug-related adverse effects. The results confirm that both
multimodal intravenous analgesia and epidural analgesia can provide
sufficient pain control and are safe strategies for treating acute
post-thoracotomy pain.

<12>
Accession Number
628142517
Title
Women's Health Initiative clinical trials: potential interactive effect of
calcium and vitamin D supplementation with hormonal therapy on
cardiovascular disease.
Source
Menopause (New York, N.Y.). 26 (8) (pp 841-849), 2019. Date of
Publication: 01 Aug 2019.
Author
Jiang X.; Nudy M.; Aragaki A.K.; Robbins J.A.; Manson J.E.; Stefanick
M.L.; O'Sullivan D.M.; Shikany J.M.; LeBlanc E.S.; Kelsey A.M.; Cauley J.;
Martin L.W.; Payne M.E.; Johnson K.C.; Howard B.; Schnatz P.F.
Institution
(Jiang, O'Sullivan, Schnatz) Department of ObGyn, Reading Hospital,
Reading, PA, United States
(Jiang, Schnatz) Department of ObGyn, Sidney Kimmel Medical College at
Thomas Jefferson University, Philadelphia, PA, United States
(Nudy) Department of Internal Medicine, Penn State Hershey Medical Center,
Hershey, PA, United States
(Aragaki) Division of Public Health Sciences, Fred Hutchinson Cancer
Research Center, Seattle, WA, United States
(Robbins) UC Davis Medical Center, Sacramento, CA, United States
(Manson) Division of Preventive Medicine, Brigham and Women's
Hospital/Harvard Medical School, Boston, MA, United States
(Stefanick) Department of Medicine, Stanford Prevention Research Center,
Stanford University School of Medicine, Stanford University, Stanford, CA,
United States
(Shikany) Division of Preventive Medicine, School of Medicine, University
of Alabama at Birmingham, Birmingham, AL, United States
(LeBlanc) Kaiser Permanente Center for Health Research NW, Portland, OR,
United States
(Kelsey) Division of Cardiology, Saint Francis Hospital and Medical
Center, Hartford, CT, United States
(Cauley) Department of Epidemiology, Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, PA, United States
(Martin) Division of Cardiology, Department of Internal Medicine, George
Washington University School of Medicine and Health Sciences, WA, United
States
(Payne) Office of Research Development, Duke University School of
Medicine, Durham, NC, United States
(Johnson) Department of Preventive Medicine, University of Tennessee
Health Science Center, Memphis, TN, United States
(Howard) MedStar Health Research Institute and Georgetown/Howard
Universities Center for Clinical and Translational Science, WA, United
States
(Schnatz) Department of Internal Medicine, Reading Hospital, Reading, PA,
United States
(Schnatz) Department of Internal Medicine, Sidney Kimmel Medical College
at Thomas Jefferson University, Philadelphia, PA, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Data in humans and nonhuman primates have suggested a possible
synergistic effect of vitamin D and calcium (CaD) and estrogen on the
cardiovascular disease (CVD) risk factors. Using randomized trial data we
explored whether the effect of menopausal hormone therapy (HT) on CVD
events is modified by CaD supplementation. <br/>METHOD(S): A prospective,
randomized, double-blind, placebo-controlled trial was implemented among
postmenopausal women in the Women's Health Initiative. A total of 27,347
women were randomized to the HT trials (0.625 mg/d of conjugated equine
estrogens [CEE] alone for women without a uterus vs placebo; or 0.625 mg
of CEE in addition to 2.5 mg of medroxyprogesterone acetate daily [CEE +
MPA] for women with a uterus vs placebo). After 1 year, 16,089 women in
the HT trial were randomized to the CaD trial and received either 1,000 mg
of elemental calcium carbonate and 400 IU of vitamin D3 daily or placebo.
The mean (SD) duration of follow-up after CaD randomization was 6.2 (1.3)
years for the CEE trial and 4.6 (1.1) years for the CEE + MPA trial. CVD
and venous thromboembolism events evaluated in this subgroup analysis
included coronary heart disease, stroke, pulmonary embolism, all-cause
mortality, plus select secondary endpoints (total myocardial infarction,
coronary revascularization, deep venous thrombosis, cardiovascular death,
and all CVD events). Time-to-event methods were used and models were fit
with a Cox proportional hazards regression model. <br/>RESULT(S): In the
CEE trial, CaD significantly modified the effect of CEE on stroke (P
interaction = 0.04). In the CaD-placebo group, CEE's effect on stroke was
harmful (hazard ratio [95% confidence interval] = 2.19[1.34-3.58]);
however, it was neutral in the CaD-supplement group (hazard ratio [95%
confidence interval] = 1.07[0.66-1.73]). We did not observe significant
CEE-CaD interactions for coronary heart disease, total CVD events, or any
of the remaining endpoints. In the CEE + MPA trial, there was no evidence
that the effect of CEE + MPA on any of CVD endpoints was modified by CaD
supplementation. <br/>CONCLUSION(S): CaD did not consistently modify the
effect of CEE therapy or CEE + MPA therapy on CVD events. However, the
increased risk of stroke due to CEE therapy appears to be mitigated by CaD
supplementation. In contrast, CaD supplementation did not influence the
risk of stroke due to CEE + MPA.

<13>
Accession Number
628948346
Title
A post cardiac surgery intervention to manage delirium involving families:
a randomized pilot study.
Source
Nursing in critical care. 22 (4) (pp 221-228), 2017. Date of Publication:
01 Jul 2017.
Author
Mailhot T.; Cossette S.; Cote J.; Bourbonnais A.; Cote M.-C.; Lamarche Y.;
Denault A.
Institution
(Mailhot) Montreal Heart Institute Research Center S-2490, University of
Montreal, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada
(Cossette) University of Montreal, Montreal Heart Institute Research
Center S-2510, 5000 Belanger Street, Montreal (Quebec) H1T 1C8, Canada
(Cote) Centre de Recherche du Centre Hospitalier de l'Universite de
Montreal, University of Montreal, Downtown Branch, PO Box 6128, Montreal
(Quebec) H3C 3J7, Canada
(Bourbonnais) University of Montreal, Chair of the Desjardins Research,
Chair in Nursing Care for Older People and their Families, Centre de
recherche de l'Institut universitaire de geriatrie de Montreal, Downtown
Branch, PO Box 6128, Montreal (Quebec) H3C 3J7, Canada
(Cote) Department of Psychosomatics, Montreal Heart Institute, 5000
Belanger Street, Montreal (Quebec) H1T 1C8, Canada
(Lamarche) Department of Cardiac Surgery, Montreal Heart Institute, 5000
Belanger Street, Montreal (Quebec) H1T 1C8, Canada
(Denault) Department of Anesthesiology, Montreal Heart Institute, 5000
Belanger Street, Montreal (Quebec) H1T 1C8, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: As many delirium manifestations (e.g., hallucinations or
fears) are linked to patients' experiences and personality traits, it is
suggested that interventions should be tailored to optimize its
management. The inclusion of family members, as part of an intervention,
has recently emerged as a solution to developing individualised patient
care, but has never been assessed in post-cardiac surgery intensive care
unit where almost half of patients will present with delirium. AIMS: To
assess the feasibility, acceptability and preliminary efficacy of an
nursing intervention involving family caregivers (FC) in delirium
management following cardiac surgery. DESIGN: A randomized pilot study.
<br/>METHOD(S): A total of 30 patient/FC dyads were recruited and
randomized to usual care (n=14) or intervention (n=16). The intervention
was based on the Human Caring Theory, a mentoring model, and sources
informing self-efficacy. It comprised seven planned encounters spread over
3 days between an intervention nurse and the FC, each including a 30-min
visit at the patient's bedside. During this bedside visit, the FC used
delirium management strategies, e.g. reorient the person with delirium.
The primary indicator of acceptability was to obtain consent from 75% of
approached FCs. The preliminary effect of the intervention on patient
outcomes was assessed on (1) delirium severity using the Delirium Index,
(2) occurrence of complications, such as falls, (3) length of
postoperative hospital stay and (4) psycho-functional recovery using the
Sickness Impact Profile. The preliminary effect on FC outcomes was
assessed on FC anxiety and self-efficacy. Data were analysed using
descriptive statistics, ANCOVAs and logistic regressions. <br/>RESULT(S):
The primary indicator of obtaining consent from FC was achieved (77%). Of
the 14 dyads, thirteen (93%) dyads received all seven encounters planned
in the experimental intervention. Intervention group patients presented
better psycho-functional recovery scores when compared with control group
patients (p=0.01). Mean delirium severity scores showed similar
trajectories on days 1, 2 and 3 in both groups. <br/>CONCLUSION(S): The
mentoring intervention was acceptable and feasible and shows promising
results in improving patients and FC outcomes. RELEVANCE TO CLINICAL
PRACTICE: Nurses should involve, if willing, FC to participate in
activities that optimise patient well-being FC to use recognized delirium
management strategies like reorientation and reassurance.<br/>Copyright
&#xa9; 2017 British Association of Critical Care Nurses.

<14>
Accession Number
2002467574
Title
Comparison of the effect of 80 vs 40 mg atorvastatin in patients with
isolated coronary artery bypass graft surgery: A randomized clinical
trial.
Source
Journal of Cardiac Surgery. 34 (8) (pp 670-675), 2019. Date of
Publication: 2019.
Author
Shekari A.; Forouzannia S.K.; Davarpasand T.; Talasaz A.H.; Jalali A.;
Gorabi A.M.; Lotfi-Tokaldany M.; Bagheri J.
Institution
(Shekari, Forouzannia, Davarpasand, Talasaz, Jalali, Gorabi,
Lotfi-Tokaldany, Bagheri) Department of Cardiovascular Research, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Atorvastatin can decrease cardiac injury after coronary artery
bypass graft (CABG) surgery. We compared the effects of 80 and 40 mg of
atorvastatin per day on the levels of cardiac troponin T (cTnT) and
creatine kinase-MB (CK-MB) after an isolated CABG. <br/>Method(s): This
randomized single-blind parallel clinical trial enrolled 125 patients
(mean age = 60.59 +/- 8.37 years) who were candidates for elective
isolated CABG at the Tehran Heart Center between May 2017 and December
2017. Patients were randomly allocated into two groups to receive either
80 mg (n = 62) or 40 mg of atorvastatin (n = 63) per day, 5 days before
surgery. The levels of cTnT and CK-MB, used as myocardial injury markers,
were measured at baseline and then at 8 and 24 hours after CABG.
<br/>Result(s): The levels of CK-MB and cTnT at baseline and at 8 and 24
hours following CABG were not significantly different between the two
groups. Our repeated measures analysis of variance showed that the levels
of CK-MB and cTnT increased significantly over time (P <.001). No
significant interaction was observed between time and the atorvastatin
dosage on the levels of either CK-MB (P =.159) or cTnT (P =.646). In
addition, the between-group effects were not significant for CK-MB (P
=.632) and cTnT (P =.126). <br/>Conclusion(s): The higher dose of
atorvastatin (80 mg) did not exert a more protective effect than the
standard dose of atorvastatin (40 mg) after CABG surgery.<br/>Copyright
&#xa9; 2019 Wiley Periodicals, Inc.

<15>
Accession Number
2002384577
Title
Comparison of effects of propofol versus sevoflurane for patients
undergoing cardiopulmonary bypass cardiac surgery.
Source
Pakistan Journal of Medical Sciences. 35 (4) (pp 1072-1075), 2019. Date of
Publication: July-August 2019.
Author
Tang S.; Huang W.; Zhang K.; Chen W.; Xie T.
Institution
(Tang) Department of Anesthesiology, Renmin Hospital of Wuhan University,
Wuhan, Hubei Province 430060, China
(Huang) Department of Neurology, Taihe Hospital Hubei University of
Medicine, Shiyan, Hubei 442000, China
(Zhang, Xie) Department of Anesthesiology, Jingzhou Central Hospital,
Second Clinical Medical College, Yangtze University, Jingzhou, Hubei
434020, China
(Chen) Department of Anesthesiology, The first people's hospital of
Jingzhou, The first Clinical Medical College, Yangtze University,
Jingzhou, Hubei 434020, China
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: To compare the effects of propofol versus sevoflurane on the
outcomes of patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). <br/>Method(s): A total of 110 patients undergoing cardiac
surgery with CPB in our hospital from January 2015 to June 2017 were
randomly divided into 2 groups (n=55): Group A, in which anesthesia was
maintained with sevoflurane, and Group B, in which anesthesia was
maintained with propofol. The MMSE score before and after operation,
perioperative laboratory index, incidence of postoperative cognitive
dysfunction (POCD) and incidence of adverse events between the two groups
were compared. <br/>Result(s): The MMSE score was significantly higher in
Group B than in Group A after anesthesia (p<0.05). Serum levels of the
brain injury markers neuron-specific enolase, S100B and matrix
metalloproteinase 9 were significantly lower in Group B than in Group A
(p<0.05). POCD incidence at 12 hour and 24 hour after operation was
significantly lower in Group B than in Group A (p<0.05). There were no
significant differences in the incidence of low cardiac output and
thoracotomy bleeding between two groups. <br/>Conclusion(s): Compared with
sevoflurane, the use of propofol during cardiac surgery with CPB can
efficiently improve postoperative cognitive function without increasing
the risk of adverse reactions.<br/>Copyright &#xa9; 2019, Professional
Medical Publications. All rights reserved.

<16>
Accession Number
628951438
Title
Effects of pre-CPB administration of dexmedetomidine on cardiac injuries
and the inflammatory response in valve replacement surgery with a
sevoflurane postconditioning protocol: a pilot study.
Source
Journal of cardiovascular pharmacology. (no pagination), 2019. Date of
Publication: 22 Jul 2019.
Author
Zhou H.; Zhou D.; Lu J.; Wu C.; Zhu Z.
Institution
(Zhou, Zhou, Lu, Wu, Zhu) Department of Anesthesiology, Second Affiliated
Hospital of Jiaxing University, Jiaxing City, Zhejiang Province 314000,
China
Publisher
NLM (Medline)
Abstract
Preventing myocardial ischemia reperfusion injury in on-pump cardiac
surgeries remains an enormous challenge. Sevoflurane postconditioning has
been effective at overcoming this challenge by modulating inflammatory
mediators and ameliorating antioxidative stress. Dexmedetomidine (DEX) is
a commonly used medication for cardiac patients with organ-protective
properties that lead to positive outcomes. Whether DEX also has
cardiac-protective properties and the associated mechanism in sevoflurane
postconditioning-based valve replacement surgeries are unknown OBJECTIVE:
This study was carried out to observe the effect of DEX administration
before cardiopulmonary bypass (CPB) on myocardial injury, oxidative stress
and inflammatory response indicators in the peripheral blood METHODS:
Twenty-eight eligible cardiac patients who underwent valve replacement
surgery with standard sevoflurane postconditioning were included in the
study. The patients were randomly divided into a DEX group and a Non-DEX
group according to whether DEX (0.5-micro&#32;g/kg overload dose for 10
min and a 0.5-mug/kg/h maintenance dose) or saline was administered from
induction to the beginning of CPB. The primary outcome was the cardiac
troponin I concentration (cTnI) in the blood 24 h after CPB. The levels of
malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6) and interleukin-8 (IL-8)
were also measured RESULTS: The mean cTnI at 24 h after CPB was clearly
decreased in the DEX group compared to that in the Non-DEX group
(4.16+/-1.58 vs 6.90+/-3.73, P<0.05). TNF-alpha levels were lower in the
DEX group after CPB (T1-T5), with a significant difference found at 1-6 h
after CPB (1 h, 19.03 vs 28.09; 6 h, 20.74 vs 30.94, P<0.05). The IL-6 and
IL-8 concentrations in the DEX group were dramatically increased at 6 h
after CPB (P<0.05). The MDA content and SOD activity were comparable
between the 2 groups. A lower proportion of anemia cases was noted after
CPB in the DEX group than in the Non-DEX group (Non-DEX, 10% vs DEX, 5%,
P<0.05) <br/>CONCLUSION(S): In valve replacement surgery with sevoflurane
postconditioning, pre-CPB administration of DEX can reduce the cTnI level
at 24 h after CPB and brings synergic benefits of the inflammatory
response.

<17>
Accession Number
628943681
Title
Efficacy and Safety of Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting
Stents Versus Thin, Durable-Polymer Everolimus-Eluting Stents for Coronary
Revascularization of Patients With Diabetes Mellitus.
Source
The American journal of cardiology. (no pagination), 2019. Date of
Publication: 15 Jul 2019.
Author
Waksman R.; Shlofmitz E.; Windecker S.; Koolen J.J.; Saito S.; Kandzari
D.; Kolm P.; Lipinski M.J.; Torguson R.
Institution
(Waksman, Shlofmitz, Kolm, Lipinski, Torguson) MedStar Washington Hospital
Center, Washington, District of Columbia
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Saito) Shonan Kamakura General Hospital, Kamakura, Japan; Sapporo Higashi
Tokushukai Hospital, Sapporo, Japan
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia France
Publisher
NLM (Medline)
Abstract
Patients with diabetes mellitus are prone to increased adverse outcomes
after percutaneous coronary intervention, even with contemporary
drug-eluting stents. Randomized controlled trials have demonstrated
comparable clinical outcomes between an ultrathin bioresorbable-polymer
sirolimus-eluting stent (BP-SES) and a thin-strut durable-polymer
everolimus-eluting stent (DP-EES) that has specific labeling for patients
with diabetes. We aimed to evaluate the safety and efficacy of the BP-SES
in patients with diabetes mellitus. To determine the performance of the
BP-SES in diabetic patients, patient-level data from the BIOFLOW II, IV,
and V randomized controlled trials were pooled. The primary end point was
target lesion failure (TLF), defined as the composite of cardiovascular
death, target-vessel myocardial infarction, ischemia-driven target lesion
revascularization, and definite or probable stent thrombosis, at 1 year.
Among 1,553 BP-SES and 791 DP-EES patients, 757 diabetic patients were
identified. Of the diabetic patients included in this analysis (494 BP-SES
vs 263 DP-EES), the proportion of insulin- and noninsulin-treated patients
was similar between groups. The 1-year TLF rate in the diabetic population
was 6.3% in the BP-SES group and 8.7% in the DP-EES group (hazard ratio
0.82, 95% confidence interval 0.047 to 1.43, p=0.493). There were no
significant differences, based on stent type or diabetes treatment
regimen, in TLF hazards. In a patient-level pooled analysis of the
diabetic population from randomized trials, 1-year clinical safety and
efficacy outcomes were similar in patients treated with ultrathin BP-SES
and thin-strut DP-EES.<br/>Copyright &#xa9; 2019. Published by Elsevier
Inc.

<18>
Accession Number
2002645121
Title
Meta-analysis of propensity matched studies of robotic versus conventional
mitral valve surgery.
Source
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
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: To compare early outcomes after robotic versus conventional
mitral valve surgery (R-MVS versus C-MVS), we performed a meta-analysis of
currently available propensity score matched (PSM) studies.
<br/>Method(s): To identify all PSM studies of R-MVS versus C-MVS, PubMed
and Web of Science were searched thorough November 2018 using the terms of
robotic or robot, mitral, and propensity. Inclusion criteria were PSM
studies of isolated R-MVS versus C-MVS. Odds ratios of dichotomous data
and mean differences for continuous data were generated for each study and
combined in a meta-analysis using the random-effects model.
<br/>Result(s): We identified 7 PSM studies of R-MVS versus C-MVS
enrolling a total of 3764 patients. Pooled analyses demonstrated
significantly longer cardiopulmonary bypass (CPB) (p < 0.00001) and
cross-clamp time (p = 0.004) in R-MVS than C-MVS. However, intensive care
unit (ICU) (p = 0.0005) and hospital stay (p < 0.0001) was significantly
shorter; and incidence of red blood cell (RBC) transfusion (p = 0.03),
prolonged ventilation (p = 0.048), and atrial fibrillation (AF) (p = 0.01)
was significantly less frequent after R-MVS than C-MVS. There was no
significant difference in incidence of reoperation for bleeding and valve
dysfunction, >=moderate mitral regurgitation, renal failure, dialysis,
pneumonia, stroke, cardiac arrest, and all-cause death (p = 0.27) between
R-MVS and C-MVS. <br/>Conclusion(s): ICU/hospital stay was shorter and RBC
transfusion/prolonged ventilation/AF was less frequent after R-MVS than
C-MVS despite longer CPB and cross-clamp time in R-MVS than C-MVS. The
other early outcomes including all-cause mortality were similarly frequent
after R-MVS and C-MVS.<br/>Copyright &#xa9; 2019

<19>
Accession Number
2002624876
Title
Meta-Analysis Comparing Transcatheter Aortic Valve Implantation to
Surgical Aortic Valve Replacement in Low Surgical Risk Patients.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Saleem S.; Younas S.; Syed M.A.
Institution
(Saleem) Department of Cardiovascular Disease, University of Kentucky
College of Medicine, Bowling Green, KY, United States
(Younas) Khyber Medical College, Peshawar, Pakistan
(Syed) Department of Cardiovascular Disease, University of Toledo Medical
Center, Toledo, OH, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is recommended for
inoperable and high risk surgical patients with severe aortic stenosis. It
is noninferior to surgical aortic valve replacement (SAVR) in intermediate
risk candidates. TAVI is currently being assessed for low surgical risk
individuals. We performed a meta-analysis of randomized controlled trials
(RCTs) and matched observational studies between TAVI and SAVR in low
surgical risk patients. The primary outcomes were short-term and mid-term
mortality and neurologic events. Secondary outcomes were other
periprocedure complications. A total of 8 studies (3 RCTs and 5 matched
observational studies) totaling 6,686 patients were included. No
difference was seen in short-term mortality and neurologic events (risk
ratio [RR] 0.68, 95% confidence interval [CI] 0.45 to 1.03, p 0.07 and RR
0.76, 95% CI 0.52 to 1.13, p 0.18) as well as mid-term mortality and
neurologic events (RR 0.89, 95% CI 0.54 to 1.47, p 0.65 and RR 1.04, 95%
CI 0.55 to 1.97, p 0.9) between the 2 groups. Reduced risk of new onset
atrial fibrillation (RR 0.14, 95% CI 0.08 to 0.25, p <0.00001), acute
kidney injury (RR 0.43, 95 CI 0.23 to 0.82, p 0.01), and bleeding (RR
0.43, 95% CI 0.27 to 0.69, p 0.0005) whereas increased risk of >= moderate
aortic regurgitation (RR 6.53, 95% CI 3.48 to 12.24, p <0.00001),
pacemaker or defibrillator implantation (RR 3.11, 95% CI 1.96 to 4.94, p
<0.00001) and vascular complications (RR 5.29, 95% CI 1.58 to 17.70, p
0.007) was noted in TAVI arm. In conclusion, TAVI is comparable to SAVR in
terms of short-term and mid-term mortality and neurologic events in low
surgical risk patients. The risk of periprocedure events is
variable.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<20>
Accession Number
2002242214
Title
Prevention of postoperative delirium in elderly patients planned for
elective surgery: Systematic review and meta-analysis.
Source
Clinical Interventions in Aging. 14 (pp 1095-1117), 2019. Date of
Publication: 2019.
Author
Janssen T.L.; Alberts A.R.; Hooft L.; Mattace-Raso F.U.S.; Mosk C.A.; Van
Der Laan L.
Institution
(Janssen, Alberts, Mosk, Van Der Laan) Department of Surgery, Amphia
Hospital Breda, Breda, Netherlands
(Hooft) Cochrane Netherlands, Julius Centre for Health Sciences and
Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
(Mattace-Raso) Department of Geriatrics, Erasmus MC University Hospital
Rotterdam, Rotterdam, Netherlands
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Introduction: Vulnerable or "frail" patients are susceptible to the
development of delirium when exposed to triggers such as surgical
procedures. Once delirium occurs, interventions have little effect on
severity or duration, emphasizing the importance of primary prevention.
This review provides an overview of interventions to prevent postoperative
delirium in elderly patients undergoing elective surgery. <br/>Method(s):
A literature search was conducted in March 2018. Randomized controlled
trials (RCTs) and before-and-after studies on interventions with potential
effects on postoperative delirium in elderly surgical patients were
included. Acute admission, planned ICU admission, and cardiac patients
were excluded. Full texts were reviewed, and quality was assessed by two
independent reviewers. Primary outcome was the incidence of delirium.
Secondary outcomes were severity and duration of delirium. Pooled risk
ratios (RRs) were calculated for incidences of delirium where similar
intervention techniques were used. <br/>Result(s): Thirty-one RCTs and
four before-and-after studies were included for analysis. In 19 studies,
intervention decreased the incidences of postoperative delirium. Severity
was reduced in three out of nine studies which reported severity of
delirium. Duration was reduced in three out of six studies. Pooled
analysis showed a significant reduction in delirium incidence for
dexmedetomidine treatment, and bispectral index (BIS)-guided anaesthesia.
Based on sensitivity analyses, by leaving out studies with a high risk of
bias, multicomponent interventions and antipsychotics can also
significantly reduce the incidence of delirium. <br/>Conclusion(s):
Multicomponent interventions, the use of antipsychotics, BIS-guidance, and
dexmedetomidine treatment can successfully reduce the incidence of
postoperative delirium in elderly patients undergoing elective,
non-cardiac surgery. However, present studies are heterogeneous, and
high-quality studies are scarce. Future studies should add these
preventive methods to already existing multimodal and multidisciplinary
interventions to tackle as many precipitating factors as possible,
starting in the pre-admission period.<br/>Copyright &#xa9; 2019 Janssen et
al.

<21>
Accession Number
2000705864
Title
Three-Year Impact of Immediate Invasive Strategy in Patients With
Non-ST-Segment Elevation Myocardial Infarction (from the RIDDLE-NSTEMI
Study).
Source
American Journal of Cardiology. 122 (1) (pp 54-60), 2018. Date of
Publication: 1 July 2018.
Author
Milasinovic D.; Milosevic A.; Vasiljevic-Pokrajcic Z.; Marinkovic J.;
Vukcevic V.; Stefanovic B.; Asanin M.; Stankovic S.; Ivanovic B.;
Stankovic G.
Institution
(Milasinovic, Milosevic, Vukcevic, Stefanovic, Asanin, Ivanovic,
Stankovic) Department of Cardiology, Clinical Center of Serbia, Belgrade,
Serbia
(Milosevic, Stefanovic, Asanin) Emergency Department, Department of
Cardiology, Clinical Center of Serbia, Belgrade, Serbia
(Vasiljevic-Pokrajcic, Marinkovic, Vukcevic, Stefanovic, Asanin, Ivanovic,
Stankovic) Faculty of Medicine, University of Belgrade, Belgrade, Serbia
(Marinkovic) Institute for Medical Statistics and Informatics, Belgrade,
Serbia
(Stankovic) Center for Medical Biochemistry, Clinical Center of Serbia,
Belgrade, Serbia
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Previous studies compared clinical outcomes of early versus delayed
invasive strategy in patients with non-ST-elevation acute coronary
syndrome up to 1-year follow-up, but long-term data remain scarce. Our aim
was to evaluate the long-term effects of immediate invasive intervention
in patients with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI).
The Randomized Study of Immediate Versus Delayed Invasive Intervention in
Patients With Non-ST-Segment Elevation Myocardial Infarction
(RIDDLE-NSTEMI) was a randomized, investigator-initiated, parallel-group
trial that assigned 323 patients with NSTEMI (1:1) to either immediate
(median time to intervention 1.4 hours) or delayed invasive strategy (61.0
hours). The primary end point was the composite of death or new myocardial
infarction (MI). At 3 years, immediate invasive intervention was
associated with a lower rate of death or new MI, compared with a delayed
invasive strategy (12.3% vs 22.5%, hazard ratio 0.50, 95% confidence
interval 0.29 to 0.87, p = 0.014). The observed benefit of immediate
intervention was mainly driven by an increased early reinfarction risk in
delayed strategy, with similar new MI rates beyond 30 days (4.4% in the
immediate and 5.6% in the delayed group, p = 0.61). Three-year mortality
was 9.3% in the immediate invasive strategy, and 10.0% in the delayed
strategy (p = 0.83). High baseline Global Registry of Acute Coronary
Events score (>140) was associated with a significant increase in
long-term mortality, regardless of the timing of invasive intervention. In
conclusion, whereas immediate invasive intervention significantly reduced
the early risk of new MI, the timing of invasive intervention appears to
have no significant impact on clinical outcomes beyond 30 days, which seem
to mostly be related to the baseline clinical risk profile.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<22>
Accession Number
2000705146
Title
Nitric Oxide in Cardiac Surgery: A Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2512-2519),
2018. Date of Publication: December 2018.
Author
Sardo S.; Osawa E.A.; Finco G.; Gomes Galas F.R.B.; de Almeida J.P.;
Cutuli S.L.; Frassanito C.; Landoni G.; Hajjar L.A.
Institution
(Sardo, Finco) Department of Medical Sciences and Public Health,
University of Cagliari, Monserrato, Italy, Italy
(Osawa) Intensive Care Unit, Instituto do Cancer, Hospital das Clinicas da
Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil,
Brazil
(Gomes Galas, de Almeida, Hajjar) Heart Institute, University of Sao
Paulo, Sao Paulo, Brazil, Brazil
(Cutuli) Department of Anesthesiology and Intensive Care, Universita
Cattolica del Sacro Cuore, Rome, Italy, Italy
(Frassanito, Landoni) IRCCS San Raffaele Scientific Institute, Milan,
Italy, Italy
(Landoni) Vita-Salute San Raffaele University of Milan, Milan, Italy,
Italy
Publisher
W.B. Saunders
Abstract
Objectives: To investigate the efficacy and safety of perioperative
administration of nitric oxide in cardiac surgery. <br/>Design(s):
Meta-analysis of randomized controlled trials (RCTs). <br/>Participant(s):
Cardiac surgery patients. <br/>Intervention(s): A search of Cochrane
Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE for
RCTs that compared nitric oxide with placebo or other comparators.
<br/>Measurements and Main Results: The primary outcome was intensive care
unit (ICU) stay, and secondary outcomes were mortality, duration of
mechanical ventilation, and reduction of mean pulmonary artery pressure.
The study included 18 RCTs comprising 958 patients. The authors calculated
the pooled odds ratio (OR) and the mean difference (MD) with
random-effects model. Quantitative synthesis of data demonstrated a
clinically negligible reduction in the length of ICU stay (MD -0.38 days,
confidence interval CI [-0.65 to -0.11]; p = 0.005) and mechanical
ventilation duration (MD -4.81 hours, CI [-7.79 to -1.83]; p = 0.002)
compared with all control interventions with no benefit on mortality.
<br/>Conclusion(s): Perioperative delivery of inhaled nitric oxide
resulted to be of no or minimal benefit in patients with pulmonary
hypertension undergoing cardiac surgery. Large, randomized trials are
needed to further assess its effect on major clinical outcomes and its
cost-effectiveness.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<23>
Accession Number
2000904542
Title
Meta-Analysis Comparing Dual Versus Single Antiplatelet Therapy in
Combination With Antithrombotic Therapy in Patients With Atrial
Fibrillation Who Underwent Percutaneous Coronary Intervention With Stent
Implantation.
Source
American Journal of Cardiology. 122 (4) (pp 604-611), 2018. Date of
Publication: 15 August 2018.
Author
Lou B.; Liang X.; Wu Y.; Deng Y.; Zhou B.; Yuan Z.; She J.
Institution
(Lou, Liang, Wu, Deng, Yuan, She) Cardiovascular Department, First
Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710048, China
(Lou, Liang, Wu, Deng, Yuan, She) Key Laboratory of Environment and Genes
Related to Diseases, Ministry of Education, Xi'an 710048, China
(Lou, Liang, Wu, Deng, Yuan, She) Key Laboratory of Molecular Cardiology,
Shaanxi Province, China
(Zhou) Respiratory Department, First Affiliated Hospital of Xi'an Jiaotong
University, Xi'an 710048, China
(Lou) European Center for Angioscience (ECAS), Department of Vascular
Biology&Tumor Angiogenesis, Medical Faculty Mannheim, Heidelberg
University, Mannheim 68169, Germany
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The coexistence of atrial fibrillation and coronary artery disease is
commonly found in clinical practice. The aim of this meta-analysis is to
compare the clinical efficacy and safety of dual versus single
antiplatelet therapy in combination with antithrombotic therapy in
patients with atrial fibrillation undergoing percutaneous coronary
intervention. PubMed, EMBASE and Web of Science databases were
systematically evaluated for articles published up to October 31, 2017.
The risk ratios (RR) were extracted from each study. Pooled estimates with
corresponding 95% confidence intervals (CI) were estimated by a fixed or
random-effects model. Eight studies involving a total of 10,861 patients
with atrial fibrillation were included in this meta-analysis. Five
thousand sixty-six participants received dual antiplatelet therapy
together with warfarin or new oral anticoagulation (triple antithrombotic
therapy, TT) and 5,795 participants received single antiplatelet therapy
together with warfarin or new oral anticoagulation (dual antithrombotic
therapy). TT was associated with a significantly higher incidence of all
(RR 1.45, p <0.001) and major (RR 1.77, p <0.001) bleeding events, but no
difference with regard to stroke, in-stent thrombosis, major adverse
cardiovascular events, and all-cause mortality rate. In conclusion, as
compared to TT, dual antithrombotic therapy is equally effective in
reducing stroke, in-stent thrombosis, major adverse cardiovascular events,
and all-cause mortality rate, but shows beneficial effect in reducing
overall bleeding incidence in atrial fibrillation patients who underwent
percutaneous coronary intervention.<br/>Copyright &#xa9; 2018 The
Author(s)

<24>
Accession Number
2000900534
Title
Meta-Analysis Comparing Primary Percutaneous Coronary Intervention Versus
Pharmacoinvasive Therapy in Transfer Patients with ST-Elevation Myocardial
Infarction.
Source
American Journal of Cardiology. 122 (4) (pp 542-547), 2018. Date of
Publication: 15 August 2018.
Author
Siddiqi T.J.; Usman M.S.; Khan M.S.; Sreenivasan J.; Kassas I.; Riaz H.;
Raza S.; Deo S.V.; Sharif H.; Kalra A.; Yadav N.
Institution
(Siddiqi, Usman) Internal Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Khan, Sreenivasan) Internal Medicine, John H Stroger Jr. Hospital of Cook
County, Chicago, Illinois, United States
(Kassas) Division of Cardiology, New York University School of Medicine,
New York, New York, United States
(Riaz) Division of Cardiology, Cleveland Clinic, Cleveland, Ohio, United
States
(Raza, Kalra) Department of Cardiology, University Hospitals Cleveland
Medical Center, Cleveland, Ohio, United States
(Deo) Department of Cardiac Surgery, University Hospitals Cleveland
Medical Center, Cleveland, Ohio, Pakistan
(Sharif) Department of Cardiac Surgery, Aga Khan University Hospital,
Karachi, Pakistan
(Yadav) Division of Cardiology, John H Stroger Jr. Hospital of Cook
County, Chicago, Illinois, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
ST-elevation myocardial infarction patients presenting at non-percutaneous
coronary intervention (PCI)-capable hospitals often need to be transferred
for primary percutaneous coronary intervention (PPCI). This increases time
to revascularization, leading to increased risk of in-hospital mortality.
With recent focus on total ischemic time rather than door-to-balloon time
as the principal determinant of outcomes in ST-elevation myocardial
infarction patients, pharmacoinvasive therapy (PIT) has gained attention
as a possible improvement over PPCI in patients requiring transfer. Our
objective was to observe how PIT stands against PPCI in terms of safety
and efficacy. Electronic databases were searched for randomized controlled
trials and observational studies comparing PPCI to PIT. PIT was defined as
administration of thrombolytic drugs followed by immediate PCI only in
case of failed thrombolysis. Results from studies were pooled using a
random-effects model. We identified 17 relevant studies (6 randomized
controlled trials, 11 observational studies) including 13,037 patients.
Overall, there was no significant difference in short-term mortality (odds
ratio [OR] = 1.20 [0.97 to 1.49]; I² = 14.2%; p = 0.099);
however, PIT significantly decreased short-term mortality (OR = 1.46 [1.08
to 1.96]; I² = 0%; p = 0.01) in those studies with a
symptom-onset-to-device time >=200 minutes. There was a significantly
lower risk reinfarction (OR = 0.69 [0.49 to 0.97]; I² = 0%; p =
0.033) in the PPCI group, while the risk of cardiogenic shock was
significantly higher (OR = 1.48 [1.13 to 1.94]; I² = 0%; p =
0.005). In conclusion, PIT versus PPCI decisions should preferably be
customized in patients presenting to non-PCI capable hospitals. Factors
that need to be considered include symptom-onset to first medical contact
time, expected time of transfer to a PCI-capable hospital, and patients
risk factors.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<25>
Accession Number
2000813985
Title
Meta-Analysis Comparing Single Versus Dual Antiplatelet Therapy Following
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (2) (pp 310-315), 2018. Date of
Publication: 15 July 2018.
Author
Maes F.; Stabile E.; Ussia G.P.; Tamburino C.; Pucciarelli A.; Masson
J.-B.; Marsal J.R.; Barbanti M.; Cote M.; Rodes-Cabau J.
Institution
(Maes, Cote, Rodes-Cabau) Department of Cardiology, Quebec Heart & Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Stabile) Department of Advanced Biomedical Sciences, University "Federico
II", Napoli, Italy
(Ussia) Department of Cardiology, Tor Vergata University of Rome, Rome,
Italy
(Tamburino, Barbanti) Department of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Pucciarelli) Department of Cardiology, Clinica Montevergine, Mercogliano,
Italy
(Masson) Department of Cardiology, Centre Hospitalier Universitaire de
Montreal, Montreal, Quebec, Canada
(Marsal) Epidemiology Unit of the Cardiology Department and CIBER de
Epidemiologia y Salud Publica (CIBERESP), Vall d'Hebron University
Hospital, Barcelona, Spain
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To compare dual antiplatelet therapy (DAPT) versus single antiplatelet
therapy (SAPT) as antithrombotic treatment after transcatheter aortic
valve implantation (TAVI) for the prevention of ischemic events, vascular
and bleeding events, and death. Data from the 3 randomized trials
comparing DAPT versus SAPT post-TAVI were pooled and analyzed in a
patient-level meta-analysis. The primary end point was the occurrence of
death, major or life-threatening bleedings, and major vascular
complications at 30-day follow-up. Events were adjudicated according to
the Valve Academic Research Consortium 2 definitions. A total of 421
patients randomized to DAPT (210 patients) or SAPT (211 patients)
post-TAVI were analyzed. There were no differences between groups in
baseline clinical and procedural characteristics. The occurrence of the
30-day combined primary end point was higher in the DAPT group (17.6% vs
10.9%, odds ratio 1.73, 95% confidence interval 1.00 to 2.98, p = 0.050),
with an increased rate of major or life-threatening bleeding events in the
DAPT group (11.4% vs 5.2%, odds ratio 2.24, 95% confidence interval 1.12
to 4.46, p = 0.022). There were no differences between DAPT and SAPT
groups in the incidence of death (5.2% vs 3.8%, p = 0.477), global
ischemic events (3.8% vs 3.8%, p = 0.999), or stroke (2.4% vs 2.4%, p =
0.996). DAPT (vs SAPT) was associated with a higher rate of major adverse
events after TAVI, mainly driven by an increased risk of major or
life-threatening bleeding complications along with a lack of beneficial
effect on ischemic events. These results do not support the current
recommendation of DAPT as antithrombotic therapy after TAVI.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<26>
Accession Number
2000776232
Title
Meta-Analysis of Studies Comparing Dual- Versus Mono-Antiplatelet Therapy
Following Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 122 (1) (pp 141-148), 2018. Date of
Publication: 1 July 2018.
Author
Al Halabi S.; Newman J.; Farkouh M.E.; Fortuin D.; Leya F.; Sweeney J.;
Darki A.; Lopez J.; Steen L.; Lewis B.; Webb J.; Leon M.B.; Mathew V.
Institution
(Al Halabi, Newman, Leya, Darki, Lopez, Steen, Lewis, Mathew) Division of
Cardiology, Loyola University Medical Center, Maywood, Illinois, United
States
(Farkouh) Division of Cardiology, University of Toronto, Toronto, Ontario,
Canada
(Fortuin, Sweeney) Department of Cardiovascular Medicine, Mayo Clinic,
Phoenix, Arizona, United States
(Webb) Division of Cardiology, University of British Columbia, Vancouver,
British Columbia, Canada
(Leon) Division of Cardiology, Columbia University Medical Center, New
York, New York, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Current guidelines recommend dual-antiplatelet therapy (DAPT) after
transcatheter aortic valve implantation (TAVI), although some studies
suggest mono-antiplatelet therapy is equally efficacious with an improved
safety profile. We performed a meta-analysis of studies comparing DAPT
with mono-antiplatelet therapy after TAVI. Study quality and heterogeneity
were assessed using Jadad score, Newcastle-Ottawa Scale, and Cochran's Q
statistics. Mantel-Haenszel odds ratios (ORs) were calculated using fixed
effect models as the primary analysis. Eight studies including 2,439
patients met the inclusion criteria. At 30 days, DAPT was associated with
an increased risk of all-cause mortality (OR 2.06, 95% confidence interval
[CI] 1.34 to 3.18, p = 0.001), major or life-threatening bleeding (OR
2.04, 95% CI 1.60 to 2.59, p <0.001), and major vascular complications (OR
2.15, 95% CI 1.51 to 3.06, p <0.001). There was no difference in the rate
of the combined end point of stroke or transient ischemic attack, or
myocardial infarction. Outcome data up to 6 months were available in 5
studies; all-cause mortality and stroke were similar between groups,
although major or life-threatening bleeding was more frequent with DAPT.
In conclusion, in patients undergoing TAVI, DAPT is associated with
increased risk at 30 days of all-cause mortality, major or
life-threatening bleeding, and major vascular complications without a
decrease in ischemic complications; at 6 months, the excess bleeding risk
persisted. These data suggest a safety concern with DAPT and justify
further investigation of the optimal antiplatelet therapy regimen after
TAVI.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<27>
Accession Number
2000776173
Title
Meta-analysis Comparing Transcatheter and Surgical Treatments of
Paravalvular Leaks.
Source
American Journal of Cardiology. 122 (2) (pp 302-309), 2018. Date of
Publication: 15 July 2018.
Author
Busu T.; Alqahtani F.; Badhwar V.; Cook C.C.; Rihal C.S.; Alkhouli M.
Institution
(Busu, Alqahtani, Alkhouli) Division of Cardiology, West Virginia School
of Medicine, Morgantown, West Virginia, United States
(Badhwar, Cook) Department of Cardiothoracic Surgery, West Virginia School
of Medicine, Morgantown, West Virginia, United States
(Rihal) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Percutaneous paravalvular leak (PVL) closure has emerged as a feasible
alternative to redo valve surgery. However, comparative data on
percutaneous and surgical treatment of PVL are scarce. We performed a
systematic review and a meta-analysis of studies on percutaneous and
surgical treatments of PVL. Of the 2,267 studies screened, 22 eligible
studies were analyzed. Primary end points were technical success, 30-day
mortality, stroke, and length of stay. Secondary end points were 1-year
mortality, readmission for heart failure, reoperation, and symptomatic
improvement at follow-up. A total of 2,373 patients were included, of whom
1,511 (63.7%) underwent percutaneous closure. Technical success was higher
with surgery (96.7% vs 72.1%, odds ratio [OR] 9.7, p <0.001) but at the
cost of higher 30-day mortality (8.6% vs 6.8%, OR 1.90, p <0.001), a trend
toward higher stroke (3.3% vs 1.4%, OR 1.94, p = 0.069), and longer
hospitalizations. However, surgery was associated with similar 1-year
mortality (17.3% vs 17.2%, OR 1.07, p = 0.67), reoperation (9.1% vs 9.9%,
OR 0.72, p = 0.1), readmission for heart failure (13.3% vs 26.4%, OR 0.51,
p = 0.29), and improvement in New York Heart Association classification
(67.4% vs 56%, OR 1.37, p = 0.74), compared with percutaneous closure. A
sensitivity analysis including comparative studies only yielded similar
results. Surgical treatment of PVL achieves higher technical success rates
but is associated with higher early morbidity and mortality compared with
percutaneous closure. Nevertheless, mortality rates and clinical efficacy
parameters were similar at midterm with both procedures. Further studies
are warranted to identify the ideal management approach to patients with
symptomatic PVL.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<28>
Accession Number
623933316
Title
Effect of remote ischemic preconditioning on outcomes in adult cardiac
surgery: A systematic review and meta-analysis of randomized controlled
studies.
Source
Anesthesia and Analgesia. 127 (1) (pp 30-38), 2018. Date of Publication:
01 Jul 2018.
Author
Xie J.; Zhang X.; Xu J.; Zhang Z.; Klingensmith N.J.; Liu S.; Pan C.; Yang
Y.; Qiu H.
Institution
(Xie, Zhang, Xu, Liu, Pan, Yang) Department of Critical Care Medicine,
Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
(Zhang) Department of Critical Care Medicine, Jinhua Municipal Central
Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, China
(Klingensmith) Department of Surgery, Emory Critical Care Center, Emory
University School of Medicine, Atlanta, GA, United States
(Qiu) Department of Critical Care Medicine, Zhongda Hospital, School of
Medicine, Southeast University, Nanjing 210009, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Remote ischemic preconditioning (RIPC) has been demonstrated
to prevent organ dysfunction in cardiac surgery patients. However, recent
large, prospective, multicenter, randomized controlled trials (RCTs) had
controversial results. Thus, a meta-analysis of RCTs was performed to
investigate whether RIPC can reduce the incidence of acute myocardial
infarction (AMI), acute kidney injury (AKI), and mortality in adult
cardiac surgery patients. <br/>METHOD(S): Study data were collected from
Medline, Elsevier, Cochrane Central Register of Controlled Trials and Web
of Science databases. RCTs involving the effect of RIPC on organ
protection in cardiac surgery patients, which reported the concentration
or total release of creatine kinase-myocardial band, troponin I/troponin T
(TNI/TNT) after operation, or the incidence of AMI, AKI, or mortality,
were selected. Two reviewers independently extracted data using a
standardized data extraction protocol where TNI or TNT concentrations;
total TNI released after cardiac surgery; and the incidence of AKI, AMI,
and mortality were recorded. Review Manager 5.3 software was used to
analyze the data. <br/>RESULT(S): Thirty trials, including 7036 patients
were included in the analyses. RIPC significantly decreased the
concentration of TNI/TNT (standard mean difference [SMD], -0.25 ng/mL; 95%
confidence interval [CI], -0.41 to -0.048 ng/mL; P = .004), creatine
kinase-myocardial band (SMD, -0.22; 95% CI, -0.07-0.35 ng/mL; P = .46),
and the total TNI/TNT release (SMD, -0.49 ng/mL; 95% CI, -0.93 to -0.55
ng/mL; P = .03) in cardiac surgery patients after a procedure. However,
RIPC could not reduce the incidence of AMI (relative risk, 0.89; 95% CI,
0.70-1.13; P = .34) and AKI (relative risk, 0.88; 95% CI, 0.72-1.06; P =
.18), and there was also no effect of RIPC on mortality in adult cardiac
surgery patients. Interestingly, subgroup analysis showed that RIPC
reduced incidence of AKI and mortality of cardiac surgery patients who
received volatile agent anesthesia. <br/>CONCLUSION(S): Our meta-analysis
demonstrated that RIPC reduced TNI/TNT release after cardiac surgery. RIPC
did not significantly reduce the incidence of AKI, AMI, and mortality.
However, RIPC could reduce mortality in patients receiving volatile
inhalational agent anesthesia.<br/>Copyright &#xa9; 2018 International
Anesthesia Research Society.

<29>
Accession Number
2001012216
Title
Usefulness and Safety of Rivaroxaban in Patients Following Isolated Mitral
Valve Replacement With a Mechanical Prosthesis.
Source
American Journal of Cardiology. 122 (6) (pp 1047-1050), 2018. Date of
Publication: 15 September 2018.
Author
Duraes A.R.; Bitar Y.D.S.L.; Lima M.L.G.; Santos C.C.; Schonhofen I.S.;
Filho J.A.L.; Roever L.
Institution
(Duraes, Bitar, Lima, Santos, Schonhofen, Filho) General Hospital Roberto
Santos, Salvador, Brazil
(Roever) Leonardo Roever: Uberlandia Federal University, Uberlandia,
Brazil
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rivaroxaban has previously been tested in experimental and animal models
with encouraging results. We prospectively selected seven patients between
May 2017 and January 2018 who underwent isolated mitral valve replacement
with a mechanical prosthesis and had unstable INR control at least 3
months after surgery. An intervention of rivaroxaban 15 mg was then
administered twice daily for a period of 90 days. No patient presented
intracardiac thrombus, reversible ischemic neurological deficit, ischemic
or hemorrhagic stroke, and hospitalization or death during 3 months of
follow-up. Two patients eradicated the presence of spontaneous echo
contrast. Mean and peak pressure gradients, peak velocity, effective
orifice area, and PHT were similar before and after the intervention. In
conclusion, the use of rivaroxaban for 90 days in seven patients after
replacement of mitral valve with the mechanical prosthesis did not present
thromboembolic or bleeding events (NCT02894307).<br/>Copyright &#xa9; 2018
Elsevier Inc.

<30>
Accession Number
2000598963
Title
A Randomized Controlled Trial of Intra-Aortic Adenosine Infusion Before
Release of the Aortic Cross-Clamp During Coronary Artery Bypass Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2520-2527),
2018. Date of Publication: December 2018.
Author
Ammar A.; Mahmoud K.; Elkersh A.; Kasemy Z.
Institution
(Ammar, Mahmoud, Elkersh, Kasemy) Faculty of Medicine, Minoufiya
University, Minoufiya, Egypt, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: To assess the feasibility, safety, and potential useful effect
of adenosine as a postconditioning agent in patients undergoing coronary
artery bypass grafting surgeries. <br/>Design(s): Prospective randomized
controlled study. <br/>Setting(s): University hospital.
<br/>Participant(s): The study comprised 60 patients scheduled for
coronary artery bypass grafting surgery. <br/>Intervention(s): Adenosine
(postconditioning group) or placebo (control group). Adenosine infusion
(150 micro&#32;g/kg/min) for 10 minutes via a cardioplegia needle into the
aortic root was started 10 minutes before aortic cross-clamp removal.
<br/>Measurements and Main Results: Compared with the control group,
ejection fraction, fractional shortening, cardiac index (2.9 +/- 0.3 v 2.2
+/- 0.3 L/min/m², p = 0.032 at 60 min postbypass) and diastolic
function indices were significantly better in the postconditioning group
at most time points in the postbypass period. Cardiac troponin I and
creatine kinase-MB release and the inotropic score were significantly
lower in the postconditioning group at most time points in the
postoperative period. The need for intra-aortic balloon and epicardial
pacing were comparable in both groups, whereas incidence of arrhythmia,
duration of postoperative mechanical ventilation, and intensive care unit
and total hospital stays were significantly lower in the postconditioning
group. <br/>Conclusion(s): Adenosine postconditioning provided cardiac
protection as evidenced by a favorable outcome on systolic and diastolic
function indices, less cardiac troponin I and creatine kinase-MB release,
lower incidence of arrhythmia, lower inotropic score, and shorter duration
of postoperative mechanical ventilation and intensive care unit
stay.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<31>
Accession Number
2000888541
Title
Meta-Analysis Comparing Outcomes and Need for Renal Replacement Therapy of
Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve
Replacement.
Source
American Journal of Cardiology. 122 (3) (pp 468-476), 2018. Date of
Publication: 1 August 2018.
Author
Siddiqui W.J.; Alvarez C.; Aslam M.; Bakar A.; Khan M.H.; Aslam A.; Hanif
M.O.; Hasni S.F.; Ranganna K.; Eisen H.; Aggarwal S.
Institution
(Siddiqui, Hanif, Hasni, Ranganna, Eisen, Aggarwal) Drexel University
College of Medicine, Philadelphia, Pennsylvania, United States
(Siddiqui, Hanif, Hasni, Ranganna, Eisen, Aggarwal) Hahnemann University
Hospital, Philadelphia, Pennsylvania, United States
(Alvarez) Seton Hall University, St. Francis Medical Center, Trenton, New
Jersey, United States
(Aslam, Bakar) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Khan) Aga Khan University Medical College, Karachi, Pakistan
(Aslam) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard University, Boston, Massachusetts, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Acute kidney injury (AKI) is commonly associated with aortic valve
replacement. Surgical aortic valve replacement (SAVR) is a known risk
factor for AKI but little is known about the short- and long-term effects
of transcatheter aortic valve implantation (TAVI). The purpose of our
analysis is to identify the short- and long-term effect of TAVI on renal
outcomes. We searched Medline and PUBMED from January 1, 2000 to November
6, 2017 for randomized control trials (RCTs) comparing TAVI to SAVR in
patients with severe aortic stenosis. Three hundred sixty-nine trials were
identified, 6 RCTs were included in our analysis. RevMan version 5.3 was
used for statistical analysis. Heterogeneity is calculated using
I² statistics. Primary outcomes were AKI within 30 days and 1
year of TAVI, and requirement for renal replacement therapy. We included
5,536 patients (2,796 in TAVI and 2,740 in SAVR arm) from 6 RCTs. Baseline
characteristics were similar. There was reduced incidence of AKI at 30
days of TAVI compared with SAVR, 57 versus 133 (odds ratio [OR] 0.40,
confidence interval [CI] 0.28 to 0.56, p <0.00001, I² = 7%)
with no difference at 1 year (OR 0.65, CI 0.32 to 1.32, p = 0.23,
I² = 76%) and need for renal replacement therapy OR 0.95, CI
0.50 to 1.80, p = 0.87, I² = 0%). Permanent pacemaker was more
frequent in the TAVI arm compared with SAVR arm, 379 versus 110, (OR 3.75,
CI 1.67 to 8.42, p = 0.001, I² = 89%). In conclusion, TAVI is
associated with a reduction in AKIs at 30 days despite the exposure to
contrast and higher incidence of new permanent pacemaker
placement.<br/>Copyright &#xa9; 2018 Elsevier Inc.

<32>
Accession Number
614075979
Title
Systematic review and meta-analysis of randomized controlled trials
assessing safety and efficacy of posterior pericardial drainage in
patients undergoing heart surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 865-875.e12),
2017. Date of Publication: 01 Apr 2017.
Author
Gozdek M.; Pawliszak W.; Hagner W.; Zalewski P.; Kowalewski J.; Paparella
D.; Carrel T.; Anisimowicz L.; Kowalewski M.
Institution
(Gozdek, Pawliszak, Anisimowicz, Kowalewski) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz,
Bydgoszcz, Poland
(Gozdek, Zalewski, Kowalewski) Department of Hygiene, Epidemiology and
Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum
UMK in Bydgoszcz, Bydgoszcz, Poland
(Hagner) Chair and Clinic of Rehabilitation, Faculty of Health Sciences,
Nicolaus Copernicus University in Torun, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Paparella) Division of Cardiac Surgery, Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Bari, Italy
(Carrel) Clinic for Cardiovascular Surgery, University Hospital and
University of Bern, Bern, Switzerland
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To investigate the potential beneficial effects of posterior
pericardial drainage in patients undergoing heart surgery. Methods
Multiple online databases and relevant congress proceedings were screened
for randomized controlled trials assessing the efficacy and safety of
posterior pericardial drainage, defined as posterior pericardiotomy
incision, chest tube to posterior pericardium, or both. Primary endpoint
was in-hospital/30 days' cardiac tamponade. Secondary endpoints comprised
death or cardiac arrest, early and late pericardial effusion,
postoperative atrial fibrillation (POAF), acute kidney injury, pulmonary
complications, and length of hospital stay. Results Nineteen randomized
controlled trials that enrolled 3425 patients were included. Posterior
pericardial drainage was associated with a significant 90% reduction of
the odds of cardiac tamponade compared with the control group: odds ratio
(95% confidence interval) 0.13 (0.07-0.25); P < .001. The corresponding
event rates were 0.42% versus 4.95%. The odds of early and late
pericardial effusion were reduced significantly in the intervention arm:
0.20 (0.11-0.36); P < .001 and 0.05 (0.02-0.10); P < .001, respectively.
Posterior pericardial drainage significantly reduced the odds of POAF by
58% (P < .001) and was associated with significantly shortened (by nearly
1 day) overall length of hospital stay (P < .001). Reductions in
postoperative complications translated into significantly reduced odds of
death or cardiac arrest (P = .03) and numerically lower odds of acute
kidney injury (P = .08). Conclusions Posterior pericardial drainage is
safe and simple technique that significantly reduces not only the
prevalence of early pericardial effusion and POAF but also late
pericardial effusion and cardiac tamponade. These benefits, in turn,
translate into improved survival after heart surgery.<br/>Copyright &#xa9;
2016 The American Association for Thoracic Surgery

<33>
Accession Number
613930457
Title
Risk factors and prognosis of postpericardiotomy syndrome in patients
undergoing valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 878-885.e1),
2017. Date of Publication: 01 Apr 2017.
Author
Bunge J.J.; Doevendans P.A.; Suyker W.J.; Bredee J.J.; Buhre W.F.;
Dieleman J.M.; van Dijk D.; van Herwerden L.A.; Kalkman C.J.; van
Klarenbosch J.; Moons K.G.; Nathoe H.M.; Numan S.C.; Ottens T.H.; Roes
K.C.; Sauer A.-M.C.; Slooter A.J.; van Osch D.; Jacob K.A.; Nierich A.P.;
Ennema J.J.; Rosseel P.M.; van der Meer N.J.; van der Maaten J.M.; Cernak
V.; Hofland J.; van Thiel R.J.; Diephuis J.C.; Schepp R.M.; Haenen J.; de
Lange F.; Boer C.; de Jong J.R.; Tijssen J.G.
Institution
(van Osch, Doevendans, Nathoe) Department of Cardiology, University
Medical Center Utrecht, Utrecht, Netherlands
(Dieleman, van Dijk) Department of Anesthesiology and Intensive Care,
University Medical Center Utrecht, Utrecht, Netherlands
(Suyker) Department of Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bunge) Department of Intensive Care, Erasmus Medical Center, Rotterdam,
Netherlands
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The study aim was to investigate the long-term prognosis and
risk factors of postpericardiotomy syndrome (PPS). Methods We performed a
single-center cohort study in 822 patients undergoing nonemergent valve
surgery. Risk factors of PPS were evaluated using multivariable logistic
regression analysis. We also compared the incidence of reoperation for
tamponade at 1 year between patients with and without PPS. Main secondary
outcomes were hospital stay and mortality. Results Of the 822 patients,
119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per
point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was
associated with a lower risk of PPS, whereas preoperative treatment for
pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20)
was associated with a higher risk of PPS. The incidence of reoperation for
tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49;
95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2%
versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13
days (interquartile range, 9-18 days) versus 11 days (interquartile range,
8-15 days) (P = .001), respectively. Conclusions Despite longer hospital
stays and more short-term reoperations for tamponade, patients with PPS
had an excellent 1-year prognosis.<br/>Copyright &#xa9; 2016 The American
Association for Thoracic Surgery

<34>
Accession Number
613951017
Title
The effects of postoperative hematocrit on shunt occlusion for neonates
undergoing single ventricle palliation.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 947-955),
2017. Date of Publication: 01 Apr 2017.
Author
Anderson B.R.; Blancha V.L.; Duchon J.M.; Chai P.J.; Kalfa D.; Bacha E.A.;
Krishnamurthy G.; Ratner V.
Institution
(Anderson) Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan
Stanley Children's Hospital, Columbia University Medical Center, New York,
NY, United States
(Krishnamurthy, Ratner) Division of Neonatology,
NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia
University Medical Center, New York, NY, United States
(Blancha) Columbia University College of Physicians and Surgeons, New
York, NY, United States
(Duchon) Division of Pediatric Infectious Disease,
NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, NY,
United States
(Chai, Kalfa, Bacha) Division of Cardiothoracic Surgery, Columbia
University College of Physicians and Surgeons, New York, NY, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives Our primary objective was to test the effects of first
postoperative hematocrit on early shunt occlusion for children undergoing
systemic to pulmonary artery shunt placement. Because any intervention to
reduce shunt occlusion is only beneficial if it reduces mortality or is,
at least, mortality neutral, we also tested the effects of first
postoperative hematocrit on in-hospital mortality. Methods We conducted a
retrospective study on all neonates who underwent primary systemic to
pulmonary artery shunt placement, with or without a
Norwood/Damus-Kaye-Stansel procedure, at Columbia University Medical
Center between January 2010 and July 2015. Univariable regression was used
to test the effects of first postoperative hematocrit on early shunt
occlusion and 30-day mortality, clustering standard errors by surgeon. In
secondary analyses, we also tested associations between red blood cell
transfusion volumes in the first 24 postoperative hours and first
postoperative hematocrit, shunt occlusion, and mortality. Results Eighty
infants met inclusion criteria. Median initial postoperative hematocrit
was 41.7% (interquartile range, 37.9-46.0). Six infants (7.5%) died. Four
infants (5.0%) died within the first 30 days. Five infants (6.3%)
experienced early shunt occlusion. No children with early shunt occlusion
died. In univariable models, for every 5 additional percentage points of
hematocrit, an infant's odds of early shunt occlusion more than doubled
(odds ratio, 2.70; P = .009). The odds of all-cause 30-day mortality
remained unchanged. Conclusions Higher postoperative hematocrit levels are
associated with early shunt occlusions in infants undergoing primary
systemic to pulmonary artery shunt placement. Multicenter investigations
are warranted to validate these findings and to determine ideal
postoperative hematocrit targets for this population.<br/>Copyright &#xa9;
2016 The American Association for Thoracic Surgery

<35>
Accession Number
614669025
Title
Comparison of right ventricle-pulmonary artery shunt position in the
Single Ventricle Reconstruction trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1490-1500.e1),
2017. Date of Publication: June 2017.
Author
Andersen N.D.; Meza J.M.; Byler M.R.; Lodge A.J.; Hill K.D.; Hornik C.P.;
Jaquiss R.D.B.
Institution
(Andersen, Meza, Lodge, Jaquiss) Division of Cardiovascular and Thoracic
Surgery, Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Hill, Hornik) Division of Pediatric Cardiology, Department of Pediatrics,
Duke University Medical Center, Durham, NC, United States
(Meza, Hill, Hornik) Duke Clinical Research Institute, Durham, NC, United
States
(Meza) Hospital for Sick Children, The Congenital Heart Surgeons' Society
Data Center, Toronto, Ontario, Canada
(Byler) Department of Surgery, University of Virginia, Charlottesville,
Va, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Placement of a right ventricle-pulmonary artery shunt to the
left or right of the neoaorta may influence reinterventions, pulmonary
artery development, and survival after the Norwood procedure because of
differences in shunt and pulmonary artery geometry and blood flow. Methods
We analyzed the Pediatric Heart Network Single Ventricle Reconstruction
Trial public use dataset. Comparisons were made between patients who
received a left- or right-sided right ventricle-pulmonary artery shunt
during the Norwood procedure in both the overall (n = 274) and the
propensity score-matched (67 pairs) patient cohorts. Results A left-sided
shunt was placed in 168 patients (61%), and a right-sided shunt was placed
in 106 patients (39%). At the 12-month follow-up, there were no
differences in pulmonary artery measurements, hemodynamic measurements, or
pulmonary artery reinterventions between shunt groups. However, the
right-sided shunt was associated with fewer surgical shunt revisions in
both the overall (8.3 vs 1.9 events per 100 infants, P = .05) and the
propensity score-matched (17.9 vs 0 events per 100 infants, P < .001)
patient cohorts. In the propensity score-matched cohort only, right-sided
shunts were further associated with fewer serious adverse events (84 vs 46
events per 100 infants, P = .01) and improved transplantation-free
survival at 3 years follow-up (61% [95% confidence interval, 48-72] vs 80%
[95% confidence interval, 69-88], P = .04). Conclusions In the Single
Ventricle Reconstruction trial, right ventricle-pulmonary artery shunt
placement to the right of the neoaorta was associated with fewer shunt
revisions and may contribute to improved outcomes in select
patients.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery

<36>
Accession Number
615369098
Title
Apneic oxygen insufflation decreases the incidence of hypoxemia during
one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A
randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (1) (pp 360-366),
2017. Date of Publication: July 2017.
Author
Jung D.M.; Ahn H.J.; Jung S.-H.; Yang M.; Kim J.A.; Shin S.M.; Jeon S.
Institution
(Jung, Ahn, Yang, Kim, Jeon) Department of Anesthesiology and Pain
Medicine, Samsung Medical Centre, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Shin) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Jung) Biostatistics and Clinical Epidemiology Centre, Research Institute
for Future Medicine, Samsung Medical Centre, Seoul, South Korea
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Hypoxemia is common during one-lung ventilation (OLV) for
thoracic surgery. When hypoxemia occurs, surgery is interrupted for rescue
ventilation. Apneic oxygen insufflation (AOI), which provides
O<inf>2</inf> without applying pressure, may prevent hypoxemia and does
not interrupt surgery. The aim of this study was to determine the
effectiveness of the AOI technique for preventing hypoxemia during OLV in
thoracic surgery. Methods Patients undergoing open or thoracoscopic
pulmonary lobectomy from September to December 2015 were included.
Patients were assigned randomly to a non-AOI group or an AOI group (n = 45
each). OLV was initiated and at the 15-minute mark (OLV15), patients in
the AOI group received oxygen insufflation at 3 L/min to the nonventilated
lung for 30 minutes (OLV45). The primary endpoint was the occurrence of
hypoxemia (SaO<inf>2</inf> <90%) during OLV. Results The demographic and
operative data were similar between the 2 groups. The incidence of
hypoxemia was greater in the non-AOI than the AOI group (18% vs 0%; P
=.009). DELTAPaO<inf>2</inf> (the difference in partial pressure of oxygen
in arterial blood between OLV 45 and 15 minutes) was smaller in the AOI
than the non-AOI group (-29 mm Hg vs -69 mm Hg; P =.005). Duration of
surgery and incidence of complications did not vary between groups.
Conclusions AOI decreases the incidence of hypoxemia and improves arterial
oxygenation during OLV for open and thoracoscopic surgery. AOI may be a
valuable option to prevent hypoxemia. It can be used before relying on
continuous positive airway pressure or intermittent two-lung ventilation
and result in fewer interruptions in surgery.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery

<37>
Accession Number
613945281
Title
Randomized, multicenter trial comparing sternotomy closure with rigid
plate fixation to wire cerclage.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 888-896.e1),
2017. Date of Publication: 01 Apr 2017.
Author
Allen K.B.; Thourani V.H.; Naka Y.; Grubb K.J.; Grehan J.; Patel N.; Guy
T.S.; Landolfo K.; Gerdisch M.; Bonnell M.; Cohen D.J.
Institution
(Allen) Department of Cardiothoracic Surgery, Saint Luke's Mid America
Heart Institute and University of Missouri-Kansas City School of Medicine,
Kansas City, Mo, United States
(Cohen) Department of Cardiology, Saint Luke's Mid America Heart Institute
and University of Missouri-Kansas City School of Medicine, Kansas City,
Mo, United States
(Thourani) Department of Cardiothoracic Surgery, Emory University,
Atlanta, Ga, United States
(Naka) Department of Cardiothoracic Surgery, Columbia University Medical
Center, New York, NY, United States
(Grubb) Department of Cardiothoracic Surgery, University of Louisville,
Louisville, Ky, United States
(Grehan) Department of Cardiothoracic Surgery, Allina Health, Saint Paul,
Minn, United States
(Patel) Department of Cardiothoracic Surgery, Lenox Hill Hospital, New
York, NY, United States
(Guy) Department of Cardiothoracic Surgery, Temple University,
Philadelphia, Pa, United States
(Landolfo) Department of Cardiothoracic Surgery, Mayo Clinic,
Jacksonville, Fla, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan St. Francis
Health, Indianapolis, Ind, United States
(Bonnell) Department of Cardiothoracic Surgery, University of Toledo,
Toledo, Ohio, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To evaluate sternal healing, complications, and costs after
sternotomy closure with rigid plate fixation or wire cerclage. Methods
This prospective, single-blinded, multicenter trial randomized 236
patients at 12 US centers at the time of sternal closure to either rigid
plate fixation (n = 116) or wire cerclage (n = 120). The primary endpoint,
sternal healing at 6 months, was evaluated by a core laboratory using
computed tomography and a 6-point scale (greater scores represent greater
healing). Secondary endpoints included sternal complications and costs
from the time of sternal closure through 6 months. Results Rigid plate
fixation resulted in better sternal healing scores at 3 (2.6 +/- 1.1 vs
1.8 +/- 1.0; P < .0001) and 6 months (3.8 +/- 1.0 vs 3.3 +/- 1.1; P =
.0007) and greater sternal union rates at 3 (41% [42/103] vs 16% [16/102];
P < .0001) and 6 months (80% [81/101] vs 67% [67/100]; P = .03) compared
with wire cerclage. There were fewer sternal complications through 6
months with rigid plate fixation (0% [0/116] vs 5% [6/120]; P = .03) and a
trend towards fewer sternal wound infections (0% [0/116] vs 4.2% [5/120];
P = .06) compared with wire cerclage. Although rigid plate fixation was
associated with a trend toward greater index hospitalization costs
($23,437 vs $20,574; P = .11), 6-month follow-up costs tended to be lower
($9002 vs $13,511; P = .14). As a result, total costs from randomization
through 6 months were similar between groups ($32,439 vs $34,085; P =
.61). Conclusions Sternotomy closure with rigid plate fixation resulted in
significantly better sternal healing, fewer sternal complications, and no
additional cost compared with wire cerclage at 6 months after
surgery.<br/>Copyright &#xa9; 2016 The American Association for Thoracic
Surgery

<38>
Accession Number
613977497
Title
Incidence of sternal wound infection after tracheostomy in patients
undergoing cardiac surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1394-1400.e7),
2017. Date of Publication: June 2017.
Author
Toeg H.; French D.; Gilbert S.; Rubens F.
Institution
(Toeg, Rubens) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
(French, Gilbert) Division of Thoracic Surgery, University of Ottawa,
Ottawa, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Purpose This systematic review and meta-analysis was performed to
determine whether timing or type of tracheostomy was associated with
superficial or deep sternal wound infections after cardiac surgery.
Methods All studies reporting the incidence of sternal wound infection
after tracheostomy in patients undergoing cardiac surgery were collected
and analyzed. Subgroup analyses determined a priori included timing of
tracheostomy and type of procedure (open vs percutaneous). All analyses
used the random effects model. A meta-regression analysis was performed on
the proportion of sternal wound infection and number of days between
tracheostomy and initial cardiac surgery. Results A total of 13 studies
met inclusion criteria. The incidence of sternal wound infection across
all studies reported was 7% (95% confidence interval [CI], 4-10). The
percutaneous tracheostomy group had a sternal wound infection proportion
of 3% (95% CI, 1-8), and the open tracheostomy group had a sternal wound
infection proportion of 9% (95% CI, 5-14). The incidence of sternal wound
infection with early (<14 days) (7%; 95% CI, 3-11) versus late (>=14 days)
(7%; 95% CI, 4-10) tracheostomy was similar. Meta-regression demonstrated
no significant relationship between incidence of sternal wound infection
and number of days between tracheostomy and initial cardiac surgery
(R² = 6.13%, P = .72). Reported secondary outcomes included
30-day and 1-year mortality, which were high at 23% (95% CI, 19-28) and
63% (95% CI, 43-80), respectively. Conclusions The incidence of sternal
wound infection after tracheostomy in patients undergoing cardiac surgery
remains high at 7% (95% CI, 4-10). Open or percutaneous tracheostomy after
cardiac surgery is a feasible option because the incidence of sternal
wound infection and short-term mortality are comparable. Moreover, the
timing of tracheostomy (early or late) had comparable rates of sternal
wound infection and short-term mortality.<br/>Copyright &#xa9; 2016 The
American Association for Thoracic Surgery

<39>
Accession Number
614211087
Title
A systematic review and meta-analysis of in situ versus composite
bilateral internal thoracic artery grafting.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (5) (pp
1108-1116.e16), 2017. Date of Publication: May 2017.
Author
Yanagawa B.; Verma S.; Juni P.; Tam D.Y.; Mazine A.; Puskas J.D.;
Friedrich J.O.
Institution
(Yanagawa, Verma, Tam, Mazine) Division of Cardiac Surgery, Department of
Surgery, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute,
Toronto, Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Beth Israel,
New York, NY, United States
(Friedrich) Critical Care and Medicine Departments, St Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives This meta-analysis examines whether there is any advantage of
coronary artery bypass graft with bilateral internal thoracic artery
(BITA) as an in situ versus composite graft. Methods We searched MEDLINE
and EMBASE Databases from 1996 to 2016 for studies that compared coronary
artery bypass graft with BITA as in situ versus composite graft. Data were
extracted by 2 independent investigators and meta-analyzed with the use of
random effects. Results Two randomized controlled trials (RCTs; n = 705),
2 matched (n = 1688), and 4 unadjusted observational studies (n = 3517)
met inclusion criteria. Composite grafting trended towards greater distal
anastomoses (+0.22, 95% confidence interval, -0.01 to +0.45
anastomoses/patient; P = .06 [4 unadjusted observational studies]) and
greater distal anastomoses using an internal thoracic artery (+0.80, 95%
confidence interval, 0.41-1.18 anastomoses/patient; P < .001 [1 RCT]).
There were no differences in perioperative or longer-term composite
cardiovascular outcomes comparing in situ versus composite BITA or
individual outcomes of mortality, repeat revascularization, myocardial
infarction, and cardiovascular mortality. Pooled results differed by study
type with pooled results from lower-risk-of-bias RCTs typically showing
increases in events rates, and pooled results from higher-risk-of-bias
unadjusted observational studies typically showing decreases in event
rates of in situ versus composite BITA. Post hoc subgroup analysis
suggested possible improvements in all-cause mortality and
revascularization for in situ BITA in studies with short-term (<5 years)
versus longer-term follow-up, regardless of study type. Conclusions Our
meta-analysis found that use of BITA as a composite graft configuration
facilitated greater internal thoracic artery revascularization but both
grafting strategies offer similar clinical outcomes. Our study supports
the use of in situ and composite BITA for select patients but
high-quality, long-term prospective trials are needed.<br/>Copyright
&#xa9; 2016 The American Association for Thoracic Surgery

<40>
Accession Number
614331370
Title
Remodeling root repair with an external aortic ring annuloplasty.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (5) (pp 1033-1042),
2017. Date of Publication: May 2017.
Author
Lansac E.; Di Centa I.; Sleilaty G.; Lejeune S.; Berrebi A.; Zacek P.;
Debauchez M.
Institution
(Lansac, Sleilaty, Lejeune, Berrebi, Debauchez) Department of Cardiac
Pathology, Institut Mutualiste Montsouris, Paris, France
(Di Centa) Vascular Surgery Unit, Hopital Foch, Suresnes, France
(Zacek) Department of Cardiac Surgery, Charles University in Prague,
Faculty of Medicine and Faculty Hospital, Hradec Kralove, Czechia
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Although the remodeling technique provides the most dynamic
valve-sparing root replacement, a dilated annulus (>25 mm) is a risk
factor for failure. Aortic annuloplasty aims to reduce the annulus
diameter, thus increasing coaptation height to protect the repair. The
results of 177 patients with remodeling and external aortic ring
annuloplasty were studied. Methods Data were collected from the Aortic
Valve repair InternATiOnal Registry. Preoperative aortic insufficiency
grade 3 or greater was present in 79 patients (44.7%). The valve was
bicuspid in 59 patients (33.3%). External annuloplasty was performed
through a homemade Dacron ring (56) or a dedicated expansible aortic ring
(121). Results Thirty-day mortality was 2.9% (5). Mean follow-up was 41.1
+/- 36.4 months. For the whole series, freedom from valve-related
reoperation, aortic insufficiency grade 3 or greater, aortic insufficiency
grade 2 or greater, and major adverse valve-related events were 89.5%,
90.5%, 77.4%, and 86.6% at 7 years, respectively, with similar results for
tricuspid and bicuspid valves. Since 2007, systematic use of calibrated
expansible ring annuloplasty, followed 1 year later by systematic cusp
effective height assessment, significantly increased 7-year freedom from
valve-related reoperation, aortic insufficiency grade 3 or greater, and
major adverse valve-related events up to 99.1% +/- 0.9% (P = .017), 100%
(P = .026), and 96.3% +/- 1.8% (P = .035), respectively, whereas freedom
from aortic insufficiency grade 2 or greater remained unaffected (78.1%
+/- 7.6%). Calibrated annuloplasty and effective height assessment were
identified as protective factors from reoperation: hazard ratio, 0.13; 95%
confidence interval, 0.02-1.06; P = .057 and hazard ratio, 0.11; 95%
confidence interval, 0.01-0.95; P = .044, respectively. Conclusions The
standardization of remodeling root repair with calibrated expansible
aortic ring annuloplasty and cusp effective height assessment improves
valve repair outcomes.<br/>Copyright &#xa9; 2017 The American Association
for Thoracic Surgery

<41>
Accession Number
2002554294
Title
The OPTIMIZE randomized trial to assess safety and efficacy of the Svelte
IDS and RX Sirolimus-eluting coronary stent Systems for the Treatment of
atherosclerotic lesions: Trial design and rationale.
Source
American Heart Journal. 216 (pp 82-90), 2019. Date of Publication: October
2019.
Author
Mauri L.; Doros G.; Rao S.V.; Cohen D.J.; Yakubov S.; Lasala J.; Wong
S.C.; Zidar J.; Kereiakes D.J.
Institution
(Mauri) Harvard Medical School, United States
(Doros) Baim Institute for Clinical Research, United States
(Doros) Department of Biostatistics, Boston University, United States
(Rao) The Duke Clinical Research Institute, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Yakubov) OhioHealth Riverside Methodist Hospital, United States
(Lasala) Washington University School of Medicine in St. Louis, United
States
(Wong) Weil Cornell Medicine, United States
(Zidar) University of North Carolina, United States
(Kereiakes) The Christ Hospital and Lindner Research Center, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Coronary stenting without angioplasty pretreatment (direct stenting) may
simplify procedures in appropriate lesions. Direct stenting is facilitated
by smaller profile coronary stent platforms. The present study was
designed for regulatory approval of a novel drug-eluting coronary stent
and incorporates both randomized comparison for non-inferiority to an
approved predicate device as well as a nested evaluation of subjects
eligible for direct stenting. Study Design and Objectives: Prospective,
single-blind, randomized, active-control, multi-center study designed to
assess the safety and efficacy of the novel Svelte sirolimus-eluting stent
(SES) systems. A total of 1630 subjects with up to 3 target lesions will
be randomized 1:1 to the Svelte SES versus either the Xience or Promus
everolimus-eluting stents (control). Randomization will be stratified by
whether or not a direct stenting strategy is planned by the investigator.
The primary endpoint is target lesion failure (TLF) at 12 months post
index procedure, defined as cardiac death, target vessel myocardial
infarction, or clinically driven target lesion revascularization, and the
primary analysis is a non-inferiority test with a non-inferiority margin
of 3.58%. Secondary clinical endpoints include individual components of
TLF, stent thrombosis and measures of procedural resource utilization
including contrast administration, fluoroscopy exposure and procedural
resource utilization as well as costs. <br/>Conclusion(s): The OPTMIZE
Trial will evaluate the safety, efficacy and clinical value of the novel
Svelte SES in subjects with up to 3 lesions, and will provide a comparison
of direct stenting between randomized devices.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<42>
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.<br/>Copyright &#xa9; 2019,
Springer Science+Business Media, LLC, part of Springer Nature.

<43>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9;
2019 Author(s).

<44>
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.<br/>Copyright &#xa9; The Author(s) 2019.

<45>
Accession Number
626327954
Title
Diagnostic accuracy of dobutamine stress echocardiography in the detection
of cardiac allograft vasculopathy in heart transplant recipients: A
systematic review and meta-analysis study.
Source
Echocardiography. 36 (3) (pp 528-536), 2019. Date of Publication: March
2019.
Author
Elkaryoni A.; Abu-Sheasha G.; Altibi A.M.; Hassan A.; Ellakany K.; Nanda
N.C.
Institution
(Elkaryoni, Hassan) Division of Internal Medicine, University of Missouri
Kansas City, Kansas City, MO, United States
(Abu-Sheasha) Division of Biomedical Statistics and Medical Informatics,
Medical Research Institute, Alexandria University, Alexandria, Egypt
(Altibi) Division of Internal Medicine, Henry Ford Allegiance Health,
Jackson, MI, United States
(Ellakany) Division of Cardiovascular Disease, University of Alexandria
School of medicine, Alexandria, Egypt
(Nanda) Division of Cardiovascular Disease, University of Alabama at
Birmingham, Birmingham, AL, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Dobutamine stress echocardiography (DSE) is a well-established
imaging modality used to screen patients with mild-to-moderate risk for
coronary artery disease. In heart transplantation recipients, cardiac
allograft vasculopathy (CAV) is a common and lethal complication. The use
of DSE to detect CAV showed promising results initially, but later studies
showed limitation in its use to detect CAV. It is unclear if this cohort
of patients derives benefit from DSE. <br/>Method(s): We searched PubMed,
Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and
Scopus from inception through March 2018 for studies examining the
accuracy of DSE in correlation to coronary angiography (CA) or
intravascular ultrasound (IVUS) to detect CAV. Original studies comparing
the ability of DSE to detect CAV in comparison with CA or IVUS were
included. Relevant data were extracted and hierarchical summary receiver
operating characteristic analysis was conducted to test the overall
diagnostic accuracy of DSE for patients with CAV. <br/>Result(s): Eleven
studies (749 participants) met the inclusion criteria. The sensitivity of
DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%.
Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%-82.3%)
and specificity 85.7% (95% CI, 73.8%-92.7%). DSE had an overall diagnostic
odds ratio (OR) of 9.1 (95% CI, 4.6-17.8), positive likelihood ratio (LR+)
of 4.1 (95% CI, 2.8-6.1), negative likelihood ratio (LR-) of 0.47 (95% CI:
0.23-0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72-0.75).
Heterogeneity among studies was not statistically significant
(tau²= 0.32, Cochran's Q = 9.5, P = 0.483). <br/>Conclusion(s):
Dobutamine stress echocardiography has a limited sensitivity to detect
early CAV but its specificity is much higher. There remains a need for an
alternative noninvasive modality which will have both high sensitivity and
high specificity for detecting CAV.<br/>Copyright &#xa9; 2019 Wiley
Periodicals, Inc.

<46>
Accession Number
2000821648
Title
Critical evaluation on proper antithrombotic treatment in different groups
of patients undergoing vascular surgery.
Source
Hellenic Journal of Cardiology. 59 (6) (pp 313-316), 2018. Date of
Publication: November - December 2018.
Author
Filis K.; Tsioufis C.; Sianou A.; Triantafillou K.; Sigala F.; Galyfos G.
Institution
(Filis, Sigala, Galyfos) First Department of Propedeutic Surgery,
Hippocration Hospital, National and Kapodistrian University of Athens,
School of Medicine, Athens, Greece
(Tsioufis) First Cardiology Clinic, Medical School, National and
Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
(Sianou) Department of Microbiology, Areteion Hospital, National and
Kapodistrian University of Athens, School of Medicine, Athens, Greece
(Triantafillou) First Department of Cardiac Surgery, Hippocration
Hospital, Athens, Greece
Publisher
Hellenic Cardiological Society
Abstract
Antithrombotic treatment including anticoagulants and antiplatelets has
evolved during the last decades, and several recommendations have been
included in the latest guidelines regarding the proper management of
patients undergoing vascular surgery. However, there are significant
differences compared to older recommendations, and indications vary among
patients with peripheral artery disease, carotid disease, and abdominal
aortic aneurysm. In this mini review, we critically evaluate all these
data to produce useful conclusions for everyday clinical
practice.<br/>Copyright &#xa9; 2018 Hellenic Society of Cardiology

<47>
Accession Number
627259568
Title
Cardiac surgery 2018 reviewed.
Source
Clinical Research in Cardiology. 108 (9) (pp 974-989), 2019. Date of
Publication: 01 Sep 2019.
Author
Doenst T.; Bargenda S.; Kirov H.; Moschovas A.; Tkebuchava S.; Safarov R.;
Diab M.; Faerber G.
Institution
(Doenst, Bargenda, Kirov, Moschovas, Tkebuchava, Safarov, Diab, Faerber)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University of
Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
For the year 2018, more than 22,000 published references can be found in
PubMed when entering the search term "cardiac surgery". As in the last 4
years, this review focusses on conventional cardiac surgery publications
which provide important and interesting information especially relevant
for non-surgical colleagues. Interventional techniques have been
considered if they were published in the context of classic surgical
techniques. We have again reviewed the fields of coronary
revascularization and valve surgery and briefly touched on aortic surgery
and surgery for terminal heart failure. For revascularization of complex
coronary artery disease, bypass grafting was reconfirmed as gold standard
and computer-tomographic angiography established equipoise for
decision-making with classic angiography. For aortic valve treatment, some
new longer-term outcomes from TAVI vs. SAVR trials confirmed equipoise of
both treatments for high and medium risk. New information was provided for
INR-management of mechanical aortic valves as well as long-term
experiences for alternatives to mechanical valves (i.e., Ross and the
relatively new Ozaki procedure). In the mitral and tricuspid field,
prevalence data illustrate a significant amount of under-treatment for
mitral and tricuspid valve regurgitation and evidence for life
prolonging-effects of surgery. Finally, elongation of the ascending aorta
was identified as new risk factor for aortic dissection and 2 years
outcome of the newest generation of left ventricular assist devices
demonstrate impressive improvements in outcome. While this article
attempts to summarize the most pertinent publications, it does not expect
to be complete and cannot be free of individual interpretation. As in
recent years, it provides a condensed summary that is intended to give the
reader "solid ground" for up-to-date decision-making in cardiac surgery
and a stimulus for in-depth reading.<br/>Copyright &#xa9; 2019,
Springer-Verlag GmbH Germany, part of Springer Nature.

<48>
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. 34 (8) (pp 714-716), 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.<br/>Copyright &#xa9; 2019 Wiley Periodicals,
Inc.

<49>
Accession Number
2002370320
Title
Inter- and intrasite variability of mortality and stroke for sites
performing both surgical and transcatheter aortic valve replacement for
aortic valve stenosis in intermediate-risk patients.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Greason K.L.; Blackstone E.H.; Rajeswaran J.; Lowry A.M.; Svensson L.G.;
Webb J.G.; Tuzcu E.M.; Smith C.R.; Makkar R.R.; Mack M.J.; Thourani V.H.;
Kodali S.K.; Leon M.B.; Miller D.C.
Institution
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
Minn, United States
(Blackstone, Rajeswaran, Lowry, Svensson) Department of Thoracic and
Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, OH,
United States
(Blackstone, Rajeswaran, Lowry) Department of Quantitative Health Sciences
Cleveland Clinic, Research Institute, Cleveland, United States
(Svensson) Aorta Center, Heart and Vascular Institute, Cleveland, United
States
(Webb) Department of Cardiology, St. Paul's Hospital, Vancouver, British
Columbia, Canada
(Tuzcu) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, United States
(Smith) Department of Surgery, Columbia University Medical Center of New
York Presbyterian Hospital, New York, NY, United States
(Makkar) Department of Cardiovascular Diseases, Cedars-Sinai Medical
Center, Los Angeles, Calif, United States
(Mack) Cardiovascular Service Line, Baylor Scott & White Health, Plano,
Tex, United States
(Thourani) Department of Cardiac Surgery, MedStar Heart & Vascular
Institute, Georgetown University School of Medicine, Washington, DC,
United States
(Kodali, Leon) Structural Heart & Valve Center, Division of Cardiology,
NewYork-Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
(Kodali, Leon) Center for Interventional Vascular Therapy, Division of
Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Miller) Department of Cardiovascular Surgery, Stanford University School
of Medicine, Stanford, Calif, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Multisite procedure-based randomized trials may be confounded
by performance variability and variability among sites. Therefore, we
studied variability in mortality and stroke after patients were randomized
to surgical (SAVR) or transcatheter aortic valve replacement (TAVR) in the
Placement of Aortic Transcatheter Valves-2A (PARTNER-2A) randomized trial.
<br/>Method(s): Patients at intermediate risk for SAVR were randomized to
SAVR (n = 1017) or TAVR (n = 1011) with a SAPIEN XT device (Edwards
Lifesciences, Irvine, Calif) at 54 sites. Patients were followed to 2
years. A mixed-effect model quantified variability at intersite and
intrasite levels. <br/>Result(s): There were 336 deaths (SAVR 170, TAVR
166) and 176 strokes (SAVR 85, TAVR 91). Intersite variability for
mortality was similar across sites for SAVR (hazard ratios ranging from
0.52-1.93 among sites) and TAVR (hazard ratios ranging from 0.49-2.03),
but intersite variability for stroke was greater for SAVR (hazard ratios
ranging from 0.44-2.26) than for TAVR (no detectable variability). Case
mix and lower site trial volume accounted for 37% of mortality intersite
variability for SAVR and 73% for TAVR, but only 14% for stroke for SAVR.
Intrasite mortality hazard ratios demonstrated all but 1 site's 95%
confidence interval overlapped 1.0, indicating generally similar SAVR and
TAVR mortalities within sites. <br/>Conclusion(s): Intersite variability
was similar for mortality in SAVR and TAVR, but variability for stroke was
greater for SAVR than for TAVR. Intrasite events were similar for both
SAVR and TAVR. These findings suggest that in performance-based trials,
site variability and its sources should be taken into account in analyzing
and interpreting trial results.<br/>Copyright &#xa9; 2019

<50>
Accession Number
2002349811
Title
Video-assisted thoracoscopic surgery versus thoracotomy for non-small cell
lung cancer: A meta-analysis.
Source
Combinatorial Chemistry and High Throughput Screening. 22 (3) (pp
187-193), 2019. Date of Publication: 2019.
Author
Ye B.; Wang M.
Institution
(Ye) Department of Thoracic Surgery, Hangzhou Red Cross Hospital,
Hangzhou, Zhejiang, China
(Wang) Department of Thoracic Surgery, Shulan (Hangzhou) Hospital,
Hangzhou, Zhejiang, China
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Patients undergoing surgery for non-small cell lung cancer
(NSCLC) are often elderly and have co-morbidity conditions and decreased
performance status. Compared with open thoracotomy, video-assisted
thoracoscopic lobectomy is associated with fewer postoperative
complications. Despite encouraging results for patients with NSCLC who
underwent VATS, the procedure is still not widely accepted, and large
retrospective studies have yielded conflicting results. <br/>Objective(s):
In video-assisted lobectomy for NSCLC, it has remained controversial
whether mediastinal lymphadenectomy can be performed as effectively as an
open procedure via thoracotomy. To deal with inherent biases in any
non-randomized comparison, we analyzed propensity-matched studies and
randomized controlled trials. The aim of this study was to evaluate the
treatment outcomes of VATS and open thoracotomy for NSCLC patients.
<br/>Method(s): We collected publications on comparison of VATS versus
open thoracotomy for NSCLC patients from 2007 to 2017. All trials analyzed
the summary Hazard Ratios (HRs) of the endpoints of interest, including
perioperative mortality and morbidity, and individual postoperative
complications. Revman 5.3 software was used to analyze the combined pooled
HRs using fixed-or random-effects models according to heterogeneity.
<br/>Result(s): A systematic literature search was conducted including 15
studies. The results indicated that VATS was associated with lower
postoperative morbidity and mortality, and significantly lower rates of
prolonged pneumonia, atrial arrhythmias and renal failure.
<br/>Conclusion(s): Compared with lobectomy by thoracotomy, thoracoscopic
lobectomy is associated with a lower incidence of major complications,
including lower rates of prolonged pneumonia, atrial arrhythmias and renal
failure. Lobectomy via VATs may be the preferred strategy for
appropriately selected NSCLC patients. The determinants of this advantage
should be analyzed to improve the safety and outcomes of other thoracic
procedures.<br/>Copyright &#xa9; 2019 Bentham Science Publishers.

<51>
Accession Number
628600933
Title
Perioperative dental screening and treatment in patients undergoing
cardio-thoracic surgery and interventional cardiovascular procedures. A
consensus report based on RAND/UCLA methodology.
Source
International journal of cardiology. 292 (pp 78-86), 2019. Date of
Publication: 01 Oct 2019.
Author
Cotti E.; Cairo F.; Bassareo P.P.; Fonzar F.; Venturi M.; Landi L.;
Parolari A.; Franco V.; Fabiani C.; Barili F.; Di Lenarda A.; Gulizia M.;
Borzi M.; Campus G.; Musumeci F.; Mercuro G.
Institution
(Cotti) Department of Conservative Dentistry and Endodontics, University
of Cagliari, Italy
(Cairo) Research Unit in Periodontology and Periodontal Medicine,
University of Florence, Italy
(Bassareo) University College of Dublin, Mater Misericordiae University
Teaching Hospital, Dublin, Ireland
(Fonzar) Private practice, Udine, Italy
(Venturi) Private practice, Bologna, Italy
(Landi) Private practice, Verona, Roma, Italy
(Parolari) Unit of Cardiac Surgery and Translational Researh, IRCCS
Policlinico S. Donato, San Donato, Italy
(Franco, Fabiani) Private practice, Roma, Italy
(Barili) Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
(Di Lenarda) Cardiovascular Center ASS1, Trieste, Italy
(Gulizia) Division of Cardiology, Hospital "Garibaldi-Nesima", Catania,
Italy
(Borzi) Department of Cardiovascular Disease, University of Rome Tor
Vergata, Rome, Italy
(Campus) Department of Surgery, Microsurgery and Medicine Sciences,
University of Sassari, Italy
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Roma, Italy
(Mercuro) Department of Medical Sciences, Cagliari, Italy
Publisher
NLM (Medline)
Abstract
AIM: To reach a consensus on a consistent strategy to adopt when screening
patients for dental/periodontal infections, and on the feasibility of
providing dental treatment before cardiothoracic surgery, cardiovascular
surgery or other cardiovascular invasive procedures. METHODOLOGY: A panel
of experts from six Italian scientific societies was created. The
deliberations of the panel were based on the RAND method. From an initial
systematic literature review, it became clear that a consensually
validated protocol for the reproducible dental screening of patients
awaiting cardiac interventions was considered mandatory by professionals
with expertise in the dental, cardiologic and cardiac surgery areas.
However, systematic review also concluded that the treatment options to be
provided, their prognosis and timing in relation to the physical condition
of patients had never been defined. Following the systematic review
several fundamental questions were generated. The panel was divided into
two working groups each of which produced documents that addressed the
topic and which were subsequently used to generate a questionnaire. Each
member of the panel completed the questionnaire independently and then a
panel discussion was held to reach a consensus on how best to manage
patients with dental/periodontal infections who were awaiting invasive
cardiac procedures. <br/>RESULT(S): A high level of agreement was reached
regarding all the items on the questionnaire, and each of the clinical
questions formulated were answered. Three tables were created which can be
used to generate a useful tool to provide standardized dental/periodontal
screening of patients undergoing elective cardiovascular interventions,
and to summarize both the possible oral and cardiovascular conditions of
the patient and the timing available for the procedures considered.
<br/>CONCLUSION(S): Upon publication of this consensus document, the
dissemination of the information to a wide dental and cardiac audience
should commence. The authors hope that this consensus can become a model
for the development of a dedicated protocol, ideally usable by heart and
dental teams in the pre-interventional preparation phase.<br/>Copyright
&#xa9; 2019 Elsevier B.V. All rights reserved.

<52>
Accession Number
2002138523
Title
Traditional Chinese Medicine Treatment as Adjuvant Therapy in Completely
Resected Stage IB-IIIA Non-Small-Cell Lung Cancer: Study Protocol for a
Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial.
Source
Clinical Lung Cancer. 20 (5) (pp e541-e547), 2019. Date of Publication:
September 2019.
Author
Jiang Y.; Liu L.-S.; Shen L.-P.; Liu J.-X.; Jiang G.-N.; Gu A.-Q.; Li
H.-C.; Li Q.; Li H.-G.; Huang P.-X.
Institution
(Jiang, Liu, Shen, Liu, Li) Department of Oncology, Longhua Hospital,
Shanghai University of Traditional Chinese Medicine, Shanghai, China
(Li) Department of Oncology, Shuguang Hospital, Shanghai University of
Traditional Chinese Medicine, Shanghai, China
(Huang) Department of Health Statistics, Shanghai University of
Traditional Chinese Medicine, Shanghai, China
(Jiang) Department of Thoracic Surgery, Shanghai Pulmonary Hospital,
Tongji University, Shanghai, China
(Gu) Department of Respiratory Medicine, Shanghai Chest Hospital,
Shanghai, China
(Li) Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong
University, Shanghai, China
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Adjuvant chemotherapy (AC) has been proven to yield an approximately 5%
improvement in 5-year survival for patients with early-stage
non-small-cell lung cancer. With such small gains in survival, the optimal
treatment regimen remains to be established. Traditional Chinese medicine
(TCM) treatment in combination with AC is frequently used in China. The
efficacy and safety of this integrated approach should be scientifically
evaluated. We present the rationale and study design of the Combined
Adjuvant Chemotherapy and Traditional Chinese Medicine (ACTCM) trial
(ChiCTR-IPR-16009062). The ACTCM trial, a prospective multicenter
double-blind randomized placebo-controlled study, will recruit 312
patients overall from 5 clinical research centers in China. Within 6 weeks
of the thoracic surgery, eligible participants with stages IB-IIIA
non-small-cell lung cancer will be randomly assigned in a 1:1 ratio to
either the treatment or control group. Patients in the treatment group
will receive AC combined with TCM herbal treatment for 4 cycles, then TCM
herbal plus injection treatment for 4 cycles. Patients in the control
group will receive AC combined with TCM placebo for 4 cycles and then TCM
placebo for 4 cycles. Treatment will be discontinued if disease
progression or unacceptable toxicity occurs. The primary end point is
2-year disease-free survival. Secondary end points include disease-free
survival and quality of life. Other end points are TCM symptoms,
performance status, and safety of the regimens. Recruitment started in
October 2016 and is ongoing.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<53>
Accession Number
628873234
Title
Renin-angiotensin blockade after aortic valve replacement: A review based
on current literature.
Source
European Journal of Preventive Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Malik A.H.; Shetty S.S.; Yandrapalli S.; Accaoui R.E.
Institution
(Malik) Department of Medicine, Westchester Medical Center, New York
Medical College, Valhalla, United States
(Shetty, Accaoui) Division of Cardiology, Department of Internal Medicine,
University of Iowa Health Care, Carver College of Medicine, Iowa City,
United States
(Yandrapalli) Division of Cardiology, Westchester Medical Center, New York
Medical College, Valhalla, United States
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)

<54>
Accession Number
2002329811
Title
Preemptive alveolar recruitment maneuver followed by PEEP in obese
patients undergoing laparoscopic gastric banding. Does it make a
difference? a randomized controlled clinical study.
Source
Open Anesthesiology Journal. 13 (1) (pp 31-39), 2019. Date of Publication:
2019.
Author
Elokda S.A.; Farag H.M.
Institution
(Elokda, Farag) Department of Anesthesia, Intensive Care, and Pain
Management, Ain Shams University, Cairo, Egypt
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Impaired respiratory functions during general anesthesia are
commonly caused by lung atelectasis more in morbidly obese patients. This
occurs more frequently with laparoscopic surgery due to trendelenburg
position and pneumoperitoneum. Preemptive recruitment maneuver + PEEP
results in the prevention of these changes. <br/>Aim(s): To quantitate the
effects of RM and PEEP on intraoperative hypoxemia and respiratory
mechanics during laparoscopic gastric banding in obese patients.
<br/>Study Design: A randomized, double-blinded, controlled study. Method
and Materials: Fifty adults ASA I-II, BMI (40-50 kg/m²) for
elective laparoscopic gastric banding were randomized into, groups C, and
RM, 25 patients each. Group C patients received standard ventilation, VT 6
ml/kg, I: E ratio 1: 2 PEEP 5 cm H<inf>2</inf> O, and respiratory rate
10-12 breaths/ min. RM patients received standard ventilation with one
alveolar recruitment maneuver after mechanical ventilation with PEEP of 15
cm H<inf>2</inf> O till the end of the surgery. Heart rate, mean blood
pressure, respiratory mechanical parameters: peak airway pressure, plateau
pressure and end-expiratory lung volume, PaO<inf>2</inf>,
PaO<inf>2</inf>/FiO<inf>2</inf> and (SpO<inf>2</inf>) were assessed.
<br/>Result(s): PaO<inf>2</inf> and PaO<inf>2</inf> /FiO<inf>2</inf> ratio
increased significantly in the RM group after RM from T2 (before
pneumoperitoneum) to T6 (end of surgery) compared with group C (P <
0.001). Peak and plateau airway pressures increased significantly in group
C from T2 till T5 (60 min after pneumoperitoneum) compared with the RM
group (P < 0.001). End-expiratory lung volume increased significantly in
the RM group after RM compared with group C (P<0.001). <br/>Conclusion(s):
Preemptive RM with PEEP of 15 cm H<inf>2</inf> O was effective in
preventing pneumoperitoneum-induced intraoperative hypoxemia and
respiratory mechanics changes.<br/>Copyright &#xa9; 2019 Elokda and Farag.

<55>
Accession Number
2002329809
Title
Bisoprolol versus corticosteroid and bisoprolol combination for prevention
of atrial fibrillation after on-pump coronary artery bypass graft surgery.
Source
Open Anesthesiology Journal. 13 (1) (pp 18-24), 2019. Date of Publication:
2019.
Author
Mahrose R.; Elsayed A.M.; Elshorbagy M.S.
Institution
(Mahrose, Elsayed, Elshorbagy) Department of Anesthesiology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: The most common cardiac arrhythmia that happens after on-pump
Coronary Artery Bypass Graft (CABG) surgery is Atrial Fibrillation (AF).
It is combined with several postoperative complications such as increased
incidence of stroke, increased hospital stay and increased costs.
<br/>Objective(s): The aim of this study was to look for safe, effective,
reliable and well tolerated tools for the prevention of atrial
fibrillation after on pump coronary artery bypass surgery. <br/>Patients
and Methods: The study enclosed 176 patients (the age ranges from 40 to 79
years) and scheduled for elective on-pump CABG operations without
concomitant procedures. The patients were selected randomly into two equal
groups. Group (A) in which bisoprolol was used to prevent atrial
fibrillation after surgery. Group (B) in which bisoprolol and
hydrocortisone were used for prevention of atrial fibrillation after
surgery. For each patient, the following data were collected: gender,
preoperative diseases, cardiopulmonary bypass time, intraoperative cross
clamp time, Left internal mammary Artery usage, incidence of postoperative
atrial fibrillation, death, myocardial infarction chest infection and
C-reactive protein amount in plasma. <br/>Result(s): There was a
statistically significant decrease in the occurrence of atrial
fibrillation in group (B) when compared to corresponding values in group
(A). Also, group (B) showed a statistically significant decrease in length
of hospital stay in comparison to group (A). C-reactive protein
concentrations on the 1^st and 2^nd postoperative days
were lower significantly in group (B) than in group (A). There were no
statistically significant differences between both groups regarding
gender, preoperative diseases, cardiorespiratory bypass time,
intraoperative cross clamp time, Left internal mammary artery usage,
death, myocardial infarction and chest infection. <br/>Conclusion(s): This
study demonstrated that using bisoprolol and hydrocortisone combination
showed greater benefit than the use of bisoprolol only for prevention of
postoperative AF after on-pump coronary artery bypass graft
surgery.<br/>Copyright &#xa9; 2019 Mahrose et al.

<56>
Accession Number
628941195
Title
Donor Simvastatin Treatment in Heart Transplantation: A Randomized and
Blinded Clinical Trial.
Source
Circulation. (no pagination), 2019. Date of Publication: 29 Jul 2019.
Author
Nykanen A.I.; Holmstrom E.J.; Tuuminen R.; Krebs R.; Dhaygude K.;
Kankainen M.; Jokinen J.J.; Lommi J.; Helantera I.; Raisanen-Sokolowski
A.; Syrjala S.O.; Lemstrom K.B.
Institution
(Nykanen, Syrjala, Lemstrom) Transplantation Laboratory; Department of
Cardiothoracic Surgery; Translational Immunology Program Research Programs
Unit, University of Helsinki and Helsinki University Hospital, Helsinki,
Finland
(Holmstrom, Tuuminen, Krebs, Dhaygude) Transplantation Laboratory;
Translational Immunology Program Research Programs Unit, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Kankainen) Translational Immunology Program Research Programs Unit;
Medical and Clinical Genetics; Institute for Molecular Medicine Finland,
University of Helsinki, Helsinki, Finland
(Jokinen) Paijat-Hame Central Hospital, Department of Surgery, Lahti,
Finland
(Lommi) Department of Cardiology, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Helantera) Transplantation and Liver Surgery, University of Helsinki and
Helsinki University Hospital, Helsinki, Finland
(Raisanen-Sokolowski) Pathology, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
Publisher
NLM (Medline)

<57>
Accession Number
628940612
Title
Peri-procedural thrombocytopenia after aortic bioprosthesis implant: A
systematic review and meta-analysis comparison among conventional,
stentless, rapid-deployment, and transcatheter valves.
Source
International journal of cardiology. (no pagination), 2019. Date of
Publication: 17 Jul 2019.
Author
Jiritano F.; Santarpino G.; Serraino G.F.; Ten Cate H.; Matteucci M.; Fina
D.; Mastroroberto P.; Lorusso R.
Institution
(Jiritano) Cardio-Thoracic Surgery Dept., Heart & Vascular Centre,
Maastricht University Medical Centre, and Cardiovascular Research
Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery
Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
Electronic address: fede.j@hotmail.it
(Santarpino) Citta di Lecce Hospital, GVM Care & Research, Lecce, Italy
(Serraino, Mastroroberto) Cardiac Surgery Unit, University "Magna Graecia"
of Catanzaro, Catanzaro, Italy
(Ten Cate) Laboratory for Clinical Thrombosis and Hemostasis, Department
of Internal Medicine, Cardiovascular Research Institute Maastricht
(CARIM), Maastricht University Medical Center, Maastricht, Netherlands
(Matteucci) Cardio-Thoracic Surgery Dept., Heart & Vascular Centre,
Maastricht University Medical Centre, and Cardiovascular Research
Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of
Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
(Fina) Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht
University Medical Centre, and Cardiovascular Research Institute
Maastricht (CARIM), Maastricht, the Netherlands; University of Milan,
IRCCS San Donato, Milan, Italy
(Lorusso) Cardio-Thoracic Surgery Dept., Heart & Vascular Centre,
Maastricht University Medical Centre, Cardiovascular Research Institute
Maastricht (CARIM), Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Thrombocytopenia has been shown to occur soon after surgical
biological aortic valve replacement (AVR), and recently reported also
after transcatheter valve implantation (TAVI). The mechanism underlying
this phenomenon is still unknown, and its clinical impact on the
peri-operative outcome has been poorly investigated. <br/>METHOD(S): A
systematic review and a meta-analysis of all available studies reporting
data about peri-procedural thrombocytopenia on isolated bio-AVR, comparing
rapid-deployment (RDV), stentless (stentless-AVR), and TAVI vs. stented
(stented-AVR) valves, have been performed. <br/>RESULT(S): Fifteen trials
(2.163 patients) were included in the meta-analysis. Perioperative
platelet reduction ranged from 35% to 55% in stented-AVR, from 60% to 77%
in stentless-AVR, from 53% to 60% in RDV, and from to 21% to 72% in TAVI
(apparently, balloon-expandable valves more frequently associated to
thrombocytopenia). Stented-AVR required more red blood cells transfusion
than stentless-AVR (P<0.0001), whereas no difference has been found
between RDV and stented-AVR. Platelet transfusion rate was very low in all
surgical groups. No difference has been found in RDV and stentless-AVR vs.
stented-AVR, in terms of reoperation for bleeding, and length-of-intensive
care unit or hospital stay. <br/>CONCLUSION(S): Thrombocytopenia-related
major adverse events were mainly reported in TAVI patients, whereas
clinically meaningless in surgical patients. Transient peri-procedural
thrombocytopenia is common after bio-AVR, regardless of prosthesis's type
or implant modality. It should receive appropriate monitoring and focused
investigations.<br/>Copyright &#xa9; 2019 The Authors. Published by
Elsevier B.V. All rights reserved.

<58>
Accession Number
626156786
Title
Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the
Critically Ill.
Source
Dysphagia. 34 (4) (pp 475-486), 2019. Date of Publication: 15 Aug 2019.
Author
Perren A.; Zurcher P.; Schefold J.C.
Institution
(Perren) Department of Physiotherapy, Inselspital, University Hospital of
Bern, Bern, Switzerland
(Zurcher, Schefold) Department of Intensive Care Medicine, Inselspital,
University Hospital of Bern, University of Bern, Freiburgstrasse 18, Bern
3010, Switzerland
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Swallowing disorders and respective consequences (including
aspiration-induced pneumonia) are often observed in extubated ICU patients
with data indicating that a large number of patients are affected. We
recently demonstrated in a large-scale analysis that the incidence of
post-extubation dysphagia (PED) is 12.4% in a general ICU population and
about 18% in emergency admissions to the ICU. Importantly, PED was mostly
sustained until hospital discharge and independently predicted 28- and
90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular
ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous
breathing, and gastrointestinal reflux, are all considered to contribute
to PED, little is known about the underlying pathomechanisms and risk
factors leading to PED in critically ill patients. Systematic screening of
all potential ICU patients for oropharyngeal dysphagia (OD) seems key for
early recognition and follow-up, as well as the design and testing of
novel therapeutic interventions. Today, screening methods and clinical
investigations for dysphagia differ considerably. In the context of a
recently proposed pragmatic screening algorithm introduced by us, we
provide a concise review on currently available non-instrumental
techniques that could potentially serve for non-instrumental OD assessment
in critically ill patients. Following systematic literature review, we
find that non-instrumental OD assessments were mostly tested in different
patient populations with only a minority of studies performed in
critically ill patients. Due to little available data on non-instrumental
dysphagia assessment in the ICU, future investigations should aim to
validate respective approaches in the critically ill against an
instrumental (gold) standard, for example, flexible endoscopic evaluation
of swallowing. An international expert panel is encouraged to addresses
critical illness-related definitions, screening and confirmatory
assessment approaches, treatment recommendations, and identifies optimal
patient-centered outcome measures for future clinical
investigations.<br/>Copyright &#xa9; 2019, Springer Science+Business
Media, LLC, part of Springer Nature.

<59>
Accession Number
614031379
Title
Is subvalvular repair worthwhile in severe ischemic mitral regurgitation?
Subanalysis of the Papillary Muscle Approximation trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (2) (pp 286-295.e2),
2017. Date of Publication: 01 Feb 2017.
Author
Nappi F.; Spadaccio C.; Nenna A.; Lusini M.; Fraldi M.; Acar C.; Chello M.
Institution
(Nappi, Spadaccio, Nenna, Lusini, Chello) Department of Cardiovascular
Surgery, Universita Campus Bio-Medico di Roma, Rome, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Fraldi) Department of Structures for Engineering and Architecture and
Interdisciplinary Research Center for Biomaterials, Universita di Napoli
"Federico II", Naples, Italy
(Acar) Department of Cardiac Surgery, Hopital La Pitie Salpetriere, Paris,
France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The symmetry of mitral valve tethering and regional left
ventricle wall dysfunction are reported to play a fundamental role in the
outcomes and long-term durability of surgical repair in ischemic mitral
regurgitation (IMR). We recently demonstrated in a randomized clinical
trial (the Papillary Muscle Approximation trial) the superiority of
papillary muscle approximation (PMA) in combination with standard
restrictive annuloplasty (RA) in severe IMR over annuloplasty alone in
terms of adverse left ventricular remodeling and mitral regurgitation (MR)
recurrence. This approach, however, failed to produce a survival advantage
and was still plagued by a high incidence of reoperation. We therefore
performed a subanalysis of the PMA trial on the basis of preoperative
parameters to elucidate the value of subvalvular surgery in certain
subcategories of patients with the aim of creating a decisional algorithm
on the best operative strategy. Methods We performed a subanalysis of PMA
trial, evaluating 96 patients with severe IMR and eligible for myocardial
revascularization randomized to PMA + RA (n = 48) versus RA alone (n = 48)
in association with coronary artery bypass grafting. Endpoints included
left ventricular remodeling, MR recurrence, overall mortality,
reoperation, and a composite cardiac endpoint (cardiac death, stroke,
reintervention, hospitalization for heart failure, or New York Heart
Association class worsening). Stratification variables were preoperative
symmetry of mitral valve tethering and regional wall motion abnormality.
Results PMA improved ventricular remodeling and recurrence of MR in both
preoperative symmetric and asymmetric tethering and in case of inferior
wall dyskinesia but did not produce an additional benefit in anterolateral
wall dysfunction. Conclusions Preoperative symmetric and asymmetric
tethering and isolated inferior wall dyskinesia are an indication for
subvalvular apparatus surgery in IMR.<br/>Copyright &#xa9; 2016 The
American Association for Thoracic Surgery

<60>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2019 Barra et al.

<61>
Accession Number
2002239196
Title
Reducing red blood cell transfusion in orthopedic and cardiac surgeries
with Antifibrinolytics: A laboratory medicine best practice systematic
review and meta-analysis.
Source
Clinical Biochemistry. 71 (pp 1-13), 2019. Date of Publication: September
2019.
Author
Derzon J.H.; Clarke N.; Alford A.; Gross I.; Shander A.; Thurer R.
Institution
(Derzon) RTI International, Research Triangle Park, NC, United States
(Clarke) Pharmerit International, Bethesda, MD, United States
(Alford) National Network of Public Health Institutes, Washington, DC,
United States
(Gross) Acumen Inc., San Diego, CA, United States
(Shander) Englewood Hospital and Medical Center, NJ, United States
(Thurer) Gauss Surgical, Los Altos, CA, United States
(Clarke) Vector Oncology, Memphis, TN, United States
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: To evaluate the effectiveness of antifibrinolytics tranexamic
acid (TA), epsilon-aminocaproic acid (EACA), and aprotinin to decrease
overuse of red blood cell transfusions in adult surgical and non-surgical
patients. <br/>Method(s): This review followed the Centers for Disease
Control and Prevention (CDC) Laboratory Medicine Best Practice (LMBPTM)
Systematic Review (A-6) method. Eligible studies were assessed for
evidence of effectiveness of TA or EACA in reducing the number of patients
transfused or the number of whole blood transfusions. <br/>Result(s):
Seventy-two articles met LMBPTM inclusion criteria. Fifty-six studies
assessed Topical, Intra-articular Injection, or Intravenous TA, 4 studied
EACA, and 12 studied the effectiveness of aprotinin. The overall strength
of the body of evidence of effectiveness for each of these practices was
rated as high. <br/>Conclusion(s): LMBPTM recommends the use of topical,
intra-articular injection, or intravenous tranexamic acid and the use of
epsilon-aminocaproic acid for reducing overuse of red blood cell
transfusion.<br/>Copyright &#xa9; 2019 The Canadian Society of Clinical
Chemists

<62>
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). <br/>Background(s): The impact of antithrombotic
regimens on clinical outcomes in patients with AF and severe aortic
stenosis treated with TAVR is unknown. <br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2019 American College of Cardiology
Foundation

<63>
Accession Number
628490513
Title
Does ex vivo perfusion lead to more or less intimal thickening in the
first-year post-heart transplantation?.
Source
Clinical Transplantation. 33 (8) (no pagination), 2019. Article Number:
e13648. Date of Publication: 2019.
Author
Sato T.; Azarbal B.; Cheng R.; Esmailian F.; Patel J.; Kittleson M.; Czer
L.; Thottam M.; Levine R.; Dimbil S.; Olymbios M.; Anzai T.; Hamilton
M.A.; Khayal T.; Kobashigawa J.A.
Institution
(Sato, Azarbal, Patel, Kittleson, Czer, Thottam, Levine, Dimbil, Olymbios,
Hamilton, Kobashigawa) Department of Cardiology, Cedars-Sinai Smidt Heart
Institute, Los Angeles, CA, United States
(Sato, Anzai) Department of Cardiovascular Medicine, Hokkaido University,
Sapporo, Japan
(Cheng, Esmailian) Cardiothoracic Surgery, Cedars-Sinai Smidt Heart
Institute, Los Angeles, CA, United States
(Khayal) TransMedics Inc., Andover, MA, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: The Organ Care System (OCS), an ex vivo heart perfusion
platform, represents an alternative to the current standard of cold organ
storage that sustains the donor heart in a near-physiologic state.
Previous reports showed that this system had significantly shortened the
cold ischemic time from standard cold storage (CS). However, the effect of
reduced ischemic injury against the coronary vascular bed has not been
examined by intravascular ultrasound (IVUS). <br/>Method(s): Between
August 2011 and February 2013, heart transplant (HTx) candidates enrolled
in the PROCEED 2 trial were randomized to either CS or OCS. IVUS was
performed at 4-6 weeks (baseline) and repeated 1 year after
transplantation. The change in maximal intimal thickness (MIT) and other
clinical outcomes were examined. <br/>Result(s): Thirty-nine patients were
randomized and underwent HTx by OCS (n=16) or CS (n=18). Of these, 18
patients (OCS: n=5, CS: n=13) with paired IVUS were examined. There were
no significant differences in the change of MIT and other clinical
outcomes between the groups. <br/>Conclusion(s): The incidence of cardiac
allograft vasculopathy in donor hearts preserved with the OCS versus CS
was similar. These results suggest that this ex vivo allograft perfusion
system is a promising and valid platform for donor heart
transportation.<br/>Copyright &#xa9; 2019 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<64>
Accession Number
628838678
Title
Application of alveolar recruitment strategy and positive end-expiratory
pressure combined with autoflow in the one-lung ventilation during
thoracic surgery in obese patients.
Source
Journal of Thoracic Disease. 11 (2) (pp 488-494), 2019. Date of
Publication: 2019.
Author
Shi Z.-G.; Geng W.-M.; Gao G.-K.; Wang C.; Liu W.
Institution
(Shi, Geng, Gao, Wang, Liu) Department of Anesthesia, Beijing Chest
Hospital, Capital Medical University, Beijing 101149, China
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: The present study aims to evaluate the influence of alveolar
recruitment strategy (ARS) and positive end-expiratory pressure (PEEP)
combined with autoflow on respiratory mechanics, the oxygen index (OI),
pulmonary shut [Qs/Qt(%)], and the concentrations of IL-6 and TNF-alpha in
venous blood after surgery in obese patients who experienced thoracic
surgery with one-lung ventilation (OLV). <br/>Method(s): A total of 36
obese patients with ASAII-III degree, who experienced selective pulmonary
lobectomy, were within 36-74 years old, and had a BMI of 30-40
kg/m², were randomly divided into two groups: control group (C
group) and protective ventilation group (P group). In the P group, ARS was
given once when OLV began. Then, ventilation at 7 mmHg of PEEP and
autoflow were given. The P<inf>peak</inf> before OLV (T<inf>1</inf>), at
30 minutes after OLV (T<inf>2</inf>), and at the 5 minutes after two-lung
ventilation (TLV) (T<inf>3</inf>), and the changes of P<inf>plat</inf> and
Cdyn were recorded. Then, arteriovenous blood was drawn at T<inf>1</inf>,
T<inf>2</inf>, T<inf>3</inf> and T<inf>4</inf> (6 hours after the
operation), blood-gas indicators, including SPO<inf>2</inf>,
PaCO<inf>2</inf> and PaO<inf>2</inf>, were measured, and the value of
Qs/Qt(%) was calculated. Afterwards, venous blood was collected at
T<inf>1</inf> and T<inf>5</inf> (18 hours after surgery), and the
concentrations of IL-6 and TNF-alpha were detected. The clinical pulmonary
infection score (CPIS) was determined at the first day and seventh day
after the operation. <br/>Result(s): In both groups, Cdyn and OI
decreased, while P<inf>plat</inf>, P<inf>peak</inf> and Qs/Qt(%) increased
(P<0.05) at T<inf>2</inf>, when compared with those at T<inf>1</inf>. At
T<inf>2</inf> and T<inf>3</inf>, P<inf>plat</inf> and P<inf>peak</inf>
decreased (P<0.05) in the P group, when compared with the C group. At
T<inf>2</inf>, T<inf>3</inf> and T<inf>4</inf>, OI increased (P<0.05) in
the P group, when compared with the C group. At T<inf>2</inf>,
T<inf>3</inf> and T<inf>4</inf>, PaCO<inf>2</inf> and Qs/Qt(%) decreased
in the P group, when compared with the C group. The concentrations of IL-6
and TNF-alpha decreased in the P group, when compared with the C group.
<br/>Conclusion(s): The ventilation model of ARS and PEEP combined with
autoflow can better reduce airway pressure and the production of injurious
inflammatory cytokines in blood in obese patients. Furthermore, it can
reduce Qs/Qt during and at 6 hours after thoracotomy, improve OI and
maintain the acid-base balance of the internal environment, which may be
applied in clinical work. This brings new enlightenment and needs to be
clarified through further studies.<br/>Copyright &#xa9; Journal of
Thoracic Disease. All rights reserved.

<65>
Accession Number
628903348
Title
Does Fenoldopam Protect Kidney in Cardiac Surgery? A Systemic Review and
Meta-Analysis with Trial Sequential Analysis.
Source
Shock. 52 (3) (pp 326-333), 2019. Date of Publication: 01 Sep 2019.
Author
Sun H.; Xie Q.; Peng Z.
Institution
(Sun, Xie, Peng) Department of Critical Care Medicine, Zhongnan Hospital,
Wuhan University, Wuhan, Hubei Province 430071, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose:To assess the benefits and harms of fenoldopam for
nephroprotective effects in adult patients undergoing cardiac surgery.
<br/>Method(s):We conducted a systematic review with meta-analysis of
randomized controlled trials (RCTs) comparing fenoldopam with placebo in
cardiac surgery. Trials were systematically searched from PubMed, EMBASE,
CENTRAL, and CNKI databases, up to July 30, 2018. A trial sequential
analysis (TSA) was used to determine whether the present evidence was
valid and conclusive for the primary outcomes. <br/>Result(s):A total of
seven randomized controlled trials involving 1,107 adult patients
undergoing cardiac surgery fulfilled the inclusion criteria. The pooled
analysis suggested that the use of fenoldopam was associated with a
reduction in the incidence of AKI (18 of 216 [8.3%] in the fenoldopam
group versus 45 of 222 [20.3%] in the placebo group, RR=0.42 [0.26, 0.69],
P=0.0006) and with a higher rate of hypotension (92/357 [25.8%] versus
51/348 [14.7%], RR=1.76 [1.29, 2.39], P=0.0003). There was no significant
effect on renal replacement therapy requirement (77 of 540 [14.3%] versus
75 of 536 [14.0%], P=0.96) or hospital mortality (87/392 [22.2%] versus
83/383 [21.7%], P=0.86). TSA supported the results of the conventional
analysis on AKI. <br/>Conclusion(s):Low-dose dopamine offers transient
improvements in renal physiology, but no good evidence shows that it
offers important clinical benefits to patients with or at risk for acute
renal failure.Among patients treated with fenoldopam, there was a decrease
in AKI and an increased incidence of hypotension, had no significant
effect on RRT or mortality. Given that most studies were small and the
definition of AKI was variable between studies, there is not enough
evidence to support the systematic use of fenoldopam in cardiac
surgery.<br/>Copyright &#xa9; 2019 by the Shock Society. Unauthorized
reproduction of this article is prohibited.

<66>
Accession Number
2002349275
Title
Barth syndrome: Mechanisms and management.
Source
Application of Clinical Genetics. 12 (pp 95-106), 2019. Date of
Publication: 2019.
Author
Finsterer J.
Institution
(Finsterer) Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna,
Austria
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Objectives: Barth syndrome is an ultra-rare, infantile-onset, X-linked
recessive mitochondrial disorder, primarily affecting males, due to
variants in TAZ encoding for the cardiolipin transacylase tafazzin. This
review aimed to summarize and discuss recent and earlier findings
concerning the etiology, pathogenesis, clinical presentation, diagnosis,
treatment, and outcome of Barth syndrome. <br/>Method(s): A literature
review was undertaken through a MEDLINE search. <br/>Result(s): The
phenotype of Barth syndrome is highly variable but most frequently
patients present with hypertrophic/dilated/non-compaction cardiomyopathy,
fibroelastosis, arrhythmias, neutropenia, mitochondrial myopathy, growth
retardation, dysmorphism, cognitive impairment, and other, rarer features.
Lactic acid and creatine kinase, and blood and urine organic acids,
particularly 3-methylglutaconic acid and monolysocardiolipin, are often
elevated. Cardiolipin is decreased. Biochemical investigations may show
decreased activity of various respiratory chain complexes. The diagnosis
is confirmed by documentation of a causative TAZ variant. Treatment is
symptomatic and directed toward treating heart failure, arrhythmias,
neutropenia, and mitochondrial myopathy. <br/>Conclusion(s): Although
Barth syndrome is still an orphan disease, with fewer than 200 cases
described so far, there is extensive ongoing research with regard to its
pathomechanism and new therapeutic approaches. Although most of these
approaches are still experimental, it can be expected that causative
strategies will be developed in the near future.<br/>Copyright &#xa9; 2019
Finsterer.

<67>
Accession Number
628886804
Title
Perioperative use of levosimendan in patients undergoing cardiac surgery:
Systematic review and meta-analysis.
Source
Colombian Journal of Anesthesiology. 47 (3) (pp 142-153), 2019. Date of
Publication: 01 Jul 2019.
Author
Oliveros H.; Garcia H.; Rubio C.; Navarrete J.
Institution
(Oliveros) Universidad de la Sabana, Campus Puente del Comun, Chia,
Cundinamarca, Colombia
(Garcia, Rubio, Navarrete) Hospital Militar Central, Bogota, Colombia
(Garcia, Rubio, Navarrete) Universidad Militar Nueva Granada, Bogota,
Colombia
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction: Patients undergoing cardiac surgery frequently develop low
cardiac output syndrome (LCOS). Multiple interventions including
levosimendan have been used in the prevention and treatment of LCOS.
Preliminary studies reported lower mortality respect to placebo or other
inotropes, however, recently, 3 clinical trials found no benefit against
this outcome. <br/>Objective(s): Our objective was to evaluate the
evidence of levosimendan on mortality and secondary outcomes in patients
undergoing cardiac surgery, and to determine the sources of heterogeneity.
<br/>Method(s): We conducted a systematic review and meta-analysis of the
clinical trials that evaluated the efficacy of levosimendan in patients
undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality
and other outcomes such as kidney injury with dialysis requirement and
LCOS, using fixed and random effects models. The risk of bias was assessed
and the sources of heterogeneity were explored. <br/>Result(s): Of 47
studies identified, 14 studies were selected (n=2752). Regarding the
mortality outcome and use of levosimendan, only a decrease was found in
the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While
high-quality studies, there was no protective effect (OR 0.99, 95% CI
0.70-1.40) with an I² = 0%. The quality of the studies and
ejection fraction were the main sources of heterogeneity.
<br/>Conclusion(s): In high-quality studies, the use of levosimendan in
patients undergoing cardiovascular surgery has no effect on 30-day
mortality. There was a protective effect on postoperative renal failure
with dialysis.<br/>Copyright &#xa9; 2019 Sociedad Colombiana de
Anestesiologia y Reanimacion (S.C.A.R.E.).

<68>
Accession Number
620728255
Title
A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve
Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 32 (6) (pp 2562-2569),
2018. Date of Publication: December 2018.
Author
Moscarelli M.; Terrasini N.; Nunziata A.; Punjabi P.; Angelini G.; Solinas
M.; Buselli A.; Sarto P.D.; Haxhiademi D.
Institution
(Moscarelli) GVM Care & Research, Anthea Hospital, Bari, Italy
(Terrasini, Nunziata, Sarto, Haxhiademi) Operative Unit of Anesthesiology,
G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, Massa,
Italy
(Punjabi) Imperial College of London, Hammersmith Hospital, London, United
Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Solinas) Operative Unit of Cardiac Surgery, G. Pasquinucci Heart
Hospital, Fondazione Toscana G. Monasterio, Massa, Italy
(Buselli) Perfusion Department, G. Pasquinucci Heart Hospital, Fondazione
Toscana G. Monasterio, Massa, Italy
Publisher
W.B. Saunders
Abstract
Objective: Minimally invasive mitral valve repair may be associated with
prolonged cardioplegic arrest times and ischemic reperfusion injury.
Intravenous (propofol) and volatile (sevoflurane) anesthesia are used
routinely during cardiac surgery and are thought to provide
cardioprotection; however, the individual contribution of each regimen to
cardioprotection is unknown. Therefore, the authors sought to compare the
cardioprotective effects of propofol and sevoflurane anesthesia in
patients undergoing minimally invasive mitral valve repair.
<br/>Design(s): A single-center single-blind randomized controlled trial.
<br/>Setting(s): A specialized regional cardiac surgery center in Italy.
<br/>Participant(s): The study enrolled 62 adults undergoing elective
isolated minimally invasive mitral valve repair for degenerative disease.
Exclusion criteria included secondary mitral regurgitation, previously
treated coronary artery disease, diabetes mellitus, chronic renal failure
requiring dialysis, atrial fibrillation, and documented allergy to either
propofol or sevoflurane. <br/>Intervention(s): All patients received
video-assisted minimally invasive right minithoracotomy. Patients were
randomized to receive propofol or sevoflurane anesthesia in a 1:1 ratio.
<br/>Measurements and Main Results: Cardiac troponin I release was
measured over the first 72 hours postoperatively. Operative, cross-clamp,
and total bypass times were similar between groups. Cardiac troponin I
release was reduced nonsignificantly in the propofol group (p = 0.62), and
peak troponin I release was correlated with cross-clamp time in both
groups. There were no differences in terms of intraoperative lactate
release and blood pH between groups. <br/>Conclusion(s): Propofol and
sevoflurane anesthesia were associated with similar degrees of myocardial
injury, indicating comparable cardioprotection. Myocardial injury was
related directly to the duration of cardioplegic arrest.<br/>Copyright
&#xa9; 2018 Elsevier Inc.

<69>
Accession Number
2001509347
Title
Causes of death in intermediate-risk patients: The Randomized Surgical
Replacement and Transcatheter Aortic Valve Implantation Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (3) (pp 718-728.e3),
2019. Date of Publication: September 2019.
Author
Amrane H.; Deeb G.M.; Popma J.J.; Yakubov S.J.; Gleason T.G.; Van Mieghem
N.M.; Reardon M.J.; Williams M.R.; Mumtaz M.; Kappetein A.P.; Serruys
P.W.; Tadros P.; Zorn G.L.; Boonstra P.W.; van Boven A.; Li S.
Institution
(Amrane) Department of Cardiac and Thoracic Surgery, Medisch Centrum
Leeuwarden, Netherlands
(Deeb) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, Mich, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Mass, United States
(Yakubov) Department of Interventional Cardiology; Riverside
Methodist-Ohio Health, Columbus, OH, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, Pa, United States
(Van Mieghem) Department of Interventional Cardiology, Eramus Medical
Center, Rotterdam, Netherlands
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart & Vascular Center, Houston, Tex, United States
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Examine the causes and timing of death in the Surgical
Replacement and Transcatheter Aortic Valve Implantation intermediate-risk
randomized trial for transcatheter aortic valve replacement (TAVR) and
surgical aortic valve replacement (SAVR). <br/>Method(s): Causes of death
were adjudicated by an independent clinical event committee and by
post-hoc hierarchical classification. Causes of death were evaluated and
characteristics and procedural parameters compared between patients who
died and survivors for 3 time periods: early (0-30 days), recovery (31-120
days), and late (121-365 days). <br/>Result(s): All-cause mortality at 1
year was 6.5% after TAVR and 6.7% after SAVR. There were no differences in
mortality rates between TAVR and SAVR for any of the 3 time periods. Early
mortality was primarily due to technical, procedure-related problems in
TAVR and due to complications in SAVR. For TAVR and SAVR, most deaths
during recovery were caused by complications. Other causes, including
comorbid conditions, accounted for most late deaths. <br/>Conclusion(s):
Mortality rates were similar for patients treated with TAVR or SAVR at any
time period including at 1 year. Early cause of death was more commonly
technical failure after TAVR and due to complications after SAVR. Recovery
phase cause of death was dominated by complications from TAVR and SAVR.
Late cause of death appeared to be independent of the procedure in both
groups.<br/>Copyright &#xa9; 2018 The American Association for Thoracic
Surgery

<70>
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.
<br/>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. <br/>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.<br/>Copyright &#xa9; The
Author(s) 2019.

<71>
Accession Number
2001390378
Title
Long-term outcomes of mechanical versus biological aortic valve
prosthesis: Systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 158 (3) (pp 706-714.e18),
2019. Date of Publication: September 2019.
Author
Diaz R.; Hernandez-Vaquero D.; Alvarez-Cabo R.; Avanzas P.; Silva J.;
Moris C.; Pascual I.
Institution
(Diaz, Hernandez-Vaquero, Alvarez-Cabo, Avanzas, Silva, Moris, Pascual)
Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
(Diaz, Hernandez-Vaquero, Avanzas, Moris, Pascual) Instituto de
Investigacion Sanitaria del Principado de Asturias, Oviedo, Spain
(Silva, Moris) Department of Medicine, University of Oviedo, Oviedo, Spain
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: In recent years, the use of surgically implanted biological
aortic valves has been favored over mechanical prosthesis in patients
between 50 and 70 years of age. However, outcomes on long-term survival
are contradictory. The objective of this study was to determine if
patients with mechanical valves have worse long-term survival than
patients with biological prostheses. <br/>Method(s): We systematically
searched published studies that: (1) were propensity score-matched or
randomized controlled trials; (2) provided survival data with a minimum
follow-up of 5 years; and (3) included patients older than 50 and younger
than 70 years of age. Review articles, case reports, and editorials were
excluded. We conducted a meta-analysis on the basis of 2 types of
analysis. A reconstruction of the database of each study to simulate a
patient-level meta-analysis was performed. Log rank test of Kaplan-Meier
curves was recalculated. Hazard ratio (HR) was calculated using a
univariate Cox regression. In addition, we calculated a pooled HR using
the fixed-effect inverse variance method. <br/>Result(s): Four propensity
score-matched studies and 1 randomized controlled trial met the inclusion
criteria. Data of 4686 patients were analyzed. Survival rates for
mechanical versus biological valves at 10 and 15 years of follow-up were:
76.78% (95% confidence interval [CI], 74.72%-78.69%) versus 74.09% (95%
CI, 71.96%-76.08%), and 61.58% (95% CI, 58.29%-64.69%) versus 58.04% (95%
CI, 54.57%-61.35%). Log rank test was statistically significant (P =.012)
and the pooled HR was 0.86 (95% CI, 0.76-0.97; P =.01).
<br/>Conclusion(s): Compared with biological aortic valves, mechanical
valves are associated with a long-term survival benefit for patients
between 50 and 70 years.<br/>Copyright &#xa9; 2018 The American
Association for Thoracic Surgery

<72>
Accession Number
2002366932
Title
A Novel Speckle-Tracking Based Method for Quantifying Tricuspid Annular
Velocities in TEE.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Mauermann E.; Vandenheuvel M.; Francois K.; Bouchez S.; Wouters P.
Institution
(Mauermann, Vandenheuvel, Bouchez, Wouters) Department for Anesthesiology
and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
(Mauermann) Department for Anesthesiology, Surgical Intensive Care,
Prehospital Emergency Medicine, and Pain Therapy, Basel University
Hospital, Basel, Switzerland
(Francois) Department of Cardiac Surgery, Ghent University Hospital,
Ghent, Belgium
Publisher
W.B. Saunders
Abstract
Objectives: A novel speckle-tracking-based option for measuring tricuspid
annular velocities in the midesophageal 4-chamber view (ME4C) was compared
with velocities measured by tissue Doppler in the apical-4 chamber view
(AP4C). Because this method was based on a modified speckle-tracking-based
measurement of tricuspid annular plane systolic excursion (TAPSE), the
authors also compared TAPSE by speckle tracking in the ME4C with TAPSE by
M-mode in the AP4C. The authors hypothesized that velocities measured by
speckle tracking in transesophageal echocardiography (TEE) would be
similar, correlate, and agree with those measured by tissue Doppler in
transthoracic echocardiography (TTE). <br/>Design(s): Prospective
diagnostic study with randomization of the order of post-induction
echocardiography views by TTE (AP4C) and TEE (ME4C). Images were both
acquired and analyzed by 2 echocardiographers independently. The primary
outcome was S'; secondary outcomes were E', A', and TAPSE.
<br/>Setting(s): Single university hospital. <br/>Participant(s):
Consecutive adult patients undergoing cardiac surgery (mainly coronary
artery bypass grafting). <br/>Intervention(s): None. <br/>Main Result(s):
Complete data was available in 24 of 25 patients. For the primary outcome,
S' measured by speckle tracking in the ME4C correlated and agreed with S'
measured by tissue Doppler in the AP4C (S'<inf>STE</inf> =
0.87S<inf>TDI</inf> + 0.60, p < 0.001, r = 0.78; mean bias -0.6 cm/s, 95%
limits of agreement (LoA) -3.5 to 2.4 cm/s). Similarly results were found
for E', but not A' (E'<inf>STE</inf> = 0.69E'<inf>TDI</inf> + 2.37, p <
0.001, r = 0.71; mean bias 0.1 cm/s, 95%LoA -2.5 to 2.8cm/s;
A'<inf>STE</inf> = 0.15A'<inf>TDI</inf> + 11.17, p = 0.629). TAPSE
measurements by the authors' modified speckle-tracking-based technique
were similar to TAPSE by M-mode (18.2 +/- 5.5 mm and 17.1 +/- 3.9 mm,
respectively). <br/>Conclusion(s): Tricuspid annular velocities
(S'<inf>STE</inf>, E'<inf>STE</inf>) determined by speckle tracking in TEE
seem to be promising surrogates for velocities measured in TTE. This may
be important for perioperative assessment of the right
ventricle.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<73>
Accession Number
2002348198
Title
Vitamin B12 for the treatment of vasoplegia in cardiac surgery and liver
transplantation: a narrative review of cases and potential biochemical
mechanisms.
Source
Canadian Journal of Anesthesia. (no pagination), 2019. Date of
Publication: 2019.
Author
Charles F.-G.; Murray L.J.; Giordano C.; Spiess B.D.
Institution
(Charles, Giordano, Spiess) Department of Anesthesiology, University of
Florida College of Medicine, 1600 SW Archer Road, PO Box 100254,
Gainesville, FL 32610, United States
(Murray) Department of Chemistry, Center for Catalysis and Florida Center
for Heterocyclic Compounds, University of Florida, Gainesville, FL, United
States
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hydroxocobalamin, or vitamin B12 (V-B12), is frequently used to
treat smoke inhalation and cyanide poisoning. Recent reports have also
described its use to treat vasoplegia in cardiac surgery and liver
transplantation. This narrative review discusses this "off-label"
indication for V-B12, focusing on the potential biochemical mechanisms of
its actions. Source: PubMed, Cochrane, and Web of Science databases were
searched for clinical reports on the use of V-B12 for vasoplegia in
cardiac surgery and liver transplantation, with the biochemical mechanisms
discussed being based on a survey of the related biochemistry literature.
Principal findings: Forty-four patients have been treated with V-B12 for
vasoplegia in various isolated case reports and one series. Although 75%
of patients have increased blood pressure in response to V-B12, there were
some "non-responders". The true efficacy remains unknown because clinical
trials have not been performed, and significant reporting bias likely
exists. Plausible biochemical explanations exist for the potential
beneficial effects of V-B12 in treating vasoplegia, including binding
nitric oxide and other gasotransmitters. Additional research is required
to clarify if and how these mechanisms are causally involved in effective
clinical responders and non-responders. <br/>Conclusion(s): Although
anecdotal reports utilizing V-B12 for vasoplegia are available, no
higher-level evidence exists. Future work is necessary to further
understand the dosing, timing, adverse events, and biochemical mechanisms
of V-B12 compared with other therapies such as methylene
blue.<br/>Copyright &#xa9; 2019, Canadian Anesthesiologists' Society.

<74>
Accession Number
627429233
Title
Computed tomographic coronary angiography in risk stratification prior to
non-cardiac surgery: a systematic review and meta-analysis.
Source
Heart. 105 (17) (pp 1335-1342), 2019. Date of Publication: 01 Sep 2019.
Author
Koshy A.N.; Ha F.J.; Gow P.J.; Han H.-C.; Amirul-Islam F.M.; Lim H.S.; Teh
A.W.; Farouque O.
Institution
(Koshy, Ha, Han, Lim, Teh, Farouque) Department of Cardiology, Austin
Health, Melbourne, VIC, Australia
(Koshy, Gow, Han, Lim, Teh, Farouque) Austin Health Clinical School,
University of Melbourne, Parkville, Melbourne, VIC, Australia
(Koshy, Gow) Victorian Liver Transplant Unit, Austin Health, Melbourne,
VIC, Australia
(Amirul-Islam) Department of Statistics, Data Science and Epidemiology,
Swinburne University of Technology, Melbourne, VIC, Australia
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Utility of CT coronary angiography (CTA) and coronary artery
calcium (CAC) scoring in risk stratification prior to non-cardiac surgery
is unclear. Although current guidelines recommend stress testing in
intermediate-high risk individuals, over one-third of perioperative major
adverse cardiovascular events (MACE) occur in patients with a negative
study. This systematic review and meta-analysis evaluates the value of CTA
and CAC score in preoperative risk prognostication prior to non-cardiac
surgery. Methods MEDLINE, PubMed and EMBASE databases were searched for
articles published up to June 2018. Summary ORs for degree of coronary
artery disease (CAD) and perioperative MACE were pooled using a
random-effects model. Results Eleven studies were included. Two hundred
and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of perioperative
MACE rose with the severity and extent of CAD on CTA (no CAD 2.0%;
non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive
multivessel 23.1%, p<0.001). Multivessel disease (MVD) demonstrated the
greatest risk (OR 8.9, 95% CI 5.1 to 15.3, p<0.001). Increasing CAC score
was associated with higher perioperative MACE (CAC score: >=100 OR 5.1,
>=1000 OR 10.4, both p<0.01). In a cohort deemed high risk by established
clinical indices, absence of MVD on CTA demonstrated a negative predictive
value of 96% (95% CI 92.8 to 98.4) for predicting freedom from MACE.
Conclusions Severity and extent of CAD on CTA conferred incremental risk
for perioperative MACE in patients undergoing non-cardiac surgery. The
'rule-out' capability of CTA is comparable to other non-invasive imaging
modalities and offers a viable alternative for risk stratification of
patients undergoing non-cardiac surgery. Trial registration number
CRD42018100883.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2019.

<75>
Accession Number
628911707
Title
Transcatheter Mitral Valve Implantation with the Medtronic IntrepidTM
Transcatheter Mitral Valve Replacement System.
Source
Future Cardiology. 15 (4) (pp 281-293), 2019. Date of Publication: 2019.
Author
Koh J.Q.S.; Walton A.; Marasco S.; Duffy S.J.
Institution
(Koh, Walton, Duffy) Department of Cardiology, Alfred Hospital, Melbourne,
VIC, Australia
(Marasco) Department of Cardiothoracic Surgery, Alfred Hospital,
Melbourne, VIC, Australia
(Duffy) Department of Epidemiology and Preventive Medicine, Centre of
Cardiovascular Research and Education in Therapeutics, Monash University,
Melbourne, VIC, Australia
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Mitral regurgitation is the most prevalent yet undertreated valvulopathy
despite its adverse prognosis. With the emergence of transcatheter mitral
interventions, the potential for this huge unmet disease burden to be
addressed may finally be realized. Medtronic IntrepidTM Transcatheter
Mitral Valve Replacement System represents one of several novel solutions.
Based on early data from the pilot study, its efficacy and clinical
utility is currently being tested against the mainstay treatment of
surgical mitral valve replacement in a randomized trial. While there
remain significant challenges before transcatheter mitral intervention can
become part of the routine treatment algorithm, the authors are optimistic
that transcatheter mitral valve repair and intervention have the potential
in revolutionizing the management of severe symptomatic mitral
regurgitation.<br/>Copyright &#xa9; 2019 Future Medicine Ltd.

<76>
Accession Number
628920346
Title
Complex Decision-Making in Heart Failure: A Systematic Review and Thematic
Analysis.
Source
The Journal of cardiovascular nursing. 33 (3) (pp 225-231), 2018. Date of
Publication: 01 May 2018.
Author
Hamel A.V.; Gaugler J.E.; Porta C.M.; Hadidi N.N.
Institution
(Hamel) Aimee V. Hamel, MN, RN Nursing Student, School of Nursing,
University of Minnesota, Twin Cities, Minneapolis. Joseph E. Gaugler, PhD
Professor, School of Nursing, University of Minnesota, Twin Cities,
Minneapolis. Carolyn M. Porta, PhD, MPH, RN, SANE-A Associate Professor,
School of Nursing, University of Minnesota Y Twin Cities. Niloufar
Niakosari Hadidi, PhD, APRN, CNS-BC, FAHA Associate Professor, School of
Nursing, University of Minnesota, Twin Cities, Minneapolis
Publisher
NLM (Medline)
Abstract
BACKGROUND: Heart failure follows a highly variable and difficult course.
Patients face complex decisions, including treatment with implantable
cardiac defibrillators, mechanical circulatory support, and heart
transplantation. The course of decision-making across multiple treatments
is unclear yet integral to providing informed and shared decision-making.
Recognizing commonalities across treatment decisions could help nurses and
physicians to identify opportunities to introduce discussions and support
shared decision-making. <br/>OBJECTIVE(S): The specific aims of this
review are to examine complex treatment decision-making, specifically
implantable cardiac defibrillators, ventricular assist device, and cardiac
transplantation, and to recognize commonalities and key points in the
decisional process. <br/>METHOD(S): MEDLINE, CINAHL, PsycINFO, and Web of
Science were searched for English-language studies that included
qualitative findings reflecting the complexity of heart failure
decision-making. Using a 3-step process, findings were synthesized into
themes and subthemes. <br/>RESULT(S): Twelve articles met criteria for
inclusion. Participants included patients, caregivers, and clinicians and
included decisions to undergo and decline treatment. Emergent themes were
"processing the decision," "timing and prognostication," and "considering
the future." Subthemes described how participants received and understood
information about the therapy, making and changing a treatment decision,
timing their decision and gauging health status outcomes in the context of
their decision, the influence of a life or death decision, and the future
as a factor in their decisional process. <br/>CONCLUSION(S): Commonalities
were present across therapies, which involved the timing of discussions,
the delivery of information, and considerations of the future. Exploring
this further could help support patient-centered care and optimize shared
decision-making interventions.

<77>
Accession Number
625415467
Title
Pericardium in Reconstructive Urologic Surgeries: A Systematic Review and
Meta-Analysis.
Source
Urologia Internationalis. 102 (2) (pp 131-144), 2019. Date of Publication:
01 Mar 2019.
Author
Hosseini J.; Hosseini S.; Hosseini M.A.; Rezaei Y.
Institution
(Hosseini) Infertility and Reproductive Health Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hosseini, Rezaei) Heart Valve Disease Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Stud. Research Committee, Qazvin University of Medical
Sciences, Qazvin 1995614331, Iran, Islamic Republic of
Publisher
S. Karger AG
Abstract
Introduction: The use of pericardium has been expanded into different
surgical modalities; however, there are scarce data regarding the
feasibility of the pericardium in reconstructive urologic surgeries. We
systematically reviewed the literature on the effectiveness of the
pericardial tissue for reconstructive urologic surgeries. <br/>Material(s)
and Method(s): PubMed and Scopus were searched online for evidence on the
use of the pericardium in urologic surgeries. Through the methodology
recommended by the Preferred Reporting Items for Systematic Reviews and
Meta-analysis guidelines, 38 of 4,071 studies were identified.
<br/>Result(s): A total of 715 patients and 139 animals underwent
reconstructive urologic surgeries using the pericardium. Bladder,
urethral, and renal reconstructions were successful in 100% of the human
cases. The rates of dissatisfaction, glans hypoesthesia, and penile
shortening were comparable between the pericardial graft surgeries and the
other operations during penile straightening, but there was a trend among
the patients with pericardial grafts toward having a more penile curvature
at follow-up (risk ratio [RR] 2.03, 95% CI 0.90-4.61, p = 0.09;
I² = 0%). Among the animal studies, there were 4 reports of
penile reconstruction, 7 studies of bladder reconstruction, and 1 study of
urethroplasty. Bladder reconstruction and urethroplasty were successful in
83 and 20% of the animals, respectively. The pooled result of the
stimulated intracorporeal pressure 5 V significantly favored pericardial
grafts during penile reconstruction (RR 2.61, 95% CI 1.26-3.97, p =
0.0002; I² = 0%). <br/>Conclusion(s): Our systematic review
demonstrates the feasibility of the pericardium, regardless of its type,
in urologic surgeries. It, however, seems that urethral substitution needs
further investigation. Given the lower cost, easier handling, and less
immunogenicity of the pericardium, further studies are required to examine
its pros and cons.<br/>Copyright &#xa9; 2018 S. Karger AG, Basel.

<78>
Accession Number
626892025
Title
Guidelines for enhanced recovery after lung surgery: Recommendations of
the Enhanced Recovery after Surgery (ERAS) Society and the
European Society of Thoracic Surgeons (ESTS).
Source
European Journal of Cardio-thoracic Surgery. 55 (1) (pp 91-115), 2019.
Date of Publication: 01 Jan 2019.
Author
Batchelor T.J.P.; Rasburn N.J.; Abdelnour-Berchtold E.; Brunelli A.;
Cerfolio R.J.; Gonzalez M.; Ljungqvist O.; Petersen R.H.; Popescu W.M.;
Slinger P.D.; Naidu B.
Institution
(Batchelor) Department of Thoracic Surgery, University Hospitals Bristol
NHS Foundation Trust, Upper Maudlin Street, Bristol BS28HW, United Kingdom
(Rasburn) Department of Anaesthesia, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Abdelnour-Berchtold, Gonzalez) Division of Thoracic Surgery, Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Brunelli) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
(Cerfolio) Department of Cardiothoracic Surgery, New York University
Langone Health, New York, NY, United States
(Ljungqvist) Department of Surgery, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Petersen) Department of Thoracic Surgery, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Popescu) Department of Anesthesiology, Yale University School of
Medicine, New Haven, CT, United States
(Slinger) Department of Anesthesia, University Health Network, Toronto
General Hospital, Toronto, ON, Canada
(Naidu) Department of Thoracic Surgery, Heart of England NHS Foundation
Trust, Birmingham, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Enhanced recovery after surgery is well established in specialties such as
colorectal surgery. It is achieved through the introduction of multiple
evidence-based perioperative measures that aim to diminish postoperative
organ dysfunction while facilitating recovery. This review aims to present
consensus recommendations for the optimal perioperative management of
patients undergoing thoracic surgery (principally lung resection). A
systematic review of meta-analyses, randomized controlled trials, large
non-randomized studies and reviews was conducted for each protocol
element. Smaller prospective and retrospective cohort studies were
considered only when higher-level evidence was unavailable. The quality of
the evidence base was graded by the authors and used to form consensus
recommendations for each topic. Development of these recommendations was
endorsed by the Enhanced Recovery after Surgery Society and the European
Society for Thoracic Surgery. Recommendations were developed for a total
of 45 enhanced recovery items covering topics related to preadmission,
admission, intraoperative care and postoperative care. Most are based on
good-quality studies. In some instances, good-quality data were not
available, and subsequent recommendations are generic or based on data
extrapolated from other specialties. In other cases, no recommendation can
currently be made because either equipoise exists or there is a lack of
available evidence. Recommendations are based not only on the quality of
the evidence but also on the balance between desirable and undesirable
effects. Key recommendations include preoperative counselling, nutritional
screening, smoking cessation, prehabilitation for high-risk patients,
avoidance of fasting, carbohydrate loading, avoidance of preoperative
sedatives, venous thromboembolism prophylaxis, prevention of hypothermia,
short-acting anaesthetics to facilitate early emergence, regional
anaesthesia, nausea and vomiting control, opioid-sparing analgesia,
euvolemic fluid management, minimally invasive surgery, early chest drain
removal, avoidance of urinary catheters and early mobilization after
surgery. These guidelines outline recommendations for the perioperative
management of patients undergoing lung surgery based on the best available
evidence. As the recommendation grade for most of the elements is strong,
the use of a systematic perioperative care pathway has the potential to
improve outcomes after surgery.<br/>Copyright &#xa9; 2018 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<79>
Accession Number
625233900
Title
How to treat severe symptomatic structural valve deterioration of aortic
surgical bioprosthesis: Transcatheter valve-in-valve implantation or redo
valve surgery?.
Source
European Journal of Cardio-thoracic Surgery. 54 (6) (pp 1-9), 2018. Date
of Publication: 2018.
Author
Attias D.; Nejjari M.; Nappi F.; Dreyfus J.; Eleid M.F.; Rihal C.S.
Institution
(Attias, Nejjari, Dreyfus) Department of Cardiology, Centre Cardiologique
du Nord, 32-36 rue des Moulins Gemeaux, Saint Denis 93200, France
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint
Denis, France
(Eleid, Rihal) Department of Cardiovascular Diseases and Cardiovascular
Surgery, Mayo Clinic, Rochester, MN, United States
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The optimal management of aortic surgical bioprosthesis presenting with
severe symptomatic structural valve deterioration is currently a matter of
debate. Over the past 20 years, the number of implanted bioprostheses
worldwide has been rapidly increasing at the expense of mechanical
prostheses. A large proportion of patients, however, will require
intervention for bioprosthesis structural valve deterioration. Current
options for older patients who often have severe comorbidities include
either transcatheter valve-in-valve (TVIV) implantation or redo valve
surgery. The emergence of TVIV implantation, which is perceived to be less
invasive than redo valve surgery, offers an effective alternative to
surgery for these patients with proven safety and efficacy in high-risk
patient groups including elderly and frail patients. A potential caveat to
this strategy is that results of long-term follow-up after TVIV
implantation are limited. Redo surgery is sometimes preferable, especially
for young patients with a smaller-sized aortic bioprosthesis. With the
emergence of TVIV implantation and the long experience of redo valve
surgery, we currently have 2 complementary treatment modalities, allowing
a tailor-made and patient-orientated intervention. In the heart team, the
decision-making should be based on several factors including type of
bioprosthesis failure, age, comorbidities, operative risk, anatomical
factors, anticipated risks and benefits of each alternative, patient's
choice and local experience. The aim of this review is to provide a
framework for individualized optimal treatment strategies in patients with
failed aortic surgical bioprosthesis.<br/>Copyright &#xa9; The Author(s)
2018.

<80>
Accession Number
625026435
Title
Feasibility and safety of combined percutaneous coronary intervention
among high-risk patients with severe aortic stenosis undergoing
transcatheter aortic valve implantation: a systematic review and
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 54 (6) (pp 1052-1059),
2018. Date of Publication: 01 Dec 2018.
Author
Bao L.; Gao Q.; Chen S.; Chen Y.; Elhmidi Y.; Shehada S.-E.; Wang S.; Ma
C.
Institution
(Bao) Department of Cardiac Surgery, Aerospace Center Hospital, Beijing,
China
(Gao, Chen, Chen) Department of Cardiac Surgery, Peking University
People's Hospital, Beijing, China
(Elhmidi, Ma) Department of Cardiovascular Surgery, German Heart Centre
Munich, Technische Universitat Munchen, Munich, Germany
(Shehada) Department of Thoracic and Cardiovascular Surgery, West German
Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
(Wang) Department of Cardiovascular Surgery, Henan Provincial People's
Hospital, Zhengzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Recent reports indicated that percutaneous coronary
intervention (PCI) may be correlated with increased mortality in patients
undergoing transcatheter aortic valve implantation (TAVI). Therefore, we
performed a meta-analysis to determine the feasibility and safety of
combined PCI in high-risk patients with severe aortic stenosis undergoing
TAVI. <br/>METHOD(S): A comprehensive literature search was performed
using PubMed, Embase and the Cochrane Central Register of Controlled
trials through June 2016. <br/>RESULT(S): Five clinical trials including
1634 patients were identified. The pooled analysis revealed no significant
differences in 30-day all-cause mortality [odds ratio (OR) 1.25, 95%
confidence interval (CI) 0.52-3.05; P=0.62], 30-day cardiovascular
mortality rate (OR 1.59, 95% CI 0.52-4.88; P=0.41) and 1-year mortality
rate (OR 1.16, 95% CI 0.85-1.59; P=0.34) among the patients assigned to
TAVI and those undergoing TAVI+PCI. The incidence of myocardial infarction
(OR 2.96, 95% CI 1.03-8.45; P=0.04) was slightly higher in the TAVI+PCI
group. Other complications, such as stroke, kidney injury, bleeding and
vascular complications, were not significantly increased in the TAVI+PCI
group. Patients treated with a staged procedure of TAVI and PCI but not
simultaneous TAVI+PCI showed higher 30-day all-cause mortality as compared
to those undergoing isolated TAVI. <br/>CONCLUSION(S): Combined TAVI+PCI
showed similar rates of death from any cause at 30days and 1year as
compared to isolated TAVI. Except for myocardial infarction, the rate of
operative complications in the TAVI+PCI group was not detrimental as
compared to the isolated TAVI group. The simultaneous treatment of
significant coronary artery lesions may be preferred in selected patients
undergoing TAVI.

<81>
Accession Number
628896745
Title
Using a 3D printer in cardiac valve surgery: a systematic review.
Source
Revista da Associacao Medica Brasileira (1992). 65 (6) (pp 818-824), 2019.
Date of Publication: 22 Jul 2019.
Author
Boll L.F.C.; Rodrigues G.O.; Rodrigues C.G.; Bertollo F.L.; Irigoyen M.C.;
Goldmeier S.
Institution
(Boll, Rodrigues, Bertollo, Goldmeier) Institute of Cardiology /
University Foundation of Cardiology; Av. Princesa Isabel, 370 - Porto
Alegre, RS, Brasil
(Rodrigues) College Method of Sao Paulo, Sao Paulo, SP, Brasil
(Irigoyen) School of Medicine of the University of Sao Paulo, SP, Brazil
Publisher
NLM (Medline)
Abstract
BACKGROUND: The use of the 3D printer in complex cardiac surgery planning.
<br/>OBJECTIVE(S): To analyze the use and benefits of 3D printing in heart
valve surgery through a systematic review of the literature.
<br/>METHOD(S): This systematic review was reported following the
Preferred Reporting Items for Systematic Review and registered in the
Prospero (International Prospective Register of Systematic Reviews)
database under the number CRD42017059034. We used the following databases:
PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles
about the keywords "Heart Valves", "Heart Valve Prosthesis Implantation",
"Heart Valve Prosthesis", "Printing, Three-Dimensional", and related entry
terms. Two reviewers independently conducted data extraction and a third
reviewer solved disagreements. All tables used for data extraction are
available at a separate website. We used the Cochrane Collaboration tool
to assess the risk of bias of the studies included. <br/>RESULT(S): We
identified 301 articles and 13 case reports and case series that met the
inclusion criteria. Our studies included 34 patients aged from 3 months to
94 years. <br/>CONCLUSION(S): Up to the present time, there are no studies
including a considerable number of patients. A 3D-printed model produced
based on the patient enables the surgeon to plan the surgical procedure
and choose the best material, size, format, and thickness to be used. This
planning leads to reduced surgery time, exposure, and consequently, lower
risk of infection.

<82>
Accession Number
628901255
Title
Effects of Different Rehabilitation Protocols in Inpatient Cardiac
Rehabilitation After Coronary Artery Bypass Graft Surgery: A RANDOMIZED
CLINICAL TRIAL.
Source
Journal of cardiopulmonary rehabilitation and prevention. (no pagination),
2019. Date of Publication: 22 Jul 2019.
Author
Zanini M.; Nery R.M.; de Lima J.B.; Buhler R.P.; da Silveira A.D.; Stein
R.
Institution
(Zanini) Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande
do Sul, Brazil (Drs Zanini, Silveira, and Stein and Mss Lima and Buhler);
and Exercise Cardiology Research Group, Hospital de Clinicas de Porto
Alegre, Porto Alegre, Rio Grande do Sul, Brazil (Drs Zanini, Silveira,
Stein, and Nery and Mss Lima and Buhler)
Publisher
NLM (Medline)
Abstract
PURPOSE: Patients undergoing coronary artery bypass graft (CABG) surgery
typically experience loss of cardiopulmonary capacity in the
post-operative period. The purpose of this study was to evaluate the
effects of different rehabilitation protocols used in inpatient cardiac
rehabilitation on functional capacity and pulmonary function in patient
status post-CABG surgery. <br/>METHOD(S): This was a single-blind
randomized controlled trial. The primary endpoint of functional capacity
and secondary endpoints of lung capacity and respiratory muscle function
were assessed in patients scheduled to undergo CABG. After surgery, 40
patients were randomly assigned across 1 of 4 inpatient cardiac
rehabilitation groups: G1, inspiratory muscle training, active upper limb
and lower limb exercise training, and early ambulation; G2, same protocol
as G1 without inspiratory muscle training; G3, inspiratory muscle training
alone; and G4, control. All groups received chest physical therapy and
expiratory positive airway pressure. Patients were reassessed on
post-operative day 6 and post-discharge day 30 (including cardiopulmonary
exercise testing). <br/>RESULT(S): The 6-min walk distance on
post-operative day 6 was significantly higher in groups that included
exercise training (G1 and G2), remaining higher at 30 d post-discharge (P
< .001 between groups). Peak oxygen uptake on day 30 was also higher in G1
and G2 (P = .005). All groups achieved similar recovery of lung function.
<br/>CONCLUSION(S): Protocols G1 and G2, which included a systematic plan
for early ambulation and upper and lower limb exercise, attenuated fitness
losses while in the hospital and significantly enhanced recovery 1 mo
after CABG.

<83>
Accession Number
628898043
Title
Effect of Autotransfusion Using Intraoperative Predonated Autologous Blood
on Coagulopathy during Thoracic Aortic Surgery: A Randomized Controlled
Trial.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2019. Date of Publication: 24 Jul 2019.
Author
Suzuki R.; Mikamo A.; Matsuno Y.; Fujita A.; Kurazumi H.; Yamashita A.;
Hamano K.
Institution
(Suzuki, Mikamo, Matsuno, Fujita, Kurazumi, Hamano) Department of Surgery
and Clinical Science, Division of Cardiac Surgery, Yamaguchi University
Graduate School of Medicine, Ube, Yamaguchi, Japan
(Yamashita) Department of Anesthesiology, Yamaguchi University Graduate
School of Medicine, Ube, Yamaguchi, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative predonated autologous blood transfusion is
thought to replenish platelets and coagulation factors and ameliorate
coagulopathy. This study aimed to evaluate whether intraoperative
predonated autotransfusion improves coagulopathy during thoracic aortic
surgery. <br/>METHOD(S): Patients who underwent thoracic aortic surgery
were randomized into two groups as follows: those who received
intraoperative predonated blood (group A: n = 31) and those who did not
receive (group N: n = 22). In group A, autologous blood was retransfused
immediately after cessation of cardiopulmonary bypass (c-CPB).
<br/>RESULT(S): The mean intraoperative allogenic blood or blood product
transfusion requirements were significantly lesser in group A than in
group N (packed red blood cells [RBCs]: 6.3 +/- 5.1 vs. 9.1 +/- 4.3 units,
p = 0.04; fresh frozen plasma [FFP]: 3.0 +/- 4.1 vs. 6.1 +/- 5.7 units, p
= 0.03). After c-CPB, hemoglobin (Hb) level, platelet count, and
coagulopathy became significantly worse than those at the start of surgery
in both the groups. However, the values significantly improved 30 min
after c-CPB only in group A. Renal function was significantly worse in
group N. <br/>CONCLUSION(S): Intraoperative predonated autotransfusion
significantly improved coagulopathy, with reduced allogeneic blood
transfusion volume during thoracic aortic surgery. Furthermore, reduction
of allogeneic blood transfusion may reduce the adverse effects on renal
function.

<84>
Accession Number
2002561005
Title
Antibiotic Management for Delayed Sternal Closure Following Pediatric
Cardiac Surgery: A Systematic Review of Recent Literature.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Silvetti S.; Landoni G.; Castagnola E.; Nuri H.; Pome G.; Moscatelli A.
Institution
(Silvetti, Moscatelli) Neonatal and Pediatric Intensive Care Unit,
Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini,
Genova, Italy
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, University Vita-Salute San Raffaele, Milano, Italy
(Castagnola) Infectious Disease Unit, Department of Pediatrics, IRCCS
Istituto Giannina Gaslini, Genova, Italy
(Nuri, Pome) Cardiac Surgery Unit, Department of Surgery and Critical
Care, IRCCS Istituto Giannina Gaslini, Genova, Italy
Publisher
W.B. Saunders
Abstract
Delayed sternal closure after pediatric cardiac surgery is a management
option for the treatment of patients with severely impaired heart
function. The optimal antimicrobial treatment strategy for this condition
is unknown. The aim of this systematic review was to evaluate the current
antibiotic administration attitudes in pediatric cardiac surgery patients
needing an open chest in terms of infection with a focus on surgical site
infection rate. The authors performed a systematic review and
meta-analysis of all articles, which described the antibiotic
administration strategy and surgical site infection rate in pediatric
patients with an open chest after cardiac surgery. The authors performed a
subgroup analysis on "standard" versus "non-standard" (defined as any
antimicrobial drugs different from the adult guidelines recommendations)
therapy for one-proportion meta-analysis with a random effect model. The
authors identified 12 studies published from January 1, 2000 to July 1,
2019 including a total of 2,203 patients requiring an open chest after
cardiac surgery, 350 of whom (15.9%) developed infections and 182 (8.3%)
developed a surgical site infection. The surgical site infection rate in
patients with "non-standard" strategy was higher than in patients with
"standard" strategy: 8.8% (140 reported infections/1,582 patients) versus
6.8% (42 reported infections/621 patients), p = 0.001. The "standard"
antibiotic management proposed by guidelines for adult cardiac surgery
patients could be used an acceptable strategy to treat pediatric patients
with an open chest after cardiac surgery.<br/>Copyright &#xa9; 2019
Elsevier Inc.

<85>
Accession Number
2000815595
Title
Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac
Surgery: A Meta-Analysis.
Source
Annals of Thoracic Surgery. 106 (1) (pp 298-304), 2018. Date of
Publication: July 2018.
Author
Tam D.Y.; Nedadur R.; Yu M.; Yanagawa B.; Fremes S.E.; Friedrich J.O.
Institution
(Tam, Nedadur, Fremes) Division of Cardiac Surgery, Department of Surgery,
Sunnybrook Health Sciences Center, University of Toronto, Toronto,
Ontario, Canada
(Tam, Fremes) Institute of Health Policy, Management, and Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Yu) Division of Plastic Surgery, Department of Surgery, University of
Toronto, Toronto, Ontario, Canada
(Yanagawa) Division of Cardiac Surgery, Department of Surgery, St.
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Friedrich) Critical Care and Medicine Departments, St. Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
(Friedrich) Department of Medicine and Interdepartmental Division of
Critical Care, University of Toronto, Toronto, Ontario, Canada
Publisher
Elsevier USA
Abstract
Background: Traditionally, wire cerclage has been used to reapproximate
the sternum after sternotomy. Recent evidence suggests that rigid plate
fixation for sternal closure may reduce the risk of sternal complications.
<br/>Method(s): The Medline and Embase databases were searched from
inception to February 2017 for studies that compared rigid plate fixation
with wire cerclage for cardiac surgery patients undergoing sternotomy.
Random effects meta-analysis compared rates of sternal complications
(primary outcome, defined as deep or superficial sternal wound infection,
or sternal instability), early mortality, and length of stay (secondary
outcomes). <br/>Result(s): Three randomized controlled trials (n = 427)
and five unadjusted observational studies (n = 1,025) met inclusion
criteria. There was no significant difference in sternal complications
with rigid plate fixation at a median of 6 months' follow-up (incidence
rate ratio 0.51, 95% confidence interval [CI]: 0.20 to 1.29, p = 0.15)
overall, but a decrease when including only patients at high risk for
sternal complications (incidence rate ratio 0.23, 95% CI: 0.06 to 0.89, p
= 0.03; two observational studies). Perioperative mortality was reduced
favoring rigid plate fixation (relative risk 0.40, 95% CI: 0.28 to 0.97, p
= 0.04; four observational studies and one randomized controlled trial).
Length of stay was similar overall (mean difference -0.77 days, 95% CI:
-1.65 to +0.12, p = 0.09), but significantly reduced with rigid plate
fixation in the observational studies (mean difference -1.34 days, 95% CI:
-2.05 to -0.63, p = 0.0002). <br/>Conclusion(s): This meta-analysis,
driven by the results of unmatched observational studies, suggests that
rigid plate fixation may lead to reduced sternal complications in patients
at high risk for such events, improved perioperative survival, and
decreased hospital length of stay. More randomized controlled trials are
required to confirm the potential benefits of rigid plate fixation for
primary sternotomy closure.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons

<86>
Accession Number
2000802013
Title
Remote Ischemic Preconditioning Does Not Prevent White Matter Injury in
Neonates.
Source
Annals of Thoracic Surgery. 106 (1) (pp 151-155), 2018. Date of
Publication: July 2018.
Author
Gaynor J.W.; Nicolson S.C.; Spray D.M.; Burnham N.B.; Chittams J.L.;
Sammarco T.; Walsh K.W.; Spray T.L.; Licht D.J.
Institution
(Gaynor, Spray, Burnham, Walsh, Spray) Division of Cardiothoracic Surgery,
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United
States
(Nicolson) Department of Anesthesia and Critical Care Medicine, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
(Licht) Department of Pediatrics, Division of Neurology, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
(Chittams, Sammarco) Biostatistics Consulting Unit, Office of Nursing
Research, University of Pennsylvania School of Nursing, Philadelphia,
Pennsylvania, United States
Publisher
Elsevier USA
Abstract
Background: Remote ischemic preconditioning (RIPC) is a mechanism to
protect tissues from injury during ischemia and reperfusion. We
investigated the neuroprotective effects of RIPC in neonates undergoing
cardiac surgery. <br/>Method(s): The outcome was white matter injury
(WMI), assessed by the change in volume of WMI from preoperative to
postoperative brain magnetic resonance imaging (MRI). Patients were
randomized to RIPC or SHAM. RIPC was induced prior to cardiopulmonary
bypass by four 5-minute cycles of blood pressure cuff inflation to produce
ischemia of the lower extremity. For patients randomized to SHAM, the cuff
was positioned, but not inflated. <br/>Result(s): The study included 67
patients, with 33 randomized to RIPC and 34 randomized to SHAM.
Preoperative and postoperative MRIs were available in 50 patients,
including 26 of the 33 RIPC patients and 24 of the 34 SHAM patients. There
were no differences in baseline and operative characteristics for either
the overall study group or the group with evaluable MRIs. WMI was
identified in 28% of the patients preoperatively and in 62%
postoperatively. There was no difference in the prevalence of WMI by
treatment group (p > 0.5). RIPC patients had an average change in WMI of
600 mL³, and SHAM subjects had an average WMI change of 107
mL³. There was no significant difference in the mean value of
WMI change between patients who received RIPC and those who received SHAM
treatments (p = 0.178). <br/>Conclusion(s): In this randomized, blinded
clinical trial, there was no evidence that use of RIPC provides
neuroprotection in neonates undergoing repair of congenital heart defects
with cardiopulmonary bypass.<br/>Copyright &#xa9; 2018 The Society of
Thoracic Surgeons

<87>
Accession Number
628792365
Title
Long-term clinical outcomes in patients with untreated non-culprit
intermediate coronary lesion and evaluation of predictors by using virtual
histology-intravascular ultrasound; A prospective cohort study.
Source
BMC Cardiovascular Disorders. 19 (1) (no pagination), 2019. Article
Number: 187. Date of Publication: 05 Aug 2019.
Author
Seo Y.H.; Kim Y.-K.; Song I.G.; Kim K.-H.; Kwon T.-G.; Bae J.-H.
Institution
(Seo, Kim, Song, Kim, Kwon, Bae) Division of Cardiology, Heart Center,
Konyang University Hospital, 158, Gwanjeodong-Ro, Seo-Gu, Daejeon 35365,
South Korea
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: It is uncertain whether the coronary lesion with intermediate
stenosis is more likely to cause cardiovascular events than a normal or
minimal lesion. We conducted a single-center, prospective cohort study to
identify long-term clinical outcomes of patients with untreated
non-culprit intermediate lesion and evaluate its predictor of
cardiovascular events by using virtual histology-intravascular ultrasound
(VH-IVUS). <br/>Method(s): Subjects with non-culprit intermediate lesion
underwent VH-IVUS were prospectively registered after percutaneous
coronary intervention at the culprit lesion. Intermediate lesion was
defined as 30 to 70% stenosis in coronary angiography and primary outcome
was an occurrence of major adverse cardiovascular events (MACE) defined as
all-cause death, intermediate lesion revascularization (InLR), minimal
lesion revascularization (MnLR, unplanned revascularization elsewhere in
the target vessel or in other coronary arteries which looked normal or
minimal stenosis), cerebrovascular events, or non-fatal myocardial
infarction (MI). The mean follow-up period was 4.2 years. <br/>Result(s):
Total 25 MACE, approximately 7% incidence annually, were identified during
a follow-up period in 86 patients with 89 intermediate lesions. InLR (n =
13) was a most common event followed by MnLR (n = 6), non-fatal MI (n =
4), all-cause death (n = 3), and cerebrovascular events (n = 1). Diameter
stenosis (OR 1.07, 95% CI 1.01-1.12, p = 0.015), plaque burden (PB, OR
1.07, 95% CI 1.00-1.15, p = 0.040), fibrofatty area (FFA, OR 1.61, 95% CI
1.10-2.38, p = 0.016), PB >= 70% (OR 3.93, 95% CI 1.28-12.07, p = 0.018),
and area stenosis >= 50% (OR 2.94, 95% CI 1.01-8.56, p = 0.042) showed
significant relationships with an occurrence of MACE. In multivariable
Cox-proportional hazard analysis, FFA in intermediate lesion was an only
independent predictor of MACE (HR 1.36, 95% CI 1.05-1.77, p = 0.019).
<br/>Conclusion(s): Untreated intermediate lesions had a significantly
higher chance for requiring revascularization compared with a normal or
minimal lesion. And also, a large FFA in intermediate lesion was a
significant predictor of cardiovascular events and which finding was
mainly driven by coronary-related events, in particularly intermediate
lesion progression.<br/>Copyright &#xa9; 2019 The Author(s).

<88>
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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2019

<89>
Accession Number
2002290748
Title
Oral Triiodothyronine Supplementation Decreases Low Cardiac Output
Syndrome After Pediatric Cardiac Surgery.
Source
Pediatric Cardiology. 40 (6) (pp 1238-1246), 2019. Date of Publication: 15
Aug 2019.
Author
Marwali E.M.; Caesa P.; Darmaputri S.; Sani A.A.; Roebiono P.S.; Fakhri
D.; Djer M.M.; Munasir Z.M.; Batubara J.R.L.; Satroasmoro S.; Portman
M.A.; Haas N.A.
Institution
(Marwali, Caesa, Darmaputri, Sani) Pediatric Cardiac Intensive Care Unit,
National Cardiovascular Center Harapan Kita, Let Jend S Parman Road, Kav
87, Slipi, Jakarta 11420, Indonesia
(Marwali, Roebiono) Department of Cardiology, Faculty of Medicine,
Universitas Indonesia, Jakarta, Indonesia
(Roebiono) Pediatric Cardiology Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Unit, National Cardiovascular Center
Harapan Kita, Jakarta, Indonesia
(Fakhri) Department of Cardio-Thoracic-Vascular Surgery, Faculty of
Medicine, Universitas Indonesia, Jakarta, Indonesia
(Djer, Munasir, Batubara, Satroasmoro) Department of Pediatrics, Cipto
Mangunkusumo Hospital and Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
(Portman) Seattle Children's Hospital, University of Washington, Seattle,
WA, United States
(Haas) Department of Pediatric Cardiology and Pediatric Intensive Care,
Medical Hospital of the University of Munich, Munich, Germany
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The oral triiodothyronine for infants and children undergoing
cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3)
supplementation improved hemodynamic and clinical outcome parameters. We
tested the validity of low cardiac output syndrome (LCOS), derived using
clinical parameters and laboratory data, by comparing the LCOS diagnosis
with objective parameters commonly measured in a cardiac intensive care
unit (CCU) setting. OTICC, a randomized, placebo-controlled trial included
children younger than 3 years with an Aristotle score between 6 and 9. We
used the existing trial data set to compare the LCOS diagnosis with
echocardiographic hemodynamic parameters. Additionally, we determined if
LCOS, prospectively assigned during a clinical trial, served as an early
predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after
cross-clamp release later showed significantly lower pulse pressure,
stroke volume and cardiac output, and higher systemic vascular resistance.
These LCOS patients also had significantly longer time to extubation (TTE)
and higher mortality rate. LCOS incidence was significantly lower in the
T3 treatment group [n = 86 vs. 66, respectively, p < 0.001; OR (95% CI)
0.43 (0.36-0.52)] particularly at 6 h. Also, LCOS patients in the placebo
group had significantly lower FT3 serum levels over time. These analyses
confirm that early clinically defined LCOS successfully predicts cardiac
dysfunction determined later by objective hemodynamic echocardiographic
parameters. Furthermore, early LCOS significantly impacts TTE and
mortality. Finally, the data support prior clinical trial data, showing
that oral T3 supplementation decreases early LCOS in concordance with
reducing TTE.<br/>Copyright &#xa9; 2019, Springer Science+Business Media,
LLC, part of Springer Nature.

<90>
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. <br/>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. <br/>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). <br/>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).<br/>Copyright &#xa9; 2019 Diabetes UK

<91>
Accession Number
2002344172
Title
Adherence to lifestyle changes after coronary artery bypass graft: Outcome
of preoperative peer education.
Source
Patient Education and Counseling. (no pagination), 2019. Date of
Publication: 2019.
Author
Golaghaie F.; Esmaeili-Kalantari S.; Sarzaeem M.; Rafiei F.
Institution
(Golaghaie) Department of Community Health Nursing, Arak University of
Medical Sciences, Arak, Iran, Islamic Republic of
(Esmaeili-Kalantari) Student Research Committee, Arak University of
Medical Sciences, Arak, Iran, Islamic Republic of
(Sarzaeem) Department of Cardiovascular Surgery, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Rafiei) Department of Biostatistics & Epidemiology, School of health,
Scientific Research Center, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Elsevier Ireland Ltd
Abstract
Objective: This study was done to investigate the effect of preoperative
peer education on patients' adherence to medication and lifestyle changes
after Coronary Artery Bypass Graft (CABG). <br/>Method(s): In this
randomized clinical trial, the peers of CABG patients conducted
preoperative educational sessions at the ward in groups of 4-5 (n = 36)
while the control group (n = 34) received routine education by a nurse.
Adherence of both groups to medication and recommendations for lifestyle
modification including physical activity, smoking, and diet was measured
one and two months after discharge. <br/>Result(s): A multivariate
analysis of co-variance showed the significant effect of peer education on
adherence (F = 32.586, p < 0.001; eta² = 0.671). Univariate
ANCOVA revealed a significant difference in adherence to diet between the
two groups (F = 62.316, p = 0 0.0001; eta² = 0.482). Based on
the repeated measures ANOVA, peer education significantly improved the
CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total
adherence (F = 9.911, p = 0.002) compared to the control group.
<br/>Conclusion(s): Preoperative peer education had a significant effect
on improving CABG patients' adherence to lifestyle changes after hospital
discharge. Practice implication: Peer education can be used as an
effective method to improve the CABG patients ' adherence to lifestyle
changes.<br/>Copyright &#xa9; 2019 Elsevier B.V.

<92>
Accession Number
628880556
Title
The Effect of Speed of Normal Saline Injection on Optic Nerve Sheath
Diameter in Thoracic Epidural Anesthesia.
Source
Pain physician. 22 (4) (pp E325-E332), 2019. Date of Publication: 01 Jul
2019.
Author
Hong J.H.; Jung S.W.; Park J.H.
Institution
(Hong, Jung) Keimyung University School of Medicine Republic of Korea
(Park) Department of Anesthesiology and Pain Medicine, Keimyung University
DongSan Hospital, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intracranial pressure (ICP) is affected after epidural saline
solution or local anesthetic injection. Both ICP and epidural pressures
have been shown to reach peak pressure just after epidural injection and
begin decline thereafter. Measuring the optic nerve sheath diameter (ONSD)
through ultrasonography is one of the noninvasive methods used for ICP
assessment. <br/>OBJECTIVE(S): The purpose of this study was to
investigate the effect of the speed of epidural saline injection on the
ONSD under awake conditions. STUDY DESIGN: Prospective randomized trial.
SETTING: An interventional pain management practice in South Korea.
<br/>METHOD(S): This study included 40 patients receiving thoracic
epidural catheterization for pain management after upper abdominal or
thoracic surgery. Following successful epidural space confirmation,
patients were randomized to receive epidural saline infusion with a speed
of either 1 mL/second (slow speed, A group) or 3 mL/second (rapid speed, B
group), respectively. For the measurement of ONSD, transorbital sonography
was performed and ONSD was measured at 3 mm posterior to the optic nerve
head. <br/>RESULT(S): The A and B groups showed significant increases in
ONSD according to time. Post hoc analysis of this result revealed that
ONSD at T10 and T30 were significantly increased from baseline values (T0)
(*P < 0.05 vs. T0; +P < 0.001 vs. T0). The mean values at any of the time
points and degree of changes (T1-T0, T10-T0, and T30-T0) in ONSD between
groups A and B did not show any significance. LIMITATIONS: We could not
confirm the time of normalization of ONSD after the end of epidural
injection of normal saline. <br/>CONCLUSION(S): Thoracic epidural
injection of 10 mL of normal saline solution resulted in a significant
increase of ONSD compared to baseline, however, the speed of injection did
not affect the increase of ONSD. KEY WORDS: Epidural, saline, optic nerve,
diameter. Trial registry number: Clinical trial registry information
service (NCT03362255).

<93>
Accession Number
628880569
Title
Inflammatory Response and Endothelial Dysfunction Following
Cardiopulmonary Bypass: Pathophysiology and Pharmacological Targets.
Source
Recent patents on inflammation & allergy drug discovery. (no pagination),
2019. Date of Publication: 24 Jul 2019.
Author
Giacinto O.; Satriano U.; Nenna A.; Spadaccio C.; Lusini M.; Mastroianni
C.; Nappi F.; Chello M.
Institution
(Giacinto, Satriano, Nenna, Lusini, Mastroianni, Chello) Dept. of
Cardiovascular Surgery, Universita Campus Bio-Medico di Roma
(Spadaccio) Dept. of Cardiac Surgery, Golden Jubilee National Hospital,
Glasgow. United States
(Nappi) Dept. of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris. France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Endothelial injury occurring during cardiopulmonary bypass is
a major contributing factor in the development of organ dysfunction, which
leads to many of the postoperative complications occurring during cardiac
surgery. <br/>OBJECTIVE(S): This narrative review aims to summarize the
main mechanisms of cardiopulmonary bypass - related disease, evaluating
the unfavorable events leading to tissue injury, with a description of
current pharmacologic and non-pharmacologic mechanisms to reduce
CPB-related injury. <br/>METHOD(S): A Medline/Pubmed/Scopus search was
conducted using clinical queries with the key terms &quot;cardiac
surgery&quot;, "cardiopulmonary bypass", &quot;inflammation&quot; and
"endothelial injury", and related MeSH terms, until July 2019. The search
strategy included meta-analyses, randomized controlled trials, clinical
trials, reviews and pertinent references. Patents were searched using the
same key terms from https://patents.google.com/, www.uspto.gov, and
www.freepatentsonline.com. <br/>RESULT(S): In this review we discuss the
current knowledge of the mechanisms of vascular endothelial cell injury,
the acute inflammatory response, and the regulatory factors that control
the extent of vascular injury during extracorporeal circulation,
summarizing the main target of anti-inflammatory pharmacologic and
non-pharmacologic strategies. <br/>CONCLUSION(S): Inflammatory response
and endothelial dysfunction following cardiopulmonary bypass are the price
to pay for the benefits offered during cardiac surgery procedures.
Counteracting the detrimental effect of extracorporeal circulation appears
to be crucial to improve clinical outcomes in pediatric and adult cardiac
surgery. The intrinsic complexity and the tight interplay of the factors
involved might require a holistic approach against inflammation and
endothelial response.<br/>Copyright&#xa9; Bentham Science Publishers; For
any queries, please email at epub@benthamscience.net.

<94>
Accession Number
628877126
Title
Venoarterial Extracorporeal Membrane Oxygenation With Concomitant Impella
Versus Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic
Shock.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992).
(no pagination), 2019. Date of Publication: 17 Jul 2019.
Author
O'Horo J.C.; Antharam P.; Ananthaneni S.; Vallabhajosyula S.; Stulak J.M.;
Dunlay S.M.; Holmes D.R.; Barsness G.W.
Institution
(Vallabhajosyula, Ananthaneni, Vallabhajosyula, Dunlay, Holmes, Barsness)
From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Vallabhajosyula, O'Horo, Antharam) Division of Pulmonary and Critical
Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United
States
(O'Horo) Division of Infectious Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN, United States
(Stulak) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Dunlay) Department of Health Science Research, Robert D. and Patricia E.
Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
Publisher
NLM (Medline)
Abstract
There are contrasting data on concomitant Impella device in cardiogenic
shock patients treated with venoarterial extracorporeal membrane
oxygenation (VA ECMO) (ECPELLA). This study sought to compare early
mortality in patients with cardiogenic shock treated with ECPELLA in
comparison to VA ECMO alone. We reviewed the published literature from
2000 to 2018 for randomized, cohort, case-control, and case series studies
evaluating adult patients requiring VA ECMO for cardiogenic shock. Five
retrospective observational studies, representing 425 patients, were
included. Venoarterial extracorporeal membrane oxygenation with
concomitant Impella strategy was used in 27% of the patients. Median age
across studies varied between 51 and 63 years with 59-88% patients being
male. Use of ECPELLA was associated with higher weaning from VA ECMO and
bridging to permanent ventricular assist device or cardiac transplant in
three and four studies, respectively. The studies showed moderate
heterogeneity with possible publication bias. The two studies that
accounted for differences in baseline characteristics between treatment
groups reported lower 30 day mortality with ECPELLA versus VA ECMO. The
remaining three studies did not adjust for potential confounding and were
at high risk for selection bias. In conclusion, ECPELLA is being
increasingly used as a strategy in patients with cardiogenic shock.
Additional large, high-quality studies are needed to evaluate clinical
outcomes with ECPELLA.